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Biomedical subjects

S Sharma

Publications and source records attributed to S Sharma.

At least 253 records · Page 14Linked to original sources
PubMed2001

Quality of life associated with unilateral and bilateral good vision.

OBJECTIVE: To ascertain with patient preference-based methodology whether individuals with good visual acuity (20/20-20/25) in one eye have the same quality of life as individuals with good vision in both eyes. DESIGN: Cross-sectional comparative study. PARTICIPANTS: Consecutive patients seen in comprehensive ophthalmic and vitreoretinal practices with known ocular disease and good visual acuity (20/20 or 20/25) in one or both eyes. METHODS: Standardized patient interview. MAIN OUTCOME MEASURES: Time tradeoff and utility analysis values. RESULTS: The mean time tradeoff utility value in 81 patients with good visual acuity in one eye was 0.89 (standard deviation, 0.17; 95% confidence interval, 0.85-0.93), whereas the mean value in 66 patients with good vision in both eyes was 0.97 (standard deviation, 0.05; 95% confidence interval, 0.97-0.99). The difference between the means of the utility values in these two groups was significant using multiple linear regression (P = 0.001). CONCLUSIONS: From the patient preference-based point of view, individuals with ocular disease and good visual acuity in both eyes appear to have a higher time tradeoff utility value, and thus a better associated quality of life, than those with good visual acuity in only one eye.

Adult↗
PubMed2001

Clinical profile and outcome in Bacillus endophthalmitis.

OBJECTIVE: To study the clinical presentation, microscopic and organismal culture correlation of vitreous, and species-specific outcome in Bacillus endophthalmitis DESIGN: Retrospective noncomparative case series. INTERVENTION: Thirty-one culture proven Bacillus endophthalmitis patients between January 1991 and February 1998 underwent vitrectomy and intravitreal antibiotic injection. Lensectomy was combined when considered essential, and on a few occasions intravitreal dexamethasone was added. The patients also received topical and systemic antibiotics. The undiluted vitreous biopsy was the source for microbiologic evaluation (microscopy and culture sensitivity). MAIN OUTCOME MEASURES: The duration of symptoms, the presenting visual acuity, and influence of intravitreal dexamethasone with intravitreal antibiotics were examined for any statistical correlation with the final visual acuity. RESULTS: Trauma was the major cause of infection. Vitreous biopsy microscopy demonstrated gram-positive bacillus in 28 of 31 cases, and polymicrobial infection was seen in 12 instances. All Bacillus species were sensitive to gentamicin, followed by vancomycin and ciprofloxacin. Clinical treatment within 7 days of symptoms, use of intravitreal vancomycin, and absence of polymicrobial infection were associated with better visual outcome. CONCLUSIONS: With appropriate treatment that essentially consists of vitrectomy and intravitreal antibiotics, patients with Bacillus endophthalmitis are likely to benefit in many instances. Gram-positive bacilli detected on vitreous microscopy should be empirically treated as Bacillus species unless otherwise proved.

Adolescent↗
PubMed2001

The cost-effectiveness of photodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration.

PURPOSE: Photodynamic therapy (PDT) has recently been demonstrated to be beneficial for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). Herein, we determine the cost-effectiveness of PDT for the treatment of subfoveal choroidal neovascularization (CNV) in patients with disciform degeneration in one eye and whose second and better-seeing eye develops visual loss secondary to predominantly classic subfoveal CNV. The analysis was performed from the perspective of a for-profit third-party insurer. DESIGN: Cost-utility Markov models were created to determine the cost-effectiveness of PDT under two different scenarios, by using efficacy data derived from the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) Study and patient-based utilities. METHODS: Decision analyses were performed by incorporating data from the TAP Study, expected longevity data, and patient-based utilities. Cost-effective models were then created by incorporating incremental medical costs. Various sensitivity analyses were carried out to determine the robustness of our models. A Monte Carlo simulation was also used to determine whether there was a significant difference in quality-of-life adjusted years (QALYs) gained between PDT therapy and the placebo. RESULTS: For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/40 vision at baseline in this affected eye (base case 1), PDT was associated with a 10.7% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.1342 QALYs over a 2-year period). For the hypothetical patient whose second and better-seeing eye becomes affected and who has 20/200 vision at baseline in this affected eye (base case 2), PDT was associated with a 7.8% relative increase in their quality-of-life (treatment conferred an additional undiscounted 0.0669 QALYs over a 2-year period). Sensitivity analysis showed our models were robust and that PDT was usually the dominant treatment choice. Our cost-effective model demonstrated that the cost for a QALY was $86,721 (US dollars discounted at 3%) for base case 1, assuming 5.5 treatments; and $173,984 (USD discounted at 3%) for base case 2. CONCLUSIONS: PDT will cost a third-party insurer $86,721 for an AMD patient with 20/40 vision in the better-seeing eye to obtain one QALY and $173,984 for an AMD patient with 20/200 vision in the better-seeing eye to obtain one QALY. PDT can be considered to be a treatment that is of only minimal cost-effectiveness for AMD patients who have subfoveal CNV in their second and better-seeing eyes and who have good presenting visual acuity at baseline. It is a cost-ineffective treatment for AMD patients who have poor visual acuities in their affected better-seeing eyes.

