International journal of scientific research, 2018
BACKGROUND: Stroke in a young person can be devastating as the patients are at their most produc... more BACKGROUND: Stroke in a young person can be devastating as the patients are at their most productive age, thus causing marked long term socio-economic consequences and high public health impact due to associated indirect costs. In this study, all young patients of stroke meeting the criteria reporting to a tertiary care hospital in a metropolitan city were studied for various clinical presentations and outcome under standard protocol to combat deadly disease. OBJECTIVE: To study the various clinical presentations in patients of stroke in age group 15-49 years. MATERIALS AND METHODS:AProspective observational study was conducted on 144 patients presented to a tertiary care hospital during study period studying the clinical presentations, management and outcome. Data were analysed using Statistical Programme for Social Sciences (SPSS). RESULTS: Incidence of ischemic strokes was 68.7%, while 13.2% patients were of haemorrhagic strokes and 18.1% patients were of cerebral venous throm...
Introduction: Liver transplantation is today the most sought after treatment for patients sufferi... more Introduction: Liver transplantation is today the most sought after treatment for patients suffering from end stage liver disease. Unfortunately, organ donation has not kept pace with this rising demand, and a greater number of patients are dying each year while awaiting deceased donors. We are one of the leading centres in the country who are doing deceased donor liver transplantation (DDLT) regularly since 2007 and have changed our donor selection criteria to keep pace with this increasing demand. Aims and Objectives: To review the changing pattern of donor demographic profile from Mar 2007 till Jul 2014 and see the outcome of deceased donor liver transplantation using marginal grafts. Materials and Methods: It is a retrospective study. Donor and recipient data for liver transplantation at our centre from Mar 2007 till Jul 2014 were analysed. Donors were labeled as marginal donors based on presence of certain adverse parameters. Incidence of early graft dysfunction and primary non ...
Background: Inflammation is known to be associated with cancer development and progression. NLR i... more Background: Inflammation is known to be associated with cancer development and progression. NLR is a simple and efficient marker of inflammation in numerous malignancies. Aim: The study aimed to investigate usefulness of neutrophil to lymphocyte ratio (NLR) as an adjunct to Fine needle aspiration cytology (FNAC) to suggest thyroid malignancy confirmed by histopathological report post operatively in Bethesda class III, IV & V.Methods: Prospective observational study at a tertiary care hospital over 2 years.Results: NLR in the benign group and malignant group were 1.75+0.23 and 2.19+0.29 (mean + SD) respectively (p-value <0.001). Area under ROC curve plotted was 0.823 (p-value <0.001), with recommended cut-off of 1.9. Relatively high sensitivity and specificity at 87.5 % and 82.5% implies excellent diagnostic accuracy.Conclusion: NLR with a value of 1.9 or higher is recommended as predictor of malignancy in thyroid nodule.
Background The explicit declaration of Entrustable Professional Activities (EPA) and milestones a... more Background The explicit declaration of Entrustable Professional Activities (EPA) and milestones are an essential component of a competency based medical education curricula. The present study attempts to develop a portfolio framework to document them for adaptation in any healthcare professional education curriculum development. Methods A modified e-Delphi method was used after incorporation of a study group of medical education experts (MEDEX-G). Consensus was defined as 75% agreement. Both qualitative and quantitative data was collected and analysed to conduct three rounds of the Delphi. Results The draft template was prepared by the core faculty of medical education centre. The final template was approved by the experts after 03 iterations of anonymous online voting and presentation of summary results by the moderator. The final template lists out the milestones of each EPA separately with provision for expected expertise and level, suggestive teaching learning activities and assessments, reflections by the students and feedback by facilitator for each EPA. Conclusion The MEDEX-G consensus template is an important development to encourage the adoption of portfolios in a competency based medical education curriculum. It can be freely adopted by various healthcare professional education bodies in various disciplines.
