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Biomedical subjects

Ghan-Shyam Lohiya

Publications and source records attributed to Ghan-Shyam Lohiya.

10 recordsLinked to original sources
PubMed2006

The wheelchair thrombosis syndrome.

OBJECTIVE: To report a case of deep vein thrombosis (DVT) related to prolonged wheelchair use. CASE REPORT: A 48-year-old patient with spastic quadriplegia usually spent 10-12 hours daily in a wheelchair. He suddenly developed marked swelling of his right foot, leg and thigh. His plasma D-dimer level was 1,030 (normal <500) ng/ml. A duplex ultrasound revealed common femoral vein thrombosis. He was hospitalized and anticoagulated; his extremity swelling decreased considerably by day 45. Hypercoagulability work-up disclosed previously subclinical mild elevation of serum cardiolipin immunoglobulin G (antiphospholipid syndrome). This patient will receive longterm anticoagulation. CONCLUSION: Prolonged sitting in wheelchair may cause DVT. To enhance public recognition of this avoidable risk, we propose the term "wheelchair thrombosis syndrome."

Anticoagulants↗
PubMed2006

The futility of universal pre-employment chest radiographs.

In a developmental center, a preemployment chest x-ray was required for all job applicants. We scrutinized the pros and cons of this practice through a review of the medical literature and our experience, and discussion with our colleagues. We concluded that such chest x-ray caused unwarranted radiation exposure, did not produce compliance with the tuberculosis laws, gave a false sense of security regarding workers' compensation risk management, was contrary to established occupational medicine practice guidelines, and was unnecessary and wasteful. We discontinued such chest x-rays. The purpose of the pre-employment examination should remain narrowly job related. Even long-established procedures require periodic utilization review.

Cost-Benefit Analysis↗
PubMedDate not supplied

Identification of low bone mass in a developmental center: finger bone mineral density measurement in 562 residents.

OBJECTIVES: The objective of this study was to measure finger bone mineral density (BMD) in residents of a developmental center. DESIGN: A cross-sectional descriptive study performed during the residents' annual physical examination. SETTING: This study was conducted at a long-term care facility for people with severe developmental disabilities (mental retardation, cerebral palsy, epilepsy, and autism). PARTICIPANTS: Study participants included 562 (67%) of the 833 residents aged 30 years or more on whom we could measure BMD. MEASUREMENTS: We measured BMD by peripheral dual-energy x-ray absorptiometry (DXA) on the residents' middle fingers by Accudexa. The instrument converted the BMD values into T-scores relative to the manufacturer's reference young healthy population. We retrieved the residents' clinical variables from a centralized database. RESULTS: T-scores for the 562 residents were: <-2.5 standard deviation (SD) (osteoporotic): 98 (17%), -2.5 SD>t <-1 SD (osteopenic): 156 (28%), and >-1 SD (normal): 308 (55%). Multivariate regression analysis revealed that BMD was significantly lower in residents (compared with their counterparts) with inability to ambulate, male gender, white race, quadriplegia, profound mental retardation, and older age. CONCLUSION: There is a need for heightened osteoporosis surveillance and preventive effort in this population in which almost half of the residents had previously undiagnosed subnormal BMD, including one sixth who had osteoporosis.

Absorptiometry, Photon↗
PubMedDate not supplied

End-of-life care for a man with developmental disabilities.

BACKGROUND: Science can artificially maintain many essential life functions. Does such care prolong life or dying? METHODS: A case is described of a patient with developmental disability with unknown health care choices who was hospitalized for drug-resistant urosepsis. He developed aspiration pneumonia, deep vein thrombosis, and respiratory arrest. He required gastrostomy, tracheostomy, artificial ventilation, parenteral nutrition, hemodialysis, multiple anti-infective agents, and blood transfusions. On day 58, a bioethics committee recommended against cardiopulmonary resuscitation. On day 66, the patient's conservator concurred but required continuation of artificial ventilation. To the dismay of some caretakers, the patient continued to receive intrusive care until his death on day 104. The hospital charge was $709,206. RESULTS AND CONCLUSION: Hospital care of patients with mental incapacity can be clinically and ethically challenging. End-of-life decisions can be facilitated when the patient's legal representative and physician actively advocate the patient's best interests and communicate frequently and openly. Suggestions are made for such exigencies.

Adult↗