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Biomedical subjects

M Rao

Publications and source records attributed to M Rao.

At least 181 records · Page 10Linked to original sources
PubMed1992

The role of assisted ventilation in survival after respiratory failure in children with AIDS.

OBJECTIVES: To determine the role of assisted ventilation in children with the acquired immunodeficiency syndrome and acute respiratory failure, and to identify any measurement or variable that predicted survival. DESIGN: Retrospective study. SETTING: Kings County (New York) Hospital Center, a tertiary-level inner-city municipal hospital. PARTICIPANTS: Twenty-three children with acquired immunodeficiency syndrome who were endotracheally intubated and mechanically ventilated because of acute respiratory failure. MEASUREMENTS/MAIN RESULTS: There were 24 episodes of acute respiratory failure, as one patient survived a first episode and died during the second episode 2 years later. We failed to identify any measurement or variable that predicted survival. During 12 episodes (50%), the patients survived and were weaned from the ventilator. CONCLUSIONS: Our findings indicate that a decision to avoid intubation and assisted ventilation in a child with acquired immunodeficiency syndrome and acute respiratory failure should not be made based merely on the presumption of a lethal outcome.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage as a diagnostic tool in children with AIDS.

OBJECTIVE: To report our experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage in children with the acquired immunodeficiency syndrome and acute lower respiratory tract disease. DESIGN: Retrospective study. SETTING: Children's Medical Center of Brooklyn, NY, a tertiary-level inner-city hospital. PARTICIPANTS: Eighty-five children with acquired immunodeficiency syndrome and acute lower respiratory tract disease. INTERVENTION: One hundred five flexible fiberoptic bronchoscopies with bronchoalveolar lavages. MEASUREMENTS/MAIN RESULTS: Infective agents were recovered in 88 procedures (84%). Potentially pathogenic bacteria were identified in 56 (56.6%) of 99 procedures. Viruses were found in 28 (29%) of 96 lavages, and fungi in 37 (41.6%) of 89 specimens. Pneumocystis carinii was identified in 22 (22.2%) of 99 specimens. Mycobacteria were isolated from 14 (14%) of 100 specimens. A serious complication occurred in only one procedure (0.95%). CONCLUSION: Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic procedure that identified infective agents in 80% of children with acquired immunodeficiency syndrome and concomitant acute lower respiratory tract disease.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Multipractice analysis of laparoscopic cholecystectomy in 1,983 patients.

We analyzed the results of laparoscopic cholecystectomy in 1,983 patients from a variety of practice settings in order to evaluate a large, cross-sectional experience for this new procedure. Twenty general surgeons from 9 clinics in 4 states examined the records and outcome of their laparoscopic cholecystectomy patients through March 1991. In 88 patients (4.5%), the operation was converted to an open procedure, usually because of marked inflammation and unclear anatomy. A total of 644 cases were performed with laser dissection and 1,339 with cautery, and the results of these 2 methods were similar. There were 41 complications. Reoperation for repair was necessary in 18 patients, including 5 with common duct injuries, and, to date, the outcome has been good in each patient. Seventy-six patients (3.8%) have had recognized common duct stones; these were removed preoperatively by endoscopic sphincterotomy (ERS) in 20 patients, during cholecystectomy in 46 patients, and postoperatively by ERS in 4 patients. In six patients, common duct stones became apparent 1 to 4 months after cholecystectomy. We conclude that trained general surgeons can perform laparoscopic cholecystectomy safely with risks comparable to those for conventional open cholecystectomy.

Adolescent↗
PubMed1992

Membrane-associated neurotransmitter stimulating factor is very similar to ciliary neurotrophic factor.

