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Biomedical subjects

H Kulkarni

Publications and source records attributed to H Kulkarni.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence of beta-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase survey.

OBJECTIVE: To estimate the prevalence of beta-thalassaemia in different subcastes of the Indian Sindhi population who, in general, have a high prevalence of this disease. STUDY DESIGN: A two-phase, community-based survey. METHODS: Asymptomatic, Sindhi volunteers from Nagpur, central India, were recruited into the present study over a 7-year period. The first phase included the use of the Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT). Those positive for NESTROFT or those volunteering for haemoglobin A(2) (HbA(2)) quantification entered the second phase of the survey. Appropriate statistical methods for estimating prevalence from two-phase surveys were used. RESULTS: The prevalence of beta-thalassaemia carriers across the five major Sindhi subcastes varied substantially in the study population. Larkana Sindhis had the highest (17%) whereas Dadu Sindhis had the lowest (8%) frequency of the beta-thalassaemia allele. As a corollary, the projected incidence of beta-thalassaemia major in newborn babies greatly varied by the subcastes of the parents. CONCLUSION: Ethnic subgroups within populations known to commonly carry the beta-thalassaemia gene provide further information that is useful from epidemiological and public health perspectives.

Adolescent↗
PubMed2002

Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications.

OBJECTIVE: To evaluate the safety and efficacy of intra-ureteric capsaicin for loin pain haematuria syndrome (LPHS). PATIENTS AND METHODS: In an open prospective pilot study, four middle-aged patients (three women and one man) with LPHS resistant to therapies such as splanchnic nerve block, psychological treatment or renal autotransplantation (one) were assessed. An intra-ureteric infusion of capsaicin (30 mg/100 mL of 30% alcohol in saline) for 30 min with bladder irrigation was administered under general anaesthesia, with a subsequent intravenous patient-controlled narcotic analgesic pump for pain control. Double-concentration capsaicin was used for second infusions, if necessary when the response to the earlier infusion was inadequate or incomplete. RESULTS: The first patient had experienced reduced pain levels for the first 3 months only, with no benefit from the subsequent treatments with higher doses of capsaicin (60 mg). The second patient with recurrent pain in an autotransplanted kidney had no benefit from either a 30 or 60 mg capsaicin infusion a month apart, but developed a fibrotic stricture at the transplant pelvi-ureteric junction, requiring pyelocystoplasty. The third patient with concurrent depression had no benefit from a 30-mg infusion of capsaicin. The fourth patient experienced no pain relief from a 30 mg infusion of capsaicin but developed proteinuria secondary to mesangial proliferative glomerulonephritis, ureteric inflammation needing stenting within 7 days of treatment and subsequently nephrectomy for a nonfunctioning kidney at 3 months. CONCLUSION: Intra-ureteric capsaicin was neither effective nor safe in LPHS; the contribution of the alcohol diluent cannot be excluded.

Adult↗
PubMed2001

Bacterial vaginosis in early pregnancy and adverse pregnancy outcome.

OBJECTIVE: To assess the prevalence of bacterial vaginosis (BV) in asymptomatic pregnant women and its association with preterm birth (PTB) and premature rupture of membranes (PROM). METHODS: In a cohort study 1,006 pregnant women between 16-28 weeks' gestation were screened for BV (Nugent's criteria) and for lower genital tract infection. Women were followed to confirm pregnancy outcome. Data were analyzed using STATA software. Univariate and multivariate methods were used to investigate the association between bacterial vaginosis and adverse pregnancy outcome. RESULTS: Prevalence of BV was 11.53%. Baseline characteristics were similar for both groups, 6.8% women were lost to follow-up. Incidence of PTB was higher in BV positive women compared to BV negative women (p = 0.001). On multiple logistic regression (MLR), BV was associated with an increased risk of PTB (p = 0.001) and PROM (p = 0.001), other correlates being previous PTB (p = 0.003) and the presence of enteropharyangeal organisms in vagina (p = 0.03). BV accounted for 82.53% of the attributable risk for PTB. CONCLUSION: Presence of BV in early pregnancy is associated with an increased risk of PTB and PROM. Multicentric interventional study is recommended.

Adult↗
PubMed2001

Restenosis after coronary stenting--incidence and predictors.

