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Parashar R.,All India Institute of Medical Sciences | Bhalla P.,Vardhaman Mahavir Medical College | Pakhare A.,All India Institute of Medical Sciences | Babbar R.,Maulana Azad Medical College
International Journal of Women's Health | Year: 2014

Background: Common neurological syndrome (migraine without aura) is more common among women than men. Migraine is among the top 20 causes of disability. Menstruation is known to be a powerful trigger for migraine, and so is stress, but the presentation of headache is similar in both. Also, women are more vulnerable to stress as well as migraine, and this makes a complex relationship of menstruation, stress, and migraine. Objective: This study was done to understand the association of hormonal fluctuation in menstruation and stress with common migraine. Materials and methods: A cross-sectional comparative study was conducted in 40 young adult females, of whom 20 participants were cases of migraine without aura (18-35 years old), and the remaining 20 participants were age-matched controls. The study was done in Maulana Azad Medical College, New Delhi. Study participants were selected on the basis of International Headache Society (ICHD-IIA1.1) (2004) classification. Study participants with neurological disorders, chronic diseases, and disease suggestive of any hormonal disturbances were excluded. Clinically diagnosed migraine cases were asked to maintain a headache diary and to fill in the Depression Anxiety Stress Scales questionnaire. Biochemical assessment of hormonal status for thyroid-stimulating hormone, triiodothyronine, thyroxine, estrogen, follicle-stimulating hormone, luteinizing hormone, and prolactin was also done on the second day of their menstrual cycle. We used the Mann-Whitney U test to compare hormonal levels and the χ2 test to compare anxiety- or depression-related stress among the migraine and nonmigraine groups. Results: Significantly higher values of prolactin were observed in cases (mean ± standard deviation, 152.7 mIU/L±30.5) compared to controls (76.1 mIU/L±8.7), with a P-value <0.001. There was no statistically significant difference observed in levels of thyroid-stimulating hormone (P=0.081), estrogen (P=0.086), luteinizing hormone (P=0.091), or follicle-stimulating hormone (P=0.478). Also, anxiety with stress or depression with stress was significantly higher among the migraine group than the controls (P=0.002). Odds of any stress in migraine were higher in the migraine group than in the nonmigraine group (odds ratio 12, 95% confidence interval 2.7-53.33). Conclusion: Migraine, particularly without aura, in women is mainly associated with stress-related anxiety or depression, and are more susceptible to stress in the premenstrual period. © 2014 Parashar et al.

Jayachandran V.,Vardhaman Mahavir Medical College
Annals of Tropical Medicine and Public Health | Year: 2014

Background: Defaulters are producing the challenging, daunting category of drug resistant cases. It is important to examine and understand the patient′s notions and terms to manage them effectively. Objective: To study the reasons behind failure of adherence to treatment and to assess the health care seeking behaviour with awareness of these patients regarding the public sector provisions. Materials and Methods: In depth interviews with ten patients who had defaulted and were undergoing CAT-II treatment which included both retreatment defaulters and new defaulters, were conducted by repeated contacts in Fatehpur Beri PHC DOTS centre. Results: People refuse to seek treatment from a government health centre when they fall sick seriously as they are ready to get treated at any expense and seek private health care facility for the prompt treatment. There is a notion that free service from public sector is not as effective as private corporate hospitals. In the public sector patients defaulted because of side effects of drugs, fear of getting admitted in big tuberculosis (TB) hospitals, incompatible timing, neglect, long waiting time, TB deaths in the family and lack of family support. Among migrants, lack of employers support, family support forced them to return home. Ignorance about existence of DOTS centre with free treatment was observed. Most of the patients were unaware that incomplete treatment could lead to disease. Misconceptions observed were that treatment was futile (talk in the community about drugs being useless) and most of the patients were afraid of the disease and thought they could die because of it. Conclusion: Proposed measures include: Recognition of traditional medicine/complementary alternative medicine practitioners for universal access to TB diagnosis and care, Public sector should be made attractive to the middle class society through enhancement of services and user fees and empowerment initiatives for lack of social support of the migrants.

Deo Bhatt D.,Vardhaman Mahavir Medical College | Manoj R.,Post Graduate Institute of Medical Education and Research | Mahajan R.,Post Graduate Institute of Medical Education and Research
Echocardiography | Year: 2012

