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PubMed | Dr Rp Government Medical College and Punjab Institute of Medical science
Type: Journal Article | Journal: Journal of family medicine and primary care | Year: 2016

Effective breastfeeding is a function of the proper positioning of mother and baby and attachment of child to the mothers breast. Positioning of the babys body is important for good attachment and successful breastfeeding. The study was planned to assess mother-infant pair latch on position and its impact on health status of the child.It was community-based cross-sectional study conducted among 1267 children between age group of 0-24 months in the urban and rural field practice areas of the Department of Community Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana. A self-designed semi-structured questionnaire along with the WHO criteria for assessment of correct latch on position was used in this study.Out of 1267 mothers, only 29.9% mothers initiated breastfeeding within 1 h of delivery. Mothers who had high parity had better positioning scores as compared to mothers with low parity. About 83.7% mothers who had parity >2 had excellent scores as compared to those mothers having one child or two children. About 56.8% and 62.7% children who suffered from diarrhea and acute respiratory infection (ARI), respectively, had mothers with poor positioning and this difference was statistically significant (It was concluded that mothers who had higher parity had better positioning and attachment scores and also mothers with excellent positioning scores, their children suffered less from diarrhea and ARI. Each mother should be observed for mothers and infants positioning and attachment at the onset of breastfeeding and if needed given counseling on correct positioning and attachment.


PubMed | University of Kansas, University of Arkansas for Medical Sciences and Dr Rp Government Medical College
Type: Journal Article | Journal: Muscle & nerve | Year: 2016

YouTube is an important resource for patients. No study has evaluated the information on peripheral neuropathy disseminated by YouTube videos. In this study, our aim was to perform a systematic review of information on YouTube regarding peripheral neuropathy.The Web site (www.youtube.com) was searched between September 19 and 21, 2014, for the terms neuropathy, peripheral neuropathy, diabetic neuropathy, neuropathy causes, and neuropathy treatment.Two hundred videos met the inclusion criteria. Healthcare professionals accounted for almost half of the treatment videos (41 of 92; 44.6%), and most came from chiropractors (18 of 41; 43.9%). Alternative medicine was cited most frequently among the treatment discussions (54 of 145, 37.2%), followed by devices (38 of 145, 26.2%), and pharmacological treatments (23 of 145, 15.9%).Approximately half of the treatment options discussed in the videos were not evidence-based. Caution should be exercised when YouTube videos are used as a patient resource.


PubMed | University of Arkansas for Medical Sciences, Dr RP Government Medical College and Arkansas Children Hospital
Type: | Journal: Acta neurologica Belgica | Year: 2016

Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome that requires prompt, aggressive management to improve outcomes. Our aim was to identify factors that would necessitate care in the intensive care unit (ICU) in patients with PRES and the outcomes on discharge following ICU stay. We retrospectively reviewed the medical records and radiological data of adult PRES patients admitted to our tertiary care medical center. We dichotomized them into two groups based on their need for ICU care and compared their clinical, laboratory, imaging characteristics and discharge outcomes. Outcomes were defined using the modified Rankin Score (mRS) and Glasgow Outcome Score (GOS) on discharge. Out of 100 patients, 67% required admission to the ICU. On univariate analysis, factors associated with ICU admission were atrial fibrillation (19.4 vs 0%; p0.05), encephalopathy from PRES (89.6 vs 66.7%; p<0.05), low Glasgow Coma Score (GCS) (114 vs 142; p=0.01) and cortical involvement on imaging (89.6 vs 72.7%, p=0.03). On multivariate logistic regression analysis, encephalopathy (odds ratio 10.22; 95% CI (1.14-91.55; p=0.04) was the sole predictor of ICU utilization. This correlated with a GCS<12 (odds ratio 5.53; 95% CI (1.05-29.22; p=0.04). Despite worse functional outcomes following ICU care based on mRS (2.32.1 vs 1.31.4, p=0.02) and GOS (3.91.3 vs 4.60.7, p0.05), only a borderline increase in mortality was observed (10.4 vs 0%, p=0.05). The presence of PRES-related encephalopathy might aid in prompt identification of patients who require ICU care.


