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Biomedical subjects

J Ali

Publications and source records attributed to J Ali.

At least 73 records · Page 4Linked to original sources
PubMed1994

Cognitive and attitudinal impact of the Advanced Trauma Life Support program in a developing country.

Improvement in trauma patient outcome has been reported after Advanced Training Life Support training (ATLS) in the developing country of Trinidad and Tobago (T & T). The cognitive impact of ATLS training was assessed from pre-ATLS and post-ATLS performance of T & T physicians in multiple choice question tests and comparison with post-ATLS test performance among Nebraska physicians. Overall, improvement between the pre-test and post-test among the T & T physicians was 22.0% +/- 2.0%. All physicians including failures (199 out of 212 passed) improved in their post-test scores. Individual item analysis of the post-test, including the KR-20 determination, varied but the overall performance was similar for both physician groups with the T & T physicians performing slightly better in test 2 (6 of 16 vs. 25 of 100 failures, p < 0.05). Attitudinal impact was assessed through 87 questionnaires from 50 physicians (92% response) and 37 nurses (89% response). Physicians (97.8% compared with 69.7%) were more aware of the ATLS training, and both groups (physicians, 77.3%; nurses, 69.6%) differentiated ATLS-trained physicians based on better resuscitation, more timely and appropriate consultation, greater confidence in trauma management, and improvement in trauma mortality and morbidity; all respondents recommended ATLS training for all emergency room physicians. The demonstrated positive cognitive and attitudinal effects very likely contributed to the improved post-ATLS trauma patient outcome.

Attitude of Health Personnel↗
PubMed1994

Improving trauma care in Trinidad and Tobago.

Identification of trauma as a major cause of morbidity and mortality in Trinidad and Tobago prompted the establishment of a training programme aimed at improving trauma care in this developing country. An Advanced Trauma Life Support (ATLS) programme for physicians, funded through the Canadian International Development Agency resulted in a statistically significant improvement of in-hospital trauma patient outcome at the Port-of-Spain General Hospital (observed to expected mortality ratio of 3.16 pre-ATLS compared to 1.94 post-ATLS). A recent analysis of all motor vehicle injuries for a shorter period did not confirm this positive impact of the ATLS programme, primarily because a large number of these patients died in the pre-hospital period. Pre-hospital trauma care therefore required urgent attention to complement the positive in-hospital impact of the ATLS programme. A second training programme (the Pre-Hospital Trauma Life Support or PHTLS) for paramedical personnel was thus instituted in 1990. Over 250 physicians have been trained in the ATLS programme and to date over 100 paramedical personnel have been trained in the PHTLS programme. Attempts have also been made to equip the ambulances with more appropriate resuscitative devices in order to improve pre-hospital care. The combination of the PHTLS and the ATLS programme should result in further improvement in the care of patients sustaining major injuries in Trinidad and Tobago.

Emergency Medical Services↗
PubMed1993

Effect of culture systems on mouse early embryo development.

The amount of oxygen available to embryos in drop cultures under paraffin may be limited by the gas mixture employed, the method of equilibration or by the use of positive or negative pressure filtration. When these factors were varied, in experiments using Swiss outbred (SO) embryos, the only significant difference detected was the poorer development of embryos from the 1-cell to blastocyst stage when cultured in medium without prior equilibration. Also under these conditions, the inclusion of glucose in the medium did not increase the incidence of 2-cell block, and glutamine in the presence of glucose enhanced the development of 1-cell embryos to blastocysts. One-cell (C57BL/6 x SJL) F1 x SO embryos were successfully cultured in HEPES buffered CZB medium with added bicarbonate, under an atmosphere of air. The proportion of blastocysts formed in this medium, with a concentration of 10 mM sodium bicarbonate, was not different from that developed in CZB under 5% CO2 in air.

Animals↗
PubMed1993

Trauma outcome improves following the advanced trauma life support program in a developing country.

