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Malhotra, V.
- To Evaluate Efficacy of Non-invasive Markers of Fibrosis in Determining Liver Fibrosis Vis-à-vis Liver Biopsy, in Patients of Nonalcoholic Fatty Liver Disease
Authors
1 Department of Medical Gastroenterology, Gynaec. & Obstetrics, Anaesthesiology & Medicine, PGIMS Rohtak., IN
Source
The Indian Practitioner, Vol 67, No 5 (2014), Pagination: 298-306Abstract
Background&Purpose: Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease&liver transplantation and its incidence is increasing even in Asian countries. The gold standard for assessing hepatic fibrosis is liver histology but due to its limitations, noninvasive tests to assess hepatic fibrosis which can be used as alternative to liver biopsy have been developed, such the AST-to-platelet ratio index (APRI), Forns test, FibroTest, transient elastography, fibrometer and hepascore. Methods: In a cross-sectional study, 25 diagnosed NAFLD patients underwent detailed laboratory investigations including the specific non-invasive markers of fibrosis namely, haptoglobin, alpha-2 macroglobulin, apolipoprotein- A1 levels and insulin resistance was calculated by homoeostasis model assessment (HOMA), then patients were subjected to liver biopsy. Results. Out of 25 patients, 19(76%) were male and 6(24%) were females. Nine patients (36%) were diabetic and 21 (84%) were dyslipidaemic. Metabolic syndrome was present in 18(72%), body mass index was increased in 22 patients and waist hip ratio was altered in 22 patients (88%). Using SPSS 10, p value was significant (p = 0.04) for correlation between steatosis and waist/hip ratio and HOMA-IR with inflammation and fibrosis (p = 0.03) but non-invasive markers were not significant in predicting hepatic fibrosis on histology. Conclusion. The non-invasive markers were not significant in predicting hepatic fibrosis on histology in present study. The limitation of the study was small sample size and majority of patients had steatosis only.
- An Unusual Cause of Dysphagia
Authors
1 Department of Medical Gastroenterology, Medicine, Gynaec. & Obstetrics, Anaesthesiology, PGIMS Rohtak., IN
Source
The Indian Practitioner, Vol 67, No 5 (2014), Pagination: 311-312Abstract
We present a case of 92 yr female who was not a known case of any chronic illness and presented with gradually progressive dysphagia for last one year. There was no history of weight loss, fever, haematemesis or melaena. On evaluation except for mild anaemia, rest of labs parameters and ultrasound abdomen were normal. She was subjected to upper G.I. endoscopy (Figure 2) which revealed large posterior pharyngeal bulge with smooth mucosa, non tender and non pulsatile. The rest of the gastrointestinal tract examination were normal. She was thought to be having retropharyngeal mass lesion and was subjected to computed tomography scan of neck and thorax (Figures 1&3) which revealed severe osteophytic changes in cervical spine with spurs which were causing extrinsic compression over cervical oesophagus. The patient underwent surgical decompres- An Unusual Cause of Dysphagia Malhotra P, Sanwariya Y, Dahiya H, Chugh A, Malhotra V, Malhotra N Department of Medical Gastroenterology, Medicine, Gynaec.&Obstetrics, Anaesthesiology, PGIMS Rohtak. Correspondence to: Parveen Malhotra, Head, Department of Medical Gastroenterology, PGIMS, Rohtak, Haryana (124001) Fig.1. CT Scan showing compression from osteophytic changes with spur. sion successfully and causative spur was removed.- Anaemia of Old Age-Leave No Stone Unturned
Authors
1 Department of Medical Gastroenterology, Anaesthesiology, Gynae. & Obstetrics, Medicine, PGIMS, Haryana - 124001, IN
2 Department of Medical Gastroenterology, Anaesthesiology, Gynae. & Obstetrics, Medicine, PGIMS Rohtak, IN
Source
The Indian Practitioner, Vol 67, No 7 (2014), Pagination: 423-427Abstract
Background: Malignant melanomas of the gastrointestinal (GI) tract are usually metastatic. Primary malignant melanoma of the GI tract is rare and occurs in the anorectum and oesophagus.
Case: We report a case of a 60-year-old female who presented with short duration of anaemia but on detailed evaluation had primary anorectal melanoma (ARM) with extensive metastasis.
Conclusion: An evaluation of short duration of anaemia led to unexpected widely metastasised anorectal melanoma. Hence anaemia presenting at old age should be evaluated in detail including endoscopy of whole gastro-intestinal tract to rule out malignancy.
