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Biomedical subjects

D Thomas

Publications and source records attributed to D Thomas.

At least 73 records · Page 4Linked to original sources
PubMed2003

Acute bilateral thalamic necrosis in a child with Mycoplasma pneumoniae.

A previously neurodevelopmentally intact 5-year-old male was admitted to hospital with a right lower lobe pneumonia with pleural effusion, subsequently confirmed to be a Mycoplasma pneumoniae infection. On the seventh day of the illness he had a prolonged generalized tonic or tonic-clonic convulsion, requiring intubation and ventilation. He was slow to regain consciousness (Child's Glasgow Coma Score 7-10 over 6 days) and brain imaging with CT and then MRI demonstrated bilateral thalamic lesions with oedema and central haemorrhage suggestive of acute bilateral thalamic necrosis, without striatal or white-matter involvement. He was treated with a 2-week course of erythromycin, and as an autoimmune process was considered possible, 5 days of intravenous methylprednisolone (20 mg/kg/day) followed by a 4-week oral prednisolone taper. He made a slow recovery over the next few weeks with almost complete neurological recovery by 2 months but with significant dysarthria, drooling, and a mild left hemiparesis. At 9 months, significant dystonia continued to affect his speech and, together with tremor, his upper-limb fine motor function bilaterally. His gait, personality, and higher cognitive functions appeared to have recovered fully. Although acute striatal necrosis, acute disseminated encephalomyelitis, and encephalitis have been reported with Mycoplasma pneumoniae and a similar picture of acute bilateral thalamic necrosis with influenza-A ('acute necrotizing encephalopathy'), this is the first reported case of Mycoplasma pneumoniae-associated isolated acute bilateral thalamic necrosis.

Acute Disease↗
PubMed2003

Oral glutamine in paediatric oncology patients: a dose finding study.

OBJECTIVE: The purpose of this study was to determine the most appropriate dose of oral glutamine to use in a further clinical study in paediatric oncology patients. DESIGN: This was a phase I, pharmokinetic study. SETTING: The study was carried out at The Yorkshire Regional Centre for Paediatric Oncology and Haematology, St James's University Hospital, Leeds, UK. SUBJECTS: Thirteen patients undergoing treatment for paediatric malignancy participated in this study. All 13 completed the study. INTERVENTIONS: The most appropriate dose was determined by patient acceptability and by plasma glutamine and ammonia levels measured at timed intervals after ingestion of a single glutamine dose. RESULTS: Doses of 0.35, 0.5 and 0.65 g/kg were well tolerated with no untoward plasma glutamine and ammonia levels. One patient was recruited to a higher dose of 0.75 g/kg, but the plasma glutamine and ammonia levels peaked at 2601 and 155 micro mol/l, respectively. The ammonia level was greater than the acceptable upper limit. It was difficult to disperse the glutamine adequately at this dose, resulting in the suspension being found to be unpalatable and therefore no further patients were recruited at this dose. CONCLUSION: It was concluded that 0.65 g/kg is a safe dose of glutamine to use in a clinical study in paediatric oncology patients.

Administration, Oral↗
PubMed2003

Better detection of FLT3 internal tandem duplication using peripheral blood plasma DNA.

Somatic mutation of the FLT3 gene as an internal tandem duplication (ITD) of the juxtamembrane domain-coding sequence causes constitutive tyrosine phosphorylation and activation. Tumor-specific DNA has been documented in the sera of patients with solid tumors even when it is in an early stage. We compared the detection of FLT3 ITD in DNA extracted from cells of bone marrow (BM) aspirations with DNA extracted from peripheral blood (PB) plasma in patients newly diagnosed with acute myeloid leukemia (AML; 85 patients), myelodysplastic syndrome (MDS; 16 patients), and acute lymphocytic leukemia (ALL; 16 patients). FLT3 ITD was detected in 18 (21%) AML samples and in one (6%) MDS sample in both cellular and plasma DNA but in none of the ALL samples. Hemizygous/homozygous FLT3 ITD was detected in five (28%) of the FLT3 ITD-positive AML using plasma DNA, whereas only four of these cases showed hemizygous/homozygous FLT3 ITD using cellular DNA. The presence of FLT3 ITD was associated with significantly shorter survival (P = 0.02) when only patients younger than 50 years of age (48 AML+MDS patients) were considered. This finding was independent of cytogenetics in this age group. However, patients with the FLT3 ITD hemizygous/homozygous phenotype had even shorter survival (P = <0.001). As expected, the presence of FLT3 ITD correlated with higher white blood cell (WBC) counts. These data demonstrate that plasma DNA is a reliable alternative resource for detecting FLT3ITD, especially the hemizygous/homozygous genotype. Furthermore, the data derived from this study support the notion that the presence of FLT3 ITD in conjunction with the absence of the wild-type FLT3 allele predicts an especially poor prognosis for patients with AML.

