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PubMedDate not supplied

[Substantiated need in information support to therapeutic-and-diagnostic processes].

On the basis of analysis it is proven as necessary to use information support in treatment and diagnosis at different-status hospitals to enhance the quality and efficiency of treatment. The used theoretical-and-empirical approach is based on major parameters of three therapeutic-and-diagnostic processes studied within different coordinate systems as well as on evaluation of total knowledge needed by practitioner and on complexity of formal treatment tasks.

Diagnosis, Computer-Assisted↗
PubMed1992

Myths in neurotology.

For many diseases the etiology of disordered function is unknown and therapy is either symptomatic or empirical. The empirical approach to therapy is acceptable to many physicians, particularly if a treatment can be based on some attractive, although unproven, concept of pathogenesis. A hypothetical explanation of disordered function can become widely popular in spite of a serious lack of scientific support. When evidence emerges that refutes the logic of a concept of pathogenesis, then that concept becomes a myth. Human temporal bone studies have identified several myths in neurotology that deserve our attention. Among these myths are the following: (1) cochlear otosclerosis is a common cause for sensorineural hearing loss, (2) idiopathic sudden sensorineural hearing loss is a vascular disorder that should be treated as a medical emergency, (3) the conductive component of hearing loss in Paget's disease is caused by ossicular fixation and therefore should be surgically correctable, (4) vascular loops should be considered as a possible cause for otherwise unexplained otologic symptoms, (5) surgical manipulations on the endolymphatic sac are scientifically sound therapies for selected cases of Meniere's disease, and (6) perilymph fistulas are a common cause for audiovestibular symptoms that are not related to a stressful incident.

Ear Diseases↗
PubMed2005

[Treatment of the irritable bowel syndrome from the point of conclusive medicine].

For many years the irritable bowel syndrome therapy was based only on an empirical approach. A lot of information has appeared for this period, which allows making a judgment about the efficacy of either of the ways of the functional bowel disorders treatment. A part of them was not approved in the course of clinical testing. At the same time, new high-performance ways of treatment appeared. This article presents an analytical survey of the irritable bowel syndrome pharmacotherapy. It also shows the role of diet, spasmolysants, psychotherapy, tricyclic antidepressants, serotonin reuptake inhibitors, HT3 antagonists and HT4 agonists.

Humans↗
PubMed2005

Multiple sclerosis: a haplotype association study.

Results are presented from a genomewide haplotype association study on multiple sclerosis (MS) cases from Tasmania, an island state of Australia. Cases were ascertained on strict clinical and radiological grounds and on the fact that they had at least one grandparent born in the state. This enriched for early settler chromosomes among present day Tasmanians with MS and increased the chances of finding common haplotype sharing at disease predisposition loci in distant relatives sharing common ancestral haplotypes. Four-to-five close relatives were also collected for each of 170 cases and 105 population-based controls. All were genotyped at a 5cM resolution, haplotypes reconstructed and sharing estimated using an empirical approach based on sorting haplotypes to find the most common at each locus and then generating a test statistic for excess sharing in the cases based on permutation testing. Five initial loci were found where there was an excess sharing in the cases. These were fine-mapped with 10-12 additional markers. Only loci on chromosomes 6 and 10 remained after fine mapping. These loci demonstrate an increase in sharing of multi-marker haplotypes in MS cases compared to both population control transmitted haplotypes and case non-transmitted haplotypes.

Haplotypes↗
PubMedDate not supplied

[Reintervention in abdominal surgery. Personal experience in emergency].

The Authors, regarding their emergency surgical experience, examine the need of reintervention in abdominal surgery at a distance (operations carried out not less than 30 days after previous procedure), a controversial situation, usually dealt with empirical approach. Such a feature is not rare in the experience of a surgeon; nevertheless still few are the studies concerning the severity of the disease and related complications requiring surgery. Occasionally it is really difficult--quite impossible- in these often complex clinical conditions, to identify the aetiology and even to perform a pre-operative diagnosis. Sometimes other factors may inhibit an exhaustive evaluation (acute onset of the symptoms, time spent from the former procedure, choice of the patient to refer to another surgeon) thus conditioning an adequate review of the first surgical act. The Authors study the more frequently observed clinical features, post-surgical abdominal adhesive syndrome, cancer recurrence, incisional hernia. Former surgical diseases and the latter one may be the same, but not necessarily. Surgery is only a feature of the treatment (multimodal treatment) in case of neoplastic recurrence. Morbidity and mortality concerning the latter surgical procedure are higher than the mere sum of those related to both the former and last operation performed (pre-operative disease understaging). Finally it must be stressed the need for early and accurate diagnosis to clearly steer the choice and course of surgical action.

