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Kitaa JMA, Abuom TO, Gitonga P, Muraya J. "Chronic demodecosis in a Great Dane." Kenya Veterinarian. 2012;36(1):1-5.
Kitaa JMA, Mulei CM, Wabacha JK, Mande JD. "A retrospective study of clinical presentation of canine ehrlichiosis in the Small Animal Clinic of the University of Nairobi.". In: 47th Annual Scientific Conference of the Kenya Veterinary Association.; 2013. Abstract
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Kitaa JMA, Mulei CM, Mande JD, Wabacha J. "A retrospective study of canine ehrlichiosis in Kenya.". 2014. Abstract
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Kitaa JMA, Mulei CM, Mande JD, Wabacha J, others. "A retrospective study of canine ehrlichiosis in Kenya." International Journal of Veterinary Science. 2014;3:122-124. Abstract
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Kit KR. Privatisation of public enterprises in COMESA: An exploration of approaches and strategies: the case of the privatization of Telkom Kenya. Durham; 2006. Abstract

This thesis investigates Kenya's approach to the privatization process through an exploration of Telkom Kenya's (TKL) unfolding privatization. The thesis research identifies outlines and documents the developments in Kenya's approach to the privatization programs in a developing economy of the COMESA region. In the process, the analysis contributes to an approach of privatizing and restructuring in Kenya. It has also helped explain new phenomena in privatizing in an environment with no institutional infrastructure and in the process has generated and contributed to new knowledge whose detail is discussed in chapter five. The research took an exploratory approach because there are few or no earlier studies in which a secondary data analysis solely was to be analyzed. The empirical data was based on observing and experiencing the real world with a focus to gain insights and familiarity on approaches to the privatization process. Although there is a variety of privatization literature and studies, these have tended to focus on developed and emerging economies and lately specific sectors of their interest. The analysis uses Field primary and Secondary data sources And an extensive Literature review on Privatization focusing on Specific elements Of approaches and Developments in The less developing Countries (LDCs) And in Kenya. The data Collection and analysis Focused on outlining Kenya's actual process Of choosing And implementing sectors, objectives, methods, techniques and strategies of transacting Telkom Kenya as a Strategic enterprise Under the GOK's Privatization program. In attempting to Respond to The central Research question raised In chapter one (page 9), the Thesis undertakes an in-depth mixed method analysis (majorly qualitative) ofapproaches to the privatization process. The research is driven by the central research question (s): "What are (why and how) the approaches and strategies of Kenya’s privatization program In a developing economy?" The research outcome identifies And outlines a 'sketch approach' to Kenya's privatization program and process. The Research analysis Concludes that Efforts to institutionalize (i.e. regulatory framework) The process, in order to make Kenya's approach more tangible, effective, efficient, and accountable need further attention. Evidence further shows that privatization of Kenya's strategic state enterprises (SSE, s) raises concerns of the socio-political dynamics of the management of the selected approaches, methods, processes, and objectives of privatization by GOK. Indeed 80 % of the respondents argued that privatization is crucial in enabling the government divest from business. However, the political control remains an impediment to Independent and fair strengthening and building of privatization institutions. In this regard, this thesis' major Contribution of Identifying Kenya's Approach provides a First attempt at a 'guide' to the Privatization process that Is clear, accountable and open to Checks and balances.

Kisuthi GG,.;Knapp M;, Shibario JK,; Nderitu JH;, Kiarie N. "Effects if four biopesticides on the spider mite tetranychanus evansi Baker and Pritchard in the laboratory.". In: European Association of Acarologists (EURAAC). Berlin germany; 2004.
Kisumbi B.K, Simila O.H ONBIJ. "Choice of Impression Materials and Techniques by Dentists.". In: 33rd Kenya Dental Association Annual Scientific Conference & Exhibition. Boma Inn, Eldoret Kenya; 2015.
Kisumbi BK, Wakiaga JM. "Role of bitewing in caries management in a teaching dental hospital.". In: JOURNAL OF DENTAL RESEARCH. Vol. 82. INT AMER ASSOC DENTAL RESEARCHI ADR/AADR 1619 DUKE ST, ALEXANDRIA, VA 22314 …; 2003:. Abstract
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Kisumbi BK, Alubale EA, Simila HO, Arnisi SK, others. "Indications for Initial Placement and Replacement of Amalgam and Composite Restorations.". 2009. Abstract
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Kisumbi BK, Simila HO, Osiro OA. DENTAL BIOMATERIALS SCIENCE: MODULE II - AUXILLIARY DENTAL MATERIALS. Nairobi: University of Nairobi Press; 2013.
Kisumbi BK, Toworfe GK, Watts DC. "Dimensional changes of resin/ionomer restoratives in aqueous and neutral media.". In: JOURNAL OF DENTAL RESEARCH. Vol. 77. SAGE PUBLICATIONS INC 2455 TELLER RD, THOUSAND OAKS, CA 91320 USA; 1998:. Abstract
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Kisumbi BK, Alubale EA, Simila HO, Gathece LW, Amisi SK. "Indications of initial placement and replacement of amalgam and composite restorations." AJOHS. 2011;6(1):15-19. Abstract

Indications of initial placement and replacement of amalgam and composite restoraions.

Kisumbi BK, Simila HO, Osiro OA, Omondi BI. "Selection of impression materials and techniques employed by dentists in Kenya." East African Medical Journal. 2017;94:1040-1051. Abstract
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Kisumbi BK, Watts DC. "Toothbrush/Abrasion rates of modified glass Ionomer Restoratives In-vitro.". 2000. Abstract

Modified glass ionomer restoratives are employed in conservation of abrasion cavities, and hence the characterisation of toothbrush abrasion is clinically important. The aim was to evaluate this parameter, for; resin, metal, and polyphosphonate modified glass ionomers, compomer, experimental composite and Perspex as control. Groups (n = 5) of cylindrical specimens (6mm

Kisumbi B, Wakiaga J, Chindia ML. "Discolouration of Teeth.". 1995. Abstract
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Kisumbi BK. COLLEGE OF HEALTH SCIENCES SCHOOL OF DENTAL SCIENCES. UNIVERSITY OF NAIROBI; Submitted. Abstract
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Kisumbi BK, Simila HO, Osiro OA. "Dental Biomaterials Science (Module II): Auxiliary Dental Materials.". In: Dental Biomaterials Science (Module II): Auxiliary Dental Materials. Nairobi: University of Nairobi; 2013.
Kisumbi BK, Simila HO, Osiro OA, Omondi BI. "Selection of impression materials and techniques by dentists in Kenya." East African Medical Journal. 2017;94(12):1040-1051.selectionofimpressionmaterialsandtechniquesemployedbydentists_kisumbietal2017.pdf
Kisumbi B. PATIENT PERCEPTION OF THE IDEAL DENTIST. Department of Conservative and Prosthetic Dentistry, Faculty of Dental …; 2001. Abstract
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Kisumbi BK, Kaimenyi JT, Wakiaga JM. "Knowledge on treatment modalities and attitude of Nairobi University students towards dental care." Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research. 1995;6:133-136. Abstract
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Kisumbi BK;, Alubale EA;, Simila HO;, W; GL, Arnisi SK;, W GL. "Indications for Initial Placement and Replacement of Amalgam and Composite Restorations.". 2009.
Kisumbi BK, Simila HO, Osiro OA, Omondi BI, Nyagah J. "Choice of impression materials and techniques by dentists.". In: IADR ESAD. Eldoret, Kenya; 2015.
Kisumbi BK, Alubale EA, Simila HO, Gathece LW, Amisi SK. "Indications for initial placement and replacement of amalgam and composite restorations." African Journal of Oral Surgery. 2011.
Kisumbi BK, Simila OH, Omondi BI, Nyagah J. "Choice of Impression Materials and Techniques by Dentists.". In: 33rd Kenya Dental Association Annual Scientific Conference & Exhibition.; 2015. Abstract
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Kisiroche. IR. : “Sauti ya mwanamke dhidi ya Ubabedume katika tamthilia tatu za Kiswahili’’ . E.M. DM, K.W PW, eds. Nairobi: University of Nairobi; 2008.
Kisipan ML, Makanya AN, Oduor-Okelo D, Onyango DW. "The Functional Morphology and Adaptations of the Epididymis in a Testicondid Mammal, The Rufous Sengi (Elephantulus rufescens)." Kenya Veterinarian. 2011;35:52-58. AbstractWebsite

Sengis are testicondid African mammals that constitute order Macroscelidae. Epididymal morphology in the rufous sengis (Elephantulus rufescens) was studied with focus on features and adaptations that make it suitable for sperm maturation and storage in testicondas. The three topographic regions were distinct with the caput and cauda epididymis placed further apart and the two are connected by a slender corpus. The caput occurred as a longitudinal mass on dorsolateral border of the testis while the caput occurred as a pear-shaped mass placed laterally between the rectum and the pelvic urethra. The epithelium comprised of principal and basal cells; the former exhibiting granules and apical blebing in the caput. The lumen of cauda was densely packed with spermatozoa, with occasional masses that appeared to engulf them, and its principal cells had numerous vacuoles. This study demonstrates that beside merocrine secretion, principal cells of the caput exhibit apocrine secretion as shown by apical blebs that are shed off as epididymosomes, which transfers epididymis-secreted proteins to the spermatozoa. Additionally, the study has shown that the cauda epididymis descends to a site probably cooler than the core body temperature for optimal sperm storage, with the vacuoles indicating its involvement in fluid re-absorption and phagocytosis.

Kisipan ML, Makanya AN, Oduor-Okelo D, Onyango DW. "The Functional Morphology and Adaptations of the Epididymis in a Testicndid Mammal, The Rufous Sengi (Elephantulus rufescens). ." Keny Veterinarian. 2011;35(1):52-58.
Kisipan ML, Oduor-Okelo D, Makanya AN, Onyango DW. "The structure, morphometry and vascular perfusion of the testis in the rufous sengi (Elephantulus rufescens)." Journal of Morphological Sciences . 2014;31:146-155.
Kisipan ML, Makanya AN, Oduor-Okelo D, Onyango DW. "The epididymis of rufous sengi (Elephantulus rufescens): Structure, adaptations and role in sperm maturation and storage.". In: Faculty of Veterinary Medicine 7th Biennial Scientific Conference and Exhibitions. Nairobi: Kisipan, M.L., Makanya, A.N., Oduor-Okelo, D. and Onyango, DW; 2010. Abstract

Sengis are testicondid endemic african mammals that constitute the order Macroscelidae. The epididymides of five male rufous sengis (Elephantulus rufescens) were studied both macroscopically and microscopically to describe the structure and possible features or adaptations making it a suitable site for sperm maturation and storage in testicondas. The epididymis had three distinct topographic regions; the caput, corpus and cauda epididymis. The caput and cauda epididymis were placed further apart; the former occuring as a longitudinal mass on dorsolateral border of the tesis while the latter occurred as a pear-shaped mass placed laterally between the rectum and the pelvic urethra, the two being connected by a slender corpus epiddidymis. The epithelium comprised of principal and basal cells with the former exhibiting numerous secretory granules and apical blebing in the caput. In the cauda, principal cells had numerous vacuoles and its lumen was densely packed with spermatozoa and occasional masses that appeaed to engulf spermatozoa. This study demonstrates that the pricipal cells of the caput of sengi produces materials either through merocrine or apocrine secretion, the latter being shown by apical blebs that are shed off as epididymosomes, which in turn transfers epididymis-secreted proteins to the plasma membrane of spermatozoa. Additionally, the study has shown that the cauda epididymis remarkably descends to a site probably cooler than the core body temperature for optimal sperm storage, and the numerous vacuoles indicating its involvement in fluid reabsortion and phagocytosis of residual bodies and damaged spermazoa.

Kisipan ML. The morphology and morphometry of the male reproductive system of the rufous sengi (Elephantulus rufescens).. Onyango DW, Makanya AN, Oduor-Okelo D, eds. Nairobi: Kisipan, M.L.; 2009. Abstract

The Morphology of the male reproductive system of rufous sengi was studied using light and electron microscopy while the testicular morphometry was studied using stereology. The system consisted of the cylindrical-shaped testes, genital ducts, accessory sex glands and the penis.
The testes were intra-abdominal, located just caudal to the kidneys and comprised of a parenchyma bound by tunica albuginea. The parenchyma was composed of the seminiferous tubules and the interstitial tissue; the former being more predominant than the later and exhibiting complete spermatogenesis. The interstitial tissue occurred either between the seminiferous tubules, mainly in relatively larger spaces formed when three or four seminiferous tubules approximate or beneath the tunica albuginea. The Leydig cells were mainly polyhedral with irregular nuclei and numerous lipid droplets within the cytoplasm but, in cases where the interstitial tissue made extension into a narrow space between two adjoining seminiferous tubules, the Leydig cells therein were longate with rod-shaped nuclei.
The testicular arteries branched off from renal arteries and ran caudo-laterally to the testis without convolutions or intimate association with the vein. The testicular veins also followed a straight course, without pampiniform plexuses. These animals had separate right and left caudal vena cavae which received ipsilateral testicular and renal veins. After receiving the renal veins, the left caudal vena cava crossed to the right side to join the right one to form a common caudal vena cava which then extended cranially up to the right atrium.
The genital ducts were constituted by the rete testis, efferent ductules, epididymis, and the urethra. The rete testis was made up of interconnecting channels located outside the testicular parenchyma while the efferent ductules connected the rete testis to the caput epididymis. The epididymis consisted of a highly coiled duct organized into three topographic regions; the caput, corpus and cauda epididymis. The caput epididymis was applied on dorso-lateral border, extending from cranial to the caudal pole of the testis. The corpus epididymis extended caudally from the caput to a position between the pelvic urethra and the rectum where it joined the cauda epididymis. The cauda epididymis was organized into a pear-shaped mass, located in a somewhat lateral position between the rectum and the pelvic urethra. The caput and corpus epididymis were lined by a tall pseudostratified columnar epithelium while the cauda epididymis was lined by cuboidal or low columnar epithelium. The ductus deferens was short and connected the cauda epididymis with the pelvic urethra. The urethra consisted of two parts; the pelvic and the penile urethra. The pelvic urethra, surrounded by a thick muscular coat, extended from the neck of the urinary bladder to the bulb of the penis and received the deferent ducts, uterus masculinus and the ducts of the accessory sex glands.The penile urethra extended from the bulb of penis to the tip of the penis.
The accessory sex glands consisted of the prostate and the bulbourethral glands. The prostate gland was composed of several paired lobes organized into two groups, the cranial and the caudal group of lobes, also referred to as the cranial and the caudal prostates respectively. The cranial prostate consisted of lobes organized around the neck of urinary bladder and included the ventral, laterodorsal and the medio-dorsal lobes. The caudal prostate consisted of a single pair of lobes located dorsal to the pelvic urethra.
The mean reference volume of the sengi testis was 0.089 ± 0.003 cm3, 98.3% of which was constituted by the parenchyma and the rest being contributed by the capsule. The seminiferous tubules occupied 90.94% of the testicular parenchyma, while the interstitial tissue on the other hand occupied about 9.07% of the parenchyma with 7.87% of its volume being contributed by the subcapsular interstitial tissue.

Kisia SM, Hughes GM. "Routine oxygen consumption in different sizes of a tilapia, Oreochromis niloticus (Trewavas) using the closed chamber respiratory method.". 1993. Abstract

Routine oxygen consumption (Vo2) measurements on 54 specimens (0.055-190.4 g) of a tilapia, Oreochromis niloticus (Trewavas) were carried out using two different types of closed respirometers: a modified cuvette for fish weighing 0.055-0.91 g and ordinary closed chamber respirometer for fish weighing more than 1 g. Vo2 values over the weight range studied had a scaling value of 0.743 which relates closely to the values for the gill respiratory surface area and morphometric oxygen diffusing capacity of O. niloticus in a previous study /13/. This shows that a close relationship exists between changes in structural parameters involved in oxygen uptake and the routine metabolism of O. niloticus with development. The values for routine Vo2 of 1.38 and 7.65 ml/h for 10 g and 100 g fish, respectively (calculated from the regression equation) show that O. niloticus is a moderately active fish.

Kisia SM, Hughes* GM. "Red muscle fibre and capillary dimensions in different sizes of a tilapia, Oreochromis niloticus (Trewavas).". 2006. Abstract

Measurements of muscle dimensions that affect respiration in relation to body weight were carried out in a tilapia, Oreochromis niloticus. The fish used in all measurements weighed 0.65–812.3 g. The data were analysed with respect to body weight using logarithmic transformations (log Y=log a+blog W). The slopes (b) of the log/log regression lines for weight of body trunk red muscle, average cross-sectional area of muscle fibre, average number of capillaries in direct contact with a muscle fibre, average capillary contact length with a fibre as a fraction of average fibre circumference and number of capillaries mm2 of fibre cross-sectional area [NA(cƒ)] were 1.16, 0.221, 0.084, 0.015, and −0.137 respectively. These results show that there is an increase in muscle cross-sectional fibre area and number of capillaries in contact with muscle fibres whereas number of capillaries supplying a unit area of muscle fibre decreases during development. There is development of new capillaries with increase in cross-sectional area of red muscle fibres.

Kishosha PA, Galukande M, Gakwaya AM. "Selenium deficiency a factor in endemic goiter persistence in sub-{Saharan} {Africa}." World journal of surgery. 2011;35:1540-1545. AbstractWebsite
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Kiseli J, Kitati EM. Factors That Affect Internal Control Systems In Public Institutions. Riga, Latv ia: LAP LAMBERT Academic Publishing; Submitted. AbstractFactors That Affect Internal Control Systems In Public Institutions

Internal control is the process effected by an organization’s structure, to assist the organization to accomplish specific goals or objectives. It is a means by which an institution’s resources are directed, monitored and measured. It plays an important role in preventing and detecting fraud and protecting the organization’s resources. Internal Control mechanisms’ comprises of the control environment and control procedures. It includes all the policies and procedures adopted by the directors and management of an entity to help in achieving their objectives of ensuring, as far as practicable, the orderly and efficient conduct of its business, including adherence to internal policies, the safeguarding of assets, the prevention and detection of frauds and errors, the accuracy and completeness of the accounting records, and the timely preparation of reliable financial information. The internal control systems extend beyond those matters which relate directly to the accounting system. Internal control is concerned with the control operative in every area of corporate activity, as well as with the way in which individual controls interrelate.

Kisangaki P, Nyamasyo G, Ndegwa P, Kajobe R. "Assessment of honey bee colony performance in the agro-ecological zones of Uganda." Current Investigations in Agriculture and Current Research. 2018;1(5):1-6.
KISAKA ES, MWASARU A. "The Causal Relationship between Exchange Rates and Stock Prices in Kenya." Research of Finance and Accounting, Vol 3, N0. 7, 2012. 2012;3(7):121-130. AbstractWebsite

This study examined the causal relationship between foreign exchange rates and stock prices in Kenya from November 1993 to May 1999. The data set consisted of monthly observations of the NSE stock price index and the nominal Kenya shillings per US dollar exchange rates. The objective was to establish the causal linkages between leading prices in the foreign exchange market and the Nairobi Securities Exchange (NSE). The empirical results show that foreign exchange rates and stock prices are non-stationary both in first differences and level forms, and the two variables are integrated of order one, in Kenya. Secondly, we tested for co-integration between exchange rates and stock prices. The results show that the two variables are co-integrated. Thirdly, we used error-correction models instead of the classical Granger-causality tests since the two variables are co-integrated. The empirical results indicate that exchange rates Granger-causes stock prices in Kenya.

KIRUKI PROFMUNYUAJUSTUS. "Fractionation by size of casein micelles on controlled-pore glass. Prep Biochem. 1977;7(1):1-7.". In: Prep Biochem. 1977;7(1):1-7. SITE; 1997. Abstract
Casein micelles have been separated from skim milk by chromatography on CPG-10 3000 glass beads. Fractionation of the micelles according to size has been demonstrated. Polyacrylamide gel electrophoresis of urea treated micelles reveals that different relative amounts of the major casein components occur in the various micelle fractions. No discernible dissociation of the micelles into monomeric caseins has been observed.
KIRUI G K, J. WANJARE, J. OOKO, OLUOCH M F. "WORKING CAPITAL MANAGEMENT PRACTICES AND FINANCIAL PERFORMANCE OF SUGAR CANE OUTGROWER COMPANIES IN KENYA." International Journal of Social Science and Economic Research. 2017;2(4):ISSN: 2455-8834.
Kirui G;, Abuom TO;, Gitonga PN;, Ndurumo SM;, Tsigadi SA;, Kitaa JMA;, Mande JD. "Radiographic Evaluation of Fractures and Postoperative Outcome in Small Animals Clinic (75 cases).".; 2005.
Kirui OK, Okello JJ, Nyikal R, Mbogoh SG. Impact of Mobile Money Transfer Services in Kenyan Agriculture. LAP LAMBERT ; 2013.
Kirui OK;, Okello JJ;, Nyikal RA. "Impact of Mobile Phone-based Money Transfer Services in Agriculture: Evidence from Kenya."; 2012. Abstract

The recent introduction of mobile phone-based money transfer (MMT) services in developing countries has generated a lot of interest among development partners. It facilitates transfer of money in a quick and cost effective way. It also offers an easy and secure platform for small savings to majority of rural populations with no access to formal financial services. However, the impact of MMT services on smallholder agriculture has not been documented. This study therefore contributes to pioneering literature on the impact of MMT, especially in agriculture. It provides information regarding financial intermediation to the excluded through the use of new generation Information Communication Technology (ICT) tools especially the mobile phone. The study employs propensity score matching technique to examine the impact of MMT services on household agricultural input use, agricultural commercialization and farm incomes among farm households in Kenya. It uses cross-sectional data collected from 379 multi-stage randomly selected households in Central, Western and Nyanza provinces of Kenya. The study found that use of MMT services significantly increased level of annual household input use by $42, household agricultural commercialization by 37% and household annual income by $224. We conclude that MMT services in rural areas help to resolve an idiosyncratic market failure that farmers face; access to financial services. We therefore recommend that other developing countries should follow the Kenyan model and provide an enabling environment that would facilitate entry and survival of MMT initiatives.

