Delhi, India
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Jain S.,Mahaveer Hospital | Jain A.K.,UCMS and GTB Hospital | Kumar I.,UCMS and GTB Hospital
Chinese Journal of Traumatology - English Edition | Year: 2013

Objective: Debate continues regarding the management of calcaneal fractures, between open reduction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of comminution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97), with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler's angle, mean Gissane's angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap necrosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome, i.e. restoring anatomically reconstruction of height, width, Bohler's and Gissiane's angles of the calcaneum, and allowing early mobilization.


Patra S.,UCMS and GTB Hospital | Sharma S.,LRS Institute of Tuberculosis and Respiratory Diseases | Behera D.,PGi
Indian Journal of Tuberculosis | Year: 2012

Background: Passive smoking and biomass fuel use most probably are more harmful to children than adults for two reasons. The first one is children's respiratory and immune systems are not fully developed. Secondly, they spend more time at home and are, therefore, likely to experience more intense and prolonged smoke exposure. Aims: This study was planned to find out if there is any association between childhood tuberculosis and exposure to passive smoking and biomass fuel. Methods: A hospital-based case control study was done. All registered consecutive newly diagnosed pediatric tuberculosis cases (0-14 years) from the outpatient department of a tertiary care hospital were recruited as cases. Age and sex matched controls were recruited from a public general hospital of the same locality. A semi-structured, pre-coded interview schedule was administered to parents or legal caregivers of all subjects after obtaining informed written consent. Results: A total of 200 cases and 200 controls were recruited in the study period. The factors which were significantly associated with development of tuberculosis were education of the mother, (OR 1.411, 95% CI 0.888-2.243, p-0.001), a family member having tuberculosis in the last two years and residing in the same house (OR 2.797, 95% CI 1.353-5.789; p-0.004), being a passive smoker (OR 1.725, 95% CI 1.142-2.605; p-0.009). No association between biomass cooking fuel use and development of tuberculosis was found. Conclusion: Passive smoking is associated with development of childhood tuberculosis. This requires health education programmes and medical antitobacco advice and services.


Agarwal A.,Chacha Nehru Bal Chikitsalaya | Aggarwal A.N.,UCMS and GTB Hospital
Indian Journal of Pediatrics | Year: 2015

The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints. © 2015 Dr. K C Chaudhuri Foundation


Agarwal A.,Chacha Nehru Bal Chikitsalaya | Aggarwal A.N.,UCMS and GTB Hospital
Indian Journal of Pediatrics | Year: 2015

Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child’s presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory. © 2015 Dr. K C Chaudhuri Foundation


Agarwal A.,CNBC | Agarwal R.,UCMS and GTB Hospital
Education for Health: Change in Learning and Practice | Year: 2010

Context: Traditional bonesetting is an art that in the face of urbanization, lack of public attention and lack of modern facilities has survived more than 3,000 years. This article explores the role of bonesetters in the developing world, their successes and failures and possible utilization of their services as part of the healthcare system of a country. Methods: Articles depicting working or techniques of bonesetters or those related to training and education issues of traditional bonesetters, especially in developing countries, were reviewed. The current scenario of healthcare delivery and medical education along with existing socioeconomic conditions prevailing in India were analyzed with generalization of findings to the healthcare delivery systems of other developing countries. Findings: Bonesetting has its strengths and weaknesses. With current socioeconomic conditions and the types of health needs prevailing in developing countries, it would be difficult to abolish traditional bonesetting. These providers have widespread community acceptance and support. Complications can be minimized and practice potentially improved with training and education. Conclusions: Pending infrastructure and socioeconomic development, it appears that traditional bonesetters will remain providers of healthcare. Their methodology utilizes regional resources and is commonly believed to be cheaper and effective. Although the deficiencies of traditional bonesetters have been shown, with adequate training in the basics of orthopaedic care, they can be utilized to provide useful health services at the primary care level. © A Agarwal, R Agarwal, 2010.


