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What zinc supplementation does and does not achieve in diarrhea prevention: A systematic review and meta-analysis.

10 July, 2014 Publications
What zinc supplementation does and does not achieve in diarrhea prevention: A systematic review and meta-analysis.

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Background: Prevention of diarrhea has presented indomitable challenges. A preventive strategy that has received significant interest is zinc supplementation. Existing literature including quantitative meta-analyses and systematic reviews tend to show that zinc supplementation is beneficial however evidence to the contrary is augmenting. We therefore conducted an updated and comprehensive meta-analytical synthesis of the existing literature on the effect of zinc supplementation in prevention of diarrhea. METHODS: EMBASE(R), MEDLINE (R) and CINAHL(R) databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. Effect of zinc supplementation on the following five outcomes was studied: incidence of diarrhea, prevalence of diarrhea, incidence of persistent diarrhea, incidence of dysentery and incidence of mortality. The published RCTs were combined using random-effects meta-analyses, subgroup meta-analyses, meta-regression, cumulative meta-analyses and restricted meta-analyses to quantify and characterize the role of zinc supplementation with the afore stated outcomes. RESULTS: We found that zinc supplementation has a modest beneficial association (9% reduction) with incidence of diarrhea, a stronger beneficial association (19% reduction) with prevalence of diarrhea and occurrence of multiple diarrheal episodes (28% reduction) but there was significant unexplained heterogeneity across the studies for these associations. Age, continent of study origin, zinc salt and risk of bias contributed significantly to between studies heterogeneity. Zinc supplementation did not show statistically significant benefit in reducing the incidence of persistent diarrhea, dysentery or mortality. In most instances, the 95% prediction intervals for summary relative risk estimates straddled unity. CONCLUSIONS: Demonstrable benefit of preventive zinc supplementation was observed against two of the five diarrhea-related outcomes but the prediction intervals straddled unity. Thus the evidence for a preventive benefit of zinc against diarrhea is inconclusive. Continued efforts are needed to better understand the sources of heterogeneity. The outcomes of zinc supplementation may be improved by identifying subgroups that need zinc supplementation.
BMC Infect Dis, 2011 May 12;11(1):122.

 

By: Patel AB, Mamtani M, Badhoniya N, Kulkarni H

Risk Factors for predicting diarrheal duration and morbidity in children with acute diarrhea.

10 July, 2014 Publications
Risk Factors for predicting diarrheal duration and morbidity in children with acute diarrhea.

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Background: A third of the hospital admissions in developing countries are due to diarrhea related diseases, with 17% mortality mostly due to dehydration, prolongation of acute diarrhea and its complications Objectives: To identify baseline risk factors for prolonged diarrheal duration and subsequent complications in 808 children aged 6 to 59 months of acute diarrhea who participated in a micronutrient clinical trial in a tertiary care hospital. Methods: The adjusted odds ratio or incidence risk ratios (IRR) of the baseline variables for prolongation of diarrheal duration (cox proportional hazard model), diarrhea > 7 days (multiple logistic regression), severe dehydration experienced after hospitalization (poisson regression models) was estimated. Results: Younger age (OR 1.02, 95%CI 1.01, 1.03, p< 0.001), fever (OR 1.10, 95% CI 1.02-1.19, p=0.02), dehydration (OR 1.32, 95% CI 1.10-1.59, p=0.003), dysentery (OR 1.41 95% CI 1.09-1.82, p=0.008), those who received medications (OR 1.19, 95% CI 1.03-1.39, p=0.02), and weight for age Z score 7 days was associated with younger age (OR 1.08 , 95% CI 1.03-1.14, p=0.003), female child (OR 2.33, 95% CI 1.19-4.55, p=0.013) , diarrheal duration before enrolment (OR 1.06, 95% CI 1.04-1.09, p<0.001), fever (OR 1.7, 95% CI 1.23-2.49, p=0.002) and the weight for age Z score Ind J Pediatr: In Press.

 

By: Patel AB, Ronithung O, Badhoniya N, Dibley MJ

Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey.

