PubMed Health⌕ Search

Biomedical subjects

N Johnson

Publications and source records attributed to N Johnson.

At least 37 records · Page 2Linked to original sources
PubMed2005

Tubal flushing for subfertility.

BACKGROUND: A possible therapeutic effect of diagnostic tubal patency testing has been debated in the literature for half a century. Further debate surrounds whether oil-soluble or water-soluble contrast media might have the bigger fertility-enhancing effect. Historically a variety of agents have been used to 'flush' the fallopian tubes, although tubal flushing does not currently form part of routine practice in the treatment of fertility delay. OBJECTIVES: To evaluate the effect of flushing a woman's fallopian tubes with oil- or water-soluble contrast media on subsequent fertility outcomes in couples with infertility. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility Group's specialised register of trials (searched 2 March 2004), MEDLINE (1966 to Mar 2004), EMBASE (1980 to Mar 2004), Biological Abstract (1980 to Mar 2004) and reference lists of articles. SELECTION CRITERIA: All randomised trials where tubal flushing with oil-soluble contrast media or tubal flushing with water-soluble media was compared with one another or with no treatment were considered for inclusion in the review. DATA COLLECTION AND ANALYSIS: Eleven randomised controlled trials were identified and included in this review. All trials were assessed for quality criteria. The studied primary outcome was live birth (and ongoing pregnancy), with secondary outcomes pregnancy, miscarriage, ectopic pregnancy, treatment complications including pain, intravasation of contrast medium, infection and haemorrhage, and image quality. MAIN RESULTS: Tubal flushing with oil-soluble media versus no intervention (three trials including 381 participants) was associated with a significant increase in the odds of live birth (Peto OR 2.98, 95%CI 1.40 to 6.37) and of pregnancy (Peto OR 3.30, 95%CI 2.00 to 5.43). There were no data from RCTs to assess tubal flushing with water-soluble media versus no intervention. For the comparison of tubal flushing with oil-soluble media versus tubal flushing with water-soluble media (six trials including 1,483 participants), the increase in the odds of live birth for tubal flushing with oil-soluble versus water-soluble media (Peto OR 1.49, 95%CI 1.05 to 2.11) was based on two trials where statistical heterogeneity was present and the higher quality trial showed no significant difference; there was no evidence of a significant difference in the odds of pregnancy (Peto OR 1.24, 95%CI 0.97 to 1.57). The addition of oil-soluble media to flushing with water-soluble media (water-soluble plus oil-soluble media versus water-soluble media alone; three trials including 555 participants) showed no evidence of a significant difference in the odds of pregnancy (Peto OR 1.18, 95%CI 0.82 to 1.70) or live birth (Peto OR 1.06, 95%CI 0.64 to 1.77). Adverse event data were only available for the comparison OSCM versus WSCM: OSCM carried a significantly higher chance of intravasation (Peto OR 5.41, 95%CI 2.57 to 11.37) but a significantly lower chance of immediate pain (Peto OR 0.53, 95%CI 0.34 to 0.84), prolonged pain (Peto OR 0.26, 95%CI 0.15 to 0.45) and post-procedure bleeding (Peto OR 0.22, 95%CI 0.15 to 0.31), and no serious adverse events were reported. AUTHORS' CONCLUSIONS: There is evidence of effectiveness of tubal flushing with oil-soluble contrast media in increasing the odds of pregnancy and live birth versus no intervention. The limited evidence of an increase in the odds of live birth from tubal flushing with oil-soluble contrast media versus water-soluble contrast media must be interpreted cautiously. Further robust randomised trials, comparing oil-soluble versus water-soluble media and comparing water-soluble media versus no intervention, would be a useful further guide to clinical practice. Further research is merited to ascertain the mechanism of the fertility enhancing effect of oil-soluble media, as to whether this is a 'tubal flushing' phenomenon, an effect on the intraperitoneal environment, or an implantation enhancing effect on the endometrium.

Contrast Media↗
PubMed2005

Archival study of a Finnish isolate from the 1988/89 rabies outbreak.

