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PubMed1990

Drug abuse during pregnancy in an inner-city hospital: prevalence and patterns.

Because of the increase of illicit drug use within the inner city--and especially because of the increasing popularity of cocaine--Michigan Health Center (Detroit) implemented a policy of routine drug screening of all patients admitted to the hospital through the labor unit. This policy was first implemented in February 1989. Routine drug screening made it possible to perform a retrospective study of the prevalence and patterns of drug abuse in a population consisting predominantly of inner-city patients of minority origin and indigent circumstance. The data derived from drug screening on 290 patients performed over a 75-day period are evaluated. Urine samples were screened for amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, and opiates. Nearly 27% of the urine samples tested positive for one or more of these substances. Cannabinoids and cocaine were found most frequently. Mandatory drug screening of pregnant patients by inner-city hospitals may be warranted. No statistically significant difference was noted (P less than or equal to .05) with respect to the average age, education, and number of prenatal visits of illicit substance users compared with those of nonusers.

Adolescent↗
PubMed1989

Rhesus monkey apolipoprotein(a). Sequence, evolution, and sites of synthesis.

Human lipoprotein(a) is a low density lipoprotein-like lipoprotein whose concentration in plasma is correlated with atherosclerosis. The characteristic protein component of lipoprotein(a) is apolipoprotein(a) (apo(a)) which is disulfide-linked to apolipoprotein B-100. Sequencing of rhesus monkey apo(a) cDNA suggests that this protein, like human apo(a), is highly similar to plasminogen. Sequence data suggests that a plasminogen-like protease activity and kringle 1-, 2-, 3-, and 5-like domains are unnecessary for apo(a) function, but a highly repeated kringle four-like domain is important. Liver is the major site of apo(a) RNA synthesis; reduced amounts of message were also found in testes and brain. Co-expression with apoB-100 and plasminogen in rhesus tissues is not mandatory.

Amino Acid Sequence↗
PubMedDate not supplied

[Alanine aminotransferase--a surrogate marker of viral hepatitis].

Examinations of 4457 blood donors (about 80% were men aged 18 to 30) revealed an increased level of serum glutamic-pyruvic transaminase (SGPT) in 82 (1.8%). Specific markers of viral hepatitis C were detected in 15.9%, of hepatitis B in 12.0%, of hepatitis D in 2.0%, of hepatitis E in 8.0%, of hepatitis A in 2.0% of sera with high SGPT levels. Mandatory screening of blood donors revealed specific markers of viral hepatitis in 15.9% of cases, additional testing detected these markers in 10.9% cases more. A conclusion is made that an increase of SGPT activity is an independent surrogate marker of viral hepatitis.

Adolescent↗
PubMed1993

[Significance of a screening questionnaire for diagnosis of sleep apnea].

More and more patients present with nocturnal respiratory disorders, especially with sleep apnoea (SA). This makes it mandatory to develop methods for preselecting the patients. A symptom assessment questionnaire was developed according to the Marburg stepwise concept on sleep apnoea diagnostics. Every patient completes this questionnaire as a matter of routine before he is given an appointment for an examination. The procedure to be followed depends on the evaluation of this questionnaire. Questions asked: Weight, height, use of soporifics and sleeping pills, hypertension, snoring, involuntary falling asleep, respiratory standstills, tendency to fall asleep during car driving and accidents in which the tendency to fall asleep was also involved. Three categories result from the evaluation: presence of sleep apnoea improbable (negative), more accurate details of symptoms mandatory (checking required) sleep apnoea probable (positive), patient is given an appointment date. This method was tested on 124 patients (108 male, 16 female, average age 50 yrs., average body-mass index 29.1, average apnoea index (AI) 12.8) who completed the questionnaire and were examined as outpatients, independent of the evaluation of the questionnaire, using the MESAM-IV system (nocturnal long-term recording of respiratory noises, heart rate, oxygen saturation and posture sensor). Measurements according to MESAM-IV system yielded in 69 patients (55.6%) and AI < 6 (apnoea-negative). 12 patients (9.7%) had AI 6-10 (checking required), and 43 AI < 10 (positive). Basing on evaluation of the questionnaire, 42 of 43 apnoea-positive patients had been correctly classified (98%).(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1975

National Operating Committee on Standards for Athletic Equipment football helmet certification program.

