Rajput R.,PGIMS |
Sinha B.,AMRI Hospital |
Majumdar S.,G D Diabetes Institute & Peerless Hospital Kolkata |
Shunmugavelu M.,Trichy Diabetes Speciality Center d |
Bajaj S.,MLN Medical College
Diabetes Research and Clinical Practice | Year: 2017
Introduction Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease (CKD) which eventually leads to insulin resistance and decreased insulin degradation. In patients with diabetic kidney disease (DKD), the overall insulin requirement declines which necessitates the reassessment for individualization, adjustment and titration of insulin doses depending on the severity of kidney disease. Objective To provide simple and easily implementable guidelines to primary care physicians on appropriate insulin dosing and titration of various insulin regimens in patients with DKD. Methods Each insulin regimen (basal, prandial, premix and basal-bolus) was presented and evaluated for dosing and titration based on data from approved medical literatures on chronic kidney disease. These evaluations were then factored into the national context based on the expert committee representatives’ and key opinion leaders’ clinical experience and common therapeutic practices followed in India. Results Recommendations based on dosing and titration of insulins has been developed. Moreover, the consensus group also recommended the strategy for dose estimation of insulin, optimal glycaemic targets and self-monitoring in patients with DKD. Conclusion The consensus based recommendations will be a useful reference tool for health care practitioners to initiate, optimise and intensify insulin therapy in patients with DKD. © 2017
Sinha B.,AMRI Hospital |
Gangopadhyay K.K.,Fortis and Peerless Hospital |
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy | Year: 2014
Insulin therapy is not without side effects. In patients with complications on complex regimens, failure to attain adequate glycemic control exposes the patient to high risks and the considerable mental distress associated with failed injectable therapy. As clinicians, we felt it necessary to undertake a trial of newer therapies like insulin degludec, which according to published literature, appears to be superior to earlier basal analogs by fewer hypoglycemic episodes, better glycemic predictability, and genuine 24-hour coverage. Here we report on three cases seen in our own clinical practice where insulin degludec was used in patients experiencing inadequacies with their current basal insulin therapy (insulin glargine). Switching to insulin degludec resulted in clinically meaningful reductions in hypoglycemia, along with reduced fasting plasma glucose and glycosylated hemoglobin and improved satisfaction with treatment. We also explored the use of long-acting insulin in renal failure and the possibility of dose reduction when switching from existing basal insulin therapy. © 2014 Sinha et al. This work is published by Dove Medical Press Limited.
PubMed | AMRI Hospital, Nightingale and Fortis and Peerless Hospital
Type: Journal Article | Journal: Diabetes & metabolic syndrome | Year: 2016
To compare the changes in various glycemic parameters in insulin-nave type 2 diabetes mellitus (DM) patients who were initiated on insulin glargine or insulin degludec in a real world setting.Retrospective data were analyzed in consecutive type 2 DM patients in a real world setting, who failed oral therapy (at least 2 oral anti-diabetic drugs) and were initiated with either insulin glargine or insulin degludec. The parameters assessed were the changes in HbA1c, fasting plasma glucose, body weight, dose of Insulin and the total number of patient reported hypoglycemic episodes up to 6 months after initiation.At baseline, insulin glargine and insulin degludec groups were similar in terms of gender, age, weight, HbA1c and duration of diabetes. After 6 months follow up the change in HbA1c (-1.09 versus -1.45 P=0.124), change in FPG (-72.81mg/dl [-4mmol/L] versus -75.88mg/dl [-4.2mmol/L] P=0.755), and the change in body weight (+1.65 versus +0.85 P=0.082) were similar in glargine and degludec groups, respectively. Patients in insulin degludec group experienced significantly lesser patient reported hypoglycemic episodes (12 versus 40) and required significantly lesser dose (25.68Units versus 18.61Units per day; P=0.002) compared to insulin glargine. 41% of the patients reached HbA1C target of 7% with insulin glargine compared to 69% with insulin degludec within the specified time period.Results from this real world analysis suggest that among type 2 DM patients who were initiated on insulin degludec as compared to insulin glargine may be associated with significantly lesser patient reported hypoglycemic episodes and lesser dose of insulin while achieving similar glycemic control. This study is however limited by the retrospective nature of the data collection.
