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Bangalore, India

Bharath Kumar T.V.,Fortis Hospitals | Bhardwaj N.,Post Graduate Institute of Medical Education and Research
Journal of Anaesthesiology Clinical Pharmacology | Year: 2014

We report a case of pseudo-thrombocytopenia due to cold agglutinins against platelets. These cold agglutinins were the cause for diagnostic confusion and resulted in extensive workup and unnecessary therapeutic precautions. A thirty two year old female with Guillain-Barre syndrome was admitted in the ICU and serial work-up showed markedly low levels of platelets. The patient had no symptoms of bleeding and patient was investigated extensively for deciphering the etiology of low platelet count. In-vitro clumping of platelets was suspected and in-vitro studies showed marked clumping of platelets with ethylene-diamine-tetra-acetic acid, citrate and heparinized samples. The manual platelet count was found to be within normal limits. Thrombocytopenia as a result of platelet cold agglutinins is a rare cause of in-vitro low platelet counts. No clinical problems have been reported due to the same.

Misra P.,All India Institute of Medical Sciences | Upadhyay R.P.,All India Institute of Medical Sciences | Misra A.,Fortis Hospitals | Anand K.,All India Institute of Medical Sciences
Diabetes Research and Clinical Practice | Year: 2011

Objective: To describe the extent of problem of diabetes in rural India based on review of available literature and examine the secular trends over a period of 15 years i.e. from 1994 to 2009. Methods: A systematic search was performed using electronic as well as manual methods. Studies providing details of sample size, age group of participants, criteria used for diagnosis, along with the prevalence of any of the three outcomes of interest i.e. diabetes mellitus, impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), were included. Results: Analysis of secular trends reveals an increase in diabetes prevalence among rural population at a rate of 2.02 per 1000 population per year. The rate of increase was high in males (3.33 per 1000 per year) as compared to females (0.88 per 1000 per year). High prevalence of IFG and IGT has been observed in southern and northern parts of the country. Conclusion: The prevalence of diabetes is rising in rural India. There is a large pool of subjects with IFG and IGT at high risk of conversion to overt diabetes. Population-level and individual-level measures are needed to combat this increasing burden of diabetes. © 2011 Elsevier Ireland Ltd.

Chakravarthy M.,Critical Care | Mitra S.,Critical Care | Nonis L.,Fortis Hospitals
Indian Heart Journal | Year: 2012

Objective: Cardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. Aims of the audit: To assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. Methods: This is a retrospective observational audit of the case records of all the adult patients who were resuscitated from 'code blue'. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. Results: Twenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. Conclusion: A overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval. © 2012. Cardiological Society of India. All rights reserved.

Babu K.,Vittala International Institute of Ophthalmology | Kini R.,Vittala International Institute of Ophthalmology | Mehta R.,Fortis Hospitals | Philips M.,National Institute of Mental Health and Neuro Sciences | And 2 more authors.
Retina | Year: 2012

AIM: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population METHODS: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. RESULTS: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. CONCLUSION: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population. Copyright © by Ophthalmic Communications Society, Inc.

Bhushan B.,Northwestern University | Misra A.,Fortis Hospitals | Guleria R.,All India Institute of Medical Sciences
Metabolic Syndrome and Related Disorders | Year: 2010

Introduction: Obesity and the metabolic syndrome are rapidly increasing in developing countries. Whether the metabolic syndrome is independently associated with obstructive sleep apnea (OSA) is not clear. Objective: This study investigated the association between OSA and the metabolic syndrome in obese Asian Indians. Methods: We studied 240 obese subjects [body mass index (BMI) >25 kg/m2], 121 with OSA and 119 without OSA, matched for age, BMI, and percentage body fat (%BF). Full-montage digital polysomnography, fasting blood glucose (FBG), lipid levels, and blood pressure (BP) were done in all subjects. Results: Subjects with OSA showed higher prevalence of the metabolic syndrome as compared to subjects without OSA [67.8% vs. 42.02%; χ2=16.08, P<0.0001, odds ratio (OR)=2.90, 95% confidence interval (CI)]. Prevalence of the metabolic syndrome was significantly higher in the severe OSA group as compared to the moderate OSA group (78.7% vs. 40.9%; χ2=11.57; P<0.001; OR=0.19, 95% CI). Fasting insulin levels were significantly higher in subjects with OSA as compared to subjects without OSA [median (range); 84.03(12.5-541.7) pmol/L vs. 64.4(10.4-520.8) pmol/L; P=0.002)]. Regression analysis suggested that OSA was independently and positively associated with the metabolic syndrome, male gender, and fasting insulin levels. Conclusion: OSA is independently associated with the metabolic syndrome in Asian Indians in northern India. © Copyright 2010, Mary Ann Liebert, Inc. 2010.

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