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Biomedical subjects

V Kaul

Publications and source records attributed to V Kaul.

At least 19 recordsLinked to original sources
PubMed2001

Intravenous metronidazole for the treatment of Clostridium difficile colitis.

PURPOSE: Severe Clostridium difficile colitis may produce abdominal distention and ileus, precluding oral antibiotic therapy. Stimulated by several case reports in which intravenous metronidazole was used, we reviewed our experience. METHODS: Using pharmacy and microbiology laboratory records, we retrospectively identified patients with C. difficile colitis who received intravenous metronidazole as initial monotherapy. To be included, patients had to fulfill the following criteria: 1) at least six doses (equivalent to two days of therapy) of intravenous metronidazole were administered, 2) no other potential cause for colitis was found, and 3) the diagnosis of C. difficile colitis was firmly established. For eligible patients, five clinical parameters were assessed before and after intravenous metronidazole. RESULTS: Our patient group (n = 10) received an average of 13.7 (range, 6-24) doses of intravenous metronidazole as initial therapy for C. difficile colitis. All received a dose of 500 mg three times daily. The majority of patients with vomiting, fever, and/or abdominal pain present at the beginning of therapy had resolution with intravenous metronidazole. Only one patient developed a symptom (vomiting) while on therapy; however, this eventually resolved when oral metronidazole was instituted. No patient required colectomy for refractory colitis or developed toxic megacolon. No patient, including those on prolonged courses, developed toxicity related to intravenous metronidazole such as peripheral neuropathy. CONCLUSIONS: Intravenous metronidazole may be effective therapy in patients with C. difficile colitis. A randomized, prospective study appears warranted.

Adult↗
PubMed2001

Profound postoperative hypoglycemia in a malnourished patient.

PURPOSE: To present an unusual case of profound postoperative hypoglycemia resulting in irreversible brain damage in a malnourished patient. CLINICAL FEATURES: A 56-yr-old malnourished woman underwent laparotomy for intestinal obstruction under general anesthesia. Five hours postoperatively she was found to be unresponsive with an immeasureably low blood glucose level. This event was not associated with hyperinsulinemia. Predisposing factors like diabetes mellitus, pheochromocytoma, insulin secreting tumours, adrenal or pitutary deficiency were absent. She was treated with iv dextrose and hydrocortisone with blood glucose levels stabilizing fairly rapidly. However, she unfortunately had sustained irreversible cerebral damage and is left with significant neurological disability. CONCLUSION: Severe postoperative hypoglycemia has several well documented causes. Although hypoglycemia does occur to a moderate degree in malnutrition, it has not been reported to be so severe as to cause cerebral damage in the postoperative setting.

Brain Damage, Chronic↗
PubMed2001

Non-tuberculous iliopsoas abscess due to perforated diverticulitis presenting with intestinal obstruction and a groin mass.

Psoas abscess is an uncommon condition and, contrary to traditional teaching, tends to be of non-tuberculous aetiology in developed countries. Diagnosis can be delayed since presenting features are non-specific and in many instances misleading, necessitating a high degree of clinical suspicion and early resort to cross-sectional imaging using CT or MRI. We present a case of iliopsoas abscess secondary to perforated diverticulitis to illustrate the difficulty encountered in early diagnosis and to show that successful management of secondary psoas abscess necessitates surgical resection of the underlying condition in most cases.

Aged↗
PubMed2000

Coagulopathy of Liver Disease.

