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Biomedical subjects

M Cohen

Publications and source records attributed to M Cohen.

At least 307 records · Page 17Linked to original sources
PubMed1998

Complementary therapies and the medical profession: a study of medical students' attitudes.

BACKGROUND: Despite the popularity of complementary therapies with the public, knowledge and use of these therapies among doctors appear limited. However, studies show that physicians and medical students are positive toward complementary therapies and have a high level of interest in learning about them. METHODS: The attitudes of medical students toward complementary therapies were examined using a questionnaire distributed to 800 first-, third-, and fifth-year medical students at two universities in Melbourne, Australia. RESULTS: The survey revealed that whereas Australian medical students were positive toward complementary therapies, their self-reported knowledge was low, with 56% having no knowledge of the principles of complementary therapies. Attitudes toward different therapies were found to vary widely, with students having little knowledge of chiropractic and naturopathy, the two therapies most commonly used by Australians. Students consistently scored meditation, massage, and acupuncture the highest with regard to knowledge, perceived usefulness, intended patterns of referral after graduation, and desire for education in the undergraduate degree. CONCLUSIONS: When the medical course included some tuition on complementary therapies, students were more positive toward them. A single lecture on complementary therapies was found to have significant impact on medical students' views. Medical students have a high level of interest in complementary therapies that is not being satisfied by their undergraduate curricula.

Attitude↗
PubMed1998

Approaches to control sexually transmitted diseases in Haiti, 1992-95.

Despite major obstacles, activities to control sexually transmitted diseases (STDs) were initiated in Haiti in 1992 in collaboration with local nongovernmental organizations. The approaches included review of available local data, assessment of STD case management practices and constraints, and development of specific STD control activities at the primary health care level, such as systematic screening of all pregnant women for syphilis and improved comprehensive syndrome-based STD case management. The activities included conduct of local studies, presentation and dissemination of results to key audiences, training of health care providers, improvement of local capacities, and consensus-building on implementation of STD control approaches. STD awareness and case management improved considerably; for example, 69% of the clinicians interviewed reported correct STD treatments in the north-eastern primary health care centres in 1995, compared with < 10% in 1992. At the end of the project, national STD case management guidelines were developed by consensus between the various organizations and the Ministry of Health. Lessons learned included the importance of local data generation and of communication and collaboration with various institutions for consensus-building, the need for continued training, and field supervision to ensure behaviour change among STD care providers. A national STD control programme should be implemented as soon as possible in both the public and private sector. External funding will remain critical to control this important public health problem in Haiti.

Education, Medical, Continuing↗
PubMed1998

Mapping acupuncture points using multi channel device.

The practice of acupuncture involves the stimulation of specific points on the skin called 'acupuncture points' which are small regions of local or referred pain that are more sensitive than surrounding tissue. The fact that acupuncture points can be identified subjectively as tender points and are found to have characteristic electrical properties suggest that they are functional entities rather than structural ones. These functional properties are used diagnostically in a clinical setting as pathology in a particular body location has been shown to correlate with increased tenderness and electrical conductivity of the 'corresponding' acupuncture point using electronic 'point locators', which measure the DC resistance of points compared to surrounding skin. Commercially available point locators generally utilize a metal locator probe and an indifferent electrode and are designed to produce an auditory output (usually a high pitched tone) when a point is located. These devices however, are open to criticism. They are unable to control for local variations in skin thickness, surface secretions, or pressure placed on the electrode, and are only able to measure a single point at a time. These make them time consuming to use and subjective to user bias in point selection. Furthermore these devices do not store data and are therefore unsuitable for producing a map of skin resistance, which can be accessed over time. To overcome some of the limitations of currently available single probe devices, we have designed a multi-channel probe capable of measuring and then mapping the skin resistance of multiple points.

Acupuncture Points↗
PubMed1998

Approaches to the treatment of unstable angina and non-Q wave myocardial infarction.

