Publications

Found 5778 results

Sort by: [ Author  (Asc)] 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
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.
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.
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.
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.
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.
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.
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 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 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 MW. "Population and Employment.". 1979.Website
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.
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.
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
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-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-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, Okelo JA, Mbithi LM. "Jounce Of The African Women Studies Centre.". 2012.Website
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. "Non - Tariff Measures in Kenya.". 2012.Website
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-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.
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.

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;, 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;, Bagine RK;, Maranga EK. Integrated natural resource management.; 2010.Website
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

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

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.
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.
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' 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, OCHIENG' 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. "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.

KIRTDA DRACHARYAS. "Magnitude of hepatitis C virus infection in India: prevalence in healthy blood donors, acute and chronic liver diseases. J Med Virol. 1997 Mar;51(3):167-74.". In: J Med Virol. 1997 Mar;51(3):167-74. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1997. Abstract
An enzyme immunoassay (EIA) was developed in-house for the detection of anti-hepatitis C virus (HCV) antibody against the prevailing genotypes in India. The specific reactivity of the test was compared with commercial second and third-generation EIAs and reverse transcription nested polymerase chain reaction (RT-nested PCR). Fifteen thousand nine hundred twenty-two healthy blood donors at the All India Institute of Medical Sciences (AIIMS), New Delhi, India, were screened for anti-HCV antibody. Two hundred ninety-five (1.85%) of these donors were positive. The screening was also used to determine how many patients with acute hepatitis and chronic liver diseases were positive for anti-HCV antibody. Five hundred sixty-four chronic liver disease patients were screened for anti-HCV antibody and 78 (13.83%) were found positive. Two hundred forty-seven sporadic acute viral hepatitis patients were screened for viral infection markers. Hepatitis B and E viruses (HBV and HEV) were the major etiologic agents. HCV was associated with 9% of the acute cases. Anti-HCV core IgM with HCV RNA detection were found to be helpful for the diagnosis of acute HCV infection.
KIRTDA DRACHARYAS. "Panigrahi AK, Nanda SK, Dixit RK, Acharya SK, Zuckerman AJ, Panda SK. Diagnosis of hepatitis C virus-associated chronic liver disease in India: comparison of HCV antibody assay with a polymerase chain reaction for the 5' noncoding region.J Med Virol. 1994.". In: J Med Virol. 1994 Oct;44(2):176-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract

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

KIRTDA DRACHARYAS. "Arora A, Seth S, Acharya SK, Sharma MP.Hepatic coma as a presenting feature of constrictive pericarditis.Am J Gastroenterol. 1993 Mar;88(3):430-2.". In: Am J Gastroenterol. 1993 Mar;88(3):430-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
The efficacy of the interferon stimulator named Stronger Neo Minophagen-C (SNMC) derived form the plant G. glabra was studied at a dose of 40 or 100 ml daily for 30 days followed by thrice weekly intravenously for 8 wk in 18 patients of subacute hepatic failure due to viral hepatitis. The survival rate amongst these patients was 72.2 per cent, as compared to the earlier reported rate of 31.1 per cent in 98 patients who received supportive therapy (P < 0.01). Death in four of the five patients was due to associated infections leading to hepatorenal failure and terminal coma. Further studies are necessary to standardize the dose and duration of therapy with SNMC in subacute hepatic failure.
KIRTDA DRACHARYAS. "Madan K, Chalamalsetty SB, Srivastava S, Gupta SD, Mirdha BR, Makharia GK, Samataray JC, Acharya SK.Tropical mayhem: a chronic viral disease with superadded parasitic infection.J Med Microbiol. 2008 Feb;57(Pt 2):232-5.". In: J Med Microbiol. 2008 Feb;57(Pt 2):232-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2008. Abstract
Coexistence of two illnesses in the same patient may result in atypical manifestations of either or both diseases. A case of hepatitis B virus-related cirrhosis in a patient who presented with a pharyngeal mucosal mass lesion as a manifestation of superadded Leishmania infection is presented here. The clue to the diagnosis was the origin of the patient from an area highly endemic for leishmaniasis and the presence of unexplained polyclonal hypergammaglobulinaemia. The patient responded very well to therapy with amphotericin B with complete disappearance of the mucosal lesion.
KIRTDA DRACHARYAS. "Arora A, Tandon RK, Acharya SK, Tandon BN.The role of sustained achlorhydria in bleeding peptic ulcer.J Clin Gastroenterol. 1991 Apr;13(2):147-53.". In: J Clin Gastroenterol. 1991 Apr;13(2):147-53. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
Twenty-five patients with bleeding peptic ulcers were randomized to receive either ranitidine 50 mg 8 hourly i.v. (control group) or a continuous nasogastric antacid infusion at the rate of 0.5 ml/min along with an i.v. injection of cimetidine 100 mg/h (treatment group). Twelve patients were included in the control group and 13 in the treatment group. The mean gastric pH on therapy was significantly higher in the treatment group (7.88 +/- 0.37) than in the control group (5.00 +/- 0.55) (p less than 0.001), and the gastric pH was noted to be greater than 7 on 95% of the occasions in the treatment group and on 8.6% of the occasions in the control group. An overall control of bleeding was achieved in 92.3% of the patients in the treatment group and 50% of the patients in the control group (p less than .05). Thus, the failure of therapy was significantly more common in the control group than in the treatment group (p less than 0.05), and more patients of the control group had to undergo emergency surgery than that in the treatment group. None of the patients in the treatment group, but 16.6% of the patients in the control group, died during the study period in the hospital stay. We conclude that in patients with bleeding peptic ulcer an intensive medical therapy comprising hourly injections of cimetidine (or presumably of other H2 blockers) and continuous nasogastric antacid infusion can achieve sustained achlorhydria, better control of bleeding, and reduce the need for emergency surgery.
KIRTDA DRACHARYAS. "Acharya SK.Management of chronic hepatitis B: the Indian perspective. Trop Gastroenterol. 2005 Oct-Dec;26(4):171-2.". In: Trop Gastroenterol. 2005 Oct-Dec;26(4):171-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
AIM: Passive immunotherapy using antibody against hepatitis B surface antigen (HBsAg) has been advocated in certain cases of Hepatitis B infection. We had earlier reported on the cloning and expression of a high affinity scFv derived from a mouse monoclonal (5S) against HBsAg. However this mouse antibody cannot be used for therapeutic purposes as it may elicit anti-mouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: We cloned the V(H) and V(L) genes of this mouse antibody, and fused them with CH1 domain of human IgG1 and C(L) domain of human kappa chain respectively. These chimeric genes were cloned into a phagemid vector. After initial screening using the phage display system, the chimeric Fab was expressed in soluble form in E. coli. RESULTS: The chimeric Fab was purified from the bacterial periplasmic extract. We characterized the chimeric Fab using several in vitro techniques and it was observed that the chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. This chimeric antibody fragment was further expressed in different strains of E. coli to increase the yield. CONCLUSION: We have generated a mouse-human chimeric Fab against HBsAg without any significant loss in binding and epitope specificity. This chimeric Fab fragment can be further modified to generate a full-length chimeric antibody for therapeutic uses.
KIRTDA DRACHARYAS. "Dwivedi M, Acharya SK, Tandon BN.The ultrasonographic "common channel" sign: a characteristic feature of malignant obstruction of the lower end of common bile duct.J Clin Gastroenterol. 1989 Apr;11(2):233-5.". In: J Clin Gastroenterol. 1989 Apr;11(2):233-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
We describe an ultrasonographic "common channel" sign as the characteristic sonographic feature of malignant distal common bile duct (CBD) obstruction. Of 24 patients with obstructive jaundice due to distal CBD obstruction (pancreatic carcinoma 8, periampullary cancer 5, choledocholethiasis 10, CBD stricture due to pancreatitis 1) in whom the final diagnosis was proven at laparotomy, ultrasonography revealed 11 patients to have a thin-walled distended gallbladder continuous with a dilated CBD, which was termed the "common channel" sign. In all 11 patients, the cause of obstruction of the lower end of CBD proved to be malignant (pancreatic carcinoma 6, periampullary 5). In contrast, only 2 of the other 13 patients with obstructive jaundice with distal CBD obstruction, but without the "common channel" sign, had a malignant lesion at the lower end of CBD. The positive and the negative predictive values of the common channel sign were 100% and 85%, respectively. Thus, the ultrasonographic common channel sign is a reliable and characteristic feature of distal CBD obstruction due to malignant pathology.
KIRTDA DRACHARYAS. "Seroepidemiology of hepatitis A virus infection among school children in Delhi and north Indian patients with chronic liver disease: implications for HAV vaccination. J Gastroenterol Hepatol. 2003 Jul;18(7):822-7.". In: J Gastroenterol Hepatol. 2003 Jul;18(7):822-7. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
BACKGROUND: Universal vaccination against hepatitis A virus (HAV) has been recommended for children because of the changing epidemiological pattern of HAV. Vaccination has also been advised for patients with chronic liver disease as HAV superinfection in these patients can result in severe or even fatal disease. In India, the indications for HAV vaccination are not clear due to contradictory seroepidemiological data in children and lack of data on HAV seroprevalence in patients with chronic liver disease. METHODS: Sera were collected from children studying in two government-run schools and from patients with chronic liver disease attending the Liver Clinic at the All India Institute of Medical Sciences (AIIMS). The sera were tested for anti-HAV antibodies. The incidence of HAV-induced acute hepatitis and acute liver failure at AIIMS over the last 10 years was also assessed. RESULTS: A total of 93.2% (1328/1424) of the school children between 4-18 years of age who were included in the study had anti-HAV antibody in their sera. Eighty percent of the children had antibodies against HAV in their sera by the age of 5 years, whereas all the children above 16 years were positive for anti-HAV antibody. A total of 256 patients with chronic liver disease (94 with cirrhosis of the liver, 160 with chronic hepatitis) were tested for the presence of anti-HAV antibody. Of them, 97.6% (248/254) had anti-HAV antibody in their sera. The annual frequency of HAV-induced acute viral hepatitis and acute liver failure at AIIMS during the last 10 years did not show any change. CONCLUSION: Mass vaccination against HAV is not required in north India because of the presence of protective antibodies against HAV in the majority of the population. Copyright 2003 Blackwell Publishing Asia Pty Ltd
KIRTDA DRACHARYAS. "Acharya SK, Irshad M, Gandhi BM, Joshi YK, Tandon BN.Pre-S proteins–a new marker for the hepatitis-B virus.Trop Gastroenterol. 1987 Apr-Jun;8(2):91-8.". In: Trop Gastroenterol. 1987 Apr-Jun;8(2):91-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
A simple and sensitive ELISA was developed to characterize the interaction between polymerised human serum albumin (pHSA) and HBsAg, using pHSA-coated polyvinylmicrotitre plates as solid phase and anti-HBs-coupled HRPO as the conjugate. The interaction was found to be specific and dependent on the size of albumin polymer. pHSA-binding activity (pHSA-BA) was studied in both HBsAg-negative and HBsAg-positive sera from various liver diseases including acute viral hepatitis, fulminant hepatitis, cirrhosis of liver, chronic active hepatitis, and healthy HBsAg carriers. pHSA-BA was detected only in HBsAg-positive sera. Analysis of HBsAg-positive sera indicated pHSA-BA in high proportions of patients sera as compared to sera from healthy HBsAg carriers. pHSA-BA was detected both in the presence and absence of HBe markers, though the mean BA was relatively high in presence of HBeAg. The effect of human serum immunoglobulins (IgG, IgA, and IgM) on the BA was investigated and a correlation between pHSA-BA and HBsAg-IgM complex positivity in sera was established. Finally, the probable role of human serum IgM in facilitating the binding process was discussed.
