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Biomedical subjects

R Madhok

Publications and source records attributed to R Madhok.

At least 109 records · Page 6Linked to original sources
PubMed1994

Orthopaedic outpatient referral guidelines: experience in an English health district.

The suggestion that outpatient referral guidelines may improve patient care in orthopaedic surgery prompted this study in the South Tees Health District. In a postal questionnaire survey of all general practices (n = 48, response rate = 81%) 18 (46%) general practitioners (GPs) perceived guidelines to be helpful. Back pain in the young and middle aged was the most commonly mentioned subject. General practitioners wanted locally developed guidelines (78%), formulated with their participation mainly via the local medical committee (56%), to be distributed by post (89%) and at a special seminar (72%). Subsequent discussions in a multidisciplinary group led to three initiatives: a back pain clinic conducted by a physiotherapist or a trained nurse where all patients could be screened quickly, a policy of open access to physiotherapy for all GPs and special educational seminars on management of back pain. This case study provides valuable perspectives on outpatient referral guidelines in orthopaedic surgery in an English health district. The findings may apply equally to other subjects in other settings.

Adolescent↗
PubMed1994

Production of interleukin-6 by monocytes isolated from rheumatoid arthritis patients receiving second-line drug therapy.

IL-6 production by peripheral blood monocytes isolated from RA patients receiving the second-line drugs auranofin (AUR), sulphasalazine (SASP) or gold sodium aurothiomalate (GST) was investigated. In patients receiving AUR a significant reduction in both basal and lipopolysaccharide (LPS) stimulated IL-6 production by isolated cells was observed. Similarly, SASP significantly reduced basal IL-6 production. In contrast, monocytes isolated from individuals receiving GST had no significant change either in basal or LPS stimulated IL-6 production. We suggest an effect by AUR and SASP either on pre-monocytic cells in the bone marrow or on monocytes in the periphery may subsequently result in a reduction in IL-6 production by these cells once they have infiltrated the RA joint. This may be one way by which these therapies contribute to the beneficial effects seen in patients receiving these treatments.

Arthritis, Rheumatoid↗
PubMed1994

Equitable service provision: a feasibility study of the common waiting lists model.

Long waiting lists are of concern to policy makers, professionals and patients, and despite major initiatives to address the issue the problem remains. Suggests that one partial solution may be chronologically maintained common waiting lists for high-volume routine surgical procedures at the departmental level rather than by individual consultants. Since case severity differences between the various surgeons in a team may mitigate against such a model a pilot study of two procedures: arthroscopic examination of knee and repair of inguinal hernia was undertaken. Describes the study. Little statistically significant difference was found in case severity between the patients belonging to the different general and orthopaedic surgeons in South Tees Health district, and a significant proportion of operations was undertaken by middle grade doctors. At present waiting times vary considerably depending on which consultant the patient is referred to by their general practitioner, thus creating inequity. The problem has been further exacerbated by the NHS reforms with fund-holding general practitioners receiving preferential treatment, thus creating a two-tiered service. Common waiting lists will ensure equitable provisions and may increase efficiency, and hence need serious consideration.

Arthroscopy↗
PubMed1994

Short report: the effect of misoprostol on the anaemia of NSAID enteropathy.

BACKGROUND: Small bowel ulceration is an increasingly recognised complication of therapy with non-steroidal anti-inflammatory drugs (NSAID). The ulceration is a potent site of blood loss contributing to unexplained iron deficiency anaemia in patients with arthritis. No drug is currently available to treat NSAID small bowel ulcers. METHODS: We have retrospectively examined the effect of therapy with the prostaglandin E1 analogue misoprostol on the anaemia of patients with enteroscopically proven NSAID small bowel enteropathy. RESULTS: All of the patients had proven iron deficiency anaemia. Eleven patients received misoprostol and ten received no treatment. Haemoglobin in the misoprostol-treated group rose significantly from median (range) 9.1 (6.2-10.6) g/dL (95% confidence intervals 8.76, 10.13) to 10.6 (6.5-16.8) g/dL (95% confidence intervals 10.06, 11.82); P = 0.004). Those patients who did not receive misoprostol had no significant change in their haemoglobin: 9.1 (7.5-10.6) g/dL to 8.1 (5.6-14.7) g/dL (P = N.S.). CONCLUSION: Misoprostol therapy was associated with an improvement in the anaemia in patients with proven NSAID enteropathy.

