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Lawrence S.,University of Hertfordshire | Sokhi R.,University of Hertfordshire | Ravindra K.,Institute of Medical Education and Research PGIMER
Environmental Pollution | Year: 2016

Road tunnels act like large laboratories; they provide an excellent environment to quantify atmospheric particles emission factors from exhaust and non-exhaust sources due to their known boundary conditions. Current work compares the High Volume, Dichotomous Stacked Filter Unit and Partisol Air Sampler for coarse, PM10 and PM2.5 particle concentration measurement and found that they do not differ significantly (p = 95%). PM2.5 fraction contributes 66% of PM10 proportions and significantly influenced by traffic (turbulence) and meteorological conditions. Mass emission factors for PM10 varies from 21.3 ± 1.9 to 28.8 ± 3.4 mg/vkm and composed of Motorcycle (0.0003-0.001 mg/vkm), Cars (26.1-33.4 mg/vkm), LDVs (2.4-3.0 mg/vkm), HDVs (2.2-2.8 mg/vkm) and Buses (0.1 mg/vkm). Based on Lawrence et al. (2013), source apportionment modelling, the PM10 emission of brake wear (3.8-4.4 mg/vkm), petrol exhaust (3.9-4.5 mg/vkm), diesel exhaust (7.2-8.3 mg/vkm), re-suspension (9-10.4 mg/vkm), road surface wear (3.9-4.5 mg/vkm), and unexplained (7.2 mg/vkm) were also calculated. The current study determined that the combined non-exhaust fleet PM10 emission factor (16.7-19.3 mg/vkm) are higher than the combined exhaust emission factor (11.1-12.8 mg/vkm). Thus, highlight the significance of non-exhaust emissions and the need for legislation and abatement strategies to reduce their contributions to ambient PM concentrations. © 2016 Elsevier Ltd. All rights reserved.


Agarwal R.,Institute of Medical Education and Research PGIMER | Denning D.W.,University of Manchester | Chakrabarti A.,Institute of Medical Education and Research PGIMER
PLoS ONE | Year: 2014

Background and Objectives: It would be of considerable interest to clinicians if the burden of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) in India were known. Herein, we estimate the burden of CPA following pulmonary tuberculosis (PTB), and ABPA (and severe asthma with fungal sensitization [SAFS]) complicating asthma. Copyright:Methods: We used the population estimates for India from the 2011 census data. The burden of asthma was estimated using three different methods (Global Initiative against Asthma [GINA] report statement, World Health Survey [WHS] estimates, Indian study on the epidemiology of asthma and chronic bronchitis [INSEARCH]). Global and India-specific figures were used for calculating the prevalence of ABPA and SAFS. The World Health Organization estimates were used for calculating PTB rates while the frequency of CPA was assessed from a previously published scoping review. Sensitivity analysis was performed to determine the burden in various scenarios.Results: The total Indian population in 2011 was 1.2 billion. The asthma prevalence in adults was estimated at about 27.6 (range, 17-30) million. The burden of ABPA ranged from 0.12-6.09 million with different assumptions (best estimate, 1.38 [range, 0.86-1.52] million). The prevalence of SAFS was approximated at about 0.52-1.21 million (best estimate, 0.96 [range, 0.6-1.06] million). The incident TB cases were about 2.1 million while the annual incidence of CPA varied 27,000-0.17 million cases, with different estimates. If the mortality of CPA is estimated as 15% annually, the 5-year prevalence of CPA was placed at 290,147 cases with 5-year prevalence rate being 24 per 100,000.Conclusion: There is a significant burden of ABPA, SAFS and CPA in India. Prospective community-based studies are required to accurately determine the prevalence of these disorders. © 2014 Agarwal et al.


Subbiah S.,Institute of Medical Education and Research PGIMER | Nahar U.,Institute of Medical Education and Research PGIMER | Samujh R.,Institute of Medical Education and Research PGIMER | Bhansali A.,Institute of Medical Education and Research PGIMER
Annals of Saudi Medicine | Year: 2013

Adrenocortical oncocytomas are extremely rare, and most of the tumors are benign and nonfunctioning. To our knowledge, only 30 cases have been reported in English published studies, and most patients are 40 to 60 years of age. So far, in the pediatric age group, only three cases of functioning adrenocortical oncocytoma have been reported. We report a case of functioning adrenocortical oncocytoma in a 3 1/2-year-old female child who presented with premature pubarche, clitoromegaly, and increased serum dehydroepiandrosterone sulfate and testosterone. She was managed successfully with right adrenalectomy, and the tumor histology was consistent with adrenal oncocytoma.


