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Biomedical subjects

C Paul

Publications and source records attributed to C Paul.

At least 127 records · Page 7Linked to original sources
PubMed1998

Tetanus immunity in patients with hematological malignancies.

The aim of this study was to investigate long-term immunity to tetanus toxoid among patients with hematological disease who had been treated with conventional doses of chemotherapy. Altogether 206 patients with different hematological malignancies were included in the study. There were marked differences between the rates of seronegativity against tetanus, varying from 20% to 70% in different groups of study patients. We found that 21 of 80 (36%) patients with AML, 45 of 80 (56%) with ALL, 12 of 22 (54%) with lymphoma, 4 of 13 (31%) with myeloma and 2 of 11 (18%) with CML were not immune to tetanus. In a multivariate logistic regression model increasing age (P = 0.0001), lymphoid malignancy (P = 0.0005) and advanced disease stage (P = 0.0001) were independent risk factors for loss of tetanus immunity in patients with hematological malignancies.

Adolescent↗
PubMed1998

Ascomycins in dermatology.

Ascomycin derivatives represent a novel class of anti-inflammatory macrolactams that are under development for the treatment of skin diseases. The main biological effect of ascomycins is a blockage of the synthesis of both Th1- and Th2-type cytokines in target cells. SDZ ASM 981 is the most advanced ascomycin derivative under development. It has high antiinflammatory activity in animal models of allergic contact dermatitis and does not induce skin atrophy. Topical application of SDZ ASM 981 has been shown to be effective in atopic dermatitis (AD) and allergic contact dermatitis. Clinical studies using semi-occlusive conditions have also shown effectiveness in psoriasis. SDZ ASM 981 holds promise in overcoming the drawbacks of topical corticosteroids and studies are ongoing to further investigate its efficacy and safety in the treatment of inflammatory skin diseases.

Animals↗
PubMed1998

Epidermodysplasia verruciformis-like eruption complicating human immunodeficiency virus infection.

Three human immunodeficiency virus (HIV)-infected patients presented with disseminated pityriasis versicolor-like skin lesions. Histological examination showed features characteristic of epidermodysplasia verruciformis (EV). Hybridization studies demonstrated the presence of human papillomavirus (HPV) type 5 (HPV5) DNA in two patients and HPV20 in one. A relative increase in CD8+, CD57+ cells, which are known to inhibit cell-mediated cytolysis, was observed in all patients. HLA-DQB 0301 haplotype, which has been associated with EV, was detected in two patients. The findings suggest that infection with EV-associated HPV types can complicate HIV infection. Both cellular immune defects and a hitherto unknown genetic background might explain the occurrence of EV in HIV-infected patients.

AIDS-Related Opportunistic Infections↗
PubMed1998

High single dose of mitoxantrone and cytarabine in acute non-lymphocytic leukemia: a pharmacokinetic and clinical study.

In a phase I-II study, the authors evaluated the intracellular pharmacokinetics, toxicity, and efficiency of a high dose of mitoxantrone given as first induction in acute non-lymphocytic leukemia. Twenty-two patients with previously untreated de novo ANLL were included and received 30 or 40 mg/m2 mitoxantrone on day 1 by intravenous infusion over 1 hour and 500 mg/m2 ara-C twice a day for 5 days. If there was no complete remission (CR), a second induction with ara-C, etoposide, and amsacrine was given. The CR rate after two courses with this regimen was 77%. Median duration of severe neutropenia was 18 days in the 30-mg/m2 group and 25 days in the 40-mg/m2 group. Two patients had fatal lung complications probably unrelated to mitoxantrone. A third patient had a possible mitoxantrone-induced reversible lung complication. In the leukemic cells, we found a high accumulation of mitoxantrone which, in contrast to the plasma concentration, remained stable during the 48 hours studied. Compared with previous results with 12 mg/m2 mitoxantrone, the AUC for intracellular concentrations versus time for the first 20 hours studied was increased by 150% to 0.638 nmol/mg cell protein x hour with 30 mg/m2 mitoxantrone and by 260% to 1.103 nmol/mg cell protein x hour with 40 mg/m2 mitoxantrone. In conclusion, a high dose of mitoxantrone results in a high intracellular exposure of the leukemic cells, which may be an advantage in improving survival of these patients.

