R K Sharma

Post Graduate Institute of Medical Sciences, Rohtak, Rohtak, Haryana, India

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Publications (100)119.84 Total impact

  • V Agrawal, A Kaul, R S Ranade, R K Sharma
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    ABSTRACT: Immunoglobulin A (IgA) dominant membranoproliferative glomerulonephritis (MPGN) is rare, described only as case reports. We report a rare case of an elderly man presenting with rapidly progressive renal failure and nephrotic range proteinuria with histological, immunofluorescence, and ultrastructural findings supporting a diagnosis of IgA dominant MPGN. Autoimmune disease, cryoglobulinemia and infection-associated glomerulonephritis were excluded. Remission was achieved within 3 months of treatment. This case highlights an uncommon diagnosis with a good response to therapy. The differential diagnosis of IgA nephropathy with MPGN-like pattern is discussed.
    Indian Journal of Nephrology 05/2015; 25(3):168. DOI:10.4103/0971-4065.145425
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    ABSTRACT: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), has been reported to reduce periodontal disease severity in rat ligature-induced periodontitis model. The objective of present study is to investigate the impact of fluoxetine intake on periodontal parameters in periodontitis patients with clinical depression. A sample of 236 chronic periodontitis patients with clinical depression were assessed for clinical parameters of periodontal disease. Of these, 115 patients were taking fluoxetine (20mg/day) for ≥ 2 months and 121 patients were not. Participants taking fluoxetine were further analyzed for correlation between duration of drug intake and periodontal parameters. All periodontal parameters, except Plaque Index (PI), were significantly lower in participants taking fluoxetine (p<0.01). Partial correlation analysis, adjusted for confounders, revealed a significant and negative correlation between duration of fluoxetine intake and AL (R(2)= -.321, p < 0.05). Logistic regression analysis revealed that fluoxetine intake was associated with lower risk of having AL ≥3 (OR=0.55, 95% CI=0.31-0.96) and lower odds of increased BOP % values (OR=0.62, 95% CI=0.34-1). In this observational study, participants taking fluoxetine were associated with lower BOP % sites and lower attachment loss.
    Journal of Periodontology 03/2015; DOI:10.1902/jop.2015.140706 · 2.57 Impact Factor
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    ABSTRACT: The indications to increase the width of keratinized gingiva have not been proven beyond doubt; however it becomes indispensable in certain clinical situations. Inspite of frequently encountered complications, palate is considered most preferred area to harvest the free gingival graft (FGG). This procedure aimed at investigating the potential of buccal marginal gingiva as a donor to augment keratinized gingiva. To the best of our knowledge, no such cases have been documented in the literature. FGG harvested from maxillary buccal marginal gingiva was used to augment gingiva in the mandibular anterior region for two patients. This not only improved plaque control but also resulted in acceptable esthetic results over 3 years. Furthermore, gingiva at donor sites gained its normal form and was in harmony with the neighboring teeth. It may be concluded that buccal marginal gingiva may provide a predictable substitute to other donor tissues to augment gingiva.
    03/2015; 6(Suppl 1):S126-8. DOI:10.4103/0976-237X.152969
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    ABSTRACT: We evaluated whether polymorphisms in interleukin (IL-1) gene cluster (IL-1 alpha [IL-1A], IL-1 beta [IL-1B], and IL-1 receptor antagonist [IL-1RN]) are associated with end stage renal disease (ESRD). A total of 258 ESRD patients and 569 ethnicity matched controls were examined for IL-1 gene cluster. These were genotyped for five single-nucleotide gene polymorphisms in the IL-1A, IL-1B and IL-1RN genes and a variable number of tandem repeats (VNTR) in the IL-1RN. The IL-1B - 3953 and IL-1RN + 8006 polymorphism frequencies were significantly different between the two groups. At IL-1B, the T allele of - 3953C/T was increased among ESRD (P = 0.0001). A logistic regression model demonstrated that two repeat (240 base pair [bp]) of the IL-1Ra VNTR polymorphism was associated with ESRD (P = 0.0001). The C/C/C/C/C/1 haplotype was more prevalent in ESRD = 0.007). No linkage disequilibrium (LD) was observed between six loci of IL-1 gene. We further conducted a meta-analysis of existing studies and found that there is a strong association of IL-1 RN VNTR 86 bp repeat polymorphism with susceptibility to ESRD (odds ratio = 2.04, 95% confidence interval = 1.48-2.82; P = 0.000). IL-1B - 5887, +8006 and the IL-1RN VNTR polymorphisms have been implicated as potential risk factors for ESRD. The meta-analysis showed a strong association of IL-1RN 86 bp VNTR polymorphism with susceptibility to ESRD.
