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Biomedical subjects

J C Sharma

Publications and source records attributed to J C Sharma.

At least 19 recordsLinked to original sources
PubMed2006

Diabetes mellitus and stroke.

The aim of this article was to describe (i) the epidemiology and outcomes of stroke relating to diabetes; (ii) the pathophysiology of diabetes as a risk factor for stroke; (iii) the management of acute stroke in patients with diabetes; (iv) the evidence of primary and secondary prevention of stroke in patients with diabetes; and (v) the risk of new-onset diabetes using older antihypertensive agents. The combination of diabetes and stroke disease is a major cause of morbidity and mortality worldwide. Evidence from large clinical trials performed in patients with diabetes supports the need for aggressive and early intervention to target patients' cardiovascular (CV) risks in order to prevent the onset, recurrence and progression of acute stroke. Identification of at-risk patients with diabetes and metabolic syndrome has also allowed the delivery of early and effective intervention to reduce stroke risks, while active treatment during the acute phase of stroke will reduce long-term neurological and functional deficits. While the ongoing debate on the risk benefits of different antihypertensive, lipid-lowering and antiplatelet agents should not detract clinicians from pursuing aggressive CV risk reduction, the application of evidence-based medicine specifically in patients with diabetes will facilitate the use of appropriate agents to improve clinical outcomes. The overall management of patients with diabetes and acute stroke or at risk of secondary stroke should also include multifactorial intervention that not only targets patient's CV risk but also includes behavioural, lifestyle and, where appropriate, surgical intervention.

Anticoagulants↗
PubMed2006

Diabetes prevention: is there more to it than lifestyle changes?

Over the past years, there has been an explosive increase in the prevalence of type 2 diabetes (T2DM) and this is expected to continue, entailing associated morbidity and mortality. An increasing number of studies explore the different ways T2DM could be prevented. On-going lifestyle modifications need to be addressed. High-risk patients should be given counselling on weight loss, possibly using a low glycaemic index diet, with a target of around 7-10% over 6-12 months, as well as instruction for increasing physical activity to around 150 min of physical exercise weekly (NNT = 4-8). Moderate alcohol consumption and coffee consumption may also be of benefit (NNT = 89 and 66, respectively). Metformin (NNT = 14), acarbose (NNT = 11) and troglitazone (NNT = 6) have been shown to prevent/delay T2DM and angiotensin-converting enzyme (ACE) inhibitors and statins appear to have an adjunctive role (NNT = 42 and 112, respectively). Trials with orlistat and bariatric surgery have also prevented T2DM (NNT = 36 and 6, respectively), and forthcoming treatment with GLP1 mimetics appears promising. Diabetes prevention studies should help create well-defined strategies for screening and treating high-risk populations in the real world, as prevention is our only chance to alleviate the ever growing burden of diabetes mellitus in the world.

Diabetes Mellitus, Type 2↗
PubMed2005

The relationship of falls to injury among hospital in-patients.

The need to reduce falls is driven by the need to reduce injury. If patients at risk of injury can be distinguished from the patients at risk of falls, there is the potential for a more effective fall risk management policy by targeting injury prevention measures. We conducted a prospective observational study, with blinded endpoint evaluation of 825 consecutive patients admitted to geriatric rehabilitation wards. We identified 150 fallers (18.2%) contributing 243 falls. Fifty-six patients sustained an injury contributing 73 (30.0%) injurious falls. Only five (6.8%) falls resulted in injury of major severity. We identified no significant differences in demographics between injurious and non-injurious falls. A logistic regression analyses of the independent risk factors of suffering an injurious fall were a history of falls (p=0.036), confusion (p=0.001) and an unsafe gait (p=0.03). However, we identified no significant differences in clinical characteristics between patients suffering injurious and non-injurious falls. None of the characteristics studied can identify patients prone to injury after a fall. Injury is largely unpredictable, and more research is needed to determine how injury can be prevented in patients at risk of falls.

Accidental Falls↗
PubMed2004

Diagnostic and therapeutic value of apomorphine in Parkinsonian patients.

