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Chandra S.,Himalayan Institute of Medical science | Chandra H.,Himalayan Institute of Medical science
Mediterranean Journal of Hematology and Infectious Diseases | Year: 2013

Background: Malaria may be associated with complications which may be avoided by early diagnosis and treatment. Microscopic diagnosis showing presence of malarial parasites is needed for confirmation which at times may be unreliable and requires technical expertise. The present study was conducted to statistically analyze the haematological parameters including platelet indices which can give initial hint for malarial infection and therefore prompt the laboratory physician for active search of the parasite microscopically. Methods: A retrospective study was conducted which included 334 cases of acute malaria caused by Plasmodium vivax, falciparum and dual infection along with 100 cases of control. Routine haematological parameters along with platelet indices (MPV and PDW) which are easily available on automated cell counter were statistically analyzed to assess their role as indicators for malaria. Results. Leukocyte count and platelet count were significantly lower in cases of acute malaria in comparison to controls (p value <0.001). Platelet count<150x109/l showed 87.2% sensitivity, 65% specificity, 89.3% positive predictive value and 2.49 likelihood ratio for the infection. PDW of 6-10 and MPV >8 fl had 71.9% and 61.5% sensitivity and 78.2% and 77.7% positive predictive value respectively for infection. Platelet count <150x109/l and MPV >8 fl was comparatively more sensitive indicator for vivax (88% and 70.8% respectively) than falciparum (84.8% and 50.4% respectively) and PDW 6-10 was more sensitive indicator for falciparum (82.6%) than vivax (69.5%) infection. Conclusion: Thrombocytopenia (<150x109/l) and low leukocyte count (<4x109/l) may be used as probable indicator for malaria in endemic countries. Higher MPV (>8 fl) and PDW of 6-10 also show considerable sensitivity for malarial infection. In addition, thrombocytopenia (<150x109/l) and higher MPV (>8 fl) was more sensitive for vivax infection while PDW 6-10 was more sensitive for falciparum infection.


Gupta R.,Himalayan Institute of Medical science | Lahan V.,Himalayan Institute of Medical science | Goel D.,Himalayan Institute of Medical science
Sleep Medicine | Year: 2012

Objective: Restless Legs Syndrome is a common problem that is under-diagnosed. This disorder has a significant socio-economic impact as it worsens quality of life. There is either no or little data available in terms of the Indian context. Methods: Patients who presented with insomnia or leg pain were screened for Restless Legs Syndrome (RLS) in the Psychiatry and Neurology departments of a tertiary care teaching institution from June 2011 to October 2011. One hundred consecutive patients diagnosed with RLS were included. Duration of symptoms, previous medical consultation history, and treatment received were scrutinized and recorded. Severity of RLS was assessed using the IRLS Hindi version. For statistical analysis, descriptive analysis and independent sample t-test were used. Results: Out of 653 subjects with insomnia or leg pain, 15.31% of the subjects had RLS. Females outnumbered males by a ratio of 2:1. Ninety-four percent of subjects had a moderate to very severe form of the illness. Only 32% of subjects reported leg symptoms to their physician on each visit. The rest of the patients sought an opinion for other symptoms like insomnia, daytime-fatigue, memory impairment, irritability, etc. Eighty percent of patients visited a general Physician or a primary care Physician. On average, five consultations were made before patients came to see us. None of the patients were diagnosed with RLS by any of their general Physicians or by specialists like neurologists, psychiatrists, etc. Common misdiagnoses (available in just 8% of cases) for legs symptoms were arthritis, calcium deficiency, worms in the stomach, depression, anxiety, stress, and vitamin deficiency. All the patients were prescribed medicines. Benzodiazepines were the most frequently prescribed drugs (97%), followed by injectable vitamin B-Complex (95% cases), calcium tablets (62% cases), selective-serotonin-reuptake-inhibitors (30%), and tri-cyclic antidepressants (25%). Proton pump inhibitors or NSAIDs were prescribed to almost all the patients along with previously mentioned drugs. Conclusion: Diagnosis of RLS was missed not only by general physicians, but also by specialists like neurologists and psychiatrists. Most of the time diagnosis could not be established, yet medicines were prescribed. Many of these medicines were either ineffective or deleterious to RLS. © 2012 Elsevier B.V.