Adult↗
PubMed1998

Herpes simplex type 2 infection in a cohort aged 21 years.

OBJECTIVES: To measure the prevalence of HSV-2 antibodies in a birth cohort of 21 year old New Zealanders from whom detailed sexual histories had been obtained, and to assess the potential for HSV-2 serology in characterising a young adult population's risk for sexually transmitted diseases (STD). METHODS: Sera from 784 cohort members were tested using an indirect IgG enzyme linked immunoassay specific to the HSV-2 glycoprotein G. Positive results were confirmed by western blot. RESULTS: In all, 27 subjects were seropositive for HSV-2 (3.4%), only seven of whom gave a history of genital herpes (26%). Risk among females increased with lifetime number of partners, while risk for males increased with having a first partner who was aged 16 years or under. CONCLUSIONS: The seroprevalence of HSV-2 infection in this cohort was low, but similar to that seen in several other populations in this age group. HSV-2 seropositivity did not appear to be a sensitive marker for high risk sexual activity in this young population. This may be because a critical mass of HSV-2 carriers has not accumulated among potential partners by age 21 years.

Adult↗
PubMed1998

Where young people with multiple sexual partners seek medical care: implications for screening for chlamydial infection.

OBJECTIVE: To investigate among young people the relation between the number of sexual partners and use of medical services in order to guide planning of sexually transmitted disease screening. DESIGN: Cross sectional study within a birth cohort using a questionnaire presented by computer. SETTING: Dunedin, New Zealand in 1993-4. SUBJECTS: 477 men and 458 women aged 21 enrolled in the Dunedin Multidisciplinary Health and Development Study, comprising 91.7% of survivors of the cohort. RESULTS: Men with multiple sexual partners in the previous year were less likely to have a general practitioner than men with one or no partners (76.2% v 88.5%, p < 0.01). Among the women the respective proportions (83.1% and 88.4%) were not significantly different. Significantly more women than men (75.8% v 50.7%, p = 0.03) with five or more partners in the previous year had visited their own general practitioner over that period. Among the sexually experienced, more women than men attended any setting appropriate for sexually transmitted disease screening (93.6% v 71.6%, p < 0.001). CONCLUSIONS: In New Zealand a screening programme for sexually transmitted diseases among young adults reliant on invitation by their own general practitioner would be biased towards those at less risk. Opportunistic screening in general practice would potentially include only about half the most sexually active men and three quarters of such women over a 12 month period. The extension of opportunistic screening to other settings considered appropriate for discussion of sexual health issues could potentially engage the vast majority of women, but not men, at most risk. Any screening programme should incorporate an effective method of finding and treating the sexual partners of infected women.

Adolescent↗
PubMed1998

Breast cancer screening adherence: does church attendance matter?

Little is known about the health behaviors of church attendees. This article reviewed telephone interview data of 1,517 women who were church members from 45 churches located in Los Angeles County to determine their breast cancer screening status and to identify the key predictors of screening. Almost all of this sample (96%) reported attending church at least once a month. Key predictors of screening included physician-patient communication, ethnic background, and having medical insurance. Although church-related predictors were not significantly related to screening adherence, the authors compared community-based screening rates from another sample to their sample rates and found that, when controlling for income and education, church members fared better on mammography screening than women who were community residents. This finding suggests that frequent church attendance contributes to better mammography screening status and that the relationship between religious involvement and health behaviors needs further explanation.

Aged↗
PubMed1998

[Pretibial epidermolysis bullosa. A rare form of epidermolysis bullosa simplex].

INTRODUCTION: Pretibial epidermolysis bullosa had been classified as a rare localized form of autosomal dominant dystrophic epidermolysis bullosa. OBSERVATION: We report a sporadic case of a patient suffering from bullous lesions induced by minor trauma on pretibial skin. The lesions healed with atrophic scars. No milia formation was observed. The mapping of dermoepidermal junction by LH 7:2 and GB3 monoclonal antibodies was normal. By electron microscopy, numerous perinuclear vacuoles were observed and the cleavage occurred within the basal keratinocytes. DISCUSSION: This patient had clinical features in accordance with a diagnosis of pretibial epidermolysis bullosa. However, in contrast to previous case reports, the ultrastructural pattern was this of an epidermolysis bullosa of simplex type.