Coagulopathy in patients with liver disease results from impairments in the clotting and fibrinolytic systems, as well as from reduced number and function of platelets. Parenteral vitamin K replacement corrects coagulopathy related to biliary obstruction, bacterial overgrowth, or malnutrition. Vitamin K is less effective for coagulopathy caused by severe parenchymal liver injury. Transfusion of fresh frozen plasma is the hallmark of treatment of significant coagulopathy in patients with liver disease and active bleeding. Transfusion of fresh frozen plasma also reverses moderate to severe coagulopathy of cirrhosis prior to invasive procedures. Cryoprecipitate is useful for severe coagulopathy with hypofibrinogenemia, especially when avoidance of volume overload is desired. Exchange plasmapheresis is useful in selected patients with coagulopathy due to liver disease, in whom fresh frozen plasma fails to correct coagulopathy or in patients who have coexistent severe fluid overload. Platelet transfusions, pooled or single donor, are useful in thrombocytopenic patients prior to performing invasive procedures or in the presence of significant bleeding, especially when the platelet count is below 50,000/mL. The use of recombinant factor VIIa and thrombopoietin therapy for correction of coagulopathy and thrombocytopenia, respectively, in patients with cirrhosis, is currently under investigation. Therapy with prothrombin complex concentrates, 1-deamino-8-d-arginine vasopressin and antithrombin III concentrates for the management of coagulopathy caused by liver disease can be hazardous and the use of these products is considered investigational at the present time.

Journal Article↗
PubMed2000

Hepatic Cysts.

Treatment of hepatic cysts should be considered only for those patients who are symptomatic. For simple cysts, percutaneous aspiration invariably leads to recurrence; laparoscopic deroofing is usually curative. Open deroofing (fenestration) should be reserved for cysts inaccessible by laparoscopy. Percutaneous instillation of sclerosing agents (ethanol, iophendylate, minocycline) into nonbiliary and nonparasitic cysts is an alternative therapeutic option in certain cases. Due to increased morbidity, hepatic resection should be reserved for polycystic liver disease, diffuse hepatic involvement, or recurrence after a deroofing procedure. Patients with congenital fibropolycystic disorders (eg, congenital hepatic fibrosis) with evidence of hepatic decompensation, should be considered for liver transplantation. For hepatic hydatid cysts, simple cystectomy or the PAIR (puncture, aspirate, inject, and reaspirate) technique with albendazole treatment have been shown to be equally successful. In the case of alveolar echinococcosis, hepatic resection and liver transplantation are the only effective modalities for localized and extensive hepatic disease, respectively.

Journal Article↗
PubMed2000

Dietary and serum iron, body iron stores and coronary heart disease.

OBJECTIVES: To determine the role of body-iron stores as measured by serum iron, total iron binding capacity (TIBC), transferrin, ferritin and ferritin:transferrin ratio (FTR) in patients with coronary heart disease (CHD). METHODS: A case-control study was performed in 58 newly diagnosed CHD patients and 24 controls who were evaluated using clinical history, dietary history and biochemical examination. Dietary iron was determined by history; serum iron and TIBC were measured biochemically and ferritin by enzyme-linked immunoassay. Case-control comparisons were performed by non-parametric Mann-Whitney test. RESULTS: There was no significant difference in mean age, prevalence of diabetes, hypertension and smoking, and dietary intake of calories and fats in cases and controls. Dietary iron intake was 11.2 +/- 3.4 mg/day in cases and 11.3 +/- 3.8 mg/day in controls (p > 0.05). Serum fasting glucose, cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were not significantly different in cases and controls (p > 0.05). LDL/HDL ratio (4.17 +/- 1.4 vs. 4.62 +/- 2.3) and total cholesterol/HDL ratio (6.47 +/- 1.6 vs. 6.91 +/- 2.4) were also similar. In the whole study group serum iron (54.8 +/- 35.7 mcg/dl), transferrin (11.6 +/- 7.4%) and ferritin (52.4 +/- 57.8 ng/ml) levels were low. In cases as compared to controls serum iron (56.9 +/- 31 vs. 49.6 +/- 45 mcg/dl; z = 1.707, p = 0.088) and transferrin saturation (12.5 +/- 7.8 vs. 9.5 +/- 6.2%; z = 1.83, p = 0.066) were slightly more. Ferritin levels (48.8 +/- 55 vs. 60.9 +/- 64 ng/ml; z = 2.048, p = 0.040) as well as FTR (5.51 +/- 8.6 vs 7.47 +/- 6.1, z = 2.054, p = 0.040) was significantly lower in cases. CONCLUSIONS: In Indian CHD patients the body iron stores are lower as compared to controls.

