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Biomedical subjects

S K Jindal

Publications and source records attributed to S K Jindal.

At least 19 recordsLinked to original sources
PubMed2006

Effects of cyclin D1 (CCND1) polymorphism on susceptibility to lung cancer in a North Indian population.

Cyclin D1 is involved in normal regulation of the cell cycle and plays an important role in the transition from G1 to S phase of the cell cycle. The CCND1 gene has a G-->A polymorphism in exon 4 that increases the frequency of alternate splicing. We analyzed the potential role of CCND1 gene polymorphisms in lung cancer patients (n = 151) and in a matched control population (n = 151). DNA was isolated from blood samples, and exon 4 of CCND1 was amplified by polymerase chain reaction. After digestion with MspI, common CCND1 polymorphic alleles were analyzed by means of agarose gel electrophoresis. The data obtained were analyzed using multiple logistic regression. After adjustment for age, sex, and smoking status, the AG genotype was associated with an increased risk for overall lung cancer (odds ratio OR = 1.7, 95% confidence interval CI = 0.92-3.14). No association was found between AA genotype and risk of lung cancer. In smokers, the combined AG+AA genotypes of CCND1 were found to be significant (OR = 1.9, 95% CI = 1.03-3.71, P = 0.03). No positive association was found between CCND1 genotypes in nonsmokers. The results suggest that the CCND1 A870G gene polymorphisms may increase the risk of lung cancer in smokers from north India.

Aged↗
PubMed2006

Clinical characteristics and outcomes of empyema thoracis in 117 patients: a comparative analysis of tuberculous vs. non-tuberculous aetiologies.

BACKGROUND: Empyema thoracis remains a major problem in developing countries. Clinical outcomes in tuberculous empyema are generally believed to be worse than in non-tuberculous aetiologies because of the presence of concomitant fibrocavitary parenchymal disease, frequent bronchopleural fistulae and poor general condition of patients. We performed a prospective study over a 2-year period with the objective of comparing the clinical characteristics and outcomes of patients with tuberculous vs. non-tuberculous empyema. METHODS: Prospective study of all cases of non-surgical thoracic empyema seen at a tertiary care centre in North India over a 2-year period. A comparative analysis of clinical characteristics, treatment modalities and outcomes of patients with tuberculous vs. non-tuberculous empyema was carried out. Factors associated with poor outcomes were analysed using multivariate logistic regression. RESULTS: One hundred and seventeen cases of empyema were seen in the study period of which 95 had non-tuberculous and 41 had tuberculous empyema. Malnutrition and bronchopleural fistulae (BPF) were more common and duration of symptoms longer in the tuberculous empyema group. Time to resolution of fever, duration of pleural drainage and pleural thickening >2 cm were significantly greater as well. Eight (10.5%) patients with non-tuberculous empyema and four (9.8%) with tuberculous empyema succumbed. Presence of a BPF was significantly associated with poor outcomes on multivariate logistic regression analysis. CONCLUSIONS: Tuberculous empyema remains a common cause of thoracic empyema in India though it ranked second amongst all causes of empyema after community acquired lung infections in this study. Tuberculous empyema is associated with longer duration of symptoms, greater duration of pleural drainage and more residual pleural fibrosis.

Adolescent↗
PubMed2005

How long does it take for tuberculosis to cause secondary amyloidosis?

It is often believed that secondary amyloidosis occurs months to years after the onset of the predisposing cause. We describe two cases that, to the best of our knowledge, are the earliest described cases of amyloidosis occurring after the diagnosis of active tuberculosis.

Journal Article↗
PubMed2005

Prevalence and risk factors for transmission of infection among children in household contact with adults having pulmonary tuberculosis.

AIMS: To study the prevalence of tuberculosis infection among children in household contact with adults having pulmonary tuberculosis, and identify the possible risk factors. METHODS: Children under the age of 5 years who were in household contact with 200 consecutive adults with pulmonary tuberculosis underwent tuberculin skin testing. Transverse induration of greater than 10 mm was defined as positive tuberculin test suggestive of tubercular infection. Infected children underwent chest radiography and analysis of gastric lavage fluid or induced sputum for detection of acid fast bacilli. RESULTS: Tuberculin test was positive in 95 of 281 contacts (33.8%), of which 65 were contacts of sputum positive patients, while 30 were contacts of sputum negative patients. Nine of these children were diagnosed as having tuberculosis based on clinical features and/or recovery of acid fast bacilli; seven were in contact with sputum positive adults. The important risk factors for transmission of infection were younger age, severe malnutrition, absence of BCG vaccination, contact with an adult who was sputum positive, and exposure to environmental tobacco smoke. CONCLUSION: The prevalence of tuberculosis infection and clinical disease among children in household contact with adult patients is higher than in the general population, and risk is significantly increased by contact with sputum positive adults.

