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Biomedical subjects

E J Peters

Publications and source records attributed to E J Peters.

At least 19 recordsLinked to original sources
PubMed2005

Lung function status of workers exposed to wood dust in timber markets in Calabar, Nigeria.

The effect of chronic exposure to dust from local woods such as ebony, achi, and iroko on lung function of timber market workers in Calabar - Nigeria, was studied. Forced vital capacity (FVC), Forced Expiratory Volume in one second, (FEV1), Forced Expiratory Volume as a percentage of forced vital capacity (FEV1 %), and Peak Expiratory Flow Rate (PEFR) were measured in 221 workers (aged 20-25 years) exposed to wood dust to assess their lung function and compared with 200 age- and sex- matched control subjects who were not exposed to any known air pollutant. The concentration of respirable dust was significantly higher in the test (P<0.001) than in control site. The mean values of FVC, FEV1, FEV1% and PEFR of the timber workers were significantly lower (P<0.01) than in control subjects. Respiratory symptoms such as cough, chest pain and nasal irritation had higher prevalence in the test group than in the control group. Non-respiratory symptoms (skin and eye irritation) were prevalent in the test group but not found in the control group. Workers exposed to wood dust had restrictive pattern of ventilatory function impairment. The lung function indices of the timber workers decreased with their length of service. Chronic exposure to wood dust impairs lung function.

Adult↗
PubMed2004

Investigation of serotonin-related genes in antidepressant response.

In this study, we sought out to test the hypothesis that genetic factors may influence antidepressant response to fluoxetine. The investigation focused on seven candidate genes in the serotonergic pathway involved in the synthesis, transport, recognition, and degradation of serotonin. Our clinical sample consisted of 96 subjects with unipolar major depression treated with fluoxetine with response variables assessed after a 12-week trial. Patient data were also collected to investigate the pattern of drug response. Using a high-throughput single-nucleotide polymorphism (SNP) genotyping platform and capillary electrophoresis, we genotyped patients at 110 SNPs and four repeat polymorphisms located in seven candidate genes (HTR1A, HTR2A, HTR2C, MAOA, SLC6A4, TPH1, and TPH2). Statistical tests performed included single-locus and haplotype association tests, and linkage disequilibrium (LD) estimation. Little evidence of population stratification was observed in the sample with 20 random SNPs using a genomic control procedure. Our most intriguing result involved three SNPs in the TPH1 gene and one SNP in the SLC6A4 gene, which show significant single-locus association when response to fluoxetine is compared to nonresponse (P=0.02-0.04). All odds ratios indicated an increased risk of not responding to fluoxetine. In the specific response vs nonspecific and nonresponse comparison, three SNPs in the TPH2 gene (P=0.02-0.04) were positively associated and one SNP in the HTR2A gene (P=0.02) was negatively associated. When comparing specific response to nonspecific response, we found significant negative associations in three SNPs in the HTR2A gene (P=0.001-0.03) and two SNPs in the MAOA gene (P=0.03-0.05). We observed variable, although strong LD, in each gene and unexpectedly low numbers of estimated haplotypes, formed from tagged SNPs. Significant haplotype associations were found in all but the HTR1A and HTR2C genes. Although these data should be interpreted cautiously due to the small sample size, these results implicate TPH1 and SLC6A4 in general response, and HTR2A, TPH2, and MAOA in the specificity of response to fluoxetine. Intriguingly, we observe that a number of the less frequent alleles of many of the SNP markers were associated with the nonresponse and nonspecific phenotypes.

Antidepressive Agents, Second-Generation↗
PubMed2004

Traditional healers' practices and the spread of HIV/AIDS in south eastern Nigeria.

