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Biomedical subjects

J Gray

Publications and source records attributed to J Gray.

At least 199 records · Page 11Linked to original sources
PubMed1997

Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England.

OBJECTIVE: To describe the incidence and prevalence of primary biliary cirrhosis in an urban population between 1987 and 1994, using stringent inclusion criteria and a well-defined study area and population. DESIGN: Descriptive study based on a case register compiled by a retrospective and prospective case-finding exercise and examination of case notes. SETTING: The city of Newcastle upon Tyne. MAIN INCLUSION CRITERIA: (1) Definite cases: fulfilling all three of the following diagnostic criteria: positive antimitochondrial antibody (AMA) > or = 1:40; cholestatic liver function tests (LFT); diagnostic or compatible liver histology. (2) Probable cases: fulfilling two of these criteria. SUBJECTS: All cases of primary biliary cirrhosis identified by multiple case-finding methods, alive from 1 January 1987 to 31 December 1994, in the defined area. MAIN OUTCOME MEASUREMENTS: Incidence and point prevalence rates by age and sex. RESULTS: In all, 202 potential cases were identified, of whom 160 met at least two inclusion criteria. In definite cases annual incidence varied from 14 to 32 (mean 22) per million whole population (with no clear trend) and point prevalence rose from 180 per million in 1987 to 240 in 1994. Mean age at diagnosis in cases incident during the study period was 63.2 years (S.D. 11.1 years, range 39.8-85.7 years). CONCLUSIONS: Primary biliary cirrhosis is much more common in Newcastle than has previously been reported anywhere in the world, and prevalence appears to be rising.

Adult↗
PubMed1997

Endocarditis caused by Haemophilus parainfluenzae identified by 16S ribosomal RNA sequencing.

Haemophilus parainfluenzae, a human commensal, is an infrequent cause of serious disease. A case of endocarditis caused by this organism in a five year old boy with complex congenital heart disease is reported. The course of this disease was very aggressive, leading to heart failure, disseminated intravascular coagulation and multiorgan failure in spite of appropriate antibiotics and surgical intervention. The difficulties in the detection and identification of H parainfluenzae using conventional culture based technology, and the potential role of molecular techniques, are highlighted.

Anti-Bacterial Agents↗
PubMed1997

A FISH approach to defining the extent and possible clinical significance of deletions at the WAGR locus.

Nineteen patients were analysed by fluorescence in situ hybridisation (FISH) with selected 11p13 markers. They were examined because they had either isolated sporadic or familial aniridia, or aniridia with one or more of the WAGR (Wilms' tumour, aniridia, genital anomalies, and mental retardation) syndrome anomalies. The FISH markers from distal 11p13 were cosmids FO2121, PAX6 (aniridia), D11S324, and WT1 (Wilms' tumour predisposition). Two of the patients with isolated aniridia were abnormal, one with an apparently balanced reciprocal 7;11 translocation and an 11p13 breakpoint, which by FISH was shown to be approximately 30 kb distal to the aniridia (PAX6) gene, and the other had a submicroscopic deletion involving part of PAX6 that extended distally for approximately 245 kb. Two patients with aniridia together with other WAGR malformations had deletions involving all four cosmids. One case with aniridia associated with developmental and growth delay had a deletion including FO2121 and PAX6 but not D11S324 and WT1, while in a further case the deletion included all four test cosmids. These studies show that a combined conventional and molecular cytogenetic approach to patients presenting with aniridia is a useful method for differentiating between those with deletions extending into and including WT1 and therefore between those with high and low risks of developing Wilms' tumour.

Aniridia↗
PubMed1997

Huntington's disease: psychiatric practice in molecular genetic prediction and diagnosis.

BACKGROUND: Predictive genetic testing for Huntington's disease has been available in Cardiff since 1987 using linked genetic markers, and since 1993 using direct mutation testing, which can also be used as a diagnostic test. During this period there have been numerous referrals that have required liaison with psychiatric services at all stages of the testing programme. METHOD: A series of cases was selected to highlight issues from both genetic prediction and diagnosis that are relevant to psychiatric practice and have arisen during the testing programme. RESULTS: Issues have been raised concerning competence to consent to testing in the context of psychotic illness; depression and suicidal ideation in test candidates; requests for testing from third parties such as psychiatrists, social services and the courts; and testing of children. CONCLUSIONS: As genetic testing becomes possible for more disorders the lessons learned from Huntington's disease will provide valuable guidelines for counselling.

Adolescent↗
PubMed1997

Type of hospital setting and treatment outcome with heroin addicts. Results from a randomised trial.

