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Biomedical subjects

D Kumar

Publications and source records attributed to D Kumar.

At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Beneficial effects of electrical stimulation on neuropathic symptoms in diabetes patients.

Transcutaneous electrical nerve stimulation is utilized for relieving pain in the diabetes peripheral neuropathy. Previous studies were short-term and did not document sustained beneficial effects. In this study, the authors evaluated long-term effectiveness of electrotherapy administered by proprietary equipment, an H-wave machine. A detailed questionnaire concerning patients' symptoms prior to and following electrotherapy was mailed to the users of H-wave machine. The responses of 34 individuals who had diabetes mellitus were analyzed (age 74.1 +/- 1.6 SEM years, body mass index 28.5 +/- 0.8 kg/m2, duration of diabetes 15.8 +/- 2.0 years and duration of neuropathic symptoms 8.0 +/- 1.8 years). Telephone interviews were conducted with 20 additional diabetes patients selected randomly from the persons who did not return the questionnaire. Forty-one (76%) patients reported a 44.0 +/- 4.0% subjective improvement in their neuropathic pain. The overall improvement in pain was also significant on an analog scale of 10 (p < .01), and correlated well with the percent amelioration data (r2 = .65). These data suggest an effectiveness of electrotherapy in managing neuropathic pain as an adjunct to the analgesics. It appears to provide continued benefit as the responders have used this nonpharmacological treatment modality for an average period of 1.7 +/- 0.3 years.

Aged↗
PubMedDate not supplied

Fine needle aspiration biopsy of solitary fibrous tumors. Report of two cases with histologic, immunohistochemical and ultrastructural correlation.

BACKGROUND: Although the fine needle aspiration biopsy (FNAB) technique is widely applied to thoracic and soft tissue tumors, the cytologic morphology of solitary fibrous tumors is not fully established. CASES: We report the cytologic features observed on computed tomography (CT)-guided FNAB obtained from two benign solitary fibrous tumors of the pleura in two males. The cytologic findings were compared to the light and electron microscopic features. The smears were composed of spindle cells dispersed amid a delicate network of small blood vessels. scattered among these spindle cells were also epithelioid cells arranged singly or in small clusters. These cells were polygonal, with moderately dense, homogeneous or finely vacuolated, basophilic cytoplasm and a moderately high nuclear/cytoplasmic ratio. The nuclei were oval to round and slightly hyperchromatic and rarely had small nucleoli. Abundant spindle-shaped, round, naked nuclei were seen in the background. Stains for CD34 were positive in the epithelioid and spindle cells. Histologically the lesions were composed of spindle cells embedded in a collagenous matrix. Hypercellular nodules and focal hemangiopericytic and storiform patterns were also observed. There were no features suggesting malignancy. In electron microscopic evaluation there were fibroblastic cells in a collagenous matrix as well as polygonal cells singly and in clusters with scanty to moderate amounts of cytoplasm containing sparse organelles. The cells were attached to each other by tight junctions. Occasionally, cells were surrounded by short segments of basal lamina. CONCLUSION: The cytomorphologic pattern described above correlates well with the histologic and ultrastructural findings in benign solitary fibrous tumors (SFT) and corresponds perfectly to the histogenetic concept of this lesion. As with other tumors, fine needle aspiration biopsy is helpful in the evaluation of SFT.

Aged↗
PubMedDate not supplied

A new staging system for idiopathic retinal periphlebitis.

PURPOSE: To develop and standardize a universally acceptable new staging system for idiopathic retinal periphlebitis (Eales disease). METHODS: A new staging system was established and standardized based on standard terminology and features. Idiopathic retinal periphlebitis was classified as peripheral and central types. Peripheral disease consisted of four stages. Stage 1 is periphlebitis of small (1a) and large (1b) caliber vessels with superficial retinal hemorrhages. Stage 2a denotes capillary nonperfusion and 2b neovascularization elsewhere/of the disc. Stage 3a is classified as fibrovascular proliferation and 3b vitreous hemorrhage. Stage 4a is traction/combined rhegmatogenous retinal detachment whereas 4b is rubeosis iridis, neovascular glaucoma, complicated cataract, and optic atrophy. A total of 253 cases of idiopathic retinal periphlebitis (mean age, 24.7 +/- 4.7 years, all male) presenting at this tertiary care center were classified prospectively according to the new staging system, by two independent observers (interobserver correlation = 0.7). RESULTS: The new staging system was consistent, simple, and easy to recall. Peripheral and central types of idiopathic retinal periphlebitis were found in 94.07% and 5.93% of cases, respectively. The new staging system also defined the severity of the disease. Vitreous hemorrhage was found to be the commonest presenting feature (51.68%), whereas traction/combined rhegmatogenous detachment was found in 5.88% of cases. CONCLUSIONS: The new staging system is useful in classifying and assessing the severity of disease. Management strategy can also be defined according to the stage of the disease. It is designed to promote the use of standard assessment with applications to clinical management and research.

