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Biomedical subjects

S Bansal

Publications and source records attributed to S Bansal.

100 records · Page 6Linked to original sources
PubMedDate not supplied

Accelerated infusion of streptokinase in acute myocardial infarction results in better TIMI flow grade in infarct-related artery.

Bolus followed by rapid infusion of tissue plasminogen activator results in higher grade of TIMI flow in infarct-related artery as compared to slow infusion. In the present study, an accelerated regimen of streptokinase given over 15 minutes was compared with conventional infusion over one hour in 47 patients presenting within 12 hours of acute myocardial infarction. Forty-seven patients (44 males, 3 females; mean age 54.0 +/- 1.1 years) were randomly allocated to receive 1.5 million units of streptokinase either over 15 minutes (group 1, n = 24) or over one hour (group 2, n = 23) at a mean interval of 5.4 +/- 3.6 hours after onset of symptoms. All the patients received aspirin and intravenous heparin (1000 U/hr) for 96 hours after thrombolysis. Coronary angiography was performed in 43 patients (22 in group 1, 21 in group 2) prior to discharge from the hospital (mean 7 +/- 2.1 days after acute myocardial infarction) and patency of the infarct-related artery and grade of TIMI flow were determined. Infarct-related artery was patent (TIMI 2/3 flow) in 19 (86.4%) patients in group 1 as compared to 12 (57.1%) in group 2 (p < 0.05). TIMI grade 3 flow in the infarct-related artery was present in 13 (59.1%) in group 1 as compared to 7 (33.3%) in group 2 (p = 0.1). There was no significant difference between group 1 and 2 in time of presentation (mean 5.3 +/- 3.9 hrs vs 5.5 +/- 3.2 hrs), time to needle in hospital (25.6 +/- 11.2 min vs 26.3 +/- 6.2 min), site of infarct (anterior myocardial infarction 12 in group 1 vs 11 in group 2), relief of pain at 90 min (13 vs 12), more than 50 percent reduction of ST elevation at 90 minutes (17 vs 12) and left ventricular ejection fraction (48.8 +/- 9.1% vs 49.8 +/- 16.0%), respectively. Streptokinase was well tolerated in both the groups, although hypotension was more common with the accelerated regimen (5 in group 1 vs 3 in group 2; p = NS). Thus, 'accelerated' streptokinase given over 15 minutes in patients presenting within 12 hours of acute myocardial infarction is well tolerated and results in higher grades of TIMI flow in the infarct-related artery as compared to the "conventional" one-hour infusion regimen.

Adult↗
PubMedDate not supplied

Scleredema adultorum.

Scleredema adultorum is a rare connective tissue disorder reported usually following streptococcal infection, influenza, measles, and mumps. It has been reported occasionally following trauma and tuberculous lymphadenitis. This is a report of scleredema adultorum developing after chicken pox in an eight-year-old male child. The diagnosis was established by characteristic picture on skin biopsy using special stain. The patient had a benign course and a spontaneous recovery in two weeks. The case has been reported as the first case of scleredema adultorum developing after chicken pox.

Chickenpox↗
PubMedDate not supplied

Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh.

BACKGROUND: Community acquired pneumonia (CAP) is a common clinical problem. The present study was designed to evaluate the clinical and bacteriological profile of CAP in Shimla. METHODS: Seventy patients with community acquired pneumonia were enrolled in this study. In all the patients blood culture, sputum culture, pleural fluid culture (if available) and serological studies for the detection of Mycoplasma pneumoniae specific IgM antibodies by enzyme linked immunosorbent assay (ELISA) were done. RESULTS: Of the 70 patients, 53 (75.6%) had an identifiable atiology with 12 patients having evidence of mixed infection. No organisms could be isolated in 17 patients inspite of using serological methods for Mycoplasma pneumoniae, invasive procedures like bronchoscopic aspirations in addition to the conventional methods like sputum culture, blood culture and pleural fluid culture. The most frequent pathogen was Streptococcus pneumoniae (n = 19; 35.8%) followed by Klebsiella pneumoniae (n = 12; 22%), Staphylococcus aureus in (n=9; 17%), Mycoplasma pneumoniae (n = 8; 15%), Escherichia Coli (n = 6; 11%), beta-haemolytic streptococci (n = 4; 7.5%) and other Gram-negative bacilli (n = 5, 9%). CONCLUSION: Age smoking and under lying co-morbid conditions specially chronic obstructive pulmonary disease (COPD) were significantly associated with the development of CAP (p < 0.01).

Adolescent↗
PubMedDate not supplied

Women with septic abortion: who, how and why? A prospective study from tertiary care hospital in India.

A prospective descriptive interview based hospital study was carried on 47 women admitted with septic abortion to evaluate their psychosocial, demographic and clinical profile These women were predominantly parous (75%), hindus (60%), between 20-30 years of age (60%) and mostly married (91.4%) house wives (63.8%). More than 90% already had one or more male child. The contraceptive use was dismally low (23.4%). Their knowledge about legalisation, place and persons authorized to conduct abortions was very less, however large majority (87%) underwent abortions within 3 months of pregnancy. Large family, poverty and spacing were the main reasons cited for abortions. Abdominal pain, fever, genital bleeding, diarhoea and abdominal distension were presenting clinical features in order of frequency. Advanced sepsis and associated medical and surgical complications were present in more than half the patients and 6% succumbed to these problems. The current experience was an eye opener for most of them and changed their future attitude. Hence education, economic prosperity, easy access to reproductive health facilities and institutional management of sepsis is the key to make abortions safe.

