Biomedical subjects
R Freeman
Publications and source records attributed to R Freeman.
High blood pressure and decreased heart rate variability in the Cuban epidemic neuropathy.
Autonomic cardiovascular reflexes were investigated in patients with an epidemic optic and peripheral neuropathy, which affected more than 50 000 people in Cuba between 1991 and 1994 and was probably caused by nutritional deficiency. Affected patients had significantly higher blood pressure than age matched controls, both while supine and standing, and significantly lower heart rate variability during paced breathing, suggesting reduced cardiac parasympathetic innervation.
What is new with antibiotic-resistant gonorrhoea in Newcastle, England?
Neisseria gonorrhoeae isolates that were resistant to ciprofloxacin and/or penicillin were analysed to investigate the escalating problem of antibiotic-resistant gonorrhoea in the north east of England. Opa-typing (outer membrane opacity protein) was carried out on isolates resistant to ciprofloxacin and of nutrient nonrequiring (NR) auxotype. In the year 2000 there were 265 cases of gonorrhoea, of which 44 (16.6%) were resistant to penicillin and 12 (4.5%) were resistant or had reduced sensitivity to ciprofloxacin (with only four of these acquired outside the UK). Three (7.5%) of the non-beta-lactamase penicillin-resistant isolates were imported from abroad. By Opa-typing of ciprofloxacin-resistant strains, one pair of the isolates was similar, two were unique and one was similar to the Oldham/Rochdale outbreak strain described early in 2000. This marked increase in the prevalence of indigenous ciprofloxacin resistance requires continued surveillance and may soon necessitate an alteration in our first line treatment.
Smoking behaviour and knowledge in high school students in Riyadh and Belfast.
UNLABELLED: Smoking is one of the risk factor associated with onset, severity and progression of periodontal disease. AIM: The aim of the study was to examine the smoking behaviour and dental health knowledge of high school students in Riyadh and Belfast. MATERIALS AND METHODS: Eight schools from Riyadh and 6 from Belfast were randomly selected by cluster distribution sampling method. Two hundred and ninety students from Riyadh and 144 from Belfast were included giving an overall response rate of 85%. The age range was between 16-17 years. A questionnaire was used to assess demography, smoking habits, dental health knowledge and oral hygiene practices. RESULTS: The results showed that 18% of students were smokers; 24% in Belfast and 15% in Riyadh (x2 (1) = 4.29: P = 0.04). 24% of students in Belfast and 56% in Riyadh smoked at least 1 cigarette per day. 61% of students had bleeding gums although 85% stated that they brushed their teeth at least daily. Bleeding on brushing was common with 53% of Belfast students compared with 65% from Riyadh. Students in Belfast (2.51 +/- 1.15) had significantly higher mean scores for their knowledge about gum health compared with Riyadh students (2.21 +/- 1.44) (t = 2.29: P = 0.02). There was no differences in knowledge about oral health and smoking between the students. However, non-smokers from Belfast and Riyadh (3.32 +/- 1.60) had greater knowledge about oral health and smoking than those who smoked (2.81 +/- 1.45) (t = 2.73: P = 0.007). There was no difference in knowledge about gum health between smokers and non-smokers. CONCLUSIONS/RECOMMENDATIONS: Smoking is more prevalent in Belfast but more cigarettes are smoked in Riyadh. As non-smokers had greater knowledge of the ill-effects of smoking upon their oral health, there is a need to develop location specific interventions to control smoking habits in late adolescence.
Careers. Competition and careers in biosciences.
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Outcome in patients with eating disorders: a 5-year study.
BACKGROUND: Eating disorders are disabling, unpredictable, and difficult to treat. We did a prospective 5-year investigation of a representative sample of patients with eating disorders. Our aim was to identify predictors of outcome and to assess effects of available treatments. METHODS: We prospectively investigated 95 patients with anorexia nervosa, 88 with bulimia nervosa, and 37 with eating disorders not otherwise specified (EDNOS), who sought treatment in Adelaide, South Australia. We divided patients into those who had, and had not, received treatment in specialist units and reached a safe body weight. Individuals were then further classified dependent on intensity of any treatment received. We assessed clinical symptoms, body-related attitudes, and psychosocial function. FINDINGS: 216 (98%) patients were available for follow-up after 5 years. Three patients with anorexia nervosa and two with EDNOS died. 65 (74%) bulimic, 29 (78%) EDNOS, and 53 (56%) anorexic patients had no diagnosable eating disorder. A small proportion of patients in every group had poor Morgan-Russell-Hayward scores at outcome. Final outcome was predicted by extent and intensity, but not duration, of initial symptoms in patients with anorexia nervosa, and by initial body-related attitudes and impaired psychosocial functioning in bulimia patients. We were unable to predict EDNOS outcome. Treatment did not affect outcome for any group. INTERPRETATION: Deaths in the study confirm the serious nature of eating disorders. However, our results suggest that the efficacy of existing interventions is questionable.
