Browsing by Author "Vijay K. Shukla"

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A dangerous pleural effusion
(2010) Somprakas Basu; Shilpi Bhadani; Vijay K. Shukla
Bilothorax is a rare complication of biliary peritonitis and, if not treated promptly, can be lifethreatening. We report a case of a middle-aged woman who had undergone a bilio-enteric bypass and subsequently a biliary leak developed, which finally led to intra-abdominal biliary collection and spontaneous bilothorax. The clinical course was rapid and mimicked venous thromboembolism, myocardial infarction and pulmonary oedema, which led to a delay in diagnosis and management and finally death. We high-light the fact that bilothorax, although a rare complication of biliary surgery, should always be considered as a probable cause of massive effusion and sudden-onset respiratory and cardiovascular collapse in the postoperative period. A chest X-ray and a diagnostic pleural tap can confirm the diagnosis. Once detected, an aggressive management should be instituted to prevent organ failure and death.
A prospective, descriptive study to identify the microbiological profile of chronic wounds in outpatients
(HMP Communications, 2009) Somprakas Basu; Tetraj Ramchuran Panray; Tej Bali Singh; Anil K. Gulati; Vijay K. Shukla
Indiscriminate use of antibiotics for infected chronic wounds is a global problem that may contribute to delayed healing and the development of drug-resistant micro-organisms. A prospective, descriptive cohort study of 50 male and female outpatients (mean age 52.50 [± 14.84] years, range 18-90) with 52 chronic wounds was conducted to investigate the microbiological profile and prevalence of drug-resistant strains in chronic nonhealing wounds to develop an evidence-based approach to antibiotic therapy until drug sensitivity reports are available. Mean wound duration was 8.23 (± 12.35) months (range 1.5-72), average wound size was 29.70 (± 37.83) cm, and most patients had a lower extremity wound and diabetes mellitus (n ≤ 20). Pus and tissue samples were cultured and tested. Most (45) wounds contained a single organism and nine different genera were isolated. Of those, 39 were Gram-negative and 11 were Gram-positive (z ≤ 5.50, P ≤<0.001). The most common organisms were Pseudomonas (21 wounds) and Escherichia coli (eight wounds). Pseudomonas aeruginosa was more common in patients with diabetes mellitus, in lower extremity ulcers, and in ulcers >20 cm2 (z-test, P <0.05). The presence of two organisms was more commonly observed in postsurgical/traumatic wounds. Ten (10) out of 55 pathogens (18.18%) isolated were drug-resistant, including Pseudomonas (seven), methicillin-resistant Staphylococcus aureus (one), and extended-spectrum beta lactamase (two - E. coli and Citrobacter). Most (70%) drug-resistant pathogens were obtained from persons with diabetes mellitus. Overall sensitivity to piperacillin and tazobactum combination was high. Because the prevalence of monomicrobial flora in chronic wounds is high, if a wound infection is suspected, empiric therapy should target the most prevalent flora. The high rate of drug-resistant Pseudomonas and MRSA strains should discourage antibiotic use in chronic ulcers before obtaining culture results.
A Study of Arginase Expression in Chronic Non-healing Wounds
(SAGE Publications Inc., 2023) Ruhi Dixit; Abhik Debnath; Suman Mishra; Rajnikant Mishra; Satyanam K. Bhartiya; Arvind Pratap; Vijay K. Shukla
Arginase expression has been recently shown to increase in numerous disease states like neurodegeneration, inflammation, and malignancies. Although it has been found to be functionally important in various disease pathologies, little is known about its role in wound healing. Here, we look at the expression of arginase and its isoforms in chronic non-healing wounds and also study the expression of nitric oxide synthase (NOS) and oxidative stress enzymes in them. Wound tissues and blood samples were collected at the time of index presentation and follow-up from 61 chronic non-healing wound cases. The expression patterns of arginase isoenzymes, NOS, superoxide dismutases (SOD), lactic acid dehydrogenase (LDH), and catalase were examined by using enzyme-linked immunosorbent assay, immunohistochemistry, and western blot analysis at the transcript and protein level. We reported a significant decrease of serum arginase levels in chronic nonhealing wounds in the progress of wound healing. Interestingly, tissue arginase levels were found to be increased with improved wound condition at follow-up. Tissue NOS, LDH, and catalase activity were also found to be increased with the progress of healing, whereas SOD levels were downregulated. Our findings reported increased expression at the transcript level of arginase-I and arginase-II in chronic non-healing wounds for the first time. In conclusion, we observed decreased serum arginase levels in completely healed patients as compared to non-healed cases. Our study findings support the hypothesis that inhibition of the activity of arginase delays wound healing. Arginase and iNOS may also find their place in the future as possible biomarkers for wound healing. © The Author(s) 2021.
