Biomedical subjects
Publications and source records attributed to H U Rehman.
The pathogenesis of idiopathic multifocal osteonecrosis is poorly understood. It is difficult to diagnose with conventional radiography or computed tomography and poses a great management challenge. A case of idiopathic multifocal osteonecrosis is presented in a young boy illustrating the difficulties in the management of such patients.
Despite all of the medical advances, Babinski sign has proved reliable in precise localization of central nervous system dysfunction. It is well accepted that Babinski sign is indicative of dysfunction of fibers within the pyramidal tract. Joseph François Félix Babinski first described the clinical significance of the reflex in 1896. He showed that the extensor plantar response was indicative of pyramidal dysfunction and that it was absent in hysteria. He also illustrated that it was present in infancy and transiently appeared in epilepsy and strychnine poisoning. Babinski also pointed to the existence of "formes frustes" of his reflex and recognized its occasional absence in patients with other clinical signs of pyramidal lesions. The sign emerges when the dysfunction of the pyramidal tract involves the fibers that project on motoneurons of foot muscles and is mediated by extensor hallucis longus. Babinski sign may not be present acutely after transverse lesions of the spinal cord or acute brain lesions because of temporary inexcitability of spinal motoneurons.
Many common problems encountered in the ageing patient can be related to neuroendocrine phenomena. These include Alzheimer's disease, dementia and cognitive dysfunction, depression, Parkinson's disease, hyponatraemia and the postmenopausal increase in both vascular risk and osteoporosis. This review concentrates on the hypothalamic neuroendocrine system, including the dopaminergic, noradrenergic, serotoninergic, cholinergic and neurohypophyseal systems and the roles of the anterior pituitary and monoamine oxidases, luteinizing hormone-releasing hormone, corticotrophin-releasing factor, the pro-opiomelanocortin-derived and opioid peptides, peptides involved in growth hormone and thyrotropin regulation, and amino acid transmitters.
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Progressive supranuclear palsy (PSP) or Steele-Richardson-Olszewski syndrome is a neurodegenerative disease of middle and late age. It is under-diagnosed not only by general physicians but also by neurologists. The cause of PSP is not known. Exposure to toxins and viruses has been proposed in the aetiology of PSP without any concrete evidence. The features of PSP resemble those of Parkinson's disease and the two diseases are often confused. Corticobasal degeneration and multisystem atrophy are other differential diagnoses. Despite certain common features with Parkinson's disease, corticobasal degeneration, and mutisystem atrophy, there are important differences that help to differentiate it from these disorders.
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Two cases of Cushing's disease are presented. In both cases successful treatment was followed by the development of a steroid-responsive disease condition, a seronegative arthritis in the first case and retinal vasculitis in the second. It is likely that both these conditions were unmasked by the fall in the endogenous steroid levels following the successful treatment of the Cushing's disease by trans-sphenoidal hypophysectomy.
Fish odour syndrome (trimethylaminuria) is a metabolic syndrome caused by abnormal excretion of trimethylamine in the breath, urine, sweat, saliva and vaginal secretions. Trimethylamine is derived from the intestinal bacterial degradation of foods rich in choline and carnitine and is normally oxidised by the liver to odorless trimethylamine N-oxide which is then excreted in the urine. Impaired oxidation of trimethylamine is thought to be the cause of the fish odour syndrome and is responsible for the smell of rotting fish. Certain foods rich in choline exacerbate the condition and the patients have a variety of psychological problems. Recognition of the condition is important as dietary adjustments reduce the excretion of trimethylamine and may reduce the odour. Occasionally, a short course of metronidazole, neomycin and lactulose may suppress production of trimethylamine by reducing the activity of gut microflora.
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Congestive heart failure is a common cause of morbidity and mortality in the elderly population. Important changes occur in the structure and function of the cardiovascular system with advancing age. An understanding of these changes is vital for optimum management of these patients.
Various attempts have been made to control the depth of anaesthesia by observing different variables. In some studies, depth of anaesthesia has been correlated with inferential parameters and the control has been made through these inferred parameters. No single system has been reported which provides a fully developed architecture to control the depth of anaesthesia. This study is concerned with the development of controllers and patient models via Artificial Neural Networks and regression analysis. Two types of data sets were used for the training and development of models and controllers. The first set was for spontaneously breathing and the second set for ventilated patients. All of the controllers and patient models gave satisfactory results when tested individually. Later these two sets of controllers and patient models were studied in closed-loop modes. The robustness to the sensitivity of the regression patient model was also investigated. Various tests were performed with these closed-loop situations. Results and performance of these tests are discussed in the paper.
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