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Biomedical subjects

R Gupta

Publications and source records attributed to R Gupta.

At least 145 records · Page 8Linked to original sources
PubMed2002

The prevalence and pattern of congenital anomalies of the urinary tract detected by intravenous urography in Kuwait.

We conducted a prospective population-based study in Kuwait to determine the prevalence and pattern of previously undiagnosed congenital anomalies of urinary tract in patients undergoing intravenous urography (IVU) and to examine the demographic factors associated with these anomalies. The study included 2398 consecutive patients undergoing IVU, for various indications, in all the six public hospitals in Kuwait, during the period 1 June 1999-30 September 2000. Patients were also interviewed to obtain selected demographic information. Multiple logistic regression was used to identify factors associated with the anomalies. The average age (+/- SD) of the patients (1623 males, 775 females) was 39.2 +/- 15.1 years. A total of 335 anomalies (12.1% in males, 17.9% in females; p < 0.001) were detected in 300 (12.5%) patients (10.9% males, 15.9% females; p < 0.01). About half (47.2%) of the anomalies involved the kidney, 28.4% renal pelvis, 22.4% ureters, and 2.1% bladder. Multiple regression analysis showed that age < 20 years (odds ratio (OR) = 12.5; 95% confidence interval (95% CI): 7.0-22.3) female gender (OR = 1.5; 95% CI: 1.2-2.0) Kuwaiti nationality (OR = 1.7; 95% CI: 1.2-2.3) and family history of congenital malformation (OR = 3.8; 95% CI: 2.2-6.6) were independently associated with the anomalies of the urinary tract. Overall, 42% of the patients reported a consanguineous marriage between their parents. The frequency of anomalies was higher in individuals who had consanguineous parents (13.8 vs. 11.6%; OR = 1.2) but this positive association did not reach statistical significance. Considering the relatively high prevalence of previously undiagnosed congenital anomalies of the urinary tract, it is important to establish clinical guidelines for early detection and management of these conditions to decrease the associated morbidity and mortality.

Adult↗
PubMed2002

Allergenic cross-reactivity of Curvularia lunata with other airborne fungal species.

BACKGROUND: Curvularia lunata is an important fungus for respiratory allergic disorders. Previous studies indicated cross-reactivity of Curvularia with other fungi. However, the cross-reactive allergenic component (s) were not identified. The present work was carried out to study the shared allergenic components of C. lunata and others. METHODS: Cross-reactivity studies were performed using pooled hypersensitive patient sera to C. lunata by ELISA, immunoblot, immunoblot inhibition and ELISA inhibition. RESULTS: Many C. lunata sensitive patients showed positive skin test to five other fungi. Alternaria alternata exhibited maximum (68%) whereas Cladosporium herbarum showed the least (17%) skin reactivity. Immunoblots of fungal extracts with pooled sera showed common proteins. Fusarium solani and C. herbarum showed negligible IgE binding. IgE ELISA inhibition with C. lunata showed 92% inhibition whereas A. alternata and E. nigrum showed 84% and 63%, respectively. Immunoblot inhibition with self protein showed complete loss of IgE-binding activity. Proteins of 26, 31, 38, 45 and 50 kDa of C. lunata were inhibited by A. alternata and E. nigrum, whereas A. fumigatus inhibited 26, 45 and 50 kDa proteins. CONCLUSIONS: Significant allergenic cross-reactivity exists among proteins of C. lunata, A. alternata and E. nigrum. Proteins of 26, 31, 38, 45 and 50 kDa are shared allergens in these fungi.

Air Microbiology↗
PubMed2002

Statistical medium optimization and production of a hyperthermostable lipase from Burkholderia cepacia in a bioreactor.

