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Kakkar A.K.,Safdarjung Hospital | Dahiya N.,Lady Hardinge Medical College
European Journal of Internal Medicine | Year: 2015

Obesity is a growing epidemic and a major contributor to the global burden of disease. Obesity strains the healthcare systems and has profound economic and psychosocial consequences. Historically, pharmacotherapy for obesity has witnessed the rise and fall of several promising drug candidates that had to be eventually withdrawn due to unacceptable safety concerns. Currently four drugs are approved for chronic weight management in obese adults: orlistat, lorcaserin, phentermine/topiramate extended release and naltrexone/bupropion extended release. While lorcaserin and phentermine/topiramate were approved by US Food and Drug Administration (FDA) in 2012, after a gap of 13 years following the licensing of orlistat, naltrexone/bupropion has been recently approved in 2014. This review provides a brief overview of these current therapeutic interventions available for management of obesity along with the evidence of their safety and efficacy. Additionally, several novel monotherapies as well as combination products are undergoing evaluation in various stages of clinical development. These therapies if proven successful will strengthen the existing armamentarium of antiobesity drugs and will be critical to combat the global public health crisis of obesity and its associated co-morbidities. © 2015 European Federation of Internal Medicine. All rights reserved.

Kakkar A.K.,Safdarjung Hospital | Dahiya N.,Lady Hardinge Medical College
European Journal of Pharmacology | Year: 2015

Parkinson's disease (PD) is chronic progressive neurodegenerative disorder characterized by profound loss of dopaminergic neurons in the nigrostriatal pathway. It is recognized by the cardinal clinical features of bradykinesia, rigidity, tremor and postural instability. Current therapeutic options are primarily dopamine replacement strategies that only provide symptomatic improvement without affecting progressive neuronal loss. These treatments often fail to provide sustained clinical benefit and most patients develop motor fluctuations and dyskinesias as the disease progresses. Additionally, non-motor symptoms such as autonomic disturbances, sensory alterations, olfactory dysfunction, mood disorders, sleep disturbances and cognitive impairment cause considerable functional disability in these patients and these features often fail to respond to standard dopaminergic treatments. This mini review outlines the current pharmacotherapeutic options for PD and highlights the emerging experimental therapies in various phases of clinical development. © 2015 Elsevier B.V. All rights reserved.

Kakkar A.K.,All India Institute of Medical Sciences | Dahiya N.,Lady Hardinge Medical College
Tuberculosis | Year: 2014

Treatment of multidrug-resistant tuberculosis (MDR-TB) is hindered by limited efficacy and significant toxicity of second-line drugs. The need for new therapeutic options is critical to combat the global MDR-TB epidemic. Bedaquiline is a novel oral diarylquinoline approved by Food and Drug administration (FDA) for the treatment of adults with pulmonary MDR-TB on the basis of Phase IIb trial data under the provisions of the accelerated approval regulations for serious or life-threatening conditions. The FDA advisory committee members voted unanimously on efficacy data based on surrogate measures, however they were split on the issues of safety of bedaquiline. Main safety concerns include QT interval prolongation, hepatic related adverse events, and excess mortality in bedaquiline treated patients. While bedaquiline approval is a story of many firsts and certainly a welcome addition to the existing arsenal of anti-TB agents, a cautiously optimistic approach is required to assess the risk benefit profile of the drug. Acceleration of further Phase III trials and clinical studies is imperative, as is timely analysis of emerging data on the real world use of the drug. This mini review outlines the clinical pharmacology of bedaquiline highlighting the potential promises and challenges that implicate the risk benefit profile of drug. © 2014 The Authors. Published by Elsevier Ltd.

