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Malolan P.A.,Kasturba Medical College Hospital | Unnikrishnan B.,Kasturba Medical College Hospital
Lung India | Year: 2010

Context: The use of spirometry is currently limited to the diagnosis of obstructive airway disease for tertiary centers mainly because of the unmet need for technical expertise and funding. Use in primary care asks for a simpler and cost-effective screening tool for obstructive airway disease. Aim: To estimate the efficacy of FEV6 against the current standard of FVC in the spirometric diagnosis of obstructive airway disease. Setting and Design: The Pulmonary Function Laboratory of a tertiary care hospital in Coastal South India. It was a descriptive study. Materials and Methods: We analyzed 150 serial patients on ATS standardized spirometers. The patients were classified into normal subjects and those with airway obstruction, further categorized as mild, moderate and severe and those with mixed defect. Those with obstruction were also classified as having reversible and irreversible defects. Statistical Analysis: Data was analyzed using SPSS Software (v.11.5), statistical test ANOVA and Pearson correlation was done and P less than 0.05 considered statistically significant. Results: FVC and FEV6 showed a linear correlation in all subjects. The difference in means was statistically significant in all subjects. The sensitivity and specificity of FEV1 /FEV6 in comparison to FEV1 /FVC were both found to be 100%. Conclusion: FEV6 is an excellent screening tool in the diagnosis of airway obstruction but, there is a necessity for further research to confirm our findings. There is also a need for reference values in an Indian setting to find out the efficiency of this new parameter. Our sample size is relatively small and comprises of a very high proportion (70%) of subjects with airway obstruction and so our results may not be applicable for use in general population.


PubMed | Kasturba Medical College & Hospital and National Institute of Mental Health and Neuro Sciences
Type: Journal Article | Journal: Acta neuropsychiatrica | Year: 2016

Wilsons disease commonly presents with neurological or hepatic manifestations. When it presents with only psychiatric symptoms, or with extrapyramidal symptoms secondary to neuroleptic exposure, the diagnosis of underlying Wilsons disease may be missed.An 18-year-old boy presented to the psychiatric clinic with a manic syndrome and high propensity for extrapyramidal symptoms to neuroleptic. Initial examination revealed splenomegaly and pancytopenia. Subsequent detection of Kayser-Fleischer ring and typical biochemical findings confirmed the diagnosis of Wilsons disease.While the psychiatric symptoms came under control with lithium carbonate, extrapyramidal symptoms continue to persist even after neuroleptic withdrawal. Pancytopenia thought to be due to hypersplenism persists, and patient has developed features of liver cirrhosis. Treatment with zinc and folic acid has been started, and the patient is under evaluation for treatment with penicillamine.The psychiatrist needs to recognize that Wilsons disease can uncommonly present with isolated psychiatric symptoms, including mania. Early and severe extrapyramidal symptoms secondary to neuroleptic exposure in an adolescent age group warrants a detailed evaluation to rule out underlying neuropsychiatric conditions.


Misra D.P.,Jawaharlal Institute of Postgraduate Medical Education & Research | Shenoy S.N.,Kasturba Medical College Hospital
Rheumatology International | Year: 2016

Cardiac involvement is common in primary systemic vasculitides and may be due to direct effect of the disease on the heart or due to therapy. We shall review involvement of the heart in the various forms of primary systemic vasculitis. Among anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), eosinophilic granulomatosis with polyangiitis most commonly involves the heart. Involvement of the heart confers poorer prognosis in AAV, which is also complicated by increased risk of cardiovascular events. Kawasaki’s disease (KD) is the most common form of medium-vessel vasculitis to affect the heart, with coronary artery aneurysms being the most common manifestation. These predispose patients with KD to develop premature ischemic heart disease. Takayasu’s arteritis is the most common large-vessel vasculitis to involve the heart and can result in aortic incompetence, myocarditis, or coronary heart disease. Involvement of the heart in Behcet’s disease is usually in the form of intracardiac mass lesions, thrombosis, or endomyocardial fibrosis. Drugs used in the treatment of systemic vasculitis influence the risk of developing cardiovascular events. Corticosteroid therapy has been shown to increase the risk of myocardial infarction, whereas methotrexate, azathioprine, mycophenolate mofetil, rituximab, and anti-tumor necrosis alpha agents favorably modulate the risk of cardiovascular events, predominantly by dampening systemic inflammation. Awareness of cardiac involvement in vasculitis and accelerated cardiovascular risk in these patients should help clinicians to maximize the modulation of modifiable risk factors for heart disease in these individuals. © 2016 Springer-Verlag Berlin Heidelberg


