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Biomedical subjects

D Gill

Publications and source records attributed to D Gill.

At least 55 records · Page 3Linked to original sources
PubMed1999

A systematic review of the treatment of depression with antidepressant drugs in patients who also have a physical illness.

To determine whether antidepressants are clinically effective and acceptable for the treatment of depression in people who also have a physical illness. The method used was a systematic review of all randomised controlled trials (found by computer and hand searches) comparing any antidepressant drug with placebo or no treatment, in depressed adults with a specified physical disorder. The main outcome measures are numbers of individuals who recover/improve at the end of the trial and, as a proxy for treatment acceptability, numbers who complete treatment. 18 studies were included, covering 838 patients with a range of physical diseases. 6 studies used SSRIs, 3 atypical antidepressants, and the remainder tricyclics. Patients treated with antidepressants were significantly more likely to improve than those given placebo: about 4 patients would need to be treated with antidepressants to produce one recovery from depression which would not have occurred had they been given placebo (NNT 4.2, 95% CI 3.2-6.4). Most antidepressants (tricyclics and SSRIs together, 15 trials) produced a small but significant increase in dropout (OR 1.66, 95% CI 1.14-2.40. NNH 9.8, 95% CI 5.4-42.9). The "atypical" antidepressant mianserin produced significantly less dropout than placebo. Trends towards tricyclics being more effective than SSRIs, but also more likely to produce dropout were noted. The review provides evidence that antidepressants, significantly more frequently than either placebo or no treatment, cause improvement in depression in patients with a wide range of physical diseases.

Adult↗
PubMed1999

The frequency of common nonmalignant skin conditions in adults in central Victoria, Australia.

BACKGROUND: Nonmalignant skin conditions are believed to be common in adults, although there are very few community-based studies to determine their exact frequency. OBJECTIVE: To record the prevalence of common, nonmalignant skin conditions in adults in central Victoria, Australia. METHODS: A total of 1457 respondents from a random selection of adults aged 20 years and over from Maryborough, central Victoria, were given a total body examination by a dermatologist or dermatology trainee. People with any nail or skin signs suggestive of tinea had scrapings taken for fungal culture. RESULTS: The age- and sex-adjusted prevalence of warts was 7.1% (95% confidence interval (CI), 5.8-8.4%), acne 12.8% (95% CI, 11.0-14.5%), atopic dermatitis 6.9% (95% CI, 5.6-8.3%), seborrheic dermatitis 9. 7% (95% CI, 8.2-11.2%), asteatotic dermatitis 8.6% (95% CI, 7.1-10. 0%), psoriasis 6.6% (95% CI, 5.7-7.9%), culture-positive tinea 12% (95% CI, 10.3-13.6%), seborrheic keratoses 58.2% (95% CI, 55.6-60. 7%), and Campbell de Morgan spots (cherry angiomas) 54.4% (95% CI, 51.9-57.0%). There was variation in the prevalence of many of these conditions with age. CONCLUSIONS: This study demonstrates that nonmalignant skin conditions are common in adults in Australia. Their diagnosis and management represent a considerable burden not only to those suffering from the conditions, but also to the health system which provides for their care.

Acne Vulgaris↗
PubMed1999

A review of the epidemiology of tinea unguium in the community.

Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.

Adolescent↗
PubMed1999

Improved prognosis for congenital nephrotic syndrome of the Finnish type in Irish families.

Congenital nephrotic syndrome of the Finnish type is a rare autosomal recessive disease with a high infant mortality without aggressive treatment. The biochemical basis of the disease is not understood fully but the disease locus has been mapped recently to chromosome 19q12-q13.1 in Finnish families. This paper describes the clinical features and outcome of 20 patients in Ireland with congenital nephrotic syndrome of the Finnish type who have presented since 1980. Before 1987, all infants died by the age of 3 years. After the introduction of daily intravenous albumin infusion, nutritional support, elective bilateral nephrectomy, and renal transplantation, mortality in the past decade has fallen to 30%, with no deaths in the past five years. Genetic linkage analysis was performed in six families in whom DNA was available and the locus responsible was mapped to the same region on chromosome 19 as in Finnish families, suggesting that Irish families share the same disease locus.

Chromosomes, Human, Pair 19↗
PubMed1999

A phase I/II study of intensive dose escalation of cytarabine in combination with idarubicin and etoposide in induction and consolidation treatment of adult acute myeloid leukemia. Australian Leukaemia Study Group (ALSG).

