Biomedical subjects
Publications and source records attributed to K L Gupta.
Two patients with ulcerative colitis associated with Takayasu's arteritis are described. Gangrene of a limb was the presenting feature in one patient and renovascular disease in the other. Angiography showed vascular occlusions affecting several medium or large sized vessels in both patients.
Renal papillary necrosis in 4 diabetic patients is described. Two of them had underlying diabetic nephropathy. Urinary tract infection was present in all of them. Three patients had passed fleshy material in the urine while in one the diagnosis was established by excretory urography. Two patients required haemodialysis for acute renal failure caused by sloughed papillae. The condition should be suspected in diabetic subjects who develop recurrent episodes of urinary tract infection, renal colic, haematuria or obstructive uropathy.
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The pharmacokinetics and bioavailability of valproic acid was compared in six healthy volunteers after single dose oral administration of 400 mg of the drug in tablet, capsule and syrup form in a crossover manner. Blood samples were collected for 48 hours and valproic acid concentration analysed by enzymatic immunoassay. Following the administration of the three dosage forms, the absorption varied (Ka = Syrup K 2.64 +/- 0.5; tablet 1.57 +/- 0.22; and capsule 0.55 +/- 0.55 h-1). Valproic acid concentration reached a peak level of 102.3 micrograms.ml at 1.9 h after syrup administration, 73 micrograms/ml at 3.3 h after tablet and 44.8 micrograms/ml at 5.4 h after capsule. The bioavailability of tablet and syrup formulation was not significantly different from each other but it differed from capsule form in that the bioavailability was only 52%.
During implementation of a new Do-Not-Resuscitate (DNR) policy in New York State, decisions by 233 nursing home patients of their surrogates were evaluated. Eighteen patients with capacity (mean age +/- SD = 76.4 +/- 12.1 years) chose DNR; 30 patients with capacity (mean age +/- SD = 76.2 +/- 10.7 years) chose to be resuscitated (CODE); 54 patients without capacity, (mean age +/- SD = 86.1 +/- 9.1 years) had surrogates who chose DNR; and 131 patients without capacity and with surrogates (mean age +/- SD = 81.9 +/- 9.8 years) remained CODE. Most patients with capacity who chose DNR had multiple sclerosis, while most choosing CODE had strokes. Most patients who lacked capacity had dementia. Forty-five percent of surrogates did not respond regarding CODE status during the three-month study interval, and 10% wanted additional time to decide. Patient age appeared to be a factor in surrogate choice for DNR but not in patients with capacity making their own decision. Reasons for patients with capacity choosing DNR are discussed; perceived quality of life and premorbid feelings by patients help in the decision-making process.
Two patients who presented with recurrent gross haematuria are described. Both underwent extensive invasive investigations including renal biopsies before it was discovered that they had factitious haematuria produced by contaminating urine with blood from self inflicted skin wounds.
Though aging is a lifelong process, many persons think of their aging only late in their lives. By this time many have in fact accelerated their aging or developed diseases that may otherwise never have occurred. This article focuses on measures that, if followed throughout one's lifetime, may improve functional status during one's later years. Environmental factors and diet are a few of the areas discussed.
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Success in renal transplantation is now largely dependent on safe and effective immunosuppression. Nonspecific immunosuppression by chemical agents continues to be the mainstay of clinical immunosuppression. Azathioprine and prednisolone have remained the two main drugs used in combination in standard immunosuppressive therapy in renal transplantation for many years. Although cyclophosphamide (CP) was tried in the early years of transplantation, enthusiasm for its use was dampened by the advent of newer agents. We have analyzed our experience with 29 recipients of living-related donor (LRD) renal allotransplantation on cyclophosphamide therapy. Cyclophosphamide is a safe and effective alternative to azathioprine in clinical renal allotransplantation. Due to its easy availability and the fact that it is a cheaper alternative to azathioprine and cyclosporine, it is more significant for developing countries.
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Nutritional problems are commonly seen in elderly persons living in both community and institutional settings. Multiple interacting medical problems, age-related physiological changes, and low socio-economic status are just some of the factors placing the older person at greater risk for nutritional problems. Nutritional inadequacies often have a slow and insidious onset; many of the presenting features mimic changes of normal aging. Absence of clear-cut signs and symptoms may easily lead to a delay in the diagnosis of these potentially serious yet easily reversible conditions. Practicing physicians need to keep in mind the atypical presentation nutritional deficiencies may have in old age.
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An unusual presentation of disseminated mucormycosis as acute renal failure in a patient without any predisposing condition, is reported. The diagnosis was established at autopsy.
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It is important to differentiate normal aging from a disease process in the elderly. Normal aging must not be equated with "no treatment required." Conversely, all disease processes in the elderly must not mean "treatment required." The decision to treat elderly patients should be made on an individual basis and must be considered in relation to age, quality of life, benefit-risk ratio, presence or absence of symptoms, and the multiplicity of diseases in each patient.