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Biomedical subjects

A Patel

Publications and source records attributed to A Patel.

At least 55 records · Page 3Linked to original sources
PubMed2004

Serum triglycerides as a risk factor for cardiovascular diseases in the Asia-Pacific region.

BACKGROUND: The importance of serum triglyceride levels as a risk factor for cardiovascular diseases is uncertain. METHODS AND RESULTS: We performed an individual participant data meta-analysis of prospective studies conducted in the Asia-Pacific region. Cox models were applied to the combined data from 26 studies to estimate the overall and region-, sex-, and age-specific hazard ratios for major cardiovascular diseases by fifths of triglyceride values. During 796,671 person-years of follow-up among 96,224 individuals, 670 and 667 deaths as a result of coronary heart disease (CHD) and stroke, respectively, were recorded. After adjustment for major cardiovascular risk factors, participants grouped in the highest fifth of triglyceride levels had a 70% (95% CI, 47 to 96) greater risk of CHD death, an 80% (95% CI, 49 to 119) higher risk of fatal or nonfatal CHD, and a 50% (95% CI, 29% to 76%) increased risk of fatal or nonfatal stroke compared with those belonging to the lowest fifth. The association between triglycerides and CHD death was similar across subgroups defined by ethnicity, age, and sex. CONCLUSIONS: Serum triglycerides are an important and independent predictor of CHD and stroke risk in the Asia-Pacific region. These results may have clinical implications for cardiovascular risk prediction and the use of lipid-lowering therapy.

Aged↗
PubMed2004

A multicentre, double blind, randomised, placebo controlled trial of anakinra (Kineret), a recombinant interleukin 1 receptor antagonist, in patients with rheumatoid arthritis treated with background methotrexate.

OBJECTIVE: To assess the efficacy and safety of 100 mg daily anakinra (Kineret), a recombinant form of the naturally occurring interleukin 1 receptor antagonist, plus methotrexate (MTX) in reducing the signs and symptoms of rheumatoid arthritis (RA). METHODS: Patients with active RA (n = 506) despite current treatment with MTX were enrolled in this multicentre, double blind, randomised, placebo controlled study. Patients received subcutaneous injections of anakinra 100 mg/day or placebo. They were assessed monthly for 6 months for improvement in signs and symptoms of RA and for adverse events. The primary efficacy measure was the percentage of patients attaining ACR20 response at week 24. RESULTS: Significantly greater proportions of patients treated with anakinra compared with placebo achieved ACR20 (38% v 22%; p<0.001), ACR50 (17% v 8%; p<0.01), and ACR70 (6% v 2%; p<0.05) responses. The response to anakinra was rapid; the proportion of patients with an ACR20 response at the first study assessment (4 weeks) was twice as high with anakinra as with placebo (p<0.005). Clinically meaningful and statistically significant responses were also seen in individual components of the ACR response (for example, Health Assessment Questionnaire, pain, C reactive protein levels, and erythrocyte sedimentation rate). Anakinra was well tolerated, with a safety profile, similar to that of placebo with one exception: mild to moderate injection site reactions were more common with anakinra than with placebo (65% v 24%). CONCLUSIONS: This study confirms previous observations from a dose-ranging study showing that anakinra, in combination with MTX, is an effective and safe treatment for patients with RA who have inadequate responses to MTX alone.

Antirheumatic Agents↗
PubMed2004

Radioguided occult lesion localisation (ROLL) and sentinel node biopsy for impalpable invasive breast cancer.

