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Biomedical subjects

E Shahar

Publications and source records attributed to E Shahar.

At least 91 records · Page 5Linked to original sources
PubMed1996

Hospital care and survival of acute myocardial infarction patients in Minnesota and southern Germany: a comparative study.

BACKGROUND: The hospital care of patients with acute myocardial infarction (AMI) is likely to vary among advanced industrialized countries, but only few studies have systematically documented such differences. Moreover, despite likely differences in medical care, it is not known whether the prognosis of AMI patients differs among countries. METHODS: Using two registries of hospitalized AMI, we compared the characteristics, medical care, and survival through 1 year of patients in Augsburg, South Germany (n = 464) and Minneapolis-St. Paul (the Twin Cities), Minnesota, USA (n = 504). The samples included patients aged 25-74 years who had been treated in a coronary care unit and survived the first 24 h after admission. RESULTS: The two groups of patients did not differ in age distribution, sex ratio, or delay before admission to hospital (70% admitted within 6 h of symptom onset). The risk profile with respect to cardiovascular disease (smoking, hypertension, and diabetes) was more unfavourable among Augsburg patients than it was among Twin Cities patients but Twin Cities patients were more likely (P < 0.05) than Augsburg patients to report a previous myocardial infarction (29 versus 20%), coronary bypass surgery (9 versus 4%), and coronary angioplasty (6 versus 1%). Revascularization procedures were performed more frequently (P < 0.005) during the index hospitalization in the Twin Cities than they were in Augsburg: thrombolytic therapy 38 versus 28%, angioplasty 27 versus 13%, and bypass surgery 9 versus 3%. In contrast, cardiovascular medications, such as beta-blockers and aspirin, were administered more frequently in Augsburg than they were in the Twin Cities. There were substantial differences in duratin of hospital stay between the two sites with a median stay of 22 days for Augsburg patients versus 7 days for Twin Cities patients. However, there were no significant differences in 28-day case-fatality (6% in both) or 1-year survival (89% in Augsburg versus 88% in the Twin Cities, P = 0.70). Likewise, in multivariate analysis, allowing for the effects of age, sex and a history of myocardial infarction, the registry site was predictive neither of 28-day nor of 1-year mortality. CONCLUSION: These data document significant differences in the medical care of AMI patients in Minnesota and Augsburg, which, nonetheless, did not translate into survival differences.

Adult↗
PubMed1996

Impaired brainstem auditory evoked potentials in patients with cystic fibrosis.

Brainstem auditory evoked potentials (BAEPs) were measured in 11 young patients with cystic fibrosis (CF). Though none had clinical evidence of neurological impairment, all had various abnormal components of brainstem auditory evoked potentials (BAEPs). Abnormal BAEPs may be attributed to nutritional deficiencies including deficiencies of vitamins E and B6. As patients with CF are often deficient in vitamin E despite daily supplementation and normal serum levels, the authors suggest that the abnormal BAEPs demonstrated in the present study may reflect prolonged intracellular vitamin E deficiency. This finding suggests that BAEP studies may be useful in the neurological evaluation of patients with CF.

Case-Control Studies↗
PubMed1995

[Neurological symptoms associated with vitamin E deficiency].

Children deficient in vitamin E have various neurologic symptoms. 2 cases representing different mechanisms of this vitamin deficiency are reported. A 15-year-old boy with fat malabsorption due to cystic fibrosis who was diagnosed as being vitamin E deficient (< 0.5 mg/l), had typical neuropathies. On the other hand, a 12-year-old Beduin girl had isolated vitamin E deficiency, as well as neurological symptoms suggestive of Friedrich's ataxia. Vitamin E supplementation by intramuscular injection in the first case and per os in the second led to significant improvement in neurological symptoms.

Adolescent↗
PubMed1995

Plasma fatty acid composition as an indicator of habitual dietary fat intake in middle-aged adults. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

We compared the plasma fatty acid (FA) composition of the habitual diet, measured by a 66-item semiquantitative food-frequency questionnaire (FFQ), with the corresponding plasma phospholipid and cholesterol ester (CE) FA composition measured by gas chromatography in 3570 free-living, middle-aged adults. Pearson correlations between dietary and plasma FA (expressed as % of total FAs) for phospholipid and CE, respectively, were as follows: saturated FA (r = 0.15 and 0.23), monounsaturated FA (r = 0.05 and 0.01), polyunsaturated FA (r = 0.25, 0.31), linoleic acid (r = 0.22 and 0.28), linolenic acid (r = 0.15 and 0.21), eicosapentaenoic acid (r = 0.20 and 0.23), and docosahexaenoic acid (r = 0.42 and 0.42). The correlations between diet and plasma FAs held relatively constant regardless of whether participants were overweight, had chronic diseases, were alcohol drinkers, or were cigarette smokers. However, at similar reported dietary intakes, the plasma lipid concentration of saturated FAs was higher and/or that of linoleic acid was lower in people with these characteristics compared with those without these characteristics.

