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Biomedical subjects

J Edwards

Publications and source records attributed to J Edwards.

At least 145 records · Page 8Linked to original sources
PubMed1997

Human T-cell lymphotropic virus type I-associated facial nerve palsy in Trinidad and Tobago.

To assess the association of the human T-cell lymphotropic virus type I (HTLV-I) and idiopathic facial nerve palsy of the lower motor neuron type, we studied 78 patients consecutively admitted to the Port of Spain General Hospital in Trinidad, the West Indies, with a confirmed diagnosis of idiopathic facial nerve palsy. Patients were compared with two control groups: a population-based group of persons 20 years and older and a hospital-based group of patients 15 to 84 years old admitted to the medical wards. Sixty-two patients were Trinidadians of African origin and 16 were Trinidadians of East Indian origin. None of the East Indian patients was HTLV-I antibody positive. Three Afro-Trinidadians were infected with human immunodeficiency virus type 1 and 1 was coinfected with this virus and HTLV-I. Of the remaining 58 Afro-Trinidadians, 12 (20.7%) were HTLV-I positive only. This rate was statistically higher than the HTLV-I seroprevalence in the Afro-Trinidadian general population (3.5%) and the hospital control group (5.6%). After age standardization, the HTLV-I prevalence for patients with facial nerve palsy remained significantly elevated. HTLV-I antibody assays should be performed on all patients with idiopathic facial nerve palsy of the lower motor neuron type who live in HTLV-I endemic areas or are migrants from these areas.

Adolescent↗
PubMed1997

New technologies permit safe abortion at less than six weeks' gestation and provide timely detection of ectopic gestation.

OBJECTIVE: The previously held dictum that elective abortion before 6 weeks' gestation carried greater risks than a later procedure was challenged by this protocol. STUDY DESIGN: This study evaluated a protocol for abortion before the customary 6 weeks' gestation. Patients willing to return to the clinic within 72 hours were given the option of elective abortion even when no gestational sac could be visualized with transvaginal ultrasonography. When no chorionic membrane with villi was seen in the curettings, postoperative serum levels of beta-human chorionic gonadotropin confirmed complete evacuation or diagnosed ectopic pregnancy. RESULTS: In 1530 abortion procedures at < 6 weeks' gestation by ultrasonographic criteria no serious complications occurred. In addition, 9 (0.67%) unsuspected ectopic pregnancies were diagnosed. CONCLUSIONS: Abortion before 6 weeks' gestation is safe, given close surveillance. Early termination combined with vaginal ultrasonography and follow-up with beta-human chorionic gonadotropin measurements allows diagnosis of early, unsuspected ectopic pregnancy. Ectopic pregnancy was found to be uncommon in women requesting early abortion.

Abortion, Induced↗
PubMed1997

The risks and benefits of childhood bacille Calmette-Guérin immunization among adults with AIDS. International MAC study groups.

OBJECTIVE: To define the risks of disseminated bacille Calmette-Guérin (BCG) or disseminated Mycobacterium tuberculosis in adults with AIDS who were immunized with BCG in childhood. DESIGN: HIV-infected patients with CD4 < 200 x 10(6)/l were enrolled from five study sites (New Hampshire, Boston, Finland, Trinidad and Kenya). Prior BCG immunization was determined and blood cultures for mycobacteria were obtained at study entry and at 6 months. Acid-fast bacilli were identified as Mycobacterium tuberculosis complex (MTBC) using DNA probes. MTBC isolates were then typed by both IS6110 restriction fragment length polymorphism and polymerase chain reaction/restriction enzyme analysis. SETTING: Most patients in New Hampshire and Finland were outpatients; most patients in Trinidad were inpatients with terminal illness; and most patients in Kenya were outpatients, although 44 were inpatients with terminal illness. PARTICIPANTS: A total of 566 patients were enrolled, including 155 with childhood BCG immunization; 318 patients had a single study visit and culture, and 248 patients had two study visits and cultures. MAIN OUTCOME MEASURES: Isolation and identification of mycobacteria from blood cultures. RESULTS: Blood cultures were positive for MTBC in 21 patients; none were positive for M. bovis BCG, and 21 were M. tuberculosis-positive. In Trinidad, seven (87%) out of eight isolates of M. tuberculosis were indistinguishable by IS6110 typing; BCG immunization was associated with a decreased risk of bacteremic infection with M. tuberculosis (P = 0.05). CONCLUSIONS: The risk of disseminated BCG among adult AIDS patients with childhood BCG immunization is very low. Childhood BCG immunization is associated with protection against bacteremia with M. tuberculosis among adults with advanced AIDS in Trinidad.