Adult↗
PubMed2005

Does noninvasive ventilation work in ARDS? A case report and review of the current literature.

The role of noninvasive positive pressure ventilation (NIPPV) in adult respiratory distress syndrome (ARDS) is controversial, in contrast to its well established benefits in other types of respiratory failure, especially acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary oedema. We report a case of ARDS caused by Mycoplasma pneumoniae in a 70 year old man, treated with NIPPV in addition to standard medical therapy and analyse current evidence regarding the role of NIPPV in patients with ARDS.

Aged↗
PubMed2005

Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming.

The objective of this study was to evaluate the effects of two different dosage protocols on the outcome of patients with severe neurotoxic snake envenoming, using a retrospective analysis of patients admitted with a diagnosis of severe neurotoxic snake bite over a 4 year period. In the study, 55 snake bite victims requiring ventilatory support for severe neurotoxic envenoming received either 150 ml of polyvalent snake antivenom (SAV) (low dose SAV group, n = 28) or 100 ml of SAV at presentation followed by 100 ml every 6 hours until recovery of neurological manifestations (high dose group, n = 27). The median dose of SAV in the high dose group was 600 ml (range 300 to 1600). The duration of mechanical ventilation in the low dose group (median 47.5 hours; range 14 to 248) was similar to that in the high dose group (median 44 hours; range 6 to 400). The mean (SD) duration of intensive care unit stay was similar in the two groups. There were three deaths in the high dose group; two patients in the low dose group had neurological sequelae. All other patients improved, had no residual neurological deficit, and were discharged. We conclude that there is no difference between a protocol using lower doses of SAV and one with higher doses in the management of patients with severe neurotoxic snake envenoming.

Adult↗
PubMed2005

Non-invasive ventilation in acute cardiogenic pulmonary oedema.

Non-invasive ventilation (NIV) is the delivery of assisted mechanical ventilation to the lungs, without the use of an invasive endotracheal airway. NIV has revolutionised the management of patients with various forms of respiratory failure. It has decreased the need for invasive mechanical ventilation and its attendant complications. Cardiogenic pulmonary oedema (CPO) is a common medical emergency, and NIV has been shown to improve both physiological and clinical outcomes. From the data presented herein, it is clear that there is sufficiently high level evidence to favour the use of continuous positive airway pressure (CPAP), and that the use of CPAP in patients with CPO decreases intubation rate and improves survival (number needed to treat seven and eight respectively). However, there is insufficient evidence to recommend the use of bilevel positive airway pressure (BiPAP), probably the exception being patients with hypercapnic CPO. More trials are required to conclusively define the role of BiPAP in CPO.

Acute Disease↗
PubMed2005

Obstructive granulomatous bronchiolitis obliterans due to Mycobacterium tuberculosis.

Bronchiolitis obliterans is an uncommon cause of obstructive airway disease in adults characterised by progressive irreversible airway obstruction. Granulomatous bronchiolitis is a rare entity and tuberculosis presenting as bronchiolitis is distinctly uncommon. The authors present a case of tubercular granulomatous bronchiolitis obliterans, confirmed on histopathology, who responded completely to anti-tubercular chemotherapy.

Adolescent↗
PubMed2005

Applicability of commonly used Caucasian prediction equations for spirometry interpretation in India.

BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.

Adolescent↗
PubMed2005

Precursor lesions of adenocarcinoma lung--two case reports.

Although precursor lesions of bronchogenic squamous cell carcinoma are well documented, the preinvasive lesions of pulmonary adenocarcinoma are seen very rarely. It has been hypothesized that there is a stepwise progression of alveolar epithelial hyperplasia to atypical alveolar hyperplasia and subsequently to malignancy in the pathogenesis of peripheral adenocarcinoma of the lung. In the present paper we would like to share our experience of two cases of pulmonary adenocarcinoma with their precursor lesions in the form of atypical alveolar hyperplasia.

Adenocarcinoma↗
PubMed2004

Genetic polymorphism of the CYP1A1, CYP2E1, GSTM1 and GSTT1 genes and lung cancer susceptibility in a north indian population.

