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Biomedical subjects

R Gupta

Publications and source records attributed to R Gupta.

At least 937 records · Page 52Linked to original sources
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Lipid abnormalities in coronary heart disease: a population-based case-control study.

BACKGROUND: We performed a case-control study to estimate lipid-cholesterol fractions in patients with coronary heart disease and compared them with population-based controls. METHODS AND RESULTS: A total of 635 newly diagnosed patients with coronary heart disease (518 males and 117 females) and 632 subjects (346 males and 286 females) obtained from an ongoing urban coronary heart disease risk factor epidemiological study were evaluated. Age-specific lipid values (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, and total:high-density lipoprotein cholesterol ratio) were compared using the t-test. Age-adjusted prevalence of dyslipidemia as defined by the US National Cholesterol Education Program was compared using the Chi-square test. In all the age groups, and in both males and females, levels of total and low-density lipoprotein cholesterol were not significantly different. In males, the high-density lipoprotein cholesterol (mg/dl) was significantly lower in patients with coronary heart disease as compared to controls in the age groups 30-39 years (35.1+/-11 v. 43.7+/-9), 40-49 years (39.0+/-10 v. 47.1+/-8), 50-59 years (38.9+/-11 v. 43.8+/-9) and 60-69 years (38.6+/-11, v. 42.8+/-7) (p<0.05). In females, high-density lipoprotein cholesterol was less in the age groups 30-39 years (30.2+/-9 v. 40.7+/-9), 50-59 years (39.7+/-12 v. 44.7+/-8) and 60-69 years (35.6+/-11 v. 42.2+/-9). The level of triglycerides was significantly higher in male patients in the age groups 40-49 years (195.3+/-96 v. 152.8+/-78), 50-59 years (176.7+/-76 v. 162.9+/-97), 60-69 years (175.5+/-93 v. 148.1+/-65) and >70 years (159.8+/-62 v. 100.0+/-22); and in female patients in the age group 30-39 years (170.8+/-20 v. 149.9+/-9) (p<0.05). The total:high-density lipoprotein cholesterol ratio was significantly higher in all age groups in male as well as female patients with coronary heart disease (p<0.05). CONCLUSIONS: An age-adjusted case-control comparison showed that the prevalence of hypertension, diabetes, high total cholesterol (> or =200 mg/dl) (males 48.8% v. 20.2%; females 59.8% v. 33.4%) and high low-density lipoprotein cholesterol (> or =130 mg/dl) (males 42.1% v. 15.0%; females 52.1% v. 31.0%) was significantly more in cases than in controls. The prevalence of low high-density lipoprotein cholesterol (<35 mg/dl) (males 39.6% v. 6.2%; females 39.3% iv 9.5%), high total:high-density lipoprotein ratio (> or = 5.0) and high triglycerides (> or =200 mg/ dl: males 39.6%, v. 10.2%; females 17.1% v. 11.9%) was also significantly higher in cases (p<0.05).

Adult↗
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Indigenous rapid diagnostic method for Escherichia coli O157:H7.

Rapid methods for detection of Escherichia coli O157: H7 diarrhoea are preferred to limit differential diagnostic evaluation including invasive procedures. Fifty stool samples from children and adult patients having diarrhoea and ten control samples from volunteers without diarrhoea were collected. Each sample was inoculated into two tubes containing peptone water and one containing MacConkey broth. They were incubated for 5 hours or longer till growth occurred. The first tube of peptone water with growth was tested for production of indole. All samples were tested for enzyme beta-glucuronidase in the pellet of the second peptone water growth. The MacConkey broth growth was tested with latex beads sensitized separately with antisera to E. coli O157 and E. coli H7. All indole positive and beta glucuronidase negative samples with positive agglutination with E. coli O157 and H7 coated latex beads were taken as E. coli O157: H7 positive samples. Three out of 50 diarrhoeic samples were found to be positive for E. coli O157:H7. Confirmation of the results of our rapid assay was done by parallel conventional culture of faecal specimens on sorbitol MacConkey agar. Our rapid assay required only 7-10 hours compared to the conventional technique where the report is available only on the third day. It can therefore be used routinely for initial screening of faecal specimens for E. coli O157: H7.

Adult↗
PubMedDate not supplied

Long term follow up study of prognostic significance of exercise duration during treadmill stress test in patients with stable coronary heart disease.

