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Gautam A.P.,Manipal University India | Fernandes D.J.,Manipal University India | Vidyasagar M.S.,Father Muller Medical College | Maiya A.G.,Manipal University India | Vadhiraja B.M.,Manipal Multispecialty Hospital
Radiotherapy and Oncology | Year: 2012

Background and purpose: Oral mucositis (OM) is most cumbersome acute side effect of concurrent chemoradiotherapy (CCRT) for head and neck cancer (HNC). OM associated pain affects oral functions and nutrition of the patient that may result in discontinuity of treatment. Several modalities have been tried to prevent and treat OM, but none proved completely successful until date. We used prophylactic low level laser therapy (LLLT) for the prevention and treatment of CCRT induced OM. Materials and methods: In this triple blinded study, 221 HNC patients scheduled to undergo CCRT (Cisplatin (1, 22, 43 day) + RT = 66 Grays (2 Gy/fraction), 33 fractions, 5 fractions/week, for 45 days) were block randomized into laser (n = 111) and placebo (n = 110) group. Laser group received LLLT (HeNe, λ = 632.8 nm, power-density = 24 mW, dosage = 3.0 J/point, total dosage/session = 36-40 J, spot-size = 1 cm2, 5 sessions/week) while placebo received sham treatment daily prior to radiation. OM (RTOG/EORTC Scale), oral pain (VAS), dysphagia (FIS), weight loss and CCRT break were assessed. Data were analyzed using frequencies and percentage, generalized estimating equations (GEE) and odds ratio. Results: There was significant reduction in incidence of severe OM (F = 16.64, df = 8876, p < 0.0001) and its associated pain (F = 25.06, df = 8876, p < 0.0001), dysphagia (F = 20.17, df = 8876, p < 0.0001) and opioid analgesics use (p < 0.0001) in laser than placebo group patients. Conclusions: LLLT decreased the incidence of CCRT induced severe OM and its associated pain, dysphagia and opioid analgesics use. © 2012 Elsevier Ireland Ltd. All rights reserved.

Chacko S.K.,Father Muller Medical College | Cheluvappa R.,University of New South Wales
Experimental and Clinical Endocrinology and Diabetes | Year: 2010

The relationship between type 2 diabetes, antioxidant-enzyme serum ceruloplasmin, pro-inflammatory blood fibrinogen and antioxidant activity (AOA) was investigated in 40 diabetics and 47 non-diabetics hailing from South India as a preliminary study aspiring to be a crucial stepping stone for a large study. Serum AOA was lower (p<0.01) in diabetics (0.68±0.03mmol/L) than controls (0.92±0.07mmol/L) and ceruloplasmin more (p<0.001) in diabetics (983.20±52.18mg/L) than controls (470.79±39.20mg/L). Plasma fibrinogen was higher (p<0.001) in diabetics (480.23±19.52mg/ dl) than controls (313.94±13.42mg/dl). Males had more AOA. Fibrinogen increased with age. These significant findings point strongly to augmented oxidative stress and inflammatory states in South Indian diabetics. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart - New York.

Fernandes A.,Father Muller Medical College | Dias M.,Fr Muller Medical College
Journal of Clinical and Diagnostic Research | Year: 2013

