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Biomedical subjects

P Venugopalan

Publications and source records attributed to P Venugopalan.

At least 37 records · Page 2Linked to original sources

Efficient photocyclization of o-alkylbenzaldehydes in the solid state: direct observation of E-xylylenols en route to benzocyclobutenols.

The photocyclization to benzocyclobutenols of o-alkyl aromatic aldehydes that are predestined for gamma-hydrogen abstraction is found to occur efficiently in the solid state; in contrast, solution-phase photolysis is known to afford a mixture of several products. It is shown that mesitaldehyde, which is a liquid, also undergoes efficient cyclization when subjected to photolysis as a solid inclusion complex. The marginal energy differences in the relative energies of the E-enols and the corresponding cyclobutenols in the case of cyano-substituted mesitaldehydes has permitted direct observation, for the first time, of the E-enols en route to benzocyclobutenols. The AM1 calculations suggest that the cyano-substitution causes intrinsic stabilization of the E-enols relative to the corresponding cyclobutenols, while the bromo groups do the opposite. The lack of observation of the red color in bromo- and formyl-substituted aldehydes is attributed to rapid cyclization of the E-enols to the their respective cyclobutenols even at low temperatures.

Journal Article↗

Solid-state photochromism and photoreactivity of o- and p-anisaldehydes. Remarkable stabilization of o-xylylenols.

[reaction: see text] All of the crystalline o-anisaldehyde derivatives 1 and 3 change to brick-red color upon brief exposure to UV-vis radiation. The red color, attributed to (E)-xylylenol, is remarkably persistent for hours (ca. 10 h) in the case of 1c; such a long lifetime for the reactive o-xylylenols is unprecedented. In contrast, the p-anisaldehydes 2 undergo cyclization. Solid-state photolysis of 2b affords the benzocyclobutenol 7b regioselectively, which is not accessible from solution-phase photolysis.

Journal Article↗

Left atrial spontaneous echo contrast in patients with rheumatic mitral valve stenosis in sinus rhythm: relationship to mitral valve and left atrial measurements.

We studied 37 consecutive patients with mitral stenosis in sinus rhythm using transthoracic and transesophageal echocardiography to relate the presence of spontaneous echo contrast (SEC) in the left atrium with mitral valve area and left atrial dimensions. We also compared the value of left atrial area by planimetry with that of left atrial dimension by M mode in predicting presence of SEC and monitored the effect of anticoagulation on SEC. Transesophageal echocardiography demonstrated spontaneous echo contrast in 9/37 (24%) patients and thrombus in none. SEC continued to be present despite anticoagulation. Mitral valve orifice area by pressure half time method (P=0.001) and by planimetry (P=0.01), and left atrial area by planimetry (P<0.05) were predictors to presence of SEC. Left atrial dimension by M mode examination failed to predict SEC. Cut off values were mitral valve orifice </=1.4 cm(2) (agreement 86%) and left atrial area >/=25 cm(2) (agreement 81%). On multivariate analysis mitral valve area was the only independent predictor. SEC persisted despite anticoagulation. This supports the view that more than one mechanism is involved in the development of SEC.

Adolescent↗

The outcome of idiopathic dilated cardiomyopathy and myocarditis in children from the west of Scotland.

We analysed retrospectively all infants and children with idiopathic dilated cardiomyopathy (IDC) and myocarditis at the Regional Cardiac Centre of the Royal Hospital for Sick Children, Glasgow, during 1980-1997. Among the 39 patients with IDC, 25 (64%) were infants aged < 1 year, eight (20.5%) had wheezing as the presenting symptom, and only six (15%) had a significant cardiac murmur. Thirty-eight of thirty-nine patients diagnosed in life were followed-up for 1 day to 15 years (median 3 years). Twelve of the thirty-nine (31%) died, six deaths were within a week of presentation and the rest within a year. The survival at 1 year and at 12 years was 0.69 (95% CI 0.54 to 0.84). Fourteen patients had histologically proven myocarditis, and all 9/14 (64%) detected at post-mortem and one of the five diagnosed in life died. Patients with myocarditis exhibited an actuarial survival of 0.29 (95% CI 0.04 to 0.53) at 1 year and at 9 years, significantly lower than IDC patients (log rank 9.8, P < 0.01). There was no difference in the outcome for patients with positive or negative Coxsackie titres or who presented in the 1980s and in the 1990s. No risk factor that independently influenced the outcome or survival could be identified in either group. Thus our study from a relatively well-defined population of the west of Scotland showed that a significant proportion of children with IDC and myocarditis died in the first week of illness and that patients with myocarditis had shorter survival.

Adolescent↗

Prevalence and aetiology of heart failure in an Arab population.

