PubMed Health⌕ Search

Biomedical subjects

K V Dakshinamurty

Publications and source records attributed to K V Dakshinamurty.

17 recordsLinked to original sources
PubMed2006

Non-fatal gastric mucormycosis in a renal transplant patient and review of the literature.

Mucormycosis is historically associated with substantial morbidity and carries a very high mortality in renal transplant patients. The common sites of involvement include cerebral, pulmonary, gastrointestinal, or disseminated lesions. We report the successful outcome of gastric mucormycosis along with Strongyloides stercoralis infection in a renal transplant patient, who has survived for 5 years. We also review the literature.

Adult↗
PubMed2006

Utility of HCV core antigen ELISA in the screening for hepatitis C virus infection in patients on hemodialysis.

An enzyme immuno assay for hepatitis C core antigen was recently developed and its performance was compared with that of the hepatitis C virus (HCV) RNA in the screening of HCV infection in patients on hemodialysis. One hundred and eleven chronic renal failure patients undergoing haemodialysis between May 2003 and October 2004 were included in the study. All the patients were tested for anti HCV antibody, core antigen and RNA. Fifteen patients were anti HCV antibody positive, three patients were positive for HCV core antigen and RNA, three patients were positive for HCV RNA, while two patients were positive only for core antigen but negative for RNA. In anti HCV antibody positive patients, the core antigen was negative while the viral RNA continued to be present. Hence, relying solely on a single HCV core antigen assay may not be useful for a definite diagnosis of early HCV infection. The sensitivity and specificity of the assay were 60% and 83% respectively, while the positive predictive value was 14.3%, negative predictive value was 97.7% and the efficiency was 81.9%.

Enzyme-Linked Immunosorbent Assay↗
PubMed2004

Emphysematous renal tract disease due to Aspergillus fumigatus.

Emphysematous renal tract disease (ERTD) is a rare necrotizing infection of renal parenchyma and/or urinary tract caused by gas producing organisms. A case of acute emphysematous renal tract disease (ERTD) (emphysematous pyelonephritis along with emphysematous cystitis) caused by Aspergillus fumigatus in a non-diabetic patient, who did not apparently have any risk factor for fungal infection, is presented. Patient had refused for any surgical intervention. He was treated successfully with liposomal amphotericin B and 5-flucytosin and achieved complete recovery. Various causes of ERTD and available therapeutic options are discussed.

Adult↗
PubMed2003

Oxidative stress in hemodialysis--postdialytic changes.

BACKGROUND: There is evidence for production of free oxygen radicals during hemodialysis. Hemodialysis is an intervention that is intermittent and is usually undertaken once in two or three days. It is known that the free oxygen radicals are short lived. Hence, it is necessary to know how long the effects of this oxidative stress are seen in the postdialytic period and whether they are carried over to the next dialysis. Review of the literature showed that there is no information in this area. Hence, this study was undertaken in order to learn whether oxidative stress due to a dialysis session is carried over to next dialysis session or not. METHODS: The effects were studied after four different types of membrane and dialysate--Polysulphone-Bicarbonate (PB), Polysulphone-Acetate (PA), Cuprophan-Acetate (CA) and Cuprophan-Bicarbonate (CB). Two consecutive dialysis sessions were studied to know the effect of re-use of the membrane. For each dialysis session, blood samples were collected at 0 (immediately prior to dialysis or preHD), 4 (immediate postdialysis), 6, 12, 24 and 48 hours (start of next session). Lipid peroxides, SOD and GP were determined in erythrocytes. Vitamins A and E and lipid peroxides were estimated in plasma. RESULTS: In the postdialytic phase there was an increase in plasma lipid peroxide levels. Plasma vitamin E levels increased significantly in all groups after first use dialysis, whereas the increase found after re-use dialysis was not statistically significant. Erythrocyte lipid peroxide levels showed a significant decrease. No significant changes were observed in the plasma vitamin A, erythrocyte SOD and GP levels. There was no significant change in any of the parameters between preHD and either 48-hour or 96-hour samples in all groups studied. CONCLUSIONS: Our results show that there is no carry-over of oxidative stress produced by dialysis to the next session regardless of the type of dialysis.

Adult↗
PubMed2001

Oxidative stress in haemodialysis--intradialytic changes.

Oxidative stress is likely to be involved in the development of complications due to haemodialysis. Though there is evidence for production of oxygen free radicals during haemodialysis, reports on net oxidative imbalance due to a single dialysis session are conflicting. Hence, a time-course analysis of changes in lipid peroxides (LPO) along with antioxidant enzymes and vitamins was carried out. Hourly changes in LPO and antioxidants were studied during a first-use cuprophan membrane and acetate dialysis in 20 patients on regular haemodialysis treatment. Data were corrected for haemoconcentration and standardised to measure the rate of change before statistical evaluation using analysis of variance for repeated measures. The results of the study showed a net oxidative stress due to a single dialysis session in the form of increased plasma and erythrocyte lipid peroxidation, decrease in plasma vitamin E, slight increase in plasma superoxide dismutase and erythrocyte glutathione peroxidase and no change in plasma glutathione peroxidase. erythrocyte superoxide dismutase and plasma vitamin A levels. The oxygen radical production was found to be maximum in the first hour of dialysis.

