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Papers by Shiv Lal

Iranian journal of microbiology, 2010

Rapid clinical manifestation/progression of the meningococcal meningitis and lacunae in conventio... more Rapid clinical manifestation/progression of the meningococcal meningitis and lacunae in conventional bacteriological test often encourages indiscriminate use of antibiotics much before the etiology is established. Accordingly this study was planned to evaluate ctrA PCR for rapid molecular detection. In addition, multiplex PCR and sequencing was done for serogroup prediction to provide essential epidemiological and laboratory evidence for decision makers of health department of the country for choosing appropriate vaccine and phylogenetic analysis to establish its lineage. 73 CSF samples, collected from equal number of suspected cases, were investigated by both bacteriological (microscopy, culture, LA and drug sensitivity testing) as well as molecular tests i.e. PCR targeting conserved ctrA gene, multiplex PCR for serogroup characterization and DNA sequencing. ctrA PCR revealed sensitivity, specificity, positive predictive value and negative predictive values of 93.15%, 100%,100%, an...

Journal of the Indian Medical Association, 2006

Influenza A viruses cause pandemics at recurring yet unpredictable intervals. The past three pand... more Influenza A viruses cause pandemics at recurring yet unpredictable intervals. The past three pandemics had origin from birds. Although the viruses of avian influenza are not easily transmitted to humans, this may change due to either mutation or genetic reassortment. There is still an opportunity to pre-empt the pandemic. It is believed that if the surveillance system for animal health is able to detect infection in poultry quickly followed by rapid and safe culling of infected and exposed poultry and the surviellance system for human health is able to detect first human cases quickly followed by rapid containment measures including strategic use of antiviral drugs, the pandemic could be averted. This article discusses the principles and major steps of avian influenza outbreak investigations and containment.

Indian journal of pediatrics, 2004

Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course ... more Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course of one year was undertaken to understand the epidemiology of rabies. The data was collected using standardized proforma and was analyzed on EPI Info 6.02 software version. A total of 49.8% of the human rabies came from Delhi and rest belonged to adjoining states of UP (30.3%), Haryana (18.3%), Bihar (0.8%), Punjab (0.4%) and MP (0.4%). Children in the age group 5-14 years fell victim to the disease in significantly higher numbers (36.7%) as compared to other age groups. Male Female ratio was 4:1. Biting animals involved were dog (96.7%), jackal (1.7%), cat (0.8%), monkey (0.4%) and mongoose (0.4%). Majority (78.8%) had Category III exposure. Hydrophobia, which is the pathogonomic feature of human rabies, was present in 95% of cases. Remaining (5%) gave history of animal bite and presented with features of aerophobia, photophobia along with fever, weakness in limbs, parasthesia, and/or pa...

The Indian journal of medical research, 2006

Diagnosis of tuberculosis (TB) is largely based on microscopy and culture examination which are e... more Diagnosis of tuberculosis (TB) is largely based on microscopy and culture examination which are either less sensitive, or time consuming. In the present study a PCR (polymerase chain reaction) test based on DNA sequence coding for a 38-kilodalton protein antigen b (Pab) ,specific for Mycobacterium tuberculosis was compared with Ziehl-Neelsen (ZN) stained AFB (acid fast bacilli) smear examination, culture based on conventional Lowenstein-Jensen (LJ) medium and radiometric BACTEC 460 system for the diagnosis of TB using clinical samples obtained from pulmonary and extra-pulmonary cases of TB. Clinical samples obtained from 168 patients of suspected TB (pulmonary and extrapulmonary) were subjected to ZN smear examination, LJ culture, radiometric BACTEC culture and a PCR test by amplifying 419 bp sequence coding for Pab, a glycoprotein of molecular weight 38 kDa. A significant difference was seen in the sensitivity of different tests, the figures being 74.2 per cent for PCR test, 53.4 p...

The Indian Journal of Pediatrics, 2010

Malaria has been a complex public health problem affecting mainly the poor and the rural communit... more Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

The Indian Journal of Pediatrics, 2006

Nastmct. Objective : This study was planned to evaluate the MCH services, particularly immunizati... more Nastmct. Objective : This study was planned to evaluate the MCH services, particularly immunization in rural areas of the poor-performing state of Rajasthan. Methode : A community-based, cross-sectional survey using the WHO 30 cluster technique was carried out as a field exercise by participants of 9th Field Epidemiology Training Programme (FETP) course by National Institute of Communicable Diseases (NICD) in rural areas of Alwar district of Rajasthan. Results : Less than one third (28.9%) of children, aged 12-23 months, were fully immunized with BCG, 3 DPT, 30PV and Measles vaccines; around a quarter (26.5%) had not received even a single vaccine (non immunized), and little less than haft (44.5%) were found partially immunized. Around half of the eligible children were vaccinated for BCG (55.9%) and Measles (43.6%). Though nearly two-third (66.8%) were covered with first dose of DPT and OPV, but about one third of these children dropped out of third dose of DPT and OPV for various reasons. National Family Health Survey (NFHS) data also had revealed that BCG coverage was 64.3%; measles was 36.2%; and coverage by DPT 1,2, 3 and Polio 1,2 and 3 were 64.4%, 57,0%, 46.6% and 77.5%, 71.1% and 54.4% respectively in rural areas. The main reasons for drop-out or nonimmunization was "lack of information about the immunization programme" (41.3%). Though nearly all (more than 96%) of the children were immunized through Government established centers, but immunization cards/documents were made available only to 27.6% of children. Conclusion : The problem of low coverage and high drop-out rate of immunization could be overcome by creating awareness of the program and relevance of 2nd and 3rd doses of DPT and polio vaccines. Increasing community participation through intensive and extensive health education campaign should also be undertaken. Since most of the deliveries were done at home under the supervision of untrained midwives, training programme as well as involving them in IEC activities should be contemplated. [Indian J Pedlatr 2006; 73 (1) : 43-47]

