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Biomedical subjects

Piyush Gupta

Publications and source records attributed to Piyush Gupta.

At least 19 recordsLinked to original sources
PubMed2007

Multimicronutrient supplementation for undernourished pregnant women and the birth size of their offspring: a double-blind, randomized, placebo-controlled trial.

OBJECTIVE: To evaluate the effect of multimicronutrient supplementation for undernourished pregnant women on the birth size of their offspring, incidence of low-birth-weight infants (<2500 g), and early neonatal morbidity. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Tertiary care hospital. PARTICIPANTS: Two hundred pregnant women (of 13 465 approached) with a body mass index (calculated as weight in kilograms divided by the square of height in meters) of less than 18.5 and/or a hemoglobin level of 7 to 9 g/dL were enrolled at 24 to 32 weeks of gestation. One hundred forty-six neonates (73.0%) were available for analysis of birth size and 170 (85.0%) for analysis of morbidity in the 7 days after delivery. Intervention The micronutrient supplementation group (n = 99) received a multimicronutrient supplement containing 29 vitamins and minerals once a day, from enrollment until delivery (median duration, 58 days; interquartile range, 37-77 days; compliance, 87%). The comparison group (n = 101) received placebo for 52 (15-66) days, with 85% compliance. All subjects also received supplements of iron (given in the form of ferrous sulfate, containing 60 mg of elemental iron), 60 mg/d, and folic acid, 500 mug/d. MAIN OUTCOME MEASURES: Birth weight, length, midarm circumference, incidence of low birth weight, and early neonatal morbidity. RESULTS: Infants in the micronutrient group were heavier by 98 g (95% confidence interval [CI], -16 to 213 g) and measured 0.80 cm (95% CI, 0.03-1.57 cm) longer and 0.20 cm (95% CI, 0.04-0.36 cm) larger in midarm circumference compared with the placebo group. Incidence of low birth weight declined from 43.1% to 16.2% with multimicronutrient supplementation a (a 70% decrease; relative risk, 0.30; 95% CI, 0.13-0.71; P=.006), and that of early neonatal morbidity declined from 28.0% to 14.8% (a 58% decrease; relative risk, 0.42; 95% CI, 0.19-0.94; P=.04). CONCLUSION: Compared with iron and folic acid supplementation, the administration of multimicronutrients to undernourished pregnant women may reduce the incidence of low birth weight and early neonatal morbidity.

Adult↗
PubMed2006

Screening for retinopathy of prematurity in developing countries.

Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.

Age Factors↗
PubMed2006

Interpectoral approach to dissection of the axillary apex: an elegant and effective approach.

BACKGROUND: Axillary dissection is the gold standard for treatment of the axilla. It provides important prognostic information, accurately stages the axilla, and has the lowest recurrence rate among all modalities. In today's age of conservation surgery, the axilla is often addressed through a cosmetically acceptable small incision with limited access, thereby making clearance of the level III nodes difficult. METHODS: We describe a method of apical lymph node dissection through the interpectoral plane, which effectively clears the apex despite the constraints of limited exposure. RESULTS: This method has been used in nearly 5,000 axillary dissections performed at our institute, with excellent results. It preserves the innervation of the pectoral muscles and affords access to the interpectoral nodes. CONCLUSIONS: Our method has a short learning curve, provides good exposure of a difficult area and consistently provides a good yield of nodes.

Axilla↗
PubMed2006

Cytomegalovirus infection in neonates following exchange transfusion.

OBJECTIVES: This study was undertaken to ascertain the acquisition of cytomegalovirus infection following exchange transfusion and factors affecting such transmission in newborn infants at a tertiary care hospital in India. METHODS: Neonates undergoing double volume exchange transfusion (for any indication) with whole blood in the Neonatal Intensive Care Unit were enrolled over a 8 month period. Serum samples from the infant were collected for CMV serology before exchange transfusion, and at 6 and 12 weeks following the exchange. CMV serology was also conducted on samples obtained from the respective maternal and donor blood. RESULTS: Of 47 neonates who received exchange transfusion during the study period; only 26 (55.3%) neonates were finally followed up till 12 weeks of age. Only 3 (11.5%) children demonstrated CMV seroconversion during follow-up; all were low birth weight and small for gestational age. None of them demonstrated any clinical, hematological, biochemical, or radiological signs suggestive of perinatal CMV infection either at birth or during the course of follow-up. CONCLUSION: Exchange transfusion in neonates can result in perinatal transmission of CMV infection in low birth weight neonates. Such transmission does not result in any immediate manifestations. Data are not sufficient to warrant routine CMV screening of donor blood for exchange transfusion in our setting.

