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Biomedical subjects

G Bhat

Publications and source records attributed to G Bhat.

At least 19 recordsLinked to original sources
PubMed2002

Granulomatous angiitis of the central nervous system associated with herpes zoster.

Granulomatous angiitis of central nervous system (CNS) is a rare inflammatory disease of blood vessels mostly confined to CNS. We describe a case which presented with right sided hemiplegia with aphasia, after herpes zoster ophthalmicus. CT scan and MRI brain showed a large left sided infarct in the left middle cerebral artery (MCA) territory. MRI angiography revealed narrowing and thinning of left internal carotid artery (ICA) and to a lesser extent, left MCA suggestive of granulomatous vasculitis. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than realised.

Adolescent↗
PubMed2002

Are cardiac transplant patients more likely to have periodontitis? A case record study.

In several large epidemiological studies chronic periodontitis has been implicated as an additional risk factor, independent of other risk factors, for the development of ischaemic heart disease. The underlying mechanism is thought to be a localised infection giving rise to an inflammatory host response, and some experimental data agree with this hypothesis. Recently, however, some studies have questioned the post dated relationship between the two diseases. The current case-record study was undertaken to evaluate the prevalence of chronic periodontitis and the severity of such periodontal disease in a heart transplant population, assuming the latter represented a relatively severely compromised cardiovascular patient population. The study demonstrated that 76% of the patients had various degrees of periodontal disease prior to undergoing a heart transplant. Thus, it is possible that a relationship between cardiovascular disease and periodontal disease exists, but further, large intervention studies will be needed to confirm such a conclusion.

Adolescent↗
PubMed2001

Vertical transmission of Kaposi's sarcoma-associated herpesvirus.

Little is presently known about the specific routes of transmission of Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus-8 (HHV-8). To investigate whether this agent might be transmitted vertically from mother to infant, we conducted a study on 89 KSHV seropositive mothers and their newborn infants. Thirteen mothers (14.6%) had KSHV DNA detected in their peripheral blood mononuclear cells (PBMC). Two of 89 samples drawn at birth from infants born to KSHV seropositive mothers had KSHV DNA detectable within their PBMC. These findings suggest that KSHV can be transmitted perinatally, but infrequently. Other routes of transmission such as horizontal transmission remain the most likely means of KSHV transmission.

Adolescent↗
PubMed2001

Evaluation of predictors of clinical outcome after partial left ventriculectomy.

BACKGROUND: Outcome after partial left ventriculectomy (PLV) is difficult to predict. Our goal was to determine if clinical measurements including exercise testing could predict outcome after PLV. METHODS: Sixteen patients with dilated cardiomyopathy had left ventricular ejection fraction, left ventricular end-diastolic diameter, amount of mitral regurgitation (MR), New York Heart Association (NYHA) functional class, and cardiopulmonary exercise testing measurements measured before PLV and 3 months after PLV. Eleven patients who remained stable after PLV (group 1) were compared with 5 patients who deteriorated after PLV (group 2). RESULTS: Similar significant improvements were seen in both groups 3 months post-PLV with respect to left ventricular ejection fraction (group 1: 0.136+/-0.037 to 0.212+/-0.046; group 2: 0.139+/-0.042 to 0.179+/-0.073) and left ventricular end-diastolic diameter (group 1: 8.5+/-0.7 to 7.0+/-0.6 cm; group 2: 7.6+/-0.6 to 6.5+/-0.6 cm). The MR grade (1.0+/-0.6 versus 2.5+/-0.6), NYHA functional class (1.5+/-0.31 versus 2.5+/-0.6), and peak oxygen consumption (17.8+/-1.1 versus 12.2+/-2.0) were significantly different in the two groups 3 months after PLV (p < 0.05, analysis of variance). CONCLUSIONS: Patients that do not show significant improvement in peak oxygen consumption, NYHA class and significant decrease in the amount of MR 3 months after PLV, compared with pre-PLV, are at increased risk of clinically deteriorating.

Adult↗
PubMed2001

Necropsies in African children: consent dilemmas for parents and guardians.

