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Biomedical subjects

D Coakley

Publications and source records attributed to D Coakley.

At least 55 records · Page 3Linked to original sources
PubMed1998

A randomized, double-blind trial of valaciclovir prophylaxis for cytomegalovirus disease in patients with advanced human immunodeficiency virus infection. AIDS Clinical Trials Group Protocol 204/Glaxo Wellcome 123-014 International CMV Prophylaxis Study Group.

Cytomegalovirus (CMV) disease is a common complication of advanced human immunodeficiency virus (HIV) infection. Administration of oral valaciclovir, a valine ester of acyclovir, achieves sufficient plasma acyclovir levels to inhibit many clinical isolates. Acyclovir has been associated with enhanced survival in AIDS but not with CMV disease prevention. CMV-seropositive patients (1227) with CD4 cell counts <100/mm3 were enrolled in a randomized, double-blind trial. Valaciclovir, 8 g/day, was compared with acyclovir, 3.2 or 0.8 g/day, for CMV prevention; all three arms were compared for survival. The confirmed CMV disease rate was 11.7% among valaciclovir recipients and 17.5% in the pooled acyclovir arms, a 33% reduction in risk. Time to confirmed CMV disease was significantly longer for the valaciclovir group (P = .03). A trend toward earlier mortality for valaciclovir recipients was seen (P = .06). Toxicity and earlier medication discontinuation were more common in this group. Valaciclovir significantly reduces the risk of CMV disease. Further exploration of a better-tolerated dose is warranted.

AIDS-Related Opportunistic Infections↗
PubMed1998

The cerebellopontine angle: does the translabyrinthine approach give adequate access?

A long-standing but unfounded criticism of the translabyrinthine approach is the misperception that this approach does not give adequate access to the cerebellopontine angle. Because of what is perceived as limited visualization and operating space within the cerebellopontine angle, some surgeons still believe that the translabyrinthine approach is inappropriate for large acoustic tumors. In this study, the surgical access to the cerebellopontine angle by virtue of the translabyrinthine approach is measured and analyzed. The parameters are compared with those measured for the retrosigmoid approach. This series objectively confirms that the translabyrinthine approach offers the neurotologic surgeon a shorter operative depth to the tumor, via a similar-sized craniotomy. This permits superior visualization by virtue of a wider angle of surgical access. Such access is achieved with the merit of minimal cerebellar retraction.

Cerebellopontine Angle↗
PubMed1998

Use of folic acid-fortified milk in the elderly population.

Folic acid deficiency is common in the elderly population, resulting in anaemia, dementia, many neurological sequelae and an indirect role in atheromatous disease. An increase in natural food folate is relatively ineffective at increasing folate status and the use of folate fortification of foodstuffs is recommended. The aim of our study was to assess the benefits of folic acid-fortified milk to the folate status of an elderly institutionalised population. 49 subjects received fortified milk as part of their daily diet for at least 6 months (active group) and 40 subjects received unfortified milk (control group). Our results showed a mean serum folate level in the active group of 5.81 (1.1-17.6) microgram/l compared to the control group mean of 2.16 (0.5-9.4) microgram/l (p < 0.001; normal range for serum folate 2.7-20 microgram/l). Similarly the mean red cell folate level in the active group of 316.5 (130-905) microgram/l was significantly higher than the control group mean of 196.1 (95-490) microgram/l (p < 0.001; normal range for red cell folate 150-1,000 microgram/l). Our results suggest that folic acid-fortified milk is an efficacious and acceptable method of administration of folic acid in the elderly population and we recommend the use of folic acid-fortified milk in the regular daily diet of the elderly population.

Aged↗
PubMed1998

Hypothalamic-pituitary-adrenal axis dysfunction in Alzheimer's disease: lack of association between longitudinal and cross-sectional findings.

