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Budapest, Hungary

Jain V.,Sports Injury Center | Sen B.,St. Stephens Hospital
Journal of Pediatric Orthopaedics Part B | Year: 2014

Campomelic dysplasia is a rare hereditary congenital osteochondral dysplasia characterized by abnormal bowing of the lower limbs, sex reversal in males, and other skeletal and extraskeletal abnormalities. It is usually fatal in the neonatal period because of respiratory insufficiency. The diagnosis is usually difficult because of its rare presentation and the prognosis is poor. We present such a case in a 1-month-old child with typical skeletal abnormalities, whose presentation was unusual because of later presentation of respiratory distress and lack of genitourinary abnormalities. © Lippincott Williams & Wilkins.

Gulati S.,St. Stephens Hospital | Gulati A.,Lady Hardinge Medical College
Lung India | Year: 2012

Leptospirosis has a spectrum of presentation which ranges from mild disease to a severe form comprising of jaundice and renal failure. Involvement of the lung can vary from subtle clinical features to deadly pulmonary hemorrhage and acute respiratory distress syndrome. Of late, it has been identified that leptospirosis can present atypically with predominant pulmonary manifestations. This can delay diagnosis making and hence optimum treatment. The purpose of this review is to bring together all the reported pulmonary manifestations of leptospirosis and the recent trends in the management.

Tiwari S.,Ministry of Health and Family Welfare | Kumar A.,Ministry of Health and Family Welfare | Kapoor S.K.,St. Stephens Hospital
Indian Journal of Tuberculosis | Year: 2012

Background: The Smear Conversion Rate (SCR) is an operational indicator for the Directly Observed Treatment Shortcourse (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India. The present study was undertaken to determine the relationship between sputum smear grading and smear conversion rate among the Category I smear positive pulmonary tuberculosis patients undergoing DOTS. Methods: A prospective cohort study was conducted among the Category I smear positive pulmonary tuberculosis patients registered under DOTS at GTB, Karawal Nagar and Shahdara Chest Clinics of Delhi. Sample size for the present study was calculated on the basis of a similar study of a retrospective design conducted at LRS Institute of Tuberculosis and Respiratory diseases New Delhi, India using statistical software Epi Info version 6. Accordingly, a total of 338 sputum smear positive patients with 169 each in the High Positive Cohort (pre-treatment sputum grading 3+) and Low Positive Cohort (pre-treatment sputum grading 2+, 1+ and Scanty) were followed periodically at two months (end of Intensive Phase), at three months (after one month extension of Intensive Phase), at two months of Continuation Phase and then at the end of the treatment to record the sputum AFB result and treatment outcome as per the RNTCP guidelines. Data was analyzed using SPSS Version -15. Results: After two months (end of the intensive phase), SCR was 57.9% (98 of 169) among the High Positive and 71.6% (121 of 169) in the Low positive cohort (p -0.008). After three months (one month's extension of intensive phase), cumulative SCR was 85.2%(144 of 169)) in the High Positive and 92.3%(156 of 169) in the Low Positive cohort (p- 0.03). Cure rate was 82.8%(140 of 169) in the High Positive and 84.6%(143 of 169) in the Low Positive cohort. Default rate was 3% (five of 169) in the High Positive and 5.3% (nine of 169) in the Low Positive cohort. Failure rate was 11.2% (19 of 169) in the High positive and 6.5% in the Low positive Cohort (11 of 169). Only one patient (0.6%) in each High and Low Positive cohort died during course of treatment (p -0.631). Treatment outcome was further compared among the patients according to their sputum status achieved at two and three months of the treatment after ignoring their initial sputum status. The cure rates for the patients who converted at two months was 90.9% (199 of 219) and for those who did not convert at two months, was 74.3% (84 0f 113) (p -0.000). Similarly, the cure rate for the patients who converted at three months was 84% (68 of 81) and for those who did not convert at three months was 55.2% (16 of 29) (p-0.01). Interpretation: Patients with higher grades of sputum positivity at the beginning of the treatment have significantly lower SCR at the end of intensive phase and even after extending the intensive phase for one month. Hence, they are likely to remain infectious for a longer duration and continue to transmit infection in the community. Therefore, these patients demand to have more stringent self-precautionary measures to break the chain of infection in the community. The SCR at two months and three months as an operational indicator should be given more importance rather than being practised only as a documentation and academic exercise. The patient should be investigated for the possible co-morbid conditions and drug resistance which could be a cause for the persistent sputum smear positivity at two and three months and hence poor treatment outcome.

Stewart B.,University of Washington | Khanduri P.,St. Stephens Hospital | McCord C.,Columbia University | Ohene-Yeboah M.,Kwame Nkrumah University Of Science And Technology | And 3 more authors.
British Journal of Surgery | Year: 2014

Background: Surgical disease is inadequately addressed globally, and emergency conditions requiring surgery contribute substantially to the global disease burden. Methods: This was a review of studies that contributed to define the population-based health burden of emergency surgical conditions (excluding trauma and obstetrics) and the status of available capacity to address this burden. Further data were retrieved from the Global Burden of Disease Study 2010 and the University of Washington's Institute for Health Metrics and Evaluation online data. Results: In the index year of 2010, there were 896 000 deaths, 20 million years of life lost and 25 million disability-adjusted life-years from 11 emergency general surgical conditions reported individually in the Global Burden of Disease Study. The most common cause of death was complicated peptic ulcer disease, followed by aortic aneurysm, bowel obstruction, biliary disease, mesenteric ischaemia, peripheral vascular disease, abscess and soft tissue infections, and appendicitis. The mortality rate was higher in high-income countries (HICs) than in low- and middle-income countries (LMICs) (24·3 versus 10·6 deaths per 100 000 inhabitants respectively), primarily owing to a higher rate of vascular disease in HICs. However, because of the much larger population, 70 per cent of deaths occurred in LMICs. Deaths from vascular disease rose from 15 to 25 per cent of surgical emergency-related deaths in LMICs (from 1990 to 2010). Surgical capacity to address this burden is suboptimal in LMICs, with fewer than one operating theatre per 100 000 inhabitants in many LMICs, whereas some HICs have more than 14 per 100 000 inhabitants. Conclusion: The global burden of surgical emergencies is described insufficiently. The bare estimates indicate a tremendous health burden. LMICs carry the majority of emergency conditions; in these countries the pattern of surgical disease is changing and capacity to deal with the problem is inadequate. The data presented in this study will be useful for both the surgical and public health communities to plan a more adequate response. © 2013 BJS Society Ltd.

Vashisht N.,St. Stephens Hospital
Indian journal of medical ethics | Year: 2012

It was hoped that following polio eradication, immunisation could be stopped. However the synthesis of polio virus in 2002, made eradication impossible. It is argued that getting poor countries to expend their scarce resources on an impossible dream over the last 10 years was unethical. Furthermore, while India has been polio-free for a year, there has been a huge increase in non-polio acute flaccid paralysis (NPAFP). In 2011, there were an extra 47,500 new cases of NPAFP. Clinically indistinguishable from polio paralysis but twice as deadly, the incidence of NPAFP was directly proportional to doses of oral polio received. Though this data was collected within the polio surveillance system, it was not investigated. The principle of primum-non-nocere was violated. The authors suggest that the huge bill of US$ 8 billion spent on the programme, is a small sum to pay if the world learns to be wary of such vertical programmes in the future.

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