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Biomedical subjects

R K Gupta

Publications and source records attributed to R K Gupta.

At least 55 records · Page 3Linked to original sources
PubMed2003

St. John's Wort. An option for the primary care treatment of depressive patients?

This article reviews the historical background, active ingredients of St. John's Wort and the major double-blind placebo-controlled studies. Despite the two major failed clinical trials conducted in American Research Centers, most of the data reviewed support that hypericum extracts are more effective than placebo for the treatment of mild to moderate depressive illness. The authors examine the likely reasons for the failed studies and also describe drug interactions and the side effects of St. John's Wort. Those patients who are prescribed St. John's Wort should be closely monitored.

Antidepressive Agents↗
PubMed2003

Neuro-endoscopic surgery--experience and outcome analysis of 102 consecutive procedures in a busy neurosurgical centre of India.

BACKGROUND: Neuro-endoscopic surgery is finding increasing application for various clinical conditions. We present our experience of 100 cases of diverse intracranial lesions, including infections, managed by neuro-endoscopy in a busy neurosurgical department in the developing world. MATERIAL AND METHODS: One hundred patients treated from March 1996 to February 2002 formed the study group. Management of hydrocephalous by Endoscopic third ventriculostomy (ETV) was the aim in 75 patients with or without diagnostic biopsy. Excision or resection was attempted in 25 patients with juxtaventricular or intraventricular lesions. Endoscopic procedures included total tumour resection, partial resection, biopsy, stent placement, Monroplasty, septostomy and third ventriculostomy. Outcomes of endoscopic surgery were evaluated with respect to clinical and/or radiological improvement, complications and need for additional therapy. FINDINGS: Endoscopy was the only surgical treatment in 59 patients. Intermittent lumbar drainage for cerebrospinal fluid leak, shunt, microsurgery and/or repeat endoscopic surgery were additional treatments needed in 39 patients, who subsequently had increased hospital stay, postoperative morbidity and a higher cost of treatment. Peroperative bleeding due to distorted anatomy and obscured vision in 2 patients with post-infective loculated hydrocephalus (LH) resulted in two fatalities (2%) in the early post-operative period. INTERPRETATION: Neuro-endoscopic surgery cuts down operative time and hospital stay, reduces cost and results in a faster turnover of the patients. It is a versatile and useful tool for a busy neurosurgical department.

Adolescent↗
PubMed2003

The prevalence of hepatitis C virus antibodies among the voluntary blood donors of New Delhi, India.

Infection with hepatitis C virus (HCV) is a major cause of transfusion-associated hepatitis, cirrhosis and hepatocellular carcinoma. The present study was conducted with an objective to evaluate the prevalence of anti-HCV antibody in New Delhi, India using a large number of healthy voluntary blood donors. A total of 15,898 healthy voluntary blood donors were subjected to anti-HCV testing (using a commercially available third generation anti-HCV ELISA kit) and 249 were found to be reactive for anti-HCV antibody, yielding an overall prevalence of 1.57%. No significant difference was found between the HCV positivity rate of male (1.57%; 238/15,152) vs. female (1.47%; 11/746) donors, family (1.58%; 213/13,521) vs. altruistic (1.51%; 36/2377) donors and first-time (1.55%; 180/11,605) vs. repeat (1.61%; 69/4293) donors. The age distribution of anti-HCV reactivity showed a maximum prevalence rate of 1.8% in the age group of 20-29 years. In addition, there was a clear trend of decreasing positivity for anti-HCV with increasing age and this trend was statistically significant. The results of the present study show that the prevalence of anti-HCV antibodies in the healthy voluntary blood donors of New Delhi, India is considerably higher than the reported seroprevalence of HCV in majority of the industrialized nations and this represents a large reservoir of infection capable of inflicting significant disease burden on the society. In addition, donors of New Delhi, India showed a trend of decreasing seroprevalence with increasing age, possibly implying a higher exposure rate to HCV in younger subjects.

Adolescent↗
PubMed2003

Intermittent symptoms in neurocysticercosis: could they be epileptic?

