Yadav S.,MOTI |
Rawal G.,Max Super Specialty Hospital
The Pan African medical journal | Year: 2016
Tuberculosis is an infectious disease and is a major health problem in developing countries like India. The disease is prevalent mainly in the underprivileged sections of the society. However, the same is not always true and even the well to do sections are also affected by this disease. The lack of knowledge in the masses and the communities is a factor that contributes largely to the spread of the disease. In such a scenario, there is always a need for new and innovative ideas to create mass awareness about tuberculosis.
Arora R.S.,Max Super Specialty Hospital |
Challinor J.M.,University of California at San Francisco |
Howard S.C.,University of Memphis |
Pediatric Blood and Cancer | Year: 2016
The Paediatric Oncology in Developing Countries (PODC) committee of International Society of Paediatric Oncology (SIOP) has 10 working groups that provide a forum for individuals to engage, network, and implement improvements in the care of children with cancer in low- and middle-income countries. The development of adapted guidelines (medulloblastoma, retinoblastoma, Wilms tumor, neuroblastoma, retinoblastoma, Burkitt lymphoma, supportive care), advocacy and awareness (on hospital detention and essential drugs), education and training, and global mapping (nutritional practice, abandonment rates, and twinning collaborations) have been the initial areas of focus, and the impact of some of these activities is evident, for example, in the SIOP Africa PODC Collaborative Wilms tumor project. © 2016 Wiley Periodicals, Inc.
Israels T.,Outreach |
Challinor J.,University of California at San Francisco |
Howard S.,University of Memphis |
Arora R.H.,Max Super Specialty Hospital
Pediatrics | Year: 2015
Although morbidity from childhood cancer is second only to unintentional injuries in highincome countries, in low-income countries, it hardly hits the radar screen compared with death from pneumonia, diarrhea, malaria, neonatal sepsis, preterm birth, and neonatal asphyxia. Nevertheless, the extraordinary progress made in treating childhood cancer in high-income countries brings into harsh focus the mammoth disparities that exist in impoverished areas of the world. As the capacity to diagnose and treat childhood cancer improves in low- and middle-income countries, the ability to improve outcomes for the more common diseases benefits as well. The authors have summarized the issues related to childhood cancer care with thoughtful attention to how children everywhere can gain from the advances in medical science in high-income nations. Copyright © 2015 by the American Academy of Pediatrics.
Shrivastav M.,Medtronic |
Padte S.,Medtronic |
Arora V.,Max Super Specialty Hospital |
Biffi M.,University of Bologna
Expert Review of Cardiovascular Therapy | Year: 2014
Electrocardiographic monitoring represents one of the most reliable and time-tested methods for reducing ambiguity in cardiac arrhythmia diagnosis. In India, the resting ECG is generally the first tool of choice for in-clinic diagnosis. The external loop recorder (ELR) is another useful tool that compounds the advantages of traditional tools by coupling ambulatory monitoring with a long-term window. Thus, the objective was to test the use of a 7-day ELR for arrhythmia diagnosis in India for a broad range of presenting symptoms. In this study set in the Indian healthcare environment, an auto-triggered, wireless patch-type ELR was used with 125 patients (62.5 ± 16.7 years, 76 males) presenting a broad range of symptoms. Eighty percent of the symptoms were related to syncope, presyncope or palpitations. Patients were administered an ELR for 7-28 days depending on the physician's prescription. Prespecified significant arrhythmias included sinus pause >2 s, symptomatic bradycardia <40 b.p.m., second-degree (and higher) AV block, complete heart block, ventricular fibrillation, sustained/nonsustained ventricular tachycardia (>3 beats), atrial fibrillation (chronic or paroxysmal), atrial flutter and supraventricular tachycardia (SVT) >130 b.p.m. Diagnostic yield was 38% when a stringent tabulation methodology considering only clinically significant arrhythmia was used. When first-degree AV block, premature atrial and ventricular beats, couplets (both atrial and ventricular in origin), bigeminy or trigeminy, or sudden changes in rate (noted as sinus arrhythmia) were included in the calculation, diagnostic yield was 80%. Patient compliance was 98%; patients wore the patch for the entire prescribed monitoring period without disruption. Seventy percent of the reported symptoms corresponded with an arrhythmia. Use of the ELR led to therapy change in 24% of patients: 15 patients went on to receive an implantable cardioverter defibrillator or pacemaker, 4 received ablation therapy and 11 altered their medication after diagnosis. This study demonstrates that a high diagnostic yield for clinically significant arrhythmias and high patient compliance can be achieved with a wearable patch monitor in Indian patients suffering from a variety of symptoms. © 2014 Informa UK Ltd.
