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Gupta V.H.,Indian Institute of Technology Bombay | Amarapurkar D.N.,Bombay Hospital and Medical Research Center | Singh M.,Indian Institute of Technology Bombay | Sasi P.,Indian Institute of Technology Bombay | And 6 more authors.
Journal of Gastroenterology and Hepatology (Australia) | Year: 2013

Background and Aim: Tuberculosis (TB) is a major public health problem in India. Despite the treatment availability and monitoring, drug-induced hepatotoxicity (DIH) is a serious concern and can lead to discontinuation of treatment. Anti-TB DIH is well known and can aggravate because of pharmacokinetic and pharmacodynamic interactions. Genetic polymorphism in the drug-metabolizing enzyme genes is an important factor that predisposes certain fraction of the population to drug-induced toxicity. The purpose of this study was to assess the association of N-acetyltransferase 2 (NAT2) and cytochrome P450 2E1 (CYP2E1) gene polymorphism with anti-TB DIH in Western Indian population. Methods: A prospective cohort study of 215 patients taking treatment against TB was performed. The NAT2 and CYP2E1 genotypes were determined using polymerase chain reaction and restriction fragment length polymorphism methods. Logistic regression model was used to calculate odds ratio at 95% confidence interval and their respective P values. Results: The risk of anti-TB DIH was significantly higher in slow acetylator (SA) than in intermediate and rapid acetylator of NAT2 genotypes (odds ratio: 2.3, P=0.01). We also observed the homozygous point mutation at position 481, associated with higher risk of hepatotoxicity (P<0.01). The major haplotype NAT2*4 seems to provide protection in DIH compared with non-DIH TB patients (P=0.04). However, we did not find a significant association between CYP2E1 genotypes and anti-TB DIH. Conclusion: Increased susceptibility to isoniazid (INH)-induced hepatotoxicity due to presence of NAT2 SA polymorphism was demonstrated in Western Indian population. NAT2 genotyping can therefore serve as an important tool for identifying patients predisposed to anti-TB DIH. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.


Dhole S.D.,P.A. College | Kher A.S.,Columbia Asia Hospital | Ghildiyal R.G.,Tn Medical College | Tambse M.P.,Sbh Government Medical College
Journal of Clinical and Diagnostic Research | Year: 2015

Aim: The main aim of the study is to study the clinical profile of disorders of the liver and hepatobiliary system in paediatric patients and to correlate the histopathology findings of liver biopsy in chronic liver disease. Another aim being to assess the prognosis and to know the outcome and the effects of treatment in chronic liver diseases in paediatric age group. Materials and Methods: It was a prospective study, included the clinical profile of Chronic Liver Diseases (CLD) in children and the histopathological correlation. A total of 55 children were thoroughly investigated by doing relevant investigations and liver biopsy. Observations and results: A male predominance (60%) was noted with maximum incidence in the age group of 6-12 years. The incidence of CLD was 1.1% of total admissions. The most common presenting complaint was jaundice and abdominal distension. Hepatic encephalopathy was noted in 29% patients. Hepatomegaly was seen in 63% patients and spleenomegaly was seen in 60% patients. The incidence of . cirrhosis on liver biopsy was 42% (23cases) in CLD patients. The most common diagnosis on histopathology was Wilson’s disease (22%), followed by hepatitis and autoimmune hepatitis. The predominant spectrum of CLD was metabolic liver disease and also the predominant cause of death. conclusion: As the incidence of CLD is quite low, a very high index of suspicion is required for its diagnosis. Some uncommon causes of CLD in children were seen in our study like neutral lipid storage disease, α1-Antitrypsin deficiency disease, lupus hepatitis, Alagille syndrome and Budd-Chiari syndrome. A patient of CLD with jaundice and hepatomegaly should be treated aggressively as those are the poor prognostic indicators of the disease. Hepatic encephalopathy and cirrhosis are also associated with poor outcome in patients with CLD. Liver biopsy histopathology by an expert and its correlation with laboratory investigations plays an important role in the diagnosis of CLD. The major cause of deaths in patients with CLD is due to end stage liver disease and fulminant hepatic failure and the only way to prevent and treat these patients is by liver transplantation. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


PubMed | Tn Medical College, Grant Government Medical College and Post Graduate Research Building
Type: | Journal: Advances in preventive medicine | Year: 2014

Children are considered fully immunized if they receive one dose of BCG, three doses of DPT and polio vaccine each, and one measles vaccine. In India, only 44% of children aged 12-23 months are fully vaccinated and about 5% have not received any vaccination at all. Even if national immunization coverage levels are sufficiently high to block disease transmission, pockets of susceptibility may act as potential reservoirs of infection. This study was done to assess the immunization coverage in an urban slum area and determine various sociodemographic variables affecting the same. A total of 210 children were selected from study population using WHOs 30 cluster sampling method. Coverage of BCG was found to be the highest (97.1%) while that of measles was the lowest. The main reason for noncompliance was given as childs illness at the time of scheduled vaccination followed by lack of knowledge regarding importance of immunization. Low education status of mother, high birth order, and place of delivery were found to be positively associated with low vaccination coverage. Regular IEC activities (group talks, role plays, posters, pamphlets, and competitions) should be conducted in the community to ensure that immunization will become a felt need of the mothers in the community.