Acid exposure induces multiplication of salmonella enterica serovar typhi
(American Society for Microbiology, 2014) Suneel Kumar Ahirwar; Chandra Bhan Pratap; Saurabh Kumar Patel; Vijay K. Shukla; Indarjeet Gambhir Singh; Om Prakash Mishra; Kailash Kumar; Tej Bali Singh; Gopal Nath
Salmonella enterica serovar Typhi faces several environmental stresses while going through the stomach (acidic pH) to the small intestine (basic pH) and intracellularly in macrophages (acidic pH) in humans. The acidic pH followed by alkaline pH in the small intestine might be responsible for expression of certain stress-induced genes, resulting in not only better survival but also induction of multiplication and invasion of the bacterium in the small intestine. Based on this hypothesis, we developed a process wherein we exposed the blood, urine, and stool specimens from 90 acute typhoid fever patients and 36 chronic typhoid carriers to acidic pH to see the effect on isolation rate of S. Typhi. About 5 g of freshly passed unpreserved stool, a centrifuged deposit of 15 ml of urine, and 5 ml of blood clot were subjected to 5 ml of Luria-Bertani (LB) broth (pH 3.5) for 20 min, followed by enrichment in bile broth-selenite F broth. When the combined isolation from all 3 specimens, i.e., blood, urine, and stool, after acid exposure was considered, a total of 77.7% of the acute typhoid patients were observed to be positive for the isolation of the S. Typhi serotype, compared to 8.8% by the conventional method. Similarly, 42% (15/36) of chronic carriers yielded positive for S. Typhi growth after acid exposure, compared to 5.5% (2/36) by the conventional method. It therefore can be concluded that acid shock triggers the multiplication of the bacteria, resulting in better isolation rates from blood clot, stool, and urine specimens. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
Apoptosis: A basic physiologic process in wound healing
(2005) Nirendra K. Rai; Kamlakar Tripathi; Deborshi Sharma; Vijay K. Shukla
Apoptosis, or programmed cell death, is a complex network of biochemical pathways for controlling such events in a cell. Apoptosis is essential, as its failure can lead to disease. Because apoptosis concerns the regulation of sequential events, including the removal of inflammatory cells and the evolution of granulation tissue into scar tissue, it has an essential role in wound repair. This article examines the literature and proposes that apoptosis features in the development of diabetic foot wounds. Hyperglycemia deregulates the sequential apoptotic events by multiple mechanisms, leading to delayed wound healing. Deregulated apoptosis is emerging as a prominent cause of delayed wound healing, especially in diabetic wounds, along with the well-known triad of peripheral vascular disease, neuropathy, and infection. © 2005 Sage Publications.
Appendicectomy under local anaesthesia
(1999) Lal B. Sharma; Mudit Agarwal; Lalit Chaudhary; Vijay K. Shukla
Objective: To analyse our results of appendicectomy under local anaesthesia. Design: Prospective study. Setting: University hospital, India Subjects: 165 patients who presented with appendicitis between January 1996 and December 1997. Intervention and main outcome measures: Appendicectomy after infiltration of local anaesthetic. No patient required general or spinal anaesthesia. Result: Five patients (3%) developed postoperative wound infections. Mean operating time was 20 minutes (range 15-30) and median hospital stay 2 days (range 1-3) Conclusion: Appendicectomy under local anaesthesia is quick, cost-effective and carries little morbidity. It can be safely used for all age groups.
