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Biomedical subjects

D N Ostrow

Publications and source records attributed to D N Ostrow.

6 recordsLinked to original sources

Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection.

To investigate the effect of human immunodeficiency virus type 1 (HIV-1) infection on subsequent hepatitis B virus (HBV) infection, HIV antibody was sought in homosexual men who developed HBV infection during a hepatitis B vaccine trial. Among 134 unvaccinated HIV-1-negative men, 7% became HBV carriers, 64% had viremia, and 42% had clinical illness. Among vaccinated HIV-1-negative men, HBV infection severity decreased with number of vaccine doses administered. When adjusted for prior hepatitis B vaccination status, persons with HIV-1 infection preceding HBV infection had a significantly higher risk of developing HBV carriage, viremia, prolonged ALT elevation, and clinical illness. Among HIV-1-infected men, the risk of HBV carriage was increased in unvaccinated persons (21%) and those who failed to respond to vaccination (31%) and further increased in those who received vaccine doses at the time they developed new HBV infection (56%-80%), suggesting inactivated hepatitis B vaccine may temporarily impair the immune response to HBV infection in HIV-1-infected persons. HIV-1 infection was also associated with reduced alanine aminotransferase elevations during the first 36 months of follow-up of men who became HBV carriers.

Alanine Transaminase

High-resolution computed tomography of chronic interstitial lung disease.

The absence of superimposition of parenchymal structures on HRCT permits better assessment of the pattern and distribution of disease than is possible on the radiograph. Several studies have shown that HRCT is superior to the chest radiograph in the diagnosis and management of patients with chronic interstitial lung disease. High-resolution studies may demonstrate extensive parenchymal disease when the radiograph is normal and allow for a confident diagnosis when the radiographic findings are nonspecific. It is superior to the chest radiograph in determining whether transbronchial or open lung biopsy is indicated, and it is essential in selecting the optimal biopsy site. Although further studies are required to determine the precise role of HRCT in interstitial lung disease, current indications for HRCT include: (1) assessment of patients with symptoms suggestive of infiltrative lung disease but normal or nonspecific findings on the radiograph; (2) further evaluation of the lung parenchyma in patients in whom the radiographic findings are not in keeping with the clinical history or symptomatology; (3) as a guide to the optimal biopsy site in all patients undergoing open or transbronchial biopsy; and (4) assessment of suspected complications (e.g., infection) in patients with diffuse lung disease.

Biopsy

Professional patient-instructors in the teaching of the pelvic examination.

A class of 100 second-year medical students was randomly divided into two groups for instruction in the techniques of the gynecologic examination. Each group received a lecture and a demonstration film. The control group then had practical instruction on office or clinic patients. The study group was instructed by specially trained clinical teaching associates who acted both as professional patients and as teachers. After practice in clinics and offices, both groups received a common evaluation by gynecologists and teaching associates. Students who were instructed by clinical teaching associates performed better on subsequent pelvic examinations and demonstrated superior communications skills compared with the control group.

Educational Measurement

Alpha1-antitrypsin phenotypes and lung function in a moderately polluted northern Ontario community.

To determine whether persons with intermediate value alpha1-antitrypsin phenotypes living in a polluted environment manifest significant abnormalities in lung function, a study was undertaken of an age-, sex- and smoking-stratified sample of 391 persons from the town of Fort Frances, Ont., which has elevated values of total dustfall, suspended particulates and hydrogen sulfide. Indices of pulmonary function were derived from the maximum expiratory flow and the single breath expiratory flow and the single breath expiratory nitrogen washout curves. The percentage frequency of the M, MS and MZ pheontypes was 91.7, 7.3 and 0.8, respectively. There was no significant difference between the M and MS groups as indicated by the nitrogen washout curve and maximum expiratory flow curve. There was no significant difference between the three MZ subjects and the M group. In both M and MS groups smokers displayed evidence of airflow obstruction when compared with nonsmokers. It would appear that, when compared with M subjects, persons with the MS phenotype living in a moderately polluted area show no changes in indicators of pulmonary function, including tests of early airway disease, that cannot be attributed to their smoking habit.

Adult

Learning pulmonary function interpretation: deductive versus inductive methods.

Volunteer undergraduate medical students were randomly divided into 2 groups. One group were given pulmonary function data and the correct diagnoses from 18 patients. They were told to try to derive the rules by which the diagnoses were made. The other group were given the data from the same 18 patients, but were required to use a computer-assisted instructional program to arrive at the diagnoses in a deductive fashion. Both groups were pre- and post-tested. The deductive method provided higher post-test results. The inductive method took longer and produced more dropouts from the study.

Analysis of Variance