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Biomedical subjects

J Cohen

Publications and source records attributed to J Cohen.

At least 955 records · Page 53Linked to original sources
PubMed1992

Use of general practice by intravenous heroin users on a methadone programme.

Users of intravenous heroin represent a major challenge for general practice. A study was undertaken in a general practice in central London in 1990 to investigate the use of general practice made by intravenous heroin users who were on a methadone programme. Using information recorded in the patients' notes, 29 intravenous heroin users on a methadone programme were identified; 58 non-drug users (two controls per case) were matched for age, sex and general practitioner. A study of the number of routine consultations, missed appointments, emergency appointments and prescribed items showed that during the study period, those on a methadone programme made a larger number of routine consultations than the control subjects (median number of consultations 14 versus 0). When consultations at which only a prescription was issued were excluded this difference disappeared. Appointments were missed by 14 drug abusers (48%) but by none of the control group (P < 0.001). Emergency appointments were made by seven drug abusers (24%) compared with only two controls (3%) (P < 0.01). Even after prescriptions for methadone hydrochloride had been excluded from the analysis, patients on the methadone programme were prescribed significantly more items than patients in the control group (P < 0.001). This research has shown that intravenous heroin users on a methadone programme used general practice to a greater extent than non-drug users, according to the criteria used in the study. The implications that this may have in discouraging budget holding practices from running such schemes are discussed.

Adult↗
PubMed1992

Advances in clinical micromanipulation of gametes and embryos. Assisted fertilization and hatching.

Several methods for micromanipulation of human gametes have been proposed to enhance fertilization in cases of male infertility. Of these methods, two have been successful in producing pregnancies and live births worldwide; these include partial zona dissection and subzonal sperm insertion. During the period between October 1989 and July 1991, 251 patients with male infertility due to impaired sperm function were treated with in vitro fertilization in conjunction with gamete micromanipulation at our center. Sixty pregnancies (24% per cycle, 42% per replacement) resulted in 144 patients. The details of these treatments are discussed. In another study, in an attempt to increase the incidence of implantation, we have conducted three clinical trials of assisted hatching and selected assisted hatching. The combined results of the trials indicate a clinical pregnancy rate of 51% in the control group and 60% in the micromanipulated group (P less than .05). Moreover, while 20% of the embryos replaced in the control group implanted the implantation rate was increased to 28% in the experimental group (P less than .05). Methodologies and possible implications of these treatments are discussed.

Embryo Implantation↗
PubMed1991

Acetaminophen does not impair clearance of zidovudine.

OBJECTIVE: To determine whether concurrent treatment with acetaminophen and zidovudine impairs clearance of zidovudine, thereby increasing the risk for zidovudine-induced hematologic toxicity. DESIGN: Dose escalation, drug interaction study. SETTING: University clinical research center. PATIENTS: Patients with the acquired immunodeficiency syndrome (AIDS) or advanced AIDS-related complex. INTERVENTIONS: Acetaminophen and 200 mg of zidovudine simultaneously every 4 hours. For 13 patients, the unit dosage of acetaminophen was 325 mg for 3 days; for 8 patients, the dosage was 650 mg for 3 days; and, for 6 patients, the dosage was 650 mg for 7 days. MEASUREMENTS: Zidovudine clearance and production of the glucuronide conjugate of zidovudine were assessed after acetaminophen treatment. MAIN RESULTS: Neither zidovudine clearance nor production of the glucuronide conjugate of zidovudine was impaired after treatment with acetaminophen. Clearance of zidovudine was actually accelerated by 5%, 11%, and 33% with the three acetaminophen regimens, respectively (P = 0.002 by analysis of variance; P = 0.04 for linear trend when changes in the area-under-the-curve for zidovudine were compared). CONCLUSION: Because serum concentrations of zidovudine decrease after the coadministration of acetaminophen, a pharmacokinetic interaction between zidovudine and acetaminophen is unlikely to increase the risk for hematologic toxicity associated with zidovudine.

AIDS-Related Complex↗
PubMed1991

Induction of anti-phospholipid syndrome in naive mice with mouse lupus monoclonal and human polyclonal anti-cardiolipin antibodies.

The primary anti-phospholipid syndrome is characterized by recurrent venous and arterial thromboembolic phenomena, recurrent fetal loss, thrombocytopenia, and serological evidence of anti-cardiolipin (aCL) antibodies or/and the presence of lupus anticoagulant (prolonged activated partial thromboplastin time). The exact role of aCL antibodies in pathogenesis is not clear and the mechanism by which the antibodies may induce the various manifestations is unknown. In the current study we evaluated the effect of passive transfer of aCL antibodies (to the tail vein of naive mice) on fecundity, fetal loss (fetal resorption), and the weight of embryos and placentae. Two types of aCL antibodies were employed: (i) mouse monoclonal aCL antibodies derived from a BALB/c mouse in which experimental systemic lupus erythematosus was induced by a pathogenic idiotype (idiotype 16/6) of anti-DNA antibodies and (ii) polyclonal IgG and IgM aCL antibodies derived from serum of a patient with primary anti-phospholipid syndrome. After infusion of either antibody (10 micrograms per mouse) we could demonstrate lower fecundity rate, increased resorption index of embryos (equivalent to recurrent fetal loss), lower number of embryos per pregnancy, and lower mean weights of embryos and placentae in comparison to mice infused with appropriate control immunoglobulins. We conclude that the aCL antibodies may have direct effects on fecundity and on the outcome of pregnancy.

Animals↗
PubMed1991

[Venous insufficiency and oral contraception].

Varicose veins are commoner in women than in men. The recrudescence of venous symptoms during pregnancy or premenstrual syndrome indicate the preponderant role of sex hormones in their etiology. Oral contraception may thus have effects on the veins. These effects can be broadly divided into two groups: risks of thromboembolism (clotting disorders, venous wall changes and hemodynamic abnormalities). These risks are rare but serious, venous pathology (loss of venous tone, slowing of blood flow, valve insufficiency, trophic lesions, etc.) Since the availability of low dose oral contraceptives, and since improved knowledge of contraindications, vascular repercussions have almost disappeared except when there is a vascular past history which must be routinely sought.

Contraceptives, Oral↗
PubMed1991

Social environment and social support.

Research on the relevance of social support to cancer has been plentiful since the first American Cancer Society workshop on methodological issues in behavioral and psychosocial science. Nonetheless, critical shortcomings continue to characterize the attempt empirically to establish such things as the extent to which social support predicts adjustment to cancer diagnosis and treatment. Prominent among these is the failure to adequately address large elements of the social structure, such as social class and urbanization, and to investigate how they shape the well being of persons with or at risk for cancer and their caregivers. We recommend that more psychosocial research on the link between social support and cancer be conducted within populations beset by poverty and without adequate access to health care. Funding is needed for the training and maintenance of multidisciplinary and multicultural teams of researchers working within community-based organizations and hospitals serving the underserved.

Humans↗