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Biomedical subjects

A Menon

Publications and source records attributed to A Menon.

At least 19 recordsLinked to original sources
PubMed2002

National incidence of type 1 diabetes in childhood and adolescence.

The Republic of Ireland is considered a region of low type 1 diabetes incidence compared with the British Isles and the rest of Europe. To establish a baseline national incidence of type 1 diabetes, in those under 15 years, with a measure of case ascertainment. Prospective active monthly reporting of incident cases by paediatricians was undertaken, with survey of adult physicians, endocrinologists and nurse specialists nationally. A secondary source of case ascertainment was employed. The crude incidence rate of type 1 diabetes was 16.6 per 100,000 per year and the directly standardised incidence rate was 16.3 per 100,000 per year. The Republic has a high incidence of type 1 diabetes. Services should be planned and resources allocated accordingly. A register should be established to monitor changes in this important disease. Further study is required to explore differing incidence in Northern and Southern Ireland.

Adolescent↗
PubMed2001

Long-term outcome of undifferentiated spondylarthropathy.

Undifferentiated spondylarthropathy is one of the common disease subsets in the group of so-called seronegative spondarthritides. It is not exactly known how often it differentiates into ankylosing spondylitis or other well-defined disease subsets over time. The present study was designed to find out the long-term outcome in this subset. Thirty-five patients diagnosed with undifferentiated spondylarthropathy between January 1987 and December 1988 were recruited. Twenty-two (63%) of them were available for detailed assessment 11 years after the original diagnosis. Their baseline characteristics did not differ from those of the original cohort of 35 patients and were as follows: male:female ratio 19:3, median age of onset 17 years (range 8-39), and median duration of disease 8 months (range 4-24). Clinical features were enthesitis (45%) and inflammatory pain in the back (100%), buttock (77%), hip (64%), shoulder (18%), knee (82%), ankle (77%), and hand and wrists (50%). There was no restriction in spinal movement. Family history was positive in two cases. Radiologically, the only finding was grade I sacroiliitis in 17 patients (77%). Human leukocyte antigen (HLA)-B27 was positive in all. Functionally, all were in class I. During follow-up, one patient developed psoriatic skin lesions after 9 years. Uveitis developed in four patients (18%). After a median follow-up of 11 years, 15 (68%) had ankylosing spondylitis, one developed psoriatic arthritis, four remained undifferentiated, and two had natural remission. Functionally, 19 patients (86%) were in class I and three (14%) were in class III. No patient had bamboo spine, but three underwent total hip replacement. Thus, a majority of patients (68%) with undifferentiated spondylarthropathy gradually developed ankylosing spondylitis of mild severity.

Adolescent↗
PubMed2001

Effective graphical displays.

A graph is a visual display of data to achieve an understanding of the underlying patterns and interrelationships of the data. Such visual representations of data often form the basis for inferences and decisions. However, a poorly chosen graphical form can lead to erroneous inferences. In this paper previously published graphs depicting biopharmaceutical, drug metabolism, formulation, and pharmacokinetic data are recast using alternate display methods in an attempt to better clarify the data structure. The display methods used include dot plots and trellis plots.

Animals↗
PubMed2000

Refining the mouse chromosomal location of Cdm, the major gene associated with susceptibility to cadmium-induced testicular necrosis.

Cadmium (Cd++) is a widespread environmental pollutant and classifed as an IARC 'Category I' human carcinogen. Cd++ can also cause severe renal toxicity and may be involved clinically in cardiovascular disease and osteoporosis. Genetic differences in sensitivity to cadmium toxicity have been noted in humans, whereas, among inbred mouse strains, unequivocal genetic data exist. Resistance to cadmium-induced testicular damage was reported in 1973 to be associated with a single major recessive gene, named Cdm, which has now been localized to mouse chromosome (Chr) 3. Using polymorphic microsatellite markers and semiquantitative histological parameters, we have corroborated the original 1973 data concerning mendelian inheritance and have further refined the region containing the Cdm gene from more than 24 cM to 0.64 cM (estimated 40-80 genes). We phenotyped 26 recombinant inbred lines generated from C57BL/6J (B6, resistant) and DBA/2J (D2, sensitive) inbred mice, and determined that the Cdm gene maps between microsatellite markers D3Mit110 and D3Mit255. Although toxicity to numerous heavy metals is well known, virtually no molecular mechanisms have yet been uncovered either in humans or laboratory animals. Identification and characterization of the mouse Cdm gene should enhance our understanding of heavy metal toxicity by identifying and characterizing, for the first time, a major mammalian gene responsible for susceptibility to diseases caused by heavy metal toxicity.

Animals↗
PubMed1999

Health advice given by general practitioners for travellers from New Zealand.

