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Background: Potassium levels in stored blood bags increases as they age. Hyperkalemia in transfused blood has undesirable cardiac effects. Materials and methods: Within a 19-month period, baseline and weekly samples from 15 CPDA-1 whole blood bags were collected till 28days of storage and analysed for potassium, sodium, uric acid, albumin and whole blood haemoglobin. Results: One unit increase in baseline (0 day) potassium in extracellular fluid of blood units was associated with the following increases in potassium levels on later days of storage: around two unit increase at 1 week (r2=0·50, P<0·01) of storage; four units increase at 2 weeks (r2=0·64, P<0·001) and 3 weeks (r2=0·51, P<0·01) of storage; six units at 4 weeks (r2=0·53, P<0·01) of storage. Baseline whole blood haemoglobin showed a moderate association with baseline potassium (r2=0·36, P<0·05) and 2-week potassium (r2=0·35, P<0·05) values. Conclusion: For CPDA-1 blood bags (i) low baseline potassium blood bags might be preferred for transfusion in cases demanding a low potassium load and (ii) coordinating the 'first-in-first-out' (FIFO) policy with 'early release of blood-bags with high initial potassium' might be helpful in improving the release of suitable blood units from blood-banks. © 2013 The Authors. Transfusion Medicine © 2013 British Blood Transfusion Society.


Kumari A.,Shri Ram Murti Smarak Institute of Medical science | Agrawal S.C.,Shri Ram Murti Smarak Institute of Medical science
Journal of Neurosciences in Rural Practice | Year: 2014

Pneumocephalus is a rare condition characterized by the presence of gas within the cranial cavity. This gas may arise either from a trauma, a tumor, a surgical, or a diagnostic procedure or occasionally from an infection. Pneumocephalus as a complication of bacterial meningitis, in absence of trauma or a procedure, is extremely rare, particularly in a newborn. A case of pneumocephalus occurring in a baby, suffering from neonatal meningitis, acquired probably through unsafe cutting and tying of the cord, is reported here. Cutting, tying, and care of the umbilical cord is of utmost importance to prevent neonatal infection as the same is a potential cause of serious anaerobic infections, besides tetanus.


Goel J.K.,Shri Ram Murti Smarak Institute of Medical science | Kumar P.,Shri Ram Murti Smarak Institute of Medical science
Journal of SAFOG | Year: 2012

Endometrial cancer is the most common gynecological cancer in developed countries and second most common in developing countries. Its incidence is increasing in postmenopausal women. Factors related to chronic estrogen exposure are associated with a higher incidence. Abnormal uterine bleeding is the cardinal symptom. All women with suspected endometrial cancer require transvaginal ultrasonography and most will undergo endometrial biopsy; more sophisticated radiological examinations are required for preoperative staging. The general approach for treatment of endometrial cancer is hysterectomy, bilateral salpingo-oophorectomy, abdominopelvic washings, lymph node evaluation and maximal surgical cytoreduction for those with advanced disease. Postoperative adjuvant therapy [vaginal brachytherapy, external beam radiation therapy (RT), chemotherapy] may be recommended depending on the estimated risk of recurrence. Individual patient characteristics and surgical as well as pathologic staging are the main factors that are used for postsurgical risk stratification, which in turn, directs the selection of adjuvant treatment.


Madhok R.,Shri Ram Murti Smarak Institute of Medical science | Aggarwal A.,Shri Ram Murti Smarak Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2014

Background: Coronary artery disease (CAD) is one of the leading cause of the morbidity and mortality in India as well as worldwide & last decade has seen a steep rise in incidence of CAD in India. Direct visualization of the coronary arteries by invasive catheterization still represents the cornerstone of the evaluation of coronary artery disease. Cardiac imaging is a challenge of 21st century and is being answered by 128 slice dual source CT as it has good temporal resolution, high scanning speed as well as low radiation dose. Aim: To assess the diagnostic accuracy of 128-slice dual source CT Cardiac Angiography in comparison with Conventional Catheter Cardiac Angiography. Materials and Methods: Forty patients attending the cardiology OPD with complaint of chest pain and suspected of having coronary artery disease (CAD) were evaluated by CT coronary angiography and conventional invasive Catheter coronary angiography and the results were compared. All patients were checked for serum creatinine and ECG before the angiography. Computed Tomography (CT) coronary angiography was done using SIEMENS 128- slice Dual Source Flash Definition CT Scanner under either Retrospective or Prospective mode depending on the heart rate of the patient. Oral/ IV beta-blocker were used whenever required. Results: Coronary arteries were assessed as per 17- segment AHA model. A total of 600/ 609 segments were evaluable in 40 suspected patients on CT coronary angiography, of which 21 were false positives and 8 were false negatives with specificity of 95.12% and sensitivity and positive predictive value of 95.26% & 88.46% respectively. Conclusion: Non-invasive assessment of coronary artery disease is now possible with high accuracy on 128-slice dual source CT scanner.


