Government Medical College Hospital

Chandigarh, India

Government Medical College Hospital

Chandigarh, India
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Narang S.,Government Medical College Hospital | Mashayekhi A.,Thomas Jefferson University | Rudich D.,Thomas Jefferson University | Shields C.L.,Thomas Jefferson University
Clinical and Experimental Ophthalmology | Year: 2012

Background: To determine the predictors of long-term visual outcome after chemoreduction for management of intraocular retinoblastoma. Design: Retrospective case series. Participants: One hundred and forty eyes of 96 new retinoblastoma patients. Methods: The clinical records were reviewed for demographical profile, tumour characteristics, treatment methods, treatment side effects and final visual outcome. Multivariate analysis was used to evaluate factors predictive of final visual acuity. Main Outcome Measure: The clinical data were analysed for main outcome measures of good vision (visual acuity ≥6/12) or ambulatory vision (visual acuity ≥6/60). The correlation among predictor variables was determined using Pearson's product moment correlation for continuous variables, and t-test and analysis of variance test for categorical baseline variables. Results: Follow-up ranged from 2years to 14years (median 75months). The final mean logarithm of minimum angle of resolution visual acuity was 0.79. Ambulatory vision (≥6/60) was achieved in 100 of 140 (71%) eyes, and vision of ≥6/12 was seen in 52 eyes (37%). Extrafoveolar tumour and greater number of tumours in the eye were the only predictors of visual acuity ≥20/40. Greater number of tumours correlated with smaller mean basal tumour diameter. The mean basal tumour diameter was 9.8mm in eyes with multiple tumours and 12.2mm in eyes with single tumours (P=0.03). Conclusion: Long-term ambulatory vision (≥6/60) was achieved in the majority (71%) of retinoblastoma containing eyes not requiring enucleation after treatment with chemoreduction and adjunctive therapy. Absence of foveolar involvement and greater number of tumours were the predictor of long- term visual outcome of 6/12 or better. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Vadivelu N.,Yale University | Mitra S.,Government Medical College & Hospital | Kaye A.D.,Louisiana State University | Urman R.D.,Harvard University
Best practice & research. Clinical anaesthesiology | Year: 2014

The epidemic use of illicit drugs has led to an increasing number of patients with drug addiction and dependence presenting for perioperative care. There are a wide variety of drugs commonly abused including opioids, such as heroin and prescription drugs; stimulants, such as amphetamine and cocaine; depressant drugs, such as alprazolam and diazepam; and hallucinogens, such as lysergic acid diethylamide, phencyclidine, and marijuana. Treatment of opioid dependence by office-based buprenorphine and methadone maintenance programs has expanded opportunities for therapy. Treatment of these patients in the perioperative period is challenging. In addition to pain control, management of anxiety, psychological states, and hemodynamic control are the factors to be considered to provide optimum treatment. Although opioids are the mainstay for the control of acute pain, other therapeutic options include alternative routes of administration of local anesthetic, ketamine infusion, and the use of regional anesthesia. We discuss optimum perioperative management, the role of perioperative urine testing, and special considerations in patients on methadone and buprenorphine. Copyright © 2014 Elsevier Ltd. All rights reserved.

Chawla D.,Government Medical College Hospital | Parmar V.,Government Medical College Hospital
Indian Pediatrics | Year: 2010

Objective: To evaluate the role of phenobarbitone in the management of unconjugated hyperbilirubinemia during first two weeks of life in preterm neonates. Design: Meta-analysis. Methods: A study was eligible for inclusion in the meta-analysis if it randomized preterm neonates into control and treatment groups. Standard search strategy of the Cochrane Neonatal Review Group was used. For categorical and continuous data the odds ratio (OR) and weighted mean difference (WMD) were calculated, respectively. 95% confidence intervals were used and a fixed effects model was assumed for the meta-analysis. Main outcome measures: Peak serum bilirubin, duration of phototherapy, need of phototherapy and exchange transfusion, neurodevelopmental outcome and adverse effects. Results: A total of 19 potentially relevant studies were identified. Of these, 3 studies (497 neonates) were included in the meta-analysis. Peak serum bilirubin was significantly lower in phenobarbitone group (mean difference: -1.78 mg/dL, 95% CI: -2.29 to -1.27). Duration of phototherapy was shorter (mean difference: -14.75 h, 95% CI: -26.67 to -2.83). Need of phototherapy (OR: 0.33, 95% CI: 0.13 to 0.81) and exchange transfusion (OR: 0.30, 95% CI: 0.14 to 0.64) were also reduced in phenobarbitone group. Conclusion: Phenobarbitone reduces peak serum bilirubin, duration and need of phototherapy and need of exchange transfusion in preterm very low birthweight neonates. Further studies are warranted to evaluate adverse effects and neurodevelopmental outcome. © 2010 Indian Academy of Pediatrics.

