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Biomedical subjects

L Cassidy

Publications and source records attributed to L Cassidy.

32 records · Page 2Linked to original sources

Women and HIV infection: investigation of its psychosocial consequences.

HIV infection is associated with substantial psychological and social morbidity, although there is a dearth of studies of women with the infection. In recent years, developed countries have reported an increase in the prevalence of HIV infection in women, a fact that makes it all the more important to address the study of their psychological and social status. The study is a controlled investigation of HIV seropositive (n = 49) and seronegative women (n = 43), including study of psychological status and history, social functioning and perceived supports, coping style, life events, and sexual difficulties. The results show that about a third of women were psychiatric cases, regardless of HIV status, although more than half of symptomatic women were psychiatric cases. Seropositive women were less likely to use instrumental social supports and more likely to use mental disengagement as ways of coping. Regarding perceived social supports, positive women had lower scores on social integration and guidance. Positive women were more likely to experience sexual difficulties and not to be in a relationship. Negative women reported more adverse life events in the last 6 months. Psychiatric morbidity was associated with poorer social adjustment and more adverse life events, but not with serostatus. HIV positive women and those at risk of HIV infection have substantial levels of psychological and social morbidity that require recognition by those involved in their care and provision of adequate mental health intervention.

Adaptation, Psychological↗

The influence of victim's attire on adolescents' judgments of date rape.

A vignette depicting a date rape was presented to 352 male and female high school students. To investigate the effect of the victim's clothing on subjects' judgments of the date rape, the vignette was accompanied by either a photograph of the victim dressed provocatively, a photograph of the victim dressed conservatively, or no photograph. Subjects who viewed the photograph of the victim in provocative clothing were more likely than subjects who viewed the victim dressed conservatively or who saw no photograph of the victim to indicate that the victim was responsible for her assailant's behavior, that his behavior was justified, and were less likely to judge the act of unwanted sexual intercourse as rape.

Adolescent↗

The carotid stump syndrome.

Transient ischaemic attacks (TIAs) following internal carotid artery occlusion are not uncommon. Micro-embolisation from an ipsilateral internal carotid artery stump has been implicated in the pathogenesis of such TIAs. We report six patients who had persistent TIAs in association with an occluded ipsilateral internal carotid artery and a carotid stump. Four patients who underwent surgery and stump exclusion remain asymptomatic at 2 years while of two patients who were treated with antiplatelet therapy, one remains asymptomatic and one died from a cerebro-vascular accident.

Aged↗

A randomised study comparing standard dose carboplatin with chlorambucil and carboplatin in advanced ovarian cancer.

A total of 161 previously untreated patients with FIGO stage III or IV epithelial ovarian cancer were randomised after surgery to receive six courses of either carboplatin 400 mg m-2 alone (Arm A) or carboplatin 300 mg m-2 with chlorambucil 10 mg day-1 for 7 days (Arm B). The median progression free survival (PFS) was similar: arm A: 45 weeks; arm B: 61 weeks (P = 0.830). Multivariate Cox regression analysis showed that the extent of residual disease and performance status were the most important prognostic factors for PFS. Fifty-two per cent of patients received dose escalations based on nadir blood counts, and 89% of all dose adjustments were made according to protocol. Failure to achieve a significant degree of leucopenia was associated with worse progression free survival (P less than 0.001). A total of 29.4% of patients fall into this category. The median survival was similar in both arms, i.e. 75 weeks. It is unlikely that there is any major clinical advantage to adding chlorambucil to single agent carboplatin for the management of advanced ovarian cancer, but whether used in combination or a single agent, the dose of carboplatin should be sufficient to cause at least grade I leucopenia. This may best be achieved by determining the initial dose based on renal function, and then adjusting subsequent doses according to nadir blood counts.

Adult↗

Expression of normal and novel glucokinase mRNAs in anterior pituitary and islet cells.

