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Biomedical subjects

A B Dey

Publications and source records attributed to A B Dey.

At least 37 records · Page 2Linked to original sources
PubMed1997

The impact of a dedicated "syncope and falls" clinic on pacing practice in northeastern England.

This study examined whether the increased demand for pacemaker implants for carotid sinus syndrome (CSS) at the Regional Pacing Service in northeastern England was related to the establishment of a dedicated "syncope and falls" clinic or to the publication of NASPE and BPEG guidelines for pacing symptomatic bradycardia. To this end, pacemaker rates for various indications at this institution were compared with those of a comparable region (Liverpool), as well as with BPEG's national pacemaker database. Findings indicate a distinct impact of the Newcastle syncope and falls clinic on recognition and pacemaker treatment of CSS.

Accidental Falls↗
PubMed1997

Cardiovascular syncope is the most common cause of drop attacks in the elderly.

Drop attacks are defined as a sudden loss of postural tone without loss of consciousness. The mechanism is often unknown. This report examines findings in consecutive elderly patients with drop attacks referred to a dedicated "syncope and falls" center. Thirty-five patients were included. A diagnosis was established in 25 (71%); cardioinhibitory cartoid sinus syndrome (CSS) or mixed CSS in 15, vasodepressor CSS in 3, orthostatic hypotension in 5, vasovagal syncope in 1, and gait imbalance in 1. In 21%, more than one pathological diagnosis was present. In conclusion, absence of a history of syncope is unreliable in elderly patients, and these individuals should be routinely investigated for hemodynamic changes during carotid massage and standing.

Accidental Falls↗
PubMed1997

Prolonged pyrexia in a diabetic due to systemic aspergillosis.

Immuno-compromised patients are susceptible to a variety of opportunistic infections. Systemic aspergillosis is one such common infection in neutropenic subjects. A case of primary cutaneous aspergillosis with fungimia in a diabetic is reported.

Aspergillosis↗
PubMed1997

Infections in the elderly.

Ageing of the immune system is a complex process involving both humoral and cell mediated immunity. Along with decline in immunity, morphological changes in various organ makes the elderly especially vulnerable to infection. In clinical practice, infections of respiratory tract and urinary tract, endocarditis, septicaemia and tuberculosis are commonly encountered in elderly subjects Atypical clinical presentation, slow response to treatment and high mortality are hall marks of infection in order patients. Antibiotic therapy in elderly needs to be early, empirical and broad spectrum through parenteral route, with early change over to oral therapy. Aminopenicillins and cephalosporins are safer drugs in old age as compared to aminoglycosides. Pneumococcal and influenza vaccines are recommended in elderly subjects with medical conditions with higher risk of mortality and complications.

Aged↗
PubMed1989

Malignant fibrous histiocytoma of the mediastinum.

A case of malignant fibrous histiocytoma of the mediastinum presenting with unusual features of fever and leucocytosis is reported. This is the youngest patient reported in the literature who had this tumour in the mediastinum.

Adolescent↗
PubMedDate not supplied

Drug-resistant Salmonella enterica serotype paratyphi A in India.

The incidence of enteric fever caused by Salmonella enterica serotype Paratyphi A has been increasing in India since 1996. In 1998, the incidence of enteric fever caused by drug- resistant S. Paratyphi A abruptly increased in the New Delhi region. In the first 6 months of 1999, 32% of isolates were resistant to both chloramphenicol and cotrimoxazole and another 13% were resistant to more than two antibiotics.

Anti-Bacterial Agents↗
PubMedDate not supplied

Constipation.

Constipation is a common problem in day-to-day practice. As there are wide variations in normal bowel habits, there is no standard definition. Altered colonic transit and disorders of the anorectal mechanism are the essential abnormalities in patients who experience this symptom. While there are several organic causes, functional disorders are by far the commonest cause of constipation. Clinical assessment should include a careful history, eliciting information on lifestyle, diet and personality. Extensive investigations are seldom warranted. Reassurance and long term treatment with a wide range of laxatives provide symptomatic relief.

