Lateral cranial meningocele.
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Cyst Fluid↗
Biomedical subjects
K Singh
Publications and source records attributed to K Singh.
Epidemiology, presentation and management of congenital muscular torticollis.
AIM OF STUDY: Congenital muscular torticollis is a condition of debatable aetiology and management. Untreated, cervical function and facial cosmesis may be severely compromised. The aim of this study was to establish the epidemiology, presentation and management of congenital muscular torticollis in Singapore. PATIENTS: Ninety-one patients with torticollis were seen at the National University Hospital (NUH) from January 1994 to December 1997. Torticollis was first noted at a median age of 2 months with the median age of presentation being 6 months. At presentation, a sternomastoid tumour was noted in 33 patients and 62 patients had facial asymmetry. Thirteen of 22 patients with neonatal records available had mandibular hypoplasia at birth on the side where the sternomastoid was affected. Half of the patients (45) had a right sided lesion, with 46 being left sided. The rates of assisted breech delivery, instrumental deliveries (forceps and vacuum) and Caesarean section were higher in the study group. Nine (59.1%) of 13 patients with vertex presentation, had a lesion on the side of the presenting shoulder. Forty-eight of 72 patients responded well to therapy with improvement; 20 underwent surgery and the median age of presentation of 19.5 months in this group was significantly later than that of 4 months in the group which responded to physiotherapy alone. CONCLUSION: Birth trauma appears to be the main aetiological factor in congenital muscular torticollis. Patients generally respond well to physiotherapy. This study revealed 2 findings hitherto unreported: (1) mandibular hypoplasia may be an useful early sign of this condition, and (2) the side affected may depend on the side of shoulder delivered first. More studies, however, are required to confirm these findings.
Age of Onset↗
Pancreatopleural fistula presenting as hemorrhagic pleural effusion.
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Abdominal Injuries↗
Mandibulo-acral dysplasia: Indian patient with severe bony changes.
We report an Indian patient with mandibulo-acral dysplasia. This patient had absence of spinous processes of 4th and 5th cervical vertebrae and very severe bony changes but no loss of teeth.
Adult↗
Hepatoprotective activity of ellagic acid against carbon tetrachloride induced hepatotoxicity in rats.
Administration of CCl4 to normal rats and consequent oral feeding with ellagic acid (50 mg/kg) provided a significant protection against the biochemical alterations in serum and liver produced by CCl4. In vitro experiments showed that liver microsomes from animals treated with ellagic acid and CCl4, decreased lipid peroxidation compared to microsome prepared from rats exposed to CCl4 alone.
Animals↗
Factors explaining the use of psychiatric services by general practices.
BACKGROUND: Referral rates from general practitioners to hospital services vary up to 25-fold, and several studies have sought reasons for this apparent inconsistency in clinical practice. However, few studies have concentrated on, or indeed included, psychiatric patients or psychiatric referral rates. AIM: To determine the effect of population, general practice, and mental health service factors on use of specialist mental health services by general practices. METHOD: Cross-sectional data from computerized records used in managing clinical care on all patients aged 16 to 64 years who had been in contact with any mental health service staff over a two-year period. Twenty-three practices in Huntingdon Health District were studied, with a list population of 87,643 patients aged 16 to 64 years, served by one inpatient ward and three community mental health teams. The main outcome measures were the relation between age-standardized utilization ratio and markers of morbidity, deprivation, community mental health provision, and practice prescribing. RESULTS: Variation between practices in the use of mental health services was relatively limited, especially compared with the use of other secondary medical and surgical services. Three factors together explained 60.8% of the variance in use between practices: a census-based index of long-term limiting illness in females registered with the practice, use of one of the three community mental health teams, and average quarterly defined daily doses of hypnotics prescribed per practice population. Relatively high prescribing of hypnotics was associated with lower service use. CONCLUSION: Population morbidity and factors in the mental health service explain a substantial part of the variation in the use of mental health services between practices. Further work is needed to replicate these findings and explore why team factors and prescribing patterns influence utilization ratios. This study underlines the importance of examining population, practice, and specialist service factors in explaining variation in the use of secondary care by general practices.
Adolescent↗
Norepinephrine stimulates apoptosis in adult rat ventricular myocytes by activation of the beta-adrenergic pathway.