BACKGROUND: Spontaneous aneurysm of the superficial temporal artery in a helicopter pilot while o... more BACKGROUND: Spontaneous aneurysm of the superficial temporal artery in a helicopter pilot while operating in the extreme cold climatic conditions of a very high altitude area led to a thorough search for etiological possibilities related to this case.CASE REPORT: A 38-yr-old military helicopter pilot, while flying at altitudes ranging from 4500 m to 6000 m (15,000 to 20,000 ft) reported with an acute onset of a subcutaneous swelling on his left temple. History and clinical profile did not suggest any traumatic, hematologic, or vasculitic etiology. His inflammatory markers, anti-nuclear antibody, anti-neutrophil cytoplasmic antibodies, complement levels, and whole-body PET scan did not suggest any evidence of vasculitis. Presence of any other intracranial aneurysms was also ruled out. He underwent curative excision biopsy, which showed perivascular inflammation. He was diagnosed as a case of left superficial temporal artery aneurysm. The recovery period was uneventful and the follow-up color Doppler flow imaging of the temporal artery and acute phase reactants was normal.DISCUSSION: Spontaneous aneurysms involving the superficial temporal artery is a very rare diagnosis. Occurrence of such an aneurysm in a young pilot without any identifiable predisposing factors led the authors to hypothesize a possible etiological combination of environmental and mechanical factors along with aviation stresses with the likely compounding role of the helmet. Management and aeromedical aspects of this unique case are discussed in this paper.Sekhar BM, Sheoran S, Routh D, Sharma S. Superficial temporal artery aneurysm in a helicopter pilot operating at high altitude. Aerosp Med Hum Perform. 2019; 90(1):53-57.
International journal of surgery (London, England), 2018
The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to ... more The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications. The study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented. There were 60 men and 37 women (mean age was ...
Aim-Background Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult ... more Aim-Background Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult diagnosis, has a high rate of complications and is associated with a high mortality rate. We reviewed our experience of patients presenting with AMI in order to evaluate the current management and factors associated with survival in a tertiary care hospital. Material and Methods Clinical data of all patients who were diagnosed with AMI between 01 January 2012 and 30 June 2013 were retrospectively reviewed. Preoperative presentation, investigation, management and outcome in this group of patients were analyzed. Results Thirteen patients were included in the study, of whom twelve were male and one female, mean age 44.5 years ranging from 35 to 78 years. The cause of AMI was embolism in three patients (23.1%), and thrombosis in ten patients (76.9%). Abdominal pain was the most common presenting symptom (100%). Four patients (30.8%) had previous symptoms of chronic mesenteric ischaemia in th...
Journal of Clinical and Experimental Hepatology, 2014
treatment of such cases. It is documented to be associated with a very poor prognosis. Alternativ... more treatment of such cases. It is documented to be associated with a very poor prognosis. Alternative modalities like Radio frequency ablation (RFA), Trans-arterial chemo-embolization (TACE) and external beam radiotherapy (EBRT) have been tried in such cases. Role of EBRT is gradually emerging with novel imaging and treatment techniques in adequately selected cases. Methods: We reviewed 8 of our recent cases treated for primary liver disease [HCC with or without PVTT]. Radiotherapy planning involved breathing motion management and triple phase PET-CT fusion for all cases. Image guidance with six dimensional couch correction enabled precise delivery of planned therapy. Intent of therapy was possible resolution of PVTT and primary tumor in six of the cases, while palliation in the rest of the two cases, due to larger volume at presentation. Available imaging follow and symptom response till date was evaluated in these cases. Results: Of the eight patients, four patients underwent diagnostic imaging on follow-up. There was partial response in three, stable disease in one; three international patients are awaiting evaluation, while 1 has been lost to follow up. Following good response to therapy, one patient underwent successful liver transplantation. The initial response evaluation showing an evolving local necrosis and beginning of re-canalization of PVTT is encouraging. Pain relief in the palliative cases has also been satisfying. Conclusion: With encouraging support from evolving literature, the utilization of radiation therapy in HCC and PVTT is going to increase. With technological innovations and improvement in existing knowledge, radiation therapy has a potential to become an integral part of multidisciplinary treatment approach for inoperable HCC, realizing the unmet need of adequate local control.