Sethi S.,Institute of Medical Education and Research PGIMER | Ghai B.,Institute of Medical Education and Research PGIMER | Sen I.,Institute of Medical Education and Research PGIMER | Ram J.,Institute of Medical Education and Research PGIMER | Wig J.,Institute of Medical Education and Research PGIMER
Paediatric Anaesthesia | Year: 2013

Summary Background General anesthesia with opioids provides good perioperative analgesia in infantile ocular surgeries but is associated with the risk of respiratory depression and postoperative emesis. This study aimed to assess the effectiveness of subtenon block for providing perioperative analgesia in infants undergoing cataract surgeries. Methods In this prospective, randomized, controlled, double-blinded trial, 63 infants of ASA grade I and II (1-12 months) were recruited to receive either subtenon block (Group SB) or 1 μg·kg-1 i.v. fentanyl (Group F) after induction of anesthesia. Primary outcome was the number of infants requiring rescue analgesia during 4-h study period before discharge of the infants. Secondary outcomes assessed were CRIES pain score, incidence of oculocardiac reflex, surgical difficulty, and incidence of postoperative emesis. Results The number of infants requiring rescue analgesia during 4-h study period was significantly less in Group SB (n = 6/32, 18.8%) compared to Group F (n = 14/31, 45.2%, P = 0.032). CRIES scores were significantly lower at and after 40 min compared to immediate postoperative period in Group F while these were comparable at all time intervals in Group SB. CRIES scores were significantly lower in Group SB compared to Group F at all time intervals except at 1 h. The incidence of oculocardiac reflex and the postoperative emesis were comparable in both the groups. Conclusion Subtenon block is an effective superior technique for postoperative analgesia compared to intravenous fentanyl in infants undergoing cataract surgery. © 2013 John Wiley & Sons Ltd.


Rana S.S.,Institute of Medical Education and Research PGIMER | Bhasin D.K.,Institute of Medical Education and Research PGIMER | Rao C.,Institute of Medical Education and Research PGIMER | Sharma R.,Institute of Medical Education and Research PGIMER | Gupta R.,Institute of Medical Education and Research PGIMER
Pancreatology | Year: 2013

Introduction: There is limited data on the long term consequences and safety profile of long term indwelling transmural stents after successful treatment of walled off pancreatic necrosis (WOPN). Aim: To retrospectively evaluate consequences of long term indwelling transmural stents in patients with WOPN. Methods: The records of patients who underwent endoscopic transmural drainage of WOPN and had disconnected pancreatic duct syndrome (DPDS) were analyzed. Results: Thirty patients (26 M; mean age 37.17.8 years) with long term indwelling transmural stents and DPDS were followed up for a mean of 20.412.2 months (range: 3e38 months). The etiology of acute necrotizing pancreatitis was alcohol in 21, gall stones in 7 and idiopathic in 2 patients. In all patients two or three, 7 (17 patients) or 10 Fr (13 patients) 5 cm double pigtail stents were placed. ERCP revealed disconnected PD at the pancreatic head, body and tail region in 22, 7, and 1 patient respectively. Five patients (16.6%) had spontaneous migration of stents (both the stents in four patients and one stent in one patient; 7 Fr in four and 10 Fr in one patient respectively). Stent migration led to recurrence of pancreatic fluid collection (PFC) in one patient whereas in the remaining 4 patients it did not cause any symptoms. There was no recurrence of symptomatic PFC in remaining 25 patients. Conclusion: Long term indwelling transmural stents in patients with WOPN and DPDS seem to be safe and also appear to decrease the risk of PFC recurrence. Copyright © 2013, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd. All rights reserved.


Saboo A.R.,Institute of Medical Education and Research PGIMER | Dutta S.,Institute of Medical Education and Research PGIMER | Dutta S.,McMaster University | Sodhi K.S.,Institute of Medical Education and Research PGIMER
Paediatric Anaesthesia | Year: 2013

Objective: To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip. Design: Open-label, randomized controlled trial (RCT). Setting: Level III neonatal intensive care unit (NICU). Subjects: All newborn babies admitted in NICU requiring intubation. Interventions: Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained. Primary Outcome: Rate of malposition of ETT as judged on chest X-ray (CXR). Results: Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique. Conclusion: Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates. © 2013 John Wiley & Sons Ltd.


Sodhi K.S.,Institute of Medical Education and Research PGIMER | Lee E.Y.,Harvard University
Acta Paediatrica, International Journal of Paediatrics | Year: 2014

The repeated use of CT imaging raises a child's radiation exposure, overall radiation accrual and future cancer risks. However, our review suggests that these risks can be considerably reduced by physicians, radiologists and academic bodies, through proper justification, optimisation and dose limitation. Conclusion Computed tomography poses a potential risk of radiation-induced cancer in children. The physician must weigh up the overall risks and benefits of CT before referring a child for imaging. ©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.


