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Biomedical subjects

D Shah

Publications and source records attributed to D Shah.

At least 73 records · Page 4Linked to original sources
PubMed1997

Nasopharyngeal flora in HIV seropositive men who have sex with men.

OBJECTIVES: To assess, in men who were infected with the human immunodeficiency virus (HIV) and who identified themselves as having had sex with men; the nasopharyngeal prevalence of Neisseria gonorrhoeae, N meningitidis, Corynebacterium diphtheriae, and candida species; oral sexual behaviour; the relation between oral flora and oral sexual behavior. METHOD: Nasopharyngeal swabs were taken from HIV seropositive men for culture. The men were also asked to complete a self administered questionnaire. RESULTS: 390 men were recruited; 286 (73.3%) provided nasopharyngeal samples and questionnaires; 41 (10.5%) provided nasopharyngeal samples only; 63 (16.2%) provided questionnaires only. From the 327 nasopharyngeal samples N meningitidis was cultured in 49 (15%) and candida species in 165 (50.5%). Cultures for N gonorrhoeae and C diphtheriae were all negative. Data from the 349 completed questionnaires indicated that 285 men were practising oro-penile sex, over 90% did not consistently use condoms; 150 men were practising oro-anal sex, one used dental dams. In those providing both nasopharyngeal samples and sexual behaviour data meningococcal carriage was identified in 40 (17.5%) of the 228 men practising receptive oro-penile sex, compared with one (2.3%) of the 43 non-practisers (p < 0.025); in 21 (20%) of the 105 men practising insertive oro-anal sex, compared with 17 (12.5%) of the 136 non-practisers (p = 0.12). No correlation was identified between yeast carriage and oro-genital sex. CONCLUSION: Oro-genital sex, usually without barrier protection, is common among HIV infected men who have sex with men. It appears to be associated with increased meningococcal carriage but is autonomous to candida species isolation. Routine screening for nasopharyngeal N gonorrhoeae is not deemed necessary.

Candida↗
PubMed1997

Patterns of use of a free nicotine patch program for Medicaid and uninsured patients.

This study assessed the use and effectiveness of a free nicotine patch program among Medicaid and uninsured smokers. Patterns of patch use, associated behaviors with quit attempt, side effects, and self-reported abstinence from smoking for 6 months were evaluated prospectively among patients from five urban family practice offices and a nicotine dependence clinic located in a comprehensive cancer center in Western New York. Results indicated that the majority of participants used the program as intended, and 90% of the participants found the patch useful in their quit attempt. Fourteen percent of participants were abstinent for 6 months or more. We found no support for inappropriate use of transdermal nicotine patches among patients with no health insurance or those on Medicaid. Transdermal nicotine patches are an effective cessation aid for smokers. Given the tall of the consequences of smoking on health costs, barriers to access to effective treatment for smoking cessation among individuals covered by Medicaid for health insurance need to be eliminated.

Administration, Cutaneous↗
PubMed1997

Sequential interleukin-3 and granulocyte-colony stimulating factor prior to and following high-dose etoposide and cyclophosphamide: a phase I/II trial.

Administration of growth factors prior to chemotherapy (priming) may reduce myelosuppression and provide an alternative to the use of stem cell support for the delivery of dose-intensive therapy. It is possible, however, that such priming may worsen aplasia, either by recruitment of progenitors into cell cycle and thereby increasing their sensitivity to chemotherapy or by depleting stem cell pools. We performed a Phase I/II trial of sequential interleukin 3 (IL-3)/granulocyte colony-stimulating factor (G-CSF) prior to and following high-dose etoposide and cyclophosphamide to determine the safety and efficacy of priming. IL-3 was given for 7 days, and then G-CSF was given until the WBC count reached a level of 100, 000/microliter or stopped rising. Chemotherapy was started 48 h after the last dose of G-CSF. Sequential administration of IL-3/G-CSF was repeated beginning 36 h after the last dose of chemotherapy. Twenty-five eligible patients with Hodgkin's disease, non-Hodgkin's lymphoma, or breast cancer were enrolled. Priming was generally well tolerated. The median maximum WBC count and absolute neutrophil count achieved was 66,400 and 57,600/microliter, respectively. Significant decreases in platelet counts were seen during priming with 15 patients having a >/=40% decrease from prepriming values. Hematological recovery of study patients was compared to that of an unprimed historical control group (n = 38) treated with the same chemotherapy followed by G-CSF alone. Neutrophil recovery to 500 and 1000/microliter and platelet recovery to >/=50,000/microliter was significantly faster in the study group compared to that of historical controls (P = 0.03, 0.05, and 0.01, respectively). Sequential IL-3/G-CSF given prior to and following high-dose etoposide and cyclophosphamide is safe and is a feasible strategy to compare in prospective randomized trials to patients treated with only postchemotherapy IL-3 and G-CSF and to patients treated with peripheral blood stem cell support.

