Maulana Azad Medical College and associated hospitals

Delhi, India

Maulana Azad Medical College and associated hospitals

Delhi, India
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Kerai S.,Rajiv Gandhi Super Speciality Hospital | Saxena K.N.,Maulana Azad Medical College and Associated Hospitals | Taneja B.,Maulana Azad Medical College and Associated Hospitals
Indian Journal of Anaesthesia | Year: 2017

Adequate post-operative analgesia after caesarean section (CS) is vital as it impacts the distinct surgical recovery requirements of the parturient. Although newer analgesic modalities and drugs for post-caesarean analgesia have been introduced over the recent years, review of the literature suggests suggests that we are far from achieving the goals of optimum post-operative analgesia. We conducted a systematic review of recent advances in modalities for post-caesarean analgesia. After systematic search and quality assessment of studies, we included a total of 51 randomised controlled trials that evaluated the role of opioids, transversus abdominis plane (TAP) block, wound infiltration/infusion, ketamine, gabapentin and ilioinguinal-iliohypogastric nerve block (II-IH NB) for post-caesarean analgesia. Administration of opioids still remains the gold standard for post-operative analgesia, but the associated troublesome side effects have led to the mandatory incorporation of non-opioid analgesics in post-CS analgesia regime. Among the non-opioid techniques, TAP block is the most investigated modality of the last decade. The analgesic efficacy of TAP block as a part of multimodal analgesia is established in post-CS cases where intrathecal morphine is not employed and in CS under general anaesthesia. Among non-steroidal anti-inflammatory drugs, COX-I inhibitors and intravenous paracetamol are found to be useful in post-operative analgesic regimen. The perioperative use of ketamine is found useful only in CS done under spinal anaesthesia; no benefit is seen where general anaesthesia is employed. Wound infiltration with local anaesthetics, systemic gabapentin and II-IH NB need further trials to assess their efficacy. © 2017 Indian Journal of Anaesthesia.

Goyal N.,University of Delhi | Kashyap B.,Maulana Azad Medical College and Associated Hospitals | Kashyap B.,Vimal CGHS Ltd. | Kaur I.R.,University of Delhi
Scandinavian Journal of Immunology | Year: 2016

Extrapulmonary tuberculosis (EPTB) remains a challenging diagnosis both for clinicians and microbiologists. We hypothesized that the profile of IFN-γ/IL-2 ratio in clinically diagnosed cases of EPTB would be distinct from that of age- and sex-matched healthy controls. Therefore, in our study, we have assessed the ratio of serum levels of IFN-γ and IL-2 in clinically diagnosed cases of EPTB to assess their potential role as diagnostic biomarkers. Sixty-nine (69) clinically confirmed EPTB cases and 69 age- and sex-matched healthy controls were included in the study. All the extrapulmonary specimens were subjected to Ziehl-Neelsen staining for acid-fast bacilli and culture on Lowenstein-Jensen (LJ) medium. Detection of serum levels of IFN-γ and IL-2 was carried out using commercially available ELISA kits following manufacturers' instructions. The ratio of serum levels of IFN-γ and IFN-γ/IL-2 was discriminative for the diagnosis of EPTB cases (p < 0.001), although the same was not observed with IL-2 (p > 0.05). Distribution of all biomarkers significantly differed between culture-positive and culture-negative cases (p < 0.05). Among the smear-positive and smear-negative ones, only IFN-γ and IFN-γ/IL-2 ratio could significantly differentiate (p < 0.05). Ratio of IFN-γ and IL-2 rather than the individual levels was the best discriminatory biomarker with the highest area under the ROC curve. Although IFN-γ and IFN-γ/ IL-2 ratio could aid in the diagnosis of EPTB, IL-2 has a limited utility in the diagnosis of EPTB. Further elaborate studies to validate these results are required. © 2016 The Foundation for the Scandinavian Journal of Immunology.

Chugh P.K.,Maulana Azad Medical College and Associated Hospitals | Lhamo Y.,Maulana Azad Medical College and Associated Hospitals
Indian Journal of Pharmaceutical Sciences | Year: 2012

We aimed to study the composition and availability of various vitamin preparations in the Indian market, data about which was collected from an annual Drug Compendium. The preparations were assessed for total number, different formulations, constituents and amount of each constituent present in the formulation. A large number of vitamin supplements are available in the Indian market. It includes single-ingredient products and various combinations of vitamins, minerals, and other constituents. Among single products, the maximum number was that of vitamin D3 (n=150). Most of the supplements are available as combinations (76.49%), with vitamin-minerals combinations constituting the maximum number. In a large number of products, amount of the vitamins was not specified. The most common formulation for oral administration was capsules (34.1%). In our research, majority of the supplements contained nutrient amounts higher than the recommended intakes recommended dietary allowance. Unsupervised intake of vitamins can pose a serious health risk in the susceptible population. The composition and amount of each constituent in the dietary supplement should be detailed and properly labelled for each preparation. Availability of a large number of preparations with unknown composition as 'over the counter' agents requires a serious review of the legal provisions in India for drug manufacturing and marketing. There is a need for proper guidelines and regulations for the manufacturing, labelling and marketing of dietary supplements in India. Strict enforcement of such provisions is essential to safeguard the health of the population at large.

