Command Hospital Southern Command

Pune, India

Command Hospital Southern Command

Pune, India
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Mustafa M.S.,Station Health Organisation Large | Rastogi V.,Command Hospital Southern Command
Medical Journal Armed Forces India | Year: 2017

Resistance to standard antimalarials has led to the need for newer options. Artemisinin-based combination therapies (ACTs), which require a tedious three-day treatment schedule, have been introduced for the treatment of drug-resistant malaria. Of late, the new generation artemisinin–naphthoquine (ANQ) combination has been developed, which requires a single dose treatment. Artemisinin initiates the action through the cleavage of the endoperoxide bridge while naphtoquine maintains the process by getting concentrated in the digestive vacuole of the parasite. One ANQ tablet contains 50 mg naphthoquine and 125 mg of artemisinin in the ratio of 1:2.5. The optimal dosage in adults is 400 mg of naphthoquine and 1000 mg artemisinin; which amounts to 8 tablets in a single dose. The dosage for children is adjusted based on the body-weight. The combination has been found to be quite effective with and safe. Studies have demonstrated an adequate clinical and parasitologic response of 98.1–100% in both adults and children. However, further trials are required to confirm its non-inferiority with other ACTs. Adverse reactions with ANQ have been mild. Further studies are needed before safety can be established during pregnancy. ANQ increases the compliance rates because of single dosage. It may be administered by the peripheral health workers as a directly observed therapy, which would be of special benefit to troops in the North-Eastern Sector. © 2016


Agrawal A.,Command Hospital Southern Command | Karan S.C.,Columbia Asia Hospital
Medical Journal Armed Forces India | Year: 2017

Background: Serum prostate-specific antigen (PSA) is an important tumour, marker which is widely used to trigger trans-rectal ultrasound (TRUS)-guided prostate biopsy. However, the PSA levels vary with race and ethnicity. Therefore, there is a need to have an Indian reference range. Methods: All adult male patients meeting the inclusion and exclusion criteria were enrolled in this study. They were subjected to assessment of serum total PSA, digital rectal exami-nation and trans-abdominal ultrasound. If any one or more of these were found abnormal, then a TRUS-guided 12-core prostate biopsy was done. Patients who were detected to have prostatic cancer were excluded from the final analysis. The data so obtained was grouped among the following three age groups: 40–49, 50–59 and 60–70 years, and the age-specific PSA values, prostatic volume and PSA density were found. Results: A total of 1772 patients were analysed. The mean serum total PSA was 1.76 ng/ml with a standard deviation of 2.566 ng/ml. Group-wise age distribution of the mean serum total PSA was 1.22, 1.97 and 2.08 ng/ml in 40–49, 50–59 and 60–70 years age groups. Conclusion: The mean total PSA and the age-specific PSA range tend to be lower in the Indians than the Western population. © 2017 Published by Elsevier B.V.


Mishra A.,Military Hospital Cardio Thoracic Center | Jain N.,Military Hospital Cardio Thoracic Center | Bhagwat A.,Command Hospital Southern Command
Vascular and Endovascular Surgery | Year: 2017

Background: Peripheral arterial occlusive disease (PAOD) may cause disabling claudication or critical limb ischemia. Multidetector computed tomography (CT) technology has evolved to the level of 256-slice CT scanners which has significantly improved the spatial and temporal resolution of the images. This has provided the capability of chasing the contrast bolus at a fast speed enabling angiographic imaging of long segments of the body. These images can be reconstructed in various planes and various modes for detailed analysis of the peripheral vascular diseases which helps in making treatment decision. Purpose: The aim of this retrospective study was to compare the CT angiograms (CTAs) of all cases of PAOD done by 256-slice CT scanner at a tertiary care vascular center and comparing these images with the digital subtraction angiograms (DSAs) of these patients. Materials and Methods: The retrospective study included 53 patients who underwent both CTA and DSA at our center over a period of 3 years from March 2013 to March 2016. Results: The CTA showed high sensitivity (93%) and specificity (92.7%) for overall assessment of degree of stenosis in a vascular segment in cases of aortic and lower limb occlusive disease. The assessment of lesions of infrapopliteal segment was comparatively inferior (sensitivity 91.6%, accuracy 73.3%, and positive predictive value 78.5%), more so in the presence of significant calcification. The advantages of CTA were its noninvasive nature, ability to image large area of body, almost no adverse effects to the patients, and better assessment of vessel wall disease. However, the CTA assessment of collaterals was inferior with a sensitivity of only 62.7% as compared to DSA. Overall, 256-slice CTA provides fast and accurate imaging of vascular tree which can restrict DSA only in few selected cases as a problem-solving tool where clinico-radiological mismatch is present. © The Author(s) 2017.