Trauma outcome variables before and after the institution of the Advanced Trauma Life Support (ATLS) program were compared for the largest hospital in Trinidad and Tobago from July 1981 through December 1985 (pre-ATLS) and from January 1986 to June 1990 (post-ATLS). A total of 199 physicians were ATLS trained by June 1990. Outcome data were analyzed for all dead or severely injured patients (ISS > or = 16; n = 413 pre-ATLS and n = 400 post-ATLS). Trauma mortality decreased post-ATLS (134 of 400 vs. 279 of 413) throughout the hospital, including the ICU (13.6% post-ATLS ICU mortality vs. 55.2% pre-ATLS). The odds of dying from trauma increased with age (1.02 for each year), ISS score (1.24 for each ISS increment), and blunt injury, both pre-ATLS and post-ATLS. Post-ATLS mortality was associated with a higher ISS (31.6 vs. 28.8). Although there was a higher percentage of blunt injury pre-ATLS (84.0%) versus post-ATLS (68.3%), the mortality rates for both blunt and penetrating injuries were higher in the pre-ATLS group (19.7% pre-ATLS vs. 6.3% post-ATLS for penetrating and 76.6% pre-ATLS versus 46.2% post-ATLS for blunt). For each ISS category, mortality was greater in the pre-ATLS group (ISS > or = 24 pre-ATLS mortality 47.9% vs. 16.7% post-ATLS; ISS 25-40 pre-ATLS mortality 91.0% vs. 71.0% post-ATLS). The overall ratio of observed to expected mortality based on the MTOS data base was lower for the post-ATLS period (pre-ATLS ratio 3.16; post-ATLS ratio 1.94).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Vitrification of preimplantation stages of mouse embryos.

Three vitrification solutions (VS) namely VS1 (5.5 mol ethylene glycol l-1 and 2.5 mol glycerol l-1), VS11 (6.0 mol ethylene glycol l-1 and 1.8 mol glycerol l-1) and VS14 (5.5 mol ethylene glycol l-1 and 1 mol sucrose l-1) were tested for cryopreservation by vitrification of all developmental stages of mouse preimplantation embryos. In these experiments all preparative work was at room temperature (25 degrees C). VS1 was toxic to embryos at and earlier than the eight-cell stage, whereas VS11 was toxic to the four-cell and earlier stages. VS14 was the least toxic VS. All three VS resulted in good viability of vitrified Swiss Outbred day-4 embryos (morulae, early blastocysts and blastocysts) in vitro and vitrification with VS14 resulted in no loss of viability in all preimplantation stage Swiss Outbred embryos except one-cell embryos. One-cell F1 embryos were vitrified successfully with VS14 and VS1. The minimal equilibration time essential for successful vitrification of embryos suggests that concentration of the intracellular solutes by dehydration has a major role in establishing conditions conducive to intracellular vitrification. Studies in vitro suggested that sucrose dilution was not necessary in the removal of cryoprotectant from vitrified eight-cell and day-4 mouse embryos but, in contrast, development of vitrified day-4 embryos in vivo was better when the VS was diluted with sucrose.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Successful vitrification of day-6 sheep embryos.

The aim of the experiments described here was to investigate cryopreservation of day-6 sheep embryos by vitrification methods in which the preliminary procedures can be performed at room temperature using VS1 (5.5 mol ethylene glycol l-1 and 2.5 mol glycerol l-1), VS11 (6.0 mol ethylene glycol l-1 and 1.8 mol glycerol l-1) and VS14 (5.5 mol ethylene glycol l-1 and 1.0 mol sucrose l-1). None of the day-6 sheep embryos vitrified with VS1 survived. Day-6 sheep embryos with the exception of blastocysts were vitrified with VS11 with no loss of viability in vitro. The viability of transferred day-6 embryos vitrified with VS11 was however extremely poor. Osmotic damage was avoided by initially exposing the embryos to one of four dilutions (20%, 30%, 40% and 50%) of VS11 for 5 min at 25 degrees C and then vitrifying with the undiluted VS11. The highest survival (88.2%) in vitro was obtained when embryos were exposed to 30% VS11 before vitrification with the undiluted VS11. Survival of transferred embryos exposed to 30% VS11 and then vitrified with undiluted VS11 was 55% (16 of 29) for morulae and 62% (18 of 29) for blastocysts. The pregnancy rate for recipients that received two vitrified sheep embryos of these developmental stages per ewe was 79% (22 of 28). In a small study performed with VS14 the survival of day-6 sheep embryos vitrified with VS14 (in one-step) was 100% in vitro and 50% after transfer.