Acute Disease↗
PubMed2003

Regional dissemination of Salmonella enterica serovar Enteritidis is season dependent.

OBJECTIVE: To carry out epidemiological typing of clinical isolates of Salmonella enterica serovar Enteritidis by pulsed-field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD) and analysis of their antibiotic resistance. METHODS: Over a 12-month period, 44 Salmonella Enteritidis isolates, recovered from 40 patients admitted to the University Hospital Center of Amiens, France and from three outpatients, were characterized by the analysis of phenotypic and genotypic traits and clinical data from medical reports. RESULTS: Forty nontyphoidal salmonellosis episodes were diagnosed in hospitalized patients (34 episodes of gastroenteritis, two episodes of bacteremia not affecting other organs, one episodes of bacteremia plus urinary infection, one episodes of bacteremia plus gastroenteritis, one episodes of chronic colitis plus gastroenteritis and one episode of peritonitis), and three carriers were observed in outpatients. By means of PFGE, RAPD and antibiotic susceptibility patterns 44 isolates were subdivided into 16 clonally related groups. Two of them were predominantly implicated in the course of these infections, being responsible for two successive waves of infection, while the others were encountered sporadically.

Adolescent↗
PubMed2003

Development of a continuous aerosol mass concentration measurement device.

A dynamic aerosol mass concentration measurement device has been developed for personal sampling. Its principle consists in sampling the aerosol on a filter and monitoring the change of pressure drop over time (Delta P). Ensuring that the linearity of the Delta P = f(mass of particles per unit area of filter) relationship has been well established, the change of concentration can be deduced. The response of the system was validated in the laboratory with a 3.5 microm alumina aerosol (mass median diameter) generated inside a 1-m(3) ventilated enclosure. As the theory predicted that the mass sensitivity of the system would vary inversely with the square of the particle diameter, only sufficiently fine aerosols were able to be measured. The system was tested in the field in a mechanical workshop in the vicinity of an arc-welding station. The aerosol produced by welding is indeed particularly well-adapted due to the sub-micronic size of the particles. The device developed, despite this limitation, has numerous advantages over other techniques: robustness, compactness, reliability of calibration, and ease of use.

Aerosols↗
PubMed2003

Does the use of a specialised paediatric retrieval service result in the loss of vital stabilisation skills among referring hospital staff?

AIMS: To compare the proportion of airway and vascular access procedures performed by referring hospital staff on critically ill children in two discrete time periods, before and after widespread use of a specialised paediatric retrieval service. METHODS: Transport data were obtained from retrieval logs of all children for whom a paediatric retrieval team was launched in each of two time periods (October 1993 to September 1994; and October 2000 to September 2001). RESULTS: The overall intubation rate was similar in the first and second time periods (83.9% v 79.1%). However, 31/51 (61%) retrieved children were intubated by referring hospital staff in 1993-94, compared to 227/269 (84%) in 2000-01. Referring hospital staff gained central venous access in 11% v 18% and arterial access in 22% v 19% of retrieved children in the first and second time periods respectively. This was in spite of a significant reduction in the proportion of children on whom these procedures were performed. CONCLUSION: Referring hospital staff are performing a greater proportion of initial airway and vascular access procedures undertaken in the stabilisation of sick children retrieved by a specialised paediatric retrieval team. The provision of this service has not resulted in the loss of vital skills at the local hospital.

Catheterization↗
PubMed2003

Biodegradation of cyclic amines by a Pseudomonas strain involves an amine mono-oxygenase.

