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Chachan S.,Veer Surendra Sai Medical College | Tudu B.,Veer Surendra Sai Medical College | Sahu B.,Veer Surendra Sai Medical College
Journal of Orthopaedic Trauma | Year: 2015

Objective: To compare the efficacy of ultrasonography (US) versus radiography (XR) in monitoring fracture healing. Design: Prospective diagnostic follow-up study. Setting: Department of Orthopaedics, Level II trauma center. Patients: Forty-eight acute closed tibial mid diaphysis fracture (OTA 42-A and B) treated by closed reduction and internal fixation with a reamed statically locked tibial interlocking nail between October 2011 and October 2012. Intervention: Evaluation of fracture healing using both US and XR at 2 week intervals. Main Outcome Measurements: Ultrasonographic criterion for fracture healing was set as progressive appearance of periosteal callus along with progressive decrease in visibility of nail. Radiographic criterion for fracture union was set as the appearance of bridging callus across all 4 cortices. Results: Thirty-eight of 48 fractures achieved union, 6 developed a delayed union, whereas 4 went onto nonunion. It was observed that using the above-stated criteria, fracture union was diagnosed at an average of 2 weeks earlier with US as compared with XR. Four of the 6 delayed unions and all nonunions declared themselves much earlier on US versus XR. Conclusions: Ultrasonography can provide valuable early information about union and predict delayed and nonunions at an earlier time interval than standard plain radiographs. Level of Evidence: Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.

Purohit P.,Veer Surendra Sai Medical College | Mashon R.S.,Veer Surendra Sai Medical College | Mashon R.S.,Indian Council for Medical Research | Patel S.,Veer Surendra Sai Medical College | And 8 more authors.
International Journal of Laboratory Hematology | Year: 2014

Introduction: Hb Hofu (HBB:c. 380T>A) is a rare inherited hemoglobin abnormality with few case reports in the world literature. Methods: Screening for the sickle cell gene mutation and other hemoglobinopathies was carried out using the sickle slide test, Hb electrophoresis, and HPLC under an ongoing central government project. Results: We detected twelve Hb Hofu heterozygotes and three sickle Hb Hofu compound heterozygotes. The heterozygotes were asymptomatic except for one individual who had chronic kidney disease and moderate anemia. Only one HbS-Hofu case was symptomatic and presented with intermittent attacks of painful crisis. In the carrier state, the Hb Hofu eluted as a hump at the beginning of the HbA0 window. But in HbS-Hofu cases, Hb Hofu eluted as a single peak in the HbA0 window, with the HbA2 levels being >4% consistently. Conclusion: HbS-Hofu has a variable clinical presentation. The retention time of Hb Hofu on HPLC is very close to that of HbA0 and often elutes in the A0 window. Thus, there is every possibility of the HbS-Hofu chromatogram to be misinterpreted as that of a sickle cell trait/transfused sickle cell-beta-thalassemia case. This is the first time where Hb Hofu has been detected by HPLC, which is the widely accepted screening technique for hemoglobinopathies around the world. © 2013 John Wiley & Sons Ltd.

Patel D.K.,Veer Surendra Sai Medical College | Patel D.K.,Sickle Cell Clinic and Molecular Biology Laboratory and Project | Purohit P.,Veer Surendra Sai Medical College | Dehury S.,Veer Surendra Sai Medical College | And 8 more authors.
International Journal of Laboratory Hematology | Year: 2014

Introduction: HbSD-Punjab (HbSD) is a less common form of sickle cell disease (SCD) and discrimination between HbSD and HbSS is not possible on alkaline electrophoresis because the two variants overlap in the compound heterozygous state. There are only a few publications consisting mostly of case reports. Thus, the phenotypic expression of HbSD and its modifiers has not been studied. Methods: We studied the phenotypic expression of 42 cases of HbSD (the largest number of subjects ever included in this kind of study) and compared them with 84 HbSS cases matched for age, sex, and caste. Further, we evaluated the influence of HbF concentration and alpha thalassemia on the phenotypic expressions of HbSD, namely the frequency of VOC and degree of hemolysis. Results: The frequencies of VOC were similar in both the groups. The markers of hemolysis such as total bilirubin, unconjugated bilirubin, and LDH were higher where as HbF concentration was significantly low in HbSD. There was a negative correlation between HbF concentration and risk of VOC in the HbSD. The total hemoglobin level and hematocrit were significantly high, and the MCV and MCH were significantly low in HbSD with alpha thalassemia. Alpha thalassemia had no influence on the frequency of VOC and severity of hemolysis in HbSD. Conclusion: HbF reduced the frequency of VOC but had no influence on the hemolytic markers in HbSD. HbSD with alpha thalassemia was associated with hypohromic and microcytic features of red blood cells. © 2013 John Wiley & Sons Ltd.

