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Biomedical subjects

D C Lewis

Publications and source records attributed to D C Lewis.

At least 55 records · Page 3Linked to original sources
PubMed1991

Recent advances in health professional training on substance abuse disorders.

The trainee health professional is influenced by many factors-personal and family experiences, the effectiveness of the teacher as role model, the attitudes in the institution in which training takes place and the cultural norms of society. Adverse experiences, if any, in these areas can negate the input from training programmes. This is particularly true for training in substance use disorders. In designing curricula in this field it is crucial to identify the core competencies expected at the end of training. 'Project Adept', a comprehensive compilation of curriculum materials, is based on such competencies. It emphasizes skills training and an adult learning mode of education. However, to achieve sustained curricular changes, development of a committed faculty is essential. Training must be complemented by systematic programmes of early diagnosis and treatment for substance use disorders in teaching hospitals. The need to train generalist physicians and to focus on early intervention have been endorsed by the recent Institute of Medicine report on the treatment of alcohol problems.

Journal Article↗
PubMed1991

A survey of drinking patterns during medical school.

Several studies have documented the common use of alcohol among medical students and the significant fraction of students (7% to 17%) who show a pattern of alcohol abuse. Many authors have pointed out the implications of physician impairment due to alcoholism, presently estimated at about 10%. We surveyed 263 junior and senior medical students, and our data support earlier surveys of the prevalence of alcohol abuse and indicate that students tend to drink less heavily and less frequently after entering medical school. The clinically proven CAGE questions used in the survey showed statistically significant associations between heavy or frequent drinking before and during medical school, but only 4.2% of respondents indicated that school officials had asked whether they had a drinking or drug abuse problem. Given these findings, we suggest the routine administration of screening instruments to medical students, using education and minimal intervention strategies with individuals at risk.

Alcohol Drinking↗
PubMed1991

Benzodiazepine requirements during alcohol withdrawal syndrome: clinical implications of using a standardized withdrawal scale.

An accurate characterization of the severity of the alcohol withdrawal syndrome is likely to provide clear guidelines for drug therapy in this disorder. We studied (retrospectively) the usefulness of a standardized withdrawal scale on benzodiazepine drug requirements for patients undergoing alcohol detoxification in a general hospital. One hundred thirty-three patients received the revised Clinical Institute withdrawal Assessment Scale for Alcohol and were medicated only if the score was greater than 10. A comparison group of 117 patients was treated without reference to the scale. The groups were evenly matched with respect to age, sex, concurrent drug use, and laboratory abnormalities. Subjects treated according to the scale required less benzodiazepine (median dose, 50 mg diazepam equivalent compared with 75 mg) (p = 0.04). Rates of complications, discharge against medical advice, and length of stay did not differ between the groups. Rank correlation coefficients revealed a closer relationship between the degree of alcohol exposure (as determined by admitting blood alcohol levels, creatine phosphokinase, and SGOT) and benzodiazepine requirements during withdrawal for the group treated with the scale. Findings suggest that when the scale is used, patients with a greater degree of physical dependence receive (appropriately) a higher dose of benzodiazepine and those with a lesser degree of dependence receive (appropriately) a lower dose of benzodiazepine. Use of the scale appears to minimize both under- and overdosing with benzodiazepine for alcohol withdrawal syndrome.

Administration, Oral↗
PubMed1991

Complicated peptic ulcer disease in childhood: an overlooked diagnosis.

Primary peptic ulceration is no longer regarded as a rare disease of childhood, but its exact incidence and pathogenesis remain debatable. We report the case of an 11-year-old boy, who presented with a perforated primary gastric ulcer, a rare complication in this age group.

Appendicitis↗
PubMed1990

Medical education for alcohol and other drug abuse in the United States.

Initiatives by individuals, private foundations and government have led to improvements in the United States in medical education dealing with alcohol and drug-related problems. Progress has been made, particularly in the past 5 years, in developing new medical school curricula and in faculty development. Greater activity by national professional organizations has helped raise the priority of training in alcohol- and drug-related areas for undergraduate and postgraduate medical education. As an example, Project ADEPT (Alcohol and Drug Education for Physician Training in primary care) at Brown University in Providence, Rhode Island, is described. The importance of positive and motivated faculty role models and of skills training is emphasized.

Academic Medical Centers↗
PubMed1990

Three serotypes of Norwalk-like virus demonstrated by solid-phase immune electron microscopy.

Solid phase immune electron microscopy (SPIEM) was used to investigate the serological differences between Norwalk-like virus (NLV) strains from five different outbreaks within the United Kingdom. The existence of two previously demonstrated serotypes, Lewis et al. (Journal of Clinical Microbiology 26:938-942, 1988), was confirmed by the use of whole convalescent sera and purified IgM. A third serotype was found to be the agent of two recent hospital outbreaks and could similarly be typed by use of whole sera or pure IgM. Paired sera were available for two of the three serotypes and demonstrated rising antibody levels. These antibody rises were also specific for the infecting serotype. However, two serum pairs from a later outbreak gave antibody rises to all three serotypes, although much higher counts were produced with the infecting serotype. SPIEM is a useful method for distinguishing NLV serotypes and can also be used to detect specific IgM and to demonstrate seroconversion. Cross-reacting antibodies, possibly anamnestic in origin, can occur after natural infection and could cause confusion in typing virus unless further evidence of the identity of the infecting agent is obtained.

Adult↗
PubMed1990

Cocaine and marijuana use by medical students before and during medical school.