OBJECTIVES: Some patients with neurocysticercosis (NCC) develop perilesional gliosis during the course of healing and carry poor prognosis for the seizure control. We evaluated the clinical status of these patients during complete control of their original seizures on anti-epileptic drugs (AED). MATERIAL AND METHODS: We studied 172 patients with solitary NCC, 45 with perilesional gliosis as visible on magnetization transfer spin echo (MTSE) magnetic resonance imaging and 127 without gliosis, for any abnormal symptom during the course of their "seizure-free" period. All of them received optimum doses of AED to control the original seizures. RESULTS: Patients with gliosis had high incidence of abnormal symptoms with or without corresponding abnormalities on surface electroencephalogram (EEG). These symptoms disappeared on increasing the dose or adding a new AED. The symptoms, which were transient episodic in nature, included heaviness, dystonic posturing, weightlessness, numbness and alien limb phenomenon on the side of the body contralateral to cerebral lesion, and headache. CONCLUSION: Patients with NCC who develop perilesional gliosis during the process of healing tend to suffer from disturbing intermittent symptoms during their apparent control of seizures. The symptoms are controllable with increased dosage of previously prescribed or addition of another AED. As these symptoms could possibly be epileptic in nature, their identification and treatment may have a bearing on long-term seizure control after stopping AED therapy.

Adolescent↗
PubMed2003

The diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes: a study of 218 cases.

The aim of this study was to evaluate the diagnostic value of fine needle aspiration cytology (FNAC) in the assessment of palpable supraclavicular lymph nodes. The material was analysed in 218 cases with enlarged supraclavicular lymph nodes in which FNAC was performed by the conventional method. In all cases cytological examination was performed on-site after staining the smears by the Papanicolaou method. In addition, air-dried smears, fixed smears, filter preparations from needle washings and cell blocks were studied. The FNAC diagnosis was supported by examining cell blocks which added the reliability of histological architecture; further support was obtained by tissue biopsy and/or comparison with the primary tumour in some of the cases. Eleven cases were diagnosed as inflammatory lesions and 41 cases were unsatisfactory because of scanty/acellular samples (despite two to three repeat samplings). However, in five of these, malignant tumours were later found on biopsy, which was done for persistent enlargement of the supraclavicular lymph node(s). Fifty-three cases were diagnosed as negative for malignancy (normal cellular elements, n=15; reactive elements, n=38) and 12 cases were suspicious of malignancy. In 11 cases a diagnosis of lymphoma was made on histology and in 90 cases metastatic tumours were diagnosed. The overall sensitivity was 92.7%, specificity 98.5%, positive predictive value 97.3% and the negative predictive value was 94.8%. Based on our study we feel that FNAC of palpable supraclavicular lymph nodes as a first line of investigation is a cost-effective procedure and is not only useful in the diagnosis of various lesions but can also help in deciding on appropriate management. Furthermore, the histological architecture from cell blocks can be correlated with cytology, and such material can be used for appropriate histochemical and immunomarker studies, which can be useful in enhancing the diagnosis.

Adolescent↗
PubMed2003

Broad identification of bacterial type from pus by 1H MR spectroscopy.

BACKGROUND: Abscess formation is a common bacterial infection and requires an immediate antimicrobial approach for apposite treatment. Delay in patient treatment is usually a common feature, as the bacterial identification of clinical samples is based on the culture, which is a time-consuming exercise. The current study was aimed at developing an alternative technique with the potential for rapid bacterial group identification. MATERIALS AND METHODS: In the present study we performed ex vivo proton magnetic resonance spectroscopy of 40 pus samples collected from abscesses in different locations and the results have been retrospectively compared with the microorganism identified in the pus culture. In addition, the microbes obtained from the culture have been further subcultured and studied with magnetic resonance spectroscopy to identify the bacterial fingerprint in the pus sample seen on spectroscopy. RESULTS: On reviewing the spectra obtained from the various abscesses, they were found to be qualitatively similar for a particular bacterium. The similar spectral pattern of the pus with obligate aerobes/anaerobes and pure cultures of the same bacteria suggests its strict metabolism under in vivo and in vitro conditions, respectively. CONCLUSIONS: The characteristic metabolite pattern of obligate anaerobes may be used as a prototype for its rapid identification. This information may be of value for more appropriate clinical management of such cases.

