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Biomedical subjects

A Shah

Publications and source records attributed to A Shah.

At least 73 records · Page 4Linked to original sources
PubMed2001

The prevalence and correlates of capacity to consent to a geriatric psychiatry admission.

In the UK the recent House of Lords ruling on the Bournewood case provided a statutory basis for admitting patients into psychiatric beds who lack the capacity to consent, but do not dissent, without recourse to detention under the Mental Health Act. A study to ascertain the prevalence and correlates of the lack of capacity to consent to geriatric psychiatry inpatient admission was undertaken. All consecutive acute inpatient admissions to a geriatric psychiatry unit over a six-month period were examined by an independent research psychiatrist (SM). Data on demography, diagnosis, severity of cognitive impairment, insight, the SM's assessment of capacity to consent to the admission and the consultant psychiatrists' assessment of the capacity to consent to the admission were ascertained. The overall prevalence of lack of capacity to consent to geriatric psychiatry inpatient admission was 48%. It was associated with a diagnosis of dementia, increased severity of cognitive impairment, reduced insight and detention under the Mental Health Act. The kappa concordance between SM's and the consultant psychiatrist's assessment of capacity was modest at 0.6. These findings require replication in a larger multi-centre study, perhaps using standardised instruments to measure capacity. A large number of psychiatric patients are informally admitted despite lacking the capacity to consent to the admission because they do not dissent. These patients do not enjoy the safeguards available under the Mental Health Act.

Aged↗
PubMed2001

In Caenorhabditis elegans, the RNA-binding domains of the cytoplasmic polyadenylation element binding protein FOG-1 are needed to regulate germ cell fates.

FOG-1 controls germ cell fates in the nematode Caenorhabditis elegans. Sequence analyses revealed that FOG-1 is a cytoplasmic polyadenylation element binding (CPEB) protein; similar proteins from other species have been shown to bind messenger RNAs and regulate their translation. Our analyses of fog-1 mutations indicate that each of the three RNA-binding domains of FOG-1 is essential for activity. In addition, biochemical tests show that FOG-1 is capable of binding RNA sequences in the 3'-untranslated region of its own message. Finally, genetic assays reveal that fog-1 functions zygotically, that the small fog-1 transcript has no detectable function, and that missense mutations in fog-1 cause a dominant negative phenotype. This last observation suggests that FOG-1 acts in a complex, or as a multimer, to regulate translation. On the basis of these data, we propose that FOG-1 binds RNA to regulate germ cell fates and that it does so by controlling the translation of its targets. One of these targets might be the fog-1 transcript itself.

3' Untranslated Regions↗
PubMed2001

Results of hepatic resection for sarcoma metastatic to liver.

OBJECTIVE: To evaluate the outcome of patients with liver metastases from sarcoma who underwent hepatic resection at a single institution and were followed up prospectively. SUMMARY BACKGROUND DATA: The value of hepatic resection for metastatic sarcoma is unknown. METHODS: There were 331 patients with liver metastases from sarcoma who were admitted to Memorial Hospital from 1982 to 2000, and 56 of them underwent resection of all gross hepatic disease. Patient, tumor, and treatment variables were analyzed to assess outcome. RESULTS: Of the 56 patients who underwent complete resection, 34 (61%) had gastrointestinal stromal tumors or gastrointestinal leiomyosarcomas. Half of the patients required an hepatic lobectomy or extended lobectomy. There were no perioperative deaths in the completely resected group, although 3 of the 75 patients who underwent exploration (4%) died. The postoperative 1-, 3-, and 5-year actuarial survival rates were 88%, 50%, and 30%, respectively, with a median of 39 months. In contrast, the 5-year survival rate of patients who did not undergo complete resection was 4%. On multivariate analysis, a time interval from the primary tumor to the development of liver metastasis greater than 2 years was a significant predictor of survival after hepatectomy. CONCLUSIONS: Complete resection of liver metastases from sarcoma in selected patients is associated with prolonged survival. Hepatectomy should be considered when complete gross resection is possible, especially when the time to the development of liver metastasis exceeds 2 years.

Adult↗
PubMed2001

Acute statin treatment in reducing risk after acute coronary syndrome: the MIRACL (Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering) Trial.

Three-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors (statins) reduce coronary events and death in both primary and secondary prevention trials. In these trials benefit did not appear for years after randomization. It is noteworthy that these trials did not include patients with recent myocardial infarctions or unstable angina. It is well known that mortality and recurrent ischemic events rates are the highest in the early period after acute coronary syndromes. Favorable physiologic effects of statins have been described within a few weeks of exposure to the statin in a number of experimental studies. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study was designed to bridge the gap between primary and secondary prevention trials and specifically included patients with unstable angina or non-ST elevation myocardial infarction.

