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PubMed | Swami Rama Himalayan University and Max Superspeciality Hospital
Type: | Journal: The neuroradiology journal | Year: 2017

A young adult female with restricted water intake during the postpartum period presented with history of progressive weakness, dizziness and tendency to fall with generalized slowing of movement. On examination, patient was anaemic, febrile and stuporous. Investigations revealed hypernatremia, delta waves in electroencephalogram (EEG) and features suggestive of extra-pontine myelinolysis on magnetic resonance imaging (MRI) of brain. After correcting hypernatremia and instituting anti-cholinergic therapy, there was a gradual but steady improvement in neurological symptoms of the patient over a period of one week and the patient was discharged in a conscious, oriented and ambulant state. As such, neuroimaging findings can be crucial in diagnosing hypernatremic encephalopathy in the postpartum period.

Shrivastava A.,Swami Rama Himalayan University | Saxena Y.,Swami Rama Himalayan University
Indian Journal of Physiology and Pharmacology | Year: 2014

Exposure to extremely low frequency (ELF) electromagnetic radiations from mobile phones may affect the circadian rhythm of melatonin in mobile users. The study was designed with objective to evaluate the influence of mobile phone on circadian rhythm of melatonin and to find the association if any between the hours of mobile usage with serum melatonin levels. All the volunteers medical students using mobiles for > 2 hrs/day were included in high users group and volunteers who used mobile for ≤ 2 hrs where included in low users group. Both high and low users volunteers were sampled three times in the same day (Morning- 3-4 am, Noon 1-2 pm, Evening-5-6 pm) for estimation of serum melatonin levels. Comparsion of sernum melatonin levels in high users and low users were done by Mann Whitney “U” Test. Reduced morning melatonin levels (3-4 am) was observed in high users (> 2 hrs/day) i.e high users had a disturbed melatonin circadian rhythm.There was a negative correlation between melatonin secretion and hours of mobile usages. © 2014, Association of Physiologists and Pharmacologists of India. All rights reserved.

Jain A.,Swami Rama Himalayan University | Kaushik R.,Swami Rama Himalayan University | Kaushik R.M.,Swami Rama Himalayan University
Acta Tropica | Year: 2016

This prospective study assessed the incidence, clinical profile and outcome of malarial hepatopathy and its association with other complications in patients with malaria, proved by peripheral blood smear examination and rapid malaria test. Hyperbilirubinemia (Serum bilirubin >3 mg/dL) with >3-fold rise in serum aminotransferases in absence of a different explanation for such derangement was considered as malarial hepatopathy. Of 134 (falciparum-81, vivax-48 and mixed falciparum and vivax-5) malaria cases, hyperbilirubinemia occurred in 41.04%. Serum aspartate aminotransferase (AST) was raised >3-fold in 17.16% and serum alanine aminotransferase (ALT) in 4.47% cases. Malarial hepatopathy was observed in 4.47% (falciparum-5 and vivax malaria-1) cases, but had insignificant association with the type of malaria (p = 0.532). Serum bilirubin, AST and ALT levels were higher while age was lower overall (p < 0.05 each) and in falciparum malaria cases with hepatopathy than without hepatopathy (p < 0.05 each). Malarial hepatopathy was associated with a higher incidence of cerebral malaria, shock, hyponatremia, acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulation overall (p < 0.05 each) and in falciparum malaria (p < 0.05 each) and acute kidney injury only in overall malaria (p < 0.05). Malarial hepatopathy had significant association with duration of hospitalization, parasite clearance time, fever clearance time and jaundice clearance time overall (p < 0.05 each) and in falciparum (p < 0.05 each) but not vivax malaria (p > 0.05 each). Mortality occurred in 1 (20%) case of falciparum-induced hepatopathy with an overall mortality of 16.66%. ARDS (p = 0.003) and shock (p = 0.026) were independently associated with malarial hepatopathy overall while only ARDS with falciparum-induced hepatopathy. Thus, hepatocellular dysfunction is common in malaria but that qualifying as malarial hepatopathy is not common. Malarial hepatopathy is likely to occur in presence of other malarial complications. It is an epiphenomenon in severe malaria and indicative of severe disease. Establishing a particular association with malaria or mortality would require a larger case-control study of severe malaria. © 2016 Elsevier B.V.

