Old is gold: Krukenberg operation performed in a tertiary setup in India for the rehabilitation of the amputated hand of a poor patient

It is a known fact that a disabled person is a greater burden to society than a dead person. Krukenberg operation, first described by German army surgeon in 1917, Hermann Krukenberg, converts a forearm stump into a pincer, so as to retain some dexterity of the hand rather than it being reduced to a mere stump. We report this case of Krukenberg operation performed in a tertiary care setup, wherein an amputated forearm stump was converted into a functional pincer that can result in huge advantage for poor amputee patients in developing countries who rely heavily on the functionality of their hands to earn their everyday meal and are unable to bear the expense of costly prosthesis. One such patient, a 25-year-old male hailing from a very poor background who came to us with traumatic amputation of his dominant hand.

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Sporadic Creutzfeldt-Jakob Disease: Diagnosing Typical and Atypical Presentations under Limited Circumstances

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000514470 ◽

2021 ◽

pp. 1-7

Author(s):

Shazma Khan ◽

Sara Khan

Keyword(s):

Developing Countries ◽

Brain Mri ◽

Tertiary Care ◽

Rapid Onset ◽

Spongiform Encephalopathy ◽

Care Hospital ◽

Jakob Disease ◽

The Central Nervous System ◽

Missed Diagnosis ◽

Atypical Presentations

Introduction: Sporadic Creutzfeldt-Jakob disease (sCJD) is a transmissible disorder of the central nervous system caused by the transformation of normal prion protein into an abnormal misfolded form. The process begins spontaneously and runs a vicious cycle to cause spongiform encephalopathy, rapidly resulting in death. Amply described in the western literature, CJD is scarcely reported in Asia due to certain limitations including missed diagnosis, under-reporting, and rarity of the disease. Brain MRI, electroencephalogram, cerebrospinal fluid testing, and biopsy of the infected brain tissue support the diagnosis in cases of clinical suspicion. However, the diagnosis can still be made with limited available resources in developing countries. Method: A review of CJD cases evaluated in the neurology department of a tertiary care hospital in Pakistan was done from 2002 to 2018. Results: Eleven cases labeled as sCJD are identified based on the European MRI-CJD consortium criteria. This is the first study on CJD from Pakistan, which includes both the typical and atypical presentations. Conclusion: Even with limited testing available, the diagnosis of CJD can be made with confidence in the developing countries, provided the suspicion is kept high in cases of rapid onset dementia and acute behavioral changes.

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TOE TO THUMB TRANSFER

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.06.2467 ◽

2012 ◽

Vol 19 (06) ◽

pp. 877-883

Author(s):

Muhammad AZEEM ◽

TAHSEEN AHMED CHEEMA ◽

MUHAMMAD ZAFAR IQBAL

Keyword(s):

Vascular Reconstruction ◽

Early Rehabilitation ◽

Human Hand ◽

Microvascular Reconstruction ◽

Dominant Hand ◽

Traumatic Amputation ◽

Minor Complication ◽

Male And Female ◽

Conventional Methods ◽

Toe Transfer

Introduction: Thumb is the most important part of human hand both functionally and cosmetically. The reconstruction of lostthumb is always challenging for the surgeons. Objectives: The aim of study is to evaluate the results of micro – vascular reconstruction ofthumb by toe transfer. Place and duration of study: B. Victoria hospital Bahawalpur from January 1998 to December 2008. Material andmethod: Both male and female patients who presented to the orthopedic Department with traumatic amputation of thumb were included in thestudy. Results: All ten thumbs survived with minor complication as for as functionally and cosmetically are assessed. Dominant hand wasinvolved in eight cases. Conclusions: Results of Microvascular reconstruction are much better as compared to conventional methods. This issingle stage procedure and early rehabilitation of hand is possible. Cosmetically and functionally this is far superior to conventional methods.

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Estimation of the Burden of Pandemic(H1N1)2009 in Developing Countries: Experience from a Tertiary Care Center in South India

PLoS ONE ◽

10.1371/journal.pone.0041507 ◽

2012 ◽

Vol 7 (9) ◽

pp. e41507 ◽

Cited By ~ 5

Author(s):

Mahesh Moorthy ◽

Prasanna Samuel ◽

John Victor Peter ◽

Saranya Vijayakumar ◽

Dipika Sekhar ◽

...

