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Biomedical subjects

R K Garg

Publications and source records attributed to R K Garg.

At least 19 recordsLinked to original sources
PubMed2006

Intravenous methyl prednisolone in patients with solitary cysticercus granuloma: a random evaluation.

PURPOSE: To evaluate the role of intravenous methyl prednisolone in patients with solitary cysticercus granuloma with new-onset seizures. METHODS: In this open-label, randomized, prospective, follow-up study, 52 patients with new-onset seizures and a single enhancing CT lesion of cysticercus were randomly divided in two groups to receive either intravenous methyl prednisolone for 5 days along with antiepileptic drug (n=25) or antiepileptic drug monotherapy (n=27) alone. The patients were followed up for at least for 9 months. Repeat CT scans were performed after 2 months. RESULTS: After 2 months, lesion disappeared in 60% patients of intravenous methyl prednisolone group and 18.5% patients receiving only antiepileptic drug (p=0.001). As far as seizure recurrence was concerned, a lower number (16% versus 33%) of intravenous methyl prednisolone treated patient had recurrence, the difference was insignificant. CONCLUSION: Intravenous methyl prednisolone therapy helps in early resolution of solitary cysticercus granuloma.

Adolescent↗
PubMed2006

Predictive efficacy of nalidixic acid resistance as a marker of fluoroquinolone resistance in Salmonella enterica var Typhi.

BACKGROUND AND OBJECTIVES: Resistance in Salmonella enterica var Typhi (S. Typhi) to chloramphenicol, amoxicillin and co-trimoxazole has posed a challenge to treatment of typhoid fever. Ciprofloxacin has been the empirical therapy of choice, but the recent increase in minimum inhibitory concentration (MIC) to ciprofloxacin in S. Typhi, not detectable by disc diffusion (DD) tests, may result in delayed response and serious complications. Nalidixic acid (NA) resistance has been used as an indirect evidence of increased ciprofloxacin MIC in S. Typhi. We evaluated the predictive value of NA resistance for fluoroquinolone resistance in clinical isolates of S. Typhi. METHODS: A total of 70 clinical isolates of S. Typhi were tested for antimicrobial susceptibility according to the National Committee for Clinical Laboratory Standards (NCCLS) method. MIC to fluoroquinolones was carried out by the agar dilution method. RESULTS: Thirteen (18.6 %) isolates were resistant to amoxicillin, chloramphenicol and cotrimoxazole; all were sensitive to ciprofloxacin and cefotaxime. Fifty (71.4%) were resistant to NA. Nineteen (27.1 %) isolates were resistant to ciprofloxacin by MIC tests. The MIC for ciprofloxacin was 0.03-4 microg/ml for NA(S) and 0.25-4 microg/ml for NA(R) isolates. NA susceptibility showed a predictive value of 95 per cent for ciprofloxacin susceptibility while NA resistance had a predictive value of 36 per cent for ciprofloxacin resistance. Thirty isolates studied were sensitive to gatifloxacin; MIC values were 0.03-0.5 microg/ml for NA(S) and 0.25-0.5 microg/ml for NA(R) isolates. INTERPRETATION AND CONCLUSION: NA susceptibility was a good marker for fluoroquinolone susceptibility but NA resistance had a poor predictive value for ciprofloxacin resistance. NA resistant isolates should be tested for ciprofloxacin MIC before deciding a change in therapeutic regimen. Higher MIC for gatifloxacin was also noticed in NA resistant isolates.

Biomarkers↗
PubMed2005

Short course of prednisolone in patients with solitary cysticercus granuloma: a double blind placebo controlled study.

