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Association of Obesity in Children with Pancreatitis in a Predominantly Hispanic Population at the US-Mexican Border: A Single Center Outpatient Study

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Health 2016年第15期8卷 1820-1829页

作者： Indu Pathak Diana Malbas Pukhraj Rai alok kumar Dwivedi Department of Pediatrics Paul L. Foster School of Medicine Texas Tech University Health Sciences Center El Paso Texas USA El Paso Children’s Hospital El Paso Texas USA Division of Biostatistics & Epidemiology Department of Biomedical Sciences Paul L. Foster School of Medicine Texas Tech Univer-sity Health Sciences Center El Paso Texas USA

Importance: The incidence of pancreatitis has been increasing over the last decade. Limited data are available for pancreatitis in the Hispanic population. The clinical profile of pancreatitis and its association with obesity in a Mexican American population has not been well studied. Objective: To describe prevalence, the characteristics of pancreatitis cases, and determine its association with obesity. Design and Setting: Retrospective review of children from February 2012 to February 2015, at the Texas Tech University Health Sciences Center of El Paso (TTUHSC-El Paso) outpatient center. Case/non-case study was used to determine the association of overweight and obesity with pancreatitis. Participants: Children ages 2 - 18 years, only the newly diagnosed pancreatitis cases irrespective of its type excluding patients with traumatic and repeat visit for pancreatitis. Main Outcome and Measures: Pancreatitis and obesity. Results: The prevalence of pancreatitis was estimated as 20 cases in 21,444 patients seen in the outpatient clinic. In multivariable analysis, only obesity and ethnicity were significantly associated with pancreatitis. Obesity was found to be more than 7-fold likely with pancreatitis as compared to non-cases. Overweight was found to be more than 6-fold likely with pancreatitis as compared with non-cases. Our study demonstrates an association between obesity and pancreatitis in the study population. Conclusions and Relevance: Appropriate intervention for managing obesity may reduce the prevalence of pancreatitis and associated co-morbidities. A larger prospective study should be done to determine underlying causes of association between obesity and pancreatitis.

关键词： Pancreatitis Obesity Body Mass Index (BMI)

Customized autophagy: a long way to go

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Neuroimmunology and Neuroinflammation 2018年第5期5卷 1-3页

作者： Jayantee Kalita Usha Kant Misra alok kumar Department of Neurology Sanjay Gandhi Post Graduate Institute of Medical SciencesUttar Pradesh 226014India

The survival of any eukaryotic cell may have a unified theory i.e., energy production and clearance of unwanted organelles or pathogens which may be biological or non-biological. Survival of species over time depends ... 详细信息

关键词： Customized autophagy eukaryotic cell autophagy

Sensitivity of Nanostructured Iron Metal on Ultrasonic Properties

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Open Journal of Metal 2011年第2期1卷 34-40页

作者： alok kumar Gupta Archana Gupta Devraj Singh Sudhanshu Tripathi 不详

The present investigation is focused on the influence of the nanocrystalline structure of pure iron metal on the ultrasonic properties in the temperature range 100 - 300 K. The ultrasonic attenuation due to phonon- phonon interaction and thermoelastic relaxation phenomena has been evaluated for longitudinal and shear waves along , and crystallographic directions. The second-and third-order elastic constants, ultrasonic velocities, thermal relaxation, anisotropy and acoustic coupling constants were also com- puted for the evaluation of ultrasonic attenuation in this temperature scale. The direction is most ap- propriate to study longitudinal sound waves, while , direction are best to propagate shear waves due to lowest values of attenuation in these directions. Other physical properties correlated with obtained results have been discussed.

关键词： Iron Metal Elastic properties Ultrasonic Attenuation

Determinants of infant mortality in rural India: A three-level model

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Health 2013年第11期5卷 1742-1749页

作者： Sada Nand Dwivedi Shahina Begum alok kumar Dwivedi Arvind Pandey Department of Biostatistics All India Institute of Medical Sciences (AIIMS) New Delhi India Department of Biostatistics All India Institute of Medical Sciences (AIIMS) New Delhi India National Institute of Medical Statistics Indian Council of Medical Research New Delhi India

Taking into account the hierarchical structure of the data, through two-level analysis on infant mortality available under second round of National family Health Survey, the same group of authors recently reported determinants of infant mortality while examining possible changes in results under traditional regression analysis that ignores hierarchical structure of data. They reported that the community (e.g., state) level characteristics still have a major role regarding infant mortality in India. For better epidemiological understanding, the present study is to assess determinants of infant mortality in rural India, where three level considerations were possible. The results indicate that even after consideration of these covariates, variation in infant mortality remains significant not only between States but also between Districts. Further, as an additional observation, the probability of infant mortality is still high in rural areas of districts having health facility beyond three kilometers than their counterparts.

