SGRR Institute of Medical and Health science

Dehradun, India

SGRR Institute of Medical and Health science

Dehradun, India
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Mishra P.K.,SGRR Institute of Medical and Health science
Indian Journal of Community Health | Year: 2012

Background: Antimicrobial resistance(AMR) threatens the health of many throughout the world, since both old and new infectious diseases remain a formidable public health threat. When pathogenic microorganisms can multiply beyond some critical mass in the face of invading antimicrobials, treatment outcome is compromised. This phenomenon is referred as antimicrobial resistance (AMR). Objective: This retrospective study was conducted to assess the overall antimicrobial resistance in bacterial isolates from tertiary care hospitals as majority of patients here receive empirical antibiotics therapy. Method: This retrospective study was carried out in teaching hospital, Greater Noida to determine prevalence of multidrug resistance in patients in relation to empirical antibiotic therapy in hospital. Various samples (pus,urine,blood) were collected for bacterial culture and antibiotic sensitivity. Results: Total 500 bacterial strains isolated from ICU, surgery, obstetrics & gynaecology and orthopaedics and their sensitivity pattern was compared in this study. The highest number of resistant bacterias were of pseudomonas sp. i.e. 21(33.87%) followed by 16(25.80%) of staphylococcus aureus, 12(19.35%) of Escherichia coli, Klebseilla sp & Proteus vulgaris were 05(8.06%) each & Citrobacter sp. 03(4.83%). Total 62(12.4%) bacterial isolates were found to be resistant to multiple drugs. The 31 (50%) of these resistant bacteria were prevalent in ICU, 12(19.35%) in Surgery, 11(17.74%) in Gynaecology, 08(12.90%) in Orthopaedics. All the bacterial strains were resistant to common antibiotics like Penicillin, Amoxicillin, Doxycycline & Cotrimoxazole and some were even resistant to Imipenem. Conclusion: Therefore we have outlined the nature of the antimicrobial resistance problem as an important health issue for national and international community. It is advised to avoid use of empirical antibiotics therapy.


Oberoi D.V.,SGRR Institute of Medical and Health science | Pradhan C.,National Institute of Mental Health and Neuro Sciences | Jairaj Kumar C.,NITTE University | D'Souza S.C.,Manipal University India
Australasian Medical Journal | Year: 2010

Background: In diabetic individuals (DI), neuropathy hinders the redistribution of plantar pressure points thus leading to susceptible areas where there is constant capillary blanching which may develop into trophic ulcers. The redistribution of pressure points may precede evidence of clinical neuropathy. In this study we compare temporal redistribution of plantar pressure points (areas of capillary blanching) between normal subjects taken as controls and DI with no clinical signs of neuropathy. Method: Four adults (45±4.55 years) diagnosed to have Type-2 Diabetes, without signs of clinical neuropathy and age -matched controls (43±3.74 years) were studied. The subjects were asked to stand on a glass slab and a 10 minute video recording of 10 selected plantar pressure points was made. Changes in the distance of these points with reference to a defined point on Mayer's line were measured at every 10 seconds. Standard deviation of difference of redistributed consecutive pressure point (SDPP) in cms., and fractal dimension (FD) was used to compare the two groups. Results: Combined mean SDPP (DI =0.013 ± 0.008 cms, controls= 0.196±0.233 cms, P <0.001) and FD (DI =1.000 ± 0.000, controls= 1.010±0.017, P <0.001) of diabetic patients were significantly lower than controls. Pressure point at base of the 4th toe and the lower limit of blanching to the left Mayers line at the heel did not differ significantly between DI and controls. Conclusion: There is impaired redistribution of plantar pressure points in individuals with diabetes without signs of clinical neuropathy. This can be attributed to loss of chaos generating mechanisms in DI. Redistribution of pressure points may be essential in the prevention of trophic ulcers in susceptible individuals.


