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Biomedical subjects

S Ebrahim

Publications and source records attributed to S Ebrahim.

At least 73 records · Page 4Linked to original sources
PubMed2003

Performance of the WHO Rose angina questionnaire in post-menopausal women: are all of the questions necessary?

OBJECTIVE: To assess the performance of a shortened version of the Rose angina questionnaire focusing on exertional chest pain. METHODS: Cross sectional analysis of 3987 women aged 60 to 79 years from 23 British towns. The performances of definite Rose angina (using data from the full Rose angina questionnaire) and exertional chest pain (using data from a subset of three questions from the Rose angina questionnaire) were assessed against a medical record of angina. RESULTS: The sensitivity (the proportion with a medical record of angina who were identified as having angina by the questionnaire) was 29.9% (95% confidence intervals 25.7% to 34.4%) comparing definite Rose angina to any medical record of angina since 1978 and 50.7% (45.9% to 55.5%) comparing exertional chest pain to any medical record diagnosis of angina. The positive predictive values of both questionnaires were similar. When the two questionnaires were compared with a gold standard of a primary care consultation for angina symptoms within the past five years the sensitivity of definite Rose angina was 33.0% (26.9% to 39.6%) and that of exertional chest pain was 51.8% (45.1% to 58.5%). Although the sensitivity of both versions of the questionnaire was greater in those aged 60-69 years compared with those aged 70-79 years, it remained higher in the exertional chest pain version of the questionnaire than for definite Rose angina based on the full version of the questionnaire in both age groups. Performance of either version of the questionnaire was not affected by occupational social class. CONCLUSIONS: With respect to identifying women with a medical diagnosis of angina or those presenting to primary care with anginal symptoms, these results suggest that a shortened version of the Rose angina questionnaire focusing on exertional chest pain performs better than the full version. Other studies suggest that exertional chest pain is the crucial element of the Rose angina questionnaire with respect to predicting future coronary events. It is concluded that using a shortened version of the Rose angina questionnaire is adequate in epidemiological studies.

Aged↗
PubMed2003

Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling.

OBJECTIVE: To review the evidence for the effectiveness of different isolation policies and screening practices in reducing the incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonisation and infection in hospital in-patients. To develop transmission models to study the effectiveness and cost-effectiveness of isolation policies in controlling MRSA. DATA SOURCES: MEDLINE, EMBASE, CINAHL, The Cochrane Library and SIGLE (1966-2000). Hand-searching key journals. No language restrictions. REVIEW METHODS: Key data were extracted from articles reporting MRSA-related outcomes and describing an isolation policy in a hospital with epidemic or endemic MRSA. No quality restrictions were imposed on studies using isolation wards (IW) or nurse cohorting (NC). Other studies were included if they were prospective or employed planned comparisons of retrospective data. Stochastic and deterministic models investigated long-term transmission dynamics, studying the effect of a fixed capacity IW, producing economic evaluations using local cost data. RESULTS: A total of 46 studies were accepted: 18 IWs, 9 NC, 19 other isolation policies. Most were interrupted time series, with few planned formal prospective studies. All but one reported multiple interventions. Consideration of potential confounders, measures to prevent bias, and appropriate statistical analysis were mostly lacking. No conclusions could be drawn in a third of studies. Most others provided evidence consistent with reduction of MRSA acquisition. Six long interrupted time series provided the strongest evidence. Four of these provided evidence that intensive control measures which included patient isolation were effective in controlling MRSA. In two others IW use failed to prevent endemic MRSA. There was no robust economic evaluation. Models showed that improving the detection rate or ensuring adequate isolation capacity reduced endemic levels, with substantial savings achievable. CONCLUSIONS: Major methodological weaknesses and inadequate reporting in published research mean that many plausible alternative explanations for reductions in MRSA acquisition associated with interventions cannot be excluded. No well-designed studies allow the role of isolation measures alone to be assessed. Nonetheless, there is evidence that concerted efforts that include isolation can reduce MRSA even when endemic. Little evidence was found to suggest that current isolation measures recommended in the UK are ineffective, and these should continue to be applied until further research establishes otherwise. The studies with the strongest evidence, together with the results of the modelling, provide testable hypotheses for future research. Guidelines to facilitate design of future research are produced.

