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Biomedical subjects

M K Bulsara

Publications and source records attributed to M K Bulsara.

At least 19 recordsLinked to original sources
PubMed2005

Early changes in 24-hour ambulatory blood pressure are associated with high normal albumin excretion rate in children with type 1 diabetes mellitus.

OBJECTIVE: The relationship between urinary albumin excretion rate (AER) and elevated blood pressure (BP) is unclear as a cause-effect phenomenon in the development of diabetic nephropathy. The aim of this study was to examine the association between AER, HbA1c and BP in children with normoalbuminuria. METHODS: 24-hour ambulatory BP assessment was performed in 78 children with type 1 diabetes mellitus (DM1), age mean +/- SD 13.4 +/- 2.7 yr, range 7.3-18.3 yr, DM1 duration mean +/- SD 6.6 +/- 2.9 yr, range 2.1-11.9 yr. Using generalised linear mixed models with systolic (SBP) and diastolic (DBP) blood pressure as dependent variables, the effects of AER and HbA1c were examined, adjusting for age, gender, DM1 duration and insulin dose. RESULTS: Patients with high normal AER (7-20 microg/min) had higher SBP during daytime and night-time compared to the low normal AER (< or = 7 microg/min) (mean +/- SD 118.20 +/- 7.98 and 110.33 +/- 7.08 mm Hg, p = 0.02; mean +/- SD 108.76 +/- 9.21 and 100.20 +/- 7.75 mm Hg, p = 0.03, respectively). DBP was also higher both during day- and night-time when compared to the < or = 7 microg/min group (mean +/- SD 73.40 +/- 6.50 and 64.86 +/- 5.67 mm Hg, p = 0.002; mean +/- SD 62.50 +/- 6.75 and 56.30 +/- 5.56 mm Hg, p = 0.03 day- and night-time, respectively). CONCLUSION: A rise in SBP and DBP is associated with increased levels of AER even within the normal range.

Adolescent↗
PubMed2004

Continued increase in the incidence of childhood Type 1 diabetes in a population-based Australian sample (1985-2002).

AIMS/HYPOTHESIS: Our aim was to determine the incidence of Type 1 diabetes in children who were 0 to 14 years of age in Western Australia from 1985 to 2002, and to analyse the trends in incidence rate over the same period. METHODS: Primary case ascertainment was from a prospective population-based diabetes register that was established in 1987, and secondary case ascertainment was from the Western Australia Hospital Morbidity Data System. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyse the incidence rates by calendar year, sex and age at diagnosis. RESULTS: There was a total of 1144 cases (560 boys, 584 girls). Using the capture-recapture method, case ascertainment was estimated to be 99.8% complete. The mean age standardised incidence from 1985 to 2002 was 16.5 per 100,000 person years (95% CI 14.7-18.2), ranging from 11.3 per 100,000 in 1985 to 23.2 per 100,000 in 2002. The incidence increased on average by 3.1% (95% CI 1.9%-4.2%) a year over the period ( p<0.001). No significant difference was found between boys and girls. A significant increase in incidence was found in all age groups, with no disproportionate increase found in the 0 to 4-year-olds. CONCLUSIONS/INTERPRETATION: The incidence of childhood-onset Type 1 diabetes in Western Australia has increased significantly over the past 18 years and shows no signs of abating. In contrast to other studies, a higher rate of increase was not found in the youngest children.

Adolescent↗
PubMed2004

Evaluating risk factors associated with severe hypoglycaemia in epidemiology studies-what method should we use?

AIMS: To determine the most appropriate regression models to use when assessing risk factors for severe hypoglycaemia and to investigate the impact of model misspecification and its clinical implications. METHODS: A total of 1229 children with Type 1 diabetes (mean age 11.7 years sd 4.1), of which 605 (49.2%) were males, were studied. Prospective assessment of severe hypoglycaemia (an event leading to loss of consciousness or seizure) was made over the 9-year period, 1992-2001. Patients were seen every 3 months and episodes of hypoglycaemia along with clinical data were recorded. Over 70% of children never experienced a severe hypoglycaemic event. Data were analysed using the Poisson regression, negative binomial, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models. The over-dispersion and likelihood ratio statistics were calculated and the analytical methods compared. RESULTS: The Poisson regression model did not fit the data well. The negative binomial and the zero inflated Poisson and negative binomial models fitted the data better than Poisson. CONCLUSIONS: The commonly used Poisson regression models to analyse hypoglycaemia epidemiology may lead to biased parameter estimates and incorrect determination of risk factors for hypoglycaemia. We recommend the use of the negative binomial or zero inflated models to examine any risk factors associated with severe hypoglycaemia. Careful consideration must be given to the interpretation of hypoglycaemia surveys and their analysis.