BACKGROUND: Myocardial sympathetic activity is increased in heart failure. We tested the hypothesis that norepinephrine (NE) stimulates apoptosis in adult rat ventricular myocytes in vitro. METHODS AND RESULTS: Myocytes were exposed to NE alone (10 micromol/L), NE+propranolol (2 micromol/L), NE+prazosin (0.1 micromol/L), or isoproterenol (ISO, 10 micromol/L) for 24 hours. NE and ISO decreased the number of viable myocytes by approximately 35%. This effect was completely blocked by the beta-adrenergic antagonist propranolol but was not affected by the alpha1-adrenergic antagonist prazosin. NE increased DNA laddering on agarose gel electrophoresis and increased the percentage of cells that were stained by terminal deoxynucleotidyl transferase-mediated nick end-labeling from 5.8+/-1. 0% to 21.0+/-2.3% (P<0.01; n=4). NE likewise increased the percentage of apoptotic cells with hypodiploid DNA content as assessed by flow cytometry from 7.8+/-0.7% to 16.7+/-2.2% (P<0.01; n=6), and this effect was abolished by propranolol but not prazosin. ISO and forskolin (10 micromol/L) mimicked the effect of NE, increasing the percentage of apoptotic cells to 14.7+/-1.9% and 14. 4+/-2.2%, respectively. NE-stimulated apoptosis was abolished by the protein kinase A inhibitor H-89 (20 micromol/L) or the voltage-dependent calcium channel blockers diltiazem and nifedipine. CONCLUSIONS: NE, acting via the ss-adrenergic pathway, stimulates apoptosis in adult rat cardiac myocytes in vitro. This effect is mediated by protein kinase A and requires calcium entry via voltage-dependent calcium channels. NE-stimulated apoptosis of cardiac myocytes may contribute to the progression of myocardial failure.
Adenylyl Cyclases↗
Changes in circulating insulin and corticosterone concentrations during different reproductive phases and their relationships to body weight and androstenedione concentration of male Scotophilus heathi.
The aim of the present study was to determine the serum levels of insulin and corticosterone during different reproductive stages in a natural population of the male bat, Scotophilus heathi and their relationship to body weight and androstenedione level. Changes in body weight were marked by weight gain before winter dormancy and weight loss during winter dormancy. Circulating insulin level varied significantly over the season and correlated positively with changes in body weight and androstenedione level. Circulating corticosterone level also varied significantly over the season but correlated negatively with changes in body weight and androstenedione level. High corticosterone level during August coincided with a period of increased feeding activity in this species. The results suggest that insulin may act as an anabolic agent to promote fat deposition and corticosterone exerts a predominantly fat-mobilizing influence. A high insulin level prior to winter dormancy may be an important factor responsible for inducing high androstenedione concentration shown in Scotophilus heathi.
Adipose Tissue↗
Cloning and expression of the gene for the active PPi-dependent phosphofructokinase of Entamoeba histolytica.
Pyrophosphate-dependent phosphofructokinase (PPi-PFK) from Entamoeba histolytica (HM-1) was purified from trophozoites. Oligonucleotide probes based on partial amino acid sequence were used to clone and sequence the gene and the cDNA of the enzyme. The molecular mass of the subunit was greater than, and the derived sequence significantly different from, that of the product of the PPi-PFK gene previously cloned from E. histolytica [Huang, Albach, Chang, Tripathi and Kemp (1995) Biochim. Biophys. Acta 1260, 215-217; Bruchhaus, Jacobs, Denart and Tannich (1996) Biochem. J. 316, 57-63]. The sequence identity between the two proteins was 17%. The sequence bore greater identity with the more phylogenetically advanced plant PPi-PFKs than with bacterial PPi-PFKs. The cloned cDNA was expressed and the protein purified. The kinetic properties were identical with those of the enzyme isolated from the organism. Furthermore, the specific activity was more than three orders of magnitude higher than that described for the product of the previously cloned E. histolytica PFK gene [Bruchhaus et al. (1996)]. The pH-dependence and apparent substrate affinities of the cloned enzyme were identical with those of the PPi-PFK in trophozoite extracts, indicating that the product of the cloned gene accounts for most if not all of the PFK activity in E. histolytica trophozoites.
Amino Acid Sequence↗
Intestinal obstruction caused by caecal volvulus.
The case of a 6-month-pregnant woman who had an uneventful postoperative recovery and normal vaginal delivery following a right hemi-colectomy for volvulus of the caecum with gangrene is reported.
Adult↗
Double guidewire placement in common bile duct: a technique for teaching biliary endoprosthesis placement.
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Catheterization↗
The influence of abortion legislation on maternal mortality.
