1
|
Walker S, Colletta K, Devos H, Gaynes B, Ellison RL, Alsakaji R, Watters K, Todfield A, Chawla J, Kletzel S. A PATIENT'S GUIDE TO VISUAL PERCEPTION CHANGES THAT OCCUR WITH PARKINSON'S DISEASE. Arch Phys Med Rehabil 2023:S0003-9993(23)00188-0. [PMID: 37040864 DOI: 10.1016/j.apmr.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/28/2022] [Indexed: 04/13/2023]
Affiliation(s)
- Sadie Walker
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Shirley Ryan AbilityLab, Chicago, IL, USA.
| | - Kalea Colletta
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Hannes Devos
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training,University of Kansas Medical Center, Kansas City, KS, USA
| | - Bruce Gaynes
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Rachael L Ellison
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Illinois Institute of Technology, Chicago, IL, USA
| | | | | | | | - Jasvinder Chawla
- Edward Hines Jr. VA Hospital, Hines, IL, USA; Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | | |
Collapse
|
2
|
Chawla J. How much time is sufficient to achieve hemostasis following dental extraction: Few minutes to many minutes- A randomized controlled trial. Int J Oral Maxillofac Surg 2021. [DOI: 10.1016/j.ijom.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
3
|
Gaynes BI, Zaffer A, Yousefzai R, Chazaro-Cortes M, Colletta K, Kletzel SL, Jost MB, Park Y, Chawla J, Albert MV, Xiao T. Variable abnormality of the melanopsin-derived portion of the pupillary light reflex (PLR) in patients with Parkinson's disease (PD) and parkinsonism features. Neurol Sci 2021; 43:349-356. [PMID: 33945034 DOI: 10.1007/s10072-021-05245-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/10/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Ascertain and quantify abnormality of the melanopsin-derived portion of the pupillary light reflex (PLR) in patients with Parkinson's disease (PD) and parkinsonism features based on a statistical predictive modeling strategy for PLR classification. METHODS Exploratory cohort analysis of pupillary kinetics in non-disease controls, PD subjects, and subjects with parkinsonism features using chromatic pupillometry. Receiver operating characteristic (ROC) curve interpretation of pupillary changes consistent with abnormality of intrinsically photosensitive retinal ganglion cells (ipRGCs) was employed using a thresholding algorithm to discriminate pupillary abnormality between study groups. RESULTS Twenty-eight subjects were enrolled, including 17 PD subjects (age range 64-85, mean 70.65) and nine controls (age range 48-95, mean 63.89). Two subjects were described as demonstrating parkinsonism symptoms due to presumed Lewy body dementia and motor system atrophy (MSA) respectively. On aggregate analysis, PD subjects demonstrated abnormal but variable pupillary dynamics suggestive of ipRGC abnormality. Subjects with parkinsonism features did not demonstrate pupillary changes consistent with ipRGC abnormality. There was no relationship between levodopa equivalent dosage or PD severity and ipRGC abnormality. The pupillary test sensitivity in predicting PD was 0.75 and likelihood ratio was 1.2. CONCLUSIONS ipRGC deficit is demonstrated in PD subjects; however, the degree and constancy of abnormality appear variable.
Collapse
Affiliation(s)
- Bruce I Gaynes
- Edward Hines Jr. VA Medical Center, Hines, IL, USA. .,Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| | | | | | | | | | | | | | | | - Jasvinder Chawla
- Edward Hines Jr. VA Medical Center, Hines, IL, USA.,Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Mark V Albert
- Biomedical Engineering, Computer Science and Engineering, University of North Texas, Denton, TX, USA
| | - Ting Xiao
- Computer Science and Engineering, University of North Texas, Denton, TX, USA
| |
Collapse
|
4
|
Tabashum T, Zaffer A, Yousefzai R, Colletta K, Jost MB, Park Y, Chawla J, Gaynes B, Albert MV, Xiao T. Detection of Parkinson's Disease Through Automated Pupil Tracking of the Post-illumination Pupillary Response. Front Med (Lausanne) 2021; 8:645293. [PMID: 33842509 PMCID: PMC8026862 DOI: 10.3389/fmed.2021.645293] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Parkinson's disease (PD) is one of the most common neurodegenerative disorders, but it is often diagnosed after the majority of dopaminergic cells are already damaged. It is critical to develop biomarkers to identify the disease as early as possible for early intervention. PD patients appear to have an altered pupillary response consistent with an abnormality in photoreceptive retinal ganglion cells. Tracking the pupil size manually is a tedious process and offline automated systems can be prone to errors that may require intervention; for this reason in this work we describe a system for pupil size estimation with a user interface to allow rapid adjustment of parameters and extraction of pupil parameters of interest for the present study. We implemented a user-friendly system designed for clinicians to automate the process of tracking the pupil diameter to measure the post-illumination pupillary response (PIPR), permit manual corrections when needed, and continue automation after correction. Tracking was automated using a Kalman filter estimating the pupil center and diameter over time. The resulting system was tested on a PD classification task in which PD subjects are known to have similar responses for two wavelengths of light. The pupillary response is measured in the contralateral eye to two different light stimuli (470 and 610 nm) for 19 PD and 10 control subjects. The measured Net PIPR indicating different responsiveness to the wavelengths was 0.13 mm for PD subjects and 0.61 mm for control subjects, demonstrating a highly significant difference (p < 0.001). Net PIPR has the potential to be a biomarker for PD, suggesting further study to determine clinical validity.
