Acute glaucoma, chronic glaucoma, and serotoninergic drugs.
Explore the source record for details and available documents.
Acute Disease↗
Biomedical subjects
S Carr
Publications and source records attributed to S Carr.
HIV infection among family planning clinic attenders in Glasgow: why prevalence has remained low in this general population group.
OBJECTIVE: During 1991-2, unlinked anonymous testing of dried blood spots from neonatal metabolic screening cards showed the prevalence of HIV among childbearing women from Glasgow to be extremely low at 0.01%. A study was conducted to determine if non-pregnant sexually active women who engaged in unprotected sexual intercourse were more likely to be infected than those who were pregnant. METHODS: Unlinked anonymous HIV testing of urine specimens submitted by attenders of the family planning clinic in Glasgow for pregnancy testing. RESULTS: Of 11,990 urine specimens tested, 7664 were from women with a negative pregnancy test and two of these were HIV positive (0.026%); none of the remainder from those with a positive pregnancy test had HIV antibodies. CONCLUSION: No hidden epidemic was unearthed among a population which had engaged in unprotected sexual intercourse and was not pregnant. Other data from Glasgow strongly suggest that the control of HIV transmission among the city's population of current injectors (HIV prevalence, 1% of 8500) has prevented the spread of infection into its wider heterosexual population. It is essential that preventive measures which have been responsible for this public health success should be maintained.
Adult↗
Discharged residents' satisfaction with transitional housing for the homeless.
One year following discharge from a transitional residential program, homeless women, some of whom were chemically dependent or mentally ill, indicated that they were satisfied with the program and that it had met their needs. Suggestions for improvement related primarily to greater flexibility of rules in the transitional residence. Most of the women had improved their housing situation since discharge; all of the women continued to maintain a home for their children.
Adult↗
Assessment of costs and benefits of management of gestational diabetes mellitus.
The purpose of this pilot study was to perform a cost-identification analysis of care for gestational diabetes mellitus (GDM) by determining the direct costs of the diagnostic procedures and treatment used for the outpatient management of GDM (program input costs) and the direct costs of maternal hospitalization after diagnosis of GDM, delivery of the baby, and newborn care (outcome costs). Reimbursed average charges in the Northern California (NoCal) managed care market in 1996 were used to establish the direct costs, and the direct costs were then applied to the elements of care and pregnancy outcomes of three GDM management programs in NoCal, Southern California (SoCal), and New England (NewEng), using prospectively collected data. Reimbursed amounts for the detailed elements of GDM management (program input costs) are presented in the categories of diagnosis of GDM, diabetes treatment supplies, doctor's office visits, office visits to ancillary providers, and fetal surveillance. Program input costs per patient were $817 for diet-treated and $1,838 for insulin-treated women in NoCal, and were estimated to be $882 for diet-treated and $1,425 for insulin-treated women in NewEng. Program input costs for women requiring insulin treatment who were randomized to premeal or postprandial blood glucose testing (N Engl J Med 333:1237, 1995) in SoCal were estimated to be $3,596 per patient for the premeal group and $3,770 per patient for the postprandial group. Reimbursed amounts for health care expenditures related to pregnancy outcomes are detailed in the categories of hospital and physician charges for maternal antepartum hospitalization ($1,864 for 2 days), vaginal delivery with 50% use of epidural anesthesia ($4,050), cesarean section ($5,932), and neonatal intensive care ($9,130 for 4 days). Outcome costs per patient were $5,792 for diet-treated and $6,462 for insulin-treated women in NoCal. Outcome costs per patient were estimated to be $6,096 for diet-treated and $11,216 for insulin-treated women in NewEng, and $8,013 for the premeal blood glucose group and $7,495 for the postprandial blood glucose group in SoCal (both groups required insulin treatment). Incremental cost-effectiveness of postprandial monitoring in the SoCal controlled trial was $35 per patient in input costs per cesarean section averted and $25 per patient in input costs per neonatal intensive care unit day prevented. The benefit-to-cost ratio of the difference in input and outcome costs was 2.98 in favor of postprandial monitoring in the SoCal study. Cost analysis should be included in clinical trials of the management of GDM.
Cesarean Section↗
Hypopigmented common blue nevus.
