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Biomedical subjects

P K Misra

Publications and source records attributed to P K Misra.

At least 19 recordsLinked to original sources

Infection with hepatitis A, B, delta, and human immunodeficiency viruses in children receiving cycled cancer chemotherapy.

Serological markers of hepatitis A, B, and Delta and human immunodeficiency viruses were studied in 25 children receiving cancer chemotherapy. Eighty-eight percent had pre-existing HAV immunity which was unaltered by chemotherapy. HDV infection was observed in 8% while HIV was conspicuous by its absence. Active HBV infection, observed in 76% of the children, was asymptomatic in the majority and was accompanied by a high incidence of HBe antigenaemia (57.9%) and its persistence. Pre-existing anti-HBs failed to prevent HBV infection recurrence, which was, however, transient and self-limiting. Multiple blood transfusions and repeated parenteral exposures appeared to be the possible sources of HBV acquisition. Transmission to close contacts was also observed. The study suggests that although HBV vaccine might not be protective against HBV infection in patients receiving cancer chemotherapy, it may prevent its persistence and thereby help in reducing chronic liver disease-related morbidity and a highly infectious reservoir. Strict HBV screening of blood donors, exclusive use of disposable equipment, and vaccination of close contacts of cancer patients is recommended, particularly in HBV endemic third-world countries.

Antineoplastic Agents

Testing a test.

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Diagnostic Tests, Routine

Ketotifen.

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Airway Resistance

An Indian hospital study of viral causes of acute respiratory infection in children.

From Sept. 1986 to Jan. 1989, a hospital-based study was conducted on 736 children, under 5 years of age, with acute respiratory infection. Nasopharyngeal secretions were examined for viruses by culture and by immunofluorescence. Viruses were detected in 22% of specimens: respiratory syncytial (5%), parainfluenza (5%), influenza A (4%), influenza B (2%), adenovirus (3%), measles (3%). The highest rates of detection were with patients diagnosed clinically as pneumonia or upper respiratory tract infection. The case fatality rate was very high (43%) in children with measles virus infection.

Child, Preschool

Hepatotoxicity of rifampin and isoniazid. Is it all drug-induced hepatitis?

Serologic markers for hepatitis viruses were studied in 40 children who developed acute hepatitis during antituberculosis therapy with rifampin and isoniazid, with the aim of assessing the contributory role of these viruses toward producing hepatic injury. Hepatitis A and B were confirmed in 7.5 and 35% patients, respectively, by IgM antibodies. Epidemiologic evidence suggested the possibility of non-A, non-B hepatitis in at least a few of the remaining 23 children. Hepatitis B was seen more often in children with severe tubercular disease (72%) and was largely (92.8%) parenterally transmitted. The study highlights that the endemicity of viral hepatitis in developing countries, among other factors, could also be responsible for the reported higher incidence of hepatotoxicity from developing countries and also for the increased risk of hepatotoxicity seen in severe tubercular disease.

Chemical and Drug Induced Liver Injury

Prevalence & spectrum of congenital malformations in a prospective study at a teaching hospital.

A prospective survey for congenital malformations at birth, at a teaching hospital, over a period of two and half years on 9405 consecutive single births has shown that prevalence of major congenital malformations in live births was 1.6 per cent and in still births 16.4 per cent. There was no significant difference in the prevalence of congenital malformations between Hindus (2.0%) and Muslims (2.7%) but amongst Muslims with consanguinity the prevalence of congenital malformation was 4.6 per cent compared to 2.3 per cent in non-consanguineous Muslim spouses (P less than 0.05). Open neural tube defect was the single most common anomaly (31.7% of all malformations) occurring at a rate of 4.7 per 1000 single births, with equal prevalence of anencephaly and meningomyelocoele. Case control study showed that history of concomitant medical illness, drug intake during the first trimester, threatened abortion, hydramnios and pre-eclamptic toxaemia in the current pregnancy were significantly associated with the occurrence of congenital malformations.

Congenital Abnormalities

Renal failure in symptomatic perinatal asphyxia.

The study included seven term newborns developing acute renal failure due to symptomatic perinatal asphyxia in early neonatal period. Its diagnosis was based on clinical and biochemical indices. Urinary output, serum and urinary sodium, potassium and creatinine, and blood urea nitrogen were evaluated in all of them. All the patients had oliguria not responding to fluid challenge and/or diuretic therapy, high serum K, FeNa of greater than 2.5% and RFI of greater than 3 indicative of intrinsic renal disease. The condition was associated with a very high mortality.

Acute Kidney Injury

Computed tomography of brain in symptomatic birth asphyxia.

Twenty five asphyxiated newborns (seventeen term and eight preterm) with mean gestational age of 37 weeks (range 28-48 weeks) and mean birth weight of 2.4 kg (range 0.75 kg to 3.5 kg), respectively, constituted the cases in present study. Normal CT scan was found in five term (29.4%) and two preterm babies (25%). CT abnormalities noted in term babies included hemorrhage (subarachnoid 5.8%, intracerebral 11.6%), hypodensity (mild 23.2%, moderate 11.6% severe 5.8%); hypodensity with hemorrhage 5.8% and cerebral atrophy 5.8%. In the preterm babies abnormalities included intraventricular hemorrhage in 25%, isolated hypodensity in 37.5% and hypodensity with hemorrhage in 12.5% cases. Where as mild hypodensity on CT scan in the absence of hemorrhage or other gross abnormality was indicative of a favourable outcome, moderate to severe hypodensity was indicative of ischemic brain injury and an unfavourable outcome. The presence of intraventricular hemorrhage irrespective of the size of bleed was associated with mortality in all in the present study.

