Using simulation to train residents in managing critical events.
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Biomedical subjects
Publications and source records attributed to R M Patel.
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Pseudomonas aeruginosa GS3 produced rhamnolipid biosurfactants during growth on carbohydrates, higher chain length n-alkanes and l-alkenes, petroleum crude oil and vegetable oils. With glucose as the substrate, maximum surfactant production (0.44 g/l) was observed during the stationary phase of growth. Partially purified rhamnolipids showed excellent surface-active properties in terms of reduction in the interfacial tension between them and a variety of hydrocarbons, hydrocarbon mixtures and vegetable oils and formation of stable emulsion.
Regulatory requirements for modifications to an approved innovator metered dose inhaler (pressurized MDI; USP nomenclature: inhalation aerosol) and for development of a new generic product are discussed. Although many of the requirements apply generally to MDI's, they are discussed with specific reference to albuterol. Changes to the container and closure system may impact on the dosimetry of the redesigned product, as well as upon toxicologic and chemistry, manufacturing and controls (CMC) concerns. Changes to the formulation, including the use of alternate propellants, may raise issues requiring both clinical and in vivo performance evaluation. In view of the level of interest of a number of firms in approval requirements for generic Albuterol Inhalation Aerosol products, the article discusses in considerable detail the CMC and bioequivalence requirements for a generic product. Similarities in the CMC requirements for innovator and generic products are evident. Three comparative in vivo bioequivalence tests, particle size distribution, spray pattern and plume geometry, and unit spray content, established by the Division of Bioequivalence are discussed. Similarities and differences in the in vivo requirements for innovator and generic products are evident. Differences are the result of U.S. statute, which requires safety and efficacy testing for a product approved under a new drug application (NDA), but documentation of bioequivalence for a product approved under an abbreviated new drug application (ANDA). The advantages and disadvantages of three pharmacodynamic study designs which have potential usefulness for documentation of in vivo bioequivalence are discussed.
In a purely clinical, unbiased study, 50 patients with verrucae plana were treated with dinitrochlorobenzene for 1-24 weeks, keeping half the lesions as controls. The results were statistically insignificant when the treated patients were compared to the control group.
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We describe a 62-year-old man with diabetes mellitus and peripheral vascular insufficiency, with an ulcer on his foot which led to staphylococcal septicemia, endocarditis, and disseminated intravascular coagulation. All these factors contributed to thromboembolic occlusion of the terminal arteries and veins supplying the stomach, causing gastric infarction.
A 51-year-old white man with chronic diarrhea, generalized weakness, and a 70-lb. weight loss in 6 months developed small-bowel obstruction while undergoing investigation in the hospital. At laparotomy, an edematous, thickened mid-portion of small bowel matted between large lymph nodes, involved by characteristics of Whipple's disease, seemed to be responsible for the small-bowel obstruction.
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Two cases of granular cell tumor of the esophagus are reported and the main features of the previously reported cases are summarized. Dysphagia and substernal discomfort or pain are the most common symptoms seen and are likely to occur with lesions greater than 1 cm. in diameter. The diagnosis should be considered in adult females with an intramural mass of the esophagus. The cell of origin is still disputed. The treatment of choice, when the patient is symptomatic or the lesion greater than 1 cm. in size, is local resection. The tumor, when incidentally discovered in an asymptomatic patient, may safely be followed endoscopically.
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