Singh A.,Armed Forces Medical College AFMC |
Jaiswal S.S.,Armed Forces Medical College AFMC
Indian Journal of Surgery | Year: 2017
Gall bladder carcinoma (GBC) is most prevalent in the northern and northeastern states of India. The term ‘Incidental gall bladder carcinoma’ (IGBC) refers to the diagnosis coming as a surprise finding upon histopathological examination of the cholecystectomy specimen and its incidence varies from 0.35–2%. The conventional practice of submitting all excised gall bladder specimens for histopathological examination has also been challenged by some authors who feel that a selective approach should be adopted, in order to save costs and time. Our experience in this respect, from a tertiary level teaching hospital in southwestern India, is presented here along with a review of literature. Data in respect of all patients who underwent cholecystectomy for benign disorders from 01 Dec 2012 to 30 Nov 2014 was collected prospectively. In addition, retrospective collation of data from hospital records for the previous 2 years was undertaken. Gall bladder wall thickness ≥ 4 mm, on USG examination, was taken as abnormal. All excised gall bladder specimens were opened and examined immediately after surgery in the operation theatre and then submitted for histopathological examination. Statistical analysis was performed using SPSS 19.0. A p value of less than 0.05 was considered significant. A total of 1123 patients underwent cholecystectomy for benign gallbladder pathologies. IGBC was detected in seven (three male and four female) patients. Only one, out of these seven patients, had focal gallbladder wall thickening at the fundus while the other six cases did not have any macroscopic abnormality of the gallbladder wall or mucosa. The mean age of the patients with IGBC was 63.86 years and it was significantly higher as compared to those with benign histology (p value = 0.001). Furthermore, an age of more than 50 years was found to be significantly associated with IGBC (X2 = 9.446, p value = 0.002). In this series, IGBC was present in 0.62% of patients undergoing cholecystectomy for benign gall bladder pathologies. A patient’s age of more than 50 years was significantly associated with IGBC and we did not find any correlation between the symptomatology, ultrasound findings and macroscopic appearance of the specimen and the presence of IGBC. Hence, we feel that the practice of routine submission of all excised gall bladders for HPE should continue. © 2017 Association of Surgeons of India
PubMed | Armed Forces Medical College AFMC, Guru Gobind Singh Indraprastha University, Hindu Rao Hospital, Mar Thoma College and 4 more.
Type: Journal Article | Journal: Pregnancy hypertension | Year: 2016
Cell free fetal DNA (cffDNA) and its hypermethylated RASSF1A gene signify a recent advancement in non-invasive prenatal diagnosis of feto-placental anomalies like pre-eclampsia. The study uses hypermethylated RASSF1A gene to quantify cffDNA and to assess its relationship with placental and urine proteins in pre-eclampsia cases.DNA was isolated from plasma samples of clinically diagnosed cases of pre-eclampsia (n=103) and normal pregnancy (n=616) from 21weeks of gestation. Through methylation sensitive enzyme (BstUI) digestion; followed by real time-polymerase chain reaction (RT-PCR), quantification of hypermethylated RASSF1A was done. Immunoassays determined: placental protein-13 (pp-13) and pregnancy associated plasma protein A (PAPP-A) and pyrogallol red molybdate assay for 24h urine protein.Highly significant differences between control and pre-eclampsia cases for hypermethylated RASSF1A concentrations were found; Group I: 337.35 vs 74.4616.71, Group II: 53.7516.65 vs 244.2235.68, Group III: 93.2519.08 vs 412.3180.18, Group IV: 144.3018.13 vs 1056.89153.78, Group V: 307.5540.76 vs 2763.76259.76copies/ml. Multivariate Pearsons correlation analysis of hypermethylated RASSF1A with pp-13, PAPP-A and urine proteins showed positive and very highly significant (P<0.001) associations.Diagnostic potential of fetal specific, hypermethylated RASSF1A was evaluated. Its positive relationship with placental and urine proteins submit the case for considering it as a reliable marker for pre-eclampsia.
PubMed | Guru Gobind Singh Indraprastha University, Hindu Rao Hospital, Mar Thoma College, Institute of Nuclear Medicine and Allied Sciences and 2 more.
