2015 Navneet Sharma - Academia.edu (original) (raw)
Papers by 2015 Navneet Sharma
Asia Pacific Journal of Medical Toxicology, 2012
Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very h... more Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very high case fatality ratio. We studied five patients of aluminum phosphide poisoning with polyserositis. Methods: We enrolled all patients with aluminum phosphide poisoning presenting to emergency medical department, at a tertiary care hospital in northwestern India from January to July 2006. These patients were managed according to a standard treatment protocol and their complications were recorded. Results: During the study period, total of 35 patients were admitted with 57.5% mortality in the first 12 hours. Among the rest, 5 patients were found to develop polyserositis. All these patients had severe hypotension at presentation and developed respiratory distress requiring mechanical ventilation after an average stay of 3.8 days post-ingestion. They were managed conservatively and four of them were discharged from the hospital after the average stay of 10 days. Conclusion: In this case se...
Annals of Indian Academy of Neurology
Acute intermittent porphyria (AIP) is an inherited metabolic disease characterized by disordered ... more Acute intermittent porphyria (AIP) is an inherited metabolic disease characterized by disordered heme biosynthesis. There is no recent study reported from India. It was a retrospective, observational study. Clinical records of patients of AIP with acute porphyric attacks admitted from April 2008 to December 2016 were analyzed. Fifteen AIP patients constituted of eight females and seven males were analyzed. Mean age at presentation was 34.33 ± 15.86 years. Thirteen patients (86.67%) had acute flaccid paralysis (AFP). All of them had peripheral neuropathy. These patients concomitantly had abdominal pain, seizure, encephalopathy, autonomic hyperactivity, history of passage of dark urine, and electrolyte abnormality (hyponatremia) in various combinations. Abdominal pain was the presenting symptom in 11 (73.33%) patients. Seven (46.67%) patients had seizure episodes. Five patients (33.33%) had hyponatremia at presentation. Significantly higher percentage of them had seizure at presentati...
Drug Delivery, 2016
Context: The unique physiological limitations of the eye have been assigned as reason of low bioa... more Context: The unique physiological limitations of the eye have been assigned as reason of low bioavailability by conventional drug delivery systems. There is need of such drug carriers, which ensure improved bioavailability as well as patient compliance upon instillation into the eye. Objective: The present investigation deals with development of solid lipid nanoparticles (SLNs) containing celecoxib (CXB) for treatment of ophthalmic inflammations. Materials and methods: The SLNs were formulated by melt-emulsion sonication and low temperature-solidification process and evaluated for particle size, surface morphology, physicochemical properties, percentage drug incorporation efficiency, in vitro drug release, in vitro trans-corneal permeation, in vivo efficacy in ocular inflammation, stability study and gamma scintigraphy study to assess the residence of solid lipid nanoparticles over ocular surfaces. Results: The SLNs were spherical and the optimized formulation had particle size of 198.77 ± 7.5 nm, which is quite suitable for ocular applications. The maximum entrapment efficiency of 92.46 ± 0.07% was achieved for formulation SLN 20. The permeation across the cornea was also significantly better than aqueous suspension (8.21 ± 0.67 versus 4.61 ± 0.71) at p50.05. Discussion and conclusion: The SLN formulations demonstrated improved performance of entrapped CXB while mitigating the key parameters of ocular inflammation in rabbits. The particulate formulations have exhibited prolonged retention over ocular surfaces as evident from results of gamma scintigraphy using 99m Tc labeled SLNs.
Indian Journal of Surgical Oncology, 2015
Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is en... more Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is endemic in India and usually seen in the northern states. Biliary ascariasis is an uncommon cause of obstructive jaundice. We present a case of carcinoma of hepatic flexure of colon in which the patient developed biliary ascariasis and posed a diagnostic challenge as it mimicked tumor infiltration of the biliary system.
