Gajra Raja Medical College

Gwalior, India

Gajra Raja Medical College

Gwalior, India

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PubMed | Gajra Raja Medical College, Rabindranath Tagore International Institute of Cardiac science, Chettinad Academy of Research and Education and Bundelkhand Medical College
Type: Journal Article | Journal: Journal of anaesthesiology, clinical pharmacology | Year: 2016

With the use of ultrasound, a minimal effective volume of 20 ml has been described for supraclavicular brachial plexus block. However achieving a long duration of analgesia with this minimal volume remains a challenge. We aimed to determine the effect of dexamethasone on onset and duration of analgesia in low volume supraclavicular brachial plexus block.Sixty patients were randomly divided into two groups of 30 each. Group C received saline (2 ml) + 20 ml of 0.5% bupivacaine and Group D received dexamethasone (8 mg) + 20 ml of 0.5% bupivacaine in supraclavicular brachial plexus block. Hemodynamic variables and visual analog scale (VAS) score were noted at regular intervals until 450 min. The onset and duration of sensory and motor block were measured. The incidence of Halo around brachial plexus was observed. Students t-test and Chi-square test were used for statistical analysis.The onset of sensory and motor block was significantly earlier in dexamethasone group (10.36 1.99 and 12 1.64) minutes compared to control group (12.9 2.23 and 18.03 2.41) minutes. The duration of sensory and motor block was significantly prolonged in dexamethasone group (366 28.11 and 337.33 28.75) minutes compared to control group (242.66 26.38 and 213 26.80) minutes. The VAS score was significantly lower in dexamethasone group after 210 min. Halo was present around the brachial plexus in all patients in both the groups.Dexamethasone addition significantly increases the duration of analgesia in patients receiving low volume supraclavicular brachial plexus block. No significant side-effects were seen in patients receiving dexamethasone as an adjunct.


PubMed | Gajra Raja Medical College
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2015

Nasal cavity and Paranasal sinus malignancies are very rare, in which maxillary sinus is the commonest, followed by ethmoid, frontal and sphenoid sinus. Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) play a key role in diagnosis, staging and management of paranasal sinuses and nasal pathologies. Multiplanar imaging in CT helps better imaging of critical anatomical areas. Aim of our study was to study the incidence, clinical features, CT features and its importance in the management of sinonasal neoplasms.This prospective study was carried out in a tertiary care hospital of MP, India. Consecutive 40 histologically proven cases of sinonasal neoplasia who visited the Department of Otorhinolaryngology and Radiotherapy are included in our study. Demography and clinical features were recorded. Cases of nasal and paranasal sinus masses diagnosed on CT attending ENT and Radiotherapy OPD or admitted in the Radiotherapy ward forms the material of this study. This included patients of both sexes and all ages. Histopathological examination was asked to confirm the diagnosis made on CT.There were total 40 cases of sinonasal neoplasia among which 24 were benign. Almost all the benign cases were seen in the age group <40 y with mean age of 20 y and most of the malignant cases were seen in the age group above 40 y with mean age of 55 y. In our study we found male preponderance with male female ratio of 4:1 in both benign and malignant conditions. The commonest presenting symptoms of the patients with sinonasal masses in our study was nasal obstruction (75%) and nasal discharge (67.5%) followed by nasal mass (65%), epistaxis (62.5%) and headache (60%). Angiofibroma and papilloma were the commonest benign lesions. Commonest malignant lesion was squamous cell carcinoma. Of the malignant Sinonasal tumours studied in our series, maxillary sinus was involved in 13, ethmoid sinuses and nasal cavity in 10 cases each, and frontal sinuses in 2 cases.Contrast enhanced computed tomography with multiplanar reconstruction is an excellent modality for imaging sinonasal masses. CT can define the character of the sinonasal mass, thus differentiating benign from malignant. CT helps better imaging of critical anatomical areas and helpful in planning treatment procedures such as surgery and radiotherapy.


