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At least 685 records · Page 38Linked to original sources
PubMed2002

Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study.

OBJECTIVE: To assess the effectiveness of the simplified medication adherence questionnaire (SMAQ) in identifying non-adherent patients. DESIGN: Prospective observational study of adherence. The six-item SMAQ was developed. The following aspects were evaluated: (i) criterion validity, comparison with electronic adherence monitoring; (ii) construct validity, association between adherence, as defined by the SMAQ, and virological outcomes; and (iii) reliability, internal consistency and reproducibility. PATIENTS: A group of 3004 unselected HIV patients who had initiated nelfinavir therapy combined with other antiretroviral drugs [21% naive, 15% protease inhibitor (PI)-naive, 64% PI-experienced] between January 1998 and December 1999 were enrolled in 69 hospitals in Spain. The SMAQ was administered at months 3, 6 and 12. RESULTS: The SMAQ showed 72% sensitivity, 91% specificity and a likelihood ratio of 7.94 to identified non-adherent patients, compared with the medication-event monitoring system (40 patients evaluated). At month 12, 1797 patients were evaluated, of whom 32.3% were defined as non-adherent; viral load < 500 copies/ml found in 68.3% of the adherent, and 46% of the non-adherent patients. A logistic regression analysis of PI-naive patients was performed, including age, sex, baseline viral load > 5 log10/ml, CD4 cell count < 200 x 10(6)/l, and non-adherence as independent variables. Non-adherence was the only significant risk factor in failing to achieve virological suppression. Cronbach's alpha internal consistency coefficient was 0.75, and overall inter-observer agreement was 88.2%. CONCLUSION: The SMAQ appears to be an adequate instrument with which to assess adherence in HIV-infected patients, and may be applied in most clinical settings.

Adult↗
PubMed2002

Rare and new V3 loop variants in HIV-1-positive long-term non-progressors from Rwanda.

We identified uncommon amino acid substitutions in the V3 loop regions of HIV-1 strains infecting patients from Rwanda. Their frequency was greater in long-term non-progressors (LTNP) compared with late-stage patients (P = 0.006), particularly in a sequence region that has crucial interactions with the cell surface, and is highly relevant for the host's immune response. These variants might reflect a viral response to a strong immune pressure, or represent attenuated HIV-1 strains infecting LTNP in Rwanda.

Amino Acid Sequence↗
PubMed2003

Parenteral fat emulsions based on olive and soybean oils: a randomized clinical trial in preterm infants.

OBJECTIVE: To evaluate in premature infants a new parenteral lipid emulsion based on olive and soybean oils (ratio 4:1), with less polyunsaturated fatty acids (PUFA) and more alpha-tocopherol than standard soybean oil emulsion. STUDY DESIGN: Premature infants (gestational age, 28-<37 weeks) were randomized to receive one of the two emulsions within the first 72 hours of life. The triglyceride dose was increased to 2 g/kg/day within 3 days. Plasma phospholipid fatty acids, alpha-tocopherol/lipid ratio, and urinary malondialdehyde (MDA) excretion were determined at baseline and after 7 days. RESULTS: Of 45 recruited infants, 33 completed the study per protocol (15 soybean oil, 18 olive oil emulsion). At study end, groups did not differ in plasma phospholipid arachidonic acid, total n-6 and n-3 metabolites, but the olive oil group showed higher values of the PUFA intermediates C18:3n-6 (0.19% +/- 0.01% vs. 0.13% +/- 0.02%, P < 0.05) and C20:3n-6 (2.92% +/- 0.12% vs. 2.21% +/- 0.17%, P = 0.005). The plasma alpha-tocopherol/total lipd ratio was higher in the olive oil group (2.45 +/- 0.27 micromol/mmol vs. 1.90 +/- 0.08 micromol/mmol, P = 0.001), whereas urinary MDA excretion did not differ. CONCLUSION: The lower PUFA supply with the olive/soybean oil emulsion appears to enhance linoleic acid conversion. The reduced PUFA content, combined with a higher antioxidant intake in the olive oil group, results in an improved vitamin E status. The olive oil-based emulsion is a valuable alternative for parenteral feeding of preterm infants who are often exposed to oxidative stress, while their antioxidative defense is weak.

