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function p1() {
    ptitle.innerText = 'Platelet distribution width (PDW) is increased in vaso-occlusive crisis in sickle cell disease';
    pauthors.innerText = 'Amin MA, Amin AP, Kulkarni HR';
    pabs.innerText = 'Considering the multigenic and multifactorial nature of the disease, we argue that a generalized bone marrow hyperplasia—and not merely erythroid hyperplasia—will occur in sickle cell disease. Consequently, we expect the hematological parameters to depict erythroid, myeloid as well as megakaryocyte hyperplasia. In the light of this expectation, we hypothesized that platelet distribution width (PDW) will increase in sickle cell disease. Here, we report the results from a cross-sectional study of 216 children admitted with complaints suggestive of vaso-occlusive crisis. We observed a strong association between PDW and sickle cell disease as compared to children who had HbAA genotype. Our findings bridge previous inconsistencies relating to the role of platelets in sickle cell disease. Implications of this finding are discussed.';
    jour.innerText = 'Ann Hematol. 2004;83:331-5.';
}
function p2() {
    ptitle.innerText = 'Predictive Performance of Anthropometric Indexes of Central Obesity for the Risk of Type 2 Diabetes';
    pauthors.innerText = 'Mamtani MR, Kulkarni HR';
    pabs.innerText = 'Background. In spite of several available anthropometric indexes, the relative merit of these indexes for the prediction of type 2 diabetes remains unknown. Considering that obesity and diabetes commonly coexist as co-morbidities, our objective was to directly compare the performance of measures of central and general obesity to predict the risk of type 2 diabetes. Methods. We conducted a case-control study of type 2 diabetes on 150 cases and 150 age- and gender-matched controls. We directly compared the predictive performance of five anthropometric indexes: four related to central obesity—waist circumference (WC), waist/hip ratio (WHR), abdominal volume index (AVI) and conicity index (CI); and one related to general obesity—body mass index (BMI).We used various statistical approaches like area under (AUC) receiver-operating characteristic (ROC) curves, likelihood ratios, logistic regression and Shannon’s entropy to compare the performance of the indexes in the study sample as well as bootstrapped samples. Results. WC had the highest overall predictive accuracy that was gender insensitive (AUC 0.77 in males and 0.74 in females); a comparable information content as that of AVI (Shannon’s entropy  1.81 for WC and 1.84 for AVI) and was a better predictor  of the risk of type 2 diabetes than all the remaining indexes. WC also correlated strongly with the biochemical markers of diabetes like blood sugar and lipid profile. Conclusions. WC is a simple, non-invasive and accurate predictor of the risk of type 2 diabetes that can potentially be used in screening programs in developing countries.';
    jour.innerText = 'Arch Med Res. 2005; 36: 581-9.';
    }
function p3() {
    ptitle.innerText = 'Value of Mean Corpuscular Volume and Mean Corpuscular Haemoglobin in Screening for ß -Thalassaemia Trait';
    pauthors.innerText = 'Mamtani M, Jawahirani A, Das K, Rughwani V, Kulkarni H';
    pabs.innerText = 'No Abstract';
    jour.innerText = 'Acta Haematol. 2006; 116: 223-5.';
    }
function p4() {
    ptitle.innerText = 'Bias-corrected diagnostic performance of the naked eye single tube red cell osmotic fragility test (NESTROFT): An effective screening tool for ß-thalassemia';
    pauthors.innerText = 'Mamtani M, Jawahirani A, Das K, Rughwani V, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'Hematology. 2006;11:277-86.';
    }
function p5() {
    ptitle.innerText = 'Loss of lag-response curvilinearity of indices of heart rate variability in congestive heart failure';
    pauthors.innerText = 'Thakre TP, Smith ML';
    pabs.innerText = '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.';
    jour.innerText = 'BMC Cardiovasc Disord. 2006;6:27.';
    }
function p6() {
    ptitle.innerText = 'Association of umbilical cord blood lead with neonatal behavior at varying levels of exposure';
    pauthors.innerText = 'Patel AB, Mamtani MR, Thankre TP, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'Behav Brain Funct. 2006;2:22.';
    }
function p7() {
    ptitle.innerText = 'A prospective cohort study of postoperative complications in the management of perforated peptic ulcer';
    pauthors.innerText = 'Sharma SS, Mamtani MR, Sharma MS, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'BMC Surg. 2006;6:8.';
    }
function p8() {
    ptitle.innerText = 'Insights into age- and sickle-cell-disease- interaction using principal components analysis';
    pauthors.innerText = 'Sharma M, Mamtani MR, Amin MA, Thakre TP, Sharma S, Amin A, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'BMC Blood Disord. 2006;6:3.';
    }
function p9() {
    ptitle.innerText = 'Erythrophagocytosis in sickle cell anemia: Statistical evidence for a biological phenomenon';
    pauthors.innerText = 'Mamtani M, Sharma M, Amin M, Amin A, Jawahirani A, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'Med Hypotheses. 2007; 68: 1065-70.';
    }
function p10() {
    ptitle.innerText = 'Prevalence of b-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase survey';
    pauthors.innerText = 'Jawahirani A, Mamtani M, Das K, Rughwani V, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'Public Health. 2007; 121:193-8.';
    }
function p11() {
    ptitle.innerText = 'A simple method to combine multiple molecular biomarkers for dichotomous diagnostic classification';
    pauthors.innerText = 'Mamtani MR, Thakre TP, Kalkonde MY, Amin MA, Kalkonde YV, Amin AP, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'BMC Bioinformatics. 2006; 7: 442.';
    }
function p12() {
    ptitle.innerText = 'A clinicopathological study of eyelid malignancies from central India';
    pauthors.innerText = 'Jahagirdar SS, Thakre TP, Kale SM, Kulkarni H, Mamtani M';
    pabs.innerText = '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.';
    jour.innerText = 'Indian J Ophthalmol. 2007;55:109-12.';
    }
function p13() {
    ptitle.innerText = 'A tool for rapid socioeconomic assessment.';
    pauthors.innerText = 'Patel AB, Prabhu AS, Dibley MJ, Kulkarni LR';
    pabs.innerText = '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.';
    jour.innerText = 'Indian J Pediatr. 2007;74:349-52.';
    }
function p14() {
    ptitle.innerText = 'Association of the pattern of transition between arousal states in neonates with the cord blood lead level';
    pauthors.innerText = 'Mamtani M, Patel A, Kulkarni H';
    pabs.innerText = 'In this study of 167 neonates who demonstrated a total of 1010 transitions between arousal states, we considered whether specific state transitions were associated with umbilical cord blood lead levels. We found that the arousal patterns of neonates with varying levels (<1, 1-10 and >10 microg/dL) of lead exposure could not be distinguished based on the NBAS scoring system alone, but their transition state patterns revealed striking differences. Specifically, the neonates with the highest lead levels were more fidgety, had more state transitions from state 5 or 6, and were least likely to fall from awake states back into lower states. Arousal state transition pattern is thus a novel correlate of umbilical cord blood lead that may be useful for risk stratification of the neonates.';
    jour.innerText = 'Early Hum Dev. 2008;84:231-5.';
    }
function p15() {
    ptitle.innerText = 'Comparative study of four candidate strategies to detect cervical cancer in different health care settings';
    pauthors.innerText = 'Kamal MM, Sapkal RU, Sarodey CS, Munshi MM, Alsi YD, Chande MA, Hingway SR, Dandige S, Kane US, Kshirsagar R, Tangsale M, Zodpey S, Patel AB, Mamtani M, Kulkarni H';
    pabs.innerText = 'AIM: Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. METHODS: In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR chi(2). RESULTS: Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. CONCLUSIONS: In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances.';
    jour.innerText = 'J Obstet Gynaecol Res. 2007;33:480-9.';
    }
function p16() {
    ptitle.innerText = 'Impact of training on observer variation in chest radiographs of children with severe pneumonia';
    pauthors.innerText = 'Patel AB, Amin A, Sortey SZ, Athawale A, Kulkarni H';
