Sir Ganga Ram Hospital

Delhi, India

Sir Ganga Ram Hospital

Delhi, India
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News Article | November 3, 2015

For a few hours one morning two weeks ago, private cars were banned from driving into the heart of old Delhi. It was hard to tell at the messy road junction in front of the historic Red Fort and the shopping street of Chandni Chowk, though, which was still crammed with auto-rickshaws and buses barrelling along the roads with seemingly little regard for any traffic rules. But Delhi’s so-called “car-free day” experiment was nevertheless a success: scientists monitoring the air here, routinely one of Delhi’s most polluted areas, found a dramatic 60% drop in the amount of dangerous pollutants – the tiniest particles that come out of traffic exhausts and which can exacerbate health problems such as asthma, heart disease and stroke – compared to the previous day. Delhi is the most polluted city in the world, according to the World Health Organisation (WHO), and doctors and scientists say the locals there are facing a public health crisis. Beijing has historically drawn international attention when it comes to poor air quality but, in reality, that city’s air is nowhere near as dangerous as many of India’s major cities. The rapid development of the country in recent years means India has the dubious honour of having 13 of the world’s 20 most polluted cities. The WHO found that Delhi had an average of 153 micrograms of the smallest particles, known as PM2.5s, per cubic metre in its air. The international “safe” level for these particles is 6 micrograms per cubic metre. Delhi’s bad air is already causing a spike in the people with asthma and reduced lung function. Filming in the city’s leading chest hospital, for a series of stories for ITV News at Ten on India’s challenges ahead of the climate change summit in Paris that begins later this month, a doctor told me he had to now keep his clinics open for double their normal hours in order to keep up with demand. Even then, the corridors were overrun with wheezing patients and a room that had a line of oxygen masks for patients to take respite breaths as they waited, had queues snaking out of the door. The air is already having long-term effects on children in the Indian capital, 4.4 million of whom already have irreversible lung damage. “The children’s lung is in the budding stage, they are not mature,” said Prof Raj Kumar a respiratory specialist at the Vallabhbhai Patel Chest Institute, University of Delhi. “Ultimately their bronchi or alveoli are going to be damaged and the lung function is harmed. [Since] that is the main organ where the oxidisation is taking place, if the lung is affected then the whole of your body will be affected.” The damage goes beyond that – reaching even further back in people’s lives. At the Sir Ganga Ram Hospital, neonatologist Professor Neelam Kler has been working with the Public Health Foundation of India to track an increase in premature and underweight babies and those born with birth defects. “People are probably not so aware of the hidden effects of pollution and that is on the pregnant woman and the growing foetus in her body, which is a very vulnerable period,” she said. There is already evidence of a spectrum of health problems, ranging from allergies and respiratory conditions, malformations, growth restrictions and even an increasing incidence of cancers, all of which could be related to increased pollution. “Putting it together, we are heading towards health disasters,” said Prof Kler. The reasons behind the worsening air are manyfold – more than 8m vehicles on the roads already, with 1,400 new ones added every day. Most of those new vehicles burn diesel and face relatively low emissions standards, belching out clouds of the tiny PM2.5 particles that can be most harmful to health. In addition to vehicles, there are an increasing number of diesel-burning electrical generators attached to the swanky apartment blocks springing up across the capital. Farms and coal-burning factories around the region further worsen the air. The pollution has a double-whammy effect. Health problems are happening now but the vehicle and factory exhausts also contain greenhouse gases such as nitrous oxides, ozone and carbon dioxide. These will linger in the atmosphere for many decades and contribute to future climate change. India’s cities are facing the problems right now but the pollution (and its problems) is a stark indication of what many more developing nations will face in future. The Indian government says it is aware. Environment minister Prakash Javadekar said he wants to fast-track the construction of a bypass that would prevent around 50,000 polluting lorries having to drive into the city every day. And he wants the car companies to clean up their vehicles to the more exacting standards in Europe. “We want to migrate early but auto industry is not ready,” he said. The car industry in India could produce Euro-6 compliant vehicles, he said, but they have been lagging behind. “We will deal with this menace of air pollution and we will win the battle and there will be marked difference in the next two years.” Delhi has managed to clean up its air before. At the turn of the century, the local government moved polluting industries out of the city, shut down coal-burning power plants and forced public transport vehicles to move from diesel and petrol to cleaner gas alternatives. The air quality improved steadily until 2007, said Anumita Roychowdhury of the Centre for Science and Environment, a Delhi thinktank. “But after that, if you look at the data, 2009 onwards, you will find the levels are going up again and gone up so high that now what we are saying is that we have lost the gains of the first generation action,” she said. “And that’s the scary story unfolding today. What has gone wrong is that the momentum that we had built to clean up, we could not keep that momentum going. Somewhere along the line the pollution source has overwhelmed the action.” For Profs Kler and Kumar, all Delhi citizens need to do their part in dealing with the pollution problem. Health professionals need to petition authorities to act and individuals must work out how to keep the city growing without just buying more cars. “Development not only means industrialisation,” said Prof Kler. “I think its a time that we take a note of it and do something about the quality of air, the quality of water, our waste disposal, so that we don’t become a heap of garbage.” As Delhi chokes, initiatives such as the car-free day around the Red Fort two weeks ago will become more important in bringing attention to the pollution crisis. A small crowd had gathered that morning with banners and wearing T-shirts with slogans reading “No Pollution, No Congestion”. They marched around the road in the shadow of the Red Fort on the day, handing leaflets out to passers by. Sunil Dahiya, a campaigner with Greenpeace India who was measuring the levels of pollutants in the air around him, said: “If you talk to anybody there will be appreciation of yes Delhi air is very hazardously polluted and there should be something done about it.” • Alok Jha is science correspondent for ITV News. You can see the first of his three reports on the India’s challenge in tackling climate change on Tuesday on News at Ten on ITV1.

