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Biomedical subjects

P Hansotia

Publications and source records attributed to P Hansotia.

At least 19 recordsLinked to original sources
PubMed1997

Sleep, sleep disorders and motor vehicle crashes.

There is wide consensus that drowsiness and sleep during driving put the driver and others at high risk for motor vehicle crashes. A large percentage of both private automobile and commercial vehicle crashes and crash fatalities are associated with the sleepy driver each year. Sleepiness in persons without sleep disorders may occur from potentially preventable causes such as sleep deprivation, drinking alcohol or taking sedative medications. Sleepiness also occurs uncontrollably in persons with certain sleep disorders. It is important, therefore, for persons to have a diagnosis of a sleep disorder, objectively confirmed with an MSLT, to be considered for restriction of driving privileges. The MSLT serves as a marker for the sleep disorder and also as evidence of effective treatment. While sleepiness is widespread, this regulation addresses only the highest risk group for attention. Proposed guidelines for sleep related disorders and driving in Wisconsin are presented with this background in mind.

Accidents, Traffic↗
PubMed1993

Seizure disorders, diabetes mellitus, and cerebrovascular disease. Considerations for older drivers.

For those conditions in which loss of consciousness is the main issue, such as epilepsy, factors that contribute to risk of seizure recurrence are central to the determination of driver safety. Thus, high- and low-risk groups may be identified and factors that contribute to high risk checked. These factors also serve to develop a program to reduce such risk in the future. In the population with seizure disorders, young males under age 25 have the highest risk for traffic accidents and violations. Other factors associated with high risk are partial complex seizure type, history of drug toxicity with anticonvulsant medications, alcohol abuse or poor compliance for medications, and history of psychiatric illness. For conditions such as cerebrovascular accidents or Parkinson's disease, the recognition of the diagnosis alone is insufficient to determine driver competence. In these illnesses, the task is to recognize levels of failure of individual skills and function that specifically render a person incompetent for safe driving. Such a precise determination is currently not possible in individuals with cerebrovascular accidents or other forms of brain injury (e.g., trauma) or degenerative brain disease (e.g., Parkinson's disease). There is intuitive and general agreement that there are those so severely affected that driving has become impossible or very dangerous. Alternately, there are also those with these conditions whose driving skills and competence are virtually unaffected and pose no risk to traffic safety. Physicians vary widely in their ability and experience in judging the competence and safety of those in between these two extremes. For this reason, a standardized approach is essential both to ensure the avoidance of unnecessary bias as well as to ensure the safety of the driver and the general public. At some time in the future when all the necessary driving skills are identified and appropriate tests are developed to judge them, a battery of tests for the elderly at age 65 and at regular intervals thereafter may be used. Until then, some form of clinical judgment and legal regulation may have to be adopted. One option would be to adopt a rule similar to that in the United Kingdom where all persons with TIAs or cerebrovascular accidents would automatically suspend driving for 3 months because of the high risk for recurrence of both cerebrovascular as well as ischemic heart disease in that interval.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗
PubMed1991

The effect of epilepsy or diabetes mellitus on the risk of automobile accidents.

BACKGROUND: Previous studies of possible associations between chronic medical conditions and traffic safety have been inconsistent and subject to bias because of the incomplete identification of affected persons. Recent advances in the diagnosis and management of epilepsy and diabetes mellitus have improved the control of these disorders and suggest a need to reexamine the risk of traffic mishaps among patients with these conditions. METHODS: We conducted a population-based retrospective cohort study of 30,420 subjects 16 to 90 years of age, with and without epilepsy or diabetes mellitus. Subjects included all the licensed drivers in seven contiguous ZIP Code areas in which the Marshfield Clinic and St. Joseph's Hospital, Marshfield, Wisconsin, are the primary sources of medical care. Standardized rates of moving violations and accidents over a four-year period (1985 through 1988) were compared in affected and unaffected cohorts. RESULTS: Standardized mishap ratios for subjects with diabetes were 1.14 for all moving violations (P = 0.23) and 1.32 for accidents (P = 0.01); for subjects with epilepsy the ratios were 1.13 for moving violations (P = 0.26) and 1.33 for accidents (P = 0.04). CONCLUSIONS: We conclude that drivers with epilepsy or diabetes mellitus have slightly increased risks of traffic accidents as compared with unaffected persons. The increases in risk observed in our study were generally smaller than those in previous studies, and we believe they are not great enough to warrant further restrictions on driving privileges.

