Blind hostility: a response to Russell and Nicoll.
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Animal Rights↗
Biomedical subjects
P Singer
Publications and source records attributed to P Singer.
Mutagenesis and Laue structures of enzyme intermediates: isocitrate dehydrogenase.
Site-directed mutagenesis and Laue diffraction data to 2.5 A resolution were used to solve the structures of two sequential intermediates formed during the catalytic actions of isocitrate dehydrogenase. Both intermediates are distinct from the enzyme-substrate and enzyme-product complexes. Mutation of key catalytic residues changed the rate determining steps so that protein and substrate intermediates within the overall reaction pathway could be visualized.
Binding Sites↗
[Nutrition and amino acids in respiratory function].
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Amino Acids↗
Maximizing health benefits vs egalitarianism: an Australian survey of health issues.
Economists have often treated the objective of health services as being the maximization of the QALYs gained, irrespective of how the gains are distributed. In a cross section of Australians such a policy of distributive neutrality received: (a) very little support when health benefits to young people compete with health benefits to the elderly; (b) only moderate support when those who can become a little better compete with those who can become much better; (c) only moderate support when smokers compete with non smokers; (d) some support when young children compete with newborns; and (e) wide spread support when parents of dependent children compete with people without children. Overall, the views of the study population were strongly egalitarian. A policy of health benefit maximization received very limited support when the consequence is a loss of equity and access to services for the elderly and for people with a limited potential for improving their health.
Adult↗
Impaired nasal mucociliary clearance in long-distance runners.
For years physicians have observed a high incidence of upper respiratory tract infections (URTI) after strenuous exercise. Mucosal surfaces represent a first-line-of-defense against infections, and pollutants or organisms entrapped in respiratory secretions are cleared by mucociliary transport. Little is known about this mechanism during exercise. The purpose of this study was to examine the nasal mucociliary clearance (MMCC) in amateur runners competing in a marathon race. Twelve amateur runners entered in an inner-city marathon race and 10 healthy sedentary subjects participated in the study. On the day of the race the outside temperature was 3 degrees C. Nasal mucociliary transit time (NMTT) was measured daily for 1 week before and 1 week after the race by the saccharin sodium/indigo carmine method. Nasal tissue biopsies were taken, and cilia beat frequency (CBF) was measured as viability and function of ciliated epithelial cells were determined. NMTT was significantly prolonged after the race (17.1 +/- 1.2 min vs 8.9 +/- 0.9 min; athletes vs control group; mean +/- SEM) and returned to baseline over several days. CBF was significantly reduced only in the first 24 hours after the race (7.31 +/- 0.65 Hz for athletes vs 9.94 +/- 0.45 Hz, controls. After the race, athletes showed a higher percentage of ciliated cells with immotile cilia (37.1 +/- 1.3% vs 27.8 +/- 1.1%, athletes vs controls) or dead ciliated cells (7.3 +/- 0.9% vs 4.1 +/- 0.8%). The findings suggest impairment of NMCC up to several days after strenuous exercise, which might be partially caused by abnormally functioning ciliated cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Diagnostic value of an amplification method (Gen-Probe) compared with that of culture for diagnosis of tuberculosis.
Five hundred fifty respiratory and nonrespiratory specimens from 340 patients were analyzed by comparing the Gen-Probe Amplified Mycobacterium Tuberculosis Direct Test (MTD) with conventional culture, which was the method of reference, for the detection of the Mycobacterium tuberculosis complex. After resolution of discrepant results by retesting the samples and reviewing the patients' clinical histories, a total of 60 respiratory specimens were MTD and culture positive, 347 were MTD and culture negative, 4 were MTD positive and culture negative, and 1 was MTD negative and culture positive. This results in a sensitivity of 98.4%, a specificity of 98.9%, and positive and negative predictive values of 93.8 and 99.7%, respectively. Repeatedly, clinicians asked to test specimens of nonpulmonary origin by MTD. Although, MTD is not approved for use with nonrespiratory specimens, the following results were shown. Sixty-one pleural exudate specimens showed disappointing results (sensitivity, 20%). However, MTD performed well with another 77 nonrespiratory specimens; 17 samples were positive and 57 samples were negative by both MTD and culture. No false-negative results were found by MTD. Three MTD-positive, culture-negative specimens had high sample relative light unit/cutoff relative light unit ratios, strongly suggesting true tuberculosis. Positive microscopy and positive culture with MTD-negative results occurred 12 times. Those cultures showed atypical mycobacteria 11 times and Actinomyces species once. The stability of the reagents in the MTD kit was also assessed by testing reagents, including the enzyme mixture, kept at -70 degrees C for at least 6 months. No loss of activity was seen.