To determine the safety and efficacy of the combination of idarubicin, cytarabine and etoposide ("ICE") for induction and consolidation treatment of acute myeloid leukemia (AML), and of dose-intensification of cytarabine in this setting, 54 previously untreated patients in three cohorts were studied by sequential dose escalation of cytarabine, in combination with standard doses of idarubicin and etoposide. Cytarabine was given to Cohort 1 at the conventional dosage of 100 mg/m2 per day by continuous infusion for 7 days in induction and 5 days in consolidation; to Cohort 2 at high-dose (HiDAC) (3 g/m2 intravenously twice daily on days 1, 3, 5 and 7) during induction with conventional dosage during consolidation; to Cohort 3 HiDAC was given for both induction and consolidation. In addition, Cohort 3 patients received lenograstim (Granocyte; rHuG-CSF) after both induction and consolidation courses. We found that there was no significant difference between the three cohorts in hematological toxicity in induction, but that HiDAC was associated with a greater incidence of gastro-intestinal toxicities. There was no difference in induction mortality between the three cohorts, which was 11% overall. Consolidation with HiDAC led to a significant increase in hematological toxicity. Overall, the complete remission (CR) rate was 80% with no significant difference between the three regimens. The estimated disease free survival at 3 years was 28%, 67% and 54% respectively for Cohorts 1, 2 and 3 with an estimated overall survival of 38%, 63% and 47%. We conclude that cytarabine dosage can be escalated safely in combination with idarubicin and etoposide in both induction and consolidation. The combination is effective for induction treatment of AML and its side-effects appear similar to those of standard regimens. Whether its use offers long-term benefits compared with standard regimens is the subject of ongoing controlled randomized studies.

Adolescent↗
PubMed1998

Increased expression of Axl tyrosine kinase after vascular injury and regulation by G protein-coupled receptor agonists in rats.

Axl is a receptor tyrosine kinase originally identified as a transforming gene product in human myeloid leukemia cells. Cultured rat vascular smooth muscle cells also express Axl, where it has been proposed that Axl may play a role in cell proliferation. In the current study, we tested the hypotheses that Axl expression would parallel neointima formation in balloon-injured rat carotid, and that Axl expression would be regulated by growth factors present at sites of vascular injury. Ribonuclease protection assay showed dynamic increases in Axl mRNA in vessels, with peak expression 7 and 14 days after injury. Immunohistochemical analysis confirmed these results and demonstrated that Axl protein expression was localized primarily to cells of the neointima after injury. Northern blot analysis indicated increased mRNA expression for the secreted Axl ligand, Gas6, in injured carotids, with a time course paralleling that of Axl upregulation. Axl and Gas6 expression were temporally correlated with neointima formation, suggesting a role for Axl signaling in this process. Other studies, performed in cultured rat vascular smooth muscle cells, revealed positive regulation of Axl mRNA expression by thrombin or angiotensin II but not by basic fibroblast growth factor, platelet-derived growth factor-BB, or transforming growth factor-ss1. Western blot analysis confirmed these results, showing that Axl protein expression was specifically increased by thrombin or angiotensin II. Our results implicate Axl as a potential mediator of vascular smooth muscle migration and proliferation caused by vascular injury and G protein-coupled receptor agonists.

Angiotensin II↗
PubMed1998

Probing the active site of adenosine deaminase by a pH responsive fluorescent competitive inhibitor.

The adenine analog erythro-9-(2-hydroxy-3-nonyl)adenine, EHNA, a tight reversible inhibitor (KI = 1.6 x 10(-9) M) of adenosine deaminase (EC 3.5.4.4) (ADase), was modified into the fluorescent etheno derivative epsilon-EHNA. The latter is a competitive inhibitor of adenosine deaminase [KI = (2.80 +/- 0.01)10(-6) M], having the fluorescent properties of epsilon-adenines. Affinity to the active site, monitored by both steady-state and dynamic fluorescence polarization, was confirmed by competition experiments with 2'-deoxycoformycin, the substrate adenosine and EHNA. The epsilon-adenine moiety of epsilon-EHNA librates at the shallow active site of ADase. The low absorptivity of epsilon-EHNA required the measurement of fluorescence excitation spectra. Computer subtraction of fluorescence excitation spectrum of ADase from that of its equimolar complex with epsilon-EHNA revealed the corrected excitation spectrum of epsilon-EHNA at the active site of the enzyme. This spectrum mimics that of epsilon-EHNA at pH 5.5 in buffer solution, implying its protonation at the active site of the enzyme. These results are in agreement with the presence of acidic amino acids that are essential to the catalytic mechanism.

Adenine↗
PubMed1998

Sporting activity following kidney transplantation.

A postal questionnaire on sporting activity following renal transplantation revealed that most units encouraged participation in the majority of sports, but counselled against contact sports such as rugby football, boxing, and Asian martial arts.

Adolescent↗
PubMed1998

A multicenter comparison of the ocular efficacy and safety of diclofenac 0.1% solution with that of ketorolac 0.5% solution in patients with acute seasonal allergic conjunctivitis.

