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Biomedical subjects

S Foster

Publications and source records attributed to S Foster.

At least 19 recordsLinked to original sources
PubMed1998

A comparative study of differences in the referral behaviour patterns of men and women who have experienced cardiac-related chest pain.

Survival and long-term prognosis after a myocardial infarction are directly related to the individuals's decision to seek medical help. Early medical intervention is imperative if thrombolytic therapy is to be effective. Emerging research has indicated that women frequently have longer pre-hospital delays than men. Incorporating a comparative descriptive design, this research compared the pre-hospital admission behaviour patterns of women and men, following the onset of acute chest pain. A convenience sample of 12 women and 12 men were selected following admission to a local coronary care unit. Structured interviews and the examination of medical notes/relevant documentation provided the data. Findings were examined and compared through the use of content analysis and descriptive statistics. Severity of symptoms proved to be the strongest influence in shortening pre-hospital delay. Despite this, overall, men were admitted to hospital more quickly than women. Men were more ready than women to believe that they might be having a heart attack and this belief led them to seek treatment promptly. In order to improve female mortality and morbidity following a myocardial infarction, it is recommended that there is an urgent need to target women, through health promotion and media interventions.

Adult↗
PubMed1998

Economics and its contribution to the fight against malaria.

About 5% of deaths worldwide are due to malaria, and 5% of the total disease burden among children is due to malaria. The burden is much greater in sub-Saharan Africa, with 15% of all disability-adjusted life-years (DALY) lost to malaria. Malaria is costly, too: an estimated U.S. $1800 million is spent annually on both direct costs of prevention and care, and on indirect costs such as lost productivity, time costs and other indirect costs and losses. There are several economic issues to be addressed with regard to malaria. For example, is malaria control important in comparison with other claims on scarce health resource? Secondly, which approach or strategy for prevention and treatment is most appropriate, given the local circumstances? Thirdly, within each strategy chosen (e.g. diagnosis and treatment of cases), which options are available and which is the best? Within the choice of strategy and design, other issues arise, such as the best options for prevention, and their cost. What strategy is best for case finding? How much should be spent on diagnostics? Under which circumstances does mass treatment make economic sense? When should a new, more expensive drug be used in cases of resistance? Perhaps most importantly, the overall approach needs to be reviewed to ensure that resources are being used to best effect. The role of economics in decision making is the subject of the present review.

Africa South of the Sahara↗
PubMed1997

5'-Capping enzymes are targeted to pre-mRNA by binding to the phosphorylated carboxy-terminal domain of RNA polymerase II.

We have investigated the role of the RNA Polymerase II (Pol II) carboxy-terminal domain (CTD) in mRNA 5' capping. Transcripts made in vivo by Pol II with a truncated CTD had a lower proportion of capped 5' ends than those made by Pol II with a full-length CTD. In addition, the enzymes responsible for cap synthesis, RNA guanylyltransferase, and RNA (guanine-7)-methyltransferase bound directly to the phosphorylated, but not to the nonphosphorylated, form of the CTD in vitro. These results suggest that: (1) Pol II-specific capping of nascent transcripts in vivo is enhanced by recruitment of the capping enzymes to the CTD and (2) capping is co-ordinated with CTD phosphorylation.

Amino Acid Sequence↗
PubMed1997

Modelling the economic benefits of tuberculosis preventive therapy for people with HIV: the example of Zambia.

