HIV testing of patients with end stage renal failure.
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AIDS Serodiagnosis↗
Biomedical subjects
P Edwards
Publications and source records attributed to P Edwards.
Compensation for medical accidents.
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Costs and Cost Analysis↗
A quantitative analysis of matrix alignment in ligament scars: a comparison of movement versus immobilization in an immature rabbit model.
This investigation quantified the alignment of fibrillar matrix in normal rabbit medial collateral ligaments (MCLs) and in healing MCLs from animals treated with or without knee immobilization. Twenty-four immature female rabbits were given complete midsubstance injuries to their right MCLs. Fifteen of them had that knee pin immobilized in flexion, while the remaining nine were allowed unrestricted cage activity. Animals were sacrificed in groups of three at intervals of 3, 6, or 14 weeks after injury, and both healing MCLs and unoperated contralateral controls were fixed in situ for subsequent removal, freeze-fracture, and preparation for scanning electron microscopy (SEM). A random sampling of SEM photographs followed by automated, statistically validated image processing was used to quantify alignment of matrix in all samples. Results showed that nonimmobilized MCL scars in this model do remodel over 14 weeks of healing, returning to normal alignment values in that time. Surprisingly, MCL scars in immobilized knees were even better, with mean matrix alignments falling statistically within normal MCL limits at all healing intervals studied. If not due to an unknown sampling or fixation artifact, these results suggest that gross knee flexion and extension is not a prerequisite for scar matrix alignment in this immature model of ligament healing.
Animals↗
Outcome 1 to 3 years after severe traumatic brain injury in children and adolescents.
This study reports a consecutive series of 220 children and adolescents who sustained traumatic brain injury (BI) and were admitted to a comprehensive paediatric rehabilitation programme. Progress in areas of mobility, activities of daily living, education and cognitive function were documented for up to 3 years after the injury. Physical recovery was most rapid in the first years and cognitive and language gains generally occurred later, even up to 3 years after the injury. Cognitive assessment at the time of admission proved helpful in predicting outcome; of those patients admitted in a conscious state only one remained dependent for any aspect of self care. Even for those admitted unconscious at a median of 62 days after injury there was good potential for recovery with 27-43 per cent achieving independence in the activities of daily living. For those still unconscious at 6 months, 72 per cent remained vegetative and none achieved the highest cognitive level. Overall, 14 per cent returned to regular education while 25 per cent remained incapable of any educational programme. In a well planned and multidisciplinary rehabilitation programme, patients with severe BI have potential for continued recovery and measurable improvement for at least 3 years. The emphasis should be targeted on differing areas of the therapy programme at different phases of recovery. A realistic appraisal of the ultimate potential for recovery can usually be made by 6 months.
Accidents, Traffic↗
Ethanol-induced reductions in skeletal muscle protein synthesis: use of the inhibitors of alcohol and aldehyde dehydrogenase.
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Alcohol Dehydrogenase↗
A transducing bacteriophage for Caulobacter crescentus uses the paracrystalline surface layer protein as a receptor.
The bacteriophage phi Cr30, a transducing phage for Caulobacter crescentus strains, required the paracrystalline surface (S) layer for infectivity. Wild-type strains were phage resistant when rsaA, the gene for the 130K S-layer protein, was interrupted with an antibiotic resistance cassette. Strains that had lost the S layer by mutation were phage resistant, as were mutants that produce an S layer but which do not attach the structure to the cell surface. Phage sensitivity was restored to 130K-protein-deficient strains by introducing rsaA on a plasmid. Spontaneous phage-resistant strains produced expected phenotypes as follows (in order of decreasing frequency): S-layer cell attachment defects, no S layer, or an S layer that was wild type in appearance.
Bacteria, Aerobic↗
Outbreak of human calicivirus gastroenteritis in a day-care center in Sydney, Australia.
Between January and March 1988, an outbreak of gastroenteritis occurred among children and staff at a day-care center in Sydney, New South Wales, Australia. Over an 11-week period, 53 persons had 101 episodes of gastroenteritis; some patients had 5 separate episodes. The principal etiologic agent in the outbreak, human calicivirus (HCV), was detected by electron microscopy in 32% of fecal specimens from children and staff members with symptoms but in only 8% of asymptomatic individuals (P less than 0.01). HCV was confirmed by both an enzyme immunoassay and solid-phase immune electron microscopy. HCV infection was a particular problem in infants, who had the highest age-specific attack rates, had the greatest symptomatic/asymptomatic infection ratio, and were most likely to have a second symptomatic episode. The mode of transmission of this virus was not identified, and extensive efforts to control the 11-week outbreak had little effect. Prolonged excretion of HCV by some symptomatic patients and high rates of asymptomatic infection may have contributed to the extended duration of the outbreak. HCV may be a common cause of gastroenteritis in children that is under-recognized because of insensitive methods of detection.
