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Biomedical subjects

R Marks

Publications and source records attributed to R Marks.

At least 37 records · Page 2Linked to original sources
PubMed2002

Chlorpheniramine is no more effective than placebo in relieving the symptoms of childhood atopic dermatitis with a nocturnal itching and scratching component.

BACKGROUND: Childhood atopic dermatitis (AD) is a common disorder affecting 15% of children aged over 18 months. AD is associated with intense nocturnal itching. The central sedative effect of antihistamines is thought to be useful in interrupting the itching cycle and may prevent exacerbations. OBJECTIVE: A multi-centred, double-blind, placebo-controlled study was carried out in 155 children to evaluate chlorpheniramine in alleviating symptoms of AD. METHODS: Assessments were carried out over a 4-week study period consisting of 3 visits to out-patient clinics. During the visits the severity of AD and itching was rated using a series of visual analogue scale (VAS) and 5-point rating scales. RESULTS: The use of chlorpheniramine resulted in no greater alleviation of AD symptoms than placebo. CONCLUSIONS: The findings contradict conventional wisdom that the sedative effect of earlier-generation antihistamines alleviates symptoms of AD. The study also indicates that the use of antihistamines in AD does not affect the amounts of topical treatment used over the short term.

Antipruritics↗
PubMed2001

Efficacy theory and its utility in arthritis rehabilitation: review and recommendations.

PURPOSE: Self-efficacy, a cognitive construct implicating one's self-perception about one's performance ability, has been found to be a significant predictor of psychological well-being, adherence to prescribed treatments, and pain coping mechanisms of persons with arthritis. Heightened self-efficacy may also ameliorate arthritis-related symptoms of fatigue and depression, and preserve function and prolong physical well-being. METHODS: To elaborate upon the utility of self-efficacy enhancing strategies as this pertains to ameliorating arthritis-related disability, this paper examined the related literature on this topic and detailed the outcomes and nature of those self-efficacy enhancing strategies that have been incorporated into arthritis treatment regimens. RESULTS: Despite limitations in the prevailing database, results indicated: (1) self-efficacy is potentially a potent predictor of the overall health status of the person with arthritis; and (2) carefully designed self-efficacy enhancing strategies are likely to impact favourably upon the magnitude of the disability experienced by individuals with arthritis. CONCLUSIONS: In relation to maximizing the therapeutic outcomes for disabling arthritis, the concept of self-efficacy is very worthy of the clinical practitioners and the clinical researchers attention.

Arthritis↗
PubMed2001

Randomized phase III intergroup trial of isotretinoin to prevent second primary tumors in stage I non-small-cell lung cancer.

BACKGROUND: Promising data have suggested that retinoid chemoprevention may help to control second primary tumors (SPTs), recurrence, and mortality of stage I non-small-cell lung cancer (NSCLC) patients. METHODS: We carried out a National Cancer Institute (NCI) Intergroup phase III trial (NCI #I91-0001) with 1166 patients with pathologic stage I NSCLC (6 weeks to 3 years from definitive resection and no prior radiotherapy or chemotherapy). Patients were randomly assigned to receive a placebo or the retinoid isotretinoin (30 mg/day) for 3 years in a double-blind fashion. Patients were stratified at randomization by tumor stage, histology, and smoking status. The primary endpoint (time to SPT) and the secondary endpoints (times to recurrence and death) were analyzed by log-rank test and the Cox proportional hazards model. All statistical tests were two-sided. RESULTS: After a median follow-up of 3.5 years, there were no statistically significant differences between the placebo and isotretinoin arms with respect to the time to SPTs, recurrences, or mortality. The unadjusted hazard ratio (HR) of isotretinoin versus placebo was 1.08 (95% confidence interval [CI] = 0.78 to 1.49) for SPTs, 0.99 (95% CI = 0.76 to 1.29) for recurrence, and 1.07 (95% CI = 0.84 to 1.35) for mortality. Multivariate analyses showed that the rate of SPTs was not affected by any stratification factor. Rate of recurrence was affected by tumor stage (HR for T(2) versus T(1) = 1.77 [95% CI = 1.35 to 2.31]) and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking status = 3.11 [95% CI = 1.00 to 9.71]). Mortality was affected by tumor stage (HR for T(2) versus T(1) = 1.39 [95% CI = 1.10 to 1.77]), histology (HR for squamous versus nonsquamous = 1.31 [95% CI = 1.03 to 1.68]), and a treatment-by-smoking interaction (HR for treatment-by-current-versus-never-smoking = 4.39 [95% CI = 1.11 to 17.29]). Mucocutaneous toxicity (P<.001) and noncompliance (40% versus 25% at 3 years) were higher in the isotretinoin arm than in the placebo arm. CONCLUSIONS: Isotretinoin treatment did not improve the overall rates of SPTs, recurrences, or mortality in stage I NSCLC. Secondary multivariate and subset analyses suggested that isotretinoin was harmful in current smokers and beneficial in never smokers.