Gupta N.,UCMS and GTB Hospital | Sonambekar A.A.,UCMS and GTB Hospital | Daksh S.,UCMS and GTB Hospital | Tomar L.,UCMS and GTB Hospital
Annals of Indian Academy of Neurology | Year: 2013

Methanol is a highly toxic alcohol resembling ethanol in smell and taste. Methanol poisoning is a lethal form of poisoning that can cause severe metabolic acidosis, visual disturbances, and neurological deficit. Brain lesions typically described in methanol toxicity are in the form of hemorrhagic and non-hemorrhagic necrosis of the basal ganglia and sub-cortical white matter. To our knowledge, lesions in the parietal, temporal, or frontal areas of cerebrum and cerebellar hemispheres have been rarely reported so far. We herewith report this rare presentation.


Bhatia M.S.,UCMS and GTB Hospital | Jhanjee A.,UCMS and GTB Hospital | Srivastava S.,UCMS and GTB Hospital
Asian Journal of Psychiatry | Year: 2013

Objective: Delusional infestation or delusional parasitosis is a form of monodelusional disorder, a condition sometimes encountered in psychiatric or primary care practice. The outcome of this condition is good when compliance can be ensured. Patients and methods: In the present study, a series of 50 consecutive cases of delusional infestation is reported. Results: A majority of cases (94%) had insidious onset. The duration of symptoms in all but 3 cases was 6 months or more. Twenty-eight cases presented with a delusion of infestation by insects over the body and 20 cases with a delusion of insects crawling over the scalp. Two cases had associated diabetes mellitus, 3 cases had leprosy, 2 cases had dementia, 5 cases had depression, and 4 cases presented with trichotillomania. Among the second generation antipsychotics, risperidone was used in 12 cases, olanzapine in 9 cases, amisulpride in 7 cases, etc. Thirty-four cases (68%) showed complete remission while receiving pharmacotherapy, 13 cases showed partial improvement, and 3 cases did not respond to treatment. Conclusions: The study demonstrates the utility of second generation antipsychotics in the treatment of this disorder. Further studies are warranted to study the treatment and outcome of this important psychiatric disorder. © 2012 Elsevier B.V.


Shekhar S.,UCMS and GTB Hospital | Shah D.,UCMS and GTB Hospital
Indian Pediatrics | Year: 2012

This study aimed to assess the sensitivity, specificity, predictive values, and Youden index for mid-upper-arm-circumference cutoff of 115 mm to diagnose severe wasting (as defined by the revised WHO standards) in 346 underweight children aged 6 months to 5 years from an outpatient setting. A cut-off of 115 mm had a better performance (sensitivity 43.2%, specificity 90%, Youden index 0.32) than 110 mm (sensitivity 26.4%, specificity 95.9%, Youden index 0.22) in diagnosing severe wasting. The best performance in terms of a balance between sensitivity and specificity was that of 120 mm (sensitivity 74.4%, specificity 77.8%, Youden index 0.52).


Wadhwa R.,UCMS and GTB Hospital | Ahmad Z.,UCMS and GTB Hospital | Kumar M.,UCMS and GTB Hospital
Indian Journal of Anaesthesia | Year: 2014

Traumatic diaphragmatic hernia (TDH) is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.


Mehndiratta S.,UCMS and GTB Hospital | Suneja A.,UCMS and GTB Hospital | Gupta B.,UCMS and GTB Hospital | Bhatt S.,UCMS and GTB Hospital
Archives of Gynecology and Obstetrics | Year: 2010

Introduction: Fetal warfarin syndrome (warfarin embryopathy) is a consequence of maternal ingestion of warfarin during pregnancy. Warfarin fetotoxicity comprises wide range of manifestations including dysmorphology in neonate with characteristic classical features of nasal hypoplasia and stippling of epiphyses. Materials and methods: Here we present a case of a neonate whose mother was on unsupervised warfarin prophylaxis throughout pregnancy. A brief review of literature with suitable options for anticoagulation during pregnancy is discussed. Conclusion: The final consensus over LMWH and warfarin in the first trimester is yet to be finalised. The treatment of warfarin embryopathy is symptomatic. Long term sequels in survivors are still not known. © Springer-Verlag 2010.

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