Singh Y.,Command Hospital Southern Command | Garg M.K.,Command Hospital Southern Command | Tandon N.,All India Institute of Medical Sciences | Marwaha R.K.,International Life science
JCRPE Journal of Clinical Research in Pediatric Endocrinology | Year: 2013

Objective: Insulin resistance (IR) and associated metabolic abnormalities are increasingly being reported in the adolescent population. Cut-off value of homeostasis model of assessment IR (HOMA-IR) as an indicator of metabolic syndrome (MS) in adolescents has not been established. This study aimed to investigate IR by HOMA-IR in urban Indian adolescents and to establish cut-off values of HOMA-IR for defining MS. Methods: A total of 691 apparently healthy adolescents (295 with normal body mass index (BMI), 205 overweight, and 199 obese) were included in this cross-sectional study. MS in adolescents was defined by International Diabetes Federation (IDF) and Adult Treatment Panel III (ATP III) criteria. IR was calculated using the HOMA model. Results: Mean height, waist circumference (WC), waist/hip ratio (WHR), waist/height ratio (WHtR), and blood pressure were significantly higher in boys as compared to girls. The HOMA-IR values increased progressively from normal weight to obese adolescents in both sexes. Mean HOMA-IR values increased progressively according to sexual maturity rating in both sexes. HOMA-IR value of 2.5 had a sensitivity of >70% and specificity of >60% for MS. This cut-off identified larger number of adolescents with MS in different BMI categories (19.7% in normal weight, 51.7% in overweight, and 77.0% in obese subjects) as compared to the use of IDF or ATP III criteria for diagnosing MS. Odds ratio for having IR (HOMA-IR of >2.5) was highest with WHtR (4.9, p <0.0001) and WC (4.8, p <0.0001), compared to WHR (3.3, p <0.0001). Conclusions: In Indian adolescents, HOMA-IR increased with sexual maturity and with progression from normal to obese. A HOMA-IR cut-off of 2.5 provided the maximum sensitivity and specificity in diagnosing MS in both genders as per ATP III and IDF criteria. © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.


Chauhan R.,Command Hospital Southern Command | Mendonca S.,Command Hospital Southern Command
Indian Journal of Nephrology | Year: 2015

Hemodialysis has improved the morbidity and mortality associated with end stage renal disease. In India, hemodialysis prescription is empiric, which leads to complications related to under-dialysis. Hence, adequacy of hemodialysis in Indian setting was analyzed in this study. A total of 50 patients on twice per week hemodialysis were assessed for 1 month. The number of sessions meeting standards laid out by Kidney Diseases Outcome Quality Initiatives (KDOQI) guidelines were calculated. They were divided into two groups: one in whom dialysis was monitored and session length enhanced to meet the minimum standard Kt/V of 2 and second control group; where Kt/V was not monitored. Hemoglobin (Hb) levels, albumin levels, mean arterial pressure and World Health Organization (WHO) quality of life (QoL) score were compared in the two groups after 6 months. Only 28% of hemodialysis sessions were adequate as per KDOQI guidelines. There was significant improvement in Hb levels (1.47 vs. 0.15 g/dl), mean arterial pressure levels (15.2 vs. 3.16 mm Hg), serum albumin levels (0.82 vs. 0.11 g/dl) and WHO QoL score (17.2 vs. 2.24) in study group as compared to control group. Standard Kt/V can be used as an important tool to modify twice weekly dialysis sessions to provide better QoL to the patients. However, studies with larger sample size are required to conclusively prove our results. © 2015 Indian Journal of Nephrology.