Wayne State University, Department of Neurosurgery, was contracted in 1971 by NOCSAE to develop voluntary standards for football helmets. Preliminary tests of representative football helmets on cadavers and the Z-90 metal head form showed that a more realistic head model was necessary before it was possible to understand helmet performance. A synthetic model was developed which approached human cadaver performance and at the same time was more rugged and repeatable than a cadaver head. A test method was devised and a human tolerance limit of 1500 Severity Index based on resultant CG head accelerations was adopted as the performance standard. All new football helmets available for use in high school and college football have now been certified by the NOCSAE standard and the wearing of such helmets is mandatory for college players in 1978 and high schools in 1980. By means of design or material changes, certified helmets on the NOCSAE tests are performing at a Severity Index of 1/2 those posted by prestandard models, on the average. Experience with the equipment at a helmet reconditiong plant shows that 25% of precertified helmets being received are rejected and 84% of the remainder are testing on the front location (most critical) above a Severity Index of 1450, and should be replaced as soon as possible with certified helmets.

Athletic Injuries↗
PubMed1984

[Asymptomatic severe stenosis of the left main coronary artery].

Severe stenosis (greater than 70%) of the main stem of the left coronary artery may rarely be asymptomatic. This particular clinical presentation, which has recently been highlighted, is probably commoner than had previously been thought. Though usually a chance finding, its presence should be suspected when exercise stress tests are strongly positive at low work loads; confirmed at coronary angiography, asymptomatic stenosis of the left main coronary artery is no different from symptomatic stenoses with regard to the extent and severity of the coronary lesions; they do differ, however, in that left ventricular function is preserved and may remain normal over a long period. This has therapeutic implications in that systematic surgery of first intention may not be mandatory in these cases.

Angiography↗
PubMedDate not supplied

Education in clinical pharmacology at the Rijeka School of Medicine, Croatia.

OBJECTIVE: Irrational drug prescribing is a global problem that exists both in developed and developing countries. Education is the key to improved effectiveness and safety in drug therapy. Development of clinical pharmacology (CP) as an independent discipline at the Rijeka School of Medicine has been slow and unsatisfactory. It was taken only as a part of some postgraduate courses. In the 1995/1996 academic year clinical pharmacology was offered for the first time to sixth year medical students as a non-mandatory subject. The purpose of this study was to emphasize the importance of education in clinical pharmacology at the Rijeka School of Medicine. METHODS: This survey was an uncontrolled study based on responses to questionnaires and a test consisting of written patient problems given to sixth year medical students and to general practitioners who were following a course in clinical pharmacology. RESULTS: The results of the questionnaire showed that both undergraduate and postgraduate students consider that they are not being adequately trained to prescribe drugs rationally and that they believe that clinical pharmacology should become a mandatory subject in the undergraduate medical curriculum. The results of the written patient problem test support this. Both groups of students demonstrated greater skills in solving the diagnostic part than the therapeutic part of the test. A great improvement in the students' ability to solve the therapeutic part was observed after they had completed the CP course. CONCLUSION: The results of this survey underline the necessity of education in clinical pharmacology.

Croatia↗
PubMedDate not supplied

[Detection of HTLV-I viral antibodies in donor blood samples].

Sera from 867 donors were tested for antibodies to the virus of T-lymphocyte leukemia of adults (HTLV-I) in parallel by indirect immunofluorescence on acetone-fixed cells of HUT-102 culture producing HTLV-I and by agglutination test using a commercial set ("Serodia-ATLA", Japan). Twelve (1.38%) out of 867 sera were positive in the agglutination test and only 7 of them in immunofluorescence test. The specificity of the results was verified by absorption experiments. The activity of the sera in the agglutination test disappeared completely after their absorption with HUT-102 culture cells but did not change after absorption with LLU cells producing no HTLV-I despite a low percent of virus infection, donor blood control for HTLV-I infection becomes mandatory.

Adult↗
PubMed2005

Assessment of human islet viability using various mouse models.