Singh J.,Government Medical College Hospital | Chavali K.H.,Government Medical College Hospital
Journal of Forensic and Legal Medicine | Year: 2011

Medial clavicular epiphysis is the long bone epiphysis to fuse last and therefore, is useful for estimating age in the post-pubertal period. Age estimation was done from clavicles obtained from 343 cadavers (252 males and 91 females) of known age. The data was subjected to statistical analysis to see whether the difference obtained in the various ages was significant or not. Commencement of fusion was seen as early as 18 years of age in both male and female clavicles. No clavicle showed complete fusion until the age of 22 years. Complete fusion of the medial end of the clavicle was seen latest at 32 years in the male clavicles while the same was observed at 31 years in the female bones, i.e., the medial epiphysis of female clavicles fused one year earlier than their male counterparts. Advanced stages of clavicular epiphyseal union were seen in most of the clavicles after 24 years of age in females and 23 years of age in males. No significant difference was noticed in both sexes for the right and left clavicles as regards to the occurrence of various stages of epiphyseal union. © 2010 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Suryalatha K.,Cholera and Biofilm Research Laboratory | John J.,Government Medical College Hospital | Thomas S.,Cholera and Biofilm Research Laboratory
Future Microbiology | Year: 2015

Wohlfahrtiimonas chitiniclastica is a rare pathogen that was first isolated from a parasitic fly, Wohlfahrtia magnifica. It is a very rare but an emerging human pathogen reported only in Europe and South America. Recently, it is reported to be an egressing zoonotic pathogen from different geographical locations. The present case represents the first report of this pathogen from a patient suffering from osteomyelitis from India and so far no reports are available regarding the W. chitiniclastica associated infections in Asian countries. Clinical awareness of such emerging human pathogens is crucial for the infectious disease containment. © 2015 Future Medicine Ltd.

Gupta V.,Government Medical College Hospital | Bansal N.,Government Medical College Hospital | Singla N.,Government Medical College Hospital | Chander J.,Government Medical College Hospital
Journal of Microbiology, Immunology and Infection | Year: 2013

Resistance to carbapenems is a significant therapeutic threat. The increasing frequency of car bapenemase enzymes among Gram-negative bacilli makes their early detection and differentiation urgent. Carbapenemases belonging to Class A are most commonly produced by members of family Enterobacteriaceae and are inhibited to various degrees by clavulanic acid. The present study is aimed to determine the occurrence and phenotypic detection of Class A carbapenemases in Escherichia coli and Klebsiella pneumoniae blood isolates from septicemic patients. Methods: A total of 75 isolates of K. pneumoniae and 25 E. coli were screened for resistance to carbapenems by using meropenem and imipenem discs and meropenem E-test. Positive strains were then subjected to a modified Hodge test combined with carbapenemase inhibition tests to phenotypically detect and differentiate Class A serine carbapenemases from other classes of carbapenem hydrolyzing enzymes. Results: The screening test showing the number of isolates resistant to meropenem and imipenem were 41 and 35 for K. pneumoniae and nine and four for E. coli, respectively. A total of 25 (33.3%) K. pneumoniae isolates and two (8.0%) E. coli isolates were classified as Class A carbapenemase producers. Multidrug resistance with coexistence of extended spectrum-beta-lactamases occurred in 44.4% isolates. However, all of the isolates were susceptible to colistin, polymyxin B, and tigecycline by disc diffusion test. Conclusion: We conclude from the present study that Class A carbapenemases appear to be the predominant cause of resistance to carbapenems in Enterobacteriaceae at our center and, thus, phenotypic detection based on simple methods should be employed routinely in clinical microbiology laboratories. © 2012.

Bhala S.,Government Medical College Hospital
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2012

Endophthalmitis is the most dreaded complication of ocular trauma and knowledge of the microbial contaminants is essential to start empirical antibiotic therapy. To determine incidence of contamination after open globe injuries (OGI) in our setup and to identify the spectrum of microorganisms contaminating open globe injuries. A prospective study including 50 consecutive eyes of open globe injury over a period of two years was conducted. Intra-operatively, 4 - 5 samples were taken from the inferior conjunctival sac and anterior chamber at the beginning and end of the open globe injury repair. Any abscised tissue or foreign body was also sent for culture sensitivity. A vitreous tap was taken from eyes with posterior segment trauma with signs of endophthalmitis. Microbial cultures were positive in13 eyes (26 %). The microbial spectrum included Aspergillus species in 45.6 %, Alternaria in 15.2 %, Curvularia in 15.2 %, Staphylococcus aureus in 7.6 %, Bacillus species in 7.6 %, and Streptococcus pneumoniae in 7.6 %. Of these 13 eyes, nine eyes developed clinically evident frank endophthalmitis during follow-up. Overall, endophthalmitis developed in 20 eyes (40 %). There was a significant association between the initial contamination and development of endophthalmitis (p less than 0.05). 53 % of culture positive cases achieved ambulatory vision compared to 73 % of culture-negative cases. Initial contamination was seen in 26 % of OGI cases. Aspergillus (fungus) was the commonest contaminant. There was a strong correlation between the initial contamination and development of endophthalmitis. Culture-negative cases had a trend towards better final visual outcome than culture-positive cases. Close follow up of cases showing contamination following OGI is recommended. © NEPjOPH.