Treadmill stress tests provide useful noninvasive prognostic information in patients with coronary heart disease (CHD). The present study has prospectively analysed the long term prognostic value of exercise tolerance as measured by exercise time during treadmill stress test in 335 consecutive patients with stable CHD. 161 had exercise time of 6 minutes or less (mean 4.58 +/- 1.54 minutes) on a modified protocol (Group A) and 174 had exercise time of more than 6 minutes (mean 9.30 +/- 0.74 minutes)(Group B). Both groups were matched for major coronary risk factors (hypertension, smoking, diabetes and cholesterol levels) and type of drug therapy (betablockers, nifedipine, diuretics and aspirin). The patients have been followed up for upto 9 years with a mean of 6.28 +/- 2.99 years (Group A) and 7.87 +/- 1.98 years (Group B). Actuarial analysis shows that the overall survival after dropout due to death or coronary artery bypass surgery was significantly lower in group A [dropouts = 66 (41.0%)] than in Group B [dropouts = 19 (10.9%)] (Logrank test = 39.94, p < 0.001). The mortality was significantly higher in Group A with 58 deaths (36.0%) as compared to Group B with 16 deaths (9.2%) (x2 = 34.98, p < 0.001). The crude death rate was 5.73% per year in Group A as compared to 1.17% per year in Group B. The incidence of sudden deaths was also higher in Group A with 28(17.4%) instances as compared to 5(2.9%) in Group B (x2 = 19.85, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
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Total cholesterol and mortality in patients with pre-existing coronary artery disease.

BACKGROUND: A positive correlation exists between serum cholesterol levels and cardiovascular mortality. However, the role of serum cholesterol in persons with pre-existing coronary artery disease is not clear. METHODS: A cohort of 524 patients with coronary artery disease was divided into four groups based on the total serum cholesterol values. Group I consisted of 68 patients with cholesterol levels of 200 mg/dl or less; Group II of 116 patients with cholesterol levels between 201 and 220 mg/dl; Group III of 187 patients with levels between 221 and 240 mg/dl and Group IV of 153 patients with cholesterol levels greater than 240 mg/dl. RESULTS: Actuarial survival analysis over an 11-year follow up did not show any overall difference in mortality between these groups (Logrank test statistic = 1.89, p > 0.1). Analysis after adjustment of the data also showed that mortality rates were not different (chi (2) = 4.73, p > 0.05). Hazard function analysis indicated that death rates per thousand person years of follow up were 49.97 +/- 8.4 in Group I, 41.38 +/- 8.4 in Group II, 55.39 +/- 4.4 in Group III and 45.38 +/- 6.4 in Group IV. These were also not statistically significant. Comparison of mortality rates in patients with angina pectoris and past myocardial infarction also showed similar results. CONCLUSION: Total serum cholesterol levels do not influence long term survival in patients with pre-existing coronary artery disease.

Actuarial Analysis↗
PubMedDate not supplied

A comparative study of clinico-radiological spectrum of tuberculosis among HIV seropositive and HIV seronegative patients.

BACKGROUND: A study to determine the prevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients and to compare the clinico-radiological spectrum of tuberculosis among HIV seropositive and seronegative patients was carried out in the Department of TB and Chest Diseases, CSM Medical University, Lucknow (Uttar Pradesh), India. METHODS: A total of 1105 radiologically and/or bacteriologically confirmed patients of tuberculosis were screened for HIV infection during the years 1995 to 1997 and from 2000-2001. RESULTS: Out of a total 1105 patients screened, 31(2.8%) were found to be HIV seropositive. Tuberculin positivity was less among HIV seropositive patients as compared to HIV seronegative patients (22.6% vs 76.4%; p < 0.001). There was no statistically significant difference in sputum smear positivity for acid-fast bacilli (AFB) among HIV seropositive and seronegative patients. Among HIV seropositive patients, mid and lower zone involvement, exudative lesions and mediastinal lymphadenopathy was more common as compared to the seronegative patients. CONCLUSION: HIV seropositivity rates among tuberculosis patients was 2.8 percent. The presentation of tuberculosis was more often atypical among these patients.

Adolescent↗
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Factors to focus on.

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Antineoplastic Agents↗
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Healing physiology.

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Humans↗
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Mycoplasma pneumonia associated with rhabdomyolysis and the Guillain-Barre syndrome.

A 25-year-old housewife who presented with Mycoplasma pneumonia who developed acute respiratory distress syndrome (ARDS) and required assisted ventilation. During her hospital stay, she developed acute renal failure because of rhabdomyolysis and was put on haemodialysis. She also had difficulty in weaning from ventilator because of acute motor-sensory axonal neuropathy (AMSAN) variant of the Guillain-Barre syndrome. The patient was treated with antibiotics and corticosteroids. The patient recovered from both the complications gradually.

