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Sharma S.S.,Sawai Man Singh Medical College | Jain M.,Sawai Man Singh Medical College | Maharshi S.,Rukmani Birla Hospital and Research Institute
Indian Journal of Gastroenterology | Year: 2017

Background: Endoscopic ultrasound (EUS) is a well-established modality in diagnosing and staging of various neoplastic and non-neoplastic lesions. Its accuracy further increases in the presence of an on-site cytopathologist. There is a paucity of data on diagnostic yield of EUS-guided fine needle aspiration cytology (FNAC) without an on-site cytopathologist. Methods: Retrospective data were analyzed at SMS Medical College, Jaipur, from January 2014 to October 2015. All patients who underwent EUS-guided FNAC in the Department of Gastroenterology were included. Data related to demography, lesion parameters on EUS, and histology were analyzed. Results: Two hundred patients (age 46.2±18.6, 144 male) were studied. EUS-FNAC slides from 162 (82%) were considered adequate by cytopathologist for the diagnosis of benign or malignant lesions. Slide preparation adequacy was 100% for mediastinal and renal and suprarenal masses, 87.06% for pancreatic, 73.46% for lymph nodes, and 88.88% for other lesions. Mean number of passes was 1.92±0.82. Conclusions: Diagnostic yield of EUS-guided FNAC is high even in the absence of on-site cytopathologist. © 2017 Indian Society of Gastroenterology


Sharma S.K.,AIIMS | Solanki R.,Sir Byramjee Jeejeebhoy Medical College | Mohan A.,Sri Venkateswara Institute of Medical Sciences | Jain N.K.,Sawai Man Singh Medical College | Chauhan L.S.,National Center for Disease Control
International Journal of Tuberculosis and Lung Disease | Year: 2012

OBJECTIVES: To study the efficacy and safety of Category III DOTS treatment (intermittent thrice-weekly rifampicin [RMP], isoniazid [INH] and pyrazinamide for 2 months, followed by RMP and INH for 4 months) under India's Revised National Tuberculosis Control Programme in patients with uncomplicated small unilateral pleural effusion (<1500 ml). DESIGN: This prospective, multicentre, observational study recruited 351 patients between 2006 and 2010. Patients were regularly followed up clinically as well as with ultrasound examination of the chest. RESULTS: Successful outcome (clinical response with complete resolution on ultrasound examination at 6 months) was seen in 274 patients (78.1%). Efficacy was 88.9% (excluding defaulters), and 94% among those completing follow-up as per protocol. None of the patients received corticosteroids. Other outcomes included treatment extension (n = 26, 7.4%), default (n = 43, 12.2%), treatment failure (n = 3, 0.9%) and death (n = 3, 0.9%). Seventy-nine mild/moderate adverse events and one treatment-related serious adverse event were noted; one patient developed recurrent drug-induced hepatotoxicity. Two patients (0.7%) had relapse/re-infection at 24 months follow-up. CONCLUSION: Intermittent thrice-weekly treatment for 6 months with three drugs in the intensive phase is effective and safe for unilateral small pleural effusion in immunocompetent patients. Although Category III no longer exists in the programme, the results are reassuring for intermittent treatment in extra-pulmonary TB under programme conditions. © 2012 The Union.


Ahmad R.,Sawai Man Singh Medical College | Chana R.S.,Jawaharlal Nehru Medical College | Ali S.M.,Sawai Man Singh Medical College | Khan S.,Jawaharlal Nehru Medical College
Urology Annals | Year: 2011

Objectives: To evaluate the effect of parenteral testosterone on penile length, preputial skin and side effects in patients with hypospadias. Materials and Methods: 23 patients with hypospadias were included in this study. An oily solution, each ml of which contained testosterone propionate 25 mg, and testosterone enanthate 110 mg, equivalent to 100 mg of testosterone was given deep intramuscularly 4, 3 and 2 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Increase in penile length, transverse preputial diameter, and diameter at the base of penis were noted. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. In addition, side effect such as development of pubic hair and delay in bone age was noted. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial diameter and diameter at the base of penis was 1.350.40 cm (P<0.001), 1.400.47 cm (P<0.001), and 0.720.47 cm (P<0.001), respectively. Serum testosterone level after injection was well within normal range for that age. Minimal side effects were noted in form of development of fine pubic hair. Conclusion: We conclude that parenteral testosterone can be safely used to improve the surgical outcome of hypospadias repair.