BACKGROUND: Necropsy examination provides a good index of the accuracy of clinical diagnosis and the quality of treatment, but its use in sub-Saharan Africa is limited. AIMS: To identify the main reasons for parents'/guardians' refusal of consent for necropsy and to explore the issues affecting their decision. METHODS: A sequential necropsy study of Zambian children between 2 months and 15 years dying of respiratory disease. When the parent/guardian refused permission for necropsy, the main reason given was recorded, after encouragement to express their specific concerns in their own words. RESULTS: Parents/guardians of 891 of 1181 children (75.4%) refused to give permission, and 290 (24.6%) consented. Of those who refused, 43% did so on the grounds that it would be a "waste of time," as the diagnosis should have been made in life and the findings would now be of no benefit to them. More than one quarter of those who refused did so because a death certificate had already been issued and arrangements to transport the body had been made and could not be delayed. Traditional beliefs that ancestral spirits forbade the mutilation of dead bodies were cited by 77 (8.6%). Other reasons included the child not being their own or that they must seek permission from other family members who were not available (6%). Religious beliefs were not a major cause of refusal. CONCLUSIONS: It is possible to achieve a rate of necropsy consent sufficient to undertake valuable clinical pathology studies on children in sub-Saharan Africa. The wide range of reasons cited for refusal points to the diverse and complex interaction of social and cultural factors affecting attitudes to necropsy examination. Medical staff need training and support to improve the uptake of clinical pathology services.

Adolescent↗
PubMed2001

Making healthy baby contests more objective.

STUDY OBJECTIVES: To assess the objectivity of the criteria chosen to judge a healthy baby contest. DESIGN: Cross-sectional study design. SETTING: Urban Health Centre, Pune. PARTICIPANTS: Of the 998 children attending twelve anganwadis, who were screened preliminarily, 32 were chosen for the healthy baby contest. The contest was assessed using a specified scoring system in which due weightage was given to personal hygiene, growth, development, immunisation status and mother's knowledge about nutrition and vaccination. RESULTS: There was a significant intraobserver correlation (rs = 0.85, p < 0.05) and intraobserver correlation (rs = 0.92, p < 0.05). The scores were age independent. CONCLUSIONS: The criteria chosen were objective in nature. The objectivity of the criteria can make the assessment of the participants more unbiased, quick and easy. The results of the contests can be explained more easily and are more readily accepted. Thus, the healthy baby contests can be made more successful.

Child, Preschool↗
PubMed1999

Prediction of human transplantation arteriopathy and coronary events with lung/heart count ratios during intravenous dipyridamole thallium-201 imaging.

BACKGROUND: Cardiac allograft arteriopathy often limits long-term survival in transplantation recipients but has been difficult to detect by standard diagnostic methods. Because of the diffuse nature of transplantation coronary disease, we postulated that a lung/heart ratio during dipyridamole thallium imaging might better predict arteriopathy-related complications than diagnostic methods that detect discrete luminal stenoses. METHODS AND RESULTS: Sixty-six unselected heart transplantation recipients were evaluated with annual coronary arteriograms, endomyocardial biopsy, and intravenous dipyridamole thallium testing (initial study group). The mean lung/heart ratio on an anterior planar image was 0.40 for all patients; therefore <0.40 was arbitrarily defined as normal. After October 1992, 98 patients were tested (validation study group) and a lung/heart ratio cutoff of 0.40 was evaluated prospectively. Coronary end points were defined as (1) at least 1 coronary artery stenosis >/=50% of the luminal diameter, (2) sudden cardiac death, and (3) acute myocardial infarction. Stepwise logistic regression analysis was performed to identify independent predictors of future coronary end points. For the initial study group, the lung/heart ratio on the first annual thallium study was the only independent predictor of subsequent cardiac end points (0.47 +/- 0.13 [SD] with end points vs 0.38 +/- 0.11 without end points, P <.05). For the validation study group, independent predictors of subsequent coronary events included the lung/heart ratio and the radionuclide left ventricular ejection fraction. No patient with a lung/heart ratio <0.40 and a left ventricular ejection fraction >/=0.50 developed a cardiac event during 21 +/- 11 months of follow-up. CONCLUSIONS: A lung/heart ratio >/=0.40 on dipyridamole thallium testing is a sensitive predictor of coronary events after heart transplantation. Patients with heart transplantion who have a lung/heart ratio <0.40 and normal systolic left ventricular function are at low risk for subsequent coronary events and may not require annual surveillance by coronary arteriography.

Coronary Disease↗
PubMed1999

Bradykinin receptor localization and cell signaling pathways used by bradykinin in the regulation of gonadotropin-releasing hormone secretion.