KIRTDA DRACHARYAS. "Acharya SK.HBeAg-negative chronic hepatitis B.Indian J Gastroenterol. 2002 May-Jun;21(3):93-5.". In: Indian J Gastroenterol. 2002 May-Jun;21(3):93-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
BACKGROUND: To improve the survival rate of patients with hepatocellular carcinoma (HCC) in whom surgery is not possible, various methods have been developed employing angiographic and percutaneous techniques. We analyzed our experience with various percutaneous therapeutic interventional techniques done for HCC in our center. METHODS: Sixty-one patients with inoperable HCC (mean age 48.9 [SD 13.8] y; 47 men) were treated between January 1997 and December 2000 by transcatheter arterial chemoembolization (TACE) alone (22), TACE with percutaneous alcohol injection (PEI) (20), transcatheter arterial embolization (TAE) with steel coils and gel foam for gastrointestinal bleed (7), percutaneous radiofrequency ablation (1), percutaneous preoperative right portal vein embolization (3) and percutaneous preoperative tumor embolization to reduce blood loss at surgery (8). RESULTS: In 42 patients treated by TACE and PEI and TACE alone, tumor necrosis was scored; over 50% necrosis was seen only after six and nine months in both treatment groups. The survival rates after six and nine months and the median survival were similar in the two groups. Of 7 cases treated with TAE with steel coils and gel foam, the gastrointestinal bleeding stopped in four; in the other three, bleeding did not stop completely although less transfusion was required. In the patient treated by radiofrequency ablation, follow-up contrast-enhanced CT did not show enhancing tumor mass. We noted left lobe enlargement after percutaneous preoperative right portal vein embolization, prior to right hepatectomy. CONCLUSION: In patients with HCC not amenable to surgical intervention, a variety of percutaneous therapeutic interventional techniques may be used.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK.Immunology of giardiasis.Indian J Pediatr. 1983 May-Jun;50(404):319-24.". In: Indian J Pediatr. 1983 May-Jun;50(404):319-24. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1983. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Portal hypertensive gastropathy in noncirrhotic patients. The effect of lienorenal shunts. J Clin Gastroenterol. 1998 Jan;26(1):64-7;.". In: J Clin Gastroenterol. 1998 Jan;26(1):64-7;. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S.Interferon therapy in chronic hepatitis B: more information but clarity eludes.Trop Gastroenterol. 1994 Oct-Dec;15(4):177-8.". In: Trop Gastroenterol. 1994 Oct-Dec;15(4):177-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. 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.Spontaneous bacterial peritonitis in cirrhotics: explosion of information.Trop Gastroenterol. 1993 Jul-Sep;14(3):77-8.". In: Trop Gastroenterol. 1993 Jul-Sep;14(3):77-8. 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. "Madan K, Batra Y, Jha JK, Kumar S, Kalra N, Paul SB, Singh R, Duttagupta S, Panda SK, Acharya SK.Clinical relevance of HBV DNA load in patients with chronic hepatitis B infection.Trop Gastroenterol. 2008 Apr-Jun;29(2):84-90.". In: Trop Gastroenterol. 2008 Apr-Jun;29(2):84-90. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2008. Abstract
BACKGROUND: Hepatitis B virus (HBV) DNA detection and quantification are now playing an increasing role in the assessment of disease activity and response to therapy. However, viraemia levels which define various stages of HBV infection have not yet been established. AIM: To define viraemia levels which describe various stages of chronic hepatitis B virus infection. METHODS: In a retrospective study, stored sera samples of chronic hepatitis B virus (CHB) infected patients registered at AIIMS liver clinic, from January 1996 to June 2005 were subjected to competitive, quantitative PCR analysis. RESULTS: The median HBV DNA load was lowest among carriers and highest among patients with chronic hepatitis B [0 (0-8) vs. 7 (0-12) log10 copies/ml, respectively; p<0.05]. As compared to chronic hepatitis patients the DNA load was also lower among cirrhotics [7 (0-12) vs. 4.5 (0-8) log10 copies/ml, respectively; p<0.05] and hepatocellular cancer patients [ 7(0-12) vs. 0 (0-8) log10 copies/ml, respectively; p<0.05]. Patients with carriers had a DNA load which was significantly lower than e antigen negative CHB [0 (0-8) vs. 6 (0-10) log10 copies/ml; p<0.05] or e antigen positive CHB [0 (0-8) vs 8 (0-12) log10 copies/ml; p<0.05]. A threshold of 3.5 log10 copies/ml had sensitivity and specificity of 83% and 58% respectively in differentiating carriers from e antigen negative CHB. There was a strong positive correlation of HBV DNA load with inflammatory grade (R=0.334; p=0.0001), fibrosis stage (R=0.276; p=0.001) and ALT levels (R=0.378; p=0.0001). 82% (9/11) of those who lost e antigen had a decline in HBV DNA levels to <5 log10 copies/ml, whereas only 12.5% (1/8) of those who did not lose e antigen had a decline in DNA load below this level. CONCLUSIONS: HBV DNA viraemia levels correlate positively with the inflammatory grade, fibrosis stage and ALT levels. Most patients who loose e antigen have a decline in DNA load to below 5 log10 copies/ml. Further prospective studies employing repeated measurements are required to define a threshold to differentiate between HBV carriers and e antigen negative CHB.
KIRTDA DRACHARYAS. "Arora A, Sharma MP, Acharya SK, Panda SK, Berry M.Diagnostic utility of ultrasonography in hepatic venous outflow tract obstruction in a tropical country.J Gastroenterol Hepatol. 1991 Jul-Aug;6(4):368-73.". In: J Gastroenterol Hepatol. 1991 Jul-Aug;6(4):368-73. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
The present study was undertaken to define the role of ultrasonography (US) in screening and diagnosis of hepatic venous outflow tract obstruction. Forty-five consecutive patients clinically suspected to have hepatic venous outflow tract obstruction were included in the study for screening by US and for assessment of patency or block in the hepatic vein (HV) and/or inferior vena cava (IVC). Four patients were excluded from the study. Eleven patients had a diagnosis other than hepatic venous outflow tract obstruction and all these patients were found to have patent HV and IVC. Thirty patients were finally diagnosed to have hepatic venous outflow tract obstruction. Using US, as a screening test 27 (90%) out of 30 such cases were correctly identified as cases of hepatic venous outflow tract obstruction and in these cases the site of block in hepatic venous outflow tract (major HV and/or IVC) was correctly diagnosed in 90% of the cases. Our results indicate that US is a sensitive and accurate test and should be the initial investigation for screening and identifying the site of obstruction in patients with hepatic venous outflow tract obstruction.
KIRTDA DRACHARYAS. "Arora A, Seth S, Sharma MP, Acharya SK, Mukhopadhayaya S.Case report: unusual CT appearances in a case of Budd-Chiari syndrome.Clin Radiol. 1991 Jun;43(6):431-2.". In: Clin Radiol. 1991 Jun;43(6):431-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
We describe a case of Budd-Chiari Syndrome due to hepatic venous blockage in which there were multiple space-occupying lesions on CT simulating tumour deposits. Ultrasound directed liver biopsy and laparoscopy proved these to be areas of haemorrhagic necrosis consistent with Budd-Chiari Syndrome without any evidence of malignancy. The CT finding of multiple large focal non-enhancing areas in liver does not always indicate tumour deposits in a patient suspected to have Budd-Chiari Syndrome.
KIRTDA DRACHARYAS. "Kumar A, Bal C, Srivastava DN, Thulkar SP, Sharma S, Acharya SK, Duttagupta S.Management of multiple intrahepatic recurrences after radiofrequency ablation of hepatocellular carcinoma with rhenium-188-HDD-lipiodol.Eur J Gastroenterol Hepatol. 2006 Feb;18(.". In: Eur J Gastroenterol Hepatol. 2006 Feb;18(2):219-23. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
We tried to evaluate the role of dosimetry-guided transarterial radionuclide therapy (TART) with rhenium-188 (Re-188)-4-hexadecyl 1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol (HDD)-lipiodol in a patient with multiple intrahepatic recurrences after radiofrequency ablation of hepatocellular carcinoma (HCC). The dosimetry helped in delivering the maximum possible activity of Re-188, thus the radiation-absorbed dose, safely to the tumour without jeopardizing other organs. There was no procedure-related complication and the patient tolerated therapy well with no adverse effects. The lesions were completely ablated with a single dose of Re-188 and the patient has been disease free for the past 18 months. TART with Re-188-HDD-lipiodol appears to be a promising therapeutic option in patients with HCC who experience recurrence after percutaneous ablative therapy.
KIRTDA DRACHARYAS. "Nagabhusan G, Acharya SK, Joshi YK, Nundy S, Tandon BN.Ultrasonography in portal hypertension: a sensitive noninvasive test to demonstrate portal-vascular anatomy.Gastroenterol Jpn. 1989 Aug;24(4):442-5.". In: Gastroenterol Jpn. 1989 Aug;24(4):442-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
The accuracy of ultrasonography (US) in delineating the portal vascular anatomy was assessed clinically by the clinician in 30 cases of portal hypertension due to noncirrhotic portal fibrosis and extra hepatic portal venous obstruction. Ultrasonography detected portal vein block in 19 and in 11 patients it was found to be patent. These ultrasonic diagnoses were confirmed by spleno-portovenography (SPV) in all, except in 2 cases due to technical failure. Ultrasononic assessment of the splenic vein was found to be accurate in 93.3% (28/30) of cases. SPV also had similar accuracy of splenic vein assessment when compared with the surgical findings. In one patient, intraperitoneal haemorrhage was encounted following SPV, necessitating emergency surgery. Thus, US was found to be as accurate as splenoportovenography in the assessment of portal vascular anatomy. The imaging technique is cheap, easy, safe, and can be repeated as often as necessary. It should be the procedure of choice in assessing the anatomy of portal vascular system.
