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Biomedical subjects

S Grover

Publications and source records attributed to S Grover.

At least 37 records · Page 2Linked to original sources
PubMed2000

Temporal frequency deficits in the electroretinogram of the cone system in X-linked retinoschisis.

We investigated the extent of, and basis for, abnormalities in the flicker electroretinogram (ERG) of the cone system of patients with X-linked retinoschisis (XLRS), a form of hereditary vitreoretinal degeneration. ERGs were recorded from six patients with XLRS and from six visually normal subjects using high-contrast sinusoidal flicker that ranged in temporal frequency from 8 to 96 Hz, and that was presented against a rod-desensitizing adapting field. Compared to the control subjects, the patients with XLRS showed a significant reduction in the amplitude of the ERG response fundamental at temporal frequencies of 32 Hz and higher. In addition, their response phases were at or below the lower limits of normal (representing a phase lag) for temporal frequencies greater than 8 Hz. The higher harmonics of the patients' ERG responses to a low frequency stimulus were attenuated over the same temporal frequency range as was the response fundamental. This finding indicates that a major component of the abnormal temporal filtering responsible for the ERG abnormalities in XLRS occurs beyond the level of the early retinal nonlinearity that generates the harmonic components of the ERG response, and therefore is most likely postreceptoral in origin. Consistent with this interpretation, the ERG waveforms of the XLRS patients showed a significant attenuation of the ON-response component, with a normal OFF response. The overall pattern of results suggests that the marked reduction of ERG response amplitudes and the phase lag at the higher temporal frequencies in XLRS stem, at least in part, from a predominant attenuation of the ON-bipolar cell contribution to the flicker ERG.

Adolescent↗
PubMed2000

A longitudinal study of visual function in carriers of X-linked recessive retinitis pigmentosa.

OBJECTIVE: This study was carried out to evaluate the progression of visual function impairment in carriers of X-linked recessive retinitis pigmentosa. We also assessed the relationship between the retinal findings at presentation and the extent of deterioration. DESIGN: Observational, retrospective, case series. PARTICIPANTS: Twenty-seven carriers of X-linked recessive retinitis pigmentosa. METHODS: Each carrier was clinically categorized into one of four grades (grades 0 through 3) depending on the presence or absence of a tapetal-like retinal reflex and the extent of peripheral pigmentary degeneration. A complete ophthalmologic examination was performed and data for visual acuity, visual field area, and electroretinographic measurements were collected on the most recent visit in both eyes. These were then compared with similar data obtained on their initial visits. MAIN OUTCOME MEASURES: A comparison of visual function was carried out between the initial visit and the most recent visit on each carrier. The visual acuity was measured with Snellen's acuity charts. The visual fields to targets V-4-e and II-4-e were planimeterized and used for the analysis. The electroretinographic (ERG) measures used were light-adapted single-flash b-wave amplitudes and 30-Hz red flicker for cone function, dark-adapted maximal b-wave amplitudes, and response to a low intensity blue-flash for rod function. RESULTS: None of the 11 carriers with a tapetal-like reflex only (grade 1) showed any significant change in visual acuity or fields as compared with 3 of 7 (43%) carriers with diffuse peripheral pigmentary findings (grade 3) who showed significant deterioration in visual acuity in at least one eye, and 6 of 7 (86%) who showed a significant decrease in visual field area with at least one target size in at least one eye. By comparison, only 1 of 10 carriers with a grade 1 fundus finding demonstrated a significant decrease in maximal dark-adapted ERG function as compared with 5 of 6 (83%) carriers with grade 3 in response to a single-flash stimulus and with 4 of 5 (80%) carriers in response to a single-flash blue stimulus. For the single-flash photopic response, none of the 10 carriers with grade 1 showed any significant deterioration, whereas 2 of 4 (50%) with grade 3 did show such deterioration. The ERG responses for carriers with grade 2 were in between the extent of decrease in ERG amplitudes of those in carriers with grades 1 and 3. CONCLUSIONS: In our cohort of X-linked retinitis pigmentosa carriers, those with only a tapetal-like retinal reflex at presentation had a better prognosis to retain visual function than those with peripheral retinal pigmentation. These data are useful in counseling such carriers as to their visual prognosis.

