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Biomedical subjects

Rajesh Gupta

Publications and source records attributed to Rajesh Gupta.

At least 37 records · Page 2Linked to original sources
PubMed2005

Limited good and limited vision: multidrug-resistant tuberculosis and global health policy.

Almost a third of the world's population is infected with Mycobacterium tuberculosis, the organism that causes tuberculosis disease. Most of those infected never fall ill, but individuals who do can recover if they have access to effective therapies. This paper discusses certain ethical and ethnographic issues raised by cases in which patients are infected with M. tuberculosis strains resistant to at least the two most powerful drugs on which therapy is usually based. In most poor countries, people with such multidrug-resistant tuberculosis (MDR-TB) were, until very recently, considered "untreatable." In addition to being consigned to a permanent state of ill health, they were also at risk of transmitting their resistant strain to others. In this paper we discuss the logic of "cost-effectiveness," which international health policy-makers utilized to make the case that treatment of MDR-TB is not feasible in resource poor settings. These analyses, which have held sway in public health policy for many years, are flawed, we argue, because they ignore and conceal the social determinants of access to health services and often rely on assumptions rather than evidence. We propose that policies based solely on analyses of cost-effectiveness of specific interventions for individual settings can be short-sighted and, because they do not pay sufficient attention to the social, political, economic, epidemiological and pathophysiological factors influencing the production of health, will ultimately hinder progress toward effective global TB control.

Cost-Benefit Analysis↗
PubMed2005

Norfloxacin and cisapride combination decreases the incidence of spontaneous bacterial peritonitis in cirrhotic ascites.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, having high recurrence despite antibiotic prophylaxis. Small bowel dysmotility and bacterial overgrowth have been documented to be related to SBP. The purpose of the present paper was (i) to study whether addition of a prokinetic agent to norfloxacin ameliorates the development of SBP in high-risk patients; and (ii) to identify risk factors for SBP development. METHODS: A prospective, single blinded, randomized controlled trial was conducted in high-risk cirrhotic patients with ascites who had either recovered from an episode of SBP or who had low ascitic fluid protein. Norfloxacin 400 mg once daily (group I) or norfloxacin 400 mg once daily with cisapride 20 mg twice a day (group II) was given and occurrence of side-effects of therapy and mortality were recorded. RESULTS: Of the 94 patients, 48 (51%) were in group I, and 46 (49%) in group II. The actuarial probability of developing SBP at 12 month in group I was 56.8% and in group II, 21.7% (P = 0.026). Treatment failure was observed in five patients (10%) in group I and none in group II (P = 0.003). The actuarial probability of death at 18 months was 20.6% in group I and 6.2% in group II (P = 0.1). Low serum albumin, low ascitic fluid protein and alcoholic cirrhosis were related to development of SBP (P < 0.05). Additionally, low serum albumin (2.8 g/dL), gastrointestinal bleeding, alcoholic cirrhosis and low ascitic fluid protein were significantly associated with multiple occurrences of SBP. CONCLUSIONS: Prophylaxis with norfloxacin and cisapride significantly reduces the incidence of SBP in high-risk cirrhosis patients; low serum albumin, low ascitic fluid protein and alcoholic cirrhosis predispose to the development of SBP in high-risk cirrhosis patients; and low ascitic fluid protein should also be considered as a risk factor for the development of SBP requiring prophylaxis.

Adult↗
PubMed2004

Application of electrospray ionization mass spectrometry to study the hydrophobic interaction between the epsilon and theta subunits of DNA polymerase III.

The interactions between the N-terminal domain of the epsilon (epsilon186) and theta subunits of DNA polymerase III of Escherichia coli were investigated using electrospray ionization mass spectrometry. The epsilon186-theta complex was stable in 9 M ammonium actetate (pH 8), suggesting that hydrophobic interactions have a predominant contribution to the stability of the complex. Addition of primary alkanols to epsilon186-theta in 0.1 M ammonium acetate (pH 8), led to dissociation of the complex, as observed in the mass spectrometer. The concentrations of methanol, ethanol, and 1-propanol required to dissociate 50% of the complex were 8.9 M, 4.8 M, and 1.7 M, respectively. Closer scrutiny of the effect of alkanols on epsilon186, theta, and epsilon186-theta showed that epsilon186 formed soluble aggregates prior to precipitation, and that the association of epsilon186 with theta stabilized epsilon186. In-source collision-induced dissociation experiments and other results suggested that the epsilon186-theta complex dissociated in the mass spectrometer, and that the stability (with respect to dissociation) of the complex in vacuo was dependent on the solution from which it was sampled.

