Search PubMed⌕ Search

Biomedical subjects

S Kaushik

Publications and source records attributed to S Kaushik.

At least 55 records · Page 3Linked to original sources
PubMed2001

Prevention of postoperative infections in ophthalmic surgery.

Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.

Administration, Topical↗
PubMed2000

Molecular cloning, tissue distribution and sequence analysis of complete glucokinase cDNAs from gilthead seabream (Sparus aurata), rainbow trout (Oncorhynchus mykiss) and common carp (Cyprinus carpio).

The enzyme glucokinase (GK) (EC 2.7.1.1) plays an important role in the control of glucose homeostasis. Qualitative and/or quantitative variations in GK enzyme have been postulated by previous studies to explain why dietary carbohydrate utilisation is lower in gilthead seabream (Sparus aurata) and rainbow trout (Oncorhynchus mykiss) than in common carp (Cyprinus carpio). In this study, we report the isolation and characterisation of a full-length cDNA coding for GK in these teleosts. Amino acid sequences derived from these cDNA clones are highly similar to other vertebrate GKs. These findings, including a detailed phylogenetic analysis, reveal that GK gene highly homologous to mammalian GK exists in these fish species with similar tissue specific expression (mainly liver).

Amino Acid Sequence↗
PubMed2000

Peripheral bypass surgery and amputation: northern Illinois demographics, 1993 to 1997.

HYPOTHESIS: This study tests whether age, sex, income, and racial differences predict rates of aortoiliac and femorodistal bypass surgery and above- and below-knee amputation for residents of northern Illinois from 1993 to 1997. DESIGN: A hospital discharge survey study describing standardized procedure rates and the odds of undergoing amputation vs bypass procedures for specified sociodemographic populations. Multiple logistic regression was used to compare the odds of undergoing major amputation vs bypass surgery controlling for the prevalence of diabetes, gangrene, high-risk comorbid conditions, and treatment at major area teaching hospitals. RESULTS: Between 1993 and 1997, 19,250 study procedures were performed during 18,603 admissions at 105 Illinois hospitals. The mean annual major amputation rate per 100,000 was 20.77; femorodistal and aortoiliac bypass rates were 24.26 and 4.70, respectively. Significantly higher odds (between 1.14 and 1.36) of undergoing amputation were found for low-income areas and ZIP codes with large and medium African American populations. Severe comorbidity, diabetes, and especially gangrene (odds ratio, 12.9) predicted amputation, while treatment at a major teaching hospital and male sex predicted a higher odds of undergoing bypass procedures. CONCLUSIONS: Results are consistent with unmeasured racial and income differences in the severity of atherosclerosis (or related risk factors such as smoking, diet, and exercise), barriers to timely primary care, or selective referral of lower-income and African American patients to hospitals with less vascular surgery capacity. These findings imply a particular need to identify and review the quality of care for patients undergoing primary lower-extremity amputations.

Adult↗
PubMed2000

Effect of dietary lipid content on circadian rhythm of feeding activity in European sea bass.

In fish, dietary digestible energy (DE) content is a major factor controlling feed intake. It was therefore of interest to determine how circadian rhythm of feeding activity is influenced by the dietary DE levels. To that end, groups of European sea bass were fed on demand by means of self feeders, under light-dark and constant light conditions, with a fixed or an unlimited amount of feed with variable lipid contents. Daily total feed intake, but not the feeding rhythm, was adjusted in relation to the DE content of the diet regardless of the lighting conditions. We conclude that a satiation mechanism was likely responsible for the regulation of feed intake in relation to the dietary fat content but was not acting in itself on the mechanisms that drive the free-running rhythms of feeding activity. These results are giving additional evidence that a true endogenous clock is driving feeding activity rhythms in fish.

Animals↗
PubMed2000

Lack of significant long-term effect of dietary carbohydrates on hepatic glucose-6-phosphatase expression in rainbow trout (Oncorhynchus mykiss).

