Sedation with nasal ketamine and midazolam for cryotherapy in retinopathy of prematurity.
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Administration, Intranasal↗
Biomedical subjects
A Gupta
Publications and source records attributed to A Gupta.
Randomized perturbed posturography: methodology and effects of midazolam sedation.
To study quiescent stance without applying external disturbances is not a theoretically appealing way to unveil the dynamic properties of human equilibrium. Methods to disturb equilibrium range from standing on foam surface, attaching vibrators to the calves to interfere with somatosensation, and exposure to body-position tracking environments, as in dynamic posturography (EquiTest). The EquiTest apparatus was modified by a menu-driven software to allow arbitrary movements of the support surface and visual surround, and force data were recorded for subsequent analysis. The support surface was randomly moved in the antero-posterior direction. First equilibrium was studied on the stable support surface, then low (RMS 1.3 cm) and high (RMS 2.6 cm) amplitude movements were used. Vision was either present or absent at all test amplitudes. Equilibrium was evaluated by the confidence (61%) ellipse sway area and average sway velocity during 45 s. Eleven healthy subjects aged 23-36 years (mean 29) were sedated with a short acting sedative, midazolam 0.1 mg/kg. Randomized perturbed posturography was conducted at baseline, and at about 60, 120 and 180 min after injection. Psychomotor tests were conducted at baseline, and at 30, 90, 150 and 210 min. Large interindividual variations were found. One subject could not be tested at all at 60 min due to sleepiness, whereas some subjects felt nearly full awake at 30 min. Sway areas were larger at 60 min, but not subsequently. At 60 min, sway velocities with open eyes were higher, just as when vision was absent and low amplitude movements were used. Later no effects could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Universal precautions--a critical review.
The route of HIV transmission are now well defined. For health care workers the major occupational risk is from parenteral exposure to infected blood or other body fluids. To prevent such exposures, it would be prudent for HCWs to assume that all patients are potentially infected and a set of precautions applicable universally be followed in contacts with all patients. The provisions of "Universal Precautions" apply to blood, CSF, genital secretions and all body fluids. It is essential that barrier protection and washing of hands be practiced, body fluids be handled with care, correct sterilization and disinfection procedures be followed and a suitable system of waste disposal be evolved. Although the Universal Precautions have been useful in abating some of the more extreme behavior associated with treating AIDS patients and in establishing a rational approach to infection control, some of the recommendations have not been found to be efficacious or cost effective. Preventive measures recommend on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed. The risks for occupational infection with blood borne pathogens have been a source of concern for health care workers (HCWs) because of their frequent and often substantial exposure to patient blood and body fluids. HCWs have long been identified as a group "at risk" for occupationally acquired Hepatitis B infection. With the development of acquired immunodeficiency syndrome (AIDS) epidemic, both HCWs and policy makers have become increasingly concerned about occupational risk from blood borne infections.(ABSTRACT TRUNCATED AT 250 WORDS)
Gloves, Protective↗
Effect of beta-blockers on ventilatory function in smokers and non smokers.
Twenty healthy nonsmokers, 20 asymptomatic mild smokers and 20 asymptomatic moderate smokers were assessed for ventilatory functions, before and after equipotent dosages of atenolol, propranolol and oxprenolol in a single blind longitudinal study. The basal spirometric values were significantly lower in smokers than non smokers. After propranolol significant reduction was seen from basal values in FEV1, FEF 75%, MMFR, FEF 200-1200 in all the three groups. After oxprenolol significant difference was seen only with MMFR in the moderate smokers. With atenolol the variation was not significant in any group. Intercomparison of values after the drugs in each group was done. The values after propranolol was significantly lower than values after atenolol or oxprenolol for FEF 75%, MMFR and FEF 200-1200 in both the smoker groups whereas values after oxprenolol and Atenolol did not differ significantly from each other. Thus, in smokers atenolol offers a safe choice. If propranolol is to be used, the possibility of significant bronchospasm should be considered.
Adrenergic beta-Antagonists↗
Prolonged peritoneal dialysis in acute renal failure using Tenckhoff catheter.
