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Biomedical subjects

M Lewis

Publications and source records attributed to M Lewis.

At least 235 records · Page 13Linked to original sources
PubMed1994

A survey to determine the prevalence of leprosy in a community in east Trinidad.

A house-to-house survey was conducted in a community in East Trinidad, where a clustering of cases had been observed. There were 1355 residents, of whom 73.5% had a complete visual skin examination. No new cases of leprosy were found but a variety of skin disorders were diagnosed. The most common disorder was pityriasis versicolor, which is one of the differential diagnoses of hypopigmented skin lesions. This has serious implications for the delayed diagnosis of leprosy. In all, 5 of the 9 old cases residing in the survey area suffered from paucibacillary disease, and had a history of contact with a lepromatous case. They were not listed initially as contacts of this index case. Contact lists should therefore include nonfamilial persons having frequent contact with an index case. The definition of 'frequent' should be determined by each programme. It may also be necessary to review the duration of surveillance of contacts. The survey was estimated to have cost about US $2,500 and was not considered to be cost-effective.

Adolescent↗
PubMed1994

G-force takes off.

Explore the source record for details and available documents.

Career Mobility↗
PubMed1994

[Stress factors in acute myocardial infarct: the role of physical exertion and unusual life events].

OBJECTIVE: It is controversial whether the onset of myocardial infarction is a "random" event or whether there are triggering factors of the disease. Previous reports on possible triggers were based on case studies or inadequately controlled studies. The TRIMM study (Triggers and Mechanisms of Myocardial Infarction) was designed to determine the influence of physical activity and other external factors on the acute risk of myocardial infarction. METHODS: At Klinikum Steglitz, Berlin, all consecutive patients with myocardial infarction were included. In the Augsburg area, all patients with myocardial infarction in a prospectively defined cohort (n = 330,000) were registered by monitoring 26 hospitals. Information on the circumstances and possible triggers of the disease was obtained by standardized interviews. The control group was matched for age, sex, precinct, and time of a control event. The statistical analysis included a case-control comparison of patients with control subjects and a case-crossover comparison comparing the average exposure to a possible trigger with the time of the last exposure prior to the onset of disease. RESULTS: From January 1989 to December 1991, 1194 patients (74% men, 61 +/- 9 years) were enrolled 13 +/- 6 days after myocardial infarction. During the initial three hours after awakening, the occurrence of myocardial infarction was almost threefold compared to other times of day. A multivariate analysis yielded a twofold risk of myocardial infarction during physical exertion, statistically independently of time of day. 7.1% of patients had engaged in exertional physical activity at onset of the event, as opposed to 3.9% of control subjects. The case-crossover analysis demonstrated a relative risk of 2.1 (1.6-3.1) of exertional physical activity within 1 hour prior to myocardial infarction. Patients whose average frequency of physical exertion was < 4 versus > or = to 4 times per week had relative risks of 6.9 versus 1.3 (p < 0.01). Unusual life events within 24 hours and 24 hours to 4 weeks prior to the event occurred with similar frequencies and control subjects. CONCLUSIONS: Physical exertion appears to increase the acute risk of myocardial infarction in patients with coronary heart disease, particularly in untrained individuals. Unusual life events, however, are of less importance for the acute risk of disease. These findings are important for further investigation of triggering mechanisms of myocardial infarction and for improving preventive strategies.

Adult↗
PubMed1994

Safety of the new quinolones in pregnancy.

OBJECTIVE: To investigate the effect on the fetus of intrauterine exposure to quinolones in terms of teratogenicity, with special focus on the musculoskeletal system. METHODS: We studied 38 pregnant women who received quinolones and consulted the Motherisk Program in Toronto from 1989-1992. Perinatal complications, birth weight, birth defects, and developmental milestones, with particular emphasis on the musculoskeletal system, were compared with those of controls matched for both maternal age and indication for antibacterial therapy. RESULTS: Thirty-five women (92%) treated with norfloxacin or ciprofloxacin received therapy during the first trimester. The most common indication for therapy (92%) was urinary tract infection. More pregnancies in the quinolone group resulted in cesarean delivery due to reported fetal distress as compared to the controls (P = .005), without clear reason. Children born to mothers treated with quinolones were significantly heavier (P = .05) than the control infants, possibly because of better control of the urinary tract infection. No malformations were found in the quinolone group, whereas one child in the control group had a ventricular septal defect. No differences were detected between the groups in achievement of developmental milestones or in the musculoskeletal system. CONCLUSION: The use of the new quinolones during the first trimester of pregnancy does not appear to be associated with an increased risk of malformations or musculoskeletal problems; however, longer follow-up and magnetic resonance imaging of the joints may be warranted to exclude subtle cartilage and bone damage.

