Biomedical subjects

R S Hassanein

Publications and source records attributed to R S Hassanein.

At least 19 recordsLinked to original sources

PubMed1996

Late hyponatremia in very-low-birth-weight infants: incidence and associated risk factors.

OBJECTIVE: To determine the incidence of late hyponatremia in very-low-birth-weight infants and to identify associated risk factors. Low serum sodium concentration in otherwise healthy premature infants beyond 2 weeks of life is referred to as the hyponatremia. DESIGN: Retrospective cohort review. SETTING/SUBJECTS: The intensive care nursery at St Luke's Hospital Perinatal Center, Kansas City, Mo. Criteria for subject selection were birth weight of 1,500 g or less; survival for more than 21 days; development of late hyponatremia or hospitalization for 42 days or more; and measurement of serum sodium concentration at least once between the 14th and 56th day of life. Of 515 infants admitted to the nursery for the 1992 calendar year, 124 had a birth weight of 1,500 g or less and survived for more than 21 days; however, 16 of these infants were discharged at 42 days of life or less, 11 did not have a serum sodium concentration measurement after the second week of life, and 1 did not have complete medical records. Thus, the final sample was 96 subjects. STATISTICAL ANALYSES: Percentages to determine incidence of late hyponatremia; t test of chi 2 test to determine differences between infants with and without late hyponatremia; multiple logistic regression to determine the strongest indicators of late hyponatremia. RESULTS: Incidence of late hyponatremia was 62.5%. Significant risk factors for late hyponatremia were birth weight of 1,000 g or less (P < .001), feedings of fortified human milk (P < .013), and occurrence of an intraventricular hemorrhage (P < .036). Fortified human milk feeding was a significant risk factor for late hyponatremia in both weight groups (ie, birth weight greater than or less than 1,000 g). CONCLUSION: Despite standard fortification, human milk may contain an insufficient quantity of sodium to met the needs of very-low-birth-weight infants.

Aging↗

PubMed1995

Iliac crest bone graft harvest donor site morbidity. A statistical evaluation.

STUDY DESIGN: This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. OBJECTIVES: All complications or problems, no matter how small, were sought to develop strategies of prevention. SUMMARY OF BACKGROUND DATA: A wide range of major, 0.76% (Keller et al) to 25% (Summers et al) and minor complications, 9.4% (Keller et al) to 24% (Summers et al) has been reported. METHODS: A consecutive series of 261 patients, whose bone graft harvest was done by one surgeon, was studied by chart review and a mail survey that was not conducted by the operating surgeon. The survey presented specific open-ended questions designed to uncover any complication/problem, no matter how small. Complications then were categorized as major or minor and subcategorized as acute or chronic. Statistical analysis was done using chi-squared and multiple logistical regression. RESULTS: None of the 261 patients had a severe perioperative complication--e.g., superior gluteal artery injury, sciatic nerve injury, or deep wound infection. None of the 225 patients with long term follow-up (average, 66 months; range, 32-105 months) had a severe late complication--e.g., donor site herniation, meralgia paresthetica, pelvic instability, or fracture. Of the 180 patients meeting the qualifications for statistical analysis, major complications occurred in 18 (10%), only three of which affected function (pain). Minor complications occurred in 70 (39%). CONCLUSIONS: The results indicated that severe complications from iliac crest bone graft harvest can be avoided and major complications affecting functioning are uncommon, but minor complications are common. The findings suggest that procedural refinements of limiting subcutaneous dissection and providing layered tension-free incision closure may improve results.

Adolescent↗

PubMed1995

High-risk children referred to an early-intervention developmental program.

Early-intervention programs for infants with developmental disabilities or with high-risk factors for such problems were first established in the United States more than 20 years ago. The benefits of such programs are generally recognized. This study describes the presenting problems of 698 children referred to an early-intervention program over a 15-year period (1975-1989). Medical condition groups rather than specific diagnoses are considered. The developmental progress of 464 children who attended the program for at least 6 months was determined by comparing their admission and discharge developmental quotients (DQ). Admission trends over time are noted and the value of intervention programs for young children with disabilities is discussed.

Birth Weight↗

PubMed1995

Transmission of Toxoplasma gondii in Panama City, Panama: a five-year prospective cohort study of children, cats, rodents, birds, and soil.

