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Biomedical subjects

A Sheffet

Publications and source records attributed to A Sheffet.

17 recordsLinked to original sources
PubMed2000

Applying electric and electromagnetic energy as adjuvant treatment for pressure ulcers: a critical review.

Chronic pressure ulcers are a significant health problem especially in the aging population. National estimated annual treatment costs are in the billions of dollars. Only two treatment-related recommendations receive high ratings for reported experimental evidence of validity: Use of moist wound dressings and adjunctive electrotherapy for unresponsive Stage III and IV and recalcitrant Stage II ulcers. A critical literature review pertaining to electrotherapy reveals a myriad of electrical treatment modalities varying greatly in electric current type, strength, direction, frequency, waveform, and underlying voltage. However, few clinical trials pertaining to electrotherapy exist with almost all of them characterized by a small sample size leading to a biased group assignment with no possibility for stratification by ulcer stage, site, and other important factors. Power analysis shows that a sample size of at least 164 subjects is needed to permit cost-effectiveness evaluation with attention to critical variables. "Time to healing" is recommended as the treatment outcome measure to permit proper efficiency comparisons between the various treatment modalities and controls. These comparisons are crucial in a cost-conscious environment.

Bandages↗
PubMed1997

Modified total lymphoid irradiation and low dose corticosteroids in progressive multiple sclerosis.

In a double-blind prospective randomized trial, we assessed the efficacy and safety of modified total lymphoid irradiation (TLI) plus low dose prednisone (TLI-LDP) as compared to sham TLI plus identical prednisone therapy (sham TLI-LDP) in 46 patients with progressive forms of multiple sclerosis (MS). No significant difference existed between groups at study entry in patient age, sex, duration of MS, or disability status. However, following treatment, significantly fewer TLI patients showed a sustained one point decline in the Expanded Disability Status Scale, the primary study endpoint, as compared to the sham TLI group using the Kaplan-Meier Product-limit survival analysis, (P<0.005). Risk for relapse requiring treatment with intravenous methylprednisolone was reduced by 54% in the TLI-treated group (P<0.05). Significantly fewer TLI-LDP patients had gadolinium enhancing plus new T2-weighted lesions (P=0.018) when compared to the sham group post-treatment. There was also a substantial and significant decrease in blood lymphocytes in the TLI-LDP group when compared to either pretreatment values or to sham TLI-LDP through at least 12 months post-therapy. Side effects secondary to TLI were generally mild and well-tolerated. These results further support the hypothesis that TLI and systemic immunosuppression have a beneficial effect in progressive forms of MS.

Adult↗
PubMed1996

Micronutrient profiles in HIV-1-infected heterosexual adults.

There is compelling evidence that micronutrients can profoundly affect immunity. We surveyed vitamin supplement use and circulating concentrations of 22 nutrients and glutathione in 64 HIV-1 seropositive men and women and 33 seronegative controls participating in a study of heterosexual HIV-1 transmission. We assayed antioxidants (vitamins A, C, and E; total carotenes), vitamins B6 and B12, folate, thiamin, niacin, biotin, riboflavin, pantothenic acid, free and total choline and carnitine, biopterin, inositol, copper, zinc, selenium, and magnesium. HIV-infected patients had lower mean circulating concentrations of magnesium (p < 0.0001), total carotenes (p = 0.009), total choline (p = 0.002), and glutathione (p = 0.045), and higher concentrations of niacin (p < 0.0001) than controls. Fifty-nine percent of HIV+ patients had low concentrations of magnesium, compared with 9% of controls (p < 0.0001). These abnormal concentrations were unrelated to stage of disease. Participants who took vitamin supplements had consistently fewer low concentrations of antioxidants, across HIV infection status and disease stage strata (p = 0.0006). Nevertheless, 29% of the HIV+ patients taking supplemental vitamins had subnormal levels of one or more antioxidants. The frequent occurrence of abnormal micronutrient nutriture, as found in these HIV+ subjects, may contribute to disease pathogenesis. The low magnesium concentrations may be particularly relevant to HIV-related symptoms of fatigue, lethargy, and impaired mentation.

Adult↗
PubMed1996

Lymphocyte immunoregulatory cells present in semen from human immunodeficiency virus (HIV)-infected individuals: a report from the HIV Heterosexual Transmission Study.