Background: In spite of the decreasing incidence of orthopaedic device related infections to 1%, nowadays, device-related infections still remain a diagnostic, therapeutic and cost -related problem. Aims and Objective: To record the common causative organisms and the contributing risk factors for orthopaedic device-related infections in a tertiary care teaching hospital. Methods: In a prospective study, fifty patients who underwent orthopaedic device implantation from Jan 2009 - June 2010 were enrolled; among them, 42 patients were complicated with infections. The demography, microbiological data, treatment and the outcome of each patient were recorded. Statistical Analysis: The data was analyzed in terms of frequency and percentage. Results: Of the 50 samples, 42(84%) were culture positive, while 8(16%) were cultures negative. The femur was the most commonly affected bone in both males (median age-37. 1yrs) and females (median age-41. 3 yrs). Staphylococcus aureus was the organism which was most commonly isolated and which caused biofilms, followed by non-fermenting, gram negative bacilli and Klebsiella spp. We reported the first case till date in the literature of Candida krusei PJI, to the best of our knowledge. No anaerobes were isolated. Tissue trauma, open fractures, post-operative surgical site infections and Diabetes mellitus were found to be the important risk factors. The biofilm forming organisms were commonly associated with polymicrobial infections and even an aggressive antibiotic therapy was often inadequate to eliminate the infections. A conservative surgical treatment was associated with treatment failures. Implant removal or replacement was required in most of the cases to eradicate the infection. Conclusion: The most common bacteria which were isolated included Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella. A majority of them are resistant to the commonly used antibiotics, leading to treatment failures which necessitated an implant removal.

Gautam A.P.,Manipal University India | Fernandes D.J.,Manipal University India | Vidyasagar M.S.,Father Muller Medical College | Maiya A.G.,Manipal University India | Nigudgi S.,Apollo Cancer Hospital
Supportive Care in Cancer | Year: 2013

Purpose: Chemoradiotherapy (CRT)-induced oral mucositis (OM) adversely affects a patient's oral functions and quality of life (QOL). Low-level laser therapy (LLLT) showed some preventive and curative effects against clinically reported objective measures of OM in few trials including our recently published study. There is dearth of evidence regarding the effects of LLLT on patient's subjective experience of OM and QOL. Hence, we did this study to evaluate the effects of LLLT on a patient's reported measures of OM and QOL in head and neck cancer (HNC) patients receiving CRT. Methods: This triple blinded study randomized 220 HNC patients scheduled for CRT (three weekly Cisplatin + RT = 66 Gray (2 Gy/session), five fractions/week for 6.5 weeks, total 33 fractions) into laser (110) and placebo (110) groups. The laser group received LLLT (Technomed Electronics Advanced Laser Therapy 1000, He-Ne, λ = 632.8 nm, power density = 24 mW/cm2, dosage = 3.0 J at each point, total dose/session = 36-40 J, spot size 1 cm2, irradiation time/point 125 s) before each radiation session, while the placebo group did not receive laser therapy. Methodology was similar to our recently published study (Gautam et al. Radiother Oncol 104:349-354, 2012). In this part of our study, a blinded assessor collected subjective outcomes of the patient's reported measures of OM using Oral Mucositis Weekly Questionnaire-Head and Neck (OMWQ-HN) and QOL using Functional Assessment of Cancer Treatment-Head and Neck (FACT-HN) Questionnaire. Data were analyzed using repeated measure ANOVA through general linear model. Statistical significance was kept at p < 0.05. Results: Results analysis revealed that OMWQ-HN (F = 12.199, df = 6,1314, p < 0.001) and FACT-HN (p < 0.05) scores were significantly lower in LLLT than placebo group patients. Also, a significant reduction (p < 0.001) in incidence of severe OM, need for opioid analgesics, and total parenteral nutrition was observed. Conclusions: LLLT was effective in improving the patient's subjective experience of OM and QOL in HNC patients receiving CRT. © 2012 Springer-Verlag Berlin Heidelberg.

Prabhu R.K.,Father Muller Medical College
The Cochrane database of systematic reviews | Year: 2013