PubMed | University of Arkansas for Medical Sciences, Dr RP Government Medical College and Arkansas Children Hospital
Type: Journal Article | Journal: The International journal of neuroscience | Year: 2016

Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that, although characteristically reversible, can be fatal or result in long-term disability in a subset of patients. Our aim was to identify factors associated with poor discharge outcome in PRES patients.We retrospectively reviewed the clinical and radiological records of all patients with PRES admitted at our tertiary care medical center from 2007 to 2014. They were divided based their modified Rankin Score at discharge and compared for their baseline variables, clinical, laboratory and imaging features. Poor outcome was defined by a modified Rankin scale 2-6 and was subdivided based on the primary mechanism that led to poor outcome.Out of 100 PRES subjects, 36% had poor discharge outcomes. Factors associated with poor outcomes on univariate analysis were history of diabetes mellitus, coma, high Charlson comorbidity index, post-transplantation, autoimmune condition, lack of systolic or diastolic hypertension, elevated blood urea nitrogen and involvement of the corpus callosum. On multivariate analysis, only prior diabetes mellitus odd ratio (OR) = 6.8 (95% CI 1.1-42.1, p = 0.04), corpus callosum involvement (OR = 11.7; 95% CI 2.4-57.4, p = 0.00) were associated with poor outcome. Poor outcome also correlated with increased length of hospital stay (OR = 7.9; 95% CI 1.3-49.7, p = 0.03).Large prospective studies incorporating serial blood glucose values and advanced imaging studies are required to validate these findings.


Bansal R.,Dr Rp Government Medical College | Sharma P.,Dr Rp Government Medical College | Sharma A.,Dr Rp Government Medical College
Indian Journal of Pharmacology | Year: 2013

A 32-year-old male patient was diagnosed as having pulmonary tuberculosis and put on category II antitubercular regime since he had a history of antituberculosis treatment 10 years ago. Within 3 weeks, patient presented with ulcers in mouth, and blood picture confirmed thrombocytopenia. Rifampicin-induced thrombocytopenia was suspected and antitubercular treatment stopped. Patient improved and was re-exposed to the drugs one by one. After re-exposure with pyrazinamide, the platelet count decreased drastically and oral mucosal ecchymoses reappeared, while with rifampicin, thrombocytopenia was accompanied with petechiae on legs and forearms. Isoniazid, ethambutol, and streptomycin were continued.


Mahajan V.K.,Dr RP Government Medical College | Sharma N.L.,Dr RP Government Medical College
Australasian Journal of Dermatology | Year: 2011

Mercury poisoning was once common in the 19th century. With its declining use, now clinicians and the public in general are often unaware and unsuspecting of mercury toxicity. A 40-year-old woman and her two children were hospitalized with a 1-week history of a generalized lichenoid eruption. Clinical improvement occurred without a diagnosis; however, on returning home, features of acrodynia with digital gangrene developed in the woman, leading to suspicion of heavy metal poisoning. There was no recurrence after moving from their contaminated house. © 2010 The Australasian College of Dermatologists.


Nagar R.,Dr Rp Government Medical College | Sharma K.K.,Dr Rp Government Medical College
Indian Journal of Clinical Biochemistry | Year: 2012

