PubMed | Krishna Institute of Medical science, Biostatistics, Janssen Global R&D, Sri Deepti Rheumatology Center and 6 more.
Type: Journal Article | Journal: International journal of rheumatic diseases | Year: 2016
To conduct a subgroup analysis of GO-MORE trial Part 1, comparing efficacy and safety of add-on subcutaneous golimumab therapy in rheumatoid arthritis (RA) patients enrolled from and outside India.GO-MORE was an open-label, multicenter, prospective trial of add-on golimumab in biologic-nave RA patients, having active disease despite being on conventional DMARD regimen(s). Part 1 of the study was chosen as the focus of this subgroup analysis because a substantial number of Indian patients (106) were enrolled compared to no Indian patients in Part 2. The primary efficacy outcome was proportion of patients achieving good to moderate DAS28-ESR (Disease Activity Score of 28 joints calculated using erythrocyte sedimentation rate) European League Against Rheumatism (EULAR) response at month 6.Efficacy evaluable population comprised of 105 and 3175 patients from India and outside India, respectively. Safety analysis included 106 patients enrolled from India and 3251 from outside India. A higher proportion of Indian patients had a high disease activity as measured by DAS28 ESR than outside India patients. At month 6, the proportion of Indian and non-Indian patients achieving DAS28-ESR, DAS28 - C-reactive protein, simplified disease activity index (SDAI) remission, and EuroQoL Quality-of-Life Questionnaire (EQ-5D) scores were comparable. Incidence of all adverse events was lower in Indian patients. There were no deaths, cases of tuberculosis or malignancy reported in the patients from India at month 6.The efficacy and safety results with add-on golimumab were consistent between RA patients from India and outside India, despite high baseline disease activity in the Indian patients.
PubMed | Seth Gs Medical College & Kem Hospital and Indian National Institute of Cholera and Enteric Diseases
Type: Journal Article | Journal: BMJ open | Year: 2016
Cholera is a major gastroenteric disease with reports on fluctuation and resistance. Hence, the objective is to determine the trend in seasonality, resistance pattern, prevalent biotypes, serotypes and phage types between 2004 and 2013 among Vibrio cholerae isolates.A retrospective cross-sectional study.A single-centre study was carried out at a tertiary care hospital in a metropolitan city (Mumbai) of a developing country (India).Records of stool specimen cultures of patients with suspected cholera from January 2004 to December 2013 were analysed. The organisms were identified as per standard protocol. Antimicrobial susceptibility testing was performed as per Clinical Laboratory Standard Institute. Biotyping, serotyping and phage typing were carried out. From the confirmed cases of cholera, demographic and laboratory details were noted. Descriptive analysis was used and the data were presented in the form of percentages.Vibrio cholerae was predominant in males and was isolated from 9.41% (439/4664) of stool specimens. Variability was found in terms of the gross appearance of stool specimens, seasonal trend and antibiotic resistance pattern. The antimicrobial susceptibility showed a waxing and waning pattern for most of the antibiotics (ampicillin, cefuroxime, chloramphenicol, tetracycline) tested, while for a few others the strains were either uniformly sensitive (gentamicin, norfloxacin) or resistant (trimethoprim-sulfamethoxazole, nalidixic acid). All isolates belonged to subgroup O1 and biotype El Tor. The most common serotype was Ogawa. The predominant phage type was T2 (old scheme) and T27 (new scheme).The predominant biotype, serotype and phage type were El Tor, Ogawa and T27 phage, respectively. The changing trends in antimicrobial resistance pattern over the years necessitate continued epidemiological and microbiological surveillance of the disease.
Bolte S.,Neuropsychiatric Unit |
de Schipper E.,Neuropsychiatric Unit |
Holtmann M.,Ruhr University Bochum |
Karande S.,Seth Gs Medical College & Kem Hospital |
And 4 more authors.
European Child and Adolescent Psychiatry | Year: 2014
In the study of health and quality of life in attention deficit/hyperactivity disorder (ADHD), it is of paramount importance to include assessment of functioning. The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive, universally accepted framework for the description of functioning in relation to health conditions. In this paper, the authors outline the process to develop ICF Core Sets for ADHD. ICF Core Sets are subgroups of ICF categories selected to capture the aspects of functioning that are most likely to be affected in specific disorders. The ICF categories that will be included in the ICF Core Sets for ADHD will be determined at an ICF Core Set Consensus Conference, wherein evidence from four preliminary studies (a systematic review, an expert survey, a patient and caregiver qualitative study, and a clinical cross-sectional study) will be integrated. Comprehensive and Brief ICF Core Sets for ADHD will be developed with the goal of providing useful standards for research and clinical practice, and to generate a common language for the description of functioning in ADHD in different areas of life and across the lifespan. © 2013, The Author(s).
