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Biomedical subjects

M Issa

Publications and source records attributed to M Issa.

At least 19 recordsLinked to original sources
PubMed2006

A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study.

AIMS: Insulin is generally withheld until people with Type 2 diabetes are unresponsive to other therapies. However, its potential advantages suggest that it could be added earlier to achieve glycaemic goals; this possibility was tested in a clinical trial. METHODS: Consenting adults aged 18-80 years with Type 2 diabetes for at least 6 months, HbA1c of 7.5-11%, and on 0, 1 or 2 oral agents, were randomized to one of two therapeutic approaches for 24 weeks: evening insulin glargine plus self-titration by 1 unit/day if the fasting plasma glucose (FPG) was > 5.5 mmol/l; or conventional therapy with physician adjustment of oral glucose-lowering agents if capillary FPG levels were > 5.5 mmol/l. The primary outcome was the first achievement of two consecutive HbA1c levels <or= 6.5%. RESULTS: Two hundred and six participants were allocated to glargine and 199 to oral agents. Compared with control subjects, participants receiving glargine: (i) were 1.68 times more likely to achieve two consecutive HbA1c levels <or= 6.5% (95% CI 1.00-2.83; P = 0.049); (ii) reduced their HbA1c by 1.55 vs. 1.25% (P = 0.005), achieving adjusted means of 7.0 vs. 7.2% (P = 0.0007); (iii) had lower FPG (P = 0.0001), non-high-density lipoprotein (HDL) cholesterol (P = 0.02) and triglycerides (P = 0.02); (iv) had greater increases in treatment satisfaction (P = 0.045); and (v) had a 1.9-kg greater increase in weight (P < 0.0001). No differences in hypoglycaemia were noted. CONCLUSIONS: Adding insulin glargine is more likely to achieve a lower HbA(1c) level than conventional therapy with oral agents.

Adolescent↗
PubMed2005

Pharyngeal carriage of serogroup W135 Neisseria meningitidis in Hajjees and their family contacts in Morocco, Oman and Sudan.

In 2000 the global outbreak that began in Saudi Arabia was caused by a W135:2a:P1.5,2 strain of Neisseria meningitidis belonging to the ET-37 complex and to ST-11. There was concern that introduction of this epidemic clone (EC) might lead to a wave of outbreaks in the African meningitis belt. The WHO therefore initiated studies of meningococcal carriage among pilgrims and their family contacts in Morocco, Oman and Sudan, 3 to 12 months after the Hajj 2000. In Morocco, 1186 persons were swabbed 3 times. Ninety-five meningococcal strains were isolated from 2.7% of the specimens. Pulsed-field gel electrophoresis showed that 32 (33.6%) were identical with the EC. In Sudan, 5 strains identical with the EC were obtained after sampling 285 persons. In Oman, among 18 meningococcal strains isolated from 399 subjects, 11 (61.1%) belonged to the EC. The important pharyngeal carriage of W135 (EC) and its role in the 2001-2002 outbreaks in Burkina Faso argues for the necessity of reinforcing surveillance, and adapting and planning responses in Africa and the Middle East using the most appropriate vaccine.

Carrier State↗
PubMed2004

Improved chitosan-mediated gene delivery based on easily dissociated chitosan polyplexes of highly defined chitosan oligomers.

