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Sahoo S.S.,National Institute of Science Education and Research | Biswal S.,Kalinga Institute of Medical science | Dixit M.,National Institute of Science Education and Research
Hemoglobin | Year: 2014

Hemoglobinopathies such as β-thalassemia (β-thal) and sickle cell anemia (or Hb S [β6(A3)Glu→Val]) impose a major health burden in the Indian population. To determine the frequencies of the HBB gene mutations in eastern Indian populations and to compare with the available data, a comprehensive molecular analysis of the HBB gene was done in the normal Odisha State population. Using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), amplification refractory mutation system (ARMS) and DNA sequencing techniques, β-thal and sickle cell anemia mutations were characterized in 267 healthy individuals. Entire HBB gene sequencing showed 63 different mutations including 11 new ones. The predominant mutation HBB: c.9T,>,C was observed at a high frequency (19.57%) in the normal population. In the urban population of Odisha State, India, carrier frequency of hemoglobinopathies was found to be 18.48%, and for β-thal, the carrier rate was 14.13%, which is very high indeed. In the absence of a complete cure by any expensive treatment and drug administration, this information would be helpful for planning a population screening program and establishing prenatal diagnosis of β-thal in order to reduce the burden of such a genetic disease. © 2014 Informa Healthcare USA, Inc.


Prasad D.S.,Sudhir Heart Center | Kabir Z.,Research Institute for A Tobacco Free Society | Dash A.L.,Mkcg Medical College | Das B.C.,Kalinga Institute of Medical science
Journal of Cardiovascular Disease Research | Year: 2012

Objectives: To determine the prevalence of metabolic syndrome and to identify predictors for the same, specific to an underdeveloped urban locale of Eastern India. Materials and Methods: Study design: Population-based cross-sectional study, with multistage random sampling technique. Setting: Urban city-dwellers in Orissa one of the poorest states of Eastern India bordering a prosperous state of Andhra Pradesh of Southern India. Participants: 1178 adults of age 20-80 years randomly selected from 37 electoral wards of the urban city. Definition of Metabolic Syndrome: We followed a unified definition of the metabolic syndrome by joint interim statement of five major scientific organizations - the International Diabetes Federation, the National Heart, Lung, and Blood Institute, the American Heart Association, the World Heart Federation, the International Atherosclerosis Society, and the International Association of the Study of Obesity. Individuals who meet at least three of five clinical criteria of abdominal obesity, hypertriglyceredimia, low HDL, hypertension, and hyperglycemia are diagnosed as having the condition; presence of none of these criteria is mandatory. Explicit cut points are defined for all criteria, except elevated waist circumference, which must rely on population and country-specific definitions. Main Outcome Measure: Prevalence and significant predictors of metabolic syndrome. Statistical Analysis: Both descriptive and multivariable logistic regression analyses. Results: Age-standardized prevalence rates of metabolic syndrome were 33.5% overall, 24.9 % in males and 42.3% in females. Older age, female gender, general obesity, inadequate fruit intake, hypercholesterolemia, and middle-to-high socioeconomic status significantly contributed to increased risk of metabolic syndrome. Conclusion: Metabolic syndrome is a significant public health problem even in one of the poorest states of India that needs to be tackled with proven strategies.


Bahinipati J.,Kalinga Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2016

Introduction: Normal pregnancy is always associated with immense stress in order to accommodate the increasing demands of the developing fetus. Various metabolic changes along with vascular remodeling occur in maternal system. Due to this, pregnancy is always associated with oxidative stress and generation of Reactive Oxygen Species (ROS). Ischemia Modified Albumin (IMA) generated by ROS is found to be sensitive and early biochemical marker of ischemic heart disease and now used as an important marker to distinguish between ischemic and non-ischemic pathologies. Pregnancy being a hypoxic ischemic condition may lead to increase in serum IMA. Aim: The present study was aimed at evaluating maternal serum Ischemia Modified Albumin (IMA) in normal pregnancy and correlate it with serum Malondialdehyde (MDA), a known lipid peroxidation marker. Similarly IMA/Albumin was evaluated for correction of decrease in serum albumin in pregnancy and correlated with serum MDA. Materials and Methods: Serum IMA, IMA/Albumin and MDA was analysed in 40 healthy normal pregnant women and 41 non-pregnant healthy controls. Serum IMA was estimated by albumin cobalt binding test. Student t-test and Pearson’s correlation coefficient was used for statistical analysis. Results: Serum IMA and IMA/Albumin was significantly higher (p < 0.001) in normal pregnant women (72.54±9.89 U/L, 20.16±3.94) compared to non-pregnant healthy control (48.47±8.30 U/L, 10.51±1.76). Serum MDA was also significantly higher in normal pregnant women. A statistical significant positive correlation was found between serum IMA, IMA/Albumin with MDA in normal pregnant women. Conclusion: Maternal serum IMA is also increased in normal pregnancy and its correlation with MDA shows maternal serum IMA, can be considered as the marker of oxidative stress and can be used to monitor the progress of pregnancy, which may be remarkably increased in various complications related to pregnancy. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.


