Biomedical subjects
Publications and source records attributed to A Kumar.
A safe and easily performed method for percutaneous release of trigger digits is described which is performed in the outpatient clinic within a few minutes, without requiring any special instrument. Results in terms of abolishing triggering immediately and patient acceptance are excellent. No important complications have been observed in our first 38 procedures.
In a large malaria endemic area in Panaji city, Goa, India, the weekly application of the biolarvicide Bacillus sphaericus (Strain 101, Serotype H 5a 5b) at the rate of 1 g/m2 in the main Anopheles stephensi larval habitats, viz., curing waters, masonry tanks, and sump tanks (under construction), from April to December 1993 resulted in a sharp decline in the habitat positivity (range 0.13-8.0%) as compared with the rest of the Panaji (range 2.2-30.6%) where temephos (Abate) was used as the larvicide. Bacillus sphaericus spraying also led to a significant decline in anopheline densities in positive habitats (range 0-7.3/10 dips) as compared with control habitats (range 0.9-53.0/10 dips). Concurrently, malaria incidence observed in the experimental area (slide positivity rate [SPR] range 2.3-7.8%; monthly parasite index [MPI] range 0.18-1.44) was lower than in the control area (SPR range 14.3-25.5%; MPI range 1.75-6.12).
Many hormones/factors influence the total body growth and development during embryonic life, and very few studies have been carried out to ascertain their effects on the individual organ system. In this study, the effect of exogenous insulin-like growth factor-I (IGF-I) on embryonic kidneys was investigated, and correlated with phenotypic and gene expression and synthesis of extracellular matrix (ECM) proteoglycans (PGs). Antisense experiments were carried out to elucidate the role of endogenous (IGF-I in metanephric development. Mouse metanephroi, harvested at 13th day of gestation, were exposed to IGF-I (100 ng/ml) in an organ culture for 7 days. An enlargement of the metanephroi with accentuation of its lobules, and increase in the nephron population and [3H]thymidine incorporation was observed. Immunofluorescence studies and Southern blot analysis of polymerase chain reaction products indicated augmented expression of the ECM PGs. A heavy concentration of [35S]sulfate-associated radioactivity over the tips of ureteric bud branches and ECM components of maturing glomeruli was seen. Maximal effect of radioincorporation was observed on day-4 of the culture, the period when the concentration of endogenous IGF-I is the highest. PGs synthesized had elevated proportions of chondroitin sulfate vs heparan sulfate and of free chains, and reduced charge-density characteristics. Immunoprecipitation studies of [35S]methionine-labeled glycoproteins revealed an increased synthesis of core-peptide of the PGs. IGF-I antisense oligonucleotide caused retardation in the growth of the kidneys along with the decrease in de novo synthesis of PGs. These findings indicate that IGF-I, a polypeptide essential to the renal growth and development, has a trophic effect on the embryonic kidney during the postinductive period of metanephric development, and the observed response has a temporal relationship with the increased synthesis of the PGs.
A total of 322 students from two colleges of Delhi University, one located in urban and the other in the rural area were surveyed to assess and compare their knowledge, attitudes and beliefs regarding HIV/AIDS. A pretested and self-administered questionnaire containing mostly close ended questions was used. Observations revealed that majority of the students were aware of various aspects of HIV/AIDS. However, they also had some misconceptions particularly regarding transmission of the disease. The science and urban students had significantly more knowledge as compared to their counter parts, there by leading to more positive attitudes among them. Findings suggest intensification of AIDS education campaign focussed on removal of misconceptions and changing negative attitudes, more so amongst rural students. Science students can prove as a potential source of peer communication to the non-science students both in urban as well as rural areas.
Prevalence of filariasis in 8 randomly selected villages of Puri district was studied. 782 persons were examined. The prevalence of microfilaria was found to be 7.3 per cent and the disease rate 9.5 per cent. The mf rate was higher in males (8.8 per cent) than the females (5.7 per cent) and similarly the disease rate were 10.6 per cent and 8.3 per cent respectively in the two sexes. The mf rate was considerably lower (4.6 per cent) in the population using mosquito nets regularly as compared to irregular users (8.2 per cent) and never users (9.0 per cent). Similarly persons with 'normal' clothing had lower mf rate (5.0 per cent) than than those using 'medium' clothing (7.6 per cent) and "minimum" clothing (8.9 per cent). The mf rate and disease rate correlate well (r = .65). The Culex quinquefasciatus Say constituted the main bulk (65 per cent) of mosquito collection in this area with a density of 17 per man hour.
