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Biomedical subjects

N Mir

Publications and source records attributed to N Mir.

At least 19 recordsLinked to original sources
PubMed2004

Epistaxis and oral anticoagulant therapy.

Epistaxis in the anticoagulated patient poses a complicated management problem, which requires interdisciplinary collaboration. The aetiology of the majority of cases of epistaxis remains idiopathic, but an ageing population and the prevalence of ischaemic heart disease and peripheral vascular disease has meant that there are increasing numbers of patients on long term oral anticoagulant therapy. This has led to a concomitant increase in the incidence of complications experienced. We have reviewed the available relevant literature and guidelines in the current management practice in this scenario. In light of this, we propose a more standardised algorithm for the management of epistaxis in this challenging group of patients.

Administration, Oral↗
PubMed2003

[Diagnosis of septo-pyramidal defects. Our report].

OBJECTIVE: The aim of the study is to determine the characteristics of patients who are operated on because of a nasal or septal deformity: clinical features before surgery, physical examination, anterior active rhinomanometry, and computed tomography (CT). METHODS: We retrospectively reviewed prospective data collected on 372 patients operated on between January 1998 and June 2002 by means of a septoplasty or a rhinoplasty. RESULTS: Gender distribution was: 253 male, 119 female. A smaller percentage of men underwent correction of pyramidal deformities in comparison to women. Nasal endoscopic examination diagnosed associated inflammatory pathologies in 12.4% of patients. We found a significant relationship between previous nasal trauma, laterorrinia and defects of the dorsum. Anterior active rhinomanometry had a high variability between patients. CONCLUSIONS: Prospective data collected on these patients was useful to know more precisely our activities and how to adapt them to suit management decisions. Endoscopic examination proved high efficiency in the diagnosis of this pathology.

Adolescent↗
PubMed2001

Interferon alpha and zidovudine therapy in adult T-cell leukaemia lymphoma: response and outcome in 15 patients.

Adult T-cell leukaemia lymphoma (ATLL) is an aggressive disease caused by the human T-lymphotropic virus 1 (HTLV-I) with a short survival. Responses to interferon alpha (IFN-alpha) and zidovudine (AZT) have been documented but not with long-term follow-up. We treated 15 ATLL patients with IFN and AZT. Eleven patients had acute ATLL, two had lymphoma and two smouldering ATLL, with progression. The main features were: organomegaly (14), skin lesions (10), high white blood cell (WBC) count (11) and hypercalcaemia (9). Eleven patients had previously received chemotherapy and one had received an autograft. At the time of the study, seven patients had progressive disease and eight were in partial or complete clinical remission. Responses (PR) lasting 2+ to 44+ months were seen in 67%; 26% did not respond (NR) and one patient was not evaluable. Hypercalcaemia predicted a poor outcome but differences were not significant. Eight of the 15 patients have died 3-41 months from diagnosis. Median survival for the 15 patients was 18 months. Survival of the NR ranged from 4 to 20 months; six PR patients are alive 8-82 months from diagnosis. The differences in survival between NR (median: 6 months) and PR (55% of patients alive at 4 years) were statistically significant (P = 0.002). In conclusion, IFN and AZT improves the outcome of ATLL patients and helps maintain responses.

Adult↗
PubMed2001

Partner notification in HIV-1 infection: a population based evaluation of process and outcomes in Scotland.