Pseudomonas putida O1G3 catalyzes the degradation of pyrrolidine and piperidine. This strain can use these compounds as the sole source of carbon, nitrogen, and energy. When the cyclic amines were used as the growth substrates, the synthesis of a soluble heme amine mono-oxygenase was induced in this bacteria. This observation was confirmed by spectrophotometric analysis and specific inhibitor. This mono-oxygenase is a NADH-dependent enzyme and catalyzes the cleavage of the C-N bond of the pyrrolidine and piperidine ring by a mechanism similar to a N dealkylation. This reaction could be followed by ring cleavage to form gamma-aminobutyraldehyde oxidized to gamma-aminobutyrate. Further investigations to purify the heme-containing mono-oxygenase are in progress.

Amines↗
PubMed2003

Delayed repair of a fractured penis: a new technique.

Fracture of the penis can be managed conservatively or surgically. Conservative management is associated with a high morbidity, and early surgical repair of the fracture is usually recommended in order to prevent complications. Because a fractured penis is swollen throughout its length, it is difficult to identify the fracture site accurately, so a degloving technique is usually used to locate and repair the torn corpus cavernosum; this can lead to further trauma and complications. In cases where extensive swelling makes accurate clinical localisation difficult, delaying the repair for 7-12 days facilitates easy identification and repair of the torn corpus cavernosum. We report three cases where treatment was delayed until the swelling had subsided, when a simple direct repair was successfully carried out.

Adult↗
PubMed2003

[Causes of uncontrolled hypertension. DUO-HTA survey].

OBJECTIVES: To identify the socio-demographic, clinical, psycho-behavioural and therapeutic factors explaining uncontrolled blood pressure in a population of hypertensives in ambulatory practice. METHODS: The DUO-HTA survey is a national, cross-sectional, mirrored, observational study, from a representative sample of 347 general practitioners (MG) and 210 cardiologists, and a population of 2022 hypertensive patients followed by these doctors. The data were collected by means of questionnaires completed by the hypertensives and their doctors. RESULTS: The factors significantly discriminating patients for whom BP was controlled (C) from those patients whose BP was not controlled (NC) were an age less than 65 years, smoking, obesity, alcohol consumption, sedentary lifestyle and multiple anti-hypertensive treatment. On the psycho-behavioural front, the NC patients were more often anxious and irritable, claiming to lead a stressful life and for whom hypertension was often perceived as a "foreign entity" and a source of frustration and multiple deprivations. The factors discriminating the NC doctors from the C doctors were essentially psycho-behavioural, with the NC doctors considering the management of hypertension as being less gratifying, and hypertension as a condition with fluctuating progression, poorly understood and dramatized by patients. CONCLUSION: The DUO-HTA survey underlines the weight of reciprocal representation systems in hypertension for patients and their doctors, as well as the quality of the doctor-patient relationship in blood pressure control. It prompts the development of sensitisation actions for practitioners centered on improving the doctor-patient relationship.

Adult↗
PubMed2002

Regulating dental nursing in the UK.

There has been much discussion about the impending legislation for compulsory registration of dental nurses. A questionnaire survey of Oxfordshire dental practices found that 60% (153/254) of dental nurses had no formal qualifications. Of these 49% (75/153) were already on a training course or planning to apply for one although those who achieve mediated entry may discontinue training. Overall, 40% (62/153) were planning to apply for mediated entry. Previous research indicates that there may be similarly high proportions of unqualified dental nurses throughout the UK. There are concerns that a rigid training programme and compulsory examinations will compound existing recruitment problems, and create a national shortfall of dental nurses. Proponents believe that formal training will better equip dental nurses to handle the demands of modern dental practice and bring them in line with other auxiliary health personnel. Training needs to be co-ordinated nationally to ensure adequate access and consistent standards. Dental nurses and practices should be consulted and supported throughout the implementation period.

Dental Assistants↗
PubMed2002

[Baseline characteristics and management of patients less than 45 years of age hospitalized for acute coronary syndromes: results from the nationwide French PREVENIR 1 and PREVENIR 2 studies].

Of 2,626 patients admitted for acute coronary syndromes and participating in the PREVENIR 1 and 2 registries, 202 (8%) were aged less than 45 years. Younger patients were more often smokers (79% versus 37%), but systemic hypertension and diabetes were less frequent. Reperfusion therapy was more frequently used in the younger patients (63% versus 46%). At hospital discharge, aspirin and angiotensin converting enzyme inhibitors were prescribed as often in younger and older patients. In contrast, beta-blocking agents and statins were used more often in the younger patients. More younger patients participated in a cardiac rehabilitation programme. Left ventricular ejection fraction was less altered in the younger age group and none of the younger patients died between hospital discharge and six months follow-up.

