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2015| April | Volume 141 | Issue 4
Online since
June 24, 2015
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POLICY DOCUMENT
DHR-ICMR Guidelines for diagnosis & management of Rickettsial diseases in India
Manuj Rahi, MD Gupte, Anurag Bhargava, George M Varghese, Rashmi Arora
April 2015, 141(4):417-422
DOI
:10.4103/0971-5916.159279
PMID
:26112842
Rickettsial diseases, caused by a variety of obligate intracellular, g0 ram-negative bacteria from the genera
Rickettsia, Orientia, Ehrlichia, Neorickettsia, Neoehrlichia,
and
Anaplasma
, belonging to the Alphaproteobacteria, are considered some of the most covert emerging and re-emerging diseases and are being increasingly recognized. Among the major groups of rickettsioses, commonly reported diseases in India are scrub typhus, murine flea-borne typhus, Indian tick typhus and Q fever. Rickettsial infections are generally incapacitating and difficult to diagnose; untreated cases have case fatality rates as high as 30-45 per cent with multiple organ dysfunction, if not promptly diagnosed and appropriately treated. The vast variability and non-specific presentation of this infection have often made it difficult to diagnose clinically. Prompt antibiotic therapy shortens the course of the disease, lowers the risk of complications and in turn reduces morbidity and mortality due to rickettsial diseases. There is a distinct need for physicians and health care workers at all levels of care in India to be aware of the clinical features, available diagnostic tests and their interpretation, and the therapy of these infections. Therefore, a Task Force was constituted by the Indian Council of Medical Research (ICMR) to formulate guidelines for diagnosis and management of rickettsial diseases. These guidelines include presenting manifestations, case definition, laboratory criteria (specific and supportive investigations) and treatment.
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REVIEW ARTICLES
Survivin: A molecular biomarker in cancer
Praveen Kumar Jaiswal, Apul Goel, RD Mittal
April 2015, 141(4):389-397
DOI
:10.4103/0971-5916.159250
PMID
:26112839
Survivin, a member of the inhibitor of apoptosis (IAP) protein family that inhibits caspases and blocks cell death, is highly expressed in most cancers and is associated with a poor clinical outcome. Survivin has consistently been identified by molecular profiling analysis to be associated with high tumour grade cancers, different disease survival and recurrence. Polymorphisms in the survivin gene are emerging as powerful tools to study the biology of the disease and have the potential to be used in disease prognosis and diagnosis. The survivin gene polymorphisms have also been reported to influence tumour aggressiveness as well as survival of cancer patients. The differential expression of survivin in cancer cells compared to normal tissues and its role as a nodal protein in a number of cellular pathways make it a high target for different therapeutics. This review discusses the complex circuitry of survivin in human cancers and gene variants of survivin, and highlights novel therapy that targets this important protein.
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Fidaxomicin - the new drug for
Clostridium difficile
infection
Chetana Vaishnavi
April 2015, 141(4):398-407
DOI
:10.4103/0971-5916.159251
PMID
:26112840
Clostridium difficile
is one of the many aetiological agents of antibiotic associated diarrhoea and is implicated in 15-25 per cent of the cases. The organism is also involved in the exacearbation of inflammatory bowel disease and extracolonic manifestations. Due to increase in the incidence of
C. difficile
infection (CDI), emergence of hypervirulent strains, and increased frequency of recurrence, the clinical management of the disease has become important. The management of CDI is based on disease severity, and current antibiotic treatment options are limited to vancomycin or metronidazole in the developing countries. this review article briefly describes important aspects of CDI, and the new drug, fidaxomicin, for its treatment. Fidaxomicin is particularly active against
C.difficile
and acts by inhibition of RNA synthesis. Clinical trials done to compare the efficacy and safety of fidaxomicin with that of vancomycin in treating CDI concluded that fidaxomicin was non-inferior to vancomycin for treatment of CDI and that there was a significant reduction in recurrences. The bactericidal properties of fidaxomicin make it an ideal alternative for CDI treatment. However, fidaxomicin use should be considered taking into account the potential benefits of the drug, along with the medical requirements of the patient, the risks of treatment and the high cost of fidaxomicin compared to other treatment regimens.
