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Biomedical subjects

R Madhok

Publications and source records attributed to R Madhok.

At least 55 records · Page 3Linked to original sources
PubMed1999

Modification of the GeneScan 2500 fluorescent dye standard for accurate product sizing.

This article describes a procedure for modification of the commercially prepared GeneScan 2500 size standard for allelotyping with large DNA fragments such as variable number tandem repeats (VNTRs). Here a procedure was used to adapt commercially available size standards for the sizing of the interleukin-6 (IL6) 3'VNTR, which has allele sizes ranging from 600 to 900 base pairs. The procedure involves inclusion of products from the target PCR reaction as additional size standards for use with the size standard and is therefore applicable to the sizing of any product with any commercial size standard. Initially alleles were sized by fluorescent cycle sequencing to give a true estimate of their size (base pairs). Subsequently, the major alleles were labeled with a pig-tailed ROX-dye-labeled primer and inserted into the standard range. Finally alleles were resized following PCR with an un-pig-tailed HEX labeled primer and the modified standard. Once the size standard is modified, stocks can be stored indefinitely and replenished by re-PCR of selected alleles using the ROX-labeled primer. Modification of this approach can be applied to the sizing of any product where it is thought that commercially available size standards are performing suboptimally. Modification of size standards in this way does not affect performance in size regions other than those for which the extra products are included.

Alleles↗
PubMed1999

Translating research into practice: a personal case study.

Although much will change in the National Health Service as a result of the publication of the new White Paper, The new NHS: modern, dependable, the challenges of translating research into practice and ensuring evidence-based policy and practice will remain. This case study demonstrates some of the challenges and has important lessons for the future practice of public health medicine.

Absorptiometry, Photon↗
PubMed1999

Genotyping for disease associated HLA DR beta 1 alleles and the need for early joint surgery in rheumatoid arthritis: a quantitative evaluation.

OBJECTIVE: To determine the value of HLA DR beta 1 disease associated epitope (DAE) and erythrocyte sedimentation (ESR) in predicting the need for major joint replacement in rheumatoid arthritis (RA). METHODS: Sixty five RA patients who had undergone hip, knee or shoulder arthroplasty within 15 years of disease onset and 65 who had not. HLA DR beta 1 genotype was determined by polymerase chain reaction. ESR at first hospital visit was noted. RESULTS: Significantly more patients with two DAE required surgery, (32% v 9%), chi 2 = 13.9, p = 0.001, odds ratio = 5.4 (95% CI: 1.8, 16). Sensitivity was poor, 32%, specificity high, 91%. Presentation ESR was higher in surgery patients compared with non-surgery patients, 52 mm 1st h v 25 mm 1st h, p < 0.001, but was independent of DAE status. Sensitivity of an ESR of 30 mm 1st h was 75%, specificity 53%. CONCLUSION: The presence of two DAE is a risk factor for major joint surgery in RA and is independent of ESR, whereas in those with one or no DAE, a high ESR is an important predictor.

Aged↗
PubMed1999

Does social disadvantage contribute to the excess mortality in rheumatoid arthritis patients?

BACKGROUND: Socioeconomic deprivation is associated with increased mortality from cardiovascular causes and malignancy. The influence of disadvantage in patients with rheumatoid arthritis (RA), who are known to have premature mortality, has not been ascertained. AIM: To assess the relation between the level of patient deprivation and mortality in RA patients. METHODS: 200 RA patients, enrolled in a study comparing sulfasalazine and penicillamine in 1984-85, have been followed up prospectively for 12 years. Subjects were categorised into Carstairs groups with deprivation scores ranging from 1 (most affluent) to 7 (most deprived). Information about deaths was obtained from the Registrar General in Scotland, death certificates and GP/hospital records. RESULTS: There were more RA patients in the deprived areas then expected compared with the West of Scotland and England and Wales. Some 47.5% of the RA patients had died by 12 years-the majority of cardiorespiratory causes or malignancy. There were no differences in the median age or disease duration in the various Carstairs groups at study entry, but the percentage of deaths was higher in the more deprived groups after 12 years (36% dead in most affluent area compared with 61% in the most deprived, that is, in groups 6 and 7). CONCLUSION: In patients with RA increasing deprivation was associated with premature mortality. If confirmed elsewhere these findings have implications for rheumatological management strategies, for researchers involved in collaborative studies of patients from different socioeconomic backgrounds and for resource allocation.

Adult↗
PubMed1998

The acute effects of prostacyclin on pulmonary hemodynamics in patients with pulmonary hypertension secondary to systemic sclerosis.

OBJECTIVE: To determine whether patients with isolated pulmonary hypertension secondary to systemic sclerosis (SSc) have a pulmonary vasculature that is responsive to treatment with vasodilators. METHODS: Seven SSc patients with pulmonary hypertension underwent right heart catheterization. Pulmonary pressures and cardiac output were measured before and during a systemic intravenous infusion of prostacyclin. RESULTS: Both pulmonary arterial mean pressure and pulmonary vascular resistance decreased significantly with prostacyclin infusion (median decrease 11% and 32%, respectively), with a concomitant increase in cardiac output (median increase 26%). No adverse hemodynamic effects were noted during the infusion. CONCLUSION: Vasospasm contributes to the pulmonary hypertension complicating SSc. This feature may be amenable to treatment with vasodilators.

Adult↗
PubMed1998

Satisfaction with health services among the Pakistani population in Middlesbrough, England.

BACKGROUND: Little is known about the quality of the health care available to ethnic minority groups. In the absence of empirical data, the National Health Service (NHS) is often criticized for failing to meet their needs. We assessed whether the Pakistani population in Middlesbrough used, and was satisfied with, a range of health services. METHODS: This was a cross-sectional survey of an age, sex and socio-economically stratified sample of Pakistani people. Data were collected by interview in the home. RESULTS: Satisfaction among those who had used NHS services was high. For example, 94 per cent were satisfied with general practitioner (GP) care, 93 per cent with help from the GP receptionist, and 97 per cent with the care from hospital doctors. The most dissatisfaction was with casualty, and accident and emergency services (19 per cent), the care received from the nurses in hospital, and with information given about the condition or treatment (both 12 per cent). When services were not used, lack of knowledge or need, not dissatisfaction, was the dominant problem. Of 34 hospital patients, 19 were informed about 'Asian' meals. Sixty-five per cent (11 of 17) of those who had such meals were satisfied. Dissatisfaction was mainly because of taste and quality of food. Only three of 63 (5 per cent) hospital in- or out-patients were informed of the availability of a professional interpreter, and none used the service. Fifteen (four men and 11 women; 25 per cent) said they would have used the interpreting service if they had known of it. CONCLUSIONS: Pakistani patients reported surprisingly high levels of satisfaction with health services. Policies on culturally sensitive meals and interpretation services, however, were not properly implemented. Locally, the findings are encouraging. Nationally, the message is that high levels of satisfaction with services among ethnic minority groups are potentially achievable.

Adolescent↗