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Sharma D.,VMMC and Safdarjung Hospital | Singh G.,VMMC and Safdarjung Hospital
Indian Journal of Cancer | Year: 2016

BACKGROUND: Pediatric head and neck squamous cell carcinoma is very rare. Limited data are available in English literature on this issue due to paucity of cases. Hence, we retrieved data of pediatric head and neck cancer in younger age group (≤20 years of age) for evaluation of clinicopathological characteristics, treatment, and outcome of this emerging issue. MATERIALS AND METHODS: A retrospective observational study was conducted from January 2011 to December 2015 in our Department of Radiotherapy. A total of nine patients of age 20 years or younger were identified during this period for analysis in this study. Various parameters such as age, clinical features, clinical stage, and the treatment received by the patients were recorded and analyzed for outcome. RESULTS and DISCUSSION: Median age of presentation was 19 years with male:female ratio 8:1. The most common subsite involved was tongue > buccal mucosa > tonsil > retromolar trigone. Surgery was preferred treatment modality followed by adjuvant therapy (radiotherapy/chemotherapy). Complete response was shown in 62% cases. Disease progression was found in 25% of cases. On median follow-up of 8 months, 25% of patients had developed local recurrence, none showed metastatic disease. CONCLUSION: The rarity of these tumors inevitably results in a paucity of high-level evidence to guide treatment. It has a high impact on the quality of life, cosmetic outcomes, and secondary malignancies may develop with increased survival. More clinical studies to be conducted to establish etiopathological characteristic and treatment guidelines in this issue. © 2017 Indian Journal of Cancer.

Sharma D.,VMMC and Safdarjung Hospital | Singh G.,VMMC and Safdarjung Hospital
Indian Journal of Cancer | Year: 2016

INTRODUCTION: Changing scenario of cancer in adolescents and young adult (AYA) age group becomes an emerging and alarming problem. The age span that falls under the AYA umbrella, i.e., 15-29 years, is broad and having unique characteristic as compared to older and pediatric cohort. Only a few data are available in English literature about this age group where the spectrum of cancer varies accordingly as the function of age. OBJECTIVE: The aim of this study was to evaluate the incidence and pattern of tumor in adolescents and young age group. MATERIALS AND METHODS: A retrospective observational study was done at a tertiary care center. Medical records of patients aged 15-29 years registered from 2011 to 2015 were retrieved for analysis. RESULTS: Incidence rate of malignancy in AYA age is 5.71% in this observational study. Male:female ratio was 1.81:1. Most common cancer in this age group was head and neck cancer > central nervous system > gastrointestinal tract in the entire cohort. CONCLUSION: The malignancy spectrum, their subtypes, and demographic distribution in the AYA cohort have diversity among different cancer centers within India as well as in different countries across the world.

Sharma D.,VMMC and Safdarjung Hospital | Singh G.,VMMC and Safdarjung Hospital
Indian Journal of Cancer | Year: 2016

BACKGROUND: Head and neck squamous cell carcinoma (SCC) is a disease of older age group predominately in the sixth and eighth decades of life. The incidence of oral SCC (young age <40 years) varies between 0.4% and 3.9%. There has been increasing trend in younger age group worldwide as well as in India as reported by many studies. AIM: The aim of the present study was to compare the clinicopathological profile, treatment, and outcomes of SCC of oral cavity and oropharyngeal cancer in the young age group of <40 years old. MATERIALS AND METHODS: This retrospective observational study was done by retriving data of selected cohort from 2013 to 2015. Patients were divided into 2 groups: Group 1 (10-30 years) and Group 2 (31-40 years) for comparison. SPSS Version 16 software was used for statistical analysis. RESULTS: Cohort of 217 patients was analyzed. The male:female ratio was 11:1. The most frequent site of primary tumor was tongue > buccal mucosa. The primary site of cancer as oropharynx was present in 3 (5.17%) and 22 (13.83%) patients, respectively, in two groups. Mean overall survival (OS) in two groups was 22.53 and 25.14 months, respectively (P = 0.119). The median disease-free survival (DFS) in two groups was 7 and 8 months, respectively. CONCLUSION: The present study showed that the incidence of oropharyngeal cancer increases with age, but the behavior is more aggressive in a younger age group in spite of aggressive treatment, the DFS and OS were not improved in under 30 years group. © 2017 Indian Journal of Cancer.

