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Biomedical subjects

B V Murthy

Publications and source records attributed to B V Murthy.

32 records · Page 2Linked to original sources
PubMed1997

Impact of pretransplantation GB virus C infection on the outcome of renal transplantation.

Among renal transplant recipients with posttransplantation liver disease, the etiology remains unknown in 10 to 16% of patients. The discovery of yet another parenterally transmitted hepatitis virus, GB virus C (GBV-C), has opened avenues to study the prevalence and risk factors for GBV-C infection among patients undergoing renal transplantation and its impact on posttransplantation clinical outcomes. A cohort of 103 randomly selected recipients of kidneys were examined from anti-hepatitis C virus (HCV)-negative donors between 1986 and 1990. Pretransplantation sera were available in 99 of 103 (96%) recipients and were tested for anti-HCV, using a second-generation ELISA, and for GBV-C RNA by reverse transcription PCR. Pretransplantation GBV-C RNA was present in 18 of 99 (18%, 95% confidence interval [CI], 17.2 to 18.8%) recipients. GBV-C RNA was present in 5 of 22 (23%) anti-HCV-positive recipients compared with 13 of 77 (17%) anti-HCV-negative recipients (P = 0.53). The median number of pretransplantation blood transfusion among recipients with GBV-C RNA before transplantation was significantly higher than among recipients without GBV-C RNA (10 versus 7, P = 0.05). Posttransplantation liver disease and non-A, non-B hepatitis (NANBH) was observed in 35 and 18%, respectively, of GBV-C RNA-positive recipients compared with 28 and 10%, respectively, of GBV-C RNA-negative recipients. Using Cox regression analysis, the relative risk (RR) of posttransplantation liver disease among recipients with GBV-C RNA before transplantation was 1.37 (95% CI, 0.55 to 3.41), and posttransplantation NANBH was 2.09 (95% CI, 0.64 to 6.79). The RR of graft loss and death were not increased (0.88 and 0.92, respectively). When adjusted for pretransplantation anti-HCV, the RR of posttransplantation liver disease, NANBH, graft loss, and death did not change appreciably. In summary, although a higher risk of posttransplantation liver disease was observed among recipients with pretransplantation GBV-C infection, the analyses presented here do not allow for a precise estimate of this risk.

Adult↗
PubMed1997

A 1990s perspective of hepatitis C, human immunodeficiency virus, and tuberculosis infections in dialysis patients.

Chronic infections contribute significantly to morbidity and mortality in dialysis patients. These infections are acquired either before or after initiation of dialysis, and the latter may be via nosocomial modes of transmission. Consequently, policies that deal with infection control in dialysis units have assumed increasing importance. The incidence and prevalence of hepatitis C virus (HCV) infection among patients on dialysis is steadily declining. Nonetheless, the 0.4% to 15% incidence of anti-HCV in hemodialysis (HD) units continues to be a cause for concern. Although nosocomial transmission of HCV infection in HD units has been demonstrated, the Centers for Disease Control and Prevention (CDC), Atlanta, GA, does not recommend dedicated machines, patient isolation, or a ban on reuse in HD patients with HCV infection. Conventional cleansing and sterilization procedures for reprocessing the dialyzers appear to be adequate to inactivate the virus. Over the years, there has been a steady increase in the number of human immunodeficiency virus (HIV)-infected patients entering end-stage renal disease (ESRD) programs. Transmission of HIV infection is extremely unlikely in dialysis units that conform to the standard practice guidelines. Dedicated machines or isolation from other patients are not recommended for patients with HIV infection. Risk of acquiring HIV infection after an occupational exposure is approximately 0.32%. Nonetheless, a combination of zidovudine and lamuvidine for most parenteral exposures, and the addition of a protease inhibitor in high-risk exposures, is recommended. The wide range of immunological derangements in chronic renal failure have been postulated to be the cause for the increased susceptibility of dialysis patients to tuberculosis (TB). The high incidence of extrapulmonary disease may be a significant factor in the delay in diagnosis of TB in these patients. In view of their high-risk for exposure to TB, the purified protein derivative (PPD) skin test is recommended on an annual basis in the staff of dialysis units.

Disease Transmission, Infectious↗
PubMed1996

High-frequency oscillatory ventilation combined with intermittent mandatory ventilation in critically ill neonates and infants.

