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Biomedical subjects

C A Graham

Publications and source records attributed to C A Graham.

At least 37 records · Page 2Linked to original sources
PubMed2002

Unintentional overdose of analgesia secondary to acute dental pain.

Three cases of unintentional overdose with simple analgesics are presented. Over a two month period, these patients presented to the accident and emergency (A&E) department with acute dental pain, outside normal working hours, having been unable to access emergency dental care. In one case the patient's reason for attendance was to obtain further supplies of analgesics. The patients required admission for assessment of the severity of the overdose in addition to advice about appropriate use of analgesics and advice on access to dental care. None of the patients required treatment for the overdose. These cases serve as a timely reminder of the importance of taking an accurate drug history in emergency situations. They also raise issues of patient education for self medication and access to emergency dental services outside normal working hours.

Acetaminophen↗
PubMed2002

Torsade de pointes.

A case is described of torsade de pointes in a 41 year old woman with pre-existing QTc prolongation, potentially exacerbated by treatment with sotalol. Previous cardiac investigations had been normal and after a second episode of ventricular fibrillation the patient was referred for electrophysiological studies. The authors review the physiology, causes, and treatment of QTc prolongation and torsade de pointes.

Adult↗
PubMed2001

A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation.

The purpose of the study was to explore predictors of discontinuation of oral contraceptives (OC) including pre-OC use characteristics and adverse physical, emotional, and sexual effects of OCs. Women aged 18+ years in committed, sexually active relationships were assessed before starting OC and reassessed at 3, 6, and 12 months or shortly after discontinuation. Assessment included pre-OC use attitudes and expectations about the pill; self-reported side effects and perimenstrual symptoms including premenstrual syndrome (PMS); physical and emotional well-being; and sexual interest, enjoyment, and frequency of sexual activity. Seventy-nine women completed the study, 38% continued OCs, 47% discontinued, and 14% switched to another OC. Emotional side effects, worsening of PMS, decreased frequency of sexual thoughts, and decreased psychosexual arousability correctly categorized 87% of cases by using logistic regression. Emotional and sexual side effects were the best predictors of discontinuation/switching, yet such OC effects have been largely ignored in the research literature.

Adult↗
PubMed2001

Race as a predictor of urinary incontinence and pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to assess the effect of race on the results of a standardized evaluation of urinary incontinence and prolapse in African Americans and Caucasians. STUDY DESIGN: This was an analysis of 183 African Americans and 132 Caucasians referred consecutively for symptoms associated with urinary incontinence, pelvic organ prolapse, or both. RESULTS: Genuine stress incontinence, detrusor instability, mixed incontinence, or other condition was diagnosed in 22%, 30%, 16%, and 32% of the African-American subjects, respectively, compared with 46%, 13%, 11%, and 31% of the Caucasian subjects (P =.001). There was no significant racial difference in the presence or severity of pelvic organ prolapse. With the use of stepwise logistic regression to compare risk factors for incontinence, Caucasian race was the most significant predictor of genuine stress incontinence (odds ratio 2.21; 95% confidence interval 1.31-3.73), and African-American race was the only significant predictor of detrusor instability (odds ratio 2.6; 95% confidence interval 1.45-4.80). CONCLUSION: Risk factors for and conditions of urinary incontinence differed significantly between African-American and Caucasian women in this population. Racial differences in risk factors and in prevalence of incontinence subtypes may have importance for the diagnosis and prevention of urinary incontinence.

Black People↗
PubMed2001

The electrocardiogram in hypothermia.

OBJECTIVE: Hypothermia is known to adversely affect the electrocardiogram (ECG) in many cases. This study set out to determine the incidence of defined cardiac dysrhythmias, J waves, and conduction abnormalities in urban hypothermia. METHODS: A prospective, multicenter study was carried out to determine the incidence of defined cardiac rhythms in patients suffering from accidental urban hypothermia. The ECGs were independently analyzed by 2 of the authors and placed into 1 of 6 rhythm categories. RESULTS: Seventy-three ECGs were analyzed. Normal sinus rhythm was the most common rhythm (41%). Overall mortality was 36% (26/73). J waves occurred in 36% of survivors and 38% of non-survivors and were, therefore, not prognostic. Shivering artifact was present in 66% of survivors and 38% of nonsurvivors. Although there was no statistically significant association between J waves and survival (P = .21), the presence of shivering artifact was associated with survival in severe hypothermia (P = .047). Atrial fibrillation and junctional bradycardia were both associated with high mortality. CONCLUSIONS: This study confirms that the ECG is abnormal in the majority of patients suffering from accidental hypothermia. J waves do not appear to be independently prognostic in hypothermia. The results suggest that the inability to mount a shivering response may be associated with a poorer outcome; this finding requires further study.

Adolescent↗
PubMed2000

An evaluation of interleukin genes fails to identify clear susceptibility loci for multiple sclerosis.