Adolescent↗
PubMed2000

Development of food products based on millets, legumes and fenugreek seeds and their suitability in the diabetic diet.

A multitude of investigations have demonstrated the beneficial hypoglycemic effect of millets, fenugreek seeds and legumes in diabetic subjects. However, the bitter taste of fenugreek seeds and coarse nature of millets have been limitations in using them in daily dietaries. Moreover, as of today, the availability of special foods for diabetics in the Indian market is negligible. The millets, fenugreek seeds and legumes in judicious combination, after suitable processing, were used to formulate three nutritious food products--dhokla (leavened steamed cake), uppuma (kedgeree) and laddu (sweet balls), which are popular traditional snack foods in India. Evaluation of these food products for glycemic response in five normal and five diabetic subjects showed hypoglycemic effects in terms of glycemic-index (GI). The highest GI was observed for dhokla (34.96) followed by laddu (23.52) and uppuma (17.60) in normal subjects. All three food products differed significantly from each other in GI. Comparison of GI of all three food products in normal subjects with diabetes did not show significant differences (P approximately 0.05). The food products were well tolerated and acceptable to the subjects. These food products may have an important role in dietary management for diabetic people and may cater for their needs on a large scale if commercialized.

Adult↗
PubMed2000

Pregnancy outcome and complications in women with spina bifida.

OBJECTIVE: To describe the antenatal complications, mode of delivery and outcome of pregnancy in women with spina bifida. STUDY DESIGN: Case series of women known to have attended the spina bifida clinic at the Royal Children's Hospital. Medical records, postal questionnaire and telephone interview were utilized to collect data on the effect of pregnancy on the health of women and the effect of spina bifida on pregnancy outcome. RESULTS: Of 207 women born between 1945 and 1975, 23 reported having a pregnancy, and 17 who had completed pregnancies agreed to participate. The 17 women had a total of 29 pregnancies, with 23 pregnancies progressing to births. Fourteen of 17 women had antenatal admissions, with wheelchair-dependent women requiring more-frequent and longer admissions. Recurrent urinary infections in pregnancy occurred in women with a prior history of urinary infections; stomal problems occurred but were not serious; mobility was reduced for two women during pregnancy, with full recovery afterwards; and preexisting pressure sores worsened during pregnancy. Vaginal deliveries occurred in one in five pregnancies of women who were wheelchair dependent and in ten of eighteen pregnancies in independently mobile women, including seven of eight pregnancies of independently mobile women without ileal conduits. Cesarean sections were accompanied by postoperative complications in 10 women. CONCLUSION: Women with spina bifida who become pregnant generally have a positive outcome, with relatively low complication rates.

Adult↗
PubMed1999

Intraarterial delivery of adenovirus vectors and liposome-DNA complexes to experimental brain neoplasms.

