Jehangir Hospital

Pune, India

Jehangir Hospital

Pune, India
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Khadilkar A.V.,Jehangir Hospital | Sanwalka N.J.,Jehangir Hospital | Sanwalka N.J.,University of Pune | Chiplonkar S.A.,Jehangir Hospital | And 2 more authors.
Bone | Year: 2011

For the correct interpretation of Dual Energy X-ray Absorptiometry (DXA) measurements in children, the use of age, gender, height, weight and ethnicity specific reference data is crucially important. In the absence of such a database for Indian children, the present study aimed to provide gender and age specific data on bone parameters and reference percentile curves for the assessment of bone status in 5-17year old Indian boys and girls. A cross sectional study was conducted from May 2006 to July 2010 on 920 (480 boys) apparently healthy children from schools and colleges in Pune City, India. The GE-Lunar DPX Pro Pencil Beam DXA scanner was used to measure bone mineral content (BMC [g]), bone area (BA [cm 2]) and bone mineral density (BMD [g/cm 2]) at total body, lumbar spine and left femur. Reference percentile curves by age were derived separately for boys and girls for the total body BMC (TBBMC), total body BA (TBBA), lumbar spine bone mineral apparent density (BMAD [g/cm 3]), and left femoral neck BMAD. We have also presented percentile curves for TBBA for height, TBBMC for TBBA, LBM for height and TBBMC for LBM for normalizing bone data for Indian children. Mean TBBMC, TBBA and TBBMD were expressed by age groups and Tanner stages for boys and girls separately. The average increase in TBBMC and TBBA with age was of the order of 8 to 12% at each age group. After 16years of age, TBBMC and TBBA were significantly higher in boys than in girls (p<0.01). Maximal increase in TBBMD occurred around the age of 13years in girls and three years later in boys. Reference data provided may be used for the clinical assessment of bone status of Indian children and adolescents. © 2010 Elsevier Inc.

Khadilkar V.V.,Jehangir Hospital | Khadilkar A.V.,Jehangir Hospital | Cole T.J.,University College London | Chiplonkar S.A.,Jehangir Hospital | Pandit D.,Jehangir Hospital
International Journal of Pediatric Obesity | Year: 2011

Objectives. To estimate prevalence of overweight and obesity in apparently healthy children from five zones of India in the age group of 2 to 17 years and to examine trends in body mass index (BMI) during the last two decades with respect to published growth data. Methods. A multicentric study was conducted in eleven affluent urban schools from five geographical zones of India. A total of 20 243 children (1 823 central zone, 2 092 east zone, 5 526 north zone, 3 357 south zone, and 7 445 west zone) in the age group of 217 years were studied. Height and weight were measured and BMI was calculated (kg/m 2). WHO Anthro plus was used to calculate Z-scores for height, weight and BMI. A comparison between study population and previously available nationally representative (1989) data was performed for each age-sex group. International Obesity Task Force (IOTF) and WHO cut-offs were used to calculate the percentage prevalence of overweight and obesity. Results. The overall prevalence of overweight and obesity was 18.2% by the IOTF classification and 23.9% by the WHO standards. The prevalence of overweight and obesity was higher in boys than girls. Mean BMI values were significantly higher than those reported in the 1989 data from 517 years at all ages and for both sexes. Conclusion. The rising trend of BMI in Indian children and adolescents observed in this multicentric study rings alarm bells in terms of associated adverse health consequences in adulthood. © 2011 Informa Healthcare.

