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Biomedical subjects

S Friedman

Publications and source records attributed to S Friedman.

At least 145 records · Page 8Linked to original sources
PubMed1996

Microalbuminuria as an early marker of severity in hypertensive pregnant women.

The value of microalbuminuria in predicting hypertensive complications in pregnant patients at high risk was tested in a prospective trial. A total of 276 patients were studied (142 in the study group vs 134 controls). Albumin was measured in 8-h overnight urine collection throughout pregnancy using radioimmunoassay technique. The pregnant women, in both the study and control groups demonstrated a statistically significant increase in albumin excretion rate in the second and third trimester compared with the first. Using logistic and linear regression models, the presence of microalbuminuria in the early third trimester was proven to be predictive of severe disease (odds ratio 2.1, confidence interval (CI) 1.26-3.53) and birth weight (R2 = 0.7, P < 0.05) in the study group. Intrauterine growth retardation and neonatal outcome were less predictable. With the introduction of radioimmunoassays, we believe severe disease can be predicted by detecting microalbuminuria in the early third trimester of pregnancy in high risk patients.

Adult↗
PubMed1995

HIV transmission through donor artificial insemination.

OBJECTIVE: To investigate and report cases of human immunodeficiency virus (HIV) transmission through donor artificial insemination (AI) before 1986 at five infertility clinics. DESIGN: Two types of look-back studies were performed: (1) identification of an HIV-infected woman who reported previous AI, followed by identification of the infected donor(s) and contact tracing of women who were inseminated with his semen, and (2) identification of an HIV-infected donor and subsequent examination of women receiving AI procedures using his semen. SETTING: Five infertility clinics in Los Angeles County, California; San Diego County, California; Arizona; and Vancouver, British Columbia. PATIENTS: A total of 230 women were inseminated with semen from any one of the five identified HIV-infected donors; 199 (87%) consented to HIV testing. MAIN OUTCOME MEASURE: Seropositivity for HIV among AI recipients. RESULTS: Seven (3.52%) of the 199 women (95% confidence interval, 1.55% to 7.41%) who were artificially inseminated with semen from any of five HIV-infected donors and consented to HIV testing tested HIV-seropositive. Information on HIV risk was available for three of the five donors; all three reported a history of having sex with men. Four HIV-infected women were identified through uncommon circumstances, rather than through routine look-back studies of donors. CONCLUSION: Infection with HIV through donor AI performed before routine HIV screening of semen donors represents a potentially serious threat to women who underwent AI procedures. Public health policies requiring retrospective identification of HIV-infected semen donors and patients receiving AI before 1986, especially in acquired immunodeficiency syndrome (AIDS)-prevalent areas, should be considered routine. Women diagnosed with AIDS or HIV infection, in whom no identified risk of HIV acquisition is established, should be questioned about previous AI procedures.

AIDS Serodiagnosis↗
PubMed1995

The release of fibroblast growth factor-1 from NIH 3T3 cells in response to temperature involves the function of cysteine residues.

