Appropriateness of use of emergency ambulances.
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Ambulances↗
Biomedical subjects
E Thomas
Publications and source records attributed to E Thomas.
Case-control study of breast cancer in south east England: nutritional factors.
OBJECTIVES: To explore dietary risk factors, in particular fat intake, for breast cancer, using an approach to reduce recall bias of subjects and so provide a more reliable estimate of dietary intake than previous similar studies. DESIGN: A case-control study of women aged 50-65 years attending the breast assessment clinics of the breast screening programme in Southampton and Portsmouth, southern England. Data were analysed for all women requiring further clinical procedures; all women recalled to have an early rescreen; and a random sample of women found to be normal and referred for a routine rescreening appointment (standard recall). MEASUREMENTS: An interview obtained information on various lifestyle characteristics including smoking and alcohol intake, weight, waist, and hip measurements were also taken at the clinic. Women were given a detailed questionnaire on food intake to complete at home and return by post. RESULTS: 1577 women were included in the study: 220 with breast cancer (cases); 179 with benign breast disease; 353 early rescreen and 825 given a standard recall appointment. There were few differences in nutritional intake between the four groups. Logistic regression analyses were carried out comparing the dietary intake of cases with that of each control group adjusting for important demographic and reproductive factors. Results for the case and standard recall comparison are presented. The only non-calorific nutrient to reach significance was iron, which was negatively associated with risk (p = 0.03). For fat intake, the odds decreased with increasing polyunsaturated fat (p = 0.15), showed no trend with monounsaturated fat (p = 0.37) and increased (p = 0.10) with increasing saturated fat. No pattern was clear for the other calorie providing nutrients. CONCLUSIONS: In line with recent cohort studies, this study has shown no evidence to support the hypothesis that dietary fat is an important contributor to breast cancer rates. Biases should have been reduced by studying subjects from the screening programme who were at an early stage of disease.
Aged↗
Images in medicine. Foreign body aspiration.
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Aged↗
Clinical usefulness of bone alkaline phosphatase in osteoporosis.
We have evaluated two commercial assays for serum bone specific alkaline phosphatase (bALP) as a marker of bone turnover in a group of 35 postmenopausal women with osteoporosis during their first year of treatment with the anti-resorptive drug, alendronate. The immunoradiometric assay (bALP-I) measured protein mass, whereas the immunocapture assay (bALP-E) measured activity. Before treatment, bALP values with both methods were within the postmenopausal reference ranges. Treatment with alendronate produced a decrease in bALP after 3 months, reaching a plateau after 6 months: for bALP-I a mean change of -34%, (P < 0.0001), bALP-E, -19% (P < 0.001), and total ALP, -19% (P < 0.0001). The decrease was significant in 53% (bALP-I) and 31% (bALP-E) of patients. The ratio of serum bALP-E/bALP-I in patients was not constant but rose after therapy with alendronate. Neither baseline bALP, nor the per cent change in bALP after 6 months, correlated with bone mineral density (BMD) change after 1 year at either lumbar spine or femoral neck. We conclude that bALP-I appeared to be a more sensitive marker of the suppression of bone turnover by alendronate than did bALP-E, but that neither was useful in the detection of osteoporosis, nor the prediction of individual BMD response to alendronate therapy.
Aged↗
Tophaceous gout of the navicular bone as a cause of medial inflammatory tumor of the foot.
A case of tophaceous gout of the navicular bone in a 24-year-old woman is reported. Emphasis is placed on the conditions that might have been precipitating, i.e., anorexia nervosa and alcoholism, and the mechanisms by which increased uric acid level may be explained. The main radiographic patterns of tophaceous gout of the foot are recalled to avoid unnecessary surgery in future cases.
Adult↗
Association between amputation, arthritis and osteopenia in British male war veterans with major lower limb amputations.
