Biomedical subjects
Publications and source records attributed to S George.
Opportunistic infections are known to occur with increased frequency in patients with Cushing's syndrome, particularly those due to ectopic ACTH production. This report highlights the rare situation of a patient with Cushing's disease having candidal oesophagitis as one of the major presenting manifestations.
In the light of the White Paper Working for patients, this study addresses two questions: first, whether the current pattern of service use is a valid surrogate for the assessment of the service needs of a population; second, given that information systems which will provide accurate cost per case information are several years from being implemented, what differences might be made to a specialty budget by the adjustment of case costs by use of different case-mix measures. ENT has been chosen as a case study because of its relative 'market potential'. The study addresses the first question by examining the variations in the current level and type of service use across Districts in a Region. The large variation in utilization across Districts, both in total and for different degrees of case complexity, suggests that the current pattern of service use is a poor indicator of need. The second part of the study examines a Unit which has large inflows of complex patients. Adjusting for case-mix, however, produces a comparatively small effect on the overall specialty budget, whether the adjustment is made using the BUPA schedule of surgical procedures or using diagnosis-related groups. In the light of these results, it is suggested that the current emphasis on accurately costing case-mix could be misplaced, and that more resources should be diverted to scrutinizing the appropriateness of service use to health needs and priorities, in line with the aims of the NHS reforms.
The World Health Organization (WHO) has recommended a fixed duration of multidrug therapy (MDT) for paucibacillary leprosy which is currently widely implemented in India. A clinico-pathological study was initiated in 1984 to assess the efficacy of this regimen. The clinical and histological responses of the patients to MDT were assessed at the end of 6 months, when their treatment was stopped, and at 2 1/2 years, when they were released from surveillance, and compared with the responses of a matched patient group to conventional dapsone (DDS) monotherapy during the same period. Of 28 patients who completed the MDT schedule, there was less than 60% improvement in 33% of them when treatment was stopped at the end of 6 months and in 20% of them at the end of 2 1/2 years. Of 26 patients receiving DDS monotherapy, 37% showed less than 60% improvement at the end of 6 months but only 8.8% had less than 60% improvement at 2 1/2 years. It is concluded that MDT for paucibacillary leprosy as recommended by WHO may not have a major advantage over DDS monotherapy, since about 20% of those patients on MDT continue to have evidence of active disease when discharged from surveillance.
Seventy-six patients with classic high-grade osteosarcoma of an extremity received adjuvant chemotherapy by two protocols, initiated in 1972 and 1977, respectively, after appropriate amputations. Chemotherapy consisted of high-dose methotrexate, doxorubicin, and cyclophosphamide. Dose intensity of high-dose methotrexate and doxorubicin was greater for the patients treated with the protocol initiated in 1977. The proportion of long-term disease-free survivors on the two protocols are 46% and 56%. A better outcome (P = 0.042) was seen for the latter group, which received more intensive chemotherapy. Overall, metastases developed in 35 patients; in 19 who were receiving chemotherapy and in 16 after chemotherapy. The outcome for these two protocols, compared with two control groups that were given no chemotherapy or ineffective chemotherapy (biweekly vincristine and cyclophosphamide), confirms the results of controlled studies that showed an advantage of adjuvant chemotherapy after amputation for osteosarcoma.
The effects of metolazone on the protein binding of glibenclamide were studied. It was found that increasing metolazone concentrations up to 100 ng/ml had no significant effect on the protein binding of glibenclamide studied at 10 micrograms/ml. Metolazone is unlikely to cause a clinically significant increase in the free fraction of glibenclamide in patients receiving both drugs.
The efficacy of copper bactericides for control of Xanthomonas campestris pv. vesicatoria in eastern Oklahoma tomato fields was evaluated. Copper bactericides did not provide adequate control, and copper-resistant (Cu) strains of the pathogen were isolated. The Cu genes in these strains were located on a large indigenous plasmid designated pXV10A. The host range of pXV10A was investigated; this plasmid was efficiently transferred into 8 of 11 X. campestris pathovars. However, the transfer of pXV10A to other phytopathogenic genera was not detected. DNA hybridization experiments were performed to characterize the Cu genes on pXV10A. A probe containing subcloned Cu genes from X. campestris pv. vesicatoria E3C5 hybridized to pXV10A; however, a subclone containing Cu genes from P. syringae pv. tomato PT23 failed to hybridize to pXV10A. Further DNA hybridization experiments were performed to compare pXV10A with pXvCu plasmids, a heterogenous group of Cu plasmids present in strains of X. campestris pv. vesicatoria from Florida. These studies indicated that the Cu genes on pXV10A and pXvCu plasmids share nucleotide sequence homology and may have a common origin. Further experiments showed that these plasmids are distinctly different because pXV10A did not contain sequences homologous to IS476, an insertion sequence present on pXvCu plasmids.
Activity within several states over the past two decades to require a baccalaureate nursing degree as the minimum educational preparation for licensure as a registered professional nurse is reviewed as an example of policy innovation and diffusion. Sufficient ratio of baccalaureate degree to associate degree programs and political party turnover in the governor's office have frequently accompanied private and public policy action on BS entry.
An outbreak of encephalitis in Bellary district of Karnataka state and adjoining areas of Andhra Pradesh which occurred during October 1986 to January, 1987, has been investigated. Out of the 219 patients reported, 110 were from Bellary district and the remaining 109 were from Anantapur and Kurnool districts of Andhra Pradesh; 131 (59.8%) were males and 88 (40.2%) females, while 192 (87.7%) patients were aged 10 yr and below. Sixty one patients died giving a case fatality rate of 27.9 per cent. Virological/serological investigations were carried out on 153 patients. Japanese encephalitis (JE) virus was isolated from the brain tissue of 2 cases. On the basis of the results of serological tests and virus isolation, a flavivirus (JE/WN/DEN) etiology could be established in 116 (75.8%) patients.
