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Biomedical subjects

D Stevens

Publications and source records attributed to D Stevens.

At least 55 records · Page 3Linked to original sources
PubMed1995

The effect of iron in formula milk after 6 months of age.

Ninety two normal birthweight infants aged 6 months entered a double blind controlled trial which compared a follow on formula milk with no added iron against the same formula milk containing 1.2 mg of iron per 100 ml. There was no significant difference in the social class or demographic characteristics of the two treatment groups or in the proportion of each group completing the trial. There was no difference between the two groups in the quantity of milk taken but the amounts taken lessened between 6 and 18 months of age. There was no difference between the two groups with respect to mean haemoglobin and median serum ferritin at 6, 9, 12, 15, and 18 months of age. Very few infants developed iron deficiency anaemia in either group but there was a tendency for serum ferritin levels to fall between 6 and 18 months of age in both groups. The results suggest that iron added to follow on milk was not an important source of dietary iron in the infants studied.

Anemia, Iron-Deficiency↗
PubMed1995

Persistent grossly elevated erythrocyte sedimentation rate in elderly people: one year follow-up of morbidity and mortality.

The significance of a very elevated erythrocyte sedimentation rate (ESR) in elderly patients is debated. In a retrospective study, we searched the records of a laboratory providing the sole service to a health district for ESR measurement and identified all non-surgical and non-psychiatric patients over the age of 65 who had had an ESR above 50 mm/h. Diagnoses and mortality in a 1-year follow-up were determined from case notes. Four hundred and nine subjects (median age 75; range 65-99) were identified and data on 401 of these (155 male, 246 female; median ESR 80 mm/h, range 50-148) were adequate for 1 year follow-up. Forty-eight percent had a persistently raised ESR (two values > 50 mm/h separated by at least 14 days; group 1); 39% had a single ESR measurement only (group 2), and 13% had a transiently raised ESR (group 3). The commonest diagnosis in group 1 patients was rheumatological disease (51.8%), followed by infection (31.9%) and non-haematological malignancy (11%). Infection was the commonest diagnosis in groups 2 (47.4%) and 3 (43.7%), followed by non-haematological malignancy (19.9%) in group 2 and rheumatological disease (20.4%) in group 3. In only 1 in 20 cases was no diagnosis apparent at 1 year. The standardised mortality ratio (SMR) of the combined groups 1 and 2 (482; CI: 421-544) was strikingly raised, and even more so if patients with rheumatoid arthritis were excluded (542; CI 458-625). Where there were sufficient numbers of deaths to make SMR estimations valid, a gradient of mortality against the level of the ESR could be observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

Measuring disability in juvenile dermatomyositis: validity of the childhood health assessment questionnaire.

OBJECTIVE: Physical disability is perhaps the most important outcome of juvenile dermatomyositis (JDM). No functional assessment tool has been validated for inflammatory myopathies either in children or adults. We studied the measurement properties of the Childhood Health Assessment Questionnaire (CHAQ) in children with JDM. METHODS: We studied 37 patients followed at the JDM clinic and compared the results obtained by the CHAQ to a global disease severity score and quantitative muscle strength testing measured by sphygmomanometry (construct validity). We also measured the reliability of the CHAQ and its responsiveness to clinical change. RESULTS: For the initial measurement of each subject, the correlation between disease severity and CHAQ was high [Spearman's correlation, (rs = 0.71, p < 0.002)]. Disability as measured by the CHAQ was inversely correlated with proximal muscle strength (hip abduction rs = -0.57, p < 0.002; shoulder abduction rs = -0.51, p < 0.01) but, as expected, less so with more distal muscle strength (knee extension rs = -0.40, p = 0.05; grip strength rs = -0.079, p > 0.20). The CHAQ was reliable in subjects who showed no clinical change in muscle strength (intraclass correlation coefficient = 0.87) and responsive to treatment induced clinical change (responsiveness coefficient = 0.90). CONCLUSION: The CHAQ can serve as a valid and sensitive tool in the evaluation of functional outcomes in JDM.

Adolescent↗
PubMed1995

A new glucose-6-phosphate dehydrogenase variant, G6PD Orissa (44 Ala-->Gly), is the major polymorphic variant in tribal populations in India.

