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Harjai M.M.,Commandant and Consultant in Surgery and Paediatric Surgery | Sethi N.,Armed Forces Medical College | Chandra N.,Command Hospital Southern Command
African Journal of Paediatric Surgery | Year: 2013

Background: Better exposure, possibility of extension if needed and precise placement of the anal canal within the external sphincter complex have made the posterior and anterior sagittal approaches more popular and established for the correction of anovestibular fistula. The mini posterior sagittal anorectoplasty (PSARP) was the procedure of choice for female ARM at our center till date. As an alternative surgical option, we performed anterior sagittal anorectoplasty (ASARP) in 15 cases of anovestibular fistula and compared them with 12 cases of vestibular fistula operated by PSARP technique. Patients and Methods: Fifteen female infants with vestibular fistula who had anterior sagittal anorectoplasty (ASARP) procedure were reviewed. The procedure and its outcome were evaluated. Results : The manoeuvering during anesthesia and operative access were quite easier in ASARP compared to PSARP. Delineation of plane in ASARP between rectum and vagina was easier and clearer in comparison to PSARP. Rent occurred in the posterior vaginal wall in three cases of ASARP and two cases of PSARP. There were two cases of wound infection in each group. Three cases of PSARP group developed anal stenosis and constipation while one in the ASARP group developed constipation. Conclusion : Anesthesia and access in ASARP makes it an easier alternative option to PSARP in the management of anovestibular fistula in girls.

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.

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.

Goyal B.K.,Army Hospital Research and Referral | Singh H.,Army Hospital Research and Referral | Kapur K.,Command Hospital Southern Command | Duggal B.S.,Army Hospital Research and Referral | Jacob M.J.,Army Hospital Research and Referral
International Journal of Gynecological Cancer | Year: 2010

Background: Posttreatment morbidity of multimodality therapy is substantially higher than either radical surgery or chemoradiation alone. Preoperative prediction of positive nodes limits optimal selection of the primary treatment modality. Computed tomography (CT) and magnetic resonance imaging have been tried for nodal assessment with modest results. Positron emission tomography (PET) combined with CT seems to be promising in this regard. This clinicopathologic study assesses the value of PET-CT in predicting nodal metastasis and avoiding multimodality therapy. Materials and Methods: Eighty patients with clinically operable cervical cancer underwent PET-CT during the preoperative evaluation followed by radical hysterectomy. Adjuvant chemoradiation was administered when indicated by histopathologic findings. The histopathologic finding of the pelvic nodes was correlated with the PET-CT findings for nodal metastasis. The x2 test was used as the test of significance in the statistical analysis. Observations: Of 62 patients found PET-CT negative for nodal disease, 52 were true negative, whereas 10 were false negative on histopathologic examination. On the other hand, 14 of 18 patients found PET-CT positive for nodal disease were true positives. Specificity, sensitivity, positive predictive value, and negative predictive value of PET-CT in nodal assessment were found to be 92.8, 58.33, 77.7, and 83.8, respectively. Twenty-four patients (30%) with pelvic nodes positive for disease on histopathologic examination were administered adjuvant chemoradiation. Had we operated only on those patients who were PET-CT negative for nodal disease, 10 of 62 patients would have required adjuvant chemoradiation for positive nodes. Eighteen patients found PET-CT positive for nodal disease would be treated with primary chemoradiation. Inclusion of PET-CT in the decision-making process for primary surgery versus primary chemoradiation would allow 87.5% patients to receive a single modality of treatment (65%, only surgery; 22.5%, only chemoradiation) and the proportion of patients requiring multimodality treatment would reduce significantly from 30% to 12.5% (P < 0.01). Conclusion: Positron emission tomography combined with CT in the evaluation of operable cervical cancer can help in the optimal selection of patients for surgery such that multimodality treatment with its attendant increase in morbidity is avoided. Copyright © 2010 by IGCS and ESGO.

Verma R.,Command Hospital Southern Command | Grewal R.S.,Dy DGAFMS Prov | Chatterjee M.,Command Hospital Eastern Command | Pragasam V.,Command Hospital Southern Command | And 2 more authors.
Medical Journal Armed Forces India | Year: 2014

Background: Replenishing melanocytes by autologous melanocytes selectively in vitiliginous macules is a novel and promising treatment. With expertise in culturing autologous melanocytes, it has now become possible to treat larger recipient areas with smaller skin samples. To determine the relative efficacy of cultured versus non cultured melanocyte transfer in the management of stable vitiligo. Methods: The melanocytes were harvested as an autologous melanocyte rich cell suspension from a donor split thickness graft. Cultured or non cultured melanocytes were then transplanted to the recipient area that had been superficially dermabraded. 100 patches of vitiligo in patients reporting to this hospital were randomly allocated into 2 groups to receive either of the interventions. Results: An excellent response was seen in 62.17% cases with the autologous melanocyte rich cell suspension technique and in 52% with the melanocyte culture technique. Conclusion: Autologous melanocyte transplantation can be an effective form of surgical treatment in stable but recalcitrant lesions of vitiligo. Large areas of skin can be covered with a smaller donor skin using melanocyte culture technique; however culture method is more time consuming, and a labour intensive process, requiring state of the art equipments with a sterile lab setup. © 2013, Armed Forces Medical Services (AFMS). All rights reserved.

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