Cost-Benefit Analysis↗
PubMed2003

Pharmaceutical formulation of a fixed-dose anti-tuberculosis combination.

SETTING: Department of Pharmacy and Pharmacology, University of the Witwatersrand. Despite the availability of highly effective treatment regimens for tuberculosis (TB), the cure rate still remains relatively low. This may be attributed to the high incidence of patient non-compliance, which subsequently leads to the emergence of multidrug-resistant TB (MDR-TB). To avoid the problem of further creation and propagation of MDR-TB, it may be proposed that patients should be given fixed-dose combinations of anti-tuberculosis drugs whenever self-administration is permitted. OBJECTIVE: To optimise an anti-tuberculosis extemporaneous powder formulation for suspension in order to develop a fixed combination of rifampicin, isoniazid, pyrazinamide and ethambutol hydrochloride as a powder to be reconstituted with water by the patient prior to administration. METHODS: Different suspending agents were evaluated for their influence on powder flow properties, and sediment volume on the powder blends. Sodium starch glycolate was selected as the suspending agent because of its favourable powder flow properties and sediment volume produced. The dissolution characteristics of the extemporaneous powder for suspension were also compared to the dissolution profiles of commercially available anti-tuberculosis tablet dosage forms. RESULTS: The powder for suspension for rifampicin, isoniazid, pyrazinamide and ethambutol hydrochloride all compared favourably to the dissolution rate from the commercially available tablet dosage forms.

Administration, Oral↗
PubMed2002

The association between components of adult height and Type II diabetes and insulin resistance: British Women's Heart and Health Study.

AIMS/HYPOTHESIS: The aim of this study was to investigate the associations between components of adult height (leg length, trunk length, ratio of leg to trunk length) and Type II (non-insulin-dependent) diabetes mellitus and insulin resistance. METHODS: A cross sectional study was carried out on 4286 women of age 60 to 79 years from 23 towns across England, Scotland and Wales. RESULTS: Total height was weakly and inversely associated with diabetes but this masked differences in the association with leg and trunk length. Leg length was inversely associated with Type II diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (4.3 cm) increase in leg length: 0.81 (0.73, 0.90)] whereas trunk length was not associated with diabetes [age adjusted odds ratio (95% CI) for diabetes for each standard deviation (3.6 cm) increase in trunk length: 1.05 (0.94, 1.18)]. Adjustment for potential confounding factors attenuated but did not remove the inverse association between leg length and the prevalence of diabetes: fully adjusted odds ratio (95% CI) per standard deviation increase in leg length was 0.87 (0.77, 0.98) and that per standard deviation increase in the ratio of leg to trunk length was 0.88 (0.78, 0.99). In non-diabetic women leg length was inversely associated with insulin resistance, whereas trunk length was positively associated with insulin resistance. CONCLUSION/INTERPRETATION: Leg length is an indicator of early childhood environmental circumstances, in particular of infant nutrition. These results suggest that poor infant nutrition is an important causal factor in the development of Type II diabetes and insulin resistance in later life.

Aged↗
PubMed2002

The validity, reliability and responsiveness of the Nottingham Extended Activities of Daily Living scale in patients undergoing total hip replacement.

PURPOSE: The Nottingham Extended Activities of Daily Living (EADL) scale is a popular outcome measure in stroke research. Its psychometric properties have not been tested in other conditions. METHODS: EADL has been measured before, three and six months after hip arthroplasty. A sample was retested for reliability. Comparisons were made with the SF-36 and London Handicap Scale. Standard psychometric parameters were calculated. RESULTS: The sub-scales and total score were approximately unidimensional on factor analysis and Cronbach's alpha, but did not form an adequate hierarchical (Guttmann) scale. Associations with other scales were in the expected direction and of approximately the expected strength, supporting concurrent and construct validity. Reliability was good. Responsiveness was poor compared with the other scales. CONCLUSIONS: The EADL is valid in patients with arthritis of the hip, and is reliable. However, it underestimates the size of health gain after hip arthroplasty compared with other scales.

