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Biomedical subjects

R P Sapru

Publications and source records attributed to R P Sapru.

At least 19 recordsLinked to original sources
PubMed1992

Active infective endocarditis observed in an Indian hospital 1981-1991.

Clinical data from 186 patients (133 males and 53 females) with 190 episodes of infective endocarditis (IE) occurring between January 1981 and July 1991 were studied retrospectively at a large referral hospital in Northern India with the intention of highlighting certain essential differences from those reported in the West. The mean age was much lower (25 +/- SD 12 years, range 2 to 75 years). Rheumatic heart disease was the most frequent underlying heart lesion accounting for 79 patients (42%). This was followed by congenital heart disease in 62 (33%) and normal valve endocarditis in 17 (9%). Twenty-four patients had either aortic regurgitation (n = 15) or mitral regurgitation (n = 9) of uncertain etiology. Prosthetic valve infection and mitral valve prolapse were present in only 2 patients each. A definite predisposing factor could be identified in only 28 patients (15%). Postabortal sepsis and sepsis related to childbirth accounted for 6 and 5 cases, respectively. Only 1 patient had history of intravenous drug abuse. Two-dimensional echocardiography showed vegetations in 121 patients (64%). Blood cultures were positive in only 87 (47%), with a total of 90 microbial isolates. Commonest infecting organisms were staphylococci (37 cases) and streptococci (34 cases). Except for a significantly higher number of patients with neurologic complications in the culture-negative group, there were no differences between patients with culture-positive and culture-negative IE. Of the 190 episodes of IE, the patients had received antibiotics before admission in 110 (58%) instances. A significantly greater number of culture-negative patients had received antibiotics than did culture-positive patients (87 vs 23, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Isosorbide dinitrate spray. Attenuation of cardiovascular responses to laryngoscopy and intubation.

We evaluated the efficacy of isosorbide dinitrate buccal spray (Isomack) in attenuating the cardiovascular response to laryngoscopy and tracheal intubation in 60 patients undergoing elective surgery under general anaesthesia. Patients were allocated to one of three groups of 20 patients each. Group 1 patients were administered placebo buccal spray 90 s before induction of anaesthesia. Groups 2 and 3 had isosorbide dinitrate spray 30 and 90 s before induction of anaesthesia. Systolic, diastolic and mean arterial pressures and heart rate were monitored. After the spray, group 3 patients had a significant decrease in systolic arterial pressure (p less than 0.01). At 1 min after intubation, systolic, diastolic and mean arterial pressures showed a significant increase in group 1 patients (24.9 mmHg, 14.2 mmHg and 18.7 mmHg respectively). In contrast, groups 2 and 3 showed a significant decrease in these parameters (p less than 0.01). Although significant tachycardia was present following intubation in all the three groups, the degree of tachycardia was greater in groups 2 and 3 (p less than 0.01).

Adolescent↗
PubMed1991

Profile of right-sided endocarditis: an Indian experience.

The clinical profile of right-sided infective endocarditis in India was studied from a review of records of patients with infective endocarditis admitted to this hospital. From November 1982 to November 1989, 109 patients with infective endocarditis showed vegetations on cross-sectional echocardiography confirming the diagnosis of infective endocarditis. In 19 (17.4%) patients, only the right side of the heart was involved: specifically the tricuspid valve alone in 10; tricuspid and pulmonary valves in 4; tricuspid valve and right ventricular outflow tract in 1; tricuspid valve and right ventricular free wall in 1; pulmonary valve alone in 2; and bifurcation of pulmonary trunk in 1. Eleven patients (57.9%) had underlying congenital heart disease whereas the remaining 8 patients (42.1%) did not have any underlying heart disease. The latter group, therefore, had isolated right-sided infective endocarditis. Previous illnesses leading to isolated right-sided infective endocarditis were: puerperal sepsis in 4; septic abortion in 1; staphylococcal pneumonia in 2; and epididymoorchitis in one. Eight out of 11 patients with congenital heart disease did not report any previous illness. In the remaining 3, right-sided endocarditis followed cardiac surgery in one; dental extraction without prophylaxis in one; and pulmonary balloon valvoplasty in one. All patients with isolated right-sided infective endocarditis had features of septicaemia, but a murmur of tricuspid regurgitation was audible in only 4 (50%) of them. We conclude that, unlike western reports, the pattern of right-sided infective endocarditis in India is different. No drug addict with right-sided infective endocarditis was seen; puerperal sepsis and septic abortion were the commonest causes of isolated right-sided infective endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Septic↗
PubMed1988

Anatomically isolated aortic valve disease. Morphologic study of 100 cases at autopsy.

Anatomically isolated aortic valve disease accounted for 1.1% of all and 5.2% of cardiac autopsies over a 20 year period. Among a total of 100 symptomatic cases, 52% had congenitally bicuspid, 43% had tricuspid and 5% had congenitally unicuspid valves. Nineteen percent had undergone fibrous sclerosis, including 1% unicuspid, 3% tricuspid and 15% bicuspid valves. Thirty nine percent had been affected by infective endocarditis, including 20 bicuspid and 19 tricuspid valves. The remaining 42 showed fibrocalcification, including 4 unicuspid, 17 bicuspid and 21 tricuspid valves. The nature of the valvular disease showed a correlation with the age of the patient. Infective endocarditis, fibrosis and calcific disease occurred in an ascending age pattern, at average ages of around 30 years, mid to late thirties and mid to late forties, respectively. The lesions occurred much earlier on the bicuspid than on the tricuspid valves, except for infective endocarditis. The bicuspid deformity was not found to make the aortic valve more prone to infection, nor did infection occur earlier on it than on the tricuspid valve. Four of the 100 cases, all tricuspid, were considered to be of rheumatic origin, the reasons for which are discussed. Certain well established associated cardiac lesions were identified.

