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Biomedical subjects

B Gupta

Publications and source records attributed to B Gupta.

At least 19 recordsLinked to original sources

Duration of neuroleptic treatment and prevalence of tardive dyskinesia in late life.

BACKGROUND: Although increasing age is the most consistently cited risk factor for the development of tardive dyskinesia for patients in the second to sixth decades of life, this relationship may not hold within geriatric populations. METHODS: Consecutively admitted geropsychiatric inpatients were examined with the Abnormal Involuntary Movement Scale within 72 hours of admission; comprehensive demographic, diagnostic, and psychometric data were also obtained. RESULTS: Seventy-four (19.2%) of 386 patients received diagnoses of dyskinesia. Lifetime duration of neuroleptic use was strongly correlated with dyskinesia rates. After accounting for the effect of lifetime duration of neuroleptic use in a stepwise logistic regression, only associations with Global Assessment Scale score and presence of dental problems remained statistically significant. In comparison with the duration of neuroleptic use, however, the contribution of these factors was minor. Sixteen percent of patients with less than 3 months of neuroleptic use, 29% with 3 to 12 months of neuroleptic use, 30% with 1 to 10 years of neuroleptic use, and 41% with more than 10 years of neuroleptic use had dyskinesia. Compared with patients with no history of neuroleptic treatment, the relative risks for these durations of neuroleptic use were 1.62 (95% confidence limits [CL], 0.81, 3.24), 2.89 (95% CL, 1.50, 5.55), 3.08 (95% CL, 1.66, 5.70), and 4.11 (95% CL, 2.12, 7.96), respectively. CONCLUSIONS: Within elderly populations, duration of exposure to neuroleptics is the strongest predictor of risk for tardive dyskinesia, and this risk increases rapidly within the first year of total lifetime neuroleptic use.

Age Factors

Psychologic testing as an aid to selection of residents in anesthesiology.

There are no precise psychologic criteria for the selection of residents in anesthesiology. We attempted to provide an objective guide by comparing clinical performance with psychologic tests which we administered to 95 beginning residents in six training programs. The performance of the residents was evaluated by faculty members at the end of the first and second years. We found that high-performance residents scored better than low-performance residents in the categories of Dominance, Independence, Empathy, Responsibility, Socialization, Achievement Motivation, and Well-Being. Prediction of high performance can also be based on Alpha personalities, who typically are independent, reliable, and self-disciplined. The California Psychological Inventory (CPI) is valuable in selecting people with these characteristics.

Anesthesiology

Effect of mianserin on blood glucose level in rabbits.

Blood glucose level was estimated in 18 h fasted albino rabbits following acute feeding of graded doses of mianserin. Mianserin (6.0 mg/kg) produced a gradually increasing hyperglycemic effect which became significant (P < 0.01) at 10 h and onwards. This appears to be due to increased turnover and release of noradrenaline by the drug. The same dose of mianserin also produced glucose intolerance during early hours probably by interfering with gastrin functions.

Animals

Multi drug resistant Salmonella typhi in Ludhiana (Punjab).

280 Salmonella typhi strains isolated from suspected cases of enteric fever during the year 1990 were studied for susceptibility to the antimicrobial agents chloramphenicol, ampicillin, cotrimoxazole, gentamycin, kanamycin, amikacin, ciprofloxacin by Kirby Baur disc diffusion method. All were blood culture positive cases. 63 strains (21.9%) were found resistant to chloramphenicol, ampicillin, cotrimoxazole, but sensitive to the amino glycosides and ciprofloxacin. Present study shows the prevalence of multi drug resistant Salmonella typhi in this region of Punjab.

Adult

Effect of acute & chronic imipramine treatment on glucose homeostasis.

Single dose of imipramine (IMI) produced significant (P less than 0.05) hyperglycemia in rabbits, the effect peaking at 1 h. The hyperglycemic response was less marked in rabbits which were chronically pretreated with IMI for 4 wk. Simultaneous administration of insulin, oral glucose or adrenaline with single doses of IMI resulted in an enhancement of usual hypoglycemic/hyperglycemic responses of these agents. However, when these drugs were administered in chronically IMI fed animals there was complete reversion of the enhancement. Daily administration of adrenaline for further 6 days with IMI feeding in the chronically IMI treated rabbits, led to enhancement in the hyperglycemic response to adrenaline (P less than 0.001). In contrast, similar administration of insulin resulted in reduced hypoglycemia. Further, glucose feeding with IMI plus adrenaline or insulin in these animals did not result in any significant alteration in blood glucose level (BGL), as compared to oral glucose plus single doses of adrenaline or insulin. GTT done on the day next to drug treatment in rabbits chronically pretreated with IMI and than with IMI plus insulin, produced an enhanced hyperglycemic response, as compared with the control group (P less than 0.01). These observations indicate that acute (but not chronic) treatment with IMI not only produces a rise in BGL per se but also enhances the response to other agents which affect glucose homeostasis.

