bluuebunny/crossref_metadata_2025_split huggingface dataset:
Asthma management and mode of acquisition of inhaled bronchodilators
Authors: Comino E. J. , Henry R. L. , Mitchell C. A. , Bauman A. , Monaco R. 
Published: March 2008

Abstract Background: Controversy has existed about the benefits and disadvantages associated with the availability of inhaled bronchodilators over the counter (OTC). Aims: To compare sociodemographic features, use of preventive medications, use of medical services and control of asthma in adults who purchased inhaled bronchodilators OTC with those who purchased on prescription (script). Methods: A cross‐sectional telephone survey of 772 adults 18 years and over who used inhaled bronchodilators for their asthma. Symptoms, asthma medications, and management practices were determined by a structured questionnaire administered by trained telephone interviewers. Results: Two hundred and thirty adults purchased their bronchodilator OTC and 542 on script. OTC purchasers were more likely to be male (OR: 1.5), have had tertiary education (1.5) and be in paid employment (2.8); they were less likely to report frequent symptoms (wheeze, nocturnal symptoms or EIA more than once a week) (0.71); were less likely to use preventive medications more than twice a day (0.57) and were less likely to have consulted a general practitioner in the previous year (0.38). However, poor control of asthma symptoms was evident in both OTC and script groups. Forty per cent of the OTC group who had symptoms more than two to three times a week and 34% of the script group were not using preventive medication. Conclusions: Undertreatment and suboptimal management of asthma were apparent in both OTC and script groups. (Aust NZ J Med 1995; 25: 496–502.)
Infections during severe primary undernutrition and subsequent refeeding: paradoxical findings
Authors: Murray M. J. , Murray A. B. , Murray N. J. , Murray M. B. 
Published: March 2008

Abstract Background: Our earlier uncontrolled observations during primary famine and subsequent refeeding did not suggest that severe undernutrition inevitably increases vulnerability to infection. Some infections appeared suppressed by famine but reactivated by refeeding.Aims: To examine prospectively the occurrence of infections in a large cohort of primary famine victims before and during refeeding.Methods: From 1973 to 1993,4382 famine victims aged 14 or more with an estimated weight loss greater than 25% were weighed and examined for infection before and after one, two, three and four weeks of refeeding. In 137, serum C‐reactive protein was measured in an effort to detect latent asymptomatic infections before and after two weeks of refeeding. Refeeding diets included wheat, sorghum, millet, ghee and milk powder.Results: Mean weight loss ±SD was 28.7 ± 2.3%. Before refeeding overt infections were found in 4.9%, an incidence rising to 29.1% at two weeks of refeeding and declining after four. Those developing infections gained more weight at two weeks, 4.63 ± 0.81 kg, than those never infected, 3.94 ± 0.76 (p = < 0.001 t test). C‐reactive protein levels confirmed the presence of latent infections before refeeding.Conclusions: Severe undernutrition can suppress certain infections, mostly those due to intracellular pathogens and especially P. falciparum. Refeeding reactivates suppressed infection and can increase vulnerability to certain new infections especially of viral origin. Those gaining weight the most rapidly may be at greatest risk. Refeeding with foods alien to local culture could play a role in reactivating latent infections. Our findings may be limited to severe undernutrition and not apply to lesser forms or secondary undernutrition in hospital patients. These studies were done during charitable provision of medical care to famine victims. (Aust NZ J Med 1995; 25; 507–511.)
Initial validation of a bowel symptom questionnaire* and measurement of chronic gastrointestinal symptoms in Australians
Authors: Talley N. J. , Newman P. , Boyce P. M. , Paterson K. J. , Owen B. K. 
Published: March 2008