    Indian Journal of Nephrology 01/2015; 25(1):34. DOI:10.4103/0971-4065.135350
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    ABSTRACT: Killer immunoglobulin-like receptor (KIR) gene shows a high degree of polymorphism. Natural killer cell receptor gets activated once they bind to self-human leukocyte antigens (HLAs) with specific ligand. KIR gene and HLA ligand incompatibility due to the presence/absence of KIR in the recipient and the corresponding HLA ligand in the allograft may impact graft survival in solid organ transplantation. This study evaluates the effect of matches between KIR genes and known HLA ligands. KIR genotypes were determined using sequence specific primer polymerase chain reaction. Presence of certain KIR in a recipient, where the donor lacked the corresponding HLA ligand was considered a mismatch. The allograft was considered matched when both KIR receptor and HLA alloantigen reveald compatibility among recipient and donor. The data revealed better survival among individuals with matched inhibitory KIR receptors and their corresponding HLA ligands (KIR2DL2/DL3-HLAC2, KIR3DL1-HLABw4). On the contrary, no adverse effect was seen for matched activating KIR receptors and their corresponding HLA ligands. One of the activating gene KIR2DS4 showed risk (P = 0.0413, odds ratio = 1.91, 95% confidence interval = 1.02-3.57) association with renal allograft rejection. We conclude that the presence of inhibitory KIR gene leads to better survival; whereas activating motifs show no significant role in renal allograft survival.
    Indian Journal of Nephrology 01/2015; 25(1):27. DOI:10.4103/0971-4065.134655
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    ABSTRACT: Orofacial granulomatosis (OFG) is uncommon but increasingly recognized chronic inflammatory disorder characterized by persistent and recurrent lip swelling. It also affects gingiva, buccal mucosa, floor of mouth and a number of other sites in the oral cavity. Orofacial granulomatosis may cause significant cosmetic and functional problems which can be prevented if the disease is diagnosed in its infancy and promptly treated. This is a case report of orofacial granulomatosis in 25-year-old female patient with gingival swelling bearing granular appearance lip and cheek swelling with spontaneous exacerbation and remission since 2 years. Histopathological evaluation and treatment modalities with respect to orofacial granulomatosis are discussed.
    04/2014; 26(2):255–257. DOI:10.1016/j.ajoms.2012.10.004
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    ABSTRACT: Idiopathic minimal change disease is a disorder of T-cell dysfunction. The relative predominance of regulatory T cells (Tregs), Th1, and Th2 cells in nephrotic syndrome (NS) remains controversial. Imbalance in peripheral blood regulatory and effector T cells (Teff) are linked to cell mediated immune response and may be associated with steroid response in NS. Peripheral blood CD4 + CD25 + FoxP3 + (Tregs), CD4 + IFN-γ(+) (Th1), and CD4 + IL-4 + (Th2) lymphocytes were analyzed in 22 steroid-sensitive NS (SSNS) patients in sustained remission, 21 steroid-resistant NS (SRNS) and 14 healthy controls. The absolute percentage values and ratio of Th1/Tregs, Th2/Tregs, and Th1/Th2 were compared between SSNS, SRNS and control subjects. The percentage of Tregs was lower in SRNS patients (P = 0.001) compared with that of SSNS and healthy control. The percentage of Th1 cells was higher in SRNS (P = 0.001) compared to that of SSNS patients; however, it was similar to healthy controls (P = 1.00). The percentage of Th2 cells in SRNS (P = 0.001) was higher as compared to SSNS and controls. The ratio of Th1/Treg cells in SRNS (P = 0.001) was higher as compared to SSNS patients and controls. The ratio of Th2/Treg was also higher in SRNS as compared to SSNS and controls. The ratio of Th1/Th2 cells in SSNS, SRNS, and healthy controls were similar. The cytokines secretion complemented the change in different T-cell subtypes in SSNS, SRNS and healthy controls. However, the IFN-γ secretion in healthy controles was low inspite of similar percentage of Th1 cells among SRNS cases. We conclude that greater ratio of Tregs compared to that Th1 and Th2 favor steroid sensitivity and reverse ratio results in to SRNS. The difference in ratio is related to pathogenesis or it can be used as marker to predict steroid responsiveness needs further evaluation.