Nonviral gene delivery systems based on conventional high-molecular-weight chitosans are efficient after lung administration in vivo, but have poor physical properties such as aggregated shapes, low solubility at neutral pH, high viscosity at concentrations used for in vivo delivery and a slow dissociation and release of plasmid DNA, resulting in a slow onset of action. We therefore developed highly effective nonviral gene delivery systems with improved physical properties from a series of chitosan oligomers, ranging in molecular weight from 1.2 to 10 kDa. First, we established structure-property relationships with regard to polyplex formation and in vivo efficiency after lung administration to mice. In a second step, we isolated chitosan oligomers from a preferred oligomer fraction to obtain fractions, ranging from 10 to 50-mers, of more homogeneous size distributions with polydispersities ranging from 1.01 to 1.09. Polyplexes based on chitosan oligomers dissociated more easily than those of a high-molecular-weight ultrapure chitosan (UPC, approximately a 1000-mer), and released pDNA in the presence of anionic heparin. The more easily dissociated polyplexes mediated a faster onset of action and gave a higher gene expression both in 293 cells in vitro and after lung administration in vivo as compared to the more stable UPC polyplexes. Already 24 h after intratracheal administration, a 120- to 260-fold higher luciferase gene expression was observed compared to UPC in the mouse lung in vivo. The gene expression in the lung was comparable to that of PEI (respective AUCs of 2756+/-710 and 3320+/-871 pg luciferase x days/mg of total lung protein). In conclusion, a major improvement of chitosan-mediated nonviral gene delivery to the lung was obtained by using polyplexes of well-defined chitosan oligomers. Polyplexes of oligomer fractions also had superior physicochemical properties to commonly used high-molecular-weight UPC.

Animals↗
PubMed2001

Genetic adaptive neural network to predict biochemical failure after radical prostatectomy: a multi-institutional study.

BACKGROUND AND PURPOSE: Despite many new procedures, radical prostatectomy remains one of the commonest methods of treating clinically localized prostate cancer. Both from the physician's and the patient's point of view, it is important to have objective estimation of the likelihood of recurrence, which forms the foundation for treatment selection for an individual patient. Currently, it is difficult to predict the probability of biochemical recurrence (rising serum prostate specific antigen [PSA] concentration) in an individual patient, and approximately 30% of the patients do experience recurrence. Tools predicting the recurrence will be of immense practical utility in the treatment selection and planning follow up. We have utilized preoperative parameters through a computer based genetic adaptive neural network model to predict recurrence in such patients, which can help primary care physicians and urologists in making management recommendations. PATIENTS AND METHODS: Fourteen hundred patients who underwent radical prostatectomy at participating institutions form the subjects of this study. Demographic data such as age, race, preoperative PSA, systemic biopsy based staging and Gleason scores were used to construct a neural network model. This model simulated the functioning of a trained human mind and learned from the database. Once trained, it was used to predict the outcomes in new patients. RESULTS: The patients in this comprehensive database were representative of the average prostate cancer patients as seen in USA. Their mean age was 68.4 years, the mean PSA concentration before surgery was 11.6 ng/mL, and 67% patients had a Gleason sum of 5 to 7. The mean length of follow-up was 41.5 months. Eighty percent of the cancers were clinical stage T2 and 5% T3. In our series, 64% of patients had pathologically organ-confined cancer, 33% positive margins, and 14% had seminal vesicle invasion. Lymph node positive patients were not included in this series. Progression as judged by serum PSA was noted in 30.6%. With entry of a few routinely used parameters, the model could correctly predict recurrence in 76% of the patients in the validation set. The area under the curve was 0.831. The sensitivity was 85%, the specificity 74%, the positive predictive value 77%, and the negative predictive value of 83%. CONCLUSION: It was possible to predict PSA recurrence with a high accuracy (76%). Physicians desiring objective treatment counseling can use this model, and significant cost savings are anticipated because of appropriate treatment selection and patient-specific follow-up protocols. This technology can be extended to other treatments such as watchful waiting, external-beam radiation, and brachytherapy.

Aged↗
PubMed1998

Radiofrequency Thermal Therapy for Benign Prostatic Hyperplasia by Transurethral Needle Ablation of the Prostate (TUNA): An Update.

