Air bag safety in road traffic accidents.
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Accidents, Traffic↗
Biomedical subjects
M Nazir
Publications and source records attributed to M Nazir.
[Establishment of routines for elective laparoscopic surgery].
BACKGROUND: During the autumn of 1999, elective laparoscopic cholecystectomy was introduced as a new surgical procedure in the Central Hospital Østfold, Askim. A prospective evaluation of perioperative patient logistics and patient satisfaction was performed. MATERIAL AND METHODS: 214 patients were evaluated in the ambulatory; 116 of them were scheduled for operation. The operations were performed in general anaesthesia with continuous infusion of propofol and short acting opioides. Analgetics and anti-emetics were given pre- and perioperatively as prophylaxis against postoperative pain and nausea. RESULTS: There were three unexpected cancellations. Two patients had serious postoperative bleedings and two had symptoms indicating residual bile duct stones. Twenty-eight patients (24%) were discharged on the same day. 114 patients (98%) were satisfied with their stay in hospital. INTERPRETATION: The established patient logistics proved efficient and rational.
Cholecystectomy, Laparoscopic↗
[Functional outcome after reservoir surgery in ulcerative colitis].
BACKGROUND: The aim of this study was to examine whether the functional result of restorative proctocolectomy for ulcerative colitis deteriorated by postponing follow-up from three to eight years after pouch surgery. MATERIAL AND METHODS: All patients (n = 58) operated for ulcerative colitis from 1984-97, who still had intact reservoir, responded to a questionnaire on defecating pattern, stool leakage, perianal irritation, urinary function, workload, sexual life, social life, and the patient's opinion on outcome. The results for the first 29 patients were compared to last 29 patients operated. Median follow-up was eight for the first 29 patients and three years for the last 29. RESULTS: There were no significant difference in functional outcome and patient opinion after pouch surgery between the first 29 and last 29 patients (n = 58). Respective figures for median 24-hour stool frequency were 7.0 and 6.3, leakage of stool 48% and 38%, ability to defer defecation 86% and 97%, perianal irritation 59% and 48%, use of antidiarrhoeal medication 55% and 52%, and wearing of pad 28% and 38%. Sexual life (n = 57) had improved for 11 (19%) and deteriorated for seven patients (12%). Potency was reduced in five (15%) and ejaculation in four patients (12%), one of whom (3%) had retrograde ejaculation. Three (5%) had received a disability pension and five (9%) had reduced workload. After the pouch operation 48 (91%) felt better and three (6%) felt worse because of frequent bowel emptying (n = 3), perianal eczema (n = 1) and pouch fistula (n = 1). INTERPRETATION: The results do not demonstrate any significant deterioration of functional outcome after pouch surgery for ulcerative colitis by postoperative increase of follow-up from three to eight years.
Adolescent↗
Infective endocarditis in children--incidence, pattern, diagnosis and management in a developing country.
BACKGROUND: In developing countries, patients with infective endocarditis are referred late, there is low yield of blood cultures and incidence of rheumatic heart disease is still high. OBJECTIVE: Evaluate clinical pattern, assess diagnostic criteria in our settings and determine outcome. SETTING: A tertiary referral center for paediatric and adult cardiology. PATIENTS AND METHODS: All children with infective endocarditis admitted to a single center from April 1997 to March 2000 were analysed. The diagnosis was based on Duke's criteria, which proposed two major and six minor criteria. Minor criteria were expanded to include raised acute phase reactants and presence of newly diagnosed or increasing splenomegally. The patients were stratified as definite, possible and rejected cases. RESULTS: Of 1402 hospital admissions, 45 patients fulfilled the diagnostic criteria for infective endocarditis giving an incidence of 32 per 1000 hospital admissions. The mean age was 7.9 +/- 4 years (4 months to 16 years) with only two patients under 1 year of age. Rheumatic heart disease was the underlying lesion in 24 patients (53%) while congenital heart lesions occurred in 20 patients (45%). Previous antibiotic treatment was given in 26 patients (58%) definitely. Blood cultures were positive in 21 patients (47%); Streptococcus Viridans being the most common organism, while vegetations on echocardiography were present in 32 patients (71%). Surgery was undertaken in four patients and five patients left against medical advise. Of 10 patients with aortic valve involvement, there were three deaths (30%) and overall mortality was 13% (six patients). CONCLUSIONS: The incidence of infective endocarditis is 32 per 1000 (3.2%) hospital admissions in a tertiary paediatric cardiology referral center. Rheumatic heart disease is still the most common underlying heart lesion. Blood cultures are positive in less than 50% of cases and echocardiography in expert hands is a more sensitive tool in our set up. Mortality is still high and aortic valve involvement in particular, carried poor prognosis.