PubMed | P.A. College, Columbia Asia Hospital, Tn Medical College and Sbh Government Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2015

The main aim of the study is to study the clinical profile of disorders of the liver and hepatobiliary system in paediatric patients and to correlate the histopathology findings of liver biopsy in chronic liver disease. Another aim being to assess the prognosis and to know the outcome and the effects of treatment in chronic liver diseases in paediatric age group.It was a prospective study, included the clinical profile of Chronic Liver Diseases (CLD) in children and the histopathological correlation. A total of 55 children were thoroughly investigated by doing relevant investigations and liver biopsy.A male predominance (60%) was noted with maximum incidence in the age group of 6-12 years. The incidence of CLD was 1.1% of total admissions. The most common presenting complaint was jaundice and abdominal distension. Hepatic encephalopathy was noted in 29% patients. Hepatomegaly was seen in 63% patients and spleenomegaly was seen in 60% patients. The incidence of cirrhosis on liver biopsy was 42% (23cases) in CLD patients. The most common diagnosis on histopathology was Wilsons disease (22%), followed by hepatitis and autoimmune hepatitis. The predominant spectrum of CLD was metabolic liver disease and also the predominant cause of death.As the incidence of CLD is quite low, a very high index of suspicion is required for its diagnosis. Some uncommon causes of CLD in children were seen in our study like neutral lipid storage disease, 1-Antitrypsin deficiency disease, lupus hepatitis, Alagille syndrome and Budd-Chiari syndrome. A patient of CLD with jaundice and hepatomegaly should be treated aggressively as those are the poor prognostic indicators of the disease. Hepatic encephalopathy and cirrhosis are also associated with poor outcome in patients with CLD. Liver biopsy histopathology by an expert and its correlation with laboratory investigations plays an important role in the diagnosis of CLD. The major cause of deaths in patients with CLD is due to end stage liver disease and fulminant hepatic failure and the only way to prevent and treat these patients is by liver transplantation.


PubMed | BYL Nair Hospital, Indian Institute of Technology Bombay, Bombay Hospital and Medical Research Center, TN Medical College and Jagjivanram Western Railway Hospital
Type: | Journal: Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases | Year: 2014

Tuberculosis (TB) treatment remains a challenge owing to the high incidence of drug induced hepatotoxicity (DIH). Apart from environmental factors, single nucleotide polymorphisms (SNPs) in drug metabolizing enzymes (DMEs), nuclear receptors (NRs) and transporter proteins (TPs) contribute to DIH. In the present study, we report known and novel SNPs in a total of seven genes of DMEs, NRs and TPs with high resolution melting (HRM) technique.DNA samples of 185 TB patients of Western Indian population, of which 50 showed DIH, were analyzed. Grouping of the temperature-shifted difference plots obtained from the DNA melt curves enables identification of known and novel SNPs. Representative samples of each group were sequenced.We report 18 novel SNPs, of which 3 are in 5-UTR, 14 in exonic and 1 in intronic region. Of the SNPs in exons, 7 non-synonymous, 3 synonymous and 4 deletion mutations were observed. Among the known SNPs, CYP2E1 wild-type, NAT2()5 mutant and NAT2()6 heterozygous genotypes were associated with DIH (p<0.05). Among the novel SNPs, group 2 of SLCO1B1 showed a significant association (p<0.05).While several SNPs showed borderline p values between 0.05 and 0.15, the confidence in association can be improved further by using larger data sets.


Makade K.G.,SRM University | Padhyegurjar S.B.,KarpagaVinayaga Institute of Medical science KIMS | Kulkarni R.N.,Tn Medical College | Padhyegurjar M.S.,KarpagaVinayaga Institute of Medical science KIMS
Indian Journal of Community Health | Year: 2013

Background: Marriages and having children is a universal phenomenon in India and in slum areas of cities there is a tendency to have more number of children in married women due to many interrelated causes. In the current study we have tried to explore some of the reasons for having more number of children in urban slum area. Objective: To study the effect of education, age at marriage of women and socioeconomic status of the family on number of children among married women of reproductive age group in a slum area of Mumbai. Materials and Methods: A cross sectional observational study was carried out in the field practice area of an Urban Health Training Centre of a teaching hospital in Mumbai. Results: A sample of 342 women was taken by random sampling. Questionnaire was administered in the local language. lt was found that illiteracy, marriage before 18 years of age and low socioeconomic status, are significantly associated with more than 3living children. Out of these, socioeconomic status of the family had the greatest influence on bearing of the total number of children, followed by the age of women at marriage and then educational status of the women. Conclusion: lmprovement in education, socioeconomic status and increasing the age at marriage can prove to be very effective for the control of population.


