Browsing by Author "O.P. Mishra"

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A yellow patient with hepatomegaly
(BMJ Publishing Group, 1999) O.P. Mishra; Mohan Kumar; V.K. Dixit; V.K. Shukla
[No abstract available]
Acardiac anomaly spectrum
(Wiley-Liss Inc., 2000) C. Mohanty; O.P. Mishra; C.P. Singh; B.K. Das; P.N. Singla
Background: Acardiac anomaly spectrum is a rare congenital malformation found in monozygotic twin pregnancy. Besides the absence of heart, the condition is associated with variable grades of developmental disruption. Thus, no two cases are similar. Methods: This case report is based on physical examination and autopsy findings. Results: The twin had acardia and partial development of head and face. There was complete absence of upper extremities. Conclusions: The twin reversed arterial perfusion (TRAP) theory is the most accepted etiology of the disorder. Normally, the cephalic pole is the most severely affected, being most distal to the retrograde perfusion. In acardia, partial development of head, face, and brain is usually associated with the development of the upper extremities. However, in the present case, there was extensive cephalic development in the absence of upper extremity development. (C) 2000 Wiley-Liss, Inc.
Acute acalculous cholecystitis in typhoid fever [2]
(Oxford University Press, 1996) O.P. Mishra; B.K. Das; J. Prakash
[No abstract available]
Acute megaloblastic reaction in hereditary spherocytosis.
(1993) J. Shukla; O.P. Mishra; G.P. Katiyar; B. Dube
[No abstract available]
Adenosine deaminase activity and lysozyme levels in children with tuberculosis
(Oxford University Press, 2000) O.P. Mishra; S. Yusaf; Z. Ali; G. Nath; B.K. Das
Serum adenosine deaminase (ADA) activity and lysozyme levels were measured in 51 patients with tuberculosis (21 pulmonary, 15 miliary, 11 neurotuberculoma and four abdominal plus osteoarticular) and 20 healthy controls. The mean serum ADA activity and lysozyme levels were significantly raised in children with different forms of tuberculosis in comparison with controls (p < 0.001). The neurotuberculoma cases had the lowest mean enzyme levels and the differences were significant when compared with other forms of tuberculosis. The cut-off serum ADA activity of ≥ 42 IU/l and lysozyme level of ≥ 20 U/l were diagnostic of tuberculosis with 100 per cent sensitivity. A significant correlation was observed between the two parameters (r = 0.66; p < 0.001). Thus, with compatible clinical presentation, the raised serum level of either ADA or lysozyme can be used as a supportive diagnostic test.
Adenosine deaminase activity in nephrotic syndrome
(Oxford University Press, 1997) O.P. Mishra; Rajiv Garg; Z. Ali; Usha
Cell-mediated immunity (CMI) was evaluated in 40 children with idiopathic nephrotic syndrome and 20 healthy controls. The significantly decreased response to purified protein derivative (PPD) (P < 0.001), absolute lymophocyte count (ALC) (P < 0.02), T-lymphocytes percentage (P < 0.001) and elevated serum adenosine deaminase (ADA) activity (P < 0.001) were observed in patients with active nephrotic syndrome (ANS) in comparison to controls. The overall mean values of T-lymphocytes percentage and ADA activity in ANS patients were 73.7 and 213.7 per cent of normal mean, respectively. A significant negative correlation was observed between the two parameters (r = -0.5649, P < 0.001). In remission, the ALC and T-lymphocytes percentage showed significant increase in levels in comparison to their corresponding ANS values (P < 0.05 and P < 0.001, respectively), but the latter remained significantly lower when compared with controls (P < 0.001). The ADA activity did not differ significantly in comparison to corresponding ANS level. Thus, impaired CMI was observed both in active, as well as in remission stage of the disease and ADA activity demonstrated a more pronounced change than other parameters.
