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Biomedical subjects

K B Gupta

Publications and source records attributed to K B Gupta.

At least 19 recordsLinked to original sources
PubMed2004

Evaluation of cholinesterase to differentiate pleural exudates and transudates.

AIMS AND OBJECTIVES: The present study was undertaken to evaluate the usefulness of pleural fluid cholinesterase (PChE) level in pleural fluid and its ratio to serum cholinesterase (P/SChE) in order to differentiate transudates and exudates and to compare their diagnostic efficacy with the Light's criteria. MATERIAL AND METHODS: A total of 110 patients of pleural effusion of diverse etiology were studied. Eighty patients were of exudative pleural effusion of tubercular, malignant or parapneumonic origin and 30 patients were of transudative effusion. Cholinesterase was estimated in the pleural fluid and serum in all the patients. RESULTS: The mean PChE and P/S ChE were significantly higher in exudates as compared to transudates (p < 0.001). P/S ChE was 0.79 +/- 0.45 and 0.14 +/- 0.11 in exudates and transudates, respectively. When a cut-off value of 469 IU/L for PChE was taken for the diagnosis, it was found that 10% of exudates and 2.5% of transudates were misclassified. However percentage of misclassification decreased to 1.25% in exudates and 3.3% in transudates when the cut-off value of 0.24 for P/S ChE ratio was used. Using Light's criteria, a sensitivity of 91.25% and specificity of 90% with positive predictive value (PPV) of 96.05% and negative predictive value (NPV) of 79.42% was observed. However using P/S ChE, the PPV was 98.75% and NPV was 96.67%. CONCLUSIONS: The estimation of PChE and P/SChE ratio had better discriminatory capacity than Light's criteria. It is cost effective and more specific, therefore its routine estimation is recommended.

Adult↗
PubMed2002

DOTS versus self administered therapy (SAT) for patients of pulmonary tuberculosis: a randomised trial at a tertiary care hospital.

Tuberculosis is a major public health problem in a developing country like India, it is made worse by poor adherence to and frequent interruption of treatment. Treatment of tuberculosis requires strict discipline in order to eradicate mycobacteria and to cure the disease. In the present study we have conducted a randomized control trial, to compare the effectiveness of Directly Observed Therapy Short Course (DOTS) versus Self Administered Therapy (SAT) in a tertiary care hospital.

Adult↗
PubMed2002

Left vocal cord paralysis and aortic arch aneurysm: an unusual presentation.

Recurrent laryngeal nerve in its course, follows a path that brings it in proximity to numerous structures. These structures can interfere with its function by pressure or by disruption of the nerve caused by disease invading the nerve. We report aortic aneurysm and atherosclerotic plaque as a rare cause of left vocal cord paralysis.

Aged↗
PubMed2001

Pulmonary embolism: imaging modalities--V/Q scan, spiral (helical) CT, and MRI.

Ventilation-perfusion (V/Q) imaging has been used as the screening test for pulmonary embolism (PE) for many years with diagnostic algorithms developed as a result of the Prospective Investigation of Pulmonary Embolism Diagnosis study. The primary conclusions were that high probability V/Q scans were reliable indicators for PE and normal or near-normal scans were reliable in the exclusion of PE. With the increasing availability of spiral (helical) computed tomography (CT) and many studies showing a high degree of accuracy for PE, there is much support for the replacement of V/Q by spiral CT. This article reviews the literature concerning V/Q scanning, spiral (helical) CT, and the future potential for magnetic resonance in the diagnosis of PE.

Humans↗
PubMed1998

Mechanics of the single left ventricle: a study in ventricular-ventricular interaction II.

