Biomedical subjects
Publications and source records attributed to R Gupta.
Colonic atresia is usually managed surgically by resection and end-to-end anastomosis but preferably with a venting enterostomy, if presentation is delayed. A new technique of appendicostomy was performed as a venting enterostomy in eight cases of colonic atresia with good results in our children's hospital during the period 1990-1995.
A unique case of subsustentacular dislocation of the navicular is presented. The authors propose that such a severe displacement cannot occur until there is complete instability across the whole midfoot. The mechanism of injury and the treatment options are discussed. In the present case, there was late collapse of the foot into abduction because the lateral column was not primarily stabilized. Avascular necrosis is a common complication which leads to navicular collapse. A midfoot arthrodesis gave a good result in our patient.
Some patients with haematological neoplasms have features which overlap between a myelodysplastic syndrome and a myeloproliferative disorder. Two such patients are reported, both having sideroblastic erythropoiesis and thrombocytosis and one sequentially developing features of atypical chronic myeloid leukaemia, idiopathic myelofibrosis and acute megakaryoblastic leukaemia. The prevalence of thrombocytosis among cases of refractory anaemia with ring sideroblasts may be as high as 15-20% and has implications for choice of therapy.
The present study examines the relationships between risk taking, sensation seeking, and level of gambling involvement. The intent of this research was to investigate whether risk taking and/or sensation seeking are determinants in distinguishing pathological gamblers from problem gamblers and whether risk taking and gambling behavior for a university population are positively correlated for both males and females. Results indicated that the Risk-Taking Questionnaire (RTQ), the Arnett Inventory of Sensation Seeking (AISS), and the Sensation Seeking Scale (SSS) distinguished between probable/pathological gamblers and nonproblem gamblers with probable/pathological gamblers scoring the highest on each measure. However, the RTQ was the only measure able to distinguish probable/pathological gamblers from gamblers experiencing some problems relating to their gambling behavior. Females encountering some problems resulting from their gambling behavior consistently reported higher risk-taking and sensation seeking scores than males with no gambling problems. Results indicate that excessive gamblers are significantly greater risk takers than social gamblers, a finding which could prove useful in advising treatment regimens.
The role of early endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy in acute pancreatitis is controversial. Recent randomised controlled trials mostly support the value of this procedure, but concerns remain as to its safety, efficacy and practicability. This debate critically assesses the evidence for and against the use of early ERCP in acute pancreatitis.
Colles' fracture is the most common fracture seen in orthopedic practice, but no consensus has been reached on an effective method to maintain the initial reduction achieved. This prospective, randomized study of 50 patients evaluates the efficacy of maintaining reduction and consequent functional end results of two treatment methods, ie, percutaneous crossed-pin fixation followed by plaster of Paris cast immobilization with the wrist in functional position versus conventional plaster of Paris cast immobilization. The anatomical and functional end results were significantly better with percutaneous crossed-pin fixation at final follow-up.
High blood pressure (BP) is an important cardiovascular risk factor. Hypertension experts still debate on the level of BP considered abnormal. The currently accepted dividing line is systolic BP > or = 140 mm Hg and/or diastolic BP > or = 90 mm Hg based on epidemiological and intervention studies. In India, hypertension has become a major health problem. Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 40 years, more in urban than in the rural areas. This is converse to findings reported from developed countries where there is a significant decrease in its prevalence. Objectives of clinical evaluation of hypertensive individual are: To establish that BP is elevated, to seek evidence for a causal or contributory factor which may influence management, to assess target organ involvement and to assess relevant factors which will influence the particular mode of treatment to be adopted. Proper measurement techniques are important for diagnosis of hypertension. Canadian Coalition Guidelines are important in this regard. A basic, simple screening programme is the most appropriate policy for investigating the majority of hypertensive patients. Assessment of target organ involvement is important and can be obtained from history, physical examination or investigations. Studies of hypertension in general population have shown that secondary hypertension with high BP is present in 1.1% to 5.7% of subjects. Investigating all the hypertensive patients for secondary hypertension is not cost-effective and should be guided by history and clinical examination.
The present study was conducted to examine the usefulness of anti-C1q antibody as a marker of disease activity in Indian patients with systemic lupus erythematosus (SLE). We standardized the assay for detection of IgG anti-C1q antibody using ELISA. The normal cut-off level was determined by testing 57 healthy, age and sex matched controls to be 53 units/m1 (mean +/- 2 SD). Patients with SEL (97 females and 13 males) were studied and the following parameters were obtained on all: SLE disease activity index (SLEDAI), anti-C1q, anti-ds DNA and C3. Correlations were tested between these parameters using Spearman's rank correlation coefficients. Anti-C1q was found positive in 66 (60%) patients while anti-ds DNA was found in 78 (71%). The positive predictive values of anti-C1q and anti-ds DNA for lupus nephritis were 59 and 61 per cent respectively. The titres of anti-C1q correlated positively with SLEDAI (P < 0.01) and anti-ds DNA (P < 0.01) and negatively with C3 levels (P < 0.001). No significant correlation was observed between anti-C1q positivity and any particular organ involvement. Similarly, no correlation was found between anti-C1q and proliferative lupus nephritis. Anti-C1q was found positive in 5 of 9 patients with moderate SLEDAI scores and negative for anti-ds DNA antibody. It is concluded that anti-C1q antibody can serve as a general marker for lupus activity, supplementing the currently used serum markers.
