PubMed Health⌕ Search

Biomedical subjects

S Chaturvedi

Publications and source records attributed to S Chaturvedi.

At least 19 recordsLinked to original sources
PubMed2006

Warfarin vs aspirin for symptomatic intracranial stenosis: subgroup analyses from WASID.

The WASID trial showed no advantage of warfarin over aspirin for preventing the primary endpoint of ischemic stroke, brain hemorrhage, or vascular death. In analyses of selected subgroups, there was no definite benefit from warfarin. Warfarin reduced the risk of the primary endpoint among patients with basilar artery stenosis, but there was no reduction in stroke in the basilar artery territory or benefit for vertebral artery stenosis or posterior circulation disease in general.

Aged↗
PubMed2005

Carotid endarterectomy--an evidence-based review [RETIRED]: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

OBJECTIVE: To assess the efficacy of carotid endarterectomy for stroke prevention in asymptomatic and symptomatic patients with internal carotid artery stenosis. Additional clinical scenarios, such as use of endarterectomy combined with cardiac surgery, are also reviewed. METHODS: The authors selected nine important clinical questions. A systematic search was performed for articles from 1990 (the year of the last statement) until 2001. Additional articles from 2002 through 2004 were included using prespecified criteria. Two reviewers also screened for other relevant articles from 2002 to 2004. Case reports, review articles, technical studies, and single surgeon case series were excluded. RESULTS: For several questions, high quality randomized clinical trials had been completed. Carotid endarterectomy reduces the stroke risk compared to medical therapy alone for patients with 70 to 99% symptomatic stenosis (16% absolute risk reduction at 5 years). There is a smaller benefit for patients with 50 to 69% symptomatic stenosis (absolute risk reduction 4.6% at 5 years). There is a small benefit for asymptomatic patients with 60 to 99% stenosis if the perioperative complication rate is low. Aspirin in a dose of 81 to 325 mg per day is preferred vs higher doses (650 to 1,300 mg per day) in patients undergoing endarterectomy. CONCLUSIONS: Evidence supports carotid endarterectomy for severe (70 to 99%) symptomatic stenosis (Level A). Endarterectomy is moderately useful for symptomatic patients with 50 to 69% stenosis (Level B) and not indicated for symptomatic patients with <50% stenosis (Level A). For asymptomatic patients with 60 to 99% stenosis, the benefit/risk ratio is smaller compared to symptomatic patients and individual decisions must be made. Endarterectomy can reduce the future stroke rate if the perioperative stroke/death rate is kept low (<3%) (Level A). Low dose aspirin (81 to 325 mg) is preferred for patients before and after carotid endarterectomy to reduce the rate of stroke, myocardial infarction, and death (Level A).

Aspirin↗
PubMed2005

Outcomes after placement of colorectal stents.

BACKGROUND: Colonic stents are increasingly used to palliate or alleviate large bowel obstruction in patients with colon cancer and other obstructing lesions in whom a definitive surgical procedure is inappropriate. We report on the outcomes of a large group of patients who underwent deployment of a colon stent in a single institution by a single operator. PATIENTS AND METHODS: This was a retrospective observational cohort study of all patients undergoing colonic stenting between September 1995 and May 2002. Data collected included nature of pathology, type of stent used, procedure morbidity, patient survival and details of any definitive procedures performed after stenting. RESULTS: One hundred and seven patients were evaluated (58 male) with a median age of 75 years (range 36-99 years). A total of 112 stents were successfully deployed (46 as an emergency). Twelve patients had double stents inserted coaxially and overlapping. In 7 patients the stent could not be safely deployed. Eighty-seven patients had colorectal cancer, 13 patients had an extra-luminal malignancy, 5 had diverticular strictures and in 2 patients the pathology was unknown. At last review (May 2002) 18 patients were alive, 82 patients had died and 7 patients had been lost to follow-up. Of those patients who died, the median survival after stenting alone was 6 weeks (range 4 days-36 weeks). Ten patients underwent subsequent definitive surgery. Stent complications included, 2 colonic perforations, 3 stent occlusions and 4 stent migrations. CONCLUSION: Colonic stenting can be used effectively, with acceptable morbidity, to manage patients presenting with large bowel obstruction. In a smaller number of patients colon stents may safely temporize symptoms while definitive surgery is planned.

Adult↗
PubMed2005

Profile of animal bite cases in Pune.

