PubMed Health⌕ Search

Biomedical subjects

N Reynolds

Publications and source records attributed to N Reynolds.

At least 19 recordsLinked to original sources
PubMed2006

Strategies for self-management of HIV-related anxiety.

This study examines the frequency and effectiveness of commonly used strategies for self management of anxiety in an international sample of 502 participants from Norway (n=42, 8%), Taiwan (n=35, 7%), and the US (n=426, 85%). An activities checklist summarized into five categories of self-care behaviours including activities/thoughts, exercise, medications, complementary therapies, and substance use determined self-care behaviours. Ratings of frequency and effectiveness for each self-care activity were also included. Praying received the highest overall rating of effectiveness of any self-management strategies included in this study at 8.10 (scale 1 to 10), followed by meditation (7.37), exercising (7.32), using relaxation techniques (7.22), cooking (6.98), and walking (6.90). An analysis of effectiveness scores for each self-care strategy by country reflected a wide variation. The three most effective anxiety self-care strategies reported by participants from Norway included exercise (7.31), walking (6.96), and reading (6.44). Highest ratings of effectiveness by participants from Taiwan included talking with others with HIV (6.0), attending support groups (6.0), and exercising (6.0). US participants allocated highest ratings of effectiveness to complementary/alternative therapies, including praying (8.10), meditating (7.43), and using relaxation techniques (7.35). Regardless of the country, watching television and talking with family and friends were the two most frequently reported strategies. These strategies for self-management of HIV-related anxiety are important for clinicians to be aware of in the care of persons with HIV/AIDS.

Adult↗
PubMed2005

The role of the Lumina intense pulsed light system in the treatment of port wine stains--a case controlled study.

The pulsed dye laser has been the treatment of choice for port wine stains over the past 20 years. In the past 5 years there has been increasing discussion of the role of other light treatments, such as the intense pulsed light system in the treatment of port wine stains. These systems use high-energy lamps, which emit noncoherent broad-spectrum light. Cut off filters are applied depending on the treatment modality to limit the wavelengths emitted. We present the results of a 3-year prospective within patient controlled clinical trial using an intense pulsed light system called the Lumina, developed by Lynton Lasers of Cheshire, England. Our aims and objectives were to assess the effectiveness of the system in the treatment of port wine stains in a human model and to record the optimum treatment parameters and the incidence of side effects. Following ethical approval 12 subjects were enrolled into the trial. In order to meet the requirements of the local ethics committee these were all adults with port wine stains located in less visible areas of the body. The results showed that eight of the 12 subjects had some degree of fading of their port wine stain as measured on a percentage scoring system. Of the four who failed to show any response, all had pink port wine stains. It did seem the case that the darker the port wine stain, the better the fading seen. Furthermore, the more distal lesions tended to be less responsive than those situated closer to the head area. However, it is difficult to draw any definitive statistical conclusions due to the small number of patients in the trial.

Adult↗
PubMed2003

Fatal human rabies caused by European bat Lyssavirus type 2a infection in Scotland.

We wish to report the first recorded case of indigenous human rabies caused by a bat bite in the United Kingdom in 100 years. This instructive case report highlights a number of key lessons: first, bites from insectivorous bats indiginous to the United Kingdom can cause rabies in humans; second, rabies immunization is essential for bat-handlers, and postexposure treatment for rabies is essential for patients bitten by bats; third, patients able to give a history who present with acute flaccid paralysis and/or presumptive viral encephalitis should be asked if they have been bitten by bats, irrespective of travel history, or this history should be obtained from family or friends; fourth, antemortem diagnosis of bat rabies (EBLV type 2a infection) in humans is possible using RT-PCR.

Animals↗
PubMed2003

Sandostatin LAR (long-acting octreotide acetate) for malignant carcinoid syndrome: a 3-year experience.

