Biomedical subjects
M Boland
Publications and source records attributed to M Boland.
What do people expect from their doctors?
Surprisingly few people seem to worry about the technical competence of doctors. What they worry about is their doctor's ability to understand the patient as a person and provide the right guidance. Financial, legal or managerial techniques seem powerless to ensure that this demand is met. The solution should be sought within the medical profession itself.
Pediatric HIV infection in Elista, Russia: interventional strategies.
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Older children and adolescents living with perinatally acquired human immunodeficiency virus infection.
OBJECTIVE: To describe the clinical, immunologic, and psychosocial characteristics of children living with perinatally-acquired human immunodeficiency virus (HIV) infection beyond the age of 9 years. METHODS: This is a descriptive cohort study of 42 surviving perinatally infected children older than 9 years followed at the Children's Hospital Acquired Immunodeficiency Syndrome (AIDS) Program (part of a university-based inner city medical center) as of June 1993. The study is based on medical record data of clinical, immunologic, and psychosocial parameters. RESULTS: The cohort includes 20 boys and 22 girls with a mean age of 136 months. The mean age at diagnosis of HIV infection was 88 months, and 59.5% were asymptomatic at the time of diagnosis. Currently, after a mean follow-up period of 48 months from diagnosis, 23.8% remain asymptomatic, 19.1% have non-AIDS-defining HIV-related symptoms, and 57.1% have AIDS; 85.7% of the cohort did not develop HIV-related symptoms until after 48 months of age (late-onset prolonged survivors). There was an average annual decline of 71.4 CD4+ cells/microL in the cohort from the ages of 7 to 16 years, and 21.4% have a current CD4+ lymphocyte count of greater than 500 cells/microL, 28.6% between 200 and 500 cells/microL, and 50% less than 200 cells/microL; 76% are orphaned as a result of maternal death, with the majority of the cohort (60%) cared for by extended family members. Disclosure of diagnosis has occurred in 57.1%. The vast majority of the cohort (76%) are attending regular school, with the remainder in special education. CONCLUSIONS: Although close to one quarter of the children and adolescents ages 9 to 16 years living with perinatally acquired HIV infection described in this cohort remain asymptomatic and have a relatively intact immune system, the remainder are living with significant HIV-related symptoms, many of which are chronic in nature and have an impact on daily living. The children in this cohort had both significant immunologic deterioration and symptomatic disease progression during the mean follow-up period of 48 months from the time of diagnosis with HIV infection.
Oocyte structure and follicular steroid concentrations in superovulated versus unstimulated heifers.
A highly variable yield of viable embryos in superovulated cattle is a major hindrance to the embryo transfer industry. To trace the cause of this problem, investigations were carried out on the intrafollicular steroids and structure of oocytes originating from follicles of follicular stimulating hormone (FSH)-stimulated (superovulated) and unstimulated heifers. Unstimulated heifers were slaughtered at midcycle, or administered cloprostenol (PG) at midcycle and slaughtered after 24, 48, or 72 hr, while superovulated heifers were administered 4 injections of pFSH (2 injections per day) and slaughtered 12 hr later, or administered 6, 7, or 8 injections of FSH in combination with PG at the 5th and 6th injection, and slaughtered 24, 36, or 60 hr, respectively, after the first PG injection. The follicular fluid from the largest (presumptive dominant) follicle of the unstimulated heifers and from potentially ovulatory follicles (> or = 8 mm in diameter) of the superovulated heifers were assayed for estradiol-17 beta (E2) and progesterone (P4), while the oocyte cumulus complexes from such follicles were processed for transmission electron microscopy. The mean E2 and especially P4 concentrations of the potentially ovulatory follicles of the superovulated heifers were lower than similar follicles of the unstimulated animals (83.7 +/- 76.7 ng/ml vs. 208.1 +/- 357.0 ng/ml, P > 0.05 and 31.1 +/- 38.7 ng/ml vs. 150.3 +/- 202, P < 0.05, respectively). The unstimulated oocytes had, in general, spherical oocyte nuclei and compact nucleoli before PG administration, while after PG, undulation of the nuclear envelope and nucleolus vacuolization was characteristic.(ABSTRACT TRUNCATED AT 250 WORDS)
Overview of psychosocial research concerning pediatric human immunodeficiency virus infection.