Australia↗
Metabolism of pyridoxine in mild metabolic hyperoxaluria and primary hyperoxaluria (type 1).
Plasma pyridoxine metabolites in plasma and 4-pyridoxic acid excretions in urine were measured in normal subjects, in 7 patients with type-1 hyperoxaluria and in 8 patients with mild metabolic hyperoxaluria, while receiving various doses of pyridoxine. Compliance with ingestion of pyridoxine was verified by measuring urinary 4-pyridoxic acid. In the normal subjects the maximum level of pyridoxal phosphate was obtained after only 10 mg/day of pyridoxine. The patients were divided into nonresponders, good responders and poor responders to pyridoxine according to the fall in urinary oxalate and glycollate excretions. In patients taking pyridoxine, the plasma pyridoxal phosphate levels were as for normal subjects in primary hyperoxaluria, lower than for normal subjects in mild metabolic hyperoxaluria (p less than 0.01), and in the latter group lower in partial responders than in good responders (p = 0.04). Hence in mild metabolic hyperoxaluria there may be difficulty in converting pyridoxine to pyridoxal phosphate.
Chromatography, High Pressure Liquid↗
An experimental model to assess the value of laser angioplasty in the management of atheromatous disease of the carotid bifurcation.
Laser angioplasty is used to vaporize atheroma in limb arteries. The present investigation was undertaken to determine the nature, size and quantity of particulate matter generated, and the appearance of the intima of a carotid artery model after laser treatment. Particulate matter was not significantly increased following treatment of 39 autopsy carotid bifurcations, but superficial plaques were vaporized and the surface of fibrous lesions glazed. It is anticipated that atheromatous carotid vessels would be rendered less thrombogenic and the risk of cerebral embolism reduced later angioplasty.
Aged↗
6-(substituted methylene)penems, potent broad spectrum inhibitors of bacterial beta-lactamase. III. Structure-activity relationships of the 5-membered heterocyclic derivatives.
Sodium (5RS)-Z-6-(heterocyclylmethylene)penem-3-carboxylates (2) are a series of extremely potent inhibitors of bacterial beta-lactamases. A variety of 5-membered heteroaromatic derivatives have been prepared and structure-activity studies reveal a preferred substituent orientation. One of these derivatives, the 1-methyl-1,2,3-triazolyl compound (5m) is a more potent synergist of amoxycillin than clavulanic acid, sulbactam or tazobactam.
Amoxicillin↗
Burnout among staff members at community residential facilities for persons with mental retardation.
The Maslach Burnout Inventory was used to measure burnout among 125 staff members working in community residential facilities for persons with mental retardation in North Dakota. Results showed that a moderate degree of burnout was present for direct-care and supervisory staff members in each of the three subscales of the inventory. In addition, supervisory staff members showed significantly more burnout on the Emotional Exhaustion subscale and significantly less on the Personal Accomplishment subscale than did direct-care staff members. Results were discussed in light of previous findings.
Adult↗
Esophageal ulceration induced by zidovudine.
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Adult↗
Effect of Phyllanthus amarus on duck hepatitis B virus replication in vivo.
Nine ducks congenitally infected with the duck hepatitis B virus (DHBV) were treated either orally (four ducks for 10 weeks) or intraperitoneally (five ducks for 12 weeks) with the Indian traditional herbal remedy Phyllanthus amarus. Compared to placebo-treated control ducks, these treatments did not result in a reduction of circulating viral DNA in the serum or in the level of viral DNA replication in the liver. In two of the five intraperitoneal-treated ducks, a reduction in the levels of duck hepatitis B surface antigenaemia (DHBsAg) was observed. The data strongly suggest that Phyllanthus amarus has no significant inhibitory effect on DHBV DNA replication and only a minor effect on DHBsAg production.
Animals↗
Effects of oral pyridoxine upon plasma and 24-hour urinary oxalate levels in normal subjects and stone formers with idiopathic hypercalciuria.
The effect of pyridoxine hydrochloride, 200 mg/day (0.97 mmol/day) for 3 weeks, upon plasma and urinary oxalate has been determined in ten normal subjects and seven patients with idiopathic hypercalciuria while both groups were on low-oxalate diets. Patients had higher basal urinary oxalate levels than normal subjects. In normal subjects pyridoxine administration decreased plasma oxalate levels and raised urinary oxalate. The patients showed no change in either plasma or urinary oxalate.
