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Featured researches published by Chandra Bhushan Tripathi.
Indian Journal of Clinical Biochemistry | 2008
Rachna Agarwal; S. P. S. Kushwaha; Chandra Bhushan Tripathi; Neeraj Kumar Singh; Neelam Chhillar
Alzheimer’s disease is the most common form of dementia in the elderly and it’s prevalence is rapidly rising. Oxidative stress plays important role in the pathophysiology of Alzheimer’s disease. Metals like copper, iron derived through diet can act as pro-oxidant under oxidative stress. In the present study, serum copper levels were evaluated in 50 patients with Alzheimer’s disease, 24 patients with Vascular Dementia and 30 controls. All the groups were also investigated for serum ceruloplsmin levels. The mean copper levels in Alzheimer’s disease and Vascular Dementia were significantly raised compared to controls. An attempt has been made to study the relationship of serum copper with ceruloplasmin. Our study found weak correlation between copper and ceruloplasmin levels in Alzheimer’s disease and Vascular Dementia.
American Journal of Alzheimers Disease and Other Dementias | 2014
Rachna Agarwal; Chandra Bhushan Tripathi
Background: Dementia is an age-related disorder associated with elderly population, resulting from interaction of lifestyle risk factors with genetic, vascular, and other risk factors to affect risk of disease. Alzheimer’s disease (AD) is the most common form of dementia, estimated to be affecting 4.4% of the population older than 65 years of age. Apolipoprotein E (ApoE) ∊4 allele is a known genetic risk factor for AD, which not only predisposes and influences the severity of pathological changes in the brain, thereby modifying the age at onset, but also promotes cognitive decline early in nondemented older people. Objectives: To review the published evidence on ApoE polymorphism with the susceptibility to AD and frequency of ApoE ∊4 genotype (∊4/-) and homozygotes (∊4/4) among patients diagnosed with AD as compared to controls in Indian Population. Materials and Methods: In the present study, MEDLINE was reviewed for articles published till June 2013 supplemented by citation analysis from retrieved articles to select case–control studies. A meta-analysis was performed to demonstrate the association of ApoE gene with vascular dementia by random effects to demonstrate models. The association was assessed by odds ratio (OR) with 95% confidence intervals (CIs). Study Selection: Case–control studies, using clinical criteria for AD with ApoE polymorphism determined for allele and genotype in both cases and controls. Statistical Analysis: A meta-analysis was performed to demonstrate the association of ApoE gene with AD by random effects to demonstrate models. The association was assessed by OR with 95% CIs. We also looked for publication bias and performed sensitivity analysis to investigate the influence of each individual study. Results: A total of 7 studies representing data from 417 patients with AD and 651controls in the Indian population were eligible. The ApoE ∊2/4, ∊3/4, and ∊4/4 genotypes (OR = 3.93, 95% CI: 1.60-9.68; OR = 4.18, 95% CI: 2.54-6.87; OR = 4.81, 95% CI: 1.95-11.86, respectively) as well as ApoE ∊4 allele (OR = 5.90, 95% CI: 3.44-10.13) were associated with an increased risk of AD, whereas ApoE ∊2/3, ∊3/3 genotypes (OR = 0.52, 95% CI: 0.32-0.83; OR = 0.28, 95% CI: 0.19-0.42), and ApoE ∊3 allele (OR = 0.29, 95% CI: 0.17-0.50) were found to be marginally significant protective factors for AD. There was no significant difference in ApoE ∊2/2 genotype and ApoE ∊2 allele frequency (OR = 0.42; 95% CI: 0.11-1.68; OR = 0.69, 95% CI: 0.37-1.31, respectively) in patients with AD and controls. Conclusions: These results indicate that all genotypes of ApoE ∊4 allele, that is, ∊2/4, ∊3/4, and ∊4/4, are associated with an increased risk of AD, whereas ApoE ∊2/2, ∊2/3, and ∊3/3 are protective for AD.
Annals of Indian Academy of Neurology | 2010
Rachna Agarwal; Neelam Chhillar; S. P. S. Kushwaha; Neeraj Kumar Singh; Chandra Bhushan Tripathi
Background: Vitamin B12 and folate represent modifiable risk factors for dementia. They may increase the risk of Alzheimer′s dementia (AD) and vascular dementia (VaD) as their deficiency can increase the homocysteine level due to slowed methylation reaction. Homocysteine has a neurotoxic effect that could lead to neurologic disturbances. Hence, it is important to explore the status of serum B12 and folate in AD and VaD to evolve the treatment strategies for the same. Objectives: A retrospective study was conducted to assess the levels of vitamin B12, folate, and thyroid stimulating hormone (TSH) in serum and the relationship of these factors, including age and sex to cognitive decline in VaD, AD, and dementia due to other causes (DOC). Materials and Methods: Serum vitamin B12, folate, TSH, and total cholesterol were studied in 32 AD patients (mean age: 65 years), 12 VaD patients (mean age: 61 years), 83 DOC (mean age: 65 years), and 127 control subjects (mean age: 49 years). Results: In AD, VaD, and DOC, the levels of vitamin B12 and folate were significantly lower (P < 0.002; 0.026; 0.002 for vitamin B12 and P < 0.000 in all the 3 groups for folate) as compared with the controls. Similarly, TSH levels were significantly lower in AD and DOC (P < 0.008; 0.038) as compared with the controls. Conclusion: Vitamin B12 and folate were significantly low in both AD and VaD patients. Hence, B vitamin supplementation should be considered as possible targets for the therapeutic intervention in dementia.
