Biomedical subjects
Publications and source records attributed to P Kumar.
Women suffering from endometriosis are treated with long-acting analogues of gonadotropin-releasing hormone (GnRH). This is a case of hypersensitivity reaction to a goserelin acetate implant that manifested as an anaphylactic reaction. This is the first report of a hypersensitivity reaction to the GnRH analogue, goserelin acetate (Zoladex, Zeneca Pharmaceuticals, Wilmington, DE).
Persistent buccopharyngeal membrane is an extremely rare clinical entity that can be diagnosed easily by simple examination of the oral cavity and confirmed by a lateral contrast x-ray. The abnormality can be easily corrected surgically.
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BACKGROUND: Some studies in the literature have supported, while others have denied, the relationship between results of delayed hypersensitivity skin tests (DHST), renal allograft and patient survival rates. Several factors contribute to the unreliability of these studies. For example, most of these studies were performed in the precyclosporine era, furthermore, other variables which influence renal allografts and patient survival rates were not controlled in those studies. OBJECTIVE: The purpose of this study was to investigate the relationship between results of DHST performed in the pretransplant period with the subsequent renal transplant outcome in the cyclosporine era. METHODS: The study included 103 first cadaveric renal transplant recipients. DHST were performed during pretransplant evaluation by intradermal injections of a battery of recall antigens. Based on skin-test results, the patients were assigned to two groups--those with a positive skin test (STP+) and those with a negative (anergic) skin test. These two groups were compared with each other regarding allograft survival, patient survival, and other variables known to influence survival rates. RESULTS: The mean age, sex and racial distribution, degree of HLA matches between recipients and donors, number of acute rejection episodes, and number of patients with acute tubular necrosis were similar between the two groups. Renal allograft survival rates in the anergic group at 6 months, 1 year, 2 years, and 3 years were 97%, 90%, 84%, and 57%, respectively. The survival rate for renal allografts in the STP+ group for the same time points was 90%, 86%, 80%, and 72%, respectively. Patient survival rates for the anergic group at 6 months, 1 year, 2 years, and 3 years were 95%, 94%, 89%, and 85%, respectively, while those for the STP+ group were 98%, 98%, 98%, and 97% respectively. Differences between the STP+ and anergic groups, with regard to patient and allograft survival rates, were not significant. CONCLUSION: We conclude that DHST is not helpful in predicting outcome of patient or renal allograft survival rates over a 3-year time period.
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Visceral leishmaniasis is infrequently reported in renal transplant recipients. A 40-year-old renal transplant recipient developed hepatosplenomegaly and pyrexia of unknown origin 5 months after transplantation. Visceral leishmaniasis was confirmed on bone marrow examination. The usual dose of antiparasitic therapy with stibogluconate sodium failed to eradicate Leishmania donovani. High-dose conventional therapy with stibogluconate sodium for an extended period of time was successful in the treatment of a relapse of leishmaniasis.
The pharmacokinetics of recombinant human erythropoietin was studied in 12 very low birth weight preterm infants < 32 weeks of gestation after subcutaneous administration of 300 IU/kg at a postconceptional age of 34 (32-37) weeks and a weight of 1,505 (1330-1,740)g (median and range). The administration of recombinant human erythropoietin produced a rapid increase in serum erythropoietin levels with a peak level of 362.8 mIU/ml at 8.9 h. The area under the curve was 8,177.5 (4,597.1-15,453.0) mIU/ml/h, the absorption half-life was 5.5 (1.6-6.6) h, the elimination half-life was 7.9 (5.6-19.4) h, and the residence time was 19.6 (5.1-32.6) h (all values reflect median and range). There was no significant correlation between absorption and elimination half-life of erythropoietin and birth weight, gestational age, sex, and age and weight of the infants at the time of administration of erythropoietin. Based on absorption and elimination kinetics, the dosing interval for subcutaneous administration must not be < 48 h.
BACKGROUND AND PURPOSE: Occlusion in cerebral vessels results in ischemic stroke and is followed by proliferation of microvessels, ie, angiogenesis. The process is particularly marked in the border zone of the infarct, known as the ischemic penumbra. This increase in vascularization is likely to be caused by the action of angiogenic factors, such as TGF-beta 1, which is a powerful regulator of angiogenesis. METHODS: In this study we examined 10 brain samples from patients who suffered from ischemic stroke for the expression of mRNA encoding TGF-beta 1. RESULTS: The ischemic penumbra contained the highest levels of TGF-beta 1 mRNA, whereas the normal contralateral hemispheres had the least (P < .001, Mann-Whitney U test). Unlike those from normal brain, protein extracts from infarcted tissue contained active TGF-beta 1 as a 25-kD band in Western blot analysis. Extracts from the penumbra also contained a 12.5-kD isoform of TGF-beta 1. Both penumbra and infarct contained TGF-beta 1 immunoreactive products as assessed with immunohistochemistry, whereas very weak staining was observed in the contralateral hemisphere. CONCLUSIONS: These results suggest that TGF-beta 1 is important in the pathogenesis of the angiogenic response in ischemic brain tissue and its modulation may be used for therapeutic purposes.
