Krishna Institute of Medical science

Minister Road, India

Krishna Institute of Medical science

Minister Road, India

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Das U.N.,UND Life science | Das U.N.,Krishna Institute of Medical science
Cancer and Metastasis Reviews | Year: 2011

Stem cells are pluripotent and expected to be of benefit in the management of coronary heart disease, stroke, diabetes mellitus, cancer, and Alzheimer's disease in which pro-inflammatory cytokines are increased. Identifying endogenous bioactive molecules that have a regulatory role in stem cell survival, proliferation, and differentiation may aid in the use of stem cells in various diseases including cancer. Essential fatty acids form precursors to both pro- and anti-inflammatory molecules have been shown to regulate gene expression, enzyme activity, modulate inflammation and immune response, gluconeogenesis via direct and indirect pathways, function directly as agonists of a number of G protein-coupled receptors, activate phosphatidylinositol 3-kinase/Akt and p44/42 mitogen-activated protein kinases, and stimulate cell proliferation via Ca 2+, phospholipase C/protein kinase, events that are also necessary for stem cell survival, proliferation, and differentiation. Hence, it is likely that bioactive lipids play a significant role in various diseases by modulating the proliferation and differentiation of embryonic stem cells in addition to their capacity to suppress inflammation. Ephrin Bs and reelin, adhesion molecules, and microRNAs regulate neuronal migration and cancer cell metastasis. Polyunsaturated fatty acids and their products seem to modulate the expression of ephrin Bs and reelin and several adhesion molecules and microRNAs suggesting that bioactive lipids participate in neuronal regeneration and stem cell proliferation, migration, and cancer cell metastasis. Thus, there appears to be a close interaction among essential fatty acids, their bioactive products, and inflammation and cancer growth and its metastasis. © 2011 Springer Science+Business Media, LLC.


Kaul U.,Fortis Escorts Heart Institute | Bangalore S.,New York University | Seth A.,Fortis Escorts Heart Institute | Arambam P.,Fortis Escorts Heart Institute | And 9 more authors.
New England Journal of Medicine | Year: 2015

BACKGROUND The choice of drug-eluting stent in the treatment of patients with diabetes mellitus and coronary artery disease who are undergoing percutaneous coronary intervention (PCI) has been debated. Previous studies comparing paclitaxel-eluting stents with stents eluting rapamycin (now called sirolimus) or its analogues (everolimus or zotarolimus) have produced contradictory results, ranging from equivalence between stent types to superiority of everolimus-eluting stents. METHODS We randomly assigned 1830 patients with diabetes mellitus and coronary artery disease who were undergoing PCI to receive either a paclitaxel-eluting stent or an everolimus-eluting stent. We used a noninferiority trial design with a noninferiority margin of 4 percentage points for the upper boundary of the 95% confidence interval of the risk difference. The primary end point was target-vessel failure, which was defined as a composite of cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization at the 1-year follow-up. RESULTS At 1 year, paclitaxel-eluting stents did not meet the criterion for noninferiority to everolimus-eluting stents with respect to the primary end point (rate of targetvessel failure, 5.6% vs. 2.9%; risk difference, 2.7 percentage points [95% confidence interval, 0.8 to 4.5]; relative risk, 1.89 [95% confidence interval, 1.20 to 2.99]; P = 0.38 for noninferiority). There was a significantly higher 1-year rate in the paclitaxeleluting stent group than in the everolimus-eluting stent group of target-vessel failure (P = 0.005), spontaneous myocardial infarction (3.2% vs. 1.2%, P = 0.004), stent thrombosis (2.1% vs. 0.4%, P = 0.002), target-vessel revascularization (3.4% vs. 1.2%, P = 0.002), and target-lesion revascularization (3.4% vs. 1.2%, P = 0.002). CONCLUSIONS In patients with diabetes mellitus and coronary artery disease undergoing PCI, paclitaxel-eluting stents were not shown to be noninferior to everolimus-eluting stents, and they resulted in higher rates of target-vessel failure, myocardial infarction, stent thrombosis, and target-vessel revascularization at 1 year. © 2015 Massachusetts Medical Society.


Kesiraju S.,Transimmun | Kesiraju S.,Bhagwan Mahavir Medical Research Center | Paritala P.,Krishna Institute of Medical science | Rao Ch U.M.,Krishna Institute of Medical science | And 2 more authors.
Transplant Immunology | Year: 2014

New onset of diabetes after transplantation (NODAT) is a serious and common complication following solid organ transplantation. NODAT has been reported to occur in 2% to 53% of renal transplant recipients. Several risk factors are associated with NODAT, however the mechanisms underlying were unclear. Renal transplant recipients who develop NODAT are reported to be at increased risk of infections, cardiovascular events, graft loss and patient loss. It has been reported that the incidence of NODAT is high in the early transplant period due to the exposure to the high doses of corticosteroids, calcineurin inhibitors and the physical inactivity during that period. In addition to these risk factors the traditional risk factors also play a major role in developing NODAT. Early detection is crucial in the management and control of NODAT which can be achieved through pretransplant screening there by identifying high risk patients and implementing the measures to reduce the development of NODAT. In the present article we reviewed the literature on the epidemiology, risk factors, mechanisms involved and the diagnostic criteria in the development of NODAT. Development of diagnostic tools for the assessment of β-cell function and determination of the role of glycemic control would include future area of research. © 2013 Elsevier B.V.


