PubMed Health⌕ Search

Biomedical subjects

J Attia

Publications and source records attributed to J Attia.

At least 19 recordsLinked to original sources
PubMed2006

Behavioral and neurophysiological responses of European sea bass groups reared under food constraint.

The individual food-demand behavior of juvenile European sea bass (Dicentrarchus labrax, L.) reared in groups under self-feeding conditions was investigated. The triggering activity on self-feeder, i.e. index of the food-demand activity, agonistic interactions and territorial behavior were monitored for periods of 42 to 68 days in six groups of 50 fish. The specific growth rate was calculated and the brain serotonergic activity was used as a stable index of social stress. Inter-individual differences appeared in triggering activity and three groups were distinguished: 3-5 high-triggering fish, 17-30 low-triggering fish and the remaining individuals were null-triggering fish. There were no significant differences in specific growth rates calculated at the end of the experiment (day 42 or day 68) between individuals with high, low, and null food-demand (ANOVA, p>0.05). No territorial or agonistic behaviors were observed, however, there were significant differences in brain serotonergic activity between the three triggering groups (ANOVA, p=0.050 in telencephalon and p=0.004 in cerebellum). Specifically, high-triggering fish had lower serotonergic turnover than low or null-triggering fish. We put forth the hypothesis that fish with low or null-triggering activity could be stressed by the high activity of high-triggering individuals.

Animals↗
PubMed2006

Basic concepts in meta-analysis: A primer for clinicians.

With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.

Bias↗
PubMed2006

Association between phosphodiesterase 4D gene and ischaemic stroke.

BACKGROUND: An association between the phosphodiesterase 4D (PDE4D) gene and risk of ischaemic stroke in an Icelandic population has been suggested by the deCODE group. METHODS: A case-control study of 151 hospitalised patients with first-ever ischaemic stroke and 164 randomly selected age-matched and sex-matched community controls was conducted. PDE4D genotypes for the six single-nucleotide polymorphisms (SNPs) previously reported to be independently associated with stroke were determined, common haplotypes were inferred using the expectation-maximisation algorithm, and SNP and haplotype associations with stroke were examined. A meta-analysis of published studies examining the association between PDE4D and stroke was also carried out. RESULTS: Our study of Australian patients with stroke showed an independent association between ischaemic stroke and PDE4D SNP 89 (CC: odds ratio (OR) 5.55, 95% confidence interval (CI) 1.02 to 30.19; CA: OR 1.68, 95% CI 0.96 to 2.96; AA: OR 1 (reference)), SNP 87 (CC: OR 2.13, 95% CI 1.08 to 4.20; TC: OR 1.64, 95% CI 0.89 to 3.00; TT: OR 1 (reference)) and SNP 83 (TT: OR 2.16, 95% CI 1.08 to 4.32; TC: OR 1.37, 95% CI 0.77 to 2.43; CC: OR 1 (reference)), and between ischaemic stroke and PDE4D haplotypes at SNP 89-87-83 (A-C-C: OR 2.13, 95% CI 1.15 to 3.96; C-C-T: OR 2.25, 95% CI 1.29 to 3.92), but no association between ischaemic stroke and PDE4D SNP 56, SNP 45 or SNP 41, or with PDE4D haplotypes at SNP 56-45-41. A meta-analysis of nine case-control studies (including our current results) of 3808 stroke cases and 4377 controls confirmed a significant association between stroke and PDE SNP 87 (pooled p = 0.002), SNP 83 (0.003) and SNP 41 (0.003). However, there was statistical heterogeneity (p < 0.1) among the studies in the direction of association for each of the individual SNPs tested. CONCLUSIONS: Our results and the pooled analyses from all the studies indicate a strong association between PDE4D and ischaemic stroke. This strengthens the evidence that PDE4D plays a key part in the pathogenesis of ischaemic stroke. Heterogeneity among the studies in the direction of association between individual SNPs and stroke suggests that the SNPs tested are in linkage disequilibrium with the causal allele(s).

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2006

A graphic framework for teaching critical appraisal of randomised controlled trials.

Students of evidence-based medicine often try unsuccessfully to commit to memory a particular critical appraisal framework (often lengthy), or they have to depend on pocket cards and are lost without them. We have described a pedagogic aid: a flow diagram of an RCT, which has been developed over years of teaching residents. This diagram focuses on the steps in an RCT, and by drawing arrows, it highlights the biases possible at each step. This diagram serves as a framework on which the list of critical appraisal questions can be hung and is easy to remember.

Animals↗
PubMed2003

Melatonin modulates secretion of growth hormone and prolactin by trout pituitary glands and cells in culture.

