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Biomedical subjects

A Khan

Publications and source records attributed to A Khan.

At least 685 records · Page 38Linked to original sources
PubMedDate not supplied

Vibrio cholerae O139 in Calcutta, 1992-1998: incidence, antibiograms, and genotypes.

We report results of surveillance for cholera caused by Vibrio cholerae O139 from September 1992, when it was first identified, to December 1998. V. cholerae O139 dominated as the causative agent of cholera in Calcutta during 1992-93 and 1996- 97, while the O1 strains dominated during the rest of the period. Dramatic shifts in patterns of resistance to cotrimoxazole, neomycin, and streptomycin were observed. Molecular epidemiologic studies showed clonal diversity among the O139 strains and continuous emergence of new epidemic clones, reflected by changes in the structure, organization, and location of the CTX prophages in the V. cholerae O139

Base Sequence↗
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Primary hyperparathyroidism: diagnosis and management.

OBJECTIVE: To review the manifestations of primary hyperparathyroidism and the available treatment strategies. METHODS: The epidemiologic and pathologic features of this endocrine disorder are outlined. Guidelines for surgical intervention are discussed, and the effectiveness of various medical treatments is summarized. RESULTS: Primary hyperparathyroidism, a common disorder, is diagnosed on the basis of hypercalcemia in the presence of increased parathyroid hormone levels as measured by immunoassay. Clinical manifestations are variable with many patients being asymptomatic at the time of diagnosis. Patients with severe disease require definitive surgical treatment. Surgical cure rates are high--approximately 95% in experienced hands. Indications for surgery include a serum calcium of more than 2.9 mmol/L (12 mg/dL), osteoporosis, recurrent renal stones, and parathyroid carcinoma. As well, it is recommend in individuals younger than 50 years of age. Patients with mild disease may have a benign natural history and may not have progression to severe disease. Asymptomatic individuals with mild hypercalcemia and close to normal bone mass and renal function may be managed medically, particularly those who are over the age of 50 years. Medical management includes ensuring adequate hydration and avoiding volume depletion. Estrogen therapy is valuable in postmenopausal women without contraindications to hormone replacement. Calcitonin has been shown to decrease serum calcium levels on a short-term basis. Bisphosphonates are also potential treatment options and require further study. Calcium-mimetic agents also may become valuable in the medical management of primary hyperparathyroidism in the near future. CONCLUSION: As primary hyperparathyroidism is being increasingly detected at an asymptomatic stage, medical therapy is assuming a greater role in the effective management of this common condition.

Journal Article↗
PubMedDate not supplied

Skeletal effects of primary hyperparathyroidism.

OBJECTIVE: To review the effect of primary hyperparathyroidism on bone mass and occurrence of fractures as well as the advances in medical management of this relatively common condition. METHODS: We conducted a MEDLINE search of peer-reviewed publications for the period from 1960 to 1999. Studies reviewed were those that evaluated bone mass and fracture risk in primary hyperparathyroidism in both male and female populations. Studies that assessed intervention with hormone replacement therapy, bisphosphonates, calcimimetic agents, and surgical treatment and their effect on bone mass and fracture were also reviewed. Preference was given to prospective studies, but retrospective, cross-sectional, and case-control studies were also evaluated. RESULTS: Most densitometry studies completed to date have been limited by their design. Some cross-sectional studies that used both single-photon absorptiometry and dual-energy x-ray absorptiometry have demonstrated preferential bone loss at cortical skeletal sites. Bone density seems to be relatively well preserved at cancellous bone sites. The absence of large prospective controlled trials makes it difficult to evaluate fracture incidence associated with hyperparathyroidism. Retrospective and case-control studies have found conflicting results relative to fracture incidence in patients with primary hyperparathyroidism. Parathyroidectomy has been shown to be of value in improving bone mineral density at both the lumbar spine and the femoral neck. Hormone replacement therapy in postmenopausal women with primary hyperparathyroidism has also been effective in improving bone mineral density and decreasing bone turnover. Bisphosphonates are currently being evaluated for effectiveness in improving bone mineral density and reducing the risk of fracture. Early results with alendronate treatment have demonstrated improvements in bone mass. Calcimimetic agents are a new treatment option that may become useful in the medical management of primary hyperparathyroidism. CONCLUSION: Although conflicting findings have been reported, bone loss has been noted in patients with primary hyperparathyroidism, especially at cortical skeletal sites. Medical management does not seem to be associated with increased morbidity or mortality in patients with asymptomatic primary hyperparathyroidism. Bone densitometry is advised, particularly for monitoring of bone mass at the midradius or femoral neck, in patients with primary hyperparathyroidism.

