Browsing by Author "Malhotra, R"
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Item Autoimmune-like activity of sperm specific LDH: a pathophysiological and electron microscopic study of atrophied testis and epididymis.(1994-12-01) Gupta, G S; Malhotra, RHyper-immunization of male mice with human LDH-C4 evoked autoimmune reactions illustrated by the loss of LDH activity, associated histopathological changes in testes and epididymis and induction of sterility in mice. This was substantiated by the altered morphology of sperm mitochondria and plasma membrane, and by reduced number of cytoplasmic droplets as observed by electron microscopy. However, the presence of lymphoblasts and other lymphoid cells in testes indicated that the testicular damage is accentuated by activated T lymphocytes. It is concluded that immunization with human LDH-C4 produces lesions in mouse testis and epididymis, which are similar to experimentally induced autoimmune orchitis.Item The bone and joint decade 2000-2010: the Indian perspective.(2001-09-05) Malhotra, R; Bhan, SItem Bone and tissue banking: the need and scope in India.(1999-07-26) Malhotra, RItem Epidermoid cysts of the orofacial region: A clinico-pathological study of 13 cases with review of literature(Wolters Kluwer - Medknow, 2023-09) Kumar, P; Malhotra, R; Urs, AB; Augustine, J; Mohanty, S.Background: Epidermoid cysts (ECs) are uncommon benign cystic lesions derived from the germinative epithelium. Head and neck ECs constitute only 7% of all ECs whereas only 1.6% are seen intraorally. The floor of the mouth is the commonest intraoral site whereas tongue, lips, buccal mucosa, and jaws are less commonly involved intraoral sites. To date, very few large case series of ECs of head and neck have been published. To the best of our knowledge, this is the third-largest case series of 11 intraoral ECs along with 2 extra-oral cases in the pre-auricular region. Aims: To highlight the typical and atypical features of ECs in the common as well as rare sites and draw attention to its consideration as a differential diagnosis for head and neck masses. Settings and Design: Archival data of 13 histopathological cases identified as ECs were analyzed from the Department of Oral Pathology at a tertiary dental hospital and college in New Delhi from 2007 to 2020. Materials and Methods: The demographic, clinical, radiographic, histopathological features, and treatment modalities were recorded and analyzed. Statistical Analysis Used: Appropriate statistical tests were used. Results: The study found strong male predilection in the ratio of 10:3 with an average age of presentation as 28 years. The pre-auricular region and floor of the mouth were the common sites involved followed by buccal mucosa, lips, and jaws. All patients presented with slowly growing swelling with dysphagia, dyspnea, and dysphonia seen in larger cysts on the floor of the mouth. Microscopically, all cases were lined with stratified squamous epithelium filled with laminated layers of keratin. Two cases showed the presence of melanin. One case showed recurrence even after complete surgical excision. Conclusion: ECs, though a rare entity, should be considered in differential diagnosis for head and neck masses and require close follow-up due to their potential for malignant transformation.Item Erdheim-Chester disease.(2001-06-05) Sood, A; Jain, R; Kumar, R; Malhotra, R; Chopra, PItem Health care seeking pattern of tuberculosis patients attending an urban TB clinic in Delhi.(2002-09-02) Dhingra, V K; Rajpal, S; Taneja, D K; Kalra, D; Malhotra, RThe study of pattern of health care seeking of tuberculosis patients is important for identification of factors which might influence delayed reporting of tuberculosis cases, especially the open pulmonary cases. Consecutive 301 pulmonary TB patients, belonging to any of the categories under RNTCP, diagnosed at New Delhi Tuberculosis Centre or its sub-centres over a six-month period were assessed for health care seeking pattern. "Delay" was defined as the time over 3 weeks that a case took to report to the area TB facility. 43.2% patients reported to the TB health facility on their own and others were referred by government hospitals (34.9%) and general practitioners (21.9%). Median delay over 3 weeks was 2.69 weeks for all three categories combined, with a significantly higher delay (3.41 weeks) for retreatment cases as compared to new cases (2.13 weeks). No significant differences were observed in health seeking delay in relation to sex, income, literacy status and source of referral and sputum status. Extensive health education activities can reduce this period of delay in health seeking and result in reduction of transmission of tuberculosis to healthy members of the family and community.Item The impact of new technologies on vaccines.