OBJECTIVE: To determine the intermediate term outcome after coronary artery stenting. METHODS: The six month angiographic and clinical follow-up of 92 consecutive patients (94 lesions) undergoing successful coronary stenting was performed. Multiple variables were analyzed for predicting restenosis. RESULT: The mean age was 49.7 +/- 8.5 years. There were 73 males and 19 females. Coronary artery involvement was left anterior descending artery (LAD) in 67%, left circumflex artery (LCx) in 16.5% and right coronary artery (RCA) in 16.5%. The pre-procedure mean reference diameter was 3.1 +/- 0.38 mm, minimal luminal diameter (MLD) was 0.47 +/- 0.28 mm and percentage diameter stenosis (DS) was 85 +/- 9%. Post procedure MLD improved to 3.1 +/- 0.4 mm with an acute gain of 2.6 +/- 0.4 mm and residual DS of only 3 +/- 3%. Clinical and angiographic variables were correlated with restenosis assessed as both binary and continuous variables. Angiographic follow-up could be obtained in 55 out of 92 patients (60%) and 86 patients (88%) had a clinical follow-up. Angiographic restenosis (> 50% diameter stenosis) was present in 12 (22%) patients, seven of whom required a repeat angioplasty procedure. There was no death. At follow-up, the MLD was 2.1 +/- 0.93 and the DS was 32 +/- 29% with a lumen loss of 0.92 +/- 0.84 mm. Only 14 (16%) of patients had angina and stress test was positive in 21 (23%). Hypercholesterolemia (p < 0.001) and female gender (p < 0.05) were independently associated with high lumen loss. CONCLUSION: Intracoronary stenting in an unselected patient group is associated with a 22% restenosis rate. Hypercholesterolemia and female gender are associated with higher restenosis.

Coronary Angiography↗
PubMed1998

Transcatheter closure of patent ductus arteriosus in children weighing < 10 kg with Gianturco coils using the balloon occlusion technique.

We evaluated the immediate and intermediate follow-up results of transcatheter closure (TCC) of patent ductus arteriosus (PDA) using Gianturco coils in children weighing < 10 kg. The results of PDA < or = 2.5 mm (group I, n = 18) and > 2.5 mm (group II, n = 16) were compared. Coils were deployed sequentially by transarterial route using a temporary balloon occlusion technique. The immediate clinical success rate in both groups was comparable. There was no significant difference in the number of coils required per patient and in the embolization rate between the two groups. Both groups had comparable occlusion rates at intermediate-term follow-up. At intermediate follow-up, one patient had developed left pulmonary artery stenosis while obstruction of the descending aorta was not seen in any; in 4 children the PDA had recanalized. Spontaneous reocclusion was observed in 3 of the latter at the last follow-up. We conclude that TCC of PDA is feasible and safe in children weighing < 10 kg with gratifying intermediate-term results.

Aortography↗
PubMed1997

New technique using temporary balloon occlusion for transcatheter closure of patent ductus arteriosus with Gianturco coils.

We describe our early experience with a new technique involving temporary balloon occlusion for transcatheter closure of patent ductus arteriosus (PDA) using single or multiple Gianturco coils. Coil occlusion was attempted in 21 patients of median age 3 (range 1-11) years, and angiographic PDA diameter 3.0 mm +/- 0.87 mm. The inflated balloon of a pulmonary wedge pressure catheter over a transductal wire was used to mechanically hold the first extruded loop of the coil at the pulmonary end of the duct. If a residual shunt persisted after the delivery of the first coil, additional coils were delivered with or without the balloon support. One to nine coils (median 2) of different sizes varying between 3-12 mm diameter and 4-15 cm length were used. Immediate angiographic occlusion rate was 47.6%. However color Doppler (CD) at 24 hours and at 6 weeks revealed complete closure in 66.6% and 80.9%, respectively. Blood transfusion was required in 2 (9.5%) patients. Three out of 56 coils (5.4%) embolized during deployment. The use of balloon occlusion is effective and safe in the treatment of ducti up to 4.7 mm. Residual shunts lend to occlude with time.

Aortography↗
PubMed1997

Aneurysms of sinus of Valsalva eroding into the interventricular septum: etiopathology and surgical considerations.

