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Biomedical subjects

Kartar Singh

Publications and source records attributed to Kartar Singh.

At least 37 records · Page 2Linked to original sources
PubMed2002

Epidemiology of Helicobacter pylori and peptic ulcer in India.

BACKGROUND: There is a wide variation in the prevalence of peptic ulcer in India both before and since the use of endoscopy. We studied the prevalence of peptic ulcer disease in a community in northern India and its relationship with Helicobacter pylori infection. METHODS: A house-to-house survey of residents aged 15 years or above in a sub-sector of Chandigarh was performed as part of a pilot survey. Subsequently, the study randomly covered all sectors of Chandigarh and we screened 2649 persons. A questionnaire was administered to each subject by trained staff. All individuals with history of peptic ulcer/dyspepsia and an equal number of asymptomatic individuals were asked to attend the outpatient department of the Institute. Diagnosis of peptic ulcer was based on endoscopy or history of previous ulcer surgery. RESULTS: Two hundred and fifty-four individuals attended the outpatient department at the Institute and 147 underwent endoscopy, biopsy for histology and rapid urease test, and blood was collected for H. pylori serology. There were 80 symptomatic and 67 asymptomatic individuals. Helicobacter pylori was positive in 38 (56.7%) asymptomatic and 49 (61.3%) symptomatic individuals (P > 0.05). The point prevalence of active peptic ulcer was 3.4% and the lifetime prevalence was 8.8%. The duodenal-to-gastric ulcer ratio was 12:1. Helicobacter pylori was present in 11/13 (84.6%) subjects with peptic ulcer. Peptic ulcer was more common in elderly and dyspeptic individuals and there was no effect of sex or socioeconomic status. Helicobacter pylori was associated with age only and did not depend on sex, socioeconomic status or dyspepsia. Of the 38 asymptomatic persons having H. pylori infection, none had active peptic ulcer. CONCLUSIONS: This study demonstrates frequent occurrence of peptic ulcer and H. pylori in this part of the country. Peptic ulcer was more prevalent in the elderly and dyspeptic subjects. Helicobacter pylori was not associated with dyspepsia, and was more prevalent in elderly subjects. There was a low prevalence of peptic ulcer in asymptomatic H. pylori-infected persons in this community.

Adolescent↗
PubMed2002

Treatment of Budd-Chiari syndrome with inferior vena caval occlusion by mesoatrial shunt.

OBJECTIVE: To report the effectiveness of a mesoatrial shunt in the treatment of Budd-Chiari syndrome caused by combined hepatic vein and inferior vena caval block. DESIGN: Retrospective study. SETTING: Tertiary care hospital, India. PATIENTS: 10 patients (4 men and 6 women; mean age 28, range 18-45) who had operations for Budd-Chiari syndrome between 1994 and 2000. INTERVENTION: Mesoatrial shunt. MAIN OUTCOME MEASURES: Graft patency, survival, liver function and symptoms. RESULTS: One patient died. All grafts were patent over a mean follow up period of 40 months (range 6-71). All survivors have normal liver function and were symptom free at the time of writing. CONCLUSION: Mesoatrial shunt is effective in the treatment of Budd-Chiari syndrome caused by combined hepatic vein and vena caval occlusion.

Adolescent↗
PubMed2002

Changing spectrum of sporadic acute viral hepatitis in Indian children.

From August 1997 to January 2000, 172 children (< or = 14 years) with acute viral hepatitis were studied. Their clinical features, investigations and outcome were noted. Viral markers (IgM anti-HAV, IgM anti-HEV, HBsAg and anti-HCV) were measured by ELISA using commercial kits. The mean age of these children was 5.6 +/- 2.9 (range, 4 months to 14 years) with a male to female ratio of 120:52. Prodromal symptoms were present in 161 (94 per cent) and icteric hepatitis was diagnosed in 168 (98 per cent) cases. Splenomegaly was noted in 53 (31 per cent), ascites in 52 (30 per cent) and encephalopathy (ALF) in 56 (32.6 per cent) cases. Sixteen (31 per cent) children with ascites had spontaneous bacterial peritonitis (SBP). Fifteen (27 per cent) children with encephalopathy died. Viral markers were positive in 166 (96.5 per cent) and they were: A in 111 (64.5 per cent), E in 28 (16.3 per cent), B in 13 (7.6 per cent), A + E in 12 (7 per cent), A + E + C and A + C in one each. Mortality in acute liver failure was more when associated with SBP (100 per cent) than without (20 per cent) (p < 0.001). We conclude that HEV is the second most common cause of sporadic acute viral hepatitis in children. Atypical presentations, such as splenomegaly, ascites, and SBP were present in virtually one-third of cases. In cases of ALF, the presence of ascites and SBP depicts a worse outcome.

