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Biomedical subjects

D Sharma

Publications and source records attributed to D Sharma.

228 records · Page 13Linked to original sources
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Arterial pH and arterial oxygenation are not essential for risk stratification in perforation peritonitis.

BACKGROUND: The Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system is widely used for assessing the severity of disease and prognostication in cases of perforation peritonitis. Investigations like arterial pH and oxygenation (PaO2), which are considered important in APACHE II, are not available in most hospitals. We therefore attempted to validate a modified APACHE II (without arterial pH and oxygenation) in cases of perforation peritonitis. METHODS: Fifty consecutive patients with perforation peritonitis admitted in the general surgical ward were prospectively analyzed vis-a-vis risk factors and mortality according to the modified APACHE II. RESULTS: The mean modified APACHE II score of those who died was 15.3 (SD 5.7) as compared to 6.6 (4.7) (p < 0.001) in those who survived. As the score increased, mortality rate rose (p < 0.001). When the score was greater than 15, mortality was 88.9%; there was 100% mortality with score greater than 17. CONCLUSION: The modified APACHE II, excluding arterial pH and oxygenation, is simplified, reliable and objective for prediction of outcome in perforation peritonitis.

APACHE↗
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Evaluation of garlic oil as a contact dissolution agent for gallstones: comparison with monooctanoin.

AIM: To find a better contact solvent to dissolve gallstones we studied invitro use of garlic oil and compared it with monooctanoin. METHODS: In the first stage gall stones obtained from patients after cholecystectomy were subjected to dissolution in different concentrations of garlic oil. Then the rate of dissolution of gall stones in garlic oil was compared to that in monooctanoin in stage II. Efficacy of various concentration of garlic oil and monoocatanoin in dissolving gallstones in artificial gall bladder and common bile duct models were compared in stage III. RESULTS: Garlic oil dissolved the cholesterol gall stones in proportion to the concentration used. The gall stone fragmentation was faster [6 hours V/s 36 hours] and more [88.30% V/s 71.01%] by garlic oil in comparison to monooctanoin in test tubes and even in artificial gallbladder and common bile duct models. CONCLUSIONS: Garlic oil is a better contact dissolving agent of gallstones than monooctanoin.

Allyl Compounds↗
PubMedDate not supplied

Palliative care education and training during residency: a survey among residents at a tertiary care hospital.

BACKGROUND: Palliative care is the active total care of patients in advanced and incurable stages of cancer. More than 70% of all cancer patients in India require palliative care for relief of pain, other symptoms and psychosocial distress. The need for education and training in palliative care has been emphasized by the World Health Organization (WHO) during the past 15 years. This survey aimed to assess the awareness, clinical knowledge, and education and training aspects of palliative care among the clinical residents of a tertiary care hospital. METHODS: During January and February 1999, a total of 100 residents were asked to respond to a questionnaire on palliative care education and training during residency. The questionnaire consisted of 10 questions (each question with 3 different responses). Awareness regarding palliative care was assessed by 3 questions; clinical knowledge by 4 questions; and education and training obtained during residency by 3 questions. Comparisons were made using the Chi-square test between the oncology and non-oncology resident groups. RESULTS: Forty-nine residents (23 oncology and 26 non-oncology) responded to the survey. Awareness that palliative care involves active total care was lacking in 8 (16%) residents. The cost of palliative care in India was considered high by 17 (65%) non-oncology residents and 21 (43%) of the whole group. Hospice, as the right place for palliative care, was chosen by 14 (61%) oncology and 3 (11.5%) non-oncology residents (p = 0.0003). In the whole group, 21 (43%) believed that palliative care could be provided on an outpatient basis. Pain, depression and cachexia were identified as the most distressing symptoms of patients with incurable cancer. Seventeen (83%) oncology and 4 (15%) non-oncology residents (p = 0.000) knew how to use the WHO step-ladder for cancer pain relief. All oncology residents and 10 (38%) non-oncology residents preferred the oral route for providing medications for pain relief (p = 0.0001). The didactic education and training imparted during residency was considered as 'not enough' by 39% of oncology and 62% of non-oncology residents (51% overall). The confidence to deliver quality palliative care was lacking in 43% and 58% of oncology and non-oncology residents, respectively. CONCLUSION: Clinicians in India need to be provided focused skills and training for them to be able deliver quality palliative care to the large number of patients with incurable cancer. The cost of palliative care and the optimum place to deliver it, the symptoms of advanced cancer, pain relief and symptom control methods and quality of life in end-stage cancer patients are some aspects that should be an integral part of clinical residency programmes.