Animals↗
PubMed1993

Design of vitrification solutions for the cryopreservation of embryos.

A series of experiments was performed to determine the concentrations at which ten cryoprotectants singly and in pairs would vitrify on plunging into liquid nitrogen and remain vitreous when warmed by plunging into a water bath at 25 degrees C. From these tests eight solutions (VS) were selected for testing of toxicity to mouse morulae in vitro. One of these (VS1) was modified as a further five VS of which one (VS11) was tested for toxicity to all stages of mouse embryos and to sheep compacted morulae. The concentrations at which the cryoprotectants vitrified on cooling were: butylene glycol, 3.0 mol l-1; propylene glycol, 4.0 mol l-1; dimethyl sulfoxide (DMSO) and glycerol 5.0 mol l-1; ethylene glycol, 6.5 mol l-1. None of these, at the highest concentration tested, remained vitreous during warming. Methanol and the high molecular weight polymers, dextran, Ficoll, polyethylene glycol and polyvinylpyrrolidone, did not vitrify at the concentrations tested. Toxicity studies showed the order of increasing toxicity to be ethylene glycol, methanol, DMSO, glycerol, propylene glycol and butylene glycol. Of the mixtures composed of two cryoprotectants, those containing ethylene glycol and glycerol were the least toxic at vitrifying concentrations. VS11 (6.0 mol ethylene glycol l-1 and 1.8 mol glycerol l-1) was well tolerated by mouse morulae, less well by eight- and one-cell embryos and poorly by two-cell embryos. Dilution of the VS11 from mouse embryos by exposure to 1.0 mol sucrose l-1 for 10 min did not enhance their survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The influence of intermittent positive-pressure ventilation on the cardiorespiratory dynamics of diaphragmatic rupture with gastric herniation.

To determine the effect of intermittent positive-pressure ventilation (IPPV) on gastric herniation in diaphragmatic rupture, 16 piglets underwent laceration of the left hemidiaphragm. Arterial blood gas levels, pulmonary artery wedge pressure, cardiac output and arterial blood pressure were measured. The stomach was then placed above the diaphragm. The initial measurements were repeated, and displacement of the stomach above the diaphragm (S/D) was measured. The animals were divided into two groups: group 1, eight animals breathing 80% oxygen spontaneously and group 2, eight animals receiving IPPV. Initially in group 2 there was only a small decrease in mean (+/- SD) arterial oxygen tension from 484 +/- 34 mm Hg to 424 +/- 20 mm Hg (other parameters were unchanged). In group 1, gastric herniation produced a further fall in arterial oxygen tension to 308 +/- 10 mm Hg at 1 hour, a rise in arterial carbon dioxide tension to 49 +/- 4 mm Hg and a decrease in pH to 7.32 +/- 0.04. In group 2 similar changes in arterial blood gas levels occurred with gastric herniation, but there was a return to baseline values of 490 +/- 28 mm Hg for arterial oxygen tension, 37 +/- 4 mm Hg for carbon dioxide tension and 7.38 +/- 0.05 for pH after IPPV. Similar changes were seen in blood pressure, cardiac output and pulmonary artery wedge pressure. S/D remained at 6.3 +/- 0.2 cm in group 1 but decreased from 6.0 +/- 0.2 cm to 1.1 +/- 0.5 cm after 1 hour in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The gene complementing a temperature-sensitive cell cycle mutant of BHK cells is the human homologue of the yeast RPC53 gene, which encodes a subunit of RNA polymerase C (III).