Sindhwani G.,Himalayan Institute of Medical science
The Indian journal of chest diseases & allied sciences | Year: 2012

Central airway obstruction (CAO) due to malignant and benign conditions is common. Tumour ablation by various techniques helps effective palliation of symptoms in such patients. Tumour ablation using endobronchial electrocautery (EBEC) with flexible bronchoscope (FB) is an established procedure. However, there is paucity of data from India on this topic. EBEC was performed in seven patients with CAO; six of these patients had malignant (non-small cell carcinoma) and one had benign aetiology (tracheal fibro-epithelial polyp) as the cause of CAO. Pre- and post-procedure assessment was done with the help of Speiser's symptomatic scoring. Mean age of the patients was 52.9 +/- 7.0 years; there were five males. All the patients had symptomatic relief after the procedure; in five of them the improvement in symptom scores was significant. No major complication was encountered in any patient. EBEC can be a safe, effective and cost-effective tool for palliation in patients with benign or malignant CAO. It is especially beneficial for centres where cost of bronchoscopic laser and cryotherapy is prohibitive.


Chandra S.,Himalayan Institute of Medical science
The Southeast Asian journal of tropical medicine and public health | Year: 2012

We conducted a retrospective study of genitourinary tuberculosis (TB) among males attending a hospital in the northern Himalayan region of India. Records from 1 January 1997 to 31 December 2009 were reviewed for clinical history, relevant radiological findings laboratory data, histopathology and treatment. Of the 1,113 male urogenital non-neoplastic specimens received at the histopathology laboratory of the hospital, tuberculosis was diagnosed in 25 cases (2.2%). Urinary bladder and prostate were the most common organs involved. Thirty-six percent of cases had a previous history of TB; 12% of cases presented with no symptoms. Ziehl-Neelsen staining was positive in 72% of cases. Cultures were positive for TB in 42.8% of cases and polymerase chain reaction was positive in two cases in which it was performed. Antituberculosis treatment was required for up to 12 months in some cases and surgery was required in 32% of cases. Genitourinary TB in this study had varying presentations. Cases having strong clinical and radiological findings and suggestive histopathology for tuberculosis, even without demonstration of mycobacteria may be considered for TB treatment, particularly in endemic areas. Patients living in more remote areas may have more specific and severe symptoms due to late presentation. Histopathology plays a crucial role in diagnosis due to lack of sophisticated techniques. The emphasis should be on early detection followed by prompt treatment to avoid further complications.


Rawat J.,Himalayan Institute of Medical science
The Indian journal of chest diseases & allied sciences | Year: 2011

Intrathoracic teratoma usually occurs in the mediastinum but rarely, these may originate from the lung. We report a case of an intrapulmonary teratoma in a 34-year-old male.


Bhargava A.,Himalayan Institute of Medical science
Indian journal of medical ethics | Year: 2013

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.


Gupta R.,Himalayan Institute of Medical science | Lahan V.,Himalayan Institute of Medical science | Goel D.,Himalayan Institute of Medical science
Asian Journal of Psychiatry | Year: 2013

Background: Distress is known to occur in RLS subjects consequent to symptoms. However, studies regarding prevalence of depression in RLS are scarce. This study was conducted to find out prevalence of depression in RLS patients and to explore possible underlying factors. Method: 112 consecutive RLS subjects presenting to sleep-clinic were included in this study. History regarding RLS, depression and sleep-disturbances was sought. Depression and insomnia were diagnosed using DSM-IV-TR criteria. Subjects were specifically asked whether they had depressive episodes in past one year. Severity of RLS and insomnia was measured using Hindi versions of IRLS and ISI, respectively. Family history of depression and RLS was also asked. Results: One year prevalence of depression was 41.8%. MDD was reported by 33% and dysthymia by 8.8%. Both the groups were comparable with respects to demographic and clinical features, viz., age, gender, duration, severity and family history of RLS. Duration, number of episodes and severity of insomnia were comparable between groups, so was the family history of depression. In 37.8% of the subjects with MDD, depressive symptoms preceded RLS while in 51.4% of them, they followed onset of RLS. Total duration of RLS symptoms did not correlate with total duration of depression (r2=0.07; P=0.64). Conclusion: Clinical depression is seen in more than a third of RLS patients. Depression is not affected by clinical picture of RLS and it is not consequent to sleep disturbance. Perhaps, it is a co-morbid condition. © 2013 Elsevier B.V.


