Browsing by Author "Anand, A C"
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Item Acute filarial myositis.(1992-10-01) Sundaray, N K; Das, A K; Sanchetee, P C; Anand, A C; Singh, WAn uncommon case of filariasis presenting as acute myositis is described. The patient was treated initially with steroids and antihistamines with no response. Later on with the confirmation of filariasis he was treated with diethyl carbamazine with complete recovery.Item Amoebiasis revisited: pathogenesis, diagnosis and management.(1999-01-28) Anand, A C; Puri, PItem Analysis of symptomatic patients after cholecystectomy: is the term post-cholecystectomy syndrome an anachronism?(1995-04-01) Anand, A C; Sharma, R; Kapur, B M; Tandon, R KOf 171 patients who were followed-up prospectively for 2.8 years after cholecystectomy, 31 developed postcholecystectomy symptoms, 24 of them being mild to moderate and 7 severe. Symptomatic patients mostly had functioning gall bladders preoperatively and longer duration of symptoms prior to cholecystectomy. The causes of postcholecystectomy symptoms could be identified in all of them except 9 patients who were labelled as having "essential dyspepsia". The symptoms in the latter syndrome as well as in other conditions diagnosed in the symptomatic postcholecystectomy patients appeared unrelated to the absence of gallbladder. Hence, we feel the term postcholecystectomy syndrome is an anachronism and should be redefined.Item The anatomy of an epidemic (the final report on an epidemic of multidrug resistant enteric fever in eastern India).(1993-01-01) Anand, A CTwo hundred and forty two patients of enteric fever were treated at Command Hospital (EC) Calcutta, during the period 1989-90. The mean age of the patients was 28.4 (range 2-60) years and 119 (49.2%) of them were males. Fever (100%), headache (55%), diarrhoea (25.2%), intestinal bleeding (2.9%) and icterus (3.7%) were the main presenting features. Blood cultures were positive in 216 (%) patients. A majority of the isolates were found to be resistant to all four commonly used drugs for enteric fever i.e. chloramphenicol, ampicillin, cotrimoxazole and furazolidone. The commonest phage type found in the resistant strains was 51 (biotype-1). Two plasmids of 14 and 120 kd size were detected in the resistant strains but not in the sensitive strains. Clinical response to gentamicin was not satisfactory in spite of all strains showing in vitro sensitivity. Ciprofloxacin proved to be a safe and effective drug for the treatment of multidrug resistant enteric fever.Item Antacids in the treatment of peptic ulcer: are they obsolete?(1990-01-01) Anand, A CItem Armed Forces Medical College, Pune.(1997-09-24) Anand, A CItem Bio-artificial liver from cultured human foetal hepatocytes: feasibility and prospects.(2000-01-03) Anand, A C; Bhonde, R R; Kurup, S; Kochhar, S PBACKGROUND: Conventional therapy for acute liver failure has not been able to improve survival beyond 40%. Apart from liver transplantation, the most promising development in this field is the utilization of cultured hepatocytes to make 'bio-artificial liver support systems' as a 'bridge to transplantation' or ideally as a 'bridge to total recovery'. This study examines the feasibility of culturing foetal hepatocytes without the use of growth factors and formulating a bio-artificial liver support device in our set-up. METHODS: Foetal hepatocytes were harvested from the liver obtained from mid trimester abortions at Armed Forces Medical College and Command Hospital (SC), Pune. The liver was perfused with Phosphate Buffered Saline (PBS) and collagenase type IV and was cut with a pair of sterile scissors into tiny pieces. Cells so separated, were washed with PBS plus foetal calf serum and stirred to disperse the cell aggregates. Filtered cell suspensions were inoculated in polystyrene flasks containing hepatocyte culture medium (MEM E: 75%, M199: 25%, BSA: 0.1%, Bovine Insulin 5 micrograms/ml, FCS: 10%, Penicillin: 10 i.u., Streptomycin 50 micrograms/ml, Hydrocortisone 5 micrograms/ml and incubated at 37 degrees C. The functional capabilities of the cultured hepatocytes were analyzed by studying production of albumin and a foetoprotein. Structural integrity of hepatocytes was assessed by light and electron microscopy. RESULTS: The hepatocyte yield varied from 2 