Biomedical subjects

P Philip

Publications and source records attributed to P Philip.

At least 37 records · Page 2Linked to original sources

PubMed2000

Problems associated with switch to modafinil - a novel alerting agent in narcolepsy.

Modafinil is a novel medication recently approved for the treatment of narcolepsy and idiopathic hypersomnia. Commonly, patients had already been prescribed medications for their syndrome. This report outlines difficulties encountered in the clinical practice of switching patients to modafinil. Naïve subjects accepted modafinil best. Subjects withdrawn from amphetamine had the most problems and failure to withdraw. Venlafaxine hydrochloride combined well with modafinil to control cataplectic attacks. Usage of a progressive withdrawal protocol may ease the difficulties observed.

Adult↗

PubMed2000

The sleep tutorial.

A multimedia Sleep tutorial for General Practitioners was implemented from scratch. The implementation had into account the following features: 1) Specific needs of GPs evaluated in 3 different countries, related with Tutorial contents and technical features; 2) Multinational authorship from European experts; 3) Multilingual possibilities; 4) User friendliness and easy navigation. The tutorial was implemented and tested and its gama version is now available for commercialization.

Adolescent↗

PubMed1999

Long distance driving and self-induced sleep deprivation among automobile drivers.

OBJECTIVE: To evaluate the sleep hygiene and prevalence of sleep deprivation among a large sample of automobile drivers. DESIGN: From the 15th of June to the 4th of August 1996, with the help of the French highway patrol, we randomly stopped automobile drivers at the toll booths of Bordeaux and Biarritz. All subjects completed a validated questionnaire on sleep/wake habits during the year. After answering the questionnaire, subjects completed a graphic travel and sleep log of the three days preceding the interview. PARTICIPANTS: We randomly stopped 2196 automobile drivers. Ninety-one percent of the sample (mean age 43 +/- 13 years) agreed to participate in the survey. RESULTS: Fifty percent of the drivers decreased their total sleep time in the 24 hours before the interview compared with their regular self-reported sleep time. 12.5% presented a sleep debt > 180 minutes, and 2.7% presented a sleep debt > 300 minutes. Being young, commuting to work, driving long distances, starting the trip at night, being an "evening" person, being a long sleeper during the week, and sleeping in on the week-end were risk factors significantly associated with sleep debt. CONCLUSION: The results of the study highlight variables (long-distance driving, youth, sleep restriction) that are frequently associated with sleep-related accidents.

Accidents, Traffic↗

PubMed1999

Sleep disorders in children with blindness.

To evaluate the frequency and type of sleep disorders seen in blind children compared with matched controls, a 42-item questionnaire was used on 156 children (77 blind children) ranging from 3 to 18 years of age. A total of 17.4% of blind children reported sleeping less than 7 hours per night on weekdays compared with 2.6% of controls, with blind children awakening much earlier. Blind children had more sleep complaints, and 13.4% of blind subjects had daily episodes of involuntary sleepiness compared with 1.3% of controls. Blindness has an impact on sleep and alertness that adds to the primary disability.

Adolescent↗

PubMed1999

Effects of a short-term strength training programme on lymphocyte subsets at rest in elderly humans.

The effects of a short-term strength training programme on resting lymphocyte subsets and stress hormone concentrations were analysed in 32 elderly sedentary subjects. Out of these 32 subjects, 8 women and 8 men [mean age 70.1 (SEM 1.0) years] were randomly assigned to a 8-week strength training programme which consisted of three sets of eight repetitions at 80% of one repetition maximum, for leg press, bilateral leg extension and seated chest press, 3 days a week. The remaining 8 women and 8 men [mean age 70.5 (SEM 0.9) years] served as controls. Absolute counts of lymphocyte subsets (CD20+, CD3+, CD3+CD4+, CD3+CD8+, CD3-CD56+CD16+) were measured with a new technique combining fluorescent microspheres and flow cytometry. In the trained subjects, substantial increases in strength took place in one repetition maximum during the 8-week training period for leg press [from means of 20.7 (SEM 1.0) to 23.6 (SEM 1.0) N x kg(-1) LBM (lean body mass)], chest press [from means of 5.4 (SEM 0.3) to 6.2 (SEM 0.3) N x kg(-1) LBM] and bilateral leg extension [from means of 6.3 (SEM 0.2) to 7.4 (SEM 0.3) N x kg(-1) LBM] movements. Baseline cortisol concentration (P < 0.01), CD20+ cell count (P < 0.05), CD3+ cell count (P < 0.05), and CD4+ cell count (P < 0.01) decreased in both groups secondary to circannual variations between winter and summer. No significant effect of strength training on resting adrenaline, noradrenaline and cortisol concentrations or distributions of lymphocyte subsets at rest was observed. The main finding of this study was to demonstrate that 8-week is too short a duration for a strength training programme to modify counts of lymphocyte subsets at rest in elderly sedentary adults.