Abnormalities, Drug-Induced↗
PubMed1993

Physical exertion as a trigger of acute myocardial infarction. Triggers and Mechanisms of Myocardial Infarction Study Group.

BACKGROUND: It is controversial whether the onset of myocardial infarction occurs randomly or is precipitated by identifiable stimuli. Previous studies have suggested a higher risk of cardiac events in association with exertion. METHODS: Consecutive patients with acute myocardial infarction were identified by recording all admissions to our hospital in Berlin and by monitoring a general population of 330,000 residents in Augsburg, Germany. Information on the circumstances of each infarction was obtained by means of standardized interviews. The data analysis included a comparison of patients with matched controls and a case-crossover comparison (one in which each patient serves as his or her own control) of the patient's usual frequency of exertion with the last episode of exertion before the onset of myocardial infarction. RESULTS: From January 1989 through December 1991, 1194 patients (74 percent of whom were men; mean age [+/- SD], 61 +/- 9 years) completed the interview 13 +/- 6 days after infarction. We found that 7.1 percent of the case patients had engaged in physical exertion (> or = 6 metabolic equivalents) at the onset of infarction, as compared with 3.9 percent of the controls at the onset of the control event. For the patients as compared with the matched controls, the adjusted relative risk of having engaged in strenuous physical activity at the onset of infarction or the control event was 2.1 (95 percent confidence interval, 1.1 to 3.6). The case-crossover comparison yielded a similar relative risk of 2.1 (95 percent confidence interval, 1.6 to 3.1) for having engaged in strenuous physical activity within one hour before myocardial infarction. Patients whose frequency of regular exercise was less than four and four or more times per week had relative risks of 6.9 and 1.3, respectively (P < 0.01). CONCLUSIONS: A period of strenuous physical activity is associated with a temporary increase in the risk of having a myocardial infarction, particularly among patients who exercise infrequently. These findings should aid in the identification of the triggering mechanisms for myocardial infarction and improve prevention of this common and serious disorder.

Aged↗
PubMed1993

Accidental dural puncture in obstetric patients and long term symptoms.

OBJECTIVE: To examine the association between accidental dural puncture and long term headache and related symptoms. DESIGN: Postal questionnaire survey to elucidate new symptoms occurring after childbirth, and linking of these to data in obstetric and anaesthetic case notes. Women were surveyed between 13 months and nine years after delivery. SETTING: Birmingham Maternity Hospital. SUBJECTS: 4700 women who had delivered their most recent baby under epidural anaesthesia, 74 of whom had suffered an accidental dural puncture. MAIN OUTCOME MEASURES: Frequencies of new headache or migraine or neck ache starting within three months after childbirth and lasting over six weeks. RESULTS: Among the 74 women who had had an accidental dural puncture there were 17 (23%) who reported one or more of the above symptoms. By comparison, among those who had had an epidural anaesthetic but no recorded puncture, only 329 (7.1%) reported these symptoms. The duration of the headache or migraine or neck ache in the dural tap group ranged from nine weeks to over eight years. Ten of these women reported still unresolved symptoms. CONCLUSIONS: Conclusions on causality were tentative. Most women would remember a dural tap, and this might influence their reporting of subsequent symptoms attributable to the event. In addition, detailed characterisation of the symptoms was not available. Nevertheless, the findings provide a clear indication of the need for further study of the possible long term sequelae of accidental dural puncture.

Accidents↗
PubMed1993

A symmetric inhibitor binds HIV-1 protease asymmetrically.