This study investigated the intraarterial delivery of genetically engineered replication-deficient adenovirus vectors (AVs) and cationic liposome-plasmid DNA complexes (lipoDNA) to experimental brain tumors. Adenovirus or lipoDNA was injected into the internal carotid artery (ICA) of F344 rats harboring intracerebral 9L gliosarcomas, using bradykinin (BK) to selectively permeabilize the blood-tumor barrier (BTB). Brain and internal organs of the animals were collected 48 hr after vector injection and stained for expression of the marker gene product, beta-galactosidase (beta-Gal). Intracarotid delivery of AV to 9L rat gliosarcoma without BTB disruption resulted in transgene expression in 3-10% of tumor cells distributed throughout the tumor. Virus-mediated expression of beta-gal gene products in this tumor model was particularly high in small foci (< or = 0.5 mm), which had invaded the normal brain tissue surrounding the main tumor mass. In these foci more than 50% of tumor cells were transduced. BK infusion increased the amount of transgene-expressing cells in larger tumor foci to 15-30%. In the brain parenchyma only a few endothelial cells expressed beta-gal owing to AV-mediated gene transfer. Intracarotid delivery of lipoDNA bearing a cytoplasmic expression cassette rendered more than 30% of the tumor cells positive for the marker gene without BTB disruption. The pattern of distribution was in general homogeneous throughout the tumor. BK infusion was able to increase further the number of transduced tumor cells to more than 50%. Although lipoDNA-mediated gene transfer showed increased efficacy as compared with AV-mediated gene transfer, it had less specificity since a larger number of endothelial and glial cells also expressed the transgene. AV and lipoDNA injections, in the absence and presence of BK, also resulted in transduction of peripheral organs. AV showed its known predilection for liver and lung. In the case of lipoDNA, parenchymal organs such as liver, lung, testes, lymphatic nodes, and especially spleen, were transduced. These findings indicate that intracarotid application of AV and lipoDNA vectors can effectively transduce tumor cells in the brain, and that BTB modulation by BK infusion can further increase the number of transgene-expressing tumor cells.

Adenoviridae↗
PubMed1999

Variation of clinical expression in patients with Stargardt dystrophy and sequence variations in the ABCR gene.

OBJECTIVE: To report the spectrum of ophthalmic findings in patients with Stargardt dystrophy or fundus flavimaculatus who have a specific sequence variation in the ABCR gene. PATIENTS: Twenty-nine patients with Stargardt dystrophy or fundus flavimaculatus from different pedigrees were identified with possible disease-causing sequence variations in the ABCR gene from a group of 66 patients who were screened for sequence variations in this gene. METHODS: Patients underwent a routine ocular examination, including slitlamp biomicroscopy and a dilated fundus examination. Fluorescein angiography was performed on 22 patients, and electroretinographic measurements were obtained on 24 of 29 patients. Kinetic visual fields were measured with a Goldmann perimeter in 26 patients. Single-strand conformation polymorphism analysis and DNA sequencing were used to identify variations in coding sequences of the ABCR gene. RESULTS: Three clinical phenotypes were observed among these 29 patients. In phenotype I, 9 of 12 patients had a sequence change in exon 42 of the ABCR gene in which the amino acid glutamic acid was substituted for glycine (Gly1961Glu). In only 4 of these 9 patients was a second possible disease-causing mutation found on the other ABCR allele. In addition to an atrophic-appearing macular lesion, phenotype I was characterized by localized perifoveal yellowish white flecks, the absence of a dark choroid, and normal electroretinographic amplitudes. Phenotype II consisted of 10 patients who showed a dark choroid and more diffuse yellowish white flecks in the fundus. None exhibited the Gly1961Glu change. Phenotype III consisted of 7 patients who showed extensive atrophic-appearing changes of the retinal pigment epithelium. Electroretinographic cone and rod amplitudes were reduced. One patient showed the Gly1961Glu change. CONCLUSIONS: A wide variation in clinical phenotype can occur in patients with sequence changes in the ABCR gene. In individual patients, a certain phenotype seems to be associated with the presence of a Gly1961Glu change in exon 42 of the ABCR gene. CLINICAL RELEVANCE: The identification of correlations between specific mutations in the ABCR gene and clinical phenotypes will better facilitate the counseling of patients on their visual prognosis. This information will also likely be important for future therapeutic trials in patients with Stargardt dystrophy.

ATP-Binding Cassette Transporters↗
PubMed1999

Visual acuity impairment in patients with retinitis pigmentosa at age 45 years or older.

