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1.  Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection 
Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late) of proximal gastrojejunal (PGJ) reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.
PMCID: PMC3303548  PMID: 22489267
Tuberculosis has claimed its victims throughout much of known human history and is currently the most devastating human bacterial disease. The ability to infect human population on a global scale, combined with the widespread emergence of multi-drug resistant strains, has led to the placement of Mycobacterium tuberculosis on the National Institute of Allergy and Infectious Diseases (NIAID) list of Biodefence and Emerging Infectious Disease Threats Agents. The resurgence of interest in tuberculosis (TB) has stemmed because of increased evidences from developed countries. Contrary to expectations, no country has reached the phase of elimination and in no subsection of society TB has been completely eliminated. A deeper understanding of the process will assist in the identification of the host and mycobacterial efforts involved and provide targets for therapeutic strategies against tuberculosis. The article presents a view on pathogenesis of tuberculosis and its diverse manifestations, host defense evasion, mechanisms of microbial persistence, emergence of Multiple Drug Resistance and Extensive Drug Resistance, conventional therapy used and the possible novel systems which are under extensive investigation as drug carriers for improving the cytosolic concentration of the anti-tubercular agents.
PMCID: PMC3255431  PMID: 22247841
Tuberculosis; Novel drug delivery system; Mycobacterium tuberculosis; Therapy
3.  Retroperitoneal Castleman’s disease mimicking soft tissue tumour 
The Indian Journal of Surgery  2008;69(4):153-154.
Castleman’s disease is a type of non-neoplastic lymphoproliferative disease having lymph nodal hyperplasia. It has two distinct microscopic types: hyaline-vascular type and plasma cell type. Clinically, it may present either as a solitary mass, most commonly in the mediastinum, or as a multicentric form whose features are generalized lymph-adenopathy, splenomegaly and involvement of other organs like the lungs and kidneys. Here we report a case of isolated retroperitoneal Castleman’s disease, which presented as a lump in the iliac fossa in a young female. A clinico-radio-logical diagnosis of retroperitoneal soft tissue tumour was made and the patient underwent complete surgical excision. The exact diagnosis was only obtained at histopathology and there is no evidence of recurrence at six months follow-up.
PMCID: PMC3452467  PMID: 23132970
Retroperitoneal; Castleman’s disease; Isolated; Hyaline vascular
4.  APOA1-75 G to A Substitution Associated with Severe Forms of CAD, Lower Levels of HDL and apoA-I among Northern Indians 
Disease Markers  2006;21(4):169-174.
Apolipoprotein A-I (APOA1 gene, apoA-I protein) is the major protein for plasma high density lipoprotein (HDL). The relationship of APOA1-75G/A polymorphism with lipid profile and coronary artery disease (CAD) is unclear. Out of 370 individuals initially recruited, 164 angiographically proven CAD patients (≥ 70% stenosis) and 36 individuals with normal coronaries or insignificant CAD (NCAD, ≤ 50% stenosis) from Delhi and adjoining areas were selected for analysis based on the set criteria. Polymorphism was determined by PCR followed by MspI restriction digestion. Lipid profile was estimated by enzymatic kit and apoA-I levels by immunoturbidimetry. A highly significant increasing trend in ‘A’ allele frequency was observed with the rise in severity of CAD: NCAD (0.097) < SVD (single vessel disease) (0.117) < DVD (double vessel disease) (0.223) < TVD (triple vessel disease) (0.291). In comparison to GG individuals, the OR of ‘A’ allele carriers to develop SVD, DVD, TVD was 1.3, 2.8 and 4.2 respectively (ptrend = 0.007). Analysis of intergenotypic variations in the lipid profile revealed significantly lower levels of HDL and apoA-I among ‘A’ allele carriers as compared to GG (patients). Our study, first of its kind from India, suggests that ‘A’ allele may contribute to severity of CAD and low levels of HDL & apoA-I. However, an in depth study with a larger set of sample is necessary.
