Mihir Rupani
I am a Gold Medalist in my post-graduation in MD Community Medicine (Public Health). I have seven publications in PubMed indexed journals and seventeen in other indexed journals. I have expertise in grant writing, questionnaire development, data collection, data analysis using SPSS statistical software and scientific writing. As a Principal Investigator, I successfully completed and published a research on depression among HIV patients, which was funded by the National AIDS Control Organization (NACO, New Delhi). My thesis topic covered cervical cancer screening in patients with Sexually Transmitted Diseases. Apart from these two dissertations, I participated actively in eight research projects in my department during my residency. After joining as Assistant Professor at Bhavnagar, I completed eleven research projects as PI (two of them funded), some of them are currently under review in PubMed indexed journals. Currently, I am a co-investigator for two funded research projects, being carried out under my guidance. Although I do not have any experience in the field of the proposed research project, I am sure that my experience would come handy in its timely completion and publication in a journal indexed in Science Citation Index/PubMed. I also work closely with the Health
Phone: +91-9925222421
Address: B-23, Meghna Society, Opp. Maninagar Society, Manjalpur, Vadodara - 390011, Gujarat, India.
Phone: +91-9925222421
Address: B-23, Meghna Society, Opp. Maninagar Society, Manjalpur, Vadodara - 390011, Gujarat, India.
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Methods: This was a hospital-based cross-sectional study conducted in a tertiary care government hospital on a calculated sample size of 258 SLT users in the year 2017. The patients were recruited from Ear-Nose-Throat (ENT) and dental out-patient department (OPD). The tobacco dependence was assessed using ‘Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco’ and willingness to quit was assessed on a Likert scale of 1-10.
Results: Among the 258 smokeless tobacco users, 20% were highly dependent on smokeless tobacco and 61% had low willingness to quit tobacco. “Mawa” was the most common (60%) chewed form of tobacco. Illiterate patients were three times more likely and patients whose occupation required traveling were 2.4 times more likely to develop high dependence for SLT than their counterparts. Patients living in the joint family were 2.7 times more likely to develop high dependence than patients living in a nuclear family.
Conclusion: There is a need for the introduction of tobacco cessation interventions in ENT and dental OPD of tertiary care hospitals of western India.
adequate blood flow during hemodialysis in patients with chronic renal failure, and they have superior patency rates and
lower complication rates than grafts.
Objective: To study the success rate of AV fistula, postoperative complications, and factors affecting the patency rate of
AV fistula.
Materials and Methods: This prospective study was conducted in Department of General Surgery of Sir Takhtsinhji
Hospital, Bhavnagar, Gujarat, India, during 2012–2014 in patients of all age groups and both gender with chronic kidney
disease.
Result: Of the 150 patients enrolled in the study, 62% revealed radiocephalic fistulas while 17% brachiocubital fistulas.
In majority of the patients (81%), side-to-side anastomosis was done, while in 19% patients, end-to-side anastomosis was
done. The AV fistula remained patent in 115 (77%) patients, and among them, the patency rate of radiocephalic was 60%
and that of brachiocephalic was 13%. The patency rate for side-to-side fistula was 83% and that for end-to-side was 18%.
Patency rate for patients with hemoglobin (Hb) > 9 g % was 94% with only 6% for patients with Hb < 9 g %. Nonsmokers
were 3.6 times (95% CI: 1.58–8.23) more likely to have their fistula patent than smokers. Arterial diameter is also a
predictor of patency.
Conclusion: The success rate of AV fistula by conventional vascular anastomosis technique was 77%. Side-to-side
anastomosis showed better patency rate than end-to-side anastomosis. Radiocephalic AV fistula showed better patency
rate than other types of fistulas performed in upper limb. Anemia (Hb < 9 g %), smoking, and arterial diameter were the
major factors affecting fistula patency. Thrombosis, postoperative edema, surgical site infection, steal phenomenon, and
aneurysm were the complications noted in the postoperative period.
Surat has the highest incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Gujarat, the main reason being its large migrant population. Mental health in HIV/AIDS has most often been a topic of neglect all over the world. This study attempts to assess the magnitude of depression and the socio-demographic and clinical variables associated with it in HIV-positive patients.