OBJECTIVE: To assess the economic benefits and costs of providing isoniazid preventive therapy for tuberculosis (TB) in HIV-infected persons in Zambia. DESIGN: A spreadsheet model incorporating variables drawn from published studies and unpublished data. SUBJECTS: Data drawn from a number of different studies and published literature involving a range of subjects. SETTING: Zambia. RESULTS: Using data primarily from Zambia we have modelled the costs and benefits of a TB preventive therapy programme using daily isoniazid for 6 months. The basecase scenario assumes recruitment at a voluntary testing and counselling site where HIV seroprevalence is 30%; persons with HIV have a 25% probability of developing active TB during their lifetime; two additional cases of TB would be prevented per person completing a course of preventive therapy; compliance would be 63%, and the efficacy of the isoniazid in preventing active TB of 60%. The costs under this scenario would exceed the benefits by a factor of 1.16 [benefit: cost ratio (BCR) of 0.86]. However, if preventing one case of TB prevented an additional five cases, the benefits would exceed the costs by a significant margin (BCR of 1.71). Other scenarios indicate that the targeted preventive therapy of persons with HIV whose occupation or living situation places them in contact with a large number of others (teachers and students, health personnel, military and police, miners, prisoners, etc.) would yield significant net benefit. The operational challenge for TB preventive therapy is thus to identify and target large numbers of such persons.

AIDS-Related Opportunistic Infections↗
PubMed1997

Efficacy of lorazepam and haloperidol for rapid tranquilization in a psychiatric emergency room setting.

The efficacy of a benzodiazepine was compared with that of a neuroleptic for the rapid tranquilization of patients presenting at a psychiatric emergency room service. Thirty-seven highly agitated patients exhibiting psychotic symptoms were randomly assigned to receive either 2 mg lorazepam or 5 mg haloperidol as needed every 30 min for 4 h. Administration route was either intramuscular injection or oral concentrate. Symptom ratings were conducted each hour using double-blind procedures. Both medications reduced symptom ratings on the Brief Psychiatric Rating Scale and Global Clinical Impression of Overall Symptom Severity Scale. Global Clinical Impression scores for the two medication groups did not differ significantly either at baseline or at 4 h after entry into the study. However, Global Clinical Impression scores of patients in the lorazepam group were less severe at intermittent ratings. The groups did not differ on the Brief Psychiatric Rating Scale at any rating time. No differences were found either in the number of doses administered or in the administration route selected. Given the potential for severe extrapyramidal symptoms developing hours or days after a single dose of haloperidol, lorazepam may provide an excellent alternative for the rapid tranquilization of the acutely agitated psychotic patient in the emergency room setting.

Administration, Oral↗
PubMed1997

Nasopharyngeal cryptococcosis.

Naturally occurring cryptococcosis in five cats, a dog and a koala is described. Involvement of the nasopharynx was documented in all patients, and nasopharyngeal mass lesions accounted for the major presenting complaints in four. Signs referable to nasopharyngeal disease included snoring, stertor, inspiratory dyspnoea and aerophagia. Diagnoses were made by caudal rhinoscopy using a retroverted flexible endoscope, vigorous orthograde flushing with saline, or at necropsy. Concurrent cryptococcal rhinitis was present in all cases, although involvement appeared limited to the caudal nasal cavity in most cases. Typical signs of nasal cavity disease, such as sneezing and nasal discharge, were often absent. Treatment of nasopharyngeal cryptococcosis should include physical dislodgement or debulking of lesion(s) to provide immediate alleviation of upper airway obstruction, followed by systemic antifungal therapy to eliminate residual infection from the nasal cavity. Infections caused by Cryptococcus neoformans var gattii accounted for a disproportionately large number of these cases.

Animals↗
PubMed1997

G protein and thyrotropin receptor mutations in thyroid neoplasia.

The cAMP pathway plays a central role in thyroid follicular cell growth and function. Mutations of the TSH receptor (TSHR) or G proteins (gsp) that activate adenylyl cyclase have been identified in autonomously functioning thyroid nodules. Gsp mutations have been identified also in other forms of thyroid neoplasia, but their reported prevalence has been extremely variable. We have studied the prevalence of gsp mutations and activating mutations of Gi2 alpha (gip) in a series of 66 benign and 34 malignant thyroid tumors. Thirty-six tumors were from Boston and 64 from the UK. In addition, we examined the 64 UK tumors for mutations of the TSHR gene. DNA extracted from fresh-frozen or paraffin-embedded tissue was amplified by PCR and examined for mutations using oligonucleotide-specific hybridization and single-strand conformation polymorphism analysis. No G protein gene mutations were identified in the Boston tumors. One gsp mutation, R201C, in a Hürthle cell adenoma and 1 gip mutation, R179C, in a follicular adenoma were demonstrated in tumors from the UK. Oligonucleotide-specific hybridization and single-strand conformation polymorphism analysis of the UK tumors did not demonstrate any mutations of the TSHR gene. Eleven normal thyroid tissue samples were wild-type for Gs alpha, Gi2 alpha, and the TSHR gene.