PMCID: PMC3851398  PMID: 16403951
APOA1; apolipoprotein; CAD; polymorphism; India
5.  Study of apolipoproteinc3 Sstl polymorphism in healthy volunteers from Northern India 
Several studies including a small case-control (hypertriglyceridemic/normotriglyceridemic individuals) study by us revealed close association between rare S2 allele ofAPOC3 Sstl polymorphism and hypertriglyceridemia. With the understanding that Asian Indians are highly vulnerable to the adverse effects of hypertriglyceridemia, we extended the investigation and studied the frequency distribution of this polymorphism in 216 healthy volunteers from Northern plains of India. We found that more than 50% of the study population had one or two S2 allele. This may suggest that a larger fraction of this population is genetically predisposed to hypertriglyceridemia.
PMCID: PMC3453890  PMID: 23105390
APOC3; Sstl polymorphism; CAD; India; Hypertriglyceridemia
6.  Polymorphism (C677T) in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene: A preliminary study on north Indian men 
An elevated level of plasma homocysteine, sulfur containing amino acid generated through demethylation of methionine has been widely accepted as a risk factor for cardiovascular disease (CVD). The increase can result from genetic and/or nutrient related disturbances in the remethylation or transsulfuration pathways for homocysteine metabolism. A common mutation (C677T) in the gene encoding for the enzyme 5, 10-methylenetetrahydrofolate reductase (MTHFR) or deficiency of the B vitamins namely folic acid, B12, B6 can lead to hyperhomocysteinemia.
In the present study, we have investigated the incidence of the (C677T) MTHFR polymorphism in the North Indian males. 141 angiographically proven coronary artery disease (CAD) patients and 55 age and sex matched healthy volunteers were examined for the association between MTHFR gene polymorphism and CAD. The MTHFR genotyping was performed using polymerase chain reaction (PCR) followed by restriction-isotyping with Hinf 1 endonuclease. A trend for higher ‘T’ allele frequency (0.19) was observed in patients than in controls (0.16). However no significant association was found between C677T mutation and CAD severity. The lack of statistical significance could be due to the small sample size studied. Hence a larger study including various ethnic groups is warranted.
PMCID: PMC3453723  PMID: 23105344
Genetic polymorphism; hyperhomocysteinemia; atherosclerosis; cardiovascular disease
8.  Apolipoprotein C3 SstI polymorphism and triglyceride levels in Asian Indians 
BMC Genetics  2002;3:9.
A close association between Sst I polymorphism in the 3' untranslated region of the apolipoproteinC3 (APOC3) gene and levels of plasma triglycerides (TG) had been reported by different investigators. Hypertriglyceridemia(HTG) is a known risk factor for coronary artery disease (CAD) in the context of Asian Indians. We conducted a study on the relationship between APOC3 SstI polymorphism (S1S1, S1S2 and S2S2 genotypes) and plasma TG levels in a group of 139 male healthy volunteers from Northern India.
DNA samples were analyzed by polymerase chain reaction (PCR) followed by SstI digestion. Digested PCR products were run on 3% agarose gel and visualized by ethidium bromide staining.
Rare S2 allele was highly prevalent in our study population (0.313) as compared to the Caucasians (0.00–0.11). The genotypic distribution was in agreement with Hardy-Weinberg equilibrium. S2 allele was almost two times more prevalent in the HTG group (N = 34) as compared to NTG group (N = 105) (p = 0.001). Multiple logistic regression revealed S1S2 individuals had age-adjusted odds ratio of 2.43 (95%CI = 0.99–6.01, p = 0.054) and S2S2 had 9.9 (95%CI = 2.66–37.29, p = 0.0006) for developing HTG in comparison to S1S1 genotype.
Our study shows a significant association between rare S2 allele and HTG in Asian Indians.
