Biomedical subjects
Publications and source records attributed to P A Koul.
A 45 year old man presented with recurrent hypokalaemic paralysis. Laboratory investigations revealed renal tubular acidosis as the cause of the hypokalaemia, and dynamic tubular studies suggested a gradient defect as the underlying cause. The patient had associated dextrocardia. To our knowledge, this is the first report of this condition.
A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion of the eyes. Clinically there was evidence of left auricular chondritis, nasal chondritis and conjunctivitis with a history of multiple similar episodes in the past, features suggestive of relapsing polychondritis. The patient improved with oral prednisolone.
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OBJECTIVE: To study the CT features of pulmonary hydatid disease. PATIENTS: Thirty-two consecutive patients with surgically proven pulmonary hydatid cysts. SETTING: SheriKashmir Institute of Medical Sciences, Srinagar, Kashmir, India, a tertiary-care referral center. INTERVENTIONS: CT of the chest was obtained in all cases on Somatom DR double rotate CT scanner (Siemens; Erlangen, Germany). RESULTS: Forty cysts of different size and shapes were encountered, 34 of them being ruptured. CT density of the cysts varied from - 42 to 160 Hounsfield units (HU; median, 15.5 HU). Apart from the classically described features of pulmonary hydatid disease, a crescent-shaped rim of air at the lower end of the cyst (inverse crescent sign) was seen in three cysts, and a bleb of air in the wall of two as-yet unruptured cysts (signet ring sign). Thick wall (>10 mm) was observed in four cysts, and each of them had associated evidence of infection. CONCLUSIONS: Inverse crescent sign, signet ring sign, high CT density, and thick wall should be recognized as features of pulmonary hydatid cysts on CT.
BACKGROUND: Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. OBJECTIVE: To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. METHODS: One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. RESULTS: Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel. CONCLUSION: Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.
A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.
OBJECTIVE: To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. METHODS: Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. RESULTS: Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. CONCLUSION: We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated drug for the treatment of niclosamide resistant Taenia saginata infestations.
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Lead exposure was assessed in a random cohort of 70 male papier mâché workers and compared with 35 age and sex matched controls. Blood-lead levels in workers were significantly higher than in controls (Mean 68.07 +/- 44.64 ug/dl vs 25.52 +/- 16.56 ug/dl respectively; P < 0.001). Urinary lead was also higher in workers (128.53 +/- 52.61 ug/l) compared to controls (91.18 +/- 27.06, P < 0.001), but excretion of urinary coproporphyrin in the two groups was not significantly different (102.78 +/- 153.42 vs 70.03 +/- 27.06 ug/l, P > 0.05). Blood levels bore a significant correlation with age but did not bear any correlation with the duration of exposure. Various modes of exposure to lead included hand mixing of paints, skin application of the paint to match shades and making point of the brush using lips and the tongue.
The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50 randomly selected Kashmiri Muslim patients with established rheumatic heart disease and compared with that of 50 controls of similar ethnicity. A significant increase in the frequency of HLA-DR4 (P < 0.005, RR 3.27) and a significant decrease in the frequency of HLA-B5 (P < 0.001, RR 0.19) were found in the patient group. Though HLA-DQ3 showed a significant increase (P < 0.005, RR 2.52) and HLA-DR7 a significant decrease (P < 0.05, RR 0.42) in the patient group, the corrected P value was not significant. The findings suggest that susceptibility to RHD in the studied population is HLA-related, with HLA-DR4 influencing its occurrence and HLA-B5 conferring protection against the same.
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Twenty-five consecutive patients with multidrug-resistant enteric fever were evaluated and followed for haemostatic abnormalities. Twenty-one (84%) of the patients had evidence of disseminated intravascular coagulation (DIC) and 12 (48%) also had evidence of associated fibrinolysis. Clinical bleeding was observed in 3 (12%) cases, and did not bear any correlation with clotting abnormalities. Protein C activity was found to be decreased in 11 of the 15 cases with DIC, and a block in its activation, as previously postulated, could not be substantiated. DIC was reversed in most cases within 8 days of the institution of specific antibiotic therapy.
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Twenty-one cases of renal tubular acidosis presenting with periodic hypokalaemic muscular weakness, that were seen over an 8-year period, are presented. The biochemical features suggested a diagnosis of distal renal tubular acidosis and absence of family history with negative screening of eighteen families pointed towards the primary sporadic nature of the disorder in nineteen of the cases. Alkali and replacement potassium therapy resulted in immediate and sustained clinical recovery in all the cases.
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