Abstract Background: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but Australian data are lacking. A valid instrument is required to assess GI symptoms adequately and determine their prevalence in the community. Aims: To test the feasibility, reliability and concurrent validity of a self‐report Bowel Symptom Questionnaire (BSQ) as a measure of GI symptoms, and obtain preliminary data on the prevalence of symptoms in an Australian population‐based sample. Methods: Outpatients (n= 63), volunteers (n= 163) and a random sample (n= 99) of the Penrith population, Sydney, completed the BSQ. Feasibility was evaluated in 264 subjects. Reliability was measured by a test‐retest procedure (n= 43), while concurrent validity was documented by comparing self‐report data with an independent interview (n= 20). The response rate in the population mail survey was 68%. Prevalence data on bowel symptoms in the community sample (n= 99) were age and gender standardised to the Australian population. Results: The majority of subjects found the BSQ easy to complete (97%) and understand (97%); 90% completed the questionnaire in half an hour or less. Reliability (median kappa 0.70, interquartile range 0.20) and concurrent validity (median kappa 0.79, interquartile range 0.26) of GI symptoms were both very acceptable. The internal consistency of all GI symptom scales was good (Cronbach's Alpha range 0.51‐0.74). The prevalence of the irritable bowel syndrome (defined as abdominal pain and disturbed defaecation based on two or more of the Manning criteria) was 17.2% (95% CI: 10–25%). Conclusions: The BSQ was well accepted and easy to understand; it provided reliable and valid data on GI symptoms and should prove useful in large scale epidemiological studies in Australia. (Aust NZ J Med 1995; 25: 302–308.)
Good long‐term outcome following surgical repair of post‐infarction ventricular septal defect
Authors: Ellis C. J. , Parkinson G. F. , Jaffe W. M. , Campbell M. J. , Kerr A. R. 
Published: March 2008

Abstract Background: A post‐infarction ventricular septal defect (VSD) is a serious complication of a myocardial infarction with 90% of patients dying by two months, in published series. Urgent surgical repair improves the prognosis. Aims: To assess the Green Lane Hospital experience over a ten year period, especially with regard to hospital mortality and long‐term follow up. Methods: A retrospective case note review of all 35 consecutive patients undergoing post‐infarct VSD repair from 1981 to 1990. Long‐term follow up was obtained in all but one patient (97%). Results: Twenty‐one male and 14 female patients presented with a mean age of 67 years (range 51–75). All were in NYHA class 3 or 4, 14 (40%) were in cardiogenic shock. Following urgent surgical repair, 30 day mortality was 3i% (11 patients). A further three patients died at two, 33 and 39 months; one patient was lost to follow up. At a mean follow up of 61 months (range 16–111), 15 patients were in NYHA class 1 or 2, five in NYHA class 3 or 4. For the whole group (n= 35) the actuarial survival was 66% at one year, 62% at three years and 58% at nine years. Conclusion: Post‐infarct VSD surgery is of major prognostic benefit with patients obtaining a good long‐term outcome. (Aust NZ J Med 1995; 25: 330–336.)
Radiofrequency catheter ablation of atrial tachycardia
Authors: Wang L. , Weerasooriya H. R. , Davis M. J. E. 
Published: March 2008

Abstract Background: Atrial tachycardia is a relatively uncommon arrhythmia which usually responds poorly to antiarrhythmic drug therapy. Transcatheter radiofrequency (RF) ablation is a new therapeutic modality for patients with atrial tachycardia. Aim: This study analyses our early experience with the treatment of atrial tachycardia by this technique. Methods: Thirteen consecutive patients (age 13–63 years) with 15 drug‐refractory atrial tachycardia foci were treated with RF catheter ablation. Atrial tachycardia was mapped by seeking the earliest atrial activation in the right atrium in eight patients and in the left atrium in five. Results: Tachycardias were abolished in nine (69%) patients, including two sinoatrial re‐entrant tachycardias and seven automatic atrial tachycardias, after 9±10 (range, one to 28) pulses of RF current. Six of these ablated atrial tachycardia foci were right sided and three were on the left. One patient had three separate right atrial tachycardia foci; one was eliminated. Tachycardia recurred after two weeks in one patient with apparently successful ablation of sinoatrial re‐entrant tachycardia. One patient with successful ablation of a right atrial tachycardia developed cardiac tamponade requiring surgical intervention. Conclusion: This study demonstrates that atrial tachycardia arising from diverse sites can be eliminated by RF catheter ablation.
Primary spontaneous pneumothorax treated by video assisted thoracoscopic surgery – results of intermediate follow up
Authors: Yim A. P. C. , Ho J. K. S. , Lai C. K. W. , Chan H. S. 
Published: March 2008

