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A tool for rapid socioeconomic assessment.

10 July, 2014 Publications

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Objective: To validate a simple wealth index scale (WIS) based assessment of socioeconomic status and compare it with existing kuppuswamy(KUP) scale. METHODS: Families of 300 children aged 6 to 59 months of acute diarrhoea enrolled in a cross-sectional study were interviewed for socio economic status using both 8 item ownership scale (WIS) and Kuppuswamy (KUP) scale, validated against a reference standard Income Scale (IS). RESULTS: Out of 111 people classified as low based on Income scale (IS), 17% were identified by WIS, and 21% by KUP. In the upper low, 69.4% were identified by WIS and 84.3 % by KUP. Amongst the low middle group the WIS identified 27.6% while KUP identified 10.6% and amongst upper middle patients 30% were identified by WIS and 15 % by KUP. There were none in the upper income of WIS or KUP category. The WIS performed well in all income categories whereas the KUP was better for upper low and low income categories. The agreement between WI and KUP was 55.56%. CONCLUSION: KUP scale is lengthy and difficult to administer by pediatric students and biased towards professional qualifications and education, rather than actual standard of living. It can be replaced by a simple 8 item ownership scale (WI) which is robust for all income groups and also shows good agreement with KUP.
Indian J Pediatr. 2007;74:349-52.

 

By: Patel AB, Prabhu AS, Dibley MJ, Kulkarni LR

A clinicopathological study of eyelid malignancies from central India.

10 July, 2014 Publications

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Background: Eyelid malignancies are completely treatable if detected early. The treatment depends on the invasiveness of the cancer which in turn depends on the type of malignancy. AIM: The aim of the study was to characterize the distribution of the types of eyelid malignancies in central India. SETTINGS AND DESIGN: The study was conducted in the Department of Plastic and Maxillofacial Surgery at a tertiary care hospital. MATERIALS AND METHODS: We report a series of 27 cases of eyelid malignancies. In the same case series, we also include a case of malignant hemangiopericytoma which is an extremely rare form of eyelid malignancy worldwide. STATISTICAL ANALYSIS: Depending on the underlying statistical distribution, either analysis of variance (ANOVA) or the Kruskal-Wallis (K-W) test was used to assess the differential distribution of these variables across the types of eyelid malignancies observed in this study. RESULTS: We observed that sebaceous cell carcinoma (approximately 37%) was almost as prevalent as basal cell carcinoma (approximately 44%) in the study subjects and had an earlier age of occurrence and a more rapid clinical course. CONCLUSIONS: Sebaceous cell carcinoma of the eyelid is almost as common as basal cell carcinoma in a large tertiary care centre in central India.
Indian J Ophthalmol. 2007;55:109-12.

 

By: Jahagirdar SS, Thakre TP, Kale SM, Kulkarni H, Mamtani M

A simple method to combine multiple molecular biomarkers for dichotomous diagnostic classification.

10 July, 2014 Publications

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Background: In spite of the recognized diagnostic potential of biomarkers, the quest for squelching noise and wringing in information from a given set of biomarkers continues. Here, we suggest a statistical algorithm that – assuming each molecular biomarker to be a diagnostic test – enriches the diagnostic performance of an optimized set of independent biomarkers employing established statistical techniques. We validated the proposed algorithm using several simulation datasets in addition to four publicly available real datasets that compared i) subjects having cancer with those without; ii) subjects with two different cancers; iii) subjects with two different types of one cancer; and iv) subjects with same cancer resulting in differential time to metastasis. Results: Our algorithm comprises of three steps: estimating the area under the receiver operating characteristic curve for each biomarker, identifying a subset of biomarkers using linear regression and combining the chosen biomarkers using linear discriminant function analysis. Combining these established statistical methods that are available in most statistical packages, we observed that the diagnostic accuracy of our approach was 100%, 99.94%, 96.67% and 93.92% for the real datasets used in the study. These estimates were comparable to or better than the ones previously reported using alternative methods. In a synthetic dataset, we also observed that all the biomarkers chosen by our algorithm were indeed truly differentially expressed. Conclusion: The proposed algorithm can be used for accurate diagnosis in the setting of dichotomous classification of disease states.
BMC Bioinformatics. 2006; 7: 442.

 

By: Mamtani MR, Thakre TP, Kalkonde MY, Amin MA, Kalkonde YV, Amin AP, Kulkarni H

Prevalence of b-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase survey.