Adult↗
PubMed1996

Periodic intermittent electromechanical dissociation: hemodynamic correlate of a malfunctioning mechanical prosthetic valve.

We describe a patient who developed the unusual haemodynamic phenomenon of periodic intermittent electromechanical dissociation during regular sinus tachycardia about 20 hours after mitral valve replacement with a tilting disc mechanical prosthesis. Echocardiographic confirmation allowed prompt and life saving corrective surgery for a stuck prosthetic valve disc.

Adult↗
PubMed1996

3-Carboxy-20-keto steroids are dual uncompetitive inhibitors of human steroid 5 alpha-reductase types 1 and 2.

Steroidal 3-carboxy-20-ketones have been prepared within two structural series, the androsta-3,5-dienes and the estra-1,3,5-trienes, as potential inhibitors of types 1 and 2 steroid 5 alpha-reductase, the enzyme activity responsible for the final step in biosynthesis of dihydrotestosterone. These compounds are shown to be potent uncompetitive inhibitors of both human recombinant enzyme activities, defining a novel class of dual steroid 5 alpha-reductase inhibitors.

5-alpha Reductase Inhibitors↗
PubMed1996

Transcellular delivery of an insulin-transferrin conjugate in enterocyte-like Caco-2 cells.

Insulin, acylated with dimethylmaleic anhydride, was conjugated to transferrin (Tf) via a disulfide linkage. The molar insulin: Tf ratio in the conjugate was 3:1. The insulin-Tf conjugate (insulin-Tf) was tested for the transport of insulin across enterocyte-like Caco-2 cell monolayers by the process of transferrin receptor (TfR)-mediated transcytosis. The uptake of insulin-Tf in Caco-2 cells was TfR-mediated but no insulin receptor-mediated. Transport studies showed that insulin-Tf transport was 5- to 15-fold higher than free insulin transport across Caco-2 cells in both apical-to-basal and basal-to-apical directions. Brefeldin A (BFA), an agent that we have previously shown to cause an increase in TfR transcytosis, further enhanced the transport of the conjugated insulin three-fold in both directions; thus, a combination of the conjugate and BFA can cause a net 45-fold increase in the apical-to-basolateral transport of insulin across Caco-2 cell monolayers. The transported conjugate was intact as indicated by elution on a Sephadex G-50 column. Insulin in the transcytosed conjugate, unlike the original dimethylmaleyl insulin, was capable of binding to anti-insulin antibodies, indicating that free amino groups of insulin were regenerated either during or after the transcytotic process. Because Caco-2 cell monolayers provide a good model for intestinal epithelium, the insulin-Tf conjugate in combination with BFA can be a rational approach to increase the oral absorption of insulin in vivo.

Biological Transport↗
PubMed1996

Objective measurement of contact lens-induced conjunctival redness.