    pabs.innerText = 'BACKGROUND: Pneumonia diagnosed using chest radiographs is often used as a study end point in trials and epidemiological studies. We studied whether training of the end-users in 172 standardized chest radiographic features will decrease variability in the interpretation. METHODS: Inter-observer variation of 3 observers in recognizing standardized radiographic features for pneumonia was studied in 172 chest radiographs of children with clinical severe pneumonia. (as per WHO definition). The observers were then trained using a software with a repository of normal and abnormal films showing a spectrum of radiological changes in pneumonia. The interobserver variation in recognizing the same standardized radiographic features was recorded after this training. For each radiographic feature, Cohens kappa statistics to assess the between-observer agreement and Fleisss multiple rater kappa statistics to assess agreement among all three clinicians was used. RESULTS: The uniterpretable films reduced from 16.6% (95% CI 0%-34.1%) before training to 8.1% (95% CI 0%-17.7%) after training. The adequate films increased from 54.2% (95% CI 12.5%-95.9%) before training to 70% (95% CI 46.5%-93.4%) after training. For all features, agreement between observers 1 with 2 and 1 with 3, the Cohens kappa improved from poor to moderate agreement. The Fleiss kappa values before training were 0.1 to 0.2 and after training ranged from 0.37 to 0.52 indicating moderate to good agreement after training. CONCLUSIONS: Training of the doctors using standardized features with the help of a software improves agreement substantially in identifying radiological pneumonia.';
    jour.innerText = 'Indian Pediatr. 2007;44:675-81.';
    }
function p17() {
    ptitle.innerText = 'Prognostic value of direct bilirubin in neonatal hyperbilirubinemia';
    pauthors.innerText = 'Mamtani M, Patel A, Renge R, Kulkarni H';
    pabs.innerText = 'OBJECTIVE: To determine the prognostic value of indirect and direct hyperbilirubinemia in neonates with jaundice. METHODS: A cohort of 92 consecutive neonates reporting with hyperbilirubinemia to a tertiary care center were followed up till well and discharged, or, till death to assess risk and rate of mortality. RESULTS: The baseline median values of total, direct and indirect bilirubin in the cohort of 21.8, 1.6 and 18.6 mg/dl, respectively, were used as cut-offs for high and low levels. Using survival analyses i.e. Kaplan-Meier plots, logrank tests and multivariate Cox proportional hazards regression models to adjust for other strong predictors such as receipt of breastfeeding, being small for gestational age (SGA) and exchange transfusion, high direct bilirubin (> or = median value of 1.6 mg/dl) was independently associated with a higher and faster mortality. CONCLUSION: This study showed that direct bilirubin has independent and additive prognostic value and due attention should be given to newborns with raised levels.';
    jour.innerText = 'Indian J Pediatr. 2007;74:819-22.';
    }
function p18() {
    ptitle.innerText = 'Is NESTROFT sufficient for mass screening for beta-thalassaemia trait?';
    pauthors.innerText = 'Mamtani M, Das K, Jawahirani A, Rughwani V, Kulkarni H';
    pabs.innerText = 'OBJECTIVES: Prevention of beta-thalassaemia trait will, for the foreseeable future, hinge on effective screening strategies. Routine use of haematological data from automated cell counters may complement the results of the Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT), especially because of the high cost of a false-negative error. Our objective was to assess the potential additive value of routine haematological data in screening for beta-thalassaemia trait. SETTINGS: Community survey of asymptomatic volunteers. METHODS: Using the NESTROFT results, haematological data and haemoglobin A(2) concentration from 1435 young, asymptomatic Sindhi subjects recruited in a population-based survey, and statistical analysis by classification tree approach, we examined whether haematological parameters have discriminatory utility additional to that of NESTROFT in screening for beta-thalassaemia trait. RESULTS: We observed that in the derivation subset from which the classification tree was generated, there was only a marginal--albeit statistically significant--improvement in the screening performance of NESTROFT, whereas there was no such improvement attributable to the use of haematological parameters in a separate validation subset. CONCLUSION: Our results further substantiate the claim that the use of NESTROFT is highly indicated for screening for beta-thalassaemia trait in regions where the prevalence is high and the resources are constrained.';
    jour.innerText = 'J Med Screen. 2007;14:169-73.';
    }
function p19() {
    ptitle.innerText = 'Screening for HIV infection by health professionals in India';
    pauthors.innerText = 'Kurien M, Thomas K, Ahuja RC, Patel A, Shyla PR, Wig N, Mangalani M, Sathyanathan, Kasthuri A, Vyas B, Brogen A, Sudarsanam TD, Chaturvedi A, Abraham OC, Tharyan P, Selvaraj KG, Mathew J; IndiaCLEN HIV Screening Study Group';
    pabs.innerText = 'BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patients HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.';
    jour.innerText = 'Natl Med J India. 2007;20:59-66.';
    }
function p20() {
    ptitle.innerText = 'A randomised controlled trial of high-dose isoniazid adjuvant therapy for multidrug-resistant tuberculosis';
    pauthors.innerText = 'Katiyar SK, Bihari S, Prakash S, Mamtani M, Kulkarni H';
    pabs.innerText = 'SETTING: Tertiary care hospital in Kanpur, India. BACKGROUND: The need for a standardised treatment protocol for multidrug-resistant tuberculosis (MDR-TB) in resource-limited countries is being increasingly recognised. OBJECTIVE: To assess the effectiveness of high-dose isoniazid (INH) (16-18 mg/kg) adjuvant to second-line therapy in documented cases of MDR-TB. DESIGN: The present study is a double blind, randomised controlled trial with three treatment arms, high-dose INH, normal-dose INH and placebo, in addition to second-line drugs. Primary outcomes of the study were time to sputum culture conversion and proportion with sputum culture negative 6 months after treatment initiation. Secondary outcomes were radiological improvement at 1 year post treatment and development of toxicity. RESULTS: After adjustment for potential confounders, subjects who received high-dose INH became sputum-negative 2.38 times (95%CI 1.45-3.91, P = 0.001) more rapidly than those who did not receive it, and had a 2.37 times (95%CI 1.46-3.84, P < 0.001) higher likelihood of being sputum-negative at 6 months. These subjects showed significantly better radiological improvement without an increased risk of INH toxicity. CONCLUSION: In low-resource scenarios where a standardised therapeutic protocol is used for MDR-TB, the protocol can be significantly improved by including high-dose INH as an adjuvant.';
    jour.innerText = 'Int J Tuberc Lung Dis. 2008;12:139-45.';
    }
function p21() {
    ptitle.innerText = 'Author Reply';
    pauthors.innerText = 'Mamtani M';
    pabs.innerText = 'No Abstract';
    jour.innerText = 'Indian Pediatr 2008;75:193-4';
    }
function p22() {
    ptitle.innerText = 'Influence of iron chelators on myocardial iron and cardiac function in transfusion-dependent thalassaemia: a systematic review and meta-analysis';
    pauthors.innerText = 'Mamtani M, Kulkarni H';
    pabs.innerText = 'Iron chelators have dramatically prolonged the life expectancy of patients with transfusion-dependent thalassaemia, but their precise clinical benefit in reducing the myocardial iron burden and improving cardiac function is unknown. This systematic review and meta-analysis included published clinical trials that assessed the efficacy of iron chelators in regularly transfused patients of thalassaemia major for two commonly reported outcomes - myocardial iron content and left ventricular ejection fraction (LVEF). The meta-analysis of 392 patients for myocardial iron content and 291 patients for LVEF showed that (i) iron chelators reduced cardiac iron content by 23.9% (95% confidence interval 17.3-29.8%); (ii) there was no significant difference between the amount of iron reduced by deferoxamine and deferiprone (P = 0.9504); and (iii) LVEF was not significantly influenced by iron chelators - summary Hedges g 0.13 (95% confidence interval -0.10-0.36). A significant publication bias existed for LVEF (Eggers P = 0.049) but not for myocardial iron (Eggers P = 0.871). Our results indicate that iron chelators significantly reduce myocardial iron content. Further, the choice of deferoxamine versus deferiprone may rest on factors other than their efficacy to reduce cardiac iron load.';
    jour.innerText = 'Br J Haematol. 2008;141:882-90.';
    }
function p23() {
    ptitle.innerText = 'Author Reply';
    pauthors.innerText = 'Katiyar SK, Bihari S, Prakash S, Mamtani M, Kulkarni H';
    pabs.innerText = 'No Abstract';
    jour.innerText = 'Int J Tuberc Lung Dis. 2008;12:1102.';
    }
function p24() {
    ptitle.innerText = 'Use of the QuantiFERON-TB Gold In-Tube test to monitor treatment efficacy in active pulmonary tuberculosis';
    pauthors.innerText = 'Katiyar SK, Sampath A, Bihari S, Mamtani M, Kulkarni H';
    pabs.innerText = 'SETTING: Cohort study at a tertiary care hospital. OBJECTIVE: To assess the potential use of QuantiFERON-TB Gold In-Tube (QFT-G) in monitoring clinical response to anti-tuberculosis treatment. DESIGN: We conducted a cohort study of 76 active pulmonary tuberculosis patients with serial testing by QFT-G at baseline and after 2 and 6 months of treatment. At these time points, we compared the performance of QFT-G with sputum culture status of the study subjects. RESULTS: Compared to baseline, 59 (77.6%) cases showed a decline whereas 17 (22.4%) showed persistent or stronger interferon-gamma (IFN-gamma) responses at 2 months. Using robust statistical methods, we observed that QFT-G assessment at 2 months independently and significantly predicted the likelihood of remaining sputum culture-positive at the end of the intensive phase of anti-tuberculosis treatment. A higher IFN-gamma concentration by 1 international unit (IU)/ml corresponded to a 45% (95%CI 8-97) higher likelihood of failing to convert to a negative culture, whereas a rising or persistent IFN-gamma response was associated with a 17.3 (P = 0.007) times higher likelihood of remaining culture-positive at 2 months. CONCLUSIONS: Our results suggest that QFT-G can potentially be used as a tool to monitor the efficacy of anti-tuberculosis treatment.';
