Publications by authors named "Ajit Yadav"

32 Publications

Unusual sighting in the bone marrow.

Int J Lab Hematol 2021 Jul 16. Epub 2021 Jul 16.

Department of Laboratory Medicine, Hematology Section, PD Hinduja Hospital and Medical Research Centre, Mahim, India.

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http://dx.doi.org/10.1111/ijlh.13661DOI Listing
July 2021

Retrograde transvenous selective lymphatic duct embolization in post donor nephrectomy chylous ascites.

CEN Case Rep 2021 Jul 4. Epub 2021 Jul 4.

Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.

Chylous ascites is a rare, potentially sinister complication in post donor nephrectomy patients which may cause significant morbidity in form of severe malnutrition and an immuno-compromised state. We present two patients with post donor nephrectomy-related chylous leaks who failed conservative treatment. In both cases, lymphangiography was done first to detect the chylous leak site in the left renal fossa, and thereafter transvenous retrograde approach via left subclavian vein with selective lymphatic duct embolization of chylous leak was done with coils and glue successfully. Chylous ascites resolved in both patients after the embolization. Hence retrograde transvenous embolization technique appears to be an effective management option for refractory chylous leaks.
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http://dx.doi.org/10.1007/s13730-021-00618-6DOI Listing
July 2021

Premature adult mortality in India: what is the size of the matter?

BMJ Glob Health 2021 06;6(6)

Gender research project, International Institute for Population Sciences, Mumbai, Maharashtra, India.

Background: Reducing adult mortality by 2030 is a key component of the United Nations Sustainable Development Goals (UNSDGs). Monitoring progress towards these goals requires timely and reliable information on deaths by age, sex and cause. To estimate baseline measures for UNSDGs, this study aimed to use several different data sources to estimate subnational measures of premature adult mortality (between 30 and 70 years) for India in 2017.

Methods: Age-specific population and mortality data were accessed for India and its 21 larger states from the Civil Registration System and Sample Registration System for 2017, and the most recent National Family and Health Survey. Similar data on population and deaths were also procured from the Global Burden of Disease Study 2016 and the National Burden of Disease Estimates Study for 2017. Life table methods were used to estimate life expectancy and age-specific mortality at national and state level from each source. An additional set of life tables were estimated using an international two-parameter model life table system. Three indicators of premature adult mortality were derived by sex for each location and from each data source, for comparative analysis RESULTS: Marked variations in mortality estimates from different sources were noted for each state. Assuming the highest mortality level from all sources as the potentially true value, premature adult mortality was estimated to cause a national total of 2.6 million male and 1.8 million female deaths in 2017, with Bihar, Maharashtra, Tamil Nadu, Uttar Pradesh and West Bengal accounting for half of these deaths. There was marked heterogeneity in risk of premature adult mortality, ranging from 351 per 1000 in Kerala to 558 per 1000 in Chhattisgarh among men, and from 198 per 1000 in Himachal Pradesh to 409 per 1000 in Assam among women.

Conclusions: Available data and estimates for mortality measurement in India are riddled with uncertainty. While the findings from this analysis may be useful for initial subnational health policy to address UNSDGs, more reliable empirical data is required for monitoring and evaluation. For this, strengthening death registration, improving methods for cause of death ascertainment and establishment of robust mortality statistics programs are a priority.
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http://dx.doi.org/10.1136/bmjgh-2020-004451DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211056PMC
June 2021

Does the prenatal factor or the postnatal factor contribute more to changes in the child sex ratio in India? An investigation in the context of fertility and mortality transition.

J Biosoc Sci 2021 May 10:1-9. Epub 2021 May 10.

Department of Fertility Studies, International Institute for Population Sciences (IIPS), Mumbai, India.

There has been a drastic decline in the child sex ratio (number of females per 1000 males between ages 0 and 4) in India and many of its states. This study aimed to examine if prenatal factors, such as change in sex ratio at birth, or postnatal factors, such as change in relative mortality of females and males, contribute to this more by analysing the dynamics of the child sex ratio. Changes in the child sex ratio during 2001-2011 were decomposed into a 'fertility' component attributable to prenatal sex selection and a 'mortality' component attributable to sex differentials in postnatal survival at the country as well as the state level. Between the prenatal factor and the postnatal factor, the contribution of the latter to the declining child sex ratio has been greater than the former in India as a whole and in most of the states. By focusing on both prenatal and postnatal factors, the imbalance in the child sex ratio in the country can be reduced to a large extent.
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http://dx.doi.org/10.1017/S0021932021000171DOI Listing
May 2021

Chylothorax - Modalities of management and outcomes: A case series.

Lung India 2021 Mar-Apr;38(2):154-160

Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India.

Background: At present, there are no universally accepted protocols for the management of chylothorax. This study aims at reporting the clinical experience and presenting our institutional protocol for managing chylothorax.

Materials And Methods: This is a retrospective analysis of chylothorax patients managed at a dedicated thoracic surgical unit over 8 years. A detailed analysis of demography and perioperative variables including complications was carried out. Factors influencing failure of conservative and surgical therapy were analyzed.