    Indian Journal of Nephrology 01/2014; 24(6):349-355. DOI:10.4103/0971-4065.132992
  • Anita Saxena, R K Sharma
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    ABSTRACT: Post-transplant hypertension is a major risk factor for graft loss and patient survival; therefore, hypertension following renal transplantation must be treated strictly. There seems to be a strong association between hypertension, total body water (TBW) and dry weight. In this study, we report the relationship of body water and body composition with hypertension in post-renal transplant patients. Forty-five post-transplant patients were enrolled in the study. Blood pressure (BP) was labeled as controlled if BP was 120/80 mm Hg and not under good control if BP was above 120/80 mm Hg. Based on the number of antihypertensive medications a patient was taking, patients were divided into two groups: Group 1 patients on one antihypertensive drug and Group 2 patients on more than one antihypertensive drug. Nutritional status of the patients was assessed. Body composition (water compartments, body fat and lean mass) was assessed using bioelectrical impedance analysis (BIA). Patient data were compared with 30 healthy volunteers. In patients, systolic BP was associated with TBW (P = 0.016), extracellular water (ECW Lt; r = 0.99), ECW% (r = 0.78) and diastolic BP with TBW% (P = 0.003), dry weight (r = 0.76) ECW% (r = 0.95) and percent intracellular water (ICW%) (r = 0.79). Compared with controls, ECW and ECW% was higher in patients, and the ICW% was less in patients. There was significant difference in the actual weight of the patients and BIA-derived dry weight, although patients were clinically not edematous. The study showed a significant increase in diastolic BP with increase in dry weight. Significant difference in TBW was observed when the patients were grouped on the basis of the antihypertensive medication a patient was taking (one antihypertensive drug versus more than one antihypertensive drug). This study also showed an association between hypertension and overhydration. BIA may be a useful tool for the clinical assessment of overhydration in non-edematous patients.
    Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2014; 25(1):22-8. DOI:10.4103/1319-2442.124466
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    ABSTRACT: The aim of this study was to investigate the HLA-G 14-bp insertion/deletion (I/D) polymorphism among end-stage renal disease (ESRD) patients. Cytomegalovirus (CMV) infection, acute allograft rejection (AR) and overall survival after renal transplantation was investigated in 300 ESRD patients and 302 age, sex and ethnicity-matched controls. Sequencing was performed to evaluate the impact of HLA-G promoter region single-nucleotide polymorphisms (SNPs) whereas semi-quantitative PCR method was used to determine the probable HLA-G expression pattern among ESRD and AR cases. Further, soluble human leukocyte antigen (HLA)-G (sHLA-G) expression levels were compared in AR vs non-AR cases in the light of HLA-G 14-bp I/D polymorphism. Increased risk was found for 14-bp D/D (deletion-DD) genotype and 14-bp D allele [DD: odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.03-2.06, P value = 0.0358; D: OR = 1.29, 95% CI = 1.03-1.62, P value = 0.0277], respectively for ESRD and CMV infection (DD: OR = 2.70, 95% CI = 1.45-5.05, P value = 0.0021; D: OR = 1.94, 95% CI = 1.22-3.08, P value = 0.0052). Nearly fourfold (OR = 3.62, 95%CI = 1.61-8.14, p = 0.0039) risk was observed for 14-bp I/I (insertion-II) genotype for AR. Survival analysis showed increased overall survival (OS) (AR or death) for 14-bp D/D genotype. HLA-G promoter region sequencing was carried out among 60 ESRD patients and 100 normal controls which showed increased risk for -964 G>A, -725 C>G/T and -486 A>C SNPs. -964 G>A and -725 C>G/T SNPs showed risk association for AR patients. High level of HLA-G transcripts was observed among non-AR patients. Further soluble HLA-G (sHLA-G) showed increased levels in ESRD patients (mean ± SEM; 62.16 ± 2.43 U/ml) as compared to controls (mean ± SEM; 21.06 ± 3.89 U/ml) (P = <0.0001). The 14-bp I/I, 14-bp I/D and 14-bp D/D genotypes showed significantly higher levels of sHLA-G among non-AR as compared to AR patients.
