Browsing by Author "Shukla, S K"

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    Beta-blocker (propranolol) in mild hypertension: a dose response study.
    (1979-11-01) Shukla, S K; Bhatnagar, M K; Agarwal, R K; Dwivedi, R N; Gupta, R
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    Biological warfare--an emerging threat.
    (2004-09-21) Agarwal, Reshma; Shukla, S K; Dharmani, S; Gandhi, A
    As we approach the 21st century, there is an increasing worldwide awareness and threat regarding the use of biological warfare agents both for war and terrorist attack. Biological agents include microorganisms or biological toxins that are used to produce death in humans, animals and plants. They are characterized by low visibility, high potency, substantial accessibility and relatively easy delivery. Biological warfare agents are unconventional weapons that can be delivered by unconventional means like aerosol sprays, food and water contamination, conventional explosive munitions or by covert injections. Because of their concealed delivery, easy transportation and difficult identification they are readily adaptable for terrorist operations or to gain political advantages. The detection of such attack requires recognition of the clinical syndromes associated with various biological warfare agents. Diagnosis can be made on clinical grounds and on investigations. Protective measures can be taken against biological warfare agents. These should be implemented early (if warning is received) or later (once suspicion of agent use is made). After the confirmation of diagnosis emergency medical treatment and decontamination are performed in rapid sequence. Patients are then evacuated and specific therapy is given according to the agent involved. Appropriate emergency department and hospital response could significantly limit the morbidity and mortality of biological warfare agents.
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    Complete intraventricular dissociation. Electrocardiographic manifestation of a rare intracardiac complete dissociation.
    (1989-05-01) Barthwal, S P; Sarkari, N B; Agarwal, R; Agarwal, D K; Shukla, S K
    Complete Intraventricular Dissociation manifesting as dual ventricular rhythm was observed on surface electrocardiography in two middle-aged males with acute myocardial infarction. The first patient had a dominant accelerated (AV) junctional rhythm, and there was a sudden emergence of an additional independent slow and regular idioventricular escape rhythm. These ventricular complexes were bizarre and markedly widened, waveform with prolonged undulating electric potentials. In the second case, the emergence of a dominant idioventricular rhythm was coexistent with an additional independent escape rhythm with monophasic wider agonal ventricular complexes. Terminal tracings recorded later were essentially the same, except that an ill sustained ventricular fibrillation had replaced the ectopic agonal beats, and there was an enhanced automaticity in the dominant ventricular part. The sites of ectopic ventricular rhythms were thought to be in the ischaemic damaged ventricular myocardium, with a surrounding zone of conduction block.
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    Dermatitis artefacta.
    (1989-10-01) Singh, K G; Tandon, A K; Agarwal, R; Shukla, S K
    Dermatitis artefacta is an uncommonly encountered condition. This paper presents a case report of two such rare patients. The symptomatology and history of fourteen and sixteen year old males with dermatitis artefacta are described. Possible psychophysiological aetiology of the cases is discussed.
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    Development of spray reagent for TLC detection of pyrethroid insecticides using picric acid.
    (2007-07) Jayashankar, G; Chainulu, M S C; Sarma, P N; Sarin, R K; Shukla, S K
    There have been a variety of approaches developed since the 1970s to detect pyrethroid pesticides based on gas chromatography (GC), thin layer chromatography (TLC), and high performance liquid chromatography (HPLC) with ultraviolet detection. A new thin layer chromatographic method was developed for the detection of common pyrethroids in forensic toxicology case exhibits. Various solvent systems were tried as mobile phase with different spray reagents; picric acid was used as specific spray reagent for deltamethrin, fenvalerate, and cypermethrin. The method developed is rapid and sensitive and can be used for routine case analysis with better separation. A new modified spray reagent was developed for the detection of synthetic pyrethroids containing a hydrolysable nitrile group such as deltamethrin, fenvalerate and cypermethrin using picric acid, that produces reddish-orange spots on a yellow background.
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    Diagnostic significance of T I < T III and TV1 > TV6 signs in ischaemic heart disease.
    (1993-01-01) Barthwal, S P; Agarwal, R; Sarkari, N B; Agarwal, D K; Shukla, S K
    One hundred seventy patients with ischaemic heart disease (IHD) and 141 healthy controls were evaluated to assess the diagnostic significance of T I < T III and TV1 > TV6 as compared to widening of QRS-T angle. Number of cases with abnormal widening of QRS-T angle was significantly higher (P < .001) in frontal and horizontal planes in the IHD group. T I < T III sign has 61.2% sensitivity, 74.5% specificity and 25.5% false positivity in diagnosis of IHD. Along with abnormal QRS-T angle widening it gave a specificity of 95.5% but a false positivity of 35% and a low sensitivity index (35.3%). TV1 > TV6 sign has sensitivity, specificity and false positivity of 72.9% 84.4% and 15.6% respectively. Combining it with abnormally wide QRS-T angle did not materially improve these indices. Combining T I < T III and TV1 > TV6 signs gives a sensitivity of 49.4%, specificity of 95% and false positivity of 5% in IHD. This is a good diagnostic index and can be assessed at a quick glance without cumbersome estimation of QRS-T angle.