(1999-11-25) Talwar, G P; Diwan, M; Razvi, F; Malhotra, RVast changes are taking place in vaccinology consequent to the introduction of new technologies. Amongst the vaccines included in the Expanded Programme of Immunization (EPI), the pertussis vaccine has been replaced by acellular purified fractions devoid of side-effects. Non-pathogenic but immunogenic mutants of tetanus and diptheria toxins are likely to replace the toxoids. An effective vaccine against hepatitis B prepared by recombinant technology is in large-scale use. Conjugated vaccines against Haemophilus influenzae b, S. pneumococcus and meningococcus are now available, as also vaccines against mumps, rubella and measles. Combination vaccines have been devised to limit the number of injections. Vaccine delivery systems have been developed to deliver multiple doses of the vaccine at a single contact point. A genetically-engineered oral vaccine for typhoid imparts better and longer duration of immunity. Oral vaccines for cholera and other enteric infections are under clinical trials. The nose as a route for immunization is showing promise for mucosal immunity and for anti-inflammatory experimental vaccines against multiple sclerosis and insulin-dependent diabetes mellitus. The range of vaccines has expanded to include pathogens resident in the body such as Helicobacter pylori (duodenal ulcer), S. mutans (dental caries), and human papilloma virus (carcinoma of the cervix). An important progress is the recognition that DNA alone can constitute the vaccines, inducing both humoral and cell-mediated immune responses. A large number of DNA vaccines have been made and shown interesting results in experimental animals. Live recombinant vaccines against rabies and rinderpest have proven to be highly effective for controlling these infections in the field, and those for AIDS are under clinical trial. Potent adjuvants have added to the efficacy of the vaccines. New technologies have emerged to 'humanize' mouse monoclonals by genetic engineering and express these efficiently in plants. These recombinant antibodies are opening out an era of highly specific and safe therapeutic interventions. Human recombinant antibodies would be invaluable for treating patients with terminal tetanus and rabies. Antibodies are already in use for treatment of cancer, rheumatoid arthritis and allergies. An advantage of preformed antibodies directed at a defined target and given in adequate amounts is the certainty of efficacy in every recipient, in contrast to vaccines, where the quality and quantum of immune response varies from individual to individual.Item Increasing access to cataract surgery in a rural area--a support strategy.(2005-04-07) Malhotra, R; Uppal, Y; Misra, A; Taneja, D K; Gupta, V K; Ingle, G KThe objectives of the study were to elicit the reasons for not undergoing cataract surgery from those having cataract, aged 50 years and above, in a village community and, develop, implement and assess a support strategy for getting cataract surgery done. The leading reasons identified were monetary constraints (18.8%), transport difficulty (17.4%), lack of awareness about cataract in the eyes (17.4%) and lack of escort (14.5%). Based on the identified reasons, patients were transported in groups to a government eye hospital for free surgery after completion of required pre operative formalities at the village health center itself. Out of 65 eligible individuals, 66.2% underwent surgery. The success of the approach was evident by perceived improvement in vision in 88.4% operated patients, occurrence of only few minor complications and a satisfactory hospital experience being reported by all.Item Minimally invasive atrial septal defects repair.