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Biomedical subjects

N Patel

Publications and source records attributed to N Patel.

At least 199 records · Page 11Linked to original sources
PubMed1997

A simple trajectory guidance device that assists freehand and interactive image guided biopsy of small deep intracranial targets.

Frameless image guided stereotactic systems are rapidly becoming incorporated into routine neurosurgical practice. In our unit, the Elekta Viewing Wand has been applied to a comprehensive range of neurosurgical procedures, including pituitary, posterior fossa, skull base, atlantoaxial, and epilepsy surgery. The system allows a minimally invasive surgical exposure and provides instant and continual navigational information during surgery. Subjective studies have shown this intraoperative information to facilitate the surgeon's perception of anatomic relations and identification of structures, thus improving surgical safety. Furthermore, in comparison to traditional stereotactic frames, the frameless system has been reported to reduce operative time. The technology involves the use of a localizing mechanical arm to which a pointer or biopsy probe is attached. This localizing arm is hand-held and is therefore only as steady as the surgeon's hand. This precludes the use of the Viewing Wand for functional procedures and for the safe biopsy of small, deep-seated intracranial lesions. Both types of procedures are very dependent on a steady linear approach to the target for a successful outcome. We have designed a simple guidance device that eliminates the risk of unwanted drift or angular movements of the probe as it is advanced toward the target. When used with the Viewing Wand, this device guides the wand biopsy probe along a predetermined, fixed linear trajectory to the intracranial target. We report the successful use of the fixed trajectory guidance device (FTGD) with the Elekta Viewing Wand in a series of 12 patients.

Adolescent↗
PubMed1997

Clinical outcome of patients with intermediate probability lung scans during six-month follow-up.

UNLABELLED: A retrospective review of a consecutive series of patients with intermediate probability (IP) ventilation/perfusion lung scans was performed to evaluate: the frequency of documented thromboembolic (TE) disease, either pulmonary embolism (PE) or deep-venous thrombosis (DVT), at time of presentation; the prevalence of new diagnoses of TE disease during 6-mo follow-up; and occurrence of mortality during the same follow-up interval. METHODS: Radiologic and clinical records for all patients who had ventilation/perfusion lung scans reported as IP or indeterminate during a 7-yr period were reviewed. TE disease at presentation or during follow-up was identified from results of pulmonary angiography, chest CT, lower extremity Doppler ultrasound and venography, and repeat lung scans. Occurrence of mortality and cause of death were determined by medical record review. RESULTS: Of 164 patients studied, 36 (22%) had TE disease confirmed at initial presentation (PE = 19; DVT only = 17), and four others (2%) developed evidence of TE disease during follow-up, two with PE and two with DVT. Prevalence of TE disease was significantly greater in patients with matching perfusion/chest radiographic abnormalities and ventilation/perfusion mismatches (0.5-1.5 segmental equivalents) than in those with various patterns of matching ventilation/perfusion defects (31% versus 14%, p < 0.01). Twenty-eight patients (18%) died during follow-up, but recurrent PE was implicated in only one death in a patient with angiographically-confirmed PE at initial presentation. Among the 116 patients who did not receive long-term anticoagulation after their initial lung scans, 22 (19%) died, none of whom had PE confirmed or suspected as a contributing cause. CONCLUSION: The prevalence of new or recurrent TE disease is low in patients with IP lung scans who are appropriately evaluated and managed after their initial presentation. No evidence of significant mortality secondary to untreated PE was found in the study group.

Female↗
PubMed1996

Functional replacement of cytokine receptor extracellular domains by leucine zippers.

Granulocyte-macrophage colony-stimulating factor receptor signals by a complex which includes the ligand and two different receptor subunits: a low affinity alpha receptor binding chain (granulocyte-macrophage colony-stimulating factor receptor alpha subunit (GM-Ralpha)) and a signal-transducing beta chain (GM-Rbeta). To investigate two unresolved issues in the initiation of signaling, the role of receptor extracellular domains and receptor stoichiometry, we replaced the mouse GM-Ralpha and GM-Rbeta extracellular domains with the leucine zipper domain of either the Fos or Jun molecule. We co-transfected combinations of chimeric receptors into Ba/F3 cells and found that both simple heterodimers of the GM-Ralpha and GM-Rbeta intracellular domains and homodimers of the GM-Rbeta intracellular domain signaled for proliferation. Surprisingly, homodimers of the GM-Ralpha intracellular domain also signaled for prevention of apoptosis in transfected cells. We similarly engineered dimers of the intracellular domain of the human interferon gamma receptor beta subunit and found that homodimers of the intracellular domain signaled for proliferation. When Fos peptide was added to Ba/F3 cells expressing the human interferon gamma receptor beta subunit construct, thereby preventing homodimer formation, the cells no longer proliferated in the absence of mouse interleukin 3.

