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Biomedical subjects

G Richards

Publications and source records attributed to G Richards.

At least 37 records · Page 2Linked to original sources
PubMed1999

Pneumocystis carinii pneumonia in HIV infected patients from South Africa.

OBJECTIVE: To compare the spectrum of pulmonary disease in human immunodeficiency virus positive patients of African and European origin, with particular reference to Pneumocystis carinii pneumonia. DESIGN: Descriptive study with retrospective record review. SETTING: Tertiary care, university teaching hospitals in Johannesburg, South Africa. SUBJECTS: Sixty seven HIV-infected patients and 36 HIV-negative renal transplant patients (who served as controls) whose sputa were negative for tuberculosis and Pneumocystis carinii, and who had fibreoptic bronchoscopic evaluation for pulmonary disease between January 1985 and August 1992. MEASUREMENTS: Histological and cytological evaluation of pulmonary diseases. RESULTS: In the HIV infected group Pneumocystis carinii pneumonia was the most frequent disease in patients of both African and European origin but occurred less commonly in Africans than in Europeans (27.3% and 58.8%, respectively; p = 0.01). There was no statistically significant difference between patients of African and European origin in the frequency of any other diagnosis. In the renal transplant group the most frequent diagnosis was non-specific interstitial pneumonitis (Africans 33.3%, Europeans 37.0%), followed by Pneumocystis carinii pneumonia (Africans 22.2%, European 14.8%). There was no difference between HIV-infected and renal transplant patients in the frequency of any diagnosis. CONCLUSION: Pneumocystis carinii pneumonia should be considered in the diagnosis of HIV-infected African patients with pulmonary disease whose sputum smears for tuberculosis are negative.

AIDS-Related Opportunistic Infections↗
PubMed1998

Occupational therapy. Working knowledge.

Retention of OTs in mental health had been falling in one trust, with as many as 75 per cent of senior-2 posts becoming vacant during one year. OTs surveyed cited their most popular reason for leaving a post as no career development and their most popular reason for staying as working in mental health. The survey has been used to improve trust retention strategies, using information on each grade to meet the specific needs of those groups.

Hospitals, Public↗
PubMed1998

Asthma control during long-term treatment with regular inhaled salbutamol and salmeterol.

BACKGROUND: The adverse effects of long term treatment of asthma with the short acting beta agonist fenoterol have been established in both epidemiological and clinical studies. A study was undertaken to investigate the efficacy and safety of long term treatment with salbutamol and salmeterol in patients with mild to moderate bronchial asthma. METHODS: In a two centre double dummy crossover study 165 patients were randomly assigned to receive salbutamol 400 micrograms q.i.d., salmeterol 50 micrograms b.i.d., or placebo via a Diskhaler. All patients used salbutamol as required for symptom relief. The study comprised a four week run in and three treatment periods of 24 weeks, each of which was followed by a four week washout. Asthma control was assessed by measuring mean morning and evening peak expiratory flow rate (PEFR), a composite daily asthma score, and minor and major exacerbation rates. Washout assessments included methacholine challenge and bronchodilator dose response tests. Analysis was by intention to treat. RESULTS: Data from 157 patients were analysed. Relative to placebo, the mean morning PEFR increased by 30 l/min (95% CI 26 to 35) for salmeterol but did not change for salbutamol. Evening PEFR increased by 25 l/min (95% CI 21 to 30) and 21 l/min (95% CI 17 to 26), respectively (p < 0.001). Salmeterol improved the asthma score compared to placebo (p < 0.001), but there was no overall difference with salbutamol. Only daytime symptoms were improved with salbutamol. The minor exacerbation rates were 0.29, 0.88, and 0.97 exacerbations/patient/year for salmeterol, salbutamol and placebo, respectively (p < 0.0001 for salmeterol). The corresponding major exacerbation rates were 0.22, 0.51 and 0.40, respectively (p < 0.03 for salmeterol). For salbutamol the asthma score deteriorated over time (p < 0.01), and the time spent in major exacerbation was significantly longer compared with placebo (12.3 days (95% CI 4.2 to 20.4) versus 8.4 days (95% CI 5.2 to 11.6), p = 0.02). There was no evidence of rebound deterioration in asthma control, lung function, or bronchial hyper-responsiveness following cessation of either active treatment, and no evidence of tolerance to salbutamol or salmeterol. CONCLUSIONS: Regular treatment with salmeterol is effective in controlling asthma symptoms and reduces minor more than major exacerbation rates. Salbutamol was associated with improved daytime symptoms but subtle deterioration in asthma control occurred over time. Salbutamol should therefore be used only as required.

Administration, Inhalation↗
PubMed1998

Writing the fairy Huckleberry Finn: William Goyen's and Truman Capote's genderings of male homosexuality.

