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Biomedical subjects

G Miller

Publications and source records attributed to G Miller.

At least 595 records · Page 33Linked to original sources
PubMedDate not supplied

Diagnosis of dystrophinopathies: review for the clinician.

The dystrophinopathies are muscle disorders due to an abnormality of an Xp21-linked gene which produces the dystrophin protein. The most common of these disorders are the Duchenne and Becker muscular dystrophies. Modern molecular genetic techniques enable reliable diagnosis and prognosis in many patients, but there are occasional pitfalls. Furthermore, the clinical spectrum of the dystrophinopathies are now such that the clinician needs to be aware of a broader range of clinical disorders that require analysis of the dystrophin gene and its product, not just those that mirror a classic Duchenne or Becker muscular dystrophy picture. This spectrum ranges from a severe form presenting at birth to asymptomatic elevation of CK. Females may be manifesting carriers or present as a severe phenotype when the abnormal gene is expressed as an X-autosome translocation or monosomy X. Laboratory diagnosis and prognosis can be made most accurately by using both DNA analysis at the dystrophin gene and immuno-analysis of muscle with antibodies directed against different regions of the protein product. This review describes some exemplary patients, suggests a clinical classification for dystrophinopathies, and outlines a diagnostic approach.

Adolescent↗
PubMedDate not supplied

Opportunistic lymphoproliferations associated with Epstein-Barr viral DNA in infants and children with AIDS.

Two types of lymphoproliferative disease associated with Epstein-Barr viral (EBV) DNA--central-nervous-system lymphoma and chronic lymphocytic interstitial pneumonitis (LIP)--were recognised in children with human T-lymphotropic virus type III/lymphadenopathy virus infection and the acquired immunodeficiency syndrome (AIDS). Eight of ten lung biopsy specimens from children with LIP contained EBV DNA. EBV DNA was not identified in lung biopsy specimens with Pneumocystis carinii, cytomegalovirus, or atypical mycobacteria but without LIP, nor was EBV found in lung biopsy specimens from five adults with AIDS. Children with these EBV-associated complications had raised serum antibody titres to the replicative EBV antigens, but most of them lacked antibody to the component of the EB nuclear antigen encoded by the Bam HI K fragment. EBV-associated lymphoproliferative disease is a common and important complication of childhood AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

A human B-lymphoblastoid cell line constitutively producing Epstein-Barr herpesvirus and JHK retrovirus.

The human B-lymphoblastoid cell line, designated JHK-3, with pre-B-cell characteristics, chronically produces two viruses, Epstein-Barr virus (EBV) and JHK virus, an apparently novel retrovirus. The JHK-3 cells are much more productive of extracellular EBV than the high-producer marmoset line B95-8. The extracellular virus of the JHK-3 EBV strain is relatively fragile, more broadly dispersed in an ultracentrifuged sucrose gradient than the B95-8 EBV and more susceptible to disruption by combined treatment with urea and dithiothreitol. By restriction fragment length polymorphism analysis, the JHK-3 EBV strain resembles the EBV strain FF-41. The JHK-3 cells also produce an incompletely characterized, relatively fragile, enveloped, icosahedral RNA virus that contains Mn(++)-dependent reverse transcriptase. JHK virions measure 85 nm in ultrathin sections, much smaller than other Retroviridae. The JHK virus exhibits a distinctive morphogenesis, most nearly resembling C-type retroviruses. The JHK-3 cell line provides a human cell model for investigating virus/virus interactions and their pathogenetic affects on host cells which chronically and simultaneously produce DNA and RNA viruses.

Animals↗
PubMedDate not supplied

Telehealth and communication technologies in health: summary and action plan.

INTRODUCTION: Rapid innovations and improvements in communication technologies have opened many new channels for health education and delivery, as well as disaster management. Theme 2 examined the role and applicability of these technologies to Disaster Medicine and Management and the various issues involved in their use. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set Action Plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included harnessing convergence, seeking interoperability, building partnerships and making it appropriate. This group identified four Principles of Action underlying its plan: (1) investigate possibilities, (2) identify stakeholders, (3) invite participation, and (4) involve discussants in activities. DISCUSSION: Action plans were categorized into three areas that included "thinking globally, acting regionally", forming a telehealth advisory group, and increasing corporate partnerships. CONCLUSIONS: Technology is opening many opportunities that have applications in disaster management. To optimize benefits, goals and standards must be agreed upon and implemented.

Cooperative Behavior↗
PubMedDate not supplied

Molecular approaches to epidemiologic evaluation of viruses as risk factors for patients who have chronic fatigue syndrome.

One approach to understanding the chronic fatigue syndrome might be to carry out prospective studies of fatigue that occurs following infection with viral diseases of known etiology, such as influenza, hepatitis, and infectious mononucleosis. Among the viral parameters that should be evaluated are virus burden, variation of virus strain, sites of viral replication, and the state of the viral life cycle (e.g., latent or replicative). Immunologic studies should focus on the humoral and cellular responses to defined viral gene products to identify subtle, individual variations in immune recognition of specific viral subcomponents.

Antibodies, Viral↗
PubMedDate not supplied

Hurricane Isabel-related mortality--virginia, 2003.