Adult↗
PubMed1997

Cholesterol lipoproteins, triglycerides, rural-urban differences and prevalence of dyslipidaemia among males in Rajasthan.

To develop profiles of serum cholesterol lipoproteins and triglycerides, influence of rural versus urban lifestyle in their levels and prevalence of dyslipidaemias, we studied cohorts of male population in Rajasthan. Fasting blood samples were obtained from 401 men (age range 20-73 years) randomly selected from a larger sample of 3397 during a comprehensive cardiovascular risk factor survey in rural (202 men) and urban (199 men) populations. Serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides (TG) were determined and correlated with age and anthropometric variables. The lipid levels were classified according to US National Cholesterol Education Program (NCEP) guidelines. The mean +/- SD levels in mg/dl were, total cholesterol 170.5 +/- 40, LDL cholesterol 102.1 +/- 36, HDL cholesterol 43.6 +/- 12 and TG 124.0 +/- 50. The mean levels in rural vs. urban population were total cholesterol 165 +/- 37 vs. 176 +/- 43 (p = 0.008), LDL cholesterol 97 +/- 33 vs. 108 +/- 39 (p = 0.003), HDL cholesterol 44 +/- 13 vs. 43 +/- 12 (p = 0.44) and TG 122 +/- 46 vs 126 +/- 55 (p = 0.41). There was significant positive correlation of age and body-mass index with total and LDL cholesterol and triglycerides but not with HDL cholesterol. When classified according to the NCEP guidelines high total cholesterol (> or = 240 mg/dl) and LDL cholesterol (> or = 160 mg/dl) was in 33 (8.3%). Borderline high total cholesterol (200-239) was in 64 (16%) and borderline high LDL cholesterol (130-159) in 55 (13.7%). Borderline high triglyceride (200-400 mg/dl) was in 33 (8.2%) and severe hypertriglyceridaemia in none. Low HDL cholesterol (< 35 mg/dl) was in 96 (23.9%) and protective level of HDL cholesterol (> or = 60 mg/dl) in 47 (11.7%). In urban as compared to rural men the prevalence of hypercholesterolaemia > 200 mg/dl (28% vs 22%) and hyper LDL cholesterolaemia (26% vs 18%) were significantly more.

Adult↗
PubMed1994

Accuracy of pregnancy/non pregnancy diagnosis in zebu and crossbred cattle and Murrah buffaloes by milk progesterone determination post insemination.

Milk samples collected on days 0, 6, 20, 22 and 24 post insemination from Sahiwal and Tharparkar (zebu) cows, Karan Swiss (Sahiwal x Brown Swiss) and Karan Fries (Tharparkar x Holstein Friesian) crossbred cows and Murrah buffaloes were analysed for progesterone by enzyme-linked immunosorbent assay to determine the accuracy of pregnancy and non pregnancy diagnosis in each of the 3 groups of animals. The accuracy of pregnancy diagnosis was markedly improved in cows when the milk progesterone values on days 20, 22 and 24 were considered together, and a further improvement when the levels on days 0, 6, 20, 22 and 24 were considered together particularly in crossbred cows. In contrast, buffaloes exhibited the highest degree of accuracy from samples collected on day 24, and improvement in accuracy was minimal when values were considered for all 5 days, viz. 0, 6, 20, 22 and 24 post insemination. Overall, the accuracy of positive pregnancy diagnosis was greatest in zebu cows (90.9%) followed by crossbred cows (86.6%) and Murrah buffaloes (76.5%) when milk progesterone values on all 5 days were considered. The accuracy for negative pregnancy diagnosis was 100% on all days. The results suggest that there is a greater variability in oestrous cycle length in cattle than in buffaloes, and embryonic mortality is greater in buffaloes than in cattle.

