Browsing by Author "R.N. Mishra"

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A short-term evaluative study of diabetic nephropathy patients
(2012) Archana Vaishya; R.N. Mishra; R.G. Singh; K.S. Piplani
Background: Rising diabetes incidence globally and consequently diabetic nephropathy is a major concern. Being chronic disease patients are continuously monitored. Clinical improvement of major sign/symptoms in short course of therapy may lead to satisfaction of the patient's that will increase better compliance to the treatment. Objective: To evaluate signs/symptoms and GFR status of diabetic nephropathy patient in short course of treatment therapy and nutritional management Material & Methods: All 170 incident cases of diabetic nephropathy (DN) based on glomerular filtration rate and creatinine level registered on pre-fixed dates during May 2007 to May 2010, but 127 followed inclusion criteria. Patients were recorded for demographic, biological & biochemical characteristics and presenting major sign/symptoms at registration time; further, evaluated for presenting sign/symptoms after six months of medicine and dietary intervention. Statistical Analysis: Statistical significance for association was tested by x 2 (unrelated samples) and McNemar (related samples) and for the differences of number of signs/symptoms by Mann Whitney (unrelated samples) and Wilcoxon Signed Rank tests (related samples). Results: No statistical association was seen between GFR status and presence of edema/swelling in any part of the body. After six months of treatment and dietary management, the edema/swelling presenting in 69.6% of the cases was found only in 33.3%. Pedal edema was found in 43.1%; while either eye lid or facial swelling was in 12.9% of the cases but after six months of drug treatment and dietary care these were present only in 18.6% and 3.9% cases respectively. GFR status of one third cases also improved after 6 months, while 57.8% were unchanged; very few (9.8%) deteriorated. The GFR improvement was more in cases reporting with GFR 60 and above. Conclusion: Though, for the drug compliance and dietary intake patient's statement was believed, after six months of treatment and dietary care, edema/swelling, the major signs/symptoms of diabetic nephropathy that reduced significantly and moreover on an average one third reduction of all signs/symptoms among the cases may satisfy the cases resulting to better compliance to drug and dietary management. Better improvement in cases with higher GFR indicated that early detection of diabetic nephropathy cases is essential.
A stochastic model for the study of last closed birth interval with some biosocial components
(Taylor and Francis Ltd., 1998) Arvind Pandey; S.N. Dwivedi; R.N. Mishra
We present a stochastic model to describe variation in last closed birth interval for women of a given marriage duration by parity as well as regardless of parity. The model is derived under some simplified assumptions relating to human reproduction process accounting for the non-exposure period in the beginning of the reproductive life caused by such biosocial components as adolescent sterility and temporary separation between the partners called as an inoperative period. We illustrate the model regardless of parity on an observed set of data taken from a rural area of northern India and estimate the risk of conception before and after the first birth. © 1998 OPA (Overseas Publishers Association) Amsterdam B.V. Published under license under the Gordon and Breach Publishers imprint.
Alterations in histones of the liver and oviduct of Japanese quail during aging
(Kluwer Academic Publishers, 1994) R.N. Mishra; M.S. Kanungo
Age-related changes occur in histones of the liver and oviduct of the female quail. In the liver an extra histone band, named HCX, between H2A and H4, is observed that increases with age. In the oviduct, a large complex of histones is seen which is tissue-specific. This complex declines with increasing age. The changes in the histones of the oviduct of adult and old birds in response to estradiol and progesterone are age-related. In the adult, the histone-complex increases after administration of either one of the hormones. In old birds, however, it is seen only after progesterone administration. Thus, the alterations in histones in the birds are not only tissue- and age-related, but also vary in response to steroid hormones. © 1994 Kluwer Academic Publishers.
