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Biomedical subjects

S M Lewis

Publications and source records attributed to S M Lewis.

At least 55 records · Page 3Linked to original sources
PubMed1998

Angioscopy of culprit coronary lesions in unstable angina pectoris and correlation of clinical presentation with plaque morphology.

This study demonstrates that plaque disruption and thrombus are absent in a considerable number of patients with unstable angina and that culprit lesion morphologies as assessed by angioscopy may differ among the various clinical subsets of patients. Although plaque disruption and thrombus undoubtedly play an important role in the pathogenesis of unstable angina, alternative mechanisms may be responsible for ischemia in some patients.

Adult↗
PubMed1998

Effects of movement predictability on cortical motor activation.

Humans have the ability to make motor responses to unpredictable visual stimuli, and do so as a matter of course on a daily basis. We used functional magnetic resonance imaging (fMRI) to examine the neural substrate of this behavior in six cortical motor areas. We found that five of these areas (premotor, cingulate, supplementary motor area, pre-supplementary motor area, and superior parietal lobule) showed increased activation in association with an unpredictable behavior compared to a predictable one; only the motor cortex remained unchanged. There was also a quantitative relation between the response time and functional activation in the premotor and cingulate cortex. There was less activation across all the motor areas with repetition of the motor tasks. With the exception of the pre-supplementary motor area, all areas were significantly lateralized, with a greater volume of activation in the hemisphere contralateral to the performing hand. In addition, a left hemisphere dominance was found in the activation of motor cortex and supplementary motor areas. Our results suggest that activation in motor areas is differentially and quantitatively related to higher order aspects of motor behavior such as movement predictability.

Adult↗
PubMed1998

Guidelines for organisation and management of external quality assessment using proficiency testing. Expert Panel on Cytometry of the International Council for Standardization in Haematology.

This document is intended to assist towards the WHO objective that external quality assessment (EQA) schemes be established at national and/or regional levels world-wide. Quality assurance is defined as all steps taken by the director of a laboratory to ensure reliability of laboratory results and to increase accuracy, reproducibility and between-laboratory comparability. This includes the use of internal quality control procedures and participation in external quality assessment. Internal quality control provides the means for evaluation of analytic test results at the time of testing in order to decide whether they are reliable enough to be released to the requesting clinicians. EQA, on the other hand, refers to a system of retrospective and objective comparison of results from different laboratories by means of proficiency testing (PT) organised by an external agency. The main purpose is to establish between-laboratory and between-method (including between-instrument) comparability, and agreement with a reference standard where one exists. Internal quality control and EQA complement each other and must never be considered as alternatives.

Animals↗
PubMed1998

Hairpin coding end opening is mediated by RAG1 and RAG2 proteins.

Despite the importance of hairpin opening in antigen receptor gene assembly, the molecular machinery that mediates this reaction has not been defined. Here, we show that RAG1 plus RAG2 can open DNA hairpins. Hairpin opening by RAGs is not sequence specific, but in Mg2+, hairpin opening occurs only in the context of a regulated cleavage complex. The chemical mechanism of hairpin opening by RAGs resembles RSS cleavage and 3' end processing by HIV integrase and Mu transposase in that these reactions can proceed through alcoholysis. Mutations in either RAG1 or RAG2 that interfere with RSS cleavage also interfere with hairpin opening, suggesting that RAGs have a single active site that catalyzes several distinct DNA cleavage reactions.

Alcohols↗
PubMed1998

A physical map of the Leishmania major Friedlin genome.

An extensive physical map of the Leishmania major Friedlin genome has been assembled by the combination of fingerprint analysis of a shuttle vector cosmid library and probe hybridization. The integrated data obtained for 9004 fingerprinted clones and 974 probes have placed 91.2% of the 33.58-Mb genome into contigs representing each of the 36 chromosomes. This first-generation map has already provided a suitable framework for both high-throughput DNA sequencing and functional studies of the L. major parasite.

Animals↗
PubMed1998

An inexpensive and reliable new haemoglobin colour scale for assessing anaemia.

