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Biomedical subjects

P Reddy

Publications and source records attributed to P Reddy.

At least 19 recordsLinked to original sources
PubMed2006

Nephrotic syndrome associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation.

Chronic graft-versus-host disease (cGVHD) is the most common late complication of allogeneic hematopoietic cell transplantation (HCT) causing significant morbidity and mortality. The kidneys are not considered a target organ for cGVHD in humans, although animal models show renal damage. Renal involvement in patients with cGVHD, presenting as nephrotic syndrome (NS), has rarely been reported in patients who received allogeneic transplantation. Herein we describe, by far, the largest series of nine patients with NS associated with cGVHD, including two patients who received a reduced-intensity regimen. Pathological features of membranous nephropathy were the most common finding on renal biopsy. The clinical course of the NS was temporally associated with the classical features of cGVHD in all but one of the nine cases. The clinicopathologic features of NS in our series as well as reports in the literature demonstrate an immunopathologic process typical of antibody-mediated damage consistent with cGVHD. Treatment directed against antibody-mediated damage, such as anti-B-cell antibody may play an important role in ameliorating NS associated with cGVHD.

Adult↗
PubMed2006

A to G transitions at 260, 386 and 437 in DAZL gene are not associated with spermatogenic failure in Indian population.

The autosomal DAZL (Deleted-in-Azoospermic-Like) gene, mapped to the short arm of the human chromosome 3, is the precursor for the Y-chromosomal DAZ cluster, which encodes for putative RNA-binding proteins. Mutations in the DAZL have been reported to be associated with spermatogenic failure in Taiwanese population but not in Caucasians. As there was no study on Indian populations, we have analysed the entire coding sequences of exons 2 and 3 of DAZL in a total of 1010 men from Indian subcontinent, including 660 infertile men with 598 non-obstructive azoospermia, 62 severe oligozoospermia and 350 normozoospermic fertile control men, to investigate whether mutation(s) in the DAZL is associated with male infertility. Interestingly, none of our samples (1010) showed A386G (T54A) mutation, which was found to be associated with spermatogenic failure in Taiwanese population. In contrast, A260G (T12A) mutation was observed in both infertile and normozoospermic fertile control men, without any significant association with infertile groups (chi2= 0.342; p = 0.556). Similarly, we have found a novel A437G (I71V) mutation, which is also present in both infertile and normozoospermic fertile control men without any significant difference (chi2 = 0.476; p = 0.490). Our study clearly demonstrates the complete absence of the A386G (T54A) mutation in Indian subcontinent and the other two mutations --A260G (T12A) and A437G (I71V)--observed are polymorpic. Therefore, we conclude that these mutations in the DAZL gene are not associated with male infertility in Indian subcontinent.

Adenine↗
PubMed2005

Medical record review of deaths, unexpected intensive care unit admissions, and clinician referrals: detection of adverse events and insight into the system.

AIMS AND METHODS: To determine whether a programme of continuous medical record review of deaths, unexpected intensive care unit (ICU) admissions, and admissions referred by medical and nursing staff for specific review, would provide a range of adverse events from which to gain insight into the healthcare system of a large paediatric referral hospital. A quality assurance programme was commenced in 1996. RESULTS: Over a six year period there were 103 255 admissions; 1612 (1.6%) records were reviewed, from which 325 adverse events were detected. Events were associated with operations, procedures and anaesthesia (56.5%), diagnosis and therapy (24%), drug and fluid management (12.6%), and system issues (7%). Medical records were reviewed from 23 of the 28 clinical units. Review of the records and analysis of the adverse events triggered many system changes. CONCLUSIONS: The findings suggest that continuous medical record review may be a valuable method for the detection of adverse events and identifying system issues in children's hospitals.

Child↗
PubMed2005

Global priority setting for Cochrane systematic reviews of health promotion and public health research.