The changing spectrum of acute renal failure (ARF), in children has necessitated the support by peritoneal dialysis (PD) for a longer duration. Use of permanent catheters like Tenckhoff catheter can overcome many of the problems associated with the prolonged use of temporary catheters. Thirty one infants and children with mean (SD) age of 49.3(39.4) months were subjected to PD using surgically placed Tenckhoff catheter. Catheters were put under general anesthesia in 28 patients and under local anesthesia in 3 patients. The technique of catheter insertion has been described in detail. All the catheters, except one, functioned immediately after the insertion. There was no intraperitoneal hemorrhage, dialysate leak or poor catheter drainage. The mean (SD) duration of catheter placement for PD was 11.3 (16.1) days (range 2.90 days). There were 6 episodes of infections (19.2%), peritonitis in 4 (12.8%) and exit site infection in 2 (6.4%). In 2 patients, infection episodes did not respond to antibiotics and the catheter had to be removed. There was no mortality due to complications of PD procedure and catheter insertion. Acute intermittent PD using surgically placed Tenckoff catheter was done safely for prolonged duration and also had additional advantages of good catheter drainage and no intraperitoneal hemorrhage.
Acute Kidney Injury↗
A type 1 DNA topoisomerase from the kinetoplast hemoflagellate Leishmania donovani.
A type 1 DNA topoisomerase has been purified from the nuclei of the kinetoplast hemoflagellate Leishmania donovani using polyethylene glycol fractionation and chromatography on hydroxylapatite, phosphocellulose and phenylsepharose column. The relaxation activity is ATP independent. Mg2+ is an essential cofactor for the reaction with an optimum at 10 mM. Mg2+ can be substituted by Mn2+ at 5 mM concentration. The relaxation reaction exhibits a salt optimum at 100 mM KCl. The enzyme can not remove supercoils from positive superhelical DNAs nor can induce supercoiling of relaxed DNAs. The topoisomerase activity is associated with a polypeptide of molecular weight about 67 kDa as shown by sephacryl-S200 gel filtration and by electrophoresis on sodium dodecyl sulphate-polyacrylamide gels.
Animals↗
A rapid screening method for bacteria containing firefly luciferase plasmids.
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Chloramphenicol O-Acetyltransferase↗
Acute renal failure in the elderly: experience from a single centre in India.
A total of 139 patients with acute renal failure (ARF) were studied, of which 41 (29.4%) were elderly with mean age of 67.1 years and 98 (70.6%) were younger with mean age of 32.3 years. Surgical causes accounted for 65% of geriatric ARF while medical causes were predominant in the younger patients (55.1%). Amongst the surgical causes, prostate-related problems due to obstruction or following transurethral resection of prostate were seen in 20 patients (74%). Drugs and sepsis were the predominant causes of medical ARF in the geriatric patients (85.7%). Of all the causes of geriatric ARF, which included both medical and surgical, nephrotoxic drugs either alone or in combination with other predisposing factors were the cause in 22 (51%) patients. Haemodialysis was needed in 15 of geriatric (36.6%) and 64 of younger (65.3%) ARF patients. Recovery from ARF, as evidenced by normalization of serum creatinine, was delayed in the elderly as compared to the younger patients (32.0 versus 11.4 days, P < 0.001). Mortality, though higher in the elderly as compared to the younger patients, was not significantly different (9.75% versus 6.1%).
Acute Kidney Injury↗
Conformation of dehydropeptides. Synthesis and solution structure of model peptides containing (E) and (Z) dehydroaminobutyric acid residues.
Six model dipeptide methylamides containing dehydroaminobutyric acid (delta Abu) of the type Boc-X-delta z Abu-NHCH3 and Box-X-delta E Abu-NHCH3, X = Ala, Val, Phe (Boc = tert-butoxycarbonyl), have been synthesized and their solution conformations explored using 300 MHz 1H NMR and IR spectroscopy. Studies based on delineation of intramolecularly hydrogen bonded NH groups in CDCl3 and (CD3)2SO revealed that none of the NH groups is appreciably solvent shielded. Difference NOE (Nuclear Overhauser Effect) studies have also failed to detect the presence of any discernible turn structure in these peptides. These studies indicate that the conformational preferences of peptides containing, alpha, beta-dehydroaminobutyric acid are different from those of delta ZPhe and delta ZLeu. It appears that steric interactions due to the beta-substituent in the dehydroamino acid moiety play an important role. Unlike delta ZPhe and delta ZLeu, which have relatively large beta-substituents, phenyl and isopropyl, respectively, and stabilize a beta-turn, the beta-methyl group of delta ZAbu or delta EAbu is readily accommodated in extended conformation. Clearly, the size of beta-substituent in dehydroamino acid crucially influences the conformational preferences. Thus, it may be possible to use different dehydroamino acids to introduce variable but definite constraints in synthetic peptides.
