Showing papers in "Irish Journal of Medical Science in 1998"
TL;DR: It is shown that prolonged periods of duty without sleep adversely affect junior doctors, both in their psychological well-being and in their ability to carry out simple tasks.
Abstract: The potential deleterious effects of doctors' long and arduous shifts have received relatively scant attention. This study addressed the effect of a 32 h on-call shift on 16 pre-registration medical house officers in St. James's Hospital, Dublin. We assessed 5 psychological parameters (Tension-Anxiety, Depression-Dejection, Vigour-Activity, Fatigue-Inertia and Confusion-Bewilderment) as well as 5 simple tests of alertness and concentration both pre- and post-call. The doctors were randomly assigned to be tested either pre- or post-call. On average the doctors got 4.5 hours sleep during a 32 h shift. This long shift had an adverse effect on all the psychological parameters (p < 0.05) except Depression-Dejection. The total mood disturbance score, which has been shown to correlate well with general psychological well-being, deteriorated significantly after the 32 h shift, p < 0.005. Two of the simple tests of alertness and concentration (Trail-making test and Stroop Color-Word test) also showed a significant fall-off in performance with sleep deprivation, p < 0.05, although the remaining tests (Delayed Story Recall, Critical Flicker Fusion and Three Minute Grammatical Reasoning Test) were not significantly impaired by the 32 h shift. This study shows that prolonged periods of duty without sleep adversely affect junior doctors, both in their psychological well-being and in their ability to carry out simple tasks.
108 citations
TL;DR: Cardiopulmonary exercise testing with measurement of PVO2 may be helpful in identifying patients more at risk of post-operative complications but should not be used in isolation without thorough clinical assessment.
Abstract: We have investigated the value of cardiopulmonary exercise testing in the pre-operative assessment to patients for abdominal aortic aneurysm repair. Thirty-six patients were entered into the study. All had a pre-operative clinical assessment and investigations including chest radiograph, electrocardiograph, spirometry and echocardiogram with measurement of left ventricular ejection fraction. Each patient performed a symptom limited treadmill exercise test using a STEEP protocol with on-line measurement of respiratory gas exchange. Patients were followed up for 12 months post-operatively by review of casenotes. Thirty out of 36 patients had surgical repair of abdominal aortic aneurysm. There was 1 death in the perioperative period and 2 deaths in the following 12 months. Seven other patients suffered post-operative complications. There were no significant differences in left ventricular ejection fraction, spirometry and peak achieved oxygen consumption (PVO2) between those patients who died or who had post-operative complications and those who had not. However, PVO2 < 20 ml/min/kg was found in 70 per cent of patients who had complications compared with 50 per cent of those who had not. Also 4 patients considered medically unfit for surgery all had PVO2 < 20 ml/min/kg. Cardiopulmonary exercise testing with measurement of PVO2 may be helpful in identifying patients more at risk of post-operative complications but should not be used in isolation without through clinical assessment.
43 citations
TL;DR: The suggestion is that the harm minimisation message, which reached its zenith in the early 1990s, has now been somewhat de-emphasised in both policy and practice and is not reaching the young injectors who have recently initiated intravenous drug use.
Abstract: This study compares the injecting and sexual risk-behaviour of young injectors, with injectors over the age of 25. All respondents presented for the first time at the Merchants' Quay Health Promotion Unit between May 1st 1997 and February 28th 1998. Analysis revealed that the young injectors were significantly more likely to report recently borrowing and lending used injecting equipment, and injecting paraphernalia. Regarding sexual risk behaviour, younger respondents were proportionately more likely to report being sexually active, having multiple sexual partners, and having a regular partner who is an injecting drug user. However, they were significantly more likely than older clients to report condom use. The suggestion is that the harm minimisation message, which reached its zenith in the early 1990s, has now been somewhat de-emphasised in both policy and practice. Consequently, it is not reaching the young injectors who have recently initiated intravenous drug use. Additional strategies are needed this group of drug users, in order to promote positive behaviour changes.
37 citations
TL;DR: The high seroprevalence rate of anti-HEV among male blood donors in Saudi Arabia is demonstrated, demonstrating the high involvement of hepatitis E virus in the local male donor population.