- Colposcopic Evaluation of Patients With Abnormal Cervical Cytology and/or Unhealthy Cervix
Authors
1 Department of Obstetrics & Gynaecology, Dayanand Medical College and Hospital (DMC&H), Ludhiana (Punjab), IN
2 Dept of Pathology, DMC&H, IN
Source
The Indian Practitioner, Vol 67, No 2 (2014), Pagination: 89-93Abstract
Objectives: To assess the diagnostic accuracy, sensitivity and specificity of colposcopy in patients with abnormal cervical cytology and/or unhealthy cervix.
Methods: Pap smear screening was done in 500 sexually active women attending the Gynaecological OPD at Dayanand Medical College and Hospital, Ludhiana. 252 women with abnormal cervical cytology or unhealthy cervix or both underwent Colposcopy. Cervical biopsy was taken in 87 cases and the results were compared and statistically analysed.
Results: A statistically significant relation was found between abnormal cytology and Grade III colposcopy. Diagnostic accuracy of colposcopy for LSIL and HSIL was 74.07 % and for squamous cell carcinoma it was 83.33%.
Conclusion: Colposcopy should be done routinely in women with abnormal cervical cytology and unhealthy cervix for timely detection of cervical pre neoplastic and neoplastic lesions.
Keywords
Abnormal Cytology, Colposcopy, Cervical Biopsy.- Spontaneous Haemoperitoneum Following Normal Vaginal Delivery
Authors
1 Department of Obstetrics and Gynaecology, PT BDS PGIMS, Rohtak, IN
Source
The Indian Practitioner, Vol 68, No 3 (2015), Pagination: 57-60Abstract
Background: Spontaneous haemoperitoneum during pregnancy resulting from tear or rupture of a uterine or ovarian vessel is a rare yet catastrophic event, which can be a cause of maternal and foetal loss.
Case: A 31 year old woman, Para 6, arrived in our emergency in shock within 12 hours of delivery after an uneventful spontaneous vaginal delivery at a private clinic. Abdominal palpation revealed rigidity and tenderness and uterine fundus could not be appreciated. Ultrasound examination confirmed free fluid in the abdomen and pelvis. Liver, pancreas, gall bladder, spleen and pelvic organs were normal. No obvious source of bleeding was identified. After clinical and sonographic examnation, haemoperitoneum was suspected. Per operative findings were haemoperitoneum equivlent to 500 cc, uterus was intact, a small diverticulum was present on fundus and a small peritoneal tear was present on left posterior surface of uterus with oozing from underlying uterine vessels. Peritoneal tear was stitched along with bilateral uterine artery ligation. Complete haemostasis was achieved.
Result: Her postoperative period was uneventful and patient was discharged on 7th postopertive day.
Conclusion: Haemoperitoneum after normal vaginal delivery is rare but life threatening to mothers. Although very rare, obstetrician should be aware of this cause of acute abdominal pain and hypovolaemic shock in pregnancy. Close observation, prompt diagnosis and proper intervention are the keys to patient survival.
- Malarial Hepatopathy-Experience at Tertiary Care Centre of North India
Authors
1 Department of Medical Gastroenterology, Medicine, Anaesthesiology & Critical Care, Gynaecology & Obstetrics, PGIMS, Rohtak (Haryana), IN
Source
The Indian Practitioner, Vol 68, No 5 (2015), Pagination: 29-30Abstract
BACKGROUND: Jaundice is commonly seen in severe malaria (approx. 2.5% patients) but hepatitis is unusual. Hepatocellular dysfunction varies from mild abnormalities in liver function tests (LFTs) to hepatic failure.
AIMS: To study the clinical, biochemical profile, complications and outcome in confirmed Plasmodium falciparum malaria cases with hepatopathy.
MATERIAL AND METHOD: This retrospective study was carried out in a tertiary care hospital in North India by reviewing slide confirmed case records of P falciparum malaria with biochemical evidence of hepatic dysfunction, admitted between 1/10/2012 and 1/10/ 2013.
