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Biomedical subjects

B S Das

Publications and source records attributed to B S Das.

At least 37 records · Page 2Linked to original sources
PubMed1997

Influence of malaria on markers of iron status in children: implications for interpreting iron status in malaria-endemic communities.

To investigate Fe nutritional indices in malaria infection in children, haematology (blood haemoglobin, plasma ferritin, transferrin, Fe, and transferrin saturation), acute phase markers (albumin and caeruloplasmin) and liver function tests were studied in fifty consecutive cases of severe and mild falciparum malaria, fifty matched controls and twenty-three cases of asymptomatic malaria. Blood haemoglobin and transferrin were lower, while ferritin and transferrin saturation were higher, in groups with symptomatic malaria in comparison with the control group. The differences were greatest with the severest form of the disease. There were no differences between any of the groups in plasma Fe. Plasma transferrin correlated directly with albumin in asymptomatic, mild and severe malaria groups (r 0.48, 0.65 and 0.83; P < 0.05, P < 0.05, P < 0.01 and P < 0.001 respectively), and inversely with caeruloplasmin (r -0.65, -0.34 and -0.43; P < 0.01, P < 0.05 and P < 0.01 respectively). For ferritin, the correlation was inverse with albumin (r -0.65, -0.57 and -0.64; P < 0.01, P < 0.001 and P < 0.001 respectively and direct with caeruloplasmin (r 0.83, 0.21 and 0.49, P < 0.001, NS and P < 0.001 respectively). Multiple regression analysis on data from all patients combined indicated that albumin, and to a lesser extent alanine aminotransferase (EC 2.6.1.2) activity, explained 62 % of the variance in transferrin. Caeruloplasmin, parasite count and albumin explained 59 % of the variance in ferritin, and transferrin and unconjugated bilirubin explained 62 % of the variance in Fe values. In conclusion, these data suggest that low transferrin and high ferritin values are primarily due to the acute phase response. High transferrin saturation and lack of differences in plasma Fe between the groups are probably due to Fe released from lysed erythrocytes. Finally, in both symptomatic and asymptomatic malaria, indices of Fe status can be misleading and may be especially problematic in community studies in malaria-endemic areas where asymptomatic malaria may be common.

Acute Disease↗
PubMed1997

Experience with cerebellopontine angle epidermoids.

OBJECTIVE: Cerebellopontine angle (CPA) epidermoids, although of benign nature, are of considerable neurosurgical interest because of their close proximity and adherence to the cranial nerves and the brain stem. We describe our experience and attempt to correlate the final outcomes with the extent of surgical removal. METHODS: Twenty-five consecutive patients with CPA epidermoids that were surgically treated were reviewed, and the final outcomes were assessed. RESULTS: Thirteen patients had trigeminal neuralgia. In 7 of the 13 patients, trigeminal neuralgia was the only presenting feature. The epidermoid was confined to the CPA in each of 6 patients, and in each of 18, it had varying degrees of supratentorial extension. One patient had a predominant supratentorial epidermoid with extension to the CPA. The lesions were totally excised in 12 patients. Near-total removal was accomplished in eight patients, and in the remaining five, partial removal was accomplished. Transient worsening of the cranial nerve functions occurred in 11 patients, probably as a result of aggressive dissection of the capsule from the cranial nerves. In 9 of the 11 patients, the cranial nerve functions improved by the time of discharge. All of the patients who had trigeminal neuralgia were relieved of their symptoms. Eighteen patients were followed up for a mean period of 42 months, and none had symptoms of recurrence. CONCLUSION: Aggressive surgical removal results in transient but significant cranial nerve dysfunction in the postoperative period. A conservative approach is indicated for patients in whom the capsule is adherent to the brain stem and the cranial nerves.

Adolescent↗
PubMed1997

Spinal intramedullary cysticercosis.

OBJECTIVE: Spinal intramedullary cysticercosis is an uncommon manifestation of neurocysticercosis. We review our experience with eight cases of intramedullary cysticercosis. METHODS: Eight patients who were surgically treated for spinal intramedullary cysticercosis between 1982 and 1991 were retrospectively reviewed, and the final outcomes were assessed. RESULTS: In six patients, the cysticercosis involved the thoracic cord, whereas in the other two, the cysticercosis was cervical in location. Only one patient had multiple soft tissue calcifications, as revealed by plain radiography. Myelography indicated an intramedullary lesion in each of seven patients; two of the seven patients had partial myelographic block, suggesting the segmental nature of the lesion. Cerebrospinal fluid studies were noncontributory. One patient had three cysts, whereas the other seven had one cyst each. Four patients had adjacent soft purulent materials, which were revealed by histopathological examination to be granulation tissue. The neurological statuses of seven patients improved after surgery. Six patients were followed up for a mean of 30.6 months (3 mo-5 yr). Three could resume their previous occupations, two others could manage their daily activities, and one required only minimal assistance for daily activities. CONCLUSION: The outcome of intramedullary cysticercosis is not as dismal as reported earlier, and patients with paraplegia also have favorable outcomes. A preoperative diagnosis of cysticercosis can be suspected in an endemic area in the presence of multiple soft tissue calcifications and segmental lesions revealed by myelography or magnetic resonance imaging studies.