AIDS-Related Opportunistic Infections↗
PubMed1997

Experimental infection of deer with bovine viral diarrhea virus.

In order to determine the susceptibility of deer to infection with bovine viral diarrhea virus (BVDV), four mule deer (Odocoileus hemionus) fawns and one white-tailed deer (O. virginianus) fawn were inoculated intranasally with the New York-1 strain of BVDV originally isolated from cattle. None of the animals developed clinical signs of illness. Virus was isolated from white blood cells from four fawns on one or more occasions from day 2 through day 15 post-inoculation (PI) indicating that infection and systemic spread of BVDV had occurred. In addition, virus was isolated from nasal swabs from three fawns, one to three times, from day 2 through day 8 PI. Four fawns had virus neutralizing antibody titers to two strains of BVDV prior to inoculation and all developed greater than four-fold increases in virus neutralizing antibody titers by 3 wk PI. No gross lesions of bovine viral diarrhea were detected at necropsy approximately 3 mo PI. A variety of nonspecific lesions were detected by histopathology. Based on these findings, mule and white-tailed deer are susceptible to infection with BVDV. Isolation of virus from nasal swabs is evidence that BVDV could be transmitted by deer via direct contact.

Animals↗
PubMed1997

Sudden death and the theatre nurse.

Sudden death, by definition, is a death that is unexpected and for which the people concerned are unprepared. In one sense, all deaths are sudden, after all it takes only a few seconds to stop breathing. But many deaths are expected such as when a person has been ill for a long time or is very old and infirm, or has a known terminal condition. Should a normally healthy person die unexpectedly in the operating theatre during routine surgery or as a result of trauma then this may be described as 'Sudden Death'.

Attitude of Health Personnel↗
PubMed1997

Clinical efficacy of specific immunotherapy to cat dander: a double-blind placebo-controlled trial.

OBJECTIVES: To assess the efficacy of specific immunotherapy with standardized cat dander extract, using objective endpoints and simulated 'natural' exposure to cats. DESIGN: Double-blind, randomized, placebo-controlled study carried out at a UK Allergy research clinic. SUBJECTS: Twenty-eight patients with moderate to severe allergic rhinoconjunctivitis with asthma due to cat allergy. Subjects were stratified for cat sensitivity, cat ownership and asthma, and the groups were well matched for all relevant parameters. MAIN OUTCOME MEASURES: Symptom scores and peak flow rate during and after exposure to cats in a cat-room. Skin tests and conjunctival provocation thresholds. RESULTS: The actively treated group showed a marked reduction in symptoms during the cat exposure (mean score 61.6-17.1; P < 0.001) with no change in the placebo group (64.7 vs 62.1). The active group also showed a reduced peak flow response to cat exposure (mean fall of 85 L/min pretreatment, 29 L/min after treatment, P < 0.005) as well as reductions in conjunctival provocation sensitivity, skin sensitivity to cat extract and skin sensitivity to house dust mite (D.pteronyssinus). Skin reactivity to histamine and codeine were unaltered. No significant adverse reactions were encountered. CONCLUSIONS: Specific immunotherapy seems to be an effective treatment for cat allergy. Allergy to cats is common and often poorly controlled on conventional pharmacotherapy. Although cat allergy has not traditionally been considered as a valid indication for immunotherapy in the UK, it should now be considered as a legitimate treatment, especially for those who are unable to avoid exposure.

Adult↗
PubMed1997

What the licensed practical/vocational nurse should know about pharmacological therapy for AIDS sufferers.

Illnesses can rob persons of their dignity and pride. Nowhere has this been more apparent than with people who suffer from Acquired Immunodeficiency Syndrome (AIDS). Because AIDS is a progressive and debilitating disease whose fatal outcome seems hopeless, it is often hard for the sufferer to maintain a sense of human worth. Add to that a prevailing public prejudice that keeps the individual at an arm's length from the support of the community, and a grim picture is given. However, unknown to lay persons and professionals alike, this bleak picture is no longer so grim. With the advent of drug combination therapy treatments (taking several commonly prescribed anti-HIV drugs at the same time), new hope has been given. The purpose of this paper is to describe for the licensed practical/vocational nurse the different and various drugs used for therapy and their effects on the AIDS population. Particular emphasis is placed on the modern combination therapy programs that are being utilized. Current knowledge of AIDS treatment can enable the licensed practical/vocational nurse to increase a client's feelings of hope, self worth, and dignity.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Neuropsychological, olfactory, and hygiene deficits in men with negative symptom schizophrenia.

