Browsing by Author "Sharma, Sanjeev"
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Item Anemia among 6 - 59 months children in a rural area of Bareilly district: a cross sectional study(Medip Academy, 2020-02) Gupta, Dharmendra; Mishra, Saurabh; Singh, Meenakshi; Sharma, Sanjeev; Agarwal, Ajay; Mittal, SnehaBackground: Anemia is a global health problem affecting mostly in developing countries. Iron deficiency anemia is a significant health problem and especially in developing countries. It’s the most neglected micronutrient deficiency disorder among under-five children. The objective of the study was to assess the prevalence and determinants of anemia among under-five children and to suggest suitable remediable measures to prevent and control of anemia.Method: This is a cross-sectional study. Household survey carried out in twelve villages in a rural practice area Dhaura, Bareilly. A total of 396 children were contacted for obtaining blood samples by taking 33 children from each village. Blood samples were taken from all children between the 6th month to 59 months of age using simple random sampling. After the collection, data will be analyzed using the SPSS software version 20.Result: A total of 47.5% of the children were found to have anemia. Among them 25.5% had mild, 63.3% had moderate and 11.2% had severe anemia. The majority of them were male 269 (67.9%). The mean age of participating children was 17.351±7.785 months. 48.2% of anemic children were low birth weight.Conclusion: High prevalence could be due to deficiency in iron nutrition among under-five children associated with poor food availability, due to lack of nutritional education and other sociodemographic conditions, child’s age and worse household conditions also contributed to the prevalence of anemia.Item Bacteriological Aspect of Bile in Cholecystectomy Patients(Society for Health Care & Research Development, 2019-03) Sunkaria, Babu Lal; Jamwal, Punit; Malhotra, Sita; Sharma, Sanjeev; Anant, Sarabjot Singh; Thomas, Chithra; Neki, N. S.Cholecystectomy is currently a frequent performed operation. The presence of gallstones within either the gallbladder or biliary tree is associated with the bacterial colonization of the bile. Acute cholangitis spans a continuous clinical spectrum and can progress from a local biliary infection to advanced disease with sepsis and multiple organ dysfunction syndrome. Therefore, it is important to know the microbiological flora of the gallbladder before prophylactic antibiotics are given. Aim and objectives: 1.To evaluate the bacteriological profile of bile in patients undergoing cholecystectomy. 2. To determine the appropriate antibiotics for prophylaxis in cholecystectomy patients based on the bacteriological profile of bile in our study. Methods: The study was a prospective study carried out in Guru Nanak Dev Hospital, Amritsar. A total of 100 patients undergone cholecystectomy who met the inclusion criteria were included in the study. Bile was aspirated from all patients, this collected bile from gallbladder was transported to the Microbiology Department in 5cc sterile syringe. The specimen was evaluated to find out whether it is sterile or has any bacteria present. Sensitivity of isolated organisms was done against antibiotics. Results: 25 patients showed positive bile culture (25%), whereas bile was sterile in 75 patients (75%). E.Coli was the most common isolated bacteria (60%) followed by Enterococcus (20%), Staph Aureus (8%), Salmonella (8%) and Pseudomonas (4%). Postoperative wound infection was more common (20%) in group of patients with isolated organisms from bile. Conclusion: 25% of bile samples were culture positive. E coli was the most common aerobic bacteria to be isolated from the bile culture . E. coli, salmonella and pseudomonas were most sensitive to piperacillin + tazobactum and imipenum (100%). E. coli also showed sensitivity to amikacin and gentamicin (73.33% each). Enterococcus was most sensitive to linezolid and ampicillin + salbactum (100%) followed by gentamicin and amoxicillin + clavulanate (80% each). Staphylococcus was most sensitive to linezolid (100%). Antimicrobial susceptibility of potential causative organisms and the local susceptibility pattern must be taken into consideration when prescribing drugs to patients with biliary disease.Item Clinical profile and outcome of stroke in relation to glycaemic status of patients.