RESULTS: A total of 13 patients (all male) with mean age 43.07 years, mean duration of fever prior to hospitalisation 6.5 days, were included. Fever persisted in all the patients after the onset of jaundice. Encephalopathy was present in 38.5% (5) of patients. Hepatosplenomegaly, icterus and anaemia (< 10 gm %) were found in 84.61%, 92.30% and 84.61% respectively. Predominant (> 50%) conjugated hyperbilirubinaemia was found in all the patients, with mean total bilirubin level of 21.06 mg % (1.5-54). Hyper-hyperbilirubinaemia (> 10 mg %) was associated with renal failure (serum creatinine > 2.0 mg/ dl) in 77.8% (7) cases. Mean AST, ALT and ALP levels were 164.84 IU/L (38-665), 75 IU/L (43-160) and 132.46 and > 3 upper limit of normal (ULN) was more common with AST than ALT (53.84% vs. 15.38%). Thrombocytopenia was seen in all the patients with mean platelet count of 43,853 /mm3. Most patients had only mild derangement of PT with mean INR of 1.30 (1-1.74). Main complications seen were acute renal failure (ARF) (88.89%), septicaemia (77.79%), acute respiratory distress syndrome (ARDS - 22.22%). ICU care was required by 69.23% of the patients. Mortality was 38.46% (5) and 53.84% patients (8) recovered.
CONCLUSION: Malarial hepatitis is a serious complication in patients presenting with P. falciparum malaria. Renal dysfunction is more common in those with hyper-hyperbilirubinaemia. Whether this is the cause, or effect, is difficult to hypothesise.
Keywords
Malaria, Malarial Hepatitis, Renal Dysfunction, Hyper-Hyperbilirubinaemia.- Comparison of the Maternal and Foetal Outcome in Induction of Labour by Sublingual and Vaginal Misoprostol
Authors
1 Department of Obstetrics and Gynaecology, Pt Bdspgims, Rohtak, IN
2 Department of Obstetrics and Gynaecology, 128/19 Naveen Niketan near Civil Hospital, Pt Bdspgims, Rohtak, IN
3 Department of Obstetrics And Gynaecology, Pt Bdspgims, Rohtak, IN
Source
The Indian Practitioner, Vol 69, No 2 (2016), Pagination: 31-34Abstract
Purpose of the Study: To compare the efficacy and safety of sublingual versus vaginal misoprostol for induction of labour in term pregnancy.Materials and Methods: A total of 100 women admitted for induction of labour at PGIMS Rohtak were randomized to receive 25 μg of sublingual versus vaginal misoprostol for induction of labour.
Results: Majority of women in both groups delivered vaginally (90% in both the groups). The mean number of doses of misoprostol required for induction of labour was similar in sublingual and vaginal misoprostol groups (1.64±0.802 versus 1.96±1.12). The time taken from induction to active phase of labour was 5.72±3.59 versus 7.04±4.55 (hours) in the both the groups respectively. The induction delivery interval was 8.38 (hours) in the sublingual and 7.04 (hours) in the vaginal misoprostol groups. Most of the patients in both the groups did not require oxytocin for augmentation of labour.
Conclusion: The low dose of misoprostol i.e. 25 μg is equally efficacious and safe by both sublingual and vaginal routes.
Keywords
Misoprostol, Vaginal, Sublingual.- Chronic Mesenteric Ischaemia Due to Diffuse Atherosclerosis
Authors
1 Department of Medical Gastroenterology, Anaesthesiology and Critical care and Obstetrics & Gynaecology, PGIMS, Rohtak, IN
Source
The Indian Practitioner, Vol 68, No 12 (2015), Pagination: 37-38Abstract
In more than 95% of patients, the cause of mesenteric ischaemia is diffuse atherosclerotic disease which decreases the flow of blood to the bowel. As the atherosclerotic disease progresses, symptoms worsen. We present a case of a 76 year diabetic male who was on treatment for ischaemic heart disease for the last five years. He presented with recurrent, dull, diffuse post-prandial abdominal pain for two years. The pain was classical of mesenteric ischaemia, and would occur half to one hour after taking meals. It reached its peak in next one hour and would subside within 3-4 hours. CT angiogram was done which revealed diffuse atherosclerosis of abdominal aorta with plaques obstructing origin of superior mesenteric artery and extending into bilateral common iliac arteries. The atherosclerosis is most common cause of chronic mesenteric ischaemia (CMI) but such diffuse involvement is rare.Keywords
Chronic Mesenteric Ischaemia, Atherosclerosis, Atheromatous Plaques.- Scar Endometriosis-Report of Seven Cases
Authors
1 Dept. of Obstetrics and Gynaecology, PGIMS, Rohtak, Haryana- 124001, IN
2 Dept. of Medical Gastroenterology, PGIMS, Rohtak, Haryana- 124001, IN
Source
The Indian Practitioner, Vol 69, No 4 (2016), Pagination: 23-26Abstract
Background: Endometriosis is the aberrant presence of uterine mucosa in locations outside the uterus. It may be pelvic or extra pelvic.Case: Retrospective analysis of seven cases of scar endometriosis from the file records of the department of Obstetrics and Gynaecology to study clinical characteristics and management. Five patients (71.42%) had presented after caesarean section, one each (14.2%) following hysterotomy and repair for ruptured uterus.