Multiple clinical trials have been undertaken to understand better the events leading to unstable angina and non-Q wave myocardial infarction. Some of these studies focused on evaluating the role of antithrombotic therapy; others evaluated the role of more aggressive invasive treatment versus medical therapy. In the 1980s and 1990s, studies revealed that antithrombotic therapy with either acetylsalicyclic acid alone or heparin alone was more effective than placebo. The Thrombosis in Myocardial Infarction (TIMI) IIIB study attempted to compare medical therapy with early surgical intervention, reporting that early intervention did not result in any significant improvement in patient outcome over medical therapy. In the mid- to late 1990s, the thrombin hypothesis was introduced, suggesting that thrombin antagonists would arrest the coagulation and thrombotic cascade. The Global Use of Strategies To Open Occluded Coronary Arteries (GUSTO) IIb study put the thrombin hypothesis to the test, and it found that there was no significant difference between hirudin and unfractionated heparin treatments after 30 days. Glycoprotein IIb/IIIa receptor antagonists were then researched in the Evaluation of 7E3 for the Prevention of Ischemic Complications (EPIC), the c7E3 Fab Antiplatelet Therapy in Unstable Refractory angina (CAPTURE), the Platelet IIb/IIIa Antagonism for the Reduction of Acute coronary syndrome events in a Global Organization Network (PARAGON) and the Platelet Receptor Inhibition of Ischemic Syndrome Management in Patients Limited to Unstable Angina Signs and Symptoms (PRISM-PLUS) studies, shifting the attention to the platelet. These studies gave contrasting results, bringing to the foreground the issues of optimal use of antithrombotic agents and proper timing of surgical intervention. Medical therapy for unstable angina and non-Q wave myocardial infarction was addressed in the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-wave Coronary Events (ESSENCE) study, which compared a low molecular weight heparin, enoxaparin, with unfractionated heparin. A significant difference in outcomes was found in favour of enoxaparin.

Angina, Unstable↗
PubMed1998

The dentition of Abraham's people. Why Abraham left Mesopotamia.

Ancient Mesopotamia (southern Iraq) in 2000 B.C. was the home of the biblical figure Abraham and his people. An analysis of skeletal material from cemeteries in the ancient cities of Ur (birthplace of Abraham) and Kish shows a homogeneous, short-lived population that suffered severe dental attrition (95 percent of inhabitants), periodontal disease (42 percent) and caries (two percent). Many oral congenital and neoplastic lesions were noted Skeletal (dental) evidence indicates the population suffered from extensive disease and nutritional deficiency. Of special note was a possible case of endodontic treatment. The people of Abraham had modern dentition but relatively poor dental health. It is probable that Abraham, if in truth he existed, left Mesopotamia because of the threat of famine, as evidenced by biblical record, geologic strata and dental analysis.

Adult↗
PubMed1997

Human chromosome 7 carries a putative tumor suppressor gene(s) involved in choriocarcinoma.

Choriocarcinoma developed from a complete hydatidiform mole has an unique genetic feature that involves monoallelic contribution from the paternal genome. To determine the chromosome carrying putative tumor suppressor gene(s), microcell-hybrids were isolated following fusion of choriocarcinoma cells with microcells from mouse A9 cells containing a single human chromosome (1, 2, 6, 7, 9 or 11). Microcell-hybrids with the introduction of chromosome 7 were suppressed or modulated for tumorigenicity and exhibited altered in vitro growth properties. Introduction of chromosomes 1, 2, 6, 9 or 11 had no effect. Tumorigenic revertants isolated from microcell-hybrids with the introduced chromosome 7 contains reduced numbers of chromosome 7. These findings suggest that chromosome 7 contains a putative tumor suppressor gene(s) for choriocarcinoma. Alterations in tumorigenic phenotypes seen in microcell-hybrids were not associated with the presence of either ERV3 or H-plk locus located on the introduced chromosome 7, indicating the putative tumor suppressor gene(s) is outside of ERV3 and H-plk gene loci. Furthermore, we obtained evidence to define a critical region on chromosome 7 (7p12-7q11.23) that was frequently lost in surgically removed choriocarcinoma tissues and cell lines. Using a panel of microsatellite markers, biallelic deletions were observed, which strongly suggests the presence of a tumor suppressor gene(s) within this critical region.

Animals↗
PubMed1997

Selective inhibition of mitogen-induced transactivation of the HIV long terminal repeat by carboxyamidotriazole. Calcium influx blockade represses HIV-1 transcriptional activation.