Kumar A.,Sir Ganga Ram Hospital
Indian Journal of Gastroenterology | Year: 2012

Hepatitis B virus (HBV) infection is a global problem and the world has 350 million carriers of chronic hepatitis B. Over 50 % of these have acquired their infection vertically from their mothers (mother-to-child transmission [MTCT]). Majority (>90 %) of vertically-acquired infection results into chronic infection, due to induction of an immune-tolerant state. Hence, management of chronic HBV during pregnancy and strategies to prevent MTCT would go a long way in global control of HBV infection and the morbidity and mortality associated with it. However, chronic HBV infection in pregnancy presents a unique challenge, because of existence of a complex relationship between the physiological changes of pregnancy and the pathophysiological response of body to HBV. This relationship may lead to a varied presentation of the patient to the doctor depending on the period of her pregnancy and stage of her liver disease. Each of these modes of presentation raises issues that need to be addressed for successful maternal and fetal outcome, including prevention of MTCT of HBV. This review will try to give a practical approach in addressing these issues. © 2012 Indian Society of Gastroenterology.

Wattal C.,Sir Ganga Ram Hospital | Goel N.,Sir Ganga Ram Hospital
Medical Clinics of North America | Year: 2012

This review article discusses important infectious illnesses, namely malaria, dengue, and chikungunya, in travelers returning from endemic areas. Malaria and dengue are two of the most common systemic illnesses reported in returning travelers. Because chikungunya is gaining importance, it is also briefly discussed. The clinical significance of these diseases is mainly due to the possibility of sudden deterioration with high mortality in clinically healthy looking patients. The key clinical features, their diagnosis, and treatment algorithms are discussed in detail to help in early diagnosis and appropriate clinical management of such travelers presenting in emergency departments. © 2012 Elsevier Inc.

Kumar A.,Sir Ganga Ram Hospital | Sharma P.,Sir Ganga Ram Hospital | Arora A.,Sir Ganga Ram Hospital
Alimentary Pharmacology and Therapeutics | Year: 2015

