Browsing by Author "Rabindra Nath Mishra"

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Age-Specific Nomograms for Antral Follicle Count in Fertile and Infertile Indian Women: A Comparative Study
(Thieme Medical Publishers, Inc., 2023) Shivi Jain; Ram Chandra Shukla; Madhu Jain; Rabindra Nath Mishra
Objectives: The aim of this study was to develop age-specific nomograms for antral follicle count (AFC) in fertile and infertile Indian women and (2) to compare the influence of age on AFC in both groups. Setting and Design: It is a prospective cross-sectional study in a tertiary-care hospital in north-central India. Methods and Material: One-thousand four-hundred seventy-eight fertile and 1,447 infertile women (primary infertility) of reproductive age (18-49 years) were recruited. One-thousand one-hundred eighty-one fertile and 1,083 infertile women fulfilled the selection criteria for the study. Transvaginal ultrasonography was done on the second or third day of the menstrual cycle. Statistical Analysis: Age-specific nomograms for AFC were built for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles in both groups. Correlation and regression analysis was done to estimate the relationship between the study variables. Statistical analysis was done by using IBM SPSS Statistics for Windows, version 20. Results: At every age, each percentile value of AFC was lower in infertile than in fertile women. The decline of AFC with increasing age was linear in both fertile (r = - 0.431, p < 0.001) and infertile (r = - 0.520, p < 0.001) women; however, the rate was higher in the latter (0.50 follicle/year) than in former (0.44 follicle/year) group. The variation in AFC explained by age was 16.3% in fertile and 22.7% in infertile women. Conclusion: AFC decreased linearly with advancing age in both fertile and infertile women, but more rapidly in the latter. The age only modestly explained the decline of AFC. The age-specific percentile thresholds for AFC should be used instead of age-independent constant thresholds in infertility counselling. © 2023. Indian Radiological Association. All rights reserved.
Anatomical anomalies of femoral vein are not observed in Indian patients with renal failure: Ultrasound-based study
(Elsevier (Singapore) Pte Ltd, 2009) Jai Prakash; Naveen Sharma; Rubina Vohra; Amit Dwivedi; Raja Ramachandran; Rabindra Nath Mishra; Om Prakash Sharma
Background: Femoral vein catheterization is the easiest and safest method for obtaining temporary vascular access in hemodialysis patients. We studied the structure and anatomical variation of femoral veins in uremic patients using ultrasound imaging. Methods: Ultrasonography of femoral vessels was carried out bilaterally in patients with acute renal failure (ARF) and chronic renal failure (CRF). The relationship between ultrasonographic measurements of femoral vessels and anthropometric data were evaluated using Pearson's method. Results: A total of 157 patients (67 ARF, 90 CRF) were included in the study. The majority of the patients were male (68.8 %), and mean age was 43.29 ± 16.74 years. Mean height, weight, and body mass index were 163.94 ± 9.53 cm, 61.96 ± 12.37 kg, and 22.99 ± 3.68 kg/m2, respectively. Mean depth of the femoral artery was 10.74 ± 4.74 mm on the left side and 9.92 ± 3.98 mm on the right side. Mean diameter of the femoral artery was 7.77 ± 1.57 mm on the left side and 7.64 ± 1.45 turn on the right side. Mean distance of the femoral vein from the skin surface was 13.68 ± 4.98 mm on the left side and 12.76 ± 4.85 mm on the right side. Mean diameter of the femoral vein was 9.47 ± 2.15 mrn on the left side and 9.37 ± 2.25 mm on the right side. The femoral vein had adequate diameter (≥ 5 mm) on both sides in all patients. Abnormal location of the femoral vein was not observed in our study. The depth of femoral vasculature was deeper in overweight and obese patients compared to normal weight patients. Femoral artery puncture, multiple attempts before successful catheterization, and hematoma formation were observed in 11.0%, 13.5%, and 5.4% of patients, respectively. Conclusion: Anatomical variation and location anomalies of the femoral vein were not observed in Indian uremic patients. Femoral vein diameter was adequate (≥ 5 mm) in all patients bilaterally. However, there was a slight variation in depth (≥ 1 mm) and diameter (0.1 mm) of femoral vasculature between the left and right sides (left > right).
