Antiviral chemotherapy in genital herpes simplex virus infections.
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Acyclovir↗
Biomedical subjects
R Patel
Publications and source records attributed to R Patel.
Commissioning genitourinary medicine services: the policy research agenda.
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Acquired Immunodeficiency Syndrome↗
Feedback from the XIth International Conference on AIDS.
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Acquired Immunodeficiency Syndrome↗
Using zebra mussels to monitor Escherichia coli in environmental waters.
Use of the zebra mussel (Dreissena polymorpha) as an indicator of previously elevated bacteria concentrations in a watershed was examined. The ability of the zebra mussel to accumulate and purge Escherichia coli over several days was investigated in both laboratory and field experiments. In laboratory experiments, periodic enumeration of E. coli in mussels that had been exposed to a dilute solution of raw sewage demonstrated that (i) maximum concentrations of E. coli are reached within a few hours of exposure to sewage, (ii) the tissue concentration attained is higher than the concentration in the ambient water, and (iii) the E. coli concentrations take several days to return to preexposure concentrations when mussels are subsequently placed in sterile water. In field experiments conducted in southeast Michigan in the Clinton River watershed, brief increases in E. coli concentrations in the water were accompanied by increases in mussel concentrations of E. coli that lasted 2 or 3 d. The ability of mussels to retain and to concentrate E. coli made it possible to detect E. coli in the environment under conditions that conventional monitoring may often miss. Sampling caged mussels in a river and its tributaries may enable watershed managers to reduce the sampling frequency normally required to identify critical E. coli sources, thereby providing a more cost-effective river monitoring strategy for bacterial contamination.
Animals↗
A review of thirty cases of rhabdomyolysis-associated acute renal failure among phencyclidine users.
Fifteen cases of rhabdomyolysis-associated acute renal failure among phencyclidine (PCP) users were seen at our institution between 1979-1984. An additional 15 cases were found from the literature. These 30 cases are reviewed here with respect to the incidence of acute renal failure among PCP users, its possible pathogenesis, clinical and biochemical features, and treatment.
Acute Kidney Injury↗
Management of late corneal haze following photorefractive keratectomy.
Subepithelial corneal haze and myopic regression are potential complications following excimer photorefractive keratectomy (PRK). There are many medical and surgical methods of managing this haze. We present a 37-year-old male myope who underwent PRK and subsequently developed central corneal haze late in the postoperative course. The haze was managed initially with topical medications with limited success. Mechanical superficial keratectomy was done to remove the superficial scar tissue but the haze returned necessitating repeat excimer laser PRK, using a transepithelial technique. The haze did not recur. Both mechanical superficial keratectomy and repeat excimer laser ablation may ameliorate haze. Success of these procedures may depend on the morphology of the haze and the patient's individual wound healing response.
Adult↗
Prevalence of nosocomial infection in critically ill patients with abdominal pathology.
Bacterial infection is a problem in the intensive care unit (ICU). We conducted the present study in the surgical ICU over a period of 5 months to determine the prevalence of nosocomial infection. Our ICU has a bed strength of 7 with an average occupancy rate of 5.46 patients. Mechanical ventilation associated pneumonitis was the commonest nosocomial infection. Older patients, patients with organ system failure and patients with co-morbid conditions were at high risk of developing nosocomial infections. E. coli was the commonest and most resistant organism grown in our study.
APACHE↗
Suppression activity of pro-apoptotic gene products in cancer cells, a potential application for cancer gene therapy.
