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Biomedical subjects

M A Shah

Publications and source records attributed to M A Shah.

At least 19 recordsLinked to original sources
PubMed2003

A profile of contraceptive non-use in Kuwait: implications for health and health care.

OBJECTIVES: To analyze the characteristics of women who have never used contraception, and do not intend to use it in the future; examine the factors affecting such behavior and intentions; and discuss their health implications. METHODS: Survey data from a nationally representative random sample of Kuwaiti households, collected in a study conducted in 1999 and containing 1502 currently married women, were analyzed using logistic regression analysis. RESULTS: Based on the present study, 19% of women had never used contraception and 50% were not using contraception when interviewed. Among current non-users, 42% did not intend to use contraception, and 31% were unsure about use during the following year. Negative attitudes of the respondents and their husbands were the critical factors in non-use and future intentions for non-use. Never-users were older (average age 37.8 years) and of higher parity (6.2) than other women. CONCLUSION: Being older and of higher parity, never-users constitute a high-risk group that may be in need of counseling. Also, negative attitudes towards contraception need modification.

Adult↗
PubMed2002

[Postoperative adjuvant chemoradiotherapy in high risk stomach carcinoma].

Gastric cancer is a common cancer worldwide with a high mortality rate. Despite curative intent resection, locoregional failure as a frequent site of recurrence is responsible in part for this high mortality. Many attempts have been made to decrease the risk of recurrence after resection. Studies involving postoperative chemotherapy as a single modality have not clearly demonstrated benefit. Similarly, most studies of postoperative radiation therapy have not clearly shown an improvement in overall survival. Recently, however, a USA Intergroup study indicated a survival advantage for chemoradiation therapy compared to surgery alone for patients with locally advanced gastric cancer. "Intergroup-116" is a large-scale randomized trial designed to evaluate the role of adjuvant chemotherapy plus radiotherapy following curative intent gastric resection. The data from this study demonstrate a survival benefit with adjuvant chemoradiation that may in large part be due to better locoregional control. While many patients had a less then adequate lymph node dissection, survival was not associated with the type of lymph node dissection performed. Toxicity was acceptable. "Intergroup-116" indicates that postoperative chemoradiation should be considered as a standard care option for patients with locally advanced gastric cancer. Future studies should evaluate potentially more effective systemic therapy, molecularly-directed treatment, and possibly, whether or not more formal lymph node dissections would obviate the need for radiation.

Chemotherapy, Adjuvant↗
PubMed2001

Infection of orthopedic prostheses after Staphylococcus aureus bacteremia.

We prospectively evaluated 53 patients with prosthetic joints and 27 patients with other orthopedic prosthetic devices who developed Staphylococcus aureus bacteremia (SAB). After exclusion of patients with primary postoperative infections, the risk of a prosthesis becoming infected by means of hematogenous seeding after SAB was 34% (15 of 44 patients) for prosthetic joints and 7% (1 of 15 patients) for other orthopedic prostheses.

Adult↗
PubMed2001

Over-the-counter use of oral contraceptives in Kuwait.

Oral contraceptive pills (OCPs) are available over-the-counter (OTC) in Kuwait, and constitute a leading method for spacing and limiting children. Data from a nationally representative survey of Kuwaiti women are used to examine OTC use of OCPs. One-fourth of the women initiated use without consulting a doctor, and 50% bought OCPs from the pharmacy. No socioeconomic or demographic differences were found between those who consulted a physician, implying that women of different background have similar accessibility to the physician. Using multivariate analysis, the odds of consulting a physician were found to be significantly lower for women who first bought OCPs directly from the commercial pharmacy. The duration of first time OCP use did not differ according to physician consultation. It is concluded that OTC availability of OCPs has many advantages and prevents unwanted pregnancy. However, there is a need for better packaging and instructions that would enable high-risk women to identify themselves and to use OCPs under physician supervision.

Contraceptives, Oral↗
PubMed2001

Prevalence of histological reflux oesophagitis in H. pylori positive patients: effect of density of H. pylori and activity of inflammation.