Results: A total of 26 patients were included with a mean age of 42.4 years (range, 2-72 years). Postsurgical chylothorax was the most common variant (53.8%). Majority (46.1%) of the patients had >1000 ml/24 h intercostal tube drainage at presentation. All patients were initially subjected to conservative management, of which 11 (42.4%) patients were managed successfully with conservative therapy alone. Rest 15 (57.6%) patients required video-assisted thoracoscopic thoracic duct ligation, which was successful in 10/15 (66.7%) patients, whereas additional intervention was required in 5/15 (33.3%) patients. Drain output of >1000 ml/day was an independent predictor of failure of conservative therapy. Nontraumatic bilateral chylothorax was associated with high probability of failure of surgical therapy in the first attempt and may require additional treatment modality.

Conclusions: Initial conservative management is recommended for all chylothorax patients, which is unlikely to succeed if daily drainage is >1000 ml/24 h. VATS thoracic duct ligation is recommended in such cases. Nontraumatic bilateral chylothorax has higher surgical failure rates. In such cases, additional procedures in the form of pleurodesis and/or thoracic duct embolization/disruption should be considered.
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http://dx.doi.org/10.4103/lungindia.lungindia_526_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098887PMC
March 2021

Factors Influencing the Sex Ratio at Birth in India: A New Analysis based on Births Occurring between 2005 and 2016.

Stud Fam Plann 2021 Mar 22;52(1):41-58. Epub 2021 Feb 22.

Anita Raj is Tata Chancellor Professor of Medicine and Director, Center on Gender Equity and Health, University of California San Diego, San Diego, CA.

Previous research on sex ratio at birth (SRB) in India has largely relied on macro-analysis of census data that do not contain the breadth of factors needed to explain patterns in SRB. Additionally, no previous research has examined the differentiation of factors associated with SRB across birth orders, a key determinant in societies affected by son preference. This study aims to fill these gaps using micro-data related to 553,461 births occurring between 2005 and 2016 collected as part of the 2015-2016 National Family Health Survey. Analyses used multivariable logistic regressions stratified by birth order to examine associations with SRB at the national level. The SRB at birth order 1 was outside the biological normal limit, and generally increased with birth order. First births in households with wealth in the middle and richest quintiles, with mothers who desired a higher ideal number of sons than daughters, and in lower fertility communities had a higher probability of being male. Most SRB correlates were visible at birth orders 3 or higher. Programs and policies designed to address India's male-skewed SRB must consider the diverse factors that influence SRB, particularly for higher order births.
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http://dx.doi.org/10.1111/sifp.12147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049007PMC
March 2021

Delayed Presentation of Renal Arterio-Venous Fistula and Pseudoaneurysm in Native Left Kidney in Allograft Recipient: A Case Report.

JNMA J Nepal Med Assoc 2019 Jul-Aug;57(218):272-274

Department of Interventional Radiology, Sir Ganga Ram Hospital, Rajinder Nagar, Delhi, India.

Iatrogenic complications due to renal biopsy majorly include formation of an arterio-venous fistula, pseudoaneurysm or arterio-ureteral fistula. These complications are observed within a span of few days post biopsy and are rare after few years. We reported a case of 32-year-old renal allograft recipient male presenting 6 years post biopsy of the left kidney with left lumbar region pain who was eventually diagnosed with arterio-venous fistula and pseudoaneurysm involving inferior interlobular branch of left renal artery. Superselective embolization was achieved using coils and high concentration glue and transient placement of a venous occlusion balloon with complete technical and clinical success. Keywords: renal arterio-venous fistula; renal biopsy; renal pseudoaneurysm.
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July 2020

Association between the total fertility rate and under-five child sex ratio in India: a panel study among districts of the major states.

J Biosoc Sci 2020 07 11;52(4):514-522. Epub 2019 Oct 11.

International Institute for Population Sciences (IIPS), Mumbai, India.

This study examined the relationship between the total fertility rate and under-five child sex ratio to understand the role of fertility in the phenomenon of missing girls in India. Using data from the last four decennial censuses for the fifteen major states of India and their districts, covering more than 90% of the population of India, the study showed that there was a major decline in the female to male child sex ratio from 1981 to 2011 in most of the major Indian states and their districts. The panel regression model showed that the total fertility rate was significantly associated with the under-five child sex ratio at the district level for the 30-year period from 1981 to 2011 in India, even after controlling for other factors and any other unobserved heterogeneity. This indicates that areas of India with the highest fertility had the higher female to male child sex ratio, while low-fertility districts had a more male-biased sex ratio.
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http://dx.doi.org/10.1017/S0021932019000592DOI Listing
July 2020

Dealing with technical challenges in embolization of a rare aberrant left inferior bronchial artery arising from the left gastric artery in a patient with massive hemoptysis.

Indian J Radiol Imaging 2018 Oct-Dec;28(4):476-479

Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.

Bronchial artery embolization is an established intervention for management of recurrent massive hemoptysis in a majority of patients. The source of bleeding in a majority of cases is systemic arteries - orthotopic bronchial arteries, anomalous bronchial arteries, or nonbronchial systemic collaterals. We report a case of an aberrant left inferior bronchial artery arising from the left gastric artery (LGA) in a patient with massive hemoptysis. Such origin from infradiaphragmatic vessels and specially left gastric arteries is very rare and needs to be considered by interventional radiologists and pulmonologists in case with hemoptysis disproportionate to supply by orthotopic arteries. Technical challenges were present in the present case in the form of an aneurysm in the aberrant artery and nontarget hepatic and gastric branches arising from LGA. Appropriate selection of hardware and embolic agents was done to deal with the clinical situation.
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http://dx.doi.org/10.4103/ijri.IJRI_162_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6319114PMC
January 2019

Effect of dietary supplementation of hemp (Cannabis sativa) and dill seed (Anethum graveolens) on performance, serum biochemicals and gut health of broiler chickens.