Chaudhary B.,Lady Hardinge Medical College
Journal of Indian Academy of Forensic Medicine | Year: 2013

Burn is a major cause of death in all medico-legal cases. Developing countries have a high incidence of burn injuries, creating a formidable public health problem. Our objective of the present study is to measure the magnitude and epidemiology of death due to burns in Central Delhi. A 5 years (from 1st January 2006 to 31st December 2010) autopsies based retrospective study where total 2773 medico-legal autopsies were conducted during this period, out of those 207 (7.46%) were due to burn; 117(56.52%) were males and 90 (43.47%) were females. Maximum 88 (42.51%) of the cases were in the 21-30 years of age group in both gender. The most common manner of the burn was accidental (72.94%), followed by suicidal (17.39%) and homicidal (9.66%). Almost all male deaths were accidental in nature. Smell of kerosene was present in 35 (38.88%) of females bodies. The cause of deaths in 97 (46.85%) was shock followed by 110 (53.14%) septicaemia. The history regarding whether they were killed or ablaze herself was not clear by history records but findings were suggestive of killing of bride in demand of dowry could not be ruled out.

Dwivedi P.,Lady Hardinge Medical College
European review for medical and pharmacological sciences | Year: 2012

STo study the feto-maternal outcome in pregnancy with severe thrombocytopenia. It was an observational study involving 1150 pregnant women with term gestation in labour, who were screened for thrombocytopenia. Ninety-four subjects (8.17%) were found to have thrombocytopenia i.e. platelet count < 1,50,/000/mm3, out of which 47 subjects (group A) had platelet count of less than 50.000/mm3 Simultaneously, 47 term pregnant women (group B) having a normal platelet count i.e. > 1.5 lac/mm3 formed the control group. All the subjects were followed during labour and postpartum period for any feto-maternal outcome. Significant history of bleeding tendencies like prolonged bleeding from wound site, easy bruisability and menorrhagia (p = 0.023) was evident in the study population. Abruptio placentae and early onset pregnancy induced hypertension (PIH) in previous gestations was more commonly found in the study population. Anemia and PIH were significantly more in group A. Incision site oozing during cesarean section was significantly more in group A. Moderate thrombocytopenia was more in neonates of study group (p = 0.014), but without any bleeding complications in neonates. Careful surveillance is required in these high risk patients for earlier detection and treatment of complications so as to decrease the fetomaternal morbidities.

Patra S.K.,Lady Hardinge Medical College | Arora S.,ESI Postgraduate Institute of Medical science
Clinica Chimica Acta | Year: 2012

Background: The cachexia anorexia syndrome is a complex metabolic syndrome associated with cancer and some other palliative conditions characterized by involuntary weight loss involving fat and muscle, weight loss, anorexia, early satiety, fatigue, weakness due to shifts in metabolism caused by tumour by-products and cytokines. Various neuropeptides like Leptin, neuropeptide Y, melanocortin, agouti-related peptides have been known to regulate appetite and body weight. Method: A comprehensive literature search was carried out on the websites of Pubmed Central (http://www.pubmedcentral.nih.gov/), National Library of Medicine (http://www.ncbl.nlm.nih.gov) and various other net resources. Result: Data from observational studies shows that various cytokines (TNF-α, IL-6 and IL-1) are associated with metabolic changes resulting in cachexia in cancer patients. These cytokines may mimic the action of various neuropeptides resulting in anorexia, various metabolic effects resulting from enhanced catabolic state and weight loss. Conclusion: There is a need to understand and explore the role of various neuropeptides and cytokines in the pathophysiology of cancer-anorexia syndrome so that therapeutic measures may be designed for effective palliative care. © 2012 Elsevier B.V.

Jain A.,Lady Hardinge Medical College
Indian Journal of Clinical Biochemistry | Year: 2011

Tuberculosis remains a major public health problem globally, with India being one of the high burden countries. The common causative agent is Mycobacterium tuberculosis but in developing countries M. bovis is reported as a potential human pathogen. Almost 20% of all reported cases of tuberculosis are of extra pulmonary form of disease. Diagnosis of extra pulmonary tuberculosis (EPTB) is not always possible with conventional methods, due to the long time required and the paucibacillary nature of samples; hence the need of rapid molecular methods. A prospective study was conducted on 300 patients of EPTB over a period of 5 years. These patients were suspected cases of tubercular meningitis, tubercular ascites and tubercular lymphadenitis. Samples analyzed were cerebrospinal fluid, ascitic fluid and lymph node fine needle aspirate. A two step PCR targeting hup B gene was used. Clinical response to anti tubercular therapy (ATT) was taken as positive (gold standard). PCR for hup B gene was positive in 147 samples out of 155 ATT responders. Of these 85.71% were infected with M. tuberculosis, 9.52% with M. bovis alone and 4.76% showed co infection with both M.tb and M. bovis. The sensitivity and specificity of PCR was 90.32 and 94.48% respectively. © 2011 Association of Clinical Biochemists of India.