BACKGROUND: Somatostatin analogues are the best therapy for controlling the symptoms of malignant carcinoid syndrome. Octreotide acetate given as subcutaneous injection up to three times daily, intramuscular Lanreotide injection given once per 1-2 weeks and monthly intramuscular Sandostatin LAR have demonstrated similar efficacy in short-term studies. AIM: To assess the long-term effect of Sandostatin LAR on the management of patients with malignant carcinoid syndrome. METHODS: This was a 3-year retrospective study. Twenty-seven patients were assessed with a median follow-up of 23 months. Thirteen patients were switched from subcutaneous octreotide and 14 patients were octreotide naive. All patients showed avid uptake on indium-111 octreotide imaging. RESULTS: Ten of the 13 patients previously on subcutaneous octreotide and 13 of the 14 patients who were octreotide naive had good symptom control on Sandostatin LAR. Over the period of follow-up, many patients showed progression of their tumour and required additional therapies. Patients expressed a preference for monthly intramuscular Sandostatin LAR as opposed to daily subcutaneous injections of octreotide. Although Sandostatin LAR was difficult to administer in certain instances, overall it was well tolerated. CONCLUSIONS: Sandostatin LAR provides good long-term symptomatic control in patients with malignant carcinoid syndrome; it is well tolerated and patients expressed improved satisfaction in their management.

Adult↗
PubMed2002

Eight years' experience of gastrostomy tube management.

BACKGROUND AND STUDY AIMS: Increasingly, patients fed by gastrostomy tube are surviving the lifespan of the device. Data are scarce concerning the factors affecting the longevity and failure of gastrostomy tubes or the criteria for selection of replacement devices which leads to cost-effective patient management. The aims of the study were: to set criteria for selection of replacement gastrostomy tubes; to determine the causes of gastrostomy tube failure, and the factors affecting device longevity; and to examine the effect of initiating an educational programme for caregivers on resource utilization in long-term enteral nutrition patients. MATERIALS AND METHODS: We analyzed the clinical gastrostomy tube database compiled prospectively over 8 years by the nutrition team at Ninewells Hospital, Dundee. RESULTS: For 363 gastrostomy tubes inserted in 304 patients (160 women; median age 71), the median duration of gastrostomy tube use was 138 days. The total follow-up was 294 patient-years. Death occurred before the first gastrostomy tube replacement in 48 % of patients, but 20 % resumed oral nutrition. Tube failure mechanisms were: dislodgment, 28 %; perishing of tube material, 25 %; tube-related Candida albicans infection, 16 %; leakage, 7 %; and unspecified, 7 %. Of the balloon tubes and gastrostomy buttons, 8 % needed early replacement due to dislodgment and/or leakage. The cost per day for replacement percutaneous endoscopic gastrostomy (PEG) was Euro 2.12, for balloon tubes it was Euro 0.62, and for gastrostomy buttons Euro 1.80. Despite an increasing PEG insertion rate throughout the study period, yearly referrals for PEG-related problems dropped by 30 % between 1997 to 1999, coinciding with the initiation of an educational programme for caregivers. CONCLUSION: Tube longevity is mainly limited by the patient's diagnosis and prognosis. The choice of replacement device should be based on clinical factors. The use of more durable materials in the manufacture of gastrostomy tubes may prolong tube life and reduce cost. Education of patients and caregivers by a multidisciplinary nutrition support team promotes independence and limits demand on the service.

Adolescent↗
PubMed2002

Dental fluorosis: variability among different inbred mouse strains.

Concurrent with the decline in dental caries has been an increase in the prevalence of dental fluorosis, a side-effect of exposure to greater than optimal levels of fluoride during amelogenesis. The mechanisms that underlie the pathogenesis of dental fluorosis are not known. We hypothesize that genetic determinants influence an individual's susceptibility or resistance to develop dental fluorosis. We tested this hypothesis using a mouse model system (continuous eruption of the incisors) where genotype, age, gender, food, housing, and drinking water fluoride level can be rigorously controlled. Examination of 12 inbred strains of mice showed differences in dental fluorosis susceptibility/resistance. The A/J mouse strain is highly susceptible, with a rapid onset and severe development of dental fluorosis compared with that in the other strains tested, whereas the 129P3/J mouse strain is least affected, with minimal dental fluorosis. These observations support the contribution of a genetic component in the pathogenesis of dental fluorosis.

