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Biomedical subjects

S T Chandy

Publications and source records attributed to S T Chandy.

9 recordsLinked to original sources
PubMed1998

Rheumatic fever chemoprophylaxis in adults.

In 2340 adult patients above the age of 26 years with rheumatic valvular disease (RHD) seen since 1987, injection benzathine penicillin (once in 3 weeks) was discontinued and the patients were followed for evidence of rheumatic fever for a period of one to nine years (mean of 3 years). Recurrence of rheumatic fever was seen in 5 patients (0.21%). This study confirms that recurrence of rheumatic fever in patients with RHD above 26 years of age is very low and hence we recommend long term chemoprophylaxis to the patients above the age of 26 on an individual basis.

Adolescent↗
PubMed1997

Mechanisms of cardiac perforation leading to tamponade in balloon mitral valvuloplasty.

Mechanisms of cardiac perforation in 10 cases of cardiac tamponade encountered in a single-center series of 903 balloon mitral valvuloplasty procedures were elucidated by precise localization of the site of perforation at subsequent surgery. These mechanisms were perforation of the aortic root and adjacent right atrium by sliding up of the transseptal set (2), apical tears by straight-tip balloon catheters driven distally during mitral valve dilatation (3), apical perforations by guidewires introduced through catheters wedged in the apex (2), tear of the posterior right atrial wall by dilatation of the track produced by very low septal punctures (2), and right ventricular perforation by a pacing catheter (1). Multivariate analysis showed cardiac perforation to be significantly related to the total experience at the center (inversely) and to patient age (directly). Left ventricular perforation occurred exclusively in patients > 40 yr of age. Understanding these mechanisms has enabled formulation of effective strategies to prevent cardiac perforation.

Adolescent↗
PubMed1997

Transjugular approach to transseptal balloon mitral valvuloplasty.

The feasibility of a transjugular approach to septal puncture and Inoue-balloon mitral valvuloplasty (BMV) was studied in 20 patients with severe mitral stenosis and varying degrees of anatomic atrial distortion. Left atrial entry by transjugular septal puncture was achieved without difficulty and BMV completed in all patients. In all of 16 patients who had high septal punctures, crossing the mitral valve with the Inoue-balloon was consistently simple and quick. In one patient, septal dilation after very high septal puncture led to a tear extending to the atrial free wall, resulting in cardiac tamponade requiring surgery. Another patient developed severe mitral regurgitation after BMV and required mitral valve replacement. Excellent results were obtained in 16 patients. The transjugular approach simplifies BMV procedure significantly in patients with distorted atrial anatomy and allows rapid patient mobilization. Its safety and efficacy need to be established in larger studies.

Adolescent↗
PubMed1996

Triglyceride expression.

Current epidemiologic reports claim an important role for triglycerides in coronary artery disease (CAD). By cross-sectional data analysis, the role of triglycerides was assessed in 1726 consecutive patients investigated for chest pain, 1119 with CAD and 607 with normal coronaries. Besides study of male and female patients as separate groups, the males were divided into age groups of below 40 years, 41 to 50 years, 51 to 60 years and over 61 years. The female patients were divided into those below 50 years and over 51 years because of smaller numbers. Using the mean value for cholesterol, triglyceride, HDL cholesterol, LDL cholesterol and body mass index for normals as the demarcation line, logistic regression analysis was carried out to study their association in the patients with CAD and normals. Results showed that while the odds ratio for total cholesterol were higher for the younger age groups, the odds ratio for triglycerides were consistently higher for the groups over 51 years both male and female. It is speculated that there may be a difference in the relative importance of lipid fractions with reference to age in the development of atherosclerotic plaque with cholesterol playing a more important role in younger people and triglycerides being equally or more important in older people, on the basis of metabolic handling of lipid fractions.

Adult↗
PubMed1996

Coronary angiographic findings in patients with diabetes: an exercise in cardiovascular epidemiology.

A study of 516 patients with diabetes mellitus who presented with chest pain and an equal number of matched controls without diabetes examined by selective coronary arteriography was undertaken. Detailed analysis of the angiograms showed that prevalence of CAD in diabetics with symptoms was 86.6%. This prevalence increased with age. Multivessel disease was more common in diabetics that in controls (p < 0.01). In diabetic patients disease involvement of proximal and distal segments in the same vessel was more common (p < 0.01). The Gensini score of quantitative expression of severity of CAD was higher in diabetics (p < 0.05). The number of occluded segments in the coronary tree was higher in diabetics (p < 0.01). No correlation could be established between severity of disease and age, body mass index or duration of diabetes. It is concluded that diabetes affects the coronary arteries of Indian patients more adversely than those of non-diabetics. The prevalence of CAD among diabetics increases linearly with age.

Adult↗
PubMed1992

Betamethasone in tetanus patients: an evaluation of its effect on the mortality and morbidity.

The effect of betamethasone on the outcome in moderate to severe tetanus was studied in a randomised, double blind, placebo controlled study in 22 patients. The mortality rate was reduced by 36.1% with the addition of corticosteroids to the regime of treatment. Betamethasone did not alter the duration of intensive care in those requiring it, but reduced the need for tracheostomy and ventilation. The mean daily dose of diazepam required was not significantly different between the two groups and there was no increase in the incidence of infections in the betamethasone group.

Adult↗
PubMedDate not supplied

Plasma insulin levels in coronary artery disease.

Seventy two consecutive patients without a history of diabetes and normal fasting plasma glucose were included in this study of insulin levels. Standard oral glucose tolerance test with 75 gm glucose and fasting and two hour insulin levels were estimated in all patients. Coronary artery disease (CAD) was confirmed or excluded by selective coronary arteriography. In 20 patients, CAD was diagnosed by electrocardiographic (ECG) and clinical evidence of earlier myocardial infarction. Mean fasting plasma insulin was 31.40 +/- 22.2 IU/dl in the CAD positive and 32.3 +/- 13.6 IU/dl in the CAD negative group. The mean two hour plasma insulin was 274.6 +/- 301.1 IU/dl in the CAD positive and 104.8 +/- 74.9 IU/dl in the CAD negative group (p < 0.04). Two hour plasma insulin levels were significantly higher in patients with atherosclerotic coronary artery disease. It is concluded that the estimation of a two hour plasma insulin level after 75 gm of glucose load, could help differentiate CAD from normals.

Coronary Disease↗
PubMedDate not supplied

Exercise capacity in untrained normal adults: a nomogram for Indians.

The exercise capacity of 155 hospital-based patients (125 males and 30 females) who underwent treadmill testing and coronary angiography for investigation of chest pain was used to derive regression equations for exercise capacity (METS) against age. A regression equation [18 - 0.16 x (age)] for males and [11 - 0.84 x (age)] for females was obtained. Using these equations an exercise capacity nomogram was developed. From this nomogram the predicted exercise capacity was calculated for another set of 228 patients (209 males and 19 females) whose treadmill tests were negative. The results confirmed that the nomogram could be applied to determine the expected and actual exercise capacity of Indians within a mean difference of 0.08 METS. This nomogram is being offered for clinical, therapeutic and preventive use for Indian patients.

Adult↗