Consul M.,Max Super Specialty Hospital |
Mishra S.,Max Super Specialty Hospital |
Taneja A.,Max Healthcare
Indian Journal of Pediatrics | Year: 2011
The authors report 22 patients of Kawasaki disease, diagnosed and treated over a period of 3 years at a tertiary care centre in New Delhi. Ten cases fullfiled the criteria of a "classical" case while 12 cases were "incomplete" cases. Echocardiography was performed in all cases and coronary artery involvement was found in 8 (36%) cases. All cases received high dose Intravenous Immunoglobulins (IVIG) as standard therapy. In two cases, a repeat dose of IVIG was required for defervescence to occur. All cases recovered after therapy. Those with coronary artery involvement were planned for a 2 years follow up from the time of diagnosis. © 2010 Dr. K C Chaudhuri Foundation.
Dutta A.,University of Gottingen |
Khattar B.,Max Super Specialty Hospital |
Banerjee A.,Max Super Specialty Hospital
Eurasip Journal on Advances in Signal Processing | Year: 2012
Neuromuscular electrical stimulation (NMES) facilitates ambulatory function after paralysis by activating the muscles of the lower extremities. The NMES-assisted stepping can either be triggered by a heel-switch (switch-trigger), or by an electromyogram (EMG)-based gait event detector (EMG-trigger). The command sources - switch-trigger or EMG-trigger - were presented to each group of six chronic (>6 months post-stroke) hemiplegic stroke survivors. The switch-trigger group underwent transcutaneous NMES-assisted gait training for 1 h, five times a week for 2 weeks, where the stimulation of the tibialis anterior muscle of the paretic limb was triggered with a heel-switch detecting heel-rise of the same limb. The EMG-trigger group underwent transcutaneous NMES-assisted gait training of the same duration and frequency where the stimulation was triggered with surface EMG from medial gastrocnemius (MG) of the paretic limb in conjunction with a heel-switch detecting heel-rise of the same limb. During the baseline and post-intervention surface EMG assessment, a total of 10 s of surface EMG was recorded from bilateral MG muscle while the subjects tried to stand steady on their toes. A nonlinear tool - recurrence quantification analysis (RQA) - was used to analyze the surface EMG. The objective of this study was to find the effect of NMES-assisted gait training with switch-trigger or EMG-trigger on two RQA parameters - the percentage of recurrence (%Rec) and determinism (%Det), which were extracted from surface EMG during fatiguing contractions of the paretic muscle. The experimental results showed that during fatiguing contractions, (1) %Rec and %Det have a higher initial value for paretic muscle than the non-paretic muscle, (2) the rate of change in %Rec and %Det was negative for the paretic muscle but positive for the non-paretic muscle, (3) the rate of change in %Rec and %Det significantly increased from baseline for the paretic muscle after EMG-triggered NMES-assisted gait training. Therefore, the study showed an improvement in paretic muscle function during a fatiguing task following gait training with EMG-triggered NMES. This study also showed that RQA parameters - %Rec and %Det - were sensitive to changes in paretic/non-paretic muscle properties due to gait training and can be used for non-invasive muscle monitoring in stroke survivors undergoing rehabilitation. © 2012 Dutta et al.; licensee Springer.
Thukral R.,Max Super Specialty Hospital |
Marya S.K.S.,Max Super Specialty Hospital |
Singh C.,Max Super Specialty Hospital
Indian Journal of Orthopaedics | Year: 2015
Background: Management of periprosthetic supracondylar femoral fractures is difficult. Osteoporosis, comminution and bone loss, compromise stability with delayed mobility and poor functional outcomes. Open reduction and internal fixation (ORIF) with anatomic distal femoral (DF) locking plate permits early mobilization. However, this usually necessitates bone grafting (BG). Biological fixation using minimally invasive techniques minimizes periosteal stripping and morbidity. Materials and Methods: 31 patients with comminuted periprosthetic DF fractures were reviewed retrospectively from October 2006 to September 2012. All patients underwent fixation using a DF locking compression plate (Synthes). 17 patients underwent ORIF with primary BG, whereas 14 were treated by closed reduction (CR) and internal fixation using biological minimally invasive techniques. Clinical and radiological followup were recorded for an average 36 months. Results: Mean time to union for the entire group was 5.6 months (range 3-9 months). Patients of ORIF group took longer (Mean 6.4 months, range 4.5-9 months) than the CR group (mean 4.6 months, range 3-7 months). Three patients of ORIF and one in CR group had poor results. Mean knee society scores were higher for CR group at 6 months, but nearly identical at 12 months, with similar eventual range of motion. Discussion: Locked plating of comminuted periprosthetic DF fractures permits stable rigid fixation and early mobilization. Fixation using minimally invasive biological techniques minimizes morbidity and may obviate the need for primary BG.
