America's health care follies.
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Biomedical subjects
Publications and source records attributed to A P Gelpi.
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The martyrdom of Saint Sebastian is one of the most enduring themes in Western religious art. The execution scene so often portrayed - with the Saint transfixed with arrows - is based on the legend about his life and death during the reign of the Roman emperor, Diocletian. However, it is the symbolic association of arrows with the Black Death - during the Middle Ages and during the Renaissance - which identifies Sebastian as the patron saint of plague victims. After more than four centuries of recurrent epidemics, the plague died out in Europe; but the image of St. Sebastian continued to inspire artists until the end of the 19th century.
Practicing physicians are just becoming aware of the animal rights movement, which during the 1980s spawned numerous acts of violence against research facilities throughout the United States. The animal rightists are challenging physicians to show moral justification for the human exploitation of nature and the world of subhuman species. They have aroused public interest in animal welfare, sparked protective legislation for experimental animals, and indirectly encouraged the creation of committees to oversee the conduct of animal experimentation and the conditions of animal confinement. This controversy has necessitated a closer look at the questions of animal experimentation and animal rights against the backdrop of human experimentation and human rights. Physicians and specialists in animal care seek to alleviate suffering and anxiety, and, as moderates, they may be able to bring both sides of the animal rights controversy together in a spirit of mutual tolerance and in the common cause of promoting both human and animal welfare.
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A survey of 8,084 adult Saudi male employment applicants yielded 872 with the sickle cell trait (AS) and 51 with sickle cell disease. Based on the known distribution of hemoglobin S genes between oasis and non-oasis populations in Saudi Arabia, and on calculation of the expected number of abnormal homozygotes within the non-oasis and oasis subgroups as well as the entire employment applicant group, it appears that virtually 100% of Saudis with SS disease survive to adult life. Saudi Arabs and other Caucasian populations in the Middle East exhibit a benign type of SS disease as compared with Blacks in Africa and the Americas. In the Middle East, gene contributions from SS individuals will shift equilibrium frequencies to higher levels than encountered in Black populations under sustained selective pressures, and the polymorphism will tend to be stable with decline in selective pressure. There are some indications that the hemoglobin S gene may have been a recent import into the Middle East.
Of 52 student patients with chronic inflammatory bowel disease who were observed at Stanford University over a three-year period, 16 had Crohn disease, 17 had ulcerative colitis and 19 had ulcerative proctitis. Patients with ulcerative colitis had relatively few complications. During the study period, only two students from the entire group of 52 were obliged to interrupt college attendance because of bowel disease or complications. Of the patients, 33 were first observed on remission or attained remission during the three-year observation period. Incidence and prevalence rates for Crohn disease and ulcerative colitis were comparable with age-specific rates from other published studies. At Stanford, the high reported frequency of proctitis, which exceeded that of proximal ulcerative colitis, was possibly a reflection of the diagnostic zeal with which patients with rectal bleeding were evaluated at the student health service.
Lymphocytes of patients with infectious mononucleosis (IM), EBV sero-positive subjects, patients with viral infections other than EBV, and EBV sero-negative subjects were tested for phytohaemagglutinin (PHA)-induced and spontaneous transformation in vitro. Lymphocytes of EBV sero-positive healthy subjects, tested in autologous serum, have higher spontaneous transformation than those of EBV sero-negative subjects. IM patients, in the acute phase of illness, have depressed spontaneous lymphocyte transformation, independent of serum factors. Serum factors are present in acute IM that depress spontaneous transformation further, and to a lesser extent depress reactivity to PHA. By the time the IM patients had recovered, greater than 9 weeks after onset of illness, the defects observed had disappeared.
67/369 male Saudi subjects (18%) were found to be G6PD deficient on screening, and electrophoresis of blood samples stored on filter paper strips revealed B-like variants with intermediate enzyme activityin 11%, presumed Mediterranean variant in 13%, Gd + (A+) in 2%, Gd--(A--7) in 0.8%, and indeterminate enzyme status in 6% of the subjects tested. A significant association between G6PD deficiency and hemoglobin S correlated with previous studies on similar samples from the general population.
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Among a small group of Saudi Arabs the Duffy blood group (Fy(a-b-)) was found to be associated with the sickle cell trait more often than could be explained by random gene combination thus supporting the concept that African gene flow brought the sickle cell trait to the Arabian peninsula. Based on recent observations concerning the possible role of Fy(a-b-) as a resistance factor against vivax malaria, it is proposed that the gene combination AS FyFy is likely to be selected in areas where falciparum and vivax infections are endemic and mixed infections occur frequently.
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48 of 391 apparently healthy adult Saudi males had an AS hemoglobin pattern on electrophoresis, four subjects had an S pattern, and two subjects AC. A dithionite screening test lacked sensitivity and specificity in detecting hemoglobin S under the conditions of this study. A sickle cell trait frequency of 0.123 evidenced by hemoglobin electrophoresis correlates closely with previous studies of hemoglobinopathies in Saudi Arabs. The presence of four subjects with sickle cell disease in the study group provides further evidence of the "benign" nature of sickle cell disease in Saudi Arabia.
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