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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
PubMed2001

Static lung compliance as an index of early pulmonary disease in systemic sclerosis.

Pulmonary function abnormalities constitute the most important cause of morbidity and mortality in patients with systemic sclerosis (SSc). A restrictive ventilatory defect with a reduction in pulmonary carbon monoxide diffusion capacity (DLCO) is the commonest finding. Static lung compliance (Cst) is perhaps the most sensitive parameter for the detection of abnormal pulmonary mechanics. We compared the results of Cst and DLCO in patients with SSc and normal spirometry to identify early pulmonary disease. Sixteen of 50 patients had normal spirometry, eight of whom had abnormal Cst. Four of them also had a reduced DLCO. Two patients had abnormal DLCO but their Cst was normal. One of them had pulmonary hypertension on echocardiography. We conclude that Cst was helpful in diagnosing early pulmonary abnormality in 50% of patients with normal spirometry. Among these patients Cst was a better index of abnormality than DLCO.

Adult↗
PubMed2001

Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax.

BACKGROUND: Pleural effusion in cirrhotic patients (hepatic hydrothorax) may result from migration of ascitic fluid across defects in the diaphragm. Biochemical analysis of ascitic and pleural fluid provides only indirect information about the nature and origin of the effusion. The present study was performed in order to demonstrate the presence/absence of peritoneo-pleural communication by radioisotope imaging. METHODS: Ten patients with cirrhotic ascites and pleural effusion were studied with 99mTc sulfur colloid scintigraphy to look for movement of the radiotracer from the peritoneal to the pleural cavity. Serum-ascitic albumin gradient (SAAG) and serum-pleural fluid albumin gradient (SPAG) values were determined in eight patients to examine the nature of the ascitic and pleural fluids. RESULTS: Transdiaphragmatic movement of ascitic fluid into the pleural space was demonstrated (generally within 2 h of intraperitoneal injection of the radiotracer) in eight of 10 patients; six on the right side, one on the left and one bilaterally. Two patients in whom pleural fluid was transudative on SPAG values were negative for peritoneo-pleural communications. CONCLUSIONS: Radionuclide scintigraphy is a simple, safe and relatively non-invasive method to confirm passage of ascitic fluid across the diaphragm.

Adult↗
PubMed2001

Assessment of factors predicting outcome of acute respiratory distress syndrome in North India.

OBJECTIVES: Information on the spectrum and outcome of acute respiratory distress syndrome (ARDS) in tropical countries is scanty. This study was designed to assess the factors predicting the outcome of ARDS in North India. METHODOLOGY: Consecutive patients requiring mechanical ventilation for ARDS over a 2 year period at the Respiratory Intensive Care Unit (RICU) of a tertiary referral hospital were studied. Hospital survival was correlated with age, aetiology, disease severity scores (APACHE III, SAPS II, lung injury score) and organ failure using univariate analysis. Factors significantly influencing mortality were examined by multivariate analysis to identify factors independently affecting outcome. RESULTS: Sepsis (28.6%), followed by malaria (21.4%), were the commonest risk factors. Seven out of eight patients (87.5%) with sepsis died. The presence of sepsis, more than three organ failure prior to admission, APACHE III score > 57 and SAPS II score > 39 were significantly associated with mortality. Only APACHE III score > 57 or SAPS II score > 39 were, however, independently predictive of a poor outcome following multivariate analysis. CONCLUSIONS: Sepsis, associated with a very poor outcome, and malaria were important risk factors for the development of ARDS. APACHE III score > 57 or SAPS II score > 39 were associated with increased risk of mortality.

APACHE↗
PubMed2001

Prevalence of bronchial asthma and association with environmental tobacco smoke exposure in adolescent school children in Chandigarh, north India.