Antioxidants↗
PubMed2002

Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients.

OBJECTIVES: To assess the effect of antiretroviral therapy (ART) adherence on survival in HIV-infected patients. DESIGN: Cohort study at a single hospital in Barcelona, Spain. METHODS: Data on HIV-infected patients older than 18 years of age who began ART during the period 1990 to 1999 were analyzed. Patients were considered nonadherent if the total dose of antiretroviral drug was less than 90% of that prescribed. Adherence was assessed through self-report and hospital pharmacy appointments. Cox regression with time-dependent variables was used. RESULTS: A total of 1219 patients were included. The first ART was with monotherapy in 23.7% of cases, with two drugs in 30.5%, and with triple therapy in 45.8%. In multivariate analysis, the variables that presented significant differences with respect to mortality were clinical stage at the beginning of treatment (AIDS: relative hazard (RH) = 2.97; 95% confidence interval [CI]: 2.14-4.13), CD4 cell count (<200 cells/microL: RH = 5.89; CI: 3.44-10.10), type of treatment (monotherapy: RH = 9.76; CI: 4.56-20.90; bi-therapy: RH = 9.12; CI: 4.23-19.64), and adherence (nonadherence: RH = 3.87; CI: 1.77-8.46). CONCLUSIONS: The modifiable factors most strongly associated with survival were type of treatment and adherence. It would be desirable to accompany therapy with intervention strategies intended to improve adherence.

Adolescent↗
PubMed2004

Urethral stent for the treatment of detrusor-sphincter dyssynergia: evaluation of the clinical, urodynamic, endoscopic and radiological efficacy after more than 1 year.

PURPOSE: We studied the intermediate-term clinical, urodynamic, endoscopic and radiological efficacy of the Ultraflex urethral stent (Boston Scientific Co., Boston, Massachusetts) for the treatment of detrusor-sphincter dyssynergia (DSD) in spinal cord injured patients. MATERIALS AND METHODS: A total of 47 consecutive men presenting with DSD due to spinal cord injury (39) or various spinal cord diseases (9) were treated with the Ultraflex stent. DSD was demonstrated by urodynamic assessment with electromyographic recording of the striated urethral sphincter muscle activity. RESULTS: Postoperatively, all patients voided by reflex. The number of patients with symptomatic postoperative urinary tract infection decreased significantly (p <0.001). Urodynamic assessment (mean followup +/- SD 2.2 +/- 1.3 years) showed reduction of mean peak detrusor pressure from 65.7 +/- 27.8 to 46.4 +/- 28.8 cm H2O (p <0.005) and reduction of mean residual urine from 231.6 +/- 168.1 to 70.3 +/- 85.6 ml (p <0.0005). Mean urethral closing pressure was markedly reduced from 73.9 +/- 40.9 to 23.8 +/- 25.1 cm H2O (p <0.0005). Mean endoscopic followup was 1.7 +/- 1.1 years. Mean percentage of epithelialization was 90.8% +/- 19.7%, and no obstructive granulation tissue or stone encrustation was observed inside the stent. On ultrasound signs of hydronephrosis persisted in only 1 of 8 patients. There were no immediate postoperative complications. Complementary bladder neck incision was performed in 21% of patients. CONCLUSIONS: The Ultraflex stent appears to be effective for intermediate-term treatment of DSD on the basis of clinical, urodynamic, endoscopic and radiological parameters.

Adult↗
PubMed2005

Classic transient erythroblastopenia of childhood with human parvovirus B19 genome detection in the blood and bone marrow.

The etiology of transient erythroblastopenia of childhood (TEC) remains unknown, although an association with viral infections has been proposed. The authors describe a 3.5-year-old girl with classic TEC concomitantly with human parvovirus B19 (HPV) infection. The infection was evident by detection of HPV genome in the blood and the bone marrow by polymerase chain reaction. Viral genome was no longer detected when the TEC resolved clinically. The patient was immunocompetent and the anemia has not recurred. To the authors' knowledge, this is one of the few documented cases of classic TEC attributable to HPV infection.

Blood↗
PubMed2004

Locally optimum nonlinearities for DCT watermark detection.