Adult↗
PubMed2001

Enhancing clinical trials on the internet: lessons from INVEST.

The INternational VErapamil SR/trandolapril STudy (INVEST) is the first long-term, large-scale clinical trial being conducted primarily using Web-based technology. The Web is a powerful tool for enhancing clinical trial management because of its ability to centralize all study information and coordinate multiple trial processes in real time at lower cost. The result is improved efficiency, accuracy, and safety in clinical trials conduct. In Web-based clinical trials, sites are able to focus primarily on medicine and science, rather than on trial administration. Site training, study documentation, subject recruitment, randomization, medication dispensing, and management procedures are simplified by using Web-based software to enhance processes. This paper summarizes the advantages achieved for INVEST investigators, sponsor representatives, monitors, and subjects resulting from the centralization and coordination of multiple tasks through Web-based technology.

Clinical Trials as Topic↗
PubMed2001

Degenerative alterations of dermal collagen fiber bundles in photodamaged human skin and UV-irradiated hairless mouse skin: possible effect on decreasing skin mechanical properties and appearance of wrinkles.

Dermal collagen fiber bundles (DCFB) are the major constructional element in the dermis. Although degenerative alterations of DCFB have been reported in chronologically aged skin, changes in photodamaged skin have not been fully investigated. We report ultrastructural alterations of DCFB, and their relation to skin elasticity using photodamaged human skin and UV-irradiated hairless mouse skin. The degree to which DCFB were intact and closely packed was evaluated and scored blindly. Exposed skin (outer forearm) exhibited marked ultrastructural degeneration. In UV-irradiated hairless mouse skin, the intact ultrastructural appearance of DCFB was gradually lost with increasing UV dosage; however, marked alterations in DCFB ultrastructure were absent in either human inner upper arm (unexposed) skin or nonirradiated age-matched control mouse skin. Skin mechanical properties were measured using a Cutometer SEM 474 suction extensometer, recording Ue* immediate deformation, Uv* viscous deformation, Uf* final deformation, and Ur* immediate contraction, all normalized for skin thickness. Uf*, Ue*, Uv*, and Ur/Uf were significantly decreased in exposed compared with unexposed skin. Significant positive correlations between degenerative alterations of DCFB and the decrease in Uf*, Ue*, and Uv* were seen. Changes of "% area of wrinkles" in UV-irradiated mouse skin was significantly correlated with degenerative changes of DCFB. Based on these results, we confirm observations made by others that chronic photodamage may have more severe effects on degeneration of DCFB than that of chronologic aging alone. Furthermore, degeneration of DCFB as detected ultrastructurally may, by its effect on skin elasticity, result in an increase in the appearance of wrinkles.

Adult↗
PubMed2001

Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial.

BACKGROUND: Superficial basal cell carcinoma (sBCC) is an increasingly common tumor in fair-skinned populations throughout the world. Imiquimod, an immune response modifier that induces cytokines including interferons, has been shown in preliminary studies to have an effect when applied topically to BCC. OBJECTIVE: We conducted a multicenter, randomized, open-label dose-response trial of imiquimod 5% cream in the treatment of primary sBCC assessing efficacy and safety of different dose regimens. METHODS: Ninety-nine patients were randomized to 6 weeks' application of imiquimod in 1 of 4 treatment regimens: twice every day, once every day, twice daily 3 times/week, once daily 3 times/week. The treatment site was excised and examined histologically 6 weeks after cessation of imiquimod. RESULTS: Intention-to-treat analysis revealed 100% (3/3) histologic clearance in the twice-daily regimen, 87.9% (29/33) clearance in the once every day regimen, 73.3% (22/30) clearance in the twice-daily 3 times/week regimen, and 69.7% (23/33) clearance in the once-daily 3 times/week regimen. Dose-related inflammatory skin reactions at the site of application were common. The majority were well tolerated and only 1 patient withdrew from the trial as a result of a medication-related skin reaction. CONCLUSION: Imiquimod 5% cream appears to have potential as a patient-administered treatment option in sBCC.

Administration, Topical↗
PubMed2001

Oral propylthiouracil for the treatment of resistant plaque psoriasis.

BACKGROUND: Propylthiouracil (PTU) has been used in the treatment of hyperthyroidism for many years and inhibits the enzyme 5'-deiodinase, which converts thyroxine to triiodothyronine. Several studies have reported PTU as an effective treatment for plaque psoriasis. PTU exhibits immunomodulatory effects; however, its exact mechanism of action in psoriasis is unknown. Few patients were studied in these reports and treatment with PTU was continued for no longer than 8 weeks. METHODS: In this study we report on four patients with resistant plaque psoriasis who had treatment with oral PTU for 4-32 weeks (mean 18.4). RESULTS: Three of the four patients exhibited moderate clinical improvement with reductions in psoriasis severity observed within 4-6 weeks of commencing PTU therapy. The side effects noted were subclinical hypothyroidism in two patients and worsening of muscle aches in one patient. Monitoring included regular thyroid function, full blood count, and liver and renal function tests. CONCLUSION: This study illustrates that oral PTU can be a useful addition to the therapy of resistant cases of plaque psoriasis and shows that this treatment can be continued for longer than 8 weeks with few side effects occurring secondary to PTU.

