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Biomedical subjects

L Johnson

Publications and source records attributed to L Johnson.

At least 109 records · Page 6Linked to original sources
PubMed1999

Rational prescribing: practice audit and drug switch in dyspepsia management.

Growing demands on limited healthcare resources and budgets have led to an increased focus on the costs associated with the purchase of drugs. Consequently, approaches to treatment for various disease states are now dictated not only by issues such as best medical benefits, but also by the cost of the drug that is used. As such, drug-switching strategies have become increasingly common practice where, although the clinical benefits offered by the various medications for a specific condition may be similar, the cost differentials are notable. Application of this switch procedure has recently been assessed in the context of the management of acid-related gastrointestinal disorders and has demonstrated that switching patients to therapy with the proton pump inhibitor lansoprazole from H2-receptor antagonists or other proton pump inhibitors not only offers therapeutic advantages but also has important financial implications in general practice with regard to cost savings.

Cost Savings↗
PubMed1998

Progression of hepatic neoplasms is severely retarded in mice lacking the bisecting N-acetylglucosamine on N-glycans: evidence for a glycoprotein factor that facilitates hepatic tumor progression.

The glycosyltransferase termed GlcNAc-TIII is dedicated to the transfer of a single N-acetylglucosamine (GlcNAc) residue (the bisecting GlcNAc), to a subset of N-glycans in glycoproteins. The addition of this GlcNAc is differentially regulated during development and is induced in certain cancers, particularly in hepatic tumorigenesis. To investigate a functional role for the bisecting GlcNAc in the development of liver cancer, the Mgat3 gene that codes for GlcNAc-TIII, was inactivated by targeted gene disruption, and the susceptibility of Mgat3-/- mice to tumor induction was tested. After a single injection with diethylnitrosamine and subsequent treatment with phenobarbitol for 6 months, Mgat3+/+ and Mgat3+/- mice had grossly enlarged livers that contained numerous tumors. By stark contrast, Mgat3-/- mice had livers of normal size, and only 50% of mice had one to four small tumors. However, histological examination showed that Mgat3-/- livers had significant numbers of basophilic foci, and by 10-12 months after diethylnitrosamine injection, tumors had developed in Mgat3-/- mice. Therefore, initiation occurred in Mgat3-/- mice but progression was severely retarded. Assays for Mgat3 gene expression in tumor tissue gave an unexpected result. In contrast to the situation in the rat, hepatic tumor formation in the mouse was not accompanied by a dramatic increase of GlcNAc-TIII activity nor of glycoproteins with a bisecting GlcNAc, nor of Mgat3 gene expression in tumor tissue from wild-type mice. The data suggest that a glycoprotein factor with the bisecting GlcNAc facilitates tumor progression in liver. In the absence of the bisecting GlcNAc in Mgat3-/- mice, the factor is reduced in activity, and tumor progression is severely retarded.

Acetylglucosamine↗
PubMed1998

High-affinity aptamers selectively inhibit human nonpancreatic secretory phospholipase A2 (hnps-PLA2).

A family of sequence-related 2'-aminopyrimidine, 2'-hydroxylpurine aptamers, developed by oligonucleotide-based combinatorial chemistry, SELEX (systematic evolution of ligand by exponential enrichment) technology, binds human nonpancreatic secretory phospholipase A2 (hnps-PLA2) with nanomolar affinities and inhibits enzymatic activity. Aptamer 15, derived from the family, binds hnps-PLA2 with a Kd equal to 1.7 +/- 0.2 nM and, in a standard chromogenic assay of enzymatic activity, inhibits hnps-PLA2 with an IC50 of 4 nM, at a mole fraction of substrate concentration of 4 x 10(-6) and a calculated Ki of 0.14 nM. Aptamer 15 is selective for hnps-PLA2, having a 25- and 2500-fold lower affinity, respectively, for the unrelated proteins human neutrophil elastase and human IgG. Contractions of guinea pig lung pleural strips induced by hnps-PLA2 are abolished by 0.3 microM aptamer 15, whereas contractions induced by arachidonic acid are not altered. The structure that is essential for binding and inhibition appears to be a 40-base hairpin/loop motif with an asymmetrical internal loop. The affinity and activity of the aptamers demonstrate the ability of the SELEX process to isolate antagonists of nonnucleic-acid-binding proteins from vast oligonucleotide combinatorial libraries.