AIM: Statistical medium optimization for maximum production of a hyperthermostable lipase from Burkholderia cepacia and its validation in a bioreactor. METHODS AND RESULTS: Burkholderia cepacia was grown in shake flasks containing 1% glucose, 0.1% KH2PO4, 0.5% NH4Cl, 0.24% (NH4)2HPO4, 0.01% MgSO4.7H2O and 1% emulsified palm oil, at 45 degrees C and pH 7.0, agitated at 250 rev min(-1) with 6-h-old inoculum (2% v/v) for 20 h. A fourfold enhancement in lipase production (50 U ml(-1)) and an approximately three fold increase in specific activity (160 U mg(-1)) by B. cepacia was obtained in a 14 litre bioreactor within 15 h after statistical optimization following shake flask culture. The statistical model was obtained using face centred central composite design (FCCCD) with five variables: glucose, palm oil, incubation time, inoculum density and agitation. The model suggested no interactive effect of the five factors, although incubation period, inoculum and carbon concentration were the important variables. CONCLUSIONS: The maximum lipase production was 50 U ml(-1), with specific activity 160 U mg(-1) protein, in a 14 litre bioreactor after 15 h in a medium obtained after statistical optimization in shake flasks. Further, the model predicted reduction in time for lipase production with reduction in total carbon supply. SIGNIFICANCE AND IMPACT OF THE STUDY: Statistical optimization allows quick optimization of a large number of variables. It also provides a deep insight into the regulatory role of various parameters involved in enzyme production.

Bacterial Proteins↗
PubMed2002

Recurrence and progression in stage T1G3 bladder tumour with intravesical bacille Calmette-Guérin (Danish 1331 strain).

OBJECTIVE: To report recurrence and progression rates in patients with T1G3 superficial bladder carcinoma treated with intravesical bacille Calmette-Guérin (BCG, Danish 1331 strain) after complete transurethral resection. PATIENTS AND METHODS: Data from the records of 111 patients with T1G3 bladder carcinoma treated between January 1991 and December 1999 were analysed for recurrence, progression, salvage therapy and survival. RESULTS: Of the 111 patients with T1G3 bladder tumours, 69 had intravesical BCG therapy, 20 radical cystectomy and 22 only transurethral resection (TUR). Of the 69 patients receiving BCG therapy 37 (54%) had no recurrence, and 24 (35%) had a recurrence that was not muscle-invasive (Ta/T1) and were treated with TUR only. The remaining eight (12%) progressed to muscle invasion and had salvage cystectomy. During the follow-up six patients died, four from disease and three from other causes, while the remaining 63 are alive and well. Of the other 42 patients, 15 are alive after radical cystectomy and 18 after TUR. CONCLUSION: This series further confirms the benefits of intravesical BCG (Danish 1331) in an adjuvant setting; furthermore, this treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients.

Adjuvants, Immunologic↗
PubMed2002

Prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy.

OBJECTIVE: To prospectively evaluate the safety and efficacy of the supracostal approach for percu-taneous nephrolithotomy (PCNL), as it is usually avoided because of concerns about potential chest complications. PATIENTS AND METHODS: Between August 1998 and August 2001, 465 patients underwent PCNL. Supracostal access was obtained in 62 patients (63 renal units), comprising 13% of the procedures. The indications for a supracostal approach were staghorn, upper ureteric, superior calyceal stones and high-lying kidneys. The data were analysed for stone clearance, need for additional punctures and the complications associated with supracostal puncture. RESULTS: The supracostal was the only access in 63% of the PCNL procedures. Additional punctures were required mainly for staghorn stones (15 of 23). Overall, 90% of the patients were rendered stone-free or had clinically insignificant residuals with PCNL alone. In patients with staghorn stones, they were completely cleared in 84% of renal units. Significant chest complications developed in three (5%) patients, which required insertion of a chest tube. One (2%) patient developed haemothorax secondary to injury of the intercostal artery. All the patients recovered uneventfully. CONCLUSIONS: These results indicate that supracostal access provides high clearance rates with acceptable complications; it should not be avoided for fear of chest complications. A chest X-ray after surgery should be routine, to detect any complication.

Adult↗
PubMed2002

Incidental carcinoma of the gallbladder.

