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Biomedical subjects

M Murphy

Publications and source records attributed to M Murphy.

At least 559 records · Page 31Linked to original sources
PubMedDate not supplied

The impact of HIV disease on an Irish prison population.

Between January 1987 and January 1991, 168 known HIV-infected prisoners have been incarcerated in Dublin's Mountjoy prison. This figure constitutes 16.6% of the total HIV-infected population in the Republic of Ireland over the same period. One hundred and forty-one (84%) of these prisoners have attended the Department of Genitourinary Medicine, St James's Hospital, Dublin. This group displayed considerable morbidity from HIV-related disease. Respiratory tract infection was the most frequent complication seen. Much additional morbidity was directly attributable to intravenous drug use. A survey of a representative group of inmates revealed that 64.7% were diagnosed HIV-positive in prison. The mean length of time spent incarcerated since the diagnosis of HIV infection was 38.9 months. Twenty-nine of 34 individuals who answered a questionnaire were imprisoned for drug-related crimes and 32 of 34 prisoners admitted to parenteral drug use within the prison. As the HIV epidemic unfolds in Dublin, increasing numbers of prisoners with symptomatic HIV disease will spend time incarcerated in Mountjoy prison. This will pose a considerable burden on prison and hospital medical services alike.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Use of a Dublin inner city A & E department by patients with known HIV-1 infection.

During the period January 1990 to January 1992 260 patients known to be infected with human immunodeficiency virus type 1 (HIV-1) attended the Accident & Emergency (A & E) Department of St James's Hospital, Dublin. There was a total of 709 visits with a mean annual attendance rate of 2.7, twice that for the general A & E population. Eighty-nine per cent of patients were intravenous drug users (IVDUs), 9% homosexual/bisexual and 2% heterosexual. Known HIV-1 seropositive patients accounted for 0.7% and 0.8% of the total number of patients who attended A & E in 1990 and 1991 respectively. The majority of patients disclosed their HIV status. Bacterial respiratory tract infection was the single most common reason for attending A & E and for admission to hospital. Seventy-two per cent of IVDUs fulfilled Centers of Disease Control (CDC) criteria for stage II and III disease; the majority of these used A & E for primary medical care, although listed with a general practitioner (GP) and attending during the daytime. Sixty-eight per cent of homosexuals/bisexuals were CDC stage IV with AIDS defining illnesses accounting for 52.6% of clinical presentations. Of this risk category, 79% required medical admission. Homosexuals/bisexuals represent more advanced disease, thus the full impact of HIV-1 infection in IVDUs in this A & E setting has yet to be realized.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

An audit of treatment of genital warts: opening the feedback loop.

An audit of the treatment of patients (100 men and 90 women) presenting with a first episode of anogenital warts to the Genitourinary Medicine Department at Leeds General Infirmary was performed. Treatment of patients was monitored for a period of 6 months from the time of presentation. The management of patients with genital warts lacked a clearly defined strategy and treatment was unselective and poorly monitored. Excluding patients who defaulted, at follow-up 44 (44%) men and 36 (38%) women still had genital warts at 3 months. Of those patients clear of warts at 3 months, the mean time to remission for men and women was 7.1 and 8.3 weeks respectively. Podophyllin 25% in tincture of benzoin was by far the predominant therapeutic modality used. A total of 96 (96%) men and 76 (84%) women received treatment with podophyllin. Both male and female patients had a mean of 5 treatments with podophyllin 25% (range 1-19 and 1-12 respectively). Physical methods of treatment i.e. cryotherapy and electrocautery, were underutilized, both as primary therapies and when topical agents had failed. Patients saw an average of 3 (range 1-7) doctors over the course of their treatment. Patients with warts affecting 2 or more sites, male patients with anal/perianal warts, and female patients with cervical and vaginal warts had higher failure rates from treatment at 3 months. On the basis of these findings, specific treatment protocols for the management of anogenital warts have been devised.