Aged↗
PubMed2001

Assessment of mutations in the Best macular dystrophy (VMD2) gene in patients with adult-onset foveomacular vitelliform dystrophy, age-related maculopathy, and bull's-eye maculopathy.

PURPOSE: To study the presence of Best macular dystrophy (VMD2) gene mutations in patients diagnosed with maculopathies other than classic Best disease and to describe the clinical characteristics of these subjects. DESIGN: Case-comparison study of phenotype-genotype correlations. METHODS: Patients with either age-related maculopathy (ARM; n = 259) or maculopathies other than classic Best disease (n = 28) were screened for mutations in the Best gene (VMD2; OMIM 153700). These cases were compared with ethnically similar subjects in the same age range without maculopathy (n = 196). All patients underwent a complete dilated ocular examination, and all affected individuals underwent fundus photography. Phenotype-genotype comparisons were made. MAIN OUTCOME MEASURES: Presence of mutations in the Best gene (VMD2; OMIM 153700) and the clinical phenotype. RESULTS: Three of 259 patients (1%) with ARM and 2 of 28 patients (7%) with other maculopathies including 1 of 3 patients with adult-onset foveomacular vitelliform dystrophy and 1 of 5 patients with a bull's eye maculopathy, but none of the controls, were found to possess amino acid-changing variants in the VMD2 gene. These included a man with confluent drusen and retinal pigment epithelial detachments (variant in exon 6; T216I), a man with geographic atrophy and numerous soft drusen (variant in exon 10; L567F), a woman with drusen and retinal pigment epithelial alterations (variant in exon 10; L567F), a woman with drusen and retinal pigment epithelial alterations resembling bull's-eye maculopathy (variant in exon 4; E119Q), and a woman diagnosed with adult-onset foveomacular vitelliform dystrophy (variant in exon 4; A146K). CONCLUSIONS: Novel mutations in the VMD2 gene were found in patients diagnosed with maculopathies other than classic Best disease. Some cases diagnosed as adult-onset vitelliform foveomacular dystrophy may represent a variant of Best disease with delayed onset. The VMD2 gene does not play a major role in the development of ARM.

Aged↗
PubMed2001

Developing financial autonomy in public hospitals in India: Rajasthan's model.

In India's state-administered health care system, many government decision-makers are exploring the introduction or expansion of hospital autonomy as a means of improving the efficiency and financial sustainability of the overall public health care system. One initiative that has recently received a considerable amount of attention is the introduction of Medicare Relief Societies (MRS) in the state of Rajasthan. The societies are autonomous organizations that are formed with the objective of complementing and supplementing existing service provision in public hospitals. The state has provided incentives for the formation of MRS by relaxing state-imposed restrictions on the collection and use of revenue by hospitals, thereby encouraging the use of alternative financing mechanisms such as user-fee schemes and in-hospital pharmacies. The purpose of this article is to describe and critically evaluate Rajasthan's experience with MRS. Emphasis is placed on whether and how the introduction of these societies have influenced two key aspects of hospital autonomy - operations and management, and financing. Data for the study come from a survey of representatives from each of the 69 hospitals in Rajasthan that contain 100 or more beds. Information was collected on whether a society was operating within the hospital, the management of the society, the range of activities carried out, and the revenue and expenditures of each activity. The results are used to identify key strengths and weakness of the MRS initiative in Rajasthan, and how future hospital autonomy efforts can be strengthened.

Delivery of Health Care↗
PubMed2001

99mTc labeled VIP analog: evaluation for imaging colorectal cancer.

