Published Research

December 2017

A Simplistic Approach for Registration of Orthogonal Planar Images as a Pre-Preparation for Externally Acquired Cranial Images in Department of Radiation Oncology, Nayati Healthcare and Research Centre

  • nayati_admin
  • Dec 22, 2017
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Accurate image registration for CT-CT, CT-MRI for brain is necessary to obtain clinical information from diagnostic images and translate the information to radiotherapy treatment planning CT images. Mostly in cases of Post-Surgery cases that have been operated outside hospitals and are being referred for Post-Operative adjuvant Radiotherapy to our Centre, where the pre-operative volume is very importantly necessary in radiotherapy planning, a pre preparation was needed. The intention of the work is two folds. One is to make the outside clinic diagnostic images with rectangular matrix dimension compatible with our treatment planning system (TPS), Eclipse version 11

Pitfalls in the ventilator management of Myasthenia Gravis

  • nayati_admin
  • Dec 22, 2017
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A 31 years woman, under treatment for Myasthenia gravis and no past history of underlying respiratory disease, was admitted with breathlessness, diplopia and ptosis. On evaluation she was found to have a thymoma. Soon after admission she eveloped a severe Myasthenic crisis (MC) with respiratory failure requiring steroids, immunosuppressive, mechanical ventilation and Plasmapheresis. She also underwent thymectomy after stabilisation. Her postoperative ventilatory management was difficult, prolonged and complicated by autonomic instability, poor respiratory muscle function, and anticholinesterase-induced increase in airway reactivity. High airway pressures, airway resistance, and air trapping led to bilateral pneumothoraces requiring intercostal drainage. The airway reactivity and resistance settled after discontinuing pyridostigmine and instituting inhaled Ipratropium bromide, an anticholinergic agent. Pneumothoraces resolved rapidly and the patient could be weaned successfully via a tracheostomy.

Lancet Spotlight

  • nayati_admin
  • Dec 22, 2017
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Pitfalls in the ventilator management of Myasthenia Gravis A primary goal of intensive and critical care medicine is to raise standards of care and improve outcomes for patients. But when non-responsive patients are unlikely to make a meaningful recovery, difficult decisions have to be made. Decision-making is infl uenced by many factors: ethical, economic, cultural, legal, and the wishes of the family. When there is overwhelming evidence that further treatment or keeping the patient alive with mechanical assistance is prolonging unnecessary suffering, how can this situation be explained to distressed family members?

India not a country to die in IJME 16

  • nayati_admin
  • Dec 22, 2017
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The Indian Journal of Medical Ethics (formerly Issues in Medical Ethics) is a platform for discussion on healthcare ethics, with special reference to the problems of developing countries such as India. It hopes to involve all cadres of, and beneficiaries from, this system, and strengthen the hands of those with ethical values and concern for the underprivileged. The Journal is owned and published by the Forum for Medical Ethics Society, a not-for-profit, voluntary organisation. The FMES was born out of an effort by a group of concerned doctors to focus attention on the need for ethical norms and practices in health care. Contributions to the journal, in the form of original papers, research findings, experiences in the field, case studies, debates, news and views on medical ethics, are welcome. All submissions must be in English and are subject to editorial review. Contributors are requested to refer to the detailed guidelines for submission available on the journal website, www.ijme.in Printed and published by Sanjay Nagral on behalf of the Forum for Medical Ethics Society Printed at Vibha Offset, Royal Industrial Estate, Wadala, Mumbai 400 031 Layout by Parkar Arts, India Printing House, 42, G.D. Ambekar Marg, Wadala, Mumbai 400031 Published at FMES, 0-18, ‘Bhavna’, Veer Savarkar Marg Prabhadevi, Mumbai 400 025

Constitutional and Legal Protection

  • nayati_admin
  • Dec 22, 2017
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Appropriate treatment limitations towards the end of life to reduce unwanted burdens require ethical clarity that is supported by appropriate legislation. The lack of knowledge of enabling legal provisions, physicians feel vulnerable to legal misinterpretation of treatment limiting decisions. In India the lack of ocietal awareness, inadequate exploration of the gray areas of bio-ethics and unambiguous legal position relating to terminal illness have resulted in poor quality end of life care. Much of the perceived vulnerability by the physician is ttributable to insufficient knowledge and understanding of existing constitutional and legal position in India. While we await informed legal and legislative opinion, this paper highlights possible legal liabilities arising from treatment limitation decisions with available defense. It is hoped that such clarity would lead to more confident ethical decisions and improved end of life care for patients.

