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Biomedical subjects

B Patel

Publications and source records attributed to B Patel.

At least 19 recordsLinked to original sources
PubMed2001

Combination vaccines: postlicensure safety evaluation.

The success of immunizations in nearly eliminating many vaccine-preventable diseases has resulted in an increase in the need to study risks from vaccines, combination or otherwise. The well-known limitations associated with prelicensure trials have led many to hope that postlicensure studies can address safety issues. This article reviews measures that have been or should be taken to meet this expectation: establishment of clinical immunization safety assessment centers, standardization of case definitions for vaccine adverse events, use of the Vaccine Identification Standards Initiative to improve the accuracy and efficiency with which vaccination records are transferred, integration of vaccine safety monitoring into immunization registries, establishment (and enlargement) of the Vaccine Safety Datalink project, use of innovative analytic tools for better signal detection, and implementation of various methods to overcome confounding by contraindication. Only by investing in vaccine safety infrastructure at a level commensurate with investments in vaccine development can we hope to retain the public's confidence in immunization.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

A means to an end: an overview of a hyperlipidemia outcomes management program.

Quality management and improvement are increasingly important to managed care organizations (MCOs) as competition increases. One key area on which quality improvement programs can focus is MCO activity in helping patients remain healthy. Screening for and treatment of hyperlipidemia are important components of the preventive care of patients who are at risk for coronary heart disease (CHD). This article summarizes the methodology of a three-phase hyperlipidemia outcomes management program being implemented by 27 US health plans. Phase 1 identifies inefficiencies in the clinical management of hyperlipidemia by assessing patients' attainment rates of low-density lipoprotein cholesterol (LDL-C) targets. This information is then used to develop a multifactorial intervention program for CHD prevention in phase 2. The interventions for physicians include provision of treatment algorithms for patients with varying degrees of hyperlipidemia, education programs encouraging appropriate treatment of hyperlipidemia, and academic detailing summarizing phase 1 results and providing applicable literature. In phase 3, patient records are reassessed at least 6 months after the educational intervention. This three-phase program has the potential to improve patient care, reduce unnecessary treatment costs, provide a means of quality improvement, and increase plan value to potential purchasers.

Cholesterol, LDL↗
PubMed2001

Elevated plasma amyloid beta-peptide 1-42 and onset of dementia in adults with Down syndrome.

We compared levels of plasma amyloid beta-peptides Abeta1-42 and Abeta1-40 in 108 demented and nondemented adults with Down syndrome (DS) and 64 adults from the general population. Abeta1-42 and Abeta1-40 levels were significantly higher in adults with DS than in controls (P=0.0001). Compared to nondemented adults with DS, Abeta1-42 levels in demented adults with DS were selectively increased by 26% (28.2 pg/ml vs. 22.4 pg/ml, P=0.004). In addition, mean plasma levels of Abeta1-42 were 22% higher in DS cases with the apolipoprotein varepsilon4 allele than in DS subjects without an varepsilon4 allele (25.9 pg/ml vs. 21.2 pg/ml, P=0.01), while mean plasma levels of Abeta1-40 did not vary by APOE genotype. These results support the hypothesis that Abeta1-42 plays an important role in the pathogenesis of dementia associated with DS, as it does in Alzheimer's disease, and that variations in plasma levels may be related to disease progression.

Adult↗
PubMed2001

Abnormal dendritic spine characteristics in the temporal and visual cortices of patients with fragile-X syndrome: a quantitative examination.

Fragile-X syndrome is a common form of mental retardation resulting from the inability to produce the fragile-X mental retardation protein. Qualitative examination of human brain autopsy material has shown that fragile-X patients exhibit abnormal dendritic spine lengths and shapes on parieto-occipital neocortical pyramidal cells. Similar quantitative results have been obtained in fragile-X knockout mice, that have been engineered to lack the fragile-X mental retardation protein. Dendritic spines on layer V pyramidal cells of human temporal and visual cortices stained using the Golgi-Kopsch method were investigated. Quantitative analysis of dendritic spine length, morphology, and number was carried out on patients with fragile-X syndrome and normal age-matched controls. Fragile-X patients exhibited significantly more long dendritic spines and fewer short dendritic spines than did control subjects in both temporal and visual cortical areas. Similarly, fragile-X patients exhibited significantly more dendritic spines with an immature morphology and fewer with a more mature type morphology in both cortical areas. In addition, fragile-X patients had a higher density of dendritic spines than did controls on distal segments of apical and basilar dendrites in both cortical areas. Long dendritic spines with immature morphologies and elevated spine numbers are characteristic of early development or a lack of sensory experience. The fact that these characteristics are found in fragile-X patients throughout multiple cortical areas may suggest a global failure of normal dendritic spine maturation and or pruning during development that persists throughout adulthood.