Ahmad S.,Swami Rama Himalayan University | Mittal M.,Swami Rama Himalayan University
Journal International Medical Sciences Academy | Year: 2015

Diabetic peripheral neuropathy is a well-known microvascular complication of type 2 diabetes mellitus attributed to chronic hyperglycemia. Tingling paraethesias, pain and hyperesthesias in the feet occur in newly diagnosed or poorly Table controlled 1: Severity diabetics of Diabetic and the Polyneuropathy symptoms resolve with proper glycemic control. The present article focuses on classification of diabetic neuropathy and its management. © 2015, International Medical Sciences Academy. All rights reserved.

PubMed | Swami Rama Himalayan University
Type: Journal Article | Journal: Surgical case reports | Year: 2016

The greater omentum is an uncommon location for primary tumors. Metastatic tumors of the omentum are common. In contrast, primary tumors of the omentum are very rare. Sporadic cases of primary rhabdomyosarcoma (RMS) arising in the abdomen have been reported, but these cases are limited almost exclusively to the pediatric population. We report a well-documented case of primary intra-abdominal RMS in a 21-year-old man who presented with complaints of abdominal pain and lump in left hypochondrium region. Imaging revealed it to be a large mass in the left hypochondrium region displacing the bowel loops. Further investigations revealed omental RMS. The mass had originated from the greater omentum and was excised. Our case is doing well and is presently receiving chemotherapy.

PubMed | Swami Rama Himalayan University
Type: Journal Article | Journal: Indian journal of orthopaedics | Year: 2016

New and expensive technology such as three-dimensional computer assisted surgery is being used for pedicle screw fixation in dorsolumbar spine. Their availability, expenses and amount of radiation exposure are issues in a developing country. On the contrary, freehand technique of pedicle screw placement utilizes anatomic landmarks and tactile palpation without fluoroscopy or navigation to place pedicle screws. The purpose of this study was to analyze and compare the accuracy of freehand and image-assisted technique to place pedicle screws in the dorsolumbar spine of cadavers by an experienced surgeon and a resident. Evaluation was done using dissection of pedicle and computed tomography (CT) imaging.Ten cadaveric dorsolumbar spines were exposed by a posterior approach. Titanium pedicle screws were inserted from D5 to L5 vertebrae by freehand and image-assisted technique on either side by an experienced surgeon and a resident. CT was obtained. A blinded radiologist reviewed the imaging. The spines were then dissected to do a macroscopic examination. Screws, having evidence of cortical perforation of more than 2 mm on CT, were considered to be a significant breach.A total of 260 pedicle screws were placed. The surgeon and the resident placed 130 screws each. Out of 130 screws, both of them placed 65 screws each by freehand and image- assisted technique each. The resident had a rate of 7.69% significant medial and 10.76% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 9.23% significant lateral breach. The expert surgeon had a rate of 6.15% significant medial and 1.53% significant lateral breach with freehand technique while with image-assisted had a rate of 3.07% significant medial and 6.15% significant lateral breach on CT evaluation.Freehand technique is as good as the image-assisted technique. Under appropriate supervision, residents can safely learn to place freehand pedicle screws with an acceptable violation rate.

PubMed | Indian Institute of Technology Roorkee and Swami Rama Himalayan University
Type: | Journal: Computers in biology and medicine | Year: 2016

Clinically, the severity of valvular regurgitation is assessed by manual tracing of the regurgitant jet in the respective chambers. This work presents a computer-aided diagnostic (CAD) system for the assessment of the severity of mitral regurgitation (MR) based on image processing that does not require the intervention of the radiologist or clinician. Eight different texture feature sets from the regurgitant area (selected through an arbitrary criterion) have been used in the present approach. First order statistics have been used initially, however, observing their limitations, the other texture features such as spatial gray level difference matrix, gray level difference statistics, neighborhood gray tone difference matrix, statistical feature matrix, Laws textures energy measure, fractal dimension texture analysis and Fourier power spectrum have additionally been used. For the classification task a supervised classifier i.e., support vector machine has been used in the present approach. The classification accuracy has been improved significantly by using these texture features in combination, in comparison to when fed individually as input to the classifier. The classification accuracy of 95.651.09, 95.651.09 and 95.361.13 has been obtained in apical two chamber, apical four chamber and parasternal long axis views, respectively. Therefore, the results of this paper indicate that the proposed CAD system may effectively assist the radiologists in establishing (confirming) the MR stages, namely, mild, moderate and severe.

