Search PubMed⌕ Search

Biomedical subjects

E Shahar

Publications and source records attributed to E Shahar.

At least 109 records · Page 6Linked to original sources
PubMed1994

Fish consumption may limit the damage of smoking on the lung.

High fish consumption is characteristic of Japanese-American men of the Honolulu Heart Program (HHP). Analyses of data from the Atherosclerosis Risk in Communities (ARIC) study suggest high fish intake protects the lung against smoking damage. Measurements of forced expiratory volume in 1 s (FEV1) and smoking status in the HHP cohort were done at the first examination in 1965-68. Among 8,006 men, 45 to 68 yr, 6,346 had acceptable spirograms. Within current smokers, 1,545 men consumed fish less than twice a week, and 1,264 ate fish twice a week or more. Controlling for cigarettes/d, age, height, and daily calories, separate regression models indicated an average decrease of -10.1 ml for each additional yr of smoking (95% Confidence Interval [CI]: -13.6, -6.5) at low levels of fish intake, and a decrease of -4.4 ml (95% CI: -8.2, -0.6) at high levels. The coefficients were significantly different (p = 0.03). These differences reflect a predicted FEV1 144 ml (95% CI: 62, 227) higher in the high fish group at > or = 40 yr of smoking, but no difference at < or = 35 yr. Similar analyses were conducted for cigarettes/d. On average, the FEV1 decline for each additional cigarette/d was not significantly different among subjects with low versus high fish intake. However, the predicted FEV1 at < or = 30 cigarettes/d was 52 ml (95% CI: 17, 87) higher in the high fish consumption group. No significant difference in FEV1 was noted between groups at > 30 cigarettes/d. These findings suggest that the protective role of fish is "saturated" at higher "doses" of cigarette smoking.

Aged↗
PubMed1994

Apparently coronary heart disease-free patients in the coronary care unit: characteristics, medical care, and 1-year outcome.

BACKGROUND: Coronary care units (CCUs) have contributed significantly to the improved survival rates among patients with acute myocardial infarction. Many patients admitted to CCUs are certified to be free of coronary heart disease (CHD) at discharge. There is little literature on the hospital course and prognosis of such patients. METHODS: We identified and followed 594 patients admitted to six CCUs in the Minneapolis-St Paul metropolitan area in 1990 because of suspected acute myocardial infarction who were eventually discharged without evidence of acute or chronic CHD. Their baseline characteristics, medical care, and 1-year outcome were compared with those of 672 patients with confirmed acute myocardial infarction and 612 patients with a history of CHD but without evidence of an acute coronary event. RESULTS: Similar numbers of men and women were certified to be CHD-free on discharge from hospital. These patients were significantly younger than either patients with acute myocardial infarction or patients with a history of CHD (mean age 57, 65, and 67 years, respectively). CHD-free patients commonly reported current smoking, hypertension, and hypercholesterolemia (26, 50, and 18%, respectively). These patients were less likely than those with acute myocardial infarction or a history of CHD to undergo diagnostic or therapeutic procedures, or to receive pharmacological treatment. Their 1-year mortality rate was 5%, significantly lower (P < 0.05) than the mortality among patients with either acute myocardial infarction (18%) or a history of CHD (13%) but 2.6 times greater than expected in the general population. Older age, previous or current smoking, chest pain leading to admission, and congestive heart failure were independent predictors of 1-year mortality. CONCLUSIONS: Patients certified to be CHD-free after admission to a CCU with suspected acute myocardial infarction have a lower 1-year mortality rate than patients experiencing acute myocardial infarction or chronic CHD. Their mortality rate, however, is substantially higher than expected, probably because of a high prevalence of cigarette smoking and hypertension.

Aged↗
PubMed1993

Past infection by Chlamydia pneumoniae strain TWAR and asymptomatic carotid atherosclerosis. Atherosclerosis Risk in Communities (ARIC) Study Investigators.

