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Biomedical subjects

R Arora

Publications and source records attributed to R Arora.

At least 127 records · Page 7Linked to original sources
PubMed1994

Immunological profile in congenital heart disease.

Fifty children with established congenital heart disease (CHD) were surveyed for the immune profile. Ventricular septal defect (VSD) was the commonest lesion (56%) followed by Tetralogy of Fallot (ToF; 16%), atrial septal defect (ASD; 8%), patent ductus arteriosus (PDA; 4%), transposition of great arteries (TGA; 4%), aortic stenosis (AS; 4%), and pulmonic stenosis (PS), tricuspid atresia (TA), single ventricle with pulmonic stenosis (SV with PS) and dextrocardia with ToF (2% each). Immunoglobulins (IgG, IgA and IgM) were estimated. IgG and IgA levels were significantly reduced in all children with congenital heart disease, whereas IgM levels were increased in cyanotic but unaffected in the acyanotic group. Complement C3 and C4 levels were reduced in all, more so in cyanotics. T-helper cells were decreased and T-suppressor cells were increased in all groups with congenital heart disease as compared to controls. B-cell percentage was increased in cyanotics but not affected in the acyanotics.

Antibody Formation↗
PubMed1994

Role of adrenal in establishment and development of conceptus in unilaterally ovariectomized mated rats.

The model of unilateral ovariectomy induced ovarian compensatory hypertrophy in mated bilaterally adrenalectomized rats was used to assess the role of adrenal in conceptus development. Replacement dose of dehydroepiandrosterone (DHA) or corticosterone (Comp. B) from day 2-14 post coitum was given with or without ip injections of estrogen (E, on day 2) and progesterone (P, on day 3 or 3-9). Replacement of adrenal hormones failed to support ipsilateral uterine horn (IP) pregnancy. But injections of E2 and P support IH pregnancy in variable percentages (about 38-75%) of rats depending on the type of adrenal steroids and single or multiple doses of P. Contralateral horn (CH) pregnancy developed under any of these conditions. Adrenalectomy induced reduction of fetal weight and pregnancy index (No. of fetus divided by No. of implantation sites), were not significantly improved by adrenal hormone replacement, except pregnancy index of those animals which received Comp. B and P. Adrenalectomy inhibited compensatory increase of contralateral corpus luteum (CL) volume and ovarian delta 5(3)beta-hydroxy steroid dehydrogenase (delta 5(3)beta-HSD) activity. Replacement of DHA or Comp. B induced these compensatory changes. Comp. B and P appears to be a better combination in establishment of IH pregnancy, pregnancy index maintenance and stimulation of ovarian compensatory changes. Results suggest that adrenocorticoids were not obligatory for conceptus development but were important for efficient action of ovarian steroids in establishment and maintenance of pregnancy. Relationship between nutrition or pituitary gonadotropins and adrenal steroids, having relevance to conceptus development has been discussed.

Adrenal Glands↗
PubMed1994

Eye casualty department.

A retrospective analysis of all new patients attending our eye casualty department was carried out during the 1 year period, from January to December 1987. During this time the casualty unit saw and treated 4905 new patients. Of these 40.61% were traumatic in origin, 30.52% comprised various ocular infections and the remaining 28.87% had miscellaneous ocular problems. On average, 13 new patients and seven consultations from other departments were seen and treated daily. Apart from the management of ocular emergencies, other functions provided by our department included glaucoma screening, donor eye collection, attending to referrals from other departments and eye health education.

Emergency Service, Hospital↗
PubMed1993

Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study.

Balloon mitral valvotomy (BMV) constitutes an important alternative to surgical closed mitral valvotomy (CMV) for the treatment of rheumatic mitral stenosis. To compare the immediate and long-term results of these procedures, 200 patients with rheumatic mitral stenosis were randomly assigned to undergo either BMV (n = 100) or CMV (n = 100). The age range was 10 to 30 (mean 19.4 +/- 6.5) years. Both procedures resulted in significant and similar increases in mitral valve area (BMV: 0.85 +/- 0.26 to 2.39 +/- 0.94 cm2; CMV: 0.79 +/- 0.21 to 2.2 +/- 0.85 cm2; p = NS). Mitral regurgitation developed in 14 patients after BMV and in 12 patients after CMV. Eighty patients in each group have now been followed for a mean period of 22 +/- 6.3 (range 6 to 38) months by repeat echocardiographic study. Restenosis (defined as a loss of more than 50% of the achieved increase in mitral valve area) was seen in four (5%) patients after BMV and in three (4%) after CMV. Symptomatic restenosis was seen in only one patient who at follow-up examination 20 months after CMV had a mitral valve area of 0.8 cm2 and underwent successful balloon valvotomy. We conclude that the immediate and long-term results obtained with percutaneous BMV and surgical closed mitral commissurotomy are comparable.

