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Biomedical subjects

A Shah

Publications and source records attributed to A Shah.

At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

Bilateral serous macular detachment as a presenting feature of acute lymphoblastic leukemia.

PURPOSE: To report a case of bilateral serous maculopathy as an initial sign of acute lymphoblastic leukaemia in children. METHODS/RESULTS: A 13-year-old girl, who presented with symptoms of visual blurring, was found to have a bilateral serous maculopathy. Haematological abnormalities (thrombocytopenia with a mild lymphocytosis) prompted further investigation. A bone marrow aspirate revealed the presence of leukemic blasts and a diagnosis of acute lymphoblastic leukaemia was made. Her maculopathy completely resolved following systemic chemotherapy. CONCLUSIONS: Prompt recognition of disease led to early systemic treatment and restoration of visual function.

Adolescent↗
PubMedDate not supplied

Right atrial thrombi complicating use of central venous catheters in hemodialysis.

BACKGROUND: There has been an increase in the use of central venous catheters for temporary hemodialysis access. In this report, we describe a case series of 12 patients on hemodialysis who developed intracardiac clots associated with the use of central venous catheters, their outcomes and review the literature on this syndrome. METHODS: Retrospective, single-center case series of 12 patients with right atrial thrombi associated with central venous catheter use for dialysis vascular access. These patients were treated between June 1, 2001 and June 30th 2002 at the three University of Rochester affiliated dialysis clinics. The medical records of these patients were reviewed to obtain information concerning demographics, dialysis history, dates of catheter insertion, catheter complications, identification and dimensions of intracardiac thrombi, echocardiographic data, and outcome of anticoagulant therapy. RESULTS: Right heart thrombi were identified in 12 patients in our hemodialysis population over the study interval. Anticoagulation for 6 months led to clot resolution in more than 50% of our patients. Bacteremia recurred in 6 patients (50%), in spite of catheter replacement. There was zero mortality related to presence of clots in the short term. One patient with non-bacteremic right atrial thrombus suffered sudden cardiac arrest, but was successfully resuscitated. CONCLUSION: Right atrial thrombi may occur in hemodialysis patients who use central venous catheters for dialysis access. These clots are frequently found in the right atrium or right atrial-superior vena caval junction. Ten of 12 patients (83%), had catheter-associated bacteremia, but the precise relationship between bacteremia and intracardiac clots is unclear. Chronic anticoagulation for 6 months lead to resolution of these clots in more than 50% of patients in our series.

Journal Article↗
PubMedDate not supplied

Multifunctional antigens of A. fumigatus and specific antibodies.

The majority of Aspergillus-induced infections in man are caused by the pathogenic fungus A. fumigatus, which secretes biologically and immunologically active glycosylated and nonglycosylated proteins. The complexity in the antigenic structure of A. fumigatus and the varying host immune responses lead to a wide spectrum of clinical conditions such as allergic bronchopulmonary aspergillosis (ABPA), aspergilloma, and invasive aspergillosis. It is reported that 15-20% of allergic asthmatics suffer from Aspergillus-induced allergies. The incidence of opportunistic infections, including Aspergillus infections, has risen because of the increase in the incidence of HIV and tuberculosis. Allergic bronchopulmonary aspergillosis is an immunologically significant clinical form where type I and type III hypersensitivity reactions are involved in pathogenesis. High levels of specific IgE and IgG antibodies in these patients are of diagnostic value. Molecular characterization of certain immunodominant allergens and antigens of A. fumigatus revealed the presence of complex carbohydrate moieties, heat-shock proteins, enzyme activities such as elastase, protease, catalase, dismutase, and cytotoxic ribonuclease. A Con A binding allergen/antigen (45 kDa) and Con A nonbinding allergen/antigen (18 kDa, Asp fI) have a multifunctional nature. The multifunctional nature of these antigens may play an important role in the pathogenesis of the disease. Significant amounts of a major allergen/antigen of molecular weight 18 kDa is excreted in large amounts through the urine of patients with invasive aspergillosis. Studies on the structure-function relationship of the 18-kDa allergen/antigen revealed the involvement of tryptophan residues in binding with monoclonal antibodies (MAbs). Also, the histidine residues and cysteine disulfide bonds of the 18-kDa allergen are involved in its catalytic activity. The high load of multifunctional antigens in the serum of patients for prolonged periods, the presence of high levels of specific antibodies, and the absence of protective antibodies in ABPA patients have necessitated studies on the functional properties of the antibodies. The present study shows significant immunoreactivity of antibodies in patients of ABPA to fibronectin and collagen. Analysis of IgG antibodies from the patients of ABPA showed the presence of DNA-cleaving activity. These observations offer a new line of thinking in understanding the mechanism of pathogenesis of Aspergillus-induced clinical manifestations, and may lead to novel approaches to intervention in the inflammation and infection caused by fungal pathogens.

Allergens↗
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Rehabilitation in Hansen's disease.

Hansen's disease leads to deformities of the lower and upper extremities. Eventually, these deformities become a serious handicap and limit the functional capabilities of the afflicted. This paper defines the characteristics of individuals suffering from Hansen's disease and demonstrates that disabilities caused by Hansen's disease can be overcome by: (i) use of splints, (ii) reconstructive surgery, (iii) modification of the articles and tools of daily use, and (iv) proper job--worker matching.

Health Education↗
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An exploration of the travelling-time implications in the siting of specialist units--a case study.

This paper describes a case study in which travelling-time implications for siting health-care facilities were examined for one of the health-care regions in the UK. The results of the study were produced to assist a planning consortium with a specific problem of siting a regional specialty. The accessibility of the sites was measured in terms of travelling-time distributions for the population of the county of Essex, a rural part of the North-East Thames Regional Health Authority. The results show that the optimal selection of site(s) in Essex is dependent on the service provided by centres outside Essex and the relative importance of short and long travelling-times.

