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Gurnani H, Naik S, Dsouza A, Thakur K. Using a mobile phone-based application as an adjunct to facilitate oral hygiene practices in children with Attention Deficit Hyperactivity Disorder (ADHD). Eur J Paediatr Dent 2023; 24:267 - 271. [PMID: 37782302 DOI: 10.23804/ejpd.2023.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
AIM To evaluate the efficacy of a mobile phone application to facilitate oral hygiene practices in children with ADHD. METHODS This was a randomized controlled study that included 54 ADHD children after obtaining informed parental consent. The children were randomly divided into 2 groups; Group 1 (conventional) participants were instructed verbally as well as demonstrated the brushing technique on models. Group 2 (mobile phone application) participants were made to download and use the 'BRUSH DJ' app developed by Ben Underwood. At baseline, the oral hygiene index-simplified (OHI-S) [Greene and Vermillion, 1964] of each child was evaluated clinically and the parents were asked to fill a questionnaire regarding the oral hygiene practices followed by their child every day. At the end of the second, sixth, and twelfth week, the parents were asked to fill the same questionnaire in addition to the evaluation of the OHI-S index. RESULTS A significant difference was found in the brushing time, brushing frequency, and OHI-S index between group 1 and group 2 at the end of 12 weeks. (unpaired t-test, p<0.05) CONCLUSION The mobile phone application proved to be an effective tool in captivating the attention of these children and thus improving their oral health.
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Affiliation(s)
- H Gurnani
- BDS, MDS, Pediatric & Preventive Dentist, Myofunctional Therapist, Mumbai, India
| | - S Naik
- BDS, MDS, Professor & Head of the Department, Department of Pediatric and Preventive Dentistry, D.Y Patil deemed to be University - School of Dentistry, Navi Mumbai, India
| | - A Dsouza
- BDS, MDS, Department of Pediatric & Preventive Dentistry, DY Patil deemed to be University - School Of Dentistry, Navi Mumbai, India
| | - K Thakur
- BDS, MDS, Department of Pediatric & Preventive Dentistry, DY Patil deemed to be University - School Of Dentistry, Navi Mumbai, India
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Biswas B, Thakur K, Pote TD, Sharma KD, Krishnan SG, Singh AK, Sharma TR, Rathour R. Genetic and molecular analysis of leaf blast resistance in Tetep derived line RIL4 and its relationship to genes at Pita/Pita 2 locus. Sci Rep 2023; 13:18683. [PMID: 37907574 PMCID: PMC10618204 DOI: 10.1038/s41598-023-46070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023] Open
Abstract
The Vietnamese indica landrace 'Tetep' is known worldwide for its durable and broad spectrum-resistance to blast. We performed genetic and molecular analyses of leaf blast resistance in a Tetep derived recombinant inbred line 'RIL4' which is resistant to both leaf and neck blast. Phenotypic analysis of segregating F2 progenies suggested that leaf blast resistance in RIL4 was controlled by a dominant gene tentatively designated as Pi-l(t). The gene was mapped to a 2.4 cm region close to the centromere of chromosome 12. The search for the gene content in the equivalent genomic region of reference cv. Nipponbare revealed the presence of five NBS-LRR genes, two of which corresponded to the alleles of Pita and Pi67 genes previously identified from Tetep. The two other genes, LOC_Os12g17090, and LOC_Os12g17490 represented the homologs of stripe rust resistance gene Yr10. The allelic tests with Pita2 and Pi67 lines suggested that the leaf blast resistance gene in RIL4 is either allelic or tightly linked to these genes. The genomic position of the leaf blast resistance gene in RIL4 perfectly coincided with the genomic position of a neck blast resistance gene Pb2 previously identified from this line suggesting that the same gene confers resistance to leaf and neck blast. The present results were discussed in juxtaposition with past studies on the genes of Pita/Pita2 resistance gene complex.
