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Biomedical subjects

E Wright

Publications and source records attributed to E Wright.

At least 91 records · Page 5Linked to original sources
PubMed1995

Causes of suppurative keratitis in Ghana.

AIMS: Suppurative keratitis is a serious problem in all tropical countries, but very little information is available about the causative organisms in Africa. The objectives were to identify the causative organisms and the proportion of cases caused by fungi in southern Ghana, and to determine whether correct decisions about treatment could be made on the basis of Gram stain in the eye clinic. METHODS: Scrapings were taken from corneal ulcers of consecutive new patients presenting at Korle Bu Hospital, Accra, and inoculated on 'chocolate' and Sabouraud's agars. Further scrapings were taken for Gram staining and interpretation in the eye clinic. Duplicate slides were assessed by an experienced microbiologist in the UK. RESULTS: One or more organisms were cultured from 114 of 199 patients (57.3%), the most common being Fusarium species, Pseudomonas aeruginosa, and Staphylococcus epidermidis. Fungi, alone or in combination, were isolated from 56% of the patients who had positive cultures. In total, 122 patients (61.3%) had their treatment either determined or altered based on the results of the microbiological diagnosis; in 87 of these solely on the basis of direct microscopic examination. CONCLUSIONS: Infection by filamentous fungi accounted for more than half of the ulcers from which cultures were obtained. Both training in technique and experience in interpretation are necessary for microscopy based diagnosis by staff in the clinic to be of greatest value. Direct microscopy was particularly useful for detecting fungi.

Adolescent↗
PubMed1995

Diode laser treatment for retinopathy of prematurity: structural and functional outcome.

AIMS: The anatomical and functional outcome of 13 babies with retinopathy of prematurity (ROP) treated with binocular indirect ophthalmoscope diode laser photocoagulation was assessed. METHODS: Thirteen babies (25 eyes) at median postmenstrual age (PMA) 25.5 weeks and median birth weight 725 g were treated with binocular indirect ophthalmoscope (BIO) diode laser photocoagulation when threshold retinopathy of prematurity (ROP) was detected at median PMA 35 weeks. Retinopathy was more severe in the nasal retina in 15 eyes. The median severity of retinopathy was 6 clock hours grade 3 disease. All babies were treated under general anaesthetic with no significant ocular or systemic complications during treatment. The median number of burns was 1200. RESULTS: Resolution of active retinopathy occurred 1-2 weeks following treatment in all but one baby. All eyes had favourable anatomical and functional outcome as defined by the Cryo-ROP study group at a median age of 19.5 months of follow up. CONCLUSION: BIO diode laser treatment is as effective as cryotherapy with less morbidity.

Female↗
PubMed1995

Predictors of patient adherence to long-term home nebulizer therapy for COPD. The IPPB Study Group. Intermittent Positive Pressure Breathing.

STUDY OBJECTIVE: Patients with moderate to severe COPD are frequently prescribed expensive and complicated therapies that require adjustments in usual activities of daily living. However, little is known about factors that are associated with adherence to such treatment. The objective of this study was to identify characteristics of patients who were adherent to long-term home nebulizer therapy. DESIGN: Patients were stratified into two adherence groups based on average minutes of nebulizer use each day. A logistic regression model was developed to predict adherence based on baseline variables. A questionnaire was administered to patients to assess reasons for adherence to therapy. SETTING: Five clinical centers in the United States and Canada. PARTICIPANTS: Nine hundred eighty-five patients with moderate to severe COPD enrolled in the Intermittent Positive Pressure Breathing (IPPB) Trial. INTERVENTIONS: Long-term home IPPB and nebulizer therapy. MEASUREMENTS AND RESULTS: Altogether 50.6% of patients were adherent, and 49.4% were nonadherent. Among baseline variables, good adherence was predicted by white race, married status, abstinence from cigarettes and alcohol, serum theophylline level > or = 9 micrograms/mL, more severe dyspnea, and reduced FEV1 (p < 0.05). Subjects who were adherent to nebulizer therapy were older, better educated, had a stable lifestyle, were more likely to report that the therapy made them feel better, and were more likely to keep clinic appointments. CONCLUSIONS: Sociodemographic, physiologic, and quality of life variables were associated with adherence to long-term nebulizer therapy.

Adult↗
PubMed1995

A randomized clinical trial of intraoral soft splints and palliative treatment for masticatory muscle pain.

