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Biomedical subjects

S Saxena

Publications and source records attributed to S Saxena.

At least 163 records · Page 9Linked to original sources
PubMed1994

Triazines as anti-inflammatory agents.

5,6-Diphenyl 1,2,4-triazine-3-thiol (III) was synthesized from alpha-diketone benzyl (II); II in turn was synthesized from benzoin (I). III on reaction with 1-chloro-2,3-epoxy propane yielded 3-[(oxiranyl methyl)thio]-5,6-diphenyl 1,2,4-triazine (IV). IV was converted to 3-[5,6-diphenyl-1,2,4-triazine-3-yl thio]-3-substituted propanols (V) on reaction with aryl amines. These compounds were screened for their anti-inflammatory activity in albino rats with carrageenin induced paw oedema. Two compounds, Ve and Vl, exhibited significant anti-inflammatory activity compared to the standard, phenylbutazone, with high ALD50 values.

Animals↗
PubMed1994

Gynecologic and dermatologic electrosurgical units: a comparative review.

Electrosurgery is a popular surgical technique in which high-frequency, low-voltage electrical energy produced by an electrosurgical unit is used to excise abnormal tissue with hemostasis. In this study, electrosurgical units were critically evaluated for safety, electrical specifications, design, and performance characteristics. Quantitative electrical specification and histologic thermal artifact measurements and qualitative observations were recorded for 13 electrosurgical units representing 11 manufacturers. The Aspen Sabre 180 and Laerscope e10 were considered exemplary units based on safety criteria alone. Cut-mode thermal artifact was less than 10 microns for the Cooper Leep 6000, Laserscope e10, and Utah Finesse. A maximum fulguration distance of greater than 0.5 mm was demonstrated by the Gyne-Tech Autolepe 2000 and 4000, Laserscope e10, and the Elmed ESU 30. For gynecologic electrosurgery, the Aspen Sabre 180 and Laserscope e10 were rated best, followed closely by the Utah Finesse and Finesse II and the Gyne-Tech Autolepe 4000. Dermatologic electrosurgery may be well accomplished with many of the electrosurgical units, except as noted.

Ambulatory Surgical Procedures↗
PubMed1993

Transfusion practice in medical patients.

OBJECTIVE: Blood transfusion raises serious issues of safety and economics. We therefore examined blood usage and its characteristics in medical inpatients, given the relative scarcity of existing data. DESIGN: During a 1-year period, transfusion episodes on two medical services were reviewed by five specialists for justifiability on the basis of generally agreed on guidelines. SETTING: The study was conducted at two institutions, a municipal teaching hospital where house staff deliver care and a community hospital where patients are under the direct care of private physicians. PATIENTS: Four hundred thirty-eight randomly selected transfusion episodes on the medical services of the two institutions were reviewed. MAIN OUTCOME MEASURES: The prevalence of unjustifiable transfusions based only on the information available to the managing physician at the time of transfusion. RESULTS: Eighteen percent of the 438 randomly selected transfusion episodes were viewed as not justifiable by at least four of five reviewers; another 17% were classified as equivocal because two or three reviewers judged them to be not justifiable. The most striking observation was the greater prevalence of nonjustifiable transfusion episodes at the community hospital (26% vs 16% at the teaching institution; P = .0121). Other observations included a tendency for physicians to prescribe transfusions by the numbers (at least 11% of nonjustifiable transfusions) and to overtransfuse. The routineness with which transfusion was viewed by managing physicians was also identifiable by the absence of written transfusion notes in 39% of all episodes reviewed, which incidentally raises questions about the adequacy of the medical chart's documentary functions today. CONCLUSIONS: The rate of nonjustifiable or equivocal transfusion on medical services may be as high as 35%. Reliance on numbers rather than clinical status seems to be a major problem. Education is obviously a critical issue and should also target private practitioners, who seemed to perform less well than physicians in training. Transfusion guidelines that use specific hematocrit values also need to be reexamined.

Blood Transfusion↗
PubMed1993

Local anesthesia by peribulbar block for cataract extraction in an eye relief camp. A double-masked, randomized controlled trial.

