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J Smith

Publications and source records attributed to J Smith.

At least 739 records · Page 41Linked to original sources
PubMed1993

[Management of sexually transmissible diseases in an urban environment in Cameroon in 1992].

During the progress, in 1989, of a programme of social marketing of condoms in Cameroon, it was obvious that this approach should be supplemented by a similar programme for the management of STD's. Nine surveys were carried out in 1992 in Yaounde and Douala in the sexually most active male population (in the general community, at the workplace and in the leisure environment) in order to collect the basic data necessary for its implementation. Treatment essentially consists of mono-chemotherapy with drugs which are generally inefficient against the two principal etiologies of urethritis: Neisseria gonorrhoeae and Chlamydia trachomatis. The cost of treatment is considered excessive and leads to poor follow-up of the complete prescription. Simultaneous treatment of partners should be developed. All these data have been taken into account for the elaboration of a pilot programme which should be implemented in 1993.

Adolescent↗
PubMed1993

Persistent pulmonary hypertension of the neonate in a developing country--does extracorporeal membrane oxygenation have a role to play?

A retrospective study was undertaken of survival after conventional management of 35 infants suffering from persistent pulmonary hypertension of the neonate (PPHN). The outcome of infants weighing more than 2,000 g and who also qualified for extracorporeal membrane oxygenation (ECMO) therapy on the grounds of published criteria was assessed. The admission incidence of patients with PPHN was 1.1%. Secondary PPHN was more common than primary. The overall survival rate of 69% in this study reflects the trend in recently reported improved survival rates of infants with PPHN, treated with conventional techniques. Sixteen of 28 infants weighing more than 2,000 g qualified for ECMO therapy; 4 of them died. Had ECMO been available as an alternative mode of therapy, only 2 of the 4 might have been saved. The other 2 were considered to have conditions incompatible with a normal quality of life. We therefore assessed the requirement for ECMO in our population to be approximately 0.6/1,000 live births. Although ECMO may be promising, the introduction of this technique in developing countries should rather be delayed until more substantial data refute this. Because PPHN could be related to a potential preventable cause in almost 80% of cases, we propose the support of more cost-effective strategies such as continuing obstetric and perinatal education programmes.

Developing Countries↗
PubMed1993

Synthesis and biological activities of non-peptide angiotensin receptor antagonists with tetrazole replaced imidazole ring.

Angiotensin receptor antagonists related to losartan were synthesized in which the imidazole ring was replaced by tetrazole. 1-[4-(2'-Carboxyphenyl)benzyl]-5-butyl tetrazole and 5-[4-(2'-carboxyphenyl)benzyl]-1-butyl tetrazole had antagonist activities versus angiotensin II in the rat isolated uterus assay of 70% and 10%, respectively, of that of the equivalent imidazole compound 1-[4-(2'-carboxyphenyl)benzyl]-2-butyl imidazole. These data suggest that the antagonist activity of compounds in this class is not dependent on the direction of the heterocyclic ring dipole, and that there is a preference for substitution of the acid group-bearing side-chain at the N atom rather than the C atom of tetrazole.

Angiotensin Receptor Antagonists↗
PubMed1993

Isolated fracture-dislocation of the fourth carpometacarpal joint. A report of two cases.

Dislocations and fracture-dislocations of isolated and multiple carpometacarpal (CMC) joints are rare injuries that usually result from the impact of a clenched hand on an immobile object. Various authors have presented combinations of dislocations of any or all of the CMC joints. Isolated fracture-dislocation of the fourth CMC joint, however, is either exceedingly rare or highly underreported. Two cases of isolated fracture-dislocation of the fourth CMC joint are presented here: in both, the appearance of the hand suggested a fracture-dislocation of the CMC joint, and the isolated lesion was confirmed at the time of surgery. Both patients were treated with open reduction and internal fixation and had good results at 2 years.

Adult↗
PubMed1993

Factors influencing survival in advanced gastric cancer.

Even though the incidence of gastric carcinoma is decreasing, the prognosis remains poor. A review of 88 patients with advanced gastric cancer was evaluated by univariate and multivariate analysis to determine prognostic factors. Univariate analysis showed that both "curative" resection (P = 0.006) and adjuvant chemotherapy (P = 0.02) were important therapy variables. These factors were not independent when evaluated by multivariate analysis. However, when they were combined and re-evaluated by multivariate analysis, the combination of "curative" surgery and adjuvant chemotherapy significantly improved survival in advanced gastric cancer (P = 0.04).

Adult↗
PubMed1993

Carrier detection and prenatal diagnosis of hemoglobinopathies in Ontario.

The province of Ontario has a total population of approximately 10 million people, with approximately 20% being of African, Southeast Asian, East Indian, Mediterranean, or Middle Eastern ancestry in whom the gene frequency for hemoglobinopathies is relatively high. In 1989, the Ontario Ministry of Health funded the establishment of the Provincial Hemoglobinopathy DNA Diagnostic Laboratory located at the McMaster University Medical Centre in Hamilton, Ontario. The Laboratory provides DNA analysis to identify the globin gene mutations in carriers and affected individuals, and performs prenatal diagnosis for severe hemoglobinopathies. Annually, more than 400 patient samples are referred to the Laboratory for investigation, of which 25-35 are fetal samples from pregnancies at risk for either homozygous alpha-thalassemia, beta-thalassemia major, or sickling disorders. We have detected more than 70 different globin gene mutations, including several mutations not previously reported in the literature. Here we present examples of the approaches used to detect globin gene mutations in a heterogeneous "at risk" population such as in Ontario, and discuss the impact of this service on patient care, genetic counselling, and the incidence of severe hemoglobinopathies in Ontario.

