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Biomedical subjects

R Zaman

Publications and source records attributed to R Zaman.

At least 19 recordsLinked to original sources

Deficit in motor performance correlates with changed corticospinal excitability in patients with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is characterised by fatigue and musculosketetal pain, the severity of which is variable. Simple reaction times (SRTs) and movement times (SMTs) are slowed in CFS. Our objective is to correlate the day-to-day changes in symptomatology with any change in SRT, SMT or corticospinal excitability. Ten CFS patients were tested on two occasions up to two years apart. Motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) of the motor cortex were recorded from the thenar muscles. Threshold TMS strength to evoke MEPs was measured to index corticospinal excitability. SRTs and SMTs were measured. The percentage change in both SRTs and SMTs between the two test sessions correlated with the percentage change in corticospinal excitability assessed according to threshold TMS intensity required to produce MEPs. This study provides evidence that changing motor deficits in CFS have a neurophysiological basis. The slowness of SRTs supports the notion of a deficit in motor preparatory areas of the brain.

Adult↗

Relative increase in choline in the occipital cortex in chronic fatigue syndrome.

OBJECTIVE: To test the hypothesis that chronic fatigue syndrome (CFS) is associated with altered cerebral metabolites in the frontal and occipital cortices. METHOD: Cerebral proton magnetic resonance spectroscopy (1H MRS) was carried out in eight CFS patients and eight age- and sex-matched healthy control subjects. Spectra were obtained from 20 x 20 x 20 mm3 voxels in the dominant motor and occipital cortices using a point-resolved spectroscopy pulse sequence. RESULTS: The mean ratio of choline (Cho) to creatine (Cr) in the occipital cortex in CFS (0.97) was significantly higher than in the controls (0.76; P=0.008). No other metabolite ratios were significantly different between the two groups in either the frontal or occipital cortex. In addition, there was a loss of the normal spatial variation of Cho in CFS. CONCLUSION: Our results suggest that there may be an abnormality of phospholipid metabolism in the brain in CFS.

Adult↗

Voluntary motor function in patients with chronic fatigue syndrome.

INTRODUCTION: The pathogenesis of chronic fatigue syndrome (CFS) remains unknown. In particular, little is known of the involvement of the motor cortex and corticospinal system. METHODS: Transcranial magnetic stimulation (TMS) was used to assess corticospinal function in terms of latency and threshold of motor-evoked potentials (MEPs) in thenar muscles. Reaction times and speed of movement were assessed using button presses in response to auditory tones. RESULTS: Patients had higher (P<.05) self-assessed indices of fatigue (7/10) than for pain (5/10), anxiety (4/10) or depression (3/10). Mean (+/-S.E.M.) simple reaction times (SRTs) were longer (P<.05) in the patients (275+/-19 ms) than in the controls (219+/-9 ms); choice reaction times (CRTs) were not significantly longer in the patients. Movement times, once a reaction task had been initiated, were longer (P<.05) in the patients in both SRTs (patients, 248+/-13 ms; controls, 174+/-9 ms) and CRTs (patients, 269+/-13 ms; controls, 206+/-12 ms). There was no difference (P>.05) in threshold or latency of MEPs in hand muscles between the patients (threshold, 54.5+/-2.2% maximum stimulator output [% MSO]; latency 22+/-0.3 ms) and controls (threshold 54.6+/-3.6% MSO; latency 22.9+/-0.5 ms). Regression analysis showed no correlation (P>.05) of SRTs with either threshold for MEPs or fatigue index. CONCLUSION: Corticospinal conduction times and excitability were within the normal range despite a slower performance time for motor tasks and an increased feeling of fatigue. This suggests that the feeling of fatigue and the slowness of movement seen in CFS are manifest outside the corticospinal system.

Adult↗

Somatopy of perceptual threshold to cutaneous electrical stimulation in man.

Neurological testing tools for measuring and monitoring somatosensory function lack resolution and are often dependent on the clinician testing. In this study we have measured perceptual threshold (PT) to electrical stimulation of the skin and compared it with two-point discriminative ability (TPDA) in 12 control subjects. Tests were made on both sides of the body at American Spinal Injury Association (ASIA) key points on seven spinal dermatomes (C3 (neck), C4 (shoulder), C5 (upper arm), C6 (thumb), T8 (abdomen), L3 (knee), L5 (foot)) and in the mandibular (chin) and maxillary (cheek) fields of the trigeminal (V) nerve. Electrical stimulation (0.5 ms pulse width; 3 Hz) was applied via a self-adhesive cathode and an anode strapped to the wrist or ankle. The stimulus intensity was adjusted and PT was recorded as the lowest current at which the subject reported sensation. Sites were tested in random order. Indices for both TPDA and PT differed according to the dermatome tested but there was no correlation between TPDA and PT for any dermatome. There was good correlation between results from equivalent dermatomes on left and right sides for both PT and TPDA. Women frequently had lower mean (+/- S.E.) PTs and better TPDA than men; differences were significant (P < 0.05) for PT on the knee (women, 1.31 +/- 0.15 mA; men, 2.05 +/- 0.26 mA) and the foot (women, 2.90 +/- 0.19 mA; men, 4.13 +/- 0.28 mA) and for TPDA on the thumb (women, 3.8 +/- 0.2 mm; men, 7.8 +/- 1.3 mm) and the knee (women, 17.8 +/- 1.6 mm; men, 27.1 +/- 4.0 mm). Four subjects repeated the experiment on another day and the results correlated well with the first test for PT (r2, 0.62) and TPDA (r2, 0.48). PT differs between dermatomes in a predictable way but does not relate to TPDA. PT is easy to measure and may be a useful assessment tool with which to monitor recovery or deterioration in neuropathies, neurotrauma or after surgery.