Adenosine deaminase activity in protein-energy malnutrition
(Scandinavian University Press, 1998) O.P. Mishra; S. Agrawal; Z. Ah; Usha
Cell-mediated immunity (CMI) was evaluated in 69 children with protein- energy malnutrition (PEM) and 20 healthy controls. Significantly decreased responses to purified protein derivative (PPD) (p < 0.02) and absolute lymphocyte count (ALC) (p < 0.01) and increased serum adenosine deaminase (ADA) activity (p < 0.001) were observed in PEM cases compared with the controls. The mean values of ALC and ADA activity in PEM patients were 85.9% and 158.7% of the normal mean, respectively. A significant negative correlation was observed between the two parameters (r = -0.2765, p < 0.01). The CMI tests were abnormal in all three grades of PEM, except for the response to PPD in grade I, when compared with the controls. No significant differences were found between infected and uninfected PEM cases. Thus, impaired CMI was observed not only in grades II and III but also in grade I PEM patients and the concomitant infection did not affect its status. However, ADA activity demonstrated a more pronounced change than the other tests.
Adenosine deaminase activity in typhoid fever.
(1994) O.P. Mishra; B.L. Gupta; Z. Ali; G. Nath; L. Chandra
Serum adenosine deaminase (ADA) activity was determined in 41 patients of typhoid fever and 15 normal controls. The mean ADA activity was significantly raised in typhoid fever patients as compared to controls (p < 0.001). The peak enzymatic activity was observed in the first week of illness. Complicated patients had lower mean ADA activity at diagnosis as compared to uncomplicated group and they showed a rise in enzyme level during defervescence, repeated in a few cases. A significant correlation between serum ADA activity and lymphocyte percentage was found (r = 0.4245, p < 0.001). It is concluded that ADA activity in typhoid fever patients not only indicates immunity but also has a prognostic value.
Adverse events of exchange transfusion in neonatal hyperbilirubinemia
(Nepal Paediatric Society (NEPAS), 2014) M. Chitlangia; G.S. Shah; P. Poudel; O.P. Mishra
Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary-care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre-ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.
Analysis of co-morbidities in children with severe acute malnutrition in Eastern Nepal
(Nepal Paediatric Society (NEPAS), 2015) A. Thapa; Gauri S. Shah; O.P. Mishra
Introduction: Malnutrition is a common problem in developing countries and often associated with co-morbidities. The present study was undertaken with objectives of to find out the comorbidities in children with severe acute malnutrition (SAM). Materials and Methods: This was a hospital based study carried in 77 children with SAM, diagnosed on the basis of WHO criteria. Results: The age group of children was 1- 5 years (median age 23 months) with about 39% between 1- 2 years. There were 38 males (49.3%). Low maternal education (60%), overcrowding (60%), lower- middle socioeconomic status (87%) were some of the predisposing factors observed. Pneumonia (51%), acute gastroenteritis (21%) and bacterial meningitis (8%) were common co- morbidities found. Associated abnormal laboratory parameters found were anemia (60%), leukocytosis (38%), hyboalbuminemia (36%) hyponetremia (31%), and hypokalemia (17%). Conclusion: Presence of infections and biochemical abnormalities require urgent attention in SAM cases and appropriate treatment in a hospital setting to improve their survival. © 2015, Nepal Paediatric Society (NEPAS). All rights reserved.
Association of possible osteopetrosis with acute myeloid leukaemia in a child
(2013) Rajniti Prasad; B.P. Jaiswal; O.P. Mishra; Utpal Kant Singh
Osteopetrosis is a rare disease characterised by an increase in bone mass, skeletal malformations and bone marrow failure due to defective bone resorption. We report a 3-month-old male child presented with chest infections, failure to thrive and hepatosplenomegaly and diagnosed with osteopetrosis associated with acute myeloid leukaemia M3 type (AML-M3). The patient died on day 7 of admission due to respiratory failure. To our knowledge, this is the first case where both osteopetrosis and AML is diagnosed in a patient.