Sinha A.,All India Institute of Medical Sciences | Saha A.,Ram Manohar Lohia Hospital | Kumar M.,Chacha Nehru Bal Chikitsalaya | Sharma S.,All India Institute of Medical Sciences | And 5 more authors.
Kidney International | Year: 2015

While studies show that prolonged initial prednisone therapy reduces The frequency of relapses in nephrotic syndrome, they lack power and have risk of bias. In order to examine The effect of prolonged therapy on frequency of relapses, we conducted a blinded, 1:1 randomized, placebo-controlled trial in 5 academic hospitals in India on 181 patients, 1-12 years old, with a first episode of steroid-sensitive nephrotic syndrome. Following 12 weeks of standard therapy, in random order, 92 patients received tapering prednisolone while 89 received matching-placebo on alternate days for The next 12 weeks. On intention-to-treat analyses, primary outcome of number of relapses at 1 year was 1.26 in The 6-month group and 1.54 in The 3-month group (difference-0.28; 95% confidence interval (CI)-0.75, 0.19). Relative relapse rate for 6-vs. 3-month therapy, adjusted for gender, age, and time to initial remission, was 0.70 (95% CI 0.47-1.10). Similar proportions of patients had sustained remission, frequent relapses, and adverse effects due to steroids. Adjusted hazard ratios for first relapse and frequent relapses with prolonged therapy were 0.57 (95% CI, 0.36-1.07) and 1.01 (95% CI, 0.61-1.67), respectively. Thus, extending initial prednisolone treatment from 3 to 6 months does not influence The course of illness in children with nephrotic syndrome. These findings have implications for guiding The duration of therapy of nephrotic syndrome. © 2015 International Society of Nephrology.


Jain P.,CSIR - Central Electrochemical Research Institute | Vig S.,CSIR - Central Electrochemical Research Institute | Datta M.,CSIR - Central Electrochemical Research Institute | Jindel D.,Sawai Man Singh Medical College | And 3 more authors.
PLoS ONE | Year: 2013

Genome-wide association studies (GWASs) have discovered association of several loci with Type 2 diabetes (T2D), a common complex disease characterized by impaired insulin secretion by pancreatic β cells and insulin signaling in target tissues. However, effect of genetic risk variants on continuous glycemic measures in nondiabetic subjects mainly elucidates perturbation of insulin secretion. Also, the disease associated genes do not clearly converge on functional categories consistent with the known aspects of T2D pathophysiology. We used a systems biology approach to unravel genome to phenome correlation in T2D. We first examined enrichment of pathways in genes identified in T2D GWASs at genome-wide or lower levels of significance. Genes at lower significance threshold showed enrichment of insulin secretion related pathway. Notably, physical and genetic interaction network of these genes showed robust enrichment of insulin signaling and other T2D pathophysiology related pathways including insulin secretion. The network also overrepresented genes reported to interact with insulin secretion and insulin action targeting antidiabetic drugs. The drug interacting genes themselves showed overrepresentation of insulin signaling and other T2D relevant pathways. Next, we generated genome-wide expression profiles of multiple insulin responsive tissues from nondiabetic and diabetic patients. Remarkably, the differentially expressed genes showed significant overlap with the network genes, with the intersection showing enrichment of insulin signaling and other pathways consistent with T2D pathophysiology. Literature search led our genomic, interactomic, transcriptomic and toxicogenomic evidence to converge on TGF-beta signaling, a pathway known to play a crucial role in pancreatic islets development and function, and insulin signaling. Cumulatively, we find that GWAS genes relate directly to insulin secretion and indirectly, through collaborating with other genes, to insulin resistance. This seems to support the epidemiological evidence that environmentally triggered insulin resistance interacts with genetically programmed β cell dysfunction to precipitate diabetes. © 2013 Jain et al.


