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Biomedical subjects

S Phillips

Publications and source records attributed to S Phillips.

At least 127 records · Page 7Linked to original sources
PubMed1994

Surveillance for stroke in Canada.

The goal of surveillance is to identify patterns of disease occurrence, detect disease outbreaks, develop clues about possible risk factors, find persons that need further investigation, and anticipate health service needs. Two sources of data are available for the purposes of surveillance: primary data, such as those arising from health surveys or local population-based registries; and secondary data, arising from large administrative databases. The effectiveness of any program to monitor the health of a community can be judged by the application of three "r's": right (accuracy), reasonable (cost) and rapid (speed). Programs using primary sources of data satisfy only one of the three "r's," that of accuracy. Programs using secondary sources sacrifice accuracy for speed and cost. The challenge for Canada in setting up surveillance for stroke is that there is a relatively small population unevenly distributed over a very large geographical area. To date, surveillance in Canada has consisted of a combination of individually initiated research projects and government sponsored programs. The main focus has been to tackle the issue of the accuracy of the large databases by validating the discharge codes listed in the provincial hospital discharge databases. Three provinces have carried out independent validation studies yielding remarkably similar results, and this lends confidence that hospital discharge databases will provide a means of carrying out surveillance for at least this one aspect of stroke. It is likely that any program for stroke surveillance in Canada will be multifaceted, involving the use of large computerized databases supplemented by hospital-based registries set up in a few highly motivated local centres. Stroke surveillance will best be accomplished by a joint effort between government and researchers to ensure that the end product is of high quality and will meet the needs of improving the health of Canadians.

Aged↗
PubMed1993

Pediatric gastrointestinal decontamination in acute toxin ingestion.

The appropriate implementation of the various modalities of gastrointestinal (GI) decontamination is critical in the management of the pediatric patient who is examined in the emergency department or private office after an acute ingestion. Gastrointestinal decontamination includes gastric lavage, syrup of ipecac, activated charcoal, and whole bowel irrigation. Clinical studies have delineated the role and efficacy of these procedures. Trends in GI decontamination place less emphasis on ipecac and gastric lavage and more emphasis on activated charcoal alone in the patient with a mild overdose. Gastric lavage is indicated in serious ingestion and is most effective if done soon after the exposure. Whole bowel irrigation is the newest addition and has important clinical use in the treatment of serious iron ingestions as well as in older adolescent cocaine body suffers and packers. Indications and contraindications of the various forms of GI decontamination are discussed and relevant clinical studies are reviewed.

Charcoal↗
PubMed1993

Identification of an uncommon haptoglobin type using DNA and protein analysis.

The inherited variations in haptoglobin phenotypes are attributed to the homozygous and heterozygous combinations of three common autosomal alleles: HP*1F, HP*1S and HP*2. HP*1F and HP*1S encode polypeptides that differ by two amino acids at positions 51 and 53. The formation of HP*2 is postulated to have resulted from a breakage and subsequent reunion event at non-homologous positions of two HP*1 alleles. The most common form of HP*2 is HP*2FS in which the 5' end of HP*2 resembles HP*1F and the 3' end resembles HP*1S. Homologous crossing over between HP*2 and either an HP*1F or HP*1S allele in HP*2/HP*1 heterozygotes can change the usual type of HP*2 to three other forms: HP*2SS, HP*2FF or HP*2SF. We describe a nuclear family in which the uncommon genotype HP*2SS is one parent caused initial confusion in assigning genotypes to the rest of the nuclear family. The data demonstrate the need for a cautious approach when deducing haptoglobin genotypes from molecular analysis alone.

Alleles↗
PubMed1993

Prevention of toxicity from oral cocaine by activated charcoal in mice.