OBJECTIVE: To determine the severity of visual acuity impairment in patients, age 45 years or older, with either isolated or identifiable genetic subtypes of retinitis pigmentosa (RP) and Usher syndrome. DESIGN: Multicenter, retrospective, cross-sectional analysis. PARTICIPANTS: Visual acuity data were obtained on 999 patients with different genetic subtypes of RP and Usher syndrome, age 45 years or older, from 4 major eye care centers in the United States. INTERVENTION: The best-corrected visual acuity obtained on these patients from the eye with better vision on their most recent visit was used for the analysis. MAIN OUTCOME MEASURE: Best-corrected visual acuity was the main parameter analyzed for the study, and it was obtained with Snellen or Feinbloom low vision charts or with a B-VAT II monitor (Mentor). RESULTS: The final analyses were done on 982 patients (17 patients with a sector form of RP were analyzed separately). Of the 982 patients, 506 (52%) had a visual acuity of 20/40 or better, and 678 (69%) had a visual acuity of 20/70 or better in at least one eye. There were 243 (25%) patients who had a visual acuity of 20/200 or worse in both eyes. Five (0.5%) patients had no light perception in both eyes. The odds ratio for any patient having a visual acuity of 20/200 or worse in this population was 1.4 for each difference of 10 years of age. Similarly, the odds ratio of a patient having a visual acuity of 20/40 or better in at least one eye was 0.95 for a 10-year age difference. CONCLUSIONS: In this large population of patients with RP and Usher syndrome from four centers, it was rare for such patients to lose all vision in both eyes. One fourth of the patients had a visual acuity of 20/200 or worse in both eyes, and more than half of the population had a visual acuity of 20/40 or better in at least one eye. These data can be used to counsel such patients on the extent of potential visual acuity impairment from their disease.

Aged↗
PubMed1999

Bovine chymosin: production by rDNA technology and application in cheese manufacture.

Bovine chymosin, an aspartyl protease extracted from abomasum of suckling calves, is synthesized in vivo as preprochymosin and secreted as prochymosin which is autocatalytically activated to chymosin. Chymosin is bilobular, with Asp 32 and Asp 215 acting as the catalytic residues. Chymosin A and chymosin B have pH optima of 4.2 and 3.8, respectively, and act to initiate milk clotting by cleaving kappa-casein between Phe 105 and Met 106. The gene encoding chymosin has been cloned and expressed in suitable bacteria and yeast hosts under the control of lac, trp, trp-beta, gly A genes, and serine hydroxymethyl-transferase promoters. Protein engineering of chymosin has also been attempted. A number of companies are now producing recombinant chymosin for commercial use in cheese manufacture.

Journal Article↗
PubMed1999

Psychiatric nurse practitioner versus clinical nurse specialist: moving from debate to action on the future of advanced psychiatric nursing.

The psychiatric nursing literature recently has included a proliferation of discussions regarding the nature and direction of change impacting the future of advanced practice psychiatric nursing. The debate has focused most commonly on the role of the clinical nurse specialist versus the role of the nurse practitioner. The debate has produced little in the way of outcomes other than an entrenchment of positions. The stalemate in psychiatric nursing is producing a slow but steady surrender of the boundaries of psychiatric nursing to other fields of nursing. Although advanced practice psychiatric nurses disagree on what to become and what to be called, people with conditions such as depression, anxiety disorders, and other psychiatric disorders are being treated increasingly by family nurse practitioners. The time for debate has ended. Unless consensus regarding what constitutes the domain of psychiatric nursing is reached soon, the discussions will be moot because few clients will remain to be treated. This article began as a discussion between colleagues. The two authors teach at a regional state university, but they share diverse opinions regarding the substance and nature of advanced practice psychiatric nursing. These diverse views led to discussions that have implications not only for faculty practice, but for curricular design, and for decisions regarding how to best educate future nurses. The discussion developed into a presentation at the 20th Southeast Conference of Clinical Nurse Specialists. It was presented as a point-counterpoint discussion regarding this debate; one author advocated the perspective of traditional clinical nurse specialist and one advocated the perspective of a psychiatric nurse practitioner role. We conclude with a projected model of a merged role, with delineation of traditional clinical nurse specialist and nurse practitioner that must be blended for the new role.

Certification↗
PubMed1999

The role of the plastic surgeon in the management of surgical infection.

