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Biomedical subjects

N Nand

Publications and source records attributed to N Nand.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of enzymes in pyogenic and tuberculous meningitis.

OBJECTIVES: Lactic dehydrogenase (LDH), creatine kinase (CK) and gamma glutamyl transpeptidase (GGTP) were measured serially in cerebrospinal fluid (CSF) and serum in twenty five cases of meningitis and an equal number of age and sex matched healthy control subjects with an aim to find out their diagnostic and prognostic significance in cases of meningitis. METHODS: The enzymatic activity was measured serially (day 0, 4th and 7th) in cerebrospinal fluid (CSF) and serum in twenty-five cases of meningitis consisting of fifteen cases of pyogenic meningitis (PM) and ten of tuberculous meningitis (TBM) and an equal number of age and sex matched healthy control. The clinical details including the level of consciousness and neurological deficit were correlated with the enzymatic activity and prognosis. RESULTS: The levels of these enzymes were significantly elevated in all the cases of meningitis in serum as well as CSF as compared to control subjects. The activity was significantly higher in pyogenic than tuberculous meningitis (p<0.001) and it was higher in CSF than in serum (p<0.001). The maximum elevation in activity of GGTP and LDH were seen on the first day whereas CK was highest on 4th day and thereafter, the activity of all the enzymes declined in the majority of cases who had shown clinical improvement. However, in three cases of pyogenic and five cases of tuberculous meningitis, the enzymatic activity on subsequent estimation, increased serially. All these eight cases died. Further, the basal enzymatic activity in all these eight cases that died was higher as compared to those who survived. Of all the enzymes, CSF GGTP levels correlated best with the clinical picture. CONCLUSIONS: It is concluded that GGTP, CK and LDH were significantly elevated in cases of meningitis. It was not possible to differentiate the type of meningitis on the basis of enzymatic activity in any of them. However, it was possible to predict prognosis because higher basal activity and serial rise were associated with poor prognosis.

Adult↗
PubMed2003

Comparison of oral versus intravenous iron therapy in predialysis patients of chronic renal failure receiving recombinant human erythropoietin.

OBJECTIVES: To compare oral versus intravenous iron in pre-dialysis patients of chronic renal failure (CRF) receiving recombinant human erythropoietin (rHuEPO). METHODS: The study was undertaken in 40 adult patients of chronic renal failure. The patients were randomly divided into two groups A and B of 20 patients each. Group A patients were given oral iron and group B patients were given intravenous iron. All patients in both groups were given recombinant human erythropoietin 2000 IU twice weekly subcutaneously. The study was carried for up to three months. Patients were monitored every month for renal parameters and haematological parameters which included haemoglobin, reticulocyte count and packed cell volume. Ferrokinetic studies were done at baseline and at three months. RESULTS: It was observed that haematological parameters showed significant statistical improvement in the intravenous iron group as compared to group A (oral iron group). The ferrokinetic studies revealed that serum iron, serum ferritin and transferrin saturation, decreased significantly in oral iron group, whereas significant increase was seen in group B (intravenous iron group). None of the patients developed any adverse effects because of erythropoietin or iron therapy. CONCLUSIONS: Concomitant use of intravenous iron is better than oral iron in CRF patients treated with rHuEPO. The intravenous route of iron administration may be a preferred route along with rHuEPO therapy, more so in the Indian context where prevalence of iron deficiency anaemia is fairly high.

Administration, Oral↗
PubMed2002

Evaluation of role of acute intermittent peritoneal dialysis in resistant congestive heart failure.

AIMS AND OBJECTIVES: To evaluate the role of acute intermittent peritoneal dialysis (PD) in resistant congestive heart failure (CHF). MATERIAL AND METHODS: The study was conducted on 20 adult patients of resistant CHF. These patients were subjected to 12 cycles of acute intermittent hypertonic peritoneal dialysis. Improvement was monitored by clinical symptomatology, echocardiography, measurement of ultrafiltration and quantity of sodium transferred. RESULTS: There was improvement in clinical symptomatology. There was significance improvement in left ventricular (LV) function as evidenced by improvement in ejection fraction from a predialysis value of 43.35 +/- 16.73% to a post dialysis value of 53.55 +/- 14.53%. The ultrafiltration and quantity of sodium transferred was also significant. CONCLUSIONS: Acute intermittent hypertonic peritoneal dialysis is an effective and safe treatment modality in patients of resistant CEF. The patients subsequently respond well to medical therapy.