    jour.innerText = 'nt J Tuberc Lung Dis. 2008;12:1146-52.';
    }
function p25() {
    ptitle.innerText = 'Value of chest radiography in predicting treatment response in children aged 3-59 months with severe pneumonia';
    pauthors.innerText = 'Patel A, Mamtani M, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Maulen-Radovan I, Thea DM, Qazi S, Kulkarni H';
    pabs.innerText = 'SETTING: International multicentric study at nine tertiary care centres. OBJECTIVE: The World Health Organization (WHO) currently does not recommend chest radiographs (CXRs) for routine management of pneumonia. We evaluated the use of CXR for the prediction of treatment failure in children with severe pneumonia. DESIGN: We used WHO vaccine trials radiographic assessment, clinical and nasopharyngeal microbiological data from 1121 3-59-month-old children recruited using the WHO definition of severe pneumonia in the Amoxicillin Penicillin Pneumonia International Study (APPIS). Using Poisson regression, we estimated the relative risk of developing clinical treatment failure and predictive preventive benefit of the CXR and examined the concordance of the CXR findings with the nasopharyngeal microbiological data. RESULTS: A CXR with significant pathology (defined by the WHO algorithm as end-point consolidation, pleural fluid and other infiltrates) was associated with a high risk of treatment failure, especially in children who received penicillin as compared to oral amoxicillin. Significant pathology was also associated with nasopharyngeal isolation of penicillin-resistant Streptococcus pneumoniae. Children with a normal CXR had a reduced risk of clinical treatment failure. CONCLUSIONS: CXR with significant pathology independently and additively predicts clinical treatment failure. If CXR and the WHO tool are available, they can be used in the management of severe pneumonia.';
    jour.innerText = 'Int J Tuberc Lung Dis. 2008;12:1320-6.';
    }
function p26() {
    ptitle.innerText = 'Breastfeeeding and infant feeding practices in India - A review of demographic and health surveys and national family health surveys';
    pauthors.innerText = 'Patel AB, Badhoniya N, Dibley MJ';
    pabs.innerText = 'No Abstract';
    jour.innerText = 'MCH Community Newsletter August 2008';
    }
function p27() {
    ptitle.innerText = 'Blood lead levels in children with encephalopathy';
    pauthors.innerText = 'Patel A, Athawale A';
    pabs.innerText = 'OBJECTIVE: To determine the prevalence of elevated blood lead levels (EBLL i.e blood lead >10 micrograms/dL, Centers Disease Control criteria) in children with encephalopathy. SETTING: Hospital. DESIGN: Case control study. PARTICIPANTS: 100 children, 49 with encephalopathy and 51 consecutive hospital controls. OUTCOME MEASURES: Blood lead levels, demographics, clinical, environmental correlates and residual neurological sequel or death at discharge. RESULTS: 42 (encephalopathy) and 49 (hospital controls) children were available for analysis. The overall (n=91) mean blood lead was 7.88+/-10.44 micrograms/dL (range 0.07-67.68 micrograms/dL). The predictors of EBLL were presence of wasting (P<0.03), anemia (P<0.04), use of surma (P< 0.02), recent removal of house paint (P<0.01) or recently repainted (P<0.01). The mean blood lead levels were significantly higher (P<0.01) in patients of encephalopathy (12.18+/- 13.90 micrograms/dL) than in controls (4.19+/- 2.84 micrograms/dL). EBLL was present in 3/17 (17.6%) patients with infective encephalopathy and in 18/25 (72%) with non-infective encephalopathy. The proportion of children with residual neurological sequelae, or death increased when associated with EBLL (0 to 21%, and 69% to 100% respectively). CONCLUSION: Children hospitalized with encephalopathy have elevated blood lead levels.';
    jour.innerText = 'Indian Pediatr. 2009;46:845-8.';
    }
function p28() {
    ptitle.innerText = 'A clinical tool to predict failed response to therapy in children with severe pneumonia';
    pauthors.innerText = 'Mamtani M, Patel A, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Radovan IM, Thea DM, Qazi S, Kulkarni H';
    pabs.innerText = 'Severe pneumonia in children under 5 years of age continues to be an important clinical entity with treatment failure rates as high as 20%. Where severe pneumonias are common, predictive tools for treatment failure like chest radiography and pulse oximetry are not available or affordable. Thus, there is a need for development of simple, accurate and inexpensive clinical tools for prediction of treatment failure. Using clinical, chest radiographic and pulse oximetry data from 1702 children recruited in the Amoxicillin Penicillin Pneumonia International Study (APPIS) trial we developed and validated a simple clinical tool. For development, a randomly derived development sample (n = 889) was used. The tool which was based on the results of multivariate logistic regression models was validated on a separate sample of 813 children. The derived clinical tool in its final form contained three clinical predictors: age of child, excess age-specific respiratory rate at baseline and at 24 hr of hospitalization. This tool had a 70% and 66% predictive accuracy in the development and validation samples, respectively. The tool is presented as an easy-to-use nomogram. It is possible to predict the likelihood of treatment failure in children with severe pneumonia based on clinical features that are simple and inexpensive to measure.';
    jour.innerText = 'Pediatr Pulmonol. 2009;44:379-86.';
    }
function p29() {
    ptitle.innerText = 'Factors influencing the benefit of adjunctive devices during percutaneous coronary intervention in ST-segment elevation myocardial infarction: meta-analysis and meta-regression';
    pauthors.innerText = 'Amin AP, Mamtani MR, Kulkarni H';
    pabs.innerText = 'BACKGROUND: Routine use of adjunctive devices to percutaneous coronary intervention (PCI) for the treatment of patients of ST-segment elevation myocardial infarction (STEMI) is questionable. Also, the clinical characteristics of STEMI patients that can modulate the treatment benefits of adjunctive devices are not fully understood. Objective: To synthesize the existing literature to summarize the therapeutic benefit of the adjunctive devices and to identify the patient characteristics which relate to this therapeutic benefit. METHODS: We conducted (i) meta-analyses of the randomized controlled trials (RCT) comparing the performance of the adjunctive devices with PCI for three reperfusion-related outcomes: myocardial blush grade (MBG) < 3, failed ST-segment resolution (STR), and Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3; (ii) stepwise meta-regressions of the effect of trial characteristics on between-trial heterogeneity; and (iii) analyses to examine whether the reperfusion-related end-points explained the between-trial difference in cardiac death and major adverse cardiac events (MACE). RESULTS: Our meta-analyses represent data from 23 RCT and 5,728 subjects. The overall therapeutic benefit attributable ranged from 32 to 35% for the reperfusion-related outcomes, and thrombectomy devices were more beneficial than the distal protection devices.Meta-regression identified gender, receipt of glycoprotein (GP) IIb/IIIa inhibitor, and baseline TIMI flow grade as significant predictors of improved reperfusion across trials. The available clinical trials were individually underpowered and not designed to detect the influence of adjunctive devices on death or MACE. CONCLUSIONS: Routine use of adjunctive devices cannot be recommended. Thrombus burden, treatment with GPIIb/IIIa inhibitors, and gender may modify the reperfusion benefit of adjunctive devices.';
    jour.innerText = 'J Interv Cardiol. 2009;22:49-60.';
    }
function p30() {
    ptitle.innerText = 'Value of early cardiac troponin I to predict long-term adverse events after coronary artery bypass graft surgery in patients presenting with acute coronary syndromes';
    pauthors.innerText = 'Amin AP, Mukhopadhyay E, Napan S, Mamtani M, Kelly RF, Kulkarni H';
    pabs.innerText = 'BACKGROUND: High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. HYPOTHESIS: Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long-term outcomes after CABG. METHODS: We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. RESULTS: In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%- 5%, p < 0.001) faster progression to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05-6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. CONCLUSION: Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long-term adverse events after CABG.';
    jour.innerText = 'Clin Cardiol. 2009;32:386-92.';
    }
function p31() {
