Biomedical subjects

S Flint

Publications and source records attributed to S Flint.

At least 19 recordsLinked to original sources

PubMed1999

Cervical length at 23 weeks in twins in predicting spontaneous preterm delivery.

OBJECTIVE: To establish the relationship between cervical length at 23 weeks' gestation in twin pregnancies and risk of spontaneous preterm delivery. METHODS: Cervical length was measured during routine antenatal care by transvaginal sonography at 23 (range 22-24) weeks' gestation in 215 twin pregnancies. Distribution of cervical length was determined, and sensitivity and false-positive rate for spontaneous preterm delivery at or before 28, 30, 32, and 34 weeks for cutoff cervical lengths of 15, 25, 35, and 45 mm were calculated. RESULTS: Cervical length distribution was skewed toward shorter length and the median value was 38 mm. In 11.2% and 4.2% of cases, length was up to 25 mm and up to 15 mm, respectively. The spontaneous delivery rates at or before 28, 30, 32, and 34 weeks were 3.8%, 4.7%, 8.0%, and 17.5%, respectively, and were not statistically significantly related to any demographic characteristics, obstetric history, or chorionicity. Sensitivity to predict spontaneous preterm delivery was 100%, 80%, 47%, and 35% for 28, 30, 32, and 34 weeks, respectively, for cervical length up to 25 mm. The corresponding sensitivity values for cervical lengths up to 15 mm were 50%, 40%, 24%, and 11%. The rate of spontaneous delivery at or before 32 weeks increased exponentially with decreasing cervical length at 23 weeks, from 2.9% at or greater than 46 mm, to 4.3% at 36-45 mm, 6.7% at 26-35 mm, 31% at 16-25 mm, and 66% at 15 mm or less. CONCLUSION: Measurement of cervical length in twin pregnancies predicted risk of spontaneous early preterm delivery.

Adult↗

PubMed1997

p53 mutations and protein expression in primary cultures of normal oral mucosa in smokers and non-smokers.

The normal oral mucosa from 77 individuals of known smoking and alcohol-intake history was cultured. After 14-21 days in culture, epithelial cells were stained for p53 expression using immunohistochemistry. PCR-SSCP analysis of the p53 gene was also performed on a random sub-set of these samples (20 non-smokers and 21 smokers). Expression of the stable, non-functional form of p53 protein as detected by the p53-240 antibody was found to be significantly elevated in the cultured oral mucosa of smokers. (P < 0.01). PCR-SSCP analyses indicated a higher level of base changes in smokers than in non-smokers. These observations are consistent with other findings of significantly increased p53 protein expression in the oral mucosa and other tissues of smokers and suggests that p53 mutations may be an early event in smoking-induced oral cancers.

Adolescent↗

PubMed1996

Mucosal lesions due to oral cocaine use.

Cocaine abuse is a major public health problem worldwide and is increasingly common in Europe. Oral use of cocaine in two patients resulted in unusual white lesions on their anterior maxillary gingivae/vestibule. GDPs should be alert to this newly described lesion.

Administration, Oral↗

PubMed1996

Preterm labour and delivery.

Preterm birth is a major cause of perinatal morbidity and mortality. It accounts for 5-10% of all births, and any treatment to prevent it could have a profound effect on neonatal outcome in both human and economic terms. The pathogenesis of both term and preterm birth remain poorly understood. Our ability to predict those at risk of preterm labour is also inaccurate, despite the creation of scoring systems, uterine activity monitoring, cervical ultrasound and several biochemical markers. Current drug therapies for preterm labour have not been shown in randomised controlled trials to significantly affect perinatal morbidity and mortality. Furthermore, most are associated with significant maternal or fetal side effects. Nitric oxide (NO) is a potent smooth muscle relaxant, produced when NO synthase acts on the amino acid L-arginine. Its presence has been demonstrated in human myometrium. We have conducted an observational study which has suggested that glyceryl trinitrate (GTN), and NO donor, may be effective in prolonging gestation. A randomised trial comparing GTN to intravenous ritodrine is currently recruiting patients; results will be available in the Spring of 1997. Few side effects have so far been encountered. Evidence suggests that GTN, an NO donor, should be a safe and effective tocolytic and early observations are encouraging; randomised trials currently underway should determine the significance of this breakthrough in the management of preterm labour.

Adrenergic beta-Agonists↗

PubMed1996

Recurrent second trimester miscarriage.