Amino Acid Sequence↗
PubMed1998

Health care and hospitalizations of young children born to cocaine-using women.

OBJECTIVES: To examine the health care and hospitalizations of young children (birth to age 2 years) born to cocaine-using women and to assess the extent to which premature births account for differences between these children and comparison children. DESIGN: A retrospective cohort design using a repeat-matching method: comparison children were matched to subjects with exposure to cocaine on 6 sociodemographic variables, first, without attention to gestational age and then using the gestational age as additional matching variable. SETTING: City hospitals and primary care clinics. SUBJECTS: Children of women giving birth at a single hospital. MAIN OUTCOME MEASURES: Hospital admission and indexes of health care use for children from birth to age 2 years. RESULTS: Of the 139 subjects with exposure to cocaine, 23% were born prematurely compared with only 6% in the first comparison ( P < .001). At birth, children with exposure to cocaine remained in the hospital longer (P < .01), but this difference was explained by the increased prevalence of prematurity. By age 2 years, these children had significantly fewer visits for health care maintenance (P < .001), were less likely to have completed immunizations (P < .05), and spend more days in the hospital than comparison children. These differences were not related to prematurity, but were explained by differences in sociodemographic characteristics. CONCLUSION: Although prematurity is the major reason for lengthier hospital stays at birth of children with exposure to cocaine, adverse social factors contribute most to inadequate preventive health care and increased stays in the hospital in subsequent years.

Adult↗
PubMed1998

The corn inhibitor of activated Hageman factor: purification and properties of two recombinant forms of the protein.

A cDNA clone that encodes the 14-kDa bifunctional inhibitor from corn seeds (L. Wen et al., Plant Mol. Biol. 18, 813-814, 1992) has been expressed in Escherichia coli after being incorporated into the pT7 expression vector. This inhibitor protein, referred to as CHFI (for the corn inhibitor of activated Hageman factor) or as the popcorn inhibitor, is an important tool for specific inhibition of human activated Hageman factor (activated forms of coagulation Factor XII) and has been well characterized as isolated from corn seeds. Recombinant CHFI was expressed in E. coli in high levels but was insoluble. We solubilized the expressed protein by sonication in 5 M urea and 1% Triton X-100. Several steps of purification, culminating with reversed-phase HPLC, yielded pure, recombinant corn inhibitor in about 5% yield (about 1 mg per liter of culture). The form with which we have worked most, 7N-CHFI, contains 7 amino acid residues at its N-terminus that are encoded by the expression vector. Physical properties of this recombinant protein indicate it has the expected mass and is properly folded. Functionally, 7N-CHFI is indistinguishable from the inhibitor isolated from corn seeds in its inhibition of porcine trypsin, human beta-Factor XIIa, failure to inhibit human plasma kallikrein, and its inhibition of an insect alpha-amylase. A second recombinant form, (4N-11)-CHFI, which lacks 11 residues from the corn inhibitor's N-terminus, is indistinguishable from 7N-CHFI in its pattern of inhibition of the three test proteinases but is inactive against the insect alpha-amylase. This suggests that the N-terminal region of 7N-CHFI forms at least part of the protein's site of interaction with alpha-amylase.

Base Sequence↗
PubMed1998

Effects of dietary 17 beta-estradiol exposure on serum hormone concentrations and testicular parameters in male Crl:CD BR rats.