    ptitle.innerText = 'Bone recovery after zoledronate therapy in thalassemia-induced osteoporosis: a meta-analysis and systematic review';
    pauthors.innerText = 'Mamtani M, Kulkarni H';
    pabs.innerText = 'Zoledronate is a promising bisphosphonate that improves the bone mineral density by 0.69 standard deviations in thalassemia-induced osteoporosis, but the entire range of its actions and side effects is currently not fully understood. INTRODUCTION: Zoledronate is a promising bisphosphonate for the treatment of thalassemia-induced osteoporosis; however, a quantitative summary of its beneficial effect and its effects on the markers of bone turnover are not established. METHODS: We conducted a meta-analysis of the published randomized controlled trials using standardized mean difference and a random effects model for improvement in bone mineral density (BMD). We also conducted a systematic review for the influence of zoledronate on markers of bone turnover and bone pain. RESULTS: We found that zoledronate improves the baseline BMD by 0.69 (95% confidence interval 0.47-0.90) standard deviations-an effect that was more pronounced when BMD was measured at the lumbar spine. However, the mechanistic interpretations of the effects on the markers of bone turnover are not completely clear. CONCLUSION: Sufficient evidence exists to demonstrate that 4 mg zoledronate given every 3 months markedly improves the BMD; however, more qualitative and quantitative evidence is required to understand the mechanisms of its action and the potential side effects.';
    jour.innerText = 'Osteoporos Int. 2009 Feb 26. [Epub ahead of print]';
    }
function p32() {
    ptitle.innerText = 'Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trial';
    pauthors.innerText = 'Patel A, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H';
    pabs.innerText = 'BACKGROUND: Diarrhea causes an estimated 2.5 million child deaths in developing countries each year, 35% of which are due to acute diarrhea. Zinc and copper stores in the body are known to be depleted during acute diarrhea. Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with standard treatment to children with acute watery or bloody diarrhea. METHODS: We conducted a double-blind randomized controlled clinical trial in the Department of Pediatrics at Indira Gandhi Government Medical College Nagpur, India. Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn+Cu) together with standard treatment for acute diarrhea. RESULTS: The mean duration of diarrhea from enrollment and the mean stool weight during hospital stay were 63.7 hours and 940 grams, respectively, and there were no significant differences in the adjusted means across treatment groups. Similarly, the adjusted means of the amount of oral rehydration solution or intravenous fluids used, the proportion of participants with diarrhea more than 7 days from onset, and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrollment, did not differ across the three groups. CONCLUSION: The expected beneficial effects of zinc supplementation for acute diarrhea were not observed. Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children.';
    jour.innerText = 'BMC Med. 2009;7:22.';
    }
function p33() {
    ptitle.innerText = 'Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort study';
    pauthors.innerText = 'Amin AP, Nathan S, Prodduturi P, DSilva O, Gupta A, Kumar A, Senter S, Mamtani M, Kulkarni H, Klein LW, Kelly RF';
    pabs.innerText = 'OBJECTIVES: To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are > or = 75 years of age. BACKGROUND: CS after AMI continues to pose formidable therapeutic challenges in elderly patients. METHODS: We conducted survival analyses of 310 consecutive subjects (including 80 patients > or = 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis. RESULTS: Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients > or = 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p = 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients > or = 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort. CONCLUSIONS: These retrospective data suggest a significant survival benefit of early revascularization in elderly patients > or = 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.';
    jour.innerText = 'J Invasive Cardiol. 2009;21:305-12';
    }
function p34() {
    ptitle.innerText = 'Arbitrary units are a composite and useful measure of muscle sympathetic nerve activity';
    pauthors.innerText = 'Thakre TP, Kulkarni H, Mamtani MR, Smith M';
    pabs.innerText = '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.';
    jour.innerText = 'Physiol Meas. 2009;30:861-8.';
    }
function p35() {
    ptitle.innerText = 'Lack of Association of the Apoe 4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-Regression';
    pauthors.innerText = 'Thakre TP, Mamtani M, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'SLEEP 2009;32:1507-1511.';
    }
function p36() {
    ptitle.innerText = 'Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review';
    pauthors.innerText = 'Patel AB, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'PLoS ONE 2010;5(4): e10386.';
    }
function p37() {
    ptitle.innerText = 'Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated Organism';
    pauthors.innerText = 'Patel AB, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'Int J Pediatr 2010;Article ID 671587.';
    }
function p38() {
    ptitle.innerText = 'Using wholre blood γ-interferon assay to improve diagnosis of tuberculous pleural effusion';
    pauthors.innerText = 'Katiyar SK, Sampath A, Bohari S, Mamtani M, Kulkarni H';
    pabs.innerText = 'Abstract not available';
    jour.innerText = 'Eur Respir J 2010; 36(3):679-81';
    }
function p39() {
    ptitle.innerText = 'Hemoglobin F levels influence the results of NESTROFT: replication in two surveys';
    pauthors.innerText = 'Mamtani M, Chatterjee N, Mishra A, Soni R, Jawahirani A, Das K, Rughwani V, Shrivastava M, Kulkarni H';
    pabs.innerText = 'Abstract not available';
    jour.innerText = 'Int J Lab Hematol, 2010: 33(1):113-5.';
    }
function p40() {
    ptitle.innerText = 'Ultrafast papanicolaou stain modified for developing countries: efficacy and pitfalls';
    pauthors.innerText = 'Kamal MM, Kulkarni MM, Wahane RN';
    pabs.innerText = '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.';
    jour.innerText = 'Acta Cytol, 2011: 55(2):205-12.';
    }
function p41() {
    ptitle.innerText = 'Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey';
    pauthors.innerText = 'Chatterjee N, Mishra A, Soni R, Kulkarni H, Mamtani M, Shrivasatava M';
    pabs.innerText = '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.';
    jour.innerText = 'Hemoglobin, 2010; 34(6):548-60.';
    }
function p42() {
    ptitle.innerText = 'Risk Factors for predicting diarrheal duration and morbidity in children with acute diarrhea';
    pauthors.innerText = 'Patel AB, Ronithung O, Badhoniya N, Dibley MJ';
    pabs.innerText = '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 <-2 (OR 1.25, 95% CI 1.07-1.46, p=0.004) were at a greater risk of prolonged duration of diarrhea. Diarrhea  >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 <-2 (OR 4.32, 95% CI 2.03- 9.16, p<0.001). Severe dehydration after hospitalization was associated with dehydration at baseline (OR 6.7, 95% CI 2-3.0, p<0.001), incomplete immunization (OR 3.33, 95% CI 1.5 - 7.69, p<0.001 ), failure to receive any medication(OR 3.03, 95% CI 1.26-7.14, p=0.01). Conclusion: Few studies assess risk factors for diarrheal morbidity prospectively .  This study showed that children of acute diarrhea with above risk factors need stricter monitoring for complications  to reduce diarrheal mortality.';
    jour.innerText = 'Ind J Pediatr: In Press.';
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function p43() {
    ptitle.innerText = 'What zinc supplementation does and does not achieve in diarrhea prevention: A systematic review and meta-analysis';
    pauthors.innerText = 'Patel AB, Mamtani M, Badhoniya N, Kulkarni H';
    pabs.innerText = '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.';
    jour.innerText = 'BMC Infect Dis, 2011 May 12;11(1):122.';
    }
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    ptext[0] = 'Platelet distribution width (PDW) is increased in vaso-occlusive crisis in sickle cell disease. Amin MA, Amin AP, Kulkarni HR Considering the multigenic and multifactorial nature of the disease, we argue that a generalized bone marrow hyperplasia—and not merely erythroid hyperplasia—will occur in sickle cell disease. Consequently, we expect the hematological parameters to depict erythroid, myeloid as well as megakaryocyte hyperplasia. In the light of this expectation, we hypothesized that platelet distribution width (PDW) will increase in sickle cell disease. Here, we report the results from a cross-sectional study of 216 children admitted with complaints suggestive of vaso-occlusive crisis. We observed a strong association between PDW and sickle cell disease as compared to children who had HbAA genotype. Our findings bridge previous inconsistencies relating to the role of platelets in sickle cell disease. Implications of this finding are discussed. Ann Hematol. 2004;83:331-5.'
