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Biomedical subjects

M Mogadam

Publications and source records attributed to M Mogadam.

At least 19 recordsLinked to original sources
PubMed1994

Pre-endoscopic antibiotics for the prevention of bacterial endocarditis: do we use them appropriately?

OBJECTIVE: Because native valve bacterial endocarditis following endoscopic procedures is extremely rare, recent guidelines have discouraged indiscriminate use of pre-endoscopic antibiotics. The purpose of this study was to determine whether these guidelines have had an impact in prescribing antibiotic prophylaxis prior to endoscopic procedures. METHODS: All ambulatory endoscopic procedures carried out from January 1, 1992, through December 31, 1992, in a 412-bed community hospital in Northern Virginia were reviewed to identify cases receiving antibiotic prophylaxis. Inpatients, percutaneous gastrostomies, and ERCPs were not included, since many had received antibiotics for reasons other than endocarditis prophylaxis. We also surveyed a random sample of board certified gastroenterologists practicing at teaching hospitals in Northern Virginia and Washington, DC, to determine their practice patterns. We used the recent recommendations of the American Heart Association with minor modification as the "appropriate" guideline. RESULTS: Only 10% of physicians use antibiotic prophylaxis appropriately. Most physicians over-utilize antibiotics in a variety of settings that do not require such measures. Conversely, many physicians do not prescribe antibiotics for disorders which do require prophylaxis. CONCLUSION: Although "appropriate" guidelines for prophylactic antibiotics are available, and we have estimated the risk of acquiring native valve bacterial endocarditis following endoscopic procedures to be only 1 in 5-10 million procedures, the majority of physicians do not use prophylactic antibiotics appropriately.

Ambulatory Care↗
PubMed1990

Nutritional fads.

Explore the source record for details and available documents.

Complementary Therapies↗
PubMed1990

Within-person fluctuations of serum cholesterol and lipoproteins.

The National Cholesterol Education Program has begun a National Campaign to screen millions of adult Americans for serum cholesterol. To determine whether such random samples represent an individual's true lipoprotein status, we measured fasting total serum cholesterol and lipoproteins, on a weekly basis for 4 weeks, in 20 subjects ages 22 to 63 years. Duplicate samples were tested by two standardized laboratories, each on five consecutive days. Variations of more than +/- 20% in the serum levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were seen in 75%, 95%, and 65% of the subjects, respectively. On retesting, 40% of the subjects moved in or out of one "risk category"; and in 10% two categories, from "desirable" to "high risk," or vice versa. These data demonstrate that random testing may fall to detect wide fluctuations in the levels of serum lipoproteins, and therefore result in erroneous risk assignment or therapeutic intervention.

Adult↗
PubMed1988

Cancer and nutritional misconceptions: a perspective.

Misconceptions and disinformation have clouded the relevance of nutritional practices in cancer prevention. This perspective presents data from experimental and human studies, showing that, for most cancers, no convincing evidence exists to incriminate any dietary factor. The relevance of fiber and excess energy intake to the risk of colorectal cancer is also far from established. It is concluded that the significance of dietary factors in cancer prevention, is exaggerated. Even if an association does exist between nutritional practices and the risk for certain cancers, it is very small. As physicians, we should not allow nutritional misconceptions, fads, and belief systems, to mislead the public into wasting billions of dollars for ineffective dietary practices and "nutritional" supplements, in the false hope of cancer prevention.

Animal Nutritional Physiological Phenomena↗
PubMed1984

Gallbladder dynamics in response to various meals: is dietary fat restriction necessary in the management of gallstones?

An estimated 20 million Americans have gallstones the majority asymptomatic. Yet traditionally many are often placed on low-fat or fat-free diets, presumably to reduce the risk of biliary colic. To assess the gallbladder dynamics in response to various meals, we studied 15 subjects (ages 21-54), each on 4 separate days. After an overnight fast, each subject was given, at random, either a breakfast containing greater than 30 g fat, less than 15 g fat, totally free of fat, or an infusion of C-terminal octapeptide of cholecystokinin. Gallbladder ejections at regular time intervals were measured using real time ultrasonography and the sum of cylinders technic corrected for the gallbladder shape. Considerable variability in the gallbladder dynamics and time response was noted with all the stimuli. However, among various meals, there were no statistically significant differences in the mean maximum ejection fraction or the mean maximum ejection time (p greater than 0.10). The mean maximum ejection fraction after cholecystokinin was somewhat greater (0.01 less than p less than 0.05) than that after meals, but the mean maximum ejection time was similar (p greater than 0.10). We conclude that the gallbladder dynamics in response to various meals are independent of a meal's fat content. Since the passage of gallstones into the cystic or common duct (biliary colic) is a random event unrelated to the type of food, fat-restricted diets offer no significant therapeutic advantage in the management of the large population with asymptomatic gallstones.

Adult↗
PubMed1981

Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome.

To determine the safety of corticosteroids and sulfasalazine in pregnancy associated with inflammatory bowel disease, we reviewed the outcome of 531 such pregnancies in a national survey. Two hundred eighty-seven pregnancies (172 ulcerative colitis and 115 Crohn's disease) were treated with either or both drugs, whereas 244 (137 ulcerative colitis and 107 Crohn's disease) received neither. The frequency of fetal complications was significantly lower in both "treated" and "untreated" groups, as compared with the reported rates in the general pregnant population. We conclude: 1. Inflammatory bowel disease, except for severe active Crohn's disease, does not seem to affect the outcome of concurrent pregnancy adversely. 2. The use of corticosteroid and sulfasalazine in pregnancy associated with ulcerative colitis is unlikely to increase the fetal morbidity or mortality. 3. Patients with severe Crohn's disease requiring corticosteroid and/or both drugs experience more complications than the "untreated" ones, but still fewer than the prevailing rates in the general pregnant population. The higher complication rate seems to be associated more with disease-related factors than the use of these drugs. 4. In the management of inflammatory bowel disease associated with pregnancy, either or both drugs may be used just as in the nonpregnant patients.

Adrenal Cortex Hormones↗
PubMed1981

The course of inflammatory bowel disease during pregnancy and postpartum.

To determine whether pregnancy influences the course of inflammatory bowel disease, a survey of 324 patients, 178 with ulcerative colitis and 146 with Crohn's disease was carried out. During pregnancy, 70% of the patients remained unchanged or improved, whereas 30% developed exacerbations. The course of the disease was significantly milder in patients who became pregnant while in remission, as compared to those with moderate to severe disease (P less than 0.001). Postpartum, only 13% of patients, with quiescent to mild disease at term, experienced moderate to severe disease in contrast to 53% of those with active disease (P less than 0.001). We conclude that: 1. The course of inflammatory bowel disease is not adversely affected by concurrent pregnancy or postpartum 2. Exacerbations during or after pregnancy are more frequent in patients with active or uncontrolled disease. 3. Since the risk of relapse during pregnancy and postpartum is significantly lower in patients with inactive disease, treatment designed to induce and maintain remission in the course of pregnancy should minimize such exacerbations.

Colitis, Ulcerative↗