A 90-day/one-generation reproduction study was conducted in male and female Crl:CD BR rats using dietary levels of 0, 0.05, 2.5, 10, and 50 ppm 17 beta-estradiol. The goals of this study were to set dose levels and evaluate several mechanistic endpoints for inclusion in multigeneration reproduction and combined chronic toxicity/oncogenicity studies with 17 beta-estradiol. In this report we discuss the effects of dietary 17 beta-estradiol exposure on serum hormonal levels and sperm parameters from P1 and F1 male rats. Sperm parameters were also evaluated in recovery P1 and F1 male rats that were fed control diets for 105 and 103 days, respectively, following 97 and 86-94 days of estradiol exposure, respectively. Measurement of Sertoli cell number from F1 male rats was performed to test the hypothesis that in utero exposure to estrogens will decrease Sertoli cell number and sperm production. Other findings from this 90-day/one-generation reproduction study are summarized elsewhere. 17 beta-Estradiol produced a dose-dependent decrease in body weight in P1 male rats at > or = 2.5 ppm and in the F1 male rats at 2.5 ppm. This decrease in body weight was due to a combination or reduced food consumption and food efficiency. In the recovery P1 males, body weight increased in the affected groups, albiet not to control levels, due to food consumption returning to control levels accompanied by an increase in food efficiency. However, in F1 males there was no corresponding rebound in body weight. In the P1 rats, exposure to 17 beta-estradiol decreased testis and epididymis weights in the 10 and 50 ppm groups, while no effects were seen in the P1 2.5 ppm group. In contrast, epididymis weights in the F1 and F1 recovery 2.5 ppm groups were statistically decreased; however, there were no histopathological effects observed. The decreases in testis weights in the P1 generation correlated with histopathologic evidence of interstitial cell atrophy and seminiferous tubule degeneration and reduced sperm production. Correlative changes in the epididymides of P1 rats were characterized by oligospermia or aspermia, the presence of germ cell debris in the lumen of tubules, and atrophy of epididymal tubules. 17 beta-Estradiol decreased testicular spermatid numbers, epididymal sperm numbers, and sperm motility in the P1 males in the 10 and 50 ppm groups, but not in the 2.5 ppm group. Following a 105-day recovery period in the P1 males, all sperm parameters and reproductive organ weights returned to control values except for the epididymal sperm count. Overall, the decline in testicular spermatid and epididymal sperm numbers in the P1 rats correlated with the reduced organ weights and the observed histopathological changes and appeared primarily related to the decrease in serum testosterone levels. In the F1 rats, no significant decreases were noted in the testicular spermatid number but a slight decrease in epididymal sperm number was seen in the 2.5 ppm group, which showed no evidence of recovery. Using morphometric analysis, no change was seen in the number of Sertoli cell nuclei per testis in F1 males. The pattern of hormonal responses seen in this study was characteristic of an estrogen receptor agonist such as 17 beta-estradiol: increased serum prolactin and decreased testosterone, luteinizing hormone, and follicle stimulating hormone levels. The data demonstrate that in utero and postnatal dietary administration of 17 beta-estradiol at levels which increased serum estradiol levels to approximately 400% of control and decreased testosterone levels to 33% of control did not reduce the number of Sertoli cell nuclei per testis.

Animals↗
PubMed1998

Bacteriology of preserved stallion semen and antibiotics in semen extenders.

Three experiments were conducted to evaluate the effects of different antibiotics in a milk-glucose semen extender on motility of equine sperm and elimination of bacteria following storage of extended semen in vitro. In Experiment 1, 7 antibiotics were compared: amikacin, gentamicin, streptomycin, potassium penicillin, sodium penicillin, ticarcillin, and polymixin B. In Experiment 2, 3 antibiotic treatments were compared: potassium penicillin G, amikacin, or a combination of potassium penicillin G and amikacin. In Experiment 3, 3 antibiotic treatments were compared: potassium penicillin G-amikacin, ceptiofur, and a combination of ticarcillin and clavulanic acid (Timentin). Control treatments (antibiotic-free extender) were included in each experiment. Six motility variables were evaluated: percentage of motile sperm; percentage of progressively-motile sperm; percentage of rapidly-motile sperm; mean curvilinear velocity; mean average path velocity; and mean straight-line velocity. In Experiment 1, mean percentages of motile, progressively motile and rapidly motile sperm were lower (P < 0.05) in semen exposed to polymixin B then in other treatments. Mean average-path velocity of sperm in extender containing polymixin B was lower (P < 0.05) than that of all other treatments, with exception of control or ticarcillin. Mean straight-line velocity of sperm in extender containing polymixin B was lower (P < 0.05) than that of all other treatments, with exception of control, streptomycin or ticarcillin. Semen samples containing gentamicin, amikacin, streptomycin, or potassium penicillin were more effective (P < 0.05) at eliminating bacterial growth than those samples containing polymixin B. Semen samples containing gentamicin were also more effective (P < 0.05) at eliminating bacterial growth than those samples containing ticarcillin or sodium penicillin. In Experiment 2, mean percentage of rapidly-motile sperm, and mean curvilinear, average-path, and straight-line velocities were greater (P < 0.05) for potassium penicillin-amikacin than values for all other treatments. In 2 of 3 stallions, an effect of treatment on percentage of motile sperm was detected (P < 0.05). For one stallion, mean motility of potassium penicillin-amikacin was greater (P < 0.05) than that of all other treatment groups. For another stallion, mean motility of the control was lower (P < 0.05) than that of the other treatments. Following storage, potassium penicillin (16/18 [89%]) or potassium penicillin-amikacin (17/19 [94%]) were more effective (P < 0.05) at controlling aerobic and anaerobic bacterial isolates in semen specimens than was amikacin (10/18 [56%]). In Experiment 3, a difference among treatment groups for motility variables was not detected (P < 0.05). No bacterial growth was recovered in antibiotic-treated semen, with exception of Micrococcus sp. (2 colonies) which were isolated from one semen specimen treated with ceptiofur.