Kori S.,Index Medical College and Research Center | Bhatia M.,Gajra Raja Medical College | Mishra A.,Gajra Raja Medical College
Journal of Krishna Institute of Medical Sciences University | Year: 2015

Background: The Government of India launched the National Rural Health Mission on 5th April 2005. A new band of community based functionaries, named as Accredited Social Health Activist (ASHA) was proposed to escort and transport the client to reach the hospital and provide referral services in case of complications. A time to time assessment of the knowledge of ASHAs is essential as the success of government's health programmes in rural areas depends on them and hence the present study was undertaken. Material and Methods: This cross sectional study was conducted in the Barai block rural area of Gwalior district and 88 ASHAs were included in the study as per the eligibility criteria. Results: 88.6% & 85.2% of ASHAs responded for abdominal pain & bleeding respectively as complications during pregnancy and 88.6% and 85.20% ASHAs responded for obstructed labor and excessive bleeding as complications during delivery.73.8% ASHAs responded for antenatal care counseling followed by family planning (70.4%). Conclusion: There is a need to revise and update the knowledge of ASHA workers from time to time. On the job trainings of the ASHAs should be in process to develop necessary knowledge and skills with recent updates. The block level meetings should be utilized for the feedback, enhancing knowledge & solving the problem faced by the ASHAs. © Journal of Krishna Institute of Medical Sciences University.


PubMed | Subharti Medical College, Government of Rajasthan and Gajra Raja Medical College
Type: Journal Article | Journal: Industrial psychiatry journal | Year: 2015

The aim of the present study was to study the personality characteristics and criminal behavior in the substance abusers. The role of various sociodemographic variables in substance abusers, which affected their criminal behavior was also studied. Moreover, in the present study, the personality profile of substance users and nonusers was compared using psychoticism, extraversion, and neuroticism (PEN) inventory.A total of 50 consecutive subjects diagnosed as per International Classification of Diseases-10 criteria for substance abuse, fulfilling the inclusive and exclusive criteria were taken. A well-matched control was also assessed to compare the studied subject using a well-designed semi-structured proforma and PEN inventory.Most of the substance abusers were Hindus, married, belonged to 21-30 age group and urban domicile, and were presently unemployed, educated up to middle class, and belonged to lower socioeconomic status. Family history of substance use was significant in the subjects, and the chief substance of use was opioids. Scores for psychoticism and neuroticism, as well as the criminal behavior was significantly higher in studied subjects.Thus, conclusions drawn were that personality characteristics of the substance abusers differed significantly from the control group and second, the number of variables including occupational status, socioeconomic status, family history of substance use, and type of substance of abuse significantly correlated with the criminal behavior in the substance abusers. Identifying these variables can be the first step in the intervention in substance abusers in order to reduce their future criminal behavior.


Sharma S.K.,Gajra Raja Medical College | Jehan M.,Gajra Raja Medical College | Kumar A.,Vidya Health Imaging
Journal of the Anatomical Society of India | Year: 2014

Introduction: Humans are sexually dimorphic. Identification of remnants of skeletal and decomposing parts of human is one of the most difficult skills in forensic medicine. Forensic anthropologists often receive an incomplete skeleton, which are recovered fragmented but some bones are often recovered intact e.g. maxilla. However, typical identification methods may be inconclusive, especially when certain extreme post-mortem changes have developed.The aim of this study is to compare the size and volume of the maxillary sinus between males and females by CT Scan for gender determination. Methods: 102 cases (61 males & 41 females) were studied from Gwalior region. The sinus measurements were taken from series of CT Head images on DICOM viewing software using inbuilt electronic caliper. Independent sample t-test & discriminant function analysis were done using Graph pad prism & Word Excel Sheet windows 2007 version. Results: The dimensions & volume of the maxillary sinus of male was found to be larger than those of female & this difference was statistically significant (p<0.05) for sinus AP & Volume. 65.16% of males & 68.9% of females were sexed correctly & the overall percentage for sexing maxillary sinuses correctly was 67.03% & sinus AP was the best discriminant parameter with an overall accuracy of 69.81%. Discussion: We can conclude that CT measurements of maxillary sinus dimensions & volume may be useful for identification of gender in forensic anthropology to some extent when other methods are inconclusive. © 2014, Anatomical Society of India.