Thirty subjects seeking treatment for masticatory muscle pain at a university-based TMJ clinic were randomly assigned to soft-splint, palliative-treatment, and no-treatment groups. After 4 to 11 weeks of treatment, subjects were evaluated for changes from their baseline levels of symptoms, maximum pain-free opening, pain thresholds measured by a pressure algometer, and occlusal contacts. With the use of the multivariate analysis of variance and analysis of covariance, the results suggest that the soft-splint group had statistically significant improvement (P < .01), the palliative-treatment group had improvement that was not statistically significant, and the no-treatment group had a slight aggravation of symptoms. The soft-splint group had fewer occlusal contact changes assessed with shimstock compared to the palliative-treatment and no-treatment groups. The findings of this study suggest that the soft splint is an effective short-term treatment for reducing the signs and symptoms of masticatory muscle pain in patients, and the soft splint does not cause occlusal changes.

Adolescent↗
PubMed1995

Complex Y chromosome aberrations are a recurrent secondary event in radiation-induced murine acute myeloid leukaemia.

Arbitrarily primed-PCR analysis of DNA from male CBA/H radiation-induced leukaemic spleens revealed the loss of an approximately 350-bp sequence in several leukaemias. We have isolated a lambda EMBL3 C57BL/6 genomic subclone (pJB1) which hybridizes to the AP-PCR probe and is located on the Y chromosome. Southern blot analyses using the pJB1 probe indicate that the genomic sequence was deleted in five of 14 leukaemias. Cytogenetic analyses of 31 X-ray induced leukaemias in male CBA/H mice revealed, in addition to the characteristic partial deletion of chromosome 2 (28/31 leukaemias), a high incidence (16/31) of the loss of an intact Y chromosome. Comparison of the Southern blot and cytogenetic analyses of the leukaemias demonstrate a significant lack of correspondence between the loss of an intact Y chromosome and Y chromosome-specific DNA sequences, suggesting that Y chromosome aberrations are complex. Whereas partial deletion of chromosome 2 can be detected in 6% of bone marrow cells within 6-11 days of irradiation, no Y chromosome involvement was detected, indicating that Y chromosome aberrations are a late event in radiation-induced leukaemogenesis. These findings are comparable to the loss of sex chromosomes in human t(8;21) AML.

Acute Disease↗
PubMed1995

An audit of the 1995 Royal College of Ophthalmologists guidelines for screening for retinopathy of prematurity applied retrospectively in one regional neonatal intensive care unit.

To test the effectiveness of the 1995 Royal College of Ophthalmologists (RCO) guidelines for screening for retinopathy of prematurity (ROP) in one regional neonatal intensive care unit, an analysis was carried out of screening examination results over a 4 year period, retrospectively applying the rules of the 1995 RCO guidelines. Four hundred and forty-eight examinations would have been performed in 258 infants, significantly fewer than the 764 examinations which had been performed using our existing screening protocol. Threshold ROP developed in 36 infants, and would have been detected promptly in every case. No case of threshold ROP developed in infants of birth weight greater than 1250 g. The 1995 RCO guidelines for ROP screening provide an effective and efficient means of detecting treatable ROP. The need to include infants of birth weight > 1250 g should be reviewed at a future date, following a period of further national data collection.

Birth Weight↗
PubMed1994

Bowel training in spina bifida: importance of education, patient compliance, age, and anal reflexes.

Bowel incontinence is a major social impairment for 90% of patients with spina bifida. This study assess the bowel continence of children and young adults with spina bifida before and after a toileting intervention that emphasized patient/family education and a regular, consistently timed, reflex-triggered bowel evacuation. Bowel continence defined as one or fewer incontinent stools per month, rose from 13% (5/40) to 60% (24/40) following intervention. Twenty-four of the 35 initially incontinent patients were compliant. Seventy-nine percent (19/24) of the compliant subjects achieved continence whereas 0/11 of the noncompliant subjects achieved continence p < 0.0001). Presence of the bulbocavernosus (BC) and anocutaneous (AC) reflexes correlated significantly with achieving continence (either vs none p < .02, AC vs no AC p < .01). Instituting bowel training before age 7 correlated with improved outcomes by means of better compliance. Excluding noncompliant subjects, 83% (24/29) of the original sample of 40 patients satisfied our strict definition of bowel continence after this simple low technology intervention.

Adolescent↗
PubMed1994

Semiportable electrochemical instrument for determining carbon monoxide in breath.

Measurements of carbon monoxide (CO) in breath can be used for the diagnosis of hemolytic disease. A small, semiportable, easy-to-operate CO instrument was developed at Stanford University and tested at 12 Neonatal Research Network Centers of the National Institute of Child Health and Human Development. A syringe pump delivers 7.7 mL of sample per minute through an activate carbon filter to an electrochemical (EC) sensor having a sensitivity of 0.10 +/- 0.01 V per 1 microL/L CO in air. The electronically processed sensor signal is displayed on a digital multimeter. For a typical end-tidal CO measurement, corrected for inhaled CO, three 10- to 12-mL breath and room air samples are manually or mechanically collected and analyzed. CO determination in breath samples from 108 healthy, 1-day-old infants of nonsmoking mothers compared favorably with determinations by gas chromatography (GC), 1.3 +/- 0.8 vs 1.2 +/- 0.8 (mean +/- SD), respectively, with a regression equation of EC = 0.95 GC+0.13 (r2 = 0.98). The results demonstrate that the EC-CO instrument yields results that are comparable with those obtained by the more difficult to perform GC assay.