Amikacin↗
PubMed1998

The phage lambda terminase enzyme: 2. Refolding of the gpNu1 subunit from the detergent-denatured and guanidinium hydrochloride-denatured state yields different oligomerization states and altered protein stabilities.

The terminase enzyme from bacteriophage lambda is responsible for packaging a single genome within the viral capsid. Gold and co-workers have developed a scheme for the solubilization of the small terminase subunit (gpNu1) from inclusion bodies using the strong detergent sarkosyl and purification of the protein to homogeneity (gpNu1SRK) (Parris et al., J Biol Chem 1994;269:13564-13574). We have developed a similar purification scheme except that guanidinium hydrochloride was used to denature the insoluble protein (gpNu1GDN). The circular dichroism (CD) spectra of both protein preparations suggest that they are predominantly alpha-helical when purified and stored in Tris buffers. Moreover, thermal denaturation of the proteins thus purified yielded similar thermodynamic parameters for unfolding (T(m), delta Hm and delta Sm of unfolding of approximately 306 K, approximately 22 kcal/mol and approximately 70 cal/mol.K, respectively). Interestingly, however, when the proteins were purified and stored in imidazole buffers, the gpNu1SRK preparation lost a significant amount of secondary structure and was more stable to both thermally-induced and guanidinium HCl-induced denaturation than was gpNu1GDN. The purified gpNu1 monomers oligomerize into apparent tetramers and hexamers in solution and the distribution between these two oligomeric states and into higher order aggregates depends upon buffer composition, salt concentration and protein concentration. Moreover, differences in the oligomerization state of gpNu1SRK and gpNu1GDN under identical buffer conditions were observed. The significance of these results with respect to the biological role of the phage lambda gpNu1 protein are discussed.

Bacteriophage lambda↗
PubMed1998

Physiologic concentrations of zinc affect the kinetics of copper uptake and transport in the human intestinal cell model, Caco-2.

Copper uptake was enhanced and copper transport was reduced in Caco-2 cells cultured in media containing high concentrations of zinc. Here we show that physiologic zinc concentrations also affect copper movement into and out of Caco-2 cells. Cells were seeded onto Falcon membranes with high pore density and maintained in Dulbecco's modified Eagle's medium supplemented with 10% fetal bovine serum, nonessential amino acids, glucose and glutamine. In one experiment, the cells were exposed to media containing either 5 or 25 micromol zinc/L from d 14 to 21 after seeding. Then, copper uptake and transport, in both apical and basolateral directions, were measured by using 64Cu. Cells exposed to 25 micromol zinc/L had a 25% higher (P < 0.05) uptake of 64Cu from the apical side than those exposed to 5 micromol zinc/L. There was no effect of zinc on 64Cu uptake from the basolateral side, even though the amount of label taken up was as much as threefold higher (P > 0.05) than from the apical side. Transport of 64Cu across the cell layer in both directions was 50% less (P < 0.05) in cells exposed to 25 micromol zinc/L vs. 5 micromol zinc/L. In another experiment, zinc-exposed cells were labeled with 64Cu and efflux of the label to the apical and basolateral sides was measured over time. The rate of efflux to the apical side was linear and not affected by zinc. However, there was a 37% reduction (P < 0.05) in 64Cu efflux to the basolateral side by the higher zinc concentration. Curve-fit analysis showed that the basolateral efflux was made up of an exponential and a linear component. Cellular zinc concentrations were proportional to the zinc concentrations in the media. Although the data suggest that high media zinc inhibited the copper efflux transporter and enhanced the influx transporter, copper did not accumulate in the cell.

Biological Transport↗
PubMed1998

Expression and possible role of muscle-type carnitine palmitoyltransferase I during sperm development in the rat.

