Biomedical subjects
Publications and source records attributed to N Kumar.
We report a young woman with paraganglionoma arising from the extrahepatic bile duct presenting with acute obstructive jaundice. The patient underwent excision of the gall bladder and extrahepatic bile duct with the tumor, and Roux-en-Y hepaticojejunostomy. She is asymptomatic 9 months later, with normal biochemical investigations and imaging.
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Primary biliary cirrhosis (PBC) is believed to be rare in India. We analyzed our data pertaining to patients with PBC seen in a tertiary referral center over a 5-year period. The diagnosis of PBC was based on liver biochemistry, histology and antimitochondrial antibodies, in the absence of biliary obstruction. Five patients, all women, were diagnosed to have PBC. Pruritus, jaundice and fatigue were the most common initial symptoms. Hepatomegaly was seen in 4 of 5 patients. Associated autoimmune diseases were present in 2 patients. All patients presented with mild hyperbilirubinemia (< or = 6 mg/dL) with disproportionately raised serum alkaline phosphatase level. AMA was positive in 4 patients. Liver biopsy showed stage III-IV disease in 3 of 4 patients. The clinical presentation and course of PBC in India are similar to the experience in the West.
Lipid peroxidation in vitro and in vivo has been postulated to be involved in the development of atherosclerosis. It is also known that free iron catalyses the lipid peroxidation. Therefore, we assessed the status of oxidative stress in smokers, hypertensives and non-insulin dependent subjects, who were prone to coronary artery disease. In addition, superoxide dismutase levels and iron binding capacity were also measured to know their antioxidant defences. One hundred seventy-five consecutive subjects below 60 years of age were examined; they were then divided into three groups: one with coronary artery disease, another without coronary artery disease and a healthy control group. The patients having either of the one risk factors for coronary artery disease i.e. smoking, hypertension and/or diabetes were studied. Serum lipid peroxides, superoxide dismutase, serum iron and iron binding capacity were estimated. Oxidative stress was highest in smokers with coronary artery disease (3.11+/-0.79 mmol/ml) as compared to hypertensives (2.69+/-0.20 mmol/nl) and non-insulin dependent diabetics (2.78+/-0.19 mmol/ml). Superoxide dismutase activity was also significantly decreased (p<0.001) in smokers with coronary artery disease as compared to hypertensives and non-insulin dependent diabetes mellitus. Final step of stepwise logistic regression based on malondialdehyde and superoxide dismutase correctly predicted coronary artery disease status in 90 percent smokers. Serum iron and total iron binding capacity were not significantly different in risk prone subjects. However, among all risk prone subjects, smokers with coronary artery disease showed highest serum iron levels and decreased iron binding capacity.
Thirty four patients with gall bladder disease and normal common duct were investigated prospectively by ultrasonography just before cholecystectomy and at periodic intervals of 1 months, 2 months, 3 months and once in 4-6 months after cholecystectomy. The pre and post cholecystectomy common duct diameters were measured at each visit and compared with each other to determine the statistical significance. No significant change (p > 0.05) occurred in common duct diameter following cholecystectomy.
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Anomalies of rotation and fixation of gut occur most commonly in the neonatal period and usually become symptomatic in infancy. We report an adult patient with symptomatic volvulus due to mid gut malrotation.
This is a comprehensive review of menace of free radicals and its concept and management in Ayurveda. This article highlights the various exogenous and endogenous factors responsible for the production of free radicals with special reference to the formation of unriped and purified metabolites (ama) during the metabolic activities at different levels of digestion. The purpose of this paper is to review the management of free radicals which can be designed with reference to diet and digestion biorhythms, behaviour, emotions and sense. Ayurvedic concept of free radicals scavenger, revitalisation, role of clarified butter and pollution control thereby maintaining the optimal health status by involving minimum of sophisticated technology thus guiding the individual to lead a harmonious life in unison with nature.