Abstract Background: Primary spontaneous pneumothorax (PSP) is a common clinical condition associated with high recurrence if no definitive treatment is given and could be life threatening if left untreated. The best treatment for this condition, however, remains controversial. Aims: A prospective study of patients with PSP treated by video assisted thoracoscopic surgery (VATS) after a mean follow up of 16 months. Methods: Between September 1992 and April 1994, 114 VATS procedures were performed on 110 patients with PSP (including four patients with bilateral presentation) by one surgical team from a single institution. Mechanical pleurodesis with Marlex mesh was performed on all patients. In addition, apical bullae were identified in 100 cases (88%) and these were resected. Results: There was no mortality. The median hospital stay was three days. The procedure was well accepted by patients and this was reflected subjectively in a visual analogue scale and objectively in the requirement of postoperative analgesia. Complications included one wound infection, one bleeding, eight persistent air leaks over ten days. We had two failures with recurrence of pneumothorax occurring one week and two months postoperatively (mean follow up of 16 months). Late morbidity with intercostal neuropathy was identified in nine patients but only two of them required oral analgesics. Conclusion: VATS is a quick and effective treatment for PSP. We currently recommend VATS for patients with recurrent spontaneous pneumothorax, as well as first time pneumothoraces associated with tension, bilaterality, frequent travelling, unreliable follow up and persistent air leak over three days.
Regulation of the immune response – lessons from transgenic models
Authors: de St Groth BARBARA FAZEKAS 
Published: March 2008

Abstract:Generation of the immune antigen receptor repertoire by means of semi‐random recombination requires a mechanism for ensuring that self reactivity is constrained. A model is presented which accounts not only for the generation of self tolerance during ontogeny but also for regulation of tolerance and immunity in peripheral immune responses. The model proposes a hierarchy of immune regulation in which antigen presenting cells (APCs) determine the responses of T cells and T cells those of B cells. APCs respond to environmental triggers such as microbes, particulate antigen and tissue injury by becoming highly immunogenic for T cells. At other times, APCs can either be non‐stimulatory or tolerogenic, depending on their environment. The model suggests that during ontogeny T and B cells mature in a tolerogenic environment in the thymus and bone marrow, thus ensuring that immunological tolerance results from early contact with self antigen.
Target cell apoptosis induced by cytotoxic T cells and natural killer cells involves synergy between the pore‐forming protein, perforin, and the serine protease, granzyme B
Authors: Trapani JOSEPH A. 
Published: March 2008

Abstract:Cytotoxic lymphocytes (CL) comprise two effector cell populations with the ability to eliminate unwanted or harmful cells. Cytotoxic T cells (CTLs) demonstrate both an exquisite specificity and memory in recognising target cell oligopeptides presented within the groove of major histocompatibility complex class I antigens. By contrast, natural killer (NK) cells mediate ‘innate’ immunity against virus‐infected cells and surveillance against neoplastic transformation, and do not require presensitisation. Despite recognising target cells in very different ways, CTLs and NK cells both utilise a pore‐forming protein, perforin, and a battery of serine proteases as a principal means of inflicting cell death. The action of both types of CL results in death by apoptosis. Recently, we and others have accumulated evidence that perforin and serine proteases synergistically trigger an endogenous pathway of programmed cell death that results in dissolution of the nuclear membrane, chromatin condensation and DNA fragmentation. These changes are secondary to inappropriate activation of p34cdc2, a kinase whose activation and migration from the cytoplasm to the nucleus normally controls a cell's entry into mitosis. Therefore, CL may exert their actions through the derangement of cell cycle control. The downstream molecular targets of perforin/granzyme‐mediated apoptosis (especially the physiological ligand/substrate of granzyme B) are still unclear, though candidate molecules with homology to products of cell death genes found in primitive organisms such as the nematode, C. elegans, are currently under investigation.
Mechanisms of drug resistance in malaria
Authors: Cowman ALAN F. 
Published: March 2008