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To determine presence of oxidant stress in chronic renal failure and to evaluate the efficacy of vitamin E in its amelioration, we studied 34 patients (Group I, age 32.4 +/- 11 years, M:F 3:1) and 10 healthy controls (Group II, age 27.4 +/- 5 years, M:F 4:1). The difference in baseline values of lipid peroxide (nmol/ml) was statistically significant (Group I 4.19 +/- 1.69, Group II 1.87 +/- 1.39, p = 0.004). Values of vitamin E (mg/l) were also significantly lower in Group I as compared to Group II (12.18 +/- 4.27 vs. 19.32 +/- 2.03, p = 0.003). Serum lipid peroxide values decreased significantly after supplementation with 400 mg/day of vitamin E for six weeks in Group I (4.19 +/- 1.69 to 3.21 +/- 1.13, p = 0.053) but not in Group II (1.87 +/- 1.39 to 1.03 +/- 0.87). Levels of vitamin E increased in both the groups (Group I: 12.18 +/- 4.27 to 16.01 +/- 5.13, Group II: 19.32 +/- 2.03 to 23.21 +/- 1.94, p < 0.005). No significant difference was observed in values of serum creatinine and urea before and after intervention.
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mRNA differential display RT-PCR has been extensively used for the isolation of genes differentially expressed between RNA populations. We have assessed its utility for the identification of developmentally regulated genes in plasmid cDNA libraries derived from individual tissues dissected from early mouse embryos. Using plasmid Southern blot hybridisation as a secondary screen, we are able to identify such genes and show by whole-mount in situ hybridisation that their expression pattern is that expected from the differential display profile.
A novel lipase from Aspergillus carneus has been used in organic solvents for efficient regioselective and chemoselective deacetylation of the peracetates of polyphenolic aromatic ketones, esters and amides. A reversal of regioselectivity was observed as compared with the results obtained during deacetylation with porcine pancreatic lipase (PPL).
OBJECTIVES: To measure the uptake of antenatal HIV testing and determine its relation to risk of HIV and to screening practices. DESIGN: Multicentre prospective questionnaire study. SUBJECTS: Pregnant women attending six maternity units. SETTING: Inner London, 1995-6. MAIN OUTCOME MEASURES: Uptake of testing by risk factors for HIV, ethnicity, and factors about the antenatal interview. RESULTS: All units had a "universal offer" policy for HIV testing. In five units forms were completed for 18,791 (88%) of 21,247 pregnant women. The sixth unit, where the response rate was too low to assess uptake, was excluded from the analysis. Uptake ranged from 3.4% to 51.2% (overall 22.9%), in parallel with detection of previously undiagnosed infection in pregnant women (4.9-60%). Controlling for unit, uptake was higher among the 7% who disclosed risk factors. Among those at low risk, uptake varied by ethnic group (South Asian women 9%; Latin American and Mediterranean women 33%). The relation between uptake and HIV risk category varied greatly across units. Despite increased HIV seroprevalence in black African women, uptake was similar in this group to that among women at low risk (24%). Uptake increased 2.1-fold if HIV transmission was discussed. Midwives reported spending 7 (2-15) minutes discussing HIV issues. CONCLUSIONS: Uptake of HIV testing was unacceptably low in all units, with maternity unit the strongest predictor. New approaches to antenatal HIV testing are urgently required and uptake should be audited routinely.
One hundred-twelve intracoronary stents (83 Palmaz-Schatz, 25 biliary, and 4 Gianturco-Roubin) were placed in 87 (51.7% male) patients aged > or = 70 years (70-93; mean 76.1) during a 1-year period. All stents were deployed using high-pressure inflation (mean 17.4 +/- 2 atm) without intravascular ultrasound. All patients received antiplatelet therapy with aspirin and ticlopidine. Seven patients additionally received warfarin at the physician's discretion. No patient was excluded from analysis regardless of presentation (40% acute myocardial infarction and 12.6% bailout) or complication. There were four deaths and two target vessel reinterventions in-hospital. One reintervention (a bailout) developed a non-Q-wave myocardial infarction. Bleeding, vascular complications, and length of stay were all greater for the warfarin group. The event-free survival rate was 83.9%, at an average of 8.6 months follow-up. A wide range of elderly patients can thus undergo stenting without intravascular ultrasound, usually without warfarin, yielding results comparable to those with more standard therapy in select populations.
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