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Biomedical subjects

P Gupta

Publications and source records attributed to P Gupta.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Transient hyperglycemia in acute childhood illnesses: to attend or ignore?

Transient hyperglycemia occurs as a part of stress response in acute illnesses and is brought about by elevated levels of counter regulatory hormones. It is frequently encountered but the exact prevalence and implications, especially in childhood have not been studied in detail, 758 children (1 month to 6 years) with acute illness were screened for hyperglycemia; of these 36 children were found to have a glucose level of > or = 150 mg/dl at admission and were designated hyperglycemics. The overall prevalence of hyperglycemia was 4.7 per cent. The disease-wise prevalence in neurological disorders, septicemia, respiratory illnesses and diarrhoea was 7.9, 7.6, 4.2 and 3.0 per cent respectively. Family history of diabetes did not predispose towards developing transient hyperglycemia. The demographic profile (age, sex, nutrition status and disease pattern) and severity of illness (as assessed by temperature, heart rate, respiratory rate, duration of illness and hospitalization, treatment modalities required, hypoxia and acidosis) did not affect the prevalence, extent and the rate of normalization of hyperglycemia. The mortality in hyperglycemics was double (13.9%) as compared to 6.9% in non-hyperglycemics, although the difference was insignificant, statistically (O.R = 2.17, CI = 0.81-5.82, p > 0.05). It was, therefore, concluded that transient hyperglycemia occurs in 4-5% of patients with acute pediatric illnesses. However, it does not significantly correlate with the clinical profile and severity of the illness, and has no immediate prognostic significance.

Child, Preschool↗
PubMedDate not supplied

Lung function values in healthy children (10-15 years).

The present study was designed to establish norms for pulmonary functions in urban healthy children of Delhi under the age group of 10-15 years. Pulmonary functions were assessed using an electronic lung function spirometer in 222 boys and 188 girls belonging to middle income group families of East Delhi. The pulmonary functions were separated by age and sex. All pulmonary functions showed an increase with advancing age. FEV1 and FVC were more in boys as compared to girls. Values of PEFR, FRC and TLC were similar in both sexes till the age of 13 years after which boys attained higher values. Prediction equations were obtained using height, age and weight as independent variables. Forward selection method was used to choose the best equation for each pulmonary function. Maximum variance in the lung functions was explained with the height. It is felt that norms established in the present study will act as reference standards for various lung functions in well nourished urban Delhi children under the age group of 10-15 years.

Adolescent↗
PubMedDate not supplied

Impact of positive preoperative surveillance blood cultures from chronic indwelling catheters in cadaveric intestinal transplant recipients.

Recurrent bloodstream infections are a common indication for intestinal transplantation (ITx). Often, clinical symptoms may be absent in the setting of bacteremia, especially in patients with chronic liver disease. This study investigated the incidence and impact of positive blood cultures (BCx) obtained from central venous catheters used for total parenteral nutrition (TPN) in asymptomatic patients immediately prior to cadaveric ITx. Of 13 consecutive patients transplanted between November 2003 and November 2004, 12 underwent preoperative surveillance BCx with four positives (33%). Isolates included Staphylococcus epidermidis (n = 2), methicillin-resistant Staphylococcus aureus, and Citrobacter freundii. All four patients with positive BCx displayed liver dysfunction at the time of transplant (> or = grade 2 fibrosis, total bilirubin >8.0 g/dL), three of whom were inpatients. In contrast, only three of eight nonbacteremic patients showed liver disease of comparable severity. Liver dysfunction and inpatient status at the time of transplant appear to predict positive blood cultures. Postoperative length of stay and time on the ventilator were significantly longer among bacteremic as compared with nonbacteremic patients, but there were no differences in intraoperative blood use, time to total parenteral nutrition independence, or operative time between bacteremic and nonbacteremic patients. Our study showed that occult bacteremia in asymptomatic pre-intestinal transplant patients was not uncommon and may increase postoperative morbidity. Preemptive removal of long-term central venous catheters should be considered prior to ITx.

Cadaver↗
PubMedDate not supplied

Imidazoline receptor proteins are regulated in platelet-precursor MEG-01 cells by agonists and antagonists.

