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Biomedical subjects

S Grover

Publications and source records attributed to S Grover.

At least 181 records · Page 10Linked to original sources
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Can computerized risk profiles help patients improve their coronary risk? The results of the Coronary Health Assessment Study (CHAS).

BACKGROUND: The Coronary Health Assessment Study (CHAS) was developed to determine the feasibility of using patient-specific, multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD. METHODS: Study participants included 253 community based physicians, randomized into profile and control groups, and 958 of their patients. The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback. The control group received their profiles only if the patient was clinically reevaluated during a 3-month follow-up visit. Patients' coronary risk factors were evaluated at baseline and at follow-up. RESULTS: The profile group had a significantly higher (P < 0.05) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group (1.23 vs 0.77). The patients in the profile group also had significantly (P < 0.05) greater mean reductions in total cholesterol (-0.5 vs -0.1 mmol/L), LDL cholesterol (-0.4 vs 0.0 mmol/L), the total cholesterol/ HDL ratio (-0.6 vs -0.2), and the predicted 8-year coronary risk (-1.8 vs -0.3%). CONCLUSIONS: Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients. Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients.

Adult↗
PubMedDate not supplied

Predictors of visual acuity and the relative afferent pupillary defect in optic neuropathy.

The relationships among visual acuity (log MAR), diagnostic category, age, the magnitude of a relative afferent pupillary defect (RAPD) in log units, photopic foveal thresholds to white and colored light (dB), and the mean deviation on the Humphrey visual field (dB) were studied in patients with various optic neuropathies. All acuity and dB values were expressed as interocular differences, the majority of cases having normal acuity in the fellow eye. In multiple regression analyses, acuity and RAPD were alternately chosen as the dependent or response variable with all remaining variables serving as the predictors or independent variables. The main finding was that the only significant predictor of a RAPD was the interocular mean deviation difference on the Humphrey field and the only significant predictor of acuity was the foveal threshold to white light. Redundant and insignificant variables were therefore identified with multiple regression analysis. Subsidiary findings include: (a) although diagnostic group was not a significant predictor in the above, simple linear regression line slopes relating RAPD magnitude to the Humphrey mean deviation were significantly different between optic neuritis and compression categories; (b) for a given level of acuity, foveal thresholds were substantially worse in these cases with neuronal damage than in strabismic amblyopia, refractive error, or corneal damage; and (c) sensitivity losses for red vs. blue light were similar.

Adaptation, Ocular↗
PubMedDate not supplied

Who needs an exercise stress test? Evaluating the new American College of Sports Medicine risk stratification guidelines.

PURPOSE: The American College of Sports Medicine recently published new guidelines to classify individuals at increased risk for coronary heart disease (CHD) before starting a vigorous (> 60% maximum oxygen consumption) exercise program. We compared the prognostic value of the new guidelines to the earlier guidelines. METHODS: Subjects included men and women over 30 years of age, free from known CHD according to the Lipid Research Clinic Follow-up Cohort. Endpoints included an abnormal exercise test result (+/- 1 mm ST, anginal chest pain, or exercise hypotension) and future death of CHD ascertained during an average 12.2 years of follow-up. Data analysis included 2 x 2 contingency tables to compare the test characteristics of the old and new guidelines. RESULTS: Among 4,074 subjects, 219 (5.4%) had abnormal exercise test results and 65 (1.6%) eventually died of CHD. The new guidelines classified 75.7% of individuals as high risk versus 58.7% using the old guidelines. Comparing the new guidelines with the old, test sensitivity was significantly (P = 0.007) higher for patients with an abnormal exercise test result (87% versus 77%) than for patients who died of CHD (100% versus 99%). Test specificity of the new guidelines was significantly (P < 0.001) lower than the old guidelines for individuals with abnormal exercise test results (25% versus 42%) and those who died of CHD (25% versus 42%). The new guidelines also showed significantly lower overall diagnostic accuracy and positive likelihood ratios compared with the old guidelines for both patients with abnormal exercise test results and those who died of CHD. The positive predictive value for the new and old guidelines for both patients with abnormal exercise test results and those who died of CHD were similar. CONCLUSIONS: Although the new guidelines are more sensitive in the abnormal exercise test result endpoint, they are less specific and overall less accurate than the old guidelines given the low prevalence of CHD in this asymptomatic population. The current guidelines should be modified to better target high-risk adults.

Adult↗
PubMedDate not supplied

Point surveillance of Staphylococcus aureus carriage among medical staff in Infectious Diseases Hospital, Kuwait.

OBJECTIVE: To investigate the carriage of Staphylococcus aureus among doctors and nurses in Infectious Diseases Hospital, Kuwait, following the detection of 3 cases of methicillin-resistant S. aureus (MRSA). MATERIALS AND METHODS: A total of 260 nasal and throat swabs were obtained from 19 doctors and 111 nurses and cultured for the carriage of S. aureus. Forty-three S. aureus were identified based on their growth characteristics on mannitol-salt agar, catalase and tube coagulase and DNA hydrolysis. The isolates were tested for susceptibility to antibacterial agents and typed by phage typing; plasmid analysis and pulsed-field electrophoresis were carried out to determine their relatedness. RESULTS: Of the 19 doctors, 4 (21%) had nasal carriage while only 1 of them had a throat carriage. Sixteen (14.4%) nurses carried S. aureus in their noses and 20 (18%) in their throats. The combined nasal carriage rate for both doctors and nurses was 15.8%, and combined throat carriage was 16.6%. None of them carried MRSA. The isolates were resistant to penicillin G (90%), tetracycline (23.3%), erythromycin (9.3%) and cadmium (100%). Typing of the isolates showed a variety of phage types, plasmid and pulsed-field gel electrophoresis patterns. DISCUSSION: None of the doctors or nurses carried MRSA. Typing of the methicillin-susceptible strains that they carried demonstrated that the S. aureus were different, indicating an absence of a dominant clone capable of spreading. It is important to maintain a low carriage of S. aureus among health-care workers.

Bacteriophage Typing↗
PubMedDate not supplied

Two cases of subungual glomus tumor.

Glomus tumors are uncommon, small, painful, and usually benign hamartomas arising from the arterial end of the glomus body. They often present early in the subungual stage because of intense pain. Two female patients with subungual glomus tumor are reported here. The intense pain associated with this tumor had led to disuse atrophy of the upper limb in one case. Hildreth's sign and Love's test were positive in both, but imaging did not help in preoperative diagnosis. Tumors were resected by transungual approach, leaving a 3-mm-wide margin. There was no recurrence after 1-year follow-up in both instances.

Adult↗