CYP1A1, CYP2E1, GSTM1 and GSTT1 polymorphisms were evaluated in north Indian lung cancer patients and controls. The estimated relative risk for lung cancer associated with the CYP1A1*2C allele was 2.68. Apart from the CYP1A1*2C genotype, there was no attributable risk in relation to other genotypes when analyzed singly. However, in the presence of a single copy of the variant CYP1A1 (CYP1A1*1/2A) and null GSTT1 genes, there was a three-fold increased risk for lung cancer; when stratified histologically the relative risk increased to 3.7 in case of SQCC. Similarly individuals carrying the mutant CYP1A1*2C genotype and single copy of the variant CYP1A1 Mspl allele, had a relative risk of 2.85 for lung cancer. In case of the GSTM1 and CYP1A1 genotypes, null GSTM1 and variant Msp1 alleles had two-fold elevated risk for SQCC. On the other hand CYP1A1*2C and null GSTM1 genotype had a 3.5-fold elevated risk for SCLC. Stratified analysis indicated a multiplicative interaction between tobacco smoking and variant CYP1A1 genotypes on the risk for SQCC and SCLC. The heavy smokers (BI > 400) with CYP1A1*2C genotype were at a very high risk to develop SCLC with an OR of 29.30 (95% CI = 2.42-355, p = 0.008). Taken together, these findings, the first to be analyzed in north Indian population, suggest that combined GSTT1 , GSTM1 and CYP1A1 polymorphisms could be susceptible to lung cancer induced by bidi (an Indian cigarette) smoking.

Alleles↗
PubMed2004

Effect of household exposure to environmental tobacco smoke on airflow mechanics in asymptomatic healthy women.

BACKGROUND & OBJECTIVES: Exposure to environmental tobacco smoke (ETS) can lead to airflow limitation, similar to that seen in smokers. However, the effects have not been conclusively proven. In the present study an attempt was made to characterize the effect of ETS exposure at home on airflow mechanics in asymptomatic healthy women. METHODS: Fifty women volunteers with no apparent health related problem, exposed to household ETS (group I), and 50 age-matched women not exposed (group II) were studied. Vital capacity (VC), forced expiratory flow in first second (FEV1), FEV1/VC ratio, peak expiratory flow (PEF), maximal midexpiratory flow (FEF(25-75%)), airway resistance (R(aw)) and specific airway conductance (sG(aw)) were measured, and compared between the two groups. Conditional logistic and linear regression analysis were done to assess contribution of household ETS exposure to decreased lung function. RESULTS: FEV1 and PEF values were marginally lower among women in group I (mean difference 0.13 l and 0.20 l/sec respectively). FEF(25-75%), R(aw) and sG(aw) were significantly impaired in this group. Ten (20.0%) women in group I and five (10.0%) in group II had abnormal R(aw) (adjusted odds ratio 6.72, 95% confidence limits 1.15-39.42), while eight (16.0%) women in group I and one (2.0%) in group II had abnormal sG(aw) (adjusted odds ratio 21.08, 95% confidence limits 1.30-341.05). Cumulative life time ETS exposure was, not significantly related to a reduction in FEV1, VC, PEF, FEF(25-75%), R(aw) or sG(aw) after adjustments for potential confounders. INTERPRETATION & CONCLUSION: Exposure to household ETS resulted in subtle impairment of airflow mechanics in asymptomatic women, possibly attributed to small airway narrowing. Further investigations are required to study the progression of this impairment with time.

Adult↗
PubMed2004

The relationship between tobacco smoke & bronchial asthma.

Bronchial asthma is a common disease and an important cause of morbidity among both children and adults. Tobacco smoking, both active and passive i.e., exposure to environmental tobacco smoke (ETS) has got important effects on asthma. Smoking by adults causes bronchial irritation and precipitates acute episodes. It also increases bronchial responsiveness and causes airway sensitization to several occupational allergens. Smoking may also increase the disease severity. Continued smoking by adult asthmatics is the likely cause of irreversibility of airway obstruction and development of chronic obstructive pulmonary disease. ETS exposure affects asthma in a similar fashion. Parental smoking is commonly associated with increased asthma symptoms, respiratory infections, acute episodes and frequent hospitalization of children. Bronchial responsiveness and airway sensitization may also increase. Childhood exposure to smoking is also considered as a risk factor for the development of asthma. Similarly, in utero exposure to maternal smoking may be independently responsible for early onset asthma. ETS exposure in adult asthmatics from smoking by spouses, siblings or colleagues is equally troublesome. There is increased morbidity and poorer asthma control. Asthmatic symptoms sharply decline after the ETS exposure is reduced.

Adult↗
PubMed2004

Drug susceptibility of Mycobacterium tuberculosis to primary antitubercular drugs by nitrate reductase assay.