Accidents, Traffic↗
PubMed1991

Automobile driving and epilepsy: a medical perspective.

The risks of persons with controlled seizure disorders for traffic safety are reviewed. Previous studies provide insufficient and inaccurate data on this subject. Moreover, the advances in diagnosis and treatment of epilepsy and the improved safety and technology of automobiles and roads have made previous studies out of date and inapplicable to current circumstances. A number of vital questions concerning the determination of safe prognosis remain unanswered. Studies to address these questions and ways of improving future decision making are suggested.

Accidents, Traffic↗
PubMed1990

Eye movement patterns in REM sleep.

Eye movements in 6 healthy men and women were studied for recurrent patterns during REM sleep. The REM periods of nocturnal polysomnograms, on 2 consecutive nights, were analyzed in each subject. A discrete scale from 1 to 8 was used to record each eye position. The total number of recorded eye positions for the 2 nights of testing varied from 1314 to 3006. The distributions of eye movement were similar for males and females, for both nights of testing for each subject, among individual REM periods, and between subjects. This was in spite of marked differences in the number and length of REM periods, and in the number of eye movements per minute of REM sleep. In 5 of 6 subjects there was a marked tendency for the eyes to move between the 2 opposite lateral positions. Regardless of the eye position, the opposite movement was generally most likely, with an underlying tendency to return to the most opposite of the two lateral positions. In the remaining subject the opposite movement was also favored, but in this subject eye movements were more likely to be vertical rather than horizontal. Our data suggest that eye movements in REM sleep are organized in complex recurring patterns, with marked similarities between subjects. The significance of these patterns and the significance of deviations from these patterns require further study.

Adult↗
PubMed1986

Evaluation and treatment of headache. Practical approach to a common symptom.

Chronic headache pain has many causes but is generally attributed to one of three mechanisms: muscular contraction, vascular inflammation, or traction or inflammation of pain-sensitive structures. Because of the wide variety of headache types and the often-confusing terminology and classification systems in use, evaluation of headache can be difficult. A step-by-step approach to patient workup, including patient history, physical examination, and appropriate tests, can help the physician pinpoint the underlying problem and determine appropriate therapy. Long-term drug therapy is effective for most patients with vascular headaches. For headaches of psychogenic origin, therapy includes psychotropic drugs, biofeedback training, counseling, and behavior modification. More research in the area of mind-body interactions will lead to improved management of chronic headache of nonorganic origin.

Antidepressive Agents, Tricyclic↗
PubMed1986

Granulocyte dysfunction and myotonic dystrophy.

A 52-year-old Caucasian male with typical features of myotonic dystrophy (MD) developed a lung abscess and was found to have a mild atypical cyclic neutropenia. Granulocyte function testing revealed a defect in phagocytosis, bactericidal activity and chemotaxis. The defects were less severe at the nadir of the granulocyte counts. Skin windows demonstrated that the granulocyte defects were not just an in vitro artifact. The patient was treated with lithium carbonate and improved. Mobilization into a skin window and clinical MD were unchanged. Studies of his 10 children and 2 siblings, including granulocyte function tests and complete neurological evaluations were obtained. The 4 children with abnormal parameters of granulocyte function all had definite evidence of MD. Two children had equivocal findings of MD and the others were normal. There was minimal evidence of granulocyte dysfunction in these children. Twelve of 19 unrelated patients with MD had evidence of impaired granulocyte function with the most consistent defect being chemotaxis in response to bacterial factor. Mild granulocyte dysfunction is frequently associated with MD, but severe dysfunction with many defects is uncommon but can occur, as in this family. There was a tendency for the more severely afflicted members of this family to have more pronounced granulocyte dysfunction. Longitudinal testing in this family may determine any relationship between the granulocyte dysfunction and the onset of MD, as well as any correlation with the progression of the disorder. MD patients who develop infection should have granulocyte function tests as part of their evaluation.

