Publications

Found 5750 results

Sort by: [ Author  (Desc)] Title Type Year
Filters: First Letter Of Last Name is K  [Clear All Filters]
A B C D E F G H I J [K] L M N O P Q R S T U V W X Y Z   [Show ALL]
K
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. "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. "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, 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, 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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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. "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, 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. "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. "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. "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. "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. "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. "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. "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, 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. "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. "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. "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. "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. "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. "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. "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. "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. "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.

KIRSTEEN DRAWORI. "Saidi H, Odula P, Awori K.Child maltreatment at a violence recovery centre in Kenya. Trop Doct. 2008 Apr;38(2):87-9.". In: Trop Doct. 2008 Apr;38(2):87-9. Folio Morphol; 2008. Abstract

Kenyan media reports indicate escalating levels of child maltreatment, but the characteristics of the offence are undefined. At the Gender and Violence recovery Center of the Nairobi Women's Hospital, we analysed 342 consecutive children for age, gender, perpetrator characteristics, time and scene of assault and the nature of injuries between February 2003 and April 2004. The children comprised 43.5% of all assault survivors. The mean age was 10.0 years and about 20% of the children were < or =5 years. Most (71.5%) of the child sexual abuse (CSA) was perpetrated by people known to the victim. Intra-family CSA (incest) was highest among the one to five year olds. The proportion of assaults committed against boys reduced with the age of the child. Older children were more likely to be assaulted later in the day and by multiple perpetrators. Most recorded injuries were perineal. The majority of children are assaulted by people they had trusted. The epidemiological correlates of maltreatment differ for younger and older children. More effort is needed to further characterize child violence and protect this vulnerable section of the population.

KIRSTEEN DRAWORI, OCHIENG&#39; DRODULAPAUL. "The suprascapula notch: Its morphology and distance from the glenoid cavityin a Kenyan population.". In: Folia morphol 2010; 69:241-5. Folio Morphol; 2010.
KIRSTEEN DRAWORI. "Awori KO, Atinga JE.Lower limb amputations at the Kenyatta National Hospital, Nairobi. East Afr Med J. 2007 Mar;84(3):121-6.". In: East Afr Med J. 2007 Mar;84(3):121-6. Folio Morphol; 2007. Abstract
OBJECTIVE: To determine the causes and pattern of lower limb amputations at the Kenyatta National Hospital. DESIGN: Descriptive prospective study. SETTING: The Kenyatta National Hospital between July 2003 and June 2004. RESULTS: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age ranged from seven months to 96 years (mean 44.8 +/- 22.5). Forty six patients (62.1%) were male. Majority of the patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with 39% self employed in the informal sector. Peripheral vascular diseases were the main indication for LLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) had tumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%) of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulations and seven (9%) were foot amputations. CONCLUSION: This study found peripheral vascular diseases unrelated to diabetes to be the main indication for lower limb amputations at Kenyatta National Hospital contrary to previous institutional and loco-regional studies which report trauma as the leading cause. Further investigation into vascular causes is therefore recommended.
KIRSTEEN DRAWORI, OCHIENG&#39; DRODULAPAUL. "The suprascapula notch: Its morphology and distance from the glenoid cavityin a Kenyan population.". In: Folia morphol 2010; 69:241-5. Folio Morphol; 2010.
Kirori GN, KABUBO-MARIARA J, Kiriti-Nganga TW. "Impacts of Social Capital on Household Consumption Expenditure in Rural Kenya: An Instrumental Variable Approach." International Journal of Afro-Asian Studies. 2011;2(1):15-33.
Kirori GN, KABUBO-MARIARA J, Kiriti-Nganga TW. "Rural Livelihoods in Kenya: The Role of Social Capital." Journal of International Business and Finance. 2011;3(1):1-27.
Kirori GN, KABUBO-MARIARA J, Kiriti-Nganga TW. "(2011). Rural Livelihoods in Kenya: The Role of Social Capital." Journal of International Business & Finance. 2011;3(1):1-27.
Kirori GN, J. K-M, T.W. N’ang’a. "Impacts of Social Capital on Household Consumption Expenditure in Rural Kenya: An Instrumental Variable Approach." International Journal of Afro Asian Studies.. 2011;2(1):15-33.
Kironchi G, Ondieki C, Liniger HP. "Soil cover for improved productivity: attractive water and soil conservation for the drylands in Kenya.". 1993. Abstract

The importance of soil cover and topsoil management for soil and water conservation was studied in catchment and test plot studies and infiltration trials in the west and north of Mount Kenya. The short-term improvement of productivity through specific biological and management measures is discussed along with aspects of long-term sustainable development for implementation programmes. Results show that permanent grass cover (50%) reduced catchment runoff rates to less than one third and erosion rates to less than one in thirty of that from an overgrazed area with a cover of less than 10%. Infiltration on different soil types increased 3-12 times under permanent cover compared to that under overgrazed land. Monitoring of cropland productivity under different conservation measures illustrated the potential of mulching/minimum tillage and agroforestry systems to double yields with no additional input, compared to local practices

Kironchi G, Nyariki DM;, Ogara WO;. Food Security In Rural Development.; 2001.Website
Kironchi G;, Gicheru PT;, Gachene CKK;, Macharia PN;, Mburu M;, Mureithi JG;, Maina F. "Effect of liming and triple superphosphate fertilizer application on growth and root nodulation of common bean (phaseolus vulgaris) in soils of old tea lands."; 2005. Abstract

Effect of liming and application of phosphatic fertilizer on growth and root nodulation of common bean in an old tea land was investigated. A field trial was conducted where tea had been uprooted after 70 years of monoculture under high inorganic fertilizer input. Lime was applied at 0, 4, 8 and 12 tonnes ha-1 and triple superphosphate at 0, 5, 10 and 15 g per planting hole. The treatments were combined in a factorial design and investigated for effects on the soil pH, nodule formation, and some plant growth parameters. Lime application raised the soil pH and also significantly (P= 0.05) increased dry matter production and nodule quantity. Phosphorus also increased dry matter production and nodule quantity significantly (P = 0.05). These observations are discussed in regard to ways of enabling bean crop grow on old tea lands.

