Biomedical subjects
Publications and source records attributed to S Varma.
Primary immunodeficiency syndromes are rarely diagnosed among adults. In this report, we describe a young male who had common variable immunodeficiency. He was treated with intravenous immunoglobulin and, on follow up, has been free of opportunistic infections.
Explore the source record for details and available documents.
BACKGROUND: The study was carried out to highlight the clinical and biochemical profile of patients with pheochromocytoma in a tertiary care center of North India. METHODS AND RESULTS: Thirty consecutive cases of pheochromocytoma admitted over a period of 10 years to our Institute were analyzed. The chief clinical complaints of these 30 patients (17 males and 13 females, mean age 24+/-7 years) were palpitation (80%), headache (77%), sweating (60%), breathlessness (67%) and flushing (56%). The clinical triad of headache, flushing and sweating occurred in 26.7% of cases. On clinical examination, 97% of the patients were hypertensive and 16.6% presented with malignant hypertension. Laboratory measurements showed that the levels of 24-hour urinary vanillylmandelic acid were elevated in 80% of cases. Levels of plasma adrenaline and noradrenaline were raised in 78% and 79% of cases, respectively. Anatomical localization of the tumor on computerized tomographic scan showed the presence of an adrenal tumor in 80% and extra-adrenal tumor in 20%. Surgical removal of the tumor could be carried out in 28 cases following control of the blood pressure with antihypertensive drugs including alpha and beta adrenoreceptor blockers. CONCLUSIONS: Pheochromocytoma should be suspected in all young hypertensive persons. The appropriate therapy for this tumor is surgical removal preceded by adequate blood pressure control including the use of alpha and beta adrenoreceptor antagonists.
BACKGROUND: Adult celiac disease is infrequent in India. Iron-deficiency anemia as its presenting manifestation is still rarer. METHODS: We investigated patients with refractory iron-deficiency anemia attending the hematology clinic of a tertiary-care hospital for celiac disease. The diagnosis of celiac disease was based on histology, serology and response to treatment. RESULTS: Of 19 patients with refractory iron-deficiency anemia seen from April 1998 to March 2000, 11 were diagnosed to have celiac disease. Four of these had abnormal D-xylose test and 3 had fat malabsorption. All 11 patients responded to gluten-free diet with improvement in hematological parameters. CONCLUSION: Patients with refractory iron-deficiency anemia of unknown cause should be investigated for subclinical celiac disease.
Injection of angiotensin II into a lateral cerebral ventricle (I.C.V.) or into a peripheral vein of anaesthetized dog elicited a rise in blood pressure and transient bradycardia followed by sustained tachycardia. Spinal transection at C2 and bilateral vagotomy abolished the central cardiovascular effect of I.C.V. angiotensin. However, in spinal transected dogs the usual pressor response to intravenous angiotensin was observed. Since the transient bradycardia was absent in bilaterally vagotomized dogs or in dogs with their blood pressure stabilized by means of a mechanical buffer devise it must be reflex in origin. The tachycardia was more marked in vagotomized dogs. Prior administration of a beta adrenergic receptor blocking agent propranolol, blocked the tachycardia, but the pressor response was unaffected. The cardiovascular responses to centrally administered angiotensin were practically abolished by prior treatment of dogs with reserpine or by extirpation of both adrenal glands. Thus it may be concluded that ICV angiotensin induces a centrogenic release of catecholamines from the adrenal medulla which is responsible for the cardiovascular responses.
The effect of angiotensin II on heart rate of dogs were studied by intravenous and intracerebroventricular routes. Following differences were noticeable when the results obtained with intracerebroventricular were compared with those obtained after intravenous administration. The onset of tachycardia was less as compared to the intravenously administered angiotensin. The dogs required to produce tachycardia was less and the magnitude of tachycardia was also greater with intracerebroventricular administration. The initial bradycardia observed with intracerebroventricular or intravenous administration of angiotensin, could be prevented by using the mechanical buffering device. The spinal cord transection at C2 level and bilateral vagotomy abolished the tachycardia. It is speculated that angiotensin acts centrally either on the hypothalamic or medullary accelerator neurones (central sympathetic structures) and produces some degree of increased adrenegic neuron discharge which is responsible for cardiac acceleratin in dogs.