Understanding the aetiology of a second trimester miscarriage allows the obstetrician to assess the recurrence risk in the next pregnancy and guides future management. Causes include anatomical abnormalities, cervical incompetence, genital tract infection, multiple pregnancy, auto-immune factors, vaginal bleeding, and fetal abnormalities. Transvaginal ultrasound of the cervix in pregnancy may have a role in the diagnosis of cervical incompetence. There is an association between genital tract infection and second trimester miscarriage, but the value of antibiotics in the prevention of miscarriage is still to be defined.

Abortion, Spontaneous↗

PubMed1995

Detection of cytomegalovirus and Epstein-Barr virus in labial salivary glands in Sjogren's syndrome and non-specific sialadenitis.

To investigate the role of herpes viruses in Sjogren's syndrome, minor (labial) salivary gland tissues from Sjogren's syndrome and from non-specific sialadenitis were examined for Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) DNA by the polymerase chain reaction. Almost half of all salivary glands studied contained EBV and/or HCMV. There was, however, no significant difference between the detection of EBV or HCMV in salivary glands from patients with Sjogren's syndrome or non-specific sialadenitis. The findings are consistent with the persistence of EBV and HCMV in minor salivary glands following primary infection, but do not indicate a direct role for either virus in the aetiology of Sjogren's syndrome, and do not exclude reactivation of the viruses in this disease.

Base Sequence↗

PubMed1994

Intravenous antiplatelet efficacy and safety of the platelet GPIIb/IIIa antagonist, DMP 728 in anesthetized dogs.

DMP 728, cyclo (D-2-aminobutyrate-N-Methyl-L-Arginyl-Glycyl-L-Aspartyl- 3-amino-methyl-benzoic acid) methanesulfonate salt, is a novel antiplatelet agent with high affinity and specificity for human and canine platelet GPIIb/IIIa (alpha 2/beta 3) receptors. DMP 728 demonstrated a potent antiplatelet efficacy in inhibiting ADP-induced platelet aggregation in either human or canine PRP with an IC50 of 0.046 and 0.015 microM, respectively. The IC50 of DMP 728 in inhibiting human platelet aggregation in PRP ranged from 0.02-0.05 microM regardless of the agonist used or even their combinations. Additionally, DMP 728 displayed a much greater affinity in inhibiting 125I-fibrinogen binding to stimulated human platelets as compared to the linear peptide RGDS or fibrinogen. The present study was undertaken to examine the i.v. antiplatelet efficacy and safety of DMP 728 in anesthetized dogs. In anesthetized mongrel dogs, DMP 728 (0.001-1.0 mg/kg, i.v. bolus) produced a dose-dependent inhibition of ex vivo platelet aggregation induced by ADP. The onset of inhibition was immediate, and the duration of antiplatelet effects was dose-dependent. A maximal inhibition of platelet aggregation and a reversible prolongation of bleeding time at 0.01 mg/kg were shown. Additionally, the antiplatelet efficacy/safety of DMP 728 was examined after i.v. administration at different infusion rates ranging from 0.008 to 0.833 micrograms/kg/min for 2 hours. A minimal antiplatelet effect was observed at the 0.008 micrograms/kg/min for 2 hours, while a maximal inhibition of platelet aggregation along with a reversible prolongation of bleeding time was achieved at 45-60 min post-infusion of 0.08 micrograms/kg/min x 2 hours. Prolongation of bleeding time was significantly reduced upon the cessation of the infusion while maximal inhibition of platelet aggregation was maintained longer. At all of the above regimens, DMP 728 did not result in any significant effects on platelet counts. Furthermore, DMP 728 did not elicit any other platelet unrelated adverse effects over wide range of doses. These data suggest that DMP 728, a low molecular weight platelet GPIIb/IIIa receptor antagonist, is a potent and systemically active antiplatelet agent with reversible effects on bleeding time.

Amino Acid Sequence↗

PubMed1993

A trial to control the tsetse fly, Glossina morsitans centralis, with low densities of odour-baited targets in west Zambia.

A large-scale trial investigated the possibility of eradicating G.m.centralis from a traditional cattle rearing area using odour-baited targets at a reduced overall target density from 4 to 0.5-2.3 per km2, thus cutting down initial material costs by about 50%. Only the periphery of what was thought to be prime tsetse habitat (dense woodland) was treated with targets. These were all black or blue/black cloth (1.8 x 1 m), sprayed with deltamethrin suspension concentrate and baited with butanone and/or acetone (40-130 mg/h) and 1-octen-3-ol (0.5 mg/h). Although fly catches from traps and flyrounds initially dropped by approximately 3% per day and trypanosomiasis cases declined by 99% within a year, eradication was not achieved, so that more targets were deployed at a later stage. Although initially cheaper, the option of using reduced target densities proved financially unattractive because of prolonged periods of target maintenance prior to eradication. Revised strategies for tsetse control with odour-baited, insecticide-impregnated targets in west Zambia are presented.