Garg M.K.,Command Hospital Southern Command | Mahalle N.,Deenanath Mangeshkar Hospital and Research Center
Medical Hypotheses | Year: 2013

The main physiological function of vitamin D is maintenance of calcium homeostasis by its effect on calcium absorption, and bone health in association with parathyroid gland. Vitamin D deficiency (VDD) is defined as serum 25-hydroxy vitamin D (25OHD) levels <20. ng/ml. Vitamin D insufficiency is called when serum 25OHD levels are between 20-29. ng/ml, though existence of this entity has been questioned. Do all subjects with VDD have clinical disease according to this definition? Analysis of published studies suggests that calcium absorption in inversely correlated with serum 25OHD levels and calcium intake. We hypothesize that there exist an intestinal calcistat, which controls the calcium absorption independent of PTH levels. It consists of calcium sensing receptor (CaSR) on intestinal brush border, which senses calcium in intestinal cells and vitamin D system in intestinal cells. CaSR dampens the generation of active vitamin D metabolite in intestinal cells and decrease active transcellular calcium transport. It also facilitates passive paracellular diffusion of calcium in intestine. This local adaptation adjusts the fractional calcium absorption according the body requirement. Failure of local adaptation due to decreased calcium intake, decreased supply of 25OHD, mutation in CaSR or vitamin D system decreases systemic calcium levels and systemic adaptations comes into the play. Systemic adaptations consist of rise in PTH and increase in active vitamin D metabolites. These adaptations lead to bone resorption and maintenance of calcium homeostasis. Not all subjects with varying levels of VDD manifest with secondary hyperparathyroidism and decreased in bone mineral density. We suggest that rise in PTH is first indicator of VDD is rise in PTH along with decrease in BMD depending on duration of VDD. Hence, subjects with any degree of VDD with normal PTH and BMD should not be labeled as vitamin D deficient. These subjects can be called subclinical VDD, and further studies are required to assess beneficial effect of vitamin D supplementation in this subset of population. This hypothesis further highlights pitfalls in treatment of hypoparathyroidism. © 2013 Elsevier Ltd.


Verma R.,Command Hospital Southern Command | Vasudevan B.,Command Hospital Southern Command | Pragasam V.,Command Hospital Southern Command
Medical Journal Armed Forces India | Year: 2013

Severe cutaneous drug reactions are one of the commonest medical challenges presenting to an emergency room in any hospital. The manifestations range from maculopapular rash to severe systemic symptoms like renal failure and cardiovascular compromise. Toxic epidermal necrolysis, erythroderma, drug rash with eosinophilia and systemic symptoms, acute generalised exanthematous pustulosis and drug induced vasculitis are the common cutaneous drug reactions which can have severe morbidity and even mortality. Careful history taking of the lag period after drug intake and associated symptoms, along with detailed examination of the skin, mucosa and various systems, help in early diagnosis of these reactions. Early stoppage of the incriminating drug, specific therapy including corticosteroids, cyclosporine and intravenous immunoglobulin depending on the case along with supportive therapy and local measures help in salvaging most patients. An overview of these important cutaneous drug reactions along with their management is being reviewed in this article. © 2013, Armed Forces Medical Services (AFMS). All rights reserved.


Suresh P.,Command Hospital Southern Command | Batra U.,Rajiv Gandhi Cancer Institute | Doval D.C.,Rajiv Gandhi Cancer Institute
Indian Journal of Medical and Paediatric Oncology | Year: 2013

Background: Triple negative breast cancer (TNBC) is a recent concept and the burning topic of research today. Various studies have been reported in western literature on TNBCs or the similar group of basal like cancers, all highlighting the poor prognostic features of this molecular subtype in comparison to the other types of breast cancers. However extensive data from India is lacking. The aim of this study was to analyze the epidemiological and clinical profile of TNBcs at our institute. Materials and Methods: Data on 171 patients of TNBCs registered at this hospital between 2005 and 2008 and followed up until December 2010 was collected and reviewed for epidemiological and clinical features. Results: The median age at presentation was 49 years (22-75 years). Sixty eight patients (40%) had lump in the breast of less than 1 month duration. Fourteen (8%) were nulliparous and 10 (7%) patients had crossed the age of 30 years at first full-term pregnancy, 89 (52%) were pre or peri-menopausal at presentation. Only 8 (5%) patients had a family history of breast or ovarian cancer. One hundred and six (62%) patients were stage II, 26 (15%) stage III, 21 (12%) stage I and 18 (10%) stage IV at presentation. One hundred and twenty eight patients (75%) had early breast cancer eligible for surgery at presentation, 25 (15%) were locally advanced and received neoadjuvant chemotherapy (NACT) and 18 (10%) were found to be metastatic. Modified radical mastectomy was the preferred surgical option by most patients (76%) who underwent upfront surgery in our study. The pathological overall response rates (complete and partial response) after NACT was 75% with complete response rate of 25% and there were no relapses in the complete responders. The median follow-up was 30 months (9-70 months). One hundred and twenty two patients (71%) were alive at last follow-up, 34 (22%) had relapsed, 18 (11%) had died due to progressive disease. Thirty one patients (18%) were lost to follow-up. Most of the relapses were systemic and rarely preceded by local relapses. Conclusions: TNBCs are aggressive cancers with high rates of systemic relapses within the first 3 years of presentation. Longer follow-up of these patients is required for more mature data on these cancers.