Cytomegalovirus Infections↗
PubMed2006

Length of postnatal stay in healthy newborns and re-hospitalization following their early discharge.

OBJECTIVE: The present study was conducted prospectively to determine i) the length of postnatal hospital stay of healthy newborns and determine the factors facilitating their early discharge (< 48 h) and ii) the frequency and causes of re-hospitalization following early discharge, in a tertiary care hospital. METHODS: Length of hospital stay was recorded for healthy newborns. Factors facilitating Early discharge were determined by both univariate and multivariate (multiple logistic regression) analyses. Of all newborns discharged within 48 h, every third case was called for a follow-up visit 72 hrs later and examined for any medical problem and need of re-hospitalization. RESULTS: A total of 1134 babies were enrolled, of which 861 (76.2%) were discharged at or before 48 hours. The overall mean (SD) length of hospital stay was 46.4 (45.8) h. Factors contributing to early discharge included vaginal delivery (RR: 30.2; 95% CI: 19.0, 47.9; P<0.001), absence of pre-existing maternal disease or obstetric complication (RR: 4.32; 95% CI: 2.27, 8.22; P < 0.001), and birth weight of > 2.5 kg (RR: 1.91; 95% CI: 1.27, 2.89; P = 0.002). Of the 280 neonates called for follow-up, 193 reported. Of these, 61 (31.6%) were normal. Neonatal jaundice was the most frequent problem seen in 105 (54.4%) children on follow-up. Only 16 (8.3%) newborns needed re-hospitalization; the most common indication being neonatal jaundice (n=9). CONCLUSION: Most of the children in our set-up are being discharged within 48 hrs. Early discharge is governed primarily by maternal indications. A follow-up visit after 72 hr is important to assess the need of re-hospitalization in healthy newborns discharged within 48 hrs of birth.

Humans↗
PubMed2006

What is submitted and what gets accepted in Indian Pediatrics: analysis of submissions, review process, decision making, and criteria for rejection.

OBJECTIVES: To identify the characteristics of the manuscripts submitted to the Indian Pediatrics; attributes of the peer-review process and decision-making; and factors associated with their acceptance or rejection. METHODS: All submissions to Indian Pediatrics during 2002 were analyzed by a retrospective review of records. Manuscripts were categorized by their place of origin (Indian vs. foreign), geographic region of India (north, south, east, west, central), submitting institution (teaching vs. non-teaching), subject (general pediatrics, systemic pediatrics, neonatology, genetic syndrome, allied sub-specialities, etc.), and type of article (research paper, case report, images, letter to editor, review, etc.). Manuscript details were recorded in a database that also included information on peer reviewer assignment, editorial and reviewer comments, and final disposition of the manuscript. Characteristics of accepted and rejected manuscripts were compared. RESULTS: Indian Pediatrics received 687 manuscripts for consideration in the year 2002; mostly from Indian authors (89%). Maximum contributions were received from North India (236, 39%) followed by 165 (27%) from South, 95 (16%) from West, 90 (15%) from Central and 26 (4%) from Eastern part of India. Of 687 papers, 457 (66%) articles qualified for peer review. Agreement between the reviewers was not significantly greater than that expected by chance; kappa for inter-rater agreement was 0.35, 0.17 and 0.21 between any two sets of reviewers for 431, 228 and 203 articles, respectively (P < 0.005). Of 687 submitted manuscripts, 294(43%) were accepted, 347(50%) were rejected and no decision was possible on 46(7%) manuscripts. The top reasons for rejection were 'absence of a message', 'lack of originality', 'inadequate methods', 'not relevant to journal', 'over-interpretation of results', 'unsatisfactory writing style', 'inaccurate/inconsistent/insufficient data', and 'inappropriate statistical analysis', in that order. Median number of days (IQR) needed to reach the final decision was 81 (25-210) d; ranging from 8 (3-29.5) d for Images to 180 (90-341) d for Research papers. No preference for acceptance was noted for foreign articles, geographic region of India, type of institution, or a particular topic, on both univariate and multivariate analysis. CONCLUSION: Indian Pediatrics is receiving contributions from all over India. Majority of the manuscripts are peer-reviewed. Of every 10 articles submitted, almost 4 are accepted. Median time interval from submission to final decision is less than 3 months. The decision-making is not influenced by the place of origin of manuscript.

Bibliometrics↗
PubMed2005

Devitrification of amorphous celecoxib.