Kironchi G;, Bagine RK;, Maranga EK. Integrated natural resource management.; 2010.Website
Kironchi G;, Gicheru PT;, Gachene CKK;, Macharia PN;, Mburu M;, Mureithi JG;, Maina F. "Kironchi,."; 2005. Abstract

Effect of liming and application of phosphatic fertilizer on growth and root nodulation of common bean in an old tea land was investigated. A field trial was conducted where tea had been uprooted after 70 years of monoculture under high inorganic fertilizer input. Lime was applied at 0, 4, 8 and 12 tonnes ha-1 and triple superphosphate at 0, 5, 10 and 15 g per planting hole. The treatments were combined in a factorial design and investigated for effects on the soil pH, nodule formation, and some plant growth parameters. Lime application raised the soil pH and also significantly (P= 0.05) increased dry matter production and nodule quantity. Phosphorus also increased dry matter production and nodule quantity significantly (P = 0.05). These observations are discussed in regard to ways of enabling bean crop grow on old tea lands

Kironchi G;, Mwang'ombe AW. Technology-Mediated Open and Distance Education (Tech-MODE) in Agricultural Education and Training in Kenya: Opportunities and Challenges.; 2008. Abstract

Open and distance learning (ODL) in Kenya, like in many other developing countries, is characterized by, and offered through, dual mode institutions. Most of these programmes are in humanities and social sciences. Currently, one private university is offering agricultural training at a distance using print medium. A few private organizations or NGOs carry out short duration informal agricultural capacity building programmes to farmer groups an d extension workers using technology- mediated open and distance education (Tech-MODE). The Government of Kenya placed emphasis on education and training in agriculture, because of the important role it plays in the country’s economy. Although great potential exists for the use of Tech-MOD E in agricultural sciences at primary, secondary, tertiary and informal levels in Kenya, its application still largely remains untapped. However, with the recent completion of the National ICT Policy (2006), the Ministry of Education, in consul tation with stakeholders, developed a comprehensive National ICT Strategy for education and training, with a view to guiding the implementation of informat ion and communication technology (ICT) initiatives in the education sector. This country report highlights the existing potential in Kenya that the project on Tech-MODE for agricultural education prop osed by the Commonwealth of Learning (COL) could build on. It is suggested that consideration should be given to strengthening relations with the existing national, regional and international institutions and networks or programmes . Priority areas for training should be identified by all participating stakeholde rs for support in content development and institutional capacity building. This initiative offers opportunities for mu lti-institutional part nerships to prepare training content that would not only provid e locally relevant and practical knowledge, but also would be internationally recogniz ed. Tech-MODE for agricultural education would offer viable alternatives by lowering education costs, increasing professional retention and not taking trainees out of their professional roles and homes for extended periods. In addition, benefici aries would contribute to increased and sustainable agricultural production, develo pment in the country, poverty reduction and improved food security

Kirogo V;, Kogi-Makau W;, Muroki NM. "The role of irrigation on improvement of nutritionalstatus of young children in Central Kenya."; 2007. Abstract

A comparative, retrospective cross-sectional study was conducted to investigate the role of irrigation on improvement of nutritional status of children aged 6 - 59 months in a semi-arid setting. Two equal samples of fifty-nine children (aged 6 - 59 months) hereafter, referred to as the Project and the Non-project groups, respectively were randomly selected from households with and without access to irrigation water in Kieni East Division of Nyeri District, Kenya. The study area is situated in the drier western leeward side of Mt. Kenya and is characteristic by unreliable rainfall of between 500 to 1200 mm per annum. Weight, height and age of index children were determined and the corresponding standard deviations of weight-for-age, weight-for-height and height-for-age calculated and compared to the reference standards developed by the US National Centre for Health Statistics. Energy and nutrient intake was determined using 24-hour dietary recall method. The findings on socio-demographic characteristics showed that the Project and Non-project households were similar in terms of household size, land size, marital status of the respondent, maternal and paternal education and occupation. The calorie intake of over two-fifth (42%) of the children from the Non-project households compared to 39% from the Project households was below the Recommended Daily Allowance. The children from commercial farming Project households had significantly higher weight-for-age Z-score than those from commercial farming Non-project households. Similarly, children from high-income Project households had significantly higher height-for-age Z-score than those from high-income Non-project households. The prevalence of stunting was also significantly lower in the high-income Project households compared to high-income Non-project households. Among the male children, the prevalence of underweight was significantly higher in Non-project households than in Project households. Overall, the prevalence of stunting and underweight which are indicators of long-term nutritional deprivation were higher in Non-project households than Project households. The findings of the study led to the conclusion that irrigation contributes to increased per capita food availability resulting in higher energy intakes and subsequently enables households to safeguard young children against chronic malnutrition. Also, poverty as characterised by low household income remains a main determinant of nutritional status.