BACKGROUND: Systematic reviews of health promotion and public health interventions are increasingly being conducted to assist public policy decision making. Many intra-country initiatives have been established to conduct systematic reviews in their relevant public health areas. The Cochrane Collaboration, an international organisation established to conduct and publish systematic reviews of healthcare interventions, is committed to high quality reviews that are regularly updated, published electronically, and meeting the needs of the consumers. AIMS: To identify global priorities for Cochrane systematic reviews of public health topics. METHODS: Systematic reviews of public health interventions were identified and mapped against global health risks. Global health organisations were engaged and nominated policy-urgent titles, evidence based selection criteria were applied to set priorities. RESULTS: 26 priority systematic review titles were identified, addressing interventions such as community building activities, pre-natal and early infancy psychosocial outcomes, and improving the nutrition status of refugee and displaced populations. DISCUSSION: The 26 priority titles provide an opportunity for potential reviewers and indeed, the Cochrane Collaboration as a whole, to address the previously unmet needs of global health policy and research agencies.

Evidence-Based Medicine↗
PubMed2004

West Nile virus encephalitis causing fatal CNS toxicity after hematopoietic stem cell transplantation.

We describe here a patient who died of progressive CNS deterioration following allogeneic stem cell transplant with West Nile virus as the sole pathogen on the cerebrospinal fluid and brain tissue analysis. A 50-year-old male with Philadelphia chromosome-positive acute lymphocytic leukemia (ALL) underwent allogeneic PBSCT from his HLA identical sister. After engraftment, the patient developed fever with progressive and ultimately fatal neurological deterioration. Imaging studies of the brain including CT and MRI scans were remarkable for mild low attenuation lesions of the white matter. CSF analysis was negative for neoplastic cells, bacteria, AFB, CMV, HSV, fungal infections and leukemic relapse. However, serological analysis of both the serum and CSF was positive for West Nile virus-specific IgM antibodies. At autopsy, West Nile virus PCR and cultures were positive in the mid-brain tissue. Electron micrographs showed evidence of viral particles. Given the recent increase in the spread of West Nile virus infections and the increased susceptibility of BMT patients to infectious complications, West Nile virus encephalitis should be considered in patients undergoing transplantation.

Autopsy↗
PubMed2004

Remicade as TNF suppressor in patients with myelodysplastic syndromes.

Remicade, a chimeric human-murine monoclonal antibody capable of neutralizing tumor necrosis factor alpha was given to 37 low-risk myelodysplastic syndromes (MDS) patients in two cohorts; 5 and 10 mg/kg intravenously every 4 weeks for 4 cycles. Median age was 68 years, 33 had primary MDS, 14 had refractory anemia (RA), 14 RA with ringed sideroblasts, 9 RA with excess blasts. Nine patients stopped therapy prior to completing 4 cycles, 3 from cohort 1 and 6 from cohort 2 and response was evaluated using the International Working Group criteria in 28 patients who completed the 4 cycles. Six patients showed disease progression, 14 had stable disease and 8 showed hematologic responses, 3/15 (20%) in cohort 1 and 5/13 (38%) in cohort 2. Two patients had multi-lineage responses, 2 had > 100% increase in absolute neutrophils, 1 had > 1 gm/dl increase in hemoglobin, 1 had reduction in blasts from 7% to 1%, and 2 had minor cytogenetic responses (> 50% reduction in + 8 and 20q-metaphases respectively). We conclude that Remicade may have a variety of activities in low risk MDS patients, is well tolerated with a high patient compliance, and may be considered for combination therapy in the future.

Aged↗
PubMed2003

Anatomical and possible clinical relationships between the calcaneofibular ligament and peroneus brevis--a pilot study.

The authors have observed in their clinical practice patients presenting with chronic retromalleolar pain following lateral ankle injuries. It has been hypothesized that persistent retromalleolar pain following a supination sprain may be due to peroneus brevis (PB) tendon tears (Boruta et al. 1990). The aims of this study were to investigate whether an anatomical relationship exists between the calcaneofibular ligament (CFL) and PB, and if so, the significance of this relationship in the positions of supination sprain and talar tilt test. Seven out of eight cadaveric ankles demonstrated fibrous connecting tissue between the tendon of PB and CFL. Four of the eight ankles demonstrated PB tendon abnormalities. The presence of connecting tissue between CFL and PB suggests an anatomical basis for concomitant damage to the PB tendon with a supination sprain, thus supporting the hypothesis that there may be an anatomical basis for persistent retromalleolar pain subsequent to injury to the lateral ankle complex.