BACKGROUND: Bleeding splanchnic artery pseudo-aneurysm is a rare but frequently fatal complication that can be successfully managed by angiographic embolization. However, certain patients because of hemodynamic instability, non-availability of technique or angiographic failure may require primary surgical intervention. METHOD: Retrospective review of 13 patients presenting with exsanguinating hemorrhage from ruptured pseudo-aneurysm arising from branches of coeliac axis, managed surgically in absence of angiographic embolization. RESULTS: Splenic artery was most commonly involved (n = 7) followed by hepatic (n = 3), gastroduodenal (n = 2) and left gastric artery (n = 1). The most common underlying aetiology was pancreatitis (n = 8, acute = 2; chronic = 6) followed by iatrogenic (n = 3), liver abscess (n = 1) and gastric ulcer (n = 1). Seven patients presented with upper gastrointestinal (GI) bleed, while 2 each with lower GI bleed, haemobilia and bleeding through tube drains. CT-scan accurately demonstrated the pseudo-aneurysm in 11 (84.6%) patients and additionally demonstrated the underlying pathology. The surgical management chiefly consisted of ligation of offending vessel and additional procedures directed at primary pathology. Overall, 77% patients had a favourable outcome while 23% died consequent to ongoing hemorrhage. CONCLUSION: Pseudo-aneurysm involving the branches of coeliac axis most commonly arises as a result of pancreatitis and affects splenic artery. CT-scan accurately demonstrates pseudo-aneurysm and associated pathology in majority of cases. Primary surgical management in the presence of hemodynamic instability and non-availability of angiographic embolization is a viable alternative.
Patients with chronic liver disease of any etiology are at a high risk for a more severe outcome when superinfected with hepatitis A virus (HAV). Prevention of hepatitis A, by inactivated vaccine has been shown to be safe and effective in this subgroup of patients. Most countries in the West recommend prophylaxis against hepatitis A virus for patients with chronic liver disease. However, hepatitis A virus is endemic in India. Before advocating a uniform prophylaxis against hepatitis A for chronic liver disease patients in India, we prospectively evaluated the seroprevalence of hepatitis A virus antibody (Anti HAV) among the patients with cirrhosis of liver registered at our hospital, using a commercial enzyme-immunoassay (ELISA). Prevalence of protective antibody against HAV among the 42 Cirrhotic patients included in the study was documented to be 97.6% (41/42). Therefore, vaccination against hepatitis A virus infection may not be needed among patients with chronic liver disease in our population. However, further studies including adequate sample size is needed to confirm the observation encountered in the present study.
This work reviews the contents of an Ayurvedic treatise "Sri Ranbira Cikitsa Sudha Sāra" authored by Kaviraj Neel Kanth in the year 1931 of Vikrami, in 'Takari' script, the official script during the reign of his highness Maharaja Ranbir Singh of Jammu and Kashmir. A copy of the book is presently available with Raghunath Sanskrit Library, Jammu in torn condition. This is a humble effort by the authors for the exploration of hidden and old Ayurvedic literature of Jammu and Kashmir.
Transdermal iontophoresis is a physical enhancement strategy primarily for charged molecules and offers a number of advantages for the delivery of peptides and proteins. The singular advantage of iontophoresis lies in the precise control of dose by manipulating the current protocol. The objective of the present investigation was to understand the role of electronic parameters on iontophoretic transport of large peptides using insulin as a model peptide. Ex vivo permeation experiments were conducted using excised rat skin and the influence of varying current strengths, duration, on/off ratios and switching iontophoresis on insulin permeation were studied. High performance liquid chromatography (HPLC), polyacrylamide gel electrophoresis (SDS-PAGE) and thin layer chromatography (TLC) were used to assess the electrochemical stability of insulin; while Fourier transform infra-red (FT-IR) spectroscopy and thermogravimetric analysis (TGA) were used to understand the biophysical changes in skin during iontophoresis. The permeation of insulin was found to increase as a function of current strength and duration of current application. Skin barrier integrity and electrochemical stability of insulin was dependent on the charge applied during iontophoresis. FT-IR spectroscopy and TGA studies showed that the skin hydration increased with increase in the charge applied and thus facilitated the transport of insulin. Periodic iontophoresis did not show any significant difference in insulin permeation compared with continuous current application; 1:1 on/off ratio resulted in higher amount of insulin permeation, while flux was highest with mixed duty cycle. Switching iontophoresis was useful in reducing the pH shift and in improving the electrochemical stability of insulin at pH 3.6 and 7.4, respectively. The electroosmotic flow was influenced by the pH of the donor medium, as well as by the electrode polarity during switching and non-switching iontophoresis. Overall, the study demonstrates the issues related to the optimization of electronic parameters for the iontophoretic delivery of a large peptide.