Activities of Daily Living↗
PubMed2002

Trypanocidal drugs for chronic asymptomatic Trypanosoma cruzi infection.

BACKGROUND: Prior guidelines stated that trypanocidal therapy should not be used for treating chronic asymptomatic Trypanosoma cruzi infections. However, the recent availability of clinical trials reporting high rates of parasitologic cure in children with early chronic T. cruzi infection have produced changes of these recommendations in some countries. Because of the uncertainty regarding best treatment for this stage of T. cruzi infections, the literature was reviewed systematically for a synthesis of the available evidence. OBJECTIVES: To assess the effects of trypanocidal therapy for chronic asymptomatic T. cruzi infection. SEARCH STRATEGY: We searched The Cochrane Controlled Trials Register (Issue 1, 2000), MEDLINE (start-Nov 1999), EMBASE (start - Feb 2000), LILACS (start - Feb 2000) and the Tropical Diseases Research Division of WHO database (Start - Feb 2000). Reference lists of articles were searched for relevant material. SELECTION CRITERIA: Published RCTs of trypanocidal therapy for people with chronic, asymptomatic T. cruzi infections DATA COLLECTION AND ANALYSIS: Two reviewers independently screened papers for inclusion criteria, quality assessment and data extraction. Forms were used to collect data. Reviewers resolved differences by discussion then a third reviewer if necessary. MAIN RESULTS: Of 43 papers assessed for inclusion, five RCTs (total population=756) met the inclusion criteria. The quality of the trials was rated as low (n=3) or intermediate (n=2). Two RCTs tested benznidazole in school children and three tested different agents in adults. The Odds Ratios and their 95%CI (Fixed models) were: Incidence of ECG abnormalities: 0.41 (0.09, 1.85); Negative seroconversion (AT ELISA): 10.91 (6.07, 19.58); Negative xenodiagnosis during the follow up: 5.37 (3.34, 8.64); Standardised mean reduction of antibody titres: 0.54 (0.31, 0.84). Nitroimidazolic derivatives substantially and significantly modified parasite-related outcomes compared to placebo. Other agents showed borderline or not significant effect. REVIEWER'S CONCLUSIONS: Despite major public health importance, trypanocidal.therapy for chronic asymptomatic T. cruzi infection has been tested in few, small size RCTs which were designed to assess parasitic-related, but not clinical outcomes. Therefore, the potential of trypanocidal therapy to prevent Chagas' disease among asymptomatic, chronically infected subjects is promising, but remains to be evaluated. trypanocidal therapy, particularly nitroimidazolic derivatives given to children or adults with positive xenodiagnosis improve parasite-related outcomes. The large contrast between the burden of Chagas disease and the existing evidence on its prevention points the need to test these or newer agents in more and larger RCTs that include clinical endpoints.

Animals↗
PubMed2002

Ketorolac, diclofenac, and ketoprofen are equally safe for pain relief after major surgery.

BACKGROUND: Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery. METHODS: This prospective, randomized multicentre trial evaluated the risks of death, increased surgical site bleeding, gastrointestinal bleeding, acute renal failure, and allergic reactions, with ketorolac vs diclofenac or ketoprofen administered according to their approved parenteral and oral dose and duration of treatment. Patients were followed for 30 days after surgery. RESULTS: A total of 11,245 patients completed the trial at 49 European hospitals. Of these, 5634 patients received ketorolac and 5611 patients received one of the comparators. 155 patients (1.38%) had a serious adverse outcome, with 19 deaths (0. 17%), 117 patients with surgical site bleeding (1.04%), 12 patients with allergic reactions (0.12%), 10 patients with acute renal failure (0.09%), and four patients with gastrointestinal bleeding (0.04%). There were no differences between ketorolac and ketoprofen or diclofenac. Postoperative anticoagulants increased the risk of surgical site bleeding equally with ketorolac (odds ratio=2.65, 95% CI=1.51-4.67) and the comparators (odds ratio=3.58, 95% CI=1.93-6.70). Other risk factors for serious adverse outcomes were age, ASA score, and some types of surgery (plastic/ear, nose and throat, gynaecology, and urology). CONCLUSION: We conclude that ketorolac is as safe as ketoprofen and diclofenac for the treatment of pain after major surgery.