OBJECTIVE: Recently there has been a great interest in the role of Helicobacter pylori in gastroesophageal reflux disease. Many studies do not show any significant difference in the overall prevalence of H. pylori in patients with endoscopic oesophagitis and controls. In this prospective study we assessed the influence of H. pylori density and activity of inflammation in different parts of stomach on histological oesophagitis. METHODS: One Hundred and forty consecutive patients undergoing endoscopy for dyspepsia and heartburn were evaluated. Three biopsies were taken from antrum and two each from corpus, cardia and lower oesophagus. Urease test (CLO test) was performed. Density and activity of infection was assessed in a semi-quantitative way. RESULTS: One Hundred and Fourteen (81%) patients from the 140 endoscoped, were positive for H. pylori and had H. pylori positive antral gastritis. Of these 114 cases, H. pylori were detectable in 104 (91%) of biopsies taken from corpus and 96 (84%) of biopsies from cardia. There was a strong correlation of density of H. pylori (0-3) in antrum with body and of body with cardia by Spearman correlation tests (p = 0.000). But H. pylori were more dense in antrum as compared to corpus and in corpus as compared to cardia (p = 0.0000 and 0.0003 respectively by Wilcoxon's rank test). Neutrophil activity and degree of mononuclear infiltrate were also greater in antrum as compared to corpus (p = 0.000 and 0.059). The activity and degree of inflammation was not significantly different in corpus-cardia pair. Out of 114 H. pylori positive patients, 75 had histological oesophogitis (p = 0.855). After excluding cases of hiatal hernia (H.H) and gapping lower oesophageal sphincter (LOS), number of H. pylori positive patients decreased to 73, out of these 50 had histological oesophagitis (p = 0.103). In all H. pylori positive patients with histological oesophagitis, H. pylori density (1-3) in antrum correlated with severity of oesophagitis (P = 0.011). Neutrophil activity in antrum and corpus also correlated with the severity of histological oesophagitis (P = 0.024 and 0.035 respectively). Correlation further improved after excluding cases of HH and gapping LOS (P = 0.002 for H. pylori density and 0.026 and 0.004 for activity in antrum and corpus). No correlation could be found of density and activity of infection in cardia with histological oesophagitis. CONCLUSION: Our H. pylori positive patients had more dense and severe infection in antrum. Those who had histological oesophagitis in addition showed a positive correlation of the density of H. pylori in antrum and neutrophil activity in antrum and corpus with the severity of histological oesophagitis.

Adolescent↗
PubMed2001

Determinants of job satisfaction among selected care providers in Kuwait.

The study reports job satisfaction among a sample of 370 physicians, nurses, pharmacists, and medical laboratory technologists in the Ministry of Health hospitals in Kuwait. Job satisfaction was measured using Dunnette's scale. The respondents in all four categories were satisfied with all aspects of their jobs except salary. The medical laboratory technologists were, however, dissatisfied with professional advancement as well. The physicians were found to be most satisfied, closely followed by nurses and pharmacists, while medical laboratory technologists were least satisfied. Multivariate analysis was used to assess the net effects of background and work environment characteristics on overall job satisfaction. Introduction to job, in-service training, and monthly income had significant positive effects on overall job satisfaction. These findings may have serious implications for health care delivery systems that recruit expatriate care providers.

Adult↗
PubMed2001

Cell cycle-mediated drug resistance: an emerging concept in cancer therapy.

The concept of combining chemotherapeutic agents to increase cytotoxic efficacy has evolved greatly over the past several years. The rationale for combination chemotherapy has centered, in the past, on attacking different biochemical targets, overcoming drug resistance in heterogeneous tumors, and by taking advantage of tumor growth kinetics with increasing the dose-density of combination chemotherapy. The overall goal was to improve clinical efficacy with acceptable clinical toxicity. With our increased understanding of the cell cycle and the impact chemotherapeutic agents have on the cell cycle, it is increasingly apparent that this physiology can create drug resistance, thereby reducing combination chemotherapeutic efficacy. This is particularly relevant with the advent of cell cycle-specific inhibitors but also has relevance for the action of standard chemotherapeutic agents currently in clinical practice. This cell cycle-mediated resistance may be overcome by a greater understanding of chemotherapeutic cell cycle effects and by appropriate sequencing and scheduling of agents in combination chemotherapy. In this review, we have elected to illustrate the evolving concept of cell cycle-mediated drug resistance with novel drug combinations that include the taxanes, camptothecins, and fluorouracil. This review indicates that as our understanding of the cell cycle grows, our ability to appropriately sequence chemotherapy to overcome cell cycle-mediated drug resistance can have a great impact on our therapeutic approach in the treatment of human cancers.

Antineoplastic Agents↗
PubMed2001

Augmentation of apoptosis and tumor regression by flavopiridol in the presence of CPT-11 in Hct116 colon cancer monolayers and xenografts.