关键词： Infant Mortality Hierarchical Structure National Family Health Survey State Level District Level Public Health Multilevel Logistic Regression Traditional Logistic Regression

Community effects on public health in India: A hierarchical model

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Health 2012年第8期4卷 526-536页

作者： Sada Nand Dwivedi Shahina Begum alok kumar Dwived Arvind Pandey Department of Biostatistics All India Institute of Medical Sciences (AIIMS) New Delhi India National Institute of Medical Statistics Indian Council of Medical Research New Delhi India

The data on any aspect of public health, including that on infant mortality, has inbuilt hierarchical structure. Using traditional regression approach in data analysis, i.e., ignoring hierarchical structure, either at micro (individual) or at macro (community) level will be avoiding desired assumption related to independence of records. Accordingly, this may result into distortion in the results due to probable underestimation of standard error of the regression coefficients. To be more specific, an irrelevant co-variate may emerge as an important covariate leading to inappropriate public health implications. To overcome this problem, the objective of the present work was to deal with multilevel analysis of the data on infant mortality available under second round of National family Health Survey and notify changes in results under traditional regression analysis that ignores hierarchical structure of data. This method provides more accurate results leading to meaningful public health implications. In addition, estimation of variability at different levels and their covariance are also obtained. The results indicate that the community (e.g., state) level characteristics still have major role regarding infant mortality in India. Further, if computational facilities are available, multilevel analysis may be preferred in dealing with data involving hierarchical structure leading to accurate results having meaningful public health implications.

关键词： Community Effects Public Health Multilevel Analysis Hierarchical Model Traditional Regression Model

Statistical models for predicting number of involved nodes in breast cancer patients

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Health 2010年第7期2卷 641-651页

作者： alok kumar Dwivedi Sada Nand Dwivedi Suryanarayana Deo Rakesh Shukla Center for Biostatistical Services Department of Environmental Health College of Medicine University of Cincinnati Cincinnati USA.

Clinicians need to predict the number of involved nodes in breast cancer patients in order to ascertain severity, prognosis, and design subsequent treatment. The distribution of involved nodes often displays over-dispersion—a larger variability than expected. Until now, the negative binomial model has been used to describe this distribution assuming that over-dispersion is only due to unobserved heterogeneity. The distribution of involved nodes contains a large proportion of excess zeros (negative nodes), which can lead to over-dispersion. In this situation, alternative models may better account for over-dispersion due to excess zeros. This study examines data from 1152 patients who underwent axillary dissections in a tertiary hospital in India during January 1993-January 2005. We fit and compare various count models to test model abilities to predict the number of involved nodes. We also argue for using zero inflated models in such populations where all the excess zeros come from those who have at some risk of the outcome of interest. The negative binomial regression model fits the data better than the Poisson, zero hurdle/inflated Poisson regression models. However, zero hurdle/inflated negative binomial regression models predicted the number of involved nodes much more accurately than the negative binomial model. This suggests that the number of involved nodes displays excess variability not only due to unobserved heterogeneity but also due to excess negative nodes in the data set. In this analysis, only skin changes and primary site were associated with negative nodes whereas parity, skin changes, primary site and size of tumor were associated with a greater number of involved nodes. In case of near equal performances, the zero inflated negative binomial model should be preferred over the hurdle model in describing the nodal frequency because it provides an estimate of negative nodes that are at “high-risk” of nodal involvement.

关键词： Nodal Involvement Count Models Breast Cancer

SHIELDED SUSPENDED COUPLED DIELECTRIC GUIDE AND DIRECTIONAL COUPLER

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An epidemiological study on delay in treatment initiation of cancer patients

The 2nd International Conference on Millimeter Wave and Far-Infrared Technology

作者： alok kumar Rastogi A.K.Tiwari Department of Physics Dept.of Electronics Engineering

＜正＞A shielded suspended coupled dielectric guide was analyzed using the effective dielectric constant *** dispersion characteristics of shielded suspended coupled dielectric guides have been plotted for various dimensional *** the dispersion characteristics the wave impedances have also been *** computing the even and odd mode propagation constants,various directional couplers have been obtained.