The purpose of this study was to determine the types and distribution of immune subsets present in semen from human immunodeficiency virus (HIV)-infected (HIV+) individuals and to compare these values with those measures in semen from HIV-negative (HIV-) individuals. To accomplish this, a direct three-color monoclonal antibody labeling technique was employed to identify immune cells in fresh ejaculates. Once labeled, the percent of each immune subset present in the ejaculate was determined by flow cytometric analysis. The percent of CD3+ cells present in the semen of the HIV+ group showed no significant difference when compared with semen from the HIV- group. Analysis of the CD4+ subset yielded a significantly lower percent in the HIV+ group than in the HIV- group. The analysis of the CD8+ subset yielded a higher percent of cells present in semen from HIV+ individuals. The CD8 higher value along with lower CD4 value results in a lower CD4/CD8 ratio in the HIV+ group. Further subset studies showed that the percent of cells expressing naive (CD4+ CD45RA+) and memory (CD4+ CD45RO+) markers was lower in the HIV+ group. This study provides additional data supporting the utility of flow cytometry and monoclonal antibodies to immunophenotypic cells present in semen ejaculates. It is also the first reported application of the technique to a disease-based model and may be useful to better understand issues of mucosal immunity and transmission of sexually transmitted diseases such as HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Combination total lymphoid irradiation and low-dose corticosteroid therapy for progressive multiple sclerosis.

Total lymphoid irradiation (TLI) has been reported to delay deterioration in patients with progressive multiple sclerosis and other autoimmune disorders. METHODS--In an open trial, the effect of TLI combined with a one year course of low dose prednisone was compared to the effect of sham TLI and TLI only in a prior double-blind study of patients with progressive multiple sclerosis. RESULTS--Twenty-seven patients receiving TLI combined with corticosteroids had significantly greater lymphocytopenia in the year post-therapy than those receiving TLI only or sham TLI and Kaplan Meier product-limit survival analysis showed significantly less progression in the TLI plus steroid group over 4 years of follow-up. No difference in lymphocytopenia or progression was found with TLI plus corticosteroid therapy when the spleen was removed from the field of irradiation. CONCLUSION--These results lend further support to the hypothesis that TLI may be effective in progressive MS, and indicates that adding low-dose prednisone may enhance this effect. The study also suggests that TLI may be equally effective whether or not the spleen is irradiated.

Adult↗
PubMed1994

Triple-dose versus single-dose gadoteridol in multiple sclerosis patients.

Nine patients with multiple sclerosis underwent brain magnetic resonance imaging (MRI) to evaluate the contrast enhancement of individual lesions after a single dose and a triple dose of gadolinium. A single dose (0.1 mmol/kg) of gadoteridol was administered and after a delay, axial T1-weighted images were obtained. After an additional 0.2-mmol/kg dose, the same T1-weighted sequence was repeated. An unblinded reader simultaneously viewed the images from both doses, and utilizing a computer console to rule out flow artifacts, created a gold standard of "definite" enhancing lesions. Using this system, he determined that there was a total of 12 definite enhancing lesions among the patients. This reader also evaluated lesion conspicuity. The contrast-noise ratio was calculated for each lesion. A second reader, blinded to the dose used, then evaluated the number of enhancing lesions at both doses. The unblinded reader noted increased lesions at both doses. The unblinded reader noted increased lesion conspicuity after the triple dose. Contrast-noise ratios were significantly (p < 0.001) higher after the triple dose (mean, 9.19) than after the single dose (mean, 2.97). The blinded reader detected 11 of the 12 definite lesions on MRIs after the triple dose (sensitivity, 92%) but saw only 6 on MRIs after the single dose (sensitivity, 50%). The difference was significant (p < 0.001). Subjective analysis of the films revealed an increase in "ghosting artifacts" at the high dose. Administration of triple-dose gadolinium provides increased lesion conspicuity and an improved lesion detection rate when compared to single-dose gadolinium in patients with multiple sclerosis.

Brain↗
PubMed1993

Psychological distress, drug and alcohol use as correlates of condom use in HIV-serodiscordant heterosexual couples.

OBJECTIVE: To investigate the relationship between psychological distress, alcohol, drug and condom use in HIV-serodiscordant heterosexual couples. METHODS: Structured interviews were conducted to collect demographic information, detailed data on psychological distress, drug and alcohol use and sexual behavior. RESULTS: Analyses were based on 106 pairs of sexually active discordant couples. Significant differences among heterosexual condom users and non-users varied according to gender and HIV serostatus. Affect domains of interpersonal sensitivity and hostility were significant, as were the variables of regular drug or alcohol use and combining sex with drugs or alcohol. Employment was strongly associated with condom use in HIV-negative women whose regular sexual partners were HIV-positive men. CONCLUSION: The risk of vaginal sex without condoms in HIV-serodiscordant heterosexual couples may be reduced by specific psychological counseling and attention to drug and alcohol use as risk factors. Further research on the effect of employment of HIV-negative women is required.