A Cross-sectional study was carried out to determine the profile of animal bite cases reporting to the Anti Rabies clinic of Sassoon Hospital, rune. The data was collected using pretested questionnaire. All 250 cases who reported during the period of study were included in the analysis. The male female ratio was 1.98 : 1. Children in the age group 0-14 years were the victims in 132 (52.8%) cases. Dog was the biting animal in 94.4% cases, followed by cat (2.4%), Jackal (1.2%), mongoose (1.2%), monkey (0.4%) and horse (0.4%). Of the 236 dog bite cases 30% of bites were inflicted by pet dogs of which only 38.02% were immunized. The wound was washed with soap and water in only 3.6% of cases. 64.8% of the bites were on the lower extremity and 63.2% of cases reported within 24 hours of the bite. Of the 247 cases administered Beta Propio Lactone (BPL) inactivated vaccine only 18.8% did not have any local reaction and 58.3% had one or more systemic reaction. A three pronged strategy has been recommended to reduce the burden of morbidity and mortality associated with rabies.

Adolescent↗
PubMed2004

Are patients receiving maximal medical therapy following carotid endarterectomy?

BACKGROUND: Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE). METHODS: Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 (n = 1,049). Prescription of pharmacotherapy and sustained use (>80% use of the follow-up period) were examined in the 365-day period following index CE. RESULTS: Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%). CONCLUSIONS: Use of statins has increased following carotid endarterectomy (CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at <40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.

Aged↗
PubMed2003

Evaluation of serum ferritin in screening for iron deficiency in tuberculosis.

Serum ferritin (SF) values </=10 micro g/l are diagnostic of absent Bone Marrow Iron (BMI) stores and therefore of iron deficiency (ID). However, SF, which may be elevated as a part of acute phase reaction, is an unreliable indicator of BMI stores in the setting of chronic disorders, making it difficult to diagnose ID in these patients. Thus, in chronic disorders (CD) such as tuberculosis, bone marrow examination is the only reliable way to establish ID. This study was done in order to identify levels of SF that would be indicative of absent BMI stores and also to study a combination of hematological and biochemical parameters that would be helpful in raising the predictive power of SF in patients of tuberculosis. Fifty-five tuberculosis patients were studied and classified into Iron Deplete (ID) and Iron Replete (IR) based on BMI. Raising the cut-off values of SF from </=10 micro g/l to </=30 micro g/l diagnosed 88% of ID cases correctly, as compared with 61% when cut-off levels of </=10 micro g/l were used. At cut-off values higher than 30 micro g/l, the sensitivity was markedly reduced. Therefore, raising cut-off levels of SF to </=30 micro g/l was most effective in predicting absent BMI, especially in a population where ID is highly prevalent. Combination of SF </=30 micro g/l with mean corpuscular volume (MCV), erythrocyte sedimentation rate (ESR) and total iron binding capacity (TIBC) did not improve the predictive power of SF further. Also, 89.5% cases could be correctly classified by logistic regression equations using SF with ESR and C- reactive protein (CRP).

Adult↗
PubMed2003

Awareness, treatment, and control of vascular risk factors in African Americans with stroke.

OBJECTIVE: To investigate control of risk factors in African American patients with previous stroke. METHODS: The baseline history, physical examination, and laboratory data for 1,086 subjects enrolled in the African American Antiplatelet Stroke Prevention Study from 1995 to 1999 were studied. The level of awareness, pharmacologic treatment, and control of diabetes mellitus (casual plasma glucose level > or =200 mg/dL), hypertension (blood pressure > or =140/90 mm Hg), and hypercholesterolemia (serum total cholesterol level > or =240 mg/dL) were determined. RESULTS: Forty percent of subjects reported a history of diabetes mellitus or use of diabetic medication, and 2% of the remaining subjects had a serum glucose level of > or =200 mg/dL. Of those subjects known to be diabetic, 33% had a serum glucose level of > or =200 mg/dL. A history of hypertension or use of antihypertensive medication was reported in 87% of subjects, and 48% of the remaining subjects were found to have a blood pressure of > or =140/90 mm Hg on exam. Of those subjects known to be hypertensive by history, 73% were on antihypertensive medication, but only 30% of the treated subjects had a blood pressure under 140/90 mm Hg. A history of hypercholesterolemia or use of a lipid-lowering agent was reported in 40% of subjects, and 24% of the remaining subjects had a cholesterol level of > or =240 mg/dL. Use of a lipid-lowering agent was reported in 43% of subjects known to be hypercholesterolemic, and 38% of the hypercholesterolemic subjects had a cholesterol level of > or =240 mg/dL. CONCLUSION: Inadequate rates of awareness and control of cardiovascular disease and stroke risk factors are seen in a clinical trial of African American stroke patients and are comparable with those of previously published reports.

Adult↗
PubMed2003

Is education a determinant of knowledge about malaria among Indian tribal population?

