Brij K Dhaon - Academia.edu (original) (raw)

Papers by Brij K Dhaon

Journal of the Indian Medical Association

The aim of the study was to assess the efficacy, tolerabitity and Chondroprotection afforded by n... more The aim of the study was to assess the efficacy, tolerabitity and Chondroprotection afforded by nimesulide, a selective cyclooxygenase-2 inhibitor and piroxicam in a randomised, double blind, controlled clinical trial in 90 patients suffering from osteoarthritis of the knee joint. A significant improvement in the osteoarthritis severity index at 2 weeks (p<0.01) and an improvement in physicians assessment of global arthritic condition at 4 weeks (p<0,01) was seen with both the treatments. A significant decrease In articular index of joint tenderness (p<0.05) at 8 weeks and in self assessment of handicap at 4 weeks (p<0.05), in comparison to baseline, was observed only in patients receiving nimesulide. Rescue therapy was required by a greater percentage of patients being administered piroxicam. Functional capacity improved in 64% of the patients on nimesulide and 74,5% of the patients receiving piroxicam. Adverse effects were observed in 6 patients on nimesulide and 9 patients receiving piroxicam. No significant difference was found in any of the efficacy and tolerability parameters between the two treatment groups. Magnetic resonance imaging evaluation of the knee joint of 10 patients showed no significant change in the articular cartilage and associated joint structures after 6 months of therapy with both the treatments. The results show that nimesulide and piroxicam are comparable in efficacy and tolerability in patients suffering from osteoarthritis.

The Journal of bone and joint surgery. American volume, 2005

The spine is a common site of involvement for extrapulmonary tuberculosis. The classic picture of... more The spine is a common site of involvement for extrapulmonary tuberculosis. The classic picture of paradiscal involvement of two adjacent vertebrae is readily recognized and routinely managed in countries where the disease is endemic. Atypical presentations include involvement of ...

Journal of orthopaedic surgery (Hong Kong), 2004

To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplas... more To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis. The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge. Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p<0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases. The incidence of deep vein thrombosis in Indian patients is very low compared to...

Postgraduate medical journal, 2004

Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total k... more Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total knee arthroplasty (TKA). Though the reported incidence of DVT is very high, that of proximal DVT is low and that of fatal thromboembolism is very low. Hence the issue of prophylaxis for DVT remains controversial. The incidence of DVT is based on various studies in European and American populations. The Asian population is genetically and socially quite different from American and European populations, and the incidence of DVT can be quite different. Therefore a prospective study was initiated at our centre to determine incidence of DVT after THA and TKA in Indian patients. A prospective study was conducted on 60 hips in 45 patients and 46 knees in 26 patients who underwent THA and TKA respectively, without any known risk factors for thromboembolic disease. DVT was studied by preoperative and postoperative serial colour Doppler ultrasonography. No prophylaxis was given to any of the patien...

Issues in emerging health technologies, 2004

Total hip replacement (arthroplasty) is a widely used procedure that alleviates pain and disabili... more Total hip replacement (arthroplasty) is a widely used procedure that alleviates pain and disability in people with hip disorders, such as osteoarthritis. Minimally invasive (MI) total hip replacement uses a smaller surgical incision than the conventional method. Possible advantages include less damage to tissue and muscle, smaller scars, less blood loss during surgery, less postoperative pain and shorter hospital stays and convalescence. Well designed, long-term studies are needed to compare patient outcomes and costs of the different types of MI hip replacement procedures.

Journal of surgical orthopaedic advances, 2003

Fine-needle aspiration cytology (FNAC) is a minimally invasive technique used extensively in diag... more Fine-needle aspiration cytology (FNAC) is a minimally invasive technique used extensively in diagnosis of various tumors. Frozen section biopsy is known for its usefulness in assessing adequacy of margins of resection intraoperatively. This study assesses the usefulness and significance of these procedures in tumors of musculoskeletal origin. This study includes 91 patients and all the patients were subjected to a preoperative FNAC test on an outpatient basis. An open biopsy was done in every case under appropriate anesthesia and representative tumor tissue was sent for frozen section analysis. Out of 91 patients, FNAC was feasible in 78 patients. Out of the 78 patients aspirated, a type-specific diagnosis was made in 79.5% of cases (62 out of 78). Frozen section was possible in 85 cases. The percentage of specific diagnosis by frozen section in this study is 85.9% (73 out of 85) and overall diagnostic accuracy of 96.5% (82 out of 85). FNAC and frozen section are reliable diagnostic...

