Biomedical subjects

D K Shukla

Publications and source records attributed to D K Shukla.

9 recordsLinked to original sources

PubMed2005

NICU in a community level hospital.

OBJECTIVE: To study the clinical profile and outcome of neonates in NICU of a community hospital and highlight the importance and problems in neonatal care at a community level hospital. METHODS: Retrospective analysis of case records during the period Jan. 2001- Dec. 2003. Data regarding antenatal care, maternal morbidity, place of birth, age at admission, birth weight, gestational age, diagnosis, relevant investigations, duration of stay and outcome were recorded on a preset proforma. A cost analysis for average expenses per newborn per day for different morbidities was also done. Neonatal data was analyzed among survivors and expired using appropriate statistical tests. Probability of less than 5% was taken significant. Factors found significant on univariate analysis were subjected to logistic regression model to study independent predictor of fatality. RESULTS: A total of 168 neonates were admitted during the study period. The overall survival rate was 65%. 42(25%) neonates expired and 5.4% were referred to higher centers. The commonest morbidity in survivors was hyperbilirubinemia. Prematurity with HMD and neonatal sepsis were the commonest cause of mortality. 36(24.3%) expired within 48 hr of admission (Mean 33.2 hr). 31(17.8%) could not be referred and none survived. The difference of birth weight, gestational age and duration of stay was statistically different in survivors & expired. These variables retained their significance on multivariate analysis and thus were independent predictors of fatality. An average expense of Rs 400-500/day/newborn was charged in the NICU. CONCLUSION: In a country of limited resources, 65 % neonates requiring NICU can be managed at community level hospitals.

Female↗

PubMed2003

Oral habits in school going children of Delhi: a prevalence study.

This study was conducted on 5554 children aged 5-13 years old with the objectives of recording the prevalence of oral habits among North Indian children according to sex. These children were selected from the schools of Delhi. The sample represented the entire school-going population of Delhi in the age group of 5-13 years. Statistical analysis was carried out using BMDP software and sex differences were calculated by using Fisher's exact test. The results showed that the prevalence of oral habits in Delhi school going children was 25.5%. Tongue thrust was the commonest habit (18.1%) followed by mouth breathing (6.6%). Thumb sucking was relatively less common habit and seen in only 0.7% of children. There were no significant differences between boys and girls for the prevalence of oral habits. However, for the specific habit types there was a sex difference. Thumb sucking was more common in girls (1.0%) when compared with boys (0.4%) and this difference was statistically significant (P < 0.001). There was a reverse trend for the mouth breathing, which was more common (P < 0.001) in boys (7.8%) than girls (5.3%). There were no differences for tongue thrust habit between boys (17.5%) and girls (18.6%).

Adolescent↗

PubMed2001

Epidemiological study of congenital heart disease.

A community based survey of congenital heart disease was carried out on a random sample of 11,833 children below 15 years in Delhi, India. Congenital heart disease was diagnosed on clinical history and/or clinical examination. Out of the examined sample, 50 were found suffering from congenital heart disease, giving an overall prevalence of 4.2/1000 (4.6/1000 in boys and 3.7/1000 in girls). The prevalence rate was slightly higher than other studies carried out in the country. The reason is obvious. The present study is community based while other studies were hospital or school based. The type of lesions were similar to those reported from other studies. The lesions in order of frequency were ventricular septal defect (46%), atrial septal defect (18%), patent ductus arteriosus (14%), Fallot's tetrology (10%), aortic stenosis (4%), and pulmonary stenosis (4%). Like other studies ventricular septal defect was the commonest lesion. The prevalence rate was higher in the age group 0-4 years and 5-9 years in boys whereas it was higher in adolescent age group (10-14 years) in girls.

Adolescent↗

PubMed1999

A study of dental caries in school children from rural Haryana.

