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Gupta V.,Chhatrapati Shahuji Maharaj Medical University | Gupta P.,Eras Lucknow Medical College | Jain A.,Choithram Hospital and Research Center
Journal of the Pancreas | Year: 2011

Context Brunner's gland adenoma is a rare benign duodenal neoplasm. It usually presents with luminal obstruction or gastrointestinal bleeding. In rare cases, it may mimic a pancreatic malignancy and may present with obstructive jaundice. Case report A 65-year-old female presented with a two-month history of abdominal pain, early satiety and retrosternal burning pain. Liver function tests showed elevated enzymes with normal bilirubin. Imaging studies revealed a large mass in relation to the uncinate process of the pancreas and the distal duodenum along with the dilated common bile duct and the main pancreatic duct. Initial endoscopic evaluation failed to make a correct diagnosis. Repeat endoscopic evaluation combined with endoscopic sonography, however, revealed a large polypoid mass arising from the duodenal bulb. The patient underwent a transduodenal polypectomy. A diagnosis of Brunner's gland adenoma was made on histopathological examination. Conclusion Giant Brunner's adenoma may have unusual presentations. It may present with the features of ampullary obstruction mimicking periampullary or pancreatic malignancies. Extensive preoperative evaluation is required to reach a correct diagnosis in order to avoid more extensive surgery.


Jain J.,Choithram Hospital and Research Center | Jain M.,Choithram Hospital and Research Center
Tropical Doctor | Year: 2013

SUMMARY Acute viral hepatitis A and E (HAV/HEV) are usually self-limiting illnesses. However, they can have atypical presentations which lead to increased morbidity andmortality.We studied 81patients fromall age groups admitted with these infections at our centre over a1year period. Acute liver failure, prolonged cholestasis, ascites and haemolysis are common atypicalmanifestations of acute viral HAVand HEV. Relapsing hepatitis, ascites and double peak jaundicewere seenmore often in the paediatric age group.


Chitnis S.,Choithram Hospital and Research Center | Katara G.,Choithram Hospital and Research Center | Hemvani N.,Choithram Hospital and Research Center | Pareek S.,Choithram Hospital and Research Center | Chitnis D.S.,Choithram Hospital and Research Center
Indian Journal of Medical Research | Year: 2013

Background & objectives: Growing incidence of methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant enteroccoci (VRE) is posing a therapeutic problem due to limited drug options. Therefore, the present study was undertaken to check susceptibility of MRSA and VRE isolates against new antimicrobials such as daptomycin and linezolid. Methods: A total of 586 Gram-positive isolates comprising 442 S. aureus and 144 enterococci isolated from hospitalized cases included in the study, were subjected to in vitro antimicrobial susceptibility testing by disc diffusion method. One hundred twenty four enterococci obtained from rectal swabs of neonates were also included. Minimum inhibitory concentration (MIC) was determined for daptomycin, linezolid, vancomycin and teicoplanin against 50 each isolates of MRSA and VRE by E strip. Results: Among the staphylococci, 326 (73.85%) isolates were MRSA. MIC for vancomycin and teicoplanin among MRSA was ≤3 μg/ml. MIC for daptomycin among MRSA was found to be in the range of 0.064-1.5 μg/ml. Percentage of VRE among clinical samples was 14.29 per cent while it was 47.06 per cent among enterococci from rectal swabs of neonates. MIC was >256 μg/ml for vancomycin among VRE and was associated with van A genotype. MIC range for daptomycin among VRE was 0.38-3 μg/ml. MIC for linezolid among MRSA and VRE was in the range of 0.25 to 1 and 0.38 -1.5 μg/ml, respectively. Interpretation & conclusions: The present study showed a rise in MIC to vancomycin for sizable number of MRSA and growing percentage of VRE at our centre. Daptomycin and linezolid showed 100 per cent activity against MRSA and VRE.


Gokhale S.,Choithram Hospital and Research Center
Ultrasound Clinics | Year: 2010

Color Doppler ultrasonography is an excellent screening modality for renovascular hypertension (RVH). The technique is one of the most challenging ultrasound examinations; nevertheless, with expertise and skill, it is possible to perform a technically acceptable examination in most patients. This article will highlight this technique's use in patients with RVH. © 2010 Elsevier Inc.