DNA Polymerase III↗
PubMed2004

Scaling-up treatment for HIV/AIDS: lessons learned from multidrug-resistant tuberculosis.

The UN has launched an initiative to place 3 million people in developing countries on antiretroviral AIDS treatment by end 2005 (the 3 by 5 target). Lessons for HIV/AIDS treatment scale-up emerge from recent experience with multidrug-resistant tuberculosis. Expansion of treatment for multidrug-resistant tuberculosis through the multipartner mechanism known as the Green Light Committee (GLC) has enabled gains in areas relevant to 3 by 5, including policy development, drug procurement, rational use of drugs, and the strengthening of health systems. The successes of the GLC and the obstacles it has encountered provide insights for building sustainable HIV/AIDS treatment programmes.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Efficacy of serum nitric oxide level estimation in assessing the severity of necrotizing pancreatitis.

BACKGROUND: The role of nitric oxide in the pathophysiology of necrotizing pancreatitis is unclear. METHODS: In a prospective study, the clinical course of 40 patients diagnosed as having acute necrotizing pancreatitis was followed using computed tomography severity score (CTSS) and serial APACHE II scoring. The serum nitric oxide levels in the form of reactive nitrogen intermediates (RNI) were estimated on admission and on day 3. Occurrence of complications, need for intervention, incidence of organ failure, and outcome were noted. The efficacy of CTSS, APACHE II scores, and RNI levels in predicting morbidity and mortality was assessed. The correlation between CTSS, APACHE II scores, and RNI levels was studied. RESULTS: The study group showed significantly higher levels of RNI as compared with the control group (159.1 vs. 106.0 nmol/ml, p < 0.05). The RNI levels were not affected by the occurrence of local complications or distant-organ failure. The RNI levels on admission were significantly higher in the subset of patients who developed bacterial sepsis (195.5 vs. 134.7 nmol/ml, p < 0.05). The RNI levels on admission in the non-survivors were higher as compared with those of the survivors (216.0 vs. 140.1 nmol/ml, p < 0.05). There was a significant positive correlation between the RNI levels and the CTSS in these patients (p < 0.05). There was no correlation between RNI levels and APACHE II scores. CONCLUSIONS: Acute necrotizing pancreatitis is associated with raised serum nitric oxide levels at its early stage. Patients with higher serum nitric oxide levels are at a significantly higher risk of sepsis and mortality.

APACHE↗
PubMed2004

Ruptured pancreaticoduodenal artery aneurysm treated by superselective transcatheter arterial embolization and preserving vascularity of pancreaticoduodenal arcades.

We report a case of a ruptured aneurysm in the anterior superior pancreaticoduodenal artery (PDA) with hypovolemic shock managed successfully by superselective transcatheter arterial embolization of the aneurysm. A 75-year-old male presented to our hospital with hematemesis and melena. On admission, he was in shock. Angiography showed an aneurysm about 1 cm in diameter in the anterior superior PDA. However, extravasation of contrast medium was not seen owing to hypovolemic shock. A catheter was inserted into the aneurysm, and superselective microcoil embolization of the PDA aneurysm was successfully achieved. After the microcoil was inserted into the aneurysm itself, it was observed that duodenal vascularity and pancreaticoduodenal arcades were preserved and aneurysm was not present. There was no complication such as necrosis or abscess formation in the pancreas. The patient recovered and is doing well after 18 months of follow-up. Superselective transcatheter arterial embolization should be considered as the initial treatment of choice for all peripancreatic aneurysms.

Aged↗
PubMed2004

Role of curative resection in octogenarians with malignancy.