BACKGROUND: Left ventricular (LV) effects on right ventricular (RV) function are well known. Less is understood about the effect of the RV on systemic LV mechanics. To determine this interaction, we compared systemic LVs with and without an RV mechanically coupled to them. METHODS AND RESULTS: MR myocardial tagging was used to examine 18 subjects with systemic LVs: 10 with functional single LVs (SLV) and 8 normal subjects (NL). Tracking the systolic motion of the intersecting stripes were used to determine regional twist and radial motion. Finite strain analysis was applied to derive principal strains at the atrioventricular valve (AVV) and apical short-axis levels and in 4 anatomic wall regions. Similar E1 (circumferential shortening) strain and heterogeneity of strain were noted between SLV and NL except in the septal wall. At the septal wall, NL displayed greater absolute strain (AVV=-0.16+/-0.02, apex=-0.17+/-0.02) and less heterogeneity of strain than SLV (AVV= -0.12+/-0.02, apex=-0.13+/-0.02). Similar E2 (wall thickening) strain and heterogeneity of strain were also noted between SLV and NL except again at the septal wall. At the septal wall, SLV displayed greater absolute E2 strain (AVV=0.17+/-0.08, apex=0.19+/-0.09) and less heterogeneity of strain than NL (AVV=0.07+/-0.07, apex=0.05+/-0.05). SLV twisted significantly less counterclockwise than NL in 6 of 8 wall regions and actually twisted clockwise at the AVV lateral wall. Although there was no significant difference between groups in radial wall motion, the septal and inferior walls of SLV demonstrated significantly less radial motion compared with other SLV walls. CONCLUSIONS: A major influence of the RV on systemic LV strain and radial motion occurs in the septal wall, whereas absence of the RV causes marked differences in LV twist. These findings may yield clues to the long-term functioning of the SLV and be useful in determining strategies for RV augmentation of LV function.

Adolescent↗
PubMed1998

State-related changes in upper airway caliber and surrounding soft-tissue structures in normal subjects.

State-dependent changes in upper airway caliber were studied with magnetic resonance imaging (MRI) techniques. We hypothesized that changes in airway caliber during sleep in normal subjects would result from positional and dimensional changes in upper airway soft-tissue structures, including the lateral pharyngeal walls, tongue, and soft palate. We used MRI to study 15 normal subjects during wakefulness and sleep. Sleep was facilitated by one night of sleep deprivation prior to MRI. During sleep, the volume of the retropalatal (RP) airway was reduced by 19% (p = 0.03). The volume of the retroglossal (RG) airway was not significantly reduced during sleep, suggesting that the RP region may be more likely to collapse. The mean minimal cross-sectional airway area was reduced by 228% (p = 0.004) in the RP and by 22% (p = 0.02) in the RG region during sleep as compared with values in anatomically matched axial images during wakefulness. Airway anteroposterior (AP) and lateral dimensions were also significantly reduced in the RP region. Airway narrowing in the RP region was associated with a 7% increase in thickness of the lateral pharyngeal walls (p = 0.04). In nine subjects, sagittal data showed significant posterior displacement of the soft palate during sleep as compared with wakefulness. Multiple linear regression analyses indicated that reduction in the RP airway area during sleep resulted from posterior movement of the soft palate, thickening of the lateral pharyngeal walls, and an increase in tongue oblique distance. We conclude that the lateral pharyngeal walls play an important role in upper airway narrowing during sleep in normal subjects.

Adult↗
PubMed1997

Adolescent pregnancy: a high risk group.

In a retrospective study the obstetric behaviour and outcome in 80 teenage pregnancies (< or = 19 years of age) were compared to a control group (n = 80) of women (20-30 years) of same parity. There were 32 booked cases (40%) in study group and 45 (56.2%) in control group (p < 0.05). The overall teenage pregnancy was 3.2%. Majority of patients were 18 years (27.5%) and 19 years (65.0%) in study group and most of them (87.5%) were primiparas. Of all cases 27.5% were grouped under Kuppuswamy classification III in assessing socio-economic status. Anaemia (27.5%), intra-uterine growth retardation (27.5%) and hypertension (15%) were mostly found as complications in study group as compared to controls (11.2%, 8.7% and 8.7% respectively). The incidence of forceps delivery was higher (17.4%) in the study group as compared to controls (6.2%). Stillbirth rate was 1.25% and there was no maternal mortality.

Adolescent↗
PubMed1996

Dynamic three-dimensional imaging of the mitral valve and left ventricle by rapid sonomicrometry array localization.

OBJECTIVES: The first objective was to develop a quantitative method for tracking the three-dimensional geometry of the mitral valve. The second was to determine the complex interrelationships of various components of the mitral valve in vivo. METHODS AND RESULTS: Sixteen sonomicrometry transducers were placed around the mitral vale anulus, at the tips and bases of both papillary muscles, at the ventricular apex, across the ventricular epicardial short axis, and on the anterior chest wall before and during cardiopulmonary bypass in eight anesthetized sheep. Animals were studied later on 17 occasions. Reproducibility of derived chord lengths and three-dimensional coordinates from sonomicrometry array localization, longevity of transducer signals, and the dynamics of the mitral valve and left ventricle were studied. Reproducibility of distance measurements averages 1.6%; Procrustes analysis of three-dimensional arrays of coordinate locations predicts an average error of 2.2 mm. Duration of serial sonomicrometry array localization signals ranges between 60 and 151 days (mean 114 days). Sonomicrometry array localization demonstrates the saddle-shaped mitral anulus, its minimal orifice area immediately before end-diastole, and uneven, apical descent during systole. Papillary muscles shorten only 3.0 to 3.5 mm. Sonomicrometry array localization demonstrates nonuniform torsion of papillary muscle transducers around a longitudinal axis and shows rotation of papillary muscular bases toward each other during systole. CONCLUSION: Tagging of ventricular structures in experimental animals by sonomicrometry array localization images is highly reproducible and suitable for serial observations. In sheep the method provides unique, quantitative information regarding the interrelationship of mitral valvular and left ventricular structures throughout the cardiac cycle.