AIM: The aim of this study was to simplify the technique of ROLL and sentinel node biopsy without compromising tumour excision and sentinel node biopsy. METHODS: Twenty patients with impalpable primary invasive breast carcinoma underwent an injection of 99mTc-nanocolloid mixed with radiographic contrast medium Iohexol into the centre of the lesion under ultrasound or stereotactic guidance pre-operatively. No guidewire localisation was performed. Under general anaesthesia, a periareolar intradermal/subcutaneous injection of patent blue-V dye was performed. The sentinel node was identified by blue-stained lymphatics and node and a hot spot on the gamma probe. Surgical excision of the primary tumour was then carried out using the gamma probe. RESULTS: In eight of 20 cases an immediate re-excision was carried out and on histological assessment, all 20 patients were clear of invasive disease at the margins. In two patients, in situ disease was present at the margins and a further re-excision was therefore performed. The sentinel node was identified in all cases. In all, five of 20 patients were node positive on routine HE staining. In a further two patients, tumour cells were identified by immunohistochemistry with CAM5.2 antibody. Completion axillary clearance in six patients confirmed that the sentinel node was the only positive node. CONCLUSIONS: This modification of the previously described ROLL technique is feasible and safe and does not compromise tumour excision or sentinel node detection.

Aged↗
PubMed2004

Biopsy of the red patch at cystoscopy: is it worthwhile?

OBJECTIVE: At cystoscopy red patches of urothelium are commonly seen within the bladder and frequently biopsied in order to exclude carcinoma in situ (CIS), which classically presents as a red, velvety patch. This appearance however is not specific and it is possible that many lesions are biopsied without significant benefit to the patient. The objective of this study was to determine whether routine biopsy of red patches seen in the bladder at cystoscopy is warranted. PATIENTS AND METHODS: 193 biopsies were taken from red patches seen at flexible and rigid cystoscopy during a 4-year period from December 1997 to January 2002 and examined by histopathology. Patients included in the study were those on cystoscopic follow-up for transitional cell carcinoma (TCC) of the bladder and those undergoing investigation for haematuria or lower urinary tract symptoms. RESULTS: In 193 (17.7% of total biopsies) red patch biopsies, malignancy was found in 23 (11.9%) and 18 of 23 (78.3%) were CIS. No malignancies were detected in red patches from patients under the age of 60 years. CONCLUSION: Red patch biopsy yields a positive finding of malignancy in 12% and was concluded to be a valuable exercise, particularly in those over the age of 60 years and on follow-up for TCC.

Adult↗
PubMed2004

Conducting international collaborative research in developing nations.

International research partnerships bring together some of the best and the brightest in an effort to tackle global health problems. Such collaborations also pose complex challenges, such as maintaining ethical principles in the conduct of research in developing nations. In implementing a randomized clinical trial to reduce postpartum hemorrhage (PPH) during childbirth in rural India, U.S. and Indian collaborators addressed three such issues: the appropriateness of an ethical randomized controlled trial in the developing world, the inclusion of a placebo arm, and the relevance of informed consent in a semiliterate rural population.

Administration, Oral↗
PubMed2004

FLRT3 is expressed in sensory neurons after peripheral nerve injury and regulates neurite outgrowth.

We used a molecular screen to identify genes upregulated in regenerating adult rat dorsal root ganglion cells. FLRT3 mRNA and protein characterized by a fibronectin type III domain and a leucine-rich repeat motif was upregulated in damaged sensory neurons. The protein was then transported into their peripheral and central processes where the FLRT3 protein was localized to presynaptic axon terminals. In vitro, the FLRT3 protein was expressed at the cell surface, regulated neurite outgrowth in sensory neurons, but did not exhibit homophilic binding. FLRT3 was widely expressed in the developing embryo, particularly in the central nervous system and somites. However, in the adult, we found no evidence for accumulation or reexpression of the FLRT3 protein in damaged axons of the central nervous system. We conclude that FLRT3 codes for a putative cell surface receptor implicated in both the development of the nervous system and in the regeneration of the peripheral nervous system (PNS).

Amino Acid Sequence↗
PubMed2004

Simultaneous carbon and nitrogen removal in anoxic-aerobic circulating fluidized bed biological reactor (CFBBR).