Prevalence of asthma and its association with environmental tobacco smoke (ETS) exposure were examined among adolescent schoolchildren in Chandigarh, India. Using a previously standardized questionnaire, data from 9090 students in the 9- to 20-year age range were analyzed. There were 4367 (48%) boys, in whom the observed prevalence of asthma was 2.6%. Among 4723 (52%) girls, asthma was present in 90 (1.9%) students. Presence of one or more respiratory symptoms was reported by 31% students. More students with asthma had either parents or other family members smoking at home as compared to nonasthmatics (41% vs. 28%, p<0.0001). The odds ratio for being asthmatic for patients exposed to ETS compared to those not exposed to ETS was 1.78 (95% confidence interval 1.33-2.31). ETS was also positively associated with prevalence of all the respiratory symptoms, with odds ratios varying between 1.6 and 2.25.

Adolescent↗
PubMed2001

Dust-induced interstitial lung disease in the tropics.

Inhalation of dusts is an important cause of interstitial lung disease in the tropical countries such as India. While dusts of organic origin, such as the cotton dust causing byssinosis, generally cause bronchial or bronchiolar involvement and hypersensitivity pneumonitis, inorganic metallic dusts cause progressive pulmonary fibrosis. Silicosis, coal workers' pneumoconiosis, and asbestosis are the three most commonly recognized forms of pneumoconiotic pulmonary fibrosis. Pulmonary tuberculosis is an important complication seen in up to 50% of patients of silicosis in some reports from India. The presentation is generally chronic, although acute and accelerated forms of silicosis are known when the exposures are heavy. Breathlessness, dry cough, and general constitutional symptoms are commonly seen. Patients with silicotuberculosis or other forms of infection may also have significant expectoration, hemoptysis, fever, and rapid progression. Respiratory failure and chronic cor pulmonale occur in the later stages. The diagnosis is easily established if the occupational history is available. Dense nodular opacities on chest roentgenograms, which may be large in patients with massive pulmonary fibrosis, are characteristic. Emphysematous changes generally appear in advanced stages or in patients who smoke. Bronchoalveolar lavage and/or lung biopsy may occasionally be required to establish or exclude other causes of interstitial lung disease. Treatment is largely palliative, although a variety of drugs including corticosteroids and procedures such as whole lung lavage have been tried. None of these methods has yet been found successful in the treatment. Preventive safety steps, including removal of the patient from the site of exposure, are the only effective strategies to control disease progression.

Asbestosis↗
PubMed2001

Increased nitric oxide production by neutrophils in bronchial asthma.

This study was designed to assess the production of nitric oxide (NO) by neutrophils in bronchial asthma. Thirty asthmatic patients (ten each of mild, moderate and severe asthma) and ten healthy controls were included in the study. Neutrophils from peripheral venous blood were stimulated with latex, and production of nitrite (an NO metabolise) and L-citrulline (a co-product of NO) was studied. It was postulated that peripheral blood neutrophils, being in a primed or activated state in asthma, would reflect the changes occurring in bronchial tree neutrophils. Nitrite and L-citrulline production by neutrophils was significantly higher in asthmatics (p < 0.001) and increased with disease severity. A strong negative correlation was observed between peak expiratory flow and both nitrite (r = -0.87, p < 0.001) and L-citrulline (r = -0.88, p < 0.001) production. It is concluded that nitric oxide production by neutrophils is increased in bronchial asthma and can possibly contribute to airway narrowing and disease severity.

Adolescent↗
PubMed2001

Aggressive atropinisation and continuous pralidoxime (2-PAM) infusion in patients with severe organophosphate poisoning: experience of a northwest Indian hospital.