Disaster medicine and public health preparedness, Jan 31, 2014
Skin contamination is one of the most likely risks after accidental or occupational radiological ... more Skin contamination is one of the most likely risks after accidental or occupational radiological accidents. Using scintigraphy, we assessed a topical lotion for its decontamination efficacy (DE) after exposure with short-lived medical radioisotopes technetium Tc 99m (99mTc) and thallium 201Tl (201Tl). Using 99mTc (300 ± 5 μCi/100 μl) and 201Tl (100 ± 5 μCi/100 μl), the thoracoabdominal region (shaved skin) of Sprague Dawley rats and human tissue equivalent were contaminated and then decontaminated using cotton swabs soaked in formulated lotion at different time intervals. Static counts were recorded and calculated for DE. Histologic examination was performed on the animal model. The DE of the formulation for 99mTc and 201Tl was 85% ± 5 and 88% ± 2, respectively. The prepared formulation effectively removed the radionuclides from the tissue surface. The formulated lotion assisted in the effective removal of radiocontaminants by decontaminating the radionuclides. Moreover, minimal and...
The American Journal of Gastroenterology, 2008
OBJECTIVES: Variceal ligation has been shown to be superior to sclerotherapy in prevention of reb... more OBJECTIVES: Variceal ligation has been shown to be superior to sclerotherapy in prevention of rebleeding and improving survival in patients with cirrhosis. However, 25% of patients will rebleed before completion of treatment. A number of trials have compared the combination of ligation and sclerotherapy to ligation alone in achieving rapid and complete eradication of esophageal varices, with conflicting results. METHODS: Two reviewers independently identified seven randomized, controlled trials that compared endoscopic variceal ligation with the combination of sclerotherapy and ligation for the treatment of esophageal varices. Studies were identified by searching MEDLINE, reviewing references from retrieved articles, and scanning abstracts from conference proceedings. For each outcome, odds ratios (ORs) were calculated using fixed-effects and random-effects models. The Mantel-Haenszel test for statistical heterogeneity was used to assess the validity of combining results from individual studies. RESULTS: No significant difference was seen in cessation of actively bleeding varices (OR ϭ 1.01, 95% CI ϭ 0.43-2.36), variceal rebleeding (OR ϭ 1.12, CI ϭ 0.69-1.81), and mortality (OR ϭ 1.1, CI ϭ 0.70-1.74) in patients with variceal ligation versus patients receiving the combination treatment of ligation and sclerotherapy. Treatment sessions required to achieve complete variceal eradication were similar in the two treatment arms. A significantly higher incidence of esophageal stricture was seen in combination therapy (p Ͻ 0.001). CONCLUSIONS: The combination of ligation and sclerotherapy offers no advantage over ligation alone in prevention of rebleeding and in reduction of mortality. It is also associated with a higher complication rate of esophageal stricture. (Am
Saudi Journal of Gastroenterology, 2011
Background/Aim: Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxid... more Background/Aim: Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxidant therapy in the form of high-dose vitamin has been used for the treatment of severe acute pancreatitis with equivocal results. We wished to evaluate the efficacy and safety of antioxidant (vitamin A, vitamin C, vitamin E) therapy in patients with severe acute pancreatitis. Setting and design: This was a single-center, prospective, randomized, open-label with blinded endpoint assessment study of antioxidant therapy, conducted in the emergency department attached to our hospital. Materials and Methods: Thirty-nine patients with severe acute pancreatitis were randomly assigned to antioxidant treatment group (n=19) or a control group (n=20) within 96 hours of developing symptoms. Patients in the antioxidant group received antioxidants (vitamin A, vitamin E, vitamin C) in addition to the standard treatment provided to both the groups for a period of 14 days. The primary outcome variable was presence of organ dysfunction at day 7. The secondary outcome variables were length of hospital stay, multiorgan dysfunction (MODS) at day 7, recovery at the end of 4 weeks, complications, and mortality. The change in markers of oxidative stress from baseline was also measured. Results: We demonstrated no significant difference in organ dysfunction (P=1.0), MODS (P=0.8), and length of hospital stay (P=0.29) between the two groups. All the patients survived in the antioxidant-treated group, whereas two patients died in the control group. The change in the levels of malondialdehyde, superoxide dismutase, and reduced glutathione were not significantly different in the two groups at day 7. Univariate analysis showed marginal benefit with antioxidant treatment (P=0.034) in patients with severe acute pancreatitis. Conclusions: This randomized study demonstrates that there is no significant benefit from antioxidant therapy in patients with established severe acute pancreatitis.