A cohort of more than 500 children from Panama City, Panama was studied prospectively over five years for acquisition of antibody to Toxoplasma gondii. The direct agglutination test showed that 72 of 571 children seroconverted between one and six years of age, for a cumulative incidence of 12.6%. Children were examined by pediatricians quarterly, and illnesses that had occurred in the interval and their activities were noted on questionnaires. Thirty-eight variables were examined for their role as risk factors for seroconversion. There was a higher correlation between children's seroconversion and contact with dogs than with cats. Combinations of significant predictors without dogs explained only 67% of the seroconversions, but the same factors with dogs explained 90%. On the other hand, ingestion of raw or rare meat or eggs appeared to play no role in transmission. Cats were examined and 110 (45.6%) of 241 had Toxoplasma antibody on the first bleeding. Only two (0.5%) of 383 cat fecal specimens, when tested in mice, resulted in seroconversion. Ten (1.1%) of 924 soil samples resulted in seroconversion in mice that had been injected. Antibody to Toxoplasma was found in 52 (23.3%) of 226 rats (Rattus norvegicus) and two (0.035%) of 571 mice (Mus musculus). Two hundred sixteen birds of 16 different species were bled. Antibody to Toxoplasma was found in 13.4% of these birds, mostly in grackles, blue-gray tanagers, and doves. The rate of isolation of Toxoplasma was low: one of 23 in rats and three of 201 in birds. High relative risks (RRs) of transmission to children were predicted by contact histories with nursing dogs (RR = 5.8), weaned dogs (RR = 4.7), many flies (RR = 3.6), 6-12-month-old dogs (RR = 3.4), weaned cats (RR = 3.0), 6-12-month-old cats (RR = 2.7), nursing cats (RR = 2.5), much garbage (RR = 2.4), and many roaches (RR = 2.2). The high statistical correlation of dog contact with seroconversion in children suggests the possibility that dogs, by eating and rolling in cat feces, are instrumental in mechanically transmitting Toxoplasma infection. In addition, flies, and to a lesser extent, cockroaches, may have practically important roles in transmission.

Animals↗

PubMed1995

Efficacy of once daily extended-release theophylline in decreasing the use of inhaled beta 2-agonists in stable, mild-to-moderate asthma patients.

BACKGROUND/OBJECTIVE: The purpose of this study was to determine whether the addition of extended-release theophylline to the daily treatment regimen of inhaled beta 2-agonist users would result in decreased use of beta 2-agonist while maintaining similar efficacy for treatment of asthma. METHODS: This was a single-blind, multicenter (six sites) study. Sixty-one patients with a history of mild-to-moderate asthma treated with inhaled beta 2-agonist were randomized to treatment with Theo-24 (anhydrous extended-release capsules) plus inhaled beta 2-agonist or placebo plus beta 2-agonist. Patients kept daily symptom diaries, measured peak flow rates, recorded puffs of inhaled beta 2-agonist, and adverse events during a 4-week treatment period. RESULTS: Fifty-five patients were included in the efficacy analysis. The primary efficacy variable in this study was the mean number of puffs (adjusted for baseline differences) of beta 2-agonist inhaled per day. In this study, the addition of theophylline to the daily regimen of inhaled beta 2-agonist for 4 weeks significantly reduced the total daily dose of inhaled beta 2-agonist at weeks 3 and 4 of treatment compared with placebo. The differences were significant at the P < .05 level. For patients in the theophylline group, the number of puffs decreased from an unadjusted mean of 9.81 at baseline to an adjusted mean of 6.78 after 4 weeks of treatment compared with 9.91 at baseline and 8.17 for the placebo group. There were no unexpected or serious adverse events. CONCLUSIONS: In this study, the addition of once daily, extended-release theophylline to the daily regimen of inhaled beta 2-agonist for 4 weeks significantly reduced the total daily dose of inhaled beta 2-agonist at weeks 3 and 4 of treatment compared with placebo, while maintaining acceptable asthma symptom scores.

Administration, Inhalation↗

PubMed1994

Prevalence of aneuploidy, overexpressed ER, and overexpressed EGFR in random breast aspirates of women at high and low risk for breast cancer.