A 3-year (1997-1999) prospective study was carried out to evaluate the possible role of traditional healers (THs) in the spread of HIV/AIDS in south eastern Nigeria. Their patients' knowledge of HIV infection was also ascertained during the review period. Four contiguous states in south eastern Nigeria with high prevalent rates of HIV infection were chosen for the survey. Sixty-nine patients ofTHs were randomly selected and contacted from the patients' list of five selected THs in each state. Thus, a total of 20 THs and 69 patients formed subjects of the study. The study involved a face-to-face interview of the subjects by trained health personnel in each state using a prepared structured questionnaire. The questionnaire elicited information on their biodata, past/present medical history, social/family history, nature and mode of treatment received or administered, and their knowledge of HIV infection, where applicable. The results showed that there was a serious HIV/AIDS related risk inherent in the practices of Nigerian THs patronized by over 60% of the population. This was suggested by the continuous usage of unsterilized instruments and cross contamination with patients' blood and body fluid in their practices. It was further revealed that, the patients' HIV/AIDS related knowledge was poor (30%). Basic education on HIV/AIDS must be given to all groups in Nigeria including THs, their patients and general public. The World Health Organization and other agencies involved in the fight against HIV infection should focus on the safety of THs' practices as a possible mode of transmission of HIV infection in Africa. Unless this aspect is taken seriously along with other preventive strategies already adopted, the epidemic of the disease condition may continue to spread in Africa.

Adolescent↗
PubMed2001

[Loss of an eye due to hyper-IgE syndrome after corneal transplantation].

A 37-year-old patient with bilateral keratoconus underwent a perforating cornea transplantation after acute onset of pain and hydrops of the right cornea. One day after operation endophthalmitis developed, caused by a viridans streptococcus. Hyper-IgE syndrome was suspected because of the patient's crude facial features. His medical history brought up additional symptoms of this disease. IgE levels were extremely elevated (7320 kU/l), the eosinophil count was slightly raised (0.25 x 10(9)/l). The patient was treated with several local antibiotics but his vision was only light perception at the time of discharge from the hospital. This case illustrates how an usually successful operation may have a disastrous outcome in case of late diagnosis of the hyper-IgE syndrome. The hyper-IgE syndrome can be recognized by the characteristic facial features in combination with the often extensive (juvenile) medical history with infections, and by elevated serum IgE levels. As patients with the hyper-IgE syndrome are extremely susceptible to develop infections, prophylactic antibiotic therapy is indicated in surgical procedures.

Adult↗
PubMed2001

Classification of wounds of the diabetic foot.

A classification system should be thought of as a diagnostic language. Ideally, this language should be used by a large, diverse population of clinicians to guide therapy and ultimately predict outcome. The diabetic foot ulcer is widely known to be the prime precipitant of lower extremity amputations. Its description and classification is the first step toward widespread standardization of treatment and prevention. This article chronologically describes the major diabetic foot wound classification systems devised over the previous generation, discussing each of their attributes and their shortcomings, with an emphasis on an evidence basis for care. It is our hope that discussions such as this one will ultimately lead to a diagnostic and therapeutic lingua franca for diabetic foot wounds and a commensurate reduction in the unconscionably high prevalence of amputations, which we now currently face.

Diabetic Foot↗
PubMed2001

Electric stimulation as an adjunct to heal diabetic foot ulcers: a randomized clinical trial.

OBJECTIVE: To evaluate high-voltage, pulse-galvanic electric stimulation as an adjunct to healing diabetic foot ulcers. DESIGN: Randomized, double-blind, placebo-controlled pilot trial. SETTING: University medical center. PATIENTS: Forty patients with diabetic foot ulcers, consecutively sampled. Twenty patients each assigned to treatment and placebo groups. Five patients (2 treated, 3 placebo) withdrew because of severe infection. INTERVENTIONS: Electric stimulation through a microcomputer every night for 8 hours. The placebo group used identical functioning units that delivered no current. Additional wound care consisted of weekly débridements, topical hydrogel, and off-loading with removable cast walkers. Patients were followed for 12 weeks or until healing, whichever occurred first. MAIN OUTCOME MEASURES: Proportion of wounds that healed during the study period. Compliance with use of device (in hr/wk), rate of wound healing, and time until healing. RESULTS: Sixty-five percent of the patients healed in the group treated with stimulation, whereas 35% healed with placebo (p = .058). After stratification by compliance, a significant difference was identified among compliant patients in the treatment group (71% healed), noncompliant patients in the treatment group (50% healed), compliant patients in the placebo group (39% healed), and noncompliant patients in the placebo group (29% healed, linear-by-linear association = 4.32, p = .038). There was no significant difference in compliance between the 2 groups. CONCLUSION: Electric simulation enhances wound healing when used in conjunction with appropriate off-loading and local wound care.