Fibroblast growth factor (FGF)-1 is released from NIH 3T3 cells in response to heat shock as a biologically inactive protein that is unable to bind heparin and requires activation by (NH4)2SO4 to generate a biologically active extracellular heparin-binding growth factor (Jackson, A., Friedman, S., Zhan, X., Engleka, K. A., Forough, R., and Maciag, T. (1992) Proc. Natl. Acad. Sci. USA 89, 10691-10695). To further study the mechanism of FGF-1 release in response to heat shock (42 degrees C), we examined the kinetics of FGF-1 release from FGF-1-transfected NIH 3T3 cells and observed that the cells require at least 1 h of exposure to heat shock conditions for the release of FGF-1. Interestingly, agents that interfere with the function of the endoplasmic reticulum-Golgi apparatus, exocytosis, and the multidrug resistance pathway (brefelden A, methylamine, and verapamil, respectively) do not inhibit the release of FGF-1 in response to temperature; rather, they exaggerate the release of FGF-1. Because immunoblot analysis of FGF-1 in the conditioned medium of heat-shocked NIH 3T3 cells revealed the presence of a minor band with an apparent molecular weight of a FGF-1 homodimer and because we have previously shown that FGF-1, but not FGF-2, is able to form a homodimer in response to chemical oxidation by CuCl2 (Engleka, K. A., and Maciag, T. (1992) J. Biol. Chem. 267, 11307-11315), we examined whether reducing agents would substitute for (NH4)2SO4 and activate extracellular FGF-1. Indeed, dithiothreitol and reduced glutathione are able to individually generate a FGF-1 monomer as a heparin-binding protein from the conditioned medium of heat-shocked NIH 3T3 cell transfectants. To confirm that cysteine residues are involved in the release of FGF-1 in response to temperature, we used mutagenesis to prepare a human FGF-1 Cys-free mutant in which Cys30, Cys97, and Cys131 were converted to serine. Analysis of the release of the FGF-1 Cys-free mutant in NIH 3T3 cells transfected with the FGF-1 Cys-free mutant demonstrated that the FGF-1 Cys-free mutant is not released into the conditioned medium in response to temperature. Interestingly, exposure of the NIH 3T3 cell FGF-1 Cys-free transfectants to brefelden A followed by heat shock also demonstrated the absence of the extracellular FGF-1 Cys-free mutant.(ABSTRACT TRUNCATED AT 400 WORDS)

3T3 Cells↗
PubMed1995

Crush injury in pregnancy: an unusual experience in obstetrics.

BACKGROUND: Crush injury is the result of prolonged pressure to the limbs when individuals are trapped under the debris of earthquakes, bombings, and other disasters. Muscle integrity is compromised, and the local and systemic manifestations, including rhabdomyolysis, hyperkalemia, renal failure, and disseminated intravascular coagulation may be fatal. CASE: A 32-year-old woman, gravida 2, para 1, was trapped under fallen masonry at 6 weeks' gestation for approximately 6 hours. On initial examination, she showed early signs of hypovolemic shock and crush injury, including hyperkalemia. Prompt management with fluid therapy and careful monitoring led to a rapid recovery. Antenatal follow-up was routine and concluded in spontaneous delivery of a healthy infant. CONCLUSION: The unique physiology of the pregnant woman may affect the outcome of crush injury, and it presents a particular challenge to the trauma team. The obstetrician should be aware of its dangers and should be an active participant in the prompt management of pregnant victims of crush injury to ensure a satisfactory outcome for both mother and fetus.

Adult↗
PubMed1995

A possible linkage between gonadal hormones, serum and uterine levels of IgG of dairy cows.

We have investigated the possible linkage between serum and uterine fluid immunoglobulin G (IgG) levels and the hormonal status of the cow. In cycling cows there was a significant (P < 0.01) drop in average (of 4 consecutive days) serum IgG levels, from 36.4 +/- 6.7 mg ml-1 during the luteal phase of the estrous cycle to 28.3 +/- 5.3 mg ml-1 during and around estrus. In prepartum cows, there was a significant drop (P < 0.01) from an average of 37.6 +/- 3.7 mg ml-1 from 5 consecutive days, i.e. 11-7 before parturition, to 28.0 +/- 5.5 mg ml-1 on the day of parturition. Total IgG in the uterine fluid ranged from 30 to 115 mg in one horn and from 24 mg ml-1 to 70 mg ml-1 in the other horn during the luteal phase, but was essentially undetectable at estrus. The drop in serum and uterine IgG occurred concomitantly with the drop in peripheral serum progesterone, from 2-3 ng ml-1 at the luteal phase, and 11-7 days before calving to less than 0.5 ng ml-1 around estrus and calving. Data suggest a possible linkage between steroid hormone and IgG levels.

Animals↗
PubMed1995

Evaluation of success and failure after endodontic therapy using a glass ionomer cement sealer.