Overexpression of anti-apoptotic Bcl-2 and Bcl-XL proteins may play a role in the development of resistance to cancer therapy. We examined the expression of these proteins in prostate, breast, and ovarian cancer cells. We found that some of these cancer cell lines expressed high levels of Bcl-XL or Bcl-2., In order to develop an effective strategy to overcome the potential inhibition of cancer therapy by Bcl-2 and Bcl-XL, we tested the inhibitory ability of several pro-apoptotic or tumor suppressor genes in these cells. The expression of these genes induced apoptosis or suppressed cell growth with variable efficiency in these cells. Harakiri (Hrk) appears to result in the greatest induction of apoptosis or inhibition of cell growth Mtd, bax and bcl-XS were also effective in inhibiting cell growth. Furthermore, transfection of Hrk, bax, or Mtd into these cells caused significantly less colony formation than in cells transfected with p53 or BRCA1. Therefore, these results suggest that Hrk, bax, and Mtd are potent therapeutic agents for cancers expressing high levels of Bcl-2 and Bcl-XL.
Apoptosis↗
Changing epidemiological pattern of leprosy in rural Chhattisgarh.
The study presents findings of a retrospective cohort analysis of 2972 new cases registered between 1 January 1987 and 31 December 2001 in the rural field practice area of RLTRI, Raipur. An analysis was carried out with the objective of describing the epidemiological pattern of leprosy in the preceding 15 years. The patients in the study were also followed up prospectively till December 2003 to record any development of relapse or reactions. Data collected were grouped into three time-blocks and analysed at five-yearly intervals. Epidemiological indicators in different periods were also compared. 2972 new cases were included in the analysis; of these, 15.6% were registered in time-block 1, 20.9% in time-block 2 and 63.5 % in time-block 3. The P/D ratio, which was 8.5 in 1986 declined to 6.6 in 1991, 1.3 in 1996 and 0.4 in 2001 after which it rose marginally to 0.8 in December 2002. The proportion of MB cases showed a rise of 15.3% in 1991, 25.1% in 1996 and 28.7% in 2001. The mean age at registration showed a significant decline during different time periods from 35.2 +/- 16.9 in time-block I to 28.9 +/- 15.9 in time-block 3. The proportion of grade II deformity was 3.2% in time-block 1; it rose to 6.3% in time-block 2 and 5.9% in time-block 3. The proportion of cases completing treatment was 28.2% and 17.6% for MB and PB groups respectively in time-block 1, rose to 69.9% and 77.0% in the 2nd, and 74.9% and 81.6% in the 3rd. The proportion of relapse also came down markedly in time-blocks 2 and 3. The median duration of treatment was 28.0 months in time-block 1, came down to 9.0 months in time-block 2 and 7.0 months in time-block 3 following the introduction of MDT. The proportion of child cases and reaction rates showed a rise in time-blocks 2 and 3.
Adolescent↗
Integration of leprosy control into general health care system: observations from a state with low endemicity.
The study was undertaken as part of operational research to assess the level of integration of leprosy services into general health care system in 24 low or moderately endemic states/union territories by the Ministry of Health and Family Welfare, Government of India. Himachal Pradesh was one of the nine randomly selected states for the study. Out of the 12 districts in the State, 2 were selected randomly for the study. In each of the selected districts, 8 health facilities (that included a district hospital, an urban hospital/urban health centre, an Employees' State Insurance Hospital, a community health centre and a primary health centre) and 9 sub-centres were surveyed. Selection was done randomly at each stage. Data were collected on training in leprosy of general health care staff, availability of drugs for MDT in the system and maintenance of leprosy records by the staff of the system. The study showed mixed results. About half (53.2%) of the existing medical officers, 83.9% of health supervisors and 96.8% of multi-purpose workers were trained in leprosy. But only 31.3% of medical officers were able to diagnose leprosy and most of them were relying on vertical staff and skin specialists for confirmation. MDT services were provided by 20% of rural and 66.7% of urban health facilities that were acting as treatment centres. None of the health facilities had 3 months' stock of all types of blister packs, as per the guidelines of the Government of India. None of the sub-centres was involved in MDT delivery. However, reporting as per SIS formats was universal. The study emphasized the need for training and better management of MDT drug stock.
Delivery of Health Care, Integrated↗
Initial EEG in status epilepticus is helpful in predicting seizure recurrence.