STUDY OBJECTIVE: To study the effectiveness of activated charcoal in preventing toxicity after an enterally administered cocaine hydrochloride overdose in mice. DESIGN: A prospective, randomized, controlled animal laboratory investigation. INTERVENTIONS: Fasted mice were given aqueous cocaine hydrochloride (0.8% final concentration) 100 mg/kg body weight orally by gavage tube. One minute later, animals received one of three treatments by gavage: 1 g activated charcoal/kg body weight, 2 g activated charcoal/kg body weight, or an equivolume of water (control). All treatments consisted of 20 mL/kg body weight of an activated charcoal slurry with water. MEASUREMENTS: After 24-hour observation, proportions of seizures and deaths between each group were compared using Pearson chi 2 test followed by Fisher's exact test (P < .017 for significance after Bonferroni's correction). MAIN RESULTS: There were 20 seizures and 16 deaths in the control group (20 mice). There were four seizures (P = .0004) and one death (P = .0004) in the 1-g activated charcoal/kg group (ten mice) and five seizures (P = .0018) and three deaths (P = .015) in the 2-g activated charcoal/kg group (ten mice). CONCLUSION: In this mouse model, activated charcoal decreased the incidence of seizures and death after an enteral cocaine hydrochloride overdose.

Administration, Oral↗
PubMed1993

Adventitial elastolysis is a primary event in aneurysm formation.

PURPOSE: Adventitial elastin degradation is a hallmark of abdominal aortic aneurysm (AAA) formation in human beings, although the quantitative relationship between elastin loss and AAA formation and growth is unknown. This study was undertaken to quantitate the reduction of adventitial elastin for small AAA, to determine whether the loss of this structural component parallels aneurysm growth, and to examine the ultrastructure of the remaining elastin elements. METHODS: Longitudinal strips of anterior aneurysm wall were taken from 12 patients having elective repair of small (diameter < 5 cm, n = 4), moderate (diameter < 5 to 7 cm, n = 4), or large (diameter > 7 cm, n = 4) AAA and from six normal control subjects at autopsy. Specimens were prepared with elastin and collagen stains for histologic examination or formic acid for scanning electron microscopic evaluation of elastin architecture. Adventitial elastin content of aneurysmal and control aortas was quantitated with video microscopy and compared by aneurysm diameter. RESULTS: The inner portion of adventitia of normal aortic wall was composed of densely compacted alternating lamellae of elastin and collagen, which were grossly disrupted in all aneurysms. The remaining elastin fibers were disorganized and tortuous. There was an 81.6% +/- 2.1% reduction in elastin lamellae and an 85.7% +/- 4.2% reduction in fibers per lamellae compared with the number in control aortas (p < 0.001). Size of the aneurysm made no difference in adventitial elastin content. CONCLUSION: These data strongly suggest that elastolysis is a primary event in AAA formation that occurs before over loss of adventitial structural integrity and the development of small aneurysms.

Aged↗
PubMed1993

Preoperative drinking does not affect gastric contents.

We have compared the effect of allowing free clear fluids until the time of oral premedication with conventional preoperative fasting. In a prospective, randomized trial, the residual volume and pH of gastric contents after induction of anaesthesia were measured in 100 elective surgical patients allocated randomly to a group in whom the intake of free clear fluids up to the time of premedication was measured (mean 388 ml in 6 h before surgery) or a control group who were fasted for 6 h. Preoperative drinking did not affect either mean (SD) residual gastric volume (22 (21) ml in the study group vs 19 (16) ml in the control group) or pH (study group 2.64 (1.57) vs control group 2.26 (1.45)). The study group experienced less preoperative thirst. Problems with aspiration or regurgitation were not encountered. We believe that allowing elective surgical patients to drink clear fluids until 2 h before anaesthesia may enhance patient comfort without compromising safety.

Adult↗
PubMed1993

Adrenaline-induced hypotension in neurosurgery.

We have compared the effects of scalp infiltration with 0.5% lignocaine, 0.5% lignocaine with adrenaline 1:200,000, 0.9% saline and 0.9% saline with adrenaline 1:200,000, in a prospective, randomized, double-blind study. Direct arterial pressure, heart rate and bleeding at incision were recorded in 80 patients undergoing craniotomy or craniectomy. Arterial pressure decreased by more than 20% from preinfiltration values in 40% of patients in the saline with adrenaline group, and in 55% of patients in the lignocaine with adrenaline group. It did not decrease in patients who did not receive adrenaline.

Adolescent↗
PubMed1993

Highly specific V3 peptide enzyme immunoassay for serotyping HIV-1 specimens from Thailand.

