Indira Gandhi Medical College

Shimla, India

Indira Gandhi Medical College

Shimla, India
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Vikrant S.,Indira Gandhi Medical College | Parashar A.,Indira Gandhi Medical College
American Journal of Tropical Medicine and Hygiene | Year: 2017

Snake bite is an important health hazard in tropics. Snake envenomation in pregnancy may cause fetal death and maternal mortality or morbidity. However, little is known about the toxic effects and optimal management during pregnancy after snake envenomation because of the rarity of cases. Herein, we report a case of a pregnant woman who was successfully treated for snake bite-induced acute kidney injury during the third trimester. She was treated with equine-derived polyvalent anti-snake venom without development of any adverse effects, hemodialysis, and supportive therapy. She fully recovered and subsequently gave birth to a healthy child. © 2017 by The American Society of Tropical Medicine and Hygiene.

Sharma M.,Jawaharlal Institute of Postgraduate Medical Education & Research | Sehgal R.,Jawaharlal Institute of Postgraduate Medical Education & Research | Fomda B.A.,Sher i Kashmir Institute of Medical science | Malhotra A.,Indira Gandhi Medical College | Malla N.,Jawaharlal Institute of Postgraduate Medical Education & Research
PLoS Neglected Tropical Diseases | Year: 2013

Background:Cystic echinococcosis (CE) caused by the Echinococcus granulosus, is a major public health problem worldwide, including India. The different genotypes of E. granulosus responsible for human hydatidosis have been reported from endemic areas throughout the world. However, the genetic characterization of E. granulosus infecting the human population in India is lacking. The aim of study was to ascertain the genotype(s) of the parasite responsible for human hydatidosis in North India.Methodology/Principal Findings:To study the transmission patterns of E. granulosus, genotypic analysis was performed on hydatid cysts obtained from 32 cystic echinococcosis (CE) patients residing in 7 different states of North India. Mitochondrial cytochrome c oxidase subunit1 (cox1) sequencing was done for molecular identification of the isolates. Most of the CE patients (30/32) were found to be infected with hydatid cyst of either G3 (53.1%) or G1 (40.62%) genotype and one each of G5 (cattle strain) and G6 (camel strain) genotype.Conclusions/Significance:These findings demonstrate the zoonotic potential of G1 (sheep strain) and G3 (buffalo strain) genotypes of E. granulosus as these emerged as predominant genotypes infecting the humans in India. In addition to this, the present study reports the first human CE case infected with G5 genotype (cattle strain) in an Asian country and presence of G6 genotype (camel strain) in India. The results may have important implications in the planning of control strategies for human hydatidosis. © 2013 Sharma et al.

Kapila P.,Indira Gandhi Medical College
Journal of Forensic and Legal Medicine | Year: 2011

Spontaneous hemoperitoneum in second trimester of pregnancy is a very rare but lethal condition which demands prompt diagnosis and management for the survival of both mother and fetus. A 21-year old primigravida woman was presented at 29 weeks of pregnancy with acute abdominal pain and hypovolumic shock. In a District Hospital patient was managed conservatively and referred but was brought dead at tertiary level hospital. On autopsy gross hemoperitoneum was found without any injury and uterine artery found ruptured against the suspicion of brutal beating by the relatives of husband. © 2011 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Bhardwaj R.,Indira Gandhi Medical College
Indian Heart Journal | Year: 2012

Purpose of study: Fibroids are commonest benign tumour of the uterus. It presents with bleeding per vagina in most of the cases. Surgical treatment consists of myomectomy or hysterectomy with or without salpingo oophrectomy, with its inherent morbidity, prolonged hospital stay and psychosocial problems. Surgery is not the best option especially in unmarried and nullipara. Materials and methods: Thirty-five patients were subjected to uterine artery embolisation (UAE). Mean age was 35. 51 ± 7. 36 years. Two patients were suffering from advanced carcinoma of cervix, 32 had fibroid of uterus, one had endometriosis. Three patients were unmarried, three did not have any issue, three had associated haemodynamically significant cardiac disorders, one had polycystic renal disease, and one had hypernephroma. Four patients had multiple fibroids. The UAE was done through contralateral femoral artery puncture, bilaterally, with the help of Judkin's right coronary catheter. Ultrasound was repeated after 3 months. Results: The UAE was successful in all patients. Mean procedural time was 75 minutes. Hospital stay was 1 day only. Bleeding stopped in all 35 patients. One patient had recurrence of bleeding after 2 months and underwent surgery. Fibroids disappeared in eight patients, decreased in size by > 75% in 11 patients, and by 50-75% in six patients. Five patients did not report back with ultrasound. Two patients had normal delivery after UAE. Conclusion: Uterine artery embolisation is effective therapy to stop uterine bleeding. It is effective in controlling the symptoms in uterine fibroids and also decreases the size of fibroids. Hospital stay is only 1 day. © 2012, Cardiological Society of India. All rights reserved.