Prasad D.,Sudhir Heart Center | Kabir Z.,Research Institute for A Tobacco Free Society | Dash A.,Mkcg Medical College | Das B.,Kalinga Institute of Medical science
Journal of Cardiovascular Disease Research | Year: 2011

Evidence is emerging that obesity-associated cardiovascular disorders (CVD) show variations across regions and ethnicities. However, it is unclear if there are distinctive patterns of abdominal obesity contributing to an increased CVD risk in South Asians. Also, potential underlying mechanistic pathways of such unique patterns are not comprehensively reported in South Asians. This review sets out to examine both. A comprehensive database search strategy was undertaken, namely, PubMed, Embase and Cochrane Library, applying specific search terms for potentially relevant published literature in English language. Grey literature, including scientific meeting abstracts, expert consultations, text books and government/non-government publications were also retrieved. South Asians have 3-5% higher body fat than whites, at any given body mass index. Additional distinctive features, such as South Asian phenotype, low adipokine production, lower lean body mass, ethno-specific socio-cultural and economic factors, were considered as potential contributors to an early age-onset of obesity-linked CVD risk in South Asians. Proven cost-effective anti-obesity strategies, including the development of ethno-specific clinical risk assessment tools, should be adopted early in the life-course to prevent premature CVD deaths and morbidity in South Asians.


Prasad D.S.,Sudhir Heart Center | Kabir Z.,Research Institute for a Tobacco Free Society | Dash A.K.,Mkcg Medical College | Das B.C.,Kalinga Institute of Medical science
Annals of Pediatric Cardiology | Year: 2011

Cardiovascular risk factors in children are increasing at an alarming rate in the western world. However, there is limited information regarding these in the South Asian children. This review attempts at summarizing such evidence. South Asians are remarkable for the earlier onset of adult cardiovascular disease (CVD) by almost a decade compared to the Caucasians. We identified published literature, mainly on PubMed, Embase and Cochrane library using specific search terms such as lipid abnormalities, high blood pressure, hyperglycemia, tobacco use, obesity, physical inactivity, and unhealthy dietary practices. Atherosclerotic CVD processes begin early in childhood and are influenced over the life course by genetic and potentially modifiable risk factors and environmental exposure. 80% of adult CVD burden will fall on the developing nations by 2020. The concept of primordial prevention is fast emerging as a necessary prevention tool to curb adult CVD epidemic. Established guidelines and proven preventive strategies on cardiovascular health exist; however, are always implemented half-heartedly. Composite screening and prediction tools for adults can be adapted and validated in children tailored to South Asian population. South Asian children could be at a greater risk of developing cardiovascular risk factors at an earlier stage, thus, timely interventions are imperative.


Tripathy S.,All India Institute of Medical Sciences | Mishra J.C.,Kalinga Institute of Medical science
Indian Journal of Critical Care Medicine | Year: 2015

Context: Few malnutrition screening tests are validated in the elderly Intensive Care Unit (ICU) patient. Aim: Having previously established malnutrition as a cause of higher mortality in this population, we compared two screening tools in elderly patients. Subjects and Methods: For this prospective study, 111 consecutive patients admitted to the ICU and > 65 years underwent the Malnutrition Universal Screening Tool (MUST), and the Geriatric Nutrition Risk Index (GNRI) screening tests. Statistical Analysis: Standard definition of malnutrition risk was taken as the gold standard to evaluate the sensitivity, specificity and predictive values of the tools. The k statistic was calculated to measure the agreement between the tools. The Shrout classification was used to interpret its values. Results: The mean age of the patients screened was 74.7 ± 8.4 (65-97 years). The standard definition, MUST and GNRI identified 52.2%, 65.4%, and 64.9% to be malnourished, respectively. The sensitivity and specificity of the tests were 96.5% computed tomography (CI) (87.9-99.5%) and 72.3% CI (57.5-84.5%) for MUST and 89.5% CI (75.2-96.7%) and 55.0% CI (75.2-96.9%) for GNRI, respectively. Screening was not possible by GNRI and MUST tool in 31% versus 4% of patients, respectively. The agreement between the tools was moderate for Standard-MUST k = 0.65 and MUST-GNRI k = 0.60 and fair for Standard-GNRI k = 0.43. Conclusions: The risk of malnutrition is high among our patients as identified by all the tools. Both GNRI and MUST showed a high sensitivity with MUST showing a higher specificity and greater applicability.