J Anim Physiol Anim Nutr (Berl) 2019 Mar 3;103(2):525-533. Epub 2019 Jan 3.

ICAR-Central Avian Research Institute, Izatnagar, India.

The present study was carried out to study the effect of different doses of hemp seed alone or in combination with dill seed against antibiotic growth promoter on performance, serum biochemicals and gut health of broiler chickens over a period of 42 days. Total 192 broiler chicks were grouped randomly into six treatments and fed with basal diet (BD) along with different levels of seeds, viz., T (BD), T (BD + 0.2% HS), T (BD + 0.2% HS + 0.3 DS), T (BD + 0.3% HS) and T (BD + 0.3% HS + 0.3 DS) and T (BD + 0.025% Bacitracin Methylene Disalicylate-BMD). The performance traits like feed intake, body weight gain and feed conversion ratio (FCR) and carcass traits like cut-up parts, giblet and abdominal fat yield remained unaffected due to dietary treatments for overall trial period; however, the average feed intake in early phase (0-3 weeks) reduced significantly (p < 0.05) in treatment birds than both controls (T1 & T6). Serum protein concentration remained unchanged, whereas significant (p < 0.05) reduction in serum lipids like triglyceride, LDL and total cholesterol concentration was noticed due to dietary inclusion of seeds. Serum enzymes like AST and ALT concentrations depleted significantly (p < 0.05) treated groups, except at higher seed doses (T5); however, alkaline phosphatase levels were unaffected. Coliform count in caecum and jejunum reduced linearly (p < 0.01) due to seed inclusion, whereas dose-dependent proliferation of lactobacilli was evident (p < 0.01) in caecum and jejunum of treated birds. No effect was observed on the villus height and crypt depth of the jejunal mucosa. To conclude, dietary supplementation of hemp and dill seed could not affect the growth performance and carcass traits; however, it positively altered the serum lipid profile of the birds and improved gut health as well, thereby enhanced overall performance of broiler chickens.
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http://dx.doi.org/10.1111/jpn.13052DOI Listing
March 2019

A Combination of Linalool, Vitamin C, and Copper Synergistically Triggers Reactive Oxygen Species and DNA Damage and Inhibits subsp. Serovar Typhi and .

Appl Environ Microbiol 2019 02 6;85(4). Epub 2019 Feb 6.

Chemical Biology Laboratory, Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India

Inappropriate and disproportionate use of antibiotics is contributing immensely to the development of antibiotic resistance in bacterial species associated with food contamination. The use of natural products in combination can be a potent alternative hurdle strategy to inactivate foodborne pathogens. Here, we explored the pro-oxidant properties of essential oil inalool and itamin C in combination with opper (LVC) in combating the foodborne pathogens and subsp. serovar Typhi using a three-dimensional (3D) checkerboard microdilution assay. Antibacterial activity in terms of the MIC revealed that the triple combination exerted a synergistic effect compared to the effects of the individual constituents. The bactericidal effect of the triple combination was confirmed by a live/dead staining assay. Reactive oxygen species (ROS) measurements with the terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling assay and scanning electron microscopy imaging strongly suggested that the increase in ROS production is the underlying mechanism of the enhanced antibacterial potency of the LVC combination (linalool [1.298 mM], vitamin C [8 mM], copper [16.3 μM]). In addition, the hypersensitivity of oxidative stress regulator mutants (, , , and mutants) toward LVC corroborated the involvement of ROS in cell death. Live/dead staining and changes in cellular morphology revealed that oxidative stress did not transform the cells into the viable but nonculturable (VBNC) state; rather, killing was associated with intracellular and extracellular oxidative burst. Furthermore, the LVC combination did not display toxicity to human cells, while it effectively reduced the pathogen levels in acidic fruit juices by 3 to 4 log CFU/ml without adversely altering the organoleptic properties. This study opens a new outlook for combinatorial antimicrobial therapy. There is a need to develop effective antibacterial therapies for mitigating bacterial pathogens in food systems. We used a 3D checkerboard assay to ascertain a safe synergistic combination of food-grade components: vitamin C, copper, and the essential oil linalool. Individually, these constituents have to be added in large amounts to exert their antibacterial effect, which leads to unwanted organoleptic properties. The triple combination could exceptionally inhibit foodborne Gram-negative pathogens like and subsp. serovar Typhi at low concentrations (linalool, 1.298 mM; vitamin C, 8 mM; copper, 16.3 μM) and displayed potent microbial inhibition in acidic beverages. We found increased susceptibility in deletion mutants of oxidative stress regulators (, , , and mutants) due to ROS generation by Fenton's chemistry. The results of this study show that it may be possible to use plant-based antimicrobials in synergistic combinations to control microbial contaminants.
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http://dx.doi.org/10.1128/AEM.02487-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365828PMC
February 2019

Percutaneous Recanalization of Anastomotic Portal Vein in a Pediatric Patient After Liver Transplant Without Any Recognizable Portal Vein Remnant on Imaging.

Exp Clin Transplant 2020 04 19;18(2):261-264. Epub 2018 Oct 19.

>From the Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.