Amino Acid Sequence↗
PubMed1996

Effect of amount and types of dietary fat on intestinal bacterial 7 alpha-dehydroxylase and phosphatidylinositol-specific phospholipase C and colonic mucosal diacylglycerol kinase and PKC activities during stages of colon tumor promotion.

It is evident from many studies that the effect of dietary fat on colon tumor promotion depends not only on the amount of fat but especially on fatty acid composition. Animal model studies have shown that diets which are high in omega-6 fatty acids increase colon tumor promotion, whereas diets rich in omega-3 fatty acids have no such enhancing effect. The mechanisms by which the high fat content of the diet promotes colon carcinogenesis may include the production of secondary bile acids in the colon and the modulation of colonic luminal bacterial 7 alpha-dehydroxylase that is involved in generating secondary bile acids, phosphatidylinositol-specific phospholipase C (PI-PLC), and mucosal PI-PLC, as well as diacylglycerol (DAG) kinase and protein kinase C (PKC). In the present study, we investigated the effect of high-fat diets that are rich in omega-3 and omega-6 fatty acids on cecal bacterial 7 alpha-dehydroxylase and PI-PLC, fecal secondary bile acids, and colonic mucosal DAG kinase and PKC activities during different stages of colon carcinogenesis in male F344 rats. At 5 weeks of age, groups of animals were fed a low-fat diet containing 5% corn oil (LFCO). Beginning at 7 weeks of age, all animals, except those intended as vehicle controls, received azoxymethane (AOM) s.c. once weekly for 2 weeks at a dose rate of 15 mg/kg body weight. Vehicle-treated groups received s.c. injections of normal saline. One day after the second AOM or saline treatment, the experimental groups of animals were transferred to a high-fat diet containing 23.5% corn oil (HFCO) or 20.5% fish oil + 3% corn oil (HFFO). One group continued on the LFCO diet. Animals were sacrificed at weeks 1, 12, and 36 after the AOM or saline treatment. Colonic mucosa were harvested at weeks 1, 12, or 36, and the colonic tumor tissues were examined for PKC and DAG kinase activities. Contents of the cecum were analyzed for bacterial 7 alpha-dehydroxylase and PI-PLC activities. Stool samples collected at week 12 were analyzed for bile acids. High corn oil content of the diet significantly increased the cecal bacterial 7 alpha-dehydroxylase and PI-PLC activities as compared to the diets with high fish oil or low corn oil content. Animals fed the HFCO diet excreted higher levels of secondary bile acids, such as deoxycholic acid and lithocholic acid, than those fed the LFCO or HFFO diets. Carcinogen treatment significantly enhanced the activities of DAG kinase and total membrane PKC activities in colonic mucosa compared to saline treatment in all dietary groups. Animals treated with saline or AOM and fed HFCO showed increased levels of DAG kinase and membrane PKC activities in the colonic mucosa when compared to LFCO and HFFO groups. DAG kinase and membrane PKC activities were higher in colon tumors than in the surrounding colonic mucosa, and also increased levels of these enzyme activities were found in the HFCO diet group. These results indicate that the modifying effect of dietary fat on colonic bacterial enzymes, secondary bile acids, colonic mucosal and tumor DAG kinase, and PKC that may play a role in colon carcinogenesis depends on the types and amount of fat given. The colon tumor-enhancing effect of a HFCO diet in contrast to the high dietary fish oil may be, in part, explained on the basis of its modulating effect on these bacterial and colonic mucosal enzymes and colonic secondary bile acids relevant to colon tumor promotion.

Animals↗
PubMed1996

Conformational order of phospholipids incorporated into human erythrocytes: an FTIR spectroscopy study.

