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Biomedical subjects

A Kurup

Publications and source records attributed to A Kurup.

At least 37 records · Page 2Linked to original sources
PubMed2001

Infection of central nervous system by motile Enterococcus: first case report.

A 66-year-old man with four indwelling ventriculoperitoneal shunts for multiloculated hydrocephalus from a complicated case of meningitis a year before developed shunt infection based on a syndrome of fever, drowsiness, and cerebrospinal fluid neutrophil pleocytosis in the background of repeated surgical manipulation to relieve successive shunt blockages. The cerebrospinal fluid culture, which yielded a motile Enterococcus species, was believed to originate from the gut. This isolate was lost in storage and could not be characterized further. The patient improved with vancomycin and high-dose ampicillin therapy. He relapsed a month later with Enterococcus gallinarum shunt infection, which responded to high-dose ampicillin and gentamicin therapy. This is probably the first case report of motile Enterococcus infection of the central nervous system.

Aged↗
PubMed2000

Candida tropicalis pacemaker endocarditis.

A rare case of Candida tropicalis pacemaker endocarditis was diagnosed in a 77-year-old male who presented with lethargy. The organism was isolated from cultures of blood and vegetations on the tricuspid valve, interatrial septum and the pacing wire removed at surgery. The postoperative course was stormy and he succumbed to multiorgan failure.

Aged↗
PubMed1999

Quantitative structure-activity relationship study on some nonpeptidal cholecystokinin antagonists.

A quantitative structure-activity relationship (QSAR) analysis has been performed on a series of 1,4-benzodiazepine derivatives, which were found to act as antagonists of cholecystokinin (CCK), a gastrointestinal peptide hormone. The CCK acts with three different receptor subtypes termed as CCK-A, CCK-B, and gastrin receptor, which can be found in peripheral system, brain, and stomach, respectively. With all the three subtypes, the binding of the compounds is found to significantly depend on the lipophilicity of the compounds and their ability to form the hydrogen bonds with the receptor. However, the binding sites in CCK-A receptor seem to be slightly rigid as compared to those in CCK-B or gastrin receptor. The latter two appear to have similar binding features.

Animals↗
PubMed1999

The neurological manifestations of Nipah virus encephalitis, a novel paramyxovirus.

A novel Hendra-like paramyxovirus named Nipah virus (NiV) was the cause of an outbreak among workers from one abattoir who had contact with pigs. Two patients had only respiratory symptoms, while 9 patients had encephalitis, 7 of whom are described in this report. Neurological involvement was diverse and multifocal, including aseptic meningitis, diffuse encephalitis, and focal brainstem involvement. Cerebellar signs were relatively common. Magnetic resonance imaging scans of the brain showed scattered lesions. IgM antibodies against Hendra virus (HeV) were present in the serum of all patients. Two patients recovered completely. Five had residual deficits 8 weeks later.

Adult↗
PubMed1999

Meningoencephalitis caused by a novel paramyxovirus: an advanced MRI case report in an emerging disease.

Eleven abattoir workers in Singapore were infected in March 1999 by an outbreak caused by the Nipah virus. This newly discovered, Hendra-like paramyxovirus causes acute infection of the CNS. We present the magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) findings in a patient suffering from acute meningoencephalitis. Multiple small white matter lesions were detected on diffusion-weighted imaging (DWI) and T2-weighted images. There were no abnormalities detected on MRS. We believe this to be the first reported MRI findings in this novel zoonotic viral disease.

Abattoirs↗
PubMed1999

Disseminated Penicillium marneffei infection: a report of five cases in Singapore.

Penicillium marneffei has emerged as an important opportunistic pathogen in HIV-infected patients in Southeast Asia. We report the first 5 cases of P. marneffei diagnosed in Singapore. All the patients were HIV-infected and were either Thai nationals or had frequently travelled to Thailand. Fever, weight loss, anaemia and papular skin lesions were common clinical manifestations in our patients, all of whom had the organism isolated from blood. Skin biopsy specimens showed histological evidence of P. marneffei in 2 patients. In 1 patient each, the organism grew in cultures of specimens from bone marrow and respiratory secretions. Amphotericin B therapy followed by itraconazole were used in 3 of our 5 patients and was associated with good clinical response and outcome.

AIDS-Related Opportunistic Infections↗
PubMed1998

Characterization of the altered cutaneous reactivity of transgenic mice whose keratinocytes overexpress B7-1.