In a previous publication we provided evidence of a novel neuronal pathway for the control of GnRH secretion by bradykinin. The action of bradykinin appeared to be exerted through the bradykinin B2 receptor. In this study we demonstrated that the bradykinin B2 receptor is densely localized in the arcuate nucleus, median eminence, organum vasculosum of the lamina terminalis, and preoptic area, regions known to be critical for the control of GnRH secretion. To determine the mechanism of action of bradykinin in stimulating GnRH release, we used immortalized GnRH (GT1-7) cells in vitro. Bradykinin stimulation of GnRH secretion from GT1-7 cells appears to involve activation of the phospholipase C signaling pathway and mobilization of extracellular and intracellular calcium stores. Evidence to support this contention was derived from the observations that incubation of the phospholipase C inhibitor, U-73122 with bradykinin, blocked the ability of bradykinin to stimulate release from GT1-7 cells. This effect was specific, as a nitric oxide synthase inhibitor and a cyclooxygenase inhibitor were found to have no effect on bradykinin-induced GnRH secretion, suggesting that nitric oxide and PGs do not mediate bradykinin effects. Pertussis toxin also had no effect on bradykinin action. This suggests that the bradykinin B2 receptor may be coupled to a pertussis toxin-insensitive G protein in GT1-7 cells. With respect to calcium involvement in bradykinin action, fura-2 calcium indicator studies revealed that bradykinin can rapidly increase intracellular Ca2+ levels in GT1-7 cells. A role for intracellular Ca2+ in bradykinin action was further suggested by the finding that an intracellular calcium chelator, 1,2-bis(O-aminophenoxy)]ethane-N,N,N',N'-tetraacetic acid tetraacetoxymethyl ester, significantly attenuated the effects of bradykinin on GnRH release. The elevation of intracellular calcium by bradykinin appears to be due to mobilization of calcium from the endoplasmic reticulum, as incubation of the Ca2+-adenosine triphosphatase inhibitor thapsigarin, which depletes endoplasmic reticulum Ca2+ stores, significantly attenuated bradykinin action on GnRH release. Extracellular calcium may also be involved in bradykinin action, as the L-type Ca2+ channel blockers verapamil and nifedipine had no effect on bradykinin-induced GnRH release, whereas the nonselective Ca2+ channel blocker, nickel chloride, attenuated bradykinin-induced GnRH release. Taken as a whole, these studies demonstrate that the bradykinin B2 receptor is densely localized in key hypothalamic nuclei responsible for regulation of GnRH release, and that the mechanism of bradykinin stimulation of GnRH secretion involves activation of the phospholipase C signaling pathway, with a critical role implicated for calcium in bradykinin action in GT1-7 cells.

Animals↗
PubMed1998

RESEARCH: An Ecoregional Approach to the Economic Valuation of Land- and Water-Based Recreation in the United States

/ This paper describes a framework for estimating the economic value of outdoor recreation across different ecoregions. Ten ecoregions in the continental United States were defined based on similarly functioning ecosystem characters. The individual travel cost method was employed to estimate recreation demand functions for activities such as motor boating and waterskiing, developed and primitive camping, coldwater fishing, sightseeing and pleasure driving, and big game hunting for each ecoregion. While our ecoregional approach differs conceptually from previous work, our results appear consistent with the previous travel cost method valuation studies.KEY WORDS: Recreation; Ecoregion; Travel cost method; Truncated Poisson model

Journal Article↗
PubMed1998

Seroprevalence of human herpesvirus 8 among Zambian women of childbearing age without Kaposi's sarcoma (KS) and mother-child pairs with KS.

The seroprevalence of human herpesvirus 8 (HHV-8) among a group of Zambian women of reproductive age and among mother-child pairs in which either one of them has Kaposi's sarcoma (KS) was determined. A cross-sectional group of 378 pregnant women was randomly recruited into the study, and 183 (48.4%) had HHV-8 antibodies. Among the human immunodeficiency virus (HIV)-1-infected women, 51.1% were HHV-8-seropositive, whereas of HIV-1-negative women, 47.3% were HHV-8-seropositive. In addition, 21 women index patients with KS and 5 young children index patients with KS were studied. All children with KS had mothers who were HHV-8-seropositive, while not all children whose mothers had KS were infected with HHV-8. Our study suggests that there is a high HHV-8 seroprevalence among Zambian women, and the rate is almost the same in HIV-1-positive and -negative women. This high seroprevalence may be a contributing factor toward the increased frequency of KS in this population.

Adolescent↗
PubMed1998

Minocycline-induced hepatitis with autoimmune features and neutropenia.

Minocycline can cause various types of hepatotoxicity. We report an 18-year-old male who developed a delayed onset of minocycline-induced cholestatic hepatitis with autoimmune features and neutropenia. He responded to withdrawal of the drug and a short course of corticosteroids. If minocycline is to be administered, then periodic monitoring for hepatoxicity is recommended.

Acne Vulgaris↗
PubMed1997

Distribution of gonadotropin-releasing hormone immunoreactivity in the brain of Ichthyophis beddomei (Amphibia: Gymnophiona).

