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Biomedical subjects

J Nash

Publications and source records attributed to J Nash.

At least 19 recordsLinked to original sources
PubMed2002

AIDS awareness and sexual behaviour in a high HIV prevalence area in rural northern Kwazulu-Natal, South Africa.

The objective was to assess AIDS awareness and sexual behaviour in a rural South African community with a high HIV prevalence. One hundred clinic attenders underwent a structured interview using a standard questionnaire. Although the 64 female and 36 male patients, mean age 22 (range 13-45), had good knowledge of AIDS-related issues, only 50 perceived HIV/AIDS as a common problem. Of the 75 patients who were sexually active only 30 (40%) used condoms (men 16; 55% vs women 14; 30%, P=0.033) despite being better informed about the protective effect of condoms (active 61; 81% vs abstinent 14; 56%, P=0.011). More men than women admitted to multiple sexual partners (17; 47% vs 7; 11%, P<0.0001). In conclusion, despite a high level of awareness of HIV/AIDS issues, self-perceived risk was low, condom use was infrequent and especially men continued to have multiple sexual partners. Awareness has yet to translate into reduction of risk behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Suspected pulmonary tuberculosis in rural South Africa--sputum induction as a simple diagnostic tool?

OBJECTIVES: To assess the value of sputum induction (SI) as a diagnostic tool for patients with suspected pulmonary tuberculosis (PTB) who are unable to expectorate or who have a negative sputum smear. DESIGN: Study of an inpatient cohort undergoing SI. SETTING: Mseleni Hospital, a rural district hospital in northern KwaZulu-Natal. SUBJECTS: All adult patients with suspected TB seen at the hospital over a 4-month period. OUTCOME MEASURES: (i) Successful SI; (ii) sputum acid-fast smear result; (iii) change of admission diagnosis as a result of the induction procedure; and (iv) number of patients discharged with a diagnosis other than TB who represented within 4 months with TB. RESULTS: A total of 51 patients (31 female) underwent SI; of these 36 (71%) were able to produce a sputum sample. Fifteen (42%) of those were acid-fast smear-positive (29% of all patients included). The admission diagnosis was changed in 16 (44%) of the patients who were able to give an induced sputum sample as opposed to 4 (27%) who had been unable to expectorate despite an induction attempt (P = 0.38). Three (12.5%) of the 24 patients with a discharge diagnosis other than TB (17 pneumonia, 3 old TB, 2 carcinoma of the lung, 1 bronchiectasis) turned out to have TB within the follow-up period; 2 of those had extrapulmonary TB. CONCLUSION: SI produced a positive smear result in 29% of patients with suspected TB who had previously been smear-negative or unable to expectorate. The method proved an aid to clinical decision making.

Adolescent↗
PubMed2000

Immunophenotypic shift in a case of mycosis fungoides with vitreous invasion.

The case of an 82-year-old man who developed intraocular extension from mycosis fungoides, a cutaneous T-cell lymphoma, is presented. The patient died soon after intraocular involvement occurred. Immunohistochemistry of a skin biopsy, taken early in the course of the disease, disclosed a predominance of T cells with a helper/inducer phenotype (CD4(+)). However, an intraocular infiltrate obtained 7 years later contained mostly T cells with a suppressor/cytotoxic phenotype (CD8(+)). The occurrence of ocular invasion, the change in immunophenotype, and the predominant proliferation of CD8(+) lymphocytes may have been related to the poor outcome in this patient.

Aged↗
PubMed2000

PDZ domains in synapse assembly and signalling.

Synaptic junctions are highly specialized structures designed to promote the rapid and efficient transmission of signals from the presynaptic terminal to the postsynaptic membrane within the central nervous system. Proteins containing PDZ domains play a fundamental organizational role at both the pre- and postsynaptic plasma membranes. This review focuses on recent advances in our understanding of the mechanisms underlying the assembly of synapses in the central nervous system.

Animals↗
PubMed2000

A randomized trial of enteral feeding volumes in infants born before 30 weeks' gestation.

