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Biomedical subjects

Amit Gupta

Publications and source records attributed to Amit Gupta.

At least 55 records · Page 3Linked to original sources
PubMed2003

Outcome of pediatric renal transplants in a developing country.

This study was conducted to evaluate the outcome of pediatric renal transplants at our center. A retrospective analysis was done on 39 pediatric transplants (age at transplant <18 years) done at our center over the last 10 years. The mean age at transplant was 15.6+/-1 years (10-17 years). They comprised 4.2% of all renal transplants done at our center (39/921) over the period. Girls comprised 17.5% of total recipients ( n=7). Two patients had a preemptive transplant. The underlying causes of end stage renal disease were chronic glomerulonephritis ( n=21), chronic interstitial nephritis ( n=17) and Alport syndrome [1]. All the 39 children were initiated on triple drug immunosuppression (cyclosporin A (CsA) azathioprine, prednisolone). All patients received grafts from living related donors. In the first month, three patients had graft loss (serum creatinine, SCr, >5 mg/dl). Of these, two patients died because of septicemia and one had acute cortical necrosis. There was evidence of infection in 16 patients (40%). Acute rejection was seen in 17 patients (45.8%). The 1-year patient and graft survival was 89% and at 3 years 70%. The actuarial graft survival at 5 years was 50%. Twelve children discontinued CsA after 1 year post-transplant and five of these had graft loss. Graft losses were significantly greater in patients who discontinued CsA as compared to those who continued CsA (5/12 vs 2/22). After a mean follow-up of 31.5+/-3.5 months, of the 37 patients, 10 had graft loss and chronic graft dysfunction was observed in another 9 patients. The rest of the 17 (48%) patients had a mean SCr of 1.2 mg/dl. The long-term outcome of pediatric renal transplants in our country remains suboptimal. CsA discontinuation due to financial constraints and/or non-compliance remain the most important reasons for this.

Adolescent↗
PubMed2003

Necrosis of the eyelids and sclera after retrobulbar anesthesia.

A 52-year-old man had loss of vision and black discoloration of the lids of the right eye after a retrobulbar injection of 3 mL lidocaine hydrochloride 2% (Xylocaine). Examination of the right eye revealed no light perception with extensive necrosis of the lids. Anterior segment examination revealed conjunctival pallor, corneal edema, and necrosis of the sclera. This is a previously unreported complication of retrobulbar anesthesia comprising ophthalmic artery occlusion with scleral melt, ocular ischemia, and eyelid necrosis.

Anesthesia, Local↗
PubMed2003

Role of posterior capsulotomy with vitrectomy and intraocular lens design and material in reducing posterior capsule opacification after pediatric cataract surgery.

PURPOSE: To study the effect of primary posterior capsulotomy with anterior vitrectomy (PPC + AV) and intraocular lens (IOL) design and material on the development of posterior capsule opacification (PCO) after pediatric cataract surgery. SETTING: Tertiary care institution in India. PATIENTS: Sixty-four eyes of 52 children ranging in age from 3 months to 12 years who had cataract extraction with IOL implantation were prospectively evaluated for a minimum postoperative period of 2 years. METHODS: Thirty-two eyes received a hydrophobic acrylic lens with a truncated, square edge and 32, a single-piece poly(methyl methacrylate) (PMMA) lens that was not heparin surface modified. Sixteen eyes in each IOL group had PPC + AV; in the remaining 16 eyes in each group, the posterior capsule was left intact. RESULTS: Postoperatively, 25 eyes in the intact capsule group and 5 in the PPC + AV group developed PCO; the difference between groups was significant (P<.05). Of eyes with an intact capsule, 12 with an acrylic IOL and 13 with a PMMA IOL developed PCO (P>.05). In the PPC + AV group, 2 eyes with an acrylic IOL and 3 with a PMMA IOL developed PCO (P>.05). Overall, 14 eyes with an acrylic lens and 16 eyes with a PMMA lens developed PCO (P>.05). After surgery, there was a significant short-term delay in the development of PCO in the acrylic group (14 eyes; mean 6.66 months +/- 1.57 [SD]) compared to the PMMA group (16 eyes; mean 3.16 +/- 0.83 months) (P<.05). CONCLUSIONS: It is the management of the posterior capsule rather than IOL design and material that influences the incidence of PCO after cataract surgery in children. Development of PCO in the postoperative period was delayed with a hydrophobic acrylic IOL with square edges compared with a PMMA lens without square edges.