Aged↗

PubMed1999

Simple reaction time, duration of driving and sleep deprivation in young versus old automobile drivers.

Car accidents are one of the major causes of death in modern society and sleepiness is identified as one major risk factor. The purposes of the present study were: (1) to relate the sleep loss and driving time to a performance indicator and (2) to identify risk factors of performance decrement. We investigated 294 drivers (age < 30 years, n = 100; age > or = 30 years, n = 194) who drove into a rest stop area. All were asked to fill out a questionnaire about the drive and previous sleep/wake pattern, and to carry out a 10 min, simple reaction time (RT) test. The level of performance is identified by the 10% slowest RTs. Multiple regression analysis, with the mean of the 10% Slowest RTs as the dependent variable, showed that age, duration of drive, and duration (shortness) of previous breaks were the main predictors. Our study suggests that public awareness may need to be raised with respect excessive length of driving, especially in young drivers.

Adult↗

PubMed1999

Morningness/eveningness and the need for sleep.

The purpose of this study was to determine, in a large sample of adults of all ages (17-80 years), the effect of morningness/eveningness on sleep/wake schedules, sleep needs, sleep hygiene and subjective daytime somnolence. A total of 617 subjects (219 subjects per chronotype group) matched for age, sex and employment status, completed an abridged morningness/eveningness questionnaire, a questionnaire on sleep habits and the quality of sleep, and the Epworth Sleepiness Scale. Eveningness was associated with a greater need for sleep, less time in bed during the week compared to ideal sleep needs, more time in bed at the weekend, a later bedtime and waking-up time especially at the weekend, more irregular sleep/wake habits and greater caffeine consumption. These subjects built up a sleep debt during the week and extended their duration of sleep at the weekend. They did not, however, rate themselves more sleepy than other types, despite the fact that our results showed a clear link between subjectively evaluated daytime somnolence and sleep debt. Why they were less affected by sleep deprivation is not clear. This raises the question of individual susceptibility to the modification of sleep parameters.

Adolescent↗

PubMed1999

The economic implications of animal diseases and disease control at the national level.

The authors examine the economic implications of animal diseases and control programmes at the national level, including the role of government in animal health, the effect of regulations and the use of cost-benefit analysis. Special attention is paid to the role of economic analysis in government decision-making processes. Economics provides a framework for gathering information and for the presentation of that information in a methodical manner, thereby providing a method for the decision maker to examine policy alternatives. In addition, assumptions underlying the analysis must be clearly laid out and explained by the person undertaking the analysis. Economic reasons for government intervention in animal health programmes include externalities, natural monopolies, public goods, coordination failure, information failure and distribution issues. An integrated holistic approach that includes national and international policy objectives is outlined in the paper. In the approach outlined, government coordinates the activities of stakeholders in animal health, including producers, consumers and researchers.

Animal Diseases↗

PubMed1998

Cytogenetically unrelated clones in therapy-related myelodysplasia and acute myeloid leukemia: experience from the Copenhagen series updated to 180 consecutive cases.

During the period from 1995 to 1997, we studied 19 new cases of therapy-related myelodysplasia (t-MDS) and acute myeloid leukemia (t-AML), extending our series to 180 consecutive cases: 123 patients with t-MDS and 57 patients with t-AML. Cytogenetically unrelated clones were observed in 13 patients: 11 patients with two unrelated clones, one patient with three unrelated clones, and one patient with four unrelated clones. Twelve cases of unrelated clones presented as t-MDS, whereas only one case presented as overt t-AML. Partial or complete deletions of the long arms or monosomy for chromosome 5 or chromosome 7, which are characteristic of t-MDS and t-AML, were observed in both unrelated clones in four patients and in one unrelated clone only in six patients, whereas three patients showed aberrations in both clones that were uncharacteristic of t-MDS or t-AML. Three different interpretations of the origin and significance of cytogenetically unrelated clones in t-MDS and t-AML are presented, although the disease is still considered to be monoclonal. First, patients with different defects of the long arm of chromosome 5 or chromosome 7 in two unrelated clones often seem to have acquired these aberrations as independent events. For this reason, it is possible that they may play an important role in leukemic transformation, for instance, by activating or potentiating the effect of a genetic change that is present in all cells but not disclosed as a visible chromosome abnormality. In cases with involvement of other chromosomes, unrelated clones sometimes develop by cytogenetic change in only a subclone of cells, indicating that they play a role only in tumor progression. Finally, unrelated clones in t-MDS and t-AML may represent two different monoclonal diseases: the primary tumor and t-MDS. This view is supported by the significant excess of unrelated clones observed in t-MDS following multiple myeloma (4 in 13 cases) compared with other diseases (9 in 167 cases; P = 0.02), and by results from a case with a balanced translocation that is highly characteristic of non-Hodgkin's lymphoma in one clone and a t-MDS-associated deletion of the long arm of chromosome 5 in another.

