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Biomedical subjects

R K Gupta

Publications and source records attributed to R K Gupta.

At least 73 records · Page 4Linked to original sources
PubMed2002

Clinicoradiological observation in three patients with suicidal hanging.

STUDY DESIGN: A hospital-based clinical, radiological and neurophysiological study. OBJECTIVES: Hanging is a common mode of suicide in India, but there is paucity of MRI and neurophysiological findings in the context of clinical and neurological changes. We report the clinical, neurophysiological and MRI studies of three females who attempted suicide by hanging. METHODS: All three patients who attempted hanging underwent detailed clinical, electroencephalographic, motor, somatosensory and brainstem-evoked potential and magnetic resonance imaging studies. Patients were clinically followed up for 6 months. RESULTS: Their ages were 21, 26 and 35 years. They developed altered sensorium, decorticate posturing and had a wide variety of movement disorders. Patient no. 1 had the most severe illness and recovered by the seventh month while the others recovered earlier. MRI revealed hyperintense signal changes in the globus pallidus, caudate nucleus and thalamus in all patients and in the midbrain in one patient. Electroencephalography showed nonspecific slowing. Somatosensory, motor and brainstem-evoked potential studies were normal. CONCLUSION: Hanging leads to hypoxic brain damage resulting in signal changes mainly in the basal ganglia and thalamus and may be associated with transient movement disorders.

Adult↗
PubMed2002

A Sweet-like syndrome manifesting as gingival hyperplasia and myositis without cutaneous involvement.

Sweet's syndrome or acute febrile neutrophilic dermatosis, characterized by fever, neutrophilia, and focal infiltration of the dermis was originally described after episodes of infection. It is also known to occur in acute myeloid leukemia. A patient with acute myeloid leukemia (AML M3) developed gingival hyperplasia and muscle swelling and tenderness after starting treatment with all- trans retinoic acid. Microscopic examination showed neutrophilic infiltrate. All cultures were sterile. The lesions did not respond to cytotoxic therapy and continued to persist even after achievement of remission. The response was seen only after prednisolone was started. This case highlights the fact that a Sweet-like syndrome can occur without the characteristic cutaneous lesions and in such situations there can be considerable diagnostic and therapeutic difficulty.

Child↗
PubMed2002

Multiparametric quantitation of the perilesional region in patients with healed or healing solitary cysticercus granuloma.

The purpose of this study was to compute T2 values and magnetization transfer (MT) ratios in the perilesional region of healing and healed cysticercus granulomas to determine if there are T2 abnormalities not apparent on conventional T2-weighted imaging and to determine the relationship between seizure control and the quantitative measures. Sixty-three patients were studied. T2 values and MT ratios were computed for the perilesional region and were compared with measurements from the contralateral normal-appearing region. A significantly increased T2 value was found for the perilesional region compared to the corresponding contralateral region despite the absence of qualitative abnormality on conventional T2-weighted magnetic resonance imaging. For patients showing normal-appearing perilesional regions on MT imaging, there was no significant difference in T2 and MT ratios between the perilesional and the normal contralateral regions. There was a statistically significant inverse correlation between perilesional T2 values and MT ratios, suggesting each was associated with perilesional gliosis. The study illustrates that quantitative evaluation of MT ratios and T2 augments the qualitative visual assessment of the perilesional region in healing or healed cysticercus granulomas.

Adult↗
PubMed2002

Do current recommendations for kidney biopsy in nephrotic syndrome need modifications?

The current recommendations of kidney biopsy in childhood idiopathic nephrotic syndrome (CINS) were put forward to minimize unnecessary kidney biopsies in underlying minimal change disease (MCD). However, there remains a diversity of opinion about the criteria for biopsying children with idiopathic nephrotic syndrome. This study was conducted to prospectively study their usefulness in avoiding biopsies in MCD and to evaluate further modifications for minimizing biopsies in CINS. Of 400 consecutive CINS patients, 222 patients were subjected to kidney biopsy according to the current recommendations. The histopathology spectrum of these selectively biopsied children revealed focal segmental glomerulosclerosis (FSGS) in 39%, MCD in 34.2%, membranoproliferative glomerulonephritis (MPGN) in 16.2%, mesangioproliferative glomerulonephritis (MesPGN) in 7.6%, membranous nephropathy (MN) in 1.8%, and diffuse mesangial sclerosis (DMS) in 0.9%. We observed that despite the current recommendations and efforts to minimize biopsy, 34% of children had MCD on histopathology. Two or more clinical (hematuria and hypertension) or biochemical (renal insufficiency) parameters were present in all children with MPGN. Low C3 was present only in children with MPGN. All the steroid responders were found to have MCD, FSGS, or MesPGN on biopsy. Cyclophosphamide response correlated better with steroid responsiveness ( P=0.02) than with histo- pathology ( P=0.80) in MCD, FSGS, and MesPGN. Based on these observations, we suggest some modifications in current recommendations for kidney biopsy to minimize biopsying children with MCD. These are (1) biopsies in children (age 1-16 years) should be restricted (a) to a subgroup with two or more clinical and biochemical parameters and (b) in steroid non-responders, (2) the decision to administer cyclophosphamide should be based on steroid response pattern without requiring a prior routine biopsy.