Adult↗
PubMed1994

TNF Nco-I RFLP is not an independent risk factor in rheumatoid arthritis.

The human TNF genes are located within the MHC class-III region on chromosome 6. The presence or absence of an Nco-I restriction site in the 5' non-coding sequence of the TNF beta gene defines two alleles (TNFB*1 and TNFB*2). The segregation of these alleles has been associated with levels of TNF alpha or TNF beta production in systemic lupus erythematosis (SLE), insulin-dependent diabetes mellitus (IDDM) and in healthy control individuals. Rheumatoid arthritis (RA) is characterized by high levels of TNF alpha within the synovial fluid and to address the question of whether this could be brought about by a genetic predisposition to high TNF production by RA individuals, we examined the distribution of this Nco-I polymorphism in 98 healthy volunteers and 123 patients with active rheumatoid arthritis. No difference was observed between the normal and RA groups with respect to haplotype segregation or allelic frequency. Furthermore, no difference was observed between DR4+ or DR4- individuals in the control or RA groups. These data demonstrate that the high level of TNF alpha seen in the joints of RA patients is unlikely to be due to a genetic predisposition of these patients to high TNF alpha production, as defined by the TNF Nco-I restriction fragment length polymorphism (RFLP).

Alleles↗
PubMed1994

Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.

OBJECTIVE: To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN: Before (1987) and after (1990) study of accident and emergency medical records. SETTING: Two accident and emergency departments in England. PATIENTS: 1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES: Recording of relevant symptoms and signs as determined in the guidelines; presence of, indications for, and rates and appropriateness of skull x ray examination and admission. RESULTS: The median number of guidelines variables recorded for all study periods ranged from 7 to 9 out of a possible maximum of 27. For key decision making variables the presence or absence of penetrating injury was least likely to be recorded (< or = 1%) and that of loss of consciousness most likely (> or = 75%). Altogether, the proportion of patients receiving skull x ray examination or admitted varied from 25%-60% and 7%-23% respectively; overall, 69% (1280/1856) and 64% (1177/1851) of patients were managed appropriately. However, no consistent change occurred in the departments between the study periods. For instance, in department 1 the proportion of appropriate x ray examinations rose significantly after distribution of the guidelines (from 61% (202/330) to 73% (305/417)) and appropriate decisions on whether to x ray or not also rose (from 65% (340/522) to 72% (435/608)). There was no significant change in department 2, although the proportion of appropriate admissions fell (from 33% (55/166) to 15% (19/130)). CONCLUSIONS: Recording practice and decision making were variable and had not consistently improved after dissemination of the guidelines. Strategies are required to ensure effective implementation of guidelines.

Adult↗
PubMed1994

The effect of azathioprine on serum levels of interleukin 6 and soluble interleukin 2 receptor.

Cytokine pathways are central to the perpetuation of synovial inflammation in rheumatoid arthritis (RA). Azathioprine (AZA) has disease modifying activity in RA. This study addressed the effect of AZA on serum IL-6 and soluble IL-2 receptor (sIL-2R) levels in RA. Over a 24 week period of therapy significant clinical improvement was observed. However, serum levels of both IL-6 and soluble IL-2R levels did not significantly change after AZA therapy. AZA therapy did not significantly alter the peripheral blood monocytes ability to produce IL-6 in vitro, either in the presence or absence of LPS. The mechanism by which AZA achieves clinical improvement in RA patients does not appear to be through IL-6 modulation or modification of synovial lymphocyte activation as assessed by serum sIL-2R levels.

Adult↗
PubMed1993

The spectrum of disease associated with a positive ANCA.

This is a retrospective analysis of all patients with a raised titre of ANCA in a single centre over a two-year period. Sixty-five patients were identified and clinical data is presented for 58 of these-34 male and 24 female. The median age is 56 years (13-83). Fourteen patients had Wegener's granulomatosis, 14 microscopic polyarteritis nodosa and 30 had other diagnoses. The patients with unexpectedly positive results are discussed in detail. This study confirms the sensitivity of ANCA in Wegener's granulomatosis and microscopic polyarteritis nodosa but suggests that the test is not as specific as initially claimed.

