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1.
Surg Endosc ; 35(3): 1296-1306, 2021 03.
Article in English | MEDLINE | ID: mdl-32180001

ABSTRACT

BACKGROUND: Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA. METHODS: Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE). RESULTS: A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention. CONCLUSIONS: Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.


Subject(s)
Adenoma/surgery , Colonic Neoplasms/surgery , Endoscopy/methods , Aged , Cohort Studies , Female , Humans , Male , Retrospective Studies , Treatment Outcome
2.
Int J Mol Med ; 17(6): 1151-5, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16685429

ABSTRACT

Musculoskeletal allotransplantion is the most common form of human tissue transplantation. Unlike solid organ transplants, bone allotransplants undergo rigorous processing and are considered non-viable tissue. In this study, we propose that donor genetic material may exist in circulation after bone allotransplantation. Fifty-one female patients who received bone allotransplants from male donors were assessed. Blood plasma samples were analyzed using real-time quantitative polymerase chain reaction (PCR) with dual labeled fluorogenic probes for the presence of the SRY gene on the Y chromosome. Of the total 51 patients, the SRY sequence was detected in 6 patients. Five were positive at day 1 postoperatively and negative thereafter, with the remaining patient positive at 3 months post-transplantation. Our results document, for the first time, the presence of donor DNA in the circulation of recipients after bone allotransplantation. Our findings suggest a potential new investigative tool to assess the postoperative status of bone allotransplants.


Subject(s)
Bone Remodeling/genetics , Bone Transplantation , DNA/blood , Tissue Donors , Chromosomes, Human, Y/genetics , Female , Genes, sry/genetics , Humans , Male , Middle Aged , Polymerase Chain Reaction , Prognosis , Transplantation, Homologous
3.
Indian J Pediatr ; 72(4): 325-32, 2005 Apr.
Article in English | MEDLINE | ID: mdl-15876762

ABSTRACT

The inborn errors of metabolism (IEM) constitute a diverse heterogeneous group of disorders with protean clinical manifestations presenting mainly in the pediatric population. Though individually rare, together they constitute a significant percentage of children seen in genetic and neurology clinics. This review focuses on selected IEMs and highlights those seen in the neonatal period. Data from Indian centers are presented. It also emphasizes principles of management in these difficult disorders in the context of a developing country.


Subject(s)
Metabolism, Inborn Errors , Brain Diseases, Metabolic/diagnosis , Brain Diseases, Metabolic/therapy , Child , Diagnosis, Differential , Emergencies , Hepatolenticular Degeneration/diagnosis , Hepatolenticular Degeneration/therapy , Heredodegenerative Disorders, Nervous System/diagnosis , Humans , India , Infant , Infant, Newborn , Maple Syrup Urine Disease/diagnosis , Maple Syrup Urine Disease/therapy , Menkes Kinky Hair Syndrome/diagnosis , Menkes Kinky Hair Syndrome/therapy , Metabolism, Inborn Errors/diagnosis , Metabolism, Inborn Errors/therapy , Phenylketonurias/diagnosis , Phenylketonurias/therapy
4.
Indian J Pediatr ; 72(4): 325-332, 2005 Apr.
Article in English | MEDLINE | ID: mdl-28386828

ABSTRACT

The inborn errors of metabolism (IEM) constitute a diverse heterogeneous group of disorders with protean clinical manifestations presenting mainly in the pediatric population. Though individually rare, together they constitute a significant percentage of children seen in genetic and neurology clinics. This review focuses on selected IEMs and highlights those seen in the neonatal period. Data from Indian centers are presented. It also emphasizes principles of management in these difficult disorders in the context of a developing country.

5.
Anaesthesia ; 57(6): 544-8, 2002 Jun.
Article in English | MEDLINE | ID: mdl-12010268

ABSTRACT

The aim of the study was to assess the effectiveness of computed tomography in the management of critically ill patients. We performed a prospective study over a 4-month period. The requesting clinician was asked to document their clinical diagnosis and confidence thereof on a visual analogue scale. They were also asked about their management plan if computed tomography had not been available. After imaging, any change in the management plan was assessed. During the study period, 16 computed tomograms were performed on 14 patients. There were 21 possible clinical diagnoses: of these eight were confirmed, and 13 were refuted. Seven new diagnoses were established. Computed tomography did not help in the management of two patients and it led to more confusion in the management of one patient. The management of seven patients was altered after computed tomography and in six the management depended solely on computed tomography findings.


