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Biomedical subjects

A J Jacob

Publications and source records attributed to A J Jacob.

At least 19 recordsLinked to original sources
PubMed2002

OSPE in pathology.

Undergraduate medical education is currently undergoing extensive re-evaluation with new core educational objectives being defined. Consequently, new exam systems have also been designed to test the objectives. Objective structured practical examination (OSPE) is one of them. We conducted OSPE in a regular batch of 64 students. The batch was divided into 4 groups, one group taking the conventional practical exam and the other groups OSPE with minor variations. Different aspects were compared and analyzed and we found that OSPE was more objective, measured practical skills better, had a wide discrimination index and eliminated examiner bias. The questionnaire given to the students revealed a high acceptance rate among them.

Education, Medical, Undergraduate↗
PubMed2002

Papillary cystic tumor of pancreas--report of two cases.

Two cases of Papillary cystic tumor of pancreas--one metastasizing to lymph node and the other non-metastasizing are reported for their rare occurrence. Both occurred in young females and presented with heaviness and pain in the left hypochondrium with palpable mass. On radiological examination, mass was arising from tail of pancreas and had typical gross features. The histological findings seen in metastasizing tumor were capsular invasion, infiltration to surrounding pancreatic tissue and vascular invasion with metastasis to lymph node. Difference in nuclear grade or mitosis was not observed. Adjuvant chemotherapy was given for metastasizing tumor and patient is symptom free after 56 month. Non-metastasizing case is well after 15 months.

Adult↗
PubMed2001

Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic.

Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P < 0.05). Total household income, reported amount of money spent on food and estimated cereal intakes were not correlated with the BMI of the patient, possibly due to reporting bias and other methodological issues. We propose the inclusion of nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.

Adult↗
PubMed2000

The effect of leprosy-induced deformity on the nutritional status of index cases and their household members in rural South India: a socio-economic perspective.

OBJECTIVES: To determine whether the socioeconomic and nutritional status of cured leprosy patients with residual deformity, and their household members, was lower than that of cured leprosy patients without deformity. DESIGN: Cross-sectional study. SUBJECTS: One hundred and fifty-five index cases with deformity, 100 without deformity. Also 616 household members comprising 48% of the total members enumerated. MEASUREMENTS: Nutritional status was evaluated using anthropometry. Disease characteristics, socio-economic parameters and household information were recorded using a questionnaire. RESULTS: Index cases with deformity had lower community acceptance (P<0.001), and employment (P<0.001) than those cases without deformity. Households of index cases with deformity had a lower income (P<0.01) and a lower expenditure on food (P<0.05). The presence of deformity (odds ratio (OR): 2.1-3.2, P<0.01), unemployment (OR: 2.3-4.3, P<0.01) and female gender (OR: 2.4, P<0. 01) significantly increased the risk of index cases being undernourished, as judged by body mass index (BMI) alone, or BMI and mid-upper arm circumference. A low BMI (<18.5) in the index case significantly increased the odds of other adults (OR 2.2), adolescents (OR 2.9-3.8) and children (OR 2.2) in the household being undernourished. CONCLUSIONS: Cured leprosy index cases with physical deformity are more undernourished than index cases without deformity. This is associated with a reduced expenditure on food, possibly brought on by increased unemployment, and a loss of income. Undernutrition in the index case increases the risk of undernutrition in other members of the family. European Journal of Clinical Nutrition (2000) 54, 643-649.

Adolescent↗
PubMed1998

Cardiac autoimmunity in HIV related heart muscle disease.

OBJECTIVE: To assess the frequency of circulating cardiac specific autoantibodies in HIV positive patients with and without echocardiographic evidence of left ventricular dysfunction. SUBJECTS: 74 HIV positive patients including 28 with echocardiographic evidence of heart muscle disease, 52 HIV negative people at low risk of HIV infection, and 14 HIV negative drug users who had all undergone non-invasive cardiac assessment were studied along with a group of 200 healthy blood donors. RESULTS: Cardiac autoantibodies detected by indirect immunofluorescence (serum dilution 1/10) were more common in the HIV positive patients (15%), particularly the HIV heart muscle disease group (21%), than in HIV negative controls (3.5%) (both p < 0.001). By ELISA (dilution 1/320), abnormal anti-alpha myosin autoantibody concentrations were found more often in HIV patients with heart muscle disease (43%) than in HIV positive patients with normal hearts (19%) or in HIV negative controls (3%) (p < 0.05 and p < 0.001, respectively). Anti-alpha myosin autoantibody concentrations were greater in HIV positive patients than in HIV negative controls, regardless of cardiac status ((mean SD) 0.253 (0.155) v 0.170 (0.076); p = 0.003). In particular the mean antibody concentration was higher in the HIV heart muscle disease patients (0.291 (0.160) v 0.170 (0.076); p = 0.001) than in HIV negative controls. On follow up, six subjects with normal echocardiograms but raised autoantibody concentrations had died after a median of 298 days, three with left ventricular abnormalities at necropsy. This compared with a median survival of 536 days for 21 HIV positive patients with normal cardiological and immunological results. CONCLUSIONS: There is an increased frequency of circulating cardiac specific autoantibodies in HIV positive individuals, particularly those with heart muscle disease. The data support a role for cardiac autoimmunity in the pathogenesis of HIV related heart muscle disease, and suggest that cardiac autoantibodies may be markers of the development of left ventricular dysfunction in HIV positive patients with normal hearts.