Acetone↗

PubMed1993

Oligonucleotide fingerprinting of isolates of Candida species other than C. albicans and of atypical Candida species from human immunodeficiency virus-positive and AIDS patients.

Oligonucleotide fingerprinting of genomic DNA from oral isolates of four different Candida species other than C. albicans and atypical chlamydospore-positive isolates from human immunodeficiency virus (HIV)-positive individuals and AIDS patients was investigated as a means for differentiating between isolates within individual species. Oligonucleotides composed of simple repetitive sequence motifs, including (GACA)4, (GATA)4, (GGAT)4, (GTG)5, and (GT)8, all yielded fingerprints suitable for strain segregation of 8 C. tropicalis isolates, 12 Torulopsis (Candida) glabrata isolates, 8 atypical Candida isolates, and, except for (GATA)4, 2 C. krusei probe in turn and so generate several distinct DNA fingerprints of the same DNA sample. However, none of the probes yielded fingerprints suitable for strain segregation with three C. parapsilosis isolates. The (GATA)4 probe was also used to detect restriction fragment length polymorphisms among a genetically closely related group of atypical Candida isolates on primary isolation from an additional HIV-infected patient. These chlamydospore-positive atypical Candida isolates were sucrose positive, were of C. albicans serotype A, hybridized weakly with the C. albicans-specific mid-repeat sequence probe 27A, and yielded fingerprint profiles by random polymorphic DNA analysis that were distinct from those derived from C. albicans isolates. The C. stellatoidea ex-type strain NCPF 3108 was indistinguishable from the atypical Candida isolates in all these tests and also yielded an identical carbohydrate and nitrogen source assimilation profile by using the ID 32C yeast identification system.

AIDS-Related Opportunistic Infections↗

PubMed1992

Recurrent aphthous stomatitis: the efficacy of replacement therapy in patients with underlying hematinic deficiencies.

A group of thirty-four patients with recurrent aphthous stomatitis (RAS) and single hematinic deficiencies were given replacement therapy after any reason for the deficiency had been sought and excluded. The response of the RAS was assessed in an open trial. The aphthae in 70% of patients subjectively improved with hematinic replacement therapy, a benefit exceeding the defined placebo response in recurrent aphthous stomatitis.

Adolescent↗

PubMed1991

Oral mucosa.

Explore the source record for details and available documents.

Aged↗

PubMed1991

The adequacy of physician reimbursement for pediatric care under Medicaid.

This article examines 1989 Medicaid physician reimbursement for pediatric care in 47 states and the District of Columbia. To assess the adequacy of payment, several state reimbursement policies were analyzed, including physician payment methods, frequency of payment updates, and fee data for five common evaluation and management codes and two Early and Periodic Screening, Diagnosis, and Treatment visit categories. Physician payment rates were evaluated to determine overall state and regional patterns of Medicaid reimbursement. They were also compared with regional private market fee data and average national Medicare fees to assess their adequacy. The majority of state Medicaid programs used fixed fee schedules as their physician reimbursement method. Nearly one fourth of states that update their fees overall by physician specialty have not adjusted their rates since 1985 or before. Medicaid reimbursement rates for five commonly used evaluation and management Physicians' Current Procedural Terminology (4th ed) office visit codes and Early and Periodic Screening, Diagnosis, and Treatment screening and follow-up examinations varied substantially across states and among regions. States in the West paid the highest rates for most office visits, while Northeastern states generally paid the least. A comparison of Medicaid payment rates with private market fee data revealed that Medicaid payments for established patients averaged less than two thirds of market rates for pediatricians, family physicians, and general practitioners. New patient care is reimbursed somewhat better. Regional variations are substantial. In addition, a comparison of Medicaid payment rates with 1988 Medicare fee data showed that average Medicaid reimbursement rates were less than four fifths of average allowed Medicare charges. Policy implications include the need to increase Medicaid rates so that they are much closer to private insurance and Medicare rates, particularly in the Northeast and in selected states, in order to increase participation by pediatric providers in Medicaid. In addition, efforts to re-evaluate reimbursement relative to level of service, as used in Medicare's resource-based relative value scales, deserve further research. Finally, comparable access to comprehensive pediatric care especially in underserved urban areas will require not only improvements in physician reimbursement but also more deliberate efforts to affect the maldistribution of mainstream medical care. Approaches to measure the impact of enhanced reimbursement on access to care by Medicaid-eligible children are discussed.