Apomorphine is a dopamine agonist administered subcutaneously for the management of motor symptoms of Parkinson's disease (PD). Patients with Parkinsonian syndrome underwent an apomorphine challenge for therapeutic efficacy, a positive response being a reduction of > 15% score on motor unified PD rating scale. Of the 42 patients, aged 37-81, disease duration 12 months to 20 years, 36 had a positive response. Six non-responders were later diagnosed as non-PD as compared with only two of the 36 responders. Tremor-predominant patients obtained higher motor response. Few patients demonstrated a delayed positive response. Seven (three idiopathic PD (iPD), four non-PD) suffered adverse reactions of nausea, vomiting or ill-sustained symptomatic fall in BP. Majority of the patients who continued with apomorphine therapy were able to reduce levodopa and achieved an improvement in dyskinesia and motor symptoms. Thirteen responding patients were managed by increasing dopamine agonists. Five patients, intolerant of oral dopamine agonists, were able to beneficially tolerate apomorphine. Age and disease duration did not influence tolerability or efficacy. The patients treated with apomorphine were able to significantly reduce the dose of levodopa, and there was a reduction in dyskinesia, hallucinations and fluctuations (all p < 0.05). In some patients, apomorphine prevented admission to institutions. We also describe the use of apomorphine in acutely ill patients unable to ingest oral medication. Apomorphine seems to have a diagnostic element for iPD. Its use leads to a reduction in dyskinesia, improvement in motor symptoms and prevention of institutional care. Apomorphine test also identifies patients likely to benefit with an increase in oral medication. Age and disease duration should not prevent the use of this valuable drug. Apomorphine also has a role in acutely ill PD patients.

Acute Disease↗
PubMed2003

Predictors of a nursing home placement from a non-acute geriatric hospital.

BACKGROUND: Identifying patients who need Nursing Home (NH) care following a hospital admission is important. OBJECTIVE: To identify the factors that predispose to an NH discharge. DESIGN: Prospective observational study with blinded end-point evaluation. SETTING: A non-acute geriatric hospital. SUBJECTS: Two hundred consecutive elderly patients who were admitted for rehabilitation following treatment for an acute illness. MAIN OUTCOME MEASURES: Discharge to an NH or home. RESULTS: Thirty-five out of the 150 live discharges (23.3%) were to an NH. NH discharges had a longer length of stay (38.5 versus 19.8 days; p < 0001). They were more likely to have visual impairment (p = 0.0009), confusion (p < 0.0001), wandering behaviour (p = 0.003), incontinence (p < 0.0001 or unsafe gait (p = 0.0005), to be on tranquillizers (p = 0.003), to be at risk of falls (p = 0.02) and to have sustained a fall while in hospital (p = 0.001). Multiple logistic regression identified confusion (p = 0.001), incontinence (p = 0.02), falls in hospital (p = 0.01), gait abnormalities (p < 0.001), tranquillizers (p < 0.001), impaired distant vision (p = 0.01) and living alone (p < 0.001) as independently associated with the risk of an NH discharge. This risk proportionately increased with the number of risk factors present: 4.28% for 0-2 factors, 25.8% for 3-4 factors and 81.8% for 5-6 factors (p < 0.0001). CONCLUSION: These factors should be the target of specific rehabilitation in an attempt to reduce the risk of discharge to a nursing home and improve patient outcome.

Accidental Falls↗
PubMed2002

Intra-individual difference between recumbent length and stature among growing children.

OBJECTIVE: Difference between recumbent length and stature in an individual has been observed by many researchers in the past in European and American populations. The present study explores the intra-individual differences between recumbent length and stature (R.L.-Stature). METHODS: A sample of 920 school-going children was considered in Chandigarh city. RESULT: These differences are found to be statistically significant and have definite relationship with age and weight of the children. The mean difference between recumbent length and stature is found to be greater in males than in females between 5 through 10 years and between 15 through 18 years of age. However, between 10 through 15 years, it was greater in females than in males. CONCLUSION: This was largely due to the fact that adolescent spurt in stature preceded by two to three years in girls than that of boys. This difference was also found to be significantly correlated with age, weight and stature in both the sexes. Two regression equations are derived separately for the two sexes, from which, one can convert recumbent length into stature and vice-versa.

Adolescent↗
PubMed2001

Non-neurological variables and mortality of acute stroke.

