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Biomedical subjects

L Cowan

Publications and source records attributed to L Cowan.

At least 19 recordsLinked to original sources
PubMed2004

Identification of a familial cluster of pulmonary Mycobacterium bovis disease.

SETTING: Local public health department. DESIGN: Retrospective review of a cluster of three pulmonary Mycobacterium bovis cases occurring in a family, with genotyping of M. bovis strains isolated from the family members. RESULTS: The genotypes of the M. bovis isolates were identical, as determined by three different methods: IS6110 restriction fragment length polymorphism, spoligoytping and mycobacterial interspersed repetitive units-variable number tandem repeat analyses. CONCLUSION: The identification of three acid-fast bacilli (AFB) smear-positive pulmonary M. bovis cases, presenting in a single family and caused by an identical strain, suggests that person-to-person transmission of this organism may have occurred, although infection of one or more family members through ingestion of a contaminated dairy product could not be excluded.

Adult↗
PubMed2002

A review of the literature relating caffeine consumption by women to their risk of reproductive hazards.

From this detailed review of the literature, several conclusions can be drawn: (a) An association between caffeine consumption and a reproductive hazard is more likely to be seen in lower-quality studies than in studies that come closer to approximating the ideal. This is especially evident for "lower" birthweight and congenital anomalies. (b) The association between caffeine consumption and spontaneous abortion may well reflect the Stein-Susser epiphenomenon (women with prominent nausea tend to reduce caffeine consumption and nausea appears to be a marker of good implantation, perhaps reflecting a favorable balance of hormones produced by a healthy placenta). (c) The claim that caffeine consumption by women delays conception has not been followed by convincing support. (d) Reproductive hazards associated with cigarette smoking tend to be associated with caffeine/coffee consumption. Sometimes this appears to be a consequence of residual confounding associated with inadequate adjustment for cigarette smoking, which is over-represented among those who drink the most coffee/caffeine. Sometimes this reflects the tendency of women to underreport socially undesirable behaviors (e.g. smoking) while accurately reporting socially neutral behaviors (e.g. coffee and caffeine consumption). Thus, it seems reasonable to conclude that no convincing evidence has been presented to show that caffeine consumption increases the risk of any reproductive adversity.

Abnormalities, Drug-Induced↗
PubMed2000

Mortality among males with hemophilia: relations with source of medical care. The Hemophilia Surveillance System Project Investigators.

Although persons with hemophilia are known to be at increased risk of death, no studies have examined the source of medical care and other personal characteristics for associations with mortality. To determine death rates and to identify causes of death and predictors of mortality, we studied a cohort comprised of all hemophilic males identified by a six-state surveillance system. Data were obtained by medical record review of contacts with physicians, hemophilia treatment centers (HTCs), and other sources of care during 1993-1995 and from death certificates. Factors examined included age, race, state of residence, health insurance type, medical care source, hemophilia type/severity, presence of inhibitor, liver disease, HIV infection, and AIDS. A total of 2950 subjects were followed for an average of 2.6 years. Their median age was 22 years; 73% were white, 79% had hemophilia A, 42% had severe disease, and 67% had visited an HTC. During 7575 person years (PYs) of observation, 236 persons died-an age-adjusted mortality rate of 40.4 deaths/1000 PYs; 65% of deaths were HIV related. In addition to age, factors independently associated with increased risk of death (relative risk, P value) were the following: AIDS (33.5, <.001); HIV infection (4.7, <.001); liver disease (2.4, <.001); and Medicare/Medicaid insurance (1.4,. 01). Those persons who had received care in an HTC had a significantly decreased risk of death (0.6,.002). Although HIV infection and the presence of severe liver disease remain strong predictors of mortality, survival is significantly greater among hemophilics who receive medical care in HTCs. (Blood. 2000;96:437-442)

Acquired Immunodeficiency Syndrome↗
PubMed1996

Major electrocardiographic abnormalities among American Indians aged 45 to 74 years (the Strong Heart Study).

As part of the Strong Heart Study assessment of prevalent cardiovascular disease in middle-aged to elderly American Indians, the prevalence of major Minnesota code electrocardiographic (ECG) abnormalities was assessed in 4,531 participants aged 45 to 74 years (59% women) in selected tribal communities in Arizona, South and North Dakota, and Oklahoma. The overall prevalence of major ECG abnormalities was lowest in Arizona participants, (e.g., definite ECG myocardial infarction in 0.3% vs 1.8% in the other centers), although nearly two thirds of them had diabetes. One or more major ECG abnormality occurred in progressively more women (10.4% to 21.2%) and men (13.3% to 32%) (both p < 0.0001) from 45- to 54- to 55- to 64- and 65- to 74-year age groups, with the latter prevalence rates exceeding those in predominately white age peers in the Cardiovascular Health Study. Diabetes in women, but not in men, and hypertension in both genders showed positive associations with prevalence rates of major ECG abnormalities compatible with coronary artery disease or hypertensive cardiac hypertrophy. Hypercholesterolemia was not associated with ECG abnormalities except for definite myocardial infarction in women. In conclusion, major ECG abnormalities are common in middle-aged to elderly American Indians ,consistent with recent documentation of higher cardiovascular mortality in this population than in similar aged U.S. whites.