PubMed | AMRI Hospital and West Health Institute
Type: Journal Article | Journal: Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine | Year: 2016
Phenol (carbolic acid) is one of the oldest antiseptic agents. Apart from being used in many commercially available products, in rural India, it is often used in the household to prevent snake infestation. We hereby present four cases of acute carbolic acid poisoning which we saw over the last monsoon. The cases highlight the multiple routes of absorption of carbolic acid as well as its multi-organ complications which often necessitate intensive care of local therapy decreases systemic phenol absorption from cutaneous exposure and may help in reducing severity.
PubMed | se National Center For Basic Science and AMRI Hospital
Type: Journal Article | Journal: Analytical and bioanalytical chemistry | Year: 2016
Martis R.J.,Indian Institute of Technology Kharagpur |
Acharya U.R.,Ngee Ann Polytechnic |
Mandana K.M.,AMRI Hospital |
Ray A.K.,Indian Institute of Technology Kharagpur |
Chakraborty C.,Indian Institute of Technology Kharagpur
Expert Systems with Applications | Year: 2012
Electrocardiogram (ECG) is the P, QRS, T wave indicating the electrical activity of the heart. The subtle changes in amplitude and duration of ECG cannot be deciphered precisely by the naked eye, hence imposing the need for a computer assisted diagnosis tool. In this paper we have automatically classified five types of ECG beats of MIT-BIH arrhythmia database. The five types of beats are Normal (N), Right Bundle Branch Block (RBBB), Left Bundle Branch Block (LBBB), Atrial Premature Contraction (APC) and Ventricular Premature Contraction (VPC). In this work, we have compared the performances of three approaches. The first approach uses principal components of segmented ECG beats, the second approach uses principal components of error signals of linear prediction model, whereas the third approach uses principal components of Discrete Wavelet Transform (DWT) coefficients as features. These features from three approaches were independently classified using feed forward neural network (NN) and Least Square-Support Vector Machine (LS-SVM). We have obtained the highest accuracy using the first approach using principal components of segmented ECG beats with average sensitivity of 99.90%, specificity of 99.10%, PPV of 99.61% and classification accuracy of 98.11%. The system developed is clinically ready to deploy for mass screening programs. © 2012 Published by Elsevier Ltd. All rights reserved.
PubMed | AMRI Hospital, Senior Resident and Post Graduate Institute of Medical Education and Research
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016
Chronic pancreatitis is a debilitating disease, associated with excruciating abdominal pain, exocrine and endocrine pancreatic insufficiency. Different types of surgical techniques have been described for the management of complications of this disease. The most common procedure which has been adopted for improving the quality of life of the patients with chronic pancreatitis is Freys Procedure. It is an organ preserving procedure in which the main pancreatic duct is drained by lateral pancreatico-jejunostomy along with coring of the head of the pancreas.In this study, we have assessed the outcome of Freys procedure in terms of quality of life in patients with chronic pancreatitis.This was a prospective observational study done at a tertiary care center in West Bengal, India. The study period was from 2010 to 2014. All the patients who have undergone Freys Procedure during the study duration and with the postoperative histopathology of chronic pancreatitis were included in this study. The preoperative and postoperative pain and quality of life assessment was done using VAS score (0-100) and EORTC QLQ-C30 (Version 3) respectively. The statistical analysis was performed with the help of Epi Info (TM) 3.5.3.A total of 35 patients with chronic pancreatitis underwent Freys procedure during the study period. The mean age (mean s.e) of the 33 patients included in the study was 38.485.55 years with a range of 29-49 years. The mean preoperative Physical Functional Domain (PFD), Physical Domain (PD), Emotional Domain (ED), Social Domain (SD) and general health raw score with standard errors were 32.060.40, 37.860.36, 15.180.32, 8.630.31 and 4.480.26 respectively. ANOVA showed that there was significant differences in PFD, PD, ED, SD and GH values during different time period of follow up (p<0.0001) and as per Critical Difference the postoperative values of PFD, PD, ED and SD decreased while postoperative value of GH increased significantly in different months compared to the preoperative values.We conclude that Freys procedure is a low risk surgery, which significantly improves the quality of life of the patients with chronic pancreatitis in all the domains and can be recommended as a surgical therapy for such patients.