Incidental gallbladder carcinoma (GBC) is a difficult management issue as there are no established guidelines. Laparoscopic cholecystectomy is associated with increased dissemination of the tumour cells (both in the peritoneal cavity and port sites). Depth of tumour invasion (T stage) and positive surgical margins are the most important prognostic factors, although tumour differentiation, lymphatic, perineural and vascular invasion may also affect the outcome. Simple cholecystectomy is adequate for mucosal (T1a) lesions only. For T1b tumours port site/wound excision with second radical operation (probably extended cholecystectomy -- wedge liver excision with regional lymphadenectomy) should be advised. T2 tumours should be treated with second radical operation (extended cholecystectomy or excision of medial liver segments 4b and 5 or 4, 5 and 8 with regional lymphadenectomy with or without excision of the extra-hepatic bile duct). Few T3 tumours can be cured and in some survival time may be prolonged by a second radical operation. More extensive liver resection (segments 4b and 5 or segments 4, 5 and 8) with regional lymphadenectomy with excision of the extra-hepatic bile duct should be advised. A second radical operation may palliate some T4 tumours. In the absence of extensive nodal disease, this operation may prolong the survival time. Excision of the extra-hepatic bile duct should be undertaken whenever the tumour involves the cystic duct margin or the extra-hepatic biliary tree. Epidemiology, risk factors, aetiopathogenesis and the modes of spread of GBC are discussed in relation to appropriateness of the second radical operation. Indications, types and role of the second radical operation are discussed.

Cholecystectomy↗
PubMed2002

Expression of bronchodilator response: comparison of four indices.

Several indices have been suggested to express the bronchodilator response but there is no agreement on what is the ideal expression. The forced expiratory volume in I s (FEV1) was measured in 190 patients of bronchial asthma before and after inhalation of 200 micrograms salbutamol. Four different indices of bronchodilator response were calculated. The change in FEV1 was expressed as absolute value (delta FEV1), as a percentage of initial FEV1 (delta FEV1% initial), as a percentage of the predicted normal value (delta FEV1% predicted) and as a percentage of maximum achievable reversibility, i.e. the difference between predicted and initial values (delta FEV1% [predicted-initial]). A significant negative correlation was observed between delta FEV1 initial and initial FEV1% predicted (r = -0.33, P < 0.0001) but not delta FEV1 and initial FEV1% predicted, or between delta FEV1% predicted and initial FEV1% predicted. The values of delta FEV1% [predicted-initial] tended to reach towards infinity as the initial FEV1% predicted approached 100%. delta FEV1% predicted had similar sensitivity but greater specificity than delta FEV1% initial in detecting a true bronchodilator response. It was concluded that being dependent on the initial value, delta FEV1% initial was not an appropriate method to express the bronchodilator response. Although all other methods had limitations, delta FEV1 and delta FEV1% predicted appeared to be better indices.

Adult↗
PubMed2002

Barriers in the management of asthma and attitudes towards complementary medicine.

BACKGROUND: Undertreatment is said to be an important problem for those with asthma. Misconceptions regarding the nature and treatment of asthma may contribute to this. This study was planned to evaluate the perception of those with asthma about various aspects of their condition. METHODS: A total of 1012 patients with asthma volunteered to complete the questionnaire. Questions included those regarding severity, nature, regularity of use of medicine and attitudes towards trying complementary medicine. Forced expiratory volume in 1 s (FEV1) was measured to assess the severity of airway obstruction. RESULTS: Only 9% of patients took treatment for asthma according to the advice of the doctor. The remainder reported stopping treatment when they became free of symptoms or were able to tolerate their symptoms. A majority of the patients had moderately severe airway obstruction as determined by spirometer and reported being unable to assess the severity of their disease with only 11.9% reporting that they could perceive the warning symptoms of an acute attack. Seventy-nine percent of the patients had used complementary medicine. Home remedies, such as tea, hot water, walking, ginger and turmeric, were perceived to provide relief in asthma. CONCLUSION: Patients with asthma have many barriers in the way of optimal treatment. These include a failure to recognize warning symptoms, belief in a permanent cure; not continuing treatment for as long as needed; and, an inclination to seek complimentary medicines.

Adolescent↗
PubMed2002

Apparent life threatening events in infants presenting to an emergency department.