Abstract: To our knowledge, only a few epidemiological reports on the prevalence of hepatitis E antibodies in Saudi blood donors have been published.
35 citations
TL;DR: Hidradenoma papilliferum is a rare apocrine gland tumour, described only once previously in a male, and the second such case presented here is presented.
Abstract: Hidradenoma papilliferum is a rare apocrine gland tumour, described only once previously in a male. We present the second such case.
31 citations
TL;DR: The results of FNA biopsies of head and neck masses performed at the Department of Otolaryngology, Head and Neck Surgery in Saint James’s Hospital, Dublin were reviewed and it was found that fine needle aspiration offers a safe, well tolerated and inexpensive method of obtaining a tissue biopsy.
Abstract: Patients presenting with a mass in the head and neck region require a tissue biopsy in order to make a histological diagnosis. Fine needle aspiration (FNA) offers a safe, well tolerated and inexpensive method of obtaining such a biopsy. When the patient is first seen in the clinic, the FNA can be performed, the result read and appropriate management instituted. The results of FNA biopsies of head and neck masses performed between May 1993 and June 1995, at the Department of Otolaryngology, Head and Neck Surgery in Saint James’s Hospital, Dublin were reviewed. Of the 130 patients who had FNA biopsies performed, 78 went on to have surgical excision of the mass. To determine the accuracy of FNA biopsy in the diagnosis of head and neck masses at our unit, we compared the cytology result and the final histology report of these 78 patients. The overall accuracy rate of FNA cytology was 95 per cent, when compared to the final histology result. The accuracy rate was 87 per cent for malignant lesions and 95 per cent for benign lesions. No complications were encountered in this study. Based on our results and those of other studies, we recommend performing FNA in all patients presenting with a mass in the head and neck region.
28 citations
TL;DR: A significant minority of patients (particularly male) admit to non-compliance with ambulatory surgery instructions; these figures may be underestimates; Absence of anaesthetic/medical input and lack of reinforcement probably contribute to noncompliance.
Abstract: Ambulatory surgery has proliferated as a result of increasing inpatient costs. Its high level of safety has resulted in its extension to less healthy, often elderly patients. Patient compliance with instructions is essential to avoid morbidity. We aimed to identify subgroups potentially at risk due to non-compliance. A confidential questionnaire was administered to 220 consecutive daycase patients. Data included: patient demographics, duration of fasting, taking of medications that morning, importance of fasting and medication instructions, mode of post-discharge transport, and whether they had someone to stay with them that night. Seven (3.5 per cent) patients admitted to non-compliance with fasting instructions, with 8 per cent considering these instructions non-essential. Thirteen of 59 patients on medications took them against instructions, with 9 patients considering the instructions non-essential. Eight patients admitted intending to drive home; 7 per cent admitted to having no one to stay with them on the night of surgery. A significantly minority of patients (particularly male) admit to non-compliance with ambulatory surgery instructions; these figures may be underestimates. Absence of anaesthetic/medical input and lack of reinforcement probably contribute to non-compliance. Some medication-related non-compliance may be appropriate (e.g. antianginals, antihypertensives) and may reflect conflicting instructions given to the patient. The stopping of all medications prior to ambulatory surgery needs revision. Older patients living alone may not be suitable candidates for ambulatory anaesthesia.
22 citations
TL;DR: The results of the study suggested that haptoglobin levels might be a useful, easily obtainable marker to aid the diagnosis of GBS and free radical damage may be implicated in the pathology of G BS and therefore appropriate free radical scavenging might have beneficial effects.
Abstract: Oxidative damage in three inflammatory neurological disorders; Guillain Barre syndrome (GBS), multiple sclerosis and aseptic meningitis, were assessed by measuring the peroxidation of lipids in body fluids. The results were compared to a control group consisting of patients with either migraine, chronic/tension headaches, benign intracranial hypertension or psychological disorders. Antioxidant status was assessed by the measurement of the extracellular proteins, haptoglobin, albumin, caeruloplasmin and transferrin. The results of the study suggested that firstly, haptoglobin levels might be a useful, easily obtainable marker to aid the diagnosis of GBS. Secondly, free radical damage may be implicated in the pathology of GBS and therefore appropriate free radical scavenging might have beneficial effects.
