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Biomedical subjects

C J Murray

Publications and source records attributed to C J Murray.

At least 91 records · Page 5Linked to original sources
PubMed1985

Erosive gastroduodenitis with marked epithelial atypia after hepatic arterial infusion chemotherapy.

We report the case of a 59-year-old man who was treated with intraarterial chemotherapy for metastatic colonic adenocarcinoma. After the second course he developed persistent symptoms of nausea, vomiting, and pain. Endoscopic examination demonstrated severe erosive gastritis and duodenitis, and histological examination of the antral tissue showed severe atypia and histological appearances suggestive of in situ carcinoma. A 2-month course of sucralfate and cimetidine was used and successfully produced symptomatic relief as well as complete normalization of the dysplastic changes.

Adenocarcinoma↗
PubMed1980

The salutary effect of milk on amoebiasis and its reversal by iron.

Observations among milk-drinking African nomads showed an unusual freedom from infection with Entamoeba histolytica compared with similar nomads taking a mixed diet. A controlled study among Maasai pastoralists showed that the administration of iron to correct their dietary iron deficiency sharply increased their susceptibility to amoebiasis. Examination of the milk of their Zebu cattle showed that it not only had a concentration of iron below the minimum necessary for the growth of E histolytica but also contained partly saturated lactoferrin and transferrin, which may actively compete with the parasite in the colon for ambient iron. These observations suggest the possibility of a long-standing ecological compromise between nomads, their milk diet, and E histolytica.

Adult↗
PubMed1980

Molluscum contagiosum and herpes simplex in Maasai pastoralists; refeeding activation of virus infection following famine?

An epidemic of molluscum contagiosum and oro-genital herpes simplex was observed in Maasai pastoralists of the Rift Valley. It coincided with a period of refeeding following famine, when the relief diet was different from normal milk fare. We propose that refeeding may be an important mechanism for activation of certain viral infections previously suppressed by famine.

Adolescent↗
PubMed1980

An ecological interdependence of diet and disease? A study of infection in one tribe consuming two different diets.

The nature and incidence of infections were studied in two groups of Turkana living in the same area but eating different diets; one consumed milk only and the other a combination of fish and milk. The only apparent and significant nutritional difference between the two groups was mild iron deficiency in the milk drinkers. Episodes of fever, symptomatic infection with malaria and brucellosis, molluscum contagiosum and common warts, episodes of diarrhea, and serological evidence of infection with Entamoeba histolytica were significantly increased in Turkana eating fish. We suggest that this phenomenon may result from a disruption of a long-standing ecological compromise between the all-milk diet of the Turkana and the pathogenic organisms.

Adolescent↗
PubMed1978

The adverse effect of iron repletion on the course of certain infections.

The incidence of infections was studied in 137 iron-deficient Somali nomads, 67 of whom were treated with placebo and 71 with iron. Seven episodes of infection occurred in the placebo group and 36 in the group treated with iron; these 36 episodes included activation of pre-existing malaria, brucellosis, and tuberculosis. This difference suggested that host defence against these infections was better during iron deficiency than during iron repletion. Iron deficiency among Somali nomads may be part of an ecological compromise, permitting optimum co-survival of host and infecting agent.

Adolescent↗
PubMed1977

Parotid enlargement, forehead edema, and suppression of malaria as nutritional consequences of ascariasis.

Bilateral painless enlargement of the parotids, a curiously localized edema of the forehead and relative freedom from malaria were striking findings in children of Anjouan but not of Grande Comore, two neighboring islands of the Comorro group in the Indian Ocean. Compared with those of Grande Comore, Anjouan children were heavily infested with Ascaris lumbricoides. We suggest that the clinical findings may be the nutritional consequence of severe ascariasis and that the low incidence of malaria in Anjouan children may be an example of the delicate ecological balance between the host, the Ascaris, and the plasmoidum.

Abdomen↗
PubMedDate not supplied

Cost-effectiveness of chemotherapy for sputum smear-positive pulmonary tuberculosis in Malawi, Mozambique and Tanzania.

The cost-effectiveness of chemotherapy for pulmonary sputum smear-positive tuberculosis was examined in the national tuberculosis control programmes of Malawi, Mozambique and Tanzania. In these three programmes, routine cure rates have exceeded 80 per cent. Average, average incremental and marginal unit costs for standard, short-course and retreatment regimens with and without hospitalization have been measured. The average incremental cost per year of life saved through chemotherapy ranged from US $0.90-3.10. In all conditions, short-course chemotherapy is preferable to standard 12-month chemotherapy. When hospitalization during the intensive phase of chemotherapy increases the cure rate by 10-15 percentage points, it can be relatively cost-effective. Analysing the cost-effectiveness of short-course and standard chemotherapy, where the depth of the margin of benefit is different, illustrates some of the dangers of simplistic use of cost-effectiveness ratios.

Ambulatory Care↗
PubMedDate not supplied

Toward an analytical approach to health sector reform.

An analytical approach to health sector reform requires definition of the objectives of the health sector. Although a multiplicity of objectives may be appealing, there are compelling analytical reasons for simplicity. It is argued that a health status maximization objective is a widely acceptable choice, which captures most of the important aspects of utility maximization of relevance for health sector reform. Equity can be addressed in the process of aggregating individual outcomes. The widely recognized need for health sector reform in developing countries constitutes, in itself, evidence of the market failures in the health sector. If the market worked, why would we need reform? Given an objective and a justification for reform, analysis should proceed to address measurement questions and intervention strategies. The disability-adjusted life year lost is proposed as a consistent and feasible measure of health. Based on an optimization model of health sector performance in Africa, the paper discusses interventions to improve allocative and technical efficiency. These are broadly characterized as interventions dealing with lack of knowledge and interventions dealing with institutional shortcomings. They lead to different approaches to health sector reform. The paper concludes that we now have a systematic analytical approach to reform, in which tools and methods for addressing information gaps are well developed and need to be more widely applied, while those addressing institutional failures still need further development and application.

Developing Countries↗