Adult↗
PubMed1993

Trends in the utilization of primary total hip arthroplasty, 1969 through 1990: a population-based study in Olmsted County, Minnesota.

Using the unique data resources of the Rochester Epidemiology Project, we identified the residents of Olmsted County, Minnesota, who underwent total hip arthroplasty (THA) between 1969, when this technique was introduced, and 1990. During this period, 735 residents underwent 859 primary THAs. An initial dramatic upsurge in utilization of THA soon after its introduction was followed by a lower rate of increase, to an age- and sex-adjusted rate of 59.9 per 100,000 person-years in 1987 through 1990. In Olmsted County, the procedure was used more often in women than in men, but men underwent THA at a younger age than did women. THAs were performed for various conditions of the hip, but the increased utilization during the last decade of the study was mainly attributable to its application in primary degenerative hip disease among patients (male more often than female) from a wider age range; utilization of THA for hip fractures decreased during the study period. Most THAs were of the cemented variety (86.1%); however, the rate of use of noncemented THAs, first performed in 1984, is increasing. The overall upward trend in Olmsted County was consistent with European data but less than the rate of increase observed for the United States as a whole between 1983 and 1987. Olmsted County utilization rates, if projected nationally, suggest a need for more than 139,000 primary THAs each year at an annual direct cost of more than $2.7 billion. An urgent need exists for detailed examination of national utilization patterns and clarification of the role of cementless implants and of THA for hip fractures.

Adult↗
PubMed1993

Students' knowledge and behavior concerning safer sex: a UK study.

Most students in institutions of further and higher education in the northeast of England who responded to a 1989 survey dealing with sexual behavior and safer sex were heterosexual and had been sexually active or intended to have sexual intercourse. Many students, however, believed that safer sex implied having no sex at all or were unaware of the role of nonpenetrative sex in preventing human immunodeficiency virus (HIV) infection. They did not use condoms, in spite of having positive attitudes about condom use, and they engaged in one or more sexual activities that increased the risk of acquiring HIV infection. In view of the increasing incidence of acquired immunodeficiency syndrome (AIDS), the authors assert, these findings are cause for concern and require concerted action by health educators and society to encourage safer sex practices and to prevent the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Toleration, side-effects and efficacy of sulphasalazine in rheumatoid arthritis patients of different ages.

Sulphasalazine is an effective second-line agent in the management of rheumatoid arthritis. The risk:benefit ratio in the elderly is less well established. We studied the risk:benefit ratio in relation to age, retrospectively combining five prospective studies of enteric coated sulphasalazine therapy in 352 patients with rheumatoid arthritis. Clinical and laboratory assessments of efficacy and toxicity were made by an independent assessor at 0, 12, 24 and 48 weeks. The only significant differences between young, middle aged and elderly patients at the initial assessment were in pain perception, ESR and C-reactive protein. Sulphasalazine was equally effective in all age groups. The toxicity profile was similar in all age groups. We conclude that sulphasalazine is equally effective in rheumatoid arthritis in the elderly as in the young. There was no significant change in the frequency or nature of side-effects with increasing age.

Adult↗
PubMed1993

Serum concentrations of soluble interleukin 2 receptor in patients with rheumatoid arthritis: effect of second line drugs.

Serum soluble interleukin 2 receptor (sIL-2R) concentrations reflect lymphocyte activation in vivo. An investigation was carried out to determine if sIL-2R concentrations correlate with existing disease activity parameters in patients with rheumatoid arthritis (RA) and whether these concentrations are modulated by treatment with second line drugs. Seventy nine patients with rheumatoid arthritis with active disease were prospectively treated with sodium aurothiomalate, auranofin, or sulphasalazine. Sequential concentrations of sIL-2R were measured by enzyme linked immunosorbent assay (ELISA). No correlations were observed between sIL-2R concentrations and clinical parameters and there were only moderate associations with concentrations of C reactive protein and the erythrocyte sedimentation rate. Concentrations of sIL-2R did not significantly change with treatment. It is concluded that sIL-2R probably measures an aspect of rheumatoid synovitis distinct from acute phase reactants and is not influenced by treatment with second line drugs.

Arthritis, Rheumatoid↗