Tiwari V.K.,VMMC and Safdarjung Hospital
Indian Journal of Plastic Surgery | Year: 2012

Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds.

Sarabahi S.,VMMC and Safdarjung Hospital
Indian Journal of Plastic Surgery | Year: 2012

There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no 'magical dressings'. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention.

Sharma V.,VMMC and Safdarjung Hospital | Dogra A.,Paras Hospitals
Journal of Clinical Orthopaedics and Trauma | Year: 2011

Calcaneum the largest tarsal bone accounts for 60% of all tarsal bone injuries and 2% of all fractures. The management of the calcaneal fractures is still a challenge to orthopedic surgeons. The aim of this study was to establish the best treatment, non-surgical or surgical for Sanders type II fractures.It is a prospective study in which a total of 30 patients in age group of 18-60 years were randomized (by envelope) into non-operative (group A) 15 patients and operative (group B) 15 patients. All type II fractures confirmed on CT were included in the study. Patients with any other associated injuries or with any co-morbidity were excluded from this study. The results were evaluated using Bohler's angle, Kerr Atkins, AOFAS, and visual analog scale.In our series, mode of injury was fall from height in 27 (90%) and road traffic accident (RTA) in 3 (10%). There were 21 males and 9 females. The mean Kerr Atkins score in operative group was 66.12 and in conservative group was 60.22. The mean AOFAS in operative group was 72.13 and in conservative group was 71.16. The visual analog scale in operative group was 1.83 and in conservative group was 2.12. The mean follow-up was 28.1 months. Bohler's angle is a good predictor of morbidity and the improvement after surgery was not statistically significant.It was concluded that there is no significant difference in outcome of treatment, surgical or conservative, and results were equivalent in both groups. © 2011 Delhi Orthopedic Association.

Sharma R.,VMMC and Safdarjung Hospital | Rasania S.K.,VMMC and Safdarjung Hospital | Verma A.,VMMC and Safdarjung Hospital | Singh S.,VMMC and Safdarjung Hospital
Indian Journal of Community Medicine | Year: 2010

Background: Because of the environment in which they work, many health care workers are at an increased risk of accidental needle stick injuries (NSI). Objective: To study prevalence and response to needle stick injuries among health care workers. Materials and Methods: Study Design: Cross-sectional study. Setting: A tertiary care hospital in Delhi. Participants: 322 resident doctors, interns, nursing staff, nursing students, and technicians. Statistical Analysis: Proportions and Chi-square test. Results: A large percentage (79.5%) of HCWs reported having had one or more NSIs in their career. The average number of NSIs ever was found to be 3.85 per HCW (range 0-20). 72 (22.4%) reported having received a NSI within the last month. More than half (50.4%) ascribed fatigue as a cause in their injury. Most of the injuries (34.0%) occurred during recapping. In response to their most recent NSI, 60.9% washed the site of injury with water and soap while 38 (14.8%) did nothing. Only 20 (7.8%) of the HCWs took post-exposure prophylaxis (PEP) against HIV/AIDS after their injury. Conclusions: The occurrence of NSI was found to be quite common. Avoidable practices like recapping of needles were contributing to the injuries. Prevention of NSI is an integral part of prevention programs in the work place, and training of HCWs regarding safety practices indispensably needs to be an ongoing activity at a hospital.