Alcohol Drinking↗
PubMed1995

Improved survival of stroke patients during the 1980s. The Minnesota Stroke Survey.

BACKGROUND AND PURPOSE: The underlying reasons for the decline in stroke mortality in the United States are not well understood and have been the subject of ongoing debate. This study was undertaken to determine whether survival of hospitalized stroke patients has changed during the 1980s, thereby contributing to the decline in stroke mortality during that period. METHODS: For the years 1980, 1985, and 1990, we obtained listings of discharge diagnoses from hospitals in the Minneapolis-St Paul metropolitan area and identified all hospitalizations with a discharge diagnosis code of acute cerebrovascular disease according to the International Classification of Diseases, 9th Revision. A 50% random sample of men and women aged 30 to 74 years was selected in each survey for detailed medical record abstraction. Standardized sets of criteria for stroke were then used to validate acute stroke events throughout the 1980s. Each of the three period cohorts of hospitalized stroke patients (1980, 1985, and 1990) was followed for at least 2 years for all-cause mortality end point. RESULTS: A total of 1853 patients met minimal criteria for acute stroke: 564 patients in 1980, 598 patients in 1985, and 691 patients in 1990. Controlling for age, the odds of death within 2 years after stroke were approximately 40% lower in 1990 than in 1980. The relative odds of 2-year death in 1990 (versus 1980) were 0.65 (95% confidence interval, 0.47 to 0.89) and 0.60 (95% confidence interval, 0.42 to 0.85) for men and women, respectively. The improved survival was evident in the short term (28 days) as well as for stroke patients who survived that period. Analysis according to stroke subtype revealed that improved survival of ischemic stroke and specifically of stroke with no apparent cardioembolic source largely accounted for the overall trend. The prognosis of stroke patients who were admitted in a comatose state has not changed during that decade. CONCLUSIONS: Despite the absence of any clear major advances in acute stroke therapy, survival of stroke patients substantially improved during the 1980s. The underlying reasons for this unexpected yet remarkable trend remain uncertain but may include improved supportive and rehabilitative care of stroke victims as well as a change in the natural history of the disease.

Adult↗
PubMed1994

Dietary n-3 polyunsaturated fatty acids and smoking-related chronic obstructive pulmonary disease. Atherosclerosis Risk in Communities Study Investigators.

BACKGROUND: Fish contain n-3 polyunsaturated fatty acids, principally eicosapentaenoic acid and docosahexaenoic acid, which are known to interfere with the body's inflammatory response and may be of benefit in chronic inflammatory conditions. METHODS: We studied the relation between the dietary intake of n-3 fatty acids and chronic obstructive pulmonary disease (COPD) in 8960 current or former smokers participating in a population-based study of atherosclerosis. Intake of fatty acids was estimated with a dietary questionnaire. The presence of COPD was assessed by a questionnaire on respiratory symptoms and by spirometry. Three case definitions of COPD were used: symptoms of chronic bronchitis (667 subjects), physician-diagnosed emphysema reported by the subject (185 subjects), and spirometrically detected COPD (197 subjects). RESULTS: After control for pack-years of smoking, age, sex, race, height, weight, energy intake, and educational level, the combined intake of eicosapentaenoic acid and docosahexaenoic acid was inversely related to the risk of COPD in a quantity-dependent fashion. The adjusted odds ratio for the highest quartile of intake as compared with the lowest quartile was 0.66 for chronic bronchitis (95 percent confidence interval, 0.52 to 0.85; P < 0.001 for linear trend across the range of intake values), 0.31 for physician-diagnosed emphysema (95 percent confidence interval, 0.18 to 0.52; P for linear trend, 0.003), and 0.50 for spirometrically detected COPD (95 percent confidence interval, 0.32 to 0.79; P for linear trend, 0.007). CONCLUSIONS: A high dietary intake of n-3 fatty acids may protect cigarette smokers against COPD.

Aged↗
PubMed1994

Primary central nervous system Burkitt's lymphoma presenting as Guillain-Barré syndrome.