BACKGROUND: The epidemiology of heart failure in Arabia, with a population different from the West in cultural and ethnic origin, has not been studied before. AIMS: To determine the prevalence and aetiologies of symptomatic heart failure in an indigenous Arab population over a 3-year period. METHODS: All patients with heart failure > or =13 years of age, treated at the only secondary care hospital of the Dhakliya region of Oman between 1992 and 1994 were evaluated prospectively by clinical history and physical examination. Chest radiograph and echo-Doppler studies were used to confirm the diagnosis of heart failure. Exercise stress testing and/or coronary angiography were also performed in patients >30 years of age, or earlier if ischaemic heart disease was suspected. RESULTS: A total of 1164 patients were identified giving a prevalence of 5.17/1000 population during the study period (6.04/1000 among males and 4.21/1000 among females; P<0.001). The prevalence increased with age from 1.05/1000 in age group <45 years to 15.7/1000 in 45-64 years (P<0.001) and 25.2/1000 in > or = 65 years (P<0.001). Common causes of heart failure were ischaemic heart disease (51.7%), hypertensive heart disease (24.9%) and idiopathic dilated cardiomyopathy (8.3%). Valvular heart disease and lung diseases causing heart failure were less common. CONCLUSION: The prevalence of symptomatic heart failure was appreciably significant in the population studied, showed a male preponderance and was frequent in people aged > or =45 years. Ischaemic heart disease and hypertension were the commonest aetiologies but idiopathic dilated cardiomyopathy was also present in a significant number of patients being relatively more prevalent than reported from the West.

Adolescent↗

Beneficial effect of carvedilol on heart rate response to exercise in digitalised patients with heart failure in atrial fibrillation due to idiopathic dilated cardiomyopathy.

Fourteen digitalised patients diagnosed with heart failure (NYHA Functional class II) with idiopathic dilated cardiomyopathy in chronic established atrial fibrillation were administered carvedilol in addition to their anti-heart failure medications in an attempt to improve their heart rate control. Fourteen matched patients who did not receive carvedilol acted as control subjects. Patients treated with carvedilol showed significantly reduced resting heart rates (10-36%), maximal heart rates on exercise (5-20%) and an increased exercise time (2-30%) on treadmill stress tests (all P=0.001). Ventricular ectopic activity was also diminished. This was associated with symptomatic improvement in effort intolerance and palpitations. NYHA functional class, left ventricular dimensions and ejection fractions did not improve during the study period of 3 months. Thus, addition of carvedilol to digoxin had a beneficial effect on exercise tolerance in patients with idiopathic dilated cardiomyopathy in atrial fibrillation by virtue of an improved heart rate control both at rest and on exercise. Carvedilol was well tolerated despite impaired myocardial function.

Adult↗

Low frequency of bacteraemia during eye surgery obviates the need for endocarditis prophylaxis.

PURPOSE: To determine the incidence of bacteraemia following eye surgery, and thereby evaluate the need for antibiotic cover during such procedures, in patients who are at risk for bacterial endocarditis. METHODS: This prospective study involved 50 consecutive patients undergoing extraocular surgery at the Sultan Qaboos University Hospital, Muscat, Oman. Local preparation of the surgical site in all patients included pre-operative instillation of 0.3% gentamicin and 3% povidone-iodine eye drops. Two eye swabs (one from the conjunctival sac and another from the eyelid margin) and two venous blood samples (one taken just before the procedure and the second 10 min into it) were collected and cultured for aerobic and anaerobic bacteria. Surgery-related bacteraemia was defined as a negative pre-operative blood culture followed by a positive intraoperative blood culture of the same bacterium identified in the positive eye swab. RESULTS: Only two patients (4%) demonstrated surgery-related bacteraemia: one caused by Staphylococcus epidermidis (following entropion correction) and the other by Haemophilus influenzae (following dacryocystorhinostomy). Four other patients had positive conjunctival swabs without bacteraemia, the causative organisms being Haemophilus influenzae in two, and Staphyloccus aureus and Klebsiella pneumoniae in one each. CONCLUSION: Ophthalmic surgery is not associated with significant bacteraemia, and therefore does not mandate routine antibiotic cover in patients at risk for bacterial endocarditis. Stringent pre-operative preparation of the surgical site may suffice to minimise bacteraemia; however, this requires further study.

Adolescent↗

An infant with seizure-related bradycardia and asystole.

We describe an infant girl with ictal bradycardia and asystole who died during an episode of seizure, despite anti-epileptic therapy and permanent cardiac pacemaker implantation. The mechanism of ictal bradycardia and the need to recognize it are therefore discussed. Timely cardiac intervention and adequate anticonvulsant therapy are essential for successful management.

