Gupte N.,Johns Hopkins University |
Kinikar A.,Johns Hopkins University |
Kinikar A.,Sassoon General Hospitals |
McIntire K.N.,Johns Hopkins University |
And 8 more authors.
PLoS ONE | Year: 2016
Latest World Health Organization guidelines recommend weight-based nevirapine prophylaxis for all HIV-exposed infants in resource-limited settings, yet low birth weight (LBW) infants (< 2500 g) have been understudied. Using data from the NIH-funded India six-week extended-dose nevirapine (SWEN) study, a randomized clinical trial of SWEN versus single-dose nevirapine (SD) for prevention of breast-milk HIV-1 transmission, we examined the relative impact of SWEN among 737 mother-infant pairs stratified by infant birth weight. Birth weight groups were defined as very LBW (VLBW) ô 2000 g, moderate LBW (MLBW) >2000 g and ô 2500 g, and normal birth weight (NBW) > 2500 g. Outcomes were HIV-1 infection, HIV-1 infection or death by 12 months, and severe adverse events (SAEs). The Kaplan-Meier method was used to estimate probability of efficacy outcomes in birth weight groups, and differential effects of SWEN by birth weight group were examined using Cox proportional hazards models adjusting for independent risk factors for HIV maternal-to-child transmission and significant covariates. Among 50 VLBW, 249 MLBW, and 433 NBW infants, 50% were randomized to SWEN; median gestational age was 36, 38 and 38 weeks, respectively; and there was no difference in breastfeeding duration (p = 0.99). Compared to SD: SWEN-treated VLBW had lower estimates of HIV-1 infection (13% vs. 38%, p = 0.004) and HIV-1 infection or death (13% vs. 41%, p = 0.002); SWENtreated MLBW had lower estimated HIV-1 infection (13% vs. 17%, p = 0.042); and efficacy endpoints were similar by treatment arm in NBW. In multivariate analysis, SWEN was associated with reduced risk of HIV-1 infection or death by 83% (p = 0.03) in VLBW versus 45% (p = 0.05) in MLBW. SAE frequency was similar by treatment arm in VLBW (68% vs. 76%, p = 0.53) and MLBW (37% vs. 36%, p = 0.93). SWEN may safely increase HIV-free survival among HIV-exposed LBW infants with greatest protective advantage among infants ô 2000 g. © 2016 Gupte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Kadam D.B.,Sassoon General Hospitals |
Chadha M.,National Institute of Virology
Journal of Association of Physicians of India | Year: 2011
We present a case of 16 year old female admitted with complaints of influenza like symptoms followed by convulsions and sudden impairment of consciousness. Magnetic resonance imaging abnormalities were found in bilateral thalami including cerebellum. Diagnosis of influenza associated acute necrotizing encephalopathy was made on the basis of clinical features, neuroimaging findings and isolation of influenza A(H3N2) virus from throat swab. This is probably first case of Influenza associated acute necrotizing encephalopathy reported in India in 2009.
Chugh A.P.,Sassoon General Hospitals |
Gandhoke C.S.,Sassoon General Hospitals |
Mohite A.G.,Sassoon General Hospitals |
Khedkar B.V.,Megavision Labs
Surgical Neurology International | Year: 2014
Background: Angiosarcomas are rare high grade endothelial tumors characterized by rapidly proliferating anaplastic cells derived from blood vessels and lining irregular blood filled spaces. Primary neoplasms of the skull are rare, representing 2.6% of primary neoplasms of bone. Primary malignant neoplasms of the skull are even rarer, accounting for only 0.8% of primary malignant neoplasms of bone. Copyright:Case Description: We report a 32-year-old female who presented with right parieto-occipital swelling, which gradually increased in size. Radiology was suggestive of a calvarial soft tissue lesion in the right parieto-occipital region with destruction of the adjacent parieto-occipital bone with intracranial extra-axial extension. Complete surgical excision of the calvarial lesion was done under general anesthesia. Postoperative computed tomography (CT) scan of brain (plain and with contrast) showed complete excision of the tumor mass. Histopathological diagnosis was consistent with 'an angiosarcoma of the skull'. On immunohistochemistry, the atypical endothelial cells were highlighted by CD34, CD31, and factor VIII-related antigen. The patient received adjuvant radiotherapy to the tumor bed.Conclusion: Primary angiosarcoma of the skull is a rare tumor with less than 20 cases reported worldwide till date. The treatment should include complete surgical excision with a wide bony margin followed by adjuvant radiotherapy, which in our case has given a good locoregional control even at the end of 2 years. However, these patients should be followed up with repeated scans yearly to rule out locoregional as well as distant recurrence. © 2014 Chugh AP.
