PubMed Health⌕ Search

Biomedical subjects

S N Dwivedi

Publications and source records attributed to S N Dwivedi.

At least 37 records · Page 2Linked to original sources
PubMed2000

Hepatitis B, C and human immunodeficiency virus infections in multiply-injected kala-azar patients in Delhi.

Sera from 164 patients with parasitologically confirmed kala-azar and 100 patients with non-kala-azar Delhite in 2 Delhi hospitals were tested for anti-human immunodeficiency (anti-HIV) and anti-hepatitis C virus (anti-HCV) antibodies and hepatitis B surface antigens to determine which group is more likely to contract these infections. The mean age of the patients was 32.5 y (+/-6.5 y), (120 M, 44 F). Two patients were from Nepal and the others from the kala-azar endemic state of Bihar, India. As geographical controls, 50 serum samples from sex- and age-matched healthy Bihar residents were also tested for the blood-borne viral infections. All patients had been treated with injectable medicines by 1 or more local physicians before they were referred to the Delhi hospitals. The prevalence of hepatitis B virus (HBV) and HCV infection was significantly different between the 2 patient groups. While 2 kala-azar patients (1.21%) were found to be HIV-1 positive, 54 (32.9%) patients had anti-HCV antibodies detected by ELISA and 51 (31.1%) by RIBA test. The seroprevalence of HCV was only 2% in hospitalized non-kala-azar cases and 4% in the geographical controls (p < 0.001). The seroprevalence of HBV was 13.2% in hospitalized kala-azar cases, but only 1.75% in disease control cases and 1.6% in geographical control cases. The difference in infection rates between cases and controls was significant (p < 0.001). The results indicate that kala-azar patients treated locally in Bihar have a greater chance of contracting blood-borne infections. Interestingly, we found that HCV was more prevalent than HBV. These infections were most likely acquired through the re-use of needles by local medical and paramedical practitioners for administering anti-leishmanial drugs. This trend, if not checked immediately, may have drastic consequences in the horizontal transmission of HIV in Bihar.

Adolescent↗
PubMed2000

Epidemiological models and related simulation results for understanding of contraceptive adoption in India.

BACKGROUND: For the first time, models using multilevel analysis of Indian data and related simulation results are reported. They take hierarchical structure into account and incorporate variables from all levels to get correct analysis and proper interpretation of data on current contraceptive use (including sterilization and modern methods). METHODS: The data from an Indian State, Uttar Pradesh (UP), collected by the National Family Health Survey (NFHS) conducted during 10 October 1992 to 22 February 1993 was used. For model I, 7851 currently married women who were neither pregnant nor had continuing post-partum amenorrhoea (PPA) were considered. For model II, these women with at least one child (n = 6748) were used. Two-level logistic regression analysis was carried out for which women's level (level 1) and PSU (Primary Sampling Unit) level (level 2) variables were considered. The results were considered significant at the 5% level of significance. Simulation analysis using each model was also carried out. RESULTS: Model I reveals that those more likely to adopt contraception were women exposed to a TV message (odds ratio [OR] = 1.3; 95% CI: 1.1-1.6); whose houses were pucca (bricks and mortar) (OR = 1.3; 95% CI: 1.1-1.5); who were educated to high school level and above (OR = 2.9; 95% CI: 2.2-3.7); whose husbands were literate with schooling of > or =11 years (OR = 1.7; 95% CI: 1.4-2.1); and who had > or =2 living sons (OR = 2.2; 95% CI: 1.1-4.4). Muslim and other religious women were less likely than Hindu women to adopt contraception (OR = 0.5; 95% CI: 0.4-0.6). Also, the PSU level availability of all weather road was positively associated with contraceptive adoption (OR = 1.4; 95% CI: 1.1-1.7). The PSU level variance, which is the unexplained PSU level variation after controlling for the considered characteristics, was significantly higher. The simulation results revealed that public health education (a TV message) was found to be more effective among less educated women. The PSU level availability of all weather road was as effective as public health education. Similar results were evident from the analysis of second data set (model II) with the noticeable finding that those whose last child is surviving are most likely to adopt contraception (OR = 8.82; 95% CI: 1.01-77.38). CONCLUSIONS: These results reveal that the survival status of the last child has a marked effect on the adoption of contraception in UP. They further support the idea that public health education (a TV message) is more effective among less educated women. Also, the PSU level presence of all weather road is equally effective. Consideration of higher level variables provides not only more accurate results but also important public health clues to help the policy planners.