Liver Transplantation, 2007
Journal of Infection and Public Health, 2010
Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This ... more Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This study was undertaken to find the effectiveness of neostigmine and polyvalent antivenom in improving neuromuscular paralysis following bite. All the consecutive patients admitted between June 2007 and December 2008 with common krait bite, identified either from brought snake or circumstantial evidence were studied. Ten vials of polyvalent antivenom and three doses of 2.5 mg neostigmine at 30 min intervals after administration of 0.6 mg of atropine were administered I.V. and patients were assessed for any improvement in neuroparalysis. Seventy-two patients were admitted during the study period. All the patients except two came from rural areas and were brought between June and September. Sixty-two patients were bitten during the day while clearing bricks, cutting grass or walking. The mean time interval between bite and arrival to hospital was 4.5 h. None of the patients showed any improvement following treatment and all patients developed respiratory paralysis, requiring assisted ventilation. Seventy survived and two died. Neostigmine is ineffective in reversing or improving neuroparalytic features in patients with B. caeruleus bite even at higher dose than normally recommended.
Journal of Hepatology, 2012
Results: A subset comprising 102 of the 1547 hyponatremic pts enrolled in the US between study in... more Results: A subset comprising 102 of the 1547 hyponatremic pts enrolled in the US between study initiation in September 2010 and October 2011 from 136 sites had cirrhosis and sufficient data for analysis. The mean entry and discharge [Na] values were 125.7±7.3 mmol/L, and 130.5±5.5 mmol/L, respectively. The average length of stay in days was 10.8±8.8. Conclusions: Based on interim data, HN in pts with cirrhosis is often chronic and present during multiple admissions. The majority of pts are discharged with persistent HN, even when specifically treated for HN. Additional data will be forthcoming as enrollment and analysis continue.
Journal of Gastroenterology and Hepatology, 2006
To document the clinical outcome and prognosis of acalculous cholecystitis in dengue fever. Prosp... more To document the clinical outcome and prognosis of acalculous cholecystitis in dengue fever. Prospective analysis of 27 cases of dengue fever presenting to the medical emergency of a tertiary care referral hospital in Chandigarh, India. All patients with dengue fever presenting with abdominal pain in the year 2003 were studied by ultrasound examination for the presence of acalculous cholecystitis. Five cases presented in October and 22 cases in November. Mean age was 29.8 +/- 9.7 years and there were 21 males and six females. Mean duration of fever was 5.07 +/- 1.8 days and mean duration of body ache was 4.06 +/- 2.6 days. The mean platelet counts for all cases at presentation were 29.41 +/- 18.41 x 10(9)/L and at discharge 95.28 +/- 53.01 x 10(9)/L. The mean duration of in-hospital stay was 3.4 +/- 1.7 days. Fourteen patients presented with pain in the abdomen and were confirmed to have acalculous cholecystitis on ultrasound examination of the abdomen (mean gallbladder wall thickness was 5.2 +/- 1.03 mm). Amongst all variables assessed, the only significant difference seen was that the duration of in-hospital stay was 1.68 days more in the group with acalculous cholecystitis. Acalculous cholecystitis should be strongly suspected in patients with dengue fever presenting with abdominal pain. Our study has shown that acalculous cholecystitis occurred in 14 out of 27 patients with dengue fever.
Indian Journal of Medical Sciences, 2006
Vaccine, 2012
Genetic immunization holds promise as a vaccination method, but has so far proven ineffective in ... more Genetic immunization holds promise as a vaccination method, but has so far proven ineffective in large primate and human trials. Herein, we examined the relative merits of genetic immunization and peptide immunization using bacteriophage λ. Bacteriophage λ has proven effective in immune challenge models using both immunization methods, but there has never been a direct comparison of efficacy and of the quality of immune response. In the current study, this vector was produced using a combination of cis and trans phage display. When antibody titers were measured from immunized animals together with IL-2, IL-4 and IFNγ production from splenocytes in vitro, we found that proteins displayed on λ were superior at eliciting an immune response in comparison to genetic immunization with λ. We also found that the antibodies produced in response to immunization with λ displayed proteins bound more epitopes than those produced in response to genetic immunization. Finally, the general immune re...