Methods
A cross-sectional study was conducted in 270 HIV-positive patients using Beck Depression Inventory (BDI; translated and validated in Gujarati and Hindi) along with a questionnaire for eliciting information on socio-demographic and clinical variables.
Results
The prevalence of depression among HIV-positive patients was 30% with 12.22% having mild depression; 14.07% with moderate depression and 3.7% with severe depression. Bivariate analysis showed that physical pain, physical illness, Cluster of Differentiation 4 (CD4) <300 cells/mm3, HIV positive spouse, discrimination at hospital, discrimination in society, government setup as the first place of HIV test and broken relationship with spouse after HIV disclosure were significantly associated with depression among the patients. On multiple logistic regression, discrimination at hospital, physical pain and CD4 <300 cells/mm3 were found to be the significant predictors of depression among the patients.
Discussion
HIV-positive patients can be screened by counselors using easy-to-administer scales like BDI, which can be translated and validated into any regional language. A trained psychiatrist should be appointed at the Anti-Retroviral Therapy (ART) center to take care of the mental health issues of the patients
caused by pathogenic leptospira. Leptospirosis is more
prevalent in South Gujarat due to heavy rain fall and clay soil
structure. The current study was conducted to analyse the profile
of patients with Leptospirosis admitted in Surat Municipal Institute
of Medical Education and Research (SMIMER), Surat.
Methods and Material: This prospective study, involves patients
visiting SMIMER hospital during the time period of 1st August to
31st October 2011 who were suspected for Leptospirosis. Their
presenting complaints, examination findings, lab findings, treatment
and outcome were recorded and analyzed based on the
modified Faine’s criteria.
Results: Among the 24 suspected cases of Leptospirosis, 14 (59%)
were males and age of patients ranged from 10 to 65 years with
mean age of 34 years. Fever, myalgia, and headache were predominant
complaints and all had history of contact with animals
or contaminated environment. Liver functions and renal functions
were deranged in 96% and 63% cases respectively. Fifteen patients
were found positive for Leptospirosis. Fifteen (63%) patients
had Weil’s syndrome and 8 had ARDS. There were 4
deaths, all were males, had ARF and presented with systolic hypotension.
Conclusions: The disease prevalence usually increases during
rainy season. Most cases were from rural origin and all had history
of contact with animals. Myalgia (calf tenderness), jaundice
and conjunctival suffusion were characteristic physical examination
findings. Jaundice and renal failure are associated with severity
of the disease and are considered bad prognostic signs with
high mortality rate (16%).
managed with drugs, ultrasound guided needle aspiration and open surgical drainage.
Aim: The aim of the study was to assess the etiological & predisposing factors, variation in clinical presentation in
liver abscesses, conservative management of small liver abscess, role of USG guided aspiration and percutaneous
tube drainage androle of surgical intervention in liver abscess.
Methods: A cross-sectional study was conducted in a tertiary care hospital of Ahmedabad on 100 patients with liver
abscess from 2006 to 2009. Information on socio-demographic, clinical, complications and management of the
patients was collected on a pre-tested questionnaire after taking written informed consent of the patients. Data was
entered and analysed in Excel.
Results: Amoebic liver abscess is more common in 30-40 age groups, while Pyogenic is more common in 50-60 age
groups.Males are commonly found to be affected than females. Alcoholism and Diabetes mellitus are main predisposing
factors in case of liver abscess. Most patients present with fever, abdominal pain and tenderness in right
hypochondrium. Most common signs are tenderness in right hypochondrium and fever. Most common laboratory
findings are hypoalbuminemia, leukocytosis and anemia. Ultrasoundhas been proven to be the most useful investigation.
Nine out of 14 patients with Pyogenic Abscess& 4 out of 5 patients with Amoebic Abscessresponded to medical
therapy while adjunctivepercutaneous aspiration (for abscesses smaller than 180cc on USG) was performed in 31
Amoebic & 33 Pyogenic patients.USG guided aspiration and laparotomy has the best outcome.