Kumar D.,Sawai Man Singh Medical College | Bagarhatta R.,Sawai Man Singh Medical College
Journal of Clinical and Diagnostic Research | Year: 2015

Introduction: Diuretic resistance is a common problem in congestive heart failure patients. It has been defined clinically but can be defined objectively in terms of fractional excretion of sodium (FENa). Aim: Aim of the study was to find out the association of FENa with prognosis of decompensated heart failure patients. Materials and Methods: One hundred and seventy eligible patients with a primary diagnosis of decompensated heart failure were enrolled and patients were categorized into two groups on the basis of baseline FENa- Group A (65 patients) with diuretic resistance with FENa <0.2% and Group B (105 patients) sensitive to diuretics with FENa ≥0.2%. The patients were followed-up during the hospital stay for the time taken for improvement from NYHA functional class IV to class II. They were followed telephonically at 30 days post admission for all cause mortality.Result: The mean time taken to improve from NYHA functional class IV to class II were 146 hours for FENa<0.2% and 60 h for FENa≥0.2% (p<0.0001). There was a fair negative correlation between FENa and time taken for improvement from NYHA functional class IV to class II with correlation coefficient being -0.4842. Multiple linear regression analysis showed FENa (standardized “B” is -0.480, p<0.001) and LVEF (standardized “B” is -0.182, p=0.007) as significant predictors of time taken for improvement from NYHA functional class IV to class II. The 30 days all cause mortality was significantly associated with level of Fena (p <0.001) and was inversely proportional.Conclusion: CHF patients with FENa <0.2% takes longer time to recover from NYHA functional class IV to class II. 30 days all cause mortality was also significantly higher among CHF patients with FENa <0.2%.Measuring baseline FENa and regulating diuretic dose accordingly at admission to hospital may probably improve the prognosis of CHF patients. © 2015 Journal of Clinical and Diagnostic Research. All Rights Reserved.


Ray P.,All India Institute of Medical Sciences | Ratagiri V.H.,Karnataka Institute of Medical science | Kabra S.K.,All India Institute of Medical Sciences | Lodha R.,All India Institute of Medical Sciences | And 4 more authors.
PLoS ONE | Year: 2012

Background: Chikungunya (CHIKV) has recently seen a re-emergence in India with high morbidity. However, the epidemiology and disease burden remain largely undetermined. A prospective multi-centric study was conducted to evaluate clinical, epidemiological and virological features of chikugunya infection in patients with acute febrile illness from various geographical regions of India. Methods and Findings: A total of 540 patients with fever of up to 7days duration were enrolled at Karnataka Institute of Medical Sciences (KIMS), Karnataka (South); Sawai Man Singh Medical College (SMS) Rajasthan (West), and All India Institute of Medical Sciences (AIIMS) New Delhi (North) from June 2008 to May 2009. Serum specimens were screened for chikungunya infection concurrently through RT-PCR and serology (IgM). Phylogenetic analysis was performed using Bioedit and Mega2 programs. Chikungunya infection was detected in 25.37% patients by RT-PCR and/or IgM-ELISA. Highest cases were detected in south (49.36%) followed by west (16.28%) and north (0.56%) India. A difference in proportion of positives by RT-PCR/ELISA with regard to duration of fever was observed (p<0.05). Rashes, joint pain/swelling, abdominal pain and vomiting was frequently observed among chikungunya confirmed cases (p<0.05). Adults were affected more than children. Anti-CHIK antibodies (IgM) were detected for more than 60days of fever onset. Phylogenetic analysis based on E1 gene from KIMS patients (n = 15) revealed ~99% homology clustering with Central/East African genotype. An amino acid change from lysine to glutamine at position 132 of E1 gene was frequently observed among strains infecting children. Conclusions: The study documented re-emergence of chikungunya in high frequencies and severe morbidity in south and west India but rare in north. The study emphasizes the need for continuous surveillance for disease burden using multiple diagnostic tests and also warrants the need for an appropriate molecular diagnostic for early detection of chikungunya virus. © 2012 Ray et al.


