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Biomedical subjects

P Shah

Publications and source records attributed to P Shah.

At least 19 recordsLinked to original sources
PubMed1997

Procalcitonin in acute malaria.

Procalcitonin, the precursor of calcitonin, is elevated in patients with sepsis and infection (base-line values <0.1 ng/ml). We determined PCT in 38 hospitalised patients with suspected malaria. All of them had signs of infection and had recently returned from Africa. Plasmodium vivax was proven in 15, Plasmodium falciparum in one and an infection with both species was found in another case (n = 17). PCT was determined on admission and the days thereafter. In one patient PCT was determined every 4 hours on the first day. The maxima of the PCT concentration on day 0 and 1 were 5.3 ng/ml with proven Malaria and 0.43 ng/ml without. At the following days we found a decrease to normal values (<0.5 ng/ml) which correlated with the general condition of the patient. At a cut-off point of 2 ng/ml we found a sensitivity of 52%, positive predictive value of 74%, specificity of 86%, negative predictive value of 71%. procalcitonin, malaria

Africa↗
PubMed1997

Stricture of the duodenum and jejunum in an abused child.

We report a case of abdominal injury secondary to child abuse in which the child had both a duodenal hematoma and contained perforations of the duodenum and proximal jejunum. These injuries were evaluated by both CT scan and upper gastrointestinal (GI) series. The child's nausea and vomiting persisted despite conservative treatment; after 3 weeks a repeat upper GI series demonstrated high-grade duodenal obstruction. An exploratory laparotomy was performed and a calcified, fibrotic mesentery and strictures in the distal duodenum and proximal jejunum were found. To our knowledge, this unusual complication of blunt abdominal trauma has not been described in association with child abuse.

Abdominal Injuries↗
PubMed1997

In vitro synergy of paclitaxel (Taxol) and vinorelbine (navelbine) against human melanoma cell lines.

Paclitaxel (PTXL) (Taxol), a taxane, and vinorelbine (VRB), a semisynthetic vinca alkaloid drug, have tubulin as their common intracellular target, but inhibit growth by binding to different sites. We evaluated in vitro the antiproliferative activity of these two drugs as single agents and in combination, against two human melanoma cell lines, G361 and StM111a. The SRB (sulphorhodamine B) assay was used to determine growth inhibition. Possible drug-drug interaction at the cellular level was assessed by constructing Isoboles (Isobologram analysis) and applying the concept of an 'envelope of additivity'. Both agents were active in the nanomolar range at clinically achievable concentrations. The mean IC50 for G361 was 46.6 nM (PTXL) and 19.9 nM (VRB) after a 1 h drug exposure. Mean IC50 (1 h) for StM111a was 9.7 nM (PTXL) and 26.9 nM (VRB). Isobole analysis at the isoeffect levels of 25%, 50% and 75% indicated that drug interaction was predominantly synergistic (supra-additive) when paclitaxel and VRB were added concurrently for 1 h to cultures of StM11 1a or G361. In some experiments, this synergy was observed with particularly low concentrations of paclitaxel (3 nM) and VRB (0.01 nM). A new points were located within the envelope of additivity or in the subadditive (antagonism) region of the isobole. An overall synergy was also found if the data were analysed by the median effect analysis. The effect of these agents on the cytoskeleton and ultrastructure were studied with immunofluorescence and electron microscopy, respectively. These results confirm the in vitro inhibitory activity of paclitaxel and VRB against malignant melanoma, but more importantly the two drugs appear to act synergistically at relatively low concentrations.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Primary open angle glaucoma and hypothyroidism: chance or true association?