International journal of surgery (London, England), 2014
The number of patients who could benefit from liver transplantation markedly exceeds the number o... more The number of patients who could benefit from liver transplantation markedly exceeds the number of available donors. This increasing gap has fuelled efforts to maximize existing donor pool and identify new avenues. To compare the outcome in deceased donor liver transplant (DDLT) based on extended donor selection criteria. Donor and recipients' data were analyzed following DDLT from Mar 2007 to Feb 2013. Donors were grouped into either ideal donor (ID) or extended criteria donor (ECD) based on donor and graft related characteristics. Primary nonfunction (PNF) and patient survival were the primary endpoints while early graft dysfunction (EGD) and incidence of major postoperative complications were the secondary endpoints of the study. We had a total of 6 mortalities (13%) at the end of 1 year. The Kaplan Meier survival analysis at 7 days, 3, 6 and 12 months were not statistically different (p…
ABSTRACT Introduction Categorised as poor-risk disease, primary mediastinal non-seminomatous germ... more ABSTRACT Introduction Categorised as poor-risk disease, primary mediastinal non-seminomatous germ cell tumours (PMNSGCT) with metastasis have a dismal survival rate. Case Report We report herein a case of PMNSGCT with liver metastasis that underwent primary chemotherapy followed by staged resection of the mediastinal disease and resection of the liver metastasis from a difficult anatomical position, the caudate lobe. Conclusion Primary mediastinal non-seminomatous germ cell tumour with metastasis has a poor prognosis. Recurrence is common in this group of patients even after chemotherapy and radical resection.
ABSTRACT Aim and Background:Pancreatic cystic lesions are being increasingly recognized and compr... more ABSTRACT Aim and Background:Pancreatic cystic lesions are being increasingly recognized and comprise different pathological entities. The management of these lesions is often challenging, because of inadequate preoperative diagnosis. Among this family of lesions, mature cystic teratomas are an extremely rare finding and are usually found in children. Case Report:We present the rare case of a 60-year-old man being evaluated for melena. Preoperative investigation revealed a pancreatic mass. The patient underwent a Whipple pancreaticoduodenectomy. Surprisingly, histopathology revealed a mature teratoma of the pancreas. Conclusion: This case highlights the difficulty in establishing a preoperative diagnosis of this benign pathological entity. Though unusual in older patients, mature teratomas can present in this subgroup of patients. Mimicking malignancy, they warrant a radical surgical resection.
International journal of scientific research, 2018
BACKGROUND: Stroke in a young person can be devastating as the patients are at their most produc... more BACKGROUND: Stroke in a young person can be devastating as the patients are at their most productive age, thus causing marked long term socio-economic consequences and high public health impact due to associated indirect costs. In this study, all young patients of stroke meeting the criteria reporting to a tertiary care hospital in a metropolitan city were studied for various clinical presentations and outcome under standard protocol to combat deadly disease. OBJECTIVE: To study the various clinical presentations in patients of stroke in age group 15-49 years. MATERIALS AND METHODS:AProspective observational study was conducted on 144 patients presented to a tertiary care hospital during study period studying the clinical presentations, management and outcome. Data were analysed using Statistical Programme for Social Sciences (SPSS). RESULTS: Incidence of ischemic strokes was 68.7%, while 13.2% patients were of haemorrhagic strokes and 18.1% patients were of cerebral venous throm...
Introduction: Liver transplantation is today the most sought after treatment for patients sufferi... more Introduction: Liver transplantation is today the most sought after treatment for patients suffering from end stage liver disease. Unfortunately, organ donation has not kept pace with this rising demand, and a greater number of patients are dying each year while awaiting deceased donors. We are one of the leading centres in the country who are doing deceased donor liver transplantation (DDLT) regularly since 2007 and have changed our donor selection criteria to keep pace with this increasing demand. Aims and Objectives: To review the changing pattern of donor demographic profile from Mar 2007 till Jul 2014 and see the outcome of deceased donor liver transplantation using marginal grafts. Materials and Methods: It is a retrospective study. Donor and recipient data for liver transplantation at our centre from Mar 2007 till Jul 2014 were analysed. Donors were labeled as marginal donors based on presence of certain adverse parameters. Incidence of early graft dysfunction and primary non ...
Background: Inflammation is known to be associated with cancer development and progression. NLR i... more Background: Inflammation is known to be associated with cancer development and progression. NLR is a simple and efficient marker of inflammation in numerous malignancies. Aim: The study aimed to investigate usefulness of neutrophil to lymphocyte ratio (NLR) as an adjunct to Fine needle aspiration cytology (FNAC) to suggest thyroid malignancy confirmed by histopathological report post operatively in Bethesda class III, IV & V.Methods: Prospective observational study at a tertiary care hospital over 2 years.Results: NLR in the benign group and malignant group were 1.75+0.23 and 2.19+0.29 (mean + SD) respectively (p-value <0.001). Area under ROC curve plotted was 0.823 (p-value <0.001), with recommended cut-off of 1.9. Relatively high sensitivity and specificity at 87.5 % and 82.5% implies excellent diagnostic accuracy.Conclusion: NLR with a value of 1.9 or higher is recommended as predictor of malignancy in thyroid nodule.
