Biomedical subjects
P Mathur
Publications and source records attributed to P Mathur.
Delayed diagnosis of pulmonary tuberculosis in city hospitals.
BACKGROUND: Delays in the diagnosis of tuberculosis may result in increased patient morbidity and in further spread of the disease. We examined the clinical acumen of the medical staff in the diagnosis of tuberculosis and investigated the reasons for delay in the identification and treatment of patients with pulmonary tuberculosis. METHODS: A retrospective chart review was undertaken between July 1985 and June 1988 on all patients with culture-proven pulmonary tuberculosis at two inner city hospitals. Time intervals between admission and the clinical suspicion, diagnosis, and treatment of tuberculosis were determined. Clinical features were evaluated for their effect on these time intervals. RESULTS: Eighty-five patients with culture-proven pulmonary tuberculosis were identified. Tuberculosis was suspected in 36 patients on admission. By the end of 1 week, tuberculosis was confirmed in 50 patients and suspected in 23 others. Twenty percent of patients either died or were discharged before the diagnosis of tuberculosis was made. Older patients (> 65 years) were misdiagnosed more commonly than younger patients (82% vs 48%). Patients without respiratory symptoms were misdiagnosed more frequently (78% vs 49%) than were those with symptoms. Other reasons for delayed diagnosis and treatment included low use of tuberculin skin tests, misinterpretation of unusual chest roentgenograms, and waiting for culture results in patients with negative acid-fast smears. CONCLUSIONS: The diagnosis and treatment of patients with pulmonary tuberculosis is often delayed owing to atypical presentations and slow confirmation by culture. Improved clinical acumen, development of rapid diagnostic tests, and the institution of early empiric therapy are desirable to control this disease.
Clinical utility of thoracoscopy.
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Antihypertensive efficacy of guanfacine and methyldopa in patients with mild to moderate essential hypertension.
Guanfacine, an alpha-2 adrenoceptor agonist, was compared with methyldopa as step-2 therapy for patients with mild-to-moderate essential hypertension in a 12-week, double-blind, randomized, parallel evaluation of efficacy and safety. The study consisted of a 2-week screening/weaning period (phase I), a 3-week treatment period with a diuretic (phase II), and a 12-week treatment period with a diuretic plus methyldopa or guanfacine (phase III). Patients were weaned from prior anti-hypertensive medication during the screening/weaning period and began receiving chlorthalidone 25 mg every morning. Patients received only 25 mg of chlorthalidone each morning during the phase II period. Those who had an average seated diastolic blood pressure (BP) of 95-114 mm Hg at the end of the phase II period were eligible to enter the phase III period and were randomly assigned to chlorthalidone plus guanfacine, 1 mg every night, or methyldopa, 250 mg tid. Seated and standing systolic and diastolic BP and pulses were measured biweekly for 12 weeks after randomization. Of the 112 patients who were randomly assigned to guanfacine or methyldopa, 87% completed the entire study. The mean seated systolic and diastolic BP were reduced 13/13 mm Hg by guanfacine administration and 15/13 mm Hg by methyldopa administration. No significant changes in seated pulse were seen in either group. Similar changes occurred in the standing position. Very few adverse effects were reported during the study, the most prevalent side effect was xerostomia (13% guanfacine, 9% methyldopa). No significant differences were observed between treatment groups for the incidence of cardiac arrhythmias after methyldopa or guanfacine administration was stopped.(ABSTRACT TRUNCATED AT 250 WORDS)
Assessing the feasibility of bronchoplastic surgery with magnetic resonance imaging.
Bronchoplastic surgical techniques may allow resectional therapy for non-small cell lung carcinoma in select patients in whom preoperative pulmonary function demonstrates prohibitive risk for pneumonectomy. We report an otherwise poor candidate for pneumonectomy in whom coronal magnetic resonance imaging demonstrated the potential for distal bronchial salvage.
Antihypertensive efficacy of guanfacine and prazosin in patients with mild to moderate essential hypertension.