Hepatic glucose-6-phosphatase (G6Pase) plays an important role in glucose metabolism because it catalyzes the release of glucose to the circulatory system in the processes of glycogenolysis and gluconeogenesis. The present study was initiated to analyze the regulation of hepatic G6Pase expression by dietary carbohydrates in rainbow trout. The first step in our study was the identification of a partial G6Pase cDNA in rainbow trout that was highly homologous to that of mammals. Hepatic G6Pase activities and mRNA levels were measured in trout fed one of the experimental diets, with or without carbohydrates. We found no significant effect of intake of dietary carbohydrates on G6Pase expression (mRNA and activity) 6 hours and 24 hours after feeding. These results suggest that there is no control of G6Pase synthesis by dietary carbohydrates in rainbow trout and that the lack of regulation of gluconeogenesis by dietary carbohydrates could at least partially explain the postprandial hyperglycemia and the low dietary glucose utilization observed in this species.

Journal Article↗
PubMed2000

Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit.

OBJECTIVE: To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU). DESIGN: Prospective, double-blind, randomly allocated cross-over study days. SETTING: ICU in a tertiary care university hospital. PARTICIPANTS: Twelve consecutive, conscious adult (22-54 yrs) patients with GBS during recovery from the muscular weakness and receiving pressure-support ventilation in the ICU. All patients complained of severe backache and/or leg cramps and tenderness in muscles, and they required opioids for pain relief. INTERVENTIONS: CBZ (100 mg every 8 hrs) or equivalent placebo was given to nursing staff in coded powder form. Medication was given to patients through a nasogastric feeding tube. The same coded medicine was given for 3 days, and after a 1-day omission, a second set of coded powder was given for the next 3 days in a randomized, double-blind, crossover fashion. Pethidine (1 mg x kg(-1)) was given intravenously in between, if the pain score was >2. Group 1 (n = 6) patients were given a placebo on the first 3 days, followed by CBZ. Group 2 (n = 6) patients were given CBZ on the first 3 days, followed by a placebo. MEASUREMENTS AND MAIN RESULTS: In these two study periods of different medications, we observed and scored pain (1, no pain; 5, severe pain), sedation (1, alert; 6, asleep, does not respond to verbal command), and total pethidine requirement per day. In group 1 patients, a significant (p < .001) improvement in the sedation score and a low requirement for pethidine was observed 3 days later, when CBZ was started. However, in group 2 patients, a gradual increase in the pethidine requirement and a high sedation score were noteworthy in the later days of placebo medication. Observations were also analyzed for CBZ days vs. placebo days. Overall, the pain score (1.7 +/- 0.8) during the CBZ period of both regimens was significantly (p < .001) lower than during the placebo days (3.1 +/- 0.9). Significantly higher doses of pethidine (3.7 +/- 0.9 mg/kg/day) were used on the placebo days than on the CBZ days (1.7 +/- 1.0 mg/kg/day). CONCLUSION: The pain in GBS has a dual origin, and we recommend CBZ as an adjuvant to treat pain in GBS patients, during the recovery phase in the ICU, to reduce the narcotic requirement.

Adult↗
PubMed2000

Hepatic glucokinase is induced by dietary carbohydrates in rainbow trout, gilthead seabream, and common carp.

Glucokinase (GK) plays a central role in glucose homeostasis in mammals. The absence of an inducible GK has been suggested to explain the poor utilization of dietary carbohydrates in rainbow trout. In this context, we analyzed GK expression in three fish species (rainbow trout, gilthead seabream, and common carp) known to differ in regard to their dietary carbohydrate tolerance. Fish were fed for 10 wk with either a diet containing a high level of digestible starch (>20%) or a diet totally deprived of starch. Our data demonstrate an induction of GK gene expression and GK activity by dietary carbohydrates in all three species. These studies strongly suggest that low dietary carbohydrate utilization in rainbow trout is not due to the absence of inducible hepatic GK as previously suggested. Interestingly, we also observed a significantly lower GK expression in common carp (a glucose-tolerant fish) than in rainbow trout and gilthead seabream, which are generally considered as glucose intolerant. These data suggest that other biochemical mechanisms are implicated in the inability of rainbow trout and gilthead seabream to control blood glucose closely.

Animals↗
PubMed1999

Radial artery harvest technique, use and functional outcome.