Early and reliable diagnosis of colorectal cancer continues to be demanding and challenging. Colorectal cancer cells express Vasoactive Intestinal Peptide (VIP) receptors in high density. We have prepared a VIP analog (TP3654), labeled it with (99m)Tc, and evaluated it in experimental animals as an agent for imaging colorectal cancer. The tissue distribution of (99m)Tc-TP3654 has been compared with that of (111)In-DTPA-Octreotide and (99m)Tc-anti-CEA scan in nude mice bearing human colorectal cancer LS174T. Finally, pharmacokinetic and tissue distribution studies of (99m)Tc-TP3654 have been performed in four normal human volunteers. Data suggest that (99m)Tc-TP3654 can be prepared efficiently without loss of its receptor specificity and biological activity. Although the 24 hr tumor uptake of (99m)Tc-TP3654 in the animal model used was modest (0.21 +/- 0.07% I.D./g), the tissue distribution profile was more favorable than that of (111)In-DTPA-Octreotide or (99m)Tc-anti-CEA scan. Human studies indicated that (99m)Tc-TP3654 had no adverse effect in any subject. Within 24 hours, approximately 70% of the injected dose cleared through the kidneys, and approximately 20% through the hepatobiliary system. In these non-fasting volunteers hepatobiliary clearance was slow and in cancer patients tumor uptake was rapid. Data suggest that (99m)Tc-TP3654 is a promising agent for imaging colorectal cancer.

Colorectal Neoplasms↗
PubMed2001

Increased hepatic oxidative DNA damage in patients with hepatocellular carcinoma.

Since oxidative DNA damage plays a role in experimental carcinogen-induced cancers, the purpose of the present study was to determine if hepatic oxidative DNA damage was increased in patients with HCC compared to patients with benign hepatic tumors or hepatic metastases (non-HCC) or to patients with end-stage alcoholic liver disease undergoing liver transplantation. Oxidative DNA damage was assessed by 8-hydroxy-2'-deoxyguanosine (8-OH-dG). Results showed that peritumoral 8-OH-dG was markedly increased in HCC (N= 51) (180 +/- 74 vs 32 +/- 58-OH-dG/10(6)dG for tumor, P < 0.005) in contrast to patients with non-HCC (N = 17), in whom the peritumoral 8-OH-dG did not differ from that in tumor (39 +/- 7 vs. 31 +/- 108-OH-dG/10(6)dG). Oxidative DNA damage can be both mutagenic and carcinogenic; our data suggested it will be important in future studies to determine the chronology of this type of liver injury relative to hepatocarcinogenesis.

8-Hydroxy-2'-Deoxyguanosine↗
PubMed2001

Keratitis.

Corneal inflammation or keratitis is a significant cause of ocular morbidity around the world. Fortunately, the majority of the cases are successfully managed with medical therapy, but the failure of therapy does occur, leading to devastating consequences of either losing the vision or the eye. This review attempts to provide current information on most, though not all, aspects of keratitis. Corneal inflammation may be ulcerative or nonulcerative and may arise because of infectious or noninfectious causes. The nonulcerative corneal inflammation may be confined to the epithelial layer or to the stroma of the cornea or may affect both. For clarity, this section has been divided into nonulcerative superficial keratitis and nonulcerative stromal keratitis. While the former usually includes hypersensitivity responses to microbial toxins and unknown agents, the latter can be either infectious or noninfectious. In the pathogenesis of ulcerative keratitis, microorganisms such as bacteria, fungi, parasites (Acanthamoeba), or viruses play an important role. Approximately, 12.2% of all corneal transplantations are done for active infectious keratitis. Available world literature pertaining to the incidence of microbial keratitis has been provided special place in this review. On the other hand, noninfectious ulcerative keratitis can be related to a variety of systemic or local causes, predominantly of autoimmune origin.

Acanthamoeba Keratitis↗
PubMed2001

A utility analysis correlation with visual acuity: methodologies and vision in the better and poorer eyes.

