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Hamill R.J.,Baylor College of Medicine | Sobel J.D.,Wayne State University | El-Sadr W.,Harlem Hospital Medical Center | Johnson P.C.,University of Houston | And 3 more authors.
Clinical Infectious Diseases | Year: 2010

Background. It is generally acknowledged that amphotericin B is the most effective treatment for cryptococcal meningitis. However, administration of this drug is accompanied by substantial adverse effects. This double-blind study, performed before the routine availability of highly active antiretroviral therapy, was designed to compare the efficacy and safety of liposomal amphotericin B to conventional amphotericin deoxycholate in patients with acquired immunodeficiency syndrome (AIDS) and acute cryptococcal meningitis. Methods. Patients were randomized (ratio, 1:1:1) from multiple sites in the United States and Canada to receive either amphotericin B at 0.7 mg/kg/day (np87), liposomal amphotericin B at 3 mg/kg/day (np86), or liposomal amphotericin B at 6 mg/kg/day (np94). Results. Efficacy was similar among all 3 treatment groups. The overall incidence of infusion-related reactions was significantly lower for both the 3 mg/kg/day and 6 mg/kg/day dosages of liposomal amphotericin B, compared with conventional amphotericin B (P!.001). Significantly fewer patients who received the 3 mg/kg/day dosage of liposomal amphotericin B developed nephrotoxicity, indicated by a doubling of the serum creatinine value, compared with recipients of conventional amphotericin B (Pp.004). Overall mortality at 10 weeks was 11.6%, with no significant differences among the treatment groups. Conclusions. Liposomal amphotericin B provides an equally efficacious alternative to conventional amphotericin B deoxycholate in patients with AIDS and acute cryptococcal meningitis. Liposomal amphotericin B at a dosage of 3 mg/kg/day is accompanied by significantly fewer adverse effects. © 2010 by the Infectious Diseases Society of America. All rights reserved.

Toto R.D.,University of Texas Southwestern Medical Center | Greene T.,University of Utah | Hebert L.A.,Ohio State University | Hiremath L.,Ohio State University | And 5 more authors.
American Journal of Kidney Diseases | Year: 2010

Background: Few studies have examined the association between obesity and markers of kidney injury in a chronic kidney disease population. We hypothesized that obesity is independently associated with proteinuria, a marker of chronic kidney disease progression. Study Design: Observational cross-sectional analysis. Setting & Participants: Post hoc analysis of baseline data for 652 participants in the African American Study of Kidney Disease (AASK). Predictors: Obesity, determined using body mass index (BMI). Measurements & Outcomes: Urine total proteincreatinine ratio and albumin-creatinine ratio measured in 24-hour urine collections. Results: AASK participants had a mean age of 60.2 ± 10.2 years and serum creatinine level of 2.3 ± 1.5 mg/dL; 61.3% were men. Mean BMI was 31.4 ± 7.0 kg/m2. Approximately 70% of participants had a daily urine total protein excretion rate <300 mg/d. In linear regression analyses adjusted for sex, each 2-kg/m 2 increase in BMI was associated with a 6.7% (95% CI, 3.2-10.4) and 9.4% (95% CI, 4.9-14.1) increase in urine total proteincreatinine and urine albumin-creatinine ratios, respectively. In multivariable models adjusting for age, sex, systolic blood pressure, serum glucose level, uric acid level, and creatinine level, each 2-kg/m2 increase in BMI was associated with a 3.5% (95% CI, 0.4-6.7) and 5.6% (95% CI, 1.5-9.9) increase in proteinuria and albuminuria, respectively. The interaction between older age and BMI was statistically significant, indicating that this relationship was driven by younger AASK participants. Limitations: May not generalize to other populations; cross-sectional analysis precludes statements regarding causality. Conclusions: BMI is associated independently with urine total protein and albumin excretion in African Americans with hypertensive nephrosclerosis, particularly in younger patients. © 2010 National Kidney Foundation, Inc.

PubMed | Harlem Hospital Medical Center
Type: Journal Article | Journal: Wounds : a compendium of clinical research and practice | Year: 2015

Lower extremity ulcers affect 8%-10% of individuals with sickle cell disease. The pathogenesis of this condition is poorly understood, and a good option for the long-term management of these lesions does not exist. Skin grafting and local wound care remain the mainstay of treatment; however, even short-term success often leads to long-term failure, as the wound might once again breakdown. The authors postulated that successful long-term healing of a chronic sickle cell leg ulcer would require a permanent alteration of the wound bed with recruitment of a new cell population. To this end, a skin graft, in conjunction with fat grafting, was performed for the treatment of a chronic sickle cell ulcer that had previously failed under local wound care and skin grafting treatments. .

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