Ankle Injuries↗
PubMed2003

The effects of Panax ginseng on quality of life.

Panax ginseng is marketed and used to maintain natural energy, increase mental and physical abilities, improve mood and promote general health and well-being. Panax ginseng has been studied in a number of randomized clinical trials investigating its effect on physical and psychomotor performance, cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections. Equivocal results have been demonstrated for many of these indications. P. ginseng is also commonly used to promote quality of life (QoL). As a result, ginseng's effect on QoL has become an increasingly important endpoint in clinical trials. We reviewed all studies (n = 9) that determined the effect of P. ginseng on QoL. P. ginseng's has been evaluated at dosages of 80-400 mg. Study duration has spanned from 2 to 9 months. Several QoL measures have been used, ranging from widely accepted core instruments to unpublished investigator-derived questionnaires. In addition, many of the investigators utilized ginseng extracts that were supplemented with vitamins and minerals while others used only standardized ginseng extract. Populations evaluated also differed in terms of underlying morbidity. Nearly every study evaluated (n = 8) demonstrated some degree of QoL improvement. Beneficial effects were evident within instrument summary component scores but improvement in overall composite scores of QoL was rarely seen. However, findings were equivocal. While populations evaluated varied in terms of underlying morbidity, there did not appear to be a substantial difference in their response to ginseng with respect to QoL. Despite some positive results, improvement in overall health-related quality of life cannot, given the current research, be attributed to P. ginseng. However, the possibility that various facets of QoL may have improved and the potential of early transient effects cannot be discounted.

Adjuvants, Immunologic↗
PubMed2003

Cigarette use among male and female grade 8-10 students of different ethnicity in South African schools.

OBJECTIVES: To provide data on the prevalence of cigarette use by male and female South African students of different ethnic backgrounds in grades 8-10 (ages < or = 11 to > or = 17 years), their age of initiation of cigarette use, as well as their access to cigarettes through underage sales. DESIGN: A nationally representative survey was conducted using self administered questionnaires translated into seven languages. SETTING: School based. PARTICIPANTS: Students in grades 8-10 in all of South Africa's nine provinces. OUTCOME MEASURES: The prevalence data for current users of cigarettes (smoked on one or more days in 30 days preceding the survey), and for the age of initiation (first smoking cigarettes before the age of 10) were analysed. RESULTS: Of the 160 selected schools, 123 schools participated in the survey. The completed survey comprised 6045 of 7074 selected students; 23% of the sample reported being current users of cigarettes. Significantly more males (28.8%) than females (17.5%), and significantly more "Coloured" students than "Black/African" students were classified as current smokers. Sex was the strongest contributor to the prediction of current smoking status. On the issue of age of initiation, 18.5% of students reported having first smoked cigarettes before the age of 10 years with more "Black/African" students than "Coloured" having done so. CONCLUSIONS: In order to tailor tobacco control programmes to the needs of students, historical "racial"/ethnic and sex differences have to be taken into account. Specific determinant studies are needed to understand these differences and to develop appropriate responses.

Adolescent↗
PubMed2002

Cost analysis of fentanyl and remifentanil in coronary artery bypass graft surgery without cardiopulmonary bypass.