We have evaluated the high-frequency oscillatory ventilation (HFOV) combined with intermittent mandatory ventilation (IMV) in critically ill neonates and infants using the Babylog 8000 SW 4.0. We used HFOV combined with IMV as a rescue mode in 10 neonates and infants aged 1 day to 17 months, who were receiving maximal conventional ventilation for severe respiratory failure. There was a significant reduction in inspired oxygen requirement when starting HFOV combined with intermittent mandatory ventilation (IMV), from a baseline mean of 0.90 (CI95 0.79-1.01) to 0.55 (CI95 0.40-0.71) at 6h and 0.44 (CI95 0.37-0.52) at 12h. There was also an overall improvement in gas exchange with complete haemodynamic stability. These data suggest that HFOV-IMV mode offers significant improvement as a rescue mode for neonates and infants with severe respiratory failure.

Airway Resistance↗
PubMed1996

Endotracheal suctioning causes right upper lobe collapse in intubated children.

OBJECTIVE: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors. METHODS: The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3-month period (n = 102). Graduated suction catheters and suction vacuums of < 165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n = 60). RESULTS: We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures; a significant reduction in the incidence of RUL collapse, to 7%, was observed (p < 0.05). CONCLUSIONS: We conclude that high negative pressure and deep-suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.

Child↗
PubMed1996

Cerebral venous thrombosis associated with inhalational drug abuse.

Cerebral venous thrombosis is a life-threatening disorder for which the management has been controversial. A 23-year-old critically-ill man with superior sagittal sinus thrombosis (SSST) and cavernous sinus thrombosis secondary to sinusitis following inhalational drug abuse was managed with full heparinization from the fourth day of presentation. He went on to make a full recovery. The association between this form of drug abuse, sinusitis and SSST is an important one, and warrants antibiotics and early aggressive anticoagulation therapy.

Adult↗
PubMed1995

Analgesia following day-case knee arthroscopy--the effect of piroxicam with or without bupivacaine infiltration.

Sixty patients presenting for day-case arthroscopy of the knee under general anaesthesia were studied. Patients were randomly allocated to receive, in addition to intramuscular piroxicam 20 mg, either bupivacaine 0.25% 20 ml applied locally to the knee at the end of the procedure (n = 30) or no further intra-operative analgesia (n = 30). Visual analogue pain scores were significantly lower at 1, 2 and 4 h postoperatively in the bupivacaine group (p < 0.05). A higher proportion of patients in the piroxicam-only group required supplemental analgesia before discharge from hospital. The combination of piroxicam and bupivacaine provided superior analgesia to piroxicam alone.

Adult↗
PubMed1993

Oxy-radicals, lipid peroxides and essential fatty acids in patients with glomerular disorders.

It is now believed that free radicals and eicosanoids participate in the pathogenesis of immune mediated mesangial cell injury and renal tissue damage including glomerulonephritis. But relatively little information is available about the role of essential fatty acids, (EFAs), the precursors of eicosanoids, in renal diseases. We studied the levels of superoxide anion, hydrogen peroxide, lipid peroxides and the concentrations of various metabolites of EFAs in the plasma phospholipid fraction of patients with glomerular disorders. A significant increase in the production of superoxide anion and hydrogen peroxide both by unstimulated and phorbol-myristate acetate (PMA)-stimulated leukocytes, increase in the plasma lipid peroxide levels and a marked reduction in the levels of arachidonic acid (AA) and eicosapentaenoic acid, the precursors of 2 and 3 series prostaglandins (PGs) respectively, were observed in these patients. Since eicosapentaenoic acid and prostacyclin, which is derived from AA, are believed to be of benefit in the prevention of progression of renal disease, and as free radicals can cause renal dysfunction, our results suggest that free radicals and the metabolites of EFAs play a significant role in the pathogenesis of glomerular disorders.

Adolescent↗
PubMed1991

Direct estimation of absolute glomerular filtration rate from dynamic renal scintigraphy using gamma camera.

Absolute glomerular filtration rate (GFR), which can serve as a useful parameter of renal function, is not applied in clinical practice due to various technical constraints. We estimated GFR in 20 subjects (10 controls, 10 patients) by two different techniques simultaneously with a single intravenous injection of TC99m DTPA. The GFR results obtained by a conventional plasma clearance technique were compared with that of a simpler, scintigraphic technique which does not require any blood or urine sample, and these were found to correlate significantly (r = 0.75, p less than 0.001). The linear relationship between the fraction of the dose injected taken up by the kidneys during the parenchymal phase of the dynamic imaging study and the overall plasma clearance was also found to be significant (r = 0.932, p less than 0.001) our study shows that reliable estimation of absolute GFR is possible from the routine dynamic renal scinti-scanning procedure using the gamma camera - computer system, and hence might prove applicable in clinical practice.

Adult↗