OBJECTIVE: The authors examined longitudinal hypothalamic-pituitary-adrenal (HPA) axis function in Alzheimer's disease. METHOD: Cortisol levels of 30 patients with Alzheimer's disease and 17 healthy elderly subjects were measured before and after administration of dexamethasone. These measures were repeated at 9-month intervals in the patients with Alzheimer's disease. RESULTS: At baseline, cortisol levels were higher in the Alzheimer's disease group before and after dexamethasone administration. Although only two of the four patients whose cortisol levels were not suppressed by dexamethasone also had high cortisol levels before dexamethasone administration, basal and postdexamethasone cortisol levels were correlated. HPA axis dysfunction correlated with severity of dementia at baseline but was not stable longitudinally and did not increase with follow-up. CONCLUSIONS: There was no association between longitudinal and cross-sectional findings. The longitudinal data were not consistent with a role for the glucocorticoid cascade hypothesis (that hippocampal cell loss in Alzheimer's disease results in hypercortisolism, which in turn acts as a co-factor in further degeneration) in the pathophysiology of mild and moderate Alzheimer's disease.

Aged↗
PubMed1997

The unusual occurrence of 14-methylhexadecanoic acid in Pinaceae seed oils among plants.

14-Methylhexadecanoic (14-MHD) acid has been identified in a sample of pine seed oil (Pinus contorta) by gas-liquid chromatography-mass spectrometry of its picolinyl ester derivative. Its identification (through its equivalent chain length) and its distribution in four conifer families have been checked. It occurred only in Pinaceae, where it was found in 72 species belonging to the genera Pinus, Abies, Cedrus, Tsuga, Pseudotsuga, Larix, and Picea, in the range 0.02-1.15%. 14-MHD acid could not be detected in the lipids of Taxaceae (Taxus baccata), Cupressaceae (Juniperus communis), or Taxodiaceae (Sciadopytis verticillata), even after a 10-fold concentration of the saturated acid fraction isolated by argentation thin-layer chromatography. It is concluded that Pinaceae, along with Ginkgo biloba seed lipids, are major exceptions in the plant kingdom with regard to 14-MHD acid, which otherwise occurs almost exclusively in lipids of animals and microorganisms. The biosynthesis and metabolic role of 14-MHD acid, which otherwise also occur in wood and leaf lipids, remain unknown.

Chromatography, Thin Layer↗
PubMed1997

Diffuse neurofibroma obstructing the external auditory meatus.

A case is presented of a 36-year-old male with narrowing of the external meatus due to a diffuse neurofibroma. This unusual variety of neurofibroma spreads superficially and has many ecstatic blood vessels. The size, vascularity, uncertain edges and a tendency to recur makes surgical removal difficult. The treatment options are discussed.

Adult↗
PubMed1997

Classification of mild Alzheimer's disease by artificial neural network analysis of SPET data.

An evaluation of the performance of artificial neural networks (ANNs) for the classification of probable Alzheimer's disease (pAD) patients was undertaken using data extracted from four regions of interest constructed on single photon emission tomographic (SPET) cerebral perfusion images. Two studies using feed-forward neural networks (FFNNs) were undertaken. The first was to determine if it would be possible to classify pAD patients and normal subjects in a mixed group, comprising 29 patients diagnosed as having pAD varying in severity from mild, established dementia to moderate dementia and 10 healthy control subjects. The second was to determine if the networks generated in the first study could prospectively classify 15 additional patients with very mild or mild cognitive impairment. The results were compared to those obtained using the same data and discriminant analysis. The relative performances of the two analysis techniques were assessed on the basis of the area under receiver operating characteristics (ROC) curves. The FFNN successfully classified all datasets in the first study, achieving an area under the ROC curve of 1.00, whereas discriminant analysis achieved 0.94. When tested on data from the second group, the areas under the ROC curves varied between 0.86 and 1.00 for the FFNN, whereas that for discriminant analysis was 0.99. We conclude that FFNNs can accurately classify pAD patients with mild to moderate dementia using data obtained from SPET cerebral perfusion images.

Aged↗
PubMed1997

A 200 kDa protein is associated with haemagglutinating isolates of Moraxella (Branhamella) catarrhalis.