With improved medical treatments, children with human immunodeficiency virus (HIV) infection are surviving for many years and need to be integrated into the mainstream of life. Caregivers need to be aware of psychosocial issues of children living with HIV; however, minimal research concerning children relates to psychosocial aspects of HIV infection or acquired immunodeficiency syndrome. This article describes the current state of psychosocial research related to pediatric HIV infection and suggests directions for future research. A model for organizing research on pediatric HIV infection comes from models developed for other chronic childhood illnesses. Using an interactionist model of chronic illness, we group existing research into studies relating to the child's environment and family and those concerning the child. Emerging areas of psychosocial research concerning resiliency and coping, family concerns, and intervention research are described. Additional researchable areas concerning psychosocial aspects of pediatric HIV are suggested. Finally, barriers to conducting psychosocial research with HIV-infected children are identified.
"Cognitive activity" monitored by non-invasive measurement of cerebral blood flow velocity and its application to the investigation of cerebral dominance.
We have developed a method of non-invasively detecting language lateralisation by measuring the increase in middle cerebral artery blood flow velocity occurring during a word association task, using transcranial Doppler ultrasonography. All exclusively right handed subjects (N = 12) showed a relative increase in left sided flow velocity during the task; mean rise was 4.04% on the left, and -0.03% on the right (p < 0.002). Left handed subjects (N = 6) showed a mixed pattern with three showing much greater increases (> 5%) in left, compared with right, hemisphere flow velocity, and three showing only small differences between left and right sides, possibly reflecting bilateral language representation. This technique offers potential not only in studying patterns of cerebral dominance, but also in studying cognitive responses to other stimuli.
Varicella does not appear to be a cofactor for human immunodeficiency virus infection in children.
We performed a retrospective analysis of longitudinal clinical and immunologic data obtained from 22 children in the early stages of infection with human immunodeficiency virus (HIV) when they developed varicella. We studied the course of HIV infection to determine whether clinical deterioration occurred after chickenpox. We examined the following indices: growth and development; neurologic status; helper T lymphocyte counts; blood values of core (p24) antigen of HIV; changes in the stage of HIV infection; and need for administration of zidovudine. We studied children for a mean of 2.8 years and for as long as 9.8 years after onset of varicella. There was little evidence that chickenpox affected HIV infection. Three (14%) children developed clinical zoster, 2 of whom (9%) had evidence of chronic infection with varicella-zoster virus. One additional child (5%) had 2 episodes of chickenpox. These observations suggest that children with early HIV infection could be considered for immunization with live attenuated varicella vaccine, which would be predicted to decrease their morbidity from varicella-zoster virus.
The child with HIV infection.
1. Although incurable, HIV infection is treatable. Advances in antiretroviral therapy, prophylaxis to prevent opportunistic infections, treatment of opportunistic infections, and aggressive nutritional intervention allow for prolonged survival with a reasonable quality of life for many infected children. 2. HIV-infected children tolerate the majority of surgical procedures well; HIV infection alone is not a contraindication to surgery. Because of the multiple laboratory abnormalities that occur in children with HIV, nurses must assess that the appropriate laboratory testing has been completed and that the results have been reviewed. 3. Symptoms in children with HIV result from multiple causes and present in a variety of ways. As the lives of children are extended with better supportive and antiviral treatment, additional manifestations of HIV are being noted.
Clinical and laboratory correlates of Pneumocystis carinii pneumonia in children infected with HIV.