Blue nevus is a benign pigmented lesion of dermal melanocytes with a number of histologic and clinical variants, of which the major types are the common blue nevus, cellular blue nevus and combined nevus. This study describes 9 cases of hypopigmented blue nevus (HBN), a variant of common blue nevus in which there is minimal identifiable melanin pigment. We also discuss the usefulness of the immunoperoxidase stain HMB-45 in relation to the diagnosis of HBN and the lesions with which it may be histologically confused, namely common intradermal nevus, dermatofibroma, neurofibroma, dermal scar and desmoplastic malignant melanoma. The HMB-45 stain was found to be uniformly positive in all 9 cases of HBN, in contrast to the other dermal lesions which have been reported as either negative or showing only focal positivity. The physical distribution and age range of the patients in this study was similar to the age and sites for common BN, supporting the relationship between the 2 lesions. The occurrence of HBN in predominantly young adults indicates that this lesion is not a phenomenon due to ageing or degenerative change, and should be regarded as a variant of common blue nevus.
Adolescent↗
Prenatal ultrasound diagnosis of abdominal aortic aneurysm with fibrotic occlusion in aortic branch vessels.
In a 35-year-old multiparous patient, an ultrasound scan performed at 32 weeks' gestational age for size less than dates revealed an appropriately grown fetus with a two-vessel umbilical cord. Also noted were dilated, tortuous abdominal and pelvic vessels. A scan at 33.5 weeks confirmed the two-vessel cord and noted a widely dilated abdominal aorta and a left foot 2 cm shorter than the right. Delivery at 36 weeks was followed by a neonatal course complicated by thromboses, renovascular hypertension, and a newly patent ductus with pulmonary hypertension. Successful ligation was followed by acute pulmonary hypertension, cardiac dysfunction and death. Autopsy findings included aneurysmal dilation of the abdominal aorta without evidence of arterial wall pathology.
Adult↗
Glucose and lactate kinetics during a short exercise bout in pregnancy.
Pregnancy is considered diabetogenic. Although exercise has been advocated to assist in metabolic control of the nonpregnant diabetic individual, there is a paucity of data about the metabolic effects of exercise during pregnancy. To examine whether moderate exertion may be beneficial in the maintenance of maternal carbohydrate homeostasis, glucose and lactate kinetics were measured in the third trimester in five pregnant nondiabetic women (gestational age, 34.2 +/- 0.1 weeks [mean +/- SE]) by infusion of 45 microg x kg(-1) x min(-1) [6,6-2H2]glucose and 70 microg x kg(-1) x min(-1) [U-13C]lactate tracers. Subjects were observed at rest for determination of baseline steady-state kinetics over a 30-minute period, and then they exercised for 30 minutes at 60% maximum oxygen consumption (VO2max) and were evaluated for 30 minutes postexercise. Glucose and lactate kinetics and lactate oxidation were measured throughout the exercise protocol. This study was repeated postpartum in all individuals at least 6 weeks after delivery. Compared with the steady-state preinfusion period, plasma glucose concentration was not elevated during exercise in either group, nor was plasma lactate concentration significantly different in either group. Glucose kinetics did not change during exercise, but lactate kinetics increased in both groups. V02 and percent of lactate C contribution to CO2, an indication of lactate oxidation, increased proportionally in both groups during exercise. Metabolic perturbations, as measured by glucose and lactate kinetics, do not appear to be different during the third trimester of pregnancy during a relatively short bout of exercise compared with the nonpregnant state.
Adult↗
Atherosclerotic plaque rupture in symptomatic carotid artery stenosis.
PURPOSE: Plaque rupture is often the precipitating event in acute coronary syndromes. We hypothesized that a similar process occurs in stenotic carotid plaques in association with ischemic neurologic symptoms. Our purpose was to examine several morphologic features of stenotic carotid plaques and to determine which characteristics are more commonly associated with plaques obtained from patients with symptomatic carotid artery disease than with those from patients with asymptomatic carotid artery disease. METHODS: Forty-four carotid endarterectomy specimens (from 25 asymptomatic and 19 symptomatic patients) were analyzed with pentachrome staining and light microscopy. The asymptomatic patients and symptomatic patients had similar mean percent stenosis (77% vs 74%). Other risk factors, including hypertension, diabetes mellitus, coronary artery disease, smoking history, serum cholesterol, and triglyceride levels, were similar between groups. RESULTS: Patients with symptomatic carotid artery disease were found to have more frequent plaque rupture, fibrous cap thinning, and fibrous cap foam-cell infiltration when compared with the asymptomatic group. Plaque rupture was seen in 74% of symptomatic plaques and in only 32% of plaques from asymptomatic patients (p = 0.004). Fibrous cap thinning was noted in 95% of symptomatic plaques and in 48% of asymptomatic plaques (p = 0.003). Infiltration of the fibrous cap with foam cells was also significantly more common in the symptomatic plaques (84% vs 44% of asymptomatic plaques; p = 0.006). In addition, intraplaque fibrin was more common in symptomatic plaques than in asymptomatic (100% vs 68%; p = 0.008). No significant differences were found between the two groups with respect to plaque hemorrhage, the presence of a necrotic core, luminal thrombus, smooth muscle cell infiltration, eccentric shape, and plaque type (fibrous, necrotic, or calcified). CONCLUSIONS: As in the coronary artery system, rupture of the atherosclerotic plaque may play an important role in the pathogenesis of ischemic stroke caused by carotid artery stenosis. The process of inflammation, involving foam-cell infiltration of the fibrous cap, may contribute to rupture of the atherosclerotic plaque.
