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Gupta V, Gupta A, Dogra MR. Posterior sympathetic ophthalmia: a single centre long-term study of 40 patients from North India. Eye (Lond) 2007; 22:1459-64. [PMID: 17618240 DOI: 10.1038/sj.eye.6702927] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To report 'posterior sympathetic ophthalmia' in North Indian population as an early manifestation of sympathetic ophthalmia. METHODS Forty consecutive patients with a diagnosis of sympathetic ophthalmia seen between 1989 and 2004 at our centre were studied for their clinical presentation and disease course. All received systemic corticosteroids and 12 patients, in addition, also received immunosuppressive agents. RESULTS There were 28 male and 12 female patients with a median age of 29.4 years. In 22 of the 40 sympathizing eyes, the only presenting sign was the fundus lesions without any associated anterior segment inflammation. Only four eyes showed classically described granulomatous anterior uveitis at presentation. The fundus lesions predominately included exudative retinal detachment (29 eyes), yellowish-white mid-peripheral lesions (10 eyes), optic disc oedema (15 eyes), vasculitis (three eyes), and peripapillary choroidal neovascular membrane (two eyes). Over a median follow-up of 5.2 years, recurrences were seen in 12 of 40 (30%) eyes and were mainly in the anterior segment. Over a median follow-up of 5.2 years, a final visual acuity of 20/40 or better could be achieved in 29/36 (80.5%) eyes. CONCLUSION In the early stage, sympathetic ophthalmia may present only in the posterior segment without any associated anterior segment inflammation and carries a good visual prognosis. Anterior segment inflammation, however, maybe seen during recurrences.
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Aggarwal A, Gupta A, Narang M, Faridi MMA. Familial hypercholesterolemia with coarctation of aorta. J Postgrad Med 2007; 53:185-6. [PMID: 17699994 DOI: 10.4103/0022-3859.33863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Herrada J, Campos-Gines AF, Gupta A, Vazquez CW. Ocular adnexal lymphoma subtyped according to the REAL classification: A 12-year experience from a single institution. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.18541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18541 Background: The Revised European and American Lymphoma (REAL) classification (1994) provided a useful and practical tool to define lymphomas. The aim is to report our experience with this unusual malignancy diagnosed since the REAL classification was implemented. Methods: Retrospective review was performed on patients (pts) with ocular adnexal lymphoma between 1994 and 2006. Medical records, diagnostic imaging procedures, and pathology reports, including immunophenotyping studies, were reviewed. Histologic definition of lymphoma was based on the REAL Classification. Results: 10 pts were identified. All but one were females. Median age at diagnosis was 69 years (54–84). Primary sites included conjunctiva (5), orbital soft tissue (3), and eyelid (2). No lacrimal gland location was found. Ann Arbor stage at diagnosis was IE in most cases (7). One patient (pt) had stage IIE (conjunctival and maxillary sinus) and 2 pts had simultaneous bone marrow involvement (stage IV). 6 pts had marginal zone B-cell subtype, and the remaining 4 pts had small lymphocytic B-cell lymphoma. Radiation as single treatment modality was given to all 7 pts with stage IE, and all those achieved a complete remission (CR). CR was also achieved using chemotherapy with cyclophosphamide (C), vincristine (V), doxorubicin, prednisone (P), and rituximab followed by radiation in the pt with stage IIE. Of the 2 pts with stage IV, 1 achieved a CR with rituximab-based chemotherapy, and 1 never achieved a CR despite chemotherapy (chlorambucil, CVP). With a median follow-up of 23 months (9–70), the 9 pts that achieved a CR after initial treatment remain alive and disease-free. The only pt that did not achieve a CR lost follow-up at 18 months. Conclusions: In our patient population, radiation alone appears to be an effective treatment modality for stage IE. Achieving a CR seems to be a crucial factor for long-term control of the disease. No significant financial relationships to disclose.