Abstract:Plasmodium falciparum causes the most severe form of human malaria which directly results in over two million deaths per year. As there is not yet a useful vaccine against this disease the major form of treatment and control is the use of chemotherapeutic agents. Unfortunately the parasite has managed to devise mechanisms that allow it to evade the action of almost all the antimalarials in our arsenal.The antifolate drugs include the dihydrofolate inhibitors pyrimethamine and proguanil as well as the sulfones and sulfonamides. These antimalarials act on enzymes in the folate pathway. The mechanism of resistance to these compounds involve mutations in the target enzyme that decrease the affinity of binding of the drug.A second major group of antimalarials include the quinine‐like compounds. Quinine was one of the first compounds used to treat malaria and the related drug chloroquine is the most important antimalarial. Mefloquine and halofantrine were developed in response to major problems with the spread of chloroquine resistance. Chloroquine resistance is due to the ability of the parasite to decrease the accumulation of the drug in the cell. The exact mechanism that allows this is still under investigation although at least one protein has been identified that affects the accumulation of this important antimalarial.
The cbl oncogene: a novel substrate of protein tyrosine kinases
Authors: Langdon WALLACE Y. 
Published: March 2008

Abstract:The cbl oncogene was first identified as part of a transforming retrovirus which arose in a mouse pre‐B cell lymphoma. Its protein product, p120cbl, is cytoplasmic and has several distinctive domains including a highly basic region, a RING finger motif and a large proline‐rich domain. A mutation to cbl in the 70Z/3 pre‐B cell lymphoma produces an oncogenic protein which exhibits a marked enhancement of tyrosine phosphorylation. Parallel studies have demonstrated that P120cbl is a substrate of protein tyrosine kinases activated by engagement of the T cell antigen receptor and that cbl is phosphorylated by oncogenic forms of the Abl tyrosine kinase. These studies also demonstrated a constitutive association between cbl and the SH3 domains of the Grb2 and Nek adaptor proteins in a range of haemopoietic cell lines. More recently it has been found that cbl is rapidly phosphorylated following stimulation of the EGF receptor, Fey receptor, c‐Kit receptor and CSF‐1 receptor. A genetic analysis in Caenorhabditis elegans has identified a cbl homologue, called sli‐1, that negatively regulates the LET‐23 tyrosine kinase receptor. These characteristics indicate a central role for cbl in the regulation of intracellular signals that are mediated by growth factors and antigenic stimuli which activate protein tyrosine kinases.
Patients' perceptions of food‐induced asthma
Authors: Woods R. K. , Weiner J. , Abramson M. , Thien F. , Walters E. H. 
Published: March 2008

Abstract Background: The influence of diet in asthma control remains unclear. However, there is likely to be a wide gap between patient perceptions and the probable actual role. Some 20–60% of people with asthma report food as a trigger factor while approximately 2.5% react to double‐blind placebo‐controlled challenges. The aim of this study was to determine: the frequency, type and sources of dietary advice being offered to patients, the prevalence of dietary modification, whether dietary changes were perceived to be of benefit and the type and sources of food/beverage reactions that people perceive they have experienced. Method: A self‐administered ‘food and asthma’ questionnaire was developed and mailed to 156 consecutive Alfred Hospital Asthma and Allergy Clinic patients registered on a computer database. Results: The completed questionnaire response rate was 86.5%. Dietary advice had been offered to 47% of respondents while 61% had tried to modify their diet. Dietary restriction was the most common dietary modification. Where dietary restriction had occurred 79% of respondents perceived that this had improved their asthma control. A doctor was the most common source of dietary advice. Seventy‐three per cent reported that food induced asthma. Conclusion: We confirmed that patients with asthma perceived diet to be important in their asthma control and that dietary modification is common despite its lack of objective basis. The influence of diet and asthma requires more research, evaluation and clinical attention.
Microalbuminuria in Type 2 diabetes: an independent predictor of cardiovascular mortality
Authors: Beilin J. , Stanton K. G. , McCann V. J. , Knuiman M. W. , Divitini M. L. 
Published: March 2008