Author's reply
(2009) Rabindra Nath Mishra
[No abstract available]
Changing epidemiology of community-acquired acute kidney injury in developing countries: Analysis of 2405 cases in 26 years from eastern India
(2013) Jai Prakash; Takhellambam Brojen Singh; Biplab Ghosh; Vinay Malhotra; Surendra Singh Rathore; Rubina Vohra; Rabindra Nath Mishra; Pramod Kumar Srivastava; Usha
BackgroundThe epidemiology of acute kidney injury (AKI) differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India.MethodsThis study aimed at describing changes in epidemiology of community-acquired AKI (CAAKI) over a time span of 26 years in two study periods, namely, 1983-95 and 1996-2008.ResultsWe studied 2405 (1375 male and 1030 female) cases of AKI in the age range 1-95 (mean: 40.32) years. The incidence of CAAKI in 1983-95 and 1996-2008 was 1.95 and 4.14 per 1000 admission, respectively (P < 0.01). Obstetrical AKI has decreased because of the declining number of post-abortal AKI. Surgical AKI decreased from 13.8% in 1983-95 to 9.17% in 1996-2008(P < 0.01). Malarial AKI increased significantly from 4.7% in the first half of the study to 17% in the later period (P < 0.01). Diarrhea-associated AKI had significantly decreased from 36.83% in 1983-95 to 19% in 1996-2008 (P < 0.01). Sepsis-related AKI had increased from 1.57% in 1983-95 to 11.43% in 1996-2008 (P < 0.01). Nephrotoxic AKI showed an increasing trend in recent years (P < 0.01) and mainly caused by rifampicin and NSAIDs. Liver disease-related AKI increased from 1.73% in 1983-95 to 3.17% in 1996-2008 (P < 0.01). Myeloma-associated acute renal failure (ARF) accounted for 1.25% of the total number of ARF cases in the period 1996-2008. HIV infection contributed to 1.65% of ARF of the total number of AKI cases in the second period (1996-2008). Incidence of renal cortical necrosis (RCN) decreased significantly from 5.8% in 1983-95 to 1.3% in 1996-2008 of the total number of ARF cases (P < 0.01). However, during the same period ARF due to acute tubular necrosis, acute glomerulonephritis and acute interstitial nephritis remained unchanged. The mortality rate from AKI decreased significantly from 20% in 1983-95 to 10.98% in 1996-2008 (P < 0.01).ConclusionsThe epidemiological characteristics of CAAKI have changed over the past three decades. There has been an increase in the overall incidence of ARF with the changing etiology of AKI in recent years. Incidences of obstetrical, surgical and diarrheal AKI have decreased significantly, whereas those of AKI associated with malaria, sepsis, nephrotoxic drugs and liver disease have increased. RCN has decreased significantly. In contrast to developed nations, community-acquired AKI is more common in developing countries. It often affects younger individuals and is caused by single and preventable diseases. © 2013 The Author.
Comparison of clinical characteristics of acute kidney injury versus acute-on-chronic renal failure: Our experience in a developing country
(Elsevier (Singapore) Pte Ltd, 2015) Jai Prakash; Surendra Singh Rathore; Puneet Arora; Biplab Ghosh; Takhellambam Brojen Singh; Tribhuwan Gupta; Rabindra Nath Mishra
Background From developing countries, there is paucity of information regarding epidemiological characteristics of acute-on-chronic renal failure (ACRF) that differs from acute kidney injury (AKI). Methods In this prospective study, we analyzed and compared clinical characteristics and outcome of ACRF with AKI from January 2007 to August 2012. Results A total of 1117 patients with community-acquired AKI were included in study (AKI = 835; ACRF = 282). Patients with ACRF were older than patients with AKI (p < 0.001). Sepsis was the main cause of acute decline in renal functions in patients with ACRF in comparison to AKI (p < 0.001). Volume depletion/renal hypoperfusion was the most common cause of AKI and the difference was statistically significant as compared to ACRF (33.9% vs. 17.7%; p < 0.001). Need for dialysis was significantly less in patients with ACRF as compared to AKI (68% vs. 77.4%; p 0.002). Lower inhospital mortality was observed in ACRF in comparison to AKI (5% vs. 8.9%, p = 0.04), while no significant difference was noted in terms of duration of hospital stay between the two groups (p = 0.67). However, a significantly higher proportion of patients with ACRF did not recover and progressed to end-stage renal disease as compared to AKI (20% vs. 7.8%; p < 0.001). Conclusion ACRF constituted an important cause (25%) of AKI. An episode of superimposed AKI is associated with significantly increased risk of progression to end-stage renal disease in patients with chronic kidney disease. Copyright © 2015, Hong Kong Society of Nephrology Ltd. Published by Elsevier Taiwan LLC. All rights reserved.