Membrane-associated neurotransmitter stimulating factor (MANS) can modulate sympathetic neurotransmitter expression and promote ciliary neuron survival in cell culture. Previous studies have shown that its biological effects and biochemical properties are similar to those of ciliary neurotrophic factor (CNTF). In addition, CNTF is present in spinal cord, the source of MANS. These observations raised the possibility that MANS preparations contain CNTF. We find that partially purified MANS fractions contain a 24-kD protein that is recognized in Western blots by an antiserum generated against recombinant rat CNTF (rCNTF). This antiserum immunoprecipitates virtually all the cholinergic-inducing and the ciliary neurotrophic activities present in MANS preparations. When iodinated rCNTF is incubated with spinal cord membranes, a significant proportion of the labeled CNTF segregates with the membrane pellet. The membrane-associated exogenous CNTF can be eluted from the membrane fraction by treatment with high-salt solutions, similar to that used to solubilize MANS from spinal cord membranes. Our data suggest that a substantial portion of the cholinergic differentiation and ciliary neurotrophic activities present in MANS preparations can be attributed to CNTF or a CNTF-like molecule.

Animals↗
PubMed1992

Adrenal myelolipoma.

A case of adrenal myelolipoma demonstrated by ultrasound and computed tomography is presented with a discussion of the aetiology and review of literature. Ultrasound and CT proved to be invaluable in the pre-operative diagnosis of adrenal myelolipoma.

Adrenal Gland Neoplasms↗
PubMed1992

Adjuvant effects of liposomes containing lipid A: enhancement of liposomal antigen presentation and recruitment of macrophages.

Liposomes containing lipid A induced potent humoral immune responses in mice against an encapsulated malaria antigen (R32NS1) containing NANP epitopes. The immune response was not enhanced by lipid A alone or by empty liposomes containing lipid A. Experiments to investigate the adjuvant mechanisms of liposomes and lipid A revealed that liposome-encapsulated R32NS1 was actively presented by bone marrow-derived macrophages to NANP-specific cloned T cells. The degree of presentation was related to the amount of liposomal antigen added per macrophage in the culture medium. At high cell densities, poor presentation occurred when liposomes lacked lipid A but excellent presentation occurred when the liposomes contained lipid A. Liposomes containing lipid A and encapsulated antigen also activated gamma interferon-treated macrophages to produce nitric oxide. Macrophage activation and antigen presentation occurred with liposomes that could not be detected by the Limulus amebocyte lysis assay. Intraperitoneal injection of liposomal lipid A caused a marked increase in the recruitment of immature (peroxidase-positive) macrophages to the peritoneum. On the basis of these experiments, we propose that the mechanism of the adjuvant action of liposomal lipid A is partly due to increased antigen presentation by macrophages and partly due to recruitment of an increased number of macrophages serving as antigen-presenting cells.

Adjuvants, Immunologic↗
PubMed1992

Post-renal transplant diabetes mellitus--a retrospective study.

The prevalence of post-transplant diabetes mellitus in 222 consecutive live related renal allograft recipients over a 3-year period was found to be 11.7%. Most of them (20 of 26) developed diabetes mellitus within the first 4 months of transplantation. Post-transplant diabetic patients were older, and had a significantly greater incidence of avascular necrosis of bone. An assessment of risk factors showed that abnormal postprandial blood sugar pretransplant was a significant predictor for development of post-transplant diabetes, whereas cumulative oral steroid dose, weight gain after transplant, type of immunosuppression employed, and graft function were not important. We conclude that post-transplant diabetes mellitus frequently develops in patients with a predisposition by virtue of older age and pretransplant postprandial hyperglycaemia. While steroids are important in the pathogenesis, there was no demonstrable dose-response relationship; post-transplant diabetic patients may be a group with a greater propensity to steroid-induced complications.

Adrenal Cortex Hormones↗
PubMed1992

False contraindications to childhood immunization.

An immunization advisory clinic was set up in mid-Essex in 1988 to provide a referral facility for professionals and parents who were unsure about the eligibility of certain children to receive immunization. This paper describes four typical cases. The history and management of each case are described and the fact that all the children were successfully immunized is highlighted. It is hoped that by sharing the experiences of the immunization advisory clinic with other professional staff, more positive decisions regarding immunizations will be made.

Child, Preschool↗
PubMed1991

Reactivities of serotyping monoclonal antibodies with culture-adapted human rotaviruses.

