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Biomedical subjects

A Wade

Publications and source records attributed to A Wade.

At least 55 records · Page 3Linked to original sources
PubMed2000

A model for predicting life expectancy of children with cystic fibrosis.

In this study the authors aimed to produce a model for predicting the life expectancy of children with severe cystic fibrosis (CF) lung disease. The survival of 181 children with severe CF lung disease referred for transplantation assessment 1988-1998 (mean age 11.5 yrs, median survival without transplant 1.9 yrs from date of assessment) were studied. Proportional hazards modelling was used to identify assessment measurements that are of value in predicting longevity. The resultant model included low height predicted forced expiratory volume in one second (FEV1), low minimum oxygen saturation (Sa,O2min) during a 12-min walk, high age adjusted resting heart rate, young age, female sex, low plasma albumin, and low blood haemoglobin as predictors for poor prognosis. Extrapolation from the model suggests that a 12-yr old male child with an FEV1 of 30% pred and a Sa,O2min of 85% has a 44% risk of death within 2 yrs (95% confidence interval (CI) 35-54%), whilst a female child with the same measurements has a 63% risk of death (95% CI 52-73%) within the same period. The model produced may be of value in predicting the life expectancy of children with severe cystic fibrosis lung disease and in optimizing the timing of lung transplantation.

Cause of Death↗
PubMed2000

Platelet and leucocyte activation in childhood sickle cell disease: association with nocturnal hypoxaemia.

We hypothesized that vaso-occlusive events in childhood sickle cell disease (SCD) may relate to inflammatory cell activation as well as interactions between sickle erythrocytes and vascular endothelium. Peripheral blood was examined from 24 children with SCD, of whom 12 had neurological sequelae and seven had frequent painful crises, and 10 control subjects. Platelet (CD62P and CD40L expression) and granulocyte (CD11b expression) activation and levels of platelet-erythrocyte and platelet-granulocyte complexes were determined by flow cytometry. Platelets (P = 0.019), neutrophils (P = 0.02) and monocytes (P = 0.001) were more activated and there were increased platelet-erythrocyte complexes (P = 0.026) in SCD patients compared with controls. Platelet-granulocyte complexes were not raised. There were no differences between the different groups of SCD. As hypoxia activates monocytes, platelets and endothelial cells and causes sickling of SCD erythrocytes, we also investigated 20 SCD patients with overnight pulse oximetry. Minimum overnight saturation correlated with the level of platelet-erythrocyte complexes (Spearman's rho -0.668, P < 0.02), neutrophil CD11b (Spearman's rho -0.466, P = 0.038) and monocyte CD11b (Spearman's rho -0.652, P = 0. 002). These findings provide important clues about the mechanism by which SCD patients may become predisposed to vaso-occlusive events.

Adolescent↗
PubMed2000

Urban residential fire and flame injuries: a population based study.

BACKGROUND: Fires are a leading cause of death, but non-fatal injuries from residential fires have not been well characterised. METHODS: To identify residential fire injuries that resulted in an emergency department visit, hospitalisation, or death, computerised databases from emergency departments, hospitals, ambulance and helicopter services, the fire department, and the health department, and paper records from the local coroner and fire stations were screened in a deprived urban area between June 1996 and May 1997. RESULT: There were 131 fire related injuries, primarily smoke inhalation (76%), an incidence of 36 (95% confidence interval (CI) 30 to 42)/100,000 person years. Forty one patients (32%) were hospitalised (11 (95% CI 8 to 15)/100,000 person years) and three people (2%) died (0.8 (95% CI 0.2 to 2.4)/100,000 person years). Injury rates were highest in those 0-4 (68 (95% CI 39 to 112)/100,000 person years) and > or = 85 years (90 (95% CI 29 to 213)/100,000 person years). Rates did not vary by sex. Leading causes of injury were unintentional house fires (63%), assault (8%), clothing and nightwear ignition (6%), and controlled fires (for example, gas burners) (4%). Cooking (31%) and smoker's materials (18%) were leading fire sources. CONCLUSIONS: Because of the varied causes of fire and flame injuries, it is likely that diverse interventions, targeted to those at highest risk, that is, the elderly, young children, and the poor, may be required to address this important public health problem.

Accidents, Home↗
PubMed2000

Citalopram controls phobic symptoms in patients with panic disorder: randomized controlled trial.

