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Biomedical subjects

S Houston

Publications and source records attributed to S Houston.

At least 91 records · Page 5Linked to original sources
PubMed1992

Pulmonary Kaposi's sarcoma in Africa.

BACKGROUND: A study was carried out to identify the main clinical radiological and bronchoscopic features of HIV related Kaposi's sarcoma of the lung in African patients. METHODS: Forty seven HIV positive patients with epidemic Kaposi's sarcoma who had clinical or radiological respiratory changes were investigated by simple lung function tests and fibreoptic bronchoscopy. RESULTS: The most common respiratory symptoms in the 47 patients were persistent cough in 42, haemoptysis in 23, and breathlessness in 38. A restrictive spirometric pattern was most common. The mean (SD) forced expiratory volume in one second (FEV1) was 1.88 (0.62) 1 with a forced vital capacity (FVC) of 2.66 (0.87) 1 and a FEV1/FVC% of 73.2 (7.5). On the chest radiograph 26 patients had diffuse reticulonodular shadows, 11 focal nodular shadows, seven a pleural effusion, and one a substantial increase in vascular markings; in two the radiograph was normal. At bronchoscopy characteristic discrete lesions were easily visible in 37 patients and were often bright red. Multiple nodules were seen in 11, flat or early plaque lesions in 12 (14 had both), proximal flat lesions and diffuse infiltration in three, diffuse infiltration alone in four, and masses in two; one had normal appearances at bronchoscopy. One patient had Pneumocystis carinii and two had a single bacterial pathogen cultured from the bronchoalveolar lavage fluid. Only two of 29 bronchoscopic biopsies showed classical histological Kaposi's sarcoma. After cytotoxic treatment 20 patients have died, with an overall median survival of 70 days. CONCLUSION: In this African population symptomatic pulmonary Kaposi's sarcoma was common, with lesions seen in all but one patient at bronchoscopy. Coexistent infection was uncommon. Prognosis was poor despite treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Neurocysticercosis: experience with diagnosis by ELISA serology and computerised tomography in Zimbabwe.

Over a three-year period, 646 sera from 630 patients with signs and symptoms compatible with neurocysticercosis were investigated for antibodies to cysticercal antigens using an ELISA test. Overall, 12 pc specimens were positive. The sensitivity of the ELISA, when compared with a limited number of computerised tomography investigations, was over 70 pc. False negative serology was associated with HIV infection in some patients. The positive predictive value was 87 pc and the negative predictive value was 85 pc when patients with active infection, potentially amenable to chemotherapy, were considered. The specificity, determined from serological tests of patients with a variety of trematode, cestode and other infections, was over 90 pc. Three of 11 patients with intestinal taeniasis, and each of two patients with hydatid disease were seropositive. The results suggest the value of ELISA serology as a more cost-effective diagnostic method for all patients with suspected cysticercosis.

Adult↗
PubMed1991

Absentee patterns among OR staff. Identifying aspects of the problem.

Absenteeism continues to be a great concern to hospital administrators. Nursing personnel should have a clear idea of acceptable attendance parameters based on written policies that are routinely administered. Efforts are now directed toward exploring strategies that reward personnel for good attendance records. Early development of professional attitudes related to absenteeism should continue to be supported and fostered. Implications from this preliminary study indicate that it may be more cost-effective to hire RNs than STs to work in ORs.

Absenteeism↗
PubMed1991

Measuring success: CNS performance appraisal.

With the current focus on quality outcomes and economic issues related to health care, clinical nurse specialists (CNSs) must effectively document their unique contributions that enhance the realization of organizational missions. This paper examines an outcome-oriented performance appraisal tool designed to quantify CNS services. Eleven performance criteria with performance behaviors were negotiated by CNSs and their respective supervisors based on job descriptions and organizational goals. A quantitative scoring system was then developed based on specific performance behaviors. This method of objective outcome based evaluation has not only substantiated the CNS's value but also has enhanced collaboration between CNSs and administrators.

Consultants↗
PubMed1991

Therapeutic review: tuberculosis.

Tuberculosis (TB) is increasing in Zimbabwe and other countries in Africa and world-wide. TB treatment and control face new difficulties including the impact of the HIV epidemic and drug resistance. There is now abundant evidence that six-month regimens are highly effective and, by improving compliance, can improve results and the cost-effectiveness of therapy. Intermittent therapy reduces drug costs and allows for the possibility of complete supervision. The optimal management of the HIV-infected TB patient has not yet been established but an increased rate of drug reactions suggests that standard treatment should be reassessed.

Antitubercular Agents↗
PubMed1990

High levels of Epstein-Barr virus in the oropharynx: a predictor of disease progression in human immunodeficiency virus infection.

