Browsing by Author "Kumar, Raj"
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Item A 54-Year-Old Man with Tracheomegaly, Tracheal Diverticulas and Bronchiectasis — Mounier-Kuhn Syndrome.(2015-04) Singh, Mandeep; Kumar, RajMounier-Kuhn syndrome is a rare idiopathic clinical, radiological and bronchoscopic disorder characterised by abnormal dilatation of the tracheo-bronchial tree. The usual presentation is with recurrent lower respiratory tract infections. Herein, we report the case of an adult male who was diagnosed to have Mounier-Kuhn syndrome based on radiographic finding of a tracheal diameter of 45.5 mm on computed tomography and dynamic complete collapse of the tracheo-bronchial tree on forced expiration, observed during ronchoscopy.Item Acute psychosis induced by topiramate.(2014-03) Raj, Rajnish; Kumar, RajTopiramate (TPM) is a new potent antiepileptic drug (AED) used as add-on therapy for generalized and partial seizures that are resistant to the other AEDs; or as a mood stabilizer, and for reducing weight gain associated with olanzapine and clozapine in patients with bipolar disorder or schizophrenia. However, there is a higher risk of psychosis with TPM in patients with a past history of psychiatric disorder. This case report highlights emergence of psychosis that was related to TPM which resolved on discontinuation.Item Ascites in ventriculoperitoneal shunt.(2003-11-02) Kumar, Raj; Sahay, Surbhi; Gaur, Bandana; Singh, VinitaOBJECTIVE: To fetch out the factors responsible for ascites, following shunt CSF diversion in cases of intracarnial lesions. Four children developing ascites/abdominal psuedocyst following ventriculoperitoneal shunt were analyzed to see the factors responsible for such complication. METHODS: Records of 4 cases developing ascites were studied retrospectively. These children developed ascites at 8 months, 6 months, 1 year and 1 year 2 months interval following their shunt installation. RESULTS: The primary etiology of hydrocephalus was demonstrated as thalamic glioblastoma, choroid plexus papillomas of third ventricle, post tubercular meningitis hydrocephalus and suprasellar craniopharyngioma. CONCLUSION: The proposed etiology of ascites in these cases was peritoneal metastasis from thalamic glioblastoma through ventriculoperitoneal shunt in first case, excessive production of CSF by choroid plexus papilloma in second, infection in the third case and craniopharyngioma causing excessive production of CSF in the fourth child. All the children were treated by reasonable laparotomy and fenestration of cyst along with the repositioning of shunt tip at another site.Item Breath carbon monoxide concentration in Cigarette and Bidi smokers in India.(2010-01) Kumar, Raj; Prakash, Suraj; Kushwah, A S; Vijayan, V KObjective. To measure and compare the breath carbon monoxide (CO) levels in cigarette and bidi smokers in India. Methods. Breath CO was measured in 389 smokers (241 cigarette smokers,148 bidi smokers) using portable breath CO analyser (Bedfont-England, Smokelyzer). Tobacco contents and length of single stick of different brands of cigarette and bidi were also measured. Results. Their mean age was 38.7±13.4 years. The average duration of smoking was 18.2±13.0 years. Average breath CO levels were 15.6±7.0 ppm in smokers and 4.07±1.16 ppm in non-smokers. Average breath CO level was significantly higher in bidi smokers (18.9±7.7 ppm) compared to cigarette smokers (13.6±5.8 ppm) when total consumption of cigarette/bidi was more than five pack-years (p=0.002). Average tobacco weight of bidi (216.8mg) was significantly less than cigarette (696mg). Conclusions. Bidi is equally or more harmful than cigarette smoking. One bidi may be considered to one cigarette for calculating “pack-years” of smoking.Item Choroid plexus papillomas of the cerebellopontine angle.