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Ajinkya S.A.,MGM Medical College and Hospital
Sleep and Hypnosis | Year: 2015

We report a case of a 37 year old Indian media professional suffering from panic disorder with phobia for drinking water and other liquids (aquaphobia) for the last 10 years. Despite anti-anxiety medications and counselling, symptoms prevailed and affected his social and professional life. He was thus referred for hypnotherapy. The patient underwent six sessions of cognitive hypnotherapy. After successful completion of sessions he regularly started drinking water and other liquids without any further episodes of panic. There was also a remarkable improvement in his social and professional life. His anti-anxiety medications were then slowly tapered and stopped. There were no relapses reported by the patient even after six months of follow up. This case study deepens the confidence and evidence for using cognitive hypnotherapy in the management of neurotic disorders.


Setia M.S.,McGill University | Shinde S.S.,Cutis Skin Clinic and Laser Center | Jerajani H.R.,Mgm Medical College And Hospital | Boivin J.-F.,Jewish General Hospital
Tropical Medicine and International Health | Year: 2011

Background A combination of rifampicin, ofloxacin and minocycline (ROM) is one of the newer recommendations for treatment of leprosy. We performed a systematic review and a meta-analysis of studies that had evaluated the efficacy of ROM therapy in treatment of paucibacillary and multibacillary leprosy patients. Methods Studies were identified by searching the PubMed, Embase, LILACS and Cochrane databases. Data were abstracted from all relevant studies, and fixed effects models were used to calculate the summary estimate of effect in paucibacillary and multibacillary leprosy patients. Results Six studies comparing ROM therapy to multidrug therapy and eight studies that evaluated the effect of ROM therapy alone (no comparison group) were included in the review and meta-analysis. The combined estimate for single dose ROM vs. multidrug therapy in paucibacillary leprosy patients suggested that ROM was less effective than multidrug therapy in these patients [relative risk: 0.91, 95% confidence intervals (CI): 0.86-0.97]. However, the combined estimate for multiple doses of ROM vs. multidrug therapy in multibacillary leprosy patients suggested that ROM was as effective as multidrug therapy in reducing bacillary indices in these patients (proportion change: -4%, 95% CI -31% to 23%). No major side effects were reported in either the ROM or the multidrug treatment groups. Conclusions Single-dose ROM therapy was less effective than multidrug therapy in paucibacillary patients. However, there are insufficient data to come to a valid conclusion on the efficacy of multidose ROM therapy in multibacillary leprosy, and additional studies with ROM therapy in multibacillary leprosy are needed. Furthermore, multiple doses may be considered as another alternative even for paucibacillary patients, and randomised controlled trials of this therapy may be useful to understand its contribution in the treatment and control of leprosy. © 2011 Blackwell Publishing Ltd.


Singh O.,Bhopal Memorial Hospital | Gupta S.S.,Bhopal Memorial Hospital | Hastir A.,MGM Medical College and Hospital | Arvind N.K.,Bhopal Memorial Hospital | Arvind N.K.,BGS Apollo Hospital
Journal of Endourology | Year: 2010

Background and Purpose: Laparoscopic dismembered pyeloplasty (LDP) is a minimally invasive approach that is becoming standard management of ureteropelvic junction obstruction (UPJO). It provides similar results when compared with open surgery. The main goal of LDP is to meet the standard of open dismembered pyeloplasty with reduced trauma for the patients. The purpose of the study was to evaluate the postoperative and functional results of LDP. Patients and Methods: We retrospectively reviewed and analyzed 142 cases of LDP performed at our center over a period of 7 years (January 2003 to December 2009) for UPJO with dilatation of the renal pelvis. Patients' profiles and perioperative, intraoperative, and postoperative parameters, such as time of surgery, blood loss, complications, duration of hospital stay, and outcomes of the procedure, were all evaluated and analyzed. Results: The mean operative time for LDP was 145 minutes (range 110-180 min), and the mean estimated blood loss was negligible in all patients. The mean hospital stay was 3.5 days (3-6 d). Two conversions to open surgery occurred because of difficulty to complete the anastomosis. In one patient, shock caused by bleeding from inferior epigastric vessels near the port site developed and had to be explored. The success rate was 96.8%. Conclusion: When performed by expert surgeons, LDP can safely achieve success rates that are comparable to those of open surgery described in the literature, with fewer complications and less morbidity to the patients. The few important difficulties with their management that we encountered are discussed. © 2010, Mary Ann Liebert, Inc.


