Biomedical subjects
Publications and source records attributed to M C Smith.
Quinine-induced acute renal failure attributed to the hemolytic-uremic syndrome has been infrequently reported. A case of acute renal failure due to acute interstitial nephritis associated with ingestion of quinine and the subsequent response to steroid therapy is described.
Many commercially available pulse oximeters have a variable pitch blood oxygen saturation indicator, which emits a 'beep' between 175 Hz and 675 Hz with each heart beat. The frequency of this beep is dependent on the blood oxygenation measured by the oximeter, higher frequencies corresponding to higher blood saturation percentages. This is a useful feature for an anaesthetist, rapidly communicating potentially life-threatening situations in an easily detectable manner. Most available oximeters with an audio output feature are vulnerable to the effects of magnetic resonance scanning. In this article an add-on module is described for generating a beep to indicate the blood oxygen saturation which has been specifically designed to operate in the MR environment.
The mecA-27r gene, which encodes PBP2a-27r, was modified by site-specific mutagenesis, resulting in replacement of the N-terminal membrane anchor with a short chelating peptide (CP-PBP2a-27r). CP-PBP2a-27r retained the same binding affinity for beta-lactam antibiotics as the wild-type enzyme. Approximately 95% pure CP-PBP2a-27r was recovered in a single step by use of chelating-peptide-immobilized metal ion affinity chromatography.
Two outbreaks of epizootic listerial encephalitis, one in sheep and one in goats, were investigated through pathology, microbiology, and DNA amplification-based techniques. Efforts were made to survey the diversity of Listeria monocytogenes strains in the silage consumed by affected animals and to verify the causal relationship between silage and disease outbreak. In both outbreaks, L. monocytogenes was isolated from silage and brain tissue samples. Random amplified polymorphic DNA patterns revealed two distinct L. monocytogenes strains, one of which was identical to the sheep brain isolate, in the silage associated with the outbreak in sheep. Three brain isolates and one silage isolate, all of which had different random amplified polymorphic DNA patterns, were found in the outbreak involving goats. All isolates from both outbreaks were indistinguishable in an in vitro assay for cell-to-cell spread and growth in macrophages. All brain isolates from the goat outbreak had identical intracellular ActA patterns, which were different from the pattern for the silage isolate. While the sheep brain isolate had an ActA pattern different from that of the corresponding silage isolate, the patterns for the brain isolates from the two outbreaks were not identical. This survey demonstrates the diversity of L. monocytogenes in silage and suggests the existence of one or more selective processes by which certain strains are more prone to give rise to disease.
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Epithelioid hemangioendothelioma is an unusual vascular neoplasm with prominent cytoplasmic vacuolization representing primitive lumen formation. A case is presented of this unique vascular neoplasm in a woman with a seizure disorder who had cardiac, hepatic, and recurrent nervous system lesions. To our knowledge, this is the third known case of intracranial epithelioid hemangioendothelioma. Emphasis is placed on the indolent course of this rare neoplasm, with a recommendation for aggressive surgical treatment and diligent follow-up.
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The majority of all febrile seizures represent a benign syndrome that does not require extensive testing or long term medication. A careful history of the febrile seizure, family history, developmental history and physical examination can identify those infants and children with this syndrome. While one-third of this group will experience additional febrile seizures, there is no significant increase in the incidence of later epilepsy or neurological sequelae. The parents of these children need to be reassured and educated about this syndrome. They should understand the emergency treatment of seizures and aggressively treat fever. The more difficult task for the physician is to correctly identify those children who experience nonbenign seizures. Careful history and physical examination can accurately identify this group. Further evaluation including neuroimaging, electroencephalogram and developmental assessment may be necessary. In those children with a high risk of later epilepsy, treatment with an antiepileptic drug should be considered.
Previous research has documented qualitative changes in certain cognitive abilities during the older adult years, such as in short-term memory, perceptual and motor skills, and attentional capacities. Other work has suggested that a number of significant age-related changes, across a variety of cognitive abilities, are based on social experiences, such as occupational or recreational activities. The current study is based on earlier research by Perlmutter and her colleagues (1990) and examines age and skill-related differences among adults engaged in a social-recreational activity. BINGO players, ranging in age from nineteen to seventy-four, and having from less than two months to over twenty years of playing experience, were given a variety of psychometric, cognitive, and experimental measures. The participants were also observed as they played real BINGO games. No age-related differences were found on the psychometric or memory measures, suggesting that BINGO playing experience may have positive benefits for many older adults. Skilled players at all age levels were found to be more efficient in their game-playing actions. The oldest and most experienced players did not differ from the younger, equally experienced, players on the cognitive and skill-based tasks. These findings demonstrate the need to investigate adaptive competence in those situations in which social-environmental factors play a role in enhancing older adults' cognitive skills.