Adolescent↗
PubMedDate not supplied

Cervical cytological screening in HIV-infected women in Dublin--a six-year review.

A retrospective study of the results of cervical cytological screening of HIV-infected women attending an inner city ambulatory HIV clinic over a 6-year period between 1987 and 1992 was carried out. During this time a total of 165 HIV-infected women attended for management of their HIV disease. The results of cervical cytological specimens (smears) were available in 136 (82.4%) women. The risk categories for HIV infection of these 136 women were intravenous drug use 110 (80.9%), heterosexual sex 24 (17.6%) and undetermined 2 (1.5%). Eighty-five (62.5%) of the 136 women were classified CDC group 2, 30 (22%) CDC group 3, and 21 (15.5%) CDC group 4 at the time of initial cytological screening. Forty-one (30.1%) women had mild dysplasia/CIN 1, 21 (15.4%) had moderate dysplasia/CIN 2 and 17 (12.5%) had severe dysplasia/CIN 3. The overall prevalence of dysplasia/CIN was 58.1%. Twenty-seven (34.2%) of the women with dysplasia/CIN had cytological evidence of human papillomavirus infection. No association between the clinical stage of HIV disease and the presence or degree of dysplasia/CIN was demonstrated. Women with cytological evidence of CIN were significantly more likely to have had genital warts than those with no evidence of CIN (OR 3.1, CI 1.1-10). In those women with cervical dysplasia who underwent colposcopic examination, CIN was confirmed in a high proportion of cases. The default rate from colposcopy, however, was high (35.4%).

Adult↗
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Transdermal drug delivery systems and skin sensitivity reactions. Incidence and management.

Transdermal devices are now marketed for the delivery of systemic medication through the skin. Advantages associated with transdermal drug delivery include avoidance of first-pass metabolism and variable absorption as well as improved patient compliance. Drugs currently available by this route include scopolamine, nitroglycerin (glyceryl trinitrate), estradiol, nicotine, clonidine, fentanyl, and testosterone. This novel development has brought about a specific constellation of skin problems which vary widely in incidence between drugs. It is important to vary the site of drug administration to minimize these reactions. Any eczematous reaction can be treated with a moderately potent topical corticosteroid. Patients with topical sensitivity are usually tolerant of oral challenge but systemic sensitization has been reported and caution is still advocated before proceeding to this step. The increasing use of transdermal drug delivery systems across many specialities means that problems of skin sensitivity are of growing relevance to the dermatologist, the hospital specialist, and the primary care physician.

Administration, Cutaneous↗
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Quality of life: the patient's perspective.

The quality of life for long-term psychiatric patients in the community is an area of concern for those charged with their care. Variability in community mental health services suggests that those discharged from large psychiatric hospitals may experience a deterioration in life satisfaction. In this article, the authors describe a study designed to provide a baseline by which patients' perceptions of life in hospital could be comprehensively compared with community life after discharge.

Community Mental Health Services↗
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Guidelines for administering blood and blood components.

The Serious Hazards of Transfusion (SHOT) scheme has revealed that many patients have received incorrect blood or blood component. This article reports new national guidelines for ordering, administering and managing blood, blood components and blood transfusion.

Blood Banks↗
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Essential requirements for clinical laboratory science.

OBJECTIVE: To present a sample list of essential requirements for clinical laboratory science (CLS) education that support the requirements of the Americans with Disabilities Act (ADA). The essential requirements provide a basis for student admission and academic progress measurement. DATA SOURCES: Over 700 articles have appeared in various professional and trade journals on the impact of the ADA since it was signed in 1990. DATA EXTRACTION: Literature review. DATA SYNTHESIS: The ADA prohibits discrimination against academically qualified program applicants with disabilities, and requires a list of essential requirements, distinct from academic requirements and distinct from essential functions of jobs, for each academic program. Essential requirements, also called technical standards or functional expectations, are task and attribute-based criteria that define their educational program. Applicants and students must possess or be able to achieve the essential requirements directly or through reasonable accommodations. CONCLUSION: By July 1994, all educators must have been prepared with defensible essential and academic requirements that reflect the needs of their programs, and with appropriate processes for managing applications, academic progress, and program completion that promote equal educational opportunity for qualified individuals with disabilities.

