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Biomedical subjects

S Rao

Publications and source records attributed to S Rao.

At least 19 recordsLinked to original sources
PubMed2006

Blood pressure among overweight adolescents from urban school children in Pune, India.

OBJECTIVES: To examine the magnitude of overweight and its association with blood pressure (BP) among adolescents. DESIGN: Cross-sectional study with all children in age range 9-16 years (n=1146 boys and 1077 girls) from two schools catering to urban affluent high socio-economic class (HSE), for anthropometric measurements by trained investigators and BP measurement by a pediatrician using sphygmomanometer. RESULTS: The prevalence of overweight based on conventional body mass index (BMI) cutoff was 27.5% for boys and 20.9% for girls but varied for different indicators. Prevalence of high systolic blood pressure (HSBP) was 12.0% in boys and 9.7% in girls and increased with increasing levels of BMI, weight, triceps skin fold thickness (TSFT) and percent body fat. Mean level of SBP among overweight children was significantly (P<0.001) higher by about 12 mm Hg, whereas that for diastolic blood pressure was higher by 8 mm Hg (P<0.001) as compared to their non-overweight (age, sex-matched) counterparts. This was true in both sexes and for all indicators used for assessing overweight. Prevalence of HSBP increased suddenly beyond BMI value of 20 kg/m2 in boys and 21.5 kg/m2 in girls, beyond TSFT value of 12 mm for boys and 14 mm for girls whereas such cutoffs for body fat were above 25% in both sexes. These cutoffs appear much lower than the conventional ones and therefore indicate the need for validation of conventional cutoffs in different populations. CONCLUSIONS: Our findings highlight that BP measurement needs to be a routine part of physical examination in school children, and the use of cutoffs anchored to metabolic risks may be essential for assessment of obesity.

Adolescent↗
PubMed2006

Bone mass in Indian children--relationships to maternal nutritional status and diet during pregnancy: the Pune Maternal Nutrition Study.

CONTEXT/OBJECTIVE: Bone mass is influenced by genetic and environmental factors. Recent studies have highlighted associations between maternal nutritional status during pregnancy and bone mass in the offspring. We hypothesized that maternal calcium intakes and circulating micronutrients during pregnancy are related to bone mass in Indian children. DESIGN/SETTING/PARTICIPANTS/MAIN OUTCOME MEASURES: Nutritional status was measured at 18 and 28 wk gestation in 797 pregnant rural Indian women. Measurements included anthropometry, dietary intakes (24-h recall and food frequency questionnaire), physical workload (questionnaire), and circulating micronutrients (red cell folate and plasma ferritin, vitamin B12, and vitamin C). Six years postnatally, total body and total spine bone mineral content and bone mineral density (BMD) were measured using dual-energy x-ray absorptiometry (DXA) in the children (n = 698 of 762 live births) and both parents. RESULTS: Both parents' DXA measurements were positively correlated with the equivalent measurements in the children (P < 0.001 for all). The strength of these correlations was similar for fathers and mothers. Children of mothers who had a higher frequency of intake of calcium-rich foods during pregnancy (milk, milk products, pulses, non-vegetarian foods, green leafy vegetables, fruit) had higher total and spine bone mineral content and BMD, and children of mothers with higher folate status at 28 wk gestation had higher total and spine BMD, independent of parental size and DXA measurements. CONCLUSIONS: Modifiable maternal nutritional factors may influence bone health in the offspring. Fathers play a role in determining their child's bone mass, possibly through genetic mechanisms or through shared environment.

Absorptiometry, Photon↗
PubMed2006

Long term survival in subacute sclerosing panencephalitis: an enigma.

BACKGROUND: Subacute sclerosing panencephalitis (SSPE) usually has a progressive stereotypic downhill course and results in premature death. Long-term stabilization or remission is exceptional. OBJECTIVE: To analyze the profile of patients with a relatively 'benign' course who survive beyond 3 years. DESIGN: Descriptive analysis of 19 (16 male, 3 females)/307 (6.2%) patients with benign course who were evaluated at NIMHANS between January 1995 and December 2004. Their diagnosis was based on characteristic myoclonic jerks, elevated antibody titers against measles virus in CSF and periodic complexes in EEG. RESULTS: The mean age at onset of symptoms was 11.7+/-3.9 years and mean duration of follow-up from first symptom was 5.9+/-3.1 years (3-13.8 years). Their initial symptoms were seizures (7), myoclonus (6), visual disturbances (4), behavioral changes (1) and cognitive impairment (1). These patients had varied clinical course: stabilization in different stages for 6 months to 5 years (13), remissions for 6 months to 9 years and reversal of staging with functional recovery from being bed bound to ambulant (8). Their diagnosis was often delayed. Small sample size did not permit to analyze the influence of possible disease modifying agents used in 10 patients (isoprenosine-3, amantidine-4, oral steroids-4, methylprednisolone-1, intravenous immunoglobulin-1). CONCLUSIONS: Our observations suggest that SSPE may have a highly variable clinical course and warrants cautious approach for counseling at initial evaluation and while interpreting beneficial effect of disease modifying agent(s). There is a need to explore prognostic marker(s).

