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Sahoo N.K.,AFMC | Mohan R.,15 Corps Dental Unit
Journal of Maxillofacial and Oral Surgery | Year: 2010

Intermaxillary fixation (IMF) is conventionally used for treatment of fractures involving maxillomandibular complex both for closed reduction and as an adjuvant to open reduction. To overcome the cumbersome procedure of tooth borne appliances cortical bone screws were introduced in the year of 1989 to achieve IMF which is essentially a bone borne appliance. In our institution we treated 45 cases of mandibular fracture both single and multiple fractures by open reduction over a period of 24 months. IMF screws were used to achieve dental occlusion in all the cases. Various advantages, disadvantages and complications are discussed. In our institutional experience we found that the IMF screws are an ideal device for temporary intermaxillary fixation for the cases having only mandibular fracture. © 2010 Association of Oral and Maxillofacial Surgeons of India.

Grover N.,AFMC | Sahni A.K.,AFMC | Bhattacharya S.,NCR
Medical Journal Armed Forces India | Year: 2013

Background: Resistance to broad-spectrum beta lactams mediated by extended spectrum beta lactamases (ESBLs) and AmpC beta lactamases (AmpC bLs) enzymes is an increasing problem worldwide. Determination of their prevalence is essential to formulate an effective antibiotic policy and hospital infection control measures. Present study was undertaken to determine the prevalence of ESBL and AmpC bL producers in ICU of a tertiary care center. Methods: A total of 262 clinical isolates comprising of Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis that were recovered from various clinical specimens over a one year period, were studied. Antibiogram profile was determined to conventionally used antibiotics, along with recommended tests for detection of ESBL and AmpC bL production. Results: 40.07% (105/262) were found to be ESBL producers, 14.8% (39/262) were AmpC bL producers. The coexistence of ESBL and AmpC bL producers was detected in 9.9% (26/262) of the isolates. Conclusion: Screening of multidrug resistant bacteria especially belonging to the Enterobacteriaceae poses considerable therapeutic challenges in critical care patients because of the production of ESBL and AmpC bL. Strategies to keep a check on the emergence of such drug resistant microbes by hospital environmental surveillance and laboratory monitoring should form an important aspect of Hospital Infection control policy guidelines. © 2012, Armed Forces Medical Services (AFMS). All rights reserved.

Kinra P.,Pathology | Dutta V.,AFMC
Tropical Biomedicine | Year: 2013

Complicated Plasmodium falciparum infection is associated with a 6.4% mortality rate in India, yet its prognostication is incompletely understood. The conventional prognostic markers of falciparum malaria include clinical, haematological and biochemical parameters. However these factors are non-specific. Hence there is a need of an accurate inexpensive objective marker for prognosticating falciparum malaria infection outcomes. Angiopoietins, angiogenic factors, eotaxins, adhesion molecules and inflammatory cytokines have been studied for prognostication of this common disease. Determination of the first four is technically difficult and requires a high level of expertise and equipment. Intermediary cytokines have the most promising role. This study was conducted with the aim to evaluate the serum level of TNF-α in patients with P. falciparum malaria and carry out statistical analysis of levels of serum TNF-α with parasite index, age, severity of anaemia, hypoglycaemia, hepatic and renal dysfunction. In our study the average TNF alpha level in 91healthy controls was 46.42 pg/ml whereas that in mild falciparum malaria was 100.45 pg/ml, in severe malaria - 278.63 pg/ml and in cerebral malaria it was 532.6 pg/ml. The mean TNF alpha level was significantly different in severe malaria and cerebral malaria compared to that in healthy controls (p < 0.02). The difference in levels of TNF alpha was significantly higher in falciparum malaria patients with anaemia, altered liver functions, hyperparasitemia, leucocytosis, hepatosplenomegaly and hypoglycaemia. The TNF levels did not correlate well with haemolysis markers and patients with altered renal function. Hence a raised TNF alpha can predict the likelihood of oncoming anaemia, hypoglycaemia, altered hepatic function and leucocytosis but not the grades of malaria. The duration of stay in hospital and change in parasite index between the 5th day and the 1st day of admission was used a clinical outcome marker in this study. The analysis showed that serum TNF alpha was raised significantly (p= 0.001) in patients with longer duration stay in hospital. The cytokine was significantly raised in patients having disorientation /cognitive disorder /coma and ARDS (p= 0.001, 0.0023 respectively). The study concluded that serum TNF alpha if done at time of admission and on day 3 can indicate the severity of disease and its complications.