KIRTDA DRACHARYAS. "Hasegawa I, Tanaka Y, Kramvis A, Kato T, Sugauchi F, Acharya SK, Orito E, Ueda R, Kew MC, Mizokami M.Novel hepatitis B virus genotype a subtyping assay that distinguishes subtype Aa from Ae and its application in epidemiological studies.J Virol. 2004 Jul;.". In: J Virol. 2004 Jul;78(14):7575-81. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
The eight genotypes of hepatitis B virus (HBV) have different geographical distributions, virological characteristics, and clinical manifestations. A unique subtype of HBV genotype A (HBV/A) was reported in sub-Saharan Africa, raising the possibility that patients infected with this subtype (HBV/Aa ["a" for African and Asian]) may have different clinical outcomes than other HBV/A isolates (HBV/Ae ["e" for European]). Comparison between 30 HBV/Aa and 30 HBV/Ae isolates indicated that almost all HBV/Ae isolates had G at nucleotide (nt) 1809 and C at nt 1812, whereas HBV/Aa isolates had T1809/T1812. Taking advantage of these two single nucleotide polymorphisms (SNPs), a novel subtype-specific PCR assay in the X/precore/core region was developed. This assay was combined with a restriction fragment length polymorphism assay using BglII in a different region (nt 1984 to 1989), which has a SNP distinguishing HBV/Aa from HBV/Ae, resulting in 100% specificity for the combined assay. Application of the subtyping assay using sera from 109 paid donors in the United States indicated significantly different distributions of HBV/A subtypes among races; African-Americans, Caucasians, and Hispanics had HBV/Ae, whereas Asians had mainly HBV/Aa, suggesting that the HBV/Aa isolates may have been imported by recent immigration from Asia. In conclusion, the specificity and sensitivity of the combined subtyping assay were confirmed, and its usefulness was demonstrated in a practical context.
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK, Karmarkar MG.Hyperprolactinemia in portosystemic encephalopathy.Indian J Med Res. 1987 Sep;86:372-4.". In: Indian J Med Res. 1987 Sep;86:372-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Jain R, Batra Y, Acharya SK.Post cholecystectomy hemobilia: transcatheter embolization of pseudoaneurysms with homemade steel coils.Indian J Gastroenterol. 2002 Jul-Aug;21(4):161-2.". In: Indian J Gastroenterol. 2002 Jul-Aug;21(4):161-2. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
Two patients presented with hemobilia, one and two months following cholecystectomy. Angiography demonstrated pseudoaneurysms arising form the gastroduodenal and right hepatic arteries. Percutaneous transcatheter embolization of the pseudoaneurysms was successfully performed in both patients using homemade steel coils.
KIRTDA DRACHARYAS. "Acharya SK, Mishra PK.Chronic calcific pancreatitis of the tropics.Trop Gastroenterol. 1984 Jul-Sep;5(3):124-34.". In: Trop Gastroenterol. 1984 Jul-Sep;5(3):124-34. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1984. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Kumar S, Acharya SK.2,6-Dichloro-phenol indophenol prevents switch-over of electrons between the cyanide-sensitive and -insensitive pathway of the mitochondrial electron transport chain in the presence of inhibitors.Anal Biochem. 1999 Mar 1;268(1):89-93.". In: Anal Biochem. 1999 Mar 1;268(1):89-93. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. 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. "Choudhry VP, Acharya SK.Hepatitis B, C & D viral markers in multitransfused thalassemic children: long-term complications and present management.Indian J Pediatr. 1995 Nov-Dec;62(6):655-68.". In: Indian J Pediatr. 1995 Nov-Dec;62(6):655-68. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1995. 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. "Nayak NC, Dutta Gupta S, Tandon A, Dasarathy S, Acharya SK.Pathology of subacute hepatic failure.Indian J Gastroenterol. 1993 Dec;12 Suppl 3:11-4.". In: Indian J Gastroenterol. 1993 Dec;12 Suppl 3:11-4. 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, Acharya SK.An update on viral hepatitis.Trop Gastroenterol. 1992 Jan-Mar;13(1):11-20.". In: Trop Gastroenterol. 1992 Jan-Mar;13(1):11-20. 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. "Sugiyama M, Tanaka Y, Kato T, Orito E, Ito K, Acharya SK, Gish RG, Kramvis A, Shimada T, Izumi N, Kaito M, Miyakawa Y, Mizokami M.Influence of hepatitis B virus genotypes on the intra- and extracellular expression of viral DNA and antigens.Hepatology. 200.". In: Hepatology. 2006 Oct;44(4):915-24. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
Various genotypes of the hepatitis B virus (HBV) induce liver disease of distinct severity, but the underlying virological differences are not well defined. Huh7 cells were transfected with plasmids carrying 1.24-fold the HBV genome of different genotypes/subgenotypes (2 strains each for Aa/A1, Ae/A2, Ba/B2 and D; 3 each for Bj/B1 and C). HBV DNA levels in cell lysates, determined by Southern hybridization, were the highest for C followed by Bj/Ba and D/Ae (P < .01), and the lowest for Aa (P < .01), whereas in culture media, they were the highest for Bj, distantly followed by Ba/C/D and further by Ae/Aa (P < .01). The intracellular expression of core protein was more than 3-fold lower for Ae/Aa than the others. Hepatitis B e antigen (HBeAg) was excreted in a trend similar to that of HBV DNA with smaller differences. Secretion of hepatitis B surface antigen (HBsAg) was most abundant for Ae followed by Aa, Ba, Bj/C and remotely by D, which was consistent with mRNA levels. Cellular stress determined by the reporter assay for Grp78 promoter was higher for C and Ba than the other genotypes/subgenotypes (P < .01). Severe combined immunodeficiency mice transgenic for urokinase-type plasminogen activator (uPA/SCID), with the liver replaced for human hepatocytes, were inoculated with virions passed in mouse and recovered from culture supernatants. HBV DNA levels in their sera were higher for C than Ae by 2 logs during 4-7 weeks after inoculation. In conclusion, virological differences among HBV genotypes were demonstrated both in vitro and in vivo. These differences may influence HBV infections with distinct genotypes in clinical and epidemiological settings.
KIRTDA DRACHARYAS. "Sharma MP, Rai RR, Acharya SK, Ray JC, Tandon BN.Needle aspiration of amoebic liver abscess.BMJ. 1989 Nov 25;299(6711):1308-9.". In: BMJ. 1989 Nov 25;299(6711):1308-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
OBJECTIVE–To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN–Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING–Referral based gastroenterology clinic. PATIENTS–39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION–Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES–Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS–Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS–Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.
KIRTDA DRACHARYAS. "Tanaka Y, Hasegawa I, Kato T, Orito E, Hirashima N, Acharya SK, Gish RG, Kramvis A, Kew MC, Yoshihara N, Shrestha SM, Khan M, Miyakawa Y, Mizokami M.A case-control study for differences among hepatitis B virus infections of genotypes A (subtypes Aa and Ae.". In: Hepatology. 2004 Sep;40(3):747-55. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
There are two subtypes of hepatitis B virus genotype A (HBV/A) and they are provisionally designated Aa ("a" standing for Africa/Asia) and Ae ("e" for Europe). In a case-control study, 78 HBV/Aa, 78HBV/Ae, and 78HBV/D carriers from several countries were compared. The prevalence of HBe antigen (HBeAg) in serum was significantly lower in carriers of HBV/Aa than in carriers of HBV/Ae (31% vs. 49%; P = .033), with a difference more obvious in the carriers aged 30 years or younger (34% vs. 67%; P = .029). HBV DNA levels in the carriers of HBV/Aa (median, 3.46 log copies/mL; 95% CI, 2.93-3.95) were significantly lower than those of carriers of HBV/Ae (6.09 log copies/mL; 95% CI, 4.24-7.64) or of carriers of HBV/D (5.48 log copies/mL; 95% CI, 4.06-7.02), regardless of the HBeAg status (P < .001). The most specific and frequent substitutions in 54 HBV/Aa isolates were double substitutions for T1809 (100%) and T1812 (96%) immediately upstream of the precore initiation codon, which would interfere with the translation of HBeAg in HBV/Aa infections. They were not detected in 57 HBV/Ae or 61 HBV/D isolates examined. The double mutation in the core promoter (T1762/A1764) was more frequent in both HBV/Aa (50%) and HBV/Ae (44%) than in HBV/D isolates (25%; P < .01), whereas the precore mutation (A1896) occurred in HBV/D isolates only (48%; P < .0001). In conclusion, the clearance of HBeAg from serum may occur by different mechanisms in HBV/Aa, HBV/Ae, and HBV/D infections, which may influence clinical manifestations in the Western countries where both genotypes A and D are prevalent. Copyright 2004 American Association for the Study of Liver Diseases
KIRTDA DRACHARYAS. "Sharma MP, Acharya SK, Karmarkar MG.Significance of prolactin levels in protosystemic encephalopathy.J Assoc Physicians India. 1988 Mar;36(3):207-9.". In: J Assoc Physicians India. 1988 Mar;36(3):207-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
Twenty three patients with chronic calcific pancreatitis of the tropics in Northern India were prospectively studied. All had pancreatic calcification and ERCP changes typical of chronic pancreatitis, the most predominant being ductal dilatation which was detected in all patients by both ERCP and by ultrasonography. Pain was present in 19 (83%) patients and diabetes in 11 (48%) patients. Exocrine pancreatic dysfunction was uncommon, steatorrhoea being present in only 9% of patients. Ten of the 11 patients with diabetes required insulin for control and one case was able to be controlled by an oral antidiabetic agent. Two patients developed ketoacidosis during acute episodes of pancreatitis, 3 patients had peripheral neuropathy and one patient had visual changes. Recurrent severe pain was the reason for operation in 7 patients. All had a lateral pancreaticojejunostomy. In order to obtain an objective assessment of pain, a scoring system was developed to grade its severity according to its intensity, frequency and consequences. Six patients who preoperatively had a pain score of 15 or more (out of a maximum score of 24) attained significant relief after the surgery. We feel this scoring system may provide an easy objective assessment of pain in the subsequent follow-up of these patients.
KIRTDA DRACHARYAS. "Acharya SK.Incidental detection of hepatitis B surface antigen: a growing concern for the Indian physician.Trop Gastroenterol. 2002 Apr-Jun;23(2):47-8.". In: Trop Gastroenterol. 2002 Apr-Jun;23(2):47-8. 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. "Bhargava DK, Acharya SK, Tandon BN, Nundy S.Endoscopic sclerotherapy for active variceal haemorrhage in patients not responding to balloon tamponade & vasopressin.Indian J Med Res. 1985 Feb;81:175-9.". In: Indian J Med Res. 1985 Feb;81:175-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1985. Abstract
Nine patients with acute liver failure due to Plasmodium falciparum liver injury admitted to the Rajgarhia Liver Unit of the All-India Institute of Medical Sciences during 1982-84 are presented. The liver was palpable in all the patients, and eight had splenomegaly. Investigations revealed mild to moderate abnormality in liver function tests. All were negative for the markers of acute infection due to hepatitis A and B viruses. Blood film examination showed P. falciparum alone in seven and along with P. vivax in the remaining two patients. Liver histology, which was identical in all eight patients where liver biopsy was done, showed centrizonal necrosis and hyperplastic Kupffer cells loaded with malarial pigment. All the patients recovered with specific anti-malarial and supportive treatment. Our observations suggest that malaria due to P. falciparum may present as jaundice and encephalopathy which stimulates acute hepatic failure due to fulminant hepatitis.