Background: Presleep thoughts may vary between patients of insomnia with or without depression. They are important for cognitive behavior therapy for insomnia (CBT-I), but they have never been systemically examined in Indian population. Materials and Methods: Patients with insomnia (>1 month) who were willing to undergo CBT-I were included in this study after obtaining informed consent. They were requested to fill a sleep diary and return after 15 days. At the time of intake, diagnosis of depression and anxiety disorders was made according to Diagnostic and Statistical Manual-IV-Text Revision. They were encouraged to provide information regarding presleep thoughts through open-ended and then, close-ended questions. Dysfunctional attitudes and beliefs about sleep were assessed with Hindi version of dysfunctional beliefs and attitudes scale-brief version. Hindi version of insomnia severity index was used to assess the severity of insomnia. Subjects were divided into two-groups-insomnia without depression (I) and insomnia with major depressive disorder (I-MDD+). Statistical Analysis: It was done with the help of SPSS v 21.0. Descriptive statistics was calculated. Proportions between groups were tested with Chi-square analysis and categorical variables were compared using independent sample t-test. Results: This study included a total of 63 subjects, out of which 60% were women. Mean age of the whole group was 41.7 ± 11.8 years. About 40% of all the subjects were diagnosed as having I-MDD+. Forty-one percent of the subjects had clinically significant anxiety. Both groups-I and I-MDD+ had comparable proportion of female subjects (χ2 = 0.002; P = 0.96) and there was no difference regarding precipitating factors for insomnia (χ2 = 0.97; P = 0.61). They were also comparable with regards to sleep-related measures, themes of presleep thoughts, and dysfunctional beliefs and attitudes about sleep and insomnia severity. Major themes of presleep thoughts included family issues and health issues. Only a small proportion had recurrent thoughts related to insomnia and its consequences. Conclusion: Insomnia is a co-morbid illness with depression and it needs to be separately addressed during therapy. CBT-I should include the element of problem-solving technique, especially when we are dealing with the Indian population.


Sindhwani G.,Himalayan Institute of Medical science
The Indian journal of chest diseases & allied sciences | Year: 2012

Fibroepithelial polyps of trachea are extremely rare. Here, we report a case of tracheal polyp in a 40-year-old woman that was managed successfully with endobronchial electrocautery with a review of the relevant literature.


Rawat J.,Himalayan Institute of Medical science
International journal of chronic obstructive pulmonary disease | Year: 2012

Mechanical ventilation is the recommended treatment in unconscious patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and hypercapenic respiratory failure. But, in resource-poor countries, many of these patients are not able to afford this treatment due to financial constraints. The main aim of this study was to evaluate the usefulness, safety and cost-effectiveness of bilevel positive airway pressure (BiPAP) applied via endotracheal tube in such patients. Twenty patients with acute exacerbation of COPD and altered sensorium, who were unable to afford ventilatory support, were intubated and BiPAP therapy was provided to these patients through the endotracheal tube. The outcome of these patients was studied. The BiPAP success rate and hospital mortality were 85% (17/20) and 15% (3/20) respectively. BiPAP failure was associated with high sequential organ failure assessment (SOFA) score at the time of admission (P = 0.002). Improvement in Glasgow coma scale (GCS) score (P < 0.001), pH (P = 0.001), PaCO(2) (partial pressure of carbon dioxide) (P < 0.001), respiratory rate (P < 0.001), and SOFA score (P = 0.001) was observed among the responders following 2 hours of therapy. Only one of the responders developed aspiration pneumonitis, as a complication. The daily cost of BiPAP therapy was 8.75 times lower than the average cost of mechanical ventilation. This pilot study reveals that this treatment modality could be a safe, cost-effective and efficacious method of treatment in unconscious patients with acute exacerbation of COPD.

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