Acyl chain perdeuterated dimyristoylphosphatidylcholine (DMPC-d54) and dimyristoylphosphatidylserine (DMPS-d54) were incorporated by incubation into human erythrocytes. Light microscopic analysis demonstrated that erythrocytes incubated with DMPC-d54 became echinocytic while those incubated with DMPS-d54 became stomatocytic. This indicates that DMPC-d54 was incorporated preferentially into the outer monolayer whereas DMPS-d54 was selectively incorporated into the inner monolayer. Fourier transform infrared (FTIR) spectroscopy was used to monitor the conformational order of the incorporated phospholipids. The asymmetric CD2 stretching frequency of the inserted perdeuterated acyl chains was measured in both isolated membranes and intact erythrocytes as a function of temperature. DMPC-d54 incorporated into erythrocytes exhibited a cooperative phase transition at approximately 19 degrees C, i.e., at the same temperature as pure vesicles. In contrast, DMPS-d54 incorporated into red cells exhibited no phase transition, but possessed conformational order similar to that of the liquid-crystalline state. These results suggest that DMPC-d54 persists in domains in the outer monolayer while DMPS-d54 is dispersed in the inner monolayer. These experiments are the first to demonstrate that FTIR spectroscopy can be utilized to monitor directly a specific species of lipid molecule from the entire phospholipid population.

Adult↗
PubMed1996

Cytostasis is required for IL-1 induced nitric oxide production in transformed hamster fibroblasts.

Interleukin-1 (IL-1) is known to inhibit proliferation in some tumor cells. This proinflammatory cytokine also induces nitric oxide production in a variety of cell types. In the present studies we determined if nitric oxide is involved in IL-1 induced growth inhibition in spontaneously transformed hamster embryonic fibroblasts (STHE cells). Both IL-1 alpha and IL-1 beta were found to stimulate nitric oxide production and to reduce 3H-thymidine (TdR) incorporation in high density cultures of STHE cells. However, maximal cytostasis was observed at least 24 h before significant amounts of nitric oxide accumulated in the cultures. In addition, doses of IL-1 which were too low to stimulate nitric oxide synthesis were effective in inducing cytostasis. Furthermore, in low density cultures of STHE cells, IL-1 inhibited DNA synthesis without inducing nitric oxide production. The nitric oxide synthase inhibitor NG-monomethyl-1-arginine (L-NMMA) had no effect on proliferation of cells plated at low density. In contrast, L-NMMA treatment resulted in a 40-60% reduction in IL-1 induced cytostasis in high density cultures. Neutralizing antibodies to IL-1 were found to completely block IL-1 induced cytostasis and nitric oxide production in cells plated at both densities. Although anti-IL-1 alpha and anti-IL-1 beta antibodies were highly specific and did not cross react, anti-tumor necrosis factor-alpha (TNF-alpha) antibody was able to partially suppress activation of STHE cells by both IL-1 alpha and IL-1 beta. These data suggest a potential involvement of endogenous TNF-alpha in IL-1 induced cytostasis and nitric oxide production. Exponentially growing STHE cells produced six-times less nitric oxide than non-proliferating cells. A ten-fold excess of 1-arginine was found to stimulate nitric oxide synthesis, an action that was independent of the rate of cellular proliferation. Taken together these data suggest that nitric oxide is not a major mediator of IL-1 induced cytostasis in STHE cells. Moreover, cytostasis appears to be required for nitric oxide synthesis in these cells.

Animals↗
PubMed1996

A novel organic solvent-based coupling method for the preparation of covalently immobilized proteins on gold.

A novel organic solvent-based coupling method has been developed for the covalent immobilization of biological material to gold surfaces. The method employs the polar organic solvent anhydrous 2,2,2-trifluoroethanol as the reaction medium and involves dissolution of the protein (catalase) in the solvent allowing protein coupling to proceed under basic conditions in a dry organic environment. The advantage of this method is that protein attachment is favored over hydrolysis of the coupling reagent. We have shown qualitatively and quantitatively that following attachment to the gold surface a significant proportion of the enzyme catalase remains catalytically active (at least 20-31%).

Gold↗
PubMed1996

Desflurane is not associated with faster operating room exit times in outpatients.

STUDY OBJECTIVE: To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary. DESIGN: Prospective study. SETTING: Ambulatory surgery unit of a university hospital. PATIENTS: 1,568 outpatients requiring anesthesia. INTERVENTIONS: Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit. MEASUREMENTS AND MAIN RESULTS: The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times. CONCLUSION: Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.

Adolescent↗
PubMed1996

Prospective, randomized comparison of the Flotem Iie and Hotline fluid warmers in anesthetized adults.