The Indian Journal of Pediatrics, 2008

To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source,... more To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source, to understand the circumstances due to which the outbreak was taking place and to suggest measures for its control. The team visited Bellary from 4th to 10th Sept, 2004. The team interviewed the key persons and analyzed the records at District Surveillance Unit and Entomological Surveillance Unit and case records of suspected JE cases admitted in Encephalitis ward in Vijay Nagar Institute of Medical Sciences (VIMS). Eco-entomological survey was done in houses and surroundings of 3 randomly selected cases of Encephalitis in rural and urban areas of District Bellary. Their family members and neighbors were also asked for the awareness and presence of disease. Data was analyzed for epidemiological and clinical profiles. The suspected JE cases were being reported from end of June 2004. The cases were sporadic and out of 34 cases reported to VIMS (till 10th of September), 32 were from Bellary district and 2 were from adjoining Andhra Pradesh. Among these 32, 22 were from Bellary Taluk, which in turn were mainly concentrated (10 were reported) in urban Bellary. The case fatality rate was zero as no death was reported. Entomological surveillance (done by District Surveillance Unit) revealed a high outdoor presence of Culex tritaeniorhynchus as well as an indoor rising density of this mosquito from 2 per man hour catch in January to 22 in the month of August in the affected villages. On the contrary, the investigations on 7th and 8th September revealed high densities of An.subpictus and An. peditaenatus and nil of Culex species in the urban areas. Amplifier host of pigs and water birds were occasionally sighted in the area. A good community awareness of encephalitis, a prompt referral system and a good supportive treatment for the patients and a good surveillance system and response were observed. Very close proximity with amplifying hosts of pigs was avoided by the community, though piggeries were still not very far away (1-3 Km). These may explain the reduction in cases, deaths and disabilities due to this disease in this district over the years. Possibilities of mutant strain which is less virulent and/or a better immune status of at risk population may also need to be explored. The impact of the mass vaccination with SA 14-14-2, imported from China in Bellary during July, 2006 remains to be evaluated. This will further decrease the case load.

The Indian Journal of Pediatrics, 2009

Red Baby Syndrome is a new disease seen in infants and young children. Dramatic onset of clinical... more Red Baby Syndrome is a new disease seen in infants and young children. Dramatic onset of clinical symptoms with high intensity, short duration and lack of similarity with other cutaneous lesions makes it distinct. Of 50 such patients studied over a period of 5 years, half were below one year of age. Abrupt onset of high fever and generalized erythema involving the entire skin, which is swollen and tender is characteristic. These children were highly irritable and had paradoxical cry when cuddled. Rapid resolution of symptoms occurred in 7-10 days with extensive desquamation. Routine investigations were normal, C-reactive protein was raised only in 10 patients. Human Parvo virus B-19 IgM antibodies were positive in 15 out of 24 patients. Real time polymerase chain reaction was positive for human parvovirus B 19 DNA in one. Histopathological changes in the skin biopsy showed post infectious vascular injury pattern.

The Indian Journal of Pediatrics, 2005

Objective: Hand-Foot-and-Mouth Disease (HFMD) is a mild exanthematous illness seen worldwide, aff... more Objective: Hand-Foot-and-Mouth Disease (HFMD) is a mild exanthematous illness seen worldwide, affecting mainly children under ten years of age. The causative agents were initially Coxsackie virus type A 16 and related serotypes. The situation changed drastically about thirty years ago with the advent of a new aetiological agent, Enterovirus type 71 ( EV 71 ), which has caused very large outbreaks with severe complications and many deaths. Methods: The authors report an outbreak of papulovesicular lesions on the skin and oral mucosa compatible with the diagnosis of HFMD in children in and around Calicut in October 2003. Clinical and laboratory study in collaboration with the National Institute of Communicable Diseases, Delhi. Eighty one children with the syndrome were examined and followed up from October 2003 to February 2004, when the outbreak subsided. Result: The outbreak was mild and all children recovered within 1 to 2 weeks. Conclusion: Acute and convalescent paired serum samples collected from 19 patients were examined at the NICD for IgM antibody against EV 71 by microneutralisation test in cell culture. All the paired samples tested showed significant rise in titre of antibodies, confirming the diagnosis of EV 71 infection in each of them. [Indian J Pediatr 2005; 72 (1) : 17-21]

The Indian Journal of Pediatrics, 2006

Many viral infections are associated with significant maternal and fetal consequences during preg... more Many viral infections are associated with significant maternal and fetal consequences during pregnancy among which cytomegalovirus is one of the most important agent, globally. Both primary and recurrent infection due to this virus can result in fetal infection. Samples from Congenital Anoammaled babies are referred to NICD from Delhi based Government hospitals and surrounding areas for diagnosis of congenital infections like Toxoplasm, Rubella, CMV and Herpes. In the present study, accumulated data is presented for the most common teratogenic virus -Cytomegalovirus prevalence as a causative agent for congenital infection in New Born babies at Delhi and surrounding areas. 96 samples from symptomatic babies in the age group of few days to 6 months exhibiting different congenital anomalies, were reported between 1 st Jan 04 to 30 th April/05. All the blood samples were tested for the detection of CMV (IgM) antibodies using µ-capture ELISA technique. 18(18.75%) samples from babies showed positive titres for CMV-IgM antibodies. None of the mothers of positive babies were found positive for CMV-IgM antibodies but all were serologically exposed to CMV virus previously as their serum samples were positive for CMV -IgG antibodies indicating primary infection in the past or reactivation/reinfection with a different strain of CMV in the early pregnancy.

