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Biomedical subjects

Zaher S Azzam

Publications and source records attributed to Zaher S Azzam.

11 recordsLinked to original sources
PubMed2006

Alveolar fluid reabsorption is increased in rats with compensated heart failure.

Alveolar fluid reabsorption (AFR) is important in keeping the air spaces free of edema. This process is accomplished via active transport of Na(+) across the alveolo-capillary barrier mostly by apical Na(+) channels and basolateral Na(+)-K(+)-ATPases. Recently, we have reported that acute elevation of left atrial pressures is associated with decreased AFR in isolated rat lungs. However, the effect of chronic elevation of pulmonary capillary pressure, such as seen in patients with congestive heart failure (CHF), on AFR is unknown. CHF was induced by creating an aorto-caval fistula (ACF) in Sprague-Dawley male rats. Seven days after the placement of the fistula, AFR was studied in the isolated perfused rat lung model. AFR in control rats was 0.49 +/- 0.02 ml/h (all values are means +/- SE) and increased by approximately 40% (0.69 +/- 0.03 ml/h) in rats with chronic CHF (P < 0.001). The albumin flux from the pulmonary circulation into the air spaces did not increase in the experimental groups, indicating that lung permeability for large solutes was not increased. Na(+)-K(+)-ATPase activity and protein abundance at the plasma membrane of distal alveolar epithelial tissue were significantly increased in CHF rats compared with controls. These changes were associated with increased plasma norepinephrine levels in CHF rats compared with controls. We provide evidence that in a rat model of chronic compensated CHF, AFR is increased, possibly due to increased endogenous norepinephrine upregulating active sodium transport and protecting against alveolar flooding.

Adrenalectomy↗
PubMed2006

Ethnic differences in population approach and experience regarding complementary-alternative medicine (CAM).

PURPOSE: The aim of this survey was to characterize one urban Arab population who turns to complementary-alternative medicine (CAM). METHODS: Outpatient participants were selected randomly by their ethnical affiliation. The questionnaire was filled during patient visit to their assigned urban outpatient clinic. The answers to the first two questions determined whether the questionnaire was to be completed or not (if at least one answer was Yes, the questionnaire was completed). RESULTS: More males (19%) seek for CAM in the Arab group in comparison to more females in the Jewish population (27%). Fifteen per cent and 7% of the individuals in the Jewish and Arab groups who used CAM have academic education. Fifty-two per cent and 27% of the Jewish and Arab populations declared themselves seculars, 72% of the Arab individuals declared to be traditionalists-religious-orthodox in their believes in comparison to 47% in the Jewish population. Twenty-eight per cent and 0% in the Jewish and Arab populations, respectively, preferred a conventional doctor (MD) in CAM practice. More than 30% in both populations preferred CAM to be delivered in medical and nursing schools. CONCLUSIONS: Forty per cent and 31% in the Jewish and Arab groups experienced complementary medicine intervention at least once. When comparing people who used complementary medicine to those who did not, it is observed that the percentage of individuals holding academic degrees in the Jewish group is higher than in the Arab interviewed in the group utilizing complementary medicine. Traditionalist-religious-orthodox individuals seek more complementary medicine in the Arab population (72%) in comparison to 47% in the Jewish individuals. Only 17% of the Arab individuals and 19% in the Jewish group knew about the adverse reactions caused by CAM therapies. More than 30% in both ethnic groups were in favor of 'legalizing' complementary medicine.

Adolescent↗
PubMed2004

Norepinephrine increases alveolar fluid reabsorption and Na,K-ATPase activity.

The purpose of this study was to determine whether alpha-adrenergic receptor agonists have a role in alveolar fluid reabsorption, via Na,K-ATPase, in the alveolar epithelium. Alveolar fluid reabsorption increased approximately twofold with increasing concentrations of norepinephrine (NE) as compared with control rats. Treatment with the nonselective alpha-adrenergic receptor agonist, octopamine, and the specific alpha(1) agonist, phenylephrine, increased alveolar fluid reabsorption by 54 and 40%, respectively, as compared with control. The specific alpha(1)-adrenergic receptor antagonist, prazosin, inhibited the stimulatory effects of NE by approximately 30%, whereas alpha(2)-adrenergic antagonist, yohimbine, did not prevent the stimulatory effects of NE. The administration of ouabain, Na,K-ATPase inhibitor, prevented the NE-mediated increase in alveolar fluid reabsorption. In parallel with these changes, NE increased Na,K-ATPase activity and protein abundance in alveolar epithelial type II cells via the alpha(1)- and beta-adrenergic receptor. We report here that NE increased alveolar fluid reabsorption via the activation of both alpha(1)- and beta-adrenergic receptors, but not alpha(2)-adrenergic receptors. These effects are due to increased activity and abundance of the Na,K-ATPase in the basolateral membrane of ATII cells.