Adult↗
PubMed2000

Characterization by single strand conformation polymorphism of mutations in the rpoB gene of rifampin-resistant Mycobacterium tuberculosis in strains from Vancouver, Mexico City and New Delhi.

OBJECTIVE: The study was conducted to evaluate usefulness of single strand conformation polymorphism (SSCP) over DNA sequencing in the diagnosis of rifampicin (Rif)-resistant tuberculosis. METHODS: Forty seven isolates of Mycobacterium tuberculosis (MTB) Rif-resistant and 25 Rif-sensitive were obtained from Vancouver, Mexico city and New Delhi and were analyzed by polymerase chain reaction (PCR) amplification of rpoB gene and the mutations were identified by DNA sequencing and SSCP. RESULTS: The mutations observed by DNA sequencing in 47 RIF-resistant isolates showed that the most common mutation among Vancouver isolates was in codon 526, Hist-->Arg and in Mexico isolates was in codon 531, Ser-Leu and New Delhi isolates was in codon 516, Asp-->Val. Using fluorescence based PCR-SSCP, it was possible to distinguish Rif-resistant isolates from Rif-sensitive isolates. CONCLUSION: DNA sequencing is a highly accurate method for the detection of mutations associated with drug resistance in tuberculosis but is more expensive and requires special equipment and personnel. SSCP is a simple, accurate method and suitable for analysis of large number of samples and the results are available in less than 72 hours.

DNA Mutational Analysis↗
PubMed1999

Effect of protein and phosphate restricted and calcium and alphacalcidol supplemented diet on renal and parathyroid functions and protein status in chronic renal failure patients.

OBJECTIVE: To assess the effect of low protein (0.6 g/kg/day), low phosphate (5-10 mg/kg/day) diet with calcium (600 mg/day) and alpha-D3 (0.5 microgram/day) supplementation on renal and parathyroid functions in patients with chronic renal failure (CRF). METHODS: The study included 20 adult patients of CRF, maintained on diet therapy alone. The patients were followed up for renal and parathyroid functions and protein status for 6 months at monthly interval. RESULTS: There was symptomatic improvement in 88% patients. Blood urea and serum creatinine decreased significantly (p < 0.001 and < 0.01, respectively) and the slope of inverse serum creatinine against time changed to static or an upslope. Glomerular filtration rate (GFR) improved from a basal value of 29.35 +/- 18.2 ml/min to 39.25 +/- 27 ml/min after 6 months. Serum parathyroid hormone (PTH) level of 197.65 +/- 133.7 pg/ml and post treatment level of 254.55 +/- 217.19 after 6 months were not different (p > 0.05). Serum calcium remained stationary with a slight increase in serum phosphorus. Phosphorus had a negative correlation with calcium and GFR, whereas calcium had a negative correlation with PTH and phosphorus. PTH had a positive correlation with phosphorus and negative with GFR and calcium. CONCLUSION: There was an improvement in renal functions without any deleterious effect on the protein status of the patients of CRF. Also, there was halting of parathyroid dysfunction especially in those patients where there was no evidence of pre-existing hyperparathyroidism. Hence, dietry management should be strictly enforced in CRF patients early in the course of disease.

Adult↗
PubMed1997

Lipid peroxidation and vitamin E in ischemic heart disease.

The study was carried on 90 adult cases which were divided into 3 groups of 30 cases each. Group A consisted of 30 normal healthy controls whereas Group B and C comprised of 30 patients each of chronic stable ischaemic heart disease and of acute myocardial infarction (AMI), respectively. Patients in all the 3 groups were age and sex matched. Group C consisted of 17 cases of anterior wall myocardial infarction, 10 of inferior wall, 2 of anterolateral and 1 of antero-inferior MI and they had an average 6.96 +/- 3.39 hours of chest pain before hospitalization. Serum vitamin E in group A, B and C on day 1 was 7.90 +/- 3.23, 5.345 +/- 2.37 and 1.302 +/- 1.090 micrograms/ml, respectively and malondialdehyde (MDA) levels in these groups were 0.759 +/- 0.27, 0.780 +/- 0.334 and 3.092 +/- 1.124 nmol/ml, respectively. Vitamin E and MDA levels in group C on day 3 were 3.382 +/- 1.088 micrograms/ml and 1.492 +/- 0.849 nmol/ml, respectively. In Group C, vitamin E levels were significantly decreased (p < 0.001) as compared to controls and remained low after 2 days. MDA levels were raised more than 3 times in AMI group (p < 0.01) and decreased slightly after 2 days but were elevated compared to controls. Findings suggest that vitamin E deficiency is inversely related to lipid peroxidation and is elevated during AMI. Therefore supplementation of vitamin E in AMI would be beneficial.

