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Biomedical subjects

J B Singh

Publications and source records attributed to J B Singh.

At least 19 recordsLinked to original sources

Potassium Salts Inhibit Growth of the Cyanobacteria Microcystis spp. in Pond Water and Defined Media: Implications for Control of Microcystin-Producing Aquatic Blooms.

Ten metals were assayed in 21 Indian ponds which comprised three groups: (i) eutrophic alkaline ponds containing <2.5 mM potassium and thick growths of Microcystis aeruginosa or Microcystis flos-aquae during most of the year, (ii) equally eutrophic alkaline ponds containing >2.8 mM potassium and no detectable Microcystis growth, and (iii) oligo- or mesotrophic ponds with various potassium and hydrogen ion concentrations and no persistent Microcystis blooms. The effects of potassium on Microcystis growth were examined in filter-sterilized pond water and in defined culture media. A 50% reduction in the 10-day yield of cultured M. aeruginosa was observed in DP medium and pond water supplemented with 1 and 3 mM KCl, respectively. In contrast, the addition of 2 to 30 mM NaCl did not suppress the growth of M. aeruginosa in either DP medium or pond water. Both 5 mM KCl and 20 mM KHCO(inf3) in J medium strongly inhibited the growth of M. flos-aquae C3-9, whereas 5 to 30 mM NaCl had no effect and 20 mM NaHCO(inf3) was stimulatory. For pond water cultured with a mixture of M. aeruginosa and the duckweed Wolffia arrhiza, M. aeruginosa dominated in unsupplemented water and W. arrhiza dominated in water supplemented with 4.8 mM KCl. Implications for the ecology and control of Microcystis blooms are discussed.

Journal Article↗

Amlodipine once a day in stable angina: double-blind crossover comparison with placebo.

Although calcium antagonists form a mainstay of therapy in patients with angina pectoris, the currently available agents have significant limitations. Nifedipine, diltiazem, and verapamil are all high-clearance agents with significant hepatic extraction and rapid clearance, leading to limited and short-lived bioavailability necessitating frequent daily administration. In contrast, amlodipine, a dihydropyridine calcium antagonist, has a long half-life of 35-50 h (compared with 3 to 4 h elimination half-life of diltiazem, verapamil, and nifedipine). After oral doses, the relative bioavailability of amlodipine is high (64%) and absorption is smooth, with peak plasma levels being achieved 6-12 h postdose. Bioavailability is not affected by the consumption of food. In common with other dihydropyridine calcium antagonists, amlodipine is eliminated mainly by metabolism. None of the metabolites of amlodipine has significant calcium antagonist effects in humans. In contrast to verapamil or diltiazem, amlodipine has no effect on sinus or atrioventricular node and little or no effect on the resting heart rate. Amlodipine does not have any appreciable negative inotropic effect with the relevant clinical dose. Other clinical studies have shown amlodipine to be effective when used once-daily in chronic stable angina and vasospastic angina. Comparative studies indicate that the antianginal efficacy of amlodipine is comparable to the beta blocker nadolol and the benzothiazepine calcium antagonist diltiazem. Amlodipine has also been found to provide improved antianginal effects when combined to treatment with beta blockers and/or long-acting nitrates. Treatment with amlodipine either as monotherapy or combined with other antianginal therapy for up to 26 weeks shows that efficacy is maintained, with no evidence of tolerance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Amlodipine combined with beta blockade for chronic angina: results of a multicenter, placebo-controlled, randomized double-blind study.

Amlodipine, a potent long-acting dihydropyridine calcium antagonist, was compared with placebo in a parallel, randomized, double-blind study in 134 patients with chronic stable angina pectoris maintained on beta-adrenergic blocking agents. After a single-blind, two-week placebo period, patients were randomized to receive either amlodipine (2.5, 5, and 10 mg) or placebo once daily for four weeks. The effects of amlodipine on maximal exercise time, work, time to angina onset, and subjective indices including angina frequency, nitroglycerin tablet consumption, and patient and investigator ratings were assessed. Each dose of amlodipine produced increases in exercise time and calculated total work accomplished compared to baseline. Improvements at 5 and 10 mg were significantly greater than placebo which produced no significant change (p less than 0.05). Qualitative improvements in the severity of angina were produced by amlodipine at 5 and 10 mg daily assessed by patient-rating questionnaires (p less than 0.05). Reductions in angina frequency attacks per week and weekly nitroglycerin tablet consumption occurred but were not statistically significant when compared with placebo. Adverse effects observed during amlodipine treatment prompted discontinuation of treatment in only 2 out of 100 patients. Three patients discontinued treatment for reported lack of efficacy. No laboratory abnormalities prompted treatment discontinuation and minor side effects of dizziness, nausea, headache, and fatigue were observed infrequently. The results of this controlled, large-scale multicenter trial suggest that amlodipine significantly increased exercise capacity and was well tolerated when added to the antianginal regimen of patients remaining symptomatic while receiving beta-blocking agents.