Abscess↗
PubMed2003

Multimodality image fusion in dose escalation studies of brain tumors.

This article examines the utility of integrating images from computed tomography (CT), magnetic resonance imaging (MRI), and single photon emission computed tomography (SPECT) for radiation treatment planning of brain tumors for dose escalation studies. The information obtained from these imaging modalities is complementary to each other and could provide anatomic (through CT and MRI) and metabolic (through SPECT) information of the target. This anato-metabolic target localization could be expected to facilitate precise radiation therapy planning for brain tumors by delineating the boundary between the tumor, edema, and the normal brain parenchyma and identify the viable tumor nidus with greater degree of certainty. This could in turn lead to minimize dose to the normal tissue and permit dose escalation to the region of interest. The utility of these anato-metabolic imaging modalities for defining the clinical target volumes along with planning target volumes for different phases of the radiation therapy is illustrated.

Adult↗
PubMed2003

Is neurocysticercosis a risk factor in coexistent intracranial disease? An MRI based study.

BACKGROUND: Previous reports have suggested that neurocysticercosis is associated with glioma and Japanese encephalitis, and that it is a risk factor for stroke. OBJECTIVE: To determine if neurocysticercosis has a significant association with, or is a risk factor for, coexistent pathologies such as Japanese encephalitis, glioma, abscess, tuberculoma, or infarction. SUBJECTS: 10 350 patients from the hospital population who underwent 1.5 T cranial magnetic resonance imaging during the previous 12 years were evaluated for the presence of neurocysticercosis and coexisting pathology. DESIGN: Retrospective cohort analysis. RESULTS: The prevalence of neurocysticercosis in cases with dual pathology was significantly less than in a control group (1.1% v 8.3%; z = 11.05; p < 0.001, power of test = 1). Neurocysticercosis lesions were less common (p < 0.05) in the different subgroups of coexistent pathology than in the control group except in the case of Japanese encephalitis, where the difference was non-significant (z = 0.69, p = 0.49). The relative risk was less than 1 in all subgroups except Japanese encephalitis, where it was 1.23. The location of neurocysticercosis lesions and the presence of perilesional oedema did not affect coexistent lesion location or severity on a particular side (p = 0.413 and 0.623 for location and perilesional oedema, respectively). When the above factors were analysed separately in patients with Japanese encephalitis, they also did not affect coexistent lesion location or severity (p = 0.659 and 0.548, respectively). CONCLUSIONS: The coexistence of neurocysticercosis and other lesions may be an incidental observation in a few patients referred from areas of high prevalence and endemicity. It appears unlikely that neurocysticercosis is a risk factor for other intracerebral pathology. The location of neurocysticercosis lesions and whether or not there is surrounding perilesional oedema do not appear to affect the location or severity of coexisting lesions.

Adolescent↗
PubMed2003

Efficacy of a new self-supporting low-profile bednet for personal protection against Anopheles farauti (Diptera: Culicidae) in a village in Papua New Guinea.

A new United States (U.S.) self-supporting low-profile bednet was designed by Walter Reed Army Institute of Research in collaboration with Breakthrough Technologies. The bednet incorporated permethrin-impregnated screening into a frame that erected automatically when removed from its bag. The new U.S. bednet was compared with the current Australian Defense Force (ADF) mosquito bednet at Buka Island, North Solomons Province, Papua New Guinea, in March 1999. At the time of the test, Anopheles farauti Laveran was the most abundant biting mosquito. Both bednet types provided >97.8% protection compared with an unprotected collector. The untreated U.S. Army prototype bednet provided better protection than the untreated ADF bednet against mosquitoes entering the bednet during the night.

Animals↗
PubMed2003

Immunogenicity and reactogenicity of a recombinant hepatitis B vaccine in subjects over age of forty years and response of a booster dose among nonresponders.