Vasovagal syncope: the contributions of Sir William R. Gowers and Sir Thomas Lewis.
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Males with anorexia nervosa: a controlled study of eating disorders in first-degree relatives.
OBJECTIVE: To compare lifetime rates of full and partial anorexia nervosa and bulimia nervosa in first-degree relatives of males with anorexia nervosa and in relatives of never-ill comparison subjects. METHODS: Rates of eating disorders were obtained for 747 relatives of 210 probands from personal structured clinical interviews and family history. Best-estimate diagnoses were determined blind to proband diagnosis and pedigree status. RESULTS: Full and partial syndromes of anorexia nervosa aggregated in female relatives of ill probands. For the full syndrome of anorexia nervosa, the crude relative risk was 20.3 among female relatives and for partial syndrome anorexia nervosa, the crude relative risk was 3.3. In contrast, bulimia nervosa was relatively uncommon among relatives of ill probands. CONCLUSION: Although anorexia nervosa in males is exceedingly rare, there is a pattern of familial aggregation that is highly similar to that observed in recent family studies of affected females. On the basis of these findings, there is no evidence that familial-genetic factors distinguish the occurrence of anorexia nervosa in the two sexes.
A two-dimensional experiment that separates decoupling sidebands from the main peaks.
Broadband decoupling techniques generate undesirable cycling sidebands. The new two-dimensional technique described here allows separation of these sidebands from the main peaks by spreading the sideband responses in the indirectly detected dimension (F(1)) according to their frequency separations from the parent peaks, leaving the main resonances at zero frequency in F(1). This trace at zero frequency shows a thousandfold suppression of the residual sidebands, making possible the detection of very weak signals from dilute constituents of the sample. The experimental results can be displayed as one-dimensional "quiet decoupling" spectra without any significant loss of sensitivity. The new technique (DESIRE-decoupling sideband resolved spectroscopy) is simple, robust, and straightforward to implement.
Use of combination cytomegalovirus immune globulin plus ganciclovir for prophylaxis in CMV-seronegative liver transplant recipients of a CMV-seropositive donor organ: a multicenter, open-label study.
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Tuberculosis transmitted through transplantation.
Tuberculosis in solid organ transplant recipients is associated with relatively high morbidity and mortality and is often extra-pulmonary. Reactivation of dormant infection is the usual mode of acquisition with donor and nosocomial transmission occurring infrequently. We report two cases of probable donor transmitted extra-pulmonary infection where both isolates of Mycobacterium tuberculosis proved to be indistinguishable using hemi-nested inverse PCR of the IS 6110 region.
A randomized double-blind comparative study of mycophenolate mofetil and azathioprine in combination with cyclosporine and corticosteroids in primary liver transplant recipients.
Acute hepatic allograft rejection occurs in approximately 50% to 60% of the patients undergoing liver transplantation. In this study, we compared the rate of acute rejection in liver transplant recipients randomized in a double-blind comparative study to treatment with mycophenolate mofetil (MMF) or azathioprine (AZA), both in combination with cyclosporine and corticosteroids. Five hundred sixty-five primary liver transplant recipients were randomly assigned to treatment with MMF, 1 g twice daily intravenously followed by 1.5 g twice daily orally (n = 278), or AZA, 1.0 to 2.0 mg/kg/d intravenously followed by oral administration (n = 287), in combination with cyclosporine and corticosteroids. Patients were followed up for at least 1 year, and efficacy analysis was based on intent-to-treat methods. Acute rejection was defined according to the Banff histological criteria. The two study groups were balanced for demographic and clinical baseline characteristics. The incidence of acute rejection or graft loss was 47.7% in the AZA patients and 38.5% in the MMF patients (P <.03). The incidence of biopsy-proven and treated rejection censoring for graft loss was 40.0% in the AZA group versus 31.0% in the MMF group (P <.06). Steroid-resistant rejection requiring treatment with either OKT3 or antithymocyte globulin occurred in 8.2% of AZA patients versus 3.8% in MMF patients (P <.02). Patient and graft survival rates at 1 year posttransplantation were 85.4% in the AZA group and 85.3% in the MMF group (P = not significant). MMF was superior to AZA in preventing acute rejection in the first 6 months posttransplantation. MMF and AZA were equivalent in preventing graft loss at 1 year, and the safety profiles between the two immunosuppressive agents were similar.