An archival brain sample from an infected dog taken during the 1988/89 rabies outbreak in Finland was investigated to confirm that it was infected with classical rabies virus (genotype 1). The first 400 base pairs of the virus nucleoprotein gene were then sequenced and used to undertake a phylogenetic comparison between this isolate and a panel of rabies virus sequences from the Baltic region. The Finnish dog isolate was identical to a virus isolated from a raccoon-dog also recorded during the 1988/89 outbreak and closely related to a third isolate from the Russian city of Pskov. The implications of these observations for the possible source of the Finnish outbreak are discussed.

Animals↗
PubMed2005

Surgical approach to hysterectomy for benign gynaecological disease.

BACKGROUND: There are three approaches to hysterectomy for benign disease - abdominal hysterectomy (AH), vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). Laparoscopic hysterectomy has three further subdivisions - laparoscopic assisted vaginal hysterectomy (LAVH) where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, laparoscopic hysterectomy (which we will abbreviate to LH(a)) where the laparoscopic procedures include uterine artery ligation, and total laparoscopic hysterectomy (TLH) where there is no vaginal component and the vaginal vault is sutured laparoscopically. OBJECTIVES: To assess the most appropriate surgical approach to hysterectomy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials (searched 23 March 2004), CENTRAL (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to Mar 2004), EMBASE (1985 to Mar 2004), Biological Abstracts (1968 to Mar 2004), the National Research Register and relevant citation lists. SELECTION CRITERIA: Only randomised trials comparing one surgical approach to hysterectomy with another were included. DATA COLLECTION AND ANALYSIS: Twenty-seven trials that included 3643 participants were included. Independent selection of trials and data extraction were employed following Cochrane guidelines. MAIN RESULTS: The benefits of VH versus AH were shorter duration of hospital stay (WMD 1.0 day, 95%CI 0.7 to 1.2 days), speedier return to normal activities (WMD 9.5 days, 95%CI 6.4 to 12.6 days), fewer unspecified infections or febrile episodes (OR 0.42, 95%CI 0.21 to 0.83). The benefits of LH versus AH were lower intraoperative bloodloss (WMD 45.3 mls, 95%CI 17.9 to 72.7 mls) and a smaller drop in haemoglobin level (WMD 0.55g/L, 95%CI 0.28 to 0.82g/L), shorter duration of hospital stay (WMD 2.0 days, 95%CI 1.9 to 2.2 days), speedier return to normal activities (WMD 13.6 days, 95%CI 11.8 to 15.4 days), fewer wound or abdominal wall infections (OR 0.32, 95%CI 0.12 to 0.85), fewer unspecified infections or febrile episodes (OR 0.65, 95%CI 0.49 to 0.87), at the cost of longer operating time (WMD 10.6 minutes, 95%CI 7.4 to 13.8 minutes) and more urinary tract (bladder or ureter) injuries (OR 2.61, 95%CI 1.22 to 5.60). There was no evidence of benefits of LH versus VH and the operating time was increased (WMD 41.5 minutes, 95%CI 33.7 to 49.4 minutes). There was no evidence of benefits of LH(a) versus LAVH and the operating time was increased for LH(a) (WMD 25.3 minutes, 95%CI 10.0 to 40.6 minutes). There was statistical heterogeneity in many of the outcome measures when randomised trials were pooled for meta-analysis. No other statistically significant differences were found. However, for some important outcomes, the analyses were underpowered to detect important differences, or they were simply not reported in trials. Data were notably absent for many important long-term outcome measures. AUTHORS' CONCLUSIONS: Significantly improved outcomes suggest VH should be performed in preference to AH where possible. Where VH is not possible, LH may avoid the need for AH, however the length of the surgery increases as the extent of the surgery performed laparoscopically increases, particularly when the uterine arteries are divided laparoscopically and laparoscopic approaches require greater surgical expertise. The surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards. Further research is required with full reporting of all relevant outcomes, particularly important long-term outcomes, in large RCTs, to minimise the possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as TLH.

Female↗
PubMed2005

A randomised controlled trial of a new handheld vacuum extraction device.