Determinants of survival in adult HIV patients on antiretroviral therapy in eastern Uttar Pradesh: A prospective study
(Indian Council of Medical Research, 2014) Jaya Chakravarty; Narendra K. Tiwary; Shashi Ranjan Prasad; Saurabh Shukla; Anurag Tiwari; Rabindra Nath Mishra; Shyam Sundar
Background & objectives: The National AIDS Control Organization (NACO) of India has been providing free ARV (antiretroviral) drugs since 2004. By 2012, 486,173 patients had received treatment through the antiretroviral therapy (ART) centres. The objective of this observational study was to assess the factors determining survival of patients on ART under routine programme conditions in an ART centre in north India five years after its inception.; Methods: Treatment naive HIV positive patients who were enrolled in the ART centre between May 2009 and May 2010 and started on ART as per the Revised NACO guidelines 2009, were included in the study and outcome was assessed after two years of follow up.; Results: A total of 1689 patients were included in the analysis, of whom 272 (16.10%) expired, 205 (12.13%) were lost to follow up (LFU), 526 (31.14%) were transferred out to other facilities and 686 (40.63%) were alive at the end of two years. Majority (92%) of the deaths occurred in the first six months of therapy. Age >30 yr, male gender, poor functional status, haemoglobin level <11 g/dl, body weight <45 kg and CD4 count <100/ul at baseline had significantly higher relative hazard of death. Most LFU also occurred in the first six months and these patients had significantly low CD4 count, weight, haemoglobin level and higher number of patients in Stages III and IV as compared to those who survived.; Interpretation & conclusions: The study findings revealed poor survival in the first six months of therapy especially in those with severe immunosuppression. This emphasizes the need for early enrolment into the programme. The high LFU occurring early after initiation of therapy suggests the urgent need to build an efficient patient retrieval system in the programme. © 2014, Indian Council of Medical Research. All rights reserved.
Incidence, prevalence and mortality of HIV/AIDS across different levels of human development index: A global perspective
(Institute of Medico-Legal Publications, 2018) Ravi Prakash Jha; Krittika Bhattacharyya; Rabindra Nath Mishra; Akash Mishra
Background: HIV/AIDS has asserted its pandemic status by claiming more than 35 million lives so far. The disproportionate burden of HIV/AIDS across the globe in terms of mortality, incidence and prevalence rates intrigued researchers to examine and evaluate the degree and direction of a two-way association between the global HIV/AIDS epidemic and national development across different levels of HDI to formulate the policies. The present analysis is to concentrate directional influence of HDI on these rates. Data and Method: Age-standardized HIV/AIDS mortality, prevalence, and incidence rates of 179 countries were extracted from Global Burden of Disease Study 2015. The human development index along with its 4 components were obtained from Human Development Report 2016. The association between each of the rates and HDI was judged by Spearman correlation, Linear and Quantile regression analysis, and the Kruskal-Wallis test. Results: HIV/AIDS mortality, prevalence, and incidence rates were found to be inversely correlated with national HDI (r =-0.707,-0.677,-0.557 respectively; P < .001), as well as the 4 indicators of HDI. Countries in Low HDI group were found to experience higher burden of HIV/AIDS in terms of these rates than that of Medium, High, and Very high HDI countries. Conclusions: Lower development status characterized by low HDI values was found to increase the burden of HIV/AIDS around the world. Higher levels of deprivation in terms of Health, Education, and Economy were not only found to affect the overall well-being but might just raise the severity of HIV/AIDS across the regions. Hence for HIV/AIDS control or eradication, development could be the key aspect; hence recommended that special attention should be paid to develop an enabling environment in the countries of lower HDI groups. © 2018, Indian Journal of Public Health Research and Development. All rights reserved.
