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Biomedical subjects

V Sharma

Publications and source records attributed to V Sharma.

At least 19 recordsLinked to original sources
PubMed2006

Treatment resistance in unipolar depression: Is it an iatrogenic phenomenon caused by antidepressant treatment of patients with a bipolar diathesis?

Major depressive disorder is a common psychiatric illness that is considered generally treatable; however, there are some patients who fail to respond in spite of adequate trials of antidepressants. Clinical factors known to contribute to treatment resistance include psychiatric and physical comorbidity, undiagnosed bipolarity, and treatment non-adherence. There is also emerging evidence that the use of antidepressants in some 'unipolar' patients may lead to a pattern of progressive diminution of therapeutic response and ultimately treatment resistance. A large number of these patients may have a bipolar diathesis even though there are no symptoms of hypomanic, manic or mixed episodes. It is hypothesized that the widespread and injudicious use of antidepressants in patients with a bipolar diathesis might result in treatment-induced resistant depression. Furthermore, attempts to manage the antidepressant-led mood instability might cause increased utilisation of other psychotropic drugs including sedative/hypnotics, neuroleptics and mood stabilisers and contribute to polypharmacotherapy.

Affect↗
PubMed2006

Phacoemulsification with nondominant hand.

PURPOSE: Evaluation of on axis phacoemulsification surgery through temporal incision using nondominant hand with surgeon sitting at the head end, inpatients with against-the-rule astigmatism. METHODS: Eighty eyes of 80 patients who underwent phacoemulsification through a temporal clear corneal tunnel for age-related cataract and against-the-rule astigmatism were enrolled and divided into four equal groups. In Group 1A, the surgeon was sitting at the head end for the left eye performing surgery with the left hand (nondominant hand). In group 1B, the surgeon was seated at the temporal side and surgery was performed in the left eye with dominant right hand. In group 2A, the surgeon was sitting at the head end for the right eye and performed surgery holding the phacoemulsification hand piece in his right hand. In group 2B, the surgeon sat on the temporal side of the right eye and performed phacoemulsification with his right hand. The patients were followed up on day 7, 1 month, and 3 months. Parameters evaluated included average phaco power, effective phaco time, uncorrected and best-corrected visual acuity, keratometry, intraocular pressure, surgically induced astigmatism, pachymetry, and endothelial cell counts. RESULTS: The phaco time and phaco power among the four groups were comparable (phaco time: P=0.368; phaco power: P=0.294). The four groups were also comparable on parameters like surgically induced astigmatism (P=0.674), change in postoperative keratometric astigmatism (P=0.584), endothelial cell loss (0.921), change in ultrasonic pachymetry (P=0.476), and intraocular pressure (P=0.942). No intraoperative or postoperative complications were observed in any of the groups. The mean uncorrected visual acuity at 3 months in group 1 was 0.723+/-0.21; in group 2 it was 0.756+/-0.21; in group 3 it was 0.748+/-0.22, and in group 4 it was 0.732+/-0.23. The best-corrected visual acuity was 0.96+/-0.10, 0.97+/-0.11, 0.95+/-0.13, and 0.96+/-0.10 in the four groups at 3 months. CONCLUSION: Phacoemulsification surgery can be successfully performed with nondominant hand with a good surgical outcome. The technique gives an alternative approach where surgeon does not have to shift the position to perform on-axis phacoemulsification.

Aged↗
PubMed2006

Diabetic cardiomyopathy: where are we 40 years later?

Diabetic cardiomyopathy is a cardiac disease that arises as a result of the diabetic state, independent of vascular or valvular pathology. It manifests initially as asymptomatic diastolic dysfunction, which progresses to symptomatic heart failure. The compliance of the heart wall is decreased and contractile function is impaired. The pathophysiology is incompletely understood, but appears to be initiated both by hyperglycemia and changes in cardiac metabolism. These changes induce oxidative stress and activate a number of secondary messenger pathways, leading to cardiac hypertrophy, fibrosis and cell death. Alterations in contractile proteins and intracellular ions impair excitation-contraction coupling, while decreased autonomic responsiveness and autonomic neuropathy impair its regulation. Extensive structural abnormalities also occur, which have deleterious mechanical and functional consequences.

Cardiomyopathies↗
PubMed2006

Contamination of disposable tonometer prisms during tonometry.