Tripathy S.,All India Institute of Medical Sciences | Mishra J.C.,Kalinga Institute of Medical science | Dash S.C.,Kalinga Institute of Medical science
Journal of Critical Care | Year: 2014

Purpose: To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status. Methods: A prospective study of 109 patients (215 screened) admitted consecutively to the intensive care unit from 2011 to 2012. Demographics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation, Malnutrition Universal Screening Tool score, socioeconomic category, functional status, delirium, and length of stay were recorded. Telephonic assessment of outcome was done at 1 year. Appropriate statistical tests compared differences between subgroups. Multivariate analysis was performed on significant variables (. P < .1) affecting mortality. Results: At 12 months after discharge, 46.8% of patients (mean age, 76.5 ± 9.6 years; APACHEII, 22.7 ± 6.4; and intensive care unit stay, 7.8 ± 3.4 days) had died. Risk factors for mortality at 12 months were APACHE II score (. P < .001; odds ratio [OR], 1.2; 95% confidence interval [CI], 1.1-1.3), severe malnutrition (. P = .006; OR, 0.08; 95% CI, 0.01-0.48), and delirium (. P = .03; OR, 0.32; 95% CI, 0.11-0.9). Risk factors for short-term mortality (at 28 days) were APACHE II score (. P = .02; OR, 1.1 [1.0-1.2]) and premorbid functional status (. P = .03; OR, 0.2 [0.1-0.8]). Kaplan-Meier survival analysis showed a significant association with malnutrition (log-rank test, P = .012) but not with socioeconomic category. Most (72%) of the survivors had a favorable functional status. Conclusions: Malnutrition, delirium, and APACHEII were risk factors for long-term mortality. Survivors had a good functional outcome. Appropriate quality of life tools for this population need to be developed. © 2014 Elsevier Inc.


Dash S.C.,KIIT University | Purohit K.,Kalinga Institute of Medical science | Mohanty S.K.,Kalinga Institute of Medical science | Dinda A.K.,All India Institute of Medical Sciences
Indian Journal of Nephrology | Year: 2011

Primary renal lymphoma is an uncommon variant of extranodal non-Hodgkin's lymphoma. Manifestations are usually nonspecific hematuria, fever, flank pain, and renal insufficiency. Pathological data are scanty; few reports indicate it has a very poor prognosis. We describe a child with bilateral symmetrically palpable kidneys, low-grade pyrexia, and arthralgia. Clinically, diagnosis was missed partly due to the fact that bilateral large renal tumors commonly produce asymmetric renal swelling, renal dysfunction, and hematuria which were absent in this case and partly due to rarity of the condition. However, radiological investigations combined with renal histology helped in establishing diagnosis in the present case.


Nageswar Rao G.,Kalinga Institute of Medical science | Rout K.,Kalinga Institute of Medical science | Pal A.,KIIT University
Case Reports in Ophthalmology | Year: 2012

Background: Postoperative vision loss following routine nasal surgery is an extremely rare and devastating complication. We report a case of unilateral blindness due to central retinal artery occlusion associated with third cranial nerve following septoplasty. Case Report: We report a patient who developed an unusual central retinal artery occlusion with unilateral blindness following nasal surgery under general anesthesia. A 45-year-old man underwent a nasal septal surgery for severe epistaxis. Soon after recovery, the patient noticed loss of vision in his right eye and was unable to lift his upper eyelid. Upon ophthalmic examinations, we determined that he had right-sided third cranial nerve palsy with central retinal artery obstruction and ptosis of right upper eyelid, restriction of ocular movements, and no perception of light in the right eye. Postoperative computerized tomography scan revealed multiple fractures of the left medial orbital wall, including one near the optic canal. Ptosis and ocular defects were recovered partially, but visual loss persisted until the last follow-up. Conclusion: This paper highlights one case of complete unilateral blindness from direct central retinal artery occlusion associated with third cranial nerve palsy following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complications. © 2012 S. Karger AG, Basel.


Mishra S.,Siksha ‘O’ Anusandhan University | Rekha Swain T.,Scb Medical College And Hospital | Mohanty M.,Kalinga Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2013

Background and Introduction: Depression is a prevalent mental disorder and the 4th leading cause of disability in the world as per the World Health Organization (WHO). The adverse Drug Reactions (ADRs) to antidepressants are common and they can lead to a non compliance or even a discontinuation of the therapy. This study entitled us to monitor the ADR profile of the antidepressants in a tertiary care teaching hospital. Patients and Methods: A longitudinal, observational study was conducted in the Outpatients Department of Psychiatry in S.C.B. Medical College and Hospital l in collaboration with the I.M.S and SUM Hospital. A total of 160 cases were studied for ADRs by using a predesigned CDSCO form. The patients who were on TCAs, SSRIs and newer antidepressants (SNRIs/NDRIs) were assessed by doing physical examinations, neurological examinations and relevant lab tests. The causalities were assessed by the criteria of the WHO-UMC. The analysis of ADRs was done by using the Chi square test. Results: Among the 160 patients who took antidepressants, 26.87% reported ADRs, with at least one possible causality.None were labeled as certain, as a rechallenge was not performed. ADRs were mostly observed in polytherapy (14.37%) and with antidepressants like TCAs (58.84%). Conclusions: Agitation, anxiety and insomnia were the common ADRs which were associated with the use of antidepressants. This study offers a representative profile of the ADRs which can be expected in the Psychiatry Outpatients Department and due care must be taken to avoid these ADRs.

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