Talib S.H.,MGM Medical College and Hospital | Bhattu S.R.,MGM Medical College and Hospital | Bhattu R.,MGM Medical College and Hospital | Deshpande S.G.,MGM Medical College and Hospital | Dahiphale D.B.,MGM Medical College and Hospital
International Medical Case Reports Journal | Year: 2013

We report a rare case of dengue fever triggering systemic lupus erythematosus and lupus nephritis. The patient presented herself during a large outbreak of dengue fever in December 2012 in Maharashtra, India. The diagnosis of dengue fever was confirmed by the presence of NS-1 antigen during the first few days of febrile illness. Eight weeks later, kidney tissue biopsy studies revealed evidence of lupus nephritis on microscopic examination and immunofluorescence. The report interpreted it as focal proliferative glomerulonephritis and segmental sclerosis (Stage IIIC). The case was also found positive for perinuclear antineutrophil cytoplasmic antibodies by indirect immunofluorescence assay. An active and effective management of a case essentially calls for clear perception of differentiating dengue-induced lupus flare, antineutrophil cytoplasmic antibody-related nephropathy, and/or dengue-induced de-novo lupus disease. Dengue viremia may be the trigger for immune complex formation in patients who are predisposed to developing autoimmune diseases. The present case explains the importance of considering the diagnosis of dengue-related lupus nephritis as an atypical occurrence in appropriate situations, as in this case. It would not be improper to regard this escalating disease as an expanded feature of dengue. © 2013 Talib et al.


Chaudhari V.A.,Jawaharlal Institute of Postgraduate Medical Education & Research | Ghodake D.G.,MGM Medical College and Hospital | Kharat R.D.,VCSG Government Institute of Medical Science and Research
American Journal of Forensic Medicine and Pathology | Year: 2016

Death due to a head-down position with hyperflexion of the neck is a rare event. A person accidentally falling into a narrow space and remaining in an upside-down position with no timely recovery may experience positional or postural asphyxia. It is a critical condition arising out of particular body positions, leading to mechanical obstruction of respiration. The precipitating factors are intoxication due to alcohol, drugs, obesity, psychiatric illnesses, and injuries. A 30-year-old unmarried woman, weighing 82 kg and with a body mass index of 31.24, was found in a narrow space between the bed and the wall in a naked state and in a head-down position with hyperflexion of the neck. The distribution of lividity was consistent with the position of the body at the scene. Blood was oozing from the mouth and nostrils, and signs of asphyxia were present. The toxicological analyses of viscera, blood, and urine were negative for alcohol, drugs, and poisons. Glucose levels in the blood (86 mg/dL) as well as urine and vitreous humor levels (68 mg/dL) were within normal limits. On microscopic examination, there were no findings of coronary atherosclerosis, whereas the brain and lung were edematous. After meticulous examination, we ruled out sexual assault, autoerotic asphyxia, epilepsy, psychiatric illness, diabetes, toxicity, and coronary artery disease. Death was attributed to the accidental fall of the obese individual being stuck in a narrow space, resulting in positional asphyxia. It is imperative to recognize the precipitating or risk factors before labeling positional asphyxia as a cause of death. © Copyright 2016 Wolters Kluwer Health, Inc.