Type: | Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians | Year: 2016
To quantify cell free fetal DNA (cffDNA) with fetal specific epigenetic marker, hypermethylated RASSF1A, in maternal plasma of normal pregnant women from 20 weeks of gestation and to assess its relationship with maternal age, height, pre-pregnancy weight and body mass index (BMI).Hundred normal pregnant women within the gestational age of 21-40 weeks were randomly selected and grouped into five (n=20). Group 1: 21-24, Group 2: 25-28, Group 3: 29-32, Group 4: 33-36 and Group 5: 37-40 weeks. Maternal plasma DNA was extracted, digested with methylation-sensitive restriction enzyme, BstUI and the fetal specific DNA (cffDNA) was quantified by Real-time polymerase chain reaction (qRT-PCR).The mean hypermethylated RASSF1A concentrations in different gestational groups were Group 1: 30.114.9, Group 2: 52.622.18, Group 3: 93.219.08, Group 4: 172.826.81 and Group 5: 337.852.9 copies/ml. Pearsons correlation analysis showed highly significant positive correlation between cffDNA and gestational age (r=0.899, p<0.001). BMI was also found to be positively related to cffDNA (r=0.217, p<0.05). However, it did not show any correlation with maternal age, height and pre-pregnancy weight.The gestational age-dependent increase of hypermethylated RASSF1A; the fetal specific epigenetic marker in maternal plasma was demonstrated, in an Indian study group of normal pregnant women. Findings would form the basis of future studies involving pregnancy complications that would aid in the early diagnosis of placental pathologies with hypermethylated RASSF1A.
PubMed | NIDS, Armed Forces Medical College AFMC, Military Dental Center and ADC R&R
Type: Journal Article | Journal: Journal of maxillofacial and oral surgery | Year: 2015
The patients with cranial deformity suffer from headache, dizziness, irritability, loss of concentration, depression, anxiety, intolerance to noise and vibration and neuromotor weakness. It is therefore essential to restore the calvarium.This study was conducted in the Department of Oral and Maxillofacial Surgery, Armed Forces Medical College, Pune between Oct 2010 and Mar 2012. The study population was selected from the outpatient department and from the referred cases. The aim was to study the uptake of split thickness calvarial graft in the management of residual cranial defect. After applying the inclusion and exclusion criterions, ten cases were selected with residual cranial deformity, operated for cranioplasty using split thickness calvarial graft and evaluated.It was concluded that cranioplasty using autogenous split thickness calvarial graft for restoring cranial defects is a useful technique and this procedure allows the surgeon to reconstruct a moderate-to-large cranial defect, without breaching the inner cortical plate.
Gupta S.K.,Armed Forces Medical College AFMC |
Gupta S.K.,Besides Sharma Open University |
Kotwal J.,Armed Forces Medical College AFMC |
Kotwal A.,Armed Forces Medical College AFMC |
And 2 more authors.
Indian Journal of Medical Research | Year: 2012
Background & objectives: Hyperhomocysteinaemia (HCA) either due to mutation of MTHFR gene or deficiency of vitamin B12 and folic acid, has been reported as a risk factor for coronary artery disease (CAD). The present study was aimed to determine plasma homocysteine (Hcy) levels and to evaluate MTHFR C677T gene polymorphism as risk factors for CAD, and to study the role of Hcy in conjunction with a few other risk factors of CAD in young Indians. The effect of vitamin B12 and folic acid supplements on the raised plasma Hcy levels in patients of CAD was also assessed. Methods: The present study included 199 consecutive angiography confirmed CAD patients, <45 yr of age, without any other known pro- coagulant state and 200 age- and sex-matched healthy controls. Fasting blood samples were collected in EDTA and plasma Hcy was estimated by ELISA test and the MTHFR C677T polymorphism detection was carried out by PCR-RFLP method. Results: Significant difference (P<0.001) was found between mean fasting levels of plasma Hcy in cases (22.14 ± 10.62 μmol/l) and controls (17.38 ± 8.46 μmol/l) with an Odds ratio as 1.93 (95% CI, 1.27-2.94). Levels of cholesterol, LDL, and triglycerides were significantly (P<0.001) higher in cases compared with controls. Interpretation & conclusions: Our study showed significant correlation between hyperhomocysteinaemia and coronary artery disease. Multivariate analysis by logistic regression of the various risk factors of CAD, found high levels of Hcy, cholesterol, LDL and low levels of HDL and smoking as independent predictors of CAD when all other factors were controlled. Significant post-treatment decrease found in HCA was easily modifiable by vitamin intervention irrespective to their CT or TT genotype of C677T MTHFR gene. Further studies to look at the plasma levels of folate and cobalamines and their association with Hcy are required to be done.
Dey M.,Armed Forces Medical College AFMC |
Sharma S.,All India Institute of Medical Sciences |
Aggarwal S.,All India Institute of Medical Sciences
North American Journal of Medical Sciences | Year: 2013
Aneuploidies are a major cause of perinatal morbidity and mortality. Therefore, it is the most common indication for invasive prenatal diagnosis. Initially, screening for aneuploidies started with maternal age risk estimation. Later on, serum testing for biochemical markers and ultrasound markers were added. Women detected to be at high-risk for aneuploidies were offered invasive testing. New research is now focusing on non-invasive prenatal testing using cell-free fetal DNA in maternal circulation. The advantage of this technique is the ability to reduce the risk of miscarriage associated with invasive diagnostic procedures. However, this new technique has its own set of technical limitations and ethical issues at present and careful consideration is required before broad implementation.