Adult↗
PubMed2001

Optimal reading speed in simulated cataract: development of a potential vision test.

Previous studies suggest that optimal reading speed is unaffected by cataract, yet is significantly reduced in age-related macular disease. This raises the question of whether a reading speed test could be developed to assess potential vision after cataract surgery. In this study, 20 young subjects, with and without a simulation of dense cataract, read aloud Bailey-Lovie word charts. From the results, critical print size, optimal reading speed and word acuity were calculated. The simulated cataract reduced word acuity and increased the critical print size, yet optimal reading speed remained unchanged. Measurements were also taken with the charts in reversed contrast polarity. Reversing the contrast polarity of the charts improved the word acuity and optimal reading speed with the cataract simulation. The results suggest that optimal reading speed could be used as a potential vision test. Further investigations using patients with cataract and ARMD are required.

Adult↗
PubMed2001

Stridor and difficult airway in an AIDS patient.

Kaposi's sarcoma (KS) is the most common malignancy observed in patients with acquired immune deficiency syndrome (AIDS). Although KS involves the head and neck in AIDS patients, difficult airway due to KS in an AIDS patient has rarely been reported in the literature. We report a patient with AIDS and cutaneous KS who developed inspiratory stridor and required an emergent tracheostomy. AIDS patients with cutaneous KS should have an assessment of the upper airway even in the absence of airway-related symptoms. If KS is present in the upper airway, fiber optic and/or radiologic studies are indicated to assess the extent of KS, and to define the appropriate interventions.

AIDS-Related Opportunistic Infections↗
PubMed2001

Loss of visual acuity is the main reason why reading addition increases after the age of sixty.

PURPOSE: To determine why the reading addition increases after the age of 55 to 60 years when accommodation is zero. METHODS: Distance and near visual acuities, arm length, habitual near working distance, reading addition, and pupil diameter were measured in 44 subjects aged >60 years (mean, 72.9 +/- 5.7). Reading addition values were attained using three techniques: least-plus addition using both N-notation text and MN-READ text and the cross-cylinder technique. RESULTS: The mean dioptric working distance was 2.75 +/- 0.40 D. The reading addition found using N-notation text (+2.21 +/- 0.38 D) was significantly lower than that measured using MN-READ text (+2.48 +/- 0.49 D) or the cross-cylinder method (+2.53 +/- 0.44 D). The reading addition was positively correlated with the dioptric working distance (r = 0.47, p < 0.01), and decreasing habitual working distance was associated with poorer visual acuity (r = -0.42, p < 0.01). CONCLUSIONS: Our results suggest that decreases in near visual acuity after 60 years of age lead to a reduction in habitual working distance, which increases text angular subtense. In turn, the reduced working distance requires a greater reading addition. Increases in depth of field associated with both suprathreshold text (N-notation) and lower visual acuity lead to reading additions being less than the dioptric working distance.

Accommodation, Ocular↗
PubMed2001

Development of a reading speed test for potential-vision measurements.

PURPOSE: Previous studies suggest that optimal reading speed is unaffected by cataract, yet is significantly reduced in age-related macular degeneration (ARMD ). This raises the question of whether a reading speed test could be developed to assess potential vision after cataract surgery. METHODS: Nineteen subjects with cataract, 15 with ARMD, and 13 control subjects with normal, healthy eyes read Bailey-Lovie word charts aloud, and subsequently, critical print size and optimal reading speed were calculated. Measurements were also taken with the charts in reversed-contrast polarity and after pupillary dilation. RESULTS: Although the subjects with cataract had reduced word acuity and increased critical print size, optimal reading speed was similar to that of the control group at a mean of approximately 100 wpm. Optimal reading speed in the subjects with ARMD was substantially worse (mean of 39 wpm). Reversing the contrast polarity of the charts slightly increased the word acuity and optimal reading speed of the subjects with cataract. CONCLUSIONS: The results suggest that optimal reading speed would be useful as a potential-vision test. The proposed test would use text size of at least 1.32 degrees (1.2 log minimum angle of resolution [logMAR]), and pupil dilation would be unnecessary. A reading test with black letters on a white background would be adequate, because charts with reversed-contrast polarity made minimal difference in reading speed.