BACKGROUND: Major resective surgery in octogenarians with malignancy is considered risky. Because elderly people are growing in number, there is a greater need to define the role of curative resection (CR) in these patients. METHODS: In this retrospective, consecutive review patients > or = 80 years with malignancy treated by surgery were included and categorized into 3 groups: group 1 = CR group, i.e., no residual disease; group 2 = non-CR group, i.e., microscopic tumor invasion of one or more resection margins; and group 3 = palliative surgery (PS) group. RESULTS: One hundred eighty-two patients were treated surgically with curative intent. Gastric and colorectal cancers were the most frequent (34% and 31.8%, respectively) followed by bile duct and esophageal cancers (15.3% and 5.5%, respectively). CR was performed in 53.3%, non-CR in 14.8%, and palliative surgery in 31.9% of patients. Thirty-day mortality in the 3 groups was 3.1%, 0%, and 5.2%, respectively. Mean hospital stay was similar among all 3 groups. In the CR group, gastric and colorectal cancers were the most common (41.2% and 42.2% respectively). Average survival and actuarial survival were significantly higher in the CR group. Disease-free survival was 645 +/- 744 days. Five-year actuarial survival was 45.4 % in the CR group, and no patient survived 5 years in the other 2 groups. In the CR group, mean survival was significantly better in patients with good performance status and > or = 3 supportive family members per univariate analysis. However, no significant difference was observed in patients with gastric and colorectal malignancy. Multivariate analysis revealed that TNM stage and family size affected survival the most. CONCLUSIONS: Gastric and colorectal cancers were most frequent among octogenarians reporting to our unit. CR was performed in elderly patients with low mortality and was associated with significantly better average and actuarial survival. TNM stage I to III, family size > or = 3 members, and performance status "0" to "1" were favorable factors.

Aged↗
PubMed2004

Comparison of the binding stoichiometries of positively charged DNA-binding drugs using positive and negative ion electrospray ionization mass spectrometry.

Positive and negative ion electrospray ionization (ESI) mass spectra of complexes of positively charged small molecules (distamycin, Hoechst 33258, [Ru(phen)2dpq]Cl2 and [Ru(phen)2dpqC]Cl2) have been compared. [Ru(phen)2dpq]Cl2 and [Ru(phen)2dpqC]Cl2 bind to DNA by intercalation. Negative ion ESI mass spectra of mixtures of [Ru(phen)2dpq]Cl2 or [Ru(phen)2dpqC]Cl2 with DNA showed ions from DNA-ligand complexes consistent with solution studies. In contrast, only ions from free DNA were present in positive ion ESI mass spectra of mixtures of [Ru(phen)2dpq]Cl2 or [Ru(phen)2dpqC]Cl2 with DNA, highlighting the need for obtaining ESI mass spectra of non-covalent complexes under a range of experimental conditions. Negative ion spectra of mixtures of the minor groove binder Hoechst 33258 with DNA containing a known minor groove binding sequence were dominated by ions from a 1:1 complex. In contrast, in positive ion spectra there were also ions present from a 2:1 (Hoechst 33258: DNA) complex, suggesting an alternative binding mode was possible either in solution or in the gas phase. When Hoechst 33258 was mixed with a DNA sequence lacking a high affinity minor groove binding site, the negative ion ESI mass spectra showed that 1:1 and 2:1 complexes were formed, consistent with existence of binding modes other than minor groove binding. The data presented suggest that comparison of positive and negative ion ESI-MS spectra might provide an insight into various binding modes in both solution and the gas phase.

Bisbenzimidazole↗
PubMed2004

Tuberculosis as a major global health problem in the 21st century: a WHO perspective.

The World Health Organization, the Global Partnership to Stop TB, and the Millenium Development Project have all adopted the following 2005 targets for tuberculosis control: to detect at least 70% of all estimated sputum smear-positive cases and to treat successfully at least 85% of them. Although implementation of the DOTS strategy is the foundation for proper tuberculosis control, basic DOTS implementation may not be enough to reach these targets. Instead, evidence from several countries indicates that, although cure rates are approaching the global target, the case detection target may not be met, even with 100% DOTS implementation in designated public facilities. Thus, tuberculosis control must be critically examined to foster higher performance. In the context of an expanded framework for tuberculosis control, we present four strategic interventions through which cure and case detection rates may be significantly improved: (1) wider involvement of community workers, (2) engagement of private practitioners, (3) proper management of drug-resistant tuberculosis, and (4) efforts focused on controlling tuberculosis and human immunodeficiency virus. We conclude that, although country-based estimates need further refinement to ascertain the impact of each intervention, a fundamental shift in the approach to tuberculosis control is required if the global targets are to be reached rapidly.

Journal Article↗
PubMed2004

Transhiatal esophageal resection for corrosive injury.