Coronary Disease↗
PubMed1997

Evaluation of efficacy of standard haemodialysis and verapamil added peritoneal dialysis.

The study was carried out on 30 adult subjects of acute renal failure who were randomly divided into two groups of 15 patients each. Group A patients were subjected to standard haemodialysis (HD) for 4 hours using holofibre dialyser and group B patients received 36 hours of peritoneal dialysis (PD) where Verapamil was added intraperitonealy in the dose of 10 mg/ L/cycle in the clearance periods III, V, VII, IX and XI (Total dose 150 mg). The 36 hours of PD consisted of 36 cycles of one hour duration each and these were divided into 12 clearance periods (CP) of 3 cycles each. Following both the forms of dialytic treatments, there was significant improvement in the signs of uraemia with fall in the blood urea and serum creatinine levels. The peritoneal clearances, percentage fall of urea and creatinine, and protein loss were similar in the two groups (p > 0.5). However, ultrafiltration was significantly higher in the group B. No untoward effects were noticed in group B however group A patients had episodes of hypotension (5)] disequilibrium (6) and cardiac arrhythmias (1). It can be concluded that both clinically and biochemically, 36 hours of Verapamil added PD and 4 hours of hemodialysis are comparable and therefore, peritoneal dialysis may be used more frequently in acute renal failure specially in situations where trained dialysis staff is not available and patients are not haemodynamically stable.

Adult↗
PubMed1997

Evaluation of efficacy of methylprednisolone, prednisolone and chlorambucil in idiopathic glomerulonephritis.

Thirty adults with steroid resistant idiopathic glomerulonephritis were randomly assigned to symptomatic treatment only or to a 6-month course of methylprednisolone and prednisolone alternated with chlorambucil every other month. Patients were followed up for a period of 6 months. At the end of follow-up, 11 out of 15 treated patients were in complete or partial remission as compared with only 3 of 15 control patients. Three of the treated patients were in complete remission, as compared with none of the controls. In the treated group there was a significant improvement of renal functions during follow-up, whereas in the control group renal functions did not show any significant change. None of the patients was dropped from the study because of side-effects. Therefore, it is concluded that pulse steroid and chlorambucil treatment for 6 months favours remission of idiopathic glomerulonephritis in adults and it leads to improvement of renal function.

Adult↗
PubMed1996

Cardiac status in typhoid fever.

Fifty adult patients with culture-proved typhoid fever were subjected to daily clinical, electrocardiographic (ECG), and electrolyte assessment to evaluate and correlate their cardiac status. Transaminases and creatine kinase (CCK-MB) were estimated on alternate days and echocardiographic assessment was done once during hospitalization. The patients were distributed into groups: I (21) who did not have any ECG or enzymes changes, IIa (17) who had both ECG as well as enzymes changes, IIb (5) who had ECG changes only, and IIc (7) who had elevated enzymes only. Various types of ECG abnormalities were observed in 22 patients. Transaminases were significantly raised (P < 0.001) in group IIa and IIc patients (24). However, CK-MB was significantly raised (P < 0.001) only in the 5 patients of group IIa. There was no relationship among the elevated enzyme levels, severity of disease, and ECG changes. Further, ECG changes were observed during the convalescence stage also, but transaminases were found to be elevated only during the acute stage. It is concluded that definite injury to the heart occurs during typhoid fever. However, it is difficult to ascertain the exact time and extent of the injury. Further, CK-MB was not found to be superior to transaminases for assessment.

Adult↗
PubMed1996

The effect of hematocrit on the efficiency of hemodialysis in cases of chronic renal failure.

Twenty patients of chronic renal failure were evaluated to study the effect of increase in hematocrit (Hct) on the efficiency of hemodialysis. All the patients were subjected to two hemodialysis of identical duration with an interdialytic interval of 48 hours. All were anemic with a mean hemoglobin of 6.73 gm% and a hematocrit of 22.2%. Hematocrit was raised to a mean of 32.02% following transfusion of 2 units (600-700 ml) of whole blood (p < 0.001) in the interdialytic interval. Blood clearances (Kb). Dialysate clearance (Kd), fractional decrement and Kt/V ratio of solutes (urea, creatinine and phosphates) were calculated during both the dialysis and compared with each other. Kt/V of urea decreased from 1.0589 +/- 0.24 to 0.89 +/- 0.15 (p < 0.001), and that of creatinine 1.003 +/- 0.19 to 0.832 +/- 0.009 (p < 0.001) and phosphates 0.992 +/- 0.16 to 0.826 +/- 0.006 (p < 0.001) and it showed a negative correlation with rise in hematocrit. It was significant for creatinine and phosphates and insignificant for urea, suggesting thereby that the efficiency of dialysis decreased with increase in hematocrit. This is important in view of under dialysis in patients of normal or near normal hematocrit and suggests the need for modification of dialysis prescription in such situations.