Keyword(s):

Developing Countries ◽

South India ◽

Care Center ◽

Tertiary Care ◽

Pandemic H1n1 ◽

Tertiary Care Center ◽

Pandemic H1n1 2009

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Retrospective Analysis of 1230 Patients of Immune Thrombocytopenic Purpura Reporting to a Tertiary Care Hospital in India from 1992–2004.

Blood ◽

10.1182/blood.v104.11.5294.5294 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5294-5294

Author(s):

Dharma R. Choudhary ◽

Rajat Kumar ◽

R. Saxena ◽

Manoranjan Mahapatra ◽

Atul Kotwal ◽

...

Keyword(s):

Developing Countries ◽

Response Rate ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Cost Effective ◽

Repeated Measure ◽

Care Hospital ◽

Chronic Itp ◽

Acute Itp

Abstract Background: There is very little published epidemiological data from developing countries regarding ITP and no large series from India. The aim of the study was to analyze the presenting features, response to different therapeutic options and suggest cost effective therapy. Method: The records of hematology department of All India Institute Of Medical Science were analyzed from January 1992 to June 2004. This is a premium tertiary care hospital in India. Diagnosis of ITP was made according to the standard criteria. Response criteria: complete response was defined as a platelet count increase to 100x109 /l or more, for at least 2 months: partial response was defined as doubling of platelet counts from initial levels and > 50x 109/l for at least 2 months; no response included none of the above. Statistical methods: Database was created in MS Access and SPSS ver 11 was used for statistical analysis. Descriptive statistics were calculated and appropriate tests of significance like Chi Square, repeated measure linear model were carried out. Results: During the study period, 1230 patients of ITP were seen in hematology department, with a median age of 19.6 years (range 0.9–80). Females were 51.1% and males 48.9%. Median follow-up was of 9 months (range 0–178). Presenting features were: skin bleed − 91.1%; mucosal bleed − 57.5%; hematuria − 7.2%; gastrointestinal bleed − 12.5% and intracraniall bleed − 2.8%. Per-vaginal bleeding − 31.2 % of females. History of preceding viral fever was seen in 13.1% and palpable spleen in 2.5%. The mean platelet counts at presentation were 34+ 18.3x109/l. There were 595 (48.4%) patients of acute ITP and 635 (51.6%) patients of chronic ITP. Childhood ITP (age ≤ 12 yr) was seen in 46.5% and adult ITP in 53.5%. Response to therapy: Prednisolone was given to 99.6% patients with response of 57.3 %; Intravenous gamma globulin was given to 8.9% with response in 63.6%. Splenectomy was performed in 5% of acute ITP and 15.1% of chronic ITP (p = 0.00). The overall number of splenectomies was 126, with a response rate of 83.3%. Of these 126, acute ITP constituted 23.8% while chronic ITP formed 76.2% of cases. There was no statistically significant difference in response rate in these two groups (p =0.575). Danazole was given to 66 patients with response in 44%. Various other modalities of treatment were given to 24 patients (Anti D-14; Dapsone-2; Cyclosporin-2; Azathioprine-5; and Vincristine with Cyclophosphamide -1 patient), with a response in 25% of patients. The overall response rate with all treatment modalities was 68%: in childhood ITP − 65% and in adult ITP − 70.5%. Childhood ITP did not respond as expected, possibly due to referral bias of more refractory cases being referred to the center. The values of platelets showed a continuous increase during follow up and this increase was statistically significant (P=0.000 for all, Repeated measure model). Conclusion: Pattern of ITP in India is similar to that seen in other centers. In this study Prednisolone was given as first line agent to almost all patients with response in 57.3%; Splenectomy were done in 10.2% of prednisolone refractory or dependent patients with a response in 83.3%. These should form the primary modalities of therapy in developing countries. Significant numbers of patients were refractory to above-mentioned modalities and thus there is a requirement for other cost-effective therapies.

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Global impact of a clinical informatics system: Scalable delivery of on-time access to evidence-based multidisciplinary expert treatment decisions for all cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6502 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6502-6502 ◽

Cited By ~ 1

Author(s):

Rajendra A. Badwe ◽

Pramesh CS ◽

Sudeep Gupta ◽

Nita S. Nair ◽

Nancy Renee Feldman ◽

...

