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Biomedical subjects

R Guleria

Publications and source records attributed to R Guleria.

At least 37 records · Page 2Linked to original sources
PubMed1999

Functional magnetic stimulation of the abdominal muscles in humans.

Functional magnetic stimulation (FMS) of the thoracic nerve roots to simulate cough has been suggested as a treatment approach in patients unable to voluntarily activate the abdominal muscles. However, factors that could influence the efficacy of FMS in clinical use have not been evaluated. In the present investigation we studied train length, posture, and frequency to determine the optimal stimulation protocol. We also evaluated the use of a valve at the mouth to enhance glottic function and investigated whether lung volume at the time of stimulation would influence the tension generated by the abdominal muscles. Studies were performed using a Magstim rapid stimulator augmented by four booster packs in nine healthy subjects; we measured the change in gastric (DeltaPga(FMS)), esophageal (DeltaPes(FMS)), and mouth pressure and expiratory flow. With our apparatus pressure generation was maximized by having a train length of at least 300 ms and a frequency of 25 Hz. Posture and valve use were not important determinants of DeltaPga(FMS) or DeltaPes(FMS). Lung volume exerted only a minor influence on DeltaPga(FMS), but the ratio DeltaPes(FMS):DeltaPga(FMS) was increased at TLC compared with FRC. Expiratory flow was increased by adopting a seated posture and using an occlusion valve with an opening threshold close to the maximum DeltaPes(FMS) generated by the stimulus train; however, expiratory flow was susceptible to interference from glottic incoordination. Representative results (with train length 600 ms, 25 Hz, and 100% power, seated) were mean DeltaPga(FMS), 166 cm H(2)O; mean DeltaPes(FMS), 108 cm H(2)O; and mean expiratory flow, 311 L/min. We confirm that FMS of the abdominal muscles can generate a substantial positive intra-abdominal and intrathoracic pressure and, consequently, expiratory flow in normal subjects.

Abdominal Muscles↗
PubMed1996

Spontaneous rupture of spleen in viral hepatitis A.

A twenty-five year old man presented with history of fever, malaise and jaundice and developed a spontaneous rupture of the spleen during hospital admission. Investigations revealed deranged liver function tests and positive serology for hepatitis A.

Adult↗
PubMed1996

Dyspnoea, lung function & respiratory muscle pressures in patients with Graves' disease.

To understand the pathophysiology of dyspnoea in patients with hyperthyroidism, lung function, maximum inspiratory, expiratory respiratory muscle pressures (MIP and MEP) and intensity of dyspnoea (after six minutes walking test) were recorded in 12 consecutive patients with active Graves' disease. Reassessment was done after achieving euthyroidism with 8-12 wk of carbimazole therapy. Patients covered similar distance during 6 min walking before and after carbimazole therapy. However, there was a significant reduction in dyspnoea following euthyroidism. This was accompanied by significant decrease in respiratory rate, minute ventilation, forced expiratory volume in one second (FEV1%) and improvement in the forced vital capacity (FVC). No significant changes in tidal volume (TV) and maximum-midexpiratory flow rates (MMEFR), MIP and MEP were observed. Lung function parameters, MIP and MEP did not correlate with the severity of dyspnoea. Serum T4 levels correlated inversely with the distance covered during 6 min walking test, MIP and MEP. To conclude, increased breathing effort in presence of reduced FVC may lead to dyspnoea during hyperthyroid phase in patients with active Graves' disease. Lack of correlation between the severity of dyspnoea and abnormalities in lung function suggests that other mechanisms of dyspnoea may also operate in these patients.

Adult↗
PubMed1996

Study of pulmonary and autonomic functions of asthma patients after yoga training.