Sharma T.K.,Gajra Raja Medical College | Vardey S.K.,Sms Medical College | Sitaraman S.,Sir Padampat Mother and Child Health Institute
Clinical Laboratory | Year: 2016

Background: Antiepileptic drugs (AEDs) have been associated with metabolic consequences that lead to an increase in risk of atherosclerosis in patients with epilepsy. Therefore, we evaluated whether differences exist in homocysteine, folate, and vitamin B12 levels in children receiving carbamazepine (CBZ) monotherapy. Methods: A total of 58 newly diagnosed epileptic children with ages ranging from 2 to 15 years were enrolled at the start of study. However, after 3 months follow up, the final total sample size was only 50 epileptic children. Eight children dropped out of the study due to poor follow up. Serum homocysteine levels were measured by enzyme immunoassay method. Serum folate and vitamin B12 levels were estimated by Competitive Chemiluminescent Enzyme Immunoassay method. Results: The serum homocysteine level in epileptic children was found to be significantly increased after carbamazepine (CBZ) monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the serum folate and vitamin B12 levels, after carbamazepine monotherapy as compared to before therapy in epileptic children. Conclusions: Carbamazepine monotherapy may cause a significant increase in the levels of homocysteine and a significant decrease in the levels of serum folate and vitamin B12 in children with epilepsy, significant changes in above mentioned parameters occurring early in the course of treatment. The atherogenic effect of increased serum homocysteine level is well established, and patients under carbamazepine monotherapy should be monitored for possible atherogenic effects. Therefore, it may be useful to measure serum homocysteine, folate, and vitamin B12 concentrations routinely in children with epilepsy taking carbamazepine monotherapy and be treated when their levels are found to be disturbed. © 2016, Verlag Klinisches Labor GmbH. All rights reserved.


Sharma T.K.,Gajra Raja Medical College | Vardey S.K.,Sms Medical College | Sitaraman S.,Sir Padampat Mother and Child Health Institute
Clinical Laboratory | Year: 2015

Background: The data regarding Valproate and its influence on serum folate and homocysteine levels are conflicting. The aim of this study was to evaluate whether differences exist in homocysteine, folate, and vitamin B12 levels in children receiving Valproate. Methods: A total of 55 newly diagnosed epileptic children with ages ranging from 2 to 15 years were enrolled at the start of study but after 3 months follow up, the total sample size finally was only 50 epileptic children. 5 children dropped out of study due to poor follow up. 50 age and gender matched healthy control subjects were also studied on enrollment at the start of study. Serum homocysteine levels were analyzed by enzyme immunoassay method using the kits provided by Axis-Shield Diagnostics Ltd (Dundee DD2 1XA, United Kingdom). Serum folate and serum vitamin B12 were estimated by Competitive Chemiluminescent Enzyme Immunoassay method. Results: The serum homocysteine level in epileptic children was found to be significantly increased after Valproate monotherapy as compared to before therapy. Moreover, a highly significant decrease was observed in the levels of serum folate in epileptic children after Valproate monotherapy as compared to before therapy. But a non significant difference was observed in serum vitamin B12 levels in epileptic children before and after Valproate monotherapy. Conclusions: Thus, we conclude that there is a significant increase in the levels of homocysteine and a significant decrease in the concentration of serum folate while vitamin B12 decreases non-significantly after Valproate monotherapy. The atherogenic effect of increased serum homocysteine level is well established; the patients under Valproate monotherapy should be monitored for possible atherogenic effects. Considering the above observation and results of children undergoing Valproate monotherapy, these children should be screened for levels of serum homocysteine, folate, and vitamin B12 and treated when their levels are found to be disturbed.


Arumugam A.,Sri Ganga Ram hospital | Tandon N.,Gajra Raja Medical College | Choudhary B.,Gajra Raja Medical College
Sri Lankan Journal of Anaesthesiology | Year: 2016

Background: Epidural anaesthesia is a safe alternative for general anaesthesia in patients undergoing infraumbilical surgeries. This study was conducted to evaluate the effect of clonidine as an adjuvant to levobupivacaine, an S (-) enantiomer of bupivacaine. Material and Methods: Hundred patients of ASA grade I and II undergoing infraumbilical surgeries were randomized in two groups as L and LC. Group L received 0.5% levobupivacaine (1.5mg/kg) and group LC received 0.5% levobupivacaine (1.5mg/kg) with clonidine (2µg/kg). The onset time for sensory, motor blockade, duration of anaesthesia and duration of analgesia, VAS score were observed in both the groups. The haemodynamic variables such as heart rate, systolic and diastolic blood pressure, respiratory rate and SPO2 at various time intervals were measured. Any untoward side effects were noted in both groups. Results: The onset of sensory (7.8±1.7mins) and motor blockade (10.9±1.9mins) was significantly faster in clonidine group. Duration of anaesthesia and duration of analgesia was prolonged in group LC (234.5±16.1mins, 412.8±48.3mins) compared to group L (173.56±12.78 min, 269.2±24.2mins) which was statistically significant (p<0.05). Similarly clonidine group had less VAS score compared to control group. There was no significant change in the haemodynamic variables between the two groups. Hypotension and bradycardia was found more in clonidine group compared to the control group. Conclusion: Clonidine as an adjuvant to levobupivacaine prolongs the post-operative analgesia and the duration of anaesthesia for infraumbilical surgeries. © 2016. Arumugam et al.