STUDY OBJECTIVE: To compare the fluid warming capabilities of the Hotline and Flotem IIe devices in surgical patients, and whether warming intravenous (i.v.) fluids with the Hotline device resulted in less hypothermia and less need for other warming methods compared with the Flotem IIe device. STUDY DESIGN: Part 1. Prospective, nonrandomized. Part 2. Prospective, randomized. SETTING: Teaching hospital, tertiary care center. PATIENTS: Part 1. 24 adult patients undergoing elective surgery. Part 2. 49 adult patients scheduled for major elective orthopedic or gynecologic surgery of greater than 2 hours' duration with general anesthesia. INTERVENTIONS: Part 1. Insertion of sterile in-line thermistors along the path of fluids delivered using the Hotline or Flotem device. Part 2. Patients were randomly assigned to receive i.v. fluids via the Hotline (n = 21) or Flotem IIe (n = 18) warmers. Intervention for core hypothermia [lower esophageal temperature (Teso) less than 35.5 degrees C], was with forced air warming. Intervention for postoperative shivering was with meperidine by a nurse who was blinded to the treatment group. MEASUREMENTS: Part 1. Temperature of infused fluids before and after the warmer (T in and T out) and before the fluid entered the patient after insertion of a standard 84 cm extension set having a stopcock for injection of medications (T distal). Part 2. Tympanic (Ttym) was recorded before induction of anesthesia (baseline) and at 15-minute intervals after induction. Teso was recorded at 15-minute intervals after induction. The maximum intraoperative Ttym decline from baseline (delta Ttym max) was calculated. MAIN RESULTS: Part 1. Flow rates were between 1 and 33 ml/min. T out and T distal (mean +/- SEM) of fluids infused through the Hotline device were warmer compared with those infused via the Flotem IIe device (Hotline T out: 35.7 +/- 0.1 degrees C and Hotline T distal: 33.4 +/- 0.2 degrees C vs. Flotem IIe T out: 28.9 +/- 0.2 degrees C and Flotem IIe T distal: 28.3 +/- 0.2 degrees C; p < 0.001 between warmers). Part 2. Maximal decrease in Ttym from preoperative baseline (before intervention) was greater in the Flotem IIe compared with the Hotline group (delta Ttym max = -1.4 +/- 0.1 vs. -0.9 +/- 0.1 degree C, p = 0.01). Five patients in the Flotem IIe group required forced air warming for treatment of hypothermia versus none in the Hotline group (p < 0.01). Postoperatively, five patients in the Flotem IIe group required treatment with meperidine for severe shivering versus one patient in the Hotline group (p < 0.05). CONCLUSIONS: The Hotline device delivered fluids to the patient at consistently warmer temperatures compared with the Flotem IIe device during actual clinical conditions. This was associated with maintenance of near normal core temperatures throughout the procedure in the Hotline group, and a decreased need for interventions such as forced-air warming and treatment for severe shivering.

Adult↗
PubMed1996

Comparison of esophageal, tympanic, and forehead skin temperatures in adult patients.

STUDY OBJECTIVE: To compare esophageal, tympanic membrane, and forehead skin temperatures in patients undergoing elective surgeries. DESIGN: Prospective clinical study. SETTING: Operating room and postanesthesia care unit of a tertiary care teaching hospital. PATIENTS: 40 adult ASA status I, II and III patients requiring anesthesia and surgery. INTERVENTION: Application of crystalline thermometry strips to the forehead of patients. MEASUREMENTS AND MAIN RESULTS: Concurrent forehead skin, tympanic membrane, and lower esophageal temperatures were measured and compared. The overall bias between esophageal and skin temperatures was 0.3 degrees C, between tympanic membrane and skin was 0.5 degrees C, and between esophageal and tympanic membrane was -0.1 degrees C The limits of agreement (precision) between esophageal and skin temperatures were: -1.64 degrees C to +2.32 degrees C, between esophageal and tympanic membrane were: -1.02 degrees C to +0.74, and between tympanic membrane and skin were: -1.48 degrees C to +2.52 degrees C. There was no significant relation between the change in skin temperature and change in esophageal temperature, whereas there was a weak linear relation between change in skin temperature and change in tympanic membrane temperature (y = -0.03 + 0.09, r = 0.12). CONCLUSION: There was a lack of precision between the clinically accepted measurements (lower esophageal and tympanic membranes and the skin temperature measurement. The data suggest that forehead skin temperature is not interchangeable with standard core temperature measurements, and that sole reliance on the forehead skin measurement in the perioperative setting could adversely affect patient care.

Adult↗
PubMed1996

Intra-observer and inter-observer variation in the histopathological assessment of chronic viral hepatitis.