PURPOSE: To determine whether past infection by Chlamydia pneumoniae strain TWAR is associated with asymptomatic atherosclerosis. Previous studies have linked this organism with symptomatic coronary heart disease. SUBJECTS AND METHODS: Between 1986 and 1989, 15,800 men and women aged 45 to 64 years were examined as part of the Atherosclerosis Risk in Communities Study, a prospective cohort study of atherosclerosis being conducted in 4 United States communities. The examination included B-mode ultrasonography of the carotid arteries and an assessment of cardiovascular disease risk factors. Carotid wall thickening (blood-intima to medial-adventitial interface) in the absence of clinical cardiovascular disease was considered evidence of asymptomatic atherosclerosis. In 1991, IgG antibody titers to TWAR were assayed by microimmunofluorescence in stored sera from 326 case-control pairs matched by age group, race, sex, examination period, and field center. A titer of 1:8 or higher was considered a positive TWAR antibody response. RESULTS: Seventy-three percent of atherosclerosis cases had serologic evidence of past TWAR infection versus 63% of controls (matched odds ratio 1.76; 95% confidence interval, 1.21 to 2.57). After adjustment for age, hypertension, diabetes, cigarette smoking, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and education, the odds ratio for atherosclerosis was essentially unchanged at 2.00 (95% confidence interval, 1.19 to 3.35). The association was stronger for individuals aged 45 to 54 years than for those aged 55 to 64 years. CONCLUSION: There was a significant cross-sectional association between past TWAR infection and asymptomatic atherosclerosis. This organism may be a contributor to the pathogenesis of atherosclerosis.

Age Factors↗
PubMed1993

A putative role of dietary omega-3 polyunsaturated fatty acids in oxidative modification of low density lipoprotein.

Oxidative modification of low density lipoprotein is a cell-mediated process that is believed to increase the atherogenicity of the particle. There is a growing interest in measures that could inhibit this process because of their potential impact on the risk of atherosclerotic disease. It is suggested that diets rich in polyunsaturated fatty acids of the omega-3 series inhibit cell-induced oxidative modification of low density lipoprotein (LDL), thereby contributing to the prevention of atherosclerosis.

Arteriosclerosis↗
PubMed1993

The role of stroke attack rate and case fatality in the decline of stroke mortality. The Minnesota Heart Survey.

The Minnesota Heart Survey is a population-based study designed to monitor and explain trends in cardiovascular mortality, morbidity, and risk factors in the Minneapolis-St. Paul (Twin Cities) metropolitan area. Trends in stroke mortality were examined from 1960 to 1991; stroke morbidity trends were examined in 50% samples of patients discharged with an acute stroke diagnosis in 1970, 1980, and 1985. Stroke mortality in Twin Cities residents aged 30 to 74 years declined by more than 70% from 1960 to 1991 in both men and women. The decline occurred at a rate of 2.5% per year until 1972, accelerated between 1972 and 1984 (7.9% per year), and slowed considerably thereafter (1.8% per year). Hospitalized acute-stroke discharge rates among those aged 30 to 74 years declined substantially between 1970 and 1985 in both sexes (P < 0.01), but there was no change in definite stroke rates defined by standardized clinical criteria. Both short-term (28 days) and long-term (5 years) survival of definite-stroke patients improved significantly between 1970 and 1985. These improvements, however, were not found in the entire samples of unverified acute-stroke discharges. The proportion of hospitalized acute-stroke patients who had computed tomography performed increased from 0% in 1970 to 75% in 1985. There were also improvements in hospital records pertaining to the documentation of stroke symptoms and signs. These data indicate that the impressive declines in stroke mortality observed in the 1970s and early 1980s have slowed dramatically in the latter half of the 1980s. The decline in stroke mortality likely reflects both a decline in attack rate and improved survival after stroke.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Delayed parkinsonism associated with hypotension in a child undergoing open-heart surgery.

An eight-year-old boy developed acute parkinsonism four days after open-heart surgery for repair of a ventriculo-septal defect. During the procedure he experienced a hypotensive episode which required administration of positive-inotropic agents. Complementing the clinical signs of parkinsonism, CT scan showed symmetrical hypodensities in the basal ganglia, and decreased regional cerebral blood flow was demonstrated using 99mTc HMPAO SPECT. These findings were suggestive of a hypoxic-ischaemic insult to the basal ganglia. The child was treated with levodopa/carbidopa and subsequently completely recovered within a follow-up period of eight months. CT scan appearances and cerebral blood flow findings returned to normal. Parkinsonism secondary to a hypoxic-ischaemic insult to basal ganglia in children is a rare but reversible disorder, in contrast to its progressive course which results in severe disability in adults.

Acute Disease↗
PubMed1993

Association of hemostatic variables with prevalent cardiovascular disease and asymptomatic carotid artery atherosclerosis. The Atherosclerosis Risk in Communities (ARIC) Study Investigators.