Bhilwar M.,Vardhman Mahavir Medical College and Safdarjung Hospital | Lal P.,Maulana Azad Medical College and Associated Hospitals | Sharma N.,Maulana Azad Medical College and Associated Hospitals | Bhalla P.,Maulana Azad Medical College and Associated Hospitals | Kumar A.,Maulana Azad Medical College and Associated Hospitals
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics | Year: 2017

OBJECTIVE: To document abortion practices and contraceptive use among women of reproductive age in an urban slum of Delhi.METHODS: Data were collected as part of a cross-sectional study conducted in an urban resettlement colony in the North East District of Delhi between November 2010 and December 2011. Systematic random sampling was used to enroll 200 married women aged 15-49 years from each of the four blocks of the colony. Participants were interviewed and data were entered into a pretested semi-structured questionnaire.RESULTS: Among 802 participants, 284 (35.4%) reported at least one spontaneous or induced abortion, and 196 (24.4%) reported induced abortions. Unsupervised medical termination was reported by 78 (27.5%) of the 284 women. Overall, only 207 (25.8%) women practiced any type of contraception. The predominant decision maker regarding contraception was the husband for 95 (45.9%) women and the mother-in-law for 78 (37.7%).CONCLUSION: There is a need for focused community-based education to address specific issues, particularly regarding the dangers of unsafe abortion and choosing a method of contraception in consultation with a healthcare practitioner. © 2016 International Federation of Gynecology and Obstetrics.

Agarwal S.,Maulana Azad Medical College and Associated Hospitals
Journal of Paediatrics and Child Health | Year: 2010

Duplication of the oesophagus is the second most common duplication of the gastrointestinal tract. Children with oesophageal duplication cyst usually present with dysphagia or as asymptomatic thoracic mass found o incidental chest x-ray. We report a case of oesophageal duplication cyst that presented with inspiratory stridor and dyspnoea in a 6 month old boy. Bronchoscopy revealed an external compression on the trachea. Duplication cyst arising from the oesophagus was suggested on CT and MRI. The cyst was surgically excised with resolution of symptoms. © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Chugh P.K.,Vardhman Mahavir Medical College and Associated Safdarjung Hospital | Roy V.,Maulana Azad Medical College and Associated Hospitals
Current Clinical Pharmacology | Year: 2014

The widespread use of biologics has paved way for newer options in therapeutics for once incurable illnesses. Their large and complex protein structure, post-translational modifications, elaborate manufacturing/production process and risk for immunogenicity adds to the uniqueness of a biologic product. Patent expiration of innovator biologics has led to the development of biosimilars; biologics similar/comparable to the reference product in terms of quality, safety and efficacy. We discuss the clinical safety and regulatory requirements for biosimilars in various countries across the world. Future holds promise for biosimilars to provide affordable, efficacious and safe treatment to a vast majority of patients with significant cost savings to the nation. © 2014 Bentham Science Publishers.

Chugh P.K.,Maulana Azad Medical College and Associated Hospitals | Kalra B.S.,Maulana Azad Medical College and Associated Hospitals
International Journal of Rheumatic Diseases | Year: 2013

Systemic lupus erythematosus (SLE), a complex autoimmune disease with multisystem involvement, is characterised by recurring flares and remissions throughout the course of illness. The agents currently being used for management include corticosteroids, antimalarials and various immunosuppressants. Belimumab, a B lymphocyte stimulator (BLyS) inhibitor has been recently approved for the treatment of SLE. This review aims to discuss the role of belimumab in the treatment of SLE and the trials leading to its FDA approval. Belimumab demonstrated high degree of activity in patients with autoantibody-positive active SLE disease on a stable treatment regimen. There was a significantly greater response compared to placebo as assessed with the SLE Responder Index (SRI) in two randomized, double-blind, phase III trials (BLISS-52 and BLISS-76). The treatment was well tolerated. Additional studies are required to evaluate belimumab in special populations and assess its long-term safety. This therapy could change the focus of management from symptomatic treatment to targeting an important step in the disease pathogenesis. It could enable development of treatment which could halt long-term progression, minimize target organ damage and thus provide a better quality of life for these patients. © 2012 The Authors International Journal of Rheumatic Diseases © 2012 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Premkumar M.,National Institute of Oceanography of India | Sable T.,National Institute of Oceanography of India | Dhanwal D.,Maulana Azad Medical College and Associated Hospitals | Dewan R.,Maulana Azad Medical College and Associated Hospitals
Archives of Osteoporosis | Year: 2013

