Search PubMed⌕ Search

Biomedical subjects

B C Patel

Publications and source records attributed to B C Patel.

At least 19 recordsLinked to original sources
PubMed2006

Sentinel laboratory surveillance of hepatitis C antibody testing in England: understanding the epidemiology of HCV infection.

This paper describes sentinel laboratory surveillance of hepatitis C antibody testing in England. Demographic and test result data were supplemented by follow-up questionnaires sent to the requesting clinician. Between October 2002 and September 2003 almost 75000 anti-HCV tests were performed in eight sentinel centres. More males were tested than females and over half of those tested were aged 25-44 years. Overall 5.7% (3333/58144, range 2.8-7.7%) individuals tested positive. Follow-up questionnaire data showed that 82% (1043/1277) of the positives had injecting drug use reported as the main risk exposure. The majority of negative individuals were undergoing routine screening as recommended for specific patient groups. Most individuals were asymptomatic. Antibody prevalence was estimated to be 34% in current injecting drug users and 42% in former injectors. Comparing positives to routine national surveillance suggests that only 53% (1782/3333) of diagnosed cases were reported. Sentinel laboratory data can provide valuable supplementary data to national surveillance.

Acute Disease↗
PubMed2004

Audit of the detection and notification of meningococcal disease at a North London university district hospital.

The microbiology department at a North London hospital audited notifications of suspected meningococcal disease in response to a reported high rate, which it suspected was due to over-reporting out of hours to public health specialists. All cases notified over a 14-month period were assessed with regards to time of reporting and subsequent microbiological confirmation. Of 36 notifications, 18 were confirmed as bacterial, mostly meningococcal meningitis. Of the four types of sample readily obtainable on admission (blood culture, ethylene diamine tetra-acetic acid [EDTA] blood sample, throat swab and acute serum) all were obtained in only two cases. The reporting was considered appropriate, reflecting the relatively high incidence of meningococcal disease (MD) within the local population. Further cases might perhaps have been laboratory confirmed had all samples been sent on admission. A single form requesting all four samples in suspected meningococcal disease cases is recommended. Informing public health specialists out of hours could be rationalised.

Adolescent↗
PubMed2002

Audit of turnaround times for processing Mycobacterium tuberculosis specimens in a district general hospital.

Automated liquid culture systems, coupled with molecular techniques, have decreased the time required for culture, identification and antibiotic susceptibility testing of Mycobacterium tuberculosis. This audit assessed the turnaround times of a district general hospital (DGH), assisted by the reference laboratory, for processing samples for Mycobacterium tuberculosis. A liquid culture system was in use. The hospital serves an area with a high prevalence of tuberculosis. Request forms and reference laboratory reports were examined for every new laboratory diagnosis of tuberculosis in 2000. Time to result was taken as time from receipt of specimen in the laboratory to date of reporting by reference laboratory. Seventy-two new cases of tuberculosis were culture positive in 2000. Median time to identification was 21.5 days and to antibiotic susceptibility results was 35 days. With liquid culture systems, acceptable turnaround times for processing mycobacteria are achievable, but in many DGHs this equipment is not available.

Cell Culture Techniques↗
PubMed2001

Successful treatment of rhino-orbital mucormycosis without exenteration: the use of multiple treatment modalities.

PURPOSE: To describe the successful management of rhino-orbital mucormycosis without the use of orbital exenteration. METHOD: Case report. RESULTS: The patient had successful eradication of the fungal infection with retention of normal vision and ocular function. CONCLUSIONS: The use of multiple treatment modalities including aggressive surgical debridement guided by intraoperative frozen section monitoring, intravenous liposomal amphotericin B, intraorbital regular amphotericin B and hyperbaric oxygen may allow complete resolution of orbital phycomycosis and spare the patient from the blindness and disfigurement associated with exenteration.

Adult↗
PubMed2001

Superomedial lid crease approach to the medial intraconal space: a new technique for access to the optic nerve and central space.

