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Arif T.,Government Medical College | Arif T.,Aligarh Muslim University | Masood Q.,Government Medical College | Singh J.,SKIMS | Hassan I.,Government Medical College
BMC Gastroenterology | Year: 2015

Background: Systemic sclerosis (SSc) is a generalized disorder of unknown etiology affecting the connective tissue of the body. It affects the skin and various internal organs. Gastrointestinal tract involvement is seen in almost 90% of the patients. Esophagus is the most frequently affected part of the gastrointestinal tract. Esophageal motility disturbance classically manifests as a reduced lower esophageal sphincter pressure (LESP) and loss of distal esophageal body peristalsis. Consequently, SSc patients may be complicated by erosive esophagitis and eventually by Barrett's esophagus and esophageal adenocarcinoma. Morphea, also known as localized scleroderma, is characterized by predominant skin involvement, with occasional involvement of subjacent muscles and usually sparing the internal organs. The involvement of esophagus in morphea has been studied very scarcely. The proposed study will investigate the esophageal involvement in the two forms of scleroderma (systemic and localized), compare the same and address any need of upper gastrointestinal evaluation in morphea (localized scleroderma) patients. Methods: 56 and 31 newly and already diagnosed cases of SSc and morphea respectively were taken up for the study. All the patients were inquired about the dyspeptic symptoms (heartburn and/or acid regurgitation and/or dysphagia). Upper gastrointestinal endoscopy, esophageal manometry and 24-hour pH monitoring were done in 52, 47 and 41 patients of SSc; and 28, 25 and 20 patients of morphea respectively. Results: Esophageal symptoms were present in 39 cases (69.6%) of SSc which were mild in 22 (39.3%), moderate in 14 (25%), severe in three (5.3%); while only four cases (7.1%) of morphea had esophageal symptoms all of which were mild in severity. Reflux esophagitis was seen in 17 cases (32.7%) of SSc and only two cases (7.14%) of morphea. Manometric abnormalities were seen in 32 cases (68.1%) of SSc and none in morphea. Ambulatory 24-hour esophageal pH monitoring documented abnormal reflux in 33 cases (80.5%) of SSc and no such abnormality in morphea. Conclusion: While the esophageal involvement is frequent in SSc, no such motility disorder is seen in morphea. Meticulous upper gastrointestinal tract evaluation is justified only in SSc and not in morphea. © Arif et al.

Qureshi U.A.,Pediatrics Sher I Kashmir Institute Of Medical Science Skims | Wani N.A.,SKIMS | Altaf U.,SKIMS
Journal of the Neurological Sciences | Year: 2010

Neurovascular anomalies of Parry-Romberg syndrome have been reported infrequently. We report a case of Parry-Romberg syndrome with hypoplastic left internal carotid, middle cerebral, anterior cerebral, posterior communicating and posterior cerebral artery. The patient presented with partial seizures, hemiparesis and phthisis bulbi. © 2010 Elsevier B.V. All rights reserved.

Kousar S.,SKIMS | Wafai Z.A.,SKIMS | Wani M.A.,SKIMS | Jan T.R.,University Of Kashmir | Andrabi K.I.,University Of Kashmir
International Journal of Clinical Pharmacology and Therapeutics | Year: 2015

Aims and objectives: Variations in drug metabolizing genes are known to have a clinical impact on AED therapy. We genotyped normal and epileptic patient cohorts of monoethnic population of Kashmir valley for CYP2C9 gene and allelic polymorphism and investigated the effect of CYP2C9∗2 and∗3 polymorphism on the Pharmacokinetic and therapeutic and/or adverse pharmacodynamic responses to phenytoin in the idiopathic epilepsy patients. Methods: PCR-RFLP methods were used for genotyping of 121 normal controls and 92 idiopathic epilepsy patients for CYP2C9∗2 and∗3 polymorphism, the results were validated by direct sequencing. Phenytoin pharmacokinetic (PK) analysis in idiopathic epilepsy patients was done using a validated EMIT assay technique. Pharmacodynamic analysis was done by evaluating clinical response to phenytoin therapy and ADR monitoring. Results: The respective frequencies of CYP2C9∗1,∗2, and∗3 alleles were 64%, 6.6%, 29.3%, and 58%, 9.8%, 32.6% in controls and idiopathic epilepsy patients from Kashmir valley. PK analysis revealed that AUC0-4 was a better surrogate biomarker of CYP2C9 metabolizer status compared to C4and C0 concentrations alone. A comparison of "phenytoin response categories" among CYP2C9 Wild and Heterozygous groups did not reveal any significant difference between the groups (p = 0.3800). Conclusion: CYP2C9∗3 was the most frequent mutant allele found in healthy controls and idiopathic epilepsy patients of ethnic Kashmiri population. CYP2C9 genotype based phenytoin therapy is highly relevant in Kashmiri population due to a high incidence of genetic variations associated with therapeutic and adverse responses to phenytoin. Phenytoin AUC0-4 tends to correlate better with genetic polymorphism of CYP2C9. ©2015 Dustri-Verlag Dr. K. Feistle.