    ptext[1] = 'Predictive Performance of Anthropometric Indexes of Central Obesity for the Risk of Type 2 DiabetesMamtani MR, Kulkarni HRBackground. In spite of several available anthropometric indexes, the relative merit of these indexes for the prediction of type 2 diabetes remains unknown. Considering that obesity and diabetes commonly coexist as co-morbidities, our objective was to directly compare the performance of measures of central and general obesity to predict the risk of type 2 diabetes. Methods. We conducted a case-control study of type 2 diabetes on 150 cases and 150 age- and gender-matched controls. We directly compared the predictive performance of five anthropometric indexes: four related to central obesity—waist circumference (WC), waist/hip ratio (WHR), abdominal volume index (AVI) and conicity index (CI); and one related to general obesity—body mass index (BMI).We used various statistical approaches like area under (AUC) receiver-operating characteristic (ROC) curves, likelihood ratios, logistic regression and Shannon’s entropy to compare the performance of the indexes in the study sample as well as bootstrapped samples. Results. WC had the highest overall predictive accuracy that was gender insensitive (AUC 0.77 in males and 0.74 in females); a comparable information content as that of AVI (Shannon’s entropy  1.81 for WC and 1.84 for AVI) and was a better predictor  of the risk of type 2 diabetes than all the remaining indexes. WC also correlated strongly with the biochemical markers of diabetes like blood sugar and lipid profile. Conclusions. WC is a simple, non-invasive and accurate predictor of the risk of type 2 diabetes that can potentially be used in screening programs in developing countries.Arch Med Res. 2005; 36: 581-9.';
    ptext[2] = 'Value of Mean Corpuscular Volume and Mean Corpuscular Haemoglobin in Screening for ß -Thalassaemia TraitMamtani M, Jawahirani A, Das K, Rughwani V, Kulkarni HNo AbstractActa Haematol. 2006; 116: 223-5.';
    ptext[3] = 'Bias-corrected diagnostic performance of the naked eye single tube red cell osmotic fragility test (NESTROFT): An effective screening tool for ß-thalassemiaMamtani M, Jawahirani A, Das K, Rughwani V, Kulkarni HIt 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.';
    ptext[4] = 'Loss of lag-response curvilinearity of indices of heart rate variability in congestive heart failureThakre TP, Smith MLBackground: 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.';
    ptext[5] = 'Association of umbilical cord blood lead with neonatal behavior at varying levels of exposurePatel AB, Mamtani MR, Thankre TP, Kulkarni HBackground: 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.';
    ptext[6] = 'A prospective cohort study of postoperative complications in the management of perforated peptic ulcerSharma SS, Mamtani MR, Sharma MS, Kulkarni HBackground: 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.';
    ptext[7] = 'Insights into age- and sickle-cell-disease- interaction using principal components analysisSharma M, Mamtani MR, Amin MA, Thakre TP, Sharma S, Amin A, Kulkarni HBackground: 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.';
    ptext[8] = 'Erythrophagocytosis in sickle cell anemia: Statistical evidence for a biological phenomenonMamtani M, Sharma M, Amin M, Amin A, Jawahirani A, Kulkarni HThe 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.';
    ptext[9] = 'Prevalence of b-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase surveyJawahirani A, Mamtani M, Das K, Rughwani V, Kulkarni HObjective: 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.';
    ptext[10] = 'A simple method to combine multiple molecular biomarkers for dichotomous diagnostic classificationMamtani MR, Thakre TP, Kalkonde MY, Amin MA, Kalkonde YV, Amin AP, Kulkarni HBackground: 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.';
    ptext[11] = 'A clinicopathological study of eyelid malignancies from central IndiaJahagirdar SS, Thakre TP, Kale SM, Kulkarni H, Mamtani MBACKGROUND: 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.';
    ptext[12] = 'A tool for rapid socioeconomic assessment.Patel AB, Prabhu AS, Dibley MJ, Kulkarni LROBJECTIVE: 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.';
    ptext[13] = 'Association of the pattern of transition between arousal states in neonates with the cord blood lead levelMamtani M, Patel A, Kulkarni HIn this study of 167 neonates who demonstrated a total of 1010 transitions between arousal states, we considered whether specific state transitions were associated with umbilical cord blood lead levels. We found that the arousal patterns of neonates with varying levels (<1, 1-10 and >10 microg/dL) of lead exposure could not be distinguished based on the NBAS scoring system alone, but their transition state patterns revealed striking differences. Specifically, the neonates with the highest lead levels were more fidgety, had more state transitions from state 5 or 6, and were least likely to fall from awake states back into lower states. Arousal state transition pattern is thus a novel correlate of umbilical cord blood lead that may be useful for risk stratification of the neonates.Early Hum Dev. 2008;84:231-5.';
    ptext[14] = 'Comparative study of four candidate strategies to detect cervical cancer in different health care settingsKamal MM, Sapkal RU, Sarodey CS, Munshi MM, Alsi YD, Chande MA, Hingway SR, Dandige S, Kane US, Kshirsagar R, Tangsale M, Zodpey S, Patel AB, Mamtani M, Kulkarni HAIM: Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. METHODS: In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR chi(2). RESULTS: Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. CONCLUSIONS: In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances.J Obstet Gynaecol Res. 2007;33:480-9.';
    ptext[15] = 'Impact of training on observer variation in chest radiographs of children with severe pneumoniaPatel AB, Amin A, Sortey SZ, Athawale A, Kulkarni HBACKGROUND: Pneumonia diagnosed using chest radiographs is often used as a study end point in trials and epidemiological studies. We studied whether training of the end-users in 172 standardized chest radiographic features will decrease variability in the interpretation. METHODS: Inter-observer variation of 3 observers in recognizing standardized radiographic features for pneumonia was studied in 172 chest radiographs of children with clinical severe pneumonia. (as per WHO definition). The observers were then trained using a software with a repository of normal and abnormal films showing a spectrum of radiological changes in pneumonia. The interobserver variation in recognizing the same standardized radiographic features was recorded after this training. For each radiographic feature, Cohens kappa statistics to assess the between-observer agreement and Fleisss multiple rater kappa statistics to assess agreement among all three clinicians was used. RESULTS: The uniterpretable films reduced from 16.6% (95% CI 0%-34.1%) before training to 8.1% (95% CI 0%-17.7%) after training. The adequate films increased from 54.2% (95% CI 12.5%-95.9%) before training to 70% (95% CI 46.5%-93.4%) after training. For all features, agreement between observers 1 with 2 and 1 with 3, the Cohens kappa improved from poor to moderate agreement. The Fleiss kappa values before training were 0.1 to 0.2 and after training ranged from 0.37 to 0.52 indicating moderate to good agreement after training. CONCLUSIONS: Training of the doctors using standardized features with the help of a software improves agreement substantially in identifying radiological pneumonia.Indian Pediatr. 2007;44:675-81.';
    ptext[16] = 'Prognostic value of direct bilirubin in neonatal hyperbilirubinemiaMamtani M, Patel A, Renge R, Kulkarni HOBJECTIVE: To determine the prognostic value of indirect and direct hyperbilirubinemia in neonates with jaundice. METHODS: A cohort of 92 consecutive neonates reporting with hyperbilirubinemia to a tertiary care center were followed up till well and discharged, or, till death to assess risk and rate of mortality. RESULTS: The baseline median values of total, direct and indirect bilirubin in the cohort of 21.8, 1.6 and 18.6 mg/dl, respectively, were used as cut-offs for high and low levels. Using survival analyses i.e. Kaplan-Meier plots, logrank tests and multivariate Cox proportional hazards regression models to adjust for other strong predictors such as receipt of breastfeeding, being small for gestational age (SGA) and exchange transfusion, high direct bilirubin (> or = median value of 1.6 mg/dl) was independently associated with a higher and faster mortality. CONCLUSION: This study showed that direct bilirubin has independent and additive prognostic value and due attention should be given to newborns with raised levels.Indian J Pediatr. 2007;74:819-22.';