Adolescent↗
PubMed2002

Celiac disease in India: are they true cases of celiac disease?

BACKGROUND: In a developing country, many conditions other then celiac disease (CD) can give rise to villous atrophy. We therefore assessed the role of immunoglobulin A (IgA)-antigliadin antibody (AGA) in addition to the ESPGHAN criteria in the diagnosis of CD in 104 Indian children. METHODS: Consecutive children with suspected CD were evaluated over 3 years with an intention to diagnose CD. Complete hemogram, d-xylose absorption test, endoscopic duodenal biopsy, and IgA-AGA titers were performed in all. CD was diagnosed on the basis of modified ESPGHAN criteria irrespective of IgA-AGA positivity (>5 U/mL), and those diagnosed were put on gluten-free diet and were monitored regularly. Children with suspected CD who had a normal duodenal biopsy result were taken as controls. RESULTS: The mean age of 50 children with CD was 6.3 +/- 2.6 years, with a male to female ratio of 3:2. The mean duration of symptoms was 3.4 +/- 2.2 years. Predominant symptoms were pallor in 96%, failure to thrive in 92%, and diarrhea in 80%. On follow-up (19.6 +/- 8 months), symptoms subsided within 16 +/- 9.8 days, and patients showed significant weight gain (mean weight at diagnoses and at last follow-up visit were 66% and 86% of expected, respectively; P < 0.001) and height gain (mean height at diagnoses and at last follow-up visit were 88% and 94% of expected, respectively; P = nonsignificant). The control group comprised 47 children with a mean age of 6.9 +/- 3 years. On comparing CD with controls, diarrhea, anemia, low weight, and stunting were significantly (P < 0.001) more frequent in patients with CD. Sensitivity and specificity of AGA at a cutoff value of 5 U/mL were 94% and 91.5% and at 10 U/mL 88% and 100%, respectively. Follow-up AGA test was performed in 42 of 47 positive cases. All showed significant decrease in AGA titer, and 29 (70%) had a negative test result. CONCLUSIONS: Indian children with CD are true cases of CD. They present late, diarrhea is absent in 20% of cases, and AGA test results show 88% of children without false-positive results at a cutoff value of 10 U/mL. However, AGA test with 94% sensitivity at a cutoff value of 5 U/mL can be used as screening test to select suspected cases for further workup.

Autoantibodies↗
PubMed2002

Faecal lactoferrin assay as an adjunct to Clostridium difficile diarrhoea.

Inflammation is the hallmark of Clostridium difficile associated diarrhoea and lactoferrin is produced by inflammatory cells. The aim of this study was to find out whether faecal lactoferrin latex agglutination (FLLA) assay done simultaneously with Clostridium difficile toxin (CDT) assay would help in the diagnosis of C. difficile infection in paediatric patients. One hundred and fifty faecal samples were obtained from paediatric group of patients. Both FLLA and CDT assays were done in conjunction on these samples. The data were expressed by descriptive statistics. One hundred and nineteen patients received antibiotics while 31 did not receive it. Of the former group 89 (74.8%) had diarrhoea while 30 (25.2%) did not have it. No significant relationship (p=0.287) was seen between antibiotic usage and occurrence of diarrhoea. However, CDT positivity was seen to be influenced by prior antibiotic usage as 51 (42.9%) patients receiving antibiotics were CDT positive when compared to 4 (7.3%) of those who did not receive antibiotics (p=0.002). A highly statistically significant (p<0.001) relationship was seen between CDT and FLLA positivity. FLLA appears to be an useful adjunct for C. difficile associated intestinal diseases in children when both the tests are done simultaneously and when other enteropathogens causing inflammatory diarrhoeas are ruled out.

Bacterial Toxins↗
PubMed2002

Intestinal myiasis due to Musca domestica: a report of two cases.

Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host's dead or living tissue, liquid body substances, or ingested food. Intestinal myiasis is usually an accidental phenomenon, which occurs due to the ingestion of eggs or larvae present in food. Usually the patient is asymptomatic and the larvae are excreted harmlessly in the feces. In some cases, however, the passage of larvae may be associated with symptoms. The present paper describes two such cases.

Adult↗
PubMedDate not supplied

Simultaneous assays for Clostridium difficile and faecal lactoferrin in ulcerative colitis.

Infectious agents may be one of the important factors in initiating or perpetuating ulcerative colitis. Increasing evidence has accumulated regarding the role of Clostridium difficile (C. difficile) infection in the exacerbation of ulcerative colitis. The present work was undertaken to study the implications of C. difficile toxin (CDT) and faecal lactoferrin (FL) positivity in patients with idiopathic ulcerative colitis (IUC) in a north Indian hospital. Ninety-four faecal samples from patients of IUC were processed for CDT and FL simultaneously. Clinical details of patients, including antibiotic intake in the past 6 weeks, were recorded. Eighty-one of the 94 patients (86.2%) had diarrhoea and 48 (51.1%) had received antibiotics. There was a statistically significant (p < 0.001) increase in the prevalence of diarrhoea among individuals receiving antibiotics. Twelve of the 94 samples (12.8%) were CDT positive while 16 were FL positive. No statistical significance (p > 0.05) was seen while comparing the positivity of CDT and FL in relation to the receipt of antibiotics. A statistically significant (p < 0.001) positive correlation was present between CDT and FL assays. FL positivity in IUC may depend on the intestinal inflammation precipitated by C. difficile infection.

Adolescent↗
PubMedDate not supplied

Effect of malnutrition on the digestive enzymes of the upper gastrointestinal tract of young rhesus monkeys.

The present study was planned to observe the effect of protein-energy malnutrition on the gastric and duodenal mucosa. The activities of digestive enzymes (i.e. lactase, sucrase, maltase, trehalase, glucoamylase, leucine aminopeptidase, alkaline phosphatase and gamma-glutamyl transpeptidase) from the gastric (fundus, body and antrum) and duodenal mucosa [i.e. first (D1) and second (D2) part of the duodenum] were determined in 6 control, 6 protein-energy malnourished (PEM) and 6 rehabilitated young rhesus monkeys. There was a significant increase in the activity of the lactase enzyme in the antrum, and D1 and D2 portions of the duodenum of PEM monkeys, while the activity of all other enzymes was significantly increased in the D1 and D2 portions only. The increase in the activity of the above-mentioned enzymes became normal upon rehabilitation. There was no change in the enzyme activities of the gastric mucosa in mild-to-moderate PEM states. This study demonstrates that even mild-to-moderate malnutrition states affect the activity of enzymes in the gastric and duodenal mucosa. Enzyme activity recovers on rehabilitation.

Animals↗
PubMedDate not supplied

Pulmonary and hematological alterations in idiopathic ulcerative colitis.

BACKGROUND: Patients with idiopathic ulcerative colitis (IUC) may suffer from one or more extraintestinal manifestations. We decided to prospectively study the prevalence of extraintestinal manifestations among patients with IUC, with special reference to pulmonary and hematological alterations. METHODS: Fifty-one consecutive patients with IUC attending the gastroenterology services of our tertiary-care referral center were evaluated prospectively. A detailed clinical evaluation of the musculoskeletal system, eye and skin, X-ray examination of the sacroiliac joints and chest, liver function tests, coagulation profile, hemogram, pulmonary function tests (PFT) and diffusion capacity for carbon monoxide (DLCO) were done in all patients. ERCP, liver biopsy and high-resolution computerized tomography (HRCT) of the chest were performed whenever indicated. RESULTS: Nearly half (24/51; 47%) the patients had one or more extraintestinal manifestations; these included pulmonary function abnormalities (14 patients; 27%), sacroiliitis (8; 16%), arthritis (5; 10%), ocular complications (4; 8%), and pyoderma gangrenosum and Budd-Chiari syndrome (one patient each). Of the 14 (27%) patients who had abnormal pulmonary function, isolated PFT abnormalities were seen in 8 (restrictive pattern in 7, obstructive pattern in 1), decreased DLCO in four, and both of the above in two. All patients with decreased DLCO (n=6) were asymptomatic and had normal chest X-ray and HRCT chest. Thirteen (25%) patients had thrombocytosis, 19 (37%) had increased fibrinogen level, and one patient had decreased antithrombin level. Disease activity had significant association with decreased DLCO (p=0.008), increased platelet count (p<0.0001), increased fibrinogen level (p=0.016), low antithrombin levels (p=0.046) and arthritis (p=0.002). CONCLUSION: Extraintestinal manifestations of IUC were seen in 47% of patients. Asymptomatic pulmonary interstitial involvement was seen in 12%, more often among patients with active disease.

