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Biomedical subjects

P S Mehler

Publications and source records attributed to P S Mehler.

At least 19 recordsLinked to original sources
PubMed2000

Cervical cancer screening in the urgent care setting.

OBJECTIVE: To determine the feasibility of cervical cancer screening in an urgent care clinic. DESIGN: Prospective randomized trial. SETTING: Public teaching hospital. PATIENTS: Women presenting to the urgent care clinic whose evaluation necessitated a pelvic examination were eligible for participation. Women who had a hysterectomy, had a documented Pap test at our institution in the past year, did not speak English or Spanish, or had significant vaginal bleeding were excluded. Women presenting to the gynecology clinic for a scheduled Pap test were used as a comparison group for rates of follow-up, Pap smear adequacy, and Pap smear abnormalities. INTERVENTIONS: Women randomized to the intervention group had a Pap test performed as part of their pelvic examination, while women in the usual care group were encouraged to schedule an appointment in the gynecology clinic at a later date. The women in the two groups completed identical questionnaires regarding cervical cancer risk factors and demographic information. MEASUREMENTS AND MAIN RESULTS: Ninety-four (84.7%) of 111 women in the intervention group received a Pap test, as compared with 25 (29%) of 86 in the usual care group (P <.01). However, only 5 (24%) of 21 women with abnormal Pap smears in the intervention group received follow-up compared with 6 (60%) of 10 women seen during the same time period in the gynecology clinic for self-referred, routine annual examinations (P =.11). Pap smears obtained in the urgent care clinic were similar to those in the gynecology clinic with regard to abnormality rate (22.3% vs 20%; P =.75, respectively) and specimen adequacy (67% vs 72%; P =.54, respectively). CONCLUSIONS: Urgent care clinic visits can be used as opportunities to perform Pap test screening in women who are unlikely to adhere to cervical cancer screening recommendations. However, to accrue the full potential benefit from this intervention, an improved process to ensure patient follow-up must be developed.

Adolescent↗
PubMed2000

Beware of short-course therapy for Staphylococcus aureus bacteremia without a removable cause.

Staphylococcus aureus bacteremia has long been known to cause significant morbidity and mortality. The optimal treatment of this disease has evolved over the years. Recently, criteria have been established for the use of shorter courses of antibiotic therapy in certain patients, most notably those with an easily removed source of the bacteremia. We present the case of a 55-year-old man with S aureus bacteremia unrelated to an intravascular device. He was treated with "short-course" antibiotic therapy, and lumbar diskitis and an epidural abscess developed.

Anti-Bacterial Agents↗
PubMed1999

Eating disorders.

Explore the source record for details and available documents.

Adolescent↗
PubMed1999

Leptin levels in restricting and purging anorectics.

Patients with anorexia nervosa of the restricting (AN-R) and purging (AN-P) subtypes were studied to determine if there was a differential effect on leptin levels. It was hypothesized that the AN-P subgroup would have elevated leptin compared to the AN-R subgroup. Fasting plasma and anthropormorphic measurements were collected from 8 women with AN-R and 5 with AN-P. Eleven women served as controls. Overall, the plasma leptin correlated with body mass index (BMI; R = 0.432, p < .05). The AN-P subgroup had elevated leptin compared to the AN-R subgroup (3.8 +/- 0.8 vs. 1.5 +/- 0.2 ng/ml, p < .05) despite similar BMI (16.0 +/- 0.5 vs. 14.8 +/- 0.8 kg/m2). Additionally, the AN-P subgroup had similar plasma leptins as controls (3.8 +/- 0.8 vs. 3.6 +/- 0.1) despite different BMI (16.0 +/- 0.5 vs. 20.2 +/- 0.2, p < .001). Cortisol in the AN-P subgroup trended to be higher than in the restricting anorectics (21.8 +/- 3.0 vs. 15.6 +/- 1.3, p = .06). In AN, leptin was elevated in AN-P vs. AN. This may be due to increased glucocorticoid stimulation of leptin.

Adolescent↗
PubMed1998

Septic shock from Mycobacterium tuberculosis after therapy for Pneumocystis carinii.

Septic shock resulting from Mycobacterium tuberculosis (TB) occurs only rarely, even among patients infected with human immunodeficiency virus. We report a case of fulminant TB sepsis in the setting of human immunodeficiency virus infection. This case illustrates the hazards of corticosteroid use as a part of empirical treatment of Pneumocystis carinii pneumonia, as well as the unique appearance of TB on chest x-ray films.

AIDS-Related Opportunistic Infections↗
PubMed1998

The illiterate patient: screening and management.

Illiteracy, which affects about 22% of adults in the United States, can hamper patient communication, treatment, compliance, and access to care. Alternative communication methods and active screening for illiteracy are crucial to addressing this problem.

Adult↗
PubMed1998

Lipid levels in anorexia nervosa.