The issue of copyright protection of digital multimedia data has attracted a lot of attention during the last decade. An efficient copyright protection method that has been gaining popularity is watermarking, i.e., the embedding of a signature in a digital document that can be detected only by its rightful owner. Watermarks are usually blindly detected using correlating structures, which would be optimal in the case of Gaussian data. However, in the case of DCT-domain image watermarking, the data is more heavy-tailed and the correlator is clearly suboptimal. Nonlinear receivers have been shown to be particularly well suited for the detection of weak signals in heavy-tailed noise, as they are locally optimal. This motivates the use of the Gaussian-tailed zero-memory nonlinearity, as well as the locally optimal Cauchy nonlinearity for the detection of watermarks in DCT transformed images. We analyze the performance of these schemes theoretically and compare it to that of the traditionally used Gaussian correlator, but also to the recently proposed generalized Gaussian detector, which outperforms the correlator. The theoretical analysis and the actual performance of these systems is assessed through experiments, which verify the theoretical analysis and also justify the use of nonlinear structures for watermark detection. The performance of the correlator and the nonlinear detectors in the presence of quantization is also analyzed, using results from dither theory, and also verified experimentally.

Algorithms↗
PubMed2026

Temporal Trends and Spatial Variation in Preterm Prelabour Rupture of Membranes: A Population-Based Study.

OBJECTIVE: To describe the temporal trends in Preterm prelabour rupture of membranes (PPROM) in metropolitan France and the geographical distribution at the administrative division level. DESIGN: Exploratory population-based study using administrative data of the French National Health Data System. SETTING: Metropolitan France, 2015 to 2023. POPULATION: Pregnancy with a diagnosis of PROM before 37 SA. METHODS: Annual crude incidence of PPROM was calculated by dividing the number of pregnancies with PPROM diagnosis by the number of live births recorded during the same period. Annual trend was estimated by a binomial negative mixed model. Smoothed standardised incidence ratios were estimated based on a BYM2 model, which accounts for spatial variability between departments. MAIN OUTCOME: PPROM cases, defined as pregnancies with first hospitalizations with a diagnosis of PROM before 37&#x2009;weeks. RESULTS: Over the study period, we included 150&#x2009;615 PPROM cases representing 16&#x2009;735 (&#xb1;596) per year. Incidence of PPROM cases showed an ascending trend over time (incidence rate ratio 1.023 per year; 95% CI: 1.017-1.030) with an annual crude incidence ranging from 2.2% in 2015 to 2.7% in 2023. A decrease in the incidence was observed in 2020 relative to other years (incidence rate ratio 0.903, 95% CI: 0.887-0.920). A map of smoothed SIRs of PPROM cases at the French administrative division level revealed geographical inequalities. CONCLUSIONS: This first population-based study describing PPROM cases in metropolitan France paves the way for further studies to explore environmental hypotheses. Identifying temporal and geographical disparities in PPROM incidence is relevant to public health policy and practice as such disparities argue for the development of targeted prevention strategies in high-risk areas.

French national health data system↗
PubMed1994

The effect of red cell shape on the measurement of red cell volume. A proposed method for the comparative assessment of this effect among various haematology analysers.

Shape changes of abnormally deformed red cells in aperture impedance haematology analysers are known to affect MCV, MCHC and haematocrit estimation. However, different counters vary in the manifestation of this effect. We performed a comparative study among five analysers. Three of them are based on impedance without hydrodynamic focusing (Coulter STKR, Cell-Dyn3000 Abbott and K-1000 Sysmex). The other two use hydrodynamic focusing, either with impedance (NE-8000 Sysmex) or two angle laser scatter (H*1 Bayer). A novel method of analysis was applied. Two hundred and three specimens with abnormal red cells and 50 normal specimens (according to ICSH criteria) were assayed. In all samples the PCV was estimated by the reference method without correction for trapped plasma. A true MCHC value was estimated from the mean haemoglobin value and the PCV. The shape effect was assessed by three linear regressions: 1) haematocrit deviations from PCV (corrected for any calibration bias) versus true MCHC; 2) analyser MCHC vs. true MCHC; 3) MCV vs. MCH. The regressions for the analysers with hydrodynamic focusing indicated no significant shape effect. Aperture impedance analysers without focusing varied in their behaviour. The Coulter STKR and the Cell-Dyn3000 both showed strong correlation of haematocrit deviations with true MCHC, poor MCHC correlations and linear MCV-MCH regressions. The K-1000 showed minor indications of such an effect. We conclude that comparative studies are needed to quantitate red cell shape effect errors among various impedance analysers.