Bone Density↗
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Follicular variant of papillary thyroid carcinoma: a comparative study of histopathologic features and cytology results in 141 patients.

OBJECTIVE: To characterize the histopathologic features of follicular variant of papillary thyroid carcinoma (FVPC) and its cytology results on fine-needle aspiration (FNA) biopsy and compare them with those of papillary thyroid carcinoma (PC). METHODS: We searched the University of Massachusetts Medical Center pathology database for all surgical specimens associated with a diagnosis of FVPC or PC between January 1992 and February 1998 and reviewed the related pathology reports. In addition, the associated preoperative FNA results were analyzed. RESULTS: On initial assessment, FVPC was associated with a significantly lower incidence of cervical lymph node metastatic involvement in comparison with PC (5.6% versus 35.7%; P<0.001). Even though the mean size of FVPC was larger than that of PC (2.57 cm versus 1.75 cm; P<0.05), FVPC showed a lower incidence of thyroid capsule invasion (5.6% versus 11.4%), infiltrative resection margins (2.8% versus 20.0%; P = 0.01), local soft tissue invasion (7.0% versus 25.7%; P<0.005), and multicentricity (25.4% versus 47.1%; P<0.01). Lymphocytic thyroiditis was a common feature of both FVPC (36.6%) and PC (35.7%). FNA biopsy revealed the presence of malignant cells in 9.8% of patients with FVPC in comparison with 67.5% of patients with PC. Most cytology specimens of FVPC (58.8%) were interpreted as suspicious for a malignant lesion or as a follicular neoplasm. CONCLUSION: FVPC is associated with a significantly lower incidence of cervical lymph node metastatic lesions and invasive histologic features than is PC. Long-term prospective clinical studies are needed to determine whether these findings translate into a more benign natural history for this variant of PC. Results of FNA biopsy in FVPC are more commonly interpreted as suspicious rather than malignant; this factor has major implications for preoperative planning.

Biopsy, Needle↗
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Does left ventricular function improve with L-carnitine after acute myocardial infarction?

A double blind randomized placebo controlled clinical trial was carried out to assess the efficacy and safety of L-carnitine in patients suffering from acute anterior wall myocardial infarction with respect to left ventricular function. Sixty patients (34 men, 26 women, mean age 56+11 yr.) with acute anterior wall myocardial infarction were randomized to placebo and L-carnitine. All the patients were given intravenous L-carnitine / placebo in the dose of 6gm/day for the first seven days followed by oral L-carnitine / placebo 3 gm/day in three divided doses for a period of three months. Echocardiography was performed for regional wall motion abnormality, left ventricular end systolic volume (ESV), end diastolic volume (EDV) and ejection fraction (EF) on admission, after seven days and after three months of the infarction. Forty-four patients completed the study. There were three deaths, two in the placebo and one in the L-carnitine group (p>0.05). Thirteen patients were lost to follow up. Echo parameters in both groups were comparable (p>0.05). The duration of chest pain prior to initiation of the I.V. L-carnitine was 7.5 + 5.2 hrs in the L-carnitine group and 7 + 4 hrs in the placebo group (p>0.05). There was no statistical difference in the EF, ESV and EDV on admission, at discharge and after three months in the L-carnitine and the placebo groups (p>0.05). No significant adverse effects were noted. L-carnitine, though a safe drug, does not affect the left ventricular function in patients with myocardial infarction.

Aged↗
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Prevalence and management of ovarian tumours in Women and Children Hospital Abbottabad.

BACKGROUND: The purpose of study was to compare world incidence of ovarian tumours whether benign or malignant with that of our unit. We have also discussed management of all these patients at our center. RESULTS: In our unit out of total 1400 admissions in 24 months, 26 had ovarian tumours, out of these 6 were malignant. The over all malignancy in our unit was 23% as compared to 15% of over all world incidence, 24 of these patients, were admitted through the OPD with advanced size of tumours. None of them previously had any check up at proper Gynaecological Centers. All these 24 were admitted to the ward, investigated, operated and after receiving histopathology reports were further managed accordingly. Two patients had torsion of ovarian tumour and were admitted through emergency and operated as emergency cases. In our study group the majority, 77% had benign ovarian tumours in which simple salpingoophorectomies was performed.

Adolescent↗
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Clinical studies of Platinum Coordination compounds in the treatment of various malignant diseases.

Following the prior work of Rosenberg et al, Rosenberg and VanCamp, and Speer et al, we started clinical trials with cis-dichlorodiammineplatinum(II) in April 1971. Marked tumor regression was noted in several malignant diseases in these initial clinical studies which were reported at the Chemotherapy Congress in Prague, August 1971. At the present time over 178 patients have been treated wihhis durg for a variety of malignant conditions. Approximately half of these patients received the platinum compound alone and the other half received it in combination with four other chemotherapeutic agents...

