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Bisht B, Handa U, Mohan H, Lehl SS. Complementary value of DNA flow cytometry and image morphometry in detection of malignant cells in effusion fluids. Malays J Pathol 2014; 36:83-90. [PMID: 25194530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND In cytologic evaluation of body cavity effusions, the morphologic changes exhibited by reactive mesothelial cells often confound the diagnosis. This study investigates the role of DNA flow cytometry (DNA FCM) and image morphometry (IM) in improving diagnostic accuracy. METHODS 53 pleural and 47 ascitic fluid samples were evaluated cytologically. All were also subjected to flow cytometry to assess DNA ploidy. Image morphometry was used to measure nuclear diameter, nuclear perimeter and nuclear area. RESULTS On cytomorphology 79% cases were diagnosed as benign, 19% as malignant and 2% as suggestive of malignancy. DNA FCM showed aneuploidy in 13 of 19 malignant cases and diploidy in 6 cases. The mean nuclear area of the benign group was 60.14 ± 39.91 µm² and that of malignant cases was 190.54 ± 56.06 µm². Using DNA FCM and IM, one of the two cases "suggestive of malignancy" was placed in the benign group and the other in the malignant group. Also, these modalities were able to pick up one case of malignancy that was diagnosed as benign on cytology. CONCLUSIONS Cytomorphology remains the foremost diagnostic modality in detecting malignant cells in effusions. DNA flow cytometry and image morphometry hold a valuable complementary value.
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Affiliation(s)
- Bhumika Bisht
- Departments of Pathology, Government Medical College, Chandigarh, India.
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Abstract
Cogan's syndrome is a rare inflammatory disorder predominantly affecting ocular and audiovestibular apparatus. The typical ocular picture is that of a non-syphilitic interstitial keratitis, while audiovestibular features resemble Meniere's disease. The hearing deficit often does not adequately respond to systemic steroids, which are the mainstay of therapy. Cochlear implants may ameliorate this deficit, but may not be readily available because of financial constraints in the Indian subcontinent. A high index of suspicion and multispecialty coordination will help in the early initiation of therapy and reduce long-term morbidity. We report a case of this rare entity where the recovery of deficits was dramatic on initiation of high-dose steroids.
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Affiliation(s)
- Pritam Singh
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Abstract
Takayasu's arteritis is a rare, systemic vasculitis with varied presentations across multiple medical specialities. Here, we present a young woman who had recurrent episodes of erythema nodosum on the background of a low-grade fever and no vascular manifestations. The presence of a high erythrocyte sedimentation rate generated a high index of suspicion for underlying vasculitis, and radioimaging confirmed the suspicion of Takayasu's arteritis. The patient was found to have type III diseases in the vasculitic stage and was managed with systemic corticosteroids.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Gupta M, Sachdev A, Lehl SS, Singh K. Clay impaction causing acute dysphagia. BMJ Case Rep 2013; 2013:bcr-2013-008929. [PMID: 23505285 DOI: 10.1136/bcr-2013-008929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Abstract
Liver abscess is a common pathology in the Indian subcontinent and usually results from amoebic or bacterial infection. Pyogenic abscesses usually occur in those with underlying predisposing factors like intra-abdominal infections, biliary infections or comorbidities like malignancy, immunosuppression, diabetes mellitus and previous biliary surgery or interventional endoscopy. Citrobacter is an unusual cause of pyogenic liver abscess and may occur in the setting of underlying comorbidities. We report a 56-year-old man with diabetes (operated for periampullary carcinoma 20 years ago), who presented with a history of fever for 1 week and on evaluation was found to have Citrobacter koseri-related hepatic abscess. The patient was managed with parenteral antibiotics, repeated aspiration of liver abscess and pigtail drainage.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Abstract
Touraine-Solente-Gole' syndrome, also known as pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare familial disorder generally seen in males. Although it presents with characteristic morphological and radiological features, this is an uncommon diagnosis and is entertained only once other causes of secondary hypertrophic osteoarthropathy are carefully excluded.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Abstract
Here the authors describe the case of a 23-year-old young woman with life-threatening focal suppurative intracranial collection with brain compression secondary to long forgotten chronic suppurative otitis media. With the development and availability of broad-spectrum antibiotics and their timely usage, cases of suppurative otitis media are a rarity in the current times.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Abstract
Though hypoparathyroidism is not an uncommon diagnosis, it is an unusual cause of seizures in adults. The authors report a case of late onset epilepsy due to idiopathic hypoparathyroidism in a 50-year-old man. This case reiterates the importance of CT scan and serum calcium in the evaluation of patients with recurrent seizures.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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Gupta M, Lehl SS, Singh R. Swiss-cheese appearance of the brain in a young boy. BMJ Case Rep 2011; 2011:2011/feb23_1/bcr1220103598. [PMID: 22707569 DOI: 10.1136/bcr.12.2010.3598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, GMCH Campus, Chandigarh, India.
