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Biomedical subjects

R Abboud

Publications and source records attributed to R Abboud.

At least 19 recordsLinked to original sources
PubMed2006

Dorsal capsulodesis for scapholunate instability--effect on patient disability and wrist pain.

Twenty cases of scapho-lunate instability have been reviewed, to determine the effect of dorsal capsulodesis on disability and wrist pain. The average follow-up was 41 (range 13-63) months. There was a significant improvement in the pre-operative Patient Rated Wrist Evaluation score from 108 (range 18-150) to a postoperative score of 60 (range 0-132). All wrist movements and grip strength were reduced postoperatively but only the reductions in flexion and radial deviation were statistically significant. Seventeen (85%) patients were satisfied with the operation. One patient remained unemployed after surgery. Five patients returned to their normal jobs. This study shows that dorsal capsulodesis should remain an important option in the treatment of scapholunate instability.

Adolescent↗
PubMed2001

Trends in cardiogenic shock: report from the SHOCK Study. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?

AIMS: We analysed time trends in patient characteristics, management, and outcomes of cardiogenic shock complicating acute myocardial infarction in the international, prospective SHOCK Trial Registry and pre-study Registry. BACKGROUND: Despite therapeutic advances in its management, the incidence and high mortality of this complication has remained unchanged for decades. However, in recent years mortality was reported to decrease in one community concomitant with increasing use of revascularization. METHODS: Thirty-six centres registered 1380 patients with suspected cardiogenic shock complicating acute myocardial infarction from January 1992 to August 1997. Patient and myocardial infarction characteristics, haemodynamics, medications, procedure use, and vital status at discharge were recorded. RESULTS: In all, 79% of patients had shock due to predominant pump failure (non-mechanical aetiology). The aetiology, patient profile, and clinical characteristics of cardiogenic shock did not differ over time, except for increases in the incidence of prior bypass surgery (P=0.054) and transfers to tertiary centres (P=0.008). In all, 44% underwent revascularization (n=485), with angioplasty performed more often than bypass surgery (69% vs 31%). The revascularization rate increased over time (P=0.006) with a significant decrease in the time to revascularization (P=0.033). The use of Swan-Ganz catheterization decreased over time (P=0.018), as did the mean length of hospitalization (P=0.034). Overall in-hospital mortality was high (63%) but decreased over time in all patients (P=0.004) and those with pump failure (P=0.018). Mortality was lower for patients who underwent revascularization compared to those who were not revascularized (41% vs 79%, P<0.001). CONCLUSIONS: Cardiogenic shock complicating acute myocardial infarction is associated with a high mortality rate, but mortality decreased significantly from 1992 to 1997. This partly reflects the greater use of revascularization, which was associated with better outcomes. The reported international trend towards shorter admissions for myocardial infarction was also observed in this cohort.

Adult↗
PubMed2000

Outcome and profile of ventricular septal rupture with cardiogenic shock after myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK?

OBJECTIVES: We wished to assess the profile and outcomes of patients with ventricular septal rupture (VSR) in the setting of cardiogenic shock (CS) complicating acute myocardial infarction (MI). BACKGROUND: Cardiogenic shock is often seen with VSR complicating acute MI. Despite surgical therapy, mortality in such patients is high. METHODS: We analyzed 939 patients enrolled in the SHOCK Trial Registry of CS in acute infarction, comparing 55 patients whose shock was associated with VSR with 884 patients who had predominant left ventricular failure. RESULTS: Rupture occurred a median 16 h after infarction. Patients with VSR tended to be older (p = 0.053), were more often female (p = 0.002) and less often had previous infarction (p < 0.001), diabetes mellitus (p = 0.015) or smoking history (p = 0.033). They also underwent right-heart catheterization, intra-aortic balloon pumping and bypass surgery significantly more often. Although patients with rupture had less severe coronary disease, their in-hospital mortality was higher (87% vs. 61%, p < 0.001). Surgical repair was performed in 31 patients with rupture (21 had concomitant bypass surgery); 6 (19%) survived. Of the 24 patients managed medically, only 1 survived. CONCLUSIONS: There is a high in-hospital mortality rate when CS develops as a result of VSR. Ventricular septal rupture may occur early after infarction, and women and the elderly may be more susceptible. Although the prognosis is poor, surgery remains the best therapeutic option in this setting.

Aged↗
PubMed2000

Maternal and infant factors predicting disease progression in human immunodeficiency virus type 1-infected infants. Women and Infants Transmission Study Group.