The temperature-sensitive BN51 cell cycle mutant of BHK cells arrests in G1 at the nonpermissive temperature (39.5 degrees C). We have previously reported cloning the gene which complements this mutation. The complementing gene encodes a highly charged protein with a basic amino-terminal domain and an acidic carboxyl-terminal domain. We have recently found that the predicted BN51 protein shows significant homology to the 53 kilodalton subunit of RNA polymerase C (III) from Saccharomyces cerevisiae. Consistent with this, antibodies raised to fusion proteins containing BN51 coding sequences and antipeptide antibodies reveal that the BN51 gene encodes a 48 kilodalton protein which appears to be located primarily in the nucleus following subcellular fractionation and by immunohistochemistry. Analysis of RNA polymerase III activity in temperature-sensitive BN51 cells by nuclear runoff transcription assay reveals a marked drop in RNA polymerase III transcription after 48 h at the nonpermissive temperature (39.5 degrees C). This is correlated with a significant decrease in low molecular weight RNAs after 48 h at 39.5 degrees C. In addition, RNA polymerase III activity in S100 extracts of BN51 cells is more sensitive to heat inactivation at 39 degrees C than control extracts from BHK cells. When the yeast gene is introduced into the BN51 cells in a mammalian expression vector, it weakly complements the BN51 mutation in that it prevents cell death at 39.5 degrees C. The mechanism by which inhibition of RNA polymerase III activity leads to arrest in G1 is unclear but is not due to a marked decrease in total protein synthesis.

Amino Acid Sequence↗
PubMed1993

Spontaneous rupture of the spleen in patients with infectious mononucleosis.

The author describes two cases of spontaneous splenic rupture occurring with infectious mononucleosis in young, previously healthy patients. The reports illustrate the variable clinical presentation--from sudden, fatal hemorrhage to bleeding that stops spontaneously. Although conservative nonoperative treatment may be successful in carefully selected cases, laparotomy with splenectomy appears to be the safest therapeutic approach. When a nonoperative approach is selected, the patient should be observed in a critical-care facility with immediate access to an operating room. Normal activity should not be resumed until the spleen has returned to its normal size as demonstrated by computed tomography or ultrasonography.

Adolescent↗
PubMed1993

The Advanced Trauma Life Support Program in Manitoba: a 5-year review.

Twenty Advanced Trauma Life Support (ATLS) courses were conducted at the University of Manitoba between 1982 and 1987. There were 302 registrants, 95 of whom were from rural communities. Twelve registrants failed the course. The impact of the program was assessed by questionnaire (68.8% response overall). The response from department heads of surgery in urban hospitals was 87.5% and from surgeons in rural areas 50%. Fifty-eight percent of rural surgeons, 62.5% of urban surgeons and 75% of urban emergency-department directors claimed they could identify those who had attended an ATLS course by the increased confidence demonstrated and the use of more timely and appropriate consultation and treatment. Thirty percent of rural surgeons, 37% of urban surgeons and 42% of emergency-department directors claimed that mortality and morbidity were decreased when care was provided by ATLS-trained physicians. The remainder were undecided because of lack of information. Ninety-three percent of respondents indicated that the course increased their confidence, trauma capability and ability to communicate with consultant trauma surgeons. Fifty-two percent thought the course should be mandatory for all physicians, and 100% thought it should be mandatory for all emergency-department physicians. The data suggest that although most physicians treat fewer trauma patients 5 years after their ATLS training, the course is still highly recommended, and it has improved trauma care. Although the ATLS program was intended primarily for rural physicians, more urban-based physicians registered for it.

Education, Medical, Continuing↗
PubMed1992

The cardiorespiratory effects of increased intra-abdominal pressure in diaphragmatic rupture.