Background The explicit declaration of Entrustable Professional Activities (EPA) and milestones a... more Background The explicit declaration of Entrustable Professional Activities (EPA) and milestones are an essential component of a competency based medical education curricula. The present study attempts to develop a portfolio framework to document them for adaptation in any healthcare professional education curriculum development. Methods A modified e-Delphi method was used after incorporation of a study group of medical education experts (MEDEX-G). Consensus was defined as 75% agreement. Both qualitative and quantitative data was collected and analysed to conduct three rounds of the Delphi. Results The draft template was prepared by the core faculty of medical education centre. The final template was approved by the experts after 03 iterations of anonymous online voting and presentation of summary results by the moderator. The final template lists out the milestones of each EPA separately with provision for expected expertise and level, suggestive teaching learning activities and assessments, reflections by the students and feedback by facilitator for each EPA. Conclusion The MEDEX-G consensus template is an important development to encourage the adoption of portfolios in a competency based medical education curriculum. It can be freely adopted by various healthcare professional education bodies in various disciplines.
BACKGROUND: Spontaneous aneurysm of the superficial temporal artery in a helicopter pilot while o... more BACKGROUND: Spontaneous aneurysm of the superficial temporal artery in a helicopter pilot while operating in the extreme cold climatic conditions of a very high altitude area led to a thorough search for etiological possibilities related to this case.CASE REPORT: A 38-yr-old military helicopter pilot, while flying at altitudes ranging from 4500 m to 6000 m (15,000 to 20,000 ft) reported with an acute onset of a subcutaneous swelling on his left temple. History and clinical profile did not suggest any traumatic, hematologic, or vasculitic etiology. His inflammatory markers, anti-nuclear antibody, anti-neutrophil cytoplasmic antibodies, complement levels, and whole-body PET scan did not suggest any evidence of vasculitis. Presence of any other intracranial aneurysms was also ruled out. He underwent curative excision biopsy, which showed perivascular inflammation. He was diagnosed as a case of left superficial temporal artery aneurysm. The recovery period was uneventful and the follow-up color Doppler flow imaging of the temporal artery and acute phase reactants was normal.DISCUSSION: Spontaneous aneurysms involving the superficial temporal artery is a very rare diagnosis. Occurrence of such an aneurysm in a young pilot without any identifiable predisposing factors led the authors to hypothesize a possible etiological combination of environmental and mechanical factors along with aviation stresses with the likely compounding role of the helmet. Management and aeromedical aspects of this unique case are discussed in this paper.Sekhar BM, Sheoran S, Routh D, Sharma S. Superficial temporal artery aneurysm in a helicopter pilot operating at high altitude. Aerosp Med Hum Perform. 2019; 90(1):53-57.
International journal of surgery (London, England), 2018
The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to ... more The type of anastomosis of the pancreas following pancreaticoduodenectomy is often attributed to the reason for pancreatic leak. Results of various randomized trials comparing pancreaticojejunostomy and pancreaticogastrostomy are conflicting one suggesting advantage over the other and vice versa. In this study we intend to critically analyze a novel technique of binding pancreaticogastrostomy following pancreaticoduodenectomy. The aim of this study is to see the outcome of binding pancreaticogastrostomy by evaluating the technical aspects of binding PG and study the incidence of post-operative complications. The study included all patients who had undergone binding pancreaticogastrostomy from Mar 2012 to Mar 2016 at a tertiary care hospital. Patients' data, including patients demographics, type of procedure performed, complications, mortality, hospital stay, postoperative interventional procedures or reoperations were all documented. There were 60 men and 37 women (mean age was ...
Aim-Background Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult ... more Aim-Background Acute mesenteric ischaemia (AMI), although an uncommon condition with a difficult diagnosis, has a high rate of complications and is associated with a high mortality rate. We reviewed our experience of patients presenting with AMI in order to evaluate the current management and factors associated with survival in a tertiary care hospital. Material and Methods Clinical data of all patients who were diagnosed with AMI between 01 January 2012 and 30 June 2013 were retrospectively reviewed. Preoperative presentation, investigation, management and outcome in this group of patients were analyzed. Results Thirteen patients were included in the study, of whom twelve were male and one female, mean age 44.5 years ranging from 35 to 78 years. The cause of AMI was embolism in three patients (23.1%), and thrombosis in ten patients (76.9%). Abdominal pain was the most common presenting symptom (100%). Four patients (30.8%) had previous symptoms of chronic mesenteric ischaemia in th...