Adolescent↗

Doxazosin for the treatment of chronic congestive heart failure: results of a randomized double-blind and placebo-controlled study.

In this study we evaluated the effects of once-daily administration of oral doxazosin in patients with chronic congestive heart failure (CHF). After a stabilization period of at least 2 weeks with digitalis and diuretics, 73 patients with chronic CHF were randomized to receive additionally either doxazosin or placebo in double-blind fashion. Patients underwent weekly dose adjustments with increasing doses of doxazosin (1, 2, 4, 8, and 16 mg daily) or placebo for 5 weeks, and 67 were evaluated for 12 additional weeks on maximally tolerated doses of blinded study drugs. Treatment groups were evaluated with respect to symptoms of heart failure, indexes of quality of life and left ventricular function, frequency and type of arrhythmia, adverse events, and mortality rates. Doxazosin (11.9 +/- 0.9 mg) given once daily produced a favorable trend in the investigators' and patients' assessments of symptomatic change. Doxazosin was associated with a significantly higher level of voluntary submaximal exercise and a favorable trend on left ventricular ejection fraction (increase of 9.8% of the baseline value vs 2.7% with placebo; p = NS). During the 3-month steady-dosing period, patients treated with doxazosin had a significant (p less than 0.004) reduction in ventricular arrhythmias and significantly fewer morbid and mortal cardiac events (including episodes of worsening heart failure severe enough to prompt discontinuation of the study, myocardial infarction, and death). Doxazosin was well tolerated, producing no major side effects and only a slightly higher frequency of minor treatment-related side effects compared with placebo (p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic alpha-Antagonists↗

Serum magnesium levels in chronic renal failure. Clinical significance and correlation with sodium potassium and calcium.

Fifty cases with chronic renal failure and 25 age and sex matched normal healthy controls were studied. The mean serum magnesium level was significantly higher (4.10 +/- 0.85 mg/dl) in the patients as compared to controls (2.40 +/- 0.14 mg/dl; p less than 0.001) and levels rose progressively with deterioration in renal function. Significantly higher serum magnesium levels were observed in patients of chronic renal failure with encephalopathy than in those without. Greater the impairment in level of consciousness, higher was the magnesium level. Improvement in neurological status correlated well with fall in serum magnesium level. The fall was significantly higher in patients on dialysis as compared to non-dialysed patients. Serum magnesium is a worthwhile tool in assessing duration of disease, morbidity and mortality in patients with chronic renal failure. Its estimation may help in evaluating conservative treatment and dialysis in chronic renal failure.

Adult↗

Coronary artery dissection secondary to blunt chest trauma.

A 38-yr-old woman presented with an anterolateral myocardial infarction following blunt chest trauma sustained in a motor vehicle accident. Subsequent cardiac catheterization revealed a large left ventricular aneurysm and angiographic evidence of dissection of the proximal left anterior descending artery. Review of the literature and management are discussed.

Adult↗

Reversion mode activation by myopotential sensing in a ventricular inhibited demand pacemaker.

Pacemaker follow-up in a 72-year-old woman revealed occasional failure to sense and pace, which was confirmed by Holter monitor. Neither reprogramming the pacemaker sensitivity nor repositioning the lead resolved the problem. A recheck of the Holter recordings revealed pacing and sensing failures were concurrent with "baseline artifact," suggestive of myopotentials. Furthermore, the inappropriate pacing spikes occurred at a rate of 90 pulses per minute (ppm). It was theorized that myopotential sensing was alternately inhibiting the pacer and activating the reversion mode, an asynchronous rate of 90 ppm. Reprogramming the unit to a lower sensitivity restored normal pacer function.

Aged↗

Efficacy of mexiletine in chronic ventricular arrhythmias compared with quinidine: a single-blind, randomized trial.