Worldwide some 20 million unsafe abortions take place each year and account for approximately 13% of all maternal mortality and serious complications associated with it, such as sepsis, hemorrhage and trauma. Only a quarter of all women in the world do not have any access to legal abortion, whereas 40% have a legal right to decide for themselves. This liberalization of abortion legislation has seen a tremendous drop in abortion-related maternal mortality. Death from unsafe abortions are almost unknown in countries where abortion is available on request. Reduction of the need for induced abortion through the provision of good family planning services should be an integral part of healthcare. Consistent use of contraception greatly reduces the need for abortion, but it cannot completely eliminate this need. Thus, it is essential that safe medical abortion services should be made available to all women in the world in cases of contraceptive failure.
Abortion, Legal↗
Randomized trial to determine optimal dose of vaginal misoprostol for preabortion cervical priming.
OBJECTIVE: To determine the optimal dosage of vaginal misoprostol for cervical priming before vacuum aspiration abortion. METHODS: One hundred twenty women were assigned randomly to receive 200, 400, 600, or 800 microg of misoprostol given vaginally. Vacuum aspiration was performed 3-4 hours after the insertion of misoprostol tablets. The degree of cervical dilation before operation was measured with a Hegar dilator. Preoperative and intraoperative blood loss and associated side effects also were assessed. RESULTS: Twenty-nine (96.7%) women in the 400-microg group and all in the 600-microg and 800-microg groups achieved cervical dilation of at least 8 mm. The success rate for the 200-microg group was only 23.3%, significantly less efficacious than the 400-microg dose (odds ratio 95.3; 95% confidence interval 10.9, 830.9; P < .001). There was no significant difference among the 400-, 600-, and 800-microg groups (P = .364) with respect to achieving cervical dilation at least 8 mm. However, 800 microg was associated with significantly more side effects than 600 microg (preoperative and intraoperative blood loss, P < .001; abdominal pain, P = .005; products of conception at os, P < .001; fever higher than 38.0C, P = .002). When 400 microg and 600 microg were compared, we found that the higher dose also was associated with significantly more side effects. The 600-microg group was used twice in the comparison, but all P values remained significant even after the Bonferroni adjustment for multiple comparisons. CONCLUSION: Vaginal application of 400 microg of misoprostol is the optimal dose for vacuum aspiration preabortion cervical dilation in first-trimester nulliparas.
Abortifacient Agents, Nonsteroidal↗
Medical control of intraocular pressure after cataract surgery.
PURPOSE: To compare the effectiveness of 2 medications commonly used to prevent intraocular pressure (IOP) elevation in the early period after cataract surgery. SETTING: Palo Alto Veterans Affairs Health Care System, Palo Alto, California, USA. METHODS: This prospective study comprised 202 eyes of patients scheduled for cataract extraction who agreed to participate. Patients were randomized to receive oral acetazolamide, 500 mg 1 hour preoperatively; oral acetazolamide, 500 mg immediately postoperatively; apraclonidine hydrochloride 1%, 2 drops 1 hour preoperatively; or artificial tears (control group). Intraocular pressure was measured preoperatively and 4 to 6 and 24 hours postoperatively. RESULTS: Preoperative IOP was not significantly different among the 4 groups. At 4 to 6 hours postoperatively, only preoperative acetazolamide was significantly more effective than the control medication (P = .038); at 24 hours there were no significant differences among the 4 groups. Postoperative IOP elevation in excess of 35 mm Hg at 6 or 24 hours decreased significantly in the preoperative acetazolamide group (3/46 eyes) compared with the control group (14/54 eyes). There was no statistically significant difference in IOP elevation between eyes having extracapsular cataract extraction and those having phacoemulsification, independent of treatment group. CONCLUSION: The results favor preoperative acetazolamide to control postcataract IOP elevation. The method of cataract removal did not affect postoperative IOP elevation.
Acetazolamide↗
A unified DNA- and dNTP-binding mode for DNA polymerases.
Crystal structures of various DNA polymerases show a common structural topology that resembles a right hand and has distinct finger, palm and thumb subdomains. Early models of the klenow fragment (KF) of Escherichia coli polymerase I showed DNA entering a large cleft that faces the palm subdomain where the catalytic site is situated1,2. However, subsequent resolution of the structures of HIV-1 reverse transcriptase, KF and polymerase beta (pol beta) bound to DNA3-5 yielded conflicting data that suggested a different orientation for DNA bound to pol beta compared with DNA bound to other polymerases. The debate, on the correct orientation of the template-primer DNA, that followed failed to reach a consensus. Using an alternative superposition scheme, we now provide convincing evidence for a common DNA-binding mode that is applicable to all polymerases, including pol beta.