PURPOSE: To present clinical and cadaver studies of a new approach to the medial intraconal space. METHODS: We retrospectively review our clinical results by using a new technique to gain access to the medial intraconal space through a superomedial lid crease incision. We also use cadaver dissection studies to compare this new approach with the medial transconjunctival approach, the lateral orbitotomy without bone-flap, and the lateral orbitotomy with bone-flap. RESULTS: Access to the medial intraconal orbital space through the superomedial lid crease incision allowed optic nerve sheath fenestration or biopsy in 18 eyes with few postoperative complications. One case of tonic pupil, one case of transient vertical diplopia, and two cases of transient medial ptosis were seen. Five cavernous hemangiomas were removed from the intraconal space with this approach, with one case of transient vertical diplopia and one case of transient medial ptosis. The cadaver studies showed that when the superomedial lid crease approach is used, the tangent angle with the optic nerve and the incision-to-nerve distance measurements compare favorably with the medial transconjunctival and the lateral orbital approaches. CONCLUSIONS: The superomedial lid crease approach to the medial intraconal space has a number of advantages over the medial transconjunctival and lateral orbital approaches, including ease of dissection, incision-to-nerve distance, and angle of approach to the optic nerve. This technique allows for optic nerve sheath fenestration or tumor removal from the central space with few complications.

Adolescent↗
PubMed2001

Compressive optic neuropathy caused by renal osteodystrophy. Case report.

Compressive optic neuropathy with acute or chronic vision loss has been associated with various skull base tumors, aneurysms, Graves disease, trauma, and, less commonly, fibrous dysplasia and osteopetrosis. The authors present a case of acute visual deterioration in a 25-year-old woman who had massive calvarial hypertrophy with optic canal stenosis secondary to renal osteodystrophy (uremic leontiasis ossea [ULO]: bighead disease). Significant visual field restoration was achieved with high-dose corticosteroids followed by optic nerve decompression. This is the first case report of cranial neuropathy associated with ULO.

Adult↗
PubMed2000

Burn scar malignancies of the eyelids.

PURPOSE: To study the clinicopathologic characteristics and treatment of eyelid carcinomas developing in thermal burn scars. METHODS: A review of eight cases of eyelid burn scar malignancies: two from our own experience and six from published reports. RESULTS: Reported cases of burn scar malignancy of the eyelid are short-latency basal cell carcinomas. All carcinomas arose from small superficial burns. These potentially aggressive tumors respond well to local excision. CONCLUSION: As with other areas of the body, eyelid burn scars may undergo neoplastic degeneration. These carcinomas are predominately short latency basal cell carcinomas, rather than long-latency squamous cell carcinomas that are more common elsewhere in the body, including the head and neck region. Clinicians should be diligent in the long-term surveillance of all eyelid burns.

Adult↗
PubMed1999

A comparison of patient comfort during cataract surgery with topical anesthesia versus topical anesthesia and intracameral lidocaine.

OBJECTIVE: To determine whether intraocular lidocaine increases patient comfort during cataract surgery while under topical anesthesia. DESIGN: Prospective, randomized, double-masked, placebo-controlled clinical trial. PARTICIPANTS: Both men and women between 45 and 85 years of age who were scheduled for elective cataract surgery while under topical anesthesia participated. Sixty-eight patients were randomized to each group. INTERVENTION: Patients were randomized to receive either topical anesthesia plus intracameral 1% preservative-free lidocaine or intracameral balanced salt solution. MAIN OUTCOME MEASURES: Patient assessment of pain during delivery of the anesthesia, surgery, and after surgery using a visual analog pain scale was measured. Patients also recorded the degree to which they were bothered by tissue manipulation and the microscope light. Surgeon assessments of operative conditions, patient cooperation, and intraoperative complications were recorded. The attending anesthesiologist recorded any required supplemental intravenous sedation and any increase in pulse or increase in blood pressure. RESULTS: There was no significant difference in patient-reported pain scores for delivery of anesthesia (P = 0.902), surgery (P = 0.170), or after surgery (P = 0.680). Patients in the lidocaine group reported being less bothered by tissue manipulation (P = 0.021). The surgeon assessment showed more patient cooperation in the lidocaine group (P = 0.043). CONCLUSIONS: Both topical anesthesia alone and topical anesthesia plus intracameral lidocaine provide good operative conditions for the surgeon and comfortable surgical circumstances for the patient. Injection of intraocular lidocaine increases patient cooperation and decreases the degree to which patients are bothered by tissue manipulation, two outcomes that justify its use.

Administration, Topical↗
PubMed1999

Midface rejuvenation.