The study was conducted to confirm the role of a short course of oral corticosteroids in patients with solitary cysticercus granuloma with seizures by a double-blind placebo-controlled study. In an open-label trial we, in past, had demonstrated a beneficial role of prednisolone. A short course of prednisolone helped in early resolution of solitary cysticercus granuloma. In this double-blind placebo-controlled randomized study, 60 patients with new-onset seizures and a single enhancing computed tomography (CT)-detected lesion of cysticercosis were randomly divided in two groups to receive either anti-epileptic monotherapy with prednisolone (n=30) or anti-epileptic monotherapy along with placebo (n=30). The patients received prednisolone, 1mg/kg/day for 10 days, followed by tapering over next 4 days. None of the patients received albendazole therapy. The patients were followed up monthly, at least for 9 months. A repeat CT scan was performed after 6 months. The data were analysed by chi-square test. The majority of patients were young. Simple partial seizure, with or without secondary generalization, was the commonest seizure type encountered. Follow-up CT scans at 6 months demonstrated non-significantly better response for prednisolone treated patients. In prednisolone group the lesion disappeared in 52% of patients and in 48% patients who received placebo. However, a significantly lesser number of prednisolone treated patients (n=12%) than controls (n=48%), had seizure recurrence. Our study suggests that short-term prednisolone therapy may not help in rapid resolution of solitary cysticercus granuloma, however, prednisolone therapy improves seizure-related prognosis.

Adolescent↗
PubMed2005

Determination of the hand from single digit fingerprint: a study of whorls.

In this investigation 400 bilateral rolled fingerprints of Punjabi Jat males have been examined for the determination of the hand from single digit fingerprint from whorl patterns. Direction of the flow of the apex ridges, rotation of centrally circular ridges, angles between the core and the delta, ridge tracing, ridge counting and the position of the perpendiculars drawn between the delta and the core are useful for establishing in most of the cases the hand and finger involved from the fingers having whorl pattern.

Adolescent↗
PubMed2005

Prolapsed intervertebral disc with sciatica: the role of common peroneal nerve block.

A total of 210 patients of Lumbar disc prolapse with sciatica were given common peroneal block by infiltrating 2% xylocaine around the common peroneal nerve 3 cm below the head of fibula on the affected side. After receiving the block the pain decreased on from grade 2.99 +/- 0.46 to 0.91 +/- 0.99, and straight leg raising increased from 32.1 +/- 12.55 to 59.66 +/- 12.11 degrees. The method, as an outpatient procedure, has been found to be simple and useful in the patients of sciatica with prolapsed lumbar intervertebral disc potentially appropriate for a low-resource setting.

Adolescent↗
PubMed2004

Predictive value of routine hematological and biochemical parameters on 30-day fatality in acute stroke.

OBJECTIVE: This prospective study was planned to study the prognostic value of routine clinical, hematological and biochemical parameters, including platelet aggregation in patients of acute stroke, on fatality occurring during the first 30 days. MATERIAL AND METHODS: In this study 116 consecutive patients (77 males and 39 females) of stroke (within 72 hours of onset) were included. After clinical evaluation and neuroimaging, blood investigations, hemoglobin, total leukocyte count, platelet count, platelet aggregation, erythrocyte sedimentation rate (ESR), blood sugar, urea, creatinine, sodium, potassium, serum cholesterol, serum bilirubin, aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), albumin, and globulin estimations were performed. The patients were followed up for a maximum period of 30 days from the onset of stroke, and patients who expired were grouped as 'expired' and the rest as 'survivors'. Logistic regression analysis was carried out among the significant parameters to identify independent predictors of 30-day fatality. RESULTS: Univariate analysis demonstrated that among hematological parameters, high total leukocyte count and ESR, at admission, correlated significantly with an undesirable outcome during the initial 30 days. Among biochemical parameters, elevated urea, creatinine, serum transaminases (SGOT and SGPT) and globulin levels correlated significantly with death. Logistic regression analysis demonstrated that a low Glasgow Coma Scale (GCS) score along with biochemical parameters such as high serum creatinine, SGPT, ESR and total leukocyte count correlated with death. CONCLUSION: Impaired consciousness, high total leukocyte count, raised ESR, elevated creatinine and SGPT levels, estimated within 24 hours of hospitalization, are the most important indicators of 30-day mortality in patients with first-time ischemic stroke.

Aged↗
PubMed2003

Acute disseminated encephalomyelitis.

Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system, and is characterised by multifocal white matter involvement. Diffuse neurological signs along with multifocal lesions in brain and spinal cord characterise the disease. Possibly, a T cell mediated autoimmune response to myelin basic protein, triggered by an infection or vaccination, underlies its pathogenesis. ADEM is a monophasic illness with favourable long term prognosis. The differentiation of ADEM from a first attack of multiple sclerosis has prognostic and therapeutic implications; this distinction is often difficult. Most patients with ADEM improve with methylprednisolone. If that fails immunoglobulins, plasmapheresis, or cytotoxic drugs can be given. Recent literature suggests that a significant proportion of patients with ADEM will later develop multiple sclerosis; however, follow up experience from developing countries does not support this view.