OBJECTIVE: The aim of the study was to find whether continuous pralidoxime (2-PAM) infusion along with aggressive atropinisation improves the outcome in patients with severe organophosphate poisoning who require assisted ventilation. METHODS: Sixteen patients admitted to the respiratory intensive care unit (RICU) with severe organophosphate poisoning and requiring assisted ventilation were included in the study. The compounds involved were phorate (six), dichlorvos (four), oxydimeton methyl (one), monocrotophos (one), methyl parathion (one) and in three it was unknown. After decontamination, they were given intravenous (iv) bolus atropine 5 mg at onset and then 2.5 mg every 5-10 min till atropinisation was achieved, and then maintained either by intermittent bolus doses or by continuous infusion if the required dose was large. They were also given continuous iv infusion of 2-PAM in dose of 7.5 mg/ kg body weight/h (maximum 500 mg/h) after an initial bolus dose of 2 g. RESULTS: The mean (+/-S.D.) dose of atropine was 735.02 +/- 742.98 mg (range 85-3000 mg) with maximum dose on day 1. The mean (+/-S.D) duration of 2-PAM infusion was 96.4+/-49.4 h (range 10-216 h). The mean (+/-S.D) duration of mechanical ventilation (MV) was 131.5 +/- 95.65 h (range 4-336 h). Fourteen patients could be successfully extubated and two died of bronchopneumonia and sepsis (mortality 12.5%). CONCLUSION: Continuous 2-PAM infusion along with aggressive atropinisation after initial decontamination improved the outcome but not the duration of MV in severely intoxicated patients with organophosphate compounds who required assisted ventilation in this case series.

Adolescent↗
PubMed2001

Evaluation of polymerase chain reaction for detection of Mycobacterium tuberculosis in pleural fluid.

OBJECTIVES: Tuberculosis, a reemergent killer, is threatening to assume serious proportions all over the world, particularly in view of the AIDS pandemic. The detection of mycobacterial DNA by polymerase chain reaction (PCR) in clinical samples is a promising approach for the rapid diagnosis of tuberculous infections. The aims of this study were to evaluate PCR for detection of Mycobacterium tuberculosis in pleural fluids and to correlate the results with adenosine deaminase activity (ADA) estimation and acid-fast bacilli (AFB) screening. METHODS: The sensitivity and specificity of PCR in detection of mycobacterial DNA in 20 samples of tuberculous pleural effusion were evaluated using 40 samples of nontubercular pleural effusion as controls. The results were correlated with the ADA in all 60 pleural fluids. In addition, AFB detection by Ziehl-Neelsen staining on cytospin smears of all pleural fluids was also compared. RESULTS: Of the 20 samples of tuberculous pleural effusion, mycobacterium could be detected by AFB staining in 4 samples. Fourteen samples were PCR positive. None of the samples from the control group were AFB or PCR positive. The sensitivity of PCR, therefore, was 70.0% with specificity of 100% (positive predictive value, 100%; negative predictive value, 86.95%). The sensitivity of AFB screening was at best 20%. The mean of ADA values in tubercular pleural effusions was 63.21 U/L (SD, 33.01), and the mean in the control samples was 51.1 U/L (SD, 29.71). Taking a cut-off value of 50 U/L, both the sensitivity and specificity of ADA estimation in diagnosing tuberculosis were only 55%. CONCLUSION: PCR represents a rapid and sensitive method for the detection of mycobacterial DNA in tuberculous pleural effusions. AFB screening has low sensitivity, and ADA estimation has both low sensitivity and specificity. Therefore, when the clinical suspicion is high and smear result is negative, but the signs and symptoms of M tuberculosis are apparent, PCR is the method of choice for identifying the infection.

Adenosine Deaminase↗
PubMed2001

Value of different cut-off points of tuberculin skin test to diagnose tuberculosis among patients with respiratory symptoms in a chest clinic.

OBJECTIVE: To assess the utility of various cut-off points of tuberculin skin test in making a diagnosis of tuberculosis in patients with respiratory symptoms. METHODS: Tuberculin skin test was conducted on consecutive new patients attending chest clinic for various respiratory symptoms. All subjects were then investigated to establish diagnosis, and categorized into tuberculous and nontuberculous groups. Receiver operating characteristic (ROC) curve was plotted to evaluate discrimination by tuberculin skin test. Sensitivity, specificity and predictive value were also calculated at various cut-off points. RESULTS: Of 250 patients, 59 (23.6%) had tuberculosis on clinical and microbiological criteria (other than the tuberculin test). Sensitivity and specificity of tuberculin test at readings greater than 5, 10 and 15 mm were 0.8136 and 0.7068, 0.6271 and 0.8901, and 0.2034 and 0.9738 respectively. Area under ROC curve for this test was 0.80. CONCLUSION: A cut-off point of 10 mm is likely to be useful in supporting a diagnosis of tuberculosis in patients with strong clinical suspicion of tuberculosis, in other patients, 15 mm cut-off may be more suitable.

