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Biomedical subjects

B R Sharma

Publications and source records attributed to B R Sharma.

At least 37 records · Page 2Linked to original sources
PubMed2004

Medicolegal and ethical issues of cloning: do we need to think again and again?

Research on the cloning of human cells holds the promise of medical benefits, but cloning humans is a far more complex and ethically disturbing issue. Some have argued strenuously that human cloning should be banned permanently. They have called it immoral, repugnant, and abhorrent. Most European countries have already banned it, and others are considering a proscription. While allowing fundamental research in the field to progress, we need a wide debate on human cloning. We need to think about what, if any, circumstances might warrant cloning, as well as the circumstances under which it should never be allowed.

Bioethical Issues↗
PubMed2004

Ethical and practical principles underlying the end of life decisions.

"I will not relinquish old age, if it leaves my better part intact. But, if it begins to shake my mind, if it destroys its faculties one by one, if it leaves me not life but breath, I will depart from the putrid or tottering edifice. If I must suffer without hope or relief, I will depart, not through fear of the pain itself, but because it prevents all for which I would live." Seneca, the great Roman statesman of 1st century AD, spoke these words 2 millennia before the Netherlands became, on November 28, 2000, the first country in the world to legalize euthanasia. The decisions pertaining to end of life, whether legalized or otherwise, are practiced in many parts of the world but not reported on account of legal implications. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Debate among the medical practitioners, lawmakers, and the public taking into consideration the cultural, social, and religious ethos will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end of life.

Decision Making↗
PubMed2004

Withholding and withdrawing of life support: a medicolegal dilemma.

The developments in medicine in general and the technology of life support in particular have provided the means of maintaining organ function for prolonged periods of time. However, there are many situations where life-sustaining treatment in an intensive care unit (ICU) may lead to a death with lingering and suffering of the patient, as well as burdening their family. Although often equated, withholding and/or withdrawing life-prolonging treatments that allow the patient to die needs to be differentiated from the physician-assisted suicides and euthanasia that involve the active ending of life. There is a difference between an unintended but accepted consequence of forgoing therapy and an intended result of death from suicide or euthanasia. The present-day physicians view most patient deaths as an inevitable process secondary to disorders unresponsive to treatment and/or multiple organ dysfunction syndromes. The large majority of patients dying in ICUs today succumb not after cardiopulmonary resuscitation, but rather, after the forgoing of life-sustaining treatment. Such approach has frequently caused families, institutions, and conservators of patients to resort to judicial fiat for resolution.

Decision Making↗
PubMed2004

Organ transplantation programme: an overview of the present situation.

An ever-increasing demand for organs for transplantation has failed to keep pace with their availability. Social, religious and legal restrictions on the one hand and technological developments on the other have further worsened the existing shortage of organs. A correct definition of the 'moment of death', a more humane approach in breaking the news of death to relatives and de-linking the request for donation from the announcement of death may all go a long way in enhancing organ donation and procurement for needy patients. In India, the Transplantation of Human Organs Act was passed in 1994 to regulate the removal of organs from the living as well as the dead. However, it has certain fallacies. This paper reviews the various criteria in use to define the 'moment of death' around the world and with reference both to the Transplantation of Human Organs Act 1994 and the urgent need for organ retrieval in the present day paucity of donors.

Brain Death↗
PubMed2004

Plasma cortisol response to 1-24 adrenocorticotropin in patients with treated/untreated sellar & suprasellar mass lesions.