Summary Background Portal vein obstruction may be due to portal vein thrombosis (PVT) or its sequale, the portal cavernoma. PVT is a common complication in liver cirrhosis, however, it may also occur as a primary vascular disorder, in absence of any liver disease. Aim To review the current knowledge on nomenclature, etiology, pathophysiology, clinical presentation, diagnostic workup and management of adult patients with obstruction in the portal vein, either as a primary vascular disease in adults, or as a complication of liver cirrhosis. Methods A structured search in PubMed was performed using defined keywords (portal vein obstruction, extra-hepatic portal vein obstruction, PVT and portal cavernoma), including full text articles and abstracts in English language. Results Several causes, operating both at local and systemic level, might play an important role in the pathogenesis of PVT. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernible. Diagnosis of portal vein obstruction depends on clinical presentation, imaging and laboratory investigations. Prompt treatment greatly affects the patient's outcome. Conclusions Portal vein obstruction occurring either due to thrombosis in the portal vein or due to the portal cavernoma, can contribute to significant morbidity and mortality in patients with or without cirrhosis. In recent years our understanding of etio-pathogenesis of portal vein obstruction has evolved tremendously, which has led to significant improvement in treatment outcomes. There are still areas where more studies are needed to better clarify the management issues of portal vein obstruction. © 2014 John Wiley & Sons Ltd.

METHODS: Enrolled patients (208) included 46 noninfectious SIRS, 90 culture-negative sepsis, and 72 culture-positive sepsis. Culture, PCT, and IL-6 estimations were performed on day 1 of intensive care unit admission.RESULTS: Procalcitonin and IL-6 levels were significantly higher (P < .001) in both culture-negative and culture-positive groups as compared with SIRS group. Procalcitonin was a better predictor of sepsis in both culture-negative (area under curves 0.892 vs 0.636) and culture-positive (area under curves 0.959 vs 0.784) groups as compared with IL-6. In culture-negative group, the best cutoff point for PCT was at 1.43 ng/mL (92% sensitivity; 83% negative predictive value), best cutoff point for IL-6 was at 219.85 pg/mL (47% sensitivity and 42% negative predictive value).CONCLUSIONS: Procalcitonin can accurately differentiate culture-negative sepsis from noninfectious SIRS and thereby contribute to early diagnosis and effective management of these conditions.PURPOSE: Differentiation between culture-negative sepsis and noninfectious systemic inflammatory response syndrome (SIRS) remains a diagnostic challenge for clinicians, both conditions having similar clinical presentations. Therefore, a swift accurate diagnostic tool, which helps differentiate these 2 conditions would immensely aid appropriate therapeutic continuum. This prospective study was conducted to evaluate the potential diagnostic role of biomarkers, procalcitonin (PCT) and interleukin 6 (IL-6), in culture-negative sepsis patients. Copyright © 2014 Elsevier Inc. All rights reserved.

Jain V.K.,Sir Ganga Ram Hospital
Neurology India | Year: 2012

Atlanto-axial dislocations (AADs) may be classified into four varieties depending upon the direction and plane of the dislocation i.e. anteroposterior, rotatory, central, and mixed dislocations. However, from the surgical point of view these are divided into two categories i.e. reducible (RAADs) and irreducible (IAADs). Posterior fusion is the treatment of choice for RAAD. Transarticular screw fixation with sub-laminar wiring is the most stable& method of posterior fusion. Often, IAAD is due to inadequate extension in dynamic X-ray study which may also be due to spasm of muscles. If the anatomy at the occipito-atlanto-axial region {O-C1-C2; O: occiput, C1: atlas, C2: axis} is normal on X-ray, the dislocation should be reducible. In case congenital anomalies at O-C1-C2 and IAAD are seen on flexion/extension studies of the cervical spine, the C1-C2 joints should be seen in computerized tomography scan (CT). If the C1-C2 joint facet surfaces are normal, the AAD should be reducible by cervical traction or during surgery by mobilizing the joints. The entity termed "dolichoodontoid" does not exist. It is invariably C2-C3 (C3- third cervical vertebra) fusion which gives an appearance of dolichoodontoid on plain X-ray or on mid-saggital section of magnetic resonance imaging (MRI) or CT scan. The central dislocation and axial invagination should not be confused with basilar invagination. Transoral odontoidectomy alone is never sufficient in cases of congenital IAAD, adequate generous three-dimensional decompression while protecting the underlying neural structures should be achieved. Chronic post-traumatic IAAD are usually Type II odontoid fractures which get malunited or nonunited with pseudoarthrosis in dislocated position. All these dislocations can be reduced by transoral removal of the offending bone, callous and fibrous tissue.

