Jaishri Bogra

Publications (11)9.24 Total impact

• Article: Tumor Necrosis Factor gene polymorphism results in high TNF level in sepsis and septic shock.

  Nikhil Kothari, Jaishri Bogra, Haider Abbas, Monica Kohli, Anita Malik, Divya Kothari, Shivani Srivastava, Prithvi K Singh
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  ABSTRACT: INTRODUCTION: Systemic sepsis releases several cytokines among which tumor necrosis factor alfa (TNFα) has emerged as key cytokine causing septic shock. Single Nucleotide Polymorphisms (SNPs) at positions -238, -308, -376 and +489 in the promoter region of TNF gene exhibit differential association to inflammation and increased TNF production in sepsis. MATERIALS AND METHODS: This research work was carried out in 278 critically ill patients and 115 controls. The patients were divided into four groups: Healthy controls, SIRS, Sepsis and Septic shock. Plasma cytokine level was evaluated by ELISA. Specific sequences of TNF gene (-238, -308, -376, +489) were amplified using polychromase chain reaction (PCR). SNP detected by BamHiI, NcoI, FokI, TaiI restriction enzymes. RESULTS: Mean plasma TNFα level in healthy Control group was 8.37±2.23pg/ml, in SIRS group, the mean plasma TNFα level was 77.99±5.51pg/ml, in Sepsis patients 187.1±14.33pg/ml and in septic shock 202.2±14.85pg/ml; range 56.17-417.1pg/ml. SNP was studied among different patient groups, which showed a higher frequency of mutants among sepsis and shock patients as compared to control. CONCLUSION: Plasma TNF alpha level was significantly high in patients with sepsis and septic shock. SNP of TNF gene showed significant association between polymorphism and development of severe sepsis and septic shock, this would help us in evaluating patients at high risk for septic shock and such patients needed to obtain a rational basis for therapy.
  Cytokine 01/2013; · 3.02 Impact Factor
• Article: Cytokines induced neutrophil extracellular traps formation: implication for the inflammatory disease condition.

  Ravi S Keshari, Anupam Jyoti, Megha Dubey, Nikhil Kothari, Monica Kohli, Jaishri Bogra, Manoj K Barthwal, Madhu Dikshit
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  ABSTRACT: Neutrophils (PMNs) and cytokines have a critical role to play in host defense and systemic inflammatory response syndrome (SIRS). Neutrophil extracellular traps (NETs) have been shown to extracellularly kill pathogens, and inflammatory potential of NETs has been shown. Microbial killing inside the phagosomes or by NETs is mediated by reactive oxygen and nitrogen species (ROS/RNS). The present study was undertaken to assess circulating NETs contents and frequency of NETs generation by isolated PMNs from SIRS patients. These patients displayed significant augmentation in the circulating myeloperoxidase (MPO) activity and DNA content, while PMA stimulated PMNs from these patients, generated more free radicals and NETs. Plasma obtained from SIRS patients, if added to the PMNs isolated from healthy subjects, enhanced NETs release and free radical formation. Expressions of inflammatory cytokines (IL-1β, TNFα and IL-8) in the PMNs as well as their circulating levels were significantly augmented in SIRS subjects. Treatment of neutrophils from healthy subjects with TNFα, IL-1β, or IL-8 enhanced free radicals generation and NETs formation, which was mediated through the activation of NADPH oxidase and MPO. Pre-incubation of plasma from SIRS with TNFα, IL-1β, or IL-8 antibodies reduced the NETs release. Role of IL-1β, TNFα and IL-8 thus seems to be involved in the enhanced release of NETs in SIRS subjects.
  PLoS ONE 01/2012; 7(10):e48111. · 4.09 Impact Factor
• Article: Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia.

