Search PubMed⌕ Search

Biomedical subjects

R Gupta

Publications and source records attributed to R Gupta.

At least 973 records · Page 54Linked to original sources
PubMedDate not supplied

Tuberculosis in ulcerative colitis: bird in the bush.

Records of one hundred and two patients with idiopathic ulcerative colitis were retrospectively studied to estimate the prevalence of associated tuberculosis. There were 49 males and 53 females with a mean age of 33 +/- 13 years. Seven patients (3 pulmonary and 4 intestinal) had associated tuberculosis. All patients with intestinal tuberculosis were females and had small bowel involvement. Patients with co-existing tuberculosis were on steroids at the time of presentation and responded well to anti tubercular treatment with gradual weight gain and remission of diarrhoea and fever. We conclude that in India, the prevalence of tuberculosis is high in patients with idiopathic ulcerative colitis on steroids and a high degree of suspicion is required to detect these cases.

Adult↗
PubMedDate not supplied

Influence of alcohol intake on high density lipoprotein cholesterol levels in middle-aged men.

To study the influence of alcohol (ethanol) intake on high density lipoprotein cholesterol (HDLC) levels, we studied 210 healthy middle-aged men (age 45 +/- 8 years). Other factors influencing HDLC (physical exercise, diet, smoking and body mass index) were also studied. Individuals were classified according to daily ethanol consumption. There were 39 teetotallers, 29 took drink, 30 took 1-1.9, 25 took 2-2.9, 26 took 3-3.9, 28 took 4-4.9 and 33 took 5 or more drinks per day (1 drink = 14 gm ethanol). The overall mean serum total cholesterol was 191.4 +/- 53 mg/dl and HDLC was 46.4 +/- 9 mg/dl. Total cholesterol in teetotallers was not different from those consuming different amounts of alcohol. HDLC in teetotallers (44.5 +/- 8 mg/dl) was significantly lower than in those taking 1-1.9 drinks (46.7 +/- 11 mg/dl, p < 0.05) and 2-2.9 drinks/day (51.4 +/- 9 mg/dl, p < 0.01) but was not different from those consuming > or = 3.0 drinks. There was a weak positive linear correlation between ethanol and HDLC (r = 0.016). HDLC levels were significantly lower in smokers (43.5 +/- 9 vs 47.2 +/- 11 mg/dl in non-smokers), in non-vegetarians (43.5 +/- 10 vs 46.2 +/- 9 mg/dl in vegetarians) and in those with sedentary habits (42.4 +/- 7 vs 46.1 +/- 10 mg/dl in physically active). Low level ethanol consumption (< 3 drinks or 42 gm per day) is associated with increased HDLC levels.

Alcohol Drinking↗
PubMedDate not supplied

Correlation of waist-hip ratio with coronary heart disease and risk factor prevalence in a rural male population.

Truncal obesity has been identified as a risk factor for coronary heart disease (CHD). We studied 399 males for waist hip ratio (WHR) measurement during a comprehensive cardiovascular survey in a rural population of Rajasthan. The WHR measurements were correlated with coronary risk factors and CHD prevalence. The mean WHR in the study population was 0.88 +/- 0.11. The median value was 0.88 with a range of 0.49 to 1.59. Multiple regression analysis showed a significant positive relationship of WHR with height (b = 0.77, p = 0.02), weight (b = 1.48, p = 0.02), body mass index (b = 1.44, p = 0.01) and systolic (b = 0.12, p = 0.05) and diastolic blood pressure (b = 0.13, p = 0.03) but not with age, educational level, total LDL- or HDL- cholesterol and triglycerides. The median value of 0.88 was taken to classify the study population for risk factor analysis. There were 200 males with WHR < or = 0.88 (Group A) and 199 males with WHR > or = 0.88 (Group B). Group B men had significantly higher body-weight and body-mass index and there was a trend towards lower serum HDL cholesterol and higher triglyceride levels in this group which was not statistically significant. The prevalence of hypertension was similar in the two groups. The prevalence of coronary heart disease was significantly higher in Group B.

