Growth of Epstein-Barr virus-associated B-lymphoproliferative disease tissue in a severe combined immunodeficient mouse.
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Adolescent↗
Biomedical subjects
M Phillips
Publications and source records attributed to M Phillips.
Computer-based patient records.
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Confidentiality↗
The costs and effectiveness of three vitamin A interventions in Guatemala.
The purpose of the study presented in this paper was to estimate, using secondary sources of data, the cost and effectiveness of three programs to combat vitamin A deficiency in Guatemala-the national sugar fortification program, a targeted capsules distribution program and the promotion of home food production combined with nutrition education and to draw conclusions concerning priorities for Guatemala. Data on the costs and coverage were collected from implementing agencies in Guatemala. Coverage data were converted into a common set of impact indicators. Sensitivity analyses were conducted on variables whose precise value was uncertain. Potential impacts of improvements in program performance operations were also explored. The analysis found the cost per high-risk person achieving adequate vitamin A to be US $0.98 for fortification, US $1.68-1.86 for capsule distribution and US $3.10-4.16 for food production/education. Fortification is the most efficient option if vitamin A levels in sugar are maintained at reasonable levels. Where fortified sugar is not consumed and vitamin A deficiency is highly prevalent, small-scale, targeted, complementary interventions such as capsules and food production education may be appropriate for sustained broader impacts.
Cost-Benefit Analysis↗
Breastfeeding promotion and priority setting in health.
An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.
Adult↗
Economic implications of resistance to antimalarial drugs.
The widespread evolution of drug resistance in malarial parasites has seriously hampered efforts to control this debilitating disease. Chloroquine, the mainstay of malaria treatment for many decades, is now proving largely ineffective in many parts of the world, particularly against the most severe form of malaria--falciparum. Alternative drugs have been developed, but they are frequently less safe and are all between 50 and 700% more expensive than chloroquine. Choice of drug clearly has important budgetary implications and national malaria control programmes need to weigh up the costs and benefits in deciding whether to change to more effective but more expensive drugs. The growth in drug resistance also has implications for the choice of diagnostic tool. Clinical diagnosis of malaria is relatively cheap, but less specific than some technological approaches. As more expensive drugs are employed, the cost of wasted treatment on suspected cases who do not in fact have malaria rises and the more worthwhile it becomes to invest in more specific diagnostic techniques. This paper presents an economic framework for analysing the various malaria drug and diagnostic tool options available. It discusses the nature of the key factors that need to be considered when making choices of malaria treatment (including treatment costs, drug resistance, the costs of treatment failure and compliance) and diagnosis (including diagnosis cost and accuracy, and the often overlooked costs associated with delayed treatment), and uses some simple equations to illustrate the impact of these on the relative cost effectiveness of the alternatives being considered. On the basis of some simplifying assumptions and illustrative calculations, it appears that in many countries more effective drugs and more specific and rapid diagnostic approaches will be worth adopting even although they imply additional expense.
Animals↗
Circulating anodic antigen for detection of Schistosoma mansoni infection in Egyptian patients.
We evaluated the ability of circulating anodic antigen (CAA) to identify infection with Schistosoma mansoni in a prospective cohort study of 257 Egyptian men, 147 with infection diagnosed by repeated Kato thick smears, and 110 without detectable infection. The CAA levels were obtained and the stool examinations were performed two weeks and one, two, four, and six months after praziquantel therapy for infected men. A CAA enzyme-linked immunosorbent assay was repeated twice on subjects who were otherwise negative for schistosomiasis. Circulating anodic antigen was detected in 117 cases, with an overall test sensitivity before treatment of 0.8. Sensitivity was related to the intensity of infection, ranging from 1.00 with > 400 eggs per gram (epg) of feces to 0.60 for those with < 100 epg. After praziquantel therapy, the level of the antigen was significantly reduced. Specificity was excellent before treatment (1.00, 95% confidence interval = 0.97-1.0), but it decreased to 0.98 four months after treatment. Likelihood ratios were significant for all titers > or = 4. We conclude that CAA has moderate sensitivity and excellent specificity when used to identify infection with schistosomiasis, as well as to monitor the results of therapy after at least one month after treatment.
