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Biomedical subjects

J Frederick

Publications and source records attributed to J Frederick.

At least 19 recordsLinked to original sources
PubMed2004

The prevalence of positive anticardiolipin antibody in Jamaican women with spontaneous abortion and the correlation with past clinical history.

One hundred and thirty-eight (138) pregnant women who had spontaneous abortions were screened for immunoglobulin G (IgG) antibodies to cardiolipin (aCL) by enzyme immunoassay (EIA). A total of 85 (61.6%) tested negative, while 53 (38.4%) had positive aCL test results. A review of the patients' hospital notes was conducted and comparisons were made between patients with moderate/high positive (21/138, 15.2%), those with low positive (32/138, 23.1%) and those with negative aCL results (85/138, 61.6%). The variables examined were a history of previous abortions, the number of previous fetal deaths and a past history of medical problems such as thrombosis or high blood pressure. No significant differences were found between the patients with moderate/high positive aCL; low positive aCL; and those with negative aCL test results for any of the clinical variables examined. In conclusion, the prevalence of positive IgG aCL tests was high in this cohort of patients with spontaneous abortion. However, intervention is not necessary in many of these patients who have only a positive aCL test, but none of the clinical conditions of the antiphospholipid syndrome.

Abortion, Spontaneous↗
PubMed2004

Effect of the oral contraceptive pill on patients undergoing controlled ovarian hyperstimulation.

This is a retrospective analysis of 89 patients who were undergoing controlled ovarian hyperstimulation for in vitro fertilization and embryo transfer in the Fertility Management Unit of the Department of Obstetrics, Gynaecology and Child Health, The University of the West Indies. Twenty-eight patients (Group A), who did not receive oral contraceptive pills prior to controlled ovarian hyperstimulation (COH) were compared with 61 patients in Group B treated with oral contraceptive pills for two months prior to undergoing COH assisted reproduction using the long protocol. The number of follicles, oocytes, estimated oestradiol levels on the day of administration of human chorionic gonadotrophin (hCG), pregnancy rates, miscarriage rates and the incidence of patients who developed ovarian hyperstimulation syndrome (OHSS) were the main outcome measures. The mean age and haematocrit were the same in each group. The number of follicles retrieved tended to be higher in Group A than in Group B (median 8 versus 6, p = 0.06) with significantly more oocytes being retrieved in Group A than Group B (p < 0.05). There were no statistically significant differences between the two groups in oestradiol levels, the proportion of patients with polycystic ovarian disease, the proportion of women who developed ovarian hyper-stimulation syndrome or pregnancy outcomes. There was no difference between the groups in measures of clinical severity of OHSS. In a logistic regression model the significant predictors of OHSS were haematocrit and oestradiol levels. There appeared to be no significant clinical benefit in administering oral contraceptive pills for two months to patients prior to COH.

Adult↗
PubMed2003

Endometriosis co-existing with bilateral dermoid cysts of the ovaries treated by laparoscopy.

Endometriosis co-existing with bilateral dermoid cysts of the ovaries is a rare occurrence although both benign conditions are said to be common in women in the reproductive age group. We present a case of a young woman with primary infertility associated with incapacitating dysmenorrhoea. Sonographic evaluation revealed bilateral ovarian cysts. Video-assisted laparoscopy was performed which revealed bilateral dermoid cysts and endometriotic deposits in the pelvis. The ovarian cysts were enucleated and the endometriotic deposits were endo-coagulated. The patient was treated with GnRH agonist for three months. There have been only two reports of benign and malignant teratomas co-existing with endometriomas.

Adult↗
PubMed2003

Who is at high risk? A comparison of the seroprevalence of human immunodeficiency virus in pregnant women and a high risk group.

To compare the seroprevalence of HIV in Jamaican pregnant women with that in substance abusers, two groups of antenatal patients were studied, one (A) attending a public hospital clinic and the other (B) attending private clinics. The HIV seroprevalence in the antenatal patients was compared with that in the substance abusers, group C, in 1996 and five years later in 2001. HIV antibody was determined by enzyme immunoassay. The HIV seroprevalence in group A more than doubled (1.6%-3.8%) in five-years, 1996-2001. There were no seropositives in group B. In group C, the seroprevalence rose from 2.08% in 1996 to 5.76% in 2001. There was indication that group A might no longer be considered "low risk", as there was no significant difference from group C in HIV seroprevalence in 1996 and 2001. The trend seen in this study is worthy of further investigation.