Deficiency of glucose-6-phosphate dehydrogenase (G6PD) is usually found at high frequencies in areas of the world where malaria has been endemic. The frequency and genetic basis of G6PD deficiency have been studied in Africa, around the Mediterranean, and in the Far East, but little such information is available about the situation in India. To determine the extent of heterogeneity of G6PD, we have studied several different Indian populations by screening for G6PD deficiency, followed by molecular analysis of deficient alleles. The frequency of G6PD deficiency varies between 3% and 15% in different tribal and urban groups. Remarkably, a previously unreported deficient variant, G6PD Orissa (44 Ala-->Gly), is responsible for most of the G6PD deficiency in tribal Indian populations but is not found in urban populations, where most of the G6PD deficiency is due to the G6PD Mediterranean (188 Ser-->Phe) variant. The KmNADP of G6PD Orissa is fivefold higher than that of the normal enzyme. This may be due to the fact that the alanine residue that is replaced by glycine is part of a putative coenzyme-binding site.

Base Sequence↗
PubMed1994

The management of long bone fractures in the head-injured polytrauma patient.

The polytrauma patient who sustains a significant head injury (head and neck Abbreviated Injury Scale of 3 or greater) will require prolonged and technically demanding operative intervention for musculoskeletal and associated soft tissue trauma. The presence of a head injury may delay the immediate surgical intervention for long bone injuries, which has proven to have major advantages for patient care and well-being. This retrospective review of the Sunnybrook Health Science Centre experience between January 1, 1986, and June 1, 1988, identified 153 polytrauma patients with a significant head injury. Forty-five died from complications unrelated to their long bone injuries or treatment thereof, not surviving long enough to reach the operating room for stabilization of their long bone fractures. The 108 survivors sustained 188 long bone injuries, 63 of which were open fractures. Twenty patients were treated nonoperatively. The 88 patients treated operatively had 12 complications: one peroneal nerve palsy; five cases of sepsis (three in open fractures and all resolving with removal of fixation devices); three malunions; and three cases of delayed union. Sixty-nine patients (78%) were available for long-term follow-up, 64 (93%) making a full recovery. Seven required additional surgery to achieve this goal and another patient awaits an ankle arthrodesis. Examining the head and neck AIS and Injury Severity Score of this group showed that 50 (46%) of these patients were expected to die and 22 (44%) made a full recovery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Nursing students' knowledge and anxiety about AIDS: an experimental workshop.

The purpose of this quasiexperimental study was to examine the effectiveness of an experiential workshop on nursing students' anxiety and knowledge about AIDS. This study was based on Peplau's interpersonal theory in nursing practice. The sample included 67 senior nursing students and was designed as a three-group pre/post quasiexperiment. All groups received a pretest, posttest, and 6-week follow-up posttest. The experimental intervention was a 6-hour workshop that included anxiety awareness exercises in an experiential format and information about AIDS. Knowledge and anxiety scores were significantly higher for the group that attended the didactic portion of the workshop before the experiential portion. The control group showed no change in knowledge or anxiety. Results indicated that recognition of anxiety through experiential exercises contributed to learning about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Episodes of care for chest pain: a preliminary report from MIRNET. Michigan Research Network.

BACKGROUND: Although intensively studied in hospital and emergency settings, chest pain has remained largely unstudied in primary care, where it is associated with considerable diagnostic uncertainty and high utilization of medical resources. METHODS: We employed an established primary care research network to prospectively collect detailed information on episodes of care for chest pain. Over a 12-month period, Michigan Research Network (MIRNET) clinicians prospectively collected demographic, clinical, and clinician decision-making information for all patients seen in their offices with the complaint of chest pain. RESULTS: Three hundred ninety-nine complete episodes were collected and used for analysis. Episodes were well distributed among urban, rural, academic, and private sites. The average episode length was 1.53 visits. Musculoskeletal chest pain accounted for 20.4% of all diagnoses, followed by reflux esophagitis (13.4%) and costochondritis (13.1%). Stable angina pectoris was the primary diagnosis in only 10.3% of episodes, unstable angina or possible myocardial infarction in 1.5%. Most of the ancillary services used were directed toward finding or excluding cardiac disease. CONCLUSION: A practice-based network can be used to study episodes of care. Resource use during episodes of chest pain in primary care are directed toward exclusion of cardiac disease, despite the surprisingly low frequency of cardiac diagnoses.

Adult↗
PubMed1993

Investigation of urinary tract infection in childhood.

