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PubMedDate not supplied

Primary gastric lymphoma: distribution and clinical relevance of different epidemiological factors.

BACKGROUND: Over the last 10 years the incidence of primary gastric lymphomas (PGL), and in particular those of MALT origin, has significantly increased. Recent works correlated this epidemiological observation to Helicobacter pylori (HP) infection. On the other hand, new evidence demonstrating that occupational exposure to pesticides and solvents has played an important role in the pathogenesis of non-Hodgkin lymphomas (NHL) has emerged from studies involving large series of patients. METHODS: Thirty PGL patients, observed between 1986-1992, were subdivided according to HP infection, history of previous gastric disturbances (G) and exposure to pesticides and solvents (T). RESULTS: On the basis of these parameters we divided the patients into three groups: T+HP+ (8), T+HP- (7), T-HP+ (9). T+ patients had a positive history of gastric problems or a positive histological biopsy in 13.3% of cases, versus 66.7% in T- patients. The incidence of HP infection in the T+ group was 53%, which proved to be comparable to the statistics for northeastern Italy, while in the T- group the incidence of infection was 100%. CONCLUSIONS: On the whole these data suggest that HP infection could be considered a pathogenetic factor in 34% of patients, while occupational exposure to pesticides and solvents could have played a more important role in 66% of these cases.

Aged↗

PubMed1996

Species distribution of clinical isolates of Staphylococci.

Species identification of 103 strains of staphylococci isolated from various clinical specimens revealed as many as eight species. S. aureus was the commonest isolate (57.28%) followed by S. epidermidis (17.47%). S. hominis (8.73%), S. saprophyticus (6.79%), S. intermedius, S. capitis and S. cohni (1.94% each) in decreasing order. They were mostly isolated from pus (41.74%) followed by urine (22.33%) and blood (18.44%) accordingly. Of the total isolates, 65 were coagulase positive while 38 isolates were coagulase negative. Phase typing of S. aureus strains revealed that 49 isolates were typable of which 17 isolates belonged to phase group III, 16 to phase group 1, 4 to group II and 3 belonged to group V while 9 strains could not be grouped. The antibiotic resistance pattern showed maximum resistance to penicillin (63.10%) while resistance was minimum with gentamycin (8.73%). Resistance to ampicillin (51.45%), cephazoline (51.45%), erythromycin (31.06+) and cloxacillin (18.44%) was low to moderate. The increasing recognition of pathogenic potential of various species of staphylococci and emergence of drug resistance amongst them denotes the need to adopt better laboratory procedures to identify and understand the diversity of staphylococci isolated from clinical material.

Coagulase↗

PubMedDate not supplied

Isotype distribution and clinical significance of antibodies to cardiolipin, phosphatidic acid, phosphatidylinositol and phosphatidylserine in systemic lupus erythematosus: prospective analysis of a series of 92 patients.

OBJECTIVE: To determine the prevalence and correlation with clinical manifestations of the IgG and IgM isotypes of antibodies to cardiolipin (aCL), phosphatidic acid (aPA), phosphatidylinositol (aPI) and phosphatidylserine (aPS) in patients with systemic lupus erythematosus (SLE). METHODS: Clinical and laboratory features of 92 consecutive unselected patients with SLE were prospectively studied over two years. aCL, aPA, aPI and aPS were determined by ELISA. RESULTS: aCL were detected in 34 (37%) patients, aPA in 26 (28%), aPI in 22 (24%), and aPS in 29 (32%). A significant association was found between the appearance of thrombosis and the presence of IgG aCL (p < 0.001) and IgG aPS (p < 0.05). A significant association was also found between thrombocytopenia and the presence of IgG aCL (p < 0.001), IgG aPA (p < 0.01), IgG aPI (p < 0.05), and IgG aPS (p < 0.001). The development of hemolytic anemia was associated with the detection of IgM aCL (p < 0.001), IgM aPA (p < 0.05), IgM aPI (p < 0.001), and IgM aPS (p < 0.01). CONCLUSION: We found a relatively high prevalence of aCL, aPA, aPI and aPS in our SLE population and confirmed the presence of a correlation between the IgG isotype of these antibodies and thrombosis and thrombocytopenia, and also between the IgM isotype and hemolytic anemia. These results demonstrate the variety of antiphospholipid antibodies that can be detected in SLE patients, as well as their association with the clinical manifestations of the antiphospholipid syndrome.