Behl R.K.,Indira Gandhi Medical College
The Indian journal of chest diseases & allied sciences | Year: 2010

BACKGROUND: Asthma is a major public health problem worldwide. However, there is limited data on asthma prevalence among school children in Shimla. The present study was undertaken to determine the prevalence of asthma in Shimla city and also to examine the different factors influencing its occurrence. METHODS: This was a questionnaire-based study (International Study of Asthma and Allergies in Childhood [ISAAC] protocol) carried out in four randomly selected schools in the city of Shimla. The questionnaire was pre-tested in 50 school children. The age group included in the study was 6-13 years. The questionnaire was distributed to all the children (n = 1136). A response rate of 89.5% was achieved. The socio-economic status was determined on the basis of monthly income (cumulative square root value method). The ISAAC questionnaire was given standard scores. Various factors influencing the prevalence of asthma, such as socio-economic status, history of asthma and other allergic disorders in the family, type of cooking fuel used, history of active and passive smoking were elucidated from the history. RESULTS: Overall prevalence of asthma in our study was found to be 2.3 percent. Boys had a higher prevalence (3.1%) than girls (1.4%). We found a significant association between asthma prevalence and family history of asthma and other atopic manifestations. There was no significant association of socio-economic factors and exposure to smoking with prevalence of asthma. CONCLUSION: In the present study, the prevalence of bronchial asthma in school children in the age group of 6-13 years is 2.3 percent.

Bhardwaj R.,Indira Gandhi Medical College
Journal of Association of Physicians of India | Year: 2014

Rheumatic heart disease is still a common cardiac disease in developing countries. Triscupid valve is not usually involved in RHD and whenever it is involved, it is always associated with mitral valve disease. We report a case of isolated tricuspid stenosis, most likely of rheumatic etiology. © JAPI.

Sood N.,Indira Gandhi Medical College
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco | Year: 2011

Tobacco smoking is a widespread phenomenon, and nicotine is the addictive component of tobacco. Nicotine acts through nicotinic cholinergic receptors and has been associated with different types of psychophysical disorders in human beings. The present study had explored the proconvulsive action of nicotine and its effect on the antiseizure efficacy of topiramate against kainic acid (KA)-induced seizures in mice. The study had evaluated the dose-response curves for nicotine and KA and for KA in nicotine-pretreated mice and for topiramate against KA-induced seizures. Mecamylamine was used to antagonize the nicotinic receptor-mediated actions of nicotine. CD50 (convulsive dose in 50% of animals) for KA and nicotine and ED50 (effective dose in 50% of animals as anticonvulsant) for topiramate were determined. Brain lipid peroxidation studies were also undertaken in the treated mice. Nicotine significantly potentiated the convulsive action of KA acid and reduced the CD50 (95% confidence limits [CL]) value for KA from 2.6 mg/kg (2.3-3.1) to 1.4 mg/kg (0.9-2.1), intraperitoneally (i.p.). Topiramate pretreatment significantly inhibited KA-induced seizures and brain lipid peroxidation with ED50 (95% CL) value of 21.90 mg/kg (17.3-28.2), i.p. Nicotine pretreatment caused dose-dependent antagonism to the antiseizure and antilipid peroxidative actions of topiramate. Mecamylamine had antagonized the proconvulsant action of nicotine. The study highlights the fact that intake of nicotine, through agonism to nAChR, might predispose epileptic patients to lower seizure threshold and induce a state of refractoriness to the protective effects of the antiepileptic drugs, resulting in possible breakthrough seizure attacks.