Muralidhara D.V.,Darul Iman University, Malaysia | Muralidhara K.D.,Kasturba Medical College Hospital
Indian Journal of Physiology and Pharmacology | Year: 2011

Of the two variants of adipose tissue, white fat is traditionally known as a lipid rich tissue which undergoes pathological expansion in obese conditions. To counter the excess accumulation of white fat in states of energy imbalance, the second and unique type of brown fat plays a key role by burning extra energy into heat through a special metabolic pathway. In addition brown fat also plays a vital role in thermoregulation in animals and newborn humans and infants. Recent progress in research areas of these two types of fat tissue has provided compelling evidence to show that they secrete a large number of chemicals that play an important role in body weight control that involves several mechanisms. Brown fat was considered absent in the adult humans until recently. But new techniques have provided ample support for its active existence. Based on the very recent data it has been suggested that brown fat can be a target organ in the treatment of obesity which can lead to exciting and informative outcomes in the future.


Selvaraj V.,University of Houston | Ross M.W.,University of Houston | Unnikrishnan B.,Manipal University India | Hegde S.,Kasturba Medical College Hospital
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2013

Depression in people with HIV has wide-spread implications related to faster progression to AIDS, poor drug compliance, and lower quality of life (QOL). Although there have been studies that have examined the role of sociodemographic variables in people with HIV, there have only been a few on the assessment of QOL and its association with depression among people with HIV in South India. The objectives of this study were to diagnose major depressive disorder (MDD) and examine the association of depression with health-related quality of life (HRQOL) among people with HIV in coastal South India. Structured questionnaires detailing sociodemographic and HIV related variables were filled out by 103 patients with HIV attending a tertiary care center. Interviews were carried out by a psychiatrist to diagnose ICD-10 MDD and a clinical psychologist to rate the severity of depression using the Hamilton Depression Scale (HAMD). Subjective HRQOL was assessed using HIV/AIDS targeted quality of life questionnaire in these patients. Fifty patients were diagnosed with MDD. Among them, 23 (46%) were mildly depressed, 19 (38%) were moderately depressed, 7 (14%) were severely depressed, and 1 (2%) was very severely depressed. Mean QOL scores for all dimensions except sexual function were significantly and inversely correlated (p<0.05) with HAMD implying that patients with greater severity of depressive symptoms had poorer HRQOL. Individuals with ICD-10 diagnosis of MDD presented significantly lower scores of QOL compared to individuals without MDD. The implication is that early diagnosis and referral of depressed patients needs to be incorporated into intervention programs to improve patient outcomes and QOL. More research is needed to investigate the impact of antidepressant therapy on QOL using this study as a comparison group in a similar population. © 2013 Copyright Taylor and Francis Group, LLC.


Pai K.,Kasturba Medical College Hospital | Rajashekaran P.,Kasturba Medical College Hospital
Indian Journal of Psychiatry | Year: 2011

To report oral topiramate-induced glaucoma and to asses its severity and preventability. A 40-year-old manpresented with watering, redness, pain, and diminution of vision of both eyes, one week after initiation of oral topiramate 100 mg/day for alcohol de-addiction. On examination, both eyes showed conjunctival chemosis, corneal edema, shallow anterior chamber, and intraocular pressure 48 and 46 mm Hg. The symptoms and clinical findings resolved completely upon discontinuation of topiramate and administration of antiglaucoma drugs. Topiramate-induced angle-closure glaucoma and other ocular side effects are reversible if the diagnosis is made early and the drug is discontinued in time. Hence, clinician awareness is an important aspect of preventability of this adverse event.


Gandhi K.,Kasturba Medical College Hospital | Adhikari P.,Kasturba Medical College Hospital | Basu A.,Kasturba Medical College Hospital | Achappa B.,Kasturba Medical College Hospital
Metabolic Syndrome and Related Disorders | Year: 2013