Adolescent↗
PubMed2006

Myasthenia gravis in children: a longitudinal study.

BACKGROUND: Juvenile myasthenia gravis (JMG) is an uncommon disease. Unlike adults, clinical characteristics and outcomes of myasthenia gravis (MG) are not well studied in children. PATIENTS AND METHODS: Case records of 77 patients with MG who were 15 years of age or less at disease onset, evaluated over a period of 34 years at the National Institute of Mental Health and Neurosciences, Bangalore, India, were reviewed. Their clinical characteristics and response to therapy was compared with 290 patients with MG onset after 15 years of age. RESULTS: Median age at onset was 8 years and mean period of follow-up was 6.2 years (range 6 months to 25 years). At presentation, 30% of patients had ocular myasthenia and the rest had generalized disease. Twenty-one patients (27%) had disease confined to ocular muscles throughout the course and three had limb girdle myasthenia. Familial myasthenia was more common than adult onset disease, 10 patients had positive family history. Unlike adults, none of the patients had associated autoimmune disease. Fifty-two patients (67%) received corticosteroids, and azathioprine was added in five patients. Thymectomy was performed in 11 patients, six below the age of 15 years. Thymic histology was normal in one and showed hyperplasia in eight and thymoma in one. Four patients had crisis. At the end of follow-up, 25 patients were asymptomatic, 28 had partial improvement, and nine remained unchanged or worsened and two died. Ten patients achieved complete stable remission. CONCLUSIONS: This study shows some distinctive characteristics of JMG, such as higher frequency of ocular myasthenia, benign course, better long-term outcome and lack of association of thymoma and other autoimmune disorders.

Adolescent↗
PubMed2006

New insights into pulmonary inflammation in cystic fibrosis.

Persistent lower airway infection with inflammation is the major cause of morbidity and mortality in cystic fibrosis. This review examines the recent advances in the understanding of airway inflammation in cystic fibrosis, and focuses on the evidence that pulmonary inflammation is, under some circumstances, disassociated from infection, and the potential implications for therapeutic intervention.

Child↗
PubMed2006

Head injuries in warfarinised patients.

INTRODUCTION: The objective of this study was to study the clinical course and outcome of warfarinised patients who were hospitalised because of head trauma. METHODS: 13 patients (ten males and three females; median age 69 years) who presented to the Royal Perth Hospital, Australia and who had suffered a head injury between July 1994 and June 2000 while concurrently taking warfarin, were studied. RESULTS: Confusion was the commonest presenting symptom (four patients). Five patients presented after more than 24 hours of the injury. Eight patients were anticoagulated for thromboembolic disease and five for atrial fibrillation. The patients had a median injury severity score of 25 (range 1-43). The median international normalised ratio was 2.4 (range 1.8-10) on admission and 1.8 (range 1.0-10) on discharge. 11 of the 13 patients had computed tomography of the head. Intracerebral bleeding was the commonest injury (nine patients). The median length of hospital stay was six days (range 3-30). Five patients died (38.5%). CONCLUSION: Warfarinised patients who sustain minor head trauma should be hospitalised for close neurological observation and should have a low threshold for performing computed tomography.

Accidental Falls↗
PubMed2005

Capecitabine and mitomycin C as third-line therapy for patients with metastatic colorectal cancer resistant to fluorouracil and irinotecan.

