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Biomedical subjects

C Shields

Publications and source records attributed to C Shields.

At least 19 recordsLinked to original sources
PubMed2006

Infection in a neonate caused by Pichia fabianii: importance of molecular identification.

Pichiafabianii, an uncommon yeast species recovered from clinical specimens, was documented as the cause of an infection in a 5-week-old female twin delivered at 25 and 3/7 weeks. She developed respiratory distress syndrome and necrotizing enterocolitis. At the time of the infection, she was febrile, thrombocytopenic, and still was requiring minimal ventilatory support. Blood cultures drawn on two consecutive days were positive for a germ tube negative yeast. Phenotypic methods including carbohydrate fermentations and assimilations (API 20C AUX) did not identify the yeast. Sequencing of D1/D2 domain of the large subunit rDNA was performed in one laboratory and sequencing a subunit of D2 performed in a second laboratory identified the yeast as P. fabianii. The organism was susceptible in vitro to amphotericin B, fluconazole and 5-fluorocytosinc. The patient responded to amphotericin B and removal of her vascular catheter. This case illustrates that there are an increasing number of fungi that may be pathogenic. Phenotypic tests may fail to identify them, emphasizing the need for commercially available, molecular based assays for identification.

Amphotericin B↗
PubMed2005

Intravenous antioxidant modulation of end-organ damage in L-arginine-induced experimental acute pancreatitis.

BACKGROUND: Oxidative stress mediates acinar injury in experimental acute pancreatitis (AP) and antioxidants are depleted in human AP. This study tests the hypothesis that exogenous antioxidant supplementation ameliorates experimental AP. METHODS: Male Sprague-Dawley rats were randomly allocated to 1 of 4 groups (n = 5/group) and sacrificed at 72 h. AP was induced by 250 mg per 100 g body weight of 20% L-arginine hydrochloride in 0.15 mol/l sodium chloride. Group allocations were: group 1 (control) no intervention; group 2 AP; group 3 early multiple antioxidant (MAOX) intervention comprising 15 microg/kg selenium, 30 microg/kg ascorbate and 300 mg/kg N-acetylcysteine given at 6 and 30 h and group 4 the MAOX combination above given at 24 and 48 h. Endpoints were: serum amylase, antioxidant levels, bronchoalveolar lavage (BAL) protein and lung myeloperoxidase (MPO) activity and histological assessment of pancreatic injury. RESULTS: L-arginine induced AP characterised by oedema, neutrophil infiltration, acinar cell degranulation and elevated serum amylase. Early MAOX reduced pulmonary MPO and BAL protein and reduced acinar swelling, degranulation and pancreatic parenchymal infiltration by inflammatory cells. These features were absent when intervention was delayed. CONCLUSION: In this model, early but not late antioxidant intervention ameliorates pancreatic and pulmonary injury.

Acetylcysteine↗
PubMed2004

Otitis caused by Scedosporium apiospermum in an immunocompetent child.

Scedosporium apiospermum (Pseudallescheria boydii) is a ubiquitous saprophytic mold. It is considered an infrequent but important and emerging human pathogen, mostly in immunocompromised hosts. Otomycosis secondary to S. apiospermum is extremely rare. We report an 8-year-old immunocompetent male who developed otitis media and otitis externa from S. apiospermum, which was successful treated with combination of surgical debridement and topical clotrimazole therapy. A brief literature review of infections caused by S. apiospermum follows the case presentation.

Administration, Topical↗
PubMed2003

Climbing-specific finger endurance: a comparative study of intermediate rock climbers, rowers and aerobically trained individuals.

The aim of this study was to compare the climbing-specific finger endurance of climbers, rowers and aerobically leg trained athletes. Twenty-seven males aged 21.2 +/- 2.2 years (mean +/- s) volunteered for the study. The participants were intermediate rock climbers (n = 9), rowers (n = 9) and leg trained athletes (n = 9). Maximal voluntary contraction (MVC) was determined on climbing-specific finger apparatus. Endurance isometric exercise was performed at 40% MVC in three tests performed in a random order: (1) sustained exercise; (2) 6 s exercise, 4 s rest; and (3) 18 s exercise, 12 s rest. Pre- and post-exercise blood pressure and blood lactate concentration, together with post-exercise pain perception, were measured. The climbers had a significantly greater MVC (383 +/- 35.6 N) than the rowers (321 +/- 49.5 N, P = 0.007) and aerobically leg trained athletes (288 +/- 60.6 N, P = 0.001). There were no significant differences between the groups in terms of endurance times for any of the tests. In the test with 18 s exercise and 12 s rest, the climbers showed a significantly higher increase in blood lactate concentration, on average, than the rowers by 0.01-0.89 mmol x l(-1) (P = 0.006); there were no significant differences, on average, in the comparisons of climbers and the leg trained athletes and rowers and the leg trained athletes. There were no significant differences in the average changes in blood pressure from rest to post-exercise between any of the groups. Although the climbers had greater MVC on average than the other two groups, there were no significant differences in average endurance times amongthe groups. These findings suggest that training for rock climbing and participation in rock climbing may result in some specific adaptations. However, we acknowledge that this study is descriptive and there is the possibility that differences between groups could be attributed to self-selection.