Adult↗
PubMed2001

Oxidative stress in haemodialysis: immediate changes caused by passage of blood through the dialyser.

Oxygen free radicals have been implicated in the long-term complications of maintenance haemodialysis. Studies that have probed into the mechanisms of oxygen radical production have implicated the bio-incompatibility of dialysis membranes. Changes between the arterial (inlet) and venous (outlet) points of a dialyser may give a better picture of blood membrane interaction. There are very few studies on changes across the dialyser. Hence, it was planned to study the immediate changes that occur due to passage of blood through the dialyser. Changes between the arterial and venous ends of the dialyser after 1 h of dialysis were studied in four combinations of dialysate and membrane. There was a significant decrease in plasma vitamin E concentrations in all the groups during first-use dialysis. This was not observed with re-use dialysis. A decrease in plasma lipid peroxides was also observed in all the groups with both first and re-use dialysis. There was no significant difference in the parameters studied among the four types of dialysis. A less severe, reactive oxygen radical generation was observed with re-use of membranes.

Adult↗
PubMed1993

Pharmacokinetics and pharmacodynamics of famotidine in patients with reflux oesophagitis.

The pharmacokinetics, pharmacodynamic effect and clinical efficacy of famotidine were studied in 10 patients with reflux oesophagitis Grades I and II. For the pharmacokinetic studies the patients received 20 mg famotidine i.v. The half-life of famotidine was 3.8 h, the total plasma clearance was 297 ml.min-1, and a steady state volume of distribution of 1.2 l.kg-1 was found. For pharmacodynamic assessment, intraoesophageal pH-metry was performed without and after acute treatment with famotidine 20 mg i.v. and following 3 weeks of oral famotidine 80 mg b.d. The resultant percentage total acid exposure time (pH < 4 within 24 h) were 23.9%, 19.0% and 19.2% (median), respectively (NS). At the end of 6 weeks of oral therapy, symptomatic and endoscopic improvement had occurred in 9 and 5 patients, respectively. Our study shows that the pharmacokinetics of famotidine in patients with reflux oesophagitis is comparable to that in healthy volunteers and peptic ulcer patients. The clinical response to the treatment appeared comparable to that found after other H2-receptor antagonists.

Adult↗
PubMed1993

Response of vasoactive substances to intermittent ultrafiltration in normotensive hemodialysis patients.

The changes in blood volume (BV), atrial natriuretic peptide (ANP), plasma renin activity (PRA), aldosterone (Aldo), norepinephrine (NE), epinephrine (Epi), parathyroid hormone (PTH), arginine vasopressin (AVP) and the cyclic nucleotides cAMP and cGMP were measured during a fluctuating BV cycle in 15 patients with end-stage renal failure maintained on chronic hemodialysis (HD). HD consisted of 4 periods of about 60 min each. The first half of each HD period consisted of ultrafiltration (UF) greater than 1,000 ml/h, and the second half consisted of no UF. Changes in relative BV were measured using continuous hemoglobinometry. Total BV at the end of treatment was 74.3 +/- 6.9% of the pretreatment volume. A significant positive correlation between BV and the levels of ANP, PTH, Epi and cGMP and an inverse correlation between BV and PRA, Aldo, AVP and NE were demonstrated. While mean values of NE and AVP levels were directly related to actual changes in BV, individual values did not homogeneously reflect this relationship. The cyclic nucleotides cGMP and cAMP did not follow immediate BV changes, but showed a significant decrease correlated with diminished BV. Based on a pre-postdialysis analysis, significant changes in PRA and Aldo were missing. It seems possible that vascular stability in dialysis patients may be maintained by the response of NE and AVP, and not by the renin-aldosterone system. The changes in ANP and cGMP values correlated most significantly (r = 0.38 and r = 0.51, p < 0.005) with the changes in BV, but no single variable could explain the blood pressure regulation during HD with intermittent rapid UF.

Adult↗
PubMed1993

Prevalence of Helicobacter pylori in patients with chronic renal failure.

The prevalence of Helicobacter pylori (H. pylori) was investigated in 164 consecutive patients with different degrees of renal function; group I (normal renal function) n = 84, group II (chronic renal failure, CLCR > or = 5 < 90 ml/min) n = 45, group III (haemodialysis therapy) n = 35, to test the hypothesis that the resulting different concentrations of urea in the gastric juice would have an influence on the colonization of the gastric mucosa by these urea-splitting bacteria. As every individual method for the detection of H. pylori shows disadvantages, the results of the detection methods used (urease test, Warthin-Starry stain, bacterial cultivation, direct examination of the processed sample by phase-contrast microscopy) were combined in a cumulative evaluation. These calculated cumulative indices for the antrum and corpus showed no statistically significant differences between the studied groups. The prevalence of H. pylori ranged from 34 to 54%. The histopathological findings were similar in all groups. In spite of the fact that patients with renal dysfunction had significantly higher levels of serum gastrin (P < 0.05), there was no influence on the gastric juice pH value. The relationship between the cumulative index and ammonia concentration in gastric juice was found to be linear (P < 0.05). The higher urea levels in the blood and gastric juice of patients with renal failure do not seem to be a risk factor for infection with H. pylori.

