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Biomedical subjects

B Mamdani

Publications and source records attributed to B Mamdani.

15 recordsLinked to original sources
PubMed1990

Triage considerations in medical intensive care.

As an initial step toward improving admission criteria to the medical intensive care unit (MICU), we examined Acute Physiologic and Chronic Health Evaluation scores and the diagnosis-adjusted mortality rates of 2419 medical patients, including those who received MICU consultation over a 6-month period. There was considerable overlap in the physiologic scores and the predicted mortality rates between those patients who were admitted to the MICU and those who were not. There was no discrete score or mortality rate at which triage to the MICU would have included most MICU patients but excluded most patients who survived without admission to the MICU. While uniform MICU admission criteria would be desirable, current scoring systems may not have the desired sensitivity or specificity to establish such criteria. Using a receiver operating characteristic curve, we demonstrated that diagnosis-adjusted mortality rates could predict as well as Acute Physiologic and Chronic Health Evaluation scores which patients would receive MICU admission and intervention. This suggests that, for different diagnoses, specific clinical variables and laboratory tests may have different predictive importance for MICU admission. Prospective models of clinical variables using receiver operating characteristic curves in various medical diseases may improve triage procedures.

Diagnosis-Related Groups↗
PubMed1988

Decreases in mortality on a large urban medical service by facilitating access to critical care. An alternative to rationing.

The admission and case fatality rate (CFR) on a large urban medical service for 12 months before and after the creation of an intermediate care unit were examined. In the year after the intermediate care unit was opened, total admissions to the ICU/CCU decreased by 7.1% as a result of a 14.6% decrease in admission of low-risk patients who did not require critical care services. The CFR of patients on the medical service decreased by 13.3% in the year after implementation of the intermediate care unit. The decrease in mortality was accounted for by a 25.0% decrease in general ward deaths and a 38.8% decrease in ward cardiac arrests. There was no significant difference in the ICU/CCU CFR. The admission of low-risk patients to an intermediate care unit provided greater access to intensive care and was associated with an overall lower medical service CFR.

Chicago↗
PubMed1986

Costs in the ICU.

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Costs and Cost Analysis↗
PubMed1986

A randomized comparison of nifedipine and sodium nitroprusside in severe hypertension.

We randomized patients with severe hypertension in the Medical Intensive Care Unit to a treatment regimen of oral nifedipine or intravenous nitroprusside. Patients treated with nifedipine achieved a sustained reduction in diastolic blood pressure to less than or equal to 120 mm Hg in an average of less than five hours. Patients treated with nitroprusside achieved a similar reduction in 14 hours (p less than 0.05). Treatment with nifedipine was less expensive and required less time in the ICU than treatment with nitroprusside and was accompanied by no associated increase in morbidity or mortality. Oral nifedipine can be used as an alternative to intravenous nitroprusside in severe uncomplicated hypertension.

Administration, Oral↗
PubMed1985

Inhibition of platelet function by uremic middle molecules.

To further define the platelet abnormality responsible for uremic bleeding, we studied platelet aggregation with adenosine diphosphate, ristocetin, and collagen in serum fractions obtained by Sephadex G-15 chromatography. We found that uremic patients had considerable inhibition in several peaks of middle molecular range, but the findings were inconsistent and not clearly related to the degree of uremia.

Blood Platelets↗
PubMed1984

Causes of death in an urban public hospital.

For the study reported here, we examined the charts and autopsy reports of every death in the Department of Medicine at Cook County Hospital for the year 1983. In that period, there were 11,677 admissions to the Department and 476 deaths, yielding a mortality of 4.1 percent. There were 50 percent more deaths in the intensive care unit than on the general wards. Malignancies accounted for greater than one-third of all deaths. Lung cancer, which occurred in one of every six deaths in the department, was the single most-common diagnosis. The other leading causes of death were cirrhosis, gastrointestinal malignancies and cerebrovascular accidents. Cardiovascular mortality was somewhat less than expected. These figures reflect some of the serious diseases of the urban indigent population, which are, in turn, associated with cigarette smoking, alcoholism and hypertension. Decreases in morbidity and mortality are likely to be influenced by preventive medical measures and early detection campaigns. Department of medicine curricula and outpatient clinic programs should devote attention and resources to these areas.

Chicago↗
PubMed1984

Separation, isolation and amino acid composition of uremic peptides.

Gel filtration and thin layer chromatography were conducted on sera from uremic patients and normal subjects for the isolation of nitrogenous substances unique to uremia. Many ninhydrin-positive substances were found in greater amounts in uremic patients compared to normal subjects. Some of these ninhydrin-positive substances were also detected by staining with chlorine-tolidine. Amino acid analysis of these substances showed considerable qualitative and quantitative differences, perhaps reflecting interference with enzymatic activity by the uremic environment.

Amino Acids↗
PubMed1978

Role of aluminum in dialysis dementia.

Between September 1972 and January 1976 an outbreak of dialysis dementia affected 20 patients maintained by long-term hemodialysis. The clinical picture was characterized by an insidious onset of altered behaviour, dementia, speech disturbance, myoclonus, and convulsions. Nineteen patients died, but one patient has survived for 16 months. It was later established that in June 1972 the city had altered its method of water purification and that this resulted in higher water aluminum levels. The temporal relation between periods of high water-aluminum content and the appearance of new cases supports the view that aluminum may play a role in the causation of dialysis dementia.

Adult↗
PubMed1976

Treatment of severe and moderate hypertension with minoxidil: experience in twenty-eight patients.

1. Twenty patients with severe or moderate hypertension were treated with minoxidil for 284 patient-months. 2. The blood pressure was controlled in all patients, including those refractory to maximal doses of conventional anti-hypertensive agents. 3. In patients with moderate hypertension control with minoxidil was achieved earlier and more easily than with hydrallazine. 4. Three patients developed secondary resistance and required addition of guanethidine or increased doses of diuretics. 5. Fluid retention and hypertrichosis were the main side effects with minoxidil.

Adult↗
PubMed1975

Severe hypertension. Treatment with minoxidil.

Seventeen patients who were partially or totally refractory to maximal doses of conventional antihypertensive agents were treated with minoxidil. Three patients were receiving long-term maintenance dialysis. Propranolol and diuretics were given to prevent reflex tachycardia and fluid retention. Initial control of blood pressure was excellent in 16 patient. In one patient, diastolic blood pressure remained unchanged (120 mm Hg) despite 60 mg of minoxidil and volume depletion. In three other patients, secondary resistance developed, and the addition of guanethidine was necessary. The main side-effects were fluid retention (in eight) and hypertrichosis (in ten), accompanied in some by a peculiar coarsening of the facial features. Renal function stabilized or improved in most, and urine output increased in the three hemodialysis patients. We conclude that minoxidil is a valuable drug in severe hypertension.

Adult↗