PMCID: PMC116591  PMID: 12052247
Indian Journal of Psychiatry  2002;44(1):47-52.
Luria-Nebraska Neuro-psychological Battery, is now an established tool to assess brain damage in recent years. This test battery has been reported to be very useful to find out functional organization of the brain. The biological basis of psychiatry is also now well explained. The present study is directed towards the neuro-psychological functioning of schizophrenic disorder, and the findings are discussed in the light of biological researches. The pattern of performance of schizophrenia on Luria-Nebraska Neuro-psychological battery is indicating the possibility of combined cerebral dysfunction, more towards left hemisphere functions. No single localization was found responsible for this illness. Limitations of present study, and need for well organized further research is indicated using advance technology of brain imaging techniques and neuro-psychological profile of brain functioning, would be helpful for the rehabilitation purposes and to understand the illness better.
PMCID: PMC2953654  PMID: 21206881
Neuro-psychology; schizophrenia; Luria-Nebraska Battery
Indian Journal of Psychiatry  2002;44(1):53-56.
Neuropsychological functioning of epileptic patients is emerging as an interesting area of research among clinician. There is sufficient evidence suggesting cognitive deficits among epileptics. No specific rehabilitation planning was prepared in this regard. The planning for rehabilitation can be prepared if a comprehensive functional organization of the brain of epileptics can be identified. The present study is directed towards the neuropsychological functioning of patients with idiopathic generalized epilepsies, and its comparison with normal controls. All the 60 subjects (30 normal controls and 30 epileptics), after matching their age and education were assessed on Luria-Nebraska Neuropsychological Battery (LNNB). The performance level and pattern of epileptics were significantly different than normal controls on all the parameters of LNNB. The battery could detect specific organic malfunctioning in epileptic patients.
PMCID: PMC2953655  PMID: 21206882
LNNB; Neuropsychology Epilepsy
Indian Journal of Psychiatry  2000;42(1):83-87.
This study assesses the various socio-demographic correlates, the method adopted and the psychiatric disorders in patients with attempted suicide.
Out of 208 cases presented to the hospital, one hundred individuals with suicide attempt were included in the present study. They were evaluated for socio-demographic profile and psychiatric illness on the basis of ICD-10 criteria.
Analysis of the results showed that single males outnumbered single females, whereas married females outnumbered married males in suicidal attempt. The prevalence of suicidal attempt was high among males with psychiatric illness, whereas more female suicide attempters were without psychiatric illness. The most common psychiatric illnesses were found to be mood disorders (35%) and adjustment disorders (13%) as per the ICD-10 criteria. Family type, economic status and education levels appears to be playing non significant role in suicide attempt in this part of the country Marital status and psychiatric illnesses are playing important role in suicide attempt. Other demographic variables, though, were statistically non significant, but, below 30 years of age group, low socio-economic status, low education and nuclear families were found to be more vulnerable factors for suicide.
PMCID: PMC2957009  PMID: 21407914
Attempted suicide; socio-economic status; method adopted
12.  Evaluation of routine laboratory methods in the diagnosis of tubercular lymphadenitis 
Indian Journal of Clinical Biochemistry  1997;12(Suppl 1):66-67.
Lymph node biopsies from 64 cases suspected of Tuberculosis were subjected to fluorescent smear microscopy, culture and histopathology. Fluorescent microscopy was found to be the most sensitive technique (32.8%) followed by culture (20.3%) and histopathology (14.06%). Thus, for the diagnosis of tubercular lymphadenitis requisition for bacteriological investigations must be sent along with histopathology, particularly in early cases.
PMCID: PMC3454312  PMID: 23100904
Tubercular Lymphadenitis; Diagnosis in smear; culture; histopathology
Indian Journal of Psychiatry  1997;39(3):226-231.
