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Biomedical subjects

C M Dickinson

Publications and source records attributed to C M Dickinson.

At least 19 recordsLinked to original sources

A review of gagging problems in dentistry: aetiology and classification.

Some people have a pronounced gag reflex that can be a severe limitation to their ability to accept dental care and the clinician's ability to provide it. It can compromise all aspects of dentistry, from diagnostic procedures to active treatment and can be distressing for all concerned. Many techniques have been described that attempt to overcome the problem. Dentists will undoubtedly see patients with gagging problems and knowledge of a variety of management strategies is necessary to aid the delivery of dental care. This first paper looks at the background to gagging problems and their classification and categorization prior to clinical treatment. The second article will look at the clinical assessment of the patient presenting for dental treatment with a history of gagging problems. It will also review methods used to manage patients with gagging reflexes during dental treatment.

Journal Article↗

A review of gagging problems in dentistry: 2. Clinical assessment and management.

A pronounced gag reflex can be a severe limitation to a patient's ability to accept dental care and for a clinician's ability to provide it. It can compromise all aspects of dentistry from diagnostic procedures to active treatment and can be distressing for all concerned. Many 'management' techniques have been described. This paper describes the different categories of treatment used to manage people with pronounced gag reflexes.

Acupuncture Therapy↗

A review of gagging problems in dentistry: 2. Clinical assessment and management.

A pronounced gag reflex can be a severe limitation to a patient's ability to accept dental care and for a clinician's ability to provide it. It can compromise all aspects of dentistry from diagnostic procedures to active treatment and can be distressing for all concerned. Many 'management' techniques have been described. This paper describes the different categories of treatment used to manage people with pronounced gag reflexes.

Acupuncture Therapy↗

Face recognition in age related macular degeneration: perceived disability, measured disability, and performance with a bioptic device.

AIMS: (1) To explore the relation between performance on tasks of familiar face recognition (FFR) and face expression difference discrimination (FED) with both perceived disability in face recognition and clinical measures of visual function in subjects with age related macular degeneration (AMD). (2) To quantify the gain in performance for face recognition tasks when subjects use a bioptic telescopic low vision device. METHODS: 30 subjects with AMD (age range 66-90 years; visual acuity 0.4-1.4 logMAR) were recruited for the study. Perceived (self rated) disability in face recognition was assessed by an eight item questionnaire covering a range of issues relating to face recognition. Visual functions measured were distance visual acuity (ETDRS logMAR charts), continuous text reading acuity (MNRead charts), contrast sensitivity (Pelli-Robson chart), and colour vision (large panel D-15). In the FFR task, images of famous people had to be identified. FED was assessed by a forced choice test where subjects had to decide which one of four images showed a different facial expression. These tasks were repeated with subjects using a bioptic device. RESULTS: Overall perceived disability in face recognition did not correlate with performance on either task, although a specific item on difficulty recognising familiar faces did correlate with FFR (r = 0.49, p<0.05). FFR performance was most closely related to distance acuity (r = -0.69, p<0.001), while FED performance was most closely related to continuous text reading acuity (r = -0.79, p<0.001). In multiple regression, neither contrast sensitivity nor colour vision significantly increased the explained variance. When using a bioptic telescope, FFR performance improved in 86% of subjects (median gain = 49%; p<0.001), while FED performance increased in 79% of subjects (median gain = 50%; p<0.01). CONCLUSION: Distance and reading visual acuity are closely associated with measured task performance in FFR and FED. A bioptic low vision device can offer a significant improvement in performance for face recognition tasks, and may be useful in reducing the handicap associated with this disability. There is, however, little evidence for a correlation between self rated difficulty in face recognition and measured performance for either task. Further work is needed to explore the complex relation between the perception of disability and measured performance.

Aged↗

The limitations imposed on reading by low vision aids.