Collapse
Affiliation(s)
- Thasina Tabashum
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, United States
| | - Adnaan Zaffer
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
| | - Raman Yousefzai
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
| | - Kalea Colletta
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
| | - Mary Beth Jost
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
| | - Youngsook Park
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
| | | | - Bruce Gaynes
- Edward Hines Jr. VA Medical Center, Hines, IL, United States.,Department of Ophthalmology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
| | - Mark V Albert
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, United States.,Department of Biomedical Engineering, University of North Texas, Denton, TX, United States
| | - Ting Xiao
- Department of Computer Science and Engineering, University of North Texas, Denton, TX, United States
| |
Collapse
|
5
|
Bhaskar S, Bradley S, Israeli-Korn S, Menon B, Chattu VK, Thomas P, Chawla J, Kumar R, Prandi P, Ray D, Golla S, Surya N, Yang H, Martinez S, Ozgen MH, Codrington J, González EMJ, Toosi M, Hariya Mohan N, Menon KV, Chahidi A, Mederer Hengstl S. Chronic Neurology in COVID-19 Era: Clinical Considerations and Recommendations From the REPROGRAM Consortium. Front Neurol 2020; 11:664. [PMID: 32695066 PMCID: PMC7339863 DOI: 10.3389/fneur.2020.00664] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
With the rapid pace and scale of the emerging coronavirus 2019 (COVID-19) pandemic, a growing body of evidence has shown a strong association of COVID-19 with pre- and post- neurological complications. This has necessitated the need to incorporate targeted neurological care for this subgroup of patients which warrants further reorganization of services, healthcare workforce, and ongoing management of chronic neurological cases. The social distancing and the shutdown imposed by several nations in the midst of COVID-19 have severely impacted the ongoing care, access and support of patients with chronic neurological conditions such as Multiple Sclerosis, Epilepsy, Neuromuscular Disorders, Migraine, Dementia, and Parkinson disease. There is a pressing need for governing bodies including national and international professional associations, health ministries and health institutions to harmonize policies, guidelines, and recommendations relating to the management of chronic neurological conditions. These harmonized guidelines should ensure patient continuity across the spectrum of hospital and community care including the well-being, safety, and mental health of the patients, their care partners and the health professionals involved. This article provides an in-depth analysis of the impact of COVID-19 on chronic neurological conditions and specific recommendations to minimize the potential harm to those at high risk.
Collapse
Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia
- Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research and South West Sydney Clinical School, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Simon Israeli-Korn
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan and Sackler School of Medicine, Movement Disorders Institute, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Bindu Menon
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Apollo Hospitals, Nellore, India
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Pravin Thomas
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, University Hospitals NHS Foundation Trust, Birmingham, United Kingdom
| | - Jasvinder Chawla
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Loyola University Medical Center & Hines VA Hospital, Chicago, IL, United States
| | - Rajeev Kumar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, Hamad Medical Center, Qatar & Australian National University, Canberra, ACT, Australia
| | - Paolo Prandi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, University of Eastern Piedmont Amedeo Avogadro, Novara, Italy
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
| | - Sailaja Golla
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Texas Institute for Neurological Disorders, Dallas, TX, United States
| | - Nirmal Surya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Bombay Hospital & Medical Research Centre, and Epilepsy Foundation India, Mumbai, India
| | - Harvey Yang
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Academic Hospital Paramaribo & Anton de Kom Universiteit van Suriname Faculteit der Medische Wetenschappen, Paramaribo, Suriname
| | - Sandra Martinez
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Hospital da Restauração, Recife, Brazil
| | - Mihriban Heval Ozgen
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, Parnassia Psychiatric Institute, The Hague, Netherlands
- Curium-Leiden University Medical Centre, Oegstgeest, Netherlands
| | - John Codrington
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Laboratory Medicine, Academic Hospital Paramaribo and Anton de Kom Universiteit van Suriname Faculteit der Medische Wetenschappen, Paramaribo, Suriname
| | - Eva María Jiménez González
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Forensic Psychology, Forensic Psychology and Forensic Sciences Institute, Ministry of Justice, Granada, Spain
| | - Mandana Toosi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- LodeStone Center for Behavioral Health and Eastern Illinois University, Chicago, IL, United States
| | - Nithya Hariya Mohan
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Chengalpattu Medical College and Hospital, Chengalpattu, India
| | - Koravangattu Valsraj Menon
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Psychiatry, South London and Maudsley NHS Foundation Trust, Kings Health Partners, London, United Kingdom
| | - Abderrahmane Chahidi
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- ED 268, DR 178, Sorbonne Nouvelle University, Paris, France
- Moroccan Society of Neurophysiology, Marrakech, Morocco
- Morocco and Basic and Clinical Neurosciences Research Laboratory, University Medical School of Marrakech, Marrakech, Morocco
| | - Susana Mederer Hengstl
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, Chronic Neurology REPROGRAM Sub-committee†
- Department of Neurology, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| |
Collapse
|
6
|
Chawla J, Burgess S, Heussler H. Behavioural problems, functional ability and cognitive function in children with down syndrome and sleep problems. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
Colletta K, Kartha N, Chawla J. Paraneoplastic Puzzle: An Unusual Case of Hemichorea, Renal Cell Carcinoma, and LGI1 Antibody. Mov Disord Clin Pract 2018; 5:337-338. [PMID: 30363438 DOI: 10.1002/mdc3.12620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/16/2018] [Accepted: 03/23/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Kalea Colletta
- Department of Neurology Loyola University Medical Center Maywood IL USA
| | - Ninith Kartha
- Department of Neurology Loyola University Medical Center Maywood IL USA
| | - Jasvinder Chawla
- Department of Neurology Edward Hines Junior VA Hospital Hines IL USA
| |
Collapse
|
8
|
Kaul S, Kaur H, Vats SKS, Chawla J, Jindal R, Khetarpal P. Identification of novel translocation between short arm of chromosome 4 and long arm of chromosome 6 in an infertile man using Interphase Chromosome Profiling (ICP). Andrologia 2018; 50:e12954. [PMID: 29411892 DOI: 10.1111/and.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2017] [Indexed: 11/27/2022] Open
Abstract
Conventional cytogenetics has always been a favourite to detect chromosomal aberrations. Carriers of chromosomal translocation are often phenotypically normal but are infertile. Couples are often advised to go for karyotyping, but culture failure or improper metaphase spread with poor banding often makes the analysis difficult. We report here a novel translocation between short arm of chromosome 4 and long arm of chromosome 6 in an infertile man using an advanced molecular cytogenetic technique of Interphase Chromosome Profiling (ICP).