PubMed | Seth Gs Medical College & Kem Hospital, Vardhman Mahavir Medical College & Safdarjung Hospital and Government Grant Medical College & Jj Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2017
The pancreas arises from the endoderm as a dorsal and a ventral bud which fuse together to form the single organ. It extends transversely across the posterior abdominal wall from the duodenum to the spleen. Functionally, it is endocrine and exocrine.This study was undertaken to study the morphometry of human pancreas at different gestational age groups of normal, still born fetuses.Forty aborted human fetuses (25 male and 15 female) of 12-40 weeks gestational age with no obvious congenital abnormality were obtained. The fetuses were dissected and pancreas was removed. The length and weight of the pancreas as well as height of its head were noted.It was observed that there was increase in body weight and crown rump length with increasing gestational age. The average length of pancreas was 1.80 cm in 12The knowledge of development of pancreas helps in planning new therapeutic interventions in the treatment of various congenital and functional pancreatic anomalies.
Pardeshi A.M.,Seth Gs Medical College & Kem Hospital |
Kirtikar S.N.,Seth Gs Medical College & Kem Hospital
Indian Journal of Physiology and Pharmacology | Year: 2016
Hypertension is recognized as a key risk factor for cardiovascular disease mortality and morbidity. Early detection of prehypertensive stage may help an individual to lead a healthy life by altering the life style. The present study was attempted to compare blood pressure response and anthropometric parameter in children of hypertensive and non hypertensive parents. The study was conducted on total 120 participants, 60 in control and 60 in test group. Cardiovascular response to stress was determined by Harvard step test. Heart rate (HR) and blood pressure response to exercise were measured in supine position before exercise and at 1, 2, 3, 4, 5, 7 and 10 minutes after the exercise. The results were expressed as Mean±SD and analyzed using Independent t- test (unpaired t-test) for comparison between the control group and the test group and one way ANOVA test. The “P” value < 0.05 was considered statistically significant. In the present study, body mass index (BMI), waist hip ratio (WHR) and waist circumference (WC) were found to be significantly higher in normotensive individuals with family history of hypertension. Stress induced changes in systolic blood pressure (SBP),diastolic blood pressure (DBP), heart rate (HR) were found to be significantly higher in normotensive individuals with family history of hypertension as compared to normotensive individuals without family history of hypertension. The increased blood pressure and heart rate observed in the individual of hypertensive parents emphasizes the importance of genetic influence on hypertension. This blood pressure elevation may be considered as a permanent abnormality characterizing a prehypertensive stage early in life. © 2016, Association of Physiologists and Pharmacologists of India. All rights reserved.
Gupta R.K.,Seth GS Medical College & KEM Hospital
Indian journal of pathology & microbiology | Year: 2010
CONTEXT: Pulmonary hypertension (PH) is a serious and sometimes life-threatening event that occurs as a complication of various cardiopulmonary disorders, of which rheumatic heart disease (RHD) is an important example in our country. The pathogenesis of PH is a complex, multistep process in which "pulmonary endothelial dysfunction" (PED) is widely regarded as the central pathogenetic event. PED is, in turn, influenced by several local and systemic factors, of which nitric oxide synthase 3 (NOS3) and endothelin 1 (ET1) are 2 prime candidates, and are the subject of our study. AIMS: Our aim was to study the immunoreactivity of NOS3 and ET1 in the pulmonary vasculature of PH patients of various etiologies, with emphasis on RHD cases. SETTINGS AND DESIGN: A retrospective, autopsy-based study. SUBJECTS AND METHODS: A total of 49 autopsy cases (39 patients and 10 controls) were chosen for our study. Of the 39 patients, 20 had PH secondary to RHD, whereas the remaining 19 patients had non-RHD etiologies as the basis of their PH. Lung sections taken from all the 49 cases were subjected to routine H and E, elastic van Gieson, and immunohistochemical staining (with NOS3 and ET1 separately). The intensity of immunostaining in all the cases and controls were then graded as focal/diffuse and weak/strong. RESULTS: Controls showed positivity for both NOS3 (bronchiolar epithelium) and ET1 (endothelium of pulmonary arteries). Characteristic changes of PH on H and E were seen in 14 out of 19 non-RHD cases, which matched with the number of ET1 positivity cases. Similarly, for the RHD cases, 14 out of 20 cases showed changes of PH on H and E, but only 2 cases showed mild, focal positivity for ET1. Surprisingly, NOS3 positivity was largely absent in both the non-RHD and RHD cases. CONCLUSIONS: Our study showed NOS3 negativity and ET1 positivity in the lung vasculature of patients with PH, a conclusion more or less in line with the predominant view of the other investigators in this field. But at the same time, our study could not conclude an unequivocal role of NOS3 in PH, whereas it could, in the case of ET1.
PubMed | Seth GS Medical College & KEM Hospital
Type: Case Reports | Journal: Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society | Year: 2016
Aneurysms and pseudoaneurysms of pulmonary vasculature are uncommon occurrences that contribute to mortality and morbidity, without timely diagnosis and intervention. We report a fatal massive hemoptysis in a child due to a consolidation-related pulmonary arterial pseudoaneurysm, an extremely rare phenomenon.
