Biomedical subjects
Publications and source records attributed to J Tobin.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The fasting plasma growth hormone (GH) concentration and the plasma growth hormone response to sustained hyperglycemia was examined in 8 chronically uremic subjects before and after hemodialysis employing the hyperglycemia clamp technique. The plasma glucose concentration was acutely raised and maintained at +125 mg/100 ml above basal levels. Since the glucose concentration was held constant, the glucose infusion rate is an index of glucose metabolism (M) and M divided by the plasma insulin response (I) is a measure of tissue sensitivity to insulin. Predialysis, the fasting GH concentration, 4.0 +/- 1.0 ng/ml, was significantly greater than controls, 0.3 +/- 0.1 ng/ml (p less than 0.01), and failed to suppress normally following sustained hyperglycemia. Both M, 4.23 +/- 0.36 mg/kg x min, and M/I, 5.05 +/- 0.79 mg/kg x min per microU/ml, were significantly reduced compared to controls (p less than 0.001). There was no correlation between either the fasting GH concentration or the GH response to sustained hyperglycemia and either M or M/I. Following dialysis both M, 6.30 +/- 0.64 mg/kg x min, and M/I, 8.39 +/- 1.06 mg/kg x min per microU/ml, increased (p less than 0.01) without significant change in either the fasting GH level, 4.0 +/- 1.2 ng/ml, or the plasma GH response to hyperglycemia. It is concluded that while deranged GH physiology is a common accompaniment of the uremic state, it is not responsible for the glucose intolerance and tissue insensitivity to insulin observed in uremia.
Osteoarthritis is the most ubiquitous rheumatic disease worldwide. Although its prevalence in various populations has been well documented, few studies have evaluated the longitudinal radiographic progression of the disease, especially as it is expressed in the interphalangeal joints of the hand. In this longitudinal study, left hand-wrist X-rays of 386 white male participants of the Baltimore Longitudinal Study of Aging followed for at least 5 years with two or more visits were examined for prevalence and progression of osteoarthritis of the distal and proximal interphalangeal joints of the hand. As other studies have shown, we found that the prevalence of osteoarthritis in both distal and proximal interphalangeal joints becomes progressively higher as the age of the subjects increases. Using the life table method of analysis we studied the progression of osteoarthritis as defined by the following criteria: (1) an increase in the severity of radiographic changes of the joints previously affected and (2) an increase in the number of new joints affected. The results indicated that osteoarthritis in both the distal and proximal interphalangeal joints progresses at a faster rate in the older population than in individuals less than 60 years of age. Furthermore, osteoarthritis in the interphalangeal joints progresses at the same rate whether the starting point was a Kellgren grade of 0 (no disease) or 1 (doubtful). We therefore conclude that grade 1 is an intermediate step in the inexorable progression of osteoarthritis of the interphalangeal joints and not synonymous with grade 0, as it has been customarily interpreted.
This reflection on the essay by Rothbaum, Pott, Azuma, Miyake, and Weisz focuses on how knowledge about Japanese psychological development and culture can serve as a corrective to the ethnocentrism of Western theory. Particular attention is given to the Japanese cultural concepts of amae and kejime.
BACKGROUND: Nevirapine, a nonnucleoside analogue, has demonstrated suppression of human immunodeficiency virus (HIV) replication alone and in combination therapy. However, the durable suppression of HIV with nevirapine when used along with other nucleosides in HIV-infected patients who are treated in clinical practice needs further evaluation. PURPOSE: To evaluate the sustained efficacy of nevirapine in combination with two nucleoside analogues in the treatment of HIV-infected patients in routine clinical practice. DESIGN: A multicenter study from January 1997 to December 2000, with follow-up through 48 weeks, was conducted at four different genitourinary medicine clinics in the United Kingdom. Forty-four HIV-infected patients received nevirapine and two nucleoside analogues. Information from case notes regarding age, sex, side effects, viral load, and CD4 lymphocyte counts at baseline, 24 weeks, and 48 weeks was collected and analyzed. Virologic suppression, defined as HIV RNA concentration of less than 400 copies/mL at Weeks 24 and 48, was considered as the main outcome measure. RESULTS: Out of 44 patients, 41 were men with a mean age of 39.3 years (95% CI 36.7-41.8). The baseline viral load was 2.11 x 10(2) to 9.74 x 10(5) copies/mL (median 7.7 x 10(4) and CD4 counts 6 to 605 cells/dL (M = 247; 95% CI 198-295). Of 39 patients who completed 48 weeks of treatment, viral load suppression was attained in 31 patients (79.4%; 95% CI 66.8-92.0) at 24 weeks and in 27 patients (69.2%; 95% CI 54-83) at 48 weeks. The CD4 lymphocyte count increased in 32 (82%) patients (mean 106 cells/dL, 95% CI 73-139, p =.0001, Wilcoxon signed rank test) after 24 weeks and in 33 (84.6%) patients (mean 160 cells/dL, 95% CI 115-204, p =.0001, Wilcoxon signed rank test) after 48 weeks of treatment. Of 20 patients whose baseline viral load was <100000, 16 had viral load suppressed at 24 weeks and 15 at 48 weeks (p =.6, chi-square test). CONCLUSION: A regime of nevirapine with two nucleoside analogues provided durable suppression of plasma viral load in HIV infected patients, with significant improvement in the CD4 cell count.
Using the steps from the first approach, the costing of clinical pathways is useful to both the clinical and administrative teams. With knowledge of pathway cost, clinicians can plan cost-effective changes in the pathway or consider cost factors when deliberating on different approaches to care. Using the patient classification system to unbundle the nursing component and using the number of nursing hours per day of care provides an opportunity to describe the intensity of the pathway in its entirety, and by each day of care. One is provided with an opportunity to learn from the cost variances by reviewing the standardized costs for the pathway, and the actual cost of care of patients on the pathway provides an opportunity to learn from the cost variances. This learning, coupled with the clinical variance analysis, can suggest new opportunities for improving care and potential cost savings. Lastly, the cost associated with a pathway is useful knowledge in negotiating managed care contracts.$
The purpose of this investigation was to examine cells in the stratum basale and subjacent lamina propria of oral hairy leukoplakia (OHL) specimens for previously unreported morphological changes. Tongue biopsy specimens were obtained from ten HIV-positive and five healthy male patients and examined by light (LM) and transmission electron microscopy (TEM). Observations made during the investigation revealed the following: (1) LM comparisons of control and OHL specimens indicated that clear cells in the stratum basale ranged from 3 to 7 per 100 basal epithelial cells in healthy tongue mucosa vs. 6 to 15 in OHL. (2) Merkel-like cells were noted in the stratum basale of control biopsies from the dorsal-lateral tongue surface. However, the frequency of observation was so rare as to imply that their presence was an exception rather than the norm. (3) In contrast, Merkel-like cells in OHL specimens were commonly encountered, indicating a possible unique relationship to the pathology. (4) Merkel-like cells associated with OHL lesions were morphologically similar, in all respects, to that of control specimens except for the presence of large, membrane bound, dense granules that ranged in size from 150-300 nm. (5) All biopsies of OHL exhibited evidence of Epstein Barr virus in the stratum corneum and superficial layers of the stratum spinosum. (6) A mild inflammatory infiltrate associated with OHL specimens revealed cytopathic changes in fibroblasts that appeared related to the presence of lymphoid cell types; indicating a possible cytolytic lymphocyte-mediated degradation of antigen altered host cells.