Breast tissue biomarkers which accurately predict breast cancer development within a 10 year period in high risk women are needed but currently not available. We initiated this study to determine 1) the prevalence of one or more breast tissue abnormalities in a group of women at high risk for breast cancer, and 2) if the prevalence of biomarker abnormalities is greater in high risk than in low risk women. Eligible high risk women were those with a first degree relative with breast cancer, prior breast cancer, or precancerous mastopathy. Low risk women were those without these or other major identifiable risk factors. Ductal cells were obtained via random fine needle aspirations and cytologically classified. Biomarkers included DNA ploidy, estrogen receptor (ER), and epidermal growth factor receptor (EGFR). The prevalence of DNA aneuploidy was 30%, overexpression of ER 10%, and overexpression of EGFR 35%, in the 206 high risk women whose median 10 year Gail risk (projected probability) of developing breast cancer was 4.5%. The prevalence of aneuploidy and overexpressed EGFR was significantly higher in the high risk women than in the 25 low risk controls (p < 0.002), whose median 10 year Gail risk was 0.7%. The difference in the prevalence of ER overexpression between high and low risk groups was not statistically significant (p = 0.095). This may be due to the low prevalence of overexpressed ER and the small number of controls. A significant difference was noted in the prevalence of one or more abnormal biomarkers between the high risk and low risk women (p < 0.001). A large prospective trial is needed to determine if one or more of these biomarkers, is predictive of breast cancer development.

Adult↗

PubMed1992

In vitro growth modulation by L-ascorbic acid of colony-forming cells from bone marrow of patients with myelodysplastic syndromes.

In vitro colony growth was studied on bone marrow cells from 51 patients with myelodysplastic syndromes (MDS), using a cell culture method with the unique feature of daily feeding, in an effort to gain insight into the pathophysiology of MDS and to assess the clinical utility of this cell culture assay. The colony growth pattern of MDS marrow cells is remarkably similar to that of acute myeloid leukemia but quite dissimilar from that of normal marrow, in support of a common pathophysiological mechanism for these two disorders. In particular, L-ascorbic acid (LAA) enhanced colony growth in 30% and suppressed growth in 16% of cases, a finding also similar to that in acute myeloid leukemia, indicating a unique growth requirement which may be explored for therapeutic purposes. Further, these LAA effects have prognostic value, with LAA-sensitive (both LAA-enhanced and LAA-suppressed) cases displaying shorter survivals than LAA-insensitive cases (median survival of 5 months versus 18 months; P = 0.011). This prognostic value is independent of, and more powerful than, bone marrow blasts; the median survival was 18 months for less than 5% bone marrow blasts and 8 months for greater than 5% bone marrow blasts (P = 0.044). These two risk factors can be used together to identify patients with an extremely good or an extremely poor prognosis. This study establishes the clinical usefulness of the LAA effect in MDS as a prognostic factor and provides a new lead to explore in understanding differential biochemical/molecular events and, possibly, a new therapeutic approach to the management of MDS.

Adolescent↗

PubMed1992

Comparison of responses to air, water, and closed-loop caloric irrigators.

Three types of commercially available caloric irrigation units--air, water, and closed-loop--were evaluated for nystagmus response patterns and comfort. Electronystagmographic recordings were analyzed for slow-phase velocity, response duration, amplitude, frequency, and test-retest reliability. Significant differences were found among the three types of irrigators, between warm and cool irrigators, and between male and female subjects. Test-retest reliability was adequate for all three units. Subjects clearly favored the closed-loop system over the water and air irrigators, but the water irrigator yielded the most robust caloric response.

Adolescent↗

PubMed1992

The effect of stimulus duration using the Brookler-Grams closed-loop caloric irrigator.

Nystagmic responses to traditional 40-sec, 30 degrees C water calorics were recorded and compared to those obtained with the Brookler-Grams closed-loop irrigator using 30 degrees C, 40-, 50-, and 60-sec irrigations. Significant differences were noted between the responses to the water irrigator and the 40- and 50-sec closed-loop irrigations. The 60-sec closed-loop irrigation produced responses that were equivalent to the responses obtained with the water irrigation in slow component velocity, amplitude, frequency, latency, and duration. The 30 degrees C 60-sec closed-loop irrigation is an acceptable stimulus in electronystagmographic caloric testing.

Adolescent↗

PubMed1992

Classification of essential tremor.

Classification of essential tremor was attempted using tremor frequency; tremor duration; family history of tremor; responsiveness to alcohol, propranolol, and primidone; muscle contraction pattern; and long-latency reflexes. Sixty-one patients were evaluated. The majority of patients had a tremor frequency less than 7.0 Hz, a positive family history, and a positive response to alcohol. Approximately 46% of patients had a beneficial response with propranolol and 71% with primidone. Tremor frequency was inversely correlated with age and directly correlated with an antagonist pattern of muscle contraction. Enhanced long-latency reflexes were not found. Other characteristics of essential tremor were not significantly correlated. It is concluded that essential tremor can not be classified into subtypes.

Aged↗

PubMed1992

Efficacy and efficiency: self-designed versus instructor-designed study tools.