  Rajni Gupta, Jaishri Bogra, Reetu Verma, Monica Kohli, Jitendra Kumar Kushwaha, Sanjiv Kumar
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  ABSTRACT: Spinal anaesthesia is the most common approach which is used for lower limb surgery. Dexmedetomidine is the recent drug which acts on α2-adrenergic receptors in the dorsal horn of the spinal cord to produce analgesic effects. Efficacy and safety of intrathecal dexmedetomidine added to ropivacaine. Randomised double blind trial. Sixty patients were randomly allocated to receive intrathecally either 3 ml of 0.75% isobaric ropivacaine + 0.5 ml normal saline (Group R) or 3 ml of 0.75% isobaric ropivacaine + 5 μg dexmedetomidine in 0.5 ml of normal saline (Group D). The mean time of sensory regression to S2 was 468.3±36.78 minutes in group D and 239.33±16.8 minutes in group R. Duration of analgesia (time to requirement of first rescue analgesic) was significantly prolonged in group D (478.4±20.9 minutes) as compared to group R (241.67±21.67 minutes). The maximum visual analogue scale score for pain was less in group D (4.4±1.4) as compared to group R (6.8±2.2). The addition of dexmedetomidine to ropivacaine intrathecally produces a prolongation in the duration of the motor and sensory block.
  Indian journal of anaesthesia 07/2011; 55(4):347-51.
• Article: A Comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to Bupivacaine.

  Rajni Gupta, Reetu Verma, Jaishri Bogra, Monica Kohli, Rajesh Raman, Jitendra Kumar Kushwaha
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  ABSTRACT: Various adjuvants have been used with local anesthetics in spinal anesthesia to avoid intraoperative visceral and somatic pain and to provide prolonged postoperative analgesia. Dexmedetomidine, the new highly selective α2-agonist drug, is now being used as a neuraxial adjuvant. The aim of this study was to evaluate the onset and duration of sensory and motor block, hemodynamic effect, postoperative analgesia, and adverse effects of dexmedetomidine or fentanyl given intrathecally with hyperbaric 0.5% bupivacaine. Sixty patients classified in American Society of Anesthesiologists classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly allocated to receive either 12.5 mg hyperbaric bupivacaine plus 5 μg dexmedetomidine (group D, n = 30) or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group F, n = 30) intrathecal. Patients in dexmedetomidine group (D) had a significantly longer sensory and motor block time than patients in fentanyl group (F). The mean time of sensory regression to S1 was 476±23 min in group D and 187±12 min in group F (P<0.001). The regression time of motor block to reach modified Bromage 0 was 421±21 min in group D and 149±18 min in group F (P<0.001). Intrathecal dexmedetomidine is associated with prolonged motor and sensory block, hemodynamic stability, and reduced demand for rescue analgesics in 24 h as compared to fentanyl.
  Journal of Anaesthesiology Clinical Pharmacology 07/2011; 27(3):339-43.
• Article: Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section

  Nikhil Kothari, Jaishri Bogra, Ajay Chaudhary
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  ABSTRACT: Aims and Context: The objective of the present study was to evaluate the analgesic and adverse effects of intrathecal clonidine with hyperbaric bupivacaine in spinal anesthesia. Settings and Design : Randomized single blind trial. Methods: 210 ASA I-II pregnant females undergoing emergency cesarean section were randomized in a single-blind fashion to one of the three groups. In group I (n=70) patients received 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. In group II (n=70) patients received intrathecal mixture of 0.5% hyperbaric bupivacaine (8 mg) and clonidine 50 μg. In group III (n=70) , patients received 0.5% hyperbaric bupivacaine (10 mg) intrathecally along with 50 μg of clonidine. Statistical Analysis Used: Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test (χ2 =57.2410). Results: On adding 50 μg clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21±5.15 min. (group II) vs 146.0±4.55 min (group I), P=0.021; 95% confidence interval: 238.01-257.40, group II and 134.99-157.0 group I]. Conclusions: Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief.
  Saudi Journal of Anaesthesia. 01/2011;
• Article: Optimization of subarachanoid block by oral pregabalin for hysterectomy.

