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.
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.
Javid J.,Maulana Azad Medical College and Associated hospitals |
Mir R.,University of Tabuk |
Julka P.K.,All India Institute of Medical Sciences |
Ray P.C.,Maulana Azad Medical College and Associated Hospitals |
Saxena A.,Maulana Azad Medical College and Associated Hospitals
Tumor Biology | Year: 2015
Survivin is highly expressed in fetal tissue and is completely absent in terminally differentiated cells, but its re-expression has been observed in most human tumors. Presently, we aimed to analyze the possible impact of the survivin gene (−31G > C, rs 9904341) promoter polymorphism on the expression profile of survivin gene and ultimately the role of survivin re-expression in the development and progression of non-small cell lung cancer. A case-control study of 100 non-small cell lung cancer patients and 100 cancer-free healthy controls was conducted. Survivin gene promoter polymorphism was analyzed by PCR-restriction fragment length polymorphisms (RFLP) technique, and the survivin expression profile was evaluated using quantitative real-time PCR assay. Compared to the survivin GG genotype, odd ratio of 3.2 (95 % CI 4.8–25.9, p = 0.004) was found to be associated to homozygous CC genotype with 15-fold increase of survivin gene expression in non-small cell lung cancer patients. Significant trend of increase in survivin expression was observed with the increase in severity of the disease. Patients with survivin (−31CC) genotype had significantly shorter overall survival compared to survivin (−31GG) genotype carriers. In addition, advanced disease status and significant poor overall survival were also reflected by patients with higher-fold increase in survivin gene expression. In conclusion, present study demonstrated that survivin (−31G > C) polymorphism may contribute to the risk of developing non-small cell lung cancer in Indian population. Survivin (−31CC) genotype was associated with significantly increased survivin gene expression and ultimately may contribute in the poor clinical outcome of non-small cell lung cancer patients, suggesting its possible significance in the development and progression of non-small cell lung cancer. © 2015, International Society of Oncology and BioMarkers (ISOBM).
Javid J.,University of Tabuk |
Mir R.,University of Tabuk |
Saxena A.,Maulana Azad Medical College and Associated Hospitals
Tumor Biology | Year: 2016
Downregulation of CASP3 gene expression has been observed to be associated with various malignancies, and promoter polymorphisms in the CASP3 gene may have a great impact on the CASP3 transcriptional activity. The present study aimed to analyze the possible impact of the CASP3 (−1337 C > G, rs1405937) polymorphism on the expression profile of CASP3 gene and ultimately its association in the development of non-small cell lung cancer. A case–control study of 100 non-small cell lung cancer patients and 100 cancer free healthy controls was conducted, wherein genotype and expression profile of CASP3 gene were evaluated using serum DNA and serum RNA, respectively, by primer-introduced restriction fragment analysis and real-time PCR techniques. Compared to the CASP3 CC genotype, odds ratio of 11.1 was found to be associated to the homozygous GG genotype with more than sixfold decrease of CASP3 gene expression in non-small cell lung cancer patients. Significant trend of decrease in caspase 3 expression was observed with the increase in severity of the disease. Patients with CASP3 (−1337GG) genotype had significantly shorter overall survival compared to CASP3 (−1337CC) genotype carriers. In addition, significantly poor overall survival was also reflected by patients with higher fold decrease in CASP3 gene expression. CASP3 (−1337 GG) genotype was found to be associated with significantly lower CASP3 gene expression especially among patients with advanced status of the disease, suggesting that CASP3 (−1337C > G) polymorphism may be involved in the development and progression of non-small cell lung cancer. © 2016 International Society of Oncology and BioMarkers (ISOBM)
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.
Mathur N.B.,Maulana Azad Medical College and Associated Hospitals |
Marmu K.,Maulana Azad Medical College and Associated Hospitals |
Kumar S.,Maulana Azad Medical College and Associated Hospitals
Indian Journal of Pediatrics | Year: 2010
Objective: To determine the severity of systemic inflammatory response syndrome (SIRS) at admission, bacteriological profile, antibiotic sensitivity of pathogens and factors associated with fatality in home delivered neonates with sepsis. Methods: This was a prospective observational study conducted in the referral neonatal unit of a teaching hospital admitting extramural neonates. The subjects comprised of 80 home delivered neonates presenting with systemic inflammatory response syndrome at admission. Skin temperature, oxygen saturation, capillary refill time and blood sugar were recorded in all the neonates at admission. For Blood culture, blood collected by venipuncture was placed in a tryptic soy broth culture bottle. Serum TNF-α was measured by ELISA kit. Results: Early onset sepsis was seen in 27.5%. The commonest clinical feature in the study population was decreased oral acceptance (53.8%). The mean distance traveled to reach the hospital was 19±3 km. At admission, acute physiological derangement in the form of abnormal skin temperature, oxygen saturation, perfusion and blood sugar was present in 53 neonates and 44% had more than one parameter deranged. Only 11% cases had early sepsis while the SIRS was well established in the rest. Klebsiella pneumoniae was the predominant bacteria isolated in 14 cases. Resistance of Klebsiella isolates to Ampicillin was 90% and to Gentamicin 57%. The fatality was higher in presence of advanced stages of SIRS at admission. Conclusion: SIRS was well established in 89% cases at admission. Klebsiella resistant to antibiotics was the predominant etiological organism. Fatality was higher in culture positive sepsis and in those associated with meningitis and pneumonia. © 2010 Dr. K C Chaudhuri Foundation.