Adult↗

Corticospinal inhibition appears normal in patients with chronic fatigue syndrome.

The pathogenesis of chronic fatigue syndrome (CFS) remains unknown. Thresholds and latencies of motor evoked potentials (MEPs) in response to transcranial magnetic stimulation (TMS) are normal but intracortical inhibition has not been investigated. Eleven patients with CFS were compared with 11 control subjects. Each patient completed a questionnaire using visual analogue indices of pain, fatigue, anxiety and depression. Subjects released a button to initiate simple (SRTs) and choice reaction time (CRTs) tasks; for each task, movement times were measured between release of the initiation button and depression of a second button 15 cm away. Subjects held a 10 % maximum voluntary contraction in the thenar muscles of their dominant hand while TMS was applied to the motor cortex; the duration and extent of inhibition of surface electromyographic (EMG) activity were assessed at stimulus strengths above and below the threshold for MEPs. Patients had significantly (P < 0.05) higher mean indices of fatigue than of pain, anxiety or depression. Mean (+/- S.E.M.) SRTs (but not CRTs) were longer in patients (309 +/- 45 ms) than in controls (218 +/- 9 ms). Movement times were longer in patients for both SRTs and CRTs. TMS thresholds, expressed as a percentage of the maximum stimulator output, were not significantly (P > 0.05) different in both groups for both MEPs (patients, 34 +/- 3%; controls, 36 +/- 3%) and inhibition of voluntary contraction (patients, 29 +/- 2%; controls, 34 +/- 4%). The duration and extent of inhibition did not differ significantly between groups at any stimulus strength. The pattern of change in duration and extent of inhibition with increasing stimulus intensity was no different in the two groups. The duration and extent of corticospinal inhibition in patients with CFS did not differ from controls, adding further evidence to the notion that the feeling of fatigue and the slowness of movement seen in CFS is not manifest in corticospinal output pathways.

Adult↗

Heterogeneous distribution of amyotrophic lateral sclerosis patients with SOD-1 gene mutations: preliminary data on an Italian survey.

We report the absence of superoxide dismutase (SOD-1) gene mutations in 30 patients with amyotrophic lateral sclerosis (ALS) including individuals with a confirmed family history of ALS (familial ALS/FALS), ALS with an unclear family history (UFALS) and sporadic ALS (SALS). Single strand conformation polymorphism (SSCP) and sequence analysis of the 5 SOD-1 gene exons were undertaken to improve the accuracy of the mutation detection. Our preliminary data appear to diverge from the results of studies by other groups using different populations. We discuss the possible reasons for this disparity and the apparent heterogeneous distribution of ALS with SOD-1 gene mutations among different ethnic groups.

Adult↗

Learned control of slow potential interhemispheric asymmetry in schizophrenia.

We report on the feasibility of teaching 16 (DSM-IV) schizophrenic patients, subdivided by syndrome, self-regulation of interhemispheric asymmetry having demonstrated efficient learning of interhemispheric control in normal subjects. Reversal of asymmetry may be important to treatment and recovery in schizophrenia for following improvement on neuroleptic drugs functional hemispheric asymmetries have reversed, with directions of reversal and pre-existing asymmetry dependent on syndrome. Asymmetry reversal in animals, manifested by spatial turning tendencies, has been used as a marker of neuroleptic action and involves striatal dopamine under reciprocal hemispheric control. We gave as feedback the left right asymmetry in slow potential negativity recorded from the sensory motor strip (C3,4). Feedback took the form of a rocket on a screen which rose or fell with leftward or rightward shifts in negativity. Patients were able to learn control (P < 0.01). In those patients with lesser ability this was due to inability to sustain concentration throughout the session rather than slow initial learning. Active syndrome patients were better able to shift negativity rightward and withdrawn patients leftward, directions associated with drug reversal of functional asymmetry and symptom recovery for each syndrome. Accordingly our demonstration that many symptomatic schizophrenic patients are capable of learning control opens the door to electrocortical operant conditioning training in schizophrenia with therapeutic regimens.

Adult↗

Mortality in a hospitalized mentally handicapped population: a 10-year survey.

The mortality experiences of a hospitalized mentally handicapped population between 1981 and 1990 (inclusive) were examined. A continued trend for increasing longevity in both males and females was found, with mean ages at death now approaching those in the general population. The commonest cause of death was non-tubercular respiratory infection, from which patients were particularly at risk during the months of December to February (inclusive). Patients diagnosed as suffering from psychoses other than schizophrenia and mood disorder had an increased mortality and should be thoroughly investigated for the presence of organic pathology. Epilepsy and Down's syndrome were associated with increased risk of earlier death, although in the case of Down's syndrome there has been a marked increase in longevity.