Abdomen↗
PubMed2006

In vitro optimization of antisense oligodeoxynucleotide design: an example using the connexin gene family.

The completion of the human and mouse genomes has identified at least 20 connexin isomers in this family of intercellular channel proteins. However, there are no specific gap junction blockers or channel-blocking mimetic peptides available for the study of specific connexins. We designed antisense oligodeoxynucleotides that functionally reduce targeted connexin protein expression and can be used to reveal the biological function of individual connexins in vivo. Connexin mRNA was firstly exposed in vitro to deoxyribozymes complementing the sense coding sequence. Those that cleaved the target connexin mRNA in defined regions were used as the basis to design oligodeoxynucleotides to the accessible sites, thus taking into account tertiary mRNA configurations rather than relying on computed predictions. Antisense oligodeoxynucleotides designed to bind to accessible mRNA sites selectively reduced connexin26 and -43 mRNA expression in a corneal epithelium ex vivo model. Connexin43 protein levels were reduced correlating with the knockdown in mRNA and the protein's rapid turnover; protein levels of connexin26 did not alter, supporting lower turnover rates reported for that protein. We show, for the first time, an inexpensive and empirical approach to the preparation of specific and functional antisense oligodeoxynucleotides against known gene targets in the post-genomic era.

Animals↗
PubMed2006

[Subtypes of specific language impairment in Spanish-speaking children: a cluster analysis of linguistic features].

INTRODUCTION: Specific language impairment (SLI) can be viewed as a continuum with different subtypes depending on the combination of deficits and strengths in each of the components of linguistic behavior. AIM. To analyze the phenomenological profiles in a correlative series of Spanish children in order to facilitate their endophenotypic differentiation and the choice of strategies of intervention. PATIENTS AND METHODS: 86 referred children, aged 4 to 9 years, with a mean non-verbal intelligence quotient of 93 (range 72-114) and accomplishing clinical criteria of SLI. Apart from clinical interview and neurological examination, a protocol of questionnaires and tests was used in all subjects in order to measure their formal (phonological, syntactic, lexical) and functional (semantic and pragmatic) linguistic abilities. A cluster analysis of variables was used in order to investigate SLI subtypes. RESULTS: In the total sample, a 24% of whole series have a pure phonological expressive disorder. 55% of subjects have mixed receptive/expressive disorders; from these, the most pervasive subtype is due to verbal agnosia (11%), but more frequently observed subtypes affect syntax reception and expression combined to difficulties in phonological programming (36%) or in lexical retrieval (8%). Furthermore, 21% of the total sample present with difficulties in pragmatic use of language even if their formal linguistic abilities and non-verbal behavior are normal. CONCLUSIONS: Our empirical approach confirms that the admitted SLI subtypes in international literature applies to Spanish-speaking children for endophenotyping and intervention-planning purposes.

Child↗
PubMed2005

Evaluation of malaria endemicity by peptide ELISA.

Interest in mapping the malaria transmission has motivated a need to develop a simple serological assay in a defined population. Evaluation of coded samples by peptide ELISA provided a framework to estimate the malarial impact. Comparison of field data and ELISA OD values in different malariogenic areas shows how the disease has been more correctly interpreted. Here we provide an empirical approach to estimate Annual Parasite Index (API) as well as Equivalent Transmission Index (ETI) using a combination of epidemiological, parasitological and immunological data. We estimate that there were 3 different malariogenic status like low, moderate and high transmission zones based on their' ELISA OD values. Our indigenous developed ETI estimates are 10 fold higher than API reported by the Primary Health Centre. Our record indicates that incidences of malaria will continue to be underestimated unless we adapt an alternative strategy. In order to verify the scope of malaria surveillance, coded samples were tested. Comparison of ELISA OD, API and ETI of the coded samples indicated Rourkela had high, Shahjahanpur had moderate and Bangalore had the lowest malaria transmission. For mass blood slide examination, microscopic method is a tedious process prone to human error while largely automated ELISA could reduce the scope for human error and could be a supplement for microscopic process.

Animals↗
PubMedDate not supplied

Critical care of patients with AIDS.