(2002-09-23) Kumar, Raj; Achari, G; Benerji, D; Jain, V K; Chhabra, D KThe cerebellopontine angle (CPA) is a rare site for the growth of choroid plexus papilloma (CPP). The clinicoradiological diagnosis of this tumor in the CPA is difficult because of the nonspecific clinical presentation and radiological features. Five cases of choriod plexus papilloma (3 males, 2 females) operated upon at this center are reviewed. All the cases were operated upon by retromastoid suboccipital craniectomy. As they all presented with a typical CPA syndrome without any distinctive radiological feature, a clinicoradiological diagnosis of CPP could not be reached in any of these. The diagnosis of CPP could only be suspected at the operation table and established on histopathological examination. Two patients developed recurrences at the primary site following surgery. One patient developed recurrence twice despite gross total excision of tumor in each sitting. Subsequently, this patient remained symptom free for a follow-up period of 1 year. Another patient developed recurrence 2 years following surgery, but he died due to septicemia and aspiration pneumonitis. Therefore definitive surgery could not be performed. Radiotherapy was offered to one of the patients having residual mass post operatively, to render her symptom free for a 4 year follow-up. The remaining two patients have also showed progressive improvement in their symptoms following surgery for 4 years on follow-up. Hydrocephalus was a common feature in all the cases preoperatively, but only one required shunt CSF diversion, because of rapid deterioration in visual equity. In all other cases, hydrocephalus was managed conservatively. Surgery remains the main modality of treatment for CPP, both for primary and recurrent tumors, but radiotherapy may have a role in cases of recurrence, which are quite frequent.Item Chronic Subdural Fluid Collection in Children(2005-01) Kumar, RajItem Comparative study of complex spina bifida and split cord malformation.(2005-02-11) Kumar, Raj; Singh, S N; Bansal, K K; Singh, VinitaOBJECTIVE: To see the difference in clinical profiles, radiological findings and surgical outcome of the group 1 split cord malformation and meningomyelocele (SCM with MMC) from group 2 (SCM without MMC). METHODS: 46 patients of SCM were selected from a total of 138 cases of spinal dysraphism. They were divided into two groups, based on presence or absence of MMC. Group I (SCM with MMC) n =19 patients and Group II (SCM without MMC) n=27 patients. A detail clinical evaluation and MR screening of whole spine of all cases was performed. All patients underwent surgical detethering of cord. After an average follow-up of 1.7 years, the operative results were clinically assessed and statistical significance was calculated. RESULTS: Male to female ratio was 1:09. Mean age of presentation was 3.6 years. Cutaneous markers like tuft of hair, cutaneous haemangioma, etc, had a higher incidence in group II in comparison to group I (50% vs 10.5%). The incidence of motor deficits was significant in group I in comparison to group II (63% vs 40%). The incidences of sensory loss, trophic ulcers, sphincteric dysfunction and muscle atrophy were relatively more common in group I patients, while neuro-orthopedic deformities such as congenital telepes equinovarus (CTEV), scoliosis and limb shortening were more frequent (67%) in group II children as compared to group I (53%). Type I SCM has higher incidence in group I children. Low lying conus were found in 47% patient of group I, while in group II it was noticed in 69%. The associated cranial anomalies like hydrocephalus, ACM and syrinx, were slightly higher in group I patients. At surgery, dysgenetic nerve roots, neural placode, arachnoid bands and atrophic cord were seen mainly in group I. Postoperative complications like, CSF leak, pseudomeningocele and meningitis were more commonly encountered in group I patients. The patients of group II showed better operative outcome compared to group I cases. CONCLUSION: Incidence of SCM with MMC amount to 41% of total SCM cases. Progressive neurological deficit was higher in this group (SCM with MMC) in comparison to the group harboring SCM without MMC. In view of a significant association of SCM in MMC cases, associated with other craniospinal anomalies, a thorough screening of neuraxis (by MRI) is recommended to treat all treatable anomalies simultaneously for desired outcome.Item Comparative study of intravenous hydralazine and labetalol in severe hypertensive disorders of pregnancy(Medip Academy, 2020-02) Kumari, Anupma; Rohatgi, Renu; Singh, Amrita; Kumar, RajBackground: Hypertensive disorders of pregnancy are among the most common medical complications of pregnancy and major cause of maternal, fetal and neonatal morbidity and mortality. The purpose of this study was to compare the efficacy and safety of intravenous hydralazine and labetalol for management of severe hypertensive disorders of pregnancy.Methods: This prospective study was conducted among 100 women admitted with SBP ≥ 160 or DBP ≥ 110 mmHg or