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Biomedical subjects

A B Mutgi

Publications and source records attributed to A B Mutgi.

At least 19 recordsLinked to original sources
PubMed2001

Breast cancer and NSAID use: a meta-analysis.

Recent epidemiological studies suggest that non-steroidal anti-inflammatory drugs (NSAIDs) reduce the risk of several cancers including breast cancer. This meta-analysis examined the studies on NSAID use and breast cancer. The estimators of relative risk and associated variances, which have been adjusted for the greatest number of confounders, were abstracted and included in the meta-analysis. Combined estimators of relative risk (RR) were calculated using either fixed or random effect models. Meta-analyses were performed on 6 cohort studies (number of cases ranged from 14 to 2414) and 8 case-control studies (number of cases ranged from 252 to 5882). The combined estimate of relative risk was 0.82 (95% confidence interval [CI] = 0.75-0.89). The combined estimate for cohort studies was 0.78 (95% CI = 0.62-0.99) and was 0.87 (95% CI = 0.84-0.91) for case-control studies. The findings of this meta-analysis suggest that NSAID use may be associated with a small decrease in the risk of breast cancer. However, the available data are insufficient to estimate the dose-response effect for duration and frequency of use of any particular types of NSAID.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2001

Effect of smoking cessation on major histologic types of lung cancer.

STUDY OBJECTIVES: It is well-recognized that the risk of lung cancer declines after smoking cessation. However, the degree of decline in different histologic types of lung cancer is not well understood. We conducted a meta-analysis of peer-reviewed studies to assess the effect of smoking cessation on rates of major histologic types of lung cancer. DESIGN: Studies published in English between 1970 and 1999 were identified through searches of computerized databases (ie, MEDLINE and CANCERLIT). Combined estimates of relative risk and 95% confidence intervals were calculated for 27 studies using fixed and random effects models. Separate analyses were conducted for men and women. RESULTS: Smoking cessation was associated with a reduction in the risk of all the major histologic types of lung cancer. The highest reduction was in small cell lung carcinoma (SCLC) and squamous cell carcinoma (SQC), and the lowest reduction was seen in large cell cancer and adenocarcinoma. In women, the combined risks for SQC and SCLC were higher than those in men. The dose-response curve for intensity of smoking was steeper in women. CONCLUSION: The findings of this study suggest that smoking cessation results in the greatest reductions for SCLC and SQC. This effect is most marked in heavy smokers, particularly among women.

Adenocarcinoma↗
PubMed1999

Meta-analysis of Hodgkin's disease among farmers.

OBJECTIVES: This study examined the association between Hodgkin's disease and farming. METHODS: A series of meta-analyses of peer-reviewed studies was performed, using 30 studies published between 1981 and 1998. Prior to the meta-analyses, all the studies were reviewed and evaluated for heterogeneity and publication bias. Combined relative risks (RR) were calculated using the random effect model. RESULTS: The combined RR was 1.25 [95% confidence interval (95% CI) 1.11-1.42] for all the studies, and 1.08 (95% CI 0.91-1.29) for the studies involving female farmers. Significant heterogeneity among the studies was detected, and a stratified analysis was carried out by study design, country of study, and time of publication. Significantly elevated RR values were obtained for the case-referent studies (odds ratio 1.53, 95% CI 1.18-1.98) and proportionate mortality studies (PMR)(PMR 1.18, 95% CI 1.02-1.36). A decrease in risk was eminent in the more recent studies. CONCLUSIONS: The findings suggest that male farmers have a slightly elevated risk of developing Hodgkin's disease. No specific etiologic exposure was identified, but exposures commonly experienced by farmers (infectious microorganisms, herbicides and insecticides) may contribute to the occurrence of the disease.

Agricultural Workers' Diseases↗
PubMed1998

Meta-analyses of brain cancer and farming.

BACKGROUND: A series of meta-analyses of peer-reviewed studies of brain cancer and farming were performed, using 33 studies published between 1981 and 1996. METHODS: Before the meta-analyses, all studies were reviewed and evaluated for heterogeneity and publication bias. A random-effect model was used to estimate the combined relative risk. RESULTS: A meta-analysis including all the studies yielded an estimator of relative risk equal to 1.30, with a 95% confidence interval (95% CI) of 1.09, 1.56. The estimator of relative risk obtained from a meta-analysis restricted to female farmers was 1.04 (95% CI = 0.84, 1.29). A third meta-analysis restricted to studies of farmers residing in the central United States resulted in an estimator of relative risk equal 1.25 (95% CI = 1.09, 1.44). These findings were not influenced by either a publication bias or a specific study design. CONCLUSION: The consistent significant positive findings suggests that there is a weak association between brain cancer and farming. Exposures commonly experienced by farmers including infectious microorganisms and pesticides may contribute to the increased risk of brain cancer.