American Journal of Therapeutics | 2009
Sangeeta Sharma; Sukriti Joshi; Shoma Mukherji; Kiran Bala; Chandra Bhushan Tripathi
A retrospective study was conducted to assess the appropriateness of the utilization of therapeutic drug monitoring (TDM) services with regards to antiepileptic drugs (AEDs) at a tertiary care hospital, and analysis of 5094 samples of the carbamazepine (CBZ), phenytoin (PHT), valproic acid (VAP), and phenobarbitone (PB) was undertaken. Maximum requisitions were received for CBZ (54.92%) followed by PHT (27.05%), VAP (14.40%), and PB (3.61%). About 2.12% requisitions were received for patients taking unlabeled AEDs. Reasons for TDM were routine monitoring (36.3%), adverse drug reactions (ADRs) (17.2%), relapse (30.7%), no response (3.35%), and irregular treatment (2.24%) and not mentioned (10.5%). Majority of the samples (69%) were drawn for measuring trough levels; however, in 22% time of last dose was not mentioned and 9.64% were for peak or random levels. In all, 6.9% requisitions for TDM were sent before steady-state levels, and in 15.5% duration of therapy was not mentioned. Blood levels within therapeutic range were found with CBZ (63%) followed by PB (56.52%), VAP (45.99%), and PHT (42.52%). Blood levels were above therapeutic range in 45.69%, 29%, and 21.73% patients taking VAP, PHT, and PB, respectively. Unsuspected poor compliance was uncovered in 11.8%, 41.2%, and 29.3% requisitions sent with ADR, relapse, and routine monitoring as reason for drug levels, respectively. Only half of all AED measurement requisitions were complete and met the criteria for appropriate AED-level determination. Incomplete requisitions lead to difficulty in uniform interpretation of results and thus add to unnecessary costs.
Annals of Indian Academy of Neurology | 2015
Rachna Agarwal; Puneet Talwar; Suman Kushwaha; Chandra Bhushan Tripathi; Ritushree Kukreti
Background: Leptin, a 16 kDa peptide hormone synthesized and secreted specifically from white adipose cells protects neurons against amyloid β-induced toxicity, by increasing Apolipoprotein E (APO E)-dependent uptake of β amyloid into the cells, thereby, protect individuals from developing Alzheimer′s disease (AD). The APO E ε4 allele is a known genetic risk factor for AD by accelerating onset. It is estimated that the lifetime risk of developing AD increases to 29% for carriers with one ε4 allele and 9% for those with no ε4 allele. Objectives: To determine the levels of serum leptin, cholesterol, low density lipoprotein (LDL-C), and high density lipoprotein (HDL-C) in the diagnosed cases of AD and the association of them with cognitive decline and Apolipoprotein E (APO E) genotypes in AD. Materials and Methods: Serum levels of serum leptin, cholesterol, LDL-C, and HDL-C along with APO E polymorphism were studied in 39 subjects with probable AD and 42 cognitive normal individuals. Results: AD group showed significantly lower levels of leptin (P = 0.00) as compared to control group. However, there was no significant difference in cholesterol, triglycerides, LDL-C, and HDL-C levels in AD and control groups. The frequency of ε4 allele in AD (38.5%) was found to be significantly higher than in control (10.3%). ε3 allele was more frequent than ε4 allele in AD and control group.
Annals of Indian Academy of Neurology | 2013
Rachna Agarwal; S. P. S. Kushwaha; Neelam Chhillar; Alok Kumar; Dharmendra Kumar Dubey; Chandra Bhushan Tripathi
Background: Several population based studies have demonstrated an association between hypo-or hyperthyroidism and dementia in last two decades. As a consequence, thyroid stimulating hormone has become part of the screening laboratory test for dementia. Aim: The aim of the present study was to evaluate the association between thyroid function and Alzheimers disease (AD) and vascular dementia (VaD) and to determine the risk of AD and VaD in clinically euthyroid patients. Materials and Methods: A cross-sectional hospital based study was carried out in subjects diagnosed with AD/VaD and were assessed for thyroid status as routine screening test. Results: Free T3, free T4 and TSH were studied in 114 AD patients (mean age: 65 years), 35 VaD patients (mean age: 62 years) and 105 control subjects (mean age: 62 years). In AD group, TSH levels were significantly lower than controls (P = 0.00) and for each unit increase in TSH level, the odds of having dementia decreased by 37.1%. No such relation was seen in VaD. Conclusion: The results suggest a consistent association of subclinical hyperthyroidism and AD.
