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Biomedical subjects

E Thomas

Publications and source records attributed to E Thomas.

At least 127 records · Page 7Linked to original sources
PubMed1998

Outcome of low back pain in general practice: a prospective study.

OBJECTIVES: To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month. DESIGN: Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation. SETTING: Two general practices in south Manchester. 490 subjects (203 men, 287 women) aged 18-75 years. MAIN OUTCOME MEASURES: Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months. RESULTS: Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability. CONCLUSIONS: The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

Adolescent↗
PubMed1998

Computer model of antiepileptic effects mediated by alterations in GABA(A)-mediated inhibition.

Results from a computer model of a thalamic network predict that agents augmenting GABA(A)-mediated inhibition in the reticular thalamic (RE) nucleus will be antiepileptic or desynchronizing. This provides support for the hypothesis that antiepileptics like benzodiazepines may exert their effects through an isolated increase of inhibition in the RE nucleus. When desynchronized, the model thalamocortical neurons showed a decreased probability of firing a low threshold spike, a decreased secondary inhibitory postsynaptic potential and a higher frequency of oscillations. The transition to desynchrony was also accompanied by an increased frequency in the firing of the model RE neurons.

Anticonvulsants↗
PubMed1998

CD40 ligand/CD40 stimulation regulates the production of IFN-gamma from human peripheral blood mononuclear cells in an IL-12- and/or CD28-dependent manner.

CD40 ligand (CD40L)/CD40 costimulation is an important regulator of Th1 responses. Two mechanisms by which CD40L/CD40 stimulation may enhance IFN-gamma are via direct induction of IL-12 and augmentation of the expression of costimulatory molecules such as B7 from APCs. We examined the ability of CD40L/CD40 stimulation to regulate the production of IFN-gamma through IL-12 and/or CD28 costimulation from human PBMCs stimulated with T cell-specific stimuli. The roles of exogenous and endogenous CD40L/CD40 stimulation were evaluated using a trimeric soluble CD40L agonist (CD40T) and an anti-CD40L Ab, respectively. The presence of CD40T in cultures increased the production of IL-12 and IFN-gamma from PBMCs stimulated with varying amounts of PHA. The mechanism, however, by which CD40T enhanced IFN-gamma varied according to the level of T cell activation. Under maximal stimulatory conditions (PHA, 1/100), an IL-12-dependent pathway was dominant. At relatively low levels of T cell stimulation (PHA, 1/500 and 1/1000), however, an additional IL-12-independent CD28-dependent pathway was elucidated. We further studied the role of exogenous CD28 stimulation in regulating the production of IFN-gamma. The enhancement of IFN-gamma production induced by direct CD28 stimulation was primarily dependent on endogenous IL-12 or CD40L/CD40 stimulation. Together, these data suggest that the production of IFN-gamma involves a complex interaction between two interdependent, yet distinct, costimulatory pathways and provide evidence that CD40T may be an effective adjuvant for the enhancement of responses.

Adjuvants, Immunologic↗
PubMed1998

Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care.

STUDY DESIGN: Comparison of spinal movements in new attenders to primary care with an episode of low back pain with a sample with no recalled history of ever having had low back pain. OBJECTIVES: To examine the association between restriction of spinal movement and the presence of low back pain in primary care. SUMMARY OF BACKGROUND DATA: The presence of restriction in spinal mobility has frequently been investigated by specialists in the clinical setting. What is not known, however, is whether an association exists between pain and restriction in those newly presenting to primary care and whether these measurements can be used to discriminate between those with and without back pain. METHODS: The study participants consisted of 344 consulters to two general practices, prospectively ascertained in the South Manchester Back Pain Study, who were compared with 118 individuals from the same practices who denied ever having back pain. The two groups were compared for right and left lateral flexion, standing extension, modified Schober's test, finger-to-floor distance, and right and left knee extension. RESULTS: There was a statistically significant reduction in all planes in those with low back pain. Modified Schober's, standing extension, and left knee extension were the most discriminatory, with likelihood ratios of approximately 5 for the optimal cutoff. Restriction of three or more of these seven movements was observed in 50% of the low back pain cases and in less than 5% of the pain-free participants. Stratification by presence or absence of radiation of pain to the legs did not alter these findings. CONCLUSIONS: Measures of spinal mobility are restricted to varying extents in a community-based sample of subjects with low back pain. Maximal discrimination was observed when restriction was present in three or more planes. The utility of these measures in predicting outcome remains to be assessed.