Biological nutrient removal (BNR) in municipal wastewater treatment to remove carbonaceous substrates and nutrients, has recently become increasingly popular worldwide due to increasingly stringent regulations. Biological fluidized bed (BFB) technology, which could be potentially used for BNR, can provide some advantages such as high efficiency and a compact structure. This work shows the results of simultaneous elimination of organic carbon and nitrogen using a circulating fluidized bed biological reactor (CFBBR, which has been developed recently for chemical engineering processes. The CFBBR has two fluidized beds, running as anoxic and aerobic processes to accomplish simultaneous nitrification and denitrification, with continuous liquid recirculation through the anoxic bed and the aerobic bed. Soluble COD concentrations in the effluent ranging from 4 to 20 mg l(-1) were obtained at varying COD loading rates; ammonia nitrogen removal efficiencies averaged in excess of 99% at a minimum total hydraulic retention time (HRT) of 2.0 hours over a temperature range of 25 degrees C to 28 degrees C. Effluent nitrate nitrogen concentration of less than 5 mg l(-1) was achieved by increasing effluent recycle rate. No nitrite accumulation was observed either in the anoxic bed or in the aerobic bed. The system was able to treat grit chamber effluent wastewater at a HRT of 2.0 hours while achieving average effluent BOD, COD, NH3-N, TKN, nitrates, total phosphate, TSS and VSS concentrations of 10 mg l(-1), 18 mg l(-1), 1.3 mg l(-1), 1.5 mg l(-1), 7 mg l(-1), 2.0 mg l(-1), 10 mg l(-1) and 8 mg l(-1) respectively. The CFBBR appears to be not only an excellent alternative for conventional activated sludge type BNR technologies but also capable of processing much higher loadings that are suitable for industrial applications.

Bacteria, Aerobic↗
PubMed2004

Autotransplantation of an impacted third molar: an orthodontic case report.

This case report describes the use of autotransplantation as part of an orthodontic treatment plan where there was early loss of an upper molar tooth secondary to irreversible pulpitis. An impacted lower third molar, which had symptoms of pericoronitis, was transplanted into the upper left second molar socket. Fixed orthodontic treatment, to correct the patient's initial complaint of crowding, was completed in 22 months. The transplanted tooth remained vital and functional throughout.

Adult↗
PubMed2003

Nitric oxide synthase gene polymorphisms and diabetic nephropathy.

AIMS/HYPOTHESIS: Susceptibility to diabetic nephropathy in subjects with Type 1 diabetes is mainly genetically determined. Excess cardiovascular risk associated with diabetes is overwhelmingly concentrated in patients with nephropathy. Endothelial dysfunction is a feature of cardiovascular disease, hypertension, dyslipidaemia and smoking, all of which are associated with diabetic nephropathy. Nitric oxide regulates endothelial function and so genes encoding nitric oxide synthases could confer susceptibility to nephropathy. Recently positive associations have been reported. We examined polymorphisms within NOS3 and NOS2A, the genes encoding endothelial- and inducible nitric oxide synthase, for association with nephropathy. METHODS: Large case-control studies of patients with Type 1 diabetes and overt nephropathy who had hypertension and diabetic retinopathy. The control group comprised Type 1 diabetic subjects who have been on insulin for 50 or more years and have an extremely low risk of nephropathy. Genotyping was by PCR and agarose- or automated polyacrylamide gel electrophoresis using fluorescence-labelled primers. RESULTS: NOS3 intron 4 genotype frequencies (n=860: 464 cases, 396 control subjects) were 2.6%, 23.3%, 74.1% and 2.3%, 22.7%, 75.0% for aa, ab and bb genotypes; p=0.935. NOS2A promoter genotype frequencies (n=715: 358 cases, 357 control subjects) were 0.3%, 16.8%, 83.0% and 0.3% 17.6% and 82.1% for +/+, +/- and -/- genotypes (p=0.952). CONCLUSION/INTERPRETATION: In our cohort of Caucasian subjects with Type 1 diabetes there is no association between either of the polymorphisms studied and diabetic nephropathy. The previous suggestion from smaller studies that the intron 4 polymorphism in NOS3 could play a role in susceptibility to the disease is not confirmed.

Alleles↗
PubMed2003

Facial dysgenesis: a novel facial syndrome with chromosome 7 deletion p15.1-21.1.