PubMed | AMRI Hospital and All India Institute of Medical Sciences
Type: Case Reports | Journal: Indian journal of pathology & microbiology | Year: 2016
Necrotizing sialometaplasia is a rare benign and self-limiting disease, which commonly affects the minor salivary glands. Typically, it involves the seromucinous glands located at palate, buccal mucosa, tongue, tonsil, nasal cavity, trachea, larynx, maxillary sinus, and retromolar trigone. We report two such cases of necrotizing sialometaplasia to create awareness among the pathologists and surgeons because of its close morphological and clinical resemblance to squamous cell carcinoma. We have also documented that, the ischemic necrosis of salivary gland is the result of a vasculitic process.
Savita K.S.,AMRI Hospital |
Khedkar I.,AMRI Hospital |
Bhartia V.K.,AMRI Hospital
Indian Journal of Surgery | Year: 2010
With advancement in laparoscopic surgery a number of surgical procedures can be performed combined with laparoscopic cholecystectomy in a single surgery. We evaluate the safety & efficacy of such surgeries. A retrospective review of all patients who had undergone combined procedures with laparoscopic cholecystectomy during January 2005 to June 2009 was performed. 3144 laparoscopic cholecystectomies were performed in the period from January 2005 to June 2009. Of these, 401 cases were combined with another procedure. The mean operative time was 80 min (range 50-270 min). The mean hospital stay was 3.2 days (range 1-5 days). The mean no. of days injectable analgesics was required was 2 days (range 1 day-4 days). Combined procedures provide patients with all the benefits of minimal invasive surgery and also give the benefit of single time anaesthesia without adding to post operative morbidity & hospital stay. © 2010 Association of Surgeons of India.
Savita K.S.,AMRI Hospital |
Bhartia V.K.,AMRI Hospital
Indian Journal of Surgery | Year: 2010
Laparoscopic CBD exploration (LCBDE) is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. Laparoscopic Surgery for common bile duct stones (CBDS) was first described in 1991, Petelin (Surg Endosc 17:1705-1715, 2003). The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration(LCBDE) procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes, Cuschieri et al. (Surg Endosc 13:952-957, 1999), Rhodes et al. (Lancet 351:159-161, 1998). We started doing LCBDE in 1998. Our experience with LCBDE from 1998 to 2004 has been published, Gupta and Bhartia (Indian J Surg 67:94-99, 2005). Here we present our series from January 2005 to March 2009. In a retrospective study from January 2005 to March 2009, we performed 3060 laparoscopic cholecystectomies, out of which 342 patients underwent intraoperative cholangiogram and 158 patients eventually had CBD exploration. 6 patients were converted to open due to presence of multiple stones and 2 patients were converted because of difficulty in defining Calots triangle; 42 patients underwent transcystic clearance, 106 patients had choledochotomy, 20 patients had primary closure of CBD whereas in 86 patients CBD was closed over T-tube; 2 patients had incomplete stone clearance and underwent postoperative ERCP. Choledochoduodenosotomy was done in 2 patients. Patients were followed regularly at six monthly intervals with a range of six months to three years of follow-up. There were no major complications like bile leak or pancreatitis. 8 patients had port-site minor infection which settled with conservative treatment. There were no cases of retained stones or intraabdominal infection. The mean length of hospital stay was 3 days (range 2-8 days). LCBDE remains an efficient, safe, cost-effective method of treating CBDS. Primary closure of choledochotomy in select patients is a viable & safe option with shorter operative time and length of stay. LCBDE can be performed successfully with minimal morbidity & mortality. © 2010 Association of Surgeons of India.