10 July, 2014 Publications

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Objective: To estimate the prevalence of b-thalassaemia in different subcastes of the Indian Sindhi population who, in general, have a high prevalence of this disease. Study design: A two-phase, community-based survey. Methods: Asymptomatic, Sindhi volunteers from Nagpur, central India, were recruited into the present study over a 7-year period. The first phase included the use of the Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT). Those positive for NESTROFT or those volunteering for haemoglobin A2 (HbA2) quantification entered the second phase of the survey. Appropriate statistical methods for estimating prevalence from two-phase surveys were used. Results: The prevalence of b-thalassaemia carriers across the five major Sindhi subcastes varied substantially in the study population. Larkana Sindhis had the highest (17%) whereas Dadu Sindhis had the lowest (8%) frequency of the b-thalassaemia allele. As a corollary, the projected incidence of b-thalassaemia major in newborn babies greatly varied by the subcastes of the parents. Conclusion: Ethnic subgroups within populations known to commonly carry the b-thalassaemia gene provide further information that is useful from epidemiological and public health perspectives.
Public Health. 2007; 121:193-8.

 

By: Jawahirani A, Mamtani M, Das K, Rughwani V, Kulkarni H

Erythrophagocytosis in sickle cell anemia: Statistical evidence for a biological phenomenon.

10 July, 2014 Publications

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Background: The precise role of erythrophagocytosis in sickle cell disease is not known. Using hematological data from three studies and 791 subjects comprising of eight epidemiological groups, we found a strong statistical support for the hypothesis that erythrophagocytosis is increased in sickle cell trait, that neutrophils and lymphocytes are the most likely cells involved in erythrophagocytosis in these subjects and that increased erythrophagocytosis may for a mechanistic explanation for an increased risk of vaso-occlusive crisis in sickle cell trait. Statistically, erythrophagocytosis was not increased in subjects with homozygous sickle cell disease. Our findings offer an interesting mechanistic implication about the presence of a strong autoimmune component of sickle cell trait that can be explained by the well recognized interplay between the receptor molecule signal regulatory protein-a (SIRP-a) on the phagocyte and its ligand, CD47, on the red blood cell. Our findings also support further and closer evaluation of the other hypothesized mechanisms by which neutrophils and lymphocytes partake in differential degree of erythrophagocytosis in subjects heterozygous for the sickle hemoglobin. Finally, translation of these findings into a clinical realm suggests that the extent of erythrophagocytosis, as measured by peripheral blood hematological indicators, can serve as an important indicator of the likelihood of future vaso-occlusive crisis events in subjects of sickle cell trait.
Med Hypotheses. 2007; 68: 1065-70.

 

By: Mamtani M, Sharma M, Amin M, Amin A, Jawahirani A, Kulkarni H

Insights into age- and sickle-cell-disease- interaction using principal components analysis.

10 July, 2014 Publications

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Background: In the context of sickle cell anemia, peripheral blood indexes provide key information that is also potentially influenced by age. Therefore, it is necessary to understand the extent and nature of interactions between sickle cell anemia and age, especially in situations where there is a high prevalence of sickle cell anemia. Methods: In a cross-sectional study of 374 subjects with varying hemoglobin S (HbS) status, we characterized the interaction between age and sickle hemoglobin using principal components analysis. Results: Factor analysis in subjects with hemoglobin AA identified three orthogonal factors – normal erythropoiesis, presence of thalassemia and the aggregability potential of the blood. These three factors were differentially associated with hemoglobin status. Age influenced the association of factors #2 and #3 with hemoglobin status. Conclusion: Our findings suggest that the interaction between age and hemoglobin status needs to be considered in both clinical and public health settings.
BMC Blood Disord. 2006;6:3.

 

By: Sharma M, Mamtani MR, Amin MA, Thakre TP, Sharma S, Amin A, Kulkarni H

A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

3 July, 2014 Publications
A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

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Background: With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. Methods: In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Grahams omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods – logistic regression, Cox proportional hazards regression and Poisson regression, respectively – to examine the association of the predictors with these three domains. Results: We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p < 0.001; and RR = 2.4, p = 0.002; respectively]. However, the rate of development of complications was influenced by a history suggestive of shock [relative hazards (RH) = 3.4, p = 0.002] and A- blood group (RH = 4.7, p = 0.04). Conclusion: Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.
BMC Surg. 2006;6:8.