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CORRESPONDENCES
External validity & non-probability sampling
Sunil Kumar Raina
April 2015, 141(4):487-487
DOI
:10.4103/0971-5916.159311
PMID
:26112854
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STUDENT IJMR
Profile of urinary tract infections in paediatric patients
Palak Gupta, Jharna Mandal, Sriram Krishnamurthy, Deepak Barathi, Nandini Pandit
April 2015, 141(4):473-477
DOI
:10.4103/0971-5916.159299
PMID
:26112850
Background & objectives:
This cross-sectional study was conducted at a tertiary care centre in Puducherry, south India, with the aim of finding the profile of the paediatric urinary tract infection (UTI), bacterial pathogens involved, and also to observe vesicoureteric reflux (VUR) and renal scarring in these patients.
Methods:
A total of 524 paediatric patients ≤13 yr, suspected to have UTI, were included in the study. Urine samples were collected, processed for uropathogen isolation and antibiotic susceptibility test was performed as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Thirty two culture proven children with UTI underwent micturating cysto-urethrography (MCU) and dimercaptosuccinic acid (DMSA) scanning was done for 69 children.
Results:
o0 f the 524 children, 186 (35.4%) had culture proven UTI with 105 (56.4%) being infants, 50 (27.4%) between 1-5 yr, 30 (16.12%) between 5-13 yr and 129 (69.35%) males. Posterior urethral valve (PUV) was noted in three, hydronephrosis in one, VUR in 18 and renal scarring in 33. VUR as well as renal scarring were more in males >1 yr of age. A significant association (P=0.0054) was noted with a combined sensitivity and specificity of these investigations being 83 and 90 per cent, respectively of the MCU and DMSA scans for detecting VUR. Escherichia coli was the most common pathogen isolated, sensitive to nitrofurantoin, followed by cefoperazone-sulbactam, aminoglycosides and meropenem.
Interpretation & conclusions:
Our results indicate that UTI varies with age and gender and extensive evaluation is required in boys over one year of age with UTI. This study also highlights the better efficacy of aminoglycosides, cefoperazone-sulbactam and nitrofurantoin
in vitro
compared with meropenem in gram-negative uropathogens.
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REVIEW ARTICLES
Organ transplant & the psychiatrist: An overview
BN Anil Kumar, Surendra Kumar Mattoo
April 2015, 141(4):408-416
DOI
:10.4103/0971-5916.159268
PMID
:26112841
Organ transplantation has emerged as the saving grace for those who are suffering from end organ disease. Advent of modern surgical procedures and immunosuppressants further decrease morbidity and mortality. Meta-analyses have shown that post-organ transplantation quality of life improves for social, physical and daily activity functioning, but not consistently for psychological health. Psychiatrists can play a useful role not only in selecting the best suitable candidate for the procedure by psychosocial screening but also to tackle post-operation psychological issues that trouble patients as well as caretakers and decrease their quality of life. Issues like selection of patients with psychiatric disorders and substance abuse for transplantation process and their treatment both pre- and post- operation, risky health behaviours, treatment adherence for immunosuppressants and psychological support for caretakers can be better addressed by a psychiatrist who is sensitive towards these issues. Prescribing various psychotropics and immunosuppressants in the background of impaired organ function and drug-drug interaction is further challenging. Thus, psychiatrists need to be knowledgeable about these issues and should be an integral part of organ transplantation team for overall better outcome.
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EDITORIAL
Bronchial asthma - Issues for the developing world
D Behera, Inderpaul Singh Sehgal
April 2015, 141(4):380-382
DOI
:10.4103/0971-5916.159237
PMID
:26112836
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ORIGINAL ARTICLES
Comparison of interferon gamma release assay & tuberculin skin tests for diagnosis of latent tuberculosis in patients on maintenance haemodialysis
Sanjay K Agarwal, Urvashi B Singh, Sabahat H Zaidi, Sanjay Gupta, Ravinder M Pandey
April 2015, 141(4):463-468
DOI
:10.4103/0971-5916.159297
PMID
:26112848
Background & objectives:
Tuberculosis (TB) is a common infection in patients on haemodialysis. There is a definite role of treatment of latent TB (LTB) in these patients. However, diagnosis of LTB in these patients by tuberculin skin test (TST) is unreliable. There is suggestion that interferon gamma release assay (IGRA) will be more reliable test for diagnosis of LTB in this setting. Thus, we evaluated value of IGRA and TST for the diagnosis of LTB in patients on dialysis in an Indian setting.
