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Biomedical subjects

M H Smith

Publications and source records attributed to M H Smith.

155 records · Page 9Linked to original sources
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Legal obligations to human immunodeficiency virus--seropositive patients and health care providers.

Balancing the interest of patients against the interest of health care providers with regard to potential or actual human immunodeficiency virus (HIV) has created many legal issues for health care providers. Some health care providers are reluctant to care for patients with HIV and have occasionally refused to treat HIV-seropositive patients. HIV-seropositive health care providers may be the target of widespread discrimination resulting in both personal and professional losses. Many health care facilities are concerned about the public's response to knowing that HIV-seropositive health care providers are on their staff. An even greater concern is the liability that may result if an HIV-seropositive health care provider transmitted the disease to a patient. Health care providers must keep current on the laws related to HIV/acquired immune deficiency syndrome (AIDS) as well as new developments in the treatment process that will impact on the law.

Confidentiality↗
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Hematogenous dissemination of Mycobacterium tuberculosis in patients with AIDS.

Proof of hematogenous dissemination of Mycobacterium tuberculosis was initially reported in the early 1900s and was noted to be most frequent in patients with miliary tuberculosis. More recently, M. tuberculosis bacteremia has been reported in human immunodeficiency virus (HIV)-infected patients. We describe 13 adult HIV-infected patients in whom hematogenous M. tuberculosis dissemination was evident. Although for most patients whose bone marrow aspirate cultures yielded M. tuberculosis a chest roentgenogram revealed a miliary pattern, roentgenograms for those with M. tuberculosis bacteremia usually revealed evidence of lobar or diffuse infiltrates. Most patients with M. tuberculosis bacteremia had other risk factors for M. tuberculosis, and many had a rapid death, suggesting acute fulminant infection. Our own experience suggests that there are various syndromes associated with hematogenous dissemination in patients infected with M. tuberculosis.

Acquired Immunodeficiency Syndrome↗
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Legal issues related to dismissing students for clinical deficiencies.

Clinical faculty have a legal, ethical, and professional obligation to evaluate students' clinical performance to ensure safe practitioners. However, many clinical faculty members fear litigation and hesitate to give an unsatisfactory grade to students who do not meet established standards. If the decision to assign a failing clinical grade was "careful and deliberate" and the student was afforded due process, the principle of judicial deference emerges to protect the clinical instructor and the educational institution.

Civil Rights↗
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Complement resistance-related traits among Escherichia coli isolates from apparently healthy birds and birds with colibacillosis.

In this study, 294 Escherichia coli isolates from birds with colibacillosis were collected from disease outbreaks throughout the United States and were compared with 75 fecal E. coli isolates of apparently healthy chickens by their possession of several purported virulence genes, resistance to rough-lipopolysaccharide-specific bacteriophages (rLPSr), and elaboration of capsule. Traits were selected for study on the basis of their association with complement resistance. The genes targeted in this study included those encoding colicin V (cvaC) and the outer membrane proteins TraT (traT), OmpA (ompA), and Iss (iss). No significant differences were found between the two groups of isolates in the occurrence of cvaC-, traT-, or ompA-homologous sequences or in rLPSr. Only a few isolates were encapsulated, and the isolates of healthy birds were significantly more likely to be encapsulated than were the isolates of sick birds. However, iss, whether detected through hybridization or amplification, was found in more of the disease-associated isolates than in those of healthy birds. This difference was highly significant. Further, iss sequences were widely distributed among isolates of different serotypes from various avian host species and sites within these hosts. Such results suggest that possession of the iss sequence by an avian E. coli isolate may be a good indicator of that isolate's potential to cause disease. This association warrants further study because iss and the protein it encodes may be useful targets of future colibacillosis control efforts.

Animals↗
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Sacralization of epidural block with repeated doses of 0.25% bupivacaine during labor.

A descriptive analysis of the progression of epidural block with repeated doses of 0.25% bupivacaine was performed, assessing pain relief (visual analog scoring), dermatomal spread of sensory and motor block, and the associated management and outcome of labor. The influence of epinephrine 1:200,000 on these observations was also assessed by the random assignment of study patients into two groups, one receiving 10 ml of 0.25% bupivacaine plain (n = 28) and another group receiving 10 ml of 0.25% bupivacaine with commercially added epinephrine 1:200,000 (n = 27). Only primigravid patients were studied. Data comparisons were considered significant at p less than 0.05. With repeated doses of 0.25% bupivacaine, administered within fixed dosing intervals of 60-90 minutes, there was an increasing spread of sensory block toward sacral dermatomes while the upper level of sensory block did not change. Sacral sensory analgesia was present in only 3.5% of patients after the first dose of bupivacaine but was evident in 63.2% of patients following the fourth epidural injection. A similar increase in the number of patients with significant motor weakness was also seen as the number of top-up doses increased. A comparison of patients receiving plain solutions and epinephrine containing bupivacaine showed similar demographic profiles between the groups. Both groups received a similar dose of bupivacaine and experienced comparable management and outcome of labor. Epinephrine in a 1:200,000 concentration did not influence the changing characteristics of the epidural block over time. The duration of labor was not significantly different between groups (10.3 +/- 5.2 hours for the plain group and 11.0 +/- 4.7 hours for the epinephrine group).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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Alterations in osmotic but not pressor responses to ACTH by optic recess lesions in sheep.

This study examines whether neural structures in the region of the optic recess of the third ventricle may be involved in the genesis of adrenocorticotrophic hormone (ACTH)-induced hypertension in sheep. Five sheep were prepared with lesions in an area of the forebrain that included the organum vasculosum of the lamina terminalis (OVLT) and surrounding periventricular tissue. In these animals the dipsogenic response to systemically infused hypertonic sodium chloride (NaCl) was abolished. ACTH treatment (20 micrograms/kg/day) for 5 days caused an increase in mean arterial pressure (MAP) of 19 mm Hg, a response identical to that seen in normal sheep. With ACTH treatment, increases in plasma osmolality were greater than normal, but polydipsia did not occur in the lesioned sheep. In six other sheep with lesions either lateral or anterior to the optic recess of the third ventricle, the dipsogenic response to hypertonic NaCl and pressor response to ACTH were normal. These studies establish that in ACTH-treated sheep the integrity of the anterior ventral part of the third ventricle is not essential for the development of the hypertension. This is in contrast to the finding in other models of experimental hypertension in the rat.

Adrenocorticotropic Hormone↗