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Mamtani M.,Lata Medical Research Foundation | Kulkarni H.,12023 Waterway Rdg
Osteoporosis International | Year: 2010

Zoledronate is a promising bisphosphonate that improves the bone mineral density by 0.69 standard deviations in thalassemia-induced osteoporosis, but the entire range of its actions and side effects is currently not fully understood. Introduction: Zoledronate is a promising bisphosphonate for the treatment of thalassemia-induced osteoporosis; however, a quantitative summary of its beneficial effect and its effects on the markers of bone turnover are not established. Methods: We conducted a meta-analysis of the published randomized controlled trials using standardized mean difference and a random effects model for improvement in bone mineral density (BMD). We also conducted a systematic review for the influence of zoledronate on markers of bone turnover and bone pain. Results: We found that zoledronate improves the baseline BMD by 0.69 (95% confidence interval 0.47-0.90) standard deviations-an effect that was more pronounced when BMD was measured at the lumbar spine. However, the mechanistic interpretations of the effects on the markers of bone turnover are not completely clear. Conclusion: Sufficient evidence exists to demonstrate that 4 mg zoledronate given every 3 months markedly improves the BMD; however, more qualitative and quantitative evidence is required to understand the mechanisms of its action and the potential side effects. © 2009 International Osteoporosis Foundation and National Osteoporosis Foundation.


Patel A.B.,Lata Medical Research Foundation | Patel A.B.,Indira Gandhi Government Medical College | Badhoniya N.,Lata Medical Research Foundation | Dibley M.J.,University of Sydney
Journal of Clinical Epidemiology | Year: 2013

Background: Diarrhea is one of the principal causes of morbidity and mortality among children in the developing world. Cumulative costs of treating diarrhea would be high and would further increase if zinc was used as an adjunct to treatment of acute diarrhea. Objective: To determine the impact of zinc supplementation on the mean predicted costs of treating acute diarrhea and the incremental cost-effectiveness (CE) as compared with placebo, from the provider's (government) and patient's perspective. Study Design and Setting: In a randomized, double-blind, placebo-controlled clinical trial, 808 children aged 6-59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn + Cu) together with standard treatment of acute diarrhea. The actual resource utilization and cost data were collected for all participants. The incremental CE ratio and its 95% confidence interval (95% CI) were assessed. Results: The relative CE for treating acute diarrhea was 1.5 (95% CI: 1.50, 1.52) times more when supplemented with zinc and 1.7 (95% CI: 1.69, 1.71) times more when supplemented with Zn + Cu with no additional beneficial effect. Conclusion: This study showed that zinc or zinc with copper supplementation were not cost-effective in the treatment of acute diarrhea in this study population. © 2013 Elsevier Inc. All rights reserved.


Patel A.,Lata Medical Research Foundation | Patel A.,Indira Gandhi Government Medical College | Mamtani M.,Lata Medical Research Foundation | Mamtani M.,University of Texas Health Science Center at San Antonio | And 4 more authors.
PLoS ONE | Year: 2010

Background: For over a decade, the importance of zinc in the treatment of acute and persistent diarrhea has been recognized. In spite of recently published reviews, there remain several unanswered questions about the role of zinc supplementation in childhood diarrhea in the developing countries. Our study aimed to assess the therapeutic benefits of zinc supplementation in the treatment of acute or persistent diarrhea in children, and to examine the causes of any heterogeneity of response to zinc supplementation. Methods and Findings: EMBASEH®, MEDLINE ® and CINAHL® databases were searched for published reviews and metaanalyses on the use of zinc supplementation for the prevention and treatment of childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. The reviews and published RCTs were qualitatively mapped followed by updated random-effects meta-analyses, subgroup meta-analyses and meta-regression to quantify and characterize the role of zinc supplementation with diarrhea-related outcomes. We found that although there was evidence to support the use of zinc to treat diarrhea in children, there was significant unexplained heterogeneity across the studies for the effect of zinc supplementation in reducing important diarrhea outcomes. Zinc supplementation reduced the mean duration of diarrhea by 19.7% but had no effect on stool frequency or stool output, and increased the risk of vomiting. Our subgroup meta-analyses and meta-regression showed that age, stunting, breast-feeding and baseline zinc levels could not explain the heterogeneity associated with differential reduction in the mean diarrheal duration. However, the baseline zinc levels may not be representative of the existing zinc deficiency state. Conclusions: Understanding the predictors of zinc efficacy including the role of diarrheal disease etiology on the response to zinc would help to identify the populations most likely to benefit from supplementation. To improve the programmatic use of zinc, further evaluations of the zinc salts used, the dose, the frequency and duration of supplementation, and its acceptability are required. The significant heterogeneity of responses to zinc suggests the need to revisit the strategy of universal zinc supplementation in the treatment children with acute diarrhea in developing countries. © 2010 Patel et al.


