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Ray S.,Amri Hospitals
Indian heart journal | Year: 2010

The angiographic demonstration of thrombus laden LAD in a ventilated young man with IABP (to combat cardiogenic shock) demanded thrombosuction. Following thrombosuction no significant lesion was visible that could have mandated PTCA-Stenting. Follow-up coronary angiography in this hyperhomocysteinaemic young subject after one and a half month revealed normal coronaries. Thrombosuction alone unaccompanied by any other additional intervention is infrequently reported.


Todi S.,AMRI Hospitals
Indian Journal of Critical Care Medicine | Year: 2014

Glycemic control targets in intensive care units (ICUs) have three distinct domains. Firstly, excessive hyperglycemia needs to be avoided. The upper limit of this varies depending on the patient population studied and diabetic status of the patients. Surgical patients particularly cardiac surgery patients tend to benefit from a lower upper limit of glycemic control, which is not evident in medically ill patient. Patient with premorbid diabetic status tends to tolerate higher blood sugar level better than normoglycemics. Secondly, hypoglycemia is clearly detrimental in all groups of critically ill patient and all measures to avoid this catastrophe need to be a part of any glycemic control protocol. Thirdly, glycemic variability has increasingly been shown to be detrimental in this patient population. Glycemic control protocols need to take this into consideration and target to reduce any of the available metrics of glycemic variability. Newer technologies including continuous glucose monitoring techniques will help in titrating all these three domains within a desirable range.


Sinha R.,Vision Care Hospital | Bhakta A.,AMRI Hospitals
Indian Journal of Nephrology | Year: 2012

Extended spectrum beta lactamase (ESBL) producing bacteria that are capable of hydrolyzing even third generation cephalosporin are emerging as a potent threat. We report a seven-year-old child on continuous ambulatory peritoneal dialysis, who developed ESBL producing Klebsiella pneumoniae peritonitis. The bacterium was resistant to the usual intraperitoneal antibiotics. We successfully treated the child with intravenous meropenem along with oral cotrimoxazole. The case highlights the menace of ESBL peritonitis, as also a need for the development of guidelines for such a scenario, which is becoming increasingly common in India.


Sinha B.,AMRI Hospitals | Ghosal S.,Nightingale
Diabetes and Metabolic Syndrome: Clinical Research and Reviews | Year: 2013

Over the last few years a number of important drugs like rofecoxib, Rosiglitazone, and Gatifloxacin (in diabetics) have lost their position in disease management. The newest controversy revolves around Pioglitazone, a thiozolidindione, which improves insulin sensitivity and is reputed to have cardioprotective actions, but is riddled with several controversies related to weight gain, distal fractures of long bones, recent reports of bladder cancer and others. There are now new groups of drugs, which have been introduced with stringent FDA approval. These include DPP-4 inhibitors, GLP-1 analogues and bromocriptine (old wine in a new bottle). Early in 2013 we are also looking at the launch of another new agent-SGLT-2 inhibitors. These newer agents are associated with not only a significant glucose lowering effect but also positive extra-glycemic benefits principally in the areas of hypoglycemia and weight gain. This raises a very important question-do we really need such a controversial agent when such a plethora of agents are available to us with possibly better metabolic profile than Pioglitazone? This review addresses this highly contentious area dissecting the pros and cons as we see it. © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.


Ghosal S.,Nightingale | Sinha B.,AMRI Hospitals
Journal of Diabetes Research | Year: 2016

The issue related to macrovascular outcomes and intensive glycemic control was hotly debated after the publication of landmark trials like ACCORD, ADVANCE, and VADT. The only benefits seem to come from intervening early on in the disease process as indicated by the 10-year UKPDS follow-up. To complicate matters USFDA made it mandatory for modern drugs to conduct cardiovascular safety trials in high-risk populations after the 2008 rosiglitazone scare. This led to all the modern group of drugs designing cardiovascular safety trials (gliptins, GLP-1 agonists, and SGLT-2 inhibitors) to meet USFDA regulatory requirements. We saw publication of the first 2 randomized trials with gliptins published a year and a half back. On the face value SAVOR TIMI and EXAMINE satisfied the primary composite CV end-points. However, issues related to significant increase in heart failure and all-cause 7-day on-treatment mortality created a lot of confusion. FDA reanalysis of these data (especially SAVOR) raises a lot of doubts as far as CV safety of these groups of drugs was concerned. Hence, all eyes were on TECOS, which was published this year. We take a microscopic look at these trials trying to understand where we stand as from now on this issue. © 2016 Samit Ghosal and Binayak Sinha.


Majumdar A.,AMRI Hospitals
Indian Journal of Critical Care Medicine | Year: 2010

Acute kidney injury (AKI) is a common sequel of sepsis in the intensive care unit. It is being suggested that sepsis-induced AKI may have a distinct pathophysiology and identity. Availability of biomarkers now enable us to detect AKI as early as four hours after it's inception and may even help us to delineate sepsis-induced AKI. Protective strategies such as preferential use of vasopressin or prevention of intra-abdominal hypertension may help, in addition to the other global management strategies of sepsis. Pharmacologic interventions have had limited success, may be due to their delayed usage. Newer developments in extracorporeal blood purification techniques may proffer effects beyond simple replacement of renal function, such as metabolic functions of the kidney or modulation of the sepsis cascade.