Adult↗
PubMed1996

Neurodevelopment, growth, and viral load in HIV-infected infants.

The relation of HIV-1 infection to infant growth and neurodevelopment was studied prospectively in a cohort of 65 infants born to women at risk for HIV infection. No differences were observed at birth between infected infants (INF) and uninfected infants (SR) of HIV-infected women, and infants of uninfected women (SN) with similar socioeconomic background and exposure to drugs. However, postnatal linear growth and cognitive-motor development of INF infants were impaired when compared to SR and SN infants. Declines in linear growth were observed within the first 6 months of life, whereas delays in neurodevelopment were first appreciated at 12 months. In INF infants, decreased linear growth was positively correlated with developmental delay. Moreover, growth and development were both correlated with HIV viral load. INF infants with high plasma HIV RNA copies (> 5 x 10(5)/ ml) at 6 months of life were more likely to exhibit severe growth and developmental delay than infants with a lower viral burden. The implications of these findings with respect to the mechanism of action of HIV-related growth and neurodevelopmental impairments are discussed.

Body Height↗
PubMed1996

The hypo-osmotic swelling test for selection of viable sperm for intracytoplasmic sperm injection in men with complete asthenozoospermia.

OBJECTIVE: To determine the ability of the hypo-osmotic swelling test to select viable sperm from nonmotile sperm samples for intracytoplasmic sperm injection (ICSI). DESIGN: Nonrandomized, sequential comparative study. PATIENTS: Thirteen couples enrolled in our ICSI program had 16 cycles in which sperm preparations with 0% motility were obtained. Five cycles used cryopreserved epididymal sperm with complete asthenozoospermia. INTERVENTIONS: In eight cycles, the semen samples were washed through a Percoll gradient and sperm were selected randomly for ICSI. In another eight cycles, the washed sperm were placed in a hypo-osmotic solution (75 mM fructose; 25 mM sodium citrate dihydrate) and the sperm with curled tails taken up with the microinjection needle, rinsed, and used ICSI. MAIN OUTCOME MEASURES: Fertilization rate per oocyte injected as determined by the presence of two pronuclei at 18 hours after retrieval and embryo cleavage rate per oocyte injected at 48 hours after retrieval. RESULTS: With random sperm injection, the fertilization and cleavage rates were 26% and 23%, respectively. In contrast, after injection of sperm selected using the hypo-osmotic swelling test, fertilization and cleavage rates were significantly greater (43% and 39%, respectively). There were three pregnancies in the eight cycles with the hypo-osmotic swelling test-selected sperm, including two from frozen epididymal sperm. CONCLUSION: Based on these preliminary observations, we believe that the hypo-osmotic swelling test will prove to be valuable for increasing fertilization and cleavage rates and pregnancy rates in ICSI cycles where no motile sperm are recovered.

Adult↗
PubMed1996

Theatre in AIDS education--a controlled study.

Theatre is now widely used in HIV and AIDS education for young people. However, research concerning its effectiveness has largely been conducted without using comparison or control groups and there is little evidence that other types of intervention are more or less effective. The present study was designed to measure the effects of a theatre production on HIV knowledge, attitudes and risk behaviour of young people compared with that of a standard health education seminar which used group work techniques. Both interventions were designed for young people between the ages of 12 and 18 and held in 10 youth projects in socially deprived areas of Glasgow. Five youth projects were randomly assigned to each intervention. All participants were asked to complete a self-administered HIV knowledge, attitude and behavioural questionnaire immediately before and after the event and 2 months later. Research focus groups were also used. A total of 35 young people attending the standard seminars completed three self-administered questionnaires, and 18 participated in all three focus groups. Forty-two young people attending the theatre performances completed three self-administered questionnaires and 16 participated in all three focus groups. There was little impact on the knowledge and attitudes of either audience, although there was some evidence of attitudinal change among those exposed to the health education discussion session. More of the theatre group reported a behavioural change 2 months after attending the play but only in relation to buying and carrying condoms. It is uncertain whether this led to safer sex practices. This study does not support the view that theatre in AIDS education has a significant impact on HIV knowledge, attitudes and risk behaviour.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Hypoplasia of the corpus callosum: a study of 445 consecutive MRI scans.