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Affiliation(s)
- B Biswas
- CSK Himachal Pradesh Agricultural University, Palampur, 176062, India
| | - K Thakur
- College of Horticulture and Forestry, Dr YSP University of Horticulture and Forestry, Thunag, 175048, India
| | - T D Pote
- CSK Himachal Pradesh Agricultural University, Palampur, 176062, India
| | - K D Sharma
- CSK Himachal Pradesh Agricultural University, Palampur, 176062, India
| | - S Gopala Krishnan
- Division of Genetics, Indian Agricultural Research Institute, New Delhi, 110012, India
| | - A K Singh
- Division of Genetics, Indian Agricultural Research Institute, New Delhi, 110012, India
| | - T R Sharma
- Indian Council of Agricultural Research, Krishi Bhawan, New Delhi, 110001, India
| | - R Rathour
- CSK Himachal Pradesh Agricultural University, Palampur, 176062, India.
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Sharma H, Khajuria K, Bansal N, Thakur K, Sharma A. Plateletpheresis donor deferral patterns at a tertiary care hospital in North India: A need for rethink of haemoglobin cutoff. Transfus Clin Biol 2023; 30:268-271. [PMID: 36893913 DOI: 10.1016/j.tracli.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The donor deferral criteria for blood or apheresis donations are established for two main reasons: (i) to ensure the safety of the blood donor (non-maleficence); (ii) to obtain safe blood of standard quality that has therapeutic benefit for the patient (beneficence). This study was planned to assess the various causes and patterns of plateletpheresis donor deferral in our hospital and to subsequently assess whether any evidence based changes can be done in the current plateletpheresis donor deferral criteria in India to maximize the platelet donor pool without compromising donor safety. MATERIAL AND METHODS The present study was conducted from May 2021 till June 2022 in the department of transfusion medicine of a tertiary care hospital in North India. The first part of the study was conducted from May 2021 till March 2022 to assess the various causes of donor deferral by analysing the plateletpheresis donor deferral data during the corresponding period. The second part of the study was conducted from April 2022 till June 2022, to assess: (i) average decrease in haemoglobin after plateletpheresis procedure; (ii) red blood cell loss during plateletpheresis procedure; (iii) to determine whether any correlation exists between donor haemoglobin and platelet yield. RESULTS During the study period, a total of 260 donors were screened for plateletpheresis, out of which 221 (85%) donors were accepted and 39 (15%) donors were deferred for various reasons. Out of the 39 deferred donors, 33 (84.6%) were temporary deferrals, while 6 (15.4%) were permanent deferrals. Low haemoglobin (Hb < 12.5 g/dl) was a cause of deferral in 12.8% (n = 5) of the deferred donors. 192 (73.9%) out of the 260 donors were replacement donors. The calculated mean decrease in haemoglobin as a result of plateletpheresis procedure was 0.4 g/dl. No correlation was seen between donor pre-donation haemoglobin and platelet yield (p = 0.86, r = 0.06, R2 = 0.003). The calculated mean red cell loss as a result of plateletpheresis procedure was 28 ml. CONCLUSION Low haemoglobin (<12.5 g/dl) is a significant cause of temporary plateletpheresis donor deferral in India. In view of the advancement in plateletpheresis technology, which has resulted in minimal red cell loss with the current generation apheresis devices, haemoglobin cutoff of 12.5 g/dl needs to be reconsidered. Perhaps, after performing a multi-centric trial, a consenscus can be reached for revision of haemoglobin cutoff for plateletpheresis donations.
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Affiliation(s)
- Himani Sharma
- Department of Pathology, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Kajal Khajuria
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Naveen Bansal
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India.
| | - Kusum Thakur
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Ashish Sharma
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Bansal N, Bansal Y, Singh C, Gulia A, Thakur K. Red cell alloimmunization in thalassaemia patients in India: Causes and mitigation strategies. Transfus Clin Biol 2023; 30:187-188. [PMID: 36806792 DOI: 10.1016/j.tracli.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India.