AIM: To describe a new inexpensive method (the WHO Colour Scale) for estimating haemoglobin concentration from a drop of blood by means of a colour scale, and to compare its reliability with a standard laboratory method of measuring haemoglobin, and its clinical usefulness in field trials. METHODS: The new colour scale method was used to measure haemoglobin concentration in 1213 random venous blood samples from routine work in four laboratories (one each in the UK, South Africa, Thailand, and Switzerland). Limited field trials of the method for assessing clinical usefulness were done in a rural hospital (in South Africa) staffed by nurses, at two blood donor sessions (one each in South Africa and Thailand), and by nonlaboratory personnel in malaria clinics (in Thailand), following training and a short practice session. RESULTS: In the laboratory based comparability study the presence of anaemia was reliably detected using the new method with 91% sensitivity and 86% specificity. Clinically relevant levels of anaemia (mild to moderate, pronounced, and severe) were graded and serious anaemia (< 8 g/dl) was identified with an efficiency of 89%. The clinical trials showed the ease and reliability with which the colour scale could be used by non-laboratory persons after brief training. The blood donor trials showed it to be at least as reliable as the copper sulphate method with the advantage of being more convenient. CONCLUSIONS: The preliminary studies have shown that the WHO Colour Scale is a reliable screening method for detecting anaemia, especially for diagnosing serious anaemia. Following a brief training session health workers found it simple to use and, at a cost of about 1/10th that for traditional photometric analysis, it should be of value in "countries in need" for primary health centres, obstetrical management, paediatric clinics, tropical disease control programmes, blood transfusion donor selection, as well as for industrial health checks and epidemiological studies.

Anemia↗
PubMed1997

Angioscopic assessment of coronary lesions underlying thrombus.

This study examines the characteristics of coronary lesions in which thrombus is found as assessed by angioscopy before percutaneous transluminal coronary angioplasty in patients with various coronary syndromes. Our findings demonstrate that the plaque underlying intracoronary thrombus is usually yellow and/or disrupted, and support in vitro observations that lipid-rich plaques are highly thrombogenic and that disruption of these plaques is associated with in situ thrombosis.

Angioscopy↗
PubMed1997

Frequency, risk factors, and outcome for bacteremia after percutaneous transluminal coronary angioplasty.

The objectives of this study were to examine bacteremias after percutaneous transluminal coronary angioplasty (PTCA) with respect to incidence, outcome, and risk factors. Patients undergoing PTCA from January 1990 through April 1994 were studied; during this period a total of 4,217 PTCAs were performed in 3,473 patients. With use of predefined clinical and microbiologic criteria, bacteremias were divided into 3 categories according to the relation to the PTCA procedure: PTCA-related, unrelated, and indeterminate. Ninety-one patients with at least 1 positive blood culture during a 7-week period after PTCA were identified. The bacteremia was classified as unrelated to the PTCA procedure in 32 patients, PTCA-related in 27, and indeterminant in the remaining 32 patients. The attack rate of PTCA-related bacteremia during the 52-month period was 0.64%. The most common organisms causing PTCA-related bacteremia were Staphylococcus aureus (14 patients), coagulase-negative staphylococci (9 patients) and group B streptococci (6 patients). Septic complications, which included femoral artery mycotic aneurysm, septic arthritis, and septic thrombosis, occurred in 10 patients (0.24%). Independent risk factors for PTCA-related bacteremia included duration of procedure (odds ratio [OR] 2.9; p = 0.04), number of catheterizations at the same site (OR 4.0; p = 0.015), difficult vascular access (OR 14.9; p = 0.007), arterial sheath in place > 1 day (OR 6.8; p = 0.025), congestive heart failure (OR 43.3; p = 0.002). Thus, PTCA-related bacteremia is an infrequent complication of PTCA but can be associated with significant morbidity, particularly when the infecting organism is S. aureus. Four of the 5 risk factors for PTCA-related bacteremia appear to correlate directly with increased vascular injury or maintenance of the arterial entry for the procedure.

Aged↗
PubMed1997

Synaptic vesicle glutamate uptake in epileptic (EL) mice.

The ATP-dependent glutamate uptake system of synaptic vesicles was investigated in epileptic (EL) mice to determine whether glutamate uptake activity correlates with seizure susceptibility or development. Given the focal seizure onset, glutamate uptake activity was measured in four separate brain regions: cerebrum (minus hippocampus), hippocampus, cerebellum, and brain stem. The EL values were compared to those of age-matched controls; DDY and ABP/LeJ (ABP) mice. The glutamate uptake specific activity for EL cerebrum was significantly higher than that for the control mice (approx. 400 days old), but was not elevated prior to seizure onset (46 days old). No difference in glutamate uptake was observed between the strains in the other brain regions. We conclude that increased synaptic vesicle glutamate uptake is brain-region specific (cerebrum) and is associated with the development or maintenance, rather than the initial cause, of seizures in the EL model of epilepsy.