AIMS: To investigate where general practitioners (GP's) in New Zealand view travel health advice best given and where they refer for this advice, the prevalence of travel health advice reported to be given, and the prevalence of written advice, including a doctor's letter. METHOD: This was a descriptive cross-sectional study, using self-report questionnaires, sent to 400 GPs randomly selected from the register of the New Zealand Medical Council. RESULTS: Three hundred and thirty-two GPs (83%) responded. Most GPs reported that they saw travel medicine as best practised in general practice (241/308, 78%) or in a combination of locations, usually including general practice (28/308, 9%). Most GPs (223/308, 72%) did not refer travellers for travel health advice. Health advice concerning malaria (310/310, 100%), immunisation (309/310, 100%), travellers' diarrhoea (296/305, 97%), insect avoidance (287/ 299, 96%), sexually transmitted diseases/human immunodeficiency virus (233/283, 82%), water purification (235/293, 80%) and other areas (35/75, 47%) was given. Written advice was usually given by 23% of GPs (69/302). Written advice was significantly more likely to be provided by those GPs with an interest in travel medicine (chi2=5.67, df=1, p<0.005), experience in tropical medicine/developing countries (chi2=6.69, df=1, p<0.001), a policy on travel medicine (chi2=21.4, df=1, p<0.001), a written policy on travel medicine (chi2=302.0, df=1, p<0.001), who saw a higher number of travellers per week (t=-2.51, df=296, p<0.05) and who saw a significantly higher proportion of patients who were travellers (t=-3.27, df=-295, p=0.001). Almost all GPs (303/310, 98%) reported giving their travelling patients a doctor's letter at least sometimes but only 7% (23/310) always gave travellers a doctor's letter. GPs with training in travel medicine/related area were significantly more likely to provide travellers with a doctor's letter (chi=11.61, df=3, p<0.01). CONCLUSIONS: This study confirmed that GPs in New Zealand see travel health advice as best given in general practice. Travel health advice, as recommended by New Zealand guidelines, should continue to be given. With limited time in general practice to advise travellers, GPs should also consider giving written advice, including a doctor's letter, more often. Epidemiological and specialist support by public health units and commercial groups, continuing medical education and training in travel medicine for GPs are among the major considerations. Further studies are needed concerning the adequacy and currency of destination-specific advice for travellers.

Chi-Square Distribution↗
PubMed1999

Training, experience and interest of general practitioners in travel medicine in New Zealand.

BACKGROUND: In New Zealand, general practitioners (GPs) are a major group of travel health advisers. This study was designed to investigate the prevalence of training, experience, and interest in travel medicine or related areas, interest in undertaking training in travel medicine and how training might be best delivered. METHOD: Four hundred GPs were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (83%) GPs responded and these GPs advised an average of two travelers per week. Most GPs (257/282, 91%) reported that they had no training in travel medicine/related area. Training in travel medicine/related areas was significantly associated with age group (x2=14.09, df=6, p<.05), with the proportion of GPs with training in travel medicine/related area tending to be higher in the 45-49 and 50-54 years age groups, and also with GP college membership/fellowship (x2=6.39, df=1, p<.05). Forty-one percent (121/298) of respondents stated that they had previous experience working in tropical medicine/developing country. There was a significant association between GPs having experience working in tropical medicine/developing countries and training in travel medicine (x2=14. 19, df=1, p<.001) and those who were non-New Zealand graduates (x2=7. 84, df=1, p<.01). Forty-four percent (131/300) of respondents stated that they had an interest in travel medicine. Nearly two thirds of respondents (200/309, 65%) indicated that they would be interested in undertaking various types of travel medicine training, with a short course most commonly identified (159/309). The interest for training in travel medicine was significantly associated with those GPs with an interest in travel medicine (x2=26.45, df=1, p<.001), in younger age groups (x2=41.30, df=6, p<.001), a lower mean number of years since graduation (t value=5.70, df=297, p<.001), a higher mean proportion of patients who were travelers (t value=23.15, df=303, p<. 01), and a higher mean number of travelers seen per week (t value=22. 94, df=303, p<.01). The most common postgraduate qualification amongst GPs was membership/fellowship of a GP college (85/282, 30%), which was significantly more prevalent amongst the older age groups (x2=18.18, df=8, p<.05). Membership of travel medicine was very low. CONCLUSIONS: This cross-sectional study found that most GPs in New Zealand did not have any formal training in travel medicine, although more than two fifths of GPs indicated an interest in travel medicine and experience in tropical medicine/related area. GPs mainly wanted continuing medical education (CME) on travel medicine in the form of short and certificate level courses. As membership in GP colleges and other organizations was limited, other providers of CME should also be considered for providing more of these courses, such as universities and pharmaceutical companies. Providers of CME may target less experienced GPs and those GPs who may be seeing more travelers and use various approaches. Undergraduate and postgraduate medical curricula may also need to include more training in travel medicine.

