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Biomedical subjects

K Garg

Publications and source records attributed to K Garg.

At least 19 recordsLinked to original sources
PubMed2002

Respiratory distress in neonates with special reference to pneumonia.

OBJECTIVE: (i) To find causes of respiratory distress in neonates brought to a referral neonatal unit with symptoms suggestive of respiratory disorder; (ii) to evaluate clinical signs for diagnosis of neonatal pneumonia; (iii) To determine bacterial etiology of neonatal pneumonia; and (iv) To determine indicators of fatality in neonatal pneumonia. DESIGN: Prospective descriptive. SETTING: Referral neonatal unit of a teaching hospital. SUBJECTS: 150 neonates admitted with respiratory symptoms consecutively. METHODS: All neonates presenting with respiratory symptoms were included in the study. The diagnosis of the cause of respiratory distress was based on guidelines recommended by the National Neonatology Forum. Clinical features, FiO2 requirement, sepsis screen, X-ray chest, blood culture and antibiotic sensitivity, arterial blood gases and other relevant investigations were documented in a structured proforma. The neonates were regularly followed up for outcome. Multivariate unweighted logistic regression was done to find out the indicators of fatality in neonatal pneumonia for those variables which were significantly associated with outcome on univariate analysis. RESULTS: Pneumonia was found to be the most common cause (68.6%) of respiratory distress in neonates. Other conditions included hydline membrane disease (HMD), transient tachypneia of new born (TTNB), birth asphyxia with hypoxic ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS). Clinical signs and symptoms were non specific and did not differentiate between pneumonia and other causes of respiratory distress. Respiratory rate was less than 60 per minute in 11.6% neonates with pneumonia. The most common organism responsible for neonatal pneumonia was Klebsiella pneumoniae. Chest X-ray was clear in 15% of neonates with pneumonia. On univariate analysis weight < 2000 g, gestation age < 34 weeks, age at presentation < 72 hours, lethargy, absent neonatal reflexes, shock, positive C-reactive protein, positive ventilatory support, blood culture positivity, Silverman Score >3, FiO2 >40%, pH < 7.2, alveolar arterial gradient (AaDO2) > 250 mmHg and arterial alveolar tension ratio (a/A) of < 0.25 were significantly associated with mortality in neonates with pneumonia. However, on multivariate analysis, only AaDO2 of > 250 mmHg was found to be independent predictor of fatality in neonatal pneumonia. CONCLUSION: Pneumonia was the most common cause of respiratory distress in neonates. Clinical features and X-ray chest missed the diagnosis of pneumonia in 15 cases and had to be corroborated with sepsis screen and blood culture. AaDO2 > 250 mmHg was an independent predictor of fatality in neonatal pneumonia

Analysis of Variance↗
PubMed2001

Thromboembolic disease: variability of interobserver agreement in the interpretation of CT venography with CT pulmonary angiography.

OBJECTIVE: The objective of this study was to determine interobserver agreement in the diagnosis of acute deep venous thrombosis on CT venography performed in addition to CT pulmonary angiography. SUBJECTS AND METHODS: One hundred forty-six CT venograms of 144 patients (mean age, 61.74 years) clinically suspected of having pulmonary embolism were analyzed prospectively and independently by two experienced thoracic and body imaging radiologists and later by consensus of the two radiologists. The CT venography protocol consisted of 5-mm-thick axial images at 20-mm intervals from the popliteal fossa to the renal veins. Images were acquired 3-4 min after the start of 100-150 mL of undiluted contrast medium administration at 4 mL/sec. Thirteen venous segments were analyzed in each patient. There were 1586 analyzable venous segments. RESULTS: Interobserver agreement, with the patient as the unit of analysis, was moderately good (kappa, 0.59; 95% confidence interval [CI], 0.39-0.78). Kappa values were similar for CT venography studies performed with 150 mL of contrast medium and 4-min delay (kappa, 0.62; 95% CI, 0.30-0.88) and with 3-min delay and 100 mL of contrast medium (kappa, 0.56; 95% CI, 0.32-0.80). Interobserver disagreement occurred in 17 (12%) of 146 CT venography studies. Findings of 11 CT venography studies were interpreted as negative, and six were interpreted as positive after consensus interpretation. CONCLUSION: Interobserver agreement for deep venous thrombosis with CT venography is moderately good.

Adult↗
PubMed2000

Thromboembolic disease: comparison of combined CT pulmonary angiography and venography with bilateral leg sonography in 70 patients.