Adolescent↗
PubMed2001

Management of respiratory failure in severe neuroparalytic snake envenomation.

Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50%) had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.

Adolescent↗
PubMed2001

Risk factors of lung cancer in Chandigarh, India.

BACKGROUND & OBJECTIVES: There is a paucity of data from India on the risk factors for lung cancer. In the present paper results of a case-control study on lung cancer undertaken at Chandigarh, north India, are described. METHODS: Two hundred and sixty five (235 men, 30 women) histologically confirmed patients of lung cancer and 525 (435 men, 90 women) hospital controls matched for age and sex were interviewed according to a pre-designed questionnaire. Effects of individual variables defining the various aspects of tobacco smoking, indoor and outdoor air pollution and occupational exposures were assessed using unconditional logistic regression models. RESULTS: Eighty nine per cent of men and 33 per cent of women among the patients were ever-smokers as compared to 60 per cent of men and 20 per cent of women among controls. The Odds Ratio (OR) for ever-smoking was 5.0 (CI 3.11-8.04) among men and 2.47 (CI 0.79-7.75) among women. Among the patients, men were found to smoke a higher average number of cigarette-equivalents per day, for longer duration and started at an earlier age as compared to controls. Smoking of bidi and hooka as well as cigarettes had similar ORs for cumulative consumption. ORs for female smokers were lower than those for male smokers. Cumulative exposure of > 45 yr in women to indoor air pollution from use of coal or wood for cooking or heating showed an OR of 1.43 (CI 0.33-6.30). Residence in urban areas did not entail an increased risk for developing lung cancer. Very few subjects studied were employed in high-risk occupations. INTERPRETATION & CONCLUSIONS: Smoking (cigarettes or bidis) was the principle risk factor for causation of lung cancer among men. In women there could be several other risk factors besides smoking, as the association with smoking was not as strong.

Adult↗
PubMed2000

Down-regulation of transforming growth factor beta receptors by androgen in ovarian cancer cells.

Steroid hormones have been implicated in the etiology and/or progression of epithelial ovarian cancer. As ovarian surface epithelial cells are growth inhibited by transforming growth factor beta (TGF-beta), we tested whether steroid hormones could regulate the expression of TGF-beta1 or its receptors in ovarian cancer cells, as assessed by quantitative reverse transcription-PCR. Treatment of ovarian cancer HEY cells with 500 nM 5alpha-dihydrotestosterone (DHT), but not estradiol-17beta or progesterone, for 60 h down-regulated the expression of mRNA for TGF-beta receptors I and II (TbetaR-I and TbetaR-II), betaglycan, and endoglin but had no effect on TGF-beta1 mRNA levels. Androgen receptor (AR) mRNA expression in HEY cells was compared to other ovarian cancer cell lines. OVCAR-3 cells expressed AR mRNA levels similar to that of androgen-responsive LNCaP prostate cancer cells, whereas SKOV-3 and HEY cells expressed only 3 and 0.01%, respectively. Western blot analysis and saturation binding assays confirmed the expression of AR protein in these three cell lines, but at the limit of detection in SKOV-3 and HEY cells. Treatment of SKOV-3 and HEY cells for 24 h with 1-50 nM DHT resulted in a dose-dependent down-regulation of TbetaR-II mRNA. The AR antagonist hydroxyflutamide did not reverse the effect of DHT on SKOV-3 cells but by itself down-regulated TbetaR-II mRNA. This apparent androgen-mimetic action of hydroxyflutamide and the ability of SKOV-3 and HEY cells to respond to DHT may be due to their expression of AR-associating protein 70, an AR co-activator reported to amplify AR transactivation and to result in agonist activity of AR antagonists. DHT was able to reverse TGF-beta1 growth-inhibitory action in SKOV-3 cells and in a primary culture of ovarian cancer cells derived from ascites. Thus, androgens may promote ovarian cancer progression in part by decreasing TGF-beta receptor levels, thereby allowing ovarian cancer cells to escape TGF-beta1 growth inhibition.

