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Biomedical subjects

R L Mehta

Publications and source records attributed to R L Mehta.

46 records · Page 3Linked to original sources

Binding and catabolism of aggregated immunoglobulins containing C3b by U937 cells.

We studied Fc receptor and C3b receptor (CR1) function on U937 cells, a human monocyte cell line. C3b was incorporated into stable soluble heat aggregates of 125I-IgM (A-IgM) and 125I-IgG (A-IgG) by using functionally pure classical pathway components. C3b incorporation was verified by the ability of aggregates to bind to human red cells and by cosedimentation of 125I and 131I during ultracentrifugation. Cell uptake and degradation of A-IgG X C3b was increased up to twofold compared with A-IgG not containing C3b molecules. However, A-IgG X C3b bound to CR1 after Fc receptors were blocked with nonradiolabeled A-IgG were also not endocytosed and catabolized. Moreover, A-IgM X C3b was bound but not degraded by U937 cells. As expected, uptake of A-IgM without C3b was negligible. CR1-mediated binding of A-IgM X C3b was specifically inhibited both by a murine monoclonal antibody against the human CR1 that blocks C3b binding and by C3b oligomers generated by trypsin activation of C3, but not by monoclonal antibodies against the iC3b receptor (CR3). We conclude that CR1 on U937 cells cause increased binding of A-IgG, and this increased binding leads to increased Fc-mediated endocytosis and catabolism of model immune complexes. However, binding of soluble ligands by CR1 alone, even when binding is multivalent, does not lead to endocytosis and degradation of soluble ligands bearing C3b.

Antigen-Antibody Complex↗

Conservative vs. surgical management of septic abortion with renal failure.

The role of surgery in the management of postabortum renal failure complicated with extensive uterine sepsis, perforation or peritonitis is controversial. This study compares the course and final outcome of 14 patients (66.6%) conservatively managed with appropriate antibiotics, fluid or blood replacement and dialysis, with seven patients (33.3%) for whom hysterectomy or laparotomy was undertaken in addition. Whereas all 14 patients treated conservatively died as the result of uncontrolled septicemia, three of the seven surgical patients recovered completely. Extensive necrosis with perforation of the uterine wall was confirmed either at laparotomy or at autopsy in all 21 women. To reduce mortality, the authors recommend early surgical intervention for patients suffering from postabortum renal failure complicated with uterine sepsis or perforation.

Abortion, Septic↗

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology.

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Adolescent↗

Determination of fluid shifts during chronic hemodialysis using bioimpedance spectroscopy and an in-line hematocrit monitor.

Effective ultrafiltration in hemodialysis requires a plasma refilling rate (PRR) sufficient to support blood volume. Knowledge of PRR and compartment shifts helps in understanding intradialytic events and may improve fluid removal. Simultaneous measurements with in-line hematocrit and bioimpedance spectroscopy were done in eight patients (17 runs) and extended for 15-60 min beyond the end of hemodialysis to determine fluid shifts and evaluate the relationship between changes in blood volume, extracellular fluid volume, and PRR. Absolute blood volumes, plasma refilling rates, and interstitial fluid volumes were calculated. Significant correlations were noted between different compartment volumes and the change in weight and estimates of plasma refilling. Pooling all runs, the change in interstitial fluid volume from beginning to end of hemodialysis correlated with the change in weight (r = 0.63, p = 0.01). Changes in PRR tracked changes in interstitial fluid volume for patients with two or more runs. In conclusion, the combination of in-line hematocrit and bioimpedance spectroscopy allows the quantification of different compartment volumes and PRR. Interstitial fluid volume may be a major determinant of PRR. This information would permit the development of strategies to reduce intradialytic morbidity.

Adult↗

Attitudes of Canadian nephrologists toward dialysis modality selection.

OBJECTIVE: To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design. PARTICIPANTS: Members of the Canadian Society of Nephrology. INTERVENTION: A mailed survey questionnaire. RESULTS: A 66% response rate was obtained. Decisions about modality are reported to be based most strongly on patient preference (4.4 on a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3.85), and rehabilitation (3.69), while neither facility (1.78) nor physician (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemodialysis (HD) is slightly overutilized (2.53), continuous ambulatory peritoneal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distribution to maximize survival revealed that a type of HD should constitute 62.8% of the mix, with more emphasis on cycler PD (14.9%), community-based full care HD (13.8%), self-care HD (14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fell slightly to 57.8%. CONCLUSIONS: These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysis system without compromising patient outcomes.

Attitude of Health Personnel↗

Anticoagulation during continuous renal replacement therapy.

Proper anticoagulation is an important factor in the function and life of the filter in CAVH or CAVHD and is the Achilles heel for CRRT. Several options now exist for anticoagulation and can be selected based on individual patient characteristics, availability of various anticoagulants, and local expertise. The choice of anticoagulant should be based on multiple factors, including A) the access site and whether an external pump is being used; B) the nature and geometry of the membrane; C) whether enhancements for ultrafiltration, such as predilution, are used; and D) the clinical status of the patient and preexisting coagulation abnormalities. Since anticoagulation in continuous therapy lasts longer than in intermittent hemodialysis, careful selection and monitoring are essential to prevent complications.

Acute Kidney Injury↗