KIRTDA DRACHARYAS. "Panigrahi AK, Roca J, Acharya SK, Jameel S, Panda SK.Genotype determination of hepatitis C virus from northern India: identification of a new subtype.J Med Virol. 1996 Feb;48(2):191-8.". In: J Med Virol. 1996 Feb;48(2):191-8. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract

Hepatitis C virus (HCV) shows substantial nucleotide sequence diversity distributed throughout the viral genome, with many variants showing only 68-79% overall sequence homology. This has led to problems in diagnosis of HCV using commercial immunoassays. Based on clustering of homologous sequences, various genotypes and subtypes of HCV have been described from different geographical regions. In the present study, 11 isolates from India were genotyped using sequence comparison for part of the non-structural (NS5) and structural (core) regions. Parts of the genome covering 451 bp (nt 9-459) of the core gene and a 249 bp fragment (nt 7959-8207) of the NS5 gene were reverse transcribed and amplified using nested polymerase chain reaction (RT-PCR). The amplified fragments were cloned and sequenced. The classification into genotypes was done on the basis of phylogenetic analysis. Four isolates showed sequence homology to type 1b. Two of the isolates were classified as type 3a. One isolate was classified as type 3b and the remaining four isolates were found to be variants of type 3 but did not belong to any designated subtype. On the basis of phylogenetic analysis two of the unclassified isolates were put into a new subtype of 3 named as 3g. In one of these variants, parts of a 5'-noncoding (5' NCR; 204 bp), envelope-E1 (435 bp), and NS3 (502 bp) regions were also amplified, cloned, and sequenced. This study demonstrates the type 3 variants including a new subtype (3g) to be the major cause of HCV infection in India.

KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S.Pharmacotherapy in refractory ascites due to cirrhosis; the search continues.Trop Gastroenterol. 1994 Jan-Mar;15(1):1-2.". In: Trop Gastroenterol. 1994 Jan-Mar;15(1):1-2. 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. "Dasarathy S, Misra SC, Acharya SK, Irshad M, Joshi YK, Venugopal P, Tandon BN.Prospective controlled study of post-transfusion hepatitis after cardiac surgery in a large referral hospital in India.Liver. 1992 Jun;12(3):116-20.". In: Liver. 1992 Jun;12(3):116-20. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
We studied the risk of post-transfusion hepatitis (PTH) in recipients of blood collected from voluntary donors screened for HBsAg. Two hundred and fifty patients without any previous history of liver disease or transfusion were followed up for 12 months subsequent to cardiac surgery. Thirty-five of them had closed-heart surgery without receiving transfusion and served as controls. The remaining 215 patients received single-point transfusions (mean 4 +/- 2.4 units). None of the controls and 15 (6.9%) blood recipients developed PTH. Three (20%) patients had hepatitis-B-virus-induced hepatitis while the remainder (80%) had non A, non B (NANB) hepatitis. The number of units of blood transfused and surrogate markers for development of PTH (donor alanine aminotransferase, anti-HBc and anti-HBs antibody) were not associated with the occurrence of PTH (p greater than 0.05). Nine (60%) of the 15 patients developing PTH were asymptomatic. All the patients recovered from the PTH, except one who died of fulminant hepatitis. At the end of 1 year of follow-up, none of the patients had evidence of chronic hepatitis. Only three (25%) of the patients with NANB-PTH developed anti-hepatitis C virus (HCV) antibody during the follow-up. We conclude that the incidence of PTH in India is similar to other parts of the world and NANB virus was the major cause of the PTH. The absence of chronicity and lack of seroconversion to anti-HCV antibody in the majority of the patients after 1 year of follow-up may suggest the possibility of a NANB virus other than HCV as the major cause of PTH in India.
KIRTDA DRACHARYAS. "Viral hepatitis in India. Natl Med J India. 2006 Jul-Aug;19(4):203-17.". In: Natl Med J India. 2006 Jul-Aug;19(4):203-17. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
Viral hepatitis is a major public health problem in India, which is hyperendemic for HAV and HEV. Seroprevalence studies reveal that 90%-100% of the population acquires anti-HAV antibody and becomes immune by adolescence. Many epidemics of HEV have been reported from India. HAV related liver disease is uncommon in India and occurs mainly in children. HEV is also the major cause of sporadic adult acute viral hepatitis and ALF. Pregnant women and patients with CLD constitute the high risk groups to contract HEV infection, and HEV-induced mortality among them is substantial, which underlines the need for preventive measures for such groups. Children with HAV and HEV coinfection are prone to develop ALF. India has intermediate HBV endemicity, with a carrier frequency of 2%-4%. HBV is the major cause of CLD and HCC. Chronic HBV infection in India is acquired in childhood, presumably before 5 years of age, through horizontal transmission. Vertical transmission of HBV in India is considered to be infrequent. Inclusion of HBV vaccination in the expanded programme of immunization is essential to reduce the HBV carrier frequency and disease burden. HBV genotypes A and D are prevalent in India, which are similar to the HBV genotypes in the West. HCV infection in India has a population prevalence of around 1%, and occurs predominantly through transfusion and the use of unsterile glass syringes. HCV genotypes 3 and 2 are prevalent in 60%-80% of the population and they respond well to a combination of interferon and ribavirin. About 10%-15% of CLD and HCC are associated with HCV infection in India. HCV infection is also a major cause of post-transfusion hepatitis. HDV infection is infrequent in India and is present about 5%-10% of patients with HBV-related liver disease. HCC appears to be less common in India than would be expected from the prevalence rates of HBV and HCV. The high disease burden of viral hepatitis and related CLD in India, calls for the setting up of a hepatitis registry and formulation of government-supported prevention and control strategies.
KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Joshi YK, Tandon BN.Hepatitis B virus replication in patients with chronic liver diseases.Gastroenterol Jpn. 1990 Apr;25(2):258-64.". In: Gastroenterol Jpn. 1990 Apr;25(2):258-64. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
One hundred and seventy five subjects with chronic liver diseases which included patients with chronic active hepatitis (90), liver cirrhosis (31) and asymptomatic hepatitis B carriers (54), were included in the study. Hepatitis B virus (HBV) specific DNA-polymerase activity and HBe-markers were tested as markers of HBV-multiplication. In HBsAg positive samples, DNA-P activity was positive in 44.4% of the HBV carriers, 52.9% of the patients with chronic active hepatitis and 81.8% of the patients with liver cirrhosis. The corresponding figures for the presence of HBeAg in these groups were 18.5, 26.5 and 45.5% respectively. Virus multiplication was also observed in 41.1 and 44.4% patients with chronic active hepatitis and liver cirrhosis respectively, in the absence of HBsAg. The results of the present study show that hepatitis B virus is the most important etiological factor of chronic liver diseases in India. Most of our patients of chronic liver diseases seems to have contacted HBV infection as young adults and the mode of transmission is likely to be horizontal rather than vertical. The virus replicating markers correlate well with the severity of the liver injury and decreased with the age. DNA-P activity is a more sensitive marker of viral multiplication than HBeAg. Viral multiplication was also found to occur in the absence of the usual HBV markers. Continued viral multiplication in patients with chronic active hepatitis and liver cirrhosis is implicated in continued liver injury and progressive liver disease.
KIRTDA DRACHARYAS. "Chaudhuri V, Tayal R, Nayak B, Acharya SK, Panda SK.Occult hepatitis B virus infection in chronic liver disease: full-length genome and analysis of mutant surface promoter.Gastroenterology. 2004 Nov;127(5):1356-71.". In: Gastroenterology. 2004 Nov;127(5):1356-71. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2004. Abstract
BACKGROUND AND AIMS: Genome sequence of hepatitis B virus (HBV) from occult chronic infection is scarce. Fifty-six (9.4%) of 591 patients seronegative for hepatitis B surface antigen (HBsAg) with chronic liver disease were positive for HBV DNA. The complete HBV genome from 9 of these patients (S1-S9) and 5 controls positive for HBsAg (SWT.1-SWT.5) were analyzed. METHODS: Overlapping genome fragment amplification, cloning, and sequencing was performed on these cases. Functional analysis of surface promoter was conducted using fusion construct. RESULTS: All patients with occult infection except one (S8) had a low viral titer. Eight patients had infection with genotype A (S1-S5, SWT.1-2, SWT.5) and 6 had infection with genotype D (S6-S9, SWT.3-4). S4 and S5.1 of genotype A had the characteristic nucleotide deletions in core and pre-S1 region seen in genotype D. The major observations in patients with occult HBV infection were as follows: frequent quasispecies variation, deletions in pre-S2/S region affecting the surface promoters (nt 3025-54) and pre-S protein (S3, S5, S6, S8), truncated precore (S6, S8, S7.1) and core (S9) owing to stop signal, alternate start codon for the Polymerase gene (S3, S9), and YMDD mutation (S1, S4, S9) in patients not on antiviral therapy. HBsAg and core proteins could be shown immunohistochemically in 3 of 5 liver biopsy specimens available. The mutant surface promoters (pre-S2 and S) on functional analysis showed alterations in HBsAg expression. CONCLUSIONS: These changes in the regulatory region with possible alterations in the ratio of large and small surface proteins along with other mutations in the genome may decrease the circulating HBsAg level synergistically, making the immunodetection in serum negative.
KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Tandon BN.Amebic liver abscess and circulating immune complexes of Entamoeba histolytica proteins.Am J Trop Med Hyg. 1988 Nov;39(5):440-4.". In: Am J Trop Med Hyg. 1988 Nov;39(5):440-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1988. Abstract
An enzyme-linked immunosorbent assay (ELISA) has been developed to detect amebic antigen in polyethylene-glycol-precipitable circulating immune complexes. Seventy-nine percent of 191 patients with amebic liver abscesses and 46% of 26 Entamoeba histolytica cyst passers had positive tests. None of the samples from 43 apparently healthy controls, 8 patients with past amebic liver abscesses or 31 patients with Giardia lamblia infections were positive. One patient out of 32 with viral hepatitis and 1 patient out of 27 with intestinal tuberculosis had positive tests.
