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Biomedical subjects

A Green

Publications and source records attributed to A Green.

At least 397 records · Page 22Linked to original sources
PubMed1991

Prevalence of K329E mutation in medium-chain acyl-CoA dehydrogenase gene determined from Guthrie cards.

Medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is an autosomal recessive disorder that has been associated with sudden infant death syndrome and a condition resembling Reye's syndrome. The point mutation K329E is thought to be the commonest mutation causing MCAD deficiency in caucasian patients. The prevalence of this mutation was determined by use of dried blood spots on Guthrie cards obtained during neonatal screening programmes. 12 carriers were identified among 479 newborn babies in Britain, 5 among 353 in Australia, and 5 among 536 in North America but none among 500 in Japan. Since presymptomatic diagnosis and appropriate dietary management can prevent life-threatening episodes in MCAD deficiency, population-based DNA screening for this potentially fatal disorder might be justified in countries with a high frequency of this mutation.

Acyl-CoA Dehydrogenases↗
PubMed1991

[Influence of basic health service on mortality in the first 5 years of living in northeast Nigeria].

In the area of the Gongola State, North-East Nigeria, where the Danish Sudan Mission has offered health service since 1913, survival until the 5th birthday has been actuarially calculated based on interviews with pregnant mothers in four areas with different health service intensities: 1. health clinic with medical doctor plus referral hospital, 2. nurse- and midwife health clinic, 3. "medical aide" clinic, and 4. no organized health service. Survivals to 1st birthday were 96, 97, 95, and 87 percent, respectively and to 5th birthday 90, 86, 89, and 68 percent. Differences between the first three groups are small and insignificant, whereas the difference between the area without organized health service and the other areas is highly significant. It is concluded that cost/effectiveness of even the most scanty health service is very favourable, whereas the effect of further health service development is less easily demonstrated. Reservations must be taken because of the limited size of the material and the need for data concerning basic morbidity and mortality in the different areas.

Child, Preschool↗
PubMed1991

Indirect costs of teaching in Canadian hospitals.

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching.

Bed Occupancy↗
PubMed1991

Investigation of paediatric liver disease.

The investigation of children with liver disease falls into two categories: the investigation of the cholestatic baby and the investigation of the older child (over 2 years) with hepatomegaly. The approach to investigation is directed by the clinical features and employs many different investigational methods including biochemistry, haematology, radiology, electrophysiology and histology. As the clinical presentation of many diseases is similar, it is appropriate to perform a variety of first-line tests, proceeding to more complex investigations only as indicated.

Child↗
PubMed1991

Possible deleterious effect of L-carnitine supplementation in a patient with mild multiple acyl-CoA dehydrogenation deficiency (ethylmalonic-adipic aciduria).

A patient with riboflavin-responsive mild multiple acyl-CoA dehydrogenation deficiency of the ethylmalonic--adipic aciduria type experienced a recurrence of spontaneous hypoglycaemic episodes whilst being given supplementary L-carnitine. This phenomenon is explicable in terms of the known biochemical features of this condition and suggests caution in the carnitine supplementation of patients with defective oxidation of medium- or short-chain fatty acyl-CoA esters. This patient excreted excessive phenylpropionylglycine after an oral phenylpropionic acid load. Thus the phenylpropionic acid loading test is not completely specific for primary medium-chain acyl-CoA dehydrogenase deficiency as has been supposed.

Acyl-CoA Dehydrogenases↗
PubMed1991

Oral contraceptives and skin neoplasia.

A possible association between oral contraception and the development of cutaneous melanoma has been raised largely because of the hyperpigmentation of pregnancy and the effect pregnancy may have on the outcome of established disease. Present evidence suggests there is no causal link between oral contraceptive (OC) use and melanoma (or with benign melanocytic nevi), nor has a specific subgroup of women or subtype of melanoma been consistently implicated as being at increased risk of this disease due to use of OCs.

Age Factors↗
PubMed1991

Application of Jean Piaget's theory of human development for nursing children in an adult intensive therapy unit.

Piaget (1964) believed that interaction with the environment has a large part to play in human development. Matthew (1986) states that in an ideal world critically ill children should be cared for by staff trained in paediatrics, within designated paediatric intensive therapy units. Unfortunately, there are only 28 paediatric intensive therapy units in Great Britain (CMA Medical Data, 1987), consequently each year a third of children requiring intensive care are admitted to adult intensive therapy units (ITU). A knowledge and understanding of developmental psychology can therefore be beneficial to nurses in assessing which stage of development a child has reached, in order to plan the correct level of stimulation, and hence facilitate progress rather than regression in the accomplishment of developmental tasks. The psychological and social processes involved in Jean Piaget's (1896-1980) theory of human development are discussed with regard to nursing children requiring intubation and ventilation in an adult ITU.

Adolescent↗
PubMed1991

Expression of a fetal gamma delta T-cell receptor in adult mice triggers a non-MHC-linked form of selective depletion.

Day 14 fetal thymocytes and adult dendritic epidermal T cells (dEC) of all mouse strains express a characteristic non-polymorphic gamma delta T-cell receptor which is rarely found in the adult thymus or lymph nodes. We have made transgenic mice expressing this particular set of receptors on T cells in C3H and C57BL/6 mice. In adult mice of the latter strain, a dramatic depletion of transgene expressing T cells occurs and this effect is primarily mediated by thymic radiosensitive cells. The depletion is genetically dominant but not MHC-linked with major factor(s) mapping to chromosome 18. Taken together, our results show that strain-specific developmental changes in the thymic environment may play a role in shaping the gamma delta TCR repertoire.

Animals↗
PubMed1991

Early complications in the management of open femur fractures: a retrospective study.

Fifty patients with 53 open fractures of the femur were reviewed retrospectively. There were three subtrochanteric, 32 shaft, and 18 supraintercondylar fractures. Eleven were type I open fractures, 20 were type II open fractures, and 22 were type III open fractures. After initial debridement, 33 fractures had immediate internal fixation, nine had delayed internal fixation, one had external fixation, and 10 were treated with traction and cast bracing. Nine (16%) fractures, two type II and seven type III, developed deep infection. Five infections persisted at 6 months. Immediate internal fixation was followed by deep infection in one of 22 type I or II fractures and six of 11 type III fractures. There were five nonunions and seven delayed unions. Five of 44 uninfected and seven of 10 infected fractures had delayed union or nonunion. In this series, most patients with type III open femur fractures had severe associated multiple trauma. Immediate internal fixation was associated with greater local complications. We have concluded that immediate internal fixation of type III femoral fractures is only relatively indicated and must be applied with caution.

Adolescent↗
PubMed1991

An assessment of academic performance and personality.

This study examines whether personality profiles, using personality factors, or clusters of personality factors, are associated with academic success. One hundred and forty medical students of the University of Wales College of Medicine were invited to complete a personality questionnaire (Cattell 16 PF) as they sat their final examinations in June 1988. A total of 129 usable forms were obtained. The students were divided into four groups dependent on their academic performance, which had been monitored throughout the course. The majority (62%) had no academic problems, but 16 (12%) students had serious difficulties, which entailed delaying qualification by at least 6 months. There was no relationship between the scores obtained for the students' first attempt at A-level and their subsequent medical school academic performance. However, students who obtained a degree either before or during their medical course were significantly less likely to have academic problems. Academic success was not associated with any of Cattell's personality factors. This was true of previously reported groups of factors associated with the poor student performance, and regardless of first or second order factors. We conclude that this personality profile is unlikely to be helpful in selecting future intakes of medical students, although a prospective study would be required for a definite answer to this question.

Cattell Personality Factor Questionnaire↗