At our Medical Center, our reconstructive service has actively sought referrals of acute and chronic infections by declaring an interest in undertaking the integrated management and reconstruction of these cases. The practices of the two senior surgeons were reviewed for three academic years (1992 to 1995). Cases of surgical infection were analyzed as to site, ablative procedures, and reconstructive procedures. In total, 139 patients with 147 infections were identified. Sites of infection included head and neck (9.5 percent), trunk and pelvis (39.5 percent), upper extremity (22 percent), and lower extremity (29 percent). One-hundred thirty-one ablative procedures were done on this group, as were 126 reconstructive procedures, including 17 fasciocutaneous flaps, 26 pedicled muscle flaps, and 28 microsurgical flaps. With a mean follow-up of 14 months, 92 percent of these patients had resolution of infection. The 8 percent failure group included recurrences, amputation, and death. This series demonstrates that a plastic surgery service can attract a diverse population of surgical infections and manage them successfully with ablation and a wide variety of reconstructive procedures. The coordination of ablation and reconstruction may be optimally performed by the plastic surgeon.

Adult↗
PubMed1999

Effects of varying density patterns and passes on depth of penetration in facial skin utilizing the carbon dioxide laser with automated scanner.

Histologic data describing the depth of penetration that occurs with the CO2 laser using variations in delivered energy, number of passes, and density settings have been limited. Most of the initial studies used a 3-mm collimated handpiece; few studies used the computerized pattern generator, which is now standard in treatment. This study examined histologic depth of thermal damage with varying density settings and number of passes using the computerized pattern generator. The Coherent UltraPulse 5000 CO2 laser with a computerized pattern generator was used. Preauricular (sun-exposed) and postauricular (sun-protected) facial skin samples were used from seven rhytidectomy patients aged 37 to 68 years. Preoperative skin treatment regimen included Retin-A and hydroquinone application for 3 weeks before the procedure. Three adjacent sites from the preauricular and postauricular regions were chosen from each ear (12 sites per patient). A density setting of 5 (30 percent overlap) was chosen for the right ear, and a density setting of 9 (60 percent overlap) was used for the left ear. Each region was subjected to one, two, and three passes. The laser delivers approximately 7.5 J/cm2 of fluence at a spot size of 2.25 mm and 300 mJ. Excisional biopsies were performed at the time of cervicofacial flap redraping. All specimens were evaluated for depth of thermal damage by a dermatopathologist who was blinded to the treatment parameters for each test site. Histologic examination of the treated test sites consistently demonstrated that one pass at these settings obliterated most or all of the epidermis, with minimal invasion into the papillary dermis. Test sites treated with two or three passes resulted in increased cumulative depth of penetration and thermal injury into the papillary dermis. Only one sample site showed any thermal injury extending into the reticular dermis. Depth of penetration was greater at the postauricular sites. Additionally, depth of penetration was greater with a density of 9 (60 percent overlap) than one of 5 (30 percent overlap) in both the preauricular and postauricular sites. Our study supported previous observations that the cumulative depth of penetration is greater with increasing levels of energy and additional passes. Additionally, we saw a greater average depth of penetration as density overlap increased, as one would predict. However, at these settings, fewer passes at a higher density setting did not achieve the same depth of penetration as more passes at a lower density setting. Furthermore, we found that the margin of safety using these settings is high: only 1 of 84 sites extended into the reticular dermis.

Adult↗
PubMed1999

Public hospital pregnancy termination services: are we meeting demand?

OBJECTIVES: To identify the socio-demographic characteristics of women seeking termination of pregnancy through a public hospital service and explore issues of accessibility to the service. METHOD: An audit of the Pregnancy Advisory Service (PAS) at the Royal Women's Hospital in Melbourne from January to March 1996. Data were collected from 1,088 intake forms of women seeking an abortion. RESULTS: The women were of low socio-economic status, with 437 (40.2%) living on a government pension or benefit and 55.6% holding a Health Benefits Card. However, only 33.8% were given an appointment for an abortion in the public clinic, with most (63.7%) referred to private services. CONCLUSIONS: The demand for this public hospital abortion service exceeds its capacity and economically disadvantaged women are required to seek abortion in private services. IMPLICATIONS: There is a role for regional health authorities to ensure adequate distribution of public hospital pregnancy termination services.