Pathak S.,Max Super Specialty Hospital |
Chandrashekhar M.,Max Super Specialty Hospital |
Wankhede G.R.,Bio Rad Laboratories India Pvt. Ltd
Asian Journal of Transfusion Science | Year: 2011
Background: Antibodies against only about 25-28 blood group antigens are known to cause hemolytic reactions (HTRs), and red cell antibody screening should detect such clinically significant antibodies. An extension of the antibody screening test is the 'type and screen' done to detect clinically significant antibodies, omiting the anti-human globulin (AHG) cross-match. Aim: The aim of this study was to find out if the type and screen procedure is a safe method for pre-transfusion testing when compared to the AHG cross-match currently in use in India. Materials and Methods: We evaluated data from 45373 patients for whom a total of 61668 units of packed red blood cells (PRBC) were cross-matched in the AHG phase using DiaMed® ID cards. An antibody screen was carried out in all the patients using the DiaMed® ID-DiaCell I+II+III. The AHG cross-match was also carried out for all recipients, irrespective of the result of the antibody screen. The results were compared to see if there were any cases where the antibody screening was negative but the AHG cross-match showed incompatibility. Results: Not a single case was found where the antibody screen was negative and AHG cross-match showed incompatibility. In 68 cases the antibody screening was positive. Out of the 68 cases, AHG cross-match was incompatible with at least one unit of PRBC in 41 cases. Conclusion: The screening cell panel adequately detected the clinically significant antibodies in the Indian population in our study. The type and screen policy can be safe, efficient, cost-effective, and beneficial to the transfusion service in India.
Marya S.K.S.,Max Super Specialty Hospital |
Thukral R.,Max Super Specialty Hospital
Indian Journal of Orthopaedics | Year: 2013
Background: Unicompartmental knee arthroplasty (UKA) has specific indications, producing excellent results. It, however, has a limited lifespan and needs eventual conversion to total knee arthroplasty (TKA). It is, therefore, a temporizing procedure in select active young patients with advanced unicompartmental osteoarthritis (UCOA). Being a less morbid procedure it is suggested as an alternative in the very elderly patients with tricompartmental osteoarthritis (TCOA). We performed UKA in a series of 45 octogenarians with TCOA predominant medial compartment osteoarthritis (MCOA) and analyzed the results. Materials and Methods: Forty five octogenarian patients with TCOA predominant MCOA underwent UKA (19 bilateral) from January 2002 to January 2012. All had similar preoperative work-up, surgical approach, procedure, implants and postoperative protocol. Clinicoradiological assessment was done at 3-monthly intervals for the first year, then yearly till the last followup (average 72 months, range 8-128 months). Results were evaluated using the knee society scores (KSS), satisfaction index [using the visual analogue scale (VAS)] and orthogonal radiographs (for loosening, subsidence, lysis or implant wear). Resurgery for any cause was considered failure. Results: Four patients (six knees) died due to medical conditions, two patients (three knees) were lost to followup, and these were excluded from the final analysis. Barring two failures, all the remaining patients were pain-free and performing well at the final followup. Indications for resurgery were: medial femoral condyle fracture needing fixation subsequent conversion to TKA at 2 years (n=1) and progression of arthritis and pain leading to revision TKA at 6 years (n=1). Conclusion: UKA has shown successful outcomes with regards to pain relief and function with 96.4% implant survival and 94.9% good or excellent outcomes. Due to lower demands, early rehabilitation, less morbidity, and relative short life expectancy, UKA can successfully manage TCOA in the octogenarians.
Bhargava A.,Max Super Specialty Hospital
Expert Review of Endocrinology and Metabolism | Year: 2015
By the year 2030, diabetes mellitus will globally become the seventh leading cause of death. Currently, 382 million individuals worldwide have diabetes mellitus, with 80% residing in low- and middle-income countries. At present, Type 2 diabetes mellitus (T2DM) accounts for 85-95% of the diabetes burden in high-income countries. Alarmingly, this figure may be higher in the low- and middle-income nations. In an effort to combat this silent but deadly disease, pharmaceutical manufacturers have developed a host of different agents, each targeting a specific biochemical pathway. Among the most recent additions to this armament is linagliptin/metformin HCl, a fixed combination therapy compound manufactured by Boehringer Ingelheim. This novel formulation combines metformin, an insulin sensitizer, with linagliptin, a dipeptidyl peptidase-4 enzyme inhibitor. This review will discuss the pharmacokinetic properties of this molecule, assess clinical efficacy and gauge its place in the treatment algorithm for T2DM. © Informa UK, Ltd.