Acrylic Resins↗
PubMed2003

Malnutrition and nutritional therapy of chronic kidney disease in developing countries: the Asian perspective.

There is a paucity of data regarding the prevalence and clinical consequences of protein-energy malnutrition (PEM) in the chronic renal failure, maintenance dialysis, and renal transplant population in developing countries. Malnutrition, which is reported to be present in 42% to 77% of the end-stage renal disease population in developing countries, is strongly associated with morbidity and mortality. Many religious practices in developing countries promote abstinence from meat, fish, and eggs. Both a vegetarian dietary pattern, which is being adopted by an increasing number of people, and ingestion of inadequate protein and calories in the diet to arrest the progression of chronic renal failure, may lead to malnutrition. The attendant complications of PEM, malaise, wasting, anemia, and decreased immunity, may predispose these patients to infections. This is commonly seen in both the maintenance hemodialysis and peritoneal dialysis population and may decrease their survival. There is an urgent need for nutritional counseling by a dietitian to contain the damage of malnutrition and to provide important nutritional information to the patient. Consultation with a dietitian should take place at least 3 times yearly and, in malnourished patients, more often, as needed. Dietetic documentation should include reports of food intake, subjective global assessment, anthropometric measurements, estimation of the nPNA, serum albumin, and prealbumin, the serum lipid profile, sodium and potassium intake, calcium and phosphorus status, and any changes in body weight.

Asia↗
PubMed2003

Peritoneal infection in acute intermittent peritoneal dialysis.

A prospective study was done to evaluate the incidence and microbiological trend of peritoneal infection in patients undergoing acute intermittent peritoneal dialysis (PD). Complete sterile procedure was ensured and at the completion of the procedure PD fluid was sent for bacteriological culture, sensitivity, and total and differential cell count. During the period September 2000 to February 2001 a total of 100 patients were evaluated. Male female ratio was 72:28. Mean age was 43.17 +/- 17.2 years. In 26 patients cyclers were used. Bacterial culture was positive in total of 30 cases (30%). Gram positive, Gram negative and mixed infection was found in 10%, 15%, and 5% respectively. Number of exchanges (31.61 +/- 7.7 vs. 31.3 +/- 6, p = 0.8) were similar and number of repositioning was significantly more in the infected group (23.3% vs. 11.4%, p < 0.01). Total cell count was significantly higher in infected group (274.3 +/- 502 vs. 31.25 +/- 79.34, p < 0.01). Among Gram +ve organisms Staphylococcus was found in 7, Enterococcus faecalis in 4 and Coryne bacterium sps. in 2 cases. Among Gram -ve organisms, E. coli was found in 4, Enterobacter in 3, Klebsiella 1, Pseudomonas 1, Acinetobacter arinatus 5, Acinetobacter baumani 3, and Citrobacter freundii 3. Mixed flora comprised of Enterococcus faecalis 3, Enterobacter 1, Staphlococcus 1, E. coli 3, Citrobacter 1, Acinobacter baumani 1. Although with the cyclers using collapsible bags, staphylococcus was not isolated, the total incidence of infection (11/26 cases) was not decreased with the use of cyclers. We conclude that in acute intermittent peritoneal dialysis the incidence of bacterial infection is 30% with preponderance of Gram -ve over Gram +ve organisms and organism of fecal origin being commoner than those of skin origin. Use of cycler-assisted over manual PD do not improve the incidence of infection. Repositioning of the stiff catheter significantly increases the incidence of infection.

Adult↗
PubMed2003

Spectrum and clinical profile of post cataract surgery endophthalmitis in north India.