Keyword(s):

Developing Countries ◽

Treatment Options ◽

Tertiary Care ◽

Treatment Decisions ◽

Evidence Based ◽

Expert Opinions ◽

Informatics System ◽

The World ◽

Simple Language

6502 Background: There is a scarcity of expert oncologists in the world. Patients in nonurban areas have poor access to evidence-based treatment decisions and worse outcomes. In India, there are ~1600 experts for 1.8 Million patients. Created in May 2014, “TMC NCG Navya Online” is an expert opinion service based on an informatics system. We prospectively study its real-world impact. Methods: Navya exhaustively searches and outputs evidence and experience based treatment options for an individual patient. Its accuracy was validated in trials at TMC (one of the world’s largest tertiary care centers) and UCLA-OVMC. Navya’s patient data summary and treatment options are rapidly reviewed and vetted (1-2 minutes) on mobile by experts from TMC and NCG, (consortium of 104 cancer centers in India). Expert decisions are converted into a simple language report for patients. System generated evidence based information on diagnostics, regimens, side effects etc are also provided. To prospectively assess impact, from July to December 2016, all patients were asked via phone follow-up: 1. If report was shared with treating provider, 2. Final treatments delivered. Results: 9361patients from 22 developing countries registered with TMC NCG Navya Online. 3402 expert decisions were provided and converted into 2614 simple language reports. 5229 patients received system generated evidence based information. Median time to deliver a report was 24 hours. The prospective sample was 582 decisions with a 75% (n = 436) follow-up rate. 74% of reports were shared with treating providers. 73% of TMC NCG Navya’s decisions, (n = 306), were the final treatments delivered. Common reasons for non-implementation included decline in ECOG status and not testing biomarkers (ER/PR etc). Conclusions: Expert oncologists use Navya to provide rapid online opinions to patients across 22 developing countries. Patients shared the expert opinions with their providers and received evidence-based treatments. Expanding the reach and impact of such a service to nonurban USA and the world, can maximize outcomes for patients without ready access to expertise.

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An epidemiological study to assess the mental health status of pregnant women in a tertiary care hospital, Srinagar, Jammu and Kashmir, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20172355 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2580

Author(s):

Bilal Ur Rehman ◽

Javid Ahmad ◽

Rauf Ur Rashid Kaul ◽

Mohammad Kaleem ul Haque

Keyword(s):

Mental Health ◽

Developing Countries ◽

Health Status ◽

Depressive Disorder ◽

Pregnant Women ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Antenatal Clinic ◽

Mental Health Status ◽

Care Hospital

Background: Pregnancy is a major psychological, as well as physiological event; women may find themselves unable to cope with additional demands of pregnancy. Mental illness during pregnancy-whether anxiety, depression or more severe psychiatric disorders-can have a significant negative impact on a mother and her baby. Poor psychological health has been associated with low birth weight, premature birth, perinatal and infant death, postnatal depression, as well as long term behavioural and psychological impacts on the child. Depressive disorders are a common source of disability among women. Mental health problems during pregnancy and postpartum periods are one of the alarming health issue among women. Community-based epidemiological data on antenatal depression from developing countries is scarce. This study was conducted to assess the mental health status of pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar (J and K).Methods: A cross sectional study was conducted over a period of six months from 1stSeptember 2016 to 28th February 2017 among randomly selected pregnant women attending antenatal clinic of tertiary care hospital, SKIMS, Srinagar. A total of 200 pregnant women formed the study subjects. Data was collected by interviewing the pregnant women using pre-designed, pre-tested, semi-structured questionnaire. Data was analysed using Statistical Programme for the social science (SPSS) version 19.0.Results: Amongst the study population, prevalence of depressive disorder was 26%. The depression was significantly increasing with advancing pregnancy and advancing age. Socio-economic status and depression was associated statistically significant (p=0.024). Women with bad relationship with in laws had significantly more depression compared to those who had good relationship with in laws (P=0.0037). The association between parity and depressive disorder was statistically insignificant(P=0,7144).Conclusions: When we care for mother we care for two live and live without psychological consideration is completely materialistic. A depressive symptom occurs commonly during 2nd and 3rd trimester of pregnancy, drawing attention to a need to screen for depression during antenatal care. Maternal health policies, a priority in developing countries, must integrate maternal depression as a disorder of public health importance. Intervention should target women in the early antenatal period.

