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Biomedical subjects

M Dewan

Publications and source records attributed to M Dewan.

At least 19 recordsLinked to original sources
PubMed2004

Improvements in simulated real-world relevant performance for patients with seasonal allergic rhinitis: impact of desloratadine.

BACKGROUND: Seasonal allergic rhinitis (SAR) diminishes task performance and decreases quality of life. Antihistamines are frequently used to treat the symptoms of SAR. First generation antihistamines often have their own detrimental effects upon human functioning while second generation antihistamines appear to have fewer or no undesirable side-effects. OBJECTIVE: This study evaluated the impact of desloratadine on simulated real-world performance demands in individuals suffering from SAR. METHODS: This was a randomized, double-blind, cross-over study where asymptomatic participants were treated with placebo and symptomatic participants were treated with desloratadine or placebo. They then participated in a real-world equivalent task performance simulation that assessed information processing capacity at multiple levels of task difficulty ranging from easy to difficult decision-making tasks. RESULTS: Desloratadine either completely restored performance to the level of the asymptomatic placebo control or improved performance in six of the nine performance categories, where it had been diminished by the presence of SAR. CONCLUSIONS: These findings suggest that treatment with desloratadine has considerable beneficial effects on work place performance when individuals suffer from SAR.

Adolescent↗
PubMed2003

Histopathological changes in the wall of varicose veins.

AIM: Vein wall distensibility is controlled by collagen, elastin and smooth muscle cells. However, contradicting evidence exists on the connective tissue concentration and smooth muscle pathology in varicose veins. METHODS: To study the pathological changes in the wall of varicose veins at different levels, we collected a total of 49 vein specimens from 19 patients at Asir Central Hospital, Abha, Saudi Arabia, during the period from March to October 1997. Three young trauma patients underwent repair of their arterial injuries using the thigh long saphenous vein (LSV) and 16 varicose vein patients underwent stripping of their LSV and avulsion of their distal calf varicosities. In the trauma patients, specimens were collected from the proximal thigh LSV while in the varicose vein patients, specimens were collected from both the groin and mid-thigh LSV and the distal calf varicosities. Specimens were stained with Hematoxylin & Eosin, Masson's Trichrome and von Gieson (VG) stains for examination under the light microscope. RESULTS: Compared with the normal LSV, all varicose vein sections showed marked intimal hypertrophy due fibrous tissue infiltration, localized thinning of the muscle layer and loss of both the intimal and medial smooth muscle cells (SMCs). Elastic fibers were deficient and scattered with loss of the normal elastin/collagen lattice network and decrease in both the muscle/collagen and elastin/collagen ratios. CONCLUSION: In conclusion, we propose that dilatation and distensibility of the vein wall under normal and increased venous pressure is due to deficiency in smooth muscle cells and elastic fibers and disproportionate increase in fibrous tissue.

Adolescent↗
PubMed2001

Lessons to be learned: a case study approach. Paraganglioma of the urinary bladder.

Primary paraganglioma arises infrequently in the urinary bladder. We present here the clinicopathological, immunohistochemical and ultrastructural findings in a 23-year-old Saudi female. She was hospitalised because of gross haematuria over the previous seven days. The intravenous urogram revealed a filling defect in the urinary bladder. Cystoscopy disclosed a non-papillary tumour arising from the roof of the bladder neck. Transurethral resection was, accordingly, performed--but marked fluctuation in blood pressure was observed during the procedure. The histopathological findings of trabeculae and small nests of plump oval to spindle cells with a clear to acidophilic cytoplasm, forming an organoid pattern and demonstrating inconspicuous mitotic activity, were diagnostic of paraganglioma of the urinary bladder, the diagnosis was confirmed by means of immunohistochemical and ultrastructural studies. The endocrine markers chromogranin A and neuron-specific enolase were positive in chief cells; sustentacular cells at the periphery of neoplastic cell clusters were positive for S-100 protein. Neurosecretory granules were identified by electron microscopic examination. It is emphasised that, currently, there are no anatomico-pathological criteria to distinguish benign and malignant forms of the disease. Post-surgical recovery was uneventful in this case. Recurrence and metastases, though infrequent, have been reported in the literature; therefore, radiation therapy may be an important adjunct--and long-term follow-up is mandatory.