Data on various etiologic agents causing diarrhea in human immunodeficiency virus type-1 (HIV-1) ... more Data on various etiologic agents causing diarrhea in human immunodeficiency virus type-1 (HIV-1) infected individuals are sparse in Delhi, India. The present study was undertaken to identify various causative agents, the role of associated risk factors and immune status. A case-control study was conducted among 75 HIV-1 infected individuals, 50 with and 25 without diarrheal infection. Fecal samples were screened for coccidian parasites, enteric protozoa, and helminthes by using various staining techniques. The CD4+ T-lymphocyte count was estimated. Enteric parasites were identified among 62.7% individuals, of which Cryptosporidium emerged as the single largest pathogen predominant among 33% of the individuals (P < 0.025). Other parasites diagnosed that were significantly associated with diarrhea were Giardia lamblia (13.3%), microsporidia (6.7%), and Isospora belli (2.7%). Chronic infected diarrheal cases were found to have polyparasitic infections. The mean CD4+ cell count was found to be lower among the diarrheal cases when compared with the non-diarrheal cases (mean, 141 cells/mm(3) versus 390 cells/mm(3)). Similarly, among diarrheal individuals, the chronic diarrheal cases had a comparatively lower CD4+ cell count than the acute cases (mean, 123 cells/mm(3) versus 265 cells/mm(3)). Risk factors found significant during multivariate analysis were: residence in a slum, exposure to pets and animals, use of public toilets, and practice of unsafe homosexual activity. Enteric coccidian parasites were identified as significant agents associated with diarrhea, especially among those with improper hygiene, multiple infections and a lower CD4+ cell count. Thus, this study emphasizes the need for routine screening of enteric parasites as well as education about practicing personal hygiene and taking timely and appropriate prophylactic measures.

Infectious Diseases in Clinical Practice, 2004

Samples were drawn from patients attending the ophthalmology outpatients of the 125-bedded Sant P... more Samples were drawn from patients attending the ophthalmology outpatients of the 125-bedded Sant Parmanand Hospital. The hospital is a tertiary care hospital that caters to patients not only from adjoining areas of northern Delhi, but also from dwellings located at far-off places. ...

International Journal of Gynecology & Obstetrics, 2003

Objectives: To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac dise... more Objectives: To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country. Methods: A retrospective analysis was carried out of 207 pregnancies in women with cardiac disease who delivered at ≥28 weeks of gestation from June 1994 through December 2000 at a tertiary care center. Results: Rheumatic heart disease (n=183, 88%) with isolated mitral

Virology Journal, 2009

Background: Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant sero... more Background: Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant serotypes DENV-2 and DENV-3 in India. However recent times have marked an increase in DENV-1 circulation in yearly outbreaks. Many studies have not been carried out on this virus type, leaving a lacunae pertaining to the circulating genotypes, since its earliest report in India. In the present study, we sequenced CprM gene junction of 13 DENV-1 isolated from Delhi and Gwalior (North India) between 2001-2007 and one 1956 Vellore isolate as reference. For comparison, we retrieved 11 other Indian and 70 global reference sequences from NCBI database, making sure that Indian and global isolates from all decades are available for comparative analysis.

Public Health, 2008

Objective: An earthquake struck Kashmir on 8 October 2005. A central team of public health specia... more Objective: An earthquake struck Kashmir on 8 October 2005. A central team of public health specialists was sent to Kashmir to assess the public health measures required following the earthquake, and to assist in institution of public health measures. Study design: Epidemiological and environmental investigation in Tangdar block (Kupwara district) and Uri Tehsil (Baramula district). Methodology: Visits to villages affected by the earthquake, rehabilitation camps and health care, examination of cases with acute diarrhoeal disease (ADD), environmental observations, collection of clinical samples from ADD cases and environmental samples from drinking water sources, and laboratory methods. Results: In total, 1783 cases of ADD were reported between 14 October and 17 December 2005 in Tangdar (population 65000). The overall attack rate was 20% in children under 4 years of age. Twelve cases of ADD with loose motions without blood were studied, and 11 rectal swabs and one stool sample were processed. No bacterial enteropathogens could be isolated, but three of the 12 samples yielded rotavirus antigen on enzyme-linked immunosorbent assay. Twelve of 13 (92.3%) water samples, collected from various stream or tap water (source: spring/stream) sources, were unsatisfactory (P ¼ 0.001) using the H 2 S strip method compared with other sources (well/mineral water). All eight water sources in Tangdar block were unsatisfactory, indicated by blackening of H 2 S filter paper strips. Following the earthquake, drinking stream water or tap water without boiling or chlorination may have led to a common source water-borne outbreak of rotavirus gastroenteritis. Other contributing factors were: overcrowding; poor sanitation; open-air defaecation; poor hygiene; and living in makeshift camps near streams. Person-to-person transmission may also have contributed to perpetuation of the outbreak. Following the establishment of medical camps and information, education and communication regarding the need to drink boiled water and follow safer hygienic practices, the outbreak was brought under control. Conclusions: The earthquake in Kashmir in 2005 led to widespread contamination of drinking water sources such as stream and tap water (source: stream or spring). This appears to have led to a common source outbreak of rotavirus between October and December 2005, leading to ADD, amongst infants and small children, transmitted by the faecal-oral route and perpetuated by person-to-person transmission.

Obstetrical & Gynecological Survey, 2004

... Or filter your current search. Galan HL. Division of Maternal-Fetal Medicine, Department of O... more ... Or filter your current search. Galan HL. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Campus Box B-198 Campus Box B-198, 4200 East 9th Avenue, Denver, CO 80262, USA. ...

