John S.,Amala Institute of Medical science
Indian Journal of Psychiatry | Year: 2013
Background: Psychiatric morbidity and Health Related Quality of Life (Hr-QoL) in Ischemic Heart Disease (IHD) are relatively less studied in our country. Aims: This cross-sectional observational study was undertaken to assess the common psychiatric disorders and Hr-QoL in IHD. Materials and Methods: One-hundred and thirty patients with IHD were evaluated for psychiatric morbidity and Hr-QoL. Tools used were SCID-1, Euro QoL-5D, and Socio-demographic data sheet. The data were analyzed using SPSS v 10.0 software, Chi-square test, T-test, ANOVA were used as needed. Results: Psychiatric morbidity was assessed using psychiatric assessment schedule SCID-I for generating diagnosis as per DSM-IV criteria. Major depressive disorder was found in 34.6% (n=45) patients. 23.8% (n=31) patients had a diagnosis of depression due to general medical condition. Anxiety disorder due to general medical condition was present in 36.9% (n=48) patients. Around 95.4% of patients reported psychiatric symptoms, either depression or anxiety. Though widely disputed, low educational status was reported as significantly associated with psychiatric morbidity in IHD. Female sex of the patient and the presence of diabetes mellitus were associated with psychiatric morbidity in a significant manner. Majority of patients with poor quality of life were in the domain of anxiety/depression. Conclusion: The findings of our study reveal a high rate of psychiatric morbidity and impaired quality of life in IHD Patients.
Giby V.G.,Amala Institute of Medical science |
Ajith T.A.,Amala Institute of Medical science
World Journal of Hepatology | Year: 2014
Intrahepatic fat deposition has been demonstrated in patients with nonalcoholic fatty liver disease (NAFLD). Genetic and environmental factors are important for the development of NAFLD. Diseases such as obesity, diabetes, and hypertension have been found to be closely associated with the incidence of NAFLD. Evidence suggests that obesity and insulin resistance are the major factors that contribute to the development of NAFLD. In comparing the factors that contribute to the buildup of excess calories in obesity, an imbalance of energy homeostasis can be considered as the basis. Among the peripheral signals that are generated to regulate the uptake of food, signals from adipose tissue are of major relevance and involve the maintenance of energy homeostasis through processes such as lipogenesis, lipolysis, and oxidation of fatty acids. Advances in research on adipose tissue suggest an integral role played by adipokines in NAFLD. Cytokines secreted by adipocytes, such as tumor necrosis factor-α, transforming growth factor-β, and interleukin-6, are implicated in NAFLD. Other adipokines, such as leptin and adiponectinand, to a lesser extent, resistin and retinol binding protein-4 are also involved. Leptin and adiponectin can augment the oxidation of fatty acid in liver by activating the nuclear receptor super-family of transcription factors, namely peroxisome proliferator-activated receptor (PPAR)-α. Recent studies have proposed downregulation of PPAR-α in cases of hepatic steatosis. This review discusses the role of adipokines and PPARs with regard to hepatic energy metabolism and progression of NAFLD. © 2014 Baishideng Publishing Group Inc.
Harisankar C.N.B.,Amala Institute of Medical science
Indian Journal of Nuclear Medicine | Year: 2015
Natural killer/T-cell (NK/T-cell) lymphoma is a rare condition, which presents as necrotic, granulomatous lesions involving the nose and the upper respiratory tract. The condition usually has an aggressive clinical course. The predominant subtype of NK/T-cell lymphoma noted in Asian population is the nasal type. We describe a case of biopsy-proven NK/T-cell lymphoma with bilateral adrenal involvement. Adrenal involvement by lymphoma is usually of B-cell type and occurs in disseminated disease and often unilateral. Bilateral adrenal involvement by T-cell lymphoma is extremely rare. © 2015, MEDKNOW. All rights reserved.