Potential advantages of C2-symmetric inhibitors designed for the symmetric HIV-1 protease include high selectivity, potency, stability, and bioavailability. Pseudo-C2-symmetric monools and C2-symmetric diols, containing central hydroxymethylene and (R,R)-dihydroxyethylene moieties flanked by a variety of hydrophobic P1/P1' side chains, were studied as HIV-1 protease inhibitors. The monools and diols were synthesized in 8-10 steps from D-(+)-arabitol and D-(+)-mannitol, respectively. Monools with ethyl or isobutyl P1/P1' side chains were weak inhibitors of recombinant HIV-1 protease (Ki > 10 microM), while benzyl P1/P1' side chains afforded a moderately potent inhibitor (apparent Ki = 230 nM). Diols were 100-10,000x more potent than analogous monools, and a wider range of P1/P1' side chains led to potent inhibition. Both classes of compounds exhibited lower apparent Ki values under high-salt conditions. Surprisingly, monool and diol HIV-1 protease inhibitors were potent inhibitors of porcine pepsin, a prototypical asymmetric monomeric aspartic protease. These results were evaluated in the context of the pseudosymmetric structure of monomeric aspartic proteases and their evolutionary kinship with the retroviral proteases. The X-ray crystal structure of HIV-1 protease complexed with a symmetric diol was determined at 2.6 A. Contrary to expectations, the diol binds the protease asymmetrically and exhibits 2-fold disorder in the electron density map. Molecular dynamics simulations were conducted beginning with asymmetric and symmetric HIV-1 protease/inhibitor model complexes. A more stable trajectory resulted from the asymmetric complex, in agreement with the observed asymmetric binding mode. A simple four-point model was used to argue more generally that van der Waals and electrostatic force fields can commonly lead to an asymmetric association between symmetric molecules.

Alcohols↗
PubMed1993

Psychosocial rehabilitation in schizophrenia: beginnings in acute hospitalization.

Schizophrenic patients discharged from acute inpatient settings are often unprepared to function outside the hospital, leading to recidivism and frequent rehospitalization. Social skills training programs addressing this need have hitherto only been developed for use in outpatient or long-term inpatient settings. We describe the development of a social skills training program for application in a short-term acute inpatient unit. Nursing coordinates the program, which is designed for a 3 to 4 week hospitalization and is delivered in an open group setting. The training program emphasizes communication skills, problem solving, affect identification, needs recognition, and social relatedness. The program uses group discussions, writing tasks, physical activity, education, role-play, feed-back, and assignments. Goals include assessment of individual deficits, inculcation of awareness that life-objectives can be identified and achieved, assistance with transition to postdischarge living situation or outpatient treatment program, and development of awareness of one's roles and responsibilities. The evolution and present structure of the program are described and four representative lessons are detailed.

Activities of Daily Living↗
PubMed1993

Evaluation of obstetric analgesia and anaesthesia: long-term maternal recollections.

Opinions about pain relief were sought from a sample of 11,701 women 13 months to 9 years after giving birth. Their opinions related both to levels of satisfaction with the particular forms of pain relief used and to the presence of any feelings of deprivation of the birth process. Of all forms of pain relief examined epidural anaesthesia was associated with the highest levels of satisfaction. In vaginal deliveries, 69.4% of those who had an epidural were fully satisfied, compared with 29.5% for inhalation analgesia, 20.7% for pethidine and 29.4% for relaxation techniques. Women who had spontaneous deliveries and shorter labours were least satisfied with their epidurals, while the reverse was generally true for the other forms of pain relief. After an epidural for vaginal delivery 7.1% of women reported feelings of deprivation of the full pleasure of childbirth. This was higher than the 1.4% previously reported by women in the same maternity unit when questioned immediately after the delivery,(1) but still only represents a minority of women. After an emergency caesarean section administered under epidural feelings of deprivation were expressed by 5.1%, but by only 1.7% after an elective section under epidural. Among women using pethidine 3.5% felt that this had deprived them of the pleasure of giving birth.

Journal Article↗
PubMed1993

Assessing the needs of the adult with spina bifida.

In recent years this society has heard of the plight of people with spina bifida who have graduated from childrens' to adult services, and of the lack of cohesive medical and counselling services offered to them. In the Manchester area, a joint clinic for adults has recently been set up, consisting of a Neurosurgeon, Nephrologist and Clinical Psychologist. Patients attending are those who attended the joint paediatric clinic who are now 16+ and new referrals from GPs and other consultants. 30 people of appropriate age to attend the clinic were identified, and these were contacted by mail to inquire about the sort of services they would like to receive and any problems they have or foresee for the future. 13 replies were received, 12 people indicating that a joint clinic would be of use to them. Results indicated that a total of 42 contacts with medical, paramedical and care services were lost, and 24 requests were received for contact to be resumed. Replies made it clear that guidance on work, education, social provision and sexual counselling were much in demand. Aids provided for mobility, and facilities for disabled people were not always appropriate for our respondents, who were quite vociferous about what they needed, but did not always know what was available. Conclusions to be drawn are that the joint clinic needs to include links with education, careers officers and counsellors, and that time needs to be made available to effectively meet the needs patients present. The clinic could act as a forum to collate experiences, and highlight the problems of the young disabled adult.

Adult↗
PubMed1993

Variation in course of hepatitis E in experimentally infected cynomolgus monkeys.