Curriculum↗
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HIV/AIDS and nutrition. Implications for disease management.

As a result of major advances in treatment, persons with HIV/AIDS are living longer and requiring more care management. Effective management of HIV-infected patients with nutritional alterations can result in fewer secondary infections and hospital admissions, better clinical outcomes, and lower healthcare costs. In this article, nutritional alterations, interventions, and resources during the course of HIV disease and their implications for care management are discussed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Disinsertion of the inferior oblique muscle for treatment of superior oblique paresis.

PURPOSE: To examine the safety and efficacy of disinsertion of the inferior oblique muscle in the treatment of long-standing ipsilateral superior oblique paresis. METHODS: This retrospective study included 52 patients who underwent disinsertion of the inferior oblique muscle over a 5-year period. Mean age at presentation was 30.8 years (range: 1-70 years). All patients had long-standing unilateral superior oblique paresis and overaction of the ipsilateral inferior oblique muscle. Information recorded included pre- and postoperative vertical deviation, pre- and postoperative Hess chart error scores, reoperation rate, and symptom relief. RESULTS: Following surgery, mean vertical deviation was reduced from 12.9 to 4 prism diopters, while mean Hess chart error score decreased from 596 to 258. This procedure alone resulted in satisfactory symptom relief in 84.6% of patients. The only complication was significant undercorrection requiring further surgery in 13.6% of patients and prisms in 1.8%. When further surgery was needed, the procedure of choice was tucking of the affected superior oblique. Recession of the contralateral inferior rectus was carried out when superior oblique tucking was believed to be unsuitable. CONCLUSIONS: Disinsertion of the inferior oblique muscle is a safe and effective treatment for the majority of long-standing idiopathic unilateral superior oblique pareses.

Adolescent↗
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Gastric antral vascular ectasia--a cause of refractory anaemia in systemic sclerosis.

Recurrent gastrointestinal haemorrhage is an uncommon manifestation of systemic sclerosis. We report a case of gastrointestinal bleeding due to gastric antral vascular ectasia (GAVE) in a patient with systemic sclerosis. Failure to recognise the condition as a cause of gastrointestinal bleeding may delay the instigation of appropriate treatment. GAVE should be considered in the differential diagnosis of anaemia in patients with autoimmune conditions such as systemic sclerosis and primary biliary cirrhosis.

Aged↗
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Toward an International Classification for Nursing Practice: a literature review & survey.

In 1991 the International Council of Nurses (ICN) initiated a long-term project to develop an International Classification for Nursing Practice (ICNP). To identify existing classifications and nomenclatures of nursing, a literature search and survey of national nurses' associations and individuals involved in classification across the world were conducted, in addition to a pilot search for articles describing nursing nomenclatures and classifications in countries other than the US and Canada, the latter having provided most of the examples in the original ICNP proposals. Three sources of literature were examined: international conference proceedings, Med-Line and Exerpta Medica.

Cultural Characteristics↗
PubMedDate not supplied

The acute and chronic effects of nitrendipine on plasma catecholamines in hypertensive patients.