Dihydrotestosterone↗
PubMed2000

Impact of lead exposure on pituitary-thyroid axis in humans.

Thyroid function tests (serum levels of thyroxine-T4, triiodothyronine-T3 and thyroid stimulating hormone-TSH) were performed in fifty-eight men (mean age: 31.7 +/- 10.6 years; mean duration of lead exposure: 156.9 +/- 122.7 months). These subjects were exposed to lead either as petrol pump workers or automobile mechanics. The mean whole blood lead (Pb-B) levels were 2.49 +/- 0.45 micromole/l (51.90 +/- 9.40 microg/dl) in the lead exposed workers and were approximately 5 times higher than in the control (n = 35) subjects. No significant alteration was seen in their mean T3 and T4 levels as compared with the controls. Interestingly, T3 was significantly lower with the longer (210 months) exposure time in comparison with the group having shorter (29 months) exposure duration. The mean TSH levels were significantly (p < 0.01) higher in workers exposed in comparison with the control group. This rise in TSH was independent of exposure time, but it was definitely associated with the Pb-B levels. The increase being more pronounced with mean Pb-B levels of 2.66 +/- 0.2 micromole/l (55.4 +/- 4.25 microg/dl) when compared with the group having mean levels of 1.51 +/- 0.30 micromole/l (31.5 +/- 6.20 microg/dl). The rise is TSH associated with Pb-B levels was only statistical valid, however, the levels fall within the normal laboratory range. We thus conclude that the Pb-B levels of > or = 2.4 micromole/l (50 microg/dl) could enhance the pituitary release of TSH without having any significant alterations in the circulating levels of T3 and T4.

Adult↗
PubMed2000

Ultrasound-guided transthoracic co-axial biopsy of thoracic mass lesions.

PURPOSE: To compare the diagnostic yield of fine-needle aspiration biopsy (FNAB) and cutting needle biopsy in thoracic lesions. MATERIAL AND METHODS: Thirty patients with thoracic mass lesions were subjected to ultrasound-guided co-axial FNAB and cutting needle biopsy using 0.7 mm aspirating and 1.0-mm cutting needles, respectively. The diagnostic yield of the individual modalities was compared with the combined yield. RESULTS: A conclusive diagnosis was obtained in 76.6% (n=23) of patients by FNAB and in 66.6% (n=20) by cutting needle biopsy. The combined diagnostic yield of FNAB and cutting needle biopsy was 93.3% (n=28) with a significant statistical difference (p<0.03) as compared to cutting biopsy alone. Of the patients, 23.2% (n=7) had benign and 76.6% (n=23) malignant aetiologies. The diagnostic yield of FNAB versus cutting needle biopsy in benign lesions was 57.1% (n=4) and 100% (n=7), respectively. The diagnostic yield of FNAB versus cutting needle biopsy in malignant lesions was 82.6% (n=19) and 56.5%, (n=13). Two patients remained undiagnosed by either modality. There were no complications. CONCLUSION: FNAB and cutting needle biopsy are complementary to each other and attempts should be made to obtain small tissue cores in addition to routine cytologic specimens in diagnosing thoracic lesions, especially in benign pathologies. US provides a safe guidance modality for lesions abutting the chest wall.

Adolescent↗
PubMed2000

Radioisotope bone scanning in pulmonary alveolar microlithiasis.

A 30-year-old woman was examined for a history of exertional breathlessness, swelling of her feet, and a mild dry cough of 4 to 5 months' duration. Her symptoms developed during the last month of her pregnancy, with gradually increasing dyspnea, swelling of the feet, and reduced urinary output. There was no history of expectoration, hemoptysis, chest pain, or tuberculosis. General physical examination showed no evidence of clubbing of the nails or lymphadenopathy. Chest auscultation revealed a few end-inspiratory crepitations at both lung bases. Bronchial alveolar lavage showed calcium particles, whereas results of the transbronchial lung biopsy were consistent with alveolar microlithiasis.

Adult↗