The case histories of 27 children with Pneumocystis carinii pneumonia (PCP) who were followed up in the AIDS Program at the Children's Hospital of New Jersey, Newark, are reviewed. The mean and median age at PCP diagnosis were 10.8 and 7.7 months, respectively. All of the children had other clinical evidence of infection with the human immunodeficiency virus that was documented prior to the diagnosis of PCP or found at the time of PCP diagnosis. Most patients who presented to the hospital were acutely ill, and complications of treatment occurred in 70%. Overall, 89% of the patients died and 70% survived for less than 6 months after diagnosis of PCP. Median survival after the diagnosis of PCP was only 2.0 months and the median life span of children with PCP was only 14.4 months. Only 40% of children with PCP had CD4 lymphocyte counts at or below the threshold for institution of PCP prophylaxis in adults of 200 x 10(6) cells/L (200 cells/mm3).
William Pickles Lecture 1991. My brother's keeper.
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Intra-aortic balloon cardiac assist: complication rates for the surgical and percutaneous insertion techniques.
A retrospective study was performed to evaluate complications with the two most common intra-aortic balloon pump (IABP) insertion techniques. During a nine year period, 202 patients (51 women, 151 men) underwent IABP cardiac assist utilizing the arteriotomy surgical (103 balloons) and percutaneous (99 balloons) insertion techniques. Complications, including asymptomatic loss of pedal pulse, vascular-symptomatic, infection, or balloon rupture occurred in 22.8 per cent of patients. Of the 54 complications, 13 (24%) were asymptomatic loss of pedal pulse, 36 (66.7%) were vascular symptomatic, three (5.5%) were infection, and two (3.7%) were balloon malfunctions. The overall complication rates were 16/103 (15.5%) and 38/99 (38.3%) for the surgical and percutaneous methods, respectively (P = 0.007). Thirty two per cent (33/103) of the patients receiving IABP surgically and 24 per cent (24/99) of those receiving IABP percutaneously died in the hospital (P = 0.34); no death was directly attributable to IABP. The number of patients requiring surgical intervention or removal was not significantly different between the surgical and percutaneous methods (9 versus 18%, P = .06). While the method of IABP insertion did not significantly alter hospital mortality, a significantly greater complication rate was observed with percutaneous insertion (P = .007). This was particularly relevant to complications occurring at the time of removal of IABP.
Transitory stimulation of human platelet 12-lipooxygenase by vitamin E supplementation.
Human platelet lipooxygenase converts arachidonic acid to 12-hydroperoxy-eicosatetraenoic acid (12-HPETE), which is rapidly reduced by peroxidases to 12-hydroxy-eicosatetraenoic acid (12-HETE). This study was conducted to examine the effect of vitamin E supplementation on platelet 12-lipooxygenase activity. Sixteen healthy subjects were supplemented with 400 IU/day of either D-alpha-tocopherol (268 mg) or DL-alpha-tocopherol (364 mg) for 4 wk. Supplements elicited a transitory increase of lipooxygenase activity but a suppression of peroxidase activity, as indicated by increased 12-HETE production and 12-HPETE accumulation. Plasma-tocopherol concentration was double the presupplement value and remained stable during supplementation. Neither age, sex, nor isomeric form of tocopherol supplement significantly influenced the pattern of response. Results show that vitamin E exerts a differential effect on platelet lipooxygenase and peroxidase activities.
Rapid correction of wasting in children with cerebral palsy.
Severe cerebral palsy is often accompanied by wasting. The authors used standard methods for the correction of primary protein energy malnutrition in children with severe cerebral palsy. A randomised controlled trial was used to compare intensive nasogastric tube-feeding with the best oral feeding that could be achieved. Nasogastric feeding led to highly significant increases in weight. The changes in skinfold thickness and mid-arm muscle circumference indicated increases in both lean and fat tissue. This study indicates that wasting associated with cerebral palsy can be quickly corrected, so there is no reason why such patients should be exposed to the increased risks associated with wasting.
Use of digoxin-specific antibody fragments (Fab) in the management of digoxin poisoning.
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ABC of poisoning. Miscellaneous drugs.
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Consultation rates in a group of West Cork general practitioners.
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Psychotropic drug prescribing in Irish general practice: a study in peer-group continuing education.
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