Maulana Azad Medical College
Recent publications
To describe the clinical profile, etiology and outcome of children with hospital-onset seizures (HOS) in a tertiary care public hospital. In this prospective study, consecutive children aged 3 months to 12 years admitted for at least 24 hours in the Department of Pediatrics of a tertiary care public hospital between 1 February, 2021 and 15 September, 2021, were followed-up during hospital stay till death/discharge. Any child admitted within 7 days following head trauma, or admitted for seizure control during the current illness was excluded. All patients were followed up daily for the occurrence of seizures during hospital stay. Outcomes were assessed using Glasgow Outcome Scale (GOS). Out of the 1050 children (635 boys), 25 (2.38%) children with a median (IQR) age of 12 (4,60) months developed seizures during the hospital stay. Seizures occurred at a median (IQR) interval of 21 hour (8 hour, 5 days) from admission; seizures progressed to status epilepticus in 3 (12%) children. Majority of those with seizures had an underlying neurological disorder/disease at admission. Majority of patients (68%) had generalized tonic-clonic seizures. After neuro-infections, metabolic derangements were the second most common etiological group for HOS (32%). A poor outcome, defined as death/severe disability as per GOS, was seen in 8 (32%) children with HOS. Children with HOS had a 2.76 times higher risk of a poor outcome as compared to those with no seizures during the hospital stay [RR (95% CI) 2.76 (1.07, 7.11), P = 0.035]. Physicians need to be aware of the risk factors for HOS in children so as to provide adequate monitoring and emergent treatment.
Background Pediatric neurological disorders include neurodegenerative diseases causing cognitive impairment and vision loss. They are one of the important causes of morbidity and mortality in children with diverse etiologies. Diagnosis is difficult despite genetic work, and a final diagnosis can be achieved in only 60% of cases. Case presentation We explore three Indian cases of pediatric neurological diseases (with age presented at the clinic), viz. arthrogryposis (8 years), autism (18 months), and congenital bilateral cataract (3 years), by analyzing clinical exomes. In this work, we attempt to understand rare neurological disorders in an Indian pediatric cohort using exome studies. Conclusion We used our benchmarked CONVEX pipeline for screening consensus variants, wherein EIF2B2 was found to be inherently pathogenic. We map the association of variants and genes and disease correlation to neuroleptic malignant syndrome, which matches the phenotype to the cases.
This chapter delves into the critical role of imaging in the diagnosis, staging, and management of pediatric renal neoplasms. It discusses the utility of various imaging modalities, including ultrasound, CT, MRI, and other radiological modalities, in characterizing renal masses, assessing tumor extent, and detecting metastases. The chapter emphasizes the importance of imaging in differentiating benign from malignant lesions, guiding biopsy decisions, and planning surgical interventions. Special attention is given to the role of advanced imaging techniques in monitoring treatment response and detecting recurrences. The chapter also explores emerging imaging technologies and their potential to improve diagnostic accuracy and prognostication. Through case studies and evidence-based guidelines, this chapter underscores imaging’s indispensable role in the multidisciplinary management of pediatric renal neoplasms.
Background Abortions in India are increasing despite the laws to legalize them. Many abortions are conducted through unsafe practices and are underreported. To determine the prevalence of abortions in women of a reproductive age group in a rural area of Delhi and to determine associated factors. Methodology A cross-sectional study was conducted among married women in the reproductive age group residing in Barwala village, Delhi/NCR. An interview schedule was used to interview 315 women, and information was obtained for socio-demography, use of contraceptives, medical history, and history of abortions. Chi-square and Fisher’s exact test were used for analyzing the association of abortions with other variables. Results Of all 315 women, 47% had a history of one or more abortions. Of all pregnancies (n = 953), 25.6% ended in abortions (n = 244). Of the total number of abortions reported, 60.7% (n = 148) were induced, while 39.3% (n = 96) were spontaneous. Of induced abortions, only 35% were safe, while 65% were unsafe abortions. Age of mother, age at marriage, history of contraception use, and gender of first child were significantly associated with abortions. However, no significant association was found with socio-economic status, education, and occupation of women and their spouses. Only 1.3% women knew that abortions are legal in India. Conclusion A high proportion of women are going for induced abortions, of which a greater proportion is that of unsafe abortions. There is also lack of knowledge about the legalisation of abortions in India.