Adult↗

Methicillin resistant Staphylococcus aureus (MRSA) isolated in Saudi Arabia: epidemiology and antimicrobial resistance patterns.

Methicillin resistant Staphylococcus aureus (MRSA) comprised about 7.5% per annum of all S. aureus isolated in a general hospital in Jeddah, Saudi Arabia during the 3 year period 1990-1992. Most isolates were from wound sites (71%). Resistance to gentamicin (83%) and tetracycline (93%) was frequently observed whilst resistance to ciprofloxacin (1%) and rifampicin (6%) was uncommon. Low levels of mupirocin resistance (MIC 8 mg l-1), were detected in 3% of all MRSA isolates.

Aged↗

Campylobacter enteritis in Saudi Arabia.

A 12-month survey on the incidence of campylobacter infection in 1217 patients with diarrhoea was carried out in Jeddah, Saudi Arabia. Campylobacters were isolated from 55 (4.5%) patients, second in prevalence to salmonellas (6.2%). Shigellas were isolated from 4.2% of patients. Campylobacter isolation rates were high in children of all ages, as well as in young adults (36.5% of all isolates were from adults aged 20-39 years). Isolation rates peaked in September and November. Analysis of the results showed that 69% were Campylobacter jejuni (mostly biotype IV) and 31% C. coli. Serogroups 5 and 23 (Penner scheme) and phage type 125 (Preston scheme) were most frequently isolated. Resistance to erythromycin and tetracycline was observed in 7.3 and 32.7% of the isolates. Campylobacters are an important cause of bacterial enteritis in Saudi Arabia, both in adults and in children, and should be sought routinely.

Acute Disease↗

Tuberculosis in Saudi Arabia: epidemiology and incidence of Mycobacterium tuberculosis and other mycobacterial species.

The epidemiology of mycobacterial infections was studied in a wide cross-section of the Jeddah population over 2 years (1987-1989). Saudis, non-Saudis and patients from a stable population attending National Guard King Khalid Hospital (NGKKH) were compared. The ratio of Saudi to non-Saudi was 1:2 and males accounted for 65% of the total. The incidence was highest among young adults although the peak varied slightly between Saudi and non-Saudi patients. Extra-pulmonary tuberculosis was also preponderant among young adults, particularly females. Variants of Mycobacterium tuberculosis were investigated for the first time in Saudi Arabia. African and Asian variants were isolated from both Saudi and non-Saudi patients, the former being more numerous. Extra-pulmonary tuberculosis, particularly lymphadenopathy, accounted for a large proportion of mycobacterial infections, 59% at NGKKH. Mycobacterial species other than M. tuberculosis were fully identified and accounted for 9% of the isolates, Mycobacterium fortuitum and Mycobacterium chelonei being the two most prevalent.

Adolescent↗

Tuberculosis in Saudi Arabia: initial and secondary drug resistance among indigenous and non-indigenous populations.

Resistance to six anti-mycobacterial agents rifampicin, isoniazid, streptomycin, ethambutol, p-amino salicylic acid and cycloserine was studied. Variations in the resistance pattern among Saudi, non-Saudi and a stable National Guard King Khalid Hospital (NGKKH) population were investigated. A high percentage of relapse cases, 21%, was recorded. Among the NGKKH population this figure was much lower, 9.9%. Resistance to rifampicin alone was high at 7.2% followed by streptomycin 3.3%, isoniazid 1.8%, p-amino salicylic 1.2% and cycloserine 0.8%. Resistance to rifampicin alone was higher among 'new' cases whilst combined resistance to two or more drugs was seen more often in 'old' patients. Resistance was seen more frequently among non-Saudis, both 'old' and 'new'. An unusual finding was the prevalence of rifampicin resistance among non-pulmonary isolates.

Antitubercular Agents↗

Beta-adrenoceptor blocker pharmacokinetics and the oral contraceptive pill.

Higher AUC and Cmax values were obtained for metoprolol, oxprenolol and propranolol in groups receiving the low-dose oestrogen-ethinyl oestradiol oral contraceptive, but statistical significance was reached only with metoprolol AUC. The oral contraceptive had the opposite effect on acebutolol AUC and Cmax but this was not significant. The oral contraceptive had no detectable effects on the tmax and t 1/2 values of any of the beta-adrenoceptor blockers.

Acebutolol↗

Terconazole - a new broad-spectrum antifungal.

Terconazole, a new triazole ketal, is found to be highly active in vitro on a wide range of yeasts and mycelium-forming fungi. The in vitro activity depends largely on the medium used. In vitro it is a potent antifungal agent in preventing the morphogenetic transformation of the yeast into the (pseudo-)mycelium form of Candida albicans. In vivo terconazole is highly active in topical treatment of various experimental models of dermatophytosis and candidosis. It also possesses moderate oral broad-spectrum activity. No side effects were observed.

Administration, Oral↗