The I1-imidazoline receptor is a novel brainstem modulator of sympathetic outflow that is elevated on platelets and in brains of depressed patients. A positive correlation has been reported (accompanying manuscript) between plasma norepinephrine (NE) concentrations and the densities (Bmax) of platelet I1 binding sites (I1 sites). I1-candidate proteins of 33 kDa and 85 kDa are now identified on Western blots probed with anti-imidazoline receptor antiserum (IRBP antiserum), that correlate with Bmax values for I1 sites. Furthermore, a human megakaryoblastoma cell line (MEG-01) has been used to study the regulation of these proteins on megakaryocytic cells, while bovine adrenal chromaffin cells provide a standard I1 cell type for comparison. Both the 33 kDa and 85 kDa IRBP-immunoreactive bands were enriched in plasma membrane fractions. IRBP antiserum did not cross-react with I2 imidazoline binding sites located on platelet mitochondrial membranes. The 85 kDa band was enhanced under conditions lacking fetal bovine serum (FBS) from the culture medium 6 h prior to harvesting. Conversely, 33 kDa protein was enhanced on MEG-01 cells grown in the presence of 10% FBS; suggesting that a precursor (85 kDa) and product (33 kDa) relationship might be induced by serum. The 85 kDa band was robustly up-regulated in response to imidazoline receptor-sensitive ligands; moxonidine, idazoxan and agmatine (10 microM each for 6 h). NE also up-regulated the 85 kDa IRBP-immunoreactive protein on MEG-01 membranes, but to a lesser extent. Idazoxan, an imidazoline alpha 2-antagonist, off-set its induction of 85 kDa protein by reducing the 33 kDa band. Yohimbine, a non-imidazoline alpha 2-antagonist, was ineffective alone, or in combination with moxonidine (up to 40 microM), but yohimbine blocked NE's induction of the 85 kDa band. Therefore, a rise in either plasma NE and/or endogenous I-site ligands (i.e. agmatine) could explain an elevation of imidazoline receptors observed in depression.

Agmatine↗
PubMedDate not supplied

Predicting recovery using continuous low back pain outcome measures.

BACKGROUND CONTEXT: There is a lack of research evaluating multiple follow-up visits, specifically when using continuous outcome measures. Continuous outcome measures with several follow-up assessments would allow us to evaluate rate of recovery. PURPOSE: To predict low back pain outcomes based on the quantification of initial conditions. STUDY DESIGN/SETTING: This was a prospective study where patients were enrolled within the first month of low back pain symptoms and evaluated for 3 months. Patients were recruited from several primary care facilities. PATIENT SAMPLE: Thirty-two patients with local low back pain symptoms were recruited for the study. OUTCOME MEASURES: There were four major outcome measures, including functional performance probability, symptom intensity, impairment of activities of daily living, and a summary outcome measure. METHODS: Regression models were constructed using the initial conditions, including psychological, psychosocial, physical workplace, and personal factors, to predict the rate of recovery for each outcome measure. RESULTS: Twenty-eight patients completed the study. The r2 value for the rate of recovery regression models were 0.77 symptom intensity prediction, 0.85 activities of daily living prediction, 0.87 functional performance probability prediction, and 0.96 summary outcome measure prediction. Two functional performance patterns of recovery were found, including a steady improvement and a large jump in improvement. A discriminant function model identified the pattern of recovery in 91% of cases given initial conditions. CONCLUSIONS: Continuous outcome measures can be accurately predicted given the initial conditions.

Activities of Daily Living↗
PubMedDate not supplied

Benzoylecgonine hydrazides: synthesis, coupling to horseradish peroxidase, and characterization of the conjugates.

Benzoylecgonine-horseradish peroxidase conjugate (BE-HRP) can be used as a diagnostic reagent for the detection of cocaine in illicit drug samples and in biological fluids. This paper describes the preparation and characterization of BE-HRP. Two hydrazide derivatives of benzoylecgonine, N-2-(tert-butyloxycarbonyl)benzoylecgonine hydrazide and mono(N-2'-benzoylecgoninoyl)adipic dihydrazide, were synthesized by carbodiimide-activated coupling of benzoylecgonine to N-2-(tert-butyloxycarbonyl) hydrazide and adipic dihydrazide, respectively. Removal of the tert-butyloxycarbonyl protecting group in N-2-(tert-butyloxycarbonyl)benzoylecgonine hydrazide with anhydrous HCl yielded benzoylecgonine hydrazide hydrochloride. NMR and high-resolution mass spectral analyses demonstrated that the benzoyl group of benzoylecgonine remained intact under the conditions of both carbodiimide coupling and anhydrous HCl treatment. By aldehyde-hydrazide condensation, the hydrazides were covalently conjugated to the carbohydrate residues of horseradish peroxidase (HRP). Dot blot analysis of the conjugates employing antibodies specific to benzoylecgonine demonstrated the presence of bound benzoylecgonine in HRP. The stoichiometry of benzoylecgonine residues to HRP was determined by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS). Mono(N-2'-benzoylecgoninoyl)adipic dihydrazide gave a 2.5-3-fold higher coupling compared with benzoylecgonine hydrazide. Conjugates were also prepared by the coupling of the carbodiimide-activated benzoylecgonine to HRP that was derivatized with adipic dihydrazide.