DNA↗
PubMed1993

Health care economics. Part 2: The Australian health care "jigsaw".

In this article we look at how the health care industry is organised in Australia and make some international comparisons. First, we examine how Australia has reached the present, rather confusing set of arrangements--what the Macklin inquiry has called the health "jigsaw". Then we outline the current arrangements--how responsibilities are divided between local, state and federal governments; and the contribution of the private sector. Finally, we present international data to provide some comparative perspective on Australia's health care arrangements.

Australia↗
PubMed1993

An FNS fantasy.

Explore the source record for details and available documents.

Appalachian Region↗
PubMed1993

Osteonecrosis of the humeral head in sickle cell disease.

The prevalence and incidence of osteonecrosis (ON) of the humeral head in sickle cell disease was determined by a study of 2524 patients who were entered into a prospective study and followed for an average of 5.6 years. At entry, 5.6% had roentgenographic evidence of ON in one or both shoulders. There was little difference in age-adjusted prevalence among genotypes, but there were striking differences in age-specific rates. Observed at ages ranging from five to 24 years, 3.25% of sickle cell anemia (S/S) patients, but only 1.1% of sickle cell disease (S/C) patients, had ON. No S/beta+ thalassemia patients younger than 25 years of age had ON on entry. The highest age-adjusted incidence rate was found in S/S patients with concomitant alpha-thalassemia (4.85 per hundred patient-years), followed by S/beta zero-thalassemia (4.84 per hundred patient-years), S/beta+ thalassemia (2.61 per hundred patient-years), S/S without alpha-thalassemia (2.54 per hundred patient-years), and S/C (1.66 per hundred patient-years). Only 20.9% of patients reported pain or had limited range of movement at the time of diagnosis. Sickle cell disease is a frequent cause of ON of the humeral head, especially in children and young adults.

Adolescent↗
PubMed1993

Gold therapy lowers serum interleukin 6 levels in rheumatoid arthritis.

OBJECTIVE: To determine the clinical utility and the effect of sodium aurothiomalate (GSTM) on serum interleukin 6 (IL-6) levels in patients with rheumatoid arthritis (RA). METHODS: Open prospective study of 50 patients with RA treated with GSTM. Serum IL-6 measured by bioassay. RESULTS: IL-6 showed correlations with Ritchie articular index, duration of morning stiffness and C-reactive protein. GSTM significantly reduced IL-6 levels. CONCLUSIONS: IL-6 is a potentially useful additional indicator of disease activity in RA and is modulated by GSTM.

Arthritis, Rheumatoid↗
PubMed1992

Rate of death from cervical cancer among native Indian women in British Columbia.

OBJECTIVE: To compare the rates of death from cervical cancer among native Indian women and non-native women in British Columbia from 1953 to 1984. DESIGN: Retrospective analysis of data retrieved from the British Columbia Division of Vital Statistics. MAIN OUTCOME MEASURES: Age-standardized death rate and relative rate. RESULTS: The rate of death from cervical cancer was significantly higher among the native women than among the non-native women throughout the study period. No deaths from cervical cancer were recorded in women under 20 years of age. Among those 20 to 64 the relative rate increased from 3.83 in 1953-62 to 6.53 in 1973-84; among those 65 or more it decreased slightly. For the entire study period the relative rate for women 20 to 64 years old was 5.95 and for those 65 or older 2.98. CONCLUSION: The rate of death from cervical cancer among native women in British Columbia is unacceptably high, probably because the provincial screening program does not reach as many native women as it does non-native women.

Adult↗
PubMed1992

Screening for neuroblastoma in the north of England.

OBJECTIVE: To determine the feasibility of establishing a system of screening for neuroblastoma. DESIGN: Prospective study of mass screening in four clearly defined geographical areas. SETTING: Four health districts of the Northern region of England. SUBJECTS: 20,829 babies aged 6 months, 92% of target population. INTERVENTIONS: Collection of urine on filter paper for analysis of content of homovanillic and vanillylmandelic acid in relation to urinary creatinine concentrations. MAIN OUTCOME MEASURES: Derivation of reference range. Identification of babies with homovanillic or vanillylmandelic acid > 3 SD above the mean (positive cases). Investigation of positive cases for evidence of neuroblastoma. RESULTS: The upper limit of normal (3 SD above the mean) for vanillylmandelic acid was 15 mumol/mmol creatinine and for homovanillic acid 24 mumol/mmol creatinine. Of the 20,829 babies screened, 2537 (12.2%) required a second sample to be taken because the first sample was inadequate. Of these, 527 (2.5%) provided a liquid urine specimen and 10 (0.04%) had positive results for neuroblastoma. Two of them had neuroblastoma (true positives) and eight did not (false positives). A further three children from the cohort were subsequently found to have neuroblastoma; they had raised homovanillic acid or vanillylmandelic acid values, or both, but screened negative at 6 months. CONCLUSIONS: Screening for neuroblastoma is possible in the health care system of the United Kingdom. Evaluation of the efficacy of screening in reducing the mortality from neuroblastoma requires a controlled trial.

Creatinine↗