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Biomedical subjects

J R Allen

Publications and source records attributed to J R Allen.

351 records · Page 20Linked to original sources
PubMedDate not supplied

Incidence of peritonitis in chronic peritoneal dialysis patients infused with intravenous iron dextran.

BACKGROUND: The Dialysis Outcomes Quality Initiative (DOQI) guidelines, published in 1997, emphasize the need for careful monitoring of iron stores and for provision of adequate iron replacement therapy to achieve target goals of hemoglobin concentration in end-stage renal disease (ESRD) patients, especially those treated with recombinant erythropoietin (rHuEPO). Intravenous iron dextran (IVID) therapy, which has long been used in hemodialysis patients, is increasingly being used in chronic peritoneal dialysis (CPD) patients. In 1997, we began using this form of iron therapy for our CPD patients. However, because considerable data exists to show a relationship between iron metabolism and acute infections, we questioned whether IVID infusion placed our patients at greater risk for peritonitis, the leading cause of death and patient drop-out from CPD therapy. OBJECTIVE: To evaluate the relationship between iron and infection, we studied episodes of peritonitis in CPD patients who were infused with IVID. DESIGN: In a retrospective study of adult CPD patients who received IVID during 1998, we investigated the occurrence of peritonitis episodes and the spectrum of causative organisms. Patients with a hemoglobin level of < 12.5 g/dL who also had a ferritin level < 100 ng/mL or a transferrin saturation level < 20% (or both) and who did not respond to oral iron therapy, were administered between 0.5 g and 1.0 g of IVID in an outpatient hospital setting. We calculated the expected and observed number of peritonitis episodes in these patients within 30, 60, and 90 days after infusion of IVID. RESULTS: During the study period, 56 patients received 77 doses of IVID, with 14 patients requiring 2 or more infusions. Of the 77 doses, 71 were given as a 1-g bolus. The IVID was well tolerated by all patients. Within 90 days of IVID administration, 14 patients developed peritonitis: 6 episodes occurred within 30 days, 7 episodes occurred between 31 and 60 days, and 1 episode occurred between 61 and 90 days after the IVID dosing. The peritonitis rate for patients not receiving IVID was 1 episode per 13.7 patient-months. Taking this rate as the "expected" rate, the expected number of episodes of peritonitis for the study population was 5.6 episodes within 30 days, 11.2 episodes within 60 days, and 16.8 episodes within 90 days following IVID administration. The difference between the expected and observed rates of peritonitis in patients who were dosed with IVID was not statistically different. The spectrum of organisms seen in the peritonitis episodes in the study population was not significantly different from that seen in the peritonitis episodes in our CPD unit population. CONCLUSIONS: There is evidence that IVID infusion therapy can improve anemia and reduce rHuEPO requirements in CPD patients, usually without adverse reaction and without exposing patients to an increased risk of peritonitis. More research is needed in the area of potential increased risk of infection in ESRD patients who are (1) infused with large doses of IVID, and (2) iron-overloaded.

Female↗
PubMedDate not supplied

Assessment of screening as a preventive technology: the example of HTLV-III/LAV antibody testing.

Screening for disease control can be defined as a preventive technology that is used to examine asymptomatic people in order to classify them as likely or unlikely to have the disease that is the object of screening. Screening may consist of routine physical examinations, radiologic procedures, semi-invasive procedures such as endoscopy, or serologic tests. In this paper, a new serologic test is considered. Acquired immunodeficiency syndrome (AIDS) is a devastating disease with high mortality, recently shown to be caused by a retrovirus named human T-lymphotropic virus Type III (HTLV-III) or lymphadenopathy-associated virus HTLV-III antibody in serum specimens. Performance characteristics are excellent with high sensitivity and specificity when reactive serum specimens are checked for consistency of response by enzyme immunoassay (EIA). This test is now part of the screening protocol for all blood donation centers to decrease the risk of HTLV-III transmission via blood or blood products. About 0.2% (1 in 400) of blood donors have repeatedly reactive EIA tests to HTLV-III antibody. Approximately one-third of these donors have other laboratory evidence of infection. Screening for HTLV-III is a new technology that illustrates virtually all of the factors that need consideration in an assessment of disease screening. This paper explores these technical, epidemiologic, economic, legal, social, and ethical factors.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

2,2',5,5'-Tetrachlorobiphenyl: isolation and identification of metabolites generated by rat liver microsomes.