Pulmonary actinomycosis: a clinical surprise!

  • nayati_admin
  • Dec 22, 2017
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A 65 year-old man with diabetes presented with a brief febrile illness, extreme debility and respiratory distress. X-ray chest showed a right lower lobe consolidation. A clinical diagnosis of severe community-acquired pneumonia was made for which he required antibiotics, non-invasive ventila-tory support and admission to intensive care for a week. Nasopharyngeal swab was positive for in flu-enza A by real-time PCR. The patient made appar-ent clinical recovery but a persisting right lower zone in filtrate. At follow-up as an outpatient 2 weeks later, he was stable haemodynamically but continued to have low-grade fever, mild hypoxia and a weight loss of 14 kg since illness onset. He was edentulous but had good oral hygiene. Chest X-ray (figure 1) and CT showed dense consolida-tion in the right lower lobe.

Isolated pulmonary mucormycosis

  • nayati_admin
  • Dec 22, 2017
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An obese woman aged 70 years with a history of chronic persistent asthma and diabetes mellitus pre-sented with acute exacerbation and respiratory failure. A chest X-ray and CT scan revealed patchy in filtrates on the right lung along with right hilar and upper lobe masses suggestive of malignancy(figure 1). Bronchoscopy was performed 7 days later after control of her symptoms with nebulised bronchodilators, intravenous corticosteroids and non-invasive ventilatory support. Bronchoscopy revealed signi ficant bronchomalacia (>50% collap- sibility), and masses in the right main stem and right upper lobe bronchi (figure 2 and see online supplementary figure S1). Biopsies revealed fila-mentous structures with the morphology of Mucor spp. invading the bronchial mucosa with no evi-dence of a malignancy (figure 3 and see online supplementary figure S2).

Expression and modulation of complement receptor 2 (CR2/CD21) in the pathophy siology of rheumatoid arthritis

  • nayati_admin
  • Dec 22, 2017
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Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by the presence of auto antibodies, joint inflammation and subsequent destruction of cartilage and bone. The disease affects multiple organs, including the joints, skin, heart, lungs and eyes. However, the primary target of the abnormal autoimmune response is the synovial joints. RA involves all elements of the immune response. It is initiated by immune complexes (ICs) and complement, perpetuated by cytokines and affected by metalloproteinase’s. The local production of IgG and rheumatoid factors (RF), which are auto antibodi es directed against the Fc portion of IgG, along with the antibodies to anti-cyclic citrullinated peptide lead to complement activation, appear important in destructive events associated with the synovitis.

Level and determinants of precancerous symptoms of cervical cancer in unscreened population of Uttar Pradesh and Rajasthan, India: A pilot study

  • rachna
  • Dec 18, 2017
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Problem considered: Cervical cancer, mainly caused by human papillomavirus infection, is one of the most frequent cancers in women in the developing world including India. The present study attempts to explore the risk factors related to symptoms of cervical cancer. Materials and methods: A total of 1319 females of age groups ranging from 14 years to 85 years were included in the present study and analyzed for symptoms and risk factors for cervical cancer. Results: The prevalence of painful micturition, white discharge per vagina, and pelvic pain in the age group 25–44 years was found to be 22.1%, 21%, and 8%, respectively, and the distribution of symptoms was statistically associated ( p < 0.05) with age.

Epidemiological hazards of tobacco and its manifestations in oral health of a screened population in Northern India

  • rachna
  • Dec 18, 2017
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Introduction: Tobacco addiction and its oral manifestation are serious health hazards in India, particularly in the northern region. We conducted a large scale population based screening study to evaluate the epidemiolocal hazard of tobacco and its oral manifestations leading to precancerous lesions. Methods: Total 78 cross-sectional health camps were organized in rural population of northern India and 8572 individuals were screened using visual screening method. Multivariable analysis was used to explore the factors related to tobacco use and oral ulceration and mucosal changes.