Sahasrabudhe P.,Deenanath Mangeshkar Hospital and Sassoon General Hospitals |
Panse N.,Sassoon General Hospitals |
Waghmare C.,Sassoon General Hospitals |
Waykole P.,Sassoon General Hospitals
Indian Journal of Surgery | Year: 2012
We report our experience of technique of V-Y-plasty in treatment of pilonidal sinus. A retrospective study of 25 patients performed from 2005 to 2010 at Deenanath Mangeshkar Hospital and Sassoon General Hospitals, Pune, was performed. The unilateral or bilateral V-Y advancement flap technique was used in the management of these patients. The outcome was assessed on the basis of efficacy of flap surgery in achieving wound healing and recurrence. The follow-up ranged from 6 months to 5 years. The study included 25 cases of pilonidal sinus. Nineteen patients (76%) underwent unilateral V-Y-plasty and six patients (24%) underwent bilateral V-Y-plasty. Eighty-four percent cases were from the age group of 21-30 years. Sixty-eight percent patients were mobilized on the fourth postoperative day and 32% patients were mobilized on the third postoperative day. No recurrence was found in any of the patients. Itching and hypertrophic scar were found in two cases (8%), and decreased sensation was found in one patient (4%). The V-Y advancement flap technique for the treatment of pilonidal sinus is efficient and can reduce recurrence. Unilateral/bilateral V-Y flap achieves suture line away from midline, obliteration of natal fold and coverage of defect without tension. In follow-up none of the patients showed recurrence. This technique has distinctly less morbidity and avoids of multiple dressings, reducing the total cost of the treatment. V-Y advancement flap is distinctly better choice among the available flaps as it is less time-consuming, requires less technical expertise as compared to Z-plasty and perforator flaps, and is reliable and easy to plan. © 2012 Association of Surgeons of India.
Karne S.S.,Sassoon General Hospitals |
Sangle S.A.,Sassoon General Hospitals |
Kiyawat D.S.,Sassoon General Hospitals |
Dharmashale S.N.,Sassoon General Hospitals |
And 2 more authors.
Annals of Indian Academy of Neurology | Year: 2012
Mycobacterial opportunistic infections are a major cause of morbidity and mortality among patients living with HIV (PLHIV) worldwide. Nontuberculous mycobacterial (NTM) infection is one of the leading causes of opportunistic infection in patients with advanced acquired immunodeficiency syndrome i.e., with CD4 count less than 50/cu.mm. Mycobacterium avium complex (MAC) is among the most common opportunistic bacterial infections in those patients with advanced immunodeficiency apart from cryptococcal meningitis, progressive multifocal leukoencephalopathy, etc. Common presentations of mycobacterium avium complex are fever, lymphadenitis and respiratory disease. Immune reconstitution disease is also known to manifest with MAC infections in PLHIV on highly active antiretroviral therapy. Very few cases of central nervous system involvement due to NTM infection have been described. We are reporting a case of advanced acquired immunodeficiency who presented with brain abscess due to Mycobacterium avium intracellulare.
Kunte A.R.,Sassoon General Hospitals |
Dube V.S.,Sassoon General Hospitals |
Balwantkar S.S.,Sassoon General Hospitals |
Kulkarni K.K.,Sassoon General Hospitals
International Journal of Surgery Case Reports | Year: 2015
INTRODUCTION Primary hyperparathyroidism is usually seen in females above the age of 50 years, with a prevalence of 21/1000,1 whereas the incidence in patients aged 12-28 years is less than 5%.2 A solitary adenoma is responsible for 80% of cases of primary hyperparathyroidism.3 Primary hyperparathyroidism is most commonly asymptomatic.4 The incidence of acute pancreatitis associated with hyperparathyroidism is less than 10%.5,6 The incidence of hyperparathyroidism associated with a Brown tumour is less than 5%.7 PRESENTATION OF CASE A 19 year old female patient presented with recurrent acute pancreatitis and swelling over the mandible. Complete investigative workup revealed a solitary parathyroid adenoma causing hyperparathyroidism. Surgical exploration with excision of the parathyroid adenoma was performed, following which the patient recovered uneventfully. DISCUSSION The patient was initially managed as a case of acute pancreatitis, and although not suspected initially, a high index of suspicion for hyperparathyroidism developed after a biopsy of the mandibular swelling showed the presence of osteoclastic giant cells indicating the possibility of a Brown tumour. Further investigations then revealed the presence of a solitary parathyroid adenoma with coexistent hyperparathyroidism which was then managed surgically. CONCLUSION The young age of the patient, and her presentation with acute pancreatitis and a Brown tumour of the mandible make this an extremely rare presentation of parathyroid adenoma. © 2014 The Authors.