Diabetes Research and Clinical Practice, 2007
Bilateral parietal lobe hemorrhage in a patient with diabetic ketoacidosis Acute neurological com... more Bilateral parietal lobe hemorrhage in a patient with diabetic ketoacidosis Acute neurological complications related to diabetic ketoacidosis (DKA) include cerebral edema, cerebral infarctions, brain herniation, cortical venous thrombosis and rarely cerebral hemorrhage. A 16-year-old female presented to the emergency room with history of sudden onset alteration of sensorium for 2 h. There was history of dry cough and exertional shortness of breath of MRC grade III for the last 4 days but no history of fever, seizures, headache, photophobia, neck stiffness, blurring of vision, vomiting and any neurological deficits. She had osmotic symptoms but was not evaluated previously. On examination, she was drowsy but was responding to commands and was dehydrated, tachypnoeic and had no focal neurological deficit. Her blood sugar was 490 mg/dl and urine ketones were strongly positive. There was severe metabolic acidosis on ABG with pH of 6.81, HCO 3 1 and anion gap of 47.The prothrombin time was 10 s, Aptt 32 and PTI was 100%. She was managed on the lines of DKA. As her neurological status did not improve despite the correction of metabolic parameters and normalization of anion gap, an NCCT Head was done, which revealed bilateral high parietal hyper dense cord like lesion (Fig. 1). An initial possibility of cortical venous thrombosis due to dehydration was considered and MRI + MRV was done, which showed bilateral foci of intra cranial hemorrhage with right caudate nucleus signal changes. There was no evidence of cerebral venous thrombosis. Gradually her sensorium normalised, sugars were controlled and she was shifted to multiple subcutaneous insulin schedule and was discharged. The various causes of acute neurological deterioration in children with diabetic ketoacidosis are cerebral edema, arterial and venous thrombosis, hemorrhages besides metabolic and infective conditions. Symptomatic cerebral edema occurs in 0.5-1% of pediatric diabetic
![Research paper thumbnail of p-Tertbutylcalix[4]arene nanoemulsion: Preparation, characterization and comparative evaluation of its decontamination efficacy against Technetium-99m, Iodine-131 and Thallium-201](https://attachments.academia-assets.com/101994524/thumbnails/1.jpg)
](Colloids and Surfaces B: Biointerfaces, 2014
This study aimed to develop p-tertbutylcalix[4]arene o/w nanoemulsion for decontamination of radi... more This study aimed to develop p-tertbutylcalix[4]arene o/w nanoemulsion for decontamination of radioisotopes from skin. Formulation was characterized using dynamic light scattering (DLS), transmission electron microscopy (TEM), multi-photon confocal microscopy techniques and in vitro dissolution studies. In vivo evaluation of nano-emulsion was done using nuclear medicine technique. Stability studies and dermal toxicity studies were also carried out. Comparative decontamination efficacy (DE) studies were performed on synthetic human tissue equivalent material and Sprague Dawley rat against three commonly used medical radioisotopes, i.e., Technetium-99m (99m Tc), Iodine-131 (131 I) and Thallium-201 (201 Tl). Decontamination was performed using cotton swabs soaked in nanoemulsion at different time intervals of contaminants exposure. Whole body imaging and static counts were recorded using gamma camera before and after each decontamination attempt data was analyzed using one way analysis of variance (ANOVA) and found to be statistically significant (p < 0.05). DE of the nanoemulsion loaded with p-tertbutylcalix[4]arene was observed to be 88 ± 5%, 90 ± 3% and 89 ± 3% for 99m Tc, 131 I and 201 Tl respectively. Dermal toxicity studies revealed no significant differences between treated and control animals. Skin histopathology slides with and without API (Active pharmaceutical ingredients) also found to be comparable. p-Tertbutylcalix[4]arene loaded nanoemulsion shows great promise for skin decontamination against broad ranges of radiological contaminants besides being stable and safe.
Clinical Rheumatology, 2009
Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder. Neuro... more Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder. Neuropsychiatric SLE (NPSLE) has varied clinical and radiological manifestations. Clinical manifestations range from subtle abnormalities of neurocognitive functions and mood changes to overt psychiatric or neurological manifestations such as seizures, stroke, and psychosis. Magnetic resonance imaging (MRI) may show various types of abnormalities. Cerebral white matter lesions are most common (60-86%). Here, we are discussing a young female who presented with alteration of sensorium and right-sided hemiparesis, and MRI of the brain showed extensive involvement of brainstem in the form of possible demyelination.