| | - Yashik Bansal
- Department of Microbiology, ESIC Medical College and Hospital, Alwar, Rajasthan, India
| | - Charu Singh
- Department of Microbiology, Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Ashish Gulia
- Homi Bhabha Cancer Hospital and Research Centre, Punjab, India
| | - Kusum Thakur
- Department of Transfusion Medicine, Shrimann Super Specialty Hospital, Jalandhar, Punjab, India
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Bansal N, Bansal Y, Raturi M, Thakur K, Sood A, Kumar S. Blood Inventory Management During COVID-19 Pandemic Using a Simple Mathematical Tool: A Two-Year Study from a Tertiary Care Hospital in North India. Indian J Hematol Blood Transfus 2023; 39:1-7. [PMID: 36741877 PMCID: PMC9889947 DOI: 10.1007/s12288-023-01631-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
Multiple recurrent waves of the coronavirus disease 2019 (COVID-19) resulted in major fluctuations in blood supply and demand, which presented a major challenge for the blood centres to maintain adequate blood inventory. Hence, the primary aim of the present study was to determine whether safety stock as a simple mathematical tool can be used to maintain optimum blood inventory to meet all blood demands. The secondary aim of the study was to test whether daily blood stock index (DBSI), which was a novel index developed by the authors and derived from the calculated safety stock, can be used to minimize blood wastage due to the outdating of packed red blood cells (PRBC)/whole blood (WB) units. The present study was a descriptive, cross-sectional study conducted from 1st October 2019 to 31st December 2021 at a blood centre of a tertiary care hospital. For the purpose of data analysis, the time period of study was divided into 7 periods signifying different phases during the COVID-19 outbreak. Data of PRBC/WB (referred to as red cell) collection, red cell issue and the daily red cell stock were collected for these 7 time periods. Safety stock, percentage of out-dated whole blood/packed red blood cell units (OB) and DBSI were calculated based on the data extracted. Red cell collection as well as red cell utilization decreased during the 1st as well as the 2nd wave of the COVID-19 outbreak. The blood centre was able to meet the blood demand of the hospital at all times, as the daily average red cell stock remained above the calculated safety stock during all periods. OB (12.4%) and DBSI (2.3) were highest during the lockdown period of second wave of COVID-19 outbreak (period E). A strong direct relationship was seen between OB (dependent variable) and DBSI (predictor variable) [R = 0.79; p = 0.03]. Firstly, safety stock is a simple, user-friendly mathematic tool which can be used for efficient blood inventory management not only at times of a pandemic/disaster but also during routine times. Secondly, DBSI is a logical and empirical tool to reduce OB units and consequently reduce blood wastage.
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Affiliation(s)
- Naveen Bansal
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
| | - Yashik Bansal
- Department of Microbiology, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
| | - Manish Raturi
- Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand India
| | - Kusum Thakur
- Department of Transfusion Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana India
| | - Ashwani Sood
- Department of Hospital Administration, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana India
| | - Satish Kumar
- Department of Transfusion Medicine, VCSG Government Institute of Medical Science and Research, Srinagar, Uttarakhand India
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Clarke JF, Thakur K, Polak S. A mechanistic physiologically based model to assess the effect of study design and modified physiology on formulation safe space for virtual bioequivalence of dermatological drug products. Front Pharmacol 2022; 13:1007496. [PMID: 36532731 PMCID: PMC9756572 DOI: 10.3389/fphar.2022.1007496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/07/2022] [Indexed: 10/04/2023] Open
Abstract
Physiologically based pharmacokinetic (PBPK) models are widely accepted tools utilised to describe and predict drug pharmacokinetics (PK). This includes the use of dermal PBPK models at the regulatory level including virtual bioequivalence (VBE) studies. The current work considers the Topicort® Spray formulation, which contains 0.25% desoximetasone (DSM), as an example formulation. Quantitative formulation composition and in vitro permeation testing (IVPT) data were obtained from the public literature to develop a mechanistic model using the multi-phase, multi-layer (MPML) MechDermA IVPT module in the Simcyp Simulator. In vitro-in vivo extrapolation functionality was used to simulate in vivo PK for various scenarios and predict a 'safe space' for formulation bioequivalence using the VBE module. The potential effect of vasoconstriction, impaired barrier function, and various dosing scenarios on the formulation safe space was also assessed. The model predicted 'safe space' for formulation solubility suggesting that a 50% change in solubility may cause bio-in-equivalence, whereas viscosity could deviate by orders of magnitude and the formulation may still remain bioequivalent. Evaporation rate and fraction of volatile components showed some sensitivity, suggesting that large changes in the volume or composition of the volatile fraction could cause bio-in-equivalence. The tested dosing scenarios showed decreased sensitivity for all formulation parameters with a decreased dose. The relative formulation bioequivalence was insensitive to vasoconstriction, but the safe space became wider with decreased barrier function for all parameters, except viscosity that was unaffected.
