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Biomedical subjects

E A Burns

Publications and source records attributed to E A Burns.

9 recordsLinked to original sources
PubMed1991

Familial occurrence of hypersensitivity to phenytoin.

PURPOSE: Therapy with anticonvulsants such as phenytoin, phenobarbital, and carbamazepine can be complicated by severe hypersensitivity reactions. Previous work has suggested that the predisposition to such reactions is based on an inherited abnormality in the detoxification of reactive metabolites of the drugs. However, there are no reports of familial occurrence of the reactions in the literature. In the current study, we examined a family in which three siblings developed hypersensitivity reactions to phenytoin, confirming the inheritance of a predisposition to the reactions. Detoxification of reactive metabolites of the anticonvulsants was studied in cells from the patients and their siblings. PATIENTS AND METHODS: Three siblings from a family of 12 siblings developed hypersensitivity reactions to phenytoin characterized by fever, rash, lymphadenopathy, and anicteric hepatitis. All recovered completely after discontinuation of treatment. One sibling tolerated phenobarbital without toxic sequelae. Peripheral blood mononuclear cells from the three patients and five additional siblings who had never taken anticonvulsants were exposed to oxidative metabolites of phenytoin, phenobarbital, and carbamazepine generated by a hepatic microsomal drug-metabolizing system in vitro. The toxicity of metabolites in the cells from the siblings was compared with that in cells from control subjects. RESULTS: Cells from each of the patients who had experienced a hypersensitivity reaction exhibited increased toxicity from metabolites of phenytoin and carbamazepine, while the cellular response to metabolites of phenobarbital was within normal limits. Cells from four of the other siblings showed an abnormal response to phenytoin metabolites, while cells from the final sibling detoxified phenytoin metabolites normally. CONCLUSION: Our observations on the patients confirm the inherited nature of phenytoin hypersensitivity reactions in vivo. In vitro studies demonstrated abnormal metabolite detoxification in the patients and several of their siblings. The detoxification defect included metabolites of phenytoin and carbamazepine but not of phenobarbital. A family history of a drug hypersensitivity reaction should alert physicians to the probability of a markedly increased risk of an adverse reaction in family members. In vitro assays to confirm adverse reaction risks may ultimately be able to provide individualized risk assessment for patients who must take anticonvulsants.

Adult↗
PubMed1990

Decreased specific antibody synthesis in old adults: decreased potency of antigen-specific B cells with aging.

The rise in rates of infection in adults over the age of 60 is accompanied by a decreased ability of older adults to make specific immune responses after immunization with a variety of specific antigens (Ag). This investigation delineates age-related changes in Ag-specific humoral immunity, comparing adults over age 60 to young adults aged 18-40, using tetanus toxoid (TT) as an immunologic probe. A culture system which does not require TT booster immunizations of study subjects was used to induce in vitro specific antibody responses. The amount of anti-TT antibody (Ab) produced in serum and in culture was measured by a TT-specific enzyme-linked immunosorbent assay (ELISA). The numbers of anti-TT Ab-secreting B cells were measured by a TT-specific ELISA-plaque assay. The TT-specific responses of old subjects were significantly less than that seen for young control subjects in the following measures: (1) serum anti-TT Ab titers (mean +/- S.E. log 2 titer = 3.3 +/- 1.1 vs. 9.5 +/- 1.4, P less than 0.01); (2) anti-TT Ab produced by peripheral blood lymphocytes (PBL) in cultures stimulated with TT (6 +/- 2.1 ng/ml vs. 22 +/- 8.4 ng/ml, P less than 0.01); (3) numbers of anti-TT Ab secreting B cells per million cells cultured (6.7 +/- 3.4 vs. 26.6 +/- 7.6, P less than 0.001) and (4) mean ng Ab secreted per anti-TT Ab-secreting B cell (0.6 +/- 0.4 ng vs. 12.7 +/- 7.8 ng, P less than 0.01). This study shows that both decreased numbers of Ag-specific immune B cells and decreased potency on a per cell basis contribute to the impaired immune responses to immunizations in older adults.

Adolescent↗
PubMed1986

A study of the use of adult learning theory in medical instruction.

This study examined relationships between the attitudes of medical faculty toward specific aspects of adult learning theory as well as the degree to which behaviors were actually used to build upon those beliefs. A questionnaire was developed to assess attitudes toward adult learning theory and returned by 269 of the medical faculty at the University of Iowa College of Medicine (58.5%). Several significant relationships were noted between faculty beliefs and the teaching methods they reported using. First, the six components of adult learning theory studied were independent of one another, suggesting a lack of consistent attitudes toward these components. Second, faculty who had taken teaching courses or workshops on teaching showed attitudes different than their peers, and used different types of teaching activities. This finding suggests that educational experiences can in fact affect the attitudes and teaching practices used by medical faculty, at least with respect to principles of adult learning theory.