Knowledge, attitude, and practices related to Kala-azar in a rural area of Bihar State, India
(American Society of Tropical Medicine and Hygiene, 2006) Shri Prakash Singh; Dandu Chandra Shekhar Reddy; Rabindra Nath Mishra; Shyam Sundar
The Indian Government aspires to eliminate Kala-azar by 2010. Success of any disease control program depends on community participation, and there is no published data about the knowledge, attitude, and practices of the community about Kala-azar in endemic regions of India. For this knowledge, attitude, and practices (KAP) study, the heads of 3,968 households in a rural area, consisting of 26,444 populations, were interviewed using a pre-tested, semi-structured schedule. Most of the study subjects (97.4%) were aware of Kala-azar. Fever (71.3%) and weight loss (30.5%) were the most commonly known symptoms. The infectious nature of the disease was known to 39.9%. The majority believed that the disease spreads by mosquito bites (72.8%). For 63.6%, the breeding site of the vector was garbage collection. Only 23.6% preferred the public health sector for treatment, and 55.9% believed that facilities at primary health centers are not adequate. Poor knowledge of the study subjects about the disease and breeding sites of the vector underscores the need for health educational campaigns if the elimination program is to succeed. Copyright © 2006 by The American Society of Tropical Medicine and Hygiene.
Outcome of patients on second line antiretroviral therapy under programmatic condition in India
(BioMed Central Ltd., 2015) Jaya Chakravarty; Shyam Sundar; Ankita Chourasia; Pallav Narayan Singh; Swarali Kurle; Srikanth P. Tripathy; Devidas N Chaturbhuj; Madhukar Rai; Amit Kumar Agarwal; Rabindra Nath Mishra; Ramesh S. Paranjape
Background: The National AIDS Control Organization of India has been providing free second line antiretroviral therapy (ART) since 2008. This observational study reports the survival and virologic suppression of patients on second-line ART under programmatic condition and type of mutations acquired by those failing therapy. Methods: 170 patients initiated on second-line therapy between 2008 and 2012 were followed up till 2013. Viral Load (VL) was repeated at 6 months for all patients and at 12 months for those with VL > 400 copies/ml at 6 months. Adequate virological response was defined as plasma HIV-1 VL < 400 copies/ml and virological failure was defined as VL > 1000 copies/ml. Genotyping was done in 16 patients with virological failure. Results: Out of 170 patients, 110 (64.7 %) were alive and on therapy and 35 (20.5 %) expired. In the first year the occurrence of death was 13.7/100 person years while between1 and 5 year it was 3.88/100 person years. In the first year, duration of immunological failure > 12 months, weight < 45 kg, WHO clinical stage 3 and 4 and WHO criteria CD4 count less than pretherapy baseline [hazard ratio HR 4.2. 15.8, 11.9 & 4.1 respectively] and beyond first year poor first and second line adherence and first line CD4 count < 200/μL [HR 5.2,15.8, 3.3 respectively] had high risk of death. 119/152 (78.2 %) had adequate virological response and 27/152 (17.7 %) had virological failure. High viral load at baseline and poor second line adherence (Odds Ratio 3.4 & 2.8 respectively) had increased risk of virological failure. Among those genotyped, 50 % had major Protease Inhibitor mutation (M46I commonest) however 87.5 % were still susceptible to darunavir. Conclusions: Second line therapy has shown high early mortality but good virological suppression under programmatic conditions. © 2015 Chakravarty et al.