(2004-03-12) Kyadav, Kaushal; Chaudhary, H R; Gupta, R C; Jain, Rajesh; Yadav, Shekhar Raj; Sharma, Sanjeev; Meena, RameshThe present study was undertaken in 50 patients of acute stroke to assess the role of glycaemic status on clinical profile and outcome of stroke. Subjects were divided into two groups: Group 1--Comprising of 25 patients of acute ischaemic stroke; Group 2--Comprising of 25 patients of acute haemorrhagic stroke. Each group was subdivided into euglycaemics, stress hyperglycaemics, newly diagnosed diabetics and known diabetics subgroups (stress hyperglycaemics, newly diagnosed diabetics and known diabetics together were called hyperglycaemics). Hyperglycaemics of both the groups had larger sized stroke. Neurological assessment done at day 1 and day 10 by Gillory's scoring system showed statistically significant improvement (P < 0.01) in all neurological functions in the euglycaemic subgroup in both the groups while in the hyperglycaemic subgroup improvement in higher mental function and motor function was insignificant (P > 0.05). There was statistically significant mortality (P < 0.05) (up to 10th day) with the hyperglycaemic subgroup in both the groups as compared to the euglycaemic subgroup.Item Computerized tomography based evaluation of level I and II axillary lymph nodes by high conventional tangential fields in carcinoma breast(Medip Academy, 2020-02) Chandrakant, Lalit; Thakur, Shabnum; Gupta, Manoj; Seam, Rajeev K.; Gupta, Manish; Sharma, SanjeevBackground: Axillary radiation and surgery have provided equivalent local control in early breast cancer patients. It is believed that tangential field (TF) radiation that was used to treat the breast coincidently delivered radiation treatment to the lower axilla and eradicated the disease. In the era of CT-based three dimensional- (3D) radiotherapy planning, however concerns have been raised about the adequacy of coverage of the axillary levels in the tangential fields. In this study, author evaluated the coverage of the axillary nodal levels I and II using high conventional tangential fields in patients with or without axillary dissection.Methods: A prospective study was conducted which included 18 cases for a period of one year, radiation therapy was planned to the chest wall or whole breast by using the high conventional tangential field using 2D radiation portals. Central lung distance (CLD) and the distance of superior border was measured form the head of the humerus and were recorded. CECT chest was done in the same position alike during conventional simulation. All the images were shifted to the treatment planning system. The Contouring of Axillary lymph nodes level I and II was done on Oncentra contouring software.Results: The coverage of the axillary nodes was not related to central lung distance (CLD). However, some with CLD of 1cm had more coverage of the level I nodes than with CLD of 2 cm and the maximum CLD in the field was 2.5 cm. Of the 18 patients in the study, 13 patients had <2 cm distance from the humeral head and all the axillary level II LN covered in the field. Whereas 5 patients having distance >2 cm did not have adequate coverage of level II axillary LN’s.Conclusions: The distance of the cranial border of the tangent portal from the head of the humerus shows a relationship with coverage of level II nodes cranially. As the distance decreases the coverage of level II nodes cranially keeps increasing. In majority of the patients a distance of 2 cm or less than 2 cm ensured good coverage of level II nodes cranially. Similarly, no correlation was found between volumetric coverage of the axillary nodes with central lung distance.Item Correlation between Trans-Vaginal Ultrasound and Endoscopy in Infertility(International Society for Contemporary Medical Research, 2020-01) Anand, Shifali; Sharma, Sanjeev; Gupta, MonikaIntroduction: Infertility is defined as inability to conceiveafter one or more years of unprotected intercourse. Thisstudy was taken up to evaluate the correlation of transvaginal ultrasound with endoscopies both hysteroscopy andlaparoscopy in the evaluation of infertile patients.Material and methods: A prospective study was carriedout in the department of Obstetrics and Gynaecology, MMMedical College and Hospital, Kumarhatti, Solan, HP, Indiafor a period of 6 months from October 2017 to March 2018conducted on 50 subjects.Results: 50 patients were evaluated with diagnosis of primaryand secondary infertility. TVS (Transvaginal scan) showedabnormal findings correctly in 38% of cases, and 62% caseswere undiagnosed. Hysteroscopy showed alterations in 58%cases, predominantly uterine synechiae and endometrialpolyp. There were no complications during hysteroscopy.Diagnostic Laparoscopy showed, normal pelvic findings andpatent tubes in 30% cases of primary infertility and 8% casesin secondary infertility.Conclusion: Hystero-Laparoscopy is better than TVS alonefor the diagnosis of infertility pathology as its diagnosis ismore précised and we can treat them simultaneously, butstill TVS remains the best non-invasive method for study ofuterine as well as adnexal pathology in infertility.Item Delayed response following trans-catheter coil embolization in HOCM.