Ajith T.A.,Amala Institute of Medical science |
Janardhanan K.K.,Amala Cancer Research Center
Food and Chemical Toxicology | Year: 2011
Mutations are one of the important factors contributing to oncogenesis. Somatic mutations have been detected in oncogenes and tumor suppressor genes in various types of cancers. In vitro antimutagenic activity of ethyl acetate extract of macro fungus, Phellinus rimosus was evaluated by Ames' mutagenicity assay. The effect was evaluated against the direct acting mutagens (sodium azide, N-methyl-N'-nitro-N-nitrosoguanidine, doxorubicin and 4-nitro-o-phenylenediamine) and mutagen needing activation (2-acetyl aminofluorine, and benzo[. a]pyrene). The extract was significantly (p<0.05) and dose dependently effective against direct acting mutagens and mutagen needing activation. Among the antimutagenic activity against directly acting mutagens, effect was found to be highest against doxorubicin-induced mutation. The antimutagenic effect of the extract against indirect acting mutagen in the presence of mammalian metabolic activation system was also found to be significant (p<0.01). The background bacterial growth and number of revertant colonies in the extract alone treated plate with or with out metabolic activator was almost same as that of spontaneous revertants. This indicated the non-toxic nature of the extract. The effect was partially ascribed to the antioxidant activity. The results of the study suggest the possible antitumor mechanisms of P. rimosus. © 2011 Elsevier Ltd.
Puthoor D.K.,Amala Institute of Medical science
Orthopaedic surgery | Year: 2012
A retrospective study was carried out in patients with giant cell tumor of bone to compare the functional and radiographic outcome of curettage and bone grafting using a novel CT based selection strategy to that of patients of a similar age treated with anatomic/standard curettage and bone grafting. Curettage and bone grafting after CT classification was performed in 31 patients and curettage and bone grafting without CT classification in 20. The surgical approach for curettage in the CT classified group of patients was through the site of the cortical break, irrespective of the standard approach to the particular region of bone involved. The aim of this approach was to achieve wide excision of the possibly involved soft tissue. At similar duration of follow up (72 months) in patients with a similar mean age (33 years), Musculoskeletal Tumor Society (MSTS) scores for CT classified patients were similar to those of patients who had undergone standard curettage. However, the postoperative recurrence rate in the CT classified group was significantly less (12.9%) than in the non-CT classified group. A CT based selection strategy is a valid preoperative tool for evaluation of giant cell tumor. Further, for curettage these lesions are better approached through the site of cortical break, irrespective of standard approaches, so that adequate soft tissue clearance can be achieved. © 2012 Tianjin Hospital and Blackwell Publishing Asia Pty Ltd.
Harisankar C.N.,Amala Institute of Medical science
Clinical nuclear medicine | Year: 2014
Fat spared area of liver can appear as focal areas of elevated FDG uptake on a PET scan. This may mimic metastases. PET scan performed for metastatic workup in a 35-year-old female patient, a case of exocrine tumor of the pancreas, showed focal areas of increased FDG uptake. Contrast-enhanced CT performed as a part of the PET/CT study showed enlarged fatty liver with focal hyperdense areas suggesting fat sparing. Sulfur colloid scan showed physiological colloid uptake in the suspicious areas indicating preserved Kupffer cell function. The patient is on close follow-up without any evidence of metastatic disease.
Harisankar C.N.,Amala Institute of Medical science
Clinical nuclear medicine | Year: 2013
Marine-Lenhart syndrome has been described as a variant of Graves disease with the following criteria: (1) the thyroid scan shows an enlarged gland and 1 or 2 poorly functioning nodules; (2) the nodule is TSH dependent and the paranodular tissue is TSH independent; (3) after endogenous or exogenous TSH stimulation, the return of function in the nodule can be demonstrated; and (4) the nodule is histologically benign. We report a 57-year-old woman with Marine-Lenhart syndrome evaluated with technetium scanning and hybrid SPECT/CT.