Diabetic Foot↗
PubMed2001

Functional status of persons with diabetes-related lower-extremity amputations.

OBJECTIVE: It is reasonable to predict that diabetes-related lower-extremity amputations have a detrimental impact on quality of life. However, we are unaware of any study in the medical literature describing the functional level of diabetic patients with amputations. The objective of this study was to evaluate amputations among diabetic patients and to determine the functional level of these patients with the Sickness Impact Profile (SIP). RESEARCH DESIGN AND METHODS: We enrolled 124 patients with diabetes. Case subjects (n = 35) were defined as patients who had undergone amputation of the lower-extremity, and control subjects (n = 89) were defined as patients who had not undergone amputation. Study participants received a standard history and physical examination. RESULTS: Both the physical dimension scores (33.5 +/- 14.9 vs. 22.3 +/- 14.7, P < 0.001) and the total SIP scores (27.6 +/- 9.9 vs. 22.5 +/- 10.3, P = 0.013) were significantly higher for amputees. However, the psychosocial dimension scores were not significantly different between case and control subjects (14.9 +/- 8.9 vs. 15.2 +/- 10.0, P > 0.05). Post hoc analysis showed that the group of patients who had undergone transtibial amputation had a significantly higher total impairment score than patients who had not undergone amputation (P = 0.039). This is in contrast to patients with toe or midfoot amputations, for whom total impairment scores were not significantly higher than those for the control subjects. Interestingly, bilateral amputees did not have significantly higher scores on either SIP dimension compared with unilateral amputees. CONCLUSIONS: These findings exemplify the detrimental physical and psychosocial health status of patients with diabetes-related lower-extremity amputation.

Activities of Daily Living↗
PubMed2001

Effectiveness of the diabetic foot risk classification system of the International Working Group on the Diabetic Foot.

OBJECTIVE: To evaluate the effectiveness of a diabetic foot risk classification system by the International Working Group on the Diabetic Foot to predict clinical outcomes. RESEARCH DESIGN AND METHODS: A total of 225 diabetic patients were initially evaluated as part of a prospective case-control study at the University of Texas Health Science Center at San Antonio. Complete records were available for 213 patients for follow-up evaluation after 29 months. Upon enrollment, subjects were stratified into four risk groups based on the presence of risk factors according to the consensus of the International Working Group on the Diabetic Foot. Group 0 consisted of subjects without neuropathy, group 1 consisted of patients with neuropathy but without deformity or peripheral vascular disease (PVD), group 2 consisted of subjects with neuropathy and deformity or PVD, and group 3 consisted of patients with a history of foot ulceration or a lower-extremity amputation. RESULTS: Upon enrollment, patients in higher-risk groups had longer duration of diabetes, worse glycemic control, vascular and neuropathic variables, and more systemic complications of diabetes. During 3 years of follow-up, ulceration occurred in 5.1, 14.3, 18.8, and 55.8% of the patients in groups 0, 1, 2, and 3, respectively (linear-by-linear association, P < 0.001). All amputations were found in Groups 2 and 3 (3.1 and 20.9%, P < 0.001). CONCLUSIONS: The foot risk classification of the International Working Group on the Diabetic Foot predicts ulceration and amputation and can function as a tool to prevent lower-extremity complications of diabetes.

Blood Pressure↗
PubMed2000

Reliability of digital videometry and acetate tracing in measuring the surface area of cutaneous wounds.