OBJECTIVE: To evaluate the effectiveness of a new handheld vacuum delivery device. DESIGN: Randomised controlled trial. SETTING: Southmead Hospital, Bristol, UK. POPULATION: One hundred and ninety-four women requiring delivery with vacuum extraction. METHODS: Women were recruited into the study while still in early labour. If during delivery, vacuum extraction was indicated they were then randomly allocated to either a new handheld vacuum device, the Kiwi Omnicup, or to a 'standard' vacuum cup selected by the obstetrician. The 'standard group' consisted of the silastic (66/98, 67%) or the metal cups (32/98, 33%). Study data were recorded at completion of the delivery and at 24-48 hours. An additional brief symptom questionnaire was completed by the mother at 10 days postnatally. Statistical analyses were done on an 'intention-to-treat' basis. MAIN OUTCOME MEASURES: The primary outcome was the successful completion of delivery with the allocated instrument. Secondary outcomes were substantial fetal scalp trauma and substantial maternal trauma. RESULTS: The Omnicup was associated with a significantly higher failure rate than the standard cup [34%vs 21%, odds ratio (OR) = 1.9 (1.01-3.6)]. This difference persisted after adjusting for confounding factors [adjusted OR = 2.25 (1.01-5.0)] and resulted in significantly more forceps deliveries in the Kiwi Omnicup group [22%vs 10%, unadjusted OR = 2.5 (1.1-5.5)]. The caesarean section rates were similar in both groups [9.4%vs 8.2%, OR = 1.2 (0.4-3.2)]. Rates of substantial scalp trauma and maternal trauma were similar in both groups. However, there were more cases of jaundice in the standard cup group [2.3%vs 12.0%, unadjusted OR = 0.18 (0.04-0.82) and adjusted OR = 0.10 (0.01-0.88)]. CONCLUSIONS: The Omnicup is not as successful at achieving a vaginal delivery as the combination of the currently used vacuum cups.

Female↗
PubMed2005

Development of a real-time, TaqMan reverse transcription-PCR assay for detection and differentiation of lyssavirus genotypes 1, 5, and 6.

Several reverse transcription-PCR (RT-PCR) methods have been reported for the detection of rabies and rabies-related viruses. These methods invariably involve multiple transfers of nucleic acids between different tubes, with the risk of contamination leading to the production of false-positive results. Here we describe a single, closed-tube, nonnested RT-PCR with TaqMan technology that distinguishes between classical rabies virus (genotype 1) and European bat lyssaviruses 1 and 2 (genotypes 5 and 6) in real time. The TaqMan assay is rapid, sensitive, and specific and allows for the genotyping of unknown isolates concomitant with the RT-PCR. The assay can be applied quantitatively and the use of an internal control enables the quality of the isolated template to be assessed. Despite sequence heterogeneity in the N gene between the different genotypes, a universal forward and reverse primer set has been designed, allowing for the simplification of previously described assays. We propose that within a geographically constrained area, this assay will be a useful tool for the detection and differentiation of members of the Lyssavirus genus.

Animals↗
PubMed2005

Problem-based, peer-facilitated education about antibiotic prescribing.

AIMS: To assess the feasibility and acceptability of a problem-based, peer-facilitated educational workshop about antibiotic prescribingfor GPs. METHOD PARTICIPANTS: All 39 GPs working in an average sized Local Health Care Co-operative (LHCC) in Glasgow. INTERVENTION: Prospective collection of information about 10 prescriptions for antibiotics to assess learning needs in relation to antibiotic prescribing. Two and a half hour workshop involving problem-based group work based on the needs assessment and discussions with a consultant microbiologist, prescribing adviser and academic GP. EVALUATION: Written feedback about the process of the educational intervention immediately after the workshop and outcome feedback collected after four weeks. Telephone interviews with non-participants. RESULTS: Twenty-four GPs agreed to participate in the study. 19 of these completed the Needs Assessment and 14 of these completed the workshop. The method of learning needs assessment and the educational workshop were highly acceptable. "No time, too busy" was the main reason given for not taking part in the study. CONCLUSION: Some GPs are unable to participate as fully as they would like in continuing professional learning activities due to competing workload pressures. Further research is required to investigate the necessary type and balance of learning activities and the barriers to engagement to ensure the most effective use of clinician time available for continuing educational activities.

