Search

The protobranch bivalve Solemya velum Say (Mollusca: Bivalvia) houses chemoautotrophic symbionts intracellularly within its gills. These symbionts were characterized through sequencing of polymerase chain reaction-amplified 16S rRNA coding regions and hybridization of an Escherichia coli gene probe to S. velum genomic DNA restriction fragments. The symbionts appeared to have only one copy of the 16S rRNA gene. The lack of variability in the 16S sequence and hybridization patterns within and between individual S. velum organisms suggested that one species of symbiont is dominant within and specific for this host species. Phylogenetic analysis of the 16S sequences of the symbionts indicates that they lie within the chemoautotrophic cluster of the gamma subdivision of the eubacterial group Proteobacteria.

A paradoxical drug reaction constitutes an outcome that is opposite from the outcome that would be expected from the drug's known actions. There are three types: 1. A paradoxical response in a condition for which the drug is being explicitly prescribed. 2. Paradoxical precipitation of a condition for which the drug is indicated, when the drug is being used for an alternative indication. 3. Effects that are paradoxical in relation to an aspect of the pharmacology of the drug but unrelated to the usual indication. In bidirectional drug reactions, a drug may produce opposite effects, either in the same or different individuals, the effects usually being different from the expected beneficial effect. Paradoxical and bidirectional drug effects can sometimes be harnessed for benefit; some may be adverse. Such reactions arise in a wide variety of drug classes. Some are common; others are reported in single case reports. Paradoxical effects are often adverse, since they are opposite the direction of the expected effect. They may complicate the assessment of adverse drug reactions, pharmacovigilance, and clinical management. Bidirectional effects may be clinically useful or adverse. From a clinical toxicological perspective, altered pharmacokinetics or pharmacodynamics in overdose may exacerbate paradoxical and bidirectional effects. Certain antidotes have paradoxical attributes, complicating management. Apparent clinical paradoxical or bidirectional effects and reactions ensue when conflicts arise at different levels in self-regulating biological systems, as complexity increases from subcellular components, such as receptors, to cells, tissues, organs, and the whole individual. These may be incompletely understood. Mechanisms of such effects include different actions at the same receptor, owing to changes with time and downstream effects; stereochemical effects; multiple receptor targets with or without associated temporal effects; antibody-mediated reactions; three-dimensional architectural constraints; pharmacokinetic competing compartment effects; disruption and non-linear effects in oscillating systems, systemic overcompensation, and other higher-level feedback mechanisms and feedback response loops at multiple levels. Here we review and provide a compendium of multiple class effects and individual reactions, relevant mechanisms, and specific clinical toxicological considerations of antibiotics, immune modulators, antineoplastic drugs, and cardiovascular, CNS, dermal, endocrine, musculoskeletal, gastrointestinal, haematological, respiratory, and psychotropic agents. [ABSTRACT FROM AUTHOR]

Background: Small studies have linked α1 antitrypsin (α1AT) deficiency to patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV).Objective: To test the validity and the mechanism of this association between α1AT and AAV.Methods: The distribution of α1AT deficiency alleles Z and S was compared between 856 White Europeans with AAV and 1505 geographic and ethnically matched healthy controls. Genotyping was performed by allelic discrimination assay.Results: were compared between cases and controls using χ(2) tests. The serum and renal biopsies for α1AT polymers were compared using the polymer-specific 2C1 antibody. The role of α1AT polymers in promoting inflammation was investigated by examining their ability to prime neutrophils for ANCA activation as assessed by CD62L shedding, superoxide production and myeloperoxidase degranulation. Results The Z but not the S allele was over-represented in the patients compared with controls (HR=2.25, 95% CI 1.60 to 3.19). Higher concentrations of polymers of α1AT were detected in serum from patients carrying the Z allele than in those not carrying the Z allele (median (IQR) 1.40 (0.91-3.32) mg/dl vs 0.17 (0.06-0.28) mg/dl, p<0.001); polymers of α1AT were also seen in the renal biopsy of a patient with vasculitic glomerulonephritis. Polymers of α1AT primed neutrophils with CD62L shedding and increased superoxide production following ANCA activation. Carriage of the Z allele was not associated with disease severity, survival or relapse.Conclusions: The Z but not the S deficiency allele is associated with AAV. Polymers of α1AT are present in the serum and glomeruli of at least some patients with the Z allele, which may promote inflammation through priming of neutrophils. [ABSTRACT FROM AUTHOR]

