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Biomedical subjects

J Leonard

Publications and source records attributed to J Leonard.

At least 109 records · Page 6Linked to original sources
PubMed1991

Cost-effectiveness of hepatitis B screening in a mental health institution.

In 1982, the Ohio Department of Health Screening established guidelines for hepatitis B screening and vaccination for intermediate mental health care facilities. The present study was developed to evaluate the cost-effectiveness of these guidelines. Data from an intermediate mental health care institution in Champaign/Urbana, Illinois, were used. The analysis considered the direct costs and benefits accrued over a 3-year period and a range of transmission rates. At a 3-year transmission rate of 0.030, the screening and vaccination policy cost $7300 per case of hepatitis B avoided (or $345,800 per hepatitis B fatality avoided). At a more likely 3-year transmission rate of 0.271, the screening and vaccination policy cost $300 per case of hepatitis B avoided (or $12,100 per hepatitis B fatality avoided). Either way, the active prevention policy compares very well with the amounts of money spent by the US Government on other life-saving programs. A general cost-effectiveness model is given that can be adapted for institution-specific analyses at other mental health care facilities.

Cost-Benefit Analysis↗
PubMed1990

[Fetal macrosomia in a diabetic mother].

Foetal macrosomia is arbitrarily defined as an excessive weight for the gestational age, was found to be present in 36 p. 100 of 43 diabetic pregnancies. This finding may indicate incomplete normalization of maternal metabolic control despite the use of new forms of insulin delivery systems, such as insulin pumps. However, in our series the macrosomia was usually moderate and without consequences on the foetal outcome. The levels of insulin, but not those of the insulin-like growth factor (IgF1), were increased in the umbilical cord blood of macrosomic newborns of diabetic mothers. Cardiac septum hypertrophy correlated with maternal glycosylated haemoglobin levels better than with macrosomia. We therefore suggest that in all diabetic pregnancies the cardiac septum thickness should be measured in utero by sonocardiography.

Adult↗
PubMed1990

Linear IgA disease of adults: association with lymphoproliferative malignancy and possible role of other triggering factors.

Seventy patients with linear IgA disease of adults were followed up for a mean of 8.5 years and all malignant diseases in this group were ascertained. There were three cases of lymphoproliferative malignancy, which constituted a significant excess over the 0.2 cases that would be expected by comparison with an age- and sex-matched population using National Cancer Registry statistics. In contrast, the non-lymphoid malignancy rate of 13% is almost identical to the expected 14%. A subgroup of 35 of the adult linear IgA disease patients were assessed with respect to the possible precipitating illnesses or drugs, as well as co-existing medical conditions. Almost one-third of patients described an event that was felt could possibly have triggered the linear IgA disease, the most frequent being non-steroidal anti-inflammatory or antibiotic drug therapy, trauma/burns and upper respiratory tract infections. However, it is difficult to determine how often the preceding event is coincidental, and how often, if at all, it is causal.

Adolescent↗
PubMed1990

Dust mite assays in clinical allergy practice: mite antigen exposures among skin test positive patients in Kansas.

We have attempted to determine whether sensitive monoclonal antibody assays for Dermatophagoides mite antigens Der p I and Der f I can be carried out in a private clinical allergy practice laboratory, to ascertain incidence of significant home mite exposure in dust samples from patient homes in Kansas, and to consider whether such information impacts on patient management. We analyzed 152 dust samples from 62 patient homes. All patients were skin prick test positive for one or both common mite species available for skin testing, and had potentially relevant histories. Der p I and Der f I antigen levels were added together, and levels above 2 micrograms/g of dust were considered "positive." By this definition, elevated levels were found in at least one sample from 48 of 62 homes tested (77%); however, 61% of mattress samples tested, 41% of carpet samples, and 54.5% of furniture samples had levels below those considered likely to cause symptoms. Only 13 of 152 samples yielded Der p I levels above 2 micrograms/g. We conclude that monoclonal antibody assays for Der p I and Der f I antigens can be performed in a well-equipped office laboratory staffed by trained medical technologists, that Der f I is the predominant mite species in Kansas, and that data derived from mite assays may be important in treatment planning for patients suspected of having mite-related allergy symptoms.

Allergens↗
PubMed1989

Medical and surgical management of early Q wave myocardial infarction. II. Effects on mortality and global and regional left ventricular function at 10 or more years of follow-up.

