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Biomedical subjects

T N Sugathan

Publications and source records attributed to T N Sugathan.

At least 37 records · Page 2Linked to original sources
PubMed1993

Acute renal failure in Kuwait--a prospective study.

This prospective study was conducted over a period of 18 months (February 1989 to July 1990) in the State of Kuwait. It covered a population of 1,024,211 and eight multidisciplinary hospitals with an in-patient admission of 118,079 per year. Two hundred and twenty-six adult patients with acute renal failure (ARF) were seen and followed up by nephrologists. This made the calculated annual incidence of ARF 14.7 per 100,000 population, nearly five times that reported by the EDTA registry (Biesenbach et al. 1991). Drugs, sepsis and volume depletion were the most frequent causes, with sepsis resulting in 36% cause specific mortality compared to zero mortality with the other two. The overall mortality rate was only 14% which clearly indicated a markedly improved prognosis in cases of ARF. The prognosis in ARF depended on two major factors, viz. the type of aetiological insult and the presence of predisposing associated medical illnesses. Multiple insults, though common, do not affect the mortality rate. Secondary sepsis or gastrointestinal bleeding as a cause of death in ARF was rarely seen in our study. Those who required dialytic support for renal failure had a 45% patient mortality rate in general. Over 40% of our patients were 60 years or older compared with only 3.5% in the local population. This indicated old age as a major risk factor in the development of ARF. The overall mortality in the elderly did not differ from that in the young, but sepsis in the elderly carried a mortality rate of 60% compared to only 14.8% in the younger age group.

Acute Kidney Injury↗
PubMed1990

Penicillamine in systemic sclerosis: a reappraisal.

In a 36-month prospective trial 21 patients with systemic sclerosis (diffuse systemic sclerosis 16 patients and 5 subjects with limited cutaneous subtype) were treated with D-penicillamine. In all patients with diffuse systemic sclerosis there was objective improvement. The degree and extent of skin involvement decreased significantly (p less than 0.001), whereas no objective improvement was noted in patients with limited cutaneous subtype. Further, no systemic progression of the disease was observed during the study period. Our results suggest that a prolonged treatment with D-penicillamine in small doses is not only beneficial and effective but also free of side-effects, if used at an earlier stage.

Adult↗
PubMed1990

Reliability of death certificate diagnoses.

Consistency between death certificates and clinical records from 5 general hospitals in Kuwait was studied for 470 deaths with the following underlying or associated causes: hypertensive (HYP), ischaemic heart diseases (IHD), cerebrovascular diseases (CVD) and diabetes mellitus (DM). Direct causes were not considered since they are of little interest analytically. Only deaths with definite or most probable ascertainment were included. One cardiologist, who was provided with the WHO criteria and relevant documents on death certification, independently reviewed the records. To test the reviewer's bias and the reliability of his judgement, an adjudication process was effected by having one senior cardiologist re-review a random subsample of 140 records. The two reviewers showed good agreement. Specific diagnoses criteria for deciding the underlying cause of death in multiple morbid conditions by the reviewer were followed. Due to possible reviewer bias, we aimed at measuring the difference between initial certifiers and the reviewer rather than measuring the diagnostic accuracy of initial certifiers in reference to the reviewer. The agreement index kappa showed poor agreement between original and revised certificates. The original certificates under-estimated CVD as an underlying cause of death by 69.2%, DM by 60%, IHD by 33.5% and HYP by 31.8% in our sample. Associated causes were also consistently under-estimated by initial certifiers as compared with the reviewer. This bias calls for basing mortality statistics in Kuwait on hospital death committees' reports rather than on initial certifier death certificates, use of multiple-causes of death instead of one underlying cause and adequate training of the medical profession on the value and process of death certification.

Adolescent↗
PubMed1990

Association between HLA-DR antigens and rheumatoid arthritis in Arabs.

Eighty five Arab patients with classical and definite rheumatoid arthritis were typed to determine the prevalence of HLA A, B, C, and DR antigens. A significant increase in the prevalence of HLA-A10, B8, B21, and DR3 was found in comparison with a control population matched for age and sex. HLA-DR5 was significantly decreased in the patient group. The classical association of HLA-DR4 with rheumatoid arthritis could not be confirmed in the Arab patients resident in Kuwait, supporting reported observations in different ethnic groups of associations with HLA antigens other than HLA-DR4 and indicating a heterogeneous genetic susceptibility to rheumatoid arthritis.

Adult↗
PubMed1987

Brucellosis in Kuwait: a clinico-epidemiological study.

