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Kolkata, India

Paul N.,AYJNIHH | Kumar S.,AYJNIHH | Chatterjee I.,AYJNIHH | Mukherjee B.,AMRI Hospitals
Indian Journal of Otolaryngology and Head and Neck Surgery | Year: 2011

In-depth study on laryngeal biomechanics and vocal fold vibratory patterns reveal that a single vibratory cycle can be divided into two major phases, the closed and open phase, which is subdivided into opening and closing phases. Studies reveal that the relative time course of abduction and adduction, which in turn is dependent on the relative relaxing and tensing of the vocal fold cover and body, to be the determining factor in production of a particular vocal register like the modal (or chest), falsetto, glottal fry registers. Studies further point out Electroglottography to be particularly suitable for the study of vocal vibratory patterns during register changes. However, to date, there has been limited study on quantitative parameterization of EGG wave form in vocal fry register. Moreover, contradictory findings abound in literature regarding effects of gender and vowel types on vocal vibratory patterns, especially during phonation at different registers. The present study endeavors to find out the effects of vowel and gender differences on the vocal fold vibratory patterns in different registers and how these would be reflected in standard EGG parameters of Contact Quotient (CQ) and Contact Index (CI), taking into consideration the Indian sociolinguistic context. Electroglottographic recordings of 10 young adults (5 males and 5 females) were taken while the subjects phonated the three vowels /a/,/i/,/u/ each in two vocal registers, modal and vocal fry. Obtained raw EGG were further normalized using the Derived EGG algorithm and theCQ and CI values were derived. Obtained data were subject to statistical analysis using the 3-way ANOVA with gender, vowel and vocal register as the three variables. Post-hoc Dunnett C multiple comparison analysis were also performed. Results reveal that CQ values are significantly higher in vocal fry than modal phonation for both males and females, indicating a relatively hyperconstricted vocal system during vocal fry. The males have significantly greater CQ values than females both at modal and vocal fry phonations which indicate that the males are predisposed to greater vocal fold constriction. Females demonstrated no significant increase in CI values in vocal fry state; and in some cases actually decrease in the CI values which suggest an inherently distinct vocal fold physiological adjustment from that in males. No vowel effects were found in any conditions. Perturbation values (CQP and CIP) are significantly more in vocal fry register than in modal register, and the increase was more in case of females than males. The findings give strong evidence to certain hypotheses in literature regarding effects of vowel, gender and phonatory register on vocal fold vibratory patterns. © 2011 Association of Otolaryngologists of India.

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.

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.

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.

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.

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