OBJECTIVE: To describe the aetiology and outcome of apparent life threatening events (ALTE) presenting to an emergency department (ED), and to assess the value of an initial investigation protocol. DESIGN: A 12 month prospective study of infants under 1 year of age who presented to a children's hospital ED after an ALTE. A standardised history sheet and initial investigation protocol were used. All infants were admitted to hospital and followed up at six months. RESULTS: There were 65 infants recruited, median age 7 weeks. None had died at the time of writing. Diagnoses included gastro-oesophageal reflux n=17 (26%), pertussis, n=6 (9%), seizures, n=6 (9%), urinary tract infection (5), factitious illness (2), brain tumour, atrial tachycardia, persistent ductus arteriosus and opioid related apnoea. No diagnosis was reached in 15 cases (23%). Fifty seven (88%) had only one admission to hospital for ALTE. More serious diagnoses were associated with a presentation age over 2 months, abnormal initial clinical examination, and recurrent ALTE. CONCLUSIONS: ALTEs presenting to the ED may remain as a single, unexplained event or be attributable to numerous causes, ranging from minor to serious. Knowledge of the commoner causes and factors associated with higher risk could result in a more targeted approach, improving the decision making process and benefiting both infants and parents.

Critical Illness↗
PubMed2002

Cullen's sign in amoebic liver abscess.

A 45 year old woman presented with pain in her right upper abdomen and fever. Ultrasound of her abdomen showed a large liver abscess with subhepatic collection. She had Cullen's sign. The liver abscess was managed by percutaneous catheter drainage.

Ecchymosis↗
PubMed2002

Raman-active modes of single-walled carbon nanotubes derived from the gas-phase decomposition of CO (HiPco process).

Here we report Raman scattering studies of ropes of Single-walled carbon nanotubes (SWNTs) grown by a high CO pressure process. Five samples from five different batches were studied as a function of excitation wavelength. Three of these samples exhibited Raman spectra similar to that found for SWNTs made by pulsed laser vaporization of arc-discharge methods. The other two samples were found by Raman scattering to contain a significant fraction of tubes with diameter < 1.0 nm. These samples exhibited unusual spectra that, however, can be well understood within the existing models for the electronic and phononic states in SWNTs. Spectra recorded with 1064 nm for the sample having a significant fraction of smaller diameter tubes shows strong modes present between 500 and 1200 cm-1. We suggest these modes arise due to the enhancement of Raman cross-section for small diameter tubes.

Carbon Monoxide↗
PubMed2002

Etiology, clinical profile, gender identity and long-term follow up of patients with ambiguous genitalia in India.

There is little information on the profile of children with ambiguous genitalia in India. Presented here is an analysis of patients with ambiguous genitalia registered in a general endocrine clinic during the last 2 decades. Seventy-four patients (age 4 months to 36 years) were registered during this period. Fifty-two were more than 5 years old at the time of registration. Thirty-five were reared as females, 29 as males; nine children (4 months to 1 year old) were brought for sex assignment, and one (with epispadias) was brought for correction of urinary incontinence. Investigations revealed 28 patients with congenital adrenal hyperplasia, 14 dysgenetic male pseudohermaphroditism, ten true hermaphroditism, six partial androgen insensitivity, four castration and one epispadias. There were eight patients with perineal hypospadias with normal Leydig cell reserve (normal LH, FSH and testosterone response to LHRH). Sex of rearing and gender identity were concordant in all except the patients with perineal hypospadias with normal Leydig cell response. These observations support the theory that prenatal androgen exposure masculinizes the brain.

Adolescent↗
PubMed2002

Evaluation of minimum inhibitory concentration of quinolones and third generation cephalosporins to Salmonella typhi isolates.