Adolescent↗
PubMed2002

High incidence of post-transplant diabetes mellitus in Kuwait.

Post-transplant diabetes mellitus (PTDM) has been reported to occur in 5-15% of non-diabetic renal transplant recipients. During a 15-year period (January 1983-January 1998), 631 renal transplant recipients (TxR) were followed-up in our Centre of whom 79 (12.5%) had pre-transplant diabetes mellitus. Among the 552 TxR who were non-diabetic at pre-transplantation, 117 (21.2%) developed PTDM. The gender, native renal disease and the mode of pre-transplant dialysis did not differ in those with and without PTDM. Of the 117 TxR who developed PTDM, 63 (53.8%) were above the age of 45 years where as only 90 (20.7%) of the 435 who remained non-diabetic (NDM) were above this age (P<0.05). PTDM occurred in 115 (29.6%) recipients of Arab origin (Kuwaitis and non-Kuwaitis) where as only two (1.7%) non-Arabs developed it. There was no difference in the incidence of PTDM when prednisone and azathioprine (two drug regime) were used or with cyclosporine (triple drug regime). The incidence of acute rejection episodes did not differ among PTDM and NDM groups. The over all incidence of infections requiring hospitalisation was higher in PTDM group (1.8 episodes per patient) compared to NDM group (one episode per patient) during the study period (P<0.001). Coronary heart disease was also more frequent in PTDM (15 vs. 6%, P<0.05). The cumulative graft survival at 1, 5, 10 and 14 years in the PTDM (97, 92, 74 and 67%, respectively) and NDM groups (97, 91, 80 and 73%, respectively) was similar. However, an important cause of graft loss was death of the recipient in PTDM compared to NDM (10.7 vs. 3.6%). Similarly, the patient survival up to 14 years did not differ between PTDM and NDM groups (80 and 82%, respectively), although infection related deaths were more frequent in the PTDM group (65 vs. 49%) although not statistically significant. In conclusion, there is a high incidence of PTDM in Kuwait; age and race being the two important contributory factors. The overall patient and graft survival are not adversely affected by PTDM although infections and coronary heart disease are more frequently encountered in this group.

Adult↗
PubMed2002

MR imaging and in vivo proton spectroscopy of the brain in neonates with hypoxic ischemic encephalopathy.

INTRODUCTION: A number of studies have suggested the potential utility of in vivo proton MR spectroscopy for the evaluation of brain injury in the asphyxiated neonates. We present our initial experience with in vivo proton MR spectroscopy in neonates who were diagnosed as having hypoxic injury on clinical examination and the severity of the insult was graded using Sarnat staging. METHODS AND MATERIAL: MR imaging and in vivo proton MR spectroscopy was performed in 16 neonates with hypoxic ischemic encephalopathy (HIE) to correlate the imaging and metabolite abnormality with clinical severity of the condition at the time of insult and with outcome at 2 months of age. The ratios of different metabolites were calculated as observed on MR spectroscopy from an 8 ml voxel that included thalami, basal ganglia and part of the ventricular system using spin echo technique with an echo time of 135 ms. RESULTS AND DISCUSSION: The results of the spectroscopy were compared with imaging abnormalities and Sarnat's clinical staging of HIE. MR Imaging abnormalities included basal ganglia, thalamic and periventricular hemorrhage and periventricular hyperintensities and were noticed in 8/16 neonates with different stages of HIE. Maximum imaging abnormalities were noted in stage II (6/9) followed by stage III (1/2) and stage I (1/5), respectively. The alpha-Glx resonance at 3.76 ppm was seen in 14/16, Glycine at 3.56 ppm (Gly) was seen in 10/16 and Lactate (L) at 1.33 ppm was observed in 4/16 neonates with HIE. CONCLUSION: MR spectroscopy was more sensitive than imaging in detecting the insult due to HIE and increased concentration of alpha-Glx/Cr and Gly/Cr correlated better with severity of the HIE. The demonstration of L was associated with poor outcome.

