In 24 adults with hemoglobin SS followed at the Duke University Comprehensive Sickle Cell Center, we have studied the following nutritional parameters: reduced ascorbic acid; dehydroascorbic acid; alpha and beta carotenes; cryptoxanthin; and alpha and gamma tocopherols in whole blood, washed red blood cells, plasma, or serum. In the same population we also examined reduced glutathione (GSH) and oxidized glutathione (GSSG). Fifteen of these 24 patients also were interviewed for usual dietary intakes using a 28-day dietary history. Data obtained from patients with hemoglobin SS, sickle cell anemia (SCA) were compared to those found for seven healthy normal black adults of similar age. Plasma alpha tocopherol levels were significantly lower in SCA individuals than those of the controls (P less than 0.004). Alpha and gamma tocopherol levels in sickle RBCs were significantly higher than those from RBC suspensions of control subjects (P less than 0.007, and P less than 0.001, respectively). All serum values for carotenoids examined, specifically, beta carotene, alpha carotene, and cryptoxanthin were also markedly depressed when compared to those of healthy controls (P less than 0.001, P less than 0.002, and P less than 0.001, respectively). No other statistically significant differences were found between the two groups for any of the remaining variables, including dietary estimates. Dietary analyses suggest that dietary intakes of SCA individuals exceeded the recommended daily allowances (RDA) of all macro- and micronutrients measured, and intakes of most nutrients exceeded those of black controls interviewed. These results suggest that in individuals with SCA, several micronutrients vital to maintaining reducing capacity are present in diminished quantities in plasma/serum. These anomalies exist in SCA patients even though their intake of these micronutrients are similar to those of healthy black men and women.

Adult↗

PubMed1989

The inhibitory actions of azelastine hydrochloride on the early and late bronchoconstrictor responses to inhaled allergen in atopic asthma.

We have examined the effect of azelastine hydrochloride, 8.8 mg, on the early and late responses to inhaled allergen in a group of 12 atopic subjects with asthma. On two separate days, 3 weeks apart, patients were administered either oral azelastine, 8.8 mg, or matched placebo. Four hours later they inhaled via nebulizer, a dose of allergen (grass pollen or Dermatophagoides pteronyssinus) that had previously been demonstrated to produce a 25% fall in FEV1. Plasma-histamine concentrations and FEV1 levels were measured at intervals during the subsequent 8 hours. After placebo, allergen inhalation produced rapid bronchoconstriction in all subjects with a maximum mean fall in FEV1 at 30 minutes of 22.8 +/- 3.4% from the postsaline baseline value. Five subjects also developed a late bronchoconstriction response with a fall in FEV1 of greater than 15% from postsaline baseline value between 2 and 8 hours after challenge. Azelastine reduced the bronchoconstrictor response during the first 10 minutes and produced a maximum mean fall at 30 minutes of 21.2 +/- 4.4% from the postsaline baseline value. Azelastine had a marked inhibitory effect, reducing the maximum mean fall from 23.9 +/- 6.3% to 9.6 +/- 3.9% from the postsaline baseline value. Analysis of the area under the FEV1 response time-course curves revealed that azelastine reduced the early response (first 2 hours) by 32.5% (p less than 0.05) (all subjects) and reduced the late response (2 to 8 hours) by 70.2% (p less than 0.05) (n = 5). Azelastine had no significant inhibitory effect on the early increase in plasma histamine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

The potential hazard of using multiple-dose heparin and insulin vials in continuous ambulatory peritoneal dialysis.

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Adult↗

PubMed1989

Sickle cell disease pain: relation of coping strategies to adjustment.

This study examines pain coping strategies in a relatively neglected pain population, sickle cell disease (SCD) patients. Seventy-nine patients diagnosed with SCD were given a structured interview to assess pain, activity level, and health care use during painful episodes. Patients also completed the SCL-90-R as an index of psychological distress and the Coping Strategies Questionnaire. Regression analyses controlled for age, sex, and disease severity measures. Results indicated that the coping strategies factors were important predictors of pain and adjustment. Individuals high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health care services. Individuals high on Coping Attempts were more active during painful episodes.

Adaptation, Psychological↗

PubMed1989

Risk factors associated with intravascular catheter infections in burned patients: a prospective, randomized study.

A prospective, controlled study of 101 intravascular catheter sites was undertaken to determine the importance of tubing manipulation and skin contamination in the etiology of catheter infection in burned patients. Catheters in place for 3 days were randomized to have the tubing changed every 24 or 48 hours. Catheters were removed at 72 hours and the tips cultured by the semi-quantitative technique of Maki. Hubs were cultured (by swab culture) at times of tubing change and at the time of catheter removal. Skin cultures of the area surrounding the catheter were done at the time of insertion and removal. Catheter tip infection was defined as 15 or more colony forming units. Positive cultures were found in 25.7% of the cases, and were most often due to Pseudomonas species (33%) and coagulase-negative Staphylococcus (29%). Infections occurred in 35% of arterial catheters, 27% of central, and 12% of peripheral venous catheters. No benefit was observed from changing the administration tubing at 24 hours vs. 48 hours. Hub cultures were positive 30% of the time at 24 hours, 39% at 48 hours and 41% at 72 hours. Although the isolated organisms correlated with tip cultures, false positive rates varied from 8 to 62%. Discriminant analysis showed no relationship between catheter infection and burn size or day postburn; however, the incidence of catheter infection correlated inversely with the distance of the catheter insertion site from the burn wound (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1989

Lapse, relapse and survival among opiate addicts after treatment. A prospective follow-up study.

