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Biomedical subjects

Rajeev Jain

Publications and source records attributed to Rajeev Jain.

34 records · Page 2Linked to original sources
PubMed2004

Determination of pentafluorobenzyl derivatives of phosphonic and phosphonothioic acids by gas chromatography-mass spectrometry.

A method based on gas chromatography-mass spectrometry (GC/MS) has been evaluated and standardized for the analysis of pentafluorobenzyl (PFB) derivatives of alkylphosphonic, O-alkyl alkylphosphonic and phosphonothioic acids. The pentafluorobenzyl (PFB) derivatives are much more stable as compared to the conventionally used trimethylsilyl derivatives. The conditions for the derivatization and analysis have been optimized to achieve the best detection limits in negative chemical ionization (NCI) mode.

Benzoates↗
PubMed2004

Biliary Sludge: When Should It Not be Ignored?

Biliary sludge is usually seen on transabdominal sonography as low-level echoes that layer in the dependent portion of the gallbladder without acoustic shadowing. Synonyms for biliary sludge include microlithiasis, biliary sand or sediment, pseudolithiasis, and microcrystalline disease. In most patients, biliary sludge is composed of calcium bilirubinate and cholesterol monohydrate crystals. A variety of predisposing factors are associated with biliary sludge formation. In most of these patients, removal of the risk factor can lead to resolution of sludge. In asymptomatic patients, biliary sludge can be managed expectantly. In patients who develop biliary-type pain, cholecystitis, cholangitis, or pancreatitis, the treatment of choice is cholecystectomy for those who can tolerate surgery. In patients who are not operative candidates, endoscopic sphincterotomy can prevent further episodes of cholangitis and pancreatitis, whereas medical therapy with ursodeoxycholic acid can prevent sludge formation and recurrent acute pancreatitis.

Journal Article↗
PubMed2004

Treatment of type 2 diabetes with a combination regimen of repaglinide plus pioglitazone.

The efficacy and safety of combination therapy (repaglinide plus pioglitazone) was compared to repaglinide or pioglitazone in 24-week treatment of type 2 diabetes. This randomized, multicenter, open-label, parallel-group study enrolled 246 adults (age 24-85) who had shown inadequate response in previous sulfonylurea or metformin monotherapy (HbA(1c) > 7%). Prior therapy was withdrawn for 2 weeks, followed by randomization to repaglinide, pioglitazone, or repaglinide/pioglitazone. In the first 12 weeks of treatment, repaglinide doses were optimized, followed by 12 weeks of maintenance therapy. Pioglitazone dosage was fixed at 30 mg per day. Baseline HbA(1c) values were comparable (9.0% for repaglinide, 9.1% for pioglitazone, 9.3% for combination). Mean changes in HbA(1c) values at the end of treatment were -1.76% for repaglinide/pioglitazone, -0.18% for repaglinide, +0.32% for pioglitazone. Fasting plasma glucose reductions were -82 mg/dl for combination therapy, -34 mg/dl for repaglinide, -18 mg/dl for pioglitazone. Minor hypoglycemia occurred in 5% of patients for the combination, 8% for repaglinide, and 3% for pioglitazone. Weight gains for combination therapy were correlated to individual HbA(1c) reductions. In summary, for patients who had previously failed oral antidiabetic monotherapy, the combination repaglinide/pioglitazone had acceptable safety, with greater reductions of glycemic parameters than therapy using either agent alone.

Adult↗
PubMed2004

Congenital alacrima in Pierre Robin sequence.

PURPOSE: To report the presence of congenital alacrima in a patient with Pierre Robin (PR) sequence. METHODS: A 6-month-old child with diagnosed PR sequence presented to us with dysfunctional lacrimation present since birth. The child subsequently developed bilateral corneal ulcers. This unusual presentation and its management are described in detail, and other ocular associations of the PR sequence are discussed. RESULTS: Continuous tear supplementation and appropriate treatment with antibiotics controlled the microbial infection. However, the long-term prognosis for visual rehabilitation remained poor in this patient because of the presence of central corneal opacities, persistent dry eye, which would preclude future optical keratoplasty, and possible sensory deprivation amblyopia. CONCLUSIONS: Alacrima can cause significant ocular morbidity, because persistent ocular surface dryness can be very difficult to manage. Lifelong tear supplementation may be necessary. The association or coexistence of congenital alacrima and the Pierre Robin sequence has not been described before this report.