Protracted venous infusion 5-fluorouracil (5FU) combined with mitomycin C (MMC) has demonstrated significant activity against metastatic colorectal cancer. Owing to potential synergy based upon upregulation of thymidine phosphorylase by MMC, the combination of capecitabine and MMC may improve outcomes in irinotecan-refractory disease. Eligible patients with progressive disease during or within 6 months of second-line chemotherapy were treated with capecitabine (1250 mg m(-2) twice daily) days 1-14 every 3 weeks and MMC (7 mg m(-2) IV bolus) once every 6 weeks. A total of 36 patients were recruited, with a median age of 64 years (range 40-77), and 23 patients (78%) were performance status 0-1. The objective response rate was 15.2%. In all, 48.5% of patients had stable disease. Median failure-free survival was 5.4 months (95% CI 4.6-6.2). Median overall survival was 9.3 months (95% CI: 6.9-11.7). Grade 3 toxicities were palmar-plantar erythema 16.7%, vomiting 8.3%, diarrhoea 2.8%, anaemia 8.3%, and neutropenia 2.8%. No patients developed haemolytic uraemic syndrome. Symptomatic improvement occurred for pain, bowel symptoms, and dyspnoea. Capecitabine in combination with MMC is an effective regimen for metastatic colorectal cancer resistant to 5FU and irinotecan with an acceptable toxicity profile and a convenient administration schedule.

Adult↗
PubMed2005

Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF.

The purpose of the study was to establish the optimal dose of capecitabine (X) to be used within a multicentre, randomised study evaluating the potential roles of oxaliplatin (O) and X in chemonaive patients (pts) with advanced oesophagogastric cancer. Two by two design was used, and pts were randomised to one of four regimens and stratified for extent of disease, performance status (PS) and centre. The treatment regimens are epirubicin, cisplatin, 5-fluorouracil (ECF), EOF, ECX or EOX. Doses: E 50 mg m(-2), C 60 mg m(-2) and O 130 mg m(-2) i.v. 3 weekly; F 200 mg m(-2) day(-1) i.v. and X 500 mg m(-2) b.i.d.(-1) (escalated to 625 mg m(-2) b.i.d.(-1) after results of first interim analysis) p.o., continuously. First interim analysis was performed when 80 pts had been randomised. Dose-limiting fluoropyrimidine toxicities were stomatitis, palmar plantar erythema (PPE) and diarrhoea; 5.1% of X-treated pts experienced grade 3/4 toxicity. Protocol planned dose escalation of X to 625 mg m(-2) b.i.d.(-1) was instituted and a second interim analysis has been performed; results are presented in this paper. A total of 204 pts were randomised at the time of the protocol planned 2nd interim analysis. Grade 3/4 fluoropyrimidine-related toxicity was seen in 13.7% pts receiving F, 8.4% pts receiving X 500 mg m(-2) b.i.d.(-1) and 14.7% pts receiving X 625 mg m(-2) b.i.d.(-1). Combined complete and partial response rates were ECF 31% (95% CI 18.7-46.3), EOF 39% (95% CI 25.9-53.1), ECX 35% (95% CI 21.4-50.3), EOX 48% (95% CI 33.3-62.8). Grade 3/4 fluoropyrimidine toxicity affected 14.7% of pts treated with X 625 mg m(-2) b.i.d.(-1), which is similar to that observed with F, confirming this to be the optimal dose. The replacement of C by O and F by X does not appear to impair efficacy. The trial continues to total accrual of 1000 pts.

Administration, Oral↗
PubMed2005

Erythromycin as a prokinetic agent in preterm neonates: a systematic review.

BACKGROUND: It often takes several days or even weeks to establish full enteral feeds (FEFs) in preterm, especially extremely low birthweight neonates because of feed intolerance related to gastrointestinal hypomotility. Clinical trials of erythromycin as a prokinetic agent in preterm neonates have reported conflicting results. AIM: To systematically review the efficacy and safety of erythromycin as a prokinetic agent in preterm neonates. METHODS: Only randomised controlled trials in preterm neonates (gestation < or = 37 weeks) were considered eligible for inclusion. The primary outcome was the time to reach FEFs of 150 ml/kg/day. The secondary outcomes included the incidence of erythromycin related adverse effects such as diarrhoea, cardiac arrhythmias, and hypertrophic pyloric stenosis. No restrictions were applied on the dose (low: 3-12 mg/kg/day; antimicrobial: > or = 12 mg/kg/6-8 hours) and route (oral or intravenous) and mode (prophylactic or rescue) of administration. The standard methodology for systematic reviews was followed. A subgroup analysis was pre-planned based on the dose and mode of drug administration. RESULTS: Seven trials (three prophylaxis, four rescue) with various doses, routes and modes of administration, and durations of erythromycin treatment and different results were found to be eligible for inclusion in the analysis. Meta-analysis could not be performed, as specific data were either inadequate or not available. CONCLUSION: The conflicting trial results may be explained by differences in dose and route and mode of administration of erythromycin and in gastrointestinal motor responses in the presence of different feeding conditions-for example, fasting v fed state, intermittent v continuous feeds. Gestational and postnatal ages during erythromycin treatment are also important.