Aortic valve replacement in the young patient represents a serious problem in terms of anticoagulation and limited durability of the bioprosthesis. In order to determine the possible advantages of conservative surgery, consecutive patients with aortic regurgitation, aged below 35 and operated upon between July 1988 and July 1990 were analyzed. There were 149 patients (mean age 22 years). The aetiology was rheumatic disease in 122 (81.9%) and 83.2% of the patients were in NYHA class III-IV. Sixty-one valves were replaced (AVR) and 88 (59%) were repaired by a variety of techniques (annuloplasty, cusp unrolling, resuspension or extension). The mean ischaemic times for isolated aortic regurgitation were 73.6 mins for AVR and 80.5 mins for repair. Associated mitral surgery was performed in 94 patients (63%); 33% of these had a valve replacement and 67% a repair. In the AVR group there was 1 hospital death (2.2%), 2 late deaths (3.3%), 3 major embolic events (5%) and one reoperation for infection. In the repair group there were 2 hospital deaths (2.4%), but no late deaths or embolic events. Twelve patients required reoperation which was performed without mortality; this was due to aortic dysfunction in 4 cases (4.6%) and mitral dysfunction in 8. It is concluded that aortic valve conservation in a young, predominantly rheumatic, population can be performed in a significant number of patients with a low mortality and morbidity.
This survey was done in 682 out of 1672 children tested with Batch of Tuberculin used for Testing (PPD RT 23 with Tween 80) in Jan. 1997 with financial research grant of B.P. Koirala Institute of Health Sciences, Dharan. Dharan City is situated in Eastern Development Region (EDR) of Nepal where a high percentage of migrated population is residing with very high number of sputum positive cases. The majority of population are from high hills and mountain region where the Annual Risk of Infection (ARI) is less. This survey was done to know the epidemiological situation of Tuberculosis (TB) in Dharan. Tuberculin survey was done in Eastern Development Region (EDR) (1994) by National Tuberculosis Centre (NTC)/Japan International Cooperation Agency (JICA) in Saptari and Morang. The reported result of average Annual Risk of Infection (ARI) is 2.49% and 2.38% respectively. The mean age of surveyed population was 14.8 yrs. The Bacilli Calmette Guerin (BCG) coverage (scar rate) was 38.3% and BCG 4-8 age group 83.3% was highest and it gradually decreased to 37.5% in 12 + age group. The average 23 Tween-8-Batch of Tuberculin used for Testing (PPD) positive is 33.6% with 10 mm induration as cutoff line. Annual Risk of Infection (ARI) based on above was 2.7% in 9-11 age group and 1.31% in 12 + age group. This survey is suggestive of tuberculosis being highly prevalent in Dharan. The survey also showed average ARI to be 2.44% in Dharan in 10-15 yrs age group. The finding is suggestive of high ARI although the populations has migrated from hill and mountain. Previous report of average ARI in this area was 2.5% (Morang and Saptari). The survey result suggests that high priority, effective tuberculosis program is necessary and intensive control program can only give impact to control of tuberculosis in Dharan.
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BACKGROUND: Signs of Inflammation in Children that can Kill (SICK score) is a new severity-of-illness score. It uses the physical signs of the Systemic Inflammatory Response Syndrome (SIRS) and its continuum--the Multiple Organ Dysfunction Syndrome (MODS). The development of the score used multiple logistic regression model coefficients converted to integer scores that have been published earlier. AIMS: The present study was done to validate the scoring system by predicting outcomes in a fresh data set. SETTING: Intensive care unit in a tertiary referral hospital. DESIGN: Prospective. MATERIALS AND METHODS: 125 admissions to the intensive care unit were evaluated so that the SICK score and the PRISM score could be calculated. In-hospital mortality was noted. STATISTICAL ANALYSIS: Calibration (Hosmer-Lemeshow goodness of fit) and discrimination (area under the ROC curve) were used to measure performance. RESULTS: Of the 125 patients studied 23 died. The area under the ROC curve was 0.76 compared to 0.80 in the development sample. Using PRISM in the validation group, the ROC was 0.78. Calibration was excellent. CONCLUSION: The SICK score can predict severity of illness with nearly the same accuracy as the PRISM score. The SICK score can be calculated immediately on admission and can help to prioritize care for the more sick children who need urgent aggressive management. Larger studies, that includes all admissions to the hospital, will now need to be done.
Radiology plays an important role in the diagnosis of pulmonary tuberculosis. Many medical practitioners believe in and rely primarily on the chest x-ray for the diagnosis of pulmonary tuberculosis. This study attempts to evaluate the reliability and validity of chest radiographs. This study was carried out in the tuberculosis clinic of BPKIHS. 75 radiographs were chosen for the study and viewed by 25 physicians of varying qualifications. Their findings were compared with the gold standard. The overall sensitivity and specificity was 78% and 51% respectively. There was poor agreement between the best physician and the best radiologist. This study has demonstrated an unsatisfactory sensitivity and specificity of chest x-rays in the diagnosis of pulmonary tuberculosis. The over-diagnosis and over-treatment due to chest x-rays could lead to an unmanageable burden on the resources of a poor country like Nepal. Private practitioners should be made aware about the importance of bacteriological diagnosis of tuberculosis before initiating drug therapy.