Adult↗
Clostridium perfringens sepsis with intravascular hemolysis following laparoscopic cholecystectomy: a newly reported complication.
Clostridium perfringens sepsis with hemolysis following cholecystectomy is a rare complication that has a very high mortality. The best chance for survival is ensured by early diagnosis, prompt initiation of antibiotics, and hyperbaric oxygen therapy if readily available. To our knowledge, this is the first reported case following laparoscopic cholecystectomy.
Anemia, Hemolytic↗
Noninvasive ultrasonic subtotal ablation of the prostate in dogs.
OBJECTIVE: To determine whether high-intensity focused ultrasound (HIFU) can be used for subtotal ablation of the prostate gland in dogs without causing damage to surrounding tissues. DESIGN: Experimental trial. ANIMALS: Adult hounds > or = 5 years old and weighing between 20 and 30 kg. PROCEDURE: Prostatic ablation was performed in all dogs, using a transrectal HIFU probe. Acute effects of HIFU treatment were evaluated in 4 dogs. These dogs were euthanatized and necropsied 4 hours after the procedure. Chronic effects were evaluated in the other 3 dogs. Serial CBC, serum biochemical analyses, urinalyses, and transrectal ultrasonography were performed. Dogs were euthanatized and necropsied 3 months (1 dog) or 1 year (2 dogs) after HIFU treatment. RESULTS: Histologic examination of the prostate glands from the 4 dogs euthanatized 4 hours after treatment revealed that 80 to 90% of the gland had undergone hemorrhagic, liquefactive necrosis. Only slight discoloration of the prostatic capsule was detected, and there were not any gross or histologic lesions of the rectal mucosa or urinary bladder. All 3 dogs followed up after HIFU treatment developed cystic cavities within the prostate. Clinicopathologic testing did not indicate any long-term adverse effects. CONCLUSIONS AND CLINICAL RELEVANCE: This method was effective in causing subtotal ablation of prostatic tissue in dogs. Further study of morbidity is required before the technique can be used clinically.
Animals↗
Ethnic differences in women with HIV infection in Britain and Ireland. The study group for the mrc collaborative study of HIV infection in women.
OBJECTIVE: To examine ethnic differences in the socio-epidemiological and clinical characteristics of a cohort of women with HIV infection in Britain and Ireland. DESIGN AND METHODS: Analysis of baseline data (ethnic group, sexual history, likely route of HIV infection, reasons for HIV testing and first AIDS-defining disease) from 400 women with HIV infection recruited into a cohort study from 15 genitourinary medicine/HIV clinics in Britain and Ireland. RESULTS: Sixty-five per cent of women were white and 29% black African. Their median number of lifetime sexual partners was seven and three, respectively (P < 0.001). Ninety-three per cent of black African and 43% of white women were probably infected through sexual intercourse. Injecting drug use was the most likely route of infection in 55% of white women, but none of the black African women. Perceived risk (33%) or investigation of symptoms (26%) were the most common reasons for HIV testing. Seven per cent of white women and 16% of black African women (P < 0.001) had AIDS when HIV infection was diagnosed. The distribution of first AIDS-defining diagnoses differed (P = 0.001) by ethnic group. For white women, the most common disease was Pneumocystis carinii pneumonia; for black African women it was pulmonary tuberculosis. CONCLUSION: There are important differences between black African and white women in sexual history and route of transmission, disease stage at diagnosis and pattern of AIDS-defining diseases.
AIDS Serodiagnosis↗
A novel 27/16 kDa form of subtilisin cleaved actin: structural and functional consequences of cleavage between Ser234 and Ser235.
A new 27/16 kDa form of cleaved actin was prepared by subtilisin cleavage between Ser234 and Ser235 of F(MgADP)-actin complexed with BeFx. The cleavage had little effect on actin-actin interactions as probed in polymerization measurements and by electron microscopy. In circular dichroism melting experiments the thermostability of F-actin was reduced by about 10 degrees C by this cleavage. The in vitro motility and Vmax, but not Km, of actomyosin ATPase were decreased by about 20% upon 27/16 kDa cleavage of F-actin. The binding of tropomyosin to actin was unchanged by this modification.