BACKGROUND: Infants with perinatally acquired human immunodeficiency virus type 1 (HIV-1) infection have widely variable courses. Previous studies showed that a number of maternal and infant factors, when analyzed separately, are associated with infant HIV-1 disease progression. In this study, clincal, virologic, and immunologic characteristics in the mothers and infants were examined together to determine the predictors of disease progression by 18 months of age and the associations with rapid progression during the first 6 months of life. METHODS: One hundred twenty-two HIV-1-infected women whose infants were HIV-1 infected were identified from the Women and Infants Transmission Study (WITS) cohort. WITS is a longitudinal natural history study of perinatal HIV-1 infection carried out in 6 sites in the continental United States and in Puerto Rico. The women were enrolled during pregnancy and their infants were enrolled at the time of delivery and followed prospectively by a standardized protocol. Virologic and immunologic studies were performed in laboratories certified by National Institutes of Health-sponsored quality assurance programs. Maternal factors in pregnancy were used as potential predictors of infant disease progression (progression to Centers for Disease Control and Prevention [CDC] Clinical Class C disease or death by 18 months of age) or as correlates of progression at <6 months of age. Infant factors defined during the first 6 months of life were used as potential predictors of progression during 6 to 18 months of age and as correlates of progression at <6 months of age. RESULTS: Progression by 18 months of age occurred in 32% of infants and by 6 months of age in 15%. Maternal characteristics that, by univariate analysis, were significant predictors of infant disease progression by 18 months of age were elevated viral load, depressed CD4(+)%, and depressed vitamin A. CD8(+)%, CD8(+) activation markers, zidovudine (ZDV) use, hard drug use, and gestational age at delivery were not. When examined in a combined multivariate analysis of maternal characteristics, only vitamin A concentration independently predicted infant progression. Infant characteristics during the first 6 months of life that, by univariate analysis, were associated with disease progression included elevated mean viral load at 1 to 6 months of age, depressed CD4(+)%, CDC Clinical Disease Category B, and growth delay. Early HIV-1 culture positivity (<48 hours), CD8(+)%, CD8(+) activation markers, and ZDV use during the first month of life did not predict progression. Multivariate analysis of infant characteristics showed that the only independent predictors were progression to CDC Category B by 6 months of age (odds ratio [OR], 5.80) and mean viral load from 1 to 6 months of age (OR, 1.99). The final combined maternal and infant analysis included the significant maternal and infant characteristics in a multivariate analysis. It showed that factors independently predicting infant progression by 18 months of age were progression to CDC Category B by 6 months of age (OR, 5.80) and elevated mean HIV-1 RNA copy number at 1 to 6 months of age (OR, 1.99). The characteristics associated with rapid progression to CDC Category C disease or death by 6 months of age were also examined. The only maternal characteristic associated with progression by 6 months in multivariate analysis was low maternal CD4(+)%. The infant characteristics associated with progression by 6 months of age in multivariate analysis were depressed mean CD4(+)% from birth through 2 months and the presence of lymphadenopathy, hepatomegaly, or splenomegaly by 3 months. Infant ZDV use was not assocciated with rapid progression. CONCLUSION: The strongest predictors of progression by 18 months are the presence of moderate clinical symptoms and elevated RNA copy number in the infants in the first 6 months of life. In contrast, progression by 6 months is associated with maternal and infant immun

Analysis of Variance↗
PubMed1999

Obstetric and newborn outcomes in a cohort of HIV-infected pregnant women: a report of the women and infants transmission study.

OBJECTIVE: To determine obstetric and neonatal outcomes in a cohort of HIV-infected pregnant women and to assess whether HIV-related immunosuppression increases the risk of adverse outcomes of pregnancy. METHODS: Between 1989 and 1994, interview, physical examination, laboratory, and medical record data were prospectively collected from HIV-infected pregnant women and on their newborns. Factors associated with adverse pregnancy outcome and HIV disease status were correlated with pregnancy outcome using logistic regression analysis. RESULTS: 634 women delivered after 24 weeks of gestation. Preterm birth, low birth weight, and small-for-gestational-age neonates occurred in 20.5%, 18.9%, and 24.0% of pregnancies, respectively. Factors associated with low birth weight were CD4 percentage <14%, history of adverse pregnancy outcome, pediatric HIV infection, bleeding during pregnancy, and Trichomonas infection. Preterm birth was associated with CD4 percentage <14%, a history of adverse pregnancy outcome, and bleeding during pregnancy. Being small for gestational age was associated with maternal hard drug use during pregnancy, Trichomonas infection, history of adverse pregnancy outcome, and hypertension. CONCLUSIONS: Adverse pregnancy outcomes are common for HIV-infected women and are associated with low maternal CD4 percentage and pediatric HIV infection. Preterm birth, low birth weight, and small-for-gestational-age ranking, however, are also associated with previously recognized sociodemographic and obstetric factors that are not unique to HIV infection.