Acute stroke is associated with high mortality. While this is the direct consequence of the neurological injury, stroke patients develop a number of physiological abnormalities and complications in the acute phase. Extensive research has produced a plethora of information about these non-neurological variables. Different patients have different abnormalities. Some of these variables have severe adverse effects on mortality, both acute and long term. Some of the variables are pre-existing, while others are non-modifiable. The body responds to cerebral tissue injury in a way that seems to lead to further damage to the brain and other vital systems, and patients usually have more than one variable needing attention. Acute stroke presents as a multisystem disease on the verge of multisystem failure. Although there is lack of evidence of the benefits of correcting the deranged variables, it makes clinical sense that non-neurological variables should be identified, monitored and managed, with the aim of improving the outcome of acute stroke patients.

Acute Disease↗
PubMed2000

Cardiovascular disease and outcome of acute stroke: influence of pre-existing cardiac failure.

BACKGROUND AND AIMS: Whilst a number of variables, mostly a consequence of a stroke, are known to predict mortality of acute stroke there is limited information on the significance of pre-existing cardiovascular variables on stroke mortality. We have investigated the influence of pre-existing cardiovascular factors in one cohort of stroke patients. METHODS: We studied 295 patients, mean age 74+/-10 (range 34-96) years; 133 males, presenting with acute stroke for pre-existing cardiovascular disease (CVD) defined as hypertension, atrial fibrillation (AF), ischaemic heart disease (IHD) and cardiac failure (CF). In addition, data were collected on epidemiological and neurological variables known to influence stroke mortality. The most significant of the cardiovascular factors was further investigated against all the other cardiovascular groups together and against those without any CVD. Outcome was measured as their influence on acute phase and 3-month mortality. RESULTS: There was no significant difference in 3-month mortality with hypertension (P=0.62) and IHD (P=0.33) but there was a significant higher mortality in patients with AF (P=0.05) and CF (P <0.001). CF was more significant than all other CVD (hypertension+AF+IHD) together without the failure (P<0.001); odds ratio of 4.5 (95% CI 2.28-9.07). Partial correlation coefficient revealed CF to be an independent significant variable to influence stroke mortality when controlled with AF, stroke syndromes, age, incontinence, pyrexia, dysphagia and Glasgow coma score. CONCLUSIONS: Pre-existing CF has an adverse influence on stroke mortality independent of other known factors. Cardiovascular factors without failure do not have such an effect except the marginal effect of AF.

Adult↗
PubMed2000

Prognostic value of CT scan features in acute ischaemic stroke and relationship with clinical stroke syndromes.

The aim of this prospective study was to investigate the value of CT scan in prognosis of acute ischaemic stroke patients as a variable additional to clinical stroke syndromes to develop a simple classification of CT scan features to provide a practical approach to prognosticate and manage such patients. One hundred and eight nine patients admitted with ischaemic stroke were investigated with a CT scan. CT scan features were classified into two groups: large infarct, LI (across more than one lobe) and non-large infarcts (N-LI) for all other features. Patients were also studied for clinical syndromes, analysing results for total anterior circulation syndrome (TACS). Outcome was measured as early post stroke Barthel index, acute phase and 3-month mortality. Patients with LI had features of severe strokes and had a lower Barthel index (p < 0.001), lower Glasgow coma score (p < 0.001), more association with incontinence (p < 0.001), pyrexia (p = 0.007) and dysphagia (p < 0.001). LI patients required higher level of care in acute wards and had a higher length of stay (p = 0.01). Both the LI and TACS individually had a significantly higher mortality (p < 0.001) and similar positive predictive value, sensitivity and specificity for 3-month mortality. While the combined factor of 'large infarct and TACS' provided the highest likelihood ratio (3.1) for mortality, the factor of 'large infarct or TACS' was the most sensitive (85%) to identify majority of patients at a risk of mortality. N-LI patients had a better prognosis. Classification of cerebral infarcts into large and non-large categories identifies patients who require higher level of care in acute wards and have a higher mortality. Combined factor of 'large infarct and/or TACS' identifies the majority of patients at risk of 3-month mortality as compared to either variable taken individually. CT scan features are complimentary to clinical syndromes for managing acute stroke patients.

Adult↗
PubMed2000

An epidemiological study of falls on integrated general medical wards.