Carboxyamidotriazole (CAI) is a calcium influx inhibitor that has both antiproliferative and antimetastatic activities. Pretreatment of human T-cells with micromolar concentrations of CAI causes a near complete inhibition of calcium-regulated mitogen-induced transcription from the human immunodeficiency virus (HIV) long terminal repeat (LTR). This inhibition is selective since other mitogen-activated gene regulatory elements, such as the 12-O-tetradecanoylphorbol-13-acetate response element, are not influenced by the drug. HIV LTR transcription inhibition is maximal at 1.0 microM CAI, requires a pretreatment interval of at least 8 h for optimum inhibition, and shows no acute interference with the growth properties of the cells. Moreover, the inhibition is rapidly reversible upon removal of the drug from the medium. Studies to identify enhancer elements within the HIV LTR that are functionally sensitive to low-dose long-term pretreatment with CAI indicate that the NF-kappaB-binding sites are among the major targets of drug action. In vitro DNA binding studies with nuclear extracts prepared from mitogen-induced T-cells stimulated in the presence of CAI indicate that the drug differentially influences the calcium-regulated downstream signal transduction pathways necessary for specific NF-kappaB DNA binding activity at the two kappaB sites within the HIV LTR. Studies with ionomycin and thapsigargin show that repression is specific for selected modes of inducible calcium entry and indicate that, in T-cells, a major mechanism of CAI action is to modulate calcium influx at a level that is proximal to the regulated release of calcium from intracellular stores. Measurement of calcium influx in CAI-treated cells reveals a dramatic and reversible inhibition of mitogen-induced calcium influx. These results indicate that CAI can be an important and effective pharmacological tool for analysis of the calcium-dependent modulation of HIV LTR transcription.

Anti-HIV Agents↗
PubMed1997

A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events Study Group.

BACKGROUND: Antithrombotic therapy with heparin plus aspirin reduces the rate of ischemic events in patients with unstable coronary artery disease. Low-molecular-weight heparin has a more predictable anticoagulant effect than standard unfractionated heparin, is easier to administer, and does not require monitoring. METHODS: In a double-blind, placebo-controlled study, we randomly assigned 3171 patients with angina at rest or non-Q-wave myocardial infarction to receive either 1 mg of enoxaparin (low-molecular-weight heparin) per kilogram of body weight, administered subcutaneously twice daily, or continuous intravenous unfractionated heparin. Therapy was continued for a minimum of 48 hours to a maximum of 8 days, and we collected data on important coronary end points over a period of 30 days. RESULTS: At 14 days the risk of death, myocardial infarction, or recurrent angina was significantly lower in the patients assigned to enoxaparin than in those assigned to unfractionated heparin (16.6 percent vs. 19.8 percent, P=0.019). At 30 days, the risk of this composite end point remained significantly lower in the enoxaparin group (19.8 percent vs. 23.3 percent, P=0.016). The need for revascularization procedures at 30 days was also significantly less frequent in the patients assigned to enoxaparin (27.1 percent vs. 32.2 percent, P=0.001). The 30-day incidence of major bleeding complications was 6.5 percent in the enoxaparin group and 7.0 percent in the unfractionated-heparin group, but the incidence of bleeding overall was significantly higher in the enoxaparin group (18.4 percent vs. 14.2 percent, P=0.001), primarily because of ecchymoses at injection sites. CONCLUSIONS: Antithrombotic therapy with enoxaparin plus aspirin was more effective than unfractionated heparin plus aspirin in reducing the incidence of ischemic events in patients with unstable angina or non-Q-wave myocardial infarction in the early phase. This benefit of enoxaparin was achieved with an increase in minor but not in major bleeding.

Aged↗
PubMed1997

Effect of nebulizer type and antibiotic concentration on device performance.

