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Debattista J, Martin P, Jamieson J, Crane K, Dolton I, Russell-Hall S, DeSilva J, Hargrave R, Robinson T, Ryan N, Mortlock M. Detection of Chlamydia trachomatis in an Australian high school student population. Sex Transm Infect 2002; 78:194-7. [PMID: 12238652 PMCID: PMC1744462 DOI: 10.1136/sti.78.3.194] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence of Chlamydia trachomatis infections among an Australian high school adolescent population. METHODS Over a 4 year period, 14 high schools were selected in which an infertility prevention programme targeting C. trachomatis was delivered to senior student populations. Coded first catch urine specimens were analysed by Amplicor PCR and infected students treated. Data retrospectively obtained from chlamydia screening programmes conducted among disadvantaged young people detached from formal education were also collated for comparison. RESULTS Of a total student test population of 1174, 15 (1.3%; 95% CI 0.7% to 2.1%) were diagnosed with C. trachomatis. Of 516 females and 658 males, 12 (2.3%; 95% CI 1.1% to 4.1%) and 3 (0.5%; 95% CI 0.1% to 1.4%) were tested positive respectively. Data collated for three populations of disadvantaged youth returned at total of 89 C. trachomatis infections out of 560 people (15.9% 95%CI 13.0-19.2%). CONCLUSION The overall prevalence of C. trachomatis infection among this population of senior high school adolescents is low, and significantly differs from the higher chlamydia rates detected in disadvantaged adolescents detached from formal schooling (p<0.0001).
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de Silva S, Saykao P, Kelly H, MacIntyre CR, Ryan N, Leydon J, Biggs BA. Chronic Strongyloides stercoralis infection in Laotian immigrants and refugees 7-20 years after resettlement in Australia. Epidemiol Infect 2002; 128:439-44. [PMID: 12113488 PMCID: PMC2869840 DOI: 10.1017/s0950268801006677] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
During the period 1974-91 large numbers of Southeast Asian immigrants and refugees were resettled in Western countries, including Australia. Health screening during this period demonstrated that intestinal parasite infections were common. A cross-sectional survey of 95 Laotian settlers who arrived in Australia on average 12 years prior to the study was conducted to determine if chronic intestinal parasite infections were prevalent in this group. Twenty-three participants had positive Strongyloides stercoralis test results (22 with positive serology, including I with S. stercoralis larvae detected in faeces and another with larvae and equivocal serology). Of these 23 participants, 18 (78%) had an elevated eosinophil count. Two patients had eggs of Opisthorchis spp. identified by faecal microscopy. The detection of chronic strongyloidiasis in Laotian settlers is a concern because of the potential serious morbidity associated with this pathogen.
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Formica N, Yates M, Beers M, Carnie J, Hogg G, Ryan N, Tallis G. The impact of diagnosis by legionella urinary antigen test on the epidemiology and outcomes of Legionnaires' disease. Epidemiol Infect 2001; 127:275-80. [PMID: 11693505 PMCID: PMC2869747 DOI: 10.1017/s0950268801005672] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Legionnaires' disease is an uncommon but important cause of life-threatening community-acquired or nosocomial pneumonia. The urinary antigen enzyme immunoassay test, used in Victoria since 1995, now accounts for the majority of initial laboratory notifications (81% in 1999). We review the impact of the test on the disease epidemiology and the public health investigative process. We focus on the major subgroup of cases due to Legionella pneumophila serogroup 1, comparing delays until notification and mortality for urinary antigen detected cases with culture detected cases. The urinary antigen test facilitates a 5-day reduction for the delay between onset of illness and notification. We observed that there was minimal clinical heterogeneity of urinary antigen detected cases whether they were subsequently culture confirmed or not. We encourage clinician use of the urinary antigen test in cases of community-acquired pneumonia where Legionnaires' disease is a possible diagnosis, in conjunction with culture of clinical specimens.