Adolescent↗
PubMed1993

Long-term results after balloon pulmonary valvuloplasty in adults.

Percutaneous balloon pulmonary valvuloplasty for congenital pulmonary valve stenosis was performed in 40 adult patients (aged 18 to 56 years). The duration of follow-up was 24.5 +/- 11.5 months. The peak systolic pressure gradient from the right ventricle to the pulmonary artery decreased from 107 +/- 29 mm Hg to 37 +/- 25 mm Hg immediately after the procedure. On follow-up, gradient obtained either by cardiac catheterization or Doppler echocardiography was 31 +/- 13 mm Hg. In eight patients with residual gradient after valvuloplasty of > 50 mm, the mean peak systolic gradient decreased from 74.5 +/- 18.3 to 33.5 +/- 13.9 mm Hg on follow-up. Thus balloon pulmonary valvuloplasty is a safe and effective procedure for the treatment of adult patients with pulmonic stenosis; there is a tendency for high residual gradients to regress on follow-up.

Adolescent↗
PubMed1993

Balloon angioplasty for renovascular hypertension in Takayasu's arteritis.

Percutaneous transluminal renal angioplasty was performed in 54 consecutive patients with hypertension and renal artery stenosis caused by Takayasu's arteritis. Angioplasty was technically successful in 67 (89.3%) of 75 lesions attempted. In these 67 lesions, the degree of stenosis decreased from 88.3 +/- 4.8% to 23.5% +/- 13.6% (p < 0.001) after angioplasty. Following successful angioplasty there was significant improvement in hypertension (p < 0.001) within 48 hours. Patients with bilateral renal artery stenosis had higher systolic blood pressure both before balloon dilatation (p < 0.05) and after balloon dilatation before discharge (p < 0.001), compared with patients with unilateral renal artery stenosis. Three to 70 months (mean 26.4 +/- 10.3 months) after successful angioplasty, blood pressure was reduced to normal or was improved in 93% of patients. Angiographic restudy an average of 14.2 +/- 7.8 months after angioplasty showed restenosis at the same site in 7 of 52 (13.5%) lesions and fresh stenosis in one artery. All these eight lesions were successfully dilated. Further improvement in the luminal diameter was observed in 11 (21.2%) lesions. Late angiographic restudy in seven patients an average of 56.1 +/- 6.3 months after angioplasty showed no restenosis. Our results suggest that balloon angioplasty is safe and highly effective in relieving renal artery stenosis caused by Takayasu's arteritis and should be the treatment of choice for renovascular hypertension in this disease.

Adolescent↗
PubMed1993

Cross-sectional echocardiographic left ventricular geometry in rheumatic mitral stenosis.

The ultrastructural myopathic changes and deranged left ventricular contractile function have been reported in patients with rheumatic mitral stenosis. It is not clear if as a result of these myopathic changes, global left ventricular myocardial remodelling occurs to alter its normal elliptical shape in the absence of qualitative segmental asynchrony. To study the left ventricular cavity shape independent of chamber size, cross-sectional echocardiographically measured longest long axis (L) of the left ventricular cavity in the apical four-chamber view and short axis diameters at the level of tips of the mitral leaflets in the parasternal long axis view (D-1), of the basal cavity (D-2) and the apical segment (D-3) in the apical four-chamber view at end-diastole and their ratio, were studied in 20 patients with isolated rheumatic mitral stenosis. Twenty healthy volunteers matched for age, sex, heart rate, height and body surface area provided the normal control data. The patients with mitral stenosis had shorter long axis diameter (7.2 +/- 0.7 vs 7.9 +/- 0.5 cm, p < 0.001) and greater short axis/long axis diameter ratios at every level with the most pronounced change in the apical segment of the cavity (D-3/L 0.49 +/- 0.09 vs 0.40 +/- 0.05, p < 0.001). Left ventricular end-diastolic sphericity index was also markedly increased in the patients with mitral stenosis (0.57 +/- 0.09 vs 0.40 +/- 0.05, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Atrial septal defect after balloon mitral valvuloplasty: a transesophageal echocardiographic study.