The cardiorespiratory effect of gastric herniation in diaphragmatic rupture with and without increased intra-abdominal pressure (produced by inflation of a pneumatic antishock garment [PASG] to an intraperitoneal pressure of 40 mm Hg) was studied in 16 anesthetized spontaneously breathing (80% oxygen) piglets. Four additional animals had similar measurements after PASG inflation but without diaphragmatic rupture. Arterial blood pressure (BP), cardiac output, arterial blood gases, position of the stomach relative to the diaphragm (as measured on fluoroscopy), and mortality were assessed. Gastric herniation without the PASG (group I: 8 animals) produced slight cardiorespiratory deterioration, with PO2 falling from a baseline measurement of 429 +/- 60 mm Hg to 316 +/- 5 mm Hg at 1 hour. Over this period pH decreased from 7.39 +/- 0.05 to 7.30 +/- 0.02 and PCO2 increased from 39 +/- 5 to 46 +/- 2 mm Hg. With PASG inflation (group II: 8 animals) PO2 decreased to a greater extent, from 410 +/- 30 mm Hg at baseline to 48 +/- 10 mm Hg by 1 hour; pH decreased from 7.38 +/- 0.06 to 6.8 +/- 0.2 and PCO2 increased from 39 +/- 4 to 88 +/- 6 mm Hg. Animals without diaphragmatic rupture (group III: 4 animals) showed a smaller decrease in PO2, from 480 +/- 34 mm Hg at baseline to 320 +/- 50 mm Hg by 1 hour after PASG inflation.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1992

Establishing goals and priorities in a surgery department.

Limitation of resources necessitates prioritization in the planning of goals for a clinical discipline such as surgery. Private practitioners and academic surgeons have their own priorities which reflect their specific, often conflicting, interests. We describe a model (modification of Davies & Morgan, 1983) for establishing goals and priorities with input from both private practitioners and academic full-time surgeons in a large Department of Surgery. The model consists of four phases each of which is divided into input, process and output stages. During the input stage general large group discussion allows identification of disparate views. This is followed by refinement of these ideas in small group discussions (process) which results in the formulation of a report (output). Application of this model resulted in a clear definition of goals and priorities by consensus and placed education first on this list of priorities in spite of a department in which there is a predominance of private practitioners whose major area of activity is in the realm of patient care.

Attitude of Health Personnel↗
PubMed1992

The Advanced Trauma Life Support course for senior medical students.

The authors conducted the Advanced Trauma Life Support (ATLS) Course for 90 students who were in their 4th year of medicine at the University of Manitoba. The impact of the course was evaluated through questionnaires completed by students, instructors and emergency-room physicians. The students' performances were also compared with those of 96 practising physicians who took the ATLS course in Manitoba. The failure rate for students (3.3%) was not statistically different from that for practising physicians (4.2%). Overall, the students' performances in the written test were better (55% of students scored over 90% on the test compared with 15% of practising physicians). The student-to-faculty ratio was 1.5:1 and included 21 physician-instructors. Ninety-five percent of the faculty and students suggested that this course should be mandatory in the 4th year curriculum of medicine and that the course improves trauma care provided by the students and interns by increasing their confidence and improving communication with specialist surgeons. However, 10% of the faculty suggested that more time should be allocated to the surgical-skills practicum. The authors' experience with this program suggests that the ATLS course should be uniformly incorporated in the Canadian undergraduate 4th year medical curriculum and that techniques used in this course should be considered in other areas of the undergraduate medical curriculum.

Canada↗
PubMed1992

Clinical presentations of gastrointestinal inflammatory fibroid polyps.

Two cases of inflammatory fibroid polyps are described. They involved the uncommon sites of the terminal ileum and ileocecal region respectively. Both lesions, although benign, presented as possible malignant tumours. One was associated with anemia and the other with obstructive symptoms. From a review of the literature and the two case reports the authors believe that the diagnosis of such inflammatory fibroid polyps, on clinical and gross appearance, can be difficult, and they emphasize the importance of awaiting histologic assessment before proceeding with extensive definitive surgery.

Aged↗
PubMed1992

Spontaneous gastric decompression of pancreatic pseudocyst.

Spontaneous resolution of pancreatic pseudocysts is being reported with increasing frequency. Although many mechanisms have been proposed one that is not frequently recognized is spontaneous decompression into the gastrointestinal tract. This case report demonstrates the mechanism of spontaneous resolution of a traumatic pancreatic pseudocyst, several weeks after injury, through fistulization between the pseudocyst and the stomach. Spontaneous resolution of a pancreatic pseudocyst after a transient episode of diarrhea should suggest the mechanism of gastrointestinal decompression of the pseudocyst.

Adult↗