Constipation↗
PubMedDate not supplied

Mycoplasma pneumoniae and community-acquired pneumonia.

BACKGROUND: Community-acquired pneumonia is an important cause of mortality and hospitalization in all age groups. In temperate climates, Mycoplasma pneumoniae is a common respiratory pathogen causing pneumonia. Information on human Mycoplasma infection in India is scarce. METHODS: We aimed to determine the frequency of Mycoplasma pneumoniae infection among patients with community-acquired pneumonia in a prospective cross-sectional study. The assessment included clinical and radiological evaluation followed by microbiological evaluation for the specific pathogen. Microbiological investigations included aerobic and anaerobic blood culture, anti-Mycoplasma IgM antibody detection by gelatin particle agglutination test and ELISA, culture of respiratory tract secretions for Mycoplasma pneumoniae and other organisms, and detection of specific Mycoplasma pneumoniae antigen by indirect immunofluorescence. RESULTS: Sixty-two patients (42 men and 20 women; mean age 41.7 years) with community-acquired pneumonia were investigated prospectively. They included 42 immunocompetent and 20 immunocompromised patients. Six patients had definitive evidence of Mycoplasma pneumoniae infection and an additional 16 patients had a probable diagnosis. In all, 22 (35.5%) patients with pneumonia had Mycoplasma pneumoniae infection. Of these, 12 patients belonged to the immunocompromised group and 10 to the immunocompetent group. Patients with Mycoplasma pneumoniae infection also had secondary bacterial infection as evidenced by organisms isolated from blood in 50% and from respiratory tract secretions in 68%. CONCLUSION: Community-acquired pneumonia has a polymicrobial aetiology, of which the prevalence of Mycoplasma pneumoniae is 35%. The study has two implications: (i) Mycoplasma pneumoniae infection is frequently associated with secondary bacterial infection; and (ii) initial empirical antibiotic therapy for community-acquired pneumonia in India must include antibiotics with activity against Mycoplasma pneumoniae.

Adolescent↗
PubMedDate not supplied

Evaluation of the health and functional status of older Indians as a prelude to the development of a health programme.

BACKGROUND: An estimated 68 million Indians are above the age of 60 years; however, information on their health status and needs is limited. Experience in developed countries shows that multiple chronic illnesses, nutritional deficiency and functional disability are common features of old age. For the development of any health programme, reliable situational information is essential. We therefore assessed the health and functional status of older Indians seeking health services. METHODS: We carried out a prospective cross-sectional observational study on 1586 subjects > or = 60 years of age (1035 men and 551 women), who attended the Geriatric Clinic of the All India Institute of Medical Sciences, New Delhi. A clinical and laboratory evaluation was carried out through a pre-designed protocol evolved after reviewing the relevant literature. The protocol included a questionnaire on demographic details, personal habits, socio-economic variables, family structure, past and present medical history, use of medications and aids, presence of certain common symptoms and perceived functional disability. Evaluation included a detailed physical examination, functional assessment, psychiatric assessment and a set of laboratory tests. RESULTS: Ninety-five per cent of the subjects were < 80 years of age and 87% of them sought medical attention for an acute illness that had occurred in the month prior to their coming to our clinic. One or more chronic illnesses were present in 96% and each subject had a mean of 2.5 diagnoses. However, they suffered from a limited number of illnesses of which the 10 most common accounted for 80% of the diagnoses. Hypertension, cataract and osteoarthritis were the 3 most common illnesses. About one-third of a subset of 209 subjects had a psychiatric illness; depression accounted for 50% of all psychiatric illnesses. A detailed functional assessment was carried out in 1268 subjects which showed that deficits of vision and hearing were the most frequent disabilities. Impairment of daily activities and cognition accounted for 6.9% and 5.1% of the diagnoses, respectively. A majority of them considered their home free from the hazard of accidents and were sure of support from their families at times of need. CONCLUSION: Multiple chronic illnesses, frequent acute illnesses and deficits of vision and hearing are the major health and functional problems of the health-seeking older population in India. It is difficult to assess the total service needs of the population from this study because of its unrepresentative character, though it provides a fair picture of the expectations of care of older people in India.