After rehearsing persisting representations of same-sex desire in the Southern Renaissance's literary production, this essay charts how novels by Truman Capote and William Goyen reveal contradictory genderings of male homosexuality. Capote's Other Voices, Other Rooms collapses male gay identity with effeminacy, while Goyen's The House of Breath replicates this model but also contrasts it with a coexisting and competing one in which masculine men can physically act upon gay desire. Thus, contrary to the theorizations of Michel Foucault and David Halperin, these representations suggest the absence of a unified model of mid-twentieth-century male homosexuality.

Famous Persons↗
PubMed1998

The role of filtration during humidification.

Nosocomial pneumonia remains an important problem in patients undergoing mechanical ventilation, being associated with high mortality and morbidity and considerable expenditure. In the past respiratory equipment has been implicated in the development of nosocomial pneumonia and strict recommendations for cleaning and maintenance have been practiced. It is now known that the circuit and other equipment rapidly become contaminated with microorganisms originating from the patient's upper airway flora. These organisms access the circuit through suctioning and coughing, and may contaminate distant sites by traveling in association with aerosols or condensate. Current evidence suggests that circuit contamination usually is a result rather than a cause of airway colonization and does not have an important role in the pathogenesis of nosocomial pneumonia. Provided that reasonable infection control measures are taken, circuit contamination does not pose a risk to the ventilated patient. Although bacterial filters placed in the circuit effectively prevent circuit contamination they do not significantly reduce the incidence of nosocomial pneumonia in patients receiving mechanical ventilation.

Cross Infection↗
PubMed1998

Systemic sclerosis in DRw52-positive silica-exposed males: a case report.

The aims of this paper were to describe clinical and laboratory details of 4 siblings, of whom 2 have systemic sclerosis and to describe this family in the context of reported cases of familial systemic sclerosis. The proband and his affected male sibling share the tissue typing antigens: HLA11, B57, DR13, DRw52,- and DQ2,6. Both were concordant for gender, silica exposure, marital status, migration history and antinuclear factor status but discordant for systemic sclerosis subtype, age at disease onset and ENA status. One non-affected sibling had no disease despite concordance for gender, HLA status, silica exposure, marital status, and migration history.

Age Factors↗
PubMed1997

Cell adhesion molecule expression within human glomerular and kidney organ culture.

A glomerular and kidney organ culture method was developed to study cytokine inducibility of adhesion molecules and MHC antigen expression. Glomerular cells showed constitutive expression of intercellular cell adhesion molecule-1 (ICAM-1) and MHC class I and II antigens, but not vascular cell adhesion molecule-1 (VCAM-1), E-selectin, or P-selectin. Expression of E-selectin on glomerular endothelial cells (ECs) was induced by interleukin-1 (IL-1), tumour necrosis factor (TNF), interferon-gamma (IFN-gamma) and granulocyte/ macrophage-colony stimulating factor (GM-CSF); this induction was inhibited by transforming growth factor beta (TGF beta) and by IL-4. P-selectin expression was never seen within glomeruli. VCAM-1 was constitutively expressed by Bowman's capsule and proximal tubules and was weakly induced on glomerular ECs by TNF and IL-4 in combination. Glomerular endothelial ICAM-1 expression was increased by IL-1, TNF, IFN-gamma, and GM-CSF, while TGF beta inhibited induction by TNF and IL-1. Expression of MHC class I and II antigens by glomerular ECs was constitutive; further upregulation of MHC class II by IFN-gamma was observed. These studies suggest that leukocyte-endothelial cell interactions that occur within the kidney follow broadly similar principles as are proposed to occur elsewhere in the body but, in addition, there are subtle differences that reflect local conditions.

Cell Adhesion Molecules↗
PubMed1996

Expression of a novel murine homeobox gene in the developing cerebellar external granular layer during its proliferation.

The TGIF homeobox gene encodes a homeoprotein that represses the 9-cis retinoic acid receptor-dependent transcription activation. To investigate the potential role of this gene in vertebrate development, we have isolated cDNA clones of the murine TGIF (mTGIF) gene and analyzed its expression pattern during mouse embryogenesis and postnatal development by Northern analysis, reverse transcriptase-polymerase chain reaction (RT-PCR), and in situ hybridization histochemistry. mTGIF transcripts were detected at day E16 in the emerging external granular layer (EGL), the cells of which arise from the proliferating cerebellar neuroepithelium. Expression of mTGIF transcripts was also detected at day E16 in the proliferating cells in the neuroepithelium of the hippocampal formation. Following gestation, mTGIF expression increases to a maximum between postnatal days 5 and 10 (PN5 and PN10) in the rapidly expanding cerebellar EGL. mTGIF transcripts are no longer detectable when EGL proliferation ceases on approximately day PN15. Throughout embryo development and in the adult mice, TGIF is detected in a restricted number of tissues, mostly in proliferating and differentiating cell lineages, such as tongue and testis. Our results suggest that the TGIF gene regulates target genes involved in the proliferation, migration, and/or differentiation of particular neuronal cell lineages in the developing brain.

