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Biomedical subjects

M Hakim

Publications and source records attributed to M Hakim.

At least 19 recordsLinked to original sources
PubMed2005

Recruitment of multiple cell lines by collagen-synthetic copolymer matrices in corneal regeneration.

Collagen hydrogel matrices with high optical clarity have been developed from collagen I, cross-linked with a copolymer based on N-isopropylacrylamide, acrylic acid and acryloxysuccinimide. The controlled reaction of collagen amine groups with this copolymer under neutral pH and aqueous conditions gave robust, optically clear hydrogels and prevented the excessive collagen fibrillogenesis that can lead to collagen opacity. These sterile, non-cytotoxic hydrogels allowed epithelial cell overgrowth and both stromal cell and nerve neurite ingrowth from the host tissue. This regenerative ability appeared to result from the high glucose permeability, nanoporosity and the presence of cell adhesion factors, RGD in collagen and the laminin pentapeptide, YIGSR, grafted onto the copolymer. Under physiological conditions, optical clarity superior to the human cornea and tensile performance adequate for suturing were obtained from some formulations.

Animals↗
PubMed2003

A collagen-based scaffold for a tissue engineered human cornea: physical and physiological properties.

Stabilized collagen-glycosaminoglycan scaffolds for tissue engineered human corneas were characterized. Hydrated matrices were constructed by blending type I collagen with chondroitin sulphates (CS), with glutaraldehyde crosslinking. A corneal keratocyte cell line was added to the scaffolds with or without corneal epithelial and endothelial cells. Constructs were grown with or without ascorbic acid. Wound-healing was evaluated in chemical-treated constructs. Native, noncrosslinked gels were soft with limited longevity. Crosslinking strengthened the matrix yet permitted cell growth. CS addition increased transparency. Keratocytes grown within the matrix had higher frequencies of K+ channel expression than keratocytes grown on plastic. Ascorbic acid increased uncrosslinked matrix degradation in the presence of keratocytes, while it enhanced keratocyte growth and endogenous collagen synthesis in crosslinked matrices. Wounded constructs showed recovery from exposure to chemical irritants. In conclusion, this study demonstrates that our engineered, stabilized matrix is well-suited to function as an in vitro corneal stroma.

Animals↗
PubMed2001

The outcome of grand-multiparous pregnancies of Arabic and Jewish populations in peripheral and central areas of Israel.

OBJECTIVE: To compare the antepartum and intrapartum course of Jewish and Arab great-grandmultiparas from central and peripheral areas in Israel to age-matched control multiparous women. METHODS: Medical records of four groups of parturients were compared: great-grandmultiparas (para > or = 9) and multiparae (para 2-5) delivering at Nazareth E.M.M.S. hospital (mostly Arabs) and Hadassah-Ein-Kerem hospital in Jerusalem (mostly Jews). The control groups consisted of demographically and geographically matched multiparas. Data was collected on prenatal care received, antepartum complications, as well as the intrapartum complications traditionally associated with high parity (e.g. malpresentation, placental abnormalities, peripartum hemorrhage, shoulder dystocia). Neonatal records were also examined to determine any neonatal morbidity or mortality. RESULTS: There were 139 and 141 great-grandmultiparas in the Nazareth and the Jerusalem study groups, respectively (mean parity was 10.1 and 10.9, respectively), and 142 and 139 multiparas in the Nazareth and the Jerusalem control groups, respectively (mean parity was 2.9 and 2.5, respectively). The rate of physician visits during the prenatal period in the Nazareth and the Jerusalem study groups was 2.3 +/- 2.4 and 3.2 +/- 2.7, respectively (p=0.0041). This rate was significantly higher in the controls of both areas (4.0 +/- 3.0 and 4.9 +/- 2.9, respectively). There was no difference in the rate of nurse visits in all groups in all areas. Maternal and neonatal outcomes were similar in both study groups, and were also similar in the control groups, but perinatal mortality was higher in both great-grandmultiparous groups compared to the controls (11/280 and 2/281, respectively; p<0.05). CONCLUSIONS: The differences in the intensity of prenatal care between these rural and urban areas did not affect the maternal outcomes of great-grandmultiparous pregnancies. In addition, there were no significant differences in maternal outcomes between great-grandmultiparas and multiparas in rural and urban areas although prenatal care was less intense in the former. However, increased incidence of perinatal mortality in the great-grandmultiparas may be due to factors unrelated to prenatal care intensity or quality.

Adult↗
PubMed2001

Impact of intestinal helminth infection on anemia and iron status during pregnancy: a community based study in Indonesia.