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Clinico-epidemiological profile of hepatitis A virus and hepatitis E virus co-infection in pediatric age group: a hospital based retrospective study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20190692 ◽

2019 ◽

Vol 6 (2) ◽

pp. 588 ◽

Cited By ~ 1

Author(s):

Shikha Handa ◽

Sanober Wasim ◽

B. P. Kalra ◽

Anil Rawat ◽

Vipan Chandar ◽

...

Keyword(s):

Developing Countries ◽

Retrospective Study ◽

Hepatitis E Virus ◽

Hepatitis A ◽

Hepatitis A Virus ◽

Tertiary Care ◽

Hepatitis E ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group

Background: Hepatitis-A virus (HAV) and Hepatitis E virus (HEV) are two major hepatotropic viruses of great public health importance in the developing countries like India. Both HAV and HEV are enterically transmitted and there are speculations that their co-infection might be associated with a more severe clinical course and increased rate of mortality. The objective of this study is to determine the prevalence, clinical features and biochemical parameters of Hepatitis A and Hepatitis E co-infection in hospitalized patients at a tertiary care centre in Uttarakhand.Methods: It is a retrospective study, covering a period of 4years and conducted in Himalayan Institute of Medical Sciences, SRHU Jolly Grant, Dehradun. Records of the patients with Hepatitis A and Hepatitis E co-infection were retrieved and analyzed.Results: Out of total 125 patients of acute viral hepatitis, 13 patients had HAV and HEV co-infection. 100% of the patients with co-infection presented with complaints of fever and jaundice, followed by 76.92% with vomiting, 69.23% with pruritis, 61.53% with pain in abdomen and 23.07% with altered sensorium. Mean Bilirubin, ALT, AST were 8.69±7.27 mg/dl, 2030.69±1726.93IU/L and 1880.07±1881.11IU/L respectively. Average duration of stay was 8.2 days. Encephalopathy was seen in 2 patients. However, no mortality was reported.Conclusions: Co-infection of HAV and HEV is not rare in pediatric age group. Knowledge about this will be of immense help for planning of future vaccination strategies and for better sanitation program in developing countries like India.

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Update: Primary immunodeficiency disorders among north Indian children

Indian Journal of Pathology and Oncology ◽

10.18231/j.ijpo.2021.097 ◽

2021 ◽

Vol 8 (4) ◽

pp. 465-472

Author(s):

Rakesh Kumar Deepak ◽

Prabin Kumar ◽

Abhinav Saurabh ◽

Narendra Bagri ◽

Sonia Verma

Keyword(s):

Developing Countries ◽

Primary Immunodeficiency ◽

Tertiary Care ◽

Developed Countries ◽

North India ◽

Indian Children ◽

Primary Immunodeficiency Disorders ◽

Medical Practitioners ◽

History Of ◽

The Developed Countries

Primary immunodeficiency disorders (PIDs) are a group of genetic abnormalities characterized by defectin one or more constituents of the immune system.This group of disorders are largely undiagnosed and unreported worldwide due to lack of awareness among the medical practitioners,parents as well as lack of state of art diagnostic facilities. Earlier we had reported the distribution pattern of various categories of PID in children of north India; in this report we are appending the data with current findings.In this retrospective study we pooled data from PIDs workup of 706 children with suspected PIDs, below the age of 18Yrs, in the period of May 2017 October 2019. The clinical assessment and presentation of these children was suggestive of PID. The peripheral blood of these children was used for flow cytometry based immunophenotyping of immune cells. PIDs were classified according to the International Union of Immunological Societies’ (IUIS) criteria.A total of 133 (18.38%) children were diagnosed with one or other form of PID with overall median age was 3.25 years (male: 2.3 and female: 4.2Yrs). Chronic infection, persistent diarrhea and retarded growth were the common warning signsin these patients. Combined humoral and cellular immunodeficiency was observed in 32%, phagocytic defect in 23%, antibody defect in 17%, dysregulated innate immunity in 19% and other well defined syndromes in 9% of total diagnosed PID children. Around 15.78% of PID cases were seen in coupleswithconsanguineous marriage, past family history of PID in 20.30% and families with sibling death of unknown cause in 24.06%. The cause of death of the sibling was not known. PID diagnosed children received prophylactic antibiotics and/or antifungals in addition tospecific therapy for the underlying immune deficiency.The field of PID remainsunexplored worldwide. The awareness in the developed countries is more than that of developing countries like India. The developing countries face several challenges in the diagnosis of PIDs such as awareness among patients and medical practitioners, mostly in the rural settings, lack of sufficient number of tertiary care centres, lack of equipped immunological laboratory to diagnose the disease.