Binding Sites↗
Intra- and interobserver variability in ultrasound measurements of abdominal aortic diameter. The Tromsø Study.
OBJECTIVES: To assess the variability of ultrasonographic measurements at different levels of the abdominal aorta. DESIGN: Reproducibility study as part of a population health screening for abdominal aortic aneurysm. MATERIALS AND METHODS: In 1994/1995 a total of 6892 subjects underwent ultrasound examination of the abdominal aorta. Variability of measurements was assessed in the beginning and end of the survey period by inviting 112 randomly selected participants to a second ultrasound scan within 3 weeks of the first scan. The subjects were examined by an experienced radiologist and three sonographers who had been given a short course in ultrasonography. All examiners were blinded to each other's results. RESULTS: Variability was similar in the beginning and end of the survey period. Both the intra- and interobserver variability were less than 4 mm for all sonographers in measurements of maximal infrarenal aortic diameter, and variability was similar for measurements in the anterior-posterior and transverse plane. Variability was greater for measurements at the renal level than aortic bifurcation level. The radiologist had lower variability than the other sonographers. CONCLUSION: Ultrasound measurements of the maximal diameter can be obtained with a high degree of accuracy. Inexperienced sonographers may achieve acceptable performance given appropriate training and surveillance.
Aged↗
Adverse effects associated with contraceptive implants: incidence, prevention and management.
Contraceptive implants are increasingly being used for fertility regulation all over the world. Reversible long-term use is their most appealing feature for many users. They have the practical advantage of overcoming the risks of user failure and low continuation rates associated with other methods that require continuous attention or motivation. Disruption of menstruation, complications of insertion and removal, and infection at implant site, constitute the majority of adverse effects associated with contraceptive implants. This article reviews these various common adverse effects associated with contraceptive implants and their possible management and prevention. In addition, we also discuss very rare events, like psychiatric disorders, pseudotumor cerebri, thrombotic, thrombocytopenic purpura and thrombocytopenia, that have been reported by some researchers. Further surveillance and research is necessary to determine if these rare adverse events are causally related to contraceptive implants. Until such a time, providers of contraceptive implants should be more selective in prescribing the contraceptive implants, especially in women with a history of and/or risk factors for stroke, cerebral and coronary heart disease, thrombocytopenia and pseudotumor cerebri.
Adolescent↗
Anaemia in pregnancy--a cross-sectional study in Singapore.
OBJECTIVE: To determine the prevalence and predictors of anaemia in pregnancy in Singapore. DESIGN: Hospital based case controlled study. SETTING: National University Hospital, between January-December 1993. SUBJECTS: All women delivered at the National University Hospital, Singapore in 1993 had their haemoglobin estimated. If it was less than 11 gm/dl, blood was taken to establish the cause of anaemia. Data was also collected with regard to their antenatal progress, and factors predisposing to anaemia in pregnancy. Logistic regression, Chi-square test, Fischer's exact test, Mantel-Haenszel test were used to assess the relationships between categorical variables. RESULTS: The prevalence of anaemia at delivery was 15.3%. The most common cause of anaemia in pregnancy was due to iron deficiency (81.3%). The occurrence of anaemia in pregnancy is related to the socio-economic status of the women. Multiparous women of the lower socio-economic class who tend to book late in pregnancy were found to have the highest risk of anaemia. Multivariate logistic regression analysis revealed iron prophylaxis, haemoglobin level at booking, race and previous history of anaemia in earlier pregnancy as important predictors of anaemia at delivery. The odds of anaemia for a woman not on therapy was about 11 times that of her counterpart on prophylactic iron therapy (95% CI 8.76-14.13). A 55% reduction in odds of anaemia was estimated per 1 gm% increase in haemoglobin level at booking. As compared to Chinese, Malays and Indians who experienced significant increase in odds of anaemia of 95% and 58% respectively. Further, a pregnant woman with a previous history of anaemia is 2.6 times as likely to be anaemic, as compared with one without history of anaemia. Except for a higher incidence of preterm delivery, there was no other statistically increased risk of complications in the antepartum, intrapartum or postpartum periods. There was no difference in the incidence of antepartum haemorrhage/operative deliveries, postpartum haemorrhage, low birthweight, intrauterine growth retardation and neonatal outcome. CONCLUSIONS: The study confirms that iron deficiency anaemia is the most common cause of anaemia in pregnancy and is a major health problem in developing and developed countries.
Anemia↗