Amino Acid Sequence↗
PubMed1996

Ecdysone and insect immunity: the maturation of the inducibility of the diptericin gene in Drosophila larvae.

The developmental analysis of the inducibility of the Drosophila diptericin gene promoter as a response to septic injury shows an important increase in the response during the third larval instar leading to a maximum in late larvae and early prepupae. This increase, or maturation, is temporally correlated with known ecdysone induced events of the salivary gland and we now present evidence, using wild type and mutant larvae, that it does indeed depend upon ecdysone. The response remains minimal in larvae carrying either the temperature sensitive ecdysone deficient late larval lethal allele ecd1, or l(1)t187, a deep orange allele known to be deficient in the ecdysone response. However, experiments with the late larval lethal Broad-Complex mutant l(1)t435 show that the regulation of this response is distinct from the developmental ecdysone regulated hierarchies.

Animals↗
PubMed1996

Study of critically ill patients with systemic lupus erythematosus.

OBJECTIVES: To determine the presenting features, prognostic factors, course, and outcome of critically ill patients with systemic lupus erythematosus admitted to the intensive care unit (ICU). DESIGN: Retrospective patient record review. SETTING: Two academic teaching hospitals. PATIENTS: All patients with systemic lupus erythematosus admitted to the ICUs between January 1982 and July 1993. MEASUREMENTS AND MAIN RESULTS: There were 28 female and two male patients. Fifteen patients were white, 11 patients were black, and four patients were Asian. The median age was 29 yrs. The reasons for admission to the ICU were multifactorial. However, most patients were admitted for infective, renal, cardiac, or coagulation complications. Despite aggressive management, 16 (53%) patients died in the ICU or shortly after discharge. The median ICU survival rate (admission to death) was 22 days. The only pretreatment factor that predicted a poor outcome was the presence of renal involvement due to systemic lupus erythematosus. CONCLUSIONS: Our study suggests that patients with systemic lupus erythematosus admitted to an ICU often have florid disease manifestations with multifactorial reasons precipitating the admission. The prognosis for such patients is poor, particularly in the presence of renal involvement.

APACHE↗
PubMed1996

Relationship of non-specific airway hyperresponsiveness (AHR) to measures of peak expiratory flow (PEF) variability.

BACKGROUND: The relationship between airway hyper-responsiveness (AHR) and clinical asthma remains controversial and unclear. AIMS: To test the hypothesis that serial measures of variability of peak expiratory flow rate (PEF) correlate with serial measures of AHR, and to determine which mathematical expression of variability provides the best correlation. METHODS: A longitudinal study over 180 days of 20 atopic, moderately severe asthmatics was undertaken. A diary of medication use and morning and evening PEFR before and after beta agonist was kept and AHR (PD20 histamine) was measured at three-weekly intervals. Using group data (128 sets) in PD20 was correlated with various measures of PEF variability over 9 days. RESULTS: [Table: see text] Within the group there was a weak but highly statistically significant correlation between AHR and measures of PEF variability--the strongest correlation being with mean morning PEF. Within individual subjects, however, the correlation was not a consistent finding and only four patients had a statistically significant relationship (p < 0.05) between AHR and mean morning PEF. CONCLUSIONS: These results suggest that while PEF variability may reflect AHR for the purposes of epidemiologic studies, it is unlikely to be useful as a simple 'non-invasive' means of assessing AHR in individual patients. More complex measures of PEF variability do not have an advantage over simpler measures such as mean morning PEF.

Adolescent↗
PubMed1995

The effects of privet exposure on asthma morbidity.

AIM: To determine whether privet may be an important cause of asthma morbidity. METHODS: The study was conducted in two parts; (1) a longitudinal study of asthma symptoms, medication use, peak expiratory flow rate and airway responsiveness during and after the privet-flowering season, and (2) bronchial challenge of 17 subjects with two species of flowering privet. Subjects were asthmatics who attributed worsening asthma symptoms to privet exposure. All subjects were atopic and had perennial asthma symptoms requiring treatment with inhaled steroids and beta agonists. RESULTS: 1. Twenty subjects completed the longitudinal study. Airway responsiveness (PD20 histamine) was significantly greater during the privet-flowering season (0.4 mumol vs 0.73 mumol, p < 0.05). Symptom scores and bronchodilator use were higher and peak expiratory flow rates lower during the privet-flowering season, but the changes were small and not statistically significant. 2. Seventeen subjects from the longitudinal study subsequently had bronchial challenge studies performed. There were no isolated early responses, but six had late asthmatic responses. Eleven had no airway constrictor response to challenge with either of the two local varieties of privet. CONCLUSION: Although significant increases in airway responsiveness occur during the privet flowering season, only a proportion of this highly select group had a constrictor response to direct challenge. Privet exposure may cause bronchoconstriction in certain individuals, but it is unlikely to be responsible for a large proportion of asthma morbidity in New Zealand.