Kirui G, Mande JD, Kitaa JMA. "Spectrophotometric analysis of cytoliths from a German Shepherd dog. .". In: Presented at Annual Scientific conference of Kenya Veterinary Association. Mombasa, Kenya; 2005.
Kirui GK, Misra AK, Olanya OM, Friedman M, El-Bedewy R, Ewell PT. "Glycoalkaloid content of some superior potato (Solanum tuberosum L) clones and commercial cultivars." Archives of Phytopathology and Plant Protection. 2009;42(5):453-463.
Kirui G, Mulei CM, Abuom TO. "Rabies in Donkeys-A Review.". In: Kenya Veterinary Association 45th Scientific Conference. Kisumu, Kenya; 2011.kirui_g._mulei_c._m._and_abuom_t._o._2011_rabies_in_donkeys-a_review_abstract_.docx
Kirui G;, Abuom TO;, Gitonga PN;, Ndurumo SM;, Tsigadi SA;, Kitaa JMA;, Mande JD. "Radiographic Evaluation of Fractures and Postoperative Outcome in Small Animals Clinic (75 cases).".; 2005.
Kirui OK, Okello JJ, Nyikal RA. "Awareness of Mobile Phone-Based Money Transfer Services in Agriculture by Smallholder Farmers in Kenya." International Journal of ICT Research and Development in Africa. 2012;3(1):1-13. AbstractWebsite

Smallholder farmer access to agricultural finance has been a major constraint to agricultural commercialization in developing countries. The ICT revolution in Africa has however brought an opportunity to ease this constraint. The mobile phone-based money transfer services that started in Kenya urban centres have spread to rural areas and even other countries. Using these services farmers could receive funds to invest in agricultural financial transactions. This study examines the awareness of mobile phone-based money transfer services (MMT) among rural farmers in Kenya and examines the various uses of money transferred through such services. The study employs descriptive analysis and found a very high awareness of mobile phone-based money transfer services among the smallholder farmers and found predominant use of remitted funds for agricultural related purposes (purchase of seed, fertilizer for planting and topdressing, farm equipment/implements, leasing of land for farming, wages for labour). The study concludes that there is need to expand the coverage of MMT services in rural areas since it resolves an idiosyncratic market failure that farmers face namely access to financial services. It discusses the implications of these findings for policy and practice.

Kirui OK;, Okello, J. J; Nyikal RA, Okello, J. J; Nyikal RA. "Awareness, use and effect of mobile phone-based money transfer in Kenyan agriculture."; 2010.
Kirui G, Gakuya DW, Abuom TO. "Challenges in food animal practice in the urban areas- Nairobi City and its environs.". In: The Kenya Veterinary Association, Commonwealth Veterinary Association and university Nairobi, Faculty of Veterianry Medicine Joint Scientific Conference. Safari Park Hotel, Nairobi, Kenya; 2017.
Kirui OK;, Okello JJ;, Nyikal RA. "Awareness and use of m-banking services in agriculture: The case of smallholder farmers in Kenya."; 2010. Abstract

Smallholder farmer access to agricultural finance has been a major constraint to agricultural commercialization in developing countries. The ICT revolution in Africa has however brought an opportunity to ease this constraint. The mobile phone-based banking services that started in Kenya urban centers have spread to rural areas and even other countries. Using these services farmers could receive funds invest in agriculture finance transactions. This study examines the awareness and use of m-banking services among rural farmers in Kenya. It also assesses the factors conditioning the use of such services. The study finds high awareness of m-banking services among the smallholder farmers. It also finds that education, distance to a commercial bank, membership to farmer organizations, distance to the m-banking agents, and endowment with physical and financial assets affect the use of m-banking services. It discusses the implications of these findings for policy and practice.

Kirui F, Oyoo GO, OGOLA EN, Amayo EO. "Elijah N. Ogola Elijah N. Ogola Cardiovascular risk factors in patients with Rheumatoid Arthritis at Kenyatta National Hospital." African Journal of Rheumatology. 2013;1(1). Abstract

Background: Rheumatoid arthritis is associated with excessive cardiovascular morbidity and mortality. This is predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Traditional cardiovascular risk factors as well as extra articular disease have been associated with occurrence of myocardial infarction.
Objective: To identify cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital and compare with healthy controls.
Design: This was a comparative cross sectional survey.
Setting: Kenyatta National Hospital medical outpatient clinic. The study population were patients with rheumatoid arthritis and the controls were individuals without RA age and sex matched staff of KNH. All those who consented were enrolled and a clinical evaluation was done as per the study protocol.
Results: One hundred patients with RA were screened out of which 80 were enrolled. The prevalence of hypertension among RA patients was 41.3%, diabetes 6.3%, dyslipidemia 71.3%, smoking 5%, obesity 22.5%, abnormal WHR 33.8%, family history of sudden death 5%, no family history of stroke or heart attack was reported. In the control group one hundred and five were screened and twenty five were excluded. The prevalence of hypertension was 22.5%, diabetes 5%, dyslipidemia 73.8%, smoking 2.5%, obesity 32.5%, abnormal WHR 33.8% family history of sudden death 10%, stroke 1.3% no history of heart attack was reported. Eighty percent of patients with RA were on at least one DMARD, 57.5% were on steroids and 37.5% were on NSAIDS.
Conclusion: There was a high prevalence of hypertension among RA patients (41.3%) than in the controls (22.5%) and this was statistically significant (OR 2.42 (95 CI 1.22-4.81) P = 0.017). Hypertension was also significantly associated with the use of DMARDS OR 2.189 (95% CI 1.111-4.312) P= 0.022 and steroids OR 2.06(95% CI 1.008-4.207) P= 0.022. No significant difference between patients with RA and controls in other risk factors including diabetes, dyslipidemia, smoking, obesity, abnormal waist hip ratio and family history of cardiovascular events was found.
Recommendations: Clinicians should keenly look out for hypertension in patients with RA for early identification and if necessary aggressive management of hypertension. Screening of cardiovascular risk factors in patients with RA should be done routinely and a larger study with normal controls from the general population should be undertaken in order to measure this cardiovascular risk factors and cardiovascular disease in this population.

Key words: Cardiovascular, rheumatoid arthritis, Kenyatta National Hospital

Kirui JW, Muthama JN, Opere AO, Ngaina JURI:N. "Influence of climate change on smallholder dairy productivity: A case of Kosirai, Kenya, and Namayumba, Uganda." Academe Research Journals. 2015. Abstractngaina_influence_of_climate_change_on_smallholder_dairy_productivity.pdf

Climate change influences dairy productivity in East Africa through impacts on fodder production and supply, livestock disease outbreak and water availability for livestock. This study assessed the influence of climate change on smallholder dairy farming in Kosirai, Nandi District of Kenya and Namayumba in Wakiso District of Uganda, in support of climate-smart agricultural practices. Observed (1973-2009) and model output (1950-2100) climate data comprising rainfall, minimum and maximum temperature and household survey were used. A simple random sampling technique, time series analysis, and descriptive statistics were used to achieve the objectives of the study. Mean rainfall in the two sites had progressively decreased over the last ten years. Conversely, there was a systematic rise in both the minimum and maximum temperature, both in historical and projected period in the two sites.

The weather variables namely rainfall, maximum and the minimum temperature had a positive correlation with fodder production and supply. Likewise, milk production that mainly depended on rainfed forages also correlated with the supply of feeds. There was increased milk production and supply during the wet season as compared to the dry spells. Climate change was linked to the emergence and rise of both the vector born and viral diseases in the two sites. There was a significant rise in outbreaks of foot and mouth disease and tick-borne diseases in Namayumba area. In Kosirai, there was an increase in outbreaks of tick-borne. The study recommended that dairy farmers be empowered to prepare effectively to climate change through adaptation and mitigation of the effect of extreme climate change. Farmers should also invest in the production and conservation of fodder for their dairy production.

Kirui JK, Ngure R, Bii C, Karimi PN, Mutai C, Amugune BK. "Combined Antibacterial and Antifungal Activities of Eucalyptus citriodora and Syzygium aromaticum Essential oils." Afr. J. Pharmacol. Ther. . 2014;3(1):29-37.
Kirui G;, Abuom TO;, Gitonga PN;, Ndurumo SM;, Tsigadi SA;, Kitaa JMA;, Mande JD. "Radiographic Evaluation of Fractures and Postoperative Outcome in Small Animals Clinic (75 cases).".; 2005.
Kirui G;, Abuom TO;, Gitonga PN;, Ndurumo SM;, Tsigadi SA;, Kitaa JMA;, Mande JD. "Radiographic Evaluation of Fractures and Postoperative Outcome in Small Animals Clinic (75 cases).".; 2005.
Kirui OK;, Okello JJ;, Nyikal RA. "Awareness and use of m-banking services in agriculture: The case of smallholder farmers in Kenya."; 2010. Abstract

Smallholder farmer access to agricultural finance has been a major constraint to agricultural commercialization in developing countries. The ICT revolution in Africa has however brought an opportunity to ease this constraint. The mobile phone-based banking services that started in Kenya urban centers have spread to rural areas and even other countries. Using these services farmers could receive funds invest in agriculture finance transactions. This study examines the awareness and use of m-banking services among rural farmers in Kenya. It also assesses the factors conditioning the use of such services. The study finds high awareness of m-banking services among the smallholder farmers. It also finds that education, distance to a commercial bank, membership to farmer organizations, distance to the m-banking agents, and endowment with physical and financial assets affect the use of m-banking services. It discusses the implications of these findings for policy and practice.

Kirui OK;, Okello JJ;, Nyikal RA. "Impact of Mobile Phone-based Money Transfer Services in Agriculture: Evidence from Kenya."; 2012. Abstract

The recent introduction of mobile phone-based money transfer (MMT) services in developing countries has generated a lot of interest among development partners. It facilitates transfer of money in a quick and cost effective way. It also offers an easy and secure platform for small savings to majority of rural populations with no access to formal financial services. However, the impact of MMT services on smallholder agriculture has not been documented. This study therefore contributes to pioneering literature on the impact of MMT, especially in agriculture. It provides information regarding financial intermediation to the excluded through the use of new generation Information Communication Technology (ICT) tools especially the mobile phone. The study employs propensity score matching technique to examine the impact of MMT services on household agricultural input use, agricultural commercialization and farm incomes among farm households in Kenya. It uses cross-sectional data collected from 379 multi-stage randomly selected households in Central, Western and Nyanza provinces of Kenya. The study found that use of MMT services significantly increased level of annual household input use by $42, household agricultural commercialization by 37% and household annual income by $224. We conclude that MMT services in rural areas help to resolve an idiosyncratic market failure that farmers face; access to financial services. We therefore recommend that other developing countries should follow the Kenyan model and provide an enabling environment that would facilitate entry and survival of MMT initiatives.

Kirui GK, Saifuddin Fidahussein Dossaji, Amugune NO. "Changes in Phytochemical Content During Different Growth Stages in Tubers of Five Varieties of Potato (Solanum Tuberosum L.)." Current Research in Nutrition and Food Science Journal. 2018;6(1):12-22.
KIRTDA DRACHARYAS. "Mechanisms behind hepatitis B virus persistence: the search continues. Indian J Gastroenterol. 1998 Jul-Sep;17(3):76-9.". In: Indian J Gastroenterol. 1998 Jul-Sep;17(3):76-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.
KIRTDA DRACHARYAS. "Irshad M, Gandhi BM, Acharya SK, Joshi YK, Tandon BN.Significance of anti-pre-S antibodies in patients with fulminant hepatic failure.Gastroenterol Jpn. 1990 Aug;25(4):499-502.". In: Gastroenterol Jpn. 1990 Aug;25(4):499-502. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
Anti-pre-S antibody was tested in 38 sera from patients with fulminant hepatitis (positive for HBsAg and/or IgM anti-HBc) using a specific solid phase enzyme linked immunosorbent assay (ELISA). Anti-pre-S activity was detected in 50 percent sera samples positive for HBsAg but negative for IgM anti-HBc. There were 12.5% sera positive for both HBsAg as well as IgM anti-HBc and 75% sera negative for HBsAg but positive for IgM anti-HBc. The prevalence of HBV-specific DNA-polymerase activity was high in all the three groups whereas anti-HBs positivity was low. Anti-pre-S activity was observed both in the presence as well as in the absence of DNA-polymerase activity. High-anti-pre-S level in fulminant hepatitis B patients was assumed to be implicated in the fast clearance of HBsAg from circulation.
KIRTDA DRACHARYAS. "Irshad M, Acharya SK, Joshi YK.Prevalence of hepatitis C virus antibodies in the general population & in selected groups of patients in Delhi.Indian J Med Res. 1995 Oct;102:162-4.". In: Indian J Med Res. 1995 Oct;102:162-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1995. Abstract
We report on the prevalence of anti-HCV antibodies in healthy individuals and patient groups with different liver diseases. The healthy population comprising 234 voluntary blood donors and 65 pregnant women with no history of liver diseases, had a per cent positivity of 1.5 anti-HCV in each group. The patients groups comprising 32 with acute viral hepatitis, 110 with fulminant hepatic failure, 65 with subacute hepatic failure, 33 with chronic active hepatitis, 45 with cirrhosis and 10 with hepatocellular carcinoma, had anti-HCV per cent positivity of 12.5, 43.6, 41.5, 48.5, 8.8 and 0 respectively. Anti-HCV was also tested in sera from 9 patients who had developed post-transfusion hepatitis and was recorded in 2 (22.2%) within one year of transfusion.
KIRTDA DRACHARYAS. "Acharya SK, Buch P, Irshad M, Gandhi BM, Joshi YK, Tandon BN.Outbreak of Dengue fever in Delhi.Lancet. 1988 Dec 24-31;2(8626-8627):1485-6.". In: Lancet. 1988 Dec 24-31;2(8626-8627):1485-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
Hepatitis G virus (HGV)/GB virus-C (GBV-C) has been identified as a blood-borne agent with disputed pathogenicity. This virus belongs to the flaviviridae with a distant relationship to hepatitis C virus (HCV). Genetically divergent HGV isolates have been reported from different parts of the world. This study describes the prevalence of HGV in multitransfused thalassaemic children in India and genomic sequence variations in 11 HGV isolates from the same geographical location. Hepatitis G virus RNA was detected in 39.7% multitransfused thalassaemic children. The seroprevalence of hepatitis B virus (HBV) and HCV was 23.8% and 17.1%, respectively, and 11.4% had dual infection. The nucleotide sequence of a 166 bp HGV genomic segment from the putative capsid-envelope region (nucleotide; nt 578-743) from 11 Indian isolates was compared to the sequences available in the nucleotide databases. The isolates from India were 81.3-94.5% homologous to the isolates from other parts of the world. On phylogenetic analysis, it was observed that HGV isolates from India may belong to two genetically divergent types.
KIRTDA DRACHARYAS. "Acharya SK, Panda SK, Duphare H, Dasarathy S, Ramesh R, Jameel S, Nijhawan S, Irshad M, Tandon BN.Chronic hepatitis in a large Indian hospital.Natl Med J India. 1993 Sep-Oct;6(5):202-6.". In: Natl Med J India. 1993 Sep-Oct;6(5):202-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
BACKGROUND. In developed countries as well as in Southeast Asia, the hepatitis B and C viruses are the main causes of chronic hepatitis. In India, however, there have been no major investigations on the aetiology of chronic hepatitis. (The hepatitis E virus which is responsible for half the sporadic and most of the epidemic cases of acute viral hepatitis in India does not cause chronic disease.) We, therefore, studied the profile of chronic hepatitis in India. METHODS. The clinical presentation, aetiology, serology and histological changes were studied prospectively in 48 patients with chronic hepatitis admitted to the All India Institute of Medical Sciences, New Delhi. Of these, 44 (92%) had chronic active hepatitis, 3 (6.3%) had chronic persistent hepatitis and 1 (2%) had chronic lobular hepatitis. RESULTS. The hepatitis B virus was the aetiological agent in 24 (50%) of these patients, the hepatitis D virus in association with hepatitis B virus in 10 (21%), the hepatitis C virus in 7 (15%) and the non-A, non-B viruses other than the hepatitis C virus in 6 (13%). One patient (2.0%) had autoimmune chronic active hepatitis. Jaundice at presentation was seen in 33 (69%) patients and more than half had hypoalbuminaemia (< 3 g/dl) with a prolonged prothrombin time. Alanine aminotransferase levels were less than 5 times above normal in over two-thirds of the patients. The highest alanine aminotransferase values were observed in patients with hepatitis D virus infection whereas the lowest were seen in patients with non-A, non-B related chronic active hepatitis. Histological examination revealed bridging necrosis in 40 (91%) patients with chronic active hepatitis indicating a severe form of disease. Replication of the hepatitis B virus was seen in 13 patients with chronic hepatitis, 5 of whom had hepatitis D virus-induced chronic hepatitis. Patients with hepatitis B virus replication had higher alanine aminotransferase values and more severe bridging necrosis than patients who did not have replicating viruses. Higher alanine aminotransferase values, ascites and oesophageal varices were encountered more frequently in patients with hepatitis B and D virus than in those with non-A, non-B related chronic hepatitis. CONCLUSION. Chronic hepatitis is not uncommon in India. It presents with evidence of severe disease and, as elsewhere, is most frequently caused by the hepatitis B virus.
KIRTDA DRACHARYAS. "Gandhi BM, Acharya SK, Irshad M, Gupta H, Chawla TC, Tandon BN.Entamoeba histolytica: elevated nitroblue tetrazolium reduction activity in polymorphs during amoebic liver abscess.Trans R Soc Trop Med Hyg. 1987;81(2):283-5.". In: Trans R Soc Trop Med Hyg. 1987;81(2):283-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
Peripheral blood polymorphonuclear leucocytes (PMN) from patients with invasive amoebiasis, i.e. amoebic liver abscess (ALA) and acute amoebic dysentery, showed marked elevation of nitroblue tetrazolium dye (NBT) reduction. This dramatic change was not observed in PMN from patients with non-invasive amoebiasis, i.e. non-suppurative hepatic amoebiasis, or in asymptomatic Entamoeba histolytica cyst passers. A small number (12%) of patients with viral hepatitis displayed increased NBT reduction. 10 to 12 days after recovery following treatment, the majority (75%) of ALA patients failed to show increased NBT reduction. Our results suggest that the PMN-NBT reduction test could be useful as an aid to the diagnosis of ALA.
KIRTDA DRACHARYAS. "Acharya SK, Balwinder S, Padhee AK, Nijhawan S, Tandon BN.Large volume paracentesis and intravenous dextran to treat tense ascites.J Clin Gastroenterol. 1992 Jan;14(1):31-5.". In: J Clin Gastroenterol. 1992 Jan;14(1):31-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Forty patients with cirrhosis of the liver and tense ascites were randomized to receive either aldactone 400 mg/day and furosemide 80 mg/day (n = 20) or repeated large volume paracentesis (LVP) and infusion of low molecular weight dextran (n = 20). Both treatment groups were similar in clinical and laboratory parameters. Complete mobilization of the ascitic fluid was achieved in all receiving LVP and dextran therapy within 1 week of the treatment, in contrast to the minimal mobilization of the ascitic fluid in patients receiving diuretics even after 2 weeks of therapy. Renal function, the clinical parameters of systemic hemodynamics, serum electrolytes, and hepatic function remained stable in patients receiving LVP and dextran and were similar to those in the diuretic-treated patients. We found no deterioration of these functions in the nonedematous patients treated by LVP and dextran even though the protective effect of edema against LVP was lacking in them. Plasma volume estimation in six nonedematous cirrhotic patients treated by LVP and dextran did not reveal any hypovolemia after complete mobilization of ascites. The frequency of complications and death were similar in the two groups. Dextran infusion is a safe, effective, and low-cost replacement therapy in patients with cirrhotic ascites treated by LVP.
KIRTDA DRACHARYAS. "Bose B, Khanna N, Acharya SK, Sinha S.Generation and characterization of a single-gene mouse-human chimeric antibody against hepatitis B surface antigen.J Gastroenterol Hepatol. 2006 Sep;21(9):1439-47.". In: J Gastroenterol Hepatol. 2006 Sep;21(9):1439-47. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
BACKGROUND: Antibody against hepatitis B surface antigen (HBsAg) is used for passive immunotherapy in certain cases of hepatitis B infection. The authors have earlier reported a high-affinity mouse monoclonal (5S) against HBsAg. However, this mouse antibody cannot be used for therapeutic purposes because it may elicit antimouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: A single-chain variable fragment (scFv), derived from the mouse monoclonal 5S, was fused with the fragment crystallisable (Fc) fragment of human IgG1. The scFv region is expected to bind to the antigen, whereas the Fc fragment can provide the effector functions required for virus neutralization. This chimeric molecule was expressed in Chinese hamster ovary (CHO) cells in serum-free medium. It was purified by affinity chromatography and characterized by in vitro binding studies. RESULTS: Purification and characterization indicated that this chimeric scFv-Fc fusion protein is secreted as a disulfide-linked, glycosylated, homodimeric molecule. The yield of the purified chimeric antibody was approximately 4.6 mg/L. In vitro analyses confirmed that this chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. CONCLUSION: Because it is a single-gene product, this chimeric scFv-Fc has the advantage of stable expression. Being chimeric and bivalent, it is expected to be less immunogenic and therefore suitable for further in vivo studies on virus neutralization.
KIRTDA DRACHARYAS. "Hazari S, Panda SK, Gupta SD, Batra Y, Singh R, Acharya SK.Treatment of hepatitis C virus infection in patients of northern India.J Gastroenterol Hepatol. 2004 Sep;19(9):1058-65.". In: J Gastroenterol Hepatol. 2004 Sep;19(9):1058-65. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract

BACKGROUND AND AIM: The purpose of the present study was to evaluate the therapeutic response of north Indian patients with chronic hepatitis C (CH-C) to two different treatment regimens of interferon and ribavirin. METHODS: Consecutive patients with a diagnosis of CH-C attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi between April 1999 and April 2002 were included in the study. A competitive reverse transcription-polymerase chain reaction (RT-PCR) method developed in the authors' laboratory was used for quantification of hepatitis C virus (HCV)-RNA. Genotyping of HCV was also determined. The clinical, biochemical, virological and histological parameters were used to assess the therapeutic response among a clinical cohort of patients with chronic hepatitis C. They were treated with two different protocols (interferon [IFN]-alpha-2b, 3 million units daily and ribavirin 10.6 mg/kg daily in two divided doses for 6 months or IFN-alpha-2b, 3 million units thrice weekly and ribavirin 10.6 mg/kg daily for 6 months). RESULTS: Sixty-five patients with CH-C were included in the study. Blood transfusion (n = 28, 43%) and community-acquired (n = 23, 35%) HCV infections were the commonest. The mean HCV load was high (24.14 +/- 12.5 x 10(8) copies/mL). Genotype 2 and 3 were prevalent in 80% (41/51) of the patients. Forty-five patients received 3 million units of IFN thrice weekly and 20 received the same dose daily. All received the same dose of ribavirin. A sustained virological response (SVR) of 95% (19/20) was achieved among patients receiving daily IFN, whereas 64.4% (29/45) of those who received IFN thrice weekly had SVR. The virological relapse was significantly lower among patients who received daily IFN than in those treated with thrice weekly IFN (n = 1/20, 5% vs 10/39, 25.6%; P = 0.015). The proportion of patients receiving daily IFN among those achieving SVR (19/48, 40%) was significantly higher than the proportion of patients receiving similar therapy among patients without SVR (1/17, 6%; P = 0.02). CONCLUSIONS: Transfusion and community-acquired HCV infection were the major causes of CH-C. Genotype 2 and 3 HCV were most prevalent among these patients. Despite high viral load, these patients responded well to a combination of daily IFN-alpha-2b and ribavirin. Copyright 2004 Blackwell Publishing Asia Pty Ltd

KIRTDA DRACHARYAS. "Acharya SK, Batra Y, Saraya A, Hazari S, Dixit R, Kaur K, Bhatkal B, Ojha B, Panda SK.Vaccination for hepatitis A virus is not required for patients with chronic liver disease in India.Natl Med J India. 2002 Sep-Oct;15(5):267-8.". In: Natl Med J India. 2002 Sep-Oct;15(5):267-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
BACKGROUND: Hepatitis A virus (HAV) vaccination is recommended worldwide for patients with chronic liver disease to prevent decompensation due to superinfection with HAV. India being endemic for HAV, the prevalence of pre-existing antibodies against HAV due to subclinical exposure to the virus in childhood among patients with chronic liver disease may be high and, therefore, vaccination may not be needed. However, data are lacking on the prevalence of HAV antibody among patients with chronic liver disease in India. METHODS: Two hundred fifty-four patients attending the Liver Clinic at the All India Institute of Medical Sciences, New Delhi during the past 5 years and diagnosed to have either chronic hepatitis due to the hepatitis B virus (n = 76), hepatitis C virus (n = 84) or cirrhosis of the liver due to the hepatitis B (n = 47) or C (n = 47) virus were tested for the presence of IgG anti-HAV antibody in their sera (using a commercial ELISA kit). RESULTS: Two hundred forty-eight (97.6%) patients tested positive for IgG anti-HAV. The prevalence of anti-HAV positivity was similar among patients with chronic hepatitis B (74, 97.4%), chronic hepatitis C (82, 97.6%), cirrhosis of the liver due to the hepatitis B (46, 97.8%) and hepatitis C (46, 97.8%) virus. CONCLUSION: Vaccination against HAV is not required among patients with chronic liver disease in India as there is a very high prevalence of pre-existing antibodies in these patients.
KIRTDA DRACHARYAS. "Saraya A, Acharya SK, Vashisht S, Mittal A, Tandon RK.Is protein-deficient diabetes mellitus a pancreatitis?J Gastroenterol Hepatol. 1999 Jul;14(7):705-8.". In: J Gastroenterol Hepatol. 1999 Jul;14(7):705-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. Abstract
BACKGROUND: Malnutrition-related diabetes mellitus is a distinct clinical entity subdivided into protein-deficient diabetes mellitus (PDDM) and fibrocalculus pancreatic diabetes (FCPD). Whereas FCPD has obvious pancreatitis manifested by pancreatic duct calculi, the evidence for involvement of the pancreas in PDDM is limited to the presence of ketosis-resistant hyperglycaemia. METHODS: We studied 10 patients with PDDM biochemically and radiologically. Endoscopic retrograde cholangiopancreatography was performed to determine if they had any evidence of chronic pancreatitis. RESULTS: Their mean faecal chymotrypsin level was low (13.2+/-5.72 microg/g), as was their basal c-peptide value (0.35+/-0.15 mmol/L). Islet cell antibodies were not detected in any of these patients. Ultrasound examination revealed pancreatic atrophy. In two patients, however, the pancreas was bulky. The ERCP showed generalized thinning of the pancreatic duct, measuring 2.4+/-0.06mm in the head, 2.01+/-0.08 mm in the body and 1.02 +/- 0.03 mm in tail region; side branches were seen but they were too sparse and thin. CONCLUSIONS: The significance of these changes is not clear, but they may represent an ongoing pancreatic disease and may, indeed, be the earliest changes of chronic pancreatitis.
KIRTDA DRACHARYAS. "Arora A, Tandon RK, Acharya SK.Intragastric pH and control of peptic ulcer bleeding.Am J Gastroenterol. 1991 Jan;86(1):116-7.". In: Am J Gastroenterol. 1991 Jan;86(1):116-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
Nutritional Status of 89 patients was assessed during their course of hospitalisation. All patients consumed diet deficit in protein and calories. The mean daily intake of calories was 819 +/- 425 Kcals and of protein was 22 +/- 19 g per day. 74.13 per cent patients lost weight while 31.25 per cent gained. 50% patients had fall in SKFT values during their hospital stay.
KIRTDA DRACHARYAS. "Tandon BN, Acharya SK, Tandon A.Epidemiology of hepatitis B virus infection in India.Gut. 1996;38 Suppl 2:S56-9.". In: Gut. 1996;38 Suppl 2:S56-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract

The average estimated carrier rate of hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 36 million carriers. Wide variations in social, economic, and health factors in different regions may explain variations in carrier rates from one part of the country to another. Professional blood donors constitute the major high risk group for HBV infection in India, with a hepatitis B surface antigen positivity rate of 14%. Blood transfusions represent the most important route of HBV transmission among adults. However, most of India's carrier pool is established in early childhood, predominantly by horizontal spread due to crowded living conditions and poor hygiene. Acute and subacute liver failure are common complications of viral hepatitis in India and HBV is reckoned to be the aetiological agent in 42% and 45% of adult cases, respectively. HBV is reported to be responsible for 70% of cases of chronic hepatitis and 80% of cases of cirrhosis of the liver. About 60% of patients with hepatocellular carcinoma are HBV marker positive. Small numbers of patients have been reported to be infected with the pre-core mutant virus but none with the S mutant. Coinfection with hepatitis C virus or hepatitis delta virus is comparatively uncommon. In conclusion, hepatitis B is a major public health problem in India and will continue to be until appropriate nationwide vaccination programmes and other control measures are established.

KIRTDA DRACHARYAS. "Kumar A, Acharya SK, Joshi YK, Gandhi BM, Irshad M, Tandon BN.Role of immune serum globulin in post transfusion virus B infection.Indian J Med Res. 1989 Jan;89:12-5.". In: Indian J Med Res. 1989 Jan;89:12-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
Fifty four blood recipients were administered prophylactic immune serum globulin (31) or hepatitis B immune globulin (23) and followed up for six months. None of the patients developed either acute hepatitis B or HBsAg carrier state. However, 7 (14%) had anicteric self limiting non-B post-transfusion hepatitis. Twenty (40%) of the blood recipients developed anti-HBs during the follow up period suggesting either HBV exposure by subdetectable levels of HBsAg present either in blood or immunoglobulin preparation or due to passive transfer by administration of immunoglobulins.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S, Saksena S, Pande JN.A prospective randomized study to evaluate propranolol in patients undergoing long-term endoscopic sclerotherapy.J Hepatol. 1994 Nov;21(5):918-9.". In: J Hepatol. 1994 Nov;21(5):918-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract

J Hepatol. 1993 Sep;19(2):291-300.Click here to read Links A prospective randomized double-blind study was conducted to evaluate the efficacy of propranolol in patients with portal hypertension undergoing long-term endoscopic sclerotherapy (EST) for recurrent variceal bleeding. Consecutive patients with portal hypertension (Child's class A or B) due to cirrhosis (n = 72), non-cirrhotic portal fibrosis (n = 29) and extrahepatic portal venous obstruction (n = 13) attending the liver clinic of a tertiary care center were included in the study. All patients had had at least one documented episode of variceal bleed in the previous 4 weeks. Fifty-eight patients received propranolol and 56 received placebo in addition to weekly EST. Rebleeding occurred in 12 (21%) patients in the placebo group and 10 (17%) patients in the propranolol group during a mean follow-up period of 24.4 +/- 10.4 months in the former and 23.8 +/- 9.2 months in the latter group (P > 0.1). The number of episodes of rebleeding (14 in the placebo and 12 in the propranolol group) were also similar (P > 0.1). The median bleeding-free period was more than 40 months in both treatment groups (P > 0.1). The mean transfusion requirements and the number of hospital admissions for rebleeding were also similar in the two treatment groups (P > 0.1). Complete obliteration of varices was achieved in 44 (78.9%) patients in the placebo group and 43 (75.5%) patients in the propranolol group (P > 0.1). Recurrence of new varices was seen in two patients in the placebo and in three of those in the propranolol group. Seven patients in the placebo group and five in the propranolol group died (P > 0.1). Complications related to EST were similar in the two treatment groups but additional adverse effects were observed in the propranolol group. The cumulative incidence of rebleeding in the placebo group was 12.7 and in the propranolol group it was 11.2 per 100 patient years of follow-up. It is concluded that the addition of propranolol in patients with portal hypertension and fair hepatic function on long-term EST does not confer any additional benefit.

KIRTDA DRACHARYAS. "Tandon BN, Gandhi BM, Irshad M, Acharya SK, Joshi YK.Prevalence of amoebic antibody in population affected by epidemic non-A, non-B hepatitis.Lancet. 1987 Feb 21;1(8530):455-6.". In: Lancet. 1987 Feb 21;1(8530):455-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
Even though HAV, HBV and HNANB viruses are responsible for most of the viral hepatitis cases, many other viruses have been reported to cause hepatic injury. These viruses may involve the liver, either as part of a systemic illness (e.g. EBV, CMV, HSV) or as the primary target organ (e.g. yellow fever virus, Lassa fever virus, Ebola virus). Clinically overt hepatocellular dysfunction is rare in such viral infections. Biochemical disturbance of hepatic functions shown, for example, by rises in AST and ALT, is a frequent event and indicates hepatic damage. Morphological changes of the liver include varying degrees of hepatic necrosis with a paucity of inflammatory activities. Intranuclear or cytoplasmic inclusion bodies may be characteristic findings in these diseases. Laboratory diagnosis depends upon serology and liver histology. Treatment is still largely supportive in most of these diseases, although recent trials of antiviral agents show promise against some viruses. Chronic sequelae, such as cirrhosis or hepatocellular cancer, are not encountered. More work is needed to elucidate the pathogenesis of hepatic injury in these illnesses.
KIRTDA DRACHARYAS. "Dasarathy S, Acharya SK.Training in gastroenterology.Trop Gastroenterol. 1992 Apr-Jun;13(2):45.". In: Trop Gastroenterol. 1992 Apr-Jun;13(2):45. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
We studied the risk of post-transfusion hepatitis (PTH) in recipients of blood collected from voluntary donors screened for HBsAg. Two hundred and fifty patients without any previous history of liver disease or transfusion were followed up for 12 months subsequent to cardiac surgery. Thirty-five of them had closed-heart surgery without receiving transfusion and served as controls. The remaining 215 patients received single-point transfusions (mean 4 +/- 2.4 units). None of the controls and 15 (6.9%) blood recipients developed PTH. Three (20%) patients had hepatitis-B-virus-induced hepatitis while the remainder (80%) had non A, non B (NANB) hepatitis. The number of units of blood transfused and surrogate markers for development of PTH (donor alanine aminotransferase, anti-HBc and anti-HBs antibody) were not associated with the occurrence of PTH (p greater than 0.05). Nine (60%) of the 15 patients developing PTH were asymptomatic. All the patients recovered from the PTH, except one who died of fulminant hepatitis. At the end of 1 year of follow-up, none of the patients had evidence of chronic hepatitis. Only three (25%) of the patients with NANB-PTH developed anti-hepatitis C virus (HCV) antibody during the follow-up. We conclude that the incidence of PTH in India is similar to other parts of the world and NANB virus was the major cause of the PTH. The absence of chronicity and lack of seroconversion to anti-HCV antibody in the majority of the patients after 1 year of follow-up may suggest the possibility of a NANB virus other than HCV as the major cause of PTH in India.
KIRTDA DRACHARYAS. "Acharya SK.HBV treatment: the hazy endpoint.Trop Gastroenterol. 2006 Jul-Sep;27(3):103-4.". In: Trop Gastroenterol. 2006 Jul-Sep;27(3):103-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
Viral hepatitis is a major public health problem in India, which is hyperendemic for HAV and HEV. Seroprevalence studies reveal that 90%-100% of the population acquires anti-HAV antibody and becomes immune by adolescence. Many epidemics of HEV have been reported from India. HAV related liver disease is uncommon in India and occurs mainly in children. HEV is also the major cause of sporadic adult acute viral hepatitis and ALF. Pregnant women and patients with CLD constitute the high risk groups to contract HEV infection, and HEV-induced mortality among them is substantial, which underlines the need for preventive measures for such groups. Children with HAV and HEV coinfection are prone to develop ALF. India has intermediate HBV endemicity, with a carrier frequency of 2%-4%. HBV is the major cause of CLD and HCC. Chronic HBV infection in India is acquired in childhood, presumably before 5 years of age, through horizontal transmission. Vertical transmission of HBV in India is considered to be infrequent. Inclusion of HBV vaccination in the expanded programme of immunization is essential to reduce the HBV carrier frequency and disease burden. HBV genotypes A and D are prevalent in India, which are similar to the HBV genotypes in the West. HCV infection in India has a population prevalence of around 1%, and occurs predominantly through transfusion and the use of unsterile glass syringes. HCV genotypes 3 and 2 are prevalent in 60%-80% of the population and they respond well to a combination of interferon and ribavirin. About 10%-15% of CLD and HCC are associated with HCV infection in India. HCV infection is also a major cause of post-transfusion hepatitis. HDV infection is infrequent in India and is present about 5%-10% of patients with HBV-related liver disease. HCC appears to be less common in India than would be expected from the prevalence rates of HBV and HCV. The high disease burden of viral hepatitis and related CLD in India, calls for the setting up of a hepatitis registry and formulation of government-supported prevention and control strategies.
KIRTDA DRACHARYAS. "Madan K, Batra Y, Panda SK, Dattagupta S, Hazari S, Jha JK, Acharya SK.Role of polymerase chain reaction and liver biopsy in the evaluation of patients with asymptomatic transaminitis: implications in diagnostic approach.J Gastroenterol Hepatol. 2004 Nov;.". In: J Gastroenterol Hepatol. 2004 Nov;19(11):1291-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
BACKGROUND AND AIM: Detection of an asymptomatic rise in the hepatic aminotransferase (ARHA) value has become a distinct and frequent clinical problem. We evaluated a three-step diagnostic algorithm in such patients for maximum yield. METHODS: Consecutive patients with an ARHA value 1.5-fold the upper limit of normal for at least 4 weeks and who were apparently healthy were included in the study. Each patient underwent standard biochemical investigations and a stepwise investigative protocol. In the first step, serological markers for hepatitis viruses, serum ferritin, 24-h urinary copper, alpha-1-antitrypsin phenotyping, and autoimmune markers were carried out. In step two, patients who tested negative for all the above markers had polymerase chain reaction (PCR) analysis for hepatitis B virus (HBV)-DNA and hepatitis C virus (HCV)-RNA. Patients without a diagnosis despite the above investigations underwent a liver biopsy as part of step three. RESULTS: Of 105 patients with ARHA, 38 were excluded for various reasons and 67 were included for the final analysis. The mean age was 35.11 +/- 11.96 years and 56 patients were men. The mean body mass index was 24.17 +/- 3.2 kg/m(2). The stepwise diagnostic algorithm achieved a diagnosis in 65/67 (97%) patients. Non-alcoholic steatohepatitis (NASH) and chronic viral hepatitis were the most common diagnoses, in 24 (36%) patients each. Using the diagnostic algorithm a diagnosis was reached in 34% of patients with only serological and biochemical investigations, whereas PCR for HBV and HCV could further detect the presence of active HBV or HCV viremia in 21% (14/97) and a liver biopsy was necessary to establish the diagnosis in 28/67 (42%) patients. CONCLUSIONS: A stepwise diagnostic algorithm in patients with ARHA resulted in an optimal use of PCR and invasive tests such as liver biopsy. Cryptic HBV and HCV infection was frequent among these patients and PCR was necessary in such cases. NASH and chronic viral hepatitis were the most frequent causes of ARHA.
KIRTDA DRACHARYAS. "Saraya A, Acharya SK, Vashist S, Tandon RK.A pancreatography study of chronic calcific pancreatitis of the tropics.Trop Gastroenterol. 2002 Oct-Dec;23(4):167-9.". In: Trop Gastroenterol. 2002 Oct-Dec;23(4):167-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
Chronic Calcific Pancreatitis of Tropics is a disease of unknown aetiology and is characterised by chronic pancreatitis with calcification in young persons who present with pain, diabetes, and/or steatorrhoea. ERCP performed on 42 patients with this condition revealed changes compatible with chronic pancreatitis. These changes were however, more marked and somewhat different from those seen in the alcoholic chronic pancreatitis. Cystic dilatation, tortuosity, and obstruction of the main pancreatic duct were similar to that in alcoholic pancreatitis. The features of CCPT that were different from those of latter, were large pancreatic calculi, absence of strictures/stenosis and absence of irregularity of the ductal wall. The calculi were predominantly in the head region of the pancreas causing maximal dilatation of the main pancreatic duct in the head of pancreas. The secondary branches were stunted, short and scanty but revealed a lower grade of changes, than the changes documented in the main pancreatic duct. The pancreatic ductal changes in CCPT seems to be different from that seen in chronic alcoholic pancreatitis and may be due to the difference in the pathophysiology of the underlying disease.
KIRTDA DRACHARYAS. "Management of hepatocellular carcinoma: many ways to skin a cat. Trop Gastroenterol. 1999 Apr-Jun;20(2):59-60.". In: Trop Gastroenterol. 1999 Apr-Jun;20(2):59-60. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. Abstract
Acute hepatic failure (AHF) in India almost always presents with encephalopathy within 4 weeks of the onset of acute hepatitis. Further subclassification of AHF into hyperacute, acute and subacute forms may not be necessary in this geographical area, where the rapidity of onset of encephalopathy does not seem to influence survival. Viral hepatitis is the cause in approximately 95-100% of patients, who therefore constitute a more homogeneous population than AHF patients in the West. In India, hepatitis E (HEV) and hepatitis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants are very important agents in cases where hepatitis B results in AHF in this country. Half of the patients with AHF admitted to our centre are female, one-quarter of whom are pregnant. Therefore, pregnant females who contract viral hepatitis constitute a high-risk group for the development of AHF. However, the outcome of AHF in this group is similar to that in non-pregnant women and men. No association with any particular virus has been identified among sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggressive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complications. Both fungal and gram-negative bacteria are major causes of sepsis. Among patients with AHF, despite the presence of sepsis, its overt clinical features (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identify patients suitable for liver transplantation.
KIRTDA DRACHARYAS. "Arora A, Tandon N, Sharma MP, Acharya SK.Constrictive pericarditis masquerading as Budd-Chiari syndrome.J Clin Gastroenterol. 1991 Apr;13(2):178-81.". In: J Clin Gastroenterol. 1991 Apr;13(2):178-81. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
Budd-Chiari syndrome (BCS) and constrictive pericarditis (CP) share many common clinical features. Over the last year we encountered three patients in whom CP clinically mimicked BCS. Two of the three did not even have raised jugular venous pressure. One patient with severe jaundice and hepatic coma ultimately died. Liver biopsy features were not discriminating. The final diagnosis of CP was established by echocardiography, chest computed tomography (CT), or cardiac catheterization. We conclude that in all patients with apparent BCS and atypical features, a noninvasive test like echocardiography or chest CT should be done to rule out treatable illness like CP before embarking on such invasive procedures as liver biopsy for diagnosis.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S, Kumer TL, Sushma S, Prasanna KS, Tandon A, Sreenivas V, Nijhawan S, Panda SK, Nanda SK, Irshad M, Joshi YK, Duttagupta S, Tandon RK, Tandon BN.Fulminant hepatitis in a tropical population: clinical course, cause, and early predict.". In: Hepatology. 1996 Jun;23(6):1448-55. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract

The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be implicated as the causative agent, and isolated HCV RNA could be detected in 7 (19%). Two hundred eighty eight (66%) patients died. Approximately 75% of those who died did so within 72 hours of hospitalisation. One quarter of the female patients with FHF were pregnant. Mortality among pregnant females, nonpregnant females, and male patients with FHF was similar (P > .1). Univariate analysis showed that age, size of the liver assessed by percussion, grade of coma, presence of clinical features of cerebral edema, presence of infection, serum bilirubin, and prothrombin time prolongation over controls at admission were related to survival (P < .01). The rapidity of onset of encephalopathy and cause of FHF did not influence the outcome. Cox's proportional hazard regression showed age > or = 40 years, presence of cerebral edema, serum bilirubin > or = 15 mg/dL, and prothrombin time prolongation of 25 seconds or more over controls were independent predictors of outcome. Ninety-three percent of the patients with three or more of the above prognostic markers died. The sensitivity, specificity, positive predictive value, and the negative predictive value of the presence of three or more of these prognostic factors for mortality was 93%, 80%, 86%, and 89.5%, respectively, with a diagnostic accuracy of 87.3%. We conclude that most of our patients with FHF might have been caused by hepatotropic viral infection, and non-A, non-B virus(es) seems to be the dominant hepatotropic viral infection among these patients. They presented with encephalopathy within 4 weeks of the onset of symptoms. Pregnancy, cause, and rapidity of onset of encephalopathy did not influence survival. The prognostic model developed in the current study is simple and can be performed at admission.

KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Tandon BN.A simple spot-test for circulating Entamoeba histolytica antigen-antibody complexes in patients with amoebic liver abscess.Indian J Med Res. 1989 May;89:177-83.". In: Indian J Med Res. 1989 May;89:177-83. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
An enzyme linked immunosorbent assay (ELISA) is described for the detection of E. histolytica immune complexes in serum. Antiamoebic antibody purified by affinity chromatography was used both to precoat strips of nitrocellulose membrane and as an enzyme carrier. These strips were incubated with samples of concentrated test serum and the enzyme conjugate. Following treatment with the peroxidase substrate 3-amino-9-ethylcarbazole the presence of E. histolytica antigens was visualized as red spots. Blocking of positive test sera with excess antibodies inhibited this reaction. Serum samples from 47 patients with amoebic liver abscess, 43 patients with other enteric diseases and 35 healthy controls were investigated. The spot test was positive in 75 per cent of patients with amoebic liver abscess, and in 12 per cent diseased controls whereas all the healthy controls were negative. The spot test is simple and sensitive and does not require prior separation of the immune complexes. The test is recommended as an aid to the diagnosis in patients suspected to have amoebic liver abscess.
KIRTDA DRACHARYAS. "Nanda SK, Yalcinkaya K, Panigrahi AK, Acharya SK, Jameel S, Panda SK.Etiological role of hepatitis E virus in sporadic fulminant hepatitis.J Med Virol. 1994 Feb;42(2):133-7.". In: J Med Virol. 1994 Feb;42(2):133-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract

Non-A, non-B hepatitis viruses have been implicated as the etiological agent(s) in up to 60% of patients with fulminant hepatitis. These agents are reported to induce a higher mortality than other causes of fulminant hepatitis. Hepatitis E virus (HEV) and hepatitis C virus (HCV) at present constitute the major identifiable non-A, non-B hepatitis agents. Of these, HEV has been established as the sole cause of epidemic hepatitis in Afro-Asian countries, and fulminant hepatitis has been recorded during such epidemics. However, in sporadic cases, the etiological role of HEV in fulminant hepatitis has remained uncertain. The role of HCV in acute liver disease and fulminant hepatitis remains unclear. The present study was undertaken to investigate the association of HEV and HCV in patients with fulminant hepatitis by direct detection of the viral genome using reverse transcription-polymerase chain reaction (RT-PCR). Serum samples from 50 serologically identified non-A, non-B fulminant hepatitis cases negative for cryptic hepatitis B virus (HBV) infection examined via PCR were tested for HEV and HCV RNA using RT-PCR. For HEV primers from the nonstructural region (ORF-1) were used, and for HCV primers from the highly conserved 5' untranslated regions were used. The products were analysed using agarose gel electrophoresis and confirmed by hybridisation with radiolabelled internal oligonucleotide probes. HEV was detected in 31 (62%) of the 50 fulminant non-A, non-B hepatitis cases. In 18 (36%) cases, HCV RNA was detected. In 11 (22%) of the HCV cases, the HEV genome was also amplified. In 20 (40%) cases, HEV was detected alone.(ABSTRACT TRUNCATED AT 250 WORDS)

KIRTDA DRACHARYAS. "Irshad M, Gandhi BM, Chawla TC, Acharya SK, Joshi YK, Tandon BN.Studies on HBsAg binding with polymerised human serum albumin by ELISA.J Virol Methods. 1987 May;16(1-2):75-85.". In: J Virol Methods. 1987 May;16(1-2):75-85. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
A simple and sensitive ELISA was developed to characterize the interaction between polymerised human serum albumin (pHSA) and HBsAg, using pHSA-coated polyvinylmicrotitre plates as solid phase and anti-HBs-coupled HRPO as the conjugate. The interaction was found to be specific and dependent on the size of albumin polymer. pHSA-binding activity (pHSA-BA) was studied in both HBsAg-negative and HBsAg-positive sera from various liver diseases including acute viral hepatitis, fulminant hepatitis, cirrhosis of liver, chronic active hepatitis, and healthy HBsAg carriers. pHSA-BA was detected only in HBsAg-positive sera. Analysis of HBsAg-positive sera indicated pHSA-BA in high proportions of patients sera as compared to sera from healthy HBsAg carriers. pHSA-BA was detected both in the presence and absence of HBe markers, though the mean BA was relatively high in presence of HBeAg. The effect of human serum immunoglobulins (IgG, IgA, and IgM) on the BA was investigated and a correlation between pHSA-BA and HBsAg-IgM complex positivity in sera was established. Finally, the probable role of human serum IgM in facilitating the binding process was discussed.
KIRTDA DRACHARYAS. "Acharya SK.Liver transplant in India: miles to go.Trop Gastroenterol. 1992 Oct-Dec;13(4):127-8.". In: Trop Gastroenterol. 1992 Oct-Dec;13(4):127-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK.Immunoprophylaxis of viral hepatitis.J Assoc Physicians India. 1983 Jun;31(6):355-8.". In: J Assoc Physicians India. 1983 Jun;31(6):355-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1983. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Javvaji S, Kumar A, Madan K, Garg PK, Acharya SK.Management of gastric variceal bleeding.Trop Gastroenterol. 2007 Apr-Jun;28(2):51-7.". In: Trop Gastroenterol. 2007 Apr-Jun;28(2):51-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2007. Abstract

OBJECTIVE: This study was undertaken to assess the value of clinical symptomatology, abdominal ultrasound (US), triple-phase CT (TPCT) and serum alpha-fetoprotein (AFP) estimation in predicting presence of hepatocellular carcinoma (HCC) among patients with cirrhosis. MATERIALS AND METHODS: In this cross-sectional study, Child's A/B cirrhosis patients were subjected to clinical evaluation, US, TPCT and serum AFP estimation. Sensitivity and specificity of clinical symptoms and of AFP at different cut-off levels were determined. Detection rate of HCC and agreement between US and TPCT was estimated. RESULTS: A high proportion of enrolled subjects had HCC at first presentation (40.7%). Significantly higher prevalence of abdominal pain, weight loss, and anorexia was seen in patients with cirrhosis with HCC compared to those without HCC. Sensitivity and specificity of any of these symptoms was 73 and 79%, respectively (positive and negative predictive values of 65 and 85%, respectively). A 100% agreement between TPCT and US was observed for diagnosing HCC cases. However, TPCT detected a greater number of smaller HCCs. Sensitivity of AFP at 400 ng/ml cut-off was only 25.7%, too low to be useful. Best mix of sensitivity (77.2%) and specificity (78.1%) of AFP was found to be at 10.7 ng/ml cut-off which falls within the conventional limits of normalcy. CONCLUSION: The study highlights the importance of symptomatology of weight loss, abdominal pain or anorexia as markers for HCC in patients with cirrhosis. AFP was not found to be a useful screening test. TPCT should be undertaken in all cirrhotics presenting to the hospital for the first time. Copyright 2007 S. Karger AG, Basel.

KIRTDA DRACHARYAS. "Development and evaluation of a quantitative competitive reverse transcription polymerase chain reaction (RT-PCR) for hepatitis C virus RNA in serum using transcribed thio-RNA as internal control. J Virol Methods. 2004 Mar 1;116(1):45-54.". In: J Virol Methods. 2004 Mar 1;116(1):45-54. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
A method for quantitation of hepatitis C virus (HCV) RNA was developed based on competitive reverse transcription polymerase chain reaction (RT-PCR) using in vitro transcribed mutated thio-RNA as a competitor template. The thio-RNA is more resistant to RNAse and is stable over a year. This assay was compared with the commercially available Roche Amplicor HCV Monitor assay V 2.0 and real time PCR using SYBR green 1 dye method. A total of 18 pre-therapy serum samples from chronic hepatitis C cases were tested in parallel by the three assays. All samples could be quantitated using the in-house competitive RT-PCR and real time PCR and there was a significant correlation in the virus titer (P<0.05). However, 8 (44%) samples could not be quantified by Amplicor HCV Monitor assay, which has a lower detection range (10(2) to 10(5.5) copies/ml). The in-house method of competitive RT-PCR showed a detection range of 10(3) to 10(10) copies/ml. In the patients the mean viral titer was found to be (9.66+/-9.3)x10(6) copies/ml. Ten (55%) of the samples, assessed by the Amplicor HCV Monitor assay showed a mean viral titre of (1.13+/-0.75)x10(6) copies/ml, which was lower than the other two tests. The competitive PCR method and real time PCR could amplify all prevalent genotypes. This in-house quantitative competitive RT-PCR method is simple, cheap, reproducible and useful for estimation of HCV RNA load.
KIRTDA DRACHARYAS. "Acharya SK, Batra Y.Is cirrhosis of the liver reversible? The ultimate that a hepatologist wishes.Trop Gastroenterol. 2003 Jan-Mar;24(1):1-2.". In: Trop Gastroenterol. 2003 Jan-Mar;24(1):1-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
We report a patient with fibrosing cholestatic hepatitis (FCH)-like syndrome in renal transplant recipient, who was negative for hepatitis-B and C-virus infection. The patient presented initially with extrahepatic biliary obstruction due to stricture at the lower end of the common bile duct. Cholestasis persisted inspite of effective biliary drainage. He was operated for empyema of the gallbladder and histological examination showed the presence of cytomegalovirus inclusions in the wall of the gallbladder. The patient died inspite of aggressive management; autopsy examination of the liver revealed evidence of FCH-like changes.
KIRTDA DRACHARYAS. "Bal C, Longkumer T, Patel C, Gupta SD, Acharya SK.Renal function and structure in subacute hepatic failure.J Gastroenterol Hepatol. 2000 Nov;15(11):1318-24.". In: J Gastroenterol Hepatol. 2000 Nov;15(11):1318-24. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2000. Abstract

BACKGROUND AND AIMS: Subacute hepatic failure (SHF) is a fatal complicaton of acute viral hepatitis. Renal failure has been implicated as the main cause of death in this disease. However, renal functional and structural evaluation in such patients have not been performed. The present prospective study evaluated the renal functional and structural abnormalities in patients with subacute hepatic failure. METHODS: Fourteen consecutive patients with SHF, 11 with acute liver failure (ALF) and 15 with cirrhosis of the liver (Child's B or C) were included in the present study. All 40 patients had liver disease caused by hepatitis viruses. The glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) estimations were measured in all patients by the use of technetium-99m diethylenetriaminepentaacetic acid and [131I]-labeled ortho-iodohippuric acid, respectively. Ante-mortem or post-mortem liver biopsies were performed in all patients. In three patients with SHF, post-mortem kidney biopsies were also performed. RESULTS: Thirty six percent (5/14) of patients with SHF, 18% (2/11) of patients with ALF and 20% (3/15) of patients with cirrhosis had renal failure. Seven patients with SHF, seven with ALF and nine with cirrhosis died. All the patients with renal failure in each of the three groups were among the deceased patients. Glomerular function was markedly affected among patients with SHF, which was shown by significantly higher (P < 0.05) proteinuria levels (0.367 +/- 0.38 g/24 h) compared to levels in patients with ALF (0.178 +/- 0.11 g/24 h) and cirrhosis (0.212 +/- 0.133 g/24 h). The GFR in SHF (56 +/- 27 mL/min per 1.73 m2) and cirrhotic patients (58 +/- 36 mL/min per 1.73 m2) was significantly lower compared to those in ALF patients (102 +/- 51 mL/min per 1.73 m2; P < 0.05). A significantly higher proportion (P < 0.05) of patients with SHF and cirrhosis (64 and 73%, respectively) had a GFR below 80 mL/min per 1.73 m2 compared to patients with ALF (18%). The GFR value among the deceased SHF patients (46 +/- 26 mL/min per 1.73 m2) was significantly lower (P < 0.05) than those SHF patients who survived (65 +/- 25 mL/min per 1.73 m2). However, similar features could not be documented among patients with ALF or cirrhosis. Subtle structural changes in the glomerulus were also noted in patients with SHF. These included mesangial proliferation and thickening, basal membrane thickening and increased cellularity with interstitial edema. The ERPF was markedly reduced (P = 0.058) among patients with SHF (347 +/- 131 mL/min per 1.73 m2) and cirrhosis (395 +/- 137 mL/min per 1.73 m2) in comparison to ERPF documented among patients with ALF (436 +/- 217 mL/min per 1.73 m2). Such a reduction in renal tubular blood flow, along with histologic documentation of hyaline presence, bile and grannular cast in the tubule, indicated a possible tubular dysfunction in patients with SHF. CONCLUSION: It is concluded that glomerular and tubular dysfunction with subtle structural abnormalities does occur in patients with SHF. These are similar to renal changes in cirrhosis and may have similar pathogenetic mechanisms that require further evaluation.

KIRTDA DRACHARYAS. "Arora A, Tandon RK, Acharya SK, Tandon BN.Treating bleeding peptic ulcer with sustained achlorhydria.Gastroenterol Jpn. 1991 Jul;26 Suppl 3:62-5.". In: Gastroenterol Jpn. 1991 Jul;26 Suppl 3:62-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
A controlled randomized study and a subsequent prospective therapeutic trial have demonstrated the efficacy of an intensive therapy comprising hourly intravenous injections of 100 mg of cimetidine along with a continuous nasogastric infusion of a liquid antacid at the rate of 0.5 ml per minute in achieving achlorhydria and controlling bleeding in patients with bleeding peptic ulcer. We recommend that this regimen should be routinely employed for treating patients with bleeding peptic ulcer, at least in center that do not practise topical therapeutic modalities for control of bleeding.
KIRTDA DRACHARYAS. "Panda SK, Panigrahi AK, Dasarathy S, Acharya SK.Hepatitis G virus in India.Lancet. 1996 Nov 9;348(9037):1319.". In: Lancet. 1996 Nov 9;348(9037):1319. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract
An enzyme immunoassay (EIA) was developed in-house for the detection of anti-hepatitis C virus (HCV) antibody against the prevailing genotypes in India. The specific reactivity of the test was compared with commercial second and third-generation EIAs and reverse transcription nested polymerase chain reaction (RT-nested PCR). Fifteen thousand nine hundred twenty-two healthy blood donors at the All India Institute of Medical Sciences (AIIMS), New Delhi, India, were screened for anti-HCV antibody. Two hundred ninety-five (1.85%) of these donors were positive. The screening was also used to determine how many patients with acute hepatitis and chronic liver diseases were positive for anti-HCV antibody. Five hundred sixty-four chronic liver disease patients were screened for anti-HCV antibody and 78 (13.83%) were found positive. Two hundred forty-seven sporadic acute viral hepatitis patients were screened for viral infection markers. Hepatitis B and E viruses (HBV and HEV) were the major etiologic agents. HCV was associated with 9% of the acute cases. Anti-HCV core IgM with HCV RNA detection were found to be helpful for the diagnosis of acute HCV infection.
KIRTDA DRACHARYAS. "Dwivedi M, Acharya SK, Nundy S, Tandon BN.Accuracy of abdominal ultrasonography and the role of a second investigation in surgical obstructive jaundice.Gastroenterol Jpn. 1989 Oct;24(5):573-9.". In: Gastroenterol Jpn. 1989 Oct;24(5):573-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
The diagnostic accuracy of ultrasonography (US) was evaluated in delineating the site and cause of biliary obstruction in 59 patients of surgical obstructive jaundice (SOJ). A final analysis of the ultrasonographic data was carried out in 42 patients on whom laparotomy or endoscopic papillotomy with removal of common bile duct stones, confirmed the diagnosis. Evaluation of the role of second investigation following ultrasound in 28 patients (side-viewing endoscopy in 13, ERCP in 12 and PTC in 3) was also done to determine whether they provide any additional information over ultrasonography in delineating the exact level and etiology of biliary obstruction. US was done by the clinician who interpreted the findings in conjunction with the clinical profile of the patient. US correctly diagnosed SOJ in all 42 patients. In 26 of the 28 patients with distal CBD block (specificity 87.5%; sensitivity 100%) and in 14 out of 16 patients with proximal CBD block (specificity 100%; sensitivity 87.5%) US provided and accurate diagnosis of the site of obstruction. US was correct in diagnosing a malignant etiology in 26 out of 27 malignant cases whereas it accurately indentified the benign nature of biliary obstruction in 14 of the 15 patients of SOJ due to benign obstruction (specificity and sensitivity range 93.3% to 96.3%). A second investigation could correctly change the etiology and site of biliary obstruction in only 5 patients (17.9%) whereas in the remaining 23 patients (82.1%) it did not add any additional information over the US findings. Six out of fifteen patients (40%) who underwent cholangiography had cholangitis and in one severe septicemia led to death.(ABSTRACT TRUNCATED AT 250 WORDS)
KIRTDA DRACHARYAS. "Nanda SK, Panda SK, Jameel S, Dasarathy S, Acharya SK.The epidemiologic significance and clinical pattern of HCV induced chronic hepatitis in India.Trop Gastroenterol. 1994 Jul-Sep;15(3):145-51.". In: Trop Gastroenterol. 1994 Jul-Sep;15(3):145-51. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
Hepatitis C virus (HCV) ribonucleic acid (RNA) was tested for in a group of 16 defined non-B chronic hepatitis patients using specific reverse transcription polymerase chain reaction (RT-PCR). These were chosen from amongst 56 biopsy proven cases of chronic hepatitis of which majority (40) were positive for hepatitis B virus infection. Hepatitis C virus RNA could be demonstrated in 12 (75%) of remaining 16 cases. These include all seven patients positive for antibody to HCV. Two of these patients had past history of blood transfusion and in another two the clinical course started with severe acute liver disease. This study establishes the association of HCV with severe liver disease. The clinical and biochemical profiles are also discussed. In view of limited sensitivity of the antibody assays it is justified to develop diagnostic testes based on local strains.
KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Gupta BB, Mudgil K, Tandon BN.Serological studies of Mycobacterium tuberculosis infection in north Indian population.J Assoc Physicians India. 1987 Nov;35(11):766-8.". In: J Assoc Physicians India. 1987 Nov;35(11):766-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Dasarathy S, Acharya SK.Ursodeoxycholic acid–new drug for liver diseases.Trop Gastroenterol. 1993 Jan-Mar;14(1):1-2.". In: Trop Gastroenterol. 1993 Jan-Mar;14(1):1-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract

Pancreatic abscess is a serious complication of acute pancreatitis and non-operative management has been reported to carry a mortality of nearly 100%. We present five patients with pancreatic abscess, who were successfully treated with antibiotics alone. All 5 patients had acute pancreatitis followed by prolonged fever and development of an abdominal mass. The diagnosis was confirmed in each of them by a contrast enhanced CT scan and an ultrasound guided aspiration of pus from the pancreatic mass. The choice of antibiotics was decided by the culture reports in two cases and by Gram's staining in the remaining three patients. We attribute the success of antibiotic therapy in our patients to early diagnosis by CT scan and guided aspiration as well as the absence of any unfavourable risk factors. This study suggests that a select group of patients with pancreatic abscess may be managed conservatively with antibiotics.