Collapse
Affiliation(s)
- S Kaul
- Centre for Human Genetics and Molecular Medicine, School of Health Science, Central University of Punjab, Bathinda, India
| | - H Kaur
- Adesh University, Bathinda, India
| | - S K S Vats
- Dss Imagetech Pvt. ltd, New Delhi, India
| | - J Chawla
- Jindal Heart Hospital, Jindal heart institute and IVF centre, Bathinda, India
| | - R Jindal
- Jindal Heart Hospital, Jindal heart institute and IVF centre, Bathinda, India
| | - P Khetarpal
- Centre for Human Genetics and Molecular Medicine, School of Health Science, Central University of Punjab, Bathinda, India
| |
Collapse
|
9
|
Abstract
The hydrosoluble vitamins are a group of organic substances that are required by humans in small amounts to prevent disorders of metabolism. Significant progress has been made in our understanding of the biochemical, physiologic and nutritional aspects of the water-soluble vitamins. Deficiency of these particular vitamins, most commonly due to inadequate nutrition, can result in disorders of the nervous system. Many of these disorders have been successfully prevented in developed countries; however, they are still common in developing countries. Of the hydrosoluble vitamins, the nervous system depends the most on vitamins B and C (ascorbic acid) for proper functioning. The B group vitamins include thiamin (vitamin B1), riboflavin (vitamin B2), niacin or niacinamide (vitamin B3), pantothenic acid (vitamin B5), pyridoxine or pyridoxal (vitamin B6) and cobalamin (vitamin B12). Clinical findings depend upon the deficiency of the underlying vitamin; generally, deficiency symptoms are seen from a combination rather than an isolated vitamin deficiency. True hereditary metabolic disorders and serious deficiency-associated diseases are rare and in general limited to particular geographic regions and high-risk groups. Their recognition is truly important as that determines the appropriate therapeutic management. The general availability of vitamins to practically everyone and several national health programs have saved many lives and prevented complications. However, there has been some apprehension for several decades about how harmless generous dosages of these vitamins are. Overt overdosages can cause vitamin toxicity affecting various body systems including the nervous system. Systemically, vitamin toxicity is associated with nonspecific symptoms, such as nausea, vomiting, diarrhea, and skin rash which are common with any acute or chronic vitamin overdose. At a national level, recommended daily allowances for vitamins become policy statements. Nutrition policy has far reaching implications in the food industry, in agriculture, and in food provision programs. Overall, water-soluble vitamins are complex molecular structures and even today, many areas of vitamin biochemistry still need to be explored. Many readers might be of the opinion that the classic forms of nutritional deficiency diseases have faded into the background of interesting history. This has caused their diverse symptoms to be neglected by most modern physicians since vitamin enrichment of many foods automatically erases them from their consideration in differential diagnosis. Vitamin B12 and folic acid deficiencies are discussed in other chapters.
Collapse
Affiliation(s)
- Jasvinder Chawla
- Department of Neurology, Hines VA Hospital, Hines, IL, USA; Department of Neurology, Loyola University Medical Center, Maywood, IL, USA.
| | - David Kvarnberg
- Department of Neurology, Loyola University Medical Center, Maywood, IL, USA
| |
Collapse
|
10
|
Ramirez-Zamora A, Morales-Vidal S, Chawla J, Biller J. Autopsy proven peripheral nervous system neurolymphomatosis despite negative bilateral sural nerve biopsy. Front Neurol 2013; 4:197. [PMID: 24367352 PMCID: PMC3854546 DOI: 10.3389/fneur.2013.00197] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/21/2013] [Indexed: 11/29/2022] Open
Abstract
Neurolymphomatosis (NL) refers to a lymphomatous infiltration of peripheral nerves associated with central nervous system or systemic lymphoma, or alternatively, neurodiagnostic evidence of nerve enhancement and/or enlargement beyond the dural sleeve in the setting of primary central nervous system lymphoma or systemic lymphoma. NL is a rare complication of systemic cancer with heterogeneous clinical presentations and an elusive diagnosis. Diagnosis usually requires the demonstration of infiltrating malignant lymphocytes in the peripheral nerve. Infiltration of brain parenchyma, meninges or Virchow–Robin spaces is characteristic of systemic disease at autopsy. We describe a patient presenting with biopsy negative NL affecting exclusively the peripheral nervous system at autopsy.