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Affiliation(s)
- J. F. Clarke
- Simcyp Division, Certara UK, Sheffield, United Kingdom
- Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
| | - K. Thakur
- Simcyp Division, Certara UK, Sheffield, United Kingdom
| | - S. Polak
- Simcyp Division, Certara UK, Sheffield, United Kingdom
- Faculty of Pharmacy, Jagiellonian University Medical College, Krakow, Poland
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Bansal N, Raturi M, Dhiman Y, Adhikari B, Thakur K. The Indian “blood storage centre” model for the provision of safe blood towards obstetric care in the remote regions of Uttarakhand. Transfus Clin Biol 2022; 30:183-184. [PMID: 36273774 DOI: 10.1016/j.tracli.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
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Khajuria K, Thakur K, Sharma R, Singh A. COVID-19 pandemic preparedness of blood center. Asian J Transfus Sci 2021; 15:117-118. [PMID: 34349472 PMCID: PMC8294430 DOI: 10.4103/ajts.ajts_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kajal Khajuria
- Department of Transfusion Medicine, MMIMSR, Mullana, Ambala, Haryana, India
| | - Kusum Thakur
- Department of Transfusion Medicine, MMIMSR, Mullana, Ambala, Haryana, India
| | - Raman Sharma
- Department of Transfusion Medicine, MMIMSR, Mullana, Ambala, Haryana, India
| | - Achchhar Singh
- Department of Transfusion Medicine, MMIMSR, Mullana, Ambala, Haryana, India
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Rauniyar BK, Kadel A, Thakur K, Adhikari RB, Limbu D, Acharya K, Rajbhandari S, Kansakar S, Malla R, Adhikari CM, Maskey A, Rajbhandari R. Spectrum of coronary angiographic findings in patients with ST Elevation Myocardial Infarction (STEMI) undergoing primary PCI in a tertiary care center of Nepal. Ann Cardiol Angeiol (Paris) 2021; 71:32-35. [PMID: 33637314 DOI: 10.1016/j.ancard.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Even in developing countries like Nepal, prevalence of ST-elevation myocardial infarction has been shown to be increased with rise in prevalence of conventional risk factors like diabetes, Hypertension, smoking, dyslipidemia and obesity. Our aim is to retrospectively analyze for various risk factors and angiographic patterns of coronary artery disease in patients with ST-elevation myocardial infarction undergoing Primary Percutaneous Intervention. RESULTS During the period of 1 year (January 2019 to December 2019), 816 patients presented to our ER with acute STEMI, among them 437 (53.6%) patients underwent primary PCI strategy and among them 22 (5.3%) patients were died. Thirty-six (4.4%) patients received thrombolysis, among them 5 (13.9%) patients were died while remaining 343 (42.0%) patients were managed conservatively and among them 20 (5.8%) were died. The mean age of patient who underwent primary PCI was 58.5±12.7 years range from 25 years to 99 years. Among them 55-75 years old 217 (49.6%) were highest in number followed by<55 years old 180 (41.2%). Males 318 (72.8%) were predominant. Among those who underwent primary PCI, hypertension 214 (49%) was the most common risk factor, followed by smoking 198 (45.3%), diabetes mellitus 123 (28.1%), dyslipidemia 53 (12.1%) and family history of premature coronary artery disease 18 (4.1%). Among those patients, 292 patients (66.8%) had single vessel disease, 99 patients (22.7%) had double vessel disease, 41 patients (9.3%) had triple vessel disease and 5 patients (1.1%) had non-significant coronary artery stenosis. Left anterior descending (53.3%) was the most frequently found culprit artery, followed by right coronary artery, left circumflex, ramus intermedius and left main artery. CONCLUSION Fifty percent of patients presented with acute ST-elevation myocardial infarction and underwent primary PCI were between 55-75 years of age. Hypertension and smoking were the most common risk factors present in those patients. Single vessel disease was most prevalent with left anterior descending found to be the most commonly involved coronary artery followed by right coronary artery and left circumflex.
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Affiliation(s)
- B K Rauniyar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Kadel
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Thakur
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R B Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - D Limbu
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - K Acharya
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - S Kansakar
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Malla
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - C M Adhikari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - A Maskey
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
| | - R Rajbhandari
- Department of Cardiology, Shahid-Gangalal National Heart Center, Kathmandu, Nepal.