Indian Journal of Clinical Biochemistry | 2009
Rachna Agarwal; Sangeeta Sharma; Neelam Chhillar; Kiran Bala; Neeraj Kumar Singh; Chandra Bhushan Tripathi
The present study was conducted to assess correlation of ammonia levels with valproate levels in epileptic patients presenting with valproate toxicity and also whether liver enzymes and ammonia levels could serve as biochemical marker of valproate toxicity. 100 patients with epilepsy who had received valproate therapy for more than 12 months and had presented with valproate toxicity and 100 controls were included in the study. The serum valproate, ammonia and liver enzymes were measured in these subjects. In patients with valproate toxicity, the mean level of serum valproate was 110.91 ± 28.68 mg/dL (therapeutic range 50–100 mg/dL). Serum ammonia was higher (86.37 ± 39.90 µg/dL) in patients with valproate toxicity compared to controls (68.73 ± 30.07 µg/dL). Out of 100 patients, only 37 patients had serum valproate level > 120 mg/dL and 22 patients had raised levels of valproate as well as ammonia. Age < 30 years and serum ammonia > 69 μg/dL is risk factors for valproate toxicity. Serum ammonia, liver enzymes should be regularly investigated in patients on valproate therapy for early diagnosis of valproate toxicity.
Labmedicine | 2012
Rachna Agarwal; Sujata Chaturvedi; Neelam Chhillar; Ishita Pant; Smita Kaushik; Chandra Bhushan Tripathi
Objectives To evaluate the quality indicators covering the critical steps in the pre- and postanalytical phases and to study their trends over a 21-month period in the laboratory. Methods A prospective analysis of results obtained from our clinical chemistry and haematology laboratories, which function independently, for errors in the pre- and postanalytical phases was carried out to observe the trend for all the errors after the implementation of 3 patient-safety strategies. Results A significant improvement was observed in completeness of test requisition forms (TRFs) received in the laboratory after staff training. Incidence of sample rejection decreased dramatically after the implementation of a second patient-safety activity; it dropped further after the introduction of evacuated tubes. Almost 100% improvement was observed in critical and urgent reporting. Conclusion Use of quality indicators to assess and monitor clinical-laboratory processes is an extremely valuable tool in maintaining quality control in a systematic and transparent way. * IOM : Institute of Medicine TTP : total testing process TRF : test requisition form IQC : internal quality control SOPs : standard operating procedures LIS : laboratory information system
International Journal of Alzheimer's Disease | 2011
Rachna Agarwal; Chandra Bhushan Tripathi
CSF tau and Aβ42 are considered as important markers to diagnose Alzheimers disease in early stages. Hence, it is important to assess their status in different types of dementia. The main objective of this study was to assess whether these CSF biomarkers can be used to make the differential diagnosis of AD. In the present study, articles published from 1998 till 2009 were taken and meta-analysis was performed to clarify the consistency in trends of biomarkers- CSF tau and Aβ 42 in AD and other dementias and whether the same can be used as diagnostic biomarkers for its early diagnosis. 11 out of 60 for CSF tau and 07 out of 40 for CSF Aβ 42, dementia case-control studies were selected for final analysis. Descriptive statistics shows that median effect size (raw mean difference) of CSF tau was 429 pg/mL (range: 32 to 910 pg/mL) in AD whereas in Dementia due to other causes (DOC) studies it was 69 pg/mL (range: −53 to 518 pg/mL). Similarly the median effect size of CSF Aβ 42 levels was −442 pg/mL (range: −652 to −41.200 pg/mL) whereas in DOC studies it was −193 pg/mL (range: −356 to −33 pg/mL).
International Journal of Clinicopathological Correlation | 2017
Ishita Pant; Deepak Jha; Vinod Kumar Singh Gautam; Chandra Bhushan Tripathi; Sujata Chaturvedi
Objective: The objective of the study was to describe the clinical, histopathological, and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Materials and Methods: Thirty cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analyzed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor, vascular endothelial growth factor, mouse double minute 2 homolog (MDM2), and Ki67 was done, and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in thirty cases of glioblastoma (World Health Organization Grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Among the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while among the immunohistochemical parameters, expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological, and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection, and expression of MDM2 showed a significant correlation with the patient survival.