A rare case of CNS Burkitt's lymphoma presenting as acute Guillain-Barré syndrome is presented. A 6-year-old previously healthy female presented with acute onset of limb and truncal weakness, involvement of ocular and bulbar nerves, and areflexia. The clinical diagnosis of Guillain-Barré syndrome prompted treatment with intravenous gammaglobulin with no response. A lumbar puncture following revealed marked pleocytosis, elevated protein, and decreased glucose. Immunological, cytological, and molecular studies of these cells confirmed the diagnosis of Burkitt's lymphoma IgM, kappa with t(8;14) and rearrangement of the J and kappa immunoglobulin chains. Aggressive systemic and intrathecal chemotherapy were started and within 5 days remission was achieved. The child is in complete remission 2 years from diagnosis. Although very rare, CNS lymphoma should be taken into account in every patient presenting with the clinical features of acute polyneuropathy.

Acute Disease↗
PubMed1994

Plasma phospholipid fatty acid composition and factor VII coagulant activity.

Plasma phospholipid fatty acid composition reflects, to a moderate degree, the fatty acid composition of the diet. To determine whether plasma phospholipid fatty acid composition might influence factor VII coagulant activity (factor VIIc), we examined 2207 middle-aged adults free of diabetes and cardiovascular disease. Factor VIIc was associated positively with the percentage of fatty acids that was saturated, and it was associated negatively with the linoleic acid percentage and the phospholipid polyunsaturated/saturated fatty acid ratio. For example, a 1.9% greater saturated fatty acid level was associated with approximately a 5% higher factor VIIc. These results suggest a role for dietary fat composition, or related dietary patterns, in determining levels of factor VIIc.

Age Factors↗
PubMed1994

Predictors of outcome of stroke in infants and children based on clinical data and radiologic correlates.

Outcome predictors were analyzed in 45 infants and children with cerebrovascular disorders (CVD), based on clinical features and radiological correlates. The clinical features at presentation could be categorized into three major groups: (1) generalized: alteration of consciousness with or without seizures--24 patients (54%); (2) focal: acute hemiplegia or monoplegia with or without focal seizures--18 patients (40%); (3) cerebellar disturbances--3 patients (6%). The underlying etiology was detected in 80% of children. Thirty-seven patients (82%) survived the initial debilitating event, of whom 11 (29.7%) recovered completely and the rest had either motor or cognitive handicaps during an average follow-up period of 4.2 years (range 1.5-11 years). A head CT performed in all children revealed ischemic infarction in 29 patients (64.4%), while the others had hemorrhagic infarction. Of those with an initial generalized neurological presentation, as many as 50% had multi-focal lesions on CT. All children with focal neurological findings had a solitary localized lesion on CT, mainly in the distribution of the middle cerebral artery. Statistical analysis for outcome prediction showed that the following variables were associated with increased risk of immediate death: (1) hemorrhagic infarction demonstrated by brain CT (p = 0.031); (2) patients who presented with a generalized neurological disorder, namely alteration of consciousness, with or without seizures (p = 0.036). No other clinical or laboratory variables were predictive of imminent death, motor or cognitive handicaps. These may therefore serve as outcome predictors of stroke in the pediatric age group.

Cerebellar Diseases↗
PubMed1994

Does dietary vitamin A protect against airway obstruction? The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

A recent report based on data from the first National Health and Nutrition Examination Survey suggested that low intake of vitamin A may be associated with a greater risk of airway obstruction. We attempted to replicate these findings in a population-based sample of middle-aged adults (n = 15,743) who participated in the baseline examination of the Atherosclerosis Risk in Communities (ARIC) Study. Vitamin A intake was estimated from a 66-item food frequency questionnaire, and the presence of airway obstruction was determined by spirometry. Although airway obstruction was associated in ARIC with well-established risk factors such as age, sex, and smoking, there was little evidence for a role of vitamin A. With only one exception, vitamin A intake was unrelated to airway obstruction in all smoking categories using either categorical or continuous measures of lung function (FEV1, FVC, FEV1/FVC). Only among current smokers in the upper tertile of lifetime cigarette smoking (> 41 pack-years) was the odds ratio of having airway obstruction for the lowest quartile of vitamin A intake compared with the highest quartile elevated (1.7 [95% confidence interval 1.1 to 2.7]). Despite some biological plausibility that vitamin A intake may prevent obstructive lung disease, the inability to demonstrate association in a larger population study, with better estimation of usual dietary intake, casts doubt on the existence of causal relationship.

Airway Obstruction↗