Adult↗
PubMedDate not supplied

Dual exposure and repair technique for ruptured aneurysms of aortic sinus of Valsalva.

Thirteen patients with ruptured sinus of Valsalva aneurysm have been operated over a 3-1/2 year period. Right coronary sinus was predominantly involved and right ventricle was the most common site of rupture. Early surgery was performed in all cases. Both aorta and chamber of entry were explored for effective repair. Main repair was always done in the chamber of rupture either with a patch or interrupted pledgeted sutures followed by assessment at either end. Subannular ventricular septal defects in three cases were closed with a common patch with additional fixation in the middle at the aortic annulus to prevent aortic leak into the left ventricle. Three patients needed aortic valve replacement for gross aortic incompetence. Postoperative echocardiographic study revealed uniformly excellent results with good aortic valve or prosthetic function. One patient developed fatal pulmonary embolism two weeks following surgery. All other surviving patients are doing well and are in NYHA class I. We recommend dual exposure and repair technique for the repair of ruptured sinus of Valsalva aneurysms for optimal results.

Adult↗
PubMedDate not supplied

The effect of somatostatin in dumping syndrome after gastric surgery.

The effect of somatostatin on early and late dumping syndrome was studied in 12 patients with gastric resection. Each patient underwent two glucose challenges with 75 gram of glucose administered orally. In the control study isotonic sodium chloride was given, while in the other study cyclic somatostatin in a dose of 80 ng/kg/min was given for a period of 270 minutes. In the control study all patients showed subjective symptoms of the early dumping syndrome with significant (p < 0.001) increases in pulse rate, hematocrit, and vasoactive intestinal polypeptide. Ten patients showed asymptomatic hypoglycemia, as a sign of the late dumping syndrome associated with a significant (p < 0.001) increase of insulin, gastric inhibitory peptide and glucagon levels. During the administration of somatostatin these changes failed to develop. The difference between the results of the two challenges are significant. These results indicate that somatostatin alleviates the symptoms both of early and late dumping syndrome partly by inhibiting the vasoactive intestinal polypeptide, gastric inhibitory peptide and insulin release, which are increased in dumping syndrome and may, therefore, be implicated as to have an etiological role.

Adult↗
PubMedDate not supplied

Influence of cessation of smoking on long term mortality in patients with coronary heart disease.

Cessation of smoking in patients with coronary artery disease (CAD) has shown variable results. The long term mortality in patients of coronary heart disease (CHD) who quit smoking following diagnosis of their disease has been variable. We have analysed the long term effects of cessation of smoking on mortality in a cohort of 173 patients with CAD and compared the mortality of this group with 299 nonsmokers and 52 current smokers. The baseline data were identical for major risk factors like age, hypertension, diabetes, cholesterol levels, and congestive heart failure among the three groups (p > 0.1). There were more patients with previous myocardial infarction in past (38.7%) and current smokers (40.4%) than among nonsmokers (25.4%). All patients were followed for a period extending upto 11 years. The mean duration of follow up was 6.81 +/- 2.95 years in non-smokers, 5.98 +/- 2.94 years in exsmokers, and 6.32 +/- 3.44 years in current smokers. Actuarial analysis shows that overall mortality was significantly more among exsmokers than nonsmokers (Logrank test = 3.72, 1p < 0.05). The exsmokers showed similar mortality as current smokers during the first three years of follow up (Logrank test = 1.10, 1p < 0.1); but afterwards the mortality was significantly less in exsmokers than in current smokers (Logrank test = 6.29, 1p < 0.025). However, the overall mortality was lowest in nonsmokers when compared to that of exsmokers and current smokers (Logrank test = 3.92, p < 0.05). The total mortality was 28.1% in nonsmokers, 32.4% in exsmokers, and 46.2% in current smokers. The incidence of sudden death was, however, similar in all the groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMedDate not supplied

Prevalence of coronary heart disease and coronary risk factors in an urban population of Rajasthan.