Adult↗
PubMed1996

Comparison of sodium nitroprusside added peritoneal dialysis and standard haemodialysis.

Thirty patients of acute or acute on chronic renal failure (ACRF) were randomly divided into two group of 15 cases each. Group A patients received 36 cycles of intermittent peritoneal dialysis (PD) with an exchange volume of one litre and duration of one hour per cycle. The 36 cycles of PD were divided into 12 clearance periods of 3 cycles each. Sodium Nitroprusside (SNP) was added in a dose of 4 mg/litre of dialysate in alternate clearance periods. Group B patients were given 4 hours of haemodialysis (HD) to compare the efficacy of two modes of dialysis. Symptomatic relief was observed in various uraemic signs and symptoms like vomiting, level of consciousness, fluid overload, hiccough and asterexis in most of the patients in both the groups. The percentage fall in blood urea and serum creatinine was 57.02 Vs 58.04 mg% and 46.9 Vs 47.8 mg% in group A and B respectively (P 70.5 each). Total dialysate urea removal following PD and HD was 118.8 +/- 57.3 gm and 98.5 +/- 37.0 gm respectively and also there was no significant difference in total creatinine removal. No untoward effects were observed with PD. However, following HD, 5 patients developed hypotension, supraventricular tachycardia was observed in one and disequilibrium syndrome in 8 of them. Therefore, it can be concluded that SNP added PD is comparable to 4 hours of haemodialysis both clinically as well as biochemically and in situations where facilities for HD do not exist or it is contraindicated, PD may be preferred mode of therapy.

Adult↗
PubMed1995

Effect of intraperitoneal administration of sodium nitroprusside on the efficacy of peritoneal dialysis.

A prospective randomised trial of intraperitoneal sodium nitroprusside (SNP) administration on the efficacy of acute intermittent peritoneal dialysis was carried out in 40 adult patients of acute or acute on chronic renal failure. A total of 36 cycles of peritoneal dialysis (PD) with an exchange volume of 1 litre and duration of 1 hour per cycle were given to each patient. The 36 cycles of PD were divided into 12 clearance periods (I-XII) of 3 cycles each. SNP was added in a dosage of 4 mg/l of dialysate in clearance period II, IV, VI and VIII. Of 40 patients, 20 were subjected to standard PD (Gp A) while the other 20 received SNP added PD (Gp B). The peritoneal clearance of urea, creatinine, percentage fall of blood urea, serum creatinine and protein loss during the various clearance periods were compared in the two groups. It was observed that group B patients had significantly higher peritoneal clearance and the percentage reduction in the blood levels of urea and creatinine. Protein loss per clearance period was also significantly higher in group B patients. Twenty two cycles of SNP added PD were as effective as 36 cycles of standard PD. No systematic untoward effects of SNP were observed. It is therefore, concluded that intraperitoneal SNP administration is a safe and effective way of increasing the efficacy of PD thus reducing the duration of treatment.

Adolescent↗
PubMed1993

Evaluation of lactic dehydrogenase in cases of meningitis.

Lactic dehydrogenase (LDH) was measured serially in cerebrospinal fluid (CSF) and serum in 23 cases of meningitis (15 pyogenic and 8 tuberculous) and equal number of age and sex matched healthy controls to find out its diagnostic and prognostic significance in cases of meningitis. The LDH activity was significantly elevated in the CSF and serum (p < 0.001) in cases of pyogenic (PM) as well as tuberculous meningitis (TBM). The maximum elevation was seen on the 1st day and the activity declined thereafter. However, in 3 cases of PM and 5 cases of TBM, the LDH activity on subsequent estimations increased serially and all these cases died. Further, the basal LDH activity in the 3 cases of PM who died was significantly higher (p < 0.01) than those who survived. The rise in enzymatic activity in the CSF was significantly higher (p < 0.001) than in the serum in all the cases of meningitis. The LDH activity was significantly higher in PM as compared to TBM (p < 0.001) both in the CSF as well as the serum.

Adult↗