Kiriti-Nganga TW, Okelo JA, Mbithi LM. "Jounce Of The African Women Studies Centre.". 2012.Website
Kiriti-Nganga TW, Tisdell C. "The Impact of Globalisation on Women, Agriculture and Poverty in Kenya.". In: Globalisation and World Economic Policies: Studies Highlighting Effects and Policy Responses of Nations and Country Groups. Delhi, Serials Publications; 2005.
Kiriti-Nganga TW. "Micro - financing and G ender - based P overty: the case of women's group in Nairobi.". In: Gender Development Dim ensions and Policies , Edited by Siddhartha Sarkar and Netten Narayana. New Delhi, Serials Publications. ISBN 81 - 8387 - 112 - 9 .; 2008.
Kiriti-Nganga TW. "Non - Tariff Measures in Kenya.". 2012.Website
Kiriti-Nganga TW. "“Micro - Finance and Poverty Allevia tion – How effective is it in Alleviating Gender Based Poverty.". In: Poverty, Poverty Alleviation and Social Disadvantage: Analysis, Case Studies and Policies , Edited by Clem Tisdell Ph.D. Vol. II. VII, . Serials Publications, New Delhi: India.; 2006.
Kiriti-Nganga TW, Kirori G. "Global Economic and Financial Crisis and Trade, Kenya’s Experience." International Journal f Business Policy and Economics. 2010;3(2):1 39-156.
Kiriti-Nganga TW, Tisdell C. Gender Inequality in Agricultural Households in Kenya: Economic Analysis . Germany: Lambert Academic Publishers; 2010.
Kiriti-Nganga TW. "Economic Growth and Poverty in Kenya: Will the Poverty Reduction Strategy Paper Help?" Indian Development Review , Special Issue. 2006;4(2):323-338.
Kiriti-Nganga TW, Njuguna P. "Gender Inequality in Rural Kenya: Evidence from Muranga District in Central Kenya.". In: Gender Inequality in Developing Countries / edited by Siddhartha Sarkar and Tabitha Kiriti - Nganga. New Delhi: Ar ise Publications and Distributors; 2008.
Kiriti-Nganga TW, Tisdell C. "Family Size, Economics and Child Gender Preference: A Case Study in the Nyeri District of Kenya." nternational Journal of Social Economics. 2005;32(6):492-509.
Kiriti-Nganga TW, Tisdell C, Roy K, Roy CK. "Institutional Deterrents to the Empowerment of Women: Kenya’s Experience." Twentieth Century Development: Some Relevant Issues. 2003;Nova Science Publishers, pp. 27 - 48.
Kiriti-Nganga TW. "Global Financial Crises and Remittances: The Case of Kenya .". In: Trade Discourse in Kenya: Topical Issues , Vol. 1. Edited by Kir iti and Okelo, WTO and School of Economics WTO Chairs Program, pp. 55 - 65.; 2012.
Kiriti-Nganga TW, Tisdell C. "Commercialisation of Agriculture in Kenya: Case Study of Policy Bias and Food Purchases by Farm Households." Quarterly Journal of International Agriculture. 2004;42(4):439-457.
Kiriti-Nganga TW, Tisdell C, Tisdell CA, Sankar U, Srivastava M. "Agricultural Commercialisa tion in Developing Countries, Household Food Consumption and Nutrition: A Kenyan Case Study.". In: Leading Economic Issues: Essays in Honour of Professor Chandra Srivastava. New Delhi: B. R. Publishin g Corporation; 2003.
Kiriti-Nganga TW. "Economic Growth in Kenya: How does Gender Inequality Matter?". In: Gender Inequality in Developing Countries / edited by Siddhartha Sarkar and Tabitha Kiriti - Nganga. New Delhi: Arise Publications and Distributors; 2008.
Kiriti-Nganga TW, Roy KC. "Poverty Alleviation Programs For Women’s Empowerment in Kenya Through State and Private Sector Governance.". In: Governance and Development in Developing Countries, Editors: K.C. Roy (Univ. of Queensland, Brisbane, Australia) and Biman Prasad (Univ. of the South Pacific, Suva, Fiji Islands). NOVA Science Publishers.; 2007.
Kiriti-Nganga TW, Tisdell C, Roy CK. "Globalisation and Institutional Deterrents to the Empowerment of Women: Kenya’s Experience.". In: Institutions, Globalisation and Empowerment. Chapter 9, pp 199 - 222. Cheltenham: Edward Elgar Publishing Limited.; 2006.
Kiriti-Nganga TW. "IFC Gender - Entrepreneurship - Markets and Foreign Investment Advisory Service." International Journal of Women, Social Justice and Human Rights . 2006;1(2):269-272.
Kiriti-Nganga TW. "Women in Kenya: A Second Class Citizen." nternational Journal of Women, Social Justice and Human Rights. 2006;1(2):217-236.
Kiriti-Nganga TW, Tisdell C. "Gender Inequality, Poverty and Human D evelopment in Kenya." Indian Journal of Social and Economic Policy. 2005;1(2):255-281.
Kiriti-Nganga TW. "Non - Tariff Measures in Kenya: A Case Study.". In: Trade Discourse in Kenya: Topical Issues , Vol. 1. Edited by Kiriti and Okelo, WTO and School of Economics WTO Chairs Program, pp. 84 - 97.; 2012.
Kiriti-Nganga TW, Tisdell C. "arital Status, Farm Size and other Influences on the Extent of Cash Cropping in Kenya: A Household Case Study." Indian Development Review. 2004;2(2):205-221.
Kiriti-Nganga TW, Tisdell C, Tisdell CA, Sankar U, Srivastava M. "Gender, Marital Status, Farm Size and Other Influences on the Extent of Cash Cropping in Kenya: A Case Study.". In: Leading Economic Issues: Essays in Honour of Professor Chandra Srivastava. New Delhi: B. R. Publishing Corporation; 2003.
Kiriti-Nganga TW. "Gender Inequality and Agricultural Commercialisation: Results from a Case Study in Kenya.". In: Gender and Development: An Afr o - Indian Study , Edited by Siddhartha Sarkar and John V. Mensah, . New Delhi: Arise Publications and Distributors; 2008.
Kiriti-Nganga TW. "Evaluating Public Policies for Poverty Reduction: Tools, Techniques and Process.". In: Citizen - Government Dialoguing: Evaluating Policies for Poverty Reduction. New York: United Nations Department of Economic and Social Affairs.; 2005.
Kiriti-Nganga TW. "Institutions and Women Empowerment in Kenya.". In: Institutions and Gender Empowerment in the Global Community. Pp. 151 - 192 . E dited by Kartik, C. Roy, Cal Clark, and Hans C. Blomqvist. Singapore/London. World Scientific Publishing Co (WSP)/ Imperial College Press .; 2008.
Kiriti-Nganga TW. "Global Financial Crisis a nd Remittances: The Case o f Kenya." I nternational Journal of Business and Economic Review. 2012;10(1):97-111.
Kiriti-Nganga TW. "Economic Growth and Poverty in Kenya: Will the Poverty Reduction Stra tegy Paper Help?". In: Poverty Alleviation and Social Disadvantage: Analysis, Case Studies and Policies , Edited by Clem Tisdell Ph.D , Vol. III.VII, . Serials Publications, New Delhi: India; 2007.
Kiriti-Nganga TW. "Gender, Youth Sexuality and HIV/AIDS: A Kenya Experience.". In: International Journal of Women, Social Justice and Human Rights.; 2007.
Kiriti-Nganga TW. Institutions and Gender Inequality: A Case Study of the C onstituency Development Fund in Kenya. Addis Ababa, Ethiopia: Organisation for Social Science Research in Eastern and Southern Africa (OSSREA).; 2011.
Kiriti-Nganga TW, Tisdell C, Roy K. "Female Participation in Decision - making in Agricultural Households in Kenya: Empirical Findings." International Jou rnal of Agricultural Resources, Governance and Ecology. 2003;2(2):103-124.
Kiriti-Nganga TW, Okelo JA. "Regional Trade Agreements: A Case Study of Kenya .". In: Trade Discourse in Kenya: Topical Issues , Vol. 1. Edited by Kiriti and Okelo, WTO and School of Economics WTO Chairs Program , pp. 100 - 150.; 2012.
Kiriti-Nganga TW, Tisdell C, Tisdell CA, Sankar U, Srivastava M. "Migration of Husbands, Receipt and Use of Remittances by Wives in Rural Kenya: A case Study.". In: Leading Economic Issues: Essays in Honour of Professor Chandra Srivastava. New Delhi: B. R. Publishing Corporation; 2003.
Kiriti-Nganga TW. "Economic Development and Food Security in Kenya: T he Shamba System.". In: Globalisation and Development: Coun t ry Experi ences , Edited by Kartik Roy and Anita Medhekar,. ova Science Publishers, New York: USA , pp, 147 - 160 .; 2010.
KIRITI-NG'ANG'A T. "Trade Discourse in Kenya: Topical Issues, Vol. 2.". In: WTO and School of Economics WTO Chairs Program.; 2014.
KIRITI-NG'ANG'A T. "“Barriers to Trade: the Case of Kenya”, in Connecting to Global Markets: Challenges and Opportunities.". In: Case Studies Presented by WTO Chair-holders, Edited by Marion Jansen, Mustapha Sadni Jallab and Maarten Smeets, pp. 57-71.; 2014.Connecting to Global Markets
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Wangalachi, S. and Kiriti-Nganga, T. Determinants of Expansion of Small Scale Enterprises in Kenya: A Case Study of SMEs in Three Informal Settlements in Kenya.". In: International Journal of Afro-Asian Studies, Vol. 1 No 1. pp. 186-208. Serials Publications; 2008.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti-Nganga, T. (2008), Food Security and the Shamba System in Kenya.". In: International Journal of Afro-Asian Studies, Vol. 1, No. 1, (Spring 2008), pp. 79-97. Serials Publications; 2008.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Njuguna, M. and Kiriti-Nganga. Poverty in Kenya, 1994 .". In: Asian-African Journal of Economics and Econometrics, Vol. 7, No. 1, pp. 147-170. Serials Publications; 2007. Abstract
There is a lack of consensus on how to measure poverty in general, even though poverty indices and poverty profiles are increasingly being used as guides in targeting resources to reduce poverty. In order to compare changes in poverty rates for Kenya, this study tests robustness of the observed changes in the poverty using stochastic dominance analysis, a robust way of ranking distributions. This approach avoids the problem that poverty comparisons may not be robust to the subjective choice of a poverty line. It also avoids the potential that small movements across the thresholds may have large impacts on poverty indices. This is then compared with results from other studies to determine the extent to which conclusions differ and the extent to which the findings are sensitive to the choice of poverty lines. Hence this study tries to answer the following questions. Are the results from poverty studies sensitive to the choice of poverty lines especially when the choice is at the discretion of the analyst? How does this affect their robustness? Does the conclusion differ substantially when summary measures (e.g. mean, variance) and stochastic dominance analysis methods are employed? Do we have an improvement in the levels of poverty in
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Gender Inequality in Developing Countries.". In: Regional Development Studies, Vol. 14, pp. 29-44. Arise Publishes and Distributors; 2008.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Migration of Husbands, Remittances And Agricultural Production: Impacts When Wives Are Left To Manage Households In Rural Kenya.". In: Journal of Food, Agriculture and Environment, Vol. 5 (2): 251-260. WFL Publisher; 2007. Abstract
This article investigates the forces leading to the migration of husbands from rural Kenya, the economic situation and activities of wives with migrant husbands, receipt of remittances by wives and the possible influences of remittances on capital formation in rural Kenya, using Nyeri district as a case study. Although the residual sample of rural wives whose husbands have migrated to urban areas in Kenya is small, the analysis of this sample highlights several important points worthy of further investigation. It seems that rural husbands who migrate from rural Kenya have limited education and skills and are mostly pushed out or rural areas rather than pulled. The wives seem not to be empowered in relation to economic and family decision making. The husband and his relatives retain control of important economic and household decisions and this has negative impacts on agricultural productivity. The wives are hampered by their relative lack of access to agricultural extension officers, finance for farm investment and capital resources for use on their farm. Probit analysis suggests that the probability of a wife obtaining remittances from a migrant husband declines with the number of years of his absence and the age of the wife but increases with the number of her dependent children and whether or not she employs hired labour. Duration of migration is important in explaining the amount of remittances but not in explaining the likelihood of wives receiving remittances. Overall indications are that remittances are mostly motivated by altruism or social obligation of the migrant to his family. This study was limited by lack of resources but nonetheless provides useful pointers to furthe research. 