OBJECTIVES: There is paucity of prospective studies evaluating the role of EEG in the prognosis of status epilepticus (SE). The present study aims at evaluating the role of clinical, EEG and radiological changes in predicting the outcome of SE. METHODS: Consecutive patients with SE were prospectively evaluated. Status epilepticus was classified into convulsive and nonconvulsive. Consciousness at admission was assessed by Glasgow coma scale (GCS) and presence of focal neurological signs was noted. CT or MRI abnormalities were recorded. A 10 or 21 channel EEG record wcs obtained 1 hour after therapy. The patients were treated with IV sodium valproate or phenytoin according to a fixed protocol. The EEG changes were categorized into discrete, merging, continuous, periodic pattern, slowing and normal. Outcome was assessed by seizure control at 1 hour, sustained seizure control for 24 hours and death. RESULTS: There were 70 patients with SE whose age ranged between 1 and 85 years, 26 were females and 11 below 15 years. The underlying etiology was CNS (Central nervous system) infection in 35, stroke in 11, metabolic encephalopathy in 17, drug default in 2 and no apparent cause was evident in 5 patients. Convulsive SE was present in 65 and nonconvulsive in 5. Cranial CT and MRI were abnormal in 36, and MRI revealed additional abnormality in 3 patients. The EEG at 1 hour was abnormal in 51 out of 53 patients and revealed discrete pattern in 4, merging in 5, continuous in 5, periodic in 6, multiple patterns in 2 and slowing in 29 patients. In 7patients with convulsive SE, clinical seizures were controlled but EEG showed ictal pattern. Clinical seizure recurred in 38 patients within 24 hours and 15 of them had ictal discharges at one hour EEG. Response to antiepileptic drugs correlated with underlying etiology, duration of SE and associated medical illness. 19 patients died but not due to SE per se. Death did not correlate with EEG abnormality, however, 1-hour EEG abnormality predicted seizure recurrence. CONCLUSION: EEG is useful in monitoring SE and its abnormality at 1 hour predicts seizure recurrence within 24-hour.
Adolescent↗
Inter-state variations in integration of leprosy services into general health system in low/ moderately endemic states of India.
The objective of the study was to analyse inter-state variations in integration of leprosy services into the general health system, covering broad categories of structure integration, training of health functionaries, availability of MDT services and record maintenance, in 24 low/moderately endemic states. Multi-stage random sampling technique was used to select 9 states, 86 health facilities (including district hospitals, community health centres, primary health centres) and 108 sub-centres. Information from each level was collected on a pre-tested form by officers of three leprosy institutions of the Government of India. The results showed wide inter-state variations on each aspect. Redeployment of vertical staff was complete (100%) in Tamil Nadu and Tripura. Assam reported a higher level of training (97%) of medical officers in leprosy. Training of health supervisors and multipurpose workers was better than that of medical officers in most of the states. Tripura reported negligible training of all the health functionaries because of specific local problems. In Assam, Maharashtra and Sikkim, all the urban and rural health facilities were providing MDT. Three months' stock of all types of MDT blister packs was available only in one health facility in Andhra Pradesh and in Goa. Assam and Haryana had lower availability of MDT stocks. In Assam and Maharashtra, medical officers in all health facilities were diagnosing and treating leprosy cases, as compared with Himachal Pradesh where the value was 30%. Involvement of sub-centres in MDT delivery was more at 92% and 100% in Tamil Nadu and Maharashtra respectively in comparison to none in Himachal Pradesh and Tripura. Use of the Simplified Information System (SIS) 2002 guidelines and formats was universal. However, lower involvement of GHS staff in recording and reporting was noted in Assam (0%), Andhra Pradesh (10% and 30%). The study emphasized the need for further tailor-made follow-up studies to suit local problems.
Delivery of Health Care, Integrated↗
Tuberculoma of the orbit--a case report.
