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Biomedical subjects

R Kaplan

Publications and source records attributed to R Kaplan.

At least 55 records · Page 3Linked to original sources
PubMed1998

Inherited thrombophilic states.

Thrombophilic states are a group of conditions associated with increased predisposition to thromboembolic events. The well-recognized inherited thrombophilic states include resistance to activated protein C (APC) (Factor V Leiden) and deficiencies of plasma antithrombin, protein C, and protein S. These entities are aberrations in the natural anticoagulant systems that exist in plasma and at the endothelial cell level. Other causes of inherited thrombophilia include hyperhomocysteinemia, abnormalities in the proteins of the fibrinolytic system, dysfibrinogenemias, deficiency of heparin cofactor II, abnormal thrombomodulin, and the recently described variation in the prothrombin gene. Most of the inherited abnormalities recognized to date are associated with venous thromboembolism (VTE) rather than arterial thrombosis. Approximately half of VTE episodes in patients with inherited thrombophilias occur in relation to events that are generally recognized as predisposing states, such as surgery, pregnancy, and immobilization. In this review, the risks of VTE associated with inherited risk factors are discussed, and guidelines for the diagnosis and management are presented.

Activated Protein C Resistance↗
PubMed1997

Nursing, a bridge to peace in our region: opinions on mutual co-operation between Israeli and Palestinian professional nurses and nurse educators.

The purpose of this study was to assess the activities and future direction of mutual co-operation of professional nurses from Israel and Judea and Samaria. Questionnaires were distributed to the participants, nurse educators and professional nurses from Judea and Samaria who were attending a workshop in clinical instruction at the Assaf HaRofeh School of Nursing, in Israel. Most of the nurses polled were interested in continued educational dialogue and expanded educational programmes in various nursing specialties both in education and service. The areas that received priority included: intensive care, operating room and emergency room nursing. Areas that received lower priorities included; midwifery, geriatrics and nephrology nursing. The participants expressed positive reactions to continued joint educational activities such as full length courses, workshops, day seminars and joint educational projects. The results showed an overwhelming interest for continued professional ties. Areas in the fields of clinical expertise and nursing education reflected the needs of their respective communities.

Attitude of Health Personnel↗
PubMed1997

Inherited hypercoagulable states.

Hypercoagulable states are a group of conditions associated with increased predisposition to thromboembolic events. Most of the inherited abnormalities recognized to date are associated with venous thromboembolism (VTE) rather than arterial thrombosis. The well-recognized inherited hypercoagulable states are the deficiencies of antithrombin, protein C and protein S, and the resistance to APC (factor V Leiden). These entities represent aberrations in the natural anticoagulant systems that exist in plasma. Other causes of inherited thrombophilia include abnormalities in the proteins of the fibrinolytic system, dysfibrinogenemias, deficiency of heparin cofactor II, abnormal thrombomodulin, elevated levels of histidine-rich glycoprotein, and the recently described variation in the prothrombin gene. One entity that has become firmly established as a predisposing factor for recurrent VTE is hyperhomocysteinemia. About half of VTE episodes in patients with inherited thrombophilias occur in relation to events that are generally recognized as predisposing states, such as surgery, pregnancy (particularly puerperium) and immobilization. In this review, the risks of VTE associated with inherited risk factors are discussed, and guidelines for the diagnosis and management are presented.

Antithrombin III Deficiency↗
PubMed1997

The influence of a patient-management course to dental hygiene students on the dental anxiety of their patients.

This study investigated the effect of teaching dental hygiene students a course in caregiver-patient relationships on their patients' dental anxiety, and patients' feelings toward known anxiety-provoking stimuli. The study group (twenty-five men and twenty-five women) was treated by a class of dental hygiene students following a behavioral course given after the first visit. The control group (twenty-four men, twenty-six women) was treated by another class without the intervention. Corah's Dental Anxiety Scale (DAS) and a twelve-item questionnaire identifying specific anxiety-provoking situations were completed by the patients before initial visit and after the third visit. A significant reduction in DAS within the study group was observed after the intervention. In both groups, women demonstrated higher anxiety. No significant difference was found in the twelve-item questionnaire after intervention in both groups. These findings suggest that a four-hour behavioral course to a class of dental hygiene students was an influencing factor in reducing their patients' levels of dental anxiety.

Chi-Square Distribution↗
PubMed1996

A putative DNA binding surface in the globular domain of a linker histone is not essential for specific binding to the nucleosome.

A fundamental step in the assembly of native chromatin is the specific recognition and binding of linker histones to the nucleoprotein subunit known as the nucleosome. A first step in defining this important interaction is the determination of residues within linker histones that are important for the structure-specific recognition of the nucleosome core. By combining in vitro assays for the native binding activity of linker histones and site-directed mutagenesis, we have examined a cluster of basic residues within the globular domain of H1(0), a somatic linker histone variant from Xenopus laevis. We show that these residues, which comprise a putative DNA binding surface within the globular domain, do not play an essential role in the structure-specific binding of a linker histone to the nucleosome.

Animals↗
PubMed1996

Sustained-release morphine sulfate in the management of pain associated with acquired immune deficiency syndrome.