Angina, Unstable↗
PubMed2001

External threats and nursing home administrator turnover.

External threats and volatility in the long-term-care sector in recent decades have posed serious challenges for nursing home administrators. Greater job complexity and administrative responsibilities resulting from public policies and more specialization and competitiveness in nursing home markets have made turnover a significant issue. This article examines administrator turnover from 1970 through 1997 in New York State and describes how turnover increased markedly in the late 1980s and early 1990s.

Attitude of Health Personnel↗
PubMed2001

Hospital diversification into long-term care.

In the 1990s, acute care hospitals in the United States encountered an unstable operating environment created by a series of transformations in the health care delivery system and long-term-care market. Confronted with an array of economic pressures and demographic changes, hospitals were motivated to engage in long-term-care diversification, such as establishing a long-term-care unit or providing home health services, as a means of entering new markets and ensuring financial stability. This article examines the organizational, market, and community factors associated with this strategic activity among a national sample of urban and rural hospitals.

Catchment Area, Health↗
PubMed2001

Thymic size on chest radiograph and rapid disease progression in human immunodeficiency virus 1-infected children.

BACKGROUND: Early infection of the thymus, an organ central to the ontogeny of the immune system, has been proposed as a cause of rapid progression in pediatric HIV disease. OBJECTIVE: To test the hypothesis that small thymic volume is associated with rapid disease progression in HIV-infected children. DESIGN: Three pediatric radiologists established criteria for rating the size of the thymic profile on chest radiographs. All available baseline chest radiographs were reviewed in a random sequence, with radiologists blinded to study subjects' clinical status. A consensus was reached on whether the thymus was normal or small for age. SETTING: A prospective multicenter study of the natural history of HIV-1 infection in children, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted Human Immunodeficiency Virus Infection (P2C2) Study. PATIENTS: Fifty-eight HIV-infected children and 38 control children (uninfected but born to HIV-infected women) for whom chest radiographs in the first year of life were available. MAIN OUTCOME MEASURE: Rapid progression of HIV disease, defined as CDC Clinical Category C (severely symptomatic) or Immunologic Category 3 (severe immunosuppression) by 1 year of age. RESULTS: The mean age at the time of chest radiography was 3.5 months. Ten (17%) HIV-infected children had reduced thymic profile size, whereas no controls did (P = 0.006). Of the 58 (59%) HIV-infected children 34 were classified as rapid progressors, and 9 (26%) of them had reduced thymus size, compared with 1 (4%) of the non-rapid progressor children [odds ratio, 8.28; 95% confidence interval (CI), 1.0, 70.5; P = 0.035]. Baseline mean CD4+ count was 1642 (95% CI 1322 to 2009) cells/microl for those with normal thymus and 740 (95% CI 380 to 1275) cells/microl for those with reduced thymus (P = 0.007). CONCLUSION: Early thymic involution is associated with rapidly progressive disease in HIV-infected children.

Adolescent↗
PubMed2001

Aplastic anemia in systemic lupus erythematosus: a distinct presentation of acquired aplastic anemia?

Aplastic anemia is a rare but serious complication of systemic lupus erythematosus (SLE) with an often dramatic and unanticipated onset. The peripheral destruction of formed blood elements, which frequently accompanies the syndrome, may obscure or delay the diagnosis of bone marrow suppression, and the number of published cases may be an underestimate of the actual incidence of the disease. Furthermore, the disease course may differ significantly from other forms of acquired aplastic anemia and seems to carry a more favorable prognosis once effectively diagnosed and treated. In addition, aplastic anemia may precede other manifestations of SLE. Therefore, the possibility of bone marrow aplasia should be excluded in all SLE patients with severe pancytopenia, and conversely, the diagnosis of SLE should be explored in cases of aplastic anemia. Two patients with aplastic anemia in SLE, one with aplastic anemia preceding the onset of SLE, are described along with 15 cases reviewed from the English language literature. The presentation, prognosis, treatment, and pathogenesis of aplastic anemia complicating SLE are discussed. Recognition that cytopenias, especially pancytopenia, may occur on the basis of inhibited myelopoesis rather than peripheral destruction as either a harbinger of SLE or as a manifestation of disease flare is important. This knowledge will prompt the astute clinician to obtain screening antinuclear antibodies in the setting of otherwise unexplained bone marrow acellularity or, given the prognosis of SLE associated aplastic anemia, give early consideration to more aggressive immunosuppression.

