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Biomedical subjects

Kevin O'Brien

Publications and source records attributed to Kevin O'Brien.

11 recordsLinked to original sources
PubMed2003

Prevalence of proximal adenomas after an adenoma is found on flexible sigmoidoscopy.

BACKGROUND: Adenomatous polyps are a precursor of colorectal cancer and a frequent finding on screening flexible sigmoidoscopy (FS). Performance of colonoscopy when a diminutive (<6mm) adenoma is found on FS has been the subject of considerable debate. METHODS: We retrospectively reviewed the data from our colorectal cancer screening program for patients with adenoma(s) found on FS. Patients were divided into three groups based on FS findings: (1) an adenoma <6mm in size, (2) multiple non-advanced adenomas or an adenoma 6-10mm in size, or (3) advanced adenoma defined as an adenoma >10mm or with villous histology or high-grade dysplasia or cancer. A comparison of the proximal findings was then made. RESULTS: 5291 FS reports were reviewed with 606 (12%) patients having at least one adenoma. Colonoscopy reports were available in 550 patients. Of the 258 patients with a diminutive distal adenoma, 69 (27%) had a proximal adenoma and 13 (5%) had an advanced proximal adenoma on colonoscopy. Of the 164 patients with an adenoma 6-10mm or multiple non-advanced adenomas, 59 (36%) had a proximal adenoma and 13 (8%) had an advanced proximal adenoma. Of the 128 patients with a distal advanced adenoma, 58 (45%) had a proximal adenoma and 15 (12%) had an advanced proximal adenoma. The increase in proximal adenomas across the three groups was significant (P=0.001), and there was a trend for increased prevalence of advanced adenomas (P=0.061). CONCLUSIONS: The prevalence of proximal adenomas increased significantly with more advanced lesions found distally at FS, and there was a trend towards a higher prevalence of advanced proximal adenomas. Based on current guidelines, flexible sigmoidoscopy is a screening option that can be used to identify average-risk patients at increased risk of proximal neoplasia.

Adenoma↗
PubMed2003

Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.

The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.

Adolescent↗
PubMed2003

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.

Age Factors↗
PubMed2003

Prevalence of obesity in International Special Olympic athletes as determined by body mass index.

The heights and weights of 1,749 Special Olympics athlete volunteers participating in the Special Olympics Games in 1999 and 2001 were measured, and body mass index (BMI) was computed. Results indicated that athletes from the United States (US) under 18 years of age had a significantly (P<.001) higher prevalence of being overweight or at risk of being overweight compared with athletes from other countries. Similarly, adult athletes from the United States were at least 3.1 times more likely to be overweight or obese compared with their non-US counterparts. The risk of obesity in US Special Olympic athletes parallels the prevalence of obesity in the general US population. There is a clear need for further research, surveillance, and treatment of the risky health behaviors that contribute to the development of obesity in this group.

Adolescent↗
PubMed2003

Research topics.

Explore the source record for details and available documents.

Dental Research↗
PubMed2003

Acute metabolic decompensation in an adult patient with isovaleric acidemia.

Isovaleric acidemia is a rare autosomal recessive inborn error of leucine catabolism caused by deficiency of isovaleryl coenzyme A dehydrogenase. This enzymatic deficiency leads to severe metabolic derangement, manifested clinically as vomiting, dehydration, and acidosis progressing to seizures, coma, and death. The two phenotypic expressions are the acute severe and the chronic intermittent form. The acute severe phenotype typically results in death during early infancy, whereas patients with the chronic intermittent form are asymptomatic at baseline but have episodes of acute metabolic decompensation, usually in the setting of infection, physical exertion, or ingestion of protein-rich food. This case illustrates how inborn errors of metabolism resulting in organic acidemia can be manifested in adults and why the internist needs to be aware of them.

Acute Disease↗
PubMed2003

Fighting AIDS in Sub-Saharan Africa: is a public- private partnership a viable paradigm?

UNLABELLED: In their most recent study, the United Nations AIDS Program estimates that about 22 million people around the world have died from AIDS, and about 40 million more are currently infected with the HIV virus. About 83% of AIDS deaths and 71% of HIV infections have occurred in war-ravaged, poverty-stricken Sub-Saharan Africa. This pandemic is ripping apart the social and economic fabric of this part of the world. The only remedy for this crisis is both prevention and cure. Only through massive education can early and sustained prevention efforts prevent future infections. And only by giving those infected with HIV effective treatments will people be prevented from dying of AIDS in the future. Without a bold, concerted action, not only will millions die in Africa, but the entire world will suffer. To allow sub-Saharan Africa to become socially and economically devastated will have a major impact on the economies of every country of the world. The African Comprehensive HIV/AIDS Partnership (ACHAP) is one answer to the problem. ACHAP, is a joint initiative between the government of Botswana, the Bill and Melinda Gates Foundation and the Merck Company Foundation. This public-private partnership has provided a new sense of optimism for fighting this devastating pandemic. ACHAP offers all interested parties a multifaceted paradigm that addresses not only the need for ARV medications, but also the other social and medical facets of the HIV/AIDS problem facing sub-Saharan Africa. If a coordinated effort can be launched in the other sub-Saharan African nations, using ACHAP as a paradigm, then there is the possibility that the fight against AIDS could be won. CONCLUSIONS: Clinical ethics is of necessity a two-way street, one in which ethical paradigms influence practitioners and researchers whose expertise, in turn, necessarily educates the non-clinical ethicist.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Arrhythmogenic right ventricular dysplasia in the elderly.

Arrhythmogenic right ventricular dysplasia (ARVD) is a syndrome characterized by recurrent ventricular tachycardia. However, cases of ARVD have also presented as dilated cardiomyopathy later associated with ventricular arrhythmias. Histologically, this syndrome manifests as a fibrofatty replacement of the RV myocardium, predisposing the heart to ventricular arrhythmias. ARVD was once considered a disease of the young, but may be underrecognized in the older population. This report presents two cases of elderly men with newly symptomatic ARVD, believed to represent the oldest patients with ARVD described in the literature to date. The diagnosis of ARVD should be considered in individuals of all ages who present with a clinical syndrome consistent with ARVD and supportive evidence on ECG.

Aged↗
PubMed2002

Childhood posttraumatic stress disorder and efforts to cope after Hurricane Floyd.

The authors report on the level of posttraumatic stress disorder (PTSD) experienced by fourth-grade children 6 months after Hurricane Floyd and describe the children's efforts to cope with their stress. All of the children they studied were directly affected by the hurricane, secondary to the destruction of their school by floodwaters. The homes of 37% of these children were also flooded. Ninety-five percent of the children experienced at least mild symptoms of PTSD, and 71% had symptoms that were moderate to very severe. Children who reported that their homes were flooded were 3 times more likely to report symptoms than those whose homes were not flooded, and the girls were twice as likely as the boys to report symptoms. The high PTSD prevalence rates are comparable to findings from other studies involving violence in which 94% of the victims reported experiencing symptoms. For further analyses, the authors used symptom clusters of hyperarousal, numbing/avoidance, and reexperiencing symptoms.

Adaptation, Psychological↗