Prevalence of symptomatic benign prostatic hypertophy (BPH) is 30% in the sixth decade of life and approaches 50% in the eighth decade of life. Comparable prevalence values are reported in Occidental and Oriental cultures, which suggests the disease susceprible to neither environmental nor cultural favoritism. "Prostatism" is the descriptive word for the BPH constellation of symptoms, which appear as a result of bladder outlets obstructed by an enlarged prostate. In traditional prostatism, prostate growth has a benign etiology. These urologie symptoms may be either irritative (difficulty postponing urination, frequent awakenings at night for urination), obstructive (weak stream, hesitancy), or both. In the context of so much morbidity associated with the BPH symptom complex, this disease is arguably the most bothersome disease for the elderly male. With improvements in healthcare, and with men having longer life expectancies, there is the appreciation of an expanded patient population. It has become possible to heat the prostate with radiofrequency energy (RF) to relieve symptoms associated with BPH using a heating technique called "transurethral needle ablation of the prostate" (TUNA). By both subjective and objective criteria, TUNA theraphy to the prostate for BPH compares favorably with traditional surgical treatment. Now the durability of the TUNA treatment is demonstrated beyond three years.

Journal Article↗
PubMed1996

Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study.

BACKGROUND: The anticipated rate of short-term worsening of disability scores is the basis of power estimations in clinical trials of progressive multiple sclerosis (MS). While the clinician is most concerned in modifying the long-term outcome (eg, time to reach the Expanded Disability Status Scale [EDSS]6), the end points studied in clinical trials are those describing short-term outcome (eg, worsening of EDSS scores over 1 to 3 years). However, short-term outcome of MS may not be correlated with long-term outcome. OBJECTIVES: To validate previously published models predicting time to EDSS 6. To establish predictors of short-term outcome of MS. SETTING: The Ottawa, Ontario, Regional Multiple Sclerosis Clinic. PATIENTS: Two hundred fifty-nine patients were followed up prospectively by a single neurologist. MAIN OUTCOME MEASURES: Actuarial analysis of time to reach EDSS 6 and change in EDSS scores over a follow-up period of 1 to 3 years. RESULTS: The long-term outcome in the Ottawa population was more favorable than published data from London, Ontario. Predictions of time to EDSS 6 were not strongly correlated with the degree of short-term worsening over the follow-up period. Parameters associated with a higher probability of short-term worsening were proximity of the baseline EDSS score to 4.5 and duration of MS less than 20 years. CONCLUSION: Baseline EDSS and duration of MS must be considered in the design of clinical trials of progressive MS.

Adult↗
PubMed1996

Meta-analysis of the placebo-treated groups in clinical trials of progressive MS.

The behavior of the control groups can substantially affect the power and outcome of a clinical trial. We report a meta-analysis of the control groups of four large, double-blind, placebo-controlled clinical trials of immuno-suppressive treatment of progressive MS to address the sensitivity of five hypothetical definitions of treatment failure (TF). The rate of TF in the aggregate control groups (n = 427) was 31% when a confirmed increase of 1.0 expanded disability status scale (EDSS) point was required at the end of the trial; it was 51% when confirmation was not required and TF was allowed at the first point where the criteria for TF were met. The rate of confirmed TF was 45% when the TF criteria were indexed to baseline EDSS, accounting for the observed differences in staying times at different EDSS levels. We developed models predicting TF in progressive MS. In addition to baseline EDSS, the pyramidal functional score and, for one definition, brainstem functional score were associated with probability of TF.

Autoimmune Diseases↗
PubMed1993

Synthesis of 3-deoxyaldulosonic acid esters by one-carbon chain extension of glycal-derived lactone precursors.

A convenient preparative route is described for 3-deoxyaldulosonic acids. Glycal precursors are oxidatively converted into 2-deoxyaldonolactones, which react with 1,3-dithian-2-yl anion to afford 1,3-propanediyl dithioacetals of higher 3-deoxyaldosuloses. Deprotection with mercuric salts in wet or dry alcohols gave high yields of the corresponding alkyl aldulosonates. Preparative reaction conditions were optimized and the anomeric configurations of the ketopyranose products were established by 13C NMR.

Deoxy Sugars↗
PubMed1992

Lipoma of the floor of the mouth.

A case of lipoma of the floor of the mouth presenting as an acute swelling in a 72-year-old man is reported. The clinical presentation and differential diagnosis are discussed.