The prevalence of dental caries among rural school children (688 boys and 331 girls) in the age group of 12-16 years in Haryana was found to be 39.4%. It was 37.9% in boys and 42.6% in girls. The difference between males and females was statistically not significant. A significant increase in prevalence of dental caries with age was observed (i.e. 33.1% in 12-year-old children to 45.8% in 14-year-old children). The mean DMFT per child was found to be 1.03 and DMFT per affected child was 2.6. The mean of D, M and F was found to be 1.0, 0.03 and 0.0 respectively.

Adolescent↗

PubMed1996

Prognostic markers in amebic liver abscess: a prospective study.

OBJECTIVES: Amebic liver abscess (ALA) is being increasingly recognized with the progressive spread of AIDS. The prognosis of ALA needs to be determined to decide whether aggressive intervention therapy should be used. A prospective study was conducted to determine the factors that predicted mortality in patients with ALA. METHODS: The study population consisted of 135 consecutive patients with ALA who were treated with 80 mg/kg/day of metronidazole for 10 days if they survived. Needle aspiration or open surgical drainage was performed in patients who deteriorated despite drug therapy or had an abscess that clinically appeared to be at risk of impending rupture. Survivors and nonsurvivors were compared by univariate and multivariate analysis to identify predictors of outcome. These predictors were then prospectively evaluated in a subsequent cohort of patients with ALA. RESULTS: Twenty-four patients died during the acute phase. Significant differences between survivors and nonsurvivors were observed. A stepwise logistic regression suggested that a bilirubin level >3.5 mg/dl, encephalopathy, volume of abscess cavity, hypoalbuminemia (serum albumin level <2.0 g/dl), and the number of abscesses were independent risk factors for mortality. The duration of symptoms and type of treatment did not influence mortality. The regression equation derived was then applied prospectively to 64 subsequent patients with ALA, and the validity of the prediction rule was confirmed. The qualities of simplicity, availability, low cost of derivation, and good discriminating power suggest that this index would be useful in assessing prognosis in patients with ALA.

Adult↗

PubMed1994

A study of the etiological factors associated with the development of malocclusion.

The prevalence of malocclusion among 1608 children (777 boys and 831 girls) in the age group of 5-7 years, selected from different schools of varied locations of Delhi was observed as 18.4%. A number of factors that could influence the normal development of occlusion during early mixed dentition stage were recorded. These included spacing in anterior teeth, attrition of primary teeth and deleterious oral habits. The socio-demographic variables included occupation of parents, family size, location type and the school type. The age of the child and sex were also considered. In order to find out the contribution and importance of above mentioned occlusal characteristics and socio-demographic factors in the development of malocclusion, the data were subjected to univariate analysis. Further a stepwise logistic regression analysis was done to know whether any association exists between the occurrence of malocclusion and combination of these factors. Four factors were found to contribute significantly in the occurrence of malocclusion explaining 15.5% variation in case of boys and 22% in case of girls. More significant factors were absence of spacing, effect of habits and lack of attrition of primary teeth. About 80% of the total variation was independent of these factors and could not be explained by this analysis. It further testifies possible predominance of genetic influences in the development of occlusion.

Adolescent↗

PubMed1993

Selective cervical cytology screening: discriminant analysis approach.