As pressures mount for the government to intercede in the pricing structure of pharmaceutical products, some pharmacists remain reluctant to dispense generic counterparts for branded drugs. This paper attempts to explain this reticence by identifying the sources of conflict present in the pharmaceutical distribution channel. A political economy framework is applied to the pharmaceutical distribution channel to yield a basis for developing relationship management. This approach extends the pharmacist's substitution decision process from a traditional emphasis on product attributes to the complexity of the health care channel relationship itself. Relationship management offers several insights regarding how to reduce the conflict that inherently accompanies the generic substitution decision.
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PURPOSE: To describe intervention effectiveness for symptom management in oncology nursing research. DESIGN: Integrative research review and meta-analysis. SAMPLE: 28 randomized experimental and control group studies of symptom management that were identified from 428 published and unpublished oncology nursing research reports authored by nurses from 1981-1990. METHODS: Experimental studies identified and coded by four oncology nurse specialists; findings transformed into effect sizes; effect sizes combined into overall effect for 28 studies; and effects clustered by symptoms, interventions, and outcomes. MAIN OUTCOME MEASURE: Combined effect for 28 symptom management study outcomes. FINDINGS: For 28 study outcomes tested for symptom management, weighted average effect was d = 0.47, the 95% confidence interval ranged from 0.31 to 0.61, statistical significance was p = 5.17 x 10(-12) with wide variability of effect (chi 2 = 66.574, df = 27, p = 3.41 x 10(-5), and success rate improved from 39% to 62% for subjects in the treatment group. CONCLUSION: Interventions were effective in relieving symptoms in the collection of studies and in the clusters for managing nausea and vomiting, pain, anxiety, alopecia, infection, and side effects of chemotherapy. IMPLICATIONS FOR NURSING PRACTICE: Missing data related to subject characteristics and need for replications prior to use in practice preclude making specific recommendations at this time for research-based nursing interventions for symptom management in patients with cancer.
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An antibody (IgG1) was designed for oriented adherence to a metal-containing surface. This was achieved by adding a metal-chelating peptide, (CP = His-Trp-His-His-His-Pro), to the COOH-terminus of the heavy chain through genetic engineering. Electroporation of the engineered heavy chain gene into cells expressing the complimentary light chain yielded colonies secreting an intact antibody containing the metal-chelating peptide (IgG1-CP) which had high affinity for a nickel-loaded iminodiacetate column. Purified IgG1-CP was bound to nickel-treated mica and imaged by atomic force microscopy (AFM). Antibody lacking the COOH-terminal metal binding peptide failed to produce discernible AFM images. The AFM images of individual IgG1-CP molecules and their calculated dimensions demonstrated that regiospecific binding and uniform orientation of the antibody was imparted by the peptide. The ability to stably orient macromolecules in their native state to a surface may be used advantageously to visualize them.
This study examined the relative efficacy of cognitive-behavioral and behavioral treatment approaches for bulimia nervosa. Female bulimic Ss were randomly assigned to cognitive-behavioral, behavioral, or attention placebo conditions. At posttreatment, 92% of the cognitive-behavioral group, 100% of the behavioral group, and 69% of the nonspecific self-monitoring group were abstinent from binge eating-purging. At 6-month follow-up, 69% of the cognitive-behavioral group, 38% of the behavioral group, and 15% of the nonspecific self-monitoring group were abstinent from binge eating and purging. The results support the conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that directly addresses maladaptive cognitions, problematic behaviors, and the development of more adaptive coping skills.
OBJECTIVES: To identify the neurologic complications of critical medical illnesses, and to assess their effect on mortality rates and on medical ICU and hospital lengths of stay. DESIGN: Prospective clinical evaluation of all medical ICU admissions for 2 yrs. SETTING: A 14-bed, general medical intensive and coronary care unit in a large university hospital. PATIENTS: Patients (n = 1,850) admitted to the hospital, of whom 92 were admitted for primarily neurologic problems. Of the remaining 1,758 patients, 217 (12.3%) experienced a neurologic complication. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients developing a neurologic complication while in the medical ICU demonstrated an increased risk of inhospital mortality when compared with patients who did not suffer such problems (45.7% vs. 26.6%; p < .00001). Patients with neurologic complications experienced 2.5-fold longer medical ICU stay times (p < .001) and almost two-fold longer hospital stay times (p < .001). Metabolic encephalopathy, seizures, hypoxic-ischemic encephalopathy, and stroke were the most common complications. Sepsis was the most frequent cause of encephalopathy, and cerebrovascular lesions were the most common cause of seizures. Formal neurologic consultations were requested in only 36% of these patients. CONCLUSIONS: Neurologic complications are associated with increased mortality rates and longer medical ICU and hospital lengths of stay. These conditions are probably underrecognized at present. ICUs have the potential to serve as environments for neurologic teaching and research.