CPT-11, a DNA topoisomerase I inhibitor, has demonstrated clinical activity in colorectal cancer. Flavopiridol, a cyclin-dependent kinase inhibitor, is rapidly emerging as a chemotherapy modulator. To enhance the therapeutic index of CPT-11 in colon cancer, we studied the combination of these two drugs in relatively resistant human colon cancer cells, Hct116. Exposure of parental Hct116 cells to clinically achievable concentrations of SN-38 (the active metabolite of CPT-11) induces p21 and a G(2) arrest. However, these conditions fail to induce apoptosis. In contrast, Hct116 cells that are p21 deficient (p21-/- Hct116) readily undergo apoptosis after treatment with SN-38. In this study we show that the parental Hct116 cells can be sensitized to undergo apoptosis by the addition of flavopiridol after SN-38 treatment. The induction of apoptosis was greatest with sequential therapy consisting of SN-38 followed by flavopiridol. Clonogenic assays also showed greatest inhibition with this sequence. Sequential treatment with SN-38 followed by flavopiridol was associated with higher activation of caspase-3 and greater cleavage of both p21 and XIAP, an inhibitor of apoptosis, compared with other treatment schedules. CPT-11 induced some tumor regressions but no complete responses in the p21-intact Hct116 xenografts. CPT-11 with flavopiridol more than doubled tumor regression, compared with CPT-11 alone, and produced a 30% complete response rate. Our studies indicate that CPT-11 induces cell cycle arrest rather than cell death and that flavopiridol, by activating the caspase cascade, cleaves the inhibitors of apoptosis and sensitizes the cells to undergo cell death. Thus, flavopiridol combined with CPT-11 may provide a completely new therapeutic approach in the treatment of colon cancer.

Animals↗
PubMed2000

Searching for socioeconomic risk factors in perinatal mortality in Kuwait: a case control study.

The aim of this paper was to investigate whether socioeconomic factors such as parent's education, occupation, and income constitute risk factors in perinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity and reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998. Each case (perinatal death) was matched with a control (live birth). Matching criteria were: father's nationality, place, and date of birth. Information was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Bivariate analysis showed that several of the socioeconomic variables (e.g. lower education, lower income) increased the risk of a perinatal death. However, none of these variables remained significant in the multivariate analysis in which birth weight and length of gestation emerged as the two major determinants of perinatal deaths among both nationality groups. Among the Kuwaitis, primiparity and high parity, and previous history of miscarriage were also significant risk factors. Among the non-Kuwaitis, none of the socioeconomic factors, or the maternal factors, were significant predictors of perinatal mortality. For Kuwaitis, it appears that the government's policies and programs aimed at reducing social inequalities in the society have been effective in eliminating perinatal mortality differences between socioeconomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benefit from the government's free health services. However, charges for non-Kuwaitis are due to be levied soon which may increase disparities in access to health care.

Birth Weight↗
PubMed2000

Effect of Helicobacter pylori density on inflammatory activity in stomach.

AIM: To assess the relationship of H. pylori density on inflammatory activity in different parts of stomach. MATERIALS AND METHODS: Endoscopic biopsies were taken from gastric antrum, corpus and cardia of 150 dyspeptic patients in a prospective analysis. A semiquantitative scoring was done according to updated Sydney system in accordance with the variables like H. pylori density, neutrophil activity and mononuclear cell infiltrate. Glandular atrophy and intestinal metaplasia was also noted. Statistical analysis was done using Spearman rank correlation test. RESULT: One hundred and fifty patients, 94 males and 56 females (with a mean age of 35.4) were analyzed. Morphologically within stomach 82.7% of antral, 74% of corpus and 68% of cardia biopsies were positive for H. pylori. Correlation coefficient of H. pylori density and neutrophil activity was 0.542, 0.644 and 0.729 for antrum, corpus and cardia respectively (P = 0.00); while the correlation coefficient of mononuclear cell infiltrate with H. pylori density was 0.173, 0.245 and 0.326 for antrum, corpus and cardia respectively (P = 0.035, 0.003, 0.000). H. Pylori density in corpus and cardia was proportional to its density in antrum. CONCLUSION: Density of H. pylori is more in the antrum due to its alkaline pH and the neutrophil activity shows a direct association with H. pylori density (JPMA 50:148, 2000).

Adolescent↗
PubMed1999

Effective and economical option for pain palliation in prostate cancer with skeletal metastases: 32P therapy revisited.

The role of phosphorus-32 (32P) was evaluated in patients experiencing pain due to skeletal metastases from prostate cancer and refractory to other modes of treatment. Twenty patients received 185 MBq (5 mCi)32P intravenously; 12 patients received a single dose each, five patients were injected twice and three patients three times at 3-month intervals. A blood count and clinical assessment for bone pain, tender sites, mobility and analgesic intake were performed before and 4, 8 and 12 weeks after the administration of 32P. A bone scan was performed before and 12 weeks after therapy. The results showed a significant decrease in pain at 4 weeks and a palliative response persisted for up to 12 weeks. Analgesic medication intake decreased significantly (F = 13.2213, P < 0.0001) and mobility improved after therapy. Quantitative analysis of the bone scans showed a statistically significant reduction in osteoblastic activity in metastatic lesions after therapy (t = -3.80, P < 0.001). Transient myelosuppression after 4 weeks, which was statistically significant for WBC and platelet counts only (F = 3.0226, P = 0.0358; F = 6.2514, P = 0.0009 respectively), returned within normal limits by 8 weeks. We conclude that 32P is an effective and safe therapy for pain palliation.

