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Biomedical subjects

A Menon

Publications and source records attributed to A Menon.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1995

Undernotification of tuberculosis in Otago: national implications.

AIM: To ascertain the reliability of notification of tuberculosis in Otago; to establish a more accurate incidence rate for cases of tuberculosis in Otago. METHODS: Official notification information 1985-93 was cross checked against other record systems. RESULTS: In the 1985-90 period the official notifications were underestimated by 33% (28/84) and during 1991-2 by 48.5% (17/35). The crude annual incidence rates for all cases were 7.3 per 100,000 for the 1985-90 period and 9.1 per 100,000 for the 1991-3. CONCLUSION: The average annual crude incidence rates for tuberculosis were considerably higher than the official rates. Tuberculosis remains an important clinical and public health issue. Improvements in notification locally and nationally are required if the impact of the projected increase in tuberculosis is to be minimised.

Adolescent↗
PubMed1995

Disseminated Burkitt's lymphoma presenting as multiple cranial nerve palsies.

A case of disseminated Burkitt's lymphoma with nervous system involvement in a HIV negative 35 year old lady is described. She primarily presented with multiple cranial nerve palsies. At autopsy, diffuse involvement of parenchymatous organs and lymphomatous meningitis with conspicuous sparing of gastrointestinal system was observed. In addition, there was an unusual feature of paraneoplastic demyelinating peripheral neuropathy. Incidentally, a large hydatid cyst was also seen in the left lobe in addition to the lymphomatous involvement of the liver.

Adult↗
PubMed1994

The costs of mammography screening in New Zealand: evidence from the pilot programmes.

AIMS: To measure the public health service costs associated with New Zealand's pilot mammography screening programmes. To compare the early evidence on cost per woman screened and per cancer detected in those programmes to that of overseas screening programmes. To estimate the cost of introducing a national screening programme in New Zealand. METHODS: Costs in each screening centre were obtained by a careful examination of screening budgets and public health service accounts; these were inflation adjusted using a consumers price index, and analysed in terms of equivalent annual operating costs. RESULTS: In the first year of screening the cost per woman screened (in $1991) was $182 in Waikato and $178 in Otago/Southland. The cost per woman screened in the third year of screening (with an assumed full screening throughput of 8,000 women per annum) is estimated to fall to $106 and $113 for the Waikato and Otago/Southland programmes respectively. The cost per cancer detected in the first screening round differs between the two programmes. In the first year of screening the cost per cancer detected was $35,975 in Waikato and $21,908 in Otago/Southland. The difference was primarily attributable to a lower cancer detection rate in Waikato in that period (0.51% of women screened compared with 0.81% in Otago/Southland). CONCLUSIONS: The initial performance of the New Zealand pilot programmes, both in terms of cost per woman screened and cost per cancer detected, falls within the range indicated from overseas experience. An established national screening programme is estimated to add between $9.3 and $9.9 million dollars (in 1991 dollar terms) to health service costs each year. These costs will be partly offset by savings resulting from the earlier detection of cancers.

Aged↗
PubMed1994

Development and evaluation of a monolithic floating dosage form for furosemide.

The poor bioavailability of orally dosed furosemide (60%), a weakly acidic drug, is due to the presence of a biological window comprised of the upper gastrointestinal tract. The purpose of the present study was to develop and optimize in vitro a monolithic modified-release dosage form (MMR) for furosemide with increased gastric residence time and to evaluate the in vivo performance of the dosage form. The principle of floatation was used to restrict the MMR to the stomach. A two-factor three-level full factorial experimental design was employed for formulation development. A flow-through cell was designed to evaluate in vitro dissolution parameters. Quadratic regression models indicated the polymer viscosity and polymer:drug ratio to be significant (p < 0.05) formulation factors in determining the duration of buoyancy and the release profile. Statistical optimization using response surface methodology with certain physiological constraints relating to gastric emptying time predicted an optimal MMR. In vivo evaluation of the optimized MMR in beagle dogs resulted in a significant increase (p < 0.05) in the absolute bioavailability for the MMR dosage form (42.9%) as compared to the commercially available tablet (33.4%) and enteric product (29.5%). Significant in vitro/in vivo correlations (p < 0.05) were obtained for the MMR using deconvolution analysis normalized for bioavailability. The floating dosage form was found to be a feasible approach in delivering furosemide to the upper gastrointestinal tract to maximize drug absorption.

Animals↗
PubMed1994

Effect of corticosteroid therapy on human immunodeficiency virus-associated nephropathy.

PURPOSE: Human immunodeficiency virus-associated nephropathy (HIV-AN) occurs predominantly in blacks and is characterized histologically by focal segmental glomerulosclerosis or mesangial proliferation and a lymphohistiocytic tubulointerstitial infiltrate. Patients manifest heavy proteinuria and, once azotemia occurs, progress rapidly to end-stage renal disease within 2 to 6 months. No treatment has been shown to be useful for HIV-AN. The purpose of this study was to determine the effect of corticosteroid agents on the progression of HIV-AN. PATIENTS AND METHODS: Four consecutive HIV-infected adults with fewer than 200 CD4 cells/microL, moderate to severe renal insufficiency, proteinuria greater than 2 g per 24 hours, and HIV-AN demonstrated by renal biopsy were treated with 60 mg of prednisone daily for 2 to 6 weeks. Patients were followed with respect to serum creatinine level, 24-hour protein excretion, adverse drug reactions, and the occurrence of opportunistic infections. RESULTS: CD4 counts ranged from 30 to 80 cells/microL before therapy with steroids. The mean (+/- SD) pretreatment serum creatine concentration was 9.1 +/- 5.7 mg/dL and decreased to 3.3 +/- 1.8 mg/dL (P < 0.05) after 2 to 6 weeks of corticosteroid therapy. Twenty-four hour protein excretion did not change (5.2 +/- 2.4 g pretreatment versus 4.6 +/- 4.1 g posttreatment). One patient was able to discontinue dialysis after 10 days. Two patients developed Mycobacterium avium-complex infections and steroid-associated psychosis. One of these patients developed a recurrence of genital herpes, and the other developed dermatomal zoster. None of the four required dialysis during a 1.5- to 5.5-month period of follow-up after cessation of steroid treatment. CONCLUSION: In selected patients with HIV-AN, short-term treatment with corticosteroid agents improves renal function and prevents the development of end-stage renal disease during a 1.5- to 5.5-month period of observation, but may be associated with an increased risk of opportunistic infection.

Adult↗