Guanfacine, an alpha 2 adrenoceptor agonist, was compared with prazosin hydrochloride for the treatment of patients with mild to moderate essential hypertension in an 8-week, double-blind, randomized, parallel evaluation to determine efficacy and safety. The study consisted of a 2-week screening/weaning period (phase I), a 3-week treatment period with chlorthalidone 25 mg every morning (phase II), and an 8-week double-blind treatment period with diuretic plus prazosin or guanfacine (phase III). Those who had an average seated diastolic blood pressure (BP) of 95 to 114 mm Hg at the end of the phase II period were eligible to enter the phase III period and were randomly assigned to chlorthalidone plus either guanfacine, 1 mg every night, or prazosin, 1 mg three times a day. Of the 102 patients who were randomly assigned to guanfacine or prazosin, 80% completed the entire study. Guanfacine and prazosin appeared to be equally effective and reduced seated as well as standing diastolic and systolic BP. The mean seated systolic and diastolic BP were reduced 11/9 mm Hg by guanfacine and 11/10 mm Hg by prazosin. The mean reduction in seated pulse was 3 beats/minute for guanfacine and no change with prazosin. Similar changes occurred in the standing position. Very few adverse effects were reported during the study. Adverse effects with an incidence of 5% or greater for either drug group were dizziness (6% guanfacine, 8% prazosin), xerostomia (6% guanfacine, 2% prazosin), and somnolence (0% guanfacine, 6% prazosin). Three patients (6%) in the prazosin group experienced symptoms of orthostasis requiring premature discontinuation of the drug and termination from the study.
Effect of levamisole on T cell in minimal change nephrotic syndrome.
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Persistent hyperplastic primary vitreous (PHPV in an adult--a case report).
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Alveolar cell carcinoma on CT scanning. The value of the air bronchogram sign.
The computed tomography findings in alveolar disease are described in a patient with alveolar cell carcinoma. The recognition of an air bronchogram on CT scanning may be useful in establishing the alveolar nature of diffuse or focal lung disease.
Haemostasis in leukaemia.
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Rifampicin-quinidine interaction.
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Hypercoagulable state in diGuglielmo's syndrome.
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Primary non-Hodgkins lymphoma of the rectum.
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Familial juvenile polyposis with adenomatous-carcinomatous change.
A family tree of 118 members with five members found to have juvenile polyposis-adenomatous change and four juvenile polyposis-adenomatous-carcinomatous change is presented. All the patients developed bleeding per rectum between 10 and 17 years of age. Four members died of colonic malignancy between 30 and 55 years of age. Colonoscopy in five living members revealed typical juvenile polyps throughout the whole length of the colon and atypical large lobulated polyps containing adenomatous change in juvenile polyps in the rectosigmoid area. An autosomal dominant mode of transmission was evident on analysis of the pedigree. Gastric hyperplastic polyps were present in three of the five living members. Familial juvenile polyposis may have the potential to progress into adenoma-carcinoma sequence and is not always a benign disorder. Colonoscopic surveillance should be done to detect adenomatous change if any member of the juvenile polyposis family develops colonic malignancy.
The role of selective beta 1-blocker in the preoperative preparation of thyrotoxicosis: a comparative study with propranolol.
Subtotal thyroidectomy was performed for hyperthyroidism on 130 patients; 95 treated before surgery with propranolol (Group I) and 35 given only metoprolol before surgery (Group II). These patient groups were compared with reference to preoperative medication, operative and immediate postoperative course, and late results with follow-up for one to five years. Clinical response was 100% in group II and 94.7% in group I. The median length of preoperative treatment was 7.96 +/- 1.84 days in group I and 6.25 +/- 1.73 days in group II (P less than 0.05). There were no serious adverse effects of the drugs in either treatment group. No anaesthesiologic or cardiovascular complication occurred during operation in either group. Ten patients in group I (10.5%) and six patients in group II (11.4%) observed hyperthyroid manifestations in the immediate postoperative period, eliminated by the administration of the propranolol/metoprolol, and no case of thyroid storm occurred. One patient in group II developed clinical hypocalcaemia. Two patients, one in each group, presented temporary unilateral recurrent laryngeal nerve paralysis. There were two recurrences of toxicity in group I (2.1%) and none in group II. Hypothyroidism occurred in 3 patients (2.3%) two of them were from group I and one was from group II. The postoperative hospital stay was 4.62 +/- 1.61 days in group I and 2.81 +/- 1.32 days in group II (P less than 0.05). One patient from group I died on the third postoperative day due to pulmonary oedema. The results suggest that metoprolol can be safely used and offers the advantages of desired clinical response, shorter preoperative preparation time, simplicity of dosage and shorter postoperative hospital stay in comparison to propranolol for preoperative treatment of hyperthyroidism.
Nutritional status in relation to socioeconomic level and nutritional knowledge.
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