For rapid assessment of malaria in difficult forested areas in Orissa a study on the accuracy of self-reporting of malaria showed 72 per cent accuracy along with the sensitivity and specificity values of 46 per cent and 76 per cent respectively. The study clearly indicates its utility in the ongoing national malaria eradication programme and can be effectively used for rapid assessment of the disease prevalence. The information so gathered can be used for rapid assessment by the planners and programme managers in devising the strategies for the containment of malaria in the forested areas of Orissa.
From January 1991 to December 1992 the adult and immature populations of Culex quinquefasciatus were monitored in selected localities of Rajahmundry town. The larval density per dip ranged from 1.1 in September to 25.3 in October and the pupal density from 1.2 to 8.4 in October. Two high peaks of adult density in a year were observed during the study. Infective mosquitoes were recorded only in November 1991 and August 1992. Cx. quinquefasciatus landing on human bait was maximum between 2200 to 2400 hours and they preferred to land on body site followed by legs, hands and face in that order. The anthropophilic index was 79.5 per cent. Ratio of Female: Male mosquitoes was 5:1.
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DMBA (195 nmol/50 microliters of acetone/animal) was applied topically over the dorsal skin of the mice and tumors were promoted by repeated applications of croton oil (1% in acetone, three times per week) after two weeks of DMBA application. Skin papillomas appeared in 100% animals in control as well as in groups treated orally with Liv. 52 at post-initiational stages and continuously at peri-initiational and post-initiational stages of papillomagenesis. When Liv. 52 was given orally at the peri-initiational stage of papillomagenesis, the percentage of mice bearing tumors was 75% and the tumor mean per mouse was reduced to 4.0 +/- 1.63 as compared to 7.5 +/- 3.54 in the control group after 15 weeks of observation. The tumor mean per mouse was observed to be 4.75 +/- 0.55 and 2.5 +/- 0.57 in the groups treated orally with Liv. 52 at the post-initiational stages and continuously at peri-initiational and post-initiational stages of papillomagenesis respectively. Similarly, the cumulative number of papillomas after 15 weeks was 30 in the control group, which was reduced to 10 in the animals treated with Liv. 52 continuously at peri-initiational and post-initiational stages. The cumulative number of papillomas was also reduced to 16 and 19 in animals treated with Liv. 52 at peri-initiational and post-initiational stages, respectively.
Partially decalcified allogeneic bone matrix was cut into the sizes and shapes of cylinders, bone strips and pulverized bone powder. Large osteoperiosteal gaps were created in rabbit's ulnae. A total of 14 gaps were filled with bone strips, 20 with powder, six with cylinders and two were left unbridged to serve as control. The healing of gap was assessed at intervals with a maximum follow up of 24 weeks. Clinically at 12 weeks the bone strips could not be moved separately from each other, the whole tubular bone had also united whereas gaps filled with bone powder did not diminish in size. Radiologically union occurred earlier (around 12 weeks) in bone strips as compared to cylinders (approx-18 weeks). With bone powder only a faint line of the remnants was visible. Gross examination findings of the grafted area were in concurrence with the clinical and radiological findings. Overall the gaps filled with bone strips had 100 per cent success with early osteo induction and remodelling as compared to long cylinders whereas gaps filled with bone powder had complete failure.
We examined the usefulness of serum thyroglobulin (Tg) levels in 196 patients with metastatic disease. Of these, 51 patients had a thyroidal primary (40 differentiated, 7 medullary and 4 undifferentiated), 35 patients had a nonthyroidal primary and in 110 patients the primary site was not known. Serum Tg was raised in 74.5 per cent (38 of 51) patients with carcinoma of the thyroid and in 92.5 per cent (37 of 40) patients with differentiated thyroid carcinoma (DTC). Twelve (34.3%) patients with proved nonthyroidal malignancies and 34 (30.9%) patients with unknown primary origin had elevated serum Tg levels. Of the 110 patients with unknown primary site thyroidal primary in 10 patients (all with elevated serum Tg levels) and nonthyroidal primary in 38 patients (7 had raised serum Tg levels) could be established. The sensitivity (for DTC) and the specificity (for nonthyroidal primary) of serum Tg estimation were 94.0 per cent (47 of 50) and 74.0 per cent (54 of 73) respectively and for patients with distant metastases were 100 (29 of 29) and 85.1 per cent (40 of 47) respectively. The positive and the negative predictive values of serum Tg were 71.2 (47 of 66) and 94.7 per cent (54 of 57) respectively and for patients with distant metastases were 80.6 (29 of 36) and 100 per cent (40 of 40) respectively. Our findings suggest that for patients presenting with metastases (particularly distant metastases) of an unknown primary site, serum Tg estimation is of great value to identify or rule out the involvement of the thyroid as the primary organ.