Adult↗
PubMed1997

Patterns of disease and HIV testing at sexually transmitted disease clinics.

AIM: To measure the occurrence of sexually transmitted diseases (STDs) and of HIV testing in a population of STD clinic attenders and the associations of these with age, gender, ethnicity, intravenous drug use, sexual practices and other STDs. METHODS: The study population comprised 8478 new attenders who had blood taken at STD clinics in Auckland and Christchurch between August 1991 and August 1992. Demographic and behavioural information was recorded, along with STD diagnoses and whether or not an HIV test was carried out. These data were analysed by univariate and multivariate methods to determine patterns of disease and voluntary HIV testing. RESULTS: The proportions of the study group with each of the six major STD diagnoses were syphilis 0.8%, gonorrhoea 3.1%, chlamydial infection 11.7%, nonspecific urethritis/cervicitis 12.0%, genital warts 17.4% and genital herpes 6.1%. Gonorrhoea and chlamydial infection were significantly correlated. Both Maori and Pacific Islands ethnicity were significantly associated with the occurrence of bacterial STDs and inversely associated with viral STDs. Twenty-two percent of subjects had voluntary HIV testing at this single visit. Maori were tested at 60% of the European rate and Pacific Islands people at 25-30%. CONCLUSIONS: The profiles of different STDs vary in terms of the sociodemographic and behavioural characteristics of those most often affected. There are major differences in patterns of disease and service use between ethnic groups that require further investigation.

Adolescent↗
PubMed1997

Mammographic screening: results from the 1996 National Breast Health Survey.

OBJECTIVE: To establish the extent of women's knowledge of mammographic screening, particularly in relation to the national screening program, BreastScreen Australia, and to estimate the proportion of women who are participating in screening both within and outside BreastScreen Australia. DESIGN AND SETTING: Validated prospective telephone survey of women aged 30-69 years selected at random from across Australia. PARTICIPANTS: 2935 women with no previous breast cancer diagnosis. RESULTS: The adjusted response rate was 64%. Almost 90% of women had heard of the national program; only 1% correctly stated that screening is for asymptomatic women. 60% correctly identified the current recommended age of starting screening is about 50 years of age; 26% thought screening should begin at about 40 years of age. Approximately 60% correctly reported that the recommended screening interval is every two years; 27% thought screening should be done annually. 55% reported ever having had a mammogram, and 37% reported having had at least one screening mammogram. Among women in the target age group (50-69 years) about 70% reported ever having had a screening mammogram, and about 50% reported having had a screening mammogram within the national program in the last two years. Among women aged 40-49 years, 29% reported ever having had a screening mammogram, and 22% reported having been screened in the last two years. CONCLUSIONS: Awareness of the national screening program is high, but some women do not know the purpose of screening, the target age group and the recommended screening interval. Compliance with screening is good among women in the target age group; many women in their 40s are also participating in screening.

Adult↗
PubMed1997

Family history and risk of breast cancer in New Zealand.

A national population-based case-control study was used to assess the influence on breast cancer risk of a family history of the disease and the possibility of an interaction with reproductive risk factors. A total of 891 women aged 25-54 years with a first diagnosis of breast cancer and 1,864 control subjects randomly selected from the electoral rolls were interviewed. Age-adjusted relative risks (RR) of breast cancer were similar for mothers (RR = 2.3) and sisters (RR = 2.7) but somewhat higher for first-degree (RR = 2.6) than for second-degree (RR = 1.7) relatives. Cases reporting a first- or second-degree relative with breast cancer were no more likely to be diagnosed at an early age than those with no family history. With regard to the age at diagnosis of the relative, the RR was higher if breast cancer had been diagnosed before the age of 45 years than later; this was true for first-degree as well as for second-degree relatives. In women with no family history, the falling RRs with increasing age at menarche reflected the usual pattern, but no such trend was apparent in those reporting a mother or sister with breast cancer. For age at first full-term pregnancy, parity, breast-feeding, menopausal status, infertility, history of benign breast disease and body mass index, no evidence was seen of effect modification by a family history of breast cancer. Mothers of cases had about twice the cumulative rate of breast cancer as mothers of controls, a similar difference being seen between sisters of cases and sisters of controls.

Adult↗
PubMed1997

Epidemic neuromyasthenia and chronic fatigue syndrome in west Otago, New Zealand. A 10-year follow-up.

