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Biomedical subjects

R P Swaminathan

Publications and source records attributed to R P Swaminathan.

17 recordsLinked to original sources
PubMed2006

Neuroparalysis and ventilatory support in severe tetanus.

In severe form of tetanus, even with maximum dose of muscle relaxants, spasms and apnoeic spells may persist and that may be life-threatening. The aim of this study was to assess the effect of neuroparalysing the patients and then providing ventilatory support in bringing about their recovery. Forty-nine adult patients of severe tetanus (Ablett's grade IIIA--6 patients and Ablett's grade IIIB--43 patients) were studied during the period from April, 1993 to February, 1996. Mean period of onset ie, period from trismus to first spasm, in these patients was 24 hours. Patients were neuroparalysed with a bolus dose of 2-4 mg of pancuronium followed by a continuous infusion of 1-2 mg/hour and simultaneously supported with mechanical ventilation until spasms subsided. Fourteen patients (28.6%) survived and rest died. Mean duration of ventilatory support on survived patients was 14.4 days. The commonest complication encountered during ventilatory support was respiratory tract infection observed in 36 patients (73.5%). Commonest cause of death was autonomic imbalance encountered in 15 patients (30.6%). Treatment of choice in severe tetanus should be neuroparalytic ventilatory support. With use of new generation ventilators and better intensive care facility, death in severe tetanus is likely to be very less.

Adolescent↗
PubMed2004

Lymphoplasmacytic lymphoma with IgA paraproteinemia mimicking Waldenstrom's Macroglobulinemia.

Central to the diagnosis of Waldenstrom's Macroglobulinemia is the demonstration of bone marrow infiltration by lymphoplasmacytic lymphoma with Ig M monoclonal gammopathy. We describe a patient who presented with a clinical and haematological picture, highly suggestive of Waldenstrom's Macroglobulinemia, but whose serum monoclonal immunoglobulin belonged to Ig A class. Ig A secreting lymphoplasmacytic lymphoma undoubtedly exist but are exceedingly uncommon and their relationship to Waldenstrom's Macroglobulinemia needs to be clarified.

Diagnosis, Differential↗
PubMed2003

Bone marrow cryptococcosis: a case report.

A 35-year-old male presented with fever and bilateral cervical and axillary lymphadenopathy. Peripheral blood film examination revealed thrombocytopaenia. Bone marrow aspiration and trephine biopsy, done for evaluation of thrombocytopaenia and pyrexia showed presence of ill-defined granulomas along with cryptococcal yeast forms. Fine needle aspiration of lymph nodes, cerebrospinal fluid and sputum analyses also showed cryptococci. ELISA for Human Immunodeficiency Virus (HIV) antigen was positive. Granulomas, when found in bone marrow aspiration smears and trephine biopsy, are a valuable histological clue to an opportunistic infection. Disseminated fungal infection such as cryptococcosis should raise the possibility of immunosuppression, especially Acquired Immunodeficiency Syndrome. Bone marrow examination is a useful method of diagnosing opportunistic fungal and mycobacterial infections in patients with fever, anaemia or thrombocytopaenia and underlying HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed2002

Melioidosis--a report from Pondicherry, South India.

Melioidosis is an acute infectious disease caused by a safety-pin-shaped gram-negative bacteria called Burkholderia pseudomallei. Here, we report the first case of melioidosis in a middle aged male agricultural worker, from Pondicherry. The isolation of this organism from subcutaneous nodules on the extensor aspect of his limbs underlines the diversity of its clinical presentation. Difficulty in identifying the organism which mimics any other non-fementing gram-negative bacilli (NFGNB) on cursory examination, highlights the importance of identification of NFGNB in endemic areas for specific treatment and prevention.

Anti-Bacterial Agents↗
PubMed2000

Human anthrax in India: urgent need for effective prevention.

Anthrax is a zoonotic illness caused by Bacillus anthracis. Sporadic cases continue to be reported from many parts of the world. From India, both sporadic cases and outbreaks are being reported regularly. The Union Territory of Pondicherry (a former French colony) lies on the coast of Bay of Bengal, where the incidence of anthrax is on the rise with 28 cases being detected in the year 1999 and 2000 alone. So far, about 34 human cases have been encountered in this region. Recently, an increase in the number of anthrax cases has been noted in veterinary and human practice in this area. Most cases have occurred in agricultural labourers who gave history of handling animal meat or skin of infected animals. The meningitic form of the disease has a very bad prognosis. Patients with this form of disease died despite treatment with high dose penicillin. The typical bacilli were seen in the CSF in all cases of anthrax meningitis and was diagnostic of the condition. The cutaneous form of illness had a benign course and responded favourably to penicillin treatment. Awareness among clinicians and mandatory reporting of cases to public health departments along with public education will help control morbidity and mortality due to anthrax. Effective immunization of animals is the other important control measure for anthrax.

Animals↗
PubMed1991

Influence of type I and type II diabetes mellitus on phenytoin steady-state levels.

Phenytoin kinetics was studied in male type I and type II diabetic patients, ten in each group. Age and sex matched epileptic patients receiving phenytoin alone served as control groups. Steady-state concentration of phenytoin was significantly lower in both types of diabetics compared to respective controls. The Vmax and Vmax/Km of phenytoin were significantly increased in type I diabetics. The Vmax was unaltered in type II diabetics but the Vmax/Km was higher in them. Protein binding of the drug was decreased in both groups. It is concluded that phenytoin kinetics is increased in both types of diabetics which may be responsible for the lower steady-state concentration of the drug.

Adult↗
PubMed1989

Differential effect of type I and type II diabetes mellitus on serum ampicillin levels.