Corneal Edema↗
PubMed2003

Increased reflux symptoms after calcium carbonate supplementation and successful anti-Helicobacter pylori treatment.

We used data from a randomized placebo-controlled clinical trial to examine the relationship between Helicobacter pylori and reflux symptoms in nonulcer dyspepsia patients randomly assigned anti-Helicobacter pylori triple therapy alone, calcium carbonate alone, or in combination with triple therapy, tetracycline, or placebo. We compared risk differences for posttreatment Helicobacter pylori status and increased reflux symptoms from crude, multivariable and stratified multivariable analyses. In crude analyses, 54% of subjects without Helicobacter pylori after-treatment reported an increase in reflux compared to 41% of those with persistent infection (risk difference = 13%; P = 0.07). Only subjects with multifocal atrophic gastritis assigned to calcium carbonate reported an increase in reflux symptoms more frequently when Helicobacter pylori was absent versus when it persisted (risk difference = 52%; P = 0.0001). Therefore, the interaction of calcium carbonate use, chronic multifocal atrophic gastritis, and the absence of Helicobacter pylori may increase reflux symptoms.

Adult↗
PubMed2002

Sonographic appearances of galactoceles.

PURPOSE: The aim of this study was to investigate and summarize the sonographic appearances of galactoceles. METHODS: We retrospectively reviewed the sonograms and clinical records of 10 patients with galactoceles who had been examined over a 5-year period to evaluate breast lumps that had occurred during lactation or the puerperium. RESULTS: Sonograms from all patients showed well-defined lesions with thin, echogenic walls. The internal appearances of the lesions included homogeneous contents with medium-level echoes in 6 patients and heterogeneous contents with fluid clefts and anechoic rims in 4 patients. Focal echogenic areas with distal shadowing were seen in 2 patients. Most of the lesions showed some distal acoustic enhancement, depending on the internal contents. The diagnosis of a galactocele was established by needle aspiration in 9 patients and by excision biopsy in 1 patient. Needle aspiration alone was therapeutic in 8 patients. CONCLUSIONS: Galactoceles can have a wide range of sonographic appearances and can mimic other lesions of the breast, both benign and malignant. The clues to the diagnosis are recent childbirth and lactation and the presence of a well-defined lesion with some distal acoustic enhancement. Needle aspiration of the lesion is both a diagnostic tool and an effective treatment in most patients with galactoceles.

Adult↗
PubMed2002

Sonographically guided percutaneous sclerosis using 1% polidocanol in the treatment of vascular malformations.

PURPOSE: The aim of this prospective study was to assess the safety and efficacy of sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular malformations. METHODS: Patients with vascular malformations of soft tissues were invited to enroll in the study. Gray-scale and color Doppler sonography were performed to determine the texture, margins, and size of the lesions and to determine whether high-velocity blood flow was present. Using real-time sonographic guidance, lesions were punctured with a 20/21-gauge spinal needle. When possible, venous return was occluded before injection. For each injection, 1-6 ml of 1% polidocanol was injected into 1 or more sites within the lesion. The sclerosing agent was not aspirated after injection. Repeat radiography was performed 1 month after each injection session. The procedure was repeated if the patient did not have a complete response, defined as an 80% or greater decrease in the volume of the lesion or resolution of the presenting symptoms. RESULTS: Of the 15 patients enrolled, 9 had venous malformations, 3 had lymphangiomas, 1 had a recurrent aneurysmal bone cyst, 1 had a venous pseudoaneurysm, and 1 had an arteriovenous malformation of the pinna. Each patient received 1-20 injections of 1% polidocanol (mean +/- standard deviation, 3.3 +/- 4.8 injections). This treatment resulted in a complete response of 7 venous malformations, 3 lymphangiomas, and the arteriovenous malformation and partial response of 2 venous malformations, the recurrent aneurysmal bone cyst, and the venous pseudoaneurysm. Only minor complications occurred. CONCLUSIONS: Sonographically guided percutaneous injection of 1% polidocanol for sclerosis of peripheral vascular lesions is simple, effective, and safe. This technique is especially effective in cases of soft tissue venous malformation and lymphangioma.