Adult↗

PubMed1998

[Jacobsen's syndrome, thrombopenia and humoral immunodeficiency].

BACKGROUND: Clinical features of Jacobsen syndrome include facial dysmorphism, congenital heart defects, digit anomalies and mild to moderate psychomotor retardation. Thrombocytopenia or pancytopenia is observed in one half of patients. PATIENTS: Two unrelated children, a 6-month- and a 12-year-old, presented with a moderate thrombocytopenia associated with the clinical features of Jacobsen syndrome. Bone marrow aspirates showed, in both patients, normal cellularity with an increased number of micromegacaryocytes. Chromosome analysis showed a partial deletion of the long arm of chromosome 11. The 12-year-old patient had a history of upper respiratory airways infections with immune humoral deficiency (decreased level of IgA and IgM) which, to our knowledge, has never been reported. CONCLUSION: Jacobsen syndrome is a cause of inherited thrombocytopenia in children. Humoral immune functions must be explored in patients with a history of repeated infections.

Child↗

PubMed1998

Sleep and neuromuscular disease: bilevel positive airway pressure by nasal mask as a treatment for sleep disordered breathing in patients with neuromuscular disease.

OBJECTIVE: Investigation of the therapeutic effects of bilevel positive airway pressure delivered by nasal mask in patients with neuromuscular disease. METHODS: 20 patients with neuromuscular disease were evaluated for symptoms of nocturnal sleep disruption. These symptoms included daytime tiredness, fatigue, sleepiness, and complaints of insomnia. The patients were studied with nocturnal polysomnograms and daytime multiple sleep latency tests (MSLT). Their immediate and long term responses to bilevel positive airway pressure were also investigated. The study took place at the Stanford University Sleep Disorders Clinic. Some of the polygraphic evaluations were performed with portable equipment in the patients' homes. The reported population comprised 20 patients, all of whom had progressive neuromuscular disease. Five of the patients were women. Four patients had muscular dystrophy, six had myotonic dystrophy, and two patients each had mitochondrial myopathy and glycogen storage disease. Two patients had post-traumatic lesions, one bulbar and the other phrenic. The remaining patients had vascular myopathy, unclassified myopathy, syringomyelia, and slow evolving spinocerebellar degeneration. RESULTS: 19 of the 20 patients accepted some form of non-invasive ventilation. All but one of these were initially maintained on bilevel positive airway pressure spontaneous (S) mode, although one patient required a switch to the timed (T) mode within a year. The mean expiratory positive airway pressure (EPAP) used was 4.5 with a range of 4 to 5 cm H2O. The mean inspiratory positive airway pressure (IPAP) was 11.5, range 9 to 14 cm H2O. Before treatment the MSLTs were < or = 8 minutes in 11 of the patients. The overall mean score was 8.2 (SD) 1.3 minutes. After long term treatment the mean MSLT was 12.5 (SD 2) minutes and the mean ESS score was 7 (SD 3). During the mean 3.5 years of follow up, three patients needed supplemental oxygen at a flow of 0.5 to 1.0 l/min bled into their masks. Three patients with myotonic dystrophy presented continued daytime somnolence despite apparent adequate treatment of their sleep disordered breathing. This required the addition of stimulant medication to their regimen. During this time three additional subjects had to be switched to nasal mask intermittent positive pressure ventilation delivered by traditional volume cycled home ventilator (volume controlled NIPPV). CONCLUSIONS: Bilevel positive airway pressure delivered by nasal mask may be used successfully to treat sleep disordered breathing associated with neuromuscular disease. This device can be employed to assist nocturnal ventilation by either the spontaneous or timed mode. In the United States it is less expensive and easier to institute than volume controlled NIPPV and may be as efficacious as this mode if close surveillance and regular reevaluation of the patient's status is maintained.