The size of the corpus callosum was assessed visually and by computer-assisted image analysis in a series of 445 consecutive magnetic resonance imaging (MRI) scans in children under 17 years of age. Fifty individuals were subjectively identified with small corpora callosa on visual inspection of the MRI scans. Seven patients had true hypoplasia of the corpus callosum after comparing the computer-measured relative size of the structure to previously established normal values. Five additional patients had complete agenesis, and two had partial agenesis of the corpus callosum. The cognitive functional levels of the seven patients with callosal hypoplasia and a control group of 63 randomly selected individuals from the remainder of the group were ascertained by record review. Seventy-one percent of the patients with hypoplasia of the corpus callosum and 29% of the control group had impaired function. The P value determined by Fisher's exact test was P = .061, suggesting that further study with greater numbers may be warranted. The prevalence of mental retardation in this condition, and the fact that hypoplasia is as common as complete and partial agenesis of the corpus callosum combined, suggest that hypoplasia of the corpus callosum is a marker of cerebral dysgenesis that should be looked for in the appropriate clinical setting.

Agenesis of Corpus Callosum↗
PubMed1994

Detecting domestic violence against women in the emergency department: a nursing triage model.

Objective To determine the disclosure rate for abuse in the setting of an emergency department. Design Cross-sectional survey of women assessed for triage in the emergency department of a tertiary care hospital. Methods Nursing triage was used to determine disclosure rates for abuse. Triage nurses routinely ask all women about abuse in their lives. During the study period (October 5 through 11, 1993) triage nurses were asked to record the answers to enquiries about abuse. In addition, triage nurses were asked to document the reasons why for some patients questions about abuse were not asked. Results Two hundred fifty-two women seen in the emergency department were questioned about abuse. Six percent of the women questioned in the study disclosed abuse. Triage for abuse was not done for 86 women because of the acuity of patient's condition, language barrier, presence of relatives, discomfort on the part of the nurse in asking the question, or the nurse being too busy. Conclusion A brief nursing triage question appears to be an efficient way of detecting abuse among women seen in the emergency department.

Adult↗
PubMed1994

Altered cortisol response and hippocampal atrophy in pediatric HIV disease.

The hippocampus is a major center for the regulation of the hypothalamic-pituitary-adrenal axis. There is experimental evidence that chronic exposure to high levels of glucocorticoids may be toxic to the hippocampus. We observed elevated mean basal and 60-min cortisol (F) levels in response to adrenocorticotropin stimulation (0.25 mg cortrosyn, i.v. bolus infusion) in 15 children with HIV infection. Furthermore, in eight of the children for whom data was available, in addition to high peripheral cortisol levels, neurologic dysfunction and hippocampal atrophy were noted on CT scan. These preliminary data suggest that in HIV-infected children an altered cortisol secretion may be associated with specific central nervous system damage.

Adolescent↗
PubMed1993

Prolonged parenteral meperidine analgesia during pregnancy for pain from an abdominal wall mesh graft.

BACKGROUND: Although successful pregnancy has been reported in women with prosthetic mesh abdominal wall grafts, the complication of severe pain in pregnancy from shearing of the graft has not been described. We report an unusual case of severe pain in pregnancy caused by abdominal wall stretching by the enlarging uterus. Pain was controlled with long-term intravenous meperidine analgesia. CASE: A 21-year-old multigravida with a previously placed mesh graft for multiple abdominal wall hernias presented at 30 weeks' gestation with severe abdominal pain. Meperidine patient-controlled analgesia at a mean dose of 14.2 mg/kg/day controlled the symptoms, allowing pregnancy prolongation for 28 days before induction of labor at 34 weeks when fetal lung maturity was confirmed. CONCLUSION: This is the first reported case of the use of high-dose patient-controlled parenteral narcotic analgesia in a woman whose abdominal wall mesh graft partially sheared from its attachments. The patient went on to have a successful vaginal delivery.

Abdominal Muscles↗
PubMed1987

Automated quantitative fluorescent image analysis of cervical cytology.

Cervical cytology from 122 patients with histories of one or more abnormal Pap smears were studied using slide-based automated quantitative fluorescence image analysis (QFIA) in order to determine the usefulness of the QFIA technique in detecting neoplasias. The purpose of the study was to evaluate the accuracy and validity of QFIA as a cytological method for the early detection of cervical cancer, based on comparisons with the conventional Pap smear and histopathology. The results of the analysis demonstrated that the sensitivity of the automated QFIA cytology was 100% for high-grade neoplasms (CIN III and invasive carcinoma), compared with 82% for the Pap smear. Evaluation of lower grade neoplasms was also performed. Initial analyses of the data indicate that QFIA, which uses objective biochemical criteria to identify cells with increased nuclear nucleic acid content, is a more sensitive detector of cervical neoplasia of all grades than is conventional Pap cytology.

Acridine Orange↗