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Prevalence and outcome of anaemia among pregnant women attending tertiary care hospital in Visakhapatnam

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20175782 ◽

2017 ◽

Vol 5 (1) ◽

pp. 203

Author(s):

Radha Kumari Paladugu ◽

Srinivas Jagath Pentakota ◽

Sushma N.

Keyword(s):

Socioeconomic Status ◽

Developing Countries ◽

Pregnant Women ◽

Urban Areas ◽

Tertiary Care ◽

Public Health Problem ◽

Developed Countries ◽

Major Public Health Problem ◽

Care Hospital ◽

Study Population

Background: Anaemia in pregnancy is now considered as a major public health problem, caused by iron deficiency. WHO has estimated that prevalence of anaemia in developed and developing countries in pregnant women is 14% in developed countries and 51 percent in developing countries and 65-75% in India. Various programmes regarding anaemia prophylaxis and maternal health have been implemented but still the prevalence of anaemia related complications among pregnant women continues to be high. Hence the present study was conducted to study the prevalence and pregnancy outcome as a result of anaemia in a tertiary care center in Visakhapatnam. Methods: A cross sectional descriptive study was carried out from June 2016 to August 2016 in the Department of Obstetrics and Gynecology among postnatal women in King George hospital, Visakhapatnam. A semi-structured questionnaire was prepared and information regarding age, socioeconomic status, parity, gestational age interval between pregnancies and outcome and complication of pregnancy were collected. Results: Mean age of study population is 22.4 years. Out of 100 women involved in the study 65 are from urban areas 29 from rural areas and 6 from tribal areas. Majority of the study population 66% were having HB% between 8-11% i.e. mild anaemia. When Outcome of pregnancy was seen in relation to anaemia majority of the women had live births (90%) followed by 7% IUDs and 2% still births. Conclusions: Majority of the women are in the age group of 20-24 years. Socioeconomic status is directly related to anaemic status of the women. Majority of the women had complication of puerperal sepsis.

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Intestinal obstruction in a tertiary care centre in India: are the differences with the Western experience becoming less?

10.21203/rs.3.rs-204690/v1 ◽

2021 ◽

Author(s):

Suvendu Sekhar Jena ◽

Ravi Chandra Reddy Obili ◽

Sri Aurobindo Prasad Das ◽

Ruchir Bhavsar ◽

Sanket Solanki ◽

...

Keyword(s):

Developing Countries ◽

Intestinal Obstruction ◽

Demographic Data ◽

Tertiary Care ◽

Developed Countries ◽

Western World ◽

Tertiary Care Centre ◽

Duration Of Symptoms ◽

Operative Complications ◽

Post Operative Complications

Abstract Background: Patients with intestinal obstruction consist of a major proportion of emergency room visits and the complication is associated with significant morbidity and mortality. It has a diverse etiology and varies from region to country. In developed countries it is mainly due to adhesions and in developing countries due to obstructed hernias. Although there are numerous studies from the western world there have been few recent publications from the developing world. Method: We retrospectively analyzed all the patients admitted for intestinal obstruction to our department from January 1996 to December 2019. Their demographic data, duration of symptoms before presenting to the hospital and duration of stay before surgery in the hospital were noted along with cause and level of obstruction. The type of procedure, any post-operative complications, mortality or re-exploration were also noted. Post-operative complications were graded as per Clavien Dindo classification. Results: A total of 986 patients presented with intestinal obstruction during this period out of which 743 patients underwent surgery. There were 429 (57.74%) males 314 (42.26%) females who had a mean age of 50.1 years (range 11 to 96 years). The commonest cause of obstruction was adhesions in 273 (36.7%) followed by carcinoma [130(17.5%)], tuberculosis [111(14.9%)], stricture [94(12.7%)] and hernia (5.4%) patients. Colorectal surgery was the most common previous procedure in the adhesive group [85(31.1%)]. Colon cancer was the common cause in carcinoma group. Ileum was the most common site of obstruction [329(44.3%)]. The overall operative mortality was 41 (5.5%). Conclusion: Postoperative adhesions are now the commonest cause of intestinal obstruction in our referral center with a comparable mortality rate with western reports. Though the etiology of intestinal obstruction is shifting towards the western pattern, tuberculosis, obstructed inguinal hernia still consists a major chunk of patients in developing countries.

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