21 citations
TL;DR: This study is consistent in its findings of increased psychiatric morbidity in early breast cancer patients in the months after surgery and highlights the usefulness of a self assessment questionnaire in predicting it.
Abstract: Psychiatric illness associated with breast cancer still goes unrecognised and untreated A prospective study was carried out on a consecutive series of 33 patients with early breast cancer Patients were interviewed following their diagnosis and 3 to 6 months post-mastectomy Patients also completed the General Health Questionnaire 60 (GHQ 60) and the Leeds Scales for the Self-Assessment of Anxiety and Depression Seven patients suffered from a depressive disorder at the post-operative interview One patient suffered from an anxiety disorder One of the depressed patients had received antidepressant medication from her general practitioner The GHQ 60 was able to predict depressive illness in the post-operative period with a sensitivity of 71 per cent at the pre-operative diagnostic stage This study is consistent in its findings of increased psychiatric morbidity in early breast cancer patients in the months after surgery It also highlights the usefulness of a self assessment questionnaire in predicting it
19 citations
TL;DR: Certain proteases involved in metastasis have been shown to be strong and independent prognostic markers for a variety of cancers and molecules involved in cancer spread are potential targets for new forms of antimetastatic therapies.
Abstract: The main cause of morbidity and mortality in cancer is the formation of distant metastases. While alterations in c-oncogenes, tumour suppressor genes and DNA repair enzymes are the key molecules involved in carcinogenesis, increased expression of proteases, motility factors and altered expression of adhesion molecules are causally involved in metastasis. The proteases mediating metastasis include urokinase plasminogen activator, cathepsin B, D and L and various matrix metalloproteinases. Certain proteases involved in metastasis (e.g., urokinase plasminogen activator) have been shown to be strong and independent prognostic markers for a variety of cancers. Finally, molecules involved in cancer spread are potential targets for new forms of anti-metastatic therapies.
14 citations
TL;DR: Intraocular pressures were found to be significantly lower in those patients who read for 10 min than in those who regarded a fixed target at 6 metres in a single blind randomised trial on patients with newly diagnosed open angle glaucoma.
Abstract: In a single blind randomised trial on 20 patients with newly diagnosed open angle glaucoma, intraocular pressures were found to be significantly (p>0.01) lower in those patients who read for 10 min than in those who regarded a fixed target at 6 metres
TL;DR: It is concluded that carbon fibre implants may have a role to play in the management of osteochondral defects of the femoral condyles.
Abstract: Articular cartilage defects of the knee are a common condition diagnosed at arthroscopy. The management of these osteochondral lesions is controversial. We present our experience using carbon fibre implants to repair these defects in 18 patients. Eleven patients (61 per cent) had an osteochondral defect of the medial femoral condyle. Two patients had isolated patellar defects. The mean knee assessment and functional scores were 75 and 80 respectively using The Knee Society Clinical Rating System. Serial post-operative M.R.I. scanning revealed that there was no loss of implant position with an extensive local tissue response and good joint congruity. Overall, 11 patients (61 per cent) returned to their normal sporting activity, while 3 patients (18 per cent) had a poor result. One of these underwent a patellectomy. We conclude that carbon fibre implants may have a role to play in the management of osteochondral defects of the femoral condyles.
TL;DR: It is concluded that abdominal pain, bloating and nausea occur as frequently in the general population as in patients following LC, and patients are more likely to suffer from heartburn and dysphagia following LC than a normal population supporting a link between cholecystectomy and lower oesophageal dysfunction.