Journal of the Indian Medical Association, 1977

Journal of the Indian Medical Association, 1999

The aim of the study was to assess the efficacy, tolerability and chondroprotection afforded by n... more The aim of the study was to assess the efficacy, tolerability and chondroprotection afforded by nimesulide, a selective cyclooxygenase-2 inhibitor and piroxicam in a randomised, double blind, controlled clinical trial in 90 patients suffering from osteoarthritis of the knee joint. A significant improvement in the osteoarthritis severity index at 2 weeks (p < 0.01) and an improvement in physicians assessment of global arthritic condition at 4 weeks (p < 0.01) was seen with both the treatments. A significant decrease in articular index of joint tenderness (p < 0.05) at 8 weeks and in self assessment of handicap at 4 weeks (p < 0.05), in comparison to baseline, was observed only in patients receiving nimesulide. Rescue therapy was required by a greater percentage of patients being administered piroxicam. Functional capacity improved in 64% of the patients on nimesulide and 74.5% of the patients receiving piroxicam. Adverse effects were observed in 6 patients on nimesulide a...

APLAR Journal of Rheumatology, 2004

Background: Indian data from controlled drug trials on the use of meloxicam (a new preferential ... more Background: Indian data from controlled drug trials on the use of meloxicam (a new preferential COX-2 inhibitor) and other non-steroidal anti-inflammatory drugs (NSAIDs) in arthritis is sparse.Aim: To evaluate the clinical efficacy and safety of meloxicam.Patients and methods: One hundred and twenty-one patients with rheumatoid arthritis (RA) and 133 patients with osteoarthritis (OA) knees were randomized into two different multicentric, double-blind, drug trials of four-weeks duration each. Meloxicam 7.5 mg (OA study) and 15 mg (RA study) was compared to diclofenac 100 mg and piroxicam 20 mg in daily dosages, respectively. Strict eligibility criteria ensured active symptomatic disease. Standard ACR efficacy measures of pain and function (including validated Indian versions of HAQ & WOMAC) were used. Protocol-driven evaluations were carried out throughout the study. An intent-to-treat efficacy analysis (significance at P < 0.05) was carried out to test the hypothesis of equal efficacy between meloxicam and comparator.Results: (i) There were no significant differences between meloxicam and piroxicam in the RA study. (ii) While joint count for pain/tenderness was improved (P < 0.05) by both meloxicam and piroxicam, only meloxicam showed significant improvement (95% CI ≈ 0.7,5.6) in swollen joint count. (iii) In the OA study, though painVAS reduction was marginally better (95% CI ≈ −15,−0.6) with diclofenac, both meloxicam and diclofenac were equally effective (95% CI ≈ −10,2.0) in improving WOMAC-physical function. (iv) Overall, meloxicam demonstrated a superior safety and gut tolerability profile as compared to piroxicam (maximum adverse events, 29.3%) and diclofenac. (iv) Maximum dyspepsia (6.2%) was reported by the diclofenac group. (v) Overall, the drug toxicity seen in the trials was mild, and only one patient (on diclofenac) was withdrawn due to haematuria. (vi) All treatment groups consumed paracetamol (P > 0.05) as a rescue analgesic.Conclusions: When compared to piroxicam and diclofenac, meloxicam has equal clinical efficacy and a better safety profile. Multicentric control drug trials are feasible in our population.

The efficacy and safety of Nimulid (Nimesulide) and Diclofenac was evaluated in a double blind ra... more The efficacy and safety of Nimulid (Nimesulide) and Diclofenac was evaluated in a double blind randomized diclofenac controlled trial in patients suffering from osteoarthritis of the knee joint. Out of 141 patients, 71 (42 mates, 29female) received Nimulid 100 mg. BD and 70 patients (40 male, 30 female) received Diclofenac 75 mg BD. There was no statistically significant difference in

$Research paper thumbnail of A new method of removing a fractured interlocked nail$

Injury, 2002

Injury, Volume 33, Issue 3, Pages 261-262, April 2002, Authors:Lalit Maini; Ashish Upadhyay; Ajay... more Injury, Volume 33, Issue 3, Pages 261-262, April 2002, Authors:Lalit Maini; Ashish Upadhyay; Ajay Aggarwal; BK Dhaon.

Journal of surgical orthopaedic advances, 2004

Bone islands are hamartomatous malformations in the bone that are known to be asymptomatic in nat... more Bone islands are hamartomatous malformations in the bone that are known to be asymptomatic in nature. Two cases are presented in which the presence of bone islands in the femur led to difficulty with the introduction of a femoral prosthesis. In one case, this led to fracture of the medial part of the cortex, which was fixed with a screw prior to insertion of the prosthesis. In the second case, a window was made in the femur to remove hard bone sufficient for insertion of the prosthesis. This was closed with steel wires prior to insertion of the cemented femoral stem. These cases illustrate the problems that can be encountered during surgery in the presence of bone islands. The surgeon should evaluate the site, size, and location of bone islands during preoperative planning before performing surgery.