Reducing falls in hospital requires an environmental as well as a patient-orientated approach. We studied patient and ward characteristics relating to falls in an acute setting. In a prospective open observational study, we examined fall characteristics in two nuclear designed wards (A and B) and a longitudinal ward (C). We recorded 63 falls among 1609 patients. Ward C had the most falls (31 vs 18/14; p = 0.01), fall positive days (29 vs 15/10; p = 0.002) and fallers (27 vs 13/12; p = 0.001; OR 2.54, CI--1.41-4.57). Ward C had a higher cumulative risk of falls (p = 0.006) and fall positive days (p = 0.003). Choice of ward was a significant independent risk factor for falls (p = 0.01) when controlled for age, sex, and diagnostic variation between the wards. Most falls were intrinsic (A 66.7%, B 64.2%, C 61.3%, p = 0.45). A significantly higher proportion of falls on ward C occurred by the bed (p = 0.04). Significant differences exist between the wards, and fall reduction programmes should identify and compensate for adverse ward-related factors to increase the effectiveness of patient-targeted fall risk assessments.

Accidental Falls↗
PubMed1997

Age-related changes in cognitive ERPs of attenuation.

This investigation explored developmental changes in passive and effortful components of ERPs associated with a visual attention task in children, adolescents, and adults. The task was a 'go-go' version of a continuous performance task, coupled with a passive attending phase in which the subjects merely watched the stimuli of the task. The three age groups featured a constellation of ERP components that shared the same general morphological appearance and distribution, but differences were seen with respect to latencies and amplitudes. Consistent with other studies, there was an inverse relationship with respect to age and peak latencies of the major passive and effortful components. With respect to peak amplitudes, however, the most impressive changes with age were observed in the passive processing components. For example, the P150 and P250 components presented greater amplitudes in children, whereas the N200 component presented its greatest amplitude in adults. While passive in the sense that their appearances were independent of the 'decision-making' process, these components were found to be upwardly adjustable by effort. The late positive component was found to be a combination of a passive P350 and an effortful P450. The P350 component was judged to be largely passive in character as it was well developed in subjects of all age groups when passively attending to the visual stimuli. There was no marked amplitude difference between the child and adult P450 components, but the components peaked in amplitude later in the children. Finally, the children's ERPs featured a distinct frontal negativity (FN) that was present in the Passive phase, but greatly enhanced during the Effortful phase. This study, as have many others, showed that there are reliable developmental changes in the components of visual ERPs. Therefore, the characteristics of the various components of cognitive ERPs may be effective markers of neurodevelopmental status, especially of those neuronal systems vital to attentional processing and effort regulation.

Adolescent↗
PubMed1996

Topographical analysis of adolescent affective disorders.

This study evaluated the EEG spectral content and the components of the cognitive ERPs evoked by a visual sustained-selective attention task from adolescents diagnosed as having an affective disorder and those who did not (nonreferred controls, CON) to determine if there were different electrophysiological profiles associated with major subtypes of affective disorders; i.e., Dysthymic Disorder (DysD) and Cyclothymic Disorder (CycD). Distinctive ERP and EEG profiles were found to be associated with the DysD and CycD groups. While both groups of depressives presented diminished P3b amplitudes, the DysD group showed a relatively greater suppression over the right temporal regions, whereas the CycD group exhibited relatively greater suppression over the left temporal region. In addition, there were differences with respect to the earlier components associated with information processing. For instance, the P1 was found deficient in the DysD group as compared to the other groups, whereas the N2 component was deficient in the CycD groups as compared to CON and DysD groups. In contrast to these amplitude differences, no significant latency differences were seen with respect to any component elicited by this paradigm. With respect to the EEG spectra, the CON group showed greater relative power in the Beta range than either the CycD or the DysD group, with the depressives featuring more midline frontal Theta activity. Characteristically, both depressant groups showed a greater anterior distribution of Alpha activity. In addition, the foci of the various spectral bands for the DysD subjects were shifted away from the right hemisphere as was the case for the P3b. Overall, the profiles suggested that those who fit the diagnostic classification of DysD have deficit function in right post-Rolandic zones, along with anomalous frontal function. It was also suggested that there may be a core disturbance of physiological arousal in unipolar depression. The CycD subjects, on the other hand, featured no hemispheric bias with respect to the P3b components or spectral foci, but did not show similar features of being cortically "hypoaroused" so that actively depressed adolescent CycD subjects did share certain physiological features with unipolar subjects.

Adolescent↗