Adolescent↗
PubMed2000

Factors associated with severe asthma.

OBJECTIVE: To study the role of various factors associated with development and severity of bronchial asthma in children between 5-15 years of age. SETTING: Tertiary Care Medical College Hospital. METHODS: A case control study was carried out during May 96 to April 98. Sixty children each suffering from mild (chronic) and severe asthma (chronic) and 60 controls were enrolled to study the association of various risk factors with development of asthma and for severe disease. RESULTS: On univariate analysis factors associated with significant risk for development of asthma included family history of asthma (p = 0.003), lack of exclusive breastfeeding (p = 0.05), past history of bronchiolitis (p = 0.02), associated allergic rhinitis (p = 0.04) and atopic dermatitis (p = 0.01). For development of severe asthma, associated factors were early onset of symptoms (p = 0.01), family history of asthma in grandparents (p = 0.04) and more than 10 cigarettes per day smoked by any family member. No significant effect of air pollution, overcrowding, pets and passive smoking were found on either development of asthma or it's severity. On multivariate analysis only age of onset below 48 months was associated with severe asthma (OR 2.13, 95% CI 1.00-4.54). Exclusive breastfeeding for more than 4 months was the most protective factor for development of asthma (OR 0.25, 95% CI 0.08-0.70). A strong association between development of asthma and past history of bronchiolitis or tuberculosis (OR 5.26, 95% CI 1.7-16.20) and presence of associated atopic dermatitis or rhinitis (OR 7.5, 95% CI 1.64-34.48) was observed. CONCLUSION: History of associated allergic diseases and past history of bronchiolitis were significantly associated with development of asthma. Exclusive breastfeeding for first 4 months of life was protective. The most significant factor associated with severe asthma was onset of illness before 48 months of age. There was no significant effect of air pollution, over crowding, pets at home or passive smoking on severity of asthma

Adolescent↗
PubMed2000

Role of micro-nutrients and trace elements in carcinoma of larynx.

Cancer of the larynx is fourteenth most common cancer in the world. Evidence from case-control studies conducted in developed as well as developing countries suggest that specific micro-nutrients and trace elements have been implicated to be significantly associated with laryngeal carcinoma. The association of these micro-nutrients and trace elements with laryngeal cancer has been discussed in this review article.

Carcinoma↗
PubMed2000

Doxycycline in the treatment of rheumatoid arthritis--a pilot study.

OBJECTIVE: To assess the efficacy and safety of doxycycline as a disease modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA) and compare it with methotrexate, a standard DMARD. MATERIAL AND METHODS: A single (assessor) blind prospective study with 15 patients of RA randomized to doxycycline and 14 to methotrexate. Baseline disease characteristics were similar in both groups. RESULTS: All disease activity measures studied viz. tender and swollen joint counts, physician and patient global assessment, visual analogue pain scale, health assessment questionnaire and ESR improved in both the treatment groups after six months of treatment. The difference between doxycycline and methotrexate was not statistically significant. No major side effects necessitating drug withdrawal were reported from either group. The side effects were few and mostly gastrointestinal. CONCLUSION: Doxycycline is a safe disease modifying drug in RA whose effect is sustained at six months. It compared favourably with methotrexate over a six month follow up.

Adolescent↗
PubMed1999

Cardiac involvement in limited systemic sclerosis: non-invasive assessment in asymptomatic patients.

Nineteen patients with limited systemic sclerosis (SSc) and without any cardiac symptoms were evaluated non-invasively for silent cardiac involvement using electrocardiography; M-mode, two-dimensional and Doppler echocardiography, and resting and post exercise radionuclide ventriculography. Left anterior hemiblock and mild pericardial effusion were seen in two patients. The interventricular septal thickness and left ventricular posterior wall thickness were greater in patients compared with controls. Patients with limited SSc also exhibited low early diastolic filling velocities and a low early diastolic atrial filling ratio. However, these values did not correlate with the age of the patient or disease duration. Eight patients (42.1%) were found to have cardiac dysfunction, of which four had combined systolic and diastolic dysfunction. Isolated systolic and diastolic dysfunction was seen in three patients and one patient, respectively. The age and disease duration in patients with cardiac dysfunction did not differ from patients without cardiac dysfunction. Functional cardiac involvement occurs in a large proportion (42.1%) of patients with limited SSc, and can be easily picked up by non-invasive methods such as echocardiography and radionuclide ventriculography. The prognostic significance of these findings requires further long term studies.