Christopher A.F.,Shri Ram Murti Smarak Institute of Medical science | Hora S.,Shri Ram Murti Smarak Institute of Medical science | Ali Z.,Shri Ram Murti Smarak Institute of Medical science
Annals of Tropical Medicine and Public Health | Year: 2013

Background: Escherichia coli is well known as noninvasive commensal and has been established as etiological agent of various human infections. E. coli also contributes to high rate of resistance to several antibiotics due to multiresistant antibiotic plasmid genes e.g., extended spectrum β-lactamases (ESBL). Material and Methods: To analyse the situation of antibiotic resistance, a total of 77 E.coli isolates from urine, pus, sputum and endotracheal aspirate were screened for their antibiograms for antibiotic resistance, multiple antibiotic resistance (MAR) index for evaluating the spread of resistance and plasmid profiles for the presence and characterization of plasmids. Results: Very high resistance level (> 90%) was detected against ampicillin, amoxycillin, ceftazidime, norfloxacin, tetracycline while imipenem and amikacin recorded the least resistance levels of 2.3% and 13.9%, respectively, among the isolates. An increased resistance to amoxycillin, tetracycline, cotrimoxazole and norfloxacin were observed in this geographical area which however displayed a lower resistance in other countries. The MAR index varied considerably, the lowest was 0.18 and the highest was 0.89. Plasmids of 10 size ranges were detected in the isolates. Some isolates possessed single-sized plasmid while other possessed multiple plasmids. Isolates with high MAR profiles were found to possess multiple plasmids. Conclusion: Regular antimicrobial sensitivity surveillance is necessary and acquisition of plasmid could greatly contribute in the antibiotic resistance and poses a significant risk of the spread of microbial resistance in this community. Also, it was observed that route of administration of antibiotics perhaps reduced its misuse and hence led to the reduction in the emergence of resistant bacterial strains. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Gahalaut P.,Shri Ram Murti Smarak Institute of Medical science | Mishra N.,Shri Ram Murti Smarak Institute of Medical science | Soodan P.S.,Shri Ram Murti Smarak Institute of Medical science | Rastogi M.K.,Shri Ram Murti Smarak Institute of Medical science
Dermatology Research and Practice | Year: 2014

Background. Psoriasis is associated with a high impact on health-related QoL (quality of life). PUVAsol has been successfully used for treating psoriasis instead of standard PUVA therapy in developing countries. However, data for PUVAsol therapy and its effect on QoL in psoriatic patients is meagre. Objective. To investigate the effect of PUVAsol on the quality of life in patients having chronic plaque psoriasis. Materials and Methods. An observational prospective study done in patients having chronic plaque psoriasis. PASI and DLQI were calculated before initiating treatment with oral PUVAsol. These were compared with the respective scores after 12 weeks of regular treatment with PUVAsol. Statistical analysis was done using SPSS version 20.0. Results. Both PASI and DLQI showed statistically significant reduction after 12 weeks of regular treatment. 90% of patients responded favourably to PUVAsol therapy in the study and all the domains of DLQI showed significant reduction except domain of "work and school." Conclusion. Our results show that regular PUVAsol treatment improves the physical appearance of disease as evident by decrease in PASI scores. It also improves the QoL of the patients. This study will add upon the growing evidence of efficacy of PUVAsol. © 2014 Pratik Gahalaut et al.


Baliarsingh S.,Shri Ram Murti Smarak Institute of Medical science | Sharma N.,Shri Ram Murti Smarak Institute of Medical science
Clinical Laboratory | Year: 2012

Background: Uric acid, the final product of purine catabolism, has been associated with dyslipidemia, most importantly hypertriglyceridemia. But studies on the relation between uric acid and lipid parameters in the Indian population have been minimal. Methods: Relation between serum uric acid and serum lipids in 121 healthy men, aged 34 to 60 years was studied retrospectively. The subjects were stratified according to age and uric acid levels. All biochemical parameters were measured on automated analysers using reagent kits from standard companies. Results: In men <45 years in age, those having high serum uric acid levels had a higher serum total cholesterol (p = 0.003), low density lipoprotein cholesterol (p = 0.005), triglycerides (p = 0.02), and very low density lipoprotein cholesterol (p = 0.02) than those having low serum uric acid. Whereas in the ≥45 year age group when subjects having high serum uric acid were compared to those having low uric acid levels, the only parameters that showed an increase were triglycerides (p = 0.009) and very low density lipoprotein cholesterol (p = 0.008). A statistically significant positive correlation was observed between serum uric acid and serum triglycerides in men of both age groups separately, but between serum uric acid and serum total cholesterol only in the lower age group. Conclusions: Thus, serum uric acid levels in the normal range might be a good indicator of the level of triglycerides and very low density lipoprotein cholesterol in men encompassing a wide age range but of total cholesterol and low density lipoprotein cholesterol only in men less than 45 years in age.


