Browsing by Author "Garg, A"
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Item Antibiotic associated diarrhoea: Infectious causes.(2003-01-24) Ayyagari, A; Agarwal, J; Garg, ANearly 25% of antibiotic associated diarrhoeas (AAD) is caused by Clostridium difficile, making it the commonest identified and treatable pathogen. Other pathogens implicated infrequently include Clostridium perfringens, Staphylococcus aureus, Klebsiella oxytoca, Candida spp. and Salmonella spp. Most mild cases of AAD are due to non-infectious causes which include reduced break down of primary bile acids and decrease metabolism of carbohydrates, allergic or toxic effects of antibiotic on intestinal mucosa and pharmacological effect on gut motility. The antibiotics most frequently associated with C. difficile associated diarrhoea are clindamycin, cephalosporin, ampicillin and amoxicillin. Clinical presentation may vary from mild diarrhoea to severe colitis and pseudomembranous colitis associated with high morbidity and mortality. The most sensitive and specific diagnostic test for C. difficile infection is tissue culture assay for cytotoxicity of toxin B. Commercial ELISA kits are available. Though less sensitive, they are easy to perform and are rapid. Withdrawal of precipitating antibiotic is all that is needed for control of mild to moderate cases. For severe cases of AAD, oral metronidazole is the first line of treatment, and oral vancomycin is the second choice. Probiotics have been used for recurrent cases.Item Antimicrobial resistance pattern and in vivo activity of azithromycin in Salmonella isolates.(2013-07) Garg, A; Verma, S; Kanga, A; Singh, D; Singh, BWe evaluated antimicrobial susceptibility pattern of 42 Salmonella isolates from February 2012 through January 2013. We also determined the minimum inhibitory concentrations (MICs) of azithromycin against Salmonella isolates and compared them with corresponding disc diffusion sizes. Entire 42 isolates were sensitive to chloramphenicol, 41 (97.6%) were sensitive to cotrimoxazole and amoxicillin each. MICs for azithromycin ranged from 2 μg/ml to 24 μg/ml, corresponding zone diameters ranged from 15 mm to 33 mm and the two were significantly correlated (P = 0.001). Our results indicate that whereas, azithromycin is a potential therapeutic option, the sensitivity to the first line drugs and absence of multidrug resistance reinforce the concept of antimicrobial recycling.Item Antiphospholipid antibody positive young stroke: an analysis of 12 cases.(2000-10-04) Panagariya, A; Garg, A; Sureka, R KAIMS AND OBJECTIVES: To study clinico-investigative profile of 12 young (<45 years) patients with stroke who tested positive for anti phospholipid antibodies (APLA). SUBJECTS AND METHODS: The diagnostic, clinical, laboratory and radiologic features in 12 APLA positive young patients who presented with stroke were studied. The APLA analysis included estimation of anticardiolipin (aCL) antibodies and lupus anticoagulant (LA). Other relevant tests included anti-nuclear antibody, human immunodeficiency virus, Venereal Diseases Research Laboratory, platelet count, echocardiography and carotid Doppler. APLA positive strokes were those cases where either the immunoglobulin G (IgG) and immunoglobulin M (IgM) were raised or LA was positive, and other known causes were excluded. RESULTS: Levels of IgG (aCL) was raised in 11 cases (mild 7, moderate 1, high 3), IgM was elevated in all the 12 cases (moderate 2, high 10). Of the two LA positive cases both were IgM positive but in one IgG was negative. Five patients showed small multiple bilateral cerebral infarcts on computerised tomography (CT) scan. 5 patients had history of recurrent strokes. Hemiparesis was more frequent than hemiplegia. None presented with dense hemiplegia. All patients recovered to normal functional capacity and did not have recurrence on drugs. CONCLUSION: A preliminary study on APLA positive young strokes showed certain clinical and radiological features, mild to moderate stroke, pre-treatment recurrences, multiple smaller infarcts on CT, which could be clustered in a subgroup of stroke in young. Incidentally these patients showed a good prognosis in terms of long term outcome.Item Art of teaching.(1983-10-01) Ahuja, M M; Dhar, S N; Sapru, R P; Prakash, C; Natarajan, V; Arora, A; Garg, A; Anand, M P; Bisht, D BItem Branchio-oto-renal syndrome.