AIM: Due to the theoretical possibility of prion transmission in applanation tonometry, many ophthalmological units in the United Kingdom now use disposable tonometer prisms. We have investigated the potential for bacterial and viral transmission from the health practitioner to the patient via disposable prisms. METHODS: All staff who perform applanation tonometry at the Sussex Eye Hospital (SEH) received a questionnaire to evaluate if the applanating face of the prism is touched during tonometry and the ease of use of the disposable prism compared to the reusable prisms that were previously used. We then cultured prisms handled by a random sample of staff members for common bacteria. Finally, we constructed a model to investigate the possibility of interpatient adenoviral transmission via disposable tonometer prisms. RESULTS: The questionnaire revealed that almost 50% of the staff admit to touching the applanating face of the tonometer prism prior to applanation. Cultures of the prisms grew a range of bacteria including Staphylococcus epidermidis, Staphylococcus aureus, and Bacillus species. The viral model suggested that adenovirus could be transmitted by applanation tonometry. CONCLUSION: The use of disposable prisms for applanation tonometry may reduce the risk of prion transmission but is not bacteriologically or virologically aseptic. This is a potential infection risk to patients.

Adenoviridae↗
PubMed2006

Juxtacrine function of interleukin-15/interleukin-15 receptor system in tumour derived human B-cell lines.

Interleukin-15 (IL-15) is a cytokine that induces proliferation and promotes cell survival of human T, B and NK cells. IL-15 and interleukin-2 (IL-2) exhibit a similar spectrum of immune effects and share the IL-2 receptor (IL-2R) subunits IL-2Rbeta and IL-2Rgamma(c) for signalling in haematopoietic cells. Furthermore, each cytokine has a private alpha receptor, namely IL-2Ralpha for IL-2 and IL-15Ralpha for IL-15, that functions in ligand binding. Using reverse transcriptase-polymerase chain reaction (RT-PCR) and enzyme-linked immunosorbent assay (ELISA) methods, the expression and secretion of IL-15 and IL-15Ralpha in tumour-derived B-cell lines were studied. The results as presented in this study identify that IL-15 mRNA is predominantly expressed in EBV positive (EBV(+)) B-cell lines, although IL-15Ralpha is ubiquitously and constitutively expressed in all these B-cell lines. Although no detectable levels of IL-15 protein secretion were observed in any of these cell lines, we were able to detect membrane-bound expression of IL-15 protein by FACS analysis in some cell lines. These data imply that the IL-15/IL-15R system requires complex regulatory mechanisms for protein secretion. Taken together, we speculate that these results suggest a juxtacrine, intracrine function for IL-15/IL-15R.

B-Lymphocytes↗
PubMed2006

An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department.

BACKGROUND AND OBJECTIVES: Corneal abrasions are a common presentation to accident and emergency (A&E) departments. Patients can be treated and discharged by A&E staff without the need for an ophthalmologist's attention; complicated cases, however, should be recognised and referred. Inexperience and limited training in ophthalmology may lead to suboptimal patient care and inappropriate use of ophthalmology outpatient clinics. Issues of poor documentation may also arise. The purpose of this audit was to assess the effect of guidelines on the management of corneal abrasion by A&E staff. METHODS: A retrospective case note audit was performed to assess current management of corneal abrasions. Guidelines for management of corneal abrasions were formulated following a literature search and collaboration between A&E and ophthalmology staff. A prospective case note audit was undertaken to assess management after introduction of the guidelines. RESULTS: A total of 51 cases were audited before the introduction of the guidelines and 57 cases after. Following the introduction of the guidelines documentation of visual acuity increased to 93% and specific enquiry into contact lens wear rose from 35.3% to 71.9%. A&E staff stopped giving out local anaesthetic eye drops. The follow up profile also improved; appropriate patient discharges increased by 40% whereas inappropriate referrals to eye clinic dropped by 75%. More patients were given abrasion advice (a 101% increase). CONCLUSIONS: A&E staff members are capable of managing corneal abrasions if they are given guidance and some training. This audit identified shortcomings in current management and showed that guidelines can significantly improve clinical practice.

Anesthetics↗
PubMed2006

An unusual presentation of eosinophilic granuloma in an adult: a case report.