Abstract: Previous studies have shown that up to 40 per cent of patients have symptoms after cholecystectomy or laparoscopic cholecystectomy (LC). There are concerns, however, that these symptoms reflect those of the general population and are not a specific post-operative phenomenon. Abdominal symptoms of 212 patients following LC were compared to a healthy acalculous control population (n=62). Patients and controls were assessed by questionnaire. Age and sex profiles were similar in both groups. There was no significant difference in the incidence of abdominal pain, bloating or nausea between the 2 groups. Frequent heartburn was a symptom in 19.3 per cent of patients following LC as compared to 3.2 per cent of control patients (p=0.004, chi-squared 9.39, 1 d.f.). Furthermore 11.3 per cent of post-operative patients complained of dysphagia versus 6.4 per cent of the control group (p=0.08, chi-squared 1.245, 1 d.f.). One hundred and twenty (57.1 per cent) patients judged their operation to be a complete success, while 9 (4.3 per cent) were dissatisfied. Five of the latter group cited frequent heartburn as the cause of their dissatisfaction. We conclude that abdominal pain, bloating and nausea occur as frequently in the general population as in patients following LC. Patients are more likely to suffer from heartburn and dysphagia following LC than a normal population supporting a link between cholecystectomy and lower oesophageal dysfunction.
TL;DR: The first 3 yr of a new open access gastroscopy service in the Royal Victoria Hospital, Belfast to assess service demands, patient demography and diagnostic trends showed no significant change.
Abstract: We have audited the first 3 yr of a new open access gastroscopy service in the Royal Victoria Hospital, Belfast to assess service demands, patient demography and diagnostic trends. Over 3 yr there were 1872 referrals (800 from fundholding general practitioners), 8.8 per cent were non attenders and 5.4 per cent cancelled appointments. Endoscopic diagnostic categories showed no significant change over the 3 yr, 39 per cent non ulcer dyspepsia, 35 per cent gastro-oesophageal reflux disease (GORD), 17 per cent peptic ulcer disease (PUD), 6 per cent GORD and PUD, 1 per cent gastric erosions and 0.8 per cent carcinoma.
TL;DR: In this article, the density and distribution of N-methyl-D-aspartate receptor (NMDAR1) mRNA expression in the rat midbrain Periaqueductal gray (PAG) following exposure to unilateral peripheral inflammation or chronic constrictive injury (CCI) as models for chronic peripheral nociception were examined using thein situ hybridization technique.
Abstract: The density and distribution of N-methyl-D-aspartate receptor (NMDAR1) mRNA expression in the rat midbrain Periaqueductal gray (PAG) following exposure to unilateral peripheral inflammation or chronic constrictive injury (CCI) as models for chronic peripheral nociception were examined using thein situ hybridization technique. The NMDAR1 hybridization signal intensities increased significantly in the ventrolateral areas of the caudal and middle thirds of the PAG after 3 days of Complete Freund’s Adjuvant (CFA) injection. Likewise, rats subjected to CCI showed significant increases in hybridization signal intensities in comparison to sham operated animals in both the ipsi and contra-lateral ventrolateral quadrants of the caudal and middle thirds of the PAG. In the caudal dorsal raphe, the CFA and the CCI treated animals showed a significant increase in signal hybridization compared to control and sham operated groups while the rostral dorsal raphe showed no significant changes in either CCI or CFA treated groups. In contrast, there was no significant change in signal intensity of NMDAR1 mRNA in the dorsal subdivisions of the PAG following either CCI or CFA treatment. These results demonstrate significant bilateral increase in NMDAR1 mRNA expression in the ventrolateral areas of the caudal and middle thirds of the PAG and the caudal half of the dorsal raphe following chronic nociception. The up-regulation phenomenon may constitute a reactive mechanism against chronic neuropathic pain in the PAG.
TL;DR: Surgical fusion of the spine to L5 combined with ongoing attention to seating is associated with good long-term functional results in patients with spinal deformity associated with Duchenne Muscular Dystrophy.
Abstract: Instrumented fusion of the collapsing spine has gained widespread acceptance for patients with Duchenne Muscular Dystrophy but controversy still exists on the issue of extending the surgical fusion to sacrum in these patients This retrospective study reviews the long-term outcome of a group of patients with spinal deformity associated with Duchenne Muscular Dystrophy who were managed with long spinal fusion to L5 and ongoing wheelchair seating attention The clinical notes and radiographs of 19 consecutive patients were reviewed Fifteen patients attended for clinical and radiological assessment at a mean of 28 months post operatively The surgery for these patients involved a mean anaesthetic time of 35 h and a mean transfusion requirement of 5 units of red cell concentrate At long-term follow-up 15 patients continued to sit in a well-balanced position Surgical fusion of the spine to L5 combined with ongoing attention to seating is associated with good long-term functional results in these patients
TL;DR: Bleeding time lengthens with increasing antithrombotic effect of drugs, but not in direct proportion, nor similarly with each drug.