In Teleost fish, development, growth, and reproduction are influenced by the daily and seasonal variations of photoperiod and temperature. Early in vivo studies indicated the pineal gland mediates the effects of these external factors, most probably through the rhythmic production of melatonin. The present investigation was aimed at determining whether melatonin acts directly on the pituitary to control GH and prolactin (PRL) secretion in rainbow trout. We show that 2-[125I]-iodomelatonin, a melatonin analog, binds selectively to membrane preparations and tissue sections from trout pituitaries. The affinity was within the range of that found for the binding to brain microsomal preparations, but the number of binding sites was 20-fold less than in the brain. In culture, melatonin inhibited pituitary cAMP accumulation induced by forskolin, the adenyl cyclase stimulator. Forskolin also induced an increase in GH release, which was reduced in the presence of picomolar concentrations of melatonin. At higher concentrations, the effects of melatonin became stimulatory. In the absence of forskolin, melatonin induced a dose-dependent increase in GH release, and a dose-dependent decrease in PRL release. Melatonin effects were abolished upon addition of luzindole, a melatonin antagonist. Our results provide the first evidence that melatonin modulates GH and PRL secretion in Teleost fish pituitary. Melatonin effects on GH have never been reported in any vertebrate before. The effects result from a direct action of melatonin on pituitary cells. The complexity of the observed responses suggests several types of melatonin receptors might be involved.

Animals↗
PubMed2003

Melatonin and 5-methoxytryptophol (5-ML) in nervous and/or neurosensory structures of a gastropod mollusc (Helix aspersa maxima): synthesis and diurnal rhythms.

Daily patterns of melatonin and 5-methoxytryptophol (5-ML) concentrations and of aryl alkylamine N-acetyltransferase (AA-NAT) and hydroxyindole-O-methyltransferase (HIOMT) activities have been measured in the cerebroid ganglions, visceral ganglions, and ocular tentacles of the gastropod mollusc Helix aspersa maxima. Melatonin concentrations are very low in all the studied structures, except a small peak at the end of the night in the cerebroid ganglions. 5-ML, which is quite undetectable in the cerebroid and visceral ganglions, shows clear daily variations in the ocular tentacles with low values in the middle of the light period and high values during the night. These results are opposite to what is known on daily variations of 5-ML in vertebrates. AA-NAT activity was not detected, while the presence of an HIOMT-like activity supports the hypothesis that 5-ML is synthesized in the ocular tentacles. The temporal relationships existing between the 5-ML rhythm in the ocular tentacles and the hemolymph suggest that 5-ML could be released in the general circulation. These preliminary results suggest that 5-ML could be an informative molecule involved in adaptative processes in the snail and they reinforce the hypothesis that the different 5-methoxyindoles could be implicated in the integration of environmental information.

Acetylserotonin O-Methyltransferase↗
PubMed2002

Impact numbers in health policy decisions.

OBJECTIVE: To outline the major methodological issues appropriate to the use of the population impact number (PIN) and the disease impact number (DIN) in health policy decision making. DESIGN: Review of literature and calculation of PIN and DIN statistics in different settings. SETTING: Previously proposed extensions to the number needed to treat (NNT): the DIN and the PIN, which give a population perspective to this measure. MAIN RESULTS: The PIN and DIN allow us to compare the population impact of different interventions either within the same disease or in different diseases or conditions. The primary studies used for relative risk estimates should have outcomes, time periods and comparison groups that are congruent and relevant to the local setting. These need to be combined with local data on disease rates and population size. Depending on the particular problem, the target may be disease incidence or prevalence and the effects of interest may be either the incremental impact or the total impact of each intervention. For practical application, it will be important to use sensitivity analyses to determine plausible intervals for the impact numbers. CONCLUSIONS: Attention to various methodological issues will permit the DIN and PIN to be used to assist health policy makers assign a population perspective to measures of risk.

Decision Making↗
PubMed2002

Impact numbers: measures of risk factor impact on the whole population from case-control and cohort studies.

OBJECTIVE: To describe new measures of risk from case-control and cohort studies, which are simple to understand and relate to numbers of the population at risk. DESIGN: Theoretical development of new measures of risk. SETTING: Review of literature and previously described measures. MAIN RESULTS: The new measures are: (1) the population impact number (PIN), the number of those in the whole population among whom one case is attributable to the exposure or risk factor (this is equivalent to the reciprocal of the population attributable risk); (2) the case impact number (CIN) the number of people with the disease or outcome for whom one case will be attributable to the exposure or risk factor (this is equivalent to the reciprocal of the population attributable fraction); (3) the exposure impact number (EIN) the number of people with the exposure among whom one excess case is attributable to the exposure (this is equivalent to the reciprocal of the attributable risk); (4) the exposed cases impact number (ECIN) the number of exposed cases among whom one case is attributable to the exposure (this is equivalent to the reciprocal of the aetiological fraction). The impact number reflects the number of people in each population (the whole population, the cases, all those exposed, and the exposed cases) among whom one case is attributable to the particular risk factor. CONCLUSIONS: These new measures should help communicate the impact on a population, of estimates of risk derived from cohort or case-control studies.