Tropical Doctor, 2006

Following rehydration he developed urinary retention, requiring catheterization. Two days after r... more Following rehydration he developed urinary retention, requiring catheterization. Two days after re-admission he had a short generalized convulsion, which responded to diazepam (0.3mg/kg). He was neither dehydrated nor fluid overloaded, and his blood pressure was ...

Spine, 2003

A case of nontraumatic rotatory fixation of the atlantoaxial joint associated with tuberculosis o... more A case of nontraumatic rotatory fixation of the atlantoaxial joint associated with tuberculosis of the occipital bone in an adult. To report a rare case of atlantoaxial rotatory subluxation associated with tuberculosis of the occipital bone in an adult and to discuss the mechanism of fixation. Atlantoaxial rotatory fixation in adults is rare and has been reported due to variety of causes. To the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; best knowledge no case has been reported secondary to tuberculosis of the skull bone. A 20-year-old male presented with resistant torticollis with a duration of 5 months. The patient had type 1 atlantoaxial rotatory fixation secondary to tuberculosis of the occipital bone. The subluxation was partially reduced by conservative means, and healing of the occiput lesion was achieved. Thereafter, the patient had no restriction of cervical spine motion and had no reoccurrence of subluxation at a follow-up of one and a half years. Effusion in the atlantoaxial joint secondary to infection in the occiput due to close proximity with the joint led to the laxity of ligaments and contributed to the subluxation.

Spine, 2003

Analysis of morphometric data obtained from computed tomography scans in relation to the lower th... more Analysis of morphometric data obtained from computed tomography scans in relation to the lower thoracic, lumbar, and S1 pedicle in patients from the Indian subcontinent. To record the surgically relevant parameters of transverse pedicle isthmus width, transverse pedicle angle, and depth to anterior cortex along the midline axis and the pedicle axis and to compare the results with those of similar studies in literature. Most studies reported are for white populations. Considerable differences are documented in the few reports in Oriental populations compared with Western populations. To the authors&amp;amp;amp;amp;amp;#39; knowledge, no similar study has been published for patients from the Indian subcontinent. Computed tomography scans of the lower thoracic and lumbosacral spine of patients from the Indian subcontinent were reviewed. We selected and analyzed 86 vertebrae in 31 patients. Parameters recorded were transverse pedicle isthmus width, transverse pedicle angle, and depth to anterior cortex along the midline axis and the pedicle axis. The mean transverse pedicle isthmus width was least at the T9 level (5.02 mm). Of the pedicles at T9, 46.15% had a diameter of less than 5 mm, followed by T10 (12.5%), T11 (11.11%), and L1 (11.11%). Of the pedicles at T9, 76.92% had a diameter of less than 6 mm, followed by T11 (33.33%), L1 (33.33%), T10 (25%), T12 (25%), L2 (20%), and L3 (5.56%). The mean transverse pedicle angle faced laterally at T11 (-2.97 degrees ) and T12 (-3.00 degrees ), being least at T12. The depth to the anterior cortex was more along the pedicle axis at all levels except T11 and T12, consistent with the laterally facing pedicles at these levels. Significant differences exist between the pedicles of Indian and white populations. It is suggested that preoperative computed tomography scans of the patients must be evaluated to choose the appropriately sized implant and avoid inadvertent complications. Preparation of the pedicle intraoperatively should take into account the orientation of the transverse pedicle angle.

Postgraduate Medical Journal, 2004

Background: Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA)... more Background: Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total knee arthroplasty (TKA). Though the reported incidence of DVT is very high, that of proximal DVT is low and that of fatal thromboembolism is very low. Hence the issue of prophylaxis for DVT remains controversial.

Postgraduate Medical Journal, 2002

A 26 year man, a non-addict, was referred to us as he had a right sided spontaneous pneumothorax.... more A 26 year man, a non-addict, was referred to us as he had a right sided spontaneous pneumothorax. His past medical history included surgery done at the age of 12 years for bilateral inguinal hernia and aphakia of both eyes. On physical examination there was elasticity of skin over the abdomen. Cardiac examination revealed a systolic murmur over the apex.

$Research paper thumbnail of Delayed internal fixation of fractures of the neck of the femur in young adults$

The Journal of Bone and Joint Surgery, 2004

We have compared the results and complications after closed and open reduction with internal fixa... more We have compared the results and complications after closed and open reduction with internal fixation in young adults with displaced intracapsular fractures (Garden grades III and IV) of the neck of the femur. We also studied the risk factors which influenced nonunion and the development of avascular necrosis (AVN). A total of 102 patients aged between 15 and 50 years was randomised to receive either closed or open reduction. Both groups were compared for age, gender, time to surgery and posterior comminution as well as for union and complications. Using univariate and multivariate analysis the factors influencing nonunion and AVN were assessed.