Adult↗
PubMed1998

CD40 ligand and IFN-gamma synergistically restore IL-12 production in HIV-infected patients.

IL-12 production in HIV-infected (HIV+) individuals is severely impaired after stimulation by bacterial products or T cell-dependent stimuli. Because CD40-CD40 ligand (CD40L) interactions are the major mechanism involved in the T cell-dependent activation of antigen-presenting cells, we investigated whether this pathway was functional in HIV+ donors. CD40 expression was increased on freshly isolated monocytes from HIV+ individuals compared to HIV donors. However, equivalent CD40 expression was obtained in the two groups after cytokine stimulation. Since CD40 expression was intact in HIV+ donors' cells, we determined whether IL-12 production could be restored by providing exogenous T cell-dependent stimuli, CD40L and IFN-gamma, at the time of bacterial stimulation. IL-12 production was not altered by CD40L alone, was increased by IFN-gamma, and was synergistically restored to normal values by IFN-gamma + CD40L. This combination was more efficient for enhancing IL-12 production than granulocyte-macrophage colony-stimulating factor + CD40L or neutralizing anti-IL-10 antibody + CD40L. CD40L did not affect IL-10 production, whereas IFN-gamma significantly decreased it. This study demonstrates that the defect in IL-12 production by leukocytes from HIV+ donors can be overcome in vitro if the interacting cells are provided with the right T cell-dependent co-stimuli.

Adult↗
PubMed1998

Multiplex polymerase chain reaction of Alu polymorphic insertions.

Alu sequences are present in humans in excess of 500,000 copies per haploid genome and represent the largest family of short interspersed repetitive elements (SINEs). These mobile genetic elements are ancestrally derived from the 7SL RNA gene and move throughout the genomes of primates by retroposition. Polymorphic Alu insertions have proven to be useful for population studies, paternity determinations and forensic applications. Additionally, a simple polymerase chain reaction (PCR)-based assay has been established to examine these polymorphisms. In the present study, we have applied the technique of multiplex polymerase chain reaction to the Alu polymorphic system. Duplex and triplex PCR reactions were performed for the analysis of five different Alu polymorphic loci in different combinations. This study represents a starting point for further experimentation to improve and eventually optimize Alu multiplex PCR.

Alu Elements↗
PubMed1998

Identification of H. pylori in saliva by a nested PCR assay derived from a newly cloned DNA probe.

A novel probe was developed from genomic DNA of Helicobacter pylori ATCC type strain 43629. It hybridized with all 73 H. pylori clinical isolates tested but not with any of 183 non-H. pylori DNAs in dot blot hybridization. Typing tests revealed 41 different HaeIII-digestion patterns from 57 H. pylori strains tested. Based on the sequence of the probe, a nested PCR was developed that detected as little as 2 fg of H. pylori DNA or approximately equivalent to one cell. No PCR products were amplified from any of 21 non-H. pylori strains tested. Using this nested PCR, H. pylori DNA was detected in 33 of 45 (73%) saliva samples collected from patients with gastric H. pylori infection. These data suggest that the probe is useful for typing H. pylori and that the nested PCR is a valuable tool for detecting H. pylori DNA in saliva.

DNA Fingerprinting↗
PubMed1998

Modifying infant stress responses to major surgery: spinal vs extradural vs opioid analgesia.