OBJECTIVES: To investigate the association between amputation, osteoarthritis and osteopenia in male war veterans with major lower limb amputations. Specific questions were to determine whether lower limb amputees following trauma are at subsequent risk of developing osteoarthritis (OA) and osteoporosis of the hip on both the amputated and nonamputated sides. DESIGN: Retrospective cohort study in British Male Second World War veterans with major unilateral lower limb amputations. SUBJECTS: Seventy-five male Second World War veterans with major lower limb amputations known to be alive were invited to participate from a subregional rehabilitation centre. After exclusions, 44 agreed to attend for examination and radiological screening. METHODS: The presence of hip OA was determined from a single anterior posterior pelvic X-ray using two approaches: minimum joint space and the Kellgren and Lawrence (K&L) scoring system. Bone mineral density (BMD) was measured by a dual energy X-ray absorptiometry (DXA) scan and prosthetic rehabilitation outcome measures were recorded. RESULTS: Twenty-seven (61%) hips on the amputated side and 10 (23%) on the nonamputated side were positive for OA (based on Kellgren and Lawrence grade of >2). Using a minimum joint space threshold of below 2.5 mm, 24 (55%) hips on the amputation side and 8 (18%) on the nonamputated side were also positive for OA. There was a threefold increased risk of OA for those with above-knee compared to a below-knee amputation. By contrast, from published general population surveys only 4 (11%) cases of hip OA would have been expected on both the amputated and nonamputated hips. There was a significant decrease in femoral neck BMD in the amputated side (p <0.0001) and significantly lower BMD in above-knee amputees than in below-knee amputees (p = 0.0027) as compared to normal age- and sex-matched population. CONCLUSION: Male war veterans with unilateral major lower limb amputations develop significantly more osteoarthritis of the hip than expected on both ipsi- and contralateral sides. Amputation was also associated with loss of bone density. Above-knee amputees develop significantly more hip osteoarthritis and osteopenia of greater severity in the amputated side than below-knee amputees.
Aged↗
Case-control study of primary human herpesvirus 6 infection in children with febrile seizures.
RATIONALE: Human herpesvirus 6 (HHV-6) has been demonstrated to be the causative agent in roseola infantum. It has been suggested that HHV-6 may have neurotropic properties and be involved in the pathogenesis of febrile seizures in infants. We describe a case-control study to examine the hypothesis that acute HHV-6 infection occurs more commonly in children with febrile seizures than in controls. METHODS: Patients presenting with a first or second febrile seizure between 6 months and 2 years of age were entered in the study. Control patients did not have a seizure but had similar inclusion and exclusion criteria. Specimens were obtained for HHV-6 viral serology and polymerase chain reaction in the acute stage and approximately 2 weeks later. A diagnosis of HHV-6 infection was based on HHV-6-specific IgM and IgG serology and HHV-6 polymerase chain reaction of peripheral blood mononuclear cells and saliva. RESULTS: Eighty-six patients (45 with febrile seizures; 41 controls) were enrolled. The HHV-6 infection status could be determined in only 68 patients (35 with febrile seizures; 33 controls). Acute HHV-6 infection was identified in 15 of 35 febrile seizure patients and in 15 of 33 controls. Evidence of past HHV-6 infection was demonstrated in 13 febrile seizure patients and in 8 controls. CONCLUSIONS: The incidence of primary HHV-6 infection is similar in patients with febrile seizures and age-matched controls. HHV-6 does not seem to be a major factor in the pathogenesis of first and second febrile seizures.
Acute Disease↗
Streptococcal toxic shock-like syndrome in a post-myomectomy patient.
We report on a healthy 34-year-old woman who received an elective myomectomy for uterine fibroid, and postoperatively developed fatal streptococcal toxic shock-like syndrome. We discuss the series of events that led to this life-threatening disease and its pathophysiology, and suggest areas in which management might have been improved.
Journal Article↗
Prenatal diagnosis of beta-thalassaemia: experience in a developing country.