Shah S.H.,Sassoon General Hospitals |
Sonawane P.,Sassoon General Hospitals |
Nahar P.,Sassoon General Hospitals |
Vaidya S.,Sassoon General Hospitals |
Salvi S.,Chest Research Foundation
Lung India | Year: 2013
Background: Pulmonary complications of diabetes mellitus (DM) have been poorly characterized. Some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients. Some studies have shown abnormal respiratory parameters in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects. We correlated forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV 1) in diabetic patients with duration of the disease and glycosylated hemoglobin (HbA1c). Materials and Methods: Pulmonary function tests (PFTs) were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40-60 years by using Helios 702 spirometer. The PFTs recorded were - FVC, FEV 1 , FEV 1 /FVC, FEF 25 , FEF 50 , FEF 75 , FEF 25-75 , FEF 0.2-1.2 , and peak expiratory flow rate (PEFR). HbA1c of all the patients was estimated by ion exchange resin method, which is a very standard method of estimation. PFTs of diabetic patients and controls were compared by applying Student's unpaired t test. Associations between FVC and FEV 1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson's coefficient. Results: The PFTs were significantly decreased in diabetic patients compared with the healthy controls except FEV 1 /FVC. There was no correlation found between FVC and FEV 1 and duration of illness as well as HbA1c. Conclusion: DM being a systemic disease, which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. We found glycemic levels and duration of disease are probably not the major determinants of lung pathology, which requires further research.
PubMed | & Sassoon General Hospitals
Type: Journal Article | Journal: Indian journal of psychiatry | Year: 2011
Propanidid due to its fast induction, early recovery and absence of cumulative action avoiding post recovery hangover is a useful agent and a better substitute for the established inducing agent, thiopentone It has all the advantages of thiopentone but lacks tbe disadvantages of the same. Its extremely short duration of action suits the short procedure of electroconvulsive therapy which gets over within one or two minutes. Use of propanidid will allow more number of E. C. Ts to be given in out patient department and will help in reducing the load on the hospital staff without compromising the safety of the patients.
Sangle S.A.,Sassoon General Hospitals |
Karne S.S.,Sassoon General Hospitals |
Guthe S.D.,Sassoon General Hospitals |
Lohiya R.V.,Sassoon General Hospitals
Journal, Indian Academy of Clinical Medicine | Year: 2011
Hyperhomocysteinaemia is a common condition predisposing to venous thrombosis. We are reporting a case of hyperhomocysteinaemia with extensive deep vein thrombosis. A 51-year-old female presented with progressive swelling and pain in her left lower limb. She had marked knuckle hyperpigmentation. Her left lower limb arterio-venous doppler was suggestive of thrombosis with absence of flow in the left iliac vein. Haematological investigations were suggestive of hyperhomocysteinaemia. The patient was treated with low molecular weight heparin and oral warfarin along with vitamin supplementation. She went on to make a full recovery, and follow-up arterio-venous doppler showed complete recanalisation with good venous flow.
Mane A.,National Dairy Research Institute |
Gujar P.,Sassoon General Hospitals |
Chandra J.,National Dairy Research Institute |
Lokhande R.,Sassoon General Hospitals |
And 3 more authors.
Mycopathologia | Year: 2015
The present study was undertaken to detect Pneumocystis jirovecii infection among HIV-positive patients presenting with symptoms of lower respiratory tract infection and analyze the associated dihydropteroate synthase (DHPS) and dihydrofolate reductase (DHFR) mutations. P. jirovecii infection was detected in 12.6 % cases. We did not find DHPS gene mutations at the commonest positions of codon 55 and 57; however, mutation at codon 171 was detected in two cases. No mutations in DHFR gene were detected. The results indicate low prevalence of DHPS and DHFR mutations in Indian P. jirovecii isolates, suggesting that the selective pressure of sulfa drugs on the local strains has probably not reached the levels found in developed nations. © 2014, Springer Science+Business Media Dordrecht.