(2008-11-07) Garg, A; Wadhera, R; Gulati, S P; Kumar, ABranchio-oto-renal syndrome (Melnick-Fraser syndrome) is a rare autosomal dominant disorder characterized by syndromic association of branchial cysts or fistulae along with external, middle & inner ear malformations and renal anomalies. Authors are reporting a 19 year male patient, who presented with profound deafness & low set "lop-ear" with right sided preauricular pit. USG abdomen revealed agenesis of the left kidney.Item Cerebrotendinous xanthomatosis: neuroimaging findings in two siblings from an Indian family.(2003-09-04) Gaikwad, S B; Garg, A; Mishra, N K; Gupta, V; Srivastava, A; Sarkar, CCerebrotendinous xanthomatosis (CTX) is exceptionally rare in the Indian population. We present and discuss the clinical, radiological and histopathologic findings in 2 siblings with CTX. Both the patients had juvenile cataract, mental retardation and marked cerebellar ataxia. The Achilles tendon swelling was present in only 1 patient (Case 2). MR imaging showed typical bilateral and symmetrical involvement of the dentate nuclei, inferior olives, brainstem and cerebellar hemispheric white matter. Although the diagnosis of CTX was made in the 3rd decade in both our cases, early diagnosis is possible if neuroimaging is done in the early course of the disease.Item Chemical peeling--glycolic acid versus trichloroacetic acid in melasma.(2001-03-01) Kalla, G; Garg, A; Kachhawa, DMelasma continues to be a therapeutic challenge. 100 patients of melasma not responding to conventional depigmenting agents were divided into 2 groups, one treated with 55-75% glycolic acid (68 patients) and the other with 10-15% trichloroacetic acid (32 patients). Applications were made after every 15 days and response assessed clinically along with relapse or hyperpigmentation after 3 month follow up period. More than 75% improvement was seen in 30%, and 50-75% improvement in 24% patients. Response with TCA was more rapid as compared to GA. Chronic pigmentation responded more favourably to TCA. Relapse and hyperpigmentation was more-25% in TCA as compared to 5.9% GA. Sun exposure was the most important precipitating factor followed by pregnancy and drugs.Item Chronic illness among rural population.(1988-03-01) Garg, S K; Mishra, V N; Bhatnagar, M; Singh, R B; Srivastava, R B; Garg, AItem Comparison of exercise and dipyridamole equilibrium blood pool scintigraphy (EBPS) in angina pectoris.(1989-05-01) Garg, A; Das, G S; Malhotra, A; Wasir, H STwelve patients with exertional angina underwent exercise treadmill testing, exercise equilibrium blood pool scintigraphy (Ex EBPS). Dipyridamole equilibrium blood pool scintigraphy (Dip EBPS) and coronary angiography by the Judkin's technique. Dipyridamole was infused through a venous cannula placed in the antecubital vein, in a dose of 0.56 mg/kg over four minutes. Four patients had single vessel disease, three double vessel disease, four triple vessel disease, and one had normal coronary arteries. Exercise equilibrium blood pool scintigraphy was found to have a sensitivity of 81%, and a positive predictive value for significant coronary artery disease of 100%. Dipyridamole EBPS had a sensitivity of 72% with a positive predictive value of 100%. The occurrence of regional wall motion abnormalities, following dipyridamole infusion, occurs up to fifteen minutes after exercise, and, therefore, serial acquisition for up to 20 minutes after the infusion is recommended. In patients with angina, who are unable to exercise because of orthopaedic disabilities or peripheral vascular disease, dipyridamole stress blood pool scintigraphy is a feasible alternative.Item Computed tomography as a diagnostic tool in acute renal cortical necrosis.(2002-11-14) Rathod, K; Garg, A; Chavhan, G; Rathod, NItem Confusing brand names: nightmare of medical profession.