Recent advances in our understanding of midfacial aging have resulted in the development of several techniques of midfacial rejuvenation. Because aging causes vertical as well as inferomedial migration of midfacial and periorbital tissues, techniques that reposition ptotic tissues in the opposite direction give the best results. Minimal incision techniques have been developed in conjunction with our understanding of the anatomy. It is vital to understand the specific indications and limitations of the various techniques discussed in this article.

Aged↗
PubMed1998

Cutaneous malignant melanoma and oculodermal melanocytosis (nevus of Ota): report of a case and review of the literature.

A 29-year-old white man, with oculodermal melanocytosis, had a rapidly enlarging, erythematous, painful nodule over his left brow, within the nevus. The lesion was excised and diagnosed as a malignant melanoma. Systemic evaluation showed no evidence of distant disease. This is the tenth case reported of a cutaneous melanoma developing in a nevus of Ota. Melanoma arising in the choroid, brain, orbit, iris, ciliary body, or optic nerve in association with a nevus of Ota is well documented. Careful observation is necessary in patients with a nevus of Ota, particularly in white patients, in whom malignant degeneration seems to occur with a disproportionate frequency.

Adult↗
PubMed1998

Prospective evaluation of topical versus retrobulbar anesthesia: a converting surgeon's experience.

PURPOSE: To evaluate and compare the efficacy of topical versus retrobulbar anesthesia for cataract surgery performed by a surgeon newly converting to the topical technique. SETTING: Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: Ninety patients were prospectively assigned by permuted block restricted randomization to receive topical (Group 1; n = 45) or retrobulbar (Group 2; n = 45) anesthesia. Group 1 received topical bupivacaine 0.75% and intravenous midazolam and fentanyl for anesthesia. Group 2 received intravenous methohexital followed by retrobulbar block with an equal mixture of lidocaine 2% and bupivacaine 0.75% plus hyaluronidase 150 units. A visual pain analog scale was used to assess the degree of pain during anesthesia administration and surgery and postoperatively. The degree to which eye movement, touch, and light caused patient discomfort was assessed. Intraoperative conditions and complications were recorded. RESULTS: Intraoperative operating conditions were significantly better in Group 2 (P < .05). There was a small but statistically significant difference in the degree of discomfort during anesthesia administration and surgery (P < .05). There was no difference in postoperative discomfort. Chemosis, subconjunctival hemorrhage, and eyelid hemorrhage occurred only in Group 2, in which there was one retrobulbar hemorrhage. Although eyelid squeezing and ocular motility were present more frequently in Group 1, neither was a problem to the surgeon. CONCLUSION: Cataract surgery was safely performed by a surgeon converting to topical anesthesia. After a distinct learning curve, the procedure was performed with minimal patient discomfort. Surgical training and patient preparation are the key to safe use of topical anesthesia.

Administration, Topical↗
PubMed1998

Management of complex orbital fractures.

Fractures of the orbit place the globe and associated structures at significant risk. Management of these fractures requires a thorough ophthalmic evaluation and precise imaging. Contemporary surgical approaches allow the surgeon to repair these injuries with minimal secondary cosmetic deformities and should avoid injury to the globe. A principle goal of therapy is to anatomically reduce fracture segments and to restore a normal orbital volume. Reconstitution of a normal orbital volume and support for the globe will prevent post-injury enophthalmos and globe malposition. The evaluation, imaging, exposure, and repair of orbital fractures is reviewed. Prevention and management of complications is also discussed. The causes of and prevention of blindness is discussed. Application of these techniques should allow for the repair of orbital fractures in a single stage with minimal morbidity.

Adult↗
PubMed1998

Standardized range of conformers and symblepharon rings.

Conformers and symblepharon rings are routinely used to keep fornices formed after socket surgery or in the presence of conjunctival cicatricial disease. However, there is no accepted standard size or shape of conformers or symblepharon rings. We measured the ideal conformer and symblepharon sizes in patients undergoing socket surgery and designed six conformer and symblepharon sizes. The full set of six conformers and symblepharon rings is available to the surgeon at the end of surgery. We have successfully used these conformers and symblepharon rings in over 600 cases during the last 7 years. These standardized sizes allow more accurate fitting of conformers and symblepharon rings.

Eye Enucleation↗
PubMed1998

The krypton yellow-green laser for the treatment of facial vascular and pigmented lesions.