Conclusion: We conclude from the study that needle aspiration combined with antibiotics represent a successful
therapeutic approach in the treatment of liver abscess. Open surgical drainage is usually reserved for complications
like rupture in peritoneum.
with mucosa after preputioplasty gives good cosmetic appearance and it can be utilized in future for
urethral stricture surgery. The aim of this study was to compare the post-operative complications and
post-operative hospital stay in patients operated by circumcision and preputioplasty.
Methodology: This prospective study included 50 patients (age less than 4 years) having phimosis,
treated during July 2010 to July 2012. These patients were treated by two methods viz. circumcision and
preputioplasty (25 cases by each method).The patients were assessed post-operatively at day 1, day 15, at
2 months and at 3 months.
Results: The study revealed that the immediate post-operative complications like pain, bleeding, oedema,
difficulty in micturition and fever were present after both the procedures. But post-operative pain (84%),
bleeding (24%) and difficulty in micturition (16%) were higher after circumcision than after preputioplasty
(40%, 4% and 4% cases respectively). Post-operative oedema was more prominent in preputioplastyoperated
patients (84%). Post-operative hospital stay was longer in cases treated with circumcision. After
three months, recurrent adhesions were more common after preputioplasty (32%). Cosmetic appearance
was acceptable in patients operated with both the procedures.
Conclusion: Preputioplastyis a faster, easier, relatively painless technique with excellent cosmetic results
and lesser complications than circumcision, except post-operative edema and adhesions.
Objectives: To study the probable changes in serum magnesium, lipid profile and various biochemical parameters and to assess risk factors of CVD in newly diagnosed RA patients compared to controls.
Materials and Methods: We studied 50 newly diagnosed RA adult patients and 50 healthy individuals as controls. Serum magnesium, calcium, lipid profile, uric acid and other biochemical parameters were measured in study subjects. Results were expressed as Mean ± SD and compared between RA subjects and controls by Independent sample t-test and Pearson correlation.
Results: We found decreased serum magnesium and calcium in RA subjects compared to the controls (p < 0.001). RA subjects had atherogenic lipid profile characterized by elevated total cholesterol (p = 0.054), LDL cholesterol (p = 0.008) and decreased HDL cholesterol (p < 0.001). Serum uric acid was higher in RA cases compared to controls (p = 0.025). Serum magnesium was negatively correlated with total cholesterol, LDL cholesterol and positively correlated with HDL cholesterol in RA cases.
Conclusion: Decreased magnesium level, dyslipidemia and increased uric acid observed in our study together may be more potent risk factors for CVD in newly diagnosed RA subjects. We recommend that serum magnesium should be investigated as a part of cardiovascular risk management in RA. We suggest that decreased serum magnesium and increased serum uric acid may be considered as nontraditional risk factors of CVD in RA. Further prospective studies are needed to confirm the impact of inflammation on various biochemical parameters and cardiovascular outcomes in patients with RA.
Methods: This was a hospital-based cross-sectional study conducted in a tertiary care government hospital on a calculated sample size of 258 SLT users in the year 2017. The patients were recruited from Ear-Nose-Throat (ENT) and dental out-patient department (OPD). The tobacco dependence was assessed using ‘Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco’ and willingness to quit was assessed on a Likert scale of 1-10.
Results: Among the 258 smokeless tobacco users, 20% were highly dependent on smokeless tobacco and 61% had low willingness to quit tobacco. “Mawa” was the most common (60%) chewed form of tobacco. Illiterate patients were three times more likely and patients whose occupation required traveling were 2.4 times more likely to develop high dependence for SLT than their counterparts. Patients living in the joint family were 2.7 times more likely to develop high dependence than patients living in a nuclear family.
Conclusion: There is a need for the introduction of tobacco cessation interventions in ENT and dental OPD of tertiary care hospitals of western India.
adequate blood flow during hemodialysis in patients with chronic renal failure, and they have superior patency rates and
lower complication rates than grafts.
Objective: To study the success rate of AV fistula, postoperative complications, and factors affecting the patency rate of
AV fistula.
Materials and Methods: This prospective study was conducted in Department of General Surgery of Sir Takhtsinhji
Hospital, Bhavnagar, Gujarat, India, during 2012–2014 in patients of all age groups and both gender with chronic kidney
disease.