Cervical cancer is one of the leading malignancies seen in Indian women. It has been well established that organized cervical cytology screening program is the mainstay for control of cervical cancer. It is not possible to carry out cervical cytology screening for masses in India due to paucity of human and financial resources. Hence there is a need for development of an alternate strategy to concentrate on women with high risk. In the present communication attempt was made to define a high risk group based on sociodemographic factors, viz. age, parity, education and clinical features. A total of 67,000 women were screened of which in 250 malignancy was detected. The rate of malignancy was observed to be high in women above 40 years (10.5/1000) with more than two children (6.1/1000) and in illiterate group (4.9/1000) as compared to women below 40 years, more than 3 children and illiterate group. Similarly, the rates were higher in women with clinical diagnosis of cervical erosion which bled on touch, unhealthy cervix and suspicious looking cervix, malignancy rates were 17.1, 24.7, 263.2 (per 1000), respectively. An attempt was made to study the combined effect of all the six factors (sociodemographic and clinical) by employing the technique of linear discriminant analysis to find out the discrimination power between the normal and malignant women. Discriminant score thus obtained would help to classify the case for subjecting to cervical cytology. It was observed that the model containing sociodemographic and clinical variables was able to classify 69% of malignant cases correctly. When the clinical variables were dropped from the model, the sensitivity dropped to 65%. The above exercise indicated that based on the discriminant score even in the absence of facilities for clinical examination of women, it may be possible to identify women of high risk group for subjecting them to cervical cytology screening.

Adult↗

PubMedDate not supplied

Age at which chest circumference overtakes head circumference in children.

Maximum likelihood method with probit transformation was applied to estimate median age at which chest circumference (CC) overtook head circumference (HC) in 1206 children from rural areas of Ballabhgarh in Haryana and in 1505 children from a slum population in Delhi. The results showed that, in case of rural area, this phenomenon occurred at an average age of 31.36 months and in children from urban slums, at an average age of 28 months. In both the areas, this phenomenon occurred at an average age of 20 to 21 months in normally nourished children. In children with grade I malnutrition, this was delayed by about 10 months as compared to those with normal nutrition and in children with grade II or worse malnutrition, this was further delayed by another 9 to 13 months on an average as compared to those with grade I malnutrition. These differences were found to be statistically significant (p < 0.001). These results indicate that the longer the delay in CC overtaking HC, the chance is higher for the children to be severely malnourished. Considering the relative ease of measuring head and chest circumferences, this parameter (age of CC crossing HC) could be useful in assessing the long term trend in the improvement of childhood nutrition in developing countries.

Anthropometry↗

PubMedDate not supplied

Autologous bone marrow/stem cell transplantation: initial experience at a north Indian referral centre.

BACKGROUND: High-dose chemotherapy and/or radiation therapy rescued by autologous bone marrow or peripheral blood stem cells is being increasingly used for the treatment of haematological and solid malignancies. While few centres in India use this modality of therapy, the worldwide experience is encouraging. We, therefore, analysed the results of our initial experience with this therapeutic modality. METHODS: Forty-two patients [multiple myeloma (17), Hodgkin's disease (4), non-Hodgkin's lymphoma (3), chronic myeloid leukaemia (2), acute myeloid leukaemia (2), acute lymphoblastic leukaemia (2), epithelial ovarian cancer (6), breast cancer (4), primitive neuroectodermal tumour and testicular germ cell tumour (1 each)] underwent high-dose chemotherapy followed by either autologous bone marrow transplant (n = 9), peripheral blood stem cell transplant (n = 30) or both (n = 3). The indications for transplant included either advanced stage at diagnosis, other adverse prognostic indicators during the course of their disease, or relapse. The data were analysed retrospectively in December 1998 using hospital records. Follow up data of all the patients were available. RESULTS: Thirty-four of the 42 patients (81%) showed stable engraftment. Eight patients (19%) died in the early post-transplant period (day 5 to day 52 post-transplant). Seven patients died due to neutropenic infections and one due to acute renal failure. Of the 34 surviving patients, 20 were alive at the time of analysis and 14 had died. All but one death in this group were due to progressive primary malignancy. The median overall survival for all patients was 17 months and for the 34 engrafted patients it was 27 months. An analysis of factors affecting survival revealed that patients with chemosensitive disease had a longer overall survival (20.9 v. 6.1 months, p = 0.04) compared to those with chemoresistant disease. CONCLUSION: Autologous bone marrow or peripheral stem cell transplantation is a feasible procedure in India with an acceptable morbidity and mortality. It should be offered more frequently to properly selected patients.

Adolescent↗