The purpose of this multicenter, prospective clinical study was to assess the treatment results following endodontic therapy using a glass ionomer cement sealer (Ketac-Endo) and to relate the results to various clinical factors. A total of 486 teeth were treated by three operators, using the "standardized technique" for canal preparation and either single cone or laterally condensed gutta-percha, in one or multiple treatment sessions. Six to 18 months postoperatively, the treatment results were assessed clinically and radiographically, and related to preoperative, intraoperative, and postoperative factors using a chi 2 analysis with 5% level of significance. Of 378 followed-up teeth, there was a 78.3% success, 15.6% incomplete healing, and 6.1% failure. Statistically, differences in the results were related to the number of canals (p < 0.04), primary treatment and retreatment (p < 0.02), pulp vitality (p < 0.001), periapical lesion (p < 0.001), preoperative symptoms (p < 0.003), operative complications (p < 0.001), and absence of restoration (p < 0.03). It was concluded that these treatment results were compatible with those reported in previous studies, and supported the clinical use of Ketac-Endo as an acceptable endodontic sealer.

Adolescent↗
PubMed1995

A supervisory model of professional competence: a joint service/education initiative.

This article is concerned with describing how a National Health Service (NHS) Hospital Trust teamed up with a College of Nursing and Midwifery to develop a model of clinical supervision. The article discusses definitions of clinical supervision, which were used as a basis for the development of the model; identifies the roles and responsibilities of clinical supervisors and describes the foundations of an integrated system of educational and professional development. The model aims to set standards for clinical competence which facilitate continuity in professional development throughout the practitioner's career. The collaboration between the two organisations has ensured that the model reflects the inter-relationship between theory and practice, thus enhancing both academic and professional development. The result is a comprehensive model for clinical supervision which encompasses key national initiatives in both professional and educational fields; in particular the United Kingdom Central Council (UKCC) requirements for continuing registration, maintenance of a portfolio of professional development, and continuing education (PREP) and the Ten Key Characteristics of the English National Board (ENB) Higher Award. It also encourages practitioners to demonstrate good practice through the requirement to articulate and enhance professional knowledge using a portfolio, along with a system of peer review and defined clinical competencies.

Clinical Competence↗
PubMed1995

Psychosocial adjustment among returnees to Judaism.

Two groups of returnees to Orthodox Judaism who were among Lubavitcher Hasidim attending an outpatient mental health center were studied to investigate a relief effect upon returning. One group manifested lifelong serious psychopathology, and the members of the comparison group, who had undergone similar religious transition, had sought help for adjustment-type problems. The psychopathology manifested prior to religious change persisted for those who had exhibited a lifelong history of pathology, even after the radical transition. The lack of a relief effect and the lifestyles possibly unique to Lubavitcher Hasidim are discussed.

Adult↗
PubMed1995

Trivial or terrible? The psychosocial impact of psoriasis.

BACKGROUND: Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. METHODS: The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment. RESULTS: Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well. CONCLUSIONS: Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.

Anger↗
PubMed1995

Microalbuminuria: prognostic and therapeutic implications in diabetic and hypertensive pregnancy.

Microalbuminuria is defined as urinary excretion of albumin that is persistently above normal, although below the sensitivity of conventional semiquantative test strips. Several studies have reported that Type 1 diabetic patients with microalbuminuria are apparently more likely to develop diabetic nephropathy eventually progressing to renal failure. Microalbuminuria is also a strong predictor of mortality in Type 2 diabetes, and is correlated with increased blood pressure in patients with benign essential hypertension. Radioimmunoassay revealed a significantly higher urinary albumin excretion rate in normal pregnant women in the third trimester of pregnancy, compared to the second and first, and compared to non-pregnant women. Microalbuminuria was found in 30% of women who had a record of gestational diabetes mellitus. Published results are controversial regarding the assumption that microalbuminuria is an early predictor of pregnancy-induced hypertensive complications.

Albuminuria↗
PubMed1995

Cardiac disease and nonorganic chest pain: factors leading to disability.

Research has shown that many chest pain patients, without coronary artery disease, may suffer from panic disorder, hypochondriasis, depression, and/or multiple phobias. Some patients with coronary artery disease may also suffer from these disorders and are often unable to return to previous activity. In spite of good prognosis for longevity and acceptable exercise test results, a large proportion of these patients continue to be disabled by chest pain and/or chronic cardiac fears and demand constant medical attention. This study examined the psychiatric and behavioral symptomatology that differentiated four groups of patients experiencing chest pain: the able (active/working patient) with and without coronary artery disease, as determined by exercise thallium-201 studies, and the disabled (inactive/nonworking patient) with and without coronary artery disease. The results of the study indicated that the inactive patients, both with and without heart disease, suffered from a host of debilitating psychiatric conditions.