Adolescent↗
PubMed2002

Syndrome of cerebrospinal fluid hypovolemia following lumbar puncture cerebrospinal fluid leak in a patient with idiopathic intracranial hypertension.

An 11-year-old girl presented with headache of 3 months' duration. There was bilateral disc edema. The cerebrospinal fluid pressure was 50 cm of water with normal cerebrospinal fluid cytology and biochemistry. She developed severe headache (different and disabling), dizziness, vomiting, and backache on sitting up 6 hours after lumbar puncture, and lying supine relieved all of her symptoms. Intravenous fluids, analgesics, and complete bed rest did not relieve her symptoms over the next 72 hours. She was completely relieved of her symptoms on receiving two tablets of Caffergot containing 200 mg of caffeine and 2 mg of ergotamine 72 hours after lumbar puncture. The symptoms recurred 48 hours later, and a repeat dose of Caffergot was required. Magnetic resonance imaging (MRI) done 96 hours after lumbar puncture revealed the entire dura overlying the brain, including the posterior fossa, showing intense enhancement on contrast injection with leak at the lumbar puncture site. Oral caffeine (coffee, three times a day) was advised over 1 week. The patient remained asymptomatic, and a repeat MRI scan after 10 days showed complete clearing of the cerebrospinal fluid leak with no dural enhancement. The syndrome of cerebrospinal fluid hypovolemia following lumbar puncture is reported in a girl with idiopathic intracranial hypertension.

Brain↗
PubMed2002

Accidental detection of a giant right atrial aneurysm in an asymptomatic infant.

We present a 4-month old infant boy accidentally detected to have cardiomegaly on a chest radiograph, and on further investigation discovered to have a giant right atrial aneurysm and a secundum atrial septal defect. Congenital right atrial aneurysm or diverticulum is a rare anomaly, usually presenting with atrial or supraventricular tachycardia. Previously reported patients did not have any associated congenital heart defect. Although asymptomatic our patient needs close follow-up, and surgical resettion of the aneurysm and closure of the atrial septal defect in view of potential complications.

Echocardiography, Doppler↗
PubMedDate not supplied

Starting patients with type 2 diabetes on insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin.

Transitioning safely to insulin therapy when oral antidiabetic agents fail to provide adequate glycemic control is a critical aspect of care for the patient with type 2 diabetes mellitus (T2DM). We evaluated the clinical effectiveness of starting patients on a relatively simple regimen of once-daily injections of either biphasic insulin aspart 70/30 (10 min before dinner), NPH insulin (at 10 p.m.), or biphasic human insulin 70/30 (30 min before dinner) in combination with metformin. Enrolled patients had T2DM and inadequate glycemic control (AlC>/=7.5%) on a previous regimen of metformin as monotherapy or in combination with a sulphonylurea. One hundred and forty (140) patients received metformin monotherapy for 4 weeks followed by 12 weeks of combination treatment with metformin and once-daily insulin injections. AlC levels decreased from baseline by 1.1-1.3% for patients in each of the three treatment groups. Overall, FPG values decreased from baseline by 31% (biphasic insulin aspart), 37% (NPH insulin), and 28% (biphasic human insulin). Subjects whose final FPG level was <126 mg/dl experienced the largest decreases in AlC values (-2.3%, -1.9%, -1.8%, respectively). All three treatment regimens were well tolerated. The results indicate that patients with T2DM can safely and effectively begin insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin.

Administration, Oral↗