BACKGROUND: In 1984, an outbreak of an illness characterized by prolonged unexplained fatigue was reported in West Otago, New Zealand. This outbreak resembled other reported outbreaks of epidemic neuromyasthenia in that affected individuals presented with a spectrum of complaints ranging from transient diarrhea and upper respiratory disorders to chronic fatigue syndrome (CFS). OBJECTIVE: To obtain a perspective on the natural history of CFS not possible in clinic-based studies. METHODS: Twenty-three of the 28 patients in the original report were contacted and asked to complete written questionnaires. Interviews were obtained in person or via telephone. RESULTS: Ten (48%) of the 21 patients with satisfactory interviews appeared to meet the current Centers for Disease Control and Prevention (CDC) case definition of CFS, and 11 were classified as having prolonged or idiopathic fatigue. A return to premorbid activity was seen in most (n = 16) patients, although some reported the need to modify their lifestyle to prevent relapses. A female predominance was noted in those meeting the CDC case definition for CFS, whereas males predominated in patients diagnosed as having prolonged or idiopathic fatigue. CONCLUSIONS: The high proportion of patients recovering from CFS in the West Otago cluster suggests that epidemic-associated CFS has a better prognosis than sporadic cases. Female sex was confirmed as an important risk factor for CFS.

Adolescent↗
PubMed1997

Reduced diversity of CTLs specific for multiple minor histocompatibility antigens relative to allograft rejection in vivo.

Minor histocompatibility (H) antigens stimulate in vivo rejection of allografts compatible for the MHC and are recognized by CTLs in short term in vitro assays. CTLs generated by the in vivo priming and in vitro boosting of mice with spleen cells incompatible for multiple minor H Ags are specific for a limited number of dominant Ags (peptides). We have addressed the issue of the identity of the Ags that stimulate rejection of solid tissue allografts vs the H Ags recognized by CTLs. C57BL/6 recipients reject skin grafts from BALB.B and CXB recombinant inbred strains with no significant differences in survival times. Primary grafts from these same strains prime for accelerated rejection of second-set grafts from all CXB strains regardless of inheritance of dominant Ags detected by CTLs. However, CTLs primed by these allografts and boosted in vitro do not exhibit ranges of reactivity with lymphoblast targets from CXB strains predicted by in vivo rejection, suggesting that CTLs primed by multiple Ag-incompatible skin grafts do not recognize all H Ags that stimulate allograft rejection. The fact that first- and second-set BALB.B skin grafts prime for accelerated rejection of 11/13 congenic strains defining single BALB/c minor H Ags indicates that multiple H Ags stimulate allograft rejection. However, CTLs from C57BL/6 mice primed with BALB.B grafts and boosted with BALB.B spleen cells recognize only the H4 Ag from this panel of congenic strains. Limited diversity of the CTL response is corroborated by the recognition of three minor H peptides (including H4 as the most prominent) eluted from Kb molecules from a BALB.B tumor by these CTLs. These results indicate that CTLs recognize only a limited number of Ags operative in vivo and do not accurately reveal the complexity of the antigenic specificity of the in vivo response.

Animals↗
PubMed1997

Depot medroxyprogesterone acetate. Patterns of use and reasons for discontinuation.

Little information is available from outside clinic settings about the acceptability of depot medroxyprogesterone acetate (DMPA, Depo-Provera) as an injectable contraceptive. In this national, population-based study, New Zealand women aged 25 to 54 years were selected at random from voter rolls. The 1864 subjects were interviewed by telephone after an initial approach by letter. More than 1 in 8 women (13.7%) had used DMPA at some time. The proportion was higher among Maori women and among those of lower income and education, but DMPA had been used by a substantial proportion of all socioeconomic groups. A quarter of all users reported receiving only a single injection of DMPA, and only 53% had used this method for a total of 12 months or more. Only 5 (1.6%) of discontinuations were attributed to contraceptive failure; this corresponds to a contraceptive failure rate of 0.9 per 100 woman-years. Side effects were given as the most common reasons for stopping, with menstrual disturbances and weight gain being cited most often. Other reasons for stopping included no further need for contraception or doubts about the appropriateness of DMPA. In this developed country population, DMPA is widely used for short periods but its acceptability is limited by the occurrence of side effects.

Adult↗