Eosinophilic granuloma is the most common and benign form of a rare proliferative disorder: Langerhans' cell histiocytosis. Spinal involvement is rare and only 15 adult cases have been reported. We present an unusual variant of eosinophilic granuloma in a 25-year-old woman with radiological evidence of vertebra plana. Plain radiography, magnetic resonance imaging, bone scan, and blood tests were carried out, and a specimen was taken from L4 using computed tomography-guided biopsy. Gram staining, acid fast bacillus smear, bacterial and fungal cultures were negative. Histological examination of the biopsy showed features of eosinophilic granuloma with aggregates of Langerhans histiocytes. The patient was treated with low-grade radiotherapy at 150 cGy per day for 7 days. She was asymptomatic at one-year follow-up although the radiological picture was unchanged.

Adult↗
PubMed2006

A case of human thelaziasis from Himachal Pradesh.

Small, chalky-white, threadlike, motile worms were isolated from the conjunctival sac of a 32 year-old woman residing in the Himalaya mountains. They were identified as both male and female worms of Thelazia callipaeda. To the best of our knowledge, this is the second case report of human thelaziasis from India.

Adult↗
PubMed2006

Aggressive fibromatosis--impact of prognostic variables on management.

OBJECTIVE: To determine the impact of prognostic variables on local control in patients with aggressive fibromatosis treated with or without radiation. MATERIALS AND METHODS: Forty-two patients presenting to the combined sarcoma clinic at Johannesburg Hospital with aggressive fibromatosis from 1990 to 2003 were analysed retrospectively. There were 14 males and 28 females. The lesions involved the head and neck in 6 cases (14%), the thorax in 6 (14%), the extremities in 19 (45%) and the abdomen in 11 (26%). Thirty-seven patients (88%) presented to the clinic for the first time, whereas 5 (12%) had recurrent disease at presentation. Fifteen patients (36%) underwent excision only, 15 (36%) had excision followed by postoperative radiation, 8 (19%) had biopsy only, and 4 (9%) had radiation only. The median dose of radiation was 60 Gy (range 9 - 70 Gy). RESULTS: One patient had local failure following excision and postoperative radiation therapy. The local control was 100% for surgery alone and 86% for surgery followed by postoperative radiation at > or = 24 months. On univariate analysis, age, sex, positive margins, primary or recurrent presentation, site of involvement and initial treatment did not affect local control significantly. Eight of 19 patients (42%) receiving radiation developed severe moist desquamation following treatment, and all these patients had doses of 60 Gy or more. CONCLUSION: Surgery with or without radiation therapy gave excellent local control. The addition of radiation therapy to surgery as well as other known prognostic parameters did not impact on local control. The morbidity of radiation treatment is considerable, as noted in this series, and adjuvant radiation therapy should therefore be considered only in situations where the risk of recurrence and the morbidity of re-excision are high.

Adolescent↗
PubMed2006

Relevance of Weil-Felix test in diagnosis of scrub typhus in India.

OBJECTIVE: To study the relationship of Weil-Felix test and microimmunofluorescence test. METHODS: Sera of 21 patients with clinical diagnosis of scrub typhus were subjected to Weil-Felix and Microimmunofluorescence tests. RESULTS: On Weil-Felix test, 13 (62%) sera showed titers 1: > or = 40-320. 7 patients showed titers 1: > or = 320, 3 showed titers 1 : 160, 2 showed titers 1 : 80 and 1 patients showed titers 1 : 40, to Proteus OXK antigen. All 21 sera showed significant titers to O. tsutsugamushi on microimmunofluorescence. CONCLUSION: Weil-Felix test is not a very sensitive test in diagnosis of scrub typhus but due to of lack of availability of definitive tests in India it canbe a useful tool when used and interpreted in the correct clinical context.

Adolescent↗
PubMed2005

Myofasciitis and polyneuritis related to Buprenorphine abuse.

Various kinds of neuromuscular manifestations are known with the recreational drugs. We report an interesting case of extensive myositis and fasciitis of thigh following an injection of a solution of Buprenorphine. The inflammatory process affected the sciatic and obturator nerve as well.

Adult↗
PubMed2005

Ultrabroadband beam splitter with matched group-delay dispersion.

We present a general design strategy for a broadband thin-film beam splitter with matched group-delay dispersion. By taking the substrate dispersion into account in the coating design, any combination of input and output can show the same dispersion for transmission and reflection. As a specific implementation, an ultrabroadband 50:50 beam splitter from 600 to 1500 nm for femtosecond laser applications was designed, fabricated, and characterized.

Journal Article↗