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BACKGROUND:: Propranolol has emerged as front-line therapy for infantile hemangiomas (IHs). However, a well-defined protocol for administering and predicting response to propranolol is unavailable. METHODS:: In this open-label trial, 31 children with IH (median age=5 mo; range,1 mo to 9 y) were administered propranolol (2 mg/kg/d) for a median duration of 28 weeks (12 to 50 wk). They were compared with 14 historical controls with IH who did not receive any treatment. An image-based scoring system was used to assess involution. RESULTS:: Propranolol (28/31, 90.3%) produced better and faster response compared with control treatment (4/14, 28.6%). With propranolol, 65% to 80% involution was obtained in the first 8 weeks, with an additional 2% to 10% involution until 20 weeks. After 20 weeks, the changes in IH were insignificant. Response was more pronounced among infants ≤6 months of age who attained a peak involution score of 1.86, suggesting >80% involution of IH. The similar score in the cohort aged 6 to 36 months was 3.31. The heart rate (HR) decline after propranolol treatment was significantly higher among patients whose hemangioma responded to propranolol than in those who did not respond (P=0.0006). Decline in HR by >20%, 2 weeks after propranolol administration, was predictive of IH involution (relative risk=0.11; 95% confidence interval, 0.02-0.51; P=0.036). CONCLUSIONS:: Propranolol is efficacious in patients with IH. The most pronounced response is seen in the first 8 weeks and in infants aged 6 months or younger. A decline in HR >20% is an early marker of response to propranolol. Copyright © 2013 by Lippincott Williams & Wilkins.

Jindal A.K.,Armed Forces Medical College
Indian journal of public health | Year: 2014

Universal health coverage (UHC) is the means to provide accessible and appropriate health services to all citizens without financial hardships. India, an emerging economy with demographic window of opportunity has been facing dual burden of diseases in midst of multiple transitions. Health situation in the country despite quantum improvements in recent past has enormous challenges with urban-rural and interstate differentials. Successful national programs exists, but lack ability to provide and sustain UHC. Achieving UHC require sustained mechanisms for health financing and to provide financial protection through national health packages. There is a need to ensure universal access to medicines, vaccines and emerging technologies along with development of Human Resources for Health (HRH). Health service, management, and institutional reforms are required along with enhanced focus on social determinants of health and citizen engagement. UHC is the way for providing health assurance and enlarging scope of primary health care to nook and corners of the country.

Following a suspected outbreak of scrub typhus in Kurseong, Darjeeling, the Armed Forces Medical College, Pune was requested by the National Institute of Epidemiology and the State authorities to undertake investigation of the ongoing scrub typhus outbreak and suggest containment measures. The epidemic team undertook clinical, entomological and serological studies to understand the local disease pattern and delineate high risk areas, host diversity by rodent trapping using Sherman traps, mite fauna diversity, abundance and vector species identification by phase contrast microscopy for preparation of electronic database and rodent and human serological studies by Weil Felix and PCR. The results indicate no association of scrub typhus with age and sex (P=0.37 and 0.74 respectively). The maximum cases occurred amongst the tea garden workers (73%) in the age group of 25-44 years. The predominant clinical presentation was fever (100%) with headache (75%), lymphadenopathy (45%) and presence of eschar (76.7%). The dominant host species (50% of trapped rodents) was shrew Suncus murinus, the index animal for scrub typhus, which contributed maximally to the vector abundance (52.96%) with a chigger index of 61.56. The trombiculid mite Schoengastiella ligula was the vector species much against the expected mite vector Leptotrombidium deliense, in the area. The study found the presence and abundance of vector species which corroborated well with the occurrence of cases in the various localities within the subdivisions. The study thus establishes Schoengastiella ligula as the vector of scrub typhus outbreak in Kurseong, Darjeeling. Preventive and containment measures with emphasis on reduction of man - vector contact were suggested to the state authorities to contain the outbreak.

Lall M.,Army Hospital R and R | Sahni A.K.,Armed Forces Medical College
Medical Journal Armed Forces India | Year: 2014

Background: Therapy for Staphylococcal infections may be complicated by the possibility of inducible macrolid-lincosamid-streptogramin B resistance (MLSBi). We studied the prevalence of MLSBi in community associated (CA) and hospital associated (HA) Staphylococcus aureus isolates from clinical samples. Methods: A total of 305 strains of S. aureus comprising 140 (45.9%) [95% CI 40.36e51.52] methicillin resistant S. aureus (MRSA) and 165 (54%) [95% CI 48.48e59.64] methicillinsensitive S. aureus (MSSA) were identified by conventional methods. The double disc test (D test) was applied by placing erythromycin and clindamycin discs to investigate inducible and constitutive MLSBi resistant phenotypes. Results: 16.6% of MRSA showed constitutive resistance and 37.5% inducible MLSBi resistance. Community associated MRSA (CA-MRSA) represented 10% of all isolates and had lower prevalence of MLSBi than hospital associated MRSA (HA-MRSA). Conclusion: Routine screening for inducible MLSBi resistance by double disc test can screen for potential treatment failures such that clindamycin can be used effectively and judiciously when indicated for staphylococcal infections especially for treating skin and soft tissue infections (SSTIs) in CA-MRSA due to low prevalence of MLSBi among CA-MRSA. © 2013, Armed Forces Medical Services (AFMS). All rights reserved.

Sati A.,Armed Forces Medical College
Cornea | Year: 2016

PURPOSE:: To evaluate the corneal endothelial changes in patients with chronic renal failure. METHODS:: A total of 128 corneas of 128 subjects were studied, and 3 groups were formed. The first, the dialyzed group, composed of 32 corneas of 32 patients; the second, the nondialyzed group, composed of 34 corneas of 34 patients; and the third, the age-matched control group, composed of 64 corneas of 64 healthy subjects were examined by a specular microscope and the endothelial parameters were compared. The dialyzed group (enhanced level of toxins in the blood) was further analyzed to assess the influence of blood urea, serum creatinine, serum calcium, and serum phosphorus including the duration of dialysis on corneal endothelium. RESULTS:: On comparing the 3 groups using analysis of variance and posthoc tests, a significant difference was found in the central corneal thickness (CCT) and endothelial cell density (CD) between the control (CCT: 506 ± 29 μm, CD: 2760 ± 304 cells/mm) and dialyzed groups (CCT: 549 ± 30 μm, CD: 2337 ± 324 cells/mm) [P < 0.001 (CCT); P < 0.001 (CD)]; control and nondialyzed groups (CCT: 524 ± 27 μm, CD: 2574 ± 260 cells/mm) [P = 0.023 (CCT); P = 0.016 (CD)]; and dialyzed and nondialyzed groups [P = 0.002 (CCT); P = 0.007 (CD)]. Using the linear generalized model, a significant correlation was found between the endothelial parameters and blood urea only [P = 0.006 (CCT), 0.002 (coefficient of variation), 0.022 (CD), and 0.026 (percentage of hexagonality)], although the correlation was poorly positive for CCT but poorly negative for the remaining endothelial parameters. CONCLUSIONS:: Corneal endothelial alteration is present in patients with chronic renal failure, more marked in patients undergoing hemodialysis and with raised blood urea level. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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