Erythromycin↗
PubMed2005

Phase III study of 5FU, etoposide and leucovorin (FELV) compared to epirubicin, cisplatin and 5FU (ECF) in previously untreated patients with advanced biliary cancer.

The purpose of this study was to determine whether epirubicin, cisplatin and infused 5FU (ECF) improves overall survival (OS) compared to 5FU, etoposide and leucovorin (FELV) in patients with previously untreated advanced biliary cancer in a prospective randomised study. Patients were randomly assigned to receive epirubicin, cisplatin and infused 5FU ECF or bolus 5FU etoposide and leucovorin (FELV). The primary end point was OS with secondary end points of objective response rate (ORR), failure-free survival (FFS), quality of life (QOL) and toxicity. In all, 54 patients were recruited with 27 randomly assigned to each arm. The median OS for ECF was 9.02 months (95% confidence interval (CI): 6.46-11.51) and FELV 12.03 months (95% CI: 9.3-14.7), P=0.2059. Objective response rates were similar for both arms: ECF 19.2% (95% CI: 6.55-39.3); FELV 15% (95% CI: 3.2-37.9), P=0.72. There was significantly increased grade 3/4 neutropenia with FELV vs ECF (53.8 vs 29.5%, respectively, P=0.020). Symptom resolution was impressive for both regimens. This is the largest reported randomised study to date in this setting. ECF did not improve OS compared to FELV, but was associated with less acute toxicity. These data suggest that chemotherapy can prolong OS and achieve good symptomatic relief in advanced biliary cancer.

Adult↗
PubMed2005

Large babies and unplanned Caesarean delivery.

OBJECTIVE: The relationship between birth weight > or =4000 g and unplanned Caesarean delivery was examined. DESIGN: A retrospective cohort study. SETTING: A district general hospital. POPULATION: Two thousand three hundred and ninety-three women who delivered babies weighing > or =2500 g. METHODS: The mode of delivery of babies who weighed > or =4000 g was compared with those who weighed between 2500 and 4000 g. Comparative analysis of data was followed by regression analysis of explanatory variables. The effect of increasing birth weight on unplanned Caesarean delivery was determined. RESULTS: Women who had an unplanned Caesarean were delivered at an earlier gestation (OR = 0.89, 95% CI 0.81-0.97; P = 0.007), and were more likely to be primiparous (OR 5.4, 95% CI 4.1-7.1; P = 0.0001). Further, women who had an unplanned Caesarean were more likely to have babies weighing > or =4000 g (OR = 2.24, 95% CI 1.61-3.12; P = 0.003). The odds of having an unplanned Caesarean were increased 16.9-fold with a previous Caesarean (95% CI 9.24-30.8; P = 0.001). When a previous Caesarean was combined with a baby weighing > or =4000 g, the odds of having an unplanned Caesarean increased 37.8 times (95% CI 18.8-75.8), compared to a woman who previously had a normal vaginal birth and a baby weighing between 2500 and 4000 g. CONCLUSION: Birth weight > or =4000 g is associated with more than a two-fold increased risk of an unplanned Caesarean delivery. The risk increased further (37.8 x) when a previous Caesarean delivery was combined with a birth weight > or =4000 g.

Adult↗
PubMed2005

Nontraumatic spinal cord lesions: a prospective study of medical complications during in-patient rehabilitation.

STUDY DESIGN: Prospective study between 1st Jan 1995 and 31st Dec 1999. OBJECTIVE: To document medical complications among subjects with Nontraumatic Spinal Cord Lesions (NTSCL) during in-patient rehabilitation. SETTING: Bangalore, India. METHODS: Persons with NTSCL admitted for in-patient rehabilitation were included in the study. Clinical evaluation was carried out according to The International Standards for Neurological and Functional classification of Spinal Cord Injury. Disability was quantified using Barthel index. All medical complications were documented. RESULTS: A total of 297 subjects (154 men and 143 women) with NTSCL were included. The number of medical complications in each patient varied from 0 to 17 (mean=6.1+/-3.7). Common complications seen were urinary tract infections (184), spasticity (169), pain (149), urinary incontinence (147), depression (114), respiratory tract infections (101), constipation (92), pressure ulcers (89), contractures (52) and sleep disturbance (43). The number of medical complications correlated positively with duration of stay (Pearson's correlation coefficient r=0.5, P<0.01) and negatively with Barthel Index at admission (r=-0.2, P<0.05) and at discharge (r=-0.2, P<0.05). Complications were more frequent among people with tetraplegia than those with paraplegia (P<0.001). CONCLUSIONS: Medical complications are frequent among subjects undergoing rehabilitation for NTSCL. Patients with severe disability at admission have more complications during rehabilitation. Conversely, individuals with more complications have greater disability at discharge.