A survey of alcohol and other drug-use patterns of 300 second- and third-year students at a mid-Atlantic private medical school was undertaken in 1987. Two hundred sixty-three (88%) of the medical students surveyed completed the anonymous questionnaire. Tobacco use decreased from 11% before to 4% during medical school. Before entry into medical school, 21% of the respondents had smoked marijuana 10 times or more, usually at least monthly, while 9% had smoked marijuana 10 times or more during medical school. Six percent had smoked marijuana daily in high school or college, while 1% smoked marijuana daily in medical school. Few students who used cocaine before medical school abstained from it during medical school. Cocaine was used by 17% of the respondents before and during medical school. Frequent use of cocaine (greater than 10 times) during medical school, reported by 5% of the students, was directly related to excessive alcohol intake, tobacco dependence, frequent use of marijuana before and during medical school, and medical and behavioral problems related to alcohol and other drug use. Less than 25% of medical schools have a formal policy aimed at identifying impaired students, and only 12% have formal treatment protocols for helping impaired students. We propose that all medical schools initiate programs to diagnose alcohol and other drug-abuse problems in medical student candidates and in the students themselves, and that intervention for any alcohol or other drug problem be encouraged and supported by formal medical school policies designed to help the impaired student.

Alcoholism↗
PubMed1989

Relative metabolism of quinones to semiquinone radicals in xanthine oxidase system.

Rates of enzymatic single-electron reduction of some myotoxic quinones to semiquinone metabolites in an in vitro xanthine oxidase/hypoxanthine/catalase system varied widely. Naphthoquinones, especially juglone, were found to undergo rapid single-electron reduction. Benzoquinones and benzoquinoneimines, as well as phenanthrene-9,10-quinone, benzo[a]pyrene-3,6-quinone, and diethylstilbestrolquinone, were also actively reduced. The anthraquinones danthron, doxorubicin and emodin were poorly metabolized in this system. N-Acetylcysteine inhibited quinone-stimulated cytochrome C reduction at high concentrations. The results of this study are discussed with respect to cytotoxicity and mutagenicity of selected quinones.

1-Propanol↗
PubMed1989

Effects of Cassia obtusifolia (sicklepod) extracts and anthraquinones on muscle mitochondrial function.

Naturally occurring quinones and quinone-containing extracts of seeds of the toxic plant Cassia obtusifolia (sicklepod) affected muscle mitochondrial function. Aqueous suspensions and organic extracts of C. obtusifolia seeds slightly elevated plasma creatine kinase levels of Sprague-Dawley rats. These extracts were analyzed by fused silica capillary gas chromatography and found to contain nine anthraquinones and three anthrones. Urinary metabolites primarily consisted of beta-glucuronide conjugates of the anthraquinones. The three anthrones or conjugate analogues were not present in the urine in detectable amounts. Emodin, doxorubicin and organic extracts of C. obtusifolia inhibited NADH:cytochrome c oxidoreductase activity of bovine heart mitochondrial particles and NADH:CoQ oxidoreductase activity of porcine heart mitochondrial NADH dehydrogenase, whereas juglone was stimulatory. Relative quinone metabolism correlated with semiquinone formation rate and with redox potential. A protective effect of coenzyme Q against enzyme inhibition by anthraquinones was also observed.

Animals↗
PubMed1989

Outbreaks of astrovirus type 1 and rotavirus gastroenteritis in a geriatric in-patient population.

Two outbreaks of viral gastroenteritis occurred in seven psychogeriatric wards of a 469-bed psychiatric hospital. The outbreaks occurred over an eight-week period; the first affected 30 people and rotavirus was detected in 12 of 14 persons from whom faecal specimens were available. The second affected 32 people (15 of whom were affected in the previous outbreak) and astrovirus was detected in 5 of the 24 people from whom specimens were available. Specific IgM to astrovirus was demonstrated in 3 patients. The rotavirus outbreak was characterised by a longer duration of illness (mean 4 days), and more severe symptoms; two elderly female patients had severe symptoms over a 14-15 day period but recovered. In the astrovirus outbreak the duration of illness was shorter and symptoms were milder although the attack rate was higher than that observed for rotavirus.

Adult↗
PubMed1989

Inguinal hernia repair in the elderly.

Inguinal hernia repairs were performed on 452 patients during a 14-month period. Of these patients, 116 (26%) were aged greater than 65 years. Emergency hernia repair for incarceration or strangulation was more common in the elderly (16.4%) than in those aged less than 65 years (4.4%) (P less than 0.001). Postoperative complications were significantly more common after emergency (58%) than elective repair (22%) of hernias in the elderly (P less than 0.01). There were two deaths (operative mortality 10%) following emergency repair and none after elective surgery. The average length of hospital admission was 5 days, rising to 10 days in cases suffering complications. Because of the high morbidity and mortality associated with emergency repair in the elderly, all inguinal hernias should be repaired electively unless there is an overwhelming contraindication to surgical intervention.

Aged↗
PubMed1988

Solid-phase immune electron microscopy with human immunoglobulin M for serotyping of Norwalk-like viruses.

A solid-phase immune electron microscopy method that uses protein A, goat anti-human immunoglobulin M (IgM), and human serum is described. Evaluation of the method with different immunoglobulin fractions showed that human IgM constituted the major virus capture antibody. The method appeared to distinguish between two Norwalk-like virus serotypes and demonstrated specific IgM responses to these serotypes in infected individuals. Further work is being carried out to define the relationship of these two serotypes to the previously described Norwalk agent (A. Z. Kapikian, R. G. Wyatt, R. Dolin, T. S. Thornhill, A. R. Kalica, and R. M. Chanock, J. Virol. 10:1075-1081, 1972), and four subsequent hospital outbreaks are being studied.

Humans↗