OBJECTIVE: To examine the effects of long-term treatment with citalopram or clomipramine on subjective phobic symptoms in patients with panic disorder. DESIGN: Double-blind, parallel-group, five-arm study. PATIENTS: Patients aged 18 to 65 years with panic disorder (DMS-III-R diagnosis) and with no major depressive symptoms. INTERVENTIONS: Four hundred and seventy-five patients were randomized to 8 weeks of treatment with either citalopram (10 to 15 mg per day; 20 to 30 mg per day; or 40 to 60 mg per day), clomipramine (60 to 90 mg per day) or placebo. Two hundred and seventy-nine patients continued treatment after the 8-week acute phase. OUTCOME MEASURES: Phobic symptoms were assessed using the Phobia Scale and the Symptom Checklist's (SCL-90) phobia-related factors. RESULTS: At all dosages, citalopram was more efficacious than placebo, with 20 to 30 mg generally being the most effective dosage. Citalopram (20 to 30 mg) generally decreased phobic symptoms significantly more than placebo after Month 3. Interpersonal sensitivity decreased when measured on the respective SCL-90 sub-scale. Alleviation of phobic symptoms generally continued to increase towards the end of the treatment. The effect of clomipramine was not as consistent. CONCLUSIONS: All active treatment groups, especially the group receiving 20 to 30 mg per day of citalopram, effectively controlled phobic symptoms in patients with panic disorder. Long-term treatment with citalopram further decreased phobic symptoms.

Adolescent↗
PubMed2000

[Contribution of the Kansas technique for reducing complications of mature cataract surgery].

PURPOSE: We report our experience with the Kansas technique of phakosection which eliminates or limits most complications of classic manual extracapsular extraction. PATIENTS AND METHODS: This retrospective study included our first 80 patients undergoing surgery for mature cataract between May 1996 and May 1998 where we used the Kansas technique. We compared outcome with a group of 30 patients who underwent classic manual extracapsular extraction in a study performed in 1995 by the same surgeon in the same hospital. RESULTS: Per- and post-operative complications were significantly lower with phakosection. Functional rehabilitation was quicker, better and provided better patient comfort. DISCUSSION: Despite some difficulties encountered in a public hospital (viscoelastic excessively fluid and in small quantity, lack of suitable knives or reuse of sterilized disposable knives), we found that the Kansas technique is very well adapted to mature cataracts and our working conditions. CONCLUSION: Phakosection allowed us to give our patients with mature or very mature cataracts the benefit of small incisions. With a moderate increase in cost, this technique significantly reduced our per- and post-operative complication rates and gave quicker and better visual recovery. In our countries, this technique provides better care than phakoemulsification.

Adult↗
PubMed1999

Lung transplantation and life extension in children with cystic fibrosis.

BACKGROUND: Lung transplantation has been available as therapy for end-stage lung disease since the early 1980s, but survival after transplantation remains poor, with continued controversy as to the survival benefit from the procedure. We examined the effect of lung or heart-lung transplantation on the survival of a cohort of children with cystic fibrosis and severe lung disease. METHODS: Between May, 1988, and May, 1998, 124 children with cystic fibrosis were accepted for lung transplantation. 47 received transplants, 68 died while they awaited organs, and nine remained on the active waiting list. We constructed a proportional-hazards model that used variables of prognostic significance in this population. By including transplant status as a time-dependent covariate, we were able to calculate a hazard ratio for transplantation. Date of entry into the study was the date when children were added to the list for transplantation, and measurements were taken at this time. Children were accepted for transplantation if they had a life expectancy of 2 years or less, a poor quality of life, and no contraindications to transplantation. FINDINGS: After 1 year, 35 (74%) children were still alive; after 5 years 12 (33%) children were alive. The univariate hazard ratio for transplantation was 0.41 (95% CI 0.23-0.74; p=0.003). Transplantation remained significantly associated with survival after correction for differences in age, sex, height-corrected forced expiratory volume in 1 s, minimum oxygen saturation during a 12 min walk, haemoglobin concentration, albumin concentration, and age-corrected resting heart rate (hazard ratio 0.31 [0.13-0.72]; p=0.007). INTERPRETATION: If centres follow our criteria for accepting patients for transplantation, and achieve similar survival after transplantation, they could expect a survival benefit for their patients in line with our results.

Adolescent↗
PubMed1999

Low and stable HIV infection rates in Senegal: natural course of the epidemic or evidence for success of prevention?