There has been a bewildering increase in the number and types of lasers available to the modern surgeon for the treatment of a variety of lesions. Pigmented and vascular lesions lend themselves to laser therapy and are common presentations in the cosmetic practice. While many different lasers may be effective for the treatment of these lesions, each has its own advantages and disadvantages. A detailed understanding of the specific properties and the applicability of the different lasers is vital if one is to successfully incorporate these lasers into one's practice. In this article, we discuss the different types of lasers available for the treatment of these lesions, discuss the specific indications and limitations and present our experience with the krypton laser.

Face↗
PubMed1998

Blepharospasm: past, present, and future.

To investigate causes, associations, and results of treatment with blepharospasm, 1,653 patients were evaluated by extensive questionnaires to study blepharospasm and long-term results of treatment with the full myectomy operation, botulinum-A toxin, drug therapy, and help from the Benign Essential Blepharospasm Research Foundation (BEBRF). The percent of patients improved by the BEBRF was 90%, full myectomy 88%, botulinum-A toxin 86%, and drug therapy 43%. The patient acceptance rate for the BEBRF was 96%, full myectomy 82%, botulinum-A toxin 95%, and drug therapy 57%. Blepharospasm is multifactorial in origin and manifestation. A vicious cycle and defective circuit theory to explain in origin and direct treatment rather than a defective specific locus is presented. All four forms of therapy evaluated are useful and must be tailored to the patient's needs. Mattie Lou Koster and the BEBRF have helped blepharospasm sufferers more than any other modality, and all patients should be informed of this support group. The full myectomy is reserved for botulinum-A toxin failures, and the limited myectomy is an excellent adjunct to botulinum-A toxin.

Blepharospasm↗
PubMed1997

Serogroups/types and antibiotic resistance of referred isolates of Streptococcus pneumoniae: 1993 to 1995.

Surveillance of prevalent serogroups/types of Streptococcus pneumoniae and their susceptibility to antimicrobial agents is important for understanding the epidemiology of pneumococcal infections and for guiding empirical treatment. Current vaccines for prevention of pneumococcal infection utilise serotype specific antigens, so knowledge of the prevalence of particular serotypes is relevant to vaccine use and development. Five thousand seven hundred and ninety-six isolates of S. pneumoniae from separate patients were serogrouped or serotyped by the Streptococcus and Diphtheria Reference Unit between 1993 and 1995. Antibiotic susceptibility testing was carried out by the Antibiotic Reference Unit on 3821 (65.9%) of these isolates. A total of 40 distinct serogroups/types, together with a small number of non-typable isolates, were noted over the three year period. The same five serogroups/types (6, 9, 14, 19, and 23) occurred most commonly in each year of the study, not only in the total population of isolates studied, but also in isolates obtained from blood or cerebrospinal fluid, and among isolates with antibiotic resistance. Ninety-six per cent of the isolates belonged to serogroups/types included in the currently available 23-valent capsular polysaccharide pneumococcal vaccine; the conjugate petna-, hepta-, and nonavalent vaccines covered 51%, 75%, and 80% of isolates respectively. The nonavalent vaccine offers the most promise as 74% of all blood and cerebrospinal fluid isolates and 90% of antibiotic resistant isolates belonged to serogroups or types included in this formulation.

Anti-Bacterial Agents↗
PubMed1997

Morphological changes induced by short pulse hydrogen fluoride laser radiation on dental hard tissue and restorative materials.

BACKGROUND AND OBJECTIVE: The potential benefits of the effects of lasers on dental tissues have yet to be realized but may be brought closer through the availability of a suitable laser. The objective of this project is to examine the surface morphological changes resulting from hydrogen fluoride (HF) laser radiation on tooth and restorative material surfaces. STUDY DESIGN/MATERIALS AND METHODS: A hydrogen fluoride laser emitting at 2.9 microns is used to interact with a range of dental hard tissue and restorative materials. The surface morphological changes induced by 100 mJ pulses of < 1 microsecond duration is studied using a SEM. RESULTS: The irradiated surfaces displayed microstructures similar to those of a mechanically fractured surface with no evidence of melting. CONCLUSION: This study suggests that tissue is removed by microexplosion, leaving a surface free from thermal damage with surface characteristics that would appear to facilitate the adhesion of restorative materials.

Composite Resins↗