Chiplonkar S.A.,Jehangir Hospital | Kawade R.,Health Genesis
Nutrition | Year: 2012

Objectives: The present study was aimed at assessing the effect of zinc- and micronutrient-rich food supplementation compared with ayurvedic zinc tablets on the blood levels of zinc and vitamin A in adolescent girls. Methods: One hundred eighty apparently healthy schoolgirls (12.5 ± 0.85 y old) were recruited for a 10-wk intervention trial. They were randomized to three groups: one group received a food supplement that was prepared using zinc- and micronutrient-rich foods and by adopting food-processing methods that increase zinc bioavailability; the second group received ayurvedic zinc (Jasad) tablets as a natural elemental zinc supplement; and the third group served as the control without any supplementation. Diet was assessed by 24-h recall on 3 non-consecutive days. Fasting blood samples were analyzed for plasma levels of zinc, β-carotene, retinol, vitamin C, and hemoglobin at baseline and the end of the study period. Results: Food supplementation showed a significant increase in plasma levels of zinc (9.9%), β-carotene (56.2%), and vitamin C (28.0%, P < 0.05) and a non-significant increase in hemoglobin (1.7%), although small, non-significant changes in blood micronutrient levels were observed in the control group (P > 0.1). Food supplementation decreased the prevalence of zinc deficiency (73% to 53.1%), β-carotene deficiency (31.1% to 17.4%), and mild anemia (32.2% to 23.7%). Ayurvedic zinc supplementation significantly improved plasma zinc (61.3%) and plasma retinol (38.2%) and decreased the prevalence of zinc deficiency (73.7% to 36.2%) and vitamin A deficiency (65.4% to 20.4%, P < 0.05). Conclusion: Zinc- and micronutrient-rich food supplementation was effective in improving the zinc and vitamin A status of adolescent girls. © 2012 Elsevier Inc..

Khadilkar V.V.,Jehangir Hospital | Khadilkar A.V.,Jehangir Hospital
Indian Journal of Pediatrics | Year: 2013

Approximately 1 billion people worldwide have been identified as vitamin D deficient in the 21st century, and the number is on the rise; non-classical actions of vitamin D were initially recognized around 30 y ago when receptors for vitamin D were detected in neoplastic cells lines. The aim of this review is to provide a brief overview of the non-classical actions of vitamin D. Reports describing the associations of non skeletal actions of vitamin D, especially pertaining to the immune system, inflammatory disorders, cancers and cardiovascular disease have been summarized in this paper. Reports support a role for the active form of vitamin D in mediating normal function of both the innate and adaptive immune systems. Studies also suggest a link between vitamin D deficiency and autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus and type 1diabetes. There is believed to be an inverse association between serum 25-hydroxyvitamin D concentrations and the incidence of colorectal cancer, sporadic colorectal adenoma and breast cancer. Vitamin D deficiency has been linked with various cardiovascular diseases such as hypertension, myocardial infarction, and stroke. Several epidemiological and genetic studies suggest a strong association between vitamin D and non skeletal acute and chronic disorders. However, currently, robust clinical data are still lacking to support raising intake requirements and target vitamin D plasma levels. Nonetheless, the high prevalence of vitamin D deficiency is alarming and requires implementation of clear supplementation guidelines. © 2012 Dr. K C Chaudhuri Foundation.

Khadilkar A.V.,Jehangir Hospital | Mandlik R.M.,Jehangir Hospital
International Journal of Women's Health | Year: 2015

The number of women with osteoporosis, ie, with reduced bone mass and the disruption of bone architecture, is increasing in India. While data on prevalence of osteoporosis among women in India come from studies conducted in small groups spread across the country, estimates suggest that of the 230 million Indians expected to be over the age of 50 years in 2015, 20%, ie, ~46 million, are women with osteoporosis. Thus, osteoporosis is a major public health problem in Indian women. Low calcium intakes with extensive prevalence of vitamin D deficiency, increasing longevity, sex inequality, early menopause, genetic predisposition, lack of diagnostic facilities, and poor knowledge of bone health have contributed toward the high prevalence of osteoporosis. Bone health may be optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout the life cycle, and prevention of bone loss postmenopausal. In Indian women, calcium, vitamin D, and bisphosphonates are the commonest first-line therapies used. The use of other drugs such as hormone replacement therapy, estrogen agonists, calcitonin, parathyroid hormone, and denosumab is decided as per the affordability and availability of treatment options. Major gaps still remain in the diagnosis and management of osteoporosis, thus highlighting the need for more structured research in this area. This review focuses on the epidemiology of osteoporosis in Indian women and available treatments. © 2015 Khadilkar and Mandlik.

