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Biomedical subjects

M M Chren

Publications and source records attributed to M M Chren.

44 records · Page 3Linked to original sources
PubMed1993

Severe megaloblastic anemia in a patient receiving low-dose methotrexate for psoriasis.

Severe megaloblastic anemia with a normal white blood cell and platelet count developed in a patient with psoriasis vulgaris who was receiving long-term, low-dose methotrexate. We believe she had methotrexate-induced folate deficiency anemia with isolated inhibition of the erythrocytic bone marrow line. We review hematologic toxicity from low-dose methotrexate. Physicians caring for patients who receive low-dose methotrexate should be aware that an increase in the erythrocyte mean corpuscular volume may be a useful indicator of folate deficiency and impending toxicity. In addition, folate supplementation may prevent this toxicity (even in patients who do not appear clinically to be folate deficient), although whether methotrexate efficacy diminishes is controversial.

Adult↗
PubMed1992

Congenital miliaria crystallina: case report and literature review.

Generalized congenital miliaria crystallina occurred in a black newborn boy. Although miliaria crystallina occurring in infancy and beyond is well established, congenital occurrence is very rare. The pathogenesis of the disorder is not well understood. We discuss some hypotheses of pathogenesis in the context of our patient, as well as a differential diagnosis and a comparison with a previously reported case. Miliaria crystallina should be considered in the differential diagnosis of vesiculobullous eruptions in newborns.

Humans↗
PubMed1991

Doctors, drug companies and gifts.

This paper by Chren and Landefeld was originally presented at the Miriam Hospital on March 21, 1991, as the 1991 Lichtman Oration, an annual meeting devoted to ethical problems in medicine honoring Herbert C. Lichtman, MD, former physician-in-chief at the hospital. Because of the importance of this paper, and its controversial character, the Journal has asked a number of practicing physicians and other concerned persons to offer their opinions on this paper. These commentaries will then be published in a subsequent issue of the Journal, along with reactions by our readers.

Drug Industry↗
PubMed1988

Diagnostic yield of the autopsy in a university hospital and a community hospital.

To determine the extent to which autopsies yield unexpected findings that are relevant to the patient's death and whether cases with a high yield of such findings can be identified selectively, we studied a total of 233 autopsies at a university hospital and at a community hospital. The rates at which autopsies detected major unexpected findings whose premortem diagnosis would probably have improved survival were 11 percent at the university hospital and 12 percent at the community hospital. Major unexpected findings whose premortem diagnosis would not have prolonged survival were found in another 12 and 21 percent of cases, respectively. Pulmonary embolism and fungal infections in immuno-compromised hosts were the most common major unexpected findings. Neither we nor the patients' physicians were able to identify from the clinical data the autopsies likely to have high yields. Furthermore, the physicians' estimates of an autopsy's expected yield were similar for patients evaluated by autopsy and for matched patients who were not. We conclude that the autopsy continues to yield clinically relevant findings at a high level and that it is not currently possible to predict which cases will have high yields. Autopsies are vital to ensure the quality of medical care, and autopsy rates must be increased substantially if this role is to be fully realized.

Adolescent↗
PubMedDate not supplied

Students' sexual behavior, knowledge, and attitudes relating to the acquired immunodeficiency syndrome.

Five hundred ninety students receiving primary care in a university health service were surveyed anonymously in 1985-86 to study their self-reported sexual behavior and knowledge and attitudes about acquired immunodeficiency syndrome (AIDS). Most students (75%) were heterosexual; 3% were homosexual, 3% bisexual, and 15% had never been sexually active. Many students (32%) had greater than or equal to 2 sexual partners in the past year, but only 23% of these had changed their sexual practices because of concern about AIDS. Some students with high-risk sexual behavior were not very knowledgeable: among homosexual or bisexual men, those with greater than or equal to 6 recent sexual partners knew less than others (P less than 0.001). Overall, less knowledgeable students had more personal concerns about AIDS, favored limiting the social activities of people infected with human immunodeficiency virus (HIV), and favored screening for HIV-antibody; these associations between knowledge and attitudes were significant even when controlling for demographic characteristics and sexual behavior with multiple linear regression. The authors conclude that many students receiving primary care reported sexual behavior that could spread HIV, and that less knowledgeable students had particular concerns and attitudes about AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Doctors, drug companies, and gifts.

Doctors often accept gifts from drug companies. We analyze this practice and conclude that accepting a gift has complex practical and ethical repercussions. Gifts cost patients money, and they may change society's perception of the profession as serving the best interest of patients. Also, accepting a gift establishes a relationship between the physician and the drug company that obliges a response from the physician. Accepting gifts and the resulting relationship have ethical implications as well. First, the use of patients' money to pay for gifts can be unjust. Second, the fiduciary relationship between physician and patient may be threatened if prescribing practices are affected (as intended by the drug company). Third, physicians' characters may be altered by a practice that fosters self-interest at patients' expense. We discuss the need for guidelines for the profession to help physicians promote their patients' well-being.

Drug Industry↗