Five cynomolgus monkeys (Macaca fascicularis) developed hepatitis after inoculation with a prototype strain of hepatitis E virus (HEV) from Pakistan. Although all 5 monkeys displayed liver enzyme elevations, viremia, virus secretion in feces, and seroconversion, two different patterns of these parameters were observed. For 4 monkeys, increased alanine aminotransferase (ALT) activity was first observed on days 21-26, viremia occurred before and during enzyme elevation, and the animals seroconverted coincidentally with the end of viremia or shortly thereafter. One of these monkeys had a more severe hepatitis, with peak ALT values more than twice the peak levels of the other monkeys. The fifth monkey developed biphasic hepatitis with peaks of ALT activity on days 26 and 54. In this case, viremia and seroconversion were correlated only with the second peak of enzyme elevation and liver histopathology only with the first peak. Viral shedding in this fifth animal lasted two times longer than in other animals.

Alanine Transaminase↗
PubMed1993

Tubular carcinoma of the breast: mammographic appearance.

OBJECTIVE: Tubular carcinoma of the breast is an uncommon malignant growth that can have subtle mammographic findings. Tubular carcinoma is usually found incidentally during screening mammography. It can be differentiated from conventional breast cancers by its smallness and the lack of palpable findings on physical examination of the breast. The mammographic findings in patients with pure tubular carcinoma (90% tubular formation or greater on histologic examination) have not been reported in the recent radiologic literature. MATERIALS AND METHODS: We reviewed the mammographic and sonographic findings and clinical histories of 13 patients with biopsy-proved pure tubular carcinoma. Findings on physical examination of the breast were normal in nine patients. RESULTS: On mammograms, 11 of the 13 tubular carcinomas appeared as small (1.7-cm diameter or less) spiculated masses. The average tumor diameter measured on mammograms was 0.8 cm in patients with normal results of physical examination of the breasts and 1.2 cm in patients with a palpable mass. In two patients, mammography showed suspicious microcalcifications or normal findings. Sonography was performed in three patients and results were normal. CONCLUSION: Tubular carcinoma of the breast manifests mammographically as a small spiculated mass. Because of their smallness, tubular carcinomas can be differentiated from other forms of infiltrating ductal carcinoma on mammograms. Tubular carcinomas are most frequently found incidentally at screening mammography. With the growing emphasis on screening mammography, an increase in the detection of this form of breast cancer can be expected.

Adenocarcinoma↗
PubMed1993

Identification of an mRNA species which encodes a voltage-operated Ca2+ channel in rat liver mRNA.

cDNA which encodes part of the alpha 1-subunit of the rabbit skeletal muscle L-type voltage-operated Ca2+ channel (VOCC cDNA) was employed to search for the presence in whole liver and hepatocytes of poly (A+) RNA homologous to mRNA which encodes VOCCs. Such homologous mRNA would be a candidate for mRNA which encodes the putative hepatocyte receptor-activated Ca2+ inflow system (RACIS). Northern blot analysis showed that poly (A+) RNA prepared from intact liver tissue, but not hepatocytes, contained a poly (A+) RNA species comparable in size to that which encodes the alpha 1-subunit of the L-type VOCC. It is concluded (a) that hepatocytes do not possess VOCCs or that the levels of VOCC poly(A+) RNA in hepatocytes are too low to be detected by Northern analysis and (b) that another cell type present in liver tissue does possess a VOCC. In a low stringency screen of a rat liver cDNA library employing VOCC cDNA as a probe, seven positive cDNA clones were obtained. While regions of the 2.3 kb cDNA insert from one of these clones showed sequence similarities with regions of VOCC cDNA, the 2.3 kb sequence did not appear to encode a Ca2+ channel. The present results suggest that the approach of low stringency cDNA library screening is unlikely to allow isolation of RACIS cDNA.

Animals↗
PubMed1993

Differences between Japanese infants and Caucasian American infants in behavioral and cortisol response to inoculation.

The behavioral and cortisol responses of Japanese infants and Caucasian American infants, 4 months of age, were observed during and following routine inoculation. The Caucasian American group showed a more intense initial affective response and a longer latency to quiet than the Japanese group; the Japanese group showed a greater cortisol response. A 4-group taxonomy was created based on high or low behavioral and cortisol response: high behavior-high cortisol, low behavior-low cortisol, high behavior-low cortisol, and low behavior--high cortisol. There were significant differences between the 2 groups of infants using this taxonomy: Infants in the Caucasian American group were more likely to fall in the high behavior-low cortisol group, while infants in the Japanese group were more likely to fall in the low behavior-high cortisol group.

Child Behavior↗