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Biomedical subjects

M Pai

Publications and source records attributed to M Pai.

At least 19 recordsLinked to original sources
PubMed2004

Comparing hand-held computers and paper diaries for haemophilia home therapy: a randomized trial.

Treatment of severe haemophilia with factor concentrates is by self-infusion in the home. Adherence to record keeping on paper diaries is poor. A randomized-controlled trial compared adherence with record keeping of paper diaries with hand-held computers. Forty-one individuals with severe haemophilia, were randomized to hand-held computers (n = 22) or paper diaries (n = 19) and followed for 6 months. About 86.2% (679 of 788) of infusions by patients in the computer group were in compliance with the data submission schedule compared with only 48.3% (358 of 741) of infusions by patients using paper diaries (P < 0.0001). The time intervals between infusions and the receipt of data were shorter in the computer group (median 0.25 vs. 25 days respectively, P < 0.0001). Reminder phone calls by the clinic were made less frequently to users of hand-held computers than to users of paper diaries (median one vs. five times, P < 0.0001). Accuracy of data was similar for both methods. Compliance with hand-held computers was superior to paper diaries. The clinic received data from hand-held computers mostly on the same day, and nurses could thereby provide clinical advice more effectively. Although hand-held computers did not result in increased accuracy, errors could be detected and corrected more rapidly. Electronic data can more easily be verified, analysed and summarized than that from paper diaries.

Adolescent↗
PubMed2002

Serum leptin in disabled and non-disabled children in an Indian slum population.

OBJECTIVE: To assess the concentration of serum leptin in a population of malnourished children and to compare the leptin levels of disabled and non-disabled children in this population. DESIGN: Case-control study. SUBJECTS: Eighty-one children, comprising 41 children with mixed disabilities and 40 non-disabled controls, were selected from 425 children involved in a case-control study assessing the nutritional status of children with disabilities in an Indian slum population. METHODS: Leptin was measured in the serum samples and was compared with anthropometry (weight-for-age Z-scores (WAZ), height-for-age Z-scores (HAZ), weight-for-height Z-scores (WHZ), body mass index (BMI), mid-upper-arm circumference (MUAC), sub-scapular skinfold thickness and triceps skinfold thickness) and serum acute phase proteins. RESULTS: The children were very malnourished with WAZ=-2.07 (s.d. 1.15), HAZ=-2.15 (s.d. 1.85) and WHZ=-1.07 (s.d. 0.83). Leptin was extremely low in both the disabled (1.44 ng/ml; 95% confidence interval, CI, 1.23-1.69) and the non-disabled (1.19 ng/ml; 95% CI 1.04-1.35) children. There were no differences between the disabled and non-disabled groups as a whole but 15 children with neurological disabilities had significantly higher (P<0.05) serum leptin (1.65 ng/ml; 95% CI 1.29-2.06) than the non-disabled children. Girls (1.55 ng/ml; 95% CI 1.29-1.87) had significantly higher concentrations of leptin than boys (1.11 ng/ml; 95% CI 1.02-1.22; P=0.002). Leptin did not correlate with any biochemical or anthropometric measures. CONCLUSIONS: In this population, where malnutrition was common, serum leptin levels were very low and did not correlate with anthropometry. SPONSORSHIP: UK Department for International Development; Virgin Airways through the Great Ormond Street Hospital Trustees.

Acute-Phase Proteins↗
PubMed2002

Adequate vascular training opportunities can be provided without compromising patient care.

OBJECTIVES: to review the results of index operations in vascular surgery and to evaluate the impact of a specialist vascular training programme on patient outcome. METHODS: we undertook a 5-year (January 1995-December 1999) review of the weekly-collected mortality and morbidity data. The total number, 30-day mortality and stroke rate of all index operations i.e. AAA repairs (ruptured and elective), carotid operations and infra-inguinal bypasses (above and below knee, elective and emergency) was recorded. The number of operations performed by trainees under supervision was recorded. RESULTS: in the 5-year period 991 index operation were done of which 738 (74%) were done by trainees. Operations done by trainees were supervised by a consultant in 82% of cases with no significant effect on death or stroke rates. Overall vascular trainees performed 75% of the index operations of which 82% were supervised. CONCLUSIONS: trainees under supervision performed three out of four index operations. The mortality and morbidity of index operations in our unit compared well with accepted best mortality and morbidity figures. Our unit provides good training opportunities for vascular trainees whilst maintaining satisfactory standards of patient care.

Attitude of Health Personnel↗
PubMed2001

Platelets from patients with the Quebec platelet disorder contain and secrete abnormal amounts of urokinase-type plasminogen activator.