Actins↗
Continuous-infusion verapamil with etoposide in relapsed or resistant paediatric cancers.
This study evaluates the use of a multidrug resistance (MDR) modulator (verapamil) in combination with a standard dose of single-agent etoposide in relapsed or refractory paediatric malignancy. A total of 20 patients (median age 6.5 years) were treated with an infusion of verapamil (loading dose 0.1 mg kg-1, followed by continuous infusion 0.15 mg kg-1 h-1) for 72 h. Etoposide was given daily (150 mg m-2 day-1) for three doses (each over 1 h); the first dose was given 12 h into the verapamil infusion. Cardiovascular toxicity was monitored by ECG and 2 hourly blood pressure and pulse recordings. Verapamil and norverapamil plasma concentrations were measured daily. Disease response was assessed after two courses. A total of 29/35 treatment courses were given at the desired verapamil dose; five courses required a dose reduction owing to cardiovascular toxicity. No patient required intensive monitoring. All patients who developed cardiovascular toxicity were over 14 years old. There was no correlation between plasma verapamil or norverapamil concentrations and toxicity. There were six partial responses (three rhabdomyosarcoma, three neuroblastoma) after two courses, but because of variation in the dose and schedule of etoposide these cannot be unequivocally contributed to MDR reversal. In conclusion, a regimen using a continuous infusion of verapamil combined with divided-dose etoposide is tolerable in children, and this strategy may be effective in refractory neuroblastoma and rhabdomyosarcoma.
Adolescent↗
The impact of a brief motivational intervention with opiate users attending a methadone programme.
During the 1980s Motivational Interviewing emerged as one of the memes of the addictions field. This occurred despite the lack of scientific evidence supporting its utility. In this paper findings of a controlled trial of a brief motivational intervention with illicit drug users (n = 122) attending a methadone clinic are reported. Clients who met the study's inclusion criteria were randomly allocated to either a motivational (experimental, n = 57) or educational (control, n = 65) procedure. Over the 6-month follow-up period the motivational subjects demonstrated a greater, immediate, commitment to abstention, reported more positive expected outcomes for abstention, reported fewer opiate-related problems, were initially more contemplative of change, complied with the methadone programme longer and relapsed less quickly than the control group. There was, however, no difference in terms of the severity of reported opiate dependence and the control group fared better on reported self-efficacy. It was concluded that motivational interventions of the type investigated are useful adjuncts to methadone programmes.
Adolescent↗
Decoding mystifying signals: translating symbolic communications of elusive ego states.
Traditionally, Ego-state Therapy has been conducted with parts of the personality that have been activated hypnotically and that present themselves for verbal interaction. This paper presents two cases in which ego states communicate through symbolic and sensory signals at significant points in therapy. Recognition of the meaning and usefulness of these phenomena allows otherwise enigmatic material to provide crucial information about the patient's deepest struggles. Failure to identify this material can often precipitate therapeutic stalemates when the patient's most creative expressions go unnoticed. Effective utilization of these states can often bring about dramatic resolution of inner conflict and achieve symptom relief.
Adult↗
Our bodies, our selves: treating the somatic expressions of trauma with ego-state therapy.
Trauma activates primitive defenses which often involve somatic processes. In this paper, the author explores the use of somatic approaches to ego-state therapy, developed by John and Helen Watkins (1979), which has been shown in the literature to be an effective method of treating the internal fragmentation and dissociated response patterns related to early childhood trauma. Through the use of hypnotic techniques such as the somatic bridge, ideosensory signalling, and sensory awareness training, ego-state therapy can be directed to those parts of the self which are more connected to somatic expressions of traumatic experiences. Several clinical case examples are presented to illustrate the potential of this approach in the treatment of trauma. Specific benefits for patients who complain of psychosomatic symptoms are discussed, as well as for those with compromised body image and perception, and its usefulness as a hypnoanalytic tool for uncovering memories that may be more somatically based.
Adult↗
Evaluation of the Alcopatch, a transdermal dosimeter for monitoring alcohol consumption.