Ampicillin elimination was studied in 10 poorly controlled, 6 well controlled type I and 14 poorly controlled type II diabetic patients. Two groups of age-matched healthy volunteers served as controls. After oral administration of ampicillin (500 mg), the poorly controlled type I diabetics had significantly lower serum concentration of the drug when compared to their corresponding healthy controls. The elimination half-life (t1/2) remained unaltered. Their creatinine clearance rate and urinary excretion of the drug were significantly reduced. There was no difference in these parameters between well controlled diabetics and healthy volunteers. The bioavailability data calculated from the urinary recovery of the drug, after oral and i.v. administration, suggested reduced oral absorption in poorly controlled type I diabetic patients. Ampicillin kinetics data of poorly controlled type II diabetic patients were not significantly different from that of the control group. Serum ampicillin levels and urinary excretion of the drug were similar in these groups. It is concluded that serum ampicillin level may be lower in poorly controlled type I diabetics which may be due to reduced absorption of the orally administered drug.

Adult↗
PubMed1989

Differential effect of type I and type II diabetes mellitus on antipyrine elimination.

Antipyrine elimination was studied in 11 type I and 10 type II diabetic patients and 2 age-matched control groups. After oral administration of antipyrine (15 mg/kg), salivary concentration of the drug was measured at various time intervals by high performance liquid chromatography method. In type I diabetics the clearance rate (CL) and apparent volume of distribution (V) of the drug were significantly higher when compared to corresponding controls. The elimination half-life (t 1/2) remained unaltered. In type II diabetics, the t 1/2 of the drug was increased due to increase in V. There was no significant difference in CL. It is concluded that antipyrine elimination is enhanced in type I diabetics while in type II patients it is unaltered.

Adolescent↗
PubMed1989

Effect of type II diabetes mellitus on theophylline elimination.

Theophylline elimination was studied in poorly-controlled and well-controlled type II diabetic patients, seven in each group. Eight healthy volunteers served as a control group. After a single oral dose of theophylline (200 mg) the drug concentration was measured in plasma, collected at different time intervals, using a high pressure liquid chromatography method. The poorly-controlled diabetics had significantly longer elimination half-life (t1/2) due to increased apparent volume of distribution (V) of the drug when compared to well-controlled diabetics. Their clearance rate (Cl) remained unaltered. There was no significant difference in these parameters between healthy volunteers and diabetic patients, although poorly-controlled diabetics had a tendency for higher t1/2 and V. It is concluded that theophylline clearance is unaltered in type II diabetic patients.

Adult↗
PubMed1988

Effect of diabetes mellitus on salivary paracetamol elimination.

1. Salivary elimination of paracetamol was studied in nine type I and ten type II diabetics. Ten healthy volunteers served as a control group. 2. A significant increase in the elimination half-life (t1/2) and apparent volume of distribution was observed in type I diabetics compared with controls. Clearance rate (CL) was not significantly altered. 3. In type II diabetics paracetamol elimination t1/2 was significantly increased with a corresponding decrease in CL. Apparent volume of distribution of the drug was not significantly different. 4. Paracetamol elimination t1/2 had significant correlation with fasting blood sugar values.

Acetaminophen↗
PubMed1986

A study on the neurotoxicity of broxyquinoline and brobenzoxaldine combination in therapeutic doses.

The neurotoxicity of a combination of broxyquinoline and brobenzoxaldine (Intestopan Forte, containing 500 mg and 100 mg of the drugs respectively per capsule) was investigated by prospective clinical and electrophysiological studies in patients and volunteer subjects given the drugs in therapeutic doses (two capsules three times a day for 5 days). Of 16 patients with intestinal amoebiasis given the drugs (study A), 13 (81.25%) were cured. Adverse effects were mild and did not affect treatment. No neurological adverse effect was reported. Neurological examinations revealed no abnormality in any patient after treatment. Seven volunteer subjects underwent medical, neurological and ophthalmological examinations, and electrophysiological studies of ulnar and peroneal nerve conduction before and after treatment with the drugs in therapeutic doses (study B). Transient paresthesias were reported by one subject on the fourth day of treatment. No medical, neurological or ophthalmological abnormality was detected in any subject after treatment. There was no significant change in motor nerve conduction velocities. There was a significant (P less than 0.001) increase in the stimulus strength for distal ulnar stimulation and a significant (P less than 0.01) decrease in stimulus duration for proximal and distal ulnar stimulation. No significant changes were seen in the peroneal nerves in these parameters. No qualitative abnormality was seen in the oscilloscopic patterns of nerve conduction after treatment. Literature on the neurotoxicity of the halogenated hydroxyquinolines is reviewed. It is concluded that broxyquinoline and brobenzoxaldine (and probably other halogenated hydroxyquinolines as well) are safe and effective in therapeutic doses; neurotoxicity is unlikely to occur when these drugs are used according to therapeutic recommendations.

Adult↗
PubMedDate not supplied

A comparative study of creatinine clearance rate in type I (IDDM) and II (NIDDM) diabetic patients.

The endogenous creatinine clearance test was done in 14 Type I and 15 Type II poorly controlled diabetic patients and compared with respective age matched healthy volunteers. Type I diabetics had significantly lower creatinine clearance rate, body mass index and serum albumin levels when compared to their control group. In Type II diabetics these values remained unaltered. Both Type I and Type II diabetics had significantly higher blood sugar and glycosylated haemoglobin levels. The creatinine clearance rate had significant positive correlation with patients' body mass index and serum albumin levels. This suggests that the undernutrition of Type I diabetics may be responsible for the decreased creatinine clearance.

Adult↗