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Ryan N, Rosner A. Quality of life and costs associated with micronized progesterone and medroxyprogesterone acetate in hormone replacement therapy for nonhysterectomized, postmenopausal women. Clin Ther 2001; 23:1099-115. [PMID: 11519773 DOI: 10.1016/s0149-2918(01)80094-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Because natural progesterone is poorly absorbed and rapidly metabolized, synthetic derivatives of progesterone, such as medroxyprogesterone acetate (MPA), are used in combination with estrogen in hormone replacement therapy. A micronized form of natural progesterone is available that is readily absorbed and reaches peak serum concentrations from 1 to 4 hours after administration. OBJECTIVE The purpose of this study was to compare the quality of life (QOL), menopausal symptoms, and costs associated with a natural micronized progesterone (MP) formulation versus MPA as add-on therapy to estrogen in hormone replacement for post-menopausal women. METHODS This prospective, multicenter, randomized, fixed-dose, open-label, parallel-group study enrolled postmenopausal, otherwise healthy, nonhysterectomized women 45 to 65 years of age who had been amenorrheic for > or =6 months and exhibited symptoms of estrogen deficiency. All women received 0.625 mg conjugated equine estrogens on days 1 to 25 of a 30-day cycle; on days 12 to 25, women were randomized to receive either MP 200 mg or MPA 5 mg; patients were followed for 9 months. QOL, the primary end point, was measured at baseline and months 3, 6, and 9 using the 36-Item Short-Form Health Survey (SF-36), the Nottingham Health Profile (NHP), and the condition-specific Women's Health Questionnaire (WHQ). Bleeding pattern, compliance, menopausal symptoms, and cost were evaluated as secondary end points. Costs (in 1997 Canadian dollars) were assessed from the societal perspective and included costs of study medication, hormone therapy monitoring, concomitant medication, outpatient resources, out-of-pocket expenses, and patient and caregiver time loss. RESULTS A total of 182 women were enrolled; 89 received MP and 93 received MPA. Improvements in climacteric symptoms were observed from baseline to month 9 for both treatments. Mean scores on all domains of the SF-36 at month 9 were greater than scores at baseline in both treatment groups but the increases were not statistically significant. All domains within the NHP and WHQ improved significantly over this period for both groups (P < or = 0.008). Only patients receiving MP showed specific improvements in the menstrual problems and cognitive domains of the WHQ. The difference in average 9-month cost per patient was not statistically significant, at Can 367 dollars +/- 120 dollars and Can 360 dollars +/- 369 dollars for patients receiving MP and MPA, respectively. CONCLUSIONS MP is a clinically effective, well-tolerated, and cost-comparable alternative to MPA.
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Strauss J, Birmaher B, Bridge J, Axelson D, Chiappetta L, Brent D, Ryan N. Anxiety disorders in suicidal youth. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2000; 45:739-45. [PMID: 11086557 DOI: 10.1177/070674370004500807] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the hypothesis that anxiety disorders are associated with suicidal ideation and suicide attempts in a child and adolescent sample referred to a clinic. METHOD The sample comprised 1979 patients aged 5 to 19 years who were assessed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children--Present Episode (K-SADS-P) at an outpatient mood and anxiety disorders clinic. Subjects were stratified by age and categorized into mutually exclusive groups as being nonsuicidal (n = 817), having suicidal ideation (n = 768), or having attempted suicide (n = 394) in the current episode. Psychiatric diagnoses based on DSM-IV criteria were compared to determine if anxiety disorders were a risk factor for suicidal ideation and suicide attempts. Logistic regression was used to control for significant demographic characteristics and comorbid disorders. RESULTS After stratifying by age, we found no differences across the 3 groups (ideators, attempters, and nonsuicidal youth) in rates of an anxiety disorder in general or in specific rates of panic disorder, agoraphobia, social phobia, simple phobia, and obsessive-compulsive disorder. Two salient findings involving anxiety disorders were noted with regression analysis. In younger children (age < or = 15 years), attempters had a significantly lower prevalence of separation anxiety disorder (SAD), compared with ideators (OR = 0.30; 95%CI, 0.11 to 0.80; P = 0.006) and nonsuicidal youngsters (OR = 0.14; 95%CI, 0.05 to 0.39; P < 0.0001). In older children (age > 15 years), generalized anxiety disorder (GAD) was more prevalent in ideators (OR = 1.65; 95%CI, 1.03 to 2.66; P = 0.03) than in nonsuicidal patients. CONCLUSIONS Based on this clinical sample, the relation between pediatric anxiety disorder and suicidal ideation and suicide attempts is not straightforward. However, further studies in nonreferred samples are warranted.
