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Khan Z.,Bhopal Memorial Hospital and Research Center | Pandey M.,Bhopal Memorial Hospital and Research Center
Saudi Journal of Biological Sciences | Year: 2014

Chronic kidney disease (CKD) is a progressive pathological condition marked by deteriorating renal function over time. Diagnostic of kidney disease depend on serum creatinine level and glomerular filtration rate which is detectable when kidney function become half. The detection of kidney damage in an early stage needs robust biomarkers. Biomarkers allow monitoring the disease progression at initial stages of disease. On the onset of impairment in cellular organization there is perturbation in signaling molecules which are either up-regulated or down-regulated and act as an indicator or biomarker of diseased stage. This review compiled the cell signaling of different kidney biomarkers associated with the onset of chronic kidney diseases. Delay in diagnosis of CKD will cause deterioration of nephron function which leads to End stage renal disease and at that point patients require dialysis or kidney transplant. Detailed information on the complex network in signaling pathway leading to a coordinated pattern of gene expression and regulation in CKD will undoubtedly provide important clues to develop novel prognostic and therapeutic strategies for CKD. © 2014.

Desikan P.,Bhopal Memorial Hospital and Research Center
Indian Journal of Medical Microbiology | Year: 2010

Over the past decade, sequence differences between microbes from various geographical areas have been studied with the intent to interpret population movements of their hosts. An organism that is a reliable storehouse of such data, by virtue of its long association with its human host, is Helicobacter pylori. Functional and comparative analyses of its genome provide fascinating insights into human behaviour in the ancient past.

Vijayan V.K.,Bhopal Memorial Hospital and Research Center
Expert review of respiratory medicine | Year: 2012

Obstructive sleep apnea (OSA)-induced biological changes include intermittent hypoxia, intermittent hypercapnia, intrathoracic pressure changes, sympathetic activation and sleep fragmentation. OSA can cause metabolic dysregulation, endothelial dysfunction, systemic inflammation, oxidative stress and hypercoagulation, and neurohumoral changes. There is evidence suggesting that OSA is independently associated with metabolic syndrome. OSA has been shown to increase the risk for systemic hypertension, pulmonary vascular disease, ischemic heart disease, cerebral vascular disease, congestive heart failure and arrhythmias. Although there are evidences accumulating that there may be a causal relationship between OSA and cardiovascular disorders, there is a need for more data from randomized controlled intervention trials to confirm this relationship. Many risk factors of OSA (age, male gender and obesity) are also known risk factors for cardiovascular disease. Severe OSA-hypopnea significantly increases the risk of fatal and nonfatal cardiovascular events in both men and women, and continuous positive airway pressure treatment reduces this risk in both. Neurocognitive consequences of OSA include daytime sleepiness, loss of alertness, memory deficit, reduced vigilance, impaired executive function, increased risk for automobile and occupational accidents, and decreased quality of life.

De S.,Bhopal Memorial Hospital and Research Center
Indian Journal of Physiology and Pharmacology | Year: 2012

Body mass index (BMI) is one of the important parameter to assess functional status of patients with Chronic Obstructive Pulmonary Disease (COPD). The aim of present study was to assess the prevalence of underweight among clinically stable COPD patients and relationship of BMI with increasing severity of COPD. COPD was defined as a subject who had post-bronchodilator FEV1/FVC < lower limit of normal, age more than 40 years and either current or ex smoker. Spirometry data of 7412 subjects were retrospectively analyzed and 1269 COPD patients and 1202 bronchial asthma patients were identified. The severity of airflow obstruction was classified as per GOLD guideline. The BMI of each patient was calculated from weight and height. The BMI of COPD patients were compared with bronchial asthma. The average BMI of COPD patients and bronchial asthma patients were 20.2±4.3 kg/m2 and 23.2±5.4 kg/m2 respectively. Overall, 38 % COPD patients were underweight (BMI<18.5 kg/m2) and irrespective of severity of the disease, proportion of underweight COPD patient was significantly more as compared to bronchial asthma patients (P<0.001). The mean BMI also reduces significantly with progression of COPD severity.