Bacterial Antigen Detection Test in Meningitis
(The Indian Journal of Pediatrics, 2003) B.K. Das; Rajesh Lal Gurubacharya; T.M. Mohapatra; O.P. Mishra
Objective: To evaluate the role of bacterial antigen detection test in cerebrospinal fluid (CSF) for a rapid etiological diagnosis of bacterial meningitis. Methods: The study included 36 cases of bacterial meningitis and 14 controls. Latex particle agglutination test (LPA test) for detection of bacterial antigen was done in the CSF using slidex meningitis kit (Biomeriux, France). Results: Using LPA test, an etiological diagnosis could be made in 83% cases of bacterial meningitis. In contrast, CSF Gram stain and culture showed 36% and 6% positivity, respectively. The sensitivity and specificity of LPA test were 83% and 100%, respectively. The common etiological organisms were S. pneumoniae, H. influenzae type b and N. meningitidis A. S. pneumoniae was encountered in all age groups while H. influenzae type b was found only below one year of age. Conclusions: LPA test is a rapid and superior diagnostic tool as compared to CSF Gram stain and culture. The study recommends LPA test as an adjunct laboratory test for rapid etiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.
Blood glucose and serum insulin response in protein-energy malnutrition following nutritional rehabilitation
(Oxford University Press, 1998) B.K. Das; Jayanthy Ramesh; J.K. Agarwal; O.P. Mishra; R.P. Bhatt
Fifteen children with protein-energy malnutrition and eight healthy children between the ages of 6 months and 60 months were studied for blood glucose and serum insulin levels in the fasting state and 120 minutes following oral glucose load. The measurements were repeated after normalization of the body weight following 6 weeks of nutritional rehabilitation. The fasting blood glucose increased significantly in the post-treatment period and became comparable to the control value. The abnormal blood glucose response to oral glucose load also normalized. The serum insulin level rose significantly (p < 0.001) in the post-treatment period but failed to normalize. The response to oral glucose load was similar. The observed lower insulin response, despite normoglycemia, after 6 weeks of nutritional rehabilitation indicates persistence of hormonal imbalance which may need a longer duration of rehabilitation for full recovery.
Blood sugar and serum insulin response in protein-energy malnutrition
(Oxford University Press, 1998) B.K. Das; Jayanthy Ramesh; J.K. Agarwal; O.P. Mishra; R.P. Bhatt
Blood sugar and serum insulin levels in the fasting state and following an oral glucose load in children with protein-energy malnutrition (PEM) were studied. Twenty-nine children with PEM (15 marasmus, 7 kwashiorkor, and 7 marasmic kwashiorkor) and eight healthy children aged between 6 and 60 months were the subjects of the study. Fasting samples were collected after a 6 h fast. Post-glucose samples were collected after an oral glucose load of 1.75 g/kg. Serum insulin was estimated by radioimmunoassay and glucose by the glucose oxidase method. In malnourished children, the mean fasting blood glucose levels were significantly lower. Two hours following an oral glucose load, only marasmus and marasmic kwashiorkor patients showed significantly higher blood glucose levels. Similarly, the fasting serum insulin levels were significantly lower in malnourished children. Two hours after the oral glucose load, serum insulin levels increased significantly in malnourished children but fell well short of the control values. The insulin:glucose ratio was consistently low in all cases but was more marked in PEM patients, both in the basal state as well as after oral glucose loading.
Bone mineral density in children with steroid-sensitive nephrotic syndrome
(2009) O.P. Mishra; S.K. Meena; S.K. Singh; R. Prasad; R.N. Mishra
Objective: To observe the influence of prednisolone treatment on bone mineral density (BMD) in children with idiopathic nephrotic syndrome. Methods: Duel-energy X-ray absorptiometry of lumbar spine (L1-L4) was performed on 40 patients (18 first episode and 22 relapsers) of steroid sensitive idiopathic nephrotic syndrome. Results: Patients of first episode and relapsers had comparable values of mean age, weight, height, body mass index, serum calcium, phosphate, spine area, bone mineral content (BMC) and BMD. Relapsing nephrotic syndrome patients received significantly higher mean total cumulative dose of prednisolone in comparison to first episode (p<0.001). The BMD Z-scores were normal in 39 of 40 (97.5%) patients. On regression analysis, it was found that both BMC and BMD did not correlate with cumulative dose of prednisolone, when other co-variants such as age, weight, height and spine area were adjusted. Conclusion: Bone mineral density in steroid sensitive nephrotic syndrome is unaffected by cumulative dose of prednisolone therapy both in first episode as well as relapser group of patients. © 2009 Dr. K C Chaudhuri Foundation.
