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Biomedical subjects

K Madan

Publications and source records attributed to K Madan.

At least 19 recordsLinked to original sources
PubMed2006

Assessment of uterine cavity by hysteroscopy in assisted reproduction programme and its influence on pregnancy outcome.

OBJECTIVE: The aim of the study was to evaluate if the diagnosis and treatment of uterine cavity abnormalities by hysteroscopy in patients undergoing IVF programme is of any value in improving clinical pregnancy outcome. METHODS: 520 patients participated in this prospective randomized study and were classified into two groups. Group I (n = 265) without office hysteroscopy. Group II (n = 255) had office hysteroscopy and was sub classified into Group II a and Group II b. Group II a (n = 160) had normal hysteroscopic findings whereas Group II b (n = 95) had abnormal office hysteroscopy findings, which were corrected at the same time. RESULT: There was no difference in the mean number of oocytes retrieved, fertilization rate, and number of embryos transferred among the patients in different groups. Statistically significant difference was observed in terms of clinical pregnancy rates between Group I and Group II a (26.2 and 44.44%, P < 0.05), and Group I and Group II b (26.2 and 39.55%, P < 0.05), respectively. CONCLUSION: Patients with recurrent IVF embryo transfer failures after normal hysterosalpingography findings should also be reevaluated using hysteroscopy prior to further commencing IVF-embryo transfer cycles in order to enhance the clinical pregnancy rates.

Adult↗
PubMed2006

Cerebral white matter abnormalities in 6p25 deletion syndrome.

Submicroscopic deletion of the terminal part of the short arm of chromosome 6, including 6p25, leads to developmental retardation, hearing impairment, ocular dysgenesis, and dysmorphic features. We diagnosed 3 patients referred because of white matter abnormalities of unknown origin. MR imaging showed multifocal areas of abnormal signal and enlarged perivascular spaces in the cerebral white matter that were stable during follow-up. Multifocal white matter abnormalities are most commonly seen in static, nonmetabolic encephalopathies, including chromosomal abnormalities.

Abnormalities, Multiple↗
PubMed2006

Successful pregnancy with laparoscopic oocyte retrieval and in-vitro fertilisation in mullerian agenesis.

A 28-year-old woman with mullerian agenesis presented with primary infertility and was considered for laparoscopic oocyte retrieval and in-vitro fertilisation. Her 27-year-old younger sister served as a gestational carrier. The patient underwent ovarian stimulation and 11 mature oocytes were retrieved by laparoscopy. After successful in-vitro fertilisation, two embryos were transferred to the gestational carrier. Two weeks after embryo transfer, the pregnancy was confirmed by serum human chorionic gonadotropin levels. Another two weeks later, an ongoing singleton pregnancy with foetal heartbeat was confirmed by transvaginal ultrasonography.

Adult↗
PubMed2004

Comparison of efficacy of pantoprazole alone versus pantoprazole plus mosapride in therapy of gastroesophageal reflux disease: a randomized trial.

The present study aimed to compare the efficacy for the therapy of GERD of pantoprazole alone with a combination of pantoprazole and mosapride. The study was a prospective, randomized trial involving 68 patients suffering heartburn and/or regurgitation at least twice a week for 6 weeks. Sixty-one patients consented to be randomized to receive either pantoprazole 40 mg b.i.d. (n = 33, group A) or pantoprazole 40 mg b.i.d. plus mosapride 5 mg t.d.s. (n = 28, group B) for 8 weeks. Twenty-four-hour esophageal pH-metry and endoscopy were conducted at recruitment and endoscopy was repeated at 8 weeks in all the patients studied. There were no differences in symptomatic responses to therapy between the groups (69.7% vs 89.2%; P = 0.11). The mean symptom score after 8 weeks was significantly lower in group B (3.78 +/- 3.62 vs 1.67 +/- 2.09; P = 0.009). Nonerosive esophagitis was present in 29 patients. In patients with nonerosive GERD there was no significant difference in symptomatic response to either regimen (17/20 in group A and 7/9 in group B responded; P = 0.63). In erosive esophagitis, symptomatic responses occurred more frequently in group B, 18/19 (94.7%), than in group A, 6/13 (46.2%; P = 0.003). However endoscopic healing of esophagitis occurred equally with either regimen (6/11, 54.5% in group A; 12/17, 70.5% in group B; P = 0.44). In nonerosive GERD, the addition of mosapride offers no benefit over pantoprazole alone. A combination of pantoprazole and mosapride is more effective than pantoprazole alone in providing symptomatic relief to patients with erosive GERD.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Atypical progeroid syndrome: an unknown helicase gene defect?