OBJECTIVES: To determine the time course of free radical generation and the role of allopurinol as a cardioprotective agent during coronary artery bypass surgery. DESIGN: Patients were chosen on a strict 'first come, first chosen' basis, irrespective of their age and sex. SETTING: Tertiary referral-based hospital and medical research centre. PATIENTS: A total of 36 patients underwent nonurgent coronary artery bypass grafting surgery. Eighteen patients were treated with allopurinol and 18 patients acted as control. INTERVENTIONS: Allopurinol 300 mg was administered orally, twice a day for one day preoperatively and a single dose (600 mg) was administered on the morning of the day of the operation. MEASUREMENTS AND MAIN RESULTS: Lipid peroxidation products were measured by assays for thiobarbituric acid reactive substances, mainly malondialdehyde (MDA). There were no considerable changes in either MDA levels or creatine kinase isoenzyme with muscle and brain subunits (CK-MB) activity during the ischemic period. One minute after release of the cross-clamp the level of MDA was raised significantly (P<0.001). This rise correlated with the severity of ischemia in the group treated with allopurinol as well as the control group (r=0.58, P<0.05 and r=0.49, P<0.05, respectively). The level of MDA and the activity of CK-MB were significantly lower in patients treated with allopurinol (P<0.05 and P<0.001, respectively). The increase in CK-MB activity during reperfusion correlated with aortic cross-clamp time in both the groups (r=0.62, P<0.05 and r=0.69, P<0.05, respectively). Preliminary studies using electron spin resonance spin trapping technique also demonstrated a rise in free radical adducts during reperfusion and this corroborated well with the spectrophotometric method. CONCLUSION: The results of this study show that, during bypass surgery, there is an increase in lipid peroxidation products and cardiac creatine kinase enzyme at the onset of reperfusion indicating increased free radical activity. It also suggests that pretreatment with allopurinol could effectively attenuate post-ischemic reperfusion injury.
BACKGROUND: Colonic tuberculosis is common in developing countries. However, its diagnosis is difficult. Nevertheless, colonoscopy and biopsy examination have shown promising results. METHODS: We evaluated the clinical spectrum and colonoscopic features of 62 patients with colonic tuberculosis. RESULTS: Abdominal pain, fever, anorexia, weight loss, and change in bowel habit were seen in more than 50% of the patients. Massive rectal bleeding was frequently (13%) observed. Colonoscopy revealed strictures in 17, deformed ileocecal valve in 34, ulcers in 52, nodules in 49, polypoidal lesions in three, and fibrous bands in five patients. Segmental tuberculosis, lesions mimicking carcinoma, and multiple site involvement were observed in 19%, 20%, and 50% of the patients, respectively. Histopathologically, well formed granulomas were seen in 27, collections of epithelioid cells in 18, and chronic, nonspecific inflammatory changes in 17 of the cases. Acid-fast bacilli could not be isolated from any of the patients. All of the patients responded to the anti-tubercular treatment. Follow-up colonoscopy in 22 patients demonstrated regression of lesions. CONCLUSIONS: Colonic tuberculosis is common in India. Our findings indicate that colonoscopy is useful for its diagnosis. However, histopathology many not always be helpful. Therefore, in a given clinical and colonosopic setting, a therapeutic trial may be indicated.
BACKGROUND: Malignant hypertension is now an uncommon entity in the western world but still remains a significant problem in India. Therefore we studied the aetiological spectrum, management, and outcome of these patients. METHODS: Forty consecutive children (<16 years) with malignant hypertension were admitted and investigated to exclude or confirm the secondary causes of hypertension. For acute control of blood pressure sublingual nifedipine was used in dosage of 0.3-0.6 mg/kg, failing which intravenous nitroglycerin was used. In patients with aortoarteritis with active disease, steroids were used. Angioplasty was carried out for renal artery stenosis whenever possible. RESULTS: Renoparenchymal disease was the commonest cause of malignant hypertension, and was seen in 25 cases, renovascular hypertension in 13 cases (11 aortoarteritis and two fibromuscular dysplasia) and two had essential hypertension. For acute control of severe hypertension, sublingual nifedipine was effective in 92.5% of patients. Of the patients with renoparenchymal disease five became normotensive with treatment of the underlying disease, four received renal allograft, seven died, and nine are stable on antihypertensive drugs. Renal angioplasty was carried out in seven patients with renovascular hypertension (4 cured, 3 improved) and six are controlled on drugs. CONCLUSIONS: We conclude that apart from renoparenchymal disease, aortoarteritis is a common cause of malignant hypertension in children. Sublingual nifedipine is effective for the rapid control of severe hypertension, and angioplasty is effective in aortoarteritis for short-term preservation of renal function and control of hypertension.