    Tissue Antigens 11/2013; 82(5):317-26. DOI:10.1111/tan.12210 · 2.35 Impact Factor
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    ABSTRACT: a b s t r a c t A review of high operating temperature (HOT) infrared (IR) photon detector technology vis-a-vis material requirements, device design and state of the art achieved is presented in this article. The HOT photon detector concept offers the promise of operation at temperatures above 120 K to near room temperature. Advantages are reduction in system size, weight, cost and increase in system reliability. A theoretical study of the thermal generation–recombination (g–r) processes such as Auger and defect related Shock-ley Read Hall (SRH) recombination responsible for increasing dark current in HgCdTe detectors is pre-sented. Results of theoretical analysis are used to evaluate performance of long wavelength (LW) and mid wavelength (MW) IR detectors at high operating temperatures.
    Infrared Physics & Technology 11/2013; 61:290-298. DOI:10.1016/j.infrared.2013.09.004 · 1.46 Impact Factor
  • Anita Saxena, R.K. Sharma, Amit Gupta
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    ABSTRACT: Bioelectrical Impedance Analysis (BIA) is a noninvasive and bedside tool for assessment of nutritional status. It is expected that patients who have undergone successful renal transplant will have good nutritional intake and steadily the patient will return to normal health and have good nutritional status. Objective The aim of the study was to evaluate effect of graft function on nutritional status in post renal transplant patients with borderline to good allograft function using BIA. Material and methods For this study, 45 post-renal transplant patients with mean serum creatinine 1.42 ± 0.42 mg% and glomerular filtration rate (GFR) 45.1 ± 14.1 ml/min were subjected to bioimpedance analysis. Several parameters were evaluated. Based on BIA derived GFR, patients were divided into two groups (group 1: borderline graft function GFR < 40 ml/min, X = 27.34 ± 9.1 ml/min and group 2: good graft function GFR ≥ 40 ml/min, X = 51.60 ± 9.16 ml/min). Patient data were compared with 30 healthy individuals. Results There was significant difference between healthy controls and the post transplant patients. Based on GFR, there was significant difference in patient groups in body weight (p = 0.01), serum creatinine (p = 0.005), BMI (p = 0.000), fat free mass (p = 0.003), fat mass (p = 0.003), body cell mass (p = 0.000), dry weight (p = 0.001). Patients with borderline GFR had higher serum creatinine but significantly lower body weight, BMI, FFM, FM, and dry weight, indicating poorer nutritional status as compared to those with good graft function. Based on phase angle, there was significant difference between groups A and B in GFR (p = 0.000), extracellular water (p = 0.015), intracellular water (p = 0.002), plasma fluid (p= 0.016), interstitial fluid (p = 0.016), body cell mass (p = 0.024). SGA scores showed that transplant patients had normal nutritional status, but when compared with healthy individuals, there was significant difference in the fat mass, fat free mass and body cell mass as assessed by BIA. Conclusion Compared to patients with good graft function, patients with borderline GFR showed evidence of early nutritional depletion as picked up by BIA implying nutritional deficiency sets in with reduction in GFR (<40 ml/min) which may not be picked up by subjective global assessment but is objectively detected by BIA.
    10/2013; DOI:10.1016/j.cqn.2013.11.010
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    ABSTRACT: Malnutrition inflammation syndrome (MIS) is common among ESRD patients. In the present study, we have investigated the association of genetic markers associated with appetite and energy regulation with malnutrition inflammation syndrome among end-stage renal disease (ESRD) patients. Two hundred and fifty-seven patients on maintenance hemodialysis and 200 normal healthy controls were included in the study. Nutritional assessment was done by subjective global assessment scores (SGA). Genotyping of leptin-2548 G/A (rs7799039), ghrelin Leu72Met (rs696217-408 C/A), Arg51Gln (rs34911341-346 G/A) and uncoupling protein 2 (UCP2) 45 bp insertion deletion was done using PCR-RFLP. Levels of leptin and acyl ghrelin were assessed using ELISA. Leptin-2548 AA genotype was associated with twofold higher risk of disease susceptibility while UCP2 insertion-deletion heterozygotes showed protective effect. Ghrelin Gln51Gln and Met72Met genotype were associated with 3.4- and 2.5-fold higher disease susceptibility. The Met72 and Gln51 allele showed 3.3- and 2.1-fold higher susceptibility to malnutrition in severe SGA group. Further, the levels of acyl ghrelin were significantly less in severe category of malnutrition and in poor appetite group. On combined analysis, the group 2 (presence of 3-4 risk alleles) showed 1.5- and twofold higher susceptibility to disease and malnutrition, respectively. On docking analysis, it was observed that higher receptor binding energy was associated with the mutant form of ghrelin (Gln51). Moderate and severe SGA were associated with 2.2- and 4.1-fold higher death hazard. Our study suggests that ghrelin may be major marker contributing to susceptibility to MIS among ESRD patients.