Adult↗
PubMed2000

Indian childhood-like cirrhosis in three Saudi Arabian siblings.

Three Saudi siblings, two girls and one boy, presented at the ages of 7, 6 and 2.5 years, respectively, and were diagnosed as having features of Indian childhood cirrhosis (ICC). The two girls presented at a late stage of the disease and the boy was diagnosed during routine examination of the family. The initial presenting complaint was abdominal distention and pruritus. All three had a rapid and fatal course. There was no evidence of increased copper ingestion by the families, supporting the suggestion of a hereditary metabolic role in the aetiology of ICC. As far as we are aware, this is the first report of ICC in Saudi Arabian children.

Child↗
PubMed2000

An examination of whether discharging patients against medical advice protects physicians from malpractice charges.

OBJECTIVE: Many physicians believe that documenting a discharge as "against medical advice" protects them from legal actions for adverse consequences related to the discharge. The authors examined case law for evidence of such protection. METHODS: MEDLINE and PsycINFO databases were searched for relevant articles. The medmal. base of Lexis and West Group was searched for annotated case law. RESULTS: Four relevant cases were found in which medical authorities and physicians were sued for medical malpractice even though they discharged a patient against medical advice. In all cases the defendants prevailed. However, their success was not due to the fact that they used the procedure of discharging patients against medical advice. Rather, it was based on the plaintiffs' failure to prove negligence. The authors offer guidelines for physicians faced with the decision to discharge against medical advice. Physicians should perform a careful and well-documented examination. They should assess the severity of illness and the severity of the risk if the patient is discharged. They should engage in a constructive dialogue with the patient about grievances. They should ensure that the patient's withholding of consent for further hospitalization is informed with respect to risks, benefits, and alternatives. If the patient meets criteria for involuntary hospitalization, the patient should be committed. CONCLUSIONS: Good clinical practice and thorough documentation remain the best legal protection. Discharging a patient against medical advice may provide partial protection, but it is not a royal road to legal immunity.

Adult↗
PubMed2000

Carcinoid tumourlets associated with diffuse bronchiectasis and intralobar sequestration.

Innumerable carcinoid tumourlets may develop within pulmonary lobes should there be scarring from intralobar sequestration; these tumourlets may, in turn, be the cause of chronic lung disease. This report documents the incidental detection of multifocal carcinoid tumourlets in the lung of a 65-year-old man who had repeated episodes of lung infection, progressive dyspnea and haemoptysis; he lived at high altitude. The left lower lobe of the lung was resected surgically, during which procedure an aberrant systemic arterial supply was noticed. The patient had diffuse bronchiectasis and intralobar sequestration. The latter implies the development of abnormal lung tissue located within lobar tissue--but which does not communicate with the bronchial tree; it is supplied with arterial blood from a branch of the aorta--arising either above or below the diaphragm. There was loss of demarcation between the sequestered lung and the surrounding lower lobe lung parenchyma. The proliferation of pulmonary neuroendocrine cells in the form of tumourlets, had probably occurred as an adaptive response to the chronic hypoxia experienced. The combination of intralobar sequestration, bronchiectasis and carcinoid tumourlets, although uncommon, may arise when intralobar sequestration of the lung has not been resected at an incipient stage.

Aged↗
PubMed2000

Does identifying a discharge as "against medical advice" confer legal protection?

BACKGROUND: One in every 65 to 120 discharges from general hospitals are against medical advice and have an expected increased risk of adverse consequences and subsequent litigation. Does the term "against medical advice" confer legal protection? METHODS: We searched the MEDLINE and PsychInfo databases for relevant articles. We also searched the national medico-legal databases of LEXIS-NEXIS. Additional case law was obtained through a search for "against medical advice" in the West Premise CD-ROM database of New York State cases. RESULTS: We found 8 relevant cases. There was no case in which "against medical advice" was entirely protective, though partial protection existed in some cases. CONCLUSIONS: Since patients are admitted voluntarily to a general hospital, a discharge against medical advice is merely a withdrawal of the original consent.