Brain↗
PubMed2002

Thrombocytopenia as the presenting manifestation of sarcoidosis.

Sarcoidosis is a chronic granulomatous disorder characterized by multisystem involvement, however, symptomatic thrombocytopenia as a presenting manifestation is rare. Here we are reporting a case of sarcoidosis presenting with splenomegaly and severe immune thrombocytopenia as a presenting manifestation.

Adrenal Cortex Hormones↗
PubMed2002

Demonstration of scolex in calcified cysticercus lesion using gradient echo with or without corrected phase imaging and its clinical implications.

AIM: This study was performed to determine the magnetic resonance imaging (MRI) sequence that was best suited to demonstrate the scolex in a calcified lesion and to seek the explanation for the appearance of a negative phase in a calcified scolex on corrected gradient refocused echo (GRE) phase imaging. MATERIALS AND METHODS: Forty-nine patients with single/multiple computed tomography (CT) documented homogeneous calcified lesions and/or calcified scolices in cysts were studied with conventional spin echo and corrected GRE phase imaging. Calcium and different paramagnetic substances from cysticerci scolices of a sample of infected swine muscle were quantified. RESULTS: The scolex could be demonstrated in 29/39 patients with single calcified lesion. GRE imaging with an echo time of 35ms was the only sequence that demonstrated scolex in all these 29 cases. 15/29 patients with a single calcified lesion, in all 10 patients with multiple calcified lesions and infected swine muscle with multiple cysts and calcified scolex, corrected GRE phase imaging showed negative phase in all these scolices. Estimation of minerals from the calcified scolices from the swine muscle showed by spectroscopic techniques 41.2% of the total mineral contents as paramagnetic substances. CONCLUSION: We conclude that GRE imaging is the imaging method of choice for demonstration of the scolex in a CT calcified lesion. The negative phase on corrected GRE phase imaging is due to the presence of large amount of paramagnetic substances.

Adolescent↗
PubMed2002

Serological study of hepatitis A virus infection amongst the students of a medical college in Delhi & evaluation of the need of vaccination.

BACKGROUND & OBJECTIVES: Recent seroepidemiological studies have demonstrated a decrease in the seroprevalence of hepatitis A virus (HAV) infection, thereby increasing the pool of susceptible adult population. Health care workers, especially those working in paediatric wards and nurseries, are at an increased risk of developing HAV infection. The present study was undertaken to determine the prevalence of antibody against HAV (IgG anti-HAV) among a batch of medical students of the Maulana Azad Medical College, New Delhi, so as to identify the proportion of students who would be susceptible to HAV infection and hence would benefit from a vaccination programme against HAV. METHODS: A total of 91 medical students were enrolled and divided into groups on the basis of sex. The serum samples were evaluated for the presence of immunoglobulin (IgG) against HAV (IgG anti-HAV) using a commercially available enzyme linked immunosorbent assay (ELISA) kit. RESULTS: The mean age of all the subjects was 19.9 +/- 1.5 yr and the male: female ratio was 1.2: 1. Fifty seven (62.6 +/- 5.1%) students were positive for IgG anti-HAV while 34 (37.4%) were seronegative and hence susceptible to HAV infection. No statistically significant difference was observed in the seroprevalence of HAV between males and females [64 +/- 6.7% (32/50) versus 60.9 +/- 7.6% (25/41)]. INTERPRETATION & CONCLUSION: our results indicate that more than one-third of the medical students were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest that students in a health care set up should undergo vaccination against HAV after pre-vaccination immunity screening.

Adolescent↗
PubMed2002

Marker assisted detection of gene (1Dx5) and translocation (1B/1R) in wheat genotypes.