Malaria is a major public health problem in tribal villages of India, where 8% of the country's population lives. Literacy level among tribal population is very low. This study aims to examine the relation between education status and knowledge about malaria among Indian tribal communities. 125 randomly selected tribal respondents from one tribal village each of 17 states were administered a close ended questionnaire by trained interviewers to assess their knowledge about various aspects of malaria. Effect of educational status on the level of knowledge was analyzed using chi square test. Stratified analysis was performed using Mantel Haenszel chi square test to eliminate gender bias. 2125 respondents', randomly selected from 17 tribal villages in as many states, findings were analyzed. Fifty seven percent male and 72% female respondents were illiterate. Only 2% respondents had college level education. Educated females were more knowledgeable than their male counterparts. Mantel Haenszel chi square analysis showed that educated respondents were more knowledgeable than the illiterates, after adjusting for sex of respondents. However, there was gross lack of knowledge regarding diagnosis and treatment of malaria and use of insecticides irrespective of gender and educational status. Improvement in literacy status of tribal population will help in increasing awareness about malaria. Opportunities for disseminating information about various aspects of malaria should be utilized during treatment of malaria cases by health workers.

Adolescent↗
PubMed2002

Posterior atlantoaxial dislocation without associated fracture.

We report on a 38-year-old man with post-traumatic posterior displacement of the atlas with respect to the axis without any associated fracture or neurological deficit caused by the displacement. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) revealed posterior displacement of the atlas with the odontoid peg lying anterior and to the right of the anterior arch of the atlas.

Accidents, Traffic↗
PubMed2001

Effect of electroconvulsive therapy on hematological parameters.

Although a complete blood count is part of the evaluation before the use of electroconvulsive therapy (ECT), there are no known hematological contraindications for the procedure. A preliminary study was done on 31 randomly selected psychiatric patients (chronic schizophrenia, n=10; acute depression, n=8; acute mania, n=6; acute psychosis, n=6; delusional disorder, n=1) receiving ECT to study its hematological effects. Blood samples were drawn just before and 0, 1 and 2 h after ECT. Hemoglobin (Hb%), total and differential leukocyte count (TLC and DLC), red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and platelet count were measured on a fully automated hematology analyzer (Sysmex K-1000). Significant changes were found in TLC, percentage of polymorphs and lymphocytes, and Hb%. Changes in other parameters were not statistically significant. More such studies are needed to substantiate these observations and to understand the mechanism and implication of these effects.

Adolescent↗
PubMed2001

Molecular cloning, phylogenetic analysis and three-dimensional modeling of Cu,Zn superoxide dismutase (CnSOD1) from three varieties of Cryptococcus neoformans.

Cryptococcus neoformans (Cn), causal agent of fungal meningoencephalitis, has three varieties with variable host predilection. To explore mechanisms for these pathogenic differences, we have characterized Cu,Zn SOD gene (CnSOD1). A Saccharomyces cerevisiae sod1Delta mutant was complemented with Cn var. grubii yeast expression library. The complementing clone had an ORF of 462 bp and the deduced 154 aa sequence showed 61% identity with S. cerevisiae SOD1 and 53-65% with other eukaryotic SOD1s. Cn var. grubii CnSOD1 cDNA was used to clone corresponding cDNAs from var. neoformans and var. gattii. ORFs from three varieties revealed 20-29% differences in deduced aa (s) with a significant 6% non-synonymous aa substitution between Cn var. grubii and Cn var. gattii. Cosmid library screening and PCR cloning were used to obtain genomic SOD1, which was split by five introns with identical placements and a typical 5' splice junction sequence, GTNNGY. These introns also showed a large nt variation among the three Cn varieties. Phylogenetic analyses revealed CnSOD1 to be in a group distinct from other eukaryotic SOD1s and with a significant divergence of the var. grubii from var. gattii. The CnSOD1 -deduced protein was modeled based on the crystal structure of S. cerevisiae SOD1, which showed an excellent fit. Most of the non-synonymous aa substitutions occurred on the outside of the molecule and these may contribute to differences in antigenicity among the three varieties. Notably, Cn var. neoformans and var. gattii Cu,Zn SOD had three substitutions of glycine (Gly26, Gly92 and Gly123 for Asn26, Ser92 and Ser123) that may contribute to the observed lower thermostability of this enzyme vis-a-vis Cn var. grubii. This is the first nucleotide and structural comparison of a protein-encoding gene from the three Cn varieties, which may provide a framework for future studies on the role of Cu,Zn SOD in Cn pathogenesis.