(2005-01-29) Rataboli, P V; Garg, AOBJECTIVE: India has more than 20,000 registered pharmaceutical manufacturers. Consequently, there is a flood of brand names to choose from. We conducted this study to analyse and sort out the multitudinous brand names thronging the Indian market, and identified those that could create a possible confusion. MATERIALS AND METHODS: Recent issues of drug formularies like Indian Drug Review, Drug Index, and Monthly Index of Medical Specialities-India were checked and all the brand names given were included. Some other brand names that are available with the pharmacists but are not included in these indexes were also included in the study for analysis. OBSERVATIONS: Potentially confusing brand names were sorted out and categorised according to the severity of damage they can cause if misinterpreted by the pharmacist or the patient. Subgroups were made according to the brand name, the generic name, and the manufacturers of the drug. CONCLUSION: Several brand names are strikingly identical, similar looking (orthographic), or similar sounding (phonological). Preventing this possible confusion is not the work of any one person involved. We describe the role of prescribing doctors, dispensing pharmacists, consumer patients, and the manufacturing companies to prevent "wrong prescribing" due to similarities in brand names.Item Congenital syphilis in the era of decreasing seroprevalence.(2016-01) Baidya, A; Ghosh, A; Chopra, S; Garg, A; Sood, S; Kapil, A; Das, B KItem Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.(1996-07-01) Enas, E A; Garg, A; Davidson, M A; Nair, V M; Huet, B A; Yusuf, SThe prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors.Item Cranio-fascial tuberculosis.(1984-10-01) Bhatia, B D; Aggarwal, N K; Dubey, A P; Garg, A; Khan, NItem Current spectrum of oculomycosis in North India: A 5‑year retrospective evaluation of clinical and microbiological profile.(2016-01) Verma, S; Sharma, V; Kanga, A; Sharma, R; Angrup, A; Mokta, K; Garg, AOculomycosis is a major cause of visual impairment. Eye pain, redness, discharge, diminution and photophobia are presenting features. We collected corneal scraping, vitreous, aqueous fluids and conjunctival swabs after the slit‑lamp examination. Ophthalmological findings were hypopyon, stromal congestion, conjunctival congestion and epithelial defect. Direct microscopy of 10% potassium hydroxide (KOH) wet mounts, gram staining, fungal and bacterial cultures were performed. Fungal isolates were obtained in 24% patients with equal number of both sexes and average age 49 years. KOH revealed fungi in 73% samples and 43.33% were positive on Gram staining. Fusarium spp. (36.66%), Aspergillus spp. (23.33%) and melanised fungi (20%) were common etiological agents. Fusarium spp. was more often associated with complications. Trauma was a predisposing factor in 65% cases and occurred mainly with vegetable matter. The majority responded to the conservative management with 5% natamycin and four patients required surgery.Item Cyst with a mural nodule: unusual case of brain metastasis.(2004-03-08) Garg, A; Suri, A; Gupta, VItem Declining trends of Syphilis seroprevalance among antenatal clinic cases and STD clinic cases in a tertiary care centre: From January 2002 to December 2012.(2015-02) Chopra, S; Garg, A; Chopra, M; Ghosh, A; Sreenivas, V; Sood, S; Kapil, A; Das, B KSyphilis affects nearly 1.36 million pregnant women, majority of these cases being concentrated in the developing countries. We aimed at analysing the 11 years’ trends in syphilis seroprevalence in antenatal clinics (ANC) and STD clinic cases. Laboratory data of syphilis cases from 2002-2012 were retrospectively analysed. Out of the total 73642 cases, 393 (0.53%) tested positive for Syphilis. A statistically signifi cant decline in syphilis prevalence was found in both ANC and STD clinic cases. The efforts of various interventional programs should continue to make the screening and treatment facilities readily accessible to continue the decline in syphilis seropositivity.Item Disseminated gonococcaemia with arthritis, tenosynovitis and moderately severe jaundice.(1986-07-01) Bhat, A; Kumar, A; Garg, A; Malaviya, A NItem Edward’s syndrome with a novel karyotype.(2011) Patra, S; Garg, A; Gulati, A; Krishnamurthy, S; Aneja, SEdward’s syndrome was first described as a clinical entity in 1960 as a disorder of trisomy 18 (47 XX/XY; + 18) in babies with particular pattern of malformations. The Karyotype found in our case was (47 XX + 18 add (22) (p13) which has not been published so far in the literature. The less common findings noted in the baby were rocker bottom feet, syndactyly of 2nd and 3rd toes, microcephaly and corneal opacities. Though we didn’t find any significant association between phenotypic ranges with genotypic variation in literature, but further research is needed for it. We are reporting this case as the genotype is found to be novel.