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Formica N, Tallis G, Zwolak B, Camie J, Beers M, Hogg G, Ryan N, Yates M. Legionnaires' disease outbreak: Victoria's largest identified outbreak. Commun Dis Intell (2018) 2000; 24:199-202. [PMID: 10981350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This paper describes and analyses some aspects of an outbreak of Legionnaires' disease in Victoria, commencing in late October 1998. In all, 18 cases caused by Legionella pneumophila serogroup 1 were notified within 10 days making this the largest outbreak in Victoria reported to that date. All cases had epidemiological links to an industrial estate in a northern Melbourne suburb. Extensive environmental sampling revealed Legionella bacteria in five cooling towers. Molecular sub-typing techniques were used to compare clinical and environmental isolates. Isolates from one tower had a pulsed-field gel electrophoresis pattern that was indistinguishable from clinical isolates from eight cases. Control of outbreaks caused by Legionella bacteria requires rapid, coordinated responses to linked cases of disease. The Legionella urinary antigen test facilitated a rapid public health response, and culture and molecular sub-typing of clinical specimens assisted in developing epidemiological links.
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Ryan N, Hurst K. Clinical governance in accident and emergency services. INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE INCORPORATING LEADERSHIP IN HEALTH SERVICES 2000; 12:267-71. [PMID: 10724569 DOI: 10.1108/09526869910291832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Owing to NHS managers' preponderance with financial issues, the present Government made improving the quality of health services a statutory requirement in 1997. In this article, one means of improving the quality of health services, clinical governance, is examined in detail before some issues related to its implementation are described. The Trust's A&E services, the context for interpreting and applying clinical governance, are briefly described before introducing a force-field analysis that demonstrates the different elements when changing services broadly and clinical governance specifically. The final section concentrates on implementing and improving clinical governance in A&E departments.
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Ungar WJ, Josse R, Lee S, Ryan N, Adachi R, Hanley D, Brown J, Breton MC. The Canadian SCORE questionnaire: optimizing the use of technology for low bone density assessment. Simple Calculated Osteoporosis Risk Estimate. J Clin Densitom 2000; 3:269-80. [PMID: 11090234 DOI: 10.1385/jcd:3:3:269] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Simple Calculated Osteoporosis Risk Estimation (SCORE) questionnaire is a tool to assist physicians to identify women who might require bone densitometry. The purpose of this study was to develop a Canadian SCORE and to assess validity and reliability. Twenty sites enrolled 307 postmenopausal women ages 50-70 yr. SCORE results were compared to hip and lumbar spine bone density assessed by dual X-ray absorptiometry. Sensitivity and specificity of a range of SCORE cut-points were assessed in a receiver operating characteristics analysis to determine the optimal cut-point for SCORE. With low bone density defined as a T-score < or = -2.0, a SCORE cut-point of 6 in women ages 50-59 yr displayed a sensitivity of 0. 96, 95% confidence interval (CI) (0.89, 1.00), a specificity of 0.51, 95% CI (0.43, 0.58). In women ages 60-70 yr, a SCORE cut-point of 8 displayed a sensitivity of 0.90, 95% CI (0.80, 0.97) and a specificity of 0.20, 95% CI (0.11, 0.29). The test-retest reliability (intraclass correlation coefficient) was 0.95. SCORE performed better in women in their fifties than women in ther sixties. Older women require higher SCORE cut-points. The use of SCORE as an initial measure for identifying those at risk for osteoporosis may reduce costs by limiting unnecessary tests.