Adolescent↗

PubMed2004

Clinical and environmental distributions of Legionella strains in France are different.

In France, the clinical distribution of Legionella species and serogroups does not correspond to their environmental distribution. Legionella pneumophila serogroup 1 is more prevalent among clinical isolates (95.4%) than in the environment (28.2%), whereas L. anisa is more frequent in the environment (13.8%) than in the clinical setting (0.8%).

France↗

PubMed1993

Establishment of a bone marrow transplant satellite pharmacy.

The planning, establishment and operation of a bone marrow transplant (B.M.T.) satellite pharmacy in a 1100-bed teaching hospital are described. The B.M.T. satellite pharmacy was established because of the specialized pharmaceutical care needs of this patient population with a high risk for drug-related problems. The satellite pharmacy, which is located within a 19-bed Oncology Unit, provides integrated clinical-distributive services (unit-dose, IV-admixture system) to all B.M.T. patients. The satellite is open 10.5 hours per day, seven days per week. Staff consists of three full-time equivalent (F.T.E.) staff pharmacists, a 0.5 F.T.E. technician, and one F.T.E. clinical pharmacist. Staff pharmacists rotate between provision of B.M.T. pharmacy services, and provision of pharmacy services for the provincial Home Parenteral Nutrition program. The pharmacists are responsible for all aspects of drug distribution and clinical services for B.M.T. patients. Additional drug distribution and clinical services are provided to other Oncology Unit patients. The establishment of a satellite pharmacy has provided unique opportunities for pharmaceutical care of the B.M.T. patient.

Bone Marrow Transplantation↗

PubMed1989

Clinical features and distribution of malignant melanoma and pigmented nevi on the soles of the feet in Japan.

This study, based on 842 cases of malignant melanoma from 108 medical schools and medical centers in Japan (from 1983 to 1985), presents information regarding the incidence, sex and age distribution, anatomical location, and clinical features of malignant melanoma in Japan and compares it with data from the United States. In the white population, the epidemiologic evidence indicates that exposure to sunlight may be an important causal factor of the disease. On the other hand, in more heavily pigmented races, such as Negroids and Orientals, many of the malignant melanomas occur on the skin of the unexposed soles of the foot. In our survey, 241 out of 833 cases of melanoma (28.9%) in Japanese patients involved the skin of the soles. Whites tend to have a wide distribution of cutaneous melanoma over the whole body surface, showing the greatest aggregation of lesions on the head, neck, and trunk, with small number on the soles of the feet. This comparative study revealed that the anatomical distribution and clinical types of malignant melanoma in the United States and Japan were different. The racial difference--the highest frequency or proportion of melanoma on the skin of the soles in the pigmented races, and the lowest ratio of this anatomical area in the least-pigmented races--remains to be investigated.

Age Factors↗

PubMed1995

Prevalence of signs of temporomandibular disorders among elderly inhabitants of Helsinki, Finland.

The prevalence of clinical signs of temporomandibular disorders in 76-, 81-, and 86-year-old subjects living in Helsinki, Finland, were studied, using Helkimo's clinical dysfunction index. In percentage distribution, clinically symptom-free subjects (Di 0) constituted 20% of all those examined, and by percentage the largest group of subjects without signs was that of the oldest men (47%). Women had a higher prevalence of signs of temporomandibular disorders, and only 15% were clinically symptom-free. Four per cent of all those examined had severe symptoms. The commonest signs were impaired range of movement of the mandible and impaired function of the temporomandibular joint.

Aged↗

PubMed1999

Transitions, part 1: beyond pharmaceutical care.

A systems view of the amalgamation of existing pharmacy practice models is proposed. Pharmacy's evolution is traceable as a series of stages. The stages in pharmacy's evolution have been manufacturing pharmacy, compounding, distribution, clinical pharmacy, and pharmaceutical care. Good pharmacy practice (GPP) represents an international attempt to unite various conceptualizations of practice, including pharmaceutical care. GPP in turn provides a foundation for a model to explain current and changing practice, the total pharmacy care (TPC) model. TPC combines five existing practice models: drug information, self-care, clinical pharmacy, pharmaceutical care, and distribution. TPC, as the sum of these models, asserts that there will be an ongoing need for all five existing models of practice, that the proportion of pharmacists employing each model will reflect the needs of a given health care environment at a given time, and that if changes in health care provide more opportunities for pharmaceutical care, pharmacists will shift increasingly toward that type of practice. Total pharmacy care is the delivery of a comprehensive range of services that result in the maximum possible contribution to the health of a nation's population within the limits of the health care delivery structure.