Low serum vitamin D and increased parathormone levels were found to be associated with depression and stress in a wintering expedition of 20 healthy male subjects over a period of 1 year in Antarctica. The continuous daylight during summer and the dark polar winter affect endogenous vitamin D production. Long-term effects on bone health need to be studied further. Purpose: Vitamin D plays a significant role in calcium and bone mineral metabolism and also affects cardiovascular, psychological, and cognitive functions. The ultraviolet B radiation component of sunlight, which shows marked seasonal variation in Antarctica, influences the synthesis of vitamin D. Depression and mood disorders are associated with this extreme photoperiod. In this study, we attempted to gauge the alteration of vitamin D homeostasis in Antarctica and its effect on bone mineral metabolism and mood over a period of 1 year. Materials and methods: Twenty male subjects who wintered over at India's Antarctic base Maitri (70 45′57″ S, 11 44′09″ E) from November 2010 to December 2011 were studied. Fasting serum samples were collected at baseline, 6 months, and 12 months for serum 25-hydroxyvitamin D, intact parathyroid hormone (PTH), total alkaline phosphatase (ALP), calcium, and phosphate. Beck Depression Inventory (BDI), Positive and Negative Affect Scale (PANAS X), and Perceived Stress Scale were used to measure depression, affect, and stress. Results: Mild vitamin D deficiency was present in two (10 %) subjects on arrival, which increased to seven (35 %) subjects during the polar winter at 6 months. The mean score on the BDI-II screen for depression was significantly higher during midwinter (4.8 ± 3.9) when compared with the baseline value (2.9 ± 2.1). Only 2/20 (10 %) of subjects met the criteria for minor depression. Higher PTH levels at 6 months correlated with a higher PANAS X score (p = 0.021). The mean values of calcium, inorganic phosphorus, and ALP were comparable during the course of the expedition. Conclusion: Low light exposure during the dark polar winter, lower vitamin D, and increased intact PTH levels were found to be associated with depression during 1 year of Antarctic residence. The low dietary intake and decreased solar radiation exposure during the polar winter reduce serum vitamin D levels in otherwise healthy individuals, which suggests that supplementation may be necessary. © 2013 International Osteoporosis Foundation and National Osteoporosis Foundation.

Chugh P.K.,Maulana Azad Medical College and Associated Hospitals
European Journal of Internal Medicine | Year: 2012

There have been significant advancements in understanding the immunopathogenesis of systemic lupus erythematosus. However, the developments in therapeutics have been rather slow. Belimumab, a B lymphocyte stimulator (BLyS) inhibitor has been approved for the treatment of this disease after more than 50 years. Numerous biological agents are being developed which target the B cells, T cells, and various cytokines. Among anti-B cell therapy, drugs target CD20 + cells (ocrelizumab, SBI-087), CD22 + cells (epratuzumab) \or the receptors of tumor necrosis factor (TNF) superfamily (atacicept, LY2127399, A-623). Monoclonal antibodies targeting interferon alpha (IFN-α) and gamma (IFN-γ) and interleukins (IL-6, 10) are being investigated for SLE. Novel targets include toll like receptors, phosphodiesterases, CD40 ligand and retinoid receptors. This review discusses various drugs which are in different phases of clinical trials and hold promise for patients suffering from this chronic debilitating disease. © 2011 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Roy V.,Maulana Azad Medical College and Associated Hospitals | Gupta D.,Institute of Clinical Research India | Gupta P.,All India Institute of Medical Sciences | Sethi G.R.,Maulana Azad Medical College | Mishra T.K.,Maulana Azad Medical College
International Journal of Tuberculosis and Lung Disease | Year: 2010

Severe malnutrition is known to affect the pharmacokinetics of isoniazid (INH) in children. However, the effect of moderate malnutrition, which may be more prevalent, is not known. INH was administered to 20 children with tuberculosis at a single dose of 5 mg/kg, and serial blood samples were collected. The serum INH concentrations were higher in the undernourished group but the pharmacokinetic parameters were comparable with those in the normal nutrition group. Weight gain was signifi cantly more in the undernourished group after 1 month of treatment. The study suggests that INH pharmacokinetics may not be signifi cantly altered in children with moderate malnutrition. © 2010 The Union.

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