A cohort study was carried out in Purworejo District, Central Java, Indonesia to investigate prevalence of anemia and low iron stores during pregnancy in relation to intestinal helminth infection. 442 pregnant women were followed until 5-10 weeks postpartum, during the period of April 1996 - August 1998. Information on intestinal helminths, hemoglobin and serum ferritin was collected each trimester. Highest prevalence of anemia in pregnancy (37.1%) was found in the second trimester, while the highest prevalence of low iron stores (49.5%) was found in the third trimester. Most pregnant women (69.7%) were infected with at least one species of pathogenic intestinal helminths. The most common helminth detected was Trichuris trichiura followed by Necator americanus (hookworm) and Ascaris lumbricoides. A significant negative association was found between hookworm infection and serum ferritin at the first trimester (p = 0.010). It is concluded that hookworm infection can interfere iron stores. Other causes of anemia among pregnant women should be considered. Anthelminthic therapy could be given to infected women before conception as public health strategy to improve iron status.

Adult↗
PubMed2001

[Determining factors in mitral valve reconstructive surgery. Report of 150 cases].

150 patients had mitral valve repair for mitral valve incompetence. There were 57 males and 93 females with a mean age of 22 years. 60% of the patients were in Class II NYHA and 40% in Class III and IV. Type I was present in 18 patients, type II in 98 and type III in 34 cases. Mitral repair included correction of valve prolapse, valvular enlargement with pericardial patch and annuloplasty with semi-rigid ring in 128 cases and PTFE patch along the posterior leaflet in 12 cases. The perioperative mortality rate was 2.6%. All patients had early post-operative echocardiography. According to this, mitral regurgitation was absent or tiny in 135 patients, grade II in 10 cases and grade III in 2 cases. It was moderate or important in twelve patients. In the late post-operative period. All the others patients were reoperated upon for mitral dysfunction in a mean time of 37 months. The reason for reoperation was in the majority of the cases the recurrence of mitral regurgitation related to increase of valvular and sub valvular disease. The late mortality rate is 7%. Out of 126 reviewed survivors on the long run, 71 patients are asymptomatic in class I, 53 patients in class II and 2 patients in class III NYHA. The estimated mitral regurgitation by echography in those patients is absent or trivial in 96 cases. grade II in 29 cases and grade III in one case. Mitral valvuloplasty is the preferred procedure in mitral insufficiency surgical management. It is associated to a low early mortality and morbidity rate. Despite the need for reoperation in about 10% of the cases in the long follow-up, mitral repair offers a good quality of life without anticoagulant treatment.

Adult↗
PubMed1999

Functional human corneal equivalents constructed from cell lines.

Human corneal equivalents comprising the three main layers of the cornea (epithelium, stroma, and endothelium) were constructed. Each cellular layer was fabricated from immortalized human corneal cells that were screened for use on the basis of morphological, biochemical, and electrophysiological similarity to their natural counterparts. The resulting corneal equivalents mimicked human corneas in key physical and physiological functions, including morphology, biochemical marker expression, transparency, ion and fluid transport, and gene expression. Morphological and functional equivalents to human corneas that can be produced in vitro have immediate applications in toxicity and drug efficacy testing, and form the basis for future development of implantable tissues.

Animal Testing Alternatives↗
PubMed1997

Urgent delivery, the treatment of choice in term pregnant women with extended burn injury.

Two pregnant patients at term, suffering from major burn wounds, were treated in our burn unit during the year 1995, both were delivered immediately after admission by caesarean section. One of them had smoke inhalation injury which needed mechanical ventilation, both mothers and newborns survived. In spite of low maternal carboxyhaemoglobin the fetal cord blood carboxyhaemaglobin was high, supporting an objective physiological basis for the previous empirical conclusion of early delivery in pregnant patients at term with extensive burn injury (50 per cent TBSA and more). This obvious favourable outcome highlights the importance of urgent delivery in term pregnant women suffering a major burn injury.

Adult↗
PubMed1997

Cholecystogastrocolonic fistula with intrahepatic abscess: a rare complication of biliary stone disease.

A 52-year-old woman exhibited both a cholecystogastrocolonic fistula and intrahepatic abscess. Biliary-enteric fistulas are unusual complications of gallstone disease, and multiple, complex fistulas are extremely uncommon. Hepatic abscesses are also unusual complications of gallstone disease. The combination of a complex biliary-enteric fistula and hepatic abscess arising from gallstone disease has not been reported. In our patient, surgery was prompted by the hepatic abscesses; the fistula was not recognized preoperatively. We elected to resect gallbladder, gastric antrum, and transverse colon en bloc with primary closure of the gastric defect and, because the colon had not been "prepped," we created a right transverse colostomy and left mucus fistula. Under ideal circumstances, the anatomy of biliary fistulas is characterized preoperatively and managed definitively with a single procedure.