Amino Acid Sequence↗
PubMed1997

Metastatic prolactinoma: effect of octreotide, cabergoline, carboplatin and etoposide; immunocytochemical analysis of proto-oncogene expression.

A 49-yr-old woman presented with an extensive prolactinoma (serum PRL > 10,000 mU/L, normal range < 450 mU/L). Over a 5-yr period following transsphenoidal surgery and pituitary irradiation, she became increasingly resistant to high doses of bromocriptine and underwent transfrontal surgery followed by stereotactic radiotherapy. In spite of these treatments, serum prolactin estimations rose progressively to > 100,000 mU/L. Magnetic resonance imaging scanning demonstrated a massive cystic tumor invading the temporal lobes, extending into the cervical and thoracic spine, with metastases to cervical lymph nodes. High-dose cabergoline administration resulted in a 30% decrease in serum PRL. Octreotide was administered as a continuous sc infusion with a profound analgesic effect on facial pain but with no effect on tumor progression. She was treated with a course of chemotherapy consisting of carboplatin and etoposide without any noticeable effect. The patient died 6 months following chemotherapy. Immunocytochemical analysis demonstrated positive nuclear staining for WAF-1, Rb protein, c-myc, and p53 both in the original and metastatic tumors. The metastases but not the primary tumor stained for c-jun. Metastatic prolactinoma remains a therapeutic challenge. It is associated with a variable proto-oncogene expression, which may be coincidental or causal. Cabergoline had no advantage over bromocriptine. Octreotide relieved facial pain but did not alter tumor progression. An effective therapy for metastatic prolactinoma remains to be identified.

Antineoplastic Agents, Hormonal↗
PubMed1996

Alpha-melanocyte-stimulating hormone reduces endotoxin-induced liver inflammation.

Alpha-Melanocyte-stimulating hormone (MSH) is a potent anti-inflammatory agent in many models of inflammation, suggesting that it inhibits a critical step common to different forms of inflammation. We showed previously that alpha-MSH inhibits nitric oxide (NO) production in cultured macro-phages. To determine how alpha-MSH acts in vivo, we induced acute hepatic inflammation by administering endotoxin (LPS) to mice pretreated with Corynebacterium parvum, alpha-MSH prevented liver inflammation even when given 30 min after LPS administration. To determine the mechanisms of action of alpha-MSH, we tested its influence on NO, infiltrating inflammatory cells, cytokines, and chemokines. Alpha-MSH inhibited systemic NO production, hepatic neutrophil infiltration, and increased hepatic mRNA abundance for TNF alpha, and the neutrophil and monocyte chemokines (KC/IL-8 and MCP-1). We conclude that alpha-MSH prevents LPS-induced hepatic inflammation by inhibiting production of chemoattractant chemokines which then modulate infiltration of inflammatory cells. Thus, alpha-MSH has an effect very early in the inflammatory cascade.

Animals↗
PubMed1996

Pyronaridine.

Explore the source record for details and available documents.

Antimalarials↗
PubMed1996

Eye movement desensitization and reprocessing: effectiveness and autonomic correlates.