B7-1 (CD80) is a second signal molecule usually associated with "professional" APCs that prevents the induction of T-cell clonal anergy and induces IL-2 production during antigen presentation. Tg mice whose epidermal KC overexpress B7-1 exhibit exaggerated and persistent CHS to a variety of haptens that lasts up to 8 weeks after hapten challenge. These Tg mice also exhibit significantly enhanced ear-swelling responses to irritants that are not persistent. Exaggerated CHS was not reflected in the draining lymph node. T-lymphocyte proliferative responses after sensitization and local challenge with haptens, as there were no significant differences between the B7-1 Tg and the NTg mice. However, RT-PCR analysis of mouse ear skin at the hapten challenge site indicated that B7-1 Tg mice had an alteration in the kinetics of in situ lymphokine transcripts compared to NTg mice: IFN-gamma transcripts were first detectable in Tg mouse skin at 2 weeks versus 24 h for NTg mice. RNase protection assays to detect inflammatory cytokine transcripts at hapten application sites indicated that B7-1 Tg mice responded to hapten application with increased TNF-alpha, IL-6, and TNF-beta transcripts compared to NTg mice. Thus, hapten-induced ear swelling in these Tg mice may be mediated by enhanced inflammatory cytokines during the early phase (1-14 days). IFN-gamma-producing lymphocytes may be responsible for the late phase of the ear-swelling response (14-42 days). These data indicate that B7-1 overexpression by KC in mouse skin directly or indirectly affects the nature of cutaneous inflammation induced by haptens and irritants.

Animals↗
PubMed1997

Genetically transferred central and peripheral immune tolerance via retroviral-mediated expression of immunogenic epitopes in hematopoietic progenitors or peripheral B lymphocytes.

BACKGROUND: Based on the hypothesis that IgGs are potent tolerogens and that immature lymphohematopoietic antigen-presenting cells (APC), and even mature peripheral B cells, may be effective APC for tolerance induction, we designed an immunoglobulin fusion protein retroviral expression vector to test the role of B cells in a novel gene therapy strategy for the transfer of immune tolerance. METHODS: An immunodominant epitope (residues 12-26 of the lambda repressor cI protein) was fused in frame to an IgG heavy chain in a retroviral vector, which was used to infect either bone marrow cells or activated peripheral B lymphocytes. These cells were transferred into syngeneic recipients, who were subsequently challenged with the 12-26 peptide in adjuvant. RESULTS: Bone marrow (BM) chimeras generated with retrovirally transduced bone marrow were shown to be profoundly unresponsive to the 12-26 peptide at both the humoral and cellular levels, but were competent to respond to an unrelated protein (lysozyme or PPD). Importantly, we also show that immunocompetent adult recipients infused with transduced mature, activated B lymphocytes, are rendered unresponsive by this treatment. Surprisingly, lymphoid-deficient BM progenitors from syngeneic SCID donors could also be transduced to produce tolerogenic APC. CONCLUSIONS: Our data suggest that activated B cells are sufficient to be effective tolerogenic APC in immunocompetent adult mice, but that nonlymphoid cells may also induce tolerance in reconstituted hosts. This approach for gene-transferred tolerogenesis has the potential to be maintained indefinitely, and it requires only knowledge of cDNA sequences of target antigens.

Amino Acid Sequence↗
PubMed1996

Search for the most predictive tests of fetal well-being in early labor.

The aim of the study was to evaluate the admission CTG alone and in combination with the following tests: fetal acoustic stimulation test (FAST), maternal perception of sound provoked fetal movement (mpSPFM), amniotic fluid index (AFI), and umbilical artery doppler studies in early labor. 1092 singleton pregnancies in cephalic presentation, and with intact amniotic membranes at 37 weeks gestation or more, were admitted in early labor to the labor ward at the National University Hospital, Singapore. Admission tests were performed, and labor managed according to established labor ward protocol. Of all the tests performed, only the results of the admission CTG and color of the amniotic fluid were known to the obstetrician. If the admission CTG is normal, AFI is > 5 cm and there is an acceleratory responses to FAST the incidence of fetal distress is low. In the presence of a reactive admission CTG and in the absence of thick meconium, fetal heart rate response to FAST and the AFI provided a better selection of the high risk fetus that would require closer monitoring or early delivery. When the admission CTG was suspicious, FAST, AFI, and blood flow velocity waveform studies may allow more confident prediction of the ability of the fetus to withstand the stresses of labor.

Acoustic Stimulation↗
PubMed1991

Oxytocin titration for induction of labour: a prospective randomized study of 15 versus 30 minute dose increment schedules.