OBJECTIVE: To compare the effect of two volumes of enteral feeds on postnatal growth in infants born before 30 weeks gestation. METHODOLOGY: Fifty-four infants, less than 30 weeks gestational age, who reached full enteral feeds were randomized to remain on 150 mL/kg per day (150 group) or increase to 200 mL/kg per day (200 group). The primary outcome measure was growth at 35 weeks corrected gestational age (CGA). RESULTS: There were no statistically significant differences in demographic or clinical parameters between the study groups at commencement of the study, although there was a trend for infants in the 150 group to be lighter (895 g vs 1020 g, P = 0.27). Milk intakes were increased in 43% of the infants in the 150 group, whereas 54% of the infants in the 200 group required reduced intakes. Infants in the 200 group had greater daily weight gains (16.7 g/kg per day vs 15.2 g/kg per day, P = 0.047) and at 35 weeks CGA were heavier (2020 g vs 1885 g, P = 0.014) and had a greater arm fat area (282 mm2 vs 218 mm2, P = 0.009). There was no difference in length or head circumference at 35 weeks CGA, and no difference in any growth parameter at 1 year of age. Morbidity was not different between the groups. CONCLUSIONS: The individual milk volume requirements for adequate weight gain without significant adverse effects vary between 150 and 200 mL/kg per day in extremely premature infants. For many infants in both groups, the assigned target volume was not appropriate. Increased milk intakes (and therefore higher caloric and mineral intakes) are associated with increased daily weight gains and a greater weight at 35 weeks CGA. The weight gain may be due to an increase in fat deposition.

Anthropometry↗
PubMed1999

Is routine synovial fluid analysis necessary? Lessons and recommendations from an audit.

This audit of 408 synovial fluid samples, analysed for cell counts and crystals, revealed that crystals were present in only 25 samples (6.1%). Of these, in only three patients was the diagnosis uncertain and therefore the analysis helpful. Cell counts and types generally reflected known underlying diagnoses of inflammatory arthritis or osteoarthritis. Routine synovial fluid analysis does not contribute to diagnosis or management in established rheumatic disorders and should be performed only when the underlying cause is uncertain or in newly presenting patients. Major savings can be made by abandoning routine synovial fluid analysis.

Diagnostic Tests, Routine↗
PubMed1999

Mechanisms of action of selective serotonin reuptake inhibitors in the treatment of psychiatric disorders.

Selective serotonin reuptake inhibitors (SSRIs) have demonstrated efficacy in depression and anxiety disorders. This raises the question of how the single action of serotonin reuptake inhibition can improve several psychiatric conditions. In order to understand this apparent paradox it is necessary to consider where SSRIs act in the pathogenic process underlying depression or anxiety disorders. Tryptophan depletion has been used extensively in research into depression and has shown that, in patients receiving an SSRI whose depression is in remission, depleting serotonin leads to recurrence of the disorder. Similar results have been found for panic disorder. This suggests that increased levels of serotonin are necessary in the synapse for the SSRI to be effective in the treatment of depression and panic disorder. In obsessive compulsive disorder, depletion of serotonin in patients recovered on an SSRI does not cause relapse; receptor adaptation may be more important. Variations within the SSRI drug class, such as the selectivity ratios for serotonin versus noradrenaline uptake, elimination half-life, and affinity for the 5-HT2 receptor have been identified and may be important determinants of efficacy, side effects and clinical use.

Anxiety Disorders↗
PubMed1999

Reduction in membranous expression of beta-catenin and increased cytoplasmic E-cadherin expression predict poor survival in gastric cancer.