Twenty-six infants due to undergo major abdominal or thoracic surgery under general anaesthesia were randomized to receive additional analgesia with group A) spinal/epidural analgesia; B) epidural analgesia or C) opioid analgesia with fentanyl. We wished to determine if spinal analgesia followed by epidural analgesia might result in more complete control of cardiovascular or stress responses than the other two treatment groups. Heart rate and blood pressure were recorded at five min intervals throughout surgery. Blood samples were taken for measurement of catecholamines and whole blood sugar on induction, 45 min after skin incision and at the end of surgery. Heart rate rose significantly at the start of surgery in groups B and C but not group A. Systolic blood pressures were higher in group C compared to A and B. The rise in plasma glucose concentrations was significantly different between the groups in the order C > B > A (P < 0.05). A similar trend was seen in the plasma adrenaline and noradrenaline concentrations but this failed to achieve significance due to the limited sample size.

Abdomen↗
PubMed1998

The use of cyclical etidronate in osteoporosis: changes after completion of 3 years treatment.

An open study over 4 yr has been conducted to determine the efficacy of cyclical etidronate treatment in patients from the community, with osteoporosis and in those at risk who attended an osteoporosis clinic; and to clarify whether bone remodelling returns to baseline values and bone mass is maintained after completion of a 3 yr course of treatment. One hundred and fifteen female patients, with and without osteoporotic fractures (n = 62 and 53, respectively), who were unsuitable for, or declined, hormone replacement therapy, received 3 yr cyclical etidronate treatment (400 mg etidronate disodium for 14 days followed by 500 mg elemental calcium for 76 days repeated in 3-monthly cycles) and 1 yr treatment-free follow-up. There was an overall increase in lumbar spine bone density (patients without fractures 2.6%, P < 0.001; with fractures 4.3%, P < 0.01) with minimal change at the femoral neck. The serum concentration of bone formation markers (osteocalcin and bone alkaline phosphatase) fell in response to treatment to a nadir at 6/12 (75 and 83% of baseline, respectively; P < 0.001). A cohort of patients (n = 29), 14 without fractures and 15 with fractures, was studied in more detail. After completion of treatment in the following treatment-free year, there was a resurgence of bone turnover (osteocalcin and bone alkaline phosphatase 117 and 122% of baseline, respectively; P < 0.05 and P < 0.01) with some evidence of maintenance of bone mass already gained. There is no evidence of persistent suppression of bone turnover after completion of treatment.

Aged↗
PubMed1998

Sjögren's syndrome: a community-based study of prevalence and impact.

OBJECTIVE: Using the European Community (EC) criteria for classification Vitali et al. Arthritis Rheum 1993;36:340 7, we report the prevalence estimates of Sjogren's syndrome (SS) from a general population and present the first population data to assess the impact of the syndrome. METHODS: A cross-sectional population-based survey performed on 1000 adults, aged 18-75 yr, randomly selected from a population register. Responders to the initial postal phase were invited for an interview. The five criteria measured at interview were: (1) the reporting of subjective oral symptoms lasting for > 3 months; (2) the reporting of subjective ocular symptoms lasting for >3 months; (3) Schirmer-I test; (4) unstimulated salivary flow; (5) autoantibodies [Ro (SS-A), La (SS-B), rheumatoid factor (RF), antinuclear antibodies (ANA)]. SS was diagnosed if at least four of these five criteria were positive. The MOS Short-form 36 (SF-36), General Health Questionnaire (GHQ) and the Health and Fatigue Questionnaire (HFQ) were completed by subjects after the interview, and scores were compared between those with and without a diagnosis of SS. RESULTS: A total of 341 subjects completed both the postal questionnaire and home visit. A diagnosis of SS could be given to 13 subjects. After adjusting for the presence of possible bias due to non-response, our best estimate of the prevalence of SS in the study population was 33 per 1000 subjects (95% CI 22 44). The prevalence of the disorder was higher in females (38; 95% CI 27-52) and for those subjects aged > or = 55 yr (46; 95% CI 34-61). Those subjects diagnosed positively were more impaired for each of the eight dimensions of the SF-36 than those without a diagnosis, and also suffered from higher levels of depression and fatigue. CONCLUSIONS: SS affects approximately 3-4% of adults and in the general population appears to be associated with a clinically significant impairment of a subject's health and well-being.

Adolescent↗
PubMed1998

Do routine antibiotics after loop diathermy excision reduce morbidity?