Journal Article↗
PubMed2001

Infliximab for refractory ulcerative colitis.

Eight patients with active ulcerative colitis (UC), refractory to usual combination medical therapy, were treated with a single i.v. dose of chimeric monoclonal antibody to recombinant human tumor necrosis factor alpha; many of these patients were scheduled for surgical colectomy because of their active disease. All patients responded extremely well to a single 5 mg/kg infusion of infliximab, with marked improvement after the infusion clinically, colonoscopically, and histologically on colonic biopsy. There were no significant complications or side effects; mean duration of remission has not been determined because none of the patients have relapsed. Infliximab appears to be a potent agent for inducing remission in refractory patients with ulcerative colitis.

Adult↗
PubMed2001

Trends in age band-specific suicide rates among elderly people in England and Wales.

BACKGROUND: The elderly suicide rate in recent years in England and Wales has been declining for both sexes. METHOD: Data on the various suicide variables were ascertained from the annually published mortality data for years 1985 to 1998. Trends in the age band-specific elderly suicide rates in recent years were examined using this data. RESULTS: The main findings of this study were: (i) there was a decline in the 'pure' and 'combined' suicide rates, for both sexes, for the four five-year age bands between 65 and 85 years, but not for the older age groups; and (ii) for all age bands, male suicide rates were higher than female suicide rates. CONCLUSIONS: The challenge now is to facilitate decline in suicide rates in the very old given that demographic changes imply more people in that age group and absence of current evidence of decline in the very old age bands.

Age Distribution↗
PubMed2001

Pharmacokinetics, safety, and tolerability of BAY 12-9566 and nonsteroidal anti-inflammatory agents (naproxen, ibuprofen) during coadministration in patients with osteoarthritis.

The pharmacokinetic interactions between BAY 12-9566 and two nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen and ibuprofen, were investigated in osteoarthritis (OA) patients. The study comprised six groups: two NSAID groups with three levels of treatment (BAY 12-9566 400 mg, BAY 12-9566 100 mg, and placebo). Plasma pharmacokinetic parameters (AUC(0-tau), Cmax, and tmax) were determined for each treatment group following 5 days of NSAID administration, 14 days of BAY 12-9566 administration, and 14 days of concurrent NSAID and BAY 12-9566 administration. For most conditions, the total plasma drug concentrations of both NSAID and BAY 12-9566 were diminished by coadministration; total plasma BAY 12-9566 was not affected by ibuprofen treatment. Importantly, the free drug concentrations were largely unaffected by coadministration. Most side effects were mild or moderate in intensity, and all events, with the exception of headache, were reported in both NSAID groups and in both placebo and BAY 12-9566 groups.

Adult↗
PubMed2001

Effect of age and gender on the safety, tolerability, and pharmacokinetics of BAY 12-9566 in healthy subjects.

The impact of age and gender on the single-dose pharmacokinetics, safety, and tolerability of BAY 12-9566 was evaluated in healthy subjects. Volunteers were grouped according to age and gender (13 young males, 11 elderly males, and 12 elderly females) and then randomized in a 2:1 ratio to receive a single oral 50 mg dose of BAY 12-9566 or placebo. Serial plasma samples were collected up to 336 hours postdose and assayed for BAY 12-9566. Peak plasma concentration, time to reach peak plasma concentration, the area under the concentration-time curve, oral clearance, volume of distribution, and elimination half-life were calculated. BAY 12-9566 was well tolerated in all treatment groups, and no serious adverse events occurred during the study. Substantial age- or gender-related differences were not observed for any of the pharmacokinetic parameters tested. Based on these pharmacokinetic and tolerability profiles, age- or gender-related dose adjustments were not required for BAY 12-9566.

Adult↗
PubMed2001

Multiple metal contamination from house paints: consequences of power sanding and paint scraping in New Orleans.