OBJECTIVES: To determine the number of laboratory confirmed urinary tract infections in children and to ascertain general practitioners' practices and attitudes towards their investigation and management. DESIGN: Prospective one year survey of urine specimens submitted for bacteriological investigation; review of radiology department records; questionnaire survey of general practitioners. SETTING: Gloucester health district. SUBJECTS: 57,432 children aged < 15 and 7143 children aged < 2 registered with a general practice in Gloucester health district and their 195 general practitioners. RESULTS: 4317 urine specimens were submitted from children aged < 15, of which 563 from 442 children were culture positive. The rate (number/100 children/practice) of culture positive urine specimens in these children varied more than 10-fold between general practices, and this correlated closely with the rate of referral of urine specimens for investigation. A follow up specimen to check for clearance of infection was taken in 22% (125/563) of infections. Of the 821 specimens submitted from children aged < 2, 103 from 89 children were positive. Of these children, 28 underwent radiological imaging. Most general practitioners would aim to obtain bacteriological confirmation of urinary tract infection on weekdays but only a minority said they would do so at weekends. They were apparently more likely to refer boys and younger children for renal tract imaging after a first urinary tract infection. CONCLUSIONS: Urinary tract infection in children was underdiagnosed, and after a confirmed infection only a minority of patients received renal tract imaging or microbiological follow up. Greater awareness of the importance of investigation and management of urinary tract infection in children is needed, and the practical difficulties faced by general practitioners must be resolved.

Adolescent↗
PubMed1993

Temporal relationship of cytokine release by peripheral blood mononuclear cells stimulated by the streptococcal superantigen pep M5.

We undertook this study to determine the quality, quantity, and temporal relationship of pep M5-induced cytokine release. The ability of pep M5 to stimulate interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-alpha) production by a T-cell-depleted, monocyte- and B-cell-enriched cell population was dependent on the presence of T cells. The requirement for T cells could be met by addition of exogenous gamma interferon (IFN-gamma). In the presence of IFN-gamma, pep M5 induced the release of TNF-alpha, IL-1, and IL-6, TNF-alpha levels peaked at 24 h, while IL-1 and IL-6 levels peaked at 48 h. pep M5 induced T cells to produce IFN-gamma, which may have accounted for the ability of the super antigen to induce the production of IL-1, IL-6, TNF-alpha, and TNF-beta by peripheral blood mononuclear cells (PBMC). The addition of excess IFN-gamma to cultures of pep M5 and PBMC did not further increase the release of these cytokines at 24 and 48 h but resulted in sustained higher levels at 72 h. Interestingly, TNF-beta production occurred only in the presence of pep M5 and exogenous IFN-gamma. The ability of pep M5 to induce cytokine production was compared with that of a potent super antigen, staphylococcal enterotoxin B (SEB). SEB was a 2- to 14-fold-more-potent inducer of IFN-gamma production. Furthermore, the profile of cytokine released by PBMC in response to this super antigen mimicked that seen with pep M5 in the presence of exogenous IFN-gamma. In conclusion, pep M5 induces the production of cytokines that are involved in immune regulation and inflammation. These cytokines also play a major role in human T-cell responses to this super antigen.

Adult↗
PubMed1993

Trauma on the Isle of Man.

The Isle of Man Tourist Trophy motorcycle races remain one of the most popular venues for motorcycle races. This is despite the reduced status of the event. The reason for the loss of world championship and formula one status is the nature of the road racing circuit itself. The twisting narrow roads are only closed to the public at certain times during the practice and race weeks. Motorcycling visitors to the event attempt to emulate their heroes on machines capable of high speeds. Casualties from both visitors and racers are dealt with efficiently by an expanded medical service. This includes the use of an aeromedical evacuation helicopter. Casualties from the visitors exceeded those from the racers themselves during the period reported.

Accidents, Traffic↗
PubMed1992

Purification and characterization of the lethal toxin (alpha-toxin) of Clostridium septicum.

Clostridium septicum lethal (alpha-toxin) was purified and found to be a basic protein (pI 8.4) of approximately 48 kDa that is both lethal and hemolytic. The alpha-toxin had a hemolytic activity of approximately 2 x 10(7) hemolytic units per mg and a 50% lethal dose of approximately 10 micrograms/kg of body weight for mice. The alpha-toxin formed concentration-dependent, sodium dodecyl sulfate-resistant aggregates of approximately 230 kDa. Mice immunized with alpha-toxin showed a significant increase in survival time over mock-immunized mice when challenged with C. septicum. Rabbit polyclonal antibody was generated against the purified toxin and was used to confirm that toxin with the same molecular weight was present in seven different C. septicum isolates. No proteins in the supernatants from cultures of Clostridium perfringens, Clostridium histolyticum, Clostridium chauvoei, or Clostridium difficile were found to react with the C. septicum alpha-toxin-specific antibody.

Animals↗