Journal of Microbiology, Immunology and Infection, 2010

The re-emergence of an epidemic strain of dengue virus type-3 (DENV-3) in Delhi in 2003 and its p... more The re-emergence of an epidemic strain of dengue virus type-3 (DENV-3) in Delhi in 2003 and its persistence in subsequent years marked a changing trend in dengue virus circulation in this part of India. Its evolving phylogeny over the past decade has not been studied in detail as yet. Reverse transcription polymerase chain reaction and sequencing of the CprM gene junction of DENV-3 from different outbreaks since 2003 was carried out. Thirty CprM DENV-3 sequences from this study were compared with 46 other previously reported CprM DENV-3 sequences from India and other countries. Multiple sequence alignment and phylogenetic trees were constructed to determine the extent of genetic heterogeneity and trace the phylogeny of DENV-3. Thirty CprM DENV-3 sequences (Accession numbers AY706096-99, DQ645945-52, EU181201-14, and EU846234-36) were submitted to GenBank. The CprM junction was found to be AT rich (approximately 53%). Nucleotide sequence alignment revealed only nucleotide substitutions. Phylogenetic analysis indicated sustained evolution of a distinct Indian lineage of DENV-3 genotype III in Delhi. Active circulation of DENV-3 genotype III over the last decade in Delhi was evident and worrying. This genotype has been implicated in several outbreaks in South-East Asia and other parts of the world.

Intervirology, 2008

The impact of HIV on hepatitis C virus (HCV) genome during HCV/HIV co-infection is poorly underst... more The impact of HIV on hepatitis C virus (HCV) genome during HCV/HIV co-infection is poorly understood. The present study was intended to unveil nucleotide sequence variability in the 5'-untranslated region (5'UTR) of HCV in co-infected cases. Automated nucleotide sequencing of the 5'UTR of HCV from both mono- and co-infected cases was performed. Data analysis revealed deletion of a continuous stretch of 12 nucleotides (nt 240-251) from domain IIIc in 20% co-infected cases, but no long-stretch deletion was observed in HCV from mono-infected cases. On the contrary, there was no insertion in the 5'UTR of HCV from co-infectedcases, but there were insertions in domain II and III (3 mononucleotides and 2 dinucleotides) of the 5'UTR in mono-infected cases. Since domain III is known to be important for binding of 40S ribosomal subunit, deletion of a single stretch of 12 nucleotides in HCV from co-infected cases observed in the present study may have implications during HCV replication with or without HIV infection. Although this is the first report on genomic heterogeneity in the 5'UTR of HCV from HCV/HIV co-infected Indian patients, it would be worthwhile to study if similar changes are observed in other genes of HCV during co-infection.

International Journal of Infectious Diseases, 2008

Objectives: The sudden emergence of dengue virus type 1 (DENV-1) and its co-circulation with pred... more Objectives: The sudden emergence of dengue virus type 1 (DENV-1) and its co-circulation with predominant DENV-3 was the hallmark of the 2006 dengue fever outbreak in Delhi. Viruses that circulated between 1996 and 2005 in the City have been well characterized, but the genomic diversity in 2006 strains is not known. The present study was undertaken to reveal the emerging molecular genotype(s) and evolutionary trend of the viruses responsible for the dengue fever outbreak in Delhi during 2006. Study design: The CprM gene junction of the DENV isolates from the 2006 Delhi dengue fever outbreak were subjected to nucleotide sequencing. Comparative phylogenetic analysis was done using DENV-1 and DENV-3 sequences retrieved from the global database. Results: Multiple sequence alignment revealed only substitutions, with no insertions or deletions. A dendrogram indicated emergence of a distinct lineage of DENV-1 (having similarity with the Comoros/Singapore 1993 and Delhi 1982 strains, but quite different from the Delhi 2005 lineage) and microevolution of the pre-circulating DENV-3. These findings point towards the circulation of two independent lineages of DENV-1 in Delhi during 2005 and 2006.

International Journal of Gynecology & Obstetrics, 2007

Objective: To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrel... more Objective: To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrelreleasing intrauterine system for menorrhagia. Methods: Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 μg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. Results: The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P = 0.01) and PBAC score (P = 0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean ± SD rise in hemoglobin concentration was 1.06 ± 1.7 g/dL (P = 0.000). Endometrial thickness was decreased by 3.4 ± 3.53 mm (P = 0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. Conclusion: Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.

Iranian journal of microbiology, 2010

Rapid clinical manifestation/progression of the meningococcal meningitis and lacunae in conventio... more Rapid clinical manifestation/progression of the meningococcal meningitis and lacunae in conventional bacteriological test often encourages indiscriminate use of antibiotics much before the etiology is established. Accordingly this study was planned to evaluate ctrA PCR for rapid molecular detection. In addition, multiplex PCR and sequencing was done for serogroup prediction to provide essential epidemiological and laboratory evidence for decision makers of health department of the country for choosing appropriate vaccine and phylogenetic analysis to establish its lineage. 73 CSF samples, collected from equal number of suspected cases, were investigated by both bacteriological (microscopy, culture, LA and drug sensitivity testing) as well as molecular tests i.e. PCR targeting conserved ctrA gene, multiplex PCR for serogroup characterization and DNA sequencing. ctrA PCR revealed sensitivity, specificity, positive predictive value and negative predictive values of 93.15%, 100%,100%, an...