BACKGROUND: Opiates such as remifentanil have the potential to reduce time to extubation (TTE), shorten length of stay (LOS) and lower hospital costs, because of a short duration of action. However, the cost of remifentanil is approximately ten times higher than longer-acting opiates like fentanyl. OBJECTIVES: The objective of this analysis was to compare TTE, LOS and total hospital costs between patients who received remifentanil and fentanyl during off-pump bypass surgery. METHODS: The study was prospective and observational in design. Consecutive patients who underwent off-pump cardiac bypass surgery and received either remifentanil or fentanyl from September 1998 to August 1999 were screened for study entry. Patient bills and charges were converted to costs using hospital cost-to-charge ratios. The percent of patients' extubated in the operating room (OR), LOS and hospital costs were compared between the groups. RESULTS: The baseline demographics (age: 66 +/- 12 years mean +/- SD; female 36%) and intraoperative variables were similar between the remifentanil (n=39) and fentanyl (n=20) groups. Patients given remifentanil during surgery were significantly more likely to be extubated in the OR than patients given fentanyl (15 vs. 64%; P < 0.001). Mean LOS was similar in both groups (7.3 +/- 3.1 vs. 8.3 +/- 2.7 days; P=0.27). Patients who received remifentanil incurred lower pulmonary function testing ($0 +/- 0 vs. $34 +/- 103; P=0.045), recovery room ($31 +/- 40 vs. $65 +/- 33; P=0.002) and lower ward costs ($3973 +/- 1719 vs. $4808 +/- 1794; P=0.09) than patients who received fentanyl. Anesthesia costs were higher among patients who received remifentanil ($476 +/- 102 vs. $416 +/- 130; P=0.06). Medical and surgical supplies, OR, intensive care unit, laboratory, respiratory therapy, pharmacy, radiology and transfusion costs were similar between the two groups. The total cost was $15 272 +/- 5556 and $15 616 +/- 4169 in the remifentanil and fentanyl groups, respectively (P=0.81). CONCLUSION: Remifentanil, when used in off-pump bypass surgery, is associated with an increased likelihood of extubation in the OR. However, LOS and total hospital costs remain unchanged.

Aged↗
PubMed2001

Interleukin-18 regulates acute graft-versus-host disease by enhancing Fas-mediated donor T cell apoptosis.

Interleukin (IL)-18 is a recently discovered cytokine that modulates both T helper type 1 (Th1) and Th2 responses. IL-18 is elevated during acute graft-versus-host disease (GVHD). We investigated the role of IL-18 in this disorder using a well characterized murine bone marrow transplantation (BMT) model (B6 --> B6D2F1). Surprisingly, blockade of IL-18 accelerated acute GVHD-related mortality. In contrast, administration of IL-18 reduced serum tumor necrosis factor (TNF)-alpha and lipopolysaccharide (LPS) levels, decreased intestinal histopathology, and resulted in significantly improved survival (75 vs. 15%, P < 0.001). Administration of IL-18 attenuated early donor T cell expansion and was associated with increased Fas expression and greater apoptosis of donor T cells. The administration of IL-18 no longer protected BMT recipients from GVHD when Fas deficient (lpr) mice were used as donors. IL-18 also lost its ability to protect against acute GVHD when interferon (IFN)-gamma knockout mice were used as donors. Together, these results demonstrate that IL-18 regulates acute GVHD by inducing enhanced Fas-mediated apoptosis of donor T cells early after BMT, and donor IFN-gamma is critical for this protective effect.

Acute Disease↗
PubMed2001

Oral amiodarone for prevention of atrial fibrillation after open heart surgery, the Atrial Fibrillation Suppression Trial (AFIST): a randomised placebo-controlled trial.

BACKGROUND: Beta-blockers and amiodarone reduce the frequency of atrial fibrillation after open-heart surgery but the effectiveness of oral amiodarone in older patients already receiving beta-blockers is unknown. We have assessed the efficacy of oral amiodarone in preventing atrial fibrillation in patients aged 60 years or older undergoing open-heart surgery. METHODS: We did a randomised, double-blind placebo-controlled trial in which patients undergoing open-heart surgery (n=220, average age 73 years) received amiodarone (n=120) or placebo (n=100). Patients enrolled less than 5 days before surgery received 6 g of amiodarone or placebo over 6 days beginning on preoperative day 1. Patients enrolled at least 5 days before surgery received 7 g over 10 days beginning on preoperative day 5. FINDINGS: Patients on amiodarone had a lower frequency of any atrial fibrillation (22.5% vs 38.0%; p=0.01; absolute difference 15.5% [95% CI 3.4-27.6%]), and there were significant differences in favour of the active drug for symptomatic atrial fibrillation (4.2% vs 18.0%, p=0.001), cerebrovascular accident (1.7% vs 7.0%, p=0.04), and postoperative ventricular tachycardia (1.7% vs 7.0%, p=0.04). Beta-blocker use (87.5% amiodarone vs 91.0% placebo), nausea (26.7% vs 16.0%), 30-day mortality (3.3% vs 4.0%), symptomatic bradycardia (7.5% vs 7.0%), and hypotension (14.2% vs 10.0%) were similar. INTERPRETATION: Oral amiodarone prophylaxis in combination with beta-blockers prevents atrial fibrillation and symptomatic fibrillation and reduces the risk of cerebrovascular accidents and ventricular tachycardia.