    Genes & Nutrition 08/2013; DOI:10.1007/s12263-013-0353-7 · 3.42 Impact Factor
  • R.K. Sharma, Harsh Vardhan
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    ABSTRACT: Renal transplantation has become the modality of choice for patients with end stage renal disease. Though it has led to improvement in survival and quality of life mortality still remains high. Cardiovascular disease is the most common cause of mortality in post-renal transplant patients. Hypertension (HTN) being the major traditional risk factor for atherosclerotic cardiovascular disease develops in up to 60–80% of renal allograft recipients. Risk factor for hypertension includes both patient and donor related factor. The major patient related factor includes the use of corticosteroids, calcineurin inhibitors (CNI) and transplant renal artery stenosis (TRAS). In this review we analyze the risk factors, pathogenesis and management of post-renal hypertension.
    07/2013; 2(3):131–135. DOI:10.1016/j.cqn.2013.08.002
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    ABSTRACT: During end stage renal disease (ESRD) inflammatory pathways are activated which may lead to malnutrition inflammation syndrome (MIS). In the present study, 257 ESRD patients and 200 controls were included. Cytokine levels and genotyping was done by polymerase chain reaction-restriction fragment length polymorphism and enzyme-linked immunosorbent assay (ELISA). Risk was estimated through binary logistic regression. Cox proportional hazards regression and Kaplan-Meier were used for survival analysis. Tumor necrosis factor TNF-α-308 AA conferred 3.6-fold higher susceptibility (P=0.001) and higher TNF-α levels (P=0.05). TNF-α-238 AA was associated with 3.3-fold higher susceptibility to ESRD (P=0.002). IL-6-174 CC genotype conferred 3-fold risk to disease (P=0.001) along with higher IL-6 levels (P=0.001). IL-10-1082 GG genotype exhibited 2.2-fold higher susceptibility to disease (P=0.013). IL-10-592 AA/-819 TT genotypes were associated with high C reactive protein (P=0.02) and low IL-10 (P=0.03) levels. TNF-α-308 A allele was significantly associated with 2.3-fold higher risk of malnutrition. TNF-α-GAC, AGC and IL-6-CC were risk haplotypes associated with higher disease susceptibility. Combined analysis revealed 1.6-fold higher susceptibility to disease (P=0.02), there was 2-fold higher susceptibility to malnutrition (P=0.02) in high inflammation group. TNF-α-238 AA genotype was associated with 2.5-fold higher death hazard risk (P=0.02). Our study suggests that TNF-α and its genetic variants are major contributors to susceptibility to MIS in ESRD patients.
    Journal of interferon & cytokine research: the official journal of the International Society for Interferon and Cytokine Research 06/2013; DOI:10.1089/jir.2012.0109 · 3.90 Impact Factor
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    ABSTRACT: CdTe thin films of 500 A ° thickness prepared by a thermal evaporation technique were analyzed for leakage current and conduction mechanisms. Metal–insulator–metal (MIM) capacitors were fabricated using these films as a dielectric. These films have many possible applications, such as passivation for infrared diodes that operate at low temperatures (80 K). Direct-current (DC) current–voltage (I–V) and capacitance–voltage (C–V) measurements were performed on these films. Furthermore, the films were subjected to thermal cycling from 300 K to 80 K and back to 300 K. Typical minimum leakage currents near zero bias at room temperature varied between 0.9 nA and 0.1 lA, while low-temperature leakage currents were in the range of 9.5 pA to 0.5 nA, corresponding to resistivity values on the order of 108 X-cm and 1010 X-cm, respectively. Well-known conduction mechanisms from the literature were utilized for fitting of measured I–V data. Our analysis indicates that the conduction mechanism in general is Ohmic for low fields <5 9 104 V cm�1, while the conduction mechanism for fields>6 9 104 V cm�1 is modified Poole–Frenkel (MPF) and Fowler–Nordheim (FN) tunneling at room temperature. At 80 K, Schottky-type conduction dominates. A significant observation is that the film did not show any appreciable degradation in leakage current characteristics due to the thermal cycling.