(2007-07-08) Math, Ravi S; Singh, Sandeep; Seth, Sandeep; Shankar, Bhima; Bhargava, Balram; Sharma, Sanjeev; Gulati, GurpreetItem Early Versus Delayed Laparoscopic Cholecystectomy In Patients With Mild Acute Biliary Pancreatitis(Society for Health Care & Research Development, 2018-11) Sharma, Rajesh; Devkaran, Bhavesh; Sharma, Sanjeev; Ohri, Anil; Chaudhary, RajeshBackground: Acute gallstone pancreatitis is the common condition marked by pancreatic inflammation. In general, patients with gallstone induced mild pancreatitis should undergo definitive treatment in the form of LC before discharge from hospital, during first admission itself. This is more important to prevent a further attack of acute pancreatitis, seen in as many as 30-50%, during the waiting period of LC. Our study analyzes various parameters in patients which were treated by early and delayed laparoscopic cholecystectomy who presented with mild acute biliary pancreatitis. Methods: A prospective study was conducted for one year, where 25 cases were operated early (within 8 days of pain abdomen) and another 25 cases were operated by delayed laparoscopic cholecystectomy for diagnosed mild acute biliary pancreatitis. Various parameters were assessed and compared which included both intra operative and postoperative events. Haemodynamically unstable, associated choledocholithiasis, severe AP and patients with malignancy were excluded from this study. Results: Twelve cases presented with recurrent attacks in waiting period which were delayed for surgery. In early group, operative time ranged from 19-40 minutes, operative blood loss about 10-50 ml, 3 patients were converted from LC to OC, 6 patients needed a drain and hospital stay ranged from 2-6 days. In delayed group, operative time ranged from 18-36 minutes, operative blood loss about 10-40 ml, 2 patients converted from LC to OC, 3 patients needed a drain and hospital stay ranged from 1-5 days. Post operative analgesia dose was also comparable. Conclusion: In new era of sophisticated technology, improved operative techniques and better post operative management; early LC is gold standard approach in patients with mild to moderate gall stone induced AP. It protects against further attacks of biliary pancreatitis, with no increase in complications or morbidity. Therefore, LC in the early period is safe, effective and feasible in patients of gallstone induced AP, preventing recurrent attacks, which otherwise cause significant morbidity and even mortality in patients.Item Is vaccination against hepatitis A virus required in patients with cirrhosis of the liver?(2004-10-26) Duseja, Ajay; Sharma, Sanjeev; Das, Kshaunish; Dhiman, R K; Chawla, Y KHepatitis A virus (HAV) superinfection can cause decompensation in patients with chronic liver disease. The risk of HAV superinfection depends on the endemicity of HAV in that particular population. Recommendations of vaccination against HAV in patients with cirrhosis of the liver in India are lacking. Our aim was to assess the seroprevalence of anti-HAV antibodies in our population of patients with cirrhosis of the liver. In a retrospective analysis, the serum of 55 patients with cirrhosis of the liver was tested for total anti-HAV antibodies by ELISA. In the 35 patients who presented with acute decompensation, the serum was also analysed for IgM anti-HAV antibodies. Fifty-four of the 55 cirrhotics (99%) were positive for total anti-HAV antibodies. All 35 patients with decompensated liver disease were also positive for total anti-HAV antibodies, and none of them tested positive for IgM anti-HAV antibodies. Most of the patients with cirrhosis of the liver in the population studied were already exposed to HAV. Routine vaccination against HAV cannot be recommended in these patients.Item Occult hepatitis B virus (HBV) infection in healthy blood donors.