PURPOSE: To determine the spectrum, clinical profile and risk factors for poor visual outcome in patients of post cataract surgery endophthalmitis. METHODS: Data from 124 eyes were analysed. Various clinical and microbiological parameters were evaluated and risk factors for unfavourable outcome identified. RESULTS: The mean age of the patients was 59.50 +/- 13.75 years; 60.5% were males. The median surgery-symptom interval was 7 days (mean 15.81 +/- 24.01) and the medium symptom-presentation interval 7.5 days (mean 14.19 +/- 19.13). Corneal infiltrates were seen in 29%, hypopyon in 62 (50%). Smear positivity was 52.5% and culture positivity 38%. Equivocal microbiological positivity was seen in 22 (18%), bacterial 12 (10%), fungal 27 (21.5%), polymicrobial 8 (6.5%) and negative 55 (44%). 20% eyes had total loss of vision at last follow-up. Poor visual acuity at presentation, presence of intraocular lens, shorter surgery-symptom interval, corneal and surgical wound infiltrates, loss of red reflex, microbiological positivity of the vitreous tap and systemic diabetes mellitus were significant risk factors for unfavourable outcome. CONCLUSION: Our data highlights a low culture positivity and a predominance of fungal pathogens as a cause of post cataract surgery endophthalmitis. The visual outcome in these patients is still dismal and better treatment strategies should be evolved keeping in mind the microbiological spectrum. The risk factors identified may be helpful in prognosticating the outcome in such patients.

Aged↗
PubMed2003

Posterior scleritis associated with systemic tuberculosis.

Infective isolated posterior scleritis is rare. We report a case of isolated posterior scleritis associated with histopathologically documented systemic tuberculosis, a hitherto unreported association. The patient responded well to a combination of oral corticosteroids with antituberculosis therapy.

Antitubercular Agents↗
PubMed2002

Do current recommendations for kidney biopsy in nephrotic syndrome need modifications?

The current recommendations of kidney biopsy in childhood idiopathic nephrotic syndrome (CINS) were put forward to minimize unnecessary kidney biopsies in underlying minimal change disease (MCD). However, there remains a diversity of opinion about the criteria for biopsying children with idiopathic nephrotic syndrome. This study was conducted to prospectively study their usefulness in avoiding biopsies in MCD and to evaluate further modifications for minimizing biopsies in CINS. Of 400 consecutive CINS patients, 222 patients were subjected to kidney biopsy according to the current recommendations. The histopathology spectrum of these selectively biopsied children revealed focal segmental glomerulosclerosis (FSGS) in 39%, MCD in 34.2%, membranoproliferative glomerulonephritis (MPGN) in 16.2%, mesangioproliferative glomerulonephritis (MesPGN) in 7.6%, membranous nephropathy (MN) in 1.8%, and diffuse mesangial sclerosis (DMS) in 0.9%. We observed that despite the current recommendations and efforts to minimize biopsy, 34% of children had MCD on histopathology. Two or more clinical (hematuria and hypertension) or biochemical (renal insufficiency) parameters were present in all children with MPGN. Low C3 was present only in children with MPGN. All the steroid responders were found to have MCD, FSGS, or MesPGN on biopsy. Cyclophosphamide response correlated better with steroid responsiveness ( P=0.02) than with histo- pathology ( P=0.80) in MCD, FSGS, and MesPGN. Based on these observations, we suggest some modifications in current recommendations for kidney biopsy to minimize biopsying children with MCD. These are (1) biopsies in children (age 1-16 years) should be restricted (a) to a subgroup with two or more clinical and biochemical parameters and (b) in steroid non-responders, (2) the decision to administer cyclophosphamide should be based on steroid response pattern without requiring a prior routine biopsy.

Adolescent↗
PubMed2002

Reliability of proton and goldmann applanation tonometers in normal and postkeratoplasty eyes.

OBJECTIVE: To compare the reliability of intraocular pressure (IOP) measurements with the ProTon tonometer and the Goldmann applanation tonometer (GAT) in normal and post-penetrating keratoplasty (post-PK) eyes. DESIGN: Prospective, nonrandomized, comparative case series. PARTICIPANTS: Twenty-four individuals (48 eyes) with no known ocular disorder and 59 patients (59 eyes) that had undergone penetrating keratoplasty (PK) were included in the normal and post-PK groups, respectively. METHODS: Three readings at 5-minute intervals each were obtained with GAT and ProTon in both the groups. Each reading with ProTon was a mean of five accepted readings with the highest accuracy (standard error of mean, <0.5 mmHg). In post-PK eyes with more than 3.00 diopters of astigmatism or with irregular astigmatism, the mean of two readings taken with GAT in the steepest and flattest axis was considered to be the IOP. MAIN OUTCOME MEASURES: The IOP measurements in all groups were compared using a two-tail paired t test. The coefficient of repeatability and Cronbach's coefficient alpha were calculated separately for the IOP measured using both instruments in each group. RESULTS: There was no significant difference in the second (r1) and third (r2) IOP reading using the GAT and ProTon tonometers in normal and post-PK eyes. The coefficients of repeatability for GAT and ProTon were 2.64 and 2.49 in normal versus 3.72 and 3.47 in the post-PK group. The Cronbach's alpha for GAT and ProTon was 0.94 and 0.95 in the normal group versus 0.95 for both GAT and ProTon in the post-PK group. CONCLUSIONS: The results of our study show that the ProTon tonometer is reliable and comparable with GAT for recording IOP in normal and post-PK eyes.