We describe a boy with chromosomal breakage syndrome, who died of hepatocellular carcinoma at the age of 17 years. Other findings included growth retardation, bilateral cataracts, premature graying of hair and elevated levels of urinary hyaluronic acid. Intellectual functions were normal. Although some manifestations were suggestive of Werner syndrome, the diagnosis could not be confirmed by molecular investigations. Therefore, this patient probably represents a provisionally unique syndrome, perhaps due to a mutation in a related (helicase) gene.

Adolescent↗
PubMed2002

Colonoscopic barotrauma treated by conservative management: role of high-flow oxygen inhalation.

Most patients with colonoscopy-induced colonic perforation require urgent surgical intervention. Certain patients may, however, recover with conservative management. If the colonic perforation has been induced by barotrauma, there may be an extravasation of air which may lead to collection and tracking of air along the tissue planes, involving the retroperitoneum, peritoneal cavity, mediastinum, pleura, pericardium, or even the scrotum. The conservative treatment of colonic perforation includes bowel rest and antibiotics. Absorption of air collected in different body cavities may take some time, and inhalation of high-concentration oxygen may enhance the rate of gaseous absorption. We describe here a patient with colonic perforation induced by barotrauma, who recovered fully on conservative management with inhalation of high-concentration oxygen. We recommend that this approach should be used more frequently in such a situation.

Adult↗
PubMed2001

[Williams syndrome: new insights into genetic etiology, pathogenesis and clinical aspects].

Williams syndrome (WS) is a developmental disorder characterized by distinct facial features, congenital heart disease, mental retardation and a gregarious personality. The majority of people with this disorder have a submicroscopic deletion of genes in chromosome band 7q11.23. This deletion can be detected using fluorescence in situ hybridization (FISH). Although the condition is usually sporadic a few familial cases with autosomal dominant inheritance have been described. A clinical scoring system has been developed by Selicorni with which a diagnosis of 'Williams syndrome' can be made; in all patients in whom the diagnosis was made in this way FISH results were positive.

Child↗
PubMed2000

Epidemic dropsy--a clinical study of the Delhi outbreak.

BACKGROUND: A major outbreak of epidemic dropsy occurred in Delhi, India, in August-September 1998, due to the consumption of contaminated mustard oil. METHODS: The clinical data of 212 adult patients of epidemic dropsy who presented to our hospital is analysed. RESULTS: Pitting pedal oedema (100%), skin erythema (75%), limb tenderness (63%), diarrhea (51%) and hepatomegaly (34%) were the prominent clinical manifestations observed in the patients. Superficial retinal haemorrhages and retinal venous dilatation was observed on fundus examination and 9% of patients developed an open angle glaucoma over a three month follow up period. Cardiac failure was present in 14% of patients. Most patients had mild disease which responded to cessation of mustard oil consumption, bed rest, diuretics and antioxidants. There were six deaths, all of whom had intractable cardiac failure. A unique feature of this outbreak was the documentation of acute renal failure in three patients, a phenomenon never described previously. CONCLUSIONS: Strict law enforcement to prevent the contamination of edible oils is essential to avoid the occurrence of future similar outbreaks.

Adolescent↗
PubMed2000

Analysis of serological evidence of different hepatitis viruses in acute viral hepatitis in prisoners in relation to risk factors.

