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Biomedical subjects

A K Gupta

Publications and source records attributed to A K Gupta.

At least 91 records · Page 5Linked to original sources
PubMed2004

Interventions for rosacea.

BACKGROUND: Rosacea is a common skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often also involved. The cause of rosacea is unclear. It is a chronic disease, which can be controlled in most cases with appropriate treatment. Numerous treatments are in use although it is unclear which are best, and which are most appropriate for the different types of rosacea. OBJECTIVES: To assess and summarise current evidence for the efficacy and safety of treatments for rosacea. SEARCH STRATEGY: We searched the Skin Group Specialised Trials Register (March 2002), Cochrane Central Register of Controlled Trials (CENTRAL, March 2002), MEDLINE (from 1966 to March 2002), EMBASE (from 1980 to March 2002), Biosis (from 1970 to March 2002) and the Science Citation Index (from 1988 to March 2002). Reference lists of trials and key review articles were also searched. Relevant manufacturers and experts were contacted. SELECTION CRITERIA: Randomised controlled trials in people with moderate to severe rosacea were included. Studies judged by the reviewers to have seriously flawed methodology were excluded. DATA COLLECTION AND ANALYSIS: Study selection, assessment of methodological quality, data extraction and analysis were carried out by two independent reviewers. MAIN RESULTS: The evidence provided by twenty-two included studies was generally weak because of poor methodology and reporting. One of our primary outcome measures, 'quality of life', was not assessed in any of the studies. Only two studies of ocular rosacea could be included. Pooled data from two trials involving 174 participants indicated that topical metronidazole is more effective than placebo (odds ratio 5.96, 95% confidence interval 2.95 to 12.06). Data from a between-patient trial (114 patients) and a within-patient trial (33 patients) of azelaic cream versus placebo were not pooled, but both showed good evidence of efficacy. Data pooled from three studies of oral tetracycline versus placebo involving 152 participants showed that, according to physicians' ratings, tetracycline was effective (odds ratio 6.06, 95% confidence interval 2.96 to 12.42). Some evidence of efficacy of oral metronidazole was provided by one small study. REVIEWER'S CONCLUSIONS: The quality of studies evaluating rosacea treatments was generally poor. There is evidence that topical metronidazole and azelaic acid cream have a therapeutic effect. There is some evidence that oral metronidazole and tetracycline are effective. There is insufficient evidence concerning the effectiveness of other treatments. As many of these treatments are used for rosacea, good RCTs are urgently needed.

Humans↗
PubMed2004

Intra-abdominal extralobar pulmonary sequestration presenting antenatally as a suprarenal mass.

Extralobar pulmonary sequestration is a rare pulmonary parenchymal anomaly which rarely may be present in an intra-abdominal location. The authors report a case of intra-abdominal extralobar pulmonary sequestration which presented to us as an antenatally diagnosed suprarenal mass and was worked up as such. The diagnosis was revealed only at laparotomy. Intra-abdominal extralobar pulmonary sequestration should also be kept in differential diagnosis in cases of masses in the suprarenal location, especially on the left side.

Adrenal Gland Diseases↗
PubMed2004

A statistical analysis of particulate data sets for Jawaharlal Nehru Port and surrounding harbour region in India.

The concentrations of total suspended particulate matter (TSP) and particulate matter less than 10 microns (PM10) were measured at various locations in a Jawaharlal Nehru port and surrounding harbour region. Meteorological data was also collected to establish the correlation with air pollutant concentration. The results are analysed from the standpoint of monthly and seasonal variations, annual trends as well as meteorological effects. The monthly mean concentration of TSP was in the range of 88.2 to 199.3 microg m(-3). The maximum and minimum-recorded value of PM10 was 135.8 and 20.3 microg m(-3), respectively. The annual average concentration of PM10 was 66.1 microg m(-3). There are clear associations between TSP and PM10 data set at all the measured three sites with a correlation coefficient of 0.89, 0.69 and 0.81, respectively. PM10 data appears to be a constant fraction of the TSP data throughout the year, indicating common influences of meteorology and sources. Particle size analysis showed PM10 to be 47% of the total TSP concentration, which is lower than reported for industrial area and traffic junctions in Mumbai. Anthropogenic sources contribute significantly to the PM10 fraction in an industrial region, while contributions from natural sources are more in a port and harbour area. Statistical analysis of air quality data shows that TSP is strongly correlated with wind speed but weakly correlated with temperature. There appears to be a simple inverse relationship between TSP and wind speed data, indicating the dilution and transport by winds.

