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P P Sharma

Publications and source records attributed to P P Sharma.

At least 19 recordsLinked to original sources
PubMed2003

Adherence to tuberculosis treatment: lessons from the urban setting of Delhi, India.

The Revised National Tuberculosis Control Programme (RNTCP), which incorporated the WHO DOTS strategy was introduced in India in the mid-1990s. An operational research project was conducted between 1996 and 1998 to assess the needs and perspectives of patients and providers in two chest clinics in Delhi, Moti Nagar and Nehru Nagar, during the introduction of the new strategy. This paper reports on the findings of the project, concentrating on information collected from 40 in-depth interviews with patient defaulters and from non-participant observations in clinics and directly observed treatment centres. In Moti Nagar chest clinic, 117 of 1786 (6.5%) patients and 195 of 1890 (10%) patients in Nehru Nagar left care before their treatment was complete. It was argued that the reasons for default stem from a poor correlation between patient and programme needs and priorities, and from particular characteristics of the disease and its treatment. Patient needs that were not met by the health system included convenient clinic timings, arrangements for the provision for treatment in the event of a family emergency and provision for complicated cases like alcoholics. The problems facing the provider were poor interpersonal communication with the health staff, lack of attention and support at the clinic, difficulty for patients to re-enter the system if they missed treatment and, in certain areas, long distances to the clinic. Problems related to diseases were inability of the staff to deal with drug side-effects, and patients' conception of equating well-being with cure. Simple, practical measures could improve the provision of tuberculosis (TB) treatment: more flexible hours, allowances for poor patients to reach the clinics and training health care staff for respectful communication and monitoring drug side-effects. The findings indicate a need to rethink the label of 'defaulter' often given to the patients. The important areas for future operational research is also highlighted.

Adolescent↗
PubMed2002

TB control, poverty, and vulnerability in Delhi, India.

The Revised National Tuberculosis Control Programme (RNTCP), based on the World Health Organization's DOTS strategy,* was introduced in India in the mid-1990s. This paper reports the findings from operational research studies in two pilot sites in New Delhi from 1996 to 1998. A variety of operational research methods were used, including semi-structured interviews, focus group discussions, non-participant observations and collection of data from the tuberculosis registers. The cure rates for the clinics were 71 and 75% with a default rate of 6 and 11%, respectively. An important finding was that health workers screened patients to determine their ability to conform to the direct observation of treatment element of the RNTCP. If the health worker was confident that the patient would comply and/or be easy to trace in the community in the event of 'default', they were provided with short-course treatment under the RNTCP. Other patients, largely those who were in absolute poverty, socially marginalized, itinerant labourers, poorly integrated in the city, were put on standard tuberculosis (TB) treatment as for the previous National TB Programme. The programme was evidently excluding the most vulnerable from the best available care. These findings demonstrate the potential dangers of target-driven programmes where there is an absence of support to both frontline health workers and patients. The paper also highlights the importance of operations research in helping to identify problems within TB programmes.

Antitubercular Agents↗
PubMed2001

Catheter ablation in the elderly in the United States: use in the Medicare population from 1991 to 1998.

The safety and efficacy of catheter ablation for the treatment of drug refractory cardiac arrhythmias is well established in young patients. Little is known about its effectiveness or use in the elderly. We determined trends in the use of catheter ablation in the United States Medicare population. Data were obtained from the approximately 30 million patients covered each year by Medicare's fee-for-service program of the Health Care Financing Administration of the Department of Health and Human Services. From 1991 to 1998, Medicare's fee-for-service beneficiaries covered 80%-93% of all adults > 65 years old in the United States. All catheter-based ablative procedures performed in this population were identified through the use of the Current Procedural Terminology codes 93650, 93651, and 93652. Use rate per 1 million beneficiaries grew from 33 in 1991 to 603 in 1998. While during this 7-year period the Medicare fee-for-service population decreased by 8%, ablations increased 16-fold (1,608%). The use of catheter ablation in the older American grew exponentially during the 1990s. Further research is needed to determine the optimal use of this potentially curative technique in the elderly.

Aged↗
PubMed2001

Brucellosis in children of Dhofar Region, Oman.

OBJECTIVE: To study the epidemiological and clinical pattern of brucellosis in children of Dhofar and to ascertain the efficacy of a pre-determined antibiotic regimen to treat the disease. METHODS: The study was hospital based and was carried out prospectively for 3 years. All cases diagnosed to have brucellosis on clinical and serological basis were entered into the study. The epidemiological background and clinical presentations were analyzed and the clinical response to a combination of oral rifampicin and co-trimoxazole was evaluated. RESULTS: Three hundred and seventy five cases of brucellosis were eligible for the study. Ingestion of raw milk and its products were responsible for causation of the disease in 63% of cases. Eighty three per cent had direct contact with animals mainly cattle. A minority of 4.5% denied ingestion of raw milk or coming into direct contact with animals. Fever was the most common presenting feature at 91%. We identified 2 distinct groups of presentation: Seventy per cent of those who presented with arthritis belonged to the older age group (7.34 years, standard deviation 2.64). They did not have a systemic illness. The younger age group presented with severe systemic illness associated with severe leucopenia and thrombocytopenia. The clinical response to the combination of rifampicin and co-trimoxazole was satisfactory in 90% of patients and 98% of brucella species isolated from the blood of patients were sensitive to both antibiotics used. CONCLUSION: Ingestion of infected milk and contact with infected animals are the main causes of human brucellosis, although aerial transmission from contaminated environmental soil could not be excluded. The main clinical presentation of brucellosis in children is fever but the skeletal manifestations of the disease are significant. The hematological manifestations of the disease in endemic areas deserve special attention. The combination of oral rifampicin and co-trimoxazole for 6 weeks is adequate to treat most cases of brucellosis in children.