OBJECTIVE: To develop a simple harvest technique for radial artery (RA). To investigate the morbidity and functional outcome of RA harvest. METHODS: The neurovascular fascia surrounding the RA is divided. Only loose areolar tissue surrounds this artery making harvest of RA simple and allowing minimal trauma to the RA and surrounding muscles. Topical and intraluminal vasodilators but no systemic vasodilators are used. RESULTS: RA harvest commenced in December 1994. Between 1996 and 30 June 1998, 2167 RA were harvested and used to construct 3105 coronary anastomoses. A dramatic rise in RA use occurred during 1996. More than 80% of patients undergoing coronary artery bypass surgery (CABG) have RA harvested since this time. Total arterial revascularization rate also rose dramatically and is currently 80% of all CABG. This rate has been assisted by a rapid rise in the use of composite arterial grafting where aortic anastomoses can be avoided and currently represents 40% of all CABG. Hand strength was tested in 328 non-selected patients and was not reduced by RA harvest when hand dominance was taken into account. Objective sensation loss was present in 0.3% for the superficial radial nerve and 2.1% for the lateral cutaneous nerve of forearm. Pulse oximetry observations detected statistically significant but clinically irrelevant differences. Scar hypersensitivity occurred in 20%. Only two patients of all patients undergoing RA harvest reported late hand ischaemia. CONCLUSIONS: Harvest of the RA within the neurovascular plane is simple and associated with low morbidity.

Aged↗
PubMed1999

Internal jugular vein cannulation in neurosurgical patients: a new approach.

A new approach to internal jugular vein (IJV) cannulation with the head and neck placed in the neutral position is described. The junction of the medial two thirds and lateral one third between the angle of the mandible and symphysis menti is identified. A vertical line is drawn from this point to join another line drawn between the mastoid process and the medial end of the clavicle. The junction is the puncture point. In 120 patients studied, the failure rate was 1.66%, and there were no complications. We propose this technique as a safe and reliable alternative in neurosurgical patients.

Adolescent↗
PubMed1999

Physiological deadspace during normocapnic ventilation under anaesthesia.

Respiratory physiological deadspace (VDphys) during normocapnic ventilation under anaesthesia was studied in 253 patients scheduled for elective non-thoracic surgery. Subjects were ventilated with SERVO 900B ventilator using CO2 analyser 930 (Siemens-Elema Sweden) to adjust minute volume sufficient to maintain end-tidal carbon dioxide fraction (FECO2) around 5.5kPa with normocapnic confirmation using arterial blood gas analysis. VDphys was calculated using Enghoff's modification of Bohr's equation. VDphys and deadspace to tidal volume ratios (VD/VT) in male patients were 142.6 +/- 28.4 ml and 0.37 +/- 0.068 respectively and were significantly higher than that in females (119.4 +/- 35.6 ml and 0.36 +/- 0.067). Males had significantly higher VDphys/mass (2.5 +/- 0.68 ml.kg) compared with females (2.2 +/- 0.54 ml/kg, P < 0.001) but significantly lower body mass index (BMI) (20.67 +/- 3.2 in males and 22.47 +/- 4.1 in females, P < 0.001). VDphys showed positive correlation with weight, height and body surface area (BSA) but VDphys/kg showed negative correlation with BMI. Multiple regression analysis produced a best fit equation for VDphys = 9.7 + 64.3 x BSA + 13.51S where S = 1 for females and 2 for males.

Adolescent↗
PubMed1998

Influence of coping style and precolonoscopy information on pain and anxiety of colonoscopy.

BACKGROUND: This study assessed the relationship between patient coping style, precolonoscopy information, and anxiety and pain associated with colonoscopy. METHODS: Eighty consecutive adult patients undergoing initial colonoscopy were classified into two groups on the basis of coping style: information seekers or information avoiders. All were given standardized information about colonoscopy. Half of each group was randomly assigned to receive additional sensory information describing what they could expect to feel. Self-report, physiologic, and behavioral indices of anxiety and pain were measured. RESULTS: Patients given information congruent with coping style experienced significantly less self-report anxiety immediately after the information intervention and spent less time in recovery. In contrast, patients given information not congruent with coping style maintained their pre-intervention anxiety level. Patients given information congruent with coping style scored lower on behavioral indices of pain, but there were no differences with respect to patient perception of pain or the dosage of sedative drugs. Most patients reported that the bowel preparation was the most distressing part of the colonoscopy. CONCLUSIONS: Assessment of coping style and provision of congruent information reduces anxiety, recovery time, and observed behavioral indices of pain of colonoscopy but has no effect on sedation dose or patient perception of pain.