Air Pollutants↗
PubMed2004

Cumulative meta-analysis of systemic antifungal agents for the treatment of onychomycosis.

BACKGROUND: Onychomycosis is a common nail disease that is often chronic, difficult to eradicate, and has a tendency to recur. The most common oral therapies for dermatophyte toenail onychomycosis include terbinafine, itraconazole and fluconazole. OBJECTIVES: A cumulative meta-analysis of the randomized controlled trials (RCTs) for antimycotic agents was performed to determine whether the pooled estimate of the cure rates has remained consistent over the years. Furthermore, for each agent we compared the overall meta-analytical average of both mycological and clinical response rates of RCTs vs. open studies. METHODS: We searched MEDLINE (1966 to November 2002) for relevant studies evaluating the efficacy of the oral antifungal agents terbinafine, itraconazole (pulse or continuous), fluconazole and griseofulvin for treating dermatophyte toenail onychomycosis. Studies included in this meta-analysis required a standard accepted dosage regimen, treatment duration and follow-up period. To determine the cumulative meta-analytical average, studies were sequentially pooled by adding one study at a time according to the date of publication (i.e. earliest to the most recent). RESULTS: There were 36 studies included in the analyses. For RCTs the change in efficacy of mycological cure rates from the first trial to the overall cumulative meta-average for each drug comparator is as follows (with 95% confidence interval): terbinafine, 78 +/- 6% (n = 2 studies, 79 patients) to 76 +/- 3% (n = 18 studies, 993 patients) (P = 0.68); itraconazole pulse, 75 +/- 10% (n = 1 study, 20 patients) to 63 +/- 7% (n = 6 studies, 318 patients) (P = 0.25); itraconazole continuous, 63 +/- 5% (n = 1 study, 84 patients) to 59 +/- 5% (n = 7 studies, 1131 patients) (P = 0.47); fluconazole, 53 +/- 6% (n = 1 study, 72 patients) to 48 +/- 5% (n = 3 studies, 131 patients) (P = 0.50); and griseofulvin, 55 +/- 8% (n = 2 studies, 109 patients) to 60 +/- 6% (n = 3 studies, 167 patients) (P = 0.41). The cumulative meta-analytical average of mycological cure rates when comparing RCTs vs. open studies was: terbinafine, 76 +/- 3% (n = 18 studies, 993 patients) vs. 83 +/- 12% (n = 2 studies, 391 patients) (P = 0.0028); itraconazole pulse, 63 +/- 7% (n = 6 studies, 318 patients) vs. 84 +/- 9% (n = 3 studies, 194 patients) (P = 0.0001); and fluconazole, 48 +/- 5% (n = 3 studies, 131 patients) vs. 79 +/- 3% (n = 3 studies, 208 patients) (P = 0.0001). CONCLUSIONS: The cumulative meta-analysis of cure rates for RCTs suggests that over time, as new RCTs have been conducted, the efficacy rates have remained consistent. The efficacy rates of open studies are substantially higher compared with RCTs and may therefore overestimate cure rates.

Antifungal Agents↗
PubMed2004

Lumbotomy approach for upper urological tract surgery in children--an analysis of 68 consecutive lumbotomies.

OBJECTIVES: To comprehensively analyse the results of upper urological tract surgery performed using a lumbotomy approach in the paediatric age group. METHODS: 68 consecutive patients underwent upper urological tract surgery during the last 5 years in our surgical unit. In all of these patients, a lumbotomy approach was used with a transverse skin incision. The hospital charts were reviewed for age, sex, diagnosis, type of surgery, intra-operative problems, duration of surgery, time to oral feeds, postoperative pain, length of hospitalisation and complications. RESULTS: Age range was 1 month to 12 years with a mean of 66 months. There were 47 boys and 16 girls. Surgeries performed were: pyeloplasty, pyelolithotomy, nephroureterectomy, ureterostomy and heminephrectomy. No intraoperative problems were encountered and the mean duration of surgery was 64.68 minutes. All patients resumed full oral feeds within 24 hours of surgery and postoperative pain was minimal. The mean duration of hospital stay was 6.16 days. No incision-related complications were seen. CONCLUSIONS: Lumbotomy incision is a safe, easy and effective approach for upper urological tract surgery in children.