Moraxella catarrhalis adheres to human erythrocytes by means of a proteinaceous, trypsin sensitive, heat modifiable haemagglutinin. A 200 kDa protein was found to be associated with haemagglutinating isolates of M. catarrhalis. This protein was present on all haemagglutinating isolates (n = 17), but was absent on the non-haemagglutinating isolates (n = 23) examined. This protein demonstrated heat-modifiable properties in sodium dodecyl sulfate and was degraded by trypsin. Immunoblot assays with polyclonal antiserum indicated that the 200 kDa protein was associated exclusively with haemagglutinating isolates and antibodies to this protein did not recognise epitopes on non-haemagglutinating isolates. This protein, which appears to be a surface expressed protein may be a haemagglutinin of M. catarrhalis.

Bacterial Proteins↗
PubMed1997

Studies on haemagglutination and serum resistance status of strains of Moraxella catarrhalis isolated from the elderly.

A total of 40 strains of Moraxella catarrhalis, isolated from the sputum of elderly persons with respiratory tract infections and from nasopharyngeal swabs from healthy elderly, were examined for haemagglutination of human red blood cells and resistance to bactericidal activity in normal human serum (NHS). 15 of 20 strains isolated from the infected elderly and 3 of 20 strains isolated from the healthy elderly showed haemagglutinating properties (p < 0.001). Similarly, 13 of 20 strains from the infected group and 2 of 20 strains from the healthy group were found to be resistant to the bactericidal activity of NHS (p < 0.001). Strains of M. catarrhalis which were associated with respiratory tract infections in the elderly, in contrast to strains colonizing the healthy elderly, were found to be predominantly haemagglutinating for human red blood cells and resistant to complement killing in NHS.

Adult↗
PubMed1997

Mental disorders among the community-dwelling elderly in Dublin.

BACKGROUND: The prevalence of mental disorders among the community-dwelling elderly in the catchment area of a psychiatry for the elderly service in Dublin was determined. METHOD: A sample of 1232 individuals aged 65 years and over, identified from general practitioner practice lists, was interviewed using the Geriatric Mental State-AGECAT package. RESULTS: Depression and organic disorder occurred with prevalences of 10.3 and 4.1%, respectively. Depression diagnostic cases had comorbid anxiety at case level in 17.3% and at sub-case level in a further 59.9%. Organic diagnostic cases had comorbid depressive or anxiety symptoms, at case or sub-case level, in 32%. CONCLUSIONS: Depression is the most common mental disorder among the elderly in Dublin. The frequency of anxiety symptoms in the presentation of depression may be a factor in the under-diagnosis or misdiagnosis of depression in the community-dwelling elderly. Comorbid anxiety and depression in organic disorder may represent treatable symptoms.

Aged↗
PubMed1997

Behaviour disturbance and other predictors of carer burden in Alzheimer's disease.

OBJECTIVE: To investigate predictors of carer burden in Alzheimer's disease (AD). DESIGN: Two cohorts were formed, one comprising AD patients, the other comprising their primary carers. The relationship of patient and carer variables to carer burden was investigated. SETTING: An urban hospital memory clinic. PARTICIPANTS: A convenience sample of 50 patients meeting NINCDS-ADRDA for probable AD, age range 60-87, and their primary carers, age range 31-84. MEASURES: The Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Baumgarten et al. Dementia Behaviour Disturbance Scale, the Blessed-Roth Dementia Scale, the Personal Self-Maintenance Scale, the Zarit Burden Interview and the Vaux et al. Social Support Appraisals (SS-A) and Social Support Behaviours (SS-B) Scales. RESULTS: Daughters were particularly prone to burden. Neither patient cognitive nor functional status predicted burden. Behaviour disturbance in particular, and informal support were significant, but independent, predictors of carer burden. CONCLUSIONS: In this study increased carer burden was related independently to increased levels of patient behaviour disturbance and decreased levels of informal social support. This may have relevance to appropriate interventions for carers. As the study was based on a convenience sample of memory clinic attenders, replication in less highly selected samples is desirable.

Adaptation, Psychological↗