Asphyxia Neonatorum

Mortality patterns in breast versus artificially fed term babies in early infancy: a longitudinal study.

The present study comprised 381 term babies weighing greater than 2.5 kg and 126 babies weighing less than or equal to 2.5 kg (low birth weight; LBW) at birth. A longitudinal follow up of 334 babies was done for 6 months. There were 273 'breast fed' babies and 234 'artificially fed' babies. Neonatal mortality rate per 1000 live births for term babies was 37.5, LBW had a rate of 31.5 while those weighing greater than 2.5 kg at birth a rate of 5.9; artificially fed had a mortality rate of 21.6 while breast fed had a low rate of 15.8. For 1-6 months period a mortality rate per 1000 live births of 53.8 was found for term babies, breast fed a rate of 23.9 while artificially fed a rate of 29.9; LBW had a rate of 44.9 while those weighing more than 2.5 kg at birth, a rate of 9. Low birth weight babies whether breast fed or artificially fed had significantly higher mortality than similarly fed babies weighing more than 2.5 kg at birth. Hence, mortality rate for term babies in early infancy can be reduced by simultaneous promotion of breastfeeding and prevention of low birth weight as it was dependent on both variables in this study.

Breast Feeding

Viral aetiology of acute respiratory infections in children in north India.

Two hundred and thirty children clinically diagnosed as suffering from acute respiratory infection were tested for four major groups of viral aetiological agents, i.e. influenza para-influenza, respiratory syncytial virus (RSV) and adenoviruses using indirect immunofluorescence technique. At least one of the respiratory viruses was identified in 51 (22 per cent) specimens, which included influenza A in 6 (3 per cent), influenza B in 3 (1 per cent), para-influenza type 1 in 3 (1 per cent), para-influenza type 3 in 13 (6 per cent), RSV in 11 (5 per cent) adenovirus in 12 (5 per cent), and dual virus infections in 3 (1 per cent) cases. Maximum number of virus identification was noted in children below 1 year of age, particularly infection with RSV followed by para-influenza and adenoviruses. Value of rapid diagnosis by indirect immunofluorescence technique is stressed.

Child, Preschool

Goodwin's high risk score and neonatal outcome: an evaluation.

Goodwin's high risk scoring system was applied to a total of 725 expectant mothers at the onset of labor. The risk score ranges from 0-10, the quantum of risk increasing with the higher scores. Their newborns were assessed at birth in terms of Apgar score, birth weight, gestation age and occurrence of morbidity and/or mortality during the hospital stay. Twenty one were stillborn and out of 700 singleton liveborn, 92 developed some significant illness, of which 28 expired. The incidence of preterms, low birth weights and asphyxiated babies increased with increasing risk score. The mean risk score for alive and dead babies in perinatal period was 1.55 and 5.06, respectively. The scoring system can be easily applied at the District hospital level and CHCs but not at the level of dispensaries and PHC where the facilities for even the baseline investigations are not available and one has to decide about a home or hospital delivery.

Developing Countries

Simple hematological tests for diagnosis of neonatal sepsis.

Simple hematological tests, TLC, DLC, mESR, platelet count, were performed in 128 neonates of which 50 were controls and 78 were cases of suspected septicemia. Thirty three had positive blood cultures and were taken as 'proved' and remaining as 'probable' sepsis. A band cell neutrophil (B/N) ratio of greater than 0.2 was most sensitive index (92%) followed by raised mESR of greater than 8 mm for 1st hour, whereas leukopenia of greater than 5 x 10(3)/mm3 was most specific index (88%) for the diagnosis of sepsis. Thrombocytopenia of less than 1.5 x 10(5)/cu mm was also taken as positive test for sepsis. A combination of three positive tests had highest positive predictive accuracy (94%) for early diagnosis of sepsis, when compared to single test or two positive test combinations. The best combination of tests was B/N ratio, leukopenia and mESR which can be easily done in a side laboratory.

Blood Sedimentation

Serum and hair zinc in Indian childhood cirrhosis.

Zinc levels in serum and hair were estimated in 32 cases of Indian Childhood Cirrhosis (ICC)--14 in Stage II and 18 in Stage III. Levels were compared with 20 cases of age matched healthy controls. Mean serum zinc level in ICC was 62.0 +/- 13.10 micrograms/dl as compared to 115.7 +/- 12.62 micrograms/dl in controls. The difference was statistically significant. Further, mean level of serum zinc (70.78 +/- 12.95 micrograms/dl) in Stage II was significantly higher than the level 55.88 +/- 8.16 micrograms/dl in Stage III, thereby showing an inverse relationship with the severity of the disease. Mean hair zinc level of 144.53 +/- 23.26 micrograms/g in ICC was much lower than that of 172.5 micrograms/g in controls. The study revealed an altered state of zinc nutrition in children with ICC.

Child

Is high protein milk beneficial for SGA-terms?

A three months longitudinal followup of SGA term babies was done for their response to feeding of high protein milk (3.1 g/100 ml) and they were compared with their breast fed counterparts. The formula fed infants had no advantage over the breast fed when weight was compared. However, blood urea and serum creatinine levels were higher in the formula fed infants, than the breast fed ones. The serum valine concentrations, indicative of protein nutritional status, increased with increasing postnatal age in all the infants. Formula fed had higher serum valine than breast fed ones. Serum phenylalanine and serum tyrosine levels, which may hamper CNS development, were higher in the formula fed infants than the breast fed ones.

Follow-Up Studies

An unusual case of pycnodysostosis.

A 6 year old boy with clinical and radiological features of pycnodysostosis is described. In addition to pycnodysostosis he had a myelophthisic type of anaemia suggesting an overlap with osteopetrosis.

Anemia, Myelophthisic