Cerebrospinal fluid adenosine deaminase activity and C-reactive protein in tuberculous and partially treated bacterial meningitis
(1995) O.P. Mishra; V. Loiwal; Z. Ali; G. Nath; L. Chandra; B.K. Das
Adenosine deaminase (ADA) activity measurement and C-reactive protein (C-RP) detection were done in CSF of 27 tuberculous meningitis (TBM) and 8 patients of partially treated bacterial meningitis, apart from routine biochemical tests. Both the groups had comparable CSF cell count, protein and sugar concentrations. The mean CSF ADA activity was significantly raised in TBM as compared to partially treated bacterial meningitis patients (p < 0.05). A cut-off ADA level of ≤5 IU/L and C-RP positivity were used for differentiation of partially treated bacterial from TBM cases. Based on this, the sensitivity and specificity of ADA and C-RP were 62.5%, 88.9% and 75%, 100%, respectively. Since both the tests are simple and take lesser time to perform, they can be used as rapid diagnostic tests to remove diagnostic dilemma between the two diseases.
Cerebrospinal fluid adenosine deaminase activity for the diagnosis of tuberculous meningitis in children
(Oxford University Press, 1996) O.P. Mishra; V. Loiwal; Z. Ali; G. Nath; L. Chandra
Adenosine deaminase (ADA) activity was measured in the cerebrospinal fluid (CSF) of 27 subjects suffering from tuberculous meningitis (TBM), 19 from bacterial meningitis, 10 from encephalitis, and 10 control subjects. The mean CSF ADA level was significantly raised (P < 0.001) in TBM patients as compared to other study groups. A cut-off CSF ADA level of > 5 IU/l was considered for the diagnosis of TBM, and the test had sensitivity and specificity of 89 and 92 per cent, respectively. Overall, it was found to be a better test in comparison to any other single test for the diagnosis of TBM. Confirmed TBM patients had significantly higher CSF ADA activity when compared with clinical TBM (P < 0.01) and the levels did not differ significantly among different stages of disease. The ADA level in TBM cases had significant correlation with CSF cell count (P < 0.01), lymphocyte percentage (P < 0.02) and protein concentration (P < 0.02). Thus, the CSF ADA activity assay was found to be a simple, useful and rapid diagnostic test for the early recognition of TBM in children.
Cerebrospinal fluid and serum zinc, copper, magnesium and calcium levels in children with idiopathic seizure
(2009) Rajniti Prasad; A. Singh; B.K. Das; R.S. Upadhyay; T.B. Singh; O.P. Mishra
Objectives: The present study was conducted to observe the alteration and their relations in cerebrospinal fluid (CSF) and serum Zinc (Zn), Copper (Cu), Magnesium (Mg) and calcium (Ca) levels in patients with different types of idiopathic seizure and to determine the ratios of serum and CSF Ca/Mg and Cu/Zn. Methods: The children aged 1 to 14 years, having two or more unprovoked seizures, which were detected by normal MRI scan and abnormal EEG were included in the study group. The control group consisted of 40 healthy children without seizure. Zn, Mg and Cu levels in CSF and serum were analyzed by an atomic absorption spectrophotometer. Results: The study subjects included 34 generalized seizures (GS), 5 cases of simple partial seizure (SPS) and 5 Complex partial seizures (CPS). Serum copper (Cu) was significantly elevated (P-0.01) in children with seizures. Within the seizure group, serum Mg was significantly increased in GS and serum copper (Cu) levels were significantly increased in CPS and GS as compared to controls (p-0.001). However, calcium and zinc levels did not show any significant change in all groups. CSF Calcium was significantly increased in CPS patients. The ratio obtained for the levels of these parameters revealed a significant increase in serum Cu/Zn ratio (P-0.002) and CSF Ca/Mg (P-0.04) in patients with idiopathic seizure as compared to controls. This ratio was also significant between SPS versus CPS and CPS versus GS. Conclusion: The findings of the present study suggest that high serum Cu and the increased ratio of serum Cu/Zn and CSF Ca/ Mg may be responsible for enhanced neuronal excitability in children with idiopathic seizures.