Stromal fibroblasts are the primary cells of the kidney that produce fibrotic matrix. CD248 is a stromal marker expressed on fibroblasts and pericytes within the human kidney. Here, we tested whether CD248 expression in the kidney colocalizes with fibrosis and if it is associated with known determinants of chronic kidney disease (CKD). CD248 expression was located and quantified in situ by immunohistochemistry in kidney biopsies from 93 patients with IgA nephropathy and compared with 22 archived biopsies encompassing normal kidney tissue as control. In normal kidney tissue, CD248 was expressed by resident pericytes, stromal fibroblasts, and was upregulated in human CKD. The expression was linked to known determinants of renal progression. This relationship was maintained in a multivariate analysis with CD248 expression linked to renal survival. CD248 was expressed by a population of α-smooth muscle actin (SMA)(+) myofibroblasts and α-SMA(-) stromal cells but not expressed on CD45(+) leukocytes. Thus, CD248 defines a subset of stromal cells, including but not limited to some myofibroblasts, linked to albuminuria and tubulointerstitial damage during tissue remodeling in CKD. [ABSTRACT FROM AUTHOR]

The present study examined the convergent validity of the Shedler-Westen Assessment Procedure Q-Sort (SWAP-200; ) dependency scales (Dependent Personality Disorder [DPD] Clinical Prototype and DPD composite description) by examining links between these variables with Inventory of Interpersonal Problems Circumplex Scales (IIP-C; Alden et al., 1990; Horowitz et al., 2000; Horowitz et al., 1988), and DSM-IV diagnoses of DPD in a clinical sample (N = 85). Results showed that SWAP-200 DPD Clinical Prototype was significantly related to a DSM-IV diagnosis of DPD, higher scores on the IIP-C Affiliative/Submissive Quadrant summary scale, and elevations on Nonassertive and Overly-accommodating Octant Scales. Additional analyses revealed significant positive relationships between the DPD composite description with DSM-IV diagnosis of DPD, the Affiliative/Submissive Quadrant summary scale, and the Overly Accommodating and Self-Sacrificing Octant Scales. We discuss the implications of these findings with regard to theoretical, empirical, and clinical aspects of interpersonal dependency. [ABSTRACT FROM AUTHOR]

OBJECTIVES: While critically important, the rapid identification of the etiology of metabolic acidosis (MA) may be labor-intensive and time-consuming. Alcoholic, starvation, and severe diabetic ketoacidosis (AKA, SKA, and DKA, respectively) may produce beta-hydroxybutyrate (BOHB) in marked excess of acetone (ACET) and acetoacetate (AcAc). Unfortunately, current urine dipstick technology poorly detects ACET and cannot measure BOHB. The inability to detect BOHB might delay therapy for ketoacidoses or provoke unnecessary evaluation or empiric treatment of other causes of MA, such as toxic alcohol poisoning. The authors tested the previous assertion that commonly available hydrogen peroxide (H(2)O(2)) would improve BOHB detection. The effectiveness of alkalinization and use of a silver nitrate (AgNO(3)) catalyst was also assessed. METHODS: Control and urine test specimens containing from 0.5 to 800 mmol/L ACET, AcAc, and BOHB were prepared. Urine specimens were oxidized with H(2)O(2) (3%) 1:9 (H(2)O(2):urine), alkalinized with potassium hydroxide (KOH; 10%), exposed to AgNO(3) sticks, or altered with a combination of these methods in a random fashion. Three emergency physicians (EPs) blinded to the preparation technique evaluated urine dipsticks (Multistix, Bayer Corp.) placed in the specimens for 'ketones.' RESULTS: Multistix detected AcAc appropriately; ACET was detected only at high concentrations of >or=600 mmol/L. Multistix failed to measure BOHB at all concentrations tested. H(2)O(2) improved urinary BOHB detection, although not to clinically relevant levels (40 mmol/L). Alkalinization and AgNO(3) sticks did not improve BOHB detection beyond this threshold. CONCLUSIONS: Addition of H(2)O(2) (3%), alkalinization, or AgNO(3) sticks did not improve clinically meaningful urine BOHB detection. Clinicians should use direct methods to detect BOHB when suspected. [ABSTRACT FROM AUTHOR]