Aged↗
A primary health care service for Glasgow street sex workers--6 years experience of the "drop-in centre', 1989-1994.
In Glasgow, a health and social care centre opened in 1988 principally to facilitate HIV prevention among street prostitutes, most of whom are injecting drug users. During 1992 to 1994, 551 women made 17,554 visits to the medical room which is functional 5 nights per week. The mean age of the sex workers was 26 years (range 15 to 62) and 89% injected drugs. Fifty-five per cent of the attendances were for needle/syringe exchange only whilst the remainder involved other health care provision. Common presenting problems included abscesses, burns and venous thromboses, reflecting the high proportion of sex workers who injected drugs. Most women always used condoms for penetrative commercial sex and symptomatic sexually transmitted disease was seen infrequently. In addition to the provision of injecting equipment and condoms, other key prevention activities included Hepatitis B vaccination and cervical screening. The prevalence of HIV infection amongst the women remains under 5% and most seropositives were known to be infected before the Centre opened. This initiative shows that if multidisciplinary health and social services are provided to street sex workers at a time and place convenient to their work, the benefits are considerable.
Adolescent↗
Polymyositis: a cause of acute renal failure.
Explore the source record for details and available documents.
Acute Kidney Injury↗
Bryostatin 1 activates splenic lymphocytes and induces sustained depletion of splenocyte protein kinase C activity in vivo after a single intravenous administration.
Bryostatin 1 activates and subsequently down-regulates protein kinase C (PKC) in vitro and has potential use as an immunomodulator and as an anti-cancer agent. Despite extensive examination of its activities in vitro and anti-tumor effects in vivo, previous studies have failed to document that bryostatin 1 modulates total cellular PKC activity in tumor or normal tissues when administered in vivo. After a single bolus injection of bryostatin 1 (1.0 microgram) in normal C57BI/6 mice, blood was drawn at various intervals and assayed for bryostatin 1 levels. In addition, spleens from bryostatin-treated mice were harvested 10 min to 10 days after treatment, weighed and analyzed for cell numbers, PKC activity and cell surface phenotypes. Bryostatin 1 levels in plasma rose rapidly, reaching peak levels of 56.5 nM less than 1 min after injection, and then declined to undetectable levels by 1 h. A similar pattern was observed when bryostatin 1 was incubated with leukemia cells in vitro, raising the possibility that the rapid fall in plasma levels results from intracellular uptake and binding. Bryostatin 1 induced marked depletion of total splenocyte PKC activity (as much as 69% relative to control values) at 24-96 h after drug administration, but not at earlier times (i.e. 1 h). A single injection of bryostatin 1 also induced expression of the T cell activation marker CD69, leading to positivity in 53% of cells at 3-24 h versus 11% in control mice, and resulted in marked splenomegaly, associated with increased numbers of nucleated cells at 48-96 h. Together, these studies demonstrate that despite rapid disappearance of the drug from plasma, a single i.v. dose of bryostatin 1 exhibits significant and sustained effects on normal murine spleen cells, including early lymphocyte activation, prolonged depletion of PKC activity, splenocyte proliferation and splenomegaly. These findings may have implications for attempts to understand the in vivo effects of bryostatin 1 in normal host tissues.
Animals↗
Activation of phospholipase A2 by the human endothelin receptor in Chinese hamster ovary cells involves Gi protein-mediated calcium influx.
The signalling pathways used by the human endothelin A receptor to activate phospholipase A2 in Chinese hamster ovary cells were investigated. Pertussis toxin caused a partial but significant reduction in endothelin-1-induced arachidonic acid release although cAMP-dependent kinase inhibitors did not mimic its action. Extracellular calcium and its entry into the cell was essential for activation of phospholipase A2 as its removal from media or incubation with an intracellular calcium chelator-reduced activation. Nifedipine had no effect on endothelin-1-induced arachidonic acid release while divalent cations caused a significant reduction indicating the possible role of CRAC. Thapsigargin caused an increase in arachidonic acid release which was completely inhibited by pertussis toxin treatment. This further supports the involvement of CRAC in calcium influx and activation of phospholipase A2 by the human endothelin A receptor.
