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Articles by P Kumar
Total Records ( 6 ) for P Kumar
  H Kamran , L Salciccioli , B Venkatesan , V Namana , P Kumar , S Pushilin , M Umer and J. Lazar

Carotid—radial pulse wave velocity (PWV) decreases in normal healthy individuals following hyperemia provoked by release of arterial cuff occlusion. To determine the effects of specific cardiovascular (CV) risk factors on the hyperemic PWV response, we measured PWV before and after brachial artery (BA) occlusion in 218 participants (66% males, age 56 ± 19 years), with and without CV risk factors/disease. PWV ranged from -46% to +35% and values were normally distributed. On univariate analyses, PWV correlated with age, hypertension (Htn), hypercholesterolemia, diabetes mellitus (DM), coronary disease, congestive heart failure (CHF), smoking, and mean arterial pressure (MAP). On multivariate analysis, PWV was independently related to Htn (B = 4.56, P = .03) and CHF (B = 7.34, P = .008) and trended toward a higher MAP (B = .113, P = .067), DM (B = 4.01, P = .11), and hypercholesterolemia (B = 3.36, P = .12). In conclusion, hyperemic changes in carotid—radial PWV values are independently related to Htn and CHF and possibly DM and hyperlipidemia.

  R. R Chaturvedi , T Herron , R Simmons , D Shore , P Kumar , B Sethia , F Chua , E Vassiliadis and J. C. Kentish

Background— In ventricular dilatation or hypertrophy, an elevated end-diastolic pressure is often assumed to be secondary to increased myocardial stiffness, but stiffness is rarely measured in vivo because of difficulty. We measured in vitro passive stiffness of volume- or pressure-overloaded myocardium mainly from congenital heart disease.

Methods and Results— Endocardial ventricular biopsies were obtained at open heart surgery (n=61; pressure overload, 36; volume-overload, 19; dilated cardiomyopathy, 4; normal donors, 2). In vitro passive force-extension curves and the stiffness modulus were measured in skinned tissue: muscle strips, strips with myofilaments extracted (mainly extracellular matrix), and myocytes. Collagen content (n=38) and titin isoforms (n=16) were determined. End-diastolic pressure was measured at cardiac catheterization (n=14). Pressure-overloaded tissue (strips, extracellular matrix, myocytes) had a 2.6- to 7.0-fold greater force and stiffness modulus than volume-overloaded tissue. Myocyte force and stiffness modulus at short stretches (0.05 resting length, L0) was pressure-overloaded >normalvolume-overloaded>dilated cardiomyopathy. Titin N2B:N2BA isoform ratio varied little between conditions. The extracellular matrix contributed more to force at 0.05 L0 in pressure-overloaded (35.1%) and volume-overloaded (17.4%) strips than normal myocardium. Stiffness modulus increased with collagen content in pressure-overloaded but not volume-overloaded strips. In vitro stiffness modulus at 0.05 L0 was a good predictor of in vivo end-diastolic pressure for pressure-overloaded but not volume-overloaded ventricles and estimated normal end-diastolic pressure as 5 to 7 mm Hg.

Conclusions— An elevated end-diastolic pressure in pressure-overloaded, but not volume-overloaded, ventricles was related to increased myocardial stiffness. The greater stiffness of pressure-overloaded compared with volume-overloaded myocardium was due to the higher stiffness of both the extracellular matrix and myocytes. The transition from normal to very-low stiffness myocytes may mark irreversible dilatation.

  T. A Kupers , T Dronet , M Winter , J Austin , L Kelly , W Cartier , T. J Morris , S. F Hanlon , E. L Sparkman , P Kumar , L. C Vincent , J Norris , K Nagel and J. Mcbride

Litigation in Mississippi required the Department of Corrections to ameliorate substandard conditions at the supermaximum Unit 32 of Mississippi State Penitentiary at Parchman, remove prisoners with serious mental illness from administrative segregation and provide them with adequate treatment, and reexamine the entire classification system. Pursuant to two federal consent decrees, the Department of Corrections greatly reduced the population in administrative segregation and established a step-down mental health treatment unit for the prisoners excluded from administrative segregation. This article describes and discusses not only the process of enacting the changes but also the outcomes, including the large reductions in rates of misconduct, violence, and use of force.