Age Factors↗
PubMed2002

Domestic exposure to formaldehyde significantly increases the risk of asthma in young children.

Concern has arisen in recent years about indoor air pollution as a risk factor for asthma. Formaldehyde exposure was examined in relation to asthma among young children (between 6 months and 3 yrs old) in a population-based control study carried out in Perth, Western Australia, between 1997-1999. An association between exposure to formaldehyde and asthma in young children has been suggested. Cases (n=88), whose parents were recruited at Princess Margaret Hospital Accident and Emergency Dept (Perth, Western Australia), were children discharged with asthma as the primary diagnosis. Controls (n=104), who were children in the same age group without asthma diagnosed by a doctor, were identified from birth records through the Health Dept of Western Australia (Perth, Western Australia). Health outcomes for the children were studied using a respiratory questionnaire and skin-prick tests. Formaldehyde, average temperature and relative humidity were measured on two occasions, winter (July-September 1998) and summer (December 1998-March 1999) in the child's bedroom and in the living room. The study found seasonal differences in formaldehyde levels in the children's bedrooms and living rooms with significantly greater formaldehyde exposure during the summer period for case and control subjects. The generalised estimating equation model showed that children exposed to formaldehyde levels of > or = 60 microg x m(-3) are at increased risk of having asthma. The results suggest that domestic exposure to formaldehyde increases the risk of childhood asthma.

Age Factors↗
PubMed2001

Predictors of low bone density in young adolescent females with anorexia nervosa and other dieting disorders.

OBJECTIVE: To compare the bone density of adolescent patients with anorexia nervosa with adolescent patients with other dieting disorders and to evaluate risk factors for low bone density in these patients. METHOD: Sixty-nine consecutive female patients referred to an adolescent eating disorders clinic were studied by interview, blood sampling, body composition, and lumbar spine bone density measurement using dual energy X-ray absorptiometry. RESULTS: Although patients with anorexia nervosa were more malnourished, their bone density was similar to other dieting patients. Patients were divided into a low and normal bone density group irrespective of psychiatric diagnosis. Patients with low bone density had dieted for longer, had lower lean body mass, more often had not achieved menarche, and had longer duration of secondary amenorrhea and lower estrogen levels. DISCUSSION: Irrespective of clinical diagnosis, adolescents with dieting disorders have increased risk of low bone density when malnutrition commences early in puberty and is associated with reduced lean body mass and impaired ovarian function.

Adolescent↗
PubMed2001

Effect of hemochromatosis genotype and lifestyle factors on iron and red cell indices in a community population.

BACKGROUND: Heterozygotes for the C282Y mutation of the HFE gene may have altered hematology indices and higher iron stores than wild-type subjects. METHODS: We performed a cross-sectional analysis of 1488 females and 1522 males 20-79 years of age drawn from the Busselton (Australia) population study to assess the effects of HFE genotype, age, gender, and lifestyle on serum iron and hematology indices. RESULTS: Male C282Y heterozygotes had increased transferrin saturation compared with the wild-type genotype. Neither male nor female heterozygotes had significantly increased ferritin values compared with the wild-type genotype. Younger (20-29 years) wild-type males, but not heterozygous males, had significantly lower ferritin values than wild-type males in the older age groups. Compound heterozygous subjects had increased means for serum iron, transferrin saturation, corpuscular volume, and corpuscular hemoglobin compared with the wild-type genotype, and the males also had increased ferritin values (medians 323 vs 177 microg/L; P = 0.003). In both male and female wild-type subjects, an increased body mass index was associated with decreased serum iron and transferrin saturation and increased ferritin values. There was a significant increase in ferritin concentrations in both genders with increasing frequency of red meat consumption above a baseline of 1-2 times per week and alcohol intakes >10 g/day. CONCLUSIONS: Male C282Y heterozygotes had significantly increased transferrin saturation values. Compound heterozygous (C282Y/H63D) subjects formed a separate category of C282Y heterozygotes in whom both iron and red cell indices were significantly increased compared with the wild-type genotype.

Adult↗
PubMed2000

Dose-response to inhaled aerosolized prostacyclin for hypoxemia due to ARDS.