Adolescent↗
PubMed2002

Laparoscopic retrieval of perforated intrauterine devices at University Hospital, Jamaica.

Four intraabdominal, copper, T-shaped intrauterine devices (IUDs) were retrieved laparoscopically after the rare complication of complete perforation of the uterine wall. After the IUDs were located by ultrasound and radiographs, laparoscopy was performed under general anesthesia. The devices were easily located and all procedures were uncomplicated. In two cases anterior wall perforations with adhesion formation around the device were seen in the region of the uterovesical fold. Two IUDs were found adjacent to bowel, one in pararectal fat. Three surgeries were performed as day cases; the fourth patient, a diabetic, was kept for observation for 1 day.

Adult↗
PubMed2002

Operative morbidity and reproductive outcome in secondary myomectomy: a prospective cohort study.

BACKGROUND: This prospective study was designed to evaluate the operative morbidity and reproductive outcome in patients who had secondary myomectomy for recurrent symptomatic uterine fibroids. METHODS: A total of 58 women were subjected to a secondary myomectomy via the abdominal route. The operative morbidity such as blood loss, presence of adhesions and febrile index were estimated and the pregnancy outcome over a 2-4 year period of follow-up. RESULTS: The mean age and standard deviation (+/- SD) of the women was 35 (+/- 2.4) years. Nineteen patients (33%) had a postoperative temperature vertical line 100 degrees F and the estimated blood loss ranged from 159-2500 ml (median 700 ml). Seven patients (12%) required blood transfusion and one had a hysterectomy due to haemorrhage. Nine women (15.5%) became pregnant but only five (56%) had live births. Those with successful pregnancies tended to be younger with a mean age of 31.8 (+/- 2.6) years versus 35 (+/- 1.8) years, (P = 0.08, non-significant) and had fewer uterine leiomyomata; median with range values, 2 (1-6) versus 7 (6-15). The variables which best predicted the postoperative likelihood of pregnancy were; age, presence of tubal adhesions and the number of uterine fibroids. CONCLUSION: This prospective study showed a high operative morbidity and a poor fertility outcome after a repeat myomectomy. The factors affecting successful outcome in a logistic regression model were age, tubal adhesions and number of uterine fibroids.

Adult↗
PubMed2002

Cervical pregnancy. Case report and literature review.

Cervical pregnancy is an uncommon life threatening form of ectopic pregnancy that is associated with the unexpected occurrence of uncontrollable haemorrhage from the cervix. To avoid hysterectomy and to maintain fertility, several conservative methods of termination have been used. We present herein, one such case which relates to a young woman who had successful conservative management of a cervical pregnancy using vasopressin infiltration of the cervix, a McDonald cerclage and cervical curettage followed by balloon tamponade. Subsequently, she became pregnant again with a normal intra-uterine pregnancy and had a successful vaginal delivery.

Adult↗
PubMed2002

Successful pregnancy after hysteroscopic metroplasty.

Congenital anomalies of the uterus have been estimated to affect 0.06-10% of women. Uterine septae account for approximately 80% to 90% of these anomalies and is also associated with the poorest reproductive outcome. Pregnancy loss in patients with a septate uterus has been reported to be as high as 90% after other causes for miscarriages have been excluded. We present here the first experience in Jamaica, of a successful pregnancy outcome after hysteroscopic metroplasty in a woman with a septate uterus and three previous miscarriages.

Adult↗
PubMed2001

[Video-assisted total proctocolectomy with ileoanal anastomosis].

The indication for laparoscopy in digestive surgery has evolved with the development of the laparoscopic material as well its increasingly frequent practice in the medical community. Those complex operations such as restorative proctocolectomy require a high level of technical skill as well as a specifically designed operative approach. The study aim was to report our experience of the video-assisted approach to restorative proctocolectomy.

Anastomosis, Surgical↗
PubMed2001

Can nurses govern in a government agency?