Adult↗
PubMed1999

Clinico-haematological profile of isolated PF3 availability defect: therapeutic potential of soya bean--a pilot study.

Isolated platelet factor 3 (PF3) availability defect has been observed to be a common platelet functional disorder (PFD) in the Department of Haematology, All India Institute of Medical Sciences, New Delhi, India. One hundred and thirty-two patients were diagnosed to have this defect based on the presence of reduced PF3 availability, normal platelet aggregation with ADP, collagen, adrenaline, ristocetin, and arachidonic acid and normal PF3 content. PF3 availability was evaluated by measurement of Russel viper venom time (RVVT) on the patient's platelet-rich plasma (PRP) after incubation with ADP for 20 min. An RVVT value >19.0 s was considered diagnostic of reduced PF3 availability in patients with normal prothrombin and activated partial thromboplastin times. Isolated PF3 availability defect occurred in patients with ages between 2 and 65 yr and had a female preponderance (M:F=1:2). One fifth of the patients had a positive family history of similar mild bleeding diathesis, indicating an autosomal dominant pattern of inheritance. All patients presented with mild bleeding manifestations, the commonest symptom being appearance of recurrent ecchymotic spots. In females, menorrhagia was the commonest symptom. A pilot study was conducted on 45 patients to evaluate the therapeutic role of oral soya bean (50 g/d). The clinical response was evaluated after 3 months. Soya therapy resulted in disappearance of bleeding problems in 5 patients and reduction in frequency and severity of bleeding in 26 patients. A repeat PF3 availability test after 3 months of therapy showed complete correction in 4 and partial correction in 12 patients. It is evident from McNemer's test that both the clinical and the laboratory parameters (PF3 availability) showed a similar response to soya therapy (p>0.05). Pre-soya therapy mean PF3 availability values differ significantly from those after soya therapy (p<0.01). Thus, soya bean appears to have a therapeutic potential in isolated PF3 availability defect.

Adenosine Diphosphate↗
PubMed1999

Dengue haemorrhagic fever in adults: a prospective study of 110 cases.

One hundred and ten adult patients hospitalized with dengue haemorrhagic fever (DHF) during the recent outbreak in North India were prospectively studied. Of these, 48 (43.6%) were grade I, 40 (36.4%) grade II, 10 (9.1%) grade III and 12 (10.9%) grade IV DHF. Dengue shock syndrome (DSS) was seen in 22 (20%) patients. Fever, headache, myalgias and arthralgias were the common symptoms seen in 100%, 80.9%, 76.2% and 52.3% patients, respectively. Spontaneous bleeding was seen in 62 patients (56.4%) with mucocutaneous bleeding being the most common (46 patients). Gastrointestinal bleeding was seen in 38 (34.5%) patients. In as many as 40 patients, the haemorrhagic manifestations occurred after the fever had come down. Fifty-five patients (50%) required platelet transfusions. Twelve patients died, giving a mortality rate of 10.9% in the present study. Prompt recognition and supportive treatment can be lifesaving.

Adult↗
PubMed1999

Biotyping of Acinetobacter species isolated from clinical samples.

We used the biotyping scheme using carbohydrate substrate utilization test with 14 carbon sources to speciate Acinetobacter isolates from blood and cerebrospinal fluid cultures of patients admitted to the postoperative neurosurgery ICU during January to November 1996. Sixty one patients culture positive for Acinetobacter sp. from blood or cerebrospinal fluid were followed up prospectively. Among these patients, 40 patients had clinically diagnosed infections like bacteriemia or meningitis while in 21 patients the isolation was regarded as contaminants. A. baumanniii was the most common isolate associated with clinical infections while A. lwoffii was more likely to be an environmental contaminant.

Acinetobacter↗
PubMed1999

Micronutrient deficiency disorders amongst pregnant women in three urban slum communities of Delhi.

