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Biomedical subjects

L Kalra

Publications and source records attributed to L Kalra.

68 records · Page 4Linked to original sources
PubMed1993

Effect of antihypertensive treatment on psychomotor performance in the elderly.

The psychomotor effects of control of hypertension were studied in a parallel group comparison of 25 elderly hypertensives (aged 61-79 years; SBP = 192 (range 162-212) mmHg; DBP = 112 (range 98-124) mmHg) shown to have psychomotor impairment when not on antihypertensive treatment. Single blind treatment was commenced with placebo or a diuretic: atenolol, nifedipine or captopril (5 x n = 5). A range of tests using an automated psychomotor test battery showed a significant improvement compared with placebo in tests of attention and psychomotor speed in subjects rendered normotensive (n = 18) after treatment for one week (SDST + 3.8, P < 0.001; CAT + 1.2, P < 0.03; PWAT + 1.9, P < 0.004; INSP -49.5 ms, P < 0.001). Subgroup analysis suggested greater improvement in psychomotor performance with captopril, but this was equivocal because of the small sample size in each group. Hence, the psychomotor effects of treatment with nifedipine and captopril were compared in a further 13 hypertensives (aged 62-76 years; SBP = 178 (range 169-193) mmHg; DBP = 106 (range 97-117) mmHg) in a double-blind crossover study. With both drugs, control of hypertension was associated with a significant and comparable improvement in several psychomotor performance measures. The results suggest that impaired psychomotor performance due to hypertension improves with antihypertensive treatment. The improvement appears to be related to control of hypertension rather than to the direct CNS effects of antihypertensive drugs.

Aged↗
PubMed1989

Positive Kveim reaction in eosinophilic pneumonia.

The Kveim test is generally regarded as highly specific for sarcoidosis. We report two patients with pulmonary eosinophilia who had positive Kveim reactions. This association has not been previously reported.

Adult↗
PubMed1989

Multidisciplinary assessment of applicants for sheltered housing.

Three hundred applicants for sheltered housing underwent multidisciplinary geriatric assessment for suitability as a part of a joint assessment scheme with Local Authority Housing and Social Services Departments. Ninety-four applicants sought a move for health reasons while 206 applicants quoted housing and social reasons and denied medical problems. The assessment showed no significant disability necessitating sheltered housing facilities for 41 (44%) of the 94 people applying on health grounds. Severe disability made sheltered housing placement inappropriate for ten (10%) of the applicants with health problems. In the 206 applicants denying medical problems, the assessment revealed significant unreported physical illness in 46 (22%) and undiagnosed dementia in a further 26 (13%). Allocation of sheltered housing was affected in 99 (33%) of the 300 applicants. Eighty-two applicants were considered unsuitable, whereas 17 applicants originally thought to be unsuitable were recommended for sheltered housing. Multidisciplinary geriatric assessment is of considerable benefit in determining suitability of applicants for sheltered housing and will help in achieving better placement by avoiding inappropriate moves.

Aged↗
PubMed1988

Open access fibresigmoidoscopy: a comparative audit of efficacy.

A total of 541 open access referrals for fibresigmoidoscopy over five years were compared with 495 hospital initiated procedures during the same period. The number of open access fibresigmoidoscopies doubled during the five years but diagnostic yield remained unchanged at about 40% and was similar to that of the hospital initiated procedures. Colorectal carcinoma was seen in 64 open access patients compared with 47 hospital referred patients, the proportion of Dukes's type A lesions being similar (34%) in both groups. Polyps, colitis, and diverticular disease were equally common in open access and hospital referred patients. Fibresigmoidoscopy failed to detect disease in only 12 patients (1.2%) and the procedure was unsatisfactory in only 54. Referral was considered justified in 475 (88%) open access patients, and only 54 (17%) patients with normal appearances at endoscopy required further investigations. Diagnostic yields were low (19%; 30/156 cases) in open access patients under 40 and in patients with abdominal pain, constipation, or abdominal pain with constipation (0-17%). Most of these young patients presumably suffer from the irritable bowel syndrome and do not justify fibresigmoidoscopy. In contrast, there was a high diagnostic yield (90-100%) in patients of all ages referred for diarrhoea and rectal bleeding, altered blood from the rectum, and rectal bleeding associated with abdominal pain. Open access fibresigmoidoscopy is an effective service that should be freely available to general practitioners.