Bacteriophage Therapy of Chronic Nonhealing Wound: Clinical Study
(SAGE Publications Inc., 2019) Pooja Gupta; Hari Shankar Singh; Vijay K. Shukla; Gopal Nath; Satyanam Kumar Bhartiya
Background: A chronic wound usually results due to halt in the inflammatory phase of wound healing. Bacterial infections and biofilm formation are considered to be the basic cause of it. Chronic wounds significantly impair the quality of life. Antibiotics are now failing due to biofilm formation emergence of drug-resistant bacteria. Objective: This study aims to see the effect of bacteriophage therapy in chronic nonhealing wound infected with the following bacteria: Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. Subject: Patients with chronic nonhealing wound not responding to conventional local debridement and antibiotic therapy were included in the study. The age of patients ranged between 12 and 60 years. Method: A total of 20 patients selected and tissue biopsies and wound swabs were taken for isolation of the bacteria. After confirmation of organism, a cocktail of customized bacteriophages was topically applied over the wound on alternate days till the wound surface became microbiologically sterile. Mean bacterial count and clinical assessment were done and compared at the time of presentation and after 3 and 5 doses of application. Results: A significant improvement was observed in the wound healing, and there were no signs of infection clinically and microbiologically after 3 to 5 doses of topical bacteriophage therapy. Seven patients achieved complete healing on day21 during follow up while in others healthy margins and healthy granulation tissue were observed. Conclusion: Topical bacteriophage application may be quite effective therapy for the treatment of chronic nonhealing wounds. © The Author(s) 2019.
Bile, bacteria, and gallbladder carcinogenesis
(1995) Manoj Pandey; Ram A. Vishwakarma; Ajay K. Khatri; Salil K. Roy; Vijay K. Shukla
[No abstract available]
Cancer pattern in Varanasi district from Uttar Pradesh state of India, a foundation for cancer control based on the first report of the population-based cancer registry
(Wolters Kluwer Medknow Publications, 2024) Atul M. Budukh; Satyajit Pradhan; Virendra B. Singh; Divya Khanna; Sonali S. Bagal; Priyal S. Chakravarti; Anand N. Sharma; Rajesh K. Vishwakarma; Shraddha S. Shinde; Naveen C. Khargekar; Pankaj Chaturvedi; Rajesh P. Dikshit; Vijay K. Shukla; Rajendra A. Badwe
Background: The cancer registry provides reliable data from the population. In this article, we provide cancer burden and its patterns from the Varanasi district. Methods: The method adopted by the Varanasi cancer registry is community interaction along with regular visits to more than 60 sources to collect data on cancer patients. The cancer registry was established by the Tata Memorial Centre, Mumbai, in 2017 covering 4 million population (57% rural and 43% urban population). Results: The registry has recorded 1,907 incidence cases (1,058 male and 849 female). The age-adjusted incidence rate per 100,000 population in male and female of Varanasi district is 59.2 and 52.1, respectively. One in 15 male and one in 17 female are at risk of developing the disease. Mouth and tongue cancers are the predominant cancers in male, whereas breast, cervix uteri, and gallbladder are the leading cancer sites among the female. In female, cervix uteri cancer is significantly higher (double) in rural areas when compared with urban areas (rate ratio [RR] 0.5, 95% confidence interval [CI; 0.36, 0.72]), whereas in male, mouth cancer is higher in urban areas when compared with rural areas (RR 1.4, 95% CI [1.11, 1.72]). More than 50% of cancer cases in male are due to tobacco consumption. There may be underreporting of the cases. Conclusion: The results of the registry warrant policies and activities related to early detection services for the mouth, cervix uteri, and breast cancers. The Varanasi cancer registry is the foundation for cancer control and will play an important role in the evaluation of the interventions. © 2024 Indian Journal of Cancer.
Carcinoma of the gallbladder - Is it a sequel of typhoid?
(2000) Vijay K. Shukla; Harbans Singh; Manoj Pandey; S.K. Upadhyay; Gopal Nath
Gallbladder diseases, including carcinoma, are common in the northern part of India and so are Salmonella typhi infection and typhoid carrier state. This study was aimed to find out the association of typhoid carrier state in patients with cholelithiasis, carcinoma of the gallbladder, and controls. The three groups are comparable in age and sex composition. This is the first study of its kind from an area of high endemicity for both typhoid infection and carcinoma of the gallbladder. A case-control study was carried out to detect typhoid carrier state among the patients with biliary diseases and healthy controls, using indirect haemagglutination assay measuring antibodies against highly purified S. typhi Vi polysaccharide antigen. A significantly high Vi positivity was observed in patients with gallbladder carcinoma (29.4%) compared to controls (5%) (χ2 6.325, P < 0.004, OR = 7.19) and patients with cholelithiasis (10.7%) (χ2 = 5.066, P < 0.01, OR = 3.86). There is 8.47 times more risk of developing carcinoma of the gallbladder in culture-positive typhoid carriers than the non-carriers. The present study suggests the typhoid carrier state to be one of the possible mechanisms of gallbladder carcinogenesis.