beta-catenin, a component of the E-cadherin-catenin cell adhesion complex, also plays a separate intracellular signalling role, interacting with APC protein. Intracellular accumulation of beta-catenin is common in colorectal neoplasia. beta-catenin abnormalities are associated with poor survival in gastric cancer, but previous studies do not differentiate between membrane-associated and intracellular beta-catenin. In this study we aimed to determine which type of expression abnormalities for E-cadherin, beta-catenin and alpha-catenin correlate with clinico-pathological features and survival in gastric cancer. Immunoperoxidase staining of paraffin-embedded sections from 40 gastric cancers was performed for E-cadherin, alpha- and beta-catenins using microwave unmasking and an avidin-biotin technique. Clinical data were obtained from case records and cancer registry records. Reduced membranous expression of beta-catenin occurred in 10/12 (83%) diffuse and 8/28 (29%) intestinal tumours (P= 0.0014), and was associated with poor differentiation (P= 0.0015) and short survival (P= 0.032), but not with age, sex, tumour size or nodal status. Nuclear expression of beta-catenin was uncommon; cytoplasmic expression was observed in 13/40 cases (33%) but did not correlate with histology, tumour grade or survival. Reduced E-cadherin membrane expression was associated with lymph node metastasis (P= 0.02). Neither E-cadherin or alpha-catenin expression correlated with survival. Reduced membranous expression of beta-catenin predicts poor prognosis in gastric cancer, whilst ectopic intracellular expression is relatively rare. The apparent differences in beta-catenin expression from those found in colon cancer merit further study.

Cadherins↗
PubMed1999

Pharmacokinetics and absolute bioavailability of ribavirin in healthy volunteers as determined by stable-isotope methodology.

Ribavirin has recently been demonstrated to have efficacy in combination with alpha interferon for treatment of relapsed hepatitis C. The marked improvement in the response rate after treatment with the combination regimen (10-fold higher versus that from monotherapy with alpha interferon) highlights the importance of determining the absolute bioavailability of ribavirin as a first step in beginning to investigate the pharmacodynamics of the combination. The objective of this study was to determine the absolute bioavailability of ribavirin with an intravenous formulation containing ribavirin labeled with the stable isotope (13)C(3) ((13)C(3)-ribavirin) and unlabeled oral ribavirin. Six healthy volunteers received 150 mg of intravenous (13)C(3)-ribavirin followed 1 h later by a 400-mg oral dose of ribavirin. Samples of blood and urine were collected up to 169 h postdosing. Concentrations of (13)C(3)-ribavirin and unlabeled ribavirin were determined by a high-performance liquid chromatography tandem mass spectrometric method. All plasma and urine data were comodeled for labeled and unlabeled ribavirin by using both the two- and three-compartment models in the program ADAPT II. A three-compartment model was chosen for the pharmacokinetic analysis with the Akaike Information Criterion. The mean maximum concentrations of drug in plasma for intravenous and oral ribavirin were 4,187 and 638 ng/ml, respectively. The mean bioavailability was 51.8% +/- 21.8%, and the mean gamma-phase half-life was 37.0 +/- 14. 2 h. The mean renal clearance, metabolic clearance, and volume of distribution of the central compartment were 6.94 liters/h, 18.1 liters/h, and 17.8 liters, respectively. The use of the stable-isotope methodology has provided the best estimate of the absolute bioavailability of ribavirin that is currently available, as there was neither a period bias nor a washout effect to confound the data. The study demonstrated that the mean bioavailability for a 400-mg dose of ribavirin was 52%, which is higher than that previously reported in other investigations.

Adult↗
PubMed1999

A symposium on psychotherapy in the age of managed care.

This article is based upon a symposium presented at Vanderbilt University Medical Center on the Department of Psychiatry's 50th anniversary (September 20, 1997). The panel of psychotherapy scholar-clinicians discusses issues including: whether or not managed care and psychotherapy are compatible; the relevance of the Consumer Reports' psychotherapy study to MCOs' emphasis on brief therapy; how MCOs impact upon the therapist-patient relationship; the effects of MCOs on the psychotherapist's personal and professional identity; and training psychotherapists in the era of managed care. The paper is dedicated to Pietro Castelnuovo-Tedesco, M.D., Vanderbilt's Blakemore Professor of Psychiatry, who died on January 24, 1998.

Humans↗
PubMed1999

What would make your life better? A needs analysis of leprosy settlements in the middle belt region of Nigeria.

