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Ray P.,All India Institute of Medical Sciences | Ratagiri V.H.,Karnataka Institute of Medical science | Kabra S.K.,All India Institute of Medical Sciences | Lodha R.,All India Institute of Medical Sciences | And 4 more authors.
PLoS ONE | Year: 2012

Background: Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India. Methods and Findings: A total of 540 patients with fever of up to 7days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05). Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05). Adults were affected more than children. Anti-CHIK antibodies (IgM) were detected for more than 60days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ~99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children. Conclusions: The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus. © 2012 Ray et al. Source

Sinha A.,All India Institute of Medical Sciences | Saha A.,Jawaharlal Institute of Postgraduate Medical Education & Research | Kumar M.,Chacha Nehru Bal Chikitsalaya | Sharma S.,All India Institute of Medical Sciences | And 5 more authors.
Kidney International | Year: 2015

While studies show that prolonged initial prednisone therapy reduces The frequency of relapses in nephrotic syndrome, they lack power and have risk of bias. In order to examine The effect of prolonged therapy on frequency of relapses, we conducted a blinded, 1:1 randomized, placebo-controlled trial in 5 academic hospitals in India on 181 patients, 1-12 years old, with a first episode of steroid-sensitive nephrotic syndrome. Following 12 weeks of standard therapy, in random order, 92 patients received tapering prednisolone while 89 received matching-placebo on alternate days for The next 12 weeks. On intention-to-treat analyses, primary outcome of number of relapses at 1 year was 1.26 in The 6-month group and 1.54 in The 3-month group (difference-0.28; 95% confidence interval (CI)-0.75, 0.19). Relative relapse rate for 6-vs. 3-month therapy, adjusted for gender, age, and time to initial remission, was 0.70 (95% CI 0.47-1.10). Similar proportions of patients had sustained remission, frequent relapses, and adverse effects due to steroids. Adjusted hazard ratios for first relapse and frequent relapses with prolonged therapy were 0.57 (95% CI, 0.36-1.07) and 1.01 (95% CI, 0.61-1.67), respectively. Thus, extending initial prednisolone treatment from 3 to 6 months does not influence The course of illness in children with nephrotic syndrome. These findings have implications for guiding The duration of therapy of nephrotic syndrome. © 2015 International Society of Nephrology. Source

Sharma A.,Mahatma Gandhi Medical College | Mittal R.S.,Sawai Man Singh Medical College
Journal of Neurosciences in Rural Practice | Year: 2016

Cavernous malformations (CMs) are vascular anomalies with dilated spaces called caverns. These spaces are lined by endothelial cells and collage and devoid of smooth muscle or intervening neural tissue, and filled with blood at various stages of stasis, thrombosis, organization, and calcification. Most CMs are relatively small in size but when they are large enough they can produce sing of mass effect and may simulate neoplastic, vascular, inflammatory pathology. Giant CM (size >6 cm) are very rare lesions and very few cases are reported in world literature. We are reporting such a rare case of a 16 year male. Our case is also unique in the sense that it is the largest reported CM in Indian population. © 2016 Journal of Neurosciences in Rural Practice. Source

Sharma S.K.,AIIMS | Solanki R.,Sir Byramjee Jeejeebhoy Medical College | Mohan A.,Sri Venkateswara Institute of Medical Sciences | Jain N.K.,Sawai Man Singh Medical College | Chauhan L.S.,National Center for Disease control
International Journal of Tuberculosis and Lung Disease | Year: 2012

OBJECTIVES: To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with uncomplicated small unilateral pleural effusion (<1500 ml). DESIGN: This prospective, multicentre, observational study recruited 351 patients between 2006 and 2010. Patients were regularly followed up clinically as well as with ultrasound examination of the chest. RESULTS: Successful outcome (clinical response with complete resolution on ultrasound examination at 6 months) was seen in 274 patients (78.1%). Efficacy was 88.9% (excluding defaulters), and 94% among those completing follow-up as per protocol. None of the patients received corticosteroids. Other outcomes included treatment extension (n = 26, 7.4%), default (n = 43, 12.2%), treatment failure (n = 3, 0.9%) and death (n = 3, 0.9%). Seventy-nine mild/moderate adverse events and one treatment-related serious adverse event were noted; one patient developed recurrent drug-induced hepatotoxicity. Two patients (0.7%) had relapse/re-infection at 24 months follow-up. CONCLUSION: Intermittent thrice-weekly treatment for 6 months with three drugs in the intensive phase is effective and safe for unilateral small pleural effusion in immunocompetent patients. Although Category III no longer exists in the programme, the results are reassuring for intermittent treatment in extra-pulmonary TB under programme conditions. © 2012 The Union. Source

Kumar D.,Sawai Man Singh Medical College | Bagarhatta R.,Sawai Man Singh Medical College
Journal of Clinical and Diagnostic Research | Year: 2015

Introduction: Diuretic resistance is a common problem in congestive heart failure patients. It has been defined clinically but can be defined objectively in terms of fractional excretion of sodium (FENa). Aim: Aim of the study was to find out the association of FENa with prognosis of decompensated heart failure patients. Materials and Methods: One hundred and seventy eligible patients with a primary diagnosis of decompensated heart failure were enrolled and patients were categorized into two groups on the basis of baseline FENa- Group A (65 patients) with diuretic resistance with FENa <0.2% and Group B (105 patients) sensitive to diuretics with FENa ≥0.2%. The patients were followed-up during the hospital stay for the time taken for improvement from NYHA functional class IV to class II. They were followed telephonically at 30 days post admission for all cause mortality.Result: The mean time taken to improve from NYHA functional class IV to class II were 146 hours for FENa<0.2% and 60 h for FENa≥0.2% (p<0.0001). There was a fair negative correlation between FENa and time taken for improvement from NYHA functional class IV to class II with correlation coefficient being -0.4842. Multiple linear regression analysis showed FENa (standardized “B” is -0.480, p<0.001) and LVEF (standardized “B” is -0.182, p=0.007) as significant predictors of time taken for improvement from NYHA functional class IV to class II. The 30 days all cause mortality was significantly associated with level of Fena (p <0.001) and was inversely proportional.Conclusion: CHF patients with FENa <0.2% takes longer time to recover from NYHA functional class IV to class II. 30 days all cause mortality was also significantly higher among CHF patients with FENa <0.2%.Measuring baseline FENa and regulating diuretic dose accordingly at admission to hospital may probably improve the prognosis of CHF patients. © 2015 Journal of Clinical and Diagnostic Research. All Rights Reserved. Source

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