Carcinoma of the gallbladder presenting as scalp tumour
(W.B. Saunders Ltd, 1998) Manoj Pandey; Nakul C. Aryya; Satyajit Pradhan; A.K. Asfhana; Amitabh Gautam; Vijay K. Shukla
Carcinoma of the gallbladder is characterized by rapid tumour growth associated with lymphatic and local tumour invasion. The peritoneum, GIT and lungs are common sites of seeding. Distant metastasis to bone rarely occurs. Here we document a case of silent gallbladder carcinoma presenting as scalp tumour with improved survival.
Carcinoma of the gallbladder: A retrospective review of 99 cases
(2001) Manoj Pandey; Alok K. Pathak; Amitabh Gautam; Nakul C. Aryya; Vijay K. Shukla
Since the first description of the carcinoma of the gallbladder, about two centuries ago, this disease has evaded all attempts at early detection and a potential cure. There are only a few studies involving the Indian population, which has a high incidence of gallbladder cancer. Indians are ethnically and culturally different from their Western counterparts, for whom the incidence of this disease is comparatively low. The present study was conducted prospectively on 99 consecutive cases of carcinoma of the gallbladder of 736 patients with biliary diseases admitted to one surgical unit at the University Hospital. The staging, histological type, and grade were correlated with the clinical outcome. Abdominal pain (82.8%) and abdominal mass (73.7%) were the main presenting features. The diagnosis was obtained by ultrasonography (USG) in 93 of 99 cases and confirmed by fine-needle aspiration cytology (FNAC) in 70 patients. Ultrasonography, however, was found to be inadequate for accurate staging of the disease. Based on the TNM classification, 3 (3.0%), 12 (12.1%), 14 (14.1%), 12 (12.1%), and 58 (58.6%) patients had stage 0, I, II, III, and IV disease, with a corresponding mean survival of 28.3, 13.8, 7.5, 5.2, and 3.7 months, respectively. Carcinoma of the gallbladder is difficult to diagnose early due to its vague symptomatology. A high index of suspicion and health education seem to be the only answers available for early detection and improvement of survival.
Carcinoma of the gallbladder: Role of sonography in diagnosis and staging
(2000) Manoj Pandey; Bimal P. Sood; Ram C. Shukla; Nakul C. Aryya; Shailesh Singh; Vijay K. Shukla
Purpose. In an attempt to define the sonographic characteristics of gallbladder cancer, we retrospectively analyzed the sonographic findings in 203 cases of gallbladder cancer confirmed by cytology or histopathology. Patients and Methods. Patients with proven gallbladder cancer presenting to a single surgical unit between 1991 and 1995 were identified through a records search. All patients underwent sonographic examination followed by fine- needle aspiration (FNA), biopsy, or laparotomy for establishing the diagnosis. Results. A mass in the gallbladder and gallbladder wall thickening (> 12 mm) were cardinal sonographic findings of carcinoma. Liver infiltration was correctly identified in all patients who had it. Sonography was highly accurate for detecting mass lesions, gallstones, liver infiltration, metastasis, and ascites. However, visualization of lymph nodes, common bile duct infiltration, and peritoneal dissemination was poor. Conclusions. Sonography was found to be a good diagnostic tool for carcinoma of the gallbladder; however, its sensitivity was poor for staging nodal spread of the disease. (C) 2000 John Wiley and Sons, Inc.