Adult↗
PubMed1999

Airway inflammation, exhaled nitric oxide, and severity of asthma in patients with western red cedar asthma.

Examination of induced sputum and measurement of exhaled NO have been advocated as noninvasive methods of assessing the degree of airway inflammation. In this study, we performed follow-up evaluation on 71 subjects with asthma caused by exposure to Western red cedar; 50 subjects had left exposure, whereas the rest continued to work in the same job. Spirometry, methacholine challenge tests, exhaled nitric oxide, and sputum induction were carried out. Of the 50 subjects who left exposure, 12 had no respiratory impairment according to the American Throacic Society guidelines for assessing respiratory impairment in patients with asthma, 17 belonged to Class 1, 12 to Class 2, five to Class 3, and four to Class 4. The percentage of eosinophils in induced sputum showed a significant inverse relationship with FEV1 (r = -0.46, p < 0.001), and a significant positive correlation with levels of exhaled NO (r = 0.42, p < 0.001) and with the class of respiratory impairment (r = 0.52, p < 0.001). Mean percent eosinophils were 1.5 for impairment Class 0, 2.2 for Class 1, 1.7 for Class 2, 6.8 for Class 3, and 16.3 for Class 4. No relationship was found between the levels of exhaled NO and the functional parameters as well as the impairment class. NO levels in ppb were 21 for impairment Class 0, 30 for Class 1, 22 for Class 2, 26 for Class 3, and 49 for Class 4. This study also provides objective evidence that airway inflammation, as indicated by induced sputum, corroborates the rating of respiratory impairment in patients with asthma.

Adult↗
PubMed1998

Encephalopathy and progression of human immunodeficiency virus disease in a cohort of children with perinatally acquired human immunodeficiency virus infection. Women and Infants Transmission Study Group.

OBJECTIVE: To describe the incidence, predictors, and survival of children with human immunodeficiency virus (HIV) encephalopathy followed in the Women and Infants Transmission Study cohort. STUDY DESIGN: Retrospective review of clinical and immunologic staging of perinatally HIV-infected infants, based on the 1994 Centers for Disease Control and Prevention Classification System. RESULTS: Data were available for 128 HIV-infected children, with a median follow-up of 24 months. HIV encephalopathy was diagnosed in 27 (21%) of children. Median survival after diagnosis was 14 months. Of children with encephalopathy, 74% had at least moderate immunosuppression by the time of diagnosis. Encephalopathy represented the first acquired immunodeficiency syndrome-defining condition in 67%, and the only one in 26% of children. Hepatosplenomegaly or lymphadenopathy during the first 3 months of life was diagnosed in 63%, in contrast to 29% of those without encephalopathy (p value = 0.001). Cardiomyopathy was present in 30% of the children with encephalopathy versus 2% of those without encephalopathy. High viral load in infancy was associated with increased risk of encephalopathy but was not predictive of age at onset. CONCLUSIONS: Encephalopathy in children with HIV is common and is associated with high viral load, immunodeficiency, and shortened survival. Encephalopathy was more likely to develop in infants with early signs and symptoms of HIV, although age at onset could not be predicted.

AIDS Dementia Complex↗
PubMed1997

Laboratory and clinical evaluation of a portable computerized peak flow meter.

A mini-Wright based peak flow meter (VMX Mini-Log), which stores the readings together with the time and date of each measurement, has recently been marketed but has not yet been evaluated. The accuracy, reproducibility, and interdevice variability of this instrument were investigated using a pneumotachograph connected in series as a standard. Flows from 100 to 700 L/min were generated by an explosive decompression chamber. The performance of this instrument was also tested in 20 normal subjects and in 20 patients with airflow obstruction. The accuracy of the instrument was expressed as the percentage of error, and reproducibility and interdevice variability were assessed using the coefficient of variation. In the laboratory evaluation, all devices recorded flow rates that were within +/-10% of the pneumotachograph readings at flows between 200 and 600 L/min. At the extreme flow rates of 100 and 700 L/min, the mean error was higher than 10%. The reproducibility of the VMX was within +/-5% at all the flows tested. The interdevice variability was less than 5% at flow rates between 200 and 700 L/min. When tested on normal subjects with PEF between 400 and 700 L/min, the VMX performed well. In patients with airflow obstruction, four devices had greater than 10% error. The largest error was observed in those patients with PEF below 200 L/min. The VMX Mini-Log peak flow meter is accurate and precise in the flow range between 200 and 600 L/min. Its performance, however, may be affected in subjects with airflow obstruction and PEF below 200 L/min.