Aged↗
PubMed1998

Prevalence of Helicobacter pylori antibodies in endoscopy personnel and non-medical volunteers of Karachi.

Prevalence of Helicobacter pylori (Hp) is high in developing countries. As endoscopy personnel are at greater risk of exposure to gastric secretions, they are apparently at higher risk of acquiring this infection. The aim of this study was to determine prevalence of Hp antibodies in endoscopy staff and compare it with non-medical volunteers and assess any additional risk of occupational exposure to Hp in the former group. Thirty-three subjects working in endoscopy suites of different hospitals of Karachi and 33 non-medical volunteers were investigated for the prevalence of Hp antibodies by using a commercially available rapid qualitative test (FlexPack HP; Abbott). The two groups were comparable in mean age, sex and social class. Twenty-six of 33 (79%) of the endoscopy personnel and 19/33 (58%) of the non-medical volunteers were positive for Hp serology (p = 0.06 R.R 1.37). Among the endoscopy personnel 13/14 (93%) of endoscopy assistants were positive and this subgroup had a significantly higher prevalence of Hp antibodies as compared to the control group (p = 0.019). No correlation could be found between the positive serology and symptoms of dyspepsia.

Adult↗
PubMed1998

Prevalence of pulmonary tuberculosis on the roof of the world.

SETTING: The Shimshal Valley, a remote village in Northern Pakistan, is one of the seven Pamirs of Central Asia, widely known as the roof of the world. OBJECTIVE: To investigate the prevalence of pulmonary tuberculosis (TB) in the Shimshal Valley. DESIGN: The Rapid Village Survey Method (RVS) was used to investigate the prevalence of pulmonary tuberculosis. The selection criteria were chronic cough, hemoptysis, past history of TB and close contact with a tuberculous patient. After clinical examination, a chest radiograph was done and a single spot sputum sample was obtained for smear examination. RESULTS: The total population of the village was 1077, of whom 231 cases were studied. Overcrowding affected 75% of the study population. The prevalence of smear positive pulmonary TB in the village studied was 554 per 100000 population, and the prevalence of active smear-negative TB was estimated at 1949/100 000. The prevalence of active pulmonary TB increased with age and the only risk factor for active TB was age over 45 years. Of the 21 cases with a past history of pulmonary TB, only 38% had completed a full course of chemotherapy. CONCLUSION: Pulmonary TB is a very serious health issue in the rural community (Shimshal Valley) of Pakistan. This study highlights the lack of efficacy of national tuberculosis control programs in the country.

Adolescent↗
PubMed1997

Antilymphocytic and immunosuppressive effects of Lantana camara leaves in rats.

Once daily administration of Lantana camara leaves juice at different dose levels (60, 300, 600 and 1500 mg/kg/day) for 14 days in rats resulted in alterations in various haemato- and biochemical parameters. Significant increase in blood urea nitrogen was observed with the doses of 600 and 1500 mg while significant increase in the relative weights of adrenals was observed at all the four dose levels. Total proteins, globulins, absolute lymphocyte count and per cent lymphocyte count were significantly decreased with 60, 600 and 1500 mg doses while a significant hypoglycemic effect was observed with 1500 mg only. Rats treated with 1500 mg dose did not exhibit any increase in alanine aminotransferase and aspartate aminotransferase activities or the alterations in relative kidney and liver weights. In another set of experiment, once daily oral administration of 1500 mg/kg/day for 14 days significantly inhibited the granulomatous tissue formation in rats and this effect was comparable to that of cyclophosphamide (10 mg/kg/day).

Animals↗
PubMed1996

Probing structure-activity relationship in diamine oxidase--reactivities of lysine and arginine residues.

Lysine and arginine residues of pig kidney diamine oxidase (DAO) were modified with 2,4,6-trinitrobenzenesulphonic acid (TNBS), 2,3-butanedione and phenylglyoxal, respectively, using different concentrations and time periods. Lysine residues are classified into 3 categories: completely exposed, highly reactive; sluggish, partly buried; and unreactive, completely buried. About 21 lysine residues whose modification did not lead to any significant conformational change as well as loss of catalytic activity are believed to be less important for the structural stability of the enzyme. On the other hand, the remaining 19 lysine residues are more important in maintaining the native structure of the enzyme as evidenced by the change in hydrodynamic parameters and loss of catalytic activity upon their modification. Arginine residues when probed with butanedione or phenylglyoxal treatment resulted in the significant loss of catalytic activity without any change in conformation implicating their involvement in the catalytic function of the enzyme. Significant change in conformation was noted when 10 arginine residues were modified, which suggests the structural role of these residues.

Amine Oxidase (Copper-Containing)↗