  Monica Kohli, T Murali, Rajni Gupta, Parveez Khan, Jaishri Bogra
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  ABSTRACT: 80% of patients undergoing surgical procedures experience postoperative pain1 and requires adequate pain relief. Nowadays drugs like COX2 inhibitors and calcium channel modulators (Pregabalin and Gabapentin) are been increasingly used for postoperative pain management effectively. We conducted this study to find whether preoperative pregabalin has any effect in postoperative analgesic requirement in patients undergoing hysterectomy under spinal anaesthesia. PATIENTS #ENTITYSTARTX00026; This randomized, double-blind, placebo-controlled trial was conducted in 150 patients undergoing hysterectomy under spinal anaesthesia, divided in three groups - Group I (PO) - Control group, Group II (P150) received 150 mg pregabalin and Group III (P300) received 300 mg pregabalin. We used VAS for anxiety, Ramsay sedation scale and VAS for patient satisfaction regarding pain relief. There was significant reduction in anxiety in groups P (150) and P (300) than placebo group P (0) during intraoperative and postoperative period than preoperative period. There was significant sedation seen in groups P (150) and P (300) than placebo group P (0). First rescue analgesia in group P (300) was202.42±6.77 and in group P (150) was176.38±4.80on average, group P (0) was131.38±5.15. Dizziness was 44.44% in group P (300), 36.11% in group P (150), and 19.44% in group P (0). Patient satisfaction was better in P (300) group than other two groups. Pregabalin being an oral drug which would be easy for the patients to take and also its prolongation of the neuraxial block helps in immediate postoperative analgesia and further reduction of other parentral analgesics. Pregabalin 150mg would be the optimal preemptive dose for hysterectomy under spinal anaesthesia.
  Journal of Anaesthesiology Clinical Pharmacology 01/2011; 27(1):101-5.
• Article: Evaluation of analgesic effects of intrathecal clonidine along with bupivacaine in cesarean section.

  Nikhil Kothari, Jaishri Bogra, Ajay K Chaudhary
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  ABSTRACT: AIMS AND CONTEXT: The objective of the present study was to evaluate the analgesic and adverse effects of intrathecal clonidine with hyperbaric bupivacaine in spinal anesthesia. Randomized single blind trial. 210 ASA I-II pregnant females undergoing emergency cesarean section were randomized in a single-blind fashion to one of the three groups. In group I (n=70) patients received 12.5 mg of 0.5% hyperbaric bupivacaine intrathecally. In group II (n=70) patients received intrathecal mixture of 0.5% hyperbaric bupivacaine (8 mg) and clonidine 50 μg. In group III (n=70), patients received 0.5% hyperbaric bupivacaine (10 mg) intrathecally along with 50 μg of clonidine. Groups were compared using one-way ANOVA with the Bonferroni multiple comparison post hoc test. The proportion of adverse events was compared using the chi-square test (χ(2) =57.2410). On adding 50 μg clonidine, we were able to reduce intrathecal dose of bupivacaine for cesarean section to 8 mg. Patients receiving intrathecal clonidine along with bupivacaine had significantly long lasting analgesia with lower bupivacaine dose [246.21±5.15 min. (group II) vs 146.0±4.55 min (group I), P=0.021; 95% confidence interval: 238.01-257.40, group II and 134.99-157.0 group I]. Addition of intrathecal clonidine causes some sedation in the postoperative period, but it provides adequate analgesia and motor paralysis at lower dose of bupivacaine. It also significantly prolongs postoperative pain relief.
  Saudi journal of anaesthesia. 01/2011; 5(1):31-5.
• Article: Increased myeloperoxidase enzyme activity in plasma is an indicator of inflammation and onset of sepsis.