This single-blind, randomized study was designed to evaluate the efficacy and safety of oral mexiletine compared with oral quinidine in suppressing premature ventricular contractions (PVCs). Fifty-one patients were studied for less than or equal to 12 weeks; 26 patients were randomized to the mexiletine group and 25 to the quinidine group. The drugs were administered in an increasing dose regimen to suppress the PVCs by 70% from the baseline value in both groups. Mexiletine reduced the average number of PVCs by 70% of the baseline number in a comparable fashion to quinidine; 69% in the mexiletine group vs 70% in the quinidine group (p greater than 0.05). There was a comparable reduction (greater than or equal to 50%) of ventricular couplets from the baseline value in the 2 groups, 78% in the mexiletine group vs 86% in the quinidine group (p greater than 0.05). The effect of mexiletine on suppression of ventricular tachycardia was also similar, 72% in the mexiletine group vs 71% in the quinidine group (p greater than 0.05). There was no significant difference in the 2 groups in side effects. This study shows the comparable efficacy and tolerance of mexiletine and quinidine for the control of ventricular arrhythmias in a large number of patients with diverse forms of heart diseases.

Adult↗

Mitral valve prolapse and spasm of normal coronary arteries: report of four cases and review of the literature.

The association between mitral valve prolapse (MVP) and atypical chest pain has been well-described. Numerous theories have been proposed to explain this association. A number of lines of evidence suggest that underlying ischemia may cause chest pain in some patients with MVP. We have recently evaluated 4 patients with chest pain syndromes who had angiographic evidence of MVP and spasm of angiographically normal coronary arteries. The possibility that coronary spasm is the underlying etiology of chest pain in some patients with mitral valve prolapse raises a theoretical argument against beta-blockade in these patients. Three of our patients were successfully treated with calcium channel blockers.

Adult↗

Tracking left ventricular performance noninvasively. Response of the peak ear pulse derivative during cardiac catheterization.

The peak derivative of the ear densitograph displacement pulse was monitored on 12 patients undergoing routine coronary angiography and left ventricular angiography. Simultaneous recording of cardiac output, heart rate, systolic time intervals, and ear densitogram were obtained throughout the progression from before angiographic injections to postcoronary angiography to after left ventricular angiography. The peak derivative of the ear densitogram (PD) consistently tracked mean systolic ejection rate, and changes in PD showed good correlation with changes in ejection rate (r=.749, p less than 0.0001). The PD of the ear densitogram appears to be a reliable noninvasive tool for tracking left ventricular function during hemodynamic and other challenges.

Angiocardiography↗

Noninvasive tracking of peripheral resistance by ear densitography.

Owing to the interaction between the left ventricle and the arterial system, pulse contour during ejection is significantly affected by changes in peripheral resistance. Quantitative description of the pulse configuration as a function of peripheral resistance involves invasive investigation of complex frequency and impedance spectra. The ear densitogram noninvasively yields a pulse wave shown to closely track changes in the central arterial pulse; in this investigation, its decreasing systolic slope responded to changes in the peripheral resistance like those in the central pulse and in arterial models. The decreasing slope of the ear densitogram pulse (RNAD) can reliably track changes in peripheral resistance.

Aorta↗

Cimetidine, vasopressin and chronotropic incompetence.

A 59-year-old man with severe variceal bleeding received therapy with intravenously administered vasopressin and cimetidine. Inappropriate bradycardia, sinoatrial and atrioventricular blocks, and terminal bradycardia leading to asystole, occurred during bleeding, with the greatest number of rhythm abnormalities occurring during combined cimetidine and vasopressin therapy. The results of post-mortem examination showed only mild coronary artery disease. The hazards of combined vasopressin and cimetidine therapy are reviewed.

Arrhythmias, Cardiac↗

Sudden death recorded during Holter monitoring.

Six instances of sudden death were recorded by Holter monitoring, which showed ventricular fibrillation in five and a bradyarrhythmia in one. Complex ventricular ectopic activity preceded cardiac arrest in five patients, including the one with the bradyarrhythmic arrest. Two patients with chronic bifascicular block arrested as a result of ventricular fibrillation. Fifteen cases reports from the literature are reviewed. The composite profile includes advanced myocardial disease (present in all cases), complex ventricular ectopic activity, R-on-T initiation of the terminal rhythm except in patients with prolonged QT interval, and variations in cycle length preceeding the onset of ventricular tachycardia or fibrillation. The role of supraventricular mechanisms in sudden death is uncertain.

Aged↗