Administration, Oral↗
PubMed2001

Extracellular matrix gene responses in a novel ex vivo model of bladder stretch injury.

PURPOSE: Congenital bladder outlet obstruction from either mechanical or functional causes often results in clinical bladder fibrosis. We tested the hypothesis that early molecular changes relevant to fibrosis occur in response to stretch injury of the bladder wall and that specific extracellular matrix receptors mediate some of these responses. Furthermore, we introduce a novel ex vivo model of bladder injury which has advantages over previously described in vivo bladder outlet obstruction models by uniquely interrogating molecular responses to bladder distention. MATERIALS AND METHODS: The bladders of Sprague Dawley rats were hydrodistended transurethrally, the ureters and bladder neck were ligated, and the whole bladder was excised and incubated in culture medium in the distended state. At fixed time-points control and stretch bladders were snap frozen, RNA was extracted, and semiquantitative reverse transcription polymerase chain reaction for collagens I, III and XII, and RHAMM (receptor for hyaluronic acid) messenger (m) RNA was performed to establish trends in stretch related gene expression. Bladder specimens were also subjected to routine histological evaluation. RESULTS: An average 3-fold reduction in collagen I mRNA expression was seen with 8 hours of static stretch (p <0.05). Bladder stretch increased collagen III mRNA levels approximately 2.5-fold (p <0.05). Whole bladder collagen XII and RHAMM mRNA were elevated as much as 5-fold (p <0.05) with stretch. Blocking RHAMM function significantly attenuated these matrix gene responses (p = 0.01 to 0.005). CONCLUSIONS: The ex vivo model of whole bladder stretch is viable and easily reproducible for the study of molecular pathophysiological mechanisms contributing to maladaptive bladder disease. Furthermore, collagen gene transcription is revealed to be rapidly responsive to stretch injury of the bladder. Intact RHAMM receptor function is involved in these responses. Elucidation of the intermediate steps in this response to injury may allow for the development of novel therapeutic strategies which may prevent pathological matrix remodeling seen in clinical bladder disease.

Animals↗
PubMed2001

Pathological evaluation of intervertebral disc tissue specimens after routine cervical and lumbar decompression. A cost-benefit analysis retrospective study.

BACKGROUND: After decompression of cervical and lumbar nerve roots for radicular pain, pathological evaluation of the extracted disc material is commonly performed. Although histological examination rarely detects clinically significant unsuspected disease, it remains a common practice in most hospitals in the United States. To determine the cost-effectiveness of this routine practice, we conducted a retrospective study. The results are contained within this report. METHODS: Using the University Neurosurgery database, we retrospectively identified 1,387 patients who had spinal decompression surgery (laminectomy and/or discectomy). These cases were broadly classified into routine and non-routine cases depending on the preoperative diagnosis. Benign and noninfectious cases were classified as routine; malignant and all other cases were classified as nonroutine. We reviewed the medical records and pathology reports of these routine and nonroutine cases in an attempt to study the efficacy of the pathological evaluation of the disc material. The cost-benefit value of histopathology in these cases was analyzed, retrospectively. RESULTS: In all routine cases, the histopathology was consistent with benign disc disease and yielded no additional information that could have altered the treatment plan. In the nonroutine cases, however, histopathology was significant in the management of the patient. The cost factor for pathological study was the same for both case groups. CONCLUSIONS: Pathological study of intervertebral disc specimens is cost beneficial only in cases with significant preoperative clinical diagnoses. Pathological evaluation of routine herniated nucleus pulposus extracted during decompressive surgeries is not warranted.