Collapse
Affiliation(s)
| | - Sarkis Morales-Vidal
- Department of Neurology, Maguire Center, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | | | - José Biller
- Department of Neurology, Maguire Center, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| |
Collapse
|
11
|
Fall A, Chawla J. 269 Oral vitamin D2 supplementation in children with cystic fibrosis makes a relatively small contribution to total serum 25OH vitamin D levels. J Cyst Fibros 2012. [DOI: 10.1016/s1569-1993(12)60438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Abstract
Muscle diseases can constitute a large variety of both acquired and hereditary disorders. Myopathies in systemic disease results from several different disease processes including endocrine, inflammatory, paraneoplastic, infectious, drug- and toxin-induced, critical illness myopathy, metabolic, and myopathies with other systemic disorders. Patients with systemic myopathies often present acutely or sub acutely. On the other hand, familial myopathies or dystrophies generally present in a chronic fashion with exceptions of metabolic myopathies where symptoms on occasion can be precipitated acutely. Most of the inflammatory myopathies can have a chance association with malignant lesions; the incidence appears to be specifically increased only in patients with dermatomyositis. In dealing with myopathies associated with systemic illnesses, the focus will be on the acquired causes. Management is beyond the scope of this chapter. Prognosis is based upon the underlying cause and, most of the time, carries a good prognosis. In order to approach a patient with suspected myopathy from systemic disease, a stepwise approach is utilized.
Collapse
Affiliation(s)
- Jasvinder Chawla
- Chief of Neurology, Hines VA Hospital and Neurology Residency Program Director, Loyola University Medical Center Hines, IL, USA
| |
Collapse
|
13
|
Dewan M, Chawla J, Thaman D, Chatrath R. Arteriovenous malformation of head and neck region. Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
14
|
Chawla J, Ramirez-Zamora A, Morales-Vidal S. 102. Paraneoplastic myasthenia gravis and multifocal motor neuropathy with lung cancer. Clin Neurophysiol 2009. [DOI: 10.1016/j.clinph.2008.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
15
|
Fisher MA, Chawla J, Webber CL. Deterministic recurrences of sequential F-wave latencies. Neurol Neurophysiol Neurosci 2006:8. [PMID: 17260085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 01/12/2007] [Indexed: 05/13/2023]
Abstract
PURPOSE Historically, F-waves have been classified by various linear descriptors like persistence, latency, duration, amplitude, chrono-dispersion and number of repeater waves. But because physiological signals are notoriously nonlinear in nature, the objective of this study was to apply modern nonlinear methodology to F-waves sequences to assess the presence of underlying deterministic structures. Subtle changes in these sensitive markers could give early warnings for neurological problems. METHODS F-waves were elicited in the left abductor pollicis breivs muscle by supra-maximally stimulating the median nerve percutaneously at the wrist. Approximately 200 stimuli were applied (0.5 Hz) to three subjects for at least four trials each. F-wave latencies were measured and assembled into sequences in proper order. Recurrence quantification analysis (RQA) was applied to these F-wave sequences from different dimensional perspectives. Controls were constructed by randomly shuffling the ordered sequences. RQA has a theoretical mathematical foundation and practical performance record on numerous other physiological systems. RESULTS Recurrence analysis showed that sequential F-waves form recurrent patterns with parallel trajectories with deterministic and laminated structures. These features could be destroyed by randomizing the sequential orders of F-waves, upholding the hypothesis that sequences of F-waves are deterministically formed from underlying physiological rules. CONCLUSIONS F-wave time series are fully amenable to recurrence analysis which provides a higher-dimensional perspective on the physiological dynamic. The recurrent patterns are complex, but not random, meaning that physiological rules dominate the sequence of F-waves. Disease processes within the central or peripheral nervous system may alter F-wave patterns. If so, RQA potentially may be a diagnostic tool to help discern subtleties between altered deterministic rules operating in disease.
Collapse
|
16
|
Wilson J, Chawla J, Fisher M. Sensitivity and specificity of electrodiagnostic criteria for CIDP using ROC curves: comparison to patients with diabetic and MGUS associated neuropathies. J Neurol Sci 2005; 231:19-28. [PMID: 15792816 DOI: 10.1016/j.jns.2004.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Revised: 09/24/2004] [Accepted: 12/10/2004] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Electrodiagnostic testing plays a key role in the characterization of neuropathies. To this end, sets of electrodiagnostic criteria have been proposed to define chronic inflammatory demyelinating polyneuropathy (CIDP). These criteria sets differ because of the number of data points within the sets, the number of required abnormal measures within a criterion, and the cutoff value of each measure. OBJECTIVE To evaluate the sensitivity and specificity of the published criteria for defining CIDP in comparison to diabetic polyneuropathy (DMPN) and monoclonal gammopathy of undetermined significance associated neuropathies (MGUS-PN). DESIGN/METHODS Electrodiagnostic studies of 21 patients with biopsy proven CIDP, 35 patients with MGUS-PN, and 82 patients with DMPN were analyzed. Data were compared against 4 different published criteria sets. Receiver operator characteristic (ROC) curves were used to determine the ideal threshold values for individual electrodiagnostic parameters. RESULTS/CONCLUSION None of the currently published criteria sets could adequately separate CIDP from DMPN and MGUS-PN. Analysis of our data using ROC curves shows that the best discrimination was achieved using the following criteria: (1) FWL>145%ULN in one nerve or 110%ULN in two nerves in separate nerve roots. (2) Motor CV<90%LLN in four nerves with at least one nerve <70%LLN. Furthermore, proximal-to-distal amplitude ratio alone is not adequate to define conduction block. Although electrodiagnostic studies are important for evaluating CIDP, these studies by themselves cannot be used to define this neuropathy.