Only one of several available ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) is currently FDA approved for use in acute seasonal allergic conjunctivitis (SAC). Sixty patients with SAC and moderate itching and bulbar conjunctival injection were enrolled in a multicenter, randomized, double-masked, parallel-group trial comparing diclofenac sodium (DS) with ketorolac tromethamine (KT). Patients instilled 1 drop four times daily while awake for 14 days. Ocular signs and symptoms were evaluated at one and two weeks. The primary efficacy variables were itching and bulbar conjunctival injection. For both treatments, the ocular allergy sign and symptom scores were comparable at baseline. Both treatments evaluated in this study were well tolerated. Significant clinical and statistical reductions from baseline were observed in the primary efficacy variables. Treatment group differences were observed for the pain/soreness score with an advantage observed for the DS group at 30 minutes and at day 7. Our conclusion is that diclofenac sodium and ketorolac tromethamine acted similarly to reduce the ocular signs and symptoms associated with acute seasonal allergic conjunctivitis. There was a statistically significant advantage for the DS group to be free of symptoms at the day 7 visit as compared to the KT group (20.7% vs. 3.2%).

Acute Disease↗
PubMed1998

GP frequent consulters: their prevalence, natural history, and contribution to rising workload.

A small proportion of patients use a disproportionate amount of general practitioners' (GPs') time. We demonstrate here that such frequent attending behaviour tends to persist through five-year follow-up, suggesting the need for the development of specific management strategies. We also show that, at any rate in one practice, total workload is increasing dramatically, and that frequent consulters make up a large part of the increase.

Adolescent↗
PubMed1997

Removal of dissolved O2 by a fluid membrane of Fomblin Y (perfluoro polyether): fluorescence of diphenylhexatriene in Fomblin Y.

O2 can be gently removed from solutions by contact with a "bulk fluid membrane" of the viscous and nearly inert perfluoro polyether Fomblin Y. A volume of Fomblin dissolves approximately 20 times more O2 than an equal volume of water. Hence, when a volume of aqueous solution which was in equilibrium with air is enclosed with an equal volume of Fomblin which had been flushed with argon, oxygen would diffuse into the Fomblin, leaving in the water only 5% of the oxygen that was there. When the Fomblin is stirred, diffusion is rather rapid. The residue can be removed either by placing an oxygen scavenger on the other side of the Fomblin or by flowing a trickle of deoxygenated Fomblin through the sample. Diphenylhexatriene, a fluorescent probe of cell membranes, can be dissolved in Fomblin Y and has a fluorescence lifetimes extending from 12 ns in O2 saturation to 30 ns (!) in the absence of oxygen. Stern-Volmer plots calibrated against a Clark electrode validate this system for oximetry. A general purpose anaerobic cuvette for fluorescence spectroscopy, containing the sample solution, a Fomblin compartment and the oxygen scavenger Na-dithionite is demonstrated.

Diphenylhexatriene↗
PubMed1997

The unreamed tibial rod in open tibial fractures.

BACKGROUND: Open tibial fractures may be managed surgically by either external fixation or the intramedullary rod. If a rod is used, the delayed removal of the locking screws has been advocated to enhance fracture healing. The aim of the present study was to report the results of closed unreamed locked tibial rods in open fractures and evaluate the effect of locking screw removal. METHODS: Fifty-one patients with open tibial fractures were treated by debridement, intravenous antibiotics, soft-tissue coverage and closed, unreamed, locked intramedullary rods. Forty-six patients were available for review at an average of 13.7 months after surgery. RESULTS: Union occurred at a mean of 240 days (168.1-312.3 CI). Five (10.8%) patients required bone grafting (two required a bone graft alone, three with exchange rods). Deep infection occurred in three (6.5%) cases, and malunion occurred in seven (15.2%) cases. Locking screw failure occurred in five (11%) cases. There was no significant association between removal of the locking screws, injury type and time to union when comminution was controlled for (P = 0.54). CONCLUSIONS: These results compare favourably to other methods of treatment for open fractures and suggest that removal of locking screws does not alter the time to union.

Bone Screws↗
PubMed1997

Attitudes of rural general practitioners towards undergraduate medical student attachments.

OBJECTIVE: Increasing exposure of undergraduate medical students to rural practice is a key component of the national effort in Australia to redress the rural workforce shortage. For this exposure to be successful, willing cooperation of current rural general practitioners is essential. To date there has been no formal assessment of rural general practitioners' attitudes to having undergraduate medical students attached to their practice. METHOD: A descriptive survey, using a mailed questionnaire was sent to all 316 general practitioners currently practising in rural areas of South Australia, as identified from the database maintained by the South Australian Rural Practice Training Unit. RESULTS: A 71.5% response rate (n = 225) was achieved, of which 203 were eligible for inclusion. Of these, 176 doctors had medical student attachments in their practice on at least one occasion; 74.4% of whom (n = 131) perceived the attachments to have a positive experience on their continuing medical education experience, and 81.1% (n = 142) described a positive experience on their professional development. However, 52.6% (n = 92) felt the attachments had a negative effect on their income. Almost all the doctors who were included in the survey (94.6%, n = 192) were willing to have students attached to their practice in the future for between one to two weeks. Of these, 169 wanted quality assurance points, 112 wanted financial reimbursement, and 108 wanted 'academic status' with a university. CONCLUSION: The results suggest that rural general practitioners are willing to have students attached to their practice for periods between one to two weeks, providing they receive quality assurance points, and to a lesser extent, financial reimbursement and academic status.

Attitude of Health Personnel↗