Methods:
Patients with end stage kidney disease on dialysis were included. Patients with active TB were excluded. Each patient was subjected to TST (induration of ≥10 mm was taken as positive) and QuantiFERON TB Gold In-Tube test (QFT-GIT) for diagnosis of LTB.
Results:
A total of 185 patients were included; 129 (69.7%) were males and mean age was 36.7 ± 12.3 yr. Past history of TB was present in 18 (9.7%) patients. One hundred and thirty four (72.4%) patients had scar of BCG vaccination. QFT-GIT test was positive in 66 (36%), TST in 32 (17%) and both in 13 (7%) patients. Of the 66 patients positive with QFT-GIT, only 13 (19.6%) were positive for TST. Of the 32 patients positive with TST, only 13 (40.6%) were positive with QFT-GIT; 100 (54%) patients were negative for both the tests. Overall, 85 (45.9%) patients were positive for either of the two tests. Poor agreement was shown between the two methods. On logistic regression analysis, odds of QFT-GIT to be positive in patients with BCG vaccination was 1.23 and with history of TB 0.99, both being insignificant. odds of tuberculin skin test to be positive in patients with BCG vaccination was 1.04 and with history of TB 0.99, both again being insignificant.
Interpretation & conclusions:
Our findings showed that more number of patients (36%) on haemodialysis were positive for QuantiFERON Gold In-Tube test as compared to TST (17%). There was poor agreement between the two tests. No significant effect of BCG vaccination and history of TB in past was observed on both tests.
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Effect of oral hypoglycaemic agents on bone metabolism in patients with type 2 diabetes mellitus & occurrence of osteoporosis
B Siddhartha Kumar, A Ravisankar, Alladi Mohan, D Prabath Kumar, DT Katyarmal, Alok Sachan, KVS Sarma
April 2015, 141(4):431-437
DOI
:10.4103/0971-5916.159287
PMID
:26112844
Background & objectives:
Type 2 diabetes mellitus (T2DM) is considered to be a protective factor against development of osteoporosis. But oral hypoglycaemic agents (OHA) are likely to increase the risk of osteoporosis. This study was carried out to evaluate the effect of various OHA on bone mineral density (BMD) in patients with T2DM.
Methods:
Forty one patients (study group) with T2DM (mean age 51.9±5.5 yr; 31 females) receiving treatment with oral hypoglycaemic agents (OHA) [thiazolidinediones alone (n=14) or in combination with other OHA (n=27)] for a period of at least three consecutive years and 41 age- and gender-matched healthy controls (mean age 51.4±5.1 yr) were included in the study. A detailed clinical history was taken and all were subjected to physical examination and recording of anthropometric data. BMD was assessed for both patients and controls.
Results:
The mean body mass index (kg/m
[2]
) (26.5±4.90 vs 27.3 ±5.33) and median [inter-quartile range (IQR)] duration of menopause (yr) among women [6(2-12) vs 6(1-13)] were comparable between both groups. The bone mineral density (BMD; g/cm
[2]
) at the level of neck of femur (NOF) (0.761±0.112 vs 0.762±0.110), lumbar spine antero-posterior view (LSAP) (0.849±0.127 vs 0.854±0.135); median Z-score NOF {0.100[(-0.850)-(0.550)] vs -0.200[(-0.800)-(0.600)]}, LSAP {-1.200[(-1.700)-(-0.200)] vs -1.300 [(-1.85)-(-0.400)]} were also similar in study and control groups. Presence of normal BMD (9/41 vs 8/41), osteopenia (16/41 vs 18/41) and osteoporosis (16/41 vs 15/41) were comparable between the study and control groups. No significant difference was observed in the BMD, T-scores and Z-scores at NOF and LSAP among T2DM patients treated with thiazolidinediones; those treated with other OHA and controls.
Interpretation & conclusions:
The present findings show that the use of OHA for a period of three years or more does not significantly affect the BMD in patients with T2DM.