Cervical Vertebrae↗
PubMed2001

The benefits of anthropological approaches for health promotion research and practice.

In recent years health education practitioners have been looking for ways to extend the social psychological analysis of human behavior with approaches that focus on the cultural and social context of human behavior. In this article the value of the 'thick description' approach, borrowed from anthropology, is explored by examples from the Caribbean and South Africa. It demonstrates that an anthropological approach has much to offer as a basis for sound interventions for understanding human behavior. However, although an anthropological approach offers valuable starting points for interventions, its broad scope exceeds the traditional goals of health education (changing health beliefs, health counseling). Interventions will not aim at informing individuals, but at improving cultures. They may concern the change of basic cultural and social structures such as gender roles. To limit the risk of ethnocentrism, adequate ways need to be developed to make optimal use of the information thick description offers, while avoiding ethnocentrism. The article ends with a discussion concerning the assets of a dialogical approach towards health promotion. A dialogue between health promoters and their target population may help solve the problem of ethnocentrism in broadly scoped interventions.

Anthropology, Cultural↗
PubMed2001

Medicaid's beta 2-agonist recipients and their treatment by national standards.

OBJECTIVE: To determine whether Connecticut's Medicaid high-dose beta 2-agonists (HDB) users (> 1 canister/mo) are receiving medications according to National Institutes of Health (NIH) asthma guidelines, and to compare healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month. METHODS: All Connecticut Medicaid pharmacy claims from April to December 1998 were examined. Subjects were included if they had an asthma diagnosis and were excluded if they had chronic obstructive pulmonary disease. The percentage of HDB users not receiving long-term-control medication; receiving low doses of a long-term-control medication; and receiving oral, nebulized, or long-acting beta 2-agonists was determined. Healthcare utilization between HDB users and patients receiving no more than one canister of a short-acting beta 2-agonist per month was also compared. RESULTS: Of 1599 profiles included, 14% (n = 223) were HDB users. Twenty-five percent of these patients did not receive a long-term-control medication, and 35% received low doses of a long-term-control medication. Claims for oral, nebulized, and long-acting beta 2-agonists were submitted for 4%, 29%, and 22% of HDB users, respectively. More claims for short courses of oral corticosteroids were submitted for HDB users than for patients receiving no more than one canister of a short-acting beta 2-agonist per month (n = 1376) (1.99 +/- 3.60 vs. 0.39 +/- 1.07 mean +/- SD; p < 0.001). HDB users visited their physicians' offices an average of 4.72 +/- 24.08 times per month compared with an average of 2.40 +/- 14.4 office visits per month for patients receiving no more than one canister of a short-acting beta 2-agonist (p = 0.04). CONCLUSIONS: A high proportion of Connecticut's Medicaid HDB users are not receiving medications according to NIH guidelines. HDB users were significantly more likely to receive short courses of oral corticosteroids and required significantly more office visits than patients receiving no more than one canister of a short-acting beta 2-agonist per month. Intervention programs designed to improve adherence to the guidelines will be developed.

Adolescent↗
PubMed2001

Does prophylaxis against atrial fibrillation after cardiac surgery reduce length of stay or hospital costs?

Atrial fibrillation (AF) is common after cardiac surgery and may result in stroke, need for permanent pacemaker, hemodynamic instability, and sustained AF. Studies determining the effect of prophylaxis against AF in cardiac surgery on length of stay (LOS) and hospital cost were reviewed. A MEDLINE search from January 1966-November 2000 was conducted using the medical subject heading (MeSH) "atrial fibrillation." The search was limited to clinical trials in the English language. In five of the seven studies reviewed, the frequency of postoperative AF was significantly reduced with prophylactic amiodarone or sotalol. In only one study were LOS and costs significantly reduced. Whereas there is strong evidence that prophylactic drug therapy reduces the frequency of postoperative AF, there is little evidence of an economic advantage. Future studies are warranted that examine costs beyond initial hospitalization; compare prophylaxis administered selectively to high-risk patients with prophylaxis administered universally; and compare prophylaxis with the combination of rate control and anticoagulation with cardioversion if AF persists.

Amiodarone↗