Adolescent↗
PubMed1995

[2 cases of isolated tricuspid endocarditis following colonic intervention].

We report two cases of tricuspid valve endocarditis with related organisms (Enterococcus faecalis and Gemella morbillorum), some months after colonic operation. This association, without preexistent valvular pathology and without any other classical aetiology of tricuspid endocarditis, has only exceptionally been described.

Aged↗
PubMed1992

Evaluation of cardiac output by thoracic electrical bioimpedance during exercise in normal subjects.

We compared cardiac output determined simultaneously by two methods, the CO2 rebreathing technique and the thoracic electrical bioimpedance method (Bomed NCCOM-3 equipment). The studies were performed in duplicate in 11 healthy male subjects at rest and during three levels of steady-state exercise on a cycle ergometer at 60, 120, and 180 W. Cardiac output at 60 and 120 W was slightly lower (p less than 0.01) by the thoracic impedance method (12.2 +/- SE 2.2 and 15.7 +/- SE 3.5 L/min, respectively) than by the CO2 rebreathing method (14.0 +/- SE 2.1 and 17.9 +/- SE 3.0 L/min, respectively), suggesting a systematic bias between the two methods of measurement. However, if allowance is made for that bias, there would be acceptable agreement between the two methods at 60 and 120 W. Although the results were not significantly different between the two methods at rest and at 180 W, there was no acceptable agreement between the two methods probably because the CO2 rebreathing method at rest was more liable to show error due to the small arteriovenous CO2 difference, while the impedance method was less reliable at 180 W. Cardiac output by both methods correlated with O2 consumption, with the correlation being higher for cardiac output by the rebreathing method (r = 0.94) than for thoracic impedance (r = 0.88). The results suggest that the thoracic electrical bioimpedance method can be used for determination of cardiac output during mild or moderate levels of exercise in normal subjects.

Adult↗
PubMed1989

Sarcoidosis: correlation of extent of disease at CT with clinical, functional, and radiographic findings.

Computed tomography (CT) was compared with chest radiography in the assessment of disease severity in 27 patients with sarcoidosis. The CT scans and radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by visual scoring (0%-100% involvement of the lung parenchyma) and on radiographs by using an adaptation of the International Labour Office classification. The severity of parenchymal changes on the CT scan and on the radiograph was significantly correlated with the severity of dyspnea (r = .61 and .58, respectively; P less than .001), diffusing capacity (r = -.62 and -.52, P less than .01), and vital capacity (r = -.49 and -.51, P less than .01). Patients with predominantly irregular opacities had more severe dyspnea and lower lung volumes than patients with predominantly nodular opacities (P less than .05). The authors conclude that in patients with sarcoidosis, the radiographic and CT assessments of disease severity show similar correlation with clinical and functional impairment.

Adult↗
PubMed1988

Peripheral leucocyte count and longitudinal decline in lung function.

A six year follow up study of 750 aluminium smelter workers was undertaken to evaluate the relationship between the leucocyte count at the start of the study and the rate of decline in lung function. An inverse relationship between the leucocyte count and the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was present cross sectionally irrespective of cigarette smoking habit. The initial leucocyte count was also significantly related to the mean annual decline in FEV1 in smokers (p = 0.04) but not in former smokers or those who had never smoked. These observations suggest that the leucocyte count is a factor influencing the annual decline in FEV1 in smokers.

Adult↗
PubMed1987

Nebulized anticholinergic and sympathomimetic treatment of asthma and chronic obstructive airways disease in the emergency room.

The effectiveness of nebulized anticholinergic and sympathomimetic regimens was evaluated in a double-blind study of 199 patients with acute airways obstruction. Patients were assigned to one of three treatment regimens according to a randomized schedule: 0.5 mg of ipratropium bromide, 1.25 mg of fenoterol hydrobromide, and 0.5 mg of ipratropium plus 1.25 mg of fenoterol. In 148 patients with acute exacerbations of asthma (mean one-second forced expiratory volume, 1.18 +/- 0.64 liters), all three regimens produced significant improvement in one-second forced expiratory volume (p less than 0.001). The greatest improvement followed treatment with the ipratropium-fenoterol combination (0.53 +/- 0.40 liters at 45 minutes; 0.57 +/- 0.51 liters at 90 minutes) and was significantly greater than that following either ipratropium alone (p less than 0.001) or fenoterol alone (p less than 0.05). In 51 patients with acute exacerbations of chronic obstructive pulmonary disease (mean one-second forced expiratory volume, 0.67 +/- 0.29 liter), each regimen produced significant improvement in one-second forced expiratory volume at both 45 and 90 minutes (for all, p less than 0.05), but there was no significant difference among the three treatment regimens. It is concluded that, in patients with acute asthma, combination therapy with sympathomimetic and anticholinergic agents is more efficacious than either one alone. In patients with acute exacerbations of chronic obstructive pulmonary disease, although either sympathomimetic or anticholinergic therapy provides bronchodilatation, no further benefit could be demonstrated from combination therapy.