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Krondl M, Coleman PH, Bradley CL, Lau D, Ryan N. Subjectively healthy elderly consuming a liquid nutrition supplement maintained body mass index and improved some nutritional parameters and perceived well-being. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 1999; 99:1542-8. [PMID: 10608948 DOI: 10.1016/s0002-8223(99)00378-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate regular use of a liquid nutrition supplement by subjectively healthy elderly persons in terms of body mass index, nutrient intake, selected biochemical parameters, and perceived quality-of-life changes, and to identify advantages and limitations of use. DESIGN A 16-week intervention study in which subjects were assigned randomly to either a supplemented group or a control group and compared in terms of intergroup and intragroup differences in weight, food intake, blood values, and quality-of-life indexes. Adherence to protocol was monitored by monthly visits with an interviewer and food intake records. SUBJECTS/SETTING Seventy-one independent living, older Canadian adults (mean age = 70 +/- 7 years) consuming on average less than 4 servings of fruit and vegetables daily and a supplement-free diet before the study. Subjects were without functional limitations and did not require therapeutic diets or medical treatments that affect nutritional status. Data were collected in home interviews. Blood for analysis was obtained from a subsample of 36 subjects. INTERVENTION Inclusion of six 235-mL cans of liquid nutrition supplement weekly into the self-selected dietary patterns of the supplemented group. STATISTICAL ANALYSIS Results were analyzed by Student t tests or Wilcoxon rank sum test, analysis of variance, and multiple stepwise regression. RESULTS Body mass index, energy intake, and consumption of fruit and vegetables did not change throughout the study. In the supplemented group, statistically significant increases occurred from baseline to termination of the study in these nutrients: protein, calcium, iron, magnesium, and folate. Serum albumin, folate, ferritin, hemoglobin, and zinc values were within the normal range for the supplemented and control groups. Scores for the Medical Outcomes Study 36-Item Short-Form Health Status scales increased for the supplemented group from baseline to termination for vitality and general health perception. Values for the General Well-Being Questionnaire improved for anxiety and general well-being. Of the dietary predictors, folate intake explained the most variance for vitality and for general well-being, 8.6% and 14.2%, respectively. APPLICATIONS A liquid nutrition supplement could be recommended to the elderly when energy maintenance and increases in nutrient intake are necessary and convenience is an important consideration. Dietetics professionals should address the issues of affordability of the supplement, the role of food in achieving nutritional adequacy, and overall quality of life of clients. Folate intake as a predictor of perceived general well-being and vitality requires further investigation.
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Howarth S, Marshall LR, Barr AL, Evans S, Pontre M, Ryan N. Platelet indices during normal pregnancy and pre-eclampsia. Br J Biomed Sci 1999; 56:20-2. [PMID: 10492911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Platelet count and mean platelet volume (MPV) were estimated in 349 normal pregnancies at various gestational stages, and in 30 cases of pre-eclampsia. A probability plot was constructed from these data using discriminant analysis of MPV versus platelet count for the pre-eclamptic versus normal pregnancies. The sensitivity for pre-eclampsia was 90% (27/30) and the specificity was 83.3%. This plot may be of use in confirming risk of pre-eclampsia.