"The concept of yoga is helpful for the treatment of Bronchial Asthma", has created a great interest in the medical research field. In order to investigate whether autonomic functions and pulmonary functions are improved in asthma patients after short term yoga training, a study was conducted with nine diagnosed bronchial asthma patients. Yoga training was given for seven days in a camp in Adhyatma Sadhna Kendra, New Delhi. The autonomic function tests to measure the parasympathetic reactivity (Deep Breathing test, Valsalva Manouever), Sympathetic reactivity (Hand Grip test, Cold Pressure test), and pulmonary function tests FVC, FEV1, PEFR, PIF, BHT and CE were recorded before and after yoga training. The resting heart rate after yoga training (P < 0.05) was significantly decreased (89.55 +/- 18.46/min to 76.22 +/- 16.44/min). The sympathetic reactivity was reduced following yoga training as indicated by significant (P < 0.01) reduction in DBP after HGT. There was no change in parasympathetic reactivity. The FVC, FEV1, PEFR did not show any significant change. The PIF (P < 0.01), BHT (P < 0.01) and CE (P < 0.01) showed significant improvement. The results closely indicated the reduction in sympathetic reactivity and improvement in the pulmonary ventilation by way of relaxation of voluntary inspiratory and expiratory muscles. The "comprehensive yogic life style change programme for patients of Bronchial Asthma" have shown significant benefit even within a short period.

Adolescent↗
PubMed1995

Bronchoalveolar lavage in pulmonary tuberculosis: a decision analysis approach.

We assessed the utility of bronchoalveolar lavage (BAL) in the diagnosis of pulmonary tuberculosis (PTB) in 50 consecutive HIV-negative patients with clinical and radiographic findings suggestive of PTB, but with negative microscopy for acid-fast bacilli (AFB) on sputum smear. Patients were grouped, using a scoring system, into relative likelihoods of having PTB (I-IV, in descending probability). Patients were started on anti-tuberculosis treatment according to the BAL results. Bacteriological diagnosis of PTB was confirmed in 22/50 BAL; 11 (91.6%), seven (37%) and four (40%) of groups I-III, respectively. In 13 cases, an early diagnosis of PTB was made by positive microscopy for AFB on BAL; an alternative diagnosis was made in six cases (bacterial pneumonia 4, carcinoma 2). A decision analysis model was created to assess the overall utility of BAL. This suggested that in a region of high PTB prevalence, and when the clinical diagnosis of PTB is likely, empirical treatment is the best course of action, with BAL being reserved for further investigation of non-responders. Early BAL should be considered when the diagnosis of PTB is uncertain.

Adolescent↗
PubMed1993

Treatment of pulmonary aspergilloma by endoscopic intracavitary instillation of ketoconazole.

The authors report a case of pulmonary aspergilloma in which a fungus ball was visualized and a biopsy specimen was obtained at fiberoptic bronchoscopy. The fungus ball was successfully treated with bronchoscopic instillation of ketoconazole. It appears that this approach can be useful in the treatment of patients who are high-risk candidates for pulmonary resection.

Adult↗
PubMed1992

Pathogenesis of congestive state in chronic obstructive pulmonary disease. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery.