INTRODUCTION: The changes that occur in the reading eye movements of normally sighted readers were measured as they used hand magnifiers to identify how these devices contribute to the slow reading of visually-impaired patients. METHODS: Subjects inexperienced in magnifier use read texts containing two sizes of print, using hand magnifiers of two different powers, held at two different eye-to-magnifier distances. The effect of magnification (up to 13.5x) and field-of-view (FOV) (2-45 characters) could be assessed independently. RESULTS: Reading speed decreased with increasing magnification because the size of the saccades did not increase in proportion to the magnification: for a given level of magnification, decreasing the FOV and decreasing the viewing distance both reduce the size of the saccades even further. The overall reading speed is only slowed significantly when the FOV restriction is extreme (two characters' width). CONCLUSIONS: Two mechanisms seem to be used spontaneously by normally sighted readers to mitigate the limitation of reading speed created by the shortened saccades: head movement in the direction of reading and retinal image slip during fixation.

Adolescent↗

The inter-relationship between magnification, field of view and contrast reserve: the effect on reading performance.

For the reading task, contrast reserve is defined as the ratio of the letter contrast of the printed letters, to the reader's contrast threshold. Acuity reserve is the ratio of the print size used for the reading task, to the reader's visual acuity. The effects of low contrast reserve on reading performance were investigated at various magnifications, ranging from 3x to 7.5x, with the field of view systematically controlled. Eye movements were recorded whilst normally sighted subjects read using the magnifiers. It was shown that with adequate contrast reserve, increasing the field of view improved the reading rate because of the resulting increase in forward saccade length. Conversely, reducing the contrast reserve slowed the reading rate by decreasing the length of forward saccades and increasing the mean fixation duration, suggesting that the perceptual span is reduced at low contrast reserve. This study also shows that when the contrast reserve is low, providing magnification higher than that required for letter recognition (that is, increasing the acuity reserve) will not improve the reading performance. Furthermore, even when the contrast reserve was high, reading rates were lower for the magnifications of 5x and higher, because increases in saccade length do not match those of the retinal image size at these magnifications.

Contrast Sensitivity↗

Spectral sensitivity in patients with dysthyroid eye disease.

The majority of patients with dysthyroid eye disease have an acquired colour vision defect. However, no psychophysical investigation of selective damage to colour or flicker pathways has been carried out. In order to clarify the nature of the visual pathology, we have used a psychophysical technique (spectral sensitivity) to selectively stimulate the chromatic and achromatic mechanisms. Spectral spots of size 1 degree presented at a rate of 1 Hz on a bright 1000 td white background are detected by the chromatic mechanism but a rate of 25 Hz reveals the achromatic mechanism. Fifteen patients (28 eyes) between the ages of 50-70 years were tested. The study showed that all patients had reduced spectral sensitivity, either 1 Hz, 25 Hz or both. The patients with reduced 1 Hz or 25 Hz spectral sensitivity only had a shorter systemic and ocular duration of the condition, had no proptosis, normal intraocular pressures in primary gaze, slightly higher intraocular pressures on upgaze, normal visual field plots and FM 100-Hue error scores higher than the normal age-matched values. The patients with reduced both 1 Hz and 25 Hz spectral sensitivities had a longer systemic and ocular duration of the condition, had proptosis, normal intraocular pressures in primary position, higher intraocular pressures on upgaze and higher FM 100-Hue error scores than the age-matched normals and those in Groups 1 and 2. A total of 50% of patients in Group 3 had defective visual field plots. These data suggest that there is a damage of the large achromatic fibres and small chromatic fibres in dysthyroid eye disease. The mechanism of the damage could be one of ischaemic or mechanical or both.

Aged↗

More folic acid for everyone, now.