Anti-Infective Agents↗
PubMed1999

Radiofrequency ablation of an accessory pathway years after heart transplant: a case report.

A patient who had an orthotopic heart transplantation performed 9 years previously presented with a history of tachycardia lasting for three hours. He had only 1 previous episode of sustained tachycardia 4 years previously. Electrophysiological study showed a left antero-lateral accessory pathway which was successfully ablated using radiofrequency energy. This report indicates that some pathways may remain dormant for a long time after heart transplantation.

Adult↗
PubMed1998

Role of chewing and smoking habits in the etiology of oral submucous fibrosis (OSF): a case-control study.

Oral submucous fibrosis (OSF), a premalignant and crippling condition of the oral mucous membrane, was studied to identify its relationship to various chewing and smoking habits. Two hundred and thirty-six consecutive cases of OSF were compared with 221 control subjects matched for age, sex and socio-economic conditions. It was found that chewing of areca nut/quid or pan masala (a commercial preparation of areca nuts, lime, catechu and undisclosed colouring, flavouring and sweetening agents) was directly related to OSF. Also, pan masala was chewed by a comparatively younger age group and was associated with OSF changes earlier than areca nut/quid chewing. However, chewing or smoking tobacco with various other chewing habits did not increase the risk of developing OSF. It was also found that frequency of chewing rather than the total duration of the habit was directly correlated to OSF.

Adolescent↗
PubMed1998

Survey of knowledge, attitudes and practices for tuberculosis among general practitioners in Delhi, India.

SETTING: Random survey of knowledge, attitudes and practices (KAP) for tuberculosis among private practitioners (PPs) in Delhi, India, in 1995. OBJECTIVE: To investigate the KAP of private practitioners for tuberculosis in Delhi where the Revised National Tuberculosis Programme (RNTP) is being field tested. DESIGN: A pre-tested questionnaire survey was performed among 204 doctors attending updates/seminars on tuberculosis in various parts of Delhi. RESULTS: In a suspected case of tuberculosis, sputum examination was advised by only 12% of the PPs, while 89.5% would recommend chest X-ray. For treating tuberculosis 187 PPs were using 102 different regimens, and only 29.4% PPs were using the regimen recommended by the RNTP; 51.3% PPs were over-treating their patients. Only 23.5% of PPs requested sputum examination before the end of treatment, while 35.5% depended on X-ray clearance with clinical improvement. Only 19.5% of PPs emphasized the importance of regular treatment for their patients. CONCLUSION: Among PPs there is marked reliance on X-ray; sputum examination is being neglected for initial diagnosis, treatment monitoring and as a criterion for stopping treatment. The majority of PPs are not aware of, or are not prescribing, the treatment regimen recommended by the RNTP, and the majority of patients are being over-treated. There is a lack of emphasis on proper health education. PPs need more training, and more collaborative efforts are required between public health facilities and practising doctors for national control of tuberculosis.

Adult↗
PubMed1998

Awareness about tuberculosis among nurses working in a tuberculosis hospital and in a general hospital in Delhi, India.

SETTING: A tuberculosis institute and a general hospital in Delhi, India. OBJECTIVE: To investigate the awareness of nurses about tuberculosis and to evaluate the differences in awareness, if any, between nurses working in tuberculosis and those in a general hospital. DESIGN: A pretested questionnaire survey was performed on 213 nurses. RESULTS: The present study showed that a substantial number of nurses have inadequate knowledge regarding causative factors, the importance of sputum examination, correct doses of routinely used short-course chemotherapy drugs, the minimum duration of short-course chemotherapy, instructions at discharge, and health education for patients and family members. If responding correctly to 75% of the questions asked is taken as the criterion for satisfactory awareness, only 40.2% of tuberculosis nurses and 10.7% of general hospital nurses had a satisfactory level of awareness. There was no effect of increasing age or years of experience on the level of awareness. CONCLUSIONS: There is a general lack of knowledge regarding various aspects of tuberculosis among nurses. Active interventions are required to improve awareness for a better implementation of the revised national tuberculosis control programme in India.

Adult↗
PubMed1995

Diarrhoeal outbreak of Vibrio cholerae 0139 from north India.