Abortion, Induced↗
PubMed1999

Female genital mutilation--experience of The Royal Women's Hospital, Melbourne.

This study was performed to improve our knowledge and understanding of the needs of women affected by female genital mutilation. We looked at the types of complications of these practices which present to a large metropolitan women's hospital in order to determine how we can appropriately treat and support affected women. This was an observational study of women from countries with a high prevalence of female genital mutilation who presented to the Royal Women's Hospital between October, 1995 and January, 1997. Fifty-one patients with a past history of female genital mutilation who were attending the hospital for antenatal or gynaecological care consented to participate in the study. We found that 77.6% of women identified as having had female genital mutilation had undergone infibulation. More than 85% of the women in our study reported a complication of the procedure. The major complications were dyspareunia, apareunia and urinary tract infections; 29.4% of these women required surgery to facilitate intercourse. In our study group there was no difference in Caesarean section rates between the women who had previously delivered in Australia compared with those who had delivered in Africa. Women who have had a female genital mutilation procedure have specific needs for their care which present challenges to both their general practitioners and obstetrician/gynaecologists. These women have significant complications related to their procedure including social and psychosexual problems which require sympathetic management.

Adult↗
PubMed1999

Vulvovaginitis: clinical features, aetiology, and microbiology of the genital tract.

AIM: To clarify the contribution of clinical and environmental factors and infection to the aetiology of vulvovaginitis in premenarchal girls, and to determine clinical indicators of an infectious cause. DESIGN: It was necessary first to define normal vaginal flora. Cases were 50 premenarchal girls > 2 years old with symptoms of vulvovaginitis; 50 controls were recruited from girls in the same age group undergoing minor or elective surgery. RESULTS: Interview questionnaire showed no difference between cases and controls in regards to hygiene practices, exposure to specific irritants, or history of possible sexual abuse. Normal vaginal flora was similar to that described in previous studies, with the exception of organisms likely to be associated with sexual activity. 80% of cases had no evidence of an infectious cause. In the 10 cases in whom an infectious cause was found, there was significantly more visible discharge and distinct redness of the genital area on examination compared with other cases. CONCLUSIONS: The findings suggest that vulvovaginitis in this age group is not usually infectious or necessarily related to poor hygiene, specific irritants or sexual abuse, although any of these can present with genital irritation. The possibility of sexual abuse should always be considered when a child presents with genital symptoms, but our data indicate it is not a common contributing factor. Infection is generally associated with vaginal discharge and moderate or severe inflammation.

Adolescent↗
PubMed1999

The anatomic tip graft for nasal augmentation.

A modification of standard tip graft techniques that mimics the surface morphology of aesthetic nasal tip cartilages was evaluated. Because this graft represents the surface anatomy of the aesthetic nasal tip, it is referred to as the anatomic tip graft. It emphasizes the high point (pronasale) of the nose, the full length of the domes, and the normal angulation that commonly occurs between the domes and the middle crura. Additional cartilage deep to the tip graft helps secure it and accentuates tip definition.

Cartilage↗
PubMed1998

Night blindness secondary to vitamin A deficiency in a patient with bile duct strictures after liver transplantation.

Vitamin A deficiency and resulting night blindness have previously been reported in patients with chronic liver disease before undergoing liver transplantation. Because early identification of patients with vitamin A deficiency can lead to the relief of symptoms and the prevention of irreversible retinal degeneration, vitamin A deficiency should always be considered in the differential diagnosis of visual disturbances in patients with liver disease. We describe a case of night blindness due to vitamin A deficiency resulting from bile duct strictures in a post-orthotopic liver transplant patient and its successful resolution with vitamin A supplementation.

Cholestasis↗