Biliary Fistula↗
PubMed1996

[Ogilvie's syndrome or colonic pseudo-obstruction. Apropos of 26 cases].

From twenty six personal cases, the authors make a review of the literature. 92% of their cases are met in a post operative (28%), neurological (28%), general (24%) context, or in intensive care with assisted ventilation (36%). The major symptom is the meteorism (100%) with in one out of three cases, abdominal pain, vomiting, right iliac defense, absence of bowel sounds. Radiological distension involves mostly the right colon and the coecum (28%), right and transverse colon (40), sometimes the whole colon (32%). The mean diameter of the coecum reached 12 cm (9 to 25 cm). Early coloscopy was mandatory in 20 patients, of which 14 were cured, 13 patients were operated on, for suspicion of ischemia or perforation, because incertain diagnosis, or failure of colonoscopy. Ceocostomy or right hemicolectomy (55%) were performed rather than transverse colostomy. The surgical approach must be adapted to the anatomical lesions. Total mortality was 4% in this series. Early diagnosis of pseudo obstruction, early colonoscopy with intubation must allow to avoid surgery.

Acute Disease↗
PubMed1995

[Evolution of Hartmann's procedure. 249 interventions].

A retrospective study of 249 patients undergoing Hartmann's procedure over twenty-five years was undertaken to analyse the evolution of indications and results. Patients were divided into three time period groups: from 1969 to 1978, 1979 to 1990 and 1991 to 1994. Mean age was 68 years old. Major indications were complicated diverticular disease (42.9%), colo-rectal malignancies (35.7%) and ischemic colitis (14%). Operative mortality is 10.8%, higher in ischemic colitis (20%) than in complicated diverticulitis (6.5%) and cancer (13.4%). Overall morbidity has significantly reduced, from 65.51% to 17.24%. General complications have changed a little, while local and/or inherent operative complications have reduced from 22.4% to 1.72. Restoration of colorectal continuity was done in 59.54% of patients, increasing from 36% to 71% during the three periods. This is variable depending on initial disease: 92% in diverticular disease, 69% in ischemic colitis but remains stable for carcinoma at 33%. Overall mortality since 1981 is 2.5% and morbidity is 19.13%. Mean Hospital stay was 20 days for the initial operation and 15 days for secondary restoration of colorectal continuity. Hartmann's procedure is well indicated as emergency surgery in colonic perforations, abscessus and ischemia. Progressive improvement of its results is essentially due to persistent attention to indications and technical details.

Adult↗
PubMed1993

Diagnosis and treatment of cervical pregnancy. A case report.

A case of preoperative diagnosis of cervical pregnancy by transvaginal sonography is presented. The widespread use of transvaginal sonography facilitates earlier detection of this kind of ectopic gestation, thus improving the prospects for conservative treatment with preservation of fertility.

Adult↗
PubMed1989

Toxoplasmosis in heart and heart and lung transplant recipients.

Of the first 250 heart and 35 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 217 heart and 33 heart and lung patients were investigated serologically for evidence of Toxoplasma gondii infection. Six patients acquired primary T gondii infection, most probably from the donor organ. Five patients experienced T gondii recrudescence, two of whom had recovered from primary infection a few years earlier. Two patients died from primary T gondii infection and the severity of symptoms in the other patients with primary infection was related to the amount of immunosuppressive treatment. Prophylaxis with pyrimethamine (25 mg a day for six weeks) was introduced for T gondii antibody negative transplant recipients who received a heart from a T gondii antibody positive donor after the first four cases of primary toxoplasmosis. Of the seven patients not given pyrimethamine, four (57%) acquired primary T gondii infection. This compared with two of the 14 patients (14%) given prophylaxis.

Adult↗
PubMed1988

Cyclosporin A in cardiac transplantation: medium-term results in 62 patients.

Between March, 1982, and October, 1984, 62 patients underwent orthotopic cardiac transplantation in our institution. Immunosuppression was based on cyclosporin A (Cy A) and low-dose steroids with an initial 10-day course of antithymocyte globulin. Follow-up ranged between 39 and 71 months (mean, 51.7 months). Actuarial survival at 1 year through 5 years was 80.6%, 77.4%, 74.2%, 71.4%, and 63.5%, respectively. Graft atheroma led to graft failure in 6 patients, 4 of whom died between 23 and 55 months after transplantation and 2 of whom had a repeat transplantation at 32 and 53 months. Diastolic hypertension (90 mm Hg or higher) developed in 88% of patients at 1 year. Chronic renal impairment was evident in all patients who survived for 2 years. Mean serum creatinine preoperatively and at 1 year through 4 years was 1.49 +/- 0.08 mg/100 ml (+/- the standard error), 2.01 +/- 0.09 mg/100 2.07 +/- 0.09 mg/100 ml, 2.26 +/- 0.19 mg/100 ml, and 2.32 +/- 0.33 mg/100 ml, respectively. End-stage renal failure requiring regular hemodialysis developed in 3 patients, 2 of whom died. We conclude that in addition to graft atheroma, Cy A-related nephrotoxicity is emerging as a major cause of medium-term and long-term morbidity and mortality. The use of lower doses of Cy A in a triple-therapy protocol, that is, Cy A, azathioprine, and low-dose steroids, could help reduce the extent of renal impairment.