Associations between symptom subtypes, life skills, olfactory identification, and neuropsychological ability were investigated in patients with schizophrenia and related to observations of poor personal hygiene and implied functional compromise of orbitofrontal integrity. Twenty-seven men with chronic schizophrenia were assessed using the Positive and Negative Syndrome Scale for Schizophrenia and the Life Skills Profile. Performance on the University of Pennsylvania Smell Identification Test (UPSIT), the Modified Wisconsin Card Sorting Test (MWCST), delayed response/alternation, and memory tasks derived from the Wechsler Memory Scale-Revised (WMS-R) was also compared to that of an age-, sex-, and IQ-matched control group. Patient UPSIT, MWCST, and WMS-R performance was significantly impaired in comparison to controls. Poor UPSIT performance and poor self-care were significantly associated with negative symptoms. Also, UPSIT ability was associated with performance on the MWCST in both patients and controls, whereas an association with performance on the WMS-R was only found in normal subjects rather than in the patients with schizophrenia. The importance of these findings to postulated mechanisms involving prefrontal rather than mediotemporal lobe (MTL) function in schizophrenia are discussed, as is the relevance of the use of smell identification ability to subtype identification and rehabilitative strategies.

Activities of Daily Living↗
PubMed1996

Ambulatory electromyogram activity in the upper trapezius region: patients with muscle pain vs. pain-free control subjects.

STUDY DESIGN: This study compared the ambulatory electromyogram activity of persons reporting pain in the shoulder and cervical regions with an equal group of persons not reporting such pain. Ambulatory electromyogram data were obtained over 3-day periods. In addition, all participants completed several standard psychological questionnaires. OBJECTIVES: The results were analyzed with inferential statistics to determine whether subjects reporting significant pain in the shoulder and cervical regions had greater ambulatory electromyogram activity than an equal number of subjects not reporting pain. SUMMARY OF BACKGROUND DATA: Considerable controversy exists regarding the role of muscle activity in the etiology and maintenance of muscle pain disorders. Given the availability of ambulatory recording devices that can provide a detailed record of muscle activity over an extended period of time, the present research was conducted to determine whether persons reporting shoulder and cervical pain could be differentiated from a group of normal subjects. METHODS: All subjects (N = 20) completed a battery of tests with standardized psychometric instruments and then were fitted with ambulatory electromyogram monitors to record electromyographic activity of the upper trapezius region of the dominant side; the time, duration, and amplitude of electromyogram activity greater than 2 microV was recorded. The monitors were worn during normal working hours (mean, 6.2 hours per day) over 3 consecutive days. In addition to wearing the monitors, all subjects completed hourly self-ratings of perceived muscle tension during the recording periods. RESULTS: As expected, subjects with muscle pain reported significantly more pain (mean, 4.9) than did the normal control subjects (mean, 0.9), t(15) = 3.29, P < 0.01. However, patients with muscle pain did not have greater average electromyogram activity (mean, 6.4 microV) over the 3-day period as compared to the normal controls (mean, 7.1 microV), t(18) = -0.25, P < 0.80. Self-monitoring of perceived muscle tension also did not reveal differences between pain subjects and the normal control subjects (P < 0.75). CONCLUSIONS: Ambulatory measurements of electromyogram activity did not differentiate persons reporting upper trapezius or cervical pain from those that did not report such pain. Persons reporting pain are also not distinguishable from normal control subjects on a variety of self-report measures. These results raise questions regarding the role of ambulatory electromyogram recordings in the evaluation and treatment of muscle pain disorders.

Adult↗
PubMed1996

Brush cytology for the diagnosis of rectal carcinoma.

The use of brush cytology as an aid in the preoperative diagnosis of rectal cancer was prospectively assessed at 328 examinations in 289 consecutive patients with rectal lesions suspicious of carcinoma. Forty-five patients were reported as having benign polyps. There was 97 per cent agreement between conventional biopsy and cytology brushings for this group. Some 249 patients underwent a subsequent resection allowing comparison with formal histology. Forceps biopsy produced a true-positive diagnosis of cancer in 218 patients (89.7 per cent) and cytology in 222 (91 per cent). The sensitivity for forceps biopsy and cytology was 81 and 83 per cent respectively, with a combined sensitivity of 98 per cent. It is concluded that the addition of cytology to forceps biopsy increases the diagnostic yield in a single examination, and may be a complementary method of establishing the diagnosis of rectal lesions.

Biopsy↗
PubMed1996

Psychosocial factors and chronic pelvic pain: a comparison of women with endometriosis and with unexplained pain.