Forecasting↗

PubMed1982

A comparison of the safety, efficacy, and distribution of ceforanide and cephalothin in coronary artery bypass graft surgery.

Antibiotic prophylaxis in open-heart operations is a widely accepted practice. Introduction of new antibiotics with differences in tissue distribution, spectrum of activity and therapeutic index prompts their evaluation as possible effective prophylactic agents. We compared the distribution, clinical efficacy, and safety of ceforanide with cephalothin as a prophylactic agent in coronary artery bypass graft (CABG) procedures. The results indicated that the intravenous administration of ceforanide at the dose of 1 gm every 12 hours for 2.5 days was equivalent to cephalothin 1 gm every 6 hours for 2.5 days. Serum, muscle, and bone concentrations of ceforanide were significantly greater than those of cephalothin. These concentrations consistently exceeded the minimal inhibitory concentration for Staphylococcus aureus, the major pathogen implicated in wound infections. No toxicty was observed with either antibiotic. Ceforanide merits consideration as a prophylactic antibiotic in CABG operations.

Aged↗

PubMed2006

Clinical significance and distribution of putative virulence markers of 116 consecutive clinical Aeromonas isolates in southern Taiwan.

OBJECTIVES: The objectives of this study were to elucidate the clinical manifestations of Aeromonas infections and the association of putative virulence genes with clinical invasiveness. METHODS: 116 consecutive clinical Aeromonas isolates collected from July 1999 to June 2001 in a medical center in southern Taiwan were included. All isolates were identified by biochemical phenotyping and their genomic sequences encoding eight putative virulence factors, including cytolytic enterotoxin (AHCYTOEN), aerolysin (aerA), hemolysin (hlyA), heat-labile enterotoxin (alt), heat-stable enterotoxin (ast), and components of type III secretion system (ascV, aexT and ascF-ascG) were analyzed using polymerase chain reaction and colony blot hybridization. The association of clinical diseases of the patients with the putative virulence genes in the isolates was analyzed. RESULTS: Sixty-two percent of Aeromonas isolates caused clinically evident infections, of which the major clinical manifestations were primary bacteremia (40%), followed by soft tissue infections (27%), and hepatobiliary tract infections (15%). Liver cirrhosis (36%), malignancy (25%), and hepatobiliary diseases (13%) were the major underlying diseases in patients with Aeromonas bacteremia. The majority (64%) of patients with Aeromonas hepatobiliary infections had underlying hepatobiliary diseases, whereas 71% of those with soft tissue infections had antecedent water- or soil-related injuries. The crude fatality rate for Aeromonas infections was 26%. Aeromonas hydrophila complex was the most common (52%) of the three major complex groups investigated, followed by Aeromonas sobria complex (24%) and Aeromonas caviae complex (23%). None of the eight putative virulence factors was associated with invasiveness or bacteremia. CONCLUSIONS: Primary bacteremia, soft tissue infections, and hepatobiliary tract infections are the three major clinical manifestations of invasive Aeromonas infections in southern Taiwan. This study found no association between the presence of AHCYTOEN, aerA, hlyA, alt, ast, ascV, aexT or ascF-ascG genes in Aeromonas isolates and the development of extra-intestinal infections or bacteremia.

Aeromonas↗

PubMed1989

Aerobactin production and plasmid distribution in Escherichia coli clinical isolates.

The distribution of plasmids as a function of aerobactin production, antibiotic resistance and antimicrobial agents production was studied in 139 Escherichia coli strains obtained from clinical sources. Ninety eight per cent of the strains analyzed presented plasmids with a median value of 2.97 plasmids per cell. Differences in the number of plasmids were observed for aerobactin production (3.52 for aerobactin producing strains, 2.56 (for non-producing ones) and antibiotic resistance (3.19 for antibiotic resistant strains and 2.58 for the sensitive ones). But this was not the case for antibacterial agent production (2.96 for the producing strains, 2.98 for the non-producing ones. Ecological implications of these results are discussed.

Bacteriocins↗

PubMed1995

A server architecture for ambulatory patient record systems.