PURPOSE: The purpose of this study was to evaluate the reliability of digital videometry and acetate tracing in the measurement of cutaneous wound area. METHODS: Four clinicians used both digital videometry and acetate tracing to measure five wounds that were artificially created on a cadaver specimen. In addition, the clinicians used an analog centimeter ruler to determine a rough estimate of the area of each wound. The wounds were measured a total of five times with each measurement instrument using a non-sequential repeat measures design. Associations between the three wound measurement techniques were examined with Pearson correlation coefficients. In addition, intraclass correlation coefficients (ICC) were calculated for each pair of the three measurement techniques. RESULTS: Correlation between the measurement systems for all raters combined yielded Pearson r-values of 0.93 for ruler and acetate, 0.95 for ruler and digital and 0.97 for acetate and digital. Furthermore, the average measure ICC between acetate and digital was 0.94, between acetate and ruler was 0.76 and between digital and ruler was 0.57. CONCLUSION: These results suggest that wound area measurements obtained using digital videometry and acetate tracing are very similar and both techniques can be used interchangeably in either clinical or research settings.

Acetates↗
PubMed2000

Elevated nitric oxide metabolite levels in chronic sinusitis.

Decreased exhaled nitric oxide (NO) is found in chronic sinusitis. NO metabolites (nitrates, nitrites, and S-nitrosothiols) were measured in sinus lavages with a rabbit model of chronic sinusitis. NO metabolite levels (mean +/- SD) were 3.0+/-1.6 micromol/L in uninfected rabbits, 10.7+/-11.4 micromol/L in infected animals, and 7.6+/-5.4 micromol/L in postantrostomy recovering animals. Infected sinuses had elevated levels of NO metabolites that were statistically significant (P<0.01) when compared with uninfected sinuses. Mucociliary transport velocity was measured in uninfected (16.0+/-5.7 mm/minute), infected (5.2+/-1.3 mm/minute), and recovery phases (3.0 mm/minute). Endoscopic appearance, light and electron microscopy, and bacterial cultures improved during recovery. Elevated levels of NO metabolites were found during chronic sinusitis and began to return to normal levels during recovery. The possible link between NO in epithelial autotoxicity and host defense mechanisms warrants further investigation.

Animals↗
PubMed2000

Systemic hyperbaric oxygen therapy: lower-extremity wound healing and the diabetic foot.

OBJECTIVE: To document peer-reviewed medical publications that have reported on hyperbaric oxygen (HBO) therapy as an adjunct to standard lower-extremity wound care, focusing on publications dealing with the diabetic foot. RESEARCH DESIGN AND METHODS: A review of the medical literature was conducted using MEDLINE. Research articles involving HBO treatment and the diabetic foot were critiqued to identify factors that may have been a source of bias. RESULTS: Of the published reports on human studies, seven involved diabetes-related foot pathology. Five of these studies, two of which were randomized, included a control group that did not receive HBO therapy The controlled diabetic foot studies included an average of 28 subjects in the HBO therapy group (range 10-62) and an average of 16.2 subjects in the non-HBO control group (range 5-33). Most of the published reports have several potential sources of bias, including, but not limited to, inadequate evaluation of comorbid conditions relevant to wound healing, small sample size, and poor documentation of wound size or severity. Four of the seven reports involving the diabetic foot were published by a group of researchers at the University of Milan between 1987 and 1996. CONCLUSIONS: Additional randomized placebo-controlled clinical trials in large diabetic populations would further lend credence to the presumption that HBO therapy improves clinical outcomes. Given the relatively high cost of this treatment modality, perhaps a more acute awareness of the medical literature would reduce the economic burden that HBO therapy imposes on care providers that are financially at risk.

Clinical Trials as Topic↗
PubMed1999

Cessation of human motor unit discharge during sustained maximal voluntary contraction.

The purpose of this study was to determine whether cessation of motor unit discharge contributes to fatigue in human subjects. Multiple fine-wire and tungsten microelectrodes were inserted into the extensor digitorum or extensor indicis muscles of the forearm in an attempt to record the activity of the same motor unit from different locations within either muscle while subjects maintained a maximal voluntary contraction of the finger extensors until force dropped by approximately 50%. The activities of 13 motor units were followed for extended periods during the fatigue task. Of these, six appeared to cease discharging prior to the end of the task, which could not be attributed to electrode movement. These findings suggest that some motor neurons may not be able to discharge continuously in the presence of sustained volitional synaptic drive or that excitatory drive may diminish during maximal voluntary effort.