The glucose-phosphorylating enzyme glucokinase likely plays an important role in regulating glucose-stimulated insulin secretion from the islets of Langerhans and has previously been thought to be expressed only in that tissue and in liver. In this study, we demonstrate high levels of glucokinase mRNA in the anterior pituitary cell line AtT20ins, which has been engineered to secrete correctly processed insulin, as well as in primary anterior pituitary tissue. Unlike islet or liver cells, expression of glucokinase mRNA in anterior pituitary cells was not accompanied by expression of the high Km glucose transporter (GLUT-2) mRNA. The glucokinase transcript in anterior pituitary cells was similar in size to islet glucokinase mRNA, which has a unique, elongated 5'-end relative to the liver glucokinase message. Amplification and sequence analysis of the glucokinase mRNA expressed in islets, RIN1046-38 cells, and anterior pituitary cells confirmed that the glucokinase transcripts in these cell types contain the same 5'-sequence. In addition, a novel alternative transcript was identified that contains a 52-nucleotide deletion and that predicts a 58-amino acid peptide as a result of a frame shift. Both the deleted and undeleted transcripts were found in islets, RIN cells, and AtT20ins cells, whereas only the deleted product was identified in primary anterior pituitary tissue. An antibody prepared against a peptide found at the N terminus of the islet isoform of glucokinase easily detected a protein with a size predicted by the undeleted transcript in extracts prepared from islets, RIN1046-38 cells, and AtT20ins cells. Since both the glucokinase protein and mRNA are naturally expressed in AtT20ins and RIN1046-38 cells, we compared the effect of varying concentrations of glucose on insulin secretion from the two lines. Insulin secretion from RIN1046-38 cells was stimulated by glucose in a dose-dependent manner over the range 0-2.5 mM, where it reached a maximum. AtT20ins cells, in contrast, exhibited no response to glucose at any concentration tested, despite the fact that insulin secretion from both cell lines was stimulated by incubation with dibutyryl cAMP. We conclude that glucokinase expression in AtT20ins cells may be necessary, but is not sufficient to confer glucose-stimulated insulin secretion.

Amino Acid Sequence↗

Estrogen and progesterone receptors in ovarian cancer.

To determine whether steroid hormone receptor expression is clinically relevant in ovarian cancer, cytoplasmic and nuclear estrogen (ER) and progesterone (PR) receptor levels have been measured and their concentration calculated by Scatchard analysis. Of 89 samples from patients with non-pretreated epithelial ovarian cancer, 33% were ER-positive, PR-positive (ER+PR+) and 40% ER-negative, PR-negative (ER-PR-); 20% were ER+PR-, and 7% ER-PR+. There was no correlation between receptor status and patient age, menopausal status, or tumor grade, although serous tumors were more likely to be ER+. The incidence of PR+ tumors was highest in early disease and decreased with increasing International Federation of Gynecology and Obstetrics (FIGO) stage. Survival of patients with advanced disease (FIGO Stages IIC, III, or IV) was significantly prolonged by optimal initial cytoreductive surgery (P = 0.002), platinum therapy (P = 0.003), and tumor expression of PR (P = 0.009). On multivariate analysis, PR positivity was still associated with improved survival, although this did not retain statistical significance (P = 0.09).

Adult↗

Outcome of pregnancy in insulin-dependent (type 1) diabetic women between 1971 and 1984.

We have looked at the outcome of pregnancy in women with type 1 (insulin-dependent) diabetes mellitus who were confined at Glasgow Royal Maternity Hospital between 1971 and 1984. Of 134 pregnancies, 123 proceeded beyond 28 weeks' gestation and yielded 125 live infants. The perinatal mortality rate was 16/1000, due solely to congenital foetal malformation. Malformations were not related either to the severity of maternal diabetes (as graded by the White classification) or the glycaemic control in the first trimester (as judged by maternal glycosylated haemoglobin concentration). Over the period of study, there has been a marked reduction in the frequency of ketoacidosis during pregnancy and in the delivery of small-for-dates babies; more mature lecithin:sphingomyelin ratios have been obtained by amniocentesis; and better Apgar scores have been demonstrated in the infants at delivery. The Caesarean section rate has fallen from 83 to 30 per cent, and babies now spend less time separated from their mothers in paediatric units. These improvements largely reflect better diabetic treatment (improved insulin regimens and glycaemic control) and closer obstetric assessment. Foetal malformation occurred overall in 11.4 per cent of pregnancies and did not become less frequent over the period of study. Further major improvement in the outcome of diabetic pregnancy will only come from a reduction in the congenital malformation rate, which implies better diabetic control at and around the time of conception.

Adult↗

Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation.

Abnormal eye movements in the infant or voting child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.

Child↗

Developing nursing guidelines for the PTCA patient.

Developing guidelines for the care of complicated patients is not an easy task. This article describes how a group of critical care nurses produced guidelines for the nursing care of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Guidelines are important in guiding nursing actions without the legal restrictions implicit in using standards.

Angioplasty, Balloon, Coronary↗