Adolescent↗
PubMedDate not supplied

Response time and safety profile of pulsed oral methotrexate therapy in idiopathic retinal periphlebitis.

PURPOSE: To evaluate the response time and safety profile of low-dose oral methotrexate pulsed therapy in idiopathic retinal periphlebitis (Eales' disease). METHODS: A tertiary care center-based prospective interventional study, based on visual acuity grading, was undertaken. Twenty-one consecutive patients with idiopathic retinal periphlebitis were administered 12.5 mg methotrexate as a single oral dose, once per week for 12 weeks (cumulative dose = 150 mg). Each patient was assessed for change in visual acuity grades. Time of first therapeutic response was also noted. Drug safety was monitored by laboratory tests that included twice-weekly white blood cells and differential counts, twice-weekly platelet counts, and monthly liver function tests. RESULTS: Twenty-one eyes were assessed. Mean follow-up period was 6 months. All showed improvement in visual acuity grades. An excellent visual outcome (6/6 or better) was achieved in 18 (69%) eyes. Time of first therapeutic response varied from 2 to 6 weeks with a majority of eyes (80%) showing response by 4 weeks (median = 3 weeks). All the side effects of methotrexate were mild or moderate in severity and rapidly reversible on dose reduction or discontinuation. No patient had any constitutional symptoms severe enough to necessitate cessation of therapy. CONCLUSIONS: Low dose oral methotrexate pulse therapy (at a dose of 12.5 mg/week) is clinically effective within 4 weeks, and is associated with an acceptable safety profile.

Administration, Oral↗
PubMedDate not supplied

Glyburide and glipizide in treatment of diabetic patients with secondary failures to tolazamide or chlorpropamide.

We evaluated therapeutic usefulness of the second-generation sulfonylurea agents glyburide and glipizide in non-insulin-dependent diabetic patients who were secondary failures on chlorpropamide or tolazamide. Twenty patients were treated with glyburide, and 10 of them were subsequently treated with glipizide. Fasting and postprandial serum glucose, insulin, C-peptide, glycosylated hemoglobin, urinary C-peptide, and glucose levels all failed to show significant improvement. We concluded that both glyburide and glipizide proved ineffective in the treatment of secondary failures to first-generation sulfonylureas.

Blood Glucose↗
PubMedDate not supplied

Insulin allergy: differences in the binding of porcine, bovine, and human insulins with anti-insulin IgE.

We investigated in vitro binding of insulins of various species sources (bovine, porcine, and human) with anti-insulin reaginic immunoglobulins (IgE) in 10 patients with systemic insulin allergy and in 5 nonallergic but insulin-resistant cases. Anti-insulin IgE had a higher avidity for bovine compared with porcine insulin in both groups. Avidity for bovine insulin was also significantly higher compared with human or desalanine porcine insulin in the insulin-allergic patients. These observations provide a rationale for using porcine insulin in the treatment of systemic insulin allergy.

Animals↗
PubMedDate not supplied

One-hour meal tolerance test to assess withdrawal of insulin therapy in overweight patients with type 2 diabetes.

OBJECTIVE: To evaluate the clinical usefulness of a 1-hour meal tolerance test to determine the feasibility and safety of discontinuation of insulin therapy in overweight, insulin-treated patients with type 2 diabetes mellitus. METHODS: Overweight patients who presented with metabolic decompensation at initial diagnosis of type 2 diabetes were hospitalized and treated with insulin. A 1-hour meal tolerance test was performed in an outpatient setting when patients had maintained a stable metabolic status with decreasing daily insulin requirement and the possibility of withdrawal of insulin therapy was considered. After an overnight fast, venous blood samples were collected before and 1 hour after consumption of an oral liquid meal (240 mL, 240 kcal, approximately 30 g of sucrose) to measure glucose and C-peptide levels. If the postmeal glucose level was < or = 10 mmol/L, the insulin therapy was discontinued. Patients underwent follow-up to validate the clinical decision. RESULTS: Twenty-four overweight adult Mexican American patients (8 of whom had ketoacidosis) were treated with insulin at initial diagnosis of type 2 diabetes. The mean insulin dosages were reduced progressively from 71 +/- 8 U/day to 31 +/- 3 U/day during a period of 4 +/- 0.5 months. At that stage, the mean fasting and 1-hour postmeal blood glucose levels were 5.0 +/- 0.2 mmol/L and 8.4 +/- 0.4 mmol/L, respectively. Meal-induced plasma C-peptide levels showed 1.9- to 4-fold increases, confirming substantial endogenous insulin secretion. The C-peptide responses were similar in the two subgroups of patients with or without initial ketoacidosis. On the basis of postmeal blood glucose levels, the insulin therapy was discontinued in all cases. After 3 months of follow-up, all patients were in good metabolic control. Fourteen patients underwent follow-up for >12 months; 10 of them were maintained without antidiabetic medications for 21.4 +/- 2.8 months. Two patients were treated with sulfonylurea drugs after 4 months, and another two required insulin therapy by the 4th and 18th months, respectively. CONCLUSION: A 1-hour postmeal blood glucose level is helpful for deciding the withdrawal of insulin therapy in overweight, insulin-treated patients with type 2 diabetes.