In patients with complete portal vein thrombosis, the main portal vein is obstructed, resulting in development of hepatopetal collateral vessels. In cases of complete portal vein thrombosis, interventional procedures are challenging, with the greatest difficulty in the form of passing the guide wire across the level of obstruction. A recognizable main portal vein remnant has been deemed as a mandatory criterion in previous reports. Here, we report a case of cavernous trans-formation of the portal vein in a pediatric patient after liver transplant who had no obvious detectable portal vein remnant on radiologic imaging. Using digital subtraction angiography, we were successful in passing a guide wire through the level of obstruction and placing a stent, thus causing successful recanalization of the occluded segment.
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http://dx.doi.org/10.6002/ect.2017.0326DOI Listing
April 2020

Percutaneous Transhepatic Approach for Recanalization of Superior Mesenteric and Portal Vein in a Patient With Pancreatic Neuroendocrine Tumor Presenting With Bleeding Duodenal Varices: A Brief Case Report.

J Clin Exp Hepatol 2018 Sep 30;8(3):318-320. Epub 2018 Mar 30.

Chairperson, Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.

Occlusion of Portal Vein (PV) and Superior Mesenteric Vein (SMV) is a known effect of local infiltration by pancreatic or mesenteric neuroendocrine tumors. Venous occlusion leads to formation of collateral pathways to restore hepatopetal flow in main PV and these collateral pathways can be seen in the form of ectopic (duodenal or jejunal) varices. We present a case of bleeding duodenal varices secondary to SMV occlusion by a locally infiltrating pancreatic neuroendocrine tumor which was successfully treated by coil embolization of varices and SMV stenting of the occluded venous segment after failure of endoscopic glue injection. Various endovascular minimally invasive approaches have been described in literature for recanalization of SMV in such clinical scenarios which maybe challenging to treat for surgical methods. We recommend use of the retrograde transhepatic technique for recanalization of occluded SMV and embolization of associated varices as an alternate treatment option in such scenarios.
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http://dx.doi.org/10.1016/j.jceh.2018.03.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175724PMC
September 2018

Deciphering Stability of Five-Membered Heterocyclic Radicals: Balancing Act Between Delocalization and Ring Strain.

J Phys Chem A 2018 Jun 8;122(24):5464-5476. Epub 2018 Jun 8.

Department of Chemical Sciences , Indian Institute of Science Education and Research Mohali , Sector 81, SAS Nagar , Knowledge City, Mohali , Punjab 140306 , India.

Computational studies on five-membered heterocycles with single heteroatom and their isomeric dehydro-borole 1a-1c, cyclopentadiene 2a-2c, pyrrole 3a-3c, furan 4b-4c, phosphole 5a-5c, and thiophene 6b-6c radicals have been carried out. Geometrical aspects through ground state electronic structures and stability aspects using bond dissociation energies (BDE) and radical stabilization energies (RSE) have been envisaged in this regard. Spin densities, electrostatic potentials (ESP), and natural bond orbital (NBO) analysis unveiled the extent of spin delocalization. The estimated nucleus-independent chemical shifts (NICS) values revealed the difference in aromaticity characteristics of radicals. Particularly the heteroatom centered radicals exhibit odd electron π-delocalized systems with a quasi-antiaromatic character. Various factors such as, the relative position of the radical center with respect to heteroatoms, resonance, ring strain and orbital interactions influence the stability that follows the order: heteroatom centered > β-centered > α-centered radicals. Among the influences of various factors, we confirmed the existence of a competition between delocalization and the ring strain, and the interplay of both decides the overall stability order.
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http://dx.doi.org/10.1021/acs.jpca.8b03145DOI Listing
June 2018

Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Control of Bleeding from Post-Glue Ulcer over Gastric Varices. Report of Two Cases and Review of Literature.

J Clin Exp Hepatol 2016 Dec 31;6(4):326-330. Epub 2016 Aug 31.

Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.

Bleeding gastric varices (GV) are managed by cyanoacrylate glue injection with transjugular intrahepatic portosystemic shunt (TIPSS) as modality for treatment failure. Ulcer can form at the site of glue injection over GV and it can cause bleeding. Treatment approach for such bleed is not well described. Balloon-occluded retrograde transvenous obliteration (BRTO), TIPSS, and devascularization remain the treatment options in this scenario. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of GV, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. BRTO has the benefit of increasing portal hepatic blood flow and can also be useful in patients who may not tolerate TIPSS. We report two cases where BRTO was done for control of bleeding from ulcers formed over previously injected GV.
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http://dx.doi.org/10.1016/j.jceh.2016.08.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5157881PMC
December 2016

Management of implant-stable distal femoral periprosthetic fractures by distal femoral locking plate: A retrospective study.

Authors:
Ajit Yadav

Indian J Orthop 2015 Nov-Dec;49(6):680

Department of Orthopedic and Joint Replacement Surgery, Global Hospitals, Chennai, Tamil Nadu, India.

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http://dx.doi.org/10.4103/0019-5413.168756DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4705738PMC
January 2016

Thermal inactivation of Salmonella Enteritidis on chicken skin previously exposed to acidified Sodium chlorite or tri-sodium phosphate.

J Food Sci Technol 2015 Dec 26;52(12):8236-43. Epub 2015 Jun 26.

Food Microbiology Laboratory, Post Harvest Technology Division, ICAR-Central Avian Research Institute, Izatnagar, 243122 UP India.