Rath A.,Sir Ganga Ram Hospital
Asian journal of endoscopic surgery | Year: 2013

Spigelian hernias, also known as spontaneous lateral ventral hernias, are rare primary ventral hernias arising in the Spigelian, or semilunar, line located at the lateral border of recti. Because of its varied presentation, clinical examination is often inconclusive. Traditional repair of such hernias use the open approach. Herein we report on three cases of Spigelian hernias. All were diagnosed and treated laparoscopically at our institution between March 2011 and June 2012. Multiple surgeons performed the repairs using the laparoscopic transabdominal preperitoneal technique of mesh reinforcement and reperitonization. There were no perioperative or postoperative complications. All three were discharged 1 day postoperatively. A complete resolution of preoperative symptoms was observed at follow-up at 1 week, 1 month and 6 months. Laparoscopic transabdominal preperitoneal repair of Spigelian hernia is safe, easy, and feasible for experienced laparoscopic surgeons. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Growth and development of neuroepidemiology in India during the last four decades has been documented highlighting the historical milestones. The prevalence rates of the spectrum of neurological disorders from different regions of the country ranged from 967-4,070 with a mean of 2394 per 100000 population, providing a rough estimate of over 30 million people with neurological disorders (excluding neuroinfections and traumatic injuries). Prevalence and incidence rates of common disorders including epilepsy, stroke, Parkinson's disease and tremors determined through population-based surveys show considerable variation across different regions of the country. The need for a standardized screening questionnaire, uniform methodology for case ascertainment and diagnosis is an essential requiste for generating robust national data on neurological disorders. Higher rates of prevalence of neurological disorders in rural areas, 6-8 million people with epilepsy and high case fatality rates of stroke (27-42%) call for urgent strategies to establish outreach neurology services to cater to remote and rural areas, develop National Epilepsy Control Program and establish stroke units at different levels of health care pyramid.

Objective: To compare the obstetric outcome in terms of risk of low birth weight, preterm delivery, cesarean section rate and anemia in primigravid adolescents and older primigravida. Study Design: Cohort study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, Lahore, from July to December 2012. Methodology: Three hundred primigravid women presenting to department of obstetrics and gynecology of Sir Ganga Ram Hospital, Lahore, having live singleton pregnancy, including 150 adolescents (≤ 19 years) and 150 adults (≥ 20 years) were studied. Obstetric outcome in terms of gestational age at delivery, infant's birth weight, presence of anemia and cesarean section rate was compared between two groups. Results were analyzed using Statistical Package for Social Sciences (SPSS) version 16. Chi-square test was applied with 0.05 as level of significance. Results: The mean age of adolescent subjects was 17.3 ± 1.5 years and of adults 25.6 ± 3.4 years. Mean gestational age at delivery was similar in two groups (39.2 weeks and 39.4 weeks, p = 0.37). Adolescents were more likely to have a preterm delivery (11.2% vs. 4.9%, p = 0.04) and low birth weight infants (19.3% vs. 8.2%, p = 0.005) than adults. Adolescents were more likely to be anemic (46% vs. 32%, p = 0.01) than adults. However, cesarean section rate was not statistically different between two groups. Conclusion: This study showed that primiparous adolescents have significantly higher risk of adverse pregnancy outcomes such as preterm delivery, low birth weight infants and anemia as compared to adult primiparas.

Sood J.,Sir Ganga Ram Hospital
World Journal of Gastroenterology | Year: 2014

The introduction of laparoscopy in the surgeon's armamentarium was in fact a "revolution in the history of surgery". Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitoneum and increased intra-abdominal pressure. Venous air embolism, although very rare, can be lethal if not managed promptly. Other complications include subcutaneous emphysema, haemodynamic compromise and arrhythmias. Although associated with minimal postoperative morbidity, postoperative pain, nausea and vomiting can be quite problematic. The limitations of laparoscopy have been overcome by the introduction of robotic surgery. There are important implications for the anaesthesiologist during robotic surgeries which have to be practiced accordingly. Robotic surgery has a learning curve for both the surgeon and the anaesthesiologist. The robot is bulky, and cannot be disengaged after docking. Therefore it is important that the anaesthetized patient remains immobile throughout surgery and anaesthesia is reversed only after the robot has been disengaged at the end of surgery. Advances in laparoscopy and robotic surgery have modified anaesthetic techniques too. © 2014 Baishideng Publishing Group Inc. All rights reserved.

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