Activities of Daily Living↗
PubMed1997

Anomaly of arch of atlas--a rare cause of symptomatic canal stenosis in children.

Symptomatic canal stenosis at the level of atlas (C1) without atlantoaxial dislocation is thought to be very rare in children. Though common, anomalies of the arch of atlas are generally incidental findings in X-rays. High cord compression due to a narrow canal from a bifid posterior arch, or an absent posterior arch, is a very rare condition. We report 5 children with high cord compression from stenosis of C1 arch.

Cervical Atlas↗
PubMed1996

Improving cancer radiotherapy with 2-deoxy-D-glucose: phase I/II clinical trials on human cerebral gliomas.

PURPOSE: Evaluation of tolerance, toxicity, and feasibility of combining large fraction (5 Gy) radiotherapy with 2-deoxy-D-glucose (2DG), an inhibitor of glucose transport and glycolysis, which has been shown to differentially inhibit repair of radiation damage in cancer cells. METHODS AND MATERIALS: Twenty patients with supratentorial glioma (Grade 3/4), following surgery were treated with four weekly fractions of oral 2DG (200 mg/kg body weight) followed by whole brain irradiation (5 Gy). Two weeks later, supplement focal radiation to the tumor (14 Gy/7 fractions) was given. Routine clinical evaluation, x-ray computerized tomography (CT), and magnetic resonance (MR) imaging were carried out to study the acute and late radiation effects. RESULTS: All the 20 patients completed the treatment without any interruption. The vital parameters were within normal limits during the treatment. None reported headache during the treatment. Mild to moderate nausea and vomiting were observed during the days of combined therapy (2DG + RT) in 10 patients. No significant deterioration of the neurological status was observed during the treatment period. Seven patients were alive at 63, 43, 36, 28, 27, 19, and 18 months of follow-up. In these patients, the clinical and MR imaging studies did not reveal any late radiation effects. CONCLUSIONS: Feasibility of administering the treatment (2DG + 5 Gy) is demonstrated by the excellent tolerance observed in all 20 patients. Further, the clinical and MR studies also show the absence of any brain parenchymal damage.

Adult↗
PubMed1996

Plasma alpha-tocopherol, retinol, and carotenoids in children with falciparum malaria.

Cross-sectional interactions by malaria status were investigated between plasma alpha-tocopherol, retinol, and several carotenoids (lutein, beta-cryptoxanthin, lycopene, and alpha- and beta-carotene) and indicators of disease severity (blood parasite count, hemoglobin concentration), acute-phase response (plasma albumin and ceruloplasmin concentrations), hepatic involvement (plasma alanine aminotransferase), oxidant status and antioxidant status (plasma thiobarbituric acid-reactive material and ascorbate), nutritional (weight-for-age) and carrier protein [retinol binding protein (RBP)] status, and cholesterol concentration (as a proxy for lipoprotein) in 100 consecutively admitted children with malaria. There were 50 children with severe and 50 with mild malaria and 50 age- and sex-matched control subjects. alpha-Tocopherol, retinol, and all the carotenoid concentrations were lower in the patients than in the control subjects (P < 0.001). The differences were greater in severe than in mild malaria, except for lutein. In severe malaria only, both retinol and alpha-tocopherol correlated with albumin, ceruloplasmin, and RBP concentrations whereas in all three groups retinol correlated with RBP and alpha-tocopherol correlated with cholesterol (all P < 0.01)). Using multivariate analysis on data from all patients combined, cholesterol was the most significant factor explaining the variance in alpha-tocopherol (29%) whereas RBP was responsible for 95% of the variance in retinol. Plasma cholesterol and RBP values in turn (in the absence of alpha-tocopherol and retinol, respectively) were influenced primarily by acute-phase markers (mainly albumin and ceruloplasmin). Alanine aminotransferase (r = -0.17) and thiobarbituric acid-reactive material (r = -0.17) also showed a small contribution to the variance of RBP but 60-70% remained unexplained. In conclusion, low plasma lipid-soluble micronutrient concentrations in malaria are strongly influenced by the reductions in their carrier molecules, which, in turn, are low as a consequence of the acute-phase response.

Carotenoids↗
PubMed1995

Prognosis of extradural haematomas in children.