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Institutions and Gender Inequality: A Case Study of the Constituency Development Fund in Kenya.". In: Regional Development Studies, Vol. 14, pp. 29-44. OSSREA; 2011.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti Nganga, T. and Kirori, G. (2010), .". In: ", International Journal f Business Policy and Economics, Vol. 3, No. 2, pp. 139-156. Serials Publications; 2010.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti-Nganga, T. and Okelo, J. Regional Trade Agreements: A Case Study for Kenya.". In: UNITED NATIONS CONFERENCE ON TRADE AND DEVELOPMENT VIRTUAL INSTITUTE RESEARCH MATERIAL pp. 17-81. UNCTAD Vi; 2009. Abstract
This paper first defines what regional economic commuities are using economic theory as a point of reference. The Economic integration in Africa is also discussed at length and the various forms of integration in Africa such as the East African Community (EAC), the South African Customs Union (SACU), Common Market for East and Southern Africa (COMESA), the Southern African Development Community (SADC) and may others. Consequences of overlapping membership of various forms of integration and the constrainst of regional  integration in Africa are also discussed.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti-Nganga, T. (2007), .". In: Journal of Food, Agriculture & Environment, Vol. 5 (2): 251-260. WFL Publisher; 2007. Abstract
This article investigates the forces leading to migration of husbands from rural Kenya, the economic situation and activities of wives with migrant husbands, receipt of remittances by wives and the possible influences on capital formation in rural Kenya, using the Nyeri district as a case study. Although the residual sample of rural wives whose husbands have migrated to urban areas in Kenya is small, the analysis of this sample highlights several important points worthy of investigation. It seems that rural husbands who migrate from rural Kenya have limited education and skills and are mostly pushed out of rural areas rather than pulled. The wives seem not to be empowered in relation to economic and family decisions-making. The husband and his relatives retain control of important economic and household decisions and this has negative impacts on agricultural productivity. The wives are hampered by their relative lack of access to agricultural extension officers, finance for farm investment and capital resources for use on their farm. Probit analysis suggests that the probability of a wife obtaining remittances from a migrant husband declines with the number of years of his absence and the age of the wife but increases with the number of her dependent children and whether or not she employs hired labour. Duration of migration is important in explaning the amount of remittances but not in explaining the likelihood of wives receiving remittances. Overall indications are that remittances are mostly motivated by altruism or social obligation of the migrant to his family. This study was limited by lack of resources but nonetheless provides useful pointers to further research.  
KIRITI DRNG'ANG'ATABITHAWAGITHI. "16. Kabubo, F. M. and Kiriti-Nganga, T. (2008), .". In: International Journal of Afro-Asian Studies, Vol. 1, No. 2, pp.40-56. Serials Publications; 2008.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Socioeconomic Determinants of Family Size in Nyeri District of Rural Kenya.". In: Regional Development Studies (RDS), Vol. 14, pp. 29-44. UNCRD; 2010.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "The Economic and Social Context of Labour Migration from Africa.". In: International Journal of Human Development and Information System, Vol. (3) NO.1. Serials Publications; 2008. Abstract
Migration leads to a significant loss of human capital and subsequent manpower gaps in key sectors for national development. Brain drain is one of the negative consequences of international labour migration and has affected many African countries. Brain waste results when the migrants abilities are not well utilised in the countries of destination.  However, migration contributes to balancing economic growth within
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Gender Inequality in Kenya: Gender Inequality in Agricultural Households in Kenya: An Economic Analyis.". In: Regional Development Studies, Vol. 14, pp. 29-44. Lambert Academic Publishing; 2010.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kirori, G. N. Kiriti-Nganga, T. Mariara, J. W and Mwabu G. (2009), .". In: Regional Development Studies, Vol. 13, pp. 1-16. UNCRD; 2009. Abstract
This article investigates the influence of social capital on consumption expenditure in rural Kenya. It uses primary data collected from a sample of 340 households in Nyeri district to demonstrate the linkage between social capital and rural livelihoods. Econometric methods (OLS) are used to explore the nexus between social capital and consumption expenditure. Results from econometric analysis show that social capital significantly affects total household expenditure. There is evidence in the study that social capital enables households to generate consumption expenditure sources that support non-monetary forms of exchange. This non-monetary exchange is presumed to reduce transactions demand for cash and facilitate household savings. Contrary to expectations, it is found that total household expenditure is negatively associated with aggregate social capital. This finding seems to indicate that social capital reduces welfare. Contrary to this simple interpretation, the finding suggests that households with large social capital endowments are able to meet their basic needs through non-cash transactions. Social capital can enable households to increase consumption without cash expenditures and relying on self-purchased goods. The article further shows that the welfare effects of various  forms of social capital differ, indicating that effects of social capital are not sufficiently measured using aggregate quantity of this variable. The findings of the study are used to suggest policies for promoting formation of social capital as a mechanism for improving conditions of rural households.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kirori, G. N. Kiriti-Nganga, T. Mariara, J. W and Mwabu G. Impacts of Social Capital on Household Consumption Expenditure in Rural Kenya.". In: Regional Development Studies, Vol. 13, pp. 1-16. UNCRD; 2009. Abstract
This article investigates the influence of social capital on consumption expenditure in rural Kenya. It uses primary data collected from a sample of 340 households in Nyeri district to demonstrate the linkage between social capital and rural livelihoods. Econometric methods (OLS) are used to explore the nexus between social capital and consumption expenditures. Results from econometric analysis show that social capital significantly affects total household expenditure. There is evidence in the study area that social capital enables households generate consumption expenditure sources that support non-monetary forms of exchange. This non-monetary exchange is presumed to reduce transactions demand for cash and facilitate household savings. Contrary to expectations, it is found that total household expenditure is negatively associated with aggregate social capital. This finding seems to indicate that social capital reduces household welfare. Contrary to this simple interpretation, the finding suggests that households with large social capital endowments are able to meet their basic needs through non-cash transactions. Social capital can enable households to increase consumption without cash expenditure and relying on self-purchased goods. The article further shows that the welfare effects of various forms of social capital differ, indicating that effects of social capital are not sufficientle measured using aggregate quantity of this variable. The findings of the study are used to suggest policies for promoting formation of social capital as a mechanism for improving living conditions of rural households.   
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti-Nganga, T. The Economic and Social Context of Labour Migration from Africa.". In: International Journal of Human Development and Information System, Vol. 3 No. 1. pp. 4-13. Serials Publications; 2008. Abstract
Migration leads to a significant loss of human capital and subsequent manpower gaps in key sectors for national development. Brain drain is one of the negative consequences of international labour migration and has affected many African countries. Brain waste results when the migrants abilities are not well utilised in the countries of destination.  However, migration contributes to balancing economic growth within
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kabubo, F. M. and Kiriti-Nganga, T. (2008), .". In: International Journal of Afro-Asian Studies, Vol. 1, No. 2, pp.40-56. Serials Publications; 2008.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti-Nganga, T. and Sarkar, S. Gender, Poverty and Disability in Kenya.". In: Indian Journal of Human Rights, Vol. 3, No. 1-2, pp. 219-234. Serials Publications; 2008. Abstract
This paper shows that disability is a big problem in  
KIRITI DRNG'ANG'ATABITHAWAGITHI. "INSTITUTIONS AND GENDER INEQUALITY: A CASE STUDY OF CONSTITUENCY DEVELOPMENT FUND IN KENYA.". In: Regional Development Studies, Vol. 14, pp. 29-44. OSSREA; 2011.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kiriti- Nganga, T. and Roy, K. Gender Inequality and Poverty: The Kenyan Case.". In: Focus on Poverty. Nova Science Publishers; 2007. Abstract
OBJECTIVE: Sialidase and the presence of Gardnerella vaginalis have been proposed as biomarkers for bacterial vaginosis. Sialidase has been associated with adverse pregnancy outcome. We genotyped G. vaginalis isolates, assessed the presence and diversity of sialidase-en- coding genes, and determined the production of sialidase. STUDY DESIGN: One hundred thirty-four G vaginalis isolates were genotyped by random amplified polymorphic deoxyribonucleic acid (RAPD) and a selection of 29 isolates with amplified ribosomal deoxyri-bonucleic acid restriction analysis (ARDRA). A G vaginalis sialidase quantitative polymerase chain reaction was developed, and the siali- dase production was assessed with the filter spot test. RESULTS: Three G vaginalis genotypes could be distinguished by both RAPD and ARDRA. Only 2 genotypes encoded and produced sialidase. CONCLUSION: Three genotypes exist among G vaginalis isolates, and there is a clear link between genotype and sialidase production. A possible link between sialidase production and (symptomatic) bacterial vaginosis and biofilm production can be hypothesized. Key words: adverse pregnancy outcome, bacterial vaginosis, Gardnerella vaginalis, genotyping, sialidase
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Socioeconomic Determinants of Family Size in Nyeri District of Rural Kenya.". In: Regional Development Studies, Vol. 14, pp. 29-44. UNCRD; 2011.
KIRITI DRNG'ANG'ATABITHAWAGITHI. "Kirori, G. N.. Mariara, J. W. and Kiriti-Nganga, T. (2011), .". In: Journal of International Business and Finance, Vol. 3, No. 1, pp. 1-27. Serials Publications; 2011. Abstract
This paper investigates the impact of social capital on consumption expenditure of households in rural
Kiringe, J.W., Mwaura F, Warinwa F&. "Characterization of Chyulu Hills Watershed Ecosystem Services in South-Eastern Kenya." Environment and Natural Resources Research. 2016;6(3):65-76.
Kiringe, J.W., Mwaura F, Warinwa F&. "Characterization of Water Source Types and Uses in Kirisia Forest Watershed, Samburu County, Kenya." Environment and Natural Resources Research. 2016;6(3):77-90.
Kirimi H, Wanjohi J. "Factors influencing use of alternative dispute resolution in construction projects: Case of Imenti North Sub County, Meru County." International Academic Journal of Information Sciences and Project Management. 2019;3(4):572-602. AbstractInternational Academic Journal of Information Sciences and Project Management