OBJECTIVES: To document the level of HIV infection in Senegal and also to review evidence of the impact of efforts in prevention, developed by the National AIDS Control Programme and the Civil Society, on the level of the HIV epidemic. METHODS: Research, compilation and critical review of all relevant data on HIV and sexually transmission diseases (STDs) epidemiology, sexual behaviour, and the efforts in prevention developed in Senegal. RESULTS: From 1989 to 1996, the levels of HIV infection estimated in four sentinel urban regions remained stable at around 1.2% in the population of pregnant women, and at 3% in male STD patients. It had increased to 19% in female sex workers. A strong political and community commitment led to an early response to the HIV/AIDS epidemic that has been extended since 1986. Blood transfusion safety was established at the start of the HIV epidemic. The level of knowledge of preventive practices relating to HIV/AIDS among the general population exceeded 90% in the early 1990s. From 1991 to 1996, a 30% to 66% decrease of the STD prevalence rates was observed in pregnant women and sex workers in Dakar. In 1997, 33% of men aged 15-49 years in Dakar reported having had sex with non-regular partners. Among them 67% reported condom use. CONCLUSIONS: It is not possible to know what the course of the HIV epidemic in Senegal would have taken in the absence of efforts at prevention. Certainly, several factors that pre-dated the occurrence of AIDS in Senegal laid the groundwork for a positive response. However, data from a number of sources do reveal the successfulness of efforts in prevention. From available data, Senegal can rightfully claim to have contained the spread of HIV by intervening early and comprehensively to increase knowledge and awareness of HIV/AIDS and to promote safe sexual behaviour.

Condoms↗
PubMed1999

The effects of inflammation and inflammatory mediators on nociceptive behaviour induced by ATP analogues in the rat.

1. We have studied the behavioural effects of intraplantar injections of adenosine 5'-triphosphate (ATP) and related compounds in freely moving rats and investigated whether these nociceptive effects are augmented in the presence of inflammatory mediators. 2. We find that in normal animals ATP and analogues produce dose-dependent nocifensive behaviour (seen as bursts of elevation of the treated hindpaw), and localized thermal hyperalgesia. The rank order of potency was: alpha,beta-methyleneadenosine 5'-triphosphate (alpha,beta-methylene ATP) > 2-methylthioadenosine triphosphate (2-methylthio ATP) > ATP. After neonatal treatment with capsaicin, to destroy small calibre primary sensory neurones, nocifensive behaviour was largely absent. 3. The effects of ATP analogues were assessed in three models of peripheral sensitization: 2 h after dilute intraplantar carrageenan (0.25% w v(-1)); 24 h after irradiation of the hindpaw with ultraviolet (U.V.) B; immediately following prostaglandin E2 (PGE2) treatment. In all models the effect of alpha,beta-methylene ATP was greatly augmented. After carrageenan, significant hindpaw-lifting behaviour activity was induced by injection of only 0.05 nmol of alpha,beta-methylene ATP, some 100 times less than necessary in normal skin. 4. Our data suggest that it is much more likely that endogenous levels of ATP will reach levels capable of exciting nociceptors in inflamed versus normal skin. Our data also suggest the involvement of P2X3 receptor subunits in ATP-induced nociception.

Adenosine Triphosphate↗
PubMed1999

The "Let's Get Alarmed!" initiative: a smoke alarm giveaway programme.

OBJECTIVES: To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households. SETTING: The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership. The target population included low income and rental households and households with elderly persons or young children. METHODS: Forty wards, averaging 4000 households each, were randomised to intervention or control status. Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods. Recipients provided data on household age distribution and housing tenure. Programme costs were documented from a societal perspective. Data are being collected on smoke alarm ownership and function, and on fires and related injuries and their costs. RESULTS: Community and paid workers distributed 20,050 smoke alarms, potentially sufficient to increase smoke alarm ownership by 50% in intervention wards. Compared with the total study population, recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older. Total programme costs were 145,087 Pounds. CONCLUSIONS: It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated, multicultural, materially deprived community. The programme's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries, and its cost effectiveness, are being evaluated as a randomized controlled trial.

Adolescent↗
PubMed1999

[Scleral mini-incision without ultrasound in the treatment of congenital cataract].