A case of orbital tuberculoma presenting with proptosis and gross diminution of vision in a young girl 20 years is reported. The tuberculoma disappeared within 3 months of antitubercular therapy and there was marked improvement in visual acuity. Because of its rarity in the younger age group, the case is being reported.
Adult↗
Embryonal rhabdomyosarcoma of orbit--a case report.
Embryonal rhabdomyosarcoma of orbit presenting as a case of rapid proptosis of the right eye is reported in a 4 year old male child. There was no evidence of recurrence during a follow up of 6 months. Rhabdomyosarcoma is one of the most common primary malignant orbital neoplasms of child hood. It usually produces a precipitously progressing unilateral proptosis of sudden onset. It is a highly malignant neoplasm of pleuripotential embryonic mesoderm, which commonly differentiates to form cells similar to rhabdomyoblasts of the foetus. Because of the presence of elongated cells that contain abundance of eosinophilic glycogen rich cytoplasm, it is generally referred to as embryonal form of rhabdomyosarcoma.
Child, Preschool↗
Isolation of T lymphocyte subsets from peripheral blood using monoclonal antilymphocyte antibodies.
Monoclonal antisera against helper (serum OKT4) and suppressor (serum OKT8) T cells were employed in a complement-dependent lymphocytotoxicity reaction to isolate helper and suppressor T cells from peripheral blood mononuclear cells. When prepared by this method, helper and suppressor T cells had a purity of 67.8 percent and 78.8 percent, respectively. Approximately 56 percent of viable suppressor and 33 percent of viable helper T cells were lost during the procedure.
Antibodies, Monoclonal↗
Arterial thrombosis associated with the nephrotic syndrome.
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Adult↗
Correction of myopia and astigmatism using an ablatable mask.
BACKGROUND: Most excimer laser refractive procedures use a computer driven mechanical diaphragm to shape the laser beam. Studies are currently underway using an ablatable polymethylmethacrylate (PMMA) mask to transfer a new spherical or toric curve to the cornea for the correction of myopia and astigmatism; it may leave a smoother corneal surface than diaphragm procedures. METHODS: As part of a Phase IIb FDA clinical study, 25 eyes of 25 patients underwent excimer laser photorefractive keratectomy using a hand held ablatable mask. Fifteen eyes had attempted spherical corrections of up to 6.00 diopters (D) and 10 had toric corrections of up to 6.00 D of sphere and 2.75 D of astigmatism. RESULTS: Seventy-four percent of all eyes achieved uncorrected visual acuity of 20/40 or better--86% in the spherical group and 63% in the astigmatism group. Sixty-nine percent of eyes were within +/- 1 D of the attempted correction. In eyes treated for astigmatism, mean astigmatism decreased from 1.48 D preoperatively to 0.86 D postoperatively. Approximately one half of the eyes treated for astigmatism had a decrease in cylinder of more than 0.5 D. One eye lost 2 Snellen lines of best spherical corrected visual acuity. Video keratography showed toric ablations to result in an elliptical optical zone. Analysis of centration of the procedure showed 66% of ablations centered within 1.0 mm of the center of the pupil aperture. CONCLUSIONS: The ablatable mask represents a promising modality for the treatment of eyes with both myopia and myopic astigmatism.
Adult↗
Tuberculous peritonitis presenting as coloenteric fistula.
Abdominal tuberculosis can present as tuberculous peritonitis with generalised or loculated ascites, lymphadenitis of the mesenteric or retroperitoneal nodes, or as intestinal tuberculosis. In the last case it could be annular mucosal ulceration, single or multiple strictures or hyperplastic tuberculosis of the bowel, usually involving the terminal ileum or ileocaecal region. Disease higher in the ileum is considered common but involvement of the appendix, stomach, duodenum, jejunum, colon and rectum is unusual. Tuberculous peritonitis presenting as a coloenteric fistula is not a common clinical entity. In this case a patient who presented with peritonitis was found to have tuberculous peritonitis with coloenteric fistula.
Adult↗