Aged↗
PubMed1991

Oral Crohn's disease with late intestinal manifestations.

Oral Crohn's disease has been reported frequently in the last two decades with and without intestinal manifestations. In the latter case it is considered one of the orofacial granulomatoses. This reference is claimed to eliminate the patient's distress caused by the term Crohn's disease. There has been much doubt whether intestinal Crohn's disease will eventually develop in these patients. A case is reported in a 10-year-old West Indian girl in whom oral Crohn's disease developed at the age of 10 years and was followed by rectal Crohn's disease 9 years later. In this article the term Crohn's disease is used to describe those patients with intestinal manifestations with or without oral disease whereas oral Crohn's disease is used for those who have only oral manifestations.

Child↗
PubMed1990

Ruminal excretion of sulfadimethoxine and sulfadimethyloxazole in goats and their influence on some enzyme activities and renal clearances.

Five clinically health goats were injected with sulfadimethoxine and sulfadimethyloxazole in a single dose of 100 mg/kg b. wt. by intravenous route. Highest concentration levels of sulfadimethoxine and sulfadimethyloxazole in rumen were detected 1 hour following intravenous injection, then the concentration for both compounds declined at 12 and 8 hours post administration, respectively. In addition, both types of sulfonamide completely disappeared in ruminal fluid samples taken after 24 and 12 hours, respectively. The rate of acetylation for sulfadimethoxine and sulfadimethyloxazole were nearly similar and occurred to a high extent in ruminal fluid (22.95 and 23.72%, respectively). On the other hand, both tested drugs increased significantly the ruminal gas production from the first to eight hours after i.v. injection in goats. Changes in the serum enzyme activities (SGOT, SGPT and alkaline phosphatase) observed with sulfadimethoxine and sulfadimethyloxazole, and represented by a significant decrease in the activity of SGOT and SGPT level, alkaline phosphatase 4 hours sulfadimethoxine and in GOT/GPT ratio 24 and 48 hours after i.v. injection, respectively. The creatinine clearance was significantly decreased after 4 hours following the i.v. administration of sulfadimethoxine and sulfadimethyloxazole in goats.

Alanine Transaminase↗
PubMed1984

[Early surgical treatment of acute cholecystitis].

Correlations between anatomic and clinical findings were absent in a series of 214 cases of acute cholecystitis, and there was a high percentage of severe forms (58 p. 100). Early operation (between 48 and 72 hours) is therefore the most logical treatment and demonstrates comparable morbidity and mortality, if not lower figures, than with delayed surgery. Diagnosis can usually be made on clinical grounds and results of ultra-sound imaging and allows surgery to be performed after intensive care and preoperative antibiotic therapy. Total surgery with perioperative cholangiography is usually possible (95 p. 100 cases).

Acute Disease↗
PubMed1983

Mixed gonadal dysgenesis and sex chromosome mosaicism with multiple cell lines including structural aberrations of the Y chromosome.

A case of mixed (asymmetric) gonadal dysgenesis is reported in a girl with ambiguous external genitalia, a right intra-abdominal testis, a left streak gonad containing follicle-like structures devoid of oocytes and bilateral Mullerian derivatives. Buccal smear cells were X-chromatin negative and a Y-chromatin body was present in 31% of cells. Cytogenetic studies in peripheral blood leucocyte cultures showed sex chromosome mosaicism with cell lines including structural abnormalities of the Y chromosome in 36% of the cells: 45,X/46,XY/46,X + i(Yp)/46,X, + Yq-/47,XYY/47,XY + Yq-.

Child, Preschool↗
PubMed1981

Familial jejunal atresia with 'apple-peel' variant.

We report two siblings who had jejunal atresia which we believe to be familial. The parents of these siblings were first cousins. The first child had jejunal atresia with mesenteric agenesis and 'apple-peel' configuration; the second child had jejunal atresia with a V-shaped mesenteric defect. Other reported cases of familial atresia of the small intestine are reviewed.

Humans↗