The relation of hemostatic factor levels to the occurrence of cardiovascular disease is incompletely established. The Atherosclerosis Risk in Communities Study measured fibrinogen, factor VII, factor VIII, von Willebrand factor, antithrombin III, protein C, activated partial thromboplastin time, and other cardiovascular risk factors in nearly 15,000 men and women aged 45 to 64. This analysis assessed the relations of these hemostatic factors with prevalent cardiovascular disease and asymptomatic carotid artery intimal-medial thickness measured by B-mode ultrasound. Compared with participants without cardiovascular disease, those with cardiovascular disease had higher levels of fibrinogen, factor VIII, and von Willebrand factor in both sexes. The other hemostatic factors were less consistently associated with prevalent cardiovascular disease. Only fibrinogen was associated with carotid intimal-medial thickness. Adjusted for age, race, and field center, the odds ratio for carotid wall thickness in the 90th percentile or greater, compared with < 50th percentile, for each SD higher fibrinogen concentration (65 mg/dL) was 1.42 (95% confidence interval, 1.25, 1.62) in men and 1.43 (1.25, 1.64) in women. This population-based study provides further evidence that fibrinogen and possibly factor VIII and von Willebrand factor are risk factors for cardiovascular disease.

Arteriosclerosis↗
PubMed1993

Associations of fish intake and dietary n-3 polyunsaturated fatty acids with a hypocoagulable profile. The Atherosclerosis Risk in Communities (ARIC) Study.

Recent epidemiological evidence indicates that the hemostatic profile is an important predictor of cardiovascular disease, yet its dietary determinants are not well established. An important question is whether dietary fatty acid intake influences blood levels of coagulation proteins. We examined potential dietary determinants of six hemostatic factors--fibrinogen, factor VII, factor (vWF), protein C, and antithrombin III--in four population-based samples totaling over 15,000 participants, blacks and whites, in the Atherosclerosis Risk in Communities (ARIC) Study. Usual dietary intake was assessed by a food frequency questionnaire. Cross-sectional associations were explored using multiple linear regression analysis, adjusting for gender, race, age, body mass index, smoking status, alcohol use, diabetes, and field center. Dietary intake of n-3 polyunsaturated fatty acids (PUFAs) showed negative associations with fibrinogen, factor VIII, and vWF (blacks and whites) and a positive association with protein C (whites only). Fish intake, the major source of dietary n-3 PUFAs, was similarly related to the hemostatic profile: a 1 serving per day greater fish intake was associated with the following predicted differences (95% confidence interval): fibrinogen, -2.9 mg/dL (-6.3, 0.5); factor VIII, -3.3% (-5.4, -1.3); vWF, -2.7% (-5.2, -0.1) (blacks and whites); and protein C, +0.07 microgram/mL (0.03, 0.11) (whites only). Other nutrients or foods were variably associated with the hemostatic factors. These population-based associations, although cross-sectional, suggest that increases in n-3 PUFA intake from fish may modify the blood levels of several coagulation factors.

Animals↗
PubMed1993

Trends in survival of hospitalized stroke patients between 1970 and 1985. The Minnesota Heart Survey.

BACKGROUND AND PURPOSE: Age-adjusted stroke mortality rates declined approximately 50% between 1970 and 1990 in both the United States and Minnesota, but the reasons for this decline are not clear. This report examines possible improvements in short- and long-term survival of hospitalized definite stroke patients in the Minneapolis-St Paul (the Twin Cities) metropolitan area during this period. METHODS: Fifty percent random samples of patients discharged with an acute stroke diagnosis from area hospitals were selected in 1970 (n = 1200), 1980 (n = 1040), and 1985 (n = 896). Trained nurses abstracted pertinent clinical data from the hospital charts. By standardized clinical criteria similar to World Health Organization criteria (without computed tomography data), 376, 442, and 453 definite strokes were established for 1970, 1980, and 1985, respectively. RESULTS: Age- and sex-adjusted 28-day case fatality of definite stroke improved significantly from 1970 to 1985; the odds ratio (OR) of death within 28 days in 1985 (versus 1970) patients was 0.55 (95% confidence interval [CI], [0.39, 0.77]). Substantial improvements in 28-day mortality were observed both from 1970 to 1980 and from 1980 to 1985, although the latter change was not statistically significant. Further adjustment for predictors of early stroke mortality (such as level of consciousness) somewhat attenuated these results. Age- and sex-adjusted 5-year survival of definite stroke also improved significantly from 1970 to 1985 (OR, 0.72; 95% CI, [0.54, 0.96]), although the improvement was restricted to the 1970 to 1980 time period (OR, 0.76; 95% CI, [0.57, 1.01]). None of the survival trends differed significantly between men and women. CONCLUSIONS: There were marked improvements in survival from 1970 to 1985 among hospitalized stroke patients in the Twin Cities. These improvements occurred almost exclusively in the acute hospitalization phase. Although the advent of computed tomography and improvements in hospital record-keeping during this period prevent an unequivocal conclusion, improved medical care and decreased severity of stroke probably contributed to gains in survival.