Malshikare V.A.,Jehangir Hospital
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand | Year: 2015

Allen type IV fingertip amputations were treated by a modified technique, when the replantation is difficult to be performed or not an option. The pre-existing technique involves nail bed grafting and local flap. In the modified technique, a free bone graft is added, bone and free nail bed repositioned and pulp reconstruction by local flap. This can be best described "graft reposition on flap" (GRF). GRF was found to be simple and cost effective. It allows preservation of finger length and a fully functional and cosmetically acceptable nail.

Ekbote V.H.,Jehangir Hospital | Khadilkar A.V.,Jehangir Hospital | Chiplonkar S.A.,Jehangir Hospital | Khadilkar V.V.,Jehangir Hospital
Journal of Bone and Mineral Metabolism | Year: 2011

The objective of this study was to examine the lifestyle factors that influence total body bone mineral content (TB BMC) and total body bone area (TB BA) in Indian preschool children. TB BMC and TB BA were measured by dual-energy X-ray absorptiometry (Lunar DPX PRO) in 71 apparently healthy children aged 2-3 years. A fasting blood sample was analyzed for serum concentrations of ionized calcium (iCa), intact parathyroid hormone (iPTH), phosphorus (iP) and 25-hydroxyvitamin D3 (25 OHD). Dietary intake of energy, protein, calcium and phosphorus was estimated from a 3-day diet recall. The daily physical activity and sunlight exposure were recorded by a questionnaire. The study children were shorter than their age-gender matched WHO counterparts with a mean height for age Z score of -1.3 ± 1.5. The mean dietary intake of calcium was 46% of the Indian recommended dietary intakes (RDI). Seventy-three percent of children had low iCa concentrations, and 57% were deficient in vitamin D. Generalized linear model analysis revealed that height, lean body mass, weight, activity, sunlight exposure in minutes and dietary intakes of calcium, zinc and iron were the significantly influencing factors (p < 0.05) of TB BMC and TB BA. In conclusion, attaining optimal height for age, achieving the goals of overall nutrition with adequate calcium, iron and zinc intakes as well as adequate physical activity and sunlight exposure play an important role in achieving better TB BMC and TB BA in preschool children. © 2010 The Japanese Society for Bone and Mineral Research and Springer.

Kajale N.A.,Jehangir Hospital | Khadilkar A.V.,Jehangir Hospital | Chiplonkar S.A.,Jehangir Hospital | Khadilkar V.V.,Jehangir Hospital
Indian Pediatrics | Year: 2014

Background: High adiposity is major risk factor for hypertension. Various anthropometric indices are used to assess excess fatness. Objectives: (1) To examine relationship of body mass index (BMI), waist circumference (WC), waist to height ratio (WHtR), triceps skin fold thickness (TSFT) and wrist measurements with blood pressure in children and adolescents 2) to suggest age- and gender-specific cutoffs for these indices in Indian children. Methods: Cross-sectional school-based study on a random sample of 6380 children (6-18 yr old, 3501 boys) from five major cities in India. Height, weight, waist and wrist circumference, TSFT, and blood pressure were recorded. Children with systolic blood pressure (BP) and/or Diastolic BP >95th percentile were classified as hypertensive. Results: Prevalence of overweight and obesity was 23.5% and 9.7%, respectively. Hypertension was observed in 5.6%. Multiple logistic regression (adjustments: age, gender) indicated double risk of hypertension for overweight and 7 times higher odds for obese than normal-weight children. Children with TSFT >95th centile for US children showed three times risk and with TSFT from 85th to 95th double risk of hypertension. Higher WC and WHtR exhibited 1.5 times risk and larger Wrist 1.3 times higher risk of hypertension (P<0.001). Receiver operating curve (ROC) analysis provided age-gender specific cut offs for the five indices to detect the risk of high BP. Area under ROC curves (AUC) for five indices were similar and greater in older age groups indicating equal sensitivity and specificity. Conclusion: Using age- and gender-specific cutoffs for BMI, TSFT, WC or WHtR may offer putative markers for early detection of hypertension. © 2014 Indian Academy of Pediatrics.