Case-Control Studies↗
PubMed2001

Deep vein thrombosis and its prevention in critically ill adults.

BACKGROUND: Our objective was to systematically review the incidence of deep vein thrombosis (DVT) and the efficacy of thromboprophylaxis in critically ill adults, including patients admitted to intensive care units and following trauma, neurosurgery, or spinal cord injury. METHODS: Two authors independently searched MEDLINE, EMBASE, abstract databases, and the Cochrane database. Data were extracted independently in triplicate. RESULTS: Ten percent to 30% of medical and surgical intensive care unit patients develop DVT within the first week of intensive care unit admission. The use of subcutaneous low-dose heparin reduced the rate by 50% compared with no prophylaxis. Approximately 60% of trauma patients developed DVT within the first 2 weeks of admission. Use of unfractionated heparin appears to decrease the incidence of DVT by only 20%, whereas low-molecular-weight heparin decreases the incidence by a further 30%. The estimated prevalence of DVT in neurosurgical patients not given prophylaxis is 22% to 35%. Mechanical prophylaxis is efficacious, with a pooled odds ratio in 5 randomized trials of 0.28. Use of low-molecular-weight heparin has been investigated as an adjunct to mechanical prophylaxis with a pooled odds ratio of 0.59 compared with graduated compression stockings alone. The incidence of DVT without prophylaxis in acute spinal cord injury patients is likely in excess of 50% to 80%. Studies of prophylaxis in these patients are too sparse to come to any definitive conclusion. CONCLUSIONS: Critically ill patients commonly develop DVT, with rates that vary from 22% to almost 80%, depending on patient characteristics. Methods of prophylaxis proven in one group do not necessarily generalize to other critically ill patient groups. More potent prophylactic regimens other than unfractionated or low-molecular-weight heparins alone may be needed with higher-risk groups.

Anticoagulants↗
PubMed2000

Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients.

PURPOSE: Acute and chronic illness, immobility, and procedural and pharmacologic interventions may predispose patients in the intensive care unit (ICU) to venous thromboembolic (VTE) disease. The purpose of this study was to observe potential risk factors and diagnostic tests for VTE, and prophylaxis against VTE in medical-surgical ICU patients. MATERIALS AND METHODS: In a prospective observational study, 93 consecutive patients admitted to a mixed medical-surgical ICU were followed. We recorded demographics, admitting diagnoses, APACHE II score, VTE risk factors, antithrombotic, anticoagulant and thrombolytic agents, diagnostic tests for deep venous thrombosis (DVT) and pulmonary embolus (PE), and clinical outcomes. RESULTS: Patients were 65.5 (15.5) years old with an APACHE II score of 21.1 (9.0); 44 (47.3%) were female. Admission diagnoses were medical (58, 67.4%) and surgical (35, 37.6%). The duration of ICU stay was 3 days (interquartile range: 1, 8.5 days) and the ICU mortality rate was 20.4% (19 of 93). We observed 8 VTE events among 5 of 93 patients (incidence 5.4% [0.8 to 10.0]); 2 patients had DVT and PE before admission, 1 had DVT as an admitting diagnosis, 1 had DVT on day 2 and PE on day 3, and 1 had PE on day 2. Over 804 ICU patient-days, 2 of 5 ultrasound examinations diagnosed DVT and 2 of 3 ventilation-perfusion lung scans diagnosed PE. Of 64 patients in whom heparin was not contraindicated and who were not anticoagulated, subcutaneous heparin prophylaxis was prescribed for 40 (62.5%) patients. ICU-acquired VTE risk factors were mechanical ventilation (odds ratio [OR] 1.56), immobility (OR 2.14), femoral venous catheter (OR 2.24), sedatives (OR 1.52), and paralytic drugs (OR 4.81), whereas VTE heparin prophylaxis (OR 0.08), aspirin (OR 0.42), and thromboembolic disease stockings (OR 0.63) were associated with a lower risk. Only warfarin (OR 0.07, P =.01) and intravenous heparin (OR 0.04, P<.01) were associated with a significantly decreased risk of VTE. CONCLUSIONS: Several ICU-acquired risk factors for VTE were documented in this medical-surgical ICU. VTE prophylaxis was underprescribed, and VTE diagnostic tests were infrequent. Further research is required to determine the incidence, predisposing factors, attributable morbidity, mortality, and costs of VTE in medical-surgical ICU patients, the optimal diagnostic test strategies, and the most cost-effective approaches of prophylaxis.