Adolescent↗
Morbidity and functional outcome after restorative proctocolectomy for ulcerative colitis.
OBJECTIVE: To find out whether a threefold increase in follow up (median 108 compared with 36 months) influenced major morbidity and functional outcome between the first 32 and the last 32 patients consecutively operated on with J-pouch ileoanal anastomosis for ulcerative colitis from 1984 to 1997. DESIGN: Retrospective and prospective study. SETTING: University hospital, Norway. PATIENTS: 64 patients with ulcerative colitis who had proctocolectomy and ileal pouch-anal anastomoses. INTERVENTIONS: The pouches were mainly hand anastomosed (n = 61) to the dentate line after mucosectomy or anastomosed by double stapling technique without mucosectomy (n = 3). The 58 patients who still had their pouches responded to a questionnaire on functional outcome and satisfaction. MAIN OUTCOME MEASURES: Morbidity, functional outcome, and patients' satisfaction. RESULTS: Major morbidity in these 64 patients comprised pelvic sepsis in 3 (5%), operation for intestinal obstruction in 5 (8%), pouchitis in 12 (19%), fistulas in 7 (11%) and pouch excision in 6 (9%). Thirteen patients (20%) had 35 reoperations and 11 patients (17%) had 22 re-laparotomies. There were more complications among the first 32 patients with the longest follow up than among the last 32 patients, but this difference was significant only concerning the rate of reoperations (31% compared with 9%) because of the higher number of pouch excisions (5 compared with 1) in this group. There were no significant differences in the functional outcome and degree of patient satisfaction between the first 29 and the last 29 patients. Respective values for 24 hour median stool freqency were 7.0 and 6.3, leakage of stool 48% and 38%, ability to defer defaecation 86% and 97%, perineal irritation 59% and 48%, use of antidiarrhoeal medication 55% and 52%, and wearing of pad 28% and 38%. Sexual life (n = 57) was improved in 11 (19%) and reduced in 7 (12%). Potency was reduced in 5 (15%) and ejaculation in 4 (12%), one of whom (3%) had retrograde ejaculation. Three (5%) received disability pensions and five (9%) had reduced workload. After the pouch operation 48 (91%) felt better and 3 (6%) felt worse because of frequent bowel emptying, perineal eczema, or pouch fistula. CONCLUSION: Continence-preserving proctocolectomy carries considerable morbidity, but the long term functional outcome is satisfactory and does not seem to deteriorate substantially.
Adolescent↗
[Surgical treatment of ulcerative colitis].
Continence-preserving coloproctectomy for ulcerative colitis is technically demanding and is relatively often afflicted with complications. We have retrospectively reviewed the files of all patients being operated for ulcerative colitis at Ullevål Hospital from 1992 to 1997 (n = 53). Most of the patients (n = 50) were examined clinically; 12 patients had anal manometry before and after operation. 44 patients were operated with continence-preserving coloproctectomy with J-pouch and handsewn anastomosis; of these, 42 were followed more than six months. Eight had pouchitis, four perianal abscess/fistula, three septicaemia and three were operated for ileus. Two had anastomotic leakage and pelvic abscess that required transanal drainage. One had the pouch removed six years after operation due to chronic pouchitis and pouch-vaginal fistula. There was no deterioration of anal maximal resting and squeezing pressures on pre- and post-operative anal manometry. Mean number of stools from the reservoir per 24 hours were 6.2 (range 3-11); 11 patients had leakage of air and loose stool, three at day-time and eight at night. Two patients (4%) died from colorectal cancer and three (7%) had Crohn's disease. Nine patients were unfit for pouch surgery and underwent coloproctectomy (n = 7) or subtotal colectomy (n = 2). Our results indicate that pouch surgery for ulcerative colitis is a good option for most patients.