Journal of the Indian Medical Association, 2006

Influenza A viruses cause pandemics at recurring yet unpredictable intervals. The past three pand... more Influenza A viruses cause pandemics at recurring yet unpredictable intervals. The past three pandemics had origin from birds. Although the viruses of avian influenza are not easily transmitted to humans, this may change due to either mutation or genetic reassortment. There is still an opportunity to pre-empt the pandemic. It is believed that if the surveillance system for animal health is able to detect infection in poultry quickly followed by rapid and safe culling of infected and exposed poultry and the surviellance system for human health is able to detect first human cases quickly followed by rapid containment measures including strategic use of antiviral drugs, the pandemic could be averted. This article discusses the principles and major steps of avian influenza outbreak investigations and containment.

Indian journal of pediatrics, 2004

Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course ... more Analysis of human rabies cases admitted in Infectious Diseases Hospital, Delhi during the course of one year was undertaken to understand the epidemiology of rabies. The data was collected using standardized proforma and was analyzed on EPI Info 6.02 software version. A total of 49.8% of the human rabies came from Delhi and rest belonged to adjoining states of UP (30.3%), Haryana (18.3%), Bihar (0.8%), Punjab (0.4%) and MP (0.4%). Children in the age group 5-14 years fell victim to the disease in significantly higher numbers (36.7%) as compared to other age groups. Male Female ratio was 4:1. Biting animals involved were dog (96.7%), jackal (1.7%), cat (0.8%), monkey (0.4%) and mongoose (0.4%). Majority (78.8%) had Category III exposure. Hydrophobia, which is the pathogonomic feature of human rabies, was present in 95% of cases. Remaining (5%) gave history of animal bite and presented with features of aerophobia, photophobia along with fever, weakness in limbs, parasthesia, and/or pa...

The Indian journal of medical research, 2006

Diagnosis of tuberculosis (TB) is largely based on microscopy and culture examination which are e... more Diagnosis of tuberculosis (TB) is largely based on microscopy and culture examination which are either less sensitive, or time consuming. In the present study a PCR (polymerase chain reaction) test based on DNA sequence coding for a 38-kilodalton protein antigen b (Pab) ,specific for Mycobacterium tuberculosis was compared with Ziehl-Neelsen (ZN) stained AFB (acid fast bacilli) smear examination, culture based on conventional Lowenstein-Jensen (LJ) medium and radiometric BACTEC 460 system for the diagnosis of TB using clinical samples obtained from pulmonary and extra-pulmonary cases of TB. Clinical samples obtained from 168 patients of suspected TB (pulmonary and extrapulmonary) were subjected to ZN smear examination, LJ culture, radiometric BACTEC culture and a PCR test by amplifying 419 bp sequence coding for Pab, a glycoprotein of molecular weight 38 kDa. A significant difference was seen in the sensitivity of different tests, the figures being 74.2 per cent for PCR test, 53.4 p...

The Indian Journal of Pediatrics, 2010

Malaria has been a complex public health problem affecting mainly the poor and the rural communit... more Malaria has been a complex public health problem affecting mainly the poor and the rural communities in India. Insecticide treated nets (ITN) and antimalarials are the two proven interventions for prevention and control of malaria. ITN has been amply demonstrated to be an effective intervention to protect children from malaria, and in preventing deaths due to falciparum malaria. Antimalarials are a therapeutic intervention for management of malaria, and prevention of complications due to Plasmodium falciparum infection. However, implementation of these interventions is fraught with problems of complex and multidimensional nature at the periphery. These can be addressed by optimizing the use of the 2 interventions, the insecticide treated nets and antimalarials, for area specific application and country specific needs, determined by the eco-epidemiological diversity of malaria in India. This article reviews the significant role of ITN in reducing child mortality, and the judicious use of antimalarials in the management of malaria patient, and the problems associated with the use of these interventions in protecting children against malaria in India.

The Indian Journal of Pediatrics, 2006

Nastmct. Objective : This study was planned to evaluate the MCH services, particularly immunizati... more Nastmct. Objective : This study was planned to evaluate the MCH services, particularly immunization in rural areas of the poor-performing state of Rajasthan. Methode : A community-based, cross-sectional survey using the WHO 30 cluster technique was carried out as a field exercise by participants of 9th Field Epidemiology Training Programme (FETP) course by National Institute of Communicable Diseases (NICD) in rural areas of Alwar district of Rajasthan. Results : Less than one third (28.9%) of children, aged 12-23 months, were fully immunized with BCG, 3 DPT, 30PV and Measles vaccines; around a quarter (26.5%) had not received even a single vaccine (non immunized), and little less than haft (44.5%) were found partially immunized. Around half of the eligible children were vaccinated for BCG (55.9%) and Measles (43.6%). Though nearly two-third (66.8%) were covered with first dose of DPT and OPV, but about one third of these children dropped out of third dose of DPT and OPV for various reasons. National Family Health Survey (NFHS) data also had revealed that BCG coverage was 64.3%; measles was 36.2%; and coverage by DPT 1,2, 3 and Polio 1,2 and 3 were 64.4%, 57,0%, 46.6% and 77.5%, 71.1% and 54.4% respectively in rural areas. The main reasons for drop-out or nonimmunization was "lack of information about the immunization programme" (41.3%). Though nearly all (more than 96%) of the children were immunized through Government established centers, but immunization cards/documents were made available only to 27.6% of children. Conclusion : The problem of low coverage and high drop-out rate of immunization could be overcome by creating awareness of the program and relevance of 2nd and 3rd doses of DPT and polio vaccines. Increasing community participation through intensive and extensive health education campaign should also be undertaken. Since most of the deliveries were done at home under the supervision of untrained midwives, training programme as well as involving them in IEC activities should be contemplated. [Indian J Pedlatr 2006; 73 (1) : 43-47]

