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Biomedical subjects

E S Smith

Publications and source records attributed to E S Smith.

At least 19 recordsLinked to original sources
PubMed1991

IgG subclass responses to human immunodeficiency virus-1 antigens: lack of IgG2 response to gp41 correlates with clinical manifestation of disease.

To analyze differential antibody responsiveness of potential pathogenetic significance, sera from 66 patients with human immunodeficiency virus-1 (HIV-1) infections at various Walter Reed (WR) stages of the disease were analyzed to determine the subclass distribution of HIV antibodies. Although all IgG subclasses were involved in the HIV antibody response, the frequency was highest for IgG1 and the lowest for IgG4. When IgG subclass responses to different HIV antigens were compared qualitatively, IgG1 was the major subclass reactive with env, pol, and gag antigens; IgG2 and IgG3 were almost equally represented in response to gag gene products; and IgG4 showed minimal reactivity to p24 antigen in all HIV-infected patients regardless of their clinical presentation. In contrast, significantly lower levels of IgG2 anti-gp41 were observed in patients at WR 5 and 6 (5%) when compared to those at stage WR 1 and 2 (88%). The IgG2 response to a recombinant gp 120/41 antigen, however, remained unchanged, suggesting that the lack of IgG2 response may be associated with lack of responsiveness to the carbohydrate epitope on gp41. Indeed, parallel measurements of IgG antibody responses to group A carbohydrate were also lower in patients at WR 5 and 6 stages, without affecting antibody responses to polyribosyl ribitol phosphate and phosphocholine. As antibody responses to group A carbohydrate with its N-acetyl D-glucosamine (GlcNAc) determinant were lower at the WR 5 and 6 stage of HIV disease, GlcNAc may be one of the antigenic determinants on gp41 that plays a critical role in some of the pathologic events of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The case of Ohio v. Robinson. An 1870 bite mark case.

In 1870, Ansil L. Robinson was charged with the murder of his mistress, Mary Lunsford, in Mansfield, Ohio, U.S.A. Evidence against Robinson included an attempt to match his teeth to bite marks on the victim's arm. Robinson was acquitted after a 3-week trial despite the evidence linking his teeth to the wounds. This trial represents an early and perhaps the first attempt to admit bite-mark evidence in a court of law in the United States. The acquittal resulted in the obscurity that prevented this case from coming to the awareness of the forensic dental and legal communities sooner.

Bites and Stings↗
PubMed1989

Evaluation and treatment of patients with human bite marks.

Physicians and other health care workers who care for patients who have sustained human bite marks need a working protocol to ensure that these patients receive proper care. This protocol involves taking a thorough history and performing a physical examination, approximately determining the bite mark age, and administering proper therapy. The history will help to determine whether a criminal act has been committed and which agencies need to be notified. The American Board of Forensic Odontology published criteria for bite mark analysis in 1984 that included a description of the bite mark including its size, shape, and color, along with techniques for collection of evidence from both the victim and suspect. To determine bite mark age, tissue response to injury (inflammation, granulation tissue formation, and matrix formation and remodeling) is reviewed. Finally, the bacteria that are found in these wounds and the proper use of antimicrobial agents are expanded upon.

Anti-Bacterial Agents↗
PubMed1989

Human bite marks. Differential diagnosis.

Human bite marks are common findings in cases of fights among children, child abuse, sexual abuse, among institutionalized persons, and in a number of homicide cases. Human bites can mimic annular or arciform dermatoses. These are reviewed from both a clinical and histologic viewpoint. An example is presented of a 2 year-old girl with several annular lesions that were clinically mistaken for a dermatophyte infection. Antifungal medications were ineffective. After several days, a dermatologist identified the lesions as human bites. Physicians and other health care workers must be able to differentiate the clinical appearance of bite marks from other dermatologic diseases at an early stage so as to initiate proper therapy and counseling and, if indicated, a search for the perpetrator.

Bites and Stings↗
PubMed1988

Isovolemic hemodilution in stroke. A study in gerbils.

Isovolemic hemodilution has been reported to increase cerebral perfusion in humans and has been advocated as a treatment for acute cerebral infarction. This study examines the effect of isovolemic hemodilution with low-molecular-weight dextran on mortality and the incidence of neurological deficit in gerbils after internal carotid ligation. Sixty-four Mongolian gerbils were anesthetized with pentobarbital and the left internal carotid artery was ligated in both control and experimental animals. In the experimental group, blood was removed and an equal volume of dextran was injected to reestablish normal blood volume and lower hematocrit to a mean of 30.5. Control animals were not so treated. Animals were observed for neurological deficits for 24 hours after carotid ligation. The incidence of neurological deficit in control animals was 67%; it was 64% in the experimental group. Mortality within the first 24 hours was 28% in the controls and 75% in animals that were treated by hemodilution (p less than 0.001). Isovolemic hemodilution with dextran did not reduce the incidence of neurological deficit after carotid ligation in gerbils and was associated with a significant increase in mortality during the first 24 hours.

Animals↗
PubMed1987

A prospective study of the epidemiology and ecology of Lassa fever.