Patel S.,Veer Surendra Sai Medical College | Purohit P.,Veer Surendra Sai Medical College | Mashon R.S.,Veer Surendra Sai Medical College | Dehury S.,Veer Surendra Sai Medical College | And 6 more authors.
Pediatric Blood and Cancer | Year: 2014

Background: Although hydroxyurea is the only effective agent for the treatment of sickle cell disease, published experience with this drug is limited to treatment of homozygous sickle cell anemia and HbS/β thalassemia. The role of hydroxyurea in the treatment of patients with HbSD-Punjab, a rare hemoglobinopathy with phenotypic expression similar to that of sickle cell anemia is unknown. Procedure: Over a period of 10 years, we followed 42 patients with HbSD-Punjab, of which 20 presented with severe clinical manifestations (≥3 episodes of VOC and/or ≥2 units of blood transfusion in the previous 12 months). These 20 patients were enrolled for treatment with hydroxyurea at a dose of 10mg/kg/day and followed prospectively for a period of 24 months. Results: The frequency of VOC decreased significantly and none of them required blood transfusion while receiving hydroxyurea. The HbF, total hemoglobin, MCV, MCH, and MCHC levels increased significantly, whereas HbS, WBC, platelet count, total serum bilirubin, and LDH levels decreased significantly in all the patients. No short-term drug toxicity was observed. Conclusion: This study describes the use of hydroxyurea therapy in patients with HbSD-Punjab. Low dose hydroxyurea (10mg/kg/day) was found to be effective in reducing the clinical severity in patients with HbSD-Punjab without any short-term toxicity. In view of easy affordability amongst poor patients, widespread acceptability by patients and doctors, the need of infrequent monitoring and its potential effectiveness, low dose hydroxyurea is suitable for treatment of patients with HbSD-Punjab. © 2014 Wiley Periodicals, Inc.

Patel D.K.,Veer Surendra Sai Medical College | Mashon R.S.,Veer Surendra Sai Medical College | Purohit P.,Veer Surendra Sai Medical College | Meher S.,Veer Surendra Sai Medical College | And 6 more authors.
Mediterranean Journal of Hematology and Infectious Diseases | Year: 2015

Although several studies have supported that sickle cell trait (HbAS) protects against falciparum malaria, the exact mechanism by which sickle gene confers protection is unclear. Further, there is no information on the influence of the sickle gene on the parasitic diversity of P. falciparum population in severe symptomatic malaria. This study was undertaken to assess the effect of the sickle gene on the parasite densities and diversities in hospitalized adult patients with severe falciparum malaria. The study was carried out in 166 adults hospitalized subjects with severe falciparum malaria at Sickle Cell Clinic and Molecular Biology Laboratory, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India. They were divided into three groups on the basis of hemoglobin variants HbAA (n=104), HbAS (n=30) and HbSS (n=32). The msp-1 loci were genotyped using a PCR-based methodology. The parasite densities were significantly high in HbAA compared to HbAS and HbSS. The multiplicity of infection (MOI) and multi-clonality for msp-1 were significantly low in HbSS and HbAS compared to HbAA. The prevalence of K1 (p < 0 .0001) and MAD20 (p=0.0003) alleles were significantly high in HbAA. The RO33 allele was detected at a higher frequency in HbSS and HbAS, compared to K1 and MAD20. Sickle gene was found to reduce both the parasite densities and diversity of P. falciparum in adults with severe malaria.

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