BACKGROUND: The pathogenesis of salt and water accumulation in patients with chronic obstructive pulmonary disease is unclear and may differ from that in patients with congestive heart failure due to myocardial disease. This study was undertaken to investigate some of the mechanisms involved. METHODS AND RESULTS: Hemodynamics, water and electrolyte spaces, renal function, and plasma hormone concentrations were measured in nine patients with edema due to chronic obstructive pulmonary disease and in six patients after recovery. Mean cardiac output (3.8 +/- 0.26 l/min.m2) was normal, but right atrial (11 +/- 1 mm Hg) and mean pulmonary arterial (41 +/- 3 mm Hg) pressures were increased. Mean pulmonary arterial wedge pressure (11 +/- 1 mm Hg) was normal. Pulmonary vascular resistance (8.6 +/- 1.3 mm Hg.min.m2/l) was increased, but systemic vascular resistance (19.3 +/- 1.3 mm Hg.min.m2/l) and mean arterial pressure (83 +/- 4 mm Hg) were low. All patients were hypoxemic (PaO2, 40 +/- 2 mm Hg) and hypercapnic (PaCO2, 60 +/- 2 mm Hg). There was a significant increase in total body water (+21%), extracellular volume (+45%), plasma volume (+45%), blood volume (+88%), and exchangeable sodium (+38.2%). Renal plasma flow was severely reduced (-63.2%), but glomerular filtration rate was only mildly decreased (-32%). Significant increases were seen in plasma norepinephrine (3.5-fold normal), renin activity (7.6-fold normal), vasopressin (twice normal), atrial natriuretic peptide (9.4-fold normal), growth hormone (10.7-fold normal), and cortisol (1.9-fold normal). After recovery, the PaO2 increased (50 +/- 3 mm Hg) and PaCO2 fell (45 +/- 4 mm Hg), and the patients became free from edema. All the body compartments returned toward normal, although they did not entirely reach normal values. Renal plasma flow increased significantly, and glomerular filtration became normal. Right atrial and pulmonary arterial pressures and pulmonary vascular resistance decreased (p less than 0.01). Cardiac output decreased but not significantly. Blood pressure increased but not significantly. However, systemic vascular resistance increased significantly to a normal value. CONCLUSIONS: We conclude that patients with edema due to chronic obstructive pulmonary disease have severe retention of salt and water, reduction in renal blood flow and glomerular filtration, and neurohormonal activation similar to that seen in patients with edema due to myocardial disease. However, unlike the latter, in chronic obstructive pulmonary disease cardiac output is normal, and systemic vascular resistance and arterial blood pressure are low. This probably is due to the vasodilator properties of hypercapnia. The consequent low arterial blood pressure may be the stimulus for the neurohormonal activation and retention of salt and water.

Adult↗
PubMed1992

Normal maximal expiratory and inspiratory pressures in healthy teenagers.

Maximal expiratory pressure at total lung capacity and maximal inspiratory pressure at residual volume were measured in 364 male and 325 female healthy teenage subjects. Predictive equations have been drawn based on coefficients of age, height and weight. The pressures may be used to evaluate respiratory muscle strength and follow the progress in patients with neuromuscular disorders, dyspnoea and respiratory failure.

Adolescent↗
PubMed1991

Comparison of bronchodilatation produced by an anticholinergic (ipratropium bromide), a beta-2 adrenergic (fenoterol) and their combination in patients with chronic obstructive airway disease. An open trial.

Fenoterol hydrobromide (200 micrograms), ipratropium bromide (40 micrograms) and a combination of the two in the same dosage were administered by metered dose inhaler on 3 separate days to 20 patients with chronic bronchitis and emphysema. On each day, baseline forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR) and mid maximum flow rate (MMFR) were recorded. The values were again recorded after administration of the drug at 15, 30, 45 and 60 minutes. Side effects if any were recorded. There was a significant increase from baseline in FVC and FEV1 with all the three regimens at 15, 30 and 45 minutes. However, the rise in MMFR was significant only with ipratropium bromide and the combination regimen. At 60 minutes, the rise in FVC, FEV1 and MMFR was significant only with the combination regimen. There was no significant change in the PEFR values at any time with any drug. The difference in rise in all the four parameters with the 3 regimens was not statistically significant. No side effects were noted. Thus, a combination fenoterol and ipratropium bromide produced a more prolonged bronchodilatation, and ipratropium bromide perhaps acts both in the major (indicated by rise in FEV1) and small airways (measured by MMFR).

Aerosols↗
PubMed1990

Pregnancy with heart disease. Experience at Postgraduate Institute of Medical Education and Research, Chandigarh.