British Journal of Clinical Pharmacology, 2009
Asia Pacific Journal of Medical Toxicology, 2012
Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very h... more Background: Aluminum phosphide is the common cause of poisoning in adults in India, with a very high case fatality ratio. We studied five patients of aluminum phosphide poisoning with polyserositis. Methods: We enrolled all patients with aluminum phosphide poisoning presenting to emergency medical department, at a tertiary care hospital in northwestern India from January to July 2006. These patients were managed according to a standard treatment protocol and their complications were recorded. Results: During the study period, total of 35 patients were admitted with 57.5% mortality in the first 12 hours. Among the rest, 5 patients were found to develop polyserositis. All these patients had severe hypotension at presentation and developed respiratory distress requiring mechanical ventilation after an average stay of 3.8 days post-ingestion. They were managed conservatively and four of them were discharged from the hospital after the average stay of 10 days. Conclusion: In this case se...
Annals of Indian Academy of Neurology
Acute intermittent porphyria (AIP) is an inherited metabolic disease characterized by disordered ... more Acute intermittent porphyria (AIP) is an inherited metabolic disease characterized by disordered heme biosynthesis. There is no recent study reported from India. It was a retrospective, observational study. Clinical records of patients of AIP with acute porphyric attacks admitted from April 2008 to December 2016 were analyzed. Fifteen AIP patients constituted of eight females and seven males were analyzed. Mean age at presentation was 34.33 ± 15.86 years. Thirteen patients (86.67%) had acute flaccid paralysis (AFP). All of them had peripheral neuropathy. These patients concomitantly had abdominal pain, seizure, encephalopathy, autonomic hyperactivity, history of passage of dark urine, and electrolyte abnormality (hyponatremia) in various combinations. Abdominal pain was the presenting symptom in 11 (73.33%) patients. Seven (46.67%) patients had seizure episodes. Five patients (33.33%) had hyponatremia at presentation. Significantly higher percentage of them had seizure at presentati...
Drug Delivery, 2016
Context: The unique physiological limitations of the eye have been assigned as reason of low bioa... more Context: The unique physiological limitations of the eye have been assigned as reason of low bioavailability by conventional drug delivery systems. There is need of such drug carriers, which ensure improved bioavailability as well as patient compliance upon instillation into the eye. Objective: The present investigation deals with development of solid lipid nanoparticles (SLNs) containing celecoxib (CXB) for treatment of ophthalmic inflammations. Materials and methods: The SLNs were formulated by melt-emulsion sonication and low temperature-solidification process and evaluated for particle size, surface morphology, physicochemical properties, percentage drug incorporation efficiency, in vitro drug release, in vitro trans-corneal permeation, in vivo efficacy in ocular inflammation, stability study and gamma scintigraphy study to assess the residence of solid lipid nanoparticles over ocular surfaces. Results: The SLNs were spherical and the optimized formulation had particle size of 198.77 ± 7.5 nm, which is quite suitable for ocular applications. The maximum entrapment efficiency of 92.46 ± 0.07% was achieved for formulation SLN 20. The permeation across the cornea was also significantly better than aqueous suspension (8.21 ± 0.67 versus 4.61 ± 0.71) at p50.05. Discussion and conclusion: The SLN formulations demonstrated improved performance of entrapped CXB while mitigating the key parameters of ocular inflammation in rabbits. The particulate formulations have exhibited prolonged retention over ocular surfaces as evident from results of gamma scintigraphy using 99m Tc labeled SLNs.
Indian Journal of Surgical Oncology, 2015
Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is en... more Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is endemic in India and usually seen in the northern states. Biliary ascariasis is an uncommon cause of obstructive jaundice. We present a case of carcinoma of hepatic flexure of colon in which the patient developed biliary ascariasis and posed a diagnostic challenge as it mimicked tumor infiltration of the biliary system.
