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Biomedical subjects

S S Bakhshi

Publications and source records attributed to S S Bakhshi.

18 recordsLinked to original sources
PubMed2001

Code of practice for funeral workers: managing infection risk and body bagging.

There is substantial variation in the advice given to funeral workers on handling bodies with infection risk. Inconsistent advice results in inappropriate practice. A model code of practice is presented that uses risk assessment in response to statutory and executive responsibilities to provide health and safety advice to funeral workers. The code of practice should increase compliance with safety requirements, avoid unnecessary bagging and allow bereaved families freer access to the deceased.

Bacterial Infections↗
PubMed1999

Ecological analysis of ethnic differences in relation between tuberculosis and poverty.

OBJECTIVE: To examine the effect of ethnicity on the relation between tuberculosis and deprivation. DESIGN: Retrospective ecological study comparing incidence of tuberculosis in white and south Asian residents of the 39 electoral wards in Birmingham with ethnic specific indices of deprivation. SETTING: Birmingham, 1989-93. SUBJECTS: 1516 notified cases of tuberculosis. MAIN OUTCOME MEASURES: Rates of tuberculosis and measures of deprivation. RESULTS: Univariate analysis showed significant associations of tuberculosis rates for the whole population with several indices of deprivation (P<0.01) and with the proportion of the population of south Asian origin (P<0.01). All deprivation covariates were positively associated with each other but on multiple regression, higher level of overcrowding was independently associated with tuberculosis rates. For the white population, overcrowding was associated with tuberculosis rates independently of other variables (P=0.0036). No relation with deprivation was found for the south Asian population in either single or multivariable analyses. CONCLUSIONS: Poverty is significantly associated with tuberculosis in the white population, but no such relation exists for those of Asian ethnicity. These findings suggest that causal factors, and therefore potential interventions, will also differ by ethnic group.

Adolescent↗
PubMed1998

Appointment of medical officers of health (food safety) is essential for achieving food safety objectives in the UK. Response to food borne illness section (4.44-4.49) of the White Paper, the Food Standard Agency--a force for change, MAFF January 1998.

National surveys reveal that the public has lost confidence in the safety of food. There is lack of co-ordination and failure to overcome institutional barriers at many levels throughout the food chain. The abolition of the post of medical officer of health and the public health departments of local government over which it presided, in view of many, including members of parliament, has been the most damaging of all changes to the public health and many have asked for the restoration of this post. Health departments have no overall statutory responsibility for food safety. The medical expertise of medical officers of health provided the executive authority with the necessary support in managing and controlling outbreaks of food poisoning, a point emphasised in the recommendations made by an inquiry set up by the government following the worst ever outbreak of food poisoning in Lanarkshire, Scotland, UK. Only such an appointment at local level will restore public confidence in food safety.

Attitude to Health↗
PubMed1998

Tuberculosis mortality in notified cases from 1989-1995 in Birmingham.

This is a retrospective descriptive study examining medical records of notified cases of tuberculosis in Birmingham, UK, who died before completion of treatment, plus notified cases identified at postmortem. During the study period, 1989-1995, there were a total of 2088 notifications of tuberculosis of which 75 (3.6%) died. This case-fatality rate is lower than that reported from earlier studies, a finding which may be due to improved ascertainment, earlier diagnosis and improved treatment in recent years. Forty-five deaths (60%) were in males and 30 (40%) in females. The median age at death was 66 y. Forty-five deaths (60%) were among the white ethnic group, 21 (28%) among persons of Indian sub-continent origin, 4 (5.3%) among Black Caribbeans and 5 (6.6%) among the other ethnic groups. Case-fatality rates were significantly higher (P < 0.01) in caucasians (9.4%) than in Asians (1.5%) and only half of this difference was explained by the age of those affected. Twenty-two (29%) cases were confirmed by a positive sputum smear and a further 23 (31%) by a positive sputum culture. Eighteen (24%) cases also had histological confirmation. Twelve (16%) cases were identified on autopsy. The case fatality rate in respiratory disease was significantly higher (RR = 1.19, P > 0.05) than in non-respiratory disease. As delay in diagnosis is likely to be the main contributing factor leading to death, a high index of suspicion of tuberculosis is needed when investigating elderly patients with general chronic illness, especially if there are prolonged respiratory symptoms. Early diagnosis will reduce mortality as the disease rapidly responds to treatment.

Black or African American↗
PubMed1998

Does vitamin D deficiency account for ethnic differences in tuberculosis seasonality in the UK?

OBJECTIVES: Notifications of tuberculosis in England and Wales are reported to peak in the summer season. The purpose of this study was to confirm that finding and to determine to what extent patients of Indian Subcontinent (ISC) ethnic origin contributed to the seasonality. The clinical presentation of the disease is presumed to occur some months following reactivation of the endogenous latent focus of tuberculosis infection. There arises the possibility of vitamin D deficiency producing immunological inadequacy at the end of winter and beginning of spring. PATIENTS AND METHODS: Monthly (or 4-weekly) aggregated data over 7 years were collected from the three countries of mainland Britain, England, Wales, Scotland and from the city of Birmingham in England. The notifications from Birmingham were divided into those of ISC ethnic origin and 'whites'. The presence or absence of seasonality was determined by fitting a sinusoidal curve by the technique called 'cosinor analysis'. In this method amplitude gives a measure of the extent of the seasonal variation. RESULTS: The summer peak of clinical diagnosis was confirmed in the UK series from England, Wales and Scotland. In England and Wales without Scotland a larger seasonal variation was present. Scotland, with a lower proportion of population of ISC ethnic origin, was examined separately and the results in Scotland alone failed to confirm seasonality. In the data from Birmingham, seasonality was confirmed with a greater amplitude, particularly in those over 60 years of age. The finding was influenced by those of ISC ethnic origin, seasonality not being present in the 'white' population. CONCLUSION: The results from Birmingham are very striking, but there were almost three times as many patients in the ISC ethnic group as in indigenous 'white' patients. A series with larger numbers of 'white' patients would be necessary to confirm the absence of seasonality in the 'white' population. The discussion reviews the evidence that vitamin D may have an important hormonal role in immunological defence in the prevention of tuberculosis.