Baylor College of Medicine is developing the Collaborative Social and Medical Services System (CSMSS) to provide a computerized patient record (CPR) system for the Teen Health Clinics (THC) [1]. The THCs consist of five geographically distributed clinics providing health care and social services to teenagers in the Harris County Hospital District. The CSMSS is the first application built upon the Ambulatory Systems Architecture (ASA) [2]. The ASA is aimed at providing an architecture and application framework for the development and deployment of CPR systems in ambulatory care settings. This paper describes the ASA server architecture.

Ambulatory Care↗

PubMedDate not supplied

Access control based on attribute certificates for medical intranet applications.

BACKGROUND: Clinical information systems frequently use intranet and Internet technologies. However these technologies have emphasized sharing and not security, despite the sensitive and private nature of much health information. Digital certificates (electronic documents which recognize an entity or its attributes) can be used to control access in clinical intranet applications. OBJECTIVES: To outline the need for access control in distributed clinical database systems, to describe the use of digital certificates and security policies, and to propose the architecture for a system using digital certificates, cryptography and security policy to control access to clinical intranet applications. METHODS: We have previously developed a security policy, DIMEDAC (Distributed Medical Database Access Control), which is compatible with emerging public key and privilege management infrastructure. In our implementation approach we propose the use of digital certificates, to be used in conjunction with DIMEDAC. RESULTS: Our proposed access control system consists of two phases: the ways users gain their security credentials; and how these credentials are used to access medical data. Three types of digital certificates are used: identity certificates for authentication; attribute certificates for authorization; and access-rule certificates for propagation of access control policy. Once a user is identified and authenticated, subsequent access decisions are based on a combination of identity and attribute certificates, with access-rule certificates providing the policy framework. CONCLUSIONS: Access control in clinical intranet applications can be successfully and securely managed through the use of digital certificates and the DIMEDAC security policy.

Certification↗

PubMed1994

Abnormally phosphorylated tau protein in Alzheimer's disease: heterogeneity of individual regional distribution and relationship to clinical severity.

The distribution of abnormally phosphorylated tau proteins was investigated in a number of cortical areas and in the basal nucleus of Meynert of 12 patients with Alzheimer's disease. Quantification was performed with a sensitive sandwich enzyme-linked immunosorbent assay employing the monoclonal antibody B5-2, which immunoreacts with neurofibrillary tangles, dystrophic neurites surrounding amyloid cores of plaques and neuropil threads. On western blots, the monoclonal antibody B5-2 specifically labels the abnormally phosphorylated paired helical filament-tau species in a phosphorylation-dependent manner but is not cross-reactive to normal tau proteins. The preferential involvement of cytoarchitecturally defined cortical areas showed marked individual differences in Alzheimer's disease, and no unique distribution pattern of abnormally phosphorylated tau proteins could be established. While regional heterogeneities along the rostrocaudal extension of the brain declined with the progression of the disease, lateral differences which were largely non-directional appeared to be more stable over time. The mean content of abnormally phosphorylated tau proteins of individual cases was significantly related to the severity of the disease. On a regional scale, this correlation was highest for the basal nucleus. The formation of abnormally phosphorylated tau was associated with a loss of normal soluble tau proteins. Those cortical areas which in normal brain showed the highest amount of normal soluble tau proteins appeared to be particularly prone to deposition of abnormally phosphorylated tau proteins. The present results indicate that the formation of abnormally phosphorylated tau proteins can be initiated in the neuropil at more than one brain area. The spreading of the pathology appears to involve both intracortical and subcortical pathways but largely spares interhemispheric pathways. It is hypothesized that regional differences in the compartmentation and metabolism of tau proteins might reflect the molecular basis for the regionally different vulnerability in Alzheimer's disease.

Adult↗

PubMed1985

The influence of a hospital pharmacy residency program on career advancement and satisfaction.

A mail survey of practicing hospital pharmacists in British Columbia who graduated since the introduction of hospital residency programs was conducted to determine the influence of a hospital pharmacy residency program on career advancement and satisfaction. Respondents included 33 past residents and 38 non residents. Career advancement was measured by union grade level. Professional and employment satisfaction were assessed using a five-level satisfaction scale. Percentage time allocated to each of administrative, clinical, distributional and research activities was determined for each group. Past residents were also requested to estimate residency program time allocation devoted to these activities which would best prepare them for their present employment. The results of this study indicate that in the ten years the program has been in operation, no difference can be demonstrated between past residents and non residents with respect to career advancement, professional satisfaction or employment satisfaction. Past residents recommend that a hospital residency should consist of approximately 40% clinical activities, 30% distributional activities and the remainder time allocated equally to administrative and research activities. Further research is recommended to evaluate the impact of a hospital pharmacy residency program in a location independent of union grade restrictions and later in the career of past residents to determine the influence of these factors on career advancement and satisfaction.