Disaster medicine and public health preparedness, Jan 31, 2014
Skin contamination is one of the most likely risks after accidental or occupational radiological ... more Skin contamination is one of the most likely risks after accidental or occupational radiological accidents. Using scintigraphy, we assessed a topical lotion for its decontamination efficacy (DE) after exposure with short-lived medical radioisotopes technetium Tc 99m (99mTc) and thallium 201Tl (201Tl). Using 99mTc (300 ± 5 μCi/100 μl) and 201Tl (100 ± 5 μCi/100 μl), the thoracoabdominal region (shaved skin) of Sprague Dawley rats and human tissue equivalent were contaminated and then decontaminated using cotton swabs soaked in formulated lotion at different time intervals. Static counts were recorded and calculated for DE. Histologic examination was performed on the animal model. The DE of the formulation for 99mTc and 201Tl was 85% ± 5 and 88% ± 2, respectively. The prepared formulation effectively removed the radionuclides from the tissue surface. The formulated lotion assisted in the effective removal of radiocontaminants by decontaminating the radionuclides. Moreover, minimal and...
The American Journal of Gastroenterology, 2008
OBJECTIVES: Variceal ligation has been shown to be superior to sclerotherapy in prevention of reb... more OBJECTIVES: Variceal ligation has been shown to be superior to sclerotherapy in prevention of rebleeding and improving survival in patients with cirrhosis. However, 25% of patients will rebleed before completion of treatment. A number of trials have compared the combination of ligation and sclerotherapy to ligation alone in achieving rapid and complete eradication of esophageal varices, with conflicting results. METHODS: Two reviewers independently identified seven randomized, controlled trials that compared endoscopic variceal ligation with the combination of sclerotherapy and ligation for the treatment of esophageal varices. Studies were identified by searching MEDLINE, reviewing references from retrieved articles, and scanning abstracts from conference proceedings. For each outcome, odds ratios (ORs) were calculated using fixed-effects and random-effects models. The Mantel-Haenszel test for statistical heterogeneity was used to assess the validity of combining results from individual studies. RESULTS: No significant difference was seen in cessation of actively bleeding varices (OR ϭ 1.01, 95% CI ϭ 0.43-2.36), variceal rebleeding (OR ϭ 1.12, CI ϭ 0.69-1.81), and mortality (OR ϭ 1.1, CI ϭ 0.70-1.74) in patients with variceal ligation versus patients receiving the combination treatment of ligation and sclerotherapy. Treatment sessions required to achieve complete variceal eradication were similar in the two treatment arms. A significantly higher incidence of esophageal stricture was seen in combination therapy (p Ͻ 0.001). CONCLUSIONS: The combination of ligation and sclerotherapy offers no advantage over ligation alone in prevention of rebleeding and in reduction of mortality. It is also associated with a higher complication rate of esophageal stricture. (Am
Saudi Journal of Gastroenterology, 2011
Background/Aim: Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxid... more Background/Aim: Oxidative stress plays a major role in the pathogenesis of pancreatitis. Antioxidant therapy in the form of high-dose vitamin has been used for the treatment of severe acute pancreatitis with equivocal results. We wished to evaluate the efficacy and safety of antioxidant (vitamin A, vitamin C, vitamin E) therapy in patients with severe acute pancreatitis. Setting and design: This was a single-center, prospective, randomized, open-label with blinded endpoint assessment study of antioxidant therapy, conducted in the emergency department attached to our hospital. Materials and Methods: Thirty-nine patients with severe acute pancreatitis were randomly assigned to antioxidant treatment group (n=19) or a control group (n=20) within 96 hours of developing symptoms. Patients in the antioxidant group received antioxidants (vitamin A, vitamin E, vitamin C) in addition to the standard treatment provided to both the groups for a period of 14 days. The primary outcome variable was presence of organ dysfunction at day 7. The secondary outcome variables were length of hospital stay, multiorgan dysfunction (MODS) at day 7, recovery at the end of 4 weeks, complications, and mortality. The change in markers of oxidative stress from baseline was also measured. Results: We demonstrated no significant difference in organ dysfunction (P=1.0), MODS (P=0.8), and length of hospital stay (P=0.29) between the two groups. All the patients survived in the antioxidant-treated group, whereas two patients died in the control group. The change in the levels of malondialdehyde, superoxide dismutase, and reduced glutathione were not significantly different in the two groups at day 7. Univariate analysis showed marginal benefit with antioxidant treatment (P=0.034) in patients with severe acute pancreatitis. Conclusions: This randomized study demonstrates that there is no significant benefit from antioxidant therapy in patients with established severe acute pancreatitis.
