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Biomedical subjects

M Agarwal

Publications and source records attributed to M Agarwal.

At least 73 records · Page 4Linked to original sources
PubMed1997

Variations in lipid and lipoprotein levels during isotretinoin treatment for acne vulgaris with special emphasis on HDL-cholesterol.

BACKGROUND: Many studies have demonstrated an increase in total cholesterol and triglycerides on oral isotretinoin therapy. This has led several investigators to comment on the possibility of increased risk for cardiovascular disease. Yet, the status of high density lipoprotein (HDL) in patients on isotretinoin therapy has not been studied extensively. PATIENTS AND METHODS: We studied 104 United Arab Emirates (UAE) nationals (78 women, 26 men) who underwent isotretinoin therapy for acne at doses ranging from 0.2 to 1.6 mg/kg, and determined the lipid and lipoprotein levels before and after an 8-week period of treatment. The risk for cardiovascular disease was evaluated as the ratio of cholesterol/HDL-cholesterol. RESULTS: Mean cholesterol, triglycerides, and low density lipoprotein-cholesterol (LDL-cholesterol) levels rose significantly after treatment (p = 0.01) whereas HDL-cholesterol values decreased significantly (p = 0.01). In the entire subject population, the overall risk for cardiovascular disease rose from 3.45 to 3.67, indicating that these subjects remained in the category considered to have "half-average" to "average" risk of cardiovascular disease. CONCLUSIONS: In young and healthy individuals, significant variations in lipid and lipoprotein levels, resulting from isotretinoin treatment for acne, do not influence the overall risk for cardiovascular disease. Isotretinoin is thus a safe and efficient drug for the treatment of acne in these subjects.

Acne Vulgaris↗
PubMed1997

Gestational diabetes and fetal macrosomia in a multi-ethnic population.

We set out to examine maternal and neonatal factors surrounding increased birthweight in a multi-ethnic population having an increased prevalence of diabetes mellitus. Additionally, to document the difference (if any) for such neonates in rates of obstetrical operative intervention at delivery where a specific diagnosis of maternal gestational diabetes mellitus had been made. This was an observational study of unselected mothers giving birth to a neonate of 4000 g or more. Data for this population concerning the results of antenatal screening and diagnostic testing for gestational diabetes mellitus were available as a subset of a larger independent and ongoing database. Odds ratios were used to compare group attributes subset on ethnic, diabetic screening and diabetic diagnostic status. Two ethnic groups showed an increased odds ratio for increased birthweight. A diagnosis of diabetes was associated with a twofold increase in caesarean section rate, and a significant increase in median birthweight when compared with screen positive/ diagnostic negative mothers. A total of 70.4% of mothers were overweight or obese while neonatal ponderal index showed a dependence on birthweight ( r2 = 0.17). We conclude that ethnic status is an important factor in assessing fetal size, as is maternal body mass index. A diagnosis of diabetes mellitus confers an increased risk of operative intervention at delivery. Our approach to the use of birthweight data requires re-assessment.

Journal Article↗
PubMed1996

Automated system for detailed measurement of respiratory mechanics.

OBJECTIVE: The mechanical properties of the respiratory system (i.e., elastance and resistance) depend on the frequency, tidal volume, and shape of the flow waveform used for forcing. We developed a system to facilitate accurate measurements of elastance and resistance in laboratory and clinical settings at the frequencies and tidal volumes in the physiologic range of breathing. METHODS: A personal computer (PC) is used to drive a common clinically used ventilator while simultaneously collecting measurements of airway flow, airway pressure, and esophageal pressure from the experimental subject or animal at different frequencies and tidal volumes. Analysis analogous to discrete Fourier transform at the fundamental frequency (i.e., ventilator setting) is used to calculate elastances and resistances of the total respiratory system and its components, the lungs and the chest wall. We have shown that this analysis is independent of the high-frequency harmonics that are present in the waveform from clinical ventilators. RESULTS: The system has been used successfully to make measurements in anesthetized/paralyzed dogs and awake or anesthetized human volunteers in the laboratory, and in anesthetized human volunteers in the laboratory, and in anesthetized humans in the operating room and intensive care unit. Elastances and resistances obtained with this approach are the same as those obtained during more controlled conditions, e.g., sinusoidal forcing. CONCLUSIONS: Accurate, standardized measurements of lung and chest wall properties can be obtained in many settings with relative ease with the system described. These properties, and their frequency and tidal volume dependences in the physiologic range, provide important information to aid in the understanding of changes in respiratory function caused by day-to-day conditions, clinical intervention and pathologies.

Airway Resistance↗
PubMed1996

Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics.