Patibandla M.R.,Nizam's Institute of Medical Sciences | Thotakura A.K.,NRI Medical College | Panigrahi M.K.,Krishna Institute of Medical science
British Journal of Neurosurgery | Year: 2014

Cavernomas constitute 5-10% of all the vascular malformations of the CNS. They commonly present during the 2nd and 5th decades of life. Intraventricular cavernomas constitute rare pathological entity, constituting 2.5-10.8% of cerebral cavernomas.1 The natural history of intraventricular cavernomas remains undefined to some extent. Those in third ventricle are different in biological nature and need more aggressive therapy. These cavernomas appear to have the ability to grow very rapidly, resulting in significant morbidity. It is not known whether waiting after acute hemorrhage from an intraventricular cavernoma improves our ability to remove the lesion safely or if waiting unnecessarily increases the risk of hydrocephalus, additional bleeding, or further lesion growth. © 2014 The Neurosurgical Foundation.


Mohammad H.-U.-R.,National Institute of Neurosciences and Hospital | Vooturi S.,Krishna Institute of Medical science | Panigrahi M.,Krishna Institute of Medical science
Neurology India | Year: 2016

Background: We report our experience with the far lateral approach (FLA) and its modifications in the surgical resection of tumors of craniocervical junction (CCJ). Materials and Methodology: We retrospectively reviewed data of 36 patients with CCJ lesions who underwent surgical excision. Data are presented as frequency/percentages. Tumor locations were classified by anatomical relation around the CCJ (on axial plane). For anterior and laterally placed tumors, we preferred the FLA and its modification. A postoperative complication was defined as a new neurological deficit without subsequent recovery. The perioperative mortality was defined as death within 30 days of surgery. Results: The mean age of the study population was 48.8 years (5-64 years) with 15 women. Simpson's Scale Grade 2 resection was achieved in 18 out of 19 patients with meningiomas. Overall, transient complications were observed in eight patients (22%); none of the patients developed postoperative cerebrospinal fluid fistula. The permanent morbidity rate was 5.6%. One patient died on the 6th postoperative day. The mean follow-up period was 4.1 years (range, 3 months-12 years). Tumor recurrence was observed in two patients who were advised radiotherapy. Twenty patients (96%) were independent for activities of daily living. Conclusion: The FLA is a versatile approach and is useful for a variety of lesions located ventrolateral to the brainstem and upper cervical cord. It allows adequate exposure with minimal retraction. Most of the foramen magnum meningiomas can be excised either without or with only partial resection of the condyle. The transjugular process approach to the jugular foramen (JF) is effective for JF tumors without the necessity of facial nerve transposition.


Phatak R.S.,Krishna University | Pratinidhi A.K.,Krishna University | Hendre A.S.,Krishna Institute of Medical science
Asian Journal of Pharmaceutical and Clinical Research | Year: 2015

Background: India is endowed with enormous varieties of spices grown in the majority of the country and one of the largest exporters of spices in the world. Many household spices are being used integrally in the Indian foods. Spices are normally added in the food to impart flavor. They are naturally occurring antioxidants, which have the potential capacity to counteract aging process in the body, to stabilize the cell membrane by scavenging free radicals in small doses. Objectives: The current study was designed to determine antioxidant potential of some selected spices and their mixture based on the established scientific evidences and oxygen radical absorbance capacity values using different in vitro models and correlating. Methods: The powder of assigned spices and their mixture were alcoholically extracted by a simple maceration method. They were evaluated for their total phenolic and flavonoid contents. Antioxidative abilities of the extracts of spices individually and their mixtures extracts were analyzed by phosphomolybdenum assay, cupric ions reducing antioxidant capacity (CUPRAC) and ferric ions reducing ability power methods. The free radical scavenging activities such as hydrogen peroxide, ABTS, anti-peroxidation like TBARS (thiobarbituric acid reactive substance), crocin bleaching and metal chelation capacity were assayed through in vitro models. Results and Discussion: Antioxidant and antiradical effects of the selected spices extracts and spices mixture extract (SME) was ascertained through different in vitro models. Results of individual tests demonstrated good correlation among themselves. CUPRAC has strong correlation with all other assays except to diphenyl-1-picrylhydrazyl (DPPH) and thiobarbituric acid reactive substances (TBARS). DPPH and TBARS were correlated with each other however they demonstrated no relationship with other assays. Conclusion: Extracts of selected Indian spices extracts and SME have shown dissimilarity to each other. Study for the 1st time establishes aggregate index for evaluation of Indian spices. On basis of aggregate index, nutmeg has highest value among the selected spices and no significant synergistic effect has been found in SME. CUPRAC as antioxidant assay and hydroxyl free radical scavenging assay by using Smirnoff reagent are most appropriate