Kumar A.,Institute of Medical Education and Research PGIMER | Ahuja C.K.,Institute of Medical Education and Research PGIMER | Vyas S.,Institute of Medical Education and Research PGIMER | Kalra N.,Institute of Medical Education and Research PGIMER | And 3 more authors.
Digestive Diseases and Sciences | Year: 2012

Introduction Hepatic arterial venous fistulae are abnormal communications between the hepatic artery and portal or hepatic vein and commonly occur either secondary to iatrogenic causes like liver biopsy, transhepatic biliary drainage, transhepatic cholangiogram and surgery, or following mechanical insult like blunt or penetrating trauma. Congenital fistulae are rare. Treatment is warranted as an emergency management or in the development of portal hypertension/heart failure in chronic cases. Both surgical and endovascular occlusion of the fistula can be attempted with the latter carrying low intra and post-procedure morbidity. Endovascular treatment has thus currently emerged as a minimally invasive reliable treatment option in such individuals. Methods and Results We describe a short series consisting of four cases of acquired hepatic arterioportal/venous fistulae, which were referred to interventional radiology for endovascular management over the last 2 years. Three patients had arterio-portal communication and one patient had communication between the hepatic artery and middle hepatic vein. Successful embolization through the transarterial route was achieved in all four patients. A brief discussion of these cases is presented along with a relevant review of literature. Conclusions Endovascular techniques currently form less invasive and first line treatment options in arterioportal/ venous fistulae, surgery being reserved only for unsuccessful embolizations/complex fistulae. © 2012 Springer Science+Business Media, LLC.


Aggarwal A.,Institute of Medical Education and Research PGIMER | Harjeet,Institute of Medical Education and Research PGIMER | Sahni D.,Institute of Medical Education and Research PGIMER
Surgical and Radiologic Anatomy | Year: 2010

Background The aim of this study was to classify the different patterns of cutaneous nerves found on the dorsum of foot in Indian fetuses and compare them with patterns found in other population groups. Methods A total of 60 lower limbs from 30 fetuses (19 male, 11 female) were dissected and the branching patterns of nerves were sketched and specimens photographed. Results Six main types and few subtypes of innervation patterns were found. Type 1 (53.3%): deep peroneal nerve supplied the 1st cleft, lateral dorsal cutaneous nerve supplied the lateral border of little toe and the remaining part of the dorsum of the foot is supplied by superficial peroneal nerve. Type 2 (28.3%): deep peroneal nerve supplied the 1st cleft, superficial peroneal nerve supplied the medial border of big toe, 2nd cleft and lateral 21/2 digits supplied by the lateral dorsal cutaneous nerve. Type 3 (8.3%): deep peroneal nerve supplied the 1st cleft, lateral 11/2 digits supplied by the lateral dorsal cutaneous nerve and the remaining dorsum by superficial peroneal nerve. Type 4 (3.3%): deep peroneal nerve supplied the 1st and 2nd clefts, superficial peroneal nerve supplied the medial border of great toe, lateral 21/2 digits were supplied by lateral dorsal cutaneous nerve. Type 5 (5%): deep peroneal nerve supplied 1st and 2nd clefts, lateral border of the little toe by lateral dorsal cutaneous nerve and remaining part of the dorsum of foot by superficial peroneal nerve. Type 6 (1.7%): deep peroneal nerve supplied 2nd cleft, lateral border of little toe supplied by the lateral dorsal cutaneous nerve and the remaining area by superficial peroneal nerve. Conclusions A comparison with cutaneous innervation patterns found in other population groups revealed three new variants which have not been reported in the other populations. © Springer-Verlag 2009.


Anand A.,Institute of Medical Education and Research PGIMER | Sharma N.K.,Institute of Medical Education and Research PGIMER | Singh R.,Institute of Medical Education and Research PGIMER | Gupta A.,Institute of Medical Education and Research PGIMER | And 5 more authors.
Scientific Reports | Year: 2014

It has been postulated that there is a link between age related degenerative diseases and cancer. The TNF-related apoptosis-inducing ligand (TRAIL) has been shown to selectively kill tumor cells by binding to pro-apoptotic and anti-apoptotic receptors. Our aim was to study the levels of anti-apoptotic receptor (DcR1) in age related macular degeneration (AMD) and controls. AMD patients (115) were classified into two groups: Dry and Wet AMD. Wet AMDs were further classified into occult, predominant classic and minimal classic. 61 healthy individuals were recruited as normal controls. After normalization with total protein, DcR1 levels were analyzed by ELISA. Mann Whitney U-statistic was used for analysis of DcR1 ELISA results. We have observed DcR1 levels in serum sample which were significantly lower in AMD patients as compared to controls (p = 0.001). On the other hand, we did not find difference in DcR1 levels between wet and dry AMD. The present study defines the plausible role of DcR1 in AMD pathology signifying a new therapeutic target for AMD. © 2014 Macmillan Publishers Limited. All rights reserved.

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