Dipeptides↗
Leiomyosarcoma of gallbladder: a case report.
A case of leiomyosarcoma of gallbladder, a rare tumor in hepatobiliary region, is reported. The present case differs from previously reported cases in its presentation with empyema of gallbladder and multiple intrahepatic cholangiolytic abscesses. Curative surgery could not be undertaken on account of poor condition of patient, and invasion of tumor into liver and adjacent organs.
Cholecystitis↗
Atypical salmonellosis: two cases of sacroiliitis.
Two young adult males presented with fever, severe pain, redness, swelling over the left sacroiliac joint and inability to walk and squat. A differential diagnosis of tuberculous sacroiliitis was considered. On blood culture isolation of S. Typhi in both of them was suggestive of sacroiliitis of salmonella etiology. They recovered completely following specific antibiotic therapy, aspirin and bed rest. At recovery both showed extremely high Widal titres.
Adolescent↗
Pruritus in continuous ambulatory peritoneal dialysis and hemodialysis patients.
To study the prevalence and pathogenesis of uremic pruritus, CAPD and HD patients were asked to complete a questionnaire. The replies were quantitated based on numerical scales, and the results were compared with various hematological and biochemical parameters, underlying disease, and duration of dialysis. There were 113 CAPD patients (63 males and 50 females), mean age 60 (range 20-84) years, average time on CAPD 20 (range 1-163) months and 76 HD patients (44 males and 32 females) mean age 57 (range 23-81) years, mean time on HD 44 (range 2-242) months. Replies to questions were evaluated and graded by the same investigator who did not know the patients. Pruritus was present in 70 (62%) CAPD patients (64% in females and 60% in males p = NS) and in 41 (54%) HD patients (69% in females and 43% in males, p = 0.025). Before starting dialysis pruritus was present in 30% CAPD patients and 28% HD patients. Pruritus was graded as mild, moderate and severe; the distribution was 58.6%, 34.3%, and 7.1% (CAPD) and 43.9%, 41.5%, and 14.6% (HD), respectively. Dry skin was reported by 73% CAPD patients and 72% HD patients. This xeroderma was correlated with the severity of pruritus and was also present in 65% CAPD and 48.5% HD patients without pruritus. Patients with pruritus were older than those without pruritus both for CAPD (63 vs 54 years, p = 0.004) and HD (61 vs 51 years, p = 0.003). A significant correlation was observed only between pruritus score and age for CAPD patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effect of erythropoietin treatment on nutritional status of continuous ambulatory peritoneal dialysis patients.
Seventeen patients--10 females, 7 males--mean age 52 years (range: 21-77 years), on CAPD for an average of 35 months (range 10-160 months) were studied. Mean initial dose of EPO was 114 +/- 45 U/kg/week subcutaneously (range: 59-209). The dose was adjusted to achieve and maintain a target Hb of 100 g/L and Hct 30%. Fifteen of the patients (88.2%) achieved this target within 6 months [baseline to month 6 changes: Hb 72 +/- 10 g/L to 107 +/- 12 g/L (p = 0.0001); Hct 22 +/- 3% to 33 +/- 4% (p = 0.0001)]. Serum total protein also increased significantly over the time of EPO use (p = 0.0133); changes from baseline were significant by the fourth month [68 +/- 9 g/L to 72 +/- 9 g/L (p = 0.0115)]. Serum albumin also increased significantly over time (p = 0.0157). The change from the baseline result (37 +/- 4 g/L) was statistically significant by month 2 (p = 0.0060) and was maintained over the following 4 months [month 6 result: 40 +/- 3 g/L (p = 0.0180)]. The increase was greater for 8 patients with initial serum albumin < 35 g/L (mean change 5.75 g/L) than for the 9 subjects with levels > 35 g/L (mean change 0.11 g/L). In a comparison group of 17 patients (matched for age, sex, duration of CAPD, underlying disease and antihypertensive treatment), who did not receive EPO treatment, albumin and protein did not appear to increase over time.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Influence of erythropoietin on blood pressure in continuous ambulatory peritoneal dialysis patients.