Adult↗
PubMed1999

Prevalence of dental caries and co-relation with fluorosis in low and high fluoride areas.

The aim of the study was to determine the degree of caries prevalence in the permanent dentition and the accompanying fluorosis in children between 6-16 years of age in both low (0.5 ppm) and relatively high (1.2 ppm) fluoride areas. In 3605 children in a low fluoride area (Dharwad), the mean DMFT was 0.65; 77% of the children were caries free. Grade I fluorosis (using Dean's fluorosis inded) was observed in only 0.66% of the children. Among 3618 children of similar age groups, living in high fluoride areas (Gadag), 84% were caries free and the mean DMFT value was 0.39. Varying degrees of fluorosis were present in 57.07% of the children. The results of the study suggest a definite relationship between the amounts of fluoride ingested through water and caries experience observed in the population.

Adolescent↗
PubMed1998

Chronotropic competence of the sinus node in congenital complete heart block.

Electrocardiograms taken at rest of 2 children with transplacental exposure to anti-Ro antibody but 1:1 atrioventricular conduction demonstrated sinus node disease. Treadmill exercise testing of 28 patients with congenital complete heart block found 3 patients with chronotropic incompetence of the sinus node.

Adolescent↗
PubMed1998

Safety advice for travelers from New Zealand.

BACKGROUND: Accidents and injuries are important preventable causes of morbidity and mortality for travelers. This study was designed to investigate the prevalence of advice given by general practitioners (GPs) on personal safety, health and travel insurance, and finding medical assistance abroad in the event of misadventure or ill health. METHOD: Four hundred general practitioners were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (83%) GPs responded. Advice to travelers on health and travel insurance (164/273, 60%), personal safety (127/255, 50%), and finding medical assistance abroad (165/308, 54%) was given by half or just over half of GPs. Giving advice on medical assistance abroad was significantly associated with giving advice on health and travel insurance (x2 = 18.89, df = 1, p<.001) and personal safety (x2 = 25.26, df = 1, p<.001). Seeing a higher proportion of patients who were travelers was significantly associated with giving advice on health and travel insurance (t-value = -3.39, df = 267, p = .001) and personal safety abroad (t-value = -2.63, df = 249, p < .01). Those GPs with previous experience in tropical medicine/developing countries were significantly more likely to advise travelers on personal safety abroad (x2 = 6.55, df = 1, p<.05) and about seeking medical assistance abroad (x2 = 4.11, df = 1, p<.05). Those GPs in older age groups (45-49 years and over) were significantly more likely to advise travelers on health and travel insurance (x2 = 16. 31, df = 8, p<.05) and personal safety abroad (x2 = 19.88, df = 8, p<.05). Those GPs with an interest in travel medicine were significantly more likely to advise travelers about seeking medical assistance abroad (x2 = 11.07, df = 1, p<.001) and health and travel insurance (x2 = 16.31, df = 8, p<.05). When advising travelers about seeking medical assistance abroad, GPs most commonly recommended contacting travel insurance companies (60/308, 19%), a specific medical service (48/308, 16%), tour company (30/308, 10%), specific doctor (29/308, 9%), New Zealand embassy (27/308, 9%), local medical service (23/307, 7%), personal contact (21/307, 7%), and other sources (12/307, 4%). CONCLUSIONS: This cross-sectional study found that only around half of New Zealand GPs were giving advice to travelers on personal safety, health and travel insurance, and finding medical assistance abroad. Continuing education providers should reinforce the need for this advice to be given to all travelers. There was also considerable variability in what New Zealand GPs recommended to travelers about seeking medical assistance abroad, including several nonmedical sources.

Adult↗
PubMed1998

Histopathological evaluation of inflammatory & hereditary demyelinating polyneuropathies.

In view of therapeutic implications and problems in clinical diagnosis, this study sought to evaluate and identify histopathological features of acquired inflammatory demyelinating neuropathies and hereditary demyelinating neuropathies. Sural nerve biopsies from 41 patients of demyelinating neuropathies, diagnosed on the basis of accepted clinical criteria, were studied using routine histological staining and special stains for myelin and axons. Chronic inflammatory neuropathies differed from the acute ones in having more endoneurial connective tissue, less of subperineurial oedema and presence of axonal sprouting and occasional onion bulb formation. Acquired neuropathies differed from hereditary neuropathies in having a more localized involvement, endoneurial oedema and variable inflammatory cell infiltration, while in hereditary neuropathies Schwann cell proliferation was diffuse and relatively uniform. The frequency and degree of nerve thickening was more in hereditary neuropathy. Evidence of inflammation was not universal, both in the acute and the chronic inflammatory demyelinating neuropathies. Histopathological examination is essential as the clinical and electrophysiological features alone may not offer definitive diagnosis.

Adult↗
PubMed1997

Malaria prophylaxis prescribed for travellers from New Zealand.