The prevalence of hypothyroidism in British patients with primary open angle glaucoma (POAG) was examined. A recently reported study from Montreal had shown a significant increase (p < 0.004) in biochemical hypothyroidism (23.4%) in a population of 64 POAG patients compared with controls (4.7%). Mechanisms for a possible causal association between the two diseases are discussed, including mucopolysaccharide deposition in the trabecular meshwork and vasculopathy altering ocular bloodflow. Reports of improved glaucoma control following treatment of hypothyroidism are discussed. This study examined 100 consecutive patients with POAG in a specialist glaucoma clinic. All patients were questioned regarding symptoms of thyroid dysfunction and previous thyroid disease. All patients not already taking thyroxine underwent an assay of thyroid stimulating hormone. The 4% (95% CI 1.1-9.4%) prevalence of overt hypothyroidism in our study shows no clinically significant increase either over controls in the Montreal study or over our local population. We conclude that in our local population there is no evidence for a clinically important association of hypothyroidism with glaucoma.

Aged↗
PubMed1997

Logistics of performing an ophthalmic assessment in elderly inpatients.

To assess the feasibility of performing an ophthalmic assessment on elderly inpatients, we examined 48 patients over 75 years of age who were consecutively admitted to an acute elderly-care ward. Difficulties were encountered in 35 patients (73%). By employing simple methods to overcome these problems, useful information was obtained in all cases and the time taken to complete the examination ranged from six to 20 minutes (mean 7.5 minutes). Doctors looking after elderly patients should be encouraged to assess visual function and must not be deterred by anticipated logistical difficulties.

Aged↗
PubMed1996

The separability of working memory resources for spatial thinking and language processing: an individual differences approach.

The current study demonstrates the separability of spatial and verbal working memory resources among college students. In Experiment 1, we developed a spatial span task that taxes both the processing and storage components of spatial working memory. This measure correlates with spatial ability (spatial visualization) measures, but not with verbal ability measures. In contrast, the reading span test, a common test of verbal working memory, correlates with verbal ability measures, but not with spatial ability measures. Experiment 2, which uses an interference paradigm to cross the processing and storage demands of span tasks, replicates this dissociation and further demonstrates that both the processing and storage components of working memory tasks are important for predicting performance on spatial thinking and language processing tasks.

Adult↗
PubMed1996

Long-term follow-up of a single continuous adjustable suture in penetrating keratoplasty.

Penetrating keratoplasty was performed on 30 patients using a single adjustable continuous 10/0 nylon suture. Seventeen patients had astigmatism of 4.00 dioptre cylinders (DC) or more and were adjusted. The latest adjustment was at 32 weeks. Following adjustment there was a significant reduction in median post-keratoplasty astigmatism from 6.00 DC to 2.50 DC (p < 0.001). Thirteen patients, with astigmatism of 4.00 DC or less, were not adjusted. Median astigmatism for the non-adjusted group was 3.00 DC and for the entire group was 2.88 DC. Long-term refraction and suture status were monitored with time. Mean follow-up was 112 weeks (range 53-170 weeks). Over the study period the entire group showed significant 'long-term astigmatic drift' (LTAD), from 2.88 DC to 3.25 DC (median drift, 1.25 DC; range, 0.00-5.50 DC) (p < 0.001). Suture adjustment and suture removal showed no significant effect on LTAD. With suture removal between 32 and 84 weeks median LTAD was 1.50 DC. For suture removal after 84 weeks, median LTAD was also 1.50 DC, but the range of LTAD was 1.50 DC, compared with a larger range of 5.00 DC in the earlier suture removal group. The technique of single continuous adjustable sutures for penetrating keratoplasty is safe, effective in reducing astigmatism, but may need modification to further enhance long-term refractive stability.

Adolescent↗
PubMed1996

Computed tomography morphology of the adrenal glands of patients with Addison's disease.

To study the morphology of the adrenal glands of patients with Addison's disease an ultrasound and a computed tomographic scan of the adrenal glands were performed in 28 patients with Addison's disease. Thirteen patients had bilateral, asymmetric adrenal enlargement. In six of these patients, areas of necrosis and calcification were also seen. Six patients had atrophic glands with calcification and nine patients had normal/atrophic glands without calcification. After instituting appropriate treatment, computed tomography (CT) was repeated between 6 months and 3 years later in 10 of the 13 patients with adrenal enlargement. A reduction in gland size was noted in all patients and one had functional recovery. We conclude that the appearance of the adrenal glands on CT depends not only on the nature of the underlying disease but also on the duration of the illness and the type of treatment.