Acute Kidney Injury↗
PubMed2002

Molecular typing of Treponema pallidum in South Africa: cross-sectional studies.

We evaluated a molecular subtyping system for Treponema pallidum for its ability to differentiate between strains obtained from male patients with primary syphilis in South Africa. Of 201 T. pallidum-positive specimens, 161 were typeable, revealing 35 subtypes. The unique subtypes identified in Durban, Cape Town, and Carletonville and the total number of subtypes suggested that the strain population was very diverse and varied geographically.

Bacterial Typing Techniques↗
PubMed2002

Sexual intercourse and risk of ischaemic stroke and coronary heart disease: the Caerphilly study.

OBJECTIVE: To examine the relation between frequency of sexual intercourse and risk of ischaemic stroke and coronary heart disease. DESIGN: Cohort study with 20 year follow up. SETTING: The town of Caerphilly, South Wales and five adjacent villages. SUBJECTS: 914 men aged 45-59 years at time of recruitment in 1979 to 1983. MAIN OUTCOME MEASURES: Ischaemic stroke and coronary heart disease, all first events and fatal events. RESULTS: Of the 914 men studied, 197 (21.5%) reported sexual intercourse less often than once a month, 231 (25.3%) reported sexual intercourse twice or more a week, and the remaining 486 (53.2%) men fell into the intermediate category. Frequency of sexual intercourse was not associated with all first ischaemic stroke events: age adjusted odds ratios (95% CI) for intermediate and low frequency of sexual intercourse of 0.61 (0.32 to 1.16) and 0.71 (0.34 to 1.49) respectively compared with the reference category of high frequency. A graded relation with fatal coronary heart disease events was observed in events recorded up to 10 years. The age adjusted relative risk (95% CI) of fatal coronary heart disease contrasting low frequency of sexual intercourse (that is, less than monthly) with the highest group (at least twice a week) was 2.80 (1.13 to 6.96, test for trend, p=0.04) which was not attenuated by adjustment for a wide range of potential confounders. Longer follow up to 20 years showed attenuation of this risk with odds of 1.69 (95% CI 0.90 to 3.20), contrasting low frequency of sexual intercourse with the highest group. CONCLUSIONS: The differential relation between frequency of sexual intercourse, stroke and coronary heart disease suggests that confounding is an unlikely explanation for the observed association with fatal coronary heart disease events. Middle aged men should be heartened to know that frequent sexual intercourse is not likely to result in a substantial increase in risk of strokes, and that some protection from fatal coronary events may be an added bonus.

Cerebrovascular Disorders↗
PubMed2002

Is housework good for health? Levels of physical activity and factors associated with activity in elderly women. Results from the British Women's Heart and Health Study.

