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D'Souza M.M.,Institute of Nuclear Medicine and Allied Sciences | Marwaha R.K.,Institute of Nuclear Medicine and Allied Sciences | Sharma R.,Institute of Nuclear Medicine and Allied Sciences | Jaimini A.,Institute of Nuclear Medicine and Allied Sciences | And 9 more authors.
Annals of Nuclear Medicine | Year: 2010

Purpose: The utility of 18F-FDG PET/CT in the assessment of thyroid nodules is unclear as there are several conflicting reports on the usefulness of SUV as an indicator to distinguish benign from malignant thyroid lesions. This study incorporated an additional parameter, namely dual time point imaging, to determine the diagnostic accuracy of PET/CT imaging. The performance of 18F-FDG PET/CT was compared to that of high-resolution ultrasound which is routinely used for the evaluation of thyroid nodules. Methods: Two hundred patients with incidentally detected solitary thyroid nodules were included in the study. Each patient underwent ultrasound and PET/CT evaluation within 7 days of each other, reported by an experienced radiologist and nuclear medicine specialist, respectively, in a blinded manner. The PET/CT criteria employed were maximum SUV (SUVmax) at 60 min and change in SUVmax at delayed (120 min) imaging. Final diagnosis was based on pathological evaluation and follow-up. Results: Of the 200 patients, 26 had malignant and 174 had benign nodules. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of ultrasound were 80.8, 81.6, 39.6, 96.6 and 81.5%, respectively. Using SUVmax at 60 min as the diagnostic criterion, the above indices were 80.8, 84.5, 43.8, 96.7 and 84%, respectively, for PET/CT. The SUVmax of malignant thyroid lesions was significantly higher than benign lesions (16.2 ± 10.6 vs. 4.5 ± 3.1, respectively; p = 0.0001). Incorporation of percentage change in SUV max at delayed imaging as the diagnostic criterion yielded a slightly improved sensitivity, specificity, PPV, NPV and accuracy of 84.6, 85.6, 46.8, 97.4 and 85.5%, respectively. There was a significant difference in percentage change in SUVmax between malignant and benign thyroid lesions (14.9 ± 11.4 vs. -1.6 ± 13.7, respectively; p = 0.0001). However, there was no statistically significant difference (95% confidence interval) between the diagnostic performance of PET/CT and ultrasound. Conclusions: Routine use of 18F-FDG PET/CT with SUVmax at 60 min as the sole diagnostic criterion does not appear to have a significant advantage over high-resolution ultrasound in the evaluation of thyroid nodules. Incorporation of dual time point imaging enhances image interpretation, and yields a higher diagnostic performance, yet it is not statistically significant. Bearing in mind the cost, limited availability and radiation exposure, routine use of 18F-FDG PET/CT for distinguishing benign from malignant thyroid nodules cannot be recommended. © 2010 The Japanese Society of Nuclear Medicine.

Sharma R.,Lady Hardinge Medical College LHMC | Dutta A.K.,Lady Hardinge Medical College LHMC
Indian Journal of Pediatrics | Year: 2011

Malaria is a major vector borne disease in India with significant morbidity and mortality. The official figure of 1.5 million cases annually is a gross under-estimation of the true incidence and the actual figures are estimated to be 10-100 times higher. The National Vector Borne Disease Control Programme (NVBDCP) directorate is the main body responsible for malaria control in India. Newer strategies including insecticide treated bednets, longlasting insecticidal bednets and rapid diagnostic tests have been used for malaria control in the last decade. Global assistance has come from the World Bank and Global fund in the form of Enhanced Malaria Control Programme (EMCP) and Intensified Malaria Control Programme (IMCP) respectively. Despite years of concerted global and national efforts, control of malaria continues to be a challenge. The emergence of drug resistance to antimalarial drugs has been a major hurdle in its control. The NVBDCP has formulated new treatment guidelines for malaria in 2010 which recommend artemisinin based combination therapy (ACT) as the first-line drugs for P. falciparum malaria in the country. The article discusses the recent national drug policy for malaria and the rationale for its use. © Dr. K C Chaudhuri Foundation 2011.