  M. S. S Kishore , P Kumar and A. K. Aggarwal

Background: National family health survey-3 of India has revealed startling lower exclusive breastfeeding (EBF) rates (16.9%) in the state of Haryana compared with national data (46%). The barriers to breastfeeding in this population are not clearly known. Therefore, a study was conducted in a rural population of the state to study their breastfeeding practices, knowledge regarding usefulness of breastfeeding and factors influencing the breastfeeding practices.

Methods: In six villages of Panchkula district of Haryana, all the mothers of infants between 0–6 months were interviewed using a pretested semi-structured questionnaire. Time at initiation of breastfeeding, duration of EBF and their understanding about the usefulness of breastfeeding were assessed. Position of the baby during breastfeeding and attachment of the baby's mouth to the breast were assessed by direct observation while feeding. Breastfeeding knowledge of the mother was evaluated.

Results: Out of the 77 mothers, 30% and 10% exclusively breastfed their infants till 4 and 6 months of age, respectively. There was ‘good attachment’ in 42% mother–infant pairs and infants were held in ‘correct position’ by 60% mothers. Thirty-nine percent of the mothers had ‘satisfactory’ breastfeeding knowledge. On multivariate logistic regression analysis, lack of breastfeeding counseling was significantly associated with decreased rates of EBF at 4 months and 6 months (p-value 0.01 and 0.002, respectively) and ‘full’ breastfeeding (FBF) at 6 months of age (p-value 0.002).

Conclusions: EBF/FBF practices and breastfeeding knowledge are suboptimal among the rural North Indian mothers. Breastfeeding counseling with emphasis on correct technique can improve the EBF/FBF rates.

  K Mukhopadhyay , G Chowdhary , P Singh , P Kumar and A. Narang

The aim of the study was to determine the neurodevelopmental outcome of acute bilirubin encephalopathy (ABE) in children who underwent double volume exchange transfusion (DVET). The 25 referred newborns of ≥35 weeks gestation with total serum bilirubin >20 mg dl–1 and signs of ABE were enrolled and followed up at 3, 6, 9 and 12 months. Denver Development Screening Test (DDST), Neurological examination along with MRI at discharge and brain stem evoked response audiometry (BERA) at 3 months were done. Abnormal neurodevelopment was defined as either (i) cerebral palsy or (ii) abnormal DDST or (iii) abnormal BERA. The mean bilirubin at admission was 37 mg dl–1. MRI and BERA were abnormal in 61% and 76%. At 1 year, DDST and neurological abnormality were seen in 60% and 27% and 80% had combined abnormal neurodevelopment. MRI had no relation (P = 0.183) but abnormal BERA had a significant association (P = 0.004) with abnormal outcome. Intermediate and advanced stages of ABE associated with significant adverse outcome in spite of DVET.

  P Kumar , A Kamat and C. R. Mendelson

A 246-bp region upstream of placenta-specific exon I.1 of the human aromatase (hCYP19) gene mediates placenta-specific, developmental, and O2 regulation of expression. In this study, trophoblast differentiation and associated induction of CYP19 expression were prevented when cytotrophoblasts were cultured in phenol red-free medium containing charcoal-stripped serum or with the estrogen receptor (ER) antagonist, ICI 182,780, suggesting a stimulatory role of estrogen/ER. ER protein was expressed in human trophoblasts and increased during syncytiotrophoblast differentiation, whereas ERβ was undetectable. Mutational analysis revealed that an estrogen response element-like sequence (ERE-LS) at –208 bp is required for inductive effects of estradiol/ER on hCYP19I.1 promoter activity in transfected COS-7 cells. Increased binding of syncytiotrophoblast compared with cytotrophoblast nuclear proteins to the ERE-LS was observed in vitro; however, ER antibodies failed to supershift the complex and in vitro-transcribed/translated ER did not bind. Nonetheless, chromatin immunoprecipitation assays in cultured trophoblasts revealed recruitment of endogenous ER to the –255- to –155-bp region containing the ERE-LS before induction of hCYP19 expression; this was inhibited by ICI 182,780. Chromatin immunoprecipitation also revealed increased acetylated histone H3(K9/14) and decreased methylated histone H3(K9) associated with this region during trophoblast differentiation. These modifications were prevented when trophoblasts were incubated with ICI 182,780, suggesting that ER recruitment to the –255- to –155-bp region promotes histone modifications leading to increased hCYP19 transcription. Thus, during trophoblast differentiation, estrogen/ER exerts a positive feedback role, which promotes permissive histone modifications that are associated with induction of hCYP19 gene transcription.

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