Abstract Background: Microalbuminuria has been shown to be associated with cardiovascular mortality in type 2 diabetic subjects. It is unclear to what extent this is due to the increased prevalence of other cardiac risk factors. Aims: To examine the relationship of urine albumin excretion to cardiovascular mortality and to determine its status as an independent risk factor. Methods: In a prospective longitudinal study from 1986–1999 we followed 666 type 2 diabetic subjects from a diabetes outpatient service. Cardiovascular risk factors including urine albumin concentration were measured at study entry. Cox proportional hazards regression was used to determine risk factors for mortality. The hazard ratios of microalbuminuria and macroalbuminuria for all cause, cardiovascular and coronary heart disease mortality were determined after accounting for other cardiac risk factors including blood pressure, glycated haemoglobin, total cholesterol, HDL cholesterol, triglycerides, urea, smoking, body mass index, patient age and disease duration. Results: The prevalence of urine albumin of 30–300 mg/L at study entry was 31.7%. A total of 167 deaths occurred (80 from cardiovascular disease). Mortality hazard ratios in subjects with urine albumin of 30–300 mg/L as compared to <30 mg/L, adjusted for age, sex and other cardiovascular risk factors were 1.77 (95% CI 1.22–2.57, p=0.002) for all causes, 2.34 (95% CI 1.38–3.99, p=0.002) for cardiovascular and 1.78 (95% CI 0.97–3.26, p=0.061) for coronary heart disease (CHD) mortality. Other factors significantly associated with cardiovascular mortality included diastolic blood pressure, HDL cholesterol and glycated haemoglobin. Total cholesterol and log triglyceride were significantly associated with CHD mortality. Disease duration, age at diagnosis, smoking and body mass index were not related to cardiovascular or CHD mortality. Conclusions: We confirm microalbuminuria as an independent predictor of mortality in type 2 diabetes despite its association with a number of conventional cardiovascular risk factors.
Symptomatic Human Immunodeficiency Virus (HIV) infection in Papua New Guinea
Authors: Seaton R. A. , Wembri J. P. , Armstrong P. , Ombiga J. , Naraqi S. , Kevau I. 
Published: March 2008

Abstract Background: Human Immunodeficiency Virus (HIV) infection was first detected in Papua New Guinea (PNG) in 1987. By August 1995 a total of 323 persons had been diagnosed as HIV antibody positive nationwide and seroprevalence rates were climbing. This study was prompted by a lack of data on the clinical syndromes associated with HIV infection in Melanesian adults. Aims: To describe the clinical and epidemiological features of symptomatic HIV infection in adult Melanesians. Methods: A largely retrospective study of patients was admitted to the medical wards of the Port Moresby general hospital between January 1990 and September 1995. Clinical records of patients with antibody to HIV were studied and clinical, laboratory and epidemiological data were recorded. Results: Seventy patients were studied and the majority were young, urban dwelling adults from a variety of social groups. The sex distribution was even. Common clinical syndromes associated with HIV infection were chronic diarrhoea (47.8%), wasting (94.2%) and oropharyngeal candidiasis (68.7%). Tuberculosis was suspected in 68.6% and cryptococcal meningitis was detected in 8.6% including one patient with Cryptococcus. neoformans var. gattii infection. There was a high mortality (53%) in patients admitted to hospital. Conclusions: Patients with HIV infection in PNG present to hospital late in their disease course. Clinical syndromes are similar to those observed in Africa and mortality on first admission is high. The major mode of transmission is heterosexual and sexually transmitted diseases and promiscuity are probably important factors in facilitating spread.