BACKGROUND & OBJECTIVES: One microgram short synacthene test is widely recommended as a screening test for evaluation of hypothalamo-pituitary-adrenocortical axis in patients with secondary adrenal insufficiency. Information on adequacy of cortisol response to this dose at different periods of the day in patients with hypothalamic-pituitary disorders is not available. Hence, this study was designed to assess the adequacy of cortisol response to 1 microg 1-24 adrenocorticotropin (ACTH) at 0800 h and 1600 h in patients with sellar and suprasellar mass lesions. METHODS: Thirty five consecutive patients with sellar and suprasellar mass lesions with mean age of 43.0+/-14.4 yr and 36 healthy controls with mean age of 32.3+/-9.0 yr were studied after obtaining informed consent. Maintenance doses of glucocorticoids in these patients were discontinued appropriately. On day 1, prestimulated and stimulated plasma cortisol samples at 0800 h and at 30 and 60 min following i.v. bolus of 1 microg 1-24 ACTH were collected. While on day 3, plasma cortisol samples were similarly collected at 1600 h. Cortisol estimation was done by a sensitive and specific radioimmunoassay. Stimulated plasma cortisol of 500 nmol/l or higher was defined as a normal response. RESULTS: In healthy controls, the prestimulated and peak cortisol levels at 0800 h (377.5+/-93.3 and 729.1+/-183.2 nmol/l) were higher (P<0.001 and P<0.01) than those at 1600 h (230.1+/-75.7 and 665.8+/-138.6 nmol/l). All subjects had a cortisol response of 500 nmol/l or higher in response to 1 microg 1-24 ACTH both at 0800 and 1600 h. In the patients' group, the prestimulated plasma cortisol at 0800 h (250.3+/-169.7 nmol/l) was higher (P<0.001) than that at 1600 h (166.3+/-128.9 nmol/l), while the peak cortisol response was comparable (P>0.05) in the morning as well as in the evening (490.9+/-309.4 vs 464.8+/-318.4). In 27 patients (77%) the morning and evening stimulated cortisol response to 1 microg 1-24 ACTH was consistent (normal in 13 and subnormal in 14) but was discrepant in the remaining 8 (23%). In 7 of these 8 patients, cortisol response was normal at 0800 h but not at 1600 h, while in only one, normal response was seen at 1600 h but not at 0800 h. INTERPRETATION & CONCLUSION: The demonstration of normal peak cortisol response to 1 microg 1-24 ACTH at 0800 h but not at 1600 h in substantial number of patients with sellar and suprasellar mass lesions suggests preference to morning for performing this test.

Adolescent↗
PubMed2003

Clinical forensic medicine--management of crime victims from trauma to trial.

The loss of human life and function due to violence constitutes a phenomenon that affects millions of patients annually. Society demands an investigation of trauma associated with criminal activity. No longer is it acceptable for health care professionals to operate in isolation of forensic philosophies and principles. It is assumed that the individuals responsible for the performance of the examination of forensic victims have the necessary basic education, experience, and skills. Health care professionals involved in the initial response to these victims, in the emergency department, are faced with unique problems, as social changes require continual reevaluation of standards and professional responsibility. The role of forensic medicine has been expressly designed to provide solutions to some of the most urgent concerns in our society. Forensic medicine focuses on the areas in which medicine and human behavior interface with the law. Existing problems are great and multifaceted and call for new solutions. The application of forensic science to contemporary medical practice reveals a wider role in the investigation of crime and the legal process that contributes to public health and safety. The responsibility of the forensic medicine is to provide continuity of care from the health care institution or the crime scene to courts of law...from trauma to trial.

Journal Article↗
PubMed2003

Medical advances in transsexualism and the legal implications.

Transsexualism is a condition wherein an individual's psychological gender is the opposite of his or her anatomic sex. The general belief now among behavioral scientists and physicians is that it is an identifiable and incapacitating disease, which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for postoperative transsexuals because states and the judiciary have not recognized the new gender. However, with wider acceptance of transsexuals by society, this outlook has changed for the better, with many states amending their laws in accordance with the advances in medical sciences. But in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries.

Civil Rights↗
PubMed2003

Disorders of sexual preference and medicolegal issues thereof.

Disorders of sexual preference or paraphilias are bizarre patterns of sexual behavior that have diverse manifestations and are of complicated sexual orientations. Some of these are harmless, while others are not, robbing sufferers and possibly their partners of loving sexual relationship. At least 40 paraphilias have been named, but the full extent of the field, perhaps, is still undiscovered. Recent studies have reported many paraphilias as long-term effects of sexual abuse in childhood, and the more frequent and persistent the abuse is, the worse the long-term psychologic, behavioral, and relationship problems. Psychopathology within this group of disorders may lead to criminal behavior, ranging from infringement of decency to some of the most heinous crimes known.

Female↗
PubMed2003

Suicides in northern India: causes, methods used and prevention.

