No less vulnerable: the internally displaced in humanitarian emergencies.
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Adult↗
Biomedical subjects
R Brennan
Publications and source records attributed to R Brennan.
Variability of study cast assessment among orthodontists.
This study examined the accuracy and reliability with standardized definitions among 30 orthodontists in assessing different aspects of malocclusion from the study casts of 10 patients. Previous studies have indicated a lack of consistency among orthodontists in describing malocclusions. The diagnostic subcategories measured in this study included maxillary and mandibular crowding, overbite, overjet, and a modified molar, premolar, and canine Angle classification. Intraclass correlations indicated that the reliability of all parameters was good (intraclass correlation > 0.80), with overbite being the most reliable (0.98) and maxillary crowding and canine classification somewhat less reliable (0.89 and 0.87, respectively). Among Angle classifications, molar classification was the highest (0.95), followed by premolar (0.92) and canine (0.87). This study also measured the accuracy of the orthodontists' measurements compared with established true values (validity). T tests indicated that mandibular arch crowding and overbite were not statistically different from the true values. Overjet and molar classification were assessed very close to the true values. Although premolar and canine classifications were statistically different from the true values, they were within a one-eighth cusp of the true value (a clinically insignificant difference). The orthodontists consistently overestimated the amount of maxillary arch crowding or spacing. The results suggest that high reliability and reasonable accuracy can be expected for assessing study casts when using standardized definitions for the diagnostic subcategories.
Humans↗
Repaglinide-induced factitious hypoglycemia.
We report the first case of repaglinide-induced factitious hypoglycemia in a young male. This case posed a challenging diagnostic dilemma because commercial assays for repaglinide are not available. Furthermore, the patient had a series of positive diagnostic tests such as high proinsulin and localizing intra-arterial calcium stimulation suggestive of insulinoma. This case, again, demonstrates the importance of pure clinical judgment in the face of often-conflicting laboratory data in making a correct diagnosis and the requirement of definitive data for an appropriate therapeutic resolution.
Adolescent↗
Tuberculin reactivity and the risk of tuberculosis: a review.
SETTING: Although various studies have examined the association between tuberculin reactivity and the risk of tuberculosis (TB), this evidence has not been collated and examined to determine the strength and consistency of the association across multiple studies. OBJECTIVE: To review the evidence supporting the association between tuberculin reactivity and the risk of TB. DESIGN: Prospective studies which included raw data on the incidence of TB according to three or more tuberculin reactor categories were located using electronic search methods. The findings of these studies were recalibrated if necessary and compared. RESULTS: All 11 studies identified demonstrated that increased tuberculin skin test (TST) reactivity was associated with an increased risk of TB, and several found that low tuberculin reactivity was associated with a protective effect. The magnitude of the association between TST reactivity and the risk of TB varied substantially. The association between tuberculin reactivity and the risk of TB was greater among studies that reported a lower incidence of TB among the smallest tuberculin reactor category. CONCLUSION: All studies reviewed support a positive association between tuberculin reactivity and the risk of TB. However, this review found a substantial degree of variation in the extent of increased risk associated with larger tuberculin reactions.
Humans↗
Additivity in microbial toxicity of nonuniform mixtures of organic chemicals.
Microbial toxicity of nonuniform mixtures of selected synthetic organic chemicals in several proportion is evaluated. Toxicity is quantified by the inhibition of oxygen uptake rate of a surrogate microbial text culture as measured by a respirometer. The joint toxic effects of the chemicals are analyzed for simple addition using toxic units (TU) and similarity parameters (lambda). A new approach is proposed to assign acceptance limits to sigma(TU)i and lambda to account for experiment errors and variances. Based on this approach, the joint toxic effects of 16 chemicals evaluated in this study in 14 different mixtures were found to be simply additive. Predictions of component concentration based on simple additivity agreed with the measured values within an average factor of error of 1.4.
Bacteria↗
Cloning of cold-inducible dehydrin-like genes from the blackcurrant (Ribes nigrum L.) using RT-PCR.