Delivery of Health Care↗

PubMed1990

Isolated trigeminal sensory neuropathy: a heterogeneous group of disorders.

Neuropathy affecting the face is a serious sign that warrants thorough and often multidisciplinary investigation. Patients with isolated trigeminal sensory neuropathy (TSN) should be monitored for connective tissue disease, and some may develop multiple sclerosis or paroxysmal trigeminal neuralgia. A patient with chronic isolated TSN and Sjôgren's syndrome, Raynaud's phenomenon, arthropathy, vitiligo, and evidence of other immune dysregulation is presented. The literature is reviewed with respect to the heterogeneous etiology of TSN, and an attempt is made to identify subgroups and to evaluate prognosis from details of the history and systemic disorder associations.

Chronic Disease↗

PubMed1990

Multiple myeloma and bullous lichenoid lesions: an unusual association.

Many associations of lichenoid reactions have been described but this case appears to be a previously unreported association--with multiple myeloma. This case also demonstrates the necessity of a mucosal biopsy with adequate hematologic and serologic investigations to obtain a definitive diagnosis.

Diagnosis, Differential↗

PubMed1989

Effects of the 65-mph speed limit on rural interstate fatalities in New Mexico.

As a result of federal legislation passed in April 1987, New Mexico was the first state to resume a 65-mph speed limit on rural Interstate highways. We compared the rates of fatal crashes before and after the speed limit change. The rate of fatal crashes in the 1 year after the speed limit was increased was 2.9 per 100 million vehicle-miles traveled, compared with a predicted rate of 1.5 per 100 million vehicle-miles based on the trend of the 5 previous years. When fatal crashes that occurred after the speed limit change were compared with fatal crashes in the 5 previous years, there was no difference in the mean age and sex of the at-fault drivers, mean age and sex of the victims, seat belt use by the victims, or alcohol involvement of the crashes. The increase in fatal crashes can be attributed to an increase in fatal single-vehicle crashes. Vehicles on rural Interstates are traveling at greater rates of speed and a larger proportion of vehicles are exceeding the 65-mph speed limit. The benefits associated with the 65-mph speed limit should be weighed against the increased loss of lives.

Accidents, Traffic↗

PubMed1989

Lingual abscess in a patient with anorexia nervosa.

A 30-year-old female patient suffering from anorexia nervosa, developed an acute submandibular cellulitis. She was found to have a lingual abscess, for which the only detectable source of infection was a grossly carious lower molar. The oral features of the more common eating disorders are described.

Abscess↗

PubMed1989

Anionic salivary proteins associated with connective tissue disorders: sialated tissue kallikreins.

Parotid saliva was collected from 32 patients with rheumatoid arthritis, 10 with systemic lupus erythematosus, three with mixed connective tissue disease, 12 with progressive systemic sclerosis, two with primary Sjögren's syndrome, and four with Raynaud's syndrome. Tissue kallikreins were measured by radioimmunoassay, and saliva samples were subjected to isoelectric focusing followed by immunoblotting or silver staining. The results showed that the saliva of patients with connective tissue diseases contained increased amounts of immunoreactive tissue kallikrein. In addition, there was an increase in the multiple forms of anionic tissue kallikreins, resulting mainly from a shift in their distribution towards that of higher sialic acid content and lower isoelectric point. These changes were most obvious in patients with systemic lupus erythematosus. Novel or unusual glycosylation may explain the occurrence of increased amounts of anionic salivary proteins in connective tissue diseases.

Adolescent↗

PubMed1988

Hematologic status in recurrent aphthous stomatitis compared with other oral disease.

The hematologic status of 144 consecutive patients in the United Kingdom with oral disease (69 with recurrent aphthous stomatitis; 75 with other disorders) was examined in an attempt to resolve the controversy as to whether levels of hemoglobin, blood cell numbers and indices, and blood film are adequate in the screening of patients with aphthae. Though hemoglobin levels and red blood cell indices were normal in patients with recurrent aphthous stomatitis, there was still a small minority of patients with deficiencies of iron (low serum ferritin), folate (low red blood cell levels), or vitamin B12 (low serum levels) that would have remained undetected. Full hematologic screening of patients with recurrent aphthous stomatitis thus reveals latent deficiency states, at least in some parts of the world, and there are good reasons for elucidating the underlying cause and correcting these deficiencies, particularly vitamin B12 deficiency. Therapeutic studies are now required to establish the frequency with which deficiencies actually predispose to recurrent aphthous stomatitis.

Adult↗