Suicide patterns and rates differ in various populations and cultures. It has been reported that developing countries have lower suicide rates, possibly because of a lower level of environmental stress but the Indians have a very high suicide rate (Elfawal, 1999). The choice of method used to commit suicide depends on availability of means, knowledge about lethal effectiveness, and the victim's motivation and intent. The present work was designed to investigate the different methods of self-destruction, the age and gender susceptibility to suicide, the groups particularly affected and the underlying motivating factor for such an extreme step among the North Indians. Various suggestions relating to decreasing the tensions of the modern mechanical life-style, educating the public in general and the availability, use and storage of agrochemicals have been put forward. Marriage counselling and the concept of family planning are also advocated.

Adaptation, Psychological↗
PubMed2002

Poisoning in northern India: changing trends, causes and prevention thereof.

A twenty-one years retrospective study (1980-2000) of acute poisoning deaths carried out at the Department of Forensic Medicine and Toxicology at Government Medical College Hospital, Jammu and Gov't. Medical College Hospital, Chandigarh--the two demographically different zones of Northern India. Union Territory of Chandigarh, which is the capital of Punjab and Haryana states, is one of the most developed parts of India, whereas Jammu primarily represents the rural India. The study is an attempt to analyze the various changing trends in acute poisoning in these zones with the aim that it will help immensely the health policy-makers to equip health care institutions accordingly. The present study reveals a steep increase in the number of acute poisoning cases and a change in the trends of the most commonly used poisons with the passage of time. Males outnumbered females and youth formed the majority of fatalities. The main victims were unemployed youth and students, followed by agricultural and domestic workers. Despite India's predominantly rural character, the urban preponderance of deaths by poisoning may reflect the role of leading a more stressful life in urban areas.

Adolescent↗
PubMed2001

Road-traffic accidents--a demographic and topographic analysis.

Injuries and fatalities occur in all forms of transportation, but numerically, road-traffic accidents account for the great majority worldwide. There is little that the autopsy surgeon can contribute to the elucidation of factors leading to the accident as it is largely the circumstantial and forensic laboratory evidence which is likely to reveal a non-accidental cause. However, the doctor's role in detecting the compatibility/incompatibility of the injuries with those usually sustained in traffic accidents (to detect any which are 'atypical', e.g. focal depressed fracture of the skull), distinguishing antemortem from postmortem injuries, demonstrating the presence of any disease capable of creating sudden incapacity and analysing samples for alcohol/drugs, etc., can go a long way in assigning roles to the human and to some extent vehicular and environmental factors. This warrants that a meticulous autopsy be conducted and not merely a catalogue of injuries. It must be appreciated that a fatal accident is likely to result in litigation and the extent of litigation cannot be anticipated at the time of the autopsy. One must, therefore, aim at the close study of any accident victim and a careful assessment of the case is always rewarding. The present study was undertaken in the Department of Forensic Medicine at (a) Government Medical College, Jammu (1991-93), (b) Mulana Azad Medical College, New Delhi (1993-95) and (c) Government Medical College, Chandigarh (1994-June 2000), with the object of doing a comparative analysis of the various aspects of the road-traffic accidents and accidental deaths in three topographically and demographically different cities in India and to suggest remedial measures to bring down the accident rate.

Accidents, Traffic↗
PubMed2000

Insecticide susceptibility status of Culex tritaeniorhynchus giles, vector of Japanese encephalitis in Delhi.

Laboratory studies were carried out to ascertain the current susceptibility status of adult and larval stages of the Culex tritaeniorhynchus mosquito, vector of Japanese encephalitis, to various insecticides used under public health programs in India. The present study revealed that exposure of adult mosquitoes to diagnostic concentrations of DDT - 4.0%, malathion - 5.0%, fenitrothion - 1.0%, and propoxur - 0.1% could induce only 50.0, 10. 0, 15.0, and 5.0% mortality, respectively, indicating that the species was resistant to all of these insecticides. The LT50 and LT95 values calculated using diagnostic concentrations of DDT, malathion, fenitrothion, and propoxur were found to be 56.4 and 136, 138 and 272, 185 and 258, and 187 and 249 min, respectively. However, when adult mosquitoes were exposed to the diagnostic concentration of synthetic pyrethroids, viz., deltamethrin - 0.025%, permethrin - 0.25%, and lambdacyhalothrin - 0.1%, 100.0% mortality was observed, indicating that the species was highly susceptible to these adulticides. Larval susceptibility tests carried out using diagnostic dosages of DDT- 0.008, temephos- 0.02, fenthion- 0.008, fenitrothion- 0.125, and malathion- 0.005 mg/l failed to induce any mortality, indicating that larvae were resistant to these larvicides. The LC50 and LC90 values calculated for commonly used larvicides, viz., temephos and fenthion, were 0.1511 and 1.9098, and 0.6151 and 2.395 mg/l, respectively. Increase in tolerance level were estimated at 95.5- and 299.4-fold when these LC90 values were compared with diagnostic dosages of temephos and fenthion, respectively.