Epidemics of cholera caused by Vibrio cholerae 01 occur regularly in India. Until recently, Vibrio cholerae non-01 have been the the causative agents of sporadic cases of gastroenteritis and septicaemia, especially in immunocompromised children. We describe a large outbreak of cholera-like illness from North India caused by Vibrio cholerae non-01, later serotyped as Vibrio cholerae 0139. Forty-one of a total of 391 patients with acute diarrhoea during a 2-month period (May-July 1993) were identified as having Vibrio cholerae in faecal samples. All patients were aged 1.5-12 years. Vibrio cholerae 0139 was isolated in 30 patients (73%-group I) and Vibrio cholerae 01 biotype eltor in 11 patients (27%-group II). The clinical presentation and severity of the cholera-like illness were similar to typical cholera. This strain is toxigenic with an epidemic potential and should be monitored carefully.

Acute Disease↗
PubMed1994

Effects of amiodarone on the circadian rhythm and power spectral changes of heart rate and QT interval: significance for the control of sudden cardiac death.

Effects of chronic amiodarone therapy on the circadian rhythmicity and power spectral changes of heart rate and QT intervals from Holter recordings were evaluated in three groups of patients: group 1 baseline (n = 10); group 2, treated for 3 to 6 months (n = 11); and group 3, treated for > 1 year (n = 13). Amiodarone reduced heart rate, which reached steady state at 3 to 6 months; bradycardia was evident during the entire 24 hours. The corrected QT (QTc) interval increased as a function of treatment duration. It was 457 +/- 39, 530 +/- 28 (p < 0.001), and 581 +/- 36 (p < 0.0002) msec for groups 1, 2, and 3, after 6 months, respectively. The circadian rhythmicity of QTc was abolished in group 3. Power spectral analysis showed a tendency for amiodarone to reduce both R-R and QT interval variabilities, suggesting inhibition of autonomic control on the heart by the drug. The effectiveness of amiodarone against ventricular arrhythmias may result in part from the sustained bradycardia in concert with continuous uniform prolongation of myocardial repolarization.

Aged↗
PubMed1994

Epidemic dropsy in Trans Yamuma areas of Delhi and U.P.

Thirty patients of epidemic dropsy from seven families scattered in different areas of East Delhi and UP were studied. The age group of the affected individuals varied from 2 years to 55 years. Argemone oil contamination was found in mustard oil used for cooking. Sanguinarine was detected in all suspected oil samples. Pitting edema of legs was the most consistent feature present in all cases. Other prominent features like local erythema and tenderness were present in 80% and 70% cases, respectively. In contrast to earlier epidemics, two striking features were presence of persistent tachycardia without any pyrexia in all the cases and absence of any ocular problems. There was one death due to congestive heart failure and partial recovery in all others in a 2 months follow up.

Adolescent↗
PubMed1992

Hypokalaemic paralysis in malnourished children.

Six malnourished children presenting with acute flaccid paralysis caused by hypokalaemia are described. Their ages ranged from 6 to 36 months. The extent of paralysis varied from neck flop to quadriparesis. Two cases had respiratory paralysis requiring ventilatory support for 48-72 hours. All were successfully treated with potassium supplementation. Hypokalaemia should be considered in the differential diagnosis of acute flaccid paralysis in malnourished children.

Acute Disease↗
PubMed1992

Prognostic score for kerosene oil poisoning.

Ninety five consecutive children with kerosene oil poisoning were studied, the first 70 retrospectively (internal group) and the rest 25, prospectively (external group) over a period of 3 years and 8 months. Based on clinical features and severity of illness in initial 70 cases, a weighted scoring system to determine the outcome was evolved. This included: (i) fever--absent 0, present 1; (ii) severe malnutrition--absent 0, present 1; (iii) respiratory distress--absent 0, present 2, with cyanosis 4; and (iv) neurological symptoms--absent 0, present 2, with convulsions 4. The scores ranged from 0 to 10 in the internal group. Using discriminate function analysis, a score of 4 or more was found to be associated with prolonged hospital stay and complications. The risk of dying increased if the score was equal to or more than 8. The predictive value of the score was 85.7%. For validation, this scoring was applied to the external group as well and 84% of cases could be correctly predicted.

Child, Preschool↗
PubMed1991

Multi drug resistant Salmonella typhi infection: clinical profile and therapy.

Multiple drug resistant Salmonella typhi infection was observed in thirty five recent cases among forty eight children with bacteriologically proven enteric fever. Incidence of complications such as shock, myocarditis, encephalopathy and paralytic ileus was higher among these. A combination of cephalexin and gentamicin was successfully used in the management of these children.

Amoxicillin↗
PubMed1991

Evaluation of social marketing of oral rehydration therapy.

Attempts, at social marketing of oral rehydration therapy (ORT) through television, in changing the knowledge and practice of mothers with regard to its use was assessed. One hundred and eighty seven consecutive mothers (38 excluded due to non use of ORT) were administered a preplanned questionnaire to assess their socio-economic profile, educational status, concept of diarrhea and correct use of ORT. Fifty nine mothers who watched these programmes on TV regularly formed the study group. These were compared with 90 mothers who had gained such knowledge from non-television sources. The correct application of knowledge of ORT was significantly better in study group compared with control group. The educational status of mothers had a positive impact on motivation to use ORT at home in the study group. Mass media campaigns through "TV spots" is an effective way of improving knowledge of mothers on ORT in a developing country.

Adult↗