OBJECTIVE: The purpose of this study was to compare combined CT pulmonary angiography and venography with leg sonography for accuracy and relative efficacy in diagnosis of deep venous thrombosis from the popliteal vein to the common femoral vein. SUBJECTS AND METHODS: Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT pulmonary angiography and venography and bilateral leg sonography within 24 hr. CT venograms were analyzed independently in a blinded fashion for quality of venous opacification and patency by two observers. CT venography was compared with sonography for femoropopliteal vein thrombosis, and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. RESULTS: Sixty-eight patients (97%) had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients (100% sensitivity, 97% specificity, 100% negative predictive value, and 71% positive predictive value). CT venography was better and more efficacious than sonography (category 1) in 25 patients (36%). CT venography was equivalent to sonography (category 2) in 26 patients (37%), and sonography was better than CT venography (category 3) in 19 patients (27%). CONCLUSION: Compared with sonography, CT venography in addition to CT pulmonary angiography is a relatively accurate method for evaluation of femoropopliteal venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than sonography or two separate examinations in selected patients.

Adult↗
PubMed1999

Frequency of ovarian cysts in patients with autosomal dominant polycystic kidney disease.

Extrarenal cysts occur in patients with autosomal dominant polycystic kidney disease (ADPKD) most frequently in the liver. Ovarian cysts have been reported in women with ADPKD, but their frequency has not been determined. Therefore, we analyzed the historical data in our database of 337 women with ADPKD and 199 of their unaffected female family members (NADPKD). In addition, we prospectively studied 25 nonpregnant, premenopausal women with ADPKD and 25 nonpregnant, premenopausal, age-matched control women recruited from the general population to assess the occurrence of ovarian cysts. No women in either the control or ADPKD groups were receiving exogenous estrogen or progesterone. All women underwent sonographic examination using a 5- or 7.5-MHz vaginal probe. A normal ovarian follicle was defined as a fluid-filled structure less than 2 cm in average diameter, and an ovarian cyst as one of 2 cm or greater. From the historical data, 28% of the women with ADPKD gave a history of ovarian cysts compared with 18% of the NADPKD women (P < 0.05). In the prospective study, the mean age of the women with ADPKD was not different from that of the control women (40.9 +/- 1.2 v 39.3 +/- 1.2 years; P = not significant [NS]). There was no difference in frequency of normal follicles found in women with ADPKD or controls (80% v 96%; P = NS), nor was there a difference in the frequency of ovarian cysts found in women with ADPKD or controls (12% v 12%; P = NS). There was no difference in the calculated ovarian volumes between the women with ADPKD and controls (9.9 +/- 2. 5 v 7.2 +/- 1.2 cm3). Among the women with ADPKD, there was no correlation between mean ovarian volume and mean renal volume, nor was there a significant relationship between the occurrence of hepatic cystic disease and ovarian cysts. Therefore, a prospective imaging study suggests that ovarian cysts have no increased frequency in women with ADPKD compared with women in the general population.

Adult↗
PubMed1999

Identification of candidate coding region single nucleotide polymorphisms in 165 human genes using assembled expressed sequence tags.

Using assembled expressed sequence tags (ESTs) from 50 different cDNA libraries, we have identified contigs that represent the complete coding sequences of 850 known human genes, and have scanned these for high quality sequence substitutions. We report the identification and characteristics of 201 candidate single nucleotide polymorphisms found in the coding sequences (cSNPs) of 165 of these genes. Using a conservative calculation, coding region nucleotide diversity (the average number of differences between any pair of chromosomes) was found to be 3 per 10,000 bp based on this data. This analysis reveals that assembled ESTs from multiple libraries may provide a rich source of comparative sequences to search for cSNPs in the human genome.

Amino Acid Substitution↗
PubMed1999

Clinical validity of helical CT being interpreted as negative for pulmonary embolism: implications for patient treatment.

OBJECTIVE: The purpose of our study was to assess the clinical usefulness of helical CT findings that are interpreted as negative for pulmonary embolism. MATERIALS AND METHODS: One hundred twenty-six patients underwent 132 helical CT examinations and 352 patients underwent ventilation-perfusion scanning for suspected acute pulmonary embolism over a 17-month period at a single institution. Findings from clinical follow-up at a minimum of 6 months were assessed, with a special focus on the presence of recurrent thromboembolism and mortality in 78 consecutive patients in whom helical CT findings were interpreted as negative for pulmonary embolism and anticoagulant therapy was not administered (group I). During the same 17-month period, 46 patients underwent ventilation-perfusion scanning that was interpreted as normal (group II), and 132 patients underwent ventilation-perfusion scanning that was interpreted as showing a very low to low probability for pulmonary embolism (group III). Patients in groups II and III did not undergo helical CT or pulmonary angiography and did not receive anticoagulant therapy. However, clinical follow-up was solicited. Patients from groups II and III were used as control subjects. RESULTS: Nine patients in group I died, one of whom was found to have a microscopic pulmonary embolism at autopsy. In group II, four patients died, none of whom were shown to have a missed or recurrent pulmonary embolism. Of the 18 patients in group III who died, three had a recurrent or missed pulmonary embolism (mean interval, 9 days), and two were found to have deep vein thrombosis on sonography of the leg (mean interval, 12 weeks). Negative predictive values for helical CT, normal lung scanning, and low-probability ventilation-perfusion scanning were 99%, 100%, and 96%, respectively (p = .299). CT provided either additional findings or an alternate diagnosis in 42 (53.8%) of the 78 patients in whom helical CT findings had been interpreted as negative for pulmonary embolism. CONCLUSION: A helical CT scan can be effectively used to rule out clinically significant pulmonary emboli and may prevent further investigation or unnecessary treatment of most patients.

