Biomedical subjects

V Sehgal

Publications and source records attributed to V Sehgal.

5 recordsLinked to original sources

PubMed1997

Cyclosporine-associated end-stage nephropathy after cardiac transplantation: incidence and progression.

BACKGROUND: The salutary immunosuppressive effects of cyclosporine in extending cardiac allograft survival may be curtailed by its nephrotoxic effects. We reviewed our first 9 years of experience with cyclosporine after cardiac transplantation, to evaluate the incidence and progression of cyclosporine-associated end-stage renal failure necessitating chronic hemodialysis. METHODS: Retrospective computer-based file review and personal interview when possible. RESULTS: The population at risk was comprised of all adult cardiac recipients surviving at least 3 years (n=293). Of these, 19 (6.5%) developed end-stage renal failure requiring chronic hemodialysis. There were 17 men and 2 women (mean age of 45 +/- 11 years). The mean creatinine clearance for the study group decreased by 38% (P<0.001 vs. before transplant) by 6 months after transplantation and by 48% by 3 years postoperatively (P<0.001 vs. before transplant). The mean serum creatinine rose by 80% (P< 0.001 vs. before transplant) by 6 months after transplantation and by 125% by 3 years postoperatively (P<0.001 vs. before transplant). Time elapsed from transplantation to hemodialysis ranged from 3.7 to 9.5 years (mean 6.4 +/- 2). Actuarial 1- year survival after onset of hemodialysis was 75%. CONCLUSIONS: Although cyclosporine remains the central immunosuppressive agent for cardiac allograft recipients, its use leads to a greater than one-third decrease in creatinine clearance by 6 months after transplantation and progression to end-stage renal failure, requiring hemodialysis in 6.5% of cardiac transplant recipients. Moreover, these patients are at increased risk of death compared with other cardiac allograft recipients. This data warrants the search of alternative or adjunctive agents that would allow decreased dosing or reduced nephrotoxicity of cyclosporine, while maintaining equivalent survival.

Adult↗

PubMed1997

Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections.

OBJECTIVE: To identify the predictors of mortality due to acute lower respiratory tract infection (ALRI). DESIGN: Prospective cohort study. SETTING: Urban tertiary care teaching hospital. METHODS: 201 cases with ALRI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pretested proforma. Significant independent predictors of mortality were determined by comparison of dead subjects (n = 21) with surviving children (n = 180) in a multiple logistic analytic framework. RESULTS: The case fatality rate (CFR) was 10.45%. Significant independent predictors of mortality were (OR, 95% CI) age less than 1 year (23.1, 2.7-197.5), inability to feed (6.2, 1.3-30.7), associated loose stools (5.1,1.2-27.3), weight for age Z score < -3 (3.9,1.01-9.7), short duration of fever (1.2,1.0-1.5) and bandemia (1.1,1.05-1.2). The WHO guidelines identified 91% of children diagnosed as ALRI by clinical and investigative criteria. The CFR was related to severity of WHO classification ("pneumonia"-0%, "severe pneumonia"-8.7% and "very severe pneumonia"-47.0%). However, 2 of the 18 subjects with a diagnosis of "no pneumonia" expired (CFR 11.1% and 10% of total mortality). CONCLUSION: Even in settings of high case fatality, predictors of mortality can be identified in under five children suffering from ALRI. In this context, age below 1 year, inability to feed, presence of loose stools and severe malnutrition merit attention for interventional purposes.

Age Distribution↗

PubMed1996

Cutis laxa.

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Cutis Laxa↗

PubMed1995

Progressive renal insufficiency following cardiac transplantation: cyclosporine, lipids, and hypertension.

The increasing success of cardiac transplantation has been attributed to the availability of potent immunosuppressive agents, including cyclosporine. With improved graft and patient survival, the incidence of chronic renal insufficiency has increased. We reviewed the medical records of patients who had undergone orthotopic cardiac transplantation and had been followed for at least 3 years posttransplantation to determine the risk factors at initial evaluation and in the early posttransplantation period for subsequent renal insufficiency. We followed 80 adult patients over a mean period of 4.7 years: 39 patients had a serum creatinine > or = 2.4 mg/dL at last follow-up (renal insufficiency or RI group); 41 patients had a serum creatinine < or = 1.7 mg/dL at last follow-up (controls). RI patients tended to be older and had a lower mean glomerular filtration rate (GFR) at initial evaluation. There were no differences in race, gender, or previous history of hypertension between the two groups. Although both groups experienced an improvement in GFR at transplantation and a subsequent decline in GFR by 6 months posttransplantation, the RI group achieved a lower peak GFR at transplantation and a far lower mean GFR at the 6-month analysis. Only the RI group showed a continued decline in GFR. The RI group had more severe hypertension and required a significantly greater number of antihypertensive medications. The RI group had a higher mean total cholesterol at 6 months, but this difference was not sustained. They also had higher triglyceride levels and lower high-density lipoprotein (HDL) levels; there was no difference in low-density lipoprotein (LDL) levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Naturally occurring anti-native DNA antibodies in SLE binding Z-DNA.

A high degree of specificity of circulating anti-DNA antibody for double stranded DNA in the sera of SLE patients was found, as compared to single stranded polymer. The antibody recognized brominated DNA, a polymer that appears to attain Z-conformation as indicated on the basis of UV absorption characteristics. The existence in native DNA of regions undergoing B----Z transition has been detected.

Antibody Specificity↗