Kalantri Y.,Choithram Hospital and Research Center | Hemvani N.,Choithram Hospital and Research Center | Chitnis D.S.,Choithram Hospital and Research Center
International Journal of Infectious Diseases | Year: 2011

Objective: Pleural tuberculosis (TB) is a diagnostic challenge because of its non-specific clinical presentation and paucibacillary nature. Conventional diagnosis methods have limitations. We evaluated the real-time polymerase chain reaction (PCR), interferon-gamma (IFN-γ), adenosine deaminase (ADA), and immunoglobulin A (IgA). Methods: We assessed 204 cases: 50 were confirmed pleural TB, 104 were probable pleural TB, and 50 formed the non-TB group. IFN-γ and IgA were measured by enzyme-linked immunosorbent assay and ADA was measured by colorimetric assay. Real-time PCR was carried out using the 16S rRNA sequence, pleural biopsy specimens were submitted to histopathologic examination, pleural fluid culture was undertaken using Lowenstein-Jensen and MGIT-BACTEC, and pleural fluid smears were stained with auramine O. Results: For confirmed and probable pleural TB cases, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was highest for IFN-γ (0.994 and 0.963, respectively), followed by ADA (0.989 and 0.945, respectively), real-time PCR (0.898 and 0.784, respectively), and IgA (0.817 and 0.784, respectively). For confirmed and probable pleural TB cases, IFN-γ showed the highest sensitivity (98% and 76.9%, respectively), followed by ADA (92% and 73%, respectively), real-time PCR (80% and 57.7%, respectively), and IgA (70% and 57.7%, respectively). With regard to combined positivity, the combination of 'either real-time PCR or IFN-γ' showed the highest sensitivity: 100% in confirmed pleural TB and 96.2% in probable pleural TB. Conclusions: IFN-γ showed the highest sensitivity as an individual diagnostic test. When a combination of tests was used, positivity of 'either IFN-γ or real-time PCR' appeared valuable for the diagnosis of pleural TB. © 2010 International Society for Infectious Diseases.


Kulkarni R.N.,Choithram Hospital and Research Center | Saxena S.K.,Choithram Hospital and Research Center | Hartalkar A.,Choithram Hospital and Research Center
Journal of Association of Physicians of India | Year: 2013

Posterior reversible encephalopathy syndrome is commonly associated with factors like hypertension, immunosuppression, uraemia, volume overload and electrolyte disturbances in post renal transplant patients. We report a case of (posterior reverssible encephalopathy syndrome) PRES in young post renal transplant patient where all these common associations were absent. High index of suspicion, clinical course and characteristic MRI finding was the key to the diagnosis. © JAPI.


Saha K.K.,Fortis S L Raheja Hospital | Deval M.,Fortis S L Raheja Hospital | Jagdale L.,Fortis S L Raheja Hospital | Sahani P.,Choithram Hospital and Research Center
Heart Surgery Forum | Year: 2011

Background: The advantages of off-pump coronary artery bypass grafting (OPCAB) are well documented; however, the conversion of OPCAB to cardiopulmonary bypass (CPB) is associated with higher morbidity and mortality. This issue is of particular concern in low-volume centers or centers that are beginning to use OPCAB. We present an OPCAB methodology that uses a maximum number of arterial grafts. Methods: We routinely use OPCAB in every patient unless there is another associated condition. We used the following methods to improve the safety of OPCAB: (1) maintaining normothermia, (2) routine use of a pulmonary artery catheter, (3) routine use of a femoral arterial line, (4) routine use of a cell saver, and (5) complete revascularization. Results: We included 173 consecutive patients in the study. All patients underwent OPCAB without any conversion to CPB. Hemodynamic compromise in 5 patients (2.89%) required insertion of an intra-aortic balloon pump (IABP). OPCAB was completed in all 5 patients after IABP insertion. Blood transfusions (BTs) were avoided in 55 patients (31.8%), and 68 patients (39.3%) required ≤2 units of blood. Conclusion: The OPCAB technique is still evolving. Low-volume centers have higher rates of conversion to CPB. Hypotension due to an impaired left ventricular function can be successfully treated by using an IABP. Although blood loss can be managed with BTs, use of a cell saver helps to reduce the number of BTs. We conclude that our technique of total arterial OPCAB using a cell saver can be safely performed in a low-volume center. © 2011 Forum Multimedia Publishing, LLC.