Child↗
PubMed2004

Pityriasis versicolor: quality of studies.

OBJECTIVE: To evaluate the quality of the published literature on the treatment of pityriasis versicolor and to compare this evaluation with the number of times the work has been cited. METHODS: A search was performed using MEDLINE (1966-2002) to find publications evaluating the treatment of pityriasis versicolor. Two reviewers evaluated each clinical trial according to a list of pre-determined criteria including randomization and blinding, prior sample size calculation, treatment regimen clearly explained, and well-defined efficacy parameters. A maximum score of 20 could be attained by each publication. A citation count was performed using the ISI Web of Science Database (http://www.isinet.com/isi/products/citation/wos/). RESULTS: A total of 94 studies were included in this analysis of quality. Studies with a score of 8 or more were considered to be high quality, and 61 studies were rated as high-quality studies (65%). There was no significant correlation between paper quality and citation count. CONCLUSION: It is important for investigators and clinicians to be aware of the design of a high-quality protocol, since such high-quality studies are more likely to reflect accurate efficacy rates. Also, it is important for the information on the design and conduct of the trial to be conveyed to the reader so that a meaningful comparison between the studies can be made.

Bibliometrics↗
PubMed2004

Prescribing practices for seborrheic dermatitis vary with the physician's specialty: implications for clinical practice.

The prescribing practices of different medical specialties (dermatology, family medicine, pediatrics and other) for seborrheic dermatitis were analyzed using the National Ambulatory Medical Care Survey (NAMCS). The frequency of use of various antifungal and anti-inflammatory medications was found to differ greatly between specialties, with the greatest difference being seen between dermatologists (who frequently prescribe the antifungal ketoconazole) and non-dermatologists (who most frequently prescribe corticosteroids).

Adolescent↗
PubMed2004

Integrated approaches to academic anaesthesia - the Cambridge experience.

There is mounting concern about the pressures experienced by University Departments of Anaesthesia, which, if lost, could threaten undergraduate peri-operative medicine teaching, development of critical appraisal skills among anaesthetists, and the future of coherent research programs. We have addressed these problems by establishing a foundation course in scientific methods and research techniques (the Cambridge SMART Course), complemented by competitive, fully funded, 12-month academic trainee attachments. Research conducted during academic attachments has been published and used to underpin substantive grant applications allowing work towards higher degrees. Following the attachment, a flexible scheme ensures safe reintroduction to clinical training. Research at consultant level is facilitated by encouraging applications for Clinician Scientist Fellowships, and by ensuring that the University Department champions, legitimises and validates the allocation of research time within the new consultant contract. We believe that these are important steps in safeguarding research and teaching in anaesthesia, critical care and peri-operative medicine.

Anesthesiology↗
PubMed2004

Seborrheic dermatitis.

UNLABELLED: Seborrheic dermatitis is a common inflammation of the skin, occurring most often on the face, scalp and chest. It is closely related to infantile seborrheic dermatitis, or diaper rash. Seborrheic dermatitis is particularly common in patients with Parkinson's disease or with HIV/AIDS. The recent resurgence of interest in Malassezia yeasts has revived the old hypothesis that seborrheic dermatitis is caused by an altered relationship between these skin commensals and the host. Moreover, the success of antifungal medications in treating seborrheic dermatitis provides new evidence for this view. LEARNING OBJECTIVE: Upon completing this paper, the reader should be aware of the clinical presentation of seborrheic dermatitis and which populations are at particular risk of developing this disorder. In addition, s/he will be aware of the role of Malassezia yeasts in seborrheic dermatitis and the way in which knowledge of the importance of these yeasts has altered the treatment of this disorder.

Administration, Cutaneous↗
PubMed2004

Stressful major life events are associated with a higher frequency of cutaneous sensory symptoms: an empirical study of non-clinical subjects.