Adolescent↗
PubMed1995

Major reduction in asthma morbidity and continued reduction in asthma mortality in New Zealand: what lessons have been learned?

Increasing financial barriers to primary health care against a background of social and economic decline are likely to have contributed to asthma morbidity and mortality in New Zealand. Although there would not have been a sufficient increase in asthma prevalence to have accounted for the threefold increase in mortality rates, whether or not there was an increase in asthma severity in the late 1970s remains open to debate. Misuse or poor use of newly available and potent bronchodilator medications by those with the most severe asthma may simply have contributed to further delays in obtaining appropriate care and therefore to an increase in frequency of severe attacks in the community. Despite substantial increases in the use of bronchodilator therapy in New Zealand, there was no immediate improvement in indices of either asthma morbidity or mortality. The initial reduction in mortality rates in the 1980s happened at a time when first admissions for asthma were still increasing and seems to be best explained by an improvement in utilisation of hospital services (which were free until 1992) rather than a reduction in asthma severity. However, the recent reductions in all measures of asthma morbidity and further reduction in asthma mortality since 1989 does now suggest a reduction in asthma severity and would be best explained by the substantial increase in medium and high dose inhaled corticosteroid use, and to the endorsement of the current management strategies for asthma which are being promoted internationally and which were given considerable publicity in New Zealand in 1989 and 1990. Whilst sales of inhaled beta agonists were higher in 1991 than 1989, this may not reflect their pattern of use by individual patients since the need for an increase in inhaled beta agonist treatment has been accepted as indicating a lack of control and the need for either starting or increasing the dose of inhaled steroid treatment.

Adolescent↗
PubMed1995

Sequential gene activation by ecdysone in Drosophila melanogaster: the hierarchical equivalence of early and early late genes.

Ecdysteroids are key regulators of insect development. In Drosophila melanogaster the late larval response to ecdysone is characterised by a precise sequential activation of members of the superfamily of nuclear receptors (DHR3, DHR39, EcR, E75, E78, FTZ-F1, usp). Many of these genes are localised in the polytene chromosome puffs of the salivary gland previously classified as intermoult, early or early-late puff loci. Ashburner et al. (Ashburner, M., Chihara, C., Meltzer, P. and Richards, G. (1974) Cold Spring Harbour Symp. Quant. Biol. 38, 655-662) proposed a formal model describing interactions between ecdysone, its receptor and the early and late puffs during this ecdysone response. To integrate transcripts from the intermoult and early-late puffs into this model, we have used a micro RT-PCR assay to study their hormonal regulation using salivary gland culture protocols first used in the puffing analyses. We show that transcripts from certain early-late puffs are induced in parallel with the early transcripts and are thus hierarchically equivalent. In vivo the profile of the increase in hormone titre, the sensitivity of different promoters to hormone and the rate of transcript accumulation must contribute to the temporal differences in expression observed between these two classes.

Animals↗
PubMed1994

Plasma brain natriuretic peptide in assessment of acute dyspnoea.

Recognition of heart failure (HF) may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction. Since increased secretion of the cardiac hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) occurs early in the course of HF, we have assessed the value of measuring these hormones in plasma in the diagnosis of suspected HF in 52 elderly patients presenting with acute dyspnoea, and compared values with left-ventricular ejection fraction (LVEF), a standard measure of left-ventricular function, by radionuclide angiography. Patients were enrolled prospectively. On the basis of clinical findings, conventional tests, and response to specific treatment, 20 of the 52 patients were classified as having primary lung disorder (PLD), 12 as HF alone, and 20 as HF with underlying PLD (HF/PLD). Compared with findings in PLD patients, LVEF was significantly depressed in HF and HF/PLD patients (p < 0.001), whereas both plasma ANP and BNP were significantly increased (p < 0.001). Admission plasma BNP concentration more accurately reflected the final diagnosis of HF (93% sensitivity and 90% specificity when BNP > or = 22 pmol/L) than LVEF or plasma ANP concentration. When all patients were considered together, there were strong negative correlations between LVEF and log BNP (r = -0.7, p < 0.001) and log ANP (r = -0.59, p < 0.001). Our finding that plasma BNP is raised in dyspnoeic patients with HF but not in acutely breathless patients with PLD, suggests that rapid BNP assays may assist in the diagnosis of patients with acute dyspnoea.

Acute Disease↗