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Hariprasad R, Ganessan K, Gupta A, Kumar L, Kumar S, Bhatla N, Kriplani A, Kochupillai V. Gestational trophoblastic disease: Experience at a tertiary care center from a developing country. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16041 Background: We retrospectively analyzed case records of patients diagnosed to have Gestational Trophoblastic Disease (GTD) to determine clinical characteristics, risk groups, treatment outcome, and reproductive function post treatment. Methods: Between Jan 1991 to Dec 2005, 102 patients (mean age: 28.2 years, range 19–50) were diagnosed to have GTD. 35 patients were nulliparous and 8 had prior molar pregnancy. Vaginal bleeding was the most common presenting symptom (77.5%). The antecedent pregnancy was vesicular mole in 50%, abortion - 34.3%, ectopic pregnancy - 4% and term pregnancy in 11.8% patients. The mean value of B hCG was 1225386 mIU/ml. The histopathology (n=85) was complete mole in 30, partial mole - 28, invasive mole- 9, PSTT -1 and choriocarcinoma in 17 patients. 68(66.7%) patients had non-metastatic disease. Sites of metastasis were - lung (38.2%), vagina (11%), brain (8.8%), liver (6.9%) and kidney, Urinary bladder and peritoneum in one patient each. According to modified WHO risk scoring - 78(76.5% had low risk and 24 (23.5%) were high risk. Results: Eighty-seven (85.3%) patients received chemotherapy using methotrexate with leucovorin (n=63), EMA/CO (n=19) and BEP (n=5). 77/87 (89.5%) achieved complete remission (CR) ; the response rate was higher in non-metastatic GTD (p<0.05). Two of 7(28.6%) patients with liver and 5/9 (55,6%) of brain metastasis achieved CR. Two patients had grade III oral mucositis and diarrhoea with methotrexate. One patient died of Methotrexate hypersensitivity. 19 patients received second line chemotherapy using EMA/CO (n=11), EMA/EP (n=2), BEP (n=1), actinomycin-D (n=1) and MAC (methotrexate, actinomycin D and Cyclophosphamide) n=1; 14 patients achieved CR. At a mean follow up of 180 months, 5-year survival for patients with low risk is 100% and that of high risk is 95%. Eight patients had recurrent disease including recurrent molar pregnancy in four. 16 patients had 24 successful deliveries after completion of treatment and 10 of them were primiparae. No fetal abnormalities were found. We did not observe second malignancy or other therapy related sequele. Conclusions: Present study confirms excellent outcome for patients with gestational trophoblastic disease. The potential for childbearing is well maintained. No significant financial relationships to disclose.
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Beg MS, Gupta A, Komrokji R, Atiq M, Ali S, Safa M. Impact of screening on presentation and survival of colorectal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.1535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1535 Background: There is an increasing emphasis and utilization of colorectal cancer (CRC) screening. We evaluated the effect of screening on CRC presentation and outcome. Methods: We reviewed all the invasive CRC cases diagnosed between Jan 1995-Dec 2005 at the Cincinnati Veteran’s Affairs hospital. Individual case records were reviewed and the data collected including patient demographics, treatment, outcome, mode of presentation as well as whether CRC was detected as a result of screening. Results: Altogether 288 patients were diagnosed with CRC during the study period. The median age at presentation was 69.3 years and 18.8% were African-Americans. Early stage CRC was diagnosed in 63.4% cases (stage 1: 32.7%, stage 2: 30.8%) and 33.3% were diagnosed at advanced stage (stage 3: 18.1% and stage 4: 15.3%). Seventy seven (26.7%) CRCs were asymptomatic at presentation and were diagnosed as a result of screening. Predominant screening modalities included fecal occult blood testing (46.8%) and flexible sigmoidoscopy (22.1%). The proportion of screen- detected cases increased from 19% in 1995–1999 to 32% in 2000–05 (p = 0.047). Demographics, including age and race, as well as the site of CRC were similar to symptomatic cases. Screen-detected cancers presented early, with 77.9% presenting at early stage (stage 1: 55.8%, stage 2: 22.1%), compared to 51.5% (stage 1: 21.0%, stage 2: 30.5%) of symptomatic cancers (p <0.01). Only 1.3% of screen-detected CRC was found to be metastatic as compared to 21.0% of the symptomatic cases. The screen-detected cancers had significant survival advantage compared to symptomatic cases; with median survival being 81 months vs. 43 months in the latter (p =0.018). A proportional hazard regression analysis indicated that this improvement in survival was related to the fact that screening resulted in earlier stage at diagnosis. Only 20.3% of screen-detected CRC received adjuvant chemotherapy compared to 41.4% of symptomatic cases (p=0.002). Conclusions: An increasing proportion of CRC is being diagnosed as a result of screening. These cancers present at an earlier stage and are associated with a significantly improved survival. However, most CRC still presents symptomatically and more effective population screening is needed. No significant financial relationships to disclose.