BACKGROUND: General psychiatrists have recently been encouraged to provide treatment to heroin addicts, including in-patient detoxification. No comparison has previously been made of specialist versus general psychiatric in-patient care. METHOD: During a randomised study of cue exposure, 186 opiate addicts were also randomised to either specialist in-patient (DDU; n = 115) or general psychiatric (GEN; n = 71) wards in the same hospital. RESULTS: From pre-treatment (post-randomisation) onwards, patient outcomes differed across the two in-patient settings. Of the original randomised sample, significantly more DDU than GEN subjects accepted their randomisation (100 v. 77%), were subsequently admitted (60 v. 42%), and completed in-patient detoxification (45 v. 18%). Of patients admitted, more DDU than GEN patients completed detoxification (75 v. 43%). During seven-month follow-up, of those 43 patients who reached the end of treatment, significantly more ex-DDU than ex-GEN subjects were opiate-free. CONCLUSIONS: From pre-treatment onwards, significant differences in process and outcome were found after allocation to treatment on either DDU or GEN. Further randomised studies are required to replicate and explain these findings.

Adult↗
PubMed1997

Testing the hypothesis of the multidimensional model of anorexia nervosa in adolescents.

This study statistically tested six hypothesized risk factors of the model for anorexia nervosa. Forty-three adolescents with anorexia nervosa and 85 controls were administered the EAT, EDI, and FES. In addition, 43 parents of anorexics and 85 parents of controls completed the Family History Data Sheet, the FES, and the Perfect Child Questionnaire. Three of six hypothesized risk factors were confirmed: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Log-linear analysis indicated that the hierarchical model that best fit the data had significant two-way interactions with anorexia nervosa, G2 (11, N = 128) = 65.87, p < .001. In addition, alcohol and drug abuse or dependence figured prominently in the family history of patients with anorexia nervosa. The multidimensional model for anorexia nervosa holds up as an exploratory model of this condition in the adolescent age group.

Adolescent↗
PubMed1997

Telematics in the neonatal ICU and beyond: improving care for high-risk newborns and their families.

The Beth Israel-Deaconess has recently been awarded one of 19 contracts from the National Library of Medicine (NLM) to develop, implement and test a telemedicine application to support the care of Very Low Birth Weight Infants. This project is the only one to focus on the care of newborns. We believe that this project will provide a new national approach to managing the care of high-risk newborns by leveraging evolving communication technology.

Computer Security↗
PubMed1997

General practitioner teaching in the community: a study of their teaching experience and interest in undergraduate teaching in the future.

BACKGROUND: In line with the General Medical Council (GMC) recommendations for undergraduate teaching, many medical schools are implementing new programmes of community-based teaching. Little is known about the enthusiasm of general practitioners (GPs) for, or their ability to undertake, an additional teaching role. AIM: To assess the reservoir of teaching experience among GPs and, in particular, their undergraduate teaching experience, their views on the rewards and problems of teaching, their interest in teaching in the future, and their needs for support. METHOD: Postal questionnaire sent to all 417 GP principals with Lambeth, Southwark, and Lewisham family health service authorities (FHSAs) in January 1995. RESULTS: We achieved a 74% (310/417) response rate. A total of 86% (261/303) of GPs have some sort of teaching experience in their current practice. A large number of medical and non-medical subjects are already being taught. Overall, 75% (228/303) of GPs had experience of undergraduate teaching. Only 13% (41/303) had no teaching experience of any kind. Very few responders felt that teaching was best done in hospital. Different rewards and problems of teaching were perceived by undergraduate teaching GPs and other GPs. There was a high level of interest in undergraduate teaching in the future and a demand for a variety of support measures from medical schools. CONCLUSIONS: New community-based programmes are likely to receive support from GPs, but the vital issues of time, adequate financial reward, and teacher training must be addressed by medical schools if large-scale changes in undergraduate teaching are to be achieved.

Adult↗
PubMed1996

Challenge ahead.

Explore the source record for details and available documents.

Congresses as Topic↗
PubMed1996

European Union Concerted Action on Risk Assessment in Lyme Borreliosis: clinical case definitions for Lyme borreliosis.