BACKGROUND/AIMS: The way in which liver biopsies showing chronic hepatitis are reported is undergoing re-evaluation. A related question is how the inflammatory and fibrotic changes in these liver biopsies can be semi-quantitatively assessed so that comparisons can be made between groups of patients and the effect of treatment on disease progression studied. METHODS: We have carried out a blinded trial in which 20 cases of chronic viral hepatitis were assessed by five histopathologists, using the Knodell and Scheuer scoring systems (two of the most commonly used systems), on two separate occasions. The results were analysed using Kappa statistics, and also by seeing for how many slides the pathologists showed no significant disagreement. RESULTS: While both systems produced good inter- and intra-observer variation when fibrosis was assessed the Scheuer system produced slightly higher Kappa values. The Scheuer system produced considerably better agreement when the severity of inflammation was examined. A multirater kappa analysis confirmed that both systems showed better agreement for fibrosis scores than for inflammation scores. CONCLUSION: We conclude that, while both systems produced reasonable agreement, this was greater using the Scheuer system. When any new scoring system is being developed, the question of reproducibility needs active consideration.

Chronic Disease↗
PubMed1996

Intra-operative image guidance in otolaryngology--the use of the ISG viewing wand.

The ISG viewing wand is an intra-operative guidance system with a proprioceptive robotic-like jointed arm. It provides surgeons with almost instantaneously reconstructed computer-generated CT or MRI images in two or three dimensions and can correlate any point within the operative field to its corresponding locus on the reformatted scan images. In addition to having been used in over 400 neurosurgical patients in Bristol, 14 patients with skull-base, cerebello-pontine angle or temporal bone lesions have also undergone wand-guided resections. The wand has proved to be particularly useful in pre-operative planning, allowing minimally-invasive incisions, providing per-operative navigation, identifying the relationship and proximity of important anatomical structures and in assessing the extent of lesion resection. We illustrate the advantages of intra-operative image-guidance by discussing four cases. The potential applications of this form of imaging technology to other otolaryngological procedures are discussed.

Adult↗
PubMed1996

Simulated clinical evaluation of conventional and newer fluid-warming devices.

The purpose of the study was to evaluate the ability of five commercially available devices utilizing a variety of heat exchange technologies to deliver normothermic (37 degrees C) fluids. Conditions of slow (6.5 mL/ min), moderate (13-25 mL/min), and rapid (gravity and pressure driven flows, roller clamp wide open) infusion were simulated. Fluid temperatures were measured using rapid response thermistors after the fluid exited the heat exchanger (T outlet) and before delivery to the patient intravenously (IV) (T distal). Devices tested were the FW537, H1000, Hotline, BairHugger, and Flotem IIe. Fluids tested were crystalloid at room temperature and red cells diluted with saline (11-19 degrees C). At slow and moderate flows, T distal of crystalloid was between 35.3 and 37.9 degrees C for Hotline at 42 degrees C, 33.8 and 37.7 degrees C for H1000 at 42 degrees C, 29.4 and 34.2 degrees C for BairHugger, 26.1 and 31.5 for Flotem IIe, and 23.8 and 32.1 for FW537 at 42 degrees C. With gravity and pressure driven flows, T distal of crystalloid were 39.0 and 38.9 for H1000 at 42 degrees C, 38.7 and 38.4 degrees C for FW537 at 42 degrees C, 34.7 and 28.9 degrees C for Hotline at 42 degrees C, 29.2 and 24.2 degrees C for BairHugger, and 29.7 and 24.2 degrees C for Flotem. In conclusion, only the H1000 at 42 degrees C was effective at delivering normothermic fluids at all clinically relevant flow rates. The Hotline at 42 degrees C was effective at slow and moderate flow, whereas the FW537 was effective only at rapid flow.

Crystalloid Solutions↗
PubMed1996

Suture haemorrhoidectomy: a day-only alternative.