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    Endoscopic and histological changes in upper gastrointestinal tract of patients with chronic renal failure.
    (2004-04-22) Misra, Vatsala; Misra, S P; Shukla, S K; Jaiswal, Pramod Kumar; Agarwal, Ranjan; Tondon, Soniya
    To evaluate the endoscopic and histological changes in upper gastrointestinal tract of patients with chronic renal failure 50 patients and 50 controls were studied. Upper gastrointestinal endoscopy was done and 2 biopsies each were taken from oesophagus, corpus and antrum of the stomach and duodenum. Sections were stained with haematoxylin & eosin, Alcian blue--Periodic acid Schiff's (pH 2.5), and Loeffler's methylene blue stains. Oesophagus was endoscopically normal in most of the patients. Predominant histological finding was chronic oesophagitis which was significantly higher in patients than controls (47.1% Vs 26%; p<0.05). Significantly higher (p<0.001) number of patients had gastritis, oedema and pale mucosa on endoscopic examination of stomach. Predominant histological changes were mucosal oedema (82.35%), gastritis (23.5%) and increase in number of bi- and multinucleated parietal cells with vacuolation and fragmentation of the cytoplasm (29%). Prevalence of H. pylori was less in patients as controls (35.2% Vs 54%; p< 0.01). Endoscopic examination of duodenum mainly showed duodenitis, pale mucosa, oedema and nodularity. Brunner's gland hyperplasia (82.4%), duodenitis (70.6%) and gastric metaplasia (29.4%) were the main histological features. H. pylori was seen in 5.9% cases of gastric metaplasia in duodenum. Patients with CRF have significant upper gastrointestinal tract abnormalities which mainly occur due to metabolic changes in response to high urea concentration in gastric juice and are not related to H. pylori infection.
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    An epidemic of acute pyogenic (meningococcal) meningitis.
    (1975-09-01) Sarkari, N B; Shukla, S K
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    Incidence of blaNDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India.
    (2013-07) Bora, A; Ahmed, G U; Hazarika, N K; Prasad, K N; Shukla, S K; Randhawa, V; Sarma, J B
    Purpose: Increasing reports on New Delhi metallo-β-lactamase-1 (NDM-1) producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. Materials and Methods: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤21 mm) were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. Results: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. Conclusions: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.
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    Intramuscular myxoma of deltoid--a case report.
    (1977-07-01) Monga, S; Shukla, S K; Bhargava, S; Bhatnagar, L S
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    Isolation of etiological agent of hydropericardium syndrome in chicken embryo liver cell culture and its serological characterization.
    (2003-08-14) Kumar, Rajesh; Chandra, Rajesh; Shukla, S K
    The virus causing hydropericardium syndrome was isolated in chicken embryo liver (CEL) cell culture from livers obtained from naturally infected broilers. The cytopathic effects characterized by rounding and degeneration of cells were visible 36 hr post infection in first passage. At 4th passage level, the infectivity titre was 5.24 log10 TCID50/ml. In May-Grunwald and Giemsa stained cells, basophilic intranuclear inclusions ('bird eye' inclusion), typical of aviadenovirus infection, were observed. The specificity of inclusion was confirmed by indirect immunofluorescence. Various serological tests, such as agar gel precipitation test, counter immuno electrophoresis, micro serum neutralization test and enzyme linked immunosorbent assay were also standardized to confirm the isolation of etiological agent of hydropericardium syndrome in CEL cell culture and to diagnose the disease in poultry.
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    Methyldopa and propranolol in moderate hypertension.
    (1980-01-01) Agarwal, R K; Bhatnagar, M K; Shukla, S K; Gupta, R; Dwivedi, R N
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    Neuropathy in fluorosis.
    (1977-05-01) Mangal, B D; Mangal, Y; Gupta, B K; Kumar, S; Shukla, S K
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    A new approach of real time polymerase chain reaction in detection of vancomycin-resistant enterococci and its comparison with other methods.
    (2013-01) Tripathi, A; Shukla, S K; Singh, A; Prasad, K N
    Background: Vancomycin-resistant enterococci (VRE) are third leading cause of nosocomial infection. Therefore, an effective, accurate and early detection of VRE along with their minimum inhibitory concentrations (MICs) is required to initiate appropriate therapy and thus better patient outcome. Objective: To detect VRE by real time quantitative polymerase chain reaction (Q-PCR) and to compare the results with chrom ID (C-ID) VRE and PCR. Further the study also determined the fold change of vanA gene by Q-PCR in different groups of VRE isolates classified on the basis of glycopeptides MIC range. Subjects and Methods: A total of 145 (80 VRE and 65 vancomycin-susceptible enterococci) clinical isolates were included in the study. After the screening of VRE isolates MICs were determined by E-test and agar dilution method. Further VRE was confirmed by vanA and vanB specific PCR and Q-PCR. Results: The sensitivity and specificity of C-ID VRE was 100% and 95.38%. However, sensitivity and specificity of conventional and Q-PCR were found to be 100%. Conventional and Q-PCR confirmed that our all isolates were vanA type. Mean R value was significantly higher ( P < 0.001) in group I (MIC > 1024 μg/ml) when compared to group II (MIC 512-1024 μg/ml) and group III (MIC < 512 μg/ml) isolates. The mean R was also significantly higher in group II when compared to group III isolates ( P = 0.038). Conclusion: Q-PCR is a rapid technique to detect vanA in enterococci along with their MIC range, thus it might be helpful to decide the treatment modalities of infections caused by VRE.