Cervical cancer is a largely preventable disease that claimed the lives of more than 300 000 women in 2018. Hesitation to adopt cervical cancer screening strategies motivated us to find out the knowledge gaps and attitudes of the educated section toward these practices. An in-depth knowledge of this aspect will help us comprehend the barriers that are deterring women from accepting these practices. A cross-sectional survey was conducted from November 1, 2021, to November 30, 2021, to assess the public knowledge, attitudes, and practices regarding cervical cancer. The self-designed online questionnaire was shared on social media such as Telegram, WhatsApp, LinkedIn, and Facebook. Girls and women aged 15 years and more studying in educational institutions or those who have completed their graduation were asked to fill out the questionnaire if willing to do so anonymously. 824 respondents filled out the online survey. 75% of the respondents had good knowledge about pap smear and HPV vaccination. Only 80 respondents (9.7%) were vaccinated against HPV. 255 (30.9%) had been screened with a pap smear at least once in their lifetime. Screening with pap smear was never performed in 412 subjects, which constituted 50% of the respondents. A poor knowledge about the eligibility of pap smear and the availability of HPV as a screening modality may have contributed to a poor conversion to the regular practice of screening modalities. Awareness drives need to focus on these issues.
Voice related complications are a major cause of morbidity in patients undergoing thyroidectomy in the postoperative period in the modern world. EBSLN being a primary tensor of vocal cords via cricothyroid muscle is important to produce high pitched sound above 150 Hz and it is essential for professional voice users. This nerve is prone to injury during surgery because of its proximity to the upper pole of the thyroid and complex anatomical relationship with the superior thyroid vessels. We aimed to study the occurrence of injury to EBSLN during surgery via acoustic voice analysis and comparing it with the pre-operative values. Patients of benign thyroid swelling with Bethesda type I to III and normal thyroid function tests were taken up for surgery. Pre- and post-operatively acoustic voice analysis was done in a soundproof room. Fundamental frequency (F0), amplitude perturbation (shimmer), fundamental frequency perturbation (jitter), and harmonic/noise ratio (HNR) were calculated and analysed. Intraoperatively, EBSLN was identified in Joll’s triangle and preserved. The acoustic voice analysis was performed on the postoperative day one and seven, and compared with the pre-operative values. The mean age of patients was 35.73 ± 9.13 years. Most common age group 36–45 with male to female ratio being 1:9. Cystic colloid goitre was seen in 85% patients. F0 decreased from the preoperative value (221.447 ± 45.981 Hz) on postoperative day one (217.283 ± 46.323 Hz), p-value < 0.01 and on day 7, F0 (219.872 ± 45.096 Hz) p = 0.46. Pitch sigma increase (p < 0.01) from pre-operative (16.791 ± 14.716 Hz) to postoperative day 1 (18.454 ± 15.088 Hz) and on day 7 (17.79 ± 15.315 Hz), p = 0.09. Jitter (%) pre-operatively (0.46%±0.17%), post-operative day 1 (0.45%±0.21%, p = 0.05) and postoperative day 7 (0.44%±0.19%, p = 0.11). Shimmer (dB) the pre-operative (0.582 ± 0.317 dB), post-operative day 1 (0.552 ± 0.301 dB), p = 0.08 and postoperative day 7 (0.566 ± 0.302 dB) p = 0.90 on day 7. HNR pre-operatively (19.009 ± 3.939 dB), postoperative day 1 (18.803 ± 4.14 dB, p = 0.58) and postoperative day 7 (18.740 ± 3.630 dB, p = 0.46). Acoustic voice analysis showed decreased pitch and increase in pitch sigma on postoperative day one which improved on day seven, and it shows that there was no permanent injury to ESBLN during surgery. Acoustic voice analysis being a non-invasive objective procedure, can be used to diagnose EBSLN injury post-thyroidectomy. However, research with large sample size is required to conclusively study the diagnostic efficacy of acoustic voice analysis to diagnose injury to EBSLN.