Agricultural Workers' Diseases↗
PubMed1998

Effect of cigarette smoking on major histological types of lung cancer in men.

This study examined the effect of cigarette smoking parameters such as intensity, duration, age at initiation, and quitting on the development of different histological types of lung cancer in men. We used data from a case-control study conducted in Philadelphia between 1985 and 1987. Cases included 482 men with histologically confirmed lung cancer diagnosed in 15 selected hospitals in Philadelphia. Controls were selected from a neighborhood survey of men in Philadelphia conducted concurrently to the case recruitment. Most aspects of smoking were associated with all the major histological types of lung cancer. Number of cigarettes smoked per day was the strongest predictor of risk of developing lung cancer. Early age at initiation of smoking significantly increased the risk of small cell carcinoma (odds ratio = 3.0; 95% CI, 1.1-8.4). Quitting smoking reduced the risk of squamous cell and adenocarcinoma; however, it did not affect the risk of small cell lung cancer. The findings of this study suggest the need for greater emphasis on smoking prevention programs, especially in adolescents.

Adenocarcinoma↗
PubMed1998

Can a clinical score aid in early diagnosis and treatment of various stroke syndromes?

BACKGROUND: Accurate and timely diagnosis of hemorrhagic and nonhemorrhagic strokes helps in patient management. Neuroimaging studies are useful in diagnosis and distinction of hemorrhagic (HS) and nonhemorrhagic (NHS) strokes. The use of clinical variables, such as Siriraj stroke scores (SSS), has shown good sensitivity, specificity and predictive values (distinguishing stroke types). The aim of our study was to evaluate the use of SSS in a U.S. population and assess whether it could aid to expedite treatment decisions. METHODS: Levels of consciousness, vomiting, headache and atheroma markers used in SSS were applied to patients who met the criteria for stroke. RESULTS: Of the 302 patients identified, the SSS classified 254 with sensitivity of 36% (HS) and 90% (NHS) and positive predictive values of 77% and 61%, respectively. CONCLUSION: Our results suggest that SSS is not reliable in distinguishing stroke types (in a US population). Definite neuroimaging studies are needed prior to thrombolytic therapy.

Aged↗
PubMed1997

Meta-analyses of multiple myeloma and farming.

A series of meta-analyses of peer-reviewed studies of multiple myeloma (MM) and farming were performed, using 32 studies published between 1981 and 1996. Prior to the meta-analyses, all studies were reviewed and evaluated for heterogeneity and publication bias. A random-effects meta-analysis including all of the studies yielded an estimator of relative risk equal to 1.23, with a 95% confidence interval (95% CI) of 1.14, 1.32. The estimator of relative risk obtained from a meta-analysis restricted to female farmers was 1.23 (95% CI = 1.17, 1.29). A third meta-analysis restricted to studies of farmers residing in the central United States resulted in an estimator of relative risk equal to 1.38 (95% CI = 1.27, 1.51). These findings were not influenced by either a publication bias or a specific study design. The consistent significant positive findings suggest that there is an association between MM and farming. Exposures commonly experienced by farmers and that might contribute to the occurrence of MM include infectious microorganisms, solvents and pesticides.

Agricultural Workers' Diseases↗
PubMed1997

Modified barium swallow does not affect how often PEGs are placed after stroke.

Dysphagia frequently follows stroke, but often resolves quickly. Percutaneous endoscopic gastrostomy (PEG) or other feeding tubes are placed to improve nutrition and hydration, and reduce the risk of aspiration pneumonitis. We evaluated the impact of modified barium swallow in determining PEG placements and the influence of specific swallowing abnormalities on PEG placement. The abnormalities assessed were presence of pharyngeal stasis and/or visualization of posterior pharyngeal transfer problems and aspiration of liquid or solids. A total of 302 patients with stroke were admitted to our hospital between 1989 and 1993, but only those with hemorrhagic or nonhemorrhagic stroke by computed tomographic (CT) scans or magnetic resonance imaging (MRI) or autopsy were included in our study. Patients with transient ischemic attacks (TIAs), central nervous system tumors, and traumas were excluded. Barium swallow studies were performed on 69 (23%) of patients; 49 (71%) were abnormal, based on aspiration of barium, pharyngeal stasis, or postpharyngeal transfer dysphagia. PEGs were placed in only 18% of those with abnormal studies. Of the patients with normal barium swallow studies, 25% had a PEG placed. Two hundred thirty-three patients underwent no barium swallow studies, but 11 (4.72%) of these had PEG placed. The rate of PEG placement was not related to any one of the abnormalities noted on the modified barium swallow. Rather, patients who received PEG had significant neurological deficits and increased prevalence of aspiration pneumonitis. The decision to insert PEG was made on clinical grounds and not on abnormal barium studies alone.