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Gupta A, Gillard M, Christophe B, Chatelain P, Massingham R, Hammarlund-Udenaes M. Peripheral and central H1 histamine receptor occupancy by levocetirizine, a non-sedating antihistamine; a time course study in the guinea pig. Br J Pharmacol 2007; 151:1129-36. [PMID: 17558437 PMCID: PMC2042936 DOI: 10.1038/sj.bjp.0707318] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE The H(1) receptor occupancy (H1RO) in brain is an indicator of central side effects of antihistamines. Here, we determined the kinetics of central and peripheral H1RO by levocetirizine in relation to its brain and plasma concentration, and investigated the role of the blood-brain barrier in any delay in brain H1RO. EXPERIMENTAL APPROACH Concentration-time profiles in plasma and brain were obtained after 0.1 and 1 mg kg(-1) oral doses of levocetirizine in guinea pigs. H1RO in brain was measured ex vivo using [3H]-mepyramine and, in the periphery, by measuring the degree of inhibition of histamine-induced contractions of isolated guinea pig ileum. KEY RESULTS The concentration-time profile of levocetirizine indicated lower levels (partition coefficient, K(p)=0.06-0.08), higher t(max) (2-4 h vs 1-1.5 h) and longer terminal half-life (4-5.6 h vs 2.1-2.8 h) in brain than plasma. The H1RO at 0.1 and 1 mg kg(-1) were 75% and 97%, respectively, at 1 hr in the periphery and, in the brain, were <20% and 28-67% respectively, at all time points studied. Brain H1RO vs plasma concentrations profile showed a delay, but not when compared to brain concentrations. CONCLUSIONS AND IMPLICATIONS This study demonstrates an effective peripheral antihistamine effect of levocetirizine without central adverse effects at the dose close to human therapeutic dose. The slow increase in H1RO in the brain with time was caused by slow blood-brain barrier transport of levocetirizine. This demonstrates the importance of measuring time course of brain H1RO in relation to brain concentrations of drugs.
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Wilson CH, Asher JF, Gupta A, Vijayanand D, Wyrley-Birch H, Stamp S, Rix DA, Soomro N, Manas DM, Jaques BC, Peaston R, Talbot D. Comparison of HTK and hypertonic citrate to intraarterial cooling in human non-heart-beating kidney donors. Transplant Proc 2007; 39:351-2. [PMID: 17362727 DOI: 10.1016/j.transproceed.2007.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Intraarterial cooling (IAC) of non-heart-beating donors (NHBD) for renal donation requires a cheap, low-viscosity solution. HTK contains a high hydrogen ion buffer level that theoretically should reduce the observable acidosis associated with ongoing anaerobic metabolism. A retrospective comparison of all retrieved NHBD kidneys as well as of viability on the Organ Recovery Systems Lifeporter machine perfusion circuit was performed with respect to the preservation solution HTK or Marshall's HOC. Forty-two NHBD kidneys (19 HTK and 23 HOC) were machine perfused between February 2004 and May 2005. Most of the HTK kidneys were obtained from uncontrolled donors (12 vs 5; Fisher exact test, P = .01). As a consequence, the glutathione-s-transferase viability assay (411 vs 292 IU/L, P = .12) and the lactate concentrations (2.33 vs 1.94 mmol/L, P = .13) were higher among the HTK cohort. There was evidence of greater buffering capacity in HTK, since the lactate:hydrogen ion ratios were consistently lower during the first 2 perfusion hours (1 hour P = .03, 2 hour P = .02). A linear regression analysis confirmed that this was related to the IAC solution (ANCOVA, P < .001). All controlled donor kidneys passed viability testing and were transplanted. In contrast, 83% (10/12) of the uncontrolled donor kidneys preserved with HTK passed the viability test and were transplanted, compared with only 20% (1/5) of the HOC-treated comparators (Fisher exact test, P = .03). It may be concluded that the postulated advantages of improved pH buffering with HTK appear to have clinical relevance.