Aged↗
PubMed2000

The comparative content of the mitochondrial phosphoglyceroyl-ATP-containing polymer, purinogen, in rat tissues.

Here, we describe an assay for the tissue content of purinogen, a highly phosphorylated labile polymer containing ATP and phosphoglycerate found in the mitochondrial intermembrane space. We report the purinogen content (as adenine nucleotide equivalents) of rat heart and, for the first time, of rat liver, kidney, brain and mixed skeletal muscle. The findings show that purinogen contains very significant proportions of cell adenine nucleotides ranging from 25% of the free pool in brain and skeletal muscle to 135% of it in kidney. The evidence that purinogen may form a controlled intracellular reservoir of inorganic phosphate is briefly discussed.

Adenine Nucleotides↗
PubMed2000

Patient self-injection: a new approach to administering luteinizing hormone-releasing hormone analogues.

OBJECTIVE: To investigate the feasibility and advantages of self-injection of a depot dose of luteinizing hormone-releasing hormone (LHRH) analogue in patients with prostate cancer. PATIENTS AND METHODS: Twenty patients (mean age 70.9 years, range 53-85) with locally advanced or metastatic prostate cancer were recruited from urology clinics and, using a defined protocol, were taught to perform self-injection of a depot LHRH analogue (Prostap SR or Prostap 3, leuprorelin acetate, Wyeth Laboratories, Berks, UK). Patients were then followed for 1 year. RESULTS: Of the 20 patients, 11 successfully learned to use self-injection and administered injections for the duration of the study. Ten of the patients chose self-injection and continued to self-inject after the end of this study. CONCLUSIONS: This pilot study of 20 patients showed that it is feasible for a selected group of patients to be taught self-injection of an LHRH analogue, and that some patients prefer this mode of drug administration.

Aged↗
PubMed2000

Effects of X chromosome number and parental origin on X-linked gene expression in preimplantation mouse embryos.

Diploid androgenetic mouse embryos, possessing two sets of paternally inherited chromosomes, and control fertilized embryos were used to examine the relative effects of X chromosome number and parental chromosome origin on androgenone viability and X-linked gene expression. A significant difference in efficiency of blastocyst formation was observed between XX and XY androgenones in some experiments, but this difference was not uniformly observed. Significant effects of both X chromosome number and parental origin on X-linked gene expression were observed. Male and female control embryos expressed the XIST: RNA initially. This expression was followed by a preferential reduction in XIST: RNA abundance in male embryos, indicating that dosage compensation for the X chromosome may normally require the downregulation of XIST: RNA expression in male embryos, in conjunction with the production of stable XIST: transcripts in female embryos. By the late blastocyst stage, XX control embryos expressed significantly more XIST: RNA than did XY embryos. Unlike their normal counterparts, XX androgenones did not express significantly more XIST: RNA than did XY androgenones at the late blastocyst stage. Androgenones exhibited severe repression of the Pgk1 gene, but during development to the late blastocyst stage Pgk1 mRNA expression increased in XX androgenones and decreased in XY androgenones. Thus, the initial repression of the Pgk1 gene in XX androgenones was lost as the XIST: RNA declined in abundance, and this loss was correlated with a failure of XX androgenones to express significantly more XIST: RNA than did XY androgenones. These results indicate that androgenones may lack a factor that is expressed from the maternal genome and required for dosage compensation in preimplantation embryos. The results also indicate that early dosage compensation in preimplantation embryos may normally be reversible, thus providing flexibility to meet different developmental requirements of the embryonic and extraembryonic lineages.

Animals↗
PubMed2000

The use of hypnosis in dentistry: a review.

Hypnosis is a valuable technique in patient management. With appropriate training, general dental practitioners can widen the treatment options they can offer to patients, especially those who are dentally anxious. This article provides a brief theoretical and historical overview, and a review of the literature pertaining to the clinical uses of hypnosis in dentistry.

Analgesia↗
PubMed2000

Superior mesenteric artery bypass for chronic mesenteric ischaemia: a DGH experience.