PubMed | Swami Rama Himalayan University
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Osteoporosis is a metabolic bone disease caused by progressive bone loss. It is characterized by low Bone Mineral Density (BMD) and structural deterioration of bone tissue leading to bone fragility and increased risk of fractures. When classifying a fracture, high reliability and validity are crucial for successful treatment. Furthermore, a classification system should include severity, method of treatment, and prognosis for any given fracture. Since it is known that treatment significantly influences prognosis, a classification system claiming to include both would be desirable. Since there is no such classification system, which includes both the fracture type and the osteoporosis severity, we tried to find a correlation between fracture severity and osteoporosis severity.The aim of the study was to evaluate whether the AO/ASIF fracture classification system, which indicates the severity of fractures, has any relationship with the bone mineral status in patients with primary osteoporosis. We hypothesized that fracture severity and severity of osteoporosis should show some correlation.An observational analytical study was conducted over a period of one year during which 49 patients were included in the study at HIMS, SRH University, Dehradun. The osteoporosis status of all the included patients with a pertrochanteric fracture was documented using a DEXA scan and T-Score (BMD) was calculated. All patients had a trivial trauma. All the fractures were classified as per AO/ASIF classification. Pearson Correlation between BMD and fracture type was calculated.Data was entered on Microsoft Office Excel version 2007 and Interpretation and analysis of obtained data was done using summary statistics. Pearson Correlation between BMD and fracture type was calculated using the SPSS software version 22.0.The average age of the patients included in the study was 71.2 years and the average bone mineral density was -4.9. The correlation between BMD and fracture type was calculated and the r-values obtained was 0.180, which showed low a correlation and p-value was 0.215, which was insignificant.Statistically the pertrochanteric fracture configuration as per AO Classification does not correlate with the osteoporosis severity of the patient.

PubMed | Swami Rama Himalayan University and All India Institute of Medical Sciences
Type: Journal Article | Journal: Mediterranean journal of hematology and infectious diseases | Year: 2017

Classically associated with We retrospectively compared patients with malaria hospitalised from 2009-15, with (n=105) and without (n=1155) neurological involvement regarding outcomes, complications, demographic attributes, clinical features, and laboratory parameters. Subsequently, the same parameters were studied in those with cerebral malaria due to mono-infections of Cerebral malaria was observed in 8.3% (58/696), 7.4% (38/513) and 17.6% (6/51) of The plasmodial species are comparable in clinical and laboratory parameters and outcomes in cerebral malaria in isolation and combination (p>0.05).

PubMed | Swami Rama Himalayan University
Type: Journal Article | Journal: Journal of clinical and diagnostic research : JCDR | Year: 2016

Corneal blindness forms significant proportion of visual blindness in developing countries and penetrating keratoplasty (PK) can restore vision for this. The prognosis of PK is dependent on the corneal diseases responsible for corneal blindness.To evaluate the indications and visual outcome of PK in tertiary eye care institute in Uttarakhand.Data was reviewed from the medical records of 145 PK done in Department of Ophthalmology, Himalayan Institute of Medical Sciences from January 2012 to October 2014. Analysis of data was done for evaluation of the indications and visual outcome by Paired students t-test for hypothesis testing of grouped values of preoperative and last follow-up best corrected visual acuity in cases of optical and therapeutic grafts. A p-value < 0.05 was considered statistically significant.In this study data of 145 eyes of 138 patients was reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma 48 (33.10%). Therapeutic keratoplasty was done for 33 cases with maximum 30(20.68%) cases of infectious keratitis. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (p=.0001) in best corrected visual acuity improvement from 1.39 logMAR+ 0.022(SD) preoperatively to 0.367 logMAR+0.44(SD) postoperatively and 1.4 logMAR+.000(SD) preoperatively to 0.16 logMAR+0.57(SD) postoperatively for optical and therapeutic grafts respectively.Infective keratitis either active or healed was the major indication for keratoplasty. Poor prognosis indications were most common in this part of the country. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty.

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