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Biomedical subjects

V Gupta

Publications and source records attributed to V Gupta.

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

Minimizing cervical esophageal anastomotic complications by a modified technique.

BACKGROUND: The anastomotic leak and stricture formation after esophagectomy and cervical esophagogastric anastomosis deny patients with esophageal carcinoma the benefits of surgery. The present study was designed to ascertain whether a wide cross-sectional area at the site of anastomosis leads to lesser anastomotic complications. METHODS: One hundred patients with resectable carcinoma of the esophagus were randomly distributed into two groups of 50 each. All patients underwent one-stage transhiatal esophagectomy. In group A, 3 x 2 cm gastric crescent was excised from the anterior wall of the gastric tube before constructing the cervical esophagogastric anastomosis. No such intervention was done in group B, which acted as control. All patients were followed up for at least 3 months for detection of anastomotic complications. RESULTS: The incidence of anastomotic leak in the study group was significantly less in comparison with the control group (4.3% versus 20.8%; P = 0.03). Similarly, anastomotic stricture formation was significantly lower in the study group (8.5% versus 29.2%; P = 0.02). CONCLUSIONS: A wide cross-sectional area achieved at the anastomotic site by removal of gastric crescent resulted in significantly lower anastomotic complications.

Adolescent↗
PubMed2001

Uniform 13C/15N-labeling of DNA by tandem repeat amplification.

An optimized procedure has been described for the large-scale production of stable isotopeenriched duplex oligonucleotides of designed sequence. Large-scale production of labeled nucleotide triphosphates can be produced in this procedure simultaneously with labeled proteins, thereby providing synthetic dNMP precursors at no additional cost. The procedure is robust, with a minimum product:template yield of 800:1 overall, and produces > 99% single-length product. Tandem repeat PCR amplification is a general approach to large scale synthesis of duplex oligonucleotides and may have applications to both NMR and X-ray methods, particularly for product lengths in excess of 25 base pairs where failed sequences from solid-phase synthesis can be difficult to remove chromatographically. A drawback of the present approach is that the product is a duplex of two equal-length strands, making single-stranded products more difficult to prepare. For this reason, it could be preferable to produce single-stranded products by the [figure: see text] method of Zimmer and Crothers. Although a single base type can be selectively enriched in this approach, chemical synthesis will provide greater flexibility for labeled DNAs requiring site-specific labels at only one or a small number of nucleotide positions in the sequence. Therefore, maximum flexibility in labeling patterns can be realized by judicious choice of labeling method appropriate to the type of DNA product and extent of isotopic enrichment desired.

Base Sequence↗
PubMed2001

Crater-and-chop technique for phacoemulsification of hard cataracts.

We describe a technique of in-the-bag phacoemulsification of large, hard, leathery brown nuclear cataracts. A large crater approximately 6.0 mm diameter is created by down-slope sculpting up to 90% of nuclear thickness, leaving the outer nuclear rim intact. The edge of the crater is held with the phaco probe using high vacuum, and small wedge-shaped pieces are created with a chopper. These small pieces are emulsified in the space created by the crater. This technique permits in-the-bag phacoemulsification of large brown cataracts without complications.

Cataract↗
PubMed2001

Topical ciprofloxacin-dexamethasone combination therapy after cataract surgery: randomized controlled clinical trial.

PURPOSE: To determine the efficacy of a combination of ciprofloxacin 0.3% and dexamethasone 0.1% eyedrops in controlling immediate inflammation after cataract surgery. SETTING: Dr. Rajendra Prasad Centre for Ophthalmic Sciences and Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. METHODS: This randomized controlled clinical trial comprised 61 patients, 31 of whom were treated with a combined ciprofloxacin-dexamethasone suspension (study group) and 30, with a standard formulation of betamethasone and neomycin eyedrops (control group). One and 7 days postoperatively, pain, lid edema, lacrimation, conjunctival congestion, aqueous flare and cells, and side effects were noted. A conjunctival swab for bacteria and a fungus culture were sent for evaluation 7 days postoperatively. RESULTS: At 7 days, there was no statistically significant difference between groups in lid edema, conjunctival congestion, anterior segment inflammation, lacrimation, or pain. Two patients in the ciprofloxacin-dexamethasone group noted white deposits in and around the eye that resolved after the dose was reduced to 4 times a day. No patient reported or developed an allergic reaction to either drug combination. CONCLUSION: A ciprofloxacin-dexamethasone combination was effective in controlling inflammation after cataract surgery.

