Biomedical subjects
Publications and source records attributed to A K Sharma.
A 15-day-old female child is presented with multiple joint dislocations who died during the neonatal period. She had additional features of metaphyseal dysplasia, deficient calcification of vault of the skull, growth retardation, a natal tooth, lymphoedema and facial dysmorphism. This may constitute a new syndrome of multiple joint dislocations with metaphyseal dysplasia.
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We reviewed our experience with 1369 inguinal herniotomies in 1340 children performed over the last one decade. Different grades of surgeons were assigned work according to the complexity of cases. Except for the minor scrotal hematoma, other complications were hardly seen. Recurrences were seen in only 2 cases. Careful training and supervision of junior staff in the technique of inguinal herniotomy has led to results that compare favorably to those of specialized units in developed countries.
This presentation deals with 110 surgically proven cases of abdominal tuberculosis in the pediatric age group. The protean clinical profiles and complications of the disease entity made the clinical diagnosis difficult; the investigations were also found non-pathognomonic. The most common type of pathology seen was adhesive variety followed by nodal type. Strictures of the small bowel were uncommon and hyperplastic variety was rarely seen in the present series. The pathogenesis relating to various varieties has been suggested based on the vast experience from a single institution.
The clinicopathological features of 75 children under the age of 12 years with teratomas are reviewed. Tumors arose in the following anatomic sites: sacrococcygeum (n = 49), ovary (n = 10), Testis (n = 5), oral cavity (n = 3), retroperitoneum (n = 2) and others (n = 6). Fifty five (74%) presented within the first year of life. Excluding the gonadal tumors, male-female ratio was 2:5. Majority of the tumors had only mature tissues. Such patients and those 9 patients in whom the histology was not specified, underwent excision alone and had 95% early survival rates. Five patients had admixture of mature and immature tumors. Nine patients had malignant tissues. Germ cell tumors containing only malignant component, but no mature or immature teratomatous tissues were excluded from the series. The patients with immature and malignant tissues underwent multimodal therapy including surgical excision, multiagent chemotherapy (VAC regimen) and at times radiotherapy. Mortality in patients with immature and malignant teratomas was 20 and 66.7%, respectively. Besides histology, the only factor which affected prognosis, especially in case of sacrococcygeal teratomas was the age at the time of presentation. Our experience highlights the importance of early recognition and complete surgical excision of teratomas in the pediatric age group.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
To determine th usefulness of various immunosuppressive regimens in renal transplantation and to study various complications at a new centre, we analysed 41 patients of end stage renal disease who underwent renal transplantation in our hospital over a period of three years. The first 11 patients (Group I) received azathioprine-prednisolone, the next 30 patients (Group II) received cyclosporin-prednisolone-azathioprine combination therapy. Over a mean followup of 33.36 +/- 8.19 months in group I, the survival rate was 63.6%; in group II over a followup of 14.86 +/- 2.9 months, survival was 86.66%. Kaplan-Meier survival analysis showed a trend to improved survival in group II but results did not reach statistical significance (Log rank test statistic = 2.77, p < 0.1). The incidence of infection was significantly lower in group II (p < 0.05). The major causes of death were infections, rejection, cyclosporin toxicity, acute pancreatitis, and ruptured mycotic aneurysm in one case.
To assess the value of pre- and peroperative indicators of common bile duct (CBD) stones, 167 patients undergoing cholecystectomy were randomised to receive either routine (R) or selective (S) on-table cholangiography (OTC). In all, 81/84 patients in the R group and 22/78 in the S group had OTCs (P < 0.0001). In the R group 11/81 were positive (one false-positive) and in the S group 7/22 were positive (P < 0.05). CBD stones were present in 10/81 in the R group and 7/78 in the S group (P = NS). In the R group 8/10 and in the S group 5/7 had CBD stones diagnosed preoperatively by ultrasound scanning (USS), giving USS a positive predictive value (PPV) of 100% and a sensitivity of 71.4% in the S group. A raised preoperative alkaline phosphatase (ALP) was found in 1/10 in the R group and 1/7 in the S group (PPV = 33.3%, sensitivity = 14.3%). In the R group 1/10 and in the S group 1/7 (PPV = 25%, sensitivity = 14.3%) were found to have a dilated CBD during operation suggesting CBD stones. There have been no cases of symptomatic unsuspected retained CBD stones during follow-up to date. Our study has demonstrated that selective use of OTCs can be safely employed in open cholecystectomies. Over 85% (6/7 in the S group and 15/17 overall) of CBD stones can be diagnosed preoperatively by USS and liver function tests, with USS having the greatest PPV and sensitivity.
A 670 bp BamHI repeat was isolated from the genomic DNA of Amaranthus paniculatus and was cloned in pUC19 vector (pABH3). The level of methylation of total genomic DNA and the BamHI repeat therein was studied by employing methylation sensitive enzymes to digest genomic DNA isolated from whole seedlings, hypocotyl, callus, and suspension culture of Amaranthus. The restriction pattern indicated double methylation of the target site CCGG. Methylation pattern of both the total genomic DNA and the cloned repeat was found to be similar during dedifferentiation indicating that there may not be a general relationship between hypomethylation and dedifferentiation.
The in vitro activity of three fluoroquinolones--ciprofloxacin, norfloxacin and ofloxacin--was studied on four laboratory-adapted strains (one chloroquine-resistant) and one fresh isolate of P. falciparum from Delhi by the schizont maturation inhibition microtest. The IC50 concentrations (mean +/- SD) were found to be as: ciprofloxacin 6.38 +/- 1.34 micrograms/ml, norfloxacin 11.24 +/- 1.27 micrograms/ml, and ofloxacin 22.3 +/- 3.11 micrograms/ml, while the MIC values were 32 micrograms/ml, 64 micrograms/ml and 128 micrograms/ml for the three drugs in the same order. The IC50 and MIC values for chloroquine-resistant strain were not significantly different from those for the chloroquine-sensitive strains. We conclude that there is little interstrain variability in the in vitro susceptibility of P. falciparum to fluoroquinolones, and that there is no cross resistance between them and chloroquine. The reported variability in clinical response of falciparum malaria to fluoroquinolones is not likely to be due to variation in parasite sensitivity.
Fifteen patients of uncomplicated falciparum malaria from Delhi were treated with norfloxacin (10 with 400 mg, 5 with 800 mg, both twice daily) for 3 days and the response was measured according to the WHO extended in vivo test criteria. The lower dose produced S response in two, RII response in five and RIII response in three patients, while the higher dose produced S response in four and RI response in one patient. In patients with S or RI response, the parasite clearance time was 68.6 +/- 9.1 h the defervescence time being 48 h. Thus, norfloxacin did reveal in vivo activity in falciparum malaria, but a dose of 400 mg twice daily proved to be curative only in a small percentage of cases and not consistently. Nausea and bitter taste were the only side effects noted in two patients.