A shared governance model was implemented within the nursing service of the Durham Veterans Affairs Medical Center in 1997. In 1999, members of the Nursing Quality/Staff Education/Research Council examined facility nurses' perceptions of governance to determine the degree to which the model had been implemented. Results of the study indicate that although imperatives at the organizational level were incompatible with three aspects of shared governance, there were three shared governance dimensions pertaining to basic nursing practice that reached or surpassed governance thresholds. This study highlights the potential of nursing management innovation within highly bureaucratic organizations.

Academic Medical Centers↗
PubMed2001

In vitro fertilization. The Jamaican experience.

In June 2000, twenty-eight infertile couples were treated by in vitro fertilization and embryo transfer at our initial assisted reproduction programme carried out in conjunction with Midland Fertility Services, Aldridge, Birmingham, England. A pre-requisite for treatment was that on day 3 of the menstrual cycle the levels of follicle stimulating hormone (FSH) and oestradiol (E2) should be < 10 i mu/l and < 100 pg/ml respectively in the female partner. The ages of the women ranged from 26 to 42 years with a mean age of 35.5 years. Down regulation was carried out by using buserelin acetate 0.5 microgram subcutaneously from day 21 of the cycle for 21 days. This process was completed when the ovaries and pituitary gland were quiescent and the endometrial thickness < 4 mm in diameter. On completion of down regulation the gonadotrophin hormone, pergonal (dosage of 150-450 units) was used for ovarian hyperstimulation. A total of 294 oocytes (mean of 10.5, range 2-45) were retrieved of which 138 were fertilized (mean of 4.9, range of 0-28). Twenty-four patients each received a mean of two embryos. Five patients (20.8%) had positive pregnancy tests. Three patients (0.1%) developed ovarian hyperstimulation syndrome (OHSS), one had the severe, and two, the mild form of the syndrome. All three cases were treated successfully. The success at the initial IVF controlled ovarian hyperstimulation augers well for the future of infertile couples seeking treatment at the Fertility Management Unit, The University of the West Indies, Jamaica.

Adult↗
PubMed2000

Extracorporeal circulation exacerbates microvascular permeability after endotoxemia.

BACKGROUND: Extracorporeal life support without prior inflammatory stimuli results in a modest increase in microvascular permeability. Initiating ECLS after shock, sepsis, or hypoxia results in marked increases in interstitial fluid and total body water. We sought to determine whether an inflammatory stimulus prior to initiating ECLS increases microvascular permeability to protein. METHODS: An anesthetized canine lymphatic fistula model was used to study Starling forces. LPS + ECLS received 1 mg/kg LPS 1 h prior to initiating ECLS, and the group ECLS received saline vehicle. To determine mesenteric microvascular permeability, mesenteric venous pressure was elevated to 32 +/- 1 mm Hg to reach a minimal lymph protein concentration (C(L)). With simultaneous measurement of plasma protein concentration (C(P)), the reflection coefficient, sigma, was calculated using the formula sigma = 1 - C(L)/C(P). Transvascular protein clearance and filtration coefficient (K(f)) were calculated from the measured Starling variables. After a steady state was achieved, normothermic right atrial-to-femoral artery ECLS was initiated and continued for 2 h and then discontinued. Measurements were continued for 30 min after ECLS was discontinued. Measurements were continued for 30 min after ECLS was discontinued. Within-group comparisons were made with ANOVA and Fisher's LSD, and between-group comparisons were made with Student's t tests where appropriate. RESULTS: The reflection coefficient (sigma) decreased significantly from 0.77 +/- 0.02 to 0.53 +/- 0.07 with LPS + ECLS and was lower compared to ECLS alone (0.77 +/- 0.02 to 0.65 +/- 0.03). Transvascular protein clearance increased to a greater extent in LPS + ECLS from 266 +/- 46 to 819 +/- 125 microl/min compared to ECLS alone (284 +/- 49 to 819 +/- 125 microl/min) (P = 0. 06). K(f) increased in both groups after initiation of ECLS, but to a significantly greater extent in LPS + ECLS at 60 min (30.7 +/- 2.2 microl/min/mm Hg/g in ECLS and 50.0 +/- 8.9 microl/min/mm Hg/g in LPS + ECLS). Ileal tissue water increased in both groups, but there were no differences between groups. CONCLUSIONS: Initiation of ECLS after exposure to LPS increases ileal microvascular permeability to protein and water to a greater extent than ECLS alone.