Administration, Topical↗
PubMed2001

Diabetic maculopathy and cataract surgery.

Patients with diabetic mellitus have an increased risk of developing cataract. Many such patients have pre-existing diabetic retinopathy at the time of cataract surgery Although more than 90% of the patients who have no pre-existing diabetic retinopathy carry a good visual prognosis and eventually have 20/40 or better visual acuity, nearly one-third of patients with pre-existing retinopathy may show retinopathy progression. Postoperative angiographic macular edema is more common in patients with diabetes but resolves spontaneously in patients with no or minimal diabetic retinopathy. In patients with moderate to severe NPDR or more, clinically significant macular edema tends to persist, may arise de-novo, or even worsen after cataract surgery. Patients with diabetes need a preoperative characterization of their retinopathy and a thorough discussion with the patient about the need for cataract surgery, and the risk of progression of retinopathy is mandated. Currently, early surgery is favored before the development of significant diabetic retinopathy rather than wait for the cataract to become denser. All efforts should be made to stabilize diabetic retinopathy with appropriate laser treatment before cataract surgery. All diabetic patients need close observation for at least 6 months following surgery to intervene with laser photocoagulation as and when required to prevent visual loss from diabetic maculopathy and other consequences of diabetic retinopathy.

Cataract↗
PubMed2001

The Nf2 tumor suppressor, merlin, functions in Rac-dependent signaling.

Mutations in the neurofibromatosis type II (NF2) tumor suppressor predispose humans and mice to tumor development. The study of Nf2+/- mice has demonstrated an additional effect of Nf2 loss on tumor metastasis. The NF2-encoded protein, merlin, belongs to the ERM (ezrin, radixin, and moesin) family of cytoskeleton:membrane linkers. However, the molecular basis for the tumor- and metastasis- suppressing activity of merlin is unknown. We have now placed merlin in a signaling pathway downstream of the small GTPase Rac. Expression of activated Rac induces phosphorylation and decreased association of merlin with the cytoskeleton. Furthermore, merlin overexpression inhibits Rac-induced signaling in a phosphorylation-dependent manner. Finally, Nf2-/- cells exhibit characteristics of cells expressing activated alleles of Rac. These studies provide insight into the normal cellular function of merlin and how Nf2 mutation contributes to tumor initiation and progression.

3T3 Cells↗
PubMed2001

Topical cyclosporin A in the management of vernal keratoconjunctivitis.

PURPOSE: To study the efficacy of topical cyclosporin A in children with vernal keratoconjunctivitis in a prospective randomised double-masked trial. METHODS: Twenty-four children between 5 and 16 years of age were randomly treated with cyclosporin A (CsA) and placebo (vehicle) and followed up for 4 months. RESULTS: Of the 12 patients given CsA, 11 showed symptomatic improvement by 7 days of starting treatment whereas only 3 patients in the placebo group showed mild symptomatic improvement. CONCLUSIONS: Topical cyclosporin is a safe and effective treatment in vernal keratoconjunctivitis.

Adolescent↗
PubMed2001

Calcifying pseudoneoplasm of the CNS.

Calcifying pseudoneoplasm or fibro-osseous lesion of the CNS is uncommon. We report a case in a 6-year-old boy who presented with generalized tonic-clonic seizures for 6 months. There was a calcified mass in the depth of the left temporal lobe, which on histology showed collagenous nodules surrounded by spindle cells and seperated by chondromyxoid matrix. The only other report of such a lesion in a child is of a 12-year-old boy with an epidural lesion at C-6 level. It is important to recognize this entity since it is slow growing with a good prognosis.