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1233
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Lavinio A, Timofeev I, Nortje J, Outtrim J, Smielewski P, Gupta A, Hutchinson PJ, Matta BF, Pickard JD, Menon D, Czosnyka M. Cerebrovascular reactivity during hypothermia and rewarming. Br J Anaesth 2007; 99:237-44. [PMID: 17510046 DOI: 10.1093/bja/aem118] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Experimental evidence from a murine model of traumatic brain injury (TBI) suggests that hypothermia followed by fast rewarming may damage cerebral microcirculation. The effects of hypothermia and subsequent rewarming on cerebral vasoreactivity in human TBI are unknown. METHODS This is a retrospective analysis of data acquired during a prospective, observational neuromonitoring and imaging data collection project. Brain temperature, intracranial pressure (ICP), and cerebrovascular pressure reactivity index (PRx) were continuously monitored. RESULTS Twenty-four TBI patients with refractory intracranial hypertension were cooled from 36.0 (0.9) to 34.2 (0.5) degrees C [mean (sd), P < 0.0001] in 3.9 (3.7) h. Induction of hypothermia [average duration 40 (45) h] significantly reduced ICP from 23.1 (3.6) to 18.3 (4.8) mm Hg (P < 0.05). Hypothermia did not impair cerebral vasoreactivity as average PRx changed non-significantly from 0.00 (0.21) to -0.01 (0.21). Slow rewarming up to 37.0 degrees C [rate of rewarming, 0.2 (0.2) degrees C h(-1)] did not increase ICP [18.6 (6.2) mm Hg] or PRx [0.06 (0.18)]. However, in 17 (70.1%) out of 24 patients, rewarming exceeded the brain temperature threshold of 37 degrees C. In these patients, the average brain temperature was allowed to increase to 37.8 (0.3) degrees C (P < 0.0001), ICP remained stable at 18.3 (8.0) mm Hg (P = 0.74), but average PRx increased to 0.32 (0.24) (P < 0.0001), indicating significant derangement in cerebrovascular reactivity. After rewarming, PRx correlated independently with brain temperature (R = 0.53; P < 0.05) and brain tissue O2 (R = 0.66; P < 0.01). CONCLUSIONS After moderate hypothermia, rewarming exceeding the 37 degrees C threshold is associated with a significant increase in average PRx, indicating temperature-dependent hyperaemic derangement of cerebrovascular reactivity.
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Gupta S, Jain A, Warneke CL, Gupta A, Shannon VR, Morice RC, Onn A, Jimenez CA, Bashoura L, Giralt SA, Dickey BF, Eapen GA. Outcome of alveolar hemorrhage in hematopoietic stem cell transplant recipients. Bone Marrow Transplant 2007; 40:71-8. [PMID: 17483846 DOI: 10.1038/sj.bmt.1705695] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alveolar hemorrhage (AH) is a frequent, serious complication of hematopoietic stem cell transplantation (HSCT). To study the incidence of AH, its clinical course and outcomes in HSCT patients, a retrospective review of the records of all adult patients who underwent bronchoscopy between January 1, 2002 and December 31, 2004 was carried out and those who underwent bronchoscopy after HSCT identified. A total of 223 patients underwent bronchoscopy after HSCT for diffuse pulmonary infiltrates with respiratory compromise. Eighty-seven (39%) patients had AH. Of these, 53 had AH without any identified organism while 34 had an organism along with hemorrhage on bronchoalveolar lavage (BAL). Six-month survival rate of patients with AH was 38% (95% confidence interval: 27-48%). In 95 of the 223 patients, an organism was isolated from BAL. These patients had poor outcomes compared to patients in whom no organism was identified. Patients with both AH and an organism had the worst prognosis. Mortality of patients with AH is improving and long-term survival of patients with AH is feasible. Isolation of a microbial organism in BAL is a strong predictor of poor outcome.