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Leder K, Ryan N, Spelman D, Crowe SM. Microsporidial disease in HIV-infected patients: a report of 42 patients and review of the literature. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1998; 30:331-8. [PMID: 9817510 DOI: 10.1080/00365549850160594] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Microsporidiosis is recognized as an increasingly important infection, particularly in patients with human immunodeficiency virus (HIV) infection. In this retrospective study we have reviewed the clinical features, laboratory findings and management of 42 HIV positive patients co-infected with microsporidia. All patients had spores identified in faeces stained with a modified trichome blue stain. Patients were all markedly immunosuppressed (median CD4 20 cells/microl). Common symptoms included weight loss, diarrhoea, abdominal pain, anorexia and nausea. 29 patients were diagnosed with Enterocytozoon bieneusi infection; 13 were infected with Encephalitozoon intestinalis, and disseminated disease was confirmed in 8. Albendazole therapy in patients with E. intestinalis (but not E. bieneusi) resulted in good clinical response.
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Reynolds CF, Martin C, Brent D, Ryan N, Dahl RE, Pilkonis P, Marcus MD, Kupfer DJ. Postdoctoral clinical-research training in psychiatry: a model for teaching grant writing and other research survival skills and for increasing clarity of mentoring expectations. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 1998; 22:190-6. [PMID: 19617924 PMCID: PMC2711541 DOI: 10.1901/jaba.1998.22-190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The authors describe a model for teaching grant writing and other research survival skills to postdoctoral clinical-research fellows in psychiatry and for improving research mentoring. Over the past 4 years, the authors have developed a course on writing grant applications for postdoctoral clinical-research fellows, using peer-review processes modeled after a National Institutes of Health study section. At the same time, the authors have clarified expectations of mentors in ways designed to help fellows prepare "K" (Research Career Development) applications and to receive mentored practice in skills being taught in the course. Sixteen of 30 fellows have succeeded in receiving their first extramural support by the end of their two-year fellowship tenure or during the succeeding year. The authors conclude that by teaching grant-writing skills in a supportive peer environment, providing peer review of proposals, and sharpening expectations of mentors, it may be possible to reduce the time between the end of fellowship and the receipt of the first extramural grant.
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Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36:980-8. [PMID: 9204677 DOI: 10.1097/00004583-199707000-00021] [Citation(s) in RCA: 6959] [Impact Index Per Article: 257.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe the psychometric properties of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) interview, which surveys additional disorders not assessed in prior K-SADS, contains improved probes and anchor points, includes diagnosis-specific impairment ratings, generates DSM-III-R and DSM-IV diagnoses, and divides symptoms surveyed into a screening interview and five diagnostic supplements. METHOD Subjects were 55 psychiatric outpatients and 11 normal controls (aged 7 through 17 years). Both parents and children were used as informants. Concurrent validity of the screen criteria and the K-SADS-PL diagnoses was assessed against standard self-report scales. Interrater (n = 15) and test-retest (n = 20) reliability data were also collected (mean retest interval: 18 days; range: 2 to 36 days). RESULTS Rating scale data support the concurrent validity of screens and K-SADS-PL diagnoses. Interrater agreement in scoring screens and diagnoses was high (range: 93% to 100%). Test-retest reliability kappa coefficients were in the excellent range for present and/or lifetime diagnoses of major depression, any bipolar, generalized anxiety, conduct, and oppositional defiant disorder (.77 to 1.00) and in the good range for present diagnoses of posttraumatic stress disorder and attention-deficit hyperactivity disorder (.63 to .67). CONCLUSION Results suggest the K-SADS-PL generates reliable and valid child psychiatric diagnoses.