Mahalle N.,Deenanath Mangeshkar Hospital and Research Center | Kulkarni M.V.,University of Pune | Garg M.K.,Command Hospital Southern Command | Naik S.S.,Deenanath Mangeshkar Hospital and Research Center
Journal of Cardiology | Year: 2013

Background and purpose: Folate and vitamin B12 are essential components in the metabolism of homocysteine (Hcy). Hyperhomocysteinemia has been implicated in endothelial dysfunction and cardiovascular disease. However, the association of Hcy, vitamin B12, and folic acid with cardiovascular risk factors in patients with coronary artery disease (CAD) has not been studied in Indian patients. This study was conducted with the aim to evaluate the relationship of vitamin B12, folic acid, and Hcy levels with cardiovascular risk factors in subjects with known CAD. Methods and subjects: Three hundred patients (216 men; 84 women; aged 25-92 years) who had CAD on angiography were included in this study consecutively. All patients were evaluated for anthropometry and cardiovascular risk factors, and blood samples were collected for biochemical, nutritional, and inflammatory markers. Results: Percentage of vitamin B12 and folate deficiency was 86.7% and 2.7%, respectively. Hyperhomocysteinemia was present in 95.3% patients. Vitamin B12 levels were significantly lower and Hcy levels were significantly higher in subjects with dyslipidemia, DM, and/or hypertension. Serum vitamin B12 was inversely associated with triglyceride and very low-density lipoprotein (VLDL) and positively with high-density lipoprotein (HDL). Hcy was positively associated with triglyceride and VLDL and negatively with HDL. Vitamin B12 was inversely correlated with inflammatory markers (high-sensitivity C-reactive protein and interleukin-6) directly related to insulin resistance whereas Hcy showed the opposite pattern. Conclusions: Serum vitamin B12 deficiency and hyperhomocysteinemia are related with cardiovascular risk factors in Indian patients with CAD. © 2013 Japanese College of Cardiology.


Pawar A.A.,U.S. Navy | Peters A.,Command Hospital Southern Command | Rathod J.,INHS Asvini
Medical Journal Armed Forces India | Year: 2014

Background: Stigma against mental illness exists across all countries. Stigma devalues the ill person and their relatives and denies them from attaining their rightful place in society. Stigma also prevents the ill person from seeking help. Stigma in the Armed Forces of UK and USA has been identified as a barrier to help seeking and a cause for concern as it could affect operational efficiency. However, studies conducted in the services of this country are lacking. Hence we decided to measure stigma perceived by patients and caregivers of the mentally ill and to assess stigma regarding the mentally ill patients and their caregivers, in the general population.Methods: A cross sectional survey of patients (302), their caregivers (98), and members of the general population (102) who had no relatives suffering from mental illness was done. The patients were given the Stigma Scale developed by King et al. The caregivers (98) were given the devaluation of consumers scale and devaluation of consumer families scale developed by Struening et al.Results: 90% of patients admitted to experiencing stigma. 86% of patients had experienced discrimination. Females experienced more discrimination than males. Stigma perceived was irrespective to age, mental status, rank and education of the patient. Caregivers perceived stigma and felt blamed by the community. Members of the general population gave similar responses.Conclusions: Study has brought out the high levels of stigma faced by the patients and their caregivers. High levels of stigma observed are a barrier to care. © 2013, Armed Forces Medical Services (AFMS). All rights reserved.

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