King George Medical University

King George, India

King George Medical University

King George, India

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Patel M.L.,King George Medical University | Radheyshyam C.O.,King George Medical University | Verma A.,King George Medical University | Sachan R.,King George Medical University | Kamal R.,Indian Toxicology and Research Center
North American Journal of Medical Sciences | Year: 2015

Background: Chronic kidney disease (CKD) patients on hemodialysis are highly prone to cardiovascular disease, which accounts for roughly half of the mortality in these patients. Atherosclerosis begins many years before the development of clinical manifestations. Measurement of carotid intima-media thickness (CIMT) is a noninvasive procedure to detect early atherosclerotic changes. Aims: The aim of the study was to evaluate the correlation between CIMT and cardiovascular risk factors and to investigate its prognostic signifi cance in CKD patients on hemodialysis. Materials and Methods: This was a prospective study carried out over a period of 18 months. Total 88 patients on hemodialysis and 50 healthy controls were enrolled in the study. Biochemical assay and CIMT was assessed using the high resolution 7.5 MHz sonography technique in all subjects. Results: Signifi cant positive correlation was found with age, blood urea, serum creatinine, serum triglyceride, low-density lipoprotein, serum phosphorus, serum calcium-phosphorus product, serum uric acid, 24 h urine protein, systolic blood pressure, diastolic blood pressure, and body mass index. Negative correlation was found with estimated glomerular fi ltration rate. Adjusted hazards ratios of all cause and cardiovascular mortality for an increase of 0.1 mm in CIMT was 1.16 (95% confi dence interval 0.15-9.09). Patients with CIMT value <0.97 mm had a renal survival rate of 73.4% while patients with value >0.97 mm had a renal survival rate of 16.5%. Conclusion: Uremia is an additive risk factors in those subjects who have raised CIMT despite of traditional cardiovascular risk factors. © 2015 North American Journal of Medical Sciences. All rights reserved.


Elhence P.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Sachan D.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Verma A.,Sanjay Gandhi Post Graduate Institute of Medical Sciences | Kumar A.,King George Medical University | Chaudhary R.,Sanjay Gandhi Post Graduate Institute of Medical Sciences
Transfusion and Apheresis Science | Year: 2012

Background: Alloanti-Kpb is a rare, clinically significant antibody against high frequency red cell antigen Kpb of Kell blood group system. We report here a case of Haemolytic disease of newborn (HDN) due to anti-Kpb, which manifested as severe anaemia at the age of 1 month. Aim: To diagnose and successfully manage anti-Kpb induced HDN. Methodology: Direct antiglobulin test (DAT), antigen typing, irregular antibody screening and identification were done by polyspecific LISS Coombs Gel card and standard methods. Results: At presentation the neonate had severe anemia with reticulocytopenia. Blood group was B, Rh D positive and DAT was 2+. Anti-Kpb was detected in mother's serum. Due to unavailability of Kpb negative red cells and incompatible blood group of mother (A1B Rh D positive) infant was transfused group B Rh D, Kpb positive PRBCs under steroid cover. He was symptom free at 4 months of age and DAT became negative at 6 months. Conclusion: Anti-Kpb is capable of causing severe late HDN. Infants born to irregular antibody positive mothers should be investigated and closely monitored for several weeks after birth for immune HDN even if asymptomatic at birth. © 2012 Elsevier Ltd.


Garg R.K.,King George Medical University | Malhotra H.S.,King George Medical University | Gupta R.,King George Medical University
Spinal Cord | Year: 2015

Objectives: To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. Setting: Reports from multiple countries were included. Methods: An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases. Results: Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement. Conclusions: Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory. © 2015 International Spinal Cord Society All rights reserved.