The Indian Journal of Pediatrics, 2008

To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source,... more To confirm the existence of the outbreak of suspected Japanese encephalitis, identify the source, to understand the circumstances due to which the outbreak was taking place and to suggest measures for its control. The team visited Bellary from 4th to 10th Sept, 2004. The team interviewed the key persons and analyzed the records at District Surveillance Unit and Entomological Surveillance Unit and case records of suspected JE cases admitted in Encephalitis ward in Vijay Nagar Institute of Medical Sciences (VIMS). Eco-entomological survey was done in houses and surroundings of 3 randomly selected cases of Encephalitis in rural and urban areas of District Bellary. Their family members and neighbors were also asked for the awareness and presence of disease. Data was analyzed for epidemiological and clinical profiles. The suspected JE cases were being reported from end of June 2004. The cases were sporadic and out of 34 cases reported to VIMS (till 10th of September), 32 were from Bellary district and 2 were from adjoining Andhra Pradesh. Among these 32, 22 were from Bellary Taluk, which in turn were mainly concentrated (10 were reported) in urban Bellary. The case fatality rate was zero as no death was reported. Entomological surveillance (done by District Surveillance Unit) revealed a high outdoor presence of Culex tritaeniorhynchus as well as an indoor rising density of this mosquito from 2 per man hour catch in January to 22 in the month of August in the affected villages. On the contrary, the investigations on 7th and 8th September revealed high densities of An.subpictus and An. peditaenatus and nil of Culex species in the urban areas. Amplifier host of pigs and water birds were occasionally sighted in the area. A good community awareness of encephalitis, a prompt referral system and a good supportive treatment for the patients and a good surveillance system and response were observed. Very close proximity with amplifying hosts of pigs was avoided by the community, though piggeries were still not very far away (1-3 Km). These may explain the reduction in cases, deaths and disabilities due to this disease in this district over the years. Possibilities of mutant strain which is less virulent and/or a better immune status of at risk population may also need to be explored. The impact of the mass vaccination with SA 14-14-2, imported from China in Bellary during July, 2006 remains to be evaluated. This will further decrease the case load.

The Indian Journal of Pediatrics, 2009

Red Baby Syndrome is a new disease seen in infants and young children. Dramatic onset of clinical... more Red Baby Syndrome is a new disease seen in infants and young children. Dramatic onset of clinical symptoms with high intensity, short duration and lack of similarity with other cutaneous lesions makes it distinct. Of 50 such patients studied over a period of 5 years, half were below one year of age. Abrupt onset of high fever and generalized erythema involving the entire skin, which is swollen and tender is characteristic. These children were highly irritable and had paradoxical cry when cuddled. Rapid resolution of symptoms occurred in 7-10 days with extensive desquamation. Routine investigations were normal, C-reactive protein was raised only in 10 patients. Human Parvo virus B-19 IgM antibodies were positive in 15 out of 24 patients. Real time polymerase chain reaction was positive for human parvovirus B 19 DNA in one. Histopathological changes in the skin biopsy showed post infectious vascular injury pattern.

The Indian Journal of Pediatrics, 2005

Objective: Hand-Foot-and-Mouth Disease (HFMD) is a mild exanthematous illness seen worldwide, aff... more Objective: Hand-Foot-and-Mouth Disease (HFMD) is a mild exanthematous illness seen worldwide, affecting mainly children under ten years of age. The causative agents were initially Coxsackie virus type A 16 and related serotypes. The situation changed drastically about thirty years ago with the advent of a new aetiological agent, Enterovirus type 71 ( EV 71 ), which has caused very large outbreaks with severe complications and many deaths. Methods: The authors report an outbreak of papulovesicular lesions on the skin and oral mucosa compatible with the diagnosis of HFMD in children in and around Calicut in October 2003. Clinical and laboratory study in collaboration with the National Institute of Communicable Diseases, Delhi. Eighty one children with the syndrome were examined and followed up from October 2003 to February 2004, when the outbreak subsided. Result: The outbreak was mild and all children recovered within 1 to 2 weeks. Conclusion: Acute and convalescent paired serum samples collected from 19 patients were examined at the NICD for IgM antibody against EV 71 by microneutralisation test in cell culture. All the paired samples tested showed significant rise in titre of antibodies, confirming the diagnosis of EV 71 infection in each of them. [Indian J Pediatr 2005; 72 (1) : 17-21]

The Indian Journal of Pediatrics, 2006

Many viral infections are associated with significant maternal and fetal consequences during preg... more Many viral infections are associated with significant maternal and fetal consequences during pregnancy among which cytomegalovirus is one of the most important agent, globally. Both primary and recurrent infection due to this virus can result in fetal infection. Samples from Congenital Anoammaled babies are referred to NICD from Delhi based Government hospitals and surrounding areas for diagnosis of congenital infections like Toxoplasm, Rubella, CMV and Herpes. In the present study, accumulated data is presented for the most common teratogenic virus -Cytomegalovirus prevalence as a causative agent for congenital infection in New Born babies at Delhi and surrounding areas. 96 samples from symptomatic babies in the age group of few days to 6 months exhibiting different congenital anomalies, were reported between 1 st Jan 04 to 30 th April/05. All the blood samples were tested for the detection of CMV (IgM) antibodies using µ-capture ELISA technique. 18(18.75%) samples from babies showed positive titres for CMV-IgM antibodies. None of the mothers of positive babies were found positive for CMV-IgM antibodies but all were serologically exposed to CMV virus previously as their serum samples were positive for CMV -IgG antibodies indicating primary infection in the past or reactivation/reinfection with a different strain of CMV in the early pregnancy.