STUDY OBJECTIVE: To test whether the Trendelenburg ("head-down") or reverse Trendelenburg ("head-up") postures change lung and chest wall mechanical properties in a clinical condition. DESIGN: Unblinded study, each patient serving as own control. SETTING: University of Maryland at Baltimore Hospital, Baltimore, Maryland. PATIENTS: 15 patients scheduled for laparoscopic surgery. INTERVENTIONS: Patients were anesthetized and paralyzed, tracheally intubated and mechanically ventilated at 10 to 30 per minute and at a tidal volume of 250 to 800 ml. Measurements were made before surgery in supine, head-up (10 degrees from horizontal) and head-down (15 degrees from horizontal) postures. MEASUREMENTS AND MAIN RESULTS: Airway flow and airway and esophageal pressures were measured. From these measurements, discrete Fourier transformation was used to calculate elastances and resistances of the total respiratory system, lungs, and chest wall. Total respiratory elastance and resistance increased in the head-down posture compared with supine due to increases in lung elastance and resistance (p < 0.05); but chest wall elastance and resistance did not change (p > 0.05). Lung elastance also exhibited a negative dependence on tidal volume while head-down that was not observed in the supine posture. The change in lung elastance compared with supine was positively correlated to body mass index (weight/height2) and negatively correlated to tidal volume. Lung and chest wall elastance and resistance were not affected by shifting from supine to head-up (p > 0.05). CONCLUSIONS: The Trendelenburg posture increases the mechanical impedance of the lung to inflation, probably due to decreases in lung volume. This effect may become clinically relevant in patients predisposed with lung disease and in obese patients.

Adult↗
PubMed1996

Changes in lung and chest wall properties with abdominal insufflation of carbon dioxide are immediately reversible.

Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.

Abdomen↗
PubMed1996

Violence among psychiatric in-patients at an Interim Secure Unit: changes in pattern over a two-year period.

A retrospective study of recordings of all violent episodes among in-patients requiring restraint was undertaken over a two-year period during which the nature of admissions to the unit changed to an increase in mentally abnormal offenders (those admitted through the criminal justice system and detained under criminal sections of the Mental Health Act). It was found that those detained under criminal sections were less likely to be aggressive, were of relatively older age and less likely to repeat the violence than their mentally ill counterparts detained under civil sections. In addition to the past history of violence, verbally abusive behaviour was the best predictor of subsequent physical aggression though only a minority of patients displaying serious physical assault showed verbally abusive behaviour. Deterioration in mental health and staff-patient interaction were seen as major contributory factors to aggression which will also explain a greater degree of aggression directed towards the staff. Further comparative analysis of aggressive behaviour of mentally ill patients detained under civil sections and mentally abnormal offenders is warranted.

Adult↗
PubMed1996

Effect of Leishmania donovani antigens on superoxide anion generation by mice polymorph in vitro.

The present study was planned to study the effect of priming of BALB/c mice peritoneal polymorphs (PMNLs) by viable, heat killed and formaline fixed promastigotes of L. donovani and soluble extract of proteins of L. donovani promastigotes on their capacity to produce toxic oxygen radicals (TOR). TOR production was measured by superoxide dismutase (SOD), inhibitable cytochrome C reduction and nitroblue tetrazolium reduction tests. No significant stimulation or inhibition in SOD inhibitable cytochrome C reduction and nitroblue tetrazolium reduction was seen when PMNLs were primed by soluble leishmanial protein, and formalin fixed and denatured promastigotes for both 60 and 90 min. Priming of BALB/c mice peritoneal polymorphs with live promastigotes of L. donovani for more than 60 min produced approximately 30 per cent inhibition in superoxide generation as measured by both the tests (P < 0.05). The inhibition in superoxide generation by polymorphs may be one of the important escape mechanisms in the causation of the visceral leishmaniasis.

Animals↗
PubMed1996

Comparative evaluation of serological tests for diagnosis of visceral leishmaniasis.

Sensitivity and specificity of the direct agglutination (DAT) and indirect immunofluorescent test (IFT) have been compared with indirect immunoperoxidase assay (IPA) for the serodiagnosis of visceral leishmaniasis. IPA and DAT were found to be more sensitive and specific than IFT. Indirect immunoperoxidase test was found to be better than DAT as preparation of antigen is easy. Less amount of antigen is required, storage of antigen in slide form is more convenient and shelf life is longer. It is easier to read and interpret immunoperoxidase with the help of ordinary light microscope and chances of false positive and false negatives are negligible.

Agglutination Tests↗
PubMed1996

New blood free biphasic medium with haemoglobin for cultivation of Leishmania donovani promastigotes.

A simple biphasic growth medium for cultivation of L. donovani promastigotes is described. A successful attempt has been made to replace the blood/serum from regular medium by bovine hemoglobin powder. Medium is easy to prepare within 4 hr. It is simple, reliable inexpensive and autoclavable. Ingredients used in the media preparation are readily available at low cost and components of the medium prepared in large quantities, could be stored at 4 degrees C for month without significantly altering their growth supporting potential. After an inoculation of 1 x 10(5) promastigotes/ml, it was possible to cultivate 1-3 x 10(2) promastigotes/ml from the above described media.

Animals↗
PubMed1996

Clinical assessment of autonomic functions in anemics.