Adolescent↗
A survey of atrial fibrillation in general practice: the West Birmingham Atrial Fibrillation Project.
BACKGROUND: The management of atrial fibrillation (AF) has changed substantially in recent years, especially with a greater appreciation of the prophylactic role of antithrombotic therapy against stroke. There is therefore a need for further information on the prevalence of AF in Britain, the prevalence of (and contraindications to) anticoagulant treatment, and the factors that influence doctors' decisions in treating AF, including the investigation of patients with this arrhythmia. AIM: To investigate the prevalence, clinical features and management of patients with AF in a general practice setting. METHOD: Cross-sectional survey of patients using treatment prescriptions and clinical records in two general practices from the west of Birmingham (serving a patient population of 16,519) where 4522 subjects (27.4%) were aged > or = 50 years. RESULTS: One hundred and eleven (2.4%) patients who were aged > or = 50 years were found to be in AF (42 males; mean age 76.6, SD 9.1); 77.5% were Caucasian, 2.7% Afro-Caribbean, 0.9% Asian, and 0.9% mixed race; in 20 cases there was no information on ethnicity. Of the AF patients, 5.4% were aged 50-60 years, 16.2% aged 61-70 years, 20.7% aged 71-75 years, 20.7% aged 76-80 years, 24.3% aged 81-85 years, and 12.6% aged > 85 years old, with female patients being significantly older than males. Eighty-one patients (73%) had chronic AF, while 30 patients (27%) had paroxysmal AF. The most common associated factors were hypertension (36.9%) and ischaemic heart disease (28.8%), with no obvious cause for AF in six patients. Cardiac failure was associated with AF in 34 patients (30.6%), and stroke had occurred in 29 patients (18%). Only 20 patients (18%) had had an echocardiogram, 26 (23.4%) a chest X-ray, and 58 (52.3%) thyroid function test. Only 30.6% had ever presented to hospital practice. Warfarin was prescribed to 40 patients (36%), with anticoagulation intensity monitoring by the general practitioner (GP) in three cases (7.5%), by a hospital clinic in 30 (75%), and by both GP and hospital in seven cases (17.5%). Of those not anticoagulated (n = 71), only 12 patients (16.9%) had contraindications to warfarin therapy. Patients treated with warfarin were younger than those who were not prescribed warfarin (71.3 versus 79.6 years, P < 0.001). Aspirin was being prescribed for 21 patients (18.9%), primarily for previous myocardial infarction. Only five patients (4.5%) had ever had attempted cardioversion. CONCLUSION: Atrial fibrillation is a common arrhythmia in general practice, and is commonly associated with hypertension, ischaemic heart disease and heart failure. There is a suboptimal application of standard investigations and use of antithrombotic therapy or attempted cardioversion; and few patients have presented to hospital practice. Guidelines on the management of this common arrhythmia in general practice are required.
Aged↗
Alteration of rat liver 20S proteasome activities by age and food restriction.