We present our experience with the amplification refractory mutation system (ARMS) for the prenatal diagnosis of beta-thalassaemia in 415 pregnancies of 360 women. Five mutations of the beta-thalassaemia gene common in Asian Indians accounted for 89.2 per cent and rare mutations for 7.2 per cent of all mutant chromosomes, while 3.3 per cent of chromosomes remained uncharacterized. Identical mutations were present in both parents in 43.2 per cent of cases, due to caste-based marriages in India. A confirmed diagnosis was given in 401 (98.3 per cent) cases, of which a complete diagnosis (whether the fetus was normal, a carrier, or homozygous) was possible in 391 (94.2 per cent) of the cases. In 15 couples, the mutation was identified in only one parent. In nine of these, the identified mutation was not present in the fetus, predicting normal/carrier status, while in five the identified mutation was present in the fetus, suggesting carrier/affected status. The abortion rate was 3.9 per cent. Pitfalls in diagnosis were failure of oligonucleotides to work, maternal contamination, and false paternity. The ARMS provides an inexpensive, robust and non-isotopic method for the prenatal diagnosis of beta-thalassaemia in India. Recommendations are outlined for establishing a prenatal diagnostic service in developing countries.
DNA↗
A serum-free culture model for studying the differentiation of human dendritic cells from adult CD34+ progenitor cells.
The antigen-presenting capacity of dendritic cells (DCs) makes them attractive potential cellular adjuvants for vaccination strategies. Currently, most in vitro culture systems for the production of these DCs include serum. However, this is undesirable because serum contains growth factors that vary between individuals and could affect DC development. Unless the patient's own serum is used, foreign antigens and the risk of infection will detract from the usefulness of these cells in clinical strategies. In this study we investigated the production of DCs from CD34+ progenitor cells of cancer patients or normal donors under serum-free conditions. We have established a model system for the investigation of DC development and maturation. Dendritic cells that developed from myeloid precursors accumulated after 2 weeks in an intermediate CD1a , CD80-, CD83-, CD86- stage. Intermediate DCs adhered to plastic surfaces, expressed Birbeck granules, and were negative for CD2 and CD14. In the presence of granulocyte-macrophage colony-stimulating factor and tumor necrosis factor-alpha, interleukin-4 promoted the development of these stages. Spontaneous maturation of intermediate DCs into fully activated DCs expressing CD83 and costimulatory molecules occurred asynchronously over the ensuing 2 to 3 weeks. This maturation involved increased expression of CD80, CD83, CD86, CMRF-44, HLA-A, -B, -C, and -DR as well as downregulation of CD1a and CD11b. Activated DCs are characterized by the lack of adherence to plastic surfaces and the absence of Birbeck granules. By day 28, these cells were nonphagocytic, potent antigen-presenting cells with an irreversible phenotype. This serum-free system offers advantages in that the process of differentiation and maturation of committed DCs is extended over a period of more than 28 days, allowing investigators to study the effects of individual cytokines or other supplements during distinct phases of DC development in a defined environment.
Adult↗
Retroperitoneal hemorrhage after cardiac catheterization causing a diagnostic dilemma.
Emergency coronary angioplasty is being increasingly performed these days. This procedure may be associated with complications. We report a case of massive retroperitoneal hemorrhage after coronary angioplasty that posed a diagnostic dilemma.
Cardiac Catheterization↗
Different kinetics of senescence in human fibroblasts and peritoneal mesothelial cells.