Patel A.B.,Lata Medical Research Foundation | Patel A.B.,Indira Gandhi Government Medical College | Mamtani M.,Lata Medical Research Foundation | Mamtani M.,University of Texas Health Science Center at San Antonio | And 3 more authors.
BMC Infectious Diseases | Year: 2011

Background: Prevention of diarrhea has presented indomitable challenges. A preventive strategy that has received significant interest is zinc supplementation. Existing literature including quantitative meta-analyses and systematic reviews tend to show that zinc supplementation is beneficial however evidence to the contrary is augmenting. We therefore conducted an updated and comprehensive meta-analytical synthesis of the existing literature on the effect of zinc supplementation in prevention of diarrhea.Methods: EMBASE ®, MEDLINE ®and CINAHL ®databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. Effect of zinc supplementation on the following five outcomes was studied: incidence of diarrhea, prevalence of diarrhea, incidence of persistent diarrhea, incidence of dysentery and incidence of mortality. The published RCTs were combined using random-effects meta-analyses, subgroup meta-analyses, meta-regression, cumulative meta-analyses and restricted meta-analyses to quantify and characterize the role of zinc supplementation with the afore stated outcomes.Results: We found that zinc supplementation has a modest beneficial association (9% reduction) with incidence of diarrhea, a stronger beneficial association (19% reduction) with prevalence of diarrhea and occurrence of multiple diarrheal episodes (28% reduction) but there was significant unexplained heterogeneity across the studies for these associations. Age, continent of study origin, zinc salt and risk of bias contributed significantly to between studies heterogeneity. Zinc supplementation did not show statistically significant benefit in reducing the incidence of persistent diarrhea, dysentery or mortality. In most instances, the 95% prediction intervals for summary relative risk estimates straddled unity.Conclusions: Demonstrable benefit of preventive zinc supplementation was observed against two of the five diarrhea-related outcomes but the prediction intervals straddled unity. Thus the evidence for a preventive benefit of zinc against diarrhea is inconclusive. Continued efforts are needed to better understand the sources of heterogeneity. The outcomes of zinc supplementation may be improved by identifying subgroups that need zinc supplementation. © 2011 Patel et al; licensee BioMed Central Ltd.


Patel A.,Indira Gandhi Government Medical College | Patel A.,Lata Medical Research Foundation | Pusdekar Y.,Lata Medical Research Foundation | Badhoniya N.,Lata Medical Research Foundation | And 3 more authors.
Maternal and Child Nutrition | Year: 2012

In India, poor feeding practices in early childhood contribute to the burden of malnutrition as well as infant and child mortality. This paper aims to use the newly developed World Health Organization (WHO) infant feeding indicators to determine the prevalence of complementary feeding indicators among children of 6-23months of age and to identify the determinants of inappropriate complementary feeding practices in India. The study data on 15028 last-born children aged 6-23months was obtained from the National Family Health Survey 2005-2006. Inappropriate complementary feeding indicators were examined against a set of child, parental, household, health service and community level characteristics. The prevalence of timely introduction of complementary feeding among infants aged 6-8months was 55%. Among children aged 6-23months, minimum dietary diversity rate was 15.2%, minimum meal frequency 41.5% and minimum acceptable diet 9.2%. Children in northern and western geographical regions of India had higher odds for inappropriate complementary feeding indicators than in other geographical regions. Richest households were less likely to delay introduction of complementary foods than other households. Other determinants of not meeting minimum dietary diversity and minimum acceptable diet were: no maternal education, lower maternal Body Mass Index (BMI) (<18.5kg/m 2), lower wealth index, less frequent (<7) antenatal clinic visits, lack of post-natal visits and poor exposure to media. A very low proportion of children aged 6-23months in India received adequate complementary foods as measured by the WHO indicators. © 2011 Blackwell Publishing Ltd.


