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PubMed | Bangalore Medical College & Research Institute, World Health Organization, Bowring and Lady Curzon Hospital, International Union Against Tuberculosis and Lung Disease and Médecins Sans Frontières
Type: Journal Article | Journal: Public health action | Year: 2015

Tuberculosis (TB) and diabetes mellitus (DM) clinics at Bowring and Lady Curzon Hospital, a tertiary care centre in Bangalore, India.To assess the feasibility and results of TB-DM bidirectional screening.A descriptive study conducted from 1 March to 30 September 2012, in which all TB patients were assessed for DM and vice versa. Fasting blood glucose values of 126 mg/dl and 110-125 mg/dl were considered as DM and pre-diabetes, respectively.Of 510 TB patients, 32 (6.3%) had been previously diagnosed with DM. Screening among the remaining 478 patients yielded 15 (2.9%) with pre-diabetes and 15 (2.9%) newly diagnosed cases of DM. A higher prevalence of DM was found among patients aged 40 years, patients with pulmonary TB and smokers. Of the 47 TB-DM patients, 45 were enrolled in DM care. Of 1670 DM patients followed up in DM clinics, 45 already had TB. Among the remaining 1625 patients screened, 152 (9%) had symptoms suggestive of TB; two of these were found to have the disease.Bidirectional screening for DM and TB is feasible and produces a high yield for DM among TB patients. The yield of TB among DM patients was low and needs future research using new, improved TB diagnostic tools.


Gowraiah V.,Childrens Hospital | Awasthi S.,University of Lucknow | Kapoor R.,Regency Hospital | Sahana D.,Vanivilas Hospital | And 6 more authors.
Archives of Disease in Childhood: Education and Practice Edition | Year: 2014

Background: Acute respiratory infections are the commonest cause of mortality and morbidity in children worldwide. A quarter of all deaths occur in India alone. In order to reduce this disease burden, there is a need for better diagnostic criteria, particularly ones allowing early detection of high-risk children. Methods: We enrolled 516 under 5 year olds, in four Indian hospitals, who met WHO age-dependent tachypnoea criteria for pneumonia at presentation. Patients underwent a protocolised examination assessing 29 items, including history, examination, O2 saturation, plus scores for chest X-ray, auscultation and conscious level. Treatment was determined by the emergency room (ER) physician. All children were reviewed at day 4 by a paediatrician and placed into four diagnostic categories: pneumonia, wheezy disease, mixed and non-respiratory. Results: The majority had wheezy diseases (42.8%). The remainder had pneumonia (35.9%), mixed disease (18.6%) and non-respiratory (2.7%). Best diagnostic predictors for wheezy disease were (auscultation/previous similar episodes) and for pneumonia (auscultation/CXR score). Mortality was 1.6%. Best disease severity predictors were conscious level, weight/age z score and respiratory/pulse rates. Interpretation: Current tachypnoea-based algorithms significantly overdiagnose pneumonia in children and underdiagnose wheezy diseases. Diagnostic accuracy can be improved by various combinations of clinical variables, but the best single diagnostic predictor is auscultation. Simple criteria can also be defined that reliably detect which tachypnoeic children are at high risk of death or deterioration. Management plans based on these protocols could reduce unnecessary antibiotic use, improve the management of wheezy diseases and reduce mortality by earlier identifi cation of high-risk children. © 2014, BMJ Publishing Group. All rights reserved.


Banu A.,Bangalore Medical College and Research Institute | Nagraj E.R.,Siddhartha Medical College | Vidyadevi M.,Bowring and Lady Curzon Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Endophthalmitis is a grave complication of ocular trauma. We report here a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an opportunistic organism, Corynebacterium jeikeium. The patient was treated with intra-vitreal antibiotics like ceftazidime and vancomycin to control the infection.


PubMed | Postgraduate Student., Bowring and Lady Curzon Hospital and Professor.
Type: Case Reports | Journal: The Journal of the Association of Physicians of India | Year: 2016

Werners syndrome is an adult premature aging syndrome of autosomal recessive inheritance affecting connective tissues throughout the body.1 The exact etiology remains obscure even though biochemical and connective tissue abnormalities have been postulated.2 The disease involves multiple systems of the body and may be associated with internal malignancy.3 We report a case of a 35 year old man who presented with uncontrolled diabetes and non-healing ulcers.