The impact of family and child rearing practices on personality development and psychiatric illnesses are well established. The present investigation is directed towards the study of psychopathology and temperamental characteristics of children of alcoholic parents, to find out correlation between these two areas and the role of alcoholism in child rearing practices. A group of 100 children of alcoholic parents was selected through random sampling between the age range of 4-12 years and compared with the children of nonalcoholic parents (N-100). Both groups were assessed on Temperamental Measurement Schedule. The student ‘t’ test and product moment was computed for comparative and correlation purposes. The children of alcoholics were found to be manifesting marked psychopathological disturbances. These children were also found to be more arrhythmic manifesting negative mood and low persistence as compared to the children of control group. The positive correlation between psychopathological and temperamental characteristics have been indicated.
PMCID: PMC2967119  PMID: 21584079
Children; alcoholism; personality; temperament; psychopathology
Indian Journal of Psychiatry  1990;32(2):159-161.
The present study has been carried out to assess the smoking habit among medical students and its relationship to demographic, social and psychological characteristics. Prevalence of smoking was found to be 30.79% in 854 students who responded to the questionnaire adequately. Smoking habit was more common among student who were married hailed from rural areas and the intensity of smoking increased with advancement in the career in medical profession. A strong association was observed between the habit and family history of smoking. The psychological factors associated with smoking were worry about examination unhappiness without justified cause and failure in friendship.
PMCID: PMC2990084  PMID: 21927445
15.  Thermally induced formation of polychlorinated dibenzofurans from Aroclor 1254-contaminated mineral oil. 
Numerous laboratory simulations and real-world events have demonstrated the thermal conversion of neat or high concentration of PCBs into the much more toxic PCDFs. Since millions of mineral oil transformers currently in service contain PCB concentrations in the 50 to 5000 ppm range, the thermal behavior of dilute PCB solutions is of practical and regulatory significance. In this work, neat Aroclor 1254 and 5000 ppm Aroclor 1254 in mineral oil were subjected to pyrolysis and combustion under a range of experimental conditions to define parameters resulting in maximal PCDF yields. The dependence of PCDF yield on Aroclor 1254 concentrations was then investigated in the 5000 to 50 ppm range. Combustion experiments demonstrated that PCDF yields expressed as micrograms PCDF/gram PCB were independent of concentration range, confirming that the process is kinetically first order in PCB. Much lower yields of PCDF were observed in the open tube pyrolysis experiments, as compared to combustion experiments and to earlier and concurrent sealed tube experiments. Slightly improved yields were observed in the pyrolysis experiments at lower concentrations, suggesting the existence of a PCB or PCDF destruction process of higher than first order kinetics. In all cases, yields expressed as micrograms PCDF/gram mixture were sharply and monotonically lower as concentrations decreased between neat or 5000 ppm Aroclor 1254 and 50 ppm Aroclor 1254.
PMCID: PMC1567560  PMID: 2495933
Indian Journal of Psychiatry  1987;29(4):349-352.
86 private practitioners were surveyed about the total prevalence of psychiatric morbidity in their practice. An assessment was made about their undergraduate psychiatric training and its current utility. Significance of the findings have been discussed.
PMCID: PMC3172447  PMID: 21927267
Indian Journal of Psychiatry  1987;29(4):359-362.
257 non-student youth (age range 15-24 years) have been studied on socio-demographic variables, extent and frequency of drug abuse. Results of the study have been discussed.
PMCID: PMC3172449  PMID: 21927269
Indian Journal of Psychiatry  1986;28(2):145-149.
250 rickshaw pullers have born studied on socio-demographic factor, the extent of life use, recent use, current use and the frequency of use or various drugs, and motivating factors for consuming these drugs. The results of present work have been discussed.
PMCID: PMC3172549  PMID: 21927160
21.  Doctors' Pay 
British Medical Journal  1974;4(5939):292.
PMCID: PMC1612242
22.  Letter: Doctors' pay. 
British Medical Journal  1974;4(5939):292.
PMCID: PMC1612237  PMID: 4425878

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