OBJECTIVE: To test the hypothesis that the median scores for globe anesthesia are not significantly different for patients receiving local anesthesia (LA) by peribulbar block (PB) than for those receiving retrobulbar block (RB) for cataract surgery. DESIGN: Double-masked, randomized controlled trial. SETTING: An eye camp in Bhetwa, India, base hospital was King George's Medical College, Lucknow. (Eye camps are temporary set-ups used for cataract surgery throughout rural India.) Study carried out over a 2-day period. PATIENTS: Out of 125 patients eligible for intracapsular cataract extract on under LA, 122 agreed to enter the trial, and were randomly allocated to 2 groups just before the operation. The groups were equal in size and similar in composition in terms of patient age and sex. INTERVENTION: PB or RB infiltrated with 5 mL of the same anesthetic at the same site but with a different needle size and direction. MAIN OUTCOME MEASURES: Globe anesthesia (primary outcome), globe akinesia, lid akinesia, pupillary dilatation, and hypotony were scored separately on a 4-point scale during surgery by a masked surgeon. During infiltration, surgery, and the 1st 30 minutes after surgery, pain was scored by patients and recorded by an interviewer. RESULTS: Median scores for globe anesthesia were 4.0 in both groups, and the Mann-Whitney test revealed no difference in the medians of these scores (P = 0.6). There was no difference in scores on other outcomes measured, except lid akinesia, which was better with PB. Subjective pain scores were significantly higher with RB. The surgeon's guess about the type of LA administered was correct only for 58% of patients. CONCLUSION: PB is no different from RB in terms of producing globe anesthesia when used for cataract surgery at eye camps.

Aged↗
PubMed1993

Aspiration cytology of maxillary myxoma.

Fine-needle aspiration was used to diagnose a case of maxillary myxoma. Abundant mucoid material was obtained. Microscopic examination showed three-dimensional fibrillary myxoid fragments entangling spindle-shaped, stellate, and fusiform cells with round to oval monomorphic nuclei. A striking feature was delicately branching capillaries. The diagnosis was subsequently confirmed on histology and histochemistry.

Adult↗
PubMed1993

Iron-deficiency anemia: a medically treatable chronic anemia as a model for transfusion overuse.

PURPOSE: Transfusion practice in patients with iron deficiency was reviewed. PATIENTS AND METHODS: During the study period, records of 265 consecutive patients with an unsaturated iron-binding capacity of greater than 53.7 mumol/L were evaluated for possible iron-deficiency anemia. RESULTS: Two hundred sixty-three patients met the study criteria for iron deficiency. Of these patients, 50 received 1 or more units of red blood cells (RBCs). The transfusion therapy of 12 patients could not be justified; physicians used laboratory results rather than the clinical status of the patients to initiate transfusion therapy. As a result, units of RBCs were transfused to raise the hematocrit to an arbitrarily chosen level. Furthermore, iron therapy was not prescribed for 97 of the 263 iron-deficient patients, including 11 of the patients for whom transfusion was justifiable and 2 patients for whom transfusion could not be justified. Based on records reviewed, no work-up was initiated to identify the cause of iron deficiency in 13 patients, including 4 patients who received transfusions. CONCLUSION: These findings suggest that the evaluation and treatment of iron deficiency, including transfusion therapy for that condition, may be problematic. In view of the risks of blood transfusion therapy, improvement in transfusion practices for iron deficiency should be emphasized.

Anemia, Hypochromic↗
PubMed1993

Use of a questionnaire to identify potential blood donors at risk for infection with Trypanosoma cruzi.

Trypanosoma cruzi is the protozoan parasite that causes American trypanosomiasis (Chagas' disease). Chagas' disease is endemic in Latin America. The infection is usually seen in poor people who live in rural areas in substandard housing, where they are bitten by infected reduviid bugs. Transmission also can occur by blood transfusion. Infected individuals who immigrate to the United States might donate blood if they are asymptomatic and unaware of their infection. This study evaluated the usefulness of a questionnaire for identifying T. cruzi-infected individuals among prospective blood donors who met all American Association of Blood Banks, Food and Drug Administration, and State of California criteria for donor eligibility. Seventy-two of 3492 otherwise eligible donors were disqualified because of their answers on the questionnaire. Forty-five of these 72 agreed to be tested serologically, and 2 were positive for T. cruzi antibodies. One of six autologous blood donors tested also was positive for T. cruzi antibodies. We conclude that the questionnaire selected a subgroup of Latin Americans at high risk for T. cruzi infection. The deferral of these high-risk individuals clearly reduced the risk of transmission of T. cruzi by transfusion, without intolerably decreasing the supply of donated blood.