Thermal inactivation of normal and starved cells of Salmonella Enteritidis on chicken skin previously exposed to different concentrations of acidified sodium chlorite (ASC) or tri-sodium phosphate (TSP) was investigated. Inoculated skin was pretreated with different concentration of ASC or TSP, packaged in bags, and then immersed in a circulating water bath at 60 to 68 °C. The recovery medium was Hektoen enteric agar. D-values, determined by linear regression, for normal cells on chicken skin, were 2.79, 1.17 and 0.53 min whereas D-values for starved cells were 4.15, 1.83 and 0.66 at 60, 64 and 68 °C, respectively. z-values for normal cells were 3.54 and for starved cells were 2.29. Pretreatment of Salmonella Enteritidis cells with 0 to 200 ppm of ASC or 0 to 1.0 % TSP resulted in lower D-values at all temperatures. Sensory results indicated no significance differences for control and treatments. Thus, results of this study indicated that pretreatment of chicken skin with ASC or TSP increased sensitivity of Salmonella Enteritidis to heat without affecting organoleptic quality of chicken meat.
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http://dx.doi.org/10.1007/s13197-015-1922-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648861PMC
December 2015

SELF-REPORTED MORBIDITY AND BURDEN OF DISEASE IN UTTAR PRADESH, INDIA: EVIDENCE FROM A NATIONAL SAMPLE SURVEY AND THE MILLION DEATHS STUDY.

J Biosoc Sci 2016 Aug 5;48(4):472-85. Epub 2015 Oct 5.

International Institute for Population Sciences,Deonar,Mumbai,India.

Uttar Pradesh is India's most populous state with a population of 200 million. Any change in its fertility and mortality is bound to bring change at the national level. This study analysed the burden of disease in the state by calculating the disability-adjusted life year (DALY) for infectious and non-communicable diseases. Data were from two rounds (52nd and 60th) of the National Sample Survey Organization (NSSO) survey conducted in 1995-96 and 2004, respectively, and the Million Deaths Study (MDS) of 2001-03. Descriptive and multivariate analyses were carried out to identify the determinants of different types of self-reported morbidity and DALY. The results show that in Uttar Pradesh the prevalence of all selected self-reported infectious and non-communicable diseases increased over the study period from 1995 to 2004, and in most cases by more than two times. The highest observed increase in prevalence was in non-communicable diseases excluding CVDs, which increased from 7% in 1995 to 19% in 2004. The prevalence was higher for those aged 60 and above, females, those who were illiterate and rich across the time period and for all selected morbidities. The results were significant at p<0.001. The estimation of the DALY revealed that the burden of infectious diseases was higher during infancy, noticeably among males than females in 2002. However, females aged 1-5 years were more likely to report infectious diseases than corresponding males. The age distribution of the DALY indicated that individuals aged below 5 years and above 60 years were more susceptible to ill health. The growing incidence of non-communicable diseases, especially among the older generation, puts an additional burden on the health system in the state. Uttar Pradesh has to grapple with the unresolved problem of preventable infectious diseases on the one hand and the growth in non-communicable disease on the other.
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http://dx.doi.org/10.1017/S0021932015000322DOI Listing
August 2016

Association of child health and household amenities in high focus states in India: a district-level analysis.

BMJ Open 2015 May 11;5(5):e007589. Epub 2015 May 11.

Doctoral Fellow, International Institute for Population Sciences, Mumbai, Maharashtra, India.

Objectives: To assess household amenities in districts of high focus states and their association with child health in India.

Design: The data for the study are extracted from Annual Health Survey (AHS) and Census 2011.

Settings: Districts in high focus states in India.

Participants: Information regarding children below 5 years of age and women aged 15-49 has been extracted from the AHS (2010-2011), and household amenities information has been obtained from the Census (2011).

Measures: Household amenities were assessed from the census at the district level in the high focus states. Child health indicators and wealth index were borrowed from AHS and used in this study to check their linkage with household amenities.

Results: Absence of drinking water from a treated source, improved sanitation, usage of clean cooking fuel and drainage facility in the household were adversely associated with the incidence of acute respiratory infection, diarrhoea, infant mortality rate (IMR) and under 5 mortality rate (U5MR). The mean IMR declined from 64 to 54 for districts where a high proportion of household have improved sanitation. The result of ordinary least square regression shows that improved sanitation has a negative and statistically significant association (β=-0.0067, p<0.01) with U5MR.

Conclusions: Although child healthcare services are important in addressing child health issues, they barely touch on the root of the problem. Building toilets and providing safe drinking water, clean cooking fuel and drainage facilities at the household level, may prevent a number of adverse child health issues and may reduce the burden on the healthcare system in India.
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http://dx.doi.org/10.1136/bmjopen-2015-007589DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431170PMC
May 2015

Amoebic liver abscess with hepatic artery pseudoaneurysm: successful treatment by interventional radiology.

J Clin Exp Hepatol 2015 Mar 6;5(1):86-8. Epub 2015 Jan 6.

Department of Interventional Radiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110060, India.

Amoebic liver abscess is most common extra-intestinal presentation of amoebiasis. It is rarely complicated with vascular involvement including thrombosis of hepatic vein or IVC and pseudo-aneurysm of hepatic artery. We describe a case of hepatic artery pseudo-aneurysm as a complication of amoebic liver abscess treated with percutaneous embolization.
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http://dx.doi.org/10.1016/j.jceh.2014.12.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415193PMC
March 2015

Transarterial chemoembolization in unresectable hepatocellular carcinoma--assessing the factors affecting the survival: An audit from a tertiary care center in northern India.