Ammonia↗
PubMed1992

Secondary hyperparathyroidism and sonographic evaluation of parathyroid gland hyperplasia in dialysis patients.

Ninety-six hemodialysis patients were examined by ultrasonography of the parathyroid glands to study the prevalence of parathyroid gland hyperplasia and to assess the relevance of sonography in the evaluation of secondary hyperparathyroidism. The results were compared with clinical, biochemical and radiological parameters. Thirty-two (33.3%) patients had sonographically enlarged glands. Of them 19 had 1 and 13 had 2 and more enlarged glands. Patients with enlarged glands, compared to those with undetected glands, had a significantly higher frequency of bone and joint pains (65.5% vs 40.6%), radiological features of hyperparathyroid bone disease (in hands 28.1% vs 6.9%, in acromioclavicular joints 37.5% vs 13.6%) and higher levels of intact serum parathyroid hormone (1-84) concentration (52.8 +/- 47.9 pmol/l vs 18.1 +/- 18.0 pmol/l) and serum alkaline phosphatase concentration (260.2 +/- 201.1 U/l vs 129.8 +/- 127.3 U/l). Those with enlarged glands had been on dialysis for a longer period (87.7 +/- 51.0 months vs 62.5 +/- 47.4 months). The severity of secondary hyperparathyroidism increased with the number of enlarged glands. Our study shows that ultrasonography is a useful noninvasive screening method for the evaluation of secondary hyperparathyroidism in patients on hemodialysis and that sonographically enlarged glands may be a measure of the severity of secondary hyperparathyroidism.

Female↗
PubMed1991

Pharmacokinetics and pharmacodynamics of cisapride in patients undergoing hemodialysis.

Twenty-two patients who were receiving hemodialysis were studied in three groups of eight subjects each to assess the pharmacokinetics during the dialysis-free interval and during hemodialysis treatment and to assess the pharmacodynamics of cisapride. Cisapride and its metabolite norcisapride were measured by use of HPLC and gas chromatography, respectively. The pharmacodynamic effect of cisapride was measured by means of radionuclide gastric emptying. After a single oral dose of 20 mg the terminal half-life of cisapride was 9.6 +/- 3.3 hours, the volume of distribution was 4.8 +/- 3.3 L/kg, the total oral plasma clearance was 380 +/- 161 ml/min, the area under the curve was 1024 +/- 447 ng.hr/ml (mean +/- SD). Norcisapride only could be detected in the dialysate (0.36 +/- 0.067 mg) and was eliminated by a hemodialysis clearance of 34.7 +/- 7.9 ml/min. Cisapride reduced gastric retention from 77.6% +/- 21.1% to 43.7% +/- 18.2% of maximum filling (40 minutes after meals) and normalized the abnormal gastric emptying time in patients receiving dialysis. Cisapride dosage adjustment or substitution after hemodialysis is not necessary.

Adult↗
PubMed1991

Intragastric long-term pH-metry in hemodialysis patients. A study with famotidine.

The onset and duration of famotidine action were studied in 14 hemodialysis (HD) patients and 16 healthy controls (control group: CG) who were examined by ambulatory intragastric 24-hour pH-metry. 20 mg famotidine was administered i.v. 90 min after HD in the afternoon (AN; 2 p.m.; n = 8) or evening (E; 8 p.m.; n = 6), followed by a standard meal. Mean onset of action in the AN and E groups of the HD patients was 90.3 +/- 28.2 min and 98.8 +/- 29.8 min, and in CG patients 36.3 +/- 11.9 min and 53.6 +/- 22.3 min, respectively (p less than 0.05). Duration of action in the AN and E groups of the HD patients was 22.7 +/- 2.1 h and 21.6 +/- 2.6 h, and in CG patients 6.0 +/- 1.1 h and 11.4 +/- 1.6 h, respectively (p less than 0.05). Our study showed a retarded and prolonged action of famotidine in HD patients. The time of administration of famotidine had no effect on its action in HD patients. This is in contrast to normal subjects in whom evening administration delays the onset and prolongs the duration of famotidine action in comparison to afternoon administration.

Adult↗
PubMedDate not supplied

Less symptomatic hypotension using blood volume controlled ultrafiltration.

Symptomatic hypotension due to ultrafiltration (UF) is one of the most frequent unwanted side effects of dialysis therapy. Using hemoglobinometry for continuous monitoring of blood volume (BV), ultrafiltration rate (UFR) can be adapted to actual changes in BV. A control system is shown in which UFR is set according to a predefined profile of BV. The conditions of control are: relative BV shall decrease steadily; BV shall decrease rapidly during the first 60 min of dialysis, thereafter decrease in BV should be less; UFR shall be as high as possible; and dry weight should be obtained within a given time. Application of this controlled UF method in 10 dialysis patients shows significantly fewer hypotensive periods and muscle cramps compared to conventionally constant UFR. It is concluded that BV controlled UF is an important step toward optimizing dialysis therapy.

Blood Flow Velocity↗