Singh R.,University of Lucknow | Sharma S.,Sgrr Institute of Medical and Health science | Singh R.K.,T S Misra Medical College and Hospital | Mahdi A.A.,University of Lucknow | And 2 more authors.
Clinica Chimica Acta | Year: 2016

Background: Circulating lipid components were studied under near-normal tropical conditions (around Lucknow) in 162 healthy volunteers - mostly medical students, staff members and members of their families (103 males and 59 females; 7 to 75 y), subdivided into 4 age groups: A (7-20 y; N = 42), B (21-40 y; N = 60), C (41-60 y; N = 35) and D (61-75 y; N = 25). Methods: Blood samples were collected from each subject every 6 h for 24 h (4 samples). Plasma was separated and total cholesterol, high-density-lipoprotein (HDL) cholesterol, phospholipids and total lipids were measured spectrophotometrically. Data from each subject were analyzed by cosinor. We examined by multiple-analysis of variance how the MESOR (Midline Estimating Statistic Of Rhythm, a rhythm-adjusted mean) and the circadian amplitude of these variables is affected by gender, age, diet (vegetarian vs. omnivore), and smoking status. Results: In addition to effects of gender and age, diet and smoking were found to affect the MESOR of circulating plasma lipid components in healthy Indians residing in northern India. Age also affected the circadian amplitude of these variables. Conclusion: These results indicate the possibility of using non-pharmacological interventions to improve a patient's metabolic profile before prescribing medication under near normal tropical conditions. They also add information that may help refine cut-off values in the light of factors shown here to affect blood lipids. © 2016 Elsevier B.V.


Kumar M.,SGRR Institute of Medical and Health science | Kumari R.,SGRR Institute of Medical and Health science | Nigam P.N.,Patna Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2014

Background: Status epilepticus (SE) is a common, life threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder. Objectives: To study the aetiology, clinical profile, and outcome of SE in pediatric age group. Setting and study design: Prospective study at a tertiary care medical college hospital in Bihar, India. Materials and methods: Study was carried out for a period of one year (from April 2008 to March 2009). Seventy patients of SE in the age group of 6 month to 12 years were included in the study. Clinical history, general and systemic examination and relevant investigations along with pretested questionnaire were used to categorise different variables. Independent t-test was used for continuous variables and chi-square test for categorical variables. Results: Mean age for the study population was found to be 5.94 years (SD=3.152). Preponderance of male (60%) over female (40%) was observed. Aetiology included Idiopathic (27.14%), remote symptomatic (20%), acute symptomatic (47.14%), febrile (2.86%) and progressive encephalopathy (2.86%) groups. Generalised tonic clonic convulsion (GTC) convulsion was observed in 91.4% of SE patients while 8.6% had partial SE. Eighteen patients (25.7%) had prior history of convulsion whereas 52 patients (74.3%) presented with SE as first episode of convulsion. In our study, mortality rate was found to be 31.4% and acute symptomatic causes were responsible for most of the deaths. Conclusion: SE is a severe life threatening emergency with substantial morbidity and mortality. Patients with younger age and male sex are slightly more vulnerable to develop SE. Longer duration of SE and acute symptomatic aetiologies are independent predictors for poor outcome.


Singh R.,SGRR Institute of Medical and Health science | Singh S.P.,SGRR Institute of Medical and Health science | Ahmad N.,SGRR Institute of Medical and Health science
Journal of Clinical and Diagnostic Research | Year: 2014

Background: Many parts of India are endemic for the dengue, malaria, typhoid and scrub typhus infections. The relative contribution of these illnesses in an outbreak of acute febrile illness is not known in this region. Objective: The present study was conducted to find out the etiological pattern in an epidemic of acute febrile illness in Uttarakhand during the monsoon period. The study also focuses on concurrent infections and tries to find out the mortality outcomes. Materials and Methods: A retrospective study of four months was conducted on 1141 patients who presented with fever, and were suspected to have dengue, malaria, typhoid or scrub typhus. Patients of 12-years of age or above were included in the study. Serological tests for dengue, malaria, typhoid and scrub typhus were performed. Slides for malaria parasite were examined. In case of enteric fever only culture positive cases were included in the study. Result: Among the 1141 febrile patients dengue was detected in 812(71.2%), malaria in 146(12.8%), typhoid in 92(8.1%) and scrub typhus in 69(6.0%) cases. Mixed infection was noted in 22(1.9%). Conclusion: Maximum (71.2%) cases of fever were caused by dengue but significant number (32.3%) of patients suffered from malaria typhoid and scrub typhus. Many (1.9%) suffered from concurrent and multiple infections.