We describe a female neonate with a unique constellation of features including anophthalmia and cryptophthalmos, temporal remnant "eye tags," bilateral cleft lip, unilateral cleft palate, a proboscis with absent nasal septum, choanal atresia, micrognathia, square stoma, and bilateral external auditory canal atresia. Gross brain structure, pituitary function, limbs, trunk, and genitalia were normal. Skeletal survey, echocardiogram and abdominal viscera were unremarkable except for a split central sinus of the right kidney. BAER exam indicated she could hear and temporal CT confirmed the presence of cochlea and possible ossicles. Cytogenetic evaluation revealed an interstitial deletion at chromosome 7p15.1-21.1. TWIST, a gene encoding a transcription factor involved in craniofacial development, is deleted by FISH analysis. The absence of a mutation on the non-deleted allele of TWIST as determined by sequencing virtually eliminates complete loss of the TWIST gene as the cause of this patient's severe phenotype. The HOXA gene cluster also encodes transcription factors that are crucial for directing cephalad to caudad somatic fetal development. HOXA1, the most telomeric of the 13 members of the HOXA gene cluster, is located at the centromeric boundary of the patient's chromosome 7 deletion. By FISH analysis, neither allele of HOXA1 is deleted and sequencing reveals no mutations. Haploinsufficiency or complete loss of the HOXA1 gene also does not appear to cause this patient's severe phenotype. Previous reports of chromosome 7p15-21 deletions do not have phenotypes similar to this patient.

Chromosome Banding↗
PubMed2003

Traumatic sternal fracture: outcome following admission to a Thoracic Surgical Unit.

INTRODUCTION: We reviewed our experience of the in-hospital management and early follow-up of patients admitted with a traumatic sternal fracture to a Thoracic Surgical Unit. PATIENTS AND METHODS: Over a 7-year period, 73 consecutive patients (51 males) with a median age of 51 (range 17-84) years were admitted through the Emergency Department with an acute traumatic sternal fracture. The patients were hospitalised for cardiorespiratory monitoring, pain control and physiotherapy. Outpatient follow-up occurred 6 weeks after discharge. RESULTS: The median hospital stay was 2 days (range 1-15 days). Sixty-four patients (88%) did not require parenteral analgesia or any other procedure that would necessitate admission to hospital. Three patients (4%) with severely displaced fractures and complex co-morbidities required surgical correction. Follow-up revealed no significant complications. CONCLUSIONS: Admission to hospital is not necessary for every patient sustaining a sternal fracture and should be reserved for those with high-impact trauma, severely displaced fractures, significant associated injuries, complex analgesic requirements, important co-morbidities or inadequate domestic support.

Adolescent↗
PubMed2003

Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms.

BACKGROUND: There are few longitudinal studies of patients with medically unexplained symptoms. The aim of this study was to investigate outcome in frequent attenders in secondary care who present repeatedly with medically unexplained symptoms. METHOD: Forty-eight patients presenting with medically unexplained symptoms, from a sample of 61, participated in a 3-year follow-up study. Psychiatric morbidity, functional impairment and use of services were evaluated. RESULTS: At follow-up there was a high prevalence of psychiatric morbidity with 69% having at least one psychiatric diagnosis. The sample continued to be high users of a range of health services and substantial functional impairment was reported. CONCLUSION: In this group of frequent attenders with medically unexplained symptoms outcome as measured by psychiatric morbidity, service use and functional impairment remained poor after 3 years.

Adolescent↗
PubMed2003

Use and rationale of a multicompartment microcassette for site-specific biopsies of the prostate in a consecutive cohort of men.

The collection of prostate biopsies into individual or site-specific specimen containers has not been performed routinely because of concerns of time, cost and lack of additional clinical value. This report evaluates the first ever use of a multicompartment microcassette for the collection and processing of site-specific prostate biopsies.Site-specific prostate biopsies were taken in sequential men suspected to have prostate cancer and collected in a multicompartment microcassette, which holds six biopsies and fits within a standard specimen container. Estimates were made of the cost and time savings compared with biopsies collected in individual specimen containers. In 88 men evaluated, use of the multicompartment microcassette saved time (72% reduction) and cost (83% reduction) with the added ability of easy identification of the site of each prostate biopsy. The multicompartment microcassette is a convenient, time- and cost-effective container for the collection of site-specific prostate biopsies.

Biopsy, Needle↗