Ocular redness is the principal clinical sign of any inflammatory response affecting the anterior segment of the eye. The aims of the current investigation were: (1) to develop an objective method to quantify the severity and geographic distribution of redness, (2) to validate that technique by determining its precision and compare its finding to clinical rating, and (3) to apply this technique to evaluating the diurnal variation in ocular redness associated with daily and extended soft contact lens wear. The objective capture and analysis technique involved the following steps: (1) direct image formation on the CCD array of a high resolution, high sensitivity 3/4 inch Cohu camera via a Nikon Macrolens and (2) capture and image analysis with a PC-based dedicated transputer. The key steps were: filtering to accurately locate the limbus and electronic sectioning with differential intensity color analysis at fixed intervals away from the limbus. The technique gave a direct measurement of the number and size of the vessels present. The result obtained lead to the following conclusions: (1) the digitization and analysis of video recordings of the bulbar conjunctiva provide a precise measurement of the level of conjunctival redness, (2) subjective rating of low level of conjunctival redness, using an overall nine increment clinical scale, did not relate closely to the objective measurement of conjunctival redness, (3) for non-contact lens wearers, redness in the evening was similar to redness measured upon waking, and greater than redness 2 h postwaking. In contrast, in daily soft contact lens wearers, redness was maximal in the evening and greater than before insertion or during wear in the morning. In extended soft contact lens wearers, redness was maximal upon waking when it was greater than in the evening, and (4) digitization and analysis video recordings of the redness response of the bulbar conjunctiva are sufficiently sensitive clinical research tools to monitor diurnal variation of the inflammatory response of the anterior segment of the eye.

Circadian Rhythm↗
PubMed1996

Ventricular protection against atrial arrhythmias in DDD pacing based on a statistical approach: clinical results.

Atrial arrhythmias (AA) are commonly encountered in DDD paced patients. Newer dual chamber pacemakers (PM) possess mode switching functions that convert pacing to an asynchronous mode when AAs are detected. The lack of a reliable mode switch leading to rapid, irregular ventricular responses may result from AA undersensing. To avoid this the DDDR PM Chorum 7234 Ela Medical AA diagnosis is based on a statistical approach: the PM constantly compares arrhythmic and sinus cycles and, based on "strong" and "weak" criteria, provides for rapid or slower mode switch. The aim of the study was to evaluate the efficiency and reliability of these two criteria. Thirty-one patients with a Chorum 7234 implanted for AV block (11), sinus dysfunction (10), both (5), or hypertrophic obstructive cardiomyopathy (5) were evaluated at 24 hours and 1 month using the internal memory (IM) of the PM, surface 24-hour Holter recordings, and exercise testing. Interrogation of the IM on the first day of study showed that 8 patients had mode switching episodes, based only on the strong criterion confirmed by the surface Holter recording. At 1 month, the IM revealed mode switching episodes in 12 patients, 6 of whom had used the weak criterion. No inappropriate mode switching episodes was recorded during exercise testing at the 1-month follow-up. These results confirm the reliability and efficiency of this algorithm as well as the requirement for a specific algorithm to compensate for transient loss of sensing during AA.

Algorithms↗
PubMed1996

Radiofrequency catheter ablation of common atrial flutter in 200 patients.

INTRODUCTION: The purpose of this study was to evaluate the efficacy and safety of radiofrequency (RF) catheter ablation of common atrial flutter and to determine the optimum target sites in a large series of patients. Three different approaches were used to target the ablation site. The first used a combined anatomic and electrophysiologic approach, whereas the second and the third approaches relied primarily on anatomic guidelines to target the critical area in the atrial flutter reentrant circuit located in the low right atrium. BACKGROUND: Recent studies report the efficacy of RF current application in the low right atrial region to interrupt and prevent recurrences of common atrial flutter using either anatomic or electrophysiologic targets. However, larger groups of patients are required to confirm the efficacy of this technique and to specify the target sites. METHODS AND RESULTS: Two hundred consecutive patients with drug-resistant common atrial flutter were studied. In the first 50 patients, target sites were localized using both anatomic landmarks and electrophysiologic parameters. The anatomic landmarks were area 1 between the tricuspid valve and inferior vena cava orifice; area 2 between the tricuspid valve and coronary sinus ostium; and area 3 between the inferior vena and coronary sinus. The electrophysiologic criterion was to ablate when there was an atrial electrogram occurring during the plateau phase (preceding F wave). The first targeted area was that giving the more stable catheter position. In the following 30 patients, we assessed the effect of RF energy application in a single line to area 1 in the first 10 patients, area 2 in the next 10, and area 3 in the last 10 patients. In the last 120 patients, RF energy was applied only in area 1 using repeated applications. RF energy of 12 to 30 W, or that achieving a temperature of 70 degrees C, was applied for 60 to 90 seconds at each site. The endpoint of the ablation procedure was interruption and noninducibility of common atrial flutter in the first 110 patients and additional isthmal block in 48 of the last 90 patients. Overall, atrial flutter was interrupted and rendered noninducible after a single session in 191 (95%) patients and could not be interrupted in 9 (4.5%) patients. The mean number of RF applications was 12 +/- 8. After a mean follow-up of 24 +/- 9 months, recurrences occurred in 31 (15.5%) patients, 26 of whom underwent a successful second or third session without further recurrences of atrial flutter. Atrial fibrillation not documented before the ablation was detected in 11 patients. On a retrospective analysis of the final successful site in the first group of 50 patients, the location was in area 1 in 39% of patients; area 2 in 36% of patients, and area 3 in 25% of patients. Atrial electrograms recorded at these sites showed a single spike pattern in 46% of patients, and double spike pattern (28%) or fractioned electrogram in 26% patients. When lines of RF lesions were placed at several sites, they produced a success rate of 70%, 40%, and 10% at areas 1, 2, and 3 respectively. In the last series of 120 patients, the procedure was successful in 119 patients: 92% of whom were successfully treated only by a linear lesion between the tricuspid annulus isthmus and the inferior vena cava, and the other 8% by additional applications near the coronary sinus ostium. No complications were observed. CONCLUSIONS: RF catheter ablation of atrial flutter can be done with a high success rate and is safe. The highest success rate is achieved with RF energy applied in the isthmus between the inferior vena cava orifice and the tricuspid valve. However, 15.5% of patients need multiple sessions to achieve success because of recurrence of flutter. Further follow-up is needed to evaluate the long-term effects of this procedure.