Brain Diseases↗
PubMed2001

Behavioral problems in school-going children: implications for medical teachers in developing countries.

A large number of children suffer from behavioral problems during their development. Many of these problems are transient and may not even be noticed. At times, however, the extent of these problems and their overall effects on a child's development can be serious (Morita et al., 1993). Further, children may exhibit these behaviors in one setting and not in others (e.g. at home or in school, but not both). In developed countries, parents tend to seek advice for even minor problems, such as persistent thumb sucking, while in developing countries, major problems, even childhood schizophrenia, may go unattended. An awareness of the prevalence of these problems is important so that appropriate mental health services can be planned and provided for affected children, to improve their prospects for leading healthy, productive lives. Such awareness can help enhance the teaching of graduate doctors, equipping them to deal with these problems effectively.

Journal Article↗
PubMed2001

Indications for lamellar keratoplasty in India.

PURPOSE: To study the indications for lamellar keratoplasty (LK) in a tertiary eye care hospital in northern India. METHODS: A retrospective analysis of 71 eyes that had undergone LK between January 1995 and December 1999 was performed. The parameters evaluated included demographic data, the diagnosis at admission, the laterality of involvement, and the graft size. RESULTS: The mean age of the patients was 31 +/- 21.8 years (range, 1-73 years). Forty-one male patients and 30 female patients underwent LK. Thirty-three patients (47%) lived in rural areas, and 38 patients (53%) were urban dwellers. LK was performed for optical indications in 63 eyes (88.7%), for tectonic purposes in six eyes (8.4%), and for therapeutic purposes in two eyes (2.8%). Chemical injuries (18%) were the most common indication for LK and were followed by trachomatous keratopathy (14%) and dermoids (14%). CONCLUSION: Chemical injuries, trachomatous keratopathy, and dermoids constitute the major indications for LK in India.

Adolescent↗
PubMed2001

PCR-positive tubercular retinal vasculitis: clinical characteristics and management.

BACKGROUND: Inflammation of retinal vessels is a known association of systemic tuberculosis. Patients with retinal vasculitis are subjected to extensive but unrewarding systemic workup. Polymerase chain reaction (PCR) is now commonly used to detect DNA of infective organisms including Mycobacterium tuberculosis. This study was undertaken to characterize the clinical characteristics of PCR-positive tubercular retinal vasculitis, so as to determine the clinical presentation, associated systemic features, management, and course of this form of vasculitis. METHODS: The clinical records of 13 patients seen between 1997 and 1999 with the diagnosis of PCR-positive tubercular retinal vasculitis from the aqueous or vitreous humor were reviewed. Recorded data included age, sex, race, visual acuity, anterior and posterior segment findings, and results of diagnostic evaluations. All received antituberculosis therapy with or without concomitant corticosteroids. Laser scatter photocoagulation was done in eyes with neovascularization. One eye with vitreous hemorrhage was subjected to pars plana vitrectomy. RESULTS: There were 9 (69.2%) male and 4 (30.7%) female patients with a median age of 20 years. The disease was bilateral in seven. The most consistent finding was the presence of vitritis in all the eyes followed by vitreous snowball opacities in 17 eyes (89.4%), neovascularization in 11 eyes (57.8%), retinal hemorrhages in 10 eyes (52.6%), neuroretinitis in 10 eyes (52.6%), focal choroiditis in 9 eyes (47.3%), vitreous/preretinal hemorrhage in 5 eyes (26.3%), and serous retinal detachment in 3 eyes (15.7%). Over a median follow-up of 12 months, all showed resolution of vasculitis with no recurrences. CONCLUSIONS: Polymerase chain reaction-positive tubercular retinal vasculitis had varied associated fundus findings. Its recognition is important so as to order only relevant diagnostic tests.

Adolescent↗
PubMed2001

Outbreak of Pichia anomala infection in the pediatric service of a tertiary-care center in Northern India.

