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Tiwari V.K.,VMMC and Safdarjung Hospital
Indian Journal of Plastic Surgery | Year: 2012

Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds.

Sarabahi S.,VMMC and Safdarjung Hospital
Indian Journal of Plastic Surgery | Year: 2012

There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no 'magical dressings'. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Sharma V.,VMMC and Safdarjung Hospital | Dogra A.,Paras Hospitals
Journal of Clinical Orthopaedics and Trauma | Year: 2011

Calcaneum the largest tarsal bone accounts for 60% of all tarsal bone injuries and 2% of all fractures. The management of the calcaneal fractures is still a challenge to orthopedic surgeons. The aim of this study was to establish the best treatment, non-surgical or surgical for Sanders type II fractures.It is a prospective study in which a total of 30 patients in age group of 18-60 years were randomized (by envelope) into non-operative (group A) 15 patients and operative (group B) 15 patients. All type II fractures confirmed on CT were included in the study. Patients with any other associated injuries or with any co-morbidity were excluded from this study. The results were evaluated using Bohler's angle, Kerr Atkins, AOFAS, and visual analog scale.In our series, mode of injury was fall from height in 27 (90%) and road traffic accident (RTA) in 3 (10%). There were 21 males and 9 females. The mean Kerr Atkins score in operative group was 66.12 and in conservative group was 60.22. The mean AOFAS in operative group was 72.13 and in conservative group was 71.16. The visual analog scale in operative group was 1.83 and in conservative group was 2.12. The mean follow-up was 28.1 months. Bohler's angle is a good predictor of morbidity and the improvement after surgery was not statistically significant.It was concluded that there is no significant difference in outcome of treatment, surgical or conservative, and results were equivalent in both groups. © 2011 Delhi Orthopedic Association.

Sharma R.,VMMC and Safdarjung Hospital | Rasania S.K.,VMMC and Safdarjung Hospital | Verma A.,VMMC and Safdarjung Hospital | Singh S.,VMMC and Safdarjung Hospital
Indian Journal of Community Medicine | Year: 2010

Background: Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI). Objective: To study prevalence and response to needle stick injuries among health care workers. Materials and Methods: Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test. Results: A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury. Conclusions: The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.

Sharawat I.K.,VMMC and Safdarjung Hospital | Sitaraman S.,SMS Medical College
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Diminished bone mineral density and delayed skeletal maturation are common in children with spastic quadriplegia. Aim: The purpose of our study was to evaluate the Bone Mineral Density (BMD) of children with moderate to severe spastic quadriplegia and its relationship with other variables like nutrition and growth. Materials and Methods: This was a hospital based, cross- sectional, case-control study. Forty-two (28 males, 14 females) children with spastic quadriplegia and 42 (24 males, 18 females) healthy children were included in the study. BMD of cases and control were measured by Dual Energy X-ray Absorptiometry (DEXA). Radiographs of left hand and wrist of cases and controls were taken and bone age was determined. Results: BMD values of upper extremity, lower extremity, thoraco-lumbar spine and pelvis in cases were lower than those of controls (p <0.0001). In children with non severe malnutrition, 75% of the cases had lower bone age than chronological age, whereas all cases with severe malnutrition had lower bone age than chronological age. Step wise regression analysis showed that nutritional status independently contributed to lower BMD values but the BMD values did not correlate significantly with the use of anticonvulsant drugs and presence of physical therapy. Conclusion: Decreased BMD and delayed bone age is prevalent in children with spastic quadriplegia and nutritional status is an important contributing factor. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.

Sharma S.,VMMC and Safdarjung Hospital | Gupta R.,VMMC and Safdarjung Hospital | Sehgal R.,VMMC and Safdarjung Hospital | Aggarwal K.C.,VMMC and Safdarjung Hospital
Journal of Tropical Pediatrics | Year: 2014

Posterior reversible encephalopathy, better known as potential reversible encephalopathy syndrome (PRES), is a clinicoradiological entity mostly described in adult populations manifesting predominantly as bilateral symmetrical diffuse white matter vasogenic oedema in parieto-occipital regions. Rarely it may also present as patchy reversible areas of involvement in the basal ganglia, brainstem and deep white matter. It is reported scarcely in childhood populations. Frequent association with acute hypertension (67-80%) is reported in many studies. Involvement of the brainstem and cervical cord (apart from the typical parieto-occipital lesions) is an extremely rare imaging manifestation of PRES and its recognition is important to avoid misdiagnosis as myelitis or acute disseminated encephalomyelitis by proper clinical correlation. We hereby report a case of PRES in a 7-year-old child showing an uncommon pattern on imaging study involving the brain as well as the brainstem and cervical spinal cord. © The Author [2014]. Published by Oxford University Press. All rights reserved.