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Gupta V, Singla N, Lehl SS, Chander J. Clinico-epidemiological profile of HIV infection over a period of six years in a North Indian tertiary care hospital. Indian J Med Microbiol 2007; 25:171. [PMID: 17582196 DOI: 10.4103/0255-0857.32732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bhalla A, Sachdev A, Lehl SS, Singh R, D'Cruz S. Ageing and circadian variation in cardiovascular events. Singapore Med J 2006; 47:305-8. [PMID: 16572242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Circadian variation in cardiovascular events is well recognised in vascular events. This study aims to observe any significant difference in circadian variability in geriatric patients when compared to their younger counterparts. METHODS This prospective study was conducted at medical emergency at the Government Medical College and Hospital, Chandigarh, India. All the patients attending medical emergency with symptoms suggestive of coronary artery disease were included. The time of occurrence of first symptom and subsequent symptoms was noted. Electrocardiography, cardiac enzymes and echocardiography were performed to establish the diagnosis of acute coronary syndrome. The 24-hour day was divided into 12 equal parts of two hours each. For the final analysis, the two-hour periods were grouped into six equal periods of four hours each and four quarters of six hours each. RESULTS We studied 559 patients, out of whom 459 were 65 years old or younger, and 100 patients were older than 65 years old. 459 patients had 498 episodes in all. 100 patients above the age of 65 years had 104 episodes. Both the groups had peaking of acute myocardial infarction in the early morning hours with patients older than 65 years of age having a slightly early peak. However, there was considerable variability for peaking of unstable angina and non-Q myocardial infarction. In patients older than 65 years, early morning peaking of events was noted whereas in 65 years or younger, the peaking of events was noted in the evening hours. CONCLUSION Circadian variability exists in occurrence of acute coronary events and is variable in geriatric patients when compared to their younger counterparts.
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Affiliation(s)
- A Bhalla
- Department of Medicine, Government Medical College and Hospital, Sector 32, Chandigarh, India.
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Bhalla A, Singh R, D'cruz S, Lehl SS, Sachdev A. Accurate blood pressure recording: is it difficult? Indian J Med Sci 2005; 59:480-7. [PMID: 16340147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Blood pressure (BP) measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. METHODS A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS) and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. STATISTICAL METHODS The results were recorded as percentage of doctors committing these errors. RESULTS In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. CONCLUSION The practice of recording BP in our hospital varies from the standard guidelines issued by the BHS.
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Affiliation(s)
- A Bhalla
- Department of Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Singh R, Lehl SS, Sachdev A, Handa U, D'Cruz S, Bhalla A. Metastasis to thyroid from lung carcinoma. Indian J Chest Dis Allied Sci 2003; 45:203-4. [PMID: 12866639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Metastasis to thyroid gland are rare. The primary sites which metastasize to thyroid gland include the breast, lung, kidney and stomach. Among lung cancer metastasizing to the thyroid, adenocarcinomas are the commonest followed by squamous, small cell and large cell carcinomas. The bronchioloalveolar carcinoma has not been reported to metastasize to the thyroid. In this case report we document this rare occurrence.
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Affiliation(s)
- Ram Singh
- Department of Medicine, Government Medical College, Chandigarh, India
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Lehl SS, Bambery P, Katariya S, Deodhar SD. Osteopoikilosis. J Assoc Physicians India 2003; 51:693. [PMID: 14621040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- S S Lehl
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh-160 012, India
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Sachdev A, Mahapatra M, D'Cruz S, Kumar A, Singh R, Lehl SS. Wasp sting induced neurological manifestations. Neurol India 2002; 50:319-21. [PMID: 12398066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Wasp stings generally cause local reactions like pain, wheal, flare, edema and swelling, which are generally self-limiting. Multiple stings can lead to vomiting, diarrhea, generalized edema, dyspnea, hypotension, collapse, renal failure or death. Unusually, they may cause serum sickness, vasculitis, neuritis or encephalitis. We report a case of a 40 year old male who developed focal neurological deficit 10 hours following a wasp sting, which was confirmed to be ponto-cerebellar infarction on MRI scan, and recovered within five days.
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Affiliation(s)
- A Sachdev
- Department of Medicine, Government Medical College and Hospital Chadigarh - 160 047, India.
