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Biomedical subjects

A K Shetty

Publications and source records attributed to A K Shetty.

At least 55 records · Page 3Linked to original sources
PubMed1999

Delayed diagnosis of fatal medium-chain acyl-CoA dehydrogenase deficiency in a child.

A 5-year-old white female presented with coma and died unexpectedly. She had a history of recurrent episodes of febrile illnesses associated with lethargy and coma. Postmortem investigation revealed a fatty liver, leading to a suspicion of inborn error of fatty acid oxidation. The diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency was suggested by abnormal acylcarnitine profile with increased octanoylcarnitine in the blood, and confirmed by fatty acid oxidation studies and mutation analysis in skin fibroblast cultures. This case emphasizes the need to consider fatty acid oxidation disorders in all children who present with hypoglycemia with absent or mild ketones in the urine and high anion gap metabolic acidosis.

Acidosis↗
PubMed1999

Nocardia farcinica pneumonia in chronic granulomatous disease.

Infection with Nocardia poses a diagnostic challenge in patients with chronic granulomatous disease (CGD) because the signs and symptoms are often nonspecific, delay in diagnosis is common, and invasive procedures are frequently required to obtain appropriate tissue specimens. We present the first reported case of N farcinica pneumonia in an adolescent with X-linked CGD. Differentiation of N farcinica from other members of N asteroides complex is important because of its propensity for causing disseminated infection and antimicrobial resistance. Physicians caring for patients with CGD should maintain a high index of suspicion for nocardiosis, especially in those receiving chronic steroid therapy. Early diagnosis remains critical for decreased morbidity and occasional mortality.

Adolescent↗
PubMed1999

Plasmodium falciparum malaria.

A 13-year-old adolescent daughter of a missionary presented with fever and jaundice 1 week after returning from Africa. Examination of peripheral blood film revealed the diagnosis of Plasmodium falciparum infection. Therapy with oral quinine and doxycycline was curative. Diagnosis requires a travel history and a high index of suspicion. Because of the frequency of international travel, United States physicians need to be familiar with the presentation and management of imported P falciparum. Preparation for such travel must include careful counseling and optimal use of chemoprophylaxis.

Adolescent↗
PubMed1998

In vitro survival and differentiation of neurons derived from epidermal growth factor-responsive postnatal hippocampal stem cells: inducing effects of brain-derived neurotrophic factor.

Neural stem cells proliferate in vitro and form neurospheres in the presence of epidermal growth factor (EGF), and are capable of differentiating into both neurons and glia when exposed to a substrate. We hypothesize that specific neurotrophic factors induce differentiation of stem cells from different central nervous system (CNS) regions into particular fates. We investigated differentiation of stem cells from the postnatal mouse hippocampus in culture using the following trophic factors (20 ng/mL): brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3) and glial-derived neurotrophic factor (GDNF). Without trophic factors, 32% of stem cells differentiated into neurons by 4 days in vitro (DIV), decreasing to 10% by 14 DIV. Addition of BDNF (starting at either day 0 or day 3) significantly increased neuron survival (31-43% by 14 DIV) and differentiation. Morphologically, many well-differentiated neurons resembled hippocampal pyramidal neurons. 5'-Bromodeoxyuridine labeling demonstrated that the pyramidal-like neurons originated from stem cells which had proliferated in EGF-containing cultures. However, similar application of NT-3 and GDNF did not exert such a differentiating effect. Addition of BDNF to stem cells from the postnatal cerebellum, midbrain, and striatum did not induce these neuronal phenotypes, though similar application to cortical stem cells yielded pyramidal-like neurons. Thus, BDNF supports survival of hippocampal stem cell-derived neurons and also can induce differentiation of these cells into pyramidal-like neurons. The presence of pyramidal neurons in BDNF-treated hippocampal and cortical stem cell cultures, but not in striatal, cerebellar, and midbrain stem cell cultures, suggests that stem cells from different CNS regions differentiate into region-specific phenotypic neurons when stimulated with an appropriate neurotrophic factor.

