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J C Shastry

Publications and source records attributed to J C Shastry.

98 records · Page 6Linked to original sources
PubMedDate not supplied

Diabetic nephropathy: a clinical study of 498 patients.

The clinical pattern of nephropathy was studied in 498 diabetic patients who were hospitalized during the period 1980-1985 at the Christian Medical College Hospital, Vellore, India. The diagnosis of nephropathy was confirmed in the presence of persistent proteinuria of 500 mg or more in any 24 hour urine sample in the absence of urinary infection and congestive failure. Only four patients had Type I diabetes, all the rest being non-insulin-dependent (Type II). There was significant male preponderance, and the largest number of patients were in the fifth and sixth decades. The age of onset in Type II diabetics was between 30 to 50 years in 74%; 55% of the patients were known to have diabetes for less than 10 years, and in only 6% was the duration greater than 20 years. The degree of renal failure and proteinuria showed a variable pattern in relation to the duration of diabetes. Arterial hypertension was present in 80% of the patients and coronary artery disease in 33.5%, while cerebrovascular disease and peripheral vascular disease were evident in 7.4 and 4.8%, respectively. Fundoscopic examination showed evidence of retinopathy in 278 patients (53%), with proliferative changes in 17%. Clinical evidence of retinopathy was absent in 110 patients (22%), and in the rest the results of fundus examination was not documented; thus, the incidence of clinical retinopathy in this review was 72% (278/388). It is concluded that contrary to what has been observed in Type I diabetes, the progression of nephropathy in Type II bears no relationship to the duration of disease, nor is retinopathy a constant feature.

Adult↗
PubMedDate not supplied

Primary drug resistance to Mycobacterium tuberculosis in renal transplant recipients.

BACKGROUND: After renal transplantation, patients have an up to 5% chance of being infected with Mycobacterium tuberculosis and there are reports from western countries of a 24% mortality if the infection is drug resistant. We investigated primary drug resistance in renal transplant recipients in Vellore, Tamil Nadu. METHODS: Between January 1987 and December 1993 we studied 695 patients (who had received 717 renal allografts) for evidence of tuberculosis, and performed drug sensitivity tests. RESULTS: Forty-three patients had culture-proven infection with Mycobacterium tuberculosis of whom 40 had drug sensitivity tests done. Initial drug resistance was seen from 1991. Rifampicin resistance was seen in 2, 1 and 4 patients and isoniazid resistance in 1, 2 and 2 patients in 1991, 1992 and 1993, respectively of the 23 isolates tested for drug susceptibility. Multi-drug resistance was seen in 1 and 2 patients in 1992 and 1993. CONCLUSIONS: This is probably the first report in India of primary drug resistance of Mycobacterium tuberculosis in renal allograft recipients. It is a cause for concern as it may indicate a large reservoir of drug-resistant patients in the community.

Antibiotics, Antitubercular↗
PubMedDate not supplied

Active immunization against hepatitis B infection of a haemodialysis population.

BACKGROUND: Patients undergoing haemodialysis run a high risk of developing hepatitis B virus infection. We noted high prevalence rates of this infection in our patients despite a policy of using active hepatitis B vaccination. We, therefore, examined the reasons why haemodialysis-associated hepatitis B virus infection was difficult to control. METHODS: We analysed retrospectively 131 patients who had undergone haemodialysis for end-stage renal disease at our centre between June 1991 and May 1992. Patients given hepatitis B vaccine prior to starting haemodialysis were included in group A while those vaccinated after starting haemodialysis were placed in group B. The vaccination schedule consisted of 3 doses of recombinant hepatitis B vaccine given at monthly intervals. RESULTS: Fifteen patients had hepatitis B infection at entry, of whom 12 had had prior blood transfusions. Active immunization with recombinant hepatitis B vaccine was attempted in the remaining 116 patients. There were 16 patients in group A and 100 in group B. Of the 7 patients in group A and 46 in group B who completed the vaccination schedule, protective antibodies and markers of hepatitis B viral infection were noted in 3 and 2 patients respectively in group A and 7 and 14 patients respectively in group B. Vaccination was not completed in 63 patients as 25 discontinued haemodialysis, 22 developed markers of hepatitis B infection and 16 underwent renal transplantation. CONCLUSIONS: Poor seroprotection rates with the standard vaccination schedule, unscreened blood transfusions and an inability to complete the vaccination schedule were the major reasons why active immunization against hepatitis B viral infection in our patients on haemodialysis has been largely unsuccessful.

Adolescent↗
PubMedDate not supplied

Iron stores in patients on haemodialysis after renal transplantation.

BACKGROUND: Patients with chronic renal failure receive iron orally and parenterally which can lead to iron overload. However, iron deficiency is common among Indians and it is not known whether the Indian dialysis and transplant patient runs a similar risk of iron overload. The iron status is best quantified by measuring serum ferritin levels when there is no intercurrent inflammatory process. We used this method to assess the iron stores in a random sample of the Indian population on our dialysis and transplantation programme. METHODS: Serum ferritin assay was done using ELISA on samples obtained from 24 patients at entry to dialysis, before renal transplant surgery and 3 to 6 months following the surgery. All patients received 120 mg of elemental iron orally and third party transfusions according to a fixed protocol. RESULTS: None of the patients had iron deficiency despite low haemoglobin values. Fifteen patients at entry, 12 out of 16 pre-transplant and 10 out of 17 post-transplant patients had evidence of iron overload. Three patients developed iron overload during the period of observation and 6 of the 10 who entered the programme with evidence of iron overload continued to have iron overload. CONCLUSION: Indian patients with chronic renal failure have evidence of iron overload similar to those in developed countries. Oral iron supplements in Indian patients are therefore unnecessary.

Adolescent↗