Iqbal S.,Amala Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2013
Background: Cerebrovascular diseases such as stroke, aneurysms and arterio-venous malformations are very much prevalent in our country. Circle of Willis, as an anastomotic polygon at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may condition the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies. A possible link between abnormalities of the circle of Willis and the mentally ill patients has been observed. Aim and Objectives: The aim of the present study is to have an intimate knowledge of the variations in the cerebral arterial circle and to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases. So an attempt was made to analyse the anatomical variations of the circle in a random population. Material and Methods: The work was based on fifty adult brains from persons died of diverse causes. The materials were obtained during routine autopsy studies. The base of the brain including the brain stem with intact arterial circle was preserved in 10% formalin for 10 days. The circle of Willis and its major branches were carefully dissected under water using a magnifying lens. The variations were recorded and photographed. Results: Majority of the circles (52%) showed anomalies. Hypoplasia was the most frequent anomaly and was found in 24% of the brains. Accessory vessels in the form of duplications/ triplications of anterior communicating artery were seen in 12% of the circles. The embryonic origin of the posterior cerebral artery from the internal carotid persisted in 10% of the circles. An incomplete circle due to the absence of one or other posterior communicating artery was found in 6% of the specimens. Variations are more frequent in posterior half of the circle. Conclusion: The anatomical variations of the circle of Willis were probably genetically determined, develop in early embryonic stage and persist in post natal life. The amplitude of neck movements, racial, environmental and hemodynamic factors may also modify these variations. These anomalies may alter the occurrence, severity of symptoms, treatment options and recovery from certain cerebrovascular disorders viz., stroke and aneurysms. A detailed knowledge of the vascular variants is useful to surgeons in planning their shunt operations, choice of the patients and also keeps away inadvertent vascular traumas during surgeries.
Ajith T.A.,Amala Institute of Medical science |
Padmajanair G.,Amala Institute of Medical science
Current Aging Science | Year: 2015
Association between amyloid-b (Ab) toxicity, mitochondrial dysfunction, oxidative stress and neuronal damage has been demonstrated in the pathophysiology of Alzheimer’s disease (AD). In the early stages of the disease, the defect in energy metabolism was found to be severe. This may probably due to the Ae and ROS-induced declined activity of complexes in electron transport chain (ETC) as well as damages to mitochondrial DNA. Though clinically inconclusive, supplementation with antioxidants is reported to be beneficial especially in the early stages of the disease. A mild to moderate improvement in dementia is possible with therapy using antioxidants viz coenzyme Q10 (ubiquinone), a -lipoic acid, selenium, omega-3 fatty acids and vitamin E, emphasize their possible role as an adjuvant with the existing conventional treatment. Since mitochondrial dysfunction has been observed, a new therapeutic strategy called as 'Mitochondrial Medicine' which is aimed to maintain the energy production as well as to ameliorate the enhanced apoptosis of nerve cells, has been developed. Mitochondrial CoQ10, Szeto-Schiller peptide-31 and superoxide dismutase/ catalase mimetic, EUK-207 were the mitochondrial targeted agents demonstrated in experimental studies. This article discusses the mitochondrial impairment and the possible mitochondria targeted therapeutic intervention in AD. © 2015 Bentham Science Publishers.
Puthezhath K.,Amala Institute of Medical science
Orthopaedic surgery | Year: 2013
Different techniques have been described for surgical exposure of the shoulder and proximal humerus. However, the neurovascular and muscular anatomy in the proximity of the humerus precludes the use of a "safe" extensive approach. We here present a new technique for extensive exposure of the proximal humerus and shoulder for wide resection of tumors. By reflecting the deltoid with its origin as an osteomyocutaneous flap downwards and backwards, the entire shoulder, including the rotator cuff and proximal humerus, are exposed with minimal damage to the blood supply and function of the deltoid muscle. This approach, which is a logical combination of anterior, transacromial and deltoid splitting approaches, was used in 17 patients, 11 achieving satisfactory functional results. Our new surgical approach reduces intraoperative damage to the blood supply of the deltoid and results in better function of the shoulder postoperatively because both the powerful intermediate muscle fibers of the deltoid and its acromial origin remain intact. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.