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Biomedical subjects

A Prakash

Publications and source records attributed to A Prakash.

At least 73 records · Page 4Linked to original sources
PubMed1998

Xanthogranulomatous cholecystitis.

Xanthogranulomatous cholecystitis exists in a small but significant proportion of routine cholecystectomy specimens. A few recent reports have shown a possible association of this disease with carcinoma of the gallbladder. All cholecystectomized specimens were prospectively evaluated over a period of two and half years in a single surgical unit to examine the incidence of xanthogranulomatous cholecystitis and its association, if any, with carcinoma of the gallbladder in an area that is prone to gallbladder diseases. A total of 460 cholecystectomies were performed for various gallbladder diseases. Histological confirmation revealed chronic cholecystitis in 311 (67.6%) cases, carcinoma of the gallbladder in 62 (13.5%), acute cholecystitis in 29 (6.3%), xanthogranulomatous cholecystitis in 41 (8.9%), and xanthogranuloma and carcinoma of the gallbladder in one case (0.2%) only. Almost all cases were suspected to have chronic cholecystitis on clinical and ultrasonographic features. Two specimens on gross examination showed mass lesions, and hence were suspected to be carcinoma of the gallbladder. Subsequent frozen section and histopathology demonstrated xanthogranulomatous cholecystitis. Only one case of xanthogranuloma was found to be associated with carcinoma of the gallbladder but no firm association could be established between xanthogranulomatous cholecystitis and carcinoma of the gallbladder.

Acute Disease↗
PubMed1998

Topical mometasone. A review of its pharmacological properties and therapeutic use in the treatment of dermatological disorders.

Mometasone, a synthetic 16 alpha-methyl analogue of beclomethasone, is classified as a 'potent' glucocorticoid for dermatological use. It is available as 0.1% cream, ointment and lotion formulations for the treatment of patients with inflammatory glucocorticoid-responsive dermatoses. In patients with atopic dermatitis, the effect of mometasone 0.1% applied once daily over 2 to 3 weeks were similar to those of other glucocorticoids of similar potency, such as betamethasone dipropionate 0.05% twice daily and methylprednisolone aceponate 0.1% once daily. Mometasone 0.1% was significantly superior to twice-daily application of less potent glucocorticoids such as clobetasone 0.05%, hydrocortisone 1.0%, hydrocortisone butyrate and hydrocortisone valerate 0.2%. In patients with seborrhoeic dermatitis, mometasone 0.1% was more effective than ketoconazole 2.0% and hydrocortisone 1.0% in trials lasting 4 or 6 weeks. In the management of scalp psoriasis and psoriasis vulgaris, mometasone 0.1% applied once daily for 2 to 8 weeks was generally more effective than other glucocorticoids of similar or weaker potency such as betamethasone valerate 0.1%, fluocinolone acetonide 0.025%, fluticasone propionate 0.005%, triamcinolone acetonide 0.1% and hydrocortisone 1.0% and as effective as diflucortolone valerate 0.1%. Alternate day application of mometasone 0.1% for 2 weeks was as effective as once-daily application in maintaining symptom control in a small number of patients with psoriasis vulgaris. Although mometasone demonstrates greater anti-inflammatory activity and a longer duration of action than betamethasone, it has low potential to cause adverse systemic effects such as suppression of the hypothalamic-pituitary-adrenal (HPA) axis. Moreover, its atrophogenic potential is low and no greater than that of other glucocorticoids in its class, such as betamethasone valerate. Transient, mild to moderate, local adverse effects such as burning, stinging, folliculitis, dryness, acneiform eruptions and signs of skin atrophy have been reported with mometasone. Mometasone has shown a low risk of primary sensitisation and cross-reactions in preliminary patch test studies. Mometasone is a well tolerated topical glucocorticoid effective in the management of patients with atopic dermatitis, seborrhoeic dermatitis, scalp psoriasis and psoriasis vulgaris. In addition to its low potential for causing primary sensitisation and cross-reactions with other topical glucocorticoids, mometasone offers the convenience of once-daily administration.

Administration, Topical↗
PubMed1998

Rabeprazole.

