Biomedical subjects
Publications and source records attributed to A Ashraf.
Magnetic resonance imaging (MRI), often useful for detecting spinal lesions, was unsuccessful in revealing spinal arteriovenous malformations in four patients, as recorded here. Patients with persistent neurological symptoms after "normal" MRI scans should undergo additional imaging procedures.
A Kimray-Greenfield filter was inadvertently placed in the right atrium of a patient with multiple pulmonary emboli. A percutaneous technique with the use of a chest tube and basket catheter was performed to retrieve and remove the filter.
The authors are reporting a total of 41 patients undergoing percutaneous transluminal angioplasty (PTA) at different levels of the carotid artery. The procedure for proximal carotid artery was performed on 17 patients, for mid or distal common carotid artery on 4 patients, for carotid bifurcations on 5 patients, for internal carotid artery on 6 patients, for external carotid artery on 4 patients, and for fibromuscular dysplasia of the internal carotid artery on 5 patients. We also collected research on an additional 53 patients from the literature for a total of 94 patients. To date, we have not encountered any mortalities nor neurologic complications in performing this procedure. Thus, we believe that PTA may be performed with reasonable safety and as an alternate procedure in the treatment of carotid artery stenosis.
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During two periods of almost 3 months each, a study was done in three villages of Tangail District in Bangladesh. One of the objectives was to find out how the fields of traditional medicine (Ayurveda and Unani), folk medicine and allopathic medicine were related to each other, and which processes could be discerned in these interrelationships. In this respect an important outcome was that traditional medicine had almost disappeared in this area and that Western medicine holds a very strong position. Another objective was to study the illness-behaviour of various economic categories of villagers. Here we found that the poor made much more use of the government facilities than the rich. In fact, these facilities have a large potential, but there are many defects in the way they are operating, so that the potential is not realized at all. We also studied the cures which the practitioners of folk medicine and those of Western medicine are offering to their clients. One of the conclusions was that the practices of the unqualified allopathic practitioners, who hold a strong position in the countryside, are often a hazard to health.
An empirical study of the family planning program and its clients in the rural areas of Allahabad Division of Uttar Pradesh in India was undertaken in 1971-1972. While family planning acceptance in this region is low, interviews with villagers and family planning staff suggest that organizational shortcomings of the program may help to explain the low level of acceptance. The reported level of contact between the program field staff and the village population was unexpectedly low. The paper discusses a number of administrative problems within the family planning organization, especially at the level of the primary health center. It is concluded that in designing family planning programs, efforts should be made to minimize organizational requirements.
Deep brain stimulation by high frequency (HFS) has been developed starting in the thalamic target (Vim) from pragmatic observations and subsequently followed by other targets, such as the subthalamic nucleus (STN) and pallidum as an application of current knowledge from basic preclinical research in neuroscience. The mechanism involved by this neurosurgical approach is not completely solved. For Vim we have formed the hypothesis that HFS induces a jamming of sensory-motor loops but for the STN, from our experimental research in rats we have shown that HFS induces functional inhibition of cell activity in the target nuclei. In our patients the implantation of the stimulation electrodes was carried out stereotactically, under local anesthesia, using ventriculography, MRI, microrecordings and clinical evaluation of the effects of stimulation on rigidity. When the stimulation is turned ON in the STN area a significant decrease in rigidity was determined by the neurologists. Stimulation or even penetration of the electrode may be responsible for transient dyskinesias. The average location of the clinically efficient contact of the chronic stimulating electrodes is statistically located at 5.02 +/- 0.71 1/12 degrees of AC-PC in the AP direction, at -1.5 +/- 0.66 1/8 degrees of the height of the thalamus in the ventricle direction, with laterality at 11.98 +/- 1.12 mm in the lateral direction. The beneficial effects of STN stimulation are significant providing that the electrodes are correctly placed into the target. There is strong improvement of the symptoms of the triad in which akinesia, rigidity, and tremor are reduced on average to 41. 6, 48.6, and 27%, respectively, when compared with the previous preoperative level. From our experience, HFS of the STN could be considered the surgical therapy of choice at advanced stages of Parkinson's disease.
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1. Family planning occupied a subordinate position in the medical and health bureaucracy almost two decades after its introduction. Senior Ministry officials accorded low priority to formal program objectives, while the State Family Planning Officer, the highest state official concerned solely with the family planning program, suffered from a relatively subordinate position in the Directorate and a lack of authority and support. Within the medical profession, family planning was held in low esteem, and the medical and health bureaucracies did not have a mechanism for selecting personnel on the basis of interest and commitment. 2. Organizational adjustment to family planning in the Ministry of Health was a slow and painful process, absorbing the energy and attention of Ministry officials for almost a decade. The repeated reorganizations of the district setup revolving around the division of labor between medical, health, and family planning acitvities and between the rural and urban program, led to months of almost total inertia and detracted substantially from the supervisory capacity of the officials involved. 3. Decision making and guidance suffered from the quick turnover of the Secretary, the most powerful administrator in the Ministry. In Uttar Pradesh Secretaries stayed barely long enough to begin to understand the complex organizational setup of the program. 4. Multiple and often conflicting lines of authority characterized the relationships between the higher and lower echelons within the Ministry. This was accentuated when the District Family Planning Officer was placed under the administrative control of the District Magistrate. While intended to "energize" family planning through the association of the most prestigious and powerful district official with the program, this organizational arrangement resulted in conflicting instructions to the staffs of the primary health centers. 5. The organizational behavior of the Ministry of Health was shaped by the interplay of the various "professional cultures" of its key actors. The generalist administrators' short time horizon and eagerness to produce quantitative results clashed with the specialists' emphasis upon long-term goals and technical constraints; the politician's defense of the interest of his constituents clashed with the administrator's desire to defend his autonomy. The calculus of political survival made support for family planning goals a costly burden that few politicians have been willing to shoulder. As the party system does not reward the advocacy of family planning, ministers emphasize those programs within their ministry or those decisions within their discretion that correspond to the demands of their constituents.