BACKGROUND & OBJECTIVES: Rapid susceptibility testing of Mycobacterium tuberculosis strains is imperative for therapy selection but traditional drug susceptibility tests take weeks or are expensive. In this study we evaluated nitrate reductase assay which utilizes the detection of nitrate reduction as an indication of growth and therefore results can be obtained faster than by visual detection of colonies. METHODS: One hundred clinical isolates of M. tuberculosis were tested for four first line antitubercular drugs by nitrate reductase assay (NRA) and were compared with standard proportion method. The bacteria were inoculated on Lowenstein-Jensen (LJ) medium with primary antitubercular drugs and potassium nitrate was incorporated. After incubation for 7- 14 days, nitrate reduction indicating growth could be detected by colour change when reagents were added. RESULTS: Resistance of isolates as determined by both methods for isoniazid, rifampicin, streptomycin and ethambutol was 32, 35, 62 and 15 per cent respectively. Agreement between NRA and proportion method was 99 per cent for isoniazid and ethambutol. Complete agreement (100%) was found for rifampicin and streptomycin. Results were available in 7-14 days by NRA as compared to proportion method which takes 4-6 wk. INTERPRETATION & CONCLUSION: Nitrate reductase assay is a rapid and inexpensive method for susceptibility testing of M. tuberculosis for primary antitubercular drugs and could be an appropriate alternative to existing methods, particularly in resource-poor settings.

Antitubercular Agents↗
PubMed2004

Bronchial hyperresponsiveness in patients with sarcoidosis.

OBJECTIVE: To study bronchial hyperresponsiveness (BHR) in patients with sarcoidosis. METHODS: Twenty freshly diagnosed patients with sarcoidosis were evaluated. Progressively increasing concentrations of methacholine were administered using a standard five-breath dosimeter protocol, and spirometry performed after each challenge. BHR was expressed as PC20 (provocating concentration of methacholine resulting in 20% fall in forced expiratory volume in first second). All patients were nonsmokers, had no other concurrent cardiopulmonary disease, and were not on any specific treatment for sarcoidosis. RESULTS: Borderline (PC20 4.0-16.0 mg/mL), mild (PC20 1.0-4.0 mg/mL) and moderate to severe (PC20 <1.0 mg/mL) BHR was documented in three (15%), one (5%) and five (25%) patients respectively. Patients with BHR were similar to those having normal reactivity in terms of age, gender, disease duration and results of pulmonary function testing. All patients with endobronchial disease had BHR. CONCLUSION: BHR may be seen in several patients of sarcoidosis and could possibly contribute to decline in lung function.

Adult↗
PubMed2003

Influence of Mycobacterium tuberculosis on differential activation of helper T-cells.

Host defence against tuberculosis infection involves T-lymphocyte mediated cellular immune responses. In this study we assessed T-cell activation by studying the early signal transduction events and production of cytokines by human CD4+ T-cells. The study constituted of five groups of subjects: (a) untreated acid fast bacilli (AFB)+ve TB patients who have not started anti-tuberculosis therapy (ATT) [New]; (b) patients who have taken ATT for two months [2T]; (c) patients who have taken ATT for six months [6T]; (d) mantoux positive healthy controls [T+ve]; (e) mantoux negative healthy controls [T-ve]. We found that mantoux positive healthy controls produced significantly higher levels of IP3, intracellular Ca2+ and presented increased PKC activity when CD4+ T-cells were stimulated with M. tuberculosis H37Rv cell lysate as compared to mantoux negative controls. Furthermore, decreased expression of CD54 (ICAM-1) and reduced [Ca2+]i were seen in TB patients as compared to T+ve healthy controls. TB patients showed significantly lower levels of IL-2 and IFNgamma and higher levels of IL-4 as compared to normal healthy controls, suggesting a diminished Th1 response. Thus, the reciprocal changes in cytokines, reduced [Ca2+]i levels, and CD54 expression in patients imply phenotype shifting of Th precursors to Th2 type in TB patients.

Adult↗
PubMed2003

Ventilatory management of respiratory failure in patients with severe Guillain-Barre syndrome.

Guillain-Barre syndrome (GBS) is the commonest peripheral neuropathy causing ventilatory failure, and 10-30% patients may require respiratory support. Records of 11 adult patients of GBS in respiratory failure, admitted to the Respiratory Intensive Care Unit (RICU) of our institute for mechanical ventilation over a four-year period, were studied. Six patients received intravenous immunoglobulin. The median duration of mechanical ventilation was 38 days. Seven patients underwent tracheostomy. Four patients were ventilated for less than 2 weeks and 3 for more than 2 months each. Seven developed ventilator-associated pneumonia and/or sepsis. Three patients died in, and two shortly after discharge from RICU; all had systemic problems or complications of hospitalization.

Adolescent↗