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Garg P.,Fortis Super Specialty Hospital | Garg P.,MM Institute of Medical science and Research | Garg M.,Indus Super Speciality Hospital | Menon G.R.,Indian Council of Medical Research ICMR
Colorectal Disease | Year: 2013

Aim: A systematic review was carried out to analyse continence at 2 years or more after lateral internal sphincterotomy (LIS) for chronic anal fissure (CAF). Method: PubMed, MEDLINE, Scopus, Embase, Ovid, SCI, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar were used to search the literature from 1969-2012 for studies reporting a follow-up of more than 2 years after LIS for CAF. The primary outcome parameter analysed was continence. The secondary outcome parameters included success rate, recurrence, incidence of postoperative abscess and fistula formation and patient satisfaction. Results: Of 324 studies screened, 22 (n = 4512) were included. The mean follow-up period ranged from 24-124 months. The overall continence disturbance rate was 14% (95% CI 0.09-0.2). Weighted analysis showed flatus incontinence in 9% (95% CI 0.04-0.16), soilage/seepage in 6% (95% CI 0.03-0.1), accidental defaecation in 0.91% (95% CI 0.003-0.02), incontinence to liquid stool in 0.67% (95% CI 0.001-0.02) and incontinence to solid stool in 0.83% (95% CI 0.003-0.02) of patients. Conclusion: The long-term risk of continence disturbance after lateral internal sphincterotomy is significant. Randomized controlled trials with a long follow-up are needed to substantiate these findings and to redefine its role in the treatment of chronic anal fissure. © 2013 The Association of Coloproctology of Great Britain and Ireland.


Garg P.,MM Institute of Medical science and Research | Garg P.,Fortis Super Specialty Hospital | Thakur J.D.,Louisiana State University Health Sciences Center | Garg M.,MM Institute of Medical science and Research | Menon G.R.,Indian Council of Medical Research ICMR
Journal of Gastrointestinal Surgery | Year: 2012

Introduction: We analyzed different morbidity parameters between single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC). Methods: Pubmed, Ovid, Embase, SCI database, Cochrane, and Google Scholar were searched. The primary endpoints analyzed were cosmetic result and the postoperative pain (at 6 and 24 h) and the secondary endpoints were operating time, hospital stay, incidence of overall postoperative complications, wound-related complications, and port-site hernia. Results: Six hundred fifty-nine patients (SILC-349, CLC-310) were analyzed from nine randomized controlled trials. The objective postoperative pain scores at 6 and 24 h and the hospital stay were similar in both groups. The total postoperative complications, wound-related problems, and port-site hernia formation, though higher in SILC, were also comparable in both groups. SILC had significantly favorable cosmetic scoring compared to CLC [weighted mean difference = 1.0, p = 0.0001]. The operating time was significantly longer in SILC [weighted mean difference = 15.63, p = 0.0001]. Conclusions: Single-incision laparoscopic cholecystectomy does not confer any benefit in postoperative pain (6 and 24 h) and hospital stay as compared to conventional laparoscopic cholecystectomy while having significantly better cosmetic results at the same time. Postoperative complications, though higher in SILC, were statistically similar in both the groups. © 2012 The Society for Surgery of the Alimentary Tract.


Kshirsagar N.A.,ESI PGIMSR MGM Hospital | Bachhav S.S.,Indian Council of Medical Research ICMR
International Journal of Risk and Safety in Medicine | Year: 2013

BACKGROUND: Regulatory decision for withdrawal of a drug from market in European Union (EU) or other developed countries poses a challenge to authorities in developing countries specially when decision varies from different countries, such as for nimesulide. OBJECTIVES: To compare and evaluate, benefit and risk data for regulatory action, of nimesulide in India and EU. METHODS: Data on Nimesulide from EU available from Report on EMA website and Indian data from published literature (SCOPUS data base), WHO Vigibase and International Medicines Statistics (IMS) was compared. RESULTS: Publications from India on Adverse drug reactions (ADRs) are case reports (10) and case series (14). Drug Utilization Research (DUR) studies (17) are mostly from tertiary centres. Data in the WHO Vigibase is meagre, data from IMS is not easily available and there is regional variation in prescriptions. Thus incidence of ADRs per sale, prescription or defined daily does (DDD) cannot be calculated, as has been done for EU. CONCLUSION: Limited and varying data in post marketing studies on ADRs and drug utilization for nimesulide from India made regulatory decision difficult. India and other similar countries could contribute to post marketing data for local and global regulatory decisions by systematically planned studies and networking within country and across countries in region. © 2013-IOS Press.