Adolescent↗
PubMed1988

Dopexamine hydrochloride, a beta 2 adrenergic and dopaminergic agonist; haemodynamic effects following cardiac surgery.

Twelve patients recovering from open heart surgery received an intravenous infusion of dopexamine hydrochloride, a novel beta 2 adrenergic and dopamine receptor agonist. The mean cardiac index increased from 2.58 to a maximum of 3.64 1 min-1 m-2 (P less than 0.001) and the systemic vascular resistance (SVR) decreased from 1527 to 1116 dyne s cm-5 (P less than 0.001) at a dose of 3 micrograms kg-1 min-1. Heart rate increased with dose from 85 beats min-1 to a maximum of 119 beats min-1 (P less than 0.001). There was no significant change in the pulmonary vascular resistance (PVR) with treatment in the group as a whole. However, PVR decreased (P less than 0.05) in patients who had aortic-valve replacement (AVR) only, whereas in patients who had mitral-valve replacement (MVR) the PVR increased (P less than 0.05). We conclude that dopexamine hydrochloride was well tolerated in patients following cardiac surgery. It produced a significant increase in cardiac output with evidence of afterload reduction and, although the increase in heart rate may limit its use in some patients, dopexamine hydrochloride is potentially of value in the treatment of low cardiac output state following cardiac surgery.

Adrenergic beta-Agonists↗
PubMed1988

Cytomegalovirus infections in heart and heart and lung transplant recipients.

Of the first 166 heart and 15 heart and lung transplant recipients at Papworth Hospital, Cambridge, who survived for more than one month after transplantation, 162 were investigated for cytomegalovirus (CMV) infection by serological methods. Altogether, 73 (45%) developed CMV infection after transplantation: 30 (18.5%) had acquired primary infection and 43 (26.5%) reactivation or reinfection. Six patients died of primary infection, probably acquired from the donor organ. Recipients negative for CMV antibody who received an organ from an antibody positive donor had the most severe disease. Heart and lung transplant recipients experienced more severe primary CMV infection than those in whom the heart alone was transplanted. The most sensitive and rapid serological method was a mu-capture enzyme linked immunosorbent assay (ELISA) for detecting CMV specific IgM, the amount of which was often of prognostic value and influenced the management of patients.

Adolescent↗
PubMed1988

Selection and procurement of combined heart and lung grafts for transplantation.

Between April 1984 and July 1986, 14 patients underwent heart-lung transplantation at Papworth Hospital, Cambridge, England. The donors for the first five operations were brought to our hospital and the organs removed in the operating theater adjacent to that in which the recipients were prepared. Subsequently, organs have been procured from distant centers. The total ischemic time ranged from 48 to 51 minutes (mean 49.6) for the near procurement group and from 70 to 186 minutes (mean 123.6) for the distant procurement group. Our method of preservation consists of cold cardioplegic arrest of the heart with St. Thomas' Hospital solution followed by a single cold (4 degrees C) pulmonary artery flush with a solution containing 500 ml donors blood, 700 ml Ringer's solution, 200 ml 20% salt-poor albumin, 100 ml 20% mannitol, 20 micrograms prostacyclin, and 10,000 units heparin. Function of the lungs after implantation was assessed by measuring the alveolar-arterial oxygen gradient. The median alveolar-arterial oxygen gradient measured shortly after discontinuation of bypass (point 1), just before extubation (point 2), and at 1 week (point 3) were 96.0, 62.3, and 18.8 mm Hg, respectively, for the near procurement group and 91.5, 60.0, and 11.3 mm Hg, respectively, for the distant procurement group. Comparison of the two groups at the three measurement points by the nonparametric Wilcoxon test showed no significant difference (p = 0.44, 0.52, and 0.11, respectively). The two groups showed significant decline of the alveolar arterial oxygen gradient differences over the first week (p = 0.004, nonparametric Friedman test). We conclude that our method of preservation provides a satisfactory function after implantation. The alveolar-arterial oxygen gradient differences were high immediately after implantation but decreased significantly afterward.

Adolescent↗