Dr. RPGMC Kangra

Tanda, India

Dr. RPGMC Kangra

Tanda, India
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Prakash S.,Vardhman Mahavir Medical College and Safdarjung Hospital | Mullick P.,Vardhman Mahavir Medical College and Safdarjung Hospital | Bhandari S.,Dr. RPGMC Kangra | Kumar A.,Orchid Hospital | And 2 more authors.
Saudi Journal of Anaesthesia | Year: 2017

Background: Several morphometric airway measurements have been used to predict difficult laryngoscopy (DL). This study evaluated sternomental distance (SMD) and sternomental displacement (SMDD, difference between SMD measured in neutral and extended head position), as predictors of DL and difficult intubation (Di). Materials and Methods: We studied 610 adult patients scheduled to receive general anesthesia with tracheal intubation. SMD, SMDD, physical, and airway characteristics were measured. DL (Cormack-Lehane grade 3/4) and Di (assessed by Intubation Difficulty Scale) were evaluated. The optimal cut-off points for SMD and SMDD were identified by using receiver operating characteristic (ROC) analysis. Multivariate logistic regression was used to predict DL and ROC curve was used to assess accuracy on developed regression model. Results: The incidence of DL and Di was 15.4% and 8.3%, respectively. The cut-off values for SMD and SMDD were ≤14.75 cm (sensitivity 66%, specificity 60%) and ≤5.25 cm (sensitivity 70%, specificity 53%), respectively, for predicting DL. The area under the curve (AUC) with 95% confidence interval (CI) for SMD was 0.66 (0.60-0.72) and that for SMDD was 0.687 (0.63-0.74). Multivariate analysis with logistic regression identified inter-incisor distance, neck movement <80°, SMD, SMDD, short neck and history of snoring as predictors and the predictive model so obtained exhibited a higher diagnostic accuracy (AUC: 0.82; 95% CI 0.77-0.86). SMDD, but not SMD, correlated with Di. Conclusions: Both SMD and SMDD provide a rapid, simple, objective test that may help identifying patients at risk of DL. Their predictive value improves considerably when combined with the other predictors identified by logistic regression.


Goyal V.D.,C.T.V.S | Sharma S.,Dr. RPGMC Kangra | Mahajan S.,Dr. RPGMC Kangra | Kumar A.,Dr. RPGMC Kangra
Journal of Clinical and Diagnostic Research | Year: 2014

We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery. © 2014, Journal of Clinical and Diagnostic Research. All rights reserved.


Sharma C.,Dr. RPGMC Kangra | Surya M.,Dr. RPGMC Kangra | Soni A.,Dr. RPGMC Kangra | Soni P.K.,Dr. RPGMC Kangra | And 2 more authors.
Journal of Obstetrics and Gynecology of India | Year: 2015

Purpose: To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS). Method: In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I–IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I–IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I–IV). Results: Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value = 0.000 each). However, the number of previous CS (p = 0.440) and inter-delivery interval (p = 0.062) had no statistically significant correlation with thickness of LUS. Conclusions: Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour. © 2014, Federation of Obstetric & Gynecological Societies of India.


Goyal V.D.,Dr. RPGMC Kangra | Sharma V.,Dr. RPGMC Kangra | Kalia S.,Dr. RPGMC Kangra | Pathak S.,Dr. RPGMC Kangra
Journal of Clinical and Diagnostic Research | Year: 2015

We present a rare case of ruptured pseudoaneurysm of distal femoral artery due to osteochondroma in a 21-year- old male. The patient was initially treated for osteochondroma as ruptured pseudoaneurysm was not suspected. Diagnosis of ruptured pseudoaneurysm could only be made intraoperatively when rent in the femoral artery was found along with surrounding hematoma and obstruction in the distal femoral artery. Patient underwent multiple surgeries (resection of osteochondroma and femoro-popliteal bypass) and recovered well with palpable pulsations in the operated limb. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


PubMed | Dr. RPGMC Kangra
Type: Journal Article | Journal: Journal of obstetrics and gynaecology of India | Year: 2015

To estimate the risk of uterine dehiscence/rupture in women with previous cesarean section (CS) by comparing the thickness of lower uterine segment (LUS) and myometrium with trans-abdominal (TAS) and trans-vaginal sonography (TVS).In this case-control study, in 100 pregnant women posted for elective CS (with or without previous CS; group 1 and group 2 respectively), the thickness of LUS and myometrium was measured sonographically (TAS and TVS). Intra-operatively, LUS was graded (grades I-IV), and its thickness was measured with calipers. The primary outcome of the study was correlation between echographic measurements (TAS and TVS) and features of LUS (grades I-IV) at the time of CS. Secondary outcomes were correlation between myometrial thickness, number of previous CS, and inter-delivery interval with LUS (grades I-IV).Sonographic measurements of LUS and myometrium were significantly different between the two groups (both TAS and TVS p value=0.000 each). However, the number of previous CS (p=0.440) and inter-delivery interval (p=0.062) had no statistically significant correlation with thickness of LUS.Sonographic evaluation of LUS scar and myometrial thickness (both with TAS and TVS) is a safe, reliable, and non-invasive method for predicting the risk of scar dehiscence/rupture. Specific guidelines for TOLAC, after sonographic assessment of women with previous CS, are need of the hour.

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