Dubey A.,King George Medical University | Kant S.,King George Medical University | Agarwal S.,SGPGIMS | Dixit S.,King George Medical University | And 2 more authors.
Indian Journal of Physiology and Pharmacology | Year: 2014

Obesity is an important risk factor of Obstructive Sleep Apnea Syndrome (OSAS). Previous studies suggested Leptin Receptor (LEPR) gene Polymorphisms is associated with obesity and OSAS. Study was conducted to asses association of LEPR gene polymorphism K109R, Q223R and K656N with OSAS in North Indian subjects. Genotyping and estimation of serum Leptin levels were done in 190 subjects. Polysomnography, anthropometrical measures and biochemical investigations were done in all the subjects who qualified for inclusion in the study. We observed significant association of Q223R gene polymorphism with blood pressure (BP) (P<0.05) and nocturnal max pulse rate (P<0.05). K656N gene polymorphism was associated with AHI (P<0.05), average desaturation levels (P<0.05) and HDL-C (P<0.05). No association was observed in genotype distribution of these subjects according to obesity and disease severity. These findings suggest that LEPR Q223R and K656N gene Polymorphism may influence BP, Max Pulse rate, AHI, Average desaturation levels and HDL levels in these Subjects.


Qavi A.,University of Lucknow | Garg R.K.,University of Lucknow | Malhotra H.S.,University of Lucknow | Jain A.,King George Medical University | And 5 more authors.
Medicine (United States) | Year: 2016

In this study, we describe clinical and imaging spectrum, and the natural course of patients with disseminated cysticercosis. How albendazole affects the course of disease has also been evaluated. We assessed the Toll-like receptor-4 gene polymorphisms, to know the reason for the apparently higher prevalence of disseminated cysticercosis in India. Sixty consecutive patients with disseminated cysticercosis were enrolled. Sixty age-and-sex-matched healthy controls were also enrolled for the purpose of genetic study. Twenty patients, who gave consent, were treated with albendazole along with corticosteroids. Forty patients did not give consent for antiparasitic therapy. Assessment for Toll-like receptor-4 gene polymorphisms (Asp299Gly and Thr399Ile genes) was done. Patients were followed for 6 months. We also performed a literature search of cases published in English language using PubMed electronic database and analyzed 56 cases thus available. There was an increased risk (6.63 fold and 4.61 fold) of disseminated cysticercosis in the presence of Asp299Gly and Thr399Ile polymorphisms in Toll-like receptor-4, respectively. The allelic frequency of Gly (11% vs. 3%, P=0.024, odds ratio [OR]=3.52) and Ile alleles (11% vs. 2%, P=0.009, OR=4.738) in disseminated cysticercosis was high. Albendazole resulted in complete disappearance of all cerebral lesions in 35% (7/20) patients and reduction in lesion load in remaining 65% (13/20) patients. No significant change in number of cysticercal lesion was noted in patients who did not receive albendazole. No major adverse reaction following antiparasitic treatment was noted. Three deaths were recorded in patients who did not receive antiparasitic treatment. Of the 56 cases reported in PubMed, 33 patients received antiparasitic treatment with follow-up data available for 31 patients. Most (24) of these patients received albendazole. A significant clinical and/or imaging improvements, on follow up, were observed in 27 patients. Of the 4 deaths recorded, 3 had a heavy parasitic load and died after praziquantel therapy. Toll-like receptor-4 gene polymorphisms are associated with an increased susceptibility to disseminated cysticercosis, in the Indian population. Albendazole treatment seems to reduce the lesion load and improve symptoms. Copyright © 2016 the Author(s). Published by Wolters Kluwer Health, Inc. All rights reserved.


PubMed | King George Medical University
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2015

Local anaesthetic systemic toxicity (LAST) is one of the most dreadful complications after local anaesthetic (LA) use and it is very difficult to manage. The diagnosis of LAST is purely clinical and its presentation is usually obscured in a sedated or anaesthetized patient. A 25-year-old male patient undergoing laparotomy for acute duodenal perforation under general anaesthesia developed seizures after epidural administration of 0.5% bupivacaine. All other possible causes of seizures were ruled out. Seizures were controlled with antiepileptic drugs and patient recovered fully after withholding LA administration. Although, lipid rescue is recommended for LAST, our patient was managed without its use. We, therefore, recommend that utmost care and vigilance should be exercised while using local anesthetics as there is no perfectly accurate method to rule out intravascular administration of LA. Even, if LA is correctly used, LA is detected in plasma due to its systemic absorption from injection site.


PubMed | King George Medical University
Type: Journal Article | Journal: Spinal cord | Year: 2015

To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis.Reports from multiple countries were included.An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases.Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement.Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.

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