Description
Regarded as a frequent occurrence, disputes in construction projects occasioned by substandard communication of impractical clients’ expectations, defective works and delays in architectural designs significantly contribute to adverse effects on project results. Despite these and the numerous demerits linked to litigation majority of clients, contractors and construction consultants in Kenya still opt for it as opposed to Alternative Dispute Resolution (ADR) approaches to resolve disputes in construction projects. The purpose of this study was to establish the factors influencing use of alternative dispute resolution in construction projects in Imenti North Sub-County, Meru County, Kenya. In particular it examined the influence of: lack of awareness, preservation of business relationships, cost minimization and communication and documentation issues on the use of ADR in construction projects disputes. The research was guided by two theories; Theory of Planned Behavior and Transaction Cost Economics Theory and will be support by the Stair-Step Model of Dispute Resolution. The research embraced use of descriptive survey research design. Target population is of 255 respondents. The sample size was of 45 (n= 45), Contractors, 12 (n= 12) Consultants (Architectures, Quantity Surveyors and Structural Engineers) and Construction Projects Clients 75 (n= 75) that was singled out to take part in the investigation. Stratified sampling and Simple random sampling were made use of to pick the sampled subjects. Questionnaires were used to collect primary data in the study locale. Data was analyzed qualitatively and quantitatively by employing SPSS …