Adult↗
PubMed1998

Pulmonary embolism: diagnosis with spiral CT and ventilation-perfusion scanning--correlation with pulmonary angiographic results or clinical outcome.

PURPOSE: To compare the accuracy of spiral computed tomography (CT) with that of ventilation-perfusion (V-P) scintigraphy in the diagnosis of pulmonary embolism (PE). MATERIALS AND METHODS: Fifty-four patients in whom indeterminate V-P scans or discordant clinical and scintigraphic results were obtained underwent both V-P scanning and contrast material-enhanced spiral CT. The reference standard was pulmonary angiographic results in 26 patients (group I) or clinical outcome in 28 (group II). RESULTS: Six (25%) of 24 group I patients had proved PE. The prospective sensitivity and specificity for segmental or subsegmental PE were 67% and 100%, respectively, and the positive and negative predictive values were 100% and 90%, respectively. In two group II patients, V-P scans had high probability for acute embolism, but spiral CT scans showed only chronic PE; in one patients, the V-P scan had low probability and the CT scan was positive for acute PE. An alternative CT diagnosis was established in four (31%) of 13 patients in whom a normal or low-probability V-P scan was obtained. Clinical outcome was consistent with spiral CT results in all cases. CONCLUSION: Spiral CT has greater accuracy and specificity than V-P scanning in patients with an unresolved diagnosis and may be useful as the primary screening technique for PE.

Acute Disease↗
PubMed1997

Academic performance of various categories of students admitted to Lady Hardinge Medical College, New Delhi.

A retrospective study of 4 consecutive academic batches of students was conducted to analyse the performance level of students in 3 university examinations of MBBS. The students were divided into 3 categories based on the criteria of entrance into the medical college. The category I included students who entered through a tough pre-medical test, category II comprised those nominated by government and defence personnel and category III included the Schedule Caste and Schedule Tribe students. The results of the category I was remarkably better than that of II while that of category III was dismal. The last two categories had a large number of students leaving the college without completing their course resulting in 5.4% wastage of precious medical seats and psychological distress. Necessary remedial measures must be planned at the earliest.

Adult↗
PubMed1996

Lung transplantation: indications, donor and recipient selection, and imaging of complications.

Lung transplantation has become a well-established treatment for end-stage pulmonary parenchymal and vascular disease. Careful selection of recipients and donors is important to decrease early graft failure, which is primarily due to rejection and bronchial dehiscence. Common complications include the reimplantation response, acute rejection, pleural effusion, lymphoproliferative disorders, bronchiolitis obliterans, infection, and airway stenosis or dehiscence. The reimplantation response is a form of noncardiogenic pulmonary edema that begins soon after surgery and resolves in days to weeks. Acute rejection occurs in most recipients; a dramatic response to steroid therapy is the most diagnostic clinical feature. Lymphoproliferative disorders are posttransplantation neoplasms that may disappear when immunosuppressive therapy is stopped and often manifest as a discrete lung mass. In bronchiolitis obliterans-a major long-term complication probably due to chronic rejection-computed tomography (CT) often shows bronchial dilatation and air trapping. Airway stenosis and dehiscence are easily diagnosed with bronchoscopy and CT. Infections remain the major cause of morbidity and mortality.

Adult↗
PubMed1995

Perforation of the great vessels during central venous line placement.

BACKGROUND: Placement of central venous lines for the administration of a variety of therapies has become common practice. The most severe complication of this procedure is perforation of a large vessel, with bleeding, infusion of fluids into an extravascular site, and death. It is not clear from currently available data how often this occurs, what risk factors are associated, and how this complication can be avoided. METHODS: We reviewed the records of all patients who were identified as having perforation of a major vessel during central venous line placement occurring between 1986 and 1993 at the University Hospital, the major teaching facility of the University of Colorado Health Sciences Center, Denver. Data collected included the age and sex of the patient, diagnosis, type of catheter and site of placement, operator means and time to the diagnosis of perforation, and outcome. RESULTS: Eleven such complications were identified and 10 of them are reviewed in detail. The overall incidence was less than 1%. Most complications occurred when the right subclavian vein approach was attempted, and they were thought to result from guidewire kinking during advancement of a vessel dilator. All medical specialties and levels of training were involved. Four of 10 patients died of immediate or subsequent complications of the perforation. CONCLUSIONS: Perforation of a great vessel is an uncommon, but often fatal, complication of central venous line placement. It occurs most often, when using the right subclavian vein approach, from guidewire kinking. Physicians performing this procedure should have formal training in central venous catheterization and be aware of this complication, its presumed cause, diagnosis, and treatment.

