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Biomedical subjects

A D Woolf

Publications and source records attributed to A D Woolf.

At least 73 records · Page 4Linked to original sources
PubMed1997

Smoking and nicotine addiction: a pediatric epidemic with sequelae in adulthood.

Pediatric addiction to nicotine from cigarette smoking is a major public health problem, extracting a tremendous societal toll in terms of human suffering, a loss of future productivity, and the consumption of scarce health care resources. Teenagers smoke 1.1 billion packs of cigarettes yearly and will account for more than $200 billion in future health care costs. Recent behavioral studies confirm nicotine's ability to induce in adolescents both the tolerance and abstinence phenomena typical of other addicting substances. A range of adverse health effects, first detectable in adolescent cigarette smokers, extend into adulthood. Through the effects of environmental smoke or smoking during pregnancy, adolescent smokers affect not only their own health, but that of friends, family members, and even their own fetuses and children. Additional research into effective prevention and smoking cessation programs is urgently needed to forestall the ravaging of yet another generation by this preventable and deadly habit.

Adolescent↗
PubMed1996

N-acetylcysteine reduces methemoglobin in vitro.

STUDY OBJECTIVE: To determine whether N-acetylcysteine (NAC reduces methemoglobin. METHODS: We carried out an in vitro laboratory experiment in which five healthy adult volunteers donated blood. Each sample was divided equally among three test tubes. Tube 1 served as a negative control. Sodium nitrite .18 mol/L with dextrose .23 mol/L was added to tube 2 and to tube 3. Next, phosphate-buffered saline solution (PBS) was added to tube 2 and NAC (200 mg/mL) to tube 3. Serial methemoglobin levels were measured over 5.5 hours. RESULTS: Maximum methemoglobin levels were observed at 1.5 hours for both the NAC-nitrite and the PBS-nitrite sample (62.7% +/- 8.1% and 65.1% +/- 7.0%, respectively; data expressed as mean +/- SD). The mean difference in methemoglobin between NAC-nitrite and PBS-nitrite was significant at 4.5 hours (29.3% +/- 23.0%, P = .046). The mean rate of methemoglobin decline in NAC-nitrite samples was also different from that of PBS-nitrite samples (10.7% +/- 1.0% versus 2.9% +/- 2.3%, P = .002). The rate of decline was linea (zero order) in the NAC nitrite samples and represented by the equation: % change methemoglobin = .18 x time in minutes. Area under the concentration-time curve was also different among groups (P < .05). CONCLUSION: In this in vitro model, NAC reduced chemically induced methemoglobin.

Acetylcysteine↗
PubMed1996

Bone mass measurement and bone metabolism in rheumatoid arthritis: a review.

The involvement of bone in rheumatoid arthritis (RA) is well recognized, and hand bone densitometry appears to be a promising new technique to monitor disease progression by assessing serial changes in hand bone mass in patients with RA. New biochemical markers of bone formation (i.e. osteocalcin) show contradictory results in different studies, although markers of bone resorption (i.e. urinary collagen cross-links) have shown significant increase in patients with RA. Bone histomorphometric studies suggest that the periarticular osteopenia in RA could be related to increased bone turnover locally, whereas generalized osteoporosis could be due to a global negative remodelling balance. The important factors implicated in the pathogenesis of the bone loss are circulating cytokines [e.g. tumour necrosis factor alpha (TNF alpha), interleukin (IL) 1 and IL6] produced by the inflammatory process, use of oral corticosteroids (in the dose of > or = 5 mg) and reduced mobility due to functional impairment. Apart from this underlying osteoporosis, patients with RA have an increased risk of falls secondary to functional impairment and there is an increased risk of fractures in patients with RA. Very few studies are presently available looking at the therapeutic measures to prevent osteoporosis in RA. Future drug trials on the treatment of RA should include bone mass measurement, especially of the hand, as one of the outcome measures.

Arthritis, Rheumatoid↗
PubMed1996

Hemolysis after acetaminophen overdose in a patient with glucose-6-phosphate dehydrogenase deficiency.

CASE REPORT: A sixteen year-old-male with a history of glucose-6-phosphate dehydrogenase deficiency ingested an unknown amount of acetaminophen and presented to an emergency department 7.5 h later. He was afebrile. His serum acetaminophen level was 184 micrograms/mL, and his urine toxicologic screen was otherwise negative. Vomiting led to enrollment in a experimental protocol of intravenous N-acetylcysteine. He developed no evidence of subsequent chemical hepatitis but did develop a significant Coomb's negative hemolytic anemia. Hemoglobin on presentation was 14 g/dL and reached a nadir of 9.4 g/dL on admission day 4. CONCLUSION: Patients with glucose-6-phosphate dehydrogenase deficiency who overdose with acetaminophen should be monitored for the possible development of subsequent drug-induced hemolysis.