Gupta S.S.,MGM Medical College and MY Hospital | Singh O.,MGM Medical College and MY Hospital | Sabharwal G.,NKP Salve Medical College and Lata Mangeshkar Hospital | Hastir A.,MGM Medical College and Hospital
ANZ Journal of Surgery | Year: 2011

Objectives: To compare the effectiveness of percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of large (>10cm diameter) amoebic liver abscesses. Methods: Eighty-two patients with amoebic liver abscess were randomly allocated to PCD (n= 42) or PNA (n= 40). Intervention was done under ultrasonography (US) [mainly] or computed tomography guidance within 24h of admission. PNA was repeated every 3rd day if the cavity size had not reduced to 50% of the original size, for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Duration to attain clinical relief, duration of hospital stay, complications, treatment failure and deaths were recorded. Results: PNA was successful in 32 (80%) patients (one aspiration in 4, two in 18 and three in 10 patients), while PCD was successful in 38 (90.5%) patients. Durations to attain clinical relief and parentral antibiotics required were significantly lesser in the PCD group. Hospital stay, although did not differ significantly, was lesser for PCD group. The only procedure-related complication due to PCD was rupture of abscess in two cases, leading to sepsis and death of one patient. Complications of PNA included pleural injury in one patient, and haemorrhage leading to subcapsular hematoma in another. Conclusion: PCD is a better treatment option than PNA for the management of large (>10cm diameter) amoebic liver abscess, in terms of duration to attain clinical relief and duration for which parentral antibiotics were needed. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.


Ansari I.,MGM Medical College and Hospital | Futane S.,MGM Medical College and Hospital | Ansari A.,MGM Medical College and Hospital
Acta Neurochirurgica | Year: 2016

Background: Sub-acute/chronic epidural hematoma (EDH) may present with nagging symptoms of headache, nausea, vomiting, lethargy, etc. We attempted to offer a minimally invasive, single burr hole, endoscope-assisted evacuation of EDHs instead of a conventional craniotomy. Methods: Seven patients with sub-acute/chronic EDH (six supratentorial and one infratentorial) presented to us 3 to 7 days after low-velocity road traffic accidents with complaints of headache and lethargy. The EDH volumes measured between 20 to 50 ml, and the patients were operated on using a single burr hole made through a small incision. We used 0-, 30- and 70-degree, angulated, rigid, high-definition endoscopes to identify and evacuate the organized clots in the extradural space. Flexible catheters were used for suction and irrigation. After achieving hemostasis, the dura was hitched back to the burr hole site. The wound was closed over a negative suction drain. Results: All patients had prompt recovery from symptoms. Postoperative CT scans showed complete or near complete evacuation of the hematomas. The hospital stay and analgesic requirements were minimal. There was no infective complication or conversion to conventional open surgery. The average time for surgery was 77.8 min, and average blood loss was 328.5 ml. Conclusion: Endoscope-assisted evacuation of sub-acute/chronic EDH is a novel concept, which offers quick relief from symptoms in a minimally invasive fashion and a cosmetically acceptable way. None of the standard principles of surgery are hampered. It avoids extensive dissection of the temporalis or sub-occipital muscles. However, achieving hemostasis can be difficult. Further study and better equipment will validate the procedure. © 2016, Springer-Verlag Wien.


Patidar M.,MGM Medical College and Hospital | Deshmukh A.,MGM Medical College and Hospital | Khedkar M.,MGM Medical College and Hospital
Indian Journal of Dermatology | Year: 2016