Kulkarni H.,Lata Medical Research Foundation | Kulkarni H.,The Texas Institute | Mamtani M.,Lata Medical Research Foundation | Patel A.,Lata Medical Research Foundation | Patel A.,Indira Gandhi Government Medical College
Current Infectious Disease Reports | Year: 2012

Zinc has caught wide scientific attention for the conceptual promise it has to offer for prevention, control and treatment of acute diarrhea. This review focuses on the mechanisms by which zinc might contribute to the pathogenesis of acute diarrhea and the degree of success achieved in diarrhea control and treatment by zinc supplementation. Animal and in vitro studies have continued to fascinate the scientific fraternity and form a solid basis for the potential use of zinc supplementation against diarrhea. However, emerging evidence in terms of controlled studies in humans beckons a more complete understanding of the mechanistic basis for zinc supplementation. Current evidence indicates that studies specifically addressing the variability in response to zinc supplementation need to be undertaken to better comprehend these mechanisms. © 2011 Springer Science+Business Media, LLC.


Patel A.,University of Pennsylvania | Patel A.,University of Newcastle | Patel A.,Lata Medical Research Foundation | Patel A.,Indira Gandhi Medical College | And 2 more authors.
Journal of Human Lactation | Year: 2013

Background: Early initiation of breastfeeding continues to remain uncommon in India, and the practice of giving prelacteal feeding is still prevalent. Objectives: We determined the rates of timely initiation of breastfeeeding and prelacteal feeding, factors associated with these practices, and the association between the 2. Methods: Five hundred women who delivered live infants at a tertiary care hospital in India were included. The study outcomes were timely initiation of breastfeeding and prelacteal feeding. Multiple logistic regression was used to estimate the odds ratios (OR) of both timely initiation and prelacteal feeding. Results: Timely initiation and prelacteal feeding rates were 36.4% and 16.9%, respectively. Factors associated with timely initiation were higher maternal education (adjusted OR 2.00, 95% confidence interval [CI] 1.10, 3.60), counseling on breastfeeding during antenatal visits (adjusted OR 3.60, 95% CI 2.00, 6.20); absence of obstetric problems (adjusted OR 3.48, 95% CI 1.68, 7.23); vaginal deliveries (adjusted OR 37.57, 95% CI 17.40, 81.11); and increasing gestational age of newborn (adjusted OR 1.20, 95% CI 1.00, 1.40). Factors significantly associated with higher rates of prelacteal feeding were lower maternal education (adjusted OR 2.13, 95% CI 1.06, 4.35), Muslim religion (adjusted OR 2.27, 95% CI 1.18, 4.36), and delivery by cesarean section (adjusted OR 2.56, 95% CI 1.56, 4.19). There was a significant association between delayed initiation and prelacteal feeding (P < .001). Conclusion: The rates of timely initiation of breastfeeding were undesirably low, and the practice of prelacteal feeding existed even in tertiary care hospitals. Identifying factors associated with these practices might be a strategy for optimizing timely initiation and discouraging prelacteal feeding in hospital-delivered babies. © The Author(s) 2013.