Adolescent↗
PubMed2001

Solitary retinal capillary hemangioma: hereditary (von Hippel-Lindau disease) or nonhereditary?

OBJECTIVE: To estimate the probability of von Hippel-Lindau (VHL) disease in patients with solitary retinal capillary hemangioma. METHODS: Risk estimation was performed mathematically on the basis of the Bayes theorem using the published data on prevalence of VHL disease, prevalence of solitary retinal capillary hemangioma, and age-dependent penetrance of VHL disease. RESULTS: The probability of VHL disease in patients with solitary retinal capillary hemangioma was estimated to be 46%. When adjusted for age at the time of diagnosis, the risk varied from 45% in the young age group (</=10 years) to 0.5% in the older age group (61-70 years). CONCLUSIONS: Approximately half of the patients with solitary retinal capillary hemangioma are expected to have underlying VHL disease and the risk progressively diminishes with increasing age at diagnosis. Detailed clinical evaluation in such patients is recommended using standard screening protocols. Knowledge of the age-dependent risk for VHL disease can help the clinician modify recommendations regarding systemic and genetic testing.

Adolescent↗
PubMed1999

Postpartum cerebellar herniation in von Hippel-Lindau syndrome.

PURPOSE: To describe exacerbation during pregnancy of cerebellar hemangioblastoma in von Hippel-Lindau syndrome. METHOD: Case-report. A 21-year-old woman with von Hippel-Lindau syndrome was found on routine ocular examination to have severe papilledema 1 week after giving birth. RESULTS: Immediate magnetic resonance imaging disclosed a large cerebellar cyst from hemangioblastoma causing cerebellar tonsillar herniation. Immediate neurosurgical intervention was life saving. CONCLUSION: Worsening of intracranial hemangioblastoma during pregnancy in cases of von Hippel-Lindau syndrome should be realized and periodic neurologic and ophthalmologic observation is warranted.

Acute Disease↗
PubMed1993

Primary care of patients with human immunodeficiency virus infection. The physician's perspective.

OBJECTIVE: To examine physicians' perceptions, motivations, and influences on their willingness to care for patients with human immunodeficiency virus (HIV). DESIGN: Interviews with 30 physicians. Qualitative content and narrative analyses were performed. SETTINGS: Community-based primary care practices in six moderate-sized cities in the northeastern United States with at least a moderate incidence or prevalence of reported acquired immunodeficiency syndrome cases. PARTICIPANTS: Thirty community-based primary care physicians who had cared for at least two patients with HIV during the previous 2 years. MAIN OUTCOME MEASURE: Qualitative study designed to provide rich descriptive data. RESULTS: Care of patients with HIV was regarded as part of the scope of primary care, and was perceived to be similar to the care of patients with other chronic illnesses. Many physicians were motivated by personal rewards in taking care of patients, intellectual challenge, and desire to serve the underserved. Most believed that practicing physicians have an ethical obligation to care for all patients, regardless of diagnosis. No one "type" of physician could be identified who provides care to patients with HIV. CONCLUSIONS: Primary care physicians can apply their skills in the management of other chronic diseases to the care of patients with HIV. Practicing physicians can find caring for patients with HIV rewarding, stimulating, and enjoyable. Educational programs for physicians need to emphasize psychosocial aspects of HIV care. In addition, physicians need opportunities to recognize and deal effectively with their own emotional responses to the care of patients with HIV.

Adult↗
PubMed1993

Detection of ascorbic acid in the eye of the early chicken embryo by silver staining.