Jahagirdar R.,Bharati Vidyapeeth Deemed University | Hemchand K.P.,Bharati Vidyapeeth Deemed University | Chiplonkar S.A.,Jehangir Hospital | Khadilkar V.V.,Jehangir Hospital | Khadilkar A.V.,Jehangir Hospital
Pediatric Obesity | Year: 2012

Background: Studies assessing the relationship of BMI and BF with cardiometabolic (CM) risks in Indian children are scarce. Objective: To assess the occurrence of cardiometabolic risk factors in Indian children and adolescents in relation to BMI and body fat and to study their association with body fat distribution. Methods: 286 children and adolescents (mean age 11.2 ± 2.6 years, 139 boys) were recruited from routine health checks and schools. Anthropometry and blood pressure were recorded, total body fat (BF) and fat distribution (android and gynoid) were measured by Dual Energy X-ray Absorptiometry. Fasting plasma glucose, lipid profile and insulin were also measured. Results: When the study cohort was divided as per their BMI and biochemical cardiometabolic risk factors, 8% children had normal BMI with abnormal biochemical parameters while 40% children had abnormal BMI but normal biochemical parameters. Conclusion: There are normal weight children with cardiometabolic risks. There was an increase in the occurrence of cardiometabolic risk factors with increased android distribution of fat (p-value < 0.05). © 2012 The Author.

Khadilkar A.V.,Jehangir Hospital | Sanwalka N.J.,Jehangir Hospital | Chiplonkar S.A.,Jehangir Hospital | Khadilkar V.V.,Jehangir Hospital | Pandit D.,Jehangir Hospital
International Journal of Obesity | Year: 2013

Background: Indian children and adolescents have higher body fat percentage at a given body mass index than their Western counterparts.Objective: To create gender-specific percentile curves for total body fat percentage (TBFP), total body fat mass (TBFM), fat mass index (FMI) and android:gynoid (A:G) ratio for screening adiposity in healthy Indian children. Methods: Data on body composition by dual-energy X-ray absorptiometry were obtained from a cross-sectional study conducted from May 2006-July 2010 on 888 (462 boys) apparently healthy children from affluent area schools and colleges in Pune city, India. Reference percentile curves were derived for boys and girls for TBFP, TBFM, FMI and A:G ratio. These percentile curves were validated using data on metabolic syndrome risk components in separate sample of 332 (148 boys) children. Results: The median TBFP increased little (4%) from 5 to 18 years of age in boys compared with that in girls (19%). TBFP percentiles showed plateau after 13 years of age in boys, whereas a steady increase was seen till 18 years in girls. The median TBFM increased less (7 kg) from 5 to 18 years in boys compared with that in girls (13.4 kg). The curve for median FMI in boys was relatively flat with FMI remaining near 3 kg m-2 after 13 years of age, whereas in girls median FMI increased with age till about 15 years of age. A:G ratio curves increased with age in both boys and girls up to 18 years of age. In a separate sample of 332 children, according to percentiles developed in the current study, children with TBFP/TBFM/FMI percentiles between 85th and 95th or >95th percentile had significantly higher metabolic risk parameters as compared with those with <85th percentile (P<0.05). Conclusions: Percentile curves developed in the current study would be useful in assessment of adiposity and thus cardiometabolic risk in Indian children. © 2013 Macmillan Publishers Limited.

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