Introduction: The striking phenotypic similarities between metabolic syndrome and the Cushing syndrome of glucocorticoid excess have often been linked to 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which activates inert precursors like the cortisone, 11-dehydrocortisone to active glucocorticoids by oxo-reductase activity in several organs. Thus, increased expression of 11β-HSD1 is associated with insulin resistance, diabetes, hypertension, and dyslipidemia. In this study, we investigated the association of a common polymorphism of the HSD11B1 gene with metabolic syndrome and its components. Materials and Methods: The study included 205 subjects, including 105 diagnosed with metabolic syndrome and 100 controls. The subjects were genotyped for the HSD11B1 gene polymorphism (rs12086634) T→G using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The distribution of the genotypes and its association with clinical and biochemical parameters were assessed. Results: There was a significant association between the HSD11B1 gene polymorphism (rs12086634) and occurrence of metabolic syndrome compared to controls (P<0.0001). Regarding the rs1206634 T→G variant, heterozygous patients had a higher systolic blood pressure (P=0.039), higher prevalence of diabetes (P=0.010), and higher total cholesterol levels (P=0.006) compared to homozygotes. However, there was no significant association of the polymorphism with obesity or specific body habitus. Conclusion: We conclude that in a South Indian population, a polymorphism of the HSD11B1 gene containing the single-nucleotide polymorphism (SNP) rs12086634 T→G confers increased risk of metabolic syndrome. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Chaudhary N.,Manipal University India | Kosaraju K.,Manipal University India | Bhat K.,Kasturba Medical College Hospital | Bairy I.,Manipal University India | Borker A.,Manipal University India
Journal of Pediatric Hematology/Oncology | Year: 2012

OBJECTIVES:: We evaluated the usefulness of interleukin-6 (IL-6) and C-reactive protein (CRP) at the onset of febrile neutropenia and 72 hours later, in identifying risk groups and assessing response to antibiotic therapy. METHODS:: All episodes of febrile neutropenia were divided in 3 study groups-microbiologically documented infection (MDI), clinically documented infection (CDI), and fever of unknown origin (FUO). Three outcome groups were defined as those responding to first-line antibiotics (R1), those responding to second-line antibiotics (R2), and those requiring antifungal therapy (RAF). Median values of IL-6 and CRP were compared between the groups. RESULTS:: There were 57 episodes of febrile neutropenia among 26 patients younger than 25 years during 1 year of study period. On day 1, median IL-6 level was significantly lower in FUO group compared with CDI+MDI groups combined (P<0.001). Rise in CRP on day 3 was highly significant to differentiate MDI group from other 2 groups (P<0.001). The CRP also increased significantly on day 3 in RAF (P<0.001) and R2 (P=0.002) groups than in R1 group. CONCLUSIONS:: Low level of IL-6 may help differentiate patients with FUO from those with documented infections. A rising CRP is indicative of serious infection. Copyright © 2012 by Lippincott Williams & Wilkins.


Kharbanda S.,Manipal University India | Ramakrishna A.,Kasturba Medical College Hospital | Krishnan S.,Kasturba Medical College Hospital
International Journal of COPD | Year: 2015

Introduction: COPD presents with an array of extra-pulmonary symptoms of which skeletal muscle dysfunction, particularly of the quadriceps, is well recognized. This contributes to impaired quality of life and increased health care utilization. Work on the quadriceps originated from the observation that a good proportion of COPD patients stop exercise due to the feeling of leg fatigue rather than breathlessness. This study was carried out with the aim of finding the prevalence of quadriceps weakness in a population set and correlate it with severity of COPD. Methodology: This cross-sectional study was conducted in 75 subjects suffering from COPD aged 45 years or above. COPD severity in the subjects was graded based on the GOLD staging system. A digital hand held dynamometer (HHD) was used to measure quadriceps muscle strength. Descriptive statistics were done, and Pearson’s Correlation Coefficient and ANOVA analysis was used for expressing the results. Results: Ninety two percent of subjects were suffering from quadriceps muscle weakness. Quadriceps weakness was present in significantly high proportions even in those suffering from mild disease and belonging to a younger age group. The mean quadriceps muscle force value decreased with disease severity and this relation was found to be significant (P<0.01). Conclusion: Majority of the COPD patients were found to be suffering from quadriceps weakness, which was also present in significant proportions in subjects belonging to younger age groups and suffering from mild disease. These findings indicate that onset of muscle weakness in COPD may precede the onset of symptoms. These findings suggest need for early remedial measure to prevent occurrence of associated systemic diseases. ©2015, Kharbanda et al.


Bhojwani K.M.,Kasturba Medical College Hospital
Ear, nose, & throat journal | Year: 2012

A lingual thyroid is a mass of ectopic thyroid tissue located in the midline of the base of the tongue. Its estimated prevalence ranges from 1 in 3,000 to 1 in 10,000 population. We report the interesting case of a 28-year-old woman who presented with a primary papillary carcinoma in a lingual thyroid and a histologically normal thyroid gland. To the best of our knowledge, this case probably represents only the second reported case of a follicular variant of a papillary carcinoma arising in a lingual thyroid.

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