(1999-03-17) Malhotra, R; Mishra, Y; Sharma, K K; Mehta, Y; Trehan, NThis study reviews the current method of atrial septal defect closure at our institute with a minimally invasive approach without median sternotomy. From September 1997 to August 1998, 37 patients (13 males, 24 females) with mean age 36.5 years (range 18-67 years) underwent atrial septal defect closure by right anterior thoracotomy. Femoral vessels were cannulated through a small groin incision and extracorporeal circulation was established. Venous drainage was assisted with a centrifugal pump. Aortic crossclamping was performed through the intact chest wall using a special transthoracic clamp with sliding rod design inserted through a separate tiny 3 mm incision in the right second intercostal space in the mid clavicular line. Mean duration of cardiopulmonary bypass and aortic crossclamp time was 35 +/- 14 and 23 +/- 7 minutes respectively; mean endotracheal intubation time after surgery 6.2 +/- 3 hours; mean ICU stay 10.6 +/- 2.8 hours; mean length of thoracotomy incision 7.2 +/- 1.8 cm; and, mean hospital stay 4.2 +/- 1.8 days. There was no post-operative neurological dysfunction or femoral cannulation related complication. There was no perioperative or late mortality. No residual atrial septal defect was observed by transoesophageal echocardiography in any patient. The procedure described here provides secure closure of the atrial septal defects in minimally invasive fashion with good results.Item p24 antigen screening to reduce the risk of HIV transmission by seronegative bone allograft donors.(2000-07-26) Malhotra, R; Morgan, D ABACKGROUND: During the last decade, more than 2000 bone allografts harvested from 888 donors and processed by the Queensland Bone Bank have been transplanted in over 1500 patients in Australia and New Zealand. A strict protocol to eliminate HIV transmission by fresh frozen allografts is followed; and not a single case of HIV transmission has been reported. METHODS: All donors were screened and strict donor exclusion criteria were used. All donor blood samples were subjected to double testing including antibody to HIV-1, HIV-2 and HTLV-1 and p24 antigen. The allografts negative for these tests were subjected to processing, including removal of extraneous tissue, pulsatile lavage to remove marrow elements, and immersion in 97% alcohol for 20 minutes. Allografts were subjected to 25 cGy irradiation before transplantation. RESULTS: Allografts were retrieved from a total of 950 donors and 51 were discarded after screening for contamination by organisms other than HIV-1. Eleven donors negative for HIV-1 antibodies tested positive for p24 antigen and were discarded. Allografts from donors testing negative for both the tests (n = 888) were irradiated and used for transplantation. CONCLUSIONS: Routine p24 antigen testing and irradiation of allograft should be mandatory for bone banks, especially those freezing fresh allografts. p24 antigen testing is inexpensive, rapid and easy. Certain guidelines must be followed to avoid misleading results of p24 testing.Item Pathogen burden & associated antibiogram of Pseudomonas spp. in a tertiary care hospital of India(Indian Council of Medical Research, 2019-02) Kumari, M; Khurana, S; Bhardwaj, N; Malhotra, R; Mathur, PAntimicrobial resistance particularly in Gram-negative bacilli is an increasing problem worldwide. Pseudomonas spp. is one the most common Gram-negative bacteria associated with nosocomial infections and therefore, its trend of antimicrobial resistance needs to be studied. The aim of this study was to evaluate the rate of antimicrobial resistance and changes in resistance pattern over a period of five years (2012-2016) in Pseudomonas spp. isolated from trauma patients attending a tertiary care hospital in north India. During the study, a total of 2444 Pseudomonas spp. were isolated from the various clinical sample. The most common species isolated was P. aeruginosa (2331, 95%). The highest level of resistance was observed against levofloxacin (1678, 69%) and the lowest level of resistance was observed against tobramycin (1254, 51%). Irrational and inappropriate use of antibiotics was found to be responsible for multidrug resistance in Pseudomonas spp. Hence, there is an urgent need to emphasize strict antibiotic policy to minimize the misuse of antimicrobials.Item Phenotypic & genotypic profile of antimicrobial resistance in Pseudomonas species in hospitalized patients(Indian Council of Medical Research, 2019-02) Bajpai, V; Govindaswamy, A; Khurana, S; Batra, P; Aravinda, A; Katoch, O; Hasan, F; Malhotra, R; Mathur, PBackground & objectives: Nosocomial infections caused by multidrug-resistant, Pseudomonas species have become a major clinical and public health concern. The aim of this study was to characterize phenotypic and genotypic profile of antimicrobial resistance (AMR) in Pseudomonas spp. isolated from hospitalized patients. Methods: A total of 126 consecutive, non-duplicate isolates of Pseudomonas spp. isolated from various clinical samples were included in the study over a period of two years. Identification and antimicrobial sensitivity was performed using automated culture system according to the Clinical and Laboratory Standards Institute (CLSI) recommendations. Phenotypic detection of extended-spectrum ?