Kirimi J, Guthua SW, DIMBA EOA, OMONDI B, KOTA D. "KOTA, D. Stage IV Oral Malignant Melanoma: a case report and literature review." International Journal of Oral and Maxillofacial Surgery. 2015.
Kirimi J, Guthua S, Dimba E, OMONDI B, KOTA D. "Stage IV oral malignant melanoma: a case report and literature review." International Journal of Oral and Maxillofacial Surgery. 2015;44:e91. Abstract
n/a
Kirimi J, KENYANYA A, Guthua SW. "Isn’t the football stupid: A knife stab through the Mandible – a case report." International Journal of Oral and Maxillofacial Surgery. 2015.
Kirimi MW. "Population and Employment.". 1979.Website
Kiriinya LK, Raiji TK, GATARI MJ. "Ecosystem Management and Sustainable Livelihoods: A case study of North Eastern Mt.Kenya.". In: International Sustainability Transitions Conference (IST2017). Gothenburg, Sweden; 2017.
Kiriinya LK, GATARI MJ. "Isotope Tracing Application in Source Identification of Tropospheric Black Carbon in Sub-Saharan Africa.". In: International Conference on Tracers and Tracing Methods. VIETNAM; 2019.
Kiriinya LK, Marijnissen JCM, Agostino LF. "Application of Electrospray in thermal desalination in tropical countries.”.". In: Aerosol Technology Conference (AT2018). Bilbao, Spain; 2018.
Kiriinya LK, Marijnissen JCM, GATARI MJ. "Effect of EHDA in the Simple jet mode with whipping break-up on the Evaporation ratio in Thermal Desalination Systems.". In: European Aerosol Conference (EAC2017). Zurich, Switzerland; 2017.
Kirigia JM, Mwabu GM, Orem JN, Muthuri RK. "Indirect cost of maternal mortality in the WHO African Region." . International Journal of Social Economics. 2016;43(5):pp 532-548.
KIRIAGO DRAKAMAMATHEW. "Akama MK, Guthua SW, Chindia ML.Pierre Robin Syndrome: case report.East Afr Med J. 2000 Jun;77(6):343-4.". In: East Afr Med J. 2000 Jun;77(6):343-4. University of Nairobi.; 2000. Abstract
A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.
KIRIAGO DRAKAMAMATHEW. "Elevated plasma levels of interleukin-6, interleukin-8, and granulocyte colony-stimulating factor during and after major abdominal surgery. J Clin Anesth. 1997 Jun;9(4):293-8.". In: J Clin Anesth. 1997 Jun;9(4):293-8. University of Nairobi.; 1997. Abstract
A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.
KIRIAGO DRAKAMAMATHEW. "Akama MK, Chindia ML, Guthua SW, Nyong'o A.Extra-abdominal fibromatosis invading the mandible: case report.East Afr Med J. 2002 Jan;79(1):49-50.". In: East Afr Med J. 2002 Jan;79(1):49-50. University of Nairobi.; 2002. Abstract
Extra-abdominal fibromatosis (desmoid tumour) is a rare aggressive neoplasm with a tendency to infiltrate local structures but rarely metastasises or undergoes spontaneous malignant transformation. The treatment of choice is surgery, however, recurrences have been reported even after wide-field resection. This article presents a case of extra-abdominal fibromatosis that had extensively invaded the mandible.
KIRIAGO DRAKAMAMATHEW. "Imipenem and cephem resistant Pseudomonas aeruginosa carrying plasmids coding for class B beta-lactamase. J Antimicrob Chemother. 1996 Mar;37(3):433-44.". In: J Antimicrob Chemother. 1996 Mar;37(3):433-44. University of Nairobi.; 1996. Abstract
A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.
KIRIAGO DRAKAMAMATHEW. "Odhiambo WA, Guthua SW, Macigo FG, Akama MK.Maxillofacial injuries caused by terrorist bomb attack in Nairobi, Kenya.Int J Oral Maxillofac Surg. 2002 Aug;31(4):374-7.". In: Int J Oral Maxillofac Surg. 2002 Aug;31(4):374-7. University of Nairobi.; 2002. Abstract
Although military conflicts are common on the African continent, there is a paucity of data regarding bomb-blast injuries in this region and in Kenya in particular. This paper describes the pattern of maxillofacial injuries sustained after the August 1998 bomb blast that occurred in Nairobi, Kenya. A retrospective cross-sectional study was carried out using hospital-based records of 290 bomb-blast survivors admitted at the Kenyatta National Referral and Teaching Hospital in Nairobi. Using a self-designed form to record information about variables such as the sex and age of the survivors and type of location of soft- and hard-tissue injuries, it was found that of the 290 bomb-blast survivors, 78% had sustained one or more maxillofacial injuries. Soft-tissue injuries (cuts, lacerations or bruises) were the most common, constituting 61.3% of all injuries in the maxillofacial region; 27.6% had severe eye injuries, while 1.4% had fractures in the cranio-facial region. This paper concludes that the effective management of bomb-blast injuries as well as those caused by other types of disaster requires a multidisciplinary approach. The high percentage of maxillofacial injuries confirm that maxillofacial surgeons should form an integral part of this multidisciplinary team.
KIRIAGO DRAKAMAMATHEW. "Occurrence and pattern of mandibular fractures at Kisii District Hospital, Kenya. East Afr Med J. 1993 Nov;70(11):732-3.". In: East Afr Med J. 1993 Nov;70(11):732-3. University of Nairobi.; 1993. Abstract
A retrospective study of the hospital records revealed that 39 cases of mandibular fractures presented at Kisii District Hospital during a two-year period. 27 cases were due to interpersonal violence while road traffic accidents and accidental falls accounted for 9 and 3 of the cases respectively. The male ratio was 2.9:1. Majority (26 cases) of the patients were aged between 20 and 39 years. The commonly involved fracture site was the left body of the mandible accounting for 20 of the fractures.
Kireti VM, Atinga JE. "Osgood Schlatter disease: An Audit Profile of 35 Adolescents." The Annals of African Surgery, . 2010;6. Abstract