BACKGROUND: Psychological stress resulting from stressful major life events is known to exacerbate a wide range of skin disorders. OBJECTIVE: To examine the relationship between stressful major life events and dermatological symptoms among a non-clinical sample. DESIGN: A cross-sectional survey. SETTING: Community-based subjects from London, Ontario, Canada were recruited from the local university, schools and churches. PARTICIPANTS: Out of 600 consecutive, consenting volunteers 316 subjects [73 men and 243 women; age 38.7 +/- 14.8 (mean +/- SD) years; marital status 54% married; race 94%'white'] completed the survey for this study. The exclusion criterion was a history of a major dermatological or medical disorder. MAIN OUTCOME MEASURE: The number of major life events experienced over the previous 6 months measured using the Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, and the frequency and severity of a range of cutaneous symptoms ('burning', 'crawling sensation', 'tingling', 'pricking' or 'pins and needles', 'pain', 'tenderness' of skin, 'numbness', 'moderate to severe itching', and 'easy bruising') that the subject may have experienced over the previous month. RESULTS: The most frequently reported body region affected was the scalp (59.5%) and the most frequently reported symptom was itching (69.3%). The total number of major life events experienced over the previous 6 months correlated with the severity of the individual cutaneous symptoms (0.22 < or = Pearson r < or = 0.41, P < 0.001) and with the total cutaneous symptom severity score (sum of all cutaneous severity ratings) (Pearson r = 0.40, P < 0.001). This correlation remained significant after the possible confounding effect of psychological factors on cutaneous symptoms was partialled out statistically (partial r = 0.19, P = 0.001). DISCUSSION: We observed a direct correlation between the number of major life events experienced over the previous 6 months and cutaneous symptoms experienced over the previous 1 month by non-clinical subjects. The correlation remained significant after the effect of psychological factors was partialled out, suggesting that this relationship holds even if the subject does not acknowledge psychological distress in reaction to the major life event.

Adolescent↗
PubMed2004

Molluscicidal effect of nicotinanilide and its intermediate compounds against a freshwater snail Lymnaea luteola, the vector of animal schistosomiasis.

The molluscicidal effect of nicotinanilide was evaluated and compared with niclosamide (2',5-dichloro-4'-nitrosalicylanilide, ethanolamide salt) against different stages of the freshwater snail Lymnaea luteola i.e., eggs, immature, young mature, and adults. Calculated values of lethal concentrations (LC50 and LC90) showed that both nicotinanilide and niclosamide as toxic against eggs, immature, and adults. The young mature stage of the snails was comparatively more tolerant to both molluscicides than the other stages. The toxicity of the intermediate compounds of nicotinanilide against the young mature stage of the snails showed them as ineffective. The mortality pattern of the snails exposed to LC90 concentration of these molluscicides showed niclosamide to kill faster (within 8 to 9 h) than nicotinanilide (26 to 28 h). In view of the above studies it may be concluded that both molluscicides are toxic against all the stages of the L. luteola snails.

Animals↗
PubMed2004

Vein of Galen malformations: review.

Vein of Galen malformations are unique congenital malformations of the cerebral vasculature that result in persistence and 'aneurysmal' dilatation of the venous structures. The varied clinical presentations and their distinctive and complex angioarchitecture make it important for the caring physician to understand their embryological and pathophysiological aspects. Management of these lesions--both in the neonatal period and at the time of definitive intervention, is challenging. Considering the rarity of these lesions, there are very few studies that have been able to compare the results of different techniques in the management. Continuing developments in the diagnostic as well as interventional aspects during the last two decades have radically changed the management of these lesions. Antenatal diagnosis and referral to a center with facilities for advanced neonatal cardiac care as well as for interventional neuroradiological therapy can go a long way in improving the prognosis in these children.

Adult↗
PubMed2004

Blindness, ophthalmoplegia and extensive radiculopathy: an unusual clinical syndrome in intracranial sino-venous thrombosis.

Isolated intracranial hypertension is a common manifestation of intracranial sino-venous thrombosis (ISVT). Markedly elevated intracranial tension presents with unusual features including cranial neuropathies and radiculopathy. We report two cases with ISVT, which presented with headache, papilledema, progressive visual loss, complete ophthalmoplegia and flaccid areflexic quadriparesis along with a normal sensorium. Magnetic resonance imaging (MRI) of the brain and cervical spinal cord showed no lesions that could account for the neurological deficits. Markedly elevated lumbar CSF pressure was noted in both cases. Nerve conduction study favored radiculopathy in one case and was normal in the other. Raised intracranial pressure was found to be the sole cause for the clinical manifestations. Visual impairment persisted in one patient despite lumbo-peritoneal shunting while the other died of septicemia. To our knowledge there are no previous reports of a syndrome comprising blindness, ophthalmoplegia and flaccid quadriplegia due to intracranial hypertension in ISVT.