During the course of their education, occupational therapy students learn to administer complex structured assessments. For easier administration of these assessments, students design note cards, which then replace cumbersome test manuals during administration. This study considered whether students could learn test administration with equal efficiency and efficacy if given test administration note cards rather than having to design their own. The results showed that the subjects using instructor-designed cards earned written test and practical examination scores similar to those of the subjects using self-designed cards. The subjects using instructor-designed cards spent significantly less (p = .003) total time in study than did the subjects using self-designed cards. The difference in time between the two groups was attributable to the time spent designing note cards. Therefore, distribution of instructor-designed note cards appears to offer equally effective and significantly more efficient learning when compared with that produced when students design their own cards. The differences in efficacy and efficiency were similar for students of different learning styles (as classified by Witkin's field-dependence/field-independence continuum) [corrected].

Audiovisual Aids↗

PubMed1992

Identifying the needs of home caregivers of patients with cancer.

Increasing numbers of patients with cancer are being cared for by home caregivers. The primary purpose of this methodologic, correlational study was to identify, categorize, and assess the importance of needs expressed by 492 home caregivers and to determine how well these needs were satisfied. Caregivers surveyed were selected from the records of two nonprofit community cancer agencies and two hospital outpatient oncology clinics in the Midwest. These individuals were identified by at-home patients with cancer as unpaid people who helped with physical care or coping with the disease process. Caregiver characteristics and patient activity were examined to determine their relationships to caregiver needs, and needs were examined over time. The 90-item Home Caregiver Need Survey used in this study was developed by the author in 1989 and demonstrated internal consistency, reliability, and construct validity. Using factor analysis, six need categories were identified: psychological, informational, patient care, personal, spiritual, and household. Caregivers' greatest needs were informational and psychological. Significant correlations between certain caregiver characteristics and caregiver needs and between caregiver needs and patients' activity levels were found. Both the importance and satisfying of needs changed over time. Findings indicate the urgent need for nurses, who usually provide support for caregivers, to establish specific programs and services to meet the identified and unmet informational and psychological needs of caregivers of at-home patients with cancer. Frequent reassessment of caregiver needs seems to be indicated.

Adolescent↗

PubMed1991

Environmental risk factors in siblings with Parkinson's disease.

To investigate possible risk factors in Parkinson's disease, we conducted a case-controlled study of 19 families having two or more siblings with Parkinson's disease. Demographic data were collected, including lifetime histories of places of residence; sources of drinking water; occupations, such as farming; and exposure to herbicides and pesticides. Rural living and drinking well water, but not farming and herbicide exposure, were significantly increased in 38 parkinsonians compared with 38 normal control subjects. A comparison of parkinsonian siblings with siblings with essential tremor revealed no differences in any risk factors for the years of shared environment. These data suggest that living in a rural environment and drinking well water are risk factors for Parkinson's disease and that the total life exposure to an environmental toxin may be more important than exposure in early life.

Aged↗

PubMed1990

Health problems in Galena, Kansas: a heavy metal mining Superfund site.

Health problems at a heavy metal mining Superfund site were surveyed using prevalence information from 1980-85. Current environmental exposures include lead and cadmium in drinking water, mine wastes, and surface soils. Age- and sex-specific illness rates in whites in an exposed town (Galena) were compared with similar rates in two control towns. Multivariate analyses of morbidity data examined statistically significant risk factors for relevant illness in the three towns. Mortality rates for 1980-85 for white residents of Galena and for the U.S. were compared using univariate analysis. Among residents of the three towns who had lived there at least 5 years prior to 1980, there was either a statistically significant or borderline excess reported prevalence in Galena of chronic kidney disease (females aged greater than or equal to 65), heart disease (females aged greater than or equal to 45), skin cancer (males aged 45-64), and anemia (females aged 45-64). Multivariate analyses revealed statistically significant associations of stroke, chronic kidney disease, hypertension, heart disease, skin cancer, and anemia with variables related to Galena exposure. Personal physicians were contacted to confirm the information provided by the subjects; validity was good for all reported illnesses except chronic kidney disease. A statistically significant excess of deaths from hypertensive disease (females aged greater than or equal to 65), ischemic heart disease (males and females aged greater than or equal to 65), and stroke (females aged greater than or equal to 65) was found in residents of Galena City. This study confirms that environmental agents in Galena are associated with, and may have contributed to, the causation of several chronic diseases in residents of this community. Further studies are recommended.

Adult↗

PubMed1990

Univariate and multivariate statistical analysis of high-grade gliomas: the relationship of radiation dose and other prognostic factors.