The role of Epstein-Barr virus (EBV) on the progression of human immunodeficiency virus (HIV) infection is not well defined. The objective of this prospective study was to determine the prevalence of EBV excretion and the role that EBV might have on HIV disease progression. Fifty-two homosexual males were studied, all of whom had positive EBV serology. Twenty-four of the 27 HIV-seropositive and 14 of the 25 HIV-seronegative subjects had detectable levels of EBV DNA in oropharyngeal cells. In addition to a greater prevalence of detectable EBV, the level of excretion was higher among HIV-seropositives than among HIV-seronegatives, and higher among group III than among group II HIV-seropositive men. These results are consistent with earlier studies showing a relationship between immunosuppression and EBV reactivation. The EBV excretion levels in a control group of 52 age-matched heterosexual males were substantially lower than those found in the homosexual group. In a proportional hazards regression analysis EBV excretion was found to be the best single predictor of progression of HIV infection (P less than 0.001). HIV p24 core antigenemia (P = 0.048) and low EBNA (P = 0.024) were significant predictors independent of EBV excretion. Whether EV directly accelerates the time to progression or is merely a marker of underlying subclinical immunosuppression remains an open question.

Antigens, Viral↗
PubMed1990

The effectiveness of bacillus Calmette-Guérin (BCG) vaccination against tuberculosis. A case-control study in Treaty Indians, Alberta, Canada.

Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis has been used around the world for 60 years, yet its efficacy in large, controlled prospective studies is inconsistent. The factors influencing BCG protection include variation in immunogenic potential, background exposure to environmental mycobacteria, and differences in host response to vaccine. As a means of addressing regional differences in protection, case-control studies provide a relatively inexpensive, rapid means of assessing regional vaccine effects. Treaty Indian cases (n = 160) resident in Alberta, Canada, presenting during a 5-year period (1975-1979) were individually matched for age, sex, and Band with two nontuberculous controls. A 57 percent protection by BCG vaccination was demonstrated. These results support the usefulness of case-control studies and their importance in planning tuberculosis control programs.

Adolescent↗
PubMed1990

Case discussion in clinical pharmacology: application of small group teaching methods to a large group.

Problem-oriented case discussion is a valuable teaching tool in clinical pharmacology. Small groups are ideal for discussion but attempts to extend this to large groups often magnify the problems seen with small group discussion to an unacceptable extent. We describe a format which overcomes many of the problems encountered. The class is divided into groups of six students. Cases for discussion are distributed a week before discussion. Individual groups meet, research, discuss, form a consensus opinion and appoint a chairperson for each topic. The class meets and two groups are randomly chosen to discuss the first topic. The chairperson of the first group briefly presents the group's analysis of the problem. The chairperson of the second group then acts as an 'interrogator', questioning statements of fact, application of knowledge or logic, and offers alternative opinions. After discussion between the two groups the rest of the class join the discussion. Two new groups are chosen for the second case. This format facilitates self-directed learning, well-prepared participants and worthwhile discussion.

Group Processes↗
PubMed1990

Therapeutics review: the use of parenteral drugs for falciparum malaria.

Recent studies on the pharmacokinetics of parenteral chloroquine and quinine have resulted in safer regimens for the treatment of severe falciparum malaria. In this article we summarise these regimens, and discuss the emergence of chloroquine resistance and the implications for treatment.

Animals↗
PubMed1990

Therapeutic review: antibiotic prophylaxis for bacterial endocarditis.

A recent survey of antibiotic prophylaxis found that local practice often differed from that recommended by authoritative bodies such as the British Society for Antimicrobial Chemotherapy (BSAC) and the American Heart Association (AHA). Practitioners found the subject confusing and requested guidance. For these reasons we present current recommendations. Unfortunately all recommendations are based on animal studies and an understanding of the pathogenesis of bacterial endocarditis in humans. There are no controlled trials in humans on which to base guidelines, so rigidity is inappropriate. It is also important to realise that optimal prophylaxis will not eliminate bacterial endocarditis. In developed countries it has been estimated that only 10% of cases of endocarditis are theoretically preventable.

Anti-Bacterial Agents↗
PubMed1989

Genital ulcers and transmission of HIV among couples in Zimbabwe.

Seventy-five married men found to be positive for HIV-1 in Harare, Zimbabwe, were interviewed in order to define behaviours associated with acquisition of infection and to determine factors associated with transmission of infection to their wives. The majority of infected men reported sexual intercourse with multiple heterosexual partners and female prostitutes, and gave a history of sexually transmitted diseases (STDs). All subjects denied homosexual activity and parenteral drug abuse. Serological testing of the wives of seropositive men showed that 45 (60%) were HIV-antibody-positive. Wives of men with AIDS and AIDS-related complex (ARC) and wives of men who gave a history of genital ulcer disease were more likely to be seropositive. The study demonstrates that HIV-1 infection in Zimbabwe occurs through heterosexual intercourse and is associated with other STDs. In addition, the study shows that male to female transmission of HIV-1 is facilitated by the presence of genital ulcers in infected men.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A statistical approach to the discrimination of the cranial form.

In a study of lateral cephalographic dimensions, their multivariate statistical analysis was shown to discriminate between patients with gross cranial anomalies and controls exhibiting no abnormal morphology. Although the degree of discrimination depended upon the group of dimensions included in the analysis, discrimination was more consistent than when compared using univariate statistical techniques. As cephalographic dimensions combine both size and shape parameters together, however, the interpretation of such contrasts must await more specific analytic techniques development.

Cephalometry↗