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Biomedical subjects

P S Nandi

Publications and source records attributed to P S Nandi.

10 recordsLinked to original sources
PubMed2001

Can endoscopic ultrasound or magnetic resonance cholangiopancreatography replace ERCP in patients with suspected biliary disease? A prospective trial and cost analysis.

OBJECTIVES: ERCP is the gold standard for pancreaticobiliary evaluation but is associated with complications. Less invasive diagnostic alternatives with similar capabilities may be cost-effective, particularly in situations involving low prevalence of disease. The aim of this study was to compare the performance of endoscopic ultrasound (EUS) with magnetic resonance cholangiopancreatography (MRCP) and ERCP in the same patients with suspected extrahepatic biliary disease. The economic outcomes of EUS-, MRCP-, and ERCP-based diagnostic strategies were evaluated. METHODS: Prospective cohort study of patients referred for ERCP with suspected biliary disease. MRCP and EUS were performed within 24 h before ERCP. The investigators were blinded to the results of the alternative imaging studies. A cost-utility analysis was performed for initial ERCP, MRCP, and EUS strategies for these patients. RESULTS: A total of 30 patients were studied. ERCP cholangiogram failed in one patient, and another patient did not complete MRCP because of claustrophobia. The final diagnoses (N = 28) were CBD stone (mean = 4 mm; range = 3-6 mm) in five patients; biliary stricture in three patients, and normal biliary tree in 20. Two patients had pancreatitis after therapeutic ERCP, one after precut sphincterotomy followed by a normal cholangiogram. EUS was more sensitive than MRCP in the detection of choledocolithiasis (80% vs 40%), with similar specificity. MRCP had a poor specificity and positive predictive value for the diagnosis of biliary stricture (76%/25%) compared to EUS (100%/100%), with similar sensitivity. The overall accuracy of MRCP for any abnormality was 61% (95% CI = 0.41-0.78) compared to 89% (CI = 0.72-0.98) for EUS. Among those patients with a normal biliary tree, the proportion correctly identified with each test was 95% for EUS and 65% for MRCP (p < 0.02). The cost for each strategy per patient evaluated was $1346 for ERCP, $1111 for EUS, and $1145 for MRCP. CONCLUSIONS: In this patient population with a low disease prevalence, EUS was superior to MRCP for choledocholithiasis. EUS was most useful for confirming a normal biliary tree and should be considered a low-risk alternative to ERCP. Although MRCP had the lowest procedural reimbursement, the initial EUS strategy had the greatest cost-utility by avoiding unnecessary ERCP examinations.

Adult↗
PubMed2000

Psychiatric morbidity of a rural Indian community. Changes over a 20-year interval.

BACKGROUND: Cross-sectional studies give no indication of the changes that may occur in the mental health status of a community in course of times. Studies should be designed to assess these changes. AIMS: To assess the changes, if any, in the prevalence of mental disorders in a rural community after an interval of 20 years in the context of its changing socio-economic conditions. METHOD: A door-to-door survey of the prevalence of psychiatric morbidity in two villages was conducted by a team of psychiatrists. The survey was repeated after 20 years by the same team and by the same method. Changes in the mental health status of the community were compared. RESULTS: Total morbidity per 1000 fell from 116.8 to 105.2. Morbidity in men fell from 86.9 to 73.5 per 1000 and in women from 146.8 to 138.3 per 1000. Rates of anxiety, hysteria and phobia had fallen dramatically and those of depression and mania had risen significantly. CONCLUSION: The level of psychiatric morbidity showed no statistically significant change. The morbidity pattern (relative proportion of type of morbidity), however, showed some interesting changes. Similar studies should be done on a larger sample.

Adolescent↗
PubMed1998

Esophageal dilation.

Esophageal dilation, a technique developed four centuries ago, continues to be an important method of treating the symptom of dysphagia in patients with luminal narrowing of the esophagus. Dilation is safe, with < 0.5% chance of perforation and bleeding and a 0.01% risk of death. Mercury bougienage (Maloney dilators), hollow polyvinyl dilators (Savary-Guillard), and balloon dilators (Through the Scope) are the principal types of dilators in use today. Few trials have compared the differing dilating methods. The results of these trials are mixed, and further randomized trials are necessary to determine if any technique has advantages in efficacy and cost. Although most patients successfully treated with dilation suffer with peptic strictures, those with nonpeptic strictures due to lower esophageal mucosal rings, corrosive injury, and radiation injury can also be treated effectively with dilation. By reviewing the current literature, effective treatment algorithms can be used with patients suffering from dysphagia due to various types of strictures.

Algorithms↗
PubMed1997

Cutaneous infections due to Acanthamoeba in patients with acquired immunodeficiency syndrome.

We report 2 cases of cutaneous Acanthamoeba infection in patients with acquired immunodeficiency syndrome. The disease, which manifests as subcutaneous nodules, mimics other more commonly encountered clinical entities. A high index of suspicion, familiarity with the clinical and histologic appearance of skin lesions, and communication between clinicians and pathologists are crucial for early diagnosis and treatment of this potentially fatal infection.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Evaluation of a new diuretic, diapamide, in congestive heart failure.

The diuretic response of patients with congestive heart failure to establish doses of diapamide (750 mg) and furosemide (80 mg) was compared in an open, crossover study. Peak urine output occurred in the first 6 hours after administration of furosemide but somewhat later (12 to 18 hours) with diapamide. Both agents produced active diuresis and natriuresis in most patients. Comparisons of drug effect during the first days of each treatment period and analysis of the entire first treatment period indicated that urine output with furosemide was significantly greater than with diapamide. Urinary sodium excretion on the first day of treatment was not significantly greater with furosemide than with diapamide, nor were the differences significant on subsequent days. The observed differences between drugs on urinary potassium and chloride excretion were not statistically significant. The most frequently occurring adverse reaction was mild to moderate nausea, which was reported by five patients receiving diapamide and two patients receiving furosemide. Diarrhea and vomiting were also more frequent with diapamide. Diapamide would appear to serve a role between the milder thiazide diuretics and the more effective furosemide.

Adult↗