The rapid evolution of artificial intelligence in anesthesiology brings promising opportunities and significant ethical challenges that should be considered for transparency and accountability in AI-driven decisions. AI has emerged as a powerful tool that could change the way patient care, research, and medical education are approached in the field of anesthesia. These advances bring exciting possibilities while raising important questions about responsible implementation. The integration of AI in anesthesiology raises numerous ethical dilemmas and challenges that must be carefully handled.
Children with Chronic Kidney Disease (CKD) are at increased risk for vaccine-preventable diseases. The primary objective of the study was to estimate IgG antibody titers against measles, mumps, and rubella (MMR) in children with CKD and healthy controls who were previously immunized with measles/ MMR vaccine. This case control study was conducted between January 2019 and January 2020. Children aged 2–18 years with CKD and healthy controls who had received at least one dose of measles/MMR were included. Children on dialysis were excluded. Clinical details of immunization were recorded, and antibody titers measured by ELISA based kits. 120 children (60 cases and 60 controls) were enrolled; seroprotection rates for measles, mumps and rubella in the CKD group and control group were 90% vs 86.7%, P = 0.01; 71.7% vs 77.7%, P = 0.77; and 86.7% vs 88.3%; P = 0.05, respectively, with lower antibody titers for mumps and measles in late-stages (stage 4 or 5) CKD. Seroprotection amongst children with CKD for measles, rubella and mumps is not inferior to that in controls. However, children with late-stage CKD (stages 4 and 5) have lower seroprotection especially for mumps and measles compared to those with early-stage (1–3) CKD.
With the availability of free antiretroviral therapy (ART) across India, HIV in adults has become a chronic disease with prolonged survival. The emergence of various non-communicable diseases in these prolonged survivors is a cause of concern. Metabolic dysfunction-associated steatotic liver disease (MASLD) in adults with HIV infection in India has not been explored to date. In this study, we attempted to assess the existence of MASLD in thirty adults registered at the Centre of Excellence in ART Care at a tertiary teaching hospital in New Delhi. This center provides free first-line, second-line, and third-line ART to patients as well as comprehensive HIV care including counseling, nutritional advice, and inpatient admissions for intercurrent illnesses. A total of 30 subjects were enrolled in the study to assess the occurrence of MASLD among people living with HIV (PLHIV) and its risk factors and to assess hepatic fibrosis in the subjects with MASLD using transient elastography and clinical fibrosis scores. The study population included 13 subjects on ART (43.3%) and 17 ART-naïve subjects (56.6%). All the study subjects underwent ultrasonography (USG) for the identification of the development of MASLD in them. Steatosis was identified as an increase in the echogenicity of the liver seen as an increase in the hepatorenal contrast and was further graded into the 3 grades of fatty liver. Out of the 30 subjects, 16.6% (5 out of 30) were found to have MASLD on USG, with grade 1 fatty changes seen in 4 (13.3%) and grade 2 fatty changes seen in 1 out of 30 subjects (3.3%). A majority (40%) of the subjects were underweight (body mass index [BMI] < 18.5). 22.7% of the male subjects included in the study had MASLD whereas none of the females had fatty changes in the liver on USG. Out of the study subjects, MASLD was detected in 17.6% of ART-naïve subjects while it was detected in 15.4% of subjects on ART. Although no statistically significant association was seen with any of these parameters, a few important trends were observed. These might be statistically significant in a higher power study with a larger sample size. Higher BMI (mean difference [MD] = 3.25, P = .09), waist circumference (MD = 3.84, P = .15), hip circumference (MD = 4.36, P = .14), and older age (MD = 6.56, P = .07) were observed to be associated with MASLD in our study, whereas the biochemical parameters and HIV-related factors were not seen to have any particular trend of association in our study. However, a higher median CD4 count was associated with MASLD as compared to the group without fatty changes on USG. On FibroScan, all 5 subjects with fatty changes in our study were found to have liver stiffness less than 7 kPa which corresponds to F0-F1 stage of fibrosis. Using the nonalcoholic fatty liver disease score, 2 subjects had scores corresponding to F0-F2 stage of fibrosis (as per METAVIR score) while the rest (3 out of 5) had indeterminate values. While on FIB4 scoring, 4 subjects had scores suggesting stage 0-1 fibrosis while 1 had a score suggestive of stage 4-6 fibrosis as per Ishak Fibrosis staging. As PLHIV with known diabetes mellitus, obesity, and hypothyroidism were excluded from our study, the prevalence of MASLD observed in our study underestimates the real prevalence of MASLD in this specific population. No significant association was observed between ART status or ART regimen and MASLD in our study subjects. However, in light of the existing evidence of association of dolutegravir (DTG) with significant weight gain, and the recent inclusion of DTG in the first-line ART regimen nationally in India, robust surveillance and large-scale studies are recommended to study the contribution of DTG to MASLD in PLHIV, if any.