Azad R.,SGRR Institute of Medical and Health science | Magu S.,Pt BDS | Gathwala G.,Pt BDS
Journal of Clinical and Diagnostic Research | Year: 2012

Objective: To create the reference standards for the thymic size by sonography in healthy neonates in the north Indian population and to assess the variation in its location, echogenicity and echopattern. Material and Methods: This study was done prospectively on 200 healthy term neonates from north India at less than one week of age. The size of the thymus was measured in terms of the transverse diameter, the sagittal area, the thymic index and the anteroposterior (AP) diameter and the normal reference standards were created. The thymus was assessed in terms of its location, echogenicity (done in terms of the relative echogenicity number) and echopattern. The comparison of the thymic echogenicity and the echopattern with that of the liver, spleen and the thyroid was also performed. Results: The range of the thymic transverse diameter was 1.6-4.2 cm (mean 2.68 ± 0.54), that of the sagittal area was 1.31-5.13 cm2 (mean 3.01 ± 0.74), that of the thymic index was 2.60-16.93 cm3 (mean 8.10 ±2.74), that of the AP (Right) was 0.50-2.30 cm (mean 1.27 ± 0.35), that of the AP (left) was 0.20-2.90 cm (mean 1.72 ±0.4) and that of the AP (mean) was 0.40-2.35 cm (mean 1.49 ± 0.33). The thymus was located in the supero-anterior mediastinum and it was less echogenic than the liver, spleen and the thyroid. In majority of the subjects, the thymus was coarser in echo pattern than the spleen. However, it resembled or was coarser than the liver and the thyroid in almost equal proportions. Conclusion: The normative standards of the thymic size and the thymic appearance in a given population are useful in assessing this complex lymphoid organ sonographically in health and disease and also to carry out various immunological studies.


Singh R.,SGRR Institute of Medical and Health science | Kumar S.,SGRR Institute of Medical and Health science | Rana S.K.,SGRR Institute of Medical and Health science | Thakur B.,SGRR Institute of Medical and Health science | Singh S.P.,SGRR Institute of Medical and Health science
Journal of Clinical and Diagnostic Research | Year: 2013

Background: Falciparum malaria has been constantly associated with high morbidity and mortality for a long time. Vivax malaria, which was once thought to be a relatively benign condition, is appearing in its more malignant form, with severity gradually becoming a serious concern. Aim: This study is aimed to find out and compare the clinical and pathological manifestations of vivax and falciparum malaria in pediatric age group in Uttarakhand. Setting and Design: A prospective study was carried out at a tertiary care hospital of a medical college in Uttarakhand, India. Material and Methods: This study was done for a period of 2 years, from December 2010 to November 2012. Patients of 18 years age or below from Uttarakhand and nearby regions, who were smear positive or antigen positive were included in the study. Statistical Analysis: p value was calculated using Pearson Chi-square with Yates correction by DAG stat software. Result: Eighty Five patients were found to be suffering from malaria. 61 (71.8%) had vivax malaria, while 24 (28.2%) patients suffered from falciparum. Larger majority of malaria patients in both the groups happened to be males. The detailed study of morbidity profile clearly establishes that the complication related severity, earlier attributed to only falciparum is equally seen in vivax. Thrombocytopenia was the commonest finding in both. Other complications seen in both groups were those of cerebral malaria, severe anemia, ARDS, renal failure, malarial hepatitis, leucocytopenia, pancytopenia, shock with multiorgan dysfunction and hemoglobinuria. Even the mortality in the two groups was of the same order as p value calculated for the difference between the two species was well above 0.05. Conclusion: Vivax malaria is an important cause of mortality and morbidity. The severity of illness is almost similar in both vivax and falciparum malaria.


Ahmad A.,SGRR Institute of Medical and Health science | Azad S.,SGRR Institute of Medical and Health science | Azad R.,SGRR Institute of Medical and Health science
Journal of Clinical and Diagnostic Research | Year: 2015