Adolescent↗
PubMed2002

Phacoemulsification in patients with Fuchs' heterochromic uveitis.

PURPOSE: To evaluate the results of phacoemulsification with capsular bag fixation of a poly(methyl methacrylate) (PMMA), acrylic, or silicone intraocular lens (IOL) in patients with complicated cataract resulting from Fuchs' heterochromic uveitis (FHU). SETTING: Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study evaluated 20 eyes of 19 patients with FHU and cataract who had uneventful phacoemulsification with endocapsular implantation of an IOL and completed a 1-year follow-up. RESULTS: Preoperatively, loss of the iris collarette and fine keratic precipitates were seen in all 20 eyes, iris heterochromia in 16, iris atrophy in 12, and iris nodules in 2. Fourteen eyes had mild or negligible preoperative anterior chamber inflammation. No eye had increased intraocular pressure. An acrylic IOL was implanted in 10 eyes, a silicone IOL in 4, and a PMMA IOL in 6. There were no significant differences in outcomes among the 3 IOL groups. Three patients had intraoperative hyphema that resolved spontaneously. Postoperatively, 16 eyes had mild anterior chamber reaction. Four patients had significant anterior chamber inflammation necessitating the use of frequent topical steroids. No case had secondary glaucoma or posterior synechias. The best corrected visual acuity was 6/5 in 6 eyes, 6/6 in 11, and 6/9 in 3. CONCLUSIONS: Uneventful phacoemulsification with endocapsular IOL implantation visually rehabilitated patients with FHU. All 3 IOLs yielded similar results except for increased early postoperative inflammation and late dense anterior capsule opacification in the silicone group. Further studies comparing the outcome of different IOL materials are required to determine their effectiveness in patients with FHU.

Acrylates↗
PubMed2002

Outcomes of phacoemulsification in patients with dry eye.

PURPOSE: To evaluate the outcomes of phacoemulsification in patients with dry eye. SETTING: Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. METHODS: This study included 25 eyes of 23 patients with dry eye having phacoemulsification. Dry eye was defined as Schirmer I with lidocaine hydrochloride (Xylocaine) score of 5.0 mm after 5 minutes, a tear-film breakup time (TFBUT) of less than 5 seconds, or both. Data were retrospectively analyzed for preoperative and postoperative tear function, postoperative complications, and final visual outcomes. RESULTS: Of the 23 patients, 18 had age-related dry eye and 5 had secondary Sjögren's syndrome. Twenty-two eyes had predominant aqueous deficiency (Schirmer I with Xylocaine score of 5.0 mm or less), and 3 had a Schirmer score between 6.0 mm and 9.0 mm. The TFBUT was 5 seconds or less in 17 eyes and between 6 seconds and 9 seconds in 8 eyes. The mean preoperative Schirmer score was 4.80 mm +/- 2.01 (SD) (range 2.0 to 9.0 mm) and the mean postoperative score, 3.80 +/- 2.40 mm (range 0 to 7.0 mm). The mean preoperative TFBUT was 4.00 +/- 1.87 seconds (range 0 to 9 seconds) and the mean score at the last follow-up, 3.40 +/- 1.60 seconds (range 0 to 8 seconds). Postoperatively, 8 eyes had superficial punctate keratopathy and 8 had an epithelial defect. The final visual acuity was 6/6 in 13 eyes, 6/9 to 6/12 in 8 eyes, and 6/18 to 6/60 in 4 eyes. CONCLUSION: Phacoemulsification was safe and led to minimal complications in patients with age-related dry eye with or without associated systemic disorders.

