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Kumar A.,SN Medical College | Suffixivastava U.,SN Medical College
Journal of Anaesthesiology Clinical Pharmacology | Year: 2011

Traditionally, routine investigations prior to surgery are considered an important element of preanesthetic evaluation to determine the fitness for anesthesia and surgery. During past few decades this practice has been a subject of close scrutiny due to low yield and high aggregate cost. Performing routine screening tests in patients who are otherwise healthy is invariably of little value in detecting diseases and in changing the anesthetic management or outcome. Thorough history and investigation of positive answers by the clinicians, combined with physical examination of patient represents the best method for screening diseases followed by few selective tests as guided by patient's health condition, invasiveness of planned surgery and potential for blood loss. A large number of investigations which are costly to pursue often detect minor abnormalities of no clinical relevance, may be risky to patients, cause unnecessary delay or cancellation of surgery, and increase medico-legal liability. An approach of selective testing reduces cost without sacrificing safety or quality of surgical care.


Kumbhat S.,University of Rajasthan | Sharma K.,University of Rajasthan | Gehlot R.,University of Rajasthan | Solanki A.,Sn Medical College | Joshi V.,Desert Medicine Research Center
Journal of Pharmaceutical and Biomedical Analysis | Year: 2010

Surface plasmon resonance (SPR) is a promising tool in sensor technology for biomedical applications. An SPR based immunosensor was established for label free and real time assay for the serological diagnosis of dengue virus infection employing the dengue virus antigen as the sensing element. The dengue virus antigen conjugated with bovine serum albumin is covalently immobilized on a gold sensor chip via activated self-assembled monolayer (SAM) of 11-mercaptoundecanoic acid, by amide coupling. Surface morphology of the biosensor was recorded using atomic force microscopy. Presence of dengue virus specific IgM antibodies in dengue positive sera was monitored by increase in resonance angle in direct immunoassay, whereas the principle of indirect competitive inhibition immunoassay was used to detect presence of dengue virus for early detection of the onset of dengue viral infection in clinical diagnostics. Results were compared with those obtained by MAC-ELISA. The regeneration was achieved by pepsin solution in glycin-HCl buffer (pH 2.2) and sensor surface displayed a high level of stability during repeated immunoreaction cycles. The proposed biosensor being simple, effective and based on utilization of natural antigen-antibody affinity, our study presents an encouraging scope for development of biosensors for diagnosis of dengue and dengue hemorrhagic fever (DHF) which continues to be a major health problem in the tropical and subtropical regions of world. © 2010 Elsevier B.V.


Agarwal M.,SN Medical College | Agrawal M.S.,SN Medical College | Jaiswal A.,SN Medical College | Kumar D.,SN Medical College | And 2 more authors.
BJU International | Year: 2011

Study Type - Therapy (case series) Level of Evidence 4 OBJECTIVE • To evaluate the safety and efficacy of ultrasonography (US)-guided renal access in percutaneous nephrolithotomy (PCNL), as compared with conventional fluoroscopy-guided renal access in a prospective randomized trial. PATIENTS AND METHODS • From January 2008 to October 2009, 224 patients with renal calculi undergoing PCNL were randomized into two groups. • Group 1 (112 patients) underwent PCNL using only fluoroscopy-guided renal access; while in group 2 (112 patients), US guidance for puncture was used in addition to fluoroscopy. • The inclusion criteria were: normal renal functions, American Society of Anesthesiology scores 1 or 2, absence of congenital abnormalities, aged 15-70 years, and anticipated single-tract procedure. The patients in both groups were matched for age, sex, and stone characteristics. • The Student t-test was used for statistical analysis with an allowable error of 5%. RESULTS • The mean time to successful puncture was 3.2 min and 1.8 min in group 1 and group 2, respectively (P < 0.01). • The mean duration of radiation exposure to successful puncture was 28.6 s in group 1 and 14.4 s in group 2 (P < 0.01). • The mean numbers of attempts for successful puncture in the desired calyx was 3.3 in group 1 as compared with 1.5 in group 2 (P < 0.01). • The meantime taken for tract formation in group 1 was 7.4 min with radiation exposure of 82 s, while in group 2 it took 4.8 min with radiation exposure of 58 s (P < 0.01). • Successful access was achieved in all patients. All patients were stone-free at the end of the operation. The hospital stay (2-3 days) was same in both groups. There was no incidence of significant bleeding requiring transfusion during or after surgery. All the patients were followed-up for a ≥6 months. CONCLUSION • US-guided puncture in PCNL helps in increasing accuracy of puncture and decreasing radiation exposure for the surgical team and the patients. © 2011 BJU INTERNATIONAL.