Cardiff repair of incisional hernia: A University hospital experience
(1998) Vijay K. Shukla; Anurag Gupta; Harbans Singh; Manoj Pandey; Amitabh Gautam
Objective: To analyse our results of the 'Cardiff' (far and near) repair in incisional hernias. Design: Prospective study. Setting: University hospital, Varanasi, India. Subjects: 50 patients who presented with incisional hernias between January 1990 and December 1994. Intervention: Interrupted far-and-near sutures inserted after excision of the sac. The contents were pushed into the abdomen and the peritoneum sutured with non- absorable polypropylene (prolene). Main Outcome Measures: Early and late morbidity. Six patients developed postoperative complications (wound infection, n = 3; flap necrosis, n = 2; and wound sinus, n = 1). No patient has been lost to follow up and there have been no signs of recurrence after a mean follow up of 52 months. Conclusion: The meticulous application of this simple surgical technique has low morbidity and is cost effective. We recommend it for small and medium size defects.
Cholecystosonographic evaluation of the prevalence of gallbladder diseases: A university hospital experience
(Elsevier Inc., 1996) Manoj Pandey; Ajay K. Khatri; Bimal P. Sood; Ram C. Shukla; Vijay K. Shukla
Ninety-five healthy volunteers and 515 patients with problems other than those of the biliary tract were examined using real-time, gray-scale, B-mode ultrasonography. Eighty-two patients (13.44%) were found to have asymptomatic gallbladder disease: 68 (11.14%) had cholelithiasis, 5 (0.81%) had acalculus cholecystitis, and 2 (0.32%) had polyps. Three cases of carcinoma of the gallbladder were also detected, suggesting that ultrasound examination of the high-risk population in an endemic area should not be confined to the disease concerned but that the gall-bladder of such patients should also be screened to pick up asymptomatic gallbladder disease. Hence ultrasound can be used as a screening modality for the early detection of carcinoma of the gallbladder.
Cholelithiatic human gallbladders in vitro fail to respond to cholecystokinin but are responsive to carbachol, histamine, or electrical stimulation
(2004) Shripad B. Deshpande; Narendra K. Gupta; Vijay K. Shukla
The present investigation was undertaken to delineate the in vitro responsiveness of cholelithiatic gallbladders to cholecystokinin (CCK) and compared with those evoked by carbachol, histamine, or electrical stimulation. Gallbladder muscular strips (2-3 mm wide and 15-20 mm long) from patients undergoing cholecystectomy were used for recording the in vitro contractions evoked by electrical and chemical (carbachol, histamine, or cholecystokinin) stimulation. Stimulation of strips with trains of pulses (5-msec duration, 70 V at 100 Hz) of varying train durations (0.01 to 9 sec) elicited duration-dependent increase in the amplitude of contractions and the maximal contractions were seen with 5 sec. Atropine (0.4 μM) significantly attenuated these contractions, leaving about 34% of contractions, which in turn was abolished by xylocaine. Carbachol produced a concentration-dependent (0.004-0.4 μM) increase in force of contraction and the maximal response was seen at 0.4 μM and abolished by atropine (0.4 μM). Histamine also produced contractions and the maximal contractions were about 35% of the maximal carbachol response. Histamine-induced contractions were not abolished by atropine but were abolished by xylocaine. CCK up to 10 μM failed to evoke any contraction, even though the strips were responsive to carbachol. The results indicate that cholelithiatic gallbladders exhibited responses to electrical stimulation through cholinergic and histaminergic plexuses and they were insensitive to CCK.
Cytochrome P-450 expression and lipid peroxidation in gallbladder cancer
(2003) Manoj Pandey; Lal B. Sharma; Vijay K. Shukla
Background and Objectives: Carcinoma of the gallbladder is the commonest neoplasm of the biliary tract; however, the etiology of this tumor remains unclear. Methods: A case-control study was carried out comprising 50 patients with gallbladder cancer and 50 patients with cholelithiasis. Cytochrome P-450 estimation was carried out in the gallbladder tissue, and lipid peroxide product melonaldehyde (MDA) was measured in gallbladder bile. Statistical analysis was carried out by Student's t-test, and one-way analysis of variance (ANOVA). The Pearson correlation coefficient was calculated, and linear regression analysis was performed. Results: The mean cytochrome P-450 concentration was significantly higher in patients with carcinoma of the gallbladder than in controls (t = 3.9, P < 0.001; F = 15.2, P = 0.002). Similarly, the mean concentration of melonaldehyde was significantly higher among cancer patients than in patients with gallstones (t = 2.7, P < 0.003; F = 7.37, P = 0.0078). No significant correlation was observed between tissue MDA and cytochrome P-450 levels (Pearson r = 0.1, P = 0.28). Conclusions: The results of the present study show that the rise in concentration of MDA is independent of the rise in concentration of cytochrome P-450; however, this is statistically insignificant. This could be due to biliary stasis leading to a rise in biliary concentration of melonaldeyde that is disproportionate to its production. © 2003 Wiley-Liss, Inc.