Eighteen subjects distressed by memories of a specific traumatic event were randomly assigned to a single session of one of three conditions: Eye Movement Desensitization and Reprocessing (EMDR), a Time Interval Condition (TIC), or Tapping Alternate Phalanges (TAP). All subjects treated in the EMDR group showed desensitization as monitored by SUDs, which correlated with the physiological data and cessation of pronounced symptomatology. Only one subject in a control group showed desensitization. Compared to TIC and TAP, autonomic measures showed distinct changes during EMDR: (1) respiration synchronized with the rhythm of the eye movements in a shallow, regular pattern; (2) heart rate slowed significantly overall; (3) systolic blood pressure increased during early sets, invariably declined during abreactions, and decreased overall; (4) finger tip skin temperature consistently increased; and (5) the galvanic skin response consistently decreased in a clear "relaxation response". This relaxing effect of the eye movements suggests that at least one of the mechanisms operating during EMDR is desensitization by reciprocal inhibition, by pairing emotional distress with an unlearned or "compelled" relaxation response.

Adult↗
PubMed1996

Magnetic resonance venography versus contrast venography to diagnose thrombosis after joint surgery.

Magnetic resonance venography is a recently developed, noninvasive means of visualizing the proximal veins of the lower extremity and pelvis. Magnetic resonance venography is compared with standard contrast venography in the diagnosis of proximal deep vein thrombosis after total joint arthroplasty. Two hundred seven extremities were evaluated in a blinded study 5 to 7 days after surgery. Standard contrast venography identified 11 proximal deep vein thromboses. Initial interpretations of the magnetic resonance venographies by staff radiologists identified 5 of the proximal vein thromboses (sensitivity 45%). Two patients with negative standard contrast venographies were identified as positive (specificity 99%). A retrospective review of all magnetic resonance venographies by a dedicated magnetic resonance angiographer identified 10 of 11 deep vein thromboses seen on standard contrast venography (sensitivity 91%). Both false negatives were identified as positives. Standard contrast venography remains the gold standard for identifying proximal vein thromboses. Emerging magnetic resonance imaging techniques have created a potential alternative modality by which to identify deep vein thrombosis. The present study suggests that standard contrast venography continues to be the most accurate modality currently available. Although magnetic resonance venography seems to be accurate, its interpretation requires experience. As costs diminish and experience increases, magnetic resonance venography will have increased importance in the clinical recognition of deep vein thrombosis.

Adult↗
PubMed1996

Sharing antenatal care: client satisfaction and use of the 'patient-held record'.

Two hundred women (148 shared care patients and 52 clinic patients) completed a questionnaire about care received during pregnancy and the use of a patient-held record. Women receiving shared care reported higher levels of satisfaction with their care than clinic patients (p < 0.0001). Thirty-six percent of the women in shared care forgot to take their record to an appointment on at least 1 occasion. During the pregnancy, over half of the respondents in both groups made contact with the hospital for reasons other than for their regular visit. For both groups, convenience was the most frequently reported reason for choosing their model of care. Other important issues for shared care patients were that the service was more personal and more information was provided. Among clinic patients, safety and quality of care were identified as important. Problems involved with the patient holding the only complete pregnancy record are discussed.

Family Practice↗
PubMed1996

Differences in the anti-basement membrane zone antibodies in ocular and pseudo-ocular cicatricial pemphigoid.

