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M Pai

Publications and source records attributed to M Pai.

45 records · Page 3Linked to original sources
PubMedDate not supplied

Seroepidemiology of Helicobacter pylori infection in an urban, upper class population in Chennai.

BACKGROUND: In India, no true population-based seroepidemiological data on Helicobacter pylori infection are available. Serological studies have been done on hospital-based subjects chosen predominantly from lower socioeconomic strata. METHODS: A population-based serological study was done in a randomly selected urban, upper class population (children under 12 excluded). Of 163 households, 126 participated (response rate 77%); the number of respondents was 406. Blood was collected from 354 persons (response rate 87%). A latex agglutination test was used for serology. Demographic data, socioeconomic indicators and history of treatment for acid-peptic disease (APD) were also collected. RESULTS: The overall seroprevalence was 49.4% (95% confidence interval 44.1-54.8). Seroprevalence increased with age, ranging from 21.1% in the 12-20 years age group to 76.2% in the > 70 years group (p = 0.0003), and with larger family size (p < 0.05); it was lower among those living in nuclear families (p < 0.03). No association was found with gender, treatment for APD, and number of generations living together. CONCLUSIONS: Though the overall seroprevalence of H. pylori in this urban, educated, upper class population is high, the age-specific prevalence is different from what has been reported earlier in India; the pattern resembles that of a developed country.

Adolescent↗
PubMedDate not supplied

Survival after cardiopulmonary resuscitation in an urban Indian hospital.

BACKGROUND: Survival after cardiopulmonary resuscitation depends upon the quality of pre-hospital support, availability of resuscitation equipment and the competence of the resuscitator. There are few data on the prognosis of patients undergoing such resuscitation in India. METHODS: In a retrospective analysis of 215 resuscitations done in a 125-bed community hospital between January 1995 and November 1997, return of spontaneous circulation and survival to discharge were evaluated. Multivariate methods were used to identify the predictors of successful outcome. RESULTS: Of all the patients, 14.4% were alive at discharge. Survival after a cardiorespiratory arrest in the hospital was 18.4%, which was significantly better than survival after pre-hospital events (5.9%; p = 0.027). Multivariate predictors of survival at discharge were resuscitation duration of less than 20 minutes [odds ratio (95% confidence limit): 32.6 (6.5-164.3)], presentation with ventricular tachycardia or fibrillation [odds ratio: 18.5 (4.4-77.9)], in-hospital cardiorespiratory arrest [odds ratio: 5.2 (1.2-21.6)] and female sex [odds ratio: 3.2 (1.1-9.6)]. Bystander resuscitation, though rarely provided, increased survival at discharge (p = 0.026). CONCLUSIONS: With 5.5 resuscitation attempts needed for one live discharge after in-hospital cardiorespiratory arrest and 17 attempts to save a life after pre-hospital events, our outcomes are comparable to those reported from developed nations. A return of pulse after shorter durations of cardiopulmonary resuscitation, ventricular fibrillation or tachycardia as the abnormal presenting rhythm, in-hospital location of cardiorespiratory (CR) arrest and female sex were independent predictors of live discharge. Age and aetiology of CR arrest did not influence the outcome.

Aged↗
PubMedDate not supplied

A high rate of caesarean sections in an affluent section of Chennai: is it cause for concern?

BACKGROUND: While rising Caesarean section rates have been the subject of much attention and debate worldwide, there is not much information available on this rate and its potential adverse impact in India. METHODS: Our survey was a standard Expanded Programme on Immunization 30-cluster design, carried out in an urban educated, middle/upper class population in Chennai. Mothers of 210 children aged 12-36 months were interviewed and data collected on immunization and breast-feeding practices. Since the mode of delivery was one of the questions, we could generate population-based data on the Caesarean section rate and its influence on breast-feeding. RESULTS: Of the 210 babies, 95 (45%, 95% confidence interval: 39.1-51.3) had been delivered by Caesarean section. Two hundred and six of 210 babies (98%) had been breast-fed at some time. However, babies born by Caesarean section tended to be started late on breast-feeds were given prelacteal feeds more often, and colostrum less often when compared to babies delivered vaginally (all statistically significant). CONCLUSIONS: Our study revealed a very high rate of Caesarean section in the selected metropolitan population. On purely scientific grounds, a rate of 40% to 50% is extremely difficult to justify. Though not conclusive, the data also suggest that Caesarean section may be adversely affecting some aspects of breast-feeding. There is a need for more data and audits on Caesarean section rates in India, and a wider debate on its potential adverse impact on the health of mothers and newborns.

Cesarean Section↗
PubMedDate not supplied

Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study.

BACKGROUND: Successful treatment of acute myocardial infarction is dependent on early presentation of the patient to the hospital. The factors that contribute to delay in seeking treatment have not been systematically evaluated in the Indian milieu. METHODS: Patients admitted with acute myocardial infarction to a 125-bed urban community hospital were evaluated prospectively. A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent predictors of delayed admission were identified by logistic regression. RESULTS: Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% men]. The distribution of presentation times was skewed, with the mode, median and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hours, respectively. Seventy-nine patients (59.4%) consulted a general practitioner prior to hospital referral and 48 patients (36.1%) delayed admission to hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (OR 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe symptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08-0.82) minimized delay. CONCLUSION: Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to the general practitioner were found to be an independent correlate of delay.

Adult↗
PubMedDate not supplied

Primary squamous cell carcinoma of caecum.

Proximal to the anal canal, carcinomas composed in whole or in part of squamous epithelium are distinctly uncommon, accounting for 0.1 per cent of all colorectal carcinomas. Pure squamous cell carcinoma of the colorectum are extremely rare. Here we report a case of primary squamous cell carcinoma of the caecum in a 55 year old lady from South India.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study.

BACKGROUND: Hypothyroidism is a common, potentially treatable endocrine disorder. Since hypothyroidism is not always associated with the signs and symptoms typically attributed to it, the diagnosis is often missed. Conversely, patients with typical signs and symptoms may not have the disease when laboratory tests are performed. AIMS: We aimed to determine the accuracy of physical examination in the diagnosis of hypothyroidism. SETTING AND DESIGN: Prospective, hospital-based, cross-sectional diagnostic study. MATERIAL AND METHODS: Consecutive outpatients from the medicine department were screened and an independent comparison of physical signs (coarse skin, puffy face, slow movements, bradycardia, pretibial oedema and ankle reflex) against thyroid hormone assay (TSH and FT4) was performed. STATISTICAL ANALYSIS: Diagnostic accuracy was measured as sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and positive and negative predictive values. RESULTS: Of the 1450 patients screened, 130 patients (102 women and 28 men) underwent both clinical examination and thyroid function tests. Twenty-three patients (18%) were diagnosed to have hypothyroidism by thyroid hormone assays. No single sign could easily discriminate a euthyroid from a hypothyroid patient (range of positive likelihood ratio (LR+) 1.0 to 3.88; range of negative likelihood ratio (LR-): 0.42 to 1.0). No physical sign generated a likelihood ratio large enough to increase the post-test probability significantly. The combination of signs that had the highest likelihood ratios (coarse skin, bradycardia and delayed ankle reflex) was associated with modest accuracy (LR+ 3.75; LR- 0.48). CONCLUSION: Clinicians cannot rely exclusively on physical examination to confirm or rule out hypothyroidism. Patients with suspected hypothyroidism require a diagnostic workup that includes thyroid hormone assays.

Adolescent↗