Catchment Area, Health↗
PubMedDate not supplied

Role of pulse oximetry during nonsedated upper gastrointestinal endoscopic procedures.

BACKGROUND: Although upper gastrointestinal endoscopy is generally a safe procedure, it is known to be associated with arterial oxygen desaturation, resulting in rare serious cardio-pulmonary events. OBJECTIVE: To determine the severity of oxygen desaturation during nonsedated upper gastrointestinal endoscopy and study the effect of various variables on oxygen saturation. METHODS: 126 patients underwent nonsedated upper gastrointestinal endoscopy (82 diagnostic, 44 therapeutic). Arterial oxygen saturation (SaO2) was monitored using a pulse oximeter. RESULTS: Baseline SaO2 was mean (SD) 97.8 (1.8%). It remained > 95% in 60.2% of patients during the procedure, whereas mild oxygen desaturation (SaO2 90%-94%) occurred in 23.7% and severe oxygen desaturation (SaO2 < 90%) occurred in 15.8% of patients. Six patients (4.7%) required supplemental oxygen administration sometime during the procedure. Desaturation occurred in patients undergoing diagnostic and therapeutic procedures but was severe in the latter group (p < 0.002). Patients aged more than 60 years (p < 0.001), hemoglobin < 10 g/dL (p < 0.001), history of smoking (p < 0.001), and underlying chronic obstructive airway disease (p < 0.001) were significantly related to oxygen desaturation. However, on multivariate analysis, no significant correlation was observed with hemoglobin value. CONCLUSION: Therapeutic intervention during nonsedated upper gastrointestinal endoscopy, old age, smokers and chronic obstructive airways disease are independent risk factors for oxygen desaturation. We recommend continuous monitoring of SaO2 in these high-risk patients undergoing upper gastrointestinal endoscopy.

Age Factors↗
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Percutaneous sonography-guided fine needle aspiration biopsy of colonoscopic biopsy-negative colonic lesions.

BACKGROUND: Pre-operative tissue diagnosis with colonoscopy is not always possible in patients with colonic lesions. OBJECTIVE: To study the usefulness and efficacy of percutaneous ultrasound-guided aspiration biopsy of colonic lesions. METHODS: Fifty consecutive patients with colonic lesions in whom colonoscopic brush cytology and biopsy were either negative or the lesion was not accessible on colonoscopy on two attempts, underwent percutaneous ultrasound-guided fine-needle aspiration biopsy. The results were compared with surgical findings. RESULTS: Fine-needle aspiration biopsy revealed adenocarcinoma in 40 patients; one had lymphoma, 2 had tuberculosis, 2 had abscess and 5 patients had negative aspiration. Forty-eight patients (excluding 2 with tuberculosis) underwent laparotomy and the diagnoses on aspiration biopsy were confirmed. Of the 5 negative aspirations, 3 had adenocarcinoma, one had tuberculosis and one intussusception. Thus, we had sensitivity of 91.8%, specificity of 100%, predictive value of positive results 100%, predictive value of negative results 20%, and percentage of false negative results 8.1%. Two patients developed complications--hemorrhage into the peritoneum and sepsis due to perforation at the site of aspiration; both survived after surgery. CONCLUSION: Percutaneous ultrasound-guided aspiration biopsy may be attempted for diagnosis of colonic lesions in situations where it may be the only means of obtaining a cytological diagnosis before surgery.

Adenocarcinoma↗
PubMedDate not supplied

3,5-diacetyl-1,4-dihydropyridines: synthesis and MDR reversal in tumor cells.

Eleven 4-phenyl-3,5-diacetyl-1,4-dihydropyridines (AcDHPs) [G1-11] substituted at the phenyl ring were synthesized and compared for their cytotoxic activity and multidrug resistance (MDR)-reversing activity in in vitro assay systems. Among them, compound [G7] showed the highest cytotoxic activity against human promyelocytic leukemia HL-60 and human squamous cell carcinoma HSC-2 cells. However, no compounds tested produced radicals at pH 7.4-12.5. The activity of P-glycoprotein (Pgp) responsible for MDR in tumor cells was reduced by compounds [G2, 3, 6, 5, 8, 1, 11], verapamil [VP] and nifedipine [NP]. However, compounds [G4, 7, 10] were hardly active while G9 did not show a MDR reversing effect at 2.0-20.0 micrograms/mL. These data show a relationship between chemical structures and MDR-reversing effect on tumor cells.

Antineoplastic Agents↗
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Enhanced antibacterial effect of erythromycin in the presence of 3,5-dibenzoyl-1,4-dihydropyridines.

Fifteen 3,5-dibenzoyl-1,4-dihydropyridines (BzDHP, GB1-GB15) (nifedipine (NP) analogs) were tested on three different E. coli strains. The compounds had relatively high MIC values on these strains. In combination with erythromycin (Er), compounds (G1,3,4,6,7,10,12) reduced MIC values of Er. When the BzDHPs were tested on E. coli Gy-1/Apsen.Erres strain isolated from a clinical specimen, the reduction of MIC values were similar to the previous strains, but not identical. In the polyresistant clinically isolated E. coli Gy-2/Apres.Erres strain, the MIC values of Er were slightly reduced in the presence of GB1-GB7. Compound GB12 was the most effective in enhancing the activity of Er, and was selected for plasmid elimination studies. However, GB12 itself had no antiplasmid effect and did not alter the promethazine induced plasmid elimination.

Anti-Bacterial Agents↗
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Asthma and sex.

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Asthma↗