Result: Of the 150 patients enrolled in the study, 62% revealed radiocephalic fistulas while 17% brachiocubital fistulas.
In majority of the patients (81%), side-to-side anastomosis was done, while in 19% patients, end-to-side anastomosis was
done. The AV fistula remained patent in 115 (77%) patients, and among them, the patency rate of radiocephalic was 60%
and that of brachiocephalic was 13%. The patency rate for side-to-side fistula was 83% and that for end-to-side was 18%.
Patency rate for patients with hemoglobin (Hb) > 9 g % was 94% with only 6% for patients with Hb < 9 g %. Nonsmokers
were 3.6 times (95% CI: 1.58–8.23) more likely to have their fistula patent than smokers. Arterial diameter is also a
predictor of patency.
Conclusion: The success rate of AV fistula by conventional vascular anastomosis technique was 77%. Side-to-side
anastomosis showed better patency rate than end-to-side anastomosis. Radiocephalic AV fistula showed better patency
rate than other types of fistulas performed in upper limb. Anemia (Hb < 9 g %), smoking, and arterial diameter were the
major factors affecting fistula patency. Thrombosis, postoperative edema, surgical site infection, steal phenomenon, and
aneurysm were the complications noted in the postoperative period.
Surat has the highest incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in Gujarat, the main reason being its large migrant population. Mental health in HIV/AIDS has most often been a topic of neglect all over the world. This study attempts to assess the magnitude of depression and the socio-demographic and clinical variables associated with it in HIV-positive patients.
Methods
A cross-sectional study was conducted in 270 HIV-positive patients using Beck Depression Inventory (BDI; translated and validated in Gujarati and Hindi) along with a questionnaire for eliciting information on socio-demographic and clinical variables.
Results
The prevalence of depression among HIV-positive patients was 30% with 12.22% having mild depression; 14.07% with moderate depression and 3.7% with severe depression. Bivariate analysis showed that physical pain, physical illness, Cluster of Differentiation 4 (CD4) <300 cells/mm3, HIV positive spouse, discrimination at hospital, discrimination in society, government setup as the first place of HIV test and broken relationship with spouse after HIV disclosure were significantly associated with depression among the patients. On multiple logistic regression, discrimination at hospital, physical pain and CD4 <300 cells/mm3 were found to be the significant predictors of depression among the patients.
Discussion
HIV-positive patients can be screened by counselors using easy-to-administer scales like BDI, which can be translated and validated into any regional language. A trained psychiatrist should be appointed at the Anti-Retroviral Therapy (ART) center to take care of the mental health issues of the patients
caused by pathogenic leptospira. Leptospirosis is more
prevalent in South Gujarat due to heavy rain fall and clay soil
structure. The current study was conducted to analyse the profile
of patients with Leptospirosis admitted in Surat Municipal Institute
of Medical Education and Research (SMIMER), Surat.
Methods and Material: This prospective study, involves patients
visiting SMIMER hospital during the time period of 1st August to
31st October 2011 who were suspected for Leptospirosis. Their
presenting complaints, examination findings, lab findings, treatment
and outcome were recorded and analyzed based on the
modified Faine’s criteria.
Results: Among the 24 suspected cases of Leptospirosis, 14 (59%)
were males and age of patients ranged from 10 to 65 years with
mean age of 34 years. Fever, myalgia, and headache were predominant
complaints and all had history of contact with animals
or contaminated environment. Liver functions and renal functions
were deranged in 96% and 63% cases respectively. Fifteen patients
were found positive for Leptospirosis. Fifteen (63%) patients
had Weil’s syndrome and 8 had ARDS. There were 4
deaths, all were males, had ARF and presented with systolic hypotension.
Conclusions: The disease prevalence usually increases during
rainy season. Most cases were from rural origin and all had history
of contact with animals. Myalgia (calf tenderness), jaundice
and conjunctival suffusion were characteristic physical examination
findings. Jaundice and renal failure are associated with severity
of the disease and are considered bad prognostic signs with
high mortality rate (16%).
managed with drugs, ultrasound guided needle aspiration and open surgical drainage.
Aim: The aim of the study was to assess the etiological & predisposing factors, variation in clinical presentation in
liver abscesses, conservative management of small liver abscess, role of USG guided aspiration and percutaneous
tube drainage androle of surgical intervention in liver abscess.