Adolescent↗
PubMed2005

Clinical, colonoscopic, and histological profile of colonic tuberculosis in a tertiary hospital.

BACKGROUND AND STUDY AIMS: Colonic tuberculosis is not uncommon in developing countries. As emigration to the West increases, it is worthwhile to recall the clinical, colonoscopic, and histopathological features of this condition. PATIENTS AND METHODS: The clinical, colonoscopic and histopathological findings were evaluated in 43 patients with colonic tuberculosis. RESULTS: Abdominal pain, weight loss, diarrhea, fever, and a lump in the abdomen were the commonest symptoms. Extraintestinal tuberculosis was present in 11 patients (26 %). Colonoscopy revealed ulcers in 30 patients (70 %), nodules in 24 (56 %), a deformed cecum and ileocecal valve in 17 (40 %), strictures in 10 (23 %), polypoid lesions in six (14 %), and fibrous bands forming mucosal bridges in three (7 %). The cecum and ascending colon were the commonest sites involved. Segmental tuberculosis was seen in six of the 32 patients (19 %) in whom full-length colonoscopy could be performed. Two or more sites were involved in 19 patients (44 %). Histopathology revealed well-formed granulomas in 23 patients (54 %). Fourteen of the above patients (61 %) had caseation and 11 (48 %) had confluence of the granulomas. Acid-fast bacilli were present in the biopsies from two patients (5 %). Ill-formed granulomas were seen in seven patients (16 %) and chronic inflammatory changes in 13 (30 %). Despite the various histopathological findings, all of the patients responded to antitubercular treatment and continued to remain asymptomatic during the follow-up period. CONCLUSIONS: Colonoscopy with biopsy is a useful method for diagnosing colonic tuberculosis. Even in the absence of the classic histopathological features, a therapeutic trial may be indicated in a given clinical and colonoscopic setting. Follow-up is essential.

Abdominal Pain↗
PubMed2005

Menin molecular interactions: insights into normal functions and tumorigenesis.

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disease predisposed by heterozygous germline mutations in the MEN1 tumor suppressor gene. Biallelic loss of MEN1 resulting from small mutation and/or loss of heterozygosity occurs in a large tissue spectrum of MEN1 tumors or non-hereditary tumors. Mouse models of MEN1 underexpression or overexpression have also supported the tumor-suppressor effect of the MEN1 gene. Menin, the 610-amino-acid protein encoded by MEN1, is expressed ubiquitously and found predominantly in the nucleus. Sequence analyses do not reveal motifs of known function other than two nuclear localization sequences. Menin has been found to partner in vitro with a variety of proteins that comprise transcription factors, DNA processing factors, DNA repair proteins, and cytoskeletal proteins. The diverse functions of menin interactors suggest roles for menin in multiple biological pathways. Inactivation of menin switches its JunD partner from a downstream action of growth suppression to growth promotion. This is a plausible mechanism for menin tumorigenesis.

Animals↗
PubMed2005

Rapid assessment of maternal activity among rural Indian mothers (Pune Maternal Nutrition Study).

OBJECTIVE: To develop an activity questionnaire for objective and rapid assessment of maternal habitual physical activity with the aim of describing its relationship with birth size. DESIGN: Prospective observational study. SETTING: Six villages near Pune, Maharashtra, India. SUBJECTS: Seven hundred and ninety-seven rural Indian mothers were studied after excluding abortions and termination of pregnancies, foetal anomalies, etc. METHOD: Principal components analysis (PCA) was used to identify a few leading questions from an elaborate questionnaire involving 36 questions related to 14 typical maternal activities. RESULTS: On the basis of high loading (>0.8), PCA identified three activities, i.e. farming, fetching water and washing clothes. Questions and sub-questions related to these activities only were considered for defining an activity score for rapid assessment. Validation of this new activity score, with the score based on the elaborate questionnaire, showed 70% sensitivity as well as specificity. New activity scores showed strong inverse relationships similar to those observed using the elaborate questionnaire, at early as well as late gestation, with neonatal head circumference (P=0.001 and 0.055) and mid-arm circumference (P=0.02 and 0.03). CONCLUSIONS: Simple questionnaires, based on leading activities identified by PCA, can be as informative as longer and detailed questionnaires. This method has potential for adaptation, especially in rural communities in developing countries.

Adult↗