KIRTDA DRACHARYAS. "Sharma MP, Sarin SK, Acharya SK.Left lobe amoebic abscess of liver–a distinct clinical entity.J Assoc Physicians India. 1984 Jun;32(6):477-80.". In: J Assoc Physicians India. 1984 Jun;32(6):477-80. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1984. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Goyal R, Chalamalasetty SB, Madan K, Paul SB, Arora R, Safaya R, Acharya SK.Acral and palmo-plantar hyperpigmentation in a patient with disseminated hepatocellular carcinoma.Indian J Gastroenterol. 2007 Nov-Dec;26(6):292-3.". In: Indian J Gastroenterol. 2007 Nov-Dec;26(6):292-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2007. Abstract
Capecitabine (5-fluorouracil prodrug) is being evaluated for the management of hepatocellular carcinoma, and is associated with a peculiar skin reaction called hand and foot syndrome (HFS). We describe one patient with HCC and drug-induced HFS.
KIRTDA DRACHARYAS. "Pal S, Sahni P, Pande GK, Acharya SK, Chattopadhyay TK.Outcome following emergency surgery for refractory severe ulcerative colitis in a tertiary care centre in India.BMC Gastroenterol. 2005 Nov 30;5:39.". In: BMC Gastroenterol. 2005 Nov 30;5:39. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
BACKGROUND: Steroid-based intensive medical therapy for severe ulcerative colitis is successful in 60-70% of such patients. Patients with complications or those refractory to medical therapy require emergency colectomy for salvage. Little is known about the impact of timing of surgical intervention and surgical outcomes of such patients undergoing emergency surgery in India where the diagnosis is often delayed or missed in patients who are poor, malnourished and non-compliant to medical treatment. METHODS: The clinical records of all patients undergoing emergency surgery for severe ulcerative colitis or its complication in the Department of GI surgery AIIMS, New Delhi, India, between January 1985 and December 2003 were retrieved and data pertaining to demographic features, duration of intensive medical therapy, presence of complications, time from admission to emergency surgery, surgical procedure, in-hospital morbidity and mortality and follow up status extracted. RESULTS: A total of 72 patients underwent emergency surgery (Subtotal colectomy: 60; ileostomy alone under local anaesthesia: 12). Poor nutritional status was seen in 61% of the patients. Twenty-one patients (29%) underwent emergency surgery for complications of severe ulcerative colitis such as colonic perforation (spontaneous 6, iatrogenic 4), massive lower gastrointestinal haemorrhage (5), toxic megacolon (4) and large bowel obstruction (2). The remaining patients (n = 51) underwent emergency surgery following failed intensive therapy; 17 underwent surgery < or = 5 days (Group I) and 34 were operated > 5 days (Group II) after initiation of intensive therapy. In this group all the post-operative deaths (n = 8) occurred in those who were operated after 5 days. The difference in mortality in these two groups (i.e. surgical intervention < or = or > 5 days) was statistically significant {0/17 (Group I) vs 8/34 (Group II); p = 0.03}. Overall, 12 patients died (in-hospital mortality: 16.7%). The mortality was higher (10/43; 23.3%) in our early experience (i.e. 1985-1995) when compared to our subsequent experience (2/29; 6.9%) (1996-2003). A total of 48 patients (including 3 awaiting a restorative procedure) are alive on follow up (66.7%; 3 patients lost to follow up). A restorative procedure could be successfully completed in 81% of the survivors of the emergency procedure. CONCLUSION: To optimize the outcome, a combined team of physicians and surgeons should be involved in the management of patients with severe ulcerative colitis with focus on nutritional support, correction of metabolic derangements, close clinical monitoring and timely assessment for the need for emergency surgery. This retrospective analysis shows that improved results can be achieved with experience and by following a policy of early surgical intervention within 5 days, especially in patients who have failed intensive medical therapy.
KIRTDA DRACHARYAS. "Saraya A, Acharya SK, Vashisht S, Tandon RK.A pancreaticographic study of malnutrition-related diabetes mellitus.Trop Gastroenterol. 2003 Jul-Sep;24(3):120-3.". In: Trop Gastroenterol. 2003 Jul-Sep;24(3):120-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
Pancreatic involvement is considered to be the hallmark of malnutrition-related diabetes mellitus (MRDM). Of the 2 subgroups of the disease, fibrocalculous pancreatic diabetes (FCPD) is characterized by pancreatic calcification. The nature of pancreatic abnormalities in MRDM have not been studied extensively in Indian patients. The present study was designed to compare pancreatic abnormalities (exocrine and endocrine) including endoscopic retrograde pancreaticography in patients with FCPD and protein deficient pancreatic diabetes (PDPD), in relation to controls. Ten patients each of FCPD and PDPD were studied with regard to clinical features, biochemical exocrine and endocrine pancreatic responses, C-peptide response, islet cell antibody, and pancreatographic changes. Five normal pancreatograms were taken as control. Clinical and biochemical features in patient with FCPD and PDPD were as follows: pain in 8 and 2 patients, respectively; the mean duration of diabetes was similar in both groups (62.28 +/- 71.92 months V. 72 +/- 50.9 months); and faecal fat excretion and insulin requirements were comparable in both groups. The main pancreatic duct was dilated in 6 of 10 patient with FCPD and only 1 of 10 with PDPD on ultrasonography. On pancreatography the duct was dilated in 9 of 10 patients with FCPD and only 1 of 10 patients with PDPD. The number of side branches was reduced in all cases with MRDM; in those with FCPD, these were stunted and dilated while in PDPD side branches are thin and spastic. We conclude that pancreatic ductal changes involving the main duct and side branches are more frequent in patients with FCPD as compared to those with PDPD.
KIRTDA DRACHARYAS. "Srivastava DN, Thulkar S, Sharma S, Pandey GK, Sahni P, Julka PK, Acharya SK.Therapeutic radiological interventional procedures in hepatocellular carcinoma.Indian J Gastroenterol. 2002 May-Jun;21(3):96-8.". In: Indian J Gastroenterol. 2002 May-Jun;21(3):96-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
BACKGROUND: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used.
KIRTDA DRACHARYAS. "Acharya SK.Leading-edge Scientific and clinical advances, 9-10 January, Monte Carlo, Monaco.Trop Gastroenterol. 1998 Jan-Mar;19(1):40-4.". In: Trop Gastroenterol. 1998 Jan-Mar;19(1):40-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
Fifty consecutive patients with surgical obstructive jaundice were evaluated prospectively with ultrasonography (US), computed tomographic scans (CT scan) and cholangiography-percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangio-pancreaticography (ERCP). The diagnostic accuracy of ultrasound in defining the level of obstruction was 86% as compared to 86% and 94.8% for CT scan and cholangiography, respectively. To measure the etiology of the obstruction, the accuracy of ultrasound, CT scan and cholangiography were 84%, 86% and 75%, respectively. The sensitivity of CT scans and cholangiography in the diagnosis of choledocholithiasis was 100%, 81.8% and 90%, respectively, whereas specificity was 97%, 100% and 100%, respectively. Sensitivity for a diagnosis of malignant disease was 100% for both US and CT scans whereas specificity was 90% and 81%, respectively. Ultrasonography as a single radiological investigation is sufficient in the evaluation of the majority of patients with surgical obstructive jaundice. CT scan and cholangiography should be done only when US gives equivocal findings or if concomitant therapeutic procedures like basketing and stenting are also planned.
KIRTDA DRACHARYAS. "Gupta H, Irshad M, Joshi YK, Acharya SK, Tandon BN.Hepatitis C virus antibody in acute and chronic liver diseases in India.Scand J Infect Dis. 1990;22(5):627.". In: Scand J Infect Dis. 1990;22(5):627. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
One hundred and seventy five subjects with chronic liver diseases which included patients with chronic active hepatitis (90), liver cirrhosis (31) and asymptomatic hepatitis B carriers (54), were included in the study. Hepatitis B virus (HBV) specific DNA-polymerase activity and HBe-markers were tested as markers of HBV-multiplication. In HBsAg positive samples, DNA-P activity was positive in 44.4% of the HBV carriers, 52.9% of the patients with chronic active hepatitis and 81.8% of the patients with liver cirrhosis. The corresponding figures for the presence of HBeAg in these groups were 18.5, 26.5 and 45.5% respectively. Virus multiplication was also observed in 41.1 and 44.4% patients with chronic active hepatitis and liver cirrhosis respectively, in the absence of HBsAg. The results of the present study show that hepatitis B virus is the most important etiological factor of chronic liver diseases in India. Most of our patients of chronic liver diseases seems to have contacted HBV infection as young adults and the mode of transmission is likely to be horizontal rather than vertical. The virus replicating markers correlate well with the severity of the liver injury and decreased with the age. DNA-P activity is a more sensitive marker of viral multiplication than HBeAg. Viral multiplication was also found to occur in the absence of the usual HBV markers. Continued viral multiplication in patients with chronic active hepatitis and liver cirrhosis is implicated in continued liver injury and progressive liver disease.
KIRTDA DRACHARYAS. "Tandon RK, Mehrotra R, Arora A, Acharya SK, Vashisht S.Biliary strictures on ERCP: a study in northern India.J Assoc Physicians India. 1994 Nov;42(11):865-6, 869-70.". In: J Assoc Physicians India. 1994 Nov;42(11):865-6, 869-70. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
Case records of 82 patients with biliary stricture diagnosed on endoscopic retrograde cholangiopancreatography (ERCP) during a 7-years period (1983-89) were analysed for its aetiology, clinical presentation, laboratory abnormalities and radiological characteristics. The aetiology was found to be benign in 59 and malignant in 23 patients. Forty seven percent of all strictures were post cholecystectomy strictures (PCS). Presence of mucosal irregularity and incomplete stricture were commoner with malignancy. Malignant biliary strictures (MBS) were commonly seen in males, occurred at older age, had short history, had higher alkaline phosphtase and serum bilirubin values when compared to patients with benign biliary strictures (BBS).
KIRTDA DRACHARYAS. "Rai RR, Acharya SK, Nundy S, Vashisht S, Tandon RK.Chronic calcific pancreatitis: clinical profile in northern India.Gastroenterol Jpn. 1988 Apr;23(2):195-200.". In: Gastroenterol Jpn. 1988 Apr;23(2):195-200. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Dasarathy S, Acharya SK.Nitric oxide: significance for the gastroenterologists.Trop Gastroenterol. 1993 Apr-Jun;14(2):41-3.". In: Trop Gastroenterol. 1993 Apr-Jun;14(2):41-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.
KIRTDA DRACHARYAS. "Kar P, Sethubabu P, Sharma MP, Acharya SK.Acute pancreatitis: review of 32 cases.J Assoc Physicians India. 1985 Jun;33(6):401-2.". In: J Assoc Physicians India. 1985 Jun;33(6):401-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1985. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Bhatia V, Singhal A, Panda SK, Acharya SK.A 20-year single-center experience with acute liver failure during pregnancy: Is the prognosis really worse?Hepatology. 2008 Jul 9;48(5):1577-1585. [Epub ahead of print].". In: Hepatology. 2008 Jul 9;48(5):1577-1585. [Epub ahead of print]. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2008. Abstract
Pregnant patients with acute liver failure (ALF) are believed to have a worse outcome than nonpregnant women and men with ALF. However objective data supporting this supposition are scant. Therefore, the current study compared the outcome, complications, and causes of ALF among pregnant women and girls with age-matched nonpregnant women and girls and men and boys with ALF. One thousand fifteen consecutive ALF patients in the reproductive age group, admitted at the All India Institute of Medical Sciences, New Delhi, from January 1986 to December 2006, were included in the study. A total of 249 (38.5%) women were pregnant. They were compared with 341 nonpregnant women and girls and 425 men and boys, aged 15 to 45 years. The mortality rate of pregnant women and girls (53.8%) was similar to age-matched nonpregnant women and girls (57.2%), and men and boys (57.9%); P = 0.572.The clinical and biochemical features, disease severity, and complications were also similar in the three groups. A significantly higher proportion of ALF was attributable to hepatitis E virus (HEV) among women and girls who were pregnant (59.4%), as compared with both nonpregnant women and girls (30.4%), and men and boys (23.1%); P < 0.001. However, the outcome of HEV-related ALF was independent of the sex and pregnancy status of the patients (P = 0.103). Mortality in HEV-ALF and non-HEV-ALF patients in pregnant women and girls was 51% (74/145) and 54.7% (52/95)(P > 0.1), respectively. The outcome of pregnant ALF patients was also unrelated to the trimester of pregnancy. The mortality of non-HEV-related ALF among the pregnant women and girls (54.7%), age-matched nonpregnant women and girls (61.7%), and men and boys (62.8%) were also similar (P > 0.1). Conclusion: The mortality of pregnant patients with ALF is similar to that of nonpregnant women and girls and men and boys and is independent of the cause or trimester. Pregnancy per se should not be regarded as a poor prognostic factor for a patient with ALF. (HEPATOLOGY 2008.).
KIRTDA DRACHARYAS. "High affinity mouse-human chimeric Fab against hepatitis B surface antigen. World J Gastroenterol. 2005 Dec 28;11(48):7569-78. ;21(9):1439-47.". In: World J Gastroenterol. 2005 Dec 28;11(48):7569-78. ;21(9):1439-47. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
AIM: Passive immunotherapy using antibody against hepatitis B surface antigen (HBsAg) has been advocated in certain cases of Hepatitis B infection. We had earlier reported on the cloning and expression of a high affinity scFv derived from a mouse monoclonal (5S) against HBsAg. However this mouse antibody cannot be used for therapeutic purposes as it may elicit anti-mouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: We cloned the V(H) and V(L) genes of this mouse antibody, and fused them with CH1 domain of human IgG1 and C(L) domain of human kappa chain respectively. These chimeric genes were cloned into a phagemid vector. After initial screening using the phage display system, the chimeric Fab was expressed in soluble form in E. coli. RESULTS: The chimeric Fab was purified from the bacterial periplasmic extract. We characterized the chimeric Fab using several in vitro techniques and it was observed that the chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. This chimeric antibody fragment was further expressed in different strains of E. coli to increase the yield. CONCLUSION: We have generated a mouse-human chimeric Fab against HBsAg without any significant loss in binding and epitope specificity. This chimeric Fab fragment can be further modified to generate a full-length chimeric antibody for therapeutic uses.
KIRTDA DRACHARYAS. "Occult hepatitis B infection: the enigmatic virus. Indian J Gastroenterol. 2003 Jul-Aug;22(4):121-3.". In: Indian J Gastroenterol. 2003 Jul-Aug;22(4):121-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract

Acute liver failure (ALF) is defined as liver failure occurring within one month of the occurrence of jaundice. The disease has a grim prognosis, with a mortality of 65% to 85%. The management of ALF has till recently been conservative, and newer therapeutic modalities like bioartificial liver, hepatocyte transplant, and extracorporeal liver assist devices have not yet been proven to be successful. Liver transplant has changed the gloomy outlook of the disease, and post-transplant survival rates of 60%-70% have been reported from most centers. However liver transplant is expensive, necessitates life-long immunosupression, and is limited by a global shortage of available organs. It is thus necessary to select patients who are at greatest risk of death for liver transplantation. Prognostic criteria are based primarily either on clinical and laboratory (coagulation tests, serum bilirubin) parameters, or on other parameters like liver volume. Prognostic criteria have been developed both from the East and the West; these are essentially similar except that the Western criteria take into account etiology (drug overdose being the main cause of ALF there) as well as jaundice-encephalopathy interval as factors for prognostication. The King's College criteria were one of the first prognostic systems; it has two parts for both paracetamol as well as non paracetamol ALF. The criteria from our institute found prothrombin time >25 s, serum bilirubin >15 mg/dL, age >40 years, and cerebral edema to be bad prognostic markers. Criteria from the PGIMER, Chandigarh found age >50 years, raised intracranial pressure, prothrombin time >100 s, and onset of HE more than seven days after the jaundice as poor prognostic markers. All these clinical criteria have similar sensitivity and specificity.