APACHE↗
PubMed1999

The rational clinical examination. Does this adult patient have acute meningitis?

CONTEXT: Early clinical recognition of meningitis is imperative to allow clinicians to efficiently complete further tests and initiate appropriate therapy. OBJECTIVE: To review the accuracy and precision of the clinical examination in the diagnosis of adult meningitis. DATA SOURCES: A comprehensive review of English- and French-language literature was conducted by searching MEDLINE for 1966 to July 1997, using a structured search strategy. Additional references were identified by reviewing reference lists of pertinent articles. STUDY SELECTION: The search yielded 139 potentially relevant studies, which were reviewed by the first author. Studies were included if they described the clinical examination in the diagnosis of objectively confirmed bacterial or viral meningitis. Studies were excluded if they enrolled predominantly children or immunocompromised adults or focused only on metastatic meningitis or meningitis of a single microbial origin. A total of 10 studies met the criteria and were included in the analysis. DATA EXTRACTION: Validity of the studies was assessed by a critical appraisal of several components of the study design. These components included an assessment of the reference standard used to diagnose meningitis (lumbar puncture or autopsy), the completeness of patient ascertainment, and whether the clinical examination was described in sufficient detail to be reproducible. DATA SYNTHESIS: Individual items of the clinical history have low accuracy for the diagnosis of meningitis in adults (pooled sensitivity for headache, 50% [95% confidence interval [CI], 32%-68%]; for nausea/vomiting, 30% [95% CI, 22%-38%]). On physical examination, the absence of fever, neck stiffness, and altered mental status effectively eliminates meningitis (sensitivity, 99%-100% for the presence of 1 of these findings). Of the classic signs of meningeal irritation, only 1 study has assessed Kernig sign; no studies subsequent to the original report have evaluated Brudzinski sign. Among patients with fever and headache, jolt accentuation of headache is a useful adjunctive maneuver, with a sensitivity of 100%, specificity of 54%, positive likelihood ratio of 2.2, and negative likelihood ratio of 0 for the diagnosis of meningitis. CONCLUSIONS: Among adults with a clinical presentation that is low risk for meningitis, the clinical examination aids in excluding the diagnosis. However, given the seriousness of this infection, clinicians frequently need to proceed directly to lumbar puncture in high-risk patients. Many of the signs and symptoms of meningitis have been inadequately studied, and further prospective research is needed.

Acute Disease↗
PubMed1999

Diagnosis of thyroid disease in hospitalized patients: a systematic review.

BACKGROUND: The optimal approach for the diagnosis of hypothyroidism and hyperthyroidism in hospitalized patients is controversial. OBJECTIVES: To estimate the prevalence of undiagnosed thyroid disease among inpatients, review the usefulness of clinical signs and symptoms, and elucidate the characteristics of the sensitive thyrotropin (thyroid-stimulating hormone) (sTSH) test in this population. METHODS: We undertook a systematic review of the literature by conducting a MEDLINE search covering January 1966 through December 1996. Searching was conducted in duplicate and independently. Specific inclusion and exclusion criteria were predetermined. RESULTS: Prevalence of thyroid disease among inpatients is approximately 1% to 2% and is similar to the outpatient population. Absence of clinical features of thyroid disease lowers the pretest likelihood and makes screening even less useful. Presence of clinical features, especially those specific for thyroid disease (eg, goiter), may increase the pretest likelihood and increase the yield of testing. Acute illness reduces the specificity of second-generation sTSH tests for thyroid disease. The positive likelihood ratio associated with an abnormal sTSH test result in ill inpatients is about 10 compared with about 100 in outpatients. CONCLUSION: In unselected general medical, geriatric, or psychiatric inpatient populations, sTSH testing provides a low yield of true-positive and many false-positive results.

Diagnosis, Differential↗
PubMed1999

Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care.