The purpose of this research was to analyze the devitrification of amorphous celecoxib (CEL) in the presence of different stressors (temperature, pressure, and/or humidity) encountered during processing of solid dosage forms. Amorphous CEL was prepared in situ in the analytical instruments, as well as in laboratory, by quench-cooling of melt process, and analyzed by dynamic mechanical thermal analysis, differential scanning calorimetry, microscopy, and Fourier-transform infrared spectroscopy. Amorphous CEL prepared in situ in the analytical instruments was resistant to crystallization under the influence of temperature and/or pressure, because of its protection from the external environment during preparation. These samples exhibited structural relaxation during annealing at 25 degrees C/0% relative humidity (RH) for 16 hours. Generation of amorphous CEL in the laboratory resulted in partially crystalline samples, because of exposure to environmental temperature and humidity, resulting in incomplete vitrification. Subjection to thermal stress favored crystallization of amorphous CEL into metastable polymorphic forms, which were not obtained by solvent recrystallization approach. Temperature and humidity were identified as the major factors promoting devitrification of amorphous CEL, leading to loss of solubility advantage. Exposure to International Conference on Harmonization-specified accelerated stability storage conditions (40 degrees C/75% RH) resulted in complete devitrification of amorphous CEL within 15 days. The phase-transformation process of amorphous CEL along the temperature scale was examined visually, as well as spectrally. This propensity for devitrification of amorphous CEL seemed to depend on the strength of differential molecular interactions between the amorphous and crystalline form.

Celecoxib↗
PubMed2005

Spray drying for generation of a ternary amorphous system of celecoxib, PVP, and meglumine.

Generation of amorphous forms of a poorly soluble drug by solid dispersion techniques has been a subject of intensive research for decades. Apart from the stability of the dispersions, development of a suitable production technology is a major challenge to the successful commercialization of these products. Coprocessing of celecoxib (CEL), poly(vinyl pyrrolidone), and meglumine by spray drying resulted in an amorphous drug product that provided enhanced solubility and stability to an otherwise poorly soluble crystalline form of CEL. The spray-drying process parameters were optimized to provide an amorphous product with required characteristics. The product was stable for 3 months under the accelerated stability storage conditions. This technique can serve as a suitable means for generating a ready-to-formulate amorphous drug-additive(s) composite that can be directly filled into hard gelatin capsules.

Air Pressure↗
PubMed2005

Clinical significance of polymicrobial bacteremia in newborns.

OBJECTIVE: To identify whether polymicrobial bacteremia in newborns is associated with any predisposing factors, distinguishing clinical features, or higher mortality. METHODS: Results of blood cultures obtained over a period of 1 year from neonates admitted to the paediatric ward and Neonatal Intensive Care Unit of a tertiary care hospital were retrospectively analysed. The study group included all cases with polymicrobial bacteremia (isolation of two or more organisms). Controls (double the number of study cases) were randomly selected from the monomicrobial group. Case records of included cases were retrieved and scrutinized. RESULTS: Of 770 positive cultures during the study period, 52 (6.8%) cultures were positive for more than one organism. Complete case records were retrieved for 40 polymicrobial and 78 monomicrobial cases. The two groups were comparable for maternal and neonatal parameters including: maternal and obstetric complications; period of gestation; mode of delivery; birthweight and perinatal asphyxia; clinical symptomatology; invasive therapeutic interventions; and mortality. CONCLUSIONS: Isolation of more than one organism from the blood culture of a suspected septic newborn is not rare. It does not always represent a true invasion by multiple organisms. Polymicrobial isolation per se should not be the criterion for hastily changing the therapeutic decisions.

Bacteremia↗
PubMed2005

Molecular interactions in celecoxib-PVP-meglumine amorphous system.

Stabilization of the amorphous form of a drug is conferred by additives that interact with it at the molecular level. Ternary systems of celecoxib, poly(vinyl pyrrolidone) (PVP) and meglumine were studied for molecular interactions responsible for enhanced drug stability and solubility in amorphous form. Meglumine was found to lower the glass transition temperature (T(g)) of the drug due to its plasticization effect. However, the presence of PVP masked its destabilizing effect and provided net anti-plasticization to the celecoxib-PVP-meglumine (7:2:1 w/w) ternary amorphous system. Positive deviation of the experimentally determined T(g mix) value for this composition, from those predicted by the Gordon-Taylor/Kelley-Bueche equation, inferred molecular interaction between the three species, which was also supported by band shifts from their Fourier-transform infra-red (FTIR) spectra. Further, shift of differential scanning calorimetry (DSC) melting endotherms of celecoxib in its amorphous systems from those observed for crystalline celecoxib confirmed the complexation between these components, which was also substantiated by molecular modelling studies that showed H-bonding of -S=O, 2-N of the pyrazole ring and -C-F groups of celecoxib with -O-H group of meglumine. These molecular interactions of amorphous celecoxib with meglumine were found to be the potential cause for enhanced stability and solubility of the celecoxib-PVP-meglumine ternary system.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Differential molecular interactions between the crystalline and the amorphous phases of celecoxib.

