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Biomedical subjects

R Bhatt

Publications and source records attributed to R Bhatt.

At least 19 recordsLinked to original sources
PubMed2006

Evidence-based practice in acute ophthalmology.

AIM: To study the overall level of evidence-based practice in an accident and emergency eye unit in the UK and evaluate the extent of evidence-based practice by ophthalmologists and nurse practitioners (NPs). METHODS: The case notes of all new patients attending our accident and emergency department for a period of 1 week were reviewed prospectively. For each case, the diagnosis at presentation and its intervention was ascertained. A literature search using Medline and Cochrane library was performed to assess the level of evidence provided for each diagnosis-intervention pair. Each diagnosis-intervention pair was evaluated and graded to assess the best level of evidence provided. RESULTS: A total of 474 new patients attended the eye casualty during the study period. No diagnosis was made in 27 cases and they were excluded from the analysis. Out of 447 patients, 308 (68.9%) cases were managed by NPs and 139 (31.1%) by doctors. A total of 294 (65.8%) patient interventions were based on evidence from systematic reviews, meta-analysis and randomised-controlled trials, of which 223 were managed by NPs and 71 by ophthalmologists. This difference was statistically significant with P<0.001. One hundred and seven (23.9%) interventions were supported by evidence from prospective and retrospective trials. CONCLUSION: This study demonstrated that two-thirds of interventions were based on the highest level of evidence and was comparable to studies performed in other specialities. It also highlights the advanced role of trained NPs in acute ophthalmology.

Adolescent↗
PubMed2005

Prospective survey of adverse reactions to topical antiglaucoma medications in a hospital population.

AIM: To identify the relative incidence and profile of adverse drug reaction (ADR) to various topical ocular hypotensives in a hospital setting. METHODS: All the patients presenting in outpatients clinic and accident and emergency with an ADR to topical hypotensive agent from August 2000 to January 2001 were included in the study. Details regarding the type date of commencing the treatment, the date of developing ADR, time to resolution of the ADR were noted. RESULTS: Over the period of 6 months, 66 patients presented with 73 ADRs. Brimonidine was the most frequent offending agent. In total, 23 (34.8%) presented with ADR after being commenced on treatment for more than 12 months. In all, 16 (24%) patients had IOP > 21 on presentation, eight (12%) patients underwent filtration surgery following the development of ADR. CONCLUSION: Adverse drug reaction to ocular hypotensive agents is not uncommon and can have a major impact on glaucoma management. Delayed presentation and association with raised intraocular pressure presentation emphasise the need for effective patient education to encourage prompt reporting of ADR.

Adrenergic alpha-Agonists↗
PubMed2005

An uncommon cause of back pain in pregnancy.

Back pain is a major cause of disability worldwide. A case of a 29 year old Caucasian woman with low back pain secondary to an uncommon benign condition called osteitis condensans ilii is presented and the literature is reviewed. Limited information in the literature combined with poor awareness across the specialty and among the primary care physicians leads to an extensive investigation and misdiagnosis of this benign condition. This report emphasis the salient features and the differential diagnosis in diagnosing and managing this rare condition.

Adult↗
PubMed2004

Perceptions of Indian women regarding menstruation.

Although menstruation is still considered a natural event by women in India, perceptions about menstruation are changing. We report on our study of 1150 urban and 850 rural women. The urban women included high school and college students, professional women, and housewives. A 10-point questionnaire was pretested in a clinic setting and then administered to the study group. The responses show that 80% of high school and college students and professional women wish to have infrequent menses or no menses at all. In contrast, 70% of rural women prefer to have monthly menses. The authors wish to initiate a debate on this issue among health care providers and women's groups.

Adult↗
PubMed2004

Amygdaloid kindled seizures induce weight gain that reflects left hemisphere dominance in rats.