OBJECTIVE: To assess the prevalence of three micronutrient deficiency disorders (MDDs), i.e., iron deficiency, iodine deficiency and vitamin-A deficiency individually and in combination amongst pregnant women. METHODS: A hospital based study was conducted amongst 829 pregnant women of II and III trimester attending antenatal clinic, Rural Health Training Center (RHTC), Najafgarh, New Delhi. Anemia was assessed by the presence of clinical signs and by hemoglobin levels. Iodine deficiency disorders (IDD) were assessed by clinical examination of thyroid gland and by urinary iodine excretion levels. Iodine content of the salt consumed by the pregnant women was also assessed by iodometric titration method. Vitamin A deficiency (VAD) was assessed by the presence of clinical symptoms of nightblindness. Current dietary intake, morbidity conditions on the day of survey and anthropometric measurements of pregnant women were also documented. RESULTS: Prevalence of anemia, IDD and VAD amongst pregnant women was 78.8%, 22.9% and 4.8%, respectively. One per cent of the pregnant women had concomitant presence of all the three MDDs. Pregnant women having combined prevalence of IDD and anemia, IDD and VAD, and VAD and anemia was 15.1%, 0.18% and 2.69%, respecively. Eighty nine per cent of the pregnant women were consuming salt with iodine content of more than 15 ppm which was recommended at household level. Results on dietary intake showed that 18%, 34%, 85% and 57% of the pregnant women were consuming less than 50% of calories, proteins, iron and b-carotene, respectively as compared to their RDA. Forty per cent of the pregnant women were suffering from various morbidity conditions on the day of survey. CONCLUSIONS: The prevalence of micronutrient deficiencies amongst pregnant women of urban slum communities is high.

Adolescent↗
PubMed1999

Utility of HemoCue in estimation of hemoglobin against standard blood cell counter method.

INTRODUCTION: There are various methods which have been recommended for haemoglobin (Hb) estimation for assessment of anaemia. Each method has it's advantages and limitations. OBJECTIVE: The present study was conducted to assess the utility of HemoCue, a recent method, in assessment of haemoglobin against the standard blood cell counter (BCC) method. METHODOLOGY: Eighty five venous blood samples were collected, Hb was assessed in each by utilising the HemoCue and BCC methods. The results were compared utilising the standard statistical methods. RESULTS: The HemoCue provided consistently higher value in comparison to BCC by a margin of 0.5 g/dl. It is known that the correlation coefficient is independent of change of origin but mean gets affected. Therefore, we can subtract 0.5 g/dl from the Hb estimates achieved by HemoCue through which all conditions regarding better agreement between both methods get satisfied. The two assays correlated well. CONCLUSION: The HemoCue method was found more rapid and easy in assessment of total hemoglobin as compared to blood cell counter method with an adjustment of 0.5 per dl.

Anemia, Iron-Deficiency↗
PubMed1998

Fibromyalgia in Indian patients with SLE.

One hundred and fifty-eight patients with SLE were prospectively studied at a tertiary referral centre in India to ascertain the prevalence and clinical profile of fibromyalgia (FM) in Indian patients with lupus. An attempt was made to determine whether socio-demographic factors or disease characteristics differ in SLE patients with and without FM. Only 13 patients (8.2%) in our cohort were found to have fibromyalgia. Their clinical profiles were similar to that reported in other series. Corticosteroid withdrawal or dose reduction was the probable precipitating factor in nearly one-third of our patients. Age, sex, marital status, educational level, disease duration, disease activity and the organ involvement in patients with SLE and FM were comparable to those in patients not having FM. Fibromyalgia appears to be distinctly uncommon in Indian patients with lupus. A strong family support system, the virtual lack of disability benefits and/or racial variations in pain threshold could be the likely factors responsible for the low prevalence of the disease observed in Indian patients with SLE.

Adolescent↗
PubMed1997

Evaluation of seven commercially available ELISA kits for serodiagnosis of acute toxoplasmosis.

Seven Toxoplasma gondii IgM antibody detection kits commercially available in the Indian markets were evaluated for their sensitivity, specificity, predictive values and cost-effectiveness on 140 serum samples (80 sera were positive and 60 negative). Modified direct agglutination test was used as standard. The principals of seven anti-Toxoplasma gondii IgM antibody detection kits were Organon-Teknika (Holland), Eurogenetics (Belgium), Labo Biomedical (Netherlands), Gamma-sa (Belgium), Viro-Immun Labor Diagnostika (Germany), Diamedix (USA) and Melotech (Spain). Of the seven kits, the first 4 were based on mu-capture principle. Organon-Teknika IgM ELISA kit was found to be most accurate, cost-effective and presentable, while Melotech and Viro-immun IgM kits were found unacceptable for clinical diagnosis of toxoplasmosis.