PubMed | Seth GS Medical College & KEM Hospital
Type: Journal Article | Journal: The Indian journal of medical research | Year: 2017
Sepsis due to multidrug-resistant Gram-negative pathogens is a challenge for clinicians and microbiologists and has led to use of parenteral colistin. There is a paucity of data regarding safety and efficacy of intravenous colistin use in neonates. The objective of this retrospective analysis was to study the efficacy and safety of intravenous colistin in the treatment of neonatal sepsis.An audit of the data from neonates, admitted to a neonatal intensive care unit of a tertiary care hospital during January 2012 to December 2012, and who received intravenous colistin was carried out.Sixty two neonates received intravenous colistin (52 preterm and 10 term) for the treatment of pneumonia, bloodstream infections and meningitis. The isolated pathogens in decreasing order of frequency were Acinetobacter baumannii, Klebsiella pneumonia and Pseudomonas aeruginosa. Of the total 62 neonates, 41 (66.12%) survived and 21 (33.87%) died. Significantly higher mortality was observed in neonates with lower body weights (P < 0.05). A significant association of mortality was found in those with sepsis due to Klebsiella species. Only one of seven with this infection survived as against 15 of the 23 who grew other organisms [P = 0.03; crude odds ratio = 11.25 (1.2, 110.5)]. None of the neonates developed neurotoxicity or nephrotoxicity.This retrospective study in neonates with sepsis showed that intravenous colistin was safe and effective in the treatment of neonatal sepsis. Further, well-controlled, prospective clinical trials need to be done to corroborate these findings.
PubMed | Seth GS Medical College & KEM Hospital
Type: Journal Article | Journal: Journal of burn care & research : official publication of the American Burn Association | Year: 2016
The present study attempts to compare how the patients who undergo early excision and grafting behave as compared with patients who are treated along usual conservative lines of management in centers where the resources are less than optimal. The data of 20 female patients were analyzed. Age of the patients ranged between 20 and 30 years, percentage area burn ranged between 20 and 40%, and percentage area resurfaced by skin grafting 5 to 10%. The patients were divided into two groups of 10 patients each. Group I included those patients who underwent early excision and grafting within 5 days of burn injury. Group II included those patients who were treated conservatively and the residual raw area was grafted 3 weeks or more after sustaining the burn. The two groups were compared for the amount of blood loss, transfusion requirement, graft take, and the total hospital stay. Statistical significance was tested by the application of Mann-Whitney U test. The mean percentage area burn was 29.15.6% in group I and 24.74.9% in group II. Mean percentage area resurfaced by skin grafting in group I was 9.42.3% and 8.11.6% in group II. Graft take in group I was 907.8%, whereas that in group II was 956.7%. Mean blood loss in group I and group II was 34617.6ml and 24114.7ml respectively. (P = .001). Mean transfusion requirement in the perioperative period was 1.6 pints in group I and 1.1 pints in group II. The mean hospital stay in the patients who underwent early excision and grafting was 15.14.1 days, whereas that in the patients who underwent delayed grafting was 36.26.3 days (P = .001). Early excision and grafting decreases the hospital stay of burn patients. The present study suggests that it has a definite applicability even in places where the resources might be less than optimal.
PubMed | Seth GS Medical College & KEM Hospital
Type: Journal Article | Journal: Current clinical pharmacology | Year: 2016
Various factors have been shown to increase the risk of bleeding with warfarin. This study aimed to assess the association of CYP2C9 and VKORC1 with the development of bleeding following warfarin.A case control study was initiated after obtaining institutional ethics committee clearance and written informed consent from patients. Cases were defined as those who bled within three months of warfarin initiation and controls as those who did not have any episode of bleeding within three months. Genotyping for CYP2C9 (*1, *2, *3) and VKORC1 1639 (GG, GA and AA) was performed by PCRRFLP. Chi square test was used to find out the association and trend of CYP2C9 and VKORC1 genotypes with odds ratio (95% CI) for strength of association. A binary logistic regression model was developed associating age, body weight, sex, CYP2C9 and VKORC1 status with risk of bleeding.A total of 100 controls and 38 cases were studied from Oct 2009 to July 2011. A significant association (P < 0.0001) and trend (P = 0.027) of mutant alleles of CYP2C9 and VKORC1 were noted with bleeding with odds ratios of 7.8 [3.4, 17.9] and 2.7 [1.3, 5.7] respectively. Weekly dose requirement was significantly lower with the presence of *3 allele relative to *1 in CYP2C9 (P < 0.001). The regression model showed an accuracy of 80% and could explain 35.3% of the variability.A significant association between CYP2C9 (*1,*2,*3) genotype and VKORC1 (1639 G>A) haplotype status has been found with increased bleeding tendency to warfarin. This may help to individualize therapy.