Army Hospital R and R

New Delhi, India

Army Hospital R and R

New Delhi, India
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Rajput A.K.,Army Hospital R and R
Pathogens and Global Health | Year: 2013

Infection caused by the lung fluke is endemic in north eastern parts of India. Paragonimus westermani and Paragonimus heterotremus are known to be endemic in eastern Indian states of Manipur and Nagaland. The infection is related to eating habits of the locals and is acquired by ingestion of raw, inadequately cooked crabs or crayfish containing encysted metacercariae which act as second intermediate hosts during the life cycle of the lung fluke. Diagnosis is generally delayed due to lack of suspicion and presentation similar to tuberculosis which is endemic in the population. We report pleuropulmonary paragonimiasis in a soldier from eastern India who presented with chest pain, haemoptysis, and eosinophilia. He gave history of consumption of raw crabs while on leave at his native village in Nagaland. Ova morphologically resembling Paragonimus heterotremus were detected in sputum and bronchoalveolar lavage specimen. Symptoms resolved with praziquantel treatment. © W. S. Maney & Son Ltd 2013.

Rai N.,Army Hospital R and R | Thakur N.,Lady Hardinge Medical College and Associated Hospital
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Background: In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available. Objectives: To prospectively evaluate the presence of hearing loss in all newborn babies delivered in our hospital during study period using the transient evoked otoactoustic emission as the primary screening tool followed by confirmation with brainstem evoked response audiometry before six months of age and to determine risk factors responsible for hearing loss. Design: A prospective study of nonrandomized cohort. Setting: Nursery, Postnatal ward and NICU of Tertiary care center. Participants: 500 neonates (439: not at risk; 61: at risk) from a total of 610 neonates born in between 2009 and 2010. Measurements: Incidence of hearing impairment in the "at risk" and "no risk" group was compared, using proportion test. Main outcome measure(s): Incidence of hearing loss in newborns both "at risk" and in "no risk" group, risk factors responsible for hearing loss, importance of universal newborn hearing screening. Results: The overall incidence of hearing impairment was 8 per 1000 screened. The incidence in "no risk" and "at risk" group was 2.27 per 1000 screened and 49.18 per 1000 screened respectively. Statistically significant difference in the incidence of hearing impairment between the two groups. (P < 0.05; Proportion Test) was seen. Common risk factors identified were culture positive postnatal infections, birth asphyxia, low birth weight, and prematurity. Conclusions: A high incidence of hearing impairment warrants the implementation of universal newborn hearing screening. Considering the economic limitations of our country we may employ screening of "at risk" groups initially. © 2013 Elsevier Ireland Ltd.

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.

Kulshrestha V.,Army Hospital R and R | Kumar S.,AIR INDIA
Journal of Arthroplasty | Year: 2013

The American College of Chest Physicians (ACCP) recommended routine anticoagulation for thromboprophylaxis in patients undergoing lower limb arthroplasty. We compared results of routine anticoagulation Vs risk stratified approach for Deep Venous Thrombosis (DVT) prophylaxis after TKA in terms of symptomatic DVT and wound complications. Nine hundred TKAs done in 673 patients were randomized after DVT risk screening to routine anticoagulation (n = 450) or to risk stratification (n = 450) and selective anticoagulation. 194 patients in the risk screening group received only Aspirin. Primary outcome was symptomatic DVT and wound complication. This randomized study showed that the symptomatic DVT rates after TKA were similar whether patients were routinely anticoagulated or selectively anticoagulated after risk screening. However there was a significantly higher incidence of wound complications (P< 0.014) after routine anticoagulation. © 2013 Elsevier Inc.

Puri P.,Army Hospital R and R
Journal of Clinical and Experimental Hepatology | Year: 2013

Exacerbations of chronic hepatitis B are common in endemic countries. Acute exacerbation of chronic hepatitis B virus (CHB-AE) causing derangement of liver functions may be seen in a flare of HBV in immune clearance phase or as a reactivation of HBV in patients with inactive or resolved HBV infection. While reactivation of HBV is usually seen in HBsAg positive patients, it is being increasingly recognized in patients with apparently resolved HBV infection who do not have HBsAg in serum but have IgG antibody to core antigen (anti-HBc) in the serum, especially so in patients on chemotherapy, immunosuppressive therapy or undergoing hematopoietic stem cell transplantation. In an icteric patient who is HBsAg positive, it may be difficult to differentiate CHB-AE from acute viral hepatitis B (AVH-B). Both may have similar clinical presentation and even IgM anti-HBc, the traditional diagnostic marker of AVH-B, may also appear at the time of exacerbation of CHB. The differentiation betweenCHB-AE and AVH-B is important not only for prognostication but also because management strategiesare different. Most cases of AVH-B will resolve on their own, HBsAg clearance is achieved spontaneously in 90-95% of adults and treatment is rarely indicated except in the few with severe/fulminant disease. In contrast, in CHB-AE, the onset of jaundice may lead to decompensation of liver disease and treatment is warranted. The mechanisms of acute exacerbation and the differentiating features between AVH-B and CHB-AE are reviewed. © 2013.