In studies of Lassa fever in Sierra Leone, the prevalence of human antibody to Lassa virus ranged from 8% to 52%. Mastomys natalensis, the reservoir of Lassa virus, constituted 50%-60% of the rodents captured in houses but only 10%-20% of those captured in surrounding agriculture and bush areas (chi 2 = 90.2, P less than 10(-6), df = 1), a finding suggesting that houses are the most-important location for transmission of Lassa virus. Viral infection of Mastomys from houses ranged from 0% to 80%. The incidence of seroconversions in susceptible persons ranged from 5% to 22% per year; the ratio of illness to infection ranged from 9% to 26%, and the proportion of febrile illness associated with seroconversion was 5%-14%. Eightfold rises in titer of antibody occurred in 1%-18% of the antibody-positive population, a result suggesting reinfection. We estimate the ratio of fatalities to infection to be 1%-2%, a rate lower than estimates based on hospitalized cases. The high incidence of Lassa fever makes it a major problem in West Africa.

Adolescent↗
PubMed1987

A case-control study of the clinical diagnosis and course of Lassa fever.

A prospective case-control study of Lassa fever was established in Sierra Leone to measure the frequency and case-fatality ratio of Lassa fever among febrile hospital admissions and to better delineate the clinical diagnosis and course of this disease. Lassa fever was responsible for 10%-16% of all adult medical admissions and for approximately 30% of adult deaths in the two hospitals studied. The case-fatality ratio for 441 hospitalized patients was 16.5%. We found the best predictor of Lassa fever to be the combination of fever, pharyngitis, retrosternal pain, and proteinuria (predictive value together, .81); of outcome, the best predictor was the combination of fever, sore throat, and vomiting (relative risk of death, 5.5). Complications included mucosal bleeding (17%), bilateral or unilateral eighth-nerve deafness (4%), and pleural (3%) or pericardial (2%) effusion. Lassa fever is endemic in this area and is a more-common cause of hospital admission and death than has previously been described; this disease must be considered when diagnosing febrile illness in West Africa.

Adolescent↗
PubMed1987

Clinical virology of Lassa fever in hospitalized patients.

We measured levels of virus in sequential specimens from 137 patients with Lassa fever. The probability of fatal disease increased significantly with the level of viremia measured either on admission or during the course of illness. The odds ratio of death in patients with viremia greater than 10 TCID50/ml was 3.7 (90% confidence interval, 1.9-7.2). The same ratio in patients with viremia greater than 10 TCID50/ml and with levels of aspartate aminotransferase greater than or equal to 150 IU/liter was 21.5 (95% confidence interval, 5.2-99.0). Virus was found in throat cultures from 39% of viremic patients, compared with 14% of nonviremic patients (P less than .002); however, the level of virus was usually less than or equal to TCID50/ml. Fewer than 3% of patients were viruric during acute illness, and virus was isolated from three of three samples of cerebrospinal fluid. On admission, 53% of patients had IgG antibodies, and 67% had IgM antibodies. Recovery was not associated with the presence of either IgG or IgM. Virus was isolated from greater than 100 serum specimens that also contained high titers of IgG. Clinical Lassa fever was shown to be a disseminated systemic, primary viral infection, with an outcome highly associated with viremia but not with development of antibody.

Adult↗
PubMed1987

An analysis of methods to reform Medicare payment for physician services.

Congress and the administration are changing Medicare's method of paying for physician services, with the intention of reducing the growth in or absolute level of Medicare payment rates. We analyzed the implications of four possible strategies for payment reform: modifications to the present system of paying by customary, prevailing, and reasonable (CPR) charges; payment based on fee schedules; payment for packages of related services; and capitation payment. In some cases, improved quality or access may result. The inherent danger is that constraining program expenditures may impair access to and quality of care to beneficiaries, especially for poor or infirm people, who are more vulnerable. Thus, any payment reform will require careful monitoring to safeguard beneficiaries' quality of care.

Capitation Fee↗
PubMed1977

Case-control study of recidivist drivers involved in fatal highway accidents in Alberta in 1970-72.

A 3-year enpidemiologic study of fatal motor vehicle accidents was carried out by the Alberta Task Force on Highway Accidents. It was found that 11.1% of culpable drivers had been driving while impaired by alcohol on at least one occasion prior to the fatal accident, while only 3.3% of exonerated drivers had previous records. This significant difference led to a case-control study that demonstrated that the recidivist drivers (case group) differed significantly in a number of aspects from the innocent drivers (control group)--notably, age distribution, sex, whether drinking before the accident, blood alcohol concentration, ethnic distribution, class of accident and type of collision. Thus the recidivist driver is a greater threat to highway safety than the innocent driver and needs special attention by legislators and law enforcement agencies.

Accidents, Traffic↗
PubMed1977

An epidemiological study of congenital reduction deformities of the limbs.

A retrospective study that was undertaken to determine why more infants had been born with congenital reduction deformities of the limbs is reported. The increase was detected by the Congenital Anomaly Surveillance System in 1969. Ninety-three infants born in Alberta and British Columbia in 1969-71 with congenital reduction deformities were matched with 93 normal infants and 93 infants with congenital malformations of a different type. The mothers of all infants were interviewed to obtain information on factors thought relevant to the establishment of a causal relationship. Although there were some significant differences between cases and normaland/or abnormal controls, this number of differences might have been expected by chance. No single causal relationship was established.

Alberta↗