Chhiber S.S.,SKIMS | Singh J.P.,ASCOMS
Neurology India | Year: 2010

Acute spontaneous subdural hematoma of arterial origin, a neurosurgical emergency resulting from rupture of the perisylvian cortical artery, is a rare occurrence. We report four such patients who presented with progressive neurological deterioration. All the patients were operated and perisylvian cortical artery was identified as the source of bleeding in all the patients. Three of the patients had associated hypertension. We reviewed the clinical characteristics, etiology, and outcome of the reported cases in the literature. A high index of suspicion is necessary even in young patients in view of the phenomenon of re-rupture mimicking stroke. Early diagnosis and a wide craniotomy over the sylvian fissure to obtain hemostasis of bleeding points results in good outcome.

Shah B.A.,SKIMS | Singh G.,SKIMS | Naik M.A.,SKIMS | Dhobi G.N.,SKIMS
Lung India | Year: 2010

The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29), followed by Staphylococcus aureus (7/29), Escherichia coli (6/29), Klebsiella spp. (3/29), Streptococcus pyogenes (1/29), Streptococcus pneumoniae (1/29) and Acinetobacter spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and s0 taphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would definitely be better. This emphasizes the need for further studies (including the serological tests for Legionella, mycoplasma and viruses) to identify the microbial etiology of CAP.

Shera A.H.,SKIMS | Baba A.A.,SKIMS | Bakshi I.H.,SKIMS | Lone I.A.,SKIMS
Journal of Indian Association of Pediatric Surgeons | Year: 2011

A juxtaglomerular cell tumor or reninoma is a very rare renin-secreting tumor of the kidney and can be an unusual cause of secondary hypertension. We report a case of recurrence of this uncommon tumor at the hilum of left kidney in an 8-year-old male child.

Shah M.Y.,SKIMS | Shah F.,SKIMS
Annals of Tropical Medicine and Public Health | Year: 2013

Purpose: To determine anti-Kell in Kashmiri population. Material and Methods: Prospective study of One Year. Result: Six patients were tested positive. Conclusion: The incidence of Kell is very low i.e., 0.03% and correlates to the incidence of Japanese.

The study was conducted with the purpose of finding clinical profile of early gastrointestinal complications of stem cell transplant at this center. 70 consecutive subjects, who were subject to bone marrow transplant from October 2002 to September 2004, were prospectively studied. The gastrointestinal complications were followed in first 100 days of transplant and recorded in a pre-determined format. Study population comprised of 23 allo-transplant (with 3-non-myelablative procedures) and 47 auto-transplant subjects. Gastrointestinal complications included: nausea and vomiting in 19 (82.60%), mucositis- 20 (86.95%), diarrhea- 15 (65.21%), veno-occlusive disease (VOD) - 3 (13.04%) and acute pancreatitis- 1 (4.34%) in allo-transplant group. Nausea and vomiting occurred 36 (76.59%), mucositis- 46 (97.88%) diarrhea- 39 (82.98%), VOD- 5 (10.64%) in auto- transplant subjects. Acute graft versus host disease (AGVHD) involved gut in 3 and liver in 1 case of allo-BMT-group.

Raja Dar W.,SKIMS
Middle East Journal of Cancer | Year: 2015

Multiple myeloma is a neoplastic plasma cell dyscrasia. Patients usually present with bone pain, anemia, hypercalcemia and renal failure. Unusual presentations include progressive bilateral carpal tunnel syndrome, polyarthritis, amyloidosis of the tongue, and involvement of pulmonary parenchyma. Early diagnosis is important for timely therapy. We present the case of a patient with clinical features of portal hypertension that ultimately proved to be multiple myeloma. © 2015, Shiraz University of Medical Sciences. All rights reserved.

Raashid H.,SKIMS | Nisar B.,SKIMS
Journal of Pediatric Surgery Case Reports | Year: 2016

A male child 9 years of age presented with fever, tender swelling in the right flank, with a right paramedian scar. Child had undergone exploratory laparotomy for peritonitis with appendicectomy one year back. Radiological investigations (Ultrasonography and Computed Tomography) revealed retrocecal abscess extending to the psoas muscle, which was drained via flank incision. Intermittent discharge continued through an opening in the flank just above the posterior superior iliac spine. Ultrasonography and CT fistulogram revealed a fistulous communication from skin to the cecum/appendix. Upon second exploration a fistulous communication from the tip of residual appendix (which was left in situ at the initial exploration) was found with multiple adhesions in the terminal ileum, cecum, and ascending colon. Local resection of the cecum and ascending colon was performed with ileocolic anastomosis. Fistulous tract was curetted out. Exploration confirmed the incomplete appendicectomy as a cause of this hazardous condition. © 2016 The Authors

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