We compared the performance of selected ultrasonic and jet nebulizers when aerosolizing several antibiotic formulations to determine optimum combinations for delivery of a respirable antibiotic aerosol. Three ultrasonic devices were tested: the UltraNeb 99/100, the UltraAIR and the Aerosonic. The reusable jet nebulizers were the Dura ProNeb, Pari-LL and the Sidestream. The six disposable jet nebulizers were Marquest Acorn II, Hudson T Updraft II, Baxter MistyNeb, Pari-LC, Pari IS-2, and a disposable Sidestream. Each jet was tested with four compressors: a DeVilbiss AP-50, a Pulmo-Aide, a DuraNeb and a PariMaster. All nebulizing systems were initially tested with normal saline. From the initial data, six jet nebulizers and one ultrasonic device were tested with varying concentrations of tobramycin, gentamicin, ceftazidime, ciprofloxacin and colistin. Output was assessed by measuring volume (milliliters per minute), and amount of drug (milligrams per minute) nebulized. We then measured mean particle size of the antibiotic aerosol with seven jet nebulizers and two different compressors, Pulmo-Aide and PariMaster, and two ultrasonic devices. The rate of nebulization of saline and antibiotic solutions (milliliters per minute) was greater with the ultrasonic device(s) than all jet nebulizer systems tested. Increasing the reservoir antibiotic concentration increased the drug output (milligrams per minute) with the jet nebulizers to a maximum, followed by decreasing output. When antibiotic concentrations were increased the output decreased more precipitously with the ultrasonic devices than with the jet nebulizers. At the highest antibiotic concentrations tested, the ultrasonic devices had the lowest output. Particle size distribution was most dependent on the specific jet device, with particle size distribution less affected by a specific antibiotic or its concentration. Higher reservoir concentrations can be utilized for increasing output of respirable antibiotic aerosols by jet nebulizers. We conclude that antibiotic output is dependent upon both the nebulizing system and the reservoir concentration of antibiotic.

Aminoglycosides↗
PubMed1997

Partnership nursing home care for dementia: the Glasgow experience--one-year follow-up.

The outcome of the transfer of 60 elderly patients suffering from dementia from hospital to nursing home care under a partnership contract was reviewed at 6 and 12 months following transfer. The nursing home population had fared badly compared with patients remaining in hospital during the first 3 months. This difference was less evident at 6 months follow-up and had disappeared at 12 months follow-up. It seems that a partnership agreement such as this can deliver a quality of health care at least as good as hospital treatment as long as the transfer is handled carefully.

Aged↗
PubMed1997

Partnership nursing home care for dementia: the Glasgow experience--one-year follow-up.

The outcome of the transfer of 60 elderly patients suffering from dementia from hospital to nursing home care under a partnership contract was reviewed at 6 and 12 months following transfer. The nursing home population had fared badly compared with patients remaining in hospital during the first 3 months. This difference was less evident at 6 months follow-up and had disappeared at 12 months follow-up. It seems that a partnership agreement such as this can deliver a quality of health care at least as good as hospital treatment as long the transfer is handled carefully.

Aged↗
PubMed1997

Transthyretin amyloidosis: a new mutation associated with dementia.

Familial transthyretin (TTR) amyloidosis commonly presents with peripheral neuropathy and involvement of visceral organs. In contrast, signs of central nervous system (CNS) involvement are exceptional. We report that members of a kindred affected by a slowly progressive dementia, seizures, ataxia, hemiparesis, and decreased vision without neuropathy have TTR amyloid deposits in the leptomeninges, the brain parenchyma, and the eye. This condition, previously labeled oculoleptomeningeal amyloidosis, is linked to a mutation at codon 30 of TTR gene, resulting in the substitution of valine with glycine in this family, TTR amyloid deposits were present in the leptomeninges, especially the leptomeningeal vessels, and in the subependymal regions of the ventricular system where they disrupted the ependymal lining and resulted in amyloid-glial formations protruding into and narrowing the ventricular system. Hydrocephalus and atrophy and infarction of cerebral and cerebellar cortexes were also present. Review of the literature shows that amyloid deposition in the leptomeninges is not uncommon in TTR amyloidoses clinically characterized by peripheral neuropathy and lack of CNS signs. The present kindred, which presented exclusively with signs of CNS involvement, expands the phenotype of TTR amyloidosis and raises questions concerning the mechanisms determining phenotypic expression in TTR familial amyloidosis.

Amyloid Neuropathies↗