Adult↗
PubMed2004

Molecular epidemiology of canid rabies in Sudan: evidence for a common origin of rabies with Ethiopia.

Rabies is an endemic zoonosis in Sudan with the principal reservoir species being the domestic dog. A panel of rabies virus isolates from dogs in Sudan have been used to establish a molecular phylogeny based on a partial sequence of the viral nucleoprotein. These isolates were then compared to those from countries bordering Sudan in north-east Africa. The Sudanese viruses form a tight cluster of isolates with a single outlier. When compared to other African viruses, the Sudanese isolates cluster most closely with isolates from Ethiopia to the East suggesting a common origin for rabies in both countries which supports historical records of the movement of rabies into Sudan. The Sudanese group of viruses belong to the Africa 1a group of viruses that are present throughout much of north Africa.

Animals↗
PubMed2004

Molecular epidemiology of rabies in Botswana: a comparison between antibody typing and nucleotide sequence phylogeny.

A panel of rabies virus isolates (RABV) endemic within Botswana between 1988 and 1992 have been typed by anti-nucleocapsid monoclonal antibodies (MAb) into two dominant groups. The first associated with the domestic dog (Canis familiaris) and the second associated with a range of wildlife species. Using nucleoprotein coding sequence data, we have applied molecular phylogenetic techniques to the same panel of 35 well-characterised rabies virus isolates from throughout Botswana in an attempt to compare both techniques and to further investigate the virus/host species relationships within this African country. The results confirm that there are indeed two major groups and that these are related primarily to biotype. The wildlife-associated biotype appeared more phylogenetically diverse and was more commonly isolated in the southeast of the country, with the canine-associated group dominating the north of the country. In addition, molecular phylogeny identified further groupings within both biotypes and a small number of isolates, which were not classified by MAb typing, could be assigned to a group. During the study period (4 years) there appeared to be little sequence variation within groups suggesting that distinct lineages persisted throughout the study and that there appears to be little evolutionary pressure on the nucleoprotein coding region of the viral genome.

Animals↗
PubMed2004

[Magnetic resonance studies in Alzheimer's dementia. What routine scanning shows].

Magnetic resonance images of the brain acquired in relationship to the commissural plane have been analyzed in twenty cases classified as Probable Alzheimer's disease (Pr. AD). These examinations have been compared to normal aged matched subjects. All examinations have been made in strict correlation with the planes defined by Talairach and Tournoux (1988). The analysis of brain cortical damage was made by evaluating the sulci of the brain mainly on coronal sections correlated with simultaneous image review of the same area on the two other orthogonal planes. In Pr. AD, an asymmetric atrophic pattern was found mainly on the following areas: amygdaloid nucleus, para hippocampal gyrus, hippocampus, areas 22 and 21, temporal pole, insula, dorso frontal cortex, angular gyrus, superior parietal lobule. The primary motor and visual areas were normal in all cases.

Aged↗
PubMed2004

How long does it take to perform an operative vaginal delivery?

We set out to see how long it takes to achieve an operative vaginal delivery in normal practice. This was a prospective survey, conducted in a major and well-staffed British maternity unit over 1 month. Sixty-two assisted vaginal deliveries occurred in the month of the study. Thirteen data collection sheets were spoiled or could not be confirmed and were discarded before analysis. Therefore the remaining data are based on 49 deliveries. The main outcome measure was the time interval between the decision to assist the vaginal delivery and the delivery. Fifty per cent of babies were delivered within 18 minutes once the decision to act had been made (range 6-85 minutes). If the primary indication for delivery was an abnormal CTG the median time was 16 minutes (mean 20 minutes). Any legal claim based on the assumption that a reasonably competent obstetrician should deliver a baby within 15 minutes cannot be supported by scientific data.

Delivery Rooms↗
PubMed2004

Identification of a conserved linear epitope at the N terminus of the rabies virus glycoprotein.