Abortion, Septic↗
PubMedDate not supplied

Acute renal failure due to rifampicin.

A 23-year-old male patient with bacteriologically proven pulmonary tuberculosis was treated with the various regimens of antituberculosis drugs for nearly 15 months. Rifampicin was administered thrice as one of the 3-4 drug regimen and each time he developed untoward side effects like nausea, vomiting and fever with chills and rigors. The last such episode was of acute renal failure at which stage the patient was seen by the authors of this report. The patient, however, made a full recovery.

Acute Kidney Injury↗
PubMedDate not supplied

Clinicopathologic study of healing excimer laser radial excisions.

Four radial linear excisions were created by an argon fluoride (193 nm) excimer laser in the edematous cornea of a blind eye of a diabetic human patient. Partial thickness corneal trephinations were performed at 3, 7, and 18 months after surgery for histopathologic examination. At 3 months, a wide gap in Bowman's layer permitted extension of an epithelial plug to a depth of 0.35 mm; at 7 and 18 months, the depth of the epithelial plug was decreased to 0.29 mm and 0.01 mm, respectively. With wound healing, excision width decreased and the two cut ends of Bowman's layer were almost reapposed by 18 months, suggesting wound contraction. Linear excisions with the excimer laser appear to be wider than incisions made with a diamond blade, but the pattern of wound maturation appears to be similar.

Biopsy↗
PubMedDate not supplied

Improvement in contractility of infarct zone after dobutamine infusion predicts good (TIMI II or III) flow in infarct related artery.

Eighteen patients of 'Q' wave acute myocardial infarction (AMI) (age 50 +/- 6.2 years), underwent dobutamine stress echocardiography (DSE) before hospital discharge (7.2 +/- 1.3 days after AMI) to find out the correlation between response of infarct zone to dobutamine infusion and TIMI grade flow in infarct related artery (IRA). The aim of study was to test the hypothesis that infarct zone which shows improvement in contractility after dobutamine infusion has viable myocardial tissue and would have good flow (TIMI II or III) in IRA. Echocardiographically, improvement in contractility in the centre of infarct zone by at least 1 grade (on a scale of 4) was termed as positive response on DSE. The mean dose of dobutamine was 19.4 micrograms/kg/min. Ten patients had positive response on DSE; 8 of them had good antegrade flow in IRA. Eight patients had no improvement in contractility of infarct zone on DSE; 6 of them had poor flow in IRA. Clinical markers of reperfusion (relief of chest pain, early ST settlement, peak CPK-MB levels), age of patient, site of AMI, time to thrombolysis, resting left ventricular ejection fraction, wall motion score of the infarct zone and presence of collaterals were not significantly different in patients with good or poor flow in IRA. Thus, improvement in contractility of infarct zone after dobutamine infusion can predict good flow (TIMI II or III) in IRA with 80 percent sensitivity, 75 percent specificity, 80 percent diagnostic accuracy, 80 percent positive predictive value and 75 percent negative predictive value.

Adult↗
PubMedDate not supplied

Diagnosing ascitic etiology on a biochemical basis.

BACKGROUND/AIMS: The analysis of ascitic fluid has been complicated by several new tests. To simplify its assessment, we evaluated ascitic fluid pH with six other parameters prospectively and simultaneously in blood and ascitic fluid in sixty patients with ascites. METHODOLOGY: Sixty patients were selected on whom abdominal paracentesis was performed in order to determine which tests were the most reliable for the etiological diagnosis of ascites. Their ascitic fluid pH, cholesterol, albumin, and total proteins were analyzed to distinguish between malignant and cirrhotic ascites. The diagnosis of cirrhosis was based on histological findings, and/or clinical, biochemical, and endoscopic/ultrasonographic findings in whom percutaneous liver biopsy was contraindicated. RESULTS: The serum-ascites albumin gradient was higher (p<0.001) in cirrhotic as compared to tubercular, malignant or cardiac ascites. We discovered that ascitic fluid lactate dehydrogenase and cholesterol were best for diagnosing malignant ascites, ascitic fluid glucose and ascitic fluid/blood glucose ratio were perfect for diagnosing tubercular ascites, and ascitic fluid pH and lactate dehydrogenase were suitable for diagnosing spontaneous bacterial peritonitis. Correspondingly, ascitic fluid albumin, ascitic fluid/serum albumin, total proteins, and serum ascites albumin gradient were best for diagnosing sterile cirrhotic ascites. CONCLUSIONS: Diagnostic paracentesis is a useful procedure. The practice of ordering a battery of tests on every ascitic fluid specimen should be abandoned. Rather, an algorithm approach should be adopted in which the results of initial analysis guide us to further relent tests that help in arriving at the etiology of ascites.

Albumins↗