Animals↗
PubMed1998

Hippocampal interneurons expressing glutamic acid decarboxylase and calcium-binding proteins decrease with aging in Fischer 344 rats.

Aging leads to alterations in the function and plasticity of hippocampal circuitry in addition to behavioral changes. To identify critical alterations in the substrate for inhibitory circuitry as a function of aging, we evaluated the numbers of hippocampal interneurons that were positive for glutamic acid decarboxylase and those that expressed calcium-binding proteins (parvalbumin, calbindin, and calretinin) in young adult (4-5 months old) and aged (23-25 months old) male Fischer 344 rats. Both the overall interneuron population and specific subpopulations of interneurons demonstrated a commensurate decline in numbers throughout the hippocampus with aging. Interneurons positive for glutamic acid decarboxylase were significantly depleted in the stratum radiatum of CA1, the strata oriens, radiatum and pyramidale of CA3, the dentate molecular layer, and the dentate hilus. Parvalbumin interneurons showed significant reductions in the strata oriens and pyramidale of CA1, the stratum pyramidale of CA3, and the dentate hilus. The reductions in calbindin interneurons were more pronounced than other calcium-binding protein-positive interneurons and were highly significant in the strata oriens and radiatum of both CA1 and CA3 subfields and in the dentate hilus. Calretinin interneurons were decreased significantly in the strata oriens and radiatum of CA3, in the dentate granule cell and molecular layers, and in the dentate hilus. However, the relative ratio of parvalbumin-, calbindin-, and calretinin-positive interneurons compared with glutamic acid decarboxylase-positive interneurons remained constant with aging, suggesting actual loss of interneurons expressing calcium-binding proteins with age. This loss contrasts with the reported preservation of pyramidal neurons with aging in the hippocampus. Functional decreases in inhibitory drive throughout the hippocampus may occur due to this loss, particularly alterations in the processing of feed-forward information through the hippocampus. In addition, such a profound alteration in interneuron number will likely alter inhibitory control of excitability and neuronal synchrony with behavioral states.

Aging↗
PubMed1998

A boy with a limp.

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Ascorbic Acid↗
PubMed1998

Urethral prolapse.

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Child Abuse, Sexual↗
PubMed1998

Septic arthritis in children.

Because of its seriousness, septic arthritis should be considered early in the differential diagnosis of any child presenting with joint inflammation. Physicians who care for children should be aware of the early signs and symptoms of septic arthritis and be aggressive about establishing the diagnosis so that treatment is not delayed. Early orthopedic consultation and a low threshold for performing arthrocentesis are prudent. Prolonged and appropriate antimicrobial therapy is warranted to achieve optimal results.

Arthritis, Infectious↗
PubMed1998

Preparedness of practicing pediatricians in Louisiana to manage emergencies.

BACKGROUND: Surveys in recent years show that office emergencies are likely to occur in pediatric offices and that most offices are not equipped to deal with these situations. METHODS: To determine the pediatrician's preparedness to manage emergencies, we surveyed a randomly selected sample of 240 office-based pediatricians in Louisiana. We asked for information about basic and advanced cardiac life support training of the physicians and staff, availability of office equipment and medications, prearranged emergency plans, and staff preparedness. RESULTS: Only 73% of pediatricians were trained in pediatric advanced life support (PALS). Of all support staff, only 48% were trained in basic life support, and 30% were trained in PALS. The most common deficiencies in equipment included intraosseous needles (62%), endotracheal tubes (54%), oxygen tanks (39%), intravenous catheters (29%), and nebulizers (22%). Availability of medications ranged from 75% for epinephrine 1:1,000 to 22% for calcium chloride. Although two thirds of the pediatricians had designed emergency plans for their offices, only 20% were conducting mock drills. CONCLUSIONS: Deficiencies exist among pediatricians and office staff regarding appropriate levels of preparedness to handle pediatric emergencies. Recommendations are made to attain appropriate levels of preparedness.

Child↗