Adipates↗
PubMedDate not supplied

Side-bias in alcohol and heroin addicts.

Alcoholics, heroin addicts and normal controls were asked for their degree of preference for the two lateral (left, right) sides during their performance of unilateral activities involving one of the four paired organs, hand, foot, eye and ear. Side-bias was assessed by a questionnaire, with 22 items for hand preference, and five items each for foot, eye and ear preference. Group difference was assessed with a mixed-factorial design (Group x Side) for each form of side-bias. Unlike heroin addicts and normal controls, alcoholics exhibited a significant reduction in right side-bias for all four measures, which suggests an anomalous pattern of lateralization.

Adolescent↗
PubMedDate not supplied

Genital human papillomavirus infections in patients attending an inner-city STD clinic.

One hundred and sixteen consecutive women attending a Baltimore City STD clinic were studied for the prevalence of human papillomavirus (HPV) infection of the genital tract using three criteria: presence of clinically recognized (visible) genital warts, cytopathologic evidence suggestive of HPV infection in a Papanicolaou smear, and analysis of cervical scrapes for genital tract HPV genomic sequences by Southern hybridization. The women were young (median age: 22 years) and more than 80% had a history of one or more STDs. The prevalences were 17% for visible warts, 41% for cytologic findings suggestive of HPV infection, and 12% for HPV DNA in cervical scrapes. Comparing the results of the three techniques, HPV DNA was found significantly more often in cytopathology-positive women than in cytopathology-negative women (18% vs. 5%, P = 0.05) and in women with visible warts than in women without visible warts (29% vs. 6%, P = 0.01). Visible warts were more common in women with HPV-DNA-positive cervical scrapes than in HPV-negative women (50% vs. 14%, P = .01). Although 52% of women were judged as infected by at least one of the three criteria, only 4% were infected by using all three criteria. The prevalence of infection was 23% if cytopathology alone was excluded as evidence of HPV infection. These results indicate the difficulty in an accurate estimation of the prevalence of HPV infections, even in a high-risk population.

Adolescent↗
PubMedDate not supplied

Hyponatremia secondary to reset osmostat in a child with a central nervous system midline defect and a chromosomal abnormality.

A newborn with a CNS midline defect and persistent hyponatremia was diagnosed with a "reset" osmostat using a 3% hypertonic saline test. The diagnosis was established by measuring urinary arginine vasopressin (UAVP) and plasma osmolality (P(Osmoil)). In this infant a chromosome abnormality with the karyotype 46, X, -X, +der(X) t(X;13) (p22.1;q22) was associated with the midline defect and a reset osmostat.

Arginine Vasopressin↗
PubMedDate not supplied

Regional anesthesia: preferred technique for venodilatation in the creation of upper extremity arteriovenous fistulae.

Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF). From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was recorded three times and was made in the (1) native state, (2) after application of a tourniquet with opening and closing of the hand for 15 seconds, and (3) after placement of the block. The average age of the patients was 65 +/- 14 years (SD), with ages ranging from 33 to 91 years, and the prevalence of diabetes mellitus was 50%. Complete brachial plexus block was achieved in 34 patients (83%). Sensory block was accomplished within 10 to 15 minutes and usually lasted 4 to 6 hours. Motor block was accomplished in 10 to 25 minutes. Venodilatation was not noted in patients whose blocks did not work (n = 7) or whose vein was found to be phlebitic on exploration (n = 3). The degree of venodilatation noted as a percentage increase after application of the tourniquet compared with the native state for these 34 patients (in whom the block worked) was 37% for the distal cephalic, 31% for the midcephalic, and 32% for the midbasilic vein. The degree of venodilatation noted as a percentage increase after placement of the block compared with after tourniquet application for these 34 patients was 42% for the distal cephalic, 19% for the midcephalic, and 26% for the midbasilic vein. No instances of systemic toxicity, hematomas, or nerve injury from the block were noted. Accesses placed included 20 radiocephalic AVF, 8 brachiobasilic AVF, 8 brachiocephalic AVF, 2 arteriovenous grafts, 2 radiobasilic AVF, and 1 brachial vein AVF.Regional block is a safe and, in our opinion, preferred technique for providing anesthesia for upper extremity vascular surgery. The venodilatation observed is augmented compared with that using a tourniquet and may allow more options for access placements.

Adult↗
PubMedDate not supplied

Ultrasonographic evaluation of common duct diameter in pre and post cholecystectomy patients.

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.

Adolescent↗