Chaudhary P.,Lady Hardinge Medical College
Indian Journal of Surgery | Year: 2015

Pancreatic acinar cell carcinoma is a rare tumour, accounting for only about 1 % of all pancreatic tumours. The long-term survival for patients with acinar cell carcinoma is significantly better than the long-term survival of patients with pancreatic adenocarcinoma. As no large series of patients with acinar cell carcinomas exist, our understanding of this disease comes mainly from small case series and case reports. Aggressive surgical resection with negative margins is associated with long-term survival in these more favourable pancreatic cancers. There are no clear treatment guidelines for patients in whom complete surgical resection with curative intent is not possible. Acinar cell carcinomas are chemoresponsive to agents that have activity against pancreatic adenocarcinomas and colorectal carcinomas because of the shared genetic alterations between these cancers. The role of neoadjuvant or adjuvant chemoradiotherapy remains unproven. The aim of this article is to present current knowledge on acinar cell carcinoma and comprehensive review of available literature. © 2014, Association of Surgeons of India.

Yadav A.,Lady Hardinge Medical College | Saini V.,Lady Hardinge Medical College | Arora S.,Lady Hardinge Medical College
Clinica Chimica Acta | Year: 2010

Background: Monocyte Chemoattractant Protein (MCP)-1, a potent monocyte attractant, is a member of the CC chemokine subfamily. MCP-1 exerts its effects through binding to G-protein-coupled receptors on the surface of leukocytes targeted for activation and migration. Role of MCP-1 and its receptor CCR2 in monocyte recruitment during infection or under other inflammatory conditions is well known. Method: A comprehensive literature search was conducted from the websites of the National Library of Medicine (http://www.ncbl.nlm.nih.gov) and Pubmed Central, the US National Library of Medicine's digital archive of life sciences literature (http://www.pubmedcentral.nih.gov/). The data was assessed from books and journals that published relevant articles in this field. Result: Recent and ongoing research indicates the role of MCP-1 in various allergic conditions, immunodeficiency diseases, bone remodelling, and permeability of blood - brain barrier, atherosclerosis, nephropathies and tumors. Conclusion: MCP-1 plays an important role in pathogenesis of various disease states and hence MCP-1 inhibition may have beneficial effects in such conditions. © 2010 Elsevier B.V.

Tiwari A.K.,Lady Hardinge Medical College | Lal R.,Lady Hardinge Medical College
International Journal of Surgery | Year: 2014

Background: Diagnosis of skin and soft tissue infections (SSTIs) is difficult as they commonly masquerade as other clinical syndromes. So, the prospective cohort study was carried out to study the clinical profile, evaluate the existing method of severity stratification of SSTIs and identify factors responsible for prolonged stay and poor outcome in patients with SSTIs. Methods: The prospective study was carried out based on clinical profile to evaluate the role of severity stratification of SSTIs in 105 patients attending the surgical outpatient department and surgical emergency. The patients were managed conservatively on oral or intravenous antibiotics and dressing or combined with surgical intervention based on severity stratification. Sometimes radiological investigation helped to know the deep seated abscess and thereby need of early intervention by surgical drainage, fasciotomy and rarely amputation. The data collected, summarised and evaluated using chi-square method. Result: SSTIs has been categorized into mild, moderate and severe form based on clinical and demographic profile of the patient. The study revealed risk factors that were statistically significant to be male patients of lower socioeconomic groups, temperature above 38°C, hypotension, TLC>15000, presence of gangrene, bullae, crepitus, trauma, animal/insect bite, BSA>9% except when involving hand, head & scrotum, loss of sensation, loss of movement/function of affected part and restriction of joint movement (P<0.05). Conclusion: Based on above findings, an algorithm for severity stratification is formulated for reducing the morbidity and mortality of the patients with SSTIs. © 2013 Surgical Associates Ltd.

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