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

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. Source

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

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 Source

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

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. Source

Bhojwani K.M.,Kasturba Medical College Hospital
Ear, nose, & throat journal

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. Source

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

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. Source

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