Acute erythroleukemia is a relatively rare form of acute myelogenous leukemia. In the present study we analysed ten cases of acute erythroleukemia. All the patients were anemic and nine were thrombocytopenic at the time of diagnosis. Peripheral blood showed blasts in nine cases. Dyserythropoiesis was seen in all the cases whereas dysmegakaryopoiesis was seen in five cases. Dysplasia in the granulocytic series was seen in five cases. Based on the overall features this study concludes that acute erythroleukemia is associated with dysplasia of variable degree.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: To conduct a preliminary investigation into the consistency of approach between three Ayurvedic medicine experts on treatments for inflammatory polyarthritis. METHODS: A convenience sample of three experienced Ayurvedic practitioners was recruited. These practitioners independently assessed three subjects with inflammatory polyarthritis for health status, treatment history, and lifestyle, conducted a physical examination, and then independently determined the treatment plan. The treatment plan was recorded on standardized collection forms. The subject examination order was randomized for each practitioner. Following completion of the assessments, a facilitated discussion among the practitioners permitted each to discuss all aspects of the recommended therapies. Proceedings were audio-taped and the content analyzed. RESULTS: All three practitioners agreed upon a unified concept of Ayurvedic disease origin, disease diagnosis, and treatment approach for each patient. Seven specific treatment groupings (i.e. modalities) emerged: diet, exercise, relaxation, analgesic, anti-inflammatory, immune-enhancing, and detoxification/cleansing. Based on the single visit, the practitioners agreed upon 17 of 21 treatment groups for the three patients. CONCLUSION: Despite Ayurvedic medicine's individualized approach, considerable agreement existed among the practitioners studied. The identified Ayurvedic treatment approaches require investigation in a controlled clinical setting.
We describe a rare case of acute myeloblastic leukemia presenting with superior vena cava syndrome due to a mediastinal granulocytic sarcoma. The morphologic diagnosis of granulocytic sarcoma was obtained from computed tomography-guided fine needle aspiration cytology. This is the second such case described in the world literature.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Beta adrenergic agonist isoprenaline (8x10(-6)M) produced a 500% increase in inotropic and 90% increase in the chronotropic responses of isolated rabbit atria at 37 degrees C. On cooling the atria to 23 degrees C, these responses were significantly reduced to 87% and 30% respectively. Similar results were obtained with adrenaline, but isoprenaline was more potent. The positive chronotropic and inotropic responses to isoprenaline were effectively blocked by propranolol and practolol at 37 degrees C whereas at 23 degrees C these beta blockers were unable to block even minor positive responses obtained by isoprenaline at this temperature. On the contrary at 23 degrees C, phenylephrine (alpha adrenergic agonist) produced marked positive chronotropic and inotropic effects indicating enhancement of alpha adrenoceptor activity at lower temperatures. This also suggests that reduced beta receptor activity at lower temperature is not due to a generalised depression of adrenoceptors as a result of hypothermia. Rewarming of atria to 37 degrees C restored the beta adrenoceptor responsiveness to previous level. It appears that ambient temperature is important im maintaining normal beta adrenergic activity of the atria.
Marked seasonal variations in environmental fluid losses and arterial blood pressure (BP) have been observed by us. Factors causing these changes in BP have been investigated. Effect of seasonal variation on BP was studied in 15 controls and 15 essential hypertensives. Mean temperature and relative humidity in well defined 5 local seasons was recorded. Monthly observations included the plasma levels and 24 hours urinary excretion of norepinephrine (NE), epinephrine (E), sodium (Na+) and potassium (K+). Average systolic, diastolic and mean BP were higher in winter season in both the groups (P less than 0.01). In hypertensives this variation was observed despite a significant increase in drug consumption during winter season (P less than 0.001). Both the groups revealed higher plasma levels and daily urinary excretion of NE and E during winter months, (P less than 0.05 - less than 0.001). 24 hrs urinary volume, Na+ and K+ were significantly higher in winter season (P less than 0.05 - less than 0.001). These parameters showed a negative correlation with mean ambient temperature. Increased sympathetic nervous activity as documented by increased NE and E in plasma and urinary, and decreased environmental loss of fluids and sodium may be contributory to this rise in blood pressure during winter season.
Explore the source record for details and available documents.
A 3-day treatment with 4 mg/kg Betnesol in anesthetized mongrel pups, 4-55 days of age effectively raised fasting plasma glucose concentration by 23 +/- 2.9%, which was higher than that observed in adult dogs similarly treated. Possibly this was due to the lack of effectiveness of insulin in the pups which is normally produced in response to hyperglycemia. The relative lack of effectiveness of insulin induced hypoglycemia in stimulating hepatic glucose production in the newborn pups was further demonstrated by the fact that insulin administration produced a hypoglycemia which lasted much longer than in adult dogs. On the other hand Betnesol treatment was found to be effective in restoring normoglycemia following administration of insulin in these pups presumably due to its gluconeogenic effect through the liver. In general this investigation points towards the lack of development of appropriate feedback mechanisms for glucose homeostasis in the newborn pups, and that it takes a period of about 3-4 weeks after birth to develop such mechanisms.
The cardiac effects of magnesium were studied on 40 spontaneously beating rabbit atria at 37 degrees C. Magnesium administered in doses of 30, 60, 120 and 240 mmol elicited dose dependent negative inotropic and chronotropic responses. Larger doses above 240 mmol caused complete atrial arrest. Further it was observed that propranolol with magnesium became more effective in blocking the positive chronotropic and inotropic responses to isoprenaline. The finding is interesting and suggestive that magnesium could be employed either alone or in combination with propranolol in treatment of arrhythmias which are non-responsive to propranolol.