OBJECTIVE: To evaluate and discuss etiopathology, clinical manifestations and surgical outcome of a rare subset of unruptured aneurysm of the sinus of Valsalva which erodes into the interventricular septum. METHODS: Between 1989 and 1995, seven cases of unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum underwent surgical correction at the King Edward VII Memorial Hospital, Bombay. The origin of all these aneurysms was from the right coronary sinus. The mean age of presentation was 31 years. All patients were male. Calcification of the aneurysm was seen in three. Three patients presented without aortic regurgitation; all had complete heart block. Four patients presented with aortic regurgitation and in addition, two had complete heart block. Preoperative left ventricular function was poor in patients with aortic regurgitation (Ejection fraction range; 30-42%), when compared to those without aortic regurgitation (Ejection fraction range; 48-52%). Of those without aortic regurgitation at initial presentation, one patient developed progressive aortic regurgitation after 3 years requiring surgery. While two other patients were operated at earliest for closure of aneurysm, even in the absence of aortic regurgitation. All those with aortic regurgitation required surgery for aortic valve replacement and closure of aneurysm. Aneurysm was closed by direct suturing of the ostium in two patients and by patch closure in five patients. Permanent pacemaker was implanted in five patients. RESULT: There was no operative death. Patients who underwent aortic valve replacement required postoperative ionotropic support. Two patients, who underwent surgery in absence of aortic regurgitation, remain free of aortic regurgitation at the end of 36 and 42 months of follow-up. One of the patients with calcific aneurysmal sac underwent successful re-replacement of the aortic valve for paravalvar leak after a 2 year interval. CONCLUSION: Unruptured aneurysm of the sinus of Valsalva eroding into the interventricular septum should be operated at the earliest, which makes surgery simple and prevents development of complications such as aortic regurgitation and heart block.

Adult↗
PubMed1997

Occlusion of congenital ventricular septal defects by the buttoned device. "Buttoned device" Clinical Trials International Register.

OBJECTIVES: To study the feasibility of congenital ventricular septal defect occlusion by the buttoned device and to establish guidelines for its safe and effective application. DESIGN: A descriptive study of all patients with a congenital ventricular septal defect undergoing transcatheter occlusion with the buttoned device, from March 1994 to May 1995. These patients were otherwise candidates for elective surgery at their institutions because they had persistence of a significant shunt (Qp:Qs = 1.5-2.1:1, median = 1.7), with left ventricular enlargement and/or symptoms, although their systolic pulmonary artery pressure was invariably normal (20-28 mm Hg, median = 25). The angiographic diameter of the defect ranged from 2.5 to 14 mm (median 6 mm). SETTING: A multi-institutional study. PATIENTS: Out of 25 cases attempted, 18 children and adults aged 4-35 years had devices implanted. Fifteen of these patients had membranous ventricular septal defects and three had muscular defects. All patients with a membranous ventricular septal defect had an associated aneurysm of the membranous septum. INTERVENTIONS: The buttoned device was introduced either directly or, in the last 12 cases, over a wire bridging the femoral artery and the femoral or jugular vein; the devices were delivered through 7-9 French (F) long sheaths. A membranous defect was regarded as suitable for device closure if the distance from the centre of the defect to the insertion of the right coronary aortic valve leaflet was more than 50% of the size of the required device. The device was guided by echocardiography and fluoroscopy. All muscular defects were corrected through the right jugular vein and all membranous ones through the femoral vein. RESULTS: All 18 patients underwent initial successful implantation of the device. In thirteen patients the shunts were completely occluded and in the remaining five there were trivial residual shunts. In two patients with membranous ventricular septal defects a change from the original position was noticed at two weeks; mild aortic regurgitation developed in one and the murmur recurred in the other; the devices had to be removed surgically. One patient developed transient third degree atrioventricular block during implantation; no tricuspid regurgitation was observed. CONCLUSION: Clinical occlusion of congenital ventricular septal defects was achieved in 16 out of the 18 attempted cases (13 full occlusions). Membranous ventricular septal defect occlusion can be effective and safe if patients and device sizes are carefully selected.

Adolescent↗
PubMed1996

Percutaneous balloon mitral valvotomy in mitral restenosis.