Indian J Gastroenterol 2015 Mar 5;34(2):117-26. Epub 2015 May 5.

Department of Radio Diagnosis, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.

Introduction: Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and third most common cause of cancer-related mortality. According to Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is considered a recommended option for intermediate HCC.

Objectives: The purposes of our study were to evaluate the various factors affecting the outcome of TACE, to study the efficacy of TACE by evaluating the imaging response by European Association for the Study of the Liver (EASL) necrosis criteria, and to study the survival of patients.

Methods: Fifty-three patients (M = 48, F = 5) with unresectable HCC and treated with TACE were included in our study. Baseline laboratory and imaging characteristics were obtained. Clinical and laboratory toxicities were assessed. EASL necrosis response criteria were used to determine imaging response. Survival from the time of the first chemoembolization treatment was calculated. Univariate, multivariate, and survival analyses were performed using Kaplan-Meier estimations.

Results: A total of 53 patients underwent chemoembolization. Median age was 63 years (range 21-81 years). Thirty-one patients (58.4 %) belonged to Child-Pugh class A, while 22 patients belonged to Child-Pugh class B. Thirty-five patients died during the study period. Median study period was 13 months. Overall survival rate at 1 year was 62.26 %. Prognostic factors found to be significant on multivariate analysis were Child-Pugh class, presence of metastasis, and initial tumor size, while on univariate analysis, portal vein thrombosis, EASL response, and baseline AFP levels were also significant.

Conclusion: Chemoembolization was an effective and safe treatment in Child A and early Child B patients. Factors that had adverse effect on survival were Child class B, larger tumor size, presence of portal vein thrombosis and metastasis, and high baseline alpha-fetoprotein levels.
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http://dx.doi.org/10.1007/s12664-015-0544-9DOI Listing
March 2015

Transarterial chemoembolization in unresectable hepatocellular carcinoma with portal vein thrombosis: a perspective on survival.

Oman Med J 2014 Nov;29(6):430-6

Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India.

Objective: Portal vein thrombosis is considered a relative contraindication for transarterial chemoembolization (TACE) in hepatocellular carcinoma. The purpose of our study was to evaluate the efficacy of TACE treatment in patients with hepatocellular carcinoma with portal vein (PV) thrombosis.

Methods: From April 2011 to June 2013, 17 patients with unresectable hepatocellular carcinoma with PV thrombosis were studied. Patients were assessed for tumor response by imaging at regular intervals and the data compared with the baseline laboratory and imaging characteristics obtained before treatment. Univariate analysis was used to assess the treatments impact on patient survival. Survival analysis was performed using Kaplan-Meier estimations.

Results: Overall survival rates at three, six and 12 months were 82%, 71%, and 47%, respectively, with a median of 10 months. Patients in Child-Pugh class A had a median survival of 15 months compared to five months for those patients in Child-Pugh class B. The median survival period of patients responsive to treatment was 13 months while that of non-responders was five months. Patients with ascites at the time of presentation had median survival period of six months while those who did not had a median survival period of 13 months. In univariate analysis, response to chemoembolization (p<0.001), ascites (p<0.050) and Child-Pugh class at diagnosis (p<0.050) were found to be significant prognostic factors.

Conclusion: TACE is a promising procedure in unresectable hepatocellular carcinoma with PV thrombosis. Response to chemoembolization, ascites and Child-Pugh class were the most important determining factors of survival.
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http://dx.doi.org/10.5001/omj.2014.114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289489PMC
November 2014

Differential expression of collectins in human placenta and role in inflammation during spontaneous labor.

PLoS One 2014 10;9(10):e108815. Epub 2014 Oct 10.

Department of Innate Immunity, National Institute for Research in Reproductive Health (Indian Council of Medical Research), Mumbai, Maharashtra, India.

Collectins, collagen-containing Ca(2+) dependent C-type lectins and a class of secretory proteins including SP-A, SP-D and MBL, are integral to immunomodulation and innate immune defense. In the present study, we aimed to investigate their placental transcript synthesis, labor associated differential expression and localization at feto-maternal interface, and their functional implication in spontaneous labor. The study involved using feto-maternal interface (placental/decidual tissues) from two groups of healthy pregnant women at term (≥ 37 weeks of gestation), undergoing either elective C-section with no labor ('NLc' group, n = 5), or normal vaginal delivery with spontaneous labor ('SLv' group, n = 5). The immune function of SP-D, on term placental explants, was analyzed for cytokine profile using multiplexed cytokine array. SP-A, SP-D and MBL transcripts were observed in the term placenta. The 'SLv' group showed significant up-regulation of SP-D (p = 0.001), and down-regulation of SP-A (p = 0.005), transcripts and protein compared to the 'NLc' group. Significant increase in 43 kDa and 50 kDa SP-D forms in placental and decidual tissues was associated with the spontaneous labor (p<0.05). In addition, the MMP-9-cleaved form of SP-D (25 kDa) was significantly higher in the placentae of 'SLv' group compared to the 'NLc' group (p = 0.002). Labor associated cytokines IL-1α, IL-1β, IL-6, IL-8, IL-10, TNF-α and MCP-1 showed significant increase (p<0.05) in a dose dependent manner in the placental explants treated with nSP-D and rhSP-D. In conclusion, the study emphasizes that SP-A and SP-D proteins associate with the spontaneous labor and SP-D plausibly contributes to the pro-inflammatory immune milieu of feto-maternal tissues.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0108815PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193748PMC
June 2015

Surfactant protein D inhibits HIV-1 infection of target cells via interference with gp120-CD4 interaction and modulates pro-inflammatory cytokine production.