Anticonvulsants↗

Accidental detection of lupus anticoagulants in children.

During routine pre-operative evaluation, a 6-month-old infant and an 11-year-old girl were found to have prolonged activated partial thromboplastin time with positive lupus anticoagulants. Both children underwent successful cardiac surgery and had no thrombotic or bleeding complications. A literature search revealed that positive lupus anticoagulants can follow minor infections in otherwise asymptomatic children and are benign and self-limiting. A minority, however, can develop bleeding, thrombosis or an auto-immune disorder.

Biomarkers↗

Low proportion of familial dilated cardiomyopathy in an arab population with a high prevalence of consanguineous marriages.

UNLABELLED: In this study, 770/890 (87%) first-degree relatives from 108 families of hospitalized patients with idiopathic dilated cardiomyopathy (IDC) were screened using clinical examination, electrocardiography and echocardiography. Thirty percent of the patients were born to consanguineous parents. Familial dilated cardiomyopathy (FDC) was found in 7 (6.5%) families, which is lower than the earlier published figures of 20-25%. Patients with IDC were younger at presentation (p = 0.002) and were more often associated with parental consanguinity (p = 0.04). but the survival rates of familial patients did not differ significantly. CONCLUSION: Despite the high prevalence of consanguinity, there was a low proportion of FDC in the study population. With the prospects of treatment of asymptomatic IDC to slow the progression of the disease, all family members of newly identified IDC patients should receive screening and counselling, with appropriate therapy where indicated.

Adolescent↗

A rare form of atrioventricular septal defect with severe subaortic stenosis.

An unusual form of atrioventricular septal defect associated with severe subaortic obstruction is reported in a neonate who presented with intractable cardiac failure. The baby had a large defect in the atrioventricular septum allowing communication from the left ventricle to the right atrium, without interatrial or interventricular communication, and a cleft anterior mitral leaflet. The baby expired despite palliative surgery performed to bypass the subaortic stenosis.

Aortic Valve Stenosis↗

Pelleted bioadhesive polymeric nanoparticles for buccal delivery of insulin: preparation and characterization.

The study was an attempt to develop an alternative buccal delivery system for insulin. Insulin bearing nanoparticles were prepared by the emulsion internal phase evaporation method. The effect of some formulation variables viz., polymer/drug ratio and emulsifier concentration was studied on particle size and entrapment efficiency. Nanoparticles were pelleted to impart three-dimensional structural conformity and coherence thereby facilitating buccal application. Solid lateral and horizontal sedimentaton in the pellet can be avoided by nanoparticulation and ensuring uniform drug distribution throughout the pellet. The in vitro studies of the pellets included bioadhesion and drug release profile. In vivo studies were performed on diabetic rats. A significant hypoglycemic response was observed after 7 h, without any detectable fluctuation in blood glucose profile and risk of hypoglycemia.

Acrylic Resins↗

High prevalence of microcytic anaemia in Omani children: a prospective study.

Iron deficiency is a common cause of microcytic anaemia. However, a high prevalence of haemoglobinopathies in the Arab population makes differential diagnosis difficult. This prospective study of anaemia in children attending a regional hospital in the Sultanate of Oman looked at the prevalence and causes of anaemia in 256 children, 153 in the age group 3-5 years (group A) and 103 in the age group 10-12 years (group B). Of the children studied, 45.1% in group A and 37.9% in group B were anaemic according to WHO criteria. All the anaemic children had low mean corpuscular haemoglobin and 75% showed microcytosis. Serum ferritin levels were normal and glucose-6-phosphate dehydrogenase deficiency did not contribute to the anaemia. The microcytosis and microcytic anaemia in the study population could be attributed to the alpha-thalassaemia trait which is highly prevalent in Oman. The information is of value in any country where there is a significant prevalence of alpha-thalassaemia genes because these can confound the diagnosis of iron deficiency.

Anemia, Iron-Deficiency↗

Visceral leishmaniasis in Omani children: a review.

A retrospective study was undertaken of 33 children with visceral leishmaniasis admitted to Sultan Qaboos University Hospital (SQUH), Oman between 1993 and 1999. The aim was to study the epidemiological and clinical characteristics of visceral leishmaniasis in children in Oman. All presented with fever, anaemia and splenomegaly. Hepatomegaly and lymphadenopathy were present in 88% and 39% of children, respectively. All had iron deficiency anaemia. Hypertriglyceridaemia is a new observation. Diagnosis in all cases was confirmed by histological demonstration of Leishmania amastigotes in bone marrrow (32 subjects) or splenic aspirate (one subject). All children were treated with sodium stibogluconate, 14 needed blood transfusion or blood products and all but two responded well. There were two deaths from associated complications (6% mortality).

Age Distribution↗