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Biomedical subjects

C Garrett

Publications and source records attributed to C Garrett.

71 records · Page 4Linked to original sources
PubMed1980

Iatrogenic phobic disorders in methadone maintenance treated patients.

A detoxification phobia idiosyncratic to methadone maintenance programs is described and several representative cases are presented. Reliability of diagnostic criteria for the phobia are described and their overall reliability was found to be 93% while occurrence reliability was 67%, which investigators conclude is a moderate but clinically useful level. Prevalence data show the phobia occurring in 27% of a random sample of patients treated with methadone maintenance, an estimate the investigators feel is too high to be representative of typical methadone programs. Implications for treatment are discussed.

Adult↗
PubMed1980

Use of alpha-secondary isotope effects in nucleophile-promoted reactions of pyrimidine derivatives; evidence for transient 5,6-dihydropyrimidine intermediates.

alpha-Secondary isotope effect provides a useful tool for detection of transient 5,6-dihydropyrimidine intermediates which have been indirectly implicated in a number of chemical and enzymic conversions of pyrimidine heterocycles. The method involves the use of kinetic secondary alpha-hydrogen isotope effects which are expected to accompany sp2 to sp3 rehybridization of C-6 of the pyrimidine ring if they occur prior to or at the rate determining step. Thus, using 6-tritiated pyrimidines, and measurement of the isotopic ratio of reactant and products, kT/kH values of 1.15 or greater would be indicative of rehybridization. Using this method, we have studied the inhibition of thymidylate synthetase by 5-fluorodeoxyuridylate and 5-nitro-deoxyuridylate as well as the chemical and enzymic dehalogenation of 5-bromodeoxyuridine and 5-bromodeoxyuridylate. Large secondary isotope effects observed in all of these reactions provided strong evidence for the formation of 5,6-dihydropyrimidine intermediates.

Bromodeoxyuridine↗
PubMed1979

Thymidylate synthetase. Catalysis of dehalogenation of 5-bromo- and 5-iodo-2'-deoxyuridylate.

Tymidylate synthetase catalyzes the facile dehalogenation of 5-bromo-2'-deoxyuridylate (BrdUMP) and 5-iodo-2'-deoxyuridylate )IdUMP) to give 2'-deoxyuridylate (dUMP), the natural substrate of the enzyme. The reaction does not require folate cofactors and stoichiometrically consumes 2 equiv of thiol. In addition to dUMP, a minor product is formed during the debromination of BrdUMP which has been identified as a 5-alkylthio derivative formed by displacement of bromide ion by thiolate. The reaction has been found to proceed with a substantial alpha-secondary inverse tritium isotope effect (kT/kH = 1.212--1.258) with [2-14C,6-3H]-BrdUMP as the substrate. Similarly, an inverse tritiumisotope effect of 1.18 was observed in the nonenzymatic chemical counterpart of this reaction, the cysteine-promoted dehalogenation of [2-14C,6-3H]-5-bromo-2'-deoxyuridine. Previous evidence for the mechanism of action of this enzyme has rested largely on chemical model studies and on information obtained from its stoichiometric interaction with the inhibitor 5-fluoro-2'-deoxyuridylate. The magnitude of the secondary isotope effect during the enzymatic dehalogenation described here provides direct proof for nucleophilic catalysis and formation of 5,6-dihydroprimidine intermediates in a reaction catalyzed by thymidylate synthetase.

Deoxyuracil Nucleotides↗
PubMed1972

Immediate effects of intravenous verapamil in cardiac arrhythmias.

Verapamil was administered by intravenous injection to 181 patients with various cardiac arrhythmias. The automaticity of the cardiac pacemaker was slowed in sinus, idionodal, and idioventricular tachycardia. In atrial fibrillation the drug usually slowed the ventricular response and often made it regular. In some cases atrial flutter was converted to sinus rhythm, the ventricular response being reduced in the remainder. Conversion of paroxysmal supraventricular tachycardia to sinus rhythm was consistently achieved. A favourable response occurred in four patients in whom arrhythmias were associated with pre-excitation syndromes. There were no adverse clinical side effects.

Aged↗
PubMedDate not supplied

Fetoscopy and fetal blood sampling in the management of a twin pregnancy with 45,X/46,XX amniotic fluid cell mosaicism and a suspected fluid sampling error.

A 37 year-old woman with a twin pregnancy underwent amniocentesis to exclude fetal chromosome abnormality. The results indicated that both fetuses were mosaics, with 45,X and 46,XX, cell lines. Since it was suspected from the ultrasound scan that the twins were dizygotic, the result was questioned. Fetoscopy and fetal blood sampling were performed and karyotyping the fetal lymphocytes confirmed that one twin was indeed a mosaic, 45,X/46,XX, but the other had a normal male chromosome complement. The pregnancy resulted in the birth of a phenotypically normal girl, in whom the 45,X/46,XX mosaicism was confirmed, and a normal boy.

Adult↗
PubMedDate not supplied

HIV serosurveillance of newborns. A clinician's perspective on legislative, political, and ethical issues.

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.

AIDS Serodiagnosis↗
PubMedDate not supplied

Education issues in disaster medicine: summary and action plan.

INTRODUCTION: Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration, (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis. DISCUSSION: Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences. CONCLUSIONS: The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.

Clinical Competence↗
PubMedDate not supplied

Y2K medical disaster preparedness in New York City: confidence of emergency department directors in their ability to respond.

OBJECTIVES: To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model. METHODS: Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness. RESULTS: The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management. CONCLUSIONS: Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.

Attitude of Health Personnel↗
PubMedDate not supplied

Impact of infants born at the threshold of viability on the neonatal mortality rate in Colorado.

OBJECTIVE: To determine the contribution of infants born at the threshold of viability (< 750 gm) on neonatal mortality in Colorado. STUDY DESIGN: For the period of January 1991 to December 1996, all Colorado live births who expired were evaluated for gestational age, birth weight, gender, hospital level of care, age at time of death, delivery room resuscitation, mechanical ventilation, medical and surgical complications, and serious malformations. RESULTS: Although infants weighing < 750 gm represent only 0.31% of all live births, they account for 46.3% of deaths. While those infants weighing < 500 gm and with a gestation of < 24 weeks almost always died (94.7%), the majority born in the 500- to 745-gm category (55.8%) survived. The vast majority (88.5%) of deaths occurred on the first day of life. A total of 38.4% of births in which the infant weighed < 750 gm occurred outside bona fide regional perinatal centers. CONCLUSION: Future attempts to reduce the Colorado neonatal mortality rate would best focus on the 500- to 750-gm weight group through the re-regionalization of high-risk perinatal care.

Cause of Death↗