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Biomedical subjects

C Leonard

Publications and source records attributed to C Leonard.

81 records · Page 5Linked to original sources
PubMedDate not supplied

The effect of fatigue, sleep deprivation and onerous working hours on the physical and mental wellbeing of pre-registration house officers.

The potential deleterious effects of doctors' long and arduous shifts have received relatively scant attention. This study addressed the effect of a 32 h on-call shift on 16 pre-registration medical house officers in St. James's Hospital, Dublin. We assessed 5 psychological parameters (Tension-Anxiety, Depression-Dejection, Vigour-Activity, Fatigue-Inertia and Confusion-Bewilderment) as well as 5 simple tests of alertness and concentration both pre- and post-call. The doctors were randomly assigned to be tested either pre- or post-call. On average the doctors got 4.5 hours sleep during a 32 h shift. This long shift had an adverse effect on all the psychological parameters (p < 0.05) except Depression-Dejection. The total mood disturbance score, which has been shown to correlate well with general psychological well-being, deteriorated significantly after the 32 h shift, p < 0.005. Two of the simple tests of alertness and concentration (Trail-making test and Stroop Color-Word test) also showed a significant fall-off in performance with sleep deprivation, p < 0.05, although the remaining tests (Delayed Story Recall, Critical Flicker Fusion and Three Minute Grammatical Reasoning Test) were not significantly impaired by the 32 h shift. This study shows that prolonged periods of duty without sleep adversely affect junior doctors, both in their psychological well-being and in their ability to carry out simple tasks.

Adult↗
PubMedDate not supplied

Utility of Wang transbronchial needle biopsy in sarcoidosis.

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology, commonly seen in the western world. The incidence varies and may be as high as 40/100,000 of the population per year. The commonest mode of presentation is as hilar and mediastinal lymphadenopathy on a chest radiograph. Even though sarcoid is in general a benign disease and most patients will not progress to chronic lung disease, a tissue diagnosis is necessary for management as other differential diagnoses such as lymphoma, tuberculosis and other causes of interstitial lung disease need to be excluded. The usual method of obtaining a tissue diagnosis is transbronchial forceps biopsy (TBBx), via a fibre-optic bronchoscope (FOB). The presence of non-caseating granuloma in the biopsy specimen is diagnostic of sarcoidosis if the tissue is stain and culture negative for tuberculosis and fungi. However TBBx carries significant complications-in particular there is a risk of pneumothorax (10-20 per cent) and significant and rarely life-threatening haemorrhage has been reported. Furthermore, a diagnosis of sarcoidosis is made by TBBx in only approximately 70 per cent of cases. Thus in about 30 per cent of cases a further procedure such as mediastinoscopy or open lung biopsy is required to obtain a tissue diagnosis. We report a patient with suspected sarcoidosis who had negative TBBx in whom the diagnosis was confirmed using a Wang transbronchial needle (MW-319, Mill Rose Lab., U.S.A.) to biopsy mediastinal lymph nodes via the FOB.

Adult↗
PubMedDate not supplied

A comparison of regular with intermittent bronchodilators in asthma patients on inhaled steroids.

The aim of this study was to compare the effect of regular versus intermittent (p.r.n.) bronchodilators on bronchial reactivity and asthma control in patients on concomitant inhaled corticosteroids. We studied 12 patients with asthma in a prospective, randomised, single-blind, single-dummy, three-period crossover trial comparing placebo (2 puffs t.d.s.), salbutamol (200 micrograms t.d.s.) and oxitropium bromide (200 micrograms t.d.s.) for 28 days each. Computerised spirometry and bronchial reactivity to histamine were obtained on entry and after each treatment period. Symptom scores, use of rescue bronchodilator and peak expiratory flow rates were recorded daily. There were no significant differences in bronchial hyperreactivity between the salbutamol, oxitropium and placebo treatment periods. There were no significant differences in baseline FEV1, FEF25-75%, symptom scores, use of rescue bronchodilator or morning and evening PEFR between treatment periods. Intermittent beta agonist therapy is as effective as regular therapy in terms of asthma control and bronchial hyperreactivity in patients on concomitant inhaled corticosteroid therapy. Since intermittent therapy achieves similar results with significantly lower beta agonist consumption, the data support current recommendations that beta agonists should be taken on a p.r.n. basis in asthma patients on inhaled steroids.

Administration, Inhalation↗
PubMedDate not supplied

Zuni Diabetes Project.

Widespread type II diabetes among North American Indians and certain other populations is a relatively recent medical phenomenon. Increased prevalence of diabetes appears to be related to sudden cultural shifts toward sedentary lifestyle and increased caloric intake. These changes, super-imposed on a genetic predisposition to diabetes, pose a community health threat to the Zuni and similar populations. Regular aerobic exercise is clearly beneficial to most type II diabetics. The key public health issue is how to establish community participation in effective aerobic activity. The Zuni Diabetes Project, fully described here, serves as a model in this respect.

Adult↗
PubMedDate not supplied

[Schwann cell pathology and axonal reduction in a case of congenital neuropathy with hypomyelinization].

A case of congenital dysmyelinating neuropathy is reported, in which computerised morphological analysis showed a prominent loss of fibers with large axons, in addition to overall thinness of myelin sheath. Ultrastructural examination showed aberrant formation of basal lamina and abnormal ensheathment by Schwann cells of both myelinated and unmyelinated fibers. Hypomyelination appears to be only one aspect of this neuropathy, in which axonal pathology plays a major role.

Axons↗