Manikandan A.,Narayana Hrudayalaya | Sarkar B.,AMRI Hospitals | Holla R.,Narayana Hrudayalaya | Vivek T.R.,Jupiter Hospital | Sujatha N.,Government General Hospital
British Journal of Radiology | Year: 2012

Objectives: The purpose of this study was to demonstrate quality assurance checks for accuracy of gantry speed and position, dose rate and multileaf collimator (MLC) speed and position for a volumetric modulated arc treatment (VMAT) modality (Synergy® S; Elekta, Stockholm, Sweden), and to check that all the necessary variables and parameters were synchronous. Methods: Three tests (for gantry position-dose delivery synchronisation, gantry speed-dose delivery synchronisation and MLC leaf speed and positions) were performed. Results: The average error in gantry position was 0.5° and the average difference was 3 MU for a linear and a parabolic relationship between gantry position and delivered dose. In the third part of this test (sawtooth variation), the maximum difference was 9.3 MU, with a gantry position difference of 1.2°. In the sweeping field method test, a linear relationship was observed between recorded doses and distance from the central axis, as expected. In the open field method, errors were encountered at the beginning and at the end of the delivery arc, termed the "beginning" and "end" errors. For MLC position verification, the maximum error was -2.46 mm and the mean error was 0.0153±0.4668 mm, and 3.4% of leaves analysed showed errors of >±1 mm. Conclusion: This experiment demonstrates that the variables and parameters of the Synergy® S are synchronous and that the system is suitable for delivering VMAT using a dynamic MLC. © 2012 The British Institute of Radiology.


Ghosh S.,AMRI Hospitals | Bhattacharya M.,AMRI Hospitals | Dhar S.,AMRI Hospitals
Indian Journal of Dermatology | Year: 2011

Churg-Strauss syndrome (CSS) is a rare granulomatous necrotizing small vessel vasculitis characterized by the presence of asthma, sinusitis, and hypereosinophilia. The cause of this allergic angiitis and granulomatosis is unknown. Other common manifestations are pulmonary infiltrates, skin, gastrointestinal, and cardiovascular involvement. No data have been reported regarding the role of immune complexes or cell mediated mechanisms in this disease, although autoimmunity is evident with the presence hypergammaglobulinemia, increased levels of IgE and Antineutrophil cytoplasmic antibody (positive in 40%). We report the case of a 27-year-old lady presenting with painful swelling of predominantly lower limbs with extensive vesicles and ecchymotic patches and fever shortly after stopping systemic steroids taken for a prolonged duration (2002-2010). The aim of this case report is to point to the possibility of CSS in patients presenting with extensive skin lesions masquerading as Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Syndrome (SJS/TENS).


Todi S.,AMRI Hospitals | Bhattacharya M.,AMRI Hospitals
Indian Journal of Critical Care Medicine | Year: 2014

Background: Acute hyperglycemia, hypoglycemia and glycemic variability (GV) have been found to be the three principal domains of glycemic control, which can adversely affect patient outcome. GV may be the confounding factor in tight glycemic control trials in surgical and medical patient. Objective: This study was conducted to establish if there was any relationship between GV and intensive care unit (ICU) mortality in the Indian context. Study Design: A retrospective review of a large cohort of prospectively collected database. Setting: Adult Medical/Surgical/Trauma/Neuro ICU of a tertiary care hospital. Patient Population: All patients who had four or more blood glucose measured during the ICU stay. Outcome: ICU mortality. Result: 2208 patients with a total of 11,335 blood glucose values were analyzed. GV measured by the standard deviation (SD) of mean blood glucose and glycemic lability index (GLI), both were significantly (P < 0.001) associated with ICU mortality. This relationship was maintained (odds ratio (OR): 2.023, 95% confidence interval (CI): 1.483-2.758) even after excluding patients with hypoglycemia (<60 mg/dl). Patients with blood glucose values in the euglycemic range but highest SD had higher mortality (54%) compared to mortality (24%) in patients above the euglycemic range. Similarly patients with blood sugar values below the average for study cohort and high GLI, another marker of GV had higher mortality (OR: 5.62, CI: 3.865-8.198) than compared to patients in the hyperglycemic range, reflecting the importance of GV as a prognostic marker in patients with blood sugar in the euglycemic range. Conclusion: This study demonstrated that high glucose variability is associated with increased ICU mortality in a large heterogeneous cohort of ICU patients. This effect was particularly evident among patients in the euglycemic range.


PubMed | Nightingale and AMRI Hospitals
Type: | Journal: Diabetes & metabolic syndrome | Year: 2017

Lipid modification holds the key to effective secondary prevention of cardiovascular disease (CVD). However there is a controversy on whether its all about targeting specific lipid sub fractions to a particular level or a direct effect of the agent(s) used or both. This review intends to look into these important issues from an evidence-based perspective. What is the appropriate timing of testing for lipid profile after a cardiovascular event? What is the rationale behind initiating with a high dose statin after an acute coronary event? What is the role of targeting lipid sub fractions beside LDL cholesterol? Is there any role for non-statin based therapy after an acute cardiovascular event? What constitutes a long-term lipid modification strategy in patients post CVD? These are very important questions, which needs to be addressed adequately as well as scientifically. The secondary CVD preventive strategies form a lipid perspective, which requires a thorough review.

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