Collapse
Affiliation(s)
- J Wilson
- Hines VAH, Department of Neurology, Loyola University Chicago Medical Center, Nines, Illinois 60141, USA.
| | | | | |
Collapse
|
17
|
Chawla J. 19 EDUCATION IN VENOUS STASIS EDEMA FOR THE ELDERLY POPULATION OF CATHLAMET, WA. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
18
|
Nirala AP, Vatsal DK, Husain M, Gupta C, Chawla J, Kumar V, Thamman D, Agarwal A. Percutaneous vertebroplasty: an experience of 31 procedures. Neurol India 2003; 51:490-2. [PMID: 14742929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
A prospective study of 31 percutaneous vertebroplasty procedures (PVP) in 22 patients treated during January 2000 to December 2001 is presented. PVP was performed using polymethylmethacrylate (PMMA) to treat vertebral collapse due to osteoporosis and vertebral metastasis, to obtain analgesia and spinal stabilization. We analyze the efficacy and complications related to the procedure. PVP is a safe, effective and a daycare surgery. It can be performed under local anesthesia and has minimal and manageable complications.
Collapse
Affiliation(s)
- A P Nirala
- Department of Neurosurgery, KG's Medical College, Lucknow-226003, India
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Chawla J, Sucholeiki R, Jones C, Silver K. Intractable epilepsy with ring chromosome 20 syndrome treated with vagal nerve stimulation: case report and review of the literature. J Child Neurol 2002; 17:778-80. [PMID: 12546436 DOI: 10.1177/08830738020170101805] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of a 6-year old girl with ring chromosome 20 syndrome whose medically intractable seizures were successfully treated with vagal nerve stimulation therapy. Medically intractable seizures are an expected part of this rare syndrome, and the dramatic improvement in seizure control with vagal nerve stimulation is emphasized. Earlier use of vagal nerve stimulation in similar cases should be considered.
Collapse
Affiliation(s)
- Jasvinder Chawla
- Department of Neurology, Loyola University Medical Center, Maywood, Illinois 60153, USA.
| | | | | | | |
Collapse
|
20
|
Meehan KR, Wu A, Hassan R, Miao Y, Chawla J, Slack R, Gehan E, Herscowitz HB. Ex Vivo Cytokine Activation of Peripheral Blood Stem Cells: A Potential Role for Adoptive Cellular Immunotherapy. ACTA ACUST UNITED AC 2001; 10:283-90. [PMID: 11359675 DOI: 10.1089/15258160151135006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Ex vivo activation of peripheral blood stem cells (PBSC) using interleukin-2 (IL-2) results in cytotoxic effector cells that may possess beneficial in vivo effects. We proposed to evaluate ex vivo stimulation of PBSC using various cytokines alone or in combination to optimize their function. Cytokine-activated PBSC were analyzed for tumor-directed cytotoxicity and their ability to remove tumor cells from long-term clonogenic assays. Mononuclear cells were obtained from the apheresis products of normal donors and cultured with IL-2 (1000 U/ml), interferon-alpha (IFN-alpha) (1000 U/ml), or IL-12 (50 U/ml) either alone or in combinations at 37 degrees C and 5% CO(2) for 24 h. Colony-forming unit-tumor (CFUT) assays were initiated using cytokine-activated PBSC with varying concentrations of MCF-7 or SKBR-3 human breast cancer cells. Standard 4-h (51)Cr-release assays were performed with cytokine-activated PBSC using MCF-7 or SKBR-3 cells as targets. Activation of PBSC with IL-2, IFN-alpha, or IL-12 resulted in enhanced cytotoxicity against the two breast cancer cell lines when compared to controls. PBSC activated with IL-2 and IFN-alpha or IL-2 and IL-12 were more cytotoxic than PBSC activated with single cytokines (p = 0.0004 for MCF-7 cells and p < 0.001 for SKBR-3 cells). Using clonogenic assays, IL-2-activated PBSC reduced the number of CFU-T to a greater extent than did IL-12 or IFN-alpha-activated PBSC (p = 0.0006). However, PBSC activated with a combination of IL-2 and IFN-alpha or IL-2 and IL-12 demonstrated 95% and 90% reductions, respectively, compared to 79% reduction using IL-2-activated PBSC (p < 0.0001). The greatest reduction in cytotoxicity occurred in the cell populations depleted of CD56(+) cells (p = 0.016) and CD8(+) CD56(+) cells (p = 0.002), suggesting that the effector cell population includes a combination of cytotoxic CD8(+) T cells and CD56(+) natural killer cells. These results demonstrate that the ex vivo activation of PBSC with cytokines, either alone or in combination, enhances cytotoxicity against, and removal of two human breast cancer cells. The combinations of IL-2 with IFN-alpha or IL-12 are most beneficial in cytotoxicity and purging assays. These results could play an important role in designing adoptive cellular immunotherapy clinical trials in the autologous hematopoietic stem cell transplant setting.