Aged↗
PubMedDate not supplied

Primary neuritic leprosy: a reappraisal at a tertiary care hospital.

AIM: To study the clinico-epidemiological profile of primary neuritic leprosy. METHODS: Retrospective analysis of the leprosy records of clinically diagnosed patients of PNL who attended the Leprosy Clinic from 2000 to 2004 was carried out for details of presenting complaints, age and sex distribution, duration, number of nerves involved and pattern of nerve enlargement, BI (skin), nerve abscess, and deformities. RESULTS: There were 32 (4.6%) patients of PNL out of a total of 686. Majority (56.2%) had complaints for less than a year. There were 29 (90.6%) males, and 3 (9.4%) females, with 15-30 years as the commonest age-group (65.6%) involved. Paraesthesia and numbness were the presenting complaints in 20 (62.5%), and motor deficit (paresis) in 11 (34.4%); deformities (claw hand, foot drop, trophic changes) were seen in 16 (50%) cases. Polyneuritic pattern was noted in 21 (63.56%) patients and mononeuritic in 11 (16.5%) with ulnar nerve as the most commonly enlarged nerve (63.6%). Nerve abscess was noted in 4 (12.5%) cases. Slit-skin smear was positive in 2 (6.2%) cases only. DISCUSSION: PNL continues to be common in India. Sensory complaints are early and more common. The disease is more common in males. Polyneuritic pattern was predominant, and the ulnar nerve was the most commonly involved nerve. Majority of the cases belong to the tuberculoid spectrum. Early diagnosis depends on complete neurological examination in order to reduce the sequelae of the disease.

Adolescent↗
PubMedDate not supplied

Anticoagulant therapy in acute myocardial infarction.

In 265 patients of acute myocardial infarction (AMI) heparin followed by warfarin sodium was used routinely whenever there was no contraindication to the drug. Patients were followed up to 2 years with weekly estimation of prothrombin time. Another 265 patients of AMI having identical clinical profiles were taken as control and neither any anticoagulant nor any antiplatelet agent was used in them. Both groups were also treated with identical coronary dilators whenever needed. 2 years cardiac mortality was 11.6% in the control group and 5.9% in the anticoagulant therapy (ACT) recipient group (P less than 0.05). Incidence of reinfarction (RMI) was 14.4% during the period in the control group whereas it was only 6.7% in the ACT group (P less than 0.05). The incidence of intracranial events were also more frequent in control group (8.4%) compared to ACT group (3.1%) (P less than 0.05). However on further analysis of intracranial events, it was found that haemorrhagic intracranial events were slightly more frequent in ACT (2.3%) than in the control group (2%), but this difference was statistically insignificant (P greater than 0.05); non-haemorrhagic intracranial events were however significantly less in ACT group (1.96%) compared to the control group (6%) (P less than 0.05). There was no major or fatal extracranial haemorrhagic complication in either group. Only minor extracranial haemorrhages were more commonly observed in the ACT group (4.3%) compared to the control group (1.2%) (P less than 0.05).

Adult↗
PubMedDate not supplied

Disc embolization from a Beall mitral valve prosthesis.

Although embolization of the disc from a Beall valve is rare, several reports in the literature have identified patients suffering this complication. This report details the clinical and radiologic course of a patient with an embolized disc from a Model 103 Beall mitral valve prosthesis. The patient lived approximately 39 hours without the disc prior to surgical correction. Depending on the cardiac reserve and the amount of pannus formation, patients may live long enough to allow surgical correction of this complication.

Embolism↗
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Platinum analogs of clinical interest.

Eight platinum analogs including complexes containing two isomeric forms of 1,2-diaminocyclohexane have received preliminary clinical trials. Dosage and limiting toxicity have been identified for racemic malonato-1,2-diaminocyclohexaneplatinum(II) (PHM) and its trans(-)-1,2-diaminocyclohexane isomer (neo-PHM). Dosage and toxicity for racemic sulfato-1,2-diaminocyclohexaneplatinum(II) have been identified and preliminary dosage data for the trans(-)-1,2-diaminocyclohexane isomer are presented. Of the four remaining compounds, three have been abandoned due to toxicity or lack of promise as antitumor agents and the fourth is not being pursued actively at the present time. Further trials of PHM, and especially the neo-PHM isomer, in combination with standard agents seem indicated and are underway. The search for platinum analogs of clinical interest may yet identify analogs significantly superior in effectiveness and safety to cis-dichlorodiammineplatinum(II).

Bone Marrow↗