Senescence has been reported for a wide variety of human cell types. In cultures of human fibroblasts the process is due to a percentage of the cells becoming senescent at each passage rather than all the cells entering senescence simultaneously at the end of the life span. By measuring the percentage of fibroblasts which are still cycling at each passage, a rate of decline in the growth fraction, which mirrors the rate of senescence, can be obtained. However, such an analysis has never been undertaken in multiple cell types using the same method to identify cycling cells. It is thus unknown if the rate of senescence is the same or different in cultures of different human cell types. To answer this question the rates of decline in the cycling fractions were simultaneously measured in two cultures of human cells (AGO7086A, peritoneal mesothelial cells; and 2DD, human dermal fibroblasts) which have practically identical in vitro life spans. 2DD fibroblasts showed a rate of decline of 0.89% cycling cells per population doubling when the data obtained were fitted to a simple linear equation. However, AGO7086A gave a decline of approximately 2.2% per population doubling. Thus mesothelial cells enter senescence significantly faster than fibroblasts (P < 0.001). This decline in the growth fraction was accompanied by an increasing fraction of mesothelial cells which retained detectable endogenous beta-galactosidase activity at pH 6. Such activity has previously been shown to be associated with senescent human fibroblasts. These findings suggest that the process of senescence has common features in different cell lineages but that the rate of the process can differ markedly between them.
Biomarkers↗
Community nursing profiles: their role in needs assessment.
The last article in our series of three looking at public health nursing explores the background from which community nursing profiles have developed into annual activities in provider trusts around the country. The author suggests that there are important issues which prevent them from being a valuable resource for needs assessment and service planning.
Community Health Nursing↗
Psychosocial factors in the workplace--do they predict new episodes of low back pain? Evidence from the South Manchester Back Pain Study.
STUDY DESIGN: A prospective, population-based cohort study of working adults. OBJECTIVES: To determine whether work-related psychosocial factors and social status predict the occurrence of new episodes of low back pain and influence consultation behavior. SUMMARY AND BACKGROUND DATA: Dissatisfaction with work and social status has been associated with low back pain in several studies; few of these studies have been prospective or population based. METHODS: An initial postal survey was returned by 4,501 (59%) adults (18-75 years old) registered with two primary care practices. From this, a cohort of 1,412 people currently in employment and free of low back pain was identified, and baseline information on work-related psychosocial factors and psychologic distress was obtained. Social class was derived from current occupation using a standardized classification. New episodes of low back pain occurring in the next 12 months were identified by continuous monitoring of primary care consulters and by mailing a second questionnaire a year later to identify occurrences of low back pain for which no consultation was sought. RESULTS: The baseline cross-sectional survey showed modest but significant associations between low back pain and perceived inadequacy of income (risk ratio 1.3), dissatisfaction with work (risk ratio 1.4) and social class IV/V (risk ratio 1.2). In the follow-up year, the risk of reporting low back pain for which no consultation was sought doubled in those dissatisfied with their work. Both perceived inadequacy of income (odds ratio 3.6) and social class IV/V (odds ratio 4.8) were strongly associated with consulting with a new episode of low back pain during the follow-up year, an association more marked in women. The associations with work dissatisfaction and perceived adequacy of income were not explained by general psychologic distress or social status. CONCLUSION: People dissatisfied with work are more likely to report low back pain for which they do not consult a physician, whereas lower social status and perceived inadequacy of income are independent risks for working people to seek consultation because of low back pain.
Adult↗
Employment and physical work activities as predictors of future low back pain.
STUDY DESIGN: A population-based longitudinal study conducted in northwest England for a 12-month period involving adults aged 18-75 years. OBJECTIVES: To determine physical factors related to employment that predict a new episode of low back pain. SUMMARY OF BACKGROUND DATA: Most epidemiologic studies that have examined the relation between occupation and back pain have been cross-sectional or retrospective in design. Because workers who have experienced low back pain may have changed jobs or work activities, it is important to use longitudinal studies that define "exposures" before the onset of symptoms. METHODS: From adults registered with two general practices in northwest England, 1412 people who were currently in employment and free of low back pain were identified. A lifetime occupational history was recorded for all participants, with details of activities performed in each occupation. Data on consultations for low back pain during the follow-up year were collected through computerized medical records, whereas those who had not consulted with low back pain were sent another questionnaire at the end of the 1-year follow-up. RESULTS: An increased risk of a new episode of low back pain was found in those whose jobs involved lifting/pulling/pushing objects of at least 25 lbs, or whose jobs involved prolonged periods of standing or walking. Risks were, in general, greater in women, for a first ever episode of back pain and for back pain that led to a general practice consultation. No clear relation between years of exposure to such factors and magnitude of risk was evident. CONCLUSIONS: Occupational activities, particularly in women, such as working with heavy weights or lengthy periods of standing or walking, were associated with the occurrence of low back pain. Short-term influences may be more important in the occurrence of new episodes rather than cumulative lifetime exposure, and emphasize that such morbidity may be avoidable.