An outbreak of nosocomial fungemia due to the unusual yeast, Pichia anomala occurred in the pediatric wards of our hospital over a period of 23 months (April 1996 to February 1998). A total of 379 neonates and children (4.2% admissions) were infected. The probable index case was admitted to the pediatric emergency ward, with subsequent transmission to the premature nursery, pediatric intensive care units, and other children wards. Carriage on the hands of health care personnel was likely to be responsible for dissemination of the fungus. The outbreak could only be controlled after a health education campaign to improve hand-washing practices was instituted and after nystatin-fluconazole prophylaxis to all premature neonates and high-risk infants was introduced. In a case-control study, we identified a lower gestational age, a very low birth weight (<1,500 g), and a longer duration of hospital stay as significant risk factors associated with P. anomala fungemia in premature neonates. We conducted a culture prevalence survey of 50 consecutive premature neonates and found that 28% were colonized with P. anomala at a skin or mucosal site on the date of delivery and that 20% of these neonates subsequently developed P. anomala fungemia. We performed multilocus enzyme electrophoresis on 40 P. anomala outbreak isolates (including patient and health care workers' hand isolates), and the results suggested that these isolates were identical. Our study highlights the importance of P. anomala as an emerging nosocomial fungal pathogen.

Antifungal Agents↗
PubMed2001

TB or not TB: an unusual sore finger.

A 25 year old Afro-Carribean presented to the accident and emergency department with a painful swelling of the little finger. Radiology revealed periosteal elevation and a bone scan showed a hot spot in the proximal phalanx, suggestive of a tumour or an infection. He gave a history of recurrent chest infections in the past, the chest radiograph revealed apical lesions and loculated pleural effusion. Bronchoscopy washings were positive for acid fast bacillus suggestive of pulmonary tuberculosis with tuberculous dactylitis. A detailed history and high index of suspicion is important as delay in diagnosis can have serious consequences for the patient.

Adult↗
PubMed2001

Effect of protein ingestion on the glucose appearance rate in people with type 2 diabetes.

Amino acids derived from ingested protein are potential substrates for gluconeogenesis. However, several laboratories have reported that protein ingestion does not result in an increase in the circulating glucose concentration in people with or without type 2 diabetes. The reason for this has remained unclear. In people without diabetes it seems to be due to less glucose being produced and entering the circulation than the calculated theoretical amount. Therefore, we were interested in determining whether this also was the case in people with type 2 diabetes. Ten male subjects with untreated type 2 diabetes were given, in random sequence, 50 g protein in the form of very lean beef or only water at 0800 h and studied over the subsequent 8 h. Protein ingestion resulted in an increase in circulating insulin, C-peptide, glucagon, alpha amino and urea nitrogen, and triglycerides; a decrease in nonesterified fatty acids; and a modest increase in respiratory quotient. The total amount of protein deaminated and the amino groups incorporated into urea was calculated to be approximately 20-23 g. The net amount of glucose estimated to be produced, based on the quantity of amino acids deaminated, was approximately 11-13 g. However, the amount of glucose appearing in the circulation was only approximately 2 g. The peripheral plasma glucose concentration decreased by approximately 1 mM after ingestion of either protein or water, confirming that ingested protein does not result in a net increase in glucose concentration, and results in only a modest increase in the rate of glucose disappearance.

Adult↗
PubMed2001

Amyloidoma of the thoracic spine. Case report.

The authors report the case of a patient with amyloidoma of the thoracic spine. A 34-year-old man presented with a 2-month history of upper-back pain, bilateral lower-extremity weakness, and numbness below the nipple. A computerized tomography study revealed an extradural mass with destruction of the T-2 lamina and pedicle. Intraoperatively, there was a pinkish, partially suctionable mass infiltrating the muscle plane and causing destruction of the T-2 lamina. Histological examination showed typical amyloid masses that demonstrated apple-green double refraction on examination of the Congo red-stained section under polarized light. Amyloidomas are rare benign lesions that, unlike other forms of amyloidosis, have an excellent prognosis. A cure is possible with complete resection of the mass.

Adult↗