Abstract: Bleeding can occur unexpectedly during antithrombotic therapy. Impaired haemostasis is commonly measured by the bleeding time. We measured it by 3 methods in controls and in anticoagulated animals and related it to their antithrombotic status. In 42 control rats template, tail-tip transection and needle occlusion bleeding times correlated poorly (r = 0.05-0.34). The template method had the best range (mean 126.97 +/- SEM secs) and consistency. In 10 control animals it correlated mildly (r = 0.55) with venous thrombus in the same animal. Thrombus was measured by its weight deposited on platinum wires (2 cm long, 0.4 mm diameter) set in vein and in artery for 1 h. In respective groups of 10 rats, a decrease of mean thrombogenesis was obtained using aspirin, heparin and low molecular weight heparin in 2 dosages and hirudin in 1 dosage. The drugs reduced mean venous thrombus by 13-86 per cent of the mean control thrombus, and prolonged the mean template bleeding time by 29-199 per cent. The ranking of the drugs according to their increase of template bleeding time was virtually the same as the ranking given by their reduction of thrombus weight (Spearman rank coefficient 0.81, sig 0.007). The transection test produced a similar ranking and similar correlation with thrombus (0.71, sig 0.049). Low molecular weight heparin induced the greatest thrombus reduction (39 per cent) for least prolongation of bleeding time (24 per cent). Arterial thrombus was more variable. The bleeding times and thrombus weight were measured in each animal of 2 groups given aspirin, the template method correlating mildly with venous thrombus reduction (r = 0.23, 0.58 respectively), the transection method with arterial (0.74, 0.45) and the occlusion test poorly with either (0.13, 0.22). Bleeding time lengthens with increasing antithrombotic effect of drugs, but not in direct proportion, nor similarly with each drug.
TL;DR: The Helisal test did not perform satisfactorily as a screening test in selection of patients for gastroscopy and would have missed 6 patients with peptic ulcer disease and 2 with oesophagitis.
Abstract: Screening for Helicobacter pylori in dyspeptic patients may improve selectivity for gastroscopy. Rapid serological tests based on ELISA technique are cheap, readily available and simple to use in the clinical setting. However local evaluation is essential in order to validate these techniques. Fifty-six dyspeptic patients (aged less than 45 yr) had a rapid serological test (Helisal) performed prior to gastroscopy. At gastroscopy H. pylori status was assessed using culture and histology. The Helisal sensitivity was 80 per cent, specificity 82 per cent. Screening patients with the Helisal test would have missed 6 patients with peptic ulcer disease and 2 with oesophagitis. The Helisal test did not perform satisfactorily as a screening test in selection of patients for gastroscopy.
TL;DR: The acquired haemostatic defect corrected following treatment of the primary condition in 3 patients with the other patient requiring on demand von Willebrand Factor replacement to control spontaneous and surgery induced bleeding.
Abstract: von Willebrand's disease (vWD) is the commonest inherited bleeding disorder in man with an estimated incidence of 1 per thousand of the population. Acquired von Willebrand's disease (AvWD) is rare with less than 70 cases reported. AvWD is usually associated with autoimmune or clonal proliferation disorders and whilst the precise mechanism of acquired deficiency of von Willebrand factor (vWF) is poorly understood, the most likely candidate mechanism(s) are; antibodies inactivate or form a complex with immunologic or functional sites on vWF, or vWF multimers are selectively absorbed by malignant cells. Unlike hereditary vWD, the acquired form of the disease can be exceedingly difficult to manage. We report 4 cases of AvWD diagnosed at our centre over the past 3 yr. There was no evidence of a previous personal or family history of bleeding in any of the patients and AvWD was confirmed by laboratory testing. All 4 patients had a recognised primary medical condition known to be associated with AvWD (Waldenstrom's Macroglobulinaemia in 2 patients, hypothyroidism in 1 patient and monoclonal gammopathy of unknown significance (MGUS) in 1 patient). The acquired haemostatic defect corrected following treatment of the primary condition in 3 patients with the other patient requiring on demand von Willebrand Factor replacement to control spontaneous and surgery induced bleeding.