OBJECTIVES: To evaluate the process and outcomes of HIV partner notification (PN) activity in Scotland. DESIGN: Retrospective population based study. SUBJECTS: 114 adults newly diagnosed with HIV infection (index patients) in Scotland between September 1995 and August 1996. SETTING: Healthcare settings in which all 114 new HIV diagnoses were made: 42 (37%) from genitourinary medicine; 32 (28%) infectious diseases; 18 (16%) general practice; and 22 (19%) from other sites. MAIN OUTCOME MEASURES: Number of partners notified and tested up to 9 months after initial diagnosis. RESULTS: Of 114 index patients (IPs), information on current partners was available for 102 (89%). PN was not appropriate for 47 of the 102 IPs. The remaining 55 IPs identified 63 current partners at risk, of whom 51 were notified: 44 underwent HIV testing, which yielded 11 new HIV positive diagnoses. Information on previous partners was available for only 56 IPs (49%). PN was not appropriate for 30 of the 56 IPs; the remaining 26 IPs identified 46 previous partners at risk, of whom 12 were notified: four were tested, but yielded no new diagnoses. CONCLUSIONS: Notification of current partners was performed well and was an effective strategy for identification of HIV positive individuals at a presymptomatic stage. Notification of previous partners was limited. Partner notification was attempted in a wide range of healthcare settings. Given the clinical effectiveness of antiretroviral therapy, partner notification as a tool towards early diagnosis of HIV disease deserves renewed attention.

Adult↗
PubMed2000

Effect of the growth conditions on the synthesis of a recombinant beta-1,4-endoglucanase in continuous and fed-batch culture.

Continuous culture and fed-batch fermentations were used to test the behavior of the system Bacillus subtilis DN1885(pCH7) that synthesizes a recombinant beta-1,4-endoglucanase. Continuous culture experiments were focused on the study of the instability aspects of the system as well as determination of the biomass growth rate range at which the recombinant enzyme synthesis was improved. Fed-batch fermentations were carried out to study the possibility of enhancing recombinant enzyme synthesis through the control of medium addition. It was found that, in continuous culture fermentations, the culture is less unstable at low dilution rates (dilution rate < 0.1 h(-)(1)). Also, low dilution rates give a higher specific recombinant enzyme concentration (10 times more than that obtained at high dilution rates). In fed-batch fermentation, the final recombinant enzyme concentration can be manipulated through the medium addition strategy. To increase the recombinant enzyme concentration, the carbon source has to be fed slowly, otherwise enzyme synthesis is impaired due to catabolite repression. Therefore, an increase in the biomass concentration does not necessarily imply an increase in the recombinant enzyme concentration. Higher recombinant enzyme concentrations were found in fed-batch fermentations compared to those obtained in continuous culture.

Journal Article↗
PubMed2000

Gastrointestinal mucormycosis complicated by arterio-enteric fistula in a patient with non-Hodgkin's lymphoma.

Gastrointestinal mucormycosis is a rare, often fatal, systemic infection found predominantly in immunocompromised patients. We report a case of gastrointestinal mucormycosis in a 53-year-old female with non-Hodgkin's lymphoma. Following her first course of chemotherapy, bowel obstruction developed as a result of mucormycosis. Despite treatment with antifungal therapy, she required a laparotomy owing to severe haemorrhage caused by mucormycosal invasion of her iliac artery. With continued antifungal treatment and further chemotherapy, she ultimately underwent reversal of her Hartmann's procedure and remains disease-free.

Amphotericin B↗
PubMed1999

Hepatitis E virus: relevance in blood donors and risk groups.

BACKGROUND AND OBJECTIVES: Hepatitis E virus (HEV) infection usually causes acute self-limited disease. HEV is associated with faecal-contaminated drinking water, but other vectors, such as blood, are possible. The aim of this study was to investigate the prevalence of HEV in blood donors and in two groups at high risk for parenteral infections, namely, haemodialysis patients, and children infected with HCV via blood transfusion. MATERIALS AND METHODS: We investigated the prevalence of anti-HEV in 863 blood donors, 63 haemodialysis patients, and 42 children infected post transfusion with HCV. RESULTS: The prevalence rates were 2.8, 6.3%, and zero, respectively. CONCLUSIONS: (1) The incidence of HEV in Spain is similar to that in other Western European countries, and (2) HEV is probably not transmitted parenterally to children.

Adolescent↗
PubMed1999

Malaria in inner London.

