Biomedical subjects
Publications and source records attributed to K Patil.
Botulinum toxin is now a treatment for many conditions. It is undergoing increasing use in several different unlicensed urological clinical situations which are outlined in this article. The article discusses the available evidence relating to its use, effectiveness and safety.
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BACKGROUND: Leptin, the protein product of the ob gene, has been linked to a faster heart rate in animal and human studies. The interaction between leptin and heart rate in the denervated heart is not known. Therefore, we studied the relationship between plasma leptin levels and heart rate in heart transplant recipients. METHODS AND RESULTS: We studied 32 male patients (mean age, 56.5+/-9.3 years; range, 41 to 74 years) after orthotopic heart transplantation. All subjects underwent a physical examination, anthropometric measurements, blood chemistry analysis, and office blood pressure measurements. A blood sample was collected from each subject while fasting. In univariate analysis, heart rate was related to leptin levels (r=0.47, P=0.007) but heart rate was not related to systolic or diastolic blood pressure, mean arterial pressure, body mass index, or catecholamines. Leptin levels were only strongly associated with heart rate and body mass index (r=0.73, P<0.0001). In multivariate analysis, heart rate was independently and positively associated with leptin levels (F=2.61, P=0.017). We also observed a strong, independent association between leptin levels and body mass index (F=5.8, P<0.00001). CONCLUSIONS: We show an independent association between leptin levels and heart rate in heart transplant recipients. We speculate that this may be due, in part, to a direct effect of leptin on heart rate, conceivably mediated through cardiac leptin receptors.
This paper provides a review of the scholarly and applied literature published between 1970 and 1993 on health and health care access problems among racial and ethnic minority group members living in rural U.S. areas. Results on the distribution of specific illnesses and diseases, and utilization of medical services are summarized for two major minority groups--African Americans and Hispanic Americans. Findings generally document the expected pattern of rural and minority disadvantage. A review of the conceptual and methodological limitations of existing research suggests that research does not yet permit any clear understanding of the underlying structures and processes that give rise to racial health disparities. Very little is known about the health of rural minorities living in some areas of the country, for example, the west north central United States (Kansas, Missouri, Nebraska, Iowa, North Dakota, South Dakota and Minnesota).
OBJECTIVE: To examine the independent effects of minority status, residence, insurance status, and income on physician utilization, controlling for general health status and the presence of acute or chronic health problems. Of special interest was the question of utilization differences among rural minority populations, as compared with urban non-Latino whites. DATA SOURCE: Data from the 1992 National Health Interview Survey (NHIS). STUDY DESIGN: Multivariate analyses used multiple logistic regression methods to detect independent effects of residence and minority status on whether or not individuals used physician services. DATA COLLECTION/EXTRACTION METHODS: Data were obtained from the National Health Interview Survey, 1992. The survey included information about the race/ethnicity of the respondent, health status, utilization of services, insurance status, and socioeconomic status. PRINCIPAL FINDINGS: The most salient determinant of utilization of healthcare services is insurance status, regardless of race/ethnicity or (rural or urban) place of residence. Racial and ethnic minorities were less likely than whites to use physician services, and use was generally lower for rural residents. The most striking differences were for rural Latinos and rural Asians/other persons. CONCLUSIONS: Although the results demonstrate a need to adjust policies designed to improve utilization by accounting for particular problems faced by minority populations, they also demonstrate the primacy of addressing financial access.
The lengths of time adults are without health insurance have increased since 1988, as shown by data from 1,235 household interviews completed during 1992 in Nebraska. Rural residents without insurance have experienced longer such spells than their urban counterparts. Thus, while rates of uninsurance are nearly the same between urban and rural residents, important differences exist. The relationship between insurance status and physician utilization is consistent during the five years (1989 to 1993) covered in this study. Continuously insured persons have the most physician visits, followed by those intermittently insured, followed by those continuously uninsured. The number of physician visits was expected to increase when respondents moved from uninsured to insured status. However, among urban respondents, the number of visits declined; among residents in rural frontier counties (fewer than six person per square mile) and for respondents in rural nonfrontier counties, there was no significant difference. This study points out some differences between rural and urban populations regarding insurance status, even when the overall rates of uninsurance are equal.