Research during the last 5 years has made it clear that people who do not take folic acid supplements are at increased risk for functional folate deficiency, which has been proven to cause spina bifida and anencephaly and also has been associated with an increased risk for occlusive cardiovascular disease. The overriding folate policy issue is how to increase dramatically the folate consumption of 75% of the population who are now consuming 0.4 mg of folic acid in a supplement. The most expeditious way to increase consumption is through fortification of a food staple. Public health programs are also needed to educate people about the vital importance of increased consumption of folic acid vitamin supplements and of food rich in natural folates. It is urgent that fortification of cereal-grain products be implemented now. The level proposes by FDA would accomplish some prevention, but much more prevention would occur if the fortification were 2.5 times that level. Fortification at the higher level would prevent about 1000 spina bifida and anencephaly birth defects each year and perhaps as many as 50,000 premature deaths each year from coronary disease. Available data have not demonstrated that increasing consumption of folic acid by 0.1 to 0.25 mg of folic acid a day is harmful. If a policy needs to be established on the assumption that people who take vitamin supplements could be harmed, a good policy option ia available; require that all folic acid vitamin supplements also contain 0.4 mg of vitamin B-12.

Adult↗

Evidence of nonsusceptibility to diethylcarbamazine in Wuchereria bancrofti.

This study assessed Wuchereria bancrofti-infected patients who received diethylcarbamazine (DEC) to determined if drug levels were comparable between individuals who continued to harbor circulating microfilariae and those whose blood became clear of parasites, between those with high and low microfilaria counts, and between infected and noninfected persons. Haitian volunteers undergoing treatment for W. bancrofti and two nonendemic controls were enrolled. DEC levels in serum and urine samples were determined using a gas chromatographic method. No correlation was found between pre- and posttreatment microfilarial levels and drug levels. Drug levels were comparable in persons with or without residual microfilaria and in infected and uninfected persons. These results indicate that incomplete drug regimens, differences in serum drug levels, and inadequate drug dosage are not the primary causes of treatment failure and suggest there is a degree of parasite tolerance for DEC.

Animals↗

Effects of albendazole on Echinococcus multilocularis infection in the Mongolian jird.

Albendazole chemotherapy of larval Echinococcus multilocularis was studied in the Mongolian jird by administration of medicated feed at various concentrations and durations. The effects were evaluated by comparison of treated and control groups in terms of host mortality, larval metastases to the lungs, and final weight and histologic appearance of larval tissue. Viability of larval tissue at necropsy of each animal was tested by inoculation into two noninfected jirds. Albendazole-medicated feed (0.05%-0.10%) significantly inhibited larval growth. Other effects of the drug included larval degeneration and necrosis, inhibition of protoscolex formation, decreased pulmonary metastases, and reduced mortality of hosts. Adverse effects on the parasite correlated significantly with serum albendazole metabolite levels and duration of therapy. However, serum albendazole levels in jirds equal to or exceeding concentrations achieved in humans receiving daily doses of 10 mg/kg of body weight did not kill the parasite.

Albendazole↗

Retinal image quality in albinos. A review.

This paper describes two of the factors which affect retinal image quality in oculocutaneous albinos. Contrast detection thresholds were determined to quantify the effects of intra-ocular light scatter and the consequences of continuous retinal image motion. The implications of these results on the limits of visual performance are discussed in the light of the accompanying foveal hypoplasia.

Albinism, Oculocutaneous↗

Pursuit and optokinetic responses in latent/manifest latent nystagmus.

Abnormalities of foveal smooth pursuit and the monocular optokinetic response (OKR) have often been reported in subjects with latent nystagmus (LN) and manifest latent nystagmus (MLN). This abnormality typically takes the form of a monocular asymmetry with a deficit in the response to nasal-to-temporal (N-T) motion in the visual field. Previous studies have each presented different interpretations of this finding, depending on whether the characteristics of the spontaneous oscillation were considered when analyzing the measured eye movement response: one report has suggested that these asymmetries are in fact the cause of the spontaneous nystagmus. In this study, pursuit and OKRs were examined separately and, when working synergistically and antagonistically, to attempt to overcome this difficulty. Results suggest that pursuit and the OKR could be symmetric in LN and MLN for both binocular and monocular viewing, which leads to the conclusion that the asymmetric patterns of response often reported in LN/MLN result from either shifts in the zone of minimum-intensity oscillation or from non-stimulus-specific increases in the spontaneous nystagmus.