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Qu J, Zhang F, Thakur K, Shi JJ, Zhang JG, Faisal S, Wei ZJ. The effects of process technology on the physicochemical properties of peony seed oil. Grasas y Aceites 2017. [DOI: 10.3989/gya.1058162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Peony seed oils (PSOs) were prepared using supercritical CO2 (SC) and compared with soxhlet extraction (SE) and mechanical screw press extraction (SPE) methods. The fatty acid compositions of the oils were determined, and the physicochemical properties of the oils, including free radical-scavenging activity, α-amylase and α-glucosidase inhibition, thermal and rheological properties were evaluated. The unsaturated fatty acids in the SE oils were higher than SC and SPE oils due to the higher percentage of olefinic, allylic methylene and allylic methine protons in the SE oils. The SPE oils also displayed the highest DPPH and ABTS+ radical scavenging activity at the tested concentrations. However, the SE oils showed stronger inhibitory effects on α-amylase and α-glucosidase enzymes under in vitro conditions when compared with the other oil samples. The three oils had similar melting and crystalline point due to similar contents of fatty acids (FAs). The SC oils had a lower Ea than the others.
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Bhoil R, Thakur K, Bhoil R. Bilateral neck fistulas. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:367-368. [PMID: 27050900 DOI: 10.1016/j.anorl.2015.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/18/2015] [Accepted: 04/27/2015] [Indexed: 11/25/2022]
Affiliation(s)
- R Bhoil
- Department of radiodiagnosis, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India.
| | - K Thakur
- Department of otolaryngology, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
| | - R Bhoil
- Department of prosthodontics, AFMC Pune, Pune, Maharashtra, India
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Thakur S, Thakur K, Sood A, Chaudhary S. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India. Indian J Med Microbiol 2016; 34:67-71. [PMID: 26776121 DOI: 10.4103/0255-0857.174108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is not much published literature on neonatal septicemia available for the Sub-Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. MATERIAL AND METHODS Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1-year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. RESULTS We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49%) and 96 (51%) were late onset sepsis. Gram-positive isolates were 60% and 40% were Gram-negative. Staphylococcus aureus (40%), coagulase negative Staphylococcus species (16%), non-fermenter group of organisms (NFGOs) (15%), and Klebsiella pneumoniae (10%) were the main isolates. Nasal cannula 101 (54%), birth asphyxia 91 (48%), and prematurity 73 (38%) were the prominent risk factors associated with septicemia. Gram-positive organisms were highly resistant to penicillin (87%) whereas Gram-negative isolates showed high resistance to third generation cephalosporins (53-89%) and aminoglycosides (50-67%). The S. aureus isolates were methicillin-resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram-negative isolates. CONCLUSION Our study highlights the recent emergence of Gram-positive organisms as predominant cause of neonatal septicemia in this part of Sub-Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram-negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.
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Affiliation(s)
- S Thakur
- Department of Microbiology, Dr. RPGMC, Kangra, Tanda, Himachal Pradesh, India
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Thakur S, Thakur K, Sood A, Jaryal SC. Awareness about needlestick harms and health seeking behaviour among the Safai Karamcharis at Dr. Rajendra Prasad Government Medical College Kangra at Tanda (Himachal Pradesh). Indian J Med Microbiol 2016; 34:408-9. [DOI: 10.4103/0255-0857.167675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhoil R, Mistry KA, Bhoil R, Thakur K. Unilateral submandibular depression. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:285-7. [PMID: 27173754 DOI: 10.1016/j.anorl.2015.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/10/2015] [Accepted: 08/17/2015] [Indexed: 10/21/2022]
Affiliation(s)
- R Bhoil
- Department of Radiodiagnosis, Dr. Rajendra Prasad Government Medical College, Kangra, HP, India
| | - K A Mistry
- Department of Radiodiagnosis, Dr. Rajendra Prasad Government Medical College, Kangra, HP, India
| | - R Bhoil
- Division of Prosthodontics, AFMC, Pune, India.
