Search PubMed⌕ Search

Biomedical subjects

A Desai

Publications and source records attributed to A Desai.

152 records · Page 9Linked to original sources
PubMedDate not supplied

"Myocardial infarction" in adolescents: do we have the correct diagnosis?

The evaluation of adolescents with chest pain, elevated cardiac enzymes, and abnormal electrocardiograms (ECGs) continues to pose diagnostic and management dilemmas. Myocardial infarction is an uncommon finding in this population and alternative diagnoses must be considered. Our database was retrospectively reviewed for adolescents age 16-18 years without prior cardiac history who underwent cardiac catheterization. Patients who presented with chest pain, elevated cardiac enzymes, normal ejection fraction, and abnormal ECGs were included. Management, diagnostic testing, and final diagnosis were reviewed. Nine adolescents (eight males and one female) without prior cardiac history were identified. The ECG findings in all patients were consistent with myocardial ischemia in a coronary distribution. Thrombotic coronary occlusion was not found in any patient. In adolescents without prior cardiac history of risk factors for myocardial infarction such as Kawasaki disease, familial hypercholesterolemia, or drug use who present with chest pain, multiple diagnoses must be considered even in the presence of focal ischemic ECG changes and elevated cardiac enzymes. Thrombolytic therapy or anticoagulation should be withheld until a definitive diagnosis of myocardial infarction has been made. Magnetic resonance imaging is the most useful tool to differentiate focal myocarditis from myocardial infarction.

Adolescent↗
PubMedDate not supplied

Cryptococcosis in the immunocompromised host with special reference to AIDS.

Cryptococcosis is increasing because of an ever rising population of immunocompromised individuals especially those with acquired immune deficiency syndrome (AIDS). Cryptococcal infection of the central nervous system (CNS) were diagnosed in 149 cases over a period of 19.5 years (January 1978-June 1998). Culture was positive in all cases except three who were already on antifungal therapy. India ink mounts of cerebrospinal fluid (CSF) revealed encapsulated cryptococci in 134, and cryptococcal antigen was detected in 111 of 114 patients tested. A comparison of laboratory and certain clinical parameters in patients with and without associated HIV infection showed that a poor CSF cell response and culture of cryptococci from extra-neural sites was more often associated with HIV infection and was statistically significant. Further, presence of concomitant infection especially tuberculosis, and mortality were higher in the HIV positive group.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Portable X-ray fluorescence instruments for the analysis of lead in paints.

In a study in the laboratories of the Chicago Board of Health, the results from determination of lead in paint films by X-ray fluorescence were compared with results from determination by atomic absorption. Portable instruments of three suppliers were used for X-ray fluorescence measurements. An improved version of one of these instruments was also tested. The results of X-ray fluorescence readings on painted card stock panels with one of these instruments compared satisfactorily with the results as determined by the atomic absorption method at levels below 10 mg of lead per square centimeter. Readings on multiple layers of these panels were additive and independent of the order of these panels. All four instruments were tested in the laboratory on painted surfaces from the walls of condemned buildings. The most recent version of each instrument gave a correlation coefficient of 0.96 or better for the linear regression of lead values in milligrams per square centimeter by atomic absorption against instrument readings. It was calculated that a reading of 3.2 or greater on any of the instruments would indicate with greater than 95 percent confidence that 1 mg or more of lead per square centimeter would be found when a sample of the paint was analyzed by atomic absorption. When the readings of one of the instruments showed lead to be absent, that result would inidcate with better than 95 percent confidence that less than 1 mg of lead per square centimeter would be found by the atomic absorption method. Portable X-ray fluorescence instruments can be used in situ to determine whether the walls of a building give readings for lead above the range of 0 to 3.2. Walls with readings above this range can be considered to have 1 mg or more of lead per square centimeter and would not be in conformance with the code of the City of Chicago. Samples would need to be taken for analysis in the laboratory by atomic absorption only from those walls with readings within the range of 0 to 3.2.

Chicago↗
PubMedDate not supplied

Autoantibodies, immunoglobulins, complement and circulating immune complexes in acute malaria.

BACKGROUND: Malaria caused by Plasmodium vivax and Plasmodium falciparum is common in the Indian subcontinent. Studies conducted elsewhere have suggested that malarial infection causes intense immunostimulation. We screened patients with malarial infection for autoantibodies and measured the immunoglobulin, circulating immune complex and complement levels to determine the extent of immunological alterations in these patients. METHODS: One hundred adults with acute malarial infection confirmed by examination of the peripheral blood smear and 25 age- and sex-matched controls were studied. An autoantibody screen and serum immunoglobulin complement (C3 and C4) and circulating immune complex levels were measured at the time of admission and 4 weeks after they became afebrile. A direct Coomb's test was also done. RESULTS: Anti-ssDNA, anti-dsDNA and rheumatoid factor were positive at the time of admission in 51, 30 and 38 patients respectively. None of the controls were positive for these autoantibodies except for one who was positive for rheumatoid factor. The IgM, IgG and IgA levels were raised in 16, 25 and 36 patients respectively. Circulating immune complex levels were raised in 32 patients and complement C3 and C4 were low in 8 and 31 patients. Follow up studies at 4 weeks in 19 patients showed that the autoantibodies were negative. However, the immunoglobulin, C4 and circulating immune complex levels remained elevated. Six per cent of patients had a positive direct Coomb's test with reticulocytosis at the time of presentation. CONCLUSION: Acute malarial infection can cause false-positive results for anti-ssDNA, anti-dsDNA and rheumatoid factor and may also cause a rise in the serum immunoglobulin, complement and circulating immune complex levels.

Adolescent↗
PubMedDate not supplied

The role of infusional chemotherapy and radiation in organ preservation.

Chemotherapeutic agents, used alone or in combination, have had a largely palliative effect in the treatment of solid tumors. The curative ability of these agents has been limited to about 15% of cases, in large measure due to chemotherapy's failure to accomplish locoregional control, leaving surgery or irradiation for local control of primary disease as modes of treatment. In many cases, however, surgery is not a feasible alternative, and radiation therapy may fail because of radioresistance. Whether this is caused by anoxia or by the innate radioresistance of the tumor cell, radiation oncologists have tried a number of methods to overcome the resulting insensitivity. Experience with the continuous concomitant infusion of various cytotoxic agents and radiation therapy in the treatment of advanced malignancies has been encouraging. The resultant radiosensitization has let to an increased rate of locoregional clearance of advanced carcinomas with a worthwhile increase in survival rates. The use of infusion chemo- and radiation therapy also has allowed the use of an organ-sparing program in all but the most advanced stages. There are already encouraging reports on successful organ-sparing treatment programs for carcinoma of the anus, esophagus and bladder. (ABSTRACT TRUNCATED)

Antineoplastic Combined Chemotherapy Protocols↗