Fifty patients with rheumatic mitral stenosis aged twelve to thirty-six (twenty +/- six) years were studied by two-dimensional, pulsed and color Doppler echocardiography during, seventy-two hours after, and biweekly for three months after balloon mitral valvuloplasty (BMV). Transesophageal echocardiography (TEE) done immediately after BMV (in the catheterization laboratory) detected a new atrial septal defect (ASD) in 46 (92%) patients. These measured 1 to 2 (mean 1.2 +/- 0.3) mm in diameter. Doppler color flow mapping guided the location of the ASD in most of the cases. A narrow jet of left-to-right shunt could be evaluated by pulsed Doppler studies. Velocity time integral (VTI) of the jet across one cardiac cycle and the diameter of the ASD were used to calculate the left-to-right shunt (shunt = VTI x pi (D/2)2 x heart rate). The estimated shunt was 0.04-0.39 (mean 0.20 +/- 0.10) L/minute. A repeat study at seventy-two hours revealed the defect in 40 (80%) patients. At three months, the defect persisted in only 5 (10%) cases. The mean interval of closure of ASD was 4.6 +/- 2.2 weeks. The authors conclude: (1) ASD occurs commonly after BMV, (2) the septal defect and the resultant left-to-right shunt are insignificant, and (3) ASD disappears in the majority of cases by three months after BMV.

Adolescent↗
PubMed1993

Need of dietary energy at critical implantation time when local ovarian hormones are obligatory for conceptus development.

Role of dietary energy and local ovarian hormones in conceptus development in the rat was evaluated by giving ip injections of estrogen and progesterone under diet restricted and/or dextrose supplemented conditions, using the experimental model of ovarian compensatory hypertrophy. Replacement of estrogen on day 2 and progesterone on day 3 was necessary for conceptus development in the ipsilateral uterine horn after unilateral ovariectomy on day 2. Continuation of progesterone injection up to day 9 improved the percentage of conceptus development. Conceptus development was normal when unilateral ovariectomy was performed after day 2 of pregnancy. Compensatory increases in corpus luteum (CL) volume and the activity of delta 5 3 beta-hydroxy steroid dehydrogenase (3 beta-HSD) in contralateral ovary were observed after unilateral ovariectomy on day 2-4 of pregnancy. However, 70% diet restriction reducing the energy intake (from 90 to 27 kcal/rat/day) abolished the single dose hormone therapy effects in ipsilateral horn conceptus development and also reduced the effects of continued progesterone, percentage of contralateral horn conceptus development, compensatory changes in the CL volume and delta 5 3 beta-HSD activity of the contralateral ovary. However, dietary dextrose supplementation (increasing calorie intake from 27 to 56 kcal/rat/day) significantly improved/restored hormone response for conceptus development, compensatory changes of the CL volume and enzyme activity in contralateral ovary. The results suggest that day 2-3 of pregnancy is the critical time when local ovarian supply of estrogen and progesterone are obligatory for establishment and conceptus development in the rat. During this period adequate mobilizable source of energy is necessary for execution of hormonal message.

3-Hydroxysteroid Dehydrogenases↗
PubMed1992

Pulmonary venous flow dynamics before and after balloon mitral valvuloplasty as determined by transesophageal Doppler echocardiography.

The pattern of left atrial filling was studied in 14 patients with severe mitral stenosis in sinus rhythm before and immediately after successful balloon mitral valvuloplasty by transesophageal pulsed Doppler echocardiography of the left superior pulmonary vein. Mean mitral valve orifice area increased from 0.8 +/- 0.1 to 2.2 +/- 0.3 cm2 (p less than 0.0001), and left atrial mean pressure decreased from 30 +/- 5 to 12 +/- 4 mm Hg (p less than 0.0001) after the procedure. After balloon mitral valvuloplasty, significant increases in peak systolic pulmonary velocity (35 +/- 16 to 44 +/- 10 cm/s; p less than 0.01), systolic flow velocity time integral (3.3 +/- 1.5 to 5.9 +/- 2.0 cm; p less than 0.001) and the ratio of systolic/diastolic pulmonary venous flow velocity time integrals (0.8 +/- 0.4 to 1.4 +/- 0.5; p less than 0.001) were observed. An acute increase in mitral valve orifice area caused no significant changes in peak diastolic forward flow velocity (40 +/- 7 to 41 +/- 9 cm/s; p = not significant [NS]), diastolic forward flow velocity time integral (4.3 +/- 1.7 to 4.6 +/- 1.8 cm; p = NS) and atrial flow reversal velocity (30 +/- 3 to 35 +/- 3 cm/s; p = NS) compared with at baseline. The results suggest that in patients with severe mitral stenosis and sinus rhythm, left atrial filling is biphasic with a diastolic preponderance, and successful mitral valvuloplasty is associated with an immediate increase in pulmonary venous systolic forward flow.