Adult↗
PubMed2003

Postpartum posterior leukoencephalopathy syndrome.

In this report we are presenting three patients of posterior leukoencephalopathy syndrome developing in postpartum period. Two of these patients had persistent imaging abnormalities in posterior parietal and occipital regions leading to focal atrophy of brain along with permanent cortical blindness and recurrent seizures. In both the patients the syndrome was either unrecognized, or remained untreated on initial presentation. In third patient also the syndrome was not recognized for 10 days, initial clinical manifestations and computed tomographic (CT) abnormalities remained unchanged even after two months. Failure to early recognition and treatment can produce permanent brain damage and syndrome of posterior leukoencephalopathy may become irreversible.

Adult↗
PubMed2002

Subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a progressive neurological disorder of childhood and early adolescence. It is caused by persistent defective measles virus. Brain biopsies or postmortem histopathological examination show evidence of astrogliosis, neuronal loss, degeneration of dendrites, demyelination, neurofibrillary tangles, and infiltration of inflammatory cells. Patients usually have behavioral changes, myoclonus, dementia, visual disturbances, and pyramidal and extrapyramidal signs. The disease has a gradual progressive course leading to death within 1-3 years. The diagnosis is based upon characteristic clinical manifestations, the presence of characteristic periodic EEG discharges, and demonstration of raised antibody titre against measles in the plasma and cerebrospinal fluid. Treatment for SSPE is still undetermined. A combination of oral isoprinosine (Inosiplex) and intraventricular interferon alfa appears to be the best effective treatment. Patients responding to treatment need to receive it life long. Effective immunisation against measles is the only solution presently available to the problem of this dreaded disease.

Antiviral Agents↗
PubMed2002

Posterior leukoencephalopathy in a girl with acute haemorrhagic leukoencephalitis.

In children, posterior leukoencephalopathy is frequently associated with hypertensive encephalopathy, anticancer chemotherapy, treatment with immunosuppressive drugs in patients with organ transplantation, transfusion or human immunodeficiency virus infection. Posterior leukoencephalopathy in these children appears as a complicating illness and resolves once precipitating factor (e.g. cancer chemotherapy) is removed. Here we are reporting a fatal case of acute haemorrhatic leukoencephalitis in a 13 year old girl, imaging abnormalities are also suggestive of posterior leukoencephalopathy. Posterior leukoencephalopathy in our patient possibly, is a part of post-infectious haemorrhagic leukoencephalitis, rather than because of ischaemia or cerebral oedema secondary either to abrupt increase in blood pressure or following administration of immunosuppressive drugs.

Adolescent↗
PubMed2001

Single small enhancing computed tomographic (CT) lesions in Indian patients with new-onset seizures. A prospective follow-up in 75 patients.

This study was planned to observe the clinical and radiological course of single small enhancing CT lesions in Indian patients presenting with new-onset-seizures. In this study, 75 patients with new-onset seizures and a single enhancing CT lesion were prospectively followed up for 1 year. All patients fulfilled the criteria of cysticercus granuloma. The repeat CT scans were performed 2 months after the first CT scan. Antiepileptic drug therapy was the only form of treatment given. The majority of patients were below 20 years of age. Simple partial seizure, with or without secondary generalization, was the commonest type of seizure encountered in these patients. In follow-up CT scans 84% of patients showed either disappearance or regression in the size of lesion. The proportion of patients showing complete disappearance of CT lesions was 0.73 (95% CI, 0.61-0.80). In 11 (15%) patients the lesions were calcified. In nine patients, in whom the lesion had persisted or regressed, another follow-up CT scan (6 months after the second scan) revealed either complete disappearance or calcification of the lesions. The majority (86.6%) of patients remained seizure free for 1 year after starting antiepileptic drugs. Ten patients experienced seizure recurrences within the first month of therapy. The proportion of patients who remained seizure free was 0.86 (95% CI, 0.76-0.92). Four patients experienced seizure recurrence even after complete disappearance of CT lesions. In the majority of patients the lesions disappeared spontaneously and in a few the lesions calcified; hence these patients did not require anticysticercal therapy. Antiepileptic therapy was helpful in controlling further recurrences of seizures in most of the patients. A few patients experienced seizures even after disappearance of CT lesions.