Pregnant patients with heart disease seen between 1980 and 1985 were studied. The incidence of heart disease in pregnancy was 1.3%. Rheumatic heart disease was the commonest lesion (78%), followed by congenital heart disease (18.7%). In the rheumatic heart disease group, mitral stenosis was the commonest lesion (71.54%), and patients who had been or were operated on for their heart disease had less severe dyspnoea and fewer complications. The mode of delivery and the foetal and maternal mortality did not differ significantly in operated and non operated patients.

Female↗
PubMedDate not supplied

Biomarkers in cancer screening, research and detection: present and future: a review.

Biomarkers provide a powerful and dynamic approach to understanding the spectrum of malignancies with applications in observational and analytic epidemiology, randomized clinical trials, screening, diagnosis and prognosis. Defined as alterations in the constituents of tissues or body fluids, these markers offer a means for homogeneous classification of a disease and risk factor, and they can extend one's basic information about the underlying pathogenesis of disease. The goals in cancer research include finding biomarkers that can be used for the early detection of cancers, design individual therapies, and to identify underlying processes involved in the disease. Because so many myriad processes are involved in the diseased states, the goal is similar to 'finding a needle in a haystack'. However, the development of many -omic technologies, such as genomics and proteomics, has allowed us to monitor a large number of key cellular pathways simultaneously. This has enabled the identification of biomarkers and signalling molecules associated with cell growth, cell death and cellular metabolism. These are also facilitating in monitoring the functional disturbance, molecular and cellular damage, and damage response. This brief review describes the development of biomarkers in cancer research and detection with emphasis on different proteomic tools for the identification and discovery of new biomarkers, different clinical assays to detect various biomarkers in different specimens, role of biomarkers in cancer screening and last but not the least, the challenges in this direction of cancer research.

Biomarkers, Tumor↗
PubMedDate not supplied

Survival in small cell lung cancer in India: prognostic utility of clinical features, laboratory parameters and response to treatment.

BACKGROUND: Predictors of survival and response to treatment in patients with small cell lung cancer (SCLC) are ill-defined and unclear. In an attempt to assess the impact of common presenting symptoms and laboratory values on survival, we undertook this retrospective review of patients with SCLC. To our knowledge, there is no study on survival in SCLC patients from the Indian subcontinent. DESIGN: Retrospective Cohort study. MATERIALS AND METHODS: All newly diagnosed small cell lung cancer cases from December 2001 through December 2004, were identified and clinical data on presenting symptoms and laboratory findings from their hospital records, noted. The influence of various pretreatment factors on survival was investigated using Kaplan-Meier plots and Cox multivariate regression model. RESULTS: 76 subjects were included (84% males, 91% smokers). 57% patients had five or more symptoms at presentation. Cumulative symptom burden was strongly associated with survival (P =0.02). Survival was also significantly related with Karnofsky performance status (KPS) (P =0.04), disease extent (P =0.03) and symptomatic response to treatment (P< 0.001). Patients with higher hemoglobin (P =0.02), serum sodium (P =0.04) and serum globulin (P =0.02), survived significantly longer. By multivariate regression analysis, hemoglobin, KPS and brain metastases, were significant predictors of survival (P =0.01, P =0.02, P< 0.01 respectively). CONCLUSION: Cumulative symptom burden, KPS, disease extent and symptomatic assessment of improvement after treatment, are useful predictors of survival. This has important clinical implications, keeping in view, the infrastructure and cost involved in more objective tests like CT scan, for evaluation of disease extent and prognosis. These findings can provide a simple basis for predicting prognosis in small cell lung cancer, especially in developing countries like ours.

Aged↗
PubMedDate not supplied

Respiratory pressures in normal Indian subjects.

Regression equations for the prediction of maximum inspiratory pressures (MIP) in North Indian adults are reported, based on observations in 120 females and 153 males. Age and sex were the only significant predictor variables. MIP was significantly related to vital capacity, FEV1 and peak flow rate. The MIP observed in the present study are similar to those reported earlier in Caucasians and Chinese. The lower lung volumes and flow rates in Indians are not explained by differences in MIP.

Adult↗