Animals↗
PubMed2000

New phenotypes associated with the swallow gene of Drosophila: evidence for a general role in oocyte cytoskeletal organization.

During oogenesis in Drosophila, several mRNAs and proteins are localized to discrete regions of the developing oocyte, resulting in a mature oocyte with a well-defined anterior-posterior axis. The product of the swallow (sww) gene is required for the localization of two different mRNAs during oogenesis, bicoid (bcd) and Adducin-like/hu-li tai shao (hts). We initiated a detailed characterization of the phenotypes associated with each of eight sww alleles as a means of investigating the role of sww in oogenic patterning. RNA localization defects in various sww mutants were examined by radioactive in situ hybridization to paraffin sections. Using this technique, several previously unreported RNA localization defects have been observed. Although bcd RNA localization is often lost completely in sww oocytes, in a high proportion of cases, bcd RNA is localized inappropriately along the periphery of the mature oocyte. In several sww mutants, a portion of the bcd mRNA population becomes concentrated at the posterior pole of the oocyte during late oogenesis. Several sww mutations also result in oskar RNA localization defects, consistent with a global role for sww in cytoskeletal regulation or organization. A detailed temporal and spatial analysis of hts RNA localization in sww mutants and in drug-treated ovaries reveals many similarities to bcd RNA localization, and implies the two independent localization events are accomplished by the same mechanism.

Animals↗
PubMed2000

Effects of selectin-sialyl Lewis blockade on mesenteric microvascular permeability associated with cardiopulmonary bypass.

OBJECTIVES: Cardiopulmonary bypass is associated with an inflammatory response that is associated with a neutrophil-mediated microvascular barrier injury. We studied the effects of blocking neutrophil-endothelial tethering on microvascular permeability and edema formation during cardiopulmonary bypass. Using a selectin antagonist that prevents interactions with their ligands, we hypothesized that there would be less neutrophil infiltration into the tissue and a reduction in microvascular permeability and edema formation. METHODS: A canine mesenteric lymphatic fistula was created to measure Starling forces and to determine microvascular permeability. Normothermic, atrial-femoral cardiopulmonary bypass was initiated (70-90 mL. kg(-1). min(-1)). Intestinal tissue water was determined with microgravimetry. Ileal tissue myeloperoxidase was measured as an index of neutrophil tissue infiltration. One experimental group received the selectin antagonist TBC 1269 before the initiation of bypass, and the control group received saline solution. RESULTS: There was a modest increase in microvascular permeability in both groups, as evidenced by significantly increased transvascular protein clearance and a trend toward a decrease in reflection coefficient. There were no differences in the experimental group compared with the control group. Ileal tissue myeloperoxidase levels were lower in the experimental group than in the control group. CONCLUSIONS: The selectin antagonist TBC 1269 reduces neutrophil infiltration into the ileum without altering ileal microvascular permeability or edema associated with cardiopulmonary bypass.

Animals↗
PubMed1999

A controlled investigation of bodywork in multiple sclerosis.

OBJECTIVE: To determine whether a course of Feldenkrais bodywork would result in significant improvement in physical, mood symptoms and functioning in multiple sclerosis (MS) patients beyond the effects observed using a sham condition (nontherapeutic bodywork). DESIGN: The bodywork method used was the Feldenkrais method. Subjects were randomly assigned to 1 of 2 groups in a crossover design to control for order effects of treatment. Half of the subjects received 8 weeks of sham sessions followed by 8 weeks of Feldenkrais sessions. The other half of the subjects received Feldenkrais sessions first and then sham. All subjects completed the outcome measures prior to the first course of treatment, in between Feldenkrais and sham, and at study completion. SETTING: Participants were recruited from a regional MS clinic and were administered bodywork treatment and outcome measures in a bodywork practitioner's office. SUBJECTS: Twenty individuals with clinically definite MS and disability status scores between 2.0 and 6.0 participated. OUTCOME MEASURES: Nine-hole pegboard test of hand dexterity, Hospital Anxiety and Depression Scale, MS self-efficacy scale, MS Symptom Inventory, MS Performance Scales, and the Perceived Stress Scale. RESULTS: The only significant differences were observed for perceived stress and lowered anxiety after Feldenkrais sessions. There were nonsignificant trends toward higher self-efficacy after both Feldenkrais and sham sessions. MS symptoms, levels of functional ability, and upper extremity performance were not affected by Feldenkrais or sham sessions.