To determine the long-term effect of surgical reperfusion on survival and left ventricular function of patients with anterior and inferior Q wave myocardial infarction, 387 patients were followed up for greater than or equal to 10 years after early Q wave infarction. In the anterior infarction group, 102 received conventional therapy and 101 underwent surgical reperfusion. The overall hospital mortality rate in the medically and surgically treated patients was different (16.7% [17 of 102] versus 6.9% [7 of 101], p less than 0.05). The cumulative 13 year actuarial mortality rate widened between the anterior medical and surgical groups (54% versus 31%, p = 0.0003) by the adjusted Cox proportional hazards model. The hospital mortality rate with early reperfusion (that is, less than or equal to 6 h of symptom onset) was 2% (1 of 51), whereas the mortality rate with late reperfusion was 12% (6 of 50). The 13 year actuarial cumulative mortality rate was significantly lower in both the early and late reperfusion groups (30% and 33%, respectively) than in the conventional therapy group (54%, p = 0.0006). The mortality rate in patients receiving surgery after surviving initial medical therapy was 50% (15 of 30). In the survivors of anterior Q wave myocardial infarction, improved global ejection fraction was seen in the patients undergoing early (54 +/- 13%) and late (50 +/- 10%) surgery relative to those receiving conventional therapy (43 +/- 11%, p less than 0.05). Only the early reperfusion group had better regional function of the anterior wall than that of the conventional therapy group. Thus, ventricular function correlated with improved long-term survival. In the patients with inferior Q wave myocardial infarction, the overall hospital mortality rate in the medical and surgical groups was not different (6.1% [6 of 98] versus 4.6% [6 of 86], p = NS). Likewise, the 13 year actuarial cumulative mortality rate was not different between the medical and surgical groups overall (32% versus 30%, p = 0.29) by the adjusted Cox proportional hazards model. The hospital mortality rate in the early reperfusion group was lower than that in the late reperfusion group (2.0% [1 of 49] versus 8.1% [3 of 37], p = NS). The 13 year actuarial cumulative mortality rate was lower in the early surgical group compared with that in the medical group (19% versus 32%, p = 0.04). The late surgical group had a similar 13 year actuarial cumulative mortality rate to that of the medical group (47% versus 32%, respectively, p = 0.47).(ABSTRACT TRUNCATED AT 400 WORDS)

Cardiac Catheterization↗
PubMed1989

The human immunodeficiency virus long terminal repeat is preferentially expressed in Langerhans cells in transgenic mice.

Four lines of transgenic mice containing the HIV LTR linked to the bacterial gene encoding chloramphenicol acetyltransferase (CAT) were constructed. In each line, a characteristic tissue pattern of CAT expression was observed with detectable levels present in the eye, heart, spleen, thymus, and tail. Low levels of CAT were present in circulating lymphocytes, but CAT activity in these cells could be augmented following treatment with the mitogen phytohemagglutinin (PHA). Likewise, CAT expression was present at only low levels in circulating monocytes, but higher levels of CAT were observed in macrophages grown in the presence of various cytokines (CSF-1, GM-CSF, IL-1 alpha, IL-4, and IL-2). Furthermore, Langerhans cells recovered from skin showed higher levels of CAT activity than those observed in other cells of monocyte-macrophage lineage. These results indicate that LTR-CAT expression in cells of monocyte-macrophage lineage may increase in proportion to the degree of differentiation of these cells. These animals may be useful in the study of cell-specific determinants of LTR-directed gene activity and may serve to identify exogenous cofactors that promote the progression of HIV-related disease in vivo.

Animals↗
PubMed1989

The NF-kappa B binding sites in the human immunodeficiency virus type 1 long terminal repeat are not required for virus infectivity.

Mutations were introduced into the regulatory sequences in the long terminal repeat of an infectious molecular clone of the human immunodeficiency virus. Viruses in which the NF-kappa B binding sites were deleted or ones in which one or two Sp1 binding sites were mutated still replicated efficiently in human T lymphocytes. A deletion of the two NF-kappa B sites plus the three Sp1 sites or a mutation of the tat-responsive region rendered the virus replication incompetent. Thus, the NF-kappa B sequences are not required for human immunodeficiency virus infectivity; however, a tat-responsive region is essential.

Base Sequence↗
PubMed1989

Recognising covert disease in women with chronic vulval symptoms attending an STD clinic: value of detailed examination including colposcopy.

A vulval colposcopy clinic was established in the sexually transmitted diseases (STD) clinic of St Mary's Hospital, London, to investigate patients with chronic symptoms (mean duration 3 1/2 years). Fifty patients with a mean age of 33 were studied for 12 months, and a specific diagnosis was established for many of them. Forty complained of pruritus vulvae, 33 of dyspareunia, and 30 of vulvodynia. One or more macroscopic abnormality was seen in 29 of the women, the most common being erythema, papules, plaques, and fissures. Colposcopic abnormalities, however, were identified in 45 of the women, the most common being acetowhite epithelium in a flat, papillary, or cobblestone pattern. Biopsy specimens were obtained from 33 of the patients, and all had abnormal histological features. Those of human papillomavirus (HPV) infection were the most common, and were found in 27 specimens; evidence of vulval intraepithelial neoplasia was seen in seven and that of dermatoses in 10. Further work is required, however, before concluding that HPV was necessarily responsible for the chronic symptoms.