The present study sought to determine the effects of kindled seizures generated from the left and right amygdala upon weight gain in rat. Seventy-five female Sprague-Dawley rats were implanted with electrodes in basal amygdala of the left and right hemispheres. A kindling paradigm was employed in which electrical stimulation was applied once per day for 30 days after Stage 5 seizures. An electrode was implanted into the basal amygdala of the control rats but no stimulation was applied. All rats were weighed daily during the course of the experiment and changes in weight during this period were recorded for all rats. The results demonstrated that kindling from either the left or right amygdala induced significant increases in weight gain relative to the control rats. However, kindling from the left basal amygdala induced increases in body weight that were four times greater than control rats and two times greater than the rats kindled from the right side of the basal amygdala. Likewise, serum leptin levels, which were highly correlated with weight gain, also showed significantly greater increases in left amygdaloid kindled rats relative to rats kindled from the right amygdala and control rats. These findings demonstrate that basal amygdaloid kindling induces significant increases in weight gain and that the magnitude of these effects is linked to the dominance of the left hemisphere.

Amygdala↗
PubMed2004

Developmental shifts in cortical loci for face and object recognition.

Information on normal functional organization and development of the ventral processing stream in 5- to 11-year-old children is minimal. The present fMRI study identified neural correlates for face and object processing in children aged 5-8 and 9-11 years, with data from a similar adult study used for comparison. All age groups showed face-preferential activation in the ventral processing stream, but adults and children aged 9-11 years showed face-preferential loci near the classically defined fusiform face area, whereas children aged 5-8 years showed this activation in the posterior ventral processing stream. In addition, the degree of category-selectivity in other brain regions increased with age. Collectively, these developmental changes may reflect fine-tuning in visual recognition processes based on learning and experience.

Adult↗
PubMed2003

Use of inhaled nitrous oxide for minor eyelid surgery: a placebo-controlled study.

BACKGROUND: Pain from local anaesthetic injection for minor eyelid surgery can often be severe enough to be the most unpleasant part of the procedure. This study was aimed at assessing the efficacy of 50 : 50 N(2)O/O( 2) (Entonox) in relieving such pain. METHODS: In this randomised placebo-controlled double blind trial, 100 patients were randomised to receive either Entonox or air. Questions regarding pain during the administration of local anaesthetic, discomfort during the procedure and side effects experienced were asked by an investigator who was blinded to the type of gas inhaled. RESULTS: The difference in pain score between the Entonox and control groups was not statistically significant (p = 0.474). The difference in discomfort score between the two groups was also not statistically significant (p = 0.948). More side effects were noted with Entonox than with air (p = 0.003, statistically significant). However, this was not clinically significant. CONCLUSION: Entonox has been used effectively in different specialties for pain relief. However, our study was unable to show this beneficial effect in relieving pain from local anaesthetic injections for minor eyelid surgery.

Administration, Inhalation↗
PubMed2001

Water-soluble poly-(L-glutamic acid)-Gly-camptothecin conjugates enhance camptothecin stability and efficacy in vivo.

The therapeutic efficacy of 20(s)-camptothecin (CPT) is limited in humans by the instability of the active lactone form due to preferential binding of the carboxylate to serum albumin and by difficulty in formulation. Formation of an ester bond with an amino acid via the hydroxyl group at carbon 20 of CPT stabilizes the lactone. Linking CPT to a high molecular weight (MW) anionic polymer enhances solubility and improves distribution to the tumor through enhanced permeability and retention (EPR effect). Poly-(L-glutamic acid) (PG) is an anionic homo-polymer that can theoretically bind one molecule of a drug via the gamma carboxylic acid of each monomeric subunit. It has been used to make a water-soluble PG-paclitaxel conjugate currently in Phase II clinical trials that contains 37% paclitaxel by weight and is administered in a 10 min infusion without pre-medication. We evaluated the anti-tumor activity of PG conjugates of CPT after a single intraperitoneal injection using subcutaneous murine B-16 melanoma tumor growth as an indicator. Interposition of a glycine (gly) linker allowed CPT loading up to 50% w/w on the polymer. Increasing the PG MW from 33 to 49 kDa enhanced the efficacy without altering the maximum tolerated dose (MTD). In athymic mice bearing ectopic human colon or lung tumors, efficacy was enhanced compared to free camptothecin. Thus, as with paclitaxel, conjugation of CPT to PG enhanced pharmaceutical properties and preclinical efficacy.