Anatomical variations of the splenic artery and its clinical implications
(2004) S.K. Pandey; S. Bhattacharya; R.N. Mishra; V.K. Shukla
The variations in orgin, course, and terminal branching pattern of the splenic artery were studied in 320 cadavers. The artery originated from the coeliac trunk in the majority of cadavers (90.6%), followed by abdominal aorta (8.1%), and other sights (1.3%). A suprapancreatic course of the artery was commonly observed (74.1%) followed by enteropancreatic (18.5%), intrapancreatic (4.6%), and retropancreatic (2.8%) courses. In two cases (0.63%) the proximal part of the splenic artery made a loop that was embedded in the substance of the pancreas, which is an interesting and rare finding. In five cases (1.5%) the proximal part of the artery divided into two or more branches that had suprapancreatic and enteropancreatic courses. The splenic artery divided into terminal branches in 311 (97%) cadavers. In nine (2.8%) cadavers it passed through the hilum of spleen without dividing. Two terminal branches were the most common (63.1%) followed by four (18.8%), six (9.7%), and more than six (5.6%) branches. The present study clearly indicates that there is variation in origin, course, and terminal distribution pattern of the splenic artery. The knowledge of these variations are of significant importance during surgical and radiological procedure of upper abdominal region to avoid any catastrophic complications. © 2004 Wiley-Liss, Inc.
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.
Comparative outcome of low birth weight babies.
(1993) B.K. Das; R.N. Mishra; O.P. Mishra; V. Bhargava; A. Prakash
One hundred and fifty six babies with birth weight between 1500-2000 g and 103 full term-appropriate for gestational age (FT-AGA) babies delivered at University Hospital, District Hospital and village homes were included for a comparative study of mortality, morbidity and growth pattern. The low birth weight (LBW) babies from the three centres had similar birth weight and gestational age. Neonatal mortality rates for the LBW babies were similar at the three centres. The main cause of death were infections and aspiration with rates again being similar. Diarrhea and respiratory tract infections were common causes of morbidity. The mortality rates for the LBW babies were significantly higher as compared to FT-AGA babies irrespective of the place of delivery. The incidence of morbidities like diarrhea and respiratory infections were also higher in LBW babies. However, the differences were statistically significant mostly in the preterm group. The weight gain of all LBW babies was similar up to 3 months of age. The findings of an identical outcome for the LBW babies at village level to those managed at hospitals is an encouraging trend to increasing domiciliary care for LBW babies.; Between February 1985 and January 1986 in India, pediatricians compared outcomes of 156 low birth weight (LBW) infants (1500-2000 g) with those of 103 full term-appropriate for gestational age (FT-AGA) infants. They followed up on the infants at 15 days, 1 month, 2 months, and 3 months. The LBW infants consisted of 55 full term-intrauterine growth retardation (FT-IUGR) infants and 101 premature infants. Both sets of infants were born at Banaras Hindu University Hospital and Ishwari Memorial District Hospital both in Varanasi and in 10 villages of Cholapur Block in Varanasi. The village mothers were trained in neonatal care, which included general cleanliness, hand washing, adequate baby clothing, maintenance of body temperature, and cord care with spirits and triple dye. The birth weight and gestational age of LBW infants from the 3 centers were similar. The neonatal mortality rate was essentially the same for LBW infants in all 3 groups (e.g., 21% for the university hospital, 18% for the district hospital, and 18% for the villages). The neonatal mortality rate for LBW infants was significantly higher than that of FT-AGA infants (p .01 for university hospital, p .05 for district hospital, and p .05 for villages). The death rate due to infection was similar for all 3 groups (58%, 55%, and 66%, respectively). Diarrhea and upper respiratory infection were common causes of morbidity. Diarrhea and upper respiratory infection occurred more often in FT-IUGR infants and premature infants than in FT-AGA infants. The differences tended to be significant only between premature infants and FT-AGA infants, however.. The LBW infants born in the villages gained weight at a similar rate as those born in the university and district hospitals. These findings suggest that adequate care includes health and nutrition education, follow-up, and parental participation of infant's health care.