Univariate and multivariate statistical analyses were used to examine the relationships between duration of survival and multiple variables in the presentation and treatment of 82 patients with high-grade gliomas (16 grade 3, 66 grade 4). The median survival time of the eight patients who received less than or equal to 40 Gy to the tumor bed was 16 weeks and was 17 weeks for the three who received between 40 and 50 Gy. Patients who received 50-60 Gy had a median survival time of 62 weeks, compared to 54 weeks in patients who received 60-70 Gy. These differences in median survival time were statistically significant between the extremes (p = 0.0001), as well as between the 40-50 Gy group and the 50-60 Gy group (p = 0.02). However, no significant difference could be detected between the groups receiving 50-60 Gy versus 60-70 Gy. Univariate analysis also identified preoperative performance status, age, histologic grade, extent of surgery, and seizure history as prognostic factors. Cox multivariate analysis was performed to identify variables that were significant in independently predicting duration of survival. Although contemporary studies have shown many variables to be significant in predicting survival, our analysis found that many of them were not independent predictors. The variables which independently predicted improved duration of survival were greater total radiation dose to the tumor bed (p less than 0.0001), superior preoperative performance status (p = 0.003), and grade 3 versus grade 4 (p = 0.04). Younger age at diagnosis was marginally significant (p = 0.07). In the group of 60 patients receiving greater than 50 Gy, a discriminant analysis was also performed. The patients were divided into two groups based on apparent clusters of survival times: greater than or equal to 60 weeks versus less than 60 weeks. The only variable that was found to be predictive of membership in the cluster with longer survival was the presence of seizure activity (p = 0.02). Although univariate and multivariate analyses both showed an apparent statistically significant improvement in survival with increasing total radiation dose to the tumor bed, no additional benefit could be demonstrated for doses greater than 60 Gy.

Age Factors↗

PubMed1990

Specific headache phenomena: their frequency and coincidence.

The correlation of specific headache attack characteristics derived from a standardized questionnaire was studied in a consecutive series of 392 patients attending a headache clinic. In patients reporting headache with aura such attacks tended to be infrequent, and the percentage of their headache attacks that were preceded by aura varied widely, many cases having very low percentages. Paresthesias as auras were uncommon and rarely occurred without visual aura. Unilateral headaches were associated with nausea to widely varying degrees. Most patients reported both unilateral headache and headache with tension characteristics. Definite history of hypertension was significantly correlated specifically with migraine with aura (classic migraine).

Adult↗

PubMed1990

Childhood cancer survivors: attained adult heights. Compared with sibling controls.

As part of a large collaborative study, the authors administered a pretested questionnaire to 62 childhood and adolescent cancer survivors and 62 same-sex sibling controls. The authors requested information regarding attained adult height on the questionnaire. Mean adult height of survivors (172.2 cm) was less than that of controls (174.1 cm), at a borderline significant difference of p = 0.0757. Multivariate analysis examined four potential, independent variables as possible predictors of this difference. The presence of brain tumor (vs. nonbrain tumor) (p less than .0001) and diagnosis at an early age (less than or equal to 8 years vs. 9-15 years) (p = .05) were factors significantly related to the differential; sex of patient and type of therapy were not. Our findings thus identify malignancy site and age at diagnosis as important predictors of adult height in childhood and adolescent cancer survivors.

Adolescent↗

PubMed1989

Headache as a risk factor in atherosclerosis-related diseases.

A group of 350 migraineurs (87 male, 263 female) and 300 controls without migraine (104 male, 196 female) were questioned about occurrence, in parents, of the atherosclerosis-related diseases (ASRD) of diabetes mellitus (DM), hypertension (HBP), myocardial infarction (MI), and stroke as well as about recurrent severe headache (RSHA). Occurrence of DM, HBP, MI and stroke was compared for mothers and fathers of migraine vs. those of control subjects and no significant differences were found. The mothers and fathers were pooled and resegregated by presence or absence of RSHA and then occurrence of DM, HBP, MI and stroke again compared. For mothers there was increased occurrence of stroke and DM in the RSHA group but the differences were not significant. For RSHA fathers there was increased incidence of MI (p less than .10) and HBP (p less than .01). Aggregate occurrence of all ASRD was evaluated for RSHA vs. no-RSHA parents. ASRD occurred more frequently in the RSHA than in the no-RSHA parents (p less than .05). Breakdown by age showed that this occurred at all ages in men (p less than .05) but in women the difference was significant only under age 60 (p less than .05). This study suggests that RSHA, which is primarily migraine, may be a risk factor or a marker for occurrence of ASRD.

Adult↗