Adult↗
PubMed2002

Access-related complications in peritoneal dialysis in developing countries.

Access-related complications differ considerably between acute and chronic peritoneal dialysis as a result of differences in catheter design, catheter material, number of cuffs, break in period, and the duration of peritoneal dialysis. Pain, which is the commonest complication of acute peritoneal dialysis, is seen in 56% to 75% followed by blood tinged dialysate effluent in 30%, pericatheter leak in 14% to 36%, catheter malfunction in 12% to 28%, bowel injury in 0.1% to 1.3%, rarely bladder injury and peritonitis in 2.5%. In chronic peritoneal dialysis, the incidence of exit-site infections are seen anywhere between 1 episode in 27.3 patients months to 1 episode in 41.9 patients months, and pericatheter leak is seen in 5.2%. Technique of exit-site care is variable in different countries, and regular use of mupirocin ointment at the exit site is practiced in different centers.

Developing Countries↗
PubMed2002

Use of clopidogrel loading, enoxaparin, and double-bolus eptifibatide in the setting of early percutaneous coronary intervention for acute coronary syndromes.

This study sought to evaluate the safety and feasibility of using the combination of aspirin, front-loaded clopidogrel, enoxaparin, and eptifibatide in patients with acute coronary syndromes immediately prior to percutaneous coronary intervention. One hundred ninety-eight patients (39 with acute myocardial infarction) received aspirin 325 mg orally, clopidogrel 300 mg orally, enoxaparin 0.5 mg/kg intravenous (IV), and eptifibatide using the ESPIRIT dosing (180 g/kg bolus IV, immediately followed by a 2 g/kg/minute continuous IV infusion, and then a second 180 g/kg bolus IV ten minutes after the first bolus). A total of 363 lesions were intervened; two were determined unsuccessful. Arterial sheaths were removed using manual compression after 3 hours. In the immediate follow-up, one patient developed rigors thought to be related to the eptifibatide therapy and a second patient experienced rebleeding at the access site. No other major bleeding or access-site hematomas were noted, and no patient developed thrombocytopenia. Over the subsequent 30 days, no episodes of acute vessel/stent thromboses were recognized. There were no deaths. Repeat coronary intervention was required in one patient at a previously untreated site. Clopidogrel was discontinued early in 5 patients due to rash. In conclusion, this pilot study demonstrates the feasibility of administering aspirin, clopidogrel, enoxaparin, and eptifibatide in the setting of percutaneous coronary intervention for acute coronary syndromes. These agents can be administered moments before the coronary intervention with no apparent compromise in patient safety.

Adult↗
PubMed1998

Weight decay backpropagation for noisy data.

We present a formal evaluation of the effect of weight decay training for backpropagation on noisy data sets. Weight decay training is suggested as an implementation for achieving a robust neural network which is insensitive to noise. We investigate the noisy situations of noisy training set-clean test set, clean training set-noisy test set, and noisy training set-noisy test set. Statistically speaking, there is strong evidence indicating that the noisy situation of noisy training set-clean test set provides more accurate prediction than the other two noisy situations. This finding suggests the relative importance of maintaining to-be-predicted cases noise-free for neural network classification. Furthermore, experimental results show that weight decay training is at least as good as standard backpropagation in noisy situations and, in some data sets, weight decay training outperforms standard backpropagation by a significant difference. However, for clean data sets there is no significant difference between weight decay training and standard backpropagation. Another interesting finding in this study is the effect of the number of training epochs on weight decay training and standard backpropagation in noisy situations. Weight decay training can achieve convergence after a short training. For the same short training, weight decay training usually outperforms standard backpropagation. When additional training has a significant effect on performance, it is to improve standard backpropagation but deteriorate weight decay training.

Journal Article↗
PubMedDate not supplied

Consumer-directed health care and case management: Part 1.

Consumer-directed health care (CDH) is here. A quick look at the current health care market shows that CDH is quickly gaining a foothold. Most health plans either already offer some type of a plan or are in the midst of developing one for the next enrollment period. Early adopter health plans have gained significant market traction, gaining new employer clients on the basis of a consumer-directed health care strategy.

Case Management↗