to 60 x 10(6) cells/L with an average of 38 x 10(6) cells/L in the eight consecutive experiments. Initial hepatocyte viability varied from 25% to 90% with an average of 61%. The yield and the viability of hepatocytes were adversely affected by the condition of foetus at birth and use of intra-amniotic injections for inducing abortions. Hepatocyte monolayers and colonies formed in 75% experiments. The cultures could be maintained in incubation without the use of epidermal or hepatocyte growth factors for 2-25 days with a mean survival of 8.9 days. The cells in culture were found to be structurally normal and functionally active and could be cryo-preserved. These hepatocytes were inoculated into a hollow fiber module to formulate bio-artificial liver support device. The cultures ultimately developed either cellular disintegration or bacterial infections despite use of antibiotics in the culture medium. CONCLUSIONS: We conclude that it is feasible to maintain foetal hepatocyte cultures without the use of expensive growth factors for over 8 days. Bio-artificial liver formulated with cultured foetal hepatocytes is now a step closer to clinical trials.Item Bioartificial liver support for fulminant hepatic failure.(2003-12-18) Anand, A CMortality from fulminant hepatic failure (FHF) is high (50%-80%), although survivors have absolutely normal liver function. The only treatment option that is curative is liver transplantation. However, because of shortage of cadaveric organ donors and/or delay in their availability, only 10% of FHF patients ultimately receive a transplant. This has led to development of artificial liver support systems with an idea to bridge the time to transplantation and/or recovery from FHF. Initial support systems were based on the principles of hemodialysis, hemofiltration, plasma-exchange, and hemoperfusion through adsorbent media (e.g., charcoal). However, lack of clinical efficacy, problems of bioincompatibility and fear of loss of circulating hepatocyte-regeneration factors led to the search for alternate strategies. With the successful long-term propagation and culturing of human and pig hepatocytes, and the development of adequate biocompatible microcarrier modules, it is now possible to achieve sufficient density of hepatocytes per unit volume to develop bioartificial liver systems. These can be implanted transperitoneally but are subject to early destruction because of inadequate vascularization and immune attack from the host. Thus the major thrust is now to develop bioreactors, e.g., Extracorporeal Liver Assist Device (ELAD), Bioartificial Liver (BAL), etc. These contain human or pig hepatocytes implanted on hollow-fiber ultrafiltration cartridges. The patient's blood or plasma circulates through these bioreactors and after clearance of toxic compounds (via ultrafiltration and metabolism in hepatocytes) and addition of synthesized products, is returned to the patient. This article reviews the genesis, the pros and cons, and the clinical experience of BAL support for FHF.Item Bioartificial liver support system: a "bridge" too far?(2002-03-07) Anand, A C; Puri, PItem Bioartificial livers: the state of the art.(1996-10-01) Anand, A CItem Cancers of unknown primary site: an enigmatic syndrome.(1988-04-01) Anand, A C; Singh, BItem Cytokines and inflammatory bowel disease.(1999-07-01) Anand, A C; Adya, C MCytokines are the key mediators of inflammation in the IBD and are focus of renewed interest to plan therapeutic strategies against this disease. However, there are gaps in our knowledge at present and a lot of questions need clear answers. Even with a therapy as specific as anti-TNF antibody, it is not clear if the benefit is attributable to simple binding and clearance of TNF-alpha or to binding on the cell surface and subsequent deletion of the activated macrophage. When a drug appears to be less effective than pre-clinical models suggest, can failures in effectiveness from delivery or dosing the differentiated? The disappointing results of clinical trials with IL-10 is at odds with the prediction of benefit from animal models. It even brings into question the validity of those models as well as the soundness of design of the clinical trials on which efficacy of IL-10 is assessed. Other exciting new methods to treat IBD could be use of monoclonal antibodies