This paper presents data from the first British prospective study to investigate relapse among opiate addicts after treatment. Eighty subjects were followed up over the six-month period immediately after discharge from treatment and were interviewed on several occasions. Large numbers of subjects used opiates within a very short time after discharge; 71% used them within the first six weeks. However, this first lapse to opiate use did not herald a full-blown relapse to dependent use. There was a gradual increase in the number of abstinent subjects, with 45% abstinent and living in the community at the six-month point. The practical and theoretical implications may be regarded as broadly encouraging.

Adolescent↗

PubMed1989

Circumstances surrounding the initial lapse to opiate use following detoxification.

Seventy-eight opiate abusers were followed up after successful in-patient detoxification in order to examine renewed opiate use. The greatest number of initial lapses occurred within a week of subjects leaving in-patient treatment. Eleven categories of lapse precipitant were identified: cognitive, mood, external, withdrawal, interpersonal, leaving a protected environment, drug availability, drug-related cues, craving, priming, and social pressure. Cognitions, negative moods and external events emerged as the most commonly mentioned factors; these often occurred together, either in clusters or in a sequence. Implications of these results for models of relapse and for treatment approaches are discussed.

Adolescent↗

PubMed1989

Make infection control work with office design.

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Communicable Disease Control↗

PubMed1988

Optochin-resistant Streptococcus pneumoniae.

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Aged↗

PubMed1988

Defective release of tissue plasminogen activator in patients with sickle cell anemia.

Recent studies suggest that intravascular coagulation occurs in sickle cell anemia. There is also some evidence that decreased fibrinolytic activity may be associated with the disorder. In the current study we measured tissue plasminogen activator levels (t-PA) in seven asymptomatic patients with sickle cell anemia. The mean level of releasable t-PA was only 0.01 IU/mL +/- 0.005 (SEM) as compared to 118 healthy volunteers with levels of 0.70 +/- 0.10 (SEM). Despite the small sample size, the difference between the two groups was statistically significant (P less than .001). These data suggest that defective release of t-PA may contribute to a hypercoagulable state in sickle cell anemia.

Anemia, Sickle Cell↗

PubMed1988

Totally implantable intravenous catheters in the management of sickle cell anemia.

Totally implantable catheters (TICs) have recently been employed for long-term central venous access in patients with sickle cell disease (SCD). We have reviewed our experience with 10 TICs inserted in patients with SCD. These were compared to 33 TICs inserted in patients without SCD (controls). The primary diagnosis was malignancy in most of the controls. The SCD patients experienced a marked increase in total complications (70 vs. 24%), as well as in complications requiring catheter removal (50 vs. 3%). No variable explained these differences except the presence of SCD. The complications requiring catheter removal from SCD patients were infections, catheter thrombosis, and venous thrombosis. The increased risk of these complications must be considered before a catheter is inserted; however, the average useful life of these catheters exceeded 12 months. They remained useful in the care of patients with poor venous access and multiple complications of SCD.

Adult↗

PubMed1988

Hematologic and surgical management of the dental patient with plasminogen activator deficiency.

Anticoagulation therapy is used to treat patients with a variety of hemostatic disorders in an attempt to prevent thrombus formation. A thorough understanding of the patient's medical history is essential before dental treatment that may require alteration of this anticoagulation therapy. Alteration of anticoagulation therapy should be undertaken only after consultation with the patient's physician because some patients are at greater risk than others for thrombus formation or hemorrhage. This case of a 29-year-old man with plasminogen activator deficiency illustrates how consultation can result in a coordinated treatment plan for medical and dental management formulated to help ensure safe surgical treatment for these medically compromised patients.

Adult↗

PubMed1988

Recurrent peritonitis caused by Serratia marcescens in a diabetic patient receiving continuous ambulatory peritoneal dialysis.

A diabetic patient treated by continuous ambulatory peritoneal dialysis for end-stage renal failure had recurrent peritonitis caused by Serratia marcescens. Thirty-eight isolates of S. marcescens recovered over a 14-month period from peritoneal-dialysis effluent, catheter tips and catheter-exit sites were biotyped and serotyped. The finding that most (90%) of these isolates belonged to the same biotype and serotype suggested that the patient had relapsing infections with the same strain. Similar isolates were recovered from the peritoneal dialysates of another two patients in the same ward, neither of whom developed Serratia-associated peritonitis.

Catheters, Indwelling↗