Liver Transplantation, 2007
Journal of Infection and Public Health, 2010
Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This ... more Bungarus caeruleus (Indian common krait) bite during monsoons is common in Northwest India. This study was undertaken to find the effectiveness of neostigmine and polyvalent antivenom in improving neuromuscular paralysis following bite. All the consecutive patients admitted between June 2007 and December 2008 with common krait bite, identified either from brought snake or circumstantial evidence were studied. Ten vials of polyvalent antivenom and three doses of 2.5 mg neostigmine at 30 min intervals after administration of 0.6 mg of atropine were administered I.V. and patients were assessed for any improvement in neuroparalysis. Seventy-two patients were admitted during the study period. All the patients except two came from rural areas and were brought between June and September. Sixty-two patients were bitten during the day while clearing bricks, cutting grass or walking. The mean time interval between bite and arrival to hospital was 4.5 h. None of the patients showed any improvement following treatment and all patients developed respiratory paralysis, requiring assisted ventilation. Seventy survived and two died. Neostigmine is ineffective in reversing or improving neuroparalytic features in patients with B. caeruleus bite even at higher dose than normally recommended.
Journal of Hepatology, 2012
Results: A subset comprising 102 of the 1547 hyponatremic pts enrolled in the US between study in... more Results: A subset comprising 102 of the 1547 hyponatremic pts enrolled in the US between study initiation in September 2010 and October 2011 from 136 sites had cirrhosis and sufficient data for analysis. The mean entry and discharge [Na] values were 125.7±7.3 mmol/L, and 130.5±5.5 mmol/L, respectively. The average length of stay in days was 10.8±8.8. Conclusions: Based on interim data, HN in pts with cirrhosis is often chronic and present during multiple admissions. The majority of pts are discharged with persistent HN, even when specifically treated for HN. Additional data will be forthcoming as enrollment and analysis continue.
Journal of Gastroenterology and Hepatology, 2006
To document the clinical outcome and prognosis of acalculous cholecystitis in dengue fever. Prosp... more To document the clinical outcome and prognosis of acalculous cholecystitis in dengue fever. Prospective analysis of 27 cases of dengue fever presenting to the medical emergency of a tertiary care referral hospital in Chandigarh, India. All patients with dengue fever presenting with abdominal pain in the year 2003 were studied by ultrasound examination for the presence of acalculous cholecystitis. Five cases presented in October and 22 cases in November. Mean age was 29.8 +/- 9.7 years and there were 21 males and six females. Mean duration of fever was 5.07 +/- 1.8 days and mean duration of body ache was 4.06 +/- 2.6 days. The mean platelet counts for all cases at presentation were 29.41 +/- 18.41 x 10(9)/L and at discharge 95.28 +/- 53.01 x 10(9)/L. The mean duration of in-hospital stay was 3.4 +/- 1.7 days. Fourteen patients presented with pain in the abdomen and were confirmed to have acalculous cholecystitis on ultrasound examination of the abdomen (mean gallbladder wall thickness was 5.2 +/- 1.03 mm). Amongst all variables assessed, the only significant difference seen was that the duration of in-hospital stay was 1.68 days more in the group with acalculous cholecystitis. Acalculous cholecystitis should be strongly suspected in patients with dengue fever presenting with abdominal pain. Our study has shown that acalculous cholecystitis occurred in 14 out of 27 patients with dengue fever.
Indian Journal of Medical Sciences, 2006
Vaccine, 2012
Genetic immunization holds promise as a vaccination method, but has so far proven ineffective in ... more Genetic immunization holds promise as a vaccination method, but has so far proven ineffective in large primate and human trials. Herein, we examined the relative merits of genetic immunization and peptide immunization using bacteriophage λ. Bacteriophage λ has proven effective in immune challenge models using both immunization methods, but there has never been a direct comparison of efficacy and of the quality of immune response. In the current study, this vector was produced using a combination of cis and trans phage display. When antibody titers were measured from immunized animals together with IL-2, IL-4 and IFNγ production from splenocytes in vitro, we found that proteins displayed on λ were superior at eliciting an immune response in comparison to genetic immunization with λ. We also found that the antibodies produced in response to immunization with λ displayed proteins bound more epitopes than those produced in response to genetic immunization. Finally, the general immune re...