Adult↗
PubMed1996

The role of imaging in the diagnosis of giant cell tumor of the skull base.

An expansile temporal bone lesion above the temporomandibular joint (TMJ) in a 55-year-old woman was initially diagnosed as pigmented villonodular tenosynovitis. Preoperative embolization of the tumor had resulted in excessive tumoral hemorrhagic pigment. The surgical and CT findings suggested that the TMJ was not involved, and a final diagnosis of giant cell tumor was made.

Diagnosis, Differential↗
PubMed1996

Perinatal outcome after embryo transfer in ovum recipients. A comparison with standard in vitro fertilization.

OBJECTIVE: To compare perinatal outcome after embryo transfer vs. standard in vitro fertilization (IVF) in ovum recipients. STUDY DESIGN: We reviewed 22 consecutive ovum donor pregnancies delivered at Mount Sinai Hospital between July 1989 and November 1992 and matched them for age, parity and order of gestation to a control group who underwent standard IVF-embryo transfer (ET) during that period. RESULTS: The two groups showed similar rates of maternal complications, including hypertensive disorders, gestational diabetes and puerperal complications. When compared to patients undergoing autologous IVF-ET, ovum recipients had a lower rate of preterm labor (22.7% vs. 54.6%, P < .05), a higher mean gestational age at delivery (38.7 vs. 36.1 weeks, P < .01) and increased mean birth weight of neonates (2,924 vs. 2,374 g, P < .005). Though infants born through traditional IVF-ET were more likely to be preterm, Apgar scores were similar at one and five minutes. Our data support the generally favorable outcome seen in pregnancies conceived through ovum donation despite the fact that many of these patients had prior poor prenatal outcomes, long intervals until conception, and coexisting medical conditions. CONCLUSION: Ovum donation in women of comparable ages has obstetric outcomes equal to or better than patients undergoing traditional IVF-ET. Obstetric and perinatal outcome do not seem to be impaired in patients receiving donated oocytes.

Adult↗
PubMed1995

Trends in smoking initiation among adolescents and young adults--United States, 1980-1989.

The evaluation of efforts to prevent tobacco use among adolescents requires accurate surveillance of both smoking prevalence and smoking initiation rates. Although several surveillance systems provide timely data about adolescent smoking prevalence (1), data characterizing rates of smoking initiation among adolescents have been limited. To improve characterization of trends in smoking initiation among young persons, data from the Tobacco Use Supplement of the 1992 and 1993 Current Population Surveys (CPS) (2) were used to estimate smoking initiation rates for persons who were adolescents (aged 14-17 years) or young adults (aged 18-21 years) during 1980-1989. This report summarizes the results of that analysis.

Adolescent↗