To date no in vitro viability test is known to accurately predict in vivo human islet function, making transplantation into various nonimmune animal models mandatory. The diabetic mouse model has been proposed as a standard method for human islet viability assessment. However, the use of streptozotocin for diabetes induction is associated with inconsistency with respect to induction protocols and the significant mortality rate. The purpose of this study was to compare a nondiabetic NOD-scid mouse model to its diabetic counterpart in terms of predicting islet viability. Diabetes was induced in NOD-scid mice using intraperitoneal injection of streptozotocin at concentrations ranging from 100 to 200 mg/kg. Blood glucose levels were monitored for 7 to 10 days, and mice that had levels of >300 mg/dL were used in the experiment. For nondiabetic mice, blood glucose and baseline human C-peptide levels were checked after an overnight fast. Transplantation of 2000 human islet equivalent was done in both models using the same technique. Islet function was determined in the diabetic mice by return to normoglycemia for 2 consecutive days and measurement of fasting human C-peptide on days 7 and 14 posttransplant. Viability was tested in nondiabetic mice after intraperitoneal injection of glucose (2 g/kg) and the measurement of human C-peptide levels using radioimmunoassay. Titration of the streptozotocin dose from 200 to 100 mg/kg showed a significant reduction in mice mortality (40% to 10%) and an increase of diabetes induction (55% to 81%). The 23 human islet isolations tested in both models showed complete consistency of the viability results.

Animals↗
PubMed2006

Prediction of driving after stroke: a prospective study.

BACKGROUND: The process of determining whether patients with stroke should drive again often involves off-road evaluations and road tests that usually take about 2 to 3 h to complete. OBJECTIVES: This prospective study sought to identify the combination of tests that best predicts fitness to drive after stroke. The main aim was to develop a short and predictive predriving assessment battery. METHODS: Sixty-eight consecutive stroke patients were studied who performed a mandatory predriving assessment at the Belgian Road Safety Institute, Brussels, within 18 months. Performance in a predriving assessment included medical examination (when needed), visual and neuropsychological evaluations, and an on-road test. Based on these assessments, a physician, psychologist, and the driving safety expert who administered the tests decided if a subject was either "fit to drive,""temporarily unfit to drive," or "unfit to drive." RESULTS: Logistic regression analysis revealed a combination of visual neglect, figure of Rey, and on-road tests as the model that best predicted (R(2) = 0.73) fitness to drive after stroke. Using a discriminant function that included the 3 tests of the logistic model, the fitness to drive judgments of 59 (86.8%) subjects were correctly predicted. The sensitivity and specificity of the predictions were 79.4% and 94.1%, respectively. CONCLUSION: Fitness to drive after stroke can be predicted from performance on a few road-related tests with a high degree of accuracy. However, some individuals require extended assessments and further tests.

Adult↗
PubMed2006

The fate of organs refused locally and transplanted elsewhere.