Humans↗
Straw men with broken legs: a response to Per Sundström.
Per Sundström has totally misunderstood what I was trying to do when, in the context of my debate with some German opponents of my views, I referred to their views as implying that if we break a leg, we should not try to get it mended. My brief response corrects this misunderstanding.
Congenital Abnormalities↗
Double jeopardy and the use of QALYs in health care allocation.
The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it.
Attitude to Health↗
Phagocytosis and oxidative burst of granulocytes in the upper respiratory tract in chronic and acute inflammation.
Acute diseases and chronic conditions may be associated with altered neutrophil functions. The aim of this investigation was to study the number and function of granulocytes in the upper respiratory tract in acute and chronic airway inflammation. The 136 participating subjects were assigned to 6 groups; group 1: controls; group 2: smokers, < 10 cigarettes/day; group 3: smokers, > 10 cigarettes/day; group 4: patients with allergic rhinitis; group 5: patients with obstructive sleep apnea; group 6: patients with acute viral upper respiratory tract infection. Whole blood and nasal lavage fluid were obtained and a cell count was performed. Phagocytosis of opsonized bacteria and the oxidative burst was measured. Total cell counts and absolute number of neutrophils in nasal lavage (NAL), but not in blood, were elevated in all groups compared to controls. Highest increases of neutrophils were observed in group 4 (7-fold) and group 6 (25-fold), p < .01. Phagocytosis and oxidative burst of granulocytes recovered by NAL were found to be increased in group 4 (25% and 15%, respectively) and group 6 (35% and 21%) only, but decreased in the other groups. We conclude that conditions leading to acute or chronic inflammation in the upper respiratory tract are associated with altered functions of granulocytes recovered by NAL but not blood, suggesting local modulating factors. We speculate that chronic inflammation, in contrast to acute conditions, is associated with impaired granulocyte function.
Adult↗
Preliminary report of a prospective randomized study of octreotide in the treatment of severe acute pancreatitis.
BACKGROUND: Experimental and clinical studies on the effect of octreotide in the treatment of patients with acute pancreatitis have presented controversial results. Since January 1992, we have been conducting a prospective randomized study on the clinical effect of octreotide in severe acute pancreatitis, at three hospitals in Israel. STUDY DESIGN: The entering criteria included three or more of the Ranson's prognostic signs and computed tomographic findings of severe pancreatitis. Patients were randomly assigned to conservative treatment either with or without octreotide (0.1 mg injected subcutaneously three times a day). The end points of the study included: complication rate (adult respiratory distress syndrome [ARDS], sepsis, renal failure, pseudocyst, fistula, and abscess), length of hospital stay, and mortality. RESULTS: During the first two years (from January 1992 to December 1993), 51 patients entered the study. After evaluation, 13 patients were excluded due to failure to meet the entering criteria, incomplete data, or incorrect diagnosis. Of the remaining 38 patients, 19 were assigned to octreotide (treatment group) and 19 to conservative treatment alone (control group). The two groups were matched with regard to age, sex, etiology, and severity of disease. The complication rate was lower in the treatment group compared with the control group with regard to sepsis (26 compared with 74 percent, p = 0.004) and ARDS (37 compared with 63 percent, p = 0.1). The hospital stay was shorter in the treatment group compared with the control group (17.9 compared with 34.1 days, p = 0.02). Death occurred in two patients in the treatment group and six patients in the control group. CONCLUSIONS: Although some of the parameters did not reach statistical significance, these preliminary results suggest that octreotide may have a beneficial effect in the treatment of patients with severe acute pancreatitis. This study is scheduled to continue for two more years.
