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Thiruvananthapuram, India

Jain N.,Kerala Institute of Medical science
Indian Journal of Practical Pediatrics | Year: 2011

Preterm and growth restricted babies are born low birth weight. Although our country has more growth restricted babies, studies published refer mostly to preterm babies. Breast milk is surely the safest feed and is associated with less infections and NEC. Neonatal units must make an effort to support mother and encourage breastfeeding. Calcium, phosphorus, iron, vitamins A and D and some other vitamins must be supplemented in preterm babies fed breast milk. There is a protein, energy and sodium gap in RDA and breast milk. Human milk fortifiers may be able to bridge this gap without losing the benefits of breast milk, but not recommended as routine practice, currently. Even in the most preterm babies, feeding is started early and in small amounts (minimal enteral nutrition). This is associated with better feed tolerance and shorter time to full feed as compared to babies fed late. Studies have demonstrated safety of advancing feeds as fast as 30- 40 ml / kg / day in stable very preterm infants, although the studies were not powered to safely exclude risk of NEC. Orogastricfeeding and transition to cup are preferred methods of feeding. The classical teaching of pre-feed aspirates as pointer to NEC is now challenged and may just indicate immaturity. Abdominal girth may provide the same information in a less invasive assessment. Although there are special growth charts for preterm infants, debate is unresolved on ideal growth targets.

Vijayaraghavan G.,Kerala Institute of Medical science | Sivasankaran S.,Sree Chitra Tirunal Institute for Medical Science and Technology
Indian Journal of Medical Research | Year: 2012

Tropical endomyocardial fibrosis in India was a common medical problem in the coastal districts of south India, especially the Kerala State. The clinical and autopsy studies have shown left and right ventricular apical fibrosis, with varying degree of atrioventricular valve regurgitation. Left ventricular endomyocardial fibrosis presents with severe pulmonary hypertension and right ventricular endomyocardial fibrosis presents very high systemic venous pressure and congestive cardiac failure. Surgical management improved the natural history of the disease to some extent. Various infectious and toxic factors were postulated regarding its aetiology. During the last few years, incidence of the disease has decreased considerably. The only explanation identified is the significant improvement in the living standards of the people with the corresponding decline in the childhood malnutrition, infections, worm infestation and associated eosinophilia.

Joshi H.S.,Kerala Institute of Medical science
BMJ case reports | Year: 2012

Gangrene is an uncommon complication in cases of rickettsial spotted fever. We report three cases of spotted fever from south India, presumably caused by Rickettsia conorii subspecies indica. Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome (MODS) like acute kidney injury, liver dysfunction, delirium and seizure. One patient died while the other two recovered well. This case series is being reported to highlight the occurrence of gangrene in spotted fever rickettsiosis and the importance of appropriate management at the earliest.

Belani C.P.,Penn State Hershey Cancer Institute | Brodowicz T.,Medical University of Vienna | Ciuleanu T.E.,Oncology Institute Ion Chiricuta | Krzakowski M.,Center of Oncology of Poland | And 13 more authors.
The Lancet Oncology | Year: 2012

Background: Pemetrexed maintenance therapy significantly improved overall survival and progression-free survival compared with placebo, and had a good safety profile in a phase 3 placebo-controlled study in patients with advanced non-small-cell lung cancer (NSCLC). Results for quality of life, symptom palliation, and tolerability are presented here. Methods: After four cycles of platinum-based induction therapy, 663 patients with stage IIIB or stage IV NSCLC and Eastern Cooperative Oncology Group performance status of 0 or 1 were randomly assigned (in a 2:1 ratio) from March 15, 2005, to July 20, 2007, using the Pocock and Simon minimisation method to receive pemetrexed (500 mg/m 2 every 21 days; n=441) or placebo (n=222) plus best supportive care until disease progression. The primary efficacy data have been reported previously. Patients completed the Lung Cancer Symptom Scale (LCSS) at baseline, after each cycle, and post-discontinuation. Worsening of symptoms was defined as an increase of 15 mm or more from baseline on a 100 mm scale for each LCSS item. The primary outcome for these quality-of-life analyses was time to worsening of symptoms, analysed for all randomised patients. This study is registered with ClinicalTrials.gov, number NCT00102804. Findings: Baseline characteristics, including LCSS scores, were well balanced between groups. Baseline LCSS scores were low, indicating low symptom burden for patients without disease progression after completion of first-line treatment. Longer time to worsening was recorded for pain (hazard ratio [HR] 0·76, 95% CI 0·59-0·99; p=0·041) and haemoptysis (HR 0·58, 95% CI 0·34-0·97; p=0·038) with pemetrexed than with placebo; no other significant differences in analyses of time to worsening were noted. Additional longitudinal analyses showed a greater increase in loss of appetite in the pemetrexed group than in the placebo group (4·3 mm vs 0·2 mm; p=0·028). Rates of resource use were statistically higher for pemetrexed than for placebo: admissions to hospital for drug-related adverse events (19 [4%] vs none; p=0·001), transfusions (42 [10%] vs seven [3%]; p=0·003), and erythropoiesis-stimulating agents (26 [6%] vs four [2%]; p=0·017). Interpretation: Quality of life during maintenance therapy with pemetrexed is similar to placebo, except for a small increase in loss of appetite, and significantly delayed worsening of pain and haemoptysis. In view of the improvements in overall and progression-free survival noted with pemetrexed maintenance therapy, such treatment is an option for patients with advanced non-squamous NSCLC who have not progressed after platinum-based induction therapy. Funding: Eli Lilly. © 2012 Elsevier Ltd.

Joshi H.S.,Kerala Institute of Medical science
BMJ case reports | Year: 2014

Tuberculosis is a common disease. The cutaneous form of tuberculosis known as tuberculid is an uncommon disease and is easily misdiagnosed. Lichen scrofulosorum is a rare form of tuberculid seen in children and young adults with or without other manifestations of tuberculosis. We report a case of a young adult with lichen scrofulosorum along with tuberculous lymphadenitis. The skin lesions responded promptly to antitubercular therapy with complete clearance of the lesions. Identification of the skin manifestation was especially important in this case because the lymph node biopsy was inconclusive, with tissue culture proving the diagnosis only after 4 weeks.

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