Sixty five anemics and 20 healthy control subjects carefully age and sex matched were subjected to seven standardised tests to evaluate autonomic status. Due care was taken to remove factors which could interfare with the results. Tests concerned with the basal parasympalhetec tone viz heart rate response to standing (p < 0.001) and intravenous atropine test (p < 0.05) showed significant difference which persisted with severity and type of anemia. Test requiring stimulation of the parasympathatic system i.e. deep breathing test, valsalva maneuver and carotid sinus massage did show not significant difference. No difference of significance was found with postural fall of blood pressure and sustained hand grip test, chiefly concerned with the sympathatic system. These results suggest that anemics have low basal parasympathatic outflow to increase the heart rate as compensatory mechanism. Stimulation of parasympathatic and sympathetic system arouse normal response.

Adult↗
PubMed1995

Screening for gestational diabetes in a multi-ethnic population.

A multi-ethnic population was screened for gestational diabetes mellitus (GDM) using a venous plasma glucose estimation, 1 h following a standard 50 g glucose load. A significant difference in the ethnic distribution of screen-positivity was found. Amongst the screen-positive group the odds ratio (OR) for special care baby facility (SCBU) admission and birthweight > 3999 g were both increased (OR = 1.87 and 1.99). Only limited diagnostic testing by a glucose tolerance test (GTT) could be achieved for the screen-positive population. For patients with confirmed GDM (two or more abnormal values on a GTT) the OR for SCBU admission was further increased to 5.1, while the OR for increased birthweight was only 1.34. Clinical attention should be directed towards outcome assessment in order to properly evaluate the nature of and place for screening for GDM in multi-ethnic populations.

Africa, Northern↗
PubMed1995

Positive life orientation and recovery from myocardial infarction.

The study examined the relationship between positive life orientation (PLO) and recovery from a recent myocardial infarction (MI), i.e. heart attack. PLO was defined as a predisposition to selectively focus one's attention on the brighter side of any situation. An 11-item measure of PLO was developed. Seventy male patients of first MI receiving treatment at a local government hospital were interviewed twice, 4-5 days after their first heart attack (time 1) and a month after their first heart attack (time 2). The interview schedule consisted of measures of PLO, perceived recovery, expected recovery, helplessness, personal control and mood state. At time 1 all these measures were administered but at time 2 measures of only PLO, personal control, perceived recovery and mood state were administered. In addition, the attending doctor assessed the patients' medical recovery at time 1. Results showed positive correlation of patients' PLO scores with their medical recovery, perceived recovery, expected recovery, personal control and mood state but negative with helplessness. PLO scores were not influenced by patients' age, education, or income. Patients' scores on PLO at two time points were not significantly different and were positively correlated. Their scores on sense of personal control and perceived recovery increased significantly at time 2. Significant intercorrelations among variables, under study, often reduced to insignificance on partialling out PLO. PLO, thus emerged as an important factor in recovery from MI.

Adult↗
PubMed1995

An evaluation of fructosamine estimation in screening for gestational diabetes mellitus.

Although persuasive arguments against routine screening for gestational diabetes mellitus (GDM) have been made, it is widely but not universally performed as a part of antenatal care. There is no international agreement on methods or criteria used for screening (or for diagnosis), and administered glucose-load methods have significant practical difficulties in a busy antenatal clinic setting. However, recent evidence supports the concept of an increased level of importance being given to a diagnosis of GDM, with interest in the fetal and neonatal origins of adult disease being added to the short-term obstetric and fetal concern during pregnancy. A second generation fructosamine test, corrected for total protein, has been evaluated as a practical alternative to glucose screening for GDM in a busy, multi-ethnic antenatal clinic. This achieved a 79.4% sensitivity and a 77.3% specificity for a diagnosis of GDM confirmed by a glucose tolerance test using Carpenter's modified criteria. In view of the organizational simplicity of this sample/test requirement, a wider evaluation is suggested together with a re-evaluation of clinical outcome criteria rather than blood glucose levels alone.

Adult↗
PubMed1995

Lung tissue and airway impedances during pulmonary edema in normal range of breathing.

How pulmonary edema affects lung tissue and airway properties is not clear. From measurements of airway pressure and flow, we measured lung elastance (EL) and resistance (RL) in 5 anesthetized-paralyzed open-chested dogs during sinusoidal forcing in the frequency (f) and tidal volume (VT) ranges of normal breathing. RL was divided into its tissue (Rti) and airway (Raw) components from measurements of alveolar pressure through capsules glued to the lung surface. After induction of severe pulmonary edema by injection of oleic acid into the right atrium, forcing was repeated at the same mean airway pressure (Paw) as in control animals (11 cmH2O) and at a higher Paw (14 cmH2O), as would occur in closed-chested dogs during edema (G. M. Barnas, D. Stamenovic, and K. R. Lutchen. J. Appl. Physiol. 73: 1040-1046, 1992). Edema increased EL, and this increase was greater at Paw = 14 cmH2O (P < 0.05). The f dependences of EL and Rti were increased by edema (P < 0.05), and there was a large negative dependence of EL on VT at Paw = 14 cmH2O. Edema increased RL (P < 0.05), but this increase depended on f, VT, and Paw. The increase in RL was due largely to increases in Rti at Paw = 14 cmH2O and to increases in Raw at Paw = 11 cmH2O. We conclude that the functional effects of oleic acid-induced pulmonary edema on RL are due mostly to changes in lung tissue.

Airway Resistance↗