Adolescent↗

PubMed1998

Nocturnal wandering and violence: review of a sleep clinic population.

Sleep consists of two complex states--NREM and REM sleep--and disturbances of the boundaries between the states of sleep and wakefulness may result in violence. We investigated our population for reports of violence associated with sleep. REM behavior disorder is rarely associated with injury to the sufferer or others. NREM sleep related nocturnal wandering associated with self-inflicted injuries has variable etiologies. In the elderly, it is associated with dementia. In young individuals, it may be associated with mesio-temporal or mesio-frontal foci and an indication of a complex partial seizure. It also may be related to abnormal alertness and is associated with excessive daytime sleepiness, micro-sleeps, and hypnagogic hallucinations in sleep disorders such as narcolepsy or sleep disordered breathing.

Adult↗

PubMed1998

Prolonged administration of dexamethasone induces limited reactivation of visceral leishmaniasis in chronically infected BALB/c mice.

Leishmania parasites persist in their vertebrate host after the treatment-induced clinical cure and in the asymptomatic infection. They confer resistance to reinfection but represent a risk of occurrence of acute leishmaniosis in immunosuppressed conditions. We examined the effects of prolonged dexamethasone administration on a chronic Leishmania infantum infection. Splenic T cell populations from the long-term-infected BALB/c mice were reduced by 55%, whereas those from uninfected controls were depleted by 85%. The ability of the remaining spleen cells to produce IL-2, IFN-gamma, IL-4 and TNF-alpha after in vitro specific stimulation decreased twofold, and the specific anti-leishmanial antibodies declined 3- to 5-fold. Liver, spleen and bone marrow are the main L. infantum targets in natural and experimental infections. Three-fold increase of amastigote burden was evidenced in the spleen, after dexamethasone administration was prolonged for over 2 months. No reactivation of Leishmania proliferation was disclosed in the liver and bone marrow. These results show a decreased sensitivity of splenic T cells to dexamethasone in a chronic Leishmania infection and a distinct response of the Leishmania-infected target organs to the dexamethasone-induced immunosuppression.

Animals↗

PubMed1997

Fusion of TEL, the ETS-variant gene 6 (ETV6), to the receptor-associated kinase JAK2 as a result of t(9;12) in a lymphoid and t(9;15;12) in a myeloid leukemia.

Translocations in hematologic disease of myeloid or lymphoid origin with breakpoints at chromosome band 12p13 frequently result in rearrangements of the Ets variant gene 6 (ETV6). As a consequence either the ETS DNA-binding domain or the Helix-Loop-Helix (HLH) oligomerization domain of ETV6 is fused to different partner genes. We show here that a t(9;12)(p24;p13) in a case of early pre-B acute lymphoid leukemia and a t(9;15;12)(p24;q15;p13) in atypical chronic myelogenous leukemia in transformation involve the ETV6 gene at 12p13 and the JAK2 gene at 9p24. In each case different fusion mRNAs were found, with only one resulting in an open reading frame for a chimeric protein consisting of the HLH oligomerization domain of ETV6 and the protein tyrosine kinase (PTK) domain of JAK2. The cloning of the complete human JAK2 coding and genomic sequences and of the genomic junction fragments of the translocations allowed a characterization of the different splice events leading to the various mRNAs. JAK2 plays a central role in non-protein tyrosine kinase receptor signaling pathways, which could explain its involvement in malignancies of different hematologic lineages. Besides hop in Drosophila no member of the JAK family has yet been implicated in tumorigenesis.

Amino Acid Sequence↗

PubMed1997

Objective measurement of sleepiness in summer vacation long-distance drivers.