Chronic pelvic pain is a common clinical problem, and physical investigation often fails to reveal its cause. For this reason, it has been argued that psychological and social factors contribute to such "unexplained" pain. Few studies to date using well-validated psychometric measures and adequate sample sizes have compared patients with unexplained pain and those with identified physical disease. The present study compared pain severity, mood symptoms, personality characteristics and social adjustment in women with unexplained pain and women with endometriosis. Women with endometriosis were more likely to come from upper socioeconomic groups. No differences in mood symptoms or personality characteristics were identified, but women with endometriosis had somewhat more severe pain and greater social dysfunction than those with unexplained pain. Mood disorder and social dysfunction appear to be at least as important in patients with proven endometriosis as in those with unexplained pain.

Adult↗
PubMed1996

Corticosteroid-induced delirium and dependency.

A case of a patient with chronic lung disease who developed an addiction pattern of corticosteroid dependency is described in which steroid-induced delirium also developed. The rare phenomenon of corticosteroid dependency is discussed as well as the phenomenology and possible mechanisms of steroid-induced delirium.

Adult↗
PubMed1996

Energy expenditure of walking for adult patients with spinal cord lesions using the reciprocating gait orthosis and functional electrical stimulation.

A major factor influencing compliance with walking orthoses following spinal cord damage, is the energy requirement associated with them. We compared ambulatory energy expenditure in subjects using the reciprocating gait orthosis (RGO) with and without functional electrical stimulation (FES) of the thigh muscles at self selected walking speeds. Five adult subjects (median age 34 years, range 24-37) with spinal cord lesions ranging from C2 (incomplete) to T6 volunteered to participate in this study. All subjects were successful RGO users (median use 5.7 years, range 4.1-7.3). Walking speed (m/s), ambulatory energy consumption (J/kg/s) and energy cost (J/kg/m) were derived from oxygen uptake determined using the Douglas bag technique. We anticipated that subjects walking with FES would either: (a) walk at the same speed but reduce their energy cost or (b) increase their walking speed for the same (or less) energy cost. Walking speed and energy cost remained unchanged in one subject. One subject increased his walking speed by 14.0% and increased his energy consumption by 8.4%. His energy cost remained unchanged. Three subjects increased their walking speeds (by 12.4, 12.7 and 6.8%), energy consumption (by 25.9, 20.4 and 18.4% respectively) and energy cost (by 11.6, 6.8 and 10.5% respectively). We did not find a substantial benefit, in terms of energy expenditure, from the hybrid system when walking continuously for 5 min. We suggest that the hybrid system may be of greater benefit during prolonged walking, although other limitations, inherent in the RGO itself, may prevent an increase in compliance. Repetition of walking speed tests supported the reliability of our results. Tests on comparably aged, able-bodied subjects showed that an increase in energy cost of up to 5.8% was within the biological variability of the subject and the error of the methodology.

Adult↗
PubMed1996

Why do children with specific language impairment name pictures more slowly than their peers?

To examine the role of different cognitive processes in accounting for the slower naming times of children with specific language impairment (SLI) relative to peers with no language impairment (NLI), three tasks designed to stress different types of processing, were administered: naming pictures with the signal to respond presented at various delay intervals, naming following different durations of exposure to identical and unrelated primes, and vocally responding to nonlinguistic stimuli. Children with SLI, aged 4 to 9.5 years, were significantly slower than their NLI age peers on naming and on responding to nonlinguistic stimuli, but the effect of delay interval before naming and of duration of prime exposure before naming was similar for both groups. Results suggested that speed of naming is related to the slower nonlinguistic response processing of children with SLI and not to speed of their linguistic or perceptual processing. To examine differences in processing that might relate to pattern of language performance we examined responses of two subgroups of SLI. The subgroup of children whose language problems involved expressive but not receptive skills was not significantly slower than their NLI peers. The children whose problems involved both expressive and receptive language were significantly slower, but this was influenced by age. Findings are discussed in terms of language performance, age, task variables, and a generalized rate-limiting factor.

Child↗
PubMed1996

Auditory lexical decisions of children with specific language impairment.

To determine whether children with specific language impairment (SLI) take longer than age peers to recognize sequences of sounds that represent words in their lexicon, we compared auditory lexical decision times of children with SLI to those of typically developing age peers. Children with SLI were significantly slower than peers, but speed of word recognition was not correlated with measures of language comprehension for children with SLI. Furthermore, time to detect an auditory signal and initiate a vocal response did not account for the differences between groups. Possible interpretations of the results are discussed with two explanations-differences between groups in task-related factors that stressed processing capacity or in the nature of phonetic/phonological representations-seeming more likely than others.

Child↗