The effects of age and food restriction on proteasome function in rat liver supernatant (100,000 x g) were investigated. The cellular level of the proteasome has been quantitated by using Western blot analysis. The level of the proteasome was not affected by either age or food restriction. The three best-characterized proteasomal peptidase activities, chymotrypsin-like (ChT-L), trypsin-like (T-L), and peptidylglutamyl peptide hydrolyzing (PGPH) activities, were measured in the presence and absence of the proteasomal activator, sodium dodecyl sulfate (SDS). Basal ChT-L, T-L, and PGPH activities were not markedly affected by either age or food restriction. SDS-stimulated ChT-L and T-L activities increased approximately 15% and approximately 30%, respectively, between 7 and 26 months of age, and the increase of both activities was prevented by food restriction. In marked contrast, the SDS-stimulated PGPH activity decreased approximately 40% with age. Food restriction, while not preventing the age-related decline, maintained higher levels of SDS-stimulated PGPH activity at all ages. The proteolytic activity of the proteasome toward casein was not altered by either age or food restriction. In conclusion, the cellular level of the proteasome as well as the caseinolytic activity of the proteasome appear to be unaffected by either age or food restriction. It appears unlikely that the proteasome activity changes are related to the reported age-associated decline of protein degradation. Simultaneously, proteasomal peptidase activities appear to be differentially regulated by both age and food restriction. It suggests more subtle age-related changes in proteasome function, which could include an effect on proteasomal subunit composition.
Aging↗
Stress and psychiatric disorder in the Hindu Kush: a community survey of mountain villages in Chitral, Pakistan.
BACKGROUND: It is widely believed that people in remote areas of the world suffer less emotional distress and fewer psychiatric disorders. Previous studies offer contradictory evidence. METHOD: First stage screening of two mountain villages in Chitral used the Bradford Somatic Inventory (BSI). Psychiatric interviews were conducted with stratified samples using the ICD10 Diagnostic Criteria for Research. RESULTS: The BSI was an effective screening test, with sensitivity of 80% and specificity of 77%. At a conservative estimate, 46% of women and 15% of men suffered from anxiety and depressive disorders. Literate subjects had lower levels of emotional distress than the illiterate. Higher socio-economic status was associated with less emotional distress. Members of joint and nuclear families were similar. CONCLUSIONS: The study offers no support for the belief that people who live in Chitral lead stress-free lives or have low rates of psychiatric morbidity. Women may suffer more anxiety and depressive disorders than in Western societies.
Adolescent↗
Contralateral inguinal hernial development and ipsilateral recurrence following unilateral hernial repair in infants and children.
The aim of the present study was to evaluate the frequency of contralateral hernial development and ipsilateral recurrence following surgery for unilateral inguinal hernia in infants and children. During the period 1961-1970, 161 infants and children (143 males and 18 females; 0-12 years old) underwent surgery for unilateral inguinal hernia. The patients were followed for 20-29 years (until 1990). 16/143 males (11.2%), and 1/18 females developed a contralateral inguinal hernia; the frequency among patients less than seven years old was significantly higher than the frequency among older children (16/118 > 1/43; p < 0.05). No significant difference was observed between patients primarily operated for rightsided and leftsided hernias. Four/143 boys (2.7%) experienced testicular maldescens. Recurrence after herniotomy was seen in 9/143 males (6.3%), and in 1/18 females. The low frequency of contralateral hernial development, as the risk of surgical complications, indicate that routine contralateral inguinal exploration may not be recommended while operating upon unilateral symptomatic inguinal hernias. Our recurrence rate of 6.2% may mirror the conditions in a general surgical department, where several surgeons and residents operate upon a limited number of paediatric patients.
Child↗
Effect of gamma-interferon on the synthesis of the functional alternative and terminal complement pathways by human umbilical vein endothelial cells in vitro.
The cytokine gamma-interferon (gIFN) has been reported to modulate synthesis by endothelial cells (EC) of alternative pathway complement factors (H, I, and B). However, the net effect of gIFN on the synthesis and expression of the functional alternative and terminal pathways has not yet been reported. EC cultured under serum-free conditions were treated with different concentrations of gIFN and simultaneously co-incubated with agarose beads, which activate the alternative pathway. C3b and the terminal complement complex (TCC) bound to co-incubated beads were measured by radioimmunoassay using anti-human C3c and TCC antibodies. gIFN in concentrations 500-4000 U/ml increasingly reduced the amount of C3b and TCC detected on the beads. The down-regulating effect of gIFN on EC complement biosynthesis may be physiologically relevant by locally controlling complement activation.