A method is described for the identification of conserved genes in one plant species by using sequence information on internal motifs from well-characterized clones from another species. This sequence information is used to design primers for reverse transcriptase polymerase chain reaction (RT-PCR) and to design oligonucleotide probes to identify genuine positive amplification products. The approach was successfully used to clone cDNAs encoding cold-inducible dehydrin-like genes from the woody perennial blackcurrant, Ribes nigrum L. The strategy described can accelerate the cloning of heterologous cDNAs and is a convenient alternative to direct screening of cDNA libraries.
Amino Acid Sequence↗
Vigabatrin-induced optic neuropathy.
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Anticonvulsants↗
Memory and CD8+ are the predominant bovine bronchoalveolar lymphocyte phenotypes.
Bovine lymphocytes obtained by bronchoalveolar lavage (BAL) of healthy calves were simultaneously analyzed and compared to peripheral blood lymphocytes using monoclonal antibodies specific for bovine leukocyte differentiation antigens. Phenotypic differences were observed between bronchoalveolar and peripheral blood T-lymphocyte subpopulations, demonstrating selective lymphocyte migration to the bovine lung. The bronchoalveolar and peripheral blood T-lymphocyte populations, defined by expression of CD2, were similar, but bronchoalveolar T lymphocytes were predominately CD8+ while peripheral blood T cells were predominately CD4+. In addition, memory lymphocytes, characterized by low expression of CD45R and activated lymphocytes (CD25+), were found in significantly higher proportions in the bronchoalveolar compartment. The proportion of gammadelta T lymphocytes was, however, significantly higher in peripheral blood. B cells were observed in similar proportions in the bronchoalveolar compartment and peripheral blood.
Animals↗
Magnetic resonance imaging: utilization in the management of central nervous system trauma.
OBJECTIVE: To determine the availability, use, and perceived value of magnetic resonance imaging (MR) in the management of acute central nervous system (CNS) trauma in United States Level I (or equivalent) trauma centers (TCs). DESIGN, MATERIALS, AND METHODS: One hundred sixty-nine American College of Surgeons, state or locally designated Level I (or equivalent) TCs were identified using compiled lists and telephone contacts. Surveys about MR use in CNS trauma were mailed to each institution. Follow-up telephone calls were made to nonresponding institutions. Data were analyzed using frequency distribution. MEASUREMENTS: Using returned questionnaires from trauma directors and follow-up telephone contacts, data on the physical location, technologist availability, and patient monitoring capabilities were accrued. The questionnaire addressed the perceived value and cost-effectiveness of MR for acute CNS trauma in general, distinguishing between spinal cord and traumatic brain injury, using a Likert-type rating scale. MAIN RESULTS: One hundred nine (65%) of identified TCs responded by mail. Sixty (33%) required contact by telephone. One hundred fifty-two (93%) reported MR scanners "on site." Five of seven TCs without on-site MR had facilities within 5 miles. No TC reported the inability to obtain MR scans. Seventy-four percent of TCs reported MR angiography capabilities. Ninety-seven percent of MR facilities were staffed 24 hours per day, 83% by on-call, out-of-hospital technologists at night and on weekends. TCs reported patient monitoring capabilities including cardiac monitoring (83%) and pulse oximetry (91%). Seventy-one percent reported the ability to scan intubated patients. Forty-five percent of TCs "rarely" use MR, 51% report "occasional" use, and 4% "frequently" use MR for acute trauma. Ninety-four percent of trauma directors agreed or strongly agreed that MR directed management and was cost-effective for spinal cord trauma. Fifty-four percent agreed or strongly agreed that MR directed management and was cost-effective for traumatic brain injury. No correlation existed between perceptions of MR applicability in CNS trauma and the number of trauma admissions or on-site availability. CONCLUSIONS: Most trauma directors consider MR important in the acute evaluation of spinal trauma and, to a lesser extent, for traumatic brain injury. Despite these opinions, the vast majority of these centers reported only "rare" to "occasional" use of MR in the setting of acute CNS trauma. Our results show that most TCs have on-site and continuously available MR facilities capable of cardiac and pulmonary monitoring. Other factors such as the higher relative cost of MR may be responsible for the discrepancy between the perceived value and the actual utilization of MR imaging in the setting of CNS trauma.