Adaptation, Psychological↗
PubMed1998

Percutaneous dilational tracheostomy: the Ciaglia method versus the Portex [correction of Rapitrach] method.

UNLABELLED: In a prospective study, we performed percutaneous dilational tracheostomy (PDT) using either the Ciaglia method (gradual dilation) or the Portex [corrected] method (single dilation) in 80 patients. We encountered difficulty in dilating the tracheal stoma of three (7.5%) patients in the Ciaglia group because of tight pretracheal fascia. It was difficult to insert the tracheostomy tube in four (10%) patients in the Portex [corrected] group even after appropriate tracheal dilation. However, the tracheal cannulation was successfully completed in all patients in subsequent attempts. The mean time for completion of the procedures, from skin incision to insertion of the tracheostomy tube, was 14+/-5.5 min with the Ciaglia method and 6.5+/-3.5 min with the Portex [corrected] method. PDT with either method has not been associated with clinically significant hemorrhage, infection at the stoma site, or cosmetic deformity. In a follow-up period of 9 mo, none of our decannulated patients presented with clinical tracheal stenosis. Our results indicate that PDT with both methods is as safe and easy to organize and perform as a bedside procedure, obviating the need to transport critically ill patients from the critical care unit. IMPLICATIONS: The tracheas of 80 patients were cannulated through an artificial opening using either the Ciaglia (gradual dilation) or the Portex [corrected] (single dilation) method. Both techniques were successful with no significant complications. After 9 mo of closure of this opening, none of the survivors had significant scarring or narrowing of the trachea.

Adolescent↗
PubMed1998

Effects of spinal anaesthesia on metabolic processes.

A study conducted at P.G.I., Chandigarh to find out the effect of spinal anaesthesia on arterial blood gases, blood glucose, and pyruvate-lactate during spinal anaesthesia. All patients received night sedation of oral diazepam in dose of 0.2 mg/kg body weight. No narcotic/antisialogogue premedication was given to any patient. All patients received spinal anaesthesia with 5% lignocaine (hyperbaric), in lateral position. All patients received normal saline intravenously as a maintenance fluid. Blood samples for the measurement of blood pyruvate, lactate levels and arterial blood gas analysis were collected preoperatively, 10 minutes after the administration of spinal anaesthesia after fixation of drug, and half hour after the end of operative procedure. Even though there was continued rise in blood sugar levels intraoperatively, which persisted in postoperative period, the values were within normal clinical range. Blood lactate levels and blood pyruvate levels remained unchanged. Hypocapnoea observed intra-operatively in our report is attributed to hyperventilation. There was 12.44% fall in bicarbonate level. (P > .001) which even though statistically significant did not alter the pH. We conclude that spinal anaesthesia up to T8 level does not affect the metabolic processes.

Acid-Base Equilibrium↗
PubMed1997

Accidental subdural injection of local anaesthetic: diagnosis by pressure measurement and response to aspiration of injectate.

A healthy 22-year-old man received an initial injection of 12 mL of lignocaine/bupivacaine solutions (2 mL test, then 10 mL) into an epidural catheter. This produced a satisfactory regional blockade that seemed to be epidural but, when a supplementary 6 mL injection was given 1 h later, the patient developed impaired motor function as far as the upper cranial nerves, with loss of pinprick sensation to the shoulder. The emergence of fluid dribbling freely from the catheter prompted measurement of the pressure, which was 36 mmHg. The fluid was proved not to be cerebrospinal fluid (CSF) by the absence of glucose (on dextrostix), by the appearance of turbidity with added thiopentone, and later by microscopy. Slow aspiration of 7 mL of the presumed injectate reduced the pressure in the catheter to 8 mmHg, which promptly reversed the additional excessive blockade, allowing surgery to proceed uneventfully. The retrieval of injectate argues strongly that the catheter tip had found its way subdurally, and the promptness of the reversal with aspiration argues for a mechanical rather than a pharmacological cause for the extensive neurological dysfunction after the second injection. Pressure measurement and aspiration may be helpful in other similar cases.

Adult↗