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Sachdev N, Gupta V, Abhiramamurthy V, Singh R, Gupta A. Correlation between microaneurysm closure rate and reduction in macular thickness following laser photocoagulation of diabetic macular edema. Eye (Lond) 2007; 22:975-7. [PMID: 17417620 DOI: 10.1038/sj.eye.6702801] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To correlate the microaneurysmal closure rate measured on fundus fluorescein angiography (FFA) with reduction in macular thickness observed on optical coherence tomography (OCT) following laser photocoagulation of diabetic macular edema. MATERIALS AND METHODS A prospective observational case series. Fifty patients (50 eyes) of type II diabetes mellitus with clinically significant macular oedema (CSME) underwent focal/grid laser photocoagulation. OCT and FFA were performed at baseline and at 2 and 12 weeks following laser photocoagulation to measure the change in macular thickness and the number of leaking microaneurysms respectively. Statistical analysis was performed using paired-ttest and Pearson's correlation test. RESULTS A significant reduction in macular thickness was seen at both 2 (P=0.02) and 12 weeks (P<0.0001), most remarkably in the central 1 mm quadrant. However, microaneurysm closure was only 0.67% at 2 weeks, which increased to 89.6% by 12 weeks. The change in retinal thickness correlated significantly with the decrease in the number of leaking microaneurysms at 12 weeks (r=0.597, P<0.0001), but not at 2 weeks (r=-0.228, P=0.112). On OCT, the final reduction in retinal thickness achieved at 12 weeks from baseline correlated significantly with the initial decrease in retinal thickness at 2 weeks (r=0.66, P<0.0001). However, on FFA, the final closure rate of leaking microaneurysms at 12 weeks from baseline did not correlate with the initial closure rate at 2 weeks (r=-0.039, P=0.413). CONCLUSION Following laser photocoagulation for CSME, an OCT at 2 weeks is more informative and better correlates with the final outcome than an FFA at 2 weeks.
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Gupta A, Rhodes GJ, Berg DT, Gerlitz B, Molitoris BA, Grinnell BW. Activated protein C ameliorates LPS-induced acute kidney injury and downregulates renal INOS and angiotensin 2. Am J Physiol Renal Physiol 2007; 293:F245-54. [PMID: 17409278 DOI: 10.1152/ajprenal.00477.2006] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endothelial dysfunction contributes significantly to acute renal failure (ARF) during inflammatory diseases including septic shock. Previous studies have shown that activated protein C (APC) exhibits anti-inflammatory properties and modulates endothelial function. Therefore, we investigated the effect of APC on ARF in a rat model of endotoxemia. Rats subjected to lipopolysaccharide (LPS) treatment exhibited ARF as illustrated by markedly reduced peritubular capillary flow and increased serum blood urea nitrogen (BUN) levels. Using quantitative two-photon intravital microscopy, we observed that at 3 h post-LPS treatment, rat APC (0.1 mg/kg iv bolus) significantly improved peritubular capillary flow [288 +/- 15 microm/s (LPS) vs. 734 +/- 59 microm/s (LPS+APC), P = 0.0009, n = 6], and reduced leukocyte adhesion (P = 0.003) and rolling (P = 0.01) compared with the LPS-treated group. Additional experiments demonstrated that APC treatment significantly improved renal blood flow and reduced serum BUN levels compared with 24-h post-LPS treatment. Biochemical analysis revealed that APC downregulated inducible nitric oxide synthase (iNOS) mRNA levels and NO by-products in the kidney. In addition, APC modulated the renin-angiotensin system by reducing mRNA expression levels of angiotensin-converting enzyme-1 (ACE1), angiotensinogen, and increasing ACE2 mRNA levels in the kidney. Furthermore, APC significantly reduced ANG II levels in the kidney compared with the LPS-treated group. Taken together, these data suggest that APC can suppress LPS-induced ARF by modulating factors involved in vascular inflammation, including downregulation of renal iNOS and ANG II systems. Furthermore, the data suggest a potential therapeutic role for APC in the treatment of ARF.