Rabeprazole is a proton pump inhibitor with antisecretory properties. In vitro animal experiments have indicated that the inhibition of the proton pump by rabeprazole is partially reversible. Rabeprazole has 2- to 10-fold greater antisecretory activity than omeprazole in vitro. However, it dissociates more readily from H+,K(+)-ATPase than omeprazole, resulting in a shorter duration of action. In comparative clinical trials rabeprazole was significantly more effective than placebo, famotidine or ranitidine and as effective as omeprazole in the treatment of patients with erosive or ulcerative gastro-oesophageal reflux disease or gastric or duodenal ulcers. Healing rates with rabeprazole were independent of Helicobacter pylori status. Rabeprazole in combination with either clarithromycin and metronidazole or clarithromycin and amoxicillin or amoxicillin and metronidazole or clarithromycin for 7 days produced eradication of H. pylori in 100, 95, 90 and 63% of patients. The tolerability profile of rabeprazole 20mg once daily was similar to that of famotidine 20mg twice daily, ranitidine 150mg 4 times daily or omeprazole 20mg once daily in comparative trials. The adverse events reported with once daily administration of rabeprazole 20mg include malaise, nausea, diarrhoea, headache, dizziness and skin eruptions in 0.7 to 2.2% of patients.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1998

Balsalazide.

Balsalazide is a prodrug of mesalazine which has an inert carrier molecule instead of the sulfapyridine moiety of sulfasalazine. Balsalazide 6.75 g/day was more effective than mesalazine 2.4 g/day in at least 1 trial and as effective as sulfasalazine 3 g/day for inducing remission in patients with acute ulcerative colitis in 8- and 12-week trials. Moreover, complete symptom relief occurred more promptly with balsalizide 6.75 g/day than with mesalazine 2.4g/day. In long term studies, balsalazide 2 g/day was as effective as sulfasalazine 2 g/day and balsalazide 6 g/day was as effective as mesalazine 1.5 g/day, in maintaining remission in patients with ulcerative colitis. The tolerability profile of balsalazide is significantly better than that of sulfasalazine; 70% of sulfasalazine-intolerant patients were able to tolerate balsalazide.

Aminosalicylic Acids↗
PubMed1998

Domperidone. A review of its use in diabetic gastropathy.

UNLABELLED: Domperidone is a selective antagonist at peripheral dopamine D2 receptors, with gastroprokinetic and antiemetic properties. It increases the frequency and duration of antral and duodenal contractions, thus decreasing/improving transit time of food through the gastrointestinal tract. Gastric emptying of liquids and solids is significantly improved with oral domperidone 40 to 120 mg/day in patients with diabetic gastropathy. Oral domperidone 40 to 80 mg/day significantly decreased the severity of symptoms of gastropathy from baseline values in 66 to 88% of patients with type 1 (insulin-dependent) or insulin-requiring diabetes mellitus. Double-blind withdrawal of domperidone from patients who had responded previously led to greater deterioration of symptoms in patients with delayed gastric emptying than in those who continued receiving the drug. Quality of life was significantly improved in patients who showed a symptomatic response to domperidone. The administration of domperidone 40 to 120 mg/day significantly reduced hospitalisation rates in patients with gastropathy. The symptomatic improvement with domperidone 80 mg/day was similar to that seen with cisapride 40 mg/day or metoclopramide 40 mg/day, and therapeutic benefits seen in symptoms of gastropathy were maintained with domperidone for up to 12 years. Domperidone 40 to 80 mg/day may be effective in patients who are refractory to metoclopramide, and a combination of domperidone 80 mg/day with cisapride 80 mg/day may improve some symptoms in patients who do not respond to either agent alone. Domperidone 40 to 120 mg/day was well tolerated for periods up to 12 years in trials in patients with diabetic gastropathy. Adverse events with domperidone 80 mg/day were similar to those seen in placebo recipients and significantly fewer than in patients receiving metoclopramide 40 mg/day. Although significant elevation of plasma prolactin levels (unrelated to dosage and duration of treatment) occurred in all domperidone recipients, prolactin-related adverse events were observed in only 10 to 20% of patients. CONCLUSIONS: The available data suggest that domperidone 40 to 80 mg/day is an effective agent for the management of symptoms of gastropathy in patients with type 1 diabetes mellitus. In addition, it may provide symptom improvement in patients with gastropathy refractory to other gastroprokinetic agents. Domperidone maintains efficacy in the long term (up to 12 years) and appears to have a better tolerability profile than metoclopramide 40 mg/day.

Animals↗
PubMed1998

Investigation on malaria vectors and mosquito fauna in south Tripura district, Tripura state.

In an entomological study in South Tripura district of Tripura state during June 1998, a total of 31 species of mosquitoes belonging to eight genera were recorded. Among the known malaria vectors in India, Anopheles annularis, An. jeyporiensis, An. minimus, An. philippinensis/nivipes and An. varuna were collected but none of them could be incriminated. During the survey, Aedes pallidostriatus and Malaya genurostris were recorded for the first time in the north-eastern region and Tripura state respectively. Presence of host seeking An. minimus in light-trap collections indoors and its absence during morning indoor resting collections indicated the probability of some degree of exophilic behaviour of An. minimus population in Tripura.