    ptext[17] = 'Is NESTROFT sufficient for mass screening for beta-thalassaemia trait?Mamtani M, Das K, Jawahirani A, Rughwani V, Kulkarni HOBJECTIVES: Prevention of beta-thalassaemia trait will, for the foreseeable future, hinge on effective screening strategies. Routine use of haematological data from automated cell counters may complement the results of the Naked Eye Single Tube Red cell Osmotic Fragility Test (NESTROFT), especially because of the high cost of a false-negative error. Our objective was to assess the potential additive value of routine haematological data in screening for beta-thalassaemia trait. SETTINGS: Community survey of asymptomatic volunteers. METHODS: Using the NESTROFT results, haematological data and haemoglobin A(2) concentration from 1435 young, asymptomatic Sindhi subjects recruited in a population-based survey, and statistical analysis by classification tree approach, we examined whether haematological parameters have discriminatory utility additional to that of NESTROFT in screening for beta-thalassaemia trait. RESULTS: We observed that in the derivation subset from which the classification tree was generated, there was only a marginal--albeit statistically significant--improvement in the screening performance of NESTROFT, whereas there was no such improvement attributable to the use of haematological parameters in a separate validation subset. CONCLUSION: Our results further substantiate the claim that the use of NESTROFT is highly indicated for screening for beta-thalassaemia trait in regions where the prevalence is high and the resources are constrained.J Med Screen. 2007;14:169-73.';
    ptext[18] = 'Screening for HIV infection by health professionals in IndiaKurien M, Thomas K, Ahuja RC, Patel A, Shyla PR, Wig N, Mangalani M, Sathyanathan, Kasthuri A, Vyas B, Brogen A, Sudarsanam TD, Chaturvedi A, Abraham OC, Tharyan P, Selvaraj KG, Mathew J; IndiaCLEN HIV Screening Study GroupBACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patients HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.Natl Med J India. 2007;20:59-66.';
    ptext[19] = 'A randomised controlled trial of high-dose isoniazid adjuvant therapy for multidrug-resistant tuberculosisKatiyar SK, Bihari S, Prakash S, Mamtani M, Kulkarni HSETTING: Tertiary care hospital in Kanpur, India. BACKGROUND: The need for a standardised treatment protocol for multidrug-resistant tuberculosis (MDR-TB) in resource-limited countries is being increasingly recognised. OBJECTIVE: To assess the effectiveness of high-dose isoniazid (INH) (16-18 mg/kg) adjuvant to second-line therapy in documented cases of MDR-TB. DESIGN: The present study is a double blind, randomised controlled trial with three treatment arms, high-dose INH, normal-dose INH and placebo, in addition to second-line drugs. Primary outcomes of the study were time to sputum culture conversion and proportion with sputum culture negative 6 months after treatment initiation. Secondary outcomes were radiological improvement at 1 year post treatment and development of toxicity. RESULTS: After adjustment for potential confounders, subjects who received high-dose INH became sputum-negative 2.38 times (95%CI 1.45-3.91, P = 0.001) more rapidly than those who did not receive it, and had a 2.37 times (95%CI 1.46-3.84, P < 0.001) higher likelihood of being sputum-negative at 6 months. These subjects showed significantly better radiological improvement without an increased risk of INH toxicity. CONCLUSION: In low-resource scenarios where a standardised therapeutic protocol is used for MDR-TB, the protocol can be significantly improved by including high-dose INH as an adjuvant.Int J Tuberc Lung Dis. 2008;12:139-45.';
    ptext[20] = 'Author ReplyMamtani MNo AbstractIndian Pediatr 2008;75:193-4';
    ptext[21] = 'Influence of iron chelators on myocardial iron and cardiac function in transfusion-dependent thalassaemia: a systematic review and meta-analysisMamtani M, Kulkarni HIron chelators have dramatically prolonged the life expectancy of patients with transfusion-dependent thalassaemia, but their precise clinical benefit in reducing the myocardial iron burden and improving cardiac function is unknown. This systematic review and meta-analysis included published clinical trials that assessed the efficacy of iron chelators in regularly transfused patients of thalassaemia major for two commonly reported outcomes - myocardial iron content and left ventricular ejection fraction (LVEF). The meta-analysis of 392 patients for myocardial iron content and 291 patients for LVEF showed that (i) iron chelators reduced cardiac iron content by 23.9% (95% confidence interval 17.3-29.8%); (ii) there was no significant difference between the amount of iron reduced by deferoxamine and deferiprone (P = 0.9504); and (iii) LVEF was not significantly influenced by iron chelators - summary Hedges g 0.13 (95% confidence interval -0.10-0.36). A significant publication bias existed for LVEF (Eggers P = 0.049) but not for myocardial iron (Eggers P = 0.871). Our results indicate that iron chelators significantly reduce myocardial iron content. Further, the choice of deferoxamine versus deferiprone may rest on factors other than their efficacy to reduce cardiac iron load.Br J Haematol. 2008;141:882-90.';
    ptext[22] = 'Author ReplyKatiyar SK, Bihari S, Prakash S, Mamtani M, Kulkarni HNo AbstractInt J Tuberc Lung Dis. 2008;12:1102.';
    ptext[23] = 'Use of the QuantiFERON-TB Gold In-Tube test to monitor treatment efficacy in active pulmonary tuberculosisKatiyar SK, Sampath A, Bihari S, Mamtani M, Kulkarni HSETTING: Cohort study at a tertiary care hospital. OBJECTIVE: To assess the potential use of QuantiFERON-TB Gold In-Tube (QFT-G) in monitoring clinical response to anti-tuberculosis treatment. DESIGN: We conducted a cohort study of 76 active pulmonary tuberculosis patients with serial testing by QFT-G at baseline and after 2 and 6 months of treatment. At these time points, we compared the performance of QFT-G with sputum culture status of the study subjects. RESULTS: Compared to baseline, 59 (77.6%) cases showed a decline whereas 17 (22.4%) showed persistent or stronger interferon-gamma (IFN-gamma) responses at 2 months. Using robust statistical methods, we observed that QFT-G assessment at 2 months independently and significantly predicted the likelihood of remaining sputum culture-positive at the end of the intensive phase of anti-tuberculosis treatment. A higher IFN-gamma concentration by 1 international unit (IU)/ml corresponded to a 45% (95%CI 8-97) higher likelihood of failing to convert to a negative culture, whereas a rising or persistent IFN-gamma response was associated with a 17.3 (P = 0.007) times higher likelihood of remaining culture-positive at 2 months. CONCLUSIONS: Our results suggest that QFT-G can potentially be used as a tool to monitor the efficacy of anti-tuberculosis treatment.nt J Tuberc Lung Dis. 2008;12:1146-52.';