Agarwal M.,SN Medical College | Agrawal M.S.,SN Medical College | Mittal R.,SN Medical College | Sachan V.,SN Medical College
Journal of Endourology | Year: 2012

Purpose: To perform a prospective randomized study to evaluate aspiration and sclerotherapy vs. laparoscopic deroofing in the management of symptomatic simple renal cysts. Patients and Methods: Forty patients with symptomatic simple renal cysts were randomized to treatment either by ultrasonography-guided aspiration and sclerotherapy (group A-20 patients) or by laparoscopic deroofing (group B-20 patients). Two patients in group A and one patient in group B had a parapelvic cyst. Patients were evaluated by urine analysis, serum creatinine level, coagulation profile, ultrasonography, and CT urography. In group A patients, after aspiration, 1% polidocanol in a volume equivalent to 10% of cyst volume was instilled. In group B patients, laparoscopic deroofing was performed. All patients were followed up by ultrasonography up to 1 year after treatment. Results: In group A, aspiration and sclerotherapy was performed on an outpatient basis, and none of the patients needed postoperative analgesia. Eighteen of 20 patients had complete regression; two of these had parapelvic cyst. Partial regression with relief of pain was noted in one patient, whereas treatment failed in one patient. None of the patients had any significant complication and none required analgesia. All the patients were discharged two hours after the procedure. In group B, laparoscopic deroofing was successfully performed in 19 of 20 patients. Laparoscopic deroofing could not be performed in one patient with parapelvic cyst because of failure of access. The mean analgesic requirement was 285±57.98 (200-400) mg tramadol, and average hospital stay was 2.1±0.32 (2-3) days. Conclusion: Percutaneous aspiration and sclerotherapy with polidocanol is an effective, safe, and minimally invasive therapeutic option for symptomatic simple renal cysts, with equal efficacy and lower morbidity and hospital stay in comparison with laparoscopic deroofing. © Copyright 2012, Mary Ann Liebert, Inc.


Gupta R.K.,Sn Medical College | Chandra A.,Sn Medical College | Gautam P.B.,Sn Medical College
Journal of Association of Physicians of India | Year: 2012

Allergic Bronchopulmonary Aspergillosis (ABPA) was first described by Hinson and colleagues in 1952. ABPA is a hypersensitivity disorder induced by a fungus Aspergillus and affects non-immunocompromised patients. The diagnosis is based on the presence of a combination of clinical, biological and radiological criteria. The treatment is based on oral corticosteroids for 6-8 weeks at acute phase or exacerbation and Itraconazole is now recommended and validated at a dose of 200 mg/day for 16 weeks. © JAPI.


Kumar V.,Sn Medical College | Modi P.K.,National Institute of Medical science | Saxena K.K.,LLRM Medical College
Asian Journal of Pharmaceutical and Clinical Research | Year: 2013

Background and Objectives- Tinospora cordifolia (Willd.) Miers ex Hook. f. & Thoms. (T. cordifolia) has been shown to be hepatoprotective by Ayurvedic physicians but has not been scientifically evaluated so far. So, the present study was undertaken to explore the hepatoprotective activity of T. cordifolia against experimentally induced hepatotoxicity in albino rats. Aim of The Study-To explore the hepatoprotective activity of T. cordifolia. Materials and Methods- Albino Wistar rats weighing 150-200g of either sex were divided into six groups of six animals each. Group I was given normal saline (PO), group II carbon tetrachloride(CCl4) (IP), group III Liv.52 syrup for twenty days followed by carbon tetrachloride, group IV, V & VI received aqueous extract of T. cordifolia (1ml/100g twice daily) orally for 10, 20 & 30 days respectively followed by CCl4 administration. Blood was collected from anaesthetized animals & liver was dissected out. Alanine transaminase (ALT), Alkaline phosphatase (ALP) & Total bilirubin were estimated and liver was subjected to histopatological examination. Results-ALT, ALP & Total bilirubin levels were significantly increased in CCl4 treated group while T. cordifolia displayed significant reduction in rise in these parameters in group IV, V & VI. This hepatoprotection was also reflected in histologal changes. Interpretation and Conclusion-It can be concluded from the present study that T. cordifolia extract is a potent hepatoprotective agent. It is assumed that this hepatoprotective effect of T. cordifolia may be due to several reasons such as antioxidant and/or free radical scavenger property and ability to induce hepatic regeneration.