The Quebec platelet disorder (QPD) is an autosomal dominant platelet disorder associated with delayed bleeding and alpha-granule protein degradation. The degradation of alpha-granule, but not plasma, fibrinogen in patients with the QPD led to the investigation of their platelets for a protease defect. Unlike normal platelets, QPD platelets contained large amounts of fibrinolytic serine proteases that had properties of plasminogen activators. Western blot analysis, zymography, and immunodepletion experiments indicated this was because QPD platelets contained large amounts of urokinase-type plasminogen activator (u-PA) within a secretory compartment. u-PA antigen was not increased in all QPD plasmas, whereas it was increased more than 100-fold in QPD platelets (P <.00009), which contained increased u-PA messenger RNA. Although QPD platelets contained 2-fold more plasminogen activator inhibitor 1 (PAI-1) (P <.0008) and 100-fold greater u-PA-PAI-1 complexes (P <.0002) than normal platelets, they contained excess u-PA activity, predominantly in the form of two chain (tcu-PA), which required additional PAI-1 for full inhibition. There was associated proteolysis of plasminogen in QPD platelets, to forms that comigrated with plasmin. When similar amounts of tcu-PA were incubated with normal platelet secretory proteins, many alpha-granule proteins were proteolyzed to forms that resembled degraded QPD platelet proteins. These data implicate u-PA in the pathogenesis of alpha-granule protein degradation in the QPD. Although patients with the QPD have normal to increased u-PA levels in their plasma, without evidence of systemic fibrinogenolysis, their increased platelet u-PA could contribute to bleeding by accelerating fibrinolysis within the hemostatic plug. QPD is the only inherited bleeding disorder in humans known to be associated with increased u-PA.

Blood Platelet Disorders↗
PubMed2000

Imaging of malignant lymphomas with F-18 FDG coincidence detection positron emission tomography.

PURPOSE: The authors evaluated the utility of F-18 fluorodeoxyglucose (FDG) coincidence detection (CoDe) positron emission tomography (PET) for staging, post-treatment evaluation, and follow-up assessment of patients with malignant lymphomas. MATERIALS AND METHODS: Fifty-eight patients with histologically proved malignant lymphomas (4 Hodgkin's disease, 54 non-Hodgkin's lymphoma) underwent CoDe PET using F-18 FDG. CoDe PET was performed using a dual-head gamma camera equipped with coincidence detection circuitry. Of the 87 CoDe PET studies, 26 were performed for staging, 38 for post-treatment evaluation, and 23 for follow-up evaluation of recurrence. The entire trunk, from the cervical to the inguinal regions, or selected regions were scanned with the patient in the supine position. No attenuation correction was made and reconstruction was performed using filtered back-projection rather than iterative reconstruction. CoDe PET findings were compared with corresponding results of computed tomographic (CT) and magnetic resonance imaging (MRI), tissue biopsy, or clinical follow-up. RESULTS: For staging, 52 sites were positive on CoDe PET or CT-MRI. CoDe PET detected 49 sites (94%), and CT-MRI showed 47 sites (90%). CoDe PET detected five more lymphomatous lesions and missed three lesions. For post-treatment evaluation, CoDe PET showed a positive predictive value of 100% and a negative predictive value of 83%, but the validated cases numbered only 11. For follow-up for recurrence, CoDe PET had a negative predictive value of 90%, but frequent false-positive findings were noted in the head and neck region as a result of underlying inflammatory changes. CONCLUSIONS: For staging, FDG CoDe PET alone without attenuation correction is not sensitive enough to be used as an independent imaging method, especially for small abdominal lesions. However, it appears to be an accurate method for assessing residual disease and for patient follow-up.

Adolescent↗
PubMed2000

Effect of the factor V Leiden mutation on the clinical expression of severe hemophilia A.

To determine whether the factor V Leiden mutation is associated with decreased bleeding in individuals with severe hemophilia A, factor concentrate utilization, maximum annual number of bleeding episodes, and the prevalence of hemophilic arthropathy between carriers and non-carriers of the factor V Leiden mutation were compared. Heterozygosity for the factor V Leiden mutation was found in 6 of 137 subjects (4.4%). Carriers of the factor V Leiden mutation utilized less factor concentrate (geometric mean: 310 vs. 1185 units/kg/year) and had fewer bleeding episodes than non-carriers (proportion with 10 or fewer bleeding episodes in their worst year: 50 vs. 11%). However, the factor V Leiden mutation was not associated with the absence of arthropathy. The intron 22 inversion mutation of the factor VIII gene was tested for in a subgroup of 80 subjects, but it was not found to be a significant variable for any of the bleeding endpoints. The results of this small study are consistent with the hypothesis that the factor V Leiden mutation imparts a protective effect; however, a larger confirmatory study in which the factor VIII molecular defects can be controlled for is needed. Furthermore, most severe hemophiliacs who used fewer than 200 units/kg/year of factor concentrate or who had experienced 10 or fewer bleeding episodes per year did not carry the factor V Leiden mutation, suggesting that the proportion of severe hemophiliacs whose mild clinical course can be attributed to the factor V Leiden mutation is small.