Age Factors↗
PubMed1993

Response to mail surveys: effect of a request to explain refusal to participate. The ARIC Study Investigators.

As part of a mailed health survey, we investigated the effect on the response rate of a request to explain refusal to participate. Subjects (N = 1,240) were randomized either to receive or not to receive, with the first mailing, a letter requesting an explanation of their decision not to fill out the questionnaire, if they chose that option. There was a slightly higher cumulative response during most of the study from subjects who had been sent the request, but little difference between the two study groups in the ultimate response rate [80% from the intervention group vs 83% from the control group; response rate difference = -3%; 95% confidence limits (CL) = -7%, 1%]. Of 209 individuals who were sent the request and did not return the questionnaire, only 15 (7%) sent back an explanation. A request to explain a refusal to participate in a mail survey neither jeopardized the response rate nor enhanced it.

Cooperative Behavior↗
PubMed1992

Self-inflicted ocular mutilation in the pediatric age group.

Three mentally retarded children with severe self-inflicted ocular injuries are presented. All three suffered from severe ocular injuries including retinal detachment resulting in progressive visual loss and even blindness. Self-inflicted injuries to the eyes, including self enucleation, is an extremely uncommon form of behavior, rarely encountered by pediatricians. The risk of ocular morbidity is high if the diagnosis is overlooked. Technical advances in ophthalmology permit much improvement in some formerly hopeless cases of ocular self-mutilation, but there is still no accurate method to repair destroyed retinal or nervous tissue. Early identification of patients at risk of ocular self-mutilation is essential in order to prevent or minimize such severe ocular injuries.

Child↗
PubMed1991

The use of a self-report questionnaire to assess the frequency of sexual dysfunction in family practice clinics.

The epidemiology of sexual dysfunction has been investigated recently in various clinical and nonclinical conditions but, to date, little research has been conducted in the family practice setting. The authors have developed a brief self-report questionnaire addressing most of the common sexual problems, and assessed its usefulness as a screening device in two distinctly different family practice clinics. The proposed questionnaire has gained over 90% response rate in each practice, indicating an appropriate level of acceptability. The sex- and practice-specific prevalence ranged from 31% to 63%, and was found to be significantly higher among male patients than among female patients. Overall dissatisfaction with the present sexual life of either the respondent or his partner (as indicated by the former) was expressed by nearly 20% of the respondents, the majority of whom reported on both self and partner's dissatisfaction. Relatively few patients of those who reported on a sexual problem had ever sought any professional help, but approximately 50% of men and 25% of women indicated that the family physician was their preferred expert for this purpose. It is concluded that sexual dysfunction is highly prevalent in the family practice setting but is nevertheless under-reported. Anonymous screening in one's practice, as presented in this study, will provide the family physician with valuable information, and may contribute to further direct discussions of these delicate concerns.

Adolescent↗
PubMed1991

Nose tapping test inducing a generalized flexor spasm: a hallmark of hyperexplexia.

The present report describes a benign disorder of neonates or young infants presenting with generalized hypertonicity accompanied by brisk muscle stretch reflexes, intermittent clonus, and exaggerated startle response. This condition is termed hyperexplexia, and may be either familial or sporadic. Two affected families are reported: Two sisters and their mother are involved in the first family; in the second family, where the parents are asymptomatic first degree cousins, all three siblings suffer from hyperexplexia of various severity. Nose tapping in infants of affected families induced a uniform reaction of facial twitching accompanied by head extension, and a generalized flexor spasm, all of which may be a hallmark of hyperexplexia. Severely hypertonic infants were treated with small doses of benzodiazepines and improved markedly, all becoming asymptomatic by two years of age. Unnecessary investigation and treatment may be avoided by sufficient awareness of possible hyperexplexia.

Child, Preschool↗
PubMed1991

[High-dose immunoglobulins in children with Guillain-Barré syndrome].

