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Biomedical subjects

R Gupta

Publications and source records attributed to R Gupta.

At least 235 records · Page 13Linked to original sources
PubMed2001

Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy).

In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study.

OBJECTIVES: To evaluate the effects of Trigonella foenum-graecum (fenugreek) seeds on glycemic control and insulin resistance, determined by HOMA model, in mild to moderate type 2 diabetes mellitus we performed a double blind placebo controlled study. METHODS: Twenty five newly diagnosed patients with type 2 diabetes (fasting glucose < 200 mg/dl) were randomly divided into two groups. Group I (n=12) received 1 gm/day hydroalcoholic extract of fenugreek seeds and Group II (n=13) received usual care (dietary control, exercise) and placebo capsules for two months. RESULTS: At baseline both the groups were similar in anthropometric and clinical variables. Oral glucose tolerance test, lipid levels, fasting C-peptide, glycosylated haemoglobin, and HOMA-model insulin resistance were also similar at baseline. In group 1 as compared to group 2 at the end of two months, fasting blood glucose (148.3 +/- 44.1 to 119.9 +/- 25 vs. 137.5 +/- 41.1 to 113.0 +/- 36.0) and two hour postglucose blood glucose (210.6 +/- 79.0 to 181.1 +/- 69 vs. 219.9 +/- 41.0 to 241.6 +/- 43) were not different. But area under curve (AUC) of blood glucose (2375 +/- 574 vs 27597 +/- 274) as well as insulin (2492 +/- 2536 vs. 5631 +/- 2428) was significantly lower (p < 0.001). HOMA model derived insulin resistance showed a decrease in percent beta-cell secretion in group 1 as compared to group 2 (86.3 +/- 32 vs. 70.1 +/- 52) and increase in percent insulin sensitivity (112.9 +/- 67 vs 92.2 +/- 57) (p < 0.05). Serum triglycerides decreased and HDL cholesterol increased significantly in group 1 as compared to group 2 (p < 0.05). CONCLUSIONS: Adjunct use of fenugreek seeds improves glycemic control and decreases insulin resistance in mild type-2 diabetic patients. There is also a favourable effect on hypertriglyceridemia.

Adult↗
PubMed2001

Changing pattern of biotypes, phage types & drug resistance of Salmonella typhi in Ludhiana during 1980-1999.

BACKGROUND & OBJECTIVES: Ludhiana, an industrial city of Punjab, has a large floating population where typhoid has become endemic. A retrospective study was carried out over a period of 20 years (1980-1999) at Ludhiana on the biotyping, phage typing and drug resistance pattern of Salmonella typhi. METHODS: Of a total of 1697 S. typhi isolates obtained, phage typing and biotyping were done of only 1243 isolates. Antimicrobial susceptibility pattern of these isolates was also studied. RESULTS: Of the 1243 S. typhi isolates, 963 (77.5%) and 280 (22.5%) were of biotype I and biotype II respectively. Twenty four different S. typhi phage types were prevalent in Ludhiana in the past two decades. Between 1980 and 1989, more prevalent phage types were phage type A (35%), O (17.6%) and E1 (15.1%). During 1990-1999, there was a considerable increase in the incidence of phage type E1 (48.1%). The cumulative analysis of past two decades revealed that the incidence of phage type E1 (38.8%) was most predominant. In the past one decade (1990-1999), 412 S. typhi isolates of 13 different phage types exhibited multidrug resistance (MDR) pattern ACCoT (resistant to ampicillin, chloramphenicol, co-trimoxazole and tetracycline). High chloramphenicol resistance (74.7%) and MDR pattern ACCoT (68.2%) was shown by phage type E1 of S. typhi. INTERPRETATION & CONCLUSION: An association was observed between drug resistance and phage type pattern of S. typhi as 70 per cent isolates of S. typhi phage types E1 and O exhibited ACCoT multidrug resistant pattern. Reemergence of chloramphenicol susceptibility in the last decade emphasizes the need for regular antimicrobial surveillance to minimize the misuse of these drugs.

Anti-Bacterial Agents↗
PubMed2001

Importance of patient/parents education in childhood asthma.

Asthma is fairly common in pediatric age group and the suffering due to asthma continues to increase despite excellent treatments available. One of the four major components of asthma management is patient education and is critical to the success of asthma management. Reasons for continued suffering include that our management strategies are not easily understood by the patient/parents without a simple and careful approach towards this step. Eliciting common concerns and fears is the single and foremost strategy to develop a relationship of trust with the patients/parents. Making them understand about the chronic nature of asthma, need for a long-term care approach, what happens during acute attacks and where medications act are some of the important areas you should be educating about in the beginning. Then comes the skill transfer, i.e. giving them skills to monitor asthma including use of peakflowmeter and use of inhalation devices effectively. Joint development of written plans for medications is essential. Development of plans to control of asthma; jointly with them; including learning about warning signs and a plan to manage acute attack at home is also very important and patient/parents should be having an active participation. Finally, educating them how to identify asthma triggers helps as a long-term strategy to keep control over asthma with or without medications. Reminding patient/parents when to come for follow-up and what would be discussed next time are some important tricks of the trade.