A needs analysis using rural appraisal and matrix ranking techniques was done in six leprosy communities in the middle belt region of Nigeria. Asked 'what would make their life better?' whole village groups were made to list, prioritize and rank their expressed needs by voting in a matrix table drawn on the ground. Out of a total of 504 votes, 31% was for health care or drugs for their general ailments, 23.6% for money and less than 10% for other needs that ranged from water, trade and housing to love and, least, mobility aids. Health care was prioritized in all communities but got the highest votes in three communities, money got the highest in the only two communities where it was prioritized and water in one. The need ranked the highest in each settlement seemed to be a reflection of its peculiar socio-economic situation. Apart from the similar priorities of health care and money, men's differing priorities were water, housing, clothes and assistance with farming, and women's, school fees for children, family, trade and food. These reflect their different traditional roles. Considering the variety of needs we think that there is no one solution to rehabilitation in the Nigerian context, but the situation and context of individual settlements should be considered, looking at general health care, income generation or loans schemes, schooling and water supply.

Adult↗
PubMed1999

Ruth Rose Ashworth-Cleveland: a pioneer's journey as seen through personal letters.

Ruth Rose Ashworth-Cleveland accomplished a great deal during her eighty years of life. It is generally known that she was one of the founders of Cleveland Chiropractic College. However, she was also an accomplished public speaker and active in several chiropractic organizations for much of her adult life. Not much is known of her life after she left Cleveland Chiropractic College in the early 1940s. It is the author's hope in writing this to give the reader a greater awareness of her accomplishments, and of her as a person.

Chiropractic↗
PubMed1998

Dr. Millie Cleveland: chiropractic achiever.

Dr. Mildred Genoa Allison-Cleveland, affectionately known as "Dr. Millie," was an important part of life at Cleveland Chiropractic College for over thirty years, serving first as a clerical assistant, then instructor, administrative assistant, and trusted right hand of her husband, Dr. Carl Cleveland, Jr. Yet Mildred Cleveland, like many other women who have helped the profession grow and survive over the years, has never been the subject of an article in print. In this paper, the author will strive to outline Dr. Mildred Cleveland's accomplishments, as well as to give the reader as clear a picture as possible of the woman who was the wife of one chiropractic pioneer and mother of another.

Chiropractic↗
PubMed1997

c-erbB2 and p53 expression are not associated with stage progression of gastric cancer in Britain or Japan.

The results of surgical treatment for gastric cancer are apparently better in Japan than in Western countries. It has been proposed that this is because of a biological difference between the tumours in Japan and in the West. We have previously reported very similar frequencies of positive immunohistochemical staining for the c-erbB2 oncogene and mutant p53 proteins in British and Japanese gastric cancers, findings which do not seem to support the 'biological difference' hypothesis. We realized that these studies did not rule out differences in the mechanism of cancer progression which might show themselves by a different association between p53 and c-erbB2 expression and stage in the two populations. We therefore re-analysed our data to look for differences in the frequency of p53 and c-erbB2 expression in the British and Japanese populations. Comparison of fixed tissue from 88 British and 89 Japanese tumours showed no significant association of c-erbB2 or p53 with stage progression in either population. Logistic regression showed no difference between the two populations in the relationship between stage and oncogene expression. These results do not support the idea of biologically different cancers in Japan and Britain. Other possible explanations for the difference in results such as the stage migration effect, better efficacy of Japanese-style surgery, or a difference in the host resistance to cancer in the two countries should be considered.

Humans↗
PubMed1997

Psychological responses to BRCA1 mutation testing: preliminary findings.

The short-term psychological responses of 60 adult women tested for a BRCA1 gene mutation associated with a high risk of breast and ovarian cancer were investigated. Participants were members of a large kindred enrolled in an ongoing prospective study of the psychosocial impact of genetic testing. Initial results from participants who completed both the pretest baseline and the 1-2 week posttest follow-up interviews are reported. Gene mutation carriers manifested significantly higher levels of test-related psychological distress, as measured by the Impact of Event Scale, when compared with noncarriers. The highest levels of test-related distress were observed among mutation carriers with no history of cancer or cancer-related surgery. Although general distress (state anxiety) declined after testing, carriers were more distressed than noncarriers at follow-up.

Adolescent↗