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Biomedical subjects

A Shah

Publications and source records attributed to A Shah.

At least 181 records · Page 10Linked to original sources
PubMed1998

Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy.

PURPOSE: We determined whether men who may have partial obstruction and antisperm antibodies after vasovasostomy can be distinguished from other infertile men with antisperm antibodies only, and whether repeat microsurgical reversal is beneficial in such patients. MATERIALS AND METHODS: A total of 412 patients underwent indirect immunobead testing for antisperm antibodies at our laboratory from December 1991 through July 1996. Of 95 patients with an assay greater than 20% binding 49 had normal partners and were grouped by history of vasovasostomy (20), varicocele (9), cryptorchidism (8) and epididymo-orchitis (12). Semen analysis characteristics and antisperm antibody binding variables were compared across histories. Pregnancy rates were compared between patients treated surgically for partial obstruction and those treated for antisperm antibodies. Mean followup was 33.8 months. RESULTS: Compared to the other 3 groups, men with a history of vasectomy and reversal had significantly lower sperm concentration (p = 0.002), poorer motility (p < 0.001), lower overall binding on the indirect immunobead assay (p < 0.001) and lower IgA binding (p = 0.008). The clinical diagnosis of partial obstruction was based on a sense of epididymal fullness by palpation, as well as the aforementioned semen parameters. Of the 20 patients with a history of vasectomy and reversal 14 were diagnosed with partial obstruction and underwent repeat microsurgical reversal and 6 with a history of vasovasostomy but no evidence of obstruction received no further therapy and never established pregnancies. The remaining 29 patients underwent sperm washing and assisted reproduction. Of 14 patients 7 (50%) established pregnancies after repeat reversal compared to only 5 of 29 patients (17.2%) treated with assisted reproduction (P = 0.025). CONCLUSIONS: Antisperm antibodies are not a significant factor in persistently infertile post-reversal cases with the aforementioned criteria. Repeat reversal appears to be the most successful treatment option in this setting.

Adult↗
PubMed1998

The effect of an educational intervention package about aggressive behaviour directed at the nursing staff on a continuing care psychogeriatric ward.

INTRODUCTION: Levels of aggressive behaviour on continuing care wards are high. Various staffing factors, potentially amenable to improvement by training, are important in reducing and preventing aggressive behaviour. METHOD: The efficacy of an educational package, directed at the nursing staff, in reducing aggressive behaviour on a psychogeriatric continuing care ward was prospectively evaluated over an 18-week period. The package was administered during the middle 6-week period. Aggressive behaviour was measured using the RAGE and SOAS scales. RESULTS: Aggressive behaviour on both these scales was reduced after the educational package, and the educational intervention package may explain this reduction. CONCLUSIONS: The educational package may have genuinely reduced aggressive behaviour or improved the nursing staffs tolerance and reporting threshold for aggressive behaviour. Studies with improved methodology in several different settings are suggested.

Adult↗
PubMed1998

Electroconvulsive therapy in patients with long bone fractures.

Two elderly patients with severe depression were treated with electroconvulsive therapy despite long bone fractures. Good liaison was maintained throughout with the orthopaedic surgeons and anaesthetists. Both of the patients improved significantly, and there were no musculoskeletal complications.

Aged↗
PubMed1998

Spontaneous union of a congenital pseudarthrosis of the tibia after Syme amputation.

A 4-year-old boy with congenital pseudarthrosis of the tibia had two unsuccessful operative attempts for union. After these procedures the patient had a 6-cm leg length discrepancy and an equinovalgus foot deformity. Because of these deformities he underwent Syme amputation at the ankle and was fitted with a total contact prosthesis. Eight months after the amputation, a solid union was seen across the pseudarthrosis site, although no attempt was made to achieve union with internal fixation or bone grafting. The authors think that vertical alignment of the limb in a total contact prosthesis, along with the compressive forces of weightbearing, allowed the pseudarthrosis site to heal in the patient.

Amputation, Surgical↗
PubMed1998

Effects of intravenous propranolol on human ventricular strength interval curves.