UNLABELLED: The number of kidney allografts procured from deceased donors has been fairly constant in the past few years, while organs from living donors steadily increase. In our program, existing protocols refused some kidneys which were subsequently accepted and transplanted at other hospitals. Thus, a review of our criteria to accept kidneys became necessary. METHODS: We studied the outcome of all kidneys refused by us but transplanted in other programs between 2002 and 2004. The data analyzed included ID no. donor, transplant center, procurement date, donor age, ischemic times, recipient alive or dead, creatinine level (when it was offered), initial function, hypertension, diabetes mellitus, biopsy, reason why the kidney was not accepted in our program, kidney functioning or lost, and cause of graft failure. The chi-square, Fisher, and t tests were used to analyze our data; P values of <.05 were regarded as significant. RESULTS: Originally 137, we excluded kidneys exported due to mandatory sharing (26 of 137 = 18.97%) and multiorgan placement (10 of 137 = 7.3%). Thus, 101 kidneys were not accepted by us because they did not meet the existing criteria of our program, but were accepted elsewhere. Reasons for nonacceptance were divided into donor quality, donor social history, donor age, donor size/weight, positive serological test, as well as organ preservation time, organ anatomical damage, elevated creatinine, abnormal urinalysis, abnormal biopsy, and decreased urine output. Donor issues were 66 of 101 (65.3%) with a graft loss of 13.6%, and organ issues were 35 of 101 (34.7%) with a graft loss of 66.6%. Donor quality totaled 24 of 66 (36.4%) and donor social history totaled 20 of 66 (30.3%); these were the most common causes for kidney nonacceptance related to donor issues. Reasons related to organ quality included elevated creatinine (15 of 35 = 42.9%; graft loss, 46.6%), and abnormal biopsy (9 of 35 = 25.7%; graft loss, 11.1%) and organ anatomical damage (4 of 35 = 11.4%; graft loss, 75%) (P = .42). Graft loss was more frequent with creatinine levels above 2.4 mg/dL (P < .001, RR gf = 1.5). Long-term fate of these 101 kidneys transplanted elsewhere: 82 (81.2%) were still working while 19 (18.8%) were lost. The causes of graft loss were renal artery thrombosis (42.1%), renal venous thrombosis (26.3%), death for other reasons (15.8%), graft never worked (10.5%), and ESRD (5.7%). The results suggest that the criteria for refusal related to donor issues, including hypertension, diabetes mellitus, donor age and donor size, should be revised owing to the low percentage of graft loss. Other donor issues such as positive serological test and donor social history (drug use, alcoholism) represent a serious potential risk for the health of recipients; for this reason, considering these persons as possible donors is very difficult irrespective of the graft outcome. Kidney refusals related to organ issues (especially elevated creatinine and anatomical damage) due to the very high percentage of graft loss should be considered high risk and probably be excluded. The increase in the demand of kidneys to be transplanted is a very important reason for a continuous and systematic review of donor exclusion criteria in every transplant program. The results presented here have helped us to improve both our outcomes and utilizations based on scientific evidence.

Cadaver↗
PubMed1985

Mouth occlusion pressure (P0.1) in acute respiratory failure.

We studied 20 unselected patients admitted to our Intensive Care Unit (ICU) suffering from acute respiratory failure (ARF), who needed mechanical ventilatory support. In all of them we followed a prospective protocol to investigate the value of mouth occlusion pressure (P0.1) as an indicator for weaning. Fifty-two tests were classified into three groups: a need to be reconnected to mechanical ventilation (MV), stable on intermittent mandatory ventilation (IMV), or spontaneous breathing on a T-tube (TT). The results showed that at increased values of P0.1 there were more difficulties in weaning patients from MV. Seventy-eight percent (78%) of the occasions where weaning was successful, values of P0.1 were less than or equal to 4.2 cm H2O, in chronic or non-chronic patients. Eighty-nine percent (89%) of the times when P0.1 values were higher than 4.2 cm H2O the same patients required ventilatory support, total (MV) or partial (IMV). These differences were statistically significant (p less than 0.01). We conclude that the P0.1 is an easily obtained non-invasive parameter, that can contribute along with other more conventional measurements to a superior indication for weaning.

Adult↗
PubMed1987

The prevention of acquired immunodeficiency syndrome in the United States. An objective strategy for medicine, public health, business, and the community.

Human immunodeficiency virus (HIV) is one of the most virulent infectious agents ever encountered. This virus, estimated to kill up to a half of those infected, has spread to more than 1 million Americans. There is no safe and effective treatment. Nor is there a vaccine. From our understanding of HIV transmission, further spread of the virus can be stopped by the use of various techniques. The combined use of education-motivation-skill building, serologic screening, and contact tracing/notification could eliminate or substantially reduce transmission. To accomplish this reduction an immense concerted effort by physicians, public health practitioners, business, and community organizations is required to get across the simple prevention messages. Those messages are: Any sexual intercourse (outside of mutually monogamous or HIV antibody-negative relationships) must be protected with a condom. Do not share unsterile needles or syringes. All women who may have been exposed should seek HIV-antibody testing before becoming pregnant and, if positive, avoid pregnancy. Only through a concerted, vigorous, and sustained prevention program that deals frankly with this problem will those individuals at risk be reached and motivated to take personal responsibility to protect themselves. Without such an effort, acquired immunodeficiency syndrome will continue to kill ever-increasing numbers of Americans.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Mandatory use of confirmation stage with Chlamydiazyme during urinary sediment analysis.