Bathri R.,Bhopal Memorial Hospital and Research Center | Bose P.,Bhopal Memorial Hospital and Research Center
Indian Journal of Human Genetics | Year: 2012

Context: Survivors of the Bhopal gas disaster still suffer from various respiratory ailments. We examined the effects of exposures among a cross-section of current residents suffering from COPD by ISSR-PCR. Aims: Molecular screening of the gas-affected population of Bhopal with COPD for microsatellite instability due to exposure of MIC. Settings and Design: The isocyanate-exposed population of Bhopal city suffering from chronic obstructive pulmonary disorder. Materials and Methods: Inter-(SSR) analysis was used to characterize microsatellite instability in 52 MIC victims of Bhopal, suffering from COPD using (CA) 8 RG and (CA) 8 R[Y-Q] primer. Statistical Analysis Used: Association analyses were performed using regression analysis. Results: The study on the MIC-affected population in Bhopal showed weak association between microsatellite instability and age (r = + 0.37); exposure distance from site (r = 0.44); and smoking status(r = + 0.12); while regression analysis of the above parameters displayed supporting evidence. Conclusions: The high prevalence of smoking coupled with aging and poor living habits threatens, to further increase COPD incidences among this population, highlighting the need for enhanced screening efforts.

De S.,Bhopal Memorial Hospital and Research Center | De S.,Mahatma Gandhi Institute
Indian Journal of Medical Research | Year: 2012

Background & objectives: A large numbers of subjects were exposed to the aerosol of methyl isocyanate (MIC) during Bhopal gas disaster and lung was one of the most commonly affected organs. The aim of the present study was to analyze retrospectively the lung function abnormalities among the surviving MIC exposed population (gas victims) and to compare it with the non-MIC exposed (non gas exposed) population. Methods: The spirometry data of both gas victims and non gas exposed population who attended the Bhopal Memorial Hospital & Research Centre for evaluation of their respiratory complaints from August 2001 to December 2009, were retrospectively evaluated and compared. Results: A total 4782 gas victims and 1190 non gas exposed individuals performed spirometry during the study period. Among the gas victims, obstructive pattern was the commonest (50.8%) spirometric abnormality followed by restrictive pattern (13.3%). The increased relative risk of developing restrictive abnormality among gas victims was observed in 20-29 yr age group only (adjusted relative risk: 2.94, P<0.001). Male gas victims were more affected by severe airflow obstruction than females and the overall increased relative risk (1.33 to 1.45, P<0.001) of developing obstructive pattern among gas victims was observed. Interpretation & conclusions: The present study showed that the relative risk for pulmonary function abnormalities in gas victims was significantly more among those who were young at the time of disaster. Increased smoking habit among gas victims might have played an additive effect on predominance of obstructive pattern in spirometry.

Garg N.,Bhopal Memorial Hospital and Research Center | Vohra R.,Bhopal Memorial Hospital and Research Center
Clinical Orthopaedics and Related Research | Year: 2014

Background: Spinal tuberculosis is the most common form of skeletal tuberculosis. Various approaches have been described for surgical management of spinal tuberculosis, but many entail wide exposures with attendant morbidity; whether minimally invasive surgical (MIS) approaches are suitable is unknown. Questions/purposes: We evaluated (1) neurologic results, (2) radiographic results, and (3) complications in patients with thoracic and lumbar spinal tuberculosis treated with two MIS approaches. Methods: We retrospectively evaluated 22 patients with thoracic and lumbar tuberculosis managed surgically from October 2008 to February 2011 using MIS methods; one patient was lost to followup, leaving 21 patients with a minimum followup of 15 months (mean, 30 months; range, 15-59 months) for analysis. MIS approaches were used for patients with disease below D6 and minimum pedicle diameters of 4.5 mm to permit percutaneous screw placement. The MIS approach was divided into two groups depending on the extent of destruction of the vertebral body: a posterior-only group (n = 9), where posterior transpedicular decompression sufficed, and the hybrid group (n = 12), requiring anterior débridement and ventral-column reconstruction by conventional or mini-open thoracotomy. All but two patients with more than two contiguous bodies involvement underwent MIS posterior fixation by percutaneous transpedicular screws. Plain radiographs were evaluated for deformity correction and correction maintenance. Neurologic recovery and complications were ascertained by chart review. Results: All patients with neurologic deficits recovered completely with no motor deficits at followup; 13% improved by three grades, 53% by two grades, and 33% by one grade. Mean correction was 2.5° (thoracic) and 8° (lumbar) in the posterior-only group and 4.2° in the hybrid group. Some correction loss occurred with healing (2° and 1.6° in the posterior-only and hybrid groups, respectively), but in none of those who had fixation did this progress to more than preoperative status. Two of 22 patients (9%) had complications. One had a malposition of L5 screw causing painful radiculopathy without motor deficit and required repositioning. The other had an intraoperative dural tear repaired by onlay fascial patch and cerebrospinal fluid diversion. There were no approach-related complications, neurologic deterioration, or implant fatigue at last followup. Conclusions: We found evidence of neurologic recovery, avoidance of deformity progression, and few complications with these MIS approaches. Comparative trials are called for between open and MIS approaches for patients with spinal tuberculosis. Level of Evidence: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence. © 2014 The Association of Bone and Joint Surgeons®.