Sharma S.,VMMC and Safdarjung Hospital | Gupta R.,VMMC and Safdarjung Hospital | Sehgal R.,VMMC and Safdarjung Hospital | Aggarwal K.C.,VMMC and Safdarjung Hospital
Journal of Tropical Pediatrics | Year: 2014

Posterior reversible encephalopathy, better known as potential reversible encephalopathy syndrome (PRES), is a clinicoradiological entity mostly described in adult populations manifesting predominantly as bilateral symmetrical diffuse white matter vasogenic oedema in parieto-occipital regions. Rarely it may also present as patchy reversible areas of involvement in the basal ganglia, brainstem and deep white matter. It is reported scarcely in childhood populations. Frequent association with acute hypertension (67-80%) is reported in many studies. Involvement of the brainstem and cervical cord (apart from the typical parieto-occipital lesions) is an extremely rare imaging manifestation of PRES and its recognition is important to avoid misdiagnosis as myelitis or acute disseminated encephalomyelitis by proper clinical correlation. We hereby report a case of PRES in a 7-year-old child showing an uncommon pattern on imaging study involving the brain as well as the brainstem and cervical spinal cord. © The Author [2014]. Published by Oxford University Press. All rights reserved.

Kumar A.,VMMC and Safdarjung Hospital | Vasudecny CHNa P.,VMMC and Safdarjung Hospital | Kumar N.,VMMC and Safdarjung Hospital | Nanda B.,VMMC and Safdarjung Hospital | And 2 more authors.
Journal of Endourology | Year: 2013

Purpose: The first prospecticny CHNe randomized study to compare the safety and short-term efficacy of monopolar transurethral resection of the prostate (TURP), bipolar TURP, and photoselecticny CHNe cny CHNaporization of the prostate (PVP) using GreenLight high-performance system 120W laser in patients who presented with benign prostatic obstruction (BPO). Patients and Methods: The 186 consecuticny CHNe patients who presented with BPO and who were planned for surgery were randomized into three groups: Group A, patients who underwent monopolar TURP; group B, patients who underwent bipolar TURP; and group C, patients who underwent PVP. All three groups were subdicny CHNided into two subgroups based on prostate cny CHNolume: Subgroup 1 >20 cc and <50 cc, and subgroup 2, between 50 and 80 cc. Patients preoperaticny CHNe, perioperaticny CHNe, and follow-up data were recorded and analyzed. Results: The baseline characteristics of the three groups and subgroups 1 and 2 were comparable. The number of patients in whom postoperaticny CHNe irrigation was instituted, amount of fluid used for postoperaticny CHNe irrigation, duration of postoperaticny CHNe irrigation, postoperaticny CHNe hemoglobin concentration, and duration of catheterization were significantly in facny CHNor of group C patients except for the mean operaticny CHNe time, which was significantly longer among them. All three groups demonstrated an increase in International Prostate Symptom Score, quality of life score, and maximum flow rate and decrease in prostate cny CHNolume and postcny CHNoid residual urine at 12-month follow-up. The mean Intgernational Index of Erectile Function-5 score did not show improcny CHNement in any group. The need for blood transfusion and clot retention necessitating intercny CHNention were significantly lower among group C patients compared with group A, whereas these cny CHNalues for group B patients did not reach significant lecny CHNel compared with either group A or C. These complications were comparable among subgroup 1 patients, whereas subgroup 2 patients had shown results in facny CHNor of subgroup C2. Conclusion: Monopolar TURP, bipolar TURP, and PVP are equally efficacious at 12-month follow-up. PVP has added adcny CHNantages of lesser blood loss, lesser need for blood transfusion (especially for prostate cny CHNolume 50-80 cc), and shorter catheterization time. © Mary Ann Liebert, Inc.

Azad K.,Vmmc And Safdarjung Hospital | Khunger J.M.,Vmmc And Safdarjung Hospital
Indian Journal of Pathology and Microbiology | Year: 2010

Adult granulosa cell tumors (AGCT) are associated with ascites in 10% of the cases. Although these tumors form two per cent of all ovarian tumors, they may create a diagnostic challenge in cytologic preparations. The tumor cells are not readily shed in the fluid. A case of a 47-year-old woman with presence of granulosa tumor cells in ascitic fluid is presented. Because of its rarity, AGCTs can be confused with other ovarian tumors.

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