Background
Osgood-Schlatter disease is a common cause of anterior knee pain in the adolescent. Treatment is usually conservative with surgery reserved for those who do not respond to this treatment. There is little published work regarding the experience with the disease in our local set up. This series documents the experience with 35 adolescents treated for the disease.

Design
Case series

Subjects
Thirty five adolescents with clinical and radiological diagnoses of Osgood-Schlatter disease at Nairobi and Kenyatta National Hospitals, between 2001and 2007.

Method
Patients were evaluated for demographics, knee involvement, activities associated with pain and treatment outcome

Results
There were 28 males and 7 females, aged 10 to 16 years (mean 12.8 years). Thirteen had bilateral knee involvement. Twenty two were involved in active sports while the rest had constant pain and unable to sit or kneel. A family history of the disease was documented in one case. Thirty adolescents responded well to the conservative treatment. In the five adolescents who underwent surgery, the patella tendon was edematous with thickening of the tendon sheath and neovascularisation. All the operated adolescents returned to active sports with 6 weeks after the surgery.

Conclusion
Osgood-Schlatter disease is a self-limiting condition in majority of adolescents. Surgery when indicated has an excellent outcome.

KIRETI DRVICTORN. "Osgood Schlatter disease: An Audit Profile of 35 Adolescents.". In: The Annals of African Surgery Volume 6 . Kireti VM, Atinga JEO; Submitted. Abstract
BackgroundOsgood-Schlatter disease is a common cause of anterior knee pain inthe adolescent. Treatment is usually conservative with surgery reservedfor those who do not respond to this treatment. There is little publishedwork regarding the experience with the disease in our local set up. This series documents the experience with 35 adolescents treated for the disease.DesignCase seriesSubjectsThirty five adolescents with clinical and radiological diagnoses ofOsgood-Schlatter disease at Nairobi and Kenyatta National Hospitals,between 2001and 2007.MethodPatients were evaluated for demographics, knee involvement, activitiesassociated with pain and treatment outcomeResultsThere were 28 males and 7 females, aged 10 to 16 years (mean 12.8years). Thirteen had bilateral knee involvement. Twenty two were involved in active sports while the rest had constant pain and unable to sit or kneel. A family history of the disease was documented in one case.Thirty adolescents responded well to the conservative treatment. Inthe five adolescents who underwent surgery, the patella tendon wasedematous with thickening of the tendon sheath and neovascularisation.All the operated adolescents returned to active sports with 6 weeks after the surgery.ConclusionOsgood-Schlatter disease is a self-limiting condition in majority ofadolescents. Surgery when indicated has an excellent outcome.
Kirea P, Irene GM, Joyce JC. "Factors contributing to sexual assault in children 1–13 years admitted at Nairobi women's hospital, Nairobi, Kenya." International Journal of Nursing Care. 2018;6(2):5-9.
Kiragu H, Mwangi E, Kamucha G. "A rapid MRI reconstruction method based on compressive sampling and concomitant artifacts suppression.". In: 19th IEEE Mediterranean Electrotechnical Conference (MELECON). Marrakesh, Morocco ; 2018.
Kiragu H, Kamucha G, Mwangi E. "An Improved Reconstruction Method for Compressively Sampled Magnetic Resonance Images Using Adaptive Gaussian Denoising." Springer International Publishing AG. 2017;416(LNEE):192-200.
Kiragu P, ADUDA JO, Ndwiga JM. "The Relationship between Agency Banking and Financial Performance of Commercial Banks in Kenya." Journal of Finance and Investment Analysis. 2013;2(4):97-117. Abstractthe_relationship_between_agency_banking_and_financial__performance_of_commercial_banks_in_kenya.pdf