Singh B.,Mayo Medical School | Parsaik A.K.,Mayo Medical School | Agarwal D.,Mayo Medical School | Surana A.,Sn Medical College | And 2 more authors.
Annals of Emergency Medicine | Year: 2012

Study objective: To perform a systematic review and meta-analysis to define the diagnostic performance of pulmonary embolism rule-out criteria (PERC) in deferring the need for D-dimer testing to rule out pulmonary embolism in the emergency department (ED). Methods: We searched EMBASE, MEDLINE, Scopus, Web of Knowledge, and all the evidence-based medicine reviews that included the Cochrane Database of Systematic Reviews through August 14, 2011, and hand searched references in potentially eligible articles and conference proceedings of major emergency medicine organizations for the previous 2 years. We selected studies that reported diagnostic performance of PERC, reported original research, and were conducted in the ED, with no language restrictions. Two investigators independently identified eligible studies and extracted data. We used contingency tables to calculate sensitivity, specificity, and likelihood ratios. Results: We found 12 qualifying cohorts (studying 13,885 patients with 1,391 pulmonary embolism diagnoses), 10 prospective and 2 retrospective, from 6 countries. Pooled sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios for 10 included studies were 0.97 (95% confidence interval [CI] 0.96 to 0.98), 0.23 (95% CI 0.22 to 0.24), 1.24 (95% CI 1.18 to 1.30), and 0.17 (95% CI 0.13 to 0.23), respectively. Significant heterogeneity was observed in specificity (I 2=97.2%) and positive likelihood ratio (I 2=84.2%). Conclusion: The existing literature suggests consistently high sensitivity and low but acceptable specificity of the PERC to rule out pulmonary embolism in patients with low pretest probability. Copyright © 2012 by the American College of Emergency Physicians.


Hiremath L.D.,SN Medical College | Tengelekar S.G.,MR Medical College
Journal of the Indian Medical Association | Year: 2013

There is always concern about the healthcare of women during pregnancy and child birth and prevention of maternal mortality on priority. By contrast little attention has been given to the reproductive health of non-pregnant women. There is always a relative neglect of gynaecological care which fails to appreciate the magnitude of the problem in the community. The objectives of the study were to assess the level of gynaecological morbidity among married women and to assess the magnitude of gynaecological problems in relation to their history, clinical examination and laboratory investigations. This study is one cross-sectional and the area selected was Rajapur village field practice area, MR Medical College, Gulbarga. Population of Rajapur is 5000 spread over nearly in 850 familes. Family was taken as unit for study purpose. Estimated married women were 580. The sample interval was taken as two. Sample size constituted 290 married women. The information was collected in pretested proforma, gynaecological examination and laboratory investigation were done at community health centre. In the present study gynaecological morbidity perceived by women was 81.37% (jncluding menstrual problems). Disease per woman as perceived by woman was 2.48%, but gynaecological morbid ity on clinical examination was 79.66%. Disease per woman on clinical examination was 1.57%. On laboratory investigations 24.24% women had inflammatory cells on microscopic examination of urine and 1.29% women were found to have blood VDRL reactive, on laboratory investigation done among the 231cases. Pap smear report showed out of 290 women, 162(55.86%) showed inflammatory changes. Only one woman ie, 0.34% had neoplasia, but there were 22(7.58%), 2(0.68%) and 12(4.13%) women had mild, moderate and severe dysplasia respectively. Trichomonas vaginitis was observed in 10 women (3.44%).


Srivastava V.,KLE University | Viswanathaswamy A.H.M.,KLE University | Mohan G.,Sn Medical College
Indian Journal of Pharmacology | Year: 2010

Objectives: To study the ulcer protective property of sodium cromoglycate in pylorus-ligated rats and the biochemical role in ulcer protection by various biochemical tests. Materials and Methods: The ulcer protective effect of sodium cromoglycate was studied using a Pyloric Ligation Model using Wistar albino rats. The antiulcer effect of sodium cromoglycate 40 mg/kg b.w., i.p., was compared with the reference drug ranitidine 27 mg/kg b.w., i.p. The ulcer index was calculated and other biochemical parameters like free acidity, total acidity, pH, mucin, pepsin and volume of gastric juice were determined. Results: Pylorus ligation showed a significant (P < 0.01) reduction in gastric volume, free acidity, total acidity and ulcer index as compared to the control. Conclusion: Sodium cromoglycate has activity equipotent to ranitidine.


Agarwal N.,Sn Medical College
The Indian journal of chest diseases & allied sciences | Year: 2011

Tracheostomy is a life saving procedure and many patients are discharged with permanent tracheostomy tubes. We report the rare occurrence of a fractured tracheostomy tube migrating into the tracheobronchial tree and highlight the clinical manifestations of this uncommon complication that carries the potential risk of fatal respiratory obstruction.

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