Adolescent↗
PubMed1991

Clinical correlation with serum-soluble interleukin-2 receptor levels in Guillain-Barré syndrome.

In patients with Guillain-Barré syndrome (GBS) soluble interleukin-2 receptor (sIL-2R) levels were elevated compared with those of patients with other neurologic diseases (OND), and of healthy controls. Smaller increases in sIL-2R levels occurred in OND patients compared to healthy subjects. Monitoring of GBS patients clearly demonstrated that decreases in sIL-2R levels correlated with clinical recovery. Thus, T-cell activation may be relevant in the pathogenesis of GBS.

Central Nervous System Diseases↗
PubMed1989

Cancer mortality among a cohort of chromium pigment workers.

A study of mortality among 1,879 male workers employed in a New Jersey chromium pigment factory was carried out, with follow-up from 1940 to 1982. Vital status of 1,737 (92%) of the eligible cohort members was determined. For all malignant neoplasms, 101 deaths were observed while 108.8 were expected, SMR = 93 (standardized mortality ratio; n.s.). For the entire study group, no significant excess was observed for respiratory cancer or cancer at other sites. However, the total number of years of employment in the factory and the total number of years of exposure to chromate dusts were both statistically significantly (p less than .05, for trend) associated with an increased risk for lung cancer. The excess risk for lung cancer associated with duration of exposure to chromate dusts was, however, only clearly apparent for subjects followed for 30 years or more after initial employment. For this group, the SMRs were 81, 139, 201, and 321 for the subjects with 0 years, less than 1 year, 1-9 years, and 10+ years of exposure to chromate dusts (p less than .01, for trend), respectively. The risk for digestive cancer was only weakly associated with exposure to chromate dusts.

Chromium↗
PubMed1979

Evaluation of drug abuse rehabilitation efforts: a review.

During the 1960s, three modalities of treatment aimed at rehabilitation of the drug abuser (methadone maintenance, outpatient drug free treatment, and the residential therapeutic community) were developed. Large amounts of public and private monies have gone to supporting these modalities; little evaluation as to the efficacy of such rehabilitation efforts has been done. This paper attempts to delineate the evaluative research efforts undertaken in the drug abuse field to date. In addition, the findings of an eight-year evaluation of six drug treatment programs in Newark, NJ are presented. The authors propose a paradigm for quick, effective evaluation of drug and alcohol programs at minimal cost.

Ambulatory Care↗
PubMed1976

An evaluation of detoxification as an initial step in the treatment of heroin addiction.

Of 802 voluntary patients admitted to the detoxification unit of a comprehensive treatment system, 69% completed detoxification but only 9.6% of thest patients sought long-term treatment. The demographic profile of detoxification patients differed somewhat from that of patients in long-term treatment. The authors suggest that new approaches, including legal pressure, are needed to induce detoxification patients to accept prolonged therapy.

Heroin Dependence↗
PubMedDate not supplied

Cancer mortality in a pigment plant utilizing lead and zinc chromates.

Several studies of workers exposed to various forms of chromium compounds have suggested an increased incidence of respiratory cancers. Lead and zinc chromates were among the chromium compounds implicated. The Department of Preventive Medicine and Community Health of the New Jersey Medical School undertook a detailed mortality study of a pigment plant in Newark which utilized both of these compounds. We compared observed deaths from each cause among 1296 white and 650 non-white males who were employed at the plant between January 1, 1940 and December 31, 1969, with expected deaths, as computed from cause-, age-, and time-specific standard death rates for the United States. A statistically significant relative risk of 1.6 for lung cancer among white male employees was found, as well as among the cohorts of white males employed 10 yr or more. A relative risk of 1.9 was noted for individuals employed at least 2 yr who were at least moderately exposed to chromates. An increased incidence of lung cancer among non-white males and stomach and pancreatic cancer among the total cohort was also evident. These data support the validity of the association between chromate pigment exposure and lung cancer, suggesting that pigment workers and other exposed to chromates be observed carefully in regard to possible risk or pancreatic and stomach cancers.

Black People↗
PubMedDate not supplied

Wealth from Health: an incentive program for disease and population management: a 12-year project.

The future of healthcare is linked with its ability to face the challenges of consumerism. Disease and population management will represent the dominant style of healthcare delivery in the future. This article describes the Wealth from Health programs which utilize current and future technologies to help the healthcare system become a leader in healthcare delivery and to assist many communities at an affordable cost.

Asthma↗