BACKGROUND: Hurricane Isabel had a massive negative environmental, public health, and economic impact; Virginia bore the highest death toll (32) among nine states affected by this storm. A descriptive mortality analysis was conducted to identify modifiable risk factors and corresponding injury prevention measures that might mitigate future natural disaster-related morbidity and mortality in Virginia. METHODS: Information for the decedents, including demographic data, health status, and injury circumstances, was collected from the records of the Virginia Office of the Chief Medical Examiner and Office of Vital Records/Health Statistics. Criteria from the National Hurricane Center were used to classify deaths as direct or indirect. Storm assessments and emergency-response reports were also reviewed. RESULTS: A total of 32 deaths associated with Hurricane Isabel occurred in several densely populated localities in southeastern and central Virginia. The median age of decedents was 48 years (range: 7-85 years). A disproportionately higher mortality (21 [66%] of 32) occurred among persons older than 45 years (Virginia 2000 Census data). Twelve deaths were directly caused by environmental factors related to the storm (eg, seven drowning deaths and five traumatic head injuries from falling trees). Twenty deaths were indirectly associated with the storm and its effects: six fatal motor vehicle crashes, five related to clean-up operations, seven associated with power outages, and two stress-related (ie, myocardial infarction and suicide). The presence of alcohol or drugs was observed in 9 (28%) of 32 deaths. CONCLUSIONS: Classifying deaths as direct or indirect facilitates better target interventions on the basis of the identification of modifiable risk factors underlying hurricane-associated fatal injuries. Public education messages that reinforce avoidance of use of alcohol and drugs during natural disaster situations might reduce risk for injury.

Adolescent↗
PubMedDate not supplied

Comparison of an optical catheter office arthroscope with a standard rigid rod-lens arthroscope in the evaluation of the knee.

In a prospective, randomized study, 47 patients underwent arthroscopic evaluation of the knee in an operating room setting with both a standard rod-lens arthroscope and a newer flexible optical catheter fiberoptic system. The goal of the study was to assess the diagnostic accuracy of the newer catheter system, which is recommended for use in the office setting. Forty-four patients were included in the data analysis, three were eliminated because we were unable to perform an adequate examination with the catheter scope secondary to intraarticular adhesions or excessive bleeding. A comparison of the two systems revealed an overall underestimation and underrecognition of intraarticular knee pathologic changes. Anterior cruciate ligament tears were missed in 3 of 21 knees; no posterior cruciate ligament tears were detected by the rod-lens arthroscope in 44 knees, but one false-positive result was "seen" using the optical catheter device. Similar trends in diagnosis (sensitivity, 25% to 67%; specificity, 96% to 99%) were seen for tears of the medial and lateral menisci, chondral lesions, and the identification of loose bodies. We conclude from the results of this study that the use of the optical catheter system for arthroscopic evaluation and treatment of the knee in the office setting may result in a significant compromise in visual acuity, resulting in missed and incorrect diagnoses.

Anterior Cruciate Ligament Injuries↗
PubMedDate not supplied

Recent developments in information management for primary and community health services.

While health services provided outside the hospital environment are utilised by the majority of the community, until recently there has been little interest in developing a standard approach to information management in community health settings. With greater accountability for health services expected in the future, State and Federal governments have begun to set the necessary standards by the design of a common data model and data definitions for Primary and Community Health Services. This model will affect the manner in which the National Health Data Dictionary develops--from a primarily institution-based document to a broader approach which encompasses non-institutional care. Two new high level concepts have been introduced: "issue" and "activity". Four States have also formed a consortium to design and implement an information management system for Community Health Services. This necessitates adoption of standard classification systems which could be applied in this environment, especially to the two new high level concepts. This paper outlines recent developments in information management for Community Health and provides a brief summary of available classification systems.

Ambulatory Care Information Systems↗
PubMedDate not supplied

ICPC PLUS for community health? A feasibility study.

BACKGROUND: The development of information systems in community health is being led by the Community Health Information Management Enterprise, a multi state consortium of State Health Departments. To ensure reliable and valid data collection, client problems (issues) presented to community health providers and the activities they undertook will require coding and classification. The suitability of existing classification systems for issues and activities in the community health setting therefore warranted investigation. AIMS: To assess the extent to which the extended version of the International Classification of Primary Care (ICPC PLUS) is a feasible tool with which to code issues and activities in community health settings. METHOD: 62 providers representing 22 service groups recorded, in their own words, details about issues and activities at all client contacts for a period of two weeks. These were secondarily coded with ICPC PLUS and subjective judgment made about the "goodness" of fit between the recorded term and the term available in ICPC PLUS. RESULTS: Of the 2146 issues recorded, 90.5% could be coded with ICPC PLUS. Codes with a "good fit" were available for 71.2%. ICPC PLUS had suitable codes for 67.5% of the 2470 recorded activities, but only half of these were a "good fit". Some ICPC PLUS terms required greater specificity and some of the terms recorded needed to be further defined before a code could be allocated. CONCLUSION: It is feasible to use ICPC PLUS to classify issues with only minor additions and alterations. Activities could also be classified with ICPC PLUS but far more development would be required.

Abstracting and Indexing↗