(2003-10-18) Duseja, Ajay; Sharma, Sanjeev; Subramanian, P G; Agnihotri, S K; Chakraborti, Anuradha; Chawla, YBlood transfusion is an important route of transmission of hepatitis B virus (HBV). Occult HBV infection can exist in the absence of HBsAg and can be detected by determining HBV DNA. To determine the occult HBV infection in healthy blood donors. One hundred adult healthy blood donors, negative for HBsAg, anti HCV, HIV-1 and other risk factors were screened for HBV DNA by PCR. All the healthy blood donors were negative for HBV DNA by PCR. Occult HBV infection does not occur in the healthy blood donors in the population studied.Item Post Operative Evaluation of Patients of Laparoscopy Cholecystectomy with and without Drain with the Help of Ultrasonography(International Society for Contemporary Medical Research, 2019-07) Sharma, Renuka; Sharma, Sanjeev; Gupta, Money; Jaswal, K S; Mandial, Vishal; Wadhwa, ManishIntroduction: Most common complaints after laparoscopiccholecystectomy are abdominal pain, shoulder tip pain, andnausea, vomiting in the post-operative period. These havebeen attributed to high pressure pneumoperitoneum usingcarbon dioxide gas causing irritation of the diaphragm andother abdominal viscera. Thus, a drainage tube is insertedto decrease the intra-abdominal pressure to mitigate thesesymptoms. However, the role of routine drainage afterlaparoscopic cholecystectomy is still controversial. Severalstudies including some meta-analysis performed to assessthe role of drains in reducing complications in laparoscopiccholecystectomy could not definitively establish the same.The surgical community is divided on this issue due to thelack of evidence on usefulness of drain. Therefore, we planneda controlled randomized comparative study to assess the valueof drain in uncomplicated laparoscopic cholecystectomy.Material and methods: The study was conducted indepartment of General surgery Maharishi MarkendeshwarMedical college and Hospital, Kumarhatti, Solan, HimachalPradesh, India from July 2018 to June 2019. During a periodof one year, 50 patients (group A) were randomized to havea drain placed, with No. 14 Ryles tube, kept in sub hepaticspace after laproscopic surgery, whereas the other 50 patients(group B) did not have any drain in the subhepatic space.These patients were evaluated regarding any differences inmorbidity, postoperative pain, wound infection and hospitalstay between the two groups.Result and Conclusions: The present study was unableto substantiate the utility of subhepatic drain following theelective laproscopic cholecystectomy procedure.Item Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study.(2016-09) Kothiwala, Sunil K; Khanna, Neena; Tandon, Nikhil; Naik, Nitish; Sharma, Vinod K; Sharma, Sanjeev; Sreenivas, VBackground: Previous epidemiological studies suggest an association between psoriasis and metabolic syndrome and risk of subclinical atherosclerosis. However, there is a paucity of data in the Indian population on these associations. Objectives: To evaluate the prevalence of metabolic syndrome and subclinical atherosclerosis in patients with chronic plaque psoriasis compared to healthy controls and to correlate the prevalence of metabolic syndrome with severity of psoriasis. Methods: A hospital-based cross-sectional study was performed on 140 patients with chronic plaque psoriasis and 140 controls. Psoriasis was categorized as mild, moderate and severe based on psoriasis area and severity index (<10, 10–14 and ≥15, respectively) and as disease of short (<1 year), intermediate (1–3 years) and long duration (>3 years). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting blood sugar and lipid profi le were estimated. Metabolic syndrome was diagnosed by the presence of 3 or more of the modifi ed National Cholesterol Education Program’s Adult Treatment Panel III criteria. A subset of 30 psoriatic patients and 30 healthy controls were selected by the systematic sampling method for cardiac evaluation including electrocardiography, echocardiography and carotid intima-media thickness measurement. Results: The prevalence of metabolic syndrome was signifi cantly more in psoriatic patients than in controls (39.3% vs. 17.1%, odds ratio = 3.13). Psoriatic patients also had a signifi cantly higher prevalence of hypertension, abdominal obesity and diabetes. There was a signifi cant trend to increase in prevalence of metabolic syndrome, hypertension and type 2 diabetes with increased severity and longer duration of the psoriasis. Patients with psoriasis had signifi cantly higher carotid intima-media thickness (mean 0.61 mm ± 0.01 mm vs. 0.37 mm ± 0.01 mm) than controls. Limitation: This was a hospital-based cross-sectional study with a relatively small sample size. A prospective study with a larger sample would have validated the results further. Conclusion: There is a signifi cantly higher prevalence of metabolic syndrome in psoriasis patients as compared to controls; the prevalence of metabolic syndrome and its components increases with severity and duration of psoriasis. There is a higher prevalence of subclinical atherosclerosis in patients with psoriasis thus increasing the risk of cardiovascular disease. We suggest that patients with moderate to severe psoriasis be screened routinely for metabolic syndrome and cardiovascular disease and encouraged to correct modifi able cardiovascular risk factors.Item Primary langerhans cell histiocytosis of the vulva: report of a case and brief review of the literature.