A novel, linear B-cell epitope has been identified at the N terminus of the rabies virus (RABV) glycoprotein. Screening of a phage-display library demonstrated that two glycoprotein-specific mAbs recognized a conserved sequence, WxxxDI, which aligned between aa 14 and 19 of the mature glycoprotein. Screening of truncated glycoprotein fragments with both mAbs confirmed the location of the epitope in the N-terminal region. Alignment of amino acid sequences from a range of RABV isolates indicated that the site was conserved in most viruses. Alignment with representatives of other lyssaviruses suggested that it is conserved within phylogroup I, which includes the European bat lyssaviruses, but not phylogroup II. A 12 aa synthetic peptide of this epitope was recognized by both mAbs and sera from a subset of rabies-vaccinated dogs. In a multimeric form, the peptide could induce an epitope-specific response following immunization in rabbits and mice.

Amino Acid Sequence↗
PubMed2004

Spill-over of European bat lyssavirus type 1 into a stone marten (Martes foina) in Germany.

European bat lyssavirus type 1 (EBLV-1, genotype 5) is known to endemically circulate in insectivorous bat populations in Germany. In August 2001, a rabies suspect stone marten (Martes foina) was found in the city of Burg (Saxony-Anhalt, Germany) and was sent to the regional veterinary laboratory for routine rabies diagnosis. Whereas brain samples repeatedly tested negative in the fluorescent antibody test for classical rabies virus (genotype 1), the mouse inoculation test and the rabies tissue culture inoculation test yielded positive results. Rabies viral RNA was also detected in the stone marten brain sample both by nested and heminested RT-PCR specific for the nucleoprotein gene and for the nucleoprotein phosphoprotein junction of rabies virus. The amplification products were sequenced to genotype the isolate. Sequence data obtained from the first-round RT-PCR products were analysed and the suspect stone marten isolate was confirmed as a rabies related virus (EBLV-1a). Phylogenetic comparison with sequences from recent genotype five isolates from Germany and Denmark showed that it was closely related to a previous isolate of EBLV-1 from a serotine bat in Saxony-Anhalt obtained in the same year in an area adjacent to the place where the EBLV-1 infected stone marten was found. Both EBLV-1 isolates share a 99.5% identity. This is the first report of an EBLV-1a spill-over from an insectivorous bat into wildlife in Europe.

Animals↗
PubMed2004

Effect of massage of the hamstring muscle group on performance of the sit and reach test.

OBJECTIVE: To investigate if a single massage of the hamstring muscle group would alter the performance of the sit and reach test. METHODS: Before treatment, each of 11 male subjects performed the sit and reach test. The treatment consisted of either massage of the hamstring muscle group (both legs, total time about 15 minutes) or supine rest with no massage. Performance of the sit and reach test was repeated after treatment. Each subject returned the subsequent week to perform the tests again, receiving the alternative treatment relative to their initial visit. Mean percentage changes in sit and reach scores after treatment were calculated for the massage and no massage treatments, and analysed using Student's t tests. RESULTS: Mean (SD) percentage changes in sit and reach scores after massage and no massage were small (6.0 (4.3)% and 4.6 (4.8)% respectively) and not significantly different for subjects with relatively high (15 cm and above) values before treatment. Mean percentage changes in sit and reach scores for subjects with relatively low values before treatment (below 15 cm) were large (18.2 (8.2)% and 15.5 (16.2)% respectively), but no significant differences were found between the massage and no massage groups. CONCLUSIONS: A single massage of the hamstring muscle group was not associated with any significant increase in sit and reach performance immediately after treatment in physically active young men.

Adult↗
PubMed2004

Oral lesions and conditions associated with human immunodeficiency virus infection in 1000 South Indian patients.