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One hundred and fifty cases of Japanese encephalitis (JE) in children below 12 years of age admitted to the Headquarters Hospital, Bellary Medical College during October, 1986 to January, 1987 were studied. The youngest child affected was 1 year old. The ratio of male to female was 2:1. Hindu patients (93.33%) were significantly more than Muslim patients (6.6%). The average duration of illness prior to hospitalisation was 4.2 days (SD +/- 1.9 days). Fever, headache and/or vomiting were common presenting symptoms at the onset of illness. Onset of illness was acute or sub-acute in 105 cases (70%). CSF examination showed pleocytosis with lymphocytic reaction and normal sugar. Japanese encephalitis virus was isolated from the brain biopsy tissue in one case and the seropositivity rate for JE was 50%. The mortality was 26% and was directly related to younger age, longer duration of illness prior to admission and deeper grade of coma at the time of admission. Moderate to severe sequalae were seen in 31 patients (28.82%). The mean duration of hospital stay was 8 days.
Comparisons of peritoneal clearances, hematologic and biochemical assays were performed on eleven CAPD patients using 2 liter and 2.5 liter daily exchanges. Group 1 consisted of 8 patients substituting all four daily 2 liter exchanges. These patients experienced statistically significant increases in urea and creatinine clearance (an average of 15% and 10% respectively). Corresponding reductions in serum levels occurred (8% and 9% respectively). Ultrafiltrate volume increased by an average of 12%. Group II consisted of 3 patients that substituted one 2 liter exchange. These patients also experienced increases in urea and creatinine clearance (8% and 11% respectively) and decreases in corresponding serum levels (1% and 4% respectively). Ultrafiltrate volume increased an average of 12%. After one month on the 2.5 liter regimen, patients were surveyed for their reactions to larger exchange volumes. Ninety-one percent of patients decided to continue using the 2.5 liter volume. Reasons cited included feeling better and having better weight and fluid control. None of the patients demonstrated complications such as catheter leakage or hernias. The use of four daily 2.5 liter exchanges can provide over 20% more clearance for many CAPD patients currently using 2 liter exchanges. This survey demonstrates most patients tolerate 2.5 liters, and they feel better. A 2.5 liter regimen may be indicated for patients who could benefit from more dialysis and for those at risk of dropping out of CAPD due to inadequate dialysis.
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The properties of antibodies generated in rabbits against native riboflavin carrier protein (cRCP), riboflavin carrier protein that had been denatured/renatured by SDS treatment (SDS-RCP) or disulphide-bond-reduced then S-carboxymethylated (Carb-RCP) were studied. SDS-RCP could displace native RCP in radioimmunoassay (r.i.a.), whereas Carb-RCP could not. By using antibodies raised in five different rabbits against native cRCP, 125I-labelled Carb-RCP could bind between 0 and 30% of the native antibodies. Antibodies raised against native RCP appear to be largely directed towards specific conformational determinants of RCP. Carb-RCP displaced native RCP in an r.i.a. using antibodies raised against SDS-RCP. SDS denaturation presumably unmasks cryptic epitopes in native RCP. Carb-RCP was a weak immunogen and elicited, presumably, antibodies to sequential epitope/epitopes. When injected into pregnant mice the antibodies caused neutralization of RCP, leading to termination of pregnancy, indicating highly conserved sequential epitopes in chicken and rodent RCP. Antibodies raised against Carb-RCP or native RCP reacted with CNBr fragments of native RCP, further confirming the presence of sequence-specific antibodies elicited by Carb-RCP.
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Cow calves were infected with Japanese encephalitis virus (JEV) by parenteral inoculation. One batch was reinfected with JEV, followed by West Nile virus (WNV), while another batch was reinfected directly with WNV. No viraemia due to either JEV or WNV was demonstrated in any of the calves. Culex tritaeniorhynchus mosquitoes fed on 4 of the calves infected with JEV during the first 10 d had no detectable virus, nor did they transmit the virus by bite to susceptible baby chickens. In another experiment, calves did not develop viraemia after infected C. tritaeniorhynchus mosquitoes were allowed to feed on them. Neutralizing and/or haemagglutination-inhibiting antibodies against JEV were demonstrated in 6 of the 11 calves, which explains the high proportion of JE seropositives among cattle in India. All the 5 calves that were infected with WNV subsequent to JEV developed neutralizing and haemagglutination-inhibiting antibodies against WNV also. The study indicates that cattle do not play a role in the maintenance of JEV in nature.
Human cord serum contains protein(s) capable of binding to [14C]-riboflavin. Riboflavin-bound protein cross-reacts with anti-serum to chicken riboflavin carrier protein (cRCP). The carrier protein was isolated using affinity chromatography on a riboflavin AH Sepharose column. Bulk isolation and purification was also attempted by a combination of ion exchange, gel filtration and gel permeation chromatography on HPLC. The protein so isolated had a molecular weight of 36,000 +/- 2,000 daltons with an isoelectric point of 4.1. The levels of RCP in maternal serum during pregnancy were monitored using a sensitive heterologous radioimmunoassay system, using cRCP as standard and anti serum to cRCP. The levels of the protein increased after 4 months and remained significantly elevated up to 8 months. Although the level of the protein in the maternal serum remained low until 4 months, its level in amniotic fluid was elevated 2-3-fold as compared to that in serum.