Vikrant S.,Indira Gandhi Medical College
Peritoneal Dialysis International | Year: 2014

Objective: There is a paucity of published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of continuous ambulatory PD (CAPD) in India in 1991. The purpose of this study is to report long-term clinical outcomes of PD patients at a single center. Design: Retrospective study. Setting: A government-owned tertiary-care hospital in North India. Patients: Patients who were initiated on CAPD between October 2002 and June 2011, and who survived and/or had more than 6 months' follow-up on this treatment with last follow-up till December 31, 2011, were studied. Results: Atotalof60patientswereincludedintheanaly-sis. The mean age of the patients was 60.2 ± 9.2 years. The majority (65%) of the patients lived in rural areas. A high proportion (47%) were diabetic and 62% had > 2 comorbidities. Total duration on peritoneal dialysis treatment was 1,773 patient-months (148 patient-years) with a mean duration of 29.6 ± 23 patient-months and median duration of 25 patient-months (range 6 -110 patient-months). Overall patient and technique survival at 1, 2, 3, 4 and 5 years was 77%, 53%, 25%, 15%, and 10% respectively. Patient survival of diabetics vs non-diabetics at 1, 2, 3, 4, and 5 years was 68% vs 84%, 54% vs 53%, 14% vs 34%, 11% vs 19%, and 11% vs 13%, respectively. The mortality in nondiabetics (16/32) was less than that in diabetic (18/28) patients (p = not significant). The main cause of mortality in these patients was cardiac followed by sepsis. There were 58 episodes of peritonitis. The rate of peritonitis was 1 episode per 30.6 patient-months or 0.39 episodes per patient-year. Furthermore, the total number of episodes of peritonitis and number of episodes of peritonitis per patient were higher in the non-survival group (p < 0.05). Theincidence of tuberculosis (TB), herpes zoster (HZ) and hernias was 15%, 10% and 5% respectively. Conclusion: The study reports long-term outcomes of the PD patients, the majority of whom were elderly with a high burden of comorbidities. There was a high proportion of diabetics. The survival of diabetic vs non-diabetic and elderly vs non-elderly PD patients was similar in our study. The mortality in non-diabetics was less than that in diabetic patients. TB and HZ were common causes of morbidity. Peritonitis was associated with mortality in these patients. © 2014 International Society for Peritoneal Dialysis.

Vikrant S.,Indira Gandhi Medical College | Verma B.S.,Indira Gandhi Medical College
Renal Failure | Year: 2014

Envenomations by venomous lizards are rare. Monitor lizard bite-induced acute kidney injury (AKI) is a previously unreported complication in humans. A 55-year-old female was bitten on her right leg during farming activity by a monitor lizard (Varanus bengalensis). The patient experienced severe local pain and bleeding from the wound, coagulopathy, hemolysis, rhabdomyolysis, sepsis, and AKI. Patient was treated with supportive care and peritoneal dialysis but succumbed to a sudden cardiac arrest. Post mortem kidney biopsy revealed pigment induced-acute tubular injury. AKI after monitor lizard envenomation is caused by acute tubular injury in the setting of intravascular hemolysis, rhabdomyolysis and sepsis. Coagulopathy and direct nephrotoxicity may be the other contributory factors in causing AKI. © 2014 Informa Healthcare USA, Inc.

Bhardwaj R.,Indira Gandhi Medical College
Indian Heart Journal | Year: 2012

Objective: Atrial fibrillation is the commonest sustained arrhythmia. In western countries the common causes of atrial fibrillation are hypertensive heart disease, dilated cardio- myopathy, and coronary heart disease. Rheumatic heart disease being still common in India, we studied its contribution to atrial fibrillation. Material and methods: 137 consecutive patients of atrial fibrillation coming to our hospital were subjected to echocardiography to determine the cause. Results: Out of 137 patients with atrial fibrillation, 76 were female (55. 47%) and 61 were male (44. 43%). Mean age was 51. 24 ± 15. 36 years. Commonest cause of AF was rheumatic heart disease found in 84 (61. 31%) patients. Next common causes were hypertensive heart disease in 14 (10. 2%) patients and chronic obstructive pulmonary disease (COPD) in 14 (10. 2%) patients. Mean left atrial size was 47. 8 ± 12. 25 mm. Conclusion: In our study of patients coming from a rural back ground of North India, more than 60% patients of AF are due to RHD. Hypertensive heart disease and COPD are the next common causes. © 2012, Cardiological Society of India. All rights reserved.

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