Analysis of Variance↗
PubMed2001

Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization.

OBJECTIVE: To evaluate trends in mortality and related factors among trauma patients who developed acute respiratory distress syndrome (ARDS). STUDY: Observational study based on data prospectively gathered in computerized trauma registry. SETTING: Trauma intensive care unit (ICU) of 48 beds in level I trauma center. PATIENTS: All trauma patients with ARDS admitted during 1985-87 (486, group 1 [G1]) and 1993-95 (552, group 2[G2]). METHODS: ARDS was defined by American-European Consensus Conference criteria and the need for 48 h or more on mechanical ventilation with FIO2 greater than 0.50 and PEEP of more than 5 cmH2O. Demographics, severity score, injury-admission delay time, first 24-h transfusion and septic and organ system failure complications were independent variables. ICU mortality was the dependent variable. ICU length of stay (LOS) and life support techniques were considered. Respiratory and renal support strategies were different in the two time periods. RESULTS: Mortality decreased over the period (G1: 29.2% vs G2: 21.4%, p < 0.04), in patients aged both over and under 65 years. Multivariate analysis showed mortality was related to age, severity and time period (G1 1.68-fold that in G2) and that the greater G1 mortality was related to more renal failure and hematologic failure/dysfunction. ICU LOS decreased from 31.7+/-26.7 days (G1) to 27.3+/-22 days (G2) (p < 0.003). CONCLUSIONS: Mortality among trauma patients with ARDS declined over the 8 years studied and was associated with less organ failure. This reduction was probably the result of new approaches to mechanical ventilation, renal failure replacement and vasoactive drug therapy.

Adult↗
PubMed2001

Adult respiratory distress syndrome among blunt and penetrating trauma patients: demographics, mortality, and resource utilization over 8 years.

PURPOSE: The purpose of this study was to compare demographics, resources used, and mortality rates among a subset of trauma patients (blunt versus penetrating) who developed adult respiratory distress syndrome (ARDS) and over two time periods, 8 years apart. PATIENTS AND METHODS: This retrospective observational study was based on an analysis of the computerized Trauma Registry of the Shock Trauma Center of the University of Maryland Medical Systems. All trauma patients with ARDS admitted to a 48-bed trauma intensive care unit (ICU) at a Level I Trauma Center during two time periods of 3 consecutive years each were considered: from January 1, 1985, to December 31, 1987 (G1), and January 1, 1993, to December 31, 1995 (G2). Data were collected in the two time periods on demographics, severity (Revised Trauma Score), injury-admission delay time, first 24-hour transfusion fluids and blood, septic and organ system failure complications, life-support techniques, ICU mortality, and length of stay (LOS). The independent variables were the age, type of trauma, severity scores, transport time, fluid therapy, infectious and organ system failure complications, and life-support techniques. The dependent variable was ICU mortality. RESULTS: A total of 1,108 patients satisfied the entry criteria, 486 in period G1 and 552 in period G2; 929 (89.5%) suffered blunt trauma and 109 (10.5%) penetrating trauma. Mean age was lower for the penetrating trauma populations. There were no significant differences in ICU mortality between the blunt and penetrating trauma patients with ARDS. A significant decrease in ICU mortality was observed between the time periods studied among both blunt (29.5% vs. 21.7%, P <.001) and penetrating trauma patients (25.7% vs. 18.9%, P <.001). A similar rate of renal, hematologic, and cardiovascular organ system failure was observed for both blunt and penetrating trauma patients. Resource utilization measured by ICU LOS and time on mechanical ventilation was also similar in the two groups. The multivariate analysis showed that ICU mortality was related to age, RTS-measured severity, and time period (G1 mortality 1.68-fold that in G2). Renal and hematologic failures entered a second analysis, replacing the time period variable (G2). CONCLUSIONS: ARDS in patients with blunt and penetrating trauma showed similar trends in ICU mortality, complications, and resource utilization. The ARDS mortality rate decreased over the time period studied in both blunt and penetrating trauma.