-lactamases (ESBLs), Amp-C ?-lactamase (AmpC) and metallo-?-lactamases (MBLs) were done by various combinations of disc-diffusion and E-test methods, followed by polymerase chain reaction-based detection of ?-lactamase-encoding genes. Results: Among 126 clinical isolates, 121 (96.1%) isolates were identified as Pseudomonas aeruginosa. Most of the isolates were recovered from pus sample, 35 (27.8%) followed by urine, 25 (19.84%); endotracheal aspirate, 24 (19.04%); blood, 14 (11.11%) and sputum, four (3.17%). The highest rate of resistance was against ticarcillin-clavulanic acid, 113 (89.7%) followed by meropenem, 92 (72.5%) and ceftazidime, 91 (72.3%). Overall, ESBLs, AmpC and carbapenemase production was detected in 109 (96.4%), 64 (50.8%) and 105 (94.6%) isolates by phenotypic methods. The most prevalent ESBL gene was blaTEMin 72 (57.1%) and the least prevalent was blaSHVin 19 (15.1%) isolates. AmpC gene was seen less compared to ESBL gene. The most prevalent carbapenemases gene was blaNDM-141 (46.06%) followed by blaVIM and blaOXA-1. Interpretation & conclusions: Our findings suggested that a high rate of ESBLs and carbapenemases production was observed in Pseudomonas spp. Therefore, phenotypic and genotypic detection of AMR needs to be combined for better characterization of resistance patterns in Pseudomonas spp.Item Prosthetic joint infection due to Lysobacter thermophilus diagnosed by 16S rRNA gene sequencing.(2016-01) Dhawan, B; Sebastian, S; Malhotra, R; Kapil, A; Gautam, DWe report the first case of prosthetic joint infection caused by Lysobacter thermophilus which was identified by 16S rRNA gene sequencing. Removal of prosthesis followed by antibiotic treatment resulted in good clinical outcome. This case illustrates the use of molecular diagnostics to detect uncommon organisms in suspected prosthetic infections.Item Prosthetic joint infection: A major threat to successful total joint arthroplasty(Indian Association of Medical Microbiologists, 2018-12) Sebastian, S; Malhotra, R; Dhawan, BTotal joint arthroplasty (TJA) is one of the most common and reliable orthopaedic procedures that has significantly improved the quality of life of patients with degenerative joint diseases. Following the increase in the ageing population, availability of trained orthopaedic surgeons and advances in implantation procedures, demand for TJA both globally and in India is significantly increasing. Though TJA is one of the most cost-successful orthopaedic procedures, prosthetic joint infection (PJI) is one of the major complications of joint arthroplasty. Accurate diagnosis of PJI is challenging. Since total hip and knee arthroplasties comprises the majority of TJAs, this review focuses on the current understanding of incidence, risk factors, pathogenesis, causative microorganisms, diagnosis, treatment and prevention of PJI related to these two procedures.Item Protocol for developing a surveillance system for surgical site infections(Indian Association of Medical Microbiologists, 2019-09) Mathur, P; Mittal, S; Trikha, V; Lohiya, A; Khurana, S; Katyal, S; Bhardwaj, N; Sagar, S; Kumar, S; Malhotra, R; Walia, KPurpose: Healthcare-associated infections (HCAIs/ HAIs) are the most common adverse occurrences during health care delivery. Across the globe, millions of patients are affected by HAIs annually, with a higher burden and impact in developing nations. a major lacuna in planning preventing protocols is the absence of National Surveillance Systems in most low-middle income countries, which also prevents allocation of resources to the high-priority areas. Among all the HAIs, there is a huge global burden of SSIs, in terms of morbidity, prolonged hospital stays, increased antimicrobial treatment as well as attributable mortality. Method: This manuscript details the process of establishment of an SSI surveillance protocol at a level-1 trauma centre in North India. Result and Conclusion: Surveillance is an essential tool to reduce this burden. It is also an important primary step in recognizing problems and priorities, and it plays a crucial role in identifying risk factors for SSI and to be able to target modifiable risk factors. Therefore, it is imperative to establish reliable systems for surveillance of HAIs, to regularly estimate the actual burden of HAIs, and to use these data for developing indigenous preventive measures, tailored to the country's priorities.Item Qualitative study of wild polio cases in high risk districts of Uttar Pradesh, India.