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C Patel

Publications and source records attributed to C Patel.

At least 55 records · Page 3Linked to original sources
PubMed1991

Health inequalities among British civil servants: the Whitehall II study.

The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.

Adult↗
PubMed1991

Sjögren-Larsson syndrome: case reports of two brothers.

Sjögren-Larsson syndrome (SLS) is an autosomal recessively inherited disorder characterized by the triad of congenital ichthyosis, spastic diplegia or tetraplegia and mental retardation. SLS is also often associated with a variety of other anomalies, including signs that are of interest to optometrists and ophthalmologists. Two case histories are presented. Both patients exhibited maculopathies and uncorrected astigmatism. The reduced visual acuities in one case appeared to be caused at least partly by astigmatism and the associated astigmatic amblyopia.

Adult↗
PubMed1990

Investigation of three patients with the "ring syndrome", including familial transmission of ring 5, and estimation of reproductive risks.

We report three cases of ring chromosome 5 [r(5)], two familial (mother and daughter) and one sporadic. The phenotype resembled that of the "ring syndrome" with prenatal onset of short stature, growth retardation, mild facial dysmorphism and normal psychomotor development. Extended metaphase and prometaphase chromosome preparations using G-, R- and Q-banding and scanning electron microscopy (SEM) failed to demonstrate deletion in the ring 5. Flow karyotype using the FACS cell sorter and peak area analysis showed the r(5) to be in the same position as the normal chromosome 5. The deletion that is presumably associated with ring formation appears to involve less that one megabase of DNA. In the "complex" rings, high resolution SEM showed fragile sites at the 5q34 and 5q35 region with frequent deletions at that site. A literature survey suggests that when a parent carries a ring chromosome about 80% of recognised pregnancies result in live birth. Of these, about half have a normal phenotype and karyotype, and half inherit the parental ring; about half of those acquiring the ring (20%) show significant mental retardation.

Adult↗
PubMed1990

Healthy eating.

Explore the source record for details and available documents.

Aged↗
PubMed1989

Hemodynamic and gas exchange alterations during Intralipid infusion in patients with adult respiratory distress syndrome.

Hemodynamic and pulmonary gas exchange consequences of 20 percent intravenous fat emulsion infusion (3.0 +/- .3 mg/kg/min) were evaluated in 19 patients who demonstrated ARDS. Lipid infusion precipitated a significant reduction in PaO2/FIO2 from 241 +/- 50 to 184 +/- 41 (mean +/- SD) and increased MPAP from 26.0 +/- 5.1 to 31.8 +/- 4.8 mm Hg, pulmonary vascular resistance from 149 +/- 78 to 179 +/- 61 dyne.s/cm5 and pulmonary venous admixture (Qva/Qt) from 20.7 +/- 15.2 to 30.6 +/- 8.6 percent. Further analysis revealed that the magnitude of increased Qva/Qt was greater in patients who manifested septicemia (N = 10) compared to those who did not (N = 9): 12.3 vs 7.3 percent, respectively. We conclude that intravenous lipid administration was associated with increased MPAP and Qva/Qt in patients with ARDS, particularly when accompanied by septicemia. Although these alterations resolved after the lipid infusion was terminated, we suggest that prudent measures should be taken to guarantee adequate oxygenation during intravenous fat emulsion therapy in patients suffering from ARDS.

Fat Emulsions, Intravenous↗
PubMed1988

Can general practitioners use training in relaxation and management of stress to reduce mild hypertension?

To see whether general practitioners could effectively carry out training in relaxation and management of stress to reduce mild hypertension a study was carried out with a subsample of phase 2 of the Medical Research Council's treatment of mild hypertension trial. In the main mild hypertension trial patients had been receiving either an active drug or placebo for six years. In phase 2 a subsample of these patients were randomly allocated either to continue or to stop receiving the active drug or placebo. In a further subsample patients were again randomised to receive or not to receive relaxation therapy. This factorial design presented an additional opportunity to assess whether patients controlled with active drugs might have their blood pressure maintained by this behavioural therapy once drug treatment was stopped and to assess whether blood pressure might be further reduced by this therapy in patients who had been under regular medical supervision for as long as six years and who had already received non-pharmacological advice. The therapy was conducted by general practitioners in group sessions once a week for eight weeks. The training in relaxation was accompanied by galvanic skin resistance biofeedback. At one year follow up blood pressure in the relaxation subgroups was either maintained (in the group who had stopped receiving drugs) or reduced further (in the group who had continued receiving drugs and in both placebo groups), while in the control group it had increased in all the subgroups, but particularly in those who had stopped receiving drugs. Differences in changes in blood pressure between the relaxation and control groups were significant. There were five new cardiovascular events, including evidence of myocardial ischaemia in blindly coded electrocardiograms in the control group, compared with one in the treatment group. General practitioners, if motivated, can successfully apply this technique of training those with mild hypertension in relaxation and management of stress.

Adult↗
PubMed1987

Stress management, blood pressure and quality of life.