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Piscitelli SC, Forrest A, Lush RM, Ryan N, Whitfield LR, Figg WD. Pharmacometric analysis of the effect of furosemide on suramin pharmacokinetics. Pharmacotherapy 1997; 17:431-7. [PMID: 9165547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To characterize the effects of furosemide on the pharmacokinetics of suramin, a renally eliminated investigational antineoplastic agent. DESIGN Retrospective population pharmacokinetic analysis. SETTING Government biomedical research facility. PATIENTS Twenty-six men with hormone-refractory prostate cancer and one with adrenocortical carcinoma. INTERVENTIONS Patients received suramin by continuous or intermittent infusion with and without concomitant furosemide. MEASUREMENTS AND MAIN RESULTS Optimum suramin regimens were achieved by adaptive feedback control, and pharmacokinetic data were collected both in the presence and absence of furosemide. Suramin concentrations were determined by high-performance liquid chromatography (coefficient of variation < 8%). Suramin concentrations were fit to a three-compartment linear model with six coefficients and two rate inputs, which allowed furosemide to affect suramin pharmacokinetics. Individual and population parameter estimates were determined using the iterative two-stage approach. Concomitant furosemide was associated with a median decrease in total body clearance of suramin by 36% (range 0-63%, p < 0.0001). No other parameter was significantly altered, and there was no trend for change in any pharmacokinetic value with time. Suramin plasma concentrations were simulated with and without prolonged furosemide therapy in 26 patients for 12 weeks. The average suramin concentration increased by greater than 33% in 12 patients; 2 patients had a greater than 67% increase in this extreme case model. CONCLUSION Coadministration of furosemide with suramin can cause an increase in suramin concentrations; however, due to suramin's long half-life, its rate of accumulation is very slow. Nonetheless, in individuals receiving suramin by nonadaptive control, appropriate precautions should be taken when prolonged furosemide therapy is begun.
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Figg WD, Christian MC, Lush R, Link CJ, Davis P, Kohn E, Sarosy G, Rothenberg ML, Weiss RB, Ryan N, Jacobs J, Reed E. Pharmacokinetics of elemental platinum (ultrafiltrate and total) after a thirty minute intravenous infusion of ormaplatin. Biopharm Drug Dispos 1997; 18:347-59. [PMID: 9158882 DOI: 10.1002/(sici)1099-081x(199705)18:4<347::aid-bdd23>3.0.co;2-o] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Preclinical data suggest that ormaplatin (tetrachloro-(dl-trans)-1, 2-diamminocyclohexaneplatinum) has substantial activity in cisplatin-resistant tumor models and may be less nephrotoxic than cisplatin. Based on these data we initiated a phase I clinical trial in patients with refractory metastatic cancer. This report characterizes the pharmacokinetic profile of both the total plasma concentrations of elemental platinum and the unbound ultrafiltrate concentrations of elemental platinum, following a 30 min intravenous infusion of ormaplatin. Platinum concentrations were determined by AAS, and pharmacokinetic parameters for both the total plasma concentration and the ultrafiltrate concentration of elemental platinum were determined using both compartmental and noncompartmental methods. Twenty-eight patients (14 males and 14 females; median age, 58) received ormaplatin. There was a linear relationship between Cmax and dose (r2 = 0.945) and AUC and dose (r2 = 0.976). Ormaplatin is more accurately described by a two-compartment model than by a one-compartment model. The distribution half-life (t1/2 alpha) was 0.3 h and the terminal half-life (t1/2 beta) was 39.1 h. The volume of the central compartment (V) was 68.6 L and the volume of distribution at steady state (Vdss) was 183 L. Like total plasma platinum, unbound platinum is also best characterized by a two-compartment model. The elimination of free platinum is also biphasic with a distribution half-life (t1/2 alpha) of 0.3 h and a terminal half-life (t1/2 beta) of 19.3 h. The mean volume of the central compartment (V) was 200.5 L, and the mean volume of distribution at steady state (Vdss) was 560.5 L. Clinical development of ormaplatin has been terminated due to increased frequency of neurological complications noted over other platinum agents; however, the pharmacokinetics are, in general, similar to those of other clinically used platinum compounds.