(2003-05-22) Kishore, Jugal; Pagare, D; Malhotra, R; Singh, M MBACKGROUND: India has implemented a polio eradication strategy which includes national immunization days and house-to-house visits. While there has been a reduction in wild polio cases, a few districts in some states continue to harbour the virus. We did a qualitative survey in certain districts of western Uttar Pradesh to determine the reasons for continued occurrence of wild polio cases. METHODS: Five districts of western Uttar Pradesh were selected where 10 confirmed cases of polio were studied in their local settings using qualitative tools. RESULTS: All 10 cases were below 5 years of age and belonged to the poor socioeconomic group. Except 3, all had received some doses of oral polio vaccine before the onset of illness. The majority of parents had a 'feeling of guilt' and blamed the 'bad destiny of their child' for the disease. There was a strong belief that the 'polio vaccine is mixed with substances which can cause infertility' and that it was 'used for a particular community'. CONCLUSION: Prevailing misconceptions and adverse attitudes to the polio vaccine need to be tackled urgently and sensitively to make the programme successful.Item Regulation of fertility in female mice after immunization with human sperm specific LDH: role in conception and contraception.(1994-01-01) Gupta, G S; Malhotra, R; Sehgal, SEffects on fertility of female mice after hyper-immunization with human lactate dehydrogenase-C4 have been studied at (50 + 25 x 4) and (50 + 50 x 4) micrograms doses of protein for two consecutive cycles of pregnancy. Results of heterologous immunization are described in relation to the role of LDH-C4 in conception and contraception. (i) Low dose of Immunization produced higher antibody (Ab) titer as tested before mating followed by higher infertility (70%) than by a higher dose of immunogen (46%), taking pregnancy as the end point. (ii) However, the results were reversed after second mating. For example, low dose of immunogen produced insignificant infertility, whereas high dose of immunogen gave 80% infertility. Similar order was shown by humoral Ab titer before mating i.e., high infertility was associated with high Ab titer and viceversa. (iii) It shows that the LDH-C4 induced infertility is reversible as is evidenced by low dose of immunization. (iv) In contrary to infertile dams, immunized fertile dams delivered a significantly higher litter size as compared to non-immunized control dams. It is concluded that immunity due to LDH-C4 is beneficial for embryo survival suggesting an immuno-suppressive nature of LDH-C4. Nonetheless, infertility ensues when immune-suppression is overcome by its own immune-activation.Item Risk factors and genotypes of HCV infected patients attending tertiary care hospital in North India.(2015-01) Jindal, N; Bansal, R; Grover, P; Malhotra, RItem Role of computed tomography in patients with hemoptysis and a normal chest skiagram.(2000-04-01) Magu, S; Malhotra, R; Gupta, K B; Mishra, D SThirty patients of hemoptysis with a normal skiagram chest were evaluated by computed tomography. Majority of the patients were between 21 to 50 years of age. Seventy percent had mild hemoptysis while 30 percent had moderate hemoptysis. Computed tomography provided diagnostic information in 16 patients (53%). The various aetiologies were bronchiectasis (20%), tuberculosis (20%), pneumonia (6.7%), bronchial carcinoid in one case and allergic bronchopulmonary aspergillosis in one case. Computed tomography may play a role in screening patients who present with hemoptysis with normal chest radiographs.Item Sonication of antibiotic loaded cement spacers: A valuable technique for detection of infection persistence in two-stage revision for infected joint arthroplasty(Indian Association of Medical Microbiologists, 2019-03) Sebastian, S; Malhotra, R; Dhawan, B; Sreenivas, V; Kapil, A; Chaudhry, RWe evaluated the diagnostic utility of sonication of antibiotic loaded cement spacers comparing with periprosthetic tissue cultures for the detection of persisting infection in 14 patients undergoing staged procedures. Sonication improved microbial detection of intraoperative cultures from 14.2% to 28.5% (P = 0.481). Routine sonication of spacers is recommended.