Collapse
Affiliation(s)
- K R Meehan
- Division of Hematology and Oncology, the Bone Marrow Transplant Program, Georgetown University Medical Center, Vincent T. Lombardi Cancer Center, Washington, D.C. 20007, USA.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Chawla J. Reaching consensus, discovering allies, finding tools. Midwifery Today Int Midwife 2001:10. [PMID: 11189607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- J Chawla
- Motherhood and Traditional Resources, Information, Knowledge and Action, 120 Sundernagar, New Delhi, 110003, India.
| |
Collapse
|
22
|
Chawla J. Hawa Gola and mother-in-law's big toe. Midwifery Today Int Midwife 2001:54-9. [PMID: 11051991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
|
23
|
Verma UN, van den Blink B, Pillai R, Chawla J, Mazumder A, Herscowitz HB, Meehan KR. Paclitaxel vs cyclophosphamide in peripheral blood stem cell mobilization: comparative studies in a murine model. Exp Hematol 1999; 27:553-60. [PMID: 10089919 DOI: 10.1016/s0301-472x(98)00044-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Paclitaxel is a promising drug for the treatment of breast and ovarian cancer. It also may play a role in mobilization of peripheral blood stem cells (PBSC), as an alternative to cyclophosphamide (Cy). We investigated the PBSC-mobilizing potential of paclitaxel compared to Cy in a murine model. C57B1/6 mice were primed with intraperitoneal injections of Cy (200 mg/kg) or paclitaxel (60 mg/kg) and were sacrificed 4, 6, 8, or 10 days later. Spleens were harvested and processed to obtain low-density mononuclear cells that were used as PBSC. The number of hematopoietic progenitors (CFU-C) on day 4 was significantly higher in the paclitaxel group when compared to mice receiving Cy (72.0 +/- 1.8 vs 9.8 +/- 2.8, p < 0.001). By day 6, CFU-C became significantly higher in the Cy-treated group compared to the paclitaxel-treated group (195.6 +/- 31.9 vs 95.8 +/- 20.7, p < 0.05) and this trend was maintained. However, the total number of CFU-C recovered per spleen was greater in the paclitaxel-treated group (1.27 x 10(5) +/- 0.53 x 10(5) vs 1.06 x 10(5) +/- 0.36 x 10(5), NS). In contrast to paclitaxel, mobilization with Cy was associated with marked perturbation in the proportion of lymphoid cell subsets in the PBSC population along with functional impairment of lymphocytes. After 24 hours of in vitro IL-2 activation, the cytotoxic effector cell function of the Cy-mobilized PBSC population was lower than that of paclitaxel-mobilized cells when tested against three tumor cell lines (B16, melanoma; C1498, AML; and Yak-1, lymphoma). These results indicate that paclitaxel is an efficient mobilizer of PBSC, leading to early (day 4 to 6) mobilization of PBSC when compared to Cy (day 6 to 8). In addition, paclitaxel was associated with less perturbation of phenotypic and functional characteristics of cells contained within the mobilized PBSC population.
Collapse
Affiliation(s)
- U N Verma
- Division of Hematology and Oncology, Georgetown University Medical Center, Vincent T. Lombardi Cancer Center, Washington, DC 20007, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Gewirtz DA, Randolph JK, Chawla J, Orr MS, Fornari FA. Induction of DNA damage, inhibition of DNA synthesis and suppression of c-myc expression by the anthracycline analog, idarubicin (4-demethoxy-daunorubicin) in the MCF-7 breast tumor cell line. Cancer Chemother Pharmacol 1998; 41:361-9. [PMID: 9523731 DOI: 10.1007/s002800050752] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Studies were designed to elucidate the basis for the antiproliferative activity of the anthracycline antibiotic, idarubicin (4-demethoxy-daunorubicin) in MCF-7 breast tumor cells. METHODS Growth inhibition was evaluated using the MTT tetrazolium dye assay, induction of DNA strand breaks was determined by alkaline elution, inhibition of DNA synthesis was assessed by measuring the incorporation of labelled thymidine into DNA, modulation of the expression of the c-myc oncogene was determined by Northern blotting and the induction of apoptosis was evaluated by alkaline unwinding, static field gel electrophoresis, terminal end labelling and assessment of cell morphology. RESULTS MCF-7 cells were relatively sensitive to idarubicin, with an IC50 value for growth inhibition of approximately 0.01 microM. While DNA strand breakage was not evident below a concentration of 0.1 microM idarubicin, where growth inhibition exceeded 70%, both the inhibition of DNA synthesis and suppression of c-myc expression closely paralleled the profile of antiproliferative activity for idarubicin. Finally, while exposure to idarubicin resulted in a substantial loss of viable cells within 48-72 h, there was no morphological evidence of apoptotic body formation. The absence of apoptosis in cells exposed to idarubicin was supported by studies demonstrating the absence of DNA fragmentation using gel electrophoresis, alkaline elution and in situ DNA end-labelling assays. CONCLUSIONS The results of these studies extend previous results from this laboratory indicating an association between suppression of c-myc expression, inhibition of DNA synthesis and growth arrest by topoisomerase II inhibitors, as well as the lack of induction of apoptotic cell death by topoisomerase II inhibitors in MCF-7 breast tumor cells.
