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Biomedical subjects

S Jain

Publications and source records attributed to S Jain.

At least 163 records · Page 9Linked to original sources
PubMed2001

Enalapril acts through release of nitric oxide in patients with essential hypertension.

BACKGROUND: Endothelial dysfunction has been proposed as an etiological agent in the pathogenesis of essential hypertension. Amongst the various antihypertensive drugs, angiotensin converting enzyme inhibitors (ACEI) have been implicated in modifying the vascular endothelium by the release of mediators that include bradykinin, nitric oxide, prostaglandins and thromboxane A2. MATERIALS AND METHODS: To study the mechanism of action of enalapril, an ACEI, serum reactive nitrite intermediates (RNI) and citrulline, by products of nitric oxide metabolism were measured before and after treatment with enalapril in 25 consecutive patients of essential hypertension. RESULTS: Following treatment serum RNI intermediate increased from a pretreatment value of 164.5 +/- 20.2 nmol/mL to a post treatment value of 266.9 +/- 47.3 nmol/mL (p < 0.05), however there was no significant change in the levels of citrulline (p > 0.1). There was no significant correlation between the severity of hypertension and serum RNI. Serum RNI levels were lower in the postmenopausal women but did not reach statistical significance. CONCLUSIONS: It is postulated that enalapril exhibits its antihypertensive property through release of nitric oxide.

Adolescent↗
PubMed2001

Mitomycin C reduces corneal light scattering after excimer keratectomy.

PURPOSE: To evaluate the effect of intraoperative mitomycin C (MMC) on corneal light scattering after excimer laser keratectomy. METHODS: Phototherapeutic keratectomy (PTK) was performed in 24 rabbit eyes. After 40-microm epithelial ablation, animals were divided into three groups. In group 1, filter paper discs soaked with MMC (group 1A, 0.5 mg/mL; group 1B, 0.25 mg/ml) were applied for 1 minute. In group 2, annular filter papers soaked with MMC (group 2A, 0.5 mg/mL; group 2B, 0.25 mg/mL) were applied for 1 minute. Controls received vehicle only (group 3). Six-millimeter diameter 100-microm deep PTK was performed. Corneal light scattering was measured weekly from 1 to 6 weeks, at 10 weeks, and at 8 and 13 months using a scatterometer. A corneal light scattering index (SI) ranging from 0 to 10 was calculated; SI of 1 represents normal scattering. RESULTS: A statistically significant decrease in mean SI was noted in group 2A (annular MMC 0.5 mg/mL; p<0.05) as compared with the control group at 2 weeks. At 10 weeks, SI approached baseline levels in group 2 and the control group but showed significant increase in group 1 (MMC disc; p < 0.05). At 8 and 13 months, SI showed no statistical differences between groups. CONCLUSIONS: Controlled application of 0.5 mg/mL MMC in the corneal midperiphery transiently reduces corneal light scattering after excimer keratectomy in this rabbit model.

Alkylating Agents↗
PubMed2001

Terbinafine-induced hepatic dysfunction.

A 41-year-old man developed severe hepatic dysfunction following a 3.5-week course of terbinafine (250 mg/day). He suffered marked pruritus, jaundice, malaise, anorexia and loin pain. Serum bilirubin rose to a peak value of 718 micromol/l with alkaline phosphatase at 569 U/l, alanine aminotransferase at 90 U/l, aspartate aminotransferase at 63 U/l and a prolonged prothrombin time of 21 s, unresponsive to vitamin K. Transjugular liver biopsy showed canalicular cholestasis consistent with a drug reaction. Symptoms resolved 11 months after drug cessation, with liver function tests returning to normal values after 15 months. This case represents the most severe cholestatic reaction reported to date, resulting in patient recovery without liver transplantation. A comprehensive literature review is provided.

Adult↗
PubMed2001

New lamellar keratoplasty techniques: posterior keratoplasty and deep lamellar keratoplasty.

Posterior keratoplasty is a new surgical technique that may be valuable in treating patients with corneal decompensation secondary to endothelial dysfunction. There are currently two approaches to posterior keratoplasty. In the first approach, a corneal flap is created using a microkeratome (similar to laser in situ keratomileusis flap), and posterior stromal tissue is excised (by trephination or excimer laser keratectomy). In the second approach, a deep stromal pocket is created across the cornea through a superior scleral incision. A custom-made flat trephine is inserted into the pocket to excise a posterior lamellar disc. Preliminary studies have shown the feasibility of performing these techniques in sighted human eyes. Despite potential advantages, further clinical studies are needed to determine whether these techniques reduce interface scarring, astigmatism and graft rejection, improve visual outcomes, or are potentially an alternative for penetrating keratoplasty.

Corneal Diseases↗
PubMed2001

Laser subepithelial keratomileusis: electron microscopy and visual outcomes of flap photorefractive keratectomy.