KIRTDA DRACHARYAS. "Pati HP, Dayal S, Srivastava A, Pande GK, Acharya SK.Spectrum of hemostatic derangements, in Budd-Chiari syndrome.Indian J Gastroenterol. 2003 Mar-Apr;22(2):59-60.". In: Indian J Gastroenterol. 2003 Mar-Apr;22(2):59-60. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2003. Abstract
BACKGROUND: Hemostatic abnormalities have been reported in various hepatocellular diseases. We evaluated the hemostatic functions in patients with Budd-Chiari syndrome. METHODS: Biochemical liver function tests, and measurement of prothrombin time, activated partial thromboplastin time, and plasma levels of anti-thrombin III (antigen) and activity of protein C were done in 36 patients with Budd-Chiari syndrome. RESULTS: Liver biochemistry was abnormal in 34 patients. Plasma prothrombin time and activated partial thromboplastin time were prolonged in 17 (47%) and 23 (64%) patients, respectively. Antithrombin III antigen levels and protein C activity were reduced in 15 (50%) and 25 (83%) patients, respectively, among the 30 patients studied. Albumin levels showed significant correlation with coagulation test results, levels of anti-thrombin-III, and protein C activity. CONCLUSION: Hepatic synthesis of coagulation factors and anticoagulants is reduced in Budd-Chiari syndrome; this may play a role in recurrence of thrombosis.
KIRTDA DRACHARYAS. "Gandhi BM, Irshad M, Acharya SK, Choudhuri G, Tandon BN.Nitroblue tetrazolium test in the diagnosis of amoebic liver abscess. J Assoc Physicians India. 1986 Oct;34(10):711-3.". In: J Assoc Physicians India. 1986 Oct;34(10):711-3. 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. "Modi GK, Shah P, Acharya SK, Guleria R.Portal systemic shunting of insulin does not lead to insulin resistance in patients with extrahepatic portal vein obstruction.Horm Metab Res. 1999 Aug;31(8):462-6.". In: Horm Metab Res. 1999 Aug;31(8):462-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1999. Abstract
There is no clear relation between portal systemic shunting, reduced hepatic insulin extraction leading to an increased systemic delivery of insulin, and, resultant peripheral hyperinsulinemia and insulin resistance. Extrahepatic portal vein obstruction is a natural human model of portal systemic shunting with essentially normal liver function. To investigate the role of portal systemic shunting of insulin in creating systemic hyperinsulinemia and insulin resistance, we studied nine subjects with portal systemic shunting and nine controls matched for age (+/- 2 years), body weight (+/- 2 kg) and height (+/- 5 cm). We carried out an oral glucose tolerance test and hyperinsulinemic euglycemic clamp study at insulin infusion rate of 40 mU/m2/ min. Comparable (p = 0.61) basal insulin concentrations in the two groups (Mean (SE): 21.0 (3.98) vs. 24.1 (4.28) mU/L) demonstrated a lack of hyperinsulinemia in the presence of portal systemic shunting. The lower (p = 0.03) insulin area under curve on oral glucose tolerance test in presence of portal systemic shunting (7.40 (0.95) vs. 10.83 (1.15) U/L-min) indicated that lower extraction of insulin by the liver leads to a lower requirements in the periphery. The coefficient of variation for plasma glucose between 60 and 120 min of the clamps was 4.44 (0.55)%. Comparable (p = 0.82) M-values (6.21 (0.67) vs. 6.38 (0.45) mg/kg/min) in the two groups proved a lack of significant insulin resistance in the presence of portal systemic shunting. We conclude that isolated portal systemic shunting leads to neither hyperinsulinemia nor insulin resistance.
KIRTDA DRACHARYAS. "Acharya SK.Biennial meet of the International Association for the Study of the Liver. Cape Town, 18-24 February 1996.Trop Gastroenterol. 1996 Jul-Sep;17(3):193-6.". In: Trop Gastroenterol. 1996 Jul-Sep;17(3):193-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1996. Abstract
BACKGROUND: Preliminary reports indicate that hepatitis D virus (HDV) infection exists in India. However, its prevalence in patients with different types of liver diseases has not been studied in detail. The aim of this study was to evaluate the status of HDV infection in severe types of liver disease in India. METHODS: Using commercial kits for various hepatitis viral markers, the present study was undertaken to determine the serological status of hepatitis B virus (HBV) and hepatitis D virus (HDV) markers in 208 patients with severe liver diseases. This total included 110 cases with fulminant hepatic failure (FHF), 65 cases with subacute hepatic failure (SHF) and 33 cases with chronic active hepatitis (CAH). RESULTS: The hepatitis B surface antigen (HBsAg) carrier population, indicated by the presence of HBsAg without IgM anti-HBc (hepatitis B core) in serum, was recorded in 23.6%, 24.6% and 60.6% cases of FHF, SHF and CAH groups, respectively. HBV infection, as indicated by serum positivity of IgM anti-HBc in the FHF and SHF groups and HBsAg and/or IgM anti-HBc in the CAH group, was detected in 19.1%, 23.1% and 69.7% of cases from these three groups, respectively. IgM anti-HDV, demonstrating active/recent HDV infection, was found in 8.1% cases of FHF and 9.2% cases of SHF patients. HDV as a superinfection in HBsAg carriers was noted in 4.5% and 4.6% cases, respectively of FHF and SHF groups. Similarly, HDV-HBV coinfection, diagnosed by simultaneous presence of IgM anti-HBc and IgM anti-HDV in the FHF and SHF groups, was recorded in 3.6% and 4.6% of cases from these two groups, respectively. In the CAH group, HDV infection was observed in 9.2% cases. CONCLUSION: HDV infection, recorded in less than 10% of patients with different liver diseases in India, seems to be an unimportant factor in inducing severe liver diseases in this country.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S.Liver failure; varied manifestation and confusing classification.Trop Gastroenterol. 1994 Apr-Jun;15(2):43-4.". In: Trop Gastroenterol. 1994 Apr-Jun;15(2):43-4. 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. "Mohapatra MK, Mohapatra AK, Acharya SK, Sahni P, Nundy S.Encephalopathy in patients with extrahepatic obstruction after lienorenal shunts.Br J Surg. 1992 Oct;79(10):1103-5.". In: Br J Surg. 1992 Oct;79(10):1103-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.
KIRTDA DRACHARYAS. "Paul SB, Gulati MS, Sreenivas V, Madan K, Gupta AK, Mukhopadhyay S, Acharya SK.Evaluating patients with cirrhosis for hepatocellular carcinoma: value of clinical symptomatology, imaging and alpha-fetoprotein.Oncology. 2007;72 Suppl 1:117-23. Epub 2007 Dec.". In: Oncology. 2007;72 Suppl 1:117-23. Epub 2007 Dec 13. 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. "Sharma MP, Acharya SK, Verma N, Dasarathy S.Clinical profile of multiple amoebic liver abscesses.J Assoc Physicians India. 1990 Nov;38(11):837-9.". In: J Assoc Physicians India. 1990 Nov;38(11):837-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1990. Abstract
Of 70 consecutive patients with amoebic liver abscess admitted over a 3 year period, 15 (21.4%) had multiple abscesses. This condition, like solitary abscess, was a disease of the 2nd to 5th decade with a male preponderance. Multiple abscesses were more frequently associated with fever, jaundice, upper abdominal pain, pneumonitis and tender hepatomegaly. The left lobe of the liver was always enlarged in patients with multiple abscesses and 86% of patients required drainage of an abscess cavity. The presence of more severe clinical course, jaundice and left lobe hepatomegaly should raise the suspicion of multiple abscesses. After confirmation of the diagnosis by imaging technique, the abscess cavity should be aspirated for quick relief and cure.
KIRTDA DRACHARYAS. "Bhatia V, Singh R, Acharya SK.Predictive value of arterial ammonia for complications and outcome in acute liver failure.Gut. 2006 Jan;55(1):98-104. Epub 2005 Jul 15.". In: Gut. 2006 Jan;55(1):98-104. Epub 2005 Jul 15. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
BACKGROUND AND AIMS: In acute liver failure (ALF), the brain is exposed to high levels of ammonia. Human studies defining the clinical significance of ammonia in ALF are lacking. This prospective study evaluated the relationship of arterial ammonia levels at admission to complications and survival among patients with ALF. METHODS: Eighty consecutive ALF patients admitted from March 2001 to December 2003 were followed up until death or complete recovery. All had arterial ammonia estimation at admission (enzymatic method). Logistic regression analysis was performed to identify independent predictors of mortality. RESULTS: Forty two (52.5%) patients died. Non-survivors had significantly higher median ammonia levels than survivors (174.7 v 105.0 micromol/l; p<0.001). An arterial ammonia level of > or = 124 micromol/l was found to predict mortality with 78.6% sensitivity and 76.3% specificity, and had 77.5% diagnostic accuracy. Patients with higher ammonia levels also developed more complications, including deeper encephalopathy (p = 0.055), cerebral oedema (p = 0.020), need for ventilation (p<0.001), and seizures (p = 0.006). Logistic regression analysis showed that pH, presence of cerebral oedema, and arterial ammonia at admission were independent predictors of mortality (odds ratios 6.6, 12.6, and 10.9, respectively). Incorporating these variables, a score predicting mortality risk at admission was derived: 2.53 + 2.91 ammonia + 2.41 oedema + 1.40 pH, where ammonia is scored as 0 (if <124 micromol/l) or 1 (if > or =124 micromol/l); oedema is scored as 0 (absent) or 1(present); and pH is scored as 1 (if < or =7.40) or 0 (if >7.40). Levels of partial pressure of ammonia were equally correlated with outcome. CONCLUSION: Arterial ammonia at presentation is predictive of outcome and can be used for risk stratification. Ammonia lowering therapies in patients with ALF should be evaluated.
KIRTDA DRACHARYAS. "Hepatitis G virus in multitransfused thalassaemics from India. J Gastroenterol Hepatol. 1998 Sep;13(9):902-6.". In: J Gastroenterol Hepatol. 1998 Sep;13(9):902-6. 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. "Duseja A, Nada R, Kalra N, Acharya SK, Minz M, Joshi K, Chawla Y.Fibrosing cholestatic hepatitis-like syndrome in a hepatitis B virus and hepatitis C virus-negative renal transplant recipient: a case report with autopsy findings.Trop Gastroenterol. 2003 J.". In: Trop Gastroenterol. 2003 Jan-Mar;24(1):31-4. 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. "Irshad M, Gandhi BM, Acharya SK, Tandon BN.Relation between HBsAg binding with polymerized human serum albumin and HBV replication.Intervirology. 1987;27(2):91-4.". In: Intervirology. 1987;27(2):91-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
The binding between hepatitis B surface antigen (HBsAg) and polymerized human serum albumin (poly-HSA) was studied in HBsAg-negative (25) and HBsAg-positive (92) sera by a sensitive enzyme-linked immunosorbent assay technique, and a correlation of binding activity was made with HBe-markers and hepatitis B virus-specific DNA polymerase. The binding could be detected only in HBsAg-positive sera and was found to be independent of the presence of HBe-markers and DNA polymerase activity. Further, binding was noted in significantly higher proportions of sera samples from the patient group compared with the healthy carrier group (p less than 0.01).