Collapse
Affiliation(s)
- D A Gewirtz
- Department of Medicine, Medical College of Virginia, Richmond 23298, USA.
| | | | | | | | | |
Collapse
|
25
|
Abstract
A collection of 70 strains of Escherichia coli from urinary tract infections in spine-injured patients undergoing long-term bladder catheterization were tested for characteristics that have been associated with the ability to produce pyelonephritis. The incidence of the virulence factors were: mannose-resistant haemagglutinins (30%), P-fimbriae (17%), haemolysin (27%), K-antigens (28%) and aerobactin (by bioassay 33%, by gene probe 39%). Only 54% of the strains belonged to the O-serotypes usually associated with urinary tract infections. E. coli carrying the full complement of virulence factors were rare in the urinary tract of the spinal patients and were not associated with episodes of symptomatic pyelonephritis. It is clear that the neuropathic bladder and the presence of the catheter permits a wide variety of bacterial types to colonize the urinary tract and cause infection of the kidney. The identification of host markers rather than bacterial factors is suggested as a more fruitful approach to the early detection of cases likely to progress to pyelonephritis in this group of patients.
Collapse
Affiliation(s)
- J Benton
- School of Pure and Applied Biology, University of Wales College of Cardiff, UK
| | | | | | | |
Collapse
|
26
|
Ganderton L, Chawla J, Winters C, Wimpenny J, Stickler D. Scanning electron microscopy of bacterial biofilms on indwelling bladder catheters. Eur J Clin Microbiol Infect Dis 1992; 11:789-96. [PMID: 1468417 DOI: 10.1007/bf01960877] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fifty Foley bladder catheters that had been indwelling for periods ranging from 3 to 83 days (mean 35 days) were examined for the presence of bacterial biofilm. Scanning electron microscopy on freeze-dried cross-sections and fixed, critical point-dried longitudinal sections revealed biofilm formation on the luminal surfaces of 44 of the catheters. Culture of urine samples and sonicates from catheters revealed that the prevalence of bacteriuria was less than that of catheter colonization. A wide range of nosocomial species were found colonizing the catheters, Escherichia coli being most often isolated. The bacterial composition of the biofilms ranged from single species to mixed communities containing up to four species. There was no relationship between the length of time that the catheter had been in situ and the extent of biofilm formation. The biofilms varied in thickness from 3 to 490 microns and were visible as layers of bacterial cells up to about 400 cells deep, embedded in a matrix.
Collapse
Affiliation(s)
- L Ganderton
- School of Pure and Applied Biology, University of Wales College of Cardiff, UK
| | | | | | | | | |
Collapse
|
27
|
McInerney PD, Grant A, Chawla J, Stephenson TP. The effect of intravesical Marcain instillation on hyperreflexic detrusor contractions. Paraplegia 1992; 30:127-30. [PMID: 1589288 DOI: 10.1038/sc.1992.40] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Thirty-six patients with suprasacral spinal injury were treated with intravesical local anaesthetic instillation. Eighteen of 32 patients (56%) were converted from an 'ice water positive' hyperreflexic state to an 'ice water negative' state by bupivacaine hydrochloride. Four patients treated with lignocaine hydrochloride showed no benefit. Intravesical local anaesthetic instillation is suggested as a possible treatment for selected cases of detrusor hyperreflexia in patients on intermittent catheterisation.
Collapse
|
28
|
Liu K, Moon M, Sulvetta M, Chawla J. International infant mortality rankings: a look behind the numbers. Health Care Financ Rev 1992; 13:105-18. [PMID: 10122000 PMCID: PMC4193257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The very unfavorable infant mortality ranking of the United States in international comparisons is often used to question the quality of health care there. Infant mortality rates, however, implicitly capture a complicated story, measuring much more than differences in health care across countries. This article examines reasons behind international infant mortality rate rankings, including variations in the measurement of vital events, and differences in risk factors across countries. Its goal is to offer a broader context for more informed debate on the meaning of international infant mortality statistics. These statistics offer opportunities to identify strategies for improving the U.S. health care system and learn from other countries that have been more successful.
Collapse
Affiliation(s)
- K Liu
- Urban Institute, Washington, DC 20037
| | | | | | | |
Collapse
|
29
|
Stickler D, Dolman J, Rolfe S, Chawla J. Activity of some antiseptics against urinary tract pathogens growing as biofilms on silicone surfaces. Eur J Clin Microbiol Infect Dis 1991; 10:410-5. [PMID: 1908381 DOI: 10.1007/bf01968020] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The activity of chlorhexidine, mandelic acid and a mandelic/lactic mixture were tested against biofilms of four species of gram-negative nosocomial organisms that commonly infect the catheterized urinary tract. Cells growing on silicone discs were exposed to concentrations of agents used in bladder instillation. Citrobacter diversus biofilms proved to be sensitive to all three agents. Pseudomonas aeruginosa, Proteus mirabilis and Klebsiella pneumoniae all survived well in chlorhexidine but their viability was significantly reduced by the mandelic acid formulations. These results suggest that bladder instillations of mandelic acid or mandelic/lactic acids would be more effective than chlorhexidine in eliminating biofilms from catheter surfaces.