AIM: The study was initiated to evaluate the reactogenicity and immunogenicity of a recombinant hepatitis B vaccine in age group >40 years and to study the response of a single booster dose in primary non-responders to the hepatitis B vaccination. METHODS: A total of 102 volunteers without markers of hepatitis B infection (negative for HBsAg, anti-HBc antibody, HBeAg and anti-HBs antibody) received 20 microg of recombinant HB vaccine intramuscularly at 0, 1, and 6 months. Anti HBs titers were evaluated by a quantitative Elisa kit at 90 and 210 days. A booster dose of 20 microg HB vaccine was given after 6 months of the 3(rd) vaccine dose to the 15 non-responders and anti-HBs titers were measured after 1 month. RESULTS: Seroprotection (anti-HBs GMT(3) 10 IU/L) was achieved in 85.3 % (87/102) volunteers. The mean GMT titers of the vaccine responders was 136.1 IU/L. Of the seroprotected individuals, there were 32.4 % (33/102) hyporesponders (anti-HBs titers <10-99 mlU/ml) and 52.9 % (54/102) were responders (anti-HBs titers >100 IU/L). All the non-responders (15/15) responded to a single dose of the booster dose of recombinant HB vaccine and their mean anti-HBs antibody titers were more than 100.5 mIU/ml after the booster dose. CONCLUSION: Recombinant hepatitis B vaccine offers good seroprotection in the age group >40 years and has a good safety profile. A single booster dose after 6 months in primary non-responders leads to good seroprotective anti-HBs antibody titers. However, larger population based studies are needed to evaluate the role of a booster dose in selected group of non-responders and whether such an approach will be cost effective.

Adult↗
PubMed2003

A phase II protection study of BB-10010 in patients with high grade non-Hodgkin's lymphoma undergoing intensive chemotherapy.

The aim of this study was to determine whether administration of BB-10010, a synthetic stem cell inhibitor, would allow more intensive chemotherapy to be administered to patients with newly diagnosed high grade NHL. Thirteen patients were randomised to receive BB-10010 concurrently with dose-intensified BEMOP/CA chemotherapy (7 patients) or chemotherapy alone (6 patients). Although the mean neutrophil count of BB-10010 treated patients was higher following cycles 1, 2 and 3 of chemotherapy compared with those receiving chemotherapy alone, there was no difference in the mean number of cycles tolerated, blood component usage and hospital admissions due to infections. No specific toxicity of BB-10010 was identified. Whilst BB-10010 can be administered safely, it does not improve the ability of patients to tolerate intensive chemotherapy for high grade NHL.

Adult↗
PubMed2003

Age specific incidence rate and pathological spectrum of oral cancer in Allahabad.

BACKGROUND: Cancer of the oral cavity is one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc ) is on the increase in North India and specially in Uttar Pradesh. AIMS: To assess the patients characteristics and histopathological subtypes of the oral cancer in our region. SETTINGS AND DESIGN: A single institutional retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year wise using the tumour registry data. MATERIAL AND METHODS: A total of 40,559 biopsies were examined in the department during 1990-2000, out of which the oral cavity constituted 759 biopsies. The data was analysed with emphasis on age, sex, risk factors, site and histology. STATISTICAL ANALYSIS: The data was analysed utilizing the Kolomogroo-Smirnov two sample test. RESULTS: A comparison of the age specific incidence rates of oral cancer during 1990-2000 in Allahabad showed that the incidence was maximum in the 50-59 years age group and squamous cell carcinoma grade I was the most prevalent type. Of the total of 759 biopsies from oral cavity, 303 malignant cases. 232 (76.57%) were males and 71 (23.43% were females with a male to female ratio of 3.27:1. The tongue was the most frequently involved site--found in 42.57% cases. On an average, 63 new cases of oral cavity per annum were detected during this period. CONCLUSIONS: Properly structured site specific data like this can augment National Cancer Registry Programme (NCRP) and is an essential indicator for the magnitude and the pattern of the cancer problem in India Urgent public health measures like public education and oral cancer awareness are required to curb this avoidable epidemic.

Age Distribution↗
PubMed2003

Magnetic resonance imaging and spectroscopy in hepatic encephalopathy.