Power sanding exterior paint is a common practice during repainting of old houses in New Orleans, Louisiana, that triggers lead poisoning and releases more than Pb. In this study we quantified the Pb, zinc, cadmium, manganese, nickel, copper, cobalt, chromium, and vanadium in exterior paint samples collected from New Orleans homes (n = 31). We used interior dust wipes to compare two exterior house-painting projects. House 1 was measured in response to the plight of a family after a paint contractor power sanded all exterior paint from the weatherboards. The Pb content (approximately 130,000 microg Pb/g) was first realized when the family pet died; the children were hospitalized, the family was displaced, and cleanup costs were high. To determine the quantity of dust generated by power sanding and the benefits of reducing Pb-contaminated dust, we tested a case study house (house 2) for Pb (approximately 90,000 microg/g) before the project was started; the house was then dry scraped and the paint chips were collected. Although the hazards of Pb-based paints are well known, there are other problems as well, because other toxic metals exist in old paints. If house 2 had been power sanded to bare wood like house 1, the repainting project would have released as dust about 7.4 kg Pb, 3.5 kg Zn, 9.7 g Cd, 14.8 g Cu, 8.8 g Mn, 1.5 g Ni, 5.4 g Co, 2.4 g Cr, and 0.3 g V. The total tolerable daily intake (TTDI) for a child under 6 years of age is 6 microg Pb from all sources. Converting 7.4 kg Pb to this scale is vexing--more than 1 billion (10(9)) times the TTDI. Also for perspective, the one-time release of 7.4 x 10(9) microg of Pb dust from sanding compares to 50 x 10(9) microg of Pb dust emitted annually per 0.1 mile (0.16 km) from street traffic during the peak use of leaded gasoline. In this paper, we broaden the discussion to include an array of metals in paint and underscore the need and possibilities for curtailing the release of metal dust.

Air Movements↗
PubMed2001

Capacity to consent: issues and controversies.

Capacity to consent has major ethical and legal implications, but it is often poorly understood and inadequately practiced. Varied literature on the subject is reviewed with a view to discuss the legal and clinical aspects and strategies to improve current practice.

Decision Making↗
PubMed2001

Prevention of galanin upregulation following neonatal infraorbital nerve transection or attenuation of axoplasmic transport does not rescue central vibrissae-related patterns in the rat.

Neonatal transection of, or blockade of axoplasmic transport in, the infraorbital nerve [ION, the trigeminal (V) branch that supplies the mystacial vibrissae follicles] results in a loss of all central patterns corresponding to the vibrissae follicles in the brainstem, thalamus and cortex except for those of the central terminal arbors of ION primary afferents that survive this lesion. Both of these manipulations also result in a rapid and dramatic upregulation of at least two peptides, galanin and neuropeptide Y, in surviving vibrissae-related primary afferents. Galanin is of particular interest, because this peptide has effects on neuronal activity and growth, both factors which may be involved in the disappearance of central vibrissae-related patterns in rats that have sustained neonatal ION transection or axoplasmic transport blockade. The present study used antisense technology to determine whether the upregulation of galanin in the central terminals of ION primary afferents is necessary for the loss of central vibrissae-related patterns in rats. Newborn rats had their left ION transected or axoplasmic transport in this nerve blocked by application of a vinblastine-impregnated implant, and at the same time received an injection of commercially synthesized phosphorothioate oligodeoxynucleotide sequences (15-20 bases) directly into the V ganglion in order to block galanin upregulation. These injections effectively prevented the upregulation of this peptide which is normally associated with ION transection or axoplasmic transport blockade. Preventing galanin upregulation, however, did not prevent or attenuate the loss of central vibrissae-related patterns in the brainstem or cortex normally observed following ION transection or axoplasmic transport blockade in this nerve. These results are thus consistent with the conclusion that the upregulation of galanin in the central terminals of V primary afferents, observed after damage to or attenuation of axoplasmic transport in the ION, is not necessary for the reorganization that results in a disappearance of central vibrissae-related patterns in the V neuraxis.

Animals↗
PubMed2001

Challenges in using the Arden Syntax for computer-based nosocomial infection surveillance.

CONTEXT: Detection of outbreaks of infection in the hospital typically requires daily manual review of microbiology laboratory test results. This process is time-consuming, tedious, prone to error and may miss trends in infection. A standard formalism for procedural knowledge representation, the Arden Syntax, provides a vehicle for implementing algorithms for detecting such infections. OBJECTIVE: To design and implement a computer-based system for detection of concerning patterns of infection or antibiotic resistance. SETTING: Computer-based event monitor and central patient data repository at the Columbia-Presbyterian Medical Center (CPMC). RESULTS: We designed a two-phase system, including initial filtering of individual patient laboratory results by Arden Syntax Medical Logic Modules (MLMs) and subsequent aggregation and analysis across patients and locations using a statistical monitor. Preliminary data for the filtration phase demonstrate a 94.8% reduction in the volume of messages that must be considered in surveillance. CONCLUSIONS: Filtering raw laboratory results using a standard formalism eases the process of aggregating data across patients and sites as well as detecting trends in infection. There is a need for augmenting such formalisms in order to enable population-based decision support.

Algorithms↗