Aged↗
PubMed1995

Subcutaneous sumatriptan for treatment of acute migraine in patients admitted to the emergency department: a multicenter study.

STUDY OBJECTIVE: To assess the efficacy of SC sumatriptan injection versus placebo in the treatment of acute migraine in ED patients and that of open-label 100 mg sumatriptan PO tablets for recurrent migraine. DESIGN: Randomized, double-blind, placebo-controlled, multi-center trial. SETTING: Twelve EDs in the United States. PARTICIPANTS: Adult patients presenting to the ED from September 1992 through April 1993 with a diagnosis of migraine as determined by International Headache Society criteria. Patients were randomized to receive 6 mg sumatriptan SC or placebo. Patients were monitored for improvement in headache severity using a four-point scale and for time to meaningful relief using a stopwatch. The time to discharge from the ED was recorded. An open-label 100 mg sumatriptan PO tablet was given to all patients on discharge from the ED for use at home if the headache recurred within 24 hours. RESULTS: One hundred thirty-six patients were enrolled. Seventy-five percent of patients treated with sumatriptan achieved meaningful relief compared with 35% treated with placebo (P < .001). The median time to meaningful relief was 34 minutes in the group that received sumatriptan. Seventy percent of patients in the sumatriptan group versus 35% in the placebo group reported mild or no pain at discharge (P < .001). Migraine-associated symptoms such as nausea, photophobia, and phonophobia were significantly reduced in the sumatriptan group (P < .005). The median time to discharge from the ED was shorter for the sumatriptan group than for the placebo group (60 versus 96 minutes, respectively; P = .001). At baseline, 15% of patients in the sumatriptan group and 19% of patients in the placebo group reported mild or no clinical disability. At the time of discharge, patients with mild or no disability increased to 75% in the sumatriptan group compared with 44% in the placebo group (P = .001). Fifty-seven of 92 patients (62%) with mild or no pain at discharge took open-label oral sumatriptan for headache recurrence, and 37 (65%) experienced meaningful relief within 2 hours. Median time to meaningful relief after oral sumatriptan was 65 minutes. CONCLUSION: Sumatriptan (6 mg SC) is effective in treating acute migraine in the ED. Oral sumatriptan (100 mg) is effective in treating headache recurrence within 24 hours.

Acute Disease↗
PubMed1994

Routine prolactin measurement is not necessary in the initial evaluation of male impotence.

The authors determined the prevalence of hyperprolactinemia in impotent men in a community setting and assessed the cost of case detection with routine estimation of serum prolactin. They recruited 299 consecutive patients with impotence and determined the hormonal levels (prolactin, luteinizing hormone, follicle-stimulating hormone, and testosterone). Pituitary gland imaging was done when the prolactin level was elevated. Simultaneous prolactin and testosterone levels were available for 212 patients. Three patients (1.4%) had elevated prolactin levels but none had pituitary tumor. Two of these had low testosterone levels. Overall, 51 patients (24.1%) had low testosterone levels. Cost of selective prolactin estimation in patients with low testosterone levels resulted in a net saving of $2,574 per case detected. The authors conclude that the prevalence of hyperprolactinemia in impotence is low. Routine measurement of prolactin levels in impotence is not indicated. Selective determination in patients with low testosterone reduces the cost of diagnostic evaluation.

Costs and Cost Analysis↗
PubMed1994

Enhancing faculty participation and interest in quality improvement in academic centers.

Continuous quality improvement (CQI) is necessary in maintaining and improving the quality of medical care delivered. However, quality assurance (QA) in the past was performed superficially to meet requirements of the Joint Commission on Accreditation of Health Care Organizations and other regulatory agencies. Academic faculty participation in QA activity was also limited. Faculty often assume that meaningful quality process demands excessive efforts and time unrewarded with career advancement, promotion, or monetary compensation. In addition, unstructured QA leads to duplication of data and loss of educational opportunity. We reorganized the QA process in internal medicine using the CQI concept to: (a) improve academic faculty participation, (b) incorporate educational concepts, (c) stimulate interest in outcome research and CQI, and (d) integrate cost containment. A reorganized CQI format has stimulated enthusiastic participation of faculty and residents, and has generated conferences and grand rounds pertinent to medical care, outcome research, and cost containment. We conclude that academic faculty should play leadership roles in the CQI process and include teaching models. Improved and increased academic faculty participation could be realized, when educational values, research activities, and cost analysis are incorporated into the CQI process.

Academic Medical Centers↗
PubMed1992

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Duplicate Publications as Topic↗