Kumar A.,VMMC and Safdarjung Hospital | Vasudecny CHNa P.,VMMC and Safdarjung Hospital | Kumar N.,VMMC and Safdarjung Hospital | Nanda B.,VMMC and Safdarjung Hospital | And 2 more authors.
Journal of Endourology | Year: 2013

Purpose: The first prospecticny CHNe randomized study to compare the safety and short-term efficacy of monopolar transurethral resection of the prostate (TURP), bipolar TURP, and photoselecticny CHNe cny CHNaporization of the prostate (PVP) using GreenLight high-performance system 120W laser in patients who presented with benign prostatic obstruction (BPO). Patients and Methods: The 186 consecuticny CHNe patients who presented with BPO and who were planned for surgery were randomized into three groups: Group A, patients who underwent monopolar TURP; group B, patients who underwent bipolar TURP; and group C, patients who underwent PVP. All three groups were subdicny CHNided into two subgroups based on prostate cny CHNolume: Subgroup 1 >20 cc and <50 cc, and subgroup 2, between 50 and 80 cc. Patients preoperaticny CHNe, perioperaticny CHNe, and follow-up data were recorded and analyzed. Results: The baseline characteristics of the three groups and subgroups 1 and 2 were comparable. The number of patients in whom postoperaticny CHNe irrigation was instituted, amount of fluid used for postoperaticny CHNe irrigation, duration of postoperaticny CHNe irrigation, postoperaticny CHNe hemoglobin concentration, and duration of catheterization were significantly in facny CHNor of group C patients except for the mean operaticny CHNe time, which was significantly longer among them. All three groups demonstrated an increase in International Prostate Symptom Score, quality of life score, and maximum flow rate and decrease in prostate cny CHNolume and postcny CHNoid residual urine at 12-month follow-up. The mean Intgernational Index of Erectile Function-5 score did not show improcny CHNement in any group. The need for blood transfusion and clot retention necessitating intercny CHNention were significantly lower among group C patients compared with group A, whereas these cny CHNalues for group B patients did not reach significant lecny CHNel compared with either group A or C. These complications were comparable among subgroup 1 patients, whereas subgroup 2 patients had shown results in facny CHNor of subgroup C2. Conclusion: Monopolar TURP, bipolar TURP, and PVP are equally efficacious at 12-month follow-up. PVP has added adcny CHNantages of lesser blood loss, lesser need for blood transfusion (especially for prostate cny CHNolume 50-80 cc), and shorter catheterization time. © Mary Ann Liebert, Inc.

Mishra A.,Central Institute of Orthopedics | Sharma P.,Central Institute of Orthopedics | Chaudhary D.,VMMC and Safdarjung Hospital
Indian Journal of Orthopaedics | Year: 2012

Background: The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. Materials and Methods: Sixty five patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. Results: Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre-and postoperative range of external rotation was 80.38 and 75.18, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. Conclusion: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.

Bansal S.,VMMC and Safdarjung Hospital | Dharra N.,VMMC and Safdarjung Hospital
Journal of Cancer Research and Therapeutics | Year: 2015

Primary bone lymphoma (PBL) is a relatively uncommon entity. It represents approximately 5% of all non-Hodgkin lymphomas (NHLs) and 3% of all bone malignancies. The femur, tibia, and pelvis are the most common skeletal sites involved. It can occur at any age, with a peak incidence in the fourth and fifth decades.The most common grade identified is intermediate, followed by low-grade lesions. It can mimic other disease processes, especially infection. So, thorough and prompt investigatory workup is essential for adequate treatment. Localized disease responds well to combined modality treatment with chemotherapy and radiotherapy and is associated with good prognosis. We discuss the clinical findings, diagnosis, and treatment in a case of PBL involving the talus. This is an unique clinical presentation owing to its unusual site.

Azad K.,Vmmc And Safdarjung Hospital | Khunger J.M.,Vmmc And Safdarjung Hospital
Indian Journal of Pathology and Microbiology | Year: 2010

Adult granulosa cell tumors (AGCT) are associated with ascites in 10% of the cases. Although these tumors form two per cent of all ovarian tumors, they may create a diagnostic challenge in cytologic preparations. The tumor cells are not readily shed in the fluid. A case of a 47-year-old woman with presence of granulosa tumor cells in ascitic fluid is presented. Because of its rarity, AGCTs can be confused with other ovarian tumors.

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