Because we had found whole testis from adult rats to be much richer in the messenger RNA for the muscle (M) than for the liver (L) form of mitochondrial carnitine palmitoyltransferase I (CPT I), we sought to determine which cell type(s) accounts for this expression pattern and how it might relate to reproductive function. Studies with immature (14-day-old) and adult animals included 1) Northern blot analysis of testis mRNA; 2) in situ hybridization with slices of testis; 3) enzyme assays for CPT I, CPT II, and carnitine acetyltransferase (CAT) in testicular germ cells and nongerm cells, together with measurement of the malonyl-coenzyme A (CoA) sensitivity and affinity for carnitine of CPT I; 4) labeling of testicular CPT I with [3H]etomoxir, a covalent inhibitor of the enzyme; and 5) the response of testicular and nontesticular CPT I to dietary etomoxir. The data established the following: 1) L-CPT I was the sole isoform detected in immature testis. 2) Expression of the M-CPT I gene was associated only with meiotic and postmeiotic germ cells. 3) Adult testis contains a mixture of the L- and M-CPT I enzymes, the L and M form dominating in extratubular cells and spermatids, respectively. Mature epididymal spermatozoa appear to be devoid of CPT I activity while possessing abundant levels of CPT II and CAT. 4) Five days of dietary etomoxir treatment at a dose that resulted in essentially complete inhibition of CPT I in liver, heart, skeletal muscle, and kidney was totally without effect on either the L- or M-type enzyme in the testis of mature rats. The data point to an important role for transient expression of M-CPT I, coupled with sustained activity of CAT, in the maturation and/or function of rat sperm. They also suggest that, at least in the case of one CPT I inhibitor (etomoxir), the testis is unusually resistant to the agent when given orally.

Animals↗
PubMed1998

What students say about learning and teaching in longitudinal ambulatory primary care clerkships: a multi-institutional study.

PURPOSE: Ambulatory primary care clerkships have become crucial elements in medical education. Although most such clerkships employ a block-rotation format, an alternative longitudinal approach has been developed. This study examines students' perceptions of learning and instruction occurring during longitudinal ambulatory clerkships. METHOD: Characteristics of longitudinal ambulatory primary care clerkships at five medical schools are described. Responses of 429 medical students to a standardized survey administered at these institutions are analyzed to ascertain perceptions of learning and teaching occurring during longitudinal ambulatory clerkship experiences. RESULTS: Enhancements of interpersonal communication and clinical skills were perceived to be the most positive learning attributes of the longitudinal ambulatory clerkships. No advantage was discerned with respect to disease-pattern recognition or generation of differential diagnoses. While significant inter-institutional variation was present, particularly with respect to instructional format, there was notable agreement regarding several aspects of clerkship-related learning and the adequacy of faculty supervision. CONCLUSION: Students perceived that learning during longitudinal ambulatory clerkships had greater impact on skill enhancement than on attainment of knowledge-related objectives. Sources of variation in student opinion, perceptions of learning as a function of career preference, and correlation of students' perceptions of learning to demonstrable changes in their competence require further investigation.

Ambulatory Care↗
PubMed1998

Minorities in medical school and National Medical Fellowships, Inc.: 50 years and counting.

For more than 50 years, National Medical Fellowships, Inc. (NMF) has been the only private national organization dedicated exclusively to increasing the numbers of minorities in medicine. In the 1920s, Franklin C. McLean, an eminent physician in Chicago, began working to include Negro physicians in high-ranked hospital residencies. In 1946 he and his colleagues founded Provident Medical Associates (PMA), which would later become National Medical Fellowships, Inc. During the late 1940s and 1950s, the challenge was to break down the barriers that prevented Negro physicians from training. In the 1950s, the NMF made steady progress in increasing the number of black physicians, but it was in the 1960s that the barriers to blacks in medical training began to fall and their numbers increased dramatically. In the 1970s the NMF expanded its focus to include all minorities underrepresented in medicine, and through its programs and the broad social changes in U.S. society, unprecedented proportions of blacks, Hispanics, and Native Americans entered medical training. In the 1980s the commitment to bring minority physicians into medicine deepened and broadened, yet in the late 1990s the progress of past decades is jeopardized by legal and administrative restrictions. Now, when the numbers of underrepresented minorities are declining, the need to maintain and expand programs such as those of the NMF is more urgent than ever.