Adult↗
Phylogenetic evaluation of Kenyan HIV type 1 isolates.
Diversity among global isolates of HIV-1 presents a formidable challenge for vaccine development. As distinct clades of the virus are recognized, it will be important to monitor their geographic distribution and divergence. In this study, we characterized HIV-1 subtypes from 17 seropositive individuals in Nairobi and Mombasa, Kenya. Seventy-one percent of viruses were clade A and 29% were clade D. The most divergent clade A isolate in our survey, Q45-CxA, grouped closely with two other taxa that were previously reported as having no distinct clade affiliation. Thus, these data may suggest the emergence of an outlier group of clade A variants or a new subtype of HIV-1. Phylogenetic relatedness of the 17 Kenyan isolates was determined separately for C2-V3 and V2 sequences of envelope and subtype designation for these isolates was independent of the region analyzed. However, evaluation of transitions, transversions, and specific character state changes indicated that mutations characterizing V2 differed from those in V3 for clade A and clade D isolates. Comparison of secondary structural characteristics of the V1-V3 region between a clade A and a clade D virus revealed conservation of motifs.
Female↗
Prevention of surgical infections in dogs with a single intravenous injection of marbofloxacin: an experimental model.
Eighteen healthy beagle dogs of both sexes were each given 0, 2 or 4 mg/kg marbofloxacin intravenously before the subcutaneous implantation of a silicon tissue cage. Two millilitres of a suspension containing 1.3 x 10(4) colony forming units (CFU)/ml of Staphylococcus intermedius were then injected into the cage 15 minutes after the intravenous injection. The dogs were clinically assessed immediately, and then two, four, eight and 24 hours after the challenge. Samples of inflammatory fluid were harvested at the same times in order to count staphylococci and to assay marbofloxacin concentrations. Blood samples were taken in order to assay plasma marbofloxacin levels. The staphylococcal counts were lower in both treated groups than in untreated dogs (P < 0.01). All the clinical criteria were similar in the three groups. The concentration of marbofloxacin was similar in plasma and inflammatory fluid. Both doses were well tolerated and no adverse reactions were observed.
Animals↗
Premedication with midazolam is more effective by the sublingual than oral route.
PURPOSE: This study compared the sedative effects of sublingual tablet midazolam (Roche Dormicum 7.5 mg) with the oral route as premedication. METHODS: One hundred ASA physical status I and II gynaecological patients were randomly selected to receive a 7.5 mg tablet of midazolam either sublingually or orally as premedication about one hour before elective surgery. There were 50 patients in each group. The degree of sedation was assessed according to the Ramsay scale initially and then at 20, 30, 45 and 60 min intervals by a second observer blinded to the route of administration. The time for complete drug dissolution was studied in the sublingual group by the inspection of tablet residue under the tongue every five minutes for 20 min, then the patients were interviewed regarding their acceptance of taste. RESULTS: The sedation scores in the sublingual group were higher than in the oral group at 30 and 60 min after drug administration. (P = 0.0054 and P = 0.008) Seventy-two percent of the sublingual group had complete drug dissolution within 10 min and 64% of the patients in the sublingual group found the tablet acceptable with regard to its taste. CONCLUSION: Midazolam 7.5 mg sublingual is a more effective pre-anaesthetic sedative than by the oral route.
Adjuvants, Anesthesia↗