The 160,000 population in Adan area, Kuwait, is served by Adan Regional Hospital. During the 6 months period mid-December, 1983 to mid-June, 1984, 68 cases of brucellosis were admitted to the hospital, an annual incidence of 85/100,000 population. Of these, 84% were Kuwaitis and Bedouins. The mean age was 32 years, range 12-70 years. The male female ratio was 1.4:1. 55 patients gave histories of consuming raw milk and 4 had close contact with animals. The highest incidence of the disease coincided with the animal delivery season and the desert camping period of Kuwaiti families. It appears that air transmission of contaminated soil is one of the main routes of Brucella infections in Kuwait.

Adolescent↗
PubMed1984

Effects of acute doses of ethanol on pre- and postnatal development in the mouse.

Investigators on fetal alcohol syndrome (FAS) both clinical and experimental, have generally concentrated attention on chronic alcoholism. In an attempt to elucidate the effects of binge drinking on pre- and postnatal development, single doses of 0.01, 0.02 and 0.03 ml/g body weight of alcohol solutions (25% v/v of ethanol in saline) were administered intraperitoneally to groups of mice on days 8-12 of gestation. Controls were untreated or starved for 6 h. Fetuses collected on day 18 revealed retardation, fetal mortality and craniofacial and digital malformations. While growth retardation and fetal mortality were dose-dependent, malformations were stage-dependent. The 0.01-ml group exhibited only postaxial polydactyly of the forepaw. The reduction in fetal weight of 0.03-ml groups corresponded well with that of umbilical cord length. Following administration of single doses of 0.01 ml/g of ethanol solution on days 8-12, groups of mice were allowed to deliver. Controls were untreated or pairfed and pair watered. Pups were reared by the respective mothers and their survival and growth were observed till postconception day 71 and thereafter brother/sister matings were carried out. At least one pup in each litter remained extremely stunted and failed to reproduce. No significant differences in mortality, growth rates and reproductive capacity of the rest of the pups were observed. It is concluded that single but heavy doses of ethanol during organogenesis leads to a situation reminiscent of human FAS.

Animals↗
PubMed1983

Critical performance analysis of rotating resident doctors in Iraq.

The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.

Clinical Competence↗
PubMed1982

A measure of community health needs and actions in a rural area of Iraq. The Abu-al-Khasib experience.

A longitudinal enquiry was carried out among randomly selected households in four villages in Abu-al-Khasib district of Iraq, to study health needs as perceived by the community and actions people take when the need arises. Almost three-quarters of the spells of sickness as perceived by the community were among mothers and children. Most of the morbidity was found to be within the scope of preventive services at the local health centre level. Health centre services were underutilised. Only half of the spells of sickness were reported to the local health centres for medical care; a reason for this phenomenon is the emerging preference for care at the hands of clinical specialists. The action the community takes when a health need arises depends on their perception and this is determined by rapid social and educational development. The need to increase demand for normal care, especially that of mother and child, is stressed; this care may be strengthened through introduction of a domiciliary component.

Community Participation↗
PubMed1980

Demographic and health characteristics of a rural Iraqi population.

The population of 2 representative villages in Abu-al-Khasib field practice area of the College of Medicine, Basrah in Southern Iraq was surveyed during 1979 for baseline information relating to demographic and health characteristics. The total population covered was 3399. Women of child bearing age together with children under 15 years of age accounted for 68% of the population. The birth rate was 49 and death rate, 14.5 per 1000. Nearly 10% of the morbidity was evident among women of child bearing age. The enquiry revealed a general awareness concerning the existing health care facilities available in the area. Local health centres were utilised mainly for treatment of childhood illnesses. Only 12% of the mothers used them for care during pregnancy.

Adolescent↗
PubMedDate not supplied

Efficacy and reliability of fundus digital camera as a screening tool for diabetic retinopathy in Kuwait.