Two hundred and twenty four patients admitted for induction of labour were randomized into 2 groups. The oxytocin dose was escalated every 15 minutes in the first group whilst for the second group the dose was increased every 30 minutes till optimal uterine activity was achieved. There was no significant difference in the mean maximum dose of oxytocin and length of labour in the 2 groups studied. Transient reduction of the dose of oxytocin was needed in 20.5% of patients in the '15 minute' group and 17.0% of cases in the '30 minute' group because of uterine hyperstimulation or fetal heart rate (FHR) changes; this difference was not statistically significant. The incidence of operative deliveries were similar in the 2 groups. The neonatal 1 and 5 minute Apgar scores, cord arterial blood pH, incidence of assisted ventilation and admission to the neonatal intensive care unit were similar in the 2 groups. The 15 minute schedule does not offer any advantage over the 30 minute escalation schedule for induction of labour. Hyperstimulation and FHR changes are a possibility with any regimen and close monitoring of FHR and uterine activity is advisable with the use of oxytocin.

Apgar Score↗
PubMed1991

Induction of labour in nulliparas with poor cervical score: oxytocin or prostaglandin vaginal pessaries?

In a previous study nulliparas with poor cervical score (less than 5 out of 10) had a 43.5% Caesarean section (CS) rate of which 55% were for failed induction when labour was induced by artificial rupture of membranes and oxytocin infusion. In this study induction of labour by 2 doses of 3 mg prostaglandin E2 (PGE2) vaginal pessaries, 4 hours apart, and if necessary by artificial rupture of membranes and oxytocin infusion 24 hours later, resulted in a CS rate of 23.7% of which 38.9% were for failed induction. The latter regimen resulted in a significantly lower CS rate compared with labour induced by oxytocin infusion and rupture of membranes without the use of prostaglandins (p less than 0.001). In the prostaglandin group 53.3% were established in labour within 24 hours of inserting the pessary and in these patients the CS rate was 18.5%. In those who did not start labour and needed rupture of membranes and oxytocin infusion 24 hours after the first pessary, 34 (47.9%) had a good cervical score (greater than or equal to 6 out of 10) and 37 (52.1%) had a poor cervical score (less than or equal to 5 out of 10) at the time of amniotomy. The CS rates in these groups were 8.8% and 48.6% respectively (p less than 0.001). In nulliparas with poor cervical score induction is better performed with vaginal prostaglandin pessaries in order to reduce the high CS rate associated with artificial rupture of membranes and oxytocin infusion.

Adult↗
PubMed1991

Can terbutaline be used as a nebuliser instead of intravenous injection for inhibition of uterine activity?

Terbutaline, a betamimetic drug, is used as bolus of 0.25 mg intravenously to inhibit uterine activity when encountered with uterine hyperstimulation and associated fetal heart rate changes. The effect of terbutaline used as a nebuliser in 1- and 2-mg doses on uterine activity in labor was investigated. It did not show any significant inhibition of the uterine activity in spontaneous term labor. Although convenient and easy to administer especially in an emergency, 1 or 2 mg terbutaline used in the form of nebuliser did not give the desired effect like 0.25 mg of terbutaline given intravenously for inhibition of uterine activity in term labor.

Administration, Intranasal↗
PubMed1991

Does prostaglandin confer significant advantage over oxytocin infusion for nulliparas with pre-labor rupture of membranes at term?

Ninety-four nulliparous women with a poor cervical score (less than 6) who had premature rupture of membranes at term were randomized by sealed envelope into two groups. One group received immediate stimulation of labor with oxytocin infusion. The second group received two prostaglandin E2 (PGE2) 3-mg pessaries 4 hours apart, followed by oxytocin infusion, if necessary. The interval between initiation of therapy to onset of labor was significantly longer in the PG group, but the length of labor was similar in both groups. The maximum dose of oxytocin needed was significantly higher in the oxytocin group. The cesarean delivery rate in the oxytocin group was 14.9%, compared with 19.1% in the PG group (not significantly different). All seven cesareans in the oxytocin group and seven of nine in the PG group were for failed stimulation of labor. Neonatal Apgar scores at 1 and 5 minutes and admission to the neonatal intensive care unit were similar in the two groups. The incidence of maternal and neonatal infection was small and was not different in the two groups. The use of PGE2 3-mg pessaries 4 hours apart, followed by oxytocin infusion if necessary, did not confer any benefit over the use of intravenous oxytocin in obstetric or neonatal outcome when both agents were started a few hours after admission.

Administration, Intravaginal↗