| | - K Thakur
- Department of Otolaryngology, Dr. Rajendra Prasad Government Medical College, Kangra, HP, India
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Chandra A, Chandra A, Thakur K. Synthesis and ion conduction mechanism on hot-pressed sodium ion conducting nano composite polymer electrolytes. ARAB J CHEM 2016. [DOI: 10.1016/j.arabjc.2013.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Deshpande S, Dhote D, Thakur K, Kumar M, Kumar R, Pawar A, Sutar A, Naidu S, Kannan V. EP-1612: Optimizing breast imaging dose in CBCT using patient specific acquisition parameter. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Joshi S, Kempton M, Meduoye A, Nikolopoulos I, Thakur K. Fluid management in surgical patients: An educational study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Savic RM, Ruslami R, Hibma JE, Hesseling A, Ramachandran G, Ganiem AR, Swaminathan S, McIlleron H, Gupta A, Thakur K, van Crevel R, Aarnoutse R, Dooley KE. Pediatric tuberculous meningitis: Model-based approach to determining optimal doses of the anti-tuberculosis drugs rifampin and levofloxacin for children. Clin Pharmacol Ther 2015; 98:622-9. [PMID: 26260983 DOI: 10.1002/cpt.202] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/15/2015] [Accepted: 08/01/2015] [Indexed: 01/15/2023]
Abstract
Pediatric tuberculous meningitis (TBM) is a highly morbid, often fatal disease. Standard treatment includes isoniazid, rifampin, pyrazinamide, and ethambutol. Current rifampin dosing achieves low cerebrospinal fluid (CSF) concentrations, and CSF penetration of ethambutol is poor. In adult trials, higher-dose rifampin and/or a fluoroquinolone reduced mortality and disability. To estimate optimal dosing of rifampin and levofloxacin for children, we compiled plasma and CSF pharmacokinetic (PK) and outcomes data from adult TBM trials plus plasma PK data from children. A population PK/pharmacodynamic (PD) model using adult data defined rifampin target exposures (plasma area under the curve (AUC)0-24 = 92 mg*h/L). Levofloxacin targets and rifampin pediatric drug disposition information were literature-derived. To attain target rifampin exposures, children require daily doses of at least 30 mg/kg orally or 15 mg/kg intravenously (i.v.). From our pediatric population PK model, oral levofloxacin doses needed to attain exposure targets were 19-33 mg/kg. Our results provide data-driven guidance to maximize pediatric TBM treatment while we await definitive trial results.
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Affiliation(s)
- R M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, USA
| | - R Ruslami
- Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | - J E Hibma
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, USA
| | - A Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - G Ramachandran
- National Institute for Research in Tuberculosis, Chetpet, Chennai, India
| | - A R Ganiem
- Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
| | - S Swaminathan
- National Institute for Research in Tuberculosis, Chetpet, Chennai, India
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - K Thakur
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R van Crevel
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Aarnoutse
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - K E Dooley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Deshpande S, Dhote D, Kumar R, Thakur K. SU-E-J-11: Measurement of Eye Lens Dose for Varian On-Board Imaging with Different CBCT Acquisition Techniques. Med Phys 2015. [DOI: 10.1118/1.4924099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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21
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Wehliye O, Elfadl D, Walters M, Thakur K. 185. Is microdochectomy a procedure of relevance in diagnosing early breast cancer in an era of 'high-tech' diagnostics? Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.08.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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22
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Jeph S, Thakur K, Shamim S, Verma K, Aggarwal B, Aggarwal A. Giant cardiac tumour thrombus on staging contrast enhanced 18F-FDG PET/CT in a case of non-Hodgkin's lymphoma. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Chandra A, Chandra A, Thakur K. Synthesis, characterization and ion transport properties of hot-pressed solid polymer electrolytes (1−x) PEO:x KI. Chin J Polym Sci 2013. [DOI: 10.1007/s10118-013-1223-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Lynes K, Nikolopoulos I, Akbar N, Michell M, Thakur K. 13. Outcomes following B3/B4 needle core biopsy in South East London Breast Screening Service 2000–2010. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Lynes K, Nikolopoulos I, Akbar N, Michell M, Thakur K. Outcomes following B3/B4 needle core biopsy in South East London Breast Screening Service 2000 to 2010. Breast Cancer Res 2011. [PMCID: PMC3238239 DOI: 10.1186/bcr2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kumari M, Nikolopoulos I, Huf S, Corry D, Thakur K. 6066 POSTER Does the “Two Week Wait” Target Improve the Waiting Times for Specialist Review and Also Waiting Time Between First Seen by Colorectal Cancer Specialist and Diagnosis of Colorectal Cancer? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71711-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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28
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Kumari M, Nikolopoulos I, Huf S, Thakur K. 9031 POSTER Does the “Two Week-Wait” Target Improve Survival in Patients With Lung Cancer in the UK? Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thakur K, Singh G, Agarwal S, Rani L. MENINGITIS CAUSED BY RHODOTORULA RUBRA IN AN HUMAN IMMUNODEFICIENCY VIRUS INFECTED PATIENT. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02182-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Rhodotorula spp. are common saprophytes but may be responsible for systemic infections in immunocompromised patients. Meningitis caused by Rhodotorula spp. in human immunodeficiency virus (HIV) infected patients has been reported only rarely. We present a case of meningitis caused by Rhodotorula rubra in HIV infected patient. The presumptive diagnosis of cryptococcal meningitis was made on the basis of India ink preparation, Gram staining and latex agglutination test (LAT) for cryptococcal antigen. The final diagnosis was confirmed by isolation of Rhodotorula rubra from cerebrospinal fluid on culture. LAT was considered false positive. Amphotericin B and 5-fluorocytosine were administered but the patient succumbed to his illness.