Adult↗
PubMed2001

Inadvertent diclofenac rechallenge from generic and non-generic prescribing, leading to liver transplantation for fulminant liver failure.

This case report describes fulminant hepatic failure in a 53-year-old female caused by inadvertent rechallenging with diclofenac, treated by orthotopic liver transplantation. The case also illustrates the hazards of using both generic and non-generic drug prescribing, with drugs that are known to be toxic. The literature on non-steroidal anti-inflammatory drugs and hepatoxicity is reviewed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Encapsulation of probiotic bacteria with alginate-starch and evaluation of survival in simulated gastrointestinal conditions and in yoghurt.

A modified method using calcium alginate for the microencapsulation of probiotic bacteria is reported in this study. Incorporation of Hi-Maize starch (a prebiotic) improved encapsulation of viable bacteria as compared to when the bacteria were encapsulated without the starch. Inclusion of glycerol (a cryo-protectant) with alginate mix increased the survival of bacteria when frozen at -20 degrees C. The acidification kinetics of encapsulated bacteria showed that the rate of acid produced was lower than that of free cultures. The encapsulated bacteria, however, did not demonstrate a significant increase in survival when subjected to in vitro high acid and bile salt conditions. A preliminary study was carried out in order to monitor the effects of encapsulation on the survival of Lactobacillus acidophilus and Bifidobacterium spp. in yoghurt over a period of 8 weeks. This study showed that the survival of encapsulated cultures of L. acidophilus and Bifidobacterium spp. showed a decline in viable count of about 0.5 log over a period of 8 weeks while there was a decline of about 1 log in cultures which were incorporated as free cells in yoghurt. The encapsulation method used in this study did not result in uniform bead size, and hence additional experiments need to be designed using uniform bead size in order to assess the role of different encapsulation parameters, such as bead size and alginate concentration, in providing protection to the bacteria.

Alginates↗
PubMed2000

Essential interaction between the fission yeast DNA polymerase delta subunit Cdc27 and Pcn1 (PCNA) mediated through a C-terminal p21(Cip1)-like PCNA binding motif.

Direct interaction between DNA polymerase delta and its processivity factor proliferating cell nuclear antigen (PCNA) is essential for effective replication of the eukaryotic genome, yet the precise manner by which this occurs is unclear. We show that the 54 kDa subunit of DNA polymerase delta from Schizosaccharomyces pombe interacts directly with Pcn1 (PCNA) both in vivo and in vitro. Binding is effected via a short sequence at the C-terminus of Cdc27 with significant similarity to the canonical PCNA binding motif first identified in the mammalian p21(Cip1) protein. This motif is both necessary and sufficient for binding of Pcn1 by Cdc27 in vitro and is essential for Cdc27 function in vivo. We also show that the Pcn1 binding motif in Cdc27 is distinct from its binding site for Cdc1, the 55 kDa B-subunit of polymerase delta, and present evidence that Cdc27 can bind to Pcn1 and Cdc1 simultaneously. Finally, we show that Cdc27 performs at least two distinct essential functions, one of which is independent of Pcn1 binding.

Amino Acid Sequence↗
PubMed2000

Physician utilization of a portable computed tomography scanner in the intensive care unit.