Animals↗
PubMed1998

Epidemiological importance of younger age group during malaria epidemic in PHC Tamulpur, Assam.

An investigation of a malaria epidemic was carried out in Tamulpur Primary Health Centre, district Nalbari, Assam during April 1995. The analysis revealed that children between 3 and 12 years of age who were treated and who recovered clinically from fever during the epidemic were instrumental in the progression of the epidemic by acting as Plasmodium falciparum gametocyte reservoirs. Special efforts are required for treatment of children below 12 years during an epidemic.

Age Distribution↗
PubMed1998

Multisite electrode pacing for prevention of atrial fibrillation.

There is increasing evidence that single site atrial pacing is beneficial for atrial fibrillation (AF) prevention in sick sinus syndrome. Multisite atrial pacing methods such as dual site right atrial pacing and biatrial synchronous pacing are currently under active evaluation for AF and atrial flutter prevention in patients with or without bradyarrhythmias. Clinical studies have demonstrated that multisite atrial pacing has an incremental benefit as compared with single site right and left atrial pacing. The electrophysiologic rationale for the efficacy of multisite atrial pacing is based on the reduction of global and local atrial activation times during pacing and for closely coupled atrial premature beats. This results in earlier recovery of excitability and decreased conduction delay. Dual site right atrial pacing consisting of simultaneous pacing from the high right atrium and the coronary sinus ostium reduces the activation times in virtually all left and right atrial regions, especially in areas of conduction delay. Multisite pacing methods reduce the ability to initiate AF with atrial premature beats by reducing the window for AF induction and minimizing the dispersion of atrial refractoriness. In our long-term clinical experience including 30 patients with paroxysmal and chronic drug-refractory AF, 78% of the patients were free of AF recurrence at 1 year, 63% at 2 years, and 56% at 3 years. Rhythm control was achieved in 86% of patients during a follow-up period of 3 years. Concomitantly, we observed a marked reduction in need for anticoagulation, type I antiarrhythmic drugs, and cardioversion therapies. There were no coronary sinus lead-related complications during follow-up. After the initial favorable clinical experiences, two major prospective randomized trials (DAPPAF and SYNBIAPACE) are under way in North America and Europe to evaluate quantitatively the beneficial impact of multisite atrial pacing for AF prevention.

Atrial Fibrillation↗
PubMed1997

Risk stratification and clinical outcome of minimally symptomatic and asymptomatic patients with nonsustained ventricular tachycardia and coronary disease: a prospective single-center study.

The Multicenter Automatic Defibrillator Implantation Trial (MADIT) showed improved survival with defibrillator therapy but was restricted to coronary artery disease patients with nonsustained ventricular tachycardia (NSVT) and inducible nonsupressible VT. The outcome of patients without inducible VT or inducible but suppressed VT still remains unclear. We performed risk stratification at electrophysiologic (EP) study in 111 consecutive unselected patients with nonsustained VT and coronary artery disease and randomized them to drug or device therapy. Follow-up on selected therapy was 1-71 (mean 27 +/- 20) months. Of 111 patients, 39 patients (35%) had inducible sustained VT at baseline EP study and were stratified to a "higher" risk group (group 1) for sudden death. In 9 of these patients (group 1A), sustained VT was suppressed with class IA antiarrhythmic drugs; in the remaining 30 patients (group 1B) sustained VT was not suppressed with class IA antiarrhythmic drugs. The other 72 of 111 patients (65%) had no inducible sustained VT at EP study and were stratified to a "lower"-risk group (group 2) for sudden death. Mean LVEF in group 1 was 30 +/- 10% versus 37 +/- 9% in group 2 (p = 0.001). Selected therapy in group 1 was an implantable cardioverter defibrillator (16 patients) or guided drug therapy (electrophysiologically guided class I antiarrhythmic drugs = 7 patients; Holter-guided class III antiarrhythmic drugs = 16 patients). In group 2, empiric drug therapy included beta blockers in 29 patients or Holter-guided class III antiarrhythmic drugs in 17 patients, with no antiarrhythmic drug therapy being administered in 26 patients. Mean LVEF tended to be lower in patients receiving class III antiarrhythmic drug therapy (34 +/- 12%) than in patients receiving beta blockers (40 +/- 10%, p = 0.06). Three-year total survival was comparable in group 1 (70%) and in group 2 (81%), but sudden cardiac death mortality tended to be lower in group 1 versus group 2 (0 vs 9%, p = 0.09). Patients receiving class III antiarrhythmic therapy had significantly higher 3-year all cause (40%, p = 0.04) and sudden death (25%, p = 0.06) mortality than patients receiving beta blockers (17% and 8% respectively) or no antiarrhythmic drug therapy (4% and 0%, respectively). The following conclusions can be drawn from this analysis: (1) Electrophysiologically guided drug therapy and implantable defibrillators can minimize the risk of sudden cardiac death in patients with coronary artery disease and inducible sustained VT stratified to higher risk of sudden death. A comparable outcome with respect to sudden death prevention in drug-suppressed or drug-refractory patients suggests limited prognostic benefit of class IA drug testing. (2) Lower-risk patients with severely depressed LVEF and minimal or no symptoms do not have a favorable outcome with respect to sudden and all-cause mortality on Holter-guided class III drug therapy. However, asymptomatic patients with mildly depressed left ventricular function have low sudden death event rates on beta blocker or no antiarrhythmic drug therapy.