  Nikhil Kothari, Ravi S Keshari, Jaishri Bogra, Monica Kohli, Haider Abbas, Anita Malik, Madhu Dikshit, Manoj K Barthwal
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  ABSTRACT: Circulating lipopolysaccharides released from bacteria may activate both neutrophils and monocytes. The activated neutrophils release myeloperoxidase (MPO), a specific enzyme with strong oxidative activity. The aim of this study was to evaluate MPO enzyme activity in plasma of critically ill patients and to check the hypothesis that these concentrations in plasma would be higher in sepsis and systemic inflammatory conditions, as neutrophils release their contents before proliferating in response to stress. Blood samples were collected from 105 critically ill patients admitted to the intensive care unit, consisting of those with systemic inflammatory response syndrome (n = 42), sepsis (n = 37), and septic shock (n = 26). Plasma MPO enzyme activity was determined by o-dianisidine-H(2)O(2) method, modified for 96-well plates. The plasma MPO enzyme activity in sepsis patients was significantly higher than that in the control group (mean, 2.4 ± 1.8 in sepsis and 1.86 ± 1.2 nmol per milligram protein per 10 minutes in systemic inflammatory response syndrome vs 0.32 ± 0.11 nmol per milligram protein per 10 minutes in healthy controls). Mean plasma lactate levels in sepsis (7.8 ± 1.2 mmol/L) and shock patients (9.5 ± 1.2 mmol/L) and cytokines like tumor necrosis factor-α, interleukin-8, and interleukin-1β were simultaneously evaluated to establish onset of inflammation and sepsis. These results show that neutrophil activation occurring during inflammation and sepsis could be detected by plasma MPO concentration. The plasma MPO concentrations may be a marker of the neutrophil proliferation and severity of inflammation.
  Journal of critical care 10/2010; 26(4):435.e1-7. · 2.13 Impact Factor
• Article: Alteration In Lipid Profile With Anaesthetic Agents: A Randomized Control Trial

  Jaishri Bogra, Nikhil Kothari, Monica Kohli, Rajni Gupta, Mansi Agnihotri, Pratima Shrivastav
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  ABSTRACT: Background: Cell membrane is mainly constituted of phospholipids bilayer. The modifications in membrane structure induced by the presence of volatile anaesthetic agents in turn, may indirectly alter membrane protein function. The lipids in membrane exist in either in fluid or a gel phase, transition from fluid to gel phase results in the reduction of volume. Anaesthetic agents lower the transition temperature at which this phase change occurs and may affect the channel opening. Since lipid profile witnesses alterations by the xenobiotic insults, we planned a study to see the alterations in lipid profile during and after anaesthesia administration. This study clearly indicates that lipid profile is significantly altered during anaesthesia administration; especially with Halothane. Patients and Methods: It was a Randomised Control trial; conducted on 180 patients undergoing elective surgery in general anaesthesia. Patients were classified into three groups (n=60, each). Control group was maintained with Nitrous and Oxygen anaesthesia and test groups were given Halothane and Isoflurane anesthesia respectively along with Nitrous and Oxygen. Results: The results presented here point out that after induction of general anaesthesia there is statistically significant (p<0.05) fluctuations in blood lipid levels with volatile anaesthetic agents, which got stabilized three hours after anaesthesia administration. Conclusion: These sudden iatrogenic changes lead to disruption of normal physiology of cell membranes which could affect the functioning of cells in long run, thus further investigations are to be needed in this aspect in order to know the biochemical changes occurring with inhalational anaesthetic agents.
  J Anaesth Clin Pharmacol. 01/2010; 26(1):49-53.
• Article: Effect on free radical generation with different anaesthesia.

  Jaishri Bogra, R Gangoo, V C Pandey, Pratima Srivastava
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  ABSTRACT: Reactive oxygen species are a part of the normal physiology of the biological system but their subsequent defence undergoes alteration during diseased conditions. Administration of anaesthesia for surgery may also alter the formation of reactive oxygen species. The present work deals with the comparative status of oxidative stress (lipid peroxidation) and anti-oxidant defence markers (superoxide dismutase and catalase) in blood in 3 groups of 15 patients each receiving halothane, relaxant vecuronium and spinal form of anaesthesia with lignocaine 5% heavy. The results obtained depict that the formation of malonyl dialdehyde as well as decrease in superoxide dismutase and catalase activities was highest in spinal anaesthesia followed by halothane and then relaxant group. Therefore, it seems important to consider the pre-operative anti-oxidant status while administering anaesthesia to such patients in order to provide biologically safe anaesthesia.
  Journal of the Indian Medical Association 04/2007; 105(3):128-9, 132.
• Source

  Available from: Pratima Srivastava

  Article: Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section.

  Jaishri Bogra, Namita Arora, Pratima Srivastava
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  ABSTRACT: BACKGROUND: Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. METHODS: Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 mug intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. RESULTS: Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. CONCLUSION: Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.
  BMC Anesthesiology 06/2005; 5(1):5.