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Biomedical subjects

K S Chugh

Publications and source records attributed to K S Chugh.

At least 19 recordsLinked to original sources
PubMed1996

The high incidence of tuberculosis among renal transplant recipients in India.

Tuberculosis is an important infection encountered after renal transplantation in third-world countries. Over an 8-year period, 36 cases of tuberculosis were encountered in 305 renal transplant recipients (11.8%) with grafts functioning for more than 3 months followed up at our center. The infection was limited to the thoracic cavity in 41.7% and a single extrapulmonary site in 11.1%, and it was disseminated in 27.8% cases. In 19.4% of cases, the disease appeared as pyrexia of unknown etiology and the diagnosis was confirmed by a good therapeutic response to antitubercular therapy. Tuberculosis was diagnosed within 1 year of transplantation in 58.3% of cases. There was no significant difference in the incidence of tuberculosis in patients on different immunosuppressive regimens. The Mantoux test was positive in 33.3% patients. A total of 23 patients were treated with isoniazid and rifampicin, with the addition of a third drug for the first 2 months. Treatment was continued for 9 months in 11 cases with isolated pleuropulmonary disease and for 12-15 months in the other 12 patients. The other 13 were on cyclosporine and were given isoniazid, pyrazinamide, and ethambutol for 18 months. Two patients died of fulminant disease and five more died from unrelated causes. No recurrence of disease has been noted in any of the patients after a mean follow-up of 14.6 months. We conclude that the incidence of tuberculosis in renal allograft recipients in third world countries is much higher than that seen in the western world. Most of the cases are encountered in the first posttransplant year. Tuberculosis must be considered seriously in all patients who have prolonged fever of undetermined etiology. Treatment with isoniazid and rifampicin for 9 months is adequate for patients with localized pleuropulmonary disease. In patients on cyclosporine to whom rifampicin cannot be given because of economic considerations, treatment with isoniazid, pyrazinamide, and ethambutol should be given for 18 months.

Adult↗
PubMed1996

Modulation of ouabain sensitive sodium potassium pump of erythrocytes from patients with chronic renal failure: role of acute hemodialysis.

Significantly higher levels of plasma urea creatinine and potassium were observed in patients with renal failure compared to normal controls. The RBC sodium concentration was raised whereas the RBC potassium concentration was decreased in chronic renal failure. These alterations in the RBC Na+ and K+ concentrations were associated with decrease in ouabain sensitive sodium efflux rate and ouabain sensitive sodium efflux rate constant. However, there was no significant impact of acute hemodialysis on the intracellular electrolytes levels, ouabain sensitive sodium efflux rate and ouabain sensitive sodium efflux rate constant. These findings suggest an intrinsic alteration in the transport capacity of Na(+)-K+ pump which could account for the rise in intracellular sodium and fall in intracellular potassium content in the RBCs of chronic renal failure patients.

Creatinine↗
PubMed1995

Role of reactive oxygen species in renal damage in experimental leprosy.

Renal involvement is known to occur in leprosy. In the present study the possible role of reactive oxygen species (ROS) in causation of renal damage in mice infected with Mycobacterium leprae has been investigated. At least six animals from each group (control and infected) were killed at 0 day, 3, 6 and 9 months postinfection. The results showed a significant increase in the chemiluminescence (CL) response of peritoneal macrophages which was maximum between 3 and 6 months. No significant increase was observed in CL response of blood neutrophils. A significant increase in lipid peroxidation was observed at 3 and 6 months as evident by an increase in malondialdehyde levels. The increased ROS production might be the cause of lipid peroxidation. The renal damage is alos evident by decrease in the activity of renal brush border membrane enzymes, namely, alkaline phosphatase, leucine aminopeptidase and r-glutamyl transpeptidase. Thus ROS might play a role during early stages of M. leprae infection but in the later stages other immunological mechanisms may overpower the effect of ROS.

Alkaline Phosphatase↗
PubMed1995

Differences in the care of ESRD patients worldwide: required resources and future outlook.

RRT has crossed the threshold of clinical applications, and its value as an effective modality for management of ESRD is fully established. However, RRT has emphasized the wide gap between developed and developing countries. Most of the developed nations are able to provide sufficient funds, directly or indirectly, for RRT and have organized cadaver donor networks. However, providing RRT is particulary difficult in the developing countries where national incomes are not sufficient to cover even the basic requirements of their citizens. Although some developing countries are making active efforts to establish cadaver donor transplant programs, these are virtually nonexistent in the majority at this time. The abject poverty in the developing world and the increasing success rate of transplantation following the discovery of cyclosporine have led to the commercialization and sale of kidneys for transplantation, an unethical practice which must be curbed. There is a near unanimity of opinion that renal transplantation is far cheaper than prolonged dialysis, and the benefit to the recipient is enormous in terms of the years of life saved and the quality of life. Until such time as cadaveric donor programs become a reality in the developing countries, short periods of dialysis followed by transplants with living-related donor kidneys appear to be the most cost-effective treatments of ESRD.

Forecasting↗
PubMed1995

Primary IgA nephropathy: a preliminary report.