PURPOSE: Ocular cicatricial pemphigoid (OCP) is a chronic autoimmune cicatrizing disease which affects the conjunctiva and other squamous epithelium, resulting in a scarring process. A similar process, limited only to the conjunctiva, observed in some patients using eye drops for the treatment of glaucoma, is called pseudo-ocular cicatricial pemphigoid (P-OCP). Immunofluorescence studies demonstrate deposition of immunoglobulins and complement components in the basement membrane zone (BMZ) of the conjunctiva and an anti-basement membrane zone antibody in the serum of patients. A striking association between OCP and MHC class II gene DQB1*0301 has been observed. The purpose of this study was to determine some of the differences in the binding of OCP and P-OCP sera to different lysate in an immunoblot assay, in an attempt to partially characterize the OCP and P-OCP antigens. Furthermore, we wanted to determine if the MHC class II gene association of P-OCP is similar to that of OCP. METHODS: We studied sera from 11 patients with active ocular cicatricial pemphigoid and seven patients with pseudo-ocular cicatricial pemphigoid and controls. Indirect immunofluorescence (IIF) studies were done using monkey esophagus and salt split normal human skin as substrate. A sensitive immunoblot assay (IBA) was developed using normal human epidermis, dermis and conjunctiva as substrate. Typing for MHC class II genes was performed on eight pseudo-ocular cicatricial pemphigoid patients by dot-blot analysis and compared to 38 matched controls. RESULTS: Weak staining of the basement membrane zone was observed in nine of ten ocular cicatricial pemphigoid sera and five of seven pseudo-ocular cicatricial pemphigoid sera in the IIF assay using monkey esophagus. Using salt split human skin as substrate, ten of eleven ocular cicatricial pemphigoid sera demonstrated low titer weak binding to the epidermal side of the split. No consistent pattern of staining was seen with pseudo-ocular cicatricial pemphigoid sera. Ten of the 11 ocular cicatricial pemphigoid sera demonstrated binding to 230, 205, 160 and 85 kDa proteins in the IBA using normal human epidermis and conjunctiva lysates. When the lysates were first reacted with BP sera and then immunoblotted with ocular cicatricial pemphigoid sera, the 230, 160, and 86 kDa bands disappeared, and only the 205 kDa band persisted. The sera of five of seven pseudo-ocular cicatricial pemphigoid patients bound to 290, 230, 205, 180, 97, and 85 kDa proteins in the epidermis and conjunctiva. However, the 230, 205, 180, and 85 kDa proteins are depleted when the lysates are first reacted with BP and ocular cicatricial pemphigoid sera. In the dermal lysate, the pseudo-ocular cicatricial pemphigoid sera recognize 400, 290, 150 and 45 kDa proteins. None of these are absorbed by BP, ocular cicatricial pemphigoid or pemphigus vulgaris or epidermolysis bullosa acquisita sera. The 290 kDa proteins identified in the dermis and epidermis are distinct from each other. No binding was seen with control sera with the 3 lysates. Statistically, dot-blot analysis did not demonstrate a significant increase in the frequency of the MHC DQB1*0301 gene. CONCLUSIONS: Patients with ocular cicatricial pemphigoid and pseudo-ocular cicatricial pemphigoid produce several autoantibodies. However, there are similarities and differences between them. The MHC class II genes associated with pseudo-ocular cicatricial pemphigoid are different from those with ocular cicatricial pemphigoid. This provides a new model system to study the immune abnormalities in idiopathic and drug-related organ specific autoimmunity.

Autoantibodies↗
PubMed1996

Significant savings achieved by implementing event related outdating.

The event related outdating(ERO) theory is based on the assumption that items that are properly cleaned, wrapped, sterilized, stored and handled will remain sterile indefinitely unless the integrity of the package becomes compromised. The authors describe how one Surgical Suite (performing approximately 600 cases/month) implemented an ERO program with estimated annual savings of almost $10,000/year.

Alberta↗
PubMed1995

Benefits of HIV screening of blood transfusions in Zambia.

Blood transfusion continues to be an important route of transmission of HIV in developing countries, especially for young children following the perinatal period. Testing for HIV is costly and reliable donor support for the purchase of test kits is often essential, yet difficult to secure. The costs of screening transfusions for HIV and the financial benefits in terms of savings on treatment costs averted were calculated for a district hospital in Zambia where seroprevalence among donors was 15.9%. Financial benefits exceed costs by a factor of 2.7-3.5. In 1991, 1073 transfusions were given and an estimated 150 cases of transfusion-related AIDS were prevented by screening, of which 59% were in children aged 5 years or under and 31% were in women. The total cost of HIV screening was 3061 pounds ($4745), and the cost per case of HIV infection prevented was 20.40 pounds ($31.62); the cost of this protection for the population served by the hospital was 0.02 pounds ($0.03) per person. An estimated 3625 undiscounted healthy years of life were saved, of which nearly 69% were in children under 6, at a cost of 0.85 pounds ($1.32) per year of life saved. It is essential that financial and political support for HIV screening of blood for transfusion is maintained.

AIDS Serodiagnosis↗