OBJECTIVE: To evaluate whether routinely giving an antibiotic after loop diathermy excision of the cervical transformation zone reduced post-operative vaginal loss. DESIGN: Prospective, randomised, double-blind placebo controlled parallel study. PARTICIPANTS: Five hundred women undergoing loop diathermy excision in a colposcopy clinic. INTERVENTION: Administration of either ofloxacin 400 mg (2x200 mg) once daily for 5 days or an identical placebo. MAIN OUTCOME MEASURE: Vaginal loss, assessed using a pictorial chart. RESULTS: No significant difference in post-operative vaginal loss was found. CONCLUSION: Routine antibiotic prophylaxis after loop diathermy excision is not justified.

Adult↗
PubMed1998

Comparative field evaluation of marbofloxacin tablets in the treatment of feline upper respiratory infections.

One hundred and three cats presenting with clinical signs of feline acute upper respiratory infection were selected from Belgium, France and the Netherlands in a randomised comparative field trial. Each cat underwent a bacteriological examination before treatment (day 0) and received either marbofloxacin, at a dosage of 2 mg/kg once daily for five days, or amoxycillin-clavulanic acid (ACA) at a dosage of 12.5 mg/kg twice daily for five days. Clinical examinations were performed on days 2, 5 and 14. Pasteurella species were cultured in one-third of the samples. The other main bacteria isolated were Streptococcaceae, Enterobacteriaceae and Staphylococcaceae. Response rates (cures + improvements) to treatment on day 5 were 87.8 vs 77.8 per cent for marbofloxacin and ACA, respectively. A few mild side-effects (diarrhoea, vomiting) were recorded with both drugs.

Administration, Oral↗
PubMed1998

Weak association between subjective symptoms or and objective testing for dry eyes and dry mouth: results from a population based study.

OBJECTIVES: To determine associations between symptoms of dry eyes and dry mouth and objective evidence of lacrimal and salivary gland dysfunction in a population based sample. To determine associations between these elements and the presence of autoantibodies. METHODS: A cross sectional population based survey. Subjects were interviewed and examined (Schirmer-1 test and unstimulated salivary flow) for the presence of dry eyes and mouth. Antibodies (anti-Ro [SS-A], anti-La [SS-B], rheumatoid factor, antinuclear antibody) were measured. RESULTS: 341 subjects were examined. Twenty four per cent had dry eye symptoms, 29% dry mouth symptoms, and 14% both. There was only a weak association between the presence of oral or ocular symptoms and their respective test results. Associations were strongest between dry mouth symptoms and positive test results, and in subjects under 55 years of age. There was no association between the presence of autoantibodies and either symptoms or signs of dry eyes or dry mouth. CONCLUSION: Only weak associations were found between self reported symptoms of dry eyes and dry mouth and objective measures said to define Sjögrens syndrome in the general population. The clinical significance of these symptoms in the community needs reappraisal.

Adolescent↗
PubMed1998

Psychosocial risks for low back pain: are these related to work?

OBJECTIVES: To examine whether psychosocial risks for low back pain, reported in previous studies, are specific to the working population or are more widely relevant. METHODS: A large population-based survey identified subjects free of low back pain, and obtained information on the degree of satisfaction with work (or not working) and the adequacy of income for their family's needs. New episodes of consulting and non-consulting low back pain were identified prospectively over 12 months. The psychosocial risks for developing a new low back pain episode are examined in employed and non-employed groups separately. RESULTS: Dissatisfaction with work status doubled the risk of reporting a new low back pain episode in both the employed (odds ratio 2.0, 95% confidence intervals 1.2, 3.3) and non-employed (OR 2.0, 1.2, 3.1). Those perceiving their income as inadequate were at a threefold risk of consulting for this symptom regardless of their employment status (employed: OR 3.6, 1.8, 7.2; non-employed: OR 3.6, 1.4, 9.0). CONCLUSION: Psychosocial factors pose similar risks for a new low back pain episode in workers and the non-employed. This suggests that such influences may not be related solely to work but be a function of general aspects of life. The economic and individual impact of psychosocial interventions in the workplace, therefore, are likely to be limited unless account is taken of the influence of broader non-work related aspects.

Adult↗