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Torresi J, Sheori H, Ryan N, Yung A. Usefulness of Semen Microscopy in the Diagnosis of a Difficult Case of Schistosoma haematobium Infection in a Returned Traveler. J Travel Med 1997; 4:46-47. [PMID: 9815478 DOI: 10.1111/j.1708-8305.1997.tb00774.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Schistosoma haematobium is endemic in many countries of Southeast Asia, eastern and western Africa, and South America. It affects mainly the urinary system, although infection of the genital organs is not infrequent.1,2 Infection of male genital organs, especially of the seminal vesicles and prostate1,3 may result in hematospermia and infertility.2,4,5,6,7,8,9 The diagnosis of Schistosoma haematobium traditionally relies on demonstrating the presence of characteristic ova in urine and, less often, in feces. Serology is nonspecific and lacks sensitivity because the antigens utilized in the indirect hemagglutination assay are derived from Schistosoma mansoni. In addition, serology cannot differentiate past from recently acquired infection. We report a case of Schistosoma haematobium infection in a returned traveler in whom numerous ova were detected in semen despite repeated negative urinary and fecal examinations and negative serology.
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Ryan N. The right track. NURSING TIMES 1996; 92:41. [PMID: 9000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Ryan N. A study of the contribution of effective pressure care on elderly female patients attending accident and emergency who have a suspected fractured neck of femur. ACCIDENT AND EMERGENCY NURSING 1996; 4:21-4. [PMID: 8696850 DOI: 10.1016/s0965-2302(96)90032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study describes the benefit of pressure relief and the use of pressure reducing mattresses on elderly female patients with a suspected fractured neck of femur, attending an Accident and Emergency department. The main aim of the study was to determine if pressure care, appropriate to each individual patient, reduced red pressure areas and if so, in what way? The results demonstrated that pressure relief given at regular intervals was most effective at reducing red pressure areas. The pressure reducing mattresses also showed to be beneficial in reducing these areas. The study highlighted the importance of giving regular pressure relief in all patients at risk of development of pressure sores.
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Werry JS, Biederman J, Thisted R, Greenhill L, Ryan N. Resolved: cardiac arrhythmias make desipramine an unacceptable choice in children. J Am Acad Child Adolesc Psychiatry 1995; 34:1239-45; discussion 1245-8. [PMID: 7559320 DOI: 10.1097/00004583-199509000-00023] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Birmaher B, Waterman GS, Ryan N, Cully M, Balach L, Ingram J, Brodsky M. Fluoxetine for childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 1994; 33:993-9. [PMID: 7961355 DOI: 10.1097/00004583-199409000-00009] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The objective of this open study was to determine the efficacy and safety of fluoxetine for the treatment of children and adolescents with anxiety disorders. METHOD Twenty-one patients with overanxious disorders, social phobia, or separation anxiety disorder, who were unresponsive to previous psychopharmacological and psychotherapeutic interventions, were treated openly with fluoxetine for up to 10 months. Patients with lifetime histories of obsessive-compulsive disorder (OCD) or panic disorder, or with current major depression, were excluded. Beneficial and adverse effects of fluoxetine were ascertained using the improvement and severity subscales of the Clinical Global Impression Scale (CGIS) in two ways: (1) independent chart reviews by two child psychiatrists and (2) prospective assessments by the treating nurses and the patients' mothers. RESULTS Eighty-one percent (n = 17) of patients showed moderate to marked improvement in anxiety symptoms. The severity of anxiety as measured by the CGIS was also significantly reduced from marked to mild (effect size: 2.3). There were no significant side effects. CONCLUSIONS These results suggest that fluoxetine may be an effective and safe treatment for nondepressed children and adolescents with anxiety disorders other than OCD and panic disorder. Future investigations using double-blind, placebo-controlled methodologies are warranted.