While numerous studies have demonstrated a relationship between 17-beta-estradiol (E2) deficiencies and skeletal bone loss in postmenopausal females, the influence of E2 deficiency on alveolar bone resorption is poorly understood. The purpose of this study was to examine the association between the estrogen status of postmenopausal women and alveolar bone density changes in a 1-year longitudinal study. Twenty-four postmenopausal women, within 7 years of menopause, were divided into 2 groups, E2-sufficient (n = 10) and E2-deficient (n = 14). Venous blood samples were taken at baseline, 6 months, and 1 year for radioimmunoassay determination of serum E2 levels. At baseline and 1 year, 4 vertical bite-wing radiographs were taken for computer-assisted densitometric image analysis (CADIA). Areas of interest (AOIs) for CADIA were crestal and subcrestal regions of posterior interproximal alveolar bone. Serum E2 levels were significantly higher at all 3 time points in the E2-sufficient subjects (P < 0.002), repeated measures ANOVA). Overall, mean CADIA values (0.30 +/- 0.07 for the E2-sufficient women and -0.44 +/- 0.07 for the E2-deficient women) were statistically different between groups (P < 0.001, repeated measures ANOVA), indicating that the E2-sufficient women displayed a mean net gain in alveolar bone density and the E2-deficient women displayed a mean net loss in alveolar bone density. Furthermore, the E2-sufficient women exhibited a higher frequency of sites demonstrating a gain in alveolar bone density, while the E2-deficient women exhibited a higher frequency of sites demonstrating loss in alveolar bone density. These data suggest that estrogen status may influence alveolar bone density changes as demonstrated with CADIA.
BACKGROUND: Laparoscopic herniorrhaphy is controversial and deserves critical evaluation. METHODS: In a randomized prospective study transabdominal preperitoneal laparoscopic herniorrhaphy (n = 24) was compared in patients to the tension-free Lichtenstein repair (n = 29) utilizing validated and reliable pain and activity assessment tools. The Sickness Impact Profile (SIP) was used to compare preoperative normal activity to postoperative activity. A Pain-O-Meter (visual analogue scale plus affective and sensory pain descriptors) assessed intensity of pain. The total pain assessment score and SIP were compared across time (postoperative day 1-42). Analgesic medication was used as a covariate. RESULTS: The total pain score was less for laparoscopic herniorrhaphy but this did not reach statistical significance. Similarly, the SIP showed modest improvement for laparoscopic herniorrhaphy. No differences between groups were noted for morphine equivalents of administered analgesics or length of hospitalization. CONCLUSION: Further investigation of laparoscopic herniorrhaphy is warranted.
Facial morphometry using computerised image analysis was performed on patients with growth hormone receptor deficiency (Laron syndrome) from an inbred population of southern Ecuador. Morphometrics were compared for 49 patients, 70 unaffected relatives, and 14 unrelated persons. Patients with growth hormone receptor deficiency showed significant decreases in measures of vertical facial growth as compared to unaffected relatives and unrelated persons with short stature from other causes. This report validates and quantifies the clinical impression of foreshortened facies in growth hormone receptor deficiency.
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One of the false morel mushrooms, Gyromitra esculenta, was administered p.o. to Swiss mice that were 6 weeks old at the beginning of the experiment. The mushrooms were fed to the mice for 3 days and were followed by a semisynthetic diet for 4 days each week for life. The treatment induced tumors in the lungs, nasal cavity, blood vessels, forestomach, glandular stomach, cecum, and liver in the following incidences: 80, 10, 50, 16, 4, 28, and 6% in females, and 70, 12, 32, 18, 20, 22, and 12% in males. In the untreated controls, the corresponding tumor incidences were 28, 0, 14, 0, 0, 8, and 0% in females and 38, 0, 6, 0, 0, 8, and 2% in males. The light microscopic examination revealed the typical appearance of adenomas and adenocarcinomas of lungs, adenomas and adenocarcinomas of nasal cavities, hemangiomas and hemangiosarcomas of blood vessels, squamous cell papillomas and carcinomas of the forestomach, adenomas and adenocarcinomas of the glandular stomach, polypoid adenomas and adenocarcinomas of the cecum, and hepatomas. The work demonstrates the carcinogenic action of the raw G. esculenta mushroom.
The histopathologic findings reported in 254 consecutive urinary bladder biopsies were reviewed. Evidence of urinary schistosomiasis was identified in 88 biopsies (35%) and malignant neoplasms were diagnosed in 60 cases (24%). Nine out of 60 (15%) cases of bladder cancer had urinary bladder schistosomiasis and the remaining 51 cases (85%) had no clinical evidence of schistosomiasis. Transitional cell carcinoma was the commonest type of urinary bladder cancer (70%) followed by squamous cell carcinoma (20%) adenocarcinoma (8%) and rhabdomyosarcoma (2%). The mean age of the patients included was 60 +/- 15 years and the male:female ratio was 9:1. Comparison of our findings to those reported from other provinces of Saudi Arabia and from other countries, including those with known high incidence of schistosomiasis, is included.