Sustained-release morphine (SRM) was studied in patients with acquired immune deficiency syndrome (AIDS)-related chronic pain. Outpatients and inpatients with AIDS-related pain were studied for 3-18 days in an open-label prospective survey. Patients were stratified according to prior opioid analgesic use for the purposes of initiating and titrating SRM, which was administered at a 12-hr interval. Immediate-release morphine (IRM) was offered every 2 hr as needed for supplemental analgesia at one-quarter to one-third of the 12-hourly SRM dose. Pain intensity (PI), quality of life (QL), acceptability of therapy (AT), side effects, safety, and morphine usage were evaluated. Of 44 patients enrolled, 40 (91%) were evaluable for intent-to-treat analysis, and 24 (55%) completed the study. PI decreased by 50% (from severe to mild-moderate) in the intent-to-treat patients and by 65% (from severe to mild) in the completed patients. QL was fair to good in 80% and poor in 20% of both groups. AT was good to excellent in 78% of the intent-to-treat and in 96% of the completed patients. Of 61 adverse events reported, 61% required intervention, and 92% were resolved. Total morphine dose remained stable while IRM dosage and frequency of use significantly decreased with escalation of the SRM dose. A significant reduction in PI was achievable with SRM in a variety of painful conditions experienced by AIDS patients, with limited or manageable side effects in most. This study supports the usefulness of opioid analgesia for severe pain in AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Intravenous guanethidine in patients with reflex sympathetic dystrophy.

BACKGROUND: Intravenous regional guanethidine Bier block (IVRGBB) has been used predominantly in Europe for treating reflex sympathetic dystrophy (RSD). Our experience in the United States, where its use has been limited, is reported. METHODS: Fifty-five patients received IVRGBB for RSD. Upper extremities received 20 mg (10 mg/ml) of guanethidine in 30-50 ml of 0.5% lidocaine; lower extremities received 40 mg in 40-75 ml of lidocaine (volume adjusted for size, weight, or prior adverse effect). Pain severity (mild, moderate, severe, excruciating) was obtained pretreatment. Pain severity and a global clinical assessment (GCA) (resolved, improved, no change, worse) were obtained following each treatment. The final GCA was analyzed vs: pretreatment score; age; sex; pain duration; number of treatments; and precipitating event. Adverse effects were documented. RESULTS: Of 55 enrolled patients, 2 were lost to follow-up, and 2 returned 1 and 4 years later for repeat treatment. Therefore, 53 patients were evaluated for 55 treatments. Age: 38.2 +/- 14.8 (SD) (range 10-77) years. Sex: 11 males, 44 females. Average pain duration: 2.0 +/- 1.7 years (3 days-7 years). Final assessment occurred at 3.88 +/- 5.21 months (6 days-22/3 years). Effect on pain: resolution-9.1%; improved-14.5%; no change-61.8%; worsening-14.5%. No significant relationship was found between GCA and the factors evaluated. There was a significant positive linear association between pretreatment pain and post treatment GCA (P = 0.032). Fifty-six adverse effects occurred in 19 (34.5%) patients (nausea, vomiting, orthostatic hypotension, dizziness, diarrhea, weakness). CONCLUSIONS: IVRGBB does not provide long-term pain relief and is associated with adverse effects in over 1/3 of patients.

Adolescent↗
PubMed1996

Carrot addiction.

OBJECTIVE: A case report of carrot addiction is presented with a review of the literature and comment on the role of beta carotene in addictive behaviour. CLINICAL PICTURE: The addiction occurred in a 49-year-old woman under conditions of stress due to marital problems, leading to a depressive illness and increased smoking. The patient maintained that the sensations of carrot craving and withdrawal were quite distinct from those associated with smoking. TREATMENT: The patient was advised to record her daily carrot consumption. OUTCOME: The patient did not return for several months, but stopped eating carrots after an operation, at which time she also stopped smoking. CONCLUSION: Compusive carrot eating, regarded as a rare condition, has received scant documentation, unlike hypercarotenemia due to unusual diets or food fads. Nervousness, craving, insomnia, waterbrash and irritability are associated with withdrawal from excessive carrot eating. The basis for the addiction is believed to be beta carotene, found in carrots. Does carrot eating, an aggressively oral activity, merely act as a behavioural substitute for smoking? Or does beta carotene contain a chemical element that replicates the addictive component of nicotine? Further study of this unusual but intriguing addiction may reveal more about the basis of all addictions, with particular implications for the cessation of cigarette smoking.

Behavior, Addictive↗
PubMed1996

Denied pregnancy.

OBJECTIVE: To review the literature on the topic of denied pregnancy and present a case study that illustrates some salient points. CLINICAL PICTURE: A 21-year-old woman was unaware of her pregnancy until she went into labour, at which time she went into a state of panic. She delivered a dead baby. TREATMENT: She was interviewed over the 5 days following delivery and referred for psychiatric assessment. She was discharged when cleared of serious psychiatric illness. OUTCOME: At follow-up she was well but haunted by recollections of the delivery. She was referred for further counselling. CONCLUSIONS: Denial of pregnancy is more common than realised. It is a heterogeneous condition associated with different coping styles and psychiatric diagnoses. Early testing for pregnancy is recommended in young women with nausea, weight gain and menstruation-like bleeding.

Adaptation, Psychological↗