    Journal of Electronic Materials 03/2013; 42(3). DOI:10.1007/s11664-012-2344-7 · 1.68 Impact Factor
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    ABSTRACT: Renovascular hypertension is the most common cause of secondary hypertension. Imaging plays an important role in establishing the diagnosis in these cases. Digital subtraction angiography (DSA) is the gold standard investigation in suspected cases. Colour Doppler Ultrasound (CDUS) is a very effective and cheap screening tool. CT angiography and MR angiography are effective and comparable alternatives to DSA. Captopril scintigraphy and renal vein renin sampling are used in selected patients in whom the functional significance of the renal artery stenosis is to be determined.
    01/2013; 2(1):29–32. DOI:10.1016/j.cqn.2013.02.001
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    ABSTRACT: Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain mechanism to ensure availability of the right materials at the right time at a reasonable cost. Thus innovations like HRF will prove robust in rendering quality healthcare at an affordable cost.
    Journal of health and human services administration 01/2013; 36(1):3-23.
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    ABSTRACT: This article reports a case of 45-year-old female presented with pain and swelling in lower jaw with generalised burning sensation over the gums, mobility in upper anterior teeth and difficulty in feeding. On intra oral examination diffuse reddish inflamed and fragile gingiva was noticed with granular appearance. Painful whitish sloughed and indurated ulcerative lesion with erythematous margins was found over midpalate to buccal mucosa over anterior border of ramus. Consistent radiographic examination revealed cavitatory defect over right pleural base. List of various diagnostic possibilities has been given as differential diagnosis and finally findings of our case were most consistent with Wegener's granulomatosis which was confirmed by biopsy and serum testing for anti-neutrophilic cytoplasmic antibodies. Patient was cured with oral prednisolone and cyclophosphamide in the standard dose. After 3 months cyclophosphamide was replaced with myecophenolate moeftil 500 mg BD. At the follow up of 6 months the patient was quiet normal and was relieved of all the symptoms. We feel that the clinicians should be aware of the possible, occurrence of oral lesions of WG and consider them in the differential diagnosis of any oral ulcer of unknown etiology. On further assessment, it is imperative for clinicians to conduct further laboratory and radiographic and histopathological investigations to rule out the disease.
    11/2012; 24(4):218–221. DOI:10.1016/j.ajoms.2012.03.003
  • Heart (British Cardiac Society) 10/2012; 98(Suppl 2):E276-E277. DOI:10.1136/heartjnl-2012-302920w.2 · 6.02 Impact Factor
  • R.K. Sharma, Sudeendra S. Gupta
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    ABSTRACT: The incidence of chronic kidney disease and end stage renal disease (ESRD) is increasing in the elderly, worldwide. Hemodialysis, peritoneal dialysis and renal transplantation are different modalities of renal replacement therapy employed for elderly ESRD patients. Vascular access problems are more common in the elderly patients. The survival outcomes are similar and poor among elderly hemodialysis and peritoneal dialysis patients, although only few studies hint at higher mortality in elderly diabetic patients on peritoneal dialysis. Renal transplantation in selected patients appears to be beneficial. Dialysis refusal or withdrawal by patients is also an important issue in elderly ESRD patients.
    10/2012; 1(4):291–294. DOI:10.1016/j.cqn.2012.09.006

Publication Stats

299 Citations
119.84 Total Impact Points


  • 2014–2015
    • Post Graduate Institute of Medical Sciences, Rohtak
      • Department of Medicine
      Rohtak, Haryana, India
  • 1992–2015
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • • Department of Nephrology
      • • Department of Urology
      • • Department of Pathology
      • • Department of Cardiology
      Lakhnau, Uttar Pradesh, India
  • 2012
    • Pt. BD Sharma University of Health Sciences, Rohtak
      Rohtak, Haryana, India
  • 2011
    • Concordia University–Ann Arbor
      Ann Arbor, Michigan, United States
    • Postgraduate Institute of Medical Education and Research
      Chandigarh, Chandīgarh, India
  • 1992–2010
    • University of Delhi
      • Department of Chemistry (Faculty of Science)
      Old Delhi, NCT, India
  • 2009
    • King George's Medical University
      • Department of Urology
      Lakhnau, Uttar Pradesh, India