AIMS: To assess whether false positive results found when the first stage Chlamydiazyme test is performed on urinary sediment could be reduced by using the more specific second stage blocking assay. METHODS: Sediment from 173 urine samples from patients with suspected urinary tract infection caused by Gram negative bacteria and 23 control urine samples were tested using the Chlamydiazyme assay system, which included a blocking assay. RESULTS: A reaction result with the first stage Chlamydiazyme assay test was seen in 102 (58.9%) of the test urine samples. First stage reactivity was not blocked by the Chlamydiazyme confirmatory assay performed on repeat testing. All were correctly identified as true negative (first test false positive) results. CONCLUSIONS: Use of a second (specific) blocking assay for the analysis of urinary sediment using Chlamydiazyme eliminates false positive results in Gram negative urinary tract infections.

Chlamydia Infections↗
PubMed2006

Osteoarticular tuberculosis in a developed country.

OBJECTIVES: To evaluate the clinical and diagnostic features of osteoarticular tuberculosis (OT) from a series of cases seen over 30 years in a large university hospital in Naples, Italy. METHODS: We reviewed the files of all patients admitted to our department from 1975 to 2004 with a diagnosis of osteoarticular tuberculosis. RESULTS: We identified 136 patients with 140 osteoarticular tuberculosis lesions. Fifty-three cases were diagnosed from 1975 to 1984, 36 cases from 1985 to 1994, and 47 cases from 1995 to 2004. Eleven patients (8%) were from high-incidence areas outside of Italy. The mean delay until diagnosis was 216.6 days. Pain, low-grade fever, and loss of weight were the most common presenting symptoms. Neurological involvement was present in 11 cases out of 79 spinal lesions (13.9%). Serological methods were used to study antimycobacterial antibodies using enzyme-linked immunosorbent assays (ELISA-TB test) in 59 patients (42.1%). Positive results on this test were obtained in 43 patients (72.9%). ELISA-TB test was the only diagnostic test associated with a shorter diagnostic delay in a model of multivariate regression analysis (p=0.001). Tc-99m MDP bone scans were obtained from 83 patients with 84 lesions and increased uptake in the affected area was noted in 72 lesions (85.7%). Histological and microbiological examinations were positive in 97 (69.3%) and 57 (40.7%) lesions, respectively. In 43 (30.7%) lesions, we could not definitively confirm the diagnosis. In these cases chemotherapy was nevertheless initiated. CONCLUSIONS: Thorough and even invasive diagnostic work-up is mandatory for the proper and timely management of patients with OT. Tc-99m MDP bone scanning and ELISA-TB test are useful diagnostic tools. We always used microbiological testing and histological examination to confirm the diagnosis of OT, but empirical antituberculosis treatment was nevertheless initiated in the patients with high clinical suspicion in order to limit the potentially permanent destruction of affected skeletal segments.

Adolescent↗
PubMed2000

Workplace drug testing (WDT) likely to increase in Europe. Report from the First European Symposium on WDT including selected abstracts.

Will it take a series of drug-related accidents that have already occurred in the USA before workplace drug testing (WDT) becomes accepted in Europe as a preventive measure? Currently, the development of WDT in most European countries lags some 10-15 years behind that in the USA. Labour authorities in Europe now ought to take initiatives to demand a mandatory programme for accrediting drug analytical laboratories for WDT. Companies should realise that illicit drug use is no longer only a problem at street corners, and that having a testing system in place is important, not just for public health, but also for their reputations as responsible societal actors. Improved networking among police and regulatory authorities is required to keep pace with the rapid appearance and dissemination of new substances of abuse. European research collaboration, including the newly formed European Workplace Drug Testing Group, is needed to assess the impact of drug-testing policies on accidents and other outcome variables, and thereby to convince the general public and politicians that drug testing is beneficial and necessary. A 1993-1994 survey of quality analysis in some 200 European laboratories reported from Institut Municipal d'Investigació Medica (IMIM), Spain, showed good agreement between nominal and found concentrations but that only 10% of the laboratories could both screen, identify and quantify samples. Experiences from Italy show that proficiency testing schemes lead to improved accuracy of results. These were some major conclusions of the First European Symposium on Drug Testing held at Huddinge University Hospital in Stockholm, Sweden, 30 March to 1 April 1998, organised by Karolinska Institute, with participants from 22 countries.

Europe↗