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Mumbai, India

De Souza C.E.,Lilavati Hospital | Nisar J.,Jain Health Center | De Souza R.A.,TNMC Medical College
Otolaryngology - Head and Neck Surgery (United States) | Year: 2012

This is a case series with chart review from 1997 to 2010 to determine results of endoscopic dacryocystorhinostomy in children. Thirty-seven children underwent removal of the medial wall (RMW) of the lacrimal sac (LS) and 2 had lacrimal stents inserted because they had external fistulae and small cicatrized LS. Parameters of success were (1) resolution of epiphora, (2) no further attacks of dacryocystitis, and (3) patency of neofistula. Of the 37 (95%) children who had RMW of the LS, 34 (92%) were patent after 12 weeks and were considered successful. Three (8%) neofistulae obstructed within 2 weeks and needed revision, and 2 (5%) patients had small cicatrized LS along with fistula and were stented. The fistulae closed down in 4 weeks. However, when the stents were removed 6 weeks later, epiphora returned. The authors' experience reveals that removal of the medial wall of the LS is effective in stopping chronic epiphora. © 2012 American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Redkar R.G.,B. J. Wadia Hospital for Children | Mishra P.K.,B. J. Wadia Hospital for Children | Thampi C.,Lilavati Hospital | Mishra S.,Evershine Hospital
African Journal of Paediatric Surgery | Year: 2012

Background: To assess the role of diagnostic and therapeutic value of anorectal myectomy in cases of chronic refractory constipation. Materials and Methods: Twenty-eight patients 11 months to 9 years of age presenting with chronic constipation, with contrast enema showing dilated rectum and sigmoid colon were included in the study. Anorectal myectomy under general anaesthesia was carried out in these selected patients and were followed-up for up to 6 months to 5 years. Clinical improvement was measured by post-operative bowel habits and relief of symptoms. Results: Twenty-two patients improved clinically; partial response in 4 patients, no response in 2 patients. Two patient required further pull through surgery and was found to have transition zone at the recto-sigmoid level. Ten patients had aganglionosis (of which 5 had ganglion cells present in the proximal part of speciment), 7 had normal histology, 7 had hypoganglionosis, 2 had intestinal neuronal dysplasia, one had nerve hypertrophy and one had immature ganglia. Conclusion: Anorectal myectomy is an effective and technically simple procedure in selected patients with chronic refractory constipation, for both diagnostic and therapeutic purpose. Because apart from confirming Hirschsprung's disease, it also therapeutically relieves symptoms in 93% of patients with chronic refractory constipation.

Kesavadev J.,Jothydevs Diabetes Research Center | Joshi S.R.,Lilavati Hospital
Journal of Association of Physicians of India | Year: 2013

Background: The A1chieve® study evaluated safety and effectiveness of insulin analogues in a large and diverse population. This report presents a subgroup analysis of the A1chieve®observational study pertaining to India. Objective: To assess safety and effectiveness of initiation or intensification of insulin detemir in patients with type 2 diabetes mellitus (T2DM) not achieving adequate glycemic control. Methods: The A1chieve® study was a prospective, multi-center, open-label, non-interventional study of 24-weeks duration. In this post-hoc analysis, Indian patients with T2DM who did not achieve their glycemic targets, and were started with or switched to insulin detemir, were evaluated at baseline and after 24 weeks of therapy for safety and effectiveness. Adverse events (AE) noted during the course of therapy were recorded. Additionally Glycemic, non-glycemic parameters and quality of life indices were reported. Appropriate statistical analysis was carried out to assess the statistical significance. Results: The Indian cohort of 2707 patients with T2DM treated with insulin detemir included 2336 (86.29%) insulin-naïve and 371 (13.71%) insulin-experienced patients. No adverse drug reaction (ADR) was noted over 24 weeks, one patient (out of 2707) reported serious adverse event. Major hypoglycemia was reported in 0.5% (0.08 events/patient year) patients and reduced to 0% (0events/patient year) over 24 weeks. After 24 weeks' treatment with insulin detemir, an overall reduction in HbA1c of 2.1% was noted (p < 0.001), with a 2.1% (p <0.001) and 2% (p <0.001) reduction in insulin-naïve and insulinexperienced groups, respectively. A significant reduction in fasting ([mean ± SD] -3.8 ± 2.5 mmol/L) and postprandial (-5.2 ± 3.9 mmol/L) blood glucose (FPG and PPG) was also observed (p <0.001 for both). At end of the study, 24.4% patients achieved the ADA target of <7.0% and 14.3% patients achieved the AACE target of <6.5% for HbA1c. A significant improvement in quality of life indices like ED-5D (0.31 ± 0.29; p<0.001) and EQ-VAS (21.7 ± 16.7; p<0.001) was noticed. Conclusion: In patients with T2DM not achieving their glycemic targets addition of basal insulin detemir was well tolerated and reported improvement in glycemic control. © SUPPLEMENT TO JAPI.