Abstract: Background: Diabetes mellitus is a common chronic disorder frequently resulting in hyperglycemia and numerous long-term complications. Research has shown that improved glycemic control reduces the rate and number of diabetes-related complications. Evidence suggests that patients who are more knowledgeable about diabetes self-care may be more likely to achieve better glycemic control. Objective: The purpose of this study is to determine the relationship between patients'' knowledge about their diabetes medications and their blood glucose control. Methods: Patients receiving oral pharmacologic treatment for type 2 diabetes mellitus were asked to answer a short questionnaire assessing their knowledge about their medications. Patients were part of an ambulatory care practice in Baltimore, Maryland, that provides primary care medical services to an inner-city, predominantly African American population. A medication knowledge score (number of correct responses to 8 components) was tabulated and correlated to the most recent glycosylated hemoglobin (A1c) (drawn within the previous 90 days). Multivariate models were constructed, with A1c as the outcome and patients'' medication knowledge as the independent variable. Potential confounders included in the models were age, sex, education level, number of diabetes medications, and insurance status. Results: Fifty patients were screened for the study; 44 agreed to participate and met inclusion criteria. Patients'' diabetes medication knowledge scores ranged between 1 and 7, with a median score of 5. Older patients (65 years and older) and male patients scored lower than their counterparts. There was a strong inverse association between knowledge score and A1c (r =−0.61; P <.001). Glycosylated hemoglobin was one-half unit lower with each one-unit increase in knowledge score among men; among women A1c was 1.6 units lower for each one-unit increase in knowledge score. Conclusion: Patients with greater understanding and knowledge of their diabetes medications demonstrated better glycemic control. This cross-sectional association of medication knowledge and A1c was more pronounced in women than in men. [Copyright &y& Elsevier]

A need exists for easy, reliable forms of measurement to determine functional capacity and strength of the over 75 population. The purpose of this study was to determine whether grip strength correlated with overall strength and functional capacity in females over 75 years of age. Another reason was to determine a simple strategy for employees of assisted living centers to use to determine the functional capacities of residents. Correlations among grip strength, overall strength, and functional capacity in females aged 75 to 84 and over 85 were investigated using a sample of assisted living residents in middle Tennessee. The following tests were administered to each of the 102 qualifying participants: Barthel Index, grip strength, overall strength, and Timed Get-Up-and-Go Test. Grip strength was moderately correlated with overall body strength in the very old and oldest old populations. Grip strength did not correlate highly with either the Barthel Index or the TUG. According to these findings, grip strength should be used along with other methods of determining overall strength but should not be used to determine functional capacity. [ABSTRACT FROM AUTHOR]

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender; however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort. Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p<.00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the partnership between public and private sectors. [ABSTRACT FROM AUTHOR]

This study was conducted to ascertain the vaccination beliefs and practices of physicians who provide care for low income children. Sixty-two (56.9%) of a sample of 109 physicians in suburban Cook County, Illinois responded to a mail survey. A majority of physicians reported a willingness to immunize during well child care, follow-up, and chronic illness visits; yet, a substantial lack of willingness to immunize given certain acute mild illnesses was reported. Twenty-six percent of providers did not routinely identify children who were behind in immunizations and only 16% had completed a chart aduit in the past three years. Seventy-four percent were willing to provide all shots needed at a single visit. Misconceptions regarding true contraindications was found among the group. Missed well child visits were identified as the greatest barrier to complete immunization. Improvements in vaccination rates are expected if physicians utilize all types of medical encounters to monitor the immunization status of patients and provide vaccines using only true medical contraindications. [ABSTRACT FROM AUTHOR]

Rehabilitation professionals from the Veterans Affairs Hospital (VAH) in Tampa, Florida, have four years of experience developing, utilizing and revising clinical pathways specific to most frequent rehabilitation admission diagnoses (such as strokes, traumatic brain injury, and pain diagnoses) of clients requiring comprehensive inpatient rehabilitation. The preparation, framework, and experiences of rehabilitation professionals using clinical pathways as the core method of operation are presented in this article. In addition, this article describes the interdisciplinary process utilized to develop and implement the clinical pathways for stroke and traumatic brain injury patients, and discusses the outcomes experienced by rehabilitation professionals. These clinical pathways focus on outcomes rather than process. Outcome measures are specific to program evaluation outcomes and include access to programs, functional status gains, length of stay, and length of stay efficiency. This article challenges readers to question clinical pathways that specify processes rather than outcomes, and argues the benefit of outcome-specific clinical pathways for use in rehabilitation settings. [ABSTRACT FROM AUTHOR]