STUDY OBJECTIVES: This study was carried out to determine the efficacy of and dose-response relationships to inhaled aerosolized prostacyclin (IAP), when used as a selective pulmonary vasodilator (SPV) in patients with severe hypoxemia due to ARDS. DESIGN: Unblinded, interventional, prospective clinical study. SETTING: A general ICU in a university-affiliated, tertiary referral center. PATIENTS: Nine adult patients with severe ARDS (lung injury score, > or = 2.5). INTERVENTIONS: All patients received IAP over the dose range 0 to 50 ng/kg/min. The IAP was delivered via a jet nebulizer placed in the ventilator circuit. Dose increments were 10 ng/kg/min every 30 min. MEASUREMENTS AND RESULTS: Cardiovascular parameters (cardiac index and mean pulmonary and systemic pressures), indexes of oxygenation (PaO(2)/fraction of inspired oxygen [FIO(2)] ratio and alveolar-arterial oxygen partial pressure difference [P(A-a)O(2)]) and shunt fraction were measured or calculated at each dose interval, as were platelet aggregation and systemic levels of prostacyclin metabolite (6-keto prostaglandin F1(alpha)). A generalized linear regression model was used to determine a dose effect of IAP on these parameters. The Wilcoxon rank sum test for related measures was used to compare the effects of various doses of IAP. IAP acted as an SPV, with a statistically significant dose-related improvement in PaO(2)/FIO(2) ratio (p = 0.003) and P(A-a)O(2) (p = 0.01). Systemic prostacyclin metabolite levels increased significantly in response to delivered IAP (p = 0.001). There was no significant dose effect on systemic or pulmonary arterial pressures, or on platelet function, as determined by platelet aggregation in response to challenge with adenosine diphosphate. CONCLUSIONS: IAP is an efficacious SPV, with marked dose-related improvement in oxygenation and with no demonstrable effect on systemic arterial pressures over the dose range 0 to 50 ng/kg/min. Despite significant systemic levels of prostacyclin metabolite, there was no demonstrable platelet function defect.

6-Ketoprostaglandin F1 alpha↗
PubMed1995

Age and secular trends in risk factors for cardiovascular disease in Busselton.

Mortality rates from heart disease and stroke in Australia have been falling for more than 20 years. No completely satisfactory explanations for this trend exist. However, it is believed to be due, at least in part, to changes in the incidence of cardiovascular disease arising from changes in the prevalence and severity of risk factors for cardiovascular disease. The adult community of Busselton in Western Australia participated in cross-sectional health surveys every three years from 1966 to 1981. This paper describes secular trends from 1966 to 1981 and age trends from 25 to 80 years for cardiovascular risk factors in Busselton men and women. Downwards secular trends were observed for mean blood pressure and smoking for men and women, upwards trends were observed for body mass index in men, and mean cholesterol was approximately constant over this period. The age and secular trends were consistent with other Australian studies conducted in the 1980s and with overseas studies. An estimated 67 per cent of the decline in cardiovascular mortality rates among Busselton men and 22 per cent of the decline among Busselton women may be attributed to changes in the prevalence of risk factors for cardiovascular disease.

Adult↗
PubMed1994

Mortality trends, 1965 to 1989, in Busselton, the site of repeated health surveys and interventions.

The community of Busselton in Western Australia has participated in repeated cross-sectional health surveys and other health interventions since 1966. Health surveys of adults were conducted every three years from 1966 to 1981. Health interventions, including programs for high blood pressure, smoking, high blood cholesterol levels and obesity, were implemented in the community. Mortality rates for the Busselton area are compared with rates for the remainder of the southwest region of Western Australia in an attempt to determine if the surveys and associated interventions have had any impact on survival. Statistical comparisons via Poisson regression analysis showed that mortality rates for males over the period 1965 to 1989 in Busselton declined at a similar rate to the southwest. However, for females, especially those aged 45 to 74 years, mortality rates declined significantly faster in Busselton than in the southwest, suggesting a beneficial impact on survival of the surveys and associated interventions.

Adult↗
PubMed1987

Reduction in prevalence, intensity of infection and morbidity due to Schistosoma mansoni infection in a community following treatment with praziquantel.

Five hundred and twenty-three individuals from an area endemic for Schistosoma mansoni infection were followed for a 16 month period in a population-based study in rural Zambia. Those found infected in each of five surveys were treated with praziquantel (40 mg kg-1 body weight). Data on prevalence, intensity of infection and morbidity (intestinal symptoms and liver and spleen enlargements) were also gathered. At the end of the study, prevalence had fallen from 64.8% to 11.5%, intensity of infection had dropped from 28.2 to 0.5 eggs per gram of stool (geometric means) and morbidity showed marked reduction.

