Kerala Institute of Medical science

Thiruvananthapuram, India

Kerala Institute of Medical science

Thiruvananthapuram, India
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Padmanabhan A.,Kerala Institute of Medical science | Thomas A.V.,Kerala Institute of Medical science
Lung India | Year: 2017

Actinomycosis is an indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria, primarily from the genus Actinomyces. Thoracic involvement is observed in approximately 15% of cases of infection with actinomycosis. Here, we present a case of a 61-year-old male who presented with recurrent endobronchial actinomycosis. The case is being presented because of its rarity on three counts - endobronchial involvement, which is uncommon, recurrence in different sites in the bronchial tree, which is even rarer and development of the disease following an endobronchial procedure.


Stohl W.,University of Southern California | Hiepe F.,Charité - Medical University of Berlin | Latinis K.M.,University of Kansas Medical Center | Thomas M.,Kerala Institute of Medical science | And 11 more authors.
Arthritis and Rheumatism | Year: 2012

Objective. To assess the effects of the B lymphocyte stimulator (BLyS)-specific inhibitor belimumab on immunologic biomarkers, including B cell and T cell populations, and maintenance of antibody titers to prior vaccines in autoantibody-positive systemic lupus erythematosus (SLE) patients. Methods. Pooled data from 2 phase III trials, the Study of Belimumab in Subjects with SLE 52-week (BLISS-52) and 76-week (BLISS-76) trials, comparing belimumab 1 mg/kg or 10 mg/kg versus placebo (plus standard SLE therapy for each group) were analyzed for changes in autoantibody, immunoglobulin, and complement levels. BLISS-76 patients were also analyzed for changes in B cell and T cell populations and effects on prior vaccine-induced antibody levels. Results. Belimumab-treated patients experienced significant sustained reductions in IgG and autoantibodies and improvement in C3/C4 levels, resulting in greater positive-to-negative conversion rates for IgG anti-double-stranded DNA (anti-dsDNA), anti-Sm, anticardiolipin, and anti-ribosomal P autoantibodies and normalization of hypergammaglobulinemia and low C3/C4 levels. Belimumab-treated patients experienced significant decreases in the numbers of naive and activated B cells, as well as plasma cells, whereas memory B cells and T cell populations did not decrease. Belimumab did not substantially affect preexisting antipneumococcal or anti-tetanus toxoid antibody levels. Post hoc analysis showed greater reductions in SLE disease activity and the risk of severe flares in patients treated with belimumab 10 mg/kg (P ≤ 0.01) who were anti-dsDNA positive and had low C3/C4 levels at baseline. Normalization of the C3 or anti-dsDNA level by 8 weeks, irrespective of therapy, was predictive of a reduced risk of severe flare over 52 weeks. Conclusion. Belimumab appears to promote normalization of serologic activity and reduce BLySdependent B cell subsets in serologically and clinically active SLE. Greater serologic activity may predict a better treatment response to belimumab. © 2012, American College of Rheumatology.


Navarra S.V.,University of Santo Tomas of Philippines | Guzman R.M.,SaludCoop Clinic | Gallacher A.E.,Hospital Britanico Of Buenos Aires | Hall S.,Emeritus Research Cabrini Hospital | And 13 more authors.
The Lancet | Year: 2011