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Effect of alcoholic extract of
Entada pursaetha
DC on monosodium iodoacetate-induced osteoarthritis pain in rats
Rashmi R Kumari, Amar S More, Gaurav Gupta, Madhu C Lingaraju, Venkanna Balaganur, Pankaj Kumar, Dinesh Kumar, Anil K Sharma, Santosh K Mishra, Surendra Kumar Tandan
April 2015, 141(4):454-462
DOI
:10.4103/0971-5916.159296
PMID
:26112847
Background & objectives:
Osteoarthritis (OA) is a degenerative disease characterized by joint pain and progressive loss of articular cartilage. Entada pursaetha has been traditionally used in the treatment of inflammatory disease, liver ailment, etc. In this study we investigated suppressive effect of ethanolic extract of E. pursaetha (EPE) on monosodium iodoacetate (MIA)-induced osteoarthritis pain and disease progression by histopathological changes in joints in a rat model.
Methods:
OA was induced in right knee of rat by intra-articular injection of 3 mg of MIA and characterized by pathological progression of disease and pain of affected joint. Spontaneous movements, mechanical, thermal and cold sensitivity were monitored at days 0 (before drug and MIA injection), 7, 14 and 21 of MIA administration. EPE (30, 100 and 300 mg/kg), vehicle or etoricoxib (10 mg/ kg; reference drug) were administered daily for 21 days by oral route.
Results:
EPE at various doses significantly reduced mechanical, heat, cold hyperalgesia and increased the horizontal and vertical movements in intra-articular MIA injected rats. EPE prevented the damage to cartilage structure and reduced the cellular abnormalities. Articular cartilage of rats treated with EPE at 300 mg/kg group was almost normal with well-developed smooth surface and chondrocytes were distributed individually or arranged in column.
Interpretation & conclusions:
The present findings showed that the EPE was not only able to mitigate pain and hyperalgesia but also inhibited MIA-induced cartilage degeneration in vivo. EPE may have the potential to become therapeutic modality in the treatment of osteoarthritis. However, further studies need to be done to confirm these findings in other models and clinical trials.
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Aetiology of childhood viral gastroenteritis in Lucknow, north India
Shilpi Gupta, KP Singh, Amita Jain, Shilpi Srivastava, Vishwajeet Kumar, Mastan Singh
April 2015, 141(4):469-472
DOI
:10.4103/0971-5916.159298
PMID
:26112849
Background & objectives:
Due to limited availability of data on viral aetiology of acute gastroenteritis in north India, the present study was planned to detect rotavirus, norovirus, sapovirus and astrovirus in stool samples of both in hospitalized and non-hospitalized children less than five years of age presenting with acute gastroenteritis.
Methods:
A total of 278 stool samples from equal number of children were tested for rotavirus antigen using ELISA and for norovirus, sapovirus and astroviruses by reverse transcription (RT)-PCR.
Results:
Of the 169 samples from hospitalized patients, rotavirus, norovirus, sapovirus and astrovirus were detected in 19.5, 2.3, 3.5 and 2.9 per cent samples, respectively. Of the 109 samples collected from the non-hospitalized patients, frequency of rotavirus and sapovirus detection was 9.1 and 1.8 per cent, respectively while norovirus and astrovirus were not detected.
Interpretation & conclusions:
Rotavirus was the most frequent cause of viral gastroenteritis in both hospitalized and non-hospitalized children. Maximum positivity of the viruses was seen in children less than two years of age.
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CORRESPONDENCES
Antimicrobial susceptibility pattern of vancomycin resistant enterococci to newer antimicrobial agents
Varsha Gupta, Nidhi Singla, Preeti Behl, Tripti Sahoo, Jagdish Chander
April 2015, 141(4):483-486
DOI
:10.4103/0971-5916.159309
PMID
:26112853
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ORIGINAL ARTICLES
Evaluation of cystatin C activities against HIV
Vandana Vernekar, Shilpa Velhal, Atmaram Bandivdekar
April 2015, 141(4):423-430
DOI
:10.4103/0971-5916.159282
PMID
:26112843
Background & objectives:
Several host defense proteins known to possess antimicrobial activities are present on mucosal surfaces and are consequently found in body fluids of vertebrates. Naturally occurring protease inhibitors like cystatins, especially cystatin C (cys C), are abundantly present in human seminal plasma. Although its antiviral activity against herpes simplex virus (HSV) has been demonstrated, the role of this protein against HIV is not well studied. Therefore, the aim of the present study was to evaluate the anti-HIV activities of cys C, which is present innately in the male reproductive tract.