Bias↗
PubMed2005

Circulating and thymic CD4 CD25 T regulatory cells in myasthenia gravis: effect of immunosuppressive treatment.

Accumulating evidence indicates an immunosuppressive role of the thymus-derived CD4+ T-cell population constitutively expressing high level of CD25, T regulatory (Treg) cells, in autoimmune diseases. Here we show that the number of Treg cells in the blood is significantly lower in untreated myasthenia gravis patients than in age-matched healthy subjects, whereas it is normal or elevated in patients on immunosuppressive therapy (prednisone frequently associated with azathioprine). Therapeutic thymectomy (Tx) for either the thymoma or non-neoplastic thymic alterations that are often associated with myasthenia gravis provided unique material for studying intrathymic Treg cells and correlating them with their peripheral counterparts. We observed that Tx prevents the increase of Treg cells in the circulation that follows immunosuppressive therapy (particularly evident if the thymus is not neoplastic), indicating that the thymus contributes to Treg-cell normalization. However, thymic Treg cells are not modulated by immunosuppressive therapy and even in thymectomized patients Treg-cell numbers in the blood eventually recover. The present findings suggest that a deficiency in Treg cells favours the development of myasthenia gravis and that their normalization is an important clinical benefit of immunosuppressive therapy. Treg normalization appears to be largely thymus independent and possibly reflects the reported capacity of corticosteroids to promote Treg-cell development.

Adolescent↗
PubMed2004

Familial influences on sustained attention and inhibition in preschoolers.

BACKGROUND: In this study several aspects of attention were studied in 237 nearly 6-year-old twin pairs. Specifically, the ability to sustain attention and inhibition were investigated using a computerized test battery (Amsterdam Neuropsychological Tasks). Furthermore, the Teacher's Report Form (TRF) was filled out by the teacher of the child and the attention subscale of this questionnaire was analyzed. METHODS: The variance in performance on the different tasks of the test battery and the score on the attention scale of the TRF were decomposed into a contribution of the additive effects of many genes (A), environmental effects that are shared by twins (C) and unique environmental influences not shared by twins (E) by using data from MZ and DZ twins. RESULTS: The genetic model fitting results showed an effect of A and E for the attention scale of the TRF, and for some of the inhibition and sustained attention measures. For most of the attention variables, however, it was not possible to decide between a model with A and E or a model with C and E. Time-on-task effects on reaction time or number of errors and the delay after making an error did not show familial resemblances. A remarkable finding was that the heritability of the attention scale of the TRF was found to be higher than the heritability of indices that can be considered to be more direct measures of attention, such as mean tempo in the sustained attention task and response speed in the Go-NoGo task. CONCLUSION: In preschoolers, familial resemblances on sustained attention and inhibition were observed.

Attention↗
PubMed2005

Time course of oxidative stress, lesion and edema after intrastriatal injection of malonate in rat: effect of alpha-phenyl-N-tert-butylnitrone.

The aim of this study was to characterize the model of oxidative stress consisting in the infection of malonate (3 mumol), an inhibitor of mitochondrial complex II, in the rat striatum. The striatal concentrations of both the reduced and oxidized forms of glutathione (the major endogenous antioxidant) were determined at various times after malonate injection (1-4 h) in order to evaluate the evolution of oxidative stress. The progression of lesion size and edema was also determined up to 24 h after malonate administration. Finally, the effect of alpha-phenyl-N-tert-butylnitrone (PBN), an antioxidant nitrone, was studied. The levels of reduced glutathione (GSH) progressively decreased after malonate injection up to 40% of those of sham animals at 4 h. An increase in the concentrations of oxidized glutathione (GSSG) was also observed as early as 1 h after malonate administration which was maintained up to 4 h. The size of the lesion was maximal within 2 h of malonate injection, whereas edema continued to increase between 2 and 24 h. Injection of PBN at 100 mg/kg i.p. 30 min before and 2 h after malonate administration abolished the GSSG increase caused by malonate but did not modify the drop in GSH. This moderate antioxidant effect of PBN was associated with a slight decrease of the lesion area at two levels (10.7 and 10.2 mm anterior to the interaural line), but the lesion volume remained unchanged. By contrast, PBN reduced edema by 30%. Taken together, these results show that malonate induced a severe oxidative stress leading to the rapid development of the lesion. PBN demonstrates anti-edematous properties that are not sufficient to reduce the lesion.