This retrospective analysis was performed to describe the malarial cases treated in an inner London hospital during a single year (1996). A total of 44 case records were available for review, 40 (90.9%) were due to Plasmodium falciparum. Thirty-seven patients were admitted to hospital, there were no deaths. Only two (4.5%) patients had taken adequate malarial prophylaxis. A total of 119 inpatient bed-days were utilized in the treatment of malaria in 1 year. In 75 (63%) of these bed-days, observation was the only reason for continued inpatient treatment. The commonest laboratory findings are mild elevation of serum bilirubin to a mean of 28 micromol/l, and a low platelet count to a mean of 124x10(12)/l. A bilirubin greater than 20 micromol/l was found in 72.9% of patients (95% CI; 58.7-87.3%). The platelet count was less than 150x10(12)/l in 77.3% of patients (95%, CI; 64.9-89.7%). We found that malaria is not uncommon in inner London. Whilst most cases are admitted few complications are usually seen. Many cases may well be able to be treated with a brief hospital admission, possibly to an accident and emergency observation ward.

Adolescent↗
PubMed1999

[Acute hepatitis E in Spain].

Hepatitis E virus (HEV) is the worldwide leading cause of non-A non-B enterically transmitted hepatitis, and affects most commonly the population in developing countries. Cases outside this area, are nearly always imported, although apparent local acquisition has been occasionally reported. We assisted three patients with acute HEV hepatitis, confirmed by the presence of serum anti-HEV IgM. One of them did not report travelling outside of Spain in the previous years. HEV has to be included in the differential diagnosis of acute non-A non-B non-C hepatitis, even in cases in which an exposure in endemic areas cannot be recalled.

Acute Disease↗
PubMed1999

Abnormal lipids and the acquired immunodeficiency syndrome: is there a problem and what should we do about it?

Recent research has shown abnormal lipids in acquired immunodeficiency syndrome (AIDS). In human immunodeficiency virus (HIV) infection hypocholesterolaemia, hypertriglyceridaemia and also low high density lipoprotein (HDL)-cholesterol have all been described. In addition, increased dense low density lipoprotein (LDL) particles and also lipoprotein (a) have been observed in some patients. The use of the protease inhibitors has been associated with diabetes mellitus and also features of insulin resistance. This article looks at these lipid abnormalities in detail and discusses possible therapeutic options that may be available, in order to address them.

Acquired Immunodeficiency Syndrome↗
PubMed1999

[Prospective study of Staphylococcus aureus with reduced susceptibility to glycopeptides].

The emergence of clinical methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides has recently been documented. Heterogeneous levels of glycopeptides susceptibility have been demonstrated in these isolates. Prospectively, we investigated the presence of S. aureus isolates with reduced susceptibility to vancomycin in our hospital from October 1997 to January 1998. The vancomycin and teicoplanin susceptibility of 248 consecutively methicillin-susceptible and -resistant S. aureus isolates from clinical and surveillance specimens was studied by broth microdilution and agar dilution methods. In addition, 108 CFU/mI of overnight cultures were plated onto BHI-agar plates containing 6 and 10 microg/ml of vancomycin and were incubated for 48 hours at 35 degrees C. Under these conditions selected colonies were subcultured onto vancomycin plates and vancomycin susceptibility (E-test) was determined again. Vancomycin MIC(90) values by the agar dilution technique for methicillin-susceptible and -resistant isolates were 2 and 4 microg/ml, respectively No selected colonies were observed on 10 microg/ml vancomycin plates. In contrast, 12 isolates, including 8 (3.9%) methicillin-susceptible and 4 (9. 1%) methicillin-resistant isolates, showed subpopulations at a frequency rate of 10(-6)-10(-7) on 6 microg/ml vancomycin plates. Nevertheless, a significant increase in MIC values for vancomycin was not observed in these S. aureus subpopulations.