Buchade D.,LTM Medical College | Mohite S.,TN Medical College
Journal of Indian Academy of Forensic Medicine | Year: 2011

The present study was carried out in the City of Greater Mumbai's all post mortem centres during the calendar year of 2004 to 2006 with aims and objective to determine the pattern of injuries in cases of homicides during this period with special reference to injuries sustained during these homicidal incidences. Total 371 cases of homicidal deaths were collected from post mortem reports, panchnama, police requisition and statements of relatives. The injuries present on the particular body area were noted with due consideration of kind of weapon used, internal organs injured and cause of death. Male victim's preponderance was noted over female victims with male age group of 21-30 years being most commonly affected. The head face and neck region of the body was most often targeted. Internal organs most commonly affected were neck structures followed by brain while least involved organ was heart. Hard and blunt weapons were most commonly used followed by sharp edged and pointed weapons. Infanticide was most common in female infants. The most common cause of death in male victims was shock and haemorrhages and in female victims was mechanical asphyxia.


Set R.,Tn Medical College | Rokade S.,Tn Medical College | Agrawal S.,Tn Medical College | Shastri J.,Tn Medical College
Indian Journal of Medical Microbiology | Year: 2010

Purpose: The objective of the study was to perform antimicrobial susceptibility testing of rapidly growing mycobacteria (RGM) isolated from various clinically suspected cases of extrapulmonary tuberculosis, from January 2007 to April 2008, at a tertiary care centre in Mumbai. Materials and Methods: The specimens were processed for microscopy and culture using the standard procedures. Minimum inhibitory concentrations (MIC) were determined by broth microdilution, using Sensititre CA MHBT. Susceptibility testing was also carried out on Mueller Hinton agar by the Kirby Bauer disc diffusion method. Results: Of the 1062 specimens received for mycobacterial cultures, 104 (9.79%) grew mycobacteria. Of the mycobacterial isolates, six (5.76%) were rapid growers. M. abscessus and M. chelonae appeared to be resistant organisms, with M. chelonae showing intermediate resistance to amikacin and minocycline. However, all the six isolates showed sensitivity to vancomycin and gentamicin by the disc diffusion test. Also all three isolates of M. abscessus were sensitive to piperacillin and erythromycin. Further studies are required to test their sensitivity to these four antimicrobials by using the microbroth dilution test, before they can be prescribed to patients. Conclusions: We wish to emphasize that reporting of rapidly growing mycobacteria from clinical settings, along with their sensitivity patterns, is an absolute need of the hour.


Buchade D.,LTM Medical College | Mohite S.,TN Medical College
Medico-Legal Update | Year: 2010

The study was aimed to determine underlying trends in the incidences of homicides to assess the frequency of homicide by age, sex and religion of victim. An attempt is also made to find out the motive of homicide, causative weapon, pattern of injuries and cause of death in homicide cases.


Rathod S.B.,Ruby Hall Clinic | Kumbhar S.S.,Ruby Hall Clinic | Nanivadekar A.,Ruby Hall Clinic | Aman K.,TN Medical College
Acta Radiologica | Year: 2014

Background: Imaging is vital in diagnosis of complicated pyelonephritis and has been traditionally performed by computed tomography (CT). However, CT with contrast agents cannot be performed in patients with renal failure. Diffusion-weighted (DW) magnetic resonance imaging (MRI) has the potential to overcome this disadvantage. Purpose: To prospectively evaluate the accuracy of quantitative apparent diffusion coefficient (ADC) values to differentiate nephritis from renal abscesses in patients with pyelonephritis. Material and Methods: Forty-two patients with clinical and laboratory diagnosis of pyelonephritis underwent CTand DW MRI examinations. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 0, 600, and 1000 s/mm2. Circular regions of interest were places on areas of nephritis, normal renal parenchyma, and renal abscesses as localized by CT and DW MRI images to obtain the ADC values of each of these regions. The ADC values of these three different tissue types were statistically compared using the one-way analysis of variance test for statistical significance. A P value <0.05 was considered to be statistically significant. Results: For the diagnosis of pyelonephritis, DW MRI had a higher sensitivity of 95.3% as compared to that of noncontrast CT (66.7%) and contrast-enhanced CT (88.1%). Areas of nephritis had significantly lower ADC values (P<0.001) than the normal renal cortical parenchyma. Also, renal abscesses had significantly lower ADC values (P<0.001) than areas of nephritis. However, CT is more useful for the diagnosis of renal calculi and emphysematous pyelonephritis. Conclusion: ADC values derived from the diffusion sequence have significantly lower values in renal abscesses than in areas of nephritis. Copyright © The Foundation Acta Radiologica 2014.

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