(2009-01-13) Pan, Zenggang; Sharma, Sanjeev; Sharma, PoonamPrimary Langerhans cell histiocytosis (LCH) of the vulva is rare. Fifteen cases of primary cutaneous vulvar LCH have been reported in English literature. We report an additional case of LCH confined to the vulva. In this article, we describe the clinical presentation, histopathology and immunohistochemistry findings of vulvar LCH that are helpful to both gynecologists and pathologists in the diagnosis of this entity. We briefly discuss the pathogenesis of LCH. The debate whether LCH is a reactive or neoplastic entity is still ongoing.Item A Prospective Study Comparing Single with Multiple Antibiotic Prophylaxis Dose in Elective Cholecystectomy.(2015-04) Chaudhary, Rajesh; Sharma, Sanjeev; Chaudhary, Sudarshan; Thakur, Sunil; Shukla, Ankit; Sharma, ManjeetBackground: Cholecystectomy is one of the commonest, clean and contaminated surgery operations performed by the surgeons worldwide. Antibiotic prophylaxis in elective cholecystectomy is a controversial issue and our study was undertaken to evaluate the rate of infection and the usefulness and efficacy of antibiotic prophylaxis in elective cholecystectomies. Methods: The study comprised of 100 patients admitted for elective cholecystectomy. The first fifty patients undergoing elective cholecystectomy were given the prophylactic antibiotic outside the operation theater in the wards and the next fifty patients were given a single dose of injection cefuroxime (1.5 gm i.v). Results: In single dose antibiotic prophylaxis group 10.52% people developed surgical site infection in open cholecystectomy group while patients developed infection in laparoscopic cholecystectomy group but in multiple dose group 16.21% patients who underwent open cholecystectomy developed a surgical site infection while 10% developed an SSI in laparoscopic cholecystectomy group. In both the groups, results are statistically not significant. Conclusion: This study document that one single dose of prophylactic antibiotic, administered at induction of anaesthesia, is sufficient to prevent post-operative infective complications in patients undergoing elective cholecystectomy.Item A Rare Presentation of Primary Breast Tuberculosis in a Primigravida: A Case Report.(2015-07) Chaudhary, Rajesh; Sharma, Sanjeev; Shukla, Ankit; Sharma, ManjeetTuberculosis is an endemic and very common disease in India. Breast tuberculosis is often confused with breast malignancy or pyogenic abscess. We report a rare case of breast tuberculosis which is successfully managed with Anti-tubercular drugs. After six months of compliant treatment patient delivered a healthy baby.Item A study of contaminated sharp injury and associated morbidity among health care workers(Medip Academy, 2020-01) Gupta, Dharmendra Kumar; Singh, Meenakshi; Agarwal, V. K.; Sharma, Sanjeev; Mishra, SaurabhBackground: Needles are one of the biomedical waste materials generated during the treatment or procedure in the hospital. Improper handling, capping or disposal technique causes a major health hazard among the health care workers (HCWs). Needle stick injuries (NSIs) can occur accidentally at any time when people use, disassemble, or dispose needle. The aim of the present study were to find out the burden of chronic morbid condition due to NSIs to HCWs, to find out various risk factors responsible for causing chronic disease to HCWs and to suggest the prevention and control of needle stick injury among the HCWs.Methods: A cross-sectional study, conducted among HCWs. Sample size was estimated by using standard formula and 312 HCWs were taken in study. Equal number of respondent was taken from each group. The information has been collected and data entry has been done using specific software SPSS version 20.0.Results: Most of the HCWs were infected with hepatitis B (24.0%) followed by hepatitis C virus (8.7%) and HIV (1.9%) after the percutaneous injuries with needle of infectious patients during any intervention procedures of the patients.Conclusions: Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health-care workers because of the poor practice as well as not opting personal protective equipment’s during intervention process regarding preventive and control measures. These infections are highly preventable and should be eliminated.