Subject(s)
Critical Illness , Patient Care Planning , Tomography, X-Ray Computed , Confidence Intervals , Diagnosis, Differential , Humans , Prospective Studies
6.
J Trop Pediatr ; 45(5): 287-90, 1999 10.
Article in English | MEDLINE | ID: mdl-10584470

ABSTRACT

Liver involvement is commonly observed in patients with typhoid fever. However, a hepatitis-like picture with fever and jaundice is unusual and infrequently reported in the paediatric literature. Our aim was to characterize the clinical picture, biochemical features, and prognosis of typhoid hepatitis. One hundred cases of typhoid fever (age 0 to 12 years), proven by positive blood cultures to Salmonella typhi, were studied with special reference to hepatic dysfunction. Of these, eight patients were found to have hepatitis during the course of their illness. All had high fever, tender hepatomegaly, elevated serum bilirubin (in the range of 2.5-5.8 mg/dl), and elevated serum alanine transaminase levels (in the range 100-620 IU/l). All the eight patients showed complete clinical and biochemical recovery in response to appropriate antibiotics. The clinical picture of typhoid hepatitis frequently mimics acute viral hepatitis. In tropical areas, the differential diagnosis of a child presenting with fever and jaundice should include typhoid hepatitis.


Subject(s)
Hepatitis/etiology , Typhoid Fever/complications , Child , Diagnosis, Differential , Female , Hepatitis/blood , Hepatitis/diagnosis , Humans , India , Infant , Male , Prognosis
8.
Indian Pediatr ; 32(7): 783-5, 1995 Jul.
Article in English | MEDLINE | ID: mdl-8617555

ABSTRACT

PIP: All of the 4000 infants who die daily in India have been bottle fed. Most of these infants die from infections which are typically caused by bottle feeding. Considerable research has shown that human breast milk ideally suits babies' needs. Human breast milk protects infants from several infections and allergies, such that the breastfed infant is 25 times less likely than the bottle fed infant to die due to diarrhea and pneumonia. Comparative studies have even found breastfed babies to have higher IQs than bottle fed ones. Detrimental maternity home practices, adverse social factors, and the unethical and aggressive marketing strategy adopted by the manufacturers of infant milk substitutes and feeding bottles are the major factors responsible for the erosion of the practice of breastfeeding. These factors are discussed. The Infant Milk Substitutes, Feeding Bottles, and Infant Foods Act prohibits the advertisement and promotion of feeding bottles and infant milk substitutes by unethical marketing strategies. Violations of the act are punishable by imprisonment and a heavy fine. The act and the need for its passage are discussed.^ieng


Subject(s)
Bottle Feeding/adverse effects , Health Behavior , Infant Mortality , Advertising , Breast Feeding , Humans , India/epidemiology , Infant , Infant, Newborn , Socioeconomic Factors
12.
Indian J Med Sci ; 46(3): 75-82, 1992 Mar.
Article in English | MEDLINE | ID: mdl-1639445

ABSTRACT

The article discusses the disease AIDS, and its increasing incidence all over the world. The alarming rise of HIV infection amongst those tested in India is noted. The projection as made by WHO are mentioned. The various modes of transmission of HIV infection and the high risk groups for each mode are identified. Clinical manifestation of an adult case is followed by that of a pediatric patient in whom the infection is mostly transplacental. The risk of TAA amongst children is highlighted as also the difference between adult and pediatric AIDS. Diagnosis of AIDS, its management, prognosis and prevention are mentioned. The similarity between HIV-1, SIV and HIV-2 induced immunodeficiency is recorded.


PIP: This article briefly defines AIDS, describes the invasive action of HIV-1, discusses world patterns of HIV incidence, modes of infection, infection risk, clinical and laboratory manifestations of AIDS in adults and infants, diagnosis, management, prognosis, and HIV-2. 222,740 AIDS cases from 153 countries had been reported to the World Health Organization by March, 1990. HIV prevalence was estimated to be 5.1 million in 1988; it is projected to grow to 18.3 million by the year 2000.


Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , Cross-Cultural Comparison , Developing Countries , Acquired Immunodeficiency Syndrome/transmission , Child , Cross-Sectional Studies , Humans , Incidence , India/epidemiology , Infant , World Health Organization
13.
Indian Pediatr ; 29(2): 151-4, 1992 Feb.
Article in English | MEDLINE | ID: mdl-1592493
15.
Indian Pediatr ; 28(8): 961-4, 1991 Aug.
Article in English | MEDLINE | ID: mdl-1808093

ABSTRACT

PIP: As of August 1991, 2167 people in India carried HIV. It is transmitted via sexual contact, the placenta, blood or blood product transfusions, sharing of needles, or any contact of raw tissues with infected blood or other body fluids. It is not transmitted by casual contact, breathing, or eating. Blood is the predominant infection source, yet HIV is also present in cerebrospinal fluid, pus, and other body fluids. 120 degrees Celsius and 2 atmospheric pressure in an autoclave or pressure cooker, dry heat of 170 degrees Celsius for 2 hours, or boiling in water for 20 minutes all destroy HIV. Chlorine can also destroy HIV and is relatively inexpensive and available. The Centre for AIDS Research and Control of the Indian Council of Medical Research advises health workers to quarantine AIDS patients or HIV positive patients in a separate ward identified by a sign (Biohazard--No Admission).. Health workers must wear protective aprons or gowns. When handling blood or other body fluids, they need to wear gloves and rinse them in chemical disinfectant before taking them off, and then once off, soaking them in the same disinfectant for 20 minutes. Health workers who have handled such body fluids must also thoroughly wash their hands with soap and water. Further they should not recap needles and burn the tip of disposable syringes to prevent their reuse. All needles and nondisposable syringes must either be soaked in a disinfectant for 20 minutes or destroyed in an incinerator. Physicians should always weigh the benefits and risks of performing invasive procedures. In the laboratory, technicians must wear full sleeved aprons, eye shields, masks, and gloves when collecting and testing samples. They should use a cotton plug in pipettes and disinfect the work area daily. The Centre also gives advice on special situations including blood spills, blood soiled linen and instruments, and autopsy.^ieng


Subject(s)
HIV Infections/prevention & control , Disinfection/methods , Health Personnel , Humans , Occupational Diseases , Risk Factors
17.
J Trop Pediatr ; 37(2): 67-70, 1991 03.
Article in English | MEDLINE | ID: mdl-2027167

ABSTRACT

The depression of immune responses during measles infection has been recognized since the early 20th century. Acute bacterial infections are the most common cause of morbidity and mortality in measles. This study investigated the phagocytic and bactericidal or fungicidal capacities of polymorphonuclear cells (PMN) and monocytes during measles infections. When 14 children with measles were compared with 25 healthy controls, a significant depression in PMN and monocyte function was found. Of these 14 children, seven developed acute bacterial infections. These seven children were compared with 11 children who had acute bacterial infections without measles. It was found that PMN in patients with measles did not achieve an activated state, as expected with acute infections. Serum immunoglobulins were not altered in these patients. These results confirm previous reports of depressed phagocytic and bactericial capacities of PMN in measles, and further document that peripheral blood monocyte functions are also depressed in measles.


Subject(s)
Bacterial Infections/blood , Immunoglobulins/metabolism , Measles/blood , Monocytes/physiology , Neutrophils/physiology , Acute Disease , Bacterial Infections/etiology , Bacterial Infections/physiopathology , Child, Preschool , Humans , Infant , Measles/complications , Measles/physiopathology , Reference Values
20.
Indian Pediatr ; 27(9): 911-4, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2286433

ABSTRACT

A study was carried out to test the efficacy of oral polio immunization commencing in the newborn period. In Group A, 47 term newborn infants were given trivalent oral polio vaccine (TOPV) within the first four days, at one month and at two months. In Group B, 21 infants were given TOPV at 3, 4 and 5 months. The seroconversion rates for types 1, 2 and 3 were 87.2, 95.7 and 72.3%, respectively in Group A and 85.7, 95.2 and 66.7%, respectively in Group B after 3 doses of TOPV, the differences being insignificant. Oral polio immunization beginning in the newborn period was as effective as when commenced at 3 months of age. Before immunization, the number of babies with protective titers against polioviruses were significantly more in Group A as compared to Group B. Thus, the later onset of immunization schedule leaves more children susceptible to poliomyelitis during the first 3 months of life.


Subject(s)
Poliomyelitis/prevention & control , Poliovirus Vaccine, Oral/administration & dosage , Humans , Immunization Schedule , Infant, Newborn
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