Amino Acid Sequence↗
PubMed2001

Toxoplasma gondii ADP-ribosylation factor 1 mediates enhanced release of constitutively secreted dense granule proteins.

Toxoplasma gondii dense granules are morphologically similar to dense matrix granules in specialized secretory cells, yet are secreted in a constitutive, calcium-independent fashion. We previously demonstrated that secretion of dense granule proteins in permeabilized parasites was augmented by the non-hydrolyzable GTP analogue guanosine 5'-3-O-(thio)triphosphate (GTPgammaS) (Chaturvedi, S., Qi, H., Coleman, D. L., Hanson, P., Rodriguez, A., and Joiner, K. A. (1998) J. Biol. Chem. 274, 2424-2431). As now demonstrated by pharmacological and electron microscopic approaches, GTPgammaS enhanced release of dense granule proteins in the permeabilized cell system. To investigate the role of ADP-ribosylation factor 1 (ARF1) in this process, a cDNA encoding T. gondii ARF1 (TgARF1) was isolated. Endogenous and transgenic TgARF1 localized to the Golgi of T. gondii, but not to dense granules. An epitope-tagged mutant of TgARF1 predicted to be impaired in GTP hydrolysis (Q71L) partially dispersed the Golgi signal, with localization to scattered vesicles, whereas a mutant impaired in nucleotide binding (T31N) was cytosolic in location. Both mutants caused partial dispersion of a Golgi/trans-Golgi network marker. TgARF1 mutants inhibited delivery of the secretory reporter, Escherichia coli alkaline phosphatase, to dense granules, precluding an in vivo assessment of the role of TgARF1 in release of intact dense granules. To circumvent this limitation, recombinant TgARF1 was purified using two separate approaches, and used in the permeabilized cell assay. TgARF1 protein purified on a Cibacron G3 column and able to bind GTP stimulated dense granule secretion in the permeabilized cell secretion assay. These results are the first to show that ARF1 can augment release of constitutively secreted vesicles at the target membrane.

ADP-Ribosylation Factor 1↗
PubMed2001

Training interns in population-based research: learners' feedback from 13 consecutive batches from a medical school in India.

OBJECTIVES: To document learners' feedback on an educational intervention to provide interns with a hands-on learning experience in population-based research. DESIGN: Cross-sectional inquiry using a structured tool. SETTING: A medical school in India. SUBJECTS: 306 interns from 13 consecutive groups in a 3-month posting. MAIN OUTCOME MEASURES: Interns' participatory involvement in each of the nine units of learning. RESULTS: In six out of the total of nine units of learning, nearly 70% of the students rated their participatory involvement at 3 points or above (on a 5-point rating scale). This rating was 4 or 5 (good or maximal) for 50% or more students with regard to identification of research questions, review of literature, data analysis and interpretation, and for 65.4% students in data collection. However, in the last two units, on writing the research report and its presentation, a large proportion of students rated their participatory involvement as minimal or unsatisfactory (38.9% and 46.4%, respectively). For 91.2% of students, this was the first hands-on experience of any type of population-based research. When the students were asked to identify the most important factor which hampered learning during the present exposure, 54.2% of them reported that it was the unsuitable timing of the exposure, since their priority during internship was the entrance examination for postgraduate courses. CONCLUSIONS: This study empirically demonstrates that with some extra effort from teachers, interns can be exposed to a hands-on learning experience in population-based research, on a systematic basis, without additional resources.

Attitude of Health Personnel↗
PubMed2001

Poor prognosis of acute stroke patients denied thrombolysis due to early CT findings.

OBJECTIVES: Whether acute stroke patients with major early infarct signs on computed tomography (CT) should be treated with intravenous (i.v.) thrombolysis remains controversial. The authors sought to define the outcomes in 5 consecutive patients who were not treated with i.v. thrombolysis, according to established guidelines. METHODS: The authors retrospectively analyzed the outcomes of a consecutive series of 5 patients evaluated by an acute stroke team at a university medical center and who were denied i.v. tissue plasminogen activator due to early CT changes. RESULTS: Five patients with a median National Institutes of Health Stroke Scale score of 22 (range 20-28) were evaluated. Despite aggressive care (e.g., hemicraniectomy), 2 patients died owing to herniation, 1 patient died of cardiac causes, and neither of the 2 surviving patients achieved a 3-month Rankin score below 4 (moderately severe disability). CONCLUSIONS: Given the poor prognosis of patients with hemispheric stroke and early CT changes, alternative treatment modalities such as intra-arterial thrombolysis, early hemicraniectomy, and neuroprotective therapy should be vigorously pursued.

Acute Disease↗