OBJECTIVE: Many screening and follow-up methods are available for detecting diabetic retinopathy (DR). However, once patients develop retinopathy, it is unclear as to what method should be used for their review. This study is designed to assess the correlation between fundus digital image and clinical examination and to develop a screening program for the early detection of sight-threatening DR using a Canon CF 60 UV fundus camera. METHODS: Patients who were not treated for DR earlier were enrolled in the study. All patients underwent digital fundus photography. The photographs were evaluated and compared with the clinical findings as recorded by retinal specialists. DR and macular edema were analyzed separately, and the correlation was statistically measured. The kappa statistic was used to estimate the extent of the agreement between the two procedures. RESULTS: A total of 92 eyes of 51 patients were eligible to be entered in the study. Comparison of the digital image of the fundus and the examination by an ophthalmologist showed a good correlation. The kappa score for retinopathy was estimated to be 93% with 95.6% concordance. The kappa score for diabetic maculopathy was 88% with concordance of 92.2%. CONCLUSION: We conclude that digital images provide an efficient method for diagnosing and classifying sight-threatening DR, particularly proliferative diabetic retinopathy (PDR). However, agreement between the digital fundus camera and clinical examination by an ophthalmologist for diabetic maculopathy detection, though substantial statistically, was not very satisfactory. It was also felt that the digital photographs can be used as a tool for teleophthalmology and can be integrated as a screening system in Kuwait.

Adult↗
PubMedDate not supplied

Scleroedema diabeticorum: a minor but often unrecognized complication of diabetes mellitus.

The association of specific dermatological complications with diabetes mellitus is well recognized. Of 100 hospital-based patients with diabetes mellitus (age 48 years +/- 2SE), 14% had scleroedema diabeticorum. The affected subjects had a higher prevalence of retinopathy (p less than 0.001) and albuminuria (p less than 0.025). The duration of scleroedema correlated with the duration of diabetes (p less than 0.005). These findings highlight the relatively common occurrence of this skin condition which often goes unrecognized in people with diabetes.

Diabetes Complications↗
PubMedDate not supplied

Comparison of lactose intolerance in healthy Kuwaiti and Asian volunteers.

OBJECTIVE: To study and compare the incidence of lactose intolerance among Kuwaiti and Asian healthy volunteers as measured by breath hydrogen level following challenge with lactose drink. SUBJECTS AND METHODS: The study involved 70 Kuwaiti and 79 Asian healthy volunteers. The volunteers were physicians, medical students and other hospital workers. The study was carried out prospectively at Amiri Hospital, Kuwait. None of the volunteers was sick or had taken antibiotics or any other drug that could influence breath hydrogen level 2 weeks prior to the study. After an overnight fast 20-ml baseline samples of exhaled air were collected from each volunteer prior to oral administration of 40 g of lactose drink. Following this, the same amount of exhaled air was collected at 30-min intervals for 2 h. All samples were analyzed for hydrogen level using a Quintron microlyzer. Hydrogen level of 20 ppm more than baseline value was considered positive. RESULTS: The basal breath hydrogen levels were 12.49 +/- 8.4 and 6.97 +/- 6.9 for Kuwaitis and Asians, respectively. Thirty-three (47%) of the 70 Kuwaitis and 46 (58%) of the 79 Asians were positive for the breath hydrogen test. The clinical symptoms of flatulence, abdominal pain, and diarrhea were associated with high levels of breath hydrogen. CONCLUSION: The findings indicate that the Kuwaiti volunteers had higher breath hydrogen levels than Asians, but the incidence of lactose intolerance was similar in both groups.

Abdominal Pain↗
PubMedDate not supplied

Utilization of the pulmonary function test laboratory in the evaluation of respiratory disorders in the Al-Amiri Hospital: a secondary medical center.

OBJECTIVE: The aim of this study was to describe the current use of pulmonary function tests (PFT) and the degree of matching between the diagnoses at referral and after the test. SUBJECTS AND METHODS: A pre-test questionnaire was administered to 464 (5-88 years) patients referred to the PFT laboratory followed by a complete PFT test. The results of the patients' tests were analyzed in terms of the diagnosis before the test, its relation to symptoms, and the rate of concordance between the diagnoses before and after the test. RESULTS: The most referrals were from the medical Outpatient Department; 61%) and the most frequent diagnosis before the test was asthma (31.8%). Of the 464 patients, 34% were currently smoking cigarettes, and the most common symptoms were chronic dyspnea (30.2%) and chronic cough (19.6%). The chronicity of symptoms showed some association with the diagnosis before PFT in the case of chronic obstructive pulmonary disease (COPD) showing the symptom of dyspnea (p = 0.05), and COPD and restrictive lung disease with cough (p < 0.05). The overall rate of concordance in matching diagnoses before and after the test was 60.4% by consultant physicians and 51.9% by non-consultants, with an overall rate of 55% by all physicians. CONCLUSION: Our findings show that there should be better utilization of the PFT laboratory by physicians in all sub-specialities and there is a need to facilitate its use to make a better functional diagnosis.

Adolescent↗