Adolescent↗
PubMed1985

Sleep disturbances and severity of Huntington's disease.

We studied sleep functions in two patients with mild and five with moderately severe Huntington's disease. In mild disease there was chorea, but intelligence, mental function, and sleep were all normal. In moderately severe disease, intelligence and mental function were also affected, and there was a sleep disturbance characterized by prolonged sleep-onset latency, increased interspersed wakefulness, and reduced sleep efficiency.

Humans↗
PubMed1983

Neuropsychological testing of Huntington's patients. Clues to progression.

A battery of neuropsychological and academic tests was administered to 16 patients with Huntington's chorea, several of whom received multiple testings. Generalized mental impairment was evident for most of the present sample of patients, but performance IQ was more affected than verbal IQ. Comparisons of impairments on the different tasks relative to expectations for normal adults suggest that measures requiring psychomotor problem solving, sequencing, and memory were most impaired. Sensory, fine motor, and visual motor tasks, however, also revealed relatively severe deficits. Elementary language and academic skills showed least impairment. Follow-up data were congruent with these trends. Results are consistent with other findings in the suggestion they offer for commonalities in the progression of mental impairment associated with this disease. The scarcity of severe impairment in elementary language and academic functions also supports the view that focal deficits are uncharacteristic of Huntington's dementia.

Adult↗
PubMed1983

Cerebrospinal fluid monoclonal gammopathy in multiple myeloma and Waldenström's macroglobulinemia.

Serum ratios of monoclonal immunoglobulin (Ig) to total protein, monoclonal immunoglobulin to albumin, CSF/serum Ig-albumin index, and CSF to serum monoclonal immunoglobulin were obtained in 21 patients with multiple myeloma and 2 with Waldenström's macroglobulinemia. Twelve patients (3 with CNS complications) showed CSF monoclonal proteins similar to their serum. CSF IgA levels above 10 mg/dl, IgG levels above 25 mg/dl, CSF-serum IgG ratios above 0.0034 and CSF-serum IgA ratios above 0.0051 were seen in patients with neurologic complications. Our preliminary data may signal early CNS involvement in multiple myeloma.

Antibodies, Monoclonal↗
PubMed1981

Spindle coma: incidence, clinicopathologic correlates, and prognostic value.

Three hundred seventy comatose patients were studied clinically and electrographically. Of these, 5.7% showed the "spindle coma" electroencephalogram (EEG) pattern. Spindle coma was associated with head injury, nontraumatic intracranial hemorrhage, cerebral anoxia, and other causes. Levels of consciousness, pupillary responses, ocular movements, patterns of respiration, and muscle tone all failed to correlate with either the occurrence or the outcome of "spindle coma." At autopsy, lesions were most frequent in the centrum medianum, thalamic nuclei, and rostral brainstem, but no characteristic lesion was found. Our data indicate that sleep spindles during coma are unrelated to prognosis.

Adolescent↗
PubMed1975

Diphenylhydantoin and fragility of erythrocytes in normal subjects and in patients with hereditary spherocytic anemia.

To study the effects of diphenylhydantoin (Dilantin, DPH) on membrane function, DPH was incubated with erythrocytes from normal individuals and from patients with congenital spherocytic hemolytic anemia and osmotic fragility measured. The resulting curves show that DPH reduces the osmotic fragility of normal and spherocytic erythrocytes. In the presence of ouabain, DPH still had a protective effect on erythrocytes even though ouabain alone increases hemolysis of erythrocytes at certain saline concentrations. This study shows that erythrocyte fragility can be manipulated in vitro and provides a basis for studies in vivo.

Adolescent↗