Adult↗
PubMed1989

HIV-2-associated AIDS in the United States. The first case.

A 41-year-old woman from the Cape Verde Islands, Africa, who had been residing in the United States for 11 months was found to have human immunodeficiency virus type 2 (HIV-2)-associated acquired immunodeficiency syndrome (AIDS). Antibody to HIV-2 was found by enzyme immunoassay and was verified by radioimmunoprecipitation. The patient was being treated for pulmonary tuberculosis at the time of her admission to our institution. Further laboratory and clinical evaluation at our facility revealed depressed CD4 lymphocytes, oral candidiasis, and cryptococcal meningitis with indeterminate results on serologic testing for HIV type 1 (HIV-1). The biopsy specimen of a lesion in the right occipital lobe of the brain documented Toxoplasma gondii, indicating a clinical diagnosis of AIDS. To our knowledge, our study presents the first known patient with HIV-2-associated AIDS in the United States. Our patient provides further evidence that HIV-2 causes severe immunodeficiency and opportunistic infection. The condition should be suspected in the face of normal or repeatedly equivocal HIV-1 antibody test results in the presence of clinically documented AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Effect of methionine loading and endogenous hypermethioninaemia on blood mercaptans in man.

In five patients with cirrhosis given an oral methionine load, blood mercaptan concentrations were not significantly affected by neomycin and metronidazole therapy. Methanethiol and dimethyl sulphide rose after methionine to levels encountered in hepatic encephalopathy but in stable cirrhotics no neurological abnormalities were evident. In one patient with chronic hepatic encephalopathy there was no significant change in methanethiol, dimethyl sulphide or ammonia concentration 4 h after methionine when conscious state had deteriorated by two stages of encephalopathy. Elevations in blood methanethiol and dimethyl sulphide concentration in children with congenital hypermethioninaemia were not associated with any neurological or electroencephalographic features of hepatic coma. These studies do not support an important role for mercaptans in hepatic encephalopathy although a synergistic effect cannot be excluded. Furthermore, mercaptans appear to arise from endogenous metabolism rather than bacterial action in the gut.

Hepatic Encephalopathy↗
PubMed1988

A comparative serological and molecular study of linear IgA disease and dermatitis herpetiformis.

The class I and class II HLA serologically defined antigens and DQ alpha and DX alpha restriction fragment length polymorphism (RFLP) in 23 patients with linear IgA disease (LAD) were determined and their frequencies compared with those in a group of patients with dermatitis herpetiformis (DH) and healthy controls. In LAD there was a significant increase in HLA-B8 and DR3 and a larger increase in the DQw1-DR2/DRw6 related DQ alpha 6.2 kb and 6.8 kb RFLP. In DH there was a significantly increased frequency of HLA-A1, B8, DR3, and DQw2 with a concomitant increase in the DR3-DQw2 related DQ alpha 4.6 kb RFLP. The difference in DR3 frequencies and the increased frequency of DQw1 rather than DQw2 in LAD indicates that different susceptibility genes operate in the two diseases.

Dermatitis Herpetiformis↗
PubMed1987

Activation of the human immunodeficiency virus by herpes simplex virus type 1.

Herpes simplex virus type 1 (HSV-1) and some of its immediate-early genes stimulate expression of the human immunodeficiency virus (HIV) long terminal repeat (LTR) sequences and the replication of HIV itself. To demonstrate this, the HIV LTR was linked to the indicator gene chloramphenicol acetyltransferase (CAT) and transfected into Vero cells with or without the trans-activating gene (tat) of HIV. Infection of these cells with HSV-1 strain KOS or temperature-sensitive mutant tsB21 or tsE6 resulted in a large increase in CAT activity in the absence of tat and further augmentation in the presence of tat. This stimulation was seen at both their permissive (34 degrees C) and nonpermissive (39 degrees C) temperatures, implying either that HSV-1 infection or immediate-early gene expression is all that is required. In cotransfection assays in Vero cells, cloned HSV-1 immediate-early genes ICP0 and ICP4 stimulated CAT activity in the presence of tat, while ICP27 had no effect. On the other hand, in SW480 cells, ICP4 and, to a lesser extent, ICP0 genes caused stimulation of CAT activity in the absence of tat. Deletion mutants within the HIV LTR showed that the target for HSV stimulation is distinct from the tat-responsive area and maps near the SP1 binding sites. In Hela cells, ICP0 or ICP4 stimulated the replication of a cotransfected clone of HIV, as shown by an increase in reverse transcriptase activity in the culture supernatant.

Acetyltransferases↗