TL;DR: It is concluded that urban Ireland is an area of low HAV endemicity with age and socioeconomic status as the significant influences on seropositivity.
Abstract: Aims: To determine the prevalence of immunity to hepatitis A virus (HAV) infection in urban Ireland and to categorize the region into low, intermediate or high HAV endemicity, and to analyse the significance of certain commonly associated risk factors.
TL;DR: Using a variety of methods, with PCR acting as the ’gold standard’, it is shown that H. pylori is not associated with acute appendicitis.
Abstract: The aetiology of acute appendicitis remains uncertain. H. pylori is viable outside the gastroduodenum, however its pathological role outside this area has not been fully investigated. Ten consecutive patients with a histological diagnosis of acute appendicitis were investigated for H. pylori status by serology, and by culture, histology, and polymerase chain reaction (PCR) analysis of the appendiceal specimens. One patient had positive serology for H. pylori, however PCR analysis was negative. Culture failed to reveal H. pylori colonies. Histology in 5 cases did reveal organisms with a morphological appearance of H. pylori, but PCR analysis confirmed that H. pylori was not present. Using a variety of methods, with PCR acting as the 'gold standard', we have shown that H. pylori is not associated with acute appendicitis.
TL;DR: Although the authors can no longer justify the continued use of PTFE in every case of critical ischaemia because of its inferior patency to autogenous vein, it continues to be used preferentially in patients whose lifespan is likely to be short and in cases where a remedial lesion is present.
Abstract: Ninety-six consecutive above-knee femoropopliteal bypasses, using polytetrafluoroethylene (PTFE) preferentially, were performed for limb-threatening ischaemia. Cumulative primary graft patency was 68 per cent, 49 per cent and 36 per cent and limb salvage 93 per cent, 85 per cent and 75 per cent at 1, 3 and 5 yr respectively. As a result of poor long term survival (51 per cent at 5 yr), and the healing of remedial lesions before graft occlusion, 68 patients (72 per cent) required no further intervention. Eighteen secondary bypasses were undertaken, 12 using ipsilateral saphenous vein. In this group of elderly patients with poor life expectancy, where a limited operation is desirable, the use of PTFE provided excellent limb salvage with low morbidity. Although we can no longer justify our continued use of PTFE in every case of critical ischaemia because of its inferior patency to autogenous vein, we continue to use it preferentially in patients whose lifespan is likely to be short and in cases where a remedial lesion is present.
TL;DR: Almost 1,300 unnecessary clinic visits were avoided, some reduction in delay time to gastroscopy was achieved, the family doctor maintained control of patient management in the great majority of patients, and the pattern of referral was not inappropriate and compared very well with the comparator group.
Abstract: In the first 3 yr of an uncensored open access gastroscopy service in a County Hospital, 891 patients attended for first gastroscopy. The data on these patients is presented and compared with a randomly selected group who attended for gastroscopy in the yr prior to the establishment of the service having come to the normal Consultant clinics. In the open access group the gastroscopy examination was normal in 29 per cent (32 per cent comparator group), 31 per cent had major abnormalities (33 per cent comparator group) and 40 per cent had minor abnormalities (35 per cent comparator group). Delay time from referral to endoscopy was 37 days for open access patients (45 days comparator group). Only 6 per cent of open access patients were brought back to O.P.D. (47 per cent comparator group) and 72 per cent of open access patients returned directly to their family doctor (28 per cent comparator group). A comparison of the Clonmel findings with British centres reporting their results shows a broadly similar picture. It is concluded that almost 1,300 unnecessary clinic visits were avoided by the provision of the open access service, some reduction in delay time to gastroscopy was achieved, the family doctor maintained control of patient management in the great majority of patients, the pattern of referral was not inappropriate and compared very well with the comparator group. Over the 3 yr there was a large increase in the number of gastroscopies performed which caused resource difficulties. It is recommended that adequate planning of these requirements should be carried out before an open access service is started. At least 1 additional dedicated gastroscopy only endoscopy service per week would be required.