Chander J.,Government Medical College Hospital | Singla N.,Government Medical College Hospital | Sidhu S.K.,Government Medical College Hospital | Gombar S.,Government Medical College Hospital
Journal of Infection in Developing Countries | Year: 2013

Introduction: Bloodstream infections due to Candida species are becoming a major cause of morbidity and mortality in hospitalized patients. The spectrum of candidemia has changed with the emergence of non-albicans Candida species, especially among critically ill patients. Methodology: In a retrospective study (July 2009 to December 2009) on candidemia, various Candida species isolated from blood cultures were characterized and studied along with the determination of their antifungal susceptibility to amphotericin B, itraconazole, and fluconazole by Etest. Probable risk factors for patients in the intensive care unit (ICU) presenting with candidemia were also analyzed. Results: During the study period, a total of 4651 samples were received, out of which 468 samples (10.06%) were positive for growth of organisms: 441 (94.20%) aerobic bacterial pathogens and 27 (5.79%) Candida species. The most common Candida spp. isolate was C. tropicalis (40.8%) followed by C. albicans (29.6%), C. glabrata (18.5%) and others (11.1%). Out of the 27 Candida strains, 24 (88.9%) were isolated from patients treated in the ICU. Among these, association of previous use of broad-spectrum antibiotics in 22 patients (91.6%) and central line catheter insertion in 20 patients (83.3%) were found to be statistically significant as compared to non-candidemia patients (p <0.05). Antifungal susceptibility testing of the isolates revealed a lower level of drug resistance to amphotericin B (18.5% of the isolates) versus 77.8% resistance to fluconazole. Conclusion: Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious bloodstream fungal infection. © 2013 Chander et al.

Anand A.,Government Medical College Hospital | Kapoor S.,Government Medical College Hospital
Urologia Internationalis | Year: 2013

Introduction: Paraphimosis is a urologic emergency. Many treatment options have been devised for managing this entity. The osmotic method is one of them. We used an osmotic diuretic, mannitol, for reducing paraphimosis. Mannitol is commonly used for conditions like head injury to decrease cerebral oedema, partial nephrectomy and hepatorenal syndrome; we attempted using this diuretic for reducing paraphimosis. This is a novel technique and an application of mannitol which has never been reported before. Methods: Starting in February 2011, we used mannitol 20% in patients presenting to urologic emergency with uncomplicated paraphimosis. Mannitol-soaked gauzes were wrapped around the oedematous prepuce, followed by minimal intermittent hand compression and frequent resoaking of the gauze with 20% mannitol. No needle punctures were made. The soaked gauze was removed and the paraphimosis was reduced easily. Results: A complete reduction of paraphimosis occurred after mannitol-soaked gauze had been placed over the oedematous prepuce for about 30-45 min in 6 of our patients. This is a novel agent used for this entity; it reduces paraphimosis in a minimal time with no pain, with the added advantage of the least risk of infection after the procedure as opposed to granulated sugar or 50% dextrose previously used as osmotic agents. Conclusions: Mannitol can be applied in clinical practice for reducing paraphimosis. It requires no anaesthesia and is associated with minimal/no patient discomfort unlike that seen with multiple needle punctures and the various other non-osmotic methods of reducing paraphimosis. Copyright © 2012 S. Karger AG, Basel.

Narang S.,Government Medical College Hospital
Nepalese journal of ophthalmology : a biannual peer-reviewed academic journal of the Nepal Ophthalmic Society : NEPJOPH | Year: 2012

Lipid-lowering drugs preserve vision and reduce the risk of hard exudates in clinically-significant macular edema(CSME) in diabetics with an abnormal lipid profile. But their role in reducing CSME in diabetics with a normal lipid profile is not yet known. To evaluate the role of atorvastatin in CSME in diabetics with a normal lipid profile. A prospective, randomized clinical trial was carried out. Thirty CSME patients with a normal lipid profile were randomly divided into Group A and B. Atorvastatin had been started in Group A four weeks prior to laser treatment. The main outcome measures were any improvement or deterioration in visual acuity and macular edema and hard exudates at six months follow-up. Both the groups were compared using unpaired t test for quantitative parameters and chi-square test for qualitative parameters. A p value of less than 0.05 was taken as significant. Visual acuity, macular edema and hard exudates resolution was not significantly different in the two groups (P = 0.14, 0.62, 0.39 respectively). Atorvastatin does not affect treatment outcome in CSME with a normal lipid profile over a short term follow-up. © NEPjOPH.

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