Adult↗
PubMed1995

Histological and mechanical comparison of hydroxyapatite-coated cobalt-chrome and titanium implants in the rabbit femur.

The purpose of this study was to compare hydroxyapatite (HA)-coated titanium (Ti) and HA-coated cobalt-chrome (CoCr) implants in the distal femur of the rabbit by evaluating bone apposition and interfacial shear strength. Bilateral cylindrical implants with a plasma sprayed 50-microns thick HA coating were press-fit into the metaphyseal cancellous bone of the lateral femoral condyles in a transverse fashion, and the animals were sacrificed at 2, 4, and 8 weeks postimplantation. Mechanical strength of the interface between HA and bone was measured using the pushout method. For histologic analysis, the fractional linear extent of bone apposition was quantitated. No differences were found in the interfacial shear strength between the Ti and CoCr at any time period. The amount of bone apposition increased significantly at each time interval for both substrate metals, but there were no significant differences between the two substrates at any of the time periods studied. The HA-coated CoCr implants performed in a similar manner to the HA-coated Ti implants, both mechanically and histologically, suggesting that HA-coated CoCr implants deserve further study as a viable alternative to Ti for the biological fixation of total joint components in orthopaedic surgery.

Animals↗
PubMed1994

Attenuation of benzanthrone toxicity by ascorbic acid in guinea pigs.

Oral administration of benzanthrone (BA) (50 mg/kg body wt/day) to guinea pigs for 30 days resulted in depletion of ascorbic acid (ASA) in the liver, adrenals, and blood serum and in growth retardation (36%) and an increase (18%) in relative liver weight when compared to controls. BA treatment showed a tendency toward normocytic anemia with a decrease in hemoglobin content, reduction in RBC counts, and lowered packed cell volume. Guinea pigs treated with BA showed histopathological changes in liver including fibrosis, bile duct proliferation, and focus necrosis. Testes showed marked damage of seminiferous tubules with vacuolar degeneration and irregular and distorted interstitial spaces. BA showed evidence of patchy glomerular congestion, tubular lesions, and damaged epithelial cells in kidney, while urinary bladders had mild congestion in lamina propria and submucosa. Hepatic GOT, GPT, and LDH were found to be significantly decreased (17.5-33.5%), whereas activities of these enzymes showed a significant elevation in serum of BA-exposed guinea pigs. BA treatment also led to significant decrease of testicular hyaluronidase (29.8%) and LDH (19.8%) and significant depletion of lactic acid content (14.7%). Prior daily oral supplementation with ASA (50 mg/kg body wt) to BA-administered guinea pigs resulted in marked improvement of histopathological and biochemical changes observed in liver, testis, kidney, and urinary bladder of BA-exposed animals. These results suggest that extra supplementation of ASA could attenuate the toxic manifestations of BA.

Animals↗
PubMed1994

Proliferative and constrictive bronchiolitis: classification and radiologic features.

The small airways of the lung consist of the terminal bronchioles, respiratory bronchioles, and alveolar ducts. A recently introduced pathologic classification system divides bronchiolitis into proliferative and constrictive types. The histologic classification of small-airways disease into proliferative and constrictive bronchiolitis frequently correlates with the radiographic appearances. Proliferative bronchiolitis is characterized by air-space opacification, whereas constrictive bronchiolitis tends to be associated with lobular areas of decreased attenuation and airway dilatation. The purpose of this essay is to illustrate the radiographic and CT features of these two varieties of bronchiolitis.

Bronchiolitis↗
PubMed1993

Endometrial estrogen and progesterone receptors within 2-14 days of missed menses in the human.

Serial changes in the endometrial levels of estrogen and progesterone receptors (ER and PR) were measured in 50 women from days 2 to 14 of missed menses and correlated with the plasma concentrations of hCG, progesterone and 17 beta-estradiol. Both ER and PR of nuclei were higher than cytosolic proteins, with a shift in the ratio of nER/nPR to nPR from 4th day after missed menses. On Scatchard analysis of the cytosolic and nuclear binding proteins, two classes of proteins, corresponding to Type I and II, were found. While the increasing levels of hCG maintained luteal secretion of progesterone and 17 beta-estradiol at normal mid-luteal phase levels, a gradual increase in 17 beta estradiol from 9th day of missed menses was noted. This delicate balance between circulating levels of progesterone and 17 beta-estradiol and their nuclear receptors at early stages of pregnancy may be of significance.

Cell Nucleus↗