Acute Disease↗
PubMed1997

Efficacy of sodium antimony gluconate and ketoconazole in the treatment of kala-azar--a comparative study.

The present study was undertaken to determine the efficacy of ketoconazole in comparison to sodium antimony gluconate (SAG) in the treatment of kala-azar. The study was conducted at two centres: All India Institute of Medical Science, New Delhi and Calcutta School of Tropical Medicine, Calcutta. A total of 180 patients with proven kala-azar were recruited. After preliminary investigations, the patients were randomly divided into 2 groups: One group received ketoconazole in a dose of 600 mg/ day in 3 divided doses for 4 weeks while the other group was treated with SAG at a dose of 20 mg/kg/day up to a maximum of 850 mg/day for 4 weeks. The patients were followed up by clinical examination, liver functions, haemogram and the bone marrow/splenic aspiration. Responders were followed up at 3 and 9 months of intervals. Of 90 cases in SAG, 78 (81.7%) got cured initially while under ketoconazole group, only 26 (33.3%) of 78 patients responded initially (p < 0.001). After 3 months of follow up, 75 of 78 SAG-responders (96.2%) and 24 of 26 ketoconazole-responders (92.3%) continued to be in remission. Despite the fact that 2 patients in each group were lost to follow up at 9 months, similar observations were noted with only one relapse in SAG group. The response to SAG was comparable at the two centres. However, the response to ketoconazole was better at Delhi centre as compared to that at Calcutta. There were no significant side effects or hormonal changes in any of the patients in ketoconazole group at Delhi centre. Significantly higher side effects were reported at Calcutta centre in ketoconazole group (P < 0.05). No satisfactory explanation can be given for this difference in response to ketoconazole at two centres. However, it is known that leishmanial parasites of different geographical origin differ in their response to different drugs and this could be one of the reasons for difference observed in response rate to ketoconazole as the study involved different populations of people.

Drug Monitoring↗
PubMed1995

Results of conversion from triple-drug to double-drug therapy in living related renal transplantation.

Results of 34 recipients of living related renal allografts initially treated with cyclosporine, azathioprine, and prednisolone and later electively converted to AZA and PRED are presented. Thirteen (group A), 14 (group B), and 7 (group C) patients were converted before 9 months, between 9 and 12 months, and after 12 months, respectively. Thirty-four patients who were on AZA and PRED and had never received CsA served as controls. Of the 34 patients, 33 were HLA haploidentical with their donors and 1 was HLA identical. All patients received a mean 8.62 +/- 7.39 third-party blood transfusions. In the control group, 29 patients received haploidentical grafts. The number of blood transfusions given to this group was 7.09 +/- 9.13. Of the 34 patients receiving triple-drug therapy, 9 (26%) had acute rejection within 3 months after conversion, as compared with 5 (14.7%) in the control group (P > 0.05). Although 1 case had acute rejection before conversion, all recipients had stable graft function at the time of conversion. Of these 9 recipients, 7 had conversion over 4-7 weeks, while 2 had rapid conversion. Following treatment of the rejection episodes, 4 patients in the study group responded to therapy, as compared with 3 cases in the control group (P > 0.05). After a mean follow-up of 18.62 +/- 10.31 months (range 3-41 months) following conversion, 4 patients were normal, 4 had chronic rejection (mean serum creatinine = 3.0 mg/100 ml), and 1 was back on regular dialysis. Eventually, of the 34 patients who were converted from triple-drug to double-drug therapy, 25 were normal, 5 had stable chronic rejection, 2 were back on regular dialysis, 1 was retransplanted, and 1 died due to failed graft. At the end of follow-up, graft survival in the study group was 88.2%, as compared with 85.5% in controls (P > 0.05). We conclude that conversion from triple-drug to double-drug therapy is not without risk, even in living related primary renal transplantation. Degree of HLA matching, number of pretransplant blood transfusions, and rejection before conversion did not have any significant effect on rejections following conversion, and the graft loss following conversion is unpredictable.

Adolescent↗