Prabhakar B.,Bowring and Lady Curzon Hospital | Banu A.,Bowring and Lady Curzon Hospital | Pavithra H.,ART Center | Chandrashekhara P.,Technical Resource Group
Indian Journal of Sexually Transmitted Diseases | Year: 2011

Background: Some individuals experience a discordant response during antiretroviral therapy (ART), with a blunted CD4+ cell count response despite low HIV-1 RNA plasma levels. Materials and Methods: CD4 counts and viral load of 251 individuals on ART referred to the center were analysed for immunological failure. The viral load tests of 28 patients revealed a discordant response, characterized by low CD4 counts despite viral suppression (<47 copies in 23, <5000 in 4 patients and <10000 in one patient). Univariate and multiple regression analysis was done to determine factors associated with immunological failure in patients with viral suppression. Results: Twenty-eight patients developed immunological failure over a duration of 3.71.14 years despite viral suppression. In univariate analysis of discordant patients, low CD4 counts(<100cells/l) at start of ART(P=0.0261), less than 50% gain in CD4 count (P=0.048) after one year of start of ART and duration on ART for more than 3 years (P=0.0436) were associated with immunological failure. In multiple regression, duration on ART, age and nadir CD4 count (lowest ever) on treatment were predictors of immunological failure in these patients. Overall females (n=8) demonstrated much higher CD4 counts of 13672 than males (n=20) 7938 cells/l at the time of diagnosis of immunological failure. Conclusions: Discordance was observed in 13.59% of patients. Detection of failure to first line therapy based on immunologic criteria, without viral load testing, can result in unnecessary switches to 2 nd line therapy.


Kabbin J.S.,Bowring and Lady Curzon Hospital | Vijaya D.,Bowring and Lady Curzon Hospital | Meundi M.D.,Bangalore Medical College | Leelavathy B.,Bowring and Lady Curzon Hospital
Journal of Clinical and Diagnostic Research | Year: 2012

Background: The mycological study of Pityriasis versicolor by doing Potassium hydroxide (KOH) wet mount preparations and cultures is simple, but both the techniques have their own limitations. The isolation of the organism is very difficult because it is lipophilic and it needs special media to grow, which takes time. The present study suggests that the Calcoflour white stain can be used for the preliminary identification of the fungal elements, so that clinicians can start with the treatment. Aim: The aim of this study was to know the advantage of Calcofluor white staining versus the conventional methods which are used for the demonstration of the fungi in cases of Pityriasis versicolor. Methods: Over a period of one year, from October 2004 to November 2005, a total of 100 clinically diagnosed cases of Pityriasis versicolor were referred from the Department of Dermatology to the Department of Microbiology, Bowring and Lady Curzon Hospital which is attached to the Bangalore Medical College and Research Institute, Bangalore. Skin scrapings from affected lesions were processed by doing KOH preparations, Calcoflour white staining and cultures. Results: Out of the 100 cases which were studied, the maximum number of cases were in age group of 12 to 21 yrs (51%). Males 71(71%) were affected more than females 29(29%). 98(98%) samples were positive for the fungi by Calcoflour white staining, 92(92%) by the KOH preparation and 46(46%) by culture. Conclusion: Calcoflour white staining picked up an additional four samples which were reported as negative by the KOH preparation and the culture. Two other samples were reported to be positive by Calcoflour white staining and culture and to be negative by the KOH preparation. Calcoflour white staining is a rapid, simple, sensitive and highly reliable method for identifying fungi, as it provides a good definition of the fine fungal structures and a better contrast from the background debris, cells and tissue fragments.


Agadi J.B.,Bowring and Lady Curzon Hospital | Raghav G.,Bowring and Lady Curzon Hospital | Mahadevan A.,National Institute of Mental Health and Neuro Sciences | Shankar S.K.,National Institute of Mental Health and Neuro Sciences
Journal of Clinical Neuroscience | Year: 2012

Sensitivity, specificity, and diagnostic yield of the superficial peroneal nerve (SPN)/peroneus brevis muscle (PBM) biopsy in 43 patients with clinically suspected vasculitic neuropathy was studied. Biopsies were classified as "definite", "suspicious" or "possible" in accordance with established criteria. Vasculitis was detected in 27 patients (21 with non-systemic vasculitis, and six with systemic vasculitis). In patients with "definite" vasculitis (n = 13), the sensitivity of SPN/PBM biopsy was 76.4% with 100% specificity. By including patients suspicious for vasculitis (n = 10), sensitivity increased to 85.1% but the specificity dropped to 87.5%. The overall diagnostic yield of SPN biopsy in those patients with definite vasculitis was 76.9% (10/13), and 53.8% (7/13) for muscle biopsy. The addition of muscle biopsy increased the diagnostic yield by 23%. Asymmetric nerve fiber loss, Wallerian degeneration and presence of hemosiderin were statistically significant markers of probable vasculitis. Muscle tissue was more likely to show hemosiderin (85.7%) than a nerve biopsy (71%). A combined SPN/PBM biopsy offers excellent diagnostic yield in the diagnosis of vasculitic neuropathy. © 2012 Elsevier Ltd. All rights reserved.