BACKGROUND: Prior studies on the effects of propranolol on human ventricular refractoriness have yielded occasionally inconsistent results. Most prior studies have examined refractory periods at a single stimulus intensity and without using continuous pacing; thus, the effects of propranolol on repolarization may have not been completely defined. The purpose of the present study was to reevaluate the effects of beta blockade on the human ventricular effective refractory period. METHODS: Strength-interval curves were performed in duplicate in a group of 10 patients to demonstrate their reproducibility. Strength-interval curves were performed before and after intravenous propranolol administration in a second group of 10 patients who had no evidence of structural heart disease. RESULTS: Propranolol increased the absolute refractory period from 208 +/- 9 milliseconds to 212 +/- 10 milliseconds (p = 0.01). However, propranolol decreased the coupling interval at which the strength-interval curve began to show an increase in the stimulus intensity required for capture from 236 +/- 8 milliseconds to 232 +/- 9 milliseconds. This resulted in a decrease of the width of the strength-interval curve from 28.0 +/- 5.1 milliseconds to 20.4 +/- 5.5 milliseconds (p < 0.005). Propranolol also significantly increased the slope of a logarithmic fit of the strength-interval curves. CONCLUSION: Propranolol exerts complex effects on human ventricular refractoriness. Propranolol decreases the width and increases the slope of human strength-interval curve, rather than increasing or decreasing the refractory period. These results have potential implications for antiarrhythmic effects of propranolol.

Adrenergic beta-Antagonists↗
PubMed1998

HIV-1 DNA based vaccine induces a CD8 mediated cross-clade CTL response.

Novel approaches for the generation of more effective vaccines for HIV-1 are of significant importance. In this report we analyse the immunogenicity and efficacy of a DNA vaccination approach in a chimpanzee model system. Three chimpanzees were vaccinated with DNA constructs which express the env, rev, gag and pol proteins. These animals developed specific cellular responses to these proteins, although the nature of the responses varied among the animals. We demonstrated that DNA vaccination led to a CD8 mediated killing of targets expressing the homologous clade B envelope as well as targets expressing heterologous clade E envelope. In addition seronegative individuals have been inoculated with a DNA construct which expresses the env, rev proteins. These studies serve as an important benchmark for the use of DNA vaccine technology for the production of protective immune responses.

AIDS Vaccines↗
PubMed1998

Early adolescents' perceptions of cigarette smoking: a cross-sectional survey in a junior high school.

Most adult cigarette smokers start smoking during adolescence. Since youths' perceptions of cigarette smoking may influence their decision to smoke, it is important to understand early adolescents' feelings about, and information sources regarding, smoking. In the present study, a cross-sectional survey, conducted in an urban junior high school, asked students in grades six to eight about their attitudes toward cigarette advertising, their perception of the harmful effects of cigarette smoking, and their sources of information. One hundred students completed the questionnaire, 12 of whom were current or former smokers. Approximately 27% believed cigarette advertising significantly influenced their classmates or themselves. Ninety percent recognized that cigarette smoking was seriously harmful. The source of this information was mainly teachers and parents. While 53% of the students identified their parents as the ones who taught them not to smoke, 47.8% of these parents were smokers themselves. Only 2% of the students indicated that they received information about the effects of smoking from health providers.

Adolescent↗
PubMed1997

Comparative prognostic significance of simultaneous versus independent resolution of ST segment depression relative to ST segment elevation during acute myocardial infarction.

OBJECTIVES: We sought to determine the prognostic significance of simultaneous versus independent resolution of ST segment depression that occurs concomitant with ST segment elevation during acute myocardial infarction (AMI). BACKGROUND: ST segment depression in leads other than those showing ST segment elevation during AMI is a common phenomenon. Whether this indicates adverse outcomes remains controversial. We hypothesized that the timing of ST segment depression resolution relative to ST segment elevation resolution might differentiate between a high risk group and a low risk group of patients. METHODS: Continuous 12-lead ST segment monitoring was performed after thrombolytic therapy for AMI in 413 patients, 261 of whom met technical criteria for analysis. Blinded analysis of ST segment depression resolution patterns was used to group patients as follows: 1) no ST segment depression at any time (control group); 2) ST segment depression resolving simultaneously with ST segment elevation (simultaneous group); and 3) ST segment depression persisting after ST segment elevation resolution (independent group). These patterns were correlated with the outcomes-recurrent angina, reinfarction, heart failure and death-using chi-square analysis and the Fisher exact test for categoric variables and the Wilcoxon rank-sum test for continuous variables. RESULTS: The incidence of recurrent angina, reinfarction and heart failure was similar among the three groups. In-hospital mortality, however, was significantly higher in the independent group (13%) than either the simultaneous group (1%, p < 0.001) or the control group (0%, p = 0.002). CONCLUSIONS: Continuous analysis of ST segment resolution identifies, among patients with AMI with concomitantly occurring ST segment elevation and depression, a subgroup with increased in-hospital mortality. The pathogenic mechanism of increased mortality is not currently known.