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Prichard J, Allwright S, NcSweeney M, Macleod D, O’Regan M, Lyons RA, Power CK, Sreenan S, Burke CM, Daly L, Lonergan M, Graham I, Zhang W, Bard JM, McCrum EE, McMaster D, Fruchart JC, Cambien F, Evans AE, Ryan N, Clarke R, Robinson R, Refsum R, Ueland P, Lonergan N, O’Donnell A, McGivern E, Ben-Shlomo Y, Finnan F, Davey Smith G, McArdle M, Kelleher CC, Ward J, Broodle SE, Bleakney GM, Cullen BM, Gavin AT, Hurley M, Fogarty J, Boydell LR, Broddle SE, Scally GJ, Kilcoyne D, Anderson S, Cassidy C, Graham IM, Hickey N, Mulcahy R, Gorman D, Carter H, Collins C, Shelley E, Dean G, Lavelle P, O’Kelly F, Power B, Hillery I, Gaffney B, Darragh P, Thornton L, Clarke AT, Peyton M, Scally G, O’Reilly D, Shelly E, Kirke PN, O’Connell B, Moloney AC, Evans A, Hayes C, Laffoy M, O’Flanagan D, Corcoran R, Devlin J, MacAulay DC, Stott G, Kilbane P. 13th all Ireland social medicine meeting. Ir J Med Sci 1994. [DOI: 10.1007/bf02943011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Gabram SG, Libby MC, Jacobs LM, Atweh N, Degutis L, Reich JJ, Ryan N, Thomas RG, Zelman J. Peer review of on-scene air medical triage in Connecticut. CONNECTICUT MEDICINE 1994; 58:3-12. [PMID: 8181272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Ryan N, Glennon J, Muller D. On-line trace metal ion preconcentration in ion chromatography using carboxymethyl and hydroxamate dextran-coated silicas. Anal Chim Acta 1993. [DOI: 10.1016/0003-2670(93)85242-c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The sudden death of three children receiving the tricyclic antidepressant medication desipramine for behavioral disorders was reported in 1990. We now provide new information about these children and describe a fourth case. Because desipramine is a useful medication for many children, these deaths pose clinical dilemmas for physicians and families. The cardiac long QT syndrome has been proposed as a mechanism for these sudden deaths. Considerable uncertainty remains about the basis of the apparent association between the use of desipramine and the sudden deaths.
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Albert MJ, Alam K, Ansaruzzaman M, Islam MM, Rahman AS, Haider K, Bhuiyan NA, Nahar S, Ryan N, Montanaro J. Pathogenesis of Providencia alcalifaciens-induced diarrhea. Infect Immun 1992; 60:5017-24. [PMID: 1452332 PMCID: PMC258271 DOI: 10.1128/iai.60.12.5017-5024.1992] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Providencia alcalifaciens is a member of the family Enterobacteriaceae. There are reports that P. alcalifaciens can cause diarrhea, but the mechanism(s) by which it causes diarrhea is known. We studied P. alcalifaciens isolated from a child and two adults with diarrhea for enteropathogenicity. The three isolates did not exhibit any characteristic adherence to cultured HEp-2 cell monolayers, and they did not produce enterotoxins, cytotoxins, or keratoconjunctivitis in the Sereny test. Two isolates invaded cultured HEp-2 cell monolayers, producing localized bacterial clusters and actin condensation. The pattern of actin condensation was different from that produced by enteropathogenic Escherichia coli but similar to that produced by Shigella flexneri. Invasion and actin condensation were poor for the third isolate. Histology of adult rabbit small intestinal loops inoculated with all three isolates revealed bacterial attachment to, penetration of, and microulcer formation on the surface epithelium and hyperemia, edema, and polymorphonuclear cell infiltration of lamina propria. All the isolates produced diarrhea in rabbits with removable intestinal ties, and some of these rabbits developed hindlimb paralysis. Intestinal histology of the rabbits with removable intestinal ties which developed diarrhea showed changes similar to that in adult rabbits on which ileal loop assays had been performed. Transmission electron microscopy of intestinal tissues also confirmed tissue penetration by the isolates. Nerve tissue histology of two rabbits that developed hindlimb paralysis showed focal mononuclear cell infiltration around peripheral nerve sheaths. It is concluded that some strains of P. alcalifaciens are enteropathogenic and that they cause diarrhea by invading the intestinal mucosal epithelium. However, the relevance to human disease of the hindlimb paralysis observed in this animal model is not clear.
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