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Kumar A, Sachdev A, Singh R, Lehl SS, D'Cruz S, Mahapatra M, Malhotra HS. Left atrial myxoma presenting as pseudobulbar palsy. Neurol India 2002; 50:219-21. [PMID: 12134197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A case of left atrial (LA) myxoma presenting as pseudobulbar palsy, due to multiple cerebral infarcts, without any cardiac manifestations, is presented. LA myxoma is rare cause of embolization to CNS causing ischemic infarcts. Due to multiple CNS infarcts patient can present with varied clinical picture and pseudobulbar palsy is not a very common presentation. It was a real diagnostic dilemma before LA myxoma was diagnosed on echocardiography.
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Affiliation(s)
- A Kumar
- Department of Medicine, Government Medical College and Hospital, Sector - 32B, Chandigarh, 160047, India
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Singh R, Bhalla A, Lehl SS, Sachdev A. Video game epilepsy. Neurol India 2001; 49:411-2. [PMID: 11799420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Reflex epilepsy is the commonest form of epilepsy in which seizures are provoked by specific external stimulus. Photosensitive reflex epilepsy is provoked by environmental flicker stimuli. Video game epilepsy is considered to be its variant or a pattern sensitive epilepsy. The mean age of onset is around puberty and boys suffer more commonly as they are more inclined to play video games. Television set or computer screen is the commonest precipitants. The treatment remains the removal of the offending stimulus along with drug therapy. Long term prognosis in these patients is better as photosensitivity gradually declines with increasing age. We present two such case of epilepsy induced by video game.
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Affiliation(s)
- R Singh
- Department of Medicine, Govt. Medical College and Hospital, Sector - 32/B, Chandigarh - 160032, India
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Handa U, Mohan H, Ahal S, Mukherjee KK, Dabra A, Lehl SS, Yadav TD. Cytodiagnosis of hydatid disease presenting with Horner's syndrome: a case report. Acta Cytol 2001; 45:784-8. [PMID: 11575662 DOI: 10.1159/000328306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diagnosis of echinococcosis is based on clinical, radiologic and serologic findings. Fine needle aspiration (FNA) is useful in evaluating the lesion when the presentation is atypical. We report a case of hydatid cyst at the lung apex in which the diagnosis was made on FNA, with no adverse reaction to the aspiration. CASE A 30-year-old male, a chronic smoker, presented with pain radiating to the medial two fingers of the right hand for two years. He also had miosis and ptosis of the right eye and anhidrosis of the right side of theface. There was wasting of small muscles in the right hand. Magnetic resonance imaging revealed a hyperintense mass at the apex of the right lung, thoracic inlet and adjacent vertebral bodies. A clinical diagnosis of Horner's syndrome due to pancoast tumor was rendered. Ultrasound-guided FNA showed protoscolices, scattered hooklets and bits of acellular laminated membrane, characteristic of echinococcosis. Surgical excision of the cyst was done. Gross and histopathologic examination of the excised cyst confirmed the diagnosis. CONCLUSION FNA, though traditionally contraindicated, is a highly desirable, rapid, noninvasive diagnostic mode for echinococcosis. In view of its pathognomonic cytomorphologic features and numerous reports on cytodiagnosis in the literature, it is time to evaluate the diagnostic benefits and weigh the risks against the advantages of the technique.
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Affiliation(s)
- U Handa
- Department of Pathology, Government Medical College, Chandigarh, India
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Singh R, Lehl SS, Sachdev A, Sood A, Malhotra HS. Reversible neurologic manifestations after glycerol: a short report. Neurol India 2001; 49:320-1. [PMID: 11593257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
A 46 year old male inadvertently consumed 500 ml of glycerol and presented with altered sensorium, focal neurologic signs and generalised seizures. He was managed conservatively and recovered fully within 48 hours. The case highlights the rare presentations of overdosage and neurologic effects with glycerol, an otherwise safe drug used in neurology.
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Affiliation(s)
- R Singh
- Department of Medicine, Government Medical College and Hospital, Chandigarh-160047, India
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Lehl SS, Sud A, Mukhopadhyay P, Bambery P, Deodhar SD. Progressive systemic sclerosis with breast cancer. J Assoc Physicians India 1996; 44:350. [PMID: 9282592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S S Lehl
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
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Sud A, Lehl SS, Bhasin DK, Deodhar SD. Emphysematous gastritis. Am J Gastroenterol 1996; 91:604-5. [PMID: 8633522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emphysematous gastritis is a rare infectious disease of the stomach. A patient with fatal emphysematous gastritis associated with empyema thoracis is reported. The diagnosis was suspected as a result of a plain skiagram of the abdomen and was confirmed on CT scan of the abdomen.
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Affiliation(s)
- A Sud
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research Chandigarh, India
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Lehl SS, Bambery P, Avasthi A, Dogra MR, Deodhar SD. CMV retinitis and dementia in an Indian with AIDS. J Assoc Physicians India 1995; 43:136-7. [PMID: 9282683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S S Lehl
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh
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