Adolescent↗
PubMed1999

Multimerin processing by cells with and without pathways for regulated protein secretion.

Multimerin is a massive, soluble, homomultimeric, factor V-binding protein found in platelet alpha-granules and in vascular endothelium. Unlike platelets, endothelial cells contain multimerin within granules that lack the secretory granule membrane protein P-selectin, and in culture, they constitutively secrete most of their synthesized multimerin. To further evaluate multimerin's posttranslational processing and storage, we expressed human endothelial cell prepromultimerin in a variety of cell lines, with and without pathways for regulated secretion. The recombinant multimerin produced by these different cells showed variations in its glycosylation, proteolytic processing, and multimer profile, and human embryonic kidney 293 cells recapitulated multimerin's normal processing for constitutive secretion by human endothelial cells. When multimerin was expressed in a neuroendocrine cell line capable of regulated protein secretion, it was efficiently targeted for regulated secretion. However, the multimerin stored in these cells was proteolyzed more extensively than normally occurs in platelets, suggesting that endoproteases similar to those expressed by megakaryocytes are required to produce platelet-type multimerin. The impact of the tissue-specific differences in multimerin's posttranslational processing on its functions is not yet known. Multimerin's sorting and targeting for regulated secretion may be important for its functions and its association with factor V in secretion granules.

Blood Platelets↗
PubMed1999

Fluorine-18 fluorodeoxyglucose imaging using dual-head coincidence positron emission tomography without attenuation correction in patients with head and neck cancer.

PURPOSE: An accurate, preoperative assessment of tumor extent and lymph node involvement is necessary to plan and tailor therapy for patients with head and neck cancer. Metabolic imaging with fluorine-18 fluorodeoxy-glucose (FDG) is a good method to detect primary tumors in the head and neck and to assess the involvement of lymph nodes, but it is not widely available because of the high cost of positron emission tomography (PET). Recently, an alternative method for using FDG was developed: coincidence detection PET (CoDe PET) using a gamma camera. The aim of this study was to evaluate the clinical utility of FDG CoDe PET using a gamma camera in patients with head and neck cancer. MATERIALS AND METHODS: Thirty FDG CoDe PET studies without attenuation correction were performed in seven patients before therapy and in 19 patients after therapy (ages: 25-79 years, mean, 50 +/- 13 years; 18 men, 8 women) with various head and neck cancers. All patients had fasted for 6 to 12 hours and were injected with 111 to 370 MBq F-18 FDG 1 hour before imaging. Visually detectable focal FDG uptake in the primary tumor site or in the neck was considered positive except for physiologic uptake. The FDG CoDe PET studies were correlated with MRI. The gold standard for the presence of disease was the combination of repeated MRIs, endoscopic examination, and 3 months of follow-up clinical evaluation. RESULTS: FDG CoDe PET had a detection rate that was comparable to that of MRI in the pretherapy group. However, in the posttherapy group, FDG CoDe PET could differentiate residual tumor or tumor recurrence from radiation change more accurately than could MRI. However, it had a less accurate detection rate for cervical node metastases because of asymmetric neck muscle uptake. CONCLUSIONS: FDG CoDe PET is a sensitive and cost-effective method to detect primary tumor and lymph node involvement in primary head and neck cancers. It is also useful in differentiating residual tumor or tumor recurrence from posttherapy changes in patients with head and neck tumors.

Adult↗
PubMed1999

The clinical usefulness of F-18 FDG coincidence PET without attenuation correction and without whole-body scanning mode in pulmonary lesions comparison with CT, MRI, and clinical findings.

PURPOSE: This study was undertaken to assess the clinical usefulness of fluorine-18 flurodeoxyglucose (F-18 FDG) coincidence detection (CoDe) positron emission tomography (PET) of various lung lesions by comparing it with CT, MRI, and clinical findings. MATERIALS AND METHODS: Forty-two patients with pulmonary lesions underwent CoDe PET using a dual-head gamma camera equipped with a 5/8 inch thick NaI (Tl) crystals. The patients were prepared for the study by overnight fasting. Data was acquired at approximately 1 hour after the intravenous injection of 111 to 370 MBq (3 to 10 mCi) of F-18 FDG. A spinal scan of the thorax was performed using a slip ring gantry for 30 minutes. After rebinning, routine tomographic slices were reconstructed without attenuation correction and the images were analyzed visually. RESULTS: Pathologic diagnoses and staging were obtained at surgery in nine patients; in the remaining 33 patients, aspiration cytology was available. CoDe PET detected all 35 pathologically proved malignant lesions. In nine patients who underwent surgery, seven CoDe PET studies corresponded with pathologic staging, whereas in six of the nine patients, CT and MRI corresponded with the pathologic findings. Seven patients also had benign lesions that showed FDG uptake. CONCLUSIONS: F-18 FDG CoDe PET was sensitive in the evaluation of lung lesions but was not specific for malignancy. F-18 FDG CoDe PET was more sensitive than CT and MRI in nodal staging in the limited number of patients studied thus far.