INTRODUCTION: Human immunodeficiency virus (HIV) infection is a major health problem in India. The importance of oral lesions as clinical features of HIV infection and their gender specificity have been reported worldwide. However, there are very few reports on this aspect from the Indian subcontinent. MATERIALS AND METHODS: The study population comprised 1000 consecutive HIV seropositive patients presenting to YRG CARE, a non-governmental organisation in Chennai, South India. The oral lesions were diagnosed based on clinical appearance using international criteria. Data were entered into a database and analysed using the SPSS package. RESULTS: The male-to-female ratio was 3.4:1, and 95% of the patients had acquired infection via heterosexual contact. Majority of the patients (84%) were in the 21- to 40-year-old age groups. Pulmonary tuberculosis (12%) was the most common systemic finding. Oral lesions were seen in 86.6% of the patients. Gingivitis (72.3%) and periodontitis (33.2%) were the most common lesions followed by oral pigmentation (26.3%), oral candidiasis (23.8%), angular cheilitis (7.9%), oral ulcers (3.3%), oral hairy leukoplakia (2.1%), oral submucous fibrosis (0.9%) and leukoplakia (1.5%). The prevalence of oral candidiasis, periodontitis and oral hairy leukoplakia was higher in males than in females. CONCLUSIONS: Oral lesions occur commonly in HIV infection. A comprehensive oral examination plays an important role not only in the management of the patients, but also in assessing the immune status and in their follow-up.

Adult↗
PubMed2004

[Prescription of betablockers in chronic cardiac failure: results of a national enquiry of cardiologists].

Despite recommendations from various learned establishments, there are strong reservations regarding betablockers, which have been contra-indicated in chronic cardiac failure for a long time. Several published enquiries have found a low prescription rate for betablockers. We performed an enquiry into the apparent modes of betablocker prescription in chronic cardiac failure. Questionnaires were sent to all the cardiologists in France, and 1622 were analysed. The dosage used, reasons for non-prescription, modes of repeat prescription, and the influence of the response to treatment were analysed. This enquiry shows that although the advantage of betablockers is acknowledged, there is still a block to their use.

Adrenergic beta-Antagonists↗
PubMed2004

HIV seroprevalence, uptake of interventions to reduce mother-to-child transmission and birth outcomes in greater Kingston, Jamaica.

BACKGROUND: The seroprevalence of HIV among pregnant women in the Caribbean is 2-3% and increasing. The Kingston Paediatric and Perinatal HIV Programme is developing and implementing a unified programme to eliminate mother-to-child transmission (MTCT) of HIV in Kingston, Jamaica. METHODS: Pregnant women presenting to Kingston Metropolitan Antenatal Clinics, Victoria Jubilee Hospital, Spanish Town Hospital and the University Hospital of the West Indies had HIV serology performed by ELISA, or by the new Determine Rapid Test after receiving group counselling. HIV-positive women were referred to High Risk Antenatal Clinics. Antiretroviral prophylaxis with zidovudine (AZT), or nevirapine was given. Care was administered using a standard protocol by a multi-disciplinary team of public and academic healthcare personnel. RESULTS: In year one, 19,414 women delivered Among 14,054 women who started antenatal care for this period, 5,558 (40%) received group counselling and 7,383 (53%) received HIV-testing. During the fourth quarter of follow-up, these comparative rates were 66% (2049/3 118) and 72% (2260/3118) respectively. HIV seroprevalence overall was 2.1% (152/7 383). One hundred and seven HIV+ women at varying gestational ages were identified in the programme, 72 had so far received AZT and nine nevirapine (76%). 0f 84 deliveries, birth outcomes were 75 live births (89%), six neonatal deaths and four maternal deaths (all from HIV/AIDS). Major challenges include repeat pregnancies of 36% despite prior knowledge of HIV seropositivity and poor partner notification with only 30% (32) having a HIV-test. Although rates of HIV testing in pregnant women in Greater Kingston are increasing, rates of testing overall remain sub-optimal. On the labour ward, there was sub-optimal identification of the HIV+ pregnant woman and administration of AZT chemoprophylaxis, along with issues of patient confidentiality and stigma. CONCLUSION: This programme needs strengthening in order to reduce maternal-fetal transmission of HIV in Greater Kingston, Jamaica "pMTCT-PLUS, or comprehensive family-centred care, is the next step".

Adolescent↗