Administration, Intranasal↗
PubMed1987

Usual interstitial pneumonia: correlation of CT with clinical, functional, and radiologic findings.

Correlation between disease extent on computed tomographic (CT) scans and severity of clinical and functional impairment was obtained in 23 patients with usual interstitial pneumonia (UIP) by review of the clinical data, pulmonary function tests, chest radiographs, and CT scans. The CT scans and chest radiographs were each read twice by two independent observers. Disease extent was assessed on CT scans by a visual score (0%-100% involvement of the lung parenchyma) and on the radiograph by the International Labour Office classification. There was good intraobserver and interobserver agreement for both CT and radiograph scores (all r greater than or equal to .71). CT scans gave a better estimate of disease extent and showed more extensive honeycombing than did the radiograph. A significant correlation was found between the extent of disease as assessed with CT and the severity of dyspnea (r = .62, P less than .001), as well as between CT and impairment in gas exchange as assessed by the diffusing capacity (r = .64, P less than .001). There was poor correlation between disease severity as assessed with chest radiography and the clinical and functional variables (all r less than or equal to .39).

Adult↗
PubMed1980

Interrelationships between serum chemotactic factor inactivator, alpha 1-antitrypsin deficiency, and chronic obstructive lung disease.

Serum chemotactic factor inactivator (CFI) activity was quantitated in 22 subjects with chronic airflow obstruction (CAO); 8 had normal antitrypsin levels (Pi M phenotype), 6 had intermediate antitrypsin deficiency (Pi MZ phenotype), and 8 had severe antitrypsin deficiency (Pi Z phenotype). We studied 19 healthy subjects with normal lung function as controls; 3 had Pi M and 6 had Pi MZ phenotypes. Subjects with CAO, irrespective of the alpha 1-antitrypsin (AAT) phenotype, had significantly lower CFI activity than the normal subjects; the lowest levels were found in those with CAO and Pi Z phenotype. Normal subjects with intermediate AAT deficiency and MZ phenotype had normal levels of CFI. The results suggest that deficiency of serum CFI may be important in the pathogenesis of chronic airflow obstruction, particularly in those with severe AAT deficiency.

Adult↗
PubMed1976

Effect of helium on maximal expiratory flow in patients with asthma before and during induced bronchoconstriction.

The effect of breathing helium on maximal expiratory flow at 50 per cent of vital capacity (V50) was studied in 27 patients with asthma during remission and during induced bronchoconstriction. Nine patients gave a history of asthma induced by exercise; two had asthma due to timothy pollen allergy, and the remaining 16 had asthma due to exposure to western red cedar. Bronchoconstriction was induced by exercise in 10 patients, timothy pollen in 4 patients, methacholine in 4 patients, and red cedar in 16 patients. During remission, the increase in V50 with helium (deltaV50He) was greater than 20 per cent in 22 patients who were classified as responders; deltaV50He was less than 20 per cent in the remaining 5 patients, who were classified as nonresponders. There was a significant correlation between the severity of airway obstruction as measured by V50 and the response to helium, both during remission and during induced bronchoconstriction; however, there was no correlation between helium response and specific airway conductance. In general, patients who were responders during remission remained responders during induced bronchoconstriction, and nonresponders remained nonresponders, regardless of the method of challenge or the type of reaction (immediate verus late). There were a few exceptions in which a responder became a nonresponder during severe bronchoconstriction. The results of this study suggest that in most patients with asthma, the site of airway obstruction is likely to be in the large airways and, in most cases, remains constant in an individual asthmatic; however, an asthmatic who is a helium responder may become a nonresponder during severe bronchoconstriction.

Adult↗
PubMed1976

Occupational asthma due to California red wood (Sequoia sempervirens) dusts.

Two patients with occupational asthma due to California redwood (Sequoia sempervirens) sawdust are described. They developed specific immediate and late asthmatic reactions after occupational-type exposure tests to this wood dust. In one patient the immediate asthmatic reaction was inhibited by pretreatment with disodium cromoglycate and atropine; however, the late asthmatic reaction was only partially inhibited by disodium cromoglycate and was not affected by atropine. Low molecular weight chemical compounds present in the redwood may be responsible for the symptoms.

Asthma↗