Banking agents are usually equipped with a combination of point-of-sale (POS)card reader, mobile phone, barcode scanner to scan bills for bill payment transactions, Personal Identification Number(PIN) pads, and sometimes personal computers (PCs) that connect with the bank’s server using a personal dial-up or other data connection. This research used the descriptive design method using secondary data gathered from the commercial banks in Kenya that had adopted agency banking in Kenya. The population of the study was the 10 commercial banks in Kenya that had adopted agency banking by the end of 2012 namely Equity Bank, Co-operative Bank, KCB Bank, Post Bank, Family Bank, Chase Bank ,Consolidated Bank, Diamond Trust Bank, Citibank and NIC Bank. Annual reports on individual banks’ financial performance were used to extract financial performance indicators. CBK’s annual report and supervisory reports were also used to establish the number of agents registered and the total transactional value conducted through the agents. The variable of interests were the cash withdrawal and deposit transactions done through agents, number of active agents, return on assets, cost to income ratio and staff cost to revenue ratio.
JEL classification numbers: G24
Keywords: Agency Banking, Financial Performance and Kenya.

Kiragu H, Kamucha G, Mwangi E. "A Fast Procedure for Acquisition and Reconstruction of Magnetic Resonance Images Using Compressive Sampling.". In: IEEE Africon. Addis Ababa, Ethiopia; 2015.
Kiragu H, Kamucha G, Mwangi E. "A Robust Magnetic Resonance Imaging Method Based on Compressive Sampling and Clustering of Sparsifying Coefficients.". In: IEEE Melecon. Limassol, Cyprus ; 2016.
Kiragu JW, King’oina JO, Migosi J. "School - Based Management Prospects and Challenges: A Case of Public Secondary Schools in Murang’a South District, Kenya." International Journal of Asian Social Science,. 2013;3(5):1166-1179.
Kiragu N. "Codependency you can be drug free .". In: The Battle is in your mind. University of Nairobi, Kenya; 2013.presentation1.pptx
Kipyesang E, Migosi J. "Influence of Human Resources on Hotel Performance in Kitale Municipality Trans Nzoia County." International Journal of Recent Innovations in Academic Research. 2019;3(12):81-87.
Kipyegon AN, Mutembei HM TVTT. " Effects of Ripe Carica Papaya Seed Powder on Testicular Histology of Boars." international journal of veterinary science. 2012;1(1):1-4.
Kipyegon AN, Mande JD, Mulei CM, Karanja DN. "Acute Respiratory Distress Syndrome Due to Babesiosis in a Dog: Case Report.". 2011. AbstractWebsite

Abstract: A case of acute respiratory distress syndrome due to babesiosis is reported in a 5 years old male Japanese sptiz. The patient was noticed to have developed sudden dyspnoea. The main presenting clinical signs included laboured breathing, broad-base stance but preferred recumbency, pallour and seizures. Blood smears from the ear tips revealed presence of multiple Babesia parasites in the erythrocytes. Hematology results showed slight leucocytosis, severe anemia and thrombocytopenia. Additionally, urinalysis revealed renal pathology and presence of leucocytes in urine. Despite aggressive measures to stabilize the patient, it died within an hour. Autopsy results also confirmed Babesiosis with generalized icterus.

Kipyegon AN, Mutembei HM, Tsuma VT, Oduma JA. "Effects of ripe Carica papaya seed powder on testicular histology of boars." Int. J. Vet. Sci., . 2012;1:1-4.
Kipyegon AN, Mutembei HM, Tsuma VT, Oduma JA. "Effects of ripe papaya (Carica papaya) seed powder on the seminiferous epithelium of the boar testis.". 2012. Abstract

The effect of oral administration of ripe Carica Papaya seed powder on testicular histology of Sus scrofa domestica boars has been addressed in the present article. Fifteen pubertal Large White boars were randomly selected and divided into two groups. Each boar in the experimental group received a daily dose of 300mg C Papaya mixed with 0.5 kg of conventional pig feed while the control group received a placebo. The experiment was carried out for 56 days in the University of Nairobi. After every two weeks, one boar from the control group and two from the experimental group were castrated and testicular tissue samples processed for histology. At the end of 56 days the remaining entire boars were maintained for 14 days and 60 days respectively without the papaya powder to assess reversibility. The test material had no effect on haematological parameters. However, histopathological changes of the seminiferous epithelium which appeared to be dependent upon duration of C Papaya consumption was noticed, these changes were reversible. Although the mechanism(s) for the effect of papaya seed extract is not explained by this study, it is observed that papaya seed powder causes gradual disorganization, exfoliation and loss of spermatocytes and spermatids.

Kipyego ES, Gitau G, Vanleeuwen J, Kimeli P, Abuom TA, Gakuya D, Muraya J, Makau D. "Sero-prevalence and risk factors of Infectious rhinotracheatis virus( type1) in Meru county, Kenya." Preventive Veterinary Medicine . 2020;104863.(175).
Kipyator I, Ongeti K, Butt F, Ogeng’o JA. "Regional Topography of the Internal Carotid Artery." Anatomy Journal of Africa. 2015;4(1):444-449.
Kipturgo MK, LK-BW, AKK, Muiva MM. "Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya." BMC Medical Informatics and Decision Making . 2014;14(35):1-8.
Kipturgo MK, Kivuti-Bitok LW, Karani AK, Muiva MM. "Attitudes of nursing staff towards computerisation: a case of two hospitals in Nairobi, Kenya." BMC Med Inform Decis Mak. 2014;14:35. Abstract

The health sector is faced with constant changes as new approaches to tackle illnesses are unveiled through research. Information, communication and technology have greatly transformed healthcare practice the world over. Nursing is continually exposed to a variety of changes. Variables including age, educational level, years worked in nursing, computer knowledge and experience have been found to influence the attitudes of nurses towards computerisation. The purpose of the study was to determine the attitudes of nurses towards the use of computers and the factors that influence these attitudes.

UoN Websites Search