Kalra G.S.,Sawai Man Singh Medical College | Goel P.,Sawai Man Singh Medical College | Singh P.K.,Sawai Man Singh Medical College
Indian Journal of Plastic Surgery | Year: 2013

Introduction: The severe long bone defects usually follow high-energy trauma and are often associated with a significant soft-tissue injury. The goal of management of these open long bone defects is to provide stable fixation with maintenance of limb length and soft-tissue coverage. The purpose of this article is to present the clinic-radiological outcome, complications and treatment of posttraumatic long bone defect with vascularised fibula transfer. Materials and Methods: Retrospective records of 28 patients were analysed who presented with post-traumatic long bone defects and in whom reconstruction with vascularised free fibula was done. Demographic data were recorded and clinical and radiological assessment was done. Results: Out of 28 patients in whom vascularised free fibula transfer was carried out three flaps were lost while non-union occur in three patients. Three patients developed a stress fracture of transferred free fibula in the post-operative period. Few of the patients experienced some problems in the donor leg; however, all of them improved in subsequent follow-up. Discussion: It is clearly evident from this study that timing of surgery plays an important role in the micro-vascular reconstruction in trauma cases. All the complication like flap loss, nonunion or delayed union occur in patients in whom reconstruction was delayed. Conclusion: The free vascularised fibula graft is a viable method for the reconstruction of skeletal defects of more than 6 cm, especially in cases of scarred and avascular recipient sites or in patients with combined bone and soft-tissue defects. Results are best when the reconstruction is done within 1 week of trauma.


Sharma A.,Mahatma Gandhi Medical College | Mittal R.S.,Sawai Man Singh Medical College
Journal of Neurosciences in Rural Practice | Year: 2016

Cavernous malformations (CMs) are vascular anomalies with dilated spaces called caverns. These spaces are lined by endothelial cells and collage and devoid of smooth muscle or intervening neural tissue, and filled with blood at various stages of stasis, thrombosis, organization, and calcification. Most CMs are relatively small in size but when they are large enough they can produce sing of mass effect and may simulate neoplastic, vascular, inflammatory pathology. Giant CM (size >6 cm) are very rare lesions and very few cases are reported in world literature. We are reporting such a rare case of a 16 year male. Our case is also unique in the sense that it is the largest reported CM in Indian population. © 2016 Journal of Neurosciences in Rural Practice.


Rao J.,Sawai Man Singh Medical College | Deora H.,Sawai Man Singh Medical College | Mandia R.,Sawai Man Singh Medical College
Indian Journal of Surgery | Year: 2015

Pilonidal sinus is a common chronic disease of the sacrococcygeal region. The treatment varies according to the clinical presentation of the disease. Although many surgical methods have been suggested, an ideal method is still lacking because of high recurrence rates. The aim of this work is to assess the role of Z-plasty in promoting primary healing in pilonidal disease and to evaluate morbidity and recurrence. This study included 40 patients (36 males and 4 females) who underwent excision of sinus and Z-plasty closure for sacrococcygeal pilonidal sinus. The follow-up period ranged from 6 to 12 months. There were 36 males and 4 females with a median age of 25 years. The mean hospital stay was 2 days. The mean time to return to work after discharge from the hospital was 14 days. There were no recurrences, and all patients were satisfied with the cosmesis. Two patients (5 %) had numbness over the flap. Necrosis of flaps did not occur in any patient. Only three patients were noticed to have wound infection (7.5 %). Five patients (12.5 %) developed wound seroma. Although requiring some technical expertise, excision of sinus and Z-plasty offer superior results with respect to recurrence in the hospital stay and cosmesis of patients with pilonidal sinus. © 2013, Association of Surgeons of India.

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