Kshirsagar N.A.,ESI PGIMSR MGM Hospital | Bachhav S.S.,Indian Council of Medical Research ICMR
International Journal of Risk and Safety in Medicine | Year: 2013

BACKGROUND: With globalization and signing of WTO GATT treaty, the market in India has expanded. This has necessitated important regulatory decisions. OBJECTIVE: This study aims to determine the gap in introduction and withdrawal of drugs in India and EU. METHODS: For drugs prohibited for manufacture and sale(withdrawn) in India during 1983-1998 and 1999-2012 periods, data on year of introduction and withdrawal in India and EU/internationally was extracted from Central Drugs Standard Control Organization (CDSCO), European Medical Agency (EMA) websites and Google search engine and compared. RESULTS: The gap in introduction of drug in India compared to EU/internationally during 1999-2012 period is shorter than 1983-1998 period, while the gap in withdrawal has not changed much. CONCLUSION: Regulatory authority in India has approved drugs in recent year more quickly than the past but gap in withdrawal has not shortened, indicating need for strengthening postmarketing studies and review process. © 2013-IOS Press.


Omanwar S.,Indian Council of Medical Research ICMR | Ravi K.,University of Delhi | Fahim M.,University of Delhi
Human and Experimental Toxicology | Year: 2011

Chronic mercury exposure impairs vascular function, leading to the depression of endothelium-dependent vasodilatation. Loss of the nitric oxide (NO) pathway has been implicated, but little is known about effects on other endothelial mediators. This study investigated the mechanisms of endothelial dysfunction in rats subjected to chronic mercury chloride exposure. The endothelium-dependent relaxation of rat aorta evoked by acetylcholine (ACh) and isoproterenol was impaired in a dose-dependent manner by chronic mercury chloride exposure. Endothelium-independent responses to sodium nitroprusside (SNP) were not affected by chronic mercury chloride exposure. In healthy vessels, ACh-induced relaxation was inhibited by L-N-nitroarginine methyl ester (L-NAME; 10 -4M) and partially by glybenclamide (10 -5M), indicating the involvement of NO and endothelium-derived hyperpolarizing factor (EDHF). In vessels from mercury-exposed rats, responses to ACh were insensitive to L-NAME but were significantly reduced by glybenclamide, indicating selective loss of NO-mediated relaxation. In vessels from mercury-exposed rats, responses to ACh were partially restored after treatment with the antioxidant, superoxide dismutase (SOD) and catalase, this effect was not seen when aorta from exposed group was incubated with L-NAME along with SOD and catalase indicating selective loss of NO-mediated vasodilatation and with no affect the EDHF-mediated component of relaxation. The results imply that chronic mercury exposure selectively impairs the NO pathway as a consequence of oxidative stress, while EDHF is able to maintain endothelium-dependent relaxation at a reduced level. © SAGE Publications 2011.


Sharma P.,NRHM | Rahi M.,Maulana Azad Medical College | Lal P.,Indian Council of Medical Research ICMR
Indian Journal of Community Medicine | Year: 2010

Background: Cervical cancer is the commonest malignancy among women in developing countries. Cytological screening (Pap smear) have been claimed to reduce incidence and mortality of carcinoma cervix significantly for which sensitization of women is required through community-based approach. Objectives: To find out number of cervical cancer cases among patients reporting to a general health care camp through screening program and study the prevalence of perceived morbidity and its confirmation. Settings: Cross-sectional study among women attending cancer awareness camps. Materials and Methods: A total of 435 women attending cancer awareness camps were screened for carcinoma cervix. The findings of history and clinical examination were recorded. Pap smears of all the symptomatic patients were collected and cytological diagnosis was confirmed by a pathologist. Results and Conclusions: The perceived gynecological morbidity was observed to be 59.8%. The smear of the women who were suspected of carcinoma on clinical examination was confirmed to be the cases of carcinoma-in-situ (7.8%) and high-grade neoplasia (2.9%) on laboratory investigations. The findings of the study highlight the utility and need of cancer cervix screening among the women at regular intervals through camp approach in the community.


Patel D.K.,Veer Surendra Sai Medical College | Mashon R.S.,Indian Council of Medical Research ICMR | Patel S.,Sickle Cell Research Project | Das B.S.,Institute of Life science | And 2 more authors.
Hemoglobin | Year: 2012

There are several questions pertaining to dosage, duration and potential long-term toxicity of hydroxyurea (HU) therapy. Use of HU is extremely limited in eastern India because of its high cost and apprehension of its toxicities. We undertook this study to assess the clinical, biochemical and hematological efficacy of minimal dose HU (10 mg/kg/day) in 118 sickle cell anemia patients (27 pediatric and 91 adults). The frequency of painful crises reduced significantly in 71.5 and 92.2 in pediatric and adult cases, respectively. Ninety-five percent of the patients became transfusion independent. The baseline Hb F, total hemoglobin (Hb), MCV, MCH and MCHC levels increased significantly, whereas the WBC, platelet count and total serum bilirubin values decreased significantly. This is the first study of minimal dose HU therapy in eastern India that showed impressive improvement in clinical and hematological parameters with minimal toxicity. © 2012 Informa Healthcare USA, Inc.