Addison Disease↗
PubMed1996

Sertraline response in adults with mental retardation and autistic disorder.

BACKGROUND: Self-injury and aggression are common reasons for urgent psychiatric referral of persons with mental retardation and autistic spectrum disorders. Although the treatment prescribed for these problems has traditionally been neuroleptic medication, serotonin reuptake inhibitors such as sertraline may result in significant clinical improvement as well as fewer side effects. METHOD: The authors administered sertraline in an open trial to nine consecutively admitted adult mentally retarded outpatients presenting with target behaviors of self-injury and/or aggression. Most patients (N = 6) were mildly or moderately mentally retarded by DSM-III-R criteria; five had comorbid autistic disorder. Prescribed dosages ranged from 25 mg to 150 mg daily, based on observed clinical responses. Clinical Global Impressions (CGI) ratings were made at baseline and again after sertraline treatment for at least 28 days. RESULTS: Sertraline led to improvement in CGI ratings of overall clinical severity in eight of nine subjects; mean +/- SD improvement in CGI ratings was 2.44 points +/- 1.67. Discontinuation of the treatment was necessary in only one patient, after 18 weeks of sertraline treatment, because of agitation and worsening of self-picking. Side effects were otherwise minimal. CONCLUSION: These findings from a clinical sample suggest that sertraline is promising in the treatment of self-injury and aggression. Double-blind controlled studies of sertraline and other serotonin reuptake inhibitors in the treatment of self-injury and aggression in patients with mental retardation and with autistic disorder are warranted.

1-Naphthylamine↗
PubMed1996

Dyspnoea, lung function & respiratory muscle pressures in patients with Graves' disease.

To understand the pathophysiology of dyspnoea in patients with hyperthyroidism, lung function, maximum inspiratory, expiratory respiratory muscle pressures (MIP and MEP) and intensity of dyspnoea (after six minutes walking test) were recorded in 12 consecutive patients with active Graves' disease. Reassessment was done after achieving euthyroidism with 8-12 wk of carbimazole therapy. Patients covered similar distance during 6 min walking before and after carbimazole therapy. However, there was a significant reduction in dyspnoea following euthyroidism. This was accompanied by significant decrease in respiratory rate, minute ventilation, forced expiratory volume in one second (FEV1%) and improvement in the forced vital capacity (FVC). No significant changes in tidal volume (TV) and maximum-midexpiratory flow rates (MMEFR), MIP and MEP were observed. Lung function parameters, MIP and MEP did not correlate with the severity of dyspnoea. Serum T4 levels correlated inversely with the distance covered during 6 min walking test, MIP and MEP. To conclude, increased breathing effort in presence of reduced FVC may lead to dyspnoea during hyperthyroid phase in patients with active Graves' disease. Lack of correlation between the severity of dyspnoea and abnormalities in lung function suggests that other mechanisms of dyspnoea may also operate in these patients.

Adult↗
PubMed1996

Autonomic dysfunction and peripheral vasodilatory response in diabetes.

Twenty three diabetes mellitus patients were investigated for peripheral vasodilatory response in relation to degree of autonomic dysfunction. The non-insulin dependent diabetes mellitus (NIDDM) patients had significant degree of autonomic dysfunction. Based on standard scoring system for evaluating autonomic dysfunction, diabetics were divided into 'borderline' (n = 12) and 'severe' (n = 11) diabetic autonomic neuropathy (DAN) groups. The severe DAN patients showed significantly lower pressor response when compared to borderline DAN patients. Severe DAN was also associated with significant peripheral vascular dysfunction. The severe DAN patients largely had no clinical manifestation of peripheral vascular dysfunction. Thus, at subclinical level patients with significant autonomic dysfunction do exhibit peripheral vascular dysfunction.

Adult↗
PubMed1995

Comparative evaluation of classical intrafascial-supracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy--our first 200 cases.