From a comparative viewpoint, we have investigated the presence and neuroanatomical distribution of gonadotropin-releasing hormone (GnRH)-immunoreactive material in the brain of a gymnophione amphibian, Ichthyophis beddomei. Immunocytochemical analysis of the adult brain and terminal nerves in both sexes shows the presence of neurons and fibers containing mammalian GnRH (mGnRH)- and chicken GnRH-II (cGnRH-II)-like peptides. With respect to GnRH-immunoreactive material, there are two distinct neuronal systems in the brain: one containing mGnRH, which is located in the forebrain and terminal nerve, and the other containing cGnRH-II, which is restricted to the midbrain tegmentum. Basically, this distribution pattern parallels that of many species of anurans and a urodele. Whereas the presence of cGnRH-II-immunoreactive fibers in the dorsal pallium of L. beddomei is a feature in common with a urodele amphibian, the total absence of cGnRH-II-like material in the median eminence is unique to this species. It is suggested here that the distribution profile of GnRH-like material within the brain and terminal nerve of I. beddomei represents a primitive pattern.

Amphibians↗
PubMed1997

Are surveillance endomyocardial biopsies necessary during OKT3 induction therapy?

BACKGROUND: To determine the utility of surveillance endomyocardial biopsies (EMBs) during a 14-day OKT3 induction course after cardiac transplantation, histologic results of the first two EMBs were retrospectively reviewed. METHODS: Seventy-three consecutive cardiac transplant recipients who received an OKT3-based quadruple sequential immunosuppressive protocol were analyzed. Patients were predominantly white (85%) and male (72%), with ischemic cardiomyopathy (54%) and a pretransplant panel-reactive antibody level of <10% (93%). RESULTS: The first EMB in 73 patients demonstrated no rejection in 70 patients (96%) and grade 1A rejection in 3 patients (4%). The second EMB showed no rejection in 64 patients (88%), grade 1A or 1B rejection in 8 patients (11%), and grade 3A rejection without hemodynamic compromise in only 1 patient (1%). Absolute CD3+ cells remained below 25 lymphocytes/mm3, and mean trough OKT3 serum levels exceeded 500 ng/ml throughout the 14 days of therapy, demonstrating the immunosuppressive efficacy of OKT3. Posttransplant echocardiograms showed normal left ventricular systolic function. CONCLUSIONS: Since 145 of 146 EMBs (99%) demonstrated no or minimal allograft rejection, a large cost savings could be realized if EMBs were performed only when clinically indicated during the 14-day OKT3 induction course in cardiac transplant recipients. Appropriate immunologic monitoring and echocardiographic testing may obviate the need for performing costly EMBs during OKT3 induction without an adverse clinical outcome.

Adolescent↗
PubMed1997

Relationships between self-care resources and the quality of life of persons with heart failure: a comparison of treatment groups.

Modeling and role-modeling provided the theoretical basis for this exploratory pilot quality of life study. Thirty-eight individuals undergoing three different treatment regimens for chronic heart failure were surveyed regarding various dimensions of quality of life. No differences were found in resources needed or available, physical or emotional symptoms, total activity, or global quality of life among the three groups. The health-related outcome of activity was predicted by physical symptoms and the mental composite score from the Short Form-36 Health Survey. Regression analysis provided an equation for global quality of life in which internal and external resources accounted for 43% of the variance in scores on the Index of Well-Being. Results suggest that MRM theory-based nursing interventions may enhance resources that improve the quality of life of persons with chronic heart failure.

Activities of Daily Living↗
PubMed1997

The incremental risk of female sex in heart transplantation: a multiinstitutional study of peripartum cardiomyopathy and pregnancy. Cardiac Transplant Research Database Group.

BACKGROUND: Controversy remains regarding the reason females seem to be at increased risk for rejection after heart transplantation. Therefore this study was performed to define the effect of a pretransplantation diagnosis of peripartum cardiomyopathy and the effect of previous pregnancy on the outcome (incidence of rejection and death) of females after heart transplantation. METHODS: In this multiinstitutional study of 3244 adult (greater than 13 years of age) heart transplant recipients, (a) the outcome of 40 females who underwent transplantation for peripartum cardiomyopathy was compared with that of 200 females of childbearing age (13 to 45 years) who underwent transplantation for other indications and (b) the posttransplantation outcome of 543 females with a history of pregnancy was compared with that of 101 nulliparous adult females and 2562 adult males. RESULTS: The posttransplantation outcome of females with a history of peripartum cardiomyopathy was similar to that of females of childbearing age who underwent transplantation for other indications. However, parous females had a significantly shorter time to first rejection (p < 0.0001) and greater cumulative rejection than nulliparous females or males. By multivariable analysis, the risk factors for cumulative rejection at 1 year were a history of pregnancy (p < 0.0001), younger recipient age (p < 0.0001), induction therapy (p < 0.0001), and the number of human leukocyte antigen-DR mismatches (p = 0.007). CONCLUSION: Our data suggest that it is previous pregnancy, and not sex per se, that is associated with an increased frequency of rejection in females after heart transplantation.

Actuarial Analysis↗