Adenosine Triphosphate↗
PubMed1997

Nosocomial transmission of Trichophyton tonsurans tinea corporis in a rehabilitation hospital.

OBJECTIVE: Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis. DESIGN: Descriptive study of a nosocomial epidemic of tinea corporis. SETTING: A free-standing inpatient rehabilitation facility. PARTICIPANTS: Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis. RESULTS: T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%). CONCLUSIONS: This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precautions.

Adult↗
PubMed1997

Cryptic signals and the fidelity of V(D)J joining.

V(D)J recombination is responsible for the de novo creation of antigen receptor genes in T- and B-cell precursors. To the extent that lymphopoiesis takes place throughout an animal's lifetime, recombination errors present an ongoing problem. One type of aberrant rearrangement ensues when DNA sequences resembling a V(D)J joining signal are targeted by mistake. This study investigates the type of sequence likely to be subject to mistargeting, the level of joining-signal function associated with these sequences, and the number of such cryptic joining signals in the genome.

Animals↗
PubMed1997

Potentiation of nephrotoxicity by H2-antagonists in patients receiving cyclosporine.

The literature does not support a pharmacodynamic interaction between H2-antagonists and cyclosporine that would result in potentiation of cyclosporine's nephrotoxicity. The increase in serum creatinine associated with cimetidine, in the majority of cases, is due to competition with creatinine for tubular secretion. Ranitidine is unlikely to produce a change in serum creatinine. Additionally, there is no support for a pharmacokinetic interaction. However, cimetidine may influence peak concentrations of cyclosporine. Besides the clinical data reviewed here, two abstracts concur with these findings. Information was unavailable regarding interactions between cyclosporine and either famotidine or nizatidine that potentiate nephrotoxicity in transplant patients. Furthermore, the drug manufacturers state that no evidence is available to support any interaction of their products with cyclosporine. Thus, interpretation of renal function may be confusing with concomitant administration of cimetidine and cyclosporine unless GFR is accurately monitored. On the basis of the information available at this time, ranitidine may be considered the H2-antagonist of choice in a patient treated with cyclosporine.

Animals↗
PubMed1997

Patient survey of a pharmacist-managed anticoagulation clinic.

The literature describing pharmacy involvement with anticoagulation services primarily does not include information about patients' perceptions of this involvement. A 22-question survey was developed and administered to 296 patients enrolled in the anticoagulation clinic at the VA Pittsburgh Health Care System. Excluded patients had fewer than four clinic visits or were followed outside of the anticoagulation clinic. The study period was nine weeks and any missed patients were telephoned. The median response to each question was determined. Similar questions were analyzed for acquiescent trends. Results indicate that, overall, patients are comfortable with pharmacists providing warfarin monitoring and dose adjustments.

Adult↗
PubMed1997

Field evaluation of a novel haemoglobin measuring device designed for use in a rural setting.

OBJECTIVE: To evaluate the use of a robust, cheap method for haemoglobin estimation by non-laboratory-trained personnel in a rural setting. DESIGN: Comparative study. SETTING: Tintswalo Hospital, Acornhoek. PARTICIPANTS: 7 nursing sisters, 4 medical students, 2 lay persons. OUTCOME MEASURES: Haemoglobin estimates obtained with the colour scale were compared with the 'true Hb' values determined by the H x 3 Bayer-Technicon automated blood analyser. RESULTS: Although individuals varied in their abilities to use the colour scale, its performance was generally very good when measured against automated haemoglobinometry, as determined by bias and regression analysis and also in terms of its capacity to detect anaemia, as measured by sensitivity, specificity and positive and negative predictive values. CONCLUSIONS: Haemoglobin estimates obtained with the World Health Organisation colour scale are generally reliable, although cognisance should be taken of individual variability. While the utility of the device in monitoring response to therapy remains to be seen, it promises to be a suitable method for mass screening for anaemia.

Hemoglobinometry↗