Adaptation, Psychological↗
PubMed2001

Prevalence of coronary risk factors among Indian physicians.

BACKGROUND AND OBJECTIVES: Prevalence of coronary risk factors has not been well studied in Indian physicians, therefore, to determine prevalence of selected lifestyle and biochemical coronary risk factors we performed this study. METHODS: Physicians attending a national conference were invited to participate. Of the 1000 questionnaires circulated 256 physicians (221 males, 35 females) responded and were examined for presence of smoking, obesity, truncal obesity, hypertension and ECG abnormalities. Two hundred and thirty four physicians (91.4%, 203 males, 31 females) underwent a fasting blood examination for determination of glucose and lipid profile. Subjects were divided into three age groups: Group I aged < 40 years; Group II 40-49 years; and Group III > or = 50 years. RESULTS: Mean age of the study population was 41.7 +/- 9.3 years (range 26-70). There was no significant difference in the distribution of height, weight, body-mass index (BMI), waist and hip circumference and waist-hip ratio (WHR) in different age-groups. Systolic blood pressure (BP) and fasting glucose and triglyceride levels increased with age in both males and females, while diastolic BP, total - LDL and HDL cholesterol levels did not change. Smoking or tobacco use was seen in five males (2.3%). Prevalence of obesity (BMI > or = 25.0 kg/m2) was in 104 (48.6%) males and 18 (51.4%) females. Truncal obesity diagnosed by WHR > 0.9 in males and > 0.8 in females was in 160 (72.4%) males and 23 (65.7%) females and a large waist circumference, > or = 100 cm in males and > or = 90 cm in females, was in 58 (26.2%) males and 7 (20.0%) females. Hypertension (> or = 140/90) was in 74 (33.5%) males and 7 (20%) females. A high prevalence of diabetes diagnosed using fasting blood glucose > or = 126 mg/dl or previous history was noted in males 19 (9.4%), females 4 (12.9%). Prevalence of high total cholesterol levels > or = 200 mg/dl was in 91 (44.8%) males and 10 (32.3%) females. High LDL cholesterol level (> or = 100 mg/dl) was in 144 (70.9%) males and 22 (70.9%) females and LDL levels > or = 130 mg/dl in 70 (34.5%) males and 9 (29.0%) female physicians. High triglyceride levels (> or = 200 mg/dl) were in 38 (18.7%) males and 4 (12.9%) females. Electrocardiographic abnormalities were present in seven subjects: Q-waves in two males and one female and ST-T changes in three males and one female. BMI correlated significantly (p < 0.05) with systolic BP, fasting glucose, and triglycerides and WHR with systolic BP, diastolic BP, fasting glucose, cholesterol and triglyceride levels. CONCLUSIONS: There is a high prevalence of obesity, truncal obesity, hypertension and hypercholesterolaemia in Indian physicians while smoking, low HDL cholesterol and hypertriglyceridemia is low. The overall coronary risk is lower among Indian physicians as compared to previous Indian population studies.

Adult↗
PubMed2001

Epithelioid haemangioendothelioma of the rib--a case report.

Epithelioid haemangioendothelioma is a rare primary malignant tumour of the bone that accounts for less than 1% of all primary bone malignancies. The case discussed here is of a 35 years old male who presented with gradually increasing left infrascapular mass attached to 10th rib. X-ray showed an expansile lytic lesion in 10th rib. On FNA the diagnOsis of fibrous dysplasia or fibrous-histiocytic lesions was suggested. The lesion was excised along with adjacent rib. Histopathological examination showed features of epithelioid haemangioendothelioma. Immunohistochemistry revealed focal factor VIII related antigen positivity.

Adult↗
PubMed2000

Pseudomonas aeruginosa community-acquired pneumonia in previously healthy adults: case report and review of the literature.

We report a case of rapidly fatal Pseudomonas aeruginosa community-acquired pneumonia (CAP) in a previously healthy 67-year-old woman. Eleven published case reports of P. aeruginosa CAP in previously healthy adults are reviewed. According to our review, the mean age of affected patients is 45.3 years. Five patients described in the literature were smokers with a mean smoking history of 40 pack-years. The clinical presentation is nonspecific, and although the pneumonia can be rapidly fatal, only 33% of the patients who were reported died. However, mortality may be independent of treatment within the first 36 hours of presentation. Exposure to aerosols of contaminated water is a risk factor for P. aeruginosa CAP in this population. Pseudomonas CAP should be considered in the differential diagnosis for anyone with a smoking history who presents with rapidly progressive pneumonia. We discuss treatment recommendations that are based on evidence in the currently available literature on the subject.