OBJECTIVE: We sought to review the clinical and ethical issues surrounding critical care for patients with the acquired immunodeficiency syndrome (AIDS). DATA SOURCES: We reviewed published studies and abstracts dealing with the outcome of critical care for patients with AIDS, decision making about life-sustaining treatments in patients with AIDS, and infection control in the intensive care unit. We also consulted with a number of experts in the field. STUDY SELECTION: We selected outcome studies in which patients with documented AIDS or infection with the human immunodeficiency virus (HIV) were analyzed. We rejected data concerning patients with suspected or presumed AIDS and data concerning presumed cases of Pneumocystis carinii pneumonia (PCP). DATA SYNTHESIS: Most AIDS patients who require critical care do so because of respiratory failure caused by PCP. Although studies early in the epidemic reported survival rates to hospital discharge of 0% to 14%, recent studies demonstrate improved survival rates of 36% to 55%. Treatment for patients with PCP and respiratory failure should include either intravenous trimethoprim-sulfa-methoxazole or pentamidine isethionate, as well as adjuvant corticosteroids. Patients with AIDS may require critical care for many other indications, including seizures, sepsis, and hypotension, or reasons unrelated to their immunodeficiency. In general, such patients have a better prognosis than those with respiratory failure. CONCLUSION: The provision of critical care for PCP and respiratory failure specifically or AIDS generally cannot be considered futile. Therefore, decisions about the use of critical care should be guided by the particular clinical situation and the patient's preferences. More research is needed to elucidate the reasons for the improving survival for patients with PCP and respiratory failure and the predictors of such survival.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Antimalarial activity of crude extracts from Brazilian plants studied in vivo in Plasmodium berghei-infected mice and in vitro against Plasmodium falciparum in culture.

1. Ninety-five crude extracts obtained with either organic solvents or water from 48 Brazilian plants or parts of plants were evaluated experimentally as blood schizontocides. Seventy-three extracts were obtained from 33 plants randomly collected using an empirical approach, and 22 from 15 "medicinal" plants. 2. The crude extracts were screened in vivo at up to 1.0 g/kg, po, for 4 days in mice infected with blood forms of Plasmodium berghei and parasitemia was determined on the fifth day. 3. Six plants, 2 randomly collected, Vernonia brasiliana and Eupatorium squalidum, and 4 "medicinal" plants, Acanthospermum australe, Esenbeckia febrifuga, Lisianthus speciosus, and Tachia guianensis, were partly active against the rodent malaria, i.e., they showed 40-50% inhibition of P. berghei multiplication. Forty-two plants whose extracts presented no antimalarial activity are reported. 4. Four extracts with antimalarial activity were also tested in vitro using P. falciparum cultures and two of them, V. brasiliana and A. australe, were active. Extracts of V. brasiliana caused about 50% inhibition of parasite multiplication at relatively low doses (40 ng/ml) as compared to chloroquine (30 ng/ml) and quinine (50 ng/ml). 5. The relatively high percentage of positive results obtained here for "medicinal" plants vs randomly chosen plants demonstrates the effectiveness of the ethnopharmacological approach to drug testing.

Animals↗
PubMed1991

How well has Canada contained the costs of doctoring?

Canada's provinces have had varying success at containing the costs of physician services through the use of fee schedules and expenditure targets. This article examines the wide variation in the increases in the costs of physician services among Ontario, Quebec, and British Columbia between 1975 and 1987. Cost increases during that time resulted from various combinations of increases in prices (fees) and utilization, stimulated by an increased supply of physicians. Differences among the three provinces resulted from differences in the aggressiveness of fee schedule controls and whether expenditure targets were imposed. Regardless of the degree of expenditure increases, utilization increased steadily in all three provinces and was associated most consistently with growth in the supply of physicians. This was most dramatically illustrated in Quebec, which noted the most rapid rise in physician-to-population ratio. Cost containment may ultimately require constraints on the number of new physicians in addition to controls on fees and utilization.

British Columbia↗
PubMed1991

Strategies to prevent or control infections after bone marrow transplants.

Patients receiving bone marrow transplants are at risk of life-threatening infections early post-transplant. This predisposition results from extensive mucosal damage and severe granulocytopenia. Common causes of infection include bacteria and fungi. Infections with opportunistic pathogens occur later and are associated with defects in cellular and/or humoral immunity. The most common sites of infections are the gastrointestinal tract, oropharynx, lung, skin and indwelling vascular catheters. Empiric approaches designed to treat common bacterial and fungal pathogens are generally effective as are measures designed to prevent dissemination of infections. These approaches are also used to prevent fungal infections.

Bacterial Infections↗
PubMedDate not supplied

Selective inactivation by chlorofluoroacetamides of the major phenobarbital-inducible form(s) of rat liver cytochrome P-450.

