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New Delhi, India

Jain A.K.,UCMS | Jain S.,UCMS
International Orthopaedics | Year: 2012

Spinal tuberculosis (TB) produces neurological complications and grotesque spinal deformity, which in children increases even with treatment and after achieving healing. Long-standing, severe deformity leads to painful costo-pelvic impingement, respiratory distress, risk of developing late-onset paraplegia and consequent reduction in quality and longevity of life. The treatment objective is to avoid the sequelae of neural complications and achieve the healed status with a near-normal spine. In TB, the spine may become unstable if all three columns are diseased. Pathological fracture/dislocation of a diseased vertebral body may occur secondary to mechanical insult. Surgical decompression adds further instability, as part of the diseased vertebral body is excised. The insertion of a metallic implant is to provide mechanical stability and the use of an implant in tubercular infection is safe. Indications for instrumented stabilisation can be categorised as: (a) pan vertebral disease, in which all three columns are diseased; (b) long-segment disease, in which after surgical decompression a bone graft >5 cm is inserted with instrumentation to prevent graft-related complications and consequent progression of kyphosis and neural complications and (c) when surgical correction of a kyphosis is performed when both anterior decompression and posterior column shortening is required. The implant choice should be individualised according to the case. Pedicle screw fixation in kyphus correction in healed disease is a most suitable implant. Hartshill sublaminar wiring stabilisation in active disease is a suitable implant to stabilise the spine, taking purchase against healthy posterior complex of the vertebral body to save a segment. © 2011 Springer-Verlag.

Chopra D.,Lady Hardinge Medical College | Bhandari B.,Jamia Hamdard University | Wardhan N.,UCMS
Current Clinical Pharmacology | Year: 2012

Ciclesonide (CIC) is a novel inhaled corticosteroid (ICS) approved by US Food and Drug Administration for the treatment of persistent asthma, available as a pressurized metered-dose inhaler in two strengths, 80 mcg/activation and 160 mcg/activation. Ciclesonide is a corticosteroid with unique pharmacological profile including a high degree of serum protein binding, a low oral bioavailability and rapid systemic elimination. Ciclesonide is a prodrug metabolized by esterases to desisobutyryl ciclesonide (des-CIC), an active metabolite with a 100-fold greater affinity for the glucocorticoid receptor. It has shown to improve pulmonary functions, reduce the need for oral corticosteroids (OCSs) and cause lesser suppression of the hypothalamic-pituitary-adrenal axis in asthmatic patients. Clinical efficacy studies suggest that Ciclesonide is superior to placebo and is at least as effective as several active comparators with an improved therapeutic margin thereby improving the therapeutic outcome in patients of asthma. © 2012 Bentham Science Publishers.

Bhasin S.K.,UCMS | Sharma R.,VMMC | Saini N.K.,UCMS
Indian Journal of Pediatrics | Year: 2010

Objective: To study depression, anxiety and stress (DAS) among adolescent school students belonging to affluent families and the factors associated with high levels of DAS. Methods: 242 adolescent students belonging to class 9-12th selected for the study. DASS-21 questionnaire was used for assessing DAS. Results: The scores in the three domains (DAS) were found to be remarkably correlated. It was seen that depression was significantly more among the females (mean rank 132.5) than the males (mean rank 113.2), p=0.03. Depression (p=0.025), Anxiety (0.005) and Stress (p<0.001) were all significantly higher among the 'board classes' i.e., 10th and 12 th as compared to the classes 9th and 11th. All the three (DAS) were found to have an inverse relationship with the academic performance of the students. Depression and Stress were found to be significantly associated with the number of adverse events in the student's life that occurred in last one year. Conclusion: A significant proportion of the students were found to be having high levels of DAS and several important factors were found to be associated with them. Proactive steps at the school-level and community-level and steps for improved parent-adolescent communication are needed for amelioration of the problem. © 2010 Dr. K C Chaudhuri Foundation.

Dewan P.,UCMS | Singhal S.,Maulana Azad Medical College | Harit D.,UCMS
Indian Pediatrics | Year: 2010

Context: Chemotherapy-induced nausea and vomiting (CINV) is a significant problem in the treatment of children with cancer. The last decade has seen a variety of newer antiemetics being evaluated for CINV; their efficacy and side-effects need to be assessed in children. This article attempts to highlight this revised management of CINV. Evidence acquisition: Online search; journals. Search period: 6 months. Results: Newer drugs (aprepitant, fosapritant and newer 5HT3 antagonists) have been found to be effective in CINV: both acute and delayed phases. Most of the available literature is, however, based on adult oncology patients, with a few trials on adolescent patients. Conclusion: Every child receiving treatment for cancer should be evaluated for possible CINV. Their treatment should take into account the emetogenic potential of the chemotherapeutic drugs. Newer antiemetic drugs have good efficacy and can be tried in pediatric patients, especially in children > 11 years of age.

Jain S.,UCMS | Prasad K.N.,UCMS | Ghoshal U.,UCMS | Dhole T.N.,UCMS
Indian Journal of Medical Microbiology | Year: 2012

Purpose: The present study was performed to assess the current susceptibility pattern of blood isolates of Salmonella spp from a super specialty hospital in North India against nalidixic acid, ciprofloxacin and azithromycin and compare the in vitro and in vivo response against azithromycin. Materials and Methods: We evaluated the minimum inhibitory concentration's (MIC's) of 107 blood isolates of Salmonella spp against nalidixic acid, azithromycin and ciprofloxacin and correlated in vitro and in vivo response of azithromycin from the treatment and discharge summaries from the Hospital Information System (HIS) software. Results: Among the 107 isolates evaluated, 94 (87.8%) were nalidixic acid-resistant (NAR) Salmonella and 36 were resistant to azithromycin by MIC testing. The MIC 90 value for azithromycin was 24 g/mL. Among the 57 treatment histories evaluated using the HIS software, 19 (33%) patients had documented clinical non-response to azithromycin which required change of therapy. Conclusions: The present study observed a higher MIC 90 values for azithromycin compared to Salmonella isolates from Western studies. There was also a documented clinical non-response against azithromycin. The in vitro and in vivo findings in this study suggest a guarded use of azithromycin for cases of enteric fever in India. The study also augments the reversal of resistance pattern in favour of chloramphenicol, ampicillin and trimethoprim - sulfamethoxazole.

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