PLoS One 2014 18;9(7):e102395. Epub 2014 Jul 18.

Department of Innate Immunity, National Institute for Research in Reproductive Health (ICMR), Mumbai, Maharashtra, India.

Surfactant Protein SP-D, a member of the collectin family, is a pattern recognition protein, secreted by mucosal epithelial cells and has an important role in innate immunity against various pathogens. In this study, we confirm that native human SP-D and a recombinant fragment of human SP-D (rhSP-D) bind to gp120 of HIV-1 and significantly inhibit viral replication in vitro in a calcium and dose-dependent manner. We show, for the first time, that SP-D and rhSP-D act as potent inhibitors of HIV-1 entry in to target cells and block the interaction between CD4 and gp120 in a dose-dependent manner. The rhSP-D-mediated inhibition of viral replication was examined using three clinical isolates of HIV-1 and three target cells: Jurkat T cells, U937 monocytic cells and PBMCs. HIV-1 induced cytokine storm in the three target cells was significantly suppressed by rhSP-D. Phosphorylation of key kinases p38, Erk1/2 and AKT, which contribute to HIV-1 induced immune activation, was significantly reduced in vitro in the presence of rhSP-D. Notably, anti-HIV-1 activity of rhSP-D was retained in the presence of biological fluids such as cervico-vaginal lavage and seminal plasma. Our study illustrates the multi-faceted role of human SP-D against HIV-1 and potential of rhSP-D for immunotherapy to inhibit viral entry and immune activation in acute HIV infection.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0102395PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103819PMC
March 2015

Human surfactant protein D alters oxidative stress and HMGA1 expression to induce p53 apoptotic pathway in eosinophil leukemic cell line.

PLoS One 2013 31;8(12):e85046. Epub 2013 Dec 31.

Centre for Molecular Medicine, National Institute of Immunology (NII), New Delhi, India.

Surfactant protein D (SP-D), an innate immune molecule, has an indispensable role in host defense and regulation of inflammation. Immune related functions regulated by SP-D include agglutination of pathogens, phagocytosis, oxidative burst, antigen presentation, T lymphocyte proliferation, cytokine secretion, induction of apoptosis and clearance of apoptotic cells. The present study unravels a novel ability of SP-D to reduce the viability of leukemic cells (eosinophilic leukemic cell line, AML14.3D10; acute myeloid leukemia cell line, THP-1; acute lymphoid leukemia cell lines, Jurkat, Raji; and human breast epithelial cell line, MCF-7), and explains the underlying mechanisms. SP-D and a recombinant fragment of human SP-D (rhSP-D) induced G2/M phase cell cycle arrest, and dose and time-dependent apoptosis in the AML14.3D10 eosinophilic leukemia cell line. Levels of various apoptotic markers viz. activated p53, cleaved caspase-9 and PARP, along with G2/M checkpoints (p21 and Tyr15 phosphorylation of cdc2) showed significant increase in these cells. We further attempted to elucidate the underlying mechanisms of rhSP-D induced apoptosis using proteomic analysis. This approach identified large scale molecular changes initiated by SP-D in a human cell for the first time. Among others, the proteomics analysis highlighted a decreased expression of survival related proteins such as HMGA1, overexpression of proteins to protect the cells from oxidative burst, while a drastic decrease in mitochondrial antioxidant defense system. rhSP-D mediated enhanced oxidative burst in AML14.3D10 cells was confirmed, while antioxidant, N-acetyl-L-cysteine, abrogated the rhSP-D induced apoptosis. The rhSP-D mediated reduced viability was specific to the cancer cell lines and viability of human PBMCs from healthy controls was not affected. The study suggests involvement of SP-D in host's immunosurveillance and therapeutic potential of rhSP-D in the eosinophilic leukemia and cancers of other origins.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0085046PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3877357PMC
September 2014

Predictive thermal inactivation model for the combined effect of temperature, cinnamaldehyde and carvacrol on starvation-stressed multiple Salmonella serotypes in ground chicken.

Int J Food Microbiol 2013 Jul 5;165(2):184-99. Epub 2013 May 5.

U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, 600 E. Mermaid Lane, Wyndmoor, PA 19038, USA.