This paper addresses three questions. First, we examine the effectiveness of relaxation and stress management in reducing hypertension and its complications by reviewing published studies including our own. Secondly, we report quality of life under such treatment, and thirdly, we discuss possible mechanisms. There is considerable evidence to show the effectiveness of a variety of non-pharmacological measures. In a randomized, controlled trial we showed that relaxation and stress-management training was associated with a reduction in blood pressure (BP) maintained over 4 years of observation. There were signs of a possible reduction in coronary heart disease (CHD) risk while maintaining or even enhancing the quality of life. Significantly more subjects in the relaxation group reported improved relationships at work, general health, enjoyment of life, and personal and family relationships than those in the control group at a 4-year follow-up. A similar but statistically insignificant trend was shown for the general level of physical energy, sexual life, concentration at work, mental well-being and social life. The relaxation group also displayed a belief in greater control over their health. There was no consistent relationship between the degree of reduction in BP and improvement in the above aspects of life, but those who practised relaxation regularly, who integrated relaxation in everyday activities and who used cognitive reappraisal as part of their stress-management strategies, showed greater reduction in BP than those who did not. Other studies have shown that this therapy can contribute significantly to the better control of BP with smaller doses of antihypertensive drugs, thus reducing the chances of side effects.

Biofeedback, Psychology↗
PubMed1986

Prospective testing of a scoring system designed to improve case selection for upper gastrointestinal investigation.

A recently described scoring system designed to assess the individual risk of finding serious pathology in patients referred for upper gastrointestinal investigation has been prospectively tested in 1279 patients undergoing first-time endoscopy and 321 patients undergoing radiologic examination. The scoring system has been confirmed to give a reasonable prediction of the likelihood of finding serious pathology in two hospitals with differing endoscopic practice, and also to be applicable to patients attending for radiology. The system works best at defining a low-risk group (score less than 412, 26% of total) in which the incidence of serious pathology was 3%. All cases of malignancy (n = 55) occurred in patients scoring greater than 464 (50% of total). A simple table is described that allows for the easy calculation of score at a glance without the use of a computer. We believe that this scoring system, which can be implemented in seconds, is the simplest yet described and that it could prove to be a useful educational aid.

Age Factors↗
PubMed1986

Acute complications of pulmonary artery catheter insertion in critically ill patients.

Of 142 critically ill patients undergoing pulmonary artery catheter (PAC) insertion, 1.4% suffered pneumothorax and 7.7% experienced arterial puncture during central venous access. Catheterization was successful in all cases; however, 8.4% of patients required special maneuvers for pulmonary artery cannulation. The 52.3% incidence of cardiac arrhythmias during PAC insertion was primarily due to ventricular arrhythmia (VA), which was more common among patients with complicated myocardial infarction (p less than .01) and less common in patients with sepsis (p less than .05). The development of VA was significantly related to the duration of PAC insertion. Our study suggests that PAC placement carries certain risks and complications which should be weighed against the advantages of a PAC in each patient.

Aged↗
PubMed1986

Long-term threshold stability with porous tip electrodes.

Experience with 163 unipolar tined porous endocardial electrodes is reported. One patient required repositioning of the electrode because of exit block. There were no other complications in the entire series of patients. All of the patients had low chronic stimulation thresholds. The mean pulse width 24 hours after implantation was 0.0534 +/- 0.0128 ms. Seventy-four patients were restudied six months after implantation. The mean pulse width threshold was then 0.07432 +/- 0.0775 ms. Fifty-four patients were evaluated one year after lead implantation. The mean pulse width threshold was then 0.0611 +/- 0.0230 ms. The pulse generator was reprogrammed to a lower pulse width in all of the patients. This permitted a substantial prolongation of the pulse generator life. The cost effectiveness of the pulse generator was also greatly improved by pacing with reduced pulse widths. In an additional 16 patients, the voltage amplitude was reduced from 5.0 volts to 2.5 volts. This permitted an even greater increase in the pulse generator longevity.

Electrodes, Implanted↗
PubMed1986

Determination of kanamycin concentration in serum by substrate-labeled fluorescent immunoassay.

A homogeneous substrate-labeled fluorescent immunoassay was developed for the measurement of kanamycin concentrations in serum. A fluorogenic drug reagent (FDR) (beta-galactosyl-umbelliferone-tobramycin) was prepared that is nonfluorescent under the conditions of the assay but is hydrolyzed upon catalysis by beta-galactosidase to yield a fluorescent product. Binding of the FDR to the antiserum to kanamycin prevented enzyme hydrolysis. The fixed level of FDR in the assay competed with kanamycin in the sample for a limited number of antibody-binding sites. Unbound FDR was hydrolyzed by beta-galactosidase to release a fluorescent product that is proportional to the kanamycin concentration in the sample. The assay exhibited good sensitivity, precision, and accuracy and correlated well with other methods.

Binding, Competitive↗
PubMed1985

Trial of relaxation in reducing coronary risk: four year follow up.

On screening 192 men and women aged 35-64 were identified as having two or more of the following risk factors: blood pressure greater than or equal to 140/90 mm Hg, plasma cholesterol concentration greater than or equal to 6.3 mmol/l (243.6 mg/100 ml), and current smoking habit greater than or equal to 10 cigarettes a day. They were randomly allocated to a group for modification of behaviour or to serve as controls. Both groups were given health education leaflets containing advice to stop smoking, to reduce animal fats in the diet, and on the importance of reducing blood pressure. In addition, the treatment group had group sessions of one hour a week for eight weeks in which they were taught breathing exercises, relaxation, and meditation and about managing stress. It had previously been found that after eight weeks and eight months there was a significantly greater reduction in both systolic and diastolic blood pressures in the group taught to relax compared with the control group. After four years of follow up these differences in blood pressure were maintained. Plasma cholesterol concentration and the number of cigarettes smoked were lower in the treatment group at eight weeks and eight months but not at the four year follow up. At four years more subjects in the control group reported having had angina and treatment for hypertension and its complications. Incidence of ischaemic heart disease, fatal myocardial infarction, or electrocardiographic evidence of ischaemia was significantly greater in the control group. If the results of this study could be obtained in a larger study the financial and health care implications would be enormous.

Adult↗