Ambulatory Care↗
PubMed1988

Comparative evaluation of investigations for colorectal carcinoma in symptomatic patients.

We studied 154 patients presenting with significant colonic symptoms and subsequently diagnosed to have colorectal carcinoma. They were investigated by faecal occult blood tests, fibresigmoidoscopy, double contrast barium enema (DCBE) and colonoscopy. Faecal occult blood tests (Haemoccult) alone were positive in 26% of patients with Dukes' A, in 69% with Dukes' B and in 64% with Dukes' C lesions. DCBE alone identified the lesion in 32% of Dukes' A, 79% of Dukes' B and 81% of Dukes' C carcinomas. Fibresignoidoscopy diagnosed colorectal malignancy in 84% of patients with Dukes' A, 90% with Dukes' B and 81% with Dukes' C stage. A diagnostic yield of 88% for Dukes' A, 96% for Dukes' B and 100% for Dukes' C carcinomas was seen with colonoscopy. Detection rate for all stages of carcinoma was greater than 95% when fibresigmoidoscopy and DCBE were used together. Faecal occult blood tests and DCBE alone are inadequate in diagnosing early malignancy in symptomatic patients. Fibresigmoidoscopy and DCBE used in conjunction compare favourably with the technically difficult procedure of colonoscopy and should routinely be undertaken in these patients before malignancy can confidently be excluded.

Aged↗
PubMed1988

The effect of nebulized bronchodilator therapy on intraocular pressures in patients with glaucoma.

A controlled double-blind crossover study of ocular complications associated with nebulized ipratropium bromide and salbutamol therapy for respiratory distress was undertaken in 46 chronic bronchitis patients. There was no significant rise in intraocular pressure or change in anterior chamber angle in patients with open-angle glaucoma, narrow-angle glaucoma or control subjects following treatment with either drug. However, when the two drugs were used in combination, intraocular pressure rose in patients with narrow-angle glaucoma but not in patients with open-angle glaucoma or in control subjects. Transient angle closure was seen in five of these patients. Intraocular pressures did not rise when swimming goggles were used to protect the eyes or when antiglaucoma treatment was continued. Nebulized bronchodilator therapy is safe in nonglaucomatous patients and those with open-angle glaucoma. Ocular complications can follow combined ipratropium bromide and salbutamol nebulization in patients with narrow-angle glaucoma, but can be prevented by using the drugs separately, protecting the eyes and ensuring continued antiglaucoma measures.

Administration, Intranasal↗
PubMed1987

Lymphoreticular malignancy and monoclonal gammopathy presenting as polymyalgia rheumatica.

Five patients presenting with polymyalgia rheumatica-like symptoms were found to have a monoclonal gammopathy. In addition one of these patients had acute myeloblastic leukaemia, two had early myeloma and one patient had probable Waldenström's macroglobulinaemia. The association of polymyalgia rheumatica-like symptoms, monoclonal gammopathy and lymphoreticular malignancies is discussed.

Aged↗
PubMed1986

Blue sclerae: a common sign of iron deficiency?

169 hospital inpatients were studied to assess the association of blue sclerae with iron-deficiency anaemia. Three observers independently graded the signs of blue sclerae and mucosal pallor as absent, equivocal, definite, or striking. Blue sclerae were seen more often in patients with iron-deficiency anaemia (40/46, 87%) than in those with other anaemias (2/28, 7%; p less than 0.001) or without anaemia (5/95, 5.3%; p less than 0.001). The specificity of blue sclerae in iron-deficiency anaemia was 0.94 with a sensitivity of 0.87. By comparison, mucosal pallor was noted in only 30% of patients with iron-deficiency anaemia, with a specificity of 0.96 and a sensitivity of only 0.20 (p less than 0.001). The presence of blue sclerae was unaffected by age, sex, or colour of iris. Blue sclerae appear to be a good indicator of iron deficiency and should become a regular part of clinical examination.

Aged↗