KIRTDA DRACHARYAS. "Acharya SK, Batra Y, Hazari S, Choudhury V, Panda SK, Dattagupta S.Etiopathogenesis of acute hepatic failure: Eastern versus Western countries.J Gastroenterol Hepatol. 2002 Dec;17 Suppl 3:S268-73.". In: J Gastroenterol Hepatol. 2002 Dec;17 Suppl 3:S268-73. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
Etiopathogenesis of acute hepatic failure (AHF) in Eastern and Western countries is distinct. In the East hepatitis viruses cause AHF in more than 95% of such cases, while causes of AHF in the West are quite heterogenous. Hepatitis E virus is the major etiological agent of AHF in countries like India where the virus is hyperendemic. Occult HBV infection may also be causing AHF in a sizable proportion of cases in areas where chronic HBV infection frequency is high. Paracetamol causes AHF in about 70% cases in the UK and about 20% cases in USA, whereas in France and Denmark, non-steroidal anti-inflammatory drugs are more frequently associated with AHF. Hepatitis B virus causes AHF in about one-third of cases in the latter two countries. Copyright 2002 Blackwell Publishing Asia Pty Ltd
KIRTDA DRACHARYAS. "Hepatitis E virus infection: where are we? Natl Med J India. 1998 Mar-Apr;11(2):56-8.". In: Natl Med J India. 1998 Mar-Apr;11(2):56-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK.Ultrasonography in gastroenterology: stethoscope of a gastroenterologist.Trop Gastroenterol. 1990 Jul-Sep;11(3):117-8.". In: Trop Gastroenterol. 1990 Jul-Sep;11(3):117-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
Anti-pre-S antibody was tested in 38 sera from patients with fulminant hepatitis (positive for HBsAg and/or IgM anti-HBc) using a specific solid phase enzyme linked immunosorbent assay (ELISA). Anti-pre-S activity was detected in 50 percent sera samples positive for HBsAg but negative for IgM anti-HBc. There were 12.5% sera positive for both HBsAg as well as IgM anti-HBc and 75% sera negative for HBsAg but positive for IgM anti-HBc. The prevalence of HBV-specific DNA-polymerase activity was high in all the three groups whereas anti-HBs positivity was low. Anti-pre-S activity was observed both in the presence as well as in the absence of DNA-polymerase activity. High-anti-pre-S level in fulminant hepatitis B patients was assumed to be implicated in the fast clearance of HBsAg from circulation.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S, Irshad M.Prospective study of plasma fibronectin in fulminant hepatitis: association with infection and mortality.J Hepatol. 1995 Jul;23(1):8-13.". In: J Hepatol. 1995 Jul;23(1):8-13. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1995. Abstract
BACKGROUND/AIMS: Plasma fibronectin is an opsonic glycoprotein, normally synthesized by the liver, which decreases subsequent to severe liver damage and low levels of which may contribute to reticuloendothelial system dysfunction by compromising opsonic activity. This may result in an increased frequency of infection and death. The present study was conducted to evaluate the association of plasma fibronectin activity with infection and mortality in patients with fulminant hepatic failure. METHODS: Plasma fibronectin was estimated serially in 69 consecutive patients with fulminant hepatic failure, nine patients with uncomplicated acute viral hepatitis and 32 normal volunteers. RESULTS: Plasma fibronectin levels in patients with fulminant hepatic failure (85.6 +/- 75.8 micrograms/ml) were significantly lower than in patients with uncomplicated acute viral hepatitis (295.5 +/- 88.5 micrograms/ml) and healthy volunteers (362.6 +/- 69.2 micrograms/ml). Forty-nine (72%) patients with fulminant hepatic failure died. The initial values of fibronectin in fulminant hepatic failure did not correlate with mortality. Patients with fulminant hepatic failure who survived showed a progressive rise in the fibronectin levels compared to the absence of an increase in fibronectin levels in the non-survivors. The mortality in patients with fulminant hepatic failure with infection (24/27) was significantly higher (p < 0.05) compared to those without infection (25/42). Initial fibronectin levels in patients with infection (70.3 +/- 54.2 micrograms/ml) were significantly lower (p < 0.05) than in those without infection (92.3 +/- 64.4 micrograms/ml). We conclude that plasma fibronectin levels in patients with fulminant hepatic failure are decreased compared to healthy subjects and the absence of an increase in levels indicates a poor prognosis. Low levels of fibronectin are associated with an increased incidence of infection, which increases the mortality in these patients.
KIRTDA DRACHARYAS. "Bhargava DK, Dwivedi M, Acharya SK, Sundaram KR.Effect of low dosage of polidocanol in treatment of esophageal varices in cirrhotic patients.Indian J Med Res. 1988 Dec;88:515-21.". In: Indian J Med Res. 1988 Dec;88:515-21. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
Hepatitis G virus (HGV)/GB virus-C (GBV-C) has been identified as a blood-borne agent with disputed pathogenicity. This virus belongs to the flaviviridae with a distant relationship to hepatitis C virus (HCV). Genetically divergent HGV isolates have been reported from different parts of the world. This study describes the prevalence of HGV in multitransfused thalassaemic children in India and genomic sequence variations in 11 HGV isolates from the same geographical location. Hepatitis G virus RNA was detected in 39.7% multitransfused thalassaemic children. The seroprevalence of hepatitis B virus (HBV) and HCV was 23.8% and 17.1%, respectively, and 11.4% had dual infection. The nucleotide sequence of a 166 bp HGV genomic segment from the putative capsid-envelope region (nucleotide; nt 578-743) from 11 Indian isolates was compared to the sequences available in the nucleotide databases. The isolates from India were 81.3-94.5% homologous to the isolates from other parts of the world. On phylogenetic analysis, it was observed that HGV isolates from India may belong to two genetically divergent types.
KIRTDA DRACHARYAS. "Bell DR, Plant NJ, Rider CG, Na L, Brown S, Ateitalla I, Acharya SK, Davies MH, Elias E, Jenkins NA, et al.Species-specific induction of cytochrome P-450 4A RNAs: PCR cloning of partial guinea-pig, human and mouse CYP4A cDNAs.Biochem J. 1993 Aug 15;294 ( .". In: Biochem J. 1993 Aug 15;294 ( Pt 1):173-80. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
PCR was used to demonstrate the presence of a conserved region and to clone novel members of the cytochrome P-450 4A gene family from guinea pig, human and mouse cDNAs. This strategy is based on the sequences at nucleotides 925-959 and at the haem binding domain (nucleotides 1381-1410) of the rat CYP4A1 gene. Murine Cyp4a clones showed high sequence identity with members of the rat gene family, but CYP4A clones from human and guinea pig were equally similar to the rat/mouse genes, suggesting that the rat/mouse line had undergone gene duplication events after divergence from human and guinea-pig lines. The mouse Cyp4a-12 clone was localized to chromosome 4 using interspecific backcross mapping, in a region of synteny with human chromosome 1. The assignment of the human CYP4A11 gene to chromosome 1 was confirmed by somatic cell hybridization. An RNAase protection assay was shown to discriminate between the murine Cyp4a-10 and Cyp4a-12 cDNAs. Treatment of mice with the potent peroxisome proliferator methylclofenapate (25 mg/kg) induced Cyp4a-10 RNA in liver, and to a lesser extent in kidney; there was no sex difference in this response. Cyp4a-12 RNA was present at high levels in male control liver and kidney samples, and was not induced by treatment with methylclofenapate. However, Cyp4a-12 RNA was present at low levels in control female liver and kidney RNA, and was greatly induced in both organs by methylclofenapate. Guinea pigs were exposed to methylclofenapate (50 mg/kg), but there was no significant induction of the guinea-pig CYP4A13 RNA. These findings are consistent with a species difference in response to peroxisome proliferators between the rat/mouse and the guinea pig.
KIRTDA DRACHARYAS. "Joshi YK, Tandon BN, Acharya SK, Babu S, Tandon M.Acute hepatic failure due to Plasmodium falciparum liver injury.Liver. 1986 Dec;6(6):357-60.". In: Liver. 1986 Dec;6(6):357-60. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1986. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Irshad M, Joshi YK, Gupta H, Acharya SK, Singh YN, Tandon BN.HBV transmission in healthy persons at high risk in India.Natl Med J India. 1992 Jan-Feb;5(1):40.". In: Natl Med J India. 1992 Jan-Feb;5(1):40. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Forty patients with cirrhosis of the liver and tense ascites were randomized to receive either aldactone 400 mg/day and furosemide 80 mg/day (n = 20) or repeated large volume paracentesis (LVP) and infusion of low molecular weight dextran (n = 20). Both treatment groups were similar in clinical and laboratory parameters. Complete mobilization of the ascitic fluid was achieved in all receiving LVP and dextran therapy within 1 week of the treatment, in contrast to the minimal mobilization of the ascitic fluid in patients receiving diuretics even after 2 weeks of therapy. Renal function, the clinical parameters of systemic hemodynamics, serum electrolytes, and hepatic function remained stable in patients receiving LVP and dextran and were similar to those in the diuretic-treated patients. We found no deterioration of these functions in the nonedematous patients treated by LVP and dextran even though the protective effect of edema against LVP was lacking in them. Plasma volume estimation in six nonedematous cirrhotic patients treated by LVP and dextran did not reveal any hypovolemia after complete mobilization of ascites. The frequency of complications and death were similar in the two groups. Dextran infusion is a safe, effective, and low-cost replacement therapy in patients with cirrhotic ascites treated by LVP.
KIRTDA DRACHARYAS. "Madan K, Batra Y, Gupta SD, Chander B, Rajan KD, Tewatia MS, Panda SK, Acharya SK.Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians.World J Gastroenterol. 2006 Jun 7;12(21):3400-5.". In: World J Gastroenterol. 2006 Jun 7;12(21):3400-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
{ AIM: To evaluate the clinical and biochemical profile of patients with non alcoholic fatty liver disease (NAFLD) and to assess their histological severity at presentation. METHODS: Consecutive patients presenting to the liver clinic of All India Institute of Medical Sciences (AIIMS) with raised transaminases to at least 1.5 times upper limit of normal, and histologically confirmed non-alcoholic fatty liver disease were included. Patients who had significant alcohol intake or positive markers of other liver diseases or who were taking drugs known to produce fatty liver were excluded. The clinical, biochemical and histological profile of this group was studied. RESULTS: Fifty-one patients with NAFLD formed the study population. Their median age and BMI were 34(17-58) years and 26.7(21.3-32.5) kg/m(2) respectively and 46 (90.1%) were males. The majority of the patients had mild inflammation, either grade 1 [32 (63%)] or grade 2 [16 (31%)] and only 3 (6%) patients had severe (grade 3) inflammation. Twenty-three (45%), 19 (37%), 8(16%) and 1(2%) patient had stage 0, 1, 2 and 3 fibrosis respectively on index biopsy and none had cirrhosis. On univariate analysis, triglyceride levels more than 150 mg % (OR = 7.1; 95% CI: 1.6-31.5
KIRTDA DRACHARYAS. "Bhatia V, Batra Y, Acharya SK.Prophylactic phenytoin does not improve cerebral edema or survival in acute liver failure–a controlled clinical trial.J Hepatol. 2004 Jul;41(1):89-96.". In: J Hepatol. 2004 Jul;41(1):89-96. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
BACKGROUND/AIMS: Seizure activity in patients with acute liver failure (ALF) may increase cerebral oxygen requirements and worsen cerebral edema. Recently, prophylactic phenytoin has been recommended to suppress sub-clinical seizure activity evident on electroencephalographic monitoring. To determine the clinical utility of prophylactic phenytoin therapy in patients with ALF. METHODS: Forty two patients with ALF were randomized. Twenty two patients were given prophylactic phenytoin and 22 patients acted as controls. The baseline clinical and biochemical features were similar in the two groups and patients with > or =2 poor prognostic variables were equally represented. RESULTS: Sixteen patients in the phenytoin group, and 15 in the control group developed cerebral edema (P=0.38). Mechanical ventilation was required in 10 and 12 patients in the phenytoin and control groups, respectively, (P=0.77). Seizures occurred in 5 (22.7%) control patients and 5 (25%) phenytoin treated patients (P=0.86). Fourteen (70%) patients randomized to phenytoin and 15 (68.2%) control patients died (P=0.89). CONCLUSIONS: Seizure was common in patients with ALF. Prophylactic use of phenytoin did not prevent cerebral edema, seizures or need for mechanical ventilation, and did not improve survival.
KIRTDA DRACHARYAS. "Jain R, Sawhney S, Gupta RG, Acharya SK.Sonographic appearances and percutaneous management of primary tuberculous liver abscess.J Clin Ultrasound. 1999 Mar-Apr;27(3):159-63.". In: J Clin Ultrasound. 1999 Mar-Apr;27(3):159-63. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. Abstract
Primary tuberculous liver abscesses are rare. We report on 3 patients who presented with a nonresolving abscess in the liver. Clinical presentation and sonographic findings in each case were nonspecific. A diagnosis of tuberculosis was established with microbiologic examination of pus in 2 cases and examination of an excised abscess wall in 1 case. Needle aspiration (1 patient) and short-term (72 hours) catheter drainage (1 patient) were unsuccessful, and surgical excision was required in these patients. In the third patient, continuous catheter drainage over 18 days resulted in cure, indicating that long-term catheter drainage with antituberculous chemotherapy may be a viable alternative to surgery in the management of primary tuberculous liver abscess.
KIRTDA DRACHARYAS. "Arora A, Acharya SK.Prediction of severity of acute pancreatitis.Gut. 1990 Dec;31(12):1419.". In: Gut. 1990 Dec;31(12):1419. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
Nutritional Status of 89 patients was assessed during their course of hospitalisation. All patients consumed diet deficit in protein and calories. The mean daily intake of calories was 819 +/- 425 Kcals and of protein was 22 +/- 19 g per day. 74.13 per cent patients lost weight while 31.25 per cent gained. 50% patients had fall in SKFT values during their hospital stay.
KIRTDA DRACHARYAS. "Dayal S, Patti HP, Acharya SK.Polycythemia vera: overt to latent form in a patient with Budd-Chiari syndrome.J Clin Gastroenterol. 1996 Jan;22(1):76-7.". In: J Clin Gastroenterol. 1996 Jan;22(1):76-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract

The average estimated carrier rate of hepatitis B virus (HBV) in India is 4%, with a total pool of approximately 36 million carriers. Wide variations in social, economic, and health factors in different regions may explain variations in carrier rates from one part of the country to another. Professional blood donors constitute the major high risk group for HBV infection in India, with a hepatitis B surface antigen positivity rate of 14%. Blood transfusions represent the most important route of HBV transmission among adults. However, most of India's carrier pool is established in early childhood, predominantly by horizontal spread due to crowded living conditions and poor hygiene. Acute and subacute liver failure are common complications of viral hepatitis in India and HBV is reckoned to be the aetiological agent in 42% and 45% of adult cases, respectively. HBV is reported to be responsible for 70% of cases of chronic hepatitis and 80% of cases of cirrhosis of the liver. About 60% of patients with hepatocellular carcinoma are HBV marker positive. Small numbers of patients have been reported to be infected with the pre-core mutant virus but none with the S mutant. Coinfection with hepatitis C virus or hepatitis delta virus is comparatively uncommon. In conclusion, hepatitis B is a major public health problem in India and will continue to be until appropriate nationwide vaccination programmes and other control measures are established.

KIRTDA DRACHARYAS. "Irshad M, Gandhi BM, Acharya SK, Joshi YK, Tandon BN.Anti-pre-S antibodies in different groups of patients with hepatitis B virus infection.J Gastroenterol Hepatol. 1989 Jan-Feb;4(1):25-32.". In: J Gastroenterol Hepatol. 1989 Jan-Feb;4(1):25-32. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract

The anti-pre-S antibody in the samples of sera from normal healthy persons and patients with different clinical types of liver diseases due to hepatitis B virus (HBV) infection was detected by a newly established enzyme-linked immunosorbent assay technique. This test is a blocking assay where anti-pre-S antibody in the patient's serum blocks subsequent addition of horse radish peroxidase-labelled polymerized human serum albumin (pHSA) to the pHSA-receptor site of HBsAg molecules fixed on a solid surface. Anti-pre-S activity was not detected in any from 95 healthy persons who were negative for all HBV-markers or from 105 healthy HBV carriers. In 12 sera from HBV vaccine recipients, anti-pre-S activity was noted in higher proportions compared with anti-HBs, after both the second and third doses of vaccine. Anti-pre-S activity was detected in small proportions of HBsAg positive sera from acute viral hepatitis (4.2%) and chronic active hepatitis (10%). In subacute viral hepatitis patients, the anti-pre-S antibody was totally absent. However, anti-pre-S activity was recorded in high proportions of HBsAg-positive sera from patients with cirrhosis of liver (57.2%) and fulminant hepatitis (41.6%). The anti-pre-S antibodies were assumed to be implicated in the clearance of HBV particles from circulation without causing tissue damage.

KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S, Tandon BN.Should we redefine acute liver failure?Lancet. 1993 Dec 4;342(8884):1421-2.". In: Lancet. 1993 Dec 4;342(8884):1421-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract

J Hepatol. 1993 Sep;19(2):291-300.Click here to read Links A prospective randomized double-blind study was conducted to evaluate the efficacy of propranolol in patients with portal hypertension undergoing long-term endoscopic sclerotherapy (EST) for recurrent variceal bleeding. Consecutive patients with portal hypertension (Child's class A or B) due to cirrhosis (n = 72), non-cirrhotic portal fibrosis (n = 29) and extrahepatic portal venous obstruction (n = 13) attending the liver clinic of a tertiary care center were included in the study. All patients had had at least one documented episode of variceal bleed in the previous 4 weeks. Fifty-eight patients received propranolol and 56 received placebo in addition to weekly EST. Rebleeding occurred in 12 (21%) patients in the placebo group and 10 (17%) patients in the propranolol group during a mean follow-up period of 24.4 +/- 10.4 months in the former and 23.8 +/- 9.2 months in the latter group (P > 0.1). The number of episodes of rebleeding (14 in the placebo and 12 in the propranolol group) were also similar (P > 0.1). The median bleeding-free period was more than 40 months in both treatment groups (P > 0.1). The mean transfusion requirements and the number of hospital admissions for rebleeding were also similar in the two treatment groups (P > 0.1). Complete obliteration of varices was achieved in 44 (78.9%) patients in the placebo group and 43 (75.5%) patients in the propranolol group (P > 0.1). Recurrence of new varices was seen in two patients in the placebo and in three of those in the propranolol group. Seven patients in the placebo group and five in the propranolol group died (P > 0.1). Complications related to EST were similar in the two treatment groups but additional adverse effects were observed in the propranolol group. The cumulative incidence of rebleeding in the placebo group was 12.7 and in the propranolol group it was 11.2 per 100 patient years of follow-up. It is concluded that the addition of propranolol in patients with portal hypertension and fair hepatic function on long-term EST does not confer any additional benefit.

KIRTDA DRACHARYAS. "Irshad M, Gandhi BM, Acharya SK, Joshi YK, Tandon BN.An enzyme-linked immunosorbent assay (ELISA) for the detection of IgG and IgM anti-idiotypes directed against anti-HBs molecules.J Immunol Methods. 1987 Feb 11;96(2):211-7.". In: J Immunol Methods. 1987 Feb 11;96(2):211-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
A simple and specific enzyme-linked immunosorbent assay (ELISA) has been developed to detect circulating IgG and IgM anti-idiotypic antibodies directed against anti-HBs molecules using 96-well polyvinyl microtitre plates as the solid phase and HRPO-labelled goat anti-HBs as conjugate. Anti-idiotype reactions were observed in the supernatant portion after precipitation of immune complexes from sera with polyethylene glycol 6000 (PEG). Both IgG and IgM with anti-idiotype activity were detected concurrently in HBsAg-positive sera from HBV-infected patients and asymptomatic HBV carriers. Anti-idiotype activity was absent in HBsAg-negative sera from healthy persons, and in patients with non-A, non-B hepatitis and viral hepatitis A. However, such antibodies could be demonstrated in the sera of two out of eight HBsAg vaccine recipients negative for anti-HBs but in none of 11 recipients positive for anti-HBs after receiving a booster immunising dose of HBsAg vaccine. Those sera showing positive anti-idiotype reactions were free from rheumatoid factor and HBsAg/IgM or HBsAg/IgG complex activity. An analysis of anti-idiotype positive sera for anti-HBs, HBeAg and HBV-specific DNA-polymerase activity demonstrated these markers in 20%, 30% and 60% of cases, respectively. The presence of anti-idiotypic antibodies was presumed to permit a more active multiplication of hepatitis B virus.
KIRTDA DRACHARYAS. "Irshad M, Sharma MP, Acharya SK.Plasma concentrations of fibronectin and C3d in patients with amoebic liver abscess.J Infect. 1992 Jan;24(1):7-11.". In: J Infect. 1992 Jan;24(1):7-11. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
By means of simple and specific ELISA techniques, the plasma concentrations of soluble fibronectin and C3d, a breakdown product of C3 complement, were determined in patients with amoebic liver abscesses (ALA) and in healthy controls. The mean plasma fibronectin concentrations in 23 patients with ALA and in 20 controls were found to be 441 +/- 89 mg/l and 442 +/- 66 mg/l, respectively. The difference between these two values was not statistically significant. The mean C3d value in 21 patients with ALA, however, was found to be 84 +/- 14 AU/l which was significantly different from the value of 12 +/- 4.7 AU/l noted in 20 healthy persons. Plasma concentrations of these two proteins are discussed in relation to their possible implications in the immunopathogenesis of amoebic liver abscess.
KIRTDA DRACHARYAS. "Acharya SK, Panda SK.Hepatitis E virus: epidemiology, diagnosis, pathology and prevention.Trop Gastroenterol. 2006 Apr-Jun;27(2):63-8.". In: Trop Gastroenterol. 2006 Apr-Jun;27(2):63-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
HEV, a positive stranded RNA virus, is responsible for most of the epidemics of hepatitis in the developing world and is transmitted through contaminated water. It is the major aetiological agent for acute hepatitis and acute liver failure in endemic regions. It causes severe liver disease among pregnant females and patients with chronic liver disease. Serodiagnosis of HEV is now available and should be used routinely for diagnosis. The available evidence suggests that HEV may also be transmitted parenterally as well as vertically particularly in endemic areas. Experimental studies suggest that an HEV vaccine is a distinct possibility in the near future. In the absence of an effective vaccine, public health measures such as clean water supply, improved sanitation and public education are the major tools to prevent HEV epidemics in developing nations.
KIRTDA DRACHARYAS. "Batra Y, Dutta AK, Acharya SK.Molecular adsorbent and re-circulating system.Trop Gastroenterol. 2004 Apr-Jun;25(2):60-4.". In: Trop Gastroenterol. 2004 Apr-Jun;25(2):60-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
The molecular adsorbent recirculating system (MARS) is a non-biological artificial liver support system. Used for almost a decade, there are only two randomized controlled trials on the efficacy of MARS till date. A number of uncontrolled studies have documented a marked improvement in the biochemical parameters of patients after MARS. Although MARS seems to be an effective and promising tool in the management of liver failure, its cost needs to be reduced to enable it use in a member of indications.
KIRTDA DRACHARYAS. "Acharya SK, Batra Y.Nonalcoholic steatohepatitis: lots of hype, how much substance?Trop Gastroenterol. 2002 Jul-Sep;23(3):111-2.". In: Trop Gastroenterol. 2002 Jul-Sep;23(3):111-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
Chronic Calcific Pancreatitis of Tropics is a disease of unknown aetiology and is characterised by chronic pancreatitis with calcification in young persons who present with pain, diabetes, and/or steatorrhoea. ERCP performed on 42 patients with this condition revealed changes compatible with chronic pancreatitis. These changes were however, more marked and somewhat different from those seen in the alcoholic chronic pancreatitis. Cystic dilatation, tortuosity, and obstruction of the main pancreatic duct were similar to that in alcoholic pancreatitis. The features of CCPT that were different from those of latter, were large pancreatic calculi, absence of strictures/stenosis and absence of irregularity of the ductal wall. The calculi were predominantly in the head region of the pancreas causing maximal dilatation of the main pancreatic duct in the head of pancreas. The secondary branches were stunted, short and scanty but revealed a lower grade of changes, than the changes documented in the main pancreatic duct. The pancreatic ductal changes in CCPT seems to be different from that seen in chronic alcoholic pancreatitis and may be due to the difference in the pathophysiology of the underlying disease.
KIRTDA DRACHARYAS. "Acharya SK.Hepatology in India–sailing without a mast.Trop Gastroenterol. 1999 Oct-Dec;20(4):145.". In: Trop Gastroenterol. 1999 Oct-Dec;20(4):145. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. Abstract
Acute hepatic failure (AHF) in India almost always presents with encephalopathy within 4 weeks of the onset of acute hepatitis. Further subclassification of AHF into hyperacute, acute and subacute forms may not be necessary in this geographical area, where the rapidity of onset of encephalopathy does not seem to influence survival. Viral hepatitis is the cause in approximately 95-100% of patients, who therefore constitute a more homogeneous population than AHF patients in the West. In India, hepatitis E (HEV) and hepatitis B (HBV) viruses are the most important causes of AHF; approximately 60% of cases are caused by to these viruses. Hepatitis B virus core mutants are very important agents in cases where hepatitis B results in AHF in this country. Half of the patients with AHF admitted to our centre are female, one-quarter of whom are pregnant. Therefore, pregnant females who contract viral hepatitis constitute a high-risk group for the development of AHF. However, the outcome of AHF in this group is similar to that in non-pregnant women and men. No association with any particular virus has been identified among sporadic cases of AHF. In our centre, approximately one-third of AHF patients survive with aggressive conservative therapy, whereas two-thirds of deaths occur within 72 h of hospitalization. Cerebral oedema and sepsis are the major fatal complications. Both fungal and gram-negative bacteria are major causes of sepsis. Among patients with AHF, despite the presence of sepsis, its overt clinical features (i.e. fever, leucocytosis) may be absent and objective documentation of the presence of sepsis in such patients is achieved by repeated culture of various body fluids. It should be possible to develop simple, clinical prognostic markers for AHF in this geographical region, in order to identify patients suitable for liver transplantation.
KIRTDA DRACHARYAS. "Arora A, Tandon RK, Acharya SK, Tandon BN.The role of sustained achlorhydria in bleeding peptic ulcer.J Clin Gastroenterol. 1991 Apr;13(2):147-53.". In: J Clin Gastroenterol. 1991 Apr;13(2):147-53. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
Twenty-five patients with bleeding peptic ulcers were randomized to receive either ranitidine 50 mg 8 hourly i.v. (control group) or a continuous nasogastric antacid infusion at the rate of 0.5 ml/min along with an i.v. injection of cimetidine 100 mg/h (treatment group). Twelve patients were included in the control group and 13 in the treatment group. The mean gastric pH on therapy was significantly higher in the treatment group (7.88 +/- 0.37) than in the control group (5.00 +/- 0.55) (p less than 0.001), and the gastric pH was noted to be greater than 7 on 95% of the occasions in the treatment group and on 8.6% of the occasions in the control group. An overall control of bleeding was achieved in 92.3% of the patients in the treatment group and 50% of the patients in the control group (p less than .05). Thus, the failure of therapy was significantly more common in the control group than in the treatment group (p less than 0.05), and more patients of the control group had to undergo emergency surgery than that in the treatment group. None of the patients in the treatment group, but 16.6% of the patients in the control group, died during the study period in the hospital stay. We conclude that in patients with bleeding peptic ulcer an intensive medical therapy comprising hourly injections of cimetidine (or presumably of other H2 blockers) and continuous nasogastric antacid infusion can achieve sustained achlorhydria, better control of bleeding, and reduce the need for emergency surgery.
KIRTDA DRACHARYAS. "Sriramachari S, Tandon BN, Acharya SK.Excess zinc and progressive cholestasis: a new disease?Lancet. 1996 Mar 30;347(9005):845-6.". In: Lancet. 1996 Mar 30;347(9005):845-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract

The profiles of patients with fulminant hepatic failure (FHF) from developing countries have not been reported earlier. The current study was conducted prospectively, at a single tertiary care center in India, to document the demographic and clinical characteristics, natural course, and causative profile of patients with FHF as well as to define simple prognostic markers in these patients. Four hundred twenty-three consecutive patients with FHF admitted from January 1987 to June 1993 were included in the study. Each patient's serum was tested for various hepatotropic viruses. Univariate Cox's regression for 28 variables, multivariate Cox's proportional hazard regression, stepwise logistic regression, and Kaplan-Meier survival analysis were done to identify independent predictors of outcome at admission. All patients presented with encephalopathy within 4 weeks of onset of symptoms. Hepatotropic viruses were the likely cause in most of these patients. Hepatitis A (HAV), hepatitis B (HBV), hepatitis D (HDV) viruses, and antitubercular drugs could be implicated as the cause of FHF in 1.7% (n= 7), 28% (n= 117), 3.8% (n= 16), and 4.5% (n= 19) patients, respectively. In the remaining 62% (n= 264) of patients the serological evidence of HAV, HBV, or HDV infection was lacking, and none of them had ingested hepatotoxins. FHF was presumed to be caused by non-A, non-B virus(es) infection. Sera of 50 patients from the latter group were tested for hepatitis E virus (HEV) RNA and HCV RNA. In 31 (62%), HEV could be implicated as the causative agent, and isolated HCV RNA could be detected in 7 (19%). Two hundred eighty eight (66%) patients died. Approximately 75% of those who died did so within 72 hours of hospitalisation. One quarter of the female patients with FHF were pregnant. Mortality among pregnant females, nonpregnant females, and male patients with FHF was similar (P > .1). Univariate analysis showed that age, size of the liver assessed by percussion, grade of coma, presence of clinical features of cerebral edema, presence of infection, serum bilirubin, and prothrombin time prolongation over controls at admission were related to survival (P < .01). The rapidity of onset of encephalopathy and cause of FHF did not influence the outcome. Cox's proportional hazard regression showed age > or = 40 years, presence of cerebral edema, serum bilirubin > or = 15 mg/dL, and prothrombin time prolongation of 25 seconds or more over controls were independent predictors of outcome. Ninety-three percent of the patients with three or more of the above prognostic markers died. The sensitivity, specificity, positive predictive value, and the negative predictive value of the presence of three or more of these prognostic factors for mortality was 93%, 80%, 86%, and 89.5%, respectively, with a diagnostic accuracy of 87.3%. We conclude that most of our patients with FHF might have been caused by hepatotropic viral infection, and non-A, non-B virus(es) seems to be the dominant hepatotropic viral infection among these patients. They presented with encephalopathy within 4 weeks of the onset of symptoms. Pregnancy, cause, and rapidity of onset of encephalopathy did not influence survival. The prognostic model developed in the current study is simple and can be performed at admission.

KIRTDA DRACHARYAS. "Dwivedi M, Acharya SK, Tandon BN.The ultrasonographic "common channel" sign: a characteristic feature of malignant obstruction of the lower end of common bile duct.J Clin Gastroenterol. 1989 Apr;11(2):233-5.". In: J Clin Gastroenterol. 1989 Apr;11(2):233-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
We describe an ultrasonographic "common channel" sign as the characteristic sonographic feature of malignant distal common bile duct (CBD) obstruction. Of 24 patients with obstructive jaundice due to distal CBD obstruction (pancreatic carcinoma 8, periampullary cancer 5, choledocholethiasis 10, CBD stricture due to pancreatitis 1) in whom the final diagnosis was proven at laparotomy, ultrasonography revealed 11 patients to have a thin-walled distended gallbladder continuous with a dilated CBD, which was termed the "common channel" sign. In all 11 patients, the cause of obstruction of the lower end of CBD proved to be malignant (pancreatic carcinoma 6, periampullary 5). In contrast, only 2 of the other 13 patients with obstructive jaundice with distal CBD obstruction, but without the "common channel" sign, had a malignant lesion at the lower end of CBD. The positive and the negative predictive values of the common channel sign were 100% and 85%, respectively. Thus, the ultrasonographic common channel sign is a reliable and characteristic feature of distal CBD obstruction due to malignant pathology.
KIRTDA DRACHARYAS. "Irshad M, Acharya SK.Status of hepatitis viral markers in patients with acute and chronic liver diseases in northern India.Intervirology. 1994;37(6):369-72.". In: Intervirology. 1994;37(6):369-72. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
The present study describes the frequency of hepatitis viral markers in patients with uncomplicated acute viral hepatitis (AVH; n = 32) and in patients with severe liver diseases, including those with fulminant hepatic failure (FHF; n = 110), subacute hepatic failure (SAHF; n = 65), and chronic active hepatitis (CAH; n = 33). The results indicate that hepatitis A virus infection is quite rare, whereas hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the predominant causes of acute and chronic liver failure in India. The incidence of HBV infection in AVH, FHF, SAHF, and CAH groups was recorded in 3.7, 19.1, 23.1, and 69.7% of the cases, respectively. Similarly, HCV infection in these four groups was noted in 12.5, 45, 44.6, and 48.5% of the cases, respectively. Further analysis of HCV infection demonstrated that it was as frequent as single infection in acute cases, but more commonly found in association with HBV infection in chronic liver failure cases. Hepatitis D virus (HDV) infection, as indicated by the presence of IgM anti-HDV antibodies, was recorded in 7.3% of the cases with AVH, in 7.3% of the cases with FHF, in 9.2% of the cases with SAHF, and in 6.1% of the cases with CAH. HDV was associated with HBV both as superinfection as well as coinfection. Interestingly, nearly 2-6% of the cases in each group showed the presence of simultaneous HBV, HCV, and HDV infection. 83.3% of the AVH, 42.1% of the FHF, 37.0% of the SAHF, and 15.1% of the CAH patients had unknown viral markers.(ABSTRACT TRUNCATED AT 250 WORDS)
KIRTDA DRACHARYAS. "Acharya SK, Irshad M, Gandhi BM, Joshi YK, Tandon BN.Pre-S proteins–a new marker for the hepatitis-B virus.Trop Gastroenterol. 1987 Apr-Jun;8(2):91-8.". In: Trop Gastroenterol. 1987 Apr-Jun;8(2):91-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
A simple and sensitive ELISA was developed to characterize the interaction between polymerised human serum albumin (pHSA) and HBsAg, using pHSA-coated polyvinylmicrotitre plates as solid phase and anti-HBs-coupled HRPO as the conjugate. The interaction was found to be specific and dependent on the size of albumin polymer. pHSA-binding activity (pHSA-BA) was studied in both HBsAg-negative and HBsAg-positive sera from various liver diseases including acute viral hepatitis, fulminant hepatitis, cirrhosis of liver, chronic active hepatitis, and healthy HBsAg carriers. pHSA-BA was detected only in HBsAg-positive sera. Analysis of HBsAg-positive sera indicated pHSA-BA in high proportions of patients sera as compared to sera from healthy HBsAg carriers. pHSA-BA was detected both in the presence and absence of HBe markers, though the mean BA was relatively high in presence of HBeAg. The effect of human serum immunoglobulins (IgG, IgA, and IgM) on the BA was investigated and a correlation between pHSA-BA and HBsAg-IgM complex positivity in sera was established. Finally, the probable role of human serum IgM in facilitating the binding process was discussed.
KIRTDA DRACHARYAS. "Irshad M, Singh YN, Acharya SK.HBV–status in professional blood donors in north India.Trop Gastroenterol. 1992 Jul-Sep;13(3):112-4.". In: Trop Gastroenterol. 1992 Jul-Sep;13(3):112-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Present study demonstrates the efficacy and significance of routine screening assays used for HBsAg testing in donor blood in different blood banks of Delhi city. Blood from professional donors already screened in blood banks were cross checked using micro-ELISA technique developed at All India Institute of Medical Sciences and the results were compared. HBsAg carrier rate in these professional donors was found to be 11.7% by micro ELISA as against only 6% reported in blood banks using RPHA and latex agglutination assays. Thus, assays used in blood banks were found to be missing nearly 50% HBsAg positive cases as compared to micro-ELISA. A small group of professional donors was also screened for anti-HBs and results explained in comparison of normal values.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK.Immunology of giardiasis.Indian J Pediatr. 1983 May-Jun;50(404):319-24.". In: Indian J Pediatr. 1983 May-Jun;50(404):319-24. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1983. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Sengupta S, Rehman S, Durgapal H, Acharya SK, Panda SK.Role of surface promoter mutations in hepatitis B surface antigen production and secretion in occult hepatitis B virus infection.J Med Virol. 2007 Mar;79(3):220-8.". In: J Med Virol. 2007 Mar;79(3):220-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2007. Abstract
The production, secretion, and localization of surface proteins of hepatitis B virus (HBV) and the ratio of large to small surface protein S was studied in HepG2 cells transfected with the wild-type and mutant pre-S1 and pre-S2/S promoters of HBV molecular clones 313.1 (GenBank accession no. AY161147) and 761.1 (GenBank accession no. AY161159) from two patients with occult HBV infection. Fusion constructs were made by in frame fusion of the wild-type surface gene to the mutant pre-S1 and pre-S2/S promoters and wild-type promoter so that the structural part of the small surface protein remains identical. HepG2 cells transfected transiently were used for analysis. HBV surface proteins production and secretion was determined by enzyme linked immuno assay (ELISA) and localization by immunofluorescence. Immunoprecipitation of the large, middle, and small surface protein was carried out in transient transfected and metabolically labeled cells to determine the ratio of the large to small surface protein. The results indicate that HepG2 cells transfected with mutant HBV promoters had reduced HBV surface proteins secretion compared to wild-type HBV. HepG2 cells transfected with mutant HBV pre-S1 and pre-S2/S promoters showed cytoplasmic aggregation of HBV surface proteins compared to wild-type HBV promoters, which showed diffuse cytoplasmic localization. In all cases, the HBV surface proteins localized to the endoplasmic reticulum. The ratio between the large and small surface protein was 1.89 and 0.56 with mutant HBV 313.1 and 761.1 pre-S1 and pre-S2/S promoters, respectively, compared to 0.17 in wild-type. Thus, the aggregation of surface proteins, altered ratio and secretion of surface proteins were possibly the causes of occult hepatitis B infection.
KIRTDA DRACHARYAS. "Prakash S, Dash SC, Kumar A, Dinda AK, Agarwal SK, Acharya SK.Frequency and role of hepatitis-C virus and type II cryoglobulinemia in membranoproliferative glomerulonephritis.J Assoc Physicians India. 2004 Jun;52:451-3.". In: J Assoc Physicians India. 2004 Jun;52:451-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
BACKGROUND: Many studies have claimed a major role of chronic hepatitis-C virus (HCV) infection in immune-mediated diseases such as membranoproliferative glomerulonephritis (MPGN). Chronic HCV infection is also known to produce essential mixed cryoglobulinemia (EMC), which in turn may manifest as vasculitis and cryoglobulinemic MPGN. OBJECTIVE: The aim of the study therefore, was to determine frequency of association and pathogenetic role of HCV infection as well as that of EMC in MPGN patients. METHODS: Fifty-three adult patients of MPGN were studied for HCV, HBsAg, EMC, C3, anti-nuclear antibody (ANA), rheumatoid factor serologically. Histopathology, immunofluorescence (IF) were conducted in all patients and electron microscopy (EM) in those who were found HCV positive. Simultaneously 37 follow-up patients of HCV associated chronic hepatitis were investigated for EMC, renal functions and urinalysis done for evidence of glomerulonephritis (GN). RESULTS: Thirteen percent MPGN patients were HCV positive, however, no viral particle could be seen in electron microscopy in glomeruli of these patients. There was no serologic evidence of HCV induced immune complex GN. None of the MPGN patients showed cryoglobulinaemia. Similarly none from HCV associated chronic hepatitis group had EMC nor showed evidences of glumerulonephritis. CONCLUSION: Thirteen percent of adult MPGN patients in north India were seropositive for HCV, indicating significant association. However, clear evidence in favour of its pathogenetic role was lacking in our study. Secondly, this study reveals that MPGN is non-cryoglobulinemic and HCV is not a major cause in our population compared to what is reported from other countries. These observations need confirmation by a larger study.
KIRTDA DRACHARYAS. "Occult hepatitis B infection: the enigmatic virus.Indian J Gastroenterol. 2003 Jul-Aug;22(4):121-3.". In: Indian J Gastroenterol. 2003 Jul-Aug;22(4):121-3. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
We report a patient with fibrosing cholestatic hepatitis (FCH)-like syndrome in renal transplant recipient, who was negative for hepatitis-B and C-virus infection. The patient presented initially with extrahepatic biliary obstruction due to stricture at the lower end of the common bile duct. Cholestasis persisted inspite of effective biliary drainage. He was operated for empyema of the gallbladder and histological examination showed the presence of cytomegalovirus inclusions in the wall of the gallbladder. The patient died inspite of aggressive management; autopsy examination of the liver revealed evidence of FCH-like changes.
KIRTDA DRACHARYAS. "Mohanty S, Saxena R, Acharya SK.Activated protein C resistance in Budd-Chiari syndrome.Int J Hematol. 2000 Aug;72(2):255.". In: Int J Hematol. 2000 Aug;72(2):255. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2000. Abstract

BACKGROUND AND AIMS: Subacute hepatic failure (SHF) is a fatal complicaton of acute viral hepatitis. Renal failure has been implicated as the main cause of death in this disease. However, renal functional and structural evaluation in such patients have not been performed. The present prospective study evaluated the renal functional and structural abnormalities in patients with subacute hepatic failure. METHODS: Fourteen consecutive patients with SHF, 11 with acute liver failure (ALF) and 15 with cirrhosis of the liver (Child's B or C) were included in the present study. All 40 patients had liver disease caused by hepatitis viruses. The glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) estimations were measured in all patients by the use of technetium-99m diethylenetriaminepentaacetic acid and [131I]-labeled ortho-iodohippuric acid, respectively. Ante-mortem or post-mortem liver biopsies were performed in all patients. In three patients with SHF, post-mortem kidney biopsies were also performed. RESULTS: Thirty six percent (5/14) of patients with SHF, 18% (2/11) of patients with ALF and 20% (3/15) of patients with cirrhosis had renal failure. Seven patients with SHF, seven with ALF and nine with cirrhosis died. All the patients with renal failure in each of the three groups were among the deceased patients. Glomerular function was markedly affected among patients with SHF, which was shown by significantly higher (P < 0.05) proteinuria levels (0.367 +/- 0.38 g/24 h) compared to levels in patients with ALF (0.178 +/- 0.11 g/24 h) and cirrhosis (0.212 +/- 0.133 g/24 h). The GFR in SHF (56 +/- 27 mL/min per 1.73 m2) and cirrhotic patients (58 +/- 36 mL/min per 1.73 m2) was significantly lower compared to those in ALF patients (102 +/- 51 mL/min per 1.73 m2; P < 0.05). A significantly higher proportion (P < 0.05) of patients with SHF and cirrhosis (64 and 73%, respectively) had a GFR below 80 mL/min per 1.73 m2 compared to patients with ALF (18%). The GFR value among the deceased SHF patients (46 +/- 26 mL/min per 1.73 m2) was significantly lower (P < 0.05) than those SHF patients who survived (65 +/- 25 mL/min per 1.73 m2). However, similar features could not be documented among patients with ALF or cirrhosis. Subtle structural changes in the glomerulus were also noted in patients with SHF. These included mesangial proliferation and thickening, basal membrane thickening and increased cellularity with interstitial edema. The ERPF was markedly reduced (P = 0.058) among patients with SHF (347 +/- 131 mL/min per 1.73 m2) and cirrhosis (395 +/- 137 mL/min per 1.73 m2) in comparison to ERPF documented among patients with ALF (436 +/- 217 mL/min per 1.73 m2). Such a reduction in renal tubular blood flow, along with histologic documentation of hyaline presence, bile and grannular cast in the tubule, indicated a possible tubular dysfunction in patients with SHF. CONCLUSION: It is concluded that glomerular and tubular dysfunction with subtle structural abnormalities does occur in patients with SHF. These are similar to renal changes in cirrhosis and may have similar pathogenetic mechanisms that require further evaluation.