    ptext[24] = 'Value of chest radiography in predicting treatment response in children aged 3-59 months with severe pneumoniaPatel A, Mamtani M, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Maulen-Radovan I, Thea DM, Qazi S, Kulkarni HSETTING: International multicentric study at nine tertiary care centres. OBJECTIVE: The World Health Organization (WHO) currently does not recommend chest radiographs (CXRs) for routine management of pneumonia. We evaluated the use of CXR for the prediction of treatment failure in children with severe pneumonia. DESIGN: We used WHO vaccine trials radiographic assessment, clinical and nasopharyngeal microbiological data from 1121 3-59-month-old children recruited using the WHO definition of severe pneumonia in the Amoxicillin Penicillin Pneumonia International Study (APPIS). Using Poisson regression, we estimated the relative risk of developing clinical treatment failure and predictive preventive benefit of the CXR and examined the concordance of the CXR findings with the nasopharyngeal microbiological data. RESULTS: A CXR with significant pathology (defined by the WHO algorithm as end-point consolidation, pleural fluid and other infiltrates) was associated with a high risk of treatment failure, especially in children who received penicillin as compared to oral amoxicillin. Significant pathology was also associated with nasopharyngeal isolation of penicillin-resistant Streptococcus pneumoniae. Children with a normal CXR had a reduced risk of clinical treatment failure. CONCLUSIONS: CXR with significant pathology independently and additively predicts clinical treatment failure. If CXR and the WHO tool are available, they can be used in the management of severe pneumonia.Int J Tuberc Lung Dis. 2008;12:1320-6.';
    ptext[25] = 'Breastfeeeding and infant feeding practices in India - A review of demographic and health surveys and national family health surveysPatel AB, Badhoniya N, Dibley MJNo AbstractMCH Community Newsletter August 2008';
    ptext[26] = 'Blood lead levels in children with encephalopathyPatel A, Athawale AOBJECTIVE: To determine the prevalence of elevated blood lead levels (EBLL i.e blood lead >10 micrograms/dL, Centers Disease Control criteria) in children with encephalopathy. SETTING: Hospital. DESIGN: Case control study. PARTICIPANTS: 100 children, 49 with encephalopathy and 51 consecutive hospital controls. OUTCOME MEASURES: Blood lead levels, demographics, clinical, environmental correlates and residual neurological sequel or death at discharge. RESULTS: 42 (encephalopathy) and 49 (hospital controls) children were available for analysis. The overall (n=91) mean blood lead was 7.88+/-10.44 micrograms/dL (range 0.07-67.68 micrograms/dL). The predictors of EBLL were presence of wasting (P<0.03), anemia (P<0.04), use of surma (P< 0.02), recent removal of house paint (P<0.01) or recently repainted (P<0.01). The mean blood lead levels were significantly higher (P<0.01) in patients of encephalopathy (12.18+/- 13.90 micrograms/dL) than in controls (4.19+/- 2.84 micrograms/dL). EBLL was present in 3/17 (17.6%) patients with infective encephalopathy and in 18/25 (72%) with non-infective encephalopathy. The proportion of children with residual neurological sequelae, or death increased when associated with EBLL (0 to 21%, and 69% to 100% respectively). CONCLUSION: Children hospitalized with encephalopathy have elevated blood lead levels.Indian Pediatr. 2009;46:845-8.';
    ptext[27] = 'A clinical tool to predict failed response to therapy in children with severe pneumoniaMamtani M, Patel A, Hibberd PL, Tuan TA, Jeena P, Chisaka N, Hassan M, Radovan IM, Thea DM, Qazi S, Kulkarni HSevere pneumonia in children under 5 years of age continues to be an important clinical entity with treatment failure rates as high as 20%. Where severe pneumonias are common, predictive tools for treatment failure like chest radiography and pulse oximetry are not available or affordable. Thus, there is a need for development of simple, accurate and inexpensive clinical tools for prediction of treatment failure. Using clinical, chest radiographic and pulse oximetry data from 1702 children recruited in the Amoxicillin Penicillin Pneumonia International Study (APPIS) trial we developed and validated a simple clinical tool. For development, a randomly derived development sample (n = 889) was used. The tool which was based on the results of multivariate logistic regression models was validated on a separate sample of 813 children. The derived clinical tool in its final form contained three clinical predictors: age of child, excess age-specific respiratory rate at baseline and at 24 hr of hospitalization. This tool had a 70% and 66% predictive accuracy in the development and validation samples, respectively. The tool is presented as an easy-to-use nomogram. It is possible to predict the likelihood of treatment failure in children with severe pneumonia based on clinical features that are simple and inexpensive to measure.Pediatr Pulmonol. 2009;44:379-86.'
    ptext[28] = 'Factors influencing the benefit of adjunctive devices during percutaneous coronary intervention in ST-segment elevation myocardial infarction: meta-analysis and meta-regressionAmin AP, Mamtani MR, Kulkarni HBACKGROUND: Routine use of adjunctive devices to percutaneous coronary intervention (PCI) for the treatment of patients of ST-segment elevation myocardial infarction (STEMI) is questionable. Also, the clinical characteristics of STEMI patients that can modulate the treatment benefits of adjunctive devices are not fully understood. Objective: To synthesize the existing literature to summarize the therapeutic benefit of the adjunctive devices and to identify the patient characteristics which relate to this therapeutic benefit. METHODS: We conducted (i) meta-analyses of the randomized controlled trials (RCT) comparing the performance of the adjunctive devices with PCI for three reperfusion-related outcomes: myocardial blush grade (MBG) < 3, failed ST-segment resolution (STR), and Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3; (ii) stepwise meta-regressions of the effect of trial characteristics on between-trial heterogeneity; and (iii) analyses to examine whether the reperfusion-related end-points explained the between-trial difference in cardiac death and major adverse cardiac events (MACE). RESULTS: Our meta-analyses represent data from 23 RCT and 5,728 subjects. The overall therapeutic benefit attributable ranged from 32 to 35% for the reperfusion-related outcomes, and thrombectomy devices were more beneficial than the distal protection devices.Meta-regression identified gender, receipt of glycoprotein (GP) IIb/IIIa inhibitor, and baseline TIMI flow grade as significant predictors of improved reperfusion across trials. The available clinical trials were individually underpowered and not designed to detect the influence of adjunctive devices on death or MACE. CONCLUSIONS: Routine use of adjunctive devices cannot be recommended. Thrombus burden, treatment with GPIIb/IIIa inhibitors, and gender may modify the reperfusion benefit of adjunctive devices.J Interv Cardiol. 2009;22:49-60.';
    ptext[29] = 'Value of early cardiac troponin I to predict long-term adverse events after coronary artery bypass graft surgery in patients presenting with acute coronary syndromesAmin AP, Mukhopadhyay E, Napan S, Mamtani M, Kelly RF, Kulkarni HBACKGROUND: High values of both preoperative and postoperative cardiac troponin I (cTnI) contribute to higher rates of short-term cardiac events following coronary artery bypass graft (CABG) surgery in patients with acute coronary syndrome (ACS). The prognostic value of very early cTnI in this context is unclear. HYPOTHESIS: Measurement of cTnI very early after admission to the emergency room can be used as a prognosticator for long-term outcomes after CABG. METHODS: We conducted a cohort study on 160 consecutive patients with ACS undergoing CABG at The John H. Stroger Jr. Hospital of Cook County (Chicago, IL) representing a total follow-up of 290.42 person-years. Adverse outcomes were defined as death or reinfarction. We used robust multivariate survival analyses to determine whether early cTnI measurement can independently predict the adverse outcomes in the study subjects. RESULTS: In univariate and stepwise multivariate Cox proportional hazards modeling we found that unit rise in early cTnI is associated with a 3% (95% confidence interval [CI]: 2%- 5%, p < 0.001) faster progression to long-term adverse events after CABG even after adjusting for the type of ACS. Prognostically, the most informative cut off value for cTnI was 5.6 ng/mL. Above this value, CABG patients progressed 2.58 times faster to adverse outcomes (95% CI: 1.05-6.36, p = 0.039). This effect remained after adjustment for other significant confounders namely, poor compliance to medications, female sex, Medicaid insurance, and electrocardiographic ischemia. CONCLUSION: Early cTnI measurement after admission can predict adverse outcomes after CABG. This association extends to long-term adverse events after CABG.Clin Cardiol. 2009;32:386-92.'
