Browsing by Author "R.K. Goyal"

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Bacteriological profile and antimicrobial resistance of blood culture isolates from a university hospital
(2007) Atul Garg; S. Anupurba; Jaya Garg; R.K. Goyal; M.R. Sen
Context: Blood stream infections are an important cause of mortality and morbidity and are among the most common health-care associated infections. Illness associated with blood stream infection ranges from self-limiting infections to life-threatening sepsis that require rapid and aggressive antimicrobial treatment. Aims: The objective of the study was to describe the pattern of bacterial isolates from the blood cultures in a university hospital and determine their antibiotic resistance, so that the study can provide guidelines for choosing an effective antibiotic therapy in cases of septicaemia. Settings and design: This is a retrospective study of 2,400 blood samples collected from clinically suspected cases of bacteraemia reviewed over a period of 2 years. Methods and material: The isolates were identified by standard biochemical tests and antimicrobial susceptibility testing determined by National Committee for Clinical Laboratory Standards (NCCLS) guidelines. Results: Positive cultures were obtained in 493 (20.5%) cases. Among culture positive isolates, Gram-negative bacteria accounted for 67.5% cases; most common being Pseudomonas spp. (16%) followed by Salmonella typhi and S. paratyphi A (14.2%). Of the pathogenic Gram-positive isolates, Staphylococcus aureus (8.3%) was the predominant isolate followed by Enterococcus faecalis (3.7%). Maximum Gram-negative isolates were sensitive to cefoperazone-sulbactam combination (81%). Vancomycin sensitivity was reported in 100% Staph. aureus and 83.3% Enterococcus faecalis. Conclusions: This study provides information on antibiotic resistance of blood isolates. It may be a useful guide for physicians initiating empiric therapy and will help in formulation of antibiotic therapy strategy in this part of the country.
New classes of antihypertensive drugs: Therapeutic potentials
(Marcel Dekker Inc., 1999) N.K. Singh; R.K. Goyal
A number of new classes of antihypertensive drugs have become available in the recent years which appear to hold therapeutic potential for better management of hypertension. Losartan, an angiotensin II receptor antagonist, does not produce cough which is classically seen with ACE inhibitors. Fenoldopam, a dopamine D1-receptor agonist, has a rapid and short duration of action and is ideally suited by intravenous infusion for quick control of BP in hypertensive emergencies. Kentaserin, a serotonin (5HT(2A)) receptor antagonist, has a long duration of action and can be given once daily. It has the added benefit of having antiplatelet effect. Monatepil, a dual α- receptor and calcium channel blocker, has potent antihypertensive effect, lowers serum cholesterol and also has antiatherosclerotic effect. Dual ACE and endopeptidase inhibitor, such as alatriopril, has a 'broad spectrum' antihypertensive effect and may be effective in majority of hypertensive patients. Many other classes of antihypertensive drugs are still in the investigative stage, and their therapeutic potentials and safety need to be ascertained in long-term controlled clinical trials.
Prevention of cardiovascular disease and diabetes mellitus in low and middle income countries
(2011) S.S. Rastogi; R.B. Singh; N.K. Singh; S.M. Alam; R.G. Singh; K.K. Tripathi; R.K. Srivastav; S.K. Vajpeyee; Hirdesh Gupta; V.V. Muthusamy; R.K. Goyal; M.E. Yeolekar; Adarsh Kumar; N.S. Neki; G.S. Sainani; V. Shantaram; Daniel Pella; Jan Fedacko; Fabien de Meester; T.K. Basu; Surya Acharya; Lech Ozimek
Hyperglycemia as a component of metabolic syndrome, appears to be an important risk marker of vascular disease in most developing countries which are under transition from poverty to affluence. Despite a moderate increase in fat intake and low rates of obesity, the risk of coronary artery disease (CAD) and diabetes is rapidly increasing in most of the developing economies. It is a paradox that in some of these countries the increased risk of people to diabetes and CAD, especially at a younger age, is difficult to explain by conventional risk factors. It is possible that the presence of new risk factors especially higher lipoprotein (a)(Lpa), hyperhomocysteinemia, insulin resistance, low high density lipoprotein cholesterol and poor nutrition during fetal life, infancy and childhood may explain at least in part, the cause of this paradox. The prevalence of obesity, central obesity, smoking, physical inactivity and stress are rapidly increasing in low and middle income populations, due to economic development. In high income populations, there is a decrease in tobacco consumption, increase in physical activity and dietary restrictions, due to learning of the message of prevention, resulting into reduction in coronary and sroke mortality. Hypertension, (5-10%) diabetes(3-5%) and CAD(3-4%) are very low in the adult, rural populations of India, China, and in the African sub-continent which has less economic development. However, in urban and immigrant populations of India and China, the prevalence of hypertension (>140/90, 25-30%), diabetes (6-18%) and CAD (7-14%) are significantly higher than they are in some of the high income populations. Mean serum cholesterol (180-200 mg/dl), obesity (5-8%) and dietary fat intake (25-30% en/day) are paradoxically not very high and do not explain the cause of increased susceptibility to CAD and diabetes in some South Asian countries. The force of lipid-related risk factors and refined starches and sugar appears to be greater in these populations due to the presence of the above factors and results into CVD and diabetes at a younger age in these countries. These findings may require modification of the existing American and European guidelines, proposed for prevention of CAD, in high income populations. Wild foods or designer foods (400-500g/day) substitution (www.columbus-concept.com) for proatherogenic foods; in conjunction with moderate physical activity and cessation of tobacco, may be protective against deaths and disability due to CVD and diabetes in most of these countries. © Rastogi et al.
Seroprevalence of Brucellosis in and around Varanasi
(2002) M.R. Sen; B.N. Shukla; R.K. Goyal
[No abstract available]
Superiority of dat over ELISA as a diagnostic and seroepidemiological tool for the diagnosis of Indian Kala-Azar
(L.V. Prasad Eye Institute, 2004) R.K. Goyal; T.M. Mohapatra
The aim of this study was to evaluate two methods for the diagnosis of Kala-azar. The sera of 160 individuals were evaluated by ELISA using soluble antigen and direct agglutination test (DAT) for Kala-azar. These were categorized as 100 cases of clinically and parasitologically confirmed Kala-azar and 60 controls. The controls included clinically suspected but parasitologically not confirmed Kala-azar patients (10), endemic normals (15), non-endemic normals (19), typhoid fever (10) and malaria (15). The positivity rate amongst the clinically and parasitologically confirmed Kala-azar patients by ELISA and DAT were 93% and 98% respectively. Out of 10 clinically suspected Kala-azar cases three showed positive reaction in ELISA and two in DAT. Of the endemic normals, one case was found positive by both the tests whereas ELISA was found positive in one additional case. DAT did not show any cross reactivity with malaria while ELISA was found positive in one case. Both endemic normals and typhoid fever cases showed no reaction by both tests. ELISA showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 93%, 90%, 93% and 90% respectively while for DAT these values were 98%, 95%, 98 and 95% respectively. The diagnostic accuracy for ELISA and DAT was found to be 91.9% and 96.9%, respectively. The present study shows that DAT is a simple, sensitive, specific and cost effective test with high PPV and NPV along with approximately 97% diagnostic accuracy and is comparable to ELISA. It may be applied for the routine diagnosis as well as seroepidemiological study of Kala-azar.