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Biomedical subjects

D A Green

Publications and source records attributed to D A Green.

At least 19 recordsLinked to original sources
PubMed2006

Depersonalisation/derealisation symptoms in vestibular disease.

BACKGROUND: Depersonalisation is a subjective experience of unreality and detachment from the self often accompanied by derealisation; the experience of the external world appearing to be strange or unreal. Feelings of unreality can be evoked by disorienting vestibular stimulation. OBJECTIVE: To identify the prevalence of depersonalisation/derealisation symptoms in patients with peripheral vestibular disease and experimentally to induce these symptoms by vestibular stimulation. METHODS: 121 healthy subjects and 50 patients with peripheral vestibular disease participated in the study. For comparison with the patients a subgroup of 50 age matched healthy subjects was delineated. All completed (1) an in-house health screening questionnaire; (2) the General Health Questionnaire (GHQ-12); (3) the 28-item depersonalisation/derealisation inventory of Cox and Swinson (2002). Experimental verification of "vestibular induced" depersonalisation/derealisation was assessed in 20 patients and 20 controls during caloric irrigation of the labyrinths. RESULTS: The frequency and severity of symptoms in vestibular patients was significantly higher than in controls. In controls the most common experiences were of "déjà vu" and "difficulty in concentrating/attending". In contrast, apart from dizziness, patients most frequently reported derealisation symptoms of "feel as if walking on shifting ground", "body feels strange/not being in control of self", and "feel 'spacey' or 'spaced out'". Items permitted discrimination between healthy subjects and vestibular patients in 92% of the cases. Apart from dizziness, caloric stimulation induced depersonalisation/derealisation symptoms which healthy subjects denied ever experiencing before, while patients reported that the symptoms were similar to those encountered during their disease. CONCLUSIONS: Depersonalisation/derealisation symptoms are both different in quality and more frequent under conditions of non-physiological vestibular stimulation. In vestibular disease, frequent experiences of derealisation may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference which makes the patient feel he or she is detached or separated from the world.

Adult↗
PubMed2006

Audit of nurse-led-training for epipen in a District General Hospital.

BACKGROUND: A community-based study in the London Borough of Hounslow, which included patients in our District General Hospital (DGH) Paediatric Department, found that most families who had been prescribed adrenaline auto-injectors could not use them properly. This prompted the establishment of a new protocol for doctors and an Allergy Clinic where one nurse was responsible for training all patients. AIM: This audit was done to reassess this service 3 years after the changes were made. METHODS: 68 of the 81 (83%) patients followed up in our District General Hospital Nurse led Allergy Clinic agreed to participate. They were compared with the District General Hospital sub-group of the previous study. RESULTS: We found that most patients now reported they were trained to use the devise, had written instructions, were able to demonstrate competence on a dummy and would appropriately call an ambulance. This was significantly better than the previous situation. CONCLUSION: The study shows that training can be improved in a DGH setting with the strategy of protocolised prescribing and a Nurse led Allergy Clinic.

Case-Control Studies↗
PubMed2005

Neonatal hypothermia detection by ThermoSpot in Indian urban slum dwellings.

OBJECTIVE: To look at the performance of ThermoSpot liquid crystal thermometry in detecting neonatal hypothermia. DESIGN: A comparison was made between skin temperatures taken by ThermoSpot and axillary temperatures taken by digital electric thermometry. Non-medically trained local volunteers performed daily paired recordings on infants on days 1, 2, 3, 4, 5, 6, and 7 of life. SETTING: This is a non-hospital based study set in the homes of neonates in an underprivileged urban slum community in the developing world. SUBJECTS INCLUSION CRITERIA: babies born at home. EXCLUSION CRITERIA: hospital admission; parental refusal. INTERVENTIONS: The ThermoSpot was stuck to the neonate's abdomen over the liver area on day 1 and removed on day 7. MAIN OUTCOME MEASURES: Fixed test properties of ThermoSpot. RESULTS: Over 180 paired observations, the fixed test properties of ThermoSpot in the detection of hypothermia were: sensitivity 88%; specificity 97%; positive likelihood ratio 29; negative likelihood ratio 0.13. CONCLUSIONS: ThermoSpot performed well when used by non-medically trained volunteers for the detection of neonatal hypothermia in the homes of an urban slum community.

Axilla↗
PubMed2004

Rapid diagnosis of bacterial meningitis using nitrite patch testing.