Contractures, a common complication following immobility, lead to restricted joint range of motion. Passive movements (PMs) are widely used for the treatment and prevention of contractures; however, it is not clear whether they are effective. The aim of this review was to determine the effects of PMs on persons with contractures or at risk of developing contractures. Specifically, the aim was to determine whether PMs increase joint mobility. We searched the Cochrane Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid SP), EMBASE (Ovid SP), ISI Web of Science (SCI-EXPANDED; SSCI; CPCI-S; CPCI-SSH), PEDro and PsycINFO (Ovid SP). The search was run on 21 November 2013. Randomised controlled trials of PMs administered for the treatment or prevention of contractures were included. Studies were included if they compared the effectiveness of PMs versus no intervention, sham intervention or placebo in people with or at risk of contracture. Studies that involved other co-interventions were included, provided the co-interventions were administered in the same way to all groups. Interventions administered through mechanical devices and interventions that involved sustained stretch were excluded. Three independent review authors screened studies for inclusion. Two review authors then extracted data and assessed risk of bias. Primary outcomes were joint mobility and occurrence of adverse events such as joint subluxations or dislocations, heterotopic ossification, autonomic dysreflexia and fractures or muscle tears. Secondary outcomes were quality of life, pain, spasticity, activity limitations and participation restrictions. We used standard methodological procedures as advocated by the Cochrane Handbook for Systematic Reviews of Interventions. Two identified studies randomly assigned a total of 122 participants with neurological conditions comparing PMs versus no PMs. Data from 121 participants were available for analysis. Both studies had a low risk of bias. One within-participant study involving 20 participants (40 limbs) measured ankle joint mobility and reported a mean between-group difference of four degrees (95% confidence interval (CI), two to six degrees) favouring the experimental group. Both studies measured spasticity with the Modified Ashworth Scale, but the results were not pooled because of clinical heterogeneity. Neither study reported a clinically or statistically relevant reduction in spasticity with PMs. In one study, the mean difference on a tallied 48-point Modified Ashworth Scale for the upper limbs was one of 48 points (95% CI minus two to four points), and in the other study, the median difference on a six-point Modified Ashworth Scale for the ankle plantar flexor muscles was zero points (95% CI minus one to zero points). In both studies, a negative between-group difference indicated a reduction in spasticity in the experimental group compared with the control group. One study with a total of 102 participants investigated the short-term effects on pain. The mean difference on a zero to 24-point pain scale was -0.4 points in favour of the control group (95% CI -1.4 to 0.6 points). The GRADE level of evidence about the effects of PMs on joint mobility, spasticity and pain is very low. Neither study examined quality of life, activity limitations or participation restrictions or reported any adverse events. It is not clear whether PMs are effective for the treatment and prevention of contractures.

Baliga M.S.,Father Muller Medical College | Kurian P.J.,University Road
Chinese Journal of Integrative Medicine | Year: 2012

Ixora coccinea Linn., (Rubiaceae) commonly known as jungle of geranium and red ixora, is an evergreen shrub found throughout India. Depending on the medical condition, the flowers, leaves, roots, and the stem are used to treat various ailments in the Indian traditional system of medicine, the Ayurveda, and also in various folk medicines. The fruits, when fully ripe, are used as a dietary source. Phytochemical studies indicate that the plant contains important phytochemicals such as lupeol, ursolic acid, oleanolic acid, sitosterol, rutin, lecocyanadin, anthocyanins, proanthocyanidins, glycosides of kaempferol and quercetin. Pharmacological studies suggest that the plant possesses antioxidative, antibacterial, gastroprotective, hepatoprotective, antidiarrhoeal, antinociceptive, antimutagenic, antineoplastic and chemopreventive effects, thus lending scientific support to the plant's ethnomedicinal uses. In the present review, efforts are made in addressing its ethnomedicinal uses, chemical constituents, and validated pharmacological observations. © 2011 Chinese Association of the Integration of Traditional and Western Medicine and Springer-Verlag Berlin Heidelberg.

