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Biomedical subjects

J M Joseph

Publications and source records attributed to J M Joseph.

At least 37 records · Page 2Linked to original sources
PubMed1996

Immunoisolated xenogenic chromaffin cell therapy for chronic pain. Initial clinical experience.

BACKGROUND: Chromaffin cells from the adrenal gland secrete a mixture of compounds that have a strong analgesic effect, especially when administered intrathecally. Many studies in animal models have shown that discordant xenogeneic cell isolates, including chromaffin cells, can survive and have biologic effects when transplanted within a semipermeable membrane capsule. METHODS: To evaluate the clinical potential of encapsulated cell therapy, a human-scale implant containing bovine chromaffin cells was developed, characterized, and implanted in the subarachnoid space of seven patients with severe chronic pain not satisfactorily managed with conventional therapies. Patients received no pharmacologic immunosuppression. Cell devices were implanted during minimally invasive surgery, and device design allowed retrieval. All devices were recovered after implant periods of 41 to 176 days. RESULTS: Postexplant histologic analysis, immunostaining, and secretory function all confirmed survival and biochemical function of the encapsulated cells. Reductions in morphine intake and improvement in pain ratings were observed in several patients. CONCLUSIONS: This study represents the first successful trial of encapsulated xenogeneic cells in humans. The preliminary findings of pain reduction warrant the initiation of a randomized, double-blind phase II study to evaluate the potential efficacy of the procedure.

Adult↗
PubMed1995

Association study of transforming growth factor alpha (TGF alpha) TaqI polymorphism and oral clefts: indication of gene-environment interaction in a population-based sample of infants with birth defects.

In this study of infants with isolated birth defects, 69 cleft palate only cases, 114 cleft lip with or without cleft palate cases, and 284 controls with noncleft birth defects (all born in Maryland between 1984 and 1992) were examined to test for associations among maternal exposures, genetic markers, and oral clefts. A significantly higher frequency of positive family history of birth defects among both groups of oral cleft cases compared with controls was seen in these data. While there was a modest increase in the less common C2 allele at the TaqI site in the transforming growth factor alpha (TGF alpha) locus among cleft palate only infants compared with the birth defect controls, the association appeared to reflect an underlying interaction between maternal smoking and infant genotype. This apparent gene-environment interaction was also found among those reporting no family history of any birth defect. Infants carrying the rarer C2 allele who were exposed to maternal smoking of 10 or fewer cigarettes per day showed a 6.16-fold increase in risk for cleft palate only (95% confidence interval 1.09-34.7), while similar infants whose mothers smoked more than 10 cigarettes per day showed an 8.69-fold higher risk (95% confidence interval 1.57-47.8). However, the dose-response relation was not significant.

Adult↗
PubMed1995

Quantitative analysis of fosinopril sodium by capillary zone electrophoresis and liquid chromatography.

A capillary zone electrophoresis (CZE) method was developed for the quantitative analysis of fosinopril sodium. Validation parameters of the CZE method were evaluated and compared to an existing LC method. In terms of precision and sensitivity. LC performance was superior to that of the CZE method for this application. The CZE method achieved better selectivity for several degradants of interest within a much shorter analysis time than did the LC method. Effects of detection wavelength, applied voltage and buffer concentration on optimization of the CZE method are presented. Effects of diluent composition on capillary loading and peak behaviour are also discussed.

Buffers↗
PubMed1995

Community-acquired pneumonia: impact of immune status.

This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with community-acquired pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of community-acquired pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of community-acquired pneumonia were: Streptococcus pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia pneumoniae or Mycoplasma pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001). Although S. pneumonia continues to be the most commonly identified etiologic agent of community-acquired pneumonia, it is surpassed by P. carinii in the HIV-infected patient population. The apparent decline in the frequency of S. pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture. The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with community-acquired pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1995

Failure to clinically predict NICU hearing loss.

Neonatal intensive care unit (NICU) survivors demonstrate handicapping sensorineural hearing loss up to 50 times more frequently than normal newborns, yet little is known about the etiology of the hearing loss. Theoretically, accurate identification and triage of a particular infant based on a clinical profile would be useful. Forty NICU graduates of The Massachusetts General Hospital were selected for a detailed retrospective chart review evaluating prenatal, perinatal, and NICU medical conditions and treatment. Twenty-three patients identified with hearing loss and 17 infants with normal hearing were compared clinically. Univariate and multivariate analysis was performed on a subpopulation of patients (20 with hearing loss and 16 with normal hearing). A history of ventilation was associated with hearing loss (P = .0023), but this factor was not absolute. No other clinical parameters were convincingly linked to hearing loss. We conclude that reliance on risk factors is an inadequate clinical method to select a patient for a hearing test and that each NICU survivor deserves audiometric evaluation.