The EU Concerted Action on Risk Assessment in Lyme Borreliosis (EUCALB) has consulted other clinicians and scientists in Europe to produce case definitions of the principal manifestations of European Lyme borreliosis. These case definitions will not only be helpful in supporting its own research interests, but are also intended to assist other clinicians in appropriate management and to support further studies aimed at determining the full clinical spectrum of the disease. The case definitions were achieved after a series of meetings organised by EUCALB with other expert clinicians and scientists from twelve European countries. The definitions and the diagnostic criteria presented thus represent the consensus reached at these meetings. The proposed case definitions consider skin, nervous system, cardiac and musculoskeletal presentations and the role of laboratory investigation in supporting diagnosis.

Acrodermatitis↗
PubMed1996

Nosocomial infection with Rhizopus microsporus in preterm infants: association with wooden tongue depressors.

BACKGROUND: We report four cases of cutaneous infection with Rhizopus microsporus in vulnerable preterm infants in one neonatal nursery. METHODS: There was no overlap in hospital stay between the first two cases and an extensive programme of environmental sampling was therefore initiated, with special attention being paid to items that had close contact with infants' skin. Samples were cultured by standard techniques, including fungal culture with Sabouraud's medium. Filamentous fungi with non-septate hyphae were presumptively identified as agents of mucormycosis and referred to the Mycology Reference Laboratory, Bristol, UK, for speciation. FINDINGS: The source of infection was identified as wooden tongue depressors, which were used on the nursery to construct splints for intravenous and arterial cannulation sites. The outbreak was ended by the removal of these items from the nursery. INTERPRETATION: Wooden tongue depressors can be a vehicle for transmission of mucormycosis. The combination of warm, humid conditions in neonatal incubators, particularly in association with occlusive dressings, may favour cutaneous fungal invasion and put small, sick babies at risk of infection.

Cross Infection↗
PubMed1996

Expression of functional lutropin/choriogonadotropin receptor in the baculovirus system.

The LH/CG receptor (LH/CG-R) is a G protein-coupled receptor with a relatively large glycosylated extracellular domain. The complete 674 amino acid residue rat receptor was expressed in Sf9 insect cells using the baculovirus expression system. Optimal expression under the control of the polyhedrin promoter was obtained at 72 h post-infection and a multiplicity of infection of 0.1. The recombinant LH/CG-R was expressed on the cell surface (ca. 4500 receptors/cell) and exhibited saturable, high affinity binding of human CG (hCG) with a Kd of 0.4 nM. There was no evidence of intracellular trapping of the receptor. The intracellular concentration of cAMP was increased in response to hCG binding. In contrast, baculovirus-expressed recombinant hCG only weakly stimulated intracellular cAMP levels at relatively high doses. Two forms of the receptor (approximately 75 and approximately 200 kDa) were detected by Western blot analysis. These results demonstrate that the full length LH/CG-R expressed in insect cells is functional in that it binds hormone with high affinity and is able to couple to adenylate cylase.

Adenylyl Cyclases↗
PubMed1996

Ecthyma gangrenosum occurring at sites of iatrogenic trauma in pediatric oncology patients.

We report two cases of ecthyma gangrenosum which occurred at sites of iatrogenic trauma. The first case developed due to metastatic seeding with Pseudomonas aeruginosa during an episode of septicaemia and the second case occurred as a primary skin lesion. Both required prolonged courses of antibiotics and one patient died. The different pathogenic mechanisms and outcomes associated with this condition are discussed.

Anemia, Aplastic↗
PubMed1996

Changes in "withdrawal symptoms" following discontinuation of low-dose diazepam.

The intensity of putative benzodiazepine withdrawal symptoms was evaluated as part of a double blind placebo-controlled study of benzodiazepines and behaviour therapy in the management of agoraphobia. During the first phase of that study, some subjects were switched from low dose diazepam to placebo, and others remained on diazepam. Symptoms were evaluated in long-term benzodiazepine users (n = 30) and non-users n = 32) when they first entered the study and 4 weeks later, after both groups had been randomized to either diazepam or placebo, using eight analog rating scales measuring commonly reported withdrawal symptoms. At baseline, both users and non-users reported a substantial number of symptoms, with higher levels in the more anxious patients, but no differences between groups. After the transition to either diazepam or placebo, the users switched to placebo reported significantly higher levels of symptoms than users switched to diazepam and non-users combined. Multiple regression analysis suggested that the increase in symptoms was associated with the increase in anxiety, which was higher in the withdrawing group than the other three groups. These results raise questions concerning the extent to which withdrawal symptoms uniquely characterize benzodiazepine withdrawal. They confirm the common assumption that an increase in symptoms often accompanies withdrawal from benzodiazepines, but suggest that such symptoms are not so intense as to make withdrawal excessively difficult, at least in low-dose users.

Adult↗