Many patients continue to have symptoms even after cholecystectomy. We studied 4 patients with postcholecystectomy problems over a period of seven years; 208 were females, males and their mean age was 41.8 years (range 14-70). Presenting symptoms were abdominal pain (217), jaundice (74), cholangitis (38) and external biliary fistula (eight). Fifteen patients also had a t-tube in situ. Endoscopic retrograde cholangiopancreatography was successfully performed in 239 patients and revealed abnormal findings in 179. These included: stones (89), strictures (53), choledochoduodenal fistula (10), choledochal cyst (three), biloma (three), ligation of bile duct (five), ascaris in bile duct (three), pancreatitis (nine), long cystic duct stump (11), and various other findings. Endoscopic sphincterotomy was carried out in 59 patients with stones. Seven patients with strictures were managed with stents. Ascaris in the bile duct of three patients was removed with the help of a Dormia basket. To conclude, stones and strictures are common postcholecystectomy problems and endoscopic retrograde cholangiopancreatography is very helpful in the diagnosis and management of postcholecystectomy patients.
Studies on human brains with ischemic insult were performed with immunohistochemical methods to identify antigenic properties of cells participating in that pathology. The 10 patients of whom the brains were obtained at autopsy aged from 51 to 81 years had survived from 3 to 17 days from the onset of stroke to death. Cells involved in the process of decomposition of infarcted tissue were analysed with immunocytochemical methods and CD68, EMB11 (Dako) monoclonal antibody (MAB) was used. Three cell types were visualized e.g. macrophages, astrocytes and microglial cells. Cells identified were numerous in the boundary zone of infarcts and only rarely distributed in the surrounding tissue at a distance from the necrotic tissue. A few cells only were stained in the contralateral hemisphere and none were astrocytes. Our results provide evidence that morphologically different cell types can be marked with the same antibody, which may be in agreement with their similar function in the pathogenesis of ischemic brain stroke.
A retrospective study of 62 consecutive patients undergoing resection of perforated diverticular disease was undertaken to assess influence of distal stump closure (DSC) or creating a distal mucus fistula (DMF) on subsequent restoration of bowel continuity. Forty-one patients underwent DSC and 21 DMF. Mean operating time and hospital stay were 164 min and 30 days for patients undergoing DSC compared with 142 min and 18 days for those undergoing DMF. Of the 54 survivors, 44 underwent reversal (25/35; DSC, 19/19; DMF). Mean operative time and hospital stay was 208 min and 17 days for DSC compared to 143 min and 10 days for DMF (P = 0.0003). Overall mortality and morbidity of either groups were comparable. Distal mucus fistula can often be safely created following resection of perforated sigmoid diverticulitis. This may result in higher reversal rates and significantly reduces the operating time and hospital stay without compromising the outcome.
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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.
Oral administration of Rasayanas (indigenous preparations made up of herbal drugs) significantly increased total WBC count, bone marrow cellularity, natural killer cell and antibody dependent cellular cytotoxicity in gamma radiation (4 Gy) exposed mice. Also, Rasayanas reduced radiation induced lipid peroxidation in liver. The possible mechanisms of action of Rasayanas could be increased stem cell proliferation and its effect on free radical induced injury produced by radiation.
OBJECTIVE: To evaluate the role of Fluconazole in the management of neonatal systemic candidiasis. DESIGN: Descriptive, retrospective analysis. SUBJECTS: 23 neonates diagnosed as systemic candidiasis based on clinical suspicion with blood and/or urine culture positive for candida were treated with Fluconazole (5 mg/kg/day) for > 7 days. RESULTS: Babies had mean birth weight 1590 + 533 g, mean gestation 32.3 + 3.1 wks and fungal sepsis was diagnosed at a mean age of 14.3 + 7.9 days. Candida albicans (43.5%), C. tropicalis (21.7%), C. guillermondii (13%), C. parapsillosis (13%) and C. krusei (8.7%) were the species isolated. Fluconazole was effective in 82.3% cases with no side effects. Four resistant cases were C. parapsillosis (n = 2), C. albicans (n = 1) and C. guillermondii (n = 1) and there were three deaths, all in resistant cases though one death was unrelated to candidemia. CONCLUSION: Fluconazole is a safe and effective drug for neonatal systemic candidiasis.