The study investigated whether sleepiness at the wheel is a problem in non-commercial drivers going on summer vacation. All drivers, who stopped at a rest area on a large European freeway while one of the interviewers was available, were systematically approached and asked to respond to a questionnaire. All subjects who had driven at least 400 km (240 miles), whose age was between 20 and 46 years of age, and who agreed to participate were asked to undergo a longer investigation that included a short sleep/wake diary describing overall sleep habits during the year, a sleep/wake log covering the days just prior to departure, an analog visual scale indicating sleepiness at time of interview, and a polygraphically monitored two nap sleep test (TNST). A control group was recruited that consisted of subjects of the same age range, normal sleep habits, and normal nocturnal sleep time before administration of the TNST. One hundred and four drivers (2 women) participated between 08:00 and 20:00 h. The total group was subdivided into 6 subgroups based upon the time of day of their investigation (08:00-10:00 h, 10:01-12:00 h, etc.). The control group included 50 men with 50-55% of control subjects, relative to the total number of index-cases, in each subgroup. Eighty-eight percent (n = 92) of studied drivers had experienced acute sleep deprivation within one day prior to departure due to the planned long driving. The TNST demonstrated that, overall, drivers had a significantly shorter sleep latency in nap 1 and nap 2 than controls, had a significantly longer sleep duration in nap 1 and nap 2, and there was a significant correlation between the sleep debt prior to departure and the sleep stage reached during the TNST. It is concluded that the TNST is a test which allows the objective study of sleepiness in drivers without the burden of the multiple sleep latency test. Many drivers are excessively sleepy when making long summer vacation journeys.

Adult↗

PubMed1997

Prevalence and correlates of nocturnal desaturations in a sample of elderly people.

We designed an epidemiological study to estimate the prevalence and correlates of nocturnal desaturations in a sample of elderly subjects from the general population. Sleep-related respiratory disturbances were assessed by questionnaire and MESAM IV (MADAUS electronic sleep apnoea monitor) ambulatory monitoring. An oxygen desaturation index (ODI), oxygen desaturation being defined as a decrease in SaO2 of or exceeding 4%, was then computed from these data. An oxygen desaturation index > or = 10 was observed in 27.0% of the 293 subjects studied (mean age 76.6+/-5.7 y, median=75 y, min.=69, max.=99), an oxygen desaturation index > or = 30in 4.4%. Multivariate analysis identified as correlates to an oxygen desaturation index > or = 10: male gender (OR=1.80; P=0.04), a high body mass index (BMI) in men (OR=1.20 per kg m2; P=0.0009), and advanced age in women (OR=1.09 per y; P=0.02). A positive association was found between loud snoring (OR=1.75; P=0.06) and an oxygen desaturation index > or = 10. However, there was no statistically significant relationship between an oxygen desaturation index > or = 10 and either daytime somnolence (OR=1.50; P=0.19) or trouble getting to sleep (OR=0.59; P=0.09). We found no significant relationship in our sample between oxygen desaturation index and arterial hypertension or cardiac dysrhythmia. Previous studies on younger populations have reported different results. It may well be the advanced age of our sample that explains these inconsistencies. For the elderly persons we studied our results underline the relatively high prevalence of sleep-related respiratory disturbances. However, these may be of less consequence than in younger populations.

Aged↗

PubMed1996

Determinants of sleepiness in automobile drivers.

Governmental agencies do not systematically investigate the presence of daytime sleepiness as a determinant of driving accidents. We surveyed automobile drivers traveling on summer vacations and driving long distances on a European highway. We evaluated their subjective daytime sleepiness while driving and any sleep deprivation just prior to departure. Five-hundred sixty-seven automobile drivers (mean age 37.7 +/- 11 years) were interviewed at a roadside rest-stop. Questions covered the sleep/wake schedule during the year, sleep habits, and the presence of symptoms frequently associated with sleep-disordered breathing. Sleep behavior just prior to departure was compared to the usual sleep schedule during the year. Fifty percent of the responders had a sleep restriction just prior to departure (mean -203 minutes) compared to usual total sleep time during the year; 10% had no nocturnal sleep prior to departure. Drivers younger than 30 years were significantly more acutely sleep deprived than other drivers. Economic migrants (subjects with low economic status) also experienced significant acute sleep restriction.

Accidents, Traffic↗

PubMed1996

Chronic neutrophil leukaemia in adolescence and young adulthood.

Chronic neutrophil leukaemia (CNL) is a rare myeloproliferative disorder predominantly reported in elderly patients. We present a 15-year-old girl and a 25-year-old male with CNL. Clonal cytogenetic abnormalities were detected in both patients. One showed trisomy 21 evolving into tetrasomy 21. The second patient showed a unique chromosome aberration during blast crisis: t(2;2)(q32;p24). Both patients were successfully treated with allogeneic bone marrow transplantation (BMT). CNL should also be considered as a differential diagnosis in adolescence and young adulthood. BMT represents a potentially curative treatment option in such patients.

Adolescent↗