Administration, Oral

Morbidity and survival of liver resection for colorectal adenocarcinoma.

Sixty-two patients underwent hepatic resection for isolated colorectal metastases from 1963 to 1988. The numbers of hepatic resections were: lobectomy, 24 (39 percent); wedge resection, 23 (37 percent); and segmentectomy, 15 (24 percent). The median number of intraoperative blood transfusions was 3.0 units (range, 0-16 units). The median number of days in the hospital following hepatic resection was 13 (range, 4-51 days). There were 19 patients (30 percent), who developed a total of 23 complications. Surgery was required for complications in nine patients. Surgical mortality occurred in 5 of 62 (8 percent) patients. The estimated median survival in 56 patients with one to three metastases was 26 months, with a 28 percent estimated 5-year survival. The median size of the metastases was 4.0 cm (range, 0.7-13 cm). The estimated median survival in 27 patients with metastases less than 4 cm in diameter was 26 months, with a 24 percent estimated 5-year survival. The estimated median overall survival from the time of hepatic resection was 25 months.

Adenocarcinoma

Postoperative opisthotonus and torticollis after fentanyl, enflurane, and nitrous oxide.

Most drug-induced extrapyramidal symptoms are due to blockade of dopaminergic receptors and are treated with anticholinergic drugs. We report a patient with severe postoperative extrapyramidal symptoms which responded to physostigmine and indicated a different aetiology. A young, healthy female outpatient developed severe extrapyramidal symptoms after an uneventful 50 min anaesthetic with thiopentone, fentanyl (100 micrograms), enflurane, and nitrous oxide. Although the trachea was not extubated until she obeyed commands, the patient developed opisthotonus, which resolved initially after treatment with thiopentone (40 mg), diazepam (5 mg), and diphenhydramine (50 mg). The opisthotonus recurred approximately 25 min later, in association with torticollis, obtundation, and periodic apnoea. A tentative diagnosis of central anticholinergic syndrome was proposed, and fentanyl was considered to have been responsible. Naloxone (0.4 mg) induced no improvement, but physostigmine (2 mg) reversed the dystonic symptoms and periodic apnoea and improved her mental status. The response to physostigmine may have been due specifically to increased levels of acetylcholine at the cholinergic receptors, or to a nonspecific analeptic effect.

Adult

A second time-study of the anaesthetist's intraoperative period.

This second time-study of the anaesthetist's intraoperative period was conducted at The Ohio State University Hospitals. The study involved a total of 30 anaesthetic procedures. The activities of the anaesthetists were videotaped and analysed independently by three reviewers. Unlike our previous study, the present study was performed at a time when automatic noninvasive arterial pressure monitors, automatic ventilators and patient breathing circuit disconnect alarms were in use. The greatest amount of intraoperative time of the anaesthetist (59.1%) was spent monitoring the patient directly (44.8%) or indirectly (14.3%) via patient monitors. This represented an increase from our previous study attributable to the increased use of technology in the operating room. The anaesthetist still spent about 10-12% of his/her time completing patient records.

Anesthesia

Pyloric obstruction due to gastric tuberculosis--an endoscopic diagnosis.

A 22 year old male presented with symptoms of gastric outlet obstruction. Endoscopy showed a hypertrophic nodular lesion around the pyloric opening with pyloric stenosis. The endoscopic biopsy and histopathological examination revealed tuberculosis involving the stomach, an extremely rare lesion.

Adult

Effect of electroconvulsions on leucocyte counts.

Acute electroconvulsions (EC) induced polymorphonuclear leucocytosis with relative lymphopenia in rabbits. On daily EC challenge there was no tolerance to this response but the response was blocked by propranolol. Repeated daily administration of exogenous adrenaline or EC challenge increased basal total leucocyte and polymorph but decreased the lymphocyte counts. It is suggested that repeated exposure to exogenous adrenaline or endogenous adrenaline (through EC) somehow sensitizes the system responsible for the release of polymorphs from the bone marrow.

Animals

Effect of electroconvulsions on glucose homeostasis in rabbits.

Acute electroconvulsions (ECS) produced hyperglycemic response in rabbits which peaked at 30 min and recovered within 4 h. This hyperglycemic response to acute ECS was significantly more marked in rabbits which were chronically pretreated with ECS. The hyperglycemic responses to acute ECS and oral glucose were additive in nature. Daily administration of adrenaline in chronically ECS pretreated rabbits further enhanced the hyperglycemic response to acute ECS. The hyperglycemic response to oral glucose and parenteral adrenaline were significantly more marked in such rabbits. GTT done on the day next to ECS, in rabbits chronically pretreated with ECS and then with ECS plus adrenaline produced enhanced hyperglycemic response. These results indicate that repetitive ECS disturbs glucose homeostasis.

Animals