Animals↗
PubMed2001

An audit of hip radiographs performed for general practitioners.

AIM: We carried out a prospective study of the GP referrals for hip radiographs to find out the proportion of radiographs falling within the RCR guidelines and to ascertain the reasons for not following the guidelines. MATERIALS AND METHODS: One thousand two hundred and fifty six consecutive hip radiographs were performed for GPs over a 12-month period. Questionnaires were sent to GPs for 873 referrals during an audit period of 18 months Four hundred and fifty three questionnaires were returned with adequate information. The proportion of change in management between the patients falling within the guidelines and those outside the guidelines was compared using Fisher's Exact Test (SPSS Package Version 9) and the corresponding 95% confidence interval (CI) was calculated. RESULTS: Only 194 (43%) of the 453 referrals were within RCR guidelines and 259 (57%) were outside guidelines. In the group where RCR guidelines were followed, 60% were normal, 34% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 44%. In the group where guidelines were not followed 76% were normal, 18% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 37%. There was no evidence of difference in the change in management between these two groups. Twenty per cent of the radiographs showed abnormalities other than hip changes. Of these, only 17% were abnormalities other than degenerative changes and considered significant. CONCLUSIONS: This audit does not reveal why the majority of the requests fell outside guidelines. This may be due to lack of awareness amongst GPs about guidelines, patient pressure, medico-legal problems and the need for reassurance. However, the audit does not show any evidence that following guidelines would increase efficiency of referral.

Adult↗
PubMed2001

Involvement of adrenal and thyroid activity in the annual testicular regression of red headed bunting (Emberiza bruniceps).

Thyroid and adrenal activities are closely associated with reproductive cycle and any alteration in these endocrine functions may cause changes in the pituitary-gonadal axis. To understand this interrelationship during testicular senstive phase (month of April) male birds were injected with metapyrone(corticosterone synthesis blocks 1 microg/bird/day & 10 microg/bird/day) and newmercazol (thyroxine synthesis blocks 10 microg/bird/day) over a period of 12 weeks. During late breeding phase (month of August) two sets of birds having large gonad (photosensitive) and regressed gonad (photorefractory) were injected with metapyrone (10 microg/bird/alternate day). Results indicate that decreased activity of both adrenal and thyroid, extended the breeding phase but rate of regression decreased only in the case of bird receiving higher level of metapyrone.However,in the second group rate of gonadal regression was slow only in those bird where treatment was started during photosensitive phase. It may be suggested that optimum level of activity of adrenal and thyroid function are essential for termination of reproduction and any alteration in these function may alter seasonal pattern of neuroendocrine gonadal axis.

Adrenal Glands↗
PubMed2000

Conjugation of camptothecins to poly-(L-glutamic acid).

Conjugation of water-insoluble cancer chemotherapeutic drugs to macromolecular polymers can lead to improved pharmaceutical properties and improved therapeutic ratios due to accumulation of the polymer-drug conjugate in tumor tissue through the enhanced permeability and retention (EPR) to macromolecules associated with tumor vasculature. Pharmaceutical shortcomings of certain active camptothecins including difficulty in formulation and instability of the active lactone form due to interactions with human albumin might be improved by conjugation to polymers. In this report, conjugations of camptothecin (CPT), 10-hydroxy-CPT, and 9-amino-CPT to poly-(L-glutamic acid) (PG) are described; coupling was accomplished either through the 20(S)-hydroxyl or 9 and 10 substituents with and without the use of a glycine linker. Studies using a PG paclitaxel conjugate (PG-TXL), which is currently in Phase I testing, demonstrated that PG enhanced aqueous solubility, prolonged plasma residence time, and greatly increased the distribution of paclitaxel to tumor tissue in a murine model. In this report, we describe the use of similar conjugation technology for CPT derivatives and demonstrate that these difficult to formulate compounds can be rendered water soluble, that their maximum tolerated doses are increased, and that they retain substantial anti-tumor activity in syngeneic and xenogeneic tumor models. Preliminary data suggest that PG with molecular weights between 37 and 50 kDa with CPT loading between 14% and 37% with or without glycine linkers display enhanced efficacy compared with nonconjugated camptothecins administered at their maximum tolerated dose.