OBJECTIVE: To develop and evaluate a simple V3 peptide-based enzyme immunoassay (EIA) for large-scale serotyping of HIV-1 specimens from Thailand. DESIGN: Serologic reactivities with synthetic peptides derived from the V3 loop of gp120 were used for typing HIV-1 specimens. METHODS: Synthetic peptides PND-A and PND-B, derived from the consensus amino-acid sequences of the V3 loop of gp120 from two major genomic variants of HIV-1 in Thailand (A and B), were evaluated in an EIA on 61 Thai HIV-1 sera for which genotypes had been determined by polymerase chain reaction. The peptide EIA was then applied to sera from 188 HIV-1-infected patients, selected in non-random, convenience samples of known risk groups from four geographic regions of Thailand. RESULTS: The sensitivities and specificities of PND-A and PND-B were 86% (30 out of 35) and 96% (25 out of 26) and 92% (24 out of 26) and 94% (33 out of 35), respectively, with 100% predictive values of a monoreactive positive test for both peptides. The assay classified 101 specimens as serotype A, 39 as serotype B, eight as serotype AB (dually reactive), and 40 as untypable (non-reactive). Excluding dual reactors and non-reactors, 92% (77 out of 84) of specimens from patients probably infected by sexual contact were serotype A; conversely, 76% (28 out of 37) of injecting drug users were serotype B. CONCLUSION: The serologic results corroborated previous findings, in a smaller subset of samples, of an apparent segregation of viral subtypes by mode of transmission, suggesting two separate HIV-1 epidemics in Thailand. This peptide EIA could be a valuable epidemiologic tool in determining the dynamics of the rapid spread of HIV-1 in Thailand.

Comorbidity↗
PubMed1993

Zingiber officinale does not affect gastric emptying rate. A randomised, placebo-controlled, crossover trial.

The effect of the powdered rhizome of Zingiber officinale (ginger root) on the gastric emptying rate was investigated. In a double-blind crossover trial, 16 healthy volunteers were randomly allocated to receive either 1 g of ginger or placebo. Gastric emptying was measured using the oral paracetamol absorption model. Ingestion of ginger did not effect gastric emptying. The antiemetic effect of ginger is not associated with an effect on gastric emptying. No adverse effects were noted.

Acetaminophen↗
PubMed1993

Zingiber officinale (ginger)--an antiemetic for day case surgery.

The effect of powdered ginger root was compared with metoclopramide and placebo. In a prospective, randomised, double-blind trial the incidence of postoperative nausea and vomiting was measured in 120 women presenting for elective laparoscopic gynaecological surgery on a day stay basis. The incidence of nausea and vomiting was similar in patients given metoclopramide and ginger (27% and 21%) and less than in those who received placebo (41%). The requirement for postoperative antiemetics was lower in those patients receiving ginger. The requirements for postoperative analgesia, recovery time and time until discharge were the same in all groups. There was no difference in the incidence of possible side effects such as sedation, abnormal movement, itch and visual disturbance between the three groups. Zingiber officinale is an effective and promising prophylactic antiemetic, which may be especially useful for day case surgery.

Adult↗
PubMed1993

A barrier to continuity of care. Effects of the drug tariff on wound care in the community.

In light of the recent implementation of the Community Care Act, it is paradoxical that many products and dressings needed by community nurses are not available to them. This causes particular problems for patients discharged from hospital requiring continuity of wound care. What can be done to improve community nurses' access to the full range of products?

Community Health Services↗
PubMed1992

High-efficiency receptor-mediated delivery of small and large (48 kilobase gene constructs using the endosome-disruption activity of defective or chemically inactivated adenovirus particles.

One limit to successful receptor-mediated gene delivery is the exit of the endocytosed material from the endosome. We demonstrate here the delivery of marker genes to tissue culture cells using a modification of the receptor-mediated gene delivery technique that exploits the endosomolytic activity of defective adenovirus particles. In particular, greater than 90% of the transfected-cell population is found to express a beta-galactosidase gene, and, most importantly, this high level of expression can be obtained with psoralen-inactivated virus particles. Furthermore, because the delivered gene is not carried within the genome of the adenovirus particle, the size constraints are relieved, and we can, therefore, show the delivery of a 48-kilobase cosmid DNA molecule.

Adenoviruses, Human↗