 

By: Sharma SS, Mamtani MR, Sharma MS, Kulkarni H

Association of umbilical cord blood lead with neonatal behavior at varying levels of exposure

3 July, 2014 Publications

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Background: In the light of the ongoing debate about lowering the cut-off for acceptable blood lead level to <5 μg/dL from the currently recommended level of <10 μg/dL, we considered whether prenatal exposure to varying levels of lead is associated with similar or disparate effects on neonatal behavior. Methods: Using Brazeltons Neonatal Behavioral Assessment Scale (NBAS), an epidemiological approach and robust statistical techniques like multivariate linear regression, logistic regression, Poisson regression and structural equations modeling analyses we estimated the simultaneous indirect effects of umbilical cord blood lead (CBL) levels and other neonatal covariates on the NBAS clusters. Results: We observed that when analyzed in all study subjects, the CBL levels independently and strongly influenced autonomic stability and abnormal reflexes clusters. However, when the analysis was restricted to neonates with CBL <10 μg/dL, CBL levels strongly influenced the range of state, motor and autonomic stability clusters. Abnormal walking reflex was consistently associated with an increased CBL level irrespective of the cut-off for CBL, however, only at the lower cut-offs were the predominantly behavioral effects of CBL discernible. Conclusion: Our results further endorse the need to be cognizant of the detrimental effects of blood lead on neonates even at a low-dose prenatal exposure.
Behav Brain Funct. 2006;2:22.

 

By: Patel AB, Mamtani MR, Thankre TP, Kulkarni H

Loss of lag-response curvilinearity of indices of heart rate variability in congestive heart failure

3 July, 2014 Publications

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Background: Heart rate variability (HRV) is known to be impaired in patients with congestive heart failure (CHF). Time-domain analysis of ECG signals traditionally relies heavily on linear indices of an essentially non-linear phenomenon. Poincaré plots are commonly used to study non-linear behavior of physiologic signals. Lagged Poincaré plots incorporate autocovariance information and analysis of Poincaré plots for various lags can provide interesting insights into the autonomic control of the heart. Methods: Using Poincaré plot analysis, we assessed whether the relation of the lag between heart beats and HRV is altered in CHF. We studied the influence of lag on estimates of Poincaré plot indices for various lengths of beat sequence in a public domain data set (PhysioNet) of 29 subjects with CHF and 54 subjects with normal sinus rhythm. Results: A curvilinear association was observed between lag and Poincaré plot indices (SD1, SD2,SDLD and SD1/SD2 ratio) in normal subjects even for a small sequence of 50 beats (p value for quadratic term 3 × 10-5, 0.002, 3.5 × 10-5 and 0.0003, respectively). This curvilinearity was lost in patients with CHF even after exploring sequences up to 50,000 beats (p values for quadratic term > 0.5). Conclusion: Since lagged Poincaré plots incorporate autocovariance information, these analyses provide insights into the autonomic control of heart rate that is influenced by the non-linearity of the signal. The differences in lag-response in CHF patients and normal subjects exist even in the face of the treatment received by the CHF patients.
BMC Cardiovasc Disord. 2006;6:27.

 

By: Thakre TP, Smith ML

Bias-corrected diagnostic performance of the naked eye single tube red cell osmotic fragility test (NESTROFT): An effective screening tool for ß-thalassemia

3 July, 2014 Publications

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Background: It is being increasingly recognized that a majority of the countries in the thalassemia-belt need a cost-effective screening program as the first step towards control of thalassemia. Although the naked eye single tube red cell osmotic fragility test (NESTROFT) has been considered to be a very effective screening tool for b-thalassemia trait, assessment of its diagnostic performance has been affected with the reference test- and verification-bias. Here, we set out to provide estimates of sensitivity and specificity of NESTROFT corrected for these potential biases.We conducted a cross-sectional diagnostic test evaluation study using data from 1563 subjects from Central India with a high prevalence of b-thalassemia. We used latent class modelling after ensuring its validity to account for the reference test bias and global sensitivity analysis to control the verification bias. We also compared the results of latent class modelling with those of five discriminant indexes. We observed that across a range of cut-offs for the mean corpuscular volume (MCV) and the hemoglobin A2 (HbA2) concentration the average sensitivity and specificity of NESTROFT obtained from latent class modelling was 99.8 and 83.7%, respectively. These estimates were comparable to those characterizing the diagnostic performance of HbA2, which is considered by many as the reference test to detect b-thalassemia. After correction for the verification bias these estimates were 93.4 and 97.2%, respectively. Combined with the inexpensive and quick disposition of NESTROFT, these results strongly support its candidature as a screening tool—especially in the resource-poor and high-prevalence settings.
Hematology. 2006;11:277-86.

 

By: Mamtani M, Jawahirani A, Das K, Rughwani V, Kulkarni H[/tippy]