Hemvani N.,Choithram Hospital and Research Center | Patidar V.,Choithram Hospital and Research Center | Chitnis D.S.,Choithram Hospital and Research Center
International Journal of Infectious Diseases | Year: 2012

Objectives: The early detection of drug resistance would be a boon for TB control programs. The aim of the present study was to set up a rapid phage assay for the testing of drug susceptibility of Mycobacterium tuberculosis to rifampin, isoniazid, ethambutol, streptomycin, and ciprofloxacin, directly on decontaminated sputum samples. Methods: Mueller-Hinton broth was used instead of 7H9 broth to make the method more economical. Vancomycin and polymyxin B were added to the concentrated sputum samples to reduce the bacterial contamination. The phage assay on decontaminated sputum samples was compared with the proportion method using M. tuberculosis isolates from the same sputum samples. Results: Phage assay results were available within 48. h for rifampin and streptomycin and within 72. h for all the other drugs. In contrast the proportion method required 4-6 weeks from the primary cultures. The sensitivity of the phage assay was in the range of 93% to 100% and specificity in the range of 96% to 100% for all the drugs tested. The interpretation of results was possible for 334 of the 370 (90.3%) acid-fast bacillus (AFB) smear-positive sputum samples by the phage assay. Conclusions: The phage assay for the detection of drug resistance on direct decontaminated sputum samples is economical, easy to perform, and rapid. © 2012 International Society for Infectious Diseases.


Jain P.,Choithram Hospital and Research Center | Puwar P.,Choithram Hospital and Research Center
Journal of Association of Physicians of India | Year: 2016

Tuberculosis is a granulomatous disease caused by mycobacterium.1-3 The lung is the most common site of involvement, and it is very rare to involve the oral cavity.1,2 Most of the tuberculous lesions of oral cavity are secondary to lung disease, usually seen in elderly patients.1 Primary tuberculosis of the oral cavity is rare and is most commonly found in children and adolescents rather than in adults.1,2 Among them tuberculosis of tongue is very rare. Here we report a first case of our hospital with primary tuberculosis of tongue in a 55-year-old male from Madhya Pradesh. © 2016, Journal of Association of Physicians of India. All rights reserved.


PubMed | Changi General Hospital Pte Ltd Reg. No. 198904226R, Catholic University of Korea, Hanyang University, IHMA Europe Sarl and 9 more.
Type: | Journal: The Journal of antimicrobial chemotherapy | Year: 2016

To provide susceptibility data for community-acquired respiratory tract isolates of Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis collected in 2012-14 from four Asian countries.MICs were determined using Etest() for all antibiotics except erythromycin, which was evaluated by disc diffusion. Susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. For macrolide/clindamycin interpretation, breakpoints were adjusted for incubation in CO2 where available.Susceptibility of S. pneumoniae was generally lower in South Korea than in other countries. Penicillin susceptibility assessed using CLSI oral or EUCAST breakpoints ranged from 21.2% in South Korea to 63.8% in Singapore. In contrast, susceptibility using CLSI intravenous breakpoints was much higher, at 79% in South Korea and 95% or higher elsewhere. Macrolide susceptibility was 20% in South Korea and 50%-60% elsewhere. Among S. pyogenes isolates (India only), erythromycin susceptibility (20%) was lowest of the antibiotics tested. In H. influenzae antibiotic susceptibility was high except for ampicillin, where susceptibility ranged from 16.7% in South Korea to 91.1% in India. South Korea also had a high percentage (18.1%) of -lactamase-negative ampicillin-resistant isolates. Amoxicillin/clavulanic acid susceptibility for each pathogen (PK/PD high dose) was between 93% and 100% in all countries except for H. influenzae in South Korea (62.5%).Use of EUCAST versus CLSI breakpoints had profound differences for cefaclor, cefuroxime and ofloxacin, with EUCAST showing lower susceptibility. There was considerable variability in susceptibility among countries in the same region. Thus, continued surveillance is necessary to track future changes in antibiotic resistance.

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