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Articles by S Bhatnagar
Total Records ( 2 ) for S Bhatnagar
  S Mishra , S Bhatnagar , D Gupta , Gaurav Nirvani Goyal , R Jain and H. Chauhan
 

Background. Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes.

Methods. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation.

Results. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively.

Conclusion. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

  H Li , A Mittal , D. Y Makonchuk , S Bhatnagar and A. Kumar
 

Duchenne muscular dystrophy (DMD) is a fatal X-linked genetic disorder of skeletal muscle caused by mutation in dystrophin gene. Although the degradation of skeletal muscle extracellular matrix, inflammation and fibrosis are the common pathological features in DMD, the underlying mechanisms remain poorly understood. In this study, we have investigated the role and the mechanisms by which increased levels of matrix metalloproteinase-9 (MMP-9) protein causes myopathy in dystrophin-deficient mdx mice. The levels of MMP-9 but not tissue inhibitor of MMPs were drastically increased in skeletal muscle of mdx mice. Besides skeletal muscle, infiltrating macrophages were found to contribute significantly to the elevated levels of MMP-9 in dystrophic muscle. In vivo administration of a nuclear factor-kappa B inhibitory peptide, NBD, blocked the expression of MMP-9 in dystrophic muscle of mdx mice. Deletion of Mmp9 gene in mdx mice improved skeletal muscle structure and functions and reduced muscle injury, inflammation and fiber necrosis. Inhibition of MMP-9 increased the levels of cytoskeletal protein β-dystroglycan and neural nitric oxide synthase and reduced the amounts of caveolin-3 and transforming growth factor-β in myofibers of mdx mice. Genetic ablation of MMP-9 significantly augmented the skeletal muscle regeneration in mdx mice. Finally, pharmacological inhibition of MMP-9 activity also ameliorated skeletal muscle pathogenesis and enhanced myofiber regeneration in mdx mice. Collectively, our study suggests that the increased production of MMP-9 exacerbates dystrophinopathy and MMP-9 represents as one of the most promising therapeutic targets for the prevention of disease progression in DMD.

 
 
 
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