Age Factors↗
PubMed1986

Topical nitroglycerin. A safeguard against pressor responses to tracheal intubation.

In order to attenuate the pressor response to intubation of the trachea we have studied the effects of 2% nitroglycerin ointment rubbed on the forehead approximately 12 minutes prior to intubation. A double blind, randomized design was used in 56 consecutive patients. Of these, 30 patients received the ointment while 26 patients formed the control group. The maximum rise in the systolic arterial pressure was significantly lower (p less than 0.001) in the group (7.66 mmHg, 6.2%) as compared to the control group (25.7 mmHg, 20.2%). The rise in arterial pressure persisted for up to 4 minutes in the control group, but lasted for only one minute in the nitroglycerine group. The pulse rate, however, increased in both groups to an equal extent. We have found the application of 2% nitroglycerine ointment to be a safe, inexpensive, comfortable and effective means of attenuating the pressor response to intubation of the trachea.

Administration, Topical↗
PubMed1979

An evaluation of six kits of technetium 99m human serum albumin injection for cardiac blood pool imaging.

We have investigated the suitability of five different commercially available kits which provide human serum albumin (HSA) labelled with technetium 99m (99mTc) for cardiac blood pool imaging. Four of these products were one-step processes using stannous chloride as the reducing agent; the fifth was based on an electrolytic reduction. In addition, we also assessed our own modification of the electrolytic method. We measured the radiochemical purity by precipitation with trichloroacetic acid and by gel filtration on a Biogel P4 column. In addition, we measured the clearance of radioactivity from the blood at frequent time intervals after intravenous injection. Each product was assessed in separate groups of six patients. The labelling efficiency of the one-step kits varied between 73 and 93% compared with 94 and 98% for the electrolytically labelled albumin. The blood clearance for all one-step kits was significantly faster than that obtained for the radiopharmaceuticals prepared by the electrolytic method. We conclude that HSA labelled with 99mTc by the electrolytic method is to be preferred.

Cardiac Volume↗
PubMed1979

Orthostatic hypertension.

A 40 year old man was found to have marked hypertension when he was in the upright position with normal pressures when he was supine. Investigations disclosed normal catecholamine and renin levels. The baroreceptor reflex was somewhat depressed. The mechanism of this orthostatic hypertension is not known. The condition has not been reported previously.

Adult↗
PubMed1978

The effect on myocardial contractility of a new beta-adrenergic receptor blocking drug, penbutolol.

1 The inotropic effect of penbutolol, a new beta-adrenergic receptor blocking drug, has been compared with that of propranolol in two similar groups of six subjects each. 2 Inotropic changes were assessed from changes in myocardial contractility index [LV dp-dt/11 T] as well as the slope of the regression line relating LV dp/dt to LVED during incremental pacing. 3 Penbutolol was found to have a significant negative inotropic effect of an order similar to that of propranolol in the respective doses studied.

Adult↗
PubMed1978

Comparative potency of intravenous penbutolol and propranolol in man.

A study on the comparative potency of intravenously administered penbutolol, a new non-selective beta adrenoceptor antagonist, on the resting and post-exercise heart rate and rate-pressure product was carried out in 5 normal human subjects. The effects produced by 0.1, 0.2 and 0.3 mg of penbutolol and of 0.025 mg/kg (mean dose 1.28 mg) of propranolol was recorded. The dose of penbutolol producing an effect equivalent to that of propranolol was calculating from the log dose-response curve of penbutolol. In these tests, penbutolol was 7.90 and 7.66 times more potent than propranolol on a weight to weight basis. Penbutolol was well tolerated and no side-effects were observed.

Adrenergic beta-Antagonists↗
PubMed1978

STI.

Explore the source record for details and available documents.

Blood Pressure↗
PubMed1977

Cellular reaction to group A beta-haemolytic streptococcal membrane antigen and its relation to complement levels in patients with rheumatic heart disease.

Cell-mediated immunity and blood complement activities were studied in 35 patients with chronic rheumatic heart disease (RHD) and 17 normal subjects. The T-cell population in patients with RHD was reduced, as were the CH50 and C3 complement levels. The response to phytohaemagglutinin stimulation was deficient, but the lymphocytes of patients with RHD showed increased avidity for 3H-thymidine when stimulated with specific streptococcal membrane antigen. No differences were found between patients with acute rheumatic activity and those without such activity. The susceptibility of individual patients may be related to the specific sensitisation of lymphocytes, while the fact that this persisted even when T-cell numbers had returned to normal may account for the well-known recrudescenses after streptococcal infections in these patients.

Antigens, Bacterial↗
PubMed1977

Effect of selective depletion of fibrinogen on the evolution of cholesterol-induced atherosclerosis in rabbits.

Atherosclerosis was produced by induced alimentary hyperlipaemia in four groups of rabbits. Animals of groups II and III received cholesterol feeds daily for 2 months while in groups IV and V this was followed by another 3 months of intermittent feeding. Group I comprised normal control rabbits. Selective fibrinogen depletion was produced in groups III and V with Arvin so as to maintain the plasma fibrinogen around 100 mg/dl over the last 2 months of cholesterol feeding. Serum lipids, blood coagulation and euglobulin clot lysis as well as the post mortem histopathology of aorta, heart, kidneys, liver and lungs did not reveal any significant differences between corresponding groups of hyperlipaemic animals treated with (groups III and V) or without (groups II and IV) Arvin. It appears that fibrinogen or fibrin incorporation does not play a significant role in the pathogenesis of atherosclerotic lesions induced in rabbits by cholesterol feeding.

Afibrinogenemia↗