Breath Tests↗
PubMed1994

Reactive astrogliosis in the neonatal mouse brain and its modulation by cytokines.

Reactive astrogliosis is a characteristic response of astrocytes to inflammation and trauma of the adult CNS. To assess the hypothesis that cytokines from inflammatory mononuclear cells that accumulate around lesion sites have a role in modulating astrogliosis, this study sought to take advantage of the neonatal system in which astrogliosis is reported to be minimal following injury and in which the immune system is relatively immature compared to adult animals. A nitrocellulose membrane implant into the cortex of postnatal day 3 mice resulted in a tremendous astrogliotic response 4 d later, as measured by glial fibrillary acidic protein (GFAP) immunoreactivity and GFAP content. In contrast, a neonatal stab wound produced limited astroglial response when compared to the adult stab wound. Utilizing the neonatal stab wound model, cytokines were microinjected into the wound site at the time of injury. All cytokines tested (gamma-IFN, IL-1, IL-2, IL-6, TNF-alpha, and M-CSF) resulted in a significantly increased astrogliosis. The specificity of the cytokine response was demonstrated by the inability of human gamma-IFN, but not mouse gamma-IFN, in enhancing neonatal mouse astrogliosis, in accordance with reports that the interaction of gamma-IFN with its receptor occurs in a species-specific manner. We conclude that neonatal astrocytes can become reactive if an adequate injury stimulus is presented, and that the release of immunoregulatory cytokines by cells around lesion sites may be a mechanism that contributes to the production of gliosis.

Animals↗
PubMed1993

Predicting mortality risk for infants weighing 501 to 1500 grams at birth: a National Institutes of Health Neonatal Research Network report.

OBJECTIVES: To develop and evaluate a model that predicts mortality risk based on admission data for infants weighing 501 to 1500 grams at birth, and to use the model to identify neonatal ICUs where the observed mortality rate differs significantly from the predicted rate. DESIGN: Validation cohort study. SETTING: University-based, tertiary care neonatal ICUs. PATIENTS: Sample of 3,603 infants with birth weights of 501 to 1500 grams who were born at seven National Institute of Child Health and Human Development (NICHHD) Neonatal Research Network Centers, over a 2-yr period of time. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Based on logistic regression analysis, admission factors associated with mortality risk for inborn infants were: decreasing birth weight, appropriate size for gestational age, male gender, non-black race, and 1-min Apgar score of < or = 3. The mortality prediction model based on these factors had a sensitivity of 0.50, a specificity of 0.92, a correct classification rate of 0.82, and an area under the receiver operating characteristic curve of 0.82 when applied to a validation sample. Goodness-of-fit testing showed that there was a marginal degree of fit between the observations and model predictions (chi 2 = 15.4, p = .06). The observed mortality rate for 3,603 infants at the seven centers was 24.7%, ranging from 21.8% to 27.7% at individual centers. There were no statistically significant differences between observed and predicted mortality rates at any of the centers. One center had an observed mortality rate that was 2.8% lower than predicted by the model (95% confidence interval -6.0% to 0.5%), and another center had an observed rate that was 3% higher than expected (95% confidence interval -0.3% to 6.2%). CONCLUSIONS: Mortality risk for infants weighing 501 to 1500 grams can be predicted based on admission factors. However, until more accurate predictive models are developed and validated and the relationships between care practices and outcomes are better understood, such models should not be relied on for evaluating the quality of care provided in different neonatal ICUs.

Cohort Studies↗
PubMed1993

Developmental trends in the interaction between auditory and linguistic processing.

The developmental course of multidimensional speech processing was examined in 80 children between 3 and 6 years of age and in 60 adults between 20 and 86 years of age. Processing interactions were assessed with a speeded classification task (Garner, 1974a), which required the subjects to attend selectively to the voice dimension while ignoring the linguistic dimension, and vice versa. The children and adults exhibited both similarities and differences in the patterns of processing dependencies. For all ages, performance for each dimension was slower in the presence of variation in the irrelevant dimension; irrelevant variation in the voice dimension disrupted performance more than irrelevant variation in the linguistic dimension. Trends in the degree of interference, on the other hand, showed significant differences between dimensions as a function of age. Whereas the degree of interference for the voice-dimension-relevant did not show significant age-related change, the degree of interference for the word-dimension-relevant declined significantly with age in a linear as well as a quadratic manner. A major age-related change in the relation between dimensions was that word processing, relative to voice-gender processing, required significantly more time in the children than in the adults. Overall, the developmental course characterizing multidimensional speech processing evidenced more pronounced change when the linguistic dimension, rather than the voice dimension, was relevant.