10 July, 2014 Publications
Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey.

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Background: Early detection of β-thalassemia (β-thal) trait is important. Voluntary blood donors represent an important group who are accessible and cooperative for this purpose. However, the usefulness of this population in β-thal trait detection programs has not been studied in India. We conducted a hematological survey of 5,045 blood donors who visited the Bhopal Memorial Hospital & Research Centre, Bhopal in central India. Using robust Bayesian methods, we estimated the prevalence of β-thal trait. The overall prevalence of β-thal trait in the study population was 9.59% [95% confidence interval (95% CI) 8.78-10.4%]. The prevalence of β-thal trait varied across the states of origin and within the state of Madhya Pradesh. We observed a cline effect for β-thal trait prevalence in relation to the latitude (p = 0.024). We conclude that blood donors offer an attractive adjunct to β-thal trait detection in national programs. Our study also offers insights into the β-thal trait gene flow and migration in India.
Hemoglobin, 2010; 34(6):548-60.

 

By: Chatterjee N, Mishra A, Soni R, Kulkarni H, Mamtani M, Shrivasatava M

Ultrafast papanicolaou stain modified for developing countries: efficacy and pitfalls.

10 July, 2014 Publications
Ultrafast papanicolaou stain modified for developing countries: efficacy and pitfalls.

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Objective: To study the efficacy of the ultrafast Papanicolaou (UFP) staining technique for immediate cytologic diagnosis, to check specimen adequacy during radiologically guided fine needle aspiration cytology (FNAC) procedures and to objectively assess the quality of UFP stain and factors affecting it. STUDY DESIGN: Serial and random samples of cytologic material from 347 patients during a 2-year period were divided in 3 groups. Group I included 238 outpatient FNACs, group II included 59 radiologically guided FNACs, and group III included 50 cases of intraoperative cytology. After staining air-dried smears with UFP stain, immediate diagnosis was given. In group II, material adequacy was also conveyed to the radiologist. RESULTS: Overall diagnosis was possible in 297 (85.6%) cases. Only 8 (2.3%) cases could not be diagnosed due to staining difficulties. The overall concordance rate was 98%. Seventy-five percent of cases showed excellent and good morphology, allowing easy diagnosis. In 25% of fair cases diagnosis was still possible, although with some difficulties. Factors affecting the quality of staining are discussed. CONCLUSION: The UFP staining technique is an accurate and reliable method for rapid cytology reporting. It significantly reduces total turn around time of the test result, thereby having the potential to be cost-effective, both for the patient and the hospital.
Acta Cytol, 2011: 55(2):205-12.

 

By: Kamal MM, Kulkarni MM, Wahane RN

Hemoglobin F levels influence the results of NESTROFT: replication in two surveys.

10 July, 2014 Publications
Hemoglobin F levels influence the results of NESTROFT: replication in two surveys.

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Abstract not available
Int J Lab Hematol, 2010: 33(1):113-5.

 

By: Mamtani M, Chatterjee N, Mishra A, Soni R, Jawahirani A, Das K, Rughwani V, Shrivastava M, Kulkarni H

Using wholre blood γ-interferon assay to improve diagnosis of tuberculous pleural effusion.

10 July, 2014 Publications
Using wholre blood γ-interferon assay to improve diagnosis of tuberculous pleural effusion.

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Abstract not available.
Eur Respir J 2010; 36(3):679-81.

 

By: Katiyar SK, Sampath A, Bohari S, Mamtani M, Kulkarni H

Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism.

10 July, 2014 Publications
Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism.

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Background: Zinc supplementation is recommended in all acute diarrheas in children from developing countries. We aimed to assess whether zinc supplementation would be equally effective against all the common organisms associated with acute diarrheas. We used data on 801 children with acute diarrhea recruited in a randomized, double blind controlled trial (ISRCTN85071383) of zinc and copper supplementation. Using prespecified subgroup analyses, multidimensionality reduction analyses, tests of heterogeneity, and stepwise logistic regression for tests of interactions, we found that the influence of zinc on the risk of diarrhea for more than 3 days depended on the isolated organism—beneficial in Klebsiella, neutral in Esherichia coli and parasitic infections, and detrimental in rotavirus coinfections. Although we found similar results for the outcome of high stool volume, the results did not reach statistical significance. Our findings suggest that the current strategy of zinc supplementation in all cases of acute diarrheas in children may need appropriate fine tuning to optimize the therapeutic benefit based on the causative organism, but further studies need to confirm and extend our findings.
Int J Pediatr 2010;Article ID 671587.

 

By: Patel AB, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H

Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review.