To determine the prevalence of coronary heart disease (CHD) and coronary risk factors in an urban Indian population, we studied a random sample of population of Jaipur. A physician-administered questionnaire, physical examination and a 12-lead electrocardiogram was performed on 2,212 adults of > or = 20 years of age (males 1,415, females 797). CHD was diagnosed on the basis of past documentation, response to WHO-Rose questionnaire or changes in the electrocardiogram. The overall prevalence of CHD was 7.6 percent (168 cases). The prevalence rate was 6.0 percent (84) in males and 10.4 percent (84) in females with an age-related increase in prevalence ('p' for trend < 0.001). When diagnosed on the basis of electrocardiographic changes alone (Q, ST or T wave), the prevalence was 5.2 percent (116), with 3.5 percent in males and 8.4 percent in females. CHD was silent in 57 percent males and 79 percent females. Coronary risk factors were observed in a significant proportion: smoking in 32 percent (males 39 percent, females 19 percent), hypertension (> or = 140/90 mm Hg) in 31 percent (males 30 percent, females 34 percent-JNC-V) and > or = 160/95 mm Hg in 11 percent (males 10 percent, females 12 percent; WHO classification), diabetes in 1 percent and sedentary habits in 71 percent. Additional risk factors were generalised obesity (body-mass index > or = 27 Kg/m2) in 11 percent and truncal obesity (waist-hip ratio > 0.95) in 17 percent males and 13 percent females. Significant association of CHD prevalence were seen with age, sedentary habits and presence of hypertension in both males and females, and in addition with smoking in males.

Adult↗
PubMedDate not supplied

Clinical and endoscopic features of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease) in India.

Hereditary hemorrhagic telangiectasis (HHT) is an autosomal dominant disease characterized by recurrent epistaxis and telangiectasia of the skin and mucous membranes. Most reports of HHT are from Europe and N. America. In this report of 7 patients from India we postulate that increased skin pigmentation in Asians and Negroids masks the cutaneous manifestations of the disease but without any discernible effect on mucosal lesions. The median hemoglobin value in these patients was 4 g/dl. Endoscopic lesions in the stomach or duodenum were detected in six patients. Most patients in our report (5/7) presented with a chronic iron deficiency anaemia. The treatment of HHT is mainly supportive although our preliminary data shows that low dose ethinyl estradiol therapy decreases transfusion requirement in these patients.

Aged↗
PubMedDate not supplied

Meta-analysis of coronary heart disease prevalence in India.

This meta-analysis was performed to determine the time-trends in the prevalence of coronary heart disease in India and age-and gender-specific changes. Inter-study differences, urban-rural differences and age-and gender-specific differences were examined using the Chi-square test and Mantel-Haenzel Chi-square statistics for linear association. The prevalence of coronary heart disease increased from 1.05% in 1960 to 9.67% and 7.90% in 1995 in urban populations (X2 = 277.5, p < 0.0001; Mantel-Haenzel X2 = 5.63, p = 0.018). In rural areas, the prevalence increased from 2.03% in 1974 to 3.7% in 1995 (X2 = 90.0, p < 0.0001; Mantel-Haenzel X2 = 2.94, p = 0.086). In urban areas there was a significant increase in the prevalence of coronary heart disease in men in the age groups 20-29 and 30-39 years (p = 0.001) and in women in the age groups 20-29, 30-39 and 40-49 years (p = 0.002). In rural areas the increase in men was in the age groups 20-29 and 30-39 years (p = 0.001).

Adult↗
PubMedDate not supplied

Meta-analysis of prevalence of hypertension in India.