A novel way of performing endoscopic intrafascial supracervical hysterectomy is presented. By using the endoscopic approach for dissection as well as uterine extraction using the serrated-edged macro-morcellator, we avoid giving the patient a colpotomy incision and its inherent post-operative discomfort. A further modification involves nearly complete excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervical stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complications are prevented by avoiding dissection of the parametrium at the level of endocervix. Comparison of data of the pelviscopic CISH procedure with the laparotomy approach in our preliminary series (n = 190) confirms our claims as to its safety. Data on long-term postoperative evaluation are ongoing, but the initial reports deny any postoperative discomfort. Larger randomized studies are required to prove its value compared with the existing techniques. We believe that with its multitude of benefits, the classic intrafascial serrated-edged macro-morcellated (SEMM) hysterectomy (= CISH) may emerge as an attractive alternative to conventional hysterectomy.

Adult↗
PubMed1995

Insulin autoimmune syndrome as a cause of spontaneous hypoglycemia in alcoholic cirrhosis.

Hypoglycemia in fulminant hepatic failure and hyperinsulinemia in cirrhosis are well-described phenomena. A patient with alcoholic cirrhosis who developed fasting hypoglycemia with an extremely high immunoreactive insulin level and a mildly elevated C-peptide level is reported. An insulinoma was excluded by detailed radiological imaging of the pancreas and by endoscopic ultrasonography. Detection of very high levels of insulin autoantibodies with no prior exposure to exogenous insulin confirmed the diagnosis of insulin autoimmune syndrome. During his hospital course, the patient developed another rare syndrome, acquired inhibitors to factor V, which led to the fatal coagulopathy that resulted in his death. Insulin autoimmune syndrome is the third leading cause of spontaneous hypoglycemia in Japan, where it has been associated with a variety of diseases and drugs. Outside of Japan, only approximately 20 cases have been reported and usually have been found in the context of an underlying autoimmune disorder or prior exposure to sulfhydryl drugs. It is believed that this is the first case reported outside Japan occurring in association with alcoholic liver disease, and the first in the world with coexisting acquired inhibitors to factor V.

Autoimmune Diseases↗
PubMed1995

Chronic calcific pancreatitis of the tropics (CCPT): spectrum and correlates of exocrine and endocrine pancreatic dysfunction.

The exocrine and endocrine pathophysiology of chronic calcific pancreatitis of the tropics (CCPT) remains elusive. The objective of this study was to evaluate the spectrum and correlates of the exocrine and endocrine pancreatic dysfunction in CCPT. Thirty-seven consecutive patients with a clinico-radiological diagnosis of CCPT were stratified into three subgroups: CCPT-normal glucose tolerance (NGT), CCPT-abnormal glucose tolerance (IGT) and CCPT-diabetes mellitus (DM). Ten ketosis resistant young diabetic (KRDY) patients, 10 classical insulin dependent diabetes mellitus (IDDM) patients and 18 healthy matched controls were included for comparison. Fecal chymotrypsin (FCT) levels and blood C-peptide levels (basal and post i.v. glucagon stimulation) were estimated for assessing the exocrine and endocrine pancreatic functions, respectively. Sonography was performed to evaluate the pancreatic size and ductal diameter. Pancreatic exocrine-endocrine correlation was examined by studying the C-peptide/fecal chymotrypsin ratio (CP/FCT) (CP/FCT of normal controls = 1). Mean FCT levels in all 3 subgroups of CCPT (NGT: 3.4 micrograms/g; IGT: 0.82 microgram/g; DM: 2.4 micrograms/g) were very low (87-96% reduction in exocrine pancreatic dysfunction; mean FCT in healthy controls was 22.8 micrograms/g) (P < 0.0001). In contrast, KRDY and IDDM patients displayed 50-54% reduction in pancreatic acinar function (P < 0.001). Basal and stimulated C-peptide levels progressively fell in the 3 CCPT subsets (NGT: 0.23 and 0.46 > IGT: 0.14 and 0.29 > DM 0.10 and 0.14) (P < 0.01). CCPT patients exhibited pancreatic atrophy and ductal dilation (> 3 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