Adult↗
PubMed1986

Stressful life events and depressive symptomatology in obstetric patients: a pilot study in a family practice setting.

Several studies have found the presence of stressful life events to be associated with the appearance of postpartum depression. However, many of these previous studies have been conducted in obstetric clinics; relatively little research in this area has been done in a family practice setting. The first objective of this study was to note the prevalence of depressive symptomatology in a family practice clinic's pregnant patients. The second purpose was to evaluate the relationship between stressful life events and depressive symptomatology during pregnancy and the postpartum period. Each subject (n = 27) was given a Beck Depression Inventory (BDI) at three times: second trimester, third trimester, and three weeks postpartum. Each subject also completed a life events scale for obstetric patients after delivery; both weighted and unweighted life events scores were calculated. The correlation between the weighted and unweighted life events scores was 0.85. Postpartum BDI scores were significantly related to life events scores: 0.47 (n = 27, p = .0133) for unweighted scores and 0.58 (n = 27, p = .0015) for weighted scores. Weighted life events scores were more highly correlated with BDI scores at each of the three administration. Finally, 19% of these subjects showed BDI scores consistent with mild depression after delivery. Each of these results is consistent with findings from studies done in other settings.

Adult↗
PubMed1986

Sibling grief in reaction to sudden infant death syndrome.

Much of the literature that exists regarding psychologic outcomes of sudden infant death syndrome (SIDS) has focused on parental grief or family response; at least two studies suggest that a SIDS death also affected siblings. It is believed that children who experience the death of a sibling due to SIDS do grieve. Factors related to bereavement are the child's age at the time of the sibling's death, special circumstances of the SIDS death, and explanations and grieving response of the parents. However, no information currently exists that characterizes the course of the grief response of these children. Studies have indicated that about 1 year is a normal grieving period for adults. This study was conducted to evaluate the time frame of children's grief response to the death of a sibling from SIDS. A questionnaire was designed that incorporated child grieving behaviors from several sources; 151 questionnaires were distributed to families in which a SIDS death had occurred in the past 16 years in Iowa and Illinois. Information was obtained from 43 families for 50 children who were older than 2 years of age at the time of the sibling's death. With respect to the length of children's grief response, 54% were reported to have grieved longer than 1 year and only 40% were reported to have grieved less than 6 months. Thus, it appears that the length of the grieving response for these children is similar to that described for adults.

Adolescent↗
PubMed1985

Review of the etiology and treatment of premenstrual syndrome.

Premenstrual syndrome (PMS) is a diagnostic enigma that causes significant morbidity in many woman. Numerous theories have been proposed in an attempt to explain the varied symptoms that occur cyclically in women with PMS. Suggested etiologic theories of PMS include psychological abnormalities, nutritional deficiencies, aberrations in the renin-angiotensin-aldosterone axis, altered prostaglandin activity, hormonal imbalances, and changes in endogenous opioid peptide activity. Because of the lack of standardized diagnostic criteria, clinical drug trials for PMS have been severely compromised. For every proposed cause of PMS, there exists a drug or drug class that has been investigated for treatment of the associated symptoms. Many clinical studies are uncontrolled, a significant deficiency in study design for a disorder that is associated with a high placebo response rate. At the present time, no definitive treatment for PMS exists and therapy must be individualized according to clinical response. This review article defines PMS, describes one of the current approaches to the diagnostic work-up, discusses the proposed etiologies of PMS, and reviews the various proposed treatment modalities.

Bromocriptine↗
PubMed1985

Routine pertussis immunization.

The benefits and risks of both the vaccine for pertussis and the disease itself are reviewed in this article. Unlike with the smallpox vaccine, it seems unlikely that a vaccine will be developed to eradicate pertussis completely, since most confer only a short-term immunity. A longitudinal study was undertaken to compare the mortality and morbidity rates of pertussis with the adverse reaction rate of the vaccination program. Risks of the vaccination, such as erythema, drowsiness, and vomiting are well known. However, the issue of neurologic difficulties has surfaced and disagreement exists. Some association does seem to exist between the vaccine and neurologic problems; however, the morbidity and mortality of whooping cough is of a greater health consequence than these rare neurologic reactions.

England↗
PubMedDate not supplied

Relationships between attitudes and use of adult-learning teaching activities by medical faculty.

This study examined teaching behaviors of medical faculty and their attitudes toward adult learners. A number of studies have examined characteristics of adult learners and found that certain teaching activities produce more effective learning in adults. Adult learners tend to be more self-directed and bring a variety of experiences to the educational setting; they also profit more from collaborative curriculum planning, learning activities, and evaluation of progress.

Attitude↗