OBJECTIVE: Anorexia nervosa is a chronic disorder characterized by the patient's refusal to maintain body weight and a myriad of medical complications. Two frequently cited and poorly understood complications are hypercholesterolemia and hypercarotenemia. We therefore measured fasting cholesterol and beta-carotene levels in a cohort of moderately severe anorectics. METHOD: All subjects were female and met DSM-IV criteria for anorexia nervosa. Lipid profiles and beta-carotene levels were determined in 23 female anorexics. RESULTS: The mean total cholesterol for this group of anorectics was 179.3 mg/dl. Low-density lipoprotein values (LDL) ranged from 47 to 173, with a mean of 104.1 mg/dl. The mean high-density lipoprotein value (HDL) was 51.5 mg/dl. Beta-carotene levels were all normal. DISCUSSION: We conclude that total and LDL cholesterol in anorexia are well within the range of normal, and HDL levels are favorably high. Further, hypercarotenemia was not associated with anorexia nervosa.

Adolescent↗
PubMed1998

Smoking as a risk factor for nephropathy in non-insulin-dependent diabetics.

This study examines whether there was an association between smoking and nephropathy in patients with non-insulin-dependent diabetes mellitus enrolled in the Appropriate Blood Pressure Control in Diabetes Trial. Sixty-one percent of the patients were smokers; 26% had microalbuminuria, and 14% had overt nephropathy. There was a univariate association between diabetic nephropathy and gender, smoking status, duration of diabetes, hypertension, glycosylated hemoglobin level, creatinine level, body mass index, and cholesterol level. Stepwise logistic regression demonstrated an independent association between smoking and diabetic nephropathy (odds ratio 1. 61; 95% confidence interval 1.01, 2.58). These findings may have important implications for patients with non-insulin-dependent diabetes mellitus who smoke.

Adult↗
PubMed1998

Bulimia: a primary care approach.

More common than anorexia and less easily detected, bulimia typically begins as an effort to control weight. Although the prognosis is better than that for anorexia nervosa, a number of medical complications can arise related to the mode of purging. Some of these complications can have profound deleterious sequelae if not diagnosed and treated.

Adolescent↗
PubMed1998

Primary care for those with severe and persistent mental illness.

Historically, the medical care of persons with severe and persistent mental illness (SPMI) has been suboptimal. In many communities, large gaps exist in the continuum of services necessary to meet the medical needs of those patients, and existing services are not well coordinated. The effect of the managed mental health care on patients with SPMI remains to be seen, but it does not bode well for patients who are already at risk for being undertreated. We initiated primary care clinics exclusively for patients with SPMI because of our belief that integrating primary care and mental health services offers the best hope of improving health care for those patients. Our experience to date is instructive for other health care systems.

Delivery of Health Care, Integrated↗
PubMed1997

Long QT interval.

Explore the source record for details and available documents.

Bartter Syndrome↗
PubMed1997

Associations of hypertension and complications in non-insulin-dependent diabetes mellitus.

Hypertension is a common comorbidity with non-insulin-dependent diabetes mellitus (NIDDM). Data are somewhat inconsistent as to whether hypertension exacerbates diabetic complications in this population. Therefore, we examined the relationship between hypertension and vascular complications of NIDDM in the 950 patients enrolled in the prospective and randomized Appropriate Blood Pressure Control in Diabetes (ABCD) study. We found both systolic and diastolic hypertension to be associated with diabetic nephropathy (P < .001) as well as with its macrovascular complications (P < .05). Our present results also demonstrated that there was a significant relationship between hypertension and peripheral vascular disease (P < .05), and left ventricular hypertrophy (P < .001). There was, however, no apparent relationship between hypertension and diabetic neuropathy. Thus, arterial pressure may be a major determinant of complications in NIDDM.

Aged↗
PubMed1997

Medical complications of anorexia nervosa.

Anorexia nervosa is often characterized by progressive deterioration in many different organ systems. Most medical complications are the result of starvation and can be reversed with a well-planned refeeding program. While some of the complications of anorexia nervosa are predictable physiologic adaptations to the self-imposed starvation, many others are potentially life threatening. It is therefore incumbent upon all primary care physicians to become familiar with this disorder, because it is increasing in incidence and is commonly burdened by substantial chronicity and recidivism.

Adolescent↗
PubMed1997

Antihypertensive therapy in patients with diabetic nephropathy.

Diabetic nephropathy is the most common cause of end-stage renal disease. Diabetic patients have an increased risk of hypertension. The coexistence of diabetes and hypertension confers a high risk of morbidity to this population. Antihypertensive therapy offers an important opportunity to attenuate the rate of decline in the glomerular filtration rate and urinary albumin excretion in both insulin-dependent and non-insulin-dependent diabetic subjects. Certain calcium antagonists and converting-enzyme inhibitors are emerging as first-line agents to preserve renal function.

Albuminuria↗