Anti-Bacterial Agents↗
PubMed1998

Soft salt-mannitol agar-cloxacillin test: a highly specific bedside screening test for detection of colonization with methicillin-resistant Staphylococcus aureus.

The early detection of colonization with methicillin-resistant Staphylococcus aureus (MRSA) of patients in intensive-care units is an essential step in the strategy for preventing MRSA epidemics. In this study, tubes containing soft salt-mannitol agar with cloxacillin (6 microg/ml) (SSMAC) were prepared for inoculation of clinical samples at patients' bedsides by personnel of an intensive-care unit. A total of 1,914 swabs from different sample sites of 81 patients were dipped into SSMAC tubes, and after 24 h of incubation (in an incubator located near the intensive-care unit), an evident color change was considered by the intensive-care-unit personnel to be an MRSA alarm. Sixty-three (3.3%) SSMAC tubes were considered positive for MRSA, 1,827 (95.4%) were considered negative, and 24 (1.2%) were considered intermediate. Compared with values for parallel conventional surveillance cultures for MRSA, excluding tubes with intermediate results, the SSMAC test had a sensitivity of 72.7%, a specificity of 99.2%, a positive predictive value of 76.2%, and a negative predictive value of 99.0%. When intermediate tubes were considered positive, the corresponding values were 75.3, 98.2, 63.2, and 99.0%, respectively. The sensitivity and specificity values of the test to identify MRSA-colonized patients were 89.4 and 100%, respectively. Oropharyngeal and naris specimens were the most reliable samples for MRSA detection. False-negative results were frequent in bronchial aspirates with low (< 10(3) to 10(6) CFU/ml) MRSA counts. False-positive results were mainly due to methicillin-resistant Staphylococcus haemolyticus. The SSMAC tube is a useful, rapid, and inexpensive tool for the early identification of MRSA-colonized patients and, consequently, for the implementation of measures to prevent the spread of MRSA.

Adult↗
PubMed1998

ABO blood groups, rhesus factor and Helicobacter pylori.

BACKGROUND: The aim of this study was to demonstrate an association between Helicobacter pylori infection, ABO blood groups and Rhesus factor; providing the association between duodenal ulcer and O group blood as well as the former and H. pylori infection. METHODS: Three-hundred and one healthy subjects were prospectively studied. In all of them ABO blood groups and Rhesus factor were determined by standard techniques. Systemic IgG antibodies against H. pylori were assayed using a quantitative enzyme-linked immunosorbent assay technique (Helico-G, Porton, Cambridge, UK). RESULTS: The overall seroprevalence was 52.2%. H. pylori infection distribution was similar among ABO blood groups and Rhesus factor. No statistically significant differences were observed in mean values of IgG antibodies among different blood groups. CONCLUSIONS: Distribution of H. pylori seroprevalence does not differ between different ABO or Rhesus factor blood groups. This excludes a possible link between this microorganism and the high ulcer prevalence in O blood group.

ABO Blood-Group System↗
PubMed1998

Hepatitis E virus: relevance in blood donors and other risk groups.

BACKGROUND AND OBJECTIVES: Hepatitis E virus (HEV) infection usually causes an acute self-limited disease. HEV is associated with feces-contaminated drinking water, but other vectors, such as blood, are possible. The aim of this study was to investigate the prevalence of HEV in blood donors and in two groups at high risk of parenteral infections, namely, hemodialysis patients and children infected with hepatitis C virus (HCV) via blood transfusion. MATERIALS AND METHODS: We investigated the prevalence of anti-HEV in 863 blood donors, 63 hemodialysis patients, and 42 children infected with HCV posttransfusion. RESULTS: The prevalence rates were 2.8, 6. 3%, and 0 respectively. CONCLUSIONS: (1) The incidence of HEV in Spain is similar to that in other western European countries, and (2) HEV is probably not transmitted parenterally to children.

Adolescent↗