British Columbia↗

PubMed1996

The spectrum of Helicobacter pylori in upper gastrointestinal disease.

Helicobacter pylori has been recognized as a contributing factor in gastrointestinal disease. Yet, questions remain as to its clinical significance. This prospective study was done to determine the prevalence, distribution, clinical significance, and treatment response of H. pylori gastrointestinal infection. A total of 91 patients with upper gastrointestinal symptoms underwent 122 esophagogastroduodenoscopies (EGD). Biopsies were taken for H. pylori from the gastric fundus, body, antrum, prepylorus, and duodenal bulb; 45.3 per cent of patients with abdominal pain, 27.8 per cent with "heartburn," and 55.6 per cent with anemia/GI bleed had H. pylori infections. Pertaining to EGD findings: 54.2 per cent of patients with gastroduodenal ulcer, 56.4 per cent with gastritis/duodenitis, 37.5 per cent with esophagitis/esophageal ulcer, but only 17.6 per cent with normal findings had H. pylori infection. The distribution of H. pylori: fundus (53.3%); body (55.6%); antrum (85.4%); prepylorus (78.4%); duodenum (15.6%). Treatment for H. pylori was amoxicillin, metronidazole, colloid bismuth with an antisecretory drug. H. pylori was eradicated in 78.9 per cent of patients; 93.3 per cent of these patients had symptomatic improvement and/or ulcer healing. Using stepwise logistic regression, H. pylori eradication was an independent predictor of symptomatic improvement.

Abdominal Pain↗

PubMed2003

Pelvic floor nerve conduction studies: establishing clinically relevant normative data.

OBJECTIVE: The purpose of this study was to establish data for normative distributions for pudendal and perineal nerve compound muscle action potential data in healthy women across a wide age range and varied history of vaginal deliveries. STUDY DESIGN: We studied 42 continent women, aged 20 to 67 years, including 29% nulliparous women with a disposable St. Mark's electrode to stimulate the pudendal nerve at the ischial spine by a transvaginal approach. The pudendal terminal motor latency and amplitude were detected with the use of surface patch electrodes overlying the external anal sphincter; the perineal responses were measured with the use of a surface ring electrode at the proximal urethra. RESULTS: None of the data were distributed normally and required the use of negative inverse and cube root transformations to create a normal distribution. Clinical correlations were found with advancing age and vaginal delivery. CONCLUSION: The collection of these data allows for the definition of normal limits and begins the study of clinically important variables on test results and clinical outcomes.

Action Potentials↗

PubMed2000

STDs aren't sexy: health professionals' lack of adherence to clinical guidelines in an area of high STD endemicity.

BACKGROUND: In 1997 the Health Department of Western Australia distributed clinical guidelines aimed at improving the outcomes of care of patients with STDs. In recognition of the high STD rates and issues peculiar to the Kimberley region, a Kimberley Supplement was inserted into copies distributed in the region. Since then, annual STD workshops have been conducted for all Kimberley health professionals involved in any aspect of STD management. This study aimed to assess whether health professionals were observing the Guidelines and its Kimberley Supplement, and whether adherence improved after the 1998 Kimberley STD workshop tour. METHODS: Over two periods, pre- and post-STD workshops, all pathology request forms for gonorrhoea and chlamydia tests were collected from all laboratories in the region. The outcomes of interest were which of the recommended tests had been requested. Logistic regression was used to analyse associations between adherence to the Guidelines and patient's age, sex and postcode, profession of practitioner, reason for testing and whether the test was performed pre- or post-STD workshops. RESULTS: Minimum appropriate tests were ordered on only 14.5 per cent (98/676) of request forms. Univariate and multivariate analyses showed that minimum appropriate testing was more likely to have been requested on male patients and if the practitioner was a doctor. No improvement was observed after the STD workshops. CONCLUSION: The poor adherence and lack of improvement observed can be explained by Kotter's framework on why transformation efforts fail. This study demonstrates that clinical guidelines are of little value unless they are continuously evaluated.

Adolescent↗