OBJECTIVE: To investigate the acute and chronic effects of nitrendipine on plasma catecholamines in hypertensive patients. DESIGN: The variations in level of plasma noradrenaline and adrenaline were measured in the supine and standing positions before and after the initial dose, and after 12 weeks of nitrendipine therapy. Following a washout placebo period, treatment was initiated by a single 20 mg dose of nitrendipine. This was followed by a double-blind randomization into two groups: one receiving 10 mg nitrendipine twice daily, the other receiving 20 mg once daily. SETTING: Clinical investigation unit, University Hospital (University of British Columbia site), Vancouver, British Columbia. PATIENTS: Sixteen patients (seven males and nine females), mean age 51 years (range 27 to 63), with mild to moderate, uncomplicated hypertension. RESULTS: Two hours after administration of the initial 20 mg nitrendipine dose to all patients, there was a significant fall in the supine and standing systolic and diastolic blood pressure - from 164 +/- 3/102 +/- 1 to 139 +/- 2/87 +/- 2 mmHg, and from 153 +/- 4/105 +/- 1 to 139 +/- 3/90 +/- 1 mmHg, respectively. The supine and standing heart rates were unchanged. After 12 weeks of nitrendipine therapy, blood pressure was reduced (2 h after the dose) to a similar extent as that seen after the initial dose. Acute and chronic nitrendipine administration significantly increased supine and standing noradrenaline, but not adrenaline. Two hours after the initial 20 mg dose, supine noradrenaline increased from 3404 +/- 585 to 4005 +/- 644 pmol/L and standing noradrenaline increased from 3769 +/- 609 to 5821 +/- 615 pmol/L. At the end of the 12 weeks of therapy, similar dose-dependent effects were observed 2 h after the dose, but not 12 or 24 h after the dose, in both groups. The percentage increase in noradrenaline produced by nitrendipine in the standing position was consistently greater than in the supine position. CONCLUSIONS: Chronic nitrendipine therapy results in a daily increase in plasma noradrenaline (2 h after the dose), and the effect is greater in the standing position.

Blood Pressure↗
PubMedDate not supplied

Characterization of TNF receptors on human thymocytes.

Although tumor necrosis factor-alpha (TNF) is constitutively expressed in human and mouse thymus, the effects of TNF on thymocyte proliferation, differentiation and survival suggest that its influence in the thymus is complex. To determine if this complexity results from changes in the expression of the two TNF receptors during thymocyte differentiation, we examined the expression of the 55 kDa TNF receptor (TNF-R1) and the 75 kDa TNF receptor (TNF-R2) on postnatal human thymocytes. Both TNF-R1 and TNF-R2 mRNA were found in resting human thymocytes by reverse transcriptase-polymerase chain reaction (RT-PCR). Using mAb which specifically react with the respective TNF receptors and a highly sensitive, three-step method of immunofluorescence, cell surface TNF-R1 was detected on the vast majority of thymocytes. In contrast, detectable cell surface TNF-R2 was present on a mean of only 12.9% of thymocytes. TNF conjugated to phycoerythrin (TNF-PE) also reacted with a small population of thymocytes and was found to specifically block binding of the TNF-R2 mAb and not the TNF-R1 mAb, implicating preferential binding of TNF-PE to TNF-R2. Using dual-color immunofluorescence with TNF-PE we found that the population of cells which express TNF-R2 also express high levels of the TCR alpha, beta-CD3 complex, CD4 or CD8, and IL-2 receptor alpha chain. Thus, immature (TCRneg/low) thymocytes express TNF-R1 while mature (TCRhigh) thymocytes can also express TNF-R2. This differential expression of TNF receptors provides a mechanism for distinct effects of TNF on immature vs. mature thymocytes.

Animals↗
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Isolation and identification of Ornithobacterium rhinotracheale from commercial broiler flocks on the Delmarva peninsula.

The growth and biological characteristics of isolates of Ornithobacterium rhinotracheale (ORT) from commercial broiler chickens in the mid-Atlantic region of the U.S.A. appear to be identical to those previously reported in the literature. The clinical disease and lesions are also similar to those reported from other poultry growing regions including South Africa and Europe. The diagnostic cases included in this report were often associated with known respiratory pathogens, namely, lentogenic Newcastle disease virus, and infectious bronchitis virus, and Escherichia coli bacteria. The role of ORT in the disease cases presented in this report is unclear.

Animals↗