Calcium↗
Liquid chromatographic studies of vitamin B6 metabolism in man.
The effects of increased intake of pyridoxine hydrochloride on plasma vitamin B6 metabolism within therapeutic limits (up to 800 mg/day) were investigated. Maximum plasma concentrations of pyridoxal phosphate were attained at relatively low intakes of pyridoxine hydrochloride. Two metabolism thought to be unidentified forms of vitamin B6 were present in subjects taking more than 200 mg of pyridoxine hydrochloride per day as have recently been described. We investigated the possibility that these were isomeric forms of vitamin B6. However, 'Peak 2' metabolite was shown to be probably 4-pyridoxolactone. The metabolism of isopyridoxal has not previously been investigated in man. We demonstrated that it is an active vitamer of the B6 complex in humans. The main fluorescent metabolite of isopyridoxal present in plasma and urine had a similar retention time to 'Peak 1' metabolite. Isopyridoxal was incapable of being directly phosphorylated in rat liver extract and it is therefore unlikely that peak 1 is isopyridoxal phosphate. Its nature remains unknown.
Animals↗
The gastrointestinal manifestations of AIDS.
Gastrointestinal disease in AIDS is common and is due to opportunistic infections, aggressive malignancy and possible direct HIV enteropathy. Disabling gastrointestinal symptoms are prominent both in patients with established AIDS and in patients with earlier stages of HIV infection. We report the cases of 160 patients with AIDS who underwent gastroenterological investigations at St Vincent's Hospital, Sydney, between November 1983 to October 1987. Of these, 127 had the diagnosis of AIDS established prior to referral and 33 patients had the diagnosis of AIDS established as a result of gastroenterological investigations. Diarrhoea and weight loss (88%) were the most frequent reasons for undertaking gastroenterological investigations. Swallowing disorders (47%), abdominal pain (20%), oral and perianal disease (74%) and evidence of hepatobiliary disease were the other major indications for investigation. In 90% of cases there was evidence of concurrent and active gastrointestinal disease at two or more sites within the alimentary tract. Results from this series reveal a wide range of infectious pathogens: viral (Cytomegalovirus, Herpes simplex), bacterial (Mycobacterium avium intracellulare) and parasitic (Cryptosporidium, Isospora belli). Kaposi's sarcoma and non-Hodgkin's lymphoma were the only malignancies detected in this series. Gastrointestinal disease associated with HIV infection is common, and contributes significantly to its overall morbidity and mortality. Moreover, chronic diarrhoea, weight loss and malnutrition may also contribute to the overall immunodeficiency.
Acquired Immunodeficiency Syndrome↗
Binding of sulfonamides to carbonic anhydrase: influence on distribution within blood and on pharmacokinetics.
Four new aromatic sulfonamides were synthesized and purified by standard techniques. Two were unsubstituted, primary sulfonamides and two possessed substituents on the sulfonamide nitrogen. The affinity of the inhibitors for the enzyme carbonic anhydrase was determined in terms of the inhibitory potency, which was found to be dependent on the presence of an unsubstituted sulfonamide group. Binding studies were performed in erythrocyte suspensions using a range of concentrations and the unbound, extracellular concentrations were determined by high-performance liquid chromatographic (HPLC) assay. The dissociation constant of binding and the total binding capacity of the erythrocytes were estimated by nonlinear regression using a two-site binding model. The affinity of the compounds for erythrocytes reflected their inhibitory potency against the enzyme. Binding to plasma proteins was more dependent on lipophilicity and pKa and was stronger for the substituted sulfonamides. Pharmacokinetic studies in rats showed that the unsubstituted sulfonamides with a high affinity for carbonic anhydrase in erythrocytes have longer half-lives and lower clearance values than the substituted sulfonamides which were more strongly bound to plasma proteins. However, comparison of unbound clearance values showed that the variations in molecular structure, which produced differences in carbonic anhydrase binding and in distribution, also produced variations in susceptibility to elimination processes.
Animals↗
Severe clinical manifestations of primary HIV infection.
Three cases of oesophageal candidiasis in association with primary HIV infection are described. In each case the candidiasis was associated with a decreased number of circulating CD4+ cells and responded well to treatment with ketoconazole. Clinicians should be aware that severe opportunistic infections may develop during this stage of infection, presumably as a result of transient immunodeficiency. We argue that the definition of primary HIV infection should be extended to include severe opportunistic infections and neurologic presentations.
Adult↗