Dhingra B.,Lady Hardinge Medical College LHMC | Dutta A.K.,Lady Hardinge Medical College LHMC
Indian Journal of Pediatrics | Year: 2011

The health related indices in our country are far from satisfactory and the country still bears an enormous share of the global disease burden. The lack of accessibility, scarce availability and the poor quality of health services and personnel in the remote rural and underdeveloped urban areas have been the major obstacles to the delivery of quality health care services in a vast and culturally diverse country with inter- and intra-regional variations and inequalities. The already over-stretched public health care system has been grappling with the deficiencies in linkage with the collateral health determinants, gross shortage and non utilization of infrastructure, financial and human resources. Revitalizing the existing primary health care infrastructure under the National Rural Health Mission (NRHM) will bring about the long overdue architectural corrections in the health care sector and be able to provide accessible, affordable, accountable, effective and reliable health care especially to the under-privileged sections of the society. NRHM is based on the principles of decentralisation of the health system, empowerment of the community and the panchayati raj institutions. Effective integration of health concerns with other health determinants like sanitation, hygiene and nutrition through district health plan is being made. © Dr. K C Chaudhuri Foundation 2011.

Devi A.,Lady Hardinge Medical College LHMC | Singh R.,Lady Hardinge Medical College LHMC | Dawar R.,Lady Hardinge Medical College LHMC | Tyagi S.,GB Pant Hospital
Indian Journal of Clinical Biochemistry | Year: 2016

Association of cholesteryl ester transfer protein (CETP) Gene -629C/A Polymorphism with angiographically proven atherosclerosis CETP gene has been linked to CAD risk via its role in HDL and LDL metabolism. There is no agreement of whether CETP is atherogenic or not. Furthermore, various genotypes of CETP gene have been associated with CETP levels and thus with atherosclerosis risk. Our aim was to study the association of CETP -629C/A gene polymorphism with CETP and HDL levels and their association if any with atherosclerosis. Study population consisted of angiographically documented 50 cases with coronary artery atherosclerosis and 50 controls negative for atherosclerosis of coronary artery. Serum lipid profile was measured on SYNCHRON CX-9 using standard kits. Serum CETP levels were measured by ELISA method. CETP -629C/A gene polymorphism was studied using PCR–RFLP method. There was no significant difference in lipid profile of the two groups. However, serum CETP level was significantly higher (46.44 ± 21.75 ng/ml) in cases than controls (37.10 ± 21.92 ng/ml) with p value =0.035. The frequency of -629A allele was higher (0.85) in cases than that of controls (0.81). Homozygosity of A allele was more in subjects with atherosclerosis of coronary artery. We conclude that CETP is atherogenic and could be used as atherogenic risk predictor in angiographically proven atherosclerosis. Also A allele of -629C/A polymorphism is more prevalent in cases; indicating its effect on expression of CETP gene. © 2016 Association of Clinical Biochemists of India

Ahirwar A.K.,All India Institute of Medical Sciences | Jain A.,Lady Hardinge Medical College LHMC | Singh A.,All India Institute of Medical Sciences | Goswami B.,Lady Hardinge Medical College LHMC | And 2 more authors.
Hormone Molecular Biology and Clinical Investigation | Year: 2015

Background: Metabolic syndrome (MetS) consists of a constellation of metabolic abnormalities that confer increased risk of cardiovascular disease (CVD) and diabetes mellitus (DM). Endothelial dysfunction is one of the key components of MetS which is caused by imbalance between vasodilatory substances like nitric oxide (NO) and vaso-constrictive substances like endothelin and prothrombotic factors like plasminogen activator inhibitor-1 (PAI-1). Objective: To study the markers of endothelial dysfunction (NO and endothelin) and prothrombotic markers (PAI-1) among the study subjects. Materials and methods: We enrolled 50 diagnosed cases of MetS as per International Diabetes Federation (IDF) criteria and 50 healthy volunteers as controls. Clinical evaluation included anthropometric, routine biochemical, hematological, serum insulin, NO, endothelin and PAI-1 measurements. Results: Subjects with MetS had higher insulin, endothelin and PAI-1 levels and low NO levels as compared to controls and the difference was found to be significant. The serum insulin levels were positively correlated with PAI-1 and endothelin, and negatively correlated with NO. Conclusion: Endothelial functional status as reflected by decreased NO and increased serum endothelin levels along with insulin resistance is seen in MetS. Moreover, higher serum level of PAI-1 also tilts towards a more prothrombotic milieu in the vascular endothelium. Hence endothelial dysfunction and prothrombotic markers may be used to guide for early diagnosis of cardiovascular disease and type 2 diabetes in patients with MetS. © 2015 by De Gruyter 2015.

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