Adolescent↗

Effect of azotemia in dogs on the pharmacokinetics of pentamidine.

We used a new high-performance liquid-chromatography assay to study the pharmacokinetics of pentamidine isethionate given intravenously to 10 dogs before and after surgically induced renal failure. The presurgery peak serum concentration of pentamidine averaged 867 ng/ml and by 6 hr had fallen to 30 ng/ml. After surgery the peak and 6-hr concentrations were 780 ng/ml and 28 ng/ml. Mean total body clearance of pentamidine before surgery was 46.7 ml/min per kg, of which only 2.0 ml/min per kg was due to renal clearance had fallen 80%--to 0.4 ml/min per kg. Two dogs with azotemia and two control dogs received 14 daily infusions of pentamidine. Kinetic parameters measured after the last dose were not significantly different from those after the first dose, and the amount of pentamidine recovered from tissues was similar for dogs with azotemia and controls. In summary, because renal clearance of pentamidine accounted for such a small proportion of total body clearance, none of the parameters measured was affected significantly by moderate azotemia.

Amidines↗

Waveform characteristics in congenital nystagmus.

Using infra-red oculography, electro-oculography and fundus video-recordings, waveform characteristics (amplitude, frequency, waveform shape and foveation) were examined in over 150 individuals with congenital nystagmus. For many of the subjects the nystagmus exhibited marked variability in both space and time. The sources of this variability were explored and the state of attention of the observer was found to be a dominant factor. The waveform and precision of foveation were not found to be related to any one classification group (eg. albino or idiopathic).

Adolescent↗

The elucidation and use of the effect of near fixation in congenital nystagmus.

It has frequently been reported that the spontaneous ocular oscillation in congenital nystagmats is less intense for near viewing than during distance fixation. The reason for this effect was sought, and the influences of monocular adduction, convergence and accommodation acting separately and synergistically were assessed. The frequent assumption that nystagmus intensity (amplitude and frequency) is determined by convergence angle (either symmetrical or asymmetrical) was confirmed, and it was found that binocular viewing was not necessary. An identical effect on nystagmus intensity could be created for distance fixation by the use of base-out prisms, and these were prescribed for constant wear in two congenital idiopathic nystagmats. Although nystagmus intensity was constantly reduced, no concomitant increase in binocular contrast sensitivity or Snellen visual acuity occurred.

Accommodation, Ocular↗

High-performance liquid chromatographic method for quantitation of pentamidine in blood serum.

A high-performance liquid chromatographic procedure has been developed for the determination of pentamidine concentrations in serum samples. A microbore, reversed-phase column was used with a mobile phase consisting of methanol and water with sodium heptanesulfonate and triethylamine as modifiers. Pentamidine could be extracted from serum only by the addition of an ion-pairing agent, di(2-ethylhexyl) phosphoric acid, to the chloroform used for extraction. The method can be used to reliably detect levels as low as 5 ng/ml. The pentamidine concentration in the serum of eleven patients 24 h after their tenth daily dose of pentamidine averaged 60 +/- 34 ng/ml.

Amidines↗

Amodiaquine as a prodrug: importance of metabolite(s) in the antimalarial effect of amodiaquine in humans.

Existing analytical methods for assaying the 4-aminoquinoline antimalarial amodiaquine in body fluids are nonspecific and obscure the fact that little or no amodiaquine is present in the blood of dosed persons. We have isolated four metabolites of amodiaquine. The two major metabolites have been identified; one is desethylamodiaquine, and the other has been tentatively identified on the basis of proton nuclear magnetic resonance spectroscopy as 2-hydroxydesethylamodiaquine. We developed a reverse-phase high-performance liquid chromatographic (HPLC) method that separates the two major metabolites from each other and from amodiaquine, allowing separate quantification. The impact of these findings on in vitro sensitivity testing and blood analysis of persons dosed with amodiaquine is discussed.

Amodiaquine↗