Detection of 1Dx5 gene and presence of 1B/1R wheat rye translocation were studied in nineteen elite Indian wheat genotypes using AS-PCR and STS markers, respectively. Fifteen genotypes had 1B/1R translocation whereas ten showed presence of 1Dx5 gene. More than 50 per cent of the genotypes tested were found positive for both 1Dx5 and 1B/1R translocation. The results are in conformity with HMW glutenin SDS-PAGE profile for 1Dx5 and cytological observations for 1B/1R translocation.

Genes, Plant↗
PubMed2002

Renal angiomyolipoma: a clinico-pathological study or eleven cases.

Retrospective analysis of clinical and histomorphological features and follow up of eleven cases of renal angiomyolipoma (AML) encountered during the past twelve years at our centre was performed. These included seven female and four male patients, nine of them were symptomatic and two were incidentally detected on ultrasonography for other reasons. Eight patients had solitary and three had bilateral lesions on radiological investigations. None of the three patients with bilateral AML had associated tuberous sclerosis, however, a patient with tuberous sclerosis, showing solitary lesion on radiological investigation, was detected to have multiple lesions on thorough pathological examination of the nephrectomy specimen. The surgical treatment comprised of nephrectomy in six cases, enucleation in four cases and trueut biopsy in one case. Enucleation of the largest lesion was done in all three patients of bilateral AML. The mean follow up was of three years. Two patients with bilateral AML had radiological progression of size of other lesions, whereas one died due to excessive bleeding in the postoperative period. None of the patients had any evidence of recurrence or metastasis. Bilateral AML is not always associated with tuberous sclerosis, however, in patients with tuberous sclerous thorough sampling of nephrectomy specimen is recommended.

Adult↗
PubMed2001

Importance of magnesium ions in development of tolerance to ethanol: studies on cultured cerebral vascular smooth muscle cells, type-2 astrocytes and intact rat brain.

This study was designed to examine the roles of intracellular free magnesium ion concentration ([Mg(2+)](i)) in ethanol-induced intoxication and development of tolerance in cultured canine cerebral vascular smooth muscle cells and astrocytes as well as intact rat brain. The basal, resting level of [Mg(2+)](i) in cerebrovascular cells was 732.5 +/- 82.4 microM. Exposure of cultured canine cerebral vascular smooth muscle cells to ethanol (10 and 25 mM) for 24 h reduced the concentrations of [Mg(2+)](i) to 521.1 +/- 59.6 microM, and 308.2 +/- 37.8 microM, respectively. However, exposure of these cultured vascular cells to the same concentrations of ethanol, after initial pretreatment with ethanol for 24 h, failed to interfere with the levels of [Mg(2+)](i). Measurement of [Mg(2+)](i) at 48 h and 72 h indicated that the decreased levels of [Mg(2+)](i) induced by ethanol at 24 h treatment returned toward baseline. Similar experiments were performed in cultured type-2 astrocytes isolated from neonatal rat brain. The basal level of [Mg(2+)](i) in type-2 astrocytes was about 125 microM. Incubation of these cells with 10 mM ethanol for 10 min resulted in a 27% reduction in the level of [Mg(2+)](i), whereas incubation with 25 mM ethanol resulted in almost a 50% reduction in [Mg(2+)](i). The decreased levels of [Mg(2+)](i) lasted around 30 min, until the measurement finished. Continuous incubation of these cultured astrocytes, with ethanol (either 10 mM or 25 mM), for more than 24 h, indicated that the concentrations of [Mg(2+)](i) in type-2 astrocytes were equivalent to those at basal, resting levels. In vivo 31P-NMR spectroscopy, performed on intact rat brains, indicated that an initial administration of 4 mg/kg ethanol ( approximately 20-25 mM blood alcohol level) resulted (after 20-40 min of exposure) in severe deficits in whole brain [Mg(2+)](i) (550 +/- 33 microM to 358 +/- 24 microM). Repeated injections of ethanol (4 mg/kg) over the next 24-72 h resulted in progressively diminishing effects on brain [Mg(2+)](i). These experimental data indicate that chronic ethanol treatment can induce a tolerance to depletion of [Mg(2+)](i) in cerebrovascular smooth muscle cells, type-2 astrocytes as well as intact rat brain. The results suggest that [Mg(2+)](i) might play a major role in alcohol-induced tolerance in the brain.

Alcohol-Induced Disorders, Nervous System↗
PubMed2001

A trial of acellular pertussis vaccine in hospital workers during the Cincinnati pertussis epidemic of 1993.