Dhar A.K.,Army Hospital R and R | Barman P.K.,Army Hospital R and R
Journal of Association of Physicians of India | Year: 2012

Retinoic acid syndrome is a novel complication of therapy with all-trans retinoic acid (ATRA) in patients with acute promyelocytic leukemia (APML). Primarily the syndrome consists of fever and respiratory distress. Additional features include weight gain, oedema over lower extremities, pleural or pericardial effusion and hypotension. We report electrophysiological changes in a 16 year old patient with acute promyelocytic leukemia following treatment with ATRA. Such an unusual complication is a rarity and to the best of our knowledge has not been previously reported. © JAPI.

Puri B.,Army Hospital R and R
Journal of Indian Association of Pediatric Surgeons | Year: 2010

Aim : To study the clinical outcome of laparoscopic suture rectopexy (LSRP) in children with persistent rectal prolapse (PRP). Materials and Methods : Nineteen cases of PRP were managed with LSRP from February 2005 to August 2009. Results : All were followed up for an average duration of 6 months. Only one child had recurrence and was managed with sclerotherapy. Conclusion : LSRP is safe, feasible in children and gives satisfactory results.

Datta R.,Army Hospital R and R
Medical Journal Armed Forces India | Year: 2011

Background: Although epidural steroids are commonly used for conservative management of sciatica, controversies exist regarding optimal approach, type and dose of steroids, volume of injectate and frequency of administration. This randomized comparative blinded study was undertaken to compare the efficacy of caudal methylprednisolone acetute with triamcinolone acetonide and dexalethasone acetate, for pain relief for sciatica associated with lumbar-disk herniations. Methods: A Total of 163 patients with radicular pnin due tu lumbar-disk berniations, between 27-70 years of age were randomly divided into four groups: three were given epidural steroid injection therapy (metbylprednisolone acetate, triamcinolone acetonide and betamethasone acetate) with bupivacaine; one group received bupivacaine alone via caudal approach. Injections were repeated every three weeks till a total of 210 mg of metbylprednisolone (and equivalent) or three injections. Pain relief, disability and activity levels were assessed at 3, 6, 9 and 12 weeks interval. Result: Pain relief was present in all four groups by three weeks witb no difference between tbe groups (p=0.006; 0.005; 0.0045; 0.005 respectively to baseline). By the 6 and 12 week, tbe three steroid groups bad significant pain relief (p<0.001). Among tbese, both metbylprednisolone and triamcinolone groups sbowed greater improvement in the finger-to-floor distance (p=0.006). A smaller proportion of patients in this group had residual sensory deficits (p=0.03) as compared to dexamethasone but difference was statistically insignificant. Overall pain relief was significantly better at all follow-up evaluations in tbe steroid group tban in the control group (p<0.001 at all evaluations). Conclusion: Short-term. improvement in leg pain and sensory deficits was observed in patients with sciatica due to a herniated. nucleus pulposus witb both epidural bupivacaine and steroids. All long-acting steroids had no statistically significant difference between their efficacy in pain relief but metbylprednisolone and triamcinolone were more errective by tbe second injection as compared to dexamethasone which required a third injection in a significant number of cases. Differences between metbylprednisolone and triamcinolone were insignificant. Complications were negligible and temporary.

Jacob M.J.,Army Hospital R and R
Journal of Association of Physicians of India | Year: 2011

Exercise ECG (TMT) is one of the very common investigations being used in the periodic medical examination of high risk professionals like airline pilots and executives. We have done a retrospective analysis of 152 asymptomatic persons who reported for myocardial perfusion imaging after being found to have positive TMT in the form of ST-T changes in inferolateral leads. Stress myocardial perfusion scan of all of them were normal. The fact that so many cases of positive TMT based on ST-T changes in inferolateral leads is found to be false positive should make us retrospect on the criteria for deciding positive TMT. The data available with other centers can be examined and a prospective multi centric study can be done to see whether the present criteria for positive TMT need revision. © JAPI.

Naidu S.,Army Hospital R and R
Journal of Clinical and Experimental Hepatology | Year: 2013

Living donor liver transplant has gained rapid popularity in India as a life saving procedure for end stage liver disease. The undoubted benefit for the recipient is clouded by a few unfavorable outcomes in donors which have led to allegations of lack of transparency. These factors are easily remediable with an attitude of self audit and self disclosure by transplant centers, enabling a truly informed consenting procedure. © 2012 INASL.

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