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Gupta A. Factors affecting the sagittal alignment of the lunate. J Hand Surg Eur Vol 2007; 32:155-9. [PMID: 17222952 DOI: 10.1016/j.jhsb.2006.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 11/15/2006] [Accepted: 11/17/2006] [Indexed: 02/03/2023]
Abstract
The lunate is described as having a tendency to rotate dorsally as a result of its wedge shape, with the apex towards the dorsum, but maintains an attitude of flexion in most individuals. The present study comprised CT scans of the wrist of 70 healthy volunteers. Sagittal measurements were drawn for the midcarpal and radiocarpal axes, alignment and various shape patterns of the lunate. The midcarpal axis was found to be dorsal, volar and collinear to the radiocarpal axis in 21 (30%), 29 (41%) and 20 (29%) subjects, respectively. The sagittal alignment of the lunate demonstrated significant correlation with measurements of the midcarpal and radiocarpal axes with no correlation with its various shape patterns. It is concluded that the relationship between the midcarpal axis and the radiocarpal axis in terms of dorso-volar displacement has a key role in determining the sagittal alignment of the lunate, while the shape of the lunate may be only a secondary consideration.
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Das M, Banerjee A, Ghosh R, Goswami B, Balasubramanian R, Chandra AK, Gupta A. A study on multivariable process control using message passing across embedded controllers. ISA TRANSACTIONS 2007; 46:247-53. [PMID: 17368639 DOI: 10.1016/j.isatra.2006.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 08/09/2006] [Indexed: 05/14/2023]
Abstract
Multivariable process control forms an important part of modern day control. While hardwired controllers still constitute the basic component of such control systems, with reducing communication latencies, controllers on the network are being mooted as a viable alternative. These controllers promise a large number of advantages in terms of reduction in wiring and greater flexibility in implementing supervisory control systems. In this paper, a study is presented which shows that UDP (User Datagram Protocol) can actually be used for real-time multivariable process control. Latency reduction algorithms used in high performance message passing systems have been used.
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Prasad N, Gulati S, Gupta RK, Sharma K, Gulati K, Sharma RK, Gupta A. Spectrum of radiological changes in hypertensive children with reversible posterior leucoencephalopathy. Br J Radiol 2007; 80:422-9. [PMID: 17392398 DOI: 10.1259/bjr/81758556] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We prospectively studied 19 children with severe hypertension to evaluate the spectrum of radiological changes, severity and reversibility of this entity. All of them were subjected to clinical and biochemical evaluation, followed by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Headache was seen in 17 children, 13 had confusion and drowsiness, 12 had nausea and vomiting, 10 patients had visual disturbances, seizure and dyspnoea. Only two had focal neurological deficit (one with right facial palsy and another with right lateral rectus palsy). Of these 19 children, 15 patients had hypertensive retinopathy and four had normal fundi. The positive MRI findings in 17/19 patients were: bilateral leukoencephalopathic changes in occipitoparietal region (9/17), diffuse white/grey matter lesion (3/17) patients, brain stem hyperintensity (2/17) and haemorrhagic lesions (3/17). On MRA, 12/19 patients had attenuation of cerebral arteries of different degree. On follow up, MRI findings resolved in all except three patients. All patients had normal MRA on follow up, except one with persistent minimal attenuation of middle cerebral artery and another had spasm in anterior, middle and posterior cerebral arteries. The intracranial abnormalities in these patients with severe hypertension were reversible in many of the cases after control of blood pressure was achieved. We therefore conclude that severe hypertension may lead to leuoencephalopathy, which had a wide radiological spectrum. A better understanding of this complex syndrome may obviate unnecessary investigations and allow management of associated problems in prompt and appropriate ways.
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Tokar MZ, Evans TE, Gupta A, Singh R, Kaw P, Wolf RC. Mechanisms of edge-localized-mode mitigation by external-magnetic-field perturbations. PHYSICAL REVIEW LETTERS 2007; 98:095001. [PMID: 17359161 DOI: 10.1103/physrevlett.98.095001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Indexed: 05/14/2023]
Abstract
Particle and energy transport in the tokamak edge transport barrier is analyzed in the presence of magnetic field perturbations from external resonant coils. In recent experiments such coils have been verified as an effective tool for mitigation of the edge-localized modes of type I. The observed reduction of the density in plasmas of low collisionality is explained by the generation of charged particle flows along perturbed field lines. The increase of the electron and ion temperatures in the barrier is interpreted by the reduction of perpendicular neoclassical transport with decreasing density and nonlocality of parallel heat transport. The found modification of the pressure gradient implies the stabilization of ballooning-peeling MHD modes responsible for type I ELMs.