PURPOSE: Congenital cataract surgery can be performed by pars plana or limbal incision. We report our experience with scleral incision without ultrasounds in congenital cataract surgery. MATERIAL AND METHODS: Fifteen children with congenital cataract underwent surgery of both eyes (30 eyes). The zonular ciliaris and the lens anlage were normal in all cases. All procedures were performed by the same surgeon. A 3.2 mm scleral tunnel incision was made 2 mm from the limbus. Large capsulorhexis or capsulopuncture were performed after injection of a viscoelastic substance in the anterior chamber. After hydrodissection, the nucleus and cortex were aspirated. The wound was closed by apposition suture. RESULTS: The mean age was 70.13 months (range 5 months to 130 months). Mean induced astimatism calculated with the Cravy method was 0.70 dipoters. A posterior capsular tear was observed in 1 case. CONCLUSION: Small scleral incision without ultrasounds has advantages. No expensive instruments are required and astimatism is not induced. The anterior chamber lies deep during the operation, protecting the endothelial cells and facilitating aspiration. Postoperative inflammation is minimal. The small scleral incision technique is useful in selected cases of congenital cataract.

Age Distribution↗
PubMed1999

[Analysis of implant position after envelope technique in "white" cataract surgery].

Capsulopunture in cataract surgery doesn't allow insertion of intraocular lens in the capsular bag. Envelope technique is a easy way for this insertion. The goal of our study was to analyse the position of the intraocular lens in the capsular bag, after performing envelope technique in eyes suffering from "white" cataract. We realised on 25 eyes with "white" cataract, envelope technique. GALAND method (one superior linear capsulotomy) was realised in 15 cases and double linear capsulotomy (superior and inferior), was realised in 10 cases. The mean age of our patients was 55 years with two extremes (17 and 70 years). The mean visual acuity was 14/20. After verification, in 91.636% eyes, intraocular lenses were in the capsular bag. In 2 cases, we found a decentration. Envelope technique can lessen risks of capsular zip. It protects endothelium cells and is helpful for the insertion of the intraocular lens in the capsular bag. Envelope technique is well adapted to the surgery of "White" Cataract.

Adolescent↗
PubMed1999

[Ocular burns at the ophthalmologic clinic of the Central University Hospital of Le Dantec apropos of 28 patients].

Chemical and thermal ocular burns are emergencies in ophthalmology because of the blindness sequels they occur. All patients were included in a prospective study form during 18 months. 28 patients were admitted for ocular burns, representing an incidence of 5.21%. 13 of them had occupational ocular burns, 11 homely ocular burns and 4 public way injuries. 18 had chemical burns and 10 thermal burns, with a total of 44 eyes. The clinical observations was dominated by conjunctival lesions: 90.9%, corneal lesions: 79.5%, and plapebral lesions: 43.2%. 11 of them who had chemical burns, the ocular irrigation was made immediately after the accident, and all of them had antibiotic and cicatrizing treatment. The seriousness of ocular burns, the youngness of patients must instigate the authorities to improve the working conditions in the factories, and a better information in manipulation of dangerous chemical product.

Accidents↗
PubMed1999

[Prevalence of diabetic retinopathy at the Dakar University Hospital Center].

The aim of the study is to appreciate the prevalence of diabetic retinopathy among senegalese patients in analyzing age of diagnosis, duration of diabetes, plasma glucose and type of retinopathy. 129 diabetics followed and treated in the diabetic center of internal medicine clinic (Dakar University) were examined by 90 degrees Volk's lens. A determination of plasma c peptide and glucose concentration were performed. 55 (mean age 224. +/- 0.9 years) were insulino-dependent and 74 (mean age of 54.7 +/- 11.4 years) non insulinodependent. On average the duration of diabetes was 5.4 years +/- 5.4 for the former and 6.07 +/- 5.7 for the latter with respectively glucose plasma average 2.60 g/l +/- 0.7 and 1.7 g/l +/- 0.83. Retinopathy was found in 29 patients. So total prevalence was 22.48%, shared in 29.7% for non insulino-dependant and 12.7% for insulino-dependent. In 7 cases the retinopathy was proliferative and non proliferative in 22 cases essentially among non insulino-dependant diabetics. The diabetic retinopathy is one of handicaping complications of diabetics. Its prevalence is strongly linked to the duration of diabetes, glycaemic control and to other risk factors (genetics, glycosylated hemoglobin and high blood pressure).

Adult↗