Aged↗
PubMed1997

Acute effects of dual-site right atrial pacing in patients with spontaneous and inducible atrial flutter and fibrillation.

OBJECTIVES: We tested the ability of dual-site right atrial pacing to prevent atrial fibrillation (AF) or atrial flutter induced by single-site atrial pacing and correlated its efficacy with clinical patient characteristics, atrial activation times and refractory periods. BACKGROUND: Prevention of recurrent AF with long-term dual-site right atrial pacing has been demonstrated in our previous studies. However, the mechanism of antiarrhythmic benefit is unclear. METHODS: Using standard electrophysiologic methods, baseline electrocardiographic and electrophysiologic measurements (mean +/- SD) were obtained. Programmed atrial stimulation was performed for AF or atrial flutter induction. Atrial pacing was performed at two drive cycle lengths (600 and 400 ms) and followed by one to three atrial extrastimuli at one to four pacing sites in the right atrium. In patients with inducible AF or atrial flutter, reinduction was then attempted during a dual-site atrial pacing drive train. This was achieved by simultaneously pacing at the high right atrium and coronary sinus ostium at an identical rate to the baseline stimulation, with the atrial extrastimuli being delivered at the pacing site responsible for the initial AF episode initiation. RESULTS: Twenty patients (10 men, 10 women, mean [+/- SD] age 64 +/- 16 years) with symptomatic AF (n = 10) or atrial flutter (n = 10) were studied. There was a significant abbreviation of the P wave duration to 103 +/- 17 ms with dual-site pacing compared with sinus rhythm (120 +/- 12 ms, p = 0.005) and high right atrial pacing (121 +/- 17 ms, p = 0.005). This was also associated with a characteristic change in P wave configuration with an inferior and leftward axis shift. The effective refractory period at the high right atrium remained unchanged with dual-site atrial pacing compared with single-site high right atrial pacing. Sixteen patients had inducible AF or atrial flutter and could be tested after dual-site atrial pacing. The induced atrial tachyarrhythmia was suppressed in nine patients (56%), who had either induced AF (n = 5) or atrial flutter (n = 4). The difference in the effective refractory period between the high right atrium and the coronary sinus ostium pacing sites was significantly greater (33 +/- 12 ms) in patients with suppression of atrial tachyarrhythmia with dual-site atrial pacing compared with patients without suppression (15 +/- 13 ms, p = 0.001). P wave abbreviation did not correlate with arrhythmia suppression. There was no correlation between suppression of inducible AF or atrial flutter and demographic or clinical patient characteristics. CONCLUSIONS: Dual-site right atrial pacing from the high right atrium and coronary sinus ostium can suppress inducible AF or atrial flutter elicited after single-site high right atrial pacing in selected patients. Acute suppression is more likely in patients with greater dispersion of right atrial refractoriness between these two sites.

Adult↗
PubMed1997

Assessment of microwave sterilization of foods using intrinsic chemical markers.

The uniformity of microwave processing was investigated by measuring the formation of intrinsic chemical markers in disc-shaped and cylindrically-shaped whey protein gel model systems. These markers are formed as a result of thermally induced reactions of sugar and protein precursors. They were measured in samples placed in a pressurizable Teflon vessel and microwave heated to different peak temperatures using different power levels. Heating uniformity was mapped by sectioning the sample and analyzing for markers. The destruction of B. stearothermophilus spores in alginate beads was correlated with marker formation. The results show that the markers can be used to assess sterility and spatial time-temperature distributions in solid food samples.