Baliga M.S.,Father Muller Medical College
Asian Pacific Journal of Cancer Prevention | Year: 2011

Despite good understanding of the molecular basis of the disease and advances in treatment, globally cancer is still a major cause of death. Estimates are that it will surpass cardiovascular disease as the leading cause of death, with higher incidences in the developing countries that have minimal resources. Chemotherapy and radiotherapy, the two most commonly used treatment modalities, are associated with untoward side effects. This has necessitated the search for alternatives that are effective, non toxic and easily affordable for patients and traditional medicinal plants are an ideal source. Eugenia jambolana Lam., commonly known as black plum or 'jamun' is an important medicinal plant in various traditional systems of medicine. It is effective in the treatment of diabetes mellitus, inflammation, ulcers and diarrhea and preclinical studies have also shown it to possess antineoplastic, chemopreventive and radioprotective properties. Here, for the first time, the effects of jamun in treatment and prevention of cancer, and the mechanisms responsible for these effects are appraised. Additionally the drawbacks in existing knowledge are also stressed to emphasize the possible avenues that need to be investigated, so that maximum effects on both prevention and cure can be attained.

Bhat R.M.,Father Muller Medical College | Prakash C.,Father Muller Medical College
Interdisciplinary Perspectives on Infectious Diseases | Year: 2012

Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that has a predilection for the skin and nerves. The disease is clinically characterized by one or more of the three cardinal signs: hypopigmented or erythematous skin patches with definite loss of sensation, thickened peripheral nerves, and acid-fast bacilli detected on skin smears or biopsy material. M. leprae primarily infects Schwann cells in the peripheral nerves leading to nerve damage and the development of disabilities. Despite reduced prevalence of M. leprae infection in the endemic countries following implementation of multidrug therapy (MDT) program by WHO to treat leprosy, new case detection rates are still high-indicating active transmission. The susceptibility to the mycobacteria and the clinical course of the disease are attributed to the host immune response, which heralds the review of immunopathology of this complex disease. © 2012 Ramesh Marne Bhat and Chaitra Prakash.

Nambiar N.J.,Father Muller Medical College
Journal of Clinical and Diagnostic Research | Year: 2012

Paracetamol is involved in a large proportion of accidental exposures and deliberate self-poisoning cases, although subsequent hepatic failure and death are the uncommon outcomes. The optimal management of most of the patients with a paracetamol overdose still remains unclear. The following article attempts to compile a management advice with the current clinical toxicology practice, revised guidelines and recent advances.

Pavey R.,Father Muller Medical College | Kambil S.,Father Muller Medical College | Bhat R.,Father Muller Medical College
Indian Journal of Dermatology, Venereology and Leprology | Year: 2015

The new targeted anticancer drugs as well as the older traditional chemotherapy agents are associated with adverse effects on skin, hair, nails and mucosa. These toxic effects can cause great distress to the patient leading to decreased quality of life and interruption in treatment. Aims: To study the mucocutaneous adverse effects of both single and combined chemotherapy regimens in cancer patients. Materials and Methods: We studied 53 cancer patients attending the oncology outpatient department or those admitted in the oncology ward of Father Muller Medical College Hospital, Mangalore between October 2012 and September 2013. The adverse effects of chemotherapy on skin, hair, nails and mucosa were noted. Results: The most common adverse effects observed in the study were nail changes in 33 (62.2%) patients, followed by hair changes in 20 (37.7%) patients, skin changes in 19 (33.9%) patients, and mucosal changes in 2 (3.7%) patients. The skin changes were acneiform rash in 5 (27.7%) patients, xerosis in 4 (22.2%) patients, hyperpigmentation in 4 (22.2%) patients, and toxic epidermal necrolysis, hand foot syndrome, extravasation, erythema nodosum, and supravenous hyperpigmentation in 1 patient each. The most common nail finding was melanonychia seen in 26 (78.7%) patients. Hair changes were in the form of anagen effluvium seen in 20 (37.7%) patients. Mucosal changes seen were pigmentation of tongue and stomatitis in one case each. Limitations: Sample size is small. Conclusions: While these side effects are generally not life-threatening, they can be a source of significant morbidity. Knowledge about the adverse effects of anti-cancer drugs will help in accurate diagnosis and management, thereby improving the quality of life.

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