A total of 106 renal biopsies were examined. Each biopsy was processed for routine paraffin sectioning and frozen sectioning. Direct immunofluorescence was done by the conventional method. The immunofluorescence patterns were correlated with histopathological changes and clinical presentation. Fourteen biopsies revealed weak to strong IgA staining and out of these, 11 seemed to fulfil the criteria of primary IgA nephropathy. These cases were diagnosed in a brief period of eleven months and there had not been any earlier published series from India.

Adolescent↗
PubMed1994

Evaluation of three serological tests for detection of anti-candidal antibodies in diagnosis of invasive candidiasis.

Immunoblot detection of antibody against 47 KD cytoplasmic antigen of Candida albicans was evaluated in diagnosis of invasive candidiasis and compared to whole cell agglutination and gel diffusion tests for detection of anticandidal antibody in 64 patients. The patients included 17 with culture proved candidemia, 34 with significant candiduria (more than 10,000 colony forming units per ml of urine) and 13 with nonsignificant candiduria. Antibody against 47 KD antigen was found to be the best indicator for diagnosis of invasive candidiasis even in patients with malignancy. The sensitivity of this procedure was 82.4%, specificity 86.7%, positive predictive value 77.8%, negative predictive value 89.7% and efficacy 85.1%. The gel diffusion procedure lacked in sensitivity whereas whole cell agglutination lacked in specificity. Detection of antibody against 47 KD antigen proved to be a valuable adjunct in the diagnosis of invasive candidiasis.

Agglutination Tests↗
PubMed1994

Spectrum of dermatological lesions in renal allograft recipients in a tropical environment.

A total of 157 renal allograft recipients were followed for over 1-23 months for the development of dermatological lesions. The non-infective lesions related to immunosuppressive drugs included cushingoid features in 133 (84.7%), xerosis in 120 (76.4%), striae in 69 (43.9%), hypertrichosis in 65 (21.6%), facial erythema in 42 (26.7%) and friable skin in 34 (21.4%) patients. Of the infective lesions, cutaneous mycoses were the most frequent (82.6%) and included tinea corporis and cruris in 82 (52.2%), tinea versicolor in 21 (13.3%), candidiasis in 7 (4%), onychomycosis in 4 (2%) and cryptococcosis in 2 (1.2%) patients. Viral infections included those due to herpes zoster in 17 (10.8%), herpes simplex in 5 (3.1%) and viral warts in 13 (8.2%) patients. Cutaneous malignancy was seen in 1 patient only.

Adolescent↗
PubMed1994

Acute renal cortical necrosis--a study of 113 patients.

Over a 28-year period, 113 out of 2986 (3.8%) patients dialysed for acute renal failure at a referral center in North India were diagnosed to have acute renal cortical necrosis (ACN). Obstetric causes were responsible for ACN in 56.6% patients and nonobstetric causes in 43.4%. Within the obstetric group, ACN developed in association with complications of late pregnancy in 37.1% and following septic abortion in 19.5%. The various nonobstetric causes included viperine snake bite in 14.2%, hemolytic uremic syndrome in 11.5%, renal allograft rejection in 5.3%, acute gastroenteritis in 4.4%, acute pancreatitis in 3.5%, septicemia in 2.7%, and trauma and drug-induced IV hemolysis in 0.9% patients. Total anuria was the commonest presenting feature and was noted in 78.8% of patients. Renal histology showed diffuse cortical necrosis in 62.8% and patchy lesions in 37.2% patients. Computerized tomography (CT scan) of the kidneys revealed characteristic diagnostic findings in all the 5 patients in whom it was done. Dialytic support could be withdrawn as a result of improvement in renal function in 19 patients with patchy cortical necrosis. Dialysis-free survival of as long as 12 years has been recorded. The present study shows that, in contrast to the Western world, ACN continues to be a common cause of acute renal failure in developing countries. CT scan of the kidneys is helpful in establishing an early diagnosis.

Acute Kidney Injury↗
PubMed1994

Hyponatremia in sick children: a marker of serious illness.

To study the association between hyponatremia (serum sodium < or = 130 mEq/L) and the final outcome of the illness, we correlated serum sodium concentration at the time of hospitalization with the length of hospital stay and mortality in a prospective study of 727 sick children aged upto 12 years, who sought emergency care. The mean +/- SE duration of hospital stay (7.7 +/- 0.4 days) among 217 children with serum sodium < or = 130 mEq/L was about 30% longer than that of 510 children with serum sodium > or = 131 mEq/L (5.9 +/- 0.3 days) (p < 0.01). This remained unaffected by the sex and the age group, but was further prolonged in children with hypotonic--euvolemic type of hyponatremia as compared to those with hypovolemic hyponatremia. The mortality rate in 510 children with normal serum sodium concentration (> or = 131 mEq/L) was 5.3%. In contrast, it was 17% in 47 children with serum sodium < 125 mEq/L (Relative Risk 3.2; 95% Confidence Interval 1.6-6.7) and 9.3% in 170 children with serum sodium between 126-130 mEq/L (Relative Risk--1.8; 95% Confidence Interval 1.1-3.7) (p < 0.01). Hyponatremia in acutely ill children at admission indicates a poor prognosis.

Child↗