Cachexia↗
PubMedDate not supplied

Surgical anatomy of retrohepatic inferior vena cava and hepatic veins: a quantitative assessment.

BACKGROUND: Accurate knowledge of the surgical anatomy of the retrohepatic inferior vena cava (IVC) and hepatic veins is necessary for hepatic surgery. METHODS: Lengths of different segments of retrohepatic IVC and their diameters, and prevalence of various types of ramification and lengths of different hepatic veins, were noted in 100 disease-free human livers during autopsy. RESULTS: The mean lengths of the IVC from entry into atrium to diaphragmatic hiatus, from the hiatus to the upper margin of right hepatic vein, between the upper margins of the right hepatic vein and the right suprarenal vein, from right suprarenal vein to the lowermost dorsal hepatic vein, and from the lower-most dorsal hepatic vein to the right renal vein were 29.1 mm, 8.6 mm, 40.6 mm, 28.6 mm and 33.7 mm, respectively. The mean diameter of IVC at the diaphragmatic level was 30.1 mm. The commonest ramification pattern of the hepatic veins was type I (82%) for the right hepatic vein, type II (63%) for the middle and left hepatic veins, and type II (55%) for the caudate veins. In 96% of cases the middle and left hepatic veins formed a common trunk. In a majority of cases, the diameters of the right and left hepatic veins were between 7 mm and 12 mm. No gender differences were found. CONCLUSION: This study provides an anatomical perspective for various hepatic surgical techniques.

Adolescent↗
PubMedDate not supplied

Prevalence of rheumatic and congenital heart disease in schoolchildren of Kathmandu valley in Nepal.

BACKGROUND: Rheumatic heart disease remains a major public health problem in developing countries with its very high prevalence. Rheumatic and congenital heart disease are significant causes of morbidity and mortality among Nepalese schoolchildren. The aim of our study was to determine the prevalence of rheumatic and congenital heart disease among schoolchildren of the Kathmandu valley in Nepal. METHODS AND RESULTS: The study included 9420 students, of whom 4466 were male and 4954 were female, with ages ranging from 5 to 18 years. A clinical survey was conducted by the examining team in selected schools, and involved answering standard questionnaires. A total of 83 children were suspected of having heart disease. Out of these 83 children, 23 were confirmed to have heart disease; 11 had rheumatic heart disease, and 12 congenital heart disease, giving a prevalence of 1.2/1000 and 1.3/1000, respectively. The commonest cardiac lesions were mitral regurgitation in the rheumatic heart disease group, and atrial septal defect in the congenital heart disease group. A higher prevalence of congenital heart disease was detected in females. CONCLUSIONS: The prevalence of rheumatic heart disease and congenital heart disease among schoolchildren of Kathmandu is 1.2/1000 and 1.3/1000, respectively, with mitral regurgitation and atrial septal defect being the commonest lesions.

Adolescent↗
PubMedDate not supplied

Serum proteins and immunoglobulins in leprosy.

Serum proteins and immunoglobulins were studied in patients suffering from various types of leprosy. A significant increase in total protein and decrease in albumin was found in all types of leprosy except borderline-tuberculoid. Gamma globulin was found to be increased in all types. An increase of alpha-2-globulin in lepromatous, a decrease of beta globulin in borderline-lepromatous, and a decrease of alpha-2 and increase of beta globulin in borderline-tuberculoid were observed. These changes do not seem to be of diagnostic importance. A statistically significant increase of IgG in borderline-lepromatous and lepromatous, IgM in all types of leprosy and IgA only in lepromatous was found. The increase of different immunoglobulins in leprosy, especially the lepromatous type, suggests a humoral response which was found to be directly proportional to the severity of the lesion.

Blood Proteins↗
PubMedDate not supplied

Dry meals--physiological approach to management of duodenal ulcer.

Two hundred and twenty endoscopically proved cases of duodenal ulcer were studied in a double blind manner by dividing them into control and study groups and following them up for one year. All patients were given ranitidine 150 mg bd for 3 months. Additionally, the study group patients were asked to take dry meals (they were allowed their normal diet but asked not to take water from 1 hour before meals to 1 hour after meals) for one year. The two groups of patients were compared. The recurrence rate at one year was lower in the study group. Nausea/vomiting at the time of recurrence was also significantly lower in the study group (p < 0.02). Relief in symptoms, especially nausea/vomiting and dyspepsia was also seen to be better in the study although the difference was not statistically significant. The fall in recurrence rate observed as a result of this simple regime is very encouraging.

Adult↗