10 July, 2014 Publications
Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review.

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Background: For over a decade, the importance of zinc in the treatment of acute and persistent diarrhea has been recognized. In spite of recently published reviews, there remain several unanswered questions about the role of zinc supplementation in childhood diarrhea in the developing countries. Our study aimed to assess the therapeutic benefits of zinc supplementation in the treatment of acute or persistent diarrhea in children, and to examine the causes of any heterogeneity of response to zinc supplementation. Methods and Findings: EMBASE®, MEDLINE ® and CINAHL® databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention and treatment of childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. The reviews and published RCTs were qualitatively mapped followed by updated random-effects meta-analyses, subgroup meta-analyses and meta-regression to quantify and characterize the role of zinc supplementation with diarrhea-related outcomes. We found that although there was evidence to support the use of zinc to treat diarrhea in children, there was significant unexplained heterogeneity across the studies for the effect of zinc supplementation in reducing important diarrhea outcomes. Zinc supplementation reduced the mean duration of diarrhea by 19.7% but had no effect on stool frequency or stool output, and increased the risk of vomiting. Our subgroup meta-analyses and meta-regression showed that age, stunting, breast-feeding and baseline zinc levels could not explain the heterogeneity associated with differential reduction in the mean diarrheal duration. However, the baseline zinc levels may not be representative of the existing zinc deficiency state. Conclusions: Understanding the predictors of zinc efficacy including the role of diarrheal disease etiology on the response to zinc would help to identify the populations most likely to benefit from supplementation. To improve the programmatic use of zinc, further evaluations of the zinc salts used, the dose, the frequency and duration of supplementation, and its acceptability are required. The significant heterogeneity of responses to zinc suggests the need to revisit the strategy of universal zinc supplementation in the treatment children with acute diarrhea in developing countries.
PLoS ONE 2010;5(4): e10386.
By: Patel AB, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni H

Lack of Association of the Apoe 4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-Regression.

10 July, 2014 Publications
Lack of Association of the Apoe 4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-Regression.

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Study Objectives: Reports on the association of polymorphisms in the gene encoding apolipoprotein E (APOE)—a vital macromolecule in cholesterol metabolism—with obstructive sleep apnea (OSA) have provided conflicting results. Our objective was to meta-analytically synthesize the existing evidence for the association of the APOE ε4 allele with the risk of OSA. Design: Random effects meta-analysis and meta-regression Setting: Genetic epidemiological studies reporting the association of APOE ε4 allele with OSA susceptibility. Patients or Participants: Synthesis of APOE ε4 allele data from 6,508 subjects including 1,901 cases of OSA and 4,607 controls. Interventions: None Measurements and Results: Eight studies were included in the random effects meta-analysis; the summary effect size measured as odds ratio (OR) for association of the APOE ε4 allele with the risk of OSA was found to be 1.13 (95% confidence interval 0.86–1.47). There was a statistically significant heterogeneity (I2 = 72%, P = 0.001) across study results that was not explained by the mean age, proportion of males, or the proportion possessing the APOE ε4 allele or when grouped based on the geographic location of the study. Conclusions: The hypothesis that the APOE ε4 allele may be causally associated with OSA cannot be supported on the basis of published literature.
SLEEP 2009;32:1507-1511.

 

By: Thakre TP, Mamtani M, Kulkarni H

Arbitrary units are a composite and useful measure of muscle sympathetic nerve activity.

10 July, 2014 Publications

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Background: In humans, the muscle sympathetic nerve activity (MSNA) signal is challenging to detect, record and analyze. Several methods exist that attempt to capture the latent construct of MSNA. We directly compared the performance of five MSNA parameters: burst frequency, burst incidence, median burst amplitude, arbitrary units (AU) and fractal dimension (FD). The MSNA signal was recorded in 33 subjects for approximately 30 min before, during and after the application of a graded cold pressor test stimulus at 18 degrees C, 10 degrees C and 2 degrees C in random order with an adequate wash-out period. Using coefficient of variation, Shannons entropy and principal component analysis, we observed that these five parameters defined two physical and conceptual domains of MSNA-frequency and amplitude. Since AU combines information from both these domains, we observed that it explained maximum inter-subject and inter-experimental segment variation. FD did not explain the inter-subject variability and was identified as a unique parameter in the factor analysis. Epidemiological studies that attempt to quantify MSNA may consistently use AU as the parameter for quantification of MSNA.
Physiol Meas. 2009;30:861-8.

 

By: Thakre TP, Kulkarni H, Mamtani MR, Smith M