Fatal Outcome↗
PubMed1999

Are psychiatrists cost-effective? An analysis of integrated versus split treatment.

OBJECTIVE: Managed care organizations prefer putatively less expensive split treatment, i.e., a psychopharmacologist plus a non-M.D. psychotherapist. In this study the cost of integrated care by a psychiatrist was compared with split care. METHOD: Using 1998 fee schedules of seven large managed care organizations (with 54.3% market share and 67.8 million lives) plus Medicare (37 million people), the author modeled clinical scenarios of psychotherapy alone, medication alone, and combined treatment provided by a psychiatrist or split with a psychologist or social worker. RESULTS: Brief psychotherapy by a social worker was the least expensive treatment. When treatment required both psychotherapy and medication, combined treatment by a psychiatrist cost about the same or less than split treatment with a social worker psychotherapist; it was usually less expensive than split treatment with a psychologist psychotherapist. CONCLUSIONS: The integrated biopsychosocial model practiced by psychiatry is both theoretically and economically the preferred model when combined treatment is needed.

Combined Modality Therapy↗
PubMed1999

A naturalistic study of risperidone maintenance treatment of outpatients with severe mental illness.

In a naturalistic study of the effectiveness of atypical antipsychotics for the long-term outpatient treatment of persons with severe and persistent mental illness, 19 patients began taking risperidone and were prospectively evaluated. Nine patients dropped out of risperidone treatment before three months; four of them later responded to clozapine. The ten patients who completed the study on risperidone were less severely ill at baseline. Three completers with unremitting negative symptoms required a combination of risperidone and typical antipsychotics. The results suggest that risperidone is effective for about half of patients with severe and persistent mental illness. Very ill patients who are not responsive to risperidone or combined antipsychotic therapy will likely benefit from clozapine.

Adolescent↗
PubMed1999

Mucoid degeneration of the brachial artery: case report and a review of literature.

Cystic adventitial disease (CAD) is a rare cause of intermittent claudication, occurring in approximately 1:1200 claudicants or 1:1000 of those undergoing arteriography. It is most often described in the popliteal artery and is characterised by a mucinous cyst located in the adventitia of the artery, the contents of which resemble those of a ganglion. The origins of adventitial cysts are unknown, but connections to adjacent synovial spaces have been identified, suggesting that the cyst is a variant of a ganglion. In this report, we discuss a rare case of severe mucoid degeneration of the intima and media in a 67-year-old Saudi male patient. The patient presented with a saccular aneurysm of his right "mid-arm" brachial artery and critical ischemia of his right hand from distal embolisation.

Aged↗
PubMed1997

Measurement of the power output during the acceleration phase of all-out arm cranking exercise.

The purpose of this study was to develop an original friction loaded ergometer allowing measurement of the resisting torque (Mb) and the angular velocity (omega) by means of a force transducer and an optical pick-up during all-out arm cranking exercises. Taking into account the kinetic energy variations of the flywheel, the peak power developed at the crank (P(c)peak) and the peak angular velocity (omegapeak) were determined in 6 male and 6 female able-bodied subjects during 6-8 bouts of 3 s duration, performed at maximal velocity, with Mb varying from 0.07 to 0.87 Nm x kg(-1). In each subject, the Mb increase was related to a decrease of omegapeak. This relationship was expressed through a negative linear regression (0.92 < R2 < 0.99) for omegapeak between 13 and 28 rad x s(-1) for the males and 10 and 24 rad x s(-1) for the females. The relationship between P(c)peak and Mb did not fit well for all subjects (0.01 < R2 < 0.93) with a parabolic equation, indicating that for upper limb testing, the maximal power should be defined as the highest power measured during several bouts performed with appropriate resisting torque. The present study also demonstrated the importance of taking into account the inertia of the moving flywheel during the acceleration phase of an all-out arm crank exercise, when determining the peak power output.

Acceleration↗