both. Patients were divided into 2 groups randomly: labetalol and hydralazine group.Results: Majority of patients (38%) were in the age group of 21-25 years and primigravida (52%). There was more significant decrease in the systolic, diastolic and mean arterial blood pressure at the end of 15 and 30 minutes in labetalol group. Labetalol required fewer doses as compared to hydralazine to achieve the target blood pressure (average 1.95 versus 3.1). Total numbers of term deliveries were 19 (38%) in hydralazine group and 16 (32%) in labetalol group. Pre-term deliveries in hydralazine and labetalol group were 14 (28%) and 15 (30%) respectively. Headache was significantly more common in hydralazine treated patients than labetalol group.Conclusions: Both hydralazine and labetalol were effective and well-tolerated in the treatment of severe hypertensive disorders of pregnancy. Labetalol may be preferred because it was more effective in lowering the systolic blood pressure, diastolic blood pressure and mean arterial pressure to achieve target levels with less number of doses.Item A Comparative Study of Skin Prick Test versus Serum-Specific IgE Measurement in Indian Patients with Bronchial Asthma and Allergic Rhinitis.(2015-04) Kumar, Raj; Gupta, Nitesh; Kanuga, Jayesh; Kanuga, MansiBackground. Skin prick testing (SPT) is the ‘gold standard’ in the assessment of allergic sensitivity to inhalant allergens. Serum-specific immunoglobulin E (SSIgE) measurement is a complementary test. SPT is performed with antigen extracts from India while SSIgE utilises extracts derived from European antigens. Objective. To evaluate the performance of allergic assessment by SSIgE against cockroach, housefly and mosquito aeroallergens which are frequently implicated in driving respiratory allergies in India considering SPT as the ‘gold standard’. Methods. Twenty patients (mean age 28.5 years; range 15-50 years) diagnosed to have bronchial asthma and/or rhinitis underwent SPT. The SSIgE levels were obtained at the same visit. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of SSIgE testing were calculated using SPT as the ‘gold standard’. The correlation between SPT grading and SSIgE levels was also evaluated. Results. The sensitivity of SSIgE testing to each of the 3 aero-allergens was >85%. The PPV of cockroach and mosquito SSIgE was >85%; housefly SSIgE had PPV of 68.7%. The two tests were in agreement in 85% (cockroach), 90% (mosquito) and 55% (housefly). There was a significant correlation between the grades of SPT reactions and SSIgE levels. Conclusions. The SSIgE has higher sensitivity and PPV, but lacks specificity. Higher sensitivity with low specificity leads to increased false positive diagnosis of allergic disease. Unlike allergenic pollens, however, insect antigen extracts from different regions seem to give comparable results, and can thus, reliably be used in the evaluation of allergy.Item A Comparitive Study of Mini-Appendectomy & Conventional-Appendectomy in Acute Appendicitis.(2012-10) Bhasin, Sanjay K; Kumar, Vijay; Mahajan, Manoj; Kumar, RajThe study was undertaken in an attempt to compare Mini-appendectomy with Conventional-appendectomy. 200 patients each in two groups were subjected to mini-appendectomy with 2-2.5 cm transverse incision (Group I) and conventional-appendectomy with standard Grid-Iron incision 6-8 cms (Group II). There were 92 males and 108 females in Group I whereas, 98 males and 102 females were subjected to conventional-appendectomy in Group II. Average age of patients in Group I was 22.3 years (5-65 yr) whereas, in Group II average age was 22.4 years (7-65 yr). Average weight of pts in Group I was 45.7 Kgs (20 kgs to 60 kgs) and 50.2 Kgs (24 kgs to 68 kgs) in Group II. Average time taken to complete surgery in Group I and Group II was 11.4 mt (11-35 mt) and 26.4 mt (25-45 mt) respectively. Average dose of analgesic used in Group I and II were 2.2 doses (2-4 doses) and 4.2 doses (4-8 doses) respectively. Post operative hospital stay in Group I was 2.14 days (2-5 days) and 4.34 days (4-11 days) in Group II. Time to return to work in Group I was 8.2 days (8-12 days) and 13.2 days (9-21 days) in Group II. There was no mortality and negligible morbidity in both the study groups. Mini-appendectomy has definite edge over conventional-appendectomy in terms of operation time, analgesics used, post-operative hospital stay, and return to work hence can be a safe alternative to conventional-appendectomy.Item Correlation of atopy and FeNO in allergic rhinitis an Indian study.