Embolisation of haemodialysis catheter.
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Biomedical subjects
Publications and source records attributed to S Anuradha.
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BACKGROUND: A state of increased oxidative stress has been recognised in type 2 diabetes mellitus (DM). The present study was done to assess the effects of low dose omega-3 fatty acids substitution in patients with type 2 DM with special reference to oxidative stress. METHOD: Sixty-five patients with type 2 DM of body mass index (BMI) < 27 kg/m2 and thirty age and sex matched healthy controls were evaluated for blood glucose, blood pressure and lipid profile and oxidative stress was assessed in them by measuring lipid peroxides (LP), diene conjugates (DC) and reduced glutathione (RG) in the serum. Of the 65, 40 motivated patients were randomly divided into two groups--group 1 comprising of fifteen patients prescribed a diabetic diet along with a placebo and group 2 consisting of twenty-five patients on the same diet with the addition of 0.6 g omega-3 fatty acids as one capsule Maxigard (containing 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid) twice daily. All parameters were reassessed after six weeks. RESULTS: The levels of lipid peroxides (micromol/L), diene conjugates (OD units) and reduced glutathione (mmol GSH/L) were significantly altered indicating increased oxidative stress in the diabetics compared to the healthy controls: 4.106 +/- 0.889, 2.751 +/- 0.424, 1.344 +/- 0.316 and 1.91 +/- 0.541, 1.735 +/- 0.315, 1.919 +/- 0.310, respectively (p < 0.001 for all the three). Patients in group 1 and 2 were comparable in all respects including oxidative stress at the start of therapy. After six weeks, on comparing the mean % changes in the three parameters of oxidative stress between the two groups, it was seen that the % change was significantly higher in group 2 (Maxigard group) compared to group 1 (Placebo; 5.22 +/- 1.056 (p = 0.05), 3.28 +/- 0.608 (p = 0.01), 5.27 +/- 0.585 (p < 0.001) and 0.82 +/- 0.123, 0.18 +/- 0.017, 0.56 +/- 0.035 (p < 0.001), respectively. The patients in group 2 also exhibited significantly greater improvement in glycemic status, blood pressure and lipid profiles. CONCLUSIONS: The present study documented the existence of a state of increased oxidative stress in type 2 diabetics. Significant beneficial effects of low dose omega-3 fatty acids substitution for PUFA-6 were observed not only on oxidative stress parameters but also on blood pressure and metabolic profile.
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AIM: The possible etiological role of antiphospholipid antibodies (APA) in thrombotic events on arterial side has become subject of interest. The present study was undertaken to determine the association and possible etiological role of APA in young Indian patients with acute ischaemic stroke and myocardial infarction (MI). MATERIAL AND METHODS: Forty six patients < 40 years of age including 22 with ischaemic stroke (excluding those with rheumatic heart disease and SLE), 24 with an acute MI and 21 age and sex matched healthy controls were enrolled in the study. All the patients and the controls were tested for the presence of lupus anticoagulant (LA) by a lupus sensitive activated partial thromboplastin time (APTT) and kaolin clotting time (KCT) and anti-caridiolipin antibodies (aCL) of IgM and IgG types using an ELISA technique. RESULTS: The screening tests for LA with APTT and KCT were negative in all the patients and the normal controls. In the stroke subgroup 18.18% patients (4/22) and in MI subgroup 4.16% (1/24) patients had raised aCL titers with statistically significant association only for stroke subgroup (p=0.0201) and not for MI subgroup. Significantly higher proportion of aCL positive cases were found in patients without any risk factor for atherosclerosis (4/12), compared to patients with one or more risk factor for atherosclerosis (1/34), p=0.001. CONCLUSION: Younger patients without identifiable risk factors for atheroscerosis presenting with stroke, are more likely to have an underlying antiphospholipid syndrome (APLS) as the etiology, and should be screened for it. No such association however was observed for MI patients.
BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with a profound dysregulation of the immune system and alterations in the cytokine profile. Tuberculosis, a common opportunistic infection in HIV positive patients, leads to further immune suppression and a faster progression of the disease. This study was conducted to assess and compare the cytokine profiles in HIV positive subjects with and without pulmonary tuberculosis. METHODS: Twenty HIV positive patients and 20 controls were evaluated after being divided into four groups of 10 each--group 1--HIV positive patients without tuberculosis, group 2--HIV positive patients with pulmonary tuberculosis, group 3--healthy adults and group 4--HIV negative patients with pulmonary tuberculosis. After clinical evaluation, the CD4 cell counts and the cytokine profiles--interleukins (IL)-2, 4, 6, 10, 12, interferon gamma (IFN gamma) and tumour necrosis factor alpha (TNF alpha) were studied in all the subjects at the start and after three months of antituberculosis therapy. RESULTS: the CD4 cell counts were significantly lower in groups 1 and 2 compared to groups 3 (p < 0.01) and the counts in group 2 were significantly lower than in group 1 in both at baseline (p = 0.0076) and at three months (p = 0.089). The levels of the type 1 cytokines (IL-2, IL-12 and IFN gamma were significantly lower in patients in groups 1 and 2 compared to group 3 (p < 0.001 for both). The levels in group 2 were lower than in group 1 (p < 0.001). The type 2 cytokines (IL-4, IL-6, IL-10 and TNF alpha) were higher in group 1 and 2 compared to group 3, though statistically significant for IL-6 in group 1 (p < 0.05) and for IL-4, IL-6 and TNF alpha in group 2. A highly significant (p < 0.0001) positive correlation between CD4 cell counts and type 1 cytokines and a highly significant (p < 0.0001) negative correlation between CD4 cell counts and type 2 cytokines was observed. CONCLUSIONS: A decline in the type 1 and a rise in type 2 cytokines was observed in HIV infection. Patients in group 2 had the lowest CD4 cell counts, lowest levels of type 1 cytokines and highest levels of type 2 cytokines denoting maximum immunosuppression.
The diagnosis of extrapulmonary tuberculosis including neurotuberculosis is difficult because of the low yield of culture positivity for Mycobacterium tuberculosis (M. tb). Serodiagnosis has emerged as a useful aid to the diagnosis of extrapulmonary tuberculosis. The utility and efficacy of detection of antimycobacterial antibodies to A-60 antigen in serum and/or cerebrospinal fluid (CSF) was analysed in 100 patients-neurotuberculosis-72, abdominal tuberculosis-12 and others-16. The overall positivity rate for the test was 75%. The positivity rate of the test in serum and/or CSF was 79.2% (57 of 72) in neurotuberculosis and 62.5% (10 of 16) for other forms of extrapulmonary tuberculosis. The positivity rate for antimycobacterial antibodies was higher for patients with tubercular meningitis -94.7%. To conclude, testing for antimycobacterial antibodies to A-60 antigen is a useful adjunct in the diagnosis of extrapulmonary tuberculosis especially neurotuberculosis.
DNA molecules containing stretches of contiguous guanine residues can assume a stable configuration in which planar quartets of guanine residues joined by Hoogsteen pairing appear in a stacked array. This conformation, called G4 DNA, has been implicated in several aspects of chromosome behavior including immunoglobulin gene rearrangements, promoter activation, and telomere maintenance. Moreover, the ability of the yeast SEP1 gene product to cleave DNA in a G4-DNA-dependent fashion, as well as that of the SGS1 gene product to unwind G4 DNA, has suggested a crucial role for this structure in meiotic synapsis and recombination. Here, we demonstrate that the HOP1 gene product, which plays a crucial role in the formation of synaptonemal complex in Saccharomyces cerevisiae, binds robustly to G4 DNA. The apparent dissociation constant for interaction with G4 DNA is 2 x 10(-10), indicative of binding that is about 1,000-fold stronger than to normal duplex DNA. Oligonucleotides of appropriate sequence bound Hop1 protein maximally if the DNA was first subjected to conditions favoring the formation of G4 DNA. Furthermore, incubation of unfolded oligonucleotides with Hop1 led to their transformation into G4 DNA. Methylation interference experiments confirmed that modifications blocking G4 DNA formation inhibit Hop1 binding. In contrast, neither bacterial RecA proteins that preferentially interact with GT-rich DNA nor histone H1 bound strongly to G4 DNA or induced its formation. These findings implicate specific interactions of Hop1 protein with G4 DNA in the pathway to chromosomal synapsis and recombination in meiosis.
BACKGROUND: A major outbreak of epidemic dropsy occurred in Delhi, India, in August-September 1998, due to the consumption of contaminated mustard oil. METHODS: The clinical data of 212 adult patients of epidemic dropsy who presented to our hospital is analysed. RESULTS: Pitting pedal oedema (100%), skin erythema (75%), limb tenderness (63%), diarrhea (51%) and hepatomegaly (34%) were the prominent clinical manifestations observed in the patients. Superficial retinal haemorrhages and retinal venous dilatation was observed on fundus examination and 9% of patients developed an open angle glaucoma over a three month follow up period. Cardiac failure was present in 14% of patients. Most patients had mild disease which responded to cessation of mustard oil consumption, bed rest, diuretics and antioxidants. There were six deaths, all of whom had intractable cardiac failure. A unique feature of this outbreak was the documentation of acute renal failure in three patients, a phenomenon never described previously. CONCLUSIONS: Strict law enforcement to prevent the contamination of edible oils is essential to avoid the occurrence of future similar outbreaks.