Audiometry↗
PubMed1995

Sexual knowledge, behavior and sources of information among deaf and hard of hearing college students.

A sexual health knowledge, behavior and sources of sexual health information survey was administered to 134 deaf and hard of hearing college students. Results indicated the students in this sample were not particularly well informed about sexual health and sexuality issues, were engaging in high risk sexual behaviors and relied primarily on peers for sexual health information. The need for the development of psychometrically sound measurement instruments for use with deaf populations as well as areas for future sexual health research are discussed.

Adult↗
PubMed1995

Elevation of maternal alpha-fetoprotein in systemic lupus erythematosus: a controlled study.

OBJECTIVE: To determine if maternal alpha fetoprotein (AFP) is elevated in lupus pregnancy and, if so, whether it is associated with treatment or outcome. METHODS: Maternal serum AFP values were obtained once during Weeks 16.3 to 31.7 in 54 pregnancies followed prospectively. AFP was measured by the Maryland State Health Department, who reported the AFP level and a corrected value, multiple of the median (AFP MOM), adjusted for weight, gestational age, and insulin dependent diabetes. Controls were 1001 consecutive samples measured by the same laboratory. RESULTS: AFP MOM was higher in lupus pregnancies (1.425 +/- 0.73 vs 1.169 +/- 0.50, p = 0.001), as were the unadjusted AFP levels (lupus 68.26 +/- 42.2, control 52.49 +/- 27.25, p = 0.001). Of lupus pregnancies 7.4 vs 2.6% of control pregnancies had an abnormal AFP MOM (p = 0.06). The 4 patients with abnormal AFP-MOM, using the 2.3 cutoff, were taking more prednisone (27.25 +/- 18.54 mg vs 10.85 +/- 12.29 mg, p = 0.02), were more likely to have delivered preterm (31.50 +/- 36.31 weeks, p = 0.02), and were more likely to have a high anticardiolipin (aCL) antibody during the pregnancy (p = 0.03). CONCLUSION: AFP is higher in lupus than in control pregnancies, without any increase in neural tube or other birth defects. An abnormal maternal serum AFP level is associated with higher prednisone dose, preterm delivery and aCL. Patients and obstetricians need to be aware that an elevated maternal AFP in lupus pregnancy is not necessarily due to a birth defect, and may be predictive of preterm delivery.

Adult↗
PubMed1995

Transient ictal cortical blindness during middle age. A case report and review of the literature.

We report a case of transient ictal cortical blindness in a 63-year-old woman. We reviewed the literature of all seizure-induced bilateral blindness. After careful evaluation of 44 cases, it was evident that the cases could be categorized into three groups with different etiologies, duration of blindness, and probable visual prognosis. Transient cortical blindness may occur with unilateral focal seizure or with bilateral seizure activity of the primary generalized type. Seizure-induced blindness may be ictal or postictal (Todd's) phenomenon or a permanent consequence following status epilepticus. Its duration varies between less than 1 minute to 4 months, or can be permanent. Our case of cortical blindness is related to new onset occipital epilepsy from a left occipital focus, and adds to the evidence that cortical blindness occasionally occurs as an uncommon manifestation of seizure.

Acute Disease↗
PubMed1994

Temperature, pH and agitation rate as dissolution test discriminators of zofenopril calcium tablets.

Comparative in vitro dissolution studies were performed on several tablet batches of zofenopril calcium, an ACE inhibitor, to determine if they could be differentiated on the basis of their release rates. The samples included six batches produced at Site 1 and one batch produced at Site 2. Using regular dissolution conditions (USP paddle method at a 50-rpm agitation speed in phosphate buffer, pH 7.5, at 37 degrees C), release rates of all the tablet batches were similar. By independently altering one of the dissolution test parameters, either a lower pH or a slower agitation rate, discrimination between the Site 1 and Site 2 tablets was enhanced. Discrimination was only slightly enhanced when a lower dissolution medium temperature was used. Tablets made from different polymorphs of zofenopril calcium could not be differentiated by their dissolution profiles, even with the more discriminating conditions. The dissolution profiles of certain other zofenopril calcium tablets (including film-coated vs uncoated tablets, and tablets made with micronized vs unmicronized drug particles) were indistinguishable using a 50-rpm agitation rate, but they could be clearly differentiated using a 40-rpm agitation rate.

Captopril↗
PubMed1994

["Standing waves": differential diagnosis of fibromuscular dysplasia].