Action Potentials↗
PubMed1999

Expired nitric oxide and airway obstruction in asthma patients with an acute exacerbation.

Expired nitric oxide (eNO) is a marker of airway inflammation that is increased in asthma. The present study was undertaken to examine the clinical utility of eNO as an aid in the assessment of asthma in the emergency department (ED). Fifty-two adult patients with acute asthma, 53 age- and sex-matched controls, and eight patients with stable asthma were enrolled. Subjects performed spirometry, their eosinophil counts and serum total IgE were measured, and a sample of mixed VC expirate was collected for measurement of NO. Mixed expired NO was 8.2 +/- 0.5 ppb in controls, 8.8 +/- 1.5 ppb in patients with stable asthma, and 15.0 +/- 1.0 ppb in patients with acute asthma. A significant difference in eNO was observed in patients with acute asthma and controls (p < 0.001). Twenty-three of the 52 patients with acute asthma versus two of 53 controls had an eNO >/= 15 ppb (p < 0.001). Expired NO concentration correlated with FEV1% (r = -0.42, p < 0.001) and with the peripheral blood eosinophil count (r = 0.34, p < 0.001) in the group of 60 patients with acute and stable asthma. The sensitivity of eNO > 10 ppb and eosinophilia (> 200 cells/microliter) was 90% in predicting airway obstruction (FEV1/FVC < 0. 8). No relationship of eNO was found to serum IgE, self- reported smoking, or glucocorticoid use. Measurement of eNO is a promising clinical tool for assessing acute asthma.

Acute Disease↗
PubMed1999

Prospective analysis of CT of the sinuses in acute asthma.

OBJECTIVE: Asthma and sinusitis are both inflammatory diseases of the respiratory epithelium, but to our knowledge no prospective analyses of CT of the sinuses in patients with acute asthma have been performed. The purpose of this study was to investigate the type and extent of abnormalities found on CT of the sinuses in patients with acute asthma. SUBJECTS AND METHODS: Sixty-five patients with acute asthma and 62 age-, race-, and sex-matched control subjects were enrolled in the emergency department. Limited coronal sinus CT was performed and scans were interpreted by a radiologist who was unaware of the patient's clinical condition. Scans were analyzed for the presence of mucosal thickening in the sinuses, ostiomeatal complexes, and nasal cavities. Scans were also assigned a CT score for total mucosal thickening. A CT score of 12 or more points indicated extensive disease. RESULTS: Mucosal thickening in the nasal passages (p < .001), ostiomeatal complexes (p < .05), and ethmoidal (p < .05) and sphenoidal sinuses (p < .05) was associated with acute asthma, but maxillary mucosal thickening was not (p = .44). CT scores differed significantly between asthmatic patients (7.7 +/- 0.8 points) and control subjects (4.1 +/- 0.4 points) (p < .001). Nineteen of the 65 asthmatic patients had extensive disease compared with two of the 62 control subjects (p < .001). Thirteen asthmatic patients with extensive disease underwent follow-up CT 5 months later, and 11 of the 13 patients showed improvement in CT score without having undergone specific therapy for sinusitis. CONCLUSION: Mucosal thickening in the nasal passages and sphenoidal, ethmoidal, and frontal sinuses is more common in patients with acute asthma than in control subjects. However, maxillary sinus mucosal thickening is no more common in asthmatic patients than in control subjects.

Acute Disease↗
PubMed1999

Lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood.