Ashavaid T.,Research Laboratories | Shalia K.,Hurkisondas Nurrottmdas Hospital | Shah B.,Lilavati Hospital
Indian Journal of Nephrology | Year: 2010

The outcome of renal transplantation is improved by cyclosporine and tacrolimus. However, its success is limited by drug-induced nephrotoxicity. Therefore, monitoring their levels is important. These levels are influenced mainly by CYP3A4, CYP3A5 and MDR-1 genes. These levels also affect target molecules of CNIs, mainly IL-2. Inter-individual differences in these levels have been attributed to SNPs in these genes and hence study of these SNPs assumes significance. So far no study has been carried out on Indian renal transplant recipients covering the SNPs of the genes involved in metabolism, efflux and drug target of CNIs, hence the data is lacking for Indian population. The aim is to study A-392G SNP of CYP3A4, A6986G SNP of CYP3A5, C3435T SNP of MDR-1 and T-330G SNP of IL-2 genes and correlate with CNI blood levels. Hundred healthy subjects and 100 consecutive renal transplant recipients; 56 on CsA and 44 on tacrolimus were genotyped by PCR followed by restriction enzyme assay for mentioned SNPs. No significant difference was observed between level/dose (L/D) ratio of CNIs and CYP3A4 and IL-2 SNPs. However, median L/D ratio for tacrolimus was significantly higher in subjects with CYP3A5*3/*3 (n = 24) ( P = 0.011) and MDR-1 3435TT (n = 18) ( P = 0.0122). The findings from this study show that homozygous mutant patients for CYP3A5 and MDR-1 gene SNPs could be managed with lower tacrolimus dose to avoid nephrotoxicity.

Nair S.,National Institute of Immunohaematology ICMR | Nadkarni A.,National Institute of Immunohaematology ICMR | Warang P.,National Institute of Immunohaematology ICMR | Bhave A.,Lilavati Hospital | And 2 more authors.
European Journal of Clinical Investigation | Year: 2010

Background This study was undertaken to analyse cases of microcytosis, and/or haemolytic anaemia where an unusual peak on HPLC or an abnormal electrophoretic mobility in isolation or along with common β-globin gene defects was found, and to identify the molecular abnormality in them. Patients and methods Investigations included a complete blood count, HPLC analysis, cellulose acetate electrophoresis (pH 8.9), heat stability test and DNA sequencing. Results Five α chain variants were identified. This is the first report of Hb Jackson and Hb O Indonesia in the Indian population. The presence of Hb J Meerut along with Hb E and Hb J Paris I with heterozygous β-thalassaemia are uncommon associations. Hb Sun Prairie would have remained undetected in the heterozygous state. The presence of a homozygous child in the family helped to identify this variant. Conclusions This study emphasizes the need to undertake systematic investigations while screening for the β haemoglobinopathies to identify rare α chain variants in a population. © 2010 Stichting European Society for Clinical Investigation Journal Foundation.

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