Cerebrospinal fluid lysozyme level for the diagnosis of tuberculous meningitis in children
(2003) O.P. Mishra; P. Batra; Z. Ali; S. Anupurba; B.K. Das
Lysozyme activity was assayed in the cerebrospinal fluid (CSF) of 32 tuberculous meningitis (TBM), 17 bacterial meningitis, 10 partially treated bacterial meningitis, 18 encephalitis and 18 control subjects. The mean CSF lysozyme activity was significantly raised (p < 0.001) in TBM patients compared with other study groups. A cut-off CSF lysozyme level of ≥ 26 U/l had a sensitivity and specificity of 93.7 and 84.1 per cent, respectively for the diagnosis of TBM. Overall, it was found to be a better test than any other single test and thus can be used for rapid and early diagnosis of TBM in children.
Childhood obesity: Contributing factors and consequences in Indian children
(2007) S.K. Singh; Dheeraj Kapoor; Rakesh Goyal; Amit Rastogi; Sushil Kumar; O.P. Mishra
Introduction: Childhood obesity is a risk factor for adult morbidity and mortality, independent of body mass index (BMI) in adulthood, family history of cardiovascular disease or cancer, and smoking. The present study was designed with the objectives to study contributing factors of childhood obesity and its metabolic consequences. Material and methods: Forty-nine obese and 13 normal children in the age range of 5-12 years were recruited. Subjects with hypothyroidism, Cushing's syndrome and any other disease contributing to endogenous obesity were excluded. Weight and height were recorded and BMI was calculated (weight in kg divided by square of height in meters). Children with weight above 90th percentile for age and sex and BMI > 28.5 or >95th percentile for that age were defined as obese. After an overnight fast (10-12 h) blood was drawn for the determination of plasma glucose, serum insulin, lipid profile and free fatty acids. Observations: The calorie intake in obese children was significantly higher than controls and fatty meal contributed significantly to high calorie intake. Obese children indulged less in outdoor activities than controls. Liver enzymes were significantly higher in the study group. The levels of hepatic enzymes were raised above normal in 26 (53.06%) children. Total cholesterol and LDL cholesterol were higher in the study group, but only the LDL values reached statistical significance. Fasting plasma glucose in the study and control groups were 75.25 ± 13.57 and 66.07 ± 9.52 mg/dL respectively and it was significantly higher in the study group (p = 0.009). Fasting insulin and fasting free fatty acid levels in study group were 31.66 ± 17.58 μU/mL and 379.35 ± 148.00 μmol/L and in control group were 8.6 ± 4.98 μU/mL and 263.84 ± 71.00 μmol/L respectively hence both are significantly higher in the obese children. The mean insulin glucose ratio in the study group was 0.41 ± 11.20. Sixteen (32.65%) children had values of more than 0.4, suggesting insulin resistance but none of the control group had insulin glucose ratio above this level. Insulin free fatty acid ratio was also higher in the study group 8.58 ± 6.34 than control group 3.10 ± 1.19. The mean HOMA-R in the study group and control group were 6.08 ± 3.83 and 1.37 ± 0.73 respectively indicating significant insulin resistance in the obese children. Conclusion: The environment influence like increased calorie intake and decreased physical activity are major determinants of childhood obesity. The biochemical consequences of childhood obesity are hyperinsulinemia, increased LDL, FFA levels and increased hepatic transaminases. The triglycerides, HDL, fasting hyperglycemia and hypertension do not seem to have association with metabolic syndrome in children as seen in adults. Therefore it is proposed that the diagnostic parameters of metabolic syndrome should be redefined in children with population-based values of these new biochemical parameters. © 2007 Diabetes India.