Singh O.,Bhopal Memorial Hospital and Research Center | Gupta S.S.,Bhopal Memorial Hospital and Research Center | Arvind N.K.,Bhopal Memorial Hospital and Research Center
Urologia Internationalis | Year: 2011

A review of the recent literature on the surgical management of anterior urethral stricture was performed. The literature was searched via PubMed using the search terms 'urethral stricture' and 'urethroplasty' from 1996 to 2009. The management of anterior urethral strictures is changing rapidly in the sense that the reconstructive procedures have evolved greatly. Penile skin, because of its location and because it is hairless, has been popular and used for a long time. Since the early 1990s, buccal mucosa graft (BMG) was introduced in urethral reconstructive surgery and has become the first choice of most practicing urologists. Recently, there has been an increase in the use of lingual mucosa graft with various doctors reporting easy harvesting and lesser morbidity in comparison to BMG. Also, fibrin glue has recently been used to fix the graft with promising results. With the success of tissue-engineered materials that are still in the experimental phase, the urologist would no longer be limited by the quantity of the graft. These substitutes will also boost the appealing scarless endoscopic urethroplasty. This article provides a brief up-to-date review of the main surgical techniques in the management of anterior urethral stricture disease for the contemporary practicing urologists. Present controversies have been given special emphasis. The possible future techniques and the future of the anterior urethral stricture surgery are also discussed in brief. © 2010 S. Karger AG, Basel.

De S.,Bhopal Memorial Hospital and Research Center
The Indian journal of chest diseases & allied sciences | Year: 2011

Psychological impairment is a significant co-morbid condition of chronic obstructive pulmonary disease (COPD). No studies from India have been conducted to assess the prevalence of depression in COPD. We investigated the prevalence of depression in 100 consecutive stable COPD patients during their routine outpatient department visits. Patients diagnosed to have depression or chronic systemic diseases were excluded. Severity of the COPD was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Hindi translations of patient health questionnaire-9 (PHQ-9) were administered and severity of depression was assessed at each stage of the COPD. All subjects were males with a mean age of 61.7 +/- 9.6 years. Six patients in stage I, 32 patients in stage II, 40 patients in stage III and 22 patients in stage IV of the COPD were enrolled. The cumulative prevalence of depression in the study population was 72 percent. Symptoms of depression were observed at all stages of COPD and its severity increased with an increase in severity of the COPD. High prevalence of depressive symptoms in Indian patients with COPD may be due to various confounding factors. Screening for symptoms of depression in patients with COPD by simple and quick validated questionnaires during their out-patient visits will be helpful in early diagnosis and appropriate treatment or referral.

Background: The involvement of respiratory system due to inhalation of methyl isocyanate (MIC) during Bhopal gas disaster was particularly severe. We retrospectively evaluated the annual changes in spirometric parameters among those who were affected in this disaster (exposed survivors) and had respiratory symptoms. Materials and Methods: Spirometry reports of exposed survivors that were carried out in our institution were retrospectively reviewed and we identified 252 subjects who had performed spirometry at least twice with interval of more than one year. The annual changes in spirometric indices of them were calculated. Results: The average age of study population was 55.7 years and 72% were male. Annual decline of FEV 1 ≥ 40 ml/yr was observed among 48% exposed survivors. The mean annual decline of FEV 1 among symptomatic exposed survivors with initial normal spirometry was 91 ml (95% CI: 52 ml to 130 ml) and this was more than the patients with initial obstructive pattern. Among fifty four patients with initial normal spirometry, ten patients (18.5%) developed obstructive and two patients (5%) developed restrictive lung function abnormalities during follow up spirometry. Conclusion: The exposed survivors with chronic respiratory symptoms had accelerated decline in lung function and they are at higher risk of developing obstructive lung function.

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