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Health 2012年第2期4卷 66-79页

作者： alok kumar Dwivedi Sada Nand Dwivedi Suryanarayana Deo Rakesh Shukla Arvind Pandey Durgesh kumar Dwivedi Center for Biostatistical Services Division of Biostatistics and Epidemiology Department of Environmental Health College of Medicine University of Cincinnati Cincinnati USA Department of Biostatistics All India Institute of Medical Sciences New Delhi India Department of NMR & MRI Facility All India Institute of Medical Sciences New Delhi India Department of Surgical Oncology All India Institute of Medical Sciences New Delhi India National Institute of Medical Statistics Indian Council of Medical Research New Delhi India

Early diagnosis and timely initiation of treatment of cancer patients may improve survival and quality of life. Various measures of delay can be made during diagnosis and treatment initiation. Most of the studies were based on single type of cancer with different definitions and measurements of delay in diagnosis and treatment. Thus, it has been difficult to synthesize results and generalize to other types of cancer. The study proposes to measure total duration between onsets of symptom to start of treatment into three components, namely primary, secondary and tertiary delays. Primary delay is defined as onset of symptoms to contacting the first medical person, secondary delay is from first medical contact to confirmed diagnosis, and tertiary delay is from confirmed diagnosis to treatment initiation. The aim of this study is to determine factors associated with primary, secondary and tertiary delays in cancer patients. This study was planned as a cross-sectional study. Data was collected from patients admitted to the surgical wards of Department of Surgical Oncology, Institute Rotary Cancer Hospital, New Delhi during 2006-2007. Gamma regression and quantile regressions at 25th, 50th and 75th percentile of each of the delays were used to determine related factors. A total of 403 patients were included in the analysis. The median tertiary delay was found almost two folds (59;Interquartile range: 26 - 101 days) than the primary and secondary delays. Extremity cancer patients had longest primary, secondary and tertiary delays. Shortest primary, secondary and tertiary delays were observed for gastrointestinal cancer, breast and genitourinary cancer respectively. There is an urgent need and scope to reduce delay at each level primary, secondary and tertiary delay. Intervention studies are needed through information, education and communication/screening programs to reduce the diagnostic and treatment delays in cancer patients.

关键词： Delay Cancer Log Gamma Regression Quantile Regression

Primary Extra-Gastrointestinal Stromal Tumor (GIST) arising from mesentery of small bowel and presenting as abdominal mass: A rare entity

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Open Journal of Gastroenterology 2013年第5期3卷 267-271页

作者： alok kumar Tiwari Anil kumar Choudhary Hemant Khowal Poras Chaudhary Mohinder P. Arora Department of Surgery Dr R.M.L Hospital New Delhi India Department of Surgery Lady Hardinge Medical College New Delhi India

Introduction: Majority of mesenchymal tumors of gastrointestinal tract are Gastrointestinal Stromal Tumor (GIST). It is, however, a rare tumor, accounting for less than 1% of primary gastrointestinal (GI) neoplasms. Though, these tumors are refractory to conventional chemotherapy or radiotherapy but show a good response to targeted adjuvant chemotherapy with tyrosine kinase inhibitors following surgical resection. Case Report: we report here a case of primary Extra-GIST tumor arising from mesentry of small bowel near duodeno-jejunal junction in a 69 years old male patient. The patient presented with a palpable mass in upper abdomen for past 15 days. On examination, a non-tender mobile lump of size around 17 × 10 cm, with bosselated surface and firm in consistency was palpable involving epigastric, left hypochondrium and umbilical region. Contrast enhanced computed tomography of abdomen revealed a heterogenous mesentric mass. On surgical intervention a mass was found involving mesentery near dudenojejunal junction without involvement of gastrointestinal tract. Complete surgical resection of the tumor was done and adjuvant chemotherapy with Imatinib mesylate was started as HPE revealing GIST with mitotic index of >10/50 HPF and 17 × 10 cm size placed the patient in high risk category. Patient was discharged on 12th of post-operative day with advice of regular follow-up. Conclusion: GIST occurrence is not restricted to bowel but can involve unusual sites also. The mainstay of treatment remains surgical resection with adequate margin. In cases where tumour has malignant potential (high mitotic figures on histopathology) adjuvent treatment with tyrosine kinase may prevent or delay relapse.

关键词： Extra-Gastrointestinal Stromal Tumors GIST Mesentric Tumors Imatinib Mesylate Abdominal Mass