Adrenergic alpha-Agonists↗
PubMed2004

Antibiotic utilization prevalence: prospective comparison between two medical departments in a tertiary care university hospital.

PURPOSE: The aim of this study was to analyze prospectively antibiotic utilization, comparing two in-patient Internal Medicine units. METHODS: Data on individual antibiotic utilization pattern and antibiotic costs were collected prospectively from hospitalized patient charts over a 12-month period, using the prescription-point prevalence method twice a month, for a total of 24 encounters for each admission unit. RESULTS: The antibiotic volume/patient (number of prescriptions), using the prescription-point prevalence methodology, was 330 and 557 in Internal Medicine B and D, respectively, resulting in 1.29 and 1.25 antibiotic courses/patient for each of the two units, respectively (p = 0.91). Thirty-five percent and 39% of the patients received at least one anti-microbial prescription. The total defined daily dose (DDD) and drug utilization 90% (DU90%) index for the units were 432.7 DDD, DU90% 389.7 and 727.8 DDD, DU90% 660.4, respectively (p = 0.01). The drug cost 90% index (DC90%) placed piperacillin-tazobactam in the first place in both units, while amoxycillin-clavulanic acid was in first place when the DU90% index was applied. CONCLUSIONS: A significant statistical difference was found in the anti-microbial cost analyzes of DDD, DU90% and DC90% indexes of the two units, using the prescription-point prevalence methodology. The intervention of a clinical pharmacology specialist in one of the units was effective in reducing the costs registered in that unit.

Aged↗
PubMed2004

Gender differences in the perception of chest pain.

This study investigated gender differences in pain perception as characterized by pain symptoms in patients diagnosed with unstable angina pectoris. Twenty-nine women and 32 men were asked to characterize their chest pain using a semi-open questionnaire assessing pain intensity (by numerical rating), pain location, pain characteristics, complaints following chest pain, factors that evoked or reduced chest pain, and whether the chest pain was related to heart disease. Significant gender differences were found. Women scored the intensity of their chest pain significantly higher than men (Chi-square 14.8, P < 0.0001), and related their chest pain less to heart disease (Chi-square 24.6, P < 0.0001). The women described an atypical clinical picture of chest pain that was significantly different from men's. The results are discussed in light of pschological theories regarding gender differences in pain perception. These findings imply the need for special attention to the unique clinical pictures that appear for women and men.

Aged↗
PubMed2004

Lymphangitis carcinomatosis of unknown origin presenting as severe pulmonary hypertension.

An apparently healthy 46-year-old woman was admitted because of progressive shortness of breath that had begun 2 months before her admission. Physical examination revealed a patient with respiratory distress, tachycardia, and mild jugular venous distention; otherwise, results were unremarkable. Our investigation revealed hypoxia and severe pulmonary hypertension with signs of right heart dysfunction, but no primary cause was found. The patient died 5 days after admission. Autopsy revealed pulmonary lymphangitis carcinomatosis caused by papillary carcinoma. No primary tumor was found.

Carcinoma, Papillary↗
PubMed2003

Augmentation of endogenous dopamine production increases lung liquid clearance.

We have previously reported that dopamine increased active Na+ transport in rat lungs by upregulating the alveolar epithelial Na,K-ATPase. Here we tested whether alveolar epithelial cells produce dopamine and whether increasing endogenous dopamine production by feeding rats a 4% tyrosine diet (TSD) would increase lung liquid clearance. Alveolar Type II cells express the enzyme aromatic-L-amino acid decarboxylase (AADC) and, when incubated with the dopamine precursor, 3-hydroxy-L-tyrosine (L-dopa), produce dopamine. Rats fed TSD, a precursor of L-dopa and dopamine, had increased urinary dopamine levels, which were inhibited by benserazide, an inhibitor of AADC. Rats fed TSD for 15, 24, and 48 hours had a 26, 46, and 45% increase in lung liquid clearance, respectively, as compared with controls. Also, dopaminergic D1 receptor antagonist--but not dopaminergic D2 receptor antagonist--inhibited the TSD-mediated increase in lung liquid clearance. Alveolar Type II cells isolated from the lungs of rats after they had been fed TSD for 24 hours demonstrated increased protein abundance of Na,K-ATPase alpha1 and beta1 subunits. Basolateral membranes isolated from peripheral lung tissue of tyrosine-fed rats had increased Na,K-ATPase activity and Na,K-ATPase alpha1 subunit. These data provide the first evidence that alveolar epithelial cells produce dopamine and that increasing endogenous dopamine increases lung liquid clearance.