To determine the changing trends in prevalence of hypertension and mean blood pressure (BP) levels in India and to study the urban and rural differences, a meta-analysis of all available epidemiological studies was performed. The first such study was reported by Chopra in 1942. Since then many studies (n = 34) in urban and rural areas of India have been carried out. The earlier studies of Dotto (1949), Dubey (1954) and Sathe (1959) showed hypertension prevalence of 1.24 +/- 0.2, 4.24 +/- 0.4 and 3.03 +/- 0.3 percent in urban populations of Calcutta, Kanpur and Mumbai, respectively. Studies since 1959 used the World Health Organization's guidelines and have shown an increasing trend in the prevalence of hypertension. Studies from Ludhiana (1985) and Jaipur (1995) have shown the prevalence to be 14.08 +/- 1.1 and 10.99 +/- 0.7 percent, respectively. Trend analysis comparable studies among urban areas (n = 10) shows a significant increase in the prevalence of hypertension (Mantel-Haenszel chi 2 = 5.99, p = 0.014). Studies in rural areas (n = 14) also show an increase in prevalence of hypertension although the rise is not as steep as in urban populations (Mantel-Haenszel chi 2 = 2.75, p = 0.097). Changes in mean BP levels were analysed using the data on mean systolic and diastolic BP in urban men aged 40-49 years from 1959 to 1995. There was a significant increase in systolic BP (r = 0.95, p < 0.001) and not in diastolic BP (r = 0.43, p = 0.2). In India, hypertension is emerging as a major health problem and is more in urban than in rural subjects.

Adult↗
PubMedDate not supplied

Analysis of local electrograms at successful and unsuccessful sites for slow pathway ablation of atrioventricular nodal reentrant tachycardia.

Anatomic and electrogram approaches have been described for ablation of slow pathway in patients with atrioventricular nodal tachycardia. The purpose of this study was to identify parameters to predict successful slow pathway ablation using the anatomic approach. Local electrograms at successful and unsuccessful sites were compared in 36 patients undergoing slow pathway ablation using anatomic approach. A total of 208 local electrograms were studied. Fragmented atrial electrogram was seen in 24/36 (67%) of successful and in 46/172 (26%) of unsuccessful sites (p < 0.001). The sensitivity, specificity and positive and negative predictive values of fragmented atrial electrogram were 67, 73, 34 and 91 percent respectively. A slow pathway potential was noted in three of successful sites. There was no difference in the atrial to ventricular amplitude ratio in these sites. In conclusion, fragmentation of atrial electrogram and presence of possible slow pathway potential are seen more often at successful than at unsuccessful sites. In our opinion, while using an anatomic approach for slow pathway ablation, an analysis of local electrogram may help in identifying the proper site and avoiding unnecessary radiofrequency energy delivery.

Adult↗
PubMedDate not supplied

Clinical presentation of tuberculosis in patients with AIDS: an Indian experience.

A retrospective series of 25 patients with AIDS and tuberculosis is presented. Their clinical presentation, absolute lymphocyte count, CD4+ and CD8+ lymphocyte counts, treatment details and outcome are detailed. Commonest method of acquiring HIV infection was through heterosexual contact (10 of the 25; 40%) and blood transfusion (10 of the 25; 40%). More than 50% of the patients (14 of the 25) had extrapulmonary tuberculosis. Eighteen of the 19 patients for whom values were available had CD4+ lymphocyte count < 200/mm3. Four of the 18 patients for whom follow-up details were available died.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Endobronchial tuberculosis simulating lung cancer.

We describe an atypical presentation of endobronchial tuberculosis in a 45-year-old female who presented to us with a non-resolving pneumonia. Her radiological examination including contrast enhanced CT-scan suggested a diagnosis of bronchogenic carcinoma or adenoma. Gross bronchoscopic finding also favoured malignancy. But her bronchoscopic biopsy revealed caseating granulomatic lesion. She responded to antitubercular treatment.

Antitubercular Agents↗
PubMedDate not supplied

AIDS cholangiopathy.

A 45-year-old man presented with diarrhea and profound weight loss over one year. His serum alkaline phosphatase was raised and ultrasonography showed dilated intrahepatic biliary ducts and upper part of common bile duct (CBD). ERCP showed papillary stenosis, dilated CBD, stricture at the confluence and saccular dilatation of the left intrahepatic biliary ducts. He was found HIV-positive. Duodenal biopsy, rectal biopsy and stool examination could not identify any opportunistic organism.

Acquired Immunodeficiency Syndrome↗