Methods:
Protein-protein interaction of cys C with various HIV proteins was studied using a commercially available HIV blot and specific interaction with HIV protease was studied by dot-blot technique using commercially available cys C. To purify biologically active cys C from human seminal plasma to be used for subsequent experiments, gel-permeation chromatography followed by affinity chromatography was used. The HIV infectivity inhibition activity of the purified cystatin C was tested in TZM-bl cells. To study its activity on HIV protease, time-course enzyme kinetics studies were performed using spectrometric assay.
Results:
Cystatin C reacted with some HIV proteins including HIV protease. Biologically active cys C was purified using gel permeation chromatography followed by affinity chromatography. When tested in TZM-bl cells, purified cystatin C demonstrated HIV-infectivity inhibitory activity (IC
50
: 0.28 μM). Enzyme kinetic studies demonstrated that it abrogated the action of HIV protease on its substrate.
Interpretation & conclusions:
The present data demonstrate that cystatin C possesses anti-HIV activities. Molecular models need to be designed with this protein which would assist towards prevention/ therapeutics against HIV.
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EDITORIAL
From farm to plate & beyond - A culture & context sensitive perspective for food safety
SubbaRao M Gavaravarapu, K Madhavan Nair
April 2015, 141(4):377-379
DOI
:10.4103/0971-5916.159234
PMID
:26112835
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CLINICAL IMAGES
Sirenomelia or mermaid syndrome
Rahul Saxena, Archana Puri
April 2015, 141(4):495-495
DOI
:10.4103/0971-5916.159323
PMID
:26112858
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1,230
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CORRESPONDENCES
Bayesian spatio-temporal model for tuberculosis in India
R Srinivasan, P Venkatesan
April 2015, 141(4):478-480
DOI
:10.4103/0971-5916.159307
PMID
:26112851
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1,134
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COMMENTARIES
Impact of oral antidiabetic agents on bone metabolism
Thomas V Paul, Nihal Thomas
April 2015, 141(4):385-388
DOI
:10.4103/0971-5916.159244
PMID
:26112838
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1,078
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ORIGINAL ARTICLES
Wealth related inequalities in self reported morbidity: Positional objectivity or epidemiological transition?
Shankar Prinja, Kathiresan Jeyashree, Saroj Rana, Atul Sharma, Rajesh Kumar
April 2015, 141(4):438-445
DOI
:10.4103/0971-5916.159290
PMID
:26112845
Background & objectives:
Morbidity is self reported at a higher rate among the rich than the poor. However, objective measures suggest the contrary. We examined the role of epidemiological transition in wealth related inequalities in self-reported morbidity (SRM).
Methods:
We analyzed data of two States, Bihar and Kerala, from 60
[th]
Round of National Sample Survey (NSS). Bivariate analysis was performed to study the associations between various socio-demographic variables and self-reported morbidity. A prediction model based on hierarchical logistic regression was developed to identify determinants of self-reported morbidity.
Results:
In Bihar, acute morbidities (26 per 1000) were reported more often than chronic morbidities (19 per 1000) while in Kerala the reverse was true (89 acute and 123 chronic morbidities per 1000 person). In both the s0 tates, the rate of SRM showed an increasing trend from the poorest to the richest quintiles. The rising gradient in the odds of SRM across increasing socio-economic strata was more pronounced in Bihar [OR (richest)=2.52; 1.85-3.42] as compared to Kerala [OR (richest) =1.66; 1.37-2.0]. Moreover, this gradient was more on account of chronic diseases [OR (richest) =2.7; 1.8-4.0] for Bihar; [OR (richest) =1.6; 1.26-2.0 for Kerala] than the acute diseases [OR (richest) =1.82; 1.1-2.9 for Bihar]; [OR (richest) =1.4; 1.1-1.8 for Kerala].