Aged↗
PubMed1997

Electrocardiographic differentiation of the ST-segment depression of acute myocardial injury due to the left circumflex artery occlusion from that of myocardial ischemia of nonocclusive etiologies.

Lead distributions of peak ST-segment depression were compared between patients undergoing left circumflex artery percutaneous transluminal coronary angioplasty and exercise tolerance test. Localization of peak ST-segment depression to leads V2 or V3 was 96% specific and 70% sensitive for differentiating ischemia due to occlusion of left circumflex artery occlusion from nonocclusive ischemia.

Angioplasty, Balloon, Coronary↗
PubMed1997

BFU-E colony growth in response to hydroxyurea: correlation between in vitro and in vivo fetal hemoglobin induction.

Patients with sickle-cell anemia treated with hydroxyurea may have significant reduction in frequency and severity of pain episodes. However, previous clinical trials show a variable response to hydroxyurea. Criteria which can be used to select patients who are likely to respond to hydroxyurea treatment would be useful. Our laboratory has previously demonstrated an inverse linear relationship between the total number of burst-forming unit-erythroid (BFU-E) colonies and fetal hemoglobin levels in sickle-cell patients treated with hydroxyurea. In the present report, an in vitro cell culture system was established to evaluate the effects of hydroxyurea on BFU-E colony growth and induction of fetal hemoglobin production. Five Hb SS patients who were not previously treated with hydroxyurea and three Hb SS patients who failed to respond to hydroxyurea treatment were included in the study. The results show that the number of BFU-E colonies is decreased from 153.7 to 7.2 per 3 x 10(5) mononuclear cells, whereas fetal hemoglobin levels were increased from 5.1 to 19.4% in the presence of hydroxyurea in vitro in cultured erythroid progenitors, which were derived from 5 patients before treatment. The number of BFU-E colonies decreased from 153.7 to 2.0 per 3 x 10(5) mononuclear cells in the in vitro cultures obtained from serial peripheral blood samples over a 9- to 20-week period of oral hydroxyurea therapy. A simultaneous rise in fetal hemoglobin level from 10.2 to 28.6% in the peripheral blood over the same period of hydroxyurea therapy was also observed. Our results demonstrate that the increase in fetal hemoglobin levels in cells treated with hydroxyurea in vitro is comparable to the rise of fetal hemoglobin production following hydroxyurea therapy in these patients. On the contrary, these findings were not observed in three previously non-responsive sickle-cell patients. These results suggest that the changes in number of BFU-E colonies and fetal hemoglobin levels after in vitro exposure to hydroxyurea may be a useful approach to select sickle-cell patients who will respond to hydroxyurea therapy.

Adolescent↗
PubMed1997

Screening for depression on continuing care psychogeriatric wards.

The performance of the Depressive Signs Scale (DSS) completed by the nursing staff, in detecting significant clinical depression among continuing care psychogeriatric inpatients was examined. A cutoff score of 5/6 gave the best sensitivity (70%) and specificity (72%) in the whole sample. The same cutoff value gave the best sensitivity (62%) and specificity (72%) in the dementia subsample.

Adult↗
PubMed1997

Psychogeriatric inpatient suicides in Australia.

Psychiatric inpatients have a higher suicide rate than the general population. Psychogeriatric inpatients suicides over a 21-year period, in a large psychiatric hospital in Melbourne were examined. Only 8% of all inpatient suicides were by those aged over 60 years. Psychogeriatric inpatients suicides, when compared to younger inpatient suicides, were more likely to have depression, less likely to have schizophrenia, have more children and have a longer interval between the age of onset of the illness and the index admission. These associations were probably a function of age. Psychogeriatric inpatient suicides, when compared with psychogeriatric 'alive' inpatients, were associated with depression, alcohol misuse and preadmission and intra-admission suicidal ideation. A high index of suspicion and vigilance among staff for elderly patients with these features is suggested.

Age Distribution↗