Apollo Hospital, Indraprastha

About: Apollo Hospital, Indraprastha is a healthcare organization based out in New Delhi, India. It is known for research contribution in the topics: Health care & Population. The organization has 654 authors who have published 794 publications receiving 9139 citations.

COVID-19 and remote consulting strategies in managing trauma and orthopaedics.

Abstract: As the COVID-19 pandemic took hold, the effect on healthcare systems, its resources and clinical services have been profound. With the novel coronavirus outbreak being highly contagious, there has been an ever urgent need to devise and identify new models of delivering care to avoid ‘face-to-face’ consultation between clinician and patient and thus reducing the risk of disease transmission. Managing acute trauma and orthopaedics had to be rationalised, reorganised and modified as new guidelines1 2 came into practice. In the UK, the National Health Service England Specialty Guides3 offers the primary guidance and forms the basis of all National Health Service (NHS) Trusts’ responses to this pandemic. Current and evolving telecommunication technologies play a key role in exchange of valid information for diagnosis and management of diseases and injuries. The main modalities for remote consultations include telephone consultations, virtual fracture clinics (VFC) and video consultations (VCs). Remote telephone or VCs provide a vital strategy in the delivery of trauma and orthopaedic healthcare where prevention of disease transmission, for example, current COVID-19 outbreak is of paramount importance by avoiding face-to-face consultation. However, they are appropriate in settings where a clinical interaction can occur over telecommunication channels to provide a continuity of care. Telephone consultations form the primary and readily available modality of remote access alternative to face-to-face consultations to deliver patient care.4 It allows most of the suitable reasons when remote consultation would be appropriate with some limitations.5 It can provide a means of assessing clinical condition and discussing options for managing conditions remotely, for example, assessment of pain—advice such as increasing or decreasing doses of medications or suggesting use of complimentary walking aid to improve mobility after recent surgery. It facilitates …

Fetal and neonatal thyrotoxicosis.

Abstract: Fetal thyrotoxicosis is a rare disease occurring in 1 out of 70 pregnancies with Grave's disease or in 1 out of 4000-50,000 deliveries. The mortality is 12-20%, usually from heart failure, but other complications are tracheal compression, infections and thrombocytopenia. It results from transfer of thyroid stimulating immunoglobulins from mother to fetus through the placenta. This transplacental transfer begins around 20(th) week of pregnancy and reaches its maximum by 30(th) week. These autoantibodies bind to the fetal thyroid stimulating hormone (TSH) receptors and increase the secretion of the thyroid hormones. The mother has an active autoimmune thyroid disease or has been treated for it in the past. She may be absolutely euthyroid due to past treatment by drugs, surgery or radioiodine ablation, but still have active TSH receptor stimulating autoantibodies, which can cause fetal thyrotoxicosis. The other features of this disease are fetal tachycardia, fetal goiter and history of spontaneous abortions and findings of goiter, ascites, craniosyntosis, fetal growth retardation, maceration and hydrops at fetal autopsy. If untreated, this disease can result in intrauterine death. The treatment for this disease consists of giving carbimazole to the mother, which is transferred through the placenta to the fetus. The dose of carbimazole is titrated with the fetal heart rate. If the mother becomes hypothyroid due to carbimazole, thyroxine is added taking advantage of the fact that very little of thyroxine is transferred across the placenta. Neonatal thyrotoxicosis patients are very sick and require emergency treatment. The goal of the treatment is to normalize thyroid functions as quickly as possible, to avoid iatrogenic hypothyroidism while providing management and supportive therapy for the infant's specific signs and symptoms.

Comparative Evaluation of Five Different Methods of Anti-ABO Antibody Titration: An Aid for ABO-Incompatible Organ Transplants.

Abstract: The accurate estimation of ABO antibody titers is of the utmost importance in organ transplants involving ABO incompatibility. We aim to compare five different methods of titration and analyze the data. Samples of 48 O group blood donors who donated during the month of December 2015 to January 2016 in our institution were subjected to ABO antibody titration by five different methods: immediate spin (IS) tube titer, antihuman globulin phase tube titer, Coomb's gel card titer, gel card titer after dithiotreitol (DTT) treatment of plasma, and the solid phase red cell adherence method. The mean number of titer serial dilution steps in the different titer estimation methods was compared using the paired t-test and McNemar test. A correlation between the methods was tested using Spearman's rho and kappa statistics. The median antiglobulin (AHG) phase tube titers were found to be the highest anti-A (128) and anti-B (192) titers. Significant differences in the ABO antibody titer readings among the five different methods were noted. Titers were reduced by DTT treatment in nearly 50% samples tested for both anti-A and anti-B titers. Average agreements between the DTT-applied AHG phase gel card titers and the solid phase red cell adherence (SPRCA) titers was observed for anti-A (κ = 0.473) and anti-B (κ = 0.530). The AHG phase tube and gel cards titers showed poor agreements. There are differences in the interpretability of the ABO antibody titer among different techniques. Consistent and uniform application of the method for titration throughout the treatment of a patient is highly essential.

Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure

Abstract: Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug–induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors.

Clinicopathological and treatment analysis of 13 extragastrointestinal stromal tumors of mesentery and retroperitoneum.

Abstract: Background Extragastrointestinal stromal tumors (EGISTs) are extremely rare mesenchymal tumors histologically and immunophenotypically similar to GI stromal tumors (GISTs). The aim of this study was to analyze the clinicopathological factors and treatment outcome in 13 patients with EGISTs treated at a tertiary care center. Methods Of 109 patients with GISTs treated at our center between April 2002 and December 2012, 13 patients with EGISTs were analyzed for clinicopathological factors and treatment outcome. Results Mean age was 45.8 (range 30-61) years, and females constituted 62% with a male:female ratio of 0.6:1. The most common tumor sites were mesentery in 10 patients and retroperitoneum in 3 patients. Mean tumor size was 11.7 (range 5-18) cm. Four (31%) patients were metastatic at presentation, the most common site of metastases being the liver in 3 (75%) patients. Lymph node enlargement was seen in 2 patients. Surgery was performed in 8 (62%) patients, 7 with localized disease, and 1 with metastatic disease. R0 resection was achieved in 3 (38%) patients. Five (71%) patients were considered as high-risk. Recurrences were seen in 3 patients (patient 3, 5 and 13) with localized disease after surgical resection, at 18, 7 and 137 months, respectively. At the last follow up, 7 patients were alive and 6 died of disease progression. The median overall survival was 34 (7-148) months. Conclusions EGISTs present at a younger age in the developing than in the developed countries. Females are more commonly affected than males. Lymph node metastases may be commonly present. Keywords Extrgastrointestinal stromal tumors, mesentery, retroperitoneum Ann Gastroenterol 2015; 28 (1): 105-108