Methods: A cross-sectional study was conducted in a tertiary care hospital of Ahmedabad on 100 patients with liver
abscess from 2006 to 2009. Information on socio-demographic, clinical, complications and management of the
patients was collected on a pre-tested questionnaire after taking written informed consent of the patients. Data was
entered and analysed in Excel.
Results: Amoebic liver abscess is more common in 30-40 age groups, while Pyogenic is more common in 50-60 age
groups.Males are commonly found to be affected than females. Alcoholism and Diabetes mellitus are main predisposing
factors in case of liver abscess. Most patients present with fever, abdominal pain and tenderness in right
hypochondrium. Most common signs are tenderness in right hypochondrium and fever. Most common laboratory
findings are hypoalbuminemia, leukocytosis and anemia. Ultrasoundhas been proven to be the most useful investigation.
Nine out of 14 patients with Pyogenic Abscess& 4 out of 5 patients with Amoebic Abscessresponded to medical
therapy while adjunctivepercutaneous aspiration (for abscesses smaller than 180cc on USG) was performed in 31
Amoebic & 33 Pyogenic patients.USG guided aspiration and laparotomy has the best outcome.
Conclusion: We conclude from the study that needle aspiration combined with antibiotics represent a successful
therapeutic approach in the treatment of liver abscess. Open surgical drainage is usually reserved for complications
like rupture in peritoneum.
with mucosa after preputioplasty gives good cosmetic appearance and it can be utilized in future for
urethral stricture surgery. The aim of this study was to compare the post-operative complications and
post-operative hospital stay in patients operated by circumcision and preputioplasty.
Methodology: This prospective study included 50 patients (age less than 4 years) having phimosis,
treated during July 2010 to July 2012. These patients were treated by two methods viz. circumcision and
preputioplasty (25 cases by each method).The patients were assessed post-operatively at day 1, day 15, at
2 months and at 3 months.
Results: The study revealed that the immediate post-operative complications like pain, bleeding, oedema,
difficulty in micturition and fever were present after both the procedures. But post-operative pain (84%),
bleeding (24%) and difficulty in micturition (16%) were higher after circumcision than after preputioplasty
(40%, 4% and 4% cases respectively). Post-operative oedema was more prominent in preputioplastyoperated
patients (84%). Post-operative hospital stay was longer in cases treated with circumcision. After
three months, recurrent adhesions were more common after preputioplasty (32%). Cosmetic appearance
was acceptable in patients operated with both the procedures.
Conclusion: Preputioplastyis a faster, easier, relatively painless technique with excellent cosmetic results
and lesser complications than circumcision, except post-operative edema and adhesions.
Objectives: To study the probable changes in serum magnesium, lipid profile and various biochemical parameters and to assess risk factors of CVD in newly diagnosed RA patients compared to controls.
Materials and Methods: We studied 50 newly diagnosed RA adult patients and 50 healthy individuals as controls. Serum magnesium, calcium, lipid profile, uric acid and other biochemical parameters were measured in study subjects. Results were expressed as Mean ± SD and compared between RA subjects and controls by Independent sample t-test and Pearson correlation.
Results: We found decreased serum magnesium and calcium in RA subjects compared to the controls (p < 0.001). RA subjects had atherogenic lipid profile characterized by elevated total cholesterol (p = 0.054), LDL cholesterol (p = 0.008) and decreased HDL cholesterol (p < 0.001). Serum uric acid was higher in RA cases compared to controls (p = 0.025). Serum magnesium was negatively correlated with total cholesterol, LDL cholesterol and positively correlated with HDL cholesterol in RA cases.
Conclusion: Decreased magnesium level, dyslipidemia and increased uric acid observed in our study together may be more potent risk factors for CVD in newly diagnosed RA subjects. We recommend that serum magnesium should be investigated as a part of cardiovascular risk management in RA. We suggest that decreased serum magnesium and increased serum uric acid may be considered as nontraditional risk factors of CVD in RA. Further prospective studies are needed to confirm the impact of inflammation on various biochemical parameters and cardiovascular outcomes in patients with RA.