This article evaluates the results of single vessel bypass surgery for symptomatic chronic mesenteric ischaemia (CMI) in 6 patients undergoing a total of 8 superior mesenteric artery (SMA) bypass operations, all with good post-operative symptom relief. Post-prandial pain and weight loss was present in 5 out of 6 patients. Epigastric bruit was present in only two patients and 4 out of 6 patients had diarrhoea. The patients had varying degrees of peripheral vascular disease, ischaemic heart disease and hypertension. All patients had occlusion of the SMA on angiography and bypassing the occluded segment resulted in disappearance of the symptoms and weight gain. The vascular graft was sutured end to side to the front of the infra-renal aorta and end to side to the SMA, distal to the origin of the middle colic artery. Two patients had recurrence of symptoms due to graft occlusion at 3 and 4 years, respectively; they were successfully treated with repeat SMA bypass. There were no major complications or deaths related to the procedure in this study; one patient developed an incisional hernia requiring elective repair. Thus, early restoration of SMA circulation by bypass grafting in patients with CMI is sufficient to alleviate symptoms and prevent intestinal infarction with its high mortality rate.

Adult↗
PubMed1999

Virulence in Trypanosoma cruzi infection correlates with the expression of a distinct family of sialidase superfamily genes.

The overall success of Trypanosoma cruzi depends on its ability to invade the host and establish a long-term infection. Little is known of the genetic factors responsible for observed differences in virulence from strain to strain in T. cruzi. A virulent T. cruzi line was derived from an attenuated parental line by two passages through mice. To identify virulence genes a subtraction library was constructed and screened for cDNA expressed exclusively in the virulent line. One cDNA hybridized to 3.5 and 4.5 Kb RNA present in virulent trypomastigotes but absent in attenuated trypomastigotes. Sequence analysis showed the cDNA to encode an 85 kDa protein with homology to members of the sialidase/trans-sialidase superfamily and has been designated vp85.1. The highest amino acid sequence similarity was to a previously described T. cruzi sialidase-homologue pseudogene [Takle, G.B., O'Conner, J., Young, A.J. and Cross, G.A.M. (1992) Mol. Biochem. Parasitol. 56, 117-128]. The vp85.1 amino acid sequence has higher homology to members of the 160 kDa flagellar-associated antigen family, FL-160, than to other 85 kDa expressed sialidase superfamily members. Southern blot analysis of virulent and attenuated lines demonstrated a complex hybridization pattern consistent with a multiple gene copy family that was identical in both lines. Antibody directed against recombinant vp85.1 peptide recognized proteins between 95 and 115 kDa in total virulent parasite lysates which were absent in attenuated lysates. Peptide N-glycosidase F treatment reduced the high molecular weight bands to 85 kDa, indicating vp85 is an N-linked glycoprotein. Immunofluorescence with anti-vp85.1 demonstrated surface localization of vp85.1 on virulent, but not attenuated, trypomastigotes. We postulate this new subfamily of trans-sialidases may play a role in virulence.

Animals↗
PubMed1999

Absence of cardiac valve dysfunction in obese patients treated with sibutramine.

OBJECTIVE: Serotonin-releasing agents prescribed as weight-loss medications have been implicated as a cause of acquired aortic and mitral valve abnormalities. Sibutramine hydrochloride (MERIDIA) is a serotonin and norepinephrine reuptake inhibitor with proven efficacy of weight reduction. The purpose of this study was to determine the incidence of cardiac valve disease in sibutraminetreated patients. RESEARCH METHODS AND PROCEDURES: Obese patients with type 2 diabetes mellitus enrolled in an ongoing double-blind, placebo-controlled, parallel-arm, 12-month study of sibutramine (followed by a 12-month open label extension) underwent transthoracic echocardiographic imaging and color Doppler interrogation for assessment of cardiac valve anatomy and function. RESULTS: A total of 210 patients were evaluated. Of these, 133 were receiving sibutramine (72 in the double-blind period), and 77 were receiving placebo. The mean+/-Standard Deviation age was 54+/-9 years, and the mean duration of treatment was 229+/-117 days (approximately 7.6 months). The prevalence of left-sided cardiac valve dysfunction was low and similar for the two treatment groups (sibutramine 3/133, or 2.3%; placebo 2/77, or 2.6%). All five cases were cases of aortic insufficiency; four were mild, one was severe (in a placebo patient). All three sibutramine cases were patients over age 50; two had a history of systemic hypertension. CONCLUSION: The prevalence of left-sided cardiac valve dysfunction was not higher than background in obese patients treated with sibutramine for an average of 7.6 months.

Adult↗