Comparative study of angiotensin converting enzyme inhibitor and calcium channel blocker in the treatment of steroid-resistant idiopathic nephrotic syndrome
(2004) N.S. Kumar; A.K. Singh; R.N. Mishra; J. Prakash
Background: The aim of this study was to evaluate and compare the anti-proteinuric effect of ramipril and verapamil in patients with steroid-resistant idiopathic nephrotic syndrome. Twenty one (21) cases of steroid-resistant idiopathic nephrotic syndrome were randomized to receive ramipril (11) and verapamil (10) and were followed up for 12 months; monthly for the 1st 3 months and then every 3 months for the remaining study period. The degree of reduction of proteinuria, blood pressure, serum creatinine, serum albumin and side effects were noted between the two groups. The comparison within the groups over different time periods was made using paired 't' test and between the groups for specific time period by unpaired 't' test. The level of significance was taken as 5% or below. Results: Seventeen patients (nine in the ramipril group and eight in the verapamil group) completed the study. The mean age of the patients, duration of illness, 24 hours urinary excretion of protein, mean arterial pressure, serum creatinine, cholesterol and albumin were similar in both the groups at time of randomization. The 24 hours urinary protein excretion decreased from 6319.44 ± 1971.70 mg/day to 1852.44 ± 1813.74 mg/day in patients receiving ramipril and from 5332.87 ± 1947.47 mg /day to 2759.37 ± 1929.6 mg/day in patients treated with verapamil after 12 months. There was no statistically significant difference in the reduction of proteinuria between the two groups. However, reduction in proteinuria was statistically significant from 2nd month onwards in Ramipril group and reduction was sustained throughout the study period. Reduction in mean arterial pressure was better achieved in Ramipril groups. The change in the serum potassium, creatinine, cholesterol and albumin were similar in either group of patients. Cough (2), hypotension (1) and reversible rise in serum creatinine (1) were observed with ramipril and no side effect was noted with verapamil. Conclusion: Both ramipril and verapamil can reduce proteinuria in patients suffering from steroid-resistant idiopathic nephrotic syndrome. However, ramipril had a better and sustained reduction in proteinuria with well-controlled mean arterial pressure. Verapamil can be considered as an alternative to ramipril when the use of the latter is not tolerated because of side effects and/or worsening of renal function in patients with chronic renal insufficiency. © JAPI 2004.
Determinants of school enrolment of children in slums of Varanasi
(Indian Association of Preventive and Social Medicine, 2016) Pallavi Nayak; Payal Singh; Neeraj Tripathi; Akash Mishra; R.N. Mishra
Introduction: Education plays a vital role to developing a nation. In India, urban slums constituting about 22.6% of the urban population are the poor and socially disadvantaged. This slum community is least concerned for school enrolment of their children inspite of the fact that primary education is compulsory and is free in public schools. In urban areas schools available are mostly of private sector that are not free and beyond affordability to slums; government and corporation schools are few, but beyond reach. Motive of the parents is to involve children in income generating activities and the girls are more deprived of school enrolment in poorer society. The, present analysis aim to: 1) assess the enrolment status of slum children and 2) determine the factors influencing school enrolment. Methodology: The data was collected during 2011-12 from 15 randomly selected slums out of 227 in which a total of 893 families were contacted and mothers with children aged 5-15 years interrogated. In addition to child history on age, sex and school enrolment, the family background characteristics were e.g. religion, caste, and family size as well as age, education and occupation of both mother & father were recorded. Results: Out of 1145 children, male and female equal represented; mostly (90.9%) were Hindus and half were SC/ST class. About 30% father and 57.2% mothers were illiterate; about half fathers were unskilled-worker and 96.0% mother’s house wife. Overall 31.3% children were not enrolled and were decreasing from 49.2% to 24.3% to 21.4% in the age groups 5-6, 7-9 and 10-15 years respectively. Enrolment was poor in Muslims (50.0%) compared to Hindus (29.4%); enrolment was similar irrespective of child sex among Hindus, but in Muslims 62.5% male and 35.4% female children were only enrolled. Similar was the situation as one move from SC/ST (67.6%) to OBC (73.4%) and general caste (77.9%). Education of father and mother had significant role to enrolment but not the age and occupation of father and mother. Female child enrolment was poor if father was in business and mother was aged. Logistic regression analysis indicated that school enrolment of children aged 5-7 years was associated with age of mother and educational combination of father and mother, while of children 8-15 years caste/religion, family size, sex of child and educational combination of father and mother were found associated. Conclusion: Findings suggest that slum community as a whole is the pocket constituted by habitats of socially disadvantaged class has to be promoted with attitudinal change to schooling of their children without discriminating child sex. © 2016, Indian Association of Preventive and Social Medicine. All rights reserved.