Animals↗
PubMed2000

Correlation of bone scintigraphy and histological findings in medial tibial syndrome.

OBJECTIVE: To correlate bone scintigraphy and histopathological findings in patients with medial tibial syndrome. METHODS: Twenty patients (32 limbs) with a clinical diagnosis of medial tibial syndrome had surgery. Bone scintigraphy before the operation was compared with the histological appearance of bone and periosteal specimens obtained at surgery. RESULTS: Delayed bone scintigraphy showed normal appearance in 11 limbs, characteristic diffuse tubular pattern uptake in 16 limbs, and focal uptake in five. Periosteal histology disclosed fibrous thickening as the most common finding associated with increased vascularity, occasionally with chronic inflammatory cell infiltration, haemosiderin, and acid mucopolysaccharide deposition. Loss of osteocytes was the main finding of bone histology associated with some enlargement of lacunae and lamellar structure disruption. A grading system was used to score normal and abnormal histological appearance. For analysis the findings were regrouped to provide tables using Fisher's exact test. There was no correlation between bone scintigraphy and the histology of bone and periosteum, but two interesting observations were noted. Those cases with periosteal thickening had mostly normal bone scan appearance (p = 0.0028). Those cases with low levels of osteocyte loss had mostly abnormal bone scintigraphy. CONCLUSION: Abnormal histological appearance of bone and periosteum is a feature of medial tibial syndrome. These histological findings show poor correlation with bone scintigraphy. The exact pathogenesis of this syndrome remains unclear.

Adult↗
PubMed2000

Graded compression stockings in elective orthopaedic surgery. An assessment of the in vivo performance of commercially available stockings in patients having hip and knee arthroplasty.

We recruited 89 patients who had hip or knee replacements to assess the performance of below-knee graded compression stockings. The pressure gradients generated by the stockings were measured and all patients had venography of the ipsilateral leg. We found that 98% of stockings failed to produce the 'ideal' pressure gradient (+/- 20%) of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a 'reversed gradient' on at least one occasion during the course of the study. The overall rate of deep-venous thrombosis was 16.7%. Stockings which produced reversed gradients were associated with a significantly higher incidence of deep-venous thrombosis (p = 0.026) than those with the correct gradient (25.6% v 6.1%). This suggests that the performance of graded compression stockings can be improved if reversed pressure gradients are detected and prevented.

Arthroplasty, Replacement, Hip↗
PubMed1998

Clinical and microbiological aspects of Trichomonas vaginalis.

Trichomonas vaginalis, a parasitic protozoan, is the etiologic agent of trichomoniasis, a sexually transmitted disease (STD) of worldwide importance. Trichomoniasis is the most common nonviral STD, and it is associated with many perinatal complications, male and female genitourinary tract infections, and an increased incidence of HIV transmission. Diagnosis is difficult, since the symptoms of trichomoniasis mimic those of other STDs and detection methods lack precision. Although current treatment protocols involving nitroimidazoles are curative, metronidazole resistance is on the rise, outlining the need for research into alternative antibiotics. Vaccine development has been limited by a lack of understanding of the role of the host immune response to T. vaginalis infection. The lack of a good animal model has made it difficult to conduct standardized studies in drug and vaccine development and pathogenesis. Current work on pathogenesis has focused on the host-parasite relationship, in particular the initial events required to establish infection. These studies have illustrated that the pathogenesis of T. vaginalis is indeed very complex and involves adhesion, hemolysis, and soluble factors such as cysteine proteinases and cell-detaching factor. T. vaginalis interaction with the members of the resident vaginal flora, an advanced immune evasion strategy, and certain stress responses enable the organism to survive in its changing environment. Clearly, further research and collaboration will help elucidate these pathogenic mechanisms, and with better knowledge will come improved disease control.

Animals↗