KIRTDA DRACHARYAS. "Acharya SK, Panda SK, Saxena A, Gupta SD.Acute hepatic failure in India: a perspective from the East.J Gastroenterol Hepatol. 2000 May;15(5):473-9.". In: J Gastroenterol Hepatol. 2000 May;15(5):473-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2000. 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. "Kapil A, Sood S, Das BK, Saxena S, Acharya SK.Blood culture for spontaneous bacterial peritonitis. Natl Med J India. 1997 Jan-Feb;10(1):47.". In: Natl Med J India. 1997 Jan-Feb;10(1):47. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1997. Abstract
An enzyme immunoassay (EIA) was developed in-house for the detection of anti-hepatitis C virus (HCV) antibody against the prevailing genotypes in India. The specific reactivity of the test was compared with commercial second and third-generation EIAs and reverse transcription nested polymerase chain reaction (RT-nested PCR). Fifteen thousand nine hundred twenty-two healthy blood donors at the All India Institute of Medical Sciences (AIIMS), New Delhi, India, were screened for anti-HCV antibody. Two hundred ninety-five (1.85%) of these donors were positive. The screening was also used to determine how many patients with acute hepatitis and chronic liver diseases were positive for anti-HCV antibody. Five hundred sixty-four chronic liver disease patients were screened for anti-HCV antibody and 78 (13.83%) were found positive. Two hundred forty-seven sporadic acute viral hepatitis patients were screened for viral infection markers. Hepatitis B and E viruses (HBV and HEV) were the major etiologic agents. HCV was associated with 9% of the acute cases. Anti-HCV core IgM with HCV RNA detection were found to be helpful for the diagnosis of acute HCV infection.
KIRTDA DRACHARYAS. "Irshad M, Acharya SK, Joshi YK, Tandon BN.Role of fibronectin and complement in immunopathogenesis of acute and subacute hepatic failure.J Gastroenterol Hepatol. 1994 Jul-Aug;9(4):355-60.". In: J Gastroenterol Hepatol. 1994 Jul-Aug;9(4):355-60. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
The present study describes the plasma levels of soluble fibronectin (FN), C3d, the breakdown product of C3 complement and Ba, the breakdown product of properdin factor B, in 30 patients of uncomplicated acute viral hepatitis (AVH), 64 patients of fulminant hepatic failure (FHF) and 29 patients of subacute hepatic failure (SAHF) with different hepatitis viral infections. Aetiological analysis of these patients demonstrated hepatitis B, hepatitis C and hepatitis non-A, non-B, non-C (NANB-NC) infections in 6.7, 13.3 and 80% cases, respectively, of the AVH group; 18.8, 42.2. and 39.0% cases, respectively, of the FHF group; and 31.0, 34.5 and 34.5% cases of the SAHF group. None of them had hepatitis A infection. The analysis of data showed that the plasma FN level was significantly reduced in patients with FHF and SAHF as compared to AVH patients and healthy persons. Fibronectin levels in AVH was comparable to that in the healthy group. Further, the FN level was not dependent on the nature of aetiological virus. The level of C3d in plasma was significantly high in all patients of FHF and SAHF, irrespective of their viral aetiology, compared to the AVH group and the healthy group. Like FN, the C3d level was comparable in the AVH and healthy groups. However, the Ba level was comparable to the normal value in all types of infections including the AVH, FHF and SAHF groups. These findings were used to explain the possible roles of fibronectin and complement in the immunopathogenesis of liver injury in patients of acute liver failure of viral aetiology.
KIRTDA DRACHARYAS. "Dasarathy S, Buch P, Saraya A, Acharya SK, Tandon RK. Pancreatic abscess: is there a role for conservative therapy?Trop Gastroenterol. 1993 Jan-Mar;14(1):28-32.". In: Trop Gastroenterol. 1993 Jan-Mar;14(1):28-32. 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. "Role of surface promoter mutations in hepatitis B surface antigen production and secretion in occult hepatitis B virus infection. J Med Virol. 2007 Jan 23;79(3):220-228.". In: J Med Virol. 2007 Jan 23;79(3):220-228. 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. J. Med. Virol. 79:220-228, 2007. (c) 2007 Wiley-Liss, Inc.
KIRTDA DRACHARYAS. "Kaul S, Kapil U, Joshi YK, Gupta MC, Acharya SK, Tandon BN.Hospital malnutrition: a prospective evaluation of patients during hospitalisation.Trop Gastroenterol. 1991 Apr-Jun;12(2):101-3.". In: Trop Gastroenterol. 1991 Apr-Jun;12(2):101-3. 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. "Madan K, Batra Y, Gupta DS, Chander B, Anand Rajan KD, Singh R, Panda SK, Acharya SK.Vitamin E-based therapy is effective in ameliorating transaminasemia in nonalcoholic fatty liver disease.Indian J Gastroenterol. 2005 Nov-Dec;24(6):251-5.". In: Indian J Gastroenterol. 2005 Nov-Dec;24(6):251-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2005. Abstract
BACKGROUND: Comparative trials of ursodeoxycholic acid (UDCA), vitamin E and weight management programs among patients with nonalcoholic fatty liver disease (NAFLD) are lacking. AIM: To find an effective single agent or combination of agents for management of NAFLD. METHODS: In this retrospective study, consecutive patient with histologically confirmed NAFLD with raised ALT were included. The patients received either weight management (exercise and therapeutic lifestyle changes [TLC] diet with a target to reduce body weight 10% in 6 months) (group I) ; weight management + UDCA (300 mg BID) (group II); or weight management + UDCA + vitamin E (400 mg OD) (group III). Outcome measure was normalization of ALT. RESULTS: 42 patients (18, 12 and 12 in groups I, II and III, respectively) were included between 1996 and 2004. All patients in group III normalized their ALT levels, which was significantly higher than numbers in group I (8/18) and group II (5/12); (p=0.003). Post treatment ALT was significantly lower in group III (28.6 [9.3]) as compared to group I (59.3 [32.2]) and group II (49.0[31.8]); (p=0.01). Type of therapy received was the only factor predictive of ALT normalization. CONCLUSION: Combination regimen containing vitamin E appears to be effective in normalizing ALT among NAFLD patients.
KIRTDA DRACHARYAS. "Acharya SK, Vashisht S, Tandon RK.Primary sclerosing cholangitis in India.Gastroenterol Jpn. 1989 Feb;24(1):75-9.". In: Gastroenterol Jpn. 1989 Feb;24(1):75-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
Six patients with PSC have been diagnosed and followed up at a centre in Northern India for periods up to 4 years. They all presented with cholestatic jaundice and cholangitis, but one of them subsequently presented with variceal haemorrhage. Cholangiographic features were the most characteristic and included irregular narrowing and segmental dilatation of the biliary radicles giving them a beaded appearance. Treating them was most frustrating. Two of them died of hepatic encephalopathy, others have also continued to be sick during the follow-up.
KIRTDA DRACHARYAS. "Batra Y, Acharya SK.Acute liver failure: prognostic markers.Indian J Gastroenterol. 2003 Dec;22 Suppl 2:S66-8.". In: Indian J Gastroenterol. 2003 Dec;22 Suppl 2:S66-8. 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. "Tandon BN, Acharya SK.Viral diseases involving the liver.Baillieres Clin Gastroenterol. 1987 Apr;1(2):211-30.". In: Baillieres Clin Gastroenterol. 1987 Apr;1(2):211-30. 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. "Agarwal N, Handa R, Acharya SK, Wali JP, Dinda AK, Aggarwal P.A study of autoimmune markers in hepatitis C infection.Indian J Med Res. 2001 May;113:170-4.". In: Indian J Med Res. 2001 May;113:170-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2001. Abstract
BACKGROUND & OBJECTIVES: Hepatitis C virus (HCV) infection is associated with several autoimmune markers. Despite HCV being common in India, no information on this aspect is available. This study was undertaken to ascertain the frequency and clinical significance of autoimmune markers like rheumatoid factor (RF), antinuclear antibodies (ANA), antibodies to double stranded deoxyribonucleic acid (dsDNA), anti neutrophil cytoplasmic antibody (ANCA), anti smooth muscle antibodies (ASMA), anti liver kidney microsomal 1 antibodies (anti LKM1), anti gastric parietal cell antibodies (anti GPCA), anti mitochondrial antibodies (AMA), anti cardiolipin antibodies (ACL) and cryoglobulins in HCV infection and to determine the effect of treatment on these markers. METHODS: Twenty five patients with chronic hepatitis C and 25 healthy controls were studied. Cryoglobulins were detected by cryoprecipitation, RF by latex agglutination, anti dsDNA and ACL by ELISA while indirect immunofluorescence was used to detect all other autoantibodies. RESULTS: Eighteen patients (72%) demonstrated autoimmune markers. RF, cryoglobulins and anti LKM1 antibodies were the most frequently detected markers (in 32% patients each). ASMA, perinuclear ANCA (pANCA), ANA and anti GPCA were seen in 24, 20, 12 and 4 per cent patients respectively. None of the patients exhibited ACL, AMA or antibodies to dsDNA. No antibodies were detected in healthy controls. Sixty per cent of the patients had rheumatological symptoms. Of the seven patients followed up after treatment with alpha interferon, only two exhibited persistence of RF, while symptoms and other markers disappeared. INTERPRETATION & CONCLUSION: Rheumatological symptoms and autoimmune markers are common in HCV infection and are usually overlooked. Patients with unexplained joint pains and/or palpable purpura should be screened for HCV. Further studies are needed to delineate fully the link between infection and autoimmunity.