Data on various etiologic agents causing diarrhea in human immunodeficiency virus type-1 (HIV-1) ... more Data on various etiologic agents causing diarrhea in human immunodeficiency virus type-1 (HIV-1) infected individuals are sparse in Delhi, India. The present study was undertaken to identify various causative agents, the role of associated risk factors and immune status. A case-control study was conducted among 75 HIV-1 infected individuals, 50 with and 25 without diarrheal infection. Fecal samples were screened for coccidian parasites, enteric protozoa, and helminthes by using various staining techniques. The CD4+ T-lymphocyte count was estimated. Enteric parasites were identified among 62.7% individuals, of which Cryptosporidium emerged as the single largest pathogen predominant among 33% of the individuals (P < 0.025). Other parasites diagnosed that were significantly associated with diarrhea were Giardia lamblia (13.3%), microsporidia (6.7%), and Isospora belli (2.7%). Chronic infected diarrheal cases were found to have polyparasitic infections. The mean CD4+ cell count was found to be lower among the diarrheal cases when compared with the non-diarrheal cases (mean, 141 cells/mm(3) versus 390 cells/mm(3)). Similarly, among diarrheal individuals, the chronic diarrheal cases had a comparatively lower CD4+ cell count than the acute cases (mean, 123 cells/mm(3) versus 265 cells/mm(3)). Risk factors found significant during multivariate analysis were: residence in a slum, exposure to pets and animals, use of public toilets, and practice of unsafe homosexual activity. Enteric coccidian parasites were identified as significant agents associated with diarrhea, especially among those with improper hygiene, multiple infections and a lower CD4+ cell count. Thus, this study emphasizes the need for routine screening of enteric parasites as well as education about practicing personal hygiene and taking timely and appropriate prophylactic measures.

Infectious Diseases in Clinical Practice, 2004

Samples were drawn from patients attending the ophthalmology outpatients of the 125-bedded Sant P... more Samples were drawn from patients attending the ophthalmology outpatients of the 125-bedded Sant Parmanand Hospital. The hospital is a tertiary care hospital that caters to patients not only from adjoining areas of northern Delhi, but also from dwellings located at far-off places. ...

International Journal of Gynecology & Obstetrics, 2003

Objectives: To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac dise... more Objectives: To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country. Methods: A retrospective analysis was carried out of 207 pregnancies in women with cardiac disease who delivered at ≥28 weeks of gestation from June 1994 through December 2000 at a tertiary care center. Results: Rheumatic heart disease (n=183, 88%) with isolated mitral

Virology Journal, 2009

Background: Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant sero... more Background: Dengue virus type 1 (DENV-1) have been mostly circulating silently with dominant serotypes DENV-2 and DENV-3 in India. However recent times have marked an increase in DENV-1 circulation in yearly outbreaks. Many studies have not been carried out on this virus type, leaving a lacunae pertaining to the circulating genotypes, since its earliest report in India. In the present study, we sequenced CprM gene junction of 13 DENV-1 isolated from Delhi and Gwalior (North India) between 2001-2007 and one 1956 Vellore isolate as reference. For comparison, we retrieved 11 other Indian and 70 global reference sequences from NCBI database, making sure that Indian and global isolates from all decades are available for comparative analysis.

Public Health, 2008

Objective: An earthquake struck Kashmir on 8 October 2005. A central team of public health specia... more Objective: An earthquake struck Kashmir on 8 October 2005. A central team of public health specialists was sent to Kashmir to assess the public health measures required following the earthquake, and to assist in institution of public health measures. Study design: Epidemiological and environmental investigation in Tangdar block (Kupwara district) and Uri Tehsil (Baramula district). Methodology: Visits to villages affected by the earthquake, rehabilitation camps and health care, examination of cases with acute diarrhoeal disease (ADD), environmental observations, collection of clinical samples from ADD cases and environmental samples from drinking water sources, and laboratory methods. Results: In total, 1783 cases of ADD were reported between 14 October and 17 December 2005 in Tangdar (population 65000). The overall attack rate was 20% in children under 4 years of age. Twelve cases of ADD with loose motions without blood were studied, and 11 rectal swabs and one stool sample were processed. No bacterial enteropathogens could be isolated, but three of the 12 samples yielded rotavirus antigen on enzyme-linked immunosorbent assay. Twelve of 13 (92.3%) water samples, collected from various stream or tap water (source: spring/stream) sources, were unsatisfactory (P ¼ 0.001) using the H 2 S strip method compared with other sources (well/mineral water). All eight water sources in Tangdar block were unsatisfactory, indicated by blackening of H 2 S filter paper strips. Following the earthquake, drinking stream water or tap water without boiling or chlorination may have led to a common source water-borne outbreak of rotavirus gastroenteritis. Other contributing factors were: overcrowding; poor sanitation; open-air defaecation; poor hygiene; and living in makeshift camps near streams. Person-to-person transmission may also have contributed to perpetuation of the outbreak. Following the establishment of medical camps and information, education and communication regarding the need to drink boiled water and follow safer hygienic practices, the outbreak was brought under control. Conclusions: The earthquake in Kashmir in 2005 led to widespread contamination of drinking water sources such as stream and tap water (source: stream or spring). This appears to have led to a common source outbreak of rotavirus between October and December 2005, leading to ADD, amongst infants and small children, transmitted by the faecal-oral route and perpetuated by person-to-person transmission.

Obstetrical & Gynecological Survey, 2004

... Or filter your current search. Galan HL. Division of Maternal-Fetal Medicine, Department of O... more ... Or filter your current search. Galan HL. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Campus Box B-198 Campus Box B-198, 4200 East 9th Avenue, Denver, CO 80262, USA. ...