Brain Injuries↗
Clinical and molecular genetic characterisation of a family segregating autosomal dominant retinitis pigmentosa and sensorineural deafness.
AIMS/BACKGROUND: To characterise clinically a large kindred segregating retinitis pigmentosa and sensorineural hearing impairment in an autosomal dominant pattern and perform genetic linkage studies in this family. Extensive linkage analysis in this family had previously excluded the majority of loci shown to be involved in the aetiologies of RP, some other forms of inherited retinal degeneration, and inherited deafness. METHODS: Members of the family were subjected to detailed ophthalmic and audiological assessment. In addition, some family members underwent skeletal muscle biopsy, electromyography, and electrocardiography. Linkage analysis using anonymous microsatellite markers was performed on DNA samples from all living members of the pedigree. RESULTS: Patients in this kindred have a retinopathy typical of retinitis pigmentosa in addition to a hearing impairment. Those members of the pedigree examined demonstrated a subclinical myopathy, as evidence by abnormal skeletal muscle histology, electromyography, and electrocardiography. LOD scores of Zmax = 3.75 (theta = 0.10), Zmax = 3.41 (theta = 0.10), and Zmax = 3.25 (theta = 0.15) respectively were obtained with the markers D9S118, D9S121, and ASS, located on chromosome 9q34-qter, suggesting that the causative gene in this family may lie on the long arm (q) of chromosome 9. CONCLUSIONS: These data indicate that the gene responsible for the phenotype in this kindred is located on chromosome 9 q. These data, together with evidence that a murine deafness gene is located in a syntenic area of the mouse genome, should direct the research community to consider this area as a candidate region for retinopathy and/or deafness genes.
Adolescent↗
Fingerprinting of Ehrlichia species by repetitive element polymerase chain reaction.
To facilitate identification of ehrlichial pathogens, we developed a new technique based on fingerprints resulting from repetitive element polymerase chain reaction (rep-PCR). This technique uses consensus tRNA primers to generate amplification products that reflect distance polymorphisms between adjacent tRNA genes. Species-specific fingerprint patterns were obtained for seven Ehrlichia spp., as well as the unnamed causative agent of human granulocytotropic ehrlichiosis. Bands ranged in size from approximately 50 to 1,000 base pairs. Banding patterns varied depending on dilution of template DNA, with lower dilutions giving more complex banding patterns. These preliminary data indicate that repetitive-sequence-based PCR appears to be a useful technique for identifying ehrlichial organisms to the species, and perhaps the strain level. Compared with other conventional molecular-biologic methods, rep-PCR offers the advantages of ease of performance and rapid availability of results.
Bacterial Typing Techniques↗
Creating and implementing guidelines on caring for difficult patients: a research utilization project.
Difficult patients challenge the resourcefulness of nurses. Considering the results of a focus group study, guidelines are designed for the care of difficult patients. Four case studies present the use of the guidelines, including interventions and outcomes.
Adult↗
Severe snowboarding injuries.
Thirty-seven consecutive patients with severe snowboard-related injuries (defined by referral to a Level I trauma centre) were reviewed. The type and mechanism of each injury were examined and found to be similar to those reported for skiers. Mild closed head injuries were common (54 per cent). Head and abdominal injuries were more common among snowboarders than skiers, but chest and skeletal injuries were rare. There were no deaths. Serious snowboarding injury rates were similar to those for serious skiing injuries. The incidence of snowboarding injuries sufficiently severe to require tertiary referral was estimated at 0.03 injuries/1000 snowboarder days. Similar to reports of minor snowboarding injury, these data indicate that injury patterns in more serious snowboarding accidents are quite different from those of serious downhill skiing accidents. Injured snowboarders suffer splenic injuries more often and chest and spinal injuries less often than do skiers, and should be evaluated for blunt injuries with these statistical differences in mind.
Abdominal Injuries↗
Epidemiology of trauma deaths: a reassessment.
OBJECTIVE: Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. DESIGN: Cross-sectional. MATERIAL AND METHODS: All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. MEASUREMENTS AND MAIN RESULTS: There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). CONCLUSIONS: In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.
Accidents, Traffic↗
Spine and spinal cord injuries in downhill skiers.