PubMed | Bowring and Lady Curzon Hospital, Vanivilas Hospital, Regency Hospital, BCs Childrens Hospital and University of Lucknow
Type: Journal Article | Journal: Archives of disease in childhood | Year: 2014

Acute respiratory infections are the commonest cause of mortality and morbidity in children worldwide. A quarter of all deaths occur in India alone. In order to reduce this disease burden, there is a need for better diagnostic criteria, particularly ones allowing early detection of high-risk children.We enrolled 516 under 5 year olds, in four Indian hospitals, who met WHO age-dependent tachypnoea criteria for pneumonia at presentation. Patients underwent a protocolised examination assessing 29 items, including history, examination, O2 saturation, plus scores for chest X-ray, auscultation and conscious level. Treatment was determined by the emergency room (ER) physician. All children were reviewed at day 4 by a paediatrician and placed into four diagnostic categories: pneumonia, wheezy disease, mixed and non-respiratory.The majority had wheezy diseases (42.8%). The remainder had pneumonia (35.9%), mixed disease (18.6%) and non-respiratory (2.7%). Best diagnostic predictors for wheezy disease were (auscultation/previous similar episodes) and for pneumonia (auscultation/CXR score). Mortality was 1.6%. Best disease severity predictors were conscious level, weight/age z score and respiratory/pulse rates.Current tachypnoea-based algorithms significantly overdiagnose pneumonia in children and underdiagnose wheezy diseases. Diagnostic accuracy can be improved by various combinations of clinical variables, but the best single diagnostic predictor is auscultation. Simple criteria can also be defined that reliably detect which tachypnoeic children are at high risk of death or deterioration. Management plans based on these protocols could reduce unnecessary antibiotic use, improve the management of wheezy diseases and reduce mortality by earlier identification of high-risk children.


Handargal N.,Bowring and Lady Curzon Hospital | Muralidharan J.,Bowring and Lady Curzon Hospital | Priyashree R.,Bowring and Lady Curzon Hospital
Journal of Association of Physicians of India | Year: 2016

Werner’s syndrome is an adult premature aging syndrome of autosomal recessive inheritance affecting connective tissues throughout the body.1The exact etiology remains obscure even though biochemical and connective tissue abnormalities have been postulated.2 The disease involves multiple systems of the body and may be associated with internal malignancy.3 We report a case of a 35 year old man who presented with uncontrolled diabetes and non-healing ulcers. © 2016, Journal of Association of Physicians of India. All rights reserved.


PubMed | Bowring and Lady Curzon Hospital
Type: Journal Article | Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia | Year: 2012

Sensitivity, specificity, and diagnostic yield of the superficial peroneal nerve (SPN)/peroneus brevis muscle (PBM) biopsy in 43 patients with clinically suspected vasculitic neuropathy was studied. Biopsies were classified as definite, suspicious or possible in accordance with established criteria. Vasculitis was detected in 27 patients (21 with non-systemic vasculitis, and six with systemic vasculitis). In patients with definite vasculitis (n=13), the sensitivity of SPN/PBM biopsy was 76.4% with 100% specificity. By including patients suspicious for vasculitis (n=10), sensitivity increased to 85.1% but the specificity dropped to 87.5%. The overall diagnostic yield of SPN biopsy in those patients with definite vasculitis was 76.9% (10/13), and 53.8% (7/13) for muscle biopsy. The addition of muscle biopsy increased the diagnostic yield by 23%. Asymmetric nerve fiber loss, Wallerian degeneration and presence of hemosiderin were statistically significant markers of probable vasculitis. Muscle tissue was more likely to show hemosiderin (85.7%) than a nerve biopsy (71%). A combined SPN/PBM biopsy offers excellent diagnostic yield in the diagnosis of vasculitic neuropathy.

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