Journal of Microbiology, Immunology and Infection, 2010

The re-emergence of an epidemic strain of dengue virus type-3 (DENV-3) in Delhi in 2003 and its p... more The re-emergence of an epidemic strain of dengue virus type-3 (DENV-3) in Delhi in 2003 and its persistence in subsequent years marked a changing trend in dengue virus circulation in this part of India. Its evolving phylogeny over the past decade has not been studied in detail as yet. Reverse transcription polymerase chain reaction and sequencing of the CprM gene junction of DENV-3 from different outbreaks since 2003 was carried out. Thirty CprM DENV-3 sequences from this study were compared with 46 other previously reported CprM DENV-3 sequences from India and other countries. Multiple sequence alignment and phylogenetic trees were constructed to determine the extent of genetic heterogeneity and trace the phylogeny of DENV-3. Thirty CprM DENV-3 sequences (Accession numbers AY706096-99, DQ645945-52, EU181201-14, and EU846234-36) were submitted to GenBank. The CprM junction was found to be AT rich (approximately 53%). Nucleotide sequence alignment revealed only nucleotide substitutions. Phylogenetic analysis indicated sustained evolution of a distinct Indian lineage of DENV-3 genotype III in Delhi. Active circulation of DENV-3 genotype III over the last decade in Delhi was evident and worrying. This genotype has been implicated in several outbreaks in South-East Asia and other parts of the world.

Intervirology, 2008

The impact of HIV on hepatitis C virus (HCV) genome during HCV/HIV co-infection is poorly underst... more The impact of HIV on hepatitis C virus (HCV) genome during HCV/HIV co-infection is poorly understood. The present study was intended to unveil nucleotide sequence variability in the 5'-untranslated region (5'UTR) of HCV in co-infected cases. Automated nucleotide sequencing of the 5'UTR of HCV from both mono- and co-infected cases was performed. Data analysis revealed deletion of a continuous stretch of 12 nucleotides (nt 240-251) from domain IIIc in 20% co-infected cases, but no long-stretch deletion was observed in HCV from mono-infected cases. On the contrary, there was no insertion in the 5'UTR of HCV from co-infectedcases, but there were insertions in domain II and III (3 mononucleotides and 2 dinucleotides) of the 5'UTR in mono-infected cases. Since domain III is known to be important for binding of 40S ribosomal subunit, deletion of a single stretch of 12 nucleotides in HCV from co-infected cases observed in the present study may have implications during HCV replication with or without HIV infection. Although this is the first report on genomic heterogeneity in the 5'UTR of HCV from HCV/HIV co-infected Indian patients, it would be worthwhile to study if similar changes are observed in other genes of HCV during co-infection.

International Journal of Infectious Diseases, 2008

Objectives: The sudden emergence of dengue virus type 1 (DENV-1) and its co-circulation with pred... more Objectives: The sudden emergence of dengue virus type 1 (DENV-1) and its co-circulation with predominant DENV-3 was the hallmark of the 2006 dengue fever outbreak in Delhi. Viruses that circulated between 1996 and 2005 in the City have been well characterized, but the genomic diversity in 2006 strains is not known. The present study was undertaken to reveal the emerging molecular genotype(s) and evolutionary trend of the viruses responsible for the dengue fever outbreak in Delhi during 2006. Study design: The CprM gene junction of the DENV isolates from the 2006 Delhi dengue fever outbreak were subjected to nucleotide sequencing. Comparative phylogenetic analysis was done using DENV-1 and DENV-3 sequences retrieved from the global database. Results: Multiple sequence alignment revealed only substitutions, with no insertions or deletions. A dendrogram indicated emergence of a distinct lineage of DENV-1 (having similarity with the Comoros/Singapore 1993 and Delhi 1982 strains, but quite different from the Delhi 2005 lineage) and microevolution of the pre-circulating DENV-3. These findings point towards the circulation of two independent lineages of DENV-1 in Delhi during 2005 and 2006.

International Journal of Gynecology & Obstetrics, 2007

Objective: To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrel... more Objective: To evaluate the efficacy, acceptability, and possible side effects of a levonorgestrelreleasing intrauterine system for menorrhagia. Methods: Sixty-three women with menorrhagia but without uterine enlargement, endometrial hyperplasia with atypia, or endometrial carcinoma were enrolled in this prospective, open, nonrandomized clinical trial. An intrauterine system releasing 20 μg/day of levonorgestrel (LNG-IUS; Mirena, Shering, Finland) was inserted in the postmenstrual phase. Menstrual pattern, number of bleeding days, and subjective and objective estimation of menstrual blood loss using a pictorial blood loss assessment chart (PBAC) were recorded before insertion and at specific intervals for 4 years. Hemoglobin levels and endometrial thickness were evaluated at baseline and at 12 months. Treatment continuation and hysterectomy rates were noted as well as side effects. Results: The device was expelled spontaneously in 6 patients (9.52%) and removed prematurely in 9 patients (14.3%); 3 patients (4.8%) were lost to follow-up; and 45 patients (71.4%) continued with the LNG-IUS. Menorrhagia was cured in 35 (77.7%) of these 45 patients at 3 months and in all patients at 36 months. There was a significant decrease in the mean number of bleeding days (P = 0.01) and PBAC score (P = 0.00) at 1 month, and the decrease continued with treatment duration. The subjective blood loss reduction was considerable as well, and at 12 months the mean ± SD rise in hemoglobin concentration was 1.06 ± 1.7 g/dL (P = 0.000). Endometrial thickness was decreased by 3.4 ± 3.53 mm (P = 0.0001) at 12 months. The most common side effect was intermenstrual spotting during the first 6 months, and 18 patients (28.57%) developed amenorrhea. Conclusion: Using the LNG-IUS is an effective and well-accepted option overall for the medical management of menorrhagia.