102 children treated surgically for intracranial extradural haematoma from 1982 to 1991 were evaluated retrospectively and their prognosis was compared with 387 adults treated during the same period. Children had a better prognosis than adults even with a low Glasgow Coma Scale (GSC) score at surgery. Children had a higher incidence of frontal and posterior fossa haematomas. The GCS score and the associated parenchymal injuries had a strong correlation with the outcome both in adult and children, whereas the site of haematoma had no correlation with the final outcome.

Adolescent↗
PubMed1994

Heterogeneity in DNA content & proliferative status of human brain tumours.

Intra-tumour and inter-tumour heterogeneity in the cytokinetic organization was studied in 235 primary human brain tumours. DNA index (DI; relative tumour cell DNA content) and proliferating fraction (%PF; a measure of proliferative status) were analyzed in tumour biopsy by flow cytometry using a DNA specific fluorochrome (DAPI) and internal standards (chicken erythrocytes, CE). Incidence of micronuclei was studied in tumour biopsy tissue as well as in explants maintained in organ culture. Clonal diversity (implied by the presence of multiple peaks in the DNA histograms) was highest among medulloblastomas (44%) followed by gliomas (19%) and meningiomas (14%). Nearly 85 per cent of the malignant gliomas analyzed (histological grade III/IV) exhibited a great deal of regional variation in the proliferative status as well as micronuclei frequency as compared to meningiomas. Inter-tumoural variations in the DNA content was highest among gliomas (0.9 < DI < 3.6) and lowest among schwannomas (1.7 < DI < 2.2). Similarly, the distribution of %PF values was also broader (10-49%) in gliomas as compared to the other primary brain tumours (5-36%). Analysis of tumours taking both DI and %PF values improved the ability to discern histologically graded low and high tumours. Analysis of clonal diversity and spatial heterogeneity in the cytokinetic parameters could complement the clinicopathological findings in assessing the biological behaviour of human brain tumours, facilitating the prognostification and design of otpimal treatment regimen.

Brain Neoplasms↗
PubMed1994

Vascular clogging, mononuclear cell margination, and enhanced vascular permeability in the pathogenesis of human cerebral malaria.

To document histopathologic evidence on the pathogenic mechanism of human cerebral malaria, we used light microscopy to study brain specimens from 23 patients who died of central nervous system involvement with Plasmodium falciparum. Sequestration of parasitized red blood cells (PRBCs) leading to cerebral capillary clogging was seen. In a few specimens, vascular clogging by PRBCs was associated with margination of mononuclear cells. In others, capillaries were virtually empty and lymphocytes and monocytes were seen in apposition (marginated) to the capillary endothelial surface. The endothelial cells appeared plump, hypertrophied, and prominent. The capillary wall appeared thickened by fibrinous material. Massive intercellular brain edema along with extravasated red blood cells, mononuclear cells, and plasmatic fluid was also noticed. In addition to hypoxia induced by PRBC-mediated vascular clogging, marginating mononuclear cells may contribute to the pathogenesis of cerebral malaria. The precise role played by this phenomenon needs further evaluation.

Adolescent↗
PubMed1993

Plasma antioxidants and lipid peroxidation products in falciparum malaria.

To investigate the influence of Plasmodium falciparum malaria on plasma antioxidants and lipid peroxidation, plasma ascorbate, urate, total protein and albumin, ceruloplasmin and malondialdehyde (MDA) were determined in two groups of 42 patients each, one with mild and the other with severe falciparum malaria, and in an equal number of age- and sex-matched control subjects. Plasma MDA was found to be significantly higher in malaria patients, and the increase was proportional to the severity of the disease. Of the antioxidants, ascorbate and albumin decreased with severity of disease while urate and ceruloplasmin increased. Only ascorbate correlated inversely with MDA both in mild (r = -0.341, P < 0.05) and severe malaria (r = 0.545, P < 0.01). While plasma albumin correlated inversely (r = -0.442, P < 0.01), urate and ceruloplasmin correlated directly (r = 0.419, P < 0.01 and r = 0.349, P < 0.05, respectively) only in patients with severe malaria. These antioxidants also correlated well with markers of disease severity, indicating the influence of disease severity in regulating their levels in plasma. The presence of significant quantities of ascorbate and albumin, along with increases in some of the other antioxidants and MDA, indicates ineffectiveness of the antioxidant defense system in controlling plasma lipid peroxide content. Increased amounts of thiobarbituric acid-reactive material could have been the result of spillover from increased tissue peroxidation or the presence of pro-oxidants in malarial plasma.

Analysis of Variance↗
PubMed1992

Altered plasma lipid pattern in falciparum malaria.