Adult↗
PubMed1995

A review of endocarditis in acquired immunodeficiency syndrome and human immunodeficiency virus infection.

Non-bacterial thrombotic endocarditis (NBTE) was frequently identified in early post-mortem studies of patients with HIV infection, but has not been reported since 1989. The reason for this apparent decline is not clear, but it is possible that the prevalence of the condition was overestimated in the past. We have found no evidence of NBTE in our series of 110 autopsies on subjects from all major risk groups and at various stages of immune deficiency [intravenous drug user (IVDU)-AIDS 35% (39/110), IVDU-pre AIDS 36% (40/110), homosexual-AIDS 25% (28/110), blood product recipients-AIDS 1.8% 2/110), African 0.9% (1/110)]. Infective endocarditis (IE) in HIV infection occurs almost exclusively in intravenous drug users and is rare in other HIV-positive patients. However, asymptomatic HIV infection appears to have little effect on the susceptibility to or the mortality from endocarditis and it is, therefore, appropriate to institute antimicrobial treatment in these cases. The majority (54.4%) of the 960 HIV-positive individuals in the Lothian region of Scotland are young adults who contracted the virus through IVDU around 1983. However, a prospective echocardiological study of 269 patients over four years (IVDU 69%, homosexual 18%, heterosexual 8%, bisexual 3%, multiple risk factors 1%) has demonstrated only four cases of infective endocarditis. We believe this reflects the prevalence of current parenteral drug use in our cohort which has fallen with the introduction of an oral drug replacement programme.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1995

An evaluation of the future role of non-governmental organizations currently engaged in leprosy control in India.

The mass implementation of short term multi-drug therapy in India, has led to dramatic falls in the prevalence of leprosy. This paper addresses the future role of non-governmental organizations currently involved in leprosy control. This evaluation is based on current trends in leprosy control, projected health needs in the future and the necessity to maximize health care outputs in the face of limited resources.

Drug Therapy, Combination↗
PubMed1994

Heart muscle disease related to HIV infection: prognostic implications.

OBJECTIVES: To determine the natural course of heart muscle disease in patients infected with HIV. DESIGN: Prospective echocardiographic survey and observational study over four years. SETTING: Edinburgh. SUBJECTS: 296 adults infected with HIV (mean age 32.7 years (range 21.5 to 67.6) drawn from all the major groups at risk of HIV infection in Britain. MAIN OUTCOME MEASURES: Detection of myocardial dysfunction and time to death from index echocardiogram in serial echocardiography. RESULTS: Cardiac dysfunction was identified in 44 subjects (dilated cardiomyopathy, 13; isolated right ventricular dysfunction, 12; borderline left ventricular dysfunction, 19). Dilated cardiomyopathy was strongly associated with a CD4 cell count of < 100 x 10(6)/l, in contrast with the other forms of cardiac dysfunction. During the study 12/13 (92%) subjects with dilated cardiomyopathy, 5/12 (42%) with right ventricular dysfunction, and 8/19 (42%) with borderline left ventricular function died of conditions related to AIDS. Survival was significantly reduced in the subjects with dilated cardiomyopathy compared with those with normal hearts (P < 0.001). The median survival from the index echocardiogram was 101 days (95% confidence interval 42 to 146) for the subjects with cardiomyopathy compared with 472 days (383 to 560) for those with normal hearts and a CD4 cell count of < 20 x 10(6)/l. No significant difference existed in survival for subjects with borderline left or isolated right ventricular dysfunction. CONCLUSION: Even after adjustment for the significantly reduced CD4 cell count with which dilated cardiomyopathy is associated, the outlook for patients with HIV infection and dilated cardiomyopathy is poor. Isolated right and borderline left ventricular dysfunction are not associated with reduced CD4 cells counts and do not carry adverse prognostic implications.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Cardiac dysfunction in paediatric HIV infection.

A child under long term surveillance for vertically acquired HIV-I infection developed respiratory symptoms. Dilated cardiomyopathy was diagnosed. Clinical and echocardiographic assessment of six other children with symptomatic HIV disease showed no evidence of cardiac dysfunction. The exact prevalence of this complication in paediatric HIV infection is unknown, but the potential diagnostic difficulties are highlighted.