Adult↗
PubMed1992

"Universal" T helper cell determinants enhance immunogenicity of a Plasmodium falciparum merozoite surface antigen peptide.

Synthetic peptide constructs containing a limited number of epitopes are being currently investigated as subunit vaccines against a variety of pathogens. However, because of widespread nonresponsiveness to most such constructs, possibly attributable to MHC restriction, the choice of appropriate carrier molecules to enhance immunogenicity of peptides constitutes an important and essential aspect of designing synthetic immunogens for human use. Widely used vaccines such as tetanus toxoid (TT) have not been uniformly effective as carrier proteins because of the phenomenon of epitope-specific suppression in which induction of an immune response against a synthetic peptide conjugated to TT is prevented by preexisting immunity to TT. Recently, T cell determinants that can be recognized in the context of several class II MHC molecules have been identified in tetanus toxin as well as in the circumsporozoite protein of a human malarial parasite, Plasmodium falciparum. Such determinants can be potentially used to circumvent the problem of epitope-specific suppression. In the present study we evaluated two such T cell determinants, viz., tt830-844 from tetanus toxin and CST3 from the malarial parasite, for their ability to help induce a boostable antibody response and to overcome genetic nonresponsiveness to a synthetic 20-residue construct containing a B cell and an overlapping T cell epitope from a major merozoite surface protein of P. falciparum. Our data provide support for the view that widely recognized T cell determinants may be used as universal carrier molecules for general vaccination.

Adolescent↗
PubMed1992

Breast metastases from malignant melanoma.

We review here 15 patients with cutaneous malignant melanomas metastatic to the breast. All but one were premenopausal females with a median age of 38 years. Most patients had a primary lesion on the upper extremities or trunk (80%), with only one patient having a lower extremity primary. The median interval between diagnosis of the primary and breast involvement was 33 months, with one patient developing breast involvement 11 years later, at the time of her second pregnancy. Five patients had bilateral breast involvement, and all had other sites of metastases at the time of diagnosis. The median survival after diagnosis of breast metastases was 10 months, portending a poor prognosis.

Adult↗
PubMed1992

Balloon angioplasty of native coarctation of the aorta in adolescents and young adults.

Balloon angioplasty of native coarctation of the aorta was performed in 35 consecutive adolescents and young adults, aged 14 to 37 years (mean 22.6 +/- 7.1). Twenty-eight (80%) patients had isolated discrete coarctation, six (17.1%) had tubular hypoplasia of the aortic isthmus, and one (2.9%) had hypoplasia of the post-coarctation aorta. The peak systolic pressure gradient decreased from 78.5 +/- 23.9 to 15.7 +/- 11.6 mm Hg (p less than 0.001), and the mean coarctation diameter increased from 4.7 +/- 2.4 to 13.1 +/- 2.7 mm (p less than 0.001) immediately after angioplasty. Patients with discrete-type coarctation had significantly less residual gradient than patients with long-segment tubular coarctation (12.3 +/- 10.7 vs 27.2 +/- 6.6 mm Hg, p less than 0.01). On recatheterization and angiography in 26 patients at 12.6 +/- 1.5 months after dilatation, there was no significant change in gradient (15.5 +/- 13.3 mm Hg) and diameter (13.1 +/- 1.8 mm) from the immediate post-angioplasty results. However, two patients had an increase in gradient and three had small aortic aneurysms with no change in appearance on restudy after 2 years. After 3 to 67 months' (mean 32.7 +/- 19.2) follow-up, all patients showed continued clinical improvement. Hypertension was relieved in 37.5% (12/32) and improved in 59.4% (19/32). Our experience suggests that balloon angioplasty of native aortic coarctation in adolescents and young adults is safe and highly effective with sustained improvement on intermediate-term follow-up.

Adolescent↗