Animals↗
PubMed1996

Upper airway and soft tissue structural changes induced by CPAP in normal subjects.

Nasal continuous positive airway pressure (CPAP) is the treatment of choice for adults with obstructive sleep apnea. CPAP is known to increase upper airway size; however, the direct effects of CPAP on soft tissue structures surrounding the upper airway are less well understood. Magnetic resonance imaging was used to study the effect of incremental levels (0, 5, 10, and 15 cm H2O) of CPAP on the upper airway and surrounding soft tissue structures in 10 normal subjects. Progressive increases in CPAP resulted in the following major findings: (1) airway volume and airway area (measured at several different locations [midregion, minimal, maximal]) within the retropalatal and retroglossal regions increased; (2) lateral airway dimensional changes were greater than anterior-posterior changes; (3) lateral upper airway soft tissue structural changes were significantly greater than anterior-posterior changes; (4) lateral pharyngeal wall thickness decreased and the distance between the lateral parapharyngeal fat pads increased. An inverse relationship was demonstrated between CPAP level and pharyngeal wall thickness; (5) minimal changes were noted in the soft palate and tongue. These data suggest that the lateral pharyngeal walls are more "compliant" than the soft palate and tongue. This investigation provides further evidence that the lateral pharyngeal walls play an important role in mediating upper airway caliber.

Adult↗
PubMed1996

Perinatal outcome in pregnancy induced hypertension.

Perinatal outcome and the factors affecting it were studied in 140 pregnant women with hypertension. Perinatal mortality rate (PNM) was 140/1000 and the stillbirth rate was 8.7%. In severe hypertension PNM was 52.3% and all perinatal deaths were 8.7%, when the serum uric acid level were more than 4.5 mg%.

Birth Weight↗
PubMed1996

A study of ectopic pregnancy and high risk factors in Himachal Pradesh.

Although the total number of pregnancies have declined over the past decade, the rate of ectopic pregnancies has increased dramatically. Incidence was maximum in 26-30 years of age group (37.6%) and in para 2 (32.9%). Pain was the commonest symptom (91.7%) followed by bleeding per vaginum (71.7%) and amenorrhoea (41.4%). High risk factors were present in 67% of cases (57 out of 85 cases, 7 patients had 2 high risk factors).

Adult↗
PubMed1995

Pathogenesis of acute ischemic mitral regurgitation in three dimensions.

Changes in the geometric and intravalvular relationships between subunits of the ovine mitral valve were measured before and after acute posterior wall myocardial infarction in three dimensions by means of sonomicrometry array localization. In 13 sheep, nine sonomicrometer transducers were attached around the mitral anulus and to the tip and base of each papillary muscle. Five additional transducers were placed on the epicardium. Snares were placed around three branches of the circumflex coronary artery. One to 2 weeks later, echocardiograms, dimension measurements, and left ventricular pressures were obtained before and after the coronary arteries were occluded. Data were obtained from seven sheep. Coronary occlusion infarcted 32% of the posterior left ventricle and produced 2 to 3+ mitral regurgitation by Doppler color flow mapping. Multidimensional scaling of dimension measurements obtained from sonomicrometry transducers produced three-dimensional spatial coordinates of each transducer location throughout the cardiac cycle before and after infarction and onset of mitral regurgitation. After posterior infarction, the mitral anulus enlarges asymmetrically along the posterior anulus, and the tip of the posterior papillary muscle moves 1.5 +/- 0.3 mm closer to the posterior commissure at end-systole. The posterior papillary muscle also elongates 1.9 +/- 0.3 mm at end-systole. The left ventricle enlarges asymmetrically and ventricular torsion along the long axis changes. The development of postinfarction mitral regurgitation appears to be the consequence of multiple small changes in ventricular shape and contractile deformation and in the spatial relationship of mitral valvular subunits.

Animals↗