Activities of Daily Living↗
PubMedDate not supplied

The use of diagnostic bronchoscopy in lung cancer.

BACKGROUND: The role of fibreoptic bronchoscopy in the diagnosis of bronchogenic carcinoma is well established. However, in developing countries, where the burden of illness is large and diagnostic facilities are limited, only a small number of patients are diagnosed at a stage when they might benefit from operation. We felt it would be desirable to identify subsets of patients suspected of harbouring lung cancers, in whom bronchoscopy would have not only a high diagnostic yield but also provide useful information which might influence treatment, the patient's quality of life and duration of survival. METHOD: We analysed the records of 588 patients, who had been bronchoscoped for suspected lung cancer, over a period of 8 years at a tertiary referral centre in north India. The patients were divided into different clinical subgroups on the basis of their clinical and radiological presentation, and the diagnostic yield from bronchoscopy in each group was calculated. A decision analysis model was constructed and the expected value of clinical information was determined for each group. RESULTS: A tissue diagnosis was established by bronchoscopy in 177 (30%) patients and by additional investigations in 43 (7.3%) patients. A positive tissue diagnosis was obtained most often in patients with clinical and radiological evidence of pulmonary collapse (50%) and mass lesions (38-42%). Only 12% of patients with malignancy underwent resection and 70% of them belonged to the above two groups. The expected value of clinical information was greatest in patients with collapse (0.077) or mass lesions (0.067-0.065). CONCLUSIONS: A diagnostic work-up including fibreoptic bronchoscopy is indicated early in patients with collapse or mass lesions of the lung. Patients with non-resolving pneumonia, pleural effusion, metastatic disease and non-specific lesions on chest X-ray should receive a low priority for bronchoscopy.

Adolescent↗
PubMedDate not supplied

Bronchial adenoma--an eleven-year experience.

Thirteen patients with bronchial adenoma were investigated. Most of these were young males and had recurrent hemoptysis and chest infection. Radiographs of the chest were abnormal in 11 patients. The tumor was visualized by fiberoptic bronchoscopy in all but one patient. The procedure was safe and none of the patients had massive hemoptysis following bronchoscopic biopsy. Limited follow-up revealed good results following surgery.

Adult↗
PubMedDate not supplied

Fiberoptic bronchoscopy in patients with haemoptysis and normal chest roentgenograms.

Over the last 10 years, 53 patients with hemoptysis, but with a normal chest radiograph underwent diagnostic fiberoptic bronchoscopy. Forty-three patients did not show any abnormal findings, the site of bleeding could be localised in five and non-specific mucosal changes were seen in the remaining five patients. Thirty-two patients were followed up clinically for a 3-18 months period. One patient on follow-up developed tubercular pleural effusion. Bronchogenic carcinoma was not detected in any of these patients during the procedure or at follow up. A review of literature revealed a 3 per cent incidence of bronchogenic carcinoma and the risk factors associated with higher incidence were age above 40 years, cigarette smoking and a longer duration of hemoptysis. We conclude that fiberoptic bronchoscopy has little role in this relatively benign condition (hemoptysis) especially when the risk factors are absent.

Adult↗
PubMedDate not supplied

Multi drug resistant tuberculosis.

The prevalence of multi-drug resistant tuberculosis is increasing globally which has upset tuberculosis treatment and control programmes. The problem has been further complicated by co-infection with HIV virus. Treatment of multi drug resistant tuberculosis is difficult, expensive and requires long duration chemotherapy. The long term prognosis is poor with frequent relapses following cessation of treatment. Health care workers are at considerable risk of contacting the disease. New, potent and less toxic drugs are required for management of multi drug resistant strains. Directly observed therapy of tuberculosis seems to be promising but demands enormous resources. Finally strengthening of tuberculosis control programmes for prevention and control of tuberculosis is essential.

Antitubercular Agents↗