to effector T cell molecules (such as CD4 or CD44v7) removal of such cytokine secreting cells (apheresis), antibodies to proinflammatory cytokines (such as TNF-alpha, IFN-alpha, IFN-gamma, and IL-12) or administration of anti-inflammatory cytokines (such as IL-10, IL-11). Challenges in developing new therapeutic strategies include not only identifying novel agents, but also improving the definitions of clinical endpoints and defining efficacy at the biologic level. There is also need to further refine our knowledge about genetic elements and environment initiators to comprehensively manage IBD.Item Dietary factors in the pathogenesis and management of gallstones.(1989-05-01) Tandon, R K; Anand, A CItem Diurnal variations in asthma.(1983-05-01) Anand, A C; Subramanian, A RItem Doctored admissions: are we sowing the right seed?(2003-11-10) Anand, A CItem Early pre-diabetic hormonal changes in diabetes mellitus--their significance.(1992-11-01) Gupta, M M; Anand, A CItem Evidence-based or evidence-biased medicine?(2006-03-08) Anand, A CItem Falciparum hepatitis: where is the inflammation?(1994-01-01) Anand, A C; Mehta, S R; Sivadas, PItem Gall bladder dysmotility in diabetes mellitus--an ultrasound study.(1995-07-01) Sharma, M P; Saraya, A; Anand, A C; Karmarkar, M GFifty two diabetic patients and 15 healthy control subjects were prospectively studied for their gall bladder function by ultrasound examination. The fasting gall bladder volume (FGBV) was calculated by using ellipse formula from the dimension of gall bladder shadow seen on ultrasound screen in two different cuts. The contractility of gall bladder was measured by calculating post prandial ejection fraction (EF) of the gall bladder. The mean FGBV and EF in 52 diabetic patients was found to be 20.7 +/- 10.7 cc and 47.5 +/- 20.1%, which was not significantly different from that in normal controls. Age, sex, obesity, diabetic control and presence of dyspeptic symptoms had no impact in FGBV and EF. Diabetic symptoms had no impact in FGBV and EF. However, diabetics with longer duration of disease had poorer gall bladder contractility (p < 0.05). Patients with autonomic neuropathy (AN) had significantly larger FGBV but normal contractility. Our results suggest that (a) long standing diabetics may have poor gall bladder emptying predisposing to gall stone formation (b) patients with autonomic neuropathy have reduced tone of fasting gall bladder but normal contractility.Item Gastrointestinal problems at high altitude.(2006-10-05) Anand, A C; Sashindran, V K; Mohan, LatikaGastrointestinal (GI) problems at high altitude are commonplace. The manifestations differ considerably in short-term visitors, long-term residents and native highlanders. Ethnic food habits and social norms also play a role in causing GI dysfuntion. Symptoms like nausea and vomiting are common manifestations of acute mountain sickness and are seen in 81.4% short-term visitors like mountaineers. Anorexia is almost universal and has a mutifactorial causation including effect of hormones like leptin and cholecystokinin and also due to hypoxia itself. Dyspepsia and flatulence are other common symptoms. Diarrhoea, often related to poor hygiene and sanitation is also frequently seen especially among the short-term visitors. Peptic ulceration and upper gastro-intestinal haemorrhage are reported to be common in native highlanders in the' Peruvian Andes (9.6/10000 population per year) and also from Ladakh in India. A hig h incidence o f gastriccarcinoma is also reported, especially from Bolivia (138.2 cases per 10000 population per year). Megacolon and sigmoid volvulus are common lower GI disorders at high altitude. The latter accounted for 79% of all intestinal obstructions at a Bolivian hospital. Thrombosis of the portosystemic vascultature and splenic hematomas has been reported from India. Malnutrition is multifactorial and mainly due to hypoxia. Fat malabsorption is probably significant only at altitudes > 5000m. Neonatal hyperbilirubinemia was found to be four times more common in babies born at high altitude in Colorado than at sea level. Gall stones disease is common in Peruvian highlands. A high seroprevalence of antibodies to H pylori (95%) has been found in Ladakh but its correlation to the prevalence of upper gastro-intestinal disease has not been proven.