Sahai S.,Gajra Raja Medical College | Mishra V.,Gajra Raja Medical College | Ganga D.,Gajra Raja Medical College | Jatav O.P.,Gajra Raja Medical College
Journal of Association of Physicians of India | Year: 2015

Methods: Sixty-eight pregnant women reporting to the hospital with jaundice were enrolled as cases and their Haematological, Biochemical and Viral profiles were studied. Sixteen non- pregnant women were enrolled as controls and a similar workup was done. A comparison was done between the two groups. We also divided the cases into two groups – survivors and non- survivors and tried to find out the factors predicting mortality. The unpaired student t test and chi square test were used to find out whether the differences were statistically significant.Background and Aims: The outcome of Hepatitis during pregnancy has been observed to be widely different by various authors, ranging from the benign to fatal. A poor outcome has increasingly been observed in pregnant women suffering from Hepatitis in Central India. Hence, this study was undertaken to study the incidence, causative organisms and chief prognostic factors affecting the outcome of viral hepatitis in pregnant women.Results: Viral Hepatitis in pregnancy caused a very high maternal mortality (19.1%) and foetal wastage (42.6%). Hepatitis E virus was the commonest causative organism (77.9%) responsible for viral hepatitis during pregnancy. It also caused the highest maternal mortality due to fulminant hepatic failure. Maternal mortality was significantly higher in those women presenting with features of encephalopathy, SIRS, high bilirubin levels and prolonged prothrombin time. Vertical transmission was noted in Hepatitis B and E.Conclusions: Hepatitis E is the chief causative organism causing fulminant hepatic failure in pregnant women in Central India. It leads to very high rates of maternal mortality and foetal wastage. © 2015, Journal of the association of physicians of india. All rights reserved.


Verma Y.S.,Gajra Raja Medical College | Rajput N.,Gajra Raja Medical College | Rajput S.S.,Gajra Raja Medical College
Annals of Tropical Medicine and Public Health | Year: 2014

Context: Hepatitis A is one of the most common causes of hepatitis in the pediatric age group and the most common cause of fulminant hepatic failure (FHF) among children in India. Hepatitis A is a waterborne disease. High endemicity obviates the need for vaccine in the community. Aims: We studied 116 children in the outpatient department (OPD) to know the seroprevalence of hepatitis A virus (HAV), total antibodies, and the effect of various demographic and water sanitation variables on it. Settings and Design: Children attending the pediatric OPD with minor problems in a medical college hospital were chosen for this study. It is a descriptive, cross-sectional, and seroepidemiologic investigative study. Materials and Methods: Blood samples of randomly selected children were collected and competitive enzyme-linked immunosorbent assay (ELISA) test was done for the detection of total anti-HAV antibodies, [both immunoglobulin M (IgM) and immunoglobulin G (IgG)], using a commercially available ELISA kit. Dia.Pro (Diagnostic Bioprobes srl via Columella n° 31 20128 Millano, Italy). Statistical Analysis Used: Statistical analysis was performed by the chi-square test using Epi Info software 3.5.4 version (2012) [Center for disease control and prevention (CDC), Atlanta, Georgia (USA)]. Results: Seroprevalence in children from the upper social class was 54.5% versus 87.2% in the lower social class (P = 0.00075). 90.9% of the children with rural background were seropositive compared to 77.1% of children with urban background. The mother's education above and below secondary level had a seropositivity for HAV in children up to 69.23% and 87.1%, respectively. The method of water treatment using boiled water, mechanical filtration, filtration plus ultraviolet (UV) light treatment, and no treatment had a seropositivity of 50.0%, 83.33%, 37.5%, and 84%, respectively, (P = 0.0036). Seropositivity was the highest when the water source was municipal bore well pipeline (88.88%), followed by municipal dam water through pipeline (79.16%), and personal bore well (68.16%) (P = 0.026). Conclusion: Children of this geographical area have high seroprevalence for HAV antibodies at a younger age with a significant difference between their social classes, water sources, and water treatment methods.

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