(2013-04) Kumar, Raj; Gupta, Nitesh; Goel, NitinBackground. Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation. Limited published data are available on the effect of atopy on FeNO in allergic rhinitis. Objectives. To investigate the relationship between atopy and FeNO in patients with allergic rhinitis. Methods. Patients with allergic rhinitis were assessed for atopy and exhaled breath analysis of nitric oxide. Atopy was assessed by skin prick testing (SPT) against 58 common aero-allergens; a wheal size of 3mm or more as compared to buffer saline was considered positive. Patients were labelled to be atopic if they had at least one positive SPT result. The measurement of FeNO level was done by using NIOX chemiluminescence analyser. Results. Forty-nine participants (26 males) aged between 8-50 years were studied and 31 of them were found to be atopic. The average value of FeNO in the subjects studied (n=49) was 26.0±22.7 parts per billion (ppb) with significantly higher values being observed in atopic group as compared to non-atopic group (34.2±24.3 versus 11.9±9.0 ppb; p<0 .05). Conclusion. As FeNO is a marker of lower airway inflammation, significantly higher FeNO levels in atopic allergic rhinitis patients suggest that it may be a predictor for onset of asthma in these patients.Item Correlation of physiological and radiological characteristics in chronic obstructive pulmonary disease.(2012-10) Chugh, Tarun; Goel, Nitin; Bhargava, S K; Kumar, RajBackground. Diagnosis of chronic obstructive pulmonary disease (COPD) is confirmed on spirometry but the diagnosis of emphysema remains problematic. The objective of this study was to evaluate the utility of chest radiograph (CXR) and computed tomography (CT) for the diagnosis of emphysema and to correlate these findings with pulmonary function tests (PFTs). Methods. Thirty-five patients with COPD were studied. In all of them, CXR, CT and PFTs were done; three patients had bronchiectasis on CT and were excluded from the study. Chest radiographs (CXRs) were scored for signs of hyperinflation. Lung densities were measured on CT. Results. Functional indices of hyperinflation, i.e. functional residual capacity (FRC), residual volume (RV) and RV/total lung capacity (TLC) had significant correlation with CXR scores. The mean retrosternal space (RSP) measurement was 2.63±0.6 cm (range 1.2 to 3.6cm). Mean lung density (MLD) was -867.91 Hounsfield units (HU) which significantly correlated with functional indices of hyperinflation (FRC, RV, TLC, RV/TLC). Conclusions. In Indian population hyperinflation was found to occur even with lesser values of RSP than the western criteria. CT lung density gives good radiological evidence of emphysema and correlates with lung function abnormalities.Item Demand–supply gaps in human resources to combat vector-borne disease in India: capacity-building measures in medical entomology.(WHO Regional Office for South-East Asia, 2015-01) Pandey, Anuja; Zodpey, Sanjay; Kumar, RajVector-borne diseases account for a significant proportion of the global burden of infectious disease. They are one of the greatest contributors to human mortality and morbidity in tropical settings, including India. The World Health Organization declared vector-borne diseases as theme for the year 2014, and thus called for renewed commitment to their prevention and control. Human resources are critical to support public health systems, and medical entomologists play a crucial role in public health efforts to combat vector-borne diseases. This paper aims to review the capacity-building initiatives in medical entomology in India, to understand the demand and supply of medical entomologists, and to give future direction for the initiation of need-based training in the country. A systematic, predefined approach, with three parallel strategies, was used to collect and assemble the data regarding medical entomology training in India and assess the demand-supply gap in medical entomologists in the country. The findings suggest that, considering the high burden of vector-borne diseases in the country and the growing need of health manpower specialized in medical entomology, the availability of specialized training in medical entomology is insufficient in terms of number and intake capacity. The demand analysis of medical entomologists in India suggests a wide gap in demand and supply, which needs to