Raina S.,P.A. College | Chander V.,P.A. College | Grover A.,Indian Council of Medical Research ICMR | Singh S.,P.A. College | Bhardwaj A.,P.A. College
Journal of Neurosciences in Rural Practice | Year: 2013

Introduction: Cognitive impairment, characteristic of dementia, is measured objectively by standard neuropsychological (cognitive) tests. Given the diversity of culture and language in India, it is difficult to use a single modified version of MMSE uniformly to Indian population. In this article, we report methods on the development of a cognitive screening instrument suitable for the tribal (Bharmour) elderly (60 years and above) population of Himachal Pradesh, India. Materials and Methods: We used a systematic, item-by-item, process for development of a modified version of MMSE suitable for elderly tribal population. Results: The modifications made in the English version of MMSE and the pretesting and pilot testing thereof resulted in the development of Bharmouri version of cognitive scale. Discussion: The study shows that effective modifications can be made to existing tests that require reading and writing; and that culturally sensitive modifications can be made to render the test meaningful and relevant, while still tapping the appropriate cognitive domains.


Mosquito population studies in rice agro-ecosystem of Kheda district in Central Gujarat revealed the presence of 14 anopheline species. An. subpictus (69.19%) was predominant anopheline species in rice agro-ecosystem followed by An. nigerrimus (9.18%), An. annularis (6.86%), An. culicifacies (5.52%), An. tessellatus (4.52%) and An. barbirostris (2.27%). Profuse breeding of An. subpictus and An. culcifacies was found in newly transplanted rice fields when plan height was minimum and distance between plants was maximum, which was later replaced by more shade loving mosquitoes like An. annularis, An. nigerrimus, An. tessellatus and An. barbirostris in later stages when there was enough aquatic vegetation in rice plots with thick growth of plants and canopy development. Breeding of malaria vector An. culicifacies was found in low proportions in rice nurseries and post harvested rice fields while rice field channels were the preferred place for its breeding. Besides species replacement, species groups were also noticed in rice field breeding mosquitoes when species like An. subpictus and An. culicifacies showed affinity to breed maximum in same kind of conditions of newly transplanted rice fields while, An. annularis, An. nigerrimus and An. barbirostis preferred to breed in later stages of the rice crop in an established ecosystem. Better understanding of the mosquito bionomics in this habitat may prove helpful in devising appropriate control measures for mosquito control. © ADR Journals 2015. All Rights Reserved.


Pai S.,Indian Council of Medical Research ICMR | Upadhya V.,Indian Council of Medical Research ICMR | Hegde H.,Indian Council of Medical Research ICMR | Joshi R.,Indian Council of Medical Research ICMR | Kholkute S.,Indian Council of Medical Research ICMR
Journal of Planar Chromatography - Modern TLC | Year: 2014

Triterpenoid betulinic acid (BA) was detected, quantified, and reported for the first time from leaf extract of Achyranthes aspera along with much known oleanolic acid (OA). Extraction was achieved using ultrasonic exposure, and reversed-phase.ultra flow liquid chromatographic (RP.UFLC) technique was employed during investigation. RP.UFLC separation was achieved on a Hibar 250-4.6 mm, 5 μ, Lichrospher 100, C18e column using methanol and water (90:10) as mobile phase with pH adjusted to 5.0 using glacial acetic acid (GAA) in an isocratic mode. The content of BA (0.25 mg g-1 fresh weight [FW]) was ∼75% higher than OA (0.06 mg g-1 FW). These results suggest BA to be the major triterpenoid compared to OA in the leaf of A. aspera. High-performance thin-layer chromatography (HPTLC) separation of the two triterpenic acids (oleanolic and betulinic acid) was also achieved on silica gel G 60 F25, 50 ×∼ 100 mm glass TLC plates, using benzene, ethyl acetate, and formic acid as solvent system in a ratio of 67.9:22.7:9.4. Anisaldehyde reagent was used for detection. The method was used for the screening of oleanolic and betulinic acids from A. aspera leaf extract. Similarly, Fourier transform-infrared (FT-IR) spectroscopic analysis was done in the mid IR region of 400-4000 cm-1 with 64 scan speed using OMNIC 8.1 (ver. 8.1.210) software. The results were also supported by HPTLC and FT-IR data.

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