Alginates↗
PubMed1997

Internal atrial defibrillation: effect on sinus and atrioventricular nodal function and implanted cardiac pacemakers.

Internal atrial defibrillation (IAD) has been extensively evaluated for clinical efficacy but the need for concomitant demand pacing and the effect of IAD shocks on pacemaker function is not well studied. We prospectively evaluated: (1) the incidence of bradycardia as a result of IAD shocks; and (2) effect of these shocks on functioning of implanted cardiac pacemakers. Consecutive consenting patients with atrial fibrillation (AF) requiring cardioversion or undergoing electrophysiological study were selected for IAD. IAD shocks were delivered using the right ventricle to right atrium (RV-RA), right ventricle to superior vena cava (RV-SVC), right atrium to axillary patch (RA-AX), and right atrium to left pulmonary artery or coronary sinus (RA-LPA/CS) lead configurations. Mean RR interval before and after the shocks and the time interval from shock delivery to first QRS complex were analyzed for unsuccessful and successful shocks. Pacing and sensing function was analyzed in patients with previously implanted pacemakers. Twenty-five patients, 18 men, mean age 67.9 +/- 10 years were included in the study. A total of 305 shocks (264 unsuccessful, 41 successful) were analyzed. For unsuccessful shocks the mean post-IAD shock RR interval (795 +/- 205 ms) and the time to first post-IAD shock QRS complex (970 +/- 438 ms) were both significantly greater than the pre-IAD shock RR interval (685 +/- 131 ms, P < 0.001). The increase in post-IAD shock RR interval and time to first post-IAD shock QRS complex was seen with all four lead configurations used. With successful shocks the mean post-IAD shock sinus cycle length (1,105 +/- 450 ms) and time to first post-IAD shock QRS complex (1,126 +/- 443 ms) were both also significantly greater than the pre-IAD shock RR interval (766 +/- 172 ms). Nine patients (36%) had episodes of significant bradycardia after shock delivery. Shocks of up to 20 J using the RA-LPA/CS lead configuration did not affect pacemaker function. IAD can result in transient bradycardia related to sinus and atrioventricular nodal effects requiring backup ventricular pacing. Shocks can be safely delivered using RA-LPA or RA-CS lead configurations in patients with implanted bipolar cardiac pacemakers.

Aged↗
PubMed1997

Seasonal prevalence of Anopheles dirus and malaria transmission in a forest fringed village of Assam, India.

Seasonal abundance of Anopheles dirus (s.l.) and malaria prevalence in an isolated forest fringed village was monitored at monthly intervals during August 1995 to July 1996. An. dirus was the only vector species detected during the study period. Its density pattern showed distinct seasonality with the peak occurring in the month of July and very low number during cool dry months. Positive correlation (r = 0.721) was found between the density of An. dirus and the amount of rainfall occurring two weeks prior to the collections. Overall sporozoite rate of 1.6% and parous rate of 64.7% were found in the study. Malaria transmission closely followed the density pattern of An. dirus and was seasonal with slide positivity rate and P. falciparum percentage of 47 and 83% respectively. Mean malaria prevalence was higher (p < 0.05) in females.

Animals↗
PubMed1997

Seasonality of indoor resting anophelines in stone quarry area of District Allahabad, U.P.

Alongitudinal study was conducted in four indicator villages of PHC Shankargarh, District Allahabad, U.P. from July 1991 to June 1992 to have information on seasonality of indoor resting anopheline species in silica sand/hard stone quarry area. Fourteen anopheline species namely, An. aconitus (0.35%), An. annularis (17.03%), An. barbirostris (0.09%), An. culicifacies (36.74%), An. fluviatilis (0.13%), An. nigerrimus (0.01%), An. pallidus (4.40%), An. splendidus (0.02%), An. stephensi (0.01%), An. subpictus (40.84%), An. tessellatus (0.15%), An. turkhudi (0.004%), An. vagus (0.20%) and An. varuna (0.02%) were collected. An. culicifacies, An. subpictus and An. annularis were found throughout the year. An. fluviatilis, An. pallidus, An. vagus and An. aconitus were also observed in all the seasons except extreme summer. However, An. barbirostris and An. splendidus were collected only in monsoon/post-monsoon and winter seasons. An. tessellatus and An. stephensi were recorded in winter and spring seasons. An. nigerrimus and An. varuna were recorded in winter, while An. turkhudi in spring. Prolonged high vector density may be attributed to the extended malaria transmission in this area.

Animals↗