OBJECTIVE: To determine the prevalence of achieving new recommended levels of physical activity, the types of activity involved, and their determinants among elderly British women. DESIGN: National cross sectional survey. PARTICIPANTS: 2341 women aged 60 to 79 from 15 British towns. MAIN OUTCOME MEASURES: Prevalence of subjects achieving recommended levels of physical activity. RESULTS: Over two thirds of the participants were active at new recommended levels. This was mainly achieved through participation in heavy housework. If domestic activities were excluded only 21% were regularly active. Women who participated in brisk walking for at least 2.5 hours per week had reduced odds of being overweight: odds ratio (95% confidence intervals) 0.5 (0.3 to 0.6) after adjustment for other forms of activity, health status, smoking, and socioeconomic position. Participating in at least 2.5 hours of heavy housework was not associated with reduced odds of being overweight 1.1 (0.8 to 1.4). Age, self reported poor health status, coronary heart disease, and respiratory disease were independently associated with reduced odds of participating in all types of activity. In addition participation in brisk walking and physical exercise were less likely in current smokers, those from the lowest socioeconomic class, and those living in the north of the country. Participation in heavy housework was less likely in women reporting depression but was not associated with smoking, socioeconomic class, or area of residence. CONCLUSIONS: If new physical activity recommendations, which include domestic activities, are used to assess population levels of physical activity then it seems that the majority of elderly women are sufficiently active. Heavy housework is not associated with reduced levels of being overweight and prospective studies are necessary to demonstrate an independent health benefit of participating in domestic activities.

Aged↗
PubMed2001

Sex matters: secular and geographical trends in sex differences in coronary heart disease mortality.

OBJECTIVE: To examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and investigate how these relate to distributions in risk factors. DESIGN: National and international data were used to examine secular trends and geographical variations in sex differences in mortality from coronary heart disease and risk factors. SETTING: England and Wales, 1921-98; Australia, France, Japan, Sweden, and the United States, 1947-97; 50 countries, 1992-6. DATA SOURCES: Office for National Statistics, World Health Organization, and Food and Agriculture Organization of the United Nations. RESULTS: The 20th century epidemic of coronary heart disease affected only men in most industrialised countries and had a very rapid onset in England and Wales, which has been examined in detail. If this male only epidemic had not occurred there would have been 1.2 million fewer deaths from coronary heart disease in men in England and Wales over the past 50 years. Secular trends in mean per capita fat consumption show a similar pattern to secular trends in coronary heart disease mortality in men. Fat consumption is positively correlated with coronary heart disease mortality in men (r(s)=0.79; 95% confidence interval 0.70 to 0.86) and inversely associated with coronary heart disease mortality in women (-0.30; -0.49 to -0.08) over this time. Although sex ratios for mortality from coronary heart disease show a clear period effect, those for lung cancer show a cohort effect. Sex ratios for stroke mortality were constant and close to unity for the entire period. Geographical variations in the sex ratio for coronary heart disease were associated with mean per capita fat consumption (0.64; 0.44 to 0.78) but were not associated with the sex ratio for smoking. CONCLUSION: Sex differences are largely the result of environmental factors and hence not inevitable. Understanding the factors that determine sex differences has important implications for public health, particularly for countries and parts of countries where the death rates for coronary heart disease are currently increasing.

Adult↗
PubMed2001

Variability of angina symptoms and the risk of major ischemic heart disease events.

Variability of angina symptoms over a 5-year period was examined in a prospective study, in which 7,109 British middle-aged men completed two chest pain questionnaires, Q1 (1978-1980) and Q5 (1983-1985), and were classified as having no chest pain, nonexertional chest pain, or angina (Q) (exertional chest pain) on each occasion. Within persons, there was considerable variability in response to the chest pain questions at Q1 and Q5. Angina (Q) persistence showed marked associations with previous myocardial infarction, diagnosed angina, electrocardiogram ischemia, and subsequent major ischemic heart disease events from Q5 onward. Compared with men without angina (Q), the age-adjusted hazard ratios were 1.5 (95% confidence interval (CI): 1.1, 2.2) for angina (Q) at Q1 only, 2.6 (95% CI: 2.1, 3.2) for angina (Q) at Q5 only, and 3.4 (95% CI: 2.8, 4.3) for angina (Q) on both occasions. For men without diagnosed ischemic heart disease, for whom apparent remission of angina (Q) was particularly frequent, a similar pattern of association was found between angina (Q) persistence and subsequent major events. In middle-aged men, exertional chest pain is a strong indicator of major coronary risk but frequently appears transient in the longer term. Persistently reported symptoms are associated with severe disease and a poor prognosis.

Adult↗