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Kumar M, Singh F, Khan SA, Tripathi A, Gupta A, Avasthi DK, Pandey AC. Swift heavy ion induced effects in LiF thin films. ACTA ACUST UNITED AC 2007. [DOI: 10.1002/pssc.200673767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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1243
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Spies C, Gupta A, Glock D, Spoon J, Williams L, Ranade V, Snell J, Molnar J, Somberg J. Chiral Separation of the Inotropic and Chronotropic Actions of Digoxin in a Canine Model. J Investig Med 2007. [DOI: 10.1177/108155890705500293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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1244
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Spies C, Gupta A, Glock D, Spoon J, Williams L, Ranade V, Snell J, Molnar J, Somberg JC. 93 CHIRAL SEPARATION OF THE INOTROPIC AND CHRONOTROPIC ACTIONS OF DIGOXIN IN A CANINE MODEL. J Investig Med 2007. [DOI: 10.1136/jim-55-02-93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Minzi OMS, Gupta A, Haule AF, Kagashe GAB, Massele AY, Gustafsson LL. Lack of impact of artesunate on the disposition kinetics of sulfadoxine/pyrimethamine when the two drugs are concomitantly administered. Eur J Clin Pharmacol 2007; 63:457-62. [PMID: 17333157 DOI: 10.1007/s00228-007-0278-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 02/05/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the effect of artesunate (AT) on the disposition kinetics of sulfadoxine/pyrimethamine (SP) in humans. METHODS In a randomized cross-over study, 16 healthy volunteers were given a dose of three SP tablets containing 500 mg of sulfadoxine (SDX) and 25 mg of pyrimethamine (PYR) (=SP group), while the second arm received three SP tablets + two AT tablets of 200 mg in total followed by 100 mg AT for the next 4 days (SP+AT group). Blood samples (100 microl) were collected by means of a finger prick and dried on filter paper. The blood spots were wrapped in polythene folders and stored at room temperature until analysis. The samples were assayed using high-performance liquid chromatographic methods. RESULTS The peak concentration C(max)), time required to attain peak concentration (T(max)), half-life (t ((1/2))) and area under the plasma concentration-time curve (AUC) were determined. The C(max) of SDX were 92.9 and 98.9 microg/ml for the SP and SP+AT arms, respectively; for PYR, these were 0.86 and 0.79 microg/ml, respectively. The T(max) of SDX were 10 and 8 h for the SP and SP+AT arms, respectively; for PYR, these were 4.0 and 3.0 h, respectively. The AUC(0-288) of SDX were 15,840 and 18,876 microg/ml h for the SP and SP+AT arms, respectively; for PYR, they were 124 and 112 microg/ml h, respectively. The t ((1/2)) of values for SDX were 165 and 180 h for the SP and SP+AT arms, respectively; for PYR, these were 158 and 177 h, respectively. There was no statistically significant difference between the C(max), T(max), AUC(0-288) and t ((1/2)) between the two arms (p > 0.05). CONCLUSION Taking AT concomitantly with SP does not have any impact in the disposition of SP.
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Gupta AK, Bansal S, Gupta A, Mathur N. Visual loss in the setting of allergic fungal sinusitis: pathophysiology and outcome. The Journal of Laryngology & Otology 2007; 121:1055-9. [PMID: 17319994 DOI: 10.1017/s0022215107006226] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To hypothesise the probable pathophysiological mechanism responsible for visual loss in allergic fungal sinusitis, other than direct compression.Design:Retrospective, non-randomised case series. Out of 274 cases of allergic fungal sinusitis, four cases with sudden visual loss were enrolled into the study. The fourth case had visual loss on the contralateral side to bony erosion of the lateral wall of the sphenoid sinus.Interventions:All four cases were evaluated with fungal smear, immunoglobulin (Ig) E titres, visual evoked potentials, non-contrast computed tomography and magnetic resonance imaging of the paranasal sinuses, and fundus examination. They then underwent endoscopic sinus debridement followed by intravenous methylprednisolone.Outcome measures:Improvement in vision.Results:All four cases experienced an improvement in vision: full recovery in three cases and partial improvement in one case.Conclusion:In view of the operative, radiological and laboratory findings for case four, with the suggestion of a hyperimmune response to fungal antigens (in the form of raised IgE titre and positive fungal serology), we suggest that a local immunological reaction to fungal antigens might be responsible for the observed visual loss in cases of allergic fungal sinusitis, in addition to mechanical compression of the optic nerve.