Acetaminophen↗
PubMed1996

Role of antimalarials in rheumatoid arthritis--the British experience.

Antimalarials have been used to treat rheumatoid arthritis (RA) for over 40 years, the first report of suggestive efficacy being published in 1951. Over the years they have become part of the established treatment of RA being one of a category of drugs referred to as disease modifying anti-rheumatic drugs (DMARDs). The onset of action with antimalarials is slow. Most patients use these drugs in combination with non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. This article reviews the evidence for the efficacy of antimalarials, their place in comparison to other DMARDs and comments on the current use in RA as perceived in British rheumatology.

Antimalarials↗
PubMed1995

Longitudinal study of hand bone densitometry in rheumatoid arthritis.

OBJECTIVE: To measure hand bone mineral content (BMC) by dual x-ray absorptiometry and to seek clinical correlates in patients with rheumatoid arthritis (RA), in a prospective, longitudinal study. METHODS: Eighty-one patients with non-steroid-treated RA were assessed at baseline and at month 12, for hand BMC and for disease activity and severity. Hand BMC in patients was compared with that in a control group of 95 normal volunteers, and rate of loss was compared with that in 37 controls. RESULTS: At the initial assessment, male and female patients with RA had lower hand BMC than controls, after correction for age, height, and weight (mean reduction 7.5% in men [P = 0.003] and 7.8% in women [P = 0.01]). After 1 year, there was a further loss of hand BMC in patients (median loss 3.25% in men [P = 0.001] and 1.46% in women [P = 0.05]), but normal controls did not have significant changes in their hand BMC. In patients with disease duration of < 2 years at study entry, the parameters of disease activity improved over 1 year, but they lost significant amounts of hand BMC. Hand BMC loss correlated with baseline C-reactive protein levels. In those with RA of > 2 years duration at entry, the Health Assessment Questionnaire scores and Larsen scores had worsened after 1 year, but there was no significant loss of hand BMC. CONCLUSION: Patients with RA had low hand BMC compared with normal controls, even within 2 years of disease onset. The rate of loss was highest in patients with early disease and correlated with measures of initial disease activity. This loss continued despite clinical improvement.

Absorptiometry, Photon↗
PubMed1995

Clinical toxicology for the pediatrician.

The pediatrician has at his or her disposal a highly accurate and reliable system of drug testing to provide additional information relevant to substance abuse in children and adolescents. As always, the judgments engendered in questions such as when it is ethical to order such tests, the confidentiality of the results, and how to integrate such findings into the overall management of the patient and his or her family are much more important and problematic than the technical aspects of testing. In selected clinical situations, however, drug testing can provide reliable and useful information and is indicated in the diagnosis and management of substance abuse in adolescents.

Adolescent↗
PubMed1995

ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity.

STUDY OBJECTIVE: To compare the value of ECG measurements from lead aVR with the QRS-interval duration in predicting seizures and ventricular arrhythmias due to acute tricyclic antidepressant (TCA) toxicity. DESIGN: Prospective cohort series of referral cells from hospitals to a regional poison control center. PARTICIPANTS: Seventy-nine patients (mean age, 30 +/- 15 years) who presented within 24 hours of ingestion. Seizures occurred in 16 patients (20%) and ventricular arrhythmias in 5 (6%). INTERVENTIONS: The amplitude of the terminal R wave in lead aVR (RaVR), the R-wave/S-wave ratio in lead aVR (R/SaVR), and the maximal limb-lead QRS interval were measured on the initial ECG. RESULTS: RaVR was greater in those patients who had seizures or arrhythmias than in those who did not (4.4 versus 1.8 mm, P < .001), as was R/SaVR (1.4 versus .5, P < .001). The sensitivity of an RaVR of 3 mm or more was 81% and that of an R/SaVR of .7 or more was 75%, compared with 82% for QRS intervals greater than 100 milliseconds. The positive predictive value (PPV) of an RaVR of 3 mm or more was 43% and that of the R/SaVR of .7 or more 46%, compared with a PPV for QRS interval of 100 milliseconds or more of 35%. Multiple logistic-regression analysis demonstrated that an RaVR of 3 mm or more was the only ECG variable that significantly predicted seizures and arrhythmias (OR, 6.9 [95% CI, 1.2 to 40], P = .03). CONCLUSION: RaVR and R/SaVR were greater in patients in whom seizures or arrhythmias developed after an acute TCA overdose. RaVR of 3 mm or more was the only ECG variable that significantly predicted these adverse outcomes.

Adolescent↗
PubMed1995

Ethanol-related visits by adolescents to a pediatric emergency department.