Adult↗
PubMedDate not supplied

Influence of education and occupation on knowledge about diabetes control.

BACKGROUND: A global epidemic of diabetes has been predicted during the first quarter of the twenty-first century, with a substantial increase in its prevalence in India. Good management of diabetes is a necessary step towards its control and blood glucose testing forms an integral part of this. This study was undertaken to assess the importance of education and occupation in relation to knowledge about good control of diabetes. METHODS: Perception patterns regarding methods for testing blood glucose and metabolic control were assessed by the direct interview method in 793 patients with type 2 diabetes. Patients' knowledge levels were compared for different educational and occupational categories using the Normal test (z-test) and the Student's t-test. RESULTS: The difference between the mean ages of men and women diabetics was not significant (p > 0.1). It was found that 46.7% of the subjects were aware of the importance of blood glucose testing. Awareness regarding the importance of microalbuminuria, lipid profile and glycosylated haemoglobin was observed in 24.1%, 15.5% and 7.6% of patients, respectively. A positive impact of education on overall knowledge levels was observed. However, no definite relationship was found between knowledge and occupation. CONCLUSION: There was a total lack of knowledge regarding self-care of diabetes in all educational and occupational categories (including patients who were qualified doctors). This calls for an urgent need to create greater public awareness. This study may serve as a guideline for developing an educational package for different subsections of the community.

Blood Glucose↗
PubMedDate not supplied

Calcutta: the emergence of a science city (1784-1856).

The paper narrates briefly the emergence of Calcutta as a city where one finds the early glimpses of a cultural encounter between East and West, and where a few scientific societies and institutions were first established. The emergence of Calcutta as a science city is synonymous with its growth as an imperial city. The paper focuses on the Asiatic Society, the Agriculture and Horticulture Society and the Calcutta Medical College and concludes that science was valued more as a cultural activity than a purely economic exercise.

Colonialism↗
PubMedDate not supplied

Clinical and biochemical comparative study of different types of common bile duct stones.

BACKGROUND: The chemical composition of common bile duct (CBD) stones may have significance with regard to the origin, clinical presentation and treatment. OBJECTIVE: To study the chemical composition of CBD stones and compare different types of CBD stones. METHODS: Consecutive patients with CBD stones seen over a 1-year period were studied prospectively. Their stones were analyzed for cholesterol, bilirubin and calcium contents. RESULTS: Of 74 patients with CBD stones, 42 had associated gall bladder (GB) stones (Group 1), 14 had post-cholecystectomy CBD stones (Group 2) and 18 had CBD stones with a stoneless GB in situ (Group 3). Of the 40 patients whose CBD stones were analyzed, 34 (85%; 18/19 in Group 1, 5/6 in Group 2 and 11/15 in Group 3) had cholesterol stones; the remaining 6 patients had pigment stones. CONCLUSION: Most CBD stones in northern Indian patients are cholesterol stones. Even in patients with isolated CBD stones (with stoneless GB in situ), three-quarters are cholesterol stones.

Bilirubin↗
PubMedDate not supplied

Randomized trial of a quadruple-drug regimen and a triple-drug regimen for eradication of Helicobacter pylori: long-term follow-up study.

BACKGROUND: In developing countries, H. pylori eradication rates are suboptimal. A quadruple-drug regimen may improve on the eradication rate achieved with triple-drug regimen. METHODS: 64 consecutive patients with active duodenal ulcer associated with H. pylori infection were randomized to receive either a one-week triple-drug regimen (lansoprazole, clarithromycin, secnidazole) or a one-week quadruple-drug regimen (lansoprazole, amoxycillin, colloidal bismuth subcitrate, secnidazole). H. pylori eradication and ulcer healing were assessed 4 weeks after completion of therapy. Patients were followed up at 24 weeks and 52 weeks for H. pylori recurrence. RESULTS: Both the regimens eradicated H. pylori in 75% (95% CI 0.6-0.9) of patients. The ulcer-healing rate with the triple-drug regimen was 97% (95% CI 0.91-1.0) and 91% (95% CI 0.91-1.0) with the quadruple-drug regimen. No ulcer or H. pylori recurrence occurred in patients eradicated with the triple-drug regimen, whereas 8.3% of patients eradicated with the quadruple-drug regimen had ulcer as well as H. pylori recurrence during the 52-week follow up. CONCLUSION: Triple-drug regimen achieves similar eradication rates as quadruple-drug regimen in H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