KIRTDA DRACHARYAS. "Kumar M, Prashad R, Kumar A, Sharma R, Acharya SK, Chattopadhyay TK. Relative merits of ultrasonography, computed tomography and cholangiography in patients of surgical obstructive jaundice.Hepatogastroenterology. 1998 Nov-Dec;45(24):2027-32.". In: Hepatogastroenterology. 1998 Nov-Dec;45(24):2027-32. 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. "Davies MH, Ngong JM, Yucesoy M, Acharya SK, Mills CO, Weaver JB, Waring RH, Elias E.The adverse influence of pregnancy upon sulphation: a clue to the pathogenesis of intrahepatic cholestasis of pregnancy?J Hepatol. 1994 Dec;21(6):1127-34.". In: J Hepatol. 1994 Dec;21(6):1127-34. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1994. Abstract
Sulphation of oestrogens and monohydroxy bile acids is important in attenuating their cholestatic potential. Thus, impairment of sulphation could lead to retention of cholestatic compounds and precipitate intrahepatic cholestasis in susceptible individuals. We tested the hypothesis that such a mechanism may be involved in the pathogenesis of intrahepatic cholestasis of pregnancy. In vivo and in vitro assessment of sulphation capacity was performed in patients with cholestasis of pregnancy, compared with control females on and off the oestrogen-containing oral contraceptive pill and control individuals during normal pregnancy and post partum, to assess the influence of high oestrogen states upon this metabolic pathway. During in vivo studies utilising paracetamol as a metabolic probe, the proportion of paracetamol sulphate and sulphate: glucuronide ratio were decreased in those with elevated oestrogens, whether the rise in oestrogens was endogenous, in pregnancy (paracetamol sulphate p < 0.05; paracetamol sulphate:glucuronide ratio p < 0.01), or exogenous, with the contraceptive pill (paracetamol sulphate p = 0.2; paracetamol sulphate:glucuronide ratio p < 0.001). In vitro, platelet sulphotransferase activity was measured, utilising phenol as substrate. Sulphotransferase activity decreased during pregnancy compared with repeat measurements post partum (p < 0.005) and compared with non-pregnant individuals (p < 0.05). In conclusion, we have shown that elevated oestrogens are associated with significant impairment in sulphation capacity. An imbalance of sulphation with glucuronidation provoked by high circulating oestrogen levels may be contributory in the pathogenesis of cholestasis of pregnancy.
KIRTDA DRACHARYAS. "Acharya SK, Dasarathy S, Tandon A, Joshi YK, Tandon BN.A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure.Indian J Med Res. 1993 Apr;98:69-74.". In: Indian J Med Res. 1993 Apr;98:69-74. 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. "Bhardwaj P, Garg PK, Maulik SK, Saraya A, Tandon RK, Acharya SK.A Randomized Controlled Trial of Antioxidant Supplementation for Pain Relief in Patients with Chronic Pancreatitis.Gastroenterology. 2008 Sep 25. [Epub ahead of print].". In: Gastroenterology. 2008 Sep 25. [Epub ahead of print]. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2008. Abstract
{ BACKGROUND & AIMS: Oxidative stress has been implicated in the pathophysiology of chronic pancreatitis (CP). We evaluated the effects of antioxidant supplementation on pain relief, oxidative stress and antioxidant status in patients with CP. METHODS: In a placebo-controlled double blind trial, consecutive patients with CP were randomized to groups that were given placebo or antioxidants for 6 months. The primary outcome measure was pain relief, and secondary outcome measures were analgesic requirements, hospitalization, and markers of oxidative stress (thiobarbituric acid-reactive substances [TBARS]) and antioxidant status (ferric-reducing ability of plasma [FRAP]). RESULTS: Patients (age 30.5 +/- 10.5 years, 86 male, 35 alcoholic and 92 with idiopathic CP) were assigned to the placebo (n = 56) or antioxidant groups (n = 71). After 6 months, the reduction in the number of painful days per month was significantly higher in the antioxidant group compared with the placebo group (7.4 +/- 6.8 vs 3.2 +/- 4, respectively; P < .001; 95% CI, 2.07, 6.23). The reduction in the number of analgesic tablets per month was also higher in the antioxidant group (10.5 +/- 11.8 vs 4.4 +/- 5.8 respectively; P = .001; 95% CI, 2.65, 9.65). Furthermore, 32% and 13% of patients became pain free in the antioxidant and placebo groups, respectively (P = .009). The reduction in the level of TBARS and increase in FRAP were significantly higher in the antioxidant group compared with the placebo group (TBARS: placebo 1.2 +/- 2.7 vs antioxidant 3.5 +/- 3.4 nmol/mL; P = .001; 95% CI 0.96, 3.55; FRAP: placebo -5.6 +/- 154.9 vs antioxidant 97.8 +/- 134.9 muMFe(+2) liberated
KIRTDA DRACHARYAS. "Nijhawan S, Arora A, Acharya SK, Mukhopadhyyay S.Colon carcinoma presenting as a fever of unknown origin.J Clin Gastroenterol. 1991 Apr;13(2):243-4.". In: J Clin Gastroenterol. 1991 Apr;13(2):243-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
We describe a case of Budd-Chiari Syndrome due to hepatic venous blockage in which there were multiple space-occupying lesions on CT simulating tumour deposits. Ultrasound directed liver biopsy and laparoscopy proved these to be areas of haemorrhagic necrosis consistent with Budd-Chiari Syndrome without any evidence of malignancy. The CT finding of multiple large focal non-enhancing areas in liver does not always indicate tumour deposits in a patient suspected to have Budd-Chiari Syndrome.
KIRTDA DRACHARYAS. "Bose B, Khanna N, Acharya SK, Sinha S.Generation and characterization of a high-affinity chimaeric antibody against hepatitis B surface antigen.Biotechnol Appl Biochem. 2006 Feb;43(Pt 2):93-101.". In: Biotechnol Appl Biochem. 2006 Feb;43(Pt 2):93-101. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
Antibody against HBsAg (hepatitis B surface antigen) is advocated for the passive immunotherapy in certain cases of hepatitis B infections. A recombinant monoclonal antibody against HBsAg would offer several advantages over the currently used polyclonal human hepatitis B immunoglobulin. 5S is a mouse monoclonal antibody that binds to HBsAg with very high affinity. However, this mouse antibody cannot be used for therapeutic purposes, as it may elicit antimouse immune responses. Chimaerization, by replacing mouse constant domains with human counterparts, can reduce the immunogenicity of this molecule. We have cloned the V(H) (heavy-chain variable region) and V(L) (light-chain variable region) genes of this mouse antibody, and fused them with C(H)1 (heavy-chain constant domain 1) of human IgG1 and C(L) (light-chain constant domain) of human kappa chain respectively. These chimaeric genes were cloned into a mammalian expression vector (pFab-CMV), which has a modular cassette coding for part of the hinge, C(H)2 and C(H)3 of human IgG1. The recombinant construct was transfected in CHO (Chinese-hamster ovary) cells to generate a stable transfectoma. The resulting transfectoma was maintained in a serum-free medium and the full-length chimaeric anti-HBsAg antibody was purified from the culture supernatant. The yield of the purified chimaeric antibody was moderate ( approximately 5.5 mg/l). We further characterized the chimaeric antibody using several in vitro techniques. It was observed that the chimaeric molecule was glycosylated and expressed in the expected heterodimeric form. This chimaeric antibody has very high affinity and specificity, similar to that of the original mouse monoclonal antibody.
KIRTDA DRACHARYAS. "Anand AC, Irshad M, Acharya SK, Gandhi BM, Joshi YK, Tandon BN.Fibronectin in acute and subacute hepatic failure.J Clin Gastroenterol. 1989 Jun;11(3):314-9.". In: J Clin Gastroenterol. 1989 Jun;11(3):314-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
The mean plasma fibronectin (FN) concentrations in 30 patients with fulminant hepatic failure (FHF) and in 10 patients with subacute hepatic failure (SAHF) were 111.2 +/- 70 and 123.5 +/- 46.5 micrograms/ml, respectively, significantly lower than that of normal controls (362.0 +/- 69.2 micrograms/ml) and patients with uncomplicated viral hepatitis (320 +/- 58.5 micrograms/ml) (p less than 0.001). Plasma FN levels showed significant negative correlation with serum glutamic pyruvate transaminase values in the FHF group (p less than 0.02) and with prothrombin time in the SAHF group (p less than 0.02). Serial estimation of plasma FN showed that failure of FN levels to rise despite fresh plasma infusions indicates poor prognosis in these patients. The reduced availability of FN may be responsible for the impaired Kupffer cell function and consequent increased susceptibility to endotoxemia and the bacterial infections seen in these patients.
KIRTDA DRACHARYAS. "Acute liver failure: prognostic markers. Indian J Gastroenterol. 2003 Dec;22 Suppl 2:S66-8.". In: Indian J Gastroenterol. 2003 Dec;22 Suppl 2:S66-8. 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. "Tandon BN, Rana S, Acharya SK.Bedside ultrasonography. A low-cost definitive diagnostic procedure in obstructive jaundice.J Clin Gastroenterol. 1987 Jun;9(3):353-6.". In: J Clin Gastroenterol. 1987 Jun;9(3):353-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1987. Abstract
We evaluated real-time ultrasonography carried out by gastroenterologists for its diagnostic accuracy in 89 patients with obstructive jaundice. The positive predictive values for the site and nature of the obstruction were 94.3 and 89.9%, respectively. The advanced stage of disease in our patients and the clinical background of the investigators may have contributed to the high diagnostic accuracy of ultrasonography in this study. Nevertheless, we recommend that gastroenterologists themselves perform bedside ultrasonography for a definitive diagnosis in patients with obstructive jaundice. The high degree of precision achieved by ultrasound in our setting makes more expensive investigations unnecessary as routine procedures.
KIRTDA DRACHARYAS. "Batra Y, Bhatkal B, Ojha B, Kaur K, Saraya A, Panda SK, Acharya SK.Vaccination against hepatitis A virus may not be required for schoolchildren in northern India: results of a seroepidemiological survey.Bull World Health Organ. 2002;80(9):728-31.". In: Bull World Health Organ. 2002;80(9):728-31. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2002. Abstract
OBJECTIVES: To evaluate the current seroprevalence of antibodies against hepatitis A virus (HAV) in a sample of schoolchildren above 10 years of age and to determine the prevalence of HAV-induced hepatitis in adults at a tertiary care hospital in northern India between January 1992 and December 2000. METHODS: Sera from 276 male and 224 female schoolchildren aged 10-17 years were tested for anti-HAV antibodies by enzyme-linked immunosorbent assay. Consecutive patients with a diagnosis of acute viral hepatitis who attended a liver clinic were tested for the serological markers of HAV, hepatitis B Virus, hepatitis C virus, hepatitis D virus, and hepatitis E virus. FINDINGS: Of the male and female children, 96.3% and 98.2%, respectively had anti-HAV antibodies in their sera. The prevalence of these antibodies in the age groups 10-12, 13- 14, and 15-17 years were 98.6%, 94.8%, and 98.3% respectively. The frequency of HAV- induced acute viral hepatitis (69/870, 8%) in adults did not show an increasing trend. CONCLUSION: Mass HAV vaccination may be unnecessary in northern India because the seroprevalence of protective antibodies against HAV in schoolchildren aged over 10 years remains above 95% and there has been no apparent increase in HAV-induced acute viral hepatitis in adults.