The safety and immunogenicity of acellular pertussis (AP) vaccine in outbreak control was determined in a randomized, double-blind, controlled trial. Participants received AP vaccine (n=102), which contained 25 microg of pertussis toxoid (PT) and 3 microg of filamentous hemagglutinin (FHA), or licensed meningococcal vaccine (MN; n=97). Local reactions (pain or tenderness, redness, swelling, and induration) and systemic reactions (fever, sleepiness or lethargy, and irritability) were similar among AP and MN vaccinees. One month after AP vaccination, the geometric mean level of IgG anti-PT was 33.1 microg/mL, with 2-fold increases in 85% of patients and 4-fold increases in 73% of patients; for IgG anti-FHA, the respective values were 34.7 microg/mL, 92%, and 63%. After 6 months of follow-up, no serological evidence of pertussis was seen among symptomatic or asymptomatic subjects. However, recent evidence of Bordetella pertussis infection before immunization was shown. Thus, AP vaccine was safe and immunogenic in adults.

Adult↗
PubMed2001

Tumor-associated antigen TA90 immune complex assay predicts recurrence and survival after surgical treatment of stage I-III melanoma.

PURPOSE: Immune complexes (IC) containing the tumor-associated antigen TA90 can be identified in the sera of melanoma patients. We have shown that an enzyme-linked immunosorbent assay for TA90-IC can detect subclinical metastasis before surgical treatment of early-stage melanoma. We assayed the TA90-IC levels of postoperative sera from patients with melanoma and evaluated their relationship to recurrence and survival. PATIENTS AND METHODS: Multiple archival serum samples prospectively collected during postoperative surveillance of 166 patients with American Joint Committee on Cancer stage I, II, or III melanoma were analyzed for TA90-IC in a blinded fashion. Results were correlated with disease recurrence and survival determined by database and chart review. RESULTS: TA90-IC status in the early postoperative period was strongly correlated with survival. Five-year overall survival rates were 84% for TA90-IC-negative patients and 36% for TA90-IC-positive patients (P =.0001). Respective 5-year disease-free survival rates were 74% and 24% (P =.0001). The TA90-IC assay was a significant predictor of survival for both stage II and III patients. Multivariate analysis identified TA90-IC status as the strongest independent prognostic factor for both overall and disease-free survival. The TA90-IC assay was elevated in 54 (77%) of 78 patients who developed recurrent disease, becoming positive 19 +/- 7 months before clinical evidence of recurrence. Overall, the assay detected recurrence with a sensitivity of 78% and specificity of 77%. Exclusion of patients receiving postoperative immunotherapy with a polyvalent melanoma cell vaccine increased sensitivity and specificity to 92% and 86%, respectively. CONCLUSION: The TA90-IC assay can accurately predict survival and detect the presence of subclinical disease after surgery for melanoma, which should be useful in selecting patients for adjuvant therapy. Because the TA90-IC assay detected recurrence on an average of 19 months sooner than did routine clinical and radiographic evaluation, it may allow more timely therapeutic interventions.

Antigens, Neoplasm↗
PubMed2001

Biphasic illness pattern due to early relapse in Japanese-B virus encephalitis.

Japanese-B virus encephalitis (JE) is considered a uniphasic illness with a variable outcome. Biphasic illness patterns have never been reported previously. From an endemic zone in India we observed six patients of JE (from 62 patients treated in 7 years) who had an early relapse resulting in the biphasic clinical course. Five had poor socio-economic status and three had laboratory evidence of nutritional deficiency. Two patients were adults and the other four were children. Fever, rigors, headaches, body aches, altered consciousness, rigidity and tremors predominated the first phase of illness. During the second phase, behavioural changes, dystonia, pen-oral dyskinesia, drooling, mutism and muscle wasting due to anterior horn cell involvement were the important features. Though the serial antibody titres against the JE virus showed a four-fold rise in the initial or late convalescent phases, there was no increase during the second phase of the illness as compared to the first phase. On MRI, fresh lesions appeared during the second phase at the sites known for their involvement in JE, suggesting recrudescence of the virus. One patient survived with major sequelae, two with minor sequelae and the other three had complete recovery. We conclude that some patients with JE may have an early relapse after partial recovery, giving rise to the biphasic illness pattern. A locally prevalent genetic variant of the virus or host factors may be responsible for the altered clinical course of the disease. Biphasic illness does not necessarily mean a bad prognosis.

Adolescent↗