We investigated the combined effect of three internal temperatures (60, 65 and 71.1 °C) and four concentrations (0.0, 0.1, 0.5 and 1% vol/wt) of two natural antimicrobials on the heat resistance of an eight-strain cocktail of Salmonella serovars in chicken meat. A complete factorial design (3×4×4) was used to assess the effects and interactions of heating temperature and the two antimicrobials, carvacrol and cinnamaldehyde. The 48 variable combinations were replicated to provide a total of 96 survivor curves from the experimental data. Mathematical models were then developed to quantify the combined effect of these parameters on heat resistance of starved Salmonella cells. The theoretical analysis shows that the addition of plant-derived antimicrobials overcomes the heat resistance of starvation-stressed Salmonella in ground chicken meat. The influence of the antimicrobials allows reduced heat treatments, thus reducing heat-induced damage to the nutritional quality of ground-chicken products. Although the reported omnibus log-linear model with tail and the omnibus sigmoid model could represent the experimental survivor curves, their discrepancy only became apparent in the present study when lethality times (D-values and t7.0) from each of the models were calculated. Given the concave nature of the inactivation curves, the log-linear model with tail greatly underestimates the times needed to obtain 7.0 log lethality. Thus, a polynomial secondary model, based on the sigmoid model, was developed to accurately predict the 7.0-log reduction times. The three-factor predictive model can be used to estimate the processing times and temperatures required to achieve specific log reductions, including the regulatory recommendation of 7.0-log reduction of Salmonella in ground chicken.
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http://dx.doi.org/10.1016/j.ijfoodmicro.2013.04.025DOI Listing
July 2013

Kinetics of thermal destruction of Salmonella in ground chicken containing trans-cinnamaldehyde and carvacrol.

J Food Prot 2012 Feb;75(2):289-96

Eastern Regional Research Center, U.S. Department of Agriculture, Agricultural Research Service, Wyndmoor, PA 19038, USA.

We investigated the heat resistance of an eight-strain cocktail of Salmonella serovars in chicken supplemented with trans cinnamaldehyde (0 to 1.0%, wt/wt) and carvacrol (0 to 1.0%, wt/wt). Inoculated meat was packaged in bags that were completely immersed in a circulating water bath and held at 55 to 71°C for predetermined lengths of time. The recovery medium was tryptic soy agar supplemented with 0.6% yeast extract and 1% sodium pyruvate. D-values in chicken, determined by linear regression, were 17.45, 2.89, 0.75, and 0.29 min at 55, 60, 65, and 71°C, respectively (z = 9.02°C). Using a survival model for nonlinear survival curves, D-values in chicken ranged from 13.52 min (D(1), major population) and 51.99 min (D(2), heat-resistant subpopulation) at 55°C to 0.15 min (D(1)) and 1.49 min (D(2)) at 71°C. When the Salmonella cocktail was in chicken supplemented with 0.1 to 1.0% trans-cinnamaldehyde or carvacrol, D-values calculated by both approaches were consistently less at all temperatures. This observation suggests that the addition of natural antimicrobials to chicken renders Salmonella serovars more sensitive to the lethal effect of heat. Thermal death times from this study will be beneficial to the food industry in designing hazard analysis and critical control point plans to effectively eliminate Salmonella contamination in chicken products used in this study.
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http://dx.doi.org/10.4315/0362-028X.JFP-11-307DOI Listing
February 2012

Nonhematological organ dysfunction and positive fluid balance are important determinants of outcome in adults with severe dengue infection: a multicenter study from India.

J Crit Care 2011 Oct 6;26(5):441-448. Epub 2011 Jul 6.

Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Belgium. Electronic address:

Purpose: The purpose of the study was to explore determinants of outcome in adults with dengue hemorrhagic fever or dengue shock syndrome.

Methods: We performed a multicenter, retrospective, observational study over a 2-year period in 3 intensive care units (ICUs) in Pune (India).

Results: One hundred eighty-four adult patients were admitted to the ICU with a positive dengue immunoglobulin M test result; 43 met the World Health Organization criteria for dengue hemorrhagic fever or dengue shock syndrome. One patient who was transferred to another hospital and whose outcome was unknown was not included in the analysis. Of the 42 patients, 20 (48%) had multiorgan failure on ICU admission. The ICU mortality was 19% (8/42). Nonsurvivors were more likely than survivors to have cardiovascular (100% vs 12%), respiratory (88% vs 12%), or neurological (75% vs 12%) failure (all P < .01). Hematological failure was not associated with a higher risk of death. Cumulative fluid balance at 72 hours was more positive in nonsurvivors than in survivors (6.2 vs 3.5 L, P < .05). Serum albumin concentrations at ICU admission were lower in nonsurvivors than in survivors (2.9 ± 0.3 vs 3.4 ± 0.7 g/dL, P < .05).

Conclusions: In our cohort, outcome from severe dengue was primarily related to nonhematological organ failure. Low serum albumin concentration on ICU admission and a more positive fluid balance at 72 hours were also associated with worse outcomes.
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http://dx.doi.org/10.1016/j.jcrc.2011.05.008DOI Listing
October 2011

Surfactant proteins A and D in pregnancy and parturition.

Front Biosci (Elite Ed) 2011 Jan 1;3:291-300. Epub 2011 Jan 1.

National Institute for Research in Reproductive Health, Mumbai, India.

Surfactant proteins A and D have extra-pulmonary expression at various mucosal sites including the reproductive tract. Reproductive tissues require a fine immune balance, strong enough to keep infection at a bay and at the same time, subtle enough to support an allogeneic fetus throughout the pregnancy. Roles of SP-A and SP-D have been studied in depth and include immunoregulatory function, besides strengthening the innate immune system against various pathogens in the lungs. Interestingly, levels of SP-A and SP-D in the amniotic fluid increase progressively in pregnancy. SP-A has been implicated in the induction of parturition. The present review elaborates the plausible roles of SP-A and SP-D in pregnancy maintenance and future applications.
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http://dx.doi.org/10.2741/e244DOI Listing
January 2011
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