Biomedical subjects
Publications and source records attributed to A Modi.
A 6-year-old boy presented with microangiopathic hemolytic anemia, thrombo-cytopenia, altered sensorium and intractable bleeding. A diagnosis of thrombotic thrombocytopenic purpura was made and the child recovered dramatically after plasmapheresis. Recent developments in the understanding of TTP are reviewed, including the importance of a metaloprotease required to cleave multimers of von Willibrand factor.
A main issue in modern synthetic organic chemistry, which deals with the preparation of natural products, pharmaceuticals, diagnostics, agrochemicals, and other important materials, is the improvement of efficiency, the avoidance of toxic reagents, the reduction of waste, and the responsible treatment of our resources. One of the ways to fulfill these goals is the development and use of domino processes, which consist of several bond-forming reactions and which allow the highly efficient synthesis of complex molecules starting from simple substrates. Herein, the combination of several catalytic bond-forming transformations is clearly most appropriate. The synthesis of the enantiopure alkaloid (-)-hirsutine 22, which has a strong inhibitorial effect on influenza A viruses, was accomplished using a biomimetic domino Knoevenagel-hetero-Diels Alder-solvolysis-hydrogenation process. In a similar way the alkaloids (+)-dihydrocorynantheine 23 and (-)-dihydroantirhine 24 as well as heterosteroids 62, D-homosteroids 65 and 68, and azasteroids 25 are prepared. In addition, novel steroid alkaloids 26 are accessible by a combination of the formation of an iminium salt, a hydride shift, and an alkylation. The anti-leukemic pentacyclic (-)-cephalotaxine 27 is obtained by a combination of two Pd-catalyzed reactions.
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OBJECTIVES: To review the number of superficial cultures performed in the evaluation of neonatal sepsis and to validate physicians' compliance with an established protocol. DESIGN: Before-and-after-comparison using medical audit. SETTING: Intensive care nursery in a secondary level perinatal facility. PARTICIPANTS: One hundred seventy-five consecutive newborns admitted during a 6-month period for the assessment and potential treatment of sepsis. Eligible patients met the entrance criteria of having a superficial culture performed in conjunction with at least one deep culture, which included cerebrospinal fluid, blood, or urine. This cohort was compared with 205 patients before the introduction of the protocol. INTERVENTIONS: A second audit of physician practice 9 months following the introduction of an evidence-based hospital protocol to discontinue the use of superficial cultures in the diagnostic assessment of neonatal infection. Evidence-based medicine, an opinion leader, continuing medical education rounds, immediate feedback through direct encounters with physicians, and barriers in accessing microbiological tests were used to alter physician behavior. MEASUREMENTS/RESULTS: A significant reduction from 50.5% to 6.9% was achieved in the proportion of superficial cultures performed and a substantial cost savings of $4454.84 was realized without incurring patient morbidity. CONCLUSIONS: A methodologically rigorous reaudit process with planned, interventional strategies may be used as part of a continuous quality improvement program to affect change in physicians' practices. Existing hospital practice standards should be reevaluated against emerging scientific evidence.
The clinical manifestations of angio-immunoblastic lymphadenopathy (AILD) suggest that there is an abnormality in the immune system. Most patients with AILD die from opportunistic infections associated with lymphocyte depletion. As chemotherapy further increases the already high susceptibility of infections, the therapeutic management of AILD is difficult. The achievement of complete remission (CR) by the patient described here using a danazol-based regimen raises the hope that treatment of this disease with a noncytotoxic drug may be possible. The rationale behind and advantages of using danazol are discussed.
Pure red cell aplasia (PRCA) often occurs secondary to drug therapy for rheumatoid arthritis (RA). However, idiopathic PRCA in RA is very rare. Though different immunosuppressive therapies have been tried in the past with variable responses, there has been no case report in adults of favourable response to corticosteroids alone. We report a rare case of PRCA in RA, which responded to steroid therapy. Subsequently, the patient relapsed twice, during the first trimester of consecutive pregnancies. The association of PRCA with RA and pregnancy is discussed.
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The influence of electric fields on carbon nanotubes is experimentally demonstrated. Alignment of nanotubes along field lines, directed motion of nanotubes between electrodes separated by several thousand micrometers, and impressive solid-state actuation behavior of nanotube-embedded structures are demonstrated, taking into account the polarization and charging of the nanotubes. These effects are reported for long strands of nanotubes, nanotubes dispersed on substrates, and nanotube-embedded polymer strips. The relative magnitude of the field responsible for polarization and directed motion was found to be dependent on the morphology of the nanotubes used. These observations may foreshadow novel electromechanical applications for nanotube elements.