Dash N.,Command Hospital Science | Kushwaha A.S.,AFMC
Medical Journal Armed Forces India | Year: 2012

BACKGROUND Stress fracture (SF) is the single most common cause for the lost number of manpower days during training of recruits in the Armed Forces. This prospective study was undertaken with a view to develop baseline data on incidence of SF and to identify related variables. METHOD A prospective study over a period of five years during 2004-2009 in which a total of 8,570 recruits were enrolled at the start of their training to find out the incidence and pattern of SFs. RESULTS A total of 604 (7.04%, 95% CI 6.40-7.40%) out of a total of 8,570 recruits sustained SF during the study period. The majority of fractures occurred during basic training. The factors like urban residence, vegetarianism and those without prior history of physical activity were found to be associated with SF. Tibia was the commonest bone involved. CONCLUSION Prevention is undoubtedly the best approach in SF and other sports injuries. Priority should be given to individuals with good sports and physical activity background during recruitment. Intensity of training should be gradually increased during first three months (12 weeks) of training. © 2012, AFMS.

Philip J.,AFMC | Sarkar R.S.,AFMC | Pathak A.,AFMC
Asian Journal of Transfusion Science | Year: 2013

Introduction: Apheresis procedures [Plateletpheresis, Plasmapheresis/ Therapeutic Plasma Exchange (TPE), & Peripheral Blood Stem Cell Collection (PBSC)] are usually well tolerated. Occasionally, Adverse Events (AEs) of variable severity may occur during or after the procedure. AEs that occur in Donors/Patients are divided into local reactions and systemic reactions. Materials and Methods: A total of 3,367 apheresis procedures were performed, out of which 3,120 were plateletpheresis procedures, and out of which 1,401 were on Baxter CS 3000 & 1,719 were on Haemonetics MCS+ cell separators. Rest of 247 TPE & PBSC procedures were done on Haemonetics MCS+ cell separators. Results: 90 AEs were reported in relation to the 3,367 procedures. Out of 90 AEs, 85 AEs (94%) were associated with plateletpheresis (n = 3,120) and 05 AEs (06%) with TPE & PBSC (n = 247). The rate of vascular injury (VI), Citrate reaction (CR), and Presyncopal/Syncopal (PS/S) in plateletpheresis was 1.6% (52/3,120), 0.96% (30/3,120), and 0.096% (03/3,120), respectively. The rate of CR in TPE and PBSC was 1.23% (02/162) and 2.3% (02/85), respectively. The rate of PS/S in PBSC was 1.17% (01/85). AEs for Plateletpheresis, TPE & PBSC were 2.7% (85/3,120), 1.23% (02/162), and 3.5% (03/85), respectively. VI, CR, and PS/S were mostly of mild intensity. Both cell separators were equally safe, when AEs associated with plateletpheresis were compared with each other; 2.8% on CS 3000 & 2.6% on MCS+. Conclusion: Apheresis procedures performed on cell separators are safe, with a low incidence of significant AEs. No significant difference was noted in AEs among the two cell separators studied.

Chaudhari C.N.,AFMC
Medical Journal Armed Forces India | Year: 2011

Background: Thalassaemia major patients require lifelong transfusion support due to which they are prone for alloimmunization to foreign RBCs. Alloimmunization can be prevented by extended phenotype match blood transfusion. The study was conducted to know the extent of problem of alloimmunization and to find important red cell antibodies in thalassaemia patients. Methods: A cross-sectional study was conducted. A total of 32 thalassaemia patients were enrolled. The specimen was subjected to red cell alloantibody and autoantibody by columo gel agglutination technique. R 1 wR 1,R 2R 2, rr (papaine and non papain) and 11 cell panel reagent cells were used in screening and identification of alloantibodies respectively. Result: Six (18.8%) subjects were alloimmunized. All alloimmunized subjects were recipient of more than 20 units of transfusion. Total seven clinically significant alloantibodies were identified. Anti E and anti c were commonest antibodies in four (12.5%) patients. Conclusion: Red cell alloimmunization is an important risk in thalassaemia patient. 71.4 % of alloantibodies were anti E and anti c type. Extended phenotype match blood transfusion for Rh-c and Rh-E antigens or level 2 antigen matching stringency needs to be explored in preventing alloimmunization in thalassaemia patients.

Vardhan V.,AFMC | Shanmuganandan K.,Army Hospital R and R
Medical Journal Armed Forces India | Year: 2012

BACKGROUND: Sleep-disordered breathing has been strongly associated with systemic hypertension. Increased sympathetic activity in sleep-disordered breathing may be responsible for this association. METHOD: In this sleep clinic-based study, 82 newly diagnosed patients of sleep-disordered breathing were evaluated for hypertension, and their plasma and urinary levels of catecholamines were measured. Catecholamine levels were then compared separately with the severity of sleep apnoea and blood pressure (BP). RESULTS: The prevalence of hypertension in the study population was 46.3%. The BP showed a strong and statistically significant correlation with apnoea-hypopnoea index (diastolic, r = 0.65, P < 0.001 and systolic, r = 0.60, P < 0.001) which was maintained even after the results were analysed separately for obese and non-obese subjects. Both plasma and urinary levels of catecholamines were greater in patients with severe sleep apnoea (compared to nonsevere cases) and in those with hypertension compared to normotensives. However, statistical significance was achieved only for urine catecholamines and not for plasma catechol-amines in both the cases. CONCLUSION: Hypertension is highly prevalent among Indian subjects with obstructive sleep apnoea. Catecholamine levels are significantly higher in hypertensive than in normotensive apnoeics and are also directly related to the severity of obstructive sleep apnoea. Twenty-four hour urinary catecho-lamine levels are more valid measures of sympathetic activity than spot plasma samples. © 2012, AFMS.