KIRTDA DRACHARYAS. "Raina N, Das SR, Acharya SK, Tandon BN.Nutritional factors in the etiopathogenesis of amoebic liver abscess in golden hamsters.Indian J Med Res. 1984 Feb;79:216-22.". In: Indian J Med Res. 1984 Feb;79:216-22. 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. "Mechanisms behind hepatitis B virus persistence: the search continues. Indian J Gastroenterol. 1998 Jul-Sep;17(3):76-9.". In: Indian J Gastroenterol. 1998 Jul-Sep;17(3):76-9. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1998. Abstract
To evolve a simple oxygen electrode-based method to estimate alternative respiration, one needs to develop a procedure to prevent switch-over of electrons to either pathway upon inhibition by cyanide or salicylhydroxamic acid. It was hypothesized that the inclusion of appropriate electron acceptor, possessing redox potential close to one of the electron transport carriers in between ubiquinone (branch point) and cytochrome a-a3, should be able to stop switch-over of electrons to either pathway by working as an electron sink. To test the hypothesis, 2,6-dichloro-phenol indophenol (DCPIP; redox potential +0.217 V), an artificial electron acceptor having a redox potential quite similar to the site near cytochrome c1 (redox potential +0.22 V) on the cyanide-sensitive pathway, was used with isolated mitochondria and leaf discs in the absence and presence of inhibitors (potassium cyanide, antimycin A, and salicylhydroxamic acid). Polarographic data confirmed electron acceptance by DCPIP only from the inhibited (by cyanide or salicylhydroxamic acid) mitochondrial electron transport chain, hence preventing switch-over of electrons between the cyanide-sensitive and cyanide-insensitive pathway of respiration. Results with antimycin A and reduction status of DCPIP further confirmed electron acceptance by DCPIP from the mitochondrial electron transport chain. Possible implications of the results have been discussed. Copyright 1999 Academic Press.
KIRTDA DRACHARYAS. "Irshad M, Acharya SK, Joshi YK.Prevalence of hepatitis C virus antibodies in the general population & in selected groups of patients in Delhi.Indian J Med Res. 1995 Oct;102:162-4.". In: Indian J Med Res. 1995 Oct;102:162-4. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1995. Abstract
We report on the prevalence of anti-HCV antibodies in healthy individuals and patient groups with different liver diseases. The healthy population comprising 234 voluntary blood donors and 65 pregnant women with no history of liver diseases, had a per cent positivity of 1.5 anti-HCV in each group. The patients groups comprising 32 with acute viral hepatitis, 110 with fulminant hepatic failure, 65 with subacute hepatic failure, 33 with chronic active hepatitis, 45 with cirrhosis and 10 with hepatocellular carcinoma, had anti-HCV per cent positivity of 12.5, 43.6, 41.5, 48.5, 8.8 and 0 respectively. Anti-HCV was also tested in sera from 9 patients who had developed post-transfusion hepatitis and was recorded in 2 (22.2%) within one year of transfusion.
KIRTDA DRACHARYAS. "Acharya SK, Panda SK, Duphare H, Dasarathy S, Ramesh R, Jameel S, Nijhawan S, Irshad M, Tandon BN.Chronic hepatitis in a large Indian hospital.Natl Med J India. 1993 Sep-Oct;6(5):202-6.". In: Natl Med J India. 1993 Sep-Oct;6(5):202-6. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1993. Abstract
BACKGROUND. In developed countries as well as in Southeast Asia, the hepatitis B and C viruses are the main causes of chronic hepatitis. In India, however, there have been no major investigations on the aetiology of chronic hepatitis. (The hepatitis E virus which is responsible for half the sporadic and most of the epidemic cases of acute viral hepatitis in India does not cause chronic disease.) We, therefore, studied the profile of chronic hepatitis in India. METHODS. The clinical presentation, aetiology, serology and histological changes were studied prospectively in 48 patients with chronic hepatitis admitted to the All India Institute of Medical Sciences, New Delhi. Of these, 44 (92%) had chronic active hepatitis, 3 (6.3%) had chronic persistent hepatitis and 1 (2%) had chronic lobular hepatitis. RESULTS. The hepatitis B virus was the aetiological agent in 24 (50%) of these patients, the hepatitis D virus in association with hepatitis B virus in 10 (21%), the hepatitis C virus in 7 (15%) and the non-A, non-B viruses other than the hepatitis C virus in 6 (13%). One patient (2.0%) had autoimmune chronic active hepatitis. Jaundice at presentation was seen in 33 (69%) patients and more than half had hypoalbuminaemia (< 3 g/dl) with a prolonged prothrombin time. Alanine aminotransferase levels were less than 5 times above normal in over two-thirds of the patients. The highest alanine aminotransferase values were observed in patients with hepatitis D virus infection whereas the lowest were seen in patients with non-A, non-B related chronic active hepatitis. Histological examination revealed bridging necrosis in 40 (91%) patients with chronic active hepatitis indicating a severe form of disease. Replication of the hepatitis B virus was seen in 13 patients with chronic hepatitis, 5 of whom had hepatitis D virus-induced chronic hepatitis. Patients with hepatitis B virus replication had higher alanine aminotransferase values and more severe bridging necrosis than patients who did not have replicating viruses. Higher alanine aminotransferase values, ascites and oesophageal varices were encountered more frequently in patients with hepatitis B and D virus than in those with non-A, non-B related chronic hepatitis. CONCLUSION. Chronic hepatitis is not uncommon in India. It presents with evidence of severe disease and, as elsewhere, is most frequently caused by the hepatitis B virus.
KIRTDA DRACHARYAS. "Acharya SK, Balwinder S, Padhee AK, Nijhawan S, Tandon BN.Large volume paracentesis and intravenous dextran to treat tense ascites.J Clin Gastroenterol. 1992 Jan;14(1):31-5.". In: J Clin Gastroenterol. 1992 Jan;14(1):31-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1992. Abstract
Forty patients with cirrhosis of the liver and tense ascites were randomized to receive either aldactone 400 mg/day and furosemide 80 mg/day (n = 20) or repeated large volume paracentesis (LVP) and infusion of low molecular weight dextran (n = 20). Both treatment groups were similar in clinical and laboratory parameters. Complete mobilization of the ascitic fluid was achieved in all receiving LVP and dextran therapy within 1 week of the treatment, in contrast to the minimal mobilization of the ascitic fluid in patients receiving diuretics even after 2 weeks of therapy. Renal function, the clinical parameters of systemic hemodynamics, serum electrolytes, and hepatic function remained stable in patients receiving LVP and dextran and were similar to those in the diuretic-treated patients. We found no deterioration of these functions in the nonedematous patients treated by LVP and dextran even though the protective effect of edema against LVP was lacking in them. Plasma volume estimation in six nonedematous cirrhotic patients treated by LVP and dextran did not reveal any hypovolemia after complete mobilization of ascites. The frequency of complications and death were similar in the two groups. Dextran infusion is a safe, effective, and low-cost replacement therapy in patients with cirrhotic ascites treated by LVP.
KIRTDA DRACHARYAS. "Tandon BN, Irshad M, Acharya SK, Joshi YK.Hepatitis C virus infection is the major cause of severe liver disease in India.Gastroenterol Jpn. 1991 Jul;26 Suppl 3:192-5.". In: Gastroenterol Jpn. 1991 Jul;26 Suppl 3:192-5. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1991. Abstract
The present study describes the status of hepatitis C virus infection in 167 patients with severe forms of liver diseases in India. The anti-HCV positivity rate was recorded as 43%, 47%, and 42% in patients with FHF, SAHF, and CAH respectively. HBV and HCV coinfection was recorded in 28% of FHF, 43% of SAHF and 75% of the CAH cases. Superinfection of HCV in HBsAg carriers was recorded in the 54% cases of FHF, 60% of SAHF and 42% of the CAH. None of these 167 patients was positive of HAV-IgM. Further, 27.7% of FHF, 26.4% of SAHF and 15.2% of CAH cases were neither HBV nor HCV markers positive. These can be labelled as non-A, non-B and non-C infections.
KIRTDA DRACHARYAS. "Bose B, Khanna N, Acharya SK, Sinha S.Generation and characterization of a single-gene mouse-human chimeric antibody against hepatitis B surface antigen.J Gastroenterol Hepatol. 2006 Sep;21(9):1439-47.". In: J Gastroenterol Hepatol. 2006 Sep;21(9):1439-47. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 2006. Abstract
BACKGROUND: Antibody against hepatitis B surface antigen (HBsAg) is used for passive immunotherapy in certain cases of hepatitis B infection. The authors have earlier reported a high-affinity mouse monoclonal (5S) against HBsAg. However, this mouse antibody cannot be used for therapeutic purposes because it may elicit antimouse immune responses. Chimerization by replacing mouse constant domains with human ones can reduce the immunogenicity of this antibody. METHODS: A single-chain variable fragment (scFv), derived from the mouse monoclonal 5S, was fused with the fragment crystallisable (Fc) fragment of human IgG1. The scFv region is expected to bind to the antigen, whereas the Fc fragment can provide the effector functions required for virus neutralization. This chimeric molecule was expressed in Chinese hamster ovary (CHO) cells in serum-free medium. It was purified by affinity chromatography and characterized by in vitro binding studies. RESULTS: Purification and characterization indicated that this chimeric scFv-Fc fusion protein is secreted as a disulfide-linked, glycosylated, homodimeric molecule. The yield of the purified chimeric antibody was approximately 4.6 mg/L. In vitro analyses confirmed that this chimeric molecule retained the high affinity and specificity of the original mouse monoclonal. CONCLUSION: Because it is a single-gene product, this chimeric scFv-Fc has the advantage of stable expression. Being chimeric and bivalent, it is expected to be less immunogenic and therefore suitable for further in vivo studies on virus neutralization.
KIRTDA DRACHARYAS. "Arora A, Acharya SK.Ultrasonography in portal hypertension.Indian J Gastroenterol. 1989 Oct;8(4):307.". In: Indian J Gastroenterol. 1989 Oct;8(4):307. The Icfai University Journal of Architecture, Vol. II No.1, February 2010; 1989. Abstract
OBJECTIVE–To determine the value of needle aspiration in uncomplicated amoebic liver abscess. DESIGN–Randomised case-control study with a minimum follow up of one year, comparing patients treated with drugs alone with those treated with additional needle aspiration. SETTING–Referral based gastroenterology clinic. PATIENTS–39 Consecutive patients with amoebic liver abscess in the right lobe, of whom 37 completed the study. INTERVENTION–Metronidazole 2.4 g/day was given to all patients for 10 days. Needle aspiration of the abscess was performed in 19 patients on the day of admission to hospital. MAIN OUTCOME MEASURES–Abdominal pain, fever, anorexia, and hepatomegaly were measured. Erythrocyte sedimentation rate, serum aspartate, and alanine aminotransferase activities, and alkaline phosphatase activity were also measured. RESULTS–Clinical improvement was similar in both groups of patients. Improvement in haematological and biochemical variables and rates of healing of cavities were also similar. CONCLUSIONS–Chemotherapy with potent tissue amoebicidal drugs such as metronidazole is optimally effective in treating amoebic liver abscess, and in uncomplicated cases routine aspiration is not required.

UoN Websites Search