Adrenergic beta-Antagonists↗
PubMed2002

[Evaluation of the efficacy of a multiresistant bacteria control programme in a teaching hospital, studying the evolution of methicillin-resistant Staphylococcus aureus incidence].

Methicillin-resistant Staphylococcus aureus (MRSA) constitute the most important multiresistant bacteria (MRB) recovered in French hospitals. Our objective was to measure these MRSA diffusion in our hospital to evaluate the MRB control programme which had been implemented in the beginning of 1999. This study was conducted in a teaching hospital containing 1800 beds, from February 1999 to January 2001. All MRSA isolated in clinical samples were included. Duplicates (same bacteria in the same patient) were excluded. The detection of methicillin-resistance was performed at 30 degrees C, by disk diffusion method. Incidence densities were determined with their 95% confidence interval (CI 95%). Their evolution by four-month period was evaluated with the chi-square test for trend. During the two-year period, 866 MRSA were isolated. The global incidence was 0,88 per 1000 patient-days (PD) (IC 95% = left open bracket 0,83-0,93 right open bracket ). For cases acquired in our hospital the incidence was 0,66 per 1000 PD, whereas it was 0,26 per 1000 PD for imported cases. Concerning the evolution of incidences, no significant trend was observed for global incidence. The incidence of acquired MRSA decreased during the first year, but increased thereafter. The incidence of imported MRSA increased with a significant trend (p < 10(-5)). The number of these imported MRSA isolated in our hospital was twice fold higher in 2000. This study emphasizes an important actual problem : the increase of patient colonization pressure at the time of admission in hospitals. This increase, which can be due in part to a community transmission, is responsible for a reduction of the efficacy of MRSA control programmes.

Chi-Square Distribution↗
PubMed2002

Antibody proteases: induction of catalytic response.

Most of the data accumulated throughout the years on investigation of catalytic antibodies indicate that their production increases on the background of autoimmune abnormalities. The different approaches to induction of catalytic response toward recombinant gp120 HIV-1 surface protein in mice with various autoimmune pathologies are described. The peptidylphosphonate conjugate containing structural part of gp120 molecule is used for reactive immunization of NZB/NZW F1, MRL, and SJL mice. The specific modification of heavy and light chains of mouse autoantibodies with Val-Ala-Glu-Glu-Glu-Val-PO(OPh)2 reactive peptide was demonstrated. Increased proteolytic activity of polyclonal antibodies in SJL mice encouraged us to investigate the production of antigen-specific catalytic antibodies on the background of induced experimental autoimmune encephalomyelitis (EAE). The immunization of autoimmune-prone mice with the engineered fusions containing the fragments of gp120 and encephalitogenic epitope of myelin basic protein (MBP(89-104)) was made. The proteolytic activity of polyclonal antibodies isolated from the sera of autoimmune mice immunized by the described antigen was shown. Specific immune response of SJL mice to these antigens was characterized. Polyclonal antibodies purified from sera of the immunized animals revealed proteolytic activity. The antiidiotypic approach to raise the specific proteolytic antibody as an "internal image" of protease is described. The "second order" monoclonal antibodies toward subtilisin Carlsberg revealed pronounced proteolytic activity.

Animals↗
PubMed2002

[The pathogenesis of type 2 diabetes--new aspects and clinical consequences].

Type 2 diabetes mellitus manifests itself in individuals who lose the ability to produce sufficient quantities of insulin to maintain normoglycemia in the face of insulin resistance. The ability to secrete adequate amounts of insulin depends on beta-cell function and mass. The endocrine pancreas has a remarkable capacity to adapt to conditions of increased insulin demand and only a minority of individuals fail to adapt and become diabetic with time. Secondary events that further reduce the function of beta-cells in type 2 diabetes mellitus are the so-called beta-cell gluco- and lipotoxicity: chronic stimulation of islets by high glucose and free fatty acid levels results in the reduction of insulin secretion. Part of these effects are reversible once these metabolites are normalized and the beta-cell re-exposed to a physiologic environment. The essential role of the beta-cell failure in type 2 diabetes is reminiscent to the pathophysiology of type 1 diabetes. The possible link between both diseases and the therapeutic implications are discussed.

Blood Glucose↗