Laser epithelial keratomileusis (LASEK) is a surgical technique that may be performed in patients with low myopia who are considering conventional photorefractive keratectomy (PRK), in patients with thin corneas, and in patients with professions or lifestyles that predispose them to trauma. Ethanol (18%) is applied for 25 seconds and a hinged epithelial flap is created. After laser ablation, the flap is repositioned over the ablated stroma. Our data showed that epithelial defects occurred in 63% eyes on Day 1. Postoperative pain was absent in 47%. Uncorrected visual acuity of 20/40 or better was achieved in all patients at 1 week. Data from several studies suggest that LASEK may reduce postoperative pain and corneal haze associated with PRK. LASEK offers the potential advantage of avoiding flap-related complications associated with laser in situ keratomileusis and decreasing postoperative pain and corneal scarring associated with PRK. Long-term studies are needed to confirm these potential advantages and to determine the safety, efficacy, and predictability of this surgical technique.

Epithelium, Corneal↗
PubMed2001

Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance.

BACKGROUND: Adverse drug reactions and non-compliance are important causes of admissions in the elderly to medical clinics. The contribution of adverse drug reactions and non-compliance to admission by the medical emergency department was analysed. METHODS: A total of 578 consecutive elderly patients admitted to the medical emergency department were interviewed to determine the percentage of admissions due to adverse drug reactions or non-compliance with medication regimens, their causes, consequences, and predictors. RESULTS: Eighty three (14.4%) of the 578 admissions were drug related: 39 (6.7%) caused by adverse drug reactions and 44 (7.6%) caused by non-compliance with medication. One hundred ninety two (33.2%) patients had a history of non-compliance. Factors associated with an increased risk of admission because of an adverse drug reaction were patients with diabetes or neoplasms, and patients using numerous different medications. Factors associated with a higher risk of hospitalisation because of non-compliance were poor recall of the medication regimen, seeing numerous physicians, female sex, polypharmacy, drug costs, and switching over to non-conventional forms of treatment. CONCLUSION: Many elderly admissions are drug related, with non-compliance accounting for a substantial fraction of these. Elderly people at high risk of suffering a drug related medical emergency are identified and suitable interventions may be planned by the healthcare policymakers to target them.

Aged↗
PubMed2001

Hereditary distal renal tubular acidosis: new understandings.

The primary or hereditary form of distal renal tubular acidosis (dRTA), although rare, has received increased attention recently because of dramatic advances in the understanding of its genetic basis. The final regulation of renal acid excretion is effected by various acid/base transporters localized in specialized cells in the cortical collecting and outer medullary collecting tubules. Inherited defects in two of the key acid/base transporters involved in distal acidification, as well as mutations in the cytosolic carbonic anhydrase gene, can cause dRTA. The syndrome is inherited in both autosomal dominant and recessive patterns; patients with recessive dRTA present with either acute illness or growth failure at a young age, sometimes accompanied by deafness, whereas dominant dRTA is usually a milder disease and involves no hearing loss. The AE1 gene encodes two Cl-/HCO3- exchangers that are expressed in the erythrocyte and in the acid-secreting intercalated cells of the kidney. AE1 contributes to urinary acidification by providing the major exit route for HCO3- across the basolateral membrane. Several mutations in the AE1 gene cosegregate with dominant dRTA. The modest degree of hypofunction exhibited in vitro by these mutations, however, does not explain the abnormal distal acidification phenotype. Other AE1 mutations have been linked to a recessive syndrome of dRTA and hemolytic anemia in which hypofunction can be discerned by in vitro studies. Several mutations in the carbonic anyhdrase II gene are associated with the autosomal recessive syndrome of osteopetrosis, renal tubular acidosis, and cerebral calcification. Some of these individuals present with deafness of the conductive type. By contrast, more recent studies have shown that mutations in ATP6B1, encoding the B-subtype unit of the apical H(+) ATPase, are responsible for a group of patients with autosomal recessive dRTA associated with sensorineural deafness. Thus, the presence of deafness and the type provide an important clue to the genetic lesion underlying hereditary dRTA.

Acidosis, Renal Tubular↗
PubMed2001

Neuropsychiatric perspectives from nineteenth-century India: the diaries of Dr Charles I. Smith.

The history of disease contributes to a better understanding of the growth of ideas in medicine. The colonial period was marked by a rapid increase in the variety of diseases that were known to European practitioners. We have studied the diary of Dr Charles Smith who worked in Bangalore in the nineteenth century. We feel that some of his descriptions tally with later accounts of cysticercosis. He also comments on a wide range of behavioural symptoms, and attempts to correlate neuropathological observations to these. This neuropsychiatric perspective was prominent in the nineteenth century. Infective causes of psychiatric disorders are once again considered important; this account highlights the fact that similar ideas were prevalent in British India, even 150 years ago. In addition, Dr Smith's comments describe the social mileu of 'western' medicine in India in the early colonial period.

Colonialism↗
PubMed2001

Profile of Indian women requesting reversal of sterilisation.

This is a prospective clinical study carried out on 96 tubectomised women referred for microsurgical reversal to the Pandit BDS Postgraduate Institute of Medical Sciences, Rohtak and LHMC and SSKH, New Delhi. It was concluded that in developing countries high perinatal and child mortality rates are responsible for increased demands for reversal of sterilisation. Proper pre-operative counselling, age of the women, assessment of marital stability, family size and age of children are important before advocating sterilisation as a method of contraception.