Animals↗
PubMed2000

A preliminary report on basal & stimulated plasma cortisol in patients with acquired immunodeficiency syndrome.

BACKGROUND & OBJECTIVES: Structural and/or functional alterations in adrenal glands have been reported in human immunodeficiency virus (HIV) infection. However, no information has been reported from India. Hence a study was undertaken to assess the basal and circadian variations in plasma cortisol, and cortisol response to bolus ACTH in patients with AIDS. METHODS: Basal and stimulated plasma cortisol levels at 0800 h and 1600 h and, at 30 and 60 min following an intravenous bolus of 250 micrograms ACTH (short synacthen test, SST) were estimated in 15 patients with AIDS (CD4 < or = 200/microliter) and 12 healthy controls. The nature of the opportunistic infections and/or associated disease in each patient was also studied. RESULTS: The patients had higher median basal plasma cortisol levels as compared to the controls at 0800 h (540 nmol/l vs 415 nmol/l, P < 0.005) and at 1600 h (420 nmol/l vs 285 nmol/l, P < 0.003). Five patients (33%) exhibited abnormal circadian cortisol rhythms. All subjects in the control group and all but one (6.6%) in the patients group had normal peak plasma cortisol response (> or = 550 nmol/l) to SST. The lone patient with subnormal cortisol response had no feature of adrenal insufficiency. On the contrary, 3 patients clinically suspected to have adrenal insufficiency, had normal plasma cortisol response. INTERPRETATION & CONCLUSIONS: These findings suggest that most patients with AIDS have elevated basal plasma cortisol levels with abnormal circadian rhythm in some and normal adrenocortical reserve irrespective of the symptoms/signs of adrenal insufficiency.

Acquired Immunodeficiency Syndrome↗
PubMed1995

A comparative study of genetic variation at five VNTR loci in three ethnic groups of Houston, Texas.

Following the technique of Southern blot restriction fragment length polymorphisms (RFLP) analysis, we generated a database of DNA profiles at five Variable Number of Tandem Repeats loci (D1S7, D2S44, D4S139, D10S28, and D17S79) for 669 individuals of three major ethnic populations (Caucasians, Blacks, and Hispanics) of Houston, Texas. Analysis of fragment sizes at these loci within each sample, as well as their fixed-bin analyses, reveal that the assumptions of independence of allelic occurrences within and between loci are valid for this database. Fixed-bin allele frequency tables, therefore, are the best descriptors of this database for conservative forensic calculations. Finally, we demonstrate that this regional database from Houston, Texas, does not yield any meaningfully different forensic inference than the one obtained from the National database of the respective ethnic groups.

Alleles↗
PubMed1994

Anorectal physiological testing in defecatory disorders: a prospective study.

A prospective study of anorectal physiological testing in 26 patients with obstructed defecation and 20 patients with faecal incontinence was performed. There were overlaps in individual test parameters between the two groups of patients. However, patients with severely blunted rectal sensation (maximum tolerated volume > 300 mL) and anismus were more likely to have obstructed defecation. Patients with very low anal canal pressures, a short (< 2.0 cm) anal canal, bilaterally prolonged (> 2.1 ms) pudendal nerve terminal motor latency and a grossly distorted and canal (vector symmetry index < or = to 0.75) were more likely to have faecal incontinence. Thus, patterns of anorectal physiological test results together with clinical evaluation, rather than individual test measurements, are more valuable in defining the underlying defecatory disorders and providing guidance on therapy.

Adult↗