Plasma levels of HDL, LDL, total cholesterol and triglycerides were measured in 60 patients with falciparum malaria (37 severe cases and 23 mild) and in 83 healthy individuals, to study malaria-induced changes in plasma lipids. Triglyceride levels were lower in the patients than in the controls but the difference was significant only for those with severe malaria (P < 0.001). In contrast, the levels of all the other plasma lipids were significantly higher (P < 0.001) in those with severe malaria than in those with mild malaria, and in the mild malaria cases compared with the controls. Initially LDL cholesterol was estimated by the Friedwald formula, but this gave negative values in a few cases of severe malaria. Plasma lipoproteins were therefore also measured by nephelometry; the estimated levels of S particles, corresponding to LDL, were then found to be lower in all malaria cases than in the controls (P < 0.001) but never negative. Interestingly, levels of L particles in the patients with severe malaria were significantly elevated compared with the other patients and controls (P < 0.001), indicating impaired metabolism of chylomicrons. Plasma albumin, considered a negative acute phase protein (i.e. its level decreases as a consequence of the acute phase response), was reduced significantly and was directly correlated to HDL cholesterol levels (r = 0.715 and r = 0.895, respectively) in both mild and severe malaria. Follow-up of 22 of the severe malaria cases three weeks after treatment indicated that, while triglycerides had returned to similar levels to those in the controls, total cholesterol levels were still elevated and could give misleading results if lipid profiles were used, immediately after malaria infection, to assess an individual's risk of developing atherosclerosis.

Cholesterol↗
PubMed1992

Hepatic changes in P. falciparum malaria.

Liver function tests were performed in 165 hospitalized patients suffering from P. falciparum malaria with complications. Serum bilirubin was found increased in 33 patients, and 22 of them had unconjugated hyperbilirubinaemia. Serum alanine aminotransferase was increased in 5 patients, but only to mild to moderate levels. Serum alkaline phosphatase was increased in 11 patients, gamma-glutamyl transpeptidase in 3 patients. Serum total protein and albumin were significantly decreased but these were considered more as indicator of acute phase response. Liver cell necrosis was observed in one patient, and oedema and mononuclear cell infiltration in two patients. Though hepatomegaly and mild elevation of enzymes can be observed in a significant proportion of patients, involvement of liver leading to acute hepatitis or liver cell necrosis is a relatively uncommon complication in P. falciparum malaria.

Adolescent↗
PubMed1992

Influence of serum albumin & total protein on fructosamine measurement.

To assess the effect of serum albumin and total protein on the fructosamine level 57 hypoalbuminaemic patients (serum albumin less than 30 g/1), of whom 44 were nondiabetics and 13 were diabetics, were studied. Fructosamine levels of hypoalbuminaemic diabetics was increased only marginally in comparison to healthy controls (P greater than 0.05) whereas in 122 other normalbuminaemic diabetics, the level was found to be significantly higher (P less than 0.001). In control subjects, the correlation between fructosamine and serum albumin (r = 0.69, P less than 0.001) was better than that of total protein (r = 0.42, P less than 0.01) whereas in hypoalbuminaemic patients the pattern was reversed (r = 0.51 and 0.59 respectively), indicating substantial contribution by the globulins. A working formula suggesting approximate contribution of each gram of albumin and globulin in healthy subjects was calculated. It is inferred that the use of serum fructosamine for assessment of glycaemic status could be misleading in patients with lower albumin values. Calculating serum fructosamine values from serum albumin alone in these patients is likely to be inaccurate, as it ignores the contribution of globulins which can be substantial in certain disease conditions. A gross idea regarding the glycaemic status can be obtained by comparing actual and calculated values of fructosamine from the formula.

Analysis of Variance↗
PubMed1992

Incidence of hypoglycaemia in children with severe Plasmodium falciparum malaria around Rourkela, Orissa state.

To determine the incidence of hypoglycaemia in children suffering from severe falciparum malaria, 23 patients from Rourkela (Orissa), were investigated. Plasma glucose and immunoreactive insulin were estimated before and at hourly intervals during quinine infusion. No child had hypoglycaemia at the time of admission. Correlation between parasite count and prequinine plasma glucose was not significant. In the period of quinine infusion, 20 patients showed fall in plasma glucose during all the three hours (P less than 0.05, P less than 0.01, P less than 0.01 at the end of 1st, 2nd, and 3rd h respectively) but the decrease to hypoglycaemic level (plasma glucose less than or equal to 40 mg/dl) was observed in only one child. Concomitant increase in plasma insulin was noticed in 18 of these patients. Decrease in plasma glucose and increase in plasma insulin was found to correlate well (r-0.78, P less than 0.001). Hypoglycaemia was found to be an infrequent complication of severe falciparum malaria in children from the area studied. Though decrease in plasma glucose was observed after quinine infusion, it was less severe and did not reach the hypoglycaemic level.

Blood Glucose↗