Background: The ratio of peak tricuspid regurgitation velocity (TRV) and right ventricular outflow time-velocity integral (TVI RVOT) has been described as a good correlate of pulmonary vascular resistance (PVR). However, this method has not been well studied in congenital heart disease. Method: Twenty patients with post-tricuspid shunt lesions who were planned to undergo cardiac catheterization were enrolled for the study. The ratio of TRV/TVI RVOT was measured via transthoracic echocardiography and correlated with invasively derived PVR (PVR CATH). PVR CATH was measured by cardiac catheterization. Fick's principle was used to calculate the pulmonary blood flow and oxygen consumption was assumed. Linear regression analysis was done to find the correlation between TRV/TVI RVOT and PVR CATH. Results: There was a significant correlation between the two variables, r = 0.635(P = 0.003). Subgroup analysis revealed that this correlation was better at lower values of PVR CATH (r = 0.817 for PVR < 6 Wood units (WU)) than higher values (r = 0.659 for PVR > 6 WU). TRV/TVI RVOT ratio of greater than 0.145 predicted with 80% sensitivity and specificity a PVR > 6 WU. Conclusions: There is modest correlation between TRV/TVI RVOT ratio and invasively derived PVR in congenital shunt lesions, especially in PVR < 6 WU. TRV/TVI RVOT ratio could be useful in identifying patients with congenital shunts whose PVR is likely to be <6 WU, and hence, do not need cardiac catheterization. (Echocardiography 2012;29:478-483) © 2012, Wiley Periodicals, Inc.

Karnad D.R.,Critical Care | Bhadade R.,T N Medical College | Verma P.K.,Vardhaman Mahavir Medical College | Moulick N.D.,Medical College | And 3 more authors.
Intensive Care Medicine | Year: 2014

Purpose: Ulinastatin, a serine protease inhibitor, inhibits several pro-inflammatory proteases and decreases inflammatory cytokine levels and mortality in experimental sepsis. We studied the effect of ulinastatin on 28-day all-cause mortality in a double-blind trial in patients with severe sepsis in seven Indian hospitals. Methods: Patients with sepsis were randomized within 48 h of onset of one or more organ failures to receive intravenous administration of ulinastatin (200,000 IU) or placebo 12 hourly for 5 days. Results: Of 122 randomized subjects, 114 completed the study (55 receiving ulinastatin, 59 receiving placebo). At baseline, the mean APACHE II score was 13.4 (SD = 4.4), 48 (42 %) patients were receiving mechanical ventilation, 58 (51 %) were on vasopressors, and 35 % had multiple organ failure. In the modified intention- to-treat analysis (patients receiving six or more doses of study drugs), 28-day all-cause mortality was 7.3 % with ulinastatin (4 deaths) versus 20.3 % (12 deaths) with placebo (p = 0.045). On multivariate analysis too, treatment with ulinastatin (odds ratio 0.26, 95 % CI 0.07-0.95; p = 0.042) independently decreased 28-day all-cause mortality. However, the mortality difference did not reach statistical significance in the intention-to-treat analysis [10.2 % (6/ 59 deaths) with ulinastatin versus 20.6 % (13/63 deaths) in the placebo group; p = 0.11]. The ulinastatin group had lower incidence of newonset organ failure (10 vs. 26 patients, p = 0.003), more ventilator-free days (mean ± SD 19.4 ± 10.6 days vs. 10.2 ± 12.5 days, p = 0.019), and shorter hospital stay (11.8 ± 7.1 days vs. 24.2 ± 7.2 days, p<0.001). Conclusions: In this pilot study, intravenous administration of ulinastatin reduced mortality in patients with severe sepsis in the modified intention-to-treat analysis, but not in the intention-to-treat analysis. © 2014 Springer-Verlag Berlin Heidelberg and ESICM.

Chaswal M.,Vardhaman Mahavir Medical College | Das S.,Vardhaman Mahavir Medical College | Prasad J.,Vardhaman Mahavir Medical College | Katyal A.,University of Delhi | Fahim M.,Jamia Hamdard University
Canadian Journal of Physiology and Pharmacology | Year: 2011

We evaluated the role of the sympathetic nervous system and oxidative stress in hemodynamic and autonomic control after acute inhibition of the synthesis of nitric oxide, using intravenous (i.v.) injection of 30 mg·kg-1 NG-nitro-L-arginine methyl ester (L-NAME) in adult Wistar rats. Baroreflex sensitivity (BRS) and heart rate variability (HRV) were measured as indices of cardiac autonomic control, before and after L-NAME treatment in rats with intact autonomic innervation, and in rats with chemical sympathectomy by 6-hydroxydopamine. Serum malondialdehyde (MDA) was measured as a marker of oxidative stress. In control rats, L-NAME treatment resulted in a significant rise in blood pressure, augmentation of BRS, and enhanced serum MDA. HRV showed an attenuation of total spectral power and high frequency spectral power, along with a rise of the low to high frequency ratio (LF:HF). Administration of L-NAME produced a pressor response even in sympathectomised rats, but augmented BRS was not observed, and the high frequency spectral power showed an increase, in addition to a significant decline of LF:HF and serum MDA. We therefore conclude that even though pressor response was unaffected, reversal of cardiac autonomic responses and decline in oxidative stress following sympathectomy in L-NAME-treated rats reflects a significant role for sympathetic innervation in acute LNAME-induced hypertension.

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