We report two recent observations of an angiographic artefact called "standing waves". It results in the same characteristic beaded pictures than fibromuscular dysplasia. It is induced by the angiography catheter and is related to the speed of injection. The possible occurrence of this artefact should be borne in mind whenever the films show dysplastic lesions in more than one artery.

Adult↗
PubMed1993

Peer education and the deaf community.

Gallaudet University, the world's only liberal arts university for deaf students, has recently established a peer health education program. This program is unique because of the population it is designed to serve and the rich culture within which the program exists. Although the program is still in its early stages, it has received an enthusiastic response from students and from the greater campus community.

Culture↗
PubMed1992

Liver ischemia for hepatic resection: where is the limit?

BACKGROUND: A consecutive series of 50 patients who submitted to 53 hepatic resections with use of continuous normothermic liver ischemia is reported. METHODS: Portal triad clamping has been used in 28 cases, with associated inferior vena caval clamping above and below the liver (hepatic vascular exclusion) in 25 patients. The size of the tumor required major hepatic resection in 38 cases (71.7%). Malignant tumors (83%) were the most common indication for liver resection. Patients were placed in three groups according to the duration of liver ischemia: group A, less than 30 minutes (9 patients); group B, 30 to 60 minutes (29 patients); and group C, 60 or more (15 patients). RESULTS: No differences in mortality rates (5.7% in the entire series and 0% in group C) and morbidity rate could be shown. No significant difference was found in postoperative liver test results, and no persistent alteration remained thereafter. Liver biopsy at 6 and 12 months after operation did not reveal any chronic damage. Liver capability to regenerate was maintained as documented by postoperative computerized tomography scan or magnetic resonance imaging. CONCLUSIONS: Because interruption of hepatic blood flow in normothermia is safe for at least 60 minutes (up to 85 minutes in this study), vascular clamping is recommended for hazardous liver resections to minimize blood loss, which appears to be the main factor of death and morbidity.

Bilirubin↗
PubMed1992

Identifying HIV-2-seropositive individuals by reevaluating HIV-1 indeterminate sera.

HIV-2 infections are rare in North America, with less than 30 cases identified since 1988. We conducted a surveillance for HIV-2 seroprevalence by re-evaluating 457 HIV-1 indeterminate serology specimens submitted to the Maryland Department of Health Laboratories from January 1, 1988 to July 15, 1991. All indeterminates were screened using a combination HIV-1/HIV-2 synthetic peptide EIA. The presence of HIV-2-specific antibodies in initially reactive sera was confirmed utilizing a selective HIV-2 synthetic peptide EIA and Western blotting. Eight sera from four adult males attending public health clinics in suburban Washington, D.C. were found to be specifically reactive for HIV-2 antibodies. One is a native West African; the others remain anonymous. All eight sera demonstrated a gag (core) and pol (polymerase) only pattern of reactivity on HIV-1 Western blots. Targeting selected groups of HIV-1 indeterminate sera from patients attending public health clinics may represent a more appropriate strategy to monitor the spread of HIV-2 in North America than testing similar samples from the blood donor population.

Adult↗
PubMed1990

A rural outbreak of Legionnaires' disease linked to visiting a retail store.

Between May 7 and June 7, 1986, 27 residents of a rural county in Maryland developed legionellosis, and two died. Legionella pneumophila serogroup 1 was cultured from the sputum of two patients and identified in lung tissue of a third patient by direct fluorescent antibody staining. An additional 11 patients had four-fold rises in antibody titer to L. pneumophila, and 13 had single titers greater than or equal to 1:256. To determine risk factors for disease, we performed a case-control study. Twelve of 16 case-patients reported visiting store A in the two weeks before onset of illness compared with four of 28 control-patients. A serologic survey of employees showed that employees of store A were 3.63 times more likely than control employees to have titers of antibody to L. pneumophila greater than or equal to 1:256 (95% confidence intervals 0.8, 16.7). Cultures of soil specimens, samples of water from the hot water system of store A and from stagnant ponds near store A collected five weeks after the end of the outbreak were negative for Legionella species. Store A was adjacent to a site of excavation and construction during May 1986, when the community was experiencing an extended drought. This investigation suggests that exposure to excavation and construction activity may be a risk factor for legionellosis.

Adult↗
PubMed1990

[Organ donation for transplantation. Survey of opinions of physicians and paramedics in the province of Vaud].

In 1987, two media campaigns were organized in Switzerland to promote donor cards. The purpose of this study was to test their impact on the medical community. Questionnaires were sent to qualified practitioners, doctors in training and intensive care nurses. It is concluded that the campaigns for organ donation must be repeated and that their quality can be improved. It is however more urgent to improve the level of knowledge among doctors and other health professionals.

Attitude of Health Personnel↗