Adolescent↗
PubMed1986

The relationship between morbidity and intensity of Schistosoma mansoni infection in a rural Zambian community.

Six hundred and ninety-three individuals from an area endemic for S. mansoni infection had parasitological and physical examinations done. A morbidity questionnaire was also administered to each participant. Among those with S. mansoni infection, there was significant increase in watery diarrhoea, bloody diarrhoea, blood in stool and hepatomegaly. The severity of the disease appears to be directly related to the egg load and therefore these results give further justification for treatment of high intensity age groups in community based chemotherapy programmes designed to reduce morbidity in endemic areas.

Adolescent↗
PubMed1986

Use of symptoms and signs for diagnosis of Trypanosoma brucei rhodesiense trypanosomiasis by rural health personnel.

The results are described of a study of 60 patients with sleeping sickness from north-east Zambia together with 60 hospital controls and 27 nearest-neighbour controls. Eight symptoms were significantly commoner among sleeping-sickness patients than among either set of controls, and some of these symptoms were used to devise a scoring system for use by rural medical personnel. Although most patients reported a short history of the illness, almost 90% had abnormal cerebrospinal fluid, and there was a significant tendency for the cerebrospinal fluid of adults with a longer history of sleeping sickness to contain trypanosomes. Enlargement of lymph nodes was significantly more frequent among the patients than among the controls, but often the submandibular, axillary, or inguinal rather than the posterior cervical nodes were enlarged. Signs associated with involvement of the central nervous system were common, but the cheiro-oral reflex was non-specific, also occurring frequently among hospital controls.

Adolescent↗
PubMed1986

Adult cerebral malaria in Zambia: preliminary report of clinical findings and treatment response.

Fifty-six adult patients diagnosed as having 'cerebral malaria' were admitted and treated over a 4 month period. The presenting symptoms were similar to those of control patients with malaria without cerebral manifestations except that vomiting and convulsions were significantly more frequent and joint pains were less frequent in the cases than in the controls. Physical examination revealed significantly more frequent occurrence of nuchal rigidity, positive Kernig's sign, confusion, muteness, pallor and jaundice in the cases than controls, while splenomegaly was significantly more common in controls than cases. Laboratory data showed that cerebral malaria cases had significantly lower haemoglobin and significantly higher reticulocyte count and erythrocyte sedimentation rate than controls. There was no significant difference in the parasite density between the cases and controls. All patients were treated with 200 mg base of intravenous chloroquine in 250 ml of isotonic saline infused over 2 h and repeated 12 hourly till oral therapy was possible. This proved to be efficacious and the recovery rate was over 90%. Five patients died and the diagnosis was confirmed in three in whom autopsy was permitted. A simple staging system is proposed which retrospectively seems to have prognostic value. It is recommended that the validity of this system be tested prospectively.

Adolescent↗
PubMed1986

Evaluation of conjunctival pallor in the diagnosis of anaemia.

The diagnosis of anaemia using conjunctival pallor was evaluated using the concept of predictive values. The presence or absence of pallor in 951 individuals and their haemoglobin levels were matched, defining haemoglobin of 10 g dl-1 or less as representing anaemia. The sensitivity and specificity of the test of pallor were 18.6% and 95.8%, respectively. At 16.3% prevalence of anaemia the positive and negative predictive values were 46.3% and 85.8%, respectively. The findings suggest that conjunctival pallor as a screening test for anaemia may not be very reliable.

Adolescent↗
PubMed1985

Risks of liver and spleen enlargement in schistosomiasis mansoni infection in a rural Zambian community.

At the Tropical Diseases Research Centre, Ndola, Zambia, we have used "relative risks" to demonstrate the relationship between intensity of Schistosoma mansoni infection and liver and spleen enlargement. There was a significant trend in risk for both right and left lobe liver enlargement across the intensity strata. However the risk for spleen enlargement showed no significant trend.

Feces↗
PubMed1985

Evaluation of selected symptoms in the diagnosis of Schistosoma mansoni infection.

Data on morbidity associated with S. mansoni infection was gathered using a questionnaire before parasitological screening was done in a rural Zambian community. Blood in stool, bloody diarrhoea and watery diarrhoea were found to be significantly associated with S. mansoni infection. Levels of sensitivity, specificity and predictive values were calculated for each symptom. On the basis of results obtained we speculate that these symptoms could be used by peripheral health workers in making early diagnosis of the disease in the absence of laboratory diagnostic tests.

Humans↗