The objectives of this study were to determine if the presence of ethanol (ETOH) in patients 10 to 20 years of age is associated with injury and if the patient's mental status reliably predicts their blood ethanol concentration. The study was designed as a retrospective, case-controlled report from a children's hospital emergency department. The data are from 45 patients 10 to 20 years old in whom ETOH was detected on toxic screen and 37 patients (N-ETOH) 10 to 20 years old in whom a toxic screen did not reveal ETOH. Injury occurred in 51% of the ETOH group and 8% (P = 0.0001) of the N-ETOH group. A correlation between blood ETOH level and mental status was found only at the extremes of blood ETOH levels. We conclude that the presence of ETOH may predispose adolescents to injury, requiring treatment in an emergency department. Except at the extremes of ETOH levels, mental status does not predict blood levels. A prospective assessment of mental status and blood ETOH levels in adolescents is needed before mental status assessment can replace the determination of blood ETOH concentrations.

Adolescent↗
PubMed1995

Fall frequency and incidence of distal forearm fracture in the UK.

STUDY OBJECTIVE: This analysis aimed to determine the frequency of falls in men and women aged 50 years and over and to explore whether age variation in fall frequency may explain variation in the incidence of distal forearm fracture in women. DESIGN: This was a cross sectional survey. SETTING: Primary care based registers in four UK areas. PARTICIPANTS: Altogether 501 men and 702 women age 50-79 years participated. MAIN RESULTS: A total of 131 (26.1%) men and 181 (25.8%) women reported falling in the previous year. In women, the frequency of falls rose with age (chi 2 test for trend 4.33; p = 0.04), with no obvious early post-menopausal peak or subsequent decline. Men aged 50-54 years had a significantly increased risk of falls compared with women of this same age group, (odds ratio (OR) = 2.4; 95% confidence interval (CI) 1.3, 4.6), though above this age, the risk of falling was greater in women (OR = 1.2; 95% CI 0.9, 1.5). CONCLUSION: There are important differences in the frequency of falls in relation to age and sex. The data suggest that variation in fall frequency per se does not explain age variation in the incidence of distal forearm fracture in women.

Accidental Falls↗
PubMed1995

Ginger Jake and the blues: a tragic song of poisoning.

Prohibition, "The Noble Experiment", ushered in speakeasys, gangsters and bathtub gin in the 1920s. For many Americans, however, it led to a period of joblessness, hard times, and austerity. The story of Jamaican Ginger ("Jake") poisoning, in which batches of a cheap, alcoholic tonic were laced with tri-ortho cresyl phosphate (TOCP) is one of cynical despicable behavior on the part of those responsible and a tragic enduring legacy for the invisible group of Americans who were victimized. TOCP, a potent organophosphate, caused an axonal dying-back neuropathy affecting mainly large muscle groups. Jake poisoning struck about 50,000 adults, mostly poor middle-aged vagrants with little medical care or social standing. Their symptoms and stories were told not only in medical journals but also in song. Hillbilly jazzmen sang of the "Jake Leg Blues" with a resignation to the fate of their own undoing, brought on by the intemperance of a wasted life. The postscript is grim--those responsible received little punishment; many who drank "Jake" were left both uncompensated and crippled by irreversible paralysis.

Alcoholic Beverages↗
PubMed1995

Pediatric compliance and the roles of distinct treatment characteristics, treatment attitudes, and family stress: a preliminary report.

Much research and clinical practice derives from the assumption that there is a set of psychological-social variables that commonly influence medical (non)compliance. This assumption may lead to overly general strategies for managing specific illnesses in children with chronic illness. With this concern in mind, a study was made of health provider ratings of compliance, treatment attitudes, and illness-related family stress for three pediatric cohorts (N = 75, ages 8 to 20 years): boys with hemophilia (n = 31), sickle cell disease (n = 22), or asthma (n = 22). Between-group differences were found on compliance and treatment attitudes (p < .05), with patients with sickle cell demonstrating greater treatment cooperation than their counterparts and boys with hemophilia expressing more positive outlooks on medical advice and about health outcomes (Newman-Keuls test, p < .05). Positive treatment attitudes were associated with specific compliance behaviors for boys with hemophilia (p < .045) but not for other groups.

Adaptation, Psychological↗
PubMed1994

Fluid retention syndrome and fibromyalgia.

Fluid retention syndrome (FRS) or idiopathic oedema is an unusual clinical entity almost exclusively seen in women, which remains under-diagnosed and poorly understood. It can produce a variety of symptoms ranging from headaches and blurring of vision to abdominal pains and diarrhoea [1]. More commonly it presents with symptoms of bloating, fatigue and generalized weakness. We describe four cases of FRS who presented to the rheumatology clinic with signs and symptoms of fibromyalgia. We also discuss the common features of these two conditions and argue that rheumatologists need to be aware of this condition.

Adult↗