A total of 323 Salmonella typhi isolates (261 isolates obtained during 1995-99 from Ludhiana and 62 randomly selected isolates obtained between 1980-99 from Chandigarh) were analyzed for drug resistant pattern. S. typhi isolates prior to 1986 were sensitive to all the antimicrobials tested by disc diffusion method. Most common multidrug resistance pattern noticed was ACCo T i.e. resistance to ampicillin, Chloramphenicol, cotrimoxazole and tetracycline. This study has revealed that withdrawal of chloramphenicol due to high level of resistance during 1990-94, has led to re-emergence of 43-93 percent chloramphenicol sensitive mutants during 1995-99. Two S. typhi isolates in 1995 and one in 1999 from Ludhiana depicted resistance to ciprofloxacin. Susceptibility of S. typhi isolates to third generation cephalosporins ranged between 87 to 100 per cent. There was a gradual increase with time period in mean minimum inhibitory concentration (MIC) of ciprofloxacin as it increased from 0.066 ug/ml for 1980-83 S. typhi isolates to 0.13 ug/ml for the 1996-99 isolates. Similarly, cefotaxime mean MIC for 1980-83 isolate was 0.172 ug/ml which further increased up to 0.32 ug/ml for S. typhi isolates encountered between 1996-99. In contrast, mean MIC value of 0.62 ug/ml of Ceftriaxone remained unchanged irrespective of the year of isolation of S. typhi isolates.

Anti-Bacterial Agents↗
PubMed2002

Evaluation of communication skills of physicians about asthma.

OBJECTIVE: Communication skills in medical practice are important. To assess the communication skills of physicians about asthma, we undertook this study. METHODS: One thousand four hundred and twenty one physicians attending the annual conference of association of physicians of India volunteered to participate in the study. They were divided into three categories. 'Teachers' group 1, (n = 131), 'Clinicians', group 2, (n = 951) and 'Students' group 3, (n = 339). Questionnaire containing ten most frequently asked questions by asthmatic patients were given to the physicians. A panel of three patients assessed the replies of these question and graded them as 'Convincing', 'Just convincing' and 'Not convincing'. RESULTS: Replies of only 2% of physicians were graded as convincing, 15.6% just convincing and 82.4 as not convincing. Among group 1 none gave a convincing reply while replies of 2.2% of group 2 and 2.4% of group 3 were graded as convincing. The difference in results was not significant statistically on comparing the three groups (p > 0.1). CONCLUSIONS: Communication skills are the integral part of patient care and management. Our study demonstrated lack of effective communication skills among physicians.

Asthma↗
PubMed2002

C-reactive protein (CRP) as an indicator of sepsis in orthopaedic trauma.

In the present study serial estimations of changes in plasma C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), total leucocyte count (TLC) and temperature were recorded in 100 patients. Nature and extent of tissue trauma varied from fresh soft tissue or bony injuries to elective orthopaedic procedures, besides acute orthopaedic infections. All the parameters showed a rise from day 1-3 from the normal levels, though the rise in temperature was minimal. However, from third day onwards, CRP level showed a sharp decline in all cases without any septic complication or infective patients who improved with treatment. Decline of ESR levels on the other hand was variable. Similarly, decline of TLC and temperature was also not consistent and sharp. Persistent rise of CRP level beyond third day or any subsequent rise in CRP level was consistent with a septic complication in the patient. CRP was therefore observed to be a sensitive and dependable indicator of orthopaedic sepsis even orthopaedic trauma.

Adolescent↗
PubMed2001

Effect of spermidine on the in vivo degradation of ornithine decarboxylase in Saccharomyces cerevisiae.

As part of our studies on the regulation of polyamine biosynthesis in Saccharomyces cerevisiae, we have investigated the effect of spermidine on the degradation of ornithine decarboxylase in this organism. We have found that in S. cerevisiae, as in other eukaryotic cells, the rate of degradation of ornithine decarboxylase, measured either enzymatically or immunologically, is increased by the addition of spermidine to a yeast culture. It is noteworthy that this effect of added spermidine is found even when the experiments are conducted with strains in which the ornithine decarboxylase is overexpressed several hundred-fold more than the wild-type level. The effect of added spermidine in the overexpressed SPE1 strains is best seen in spe2 mutants in which the initial intracellular spermidine is very low or absent. Experiments with cycloheximide show that new protein synthesis is required to effect the breakdown of the ornithine decarboxylase. These results indicate that S. cerevisiae contains an antizyme-like mechanism for the control of the level of ornithine decarboxylase by spermidine, even though, as contrasted with other eukaryotic cells, no specific antizyme homologue has been detected either in in vitro experiments or in the S. cerevisiae genome.

Cycloheximide↗