BACKGROUND: Haemorrhoidectomy is a common treatment for third degree symptomatic haemorrhoids, and day surgery has increased because of increasing pressure for hospital beds. The aim of the present study is to describe a technique of suture haemorrhoidectomy (SH), conducted as a day-only procedure, and compare the effectiveness and outcomes of this method with the conventional Milligan-Morgan haemorrhoidectomy (MMH). METHODS: The results of 18 consecutive patients, mean age 52 years (31-73) undergoing SH between April 1994 and June 1995 were compared with a historical control group of 17 consecutive patients, mean age 45 years (29-72), who had MMH in the preceding year. Seven patients were excluded because of intercurrent anal pathology (1), thrombosed haemorrhoids (1) or loss to follow-up (5). An interviewer followed up patients using a telephone questionnaire. RESULTS: Mean follow-up was 6 months in the SH group and 18 months in the MMH group. There was no significant difference in total operative time. The SH group had a significantly shorter mean time to first void of 3 h versus 11 h (P < 0.005), mean time to first bowel action of 11 h versus 48 h (P < 0.005) and mean in-hospital stay of 10 h versus 77 h (P < 0.005). The SH group had a significantly decreased linear analogue pain scale, a mean of 1 versus 3 (P < 0.05). The complications were: two readmissions for pain relief in the SH group and urinary retention in one MMH patient. None of the study group have had recurrence of haemorrhoids. CONCLUSION: Suture haemorrhoidectomy as a day-only procedure is safe, less painful and reduces in-hospital admission time. The long-term effectiveness and complications of the technique are as yet undetermined.

Adult↗
PubMed1996

Comparison of two cotside methods for the detection of hypoglycaemia among neonates in Nepal.

AIMS: To compare two cotside methods of blood glucose measurement (HemoCue and Reflolux II) against a standard laboratory method for the detection of neonatal hypoglycaemia in a developing country maternity hospital where hypoglycaemia is common. METHODS: 94 newborn infants and 75 of their mothers had blood glucose assessed on the same venous sample using three different methods in the Special Care Baby Unit and postnatal wards, Prasuti Griha Maternity Hospital, Kathmandu, Nepal: HemoCue and Reflolux II at the cotside; Roche Ultimate glucose oxidase method (GOM) in the laboratory. RESULTS: The mean (SD) values for blood glucose in newborn infants were GOM 2.5 (1.1) mmol/l; Reflolux II 2.1 (0.9); and HemoCue 4.2 (1.2). For mothers the values were GOM 5.3 (1.2) mmol/l; Reflolux II 3.6 (1.2); and HemoCue 5.6 (1.0). Bland-Altman plots showed that Reflolux II consistently underreads GOM blood glucose in neonates by 0.5 mmol/l (SD 0.7) and that HemoCue overreads glucose by 1.7 mmol/l (SD 0.8). For the detection of hypoglycaemia (< 2.0 mmol/l), Reflolux II achieved a sensitivity of 83%, a specificity of 62%, and a likelihood ratio of 2.2. HemoCue produced a sensitivity of 0% and a specificity of 100% using measured values. If 2.0 mmol were subtracted from all Hemocue values this rose to 81% and 68% and a likelihood ratio of 2.5. CONCLUSION: Although more accurate than Reflolux II for the measurement of blood glucose in mothers, HemoCue overreads glucose concentrations in neonates and is therefore potentially dangerous as a screening method for neonatal hypoglycaemia. Reflolux II is useful as a screening method for high risk infants (low birthweight, post-term) and could achieve a post-test probability of detecting hypoglycaemia in a high risk setting like Nepal of 50-60%.

Adult↗
PubMed1996

Is an elevated level of serum lipoprotein (a) a risk factor for cardiovascular disease in CAPD patients?

Cardiovascular disease (CVD) is the single most important cause of mortality in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. An increased lipoprotein (a) [Lp(a)] level in HD patients is associated with CVD. However, Lp(a) levels in CAPD patients are controversial, and their association with CVD has not been established. In the present study, prevalent CAPD and HD patients [excluding those who were human immunodeficiency virus (HIV)-positive] attending the Long Island College Hospital from June, 1990 to July, 1995 underwent analysis of lipid profile including Lp(a). Total and low-density lipoprotein cholesterol, triglycerides, apolipoprotein (apo) A, and apo B were all significantly increased in CAPD patients compared to HD patients. Serum Lp(a) levels were also significantly higher in CAPD patients than in HD patients (51 +/- 32 vs 34 +/- 23 mg/dL, p < 0.001). CAPD patients who had a history of myocardial infarction (MI) or coronary artery disease (CAD) at enrollment had significantly higher Lp(a) levels compared to those who did not have a history of MI or CAD. CAPD patients who died of CVD had higher Lp(a) levels than patients who died of non-CVD causes. In the Cox model with backward stepwise selection, a history of CVD was associated with a significantly elevated relative risk (RR) of mortality (RR = 1.84, p = 0.014). Expected survival by all causes of mortality and by cardiac mortality was significantly shorter in patients with a history of CVD than in those without a history of CVD. Thus, elevated Lp(a) is related to increased CVD and therefore may contribute to increased mortality in CAPD patients.

Adult↗