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Gupta A, Berg DT, Gerlitz B, Sharma GR, Syed S, Richardson MA, Sandusky G, Heuer JG, Galbreath EJ, Grinnell BW. Role of protein C in renal dysfunction after polymicrobial sepsis. J Am Soc Nephrol 2007; 18:860-7. [PMID: 17301189 DOI: 10.1681/asn.2006101167] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Protein C (PC) plays an important role in vascular function, and acquired deficiency during sepsis is associated with increased mortality in both animal models and in clinical studies. This study explored the consequences of PC suppression on the kidney in a cecal ligation and puncture model of polymicrobial sepsis. This study shows that a rapid drop in PC after sepsis is strongly associated with an increase in blood urea nitrogen, renal pathology, and expression of known markers of renal injury, including neutrophil gelatinase-associated lipocalin, CXCL1, and CXCL2. The endothelial PC receptor, which is required for the anti-inflammatory and antiapoptotic activity of activated PC (APC), was significantly increased after cecal ligation and puncture as well as in the microvasculature of human kidneys after injury. Treatment of septic animals with APC reduced blood urea nitrogen, renal pathology, and chemokine expression and dramatically reduced the induction of inducible nitric oxide synthase and caspase-3 activation in the kidney. The data demonstrate a clear link between acquired PC deficiency and renal dysfunction in sepsis and suggest a compensatory upregulation of the signaling receptor. Moreover, these data suggest that APC treatment may be effective in reducing inflammatory and apoptotic insult during sepsis-induced acute renal failure.
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Chandra PS, Sharma B, Gupta A, Rajinder. P0092 The effect of traumatic brain injury on the timing of sleep. Sleep Med 2007. [DOI: 10.1016/s1389-9457(07)70348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gupta A, Prasad K. Hematological and molecular response evaluation of CML patients on imatinib. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2007; 55:109-13. [PMID: 17571739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The BCR-ABL tyrosine kinase is a well-validated therapeutic target in Chronic Myeloid Leukemia (CML). Imatinib mesylate (formerly STI-571), a tyrosine kinase inhibitor is highly effective at the hematological, cytogenetic and molecular level in CML. AIMS To evaluate hematological and molecular response in CML patients on Imatinib and also the side effects of the therapy if any. METHODS AND MATERIALS Sixteen patients were diagnosed as having chronic phase CML at Kasturba Medical College Hospital, Attavar, Mangalore during the period of two years from January 2004 to January 2006 and were given Imatinib at 400 mg/day orally. They were followed closely over a period of 1 year using the following parameters: (1) monthly clinical examination, (2) monthly peripheral blood smear examination, (3) real time reverse transcriptase quantitative polymerase chain reaction (RT Q-PCR) for BCR-ABL at the end of every 6 months. The findings were evaluated after one year for hematological and molecular response achieved. RESULTS Fifteen (93.75%) patients achieved complete hematological response within three months of therapy. Six (37.5%) patients achieved complete molecular response(CMR) within six months of therapy as measured by real time RT Q-PCR. None of the patients who did not achieve CMR within first six months of therapy achieved it after one year of therapy. No patient lost the initial response. The median BCR--ABL/ABL value at the end of the six months was 11% and at the end of the one year was 3.38%. CONCLUSION Imatinib mesylate is highly effective in the treatment of chronic phase CML and so should be considered as the drug of first choice in CML. Molecular response evaluation after six months can predict the subsequent molecular response and can also be usedas a surrogate monitor of the marrow cytogenetic response to imatinib therapy in CML.
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MESH Headings
- Adult
- Age Factors
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Benzamides
- Female
- Fusion Proteins, bcr-abl/drug effects
- Fusion Proteins, bcr-abl/genetics
- Gene Targeting
- Hematology
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Medical Oncology/trends
- Middle Aged
- Piperazines/adverse effects
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Prospective Studies
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/pharmacology
- Protein Kinase Inhibitors/therapeutic use
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Pyrimidines/adverse effects
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
- Reverse Transcriptase Polymerase Chain Reaction
- Time Factors
- Translocation, Genetic
- Treatment Outcome
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