TL;DR: Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical and direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life.
Abstract: Paediatric HIV infection has become a major burden on families, communities and health services worldwide. The vast majority of children now acquire HIV as a result of mother to infant (vertical) transmission. Recent major advances have occurred following the greater understanding of the risk factors for perinatal transmission and the role of antiretroviral therapy in preventing transmission. Now that interruption of vertical transmission is possible, early identification of HIV-infected pregnant women is critical. As of June 1997, HIV infection has been diagnosed in 37 children under 15 yrs of age in the Republic of Ireland; 32 as a result of maternal to infant transmission. The exact timing of HIV transmission during pregnancy is unclear but it is estimated that 60-70 per cent of infants may be infected at the time of delivery with approximately 30 per cent infected earlier in gestation. Vertical transmission rates vary from 15-40 per cent in different global areas. Antenatal and perinatal zidovudine treatment can reduce this rate by 60-70 per cent. Risk factors for the vertical transmission of HIV-1 are multifactorial. These factors include maternal disease status, in particular maternal viral load, route of delivery, duration of membrane rupture, presence of obstetric complications and infant feeding practices. Definitive diagnosis of HIV infection in infancy has been difficult in the past. Direct viral detection methods now allow the reliable diagnosis of HIV infection in the first few months of life. The most effective intervention to reduce perinatal HIV infection will be the better identification of HIV positive pregnant women with the subsequent introduction of measures to interrupt vertical transmission of HIV.
TL;DR: RET proto-oncogene analysis is a reliable method of differentiating familial from sporadic MTC and can be used to affect clinical management, according to patients with medullary thyroid carcinoma.
Abstract: Introduction: Medullary carcinoma of the thyroid (MTC) is a rare tumour which occurs in both sporadic and hereditary forms. Mutations of the RET proto-oncogene have been identified in hereditary forms. The aim of our study was to confirm or exclude familial disease by examining for germline mutations in the RET proto-oncogene in patients with medullary thyroid carcinoma.
TL;DR: Strategies to reduce the transmission of HIV among drug users in combination with routine antenatal screening and antiretroviral prophylaxis of vertical transmission are all measures which can reduce HIV infection in children.
Abstract: Symptomatic HIV infection was first diagnosed in an Irish child in 1985. A prospective study was initiated to determine the vertical transmission rate (VTR) of HIV and the average age of infant seroreversion and to monitor clinical, immunologic and virologic evidence for HIV infection in seroreverters. Ninety three HIV positive infants have been prospectively identified since 1985. The predominant underlying maternal risk factor for HIV infection is intravenous drug use (IVDU) (96 per cent). Of 93 infants, median gestational age was 40 weeks and median birth weight 3125 grams. Ninety-four per cent of infants were bottle fed. Currently 72 (77 per cent) infants are uninfected, 12 (13 per cent) are infected, 4 (4.5 per cent) are indeterminate and 5 (5.5 per cent) have been lost to follow up. The intermediate estimate of vertical transmission rate (VTR) is 14.3 per cent. The median age at documented seroreversion was 12 months. There are no significant differences between infected and non-infected children in male/female ratio, gestational age, mode of delivery or birth weight. Strategies to reduce the transmission of HIV among drug users in combination with routine antenatal screening and antiretroviral prophylaxis of vertical transmission are all measures which can reduce HIV infection in our children.
TL;DR: Factors such as the severity of pain, somatic sensory impairments and psychological profile during HZ are being evaluated as potential predictors of Post herpetic neuralgia.