Blood Donors↗
PubMed1993

Does the emergency department need a dedicated stat laboratory? Continuous quality improvement as a management tool for the clinical laboratory.

Using the principles of continuous quality improvement (CQI), the authors conducted a study in response to a request from the Department of Emergency Medicine, Los Angeles County, and University of Southern California Medical Center, Los Angeles, for a dedicated stat laboratory in the emergency department. The stat orders to test serum electrolyte, glucose, blood urea nitrogen, creatinine, amylase, and lipase levels, prothrombin time, and complete blood count (CBC) were evaluated. The study was done in two phases. First, a baseline on stat laboratory test turnaround time was established, and problems were identified. Then, the authors reexamined the turnaround after problems were addressed and a new laboratory information system was installed. In the first phase, median within-laboratory turnaround for chemistry tests was 61 minutes from the time the specimens arrived in the laboratory and 70 minutes for CBCs from the time of accessioning. Delay in physician review of the results (45 minutes) was the longest component of overall turnaround. The second phase of the study found that the median within-laboratory turnaround had improved to 36 minutes for chemical and 55 minute for hematologic tests. However, other preanalytic factors outside the control of the laboratory, such as collecting blood and sending the specimens to the laboratory, and postanalytic delays in physician acknowledgment of the results remained the major components of the perceived turnaround delays. In conclusion, stat laboratory service for the emergency department improved with CQI. The study suggested that resources required to establish a dedicated stat laboratory in the emergency department would be more beneficial if directed toward reducing the preanalytic delays. Further, CQI has great potential as a management tool for the clinical laboratory.

Emergency Medical Services↗
PubMed1993

Frequency of cocaine and phencyclidine detection at a large urban public teaching hospital.

To assess the value of the current NIDA cutoff concentrations for screening assays that detect urinary cocaine metabolites and phencyclidine (PCP), we collected data on concentrations of these drugs in newborns and patients admitted to the Los Angeles County + University of Southern California Medical Center from July 1, 1991, to December 31, 1991. Less than 2% of the patients were positive for PCP. However, 16.5% of the newborns and 25.1% of the remaining age groups tested positive for cocaine metabolites. Among specimens that tested negative with the screening assays, approximately 3% (182 specimens, with 15 from newborns) clearly contained detectable amounts (between 50 and less than 300 ng/mL) of benzoylecgonine by GC/MS, while less than 0.6% had detectable amounts (10-25 ng/mL) of PCP. The mothers of 7 of the 15 newborns also had detectable benzoylecgonine at various concentrations. This indicates that a lower screening cutoff concentration may be desirable for cocaine metabolites in hospitalized patients. Among those patients positive for cocaine metabolites or PCP, most were males between 20 and 39 years old. The urine drug concentrations in this population were 4-300 times greater than the cutoff concentrations for the screening assays.

Adolescent↗
PubMed1993

Pattern of interleukins in minimal-change nephrotic syndrome of childhood.

Assays of interleukin-1 (IL-1) and IL-2 were done in supernatants from phytohaemagglutinin-activated lymphocyte cultures from 10 children suffering from minimal-change nephrotic syndrome (MCNS) to assess their role in the aetiopathogenesis of this disorder. Increased levels of IL-1 and IL-2 had been found in supernatants from patients having MCNS compared with controls, suggesting a significant role of these cytokines in the immunopathogenesis of proteinuria in this syndrome.

Child↗
PubMed1993

Generalised dissociative amnesia.

A case of generalised dissociative amnesia is presented, which illustrates several characteristic features of this uncommon condition. The case showed poor response to thiopentone interviews and in vivo cueing. Amnesia had persisted at six months follow up.

Adult↗