To assess the effect of erythropoietin (EPO) treatment on blood pressure in continuous ambulatory peritoneal dialysis (CAPD) patients, we analyzed in a retrospective study the results of 6 months of EPO treatment in 17 CAPD patients. There were 10 females and 7 males, mean age 52 years, mean duration on CAPD 35 months. They received subcutaneously a mean initial EPO dose of 114 +/- 45 U/kg/week (range 59-209). This dose was adjusted throughout 6 months to achieve and maintain a target Hb of 100 g/L (Hct 30%). Seven of the patients were hypertensive before starting EPO treatment. Fifteen patients (88.2%) achieved the target hemoglobin. For all subjects (n = 17) there was a significant increase in lying mean blood pressure (MBP) from 93.8 +/- 10.0 to 105.2 +/- 14.4 mmHg (p = 0.0024). Four patients required an increase in their antihypertensive medication, and 4 were not treated before we started antihypertensive treatment (Group I). This group represents 46% (8/17) of the patients. There was no change in the antihypertensive medication status of the remaining 9 patients (Group II). The baseline lying MBP was not significantly different for the two groups (98.8 +/- 9.8 mmHg vs 96.1 +/- 7.2 mmHg). The mean weekly dose of EPO during the first 3 months was higher in Group I (126 vs 100 U/kg) and conversely was lower during the last 3 months (mean dose 108 vs 117 U/kg).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Pulse volume recording.
Noninvasive studies, in general, and pulse volume recordings (PVRs), in particular, play important roles in diagnosis, planning, and monitoring of therapy for vascular disorders of the upper extremity. Essentially, PVR is a useful screening tool to show whether hemodynamically significant vascular disease has produced alterations of digital flow patterns. PVR also has a role in differentiating between vasospastic and vaso-occlusive disease, in evaluating cold sensitivity, in monitoring medical and surgical treatments, and as a research tool. This method also has its limitations, which must be appreciated, to place the true role of this very useful noninvasive modality in proper perspective.
Adult↗
Aluminum ingestion alters behaviour and some neurochemicals in rats.
Effect of aluminum (Al) has been investigated on the brain of rats exposed to this metal (500 mg Al/liter in drinking water) daily for 180 days. A significant reduction in the spontaneous locomotor activity was noticed after 90 and 180 days of Al exposure to the rats, the magnitude of the change being almost identical at both the time intervals. Aluminum exposure also produced significant deficits in acquisition and retention of learned response in active avoidance situation, these changes being time dependent. A significant retardation of the extinction of the learned task was noted in Al exposed rats especially at 180 days. There was significant increase in the lipid peroxidation and decrease in the activity of Mg(2+)-ATPase and Na+,K(+)-ATPase in the brain of rats at 180 days after Al exposure. The increase in the contents of the metal was maximum in rest of the brain region (87% of control) followed by hippocampus and cerebral cortex (59% of controls), cerebellum and corpus striatum (43% and 44% of controls, respectively) after 180 days. Whether Al is responsible to initiate neurotoxic effects by producing changes in the structure and function of the plasma membrane needs further investigations.
Adenosine Triphosphatases↗
Evaluating the injured hand.
Evaluation of the injured hand is undertaken to assess an acute injury, to diagnose chronic injuries prior to reconstruction, to evaluate function, and to evaluate disability. This article discusses the special evaluation method for each of these categories.
Accidents, Occupational↗
Vibration white finger.
Vibration white finger is a form of secondary Raynaud's phenomenon caused by vibratory hand tools. The pathophysiology is multifactorial, with involvement of the peripheral vascular system, sensory receptors, peripheral nerves, muscles, bones, and joints. The diagnosis of this condition is essentially clinical. In this article, the pathophysiology, clinical presentation, diagnosis, industrial standards of exposure, preventive measures, and treatment modalities have been reviewed.
Humans↗