BACKGROUND: The Alcopatch is an improved transdermal dosimeter for the measurement of alcohol consumption, by detection of ethanol in fluid excreted from the skin. The device is worn as a band around the ankle and provides a visual signal in the event of tampering. METHODS: Fourteen volunteers wore duplicate Alcopatches for a period of 7 or 8 days, while keeping a written record of their beverage alcohol consumption. Ethanol concentration in the Alcopatch was measured by gas chromatography and correlated with self-reported consumption. RESULTS: All alcohol consumption in excess of 0.25 g/kg/day resulted in measurable levels of ethanol in the Alcopatch. A positive correlation was observed between the reported consumption of ethanol (in g/kg/day) and the concentration of ethanol in the Alcopatch (square root, in mg/dl) (y = 0.91x + 0.28, r = 0.61) in 12 of 14 subjects. CONCLUSIONS: The Alcopatch detected the consumption of beverage alcohol with high sensitivity and specificity over a period of 7 to 8 days and may be useful for the study of target populations.
Adult↗
Recurrent thombotic occlusions of arteries and veins caused by intravascular metastatic adenocarcinoma.
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Adenocarcinoma↗
Volatile organic compounds in the breath of patients with schizophrenia.
AIMS: To analyse the breath of patients with schizophrenia for the presence of abnormal volatile organic compounds. METHODS: A case comparison study was performed in two community hospitals in Staten Island, New York. Twenty five patients with schizophrenia, 26 patients with other psychiatric disorders, and 38 normal controls were studied. Alveolar breath samples were collected from all participants, and volatile organic compounds in the breath were assayed by gas chromatography with mass spectroscopy. Differences in the distribution of volatile organic compounds between the three groups were compared by computerised pattern recognition analysis. RESULTS: Forty eight different volatile organic compounds were observed in the breath samples. Three separate pattern recognition methods indicated an increased differentiation capability between the patients with schizophrenia and the other subjects. Pattern recognition category classification models using 11 of these volatile organic compounds identified the patients with schizophrenia with a sensitivity of 80.0% and a specificity of 61.9%. Volatile organic compounds in breath were not significantly affected by drug therapy, age, sex, smoking, diet, or race. CONCLUSIONS: Microanalysis of volatile organic compounds in breath combined with pattern recognition analysis of data may provide a new approach to the diagnosis and understanding of schizophrenia. The physiological basis of these findings is still speculative.
Breath Tests↗
False positive seroreactivity to Borrelia burgdorferi in systemic lupus erythematosus: the value of immunoblot analysis.
UNLABELLED: The object of this study was to determine the incidence of seropositivity to B. burgdorferi by the commonly available enzyme-linked immunosorbent assay (ELISA) in patients with SLE and other rheumatic diseases and to evaluate immunoblot analysis as a tool to differentiate true from false positive ELISA. Sera were obtained from patients with SLE (n = 35), rheumatoid arthritis (n = 26), seronegative arthritis (n = 28) and Lyme disease (n = 18). Reactivity to B. burgdorferi antigens was analysed by two available diagnostic techniques: ELISA and immunoblot. Correlations were made between seroreactivity to B. burgdorferi and standard serological tests of autoimmunity: antibodies to nuclear antigens, dsDNA, cardiolipin, SSA and SSB. Seroreactivity to B. burgdorferi antigens by the ELISA system was detected in 40% of patients with SLE, 8% of patients with rheumatoid arthritis and 4% with seronegative arthritis. Among patients seropositive by ELISA, immunoblots were negative in all cases. However, eight of 14 patients with rheumatoid arthritis (57%) showed cross-reactivity to multiple borreli antigens. No significant correlations were found between Lyme seropositivity by ELISA and other autoantibodies except IgM rheumatoid factor (r = 0.61, P < 0.01) in patients with rheumatoid arthritis. IN CONCLUSION: a positive ELISA for Lyme disease was found in up to 40% of patients with established SLE and also in other rheumatic diseases. However, specific serum antibodies to Borrelia were not confirmed by the more specific immunoblot technique.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies, Bacterial↗