OBJECTIVE: To determine the utilization of a portable computed tomography (CT) scanner for critically ill adult patients in an intensive care unit (ICU). DESIGN: Survey study and retrospective review. SUBJECTS: Critical care attending staff and fellows and neurosurgery residents. SETTING: A university hospital and Level I trauma center with a multitrauma ICU, a neurotrauma ICU, and a neurosurgical ICU. INTERVENTIONS: We surveyed all physicians who ordered portable CT scans from December 1996 through June 1998. Ordering physicians included critical care attending staff and fellows (anesthesiology, surgery, internal medicine) and neurosurgery residents. Physicians who no longer worked at the institution were contacted by mail or fax. Radiology records were reviewed to determine the actual number and type of scans performed. MEASUREMENTS AND MAIN RESULTS: The survey response was 100%. Most physicians reported ordering portable head CT scans (97%), followed by chest CT (88%), abdominal CT (78%), and pelvic CT (34%) scans. Analysis of the actual number of scans performed correlated with these reports (511 head, 115 chest, 88 abdomen, and 87 pelvis). The indication for portable CT scans (as opposed to a "fixed" or "stationary" scans) cited most often was patient severity of illness (77%). Patients on extracorporeal support (93%), those with cardiovascular instability (70%), followed by those with respiratory instability (57%) and neurologic instability (40%) were deemed too ill to transport. If the portable CT scanner was unavailable, however, most physicians (67%) ordered a fixed helical CT scan and the patient was transported to the radiology suite, regardless of medical condition. CONCLUSIONS: Access to a portable CT scanner impacts the physician ordering patterns for ICU patients. We found that 100% of surveyed physicians used the portable CT scanner for critically ill patients when the patient was unstable. If the diagnostic study was deemed medically necessary, and the portable scanner was unavailable, most surveyed physicians ordered a "fixed" helical scan and the patient was transported by an experienced transport team for the study. The portable CT offered an alternative and potentially safer means of obtaining diagnostic studies.

Attitude of Health Personnel↗
PubMed1999

Characterisation of XlCdc1, a Xenopus homologue of the small (PolD2) subunit of DNA polymerase delta; identification of ten conserved regions I-X based on protein sequence comparisons across ten eukaryotic species.

DNA polymerase delta (Pol delta), which plays keys roles in DNA replication, repair and recombination in eukaryotic cells, comprises at least two essential subunits - a large catalytic subunit (PolD1) possessing both DNA polymerase and 3'-5' exonuclease activities, and a smaller subunit (PolD2) whose function is not yet clear. Here we describe the cloning and sequencing of a Xenopus cDNA encoding a homologue of the PolD2 subunit. This protein (designated XlCdc1) is 69% identical to the human PolD2 protein and 34% identical to fission yeast Cdc1. Alignment of PolD2 protein sequences across ten eukaryotic species identifies 36 invariant amino-acid positions. These 36 residues are located within ten conserved regions (designated I-X) likely to have key functional roles. Consistent with this, the mutations in six previously identified yeast mutant PolD2 proteins map within conserved regions III, VI, VII and VIII. Several of the invariant amino acids are also conserved across the archaeal DNA polymerase II DP1 protein family.

Amino Acid Sequence↗
PubMed1999

A key role for replication factor C in DNA replication checkpoint function in fission yeast.

Replication factor C (RF-C) is a five subunit DNA polymerase (Pol) delta/straightepsilon accessory factor required at the replication fork for loading the essential processivity factor PCNA onto the 3'-ends of nascent DNA strands. Here we describe the genetic analysis of the rfc2 +gene of the fission yeast Schizosaccharomyces pombe encoding a structural homologue of the budding yeast Rfc2p and human hRFC37 proteins. Deletion of the rfc2 + gene from the chromosome is lethal but does not result in the checkpoint-dependent cell cycle arrest seen in cells deleted for the gene encoding PCNA or for those genes encoding subunits of either Pol delta or Pol straightepsilon. Instead, rfc2 Delta cells proceed into mitosis with incompletely replicated DNA, indicating that the DNA replication checkpoint is inactive under these conditions. Taken together with recent results, these observations suggest a simple model in which assembly of the RF-C complex onto the 3'-end of the nascent RNA-DNA primer is the last step required for the establishment of a checkpoint-competent state.

Amino Acid Sequence↗