High-dose intravenous immunoglobulin was effective in 3 children with severe Guillain-Barre syndrome (GBS). They presented with mild to moderate, flaccid weakness which progressively deteriorated to severe tetraparesis and weakness of ocular, facial and bulbar muscles. 1 of them was treated with steroids with no response. Serum immune globulins were infused (1g/kg/day) for 2 consecutive days. There was marked clinical improvement in all 3 after the second day of infusion, and there were no adverse affects. All became ambulatory and were able to walk within the first week. Ocular, facial and bulbar impairment gradually subsided and disappeared, as did hypertension in 1. A 6-year-old boy completely recovered after 3 weeks while the 2 girls, both aged 9 years, still have mild weakness which is gradually improving. High-dose immunoglobulin therapy may be effective in children with severe GBS, with no significant adverse effects. It presumably provides idiotypic antibodies that block the autoimmune process responsible for demyelination.

Child↗
PubMed1990

Pediatric cerebrovascular disease. Alterations of regional cerebral blood flow detected by TC 99m-HMPAO SPECT.

Regional cerebral blood flow (rCBF) alterations, as determined by single photon emission computed tomography (SPECT) using technetium Tc 99m hexamethyl propylenamine oxime (Tc 99m-HM-PAO), were studied in 15 infants and children presenting with cerebrovascular disorders between the ages of 2 weeks and 16 years. The rCBF patterns were correlated with clinical presentation, electroencephalographic patterns, radiologic studies, including computed tomography and magnetic resonance imaging of the head, and cerebral angiography. All patients presented with motor weakness that was accompanied in some with dysphasia, defects in visual fields, obtundation, seizures, and high temperature. Perturbations of rCBF with Tc 99m-HMPAO SPECT brain scanning were detected in all patients investigated, with no adverse effects related to the radiotracer. All patients had a focal area of decreased rCBF, with adjacent hyperemia in 3 patients. In 7 patients, there was an rCBF decrease in a vascular distribution, mainly that of the middle cerebral artery, that correlated with the clinical findings and a focal electroencephalogram, as well as computed tomography and magnetic resonance imaging of the head. Impairment of rCBF was more extensive in 3 children, while early abnormal SPECT findings preceded abnormal computed tomographic findings in another 2 children. In 2 patients, Tc 99m-HMPAO SPECT was the only positive radiologic test to correlate with focal clinical and electroencephalographic abnormalities, in view of repeated normal computed tomographic scans. We conclude that Tc 99m-HMPAO SPECT brain scanning is a sensitive, complementary diagnostic measure in the early detection, localization, and estimation of rCBF alterations in pediatric cerebrovascular disease.

Cerebrovascular Circulation↗
PubMed1990

Calcium blocking agents in pediatric emergency care.

Blocking calcium ion entry into tissue cells appears to have therapeutic benefits in various diseases and symptoms. In the emergency department, as well as in the pediatric intensive care unit, the pediatrician often encounters life-threatening clinical episodes for which the safest, quickest, and most efficient treatment is required. Thus, being familiar with a large variety of emergency therapeutic options, including the use of CBAs, is important. In many medical centers, CBAs have already become the first line of drugs for converting PSVT into normal sinus rhythm (verapamil) and for ameliorating malignant hypertension (nifedipine). The increasing evidence that nimodipine effectively decreases the cerebral damage after head trauma and intracranial hemorrhage will also probably turn this compound into one of the drugs readily available in the emergency department. CBAs will continue to be thoroughly investigated, allowing more new therapeutic applications in pediatric emergency care.

Adolescent↗
PubMed1990

Contamination of blood cultures during venepuncture: fact or myth?

Contamination of blood cultures is believed to occur mainly during the venepuncture procedure. Consequently, meticulous preparation of the venepuncture site is widely recommended. To determine whether the contamination rate is indeed affected by the quality of the antiseptic procedure at the venepuncture site, 181 paired cultures were collected from 176 patients during a 6-month period after either strict antiseptic cleansing of skin with alcohol followed by povidone-iodine, or after brief disinfection with alcohol alone. The contamination rate was not influenced by the antiseptic procedure, and corresponded to the accepted percentage reported in most other studies. Eight false positive cultures (4.4%) were obtained after strict antisepsis of the skin and 6 (3.3%) after short simple cleansing with alcohol (P = 0.39). Our results suggest that contamination of blood cultures may not be related to the venepuncture procedure--regardless of the antiseptic technique used--but may be due to later stages of laboratory handling and processing of the specimens. Review of the literature has provided further indirect evidence to support this conclusion.

Antisepsis↗