AIM: To investigate advice given by general practitioners on the use of chemoprophylaxis and other preventive measures against malaria. METHOD: Four hundred general practitioners were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. RESULTS: Three hundred and thirty two (83%) general practitioners responded. Advice concerning malaria (310/310, 100%) and insect avoidance (287/299, 96%) was commonly given. The most commonly prescribed regimes for malaria chemoprophylaxis were chloroquine (93/305, 30.5%), chloroquine plus either quinine or mefloquine as a standby (63/305, 21%), mefloquine (45/305, 15%), chloroquine/Maloprim (pyrimethamine/dapsone) (41/305, 13%), doxycycline (26/305, 8%), and chloroquine plus doxycycline (24/305, 8%). Chloroquine plus Maloprim was used significantly more by general practitioners in older age groups, ie 45 years and over (p < 0.05). CONCLUSIONS: This cross sectional study has shown variability in the patterns of antimalarials used. Issues of concern include continued use of chloroquine alone, given widespread global resistance, and the use of Maloprim. Although Maloprim use has not been recommended since 1992, it is still being used by a substantial minority of general practitioners. This issue, which needs to be addressed nationally, is of concern given the adverse events associated with the use of Maloprim. New methods for the effective dissemination of information regarding appropriate chemoprophylaxis need to be developed.

Antimalarials↗
PubMed1997

Health care costs of obesity in New Zealand.

OBJECTIVE: To estimate the costs of health care that are attributable to obesity in New Zealand. METHODS: The 1991 health care costs of non-insulin dependent diabetes, coronary heart disease, hypertension, gallstone disease, post-menopausal breast cancer and colon cancer were estimated and multiplied by the population attributable factor for obesity for each condition. The relative risk estimates were taken from the literature, the obesity prevalence from a 1990 New Zealand survey, and the costs and volumes of services were taken from a variety of sources and covered hospital (inpatient and outpatient) services, general practitioner consultations, pharmaceuticals, laboratory tests and ambulance services. Calculations were conservative and net of goods and services tax. RESULTS: A conservative estimate of the health care costs attributable to obesity for the six conditions was NZ$135 million. This represents about 2.5% of total health care costs which is similar to analyses from other countries. CONCLUSIONS: The health care costs of obesity as estimated are considerable. However, the total cost of overfatness to the New Zealand population is far greater than this because lesser degrees of overfatness, the health care costs of other obesity-related conditions such as arthritis, the costs to individuals of weight-loss programs and the indirect and intangible costs were not included in the analysis. A substantial and wide-ranging public health effort is needed to turn around the increasing prevalence and costs of obesity.

Adult↗
PubMed1997

Human Ah receptor (AHR) gene: localization to 7p15 and suggestive correlation of polymorphism with CYP1A1 inducibility.

The mammalian aromatic hydrocarbon receptor (AHR) is a ubiquitous ligand-activated transcription factor. AHR ligands include 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD; dioxin), benzo[a]pyrene, and polychlorinated and polybrominated biphenyls; the endogenous ligand is not yet known. Following ligand binding, the AHR transcriptionally activates genes encoding drug-metabolizing enzymes important in both the metabolic potentiation of substrates to genotoxic reactive intermediates and ultimate carcinogens, and the detoxification of toxic or carcinogenic drugs and other environmental pollutants. AHR-mediated gene expression is also involved in many critical life processes (e.g. cell type-specific differentiation, cell division, apoptosis) by signal transduction mechanisms. Similar to mice, human populations exhibit a > 20-fold range of the CYP1A1 inducibility/AHR affinity phenotype. In the present study, we localized the human AHR gene to chromosome 7p15, using fluorescence in situ hybridization (FISH). Performing linkage analysis in a three-generation family, we show with good probability that the high CYP1A1 inducibility phenotype segregates with the 7p15 region. Sequencing 93 nt (31 amino acids) of the human AHR gene's exon 9, which is the region correlated with the mouse A375V polymorphism responsible for the major portion of high vs low CYP1A1 inducibility/AHR affinity, we found no nucleotide differences; Val-381 was present in all five individuals examined (four related and one unrelated), two of whom show "high' and three of whom show "low' CYP1A1 inducibility. These data indicate that the "high' and "low' CYP1A1 inducibility trait, in the population studied, cannot be explained by a difference among these 31 amino acids in exon 9 of the AHR gene.

Amino Acid Sequence↗
PubMed1996

Extra pelvic endometriosis and catamenial pneumothorax.

Extra pelvic endometriosis is rare and its presentation is varied. A case of pulmonary and umbilical endometriosis which presented as catamenial pneumothorax is presented. Due to poor response to medical treatment, a total abdominal hysterectomy and bilateral salpingo-oophorectomy was done to relieve the patient of her recurrent symptoms.

Endometriosis↗