OBJECTIVES: To analyze the feasibility and safety of transhiatal approach for resection of corrosively scarred esophagus. BACKGROUND SUMMARY DATA: The unrelenting corrosive strictures of esophagus merit esophageal substitution. Because of the risk of complications in the retained esophagus, such as malignancy, mucocele, gastroesophageal reflux, and bleeding, esophageal resection is deemed necessary. Transthoracic approach for esophageal resection is considered safe. The safety and feasibility of transhiatal resection of the esophagus is not established in corrosive injury of the esophagus. PATIENTS AND METHODS: Transhiatal approach was used for resection of the scarred esophagus for all patients between January 1986 and December 2001. The intraoperative complications, indications for adding thoracotomy, and postoperative outcome were studied in 51 patients. Follow-up period varied from minimum of 6 months to 15 years. RESULTS: Esophageal resection was achieved in 49 of 51 patients whereas thoracotomy was added in 2 patients. In 1 of the patients tracheal injury occurred whereas in other patient there were dense adhesions between tracheal membrane and esophagus. Gastric tube was used for esophageal substitution in 40 (78.4%) patients whereas colon was transplanted in 11 (21.6%) patients. Colon was used only when stomach was not available. One patient (1.9%) had tracheal membrane injury whereas 4 patients (7.8%) had recurrent laryngeal nerve palsy. One patient each had thoracic duct injury and intrathoracic gastric tube leak. There was no operative mortality. Anastomotic complications like leak were present in 19.6% and stricture in 58.8% patients. All the patients were able to resume their normal duties and swallow normal food within 6 months of the surgery. CONCLUSION: One-stage transhiatal esophageal resection and reconstruction could be safely used for the extirpation of scarred esophagus. Use of gastric conduit was technically simple, quicker, and offered good functional outcome. Postoperative anastomotic stricture amenable to dilatations was the commonest complication.

Adolescent↗
PubMed2004

Closed lesser sac lavage in the management of pancreatic necrosis.

BACKGROUND AND AIM: Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. METHODS: Fifty-eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented. RESULTS: Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post-operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis. CONCLUSION: Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re-operation rates and mortality.

Adult↗
PubMed2004

Secular change in newborn adiposity in an urban hospital.

Triceps and subscapular skinfold thickness were measured in 1080 consecutive newborns and the values were compared with an earlier study reported in 1981 from the same institution. The skinfold thickness in the present study was higher at all gestational age groups (except for 41 weeks) in both sexes. These differences were statistically significant at all periods except for males at 38 weeks and females at 39 weeks. For term infants, the mean skin fold thickness (subscapular and triceps) was significantly higher among both males (3.5 mm vs 4.0 mm; p< 0.05) and females (3.9 mm vs. 4.2 mm; p <0.05). The subscapular skin fold thickness in both males and females and triceps skin fold thickness in females were also significantly higher for all birthweight categories. The data suggests an increase in adiposity among newborns, over a period of two decades, in an urban poor population.

Adipose Tissue↗
PubMed2004

Adenosquamous carcinoma of the rectum: a case report.

Adenosquamous carcinoma is defined as a tumor with well defined malignant glandular and squamous components and the potential for both components to metastases. This tumor is extremely rare in colon and rectum with an incidence of less than 0.2%. Adenosquamous carcinoma of rectum should be distinguished from collision tumor with exemption of all lesions located distal to a level of 7 cm above the dentate line. Here we present a case of rare type adenosquamous carcinoma in rectum in a 29 year old female.

Adult↗
PubMed2003

What happens to patients who leave hospital against medical advice?

BACKGROUND: Patients who leave hospital against medical advice (AMA) may be at risk of adverse health outcomes and readmission. In this study we examined rates of readmission and predictors of readmission among patients leaving hospital AMA. METHODS: We prospectively studied 97 consecutive patients who left the general medicine service of an urban teaching hospital AMA. Each patient was matched according to age, sex and primary diagnosis with a control patient who was discharged routinely. Readmission rates were examined using Kaplan-Meier analysis. Regression models were used to test the hypothesis that readmissions among patients discharged AMA followed a biphasic curve. RESULTS: Patients who left AMA were much more likely than the control patients to be readmitted within 15 days (21% v. 3%, p < 0.001). Readmissions occurred at an accelerated pace during the first 15 days, followed by a 75-day period during which readmissions occurred at a rate comparable to that among the control patients. Among the patients who left AMA, being male and having a history of alcohol abuse were significant predictors of readmission within 15 days; however, these characteristics were common among the patients who left AMA. In the Cox proportional hazard models, leaving AMA was the only significant predictor of readmission (adjusted hazard ratio 2.5, 95% confidence interval 1.4-4.4). INTERPRETATION: The significantly increased risk of readmission among general medicine patients who leave hospital AMA is concentrated in the first 2 weeks after discharge. However, it is difficult to identify which patients will likely be readmitted.

Adult↗