Animals↗
PubMed1994

An outbreak of multidrug resistant Salmonella typhimurium in Delhi (India).

A total of 85 patients with multidrug resistant S. typhimurium were isolated between May and September 1991 at the Sir Ganga Ram Hospital, New Delhi, India. Fifty eight (72.5%) patients out of 80 stool culture positives suffered from enteritis and 23 (39.6%) of them settled with oral rehydration therapy alone. All strains were sensitive to 4 aminoquinolones (oflaxcin) but five were resistant to third generation cephalosporin (Cefotaxime; MIC between 50-75 micrograms/ml) whereas 88-96 per cent isolated were resistant to most of the other antibiotics. The convalescent carrier rate was prolonged with the use of antibiotics. The phage type of S. typhimurium isolated from the index and other cases was 178 and multidrug resistance strains had seven plasmids (1.2 to 16 kb). Barrier nursing and sodium hypochlorite disinfection helped in limiting the outbreak.

Adult↗
PubMed1989

Primary carcinoma of gall bladder--a review of thirty six cases.

The study presents the clinicopathological findings in thirty six cases of primary carcinoma of gall bladder diagnosed at SKIMS Srinagar over a period of four years (1983-86). Particular attention was paid to age, sex, presenting symptoms, presence of gall stones and site of metastasis. Majority of patients were found to be middle aged females (24 out of 36 cases). Most common presenting symptom was abdominal pain and duration of symptoms was two months or less in majority of cases. Gall stones were found in 55.5% cases. Diagnosis of primary gall bladder carcinoma was an incidental histopathological finding in 22% patients. Well differentiated adenocarcinoma was found to be the commonest type of malignancy (77.7%). 33% cases had widespread metastatic disease at the time of operation and liver was the commonest site of invasion (47.2%). Follow up records of 21 out of 36 patients available show only two patients to be alive till date with more than two year follow up and in both these cases carcinoma was an incidental histopathological diagnosis at cholecystectomy. Rest of the patients had died within 5-6 months after surgery. This reinforces the poor outcome for primary gall bladder carcinoma patients irrespective of treatment unless diagnosed and treated at a very early stage. Long term survival can be expected in incidentally found carcinoma at cholecystectomy.

Adult↗
PubMed1984

Post-pollination callose development in ovules of Rhododendron and Ledum (Ericaceae): zygote special wall.

In Rhododendron spp. and Ledum groenlandicum a callose wall is laid down around the zygote in the first 2 days after fertilization. The periodic acid/Schiff-positive, aniline blue-fluorescence-positive callosic wall is initiated adjacent to the degenerating synergid, extends to cover the entire zygote surface, and remains visible during the initiation of embryogeny as the zygote elongates before the first proembryonal division. Unfertilized ovules show eventual callose deposition in the ovule wall cells during senescence in undeveloped abscising pistils, but show no development of callose within the embryo sac. Possible roles of a zygote special callose wall are discussed.

Cell Wall↗
PubMed1981

Morphological features of Jat dentition.

Observations on morphological characters of milk and permanent teeth, based on 648 pairs of dental casts of 356 male and 292 female Jat children of Haryana (India) are reported. Deciduous teeth show high frequencies of bilateral winging of maxillary central incisor, Carabelli's cusp of maxillary second molar, and deflecting wrinkle of mandibular second molar. Reduction of maxillary molar cusps is more marked in males than in females. Y pattern is very common in deciduous molars. Permanent teeth have high frequencies of grooved cingulum of incisors, cingular nodule of lateral incisors and canines, and distal accessory ridge of canines. Low frequencies of Carabelli's cusp and winging are also common. The tendency towards faintly developed shovelling in milk incisors occurs more often than in the permanent teeth.

Adolescent↗