Peritonitis, the commonest complication of peritoneal dialysis, is usually bacterial in origin. Fungal peritonitis is rarely encountered. We are reporting a rare case of fungal peritonitis caused by Trichosporon beigelii in a patient on continuous ambulatory peritoned dialysis (CAPD), who was HIV positive.
OBJECTIVE: Left ventricular hypertrophy (LVH) has been identified as an independent risk factor for mortality in patients with chronic renal failure (CRF) and anemia has been proposed to contribute to LVH. The cardiovascular and hemodynamic effects of correction of anemia with recombinant human erythropoietin (rHU EPO) was assessed in a 12 week prospective study in patients with CRF. METHODS: Biochemical parameters and echocardiography were studied at the start and after three months therapy with EPO in 24 patients with CRF--11 predialysis (Group I) and 13 dialysis (Group II). RESULTS: The mean haemoglobin (Hb)--g/dl increased significantly from 7.5 +/- 1.0 to 10.1 +/- 1.1 in group I and from 6.7 +/- 0.6 to 9.4 +/- 0.8 in group II (p < 0.05) on EPO therapy. The left ventricular mass index (LVMi)--g/m2 reduced significantly from 185.6 +/- 44.6 to 158.3 +/- 4.1 in group I and from 158.0 +/- 26.9 to 131.6 +/- 22.1 in group II (p < 0.05 in both). The interventricular septal thickness (IVST) also showed a significant decline in both groups, 1.17 +/- 0.06 to 1.14 +/- 0.05 (group I) and 1.09 +/- 0.25 to 1.01 +/- 0.21 (group II), p < 0.05 in both. The thickness of the left ventricular posterior wall remained unchanged. The left ventricular end diastolic and systolic diameters (LVEDD and LVESD) significantly reduced from their baseline values in both the groups (p < 0.05). The diastolic filling parameters across the mitral valve remained unchanged in both the groups. The cardiac index (CI)--L/min/m2 decreased from 3.53 +/- 0.3 to 3.03 +/- 0.27 in group I and from 3.31 +/- 0.64 to 2.80 +/- 0.60 in group II (p < 0.05) and the total peripheral resistance (TPR)--dynes/cm5/sec increased from 1567 +/- 164.8 to 1883 +/- 190.7 in group I and from 1618 +/- 375.7 to 2004 +/- 437.3 in group II. The differences in all the parameters at the start and after 3 months of EPO were comparable in groups I and II. The mean arterial pressure (MAP) changed insignificantly in both the groups. CONCLUSIONS: To conclude, this study has shown that the decrease in LVMi with EPO reflects the role of anemia in the genesis of LVH and that the correction of anemia with EPO in CRF results in regression of LVMi and has a favourable effect on cardiovascular hemodynamics.
Wolman's disease is a rare autosomal recessive lysosomal storage disorder. We report a case, which we identified with foamy histiocytes in bone marrow and adrenal calcification in radiological imaging. The diagnosis can be made on minimal investigation when clinically suspected. But cytogenetic study is required to substantiate the diagnosis further.
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Symmetric peripheral gangrene (SPG) is a rare syndrome in which disseminated intravascular coagulation (DIC) is the most common underlying condition. We report three cases of SPG in association with Plasmodium falciparum malaria and DIC, an association unreported so far.
OBJECTIVES: Cell mediated immunity (CMI), cytokines and humoral immunity have been implicated in the pathogenesis of invasive amoebiasis. METHODS: The role of cytokines--tumour necrosis factor-alpha (TNF-alpha) and interleukin 2 (IL-2) in blood and pus aspirate was studied in 20 patients of amoebic liver abscess (ALA), before and after treatment and 10 controls. RESULTS: The mean TNF-alpha levels (pg/ml) in the controls and before treatment in the patients in serum and pus were 24.3 +/- 11.6, 28 +/- 14.5 and 161.2 +/- 81.3 (p < 0.002) respectively. The mean IL-2 levels (pg/ml) in the controls, serum and pus aspirate in the patients prior to treatment were 10.3 +/- 8.5, 39.2 +/- 26.1 and 117.0 +/- 65.9 respectively. The levels in the patients after therapy, increased to 47 +/- 25.7 (p < 0.001) and 134 +/- 59.4 (p < 0.01). CONCLUSIONS: The higher levels of TNF-alpha and IL-2 in the pus aspirate compared to blood pre treatment, supports the role of locally released cytokines in the target organ i.e. liver in amoebiasis. The rise in values observed after therapy are indicative of increased macrophage activity due to CMI occurring late in the course of the disease which may contribute to disease limitation and localisation in amoebiasis. The study suggests that locally released cytokines play an important role in the pathogenesis of ALA.