Recent studies have demonstrated the presence of prostate specific antigen (PSA) in cord blood of male as well as female babies. The placental progesterone and estradiol up-regulate the synthesis and secretion of PSA in Placenta. This PSA is presumed to play a role in intrauterine growth of fetus by virtue of its proteolytic action on several substrates including insulin-like-growth-factor- binding-protein-3, insulin chains and Interleukin-2. This study was planned with the objective of correlating the levels of PSA in cord blood to gestation at delivery, the type of delivery and gender of the fetus. Fifty-seven cord blood samples were collected from the umbilical cord during delivery or mid-trimester abortion and analyzed for PSA using 'Active PSA DSL-9700 ultra sensitive' kit employing two-site immuno-radiometric assay principle and having a detection limit of 0.001 ng/ml. Mean PSA levels in cord blood were found to be 0.112 ± 0.027 ng/ml. The concentration of PSA in cord blood was found to be higher in case of higher gestational age, male baby and operative delivery. 50 % of cord bloods for female babies had PSA below detection limit (range <0.001-0.460 ng/ml), while all the male samples had detectable PSA (range 0.11-0.973 ng/ml). Higher Progesterone levels found in prenatal maternal blood in case of male babies may be responsible for the higher cord blood PSA. Mean cord blood PSA was 0.150 ± 0.150 ng/ml in forceps delivery and 0.078 ± 0.012 ng/ml in normal vaginal delivery. Forceps delivery causes much more stress and strain as compared to a normal vaginal delivery, resulting in increased levels of adrenal glucocorticoids, and therefore, higher cord blood PSA. © 2012 Association of Clinical Biochemists of India.


Sharma P.,Dr Rp Government Medical College | Bansal R.,Dr Rp Government Medical College
Indian Journal of Pharmacology | Year: 2012

A 43 year old male patient, known case of multidrug resistant tuberculosis, was prescribed antitubercular drugs: kanamycin, levofloxacin, ethionamide, terizidone, Para-Aminosalicylate Sodium (PAS), pyrazinamide and pyridoxine. After 4 months of treatment, the patient developed a lump in the right breast which was approximately around 3 3 cm in size, tender on palpation, and not fixed to the underlying tissues. Ultrasonography (USG) revealed a hypoechoic mass of size 2.5 0.92 2.6 cm in the right breast region behind the nipple without any infiltration to the deeper structures. Gynecomastia due to ethionamide was suspected and the patient was advised anti-inflammatory drugs for 5 days without any change in drug therapy. The pain subsided; however, the nodule remained. Treatment was continued without any change till the patient stopped using the drugs on his own and without doctor′s consent. Within a week of stopping of treatment the nodule also disappeared.


PubMed | Dr Rp Government Medical College
Type: Journal Article | Journal: Indian journal of dermatology | Year: 2015

This paper describes a typical case of poikiloderma vasculare atrophicans (PVA) in a 48-year-old female. Histologically, the features were suggestive of PVA with the absence of Pautriers microabscess or atypical lymphoid cells. The biopsy specimen was positive for cluster of differentiation (CD) 8 on immunohistochemical staining. Its exact pathogenesis remains obscure, and it remains unclear whether PVA actually is mycosis fungoides (MF), a forme fruste of MF, or a distinct and benign dermatosis with CD8+ phenotype that can perhaps be labeled as PVA. However, it has a long benign clinical course without progression to tumor stage of MF in most cases, and its status within the spectrum of cutaneous T-cell lymphoma remains poorly understood. Yet it is imperative to distinguish PVA from poikilodermic MF.


PubMed | Dr Rp Government Medical College
Type: Journal Article | Journal: International journal of applied & basic medical research | Year: 2015

There is ample evidence to prove that medical graduates are not prescribing rationally and this can be improved by proper training.To design and implement a prescription writing teaching module for second professional medical students.A module of 3 h duration consisting of didactic lecture, interactive audiovisual small group session, and evaluation method was framed for every disease and implemented. Completeness of the prescriptions was evaluated on a scale of 1-4. Appropriateness of the prescription, knowledge about the rationale behind the drugs used and adverse events related to the drugs used was judged in three categories, that is, appropriate and complete; appropriate but insufficient; and inappropriate.One thousand six hundred and seven response sheets to 24 health problems were collected. Completeness score of 18% was 2, 59% was 3% and 24% was 4.41% prescriptions were appropriate and complete, 58% appropriate but insufficient and 1% inappropriate. The rationale behind the drugs used was appropriate and complete 24%, appropriate but insufficient 68%, inappropriate 8%. Documentation of adverse events was appropriate and complete 23%, appropriate but insufficient 49%, inappropriate 28%. All facilitators were satisfied with the duration, contents and conduct of the sessions.A module is an effective tool for teaching prescription writing to undergraduate students; modifications required in contents and strategy to emphasize the need of complete documentation.

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