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Dhawan H.K.,PGIMER | Kumawat V.,Government Medical College | Marwaha N.,PGIMER | Sharma R.R.,PGIMER | And 4 more authors.
Asian Journal of Transfusion Science | Year: 2014

Background: The development of anti-red blood cell antibodies (both allo-and autoantibodies) remains a major problem in thalassemia major patients. We studied the frequency of red blood cell (RBC) alloimmunization and autoimmunization among thalassemia patients who received regular transfusions at our center and analyzed the factors, which may be responsible for development of these antibodies. Materials and Methods: The study was carried out on 319 multiply transfused patients with β-thalassemia major registered with thalassemia clinic at our institute. Clinical and transfusion records of all the patients were examined for age of patients, age at initiation of transfusion therapy, total number of blood units transfused, transfusion interval, status of splenectomy or other interventions. Alloantibody screening and identification was done using three cell and 11 cell panel (Diapanel, Bio-rad, Switzerland) respectively. To detect autoantibodies, autocontrol was carried out using polyspecific coombs (IgG + C3d) gel cards. Results: Eighteen patients out of total 319 patients (5.64%) developed alloantibodies and 90 (28.2%) developed autoantibodies. Nine out of 18 patients with alloantibodies also had autoantibodies. Age at first transfusion was significantly higher in alloimmunized than non-immunized patients (P = 0.042). Out of 23 alloantibodies, 52.17% belonged to Rh blood group system (Anti-E = 17%, Anti D = 13%, Anti-C = 13%, Anti-C w = 9%), 35% belonged to Kell blood group system, 9% of Kidd and 4% of Xg blood group system. Conclusion: Alloimmunization was detected in 5.64% of multitransfused thalassemia patients. Rh and Kell blood group system antibodies accounted for more than 80% of alloantibodies. This study re-emphasizes the need for RBC antigen typing before first transfusion and issue of antigen matched blood (at least for Rh and Kell antigen). Early institution of transfusion therapy after diagnosis is another means of decreasing alloimmunization. © 2014 Asian Journal of Transfusion Science. All right reserved.

Bansal C.,Ispat General Hospital | Lakshmaiah V.,Sri Devaraj Urs Medical College | Raavesha A.,Sri Devaraj Urs Medical College | Waadhawan P.,RML Hospital | Priyanka M.K.,Sri Devaraj Urs Medical College
Journal of Association of Physicians of India | Year: 2013

Tuberous sclerosis is 2nd most common neurocutaneous syndrome. Bilateral renal angiomyolipoma in tuberous sclerosis is a rare entity. Reporting two cases of tuberous sclerosis with bilateral renal angiomyolipomas. © JAPI.

Grover G.,University of Delhi | Gadpayle A.K.,RML Hospital | Sabharwal A.,University of Delhi
Biomedical Research (India) | Year: 2012

Diabetes affects more than 170 million people worldwide and the number will rise to 370 million people by 2030. About one third of those affected, will eventually have progressive deterioration of renal function. To estimate progression of renal disease among type -2 diabetic population, with Serum Creatinine (SrCr), in the presence of covariates: fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and low density lipoprotein (LDL), duration of disease and age at which diabetes was diagnosed. Retrospective data collected from 132 patients, who were diagnosed as diabetic as per ADA standards with or without diabetic complications. Multiple linear regression (MLR) and logistic regression models are adopted here to estimate and predict SrCr, a well-accepted marker for the progression of diabetic nephropathy (DN). The fitted multiple linear regression models are found to be statistically significant, with p <. 001, Fitted logistic models have 88.5% and 84.7% predictive power to assess the renal disease based on mean values of predictors and last record of predictors, respectively. We conclude from the models, which are based on mean values of records, that high blood glucose and high blood pressure along with duration of diabetes are the main contributors for estimating SrCr and predicting diabetic nephropathy. Similar results are concluded from the models which are based on last records of predictors except that LDL is also a significant factor for estimating renal health and DN.

Kumar A.,RML Hospital | Rai A.,Jamia Millia Islamia University | Jha N.K.,RIMS
Hong Kong Journal of Nephrology | Year: 2014

Introduction The association between surgical jaundice and postoperative acute renal failure (ARF) has been recognized since long. Obstructive (surgical) jaundice is a common entity, and patients undergoing surgery have a constant risk of developing ARF, and this may raise the mortality figures to an alarming level. Materials and methods The present study included 50 patients of obstructive jaundice aged between 10 and 70 years. The patients were evaluated in detail, and data collection was performed using a structured questionnaire. Patients were investigated using routine laboratory investigations of blood, urine, and stool, liver function tests, renal function tests, and radiological investigations. All important tests related to liver function and renal functions were done on the 1st day of admission, 3rd day of admission, 2nd postoperative day, 7th postoperative day, and 14th postoperative day - if renal function derangements were found. Results According to the diagnostic criteria of the present series 74% of patients showed renal failure on the 2nd postoperative day. In the present series, out of seven, four renal parameters, namely serum creatinine, specific gravity, inulin clearance, and blood urea were found to show statistically significant difference in values preoperatively and postoperatively. It was observed that there was a statistically significant difference in the serum bilirubin values among patients of renal failure. Conclusion Each case of surgical jaundice should be considered as a potential case likely to pass in acute renal failure, and hence, a close monitoring of renal functions should be started at the very beginning and should be continued until the final outcome of the treatment. © 2014, Hong Kong Society of Nephrology Ltd. Published by Elsevier Taiwan LLC. All rights reserved.

Saraswat N.,Lady Hardinge Medical College | Kumar A.,SN Medical College | Mishra A.,RML Hospital | Gupta A.,SN Medical College | And 2 more authors.
Indian Journal of Anaesthesia | Year: 2011

Aims to compare the efficacy of Proseal laryngeal mask airway (PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic surgeries under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and vecuronium. PLMA or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N 2O, O 2, halothane and vecuronium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. There was no failed insertion of devices. Time taken for successful passage of NGT was 9.77 s (6-16 s) and 11.5 s (8-17 s) for groups P and E, respectively. There were no statistically significant differences in oxygen saturation (SpO 2) or end-tidal carbon dioxide (EtCO 2) between the two groups before or during peritoneal insufflation. Median (range) airway pressure at which oropharyngeal leak occurred during the leak test with PLMA was 35 (24-40) cm of H 2O. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. No significant difference in laryngopharyngeal morbidity was noted. A properly positioned PLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic surgeries. It provided equally effective pulmonary ventilation despite high airway pressures without gastric distention, regurgitation, and aspiration.

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