Animals↗
Binding interactions of human interleukin 5 with its receptor alpha subunit. Large scale production, structural, and functional studies of Drosophila-expressed recombinant proteins.
Human interleukin 5 (hIL5) and soluble forms of its receptor alpha subunit were expressed in Drosophila cells and purified to homogeneity, allowing a detailed structural and functional analysis. B cell proliferation confirmed that the hIL5 was biologically active. Deglycosylated hIL5 remained active, while similarly deglycosylated receptor alpha subunit lost activity. The crystal structure of the deglycosylated hIL5 was determined to 2.6-A resolution and found to be similar to that of the protein produced in Escherichia coli. Human IL5 was shown by analytical ultracentrifugation to form a 1:1 complex with the soluble domain of the hIL5 receptor alpha subunit (shIL5R alpha). Additionally, the relative abundance of ligand and receptor in the hIL5.shIL5R alpha complex was determined to be 1:1 by both titration calorimetry and SDS-polyacrylamide gel electrophoresis analysis of dissolved cocrystals of the complex. Titration microcalorimetry yielded equilibrium dissociation constants of 3.1 and 2.0 nM, respectively, for the binding of hIL5 to shIL5R alpha and to a chimeric form of the receptor containing shIL5R alpha fused to the immunoglobulin Fc domain (shIL5R alpha-Fc). Analysis of the binding thermodynamics of IL5 and its soluble receptor indicates that conformational changes are coupled to the binding reaction. Kinetic analysis using surface plasmon resonance yielded data consistent with the Kd values from calorimetry and also with the possibility of conformational isomerization in the interaction of hIL5 with the receptor alpha subunit. Using a radioligand binding assay, the affinity of hIL5 with full-length hIL5R alpha in Drosophila membranes was found to be 6 nM, in accord with the affinities measured for the soluble receptor forms. Hence, most of the binding energy of the alpha receptor is supplied by the soluble domain. Taken with other aspects of hIL5 structure and biological activity, the data obtained allow a prediction for how 1:1 stoichiometry and conformational change can lead to the formation of hIL5.receptor alpha beta complex and signal transduction.
Amino Acid Sequence↗
Intrauterine therapy for homozygous alpha-thalassemia.
BACKGROUND: Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life. CASE: A Filipino woman with a prior loss due to hemoglobin Bart's underwent prenatal diagnosis that confirmed recurrence in the index pregnancy. Intravascular intrauterine exchange transfusions maintained appropriate fetal growth. A cesarean delivery yielded a 2190-g male infant with minor malformations. The postnatal course was characterized by mild respiratory insufficiency. Postnatal chronic transfusion therapy is underway pending consideration for bone marrow transplantation. CONCLUSION: Antenatal diagnosis and therapy of homozygous alpha-thalassemia can prevent the prenatal consequences of hydrops and fetal death. New technologies such as stem cell transplantation may help to avert both prenatal and postnatal consequences.
Abnormalities, Multiple↗
A comparison of chamba (marijuana) abusers and general psychiatric admissions in Malawi.
The study aimed to provide the first general description of chamba-related admissions to Zomba Mental Hospital, the major psychiatric facility in Malawi, and to analyse the distinctiveness of this patient group from other admissions. A questionnaire was verbally administered to 50 chamba abusers and 50 other patients matched by gender, age, and admission date. The typical chamba abusing patient is: 27, male, a subsistence farmer, takes the drug because it is the cheapest form of intoxication, reports 'seeing things clearly' (immediate effect), and general apathy (long-term); and compared to other patients is more likely to originate from a chamba-growing area, less likely to have been raised by his natural parents, and has had more schooling.
Adolescent↗
TMD support for doctors and patients.
Explore the source record for details and available documents.
Consumer Organizations↗
The impact of caring upon the health of older women.
Much community care relies upon the provision of unpaid care by family members. The short- and longer-term effects of providing care upon older women were researched in an interview survey of 286 women aged over 50 in urban and rural areas of Queensland. The findings were validated by reports from the women's general practitioners. The results suggest that providing care has both short- and long-term negative effects upon the physical health and emotional wellbeing of older women. The major predictor of a range of self-reported health problems was the level of self-reported stress. Implications are drawn for both community care policy, which needs to focus upon the impact on the carer of continuing to provide care at home, and for health research relating to older women, which has ignored the demands of caring among older people.
Activities of Daily Living↗
Fetal tissue.
Explore the source record for details and available documents.
Fetal Tissue Transplantation↗