Collapse
Affiliation(s)
- D Stickler
- School of Pure and Applied Biology, University of Wales College of Cardiff, UK
| | | | | | | |
Collapse
|
30
|
Jordan MM, Chawla J, Owens MW, George RB. Significance of false-positive serologic tests for histoplasmosis and blastomycosis in an endemic area. Am Rev Respir Dis 1990; 141:1487-90. [PMID: 2112351 DOI: 10.1164/ajrccm/141.6.1487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
False-positive serologic tests for histoplasmosis (H) and blastomycosis (B) are common in populations from endemic areas. In order to determine the significance of false-positive test results, we reviewed the final diagnoses of all patients whose sera were submitted to our laboratory for radioimmunoassay (RIA) and immunodiffusion (ID) during a 3-yr period. Of the 263 patients whose sera were examined, 29 (11%) had H or B; 41 (17.5%) of the remaining 234 patients had false-positive test results. Of these 41 patients, 31 were positive for H alone, and 10 had antibodies to both H and B. All three patients with false-positive ID tests for histoplasmosis also had positive titers (greater than or equal to 1:16) on RIA. No patient had a false-positive ID result for blastomycosis. The percentage of patients in each of five major diagnostic categories with and without false-positive serologic tests was similar (p greater than 0.05). The majority of patients had pulmonary infections, almost half of which were granulomatous infections other than H or B; this reflects the clinical indications for requesting fungal serologic tests. A positive fungal serology is not useful in suggesting the presence of a pulmonary disease other than H or B in patients from an endemic area suspected of having a pulmonary mycosis.
Collapse
Affiliation(s)
- M M Jordan
- Department of Medicine, Louisiana State University School of Medicine, Shreveport 71130
| | | | | | | |
Collapse
|
31
|
Stickler D, Dolman J, Rolfe S, Chawla J. Activity of antiseptics against Escherichia coli growing as biofilms on silicone surfaces. Eur J Clin Microbiol Infect Dis 1989; 8:974-8. [PMID: 2513198 DOI: 10.1007/bf01967568] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The activity of chlorhexidine, acetic, lactic and mandelic acids were examined against biofilms of Escherichia coli established on silicone discs and against the test strain growing in suspension in urine. The results showed that the concentrations of chlorhexidine and acetic acid normally used for bladder instillations to control infections in patients with indwelling catheters failed to eliminate cells from the biofilm in exposure periods of up to 2 h. Lactic acid (1% v/v) had a bactericidal effect on planktonic cells but poor activity against cells in the biofilm. Mandelic acid (1% v/v), and mandelic (1% v/v) and lactic acid (1% v/v) mixtures eliminated organisms from both suspensions and biofilms. It is suggested that these solutions be considered as alternatives to acetic acid and chlorhexidine for the washing of catheterized bladders.
Collapse
Affiliation(s)
- D Stickler
- School of Pure and Applied Biology, University of Wales College of Cardiff, UK
| | | | | | | |
Collapse
|
32
|
Abstract
Forty-two spinal injury patients underwent single or sequential urodynamic studies to assess the value of dynamic urethral pressure using transducer tipped catheters. Three groups of patients were identified: those with poor detrusor function, those with unsustained dyssynergia and those with sustained dyssynergia. All patients demonstrated some dyssynergia. Urethral needle EMG mirrored urethral pressure changes accurately. The addition of dynamic profilometry to fluoroscopy, detrusor pressure and urethral EMG has clarified our understanding of lower urinary tract behaviour after cord lesions.
Collapse
|
33
|
Abstract
Of 500 patients seen because of rape, semen was identified in vaginal secretions by the identification of spermatozoa in 61%, by an acid phosphatase value of 50 units or more in 40%, and by the identification of a foreign blood group substance or a high titer of own blood group substance in 16%. The addition of the determination of the acid phosphatase to the search for spermatozoa identified semen in only 1.4% more patients, or a total of 62.4%. Identification and titers of blood group substance were confirmatory only, but further characterized the source of the semen in 25% of those patients with spermatozoa. Spermatozoa were identified for as long as 48 hours, and elevated acid phosphatase was not found after 18 hours. Acid phosphatase was elevated in only 62% of patients with spermatozoa.
Collapse
|
34
|
Vignadndra V, Ghee LT, Chawla J. EEG in brain abscess: its value in localization compared to other diagnostic tests. Electroencephalogr Clin Neurophysiol 1975; 38:611-22. [PMID: 50187 DOI: 10.1016/0013-4694(75)90162-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The EEG records of 13 cases of brain abscess were reviewed for their value in localization. Of the 11 cases of supratentorial abscesses localization was achieved in 10, and correct lateralization in the remaining 1 case. Two other cases were cerebellar abscesses; 1 of them showed a false cerebral localization; the other showed no focal abnormalities. The most consistent EEG localizing sign was focal arrhythmic delta waves. These were as slow as 0.5 c/sec in 6 of the 13 cases. Epileptiform discharges in the pre-operative EEG were seen in 4 of the 13 cases. Asymmetry of beta activity correctly lateralized the abscess in 7 of the 11 supratentorial abscesses. Generalized abnormalities when present correlated with depression of consciousness rather than with the duration of illness or the presence of raised intracranial pressure. Indium brain scans were done in 6 supratentorial abscesses and provided correct or approximate localization in 5. Carotid angiograms were also done in 7 cases and localized the abscess in 6. Our findings show that the EEG is comparable to brain scans and contrast radiological studies in localizing supratentorial abscesses. We feel that the combination of EEGs and brain scanslization in suspected brain abscess.
Collapse
|
35
|
|