Saxena A.,Veer Chandra Singh Garhwali Government Medical Science and Research Institute | Thawani V.,Lata Medical Research Foundation | Chakrabarty M.,PGIMER | Gharpure K.,Government Medical College
Journal of Pharmacology and Pharmacotherapeutics | Year: 2013

Worthiness of any scientific journal is measured by the quality of the articles published in it. The Impact factor (IF) is one popular tool which analyses the quality of journal in terms of citations received by its published articles. It is usually assumed that journals with high IF carry meaningful, prominent, and quality research. Since IF does not assess a single contribution but the whole journal, the evaluation of research authors should not be influenced by the IF of the journal. The h index, g index, m quotient, c index are some other alternatives to judge the quality of an author. These address the shortcomings of IF viz. number of citations received by an author, active years of publication, length of academic career and citations received for recent articles. Quality being the most desirable aspect for evaluating an author's work over the active research phase, various indices has attempted to accommodate different possible variables. However, each index has its own merits and demerits. We review the available indices, find the fallacies and to correct these, hereby propose the Original Research Performance Index (ORPI) for evaluation of an author's original work which can also take care of the bias arising because of self-citations, gift authorship, inactive phase of research, and length of non-productive period in research.


Mamtani M.,Lata Medical Research Foundation | Kulkarni H.,Lata Medical Research Foundation | Kulkarni H.,The Texas Institute
BMC Research Notes | Year: 2012

Background: The role of n-3 fatty acids in prevention of breast cancer is well recognized, but the underlying molecular mechanisms are still unclear. In view of the growing need for early detection of breast cancer, Graham et al. (2010) studied the microarray gene expression in histologically normal epithelium of subjects with or without breast cancer. We conducted a secondary analysis of this dataset with a focus on the genes (n = 47) involved in fat and lipid metabolism. We used stepwise multivariate logistic regression analyses, volcano plots and false discovery rates for association analyses. We also conducted meta-analyses of other microarray studies using random effects models for three outcomes - risk of breast cancer (380 breast cancer patients and 240 normal subjects), risk of metastasis (430 metastatic compared to 1104 non-metastatic breast cancers) and risk of recurrence (484 recurring versus 890 non-recurring breast cancers). Results: The HADHA gene [hydroxyacyl-CoA dehydrogenase/3-ketoacyl-CoA thiolase/enoyl-CoA hydratase (trifunctional protein), alpha subunit] was significantly under-expressed in breast cancer; more so in those with estrogen receptor-negative status. Our meta-analysis showed an 18.4%-26% reduction in HADHA expression in breast cancer. Also, there was an inconclusive but consistent under-expression of HADHA in subjects with metastatic and recurring breast cancers. Conclusions: Involvement of mitochondria and the mitochondrial trifunctional protein (encoded by HADHA gene) in breast carcinogenesis is known. Our results lend additional support to the possibility of this involvement. Further, our results suggest that targeted subset analysis of large genome-based datasets can provide interesting association signals. © 2011 Mamtani et al; licensee BioMed Central Ltd.


Vaidya S.V.,Lata Medical Research Foundation | Kulkarni H.,Lata Medical Research Foundation | Kulkarni H.,The Texas Institute
Journal of Asthma | Year: 2012

Objective. Bisphenol A (BPA) is being increasingly associated with adverse health effects. Our objective was to determine whether urinary BPA concentration is associated with allergic asthma in a representative US population. Methods. Data for this analysis were obtained from the National Health and Nutrition Examination Survey 20052006 survey and included asthma-related questions, total immunoglobulin E (IgE), 19 allergen-specific IgE levels, and urinary environmental phenol measurements. Allergic asthma was defined as a history of asthma ever, high eosinophil count, and high total IgE or atopy. Association analyses included dichotomous and polychotomous logistic regression, receiver operating characteristic curves, Akaike information criterion, and likelihood ratio χ2. Results. We found that 10-fold increase in BPA was independently associated with a higher likelihood of allergic asthma in females [odds ratio (OR) 2.21, p .032] but not in males (OR 0.83, p .474). These findings were reaffirmed when allergic asthma was defined based on atopy rather than total IgE (OR 2.45, p .001 in females and OR 0.83, p .605 in males). Urinary BPA was significantly associated with sensitization to various specific allergens in a doseresponse manner. Lastly, urinary BPA independently predicted an asthma episode in the past 12 months in females but not in males. Conclusions. Urinary BPA is significantly associated with allergic asthma in females. © 2012 Informa Healthcare USA, Inc.

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