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Affiliation(s)
- K Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh, India
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Thakur K, Singh DV, Goel A. Cranial vault Salmonella osteomyelitis leading to extradural abscess - a case report. Indian J Med Microbiol 2002; 20:219-20. [PMID: 17657075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A case of rarely encountered Salmonella typhi osteomyelitis of left occipital bone leading to extradural abscess, is reported. The causative organism was not suspected until the culture report was obtained. The patient responded promptly to surgical drainage and antibiotic therapy.
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Affiliation(s)
- K Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla - 171 001, Himachal Pradesh, India
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Beechey-Newman N, Hamed H, Thakur K, D'Ariggo C, Clark S, Fentiman I. Breast 04. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.30_4.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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35
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Singh DV, Thakur K, Goel A. Microbiological surveillance of currency. Indian J Med Microbiol 2002; 20:53. [PMID: 17657028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Faiz O, Thakur K, Bendall S, Bell R, Bates T. Moynihan 02. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.15_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Chianakwalam C, Thakur K, Bendall S, Williams P, Mackie M, Bates T. Breast 20. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.21_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Thakur K, Faiz O, Tekkis P, Chianakwalam C, Bates T. Breast 23. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.89.s.1.21_11.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Thakur K, Grover PS. Bacterial indices of drinking water from natural sources. INDIAN J PATHOL MICR 2001; 44:131-4. [PMID: 11883127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Two hundred forty samples of water from twenty natural sources were subjected to the study for the detection of four bacterial indicators of faecal pollution. The samples were subjected to the detection of coliform, faecal coliform, E. coli, S. faecalis, Cl. welchii and plate count at 37 degrees C and 22 degrees C. All these samples were found unfit for human consumption. MPN for coliforms, E. coli and S. faecalis varied from 3 to 1800 per 100 ml of water, sero to 1800 per 100 ml water and zero to 540 per 100 ml of water respectively. Plate count at 37 degrees C and 22 degrees C varied from 2.5 x 10(3) to > 150 x 10(3) per ml of water. Cl. welchii was detected in 30.4% samples in rainy season and high plate count at 37 degrees C and 22 degrees C was observed during the same period.
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Affiliation(s)
- K Thakur
- Department of Microbiology, Indira Gandhi Medical College, Shimla, H.P
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40
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Grover PS, Thakur K. Shima drinking water--a bacteriological analysis. J Commun Dis 2001; 33:44-52. [PMID: 11898462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
300 water samples, 60 from piped supply and 240 from 20 natural sources were analyzed bacteriologically for four important bacterial indicators every month over a period of one year. The MPN of total coliforms, Escherichia coli, Streptococcus faecalis were detected by multiple tube method and Clostridium perfringens was isolated using litmus milk medium. From piped water supply, only one sample was found unfit for human consumption. The plate count at 37 degrees C and 22 degrees C varied from 0.5 x 10(3) to 15 x 10(3) per ml. of water. From natural sources, MPN indices for coliforms, Esch. coli and S. faecalis varied from 3 to > 1800, 0 to > 1800 and 0 to 540 per 100 ml. of water respectively. About 1/3rd of samples showed presence of Cl. perfringens. The plate count varied from 1.0 x 10(3) to > 150 x 10(3) per ml. of water. Salmonella typhi was isolated in 1.25% samples by membrane filtration technique. The water from all the natural sources was unfit for human consumption whereas piped water supply was of good quality in general.