Differential expression of interleukins may influence susceptibility to inflammatory diseases such as MS. IL-1a production is increased in MS patients during acute relapse, IL-2 receptor (IL-2R) secretion correlates with disease activity in several inflammatory disorders and is variable in MS. Both IL-4 and IL-10 expression vary significantly with relapse/remission in MS and IL-9 is postulated to inhibit steroid-induced apoptosis. To examine the influence of interleukin (IL) genes on MS susceptibility and clinical course, gene association studies using separate polymorphic microsatellite markers for il-1 alpha, il-2, il-2r beta, il-4 il-9 and il-10 were performed, incorporating 150-177 relapsing-remitting or secondary progressive MS (RR/SPMS) patients, 100-110 primary progressive (PPMS) patients and 152-210 controls. No significant differences existed in allele frequencies between either MS group and controls for any of the interleukin microsatellite markers studied, nor were statistically significant differences observed in PPMS vs. RR/SPMS for any marker. These data indicate that the IL-1 alpha, IL-2, IL-2R beta, IL-4, IL-9 and IL-10 genes are unlikely to be susceptibility loci for MS in this population.

Alleles↗
PubMed2000

A five year study of high falls in Edinburgh.

High falls are a common cause of death and disability. The aim of this study was to obtain an epidemiologically complete picture of all high falls over a 5 year period in Edinburgh, Scotland. Prospectively collected data on hospital survivors and hospital deaths was collected from the Scottish Trauma Audit Group (STAG) database. Data on prehospital deaths was obtained from autopsy reports and detailed police enquiry reports. There were 341 patients in the study, of whom 82% were male. Seventy-four percent survived to hospital discharge. Sixty-three percent of the total deaths appeared to be suicides. Head and chest injuries were responsible for the majority of deaths. Pelvis, limb and vertebral injuries predominated in survivors. In conclusion, prevention may be the most effective method of reducing prehospital deaths. Abdominal injuries were associated with a poor outcome, but survival might improve with immediate surgical exploration in haemodynamically unstable patients.

Accidental Falls↗
PubMed2000

A scoring system for the assessment of basic life support ability.

INTRODUCTION: There are no current validated scoring systems for the assessment of adult single rescuer basic life support (BLS) ability. A system was proposed and prospectively validated. METHODS: The system was tested firstly on 12 skilled BLS providers (all instructors). It was then further evaluated on 75 undergraduate dental students, who were assessed before and after a standard training session on adult BLS. RESULTS: All 12 skilled persons passed the test according to the system. The system successfully showed a positive training effect in the dental students. It correctly identified those who 'passed' after training, i.e. those were capable of providing effective BLS (71/75, 94.7%). It also correctly identified those who were not considered competent (4/71, 5.3%). CONCLUSION: This is a simple, effective, objective system for assessment of basic life support. It is easily adaptable for the 1998 Guidelines on BLS.

Adult↗
PubMed2000

School-aged children's vulnerability to depressive symptomatology: the role of attachment security, maternal depressive symptomatology, and economic risk.

The influences of three risk factors (insecure attachment, maternal depressive symptoms, and economic risk) on children's depressive symptomatology were examined. Subjects were 85 children from a range of income levels; all subjects were between 7 and 9 years of age. Children's depressive symptomatology was assessed with the Dimensions of Depression Profile for Children and Adolescents. Results indicated that children at high economic risk were more likely to exhibit depressive symptomatology than were children at low economic risk. Security of attachment was significantly related to children's depressive symptomatology. In addition, a significant relation was noted between children's depressive symptomatology and the depressive symptomatology of their mothers. Contrary to expectations, no significant relation was found between maternal depressive symptomatology and security of attachment. A multiple regression analysis revealed that security of attachment, maternal depressive symptomatology, and economic risk accounted for 47% of the variability in children's depression scores. Secure attachment served as a buffer; economic risk was associated with depressive symptoms only among insecurely attached children.

Child↗
PubMed2000

Suicidal high falls.

There are few data on committing suicide by jumping from a height. Information on suicidal high falls in southeast Scotland was prospectively gathered over 7 years (1992-1998). Data sources included ambulance, police, hospital and forensic records. Injuries sustained were scored according to the Abbreviated Injury Scale, generating Injury Severity Scores (ISS). Sixty-three individuals (50 males), appeared to have committed suicide by falling from a height. The backgrounds were diverse, but 44 individuals had known previous psychiatric illness, 18 having attempted suicide before. The most common locations were high bridges, with two accounting for 23 deaths (37%). Only nine individuals (14%) reached hospital alive. ISS range was 16-75, including 22 scores of 75. These individuals had a total of 24 injuries acknowledged to be unsurvivable, comprising 10 thoracic aortic ruptures, eight massive brain/brainstem injuries, four cardiac injuries, and two high spinal cord transections. The high rate of prehospital death reflects the heights of the falls and consequent major injuries. Prevention of suicide is acknowledged to be difficult - these results suggest that hospital treatment of injuries sustained has little to offer in terms of reducing the death rate from suicidal high falls.

Journal Article↗