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    Nitroglycerin ointment - a drug with sustained efficacy in angina pectoris.
    (1982-04-01) Singh, S; Agarwal, B L; Kumar, K; Misra, A; Shukla, S K; Shukla, S R
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    Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a Tertiary Care Hospital in Northern India.
    (2016-01) Tripathi, A; Shukla, S K; Singh, A; Prasad, K N
    Purpose: To determine the prevalence, genotype, risk factors and mortality in patients having vancomycin-resistant Enterococcus faecalis (VR E. faecalis) and Enterococcus faecium (VR E. faecium) infection or colonisation. Materials and Methods: A total of 1488 clinical isolates of E. faecalis and E. faecium were tested for vancomycin resistance by phenotypic (disk diffusion, E-test and broth micro-dilution test) and genotypic polymerase chain reaction methods. Records of all 1488 patients who had E. faecalis or E. faecium infection or colonisation were reviewed for the identification of host, hospital and medication related risk factors associated with VR E. faecalis and VR E. faecium. Results: Of 1488 isolates, 118 (7.9%) were vancomycin-resistant and their distributions were as follows: E. faecalis =72 (61%) and E. faecium =46 (39%). All 118 vancomycin-resistant isolates were vanA genotype (minimum inhibitory concentration [MIC] to vancomycin ≥64 μg/ml and MIC to teicoplanin ≥32 μg/ml) and none of the isolates was vanB genotype. Multivariate logistic regression analysis identified ventilator support and hospital stay for ≥48 h as independent risk factors associated with VR E. faecalis and VR E. faecium infection or colonisation. Hospital stay ≥48 h was the only independent risk factor for mortality in patients infected with vancomycin-resistant enterococci. Conclusions: Strategies to limit the nosocomial infection especially in patients on ventilator support can reduce VRE incidence and related mortality.
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    Sarcoid heart disease. A case report.
    (1980-11-01) Agarwal, R K; Dwivedi, S; Gupta, R; Shukla, S K; Dwivedi, M
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    A selective method for the qualitative determination of paroxetine in forensic biological samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS).
    (2008-07) Mishra, Vindresh; Sri Chainulu, Chaitanya; Afzal, M; Kaur, Sukhminder; Shukla, S K; Sarma, P N; Sharma, J D
    Paroxetine is a schedule H antidepressant drug. It has occasionally been implicated in lethal overdoses. To identify and estimate the level of this drug in toxicological samples is a forensic challenge. Attempts have been made in the past to extract and detect paroxetine in blood samples by using a variety of techniques such as gas chromatography, gas chromatography-mass spectrometry, high pressure liquid chromatography, liquid chromatography-mass spectrometry, etc. However, no studies have been reported in other biological samples. In this study, an attempt has been made to identify paroxetine in biological samples by liquid chromatography-tandem mass spectrometry in multiple reaction monitoring mode at 330.15192.11. The product ion spectra proved to be very helpful in identification of the drug. Furthermore, multiple reaction monitoring (MRM) enhances the reliability and specificity of the method. The use of modified mobile phase produces good quality of qualifier ions. This method appears to be simple, sensitive, specific, and reliable.
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    Simultaneous separation and identification of antibiotic drugs in complex mixtures by using liquid chromatography-tandem mass spectrometry (LC-MS-MS).
    (2009-07) Mishra, Vindresh; Sharma, J D; Shukla, S K
    Antibiotics are generally considered to be potential lifesaving drugs. In recent times it has been observed that these drugs are being used indiscriminately by many individuals, including youngsters and the elderly. It is well known that most drugs including antibiotics, can cause anaphylactic shock in certain individuals, and this can lead to forensic investigation because of the unexpected nature and abruptness of the death. It is important therefore to have an effective method for the identification of these antibiotic compounds in forensic samples. Earlier workers had performed the separation and identification of fluoroquinolone antibiotics by using various analytical techniques such as High Performance Thin Layer Chromatography (HPTLC), High Performance Liquid Chromatography (HPLC), and Gas Chromatography-Mass Spectrometry (GC-MS). In this study, a simple and selective qualitative method was developed for the separation and identification of four fluoroquinolone antibiotic drugs (Ciprofloxacin, Norfloxacin, Ofloxacin and Gatifloxacin) in forensic samples by using Liquid Chromatography-Tandem Mass Spectrometry (LC-MS-MS) by using Multiple Reaction Monitoring (MRM) functions. The limit of detection (LOD) was observed to be 10 ng/mL for Norfloxacin, Ciprofloxacin and Gatifloxacin, while it was 0.5 ng/mL for Ofloxacin.