Rotaviruses collected in Bangladesh during 1985 to 1986 were culture adapted and used in a comparative serotyping study with three groups of monoclonal antibodies, all of which reacted with the major neutralization protein (VP7) of serotype 1, 2, 3, or 4. The goals were to determine which monoclonal antibodies most accurately predicted the serotype and why large variations in serotyping efficiencies have occurred with these monoclonal antibodies in previous studies. The 143 rotavirus isolates used in this study belonged to 69 different electropherotypes; and 44, 23, 21, and 55 isolates were identified as serotype 1 through 4, respectively, by neutralization with serotype-specific hyperimmune antisera. Serotyping specificity by enzyme-linked immunosorbent assay with monoclonal antibodies was 100% consistent with results found by neutralization with polyclonal antisera, but large differences were observed in the sensitivities of the different monoclonal antibodies. Monoclonal antibodies 5E8 (serotype 1), 1C10 (serotype 2), 159 (serotype 3), RV3:1 (serotype 3), ST-3:1 (serotype 4), and ST-2G7 (serotype 4) reacted with all the isolates of the corresponding serotype for which there were sufficient infectious particles. Monoclonal antibody 2F1 (serotype 2) was much less sensitive and reacted with only five serotype 2 isolates, but these were among those with the highest titers. Monoclonal antibodies RV4:2 (serotype 1), KU6BG (serotype 1), RV5:3 (serotype 2), and S2-2G10 (serotype 2), on the other hand, failed to react with between one and three isolates of the corresponding serotypes which had high titers, apparently because of epitope changes in these isolates. Effects of epitope variation were, however, most apparent with monoclonal antibodies 2C9 (serotype 1) and YO-1E2 (serotype 3), which reacted with one and no isolates of the corresponding serotypes, respectively. Cross-neutralization of escape mutants indicated that the serotype 1 monoclonal antibodies 5E8, 2C9, and RV4:2 reacted with different but probably overlapping epitopes, as did serotype 2 monoclonal antibodies 2F1, 1C10, and RV5:3, finding that were consistent with the enzyme-linked immunosorbent assay data. Because of epitope variations between rotavirus strains, serotyping with several monoclonal antibodies directed at different epitopes may increase the sensitivity of the method.

Antibodies, Monoclonal↗
PubMed1991

Culture adaptation and characterization of group A rotaviruses causing diarrheal illnesses in Bangladesh from 1985 to 1986.

Group A rotaviruses collected between 1985 and 1986 during comprehensive surveillance of treated diarrheal episodes occurring in a rural Bangladesh population were culture adapted and characterized by electropherotype, serotype, and subgroup. Of 454 episodes of rotavirus-associated diarrhea, rotaviruses were culture adapted from 381 (84%), and 335 contained 11 electrophoretically identical segments in unpassaged and cultured preparations. These 335 comprised 69 different electropherotypes with between 1 (32 isolates) and 79 representatives. The persistence of specific rotavirus strains within the study population, as defined by the detection of viruses with particular electropherotypes, was generally limited to a period of only a few months. All 335 isolates were serotyped by neutralization with hyperimmune antisera to prototype rotavirus strains representative of serotypes 1 to 4, i.e., Wa, DS-1, P, and ST-3. It was found that 80, 48, 119, and 88 isolates belonged to serotypes 1 to 4, respectively. The concentrations of hyperimmune antisera required to neutralize these isolates, however, were at least threefold greater than those needed to neutralize the homologous strains. Therefore, the isolates appeared to have altered neutralization epitopes from their prototype strains. Furthermore, the serotype 4 isolates were consistently shown to be much more closely related to the serotype 4B VA70 strain than the serotype 4A ST-3 strain. All but two isolates identified as serotypes 1, 3, or 4 had long electropherotypes and were subgroup II, and all but one serotype 2 isolate were subgroup I and had short electropherotypes. The three disparate strains appeared to be genetic reassortants. Evidence is presented that dual infections required for reassortant formation were not uncommon. Thus, formation of multiple reassortants may have been a cause for the observed rapid shift in viral strains within the study population.

Age Factors↗