The incidence of sodium saccharin (NaS)-associated bladder tumours in male rats increases when exposure to high doses begins in utero or at birth compared with treatment after weaning. The present experiment evaluated the effect of NaS exposure on selected physiological parameters in young second generation rats. 6-wk-old male and female Sprague-Dawley rats were placed on either a diet supplemented with 7.5% NaS or an untreated diet, and mated 4-6 wk later. Treatment was continued through lactation and the offspring were weaned on to the same diet. Body weights were significantly depressed in NaS-treated litters by 4 days after birth, and were 35% lower than controls by 30 days when the animals were killed. NaS treatment of the offspring was associated with an increase in faecal moisture content and caecal content weight, changes in several urinary analytes, a 50% increase in serum cholesterol a 10-fold increase in serum triglycerides and decreases in serum and hepatic vitamins. In addition, NaS-treated dams and pups were anaemic. Relatively few differences between males and females were noted, but significant inter-litter differences existed. The numerous physiological changes indicate that 7.5% dietary NaS exceeds the maximum tolerated dose for weanling rats.
Patients with schistosomiasis of the urinary bladder (SB) associated with carcinoma of the bladder (SCB) or carcinoma of the prostate (SCP) have a variety of immunologic abnormalities, including the presence of HLA-DR+ and interleukin-2 receptor-positive (IL-2R+) T-lymphocytes in circulating blood. This study demonstrated that, the HLA-DR+ and IL-2R+ antigens are selectively expressed on majority of the CD4+ T-lymphocytes of patients with SCB, whereas, these antigens are expressed almost equally on both CD4+ and CD8+ T-lymphocytes of patients with SB and SCP. Expressions of HLA-DR+ and IL-2R+ antigens in CD4+ T-lymphocytes, and a depressed response of this T-cell subset to phytohemagglutinin and Concanavalin A stimulations seems to be the characteristic feature of these patients with SCB. In addition, the autologous mixed lymphocyte reaction (AMLR) and allogenic mixed lymphocyte reaction (MLR) was depressed in patients with SCB. However, patients with SCP demonstrated a normal MLR, even though the AMLR was highly depressed. The immunoregulatory role of the HLA-DR+, IL-2R+, CD4+ helper/inducer T-lymphocytes, and the AMLR and MLR abnormalities we have identified in patients with SCB may be important and could play a role in the pathobiology of these diseases in humans.
We present a case of haematemesis and malaena, severe enough to require blood transfusion, caused by leech infestation from the southern region of Saudi Arabia. The site was the posterior pharyngeal wall. The common mode of presentation in leech endoparasitism is by nasal infestation and recurrent unexplained epistaxis. Leech endoparasitism should be considered as a cause in unexplained haematemesis in areas where aquatic leeches are commonly found.
The effects of the salt form of saccharin and of diet on urinary ion levels have been studied in rats. Sodium saccharin (NaS) or calcium saccharin (CaS) was fed at a level of 5% in either Agway Prolab 3200 diet or AIN-76 diet to male, 5-wk-old F344 rats for 10 wk. The AIN-76 diet contained considerably less calcium, sodium and potassium than the Prolab 3200 diet, and smaller amounts of these ions were eliminated over 24 hr in the urine of rats fed the AIN-76 diet. Although food consumption was less in the groups fed AIN-76, total urinary saccharinate ion excretion with either saccharin salt was comparable with, or even higher than, that excreted by rats fed either salt in the Prolab 3200 diet. Rats fed Prolab 3200 eliminated approximately equal amounts of saccharinate ion in the faeces and urine. Rats fed AIN-76 eliminated about 10-20 times as much saccharin in the urine as in the faeces. Total saccharin excretion (faecal and urinary) was not influenced by the salt form. Water intake and urine volume were lower in rats fed control AIN-76 diet in comparison with those fed Prolab 3200, and were increased above the control level in groups fed saccharin in the AIN-76 diet. Urine electrolyte levels and osmolality were lower in the groups fed AIN-76. In general, NaS administration in either diet resulted in increased urinary sodium compared with controls, and the pH was at, or above, the level of control rats. CaS resulted in increased urinary calcium and decreased pH. There were marked diurnal variations in the urinary excretion of the various electrolytes, pH, and urine volume over a 24-hr period in all rats. This diurnal variation was more pronounced in the rats fed the Prolab 3200 diet. These results indicate that NaS and CaS have marked effects on the excretion of urinary electrolytes, and that these effects are influenced by diet.
We performed a retrospective analysis of serum interleukin 2 receptor (IL-2R) levels in a group of 35 patients with malignant lymphoma (ML; 13 T cell and 22 B cell) using a new enzyme immunoassay. Our objectives were to determine if elevated levels of soluble IL-2R occur in patients with active ML, whether serum IL-2R levels are prognostic, and whether prospective studies are warranted. Our preliminary data indicate that serum IL-2R levels correlate with disease activity and size of tumor, but not with grade or stage of the tumor. Five-year actuarial survival was 20% for patients with IL-2R levels greater than 1000 U/mL at any time during their course and 86% for patients who did not exceed that threshold. Furthermore, patients with IL-2R levels lower than 1000 U/mL were more likely to achieve a complete remission. Serum lactate dehydrogenase and uric acid levels did not show significant correlation with disease activity or prognosis. We conclude that serum IL-2R levels may have clinical and prognostic significance in patients with ML and that prospective studies are indicated.