Khadka A.,Armed Forces Medical College AFMC |
Brashier D.B.S.,Armed Forces Medical College AFMC |
Tejus A.,Armed Forces Medical College AFMC |
Sharma A.K.,Armed Forces Medical College AFMC
Journal of Pharmacology and Pharmacotherapeutics | Year: 2015
Macitentan is an orphan drug for the treatment of pulmonary arterial hypertension (PAH). Endothelin-1 (ET-1) plays a critical role of pathophysiology of PAH. Macitentan, a new dual endothelin receptor antagonist, has reportedly improved prognosis of PAH patients by delaying the progression of disease. It prevents the binding of ET-1 to both endothelin A (ETA ) and endothelin B (ETB ) receptors. Macitentan displays higher efficacy, lesser adverse effects and drug interactions. It has completed phase III trials in 2012 for treatment of PAH and has been tried for ischemic digital ulcers in systemic sclerosis, recurrent glioblastoma and combination with chemotherapeutic agents against various cancers. Safety data for macitentan were obtained primarily from a placebo-controlled clinical study in 742 patients with PAH. The Food and Drug Administration (FDA) approved the drug on 13 October 2013. It is an important addition to long-term treatment of PAH.
PubMed | Armed Forces Medical College AFMC
Type: | Journal: Strategies in trauma and limb reconstruction (Online) | Year: 2017
Clavicle fracture is a common injury due to its subcutaneous and relatively anterior position. Fractures affecting the middle third account for majority of all clavicular fractures. Both non-operative and surgical methods have been described for the management of this injury. However, there is no uniform consensus on the definite choice of treatment. Hence, this study was undertaken to compare conservative approach with primary internal plate fixation in mid-shaft clavicular fractures in terms of subjective outcome, functional outcome, the rates of nonunion and malunion and other local complications. Patients were allocated into two groups, each including 30 patients on alternate basis. Group 1 patients were managed conservatively, consisting of a figure-of-eight bandage and a sling, whereas patients of group 2 were treated surgically by plate fixation. Follow-up examination was done at 06weeks, 03 and 06months using patients subjective evaluation, functional outcome, radiographic assessment and other complications. The study showed that time to union was significantly shorter in patients treated surgically and this group also showed a favorable Constant shoulder score at all follow-ups. Though there was no statistically significant difference between the groups with regard to complication rate, subjective outcome or functional outcome, the surgical intervention group fared better especially when considering overall outcome results. The present study showed that the time to union was lesser, rate of malunion and nonunion was lower, and Constant shoulder scores were higher in the surgical group. This affirms that while conservative treatment remains the treatment of choice for simple undisplaced mid-shaft clavicle fractures, for displaced and comminuted fractures the surgical intervention gives better outcomes and early functional recovery in young active adults.
PubMed | Armed Forces Medical College AFMC
Type: Journal Article | Journal: Journal of pharmacology & pharmacotherapeutics | Year: 2015
Macitentan is an orphan drug for the treatment of pulmonary arterial hypertension (PAH). Endothelin-1 (ET-1) plays a critical role of pathophysiology of PAH. Macitentan, a new dual endothelin receptor antagonist, has reportedly improved prognosis of PAH patients by delaying the progression of disease. It prevents the binding of ET-1 to both endothelin A (ETA) and endothelin B (ETB) receptors. Macitentan displays higher efficacy, lesser adverse effects and drug interactions. It has completed phase III trials in 2012 for treatment of PAH and has been tried for ischemic digital ulcers in systemic sclerosis, recurrent glioblastoma and combination with chemotherapeutic agents against various cancers. Safety data for macitentan were obtained primarily from a placebo-controlled clinical study in 742 patients with PAH. The Food and Drug Administration (FDA) approved the drug on 13 October 2013. It is an important addition to long-term treatment of PAH.
PubMed | Armed Forces Medical College AFMC
Type: Journal Article | Journal: Indian journal of clinical biochemistry : IJCB | Year: 2015
Increase in urine albumin excretion rate (AER) precede a fall in glomerular filtration rate in patients developing diabetic chronic kidney disease (CKD). Our results have shown that 7 (50%) of diabetic and hypertensive individuals with decreased GFR do not have increased AER. In this cross-sectional study, we measured AER of 75 patients with type 2 diabetes and hypertension by immunoturbidimetric method. We correlated the results with eGFR values obtained by Cockcroft-Gault and MDRD method. The method used was not a compensated method. We measured serum creatinine by modified Jaffes kinetic method in autoanalyzer XL-600. Analysis of data showed positive correlation between eGFR and microalbuminuria by both the methods with eGFR <60mL/min/1.73m(2). Pearsons correlation co-efficient (r) was 0.9 (p=0.0001) by Cockcroft-Gault formula and 0.69 (p=0.0063) by MDRD formula. Our results concluded that there was positive correlation between AER and eGFR <60mL/min/1.73m(2). We have recognized that these two parameters provide a complimentary benefit in management of cases with CKD.