Five N-monosubstituted chlorofluoroacetamides have been tested as potential specific irreversible inhibitors of the major phenobarbital-inducible form of rat liver cytochrome P-450 (P450IIB1). In vitro, N-(2-phenethyl)chlorofluoroacetamide was ineffective in causing a time-dependent loss of P450IIB1-mediated androstenedione 16 beta-hydroxylase activity in liver microsomes from phenobarbital-treated rats. However, addition of a nitro or bromo substitutent at the para position of the phenyl group or addition of a second phenyl group at the 1- or 2-position on the phenethyl side chain yielded compounds that caused a selective time-dependent decrease in androstenedione 16 beta-hydroxylase activity relative to four other P-450 form-specific androstenedione or progesterone hydroxylase activities monitored. The two compounds that were the most effective in inactivating P450IIB1 in vitro, N-(2-p-bromophenethyl) and N-(2-p-nitrophenethyl)chlorofluoroacetamide were also administered ip to phenobarbital-treated rats, and inhibition of cytochromes P-450 was assessed by in vitro assays of steroid and R- and S-warfarin hydroxylation in subsequently prepared hepatic microsomes. Both compounds selectively inhibited P450IIB1, and at a dose (200 mg/kg) of N-(2-p-nitrophenethyl)chlorofluoroacetamide that reduced androstenedione 16 beta-hydroxylase activity to approximately one-third of the control level, only two other activities, both attributable to P450IIB1, were decreased. In contrast, steroid and warfarin hydroxylase activities indicative of at least five other cytochromes P-450 were unaffected by the compound. These results indicate the feasibility of an empirical approach to the design of specific cytochrome P-450 inactivators.

Acetamides↗
PubMed1990

Management of infectious complications of acute leukemia and antileukemia therapy.

The patient with acute leukemia is predisposed to infection by bone marrow failure that leads to absence of granulocytes, by extramedullary leukemia infiltration that leads to barrier breakdown, and by cytotoxic antileukemia therapy that exaggerates both the hematopoietic and the tissue mucosal defects. Empiric approaches tailored to treat commonly occurring bacterial and fungal infections have successfully decreased the morbidity and mortality from overwhelming infection in these compromised patients. More recently, prophylaxis directed against dissemination of pathogens from specific sites has had a positive impact in preventing the clinical and microbiological manifestations of infection during profound aplasia. The approaches that have been successful in preventing and treating bacterial infections are being applied to the increasingly prevalent fungal infections that occur later during the granulocytopenic course, with encouraging results.

Acute Disease↗
PubMed1990

Is altruism enough? Required request and the donation of cadaver organs and tissues in the United States.

The lack of an adequate supply of cadaver organs and tissues for transplantation to those in need poses a major challenge to the transplant community and to those responsible for public policy. Historically, Americans have relied upon a combination of altruism and voluntarism to generate an adequate supply of cadaver organs and tissues. The ongoing shortage of organs and tissues has led, in recent years, for calls to abandon these values in favor of either a market system or a system of presumed consent. A survey of the impact of the federal and state laws that require that requests be made to next of kin for organ and tissue donation when a death occurs in a hospital setting shows that inadequate efforts have been made to implement these laws. Before abandoning altruism and voluntarism, health care professionals must insist that zealous efforts in education, enforcement, and coordination be made to implement these new laws and regulations.

Altruism↗
PubMed1985

Which drug to which patient?

When a decision to treat a given patient is taken, the embarrassing position arises of deciding which drug should first be prescribed. How can the safest choice be made? Should the physician follow a pathophysiological or an empirical approach? There is no doubt that the most rational approach would consist of matching the pharmacological properties of the drug with the pathophysiological disturbances of the patient. However, these are complex and variable, and their precise assessment in every hypertensive patient is hardly practicable. On the other hand, the pharmacological properties of drugs are often multiple, and sometimes imperfectly understood. The practical impossibility of obtaining a satisfactory pathophysiological profile of each hypertensive patient in order to choose the most suitable drug has strengthened the trend toward formulating and using stepped-care programmes. The philosophy behind these is that of lowering blood pressure with agents most likely to be effective with a minimum of untoward effects, of progressing from a simple start, generally prescribing a single drug at a low dose, to more complex therapeutic regimens. There is some evident soundness in this approach, but stepped-care programmes are sometimes criticized as dogmatic, and are contrasted with the individualized approach, the custom-tailoring provided by pathophysiological profiling. Undoubtedly, the first stepped-care programmes, as formulated in the USA in the 1970s, giving no other first choice than a thiazide diuretic, were rigid and had limitations. On the other hand, the 1978 WHO guidelines were more flexible, suggesting a first choice between either a diuretic or a beta-blocker.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1989

Mental health and abortion: review and analysis.

This survey of studies which relate to the emotional sequelae of induced abortion, draws attention to the need for more long-term, in-depth prospective studies. The literature to this point finds no psychiatric indications for abortion, and no satisfactory evidence that abortion improves the psychological state of those not mentally ill; abortion is contra-indicated when psychiatric disease is present, as mental ill-health has been shown to be worsened by abortion. Recent studies are turning up an alarming rate of post-abortion complications such as P.I.D., and subsequent infertility. The emotional impact of these complications needs to be studied. Other considerations looked at are the long-term demographic implications of abortion on demand and the effect on the medical professions.

Abortion, Induced↗