be addressed to cater for the burden of vector-borne diseases in the country.Item Diagnostic efficacy of FNAC by liquid based technique versus conventional smear in lung and mediastinal masses(Medip Academy, 2020-07) Singh, Rekha; Mittal, Vani; Bali, Irbinder Kour; Arora, Sunil; Kumar, RajBackground: Fine Needle Aspiration Cytology (FNAC) has proven to be less costly and less invasive procedure than biopsy for diagnosing benign and malignant lesions. Of the two methods liquid based cytology (LBC) and conventional cytology (CC), LBC has been standardized as more efficacious in reporting in Gynaecological cases. But, this is still lacking in non-gynaecological cases and many studies are now focusing on studying LBC due to its proven advantages in Pap smear evaluation.Methods: An observational study of 72 patients with lung mass and 11 with mediastinal mass was done for a period of six months in a tertiary care hospital in Gurugram to compare the diagnostic efficacy of LBC and CC in fine needle aspirates from lung/mediastinal mass.Results: Of the 83 cases, reporting of LBC was adequate in 75 cases and CC in only 53 cases. LBC was better when differentiating malignant and benign lesions than CC. CC smears had better cellularity in comparison to LBC smears (36%), but rest cytological features of cytoplasmic detailing, cell architecture, less background debris and blood were all more appreciable in LBC smears than CC preparations.Conclusions: LBC is a better method than conventional smear for smear preparation and processing of aspirates obtained from lung and mediastinal mass.Item Effect of home-based pulmonary rehabilitation programme on disability in patients with chronic obstructive pulmonary disease.(2005-07-19) Pande, Aman; Singhal, Pankaj; Kumar, Raj; Gaur, S NItem Effect of smoking on atopic predisposition and sensitisation to allergens.(2008-10-28) Goel, Nitin; Singh, Bhanu P; Arora, Naveen; Kumar, RajBACKGROUND: Previous studies elsewhere have shown higher serum immunoglobulin E (IgE) levels in smokers and an association between smoking and sensitisation to allergens. Such information is not available for Indian population. Hence, the present study was carried out to evaluate the effect of smoking on atopic predisposition and sensitisation to aeroallergens. METHODS: A total of 70 subjects were included in the present study comprising of 25 smokers, 22 reformed smokers and 23 non-smokers. Absolute eosinophil count (AEC), serum total IgE levels and skin prick test (SPT) against common aeroallergens were performed in all the subjects along with breath carbon monoxide (CO) levels and pulmonary function tests. RESULTS: Smokers showed significantly higher serum total IgE levels (328.80 +/- 161.82 IU/mL) as compared to reformed smokers 177.27 +/- 86.47 IU/mL) and non-smokers (29.56 +/- 9.75 IU/mL). A number of subjects among smokers and reformed smokers elicited positive SPT reactions to various allergen extracts. Non-smokers did not show any significant positive skin reaction. The AECs were slightly higher in smokers (350 +/- 1145.61/mm3) as compared to reformed smokers (305 +/- 146.33/ mm3). Breath CO was considerably higher (greater than three times) in smokers than reformed smokers. However, reformed smokers showed greater airways obstruction than smokers. The former also had higher Brinkman index (646.81 +/- 392.32) as compared to the latter (448.36 +/- 279.86). CONCLUSIONS: Smokers had significantly higher IgE serum levels than reformed smokers and non-smokers. Smoking seems to induce an atopic orientation and allergen sensitisation in individuals.Item Evaluation of changes in serum lipid profile and fasting blood glucose levels in patients with gall stone disease before and after cholecystectomy(Medip Academy, 2020-04) Kumar, Raj; Singh, Vikram; Ahmad, Shabi; Singh, Mayank; Singh, Anshul; Rai, Nandan; Kumar, Shirish; Agarwal, Abhinav; Mittal, GauravBackground: There is paucity of information regarding the effects of cholecystectomy on serum lipid profile parameters and blood glucose levels in the patients of cholelithiasis. Therefore, this study was undertaken to compare some serum lipid parameters and blood glucose levels in patients of cholelithiasis and effect of cholecystectomy on the same.Methods: The study was conducted on 50 patients of cholelithiasis who were admitted in Surgery department, MLN Medical College over a period of one year and were planned for cholecystectomy. Complete lipid profile (which included total cholesterol, triglycerides, high density lipoproteins (HDL) cholesterol, low density lipoproteins (LDL), very low density lipoproteins (VLDL) and atherogenic index) and fasting blood glucose was evaluated pre-operatively and post-operatively on the 3rd, 7th and further after 1 month of cholecystectomy. Results: Out of 50 patients, maximum of 38% were in their 4th decade with females constituting 82% of total. There was significant elevation in fasting blood glucose and HDL cholesterol on 3rd, 7th and 30th day post-cholecystectomy as compared to pre-operative values (p value<0.0001). Triglyceride and VLDL cholesterol elevated on 3rd and 7th day but it significantly decreased one-month post-cholecystectomy as compared to pre-operative levels (p value<0.0001). However, LDL, total cholesterol and atherogenic index significantly decreased on 3rd ,7th and 30th day post-cholecystectomy.Conclusions: Cholelithiasis is an important cause associated with significant pathological changes in many lipid profile parameters, which will return towards normal after cholecystectomy. This normalization will be a time dependent phenomenon with long term beneficial effects.Item Evaluation of procalcitonin as a predictor of severity of acute appendicitis(Medip Academy, 2020-06) Dharwal, Vikrant; Bharti, Ramesh; Verma, Amar; Chaudhary, Rajesh; Dogra, Ravi Singh; Kumar, RajBackground: Acute appendicitis is the most common surgical emergency worldwide. The treatment of choice is emergency appendectomy. A delayed diagnosis and hence a delayed treatment increases the complication rate. Despite the best efforts negative appendectomy rate is still high since there is no single best test available to reach the diagnosis.Methods: This was an institutional study conducted at DRPGMC Tanda, comprising of 28 patients and 7 healthy controls. The patients with clinical diagnosis of acute appendicitis were subjected to appendectomy after taking a blood sample for serum procalcitonin and performing an ultrasonogram of abdomen.Results: We observed that mean levels of procalcitonin (PCT) were significantly higher in patients of acute appendicitis in comparison to healthy controls. The range of PCT levels in group 2 i.e., patients with uncomplicated acute appendicitis were from 0.54 to 0.74 ng/ml with mean value of 0.61 ng/ml, whereas in group 3 i.e. patients with complicated acute appendicitis, the range were from 1.14 to 2.56 ng/ml with mean value of 1.62 ng/ml. PCT levels were significantly higher in group 3 as compared to group 1 and group 2 (p<0.0001). In group 2, mean PCT levels were significantly higher in comparison to group 1 (p<0.0001). Statistical analysis of our data shows a cut-off value of procalcitonin to be 0.203 ng/ml. We observed sensitivity and specificity of PCT to be 96% and 100% respectively.Conclusions: This study concludes that levels of serum PCT can be used as a laboratory marker for making a diagnosis of acute appendicitis and also for predicting its severity.Item Extracanalicular Osteoma of the Mastoid Region of Temporal Bone-A Rare Presentation.(2011-10) Aggarwal, Sushil Kumar; Keshri, Amit; Kumar, RajExtracanalicular temporal bone Osteomas are rare slow growing benign bone tumors of lamellar bone.Osteomas are commonly found in fronto-ethmoid region. In the temporal bone, they mostly occur in canalicular portion (EAC), but are very rare in extracanalicular portion of temporal bone. They are mostly asymptomatic and treatment is required mostly for cosmetic reasons. We report here an isolated case of extracanicular osteoma of temporal bone due to its rarity in world literature and unusual site of presentation.Item Femoral Hernia – A Diagnostic Dilemma(Society for Health Care & Research Development, 2018-05) Kumar, Raj; A, Giles Fanny; Chengazhacherril, Romy BFemoral hernias are less common than inguinal hernias, but more prone to strangulation. Accurate diagnosis and prompt surgical correction are extremely important to prevent bowel ischemia and necrosis in an incarcerated femoral hernia. Clinical presentation is generally a mildly painful, irreducible groin bulge below the inguinal ligament. However, differentiation from an inguinal hernia on physical exam is not entirely reliable, regardless of the examining surgeon’s experience. Even Ultrasonography and CT findings may be equivocal and sometimes femoral hernia presents a diagnostic dilemma.
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