Objective: To qualitatively and quantitatively differentiate leptomeningeal and vascular enhancement on Post-contrast Fluid Attenuated Inversion Recovery (PCFLAIR) sequence compared to post-contrast T1-weighted (PCT1W) sequence with fat suppression (FS) and evaluate its role in early detection of infectious meningitis. Materials and Methods: Thirty-one patients with diagnosis of meningitis were evaluated with pre and post-contrast FLAIR and T1-weighted sequences with fat suppression (FS). Qualitative assessment was done by two observers for presence, absence or equivocal status of leptomeningeal enhancement. Further, quantitative estimation of single pixel signal intensities (SPSI) for meningeal and vascular enhancement was undertaken. A statistical comparison was performed using Kappa coefficient and t-test. Results: The overall qualitative accuracy was 90.3% for PCFLAIR compared to 54.8% for PCT1W with FS sequence. PCFLAIR was found to be 100% accurate in the detection of tubercular and pyogenic meningitis and 70% accurate in the detection of viral meningitis while PCT1W with FS sequence showed the corresponding accuracy to be 76.2% and 0% respectively. Both observers rated PCFLAIR images better than PCT1W with FS at detecting meningitis (p<0.05). The quantitative assessment revealed that the SPSI difference between the average meningeal and vascular enhancement on PCFLAIR was significantly greater than that on PCT1W with FS sequence (t= 6.31, p<0.01). Conclusion: PCFLAIR sequence has insignificant component of vascular enhancement compared to meningeal enhancement. This makes meningeal inflammation easily discernable and aids in early detection of infectious meningitis. © 2015, Journal of Clinical and Diagnostic Research. All rights reserved.


PubMed | SGRR Institute of Medical and Health science and Patna Medical College and Hospital
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2014

Status epilepticus (SE) is a common, life threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. SE can represent an exacerbation of a pre-existing seizure disorder, the initial manifestation of a seizure disorder, or an insult other than a seizure disorder.To study the aetiology, clinical profile, and outcome of SE in pediatric age group. Setting and study design: Prospective study at a tertiary care medical college hospital in Bihar, India.Study was carried out for a period of one year (from April 2008 to March 2009). Seventy patients of SE in the age group of six month to 12 years were included in the study. Clinical history, general and systemic examination and relevant investigations along with pretested questionnaire were used to categorise different variables. Independent t-test was used for continuous variables and chi-square test for categorical variables.Mean age for the study population was found to be 5.94 years (SD=3.152). Preponderance of male (60%) over female (40%) was observed. Aetiology included Idiopathic (27.14%), remote symptomatic (20%), acute symptomatic (47.14%), febrile (2.86%) and progressive encephalopathy (2.86%) groups. Generalised tonic clonic convulsion (GTC) convulsion was observed in 91.4% of SE patients while 8.6% had partial SE. Eighteen patients (25.7%) had prior history of convulsion whereas 52 patients (74.3%) presented with SE as first episode of convulsion. In our study, mortality rate was found to be 31.4% and acute symptomatic causes were responsible for most of the deaths.SE is a severe life threatening emergency with substantial morbidity and mortality. Patients with younger age and male sex are slightly more vulnerable to develop SE. Longer duration of SE and acute symptomatic aetiologies are independent predictors for poor outcome.


PubMed | SGRR Institute of Medical and Health science
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2013

Falciparum malaria has been constantly associated with high morbidity and mortality for a long time. Vivax malaria, which was once thought to be a relatively benign condition, is appearing in its more malignant form, with severity gradually becoming a serious concern.This study is aimed to find out and compare the clinical and pathological manifestations of vivax and falciparum malaria in pediatric age group in Uttarakhand.A prospective study was carried out at a tertiary care hospital of a medical college in Uttarakhand, India.This study was done for a period of 2 years, from December 2010 to November 2012. Patients of 18 years age or below from Uttarakhand and nearby regions, who were smear positive or antigen positive were included in the study.p value was calculated using Pearson Chi-square with Yates correction by DAG stat software.Eighty Five patients were found to be suffering from malaria. 61 (71.8%) had vivax malaria, while 24 (28.2%) patients suffered from falciparum. Larger majority of malaria patients in both the groups happened to be males. The detailed study of morbidity profile clearly establishes that the complication related severity, earlier attributed to only falciparum is equally seen in vivax. Thrombocytopenia was the commonest finding in both. Other complications seen in both groups were those of cerebral malaria, severe anemia, ARDS, renal failure, malarial hepatitis, leucocytopenia, pancytopenia, shock with multiorgan dysfunction and hemoglobinuria. Even the mortality in the two groups was of the same order as p value calculated for the difference between the two species was well above 0.05.Vivax malaria is an important cause of mortality and morbidity. The severity of illness is almost similar in both vivax and falciparum malaria.

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