Developing a schedule of normative denture treatment need.
OBJECTIVES: The aim of the study is to assess the reliability and validity of a schedule to determine the normative denture treatment needs of older people. DESIGN: The design used assessed inter-examiner reliability (criterion validity), test-retest reliability, and content and face validity of the schedule. SETTING: The inter-examiner reliability study took place in a Department of Prosthetic Dentistry, the remainder of the work took place in a community setting. RESULTS: The results showed that the schedule in terms of an index performed well with reasonable inter-examiner and test-retest reliability. Difficulties however were encountered with regard to subjective judgements about denture quality and design; consequently, there was modest inter-examiner agreement for stability, retention, and occlusal balance. CONCLUSIONS: The findings from this preliminary work suggest that the schedule may be useful in the assessment of normative denture treatment need in a community setting. Nevertheless more work will be required to obtain further information on the validity of this new assessment measure.
Assessing expressed need and satisfaction in complete denture wearers.
OBJECTIVES: The need to assess both lay and professional views of oral health is believed to be at the centre of success when providing dental health care for older patients. Self-perceived physical (oral) health and perceptions of psychosocial functioning must be included if expressed need is to be assessed. The aim of this work was to construct an expressed need schedule and to assess the ability of this assessment to predict older community-based patients' satisfaction with complete dentures. DESIGN: Survey of 260 people aged 65 years and over. SETTING: Community setting. MAIN OUTCOME MEASURES: The participants were interviewed using a 55 item modified version of the Oral Health Impact Profile (OHIP) to assess their psychological, social and perceptions of their oral health. All participants were subjected to an oral examination. RESULTS: The results showed that complete denture wearers compared had greater experience of difficulties associated with oral health and psychological functioning. Factor analysis allowed the identification of three dimensions associated with psychological, social and self-perceived physical (oral) health. When these factors were regressed with normative denture treatment need against satisfaction with complete dentures, satisfaction was characterised by high self-perceived physical (oral) health, low social health problems and no identifiable normative need. CONCLUSION: This work supports the inclusion of self-perceived physical (oral) health and psychosocial health (expressed need) questions in a schedule when predicting satisfaction with complete dentures.
LightCycler-based quantitative PCR for detection of cytomegalovirus in blood, urine, and respiratory samples.
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LightCycler-based quantitative PCR for rapid detection of human herpesvirus 6 DNA in clinical material.
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Identifying sputum specimens of high priority for examination by enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of infectious pulmonary tuberculosis.
AIMS: To compare clinical information and sputum microscopy as methods for the selection of samples for enhanced mycobacterial detection, identification, and susceptibility systems (EMDISS) to promote the rapid diagnosis of patients with infectious pulmonary tuberculosis. METHODS: Two thousand, two hundred and sixty four specimen request forms were examined for clinical details, which were then used to identify specimens likely to yield Mycobacterium tuberculosis on culture. These results were compared with the results of sputum microscopy for acid fast bacilli (AFB). Both methods were assessed against the results of culture using a combination of continuous automated mycobacterial liquid culture (CAMLiC) and conventional solid culture. RESULTS: Classification based on clinical details was an inefficient method of identifying high priority specimens for EMDISS. Although, when given, clinical details were often consistent, a substantial proportion of specimens arrived with no details. This approach would result in the referral of at least 16% of the workload but lead to the detection by culture of only 46% of the M tuberculosis present within it. In contrast, microscopy for AFB defined a much smaller number of specimens (4.8% of the total), which contained 90% of the M tuberculosis isolates. CONCLUSIONS: Microscopy for AFB is the most efficient method for defining sputum specimens suitable for referral for enhanced mycobacteriological techniques. However, it is essential that the methods used for smear preparation and microscopy are of the highest possible standard, otherwise some patients with infectious pulmonary tuberculosis will be denied, unnecessarily, the benefits of important advances in mycobacteriology.
Being positive about the smear.
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