Adult↗
PubMedDate not supplied

Multiple squamous cell carcinomas of esophagus.

Multiple tumors of the esophagus are reported only rarely. We describe three patients with double carcinoma of esophagus. They developed a second squamous cell carcinoma of esophagus more than 4 1/2 years after external radiation for a primary squamous cell carcinoma at a different site in the esophagus.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Multiple spontaneous enterocutaneous fistulae in malakoplakia.

Malakoplakia is a rare chronic inflammatory disease, usually involving the urogenital tract. We report a patient who presented with a psoas abscess, and later developed colocutaneous fistula at the site of abscess drainage and multiple spontaneous fistulae away from the site of incision. Histology of the resected specimen showed Michaelis-Gutmann bodies, which are diagnostic of malakoplakia.

Adult↗
PubMedDate not supplied

Hemobilia as presenting manifestation of polyarteritis nodosa.

Polyarteritis nodosa (PAN) is a multisystem necrotizing inflammatory vasculitis of medium-sized muscular arteries. Hepatobiliary complications secondary to thrombosis or aneurysm formation in PAN are rare and are associated with poor outcome. We describe an 18-year-old man with PAN who presented with hemobilia secondary to rupture of a hepatic artery aneurysm, which was successfully managed with coil embolization followed by immunosuppressive therapy.

Adolescent↗
PubMedDate not supplied

C-reactive protein in patients with gallbladder and biliary tract diseases.

C-reactive protein (CRP) assay is widely used as a clinical tool for the evaluation of bacterial infections. No study has been undertaken to evaluate the presence of CRP and/or the estimation of this protein in the bile of patients with diseases of the gallbladder (GB). In the present study, we estimated the quantity of CRP in bile (n=358) as well as serum samples (n=186) obtained from patients with GB and biliary tract diseases, using the semiquantitative Avitex CRP kit. Bacteriological study was also done on the bile samples. CRP was positive in the bile of 56 patients, (15.6%) many of who had bacteriobilia. CRP was also present in 49 of the serum samples studied (26.3%). Control serum samples did not show any CRP within detectable limits. Hitherto, this is the first report that investigated the level of CRP in the bile of patients with GB and biliary tract diseases, along with biliary bacterial profile.

Adolescent↗
PubMedDate not supplied

Acute pancreatitis: presenting manifestation of varicella infection.

A 29-year-old man presented with symptoms suggestive of acute pancreatitis of 3 day's duration. No definite aetiology was identifiable at admission. The patient had been receiving corticosteroids for the preceding 1 month, after the evacuation of a traumatic subdural haematoma. During the hospital stay, he developed a macular skin rash, which evolved over a period of 48 hours to a papulovesicular rash typical of varicella infection. Liver function tests were suggestive of anicteric hepatitis. Acyclovir therapy was instituted. However, the patient succumbed to an episode ventricular arrhythmia of sudden onset, possibly due to varicella myocarditis. A high index of suspicion for varicella infection in immunocompromised patients presenting with acute pancreatitis is necessary for early diagnosis. The rash may at times be atypical and may rarely appear after the onset of pancreatitis. Whenever any rash develops in the setting of pancreatitis of unknown aetiology, rapid diagnostic tests should be undertaken to establish the diagnosis and start appropriate therapy.

Acute Disease↗
PubMedDate not supplied

Mesenteric ischemia and portal hypertension caused by splenic arteriovenous fistula.

Splenic arteriovenous fistula is rare and usually presents with features of established portal hypertension (PHT). Presentation as acute mesenteric ischemia with features of acute PHT is uncommon. We report a 35-year-old lady who presented with severe abdominal pain, diarrhea and ascites, which was found to result from mesenteric ischemia and acute PHT secondary to splenic arteriovenous fistula. She underwent resection of fistula, which resulted in complete symptom relief.

Abdomen, Acute↗
PubMedDate not supplied

Telemedicine: experience at SGPGIMS, Lucknow.

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.

Academic Medical Centers↗