Conclusion: Endometriosis should be considered when cutaneous swelling is present within surgical scars or where the histology of non-specific abdominal pain relates to the menstrual cycle.
- Jeevan Rekha: Combating Hepatitis C in Haryana
Authors
1 Deptt. of Medical Gastroenterology, PGIMS, Rohtak, Haryana (124001), IN
2 Deptt. of Gynaecology & Obstetrics, PGIMS, Rohtak, Haryana (124001), IN
3 Deptt. of Anaesthesiology, PGIMS, Rohtak, Haryana (124001), IN
Source
The Indian Practitioner, Vol 69, No 3 (2016), Pagination: 48-51Abstract
Introduction: Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. Progression from acute to chronic HCV infection occurs in 50% to 85% of cases. Hepatitis C virus (HCV) is a major cause of liver disease worldwide and a potential cause of substantial morbidity and mortality in the future.Aims and Objectives: To study the effectiveness of the Jeevan Rekha Scheme (State Sponsored Scheme) in combating the menace of chronic hepatitis C in the state of Haryana-India.
Material and Methods: The patients who were anti-HCV positive and subsequently confirmed on HCV RNA (quantitative) and genotyping were treated with Pegylated Interferon and Ribavirin and followed up serially for viral loads at repeated intervals, till they reached stage of sustained virological response.
Results: Majority of the subjects were male and belonged to younger age group. Genotype 3 was most common, followed by 4 and 1. The compliance rate was excellent i.e.,93%. The overall sustained virological response was very high i.e., 90%.
Keywords
Hepatitis C Virus, Sustained Virological Response, Compliance Rate, Genotype.- Malignant Mixed Mullerian Tumour of Uterus
Authors
1 Department of Gynecology & Obstetrics, PGIMS, Rohtak, IN
2 Medical Gastroenterology, PGIMS, Rohtak, IN
3 Gynecology & Obstetrics, PGIMS, Rohtak, IN
4 Gynecology and Obstetrics, PGIMS, Rohtak, IR
Source
The Indian Practitioner, Vol 69, No 11 (2016), Pagination: 25-29Abstract
Background: Malignant mixed Mullerian tumors (MMMTs) are metaplastic carcinomas including both carcinomatous and sarcomatous elements. Case: A 65-year-old postmenopausal female presented to outpatient department with chief complaints of blood mixed vaginal discharge for the last 10 days. Speculum examination revealed a large, necrotic, foul smelling polyp of approximately 4 x 4 centimeters size seen coming out through the external os. Vaginal examination revealed that the cervix was dilated and taken up and the same polypoid mass was felt coming out through the os. Polypectomy along with endometrial biopsy was done and tissue was sent for histopathological examination which revealed features of malignant mixed mullerian tumor in the polyp and the endometrial biopsy showed necrotic tissue. Result: Patient underwent total abdominal hysterectomy along with bilateral salpingoopherectomy and pelvic lymphnode sampling. On cut section of the uterine corpus, a polypoid growth of size 3 x 2 centimeters was identified which on histopathology confirmed the diagnosis of a homologous uterine malignant mixed mullerian tumor involving more than half the thickness of myometrium. Conclusion: With a highly aggressive nature and limited therapeutic options, MMMTs represent one of the most lethal neoplasms of the female genitourinary tract.Keywords
Polyp, Abnormal Uterine Bleeding.References
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- Forgotten Lippes Loupe-Accidental Diagnosis for Pain Evaluation
Authors
1 Department of Gynecology & Obstetrics, PGIMS, Rohtak, IN
2 Medical Gastroenterology, PGIMS, Rohtak, IN
3 Gynecology & Obstetrics, PGIMS, Rohtak, IN
4 Gynecology & obstetrics, PGIMS, Rohtak, IN
Source
The Indian Practitioner, Vol 69, No 11 (2016), Pagination: 32-33Abstract
Background: The intrauterine device (IUD) is the most commonly used contraceptive method in the world. Case: We report here a case of 64 year old female who was totally unaware of IUCD insertion done 40 years back until she was evaluated for pain abdomen. Result: Her post-operative period was normal. Conclusion: Ultrasound can guide the location and help in removal of IUCD but hysteroscopy is the gold standard in managing missed IUCD.Keywords
Lippes Loupe, Sonography, Hysteroscopy.References
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