Electronic structure of adenine & possibility of proton tunneling in the A T base pair of DNA
(1976) P.C. Mishra; R.N. Mishra
[No abstract available]
Estimating true burden of disease detected by screening tests of varying validity.
(2001) R.N. Mishra; C.P. Mishra; D.C. Reddy; V.M. Gupta
Timely and accurate information on disease load is essential for planning health programs. Unfortunately, complexity, cost and need of skilled personnel limit the use of screening tools of high validity in developing countries. The disease load estimated with tools of low validity differs considerably from true disease load, particularly for diseases of extreme levels of prevalence/incidence. A tool of 70% sensitivity and specificity may yield a prevalence/incidence rate of 34% (CI: 32.23-35.67%) for a disease whose true rate is only 10.0% (CI: 8.94-11.06%). We proposed a procedure to derive the true estimate in such cases, based on the concepts of sensitivity and specificity of a diagnostic/screening test. It is applied on two sets of real data--one pertaining to incidence rate of low birth weight (LBW) and the other to prevalence rate of obesity--where multiple screening tests of varying validity were used to estimate the magnitude. Different screening tests yielded widely varying incidence/prevalence rates of LBW/obesity. The prevalence/incidence rates derived by using the proposed estimation procedure are similar and close to the true estimate obtained by screening tests considered as gold standard. Further, sample size determined on the basis of the results of a tool of low validity may be either larger or smaller than the required sample size. Estimation of true disease load enables determination of correct sample size, thus improving the precision of the estimate and, in some instances, reducing the cost of investigation.
High prevalence of malnutrition and inflammation in undialyzed patients with chronic renal failure in developing countries: A single center experience from Eastern India
(2007) Jai Prakash; R. Raja; R.N. Mishra; Rubina Vohra; Naveen Sharma; I.A. Wani; A. Parekh
Background. Malnutrition is common in patients with chronic renal failure (CRF), and its prevalence before the initiation of dialysis is poorly characterized in these patients in developing countries. There is a paucity of data on the quantification of malnutrition and inflammation in undialyzed patients of CRF from India. This study analyzed the prevalence and causes of malnutrition in patients with CRF before the initiation of dialysis treatment. Material and Methods. In the present study, assessments of nutritional and inflammatory status were carried out in patients with CRF. Serum albumin, body mass index (BMI), triceps skin fold thickness (TST), mid-arm muscle circumference (MAMC), and subjective global assessment (SGA) scoring were used for assessment of nutritional parameters. Serum C-reactive protein and serum ferritin level were used to assess the inflammatory state of the patient. Results. Two hundred and three (146 male, 57 female) patients with CRF were included in the study from August 2004 to April 2006. Overall, the prevalence of malnutrition was 65% (131/203). The age of malnourished patients (93 male, 38 female) ranged from 11-82, with mean age of 52 ± 12.68 years. The mean serum total protein and albumin were also significantly lower in patients with malnutrition in comparison to non malnourished cases (5.50 ± 0.40 gm/dL vs. 5.74 ± 0.38 gm/dL; p < 0.05, and 3.18 ± 0.58 gm/dL vs. 3.68 ± 0.55 gm/dL; p < 0.05). The C-reactive protein and serum ferritin were significantly elevated in the malnourished group as compared to non-malnourished patients (63% vs. 33%; p < 0.05, and 301.2 ± 127.1 mg/dL vs. 212.7 ± 124.9 mg/dL; p < 0.05). Conclusion. Thus, malnutrition was common in patients with CRF before the commencement of dialysis. These data indicate that an emphasis should be placed on the assessment and prevention or correction of malnutrition in patients with CRF because of its documented adverse effect on the outcome on maintenance dialysis. Copyright © Informa Healthcare USA, Inc.