Harnagle R.,AFMC
Research Journal of Pharmaceutical, Biological and Chemical Sciences | Year: 2013

A Prevalence study of dental Caries among personnel and their families of all socio- economic status was carried out in Jabalpur, India for the period of two years. To find the current prevalence of dental caries among different age group, including difference during particular months of year by studying all available records. This was also compared with the disease in previous year which showed increase of dental caries Prevalence Rate of Dental caries was found to be highly significant in 2010 among all classes of socioeconomic status, with difference see significantly in lower class and families. Prevalence Rate of Dental caries was found to be highly significant in all classes of socioeconomic status, while maximum cases had occurred in age group 20-25 years. Dental caries has increased significantly in upper class, lower class and amongst families while no increase is seen in middle class in 2010. Prevalence of Caries was a observed much more in lower socio- economic status. Heavy Workers in Upper class and families were most affected than in any other class. However, the limitation of study is that population were not stationary due to frequent transfer in/out of personnel, as it gives only a moderate estimation of problem, It was seen that there is increase in Caries among Hindus & Sikhs than other religionA two year study revealed a better prevalence rate of Dental Caries than a Cross-sectional study. Prevalence Rate of Dental caries was found to be highly significant in 2010 among all classes of socioeconomic status, with difference see significantly in lower class and families.

Background: Health care workers (HCWs) are at risk of infection with blood-borne viruses in the course of their work. Over 90% of these infections are occurring in low-income countries and most are preventable. However, the situation in the Armed Forces hospitals has always been thought to be much better than the public health facilities in India. The focus of the study was on assessing the exposure frequency amongst HCWs in a teaching hospital in the Armed Forces. Methods: A cross-sectional survey amongst HCWs involved in collecting blood samples and administering injections in all wards of the hospital was conducted. Selection of study participants was by simple random sampling. A pre-tested questionnaire was administered by unlinked, anonymous method. Result: Total sample studied was 70. The proportion of HCWs experiencing exposure to blood body fluid splash (BBF) and needlestick injury (NSI) during last one week was 47.1% and 31.43 %, respectively. The incidence density of BBF exposure was 537.14 per 100 person years and that of NSI episodes was 228.57 per 100 person years. The reasons for not using personal protective equipment (pPE) ranged from busy schedule (37.14 %), non use ofPPE by co-workers (67.14%), emergencies (91.43 If» risk that patients may get offended by PPE use by HCWs (27.14%) to discomfort while using PPE (24.29%). All components of PPE were available as per only 34.29 percent. Conclusion: The high level of occupational exposure to blood and body fluids and consequent risk of infection amongst a group of HCWs in the Armed Forces highlights the urgent need for interventions to enhance the occupational safety of workers.

Sahoo N.K.,AFMC | Bhardwaj P.K.,AFMC
Journal of Oral and Maxillofacial Surgery | Year: 2013

Purpose: The aim of this retrospective study was to evaluate the increase in height and change in position of neo-articular tubercle in cases treated by Dautrey's procedure. Method: 10 cases of Tempromandibular joint (TMJ) disorders satisfying the inclusion criteria were included in this study, out of which 8 had bilateral chronic recurrent dislocations (CRD) and remaining 2 were suffering from bilateral symptomatic TMJ subluxations. Clinical and radiographic finding were recorded. Bilateral Dautrey's procedure was done under general anaesthesia (GA). Post operative clinical findings and radiographic parameters were compared. Results: Data analysis showed mean age in this study group was 40.9 years. Out of 10 patients 7 were females and 3males.The procedure resulted in statically significant stable decrease in mouth opening after 12 months. In radiological evaluation using orthopantomograph (OPG), average increase in articular tubercle height was 3.65 mm on right side and 3.52 mm on left side. The mean anterior shift of articular tubercle lowest point was 4.56 mm on right side and 4.51 mm on left side which were statically highly significant. Conclusion: Dautrey's procedure is simple, effective procedure to prevent anterior excursion of condyles. In this study it was found that down fractured zygomatic arch significantly increases the articular tubercle height and relocates the lowest point anteriorly thereby preventing excessive anterior excursion of condyles. © 2013 American Association of Oral and Maxillofacial Surgeons.

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