Interpretation & conclusions:
The present analysis shows that the epidemiologic transition results in higher prevalence and reporting of chronic ailments by the rich than the poor. This phenomenon is more evident in the early stages of transition. In later stages of transition, positional objectivity plays an important role to explain wealth related inequalities in SRM.
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CORRESPONDENCES
Defining multidrug resistance in Gram-negative bacilli
V Anil Kumar, Sadia Khan
April 2015, 141(4):491-492
DOI
:10.4103/0971-5916.159318
PMID
:26112856
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1
ORIGINAL ARTICLES
Are Indian patients with juvenile-onset ankylosing spondylitis taller than reference population ?
Pulukool Sandhya, Debashish Danda, Lakshmanan Jeyaseelan
April 2015, 141(4):446-453
DOI
:10.4103/0971-5916.159295
PMID
:26112846
Background & objectives:
Paucity of growth retardation has been observed by us in patients with juvenile-onset ankylosing spondylitis (JAS) in a tertiary care health centre in south India. We, therefore, undertook this pilot study to assess and compare anthropometry of patients with JAS who were 15 yr and older with that of adult onset ankylosing spondylitis (AAS) and matching Indian reference population.
Methods:
Consecutive male patients (December 2009- October 2012) with JAS and AAS fulfilling Modified New York Criteria were selected after applying inclusion and exclusion criteria. Demography and anthropometry were noted. Height of both patient groups as well as their parents and siblings were compared with that of the reference population. Mid-parental height and delta height were derived. Those with delta height of >8.5 cm were compared with the remaining. Multivariate logistic regression was done for variables that were found to be significant by chi-square in bivariate analysis. Similar analysis was done for BMI also.
Results:
There was no significant difference in anthropometric variables between JAS and AAS groups. Twenty eight of the 30 (93.33%) JAS patients were taller as compared to the reference population. Twenty six (86.67%) AAS patients were taller than the reference population. The mean heights of JAS (170.67 ± 6.94 cm) and AAS (168.2 ± 5.94 cm) patients were significantly higher than the reference value of 163.11 cm; both p0 <0.001. Logistic regression revealed that tallness in JAS was associated positively with hypermobility (OR=23.46,95%CI 1.2-447.2, p0 =0.036). No significant association was detected for height in AAS and for BMI in both JAS and AAS groups.
Interpretation & conclusions:
No growth retardation was seen in patients with JAS in our study. Majority of patients with JAS and AAS were taller than reference population. The difference between mean height of JAS and AAS was not significant. Larger studies involving different populations are required to confirm these findings.
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1,050
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1
CLINICAL IMAGES
Caput medusae
Brij Sharma, Sujeet Raina
April 2015, 141(4):494-494
DOI
:10.4103/0971-5916.159322
PMID
:26112857
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1,007
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CORRESPONDENCES
Performance of extended spectrum beta lactamases (ESBL) screening agar in various clinical specimens
SR Swarna, NN Srimathi, Radha Madhavan, S Gomathi
April 2015, 141(4):481-482
DOI
:10.4103/0971-5916.159308
PMID
:26112852
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892
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2
COMMENTARIES
Antiviral activity of cystatin C against HIV
Kalpana Luthra
April 2015, 141(4):383-384
DOI
:10.4103/0971-5916.159242
PMID
:26112837
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838
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1
CORRESPONDENCES
Observational studies versus controlled clinical trials for efficacy & effectiveness of a drug
Kanica Kaushal, Sunil Kumar Raina
April 2015, 141(4):489-490
DOI
:10.4103/0971-5916.159313
PMID
:26112855
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682
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CLINICAL IMAGES
Tuberculosis - The usual suspect
Mallikarjun , Ravikiran
April 2015, 141(4):496-497
DOI
:10.4103/0971-5916.159324
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BOOK REVIEWS
Essential guide to blood groups
RK Chaudhary
April 2015, 141(4):498-498
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456
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Overcoming challenges in IBD management
BS Ramakrishna
April 2015, 141(4):499-499
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432
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Critical care manual of clinical procedures and competencies
MK Arora, DK Baidya
April 2015, 141(4):498-499
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