Causality↗
PubMed1997

The epidemiology of tuberculosis by ethnic group in Birmingham and its implications for future trends in tuberculosis in the UK.

OBJECTIVES: To describe the epidemiology of tuberculosis (TB) in Birmingham, UK, by ethnic group and to assess the implications of the findings for future trends in TB in the UK. METHODS: Retrospective review of records of all patients notified with TB in Birmingham during 1989-1994. RESULTS: The decline in TB notifications in Birmingham halted and then reversed in 1987-1992. Trends in overall notifications were mainly influenced by trends in cases of Asian origin. Crude notification rates in 1989-1994 are 17 times higher in Asian than Caucasian residents (p < 0.01). Rates in African Caribbean residents are also statistically significantly higher than in Caucasians (p < 0.01) but significantly lower than in Asians. Crude rates for Asian people born abroad are 4.1 times higher than for Asians born in the UK (p < 0.01) but only 3.8% of Asian patients had been resident in the UK for less than 1 year. The group accounting for the highest number of cases were female Asians aged 20-29, followed by male Asians of the same age. Age-specific rates show that incidence increases with age in both Asian and white groups, with a small peak in 20-29-year-old Asians. TB is uncommon in all Caucasian age-groups under 50 years of age (less than 1 per 10,000) but is relatively common in all Asian age-groups over 15 years of age (over 10 per 10,000). CONCLUSIONS: The different epidemiology of TB in the Caucasian and Asian populations in the UK suggests that from about the second decade of the next century, TB in the UK will almost be entirely a problem of ethnic minorities and that even if new infection was eliminated now in Asian people, cases due to reactivation would continue to occur until the third quarter of the next century.

Adolescent↗
PubMed1997

Framework of epidemiological principles underlying chemical incidents surveillance plans and training implications for public health practitioners.

The Department of Health requires District Health Authorities to have plans ready for dealing with chemical incidents to protect public health. The three aspects of a chemical incident are environmental, medical toxicology, and public health advice and information. Public health surveillance plans require generation of a causal hypothesis and assessment of risk. Training provision should emphasize the need for application of epidemiological precepts in drawing up such surveillance plans. The epidemiological principles are systematically outlined with emphasis on their significance.

Documentation↗
PubMed1992

Hepatitis A and travel abroad: a study of notifications in Birmingham.

One hundred and seventy-two cases of viral hepatitis A (or 'infective hepatitis' or 'infective jaundice' judged to be viral hepatitis A) were notified in Birmingham in the 15 months from January 1990 to March 1991. Forty patients had travelled abroad in the three months prior to onset, 30 of whom had been to the Indian subcontinent. A survey of general practitioners attending to patients going abroad indicated that human normal immunoglobulin (HNIG) was rarely given to intending travellers, whereas other recommended immunisations often were. Furthermore, a sizeable proportion of travellers did not attend their general practitioners prior to departure. Interventions aimed at encouraging attendance, and the administration of HNIG prior to travel to endemic areas, could reduce the incidence of hepatitis A substantially, particularly in areas with a large population of Asian origin.

Adolescent↗
PubMed1989

Diphtheria and tetanus vaccine: a comparative study of reactogenicity.

One hundred and eighty children aged between four and six years were intensively followed-up after receiving diphtheria/tetanus vaccine. A daily diary was used as the method of assessment to elicit as many transient effects as possible. The results confirm the predicted profile of these vaccines with a high incidence of local effects but little general disturbance. The two vaccines used were essentially similar in results, showing a peak incidence of effects on Days 2-4 followed by a rapid decline in adverse effects. All the side effects reported were transient, self-limiting and did not require medical assistance.

Affect↗
PubMed1986

An outbreak of tuberculosis in a children's hospital.

A 3-year-old girl was admitted to a children's hospital; subsequently her mother was found to have pulmonary tuberculosis with smear-positive sputum. Of over 400 patients, their families and staff at risk in the hospital, 30 inpatients, three outpatients, two sibling visitors and one staff member became infected. A retrospective cohort study of exposed inpatients identified exposure duration, exposure proximity and primary diagnosis as independent predictors of infection risk. Children with neoplastic disease who were being treated with cytotoxic and immunosuppressive therapy with clotting factors were at a greater risk of developing clinical disease including disseminated infection. Altogether three generations of infected children and adults were diagnosed amongst community and hospital contacts in this extended outbreak. These findings support current recommendations for the follow-up of highly susceptible casual contacts of cases of pulmonary tuberculosis with smear-positive sputa.

Adult↗
PubMed1982

An outbreak of infectious hepatitis investigated using radioimmunoassays for hepatitis A virus antibody.

An outbreak of suspected infectious hepatitis in a primary school was investigated using sensitive diagnostic methods for hepatitis A. A total of 116 sera from children were tested for the presence of both IgM and IgG antibodies to hepatitis A (HAV). The results were compared to those obtained for samples from a control school. IgG antibodies were present in 45% and 10% of the children in the outbreak and control schools respectively.

Antibodies, Viral↗