Aged↗
PubMed1995

Treatment of Hassidic Jewish patients in a general hospital medical-psychiatric unit.

A combined medical-psychiatric inpatient unit at a general medical center in Brooklyn, New York, provides inpatient psychiatric treatment to members of the Orthodox Jewish sect of the Lubavitcher Hassidim, who are generally reluctant to accept treatment in traditional psychiatric inpatient settings. The unit's biological treatment model, which emphasizes long-term maintenance on psychotropic medication, monthly postdischarge pharmacotherapeutic visits, lowered expectations, and minimal use of expressive psychotherapy, is compatible with the Hassidic community's view of mental illness. A practicing Orthodox Jewish psychiatrist on the unit staff sensitizes other staff members to religious and cultural issues in treating Hassidic patients.

Adult↗
PubMed1995

Microalbuminuria following gestational diabetes.

BACKGROUND: Microalbuminuria (MA) precedes clinical nephropathy in patients with insulin-dependent diabetes mellitus, and is associated with an increased mortality, mostly due to cardiovascular disease in patients with non-insulin-dependent diabetes mellitus. Microalbuminuria is rarely detected in patients with diabetes of less than five years' duration. Our study was designed to determine whether MA and its sequelae also appear 5-8 years after pregnancy complicated by gestational diabetes mellitus (GDM). METHODS: We examined the presence of MA in 72 women who had not conceived since a previous GDM-pregnancy 5-8 years ago and compared them to a control group of 35 women who had no GDM history, and who were matched for age, parity and time since last pregnancy. Microalbuminuria was determined in all subjects using an overnight 8 hours urine collection. Mann-Whitney rank-sum test was used to compare data between the study and the control groups. Student's t test was used to compare data within the study group. RESULTS: Median value of the urinary albumin excretion rate (AER) in the study group was significantly higher than median value of urinary AER of the control group (p < 0.0001), but only 30.5% of the subjects of the study group were found to be microalbuminuria-positive, defined as urinary AER value of more than 21 mg/24 h. No correlation between MA and blood pressure, fasting blood glucose, serum creatinine, blood urea nitrogen and parity was found. CONCLUSIONS: MA was found to be more frequent after GDM and no predisposing factors for its appearance were elucidated. Hence, we suggest that it may well be a sign of early renal disease and that long-term follow-up of all GDM patients for MA and other markers of renal disease is strongly indicated.

Adult↗
PubMed1995

New York City physicians serving high volumes of Medicaid children: who are they and how do they practice?

This study examined, in 1993, the characteristics and practices of New York City physicians who submit large numbers of Medicaid claims for children. Of our sample of 33 physicians, more than 90% were educated outside the United States; fewer than half were board certified or had hospital staff appointments. These physicians saw a clientele who were 98% Medicaid; most visits (82%) were at a time of acute illness. With the rapid advent of mandatory, Medicaid managed care in New York City, and with the large estimated gap in primary care capacity in the inner city, policy questions arise as to whether these physicians should be integrated into managed care plans. If they are not, the question becomes: how will they be replaced?

Adolescent↗
PubMed1995

[Eating disorders and metabolic balance in a population++ of young adults with insulin-dependent diabetes].

We have compared the prevalence of Eating Disorders in a population of 69 out-patients with Insulin-Dependent Diabetes Mellitus including a sample of diabetic young women (average year: 23 years) with two control populations (45 medicine out-patients and 54 girl students). The diabetic population didn't present no more eating disorders--measured by self-report questionnaires (EAT, BITE) than the control population. In a sample of 40 diabetic subjects--having participated in a diagnostic structured interview (LENTCA) based on DSM-III-R criteria: nobody has anorexia nervosa, one woman has bulimia nervosa, the lifetime prevalence of bulimia nervosa not otherwise specified was 21% for men and 43% for women. Bulimia Disorders--measured by self report questionnaire (BITE) and noncompliance were linked with poor glycemic control.

Adult↗
PubMed1995

Evaluation of Community Care Network (CCN) system in a rural health care setting.

Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.

Attitude to Computers↗