Adult↗
PubMed1993

Pulsed field gel electrophoresis on single murine hemopoietic colonies.

We report a technique which allows for the direct molecular analysis of single whole murine hemopoietic colonies by pulsed field gel electrophoresis (PFGE). Murine bone marrow cells were plated out in semi-solid agarose and gave rise to macroscopic colonies after 11 days in culture. Single colonies were excised from the agarose using a sterile blade and embedded without further manipulation in molten low-melting-temperature agarose. The leucocyte DNA contained within the agarose plug was subjected to restriction enzyme digestion and PFGE. Sufficient high molecular weight DNA is afforded by this method to achieve a hybridization signal with a single copy probe. This method will make PFGE directly applicable to the clonal analysis of chromosomal aberrations in hemopoietic stem and progenitor cells.

Animals↗
PubMed1992

Keeping the faith.

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Faculty, Nursing↗
PubMed1992

A photometric study of the effect of pupil dilatation on Nd:YAG laser iridotomy area.

A photometric study of the effect of pupil dilatation on Nd:YAG laser iridotomy area was performed in 21 eyes of 21 patients. The iridotomy area was 0.075 (0.055) mm-2 (mean (SD)) before pupil dilatation and 0.073 (0.070) mm-2 after pupil dilatation (t test NS). Iridotomy area after pupil dilatation correlated with iridotomy area before pupil dilatation (r = 0.815, p < 0.01) but did not significantly correlate with measures of iridotomy shape or position, or with changed iris area following pupil dilatation. Two iridotomies became reduced to less than 20% of their initial area following pupil dilatation. Our findings suggest that the only effective method of avoiding development of unacceptably small iridotomy area after pupil dilatation is to create a sufficiently large iridotomy at the time of initial laser surgery.

Acute Disease↗
PubMed1992

Cryotherapy for retinopathy of prematurity in a regional neonatal intensive care unit.

Ninety-six low birth-weight premature infants at risk of retinopathy of prematurity (ROP) were screened over a 25-month period, yielding 30 eyes of 15 infants with 'treatable' disease. The response and complications of cryotherapy were prospectively evaluated in these infants over a 3-24-month period. Six eyes of three infants progressed to cicatricial disease despite treatment. One infant developed angle closure glaucoma but neither eye showed cicatricial disease. In 24 eyes of 12 infants regression of active ROP was observed after treatment. The local and systemic complications associated with cryotherapy are discussed.

Anesthesia, Local↗
PubMed1991

Coordination of trophic interactions by separate developmental programs in sensory neurons and their target fields.

In the developing vertebrate nervous system the survival of sensory neurons becomes dependent on neurotrophic factors when their axons reach their target fields, and the synthesis of nerve growth factor (NGF) by target field cells commences with the arrival of the earliest axons. The timing of NGF synthesis and the onset of neurotrophic factor dependence are not, however, reliant on innervation. NGF synthesis occurs on time in developing target fields in which innervation is prevented, and sensory neurons cultured before innervating their targets become dependent on neurotrophic factors for survival after a certain length of time in culture. The length of time neurons survive in culture before becoming neurotrophic factor-dependent is related to the time they would normally contact their targets in vivo: populations of neurons that have nearby targets which are innervated early respond to neurotrophic factors before neurons that have more distant targets which are innervated later. The timing of target field innervation is governed not only by the distance axons have to grow but by the rate at which they grow. Axonal growth rate is also regulated in accordance with target distance: neurons with distant targets extend axons faster than neurons with nearby targets. In addition to reviewing evidence for separate developmental programs that control the timing of neurotrophic factor synthesis in the target field and the onset of neurotrophic factor dependence in early sensory neurons, we will consider the mechanisms that might play a role in regulating the survival of neurons during the phase of neurotrophic factor independence.

Animals↗
PubMed1991

Argon laser pretreatment 4 to 6 weeks before Nd:YAG laser iridotomy.

Argon laser pretreatment followed by Nd:YAG laser iridotomy 4 to 6 weeks later was performed in the right eye of 10 patients. Primary Nd:YAG laser iridotomy was performed in the left eye. Significantly more Nd:YAG laser energy was needed to produce an iridotomy in pretreated eyes (P less than .001). Pretreated eyes developed a significantly larger pigment epithelium defect around the iridotomy site and a greater degree of pigmentation of the inferior part of the trabecular meshwork 6 months following treatment. Argon laser pretreatment followed by Nd:YAG laser iridotomy 4 to 6 weeks later appears to offer no advantages over primary Nd:YAG laser iridotomy.

Aged↗