Adult↗
PubMed2000

Structural basis for the recognition of DNA repair proteins UNG2, XPA, and RAD52 by replication factor RPA.

Replication protein A (RPA), the nuclear ssDNA-binding protein in eukaryotes, is essential to DNA replication, recombination, and repair. We have shown that a globular domain at the C terminus of subunit RPA32 contains a specific surface that interacts in a similar manner with the DNA repair enzyme UNG2 and repair factors XPA and RAD52, each of which functions in a different repair pathway. NMR structures of the RPA32 domain, free and in complex with the minimal interaction domain of UNG2, were determined, defining a common structural basis for linking RPA to the nucleotide excision, base excision, and recombinational pathways of repairing damaged DNA. Our findings support a hand-off model for the assembly and coordination of different components of the DNA repair machinery.

Amino Acid Sequence↗
PubMed2000

Skill-mix. Seams good to us.

Greater use of GPs, both in general practice and hospitals, could reduce waiting times for hospital services. PCGs might consider developing some specialist services. The development of GP specialists should be considered. Allowing GPs with a special interest in surgery to perform some hospital surgery would reduce pressure on consultants' lists.

Clinical Competence↗
PubMed2000

Timing the ancestor of the HIV-1 pandemic strains.

HIV-1 sequences were analyzed to estimate the timing of the ancestral sequence of the main group of HIV-1, the strains responsible for the AIDS pandemic. Using parallel supercomputers and assuming a constant rate of evolution, we applied maximum-likelihood phylogenetic methods to unprecedented amounts of data for this calculation. We validated our approach by correctly estimating the timing of two historically documented points. Using a comprehensive full-length envelope sequence alignment, we estimated the date of the last common ancestor of the main group of HIV-1 to be 1931 (1915-41). Analysis of a gag gene alignment, subregions of envelope including additional sequences, and a method that relaxed the assumption of a strict molecular clock also supported these results.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Interferon-gamma- and lipopolysaccharide-induced tumor necrosis factor-alpha is required for nitric oxide production: tumor necrosis factor-alpha and nitric oxide are independently involved in the killing of Mycobacterium microti in interferon-gamma- and lipopolysaccharide-treated J774A.1 cells.

A comparative study was done using J774A.1 and J774A.1-derived transfected cells (J774A.1 C.1) containing antisense tumor necrosis factor alpha (TNF-alpha) plasmid to determine the role of endogenous TNF-alpha on nitric oxide production as well as on the growth of Mycobacterium microti in interferon gamma (IFN-gamma)- and lipopolysaccharide (LPS)-treated cells. On stimulation with IFN-gamma and LPS a higher level of NO was observed in J774A.1 cells compared to J774A.1 C.1 which indicated that endogenous TNF-alpha is required for the production of NO. Comparing the effect of IFN-gamma and LPS on the intracellular growth of M. microti, the growth-reducing activity was higher in J774A.1 cells than in J774A.1 C.1 cells and was not completely abrogated in the presence of the nitric oxide inhibitor NG-methyl-L-arginine (L-NMA). J774A.1 C.1 cells infected with M. microti produced a significant amount of NO when exogenous TNF-alpha was added along with IFN-gamma and LPS and the concentration of intracellular bacteria decreased almost to that in IFN-gamma and LPS treated parental J774A.1 cells. Addition of exogenous TNF-alpha even in the presence of L-NMA in J774A.1 C.1 cells could also partially restore intracellular growth inhibition of M. microti caused by IFN-gamma and LPS. TNF-alpha is probably required for the production of NO in J774A.1 cells by IFN-gamma and LPS but TNF-alpha and NO are independently involved in the killing of intracellular M. microti with IFN-gamma and LPS.

Animals↗
PubMed2000

Bilateral sternoclavicular joint tuberculosis.

A unique case of bilateral sternoclavicular tuberculosis is presented, with discussion of the possible mechanism of infection. Early diagnosis is mandatory for good results, and with a world-wide resurgence of this disease, a high index of suspicion is mandatory (especially in immunocompromised patients and migrant populations). Computed tomography and magnetic resonance imaging are helpful for defining the exact extent of the disease.

Adult↗
PubMed2000

The early assessment and intensive care unit management of patients with severe traumatic brain and spinal cord injuries.

The assessment and management of neurotrauma have progressed significantly over the past several years. Improved understanding of the physiology of injured neural tissue and advances in technology have refined the approach to the care of patients suffering neurologic injury. Evidence-based clinical management guidelines, such as those developed by the Brain Trauma Foundation and the American Association of Neurological Surgeons, for the management of traumatic brain injury have been introduced to standardize certain aspects of care. The ongoing evolution of critical care also has had a significant impact on the care of patients suffering from neurotrauma. This article reviews some current issues related to the diagnosis and management of traumatic brain injury and spinal cord injury as we head into the next millennium.

Brain Injuries↗