Madhok R.,Shri Ram Murti Smarak Institute of Medical science | Sachdeva P.,Shri Ram Murti Smarak Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Spinal tuberculosis presents a radiological challenge in many cases when it presents with atypical pattern of involvement and has to be distinguished from various differentials, which include metastases. In such cases Diffusion Weighted Imaging (DWI) with Apparent Diffusion Co-efficient (ADC) value may play a role in reaching towards a conclusion, thereby preventing unnecessary biopsy in such patients. Aim: Measurement of mean ADC values in tubercular vertebrae and associated collection. Materials and Methods: The study comprised 55 patients and was conducted on 3.0 TESLA Siemens machine Magnetom Verio. Patients either known to have tuberculosis or those with classic tuberculous findings were included in the study. All these patients were followed up for post-treatment confirmation and ADC value. All the patients underwent routine MRI along with DW-MRI sequence and ADC values and FNAC/ Biopsy if required. The ADC values were calculated from the involved vertebral bodies and surrounding soft tissue and also from normal vertebrae preferably from one above and below the affected vertebrae to establish ADC of normal vertebrae, which was helpful in treatment response in patients with antitubercular therapy. At least six ADC value was taken from affected vertebrae and soft tissue. Results: The mean ADC value of tubercular vertebrae was found out to be 1.47 ± 0.25 x 10-3 mm2 /sec, of adjacent soft tissue collection (abscess) was 1.94 ± 0.30 x 10-3 mm2 /sec and normal vertebrae was 0.48 ± 0.16 x 10-3 mm2 /sec. ADC value of post treated vertebrae decreased and complete resolution showed ADC near normal vertebrae. Conclusion: Normal range of the ADC values in spinal tuberculosis and associated paravertebral collection may be helpful in the differentiation of spinal tuberculosis from lesions with spinal involvement which are not proven to be tuberculosis and who did not have the classical appearance of either tuberculosis or metastasis. But there exists a zone of overlap of ADC values in metastatic and tubercular vertebrae, which can lead to false negative results. Therefore, in overlap cases there should be correlation with clinical history, other related investigations or biopsy. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.


Sayedda K.,Shri Ram Murti Smarak Institute of Medical science | Kamal S.,Shri Ram Murti Smarak Institute of Medical science | Ahmed Q.S.,Shri Ram Murti Smarak Institute of Medical science
National Journal of Physiology, Pharmacy and Pharmacology | Year: 2013

Background: Ramadan is the holiest month in the Islamic calendar. Ramadan is 28-30 days fast in which food, liquids and smoking during the day light hours is prohibited. This custom provides a unique opportunity to study the biochemical changes over this time. Objective: To explore any favourable and unfavourable consequences of Ramadan fasting. Materials and Methods: The study was performed on twenty healthy male students of Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, in the month of Ramadan (July-Aug, 2012). Body weight, waist circumference, blood pressure was monitored three times: one week before the beginning of Ramadan, mid of Ramadan (15th day) and at the end (29th day). Blood samples were also taken at the same times and evaluated for serum creatine phosphokinase (CPK) activity, calcium and phosphorus. Results: Body weight and waist circumference was found to be significantly (p<0.0001) decreased. Mean blood pressure was decreased significantly (p<0.0001) in the initial half of Ramadan but it approached pre Ramadan values at the end of the month. CPK activity was reduced significantly (p<0.0001) at the mid and end of Ramadan as compared to pre Ramadan values. Serum calcium levels came out to be decreased significantly (p<0.0001) at the mid but at the end it resumed normal values. There was no significant effect on phosphorus level throughout the month. Conclusion: Ramadan fasting has beneficial influences on the anthropometric parameters especially it is a blessing for overweight or obese persons. Our findings contribute to a better understanding of previous reports.


Madhok R.,Shri Ram Murti Smarak Institute of Medical science | Tapasvi C.,Shri Ram Murti Smarak Institute of Medical science | Prasad U.,Shri Ram Murti Smarak Institute of Medical science | Gupta A.K.,Shri Ram Murti Smarak Institute of Medical science | Aggarwal A.,Shri Ram Murti Smarak Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2013

AIM: To find the normal mean values of the liver elasticity/stiffness by Acoustic Radiation Force Impulse (ARFI) Elastography in healthy subjects. Material and Method: This study was conducted on 137 healthy subjects without any known liver pathology or a history of jaundice by using the Siemens Acuson S2000TM Ultrasound machine with a convex probe. A routine ultrasound was also performed in each case, and the subjects with fatty liver changes or any other signs of a chronic liver pathology were excluded. In each subject, 10 measurements were taken and the median value of the 10 measurements was calculated, which was expressed in metres/sec (m/s). The inter quartile range method was used for the interpretation of the data. Only the measurements with an IQR of < 30% and a Success Rate (SR) of >60% were considered. The measurements were taken at 1-2 cm depth from the liver capsule through an intercostal approach, with the subject lying in the decubitus position. The mean ARFI values and the mean values according to the age and gender of the subjects were evaluated. Result: Valid ARFI measurements were taken in 108/137 patients (78.83%). The mean value of the ARFI measurements in the normal individuals was 1.197±0.25 m/s. There were no significant differences between the mean ARFI values in men vs women (1.195±.25 vs. 1.199±0.26m/s, p = 0.939), and also among the different age groups (p>0.05). Conclusion: In our study, the mean liver elasticity value (shearing wave velocity) which was obtained by ARFI in the healthy subjects was 1.197±0.25 m/s.

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