OBJECTIVE: To ascertain the correlation between visual acuity levels and ophthalmic utility values obtained using time tradeoff and standard gamble utility analysis methodologies. METHODS: Three hundred twenty-five consecutive patients with visual loss to 20/40 or less in at least one eye with predominantly vitreoretinal pathology were evaluated in a cross-sectional fashion using a standardized testing methodology to obtain ophthalmic time tradeoff and standard gamble utility values. Spearman correlation coefficients were employed to correlate the utility values with visual acuity in better seeing and poorer seeing eyes. RESULTS: The Spearman correlation coefficient for time tradeoff utility values and vision in the better seeing eye was 0.455 (p < 0.001), while that for time tradeoff utility values and visual acuity in the poorer seeing eye was 0.268 (p < 0.001). The coefficient for standard gamble utility values and the better seeing eye was 0.371 (p < 0.001), while that for standard gamble utility values and vision in the poorer seeing eye was 0.250 (p < 0.001). CONCLUSIONS: There is a greater correlation between ophthalmic utility values and vision in the better seeing eye, as versus vision in the poorer seeing eye. Time tradeoff ophthalmic utility values demonstrate a greater correlation with vision in the better seeing eye than do standard gamble utility values.

Aged↗
PubMed2001

Poorly differentiated follicular thyroid carcinoma with rhabdoid phenotype: a clinicopathologic, immunohistochemical and electron microscopic study of two cases.

Poorly differentiated thyroid carcinomas with follicular cell phenotype are not well defined. Different diagnostic criteria have been employed for these tumors, including solid growth, nodular, trabecular, and insular patterns. Cytologic features, such as a predominance of tall and columnar cells, have been considered to be diagnostic of poorly differentiated carcinoma. However, there is no agreement among surgical pathologists regarding morphologic criteria for poorly differentiated thyroid carcinoma. We report two unique thyroid neoplasms that we interpreted as poorly differentiated follicular carcinomas. Nodular, trabecular, and sheetlike patterns predominated in both tumors. They were composed of cells that were focally immunoreactive for thyroglobulin and had large vesicular nuclei with prominent nucleoli. A variable number of cells showed rhabdoid phenotype. The rhabdoid inclusions did not stain for thyroglobulin but contained whorls of intermediate filaments that were vimentin positive. There were foci of necrosis and numerous mitotic figures. Both patients were adults and died with multiple pulmonary metastases. The presence of rhabdoid cells in poorly differentiated follicular carcinomas broadens the spectrum of tumors with rhabdoid phenotype. More cases are needed to determine whether the rhabdoid phenotype is a marker for poorly differentiated follicular carcinoma as well as an independent adverse prognostic factor.

Adenocarcinoma, Follicular↗
PubMed2001

Ectopic expression of the thyroperoxidase gene augments radioiodide uptake and retention mediated by the sodium iodide symporter in non-small cell lung cancer.

Radioiodide is an effective therapy for thyroid cancer. This treatment modality exploits the thyroid-specific expression of the sodium iodide symporter (NIS) gene, which allows rapid internalization of iodide into thyroid cells. To test whether a similar treatment strategy could be exploited in nonthyroid malignancies, we transfected non-small cell lung cancer (NSCLC) cell lines with the NIS gene. Although the expression of NIS allowed significant radioiodide uptake in the transfected NSCLC cell lines, rapid radioiodide efflux limited tumor cell killing. Because thyroperoxidase (TPO) catalyzes iodination of proteins and subsequently causes iodide retention within thyroid cells, we hypothesized that coexpression of both NIS and TPO genes would overcome this deficiency. Our results show that transfection of NSCLC cells with both human NIS and TPO genes resulted in an increase in radioiodide uptake and retention and enhanced tumor cell apoptosis. These findings suggest that single gene therapy with only the NIS gene may have limited efficacy because of rapid efflux of radioiodide. In contrast, the combination of NIS and TPO gene transfer, with resulting TPO-mediated organification and intracellular retention of radioiodide, may lead to more effective tumor cell death. Thus, TPO could be used as a therapeutic strategy to enhance the NIS-based radioiodide concentrator gene therapy for locally advanced lung cancer.

Apoptosis↗
PubMed2001

Alginate as a macroaffinity ligand and an additive for enhanced activity and thermostability of lipases.

Lipases are being employed increasingly for the synthesis of drug intermediates and pharmaceutically important molecules as well as for the resolution of racemic mixtures for obtaining physiologically active enantiomers. Alginate was used as a macroaffinity ligand to purify lipases from Chromobacterium viscosum, porcine pancreas and wheatgerm by employing the technique of affinity precipitation. In all the cases, the purified preparation showed a single band on SDS/PAGE. The process gave adequate yields of 87, 75 and 62% in the case of Chromobacterium, porcine and wheatgerm lipases respectively. Alginate was also found to activate the enzymes; this effect was most dramatic in the case of wheatgerm lipase, for which a 4-5-fold activity increase was observed. Furthermore, alginate was also found to protect the enzyme against thermoinactivation.