Nine patients of acute falciparum malaria with severe hyperbilirubinemia developed acute renal failure (ARF). All of them had evidence of intrahepatic cholestasis and needed hemodialysis for several weeks; 7 survived and 2 died, one due to cerebral malaria, the other multiple organ failure. Interestingly, referal diagnosis did not include malaria as a cause of ARF in 8 out of 9 patients.
We studied the effects of D-penicillamine (DP) on the clinical response, immunoinflammatory parameters and the lymphocyte subsets in 46 patients with rheumatoid arthritis (RA). Patients were evaluated before the start of the drug and then at 3 and 9 months during the follow up. 38 of 46 (82.6%) patients could continue DP treatment for over 9 months, while in 8 the drug was withdrawn due to adverse effects. Improvement in the various disease activity indices of more than 50% (responders) was seen in 25 of 38 (65.8%) patients. Responders showed a significant decrease in the serum IgA and IgM at 9 months, and in IgM only at 3 months. The serum levels of C3 and C4 did not show any significant change. Serum levels of C-reactive protein and rheumatoid factor (RF) showed a significant decrease at 3 and 9 months. A significant decrease in CD3+ and CD4+ lymphocytes along with a fall in CD4+/CD8+ lymphocyte ratio was also seen in responders at 3 and 9 months, compared to the baseline. Our results suggest that DP may have immunomodulatory action in RA.
Forty renal transplant recipients were subjected to 99m Technicium Diethylene triamine pentacetic acid (DTPA)scans at regular intervals & whenever there was suspection of rejection. Serial scans of a group of 15 recipients from immediate post transplant period till withdrawal of cyclosporine were analysed separately & the results compared to with single scan analysis. The sensitivity & specificity of DTPA scan in the absence of acute tubular necrosis (ATN) was 94.1% & 87.5%, while the positive & negative predictive values were 88.8 & 93.3% respectively. Sensitivity & specificity of serial scan analysis (88.8% and 75%) in early post transplant period was higher than that of interpretation of single scan (75% & 66%). Serial scan changes predated clinical rejection during cyclosporine withdrawal period. We conclude that DTPA scan is both a sensitive & specific non-invasive diagnostic marker of acute rejection in absence of ATN & serial scans during early post transplant period & at the time of cyclosporine withdrawal are helpful in detecting the rejection accurately & at the earliest.
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It is a matter of concern that the elderly donor may have increased risks in the peri-operative period due to age-related changes in various organ. Nephrosclerosis, atherosclerosis and low GFR of an elderly kidney may portend a poor graft outcome. A retrospective analysis of our live related renal transplant program (from June 1989 to December 1993) revealed that 27 of the donors were above 60 years of age. 21 of the recipients have been followed up for more than 1 year. These patients were compared with a cohort of 25 patients (donor age < 45 years) with similar HLA match, immunosuppressive protocol, and follow-up period more than 1 year. Graft survival at 1 year was 86% and 88% in the recipients from elderly and younger donors respectively; 1 patient in the control group died of fulminant sepsis. Mean follow-up was 21.6 months in the study group and 22.8 months in the control group. Allograft function was evaluated by serum creatinine and differential GFR by Tc DTPA scan. Serum creatinine (mg%) was 1.3 +/- 0.2 and 1.4 +/- 0.2 in the study group and 1.3 +/- 0.3, 1.2 +/- 0.3 in the control group at 3 and 12 months respectively. Glomerular filtration rate (ml/min) was 36.5 +/- 11.6 and 43.7 +/- 12.4 in the recipients from elderly donors whereas those from the younger donors had GFR (ml/min) of 40.6 +/- 9.6 and 49.6 +/- 14.2 at 3 and 12 months respectively, GFR continued to improve in both groups with follow-up. There was no difference in incidence or severity of ATN In the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty three patients with psoriatic arthritis were treated with starting dose of 7.5 mg of methotrexate orally, every week for a period of 6 months to 7 years (mean 2.2 years) along with non-steroidal anti-inflammatory agents. The dose of methotrexate during the course of therapy ranged 5 to 15 mg/week (mean 7.8 mg). There was complete to partial remission in arthritis and psoriatic skin lesions in 94% (31) patients. No response was noticed in 2 patients. Regular monitoring of haematological, renal and liver function tests was done. No significant side effects of the drug, requiring discontinuation of the therapy, were seen during the treatment. Methotrexate can be used early in the course of psoriatic arthritis with good results.