OBJECTIVE: To determine the lung function status of some Nigerian men and women chronically exposed to fish drying using burning firewood. DESIGN: Case control study. SETTING: Ibaka, Utaewa and Ikanga fishing settlements. SUBJECTS: 183 males and 192 females engaged in fishing, aged 20 to 45 years who have been exposed for a minimum of five years as cases. The control group comprised sex matched male (142) and female (152) Nigerians from the same area who were not exposed to any known air pollutant. MAIN OUTCOME MEASURES: Lung function indices: FVC, FEV1, FEV1% and PEFR. RESULTS: Lung function indices were significantly lower in men engaged in fishing than in their controls: FVC [mean (SD): 2.98 (0.20) vs 3.52 (0.29), p < 0.001]; FEV1 [2.08 (0.18) vs 2.82 (0.25), p < 0.001]; FEV1% [69.8 (3.1) vs 80.2 (6.7), p < 0.001]; and PEFR [335 (22) vs 592 (99), p < 0.001], respectively. Similarly, lung function indices were lower in females in the fishing industry than in their controls; FVC [2.42 (0.17) vs 3.02 (0.24), p < 0.001]; FEV1 [1.70 (0.19) vs 2.55 (0.21), p < 0.001]; FEV1% [72.9 (3.2) vs 84.4 (6.7), p < 0.001]; and PEFR [298 (22) vs 418 (34), p < 0.001]. All the lung function indices (except FEV1%) of the fishermen and women declined significantly (p < 0.001) with their duration of exposure. The results showed a predominantly mixed pattern (restrictive and obstructive) of respiratory defect. There were higher prevalences of respiratory and other symptoms among the cases than the controls. The respiratory symptoms included cough with sputum, chest pain, dyspnoea catarrh and sneezing and unproductive cough. Other symptoms were eye and skin irritation, internal heat and headache. CONCLUSIONS: Chronic exposure to fish drying using burning firewood can impair lung function and cause respiratory and other symptoms.

Adult↗
PubMed1998

Pathophysiology and treatment of painful diabetic neuropathy of the lower extremity.

BACKGROUND: Symptomatic peripheral neuropathy is the most common complication of diabetes mellitus, affecting up to 62% of Americans with diabetes. METHODS: We reviewed the literature using the National Library of Medicine's MEDLINE search service. In total, we reviewed 54 articles. RESULTS: Hyperglycemia leads to increased activity in the polyol pathway in nerve cells; this ultimately results in abnormal nerve function. Numerous pharmacologic agents have been used to treat symptomatic peripheral neuropathy, but all of these drugs can be associated with adverse side effects. Recent work has indicated that subsensory electrical stimulation may be preferred to pharmacotherapy, since it is equally effective and has a more favorable safety profile. CONCLUSION: Although the pathophysiology of diabetic neuropathy is well understood, treatment of the symptoms associated with this condition can be challenging. Additional research is needed to reveal a safe and effective treatment for this debilitating sequela of diabetes mellitus.

Diabetic Neuropathies↗
PubMed1998

Distinct patterns of NCAM expression are associated with defined stages of murine hair follicle morphogenesis and regression.

Hair follicle development, growth (anagen), and regression (catagen) largely result from bidirectional epithelial-mesenchymal interactions whose molecular basis is still unclear. Because adhesion molecules are critically involved in pattern formation and because the fundamental importance of neural cell adhesion molecule (NCAM) for feather development has been demonstrated, we studied the protein expression patterns of NCAM during hair follicle development and regression in the C57BL/6 mouse model. During murine hair follicle development, NCAM immunoreactivity (IR) was first detected on epithelial hair placodes and later on selected keratinocytes in the distal outer root sheath. Mesenchymal NCAM immunoreactivity (IR) was noted on fibroblasts of the future dermal papilla (DP) and the perifollicular connective tissue sheath. Fetal hair follicle elongation coincided with strong, ubiquitous dermal NCAM IR, which remained strong until the follicles entered into their first neonatal catagen. At this time, the strong interfollicular dermal NCAM IR decreased substantially. During consecutive hair cycles, mesenchymal NCAM IR was seen exclusively on DP and perifollicular connective tissue sheath fibroblasts and on the trailing cells of regressing catagen hair follicles. These highly restricted and developmentally controlled expression patterns suggest an important role for NCAM in hair follicle topobiology during morphogenesis and cyclic remodeling of this miniorgan.

Aging↗