Adjuvants, Immunologic↗
PubMed2001

The public health approach to the burden of common skin diseases in the community.

The vast majority of work performed by dermatologists in clinical practice is managing common skin conditions including eczema, psoriasis, acne, tinea, warts and in some countries skin cancer and in others skin infections. Governments and other health organisations rely on data to plan medical services. Dermatologists seek the same data to justify their existence. In Australia, we have been studying the frequency of these conditions showing that they are very common, with particular conditions occurring at particular ages. Our data show also that less than 50% of people seek advice from the medical practitioner, with pharmacists being the most common of the other sources of advice. People are frequently misinformed about their conditions and may be using treatment that is of no value. These data suggest the need for both public and professional education programs informing the public where to seek correct advice and teaching those who provide it to ensure that they have the knowledge to do so.

Adolescent↗
PubMed2001

The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis.

OBJECTIVE: To determine the prevalence and severity of atopic dermatitis in a stratified cross-section of preschool-age children examined throughout Victoria, Australia. DESIGN: A cross-sectional skin survey using a selected cluster sample of the various centers throughout Victoria. SETTING: The study population included Victorian children attending child-care centers, preschools, and Maternal and Child Health Centres, with the reference population being Australian children aged 5 years and younger. PARTICIPANTS: Of 1634 potential participants, 1116 children (68.3%) were examined. INTERVENTION: A dermatologist performed a total skin examination, including head and neck, limbs, and trunk, on all children. The diaper area was examined in children younger than 12 months. MAIN OUTCOME MEASURE: All parents were administered a questionnaire to elicit demographic information, history of skin conditions, and family history of skin problems or related diseases. The examiner recorded the presence, site, and severity of atopic dermatitis for calculation of age- and sex-specific prevalence rates. RESULTS: The age- and sex-adjusted point prevalence was 30.8% (95% confidence interval [CI], 28.0%-33.5%). Most children (63.7%) were classified as having minimal or mild disease. Only 5.8% of children with atopic dermatitis did not have face or flexural involvement. Of the 237 children with atopic dermatitis and information available, 209 used 1 or more products to treat their condition. CONCLUSIONS: Atopic dermatitis is common, decreasing in prevalence after the first 3 years of life. Most children have mild disease requiring little if any treatment, and much could be prevented with simple measures. Educational programs directed at those caring for preschool-age children that provide information on simple preventive measures, where practical, and sources of advice for treatment, if necessary, could substantially reduce the morbidity of this condition in predisposed children.

Child Day Care Centers↗
PubMed2001

The church social.

Explore the source record for details and available documents.

HIV Infections↗
PubMed2001

Diagnosis in dermatology. Tricks of the trade.

BACKGROUND: Many medical practitioners find difficulty in diagnosing common skin conditions. This may translate into difficulty in management when treatment may have to be prescribed without a specific diagnosis. OBJECTIVE: To develop a simplified approach to diagnosis of the common skin conditions, using major discriminators on history and examination. DISCUSSION: By simplifying the history and examination, it is possible to categorise responses to questions or key signs on examination in a way that should assist in the diagnosis of common skin conditions. But, as always, when a condition cannot be fitted into the model, consider a specialist opinion.

Dermatology↗
PubMed2000

Transgenic expression of the coxsackie/adenovirus receptor enables adenoviral-mediated gene delivery in naive T cells.

The inability to easily and efficiently introduce genes into primary T cells has hampered the investigation of the pathways controlling T cell fate. To enable adenoviral-mediated gene transfer into normal naive T cells, transgenic (Tg) mice expressing the coxsackie/adenovirus receptor (CAR) in their T cell compartment were constructed. Whereas naive T cells are resistant to adenoviral infection, Tg expression of CAR on T cells greatly facilitates adenoviral-mediated gene expression ex vivo, in vivo, and in differentiated T helper cells. Thus we have developed a technology for efficient gene delivery to naive T cells. By using adenoviral vectors encoding specific inhibitors, we show that G1 cyclin-dependent kinase, NF-kappaB, and caspase activities are required for the proliferation of primary T cells. In addition, by expressing Bcl-x(L) protein at a level that closely approximates mitogen-induced levels, we demonstrate that Bcl-x(L) expression is sufficient to account for mitogen-mediated survival of primary T cells. Thus, adenoviral-mediated gene delivery to CAR Tg T cells should be useful for the analysis of many genes controlling T cell fate.

Adenoviridae↗