Animals↗
PubMed2004

A workshop to teach medical students communication skills and clinical knowledge about end-of-life care.

We describe a half-day workshop to teach third-year medical students three focused end-of-life care skills: breaking bad news, discussing advance directives, and assessing and managing pain. Our workshop included a readers' theater exercise and three role-play exercises. In two of the workshops, faculty members played the role of patients. We used readers' theater to engage the students on an emotional level and set a reflective tone for the workshop. Evaluations reflected that most respondents felt that the workshop enhanced their understanding and ability to address these skills with patients. By 6 months, many students reported applying these skills to patient care in a way they thought was effective.

Advance Directives↗
PubMed2006

The importance of spirituality in African-Americans' end-of-life experience.

A profound and moving spirituality provided emotional and psychological support for most terminally ill patients at Grady Memorial Hospital. The authors were able to trace the roots of these patients' spirituality to core beliefs described by African-American theologians. Truly bedrock beliefs often reflected in conversations with the patients at Grady included the providence of God and the divine plan for each person's life. Patients felt an intimate relationship to God, which they expressed through prayer. Importantly, almost all patients were willing to share their beliefs with the authors in long bedside interviews. This willingness to share indicates that physicians can learn about and validate such patients' spiritual sources of support.

Black or African American↗
PubMed2005

Inflammatory chemokine expression in the peripheral blood of neonates with perinatal asphyxia and perinatal or nosocomial infections.

AIM: The inflammatory response induced by perinatal infections and asphyxia is considered to participate in neonatal brain damage. Inflammatory responses are characterized by the expression of chemokines. Although chemokine levels have been investigated in healthy newborns, their role during neonatal pathological conditions has not been studied. The aim of our study was to examine chemokine serum levels in asphyxiated and infected neonates. METHODS: Peripheral blood samples were obtained from perinatally asphyxiated and infected neonates during the first days of life and from neonates who developed nosocomial infections. Serum levels of interleukin-8 (IL-8), interferon-gamma-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1), macrophage inflammatory protein-1alpha (MIP-1alpha), and regulated upon activation, normal T cells expressed and secreted (RANTES) were determined. RESULTS: In perinatally asphyxiated neonates, IL-8 levels were significantly elevated on the 1st day of life. In perinatally infected neonates, IL-8 and IP-10 levels were significantly increased on the 1st day of life, while RANTES levels were significantly lower and remained so until the 4th day. In nosocomially infected neonates, IL-8, IP-10 and MIP-1alpha levels were significantly increased on diagnosis of infection. CONCLUSION: The neonatal immune system is able to produce chemokines for the induction of an inflammatory response during perinatal asphyxia and perinatal or nosocomial infections. Blockade of inflammatory chemokines could possibly contribute to the prevention of brain damage.

Asphyxia Neonatorum↗
PubMedDate not supplied

Motion-correction techniques for standing equine MRI.

Magnetic resonance imaging (MRI) of the distal extremities of the standing, sedated horse would be desirable if diagnostic quality images could be obtained. With the availability of extremity and special purpose magnet designs on the market, a system to safely accommodate the standing horse may gain increasing popularity. This paper considers the issue of motion that will need to be addressed to achieve successful, diagnostic quality images. The motion of the carpus and tarsus of five standing, sedated horses was quantified. The obtained motion records were then used to induce motion in cadaveric joint specimens during several MRI scans. The measured dorsal-palmar/plantar, medial-lateral, and proximal-distal random wobbling motions in the standing sedated horse were several centimeters in magnitude and generated severe motion-artifacts during axial MRI of the cadaveric specimens. Two retrospective motion-correction techniques (autocorrection and navigator-based adaptive correction) were used to correct the corrupted images. The motion artifacts were nearly eliminated with the use of both techniques in series. Although significant hurdles remain, these results suggest promise for allowing diagnostic quality MRI of the carpus and tarsus in the standing horse.

Animals↗