Diabetes Research and Clinical Practice, 2007
Bilateral parietal lobe hemorrhage in a patient with diabetic ketoacidosis Acute neurological com... more Bilateral parietal lobe hemorrhage in a patient with diabetic ketoacidosis Acute neurological complications related to diabetic ketoacidosis (DKA) include cerebral edema, cerebral infarctions, brain herniation, cortical venous thrombosis and rarely cerebral hemorrhage. A 16-year-old female presented to the emergency room with history of sudden onset alteration of sensorium for 2 h. There was history of dry cough and exertional shortness of breath of MRC grade III for the last 4 days but no history of fever, seizures, headache, photophobia, neck stiffness, blurring of vision, vomiting and any neurological deficits. She had osmotic symptoms but was not evaluated previously. On examination, she was drowsy but was responding to commands and was dehydrated, tachypnoeic and had no focal neurological deficit. Her blood sugar was 490 mg/dl and urine ketones were strongly positive. There was severe metabolic acidosis on ABG with pH of 6.81, HCO 3 1 and anion gap of 47.The prothrombin time was 10 s, Aptt 32 and PTI was 100%. She was managed on the lines of DKA. As her neurological status did not improve despite the correction of metabolic parameters and normalization of anion gap, an NCCT Head was done, which revealed bilateral high parietal hyper dense cord like lesion (Fig. 1). An initial possibility of cortical venous thrombosis due to dehydration was considered and MRI + MRV was done, which showed bilateral foci of intra cranial hemorrhage with right caudate nucleus signal changes. There was no evidence of cerebral venous thrombosis. Gradually her sensorium normalised, sugars were controlled and she was shifted to multiple subcutaneous insulin schedule and was discharged. The various causes of acute neurological deterioration in children with diabetic ketoacidosis are cerebral edema, arterial and venous thrombosis, hemorrhages besides metabolic and infective conditions. Symptomatic cerebral edema occurs in 0.5-1% of pediatric diabetic
Colloids and Surfaces B: Biointerfaces, 2014
This study aimed to develop p-tertbutylcalix[4]arene o/w nanoemulsion for decontamination of radi... more This study aimed to develop p-tertbutylcalix[4]arene o/w nanoemulsion for decontamination of radioisotopes from skin. Formulation was characterized using dynamic light scattering (DLS), transmission electron microscopy (TEM), multi-photon confocal microscopy techniques and in vitro dissolution studies. In vivo evaluation of nano-emulsion was done using nuclear medicine technique. Stability studies and dermal toxicity studies were also carried out. Comparative decontamination efficacy (DE) studies were performed on synthetic human tissue equivalent material and Sprague Dawley rat against three commonly used medical radioisotopes, i.e., Technetium-99m (99m Tc), Iodine-131 (131 I) and Thallium-201 (201 Tl). Decontamination was performed using cotton swabs soaked in nanoemulsion at different time intervals of contaminants exposure. Whole body imaging and static counts were recorded using gamma camera before and after each decontamination attempt data was analyzed using one way analysis of variance (ANOVA) and found to be statistically significant (p < 0.05). DE of the nanoemulsion loaded with p-tertbutylcalix[4]arene was observed to be 88 ± 5%, 90 ± 3% and 89 ± 3% for 99m Tc, 131 I and 201 Tl respectively. Dermal toxicity studies revealed no significant differences between treated and control animals. Skin histopathology slides with and without API (Active pharmaceutical ingredients) also found to be comparable. p-Tertbutylcalix[4]arene loaded nanoemulsion shows great promise for skin decontamination against broad ranges of radiological contaminants besides being stable and safe.
Clinical Rheumatology, 2009
Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder. Neuro... more Systemic lupus erythematosus (SLE) is a multisystem, autoimmune connective tissue disorder. Neuropsychiatric SLE (NPSLE) has varied clinical and radiological manifestations. Clinical manifestations range from subtle abnormalities of neurocognitive functions and mood changes to overt psychiatric or neurological manifestations such as seizures, stroke, and psychosis. Magnetic resonance imaging (MRI) may show various types of abnormalities. Cerebral white matter lesions are most common (60-86%). Here, we are discussing a young female who presented with alteration of sensorium and right-sided hemiparesis, and MRI of the brain showed extensive involvement of brainstem in the form of possible demyelination.
British Journal of Clinical Pharmacology, 2009