Adult↗
PubMed2004

Pancreatic diseases in children in a north Indian referral hospital.

This was a cross-sectional study to determine the profile of pancreatic disorders in 54 children (age <15 years) presenting to a tertiary care center in India. Acute pancreatitis was the most common pancreatic disorder (28/54, 52%). Twenty-three children (43%) were diagnosed to have either chronic calcific (n = 15, 28%) or chronic non-calcific (n = 8, 15%) pancreatitis. Specific etiologic factors could be identified in 64.3% (18/28) of acute pancreatitis and 43.5% (10/23) of chronic pancreatitis patients. At least some of the 13 children with idiopathic chronic pancreatitis had features suggestive of tropical pancreatitis.

Acute Disease↗
PubMed2004

A study to evaluate surrogate markers of insulin resistance in forty euglycemic healthy subjects.

OBJECTIVE: Insulin resistance (IR) is increasingly being recognized as an important pathophysiological determinant of not only diabetes but also a number of other clinical states. Methods for directly estimating IR like euglycemic clamp technique and Insulin suppression test (IST) are experimentally demanding and impractical tool for large scale epidemiological studies. We evaluated several surrogate markers of IR in 40 healthy subjects. METHODS: Study included 40 euglycemic normal healthy north Indian subjects (33 males, 7 females) of mean +/- SD age 38.9 +/- 8.6 yrs, BMI 20.5 +/- 3.6 kg/m2 and WHR 0.87 +/- 0.05. All subjects were tested for fasting and postprandial (2 hr post 75 gm glucose) glucose and insulin. Then all the subjects underwent IST by modified Harano's method (simultaneous infusion of 20% dextrose @ 6mg/kg/min and plain human insulin @ 50 mU/kg/hr). Metabolic clearance rate for glucose (MCR = glucose infusion rate/steady state plasma glucose, ml/kg/min) was calculated for 120-150 min of infusion. Correlation of MCR with various surrogate markers which included fasting glucose (FG), fasting insulin (FI), fasting glucose/insulin ratio (FGIR), 120 min glucose (PPG), 120 min insulin (PPI), 120 min glucose/insulin ratio (PPGIR), homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), fasting glucose insulin product (FIGP), insulin sensitivity index (ISI), fasting insulin resistance index (FIRI), insulin ratio (IRa) and insulinogenic index (II) were evaluated. RESULTS: MCR was found to be significantly (p <0.05) correlated with FI (r= -0.347), PPI (r= -0.402), PPG (r= -0.317), PPGIR (r= 0.356), HOMA-IR (r= -0.348), FIGP (r= -0.348), and FIRI (r= -0.348). CONCLUSIONS: Among the surrogate markers which were significantly correlated to MCR, there was no significant superiority of one marker over the other. We suggest that measuring insulin levels alone in a single fasting sample can serve as a simple, cheap and convenient indirect qualitative index of IR.

Adult↗
PubMed2003

Determination of RHD zygosity using real-time quantitative PCR.

At present RHD incompatibility is still an obstetric problem despite prophylactic treatment. A very welcome recent technical advance has now made it possible to determine the foetal RHD status in a non-invasive risk-free manner using cell free foetal DNA in maternal plasma. In some cases, however, where there is a high risk that the foetus may be affected by HDN (haemolytic disease of the newborn), it may be of interest to determine whether the father is hetero- or homozygous for the RHD gene, since in the former instance there is only a 50% chance that the pregnancy is affected. It has recently been shown that quantitative PCR assays, in particular real-time Taqman PCR, can be used to determine the RHD gene dosage, and also to determine foetal aneuploidies. We demonstrate that the same real-time Taqman PCR assay we had previously developed for non-invasive analysis of the foetal RHD gene and the foetal Y chromosome from maternal plasma can be used to determine the paternal RHD genotype.

DNA↗