We have investigated the differences in molecular interactions between the crystalline (ordered) and amorphous (disordered) phase of a poorly soluble drug, celecoxib. Molecular interactions in the crystalline phase were investigated with the help of Mercury software, using single crystal X-ray diffractometric data for celecoxib. A simulated annealing molecular dynamics approach was used for the assessment of altered molecular interactions in the amorphous phase. Crystalline celecoxib was found to contain an ordered network of H-bonding between all its electron donors (-S=O group, 2-N of pyrazole ring and -C-F) and the acceptor (-N-H). Amorphous celecoxib retained all these interactions in its disordered molecular arrangement, with a relatively stronger H-bonding between the interacting groups, as compared with crystalline celecoxib. However, these inter-molecular interactions differed in strength in the two solid-state forms. The altered configurations of the molecular arrangement in the two phases were supported by the shifts observed in the Fourier-transform infra-red vibrational spectra of respective states. These interactions could have strong implications on devitrification kinetics of amorphous celecoxib, and could further guide the choice of stabilizers for the amorphous form.

Celecoxib↗
PubMed2005

References in Indian Pediatrics: authors need to be accurate.

To determine the accuracy of references published in Indian Pediatrics, we reviewed the reference lists appended to the original articles published in Indian Pediatrics during the year 2002 (volume 39) for citation and quotation accuracy. A total of 176 references out of 322 cited in 17 original articles could be retrieved from available resources. Errors of citation were found in 69 (39.27 percent) references while errors of quotation were found in 15 (8.6 percent) references. The most common errors were those in the name of authors and title of the article. Contributors should make serious efforts to check the accuracy of the references cited in their manuscripts.

Bibliographies as Topic↗
PubMed2004

Oxidative stress in term small for gestational age neonates born to undernourished mothers: a case control study.

BACKGROUND: The objective of this study was to assess the status of oxidative stress in term small for gestational age (SGA) newborn infants born to undernourished mothers by estimating levels of erythrocyte superoxide dismutase (SOD), catalase, reduced glutathione, and serum malondialdehyde (MDA) in cord blood and comparing them to healthy appropriate for gestational age (AGA) controls. This was done in a case control design at a tertiary level teaching hospital. METHODS: We included 20 singleton healthy SGA newborn infants born between 38-40 weeks to undernourished mothers with a) post-pregnancy weight < 50 kg or height < 145 cm AND b) hemoglobin < 8.0 g/dL or serum albumin < 2.5 g/dL. An equal number of age and sex matched AGA newborn infants born to healthy mothers served as Controls. Mothers with other risk factors and newborns with complications during delivery or immediate newborn period were excluded. MDA, SOD, catalase and reduced glutathione were measured in the cord blood of all neonates and compared between the groups (unpaired t test); levels were also correlated to maternal weight, height, hemoglobin, and albumin by both univariate (pearsonian correlation) and multivariate (multiple regression) analysis. RESULTS: The activity of MDA was increased (5.33 +/- 0.72 vs 2.55 +/- 0.22 nmol/mL; P < 0.0001) while levels of superoxide dismutase (493.6 +/- 54.9 vs. 786.8 +/- 79.1 U/g Hb; P < 0.0001), catalase (1.48 +/- 0.24 vs. 2.31 +/- 0.20 U/g Hb; P < 0.0001) and reduced glutathione (2.84 +/- 0.37 vs 6.42 +/- 0.23 Umol/g Hb, P < 0.0001) were decreased in term SGA born to undernourished mothers as compared to term AGA born to healthy mothers. On univariate analysis, all the markers of oxidative stress correlated significantly with maternal parameters (P < 0.005). On multivariate analysis, maternal albumin and hemoglobin accounted for maximum correlation with the markers of oxidative stress. CONCLUSIONS: Intrauterine malnutrition is associated with significant oxidative stress in small for gestational age neonates born at term to malnourished mothers.

Adult↗