OBJECTIVES: (1) To evaluate the evidence relating to the effectiveness of methods to prevent and treat obesity, and (2) to provide recommendations for the prevention and treatment of obesity in adults aged 18 to 65 years and for the measurement of the body mass index (BMI) as part of a periodic health examination. OPTIONS: In adults with obesity (BMI greater than 27) management options include weight reduction, prevention of further weight gain or no intervention. OUTCOMES: The long-term (more than 2 years) effectiveness of (a) methods to prevent obesity and (b) methods to treat obesity. EVIDENCE: MEDLINE was searched for articles published from 1966 to April 1998 that related to the prevention and treatment of obesity; additional articles were identified from the bibliographies of review articles and the listings of Current Contents. Selection criteria were used to limit the analysis to prospective studies with at least 2 years' follow-up. BENEFITS, HARM AND COSTS: Health benefits of weight reduction were evaluated in terms of alleviation of symptoms, improved management of obesity-related diseases and a reduction in major clinical outcomes. The health risk of weight-reduction methods were briefly evaluated in terms of increased mortality and morbidity. VALUES: The recommendations of this report reflect the commitment of the Canadian Task Force on Preventive Health Care to provide a structured, evidence-based appraisal of whether a manoeuvre should be part of a periodic health examination. RECOMMENDATIONS: (1) PREVENTION: There is insufficient evidence to recommend in favour of or against community-based obesity prevention programs; however, because of considerable health risks associated with obesity and the limited long-term effectiveness of weight-reduction methods, the prevention of obesity should be a high priority for health care providers (grade C recommendation). (2) TREATMENT: (a) For obese adults without obesity-related diseases, there is insufficient evidence to recommend in favour of or against weight-reduction therapy because of a lack of evidence supporting the long-term effectiveness of weight-reduction methods (grade C recommendation); (b) for obese adults with obesity-related diseases (e.g., diabetes mellitus, hypertension), weight reduction is recommended because it can alleviate symptoms and reduce drug therapy requirements, at least in the short term (grade B recommendation). (3) Detection: (a) for people without obesity-related diseases, there is insufficient evidence to recommend the inclusion or exclusion of BMI measurement as part of a periodic health examination, and therefore BMI measurement is left to the discretion of individual health care providers (grade C recommendation); (b) for people with obesity-related diseases, BMI measurement is recommended because weight reduction should be considered with a BMI of more than 27 (grade B recommendation). VALIDATION: The findings of this analysis were reviewed through an iterative process by the members of the Canadian Task Force on Preventive Health Care. SPONSORS: The Canadian Task Force on Preventive Health Care is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Adolescent↗
PubMed1998

Prognosis in anoxic and traumatic coma.

This article presents a systematic review of the prognostic factors in coma caused by hypoxia and anoxia, and traumatic head injury. In the case of anoxic coma, poor prognosis can be determined very accurately at the bedside by the lack of brainstem reflexes assessed at day three post-insult. Electroencephalogram (EEG) and evoked potentials (i.e., auditory and somatosensory) detect additional patients with poor prognosis. Clinical examination is not as helpful in the case of traumatic coma. Evoked potentials performed within the first week detect approximately half of patients with a poor prognosis. EEG adds only a small amount of prognostic information.

Adult↗
PubMed1993

Structural properties of the myelin-associated glycoprotein ectodomain.

Myelin-associated glycoprotein (MAG) has been proposed to mediate adhesive interactions during myelin development. We have used the baculovirus expression system to produce a truncated form of this molecule [soluble extracellular domain of MAG (sMAG)] consisting of the complete extracellular ectodomain. Spectroscopic studies indicate a high beta-sheet content, consistent with the prediction of Ig-like structure. Hydrodynamic studies indicate an asymmetric monomer, with a Stokes radius of 4.1-4.6 nm, a sedimentation coefficient of 3.6S, and a frictional ratio of approximately 1.6. We postulate that the outer two Ig-like domains form a unit that folds back over the rest of the molecule. Fluorescence quenching studies indicate that sMAG interacts with divalent cations and may have a functional lectin domain.

Amino Acids↗
PubMed1989

Synthesis of soluble myelin-associated glycoprotein in insect and mammalian cells.

The myelin-associated glycoprotein (MAG) has an extracellular domain containing five sequences which are homologous to the immunoglobulin-fold motif. Adhesive interactions mediated by the MAG extracellular domain are involved in the development of the myelin sheath. The MAG cDNA has been modified to introduce a stop codon immediately before the transmembrane domain. Expression of the modified cDNA in insect cells and murine NIH-3T3 cells resulted in secretion of the soluble MAG extracellular domain. Treatment of soluble MAG with glycopeptidase F and endoglycosidase H showed significant differences in glycosylation for the insect and mammalian cell-expression systems. The soluble form of MAG has been purified from insect-cell supernatants by adsorption to a lentil-lectin support. The soluble MAG will provide a powerful new approach for studies of MAG-adhesive interactions during brain development.

Amino Acid Sequence↗
PubMed1989

Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system.

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 micrograms/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.

Fentanyl↗