Drug resistance in Salmonella enterica serotype Typhi isolated from chronic typhoid carriers
(2012) Chandra Bhan Pratap; Saurabh Kumar Patel; Vijay K. Shukla; Sunil Kumar Tripathi; Tej Bali Singh; Gopal Nath
[No abstract available]
Effect of 5-fluorouracil and mitomycin on the healing of intestinal anastomosis
(2007) Vijay K. Shukla; Manoj Pandey; P.C.L. Das; S.K. Tiwary; J.P.N. Chansouria; Mohan Kumar; Gurpreet Singh; S.K. Pandey; Gajendra Singh
Objective: Antineoplastic agents affect the healing of intestinal anastomosis. The aim was to evaluate the effect of 5-fluorouracil (5-FU) and mitomycin on the healing of the intestinal anastomosis and their schedule of administration. Material and Methods: Eighty-nine male albino Charles Foster rats with a mean weight of 256.57 g were divided into six groups. Group A represents the control, while in others varying schedules of chemotherapy (5-FU and mitomycin) were administered. The sacrifices were made on days 7, 14 and 21 postoperatively and bursting pressure and hydroxyproline content were measured. Results: Nine rats died before completion of the experiment and were excluded. Adhesions were noted in all rats on sacrifice. The mean bursting pressure of normal intestine (group A) was 252 mm Hg. The bursting pressure was lower on day 7 (208 mm Hg) and it subsequently increased by day 21 (230 mm Hg). The mean bursting pressure in groups B, C, D and E was 174, 194, 182 and 188 mm Hg and it subsequently increased to 232, 272, 244 and 286 mm Hg. There was no difference in the pattern of bursting pressure in colon and ileum. The mean hydroxyproline content of ileum (group A) on day 7 was 34.37 mg/g tissue. The hydroxyproline content of the ileum in groups B, C, D and E was 15.08, 27.03, 7.75 and 21.04 mg/g tissue. There was a significant decrease in hydroxyproline content following anastomosis and chemotherapy. Conclusions: The effect of chemotherapy was pronounced when administered on the day of surgery or in the immediate pre- or postoperative period. Hence administration of chemotherapy during this period may be harmful. Copyright © 2007 S. Karger AG.
Effect of autologous epidermal cell suspension transplantation in chronic nonhealing wounds: A pilot study
(Canadian Medical Association, 2010) Vijay K. Shukla; Satyendra K. Tiwary; Shruti Barnwal; Anil K. Gulati; Shyam S. Pandey
Background: Chronic nonhealing wounds are difficult to manage. Various substances are being used to heal these wounds. We sought to observe the effects of autologous epidermal cell suspension dressings on chronic nonhealing ulcers. Methods: We enrolled patients of the wound clinic at University Hospital, Varanasi, India, with nonhealing wounds of more than 6 weeks' duration. We treated the wound beds with sterile dressings and antibiotics until the swab cultures became sterile. We prepared autologous epidermal cell suspensions from skin grafts and used them on the ulcer beds along with Vaseline gauze dressings. Follow-up visits with patients occurred weekly for assessment of wound healing and other changes. Results: Fifteen patients enrolled in our study. Of these, 6 patients had completely healed at 12 weeks, 1 patient at 16 weeks and 2 patients at 20 weeks after treatment. We observed a slow healing response in 6 patients, of whom 1 patient had healed completely at 32 weeks and another at 48 weeks. One patient needed skin grafting, and 3 patients were lost to follow-up. Conclusion: Autologous noncultured epidermal cell suspension transplantation seems to be an effective, simple and time-saving method to treat chronic nonhealing wounds. © 2010 Association médicale canadienne.