    ptext[30] = 'Bone recovery after zoledronate therapy in thalassemia-induced osteoporosis: a meta-analysis and systematic reviewMamtani M, Kulkarni HZoledronate is a promising bisphosphonate that improves the bone mineral density by 0.69 standard deviations in thalassemia-induced osteoporosis, but the entire range of its actions and side effects is currently not fully understood. INTRODUCTION: Zoledronate is a promising bisphosphonate for the treatment of thalassemia-induced osteoporosis; however, a quantitative summary of its beneficial effect and its effects on the markers of bone turnover are not established. METHODS: We conducted a meta-analysis of the published randomized controlled trials using standardized mean difference and a random effects model for improvement in bone mineral density (BMD). We also conducted a systematic review for the influence of zoledronate on markers of bone turnover and bone pain. RESULTS: We found that zoledronate improves the baseline BMD by 0.69 (95% confidence interval 0.47-0.90) standard deviations-an effect that was more pronounced when BMD was measured at the lumbar spine. However, the mechanistic interpretations of the effects on the markers of bone turnover are not completely clear. CONCLUSION: Sufficient evidence exists to demonstrate that 4 mg zoledronate given every 3 months markedly improves the BMD; however, more qualitative and quantitative evidence is required to understand the mechanisms of its action and the potential side effects.Osteoporos Int. 2009 Feb 26. [Epub ahead of print]';
    ptext[31] = 'Zinc and copper supplementation in acute diarrhea in children: a double-blind randomized controlled trialPatel A, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni HBACKGROUND: Diarrhea causes an estimated 2.5 million child deaths in developing countries each year, 35% of which are due to acute diarrhea. Zinc and copper stores in the body are known to be depleted during acute diarrhea. Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with standard treatment to children with acute watery or bloody diarrhea. METHODS: We conducted a double-blind randomized controlled clinical trial in the Department of Pediatrics at Indira Gandhi Government Medical College Nagpur, India. Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually randomized to placebo (Pl), zinc (Zn) only, and zinc and copper (Zn+Cu) together with standard treatment for acute diarrhea. RESULTS: The mean duration of diarrhea from enrollment and the mean stool weight during hospital stay were 63.7 hours and 940 grams, respectively, and there were no significant differences in the adjusted means across treatment groups. Similarly, the adjusted means of the amount of oral rehydration solution or intravenous fluids used, the proportion of participants with diarrhea more than 7 days from onset, and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrollment, did not differ across the three groups. CONCLUSION: The expected beneficial effects of zinc supplementation for acute diarrhea were not observed. Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children.BMC Med. 2009;7:22.';
    ptext[32] = 'Survival benefit from early revascularization in elderly patients with cardiogenic shock after acute myocardial infarction: a cohort studyAmin AP, Nathan S, Prodduturi P, DSilva O, Gupta A, Kumar A, Senter S, Mamtani M, Kulkarni H, Klein LW, Kelly RFOBJECTIVES: To assess if early revascularization offers any survival benefit in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) who are > or = 75 years of age. BACKGROUND: CS after AMI continues to pose formidable therapeutic challenges in elderly patients. METHODS: We conducted survival analyses of 310 consecutive subjects (including 80 patients > or = 75 years of age) who developed cardiogenic shock after AMI at two study centers - Rush University Medical Center and the John H. Stroger Jr. Hospital of Cook County (both in Chicago, Illinois). The data were collected over a 6-year period. Where appropriate, we used Kaplan-Meier survival plots, multivariate Cox proportional hazards modeling, stepwise multivariate Poisson regression analyses and unconditional logistic regression analysis. RESULTS: Early revascularization was associated with a statistically significant survival benefit both in patients < 75 years of age (relative hazard 0.40, 95% confidence interval [CI] 0.28-0.59; p < 0.001), as well as in patients > or = 75 years of age (relative hazard 0.56, 95% CI 0.32-0.99; p = 0.049). This benefit remained significant even after adjusting for the simultaneous effects of several putative confounders. In patients > or = 75 years of age, this survival benefit was evident very early and was sustained all through the period of follow up of the cohort. CONCLUSIONS: These retrospective data suggest a significant survival benefit of early revascularization in elderly patients > or = 75 years of age developing CS after AMI, albeit less as compared to those aged < 75 years.J Invasive Cardiol. 2009;21:305-12';
    ptext[33] = 'Arbitrary units are a composite and useful measure of muscle sympathetic nerve activityThakre TP, Kulkarni H, Mamtani MR, Smith MIn 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.';
    ptext[34] = 'Lack of Association of the Apoe 4 Allele with the Risk of Obstructive Sleep Apnea: Meta-Analysis and Meta-RegressionThakre TP, Mamtani M, Kulkarni HStudy 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 e4 allele with the risk of OSA. Design: Random effects meta-analysis and meta-regression Setting: Genetic epidemiological studies reporting the association of APOE e4 allele with OSA susceptibility. Patients or Participants: Synthesis of APOE e4 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 e4 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 e4 allele or when grouped based on the geographic location of the study. Conclusions: The hypothesis that the APOE e4 allele may be causally associated with OSA cannot be supported on the basis of published literature.SLEEP 2009;32:1507-1511.';
    ptext[35] = 'Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic ReviewPatel AB, Mamtani M, Dibley MJ, Badhoniya N, Kulkarni HBackground: 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.';
    ptext[36] = 'Influence of Zinc Supplementation in Acute Diarrhea Differs by the Isolated OrganismPatel AB, Dibley MJ, Mamtani M, Badhoniya N, Kulkarni HZinc 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.';
    ptext[37] = 'Using wholre blood ?-interferon assay to improve diagnosis of tuberculous pleural effusionKatiyar SK, Sampath A, Bohari S, Mamtani M, Kulkarni HAbstract not availableEur Respir J 2010; 36 (3):In Press';
    ptext[38] = 'Hemoglobin F levels influence the results of NESTROFT: replication in two surveysMamtani M, Chatterjee N, Mishra A, Soni R, Jawahirani A, Das K, Rughwani V, Shrivastava M, Kulkarni HAbstract not availableInt J Lab Hematol, 2010: In Press.';
    ptext[39] = 'Ultrafast papanicolaou stain modified for developing countries: efficacy and pitfalls. Kamal MM, Kulkarni MM, Wahane RN. 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';
    ptext[40] = 'Bayesian estimates of the prevalence of β-thalassemia trait in voluntary blood donors of central India: a survey. Chatterjee N, Mishra A, Soni R, Kulkarni H, Mamtani M, Shrivasatava M. 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.';
    ptext[41] = 'Risk Factors for predicting diarrheal duration and morbidity in children with acute diarrhea. Patel AB, Ronithung O, Badhoniya N, Dibley MJ. 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 <-2 (OR 1.25, 95% CI 1.07-1.46, p=0.004) were at a greater risk of prolonged duration of diarrhea. Diarrhea  >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 <-2 (OR 4.32, 95% CI 2.03- 9.16, p<0.001). Severe dehydration after hospitalization was associated with dehydration at baseline (OR 6.7, 95% CI 2-3.0, p<0.001), incomplete immunization (OR 3.33, 95% CI 1.5 - 7.69, p<0.001 ), failure to receive any medication(OR 3.03, 95% CI 1.26-7.14, p=0.01). Conclusion: Few studies assess risk factors for diarrheal morbidity prospectively .  This study showed that children of acute diarrhea with above risk factors need stricter monitoring for complications  to reduce diarrheal mortality. Ind J Pediatr: In Press';
    ptext[42] = 'What zinc supplementation does and does not achieve in diarrhea prevention: A systematic review and meta-analysis. Patel AB, Mamtani M, Badhoniya N, Kulkarni H. 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';

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		<p>&nbsp;&nbsp; <strong><span class="style5">LMRF&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>
<span class="style8">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Publications&nbsp; </span></strong><br>
		<strong>&nbsp;&nbsp;&nbsp; <span class="style15">Lata Medical Research Foundation</span><span class="style14">
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		<span class="style9"><strong>&nbsp;&nbsp;&nbsp;&nbsp; (Reg. No. E-1559, Nagpur, India)&nbsp;</strong></span></p>
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		<span lang="ES-CO" style="mso-ansi-language: ES-CO" class="style39">SUPPLEMENTS to following papers are available for download</p><br>
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