Urine reagent strips have been used to test cerebrospinal fluid (CSF) in areas where laboratory facilities are unavailable. Protein, glucose and leukocyte esterase patches have been shown to be useful in this context. We propose that the nitrite patch also has a contribution to make: it could provide clinically useful information, at no extra cost. We tested CSF samples from 200 children with suspected meningitis. In a pragmatic approach chosen to reflect the clinical dilemma of whether or not to use parenteral antibiotics, the final laboratory diagnosis was dichotomized into either 'bacterial meningitis' or 'not bacterial meningitis'. These diagnostic categories were compared with nitrite patch results, which were either positive or negative. Nitrite patch testing of all CSF, clear CSF and bloody CSF gave positive likelihood ratios of 49, 'infinity' and 5.8, respectively.

Humans↗
PubMed2003

Lung function changes in teenage carpet weavers.

Lung function was measured with a Microlab 3500 Spirometer in 17 teenage carpet weavers, their 17 non weaving sisters and 13 age/sex matched controls in a carpet making community in Gwalior in late 2001. All subjects were asymptomatic. Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and mid-expiratory flow rate (MEF) were expressed as percentages of expected values for the subjects age and height using prediction equations for healthy North-Indian girls (FVC% FEV1% and MEF%). There was no significant difference in FVC% FEV1% or FEV1/FVC ratio between the 3 groups but weavers had a significantly lower mean MEF% than their sisters (p< 0.01 by paired "t" test) and the age-matched control group (p< 0.002 by "t" test). The reduction in MEF% was correlated with duration of employment (Spearmans correlation = 0.5 with p < 0.05).

Adolescent↗
PubMed2001

Inhibition of malignant cell growth by 311, a novel iron chelator of the pyridoxal isonicotinoyl hydrazone class: effect on the R2 subunit of ribonucleotide reductase.

The key roles of iron and iron proteins in cell proliferation make them potential targets for cancer therapy. However, clinical trials directed toward perturbation of tumor iron homeostasis by iron chelation have been limited to the use of deferoxamine (DFO). There is thus a need to develop agents with greater efficacy. In the present study, we investigated the mechanism of cytotoxicity of 311 (2-hydroxy-1-naphthylaldehyde benzoyl hydrazone), a novel iron chelator of the pyridoxal isonicotinoyl class. We found that 311 inhibited the growth of CCRF-CEM cells in a time- and concentration-dependent fashion with an IC(50) that was approximately 20-fold lower than that of DFO. 311 also inhibited the growth of breast, bladder, and head and neck cancer cell lines. Using electron spin resonance (ESR) spectroscopy analysis, we found that a 12-h exposure of CCRF-CEM cells to 311 inhibited the tyrosyl radical ESR signal of the R2 subunit of ribonucleotide reductase. However, overproduction of the R2 subunit in hydroxyurea-resistant CCRF-CEM cells was associated with a decrease in sensitivity of cells to 311 but not to DFO. Our studies show that 311 is a more potent cytotoxic agent than DFO, with activity against both hematopoietic and nonhematopoietic cell lines regardless of their p53 status. Furthermore, the ESR studies suggest that inhibition of the R2 subunit of ribonucleotide reductase is at least one mechanism by which 311 blocks cell proliferation.

Antineoplastic Agents↗
PubMed2000

Haemolytic uraemic syndrome: prognostic factors.

Haemolytic uraemic syndrome (HUS) associated with Escherichia coli O157:H7 is the commonest cause of acute renal failure (ARF) in childhood. Production of verotoxin by the organism is pivotal in the pathogenesis of the disease. Verotoxin binds to a receptor on blood and endothelial cells, expressed as the P1 blood group antigen on red blood cells. A protective effect of the P1 phenotype has been proposed in this disease. This study investigates prognostic factors and the relationship between outcome and P1 phenotype in 27 cases of diarrhoea-associated HUS. A poor outcome as defined by the presence of chronic renal failure (CRF), hypertension or proteinuria on 6 month follow-up was associated with the age of the patient at presentation and with the following clinical markers: maximum WBC and duration of raised WBC, duration of anuria and duration of need for dialysis. None of these outcome measures or prognostic factors, and no extra-renal manifestations of the disease were associated with P1 phenotype.

Acute Kidney Injury↗
PubMed1999

The effect of deprivation on child health in Bro Taf.

