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Mumbai, India

Arsiwala S.,Saifee Hospital
Indian Journal of Dermatology, Venereology and Leprology

Moderate to severe psoriasis often needs to be addressed with standard disease modifying therapies such as methotrexate, cyclosporine, acitretin or ultraviolet radiation, which have their potential benefits and limitations. The tumor necrosis factor-alpha (TNF-α) is elevated in psoriatic plaques compared to non lesional skin as well as in the plasma of patients with moderate to severe psoriasis. Infliximab, a TNF-α blocker, has been recommended for the treatment of moderate to severe plaque psoriasis in adults who have failed to respond to these therapies or who cannot tolerate them. Its specific action on the bound and membrane forms of the pro-inflammatory cytokine TNF-α has made it the molecule of choice for obtaining quicker and longer remission in recalcitrant cases. However, the widespread use of infliximab in the Indian subcontinent is limited by its cost. This article reviews the international guidelines for use of infliximab, its dosage patterns, and efficacy in chronic plaque psoriasis, nail psoriasis, erythrodermic psoriasis, and pustular psoriasis as well as Indian experience. Source

Cornelio S.J.,Saifee Hospital | Nayak B.S.,Manipal University India | George A.,Manipal University India
Indian Journal of Palliative Care

Introduction: Childhood cancer is the leading cause of death among children. Leukemia is one of the most common childhood cancers. Objective: The objective of this study was to explore the experiences of mothers on parenting children with leukemia. Materials and Methods: A qualitative approach with phenomenological design was used. To collect depth information from the mothers of children with leukemia, purposive sampling technique was adopted. Data were collected from ten mothers. Semi-structured interview schedule was used to collect the data. Data were analyzed using Husserl's method. Result: The themes derived are the pivotal moment in life, the experience of being with a seriously ill child, having to keep distance with the relatives, overcoming the financial and social commitments, responding to challenges, experience of faith as being key to survival, health concerns of the present and future, and optimism. Conclusion: The study concluded that chronic illness such as leukemia in children results in negative impact on the child and on the mother. © 2016 Indian Journal of Palliative Care Published by Wolters Kluwer - Medknow. Source

Sheikh P.,Saifee Hospital | Sheikh P.,Nova Specialty Center
Indian Journal of Surgery

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications-recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies. © 2012 Association of Surgeons of India. Source

Sankhla S.K.,Dr. Balabhai Nanavati Hospital and Saifee Hospital | Khan G.M.,Saifee Hospital
Neurology India

Background and Objectives: The endoscopic transsphenoidal approach is commonly used surgical approach for pituitary adenomas. However, adenomas with dumbbell configuration, pure suprasellar location, and fibrous consistency are difficult to remove by this approach. Recently, the extended endoscopic endonasal approach (EEEA) has been utilized to excise this subgroup of pituitary adenomas successfully. Materials and Methods: Between January 2009 and December 2011, 13 patients with pituitary macroadenomas were treated with EEEA. The tumor subgroups included: Dumbbell tumor configuration (4), pure suprasellar tumor location (2), and large suprasellar tumors with subfrontal extension (2). Five patients had fibrous/recurrent tumors and required addition of transtubercular-transplanum extension to the standard endoscopic endonasal exposure for radical resection. Results: The tumor removal was gross total in 8 (61.5%) patients, subtotal in 4 (30.7%), and partial in 1 (7.7%) patient. Clinical improvement was observed in almost all patients, immediate relief in headaches in 88% and normalization of vision in 90% of patients with pre-operative visual disturbances. Three patients with secreting adenomas, two with growth hormone-secreting adenomas and one with prolactin-secreting adenoma, had normalization of hormonal status. Three patients developed temporary diabetes insipidus two patients suffered transient ischemic attacks and one patient with a recurrent giant pituitary adenoma experienced a serious injury to the perforating artery. Four patients (30.7%) developed post-operative cerebrospinal rhinorrhea and two patients required surgical repair. Conclusions: Our early experience suggests that the EEEA offers a potentially viable treatment option in certain pituitary tumors which are difficult to remove by the standard endoscopic approaches. However, longer follow-up and larger series are needed to establish the efficacy of this approach. Source

Lee W.-J.,Min Sheng General Hospital | Hur K.Y.,Soonchunhyang University | Lakadawala M.,Saifee Hospital | Kasama K.,Yotsuya Medical Cube | And 3 more authors.
Journal of Gastrointestinal Surgery

Background: Gastrointestinal metabolic surgery has been proposed for the treatment of not well-controlled type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) <35 kg/m 2. This study aims to describe recent experience with surgical treatment of T2DM in Asian centers. Methods: Patients aged 20 to 70 years with not well-controlled T2DM [glycated hemoglobin (HbA1C) >7. 0%] and BMI < 35 kg/m 2 were included at five institutes between 2007 and 2010. The end point is T2DM remission, defined by fasting plasma glucose <110 mg/dl and HbA1C <6. 0%. Results: Of the 200 patients, 172 (86%) underwent gastric bypass, 24 (12%) underwent sleeve gastrectomy, and the other 4 underwent adjustable banding. Laparoscopic access was used in all the patients. Gender (66. 5% female), age (mean 45. 0 ± 10. 8), and HbA1C (mean 9. 3 ± 1. 9%) did not differ between the procedure among the groups. Until now, 87 patients had 1-year data. One year after surgery, the mean BMI decreased from 28. 5 ± 3. 0 to 23. 4 ± 2. 3 kg/m 2 and HbA1C decreased to 6. 3 ± 0. 5%. Remission of T2DM was achieved in 72. 4% of the patients. Patients with a diabetes duration of <5 years had a better diabetes remission rate than patients with duration of diabetes >5 years (90. 3% vs. 57. 1%; p = 0. 006). Patients with BMI > 30 kg/m 2 had a better diabetes remission rate than those with BMI < 30 kg/m 2 (78. 7% vs. 62. 5%; p = 0. 027). Individuals who underwent gastric bypass loss more weight and had a higher diabetes remission rate than individuals who underwent restrictive-type procedures. Multivariate analysis confirmed that the duration of diabetes and the type of surgery predict the diabetes remission. No mortalities were reported and two (1. 0%) patients had major morbidities. Conclusion: Gastrointestinal metabolic surgery is an effective treatment for not well-controlled T2DM treatment. Diabetes remission is significantly higher in those with duration of diabetes less than 5 years and BMI > 30 kg/m 2. © 2011 The Society for Surgery of the Alimentary Tract. Source

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