Ascorbate is found in high concentrations in the aqueous, lens and retina of a variety of animal species. Several functions have been proposed for this, including a vital role in aqueous secretion. We investigated the possible presence of ascorbate in the early embryonic chicken eye as a marker for the differentiation of the ciliary epithelium. Embryonic chicken eyes were processed for histochemical demonstration of ascorbate by silver staining. A strongly positive reaction was found in the interstitial matrix between the lens rudiment and the optic vesicle of the 2-day chicken embryo. By 3 days, with lens and optic cup separating from each other, the silver grains were concentrated in the vitreous cavity, primarily in a band-like configuration between the lens equator and the rim of the optic cup, which is the presumptive ciliary epithelium. A weaker reaction was seen in the lens vesicle and primitive neural retina. During the second and third day of incubation the optic vesicle is just beginning to expand. The appearance of ascorbic acid in the newly formed vitreous cavity at this time may indicate its importance in the biosynthesis of the matrix that is filling the expanding optic vesicle.

Animals↗
PubMed1993

Understanding fear of contagion among physicians who care for HIV patients.

BACKGROUND: Fear of contagion has been identified as a potential deterrent for primary care physicians who would otherwise care for HIV patients. This study examines physicians' fears of occupational HIV transmission and the ways that they cope with those fears. METHODS: Thirty community-based primary care physicians who were caring for HIV patients were interviewed about their experiences with HIV patients and the meanings they ascribe to those experiences. Qualitative content and narrative analysis were used. RESULTS: Fear of contagion was common despite the relatively low reported self-assessment of risk by primary care physicians. Most physicians considered their level of risk acceptable, but for some it seemed to take a high emotional toll. Some physicians identified their fear as "irrational." Physicians reported tension between fear of contagion and ethical responsibility to care for HIV patients. Some physicians were overattentive to infection control measures, whereas others used universal precautions inconsistently. Physicians continued to care for HIV patients despite their fears. Some physicians' family members needed information and reassurance about transmission of HIV. CONCLUSIONS: Some physicians who care for HIV patients are poorly equipped to deal with their own fears. There is a need to examine in greater depth the relationship between fear of contagion and willingness to provide care, and to examine other factors that may be contributing to the expression of these fears.

Adult↗
PubMed1988

The involvement of the temporal lobes in colour discrimination.

Monkeys with ablation of lateral striate, prestriate or inferotemporal cortex were compared with unoperated controls in their ability to discriminate Munsell colours, or greys, of increasing difficulty. Whereas lateral striate or prestriate lesions centred on visual area V4 mildly impaired only the most difficult discriminations, inferotemporal ablation resulted in a severe impairment in the acquisition of colour discriminations. However, the ability to discriminate greys was much less affected.

Animals↗
PubMed1987

The reliability of estimates of interhemispheric transmission times derived from unimanual and verbal response latencies.

In this study, the reliability of estimates of interhemispheric transmission times derived from verbal and unimanual responses was assessed. Responses were made to presentations of lateralized light flashes in a series of 20 experimental sessions, with responses being made to stimuli presented at three different retinal eccentricities. The reliability of estimates of interhemispheric transmission across 20 experimental sessions was generally poorer for verbal compared to unimanual responses. This was particularly true for stimuli presented close to the centre of the visual field. In addition, for unimanual response conditions, estimates of interhemispheric transmission times for the female subjects were longer in duration and exhibited poorer reliability than estimates found for the male subjects. In the verbal response conditions, there were no differences between the mean durations of the estimates found for the male and female subjects. The results suggest that for centrally located stimulus presentations, verbal responses do not produce reliable estimates of interhemispheric transmission time. This relatively poor reliability across experimental sessions may account for the mixed results seen in previous studies which have used verbal reaction times to estimate interhemispheric transmission time. The collection of unimanual responses to lateralized visual stimulus presentations is likely the best method of estimating interhemispheric transmission time in normal man.

Adult↗
PubMed1985

Acute leukemia secondary to lung cancer. Case report and review of the literature.

A case of acute myelomonocytic leukemia following cytotoxic therapy for an oat cell carcinoma of the lung in a 48-year-old man is reported. This case is characterized by a long phase of increasing macrocytosis during cyclophosphamide maintenance therapy. 15 other cases of secondary leukemia to lung cancer from the literature are reviewed. All patients received alkylating agents. Most patients showed peripheral blood changes more than 3 months before the onset of acute leukemia. All leukemia cases, except one, were nonlymphocytic with a high frequency of erythroleukemia. The development of acute leukemia seems to be linked with an unexpected good response to chemotherapy in advanced or poor histologic prognosis cancers. With therapeutic improvement in lung cancer, secondary leukemia could become a major hazard as in other cancers successfully treated with cytotoxic agents.

Antineoplastic Combined Chemotherapy Protocols↗