BACKGROUND & OBJECTIVES: The present study describes an outbreak of acute viral hepatitis in an institutional population (inmates of a prison) with an aim to delineate the etiological agents of this outbreak and to analyse the clinical, biochemical and serological evidence of different hepatitis viruses in relation to risk factors. METHODS: Fifty patients of acute viral hepatitis identified during the outbreak were evaluated on the basis of history, clinical examination, risk factor distribution, biochemical profile and serological markers for hepatitis A-E infection. Adequate epidemiological data were collected from prison administration including housing of prisoners, food and water supply. RESULTS: Of the 50 patients, 35 (70%) had serological evidence of HEV infection. Evidence of HBV infection was found in 17 patients (34%), HAV infection in 2 (4%) and HCV in 8 (16%) patients. While 16 patients (32%) had evidence of multiple viral infections, none of the viral markers could be detected in 8 patients (16%). One or more risk factor(s) could be identified in more than half of the subjects (26/50; 52%). There were 11 patients who gave history of more than one risk factor while 24 (48%) patients had none of the risk factors. INTERPRETATION & CONCLUSIONS: HEV was found to be the major cause of the outbreak and contamination of drinking water supply could be the possible source of infection. This outbreak was seroepidemiologically similar to other outbreaks of hepatitis occurring in the country with HEV being the most common cause. However, there was evidence of multiple viral infections, particularly HBV and HCV in the high-risk predisposed prison population.

Adolescent↗
PubMed1999

'Identical' twins with discordant karyotypes.

A chromosomal abnormality in one of the fetuses of a monozygotic twin pregnancy is a rare phenomenon. In the prenatal unit of our cytogenetics laboratory we have recently come across two such heterokaryotypic twin pregnancies. In both cases ultrasound abnormalities were detected in one fetus of each twin pair. Chromosomal analysis showed that one twin pregnancy was discordant for trisomy 21 and the other for 45,X. Ultrasonographic examination suggested a monochorionic twin pregnancy in each case and DNA studies confirmed that both sets of twins were monozygotic. Both pregnancies were terminated. Biopsies taken from different sites of the placentas showed chromosomal mosaicism in both cases. There was no clear correlation between the karyotype found close to the site of the umbilical cord insertion in the placenta and the karyotype of the fetus. Sampling of amniotic fluid from both sacs is recommended in diamniotic twin pregnancies if one (or both) of the fetuses has ultrasound abnormalities, even if the twins are apparently monochorionic.

Chromosome Aberrations↗
PubMed1999

Subfertile men with constitutive chromosome abnormalities do not necessarily refrain from intracytoplasmic sperm injection treatment: a follow-up study on 75 Dutch patients.

A follow-up study was performed to investigate the impact of the detection of a chromosome abnormality in infertile men who are candidates for intracytoplasmic sperm injection (ICSI) treatment. In this collaborative study between clinical genetics centres and fertility clinics in the Netherlands, 75 ICSI couples of which the male partners had a chromosome abnormality were included. All couples were extensively counselled on the risk of having a chromosomally unbalanced child. Forty-two out of 75 couples chose to proceed with the ICSI treatment. So far, treatment has resulted in a pregnancy in 11 cases. Four of them opted to have invasive prenatal diagnosis. Despite the genetic risks related to a chromosome abnormality in infertile men, a small majority (56%) of the couples did not refrain from the ICSI treatment.

Adult↗
PubMed1999

Hepatitis C virus infection in sporadic fulminant viral hepatitis in North India: cause or co-factor?