Adult↗
PubMed1999

Chronic pancreatitis and inflammatory bowel disease: true or coincidental association?

OBJECTIVE: Several cases of pancreatitis have been described during the course of Crohn's disease (CD) or ulcerative colitis (UC), but many of them were related to either biliary lithiasis or drug intake. We tried to evaluate the clinical and morphological features of so-called idiopathic pancreatitis associated with inflammatory bowel disease and to define their pathological characteristics. METHODS: Chronic idiopathic pancreatitis was diagnosed on the basis of abnormal pancreatograms suggestive of chronic pancreatitis associated with or without impaired exocrine pancreatic function, or pathological examination in patients undergoing pancreatic resection. We found 6 patients presenting with features of chronic idiopathic pancreatitis and UC and 2 patients with CD seen between 1981 and 1996 in three hospital centers of the south of France. A review of the literature has identified 6 cases of pancreatitis associated with UC and 14 cases of pancreatitis associated with CD based on the above criteria. RESULTS: Hyperamylasemia was not a sensitive test since it was present in 44% and 64% of patients with UC or CD. In UC, pancreatitis was a prior manifestation in 58% of patients. In contrast, the pancreatitis appeared after the onset of CD in 56% of the cases. In patients with UC, pancreatitis were associated with severe disease revealed by pancolitis (42%) and subsequent surgery. Bile duct involvement was more frequent in patients with UC than with CD (58% vs 12%) mostly in the absence of sclerosing cholangitis (16% vs 6%). Weight loss and pancreatic duct stenosis were also more frequent in UC than in CD (41% vs 12% and 50% vs 23%, respectively). Pathological specimens were analyzed in 5 patients and demonstrated the presence of inter- and intralobular fibrosis with marked acinar regression in 3 and the presence of granulomas in 2 patients, both with CD. CONCLUSIONS: Pancreatitis is a rare extraintestinal manifestation of inflammatory bowel disease. Chronic pancreatitis associated with UC differs from that observed in CD by the presence of more frequent bile duct involvement, weight loss, and pancreatic duct stenosis, possibly giving a pseudotumor pattern.

Adolescent↗
PubMed1999

High prevalence of genital Chlamydia trachomatis infection in women presenting in different clinical settings in Jamaica: implications for control strategies.

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection and risk factors in women attending family planning, gynaecology, and sexually transmitted disease (STD) clinics in Jamaica. METHODS: Endocervical specimens from 645 women including 238 family planning, 170 gynaecology, and 237 STD clinic attendees were examined for C trachomatis using a direct fluorescence assay (DFA) and culture. Investigations were carried out for the presence of other STD pathogens and demographic, behavioural, historical, and clinical data recorded for each participant. RESULTS: The prevalence of C trachomatis infection was 35%, 47%, and 55% in family planning, gynaecology, and STD clinic clients, respectively. The performance of the DFA was comparable to that of culture in screening for C trachomatis. Logistic regression analysis revealed that the independent risk factors for C trachomatis infection were non-barrier contraceptive methods in family planning clients (OR = 2.1; 95% confidence interval (CI) = 1.2-3.9; p = 0.0110), cervical ectopy in gynaecology clients (OR = 3.9; 95% CI = 1.4-10.6; p = 0.0076) and concomitant Trichomonas vaginalis infection in STD clients (OR = 3.5; 95% CI = 1.8-6.8; p = 0.003). Age, number of sex partners, and reason for visit were not identified as risk factors for C trachomatis infection. CONCLUSIONS: Consistently high prevalence of C trachomatis infection occurs in Jamaican women. Universal screening or presumptive treatment should be evaluated as prevention and control measures for C trachomatis infection in this population where all women appear to be at risk.

Adolescent↗