Implementation of Revised Strategy of Filaria Control-Baseline Clinico-Parasitological Survey
(2000) Sunita Patel; R.N. Rai; R.N. Mishra
A clinico-epidemiological study of filariasis was carried out in Varanasi District in October and November, 1997 to generate baseline data for assessing the impact of Mass Drug Administration (MDA) in the district. Disease rate was found to be 6.6% (9.9% in males and 3.0% in females) and microfilaria rate was 5.3% (5.2% in males and 5.5% in females). Mean microfilaria density was found to be 9.86 per 20 Cu.mm blood. Genital manifestations (77.5%) outnumbered all other forms of clinical manifestations. Vector infectivity rate was found to be 0.93%.
Lifestyle, reproductive factors and risk of gallbladder cancer
(2008) Vijay K. Shukla; V.S. Chauhan; R.N. Mishra; S. Basu
Introduction: Lifestyle and dietary habits play an important role in carcinogenesis. Carcinoma of the gallbladder is no different. The present study was carried out to evaluate the roles of lifestyle, menstrual and reproductive factors in gallbladder cancer. Methods : A prospective case-control study involving 78 newly-diagnosed cases of carcinoma of the gallbladder and 78 age- and gender-matched controls with cholelithiasis were investigated for their lifestyle history, with an emphasis on habits with chewing betel nut and tobacco, alcohol consumption and smoking. Besides this, female patients were investigated for their menstrual and reproductive factors. Odds-ratio and significance were calculated. Results: A Hindu preponderance was seen. About half of the patients with carcinoma of the gallbladder and gallstone were either illiterate or had a very low level of education (primary or below). Religion, education, family income, chewing of tobacco as well as smoking were comparable. But numbers of chewing tobacco and smoking per day differed significantly. Alcohol was consumed by 11.6 percent of carcinoma and 4.1 percent of gallstone patients. Lower age of menarche, higher number of pregnancies and higher age at menopause had a significantly increased risk of gallbladder carcinogenesis. A significant difference in carcinogenesis was seen in the postmenopausal women compared with the menopausal group. Conclusion: Carcinoma of the gallbladder was common in tobacco chewers. Females with lower age at menarche, higher number of pregnancies and childbirths and higher age at last childbirth had an increased risk of gallbladder cancer.
Magnetic restructuring of water
(Kluwer Academic Publishers, 1995) Subas Rai; N.N. Singh; R.N. Mishra
[No abstract available]
Screening for obesity in affluent females: body mass index and its comparison with skin fold thickness.
(1998) S. Asthana; V.M. Gupta; R.N. Mishra
In the present study 625 females above 15 years of age residing in affluent localities of Varanasi city were selected by multi-stage stratified random sampling technique. Body Mass Index (BMI) and Skin-Fold Thickness (SFT) were compared as indices of obesity. Prevalence of obesity by BMI and SFT was 30.24 and 49.12 respectively. SFT gave significantly higher prevalence rate of obesity as compared to BMI. It is possible that western population based SFT cut-off points may not be truly applicable to Indian study. The sensitivity, specificity and predictive value of 'sum of SFT at four sites' were calculated at different cut-off points, and it was observed, that values > or = 90 mm is the best cut-off point instead of 80 mm, for detecting obesity in the Indian context.
Topical 0.05% betamethasone dipropionate: Efficacy in psoriasis with once a day vs. twice a day application [6]
(1995) S. Singh; J. Gopal; R.N. Mishra; S.S. Pandey
[No abstract available]