Infant mortality rate (IMR) and disability indices were compared in 16 y birth cohorts (1979-1994) inclusive) from two neighbouring but contrasting boroughs in Bro Taf. The comparison was extended to children with mild learning difficulties. Children with and without learning problems were compared for birth weight (BW). Further data on infant mortality by cause of death, BW and maternal age were analysed for 6 y within this period (all births from 1979-1984 inclusive). The more deprived area had a higher IMR and a greater number of deaths attributed to low birth weight. It had a higher rate of childhood disability which was due to a higher rate of moderate learning disabilities. There was also a higher rate of mild learning difficulty. Learning problems were associated with low birth weight. The more deprived area had a greater proportion of low birth weight and very low birth weight babies and more mothers who were in their teens and early teens.

Adolescent↗
PubMed1997

Dimercaptosuccinic acid distribution in renal tubular acidosis.

A 99Tcm dimercaptosuccinic acid (DMSA) scan performed after a urinary tract infection demonstrated an unusual pattern of isotope uptake, promoting further investigations leading to a diagnosis of renal tubular acidosis secondary to nephropathic cystinosis. This is known to affect isotope imaging but a unique feature in this undiagnosed case was the uncorrected metabolic acidosis, which had further altered the distribution of the DMSA. It is noteworthy because other patients referred for imaging with renal disease may also have abnormalities of acid base balance.

Acidosis, Renal Tubular↗
PubMed1996

Overlooked spine injuries associated with lumbar transverse process fractures.

Transverse process fractures of the lumbar spine often are considered benign fractures related to direct trauma or psoas muscle avulsion. Treatment of these usually stable injuries is primarily administered when the patient becomes symptomatic. However, significant force often is required to cause these injuries, and other injuries may occur concomitantly. For this study, all patients who presented with identified lumbar transverse process fractures were further evaluated radiographically with computed tomography for the detection of other possible spine injuries. Medical and radiology records of 28 consecutive patients who had plain radiographs and computed tomography scans taken of their lumbar spine were reviewed retrospectively; these patients presented with lumbar spine transverse process fractures between January 1, 1989 and June 30, 1992. Three of the 28 patients (11%) had a lumbar spine fracture that was identified by computed tomography but overlooked on plain radiographs. Approximately 11% of patients with major injuries may be misdiagnosed if only plain radiographs are used in the evaluation of transverse process fractures. Computed tomography scanning of all lumbar spine transverse process fractures resulting from acute trauma should be considered because this diagnostic measure decreases the risk of overlooking potentially serious injuries.

Diagnostic Errors↗
PubMed1995

Analysis of TGF-beta 1 gene expression in contused rat spinal cord using quantitative RT-PCR.

We have used northern blot analysis and quantitative reverse transcription polymerase chain reaction (RT-PCR) to determine the postinjury expression profile of the transforming growth factor-beta 1 (TGF-beta 1) gene in the contused rat spinal cord. Spectrophotometric estimates of total sample RNA and quantitative analyses of cyclophilin mRNA using RT-PCR served as controls for comparisons between samples. No changes in cyclophilin gene expression were found at any postinjury survival times. The results of the TGF-beta 1 analyses, which were carried out on spinal cord samples taken at postinjury intervals ranging from 6 h to 10 days, show that the amount of TGF-beta 1 mRNA present in spinal cord increases rapidly following injury, reaching maximum levels 7 days postinjury. Unoperated control samples contained approximately 2 x 10(8) molecules of TGF-beta 1 mRNA/0.5 microgram total RNA. By 1 day postinjury, the amount of TGF-beta 1 mRNA in the cord had increased by a factor of 2.5 to 5 x 10(8) molecules/0.5 microgram total RNA. At 7 days postinjury, there were approximately 15 x 10(8) molecules of TGF-beta 1 mRNA/0.5 microgram total RNA. By 10 days postinjury the amount of TGF-beta 1 mRNA present in the spinal cord had declined to 8 x 10(8) molecules of TGF-beta 1 mRNA/0.5 microgram total RNA, a value similar to that observed at 3 days postinjury. The roles that TGF-beta 1 might play in modifying cellular responses in injured spinal cord are discussed.

Animals↗
PubMed1995

Canadian immigration policy: the effectiveness of the point system and other instruments.

"This paper examines the effects of changes in Canadian immigration policy on the occupational composition of immigration. We focus on 1967 changes that created a regulatory system, including the point system, that still forms the framework of Canadian immigration policy. We find that the point system provides some control over occupational composition but that its effectiveness in fine tuning is limited by the large number of other characteristics it seeks to control. We also find that entry class and source country composition of inflow have impacts that have swamped the effects of the point system in the last two decades." (SUMMARY IN FRE)

Americas↗