Spine and spinal cord injuries are the most debilitating and costly of serious injuries sustained by downhill skiers. We present a series of 126 skiers with spine and spinal cord injuries drawn from 636 consecutive injured skiers evaluated at one center over an 11-year period. The incidence of spinal injury was very low (0.001/1000 skier-days). Eighteen (17%) patients had spinal cord injuries associated with their fractures; injuries in the cervical region were most likely to involve the spinal cord. The most commonly fractured levels were C6, T12 and L1; the most common fracture pattern was compression (38%). One-third of all patients had multisystem trauma; those with thoracolumbar injuries were much more likely to sustain torso and extremity trauma than those with cervical injuries. Information about injury patterns in skiers with spinal injuries should aid in the triage and initial evaluation of this blunt trauma population.
Adolescent↗
The OR suite as a unique trauma resuscitation bay.
Trauma is the fourth leading cause of death in the United States, and trauma injuries affect more than 50 million Americans annually. Inadequate care of trauma patients can cause unnecessary patient deaths. To decrease death and disability caused by trauma, one Denver hospital developed a trauma OR based on the "Golden Hour" principle (ie, the sooner a patient receives treatment, the more likely the patient will survive). Since 1977, this hospital has performed 1,838 trauma resuscitations in the trauma OR suite. This article discusses the importance of triage and recants the history of trauma patient transportation. The authors detail the trauma procedures at their hospital, including the specific roles of trauma team members and the necessary equipment, and provide demographic information on the trauma resuscitations performed at the hospital since 1988. The article also discusses the extensive and continuous orientation necessary for trauma team members and explains the quality improvement strategies implemented by this hospital.
Adolescent↗
Early definitive abdominal evaluation in the triage of unconscious normotensive blunt trauma patients.
The need for simultaneous diagnosis and treatment of life-threatening intracranial mass lesions and intra-abdominal injury results in controversy over the appropriate triage of unconscious blunt trauma patients with stable vital signs. To aid in early decisions for these patients, a retrospective analysis of 290 patients with Glasgow Coma Scale (GCS) scores < or = 8 and systolic blood pressures (SBP) > 90 mm Hg was undertaken. The hypothesis of this study was that life-threatening abdominal injury frequently occurs in these patients and injuries cannot be consistently identified from vital signs alone. Data were analyzed for injury mechanism, SBP, heart rate (HR), Injury Severity Score (ISS), Revised Trauma Score (RTS), Abbreviated Injury Scale score for the abdomen and brain (A-AIS, CNS-AIS), and the need for emergent laparotomy. Patients with concurrent injuries were more likely to come from motor vehicle crashes than falls (p < 0.001). Although severe abdominal injuries (A-AIS > or = 3) were frequently identified based on SBP and HR, the use of clinical signs alone resulted in more missed injuries than did using the results diagnostic peritoneal lavage (DPL). This study suggests that all unconscious normotensive blunt trauma patients undergo immediate DPL to prevent missing life-threatening injuries.
Abdominal Injuries↗
Save the trees: a comparative review of skier-tree collisions.
From 1981 to 1989, 323 patients whose diagnoses resulted from ski injuries were emergently admitted to a Class 1 Trauma Hospital. Of this group, 107 (33%) were injured in skier-tree collisions. This tree collision group (TC group) was compared with a group that did not hit a tree (non-tree-collision group or NTC group). The average age of the TC group was 26 years, compared with 31 years in the NTC group. The Revised Trauma Score (RTS) was recorded for each patient. The TC group's average trauma score was 7.205, compared with 7.7395 for the NTC group. The Injury Severity Score (ISS) was also recorded. The TC group's ISS averaged 14.7, compared with 9.1 for the NTC group. Both of these scores demonstrated statistical significance. Certain injuries such as skull fractures, head injuries, pelvic fractures, and chest injuries (including rib fractures, pneumothoraces, and pulmonary contusions) were more common in the TC group. Tibia fractures were more common in the NTC group. Femur fractures and upper extremity fractures were evenly distributed between the two groups. Seven deaths were recorded in the TC group and five deaths occurred in the NTC group.
Adolescent↗