Abstract: Introduction Post herpetic neuralgia (PHN) is defined as the persistence of pain following Herpes Zoster (HZ) when the rash has healed, which is usually after approximately 4 weeks. However, PHN has been variably defined as pain persisting beyond 1 to 6 months after the onset of HZ, because of the tendency of pain to diminish progressively with time. The incidence of HZ is 125/100,000 per yr in the general population 1. Octogenerians have a 5 to 10/1000 incidence 1. The incidence in patients with lymphoproliferative disease ranges from 2 to 50 per cent depending on the severity of the disease and the use of radiotherapy or chemotherapy. There is no seasonal variance and both sexes are equally affected 1. 10-20 per cent of patients with HZ infection develop PHN 1. Pain almost always resolves spontaneously in patients less than 50 yr old. Predisposing factors associated with a much higher incidence of PHN are increased age (50 per cent at age 60 yr and 75 per cent at age 70 yr), diabetes mellitus and~ophthalmic as opposed to spinal HZ 2. Factors such as the severity of pain, somatic sensory impairments (pinprick and thermal thresholds) and psychological profile during HZ are being evaluated as potential predictors of PHN. The management of PHN provides clinicians with a difficult and challenging therapeutic problem. The majority of cases will be managed by the general practitioner but the large number of therapeutic options available attest to how difficult treatment can be and referral to a specialist at the appropriate time is important. A small group of patients become progressively worse and more intractable to treatment.
TL;DR: The spectrum of activity of p Piperacillin-tazobactam for empirical antibiotic therapy is significantly greater than that of piperacillin alone and is similar to that of ciprofloxacin and gentamicin.
Abstract: Resistance of bacteria to antibiotics is an increasing problem in many countries. Accurate locally relevant information is essential for detection and control of emerging resistance and to facilitate choice of empirical antibiotic therapy in the immediate management of seriously ill patients. We have determined the minimum inhibitory concentration of piperacillin/tazobactam for 97 strains of bacteria (55 Enterobacteriaceae, 13 non-fermentative Gram-negative bacilli, 22Staphylococcus aureus), 6Enterococcus faecalis and 1Bacillus cereus) isolated from blood cultures and compared its activity to that of amoxycillin, co-amoxiclav, cephalothin, cefotaxime, ceftazidime, ciprofloxacin, gentamicin, piperacillin, cefotaxime. The strains were consecutive non-fastidious isolates with the following qualifications: coagulase negative staphylococci and diphtheroids were excluded and the number of Staphylococcus aureus isolates was limited to 12 methicillin-resistant and 10 methicillin-sensitive strains. Multiple isolates of the same species from individual patients were not included. The minimum inhibition concentrations of methicillin, penicillin, teichoplanin and vancomycin were also determined for specific groups of organisms. MICs were determined by the Etest method (AB Biodisk, Solna, Sweden) on Mueller Hinton agar. The MICs of appropriate American Type Culture Collection control strains were determined. Based on the interpretative criteria of the National Committee for Clinical Laboratory Standards (USA), 87 per cent of Gram-negative bacilli were susceptible to piperacillin/tazobactam compared with amoxycillin 26 per cent, cephalothin 35 per cent, co-amoxiclav 54 per cent, piperacillin 56 per cent, cefotaxime 69 per cent, ceftazidime 84 per cent, gentamicin 85 per cent and ciprofloxacin 91 per cent. Of all isolates 75 per cent were sensitive to piperacillin/tazobactam, compared with amoxycillin 22 per cent, cephalothin 35 per cent, piperacillin 41 per cent, co-amoxiclav 52 per cent, cefotaxime 59 per cent, ceftazidime 60 per cent, gentamicin 74 per cent and ciprofloxacin 77 per cent. Two isolates (1E. coli and 1Klebsiella pneumoniae) with antibiograms consistent with the relatively new resistance phenomenon of extended spectrum beta-Iactamase production were identified. The spectrum of activity of piperacillin-tazobactam for empirical antibiotic therapy is significantly greater than that of piperacillin alone and is similar to that of ciprofloxacin and gentamicin.
TL;DR: The melanoma-in-situ group had a similar gender ratio and mean age at diagnosis to the invasive melanoma patients but lesions were smaller, were predominantly on the head, neck and limbs with lentigo melanoma as the commonest type.
Abstract: In a study of malignant melanoma during the period 1984–1993, 134 (63 per cent) had invasive melanoma and in 79 (37 per cent) melanoma was confined to the epidermis (in situ). There was female predominance, F: M = 2.4 1, a family history of melanoma in 1.5 per cent, a mean age at diagnosis of 50 yr. Females presented a decade earlier than males on average.