Cardiomyopathy, Dilated↗
PubMed1993

Dilated cardiomyopathy in haemophiliacs infected with the human immunodeficiency virus.

Infection with the human immunodeficiency virus (HIV) can result in several cardiac abnormalities including dilated cardiomyopathy. These phenomena have been described in people contracting the virus through sexual intercourse, injection drug use and by vertical transmission. We have identified recently two Scottish haemophiliacs who have developed dilated cardiomyopathy in the context of HIV infection acquired through treatment with contaminated factor VIII. The significance of this finding is discussed.

Adolescent↗
PubMed1993

The use of topical phenytoin as an adjunct to immobilization in the treatment of trophic leprosy ulcers.

A total of 30 leprosy patients (controls n = 16; topical phenytoin n = 14) with trophic ulcers on the feet were investigated to ascertain the efficacy of topical phenytoin powder in the healing of ulcers. The ulcers in the two groups were matched for initial size. Healing patterns were assessed by determining changes in depth and planar (surface) dimensions at weekly intervals over a three week study period. Results indicate that while immobilization of the ulcer site is effective in promoting ulcer healing, additional use of topical phenytoin accelerates the healing process. There may however be non-responders to topical phenytoin.

Administration, Topical↗
PubMed1992

Early vasodilator treatment in myocardial infarction: appropriate for the majority or minority?

OBJECTIVE: To assess the influence of vasodilator treatment started early after myocardial infarction on left ventricular size and function. SETTING: Coronary care unit, Royal Infirmary, Edinburgh. PATIENTS: 105 patients with acute myocardial infarction (systolic blood pressure > 90 mm Hg) were randomised within 24 hours of the start of pain. Unlike previous studies 88% of the patients received thrombolysis. METHODS: Double blind randomised placebo controlled study with either 12.5 mg of captopril three times daily or 20 mg of isosorbide mononitrate three times daily for 28 days. MAIN OUTCOME MEASURES: Clinical outcome and left ventricular size and function assessed by echocardiography, radionuclide ventriculography, and magnetic resonance imaging. RESULTS: There was no difference in left ventricular size or function in either treatment group as measured one week after the end of the trial. Even the placebo group tended to decrease left ventricular diameter over the four week study period (one week: 5.0 (0.1) v, five weeks: 4.8 (0.1) cm, NS). Four patients had an adverse clinical outcome in the placebo group whereas no adverse outcome was seen in the captopril group. CONCLUSIONS: Vasodilator treatment may be of limited value or of no benefit for most infarct patients, particularly those treated with thrombolytic agents. Captopril, however, may benefit patients at high risk.

Captopril↗
PubMed1992

Myocardial dysfunction in patients infected with HIV: prevalence and risk factors.

OBJECTIVES: To determine the prevalence of and risk factors for myocardial dysfunction in HIV infection. SUBJECTS: 173 patients infected with HIV underwent echocardiography. 119 were current or previous injection drug users, 38 were homosexuals, 10 were haemophiliac patients, and six were heterosexual. MAIN OUTCOME MEASURE: Detection of impaired ventricular function. RESULTS: 26 patients with abnormalities of ventricular size or function or both were identified. The abnormality was (a) dilated cardiomyopathy in 13 patients (eight homosexuals, three drug users, and two haemophiliacs) with a mean CD4 count of 38 cells/mm3, which accords with end-stage disease (in addition, three patients were identified as having borderline impairment of left ventricular function); (b) left ventricular dilatation without loss of function in a further six patients; and (c) isolated right ventricular dilation in seven patients. Follow up echocardiograms were obtained in 71 patients, 18 of whom had myocardial dysfunction (103 echocardiograms, mean (SD) 2.5 (0.6) scans per patient, mean interval 200 (116) days, range 14-538 days). These showed that in four cases of isolated right ventricular dilatation, one of isolated left ventricular dilatation, and two with borderline left ventricular dysfunction myocardial function subsequently reverted to normal. There was no excess of exposure to zidovudine in the patients with myocardial dysfunction. Similarly, patients with myocardial dysfunction had no serological evidence of excess secondary infection with Toxoplasma gondii and cytomegalovirus. CONCLUSIONS: There was a high prevalence and wide range of myocardial dysfunction in HIV positive patients. Dilated cardiomyopathy was a feature of advanced HIV disease and affected all major risk groups for HIV infection. In contrast, isolated dilatation of either ventricle occurred at an earlier stage of HIV infection and, particularly in the case of the right ventricle, often was transient. Neither treatment with zidovudine nor infection with Toxoplasma gondii or cytomegalovirus seemed to be responsible for these findings.

Adult↗