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Affiliation(s)
- P S Grover
- Department of Microbiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh
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41
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Thakur K, Malhotra P, Walia I, Kumar R. Health awareness and treatment compliance of high blood pressure among women in a peri-urban colony of Chandigarh, India. J Indian Med Assoc 1999; 97:217-9. [PMID: 10645694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Health awareness is a central issue in the control of hypertension. In a cross-sectional survey among 1727 women of > 30 years, 2 blood pressure recordings were done in 1686 cases. The prevalence of hypertension was found to be 13.1% (221 out of 1686 cases). A random sub sample of 72 hypertensive women above 30 years of age from a peri-urban colony of Chandigarh was selected to find out health awareness and treatment compliance of hypertension. Sixty-three (87.5%) of the selected women were aware of their high blood pressure. However, only 12 women (16.7%) who were on treatment had achieved control of blood pressure (< 140/90 mm Hg). Main reasons for discontinuing the treatment were ignorance about the need of regular treatment (33.3%), high cost of medicines (19.44%) and non-availability of a family member who can go with the patient to hospital (9.72%). Twenty-six (36.1%) hypertensive women did not know the importance of weight reduction for controlling high blood pressure. Twenty-three (31.9%) hypertensive women were currently smoking. A comprehensive health education approach involving health care professionals, patients and general population should be launched to improve the care of hypertensives in the community.
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Affiliation(s)
- K Thakur
- Postgraduate Institute of Medical Education and Research, Chandigarh
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42
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Soonawalla Z, Thakur K, Boorman P, Macfarlane P, Sathananthan N, Parker M. Use of self-expanding metallic stents in the management of obstruction of the sigmoid colon. AJR Am J Roentgenol 1998; 171:633-6. [PMID: 9725287 DOI: 10.2214/ajr.171.3.9725287] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the clinical efficacy of a new self-expanding metallic endoprosthesis in the management of distal colonic obstruction in seven patients. CONCLUSION. The Wallstent enteral endoprosthesis is safe and effective in relieving obstruction in patients with resectable colonic tumors. Once in place, the Wallstent permits planned elective surgery and avoids a temporary stoma. In addition, the Wallstent can palliate patients with obstruction due to advanced colonic neoplasms. The results of our preliminary study are promising and show a low incidence of complications.
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Affiliation(s)
- Z Soonawalla
- Department of Surgery, Conquest Hospital, Hastings, East Sussex, United Kingdom
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Abstract
We present herein two unusual cases of multicentric liposarcoma which highlight the problems associated with the management of this disease entity. When the surgeon is confronted with multicentric liposarcomas, it is necessary to define whether they are secondary tumors or independently arising multicentric liposarcomas, since the latter situation merits a more aggressive approach. Guidelines for this differentiation are suggested in the discussion following the case reports. Surgery, which is often multiple, remains the mainstay of treatment, although adjuvant chemotherapy and radiotherapy are also usually required.
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Affiliation(s)
- V Seenu
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi
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45
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Koepke J, Thakur K. Laboratory Proficiency in Blood Banking:
The Variability of Blood Bank Reagents for Blood Typing. Vox Sang 1972. [DOI: 10.1159/000464508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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46
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Abstract
Abstract
The literature is briefly reviewed and the rarity of uretero-ileal fistulas confirmed. A case of right-sided uretero-ileal fistula associated with Crohn's disease is described.
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Abstract
The genus Naegleria comprises of free living ameboflagellates found in soil and fresh water. More than 30 species have been isolated but only N. fowleri has been associated with human disease. N. fowleri causes primary amoebic meningoencephalitis (PAM), an acute, often fulminant infection of CNS. Here we report a rare and first case of PAM in an immunocompetent elderly patient from this part of the country. Amoeboid and flagellate forms of N. fowleri were detected in the direct microscopic examination of CSF and confirmed by flagellation test in distilled water, demonstrating plaques /clear areas on 1.5% non nutrient agar and its survival at 42°C. Keywords: Meningitis; Naegleria fowleri; primary amoebic meningoencephalitis DOI: http://dx.doi.org/10.3126/joim.v32i2.4949 Journal of Institute of Medicine, August, 2010; 32: 56-59
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