Adolescent↗
PubMed2001

Posterior leukoencephalopathy syndrome.

Posterior leukoencephalopathy syndrome is a newly recognised brain disorder that predominantly affects the cerebral white matter. Oedematous lesions particularly involve the posterior parietal and occipital lobes, and may spread to basal ganglia, brain stem, and cerebellum. This rapidly evolving neurological condition is clinically characterised by headache, nausea and vomiting, seizures, visual disturbances, altered sensorium, and occasionally focal neurological deficit. Posterior leukoencephalopathy syndrome is often associated with an abrupt increase in blood pressure and is usually seen in patients with eclampsia, renal disease, and hypertensive encephalopathy. It is also seen in the patients treated with cytotoxic and immunosuppressive drugs such as cyclosporin, tacrolimus, and interferon alfa. The lesions of posterior leukoencephalopathy are best visualised with magnetic resonance (MR) imaging. T2 weighted MR images, at the height of symptoms, characteristically show diffuse hyperintensity selectively involving the parieto-occipital white matter. Occasionally the lesions also involve the grey matter. Computed tomography can also be used satisfactorily to detect hypodense lesions of posterior leukoencephalopathy. Early recognition of this condition is of paramount importance because prompt control of blood pressure or withdrawal of immunosuppressive agents will cause reversal of the syndrome. Delay in the diagnosis and treatment can result in permanent damage to affected brain tissues.

Brain Edema↗
PubMed2001

Beta blockers for CHF. Adrenergic blockade dramatically reduces morbidity and mortality.

Several large clinical trials have shown that beta blockers can reduce morbidity and mortality in patients with CHF. Therefore, current guidelines for treatment of CHF now include beta blockers as standard therapy for patients with left ventricular systolic dysfunction (ejection fraction < or = 40%) and mild to moderate heart failure. Beta-blocker therapy for CHF should be started cautiously and increased gradually to avoid exacerbating symptoms of heart failure. At this time, data for therapy in patients with NYHA class I or IV symptoms are limited, and it is unclear whether all beta blockers confer benefit or whether some are better than others. Several trials are under way to answer these questions. Until more evidence is available, only those agents that have proved beneficial in mortality trials should be used to manage CHF.

Adrenergic beta-Antagonists↗
PubMed2001

Medical management of neurocysticercosis.

Neurocysticercosis is the most common parasitic disease of the central nervous system. Praziquantel and albendazole, the two antiparasitic drugs, have been reported to be effective against cysticercosis. Both the drugs effectively destroy the cerebral parenchymal cystic lesions. However, albendazole is possibly more effective in subarachnoidal, ventricular and spinal forms of cysticercosis, and frequently obviates the need for surgery. Initially, longer courses of albendazole and praziquantel had been advocated. Now even shorter treatment regimens are found equally effective. Complete course of praziquantel therapy can be administered in a single day with comparable efficacy instead of conventional treatment of 15 days. Similarly, one week therapy of albendazole is as effective as 30 days' treatment regimen. Recently, there is an intense debate whether anticysticercal treatment is useful and safe. Opponents of anticysticercal therapy argue that effectiveness of therapy is possibly a reflection of natural course of the disease. It has been observed that even if cysticercal lesions are left untreated, they either disappear spontaneously or calcify. Anticysticercal therapy is potentially risky, it may aggravate cerebral oedema, and may produce vasculitis and stroke, and several deaths have also been reported. To minimise these risks, concomitant corticosteroids should be administered especially, if there is a massive parasitic load. It is better to avoid anticysticercal treatment in patients with cysticercotic encephalitis. Doubts have been expressed that anticysticercal therapy really affects ultimate long-term clinical outcomes (e.g. control of seizure and possibility of seizure free state after discontinuation of antiepileptic drugs). So far, definite evidences in this regard, based on finding of well planned placebo-controlled studies, are lacking and an opinion that, there is an urgent need for such a study, has been expressed. Measures for effective prevention like provision for safe drinking water and safe excreta disposal should be emphasisfxed.

Adrenal Cortex Hormones↗