BACKGROUND: Mitral restenosis often occurs within 5 to 15 years of surgical valvotomy. Percutaneous balloon mitral valvotomy is well established as a safe and effective alternative to mitral stenosis surgery, but only a few small studies have reported on the procedure. AIM: (i) To evaluate the safety and efficacy of percutaneous balloon mitral valvotomy in patients with mitral restenosis. (ii) To evaluate the intermediate-term outcome of patients undergoing balloon mitral valvotomy after previous surgical valvotomy. (iii) To compare these patients with those undergoing balloon mitral valvotomy as the initial procedure. METHODS: We analysed our experience of 614 consecutive patients undergoing balloon valvotomy and identified 84 patients (13.7%) with mitral restenosis following prior surgical valvotomy (Group I). The remaining 530 patients (86.3%) had not undergone previous surgery (Group II). The incidence of atrial fibrillation (19% vs 5.6%), mitral valve calcification (50% vs 30.6%) and total echo score > 8 (54.8% vs 24.15%) was significantly higher in Group I. Both groups were comparable as regards their functional class, technique of valvotomy, mitral valve area (0.87 +/- 0.18 vs 0.87 +/- 0.15 cm2, P = ns), mean transmitral gradient (19.63 +/- 6.01 vs 19.21 +/- 5.67 mmHg, P = ns), and mean pulmonary artery pressure (42.2 +/- 19.0 vs 40.8 +/- 14.4 mmHg, P = ns). RESULTS: After percutaneous balloon mitral valvotomy, the final mitral valve area (1.67 +/- 0.28 vs 1.69 +/- 0.29 cm2, P = ns), mean transmitral-mitral gradient (6.12 +/- 3.68 vs 5.02 +/- 3.21 mmHg, P = ns) and mean pulmonary artery pressure (31.0 +/- 15.2 vs 28.5 +/- 11.1 mmHg, P = ns) were comparable. The success rate (93.0% vs 95.3%, P = ns) were similar in both groups. Significant mitral regurgitation was seen in four (4.8%) patients in Group I and 22 (4.1%) patients in Group II (P = ns). There were two deaths (2.4%) in Group I and five (0.9%) in Group II (P = ns). The clinical and echo Doppler follow-up (8-40 months) studies showed that both groups were of similar NYHA class, and had similar mitral valve area (1.65 +/- 0.21 vs 1.66 +/- 0.3 cm2) and transmitral gradients (7.1 +/- 3.8 vs 5.9 +/- 3.5 mmHg). CONCLUSION: We conclude that percutaneous balloon mitral valvotomy can be performed safely and effectively in patients with mitral restenosis following surgical valvotomy; the beneficial acute outcome is sustained, as shown at intermediate-term follow-up and is similar to that of patients undergoing balloon mitral valvotomy as an initial procedure.

Adult↗
PubMed1996

Calcium supplementation and prevention of pregnancy induced hypertension.

In a randomized controlled trial 201 healthy nulliparous women were randomly allocated by means of a computer generated randomization list. From 20 weeks of gestation until delivery they received either 2 g of oral elemental calcium (n = 103) per day or an identical placebo (n = 98). Eleven women (5.47%) were lost to follow-up after randomization. The study groups were very similar at the time of randomization; with respect to several clinical and demographic variables. Treatment compliance was very similar in both groups as was determined by pill count. The rate of pregnancy induced hypertension was lower in the calcium group than in the placebo group 8.24%; vs 29.03%; (RR = 0.28; 95% CI 0.14-0.59). The incidence of gestational hypertension was 6.18% in the calcium group and 17.20% in the placebo group (RR = 0.28; 95% CI 0.08-0.80), and the incidence of preeclampsia was 2.06% in the calcium group and 11.82% in the placebo group (RR = 0.13; 95% CI 0.01-0.64). In conclusion calcium supplementation given in pregnancy to nulliparous women reduces the incidence of pregnancy induced hypertension.

Calcium↗
PubMed1995

Balloon mitral valvotomy: an autopsy study.

The autopsy findings in 20 patients who died following percutaneous balloon mitral valvotomy are reported. The procedure was attempted in 508 patients. In 17 of the 20 patients, balloon mitral valvotomy was attempted as a salvage procedure. Ten patients died in the immediate post valvotomy period (within 24 h), seven died within a week and three between 1 to 3 months. In 13 patients, the balloon valvotomy successfully opened out one or both commissures. Interatrial septostomy defects created by the transeptal catheter could be identified in 19 of 20 heart specimens. The size of the defects ranged from small (5 mm) openings to large (15 mm) defects especially with double balloon. Marked mitral valvar thickening with nodular calcification was observed in 16 cases. Significant complications leading to mortality included cardiac tamponade (five cases) due to left ventricle apical perforation (3/5 cases). Mitral valve damage in the form of leaflet tears, chordal rupture and long splits in five cases resulted in significant mitral regurgitation. The leaflet tears resulted in detachment of part of the leaflet from the annulus. A late complication noted was infective endocarditis. Associated pulmonary tuberculosis, chronic obstructive pulmonary disease, respiratory infections and multivalvar diseases also contributed to mortality.

Adolescent↗