Background: Acne vulgaris is the most common disease of the skin affecting adolescents and young adults causing psychological distress. The combination of antibiotic resistance, adverse effects of topical and systemic anti acne medications and desire for high tech approaches have all led to new enthusiasm for light based acne treatment. Intense pulse light (IPL) therapy has three modes of action in acne vulgaris i.e., photochemical, photo thermal and photo immunological. Aims: (1) to study efficacy of IPL therapy in facial acne vulgaris. (2) To compare two fluences - one normal and other subnormal on right and left side of face respectively. Methods: (Including settings and design and statistical analysis used). Total 45 patients in age group 16 to 28 years with inflammatory facial acne vulgaris were included in prospective study. Baseline data for each patient was recorded. All patients were given 4 sittings of IPL at 2 weeks interval and were followed for 2 months every 2 weeks. Fluence used was 35J/cm2 on right and 20J/cm2 on left side. Percentage reduction in lesion count was calculated at each sitting and follow up and graded as mild (0-25%), moderate (26-50%), good (51-75%) and excellent (76-100%). Side effects were noted. The results were analysed using Mann-Whitney Test. Results: On right side, excellent results were achieved in 10(22%), good in 22(49%) and moderate in 13(29%) patients. On left side excellent were results achieved in 7(15%), good in 19(42%) and moderate in 16(43%) patients. There was no statically significant difference noted in efficacy of two fluences used in treatment of facial acne vulgaris. Conclusions: IPL is a effective and safe option for inflammatory acne vulgaris with minimal reversible side effects. Subnormal fluence is as effective as normal fluence in Indian skin. © 2016 Indian Journal of Dermatology | Published by Wolters Kluwer - Medknow.


Reddy S.N.,MGM Medical College and Hospital | Reddy S.N.,MGM Hospital for Children | Seth B.A.,MGM Medical College and Hospital | Colaco P.,MGM Medical College and Hospital
Indian Journal of Pediatrics | Year: 2011

Jeune syndrome or Asphyxiating Thoracic Dystrophy presenting clinically with hepatic manifestations is rarely seen. Very few cases of liver involvement have been reported antemortem. The authors report a three-month-old child with Jeune syndrome who presented with prolonged neonatal cholestasis and normal stools. © 2011 Dr. K C Chaudhuri Foundation.


Ganguly B.B.,MGM New Bombay Hospital | Kadam N.N.,MGM Medical College and Hospital
Mutation Research - Reviews in Mutation Research | Year: 2016

The plethora of knowledge gained on myelodysplastic syndromes (MDS), a heterogeneous pre-malignant disorder of hematopoietic stem cells, through sequencing of several pathway genes has unveiled molecular pathogenesis and its progression to AML. Evolution of phenotypic classification and risk-stratification based on peripheral cytopenias and blast count has moved to five-tier risk-groups solely concerning chromosomal aberrations. Increased frequency of complex abnormalities, which is associated with genetic instability, defines the subgroup of worst prognosis in MDS. However, the independent effect of monosomal karyotype remains controversial. Recent discoveries on mutations in RNA-splicing machinery (SF3B1, SRSF2, ZRSR2, U2AF1, U2AF2); DNA methylation (TET2, DNMT3A, IDH1/2); chromatin modification (ASXL1, EZH2); transcription factor (TP53, RUNX1); signal transduction/kinases (FLT3, JAK2); RAS pathway (KRAS, NRAS, CBL, NF1, PTPN11); cohesin complex (STAG2, CTCF, SMC1A, RAD21); DNA repair (ATM, BRCC3, DLRE1C, FANCL); and other pathway genes have given insights into the independent effects and interaction of co-occurrence of mutations on disease-phenotype. RNA-splicing and DNA methylation mutations appeared to occur early and are reported as 'founder' mutations in over 50% MDS patients. TET2 mutation, through altered DNA methylation, has been found to have independent prognostic response to hypomethylating agents. Moreover, presence of DNMT3A, TET2 and ASXL1 mutations in normal elderly individuals forms the basis of understanding that accumulation of somatic mutations may not cause direct disease-development; however, cooperation with other mutations in the genes that are frequently mutated in myeloid and other hematopoietic cancers might result in clonal expansion through self-renewal and/or proliferation of hematopoietic stem cells. Identification of small molecules as inhibitors of epigenetic mutations has opened avenues for tailoring targeted drug development. The recommendations of a Clinical Advisory Committee is being considered by WHO for a revised classification of risk-groups of MDS, which is likely to be published in mid 2016, based on the new developments and discoveries of gene mutations. © 2016 Elsevier B.V.

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