Aged↗
PubMed1997

Multiple brown tumors in parathyroid carcinoma mimicking metastatic bone disease.

An unusual case of multiple brown tumors due to parathyroid carcinoma is reported. The patient presented with lower leg pain. Plain radiographs demonstrated multiple lytic lesions of the lower legs and a Tc-99m MDP bone scan depicted multiple areas of increased uptake suggesting skeletal metastases. Tc-99m sestamibi tumor scintigraphy showed multiple sites of tumor uptake in bones and a large area of increased uptake with a cystic component in the right lower pole of the thyroid gland. An open biopsy from the right tibial lesion revealed a brown tumor. A large parathyroid carcinoma with a necrotic cyst was removed. After parathyroidectomy and right thyroid lobectomy, the patient became free of bone pain and serum PTH levels normalized. A 9-month follow-up Tc-99m MDP bone scan demonstrated less intense uptake in the pelvis, tibia, and fibulae. Nine-month follow-up tumor imaging with Tc-99m MIBI revealed disappearance of the preoperative uptake of multiple brown tumor.

Adult↗
PubMed1997

An epidemic of diarrhoea in south India caused by enteroaggregative Escherichia coli.

A diarrhoeal epidemic in a village close to Vellore was investigated in January 1996. Faecal samples were obtained from 20 subjects with diarrhoea and from 11 individuals without diarrhoea (controls) and were examined for bacterial, viral and parasitic enteropathogens. Water samples from all sources in the village were analysed. The epidemic affected all age groups (overall attack rate 15%). The mean duration of diarrhoea was 11 days. Individuals who consumed water exclusively from a borewell had a lower relative risk (RR) of disease (0.14, 95% Cl 0.02-1.01) compared to users of two open wells (RR 6.93, Cl 0.99-48.66 and RR 7.81, Cl 1.02-59.79, respectively). No conventional bacterial enteropathogens were isolated from the stool samples. Enteroaggregative Escherichia coli (EAggEC) were identified in the stool of 11 of 20 subjects with diarrhoea, and in 1 of 11 control samples (P = 0.02). All the EAggEC isolates from the patients had identical antibiotic sensitivity patterns and produced a toxin in Ussing chamber studies. Serotyping indicated that all the EAggEC from individuals with diarrhoea belonged to one or other of two serotypes. All water samples had high coliform counts and E. coli were cultured from the two open wells but not from the borewell. The evidence suggests that EAggEC was responsible for this outbreak of diarrhoea. EAggEC should be considered as a possible pathogen in unexplained diarrhoeal outbreaks in developing countries.

Adolescent↗
PubMed1997

An outbreak of food poisoning in Tamil Nadu associated with Yersinia enterocolitica.

An outbreak of food poisoning in a Tamil Nadu village, affecting 25 of 48 individuals who participated in a feast, was investigated. The risk of developing illness was associated with consumption of buttermilk (relative risk 3.8). None of the food items consumed during the feast was available for analysis. Toxin-producing Y. enterocolitica (serotype 3, biotype 4) was grown from 1 of 11 stool samples from affected individuals, as well as from a water sample from the source used to dilute the buttermilk. High titres of antibody of Yersinia were detected in 2 of 12 patients but in neither of the two groups of controls. Toxin production was noted in buttermilk incubated for 6 h with Y. enterocolitica. This is the first report from India of a food poisoning outbreak associated with this organism.

Adolescent↗
PubMed1997

Sanitation for rural communities: first win the people's support.

A latrine project in an Indian village which failed because the inhabitants were scarcely brought into its planning and execution is contrasted with a moderately successful scheme in another village where a concerted effort was made to educate the community about the value of latrines and to obtain the people's participation.

Community Participation↗
PubMed1997

Distribution of mast cells in the axillary lymph nodes of breast cancer patients.

Fifty mastectomy specimens of carcinoma breast were studied for pattern of mast cell distribution in their axillary lymph nodes. When all axillary nodes were free of tumour, the mean mast cell count was 35.75/sq mm. In the metastatic node the mast cell count was inversely proportional to the amount of metastatic tumour. The mast cell number decreased (25.64/sq mm) as the metastasis developed in any of the enlarged axillary nodes. Their count diminished further (23.55/sq mm) as the amount of metastatic tumour increased in individual nodes and when tumour involved all enlarged nodes. Mean mast cell count was lowest (10.50/sq mm) in metaplastic carcinoma. The mast cells in metastatic nodes were found mainly at the edges of tumour deposits.

Axilla↗