Abscess↗
Advance directives in COPD.
Completed when a person is capable, advance directives guide future health care decisions when the person has become incapable. Advance directives are based on the ethical principle of respect for auronomy, and are legally recognized in many jurisdictions. Although the advance directives currently available are generic, a disease-specific directive may be useful for people with COPD. In clinical practice, advance directives raise a number of challenging questions: With whom should the topic be raised? Should a proxy or instruction directive be used? What should be done if the patient changes his/her mind about treatment? How should people insure their advance directive is available when needed? A research for advance directives is outlined.
Advance Directives↗
Glutamine metabolism and utilization: relevance to major problems in health care.
Glutamine plays an important role in normal and pathophysiological states. In this review we describe the biochemical synthesis and degradation pathways of glutamine, as well as its utilization by the immune system and in rapidly dividing cells. Also discussed are glutamine behaviour in catabolic states and the therapeutic implications of this amino acid in total parenteral nutrition, digestive diseases and cancer.
Animals↗
Bioethics and the limits of tolerance.
Since 1989 there has been an ongoing controversy about the limits of public discussion of bioethical issues in the German-speaking world. While a number of scholars have been involved, Peter Singer and Helga Kuhse have been the principal targets of those seeking to limit bioethical debates. Those who have supported silencing discussion of certain issues have argued that such public discussion leads to a loss of freedom. In the article we argue that toleration is not based on subjectivism but rather on reason. Furthermore, the efforts to suppress debate are often based on a failure to understand our position. Such efforts at suppression also rest on an elitist view of society that must assume that the general public cannot debate such topics.
Attitude↗
AIDS presenting as progressive multifocal leukoencephalopathy with clinical response to zidovudine.
Progressive multifocal leukoencephalopathy (PML) due to JC virus can be the initial manifestation of AIDS. A 40-year-old man seropositive for HIV-1 presented with aphasia, hemiparesis, and hemianopsia, and with magnetic resonance imaging of the brain typical of PML. He quickly became bed bound, incontinent, and mute. The diagnosis of PML was established by histopathology in a brain biopsy with positive immunocytochemistry for polyomavirus capsid proteins, and detection of JCV DNA by polymerase chain reaction using JCV-specific primers. High dose zidovudine therapy was initiated (1200 mg/day). Within two weeks the patient began to respond, and after three months he was able to walk and care for himself and was discharged. He lived for two years from the onset of PML. While cytarabine has been the drug most widely used for PML treatment, this is the second confirmed case with apparent response to zidovudine. High dose zidovudine may benefit some previously untreated AIDS patients with onset as PML.
AIDS Dementia Complex↗
A comparison of 6 months' compliance of patients with rheumatoid arthritis treated with tenoxicam and naproxen. Use of patient computer data to assess response to treatment.
OBJECTIVE: To assess longterm compliance in patients with rheumatoid arthritis (RA) of 20 mg tenoxicam or 500-1000 mg naproxen taken daily and to evaluate patient computer data collection. METHODS: Three hundred and seven patients were treated in a double blind, randomized multicenter study for 6 months. The first 4 weeks of treatment data were collected daily via patient operated computers in parallel with standard assessment at weekly visits to the clinics. RESULTS: Daily patient data collection was more sensitive than weekly clinical assessments. Six months' compliance was 62% for tenoxicam and 67% for naproxen with comparable rates of withdrawal due to lack of efficacy or adverse drug experiences in both groups. The spectra of adverse drug events found were very similar for both drugs but the rates were higher than in short term studies. CONCLUSION: Daily computer data collection by patients is superior to classical clinical evaluation in drug studies. The longterm compliance of tenoxicam and naproxen are comparable when treating patients with RA.
Age Distribution↗
[Current management of pancreatic necrosis and infections].
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Humans↗
Is justification of animal research necessary?
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Animal Rights↗