INTRODUCTION: The role of hepatitis C virus (HCV) infection in fulminant hepatitis (FH) is poorly understood and the available data are conflicting. We have examined the aetiological role of HCV in 50 consecutive patients with sporadic FH by employing serology and reverse transcription-polymerase chain reaction (RT-PCR). MATERIALS AND METHODS: A total of 50 consecutive patients with sporadic FH were included. After an initial clinical and biochemical assessment, tests were performed for detection of HBsAg, IgM anti-HBc, IgM anti-HAV, IgM anti-HEV and anti-HCV. RT-PCR was carried out for detection of HCV RNA in sera of all the patients and in post mortem liver biopsy tissue of 20 subjects, using primers selected from the conserved 5' non-coding region of the HCV genome. RESULTS: Hepatitis E virus (HEV) was found to be the most common viral infection (21/50; 42%) followed by HBV (14/50; 28%), HCV (7/50; 14%) and HAV (2/50; 4%). No viral markers could be detected in nine patients (18%) and multiple infections were seen in seven (14%). Of the seven subjects who tested positive for HCV-related markers, two had both anti-HCV and HCV RNA, three had HCV RNA alone and the remaining two had anti-HCV alone. Interestingly, all the HCV-infected subjects were co-infected with other hepatotropic viruses and the most common co-infecting agent was found to be HBV (5/7). Liver tissue was available in 20 cases and HCV RNA was detected in three of them. All of these patients were also positive for the viral genome in their serum samples. Comparison of the biological attributes of HCV-positive and HCV-negative cases revealed that haemorrhagic symptomatology (haematemesis, melaena and purpurae) was significantly more common, prothrombin time more deranged and mortality was much higher in the former group. The overall mortality was 68% and the most common cause of death was cerebral oedema (70.6%). No significant correlation was observed between mortality and the duration of the icterus-encephalopathy interval. The study included a total of 21 pregnant females; HEV infection was found to be significantly greater in this group and was associated with a higher mortality rate. CONCLUSIONS: The results clearly suggest that HCV is not an important aetiological factor for FH in North India. However, it may act as a co-factor in the development of FH leading to a higher mortality. HEV appears to contribute substantially to the causation of sporadic FH in India and advanced stage pregnancy is a potential risk factor for HEV-induced FH and high rate of mortality. Our study also suggests that the length of the icterus-encephalopathy period may not have significant prognostic implications in Indian patients with FH.

Acute Disease↗
PubMed1998

Detection of hepatitis C and E virus genomes in sera of patients with acute viral hepatitis and fulminant hepatitis by their simultaneous amplification in PCR.

A study was undertaken to investigate the role of hepatitis C virus (HCV) and hepatitis E virus (HEV), either alone or together, in the causation of sporadic acute viral hepatitis (AVH) and fulminant hepatitis (FH) by simultaneous detection of their genomes in serum samples using the reverse transcription and nested polymerase chain reaction (RT-PCR). A total of 50 patients were enrolled in the study of which 34 had AVH and 16 had sporadic FH. The serum samples were first tested for hepatitis B surface antigen (HBsAg) and immunoglobulin (Ig)M antibodies against hepatitis A virus (HAV), hepatitis B core antigen (HBcAg) and HEV and also antibodies against HCV using commercially available enzyme-linked immunosorbent assay (ELISA) kits. All samples were then subjected to RT-PCR using primers for both HCV and HEV simultaneously in the same reaction mixture. Hepatitis C or hepatitis E was diagnosed when either the antibodies or PCR or both were positive for the respective viruses. Evidence of hepatitis C was present in six of the 34 (17.6%) cases of AVH and two out of 16 (12.5%) cases of FH. Four patients in the AVH group and one of the fulminant hepatic failure (FHF) group were found to be positive by PCR and the rest by serology. But as a sole aetiological agent, HCV infection was found in only one (2.9%) case of AVH and in none of the FHF cases. Evidence of HEV infection was found in 22/34 (64.7%) and 8/16 (50%) cases of AVH and FHF, respectively. Excluding co-infection with other viruses, HEV was found to be the sole aetiological agent in 15/34 (44.1%) of AVH and 7/16 (43.7%) cases of FHF. In five (10%) (four AVH and one FHF) of the 50 cases, evidence of infection with both HCV and HEV was present. But only in two of these five cases, genomes of both HCV and HEV were co-amplified. In seven (four AVH and three FHF) out of 50 (14%) cases, no known viral agent could be detected. Our results suggest that HEV is the most common aetiological agent for both acute viral hepatitis and fulminant hepatic failure and that HCV is a rare cause of acute liver diseases although along with other viruses, evidence of either present or past HCV infection may be present in a substantial number of cases. Furthermore, advanced-stage pregnancy appears to be a potential risk factor for HEV infection and high rate of mortality in women. The study suggests that the method of simultaneous amplification of both HCV and HEV genomes could reduce the time, labour and cost involved in diagnostic work up of acute liver disease patients.

Acute Disease↗