Journal of Clinical and Experimental Hepatology, 2014
treatment of such cases. It is documented to be associated with a very poor prognosis. Alternativ... more treatment of such cases. It is documented to be associated with a very poor prognosis. Alternative modalities like Radio frequency ablation (RFA), Trans-arterial chemo-embolization (TACE) and external beam radiotherapy (EBRT) have been tried in such cases. Role of EBRT is gradually emerging with novel imaging and treatment techniques in adequately selected cases. Methods: We reviewed 8 of our recent cases treated for primary liver disease [HCC with or without PVTT]. Radiotherapy planning involved breathing motion management and triple phase PET-CT fusion for all cases. Image guidance with six dimensional couch correction enabled precise delivery of planned therapy. Intent of therapy was possible resolution of PVTT and primary tumor in six of the cases, while palliation in the rest of the two cases, due to larger volume at presentation. Available imaging follow and symptom response till date was evaluated in these cases. Results: Of the eight patients, four patients underwent diagnostic imaging on follow-up. There was partial response in three, stable disease in one; three international patients are awaiting evaluation, while 1 has been lost to follow up. Following good response to therapy, one patient underwent successful liver transplantation. The initial response evaluation showing an evolving local necrosis and beginning of re-canalization of PVTT is encouraging. Pain relief in the palliative cases has also been satisfying. Conclusion: With encouraging support from evolving literature, the utilization of radiation therapy in HCC and PVTT is going to increase. With technological innovations and improvement in existing knowledge, radiation therapy has a potential to become an integral part of multidisciplinary treatment approach for inoperable HCC, realizing the unmet need of adequate local control.
International journal of surgery (London, England), 2014
The number of patients who could benefit from liver transplantation markedly exceeds the number o... more The number of patients who could benefit from liver transplantation markedly exceeds the number of available donors. This increasing gap has fuelled efforts to maximize existing donor pool and identify new avenues. To compare the outcome in deceased donor liver transplant (DDLT) based on extended donor selection criteria. Donor and recipients' data were analyzed following DDLT from Mar 2007 to Feb 2013. Donors were grouped into either ideal donor (ID) or extended criteria donor (ECD) based on donor and graft related characteristics. Primary nonfunction (PNF) and patient survival were the primary endpoints while early graft dysfunction (EGD) and incidence of major postoperative complications were the secondary endpoints of the study. We had a total of 6 mortalities (13%) at the end of 1 year. The Kaplan Meier survival analysis at 7 days, 3, 6 and 12 months were not statistically different (p…
ABSTRACT Introduction Categorised as poor-risk disease, primary mediastinal non-seminomatous germ... more ABSTRACT Introduction Categorised as poor-risk disease, primary mediastinal non-seminomatous germ cell tumours (PMNSGCT) with metastasis have a dismal survival rate. Case Report We report herein a case of PMNSGCT with liver metastasis that underwent primary chemotherapy followed by staged resection of the mediastinal disease and resection of the liver metastasis from a difficult anatomical position, the caudate lobe. Conclusion Primary mediastinal non-seminomatous germ cell tumour with metastasis has a poor prognosis. Recurrence is common in this group of patients even after chemotherapy and radical resection.
ABSTRACT Aim and Background:Pancreatic cystic lesions are being increasingly recognized and compr... more ABSTRACT Aim and Background:Pancreatic cystic lesions are being increasingly recognized and comprise different pathological entities. The management of these lesions is often challenging, because of inadequate preoperative diagnosis. Among this family of lesions, mature cystic teratomas are an extremely rare finding and are usually found in children. Case Report:We present the rare case of a 60-year-old man being evaluated for melena. Preoperative investigation revealed a pancreatic mass. The patient underwent a Whipple pancreaticoduodenectomy. Surprisingly, histopathology revealed a mature teratoma of the pancreas. Conclusion: This case highlights the difficulty in establishing a preoperative diagnosis of this benign pathological entity. Though unusual in older patients, mature teratomas can present in this subgroup of patients. Mimicking malignancy, they warrant a radical surgical resection.
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Papers by Dronacharya Routh