Adult↗
PubMed2001

Drug-related visits to the medical emergency department: a prospective study from India.

OBJECTIVE: To analyze the contribution of adverse drug events (ADEs) to the overall number of visits to the medical emergency and to determine the proportion of events leading to hospital admissions. PATIENTS AND METHODS: All visits to the medical emergency were recorded in a prospective, non-interventional design study over a period of 8 months. The ADEs were divided into 5 categories: adverse drug reactions (ADRs), drug interactions, patient non-compliance, physician non-compliance, and drug overdose. The cases were then followed-up to assess the prorportion of ADEs lead to hospitaliztion. RESULTS: A total of 4764 patients were included in the study. 5.9% of all visits were considered to be drug-related. The highest percentage of ADEs was observed in the age group less than 20 and more than 80 years. ADRs accounted for 45% of all ADEs, followed by patient non-compliance (28%). Patient and physician non-compliance were the main causes of drug-related hospital admissions. 52% of all ADE-related visits and 55% of ADE-related admissions were considered to be preventable. Non-steroidal antiinflammatory agents, oral hypoglycemics and antitubercular drugs were responsible for 37% of all ADRs. Non-compliance was mainly seen in hypertensives, asthmatics and epileptics. CONCLUSION: ADEs account for a sizable proportion of all visits to a medical emergency unit and some are serious enough to require hospitaliztion. A large number of ADE-related visits and admissions are preventable which highlights the importance of public education on the proper use of drugs, and also the need for regulation of the practice of unregistered medical practitioners in developing countries.

Adult↗
PubMed2001

Nested multiplex polymerase chain reaction for the diagnosis of cutaneous herpes simplex and herpes zoster infections and a comparison with electronmicroscopy.

Herpes simplex virus (HSV) and varicella zoster virus (VZV) are common causes of cutaneous and mucocutaneous vesicular eruptions. Laboratory diagnostic techniques include Tzanck smears, electronmicroscopy, antigen detection and viral culture. This paper describes a nested multiplex polymerase chain reaction with respective sensitivities of 0.0001, 0.01 and 0.1 TCID50 for VZV, HSV-1 and HSV-2. The assay was used in (a) a salvage capacity for slides already processed for electronmicroscopy, and (b) as a front-line assay for prospectively processed specimens. Sixty-two glass slides with vesicle lymph/scrapings from 58 patients with suspected cutaneous herpetic lesions were examined. The clinical presentations were described as atypical/not specified (24), VZV (20) or HSV (18), and involved eruptions from diverse anatomical sites, including the genitalia. Of the 62 specimens, 6 and 38 were positive by electronmicroscopy and multiplex PCR respectively, giving a comparative sensitivity of 16% for electronmicroscopy. Nested multiplex PCR identified 15 VZV and 20 HSV-1 infections. Where the clinical details indicated either HSV or VZV (38/62), nested multiplex PCR was statistically likely to be reactive (26/38 vs. 9/24) (chi2 P = 0.000004) whereas electronmicroscopy was not (4/38 vs. 2/24) (chi2 P= 0.77). Where the clinical details indicated VZV (20/62) or HSV (18/62), nested multiplex PCR was statistically more likely to confirm VZV (10/20 vs. 5/42) (chi2 P= 0.001) or HSV (9/18 vs. 11/44) (chi2 P = 0.05) respectively. Two suspected HSV and 6 suspected VZV infections were shown to be VZV and HSV respectively by nested multiplex PCR.

Adolescent↗
PubMed2001

Cerebellar metastasis from papillary serous adenocarcinoma of the ovary mimicking Ménière's disease. A case report.

BACKGROUND: In rare cases, cerebellar metastasis originating in serous papillary adenocarcinoma of the ovary can mimick Ménière's disease. CASE: A 51-year-old woman, with complete remission after optimal maximal debulking and chemotherapy for an International Federation of Gynecology and Obstetrics IIIc primary ovarian carcinoma, presented with nausea, vomiting, vertigo and headache 18 months after surgery. Investigations revealed a solitary cerebellar cystic mass, 4.6 x 4.0 x 3.2 cm. Gross total excision of the cerebellar lesion followed by brain irradiation resulted in complete resolution of her symptoms. Histology showed a metastatic tumor consistent with the primary ovarian carcinoma. CONCLUSION: In an atypical presentation in patients with metastatic ovarian carcinoma, thorough investigations should be done to rule out or confirm brain metastasis, which can be aggressively managed to prevent serious consequences and improve outcome.

Adenocarcinoma, Papillary↗
PubMed2001

Trigeminal schwannoma associated with pathological laughter and crying.

A 46 year old man with trigeminal schwannoma displayed symptoms of ataxia with pathological laughter and crying. The tumour developed in the cerebellopontine angle, compressing the pontomesencephalic structures backward, extending in the posterior parasellar region and Meckel's cave. No recurrence of laughter and crying attacks were noted after total removal of the tumour. Theories of mechanism of pathological laughter and crying reported in the literature are reviewed.

Cranial Nerve Neoplasms↗