A BSTRACT Introduction This study was undertaken to assess the distribution of ganglion cells (GCs) and interstitial cells of Cajal (ICCs) across different points of distal rectal pouch in anorectal malformation (ARM) patients over the three stages of repair. We hypothesize that along with the surgical factors, there could be intrinsic factors as well which can be the cause of dysmotility in these patients after surgical repair. Methodology Full-thickness colonic biopsy specimens were taken from the proximal stoma, distal stoma, and distal rectal pouch of 21 boys aged 0–8 months undergoing 3 staged repair of ARM at our tertiary care center between August 2022 and December 2023. There was an interstage interval of approximately 12–14 weeks. All underwent high-divided sigmoid colostomy in stage 1. Biopsy specimens for GC and ICC number were routinely processed, and immunohistochemistry was done for CD117. The data was assessed and compared with respect to location and stage of surgery. Results Both GC and ICC showed a gradual decrease in mean number over three stages for both proximal and distal ends of colostomy. For proximal stoma, the distribution of either cell type did not differ across the stages, but for distal stoma, the number of cells was significantly lower in the second stage (following colostomy, before posterior sagittal anorectoplasty). However, no difference was noted between the second and third stages. This indicates that factors during/just after colostomy itself must be responsible for decrease in ICC/GC. Conclusion Lesser number of GC and/or ICC in the distal pouch from stage 2 onward may point toward its association with projected hypomotility in ARM patients. Apart from innate distribution, we also infer that this could be consequent to vascular insult which may occur at the time of divided colostomy. Loop stoma may be a better alternative as vascularity is uninterrupted in loop colostomy.
Case We present a case of isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient with a 5-year follow-up. The diagnosis was established by core needle aspiration and biopsy. He was treated with antituberculous chemotherapy and immobilization. The lesion healed with collapse of the calcaneal tuberosity that clinically resulted in shortening and heel valgus. A literature review is also presented. Conclusion Isolated tuberculous osteomyelitis of the calcaneus in an immune-competent adult patient is rare. It may pose diagnostic dilemma, and orthopaedist should work through the differential diagnosis.
Background Women empowerment programs may reduce domestic violence (DV) by taking control of their lives. In a cognizant effort to empower pregnant women who have experienced DV, a Behaviour Intervention Package (BIP) was developed and used. It incorporates yoga-based techniques for self-development, interpersonal skill development, and awareness sessions. The study aims to assess the effects of a BIP on empowerment and resilience among pregnant women who have experienced violence and were attending antenatal care at a tertiary care hospital in India. Methods A randomised controlled trial was conducted with 211 pregnant women recruited between 18 to 20 weeks of pregnancy and randomly assigned to intervention (n = 105) or control (n = 106). The intervention group received behavioural intervention and standard care, while the control group received only standard care for 28 weeks. The study tools were completed once before the intervention and again at six weeks postnatal. The assessments were compared using methods as appropriate to estimate the effect size at baseline and post-intervention. Results The results showed that at a personal, relational, and socio-environmental level, the BIP intervention effectively improved quality of life, reduced DV, reduced stress and depression, and all parameters enabled women to develop a positive self-perception. They also reported being resilient and hopeful about their future. Conclusion The BIP may effectively empower pregnant women from low socioeconomic backgrounds facing DA in India, enhancing their quality of life. With no standardized intervention currently available, the BIP can be implemented in supportive settings to address the psychosocial health needs of women in distress and protect their health. Trial registration The Indian Registry of Clinical Trials number is CTRI/2019/01/017009 dated 9.1.2019.
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478 members
Sudhir Jain
  • Department of Surgery
Ravi Meher
  • Department of E.N.T.
Achal Gulati
  • Department of E.N.T.
Swati Gupta
  • Radiology
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