Acute Kidney Injury↗
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Primary malignant melanoma of cervix - a case report.

Primary malignant melanoma is a rare neoplasm involving the uterine cervix. It may be misdiagnosed especially when amelanotic, in which case immunohistochemistry is useful in reaching the diagnosis. Though its staging and treatment are not yet well codified, prognosis is generally poor and unpredictable and hence early diagnosis is needed. We present the case of a 39-year-old female patient presenting with bleeding per vaginum. Speculum examination revealed an ulcero-proliferative growth involving the cervix. Microscopic examination of the tumor showed sheets of predominantly monomorphic cells, with few cells showing dark-brown pigment. The cells were positive for S-100 and HMB-45. In view of presence of subtle epitheliotropism, diagnosis of primary melanoma was entertained. Primary cervical melanoma should be considered while diagnosing cervical neoplasms, especially those displaying prominent eosinophilic nucleoli, even though this feature may be present only focally. Special staining and immunohistochemistry should be resorted to, whenever needed, to reach the diagnosis as early as possible. This is essential since cervical melanoma is incurable with the currently available therapies.

Adult↗
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Prognostic value of profound ST segment depression during treadmill stress test in coronary heart disease: nine years follow-up study.

To define the prognostic significance of profound ST segment depression (greater than or equal to 3mm) during exercise test, 106 patients of definite coronary heart disease enrolled in a prospective study were followed for up to 9 years. Group A (56 patients) had profound (greater than or equal to 3mm) ST segment depression (3.56 +/- 0.74mm) and Group B (50 patients) had less than 3mm ST segment depression (1.23 +/- 0.35mm, P less than 0.01) during treadmill testing. Group A patients tolerated exercise for a lesser duration in comparison to group B patients (7.22 +/- 3.35 vs. 10.18 + 4.07 minutes, p less than 0.01). At the end of the study, 21 (37.5%) group A patients either died or underwent coronary artery bypass surgery as compared to 8 (16.0%) group B patients (p = 0.02). The difference in the incidence of cardiac deaths between the two groups was not statistically significant (19.6% in group A and 14.0% in group B). However, sudden deaths were significantly more common in group A as compared to group B patients (10 of 11 (90.9%) vs 4 of 7 (57.1%), p = 0.02). These data suggest that profound ST segment depression (greater than 3mm) during treadmill stress test indicates an adverse long term prognosis with the risk in particular, of sudden cardiac death.

Adult↗
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Norms and clinical correlates of echocardiographic left ventricular mass in 3-12 year old children.

To determine norms for left ventricular mass (LVM) and correlate it with various demographic and clinical parameters 213 school children were examined using two dimensional echocardiography. The data of 183 children (108 boys, 75 girls) where no cardiovascular abnormality was found has been analysed. The mean age +/- SEM was 6.79 +/- 0.15 years. The mean LVM was 40.47 +/- 1.12 gm (40.05 +/- 1.45 gm in males; 41.06 +/- 1.79 gm in females; p greater than 0.6). Mean LVM index (grams/metre height) was 34.30 +/- 0.80 (male = 33.46 +/- 1.06; female = 35.45 +/- 1.22; p = 0.9). On univariate analysis, a significant positive correlation of LVM with age, (r = 0.57), height (r = 0.57), weight (r = 0.58) and chest size (r = 0.23) was observed. No correlation was seen with resting pulse rate, or with systolic and diastolic blood pressure.

Child↗
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Fibrosing mediastinitis--a rare cause of superior vena caval obstruction.

A rare case of fibrosing mediastinitis, possibly of tuberculous etiology, causing superior vena caval obstruction is presented. The diagnosis was based on clinical features of superior vena caval obstruction, chest radiography, phlebography and mediastinal calcification in absence of definite mass lesion on CT-scan of thorax. The disease followed a relatively benign non-progressive course over next nineteen months of follow-up.

Aged↗
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Painless myocardial ischaemia and ventricular fibrillation during treadmill stress test.

Painless myocardial ischaemia is a frequent occurrence, but its clinical importance has not been realised. We report a case who developed ventricular tachycardia and fibrillation following painless ischaemia during treadmill stress test. Significant left main severe triple vessel coronary artery disease and normal left ventricular functions were found. Symptoms improved following coronary bypass surgery. Thus, painless ischaemia is a potentially lethal phenomenon, and needs careful assessment and treatment.

Coronary Disease↗