The in vitro metabolism of 2,2',5,5'-tetrachloro[3H]biphenyl (TCB) by control and phenobarbital-induced rat liver microsomes has been investigated. Phenobarbital induction was found to significantly increase (30-fold) the NADPH-dependent, microsomal metabolism of TCB above that observed with control microscomes. The metabolites generated by microsomes of phenobarbital-induced rats were separated by Sephadex LH-20 and gas-liquid chromatography (GLC) and were subsequently characterized by infrared and mass spectral (MS) analyses and techniques of catalytic dechlorination with GLC/MS comparison to biphenylol standards. The major metablite, representing 90% of all metabolic products, was identified as 3-hydroxy-TCB. 3,4-Dihydro-3,4-dihydroxy-TCB was identified as a minor metabolite (5%), and trace amounts of two chromatographically and spectrally distinct dihydroxy-TCB's (4% and 1%) were also found. This in vitro metabolic profile is consistent with that found in vivo and suggests a mechanism of TCB metabolism incorporating both direct hydroxylation and an arene oxide intermediate.

Animals↗
PubMedDate not supplied

The use of predictive modeling to test nursing practice outcomes.

A middle range, multivariate practice model was constructed to test the impact of a perioperative teaching program on multiple patient outcomes: coping, anxiety, recovery pattern, pain, and patient satisfaction. In addition, the influence of such a program on nursing staff was examined. A quasi-experimental, causal modeling approach was used. The operative trajectory of 88 patients and their operating room nursing staff was traced from two pre-operative points through the intra-operative stage to two points post-operatively. The experimental patients (n = 54) evidenced higher satisfaction with their care, a tendency to experience less post-operative vomiting, but also tended to recover more slowly and cope less well than the control patients (n = 34). Multiple regression analysis of the practice model suggested the perioperative teaching program affected patient outcomes, indirectly, through the functioning of the staff nurses intra-operatively.

Adolescent↗
PubMedDate not supplied

Responses to submaximal treadmill exercise and training in the horse: changes in haematology, arterial blood gas and acid base measurements, plasma biochemical values and heart rate.

Four standardbred horses with subcutaneously relocated carotid arteries were given a seven week training programme of treadmill exercise at a gradient of 19 per cent in order to assess if there were any effects of exercise and training on haematology, arterial blood gas and acid base measurements, plasma biochemistry and heart rate. The exercise consisted of one minute walking at 110 metres/minute followed by five minutes trotting at 200 metres/minute, twice daily in the first week. The period of trotting exercise was increased by one minute per week so that by the seventh week the horses were being given 12 minutes trotting twice daily. Before training commenced venous blood samples, for complete blood counts and plasma biochemistry, and arterial samples, for blood gas, acid base and lactate measurements, were taken at rest, after five minutes and 15 minutes of treadmill exercise (200 metres/minute) and 30 minutes and 60 minutes after completing the exercise. Heart rate was measured by telemetric electrocardiogram at similar intervals. This exercise test and blood collection were repeated after one, three, five and seven weeks of training. The only significant changes were a decrease in exercise lactate with training, increases in exercise and recovery total protein. The haematological response to treadmill exercise included an increase in certain red cell parametes and a leucocytosis which was caused by both a neutrophilia and a lymphocytosis. These effects had largely disappeared by 30 minutes after exercise and all values had returned to resting values by one hour after exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