Background: Systemic lupus erythematosus is a heterogeneous autoimmune disease that is associated with B-cell hyperactivity, autoantibodies, and increased concentrations of B-lymphocyte stimulator (BLyS). The efficacy and safety of the fully human monoclonal antibody belimumab (BLyS-specific inhibitor) was assessed in patients with active systemic lupus erythematosus. Methods: Patients (aged ≥18 years) who were seropositive with scores of at least 6 on the Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) were enrolled in a multicentre phase 3 study, which was done in Latin America, Asia-Pacific, and eastern Europe. Patients were randomly assigned by use of a central interactive voice response system in a 1:1:1 ratio to belimumab 1 mg/kg or 10 mg/kg, or placebo by intravenous infusion in 1 h on days 0, 14, and 28, and then every 28 days until 48 weeks, with standard of care. Patients, investigators, study coordinators, and sponsors were masked to treatment assignment. Primary efficacy endpoint was improvement in the Systemic Lupus Erythematosus Responder Index (SRI) at week 52 (reduction ≥4 points in SELENA-SLEDAI score; no new British Isles Lupus Assessment Group [BILAG] A organ domain score and no more than 1 new B organ domain score; and no worsening [<0.3 increase] in Physician's Global Assessment [PGA] score) versus baseline. Method of analysis was by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00424476. Findings: 867 patients were randomly assigned to belimumab 1 mg/kg (n=289) or 10 mg/kg (n=290), or placebo (n=288). 865 were treated and analysed in the belimumab (1 mg/kg, n=288; 10 mg/kg, n=290) and placebo groups (n=287). Significantly higher SRI rates were noted with belimumab 1 mg/kg (148 [51%], odds ratio 1.55 [95% CI 1.10-2.19]; p=0.0129) and 10 mg/kg (167 [58%], 1.83 [1.30-2.59]; p=0.0006) than with placebo (125 [44%]) at week 52. More patients had their SELENA-SLEDAI score reduced by at least 4 points during 52 weeks with belimumab 1 mg/kg (153 [53%], 1.51 [1.07-2.14]; p=0.0189) and 10 mg/kg (169 [58%], 1.71 [1.21-2.41]; p=0.0024) than with placebo (132 [46%]). More patients given belimumab 1 mg/kg (226 [78%], 1.38 [0.93-2.04]; p=0.1064) and 10 mg/kg (236 [81%], 1.62 [1.09-2.42]; p=0.0181) had no new BILAG A or no more than 1 new B flare than did those in the placebo group (210 [73%]). No worsening in PGA score was noted in more patients with belimumab 1 mg/kg (227 [79%], 1.68 [1.15-2.47]; p=0.0078) and 10 mg/kg (231 [80%], 1.74 [1.18-2.55]; p=0.0048) than with placebo (199 [69%]). Rates of adverse events were similar in the groups given belimumab 1 mg/kg and 10 mg/kg, and placebo: serious infection was reported in 22 (8%), 13 (4%), and 17 (6%) patients, respectively, and severe or serious hypersensitivity reactions on an infusion day were reported in two (<1%), two (<1%), and no patients, respectively. No malignant diseases were reported. Interpretation: Belimumab has the potential to be the first targeted biological treatment that is approved specifically for systemic lupus erythematosus, providing a new option for the management of this important prototypic autoimmune disease. Funding: Human Genome Sciences and GlaxoSmithKline. © 2011 Elsevier Ltd.


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.


Megha M.,Kerala Institute of Medical science | Jain N.,Kerala Institute of Medical science | Pillai R.,Kerala Institute of Medical science
Indian Pediatrics | Year: 2011

We present a case of cardiac tamponade following umbilical venous catheterization in a neonate, an uncommon, yet potentially fatal complication. Timely diagnosis by echocardiography and urgent pericardiocentesis proved lifesaving.


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.


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.


Sen A.,Medical College | Pillay R.,Kerala Institute of Medical science
Indian Journal of Radiology and Imaging | Year: 2011

Mycetoma is a chronic granulomatous disease that is more common in tropical than in temperate regions. Early diagnosis is important due to the therapeutic implications. Although biopsy and microbiological culture provide definitive diagnosis, they are time-consuming procedures and may not be able to provide a definite diagnosis in cases of fastidious organisms. The "dot-in- circle" sign has recently been proposed as a highly specific magnetic resonance imaging (MRI) and ultrasonography (USG) sign of mycetoma, which may allow a noninvasive as well as early diagnosis. We present a case of histologically proven mycetoma that demonstrated this sign.


Padmanabhan A.,Kerala Institute of Medical science | Thomas A.,Kerala Institute of Medical science
Lung India | Year: 2016

Although diaphragmatic anomalies such as an eventration and hiatus hernia are commonly encountered in incidental chest X-ray imaging, the presence of concomitant multiple anomalies is extremely rare. This is all the more true in adults. Herein, we present the case of a 75-year-old female, while undergoing a routine chest X-ray imaging, was found to have eventration of right hemidiaphragm along with a hiatus hernia as well. © 2016 Indian Chest Society Published by Wolters Kluwer - Medknow.

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