Hepatic encephalopathy (HE) is a potentially reversible neuropsychiatric syndrome secondary to cirrhosis and other severe liver diseases. Magnetic resonance imaging (MRI) and MR spectroscopy (MRS) have been explored to provide new insight into the pathophysiology, diagnosis and treatment of HE. MRI shows brain atrophy especially in the frontal region. Globus pallidus, putamen and portions of the internal capsule appear hyperintense on T1-weighted images; this is likely to be due to deposition of manganese as a result of portosystemic shunting and liver dysfunction. MRS permits the detection and quantification of certain brain metabolites in vivo. There is decrease in myoinositol and choline concentrations and increase in glutamine concentrations. There is no change in n-acetyl-aspartate. Depletion of myoinositol is the most sensitive and specific spectroscopic marker in HE. Its loss is most likely a compensatory mechanism for the accumulation of glutamine. In conclusion, MRI and MRS examine different aspects of hepatocerebral disease.

Hepatic Encephalopathy↗
PubMed2003

Pauci-immune crescentic glomerulonephritis.

Pauci-immune crescentic glomerulonephritis (PICGN) is a rapidly progressive condition leading to renal failure within days or weeks and is potentially life threatening. Majority of these patients have clinical or pathological evidence of systemic vasculitis. PICGN may occur as renal limited disease or as a component of systemic necrotising small vessel vasculitis. Majority of these cases are attributed to Wegener's granulomatosis (WG), microscopic polyangitis (MPA) or Churg Strauss syndrome (CSS). Renal involvement is encountered in 80 to 90% cases of WG and MPA and in about 45% cases of CSS. Approximately 80 to 90% patients of untreated WG or MPA and about 60% cases of CSS are positive for anti-neutrophilic cytoplasmic antibodies (ANCA). These diseases are therefore also called as ANCA-associated vasculitis. Serial ANCA measurements provide useful information on disease activity. Renal transplant should be avoided in patients with clinical evidence of active vasculitis. Even though the treatment with oral corticosteroids and i.v. or oral cyclophosphamide results in complete long term remission in 70 to 75% patients, relapse occurs in >25% cases within a mean period of 18 months after cessation of therapy. Prognosis of untreated ANCA-associated PICGN is poor.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2002

ChlVPP/EVA hybrid versus the weekly VAPEC-B regimen for previously untreated Hodgkin's disease.

PURPOSE: To test the hypothesis that a chemotherapy regimen of relatively low toxicity and 11 weeks' duration (doxorubicin, cyclophosphamide, etoposide, vincristine, bleomycin, and prednisolone [VAPEC-B]) is at least as effective in terms of disease control as 6 months' treatment with chlorambucil, vinblastine, procarbazine, and prednisone/etoposide, vincristine, and doxorubicin (ChlVPP/EVA hybrid), which is associated with a high risk of permanent sterility. PATIENTS AND METHODS: Two hundred eighty-two patients with previously untreated Hodgkin's disease, clinical stages I/II (plus mediastinal bulk and/or B symptoms) and clinical stages III/IV were randomized at three United Kingdom and one Italian center to receive either six monthly cycles of ChlVPP/EVA hybrid or 11 weekly cycles of VAPEC-B. After chemotherapy and a restaging evaluation, radiotherapy was administered to sites of previous bulk or residual radiographic abnormality before patients were observed off treatment. RESULTS: Further accrual to the trial was halted at the planned third interim analysis in September 1996. After a median follow-up of 4.9 years, freedom from progression (FFP), event-free survival (EFS), and overall survival (OS) are all significantly better in the population treated with ChlVPP/EVA than VAPEC-B, where the comparative 5-year results are 82% and 62% (FFP), 78% and 58% (EFS), and 89% and 79% (OS), respectively. The superiority of ChlVPP/EVA was seen in both low-risk and intermediate/high-risk patients, although subset analysis suggested that ChlVPP/EVA and VAPEC-B produce equivalent results in the best-prognosis patients (Hasenclever score <or= 2, nonbulky disease). CONCLUSION: Apart from possibly in the best-prognosis group, where results are equivalent, ChlVPP/EVA hybrid produces significantly better FFP, EFS, and OS than VAPEC-B in patients with previously untreated Hodgkin's disease.

Adolescent↗