Antibody Specificity↗
Indicators for antibiotic therapy in invasive bacteria diarrhoea.
The objective of the study was to determine the clinical indications for antibiotic therapy in diarrhoeal diseases (DD) in 619 children aged 6 to 59 months who were evaluated during a clinical study of diarrhoea. The patients were seen at the outpatient clinic of the Palembang General Hospital from May 1991 through March 1992. Data concerning abdominal pain, pain during defecation, fever, status of breastfeeding, vomiting, mucoid stool, bloody stool, abdominal distention, stool leucocytes and erythrocytes were analyzed to determine their predictive value (PPV) in relation to the bacterial isolation of pathogen in the stool. All clinical variables examined had a low PPV for isolation of any enteric pathogen, including Shigella. The PPV of grossly bloody diarrhoea was 20.8% (95% confidence limits 17.6%-24%), and that of body temperature (> 37.5 degrees C) was 19.6%. When the stool leucocytes were 10 or more per high-power microscopic field (HPMF), the PPV was 22.2%; of erythrocytes found microscopically in the stool, 19.6%. We recommend that those patients with bloody stools and mucoid stools with temperatures of 37.5 degrees C get antibiotics (22%). Second, those patients having 10 or more leucocytes per HPMF plus those with red cells in stools (regardless of the number) should receive either antibiotics and or amoebicides if amoebae are present (5%).
Anti-Bacterial Agents↗
[Experience with the treatment of war injuries in Afghanistan].
The International Committee of the Red Cross surgical hospital for Afghan war-wounded is located across the border in Pakistan. The author describes experiences from his work in that hospital from July 1981 to November 1985. During the period, 6,700 patients were admitted to the hospital and 13,184 major and minor surgical operations were performed. In the case of persons wounded in guerilla warfare, when treatment is delayed due to poor transportation facilities, the accepted treatment for conventional battlefield injuries should not be applied without modification. The author discusses the principles for treating injuries to different organs.
Afghanistan↗
Fetal supraventricular tachycardia and hydrops fetalis: combined intensive, direct, and transplacental therapy.
A 25-week fetus with severe hydrops fetalis secondary to supraventricular tachycardia was treated with fetal intramuscular injections of digoxin in conjunction with maternal intravenous digoxin, followed by oral digoxin and subsequently by oral procainamide therapy. Fetal umbilical blood sampling revealed poor placental transfer of digoxin, even after 2 weeks of therapeutic maternal levels. This case suggests that direct fetal therapy is of value in the treatment of some fetuses with supraventricular tachycardia, and lends further evidence that the role of transplacental digoxin therapy is limited in the compromised fetus. It also demonstrates that resolution of hydrops may require a prolonged period.
Adult↗
[Morgagni Hernia].
The article describes a 65 year-old female with a 40 years' history of abdominal discomfort and a supposed intrathoracal lipoma who was admitted to hospital with acute obstruction of the large bowel. Emergency laparotomy revealed a subcostosternal diaphragmatic hernia (hernia of Morgagni) containing omentum and a segment of transverse colon.
Aged↗
Stability of fatty acids and leaf protein concentrate of Persian clover (Trifolium resupinatum).
Freeze-dried leaf protein concentrate (LPC) contained 18% lipids in which linolenic acid (61.5%) was the major component. Linolenic acid in LPC was almost stable when stored at ambient temperature (30 to 35 degrees C) and exposed to air for 24 weeks. Heating of LPC (50 to 200 degrees C) in presence of moisture (6 to 12%) progressively increased the rate of destruction of linolenic acid. Below 100 degrees C the presence of lipids did not affect the protein quality but at higher temperatures due to the lipid oxidation protein quality as estimated by dye-binding capacity was considerably affected.
Fatty Acids↗
Home-made rice water salt solution for oral rehydration therapy--a field trial.
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Child, Preschool↗
The incidence of diarrhoeal diseases and diarrhoeal diseases related mortality in rural swampy low-land area of south Sumatra, Indonesia.
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Adolescent↗