Black or African American↗
PubMed1998

Central and regional hemodynamics during crystalloid fluid therapy after uncontrolled intra-abdominal bleeding.

OBJECTIVE: To study the effect of graded crystalloid fluid resuscitation on central hemodynamics and outcome after intra-abdominal hemorrhage. METHODS: Ten minutes after a 5-mm long laceration was produced in the infrarenal aorta, 32 pigs were randomized to receive either no fluid or Ringer's solution in the proportion 1:1, 2:1, or 3:1 to the expected amount of blood lost per hour (26 mL kg[-1]) over 2 hours. The hemodynamics were studied using arterial and pulmonary artery catheters and four blood flow probes placed over major blood vessels. RESULTS: During the first 40 minutes after the injury, the respective blood flow rates in the distal aorta were 39% (no fluid), 41% (1:1), 56% (2:1), and 56% (3:1) of the baseline flow. Fluid resuscitation increased cardiac output but had no effect on arterial pressure, oxygen consumption, pH, or base excess. Rebleeding occurred only with the 2:1 and 3:1 fluid programs. Survival was highest with the 1:1 and 2:1 programs. CONCLUSIONS: Crystalloid fluid therapy improved the hemodynamic status but increased the risk of rebleeding. Therefore, a moderate fluid program offered the best chance of survival.

Animals↗
PubMed1998

Contact lens base curve prediction from videokeratography.

PURPOSE: To assess whether the contact lens to cornea-bearing relationship, as determined from the fluorescein pattern, can be predicted from videokeratography. METHODS: Nineteen non-rigid gas permeable (RGP) lens wearers were each tested for fluorescein patterns with a series of seven RGP contact lenses of different base curves, and compared to a theoretical estimate of the fitting relationship from videokeratography. The experimentally determined alignment lens was then compared to the theoretical alignment (TA) value as determined from the central curvature and eccentricity. RESULTS: The mean difference in lens choice between the TA and experimental alignment (EA) values was -0.01 +/- 0.04 mm and between the simulated keratometric (KA) readings and the EA choice was 0.11 +/- 0.05 mm. CONCLUSION: A knowledge of the eccentricity value from videokeratography allowed a better prediction of the base curve to cornea relationship than was provided by only a central corneal measurement.

Adult↗
PubMed1998

Severe sepsis in the emergency department and its association with a complicated clinical course.

OBJECTIVE: Infection severity as determined by clinical criteria has been recently classified and studied in hospitalized inpatients. The objective of the study was to use modified criteria to determine the clinical course associated with three levels of infection severity in infected patients admitted from the ED. METHODS: This was a retrospective cohort study involving all patients 18 years of age and older admitted through the ED of an urban teaching hospital during a four-month period whose primary reason for requiring hospitalization was an infection that was recognized in the ED. ED records were reviewed for criteria used to classify patients by three levels of infection severity: no systemic inflammatory response syndrome, sepsis, and severe sepsis (SS). The relationships between these classifications as well as certain clinical characteristics and any complicated clinical course as measured by death and/or admission to an intensive care unit (ICU), and/or prolonged hospitalization, were analyzed. RESULTS: Of 408 patients entered into the study, 138 (33.8%) fulfilled the criteria of SS in the ED. Patients with SS in the ED had a mortality of only 4.3%, though with an increased risk of dying compared with that of the other groups combined [relative risk (RR) = 11.64, 95% confidence interval (CI) = 1.43 to 96.53], an increased risk of ICU stay (RR = 7.65, 95% CI = 4.08 to 14.36), and an increased risk of prolonged hospitalization (RR = 1.99, 95% CI = 1.38 to 2.88). Although age over 60 years and several comorbid conditions also were identified by univariate analysis as risk factors, multivariate analysis revealed that only SS and diabetes mellitus (DM) were independent predictors of a complicated course. In the authors' institution, the positive predictive value (PPV) of SS for complicated clinical course was 0.48 and the negative predictive value (NPV) of no SS for no complicated course was 0.77. The PPV of [SS + DM] was 0.83, and the NPV of [SS, DM, or both] was also 0.83. CONCLUSION: Although the strongest correlate of a complicated clinical course identified in the ED is SS as defined by the study criteria, its specificity and PPV are low. The mortality of ED patients with SS is much lower than the mortality rates reported for inpatients with SS. SS as defined by the study criteria is too sensitive and therefore lacks utility in the ED setting.

Adult↗