KIRTDA DRACHARYAS. "Arora A, Seth S, Sharma MP, Acharya SK, Mukhopadhayaya S.Case report: unusual CT appearances in a case of Budd-Chiari syndrome.Clin Radiol. 1991 Jun;43(6):431-2.". In: Clin Radiol. 1991 Jun;43(6):431-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
We describe a case of Budd-Chiari Syndrome due to hepatic venous blockage in which there were multiple space-occupying lesions on CT simulating tumour deposits. Ultrasound directed liver biopsy and laparoscopy proved these to be areas of haemorrhagic necrosis consistent with Budd-Chiari Syndrome without any evidence of malignancy. The CT finding of multiple large focal non-enhancing areas in liver does not always indicate tumour deposits in a patient suspected to have Budd-Chiari Syndrome.
KIRTDA DRACHARYAS. "Irshad M, Acharya SK.Hepatitis D virus (HDV) infection in severe forms of liver diseases in north India.Eur J Gastroenterol Hepatol. 1996 Oct;8(10):995-8.". In: Eur J Gastroenterol Hepatol. 1996 Oct;8(10):995-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract
BACKGROUND: Preliminary reports indicate that hepatitis D virus (HDV) infection exists in India. However, its prevalence in patients with different types of liver diseases has not been studied in detail. The aim of this study was to evaluate the status of HDV infection in severe types of liver disease in India. METHODS: Using commercial kits for various hepatitis viral markers, the present study was undertaken to determine the serological status of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers in 208 patients with severe liver diseases. This total included 110 cases with fulminant hepatic failure (FHF), 65 cases with subacute hepatic failure (SHF) and 33 cases with chronic active hepatitis (CAH). RESULTS: The hepatitis B surface antigen (HBsAg) carrier population, indicated by the presence of HBsAg without IgM anti-HBc (hepatitis B core) in serum, was recorded in 23.6%, 24.6% and 60.6% cases of FHF, SHF and CAH groups, respectively. HBV infection, as indicated by serum positivity of IgM anti-HBc in the FHF and SHF groups and HBsAg and/or IgM anti-HBc in the CAH group, was detected in 19.1%, 23.1% and 69.7% of cases from these three groups, respectively. IgM anti-HDV, demonstrating active/recent HDV infection, was found in 8.1% cases of FHF and 9.2% cases of SHF patients. HDV as a superinfection in HBsAg carriers was noted in 4.5% and 4.6% cases, respectively of FHF and SHF groups. Similarly, HDV-HBV coinfection, diagnosed by simultaneous presence of IgM anti-HBc and IgM anti-HDV in the FHF and SHF groups, was recorded in 3.6% and 4.6% of cases from these two groups, respectively. In the CAH group, HDV infection was observed in 9.2% cases. CONCLUSION: HDV infection, recorded in less than 10% of patients with different liver diseases in India, seems to be an unimportant factor in inducing severe liver diseases in this country.
KIRTDA DRACHARYAS. "Nagabhusan G, Acharya SK, Joshi YK, Nundy S, Tandon BN.Ultrasonography in portal hypertension: a sensitive noninvasive test to demonstrate portal-vascular anatomy.Gastroenterol Jpn. 1989 Aug;24(4):442-5.". In: Gastroenterol Jpn. 1989 Aug;24(4):442-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
The accuracy of ultrasonography (US) in delineating the portal vascular anatomy was assessed clinically by the clinician in 30 cases of portal hypertension due to noncirrhotic portal fibrosis and extra hepatic portal venous obstruction. Ultrasonography detected portal vein block in 19 and in 11 patients it was found to be patent. These ultrasonic diagnoses were confirmed by spleno-portovenography (SPV) in all, except in 2 cases due to technical failure. Ultrasononic assessment of the splenic vein was found to be accurate in 93.3% (28/30) of cases. SPV also had similar accuracy of splenic vein assessment when compared with the surgical findings. In one patient, intraperitoneal haemorrhage was encounted following SPV, necessitating emergency surgery. Thus, US was found to be as accurate as splenoportovenography in the assessment of portal vascular anatomy. The imaging technique is cheap, easy, safe, and can be repeated as often as necessary. It should be the procedure of choice in assessing the anatomy of portal vascular system.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S.Management of hepatic metastases: hope for the hopeless.Trop Gastroenterol. 1994 Jul-Sep;15(3):119-20.". In: Trop Gastroenterol. 1994 Jul-Sep;15(3):119-20. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
Hepatitis C virus (HCV) ribonucleic acid (RNA) was tested for in a group of 16 defined non-B chronic hepatitis patients using specific reverse transcription polymerase chain reaction (RT-PCR). These were chosen from amongst 56 biopsy proven cases of chronic hepatitis of which majority (40) were positive for hepatitis B virus infection. Hepatitis C virus RNA could be demonstrated in 12 (75%) of remaining 16 cases. These include all seven patients positive for antibody to HCV. Two of these patients had past history of blood transfusion and in another two the clinical course started with severe acute liver disease. This study establishes the association of HCV with severe liver disease. The clinical and biochemical profiles are also discussed. In view of limited sensitivity of the antibody assays it is justified to develop diagnostic testes based on local strains.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK, Karmarkar MG.Hyperprolactinemia in portosystemic encephalopathy.Indian J Med Res. 1987 Sep;86:372-4.". In: Indian J Med Res. 1987 Sep;86:372-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Mishra A, Durgapal H, Manivel V, Acharya SK, Rao KV, Panda SK.Immune response to hepatitis B virus surface antigen peptides during HBV infection.Clin Exp Immunol. 1992 Nov;90(2):194-8.". In: Clin Exp Immunol. 1992 Nov;90(2):194-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Antibody responses of patients with acute (n = 73), fulminant (n = 30) and chronic (n = 51) hepatitis B virus (HBV) infection as well as recovered individuals (n = 7) were studied against three synthetic peptides, Pre-S1 amino acids (aa. 12-32), Pre-S2 amino acids (aa. 120-145), and S amino acids (aa. 124-147) of the envelope region (HBsAg). T cell blastogenic response was investigated in a proportion of the patients (27 acute, nine fulminant, 13 chronic hepatitis and seven recovered individuals) along with seven HBV vaccinated and three normal individuals. The presence of T cell response against S peptide was observed in all the cases (9/9, 100%) during early acute hepatitis. This was suppressed during late stages (8/18, 44%) followed by partial reversal during recovery (5/7, 71%). T cell response and antibodies to Pre-S1 and Pre-S2 peptides were present only in one-third of the patients throughout these periods. The T cell blastogenic response as well as antibody reactivity against these peptides were absent and minimal in chronic hepatitis. Immune response against envelope protein appears to play a major role in acute hepatic injury due to HBV infection and help in virus clearance.
KIRTDA DRACHARYAS. "Acharya SK, Mishra PK.Chronic calcific pancreatitis of the tropics.Trop Gastroenterol. 1984 Jul-Sep;5(3):124-34.". In: Trop Gastroenterol. 1984 Jul-Sep;5(3):124-34. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1984. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Paul SB, Sreenivas V, Gulati MS, Madan K, Gupta AK, Mukhopadhyay S, Panda SK, Acharya SK.Incidence of hepatocellular carcinoma among Indian patients with cirrhosis of liver: an experience from a tertiary care center in northern India.Indian J Gastroentero.". In: Indian J Gastroenterol. 2007 Nov-Dec;26(6):274-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2007. Abstract

BACKGROUND/AIM: Despite bearing the main burden of HCC, prospective studies from developing countries are lacking. This prospective observational study was designed to estimate the incidence of HCC among Indian patients with hepatic cirrhosis. METHODS: Between April 2001 and November 2004, we enrolled 301 patients with liver cirrhosis. Patients found to be free of HCC using baseline abdominal ultrasound, triple-phase computed tomography (TPCT) and serum alpha-fetoprotein (AFP) levels were followed up prospectively for detection of HCC using ultrasound and AFP every 6 months, and TPCT annually. RESULTS: Among the 194 patients (mean age [SD] 45.1 [+/-13.1] years; male:female 6.1:1.0) followed up, 154 had Child's A and 40 had Child's B disease. The causes of cirrhosis were: hepatitis B-71 (36.6%), hepatitis C-54 (27.8%), dual infection with hepatitis B and C-12 (6.2%) and others including autoimmune, alcoholic and cryptogenic cirrhosis 57 (29.4%). During a cumulative follow up period of 563.4 person-years, 9 cases of HCC were detected, with an incidence rate of 1.60 per 100 person-years. CONCLUSION: In our study, the incidence of HCC among patients with liver cirrhosis was intermediate, being lower than that in Japan but higher than that reported from Europe.

KIRTDA DRACHARYAS. "Prasad HK, Singhal A, Mishra A, Shah NP, Katoch VM, Thakral SS, Singh DV, Chumber S, Bal S, Aggarwal S, Padma MV, Kumar S, Singh MK, Acharya SK.Bovine tuberculosis in India: potential basis for zoonosis.Tuberculosis (Edinb). 2005 Sep-Nov;85(5-6):421-8. Ep.". In: Tuberculosis (Edinb). 2005 Sep-Nov;85(5-6):421-8. Epub 2005 Oct 25. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
Our laboratory has designed a specific nested-PCR (N-PCR) assay, based on the hupB gene of Mycobacterium tuberculosis (Rv2986c) and Mycobacterium bovis (Mb3010c) as a method to differentiate these closely related species. The present paper deciphers the utility of this assay for identification of pathogenic Mycobacteria in clinical samples. Extra-pulmonary clinical samples obtained from cattle and humans were investigated. Pre-dominance of M. tuberculosis (15.7%) and M. bovis (26.8%) was seen in humans and cattle, respectively. However, more importantly, both mycobacterial pathogens (mixed infection) were identified in a number of samples. In humans 8.7% of the samples and 35.7% in cattle were classified as mixed infection. The detection of mixed infection with the mycobacterial pathogenic duo in humans and bovines denotes the prospect of potential transmission of these pathogens from humans to cattle (zoonosis) and vice versa (reverse zoonosis).
KIRTDA DRACHARYAS. "Bose B, Chugh DA, Kala M, Acharya SK, Khanna N, Sinha S.Characterization and molecular modeling of a highly stable anti-Hepatitis B surface antigen scFv.Mol Immunol. 2003 Dec;40(9):617-31.". In: Mol Immunol. 2003 Dec;40(9):617-31. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract

We raised a mouse monoclonal antibody (5S) against the 'a' epitope of the Hepatitis B surface antigen (HBsAg) by selecting for binding of the hybridoma supernatant in conditions that usually destabilize protein-protein interactions. This antibody, which was protective in an in vitro assay, had a high affinity with a relative dissociation constant in the nanomolar range. It also displayed stable binding to antigen in conditions that usually destabilize antigen-antibody interactions, like 30% DMSO, 8 M urea, 4 M NaCl, 1 M guanidium HCl and extremes of pH. The variable regions of the antibody were cloned and expressed as an single chain variable fragment (scFv) (A5). A5 had a relative affinity comparable to the mouse monoclonal and showed antigen binding in presence of 20% DMSO, 8 M urea and 3 M NaCl. It bound the antigen in the pH range of 6-8, though its tolerance for guanidium HCl was reduced. Sequence analysis demonstrated a significant increase in the frequency of somatic replacement mutations in CDRs over framework regions in the light but not in the heavy chain. A comparison of the molecular models of the variable regions of the 5S antibody and its germ-line precursor revealed that critical mutations in the heavy and light chains interface resulted in better inter-chain packing and in the movement of CDR H3 and CDR L1 from their germline positions, which may be important for better antigen binding. In addition to providing a reagent for neutralizing for the virus, such an antibody provides a model for the evolution of stable high affinity interaction during antibody maturation.

KIRTDA DRACHARYAS. "Acharya SK.HBeAg-negative chronic hepatitis B.Indian J Gastroenterol. 2002 May-Jun;21(3):93-5.". In: Indian J Gastroenterol. 2002 May-Jun;21(3):93-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
BACKGROUND: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used.
KIRTDA DRACHARYAS. "Magnitude of hepatitis C virus infection in India: prevalence in healthy blood donors, acute and chronic liver diseases. J Med Virol. 1997 Mar;51(3):167-74.". In: J Med Virol. 1997 Mar;51(3):167-74. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1997. Abstract
An enzyme immunoassay (EIA) was developed in-house for the detection of anti-hepatitis C virus (HCV) antibody against the prevailing genotypes in India. The specific reactivity of the test was compared with commercial second and third-generation EIAs and reverse transcription nested polymerase chain reaction (RT-nested PCR). Fifteen thousand nine hundred twenty-two healthy blood donors at the All India Institute of Medical Sciences (AIIMS), New Delhi, India, were screened for anti-HCV antibody. Two hundred ninety-five (1.85%) of these donors were positive. The screening was also used to determine how many patients with acute hepatitis and chronic liver diseases were positive for anti-HCV antibody. Five hundred sixty-four chronic liver disease patients were screened for anti-HCV antibody and 78 (13.83%) were found positive. Two hundred forty-seven sporadic acute viral hepatitis patients were screened for viral infection markers. Hepatitis B and E viruses (HBV and HEV) were the major etiologic agents. HCV was associated with 9% of the acute cases. Anti-HCV core IgM with HCV RNA detection were found to be helpful for the diagnosis of acute HCV infection.
KIRTDA DRACHARYAS. "Sharma MP, Rai RR, Acharya SK, Ray JC, Tandon BN.Needle aspiration of amoebic liver abscess.BMJ. 1989 Nov 25;299(6711):1308-9.". In: BMJ. 1989 Nov 25;299(6711):1308-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
OBJECTIVE–To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN–Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING–Referral based gastroenterology clinic. PATIENTS–39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION–Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES–Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS–Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS–Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.
KIRTDA DRACHARYAS. "Panigrahi AK, Nanda SK, Dixit RK, Acharya SK, Zuckerman AJ, Panda SK. Diagnosis of hepatitis C virus-associated chronic liver disease in India: comparison of HCV antibody assay with a polymerase chain reaction for the 5' noncoding region.J Med Virol. 1994.". In: J Med Virol. 1994 Oct;44(2):176-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract

The relative value of an anti-hepatitis C virus (HCV) serological assay and reverse transcriptase-nested polymerase chain reaction assays (RT-PCR) were investigated for the constant 5' putative noncoding region of HCV for the diagnosis of HCV-associated chronic liver diseases in India. One hundred fifteen patients with biopsy proven chronic active hepatitis and 140 cases of cirrhosis of the liver were investigated for anti-HCV antibody using a second generation commercial enzyme-linked immunosorbent assay (ELISA). A proportion of these patients: 42 with chronic hepatitis and 27 with cirrhosis of the liver were analysed further for HCV RNA in the serum using RT-nested PCR assay. Thirty-three (12.9%) of the 255 patients were positive for anti-HCV antibody and 23 of 69 (33.3%) patients were positive for HCV RNA in serum. Fifteen of the 33 (45.5%) anti-HCV positive patients had HCV RNA in the serum. Eight of 36 (22.2%) HCV seronegative patients tested were found with HCV RNA. This indicates that the diagnosis of HCV infection is not possible if it is based solely on the available serodiagnostic tests. Inclusion of both assays improved the diagnostic efficiency, 18.8% (13/69) were negative for all virological markers associated with HBV and HCV infection. Since a majority of the chronic liver disease patients (143/255 [56%]) were seronegative for either HBV or HCV infection, it is significant that HCV RNA was detected in 38% (8/21) of a randomly selected group from these patients. The antibody assay and PCR were compared using interclass correlation (kappa statistics).(ABSTRACT TRUNCATED AT 250 WORDS)

KIRTDA DRACHARYAS. "Sharma MP, Acharya SK, Karmarkar MG.Significance of prolactin levels in protosystemic encephalopathy.J Assoc Physicians India. 1988 Mar;36(3):207-9.". In: J Assoc Physicians India. 1988 Mar;36(3):207-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Arora A, Seth S, Acharya SK, Sharma MP.Hepatic coma as a presenting feature of constrictive pericarditis.Am J Gastroenterol. 1993 Mar;88(3):430-2.". In: Am J Gastroenterol. 1993 Mar;88(3):430-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.
KIRTDA DRACHARYAS. "Bhargava DK, Acharya SK, Tandon BN, Nundy S.Endoscopic sclerotherapy for active variceal haemorrhage in patients not responding to balloon tamponade & vasopressin.Indian J Med Res. 1985 Feb;81:175-9.". In: Indian J Med Res. 1985 Feb;81:175-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1985. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Madan K, Chalamalsetty SB, Srivastava S, Gupta SD, Mirdha BR, Makharia GK, Samataray JC, Acharya SK.Tropical mayhem: a chronic viral disease with superadded parasitic infection.J Med Microbiol. 2008 Feb;57(Pt 2):232-5.". In: J Med Microbiol. 2008 Feb;57(Pt 2):232-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2008. Abstract
Coexistence of two illnesses in the same patient may result in atypical manifestations of either or both diseases. A case of hepatitis B virus-related cirrhosis in a patient who presented with a pharyngeal mucosal mass lesion as a manifestation of superadded Leishmania infection is presented here. The clue to the diagnosis was the origin of the patient from an area highly endemic for leishmaniasis and the presence of unexplained polyclonal hypergammaglobulinaemia. The patient responded very well to therapy with amphotericin B with complete disappearance of the mucosal lesion.
KIRTDA DRACHARYAS. "Acharya SK.Management of chronic hepatitis B: the Indian perspective. Trop Gastroenterol. 2005 Oct-Dec;26(4):171-2.". In: Trop Gastroenterol. 2005 Oct-Dec;26(4):171-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
AIM: Passive immunotherapy using antibody against hepatitis B surface antigen (HBsAg) has been advocated in certain cases of Hepatitis B infection. We had earlier reported on the cloning and expression of a high affinity scFv derived from a mouse monoclonal (5S) against HBsAg. However this mouse antibody cannot be used for therapeutic purposes as it may elicit anti-mouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: We cloned the V(H) and V(L) genes of this mouse antibody, and fused them with CH1 domain of human IgG1 and C(L) domain of human kappa chain respectively. These chimeric genes were cloned into a phagemid vector. After initial screening using the phage display system, the chimeric Fab was expressed in soluble form in E. coli. RESULTS: The chimeric Fab was purified from the bacterial periplasmic extract. We characterized the chimeric Fab using several in vitro techniques and it was observed that the chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. This chimeric antibody fragment was further expressed in different strains of E. coli to increase the yield. CONCLUSION: We have generated a mouse-human chimeric Fab against HBsAg without any significant loss in binding and epitope specificity. This chimeric Fab fragment can be further modified to generate a full-length chimeric antibody for therapeutic uses.
KIRTDA DRACHARYAS. "Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease: implications for HAV vaccination. J Gastroenterol Hepatol. 2003 Jul;18(7):822-7.". In: J Gastroenterol Hepatol. 2003 Jul;18(7):822-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
BACKGROUND: Universal vaccination against hepatitis A virus (HAV) has been recommended for children because of the changing epidemiological pattern of HAV. Vaccination has also been advised for patients with chronic liver disease as HAV superinfection in these patients can result in severe or even fatal disease. In India, the indications for HAV vaccination are not clear due to contradictory seroepidemiological data in children and lack of data on HAV seroprevalence in patients with chronic liver disease. METHODS: Sera were collected from children studying in two government-run schools and from patients with chronic liver disease attending the Liver Clinic at the All India Institute of Medical Sciences (AIIMS). The sera were tested for anti-HAV antibodies. The incidence of HAV-induced acute hepatitis and acute liver failure at AIIMS over the last 10 years was also assessed. RESULTS: A total of 93.2% (1328/1424) of the school children between 4-18 years of age who were included in the study had anti-HAV antibody in their sera. Eighty percent of the children had antibodies against HAV in their sera by the age of 5 years, whereas all the children above 16 years were positive for anti-HAV antibody. A total of 256 patients with chronic liver disease (94 with cirrhosis of the liver, 160 with chronic hepatitis) were tested for the presence of anti-HAV antibody. Of them, 97.6% (248/254) had anti-HAV antibody in their sera. The annual frequency of HAV-induced acute viral hepatitis and acute liver failure at AIIMS during the last 10 years did not show any change. CONCLUSION: Mass vaccination against HAV is not required in north India because of the presence of protective antibodies against HAV in the majority of the population. Copyright 2003 Blackwell Publishing Asia Pty Ltd
KIRTDA DRACHARYAS. "Jain R, Batra Y, Acharya SK.Post cholecystectomy hemobilia: transcatheter embolization of pseudoaneurysms with homemade steel coils.Indian J Gastroenterol. 2002 Jul-Aug;21(4):161-2.". In: Indian J Gastroenterol. 2002 Jul-Aug;21(4):161-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
Two patients presented with hemobilia, one and two months following cholecystectomy. Angiography demonstrated pseudoaneurysms arising form the gastroduodenal and right hepatic arteries. Percutaneous transcatheter embolization of the pseudoaneurysms was successfully performed in both patients using homemade steel coils.
KIRTDA DRACHARYAS. "Portal hypertensive gastropathy in noncirrhotic patients. The effect of lienorenal shunts. J Clin Gastroenterol. 1998 Jan;26(1):64-7;.". In: J Clin Gastroenterol. 1998 Jan;26(1):64-7;. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.
KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Joshi YK, Tandon BN.Hepatitis B virus replication in patients with chronic liver diseases.Gastroenterol Jpn. 1990 Apr;25(2):258-64.". In: Gastroenterol Jpn. 1990 Apr;25(2):258-64. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
One hundred and seventy five subjects with chronic liver diseases which included patients with chronic active hepatitis (90), liver cirrhosis (31) and asymptomatic hepatitis B carriers (54), were included in the study. Hepatitis B virus (HBV) specific DNA-polymerase activity and HBe-markers were tested as markers of HBV-multiplication. In HBsAg positive samples, DNA-P activity was positive in 44.4% of the HBV carriers, 52.9% of the patients with chronic active hepatitis and 81.8% of the patients with liver cirrhosis. The corresponding figures for the presence of HBeAg in these groups were 18.5, 26.5 and 45.5% respectively. Virus multiplication was also observed in 41.1 and 44.4% patients with chronic active hepatitis and liver cirrhosis respectively, in the absence of HBsAg. The results of the present study show that hepatitis B virus is the most important etiological factor of chronic liver diseases in India. Most of our patients of chronic liver diseases seems to have contacted HBV infection as young adults and the mode of transmission is likely to be horizontal rather than vertical. The virus replicating markers correlate well with the severity of the liver injury and decreased with the age. DNA-P activity is a more sensitive marker of viral multiplication than HBeAg. Viral multiplication was also found to occur in the absence of the usual HBV markers. Continued viral multiplication in patients with chronic active hepatitis and liver cirrhosis is implicated in continued liver injury and progressive liver disease.

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