Alginates↗
PubMed2001

Cultural differences in assessing dietary intake and providing relevant dietary information to British African-Caribbean populations.

Diet can play a key role in the management of disorders such as obesity, diabetes and hypertension, conditions highly prevalent in the British African Caribbean population. In this paper, information not previously available is provided on the dietary habits and foods consumed by a British African-Caribbean population representative of the local community. Food frequency questionnaires were obtained from 255 randomly selected subjects in Manchester (78% of Jamaican origin), the nutrient intake results of which are available elsewhere. Here, suggestions are given to ensure that complete and valid dietary assessments (by diet history) are obtained, and the need for the approach to be somewhat different to that used in the White European population, highlighted with examples. Suggestions have also been listed for methods of dietary modification for obesity, diabetes and hypertension, taking into account differences in cultural understanding and food practices. People of Caribbean origin are not from just one territory: food habits and cultural context play an important role in every island, with clear differences between each which persist in first and later generations in Britain. In this paper, we attempt to integrate experience of learning from patients themselves during consultations and from participants in this study, with direct quantitative data on types of foods and their frequency in the local African-Caribbean diet.

Adult↗
PubMed2001

Broncho-gastric fistula complicating transthoracic esophagectomy.

Tracheo-esophageal and broncho-esophageal fistulas are recognized complications in advanced esophageal cancers. The common complications seen after transthoracic esophagectomy include pulmonary complications, anastomotic leaks, gastric stasis, and anastomotic strictures. A broncho-gastric fistula is a very rare complication of transthoracic esophagectomy and has been reported anecdotally in the literature. We report a patient who underwent a transthoracic esophagectomy and developed a broncho-gastric fistula caused by a staple from the stomach tube suture line eroding into the right bronchus. Diagnosis was made by fiberoptic bronchoscopy. The patient was successfully treated with re-exploratory thoracotomy and closure of the fistula.

Biopsy, Needle↗
PubMed2001

Inflammatory pseudotumor of the esophagus.

Inflammatory pseudotumors of the esophagus are uncommon. They pose diagnostic and therapeutic dilemmas, especially when located in the cervical esophagus. History and physical examination are rarely contributory. Routine radiologic investigations including barium swallow and computed tomography only raise the suspicion of a benign esophageal neoplasm. Esophagoscopy and biopsy do not provide a definite diagnosis, as these 'tumors' are frequently submucosal, unless they enlarge sufficiently to cause mucosal ulcerations. Endoscopic ultrasonography may accurately localize the tumor but is not diagnostic. Conservative surgical resection or debulking would be both diagnostic and therapeutic. Steroids, cyclophosphamide and low-dose radiotherapy may at best be considered second-line therapy. One such case of inflammatory pseudotumor of the cervical esophagus is presented and the relevant literature is reviewed. Our patient could not be diagnosed on preoperative investigations and required an esophagotomy with frozen section. We debulked the mass and the patient is asymptomatic 6 months after surgery.

Adult↗
PubMed2001

Transcaruncular medial orbitotomy for stabilization of the posterior limb of the medial canthal tendon.

PURPOSE: A method to stabilize the posterior limb of the medial canthal tendon (MCT), using a transcaruncular medial orbitotomy (TMO) approach, is described in a stepwise fashion. The technique described is a modified version of procedures published by Ritleng, Crawford and Collin, and Fante and Elner METHODS: A prospective clinical evaluation of MCT stabilization via the TMO approach was undertaken in I I consecutive patients who presented with MCT laxity as one of the features of their ectropion. These cases are initially described in detail in two representative case reports, and summarized in 11 cases. The stepwise surgical approach is outlined. RESULTS: All patients had improved symptomatology in terms of epiphora and comfort. Furthermore, in all cases the lid position was improved or normalized. In four of the I cases (36%) the lower punctum did not ultimately reside in the lacrimal ake, but the punctal position was nevertheless improved and the MCT was stabilized. CONCLUSION: The TMO procedure provides both excellent MCT stabilization and adequate placement of the lower lacrimal punctum onto the globe. It does not require canalicular resection, and avoids continued anterior displacement of the medial lower lid which may occur when only the anterior limb of the MCT is addressed surgically.

Aged↗