Animals↗
PubMed2003

Patient approach and experience regarding complementary medicine: survey among hospitalized patients in a university hospital.

PURPOSE: To characterize the local population that turns to complementary medicine. METHODS: Participants were selected randomly: Medicine [A] (201 patients); Surgery [B] (100 patients); Control [C] (128 patients). The answers to the first two questions determined whether the questionnaire was to be completed. RESULTS: More females sought complementary medicine treatment, with no significant demographic differences among the groups. Nearly 20% of the subjects had academic education while 43% had completed high school. The results of the 16 significant questions were statistically different when comparing groups C and A (p = 0.025) and B (p = 0.011) respectively. A total of 16%, 12.4% and 9% of the subjects respectively preferred a physician MD as their complementary medicine practitioner and 49% [C], 34% [A] and 29% [B] respectively, favored teaching complementary medicine in medical and nursing schools. CONCLUSIONS: A total of 37% [C], 21% [B] and 27% [A] of the subjects experienced complementary medicine intervention at least once. The percentage of individuals holding academic degrees was higher in the group utilizing complementary medicine than those who did not. Only 21% of C and A groups and 12% of B group knew about adverse reactions to complementary therapies. More than 30% favored 'legalizing' complementary medicine.

Adult↗
PubMed2003

Acute vasculitis with multiorgan involvement in a patient with familial Mediterranean fever.

We report a rare case of a patient with long-standing familial Mediterranean fever who presented with sudden onset of dyspnea, abdominal pain, and cutaneous manifestations. Chest CT and histologic preparations disclosed pulmonary hemorrhage and signs of systemic vasculitis. Cyclophosphamide and steroid therapy were initiated, with marked improvement. Based on this and 1 other case, we propose that systemic vasculitis should be included as a clinical manifestation of FMF.

Acute Disease↗
PubMed2002

Na,K-ATPase overexpression improves alveolar fluid clearance in a rat model of elevated left atrial pressure.

BACKGROUND: Acute elevation of left atrial pressure (LAP) increases extravascular water and impairs active Na(+) transport in rat lungs. We have reported that overexpression of Na,K-ATPase subunit genes in the alveolar epithelium increases alveolar fluid clearance (AFC) in normal and injured rat lungs with normal LAP. We reasoned that adenovirus-mediated transfer of an Na,K-ATPase beta-subunit gene to the alveolar epithelium could improve AFC in rat lungs in the presence of acutely elevated LAP. METHODS AND RESULTS: Normal rats were infected with 4x10(9) plaque-forming units of E1a(-)/E3(-) recombinant adenoviruses that contained a cytomegalovirus promoter coupled to a rat Na,K-ATPase beta(1)-subunit cDNA (adbeta(1)) or no cDNA (adNull) 7 days before study. Na,K-ATPase alpha(1)- and beta(1)-subunit abundance in basolateral cell membranes isolated from the peripheral lung was significantly increased in adbeta(1)-infected lungs compared with sham and adNull-infected controls. In all groups, elevation of LAP reduced membrane-bound Na,K-ATPase abundance; however, abundance in adbeta(1)-infected lungs remained greater than in controls. AFC, measured with a fluid-filled isolated lung preparation in the presence of elevated LAP (15 cmH(2)O), in Na,K-ATPase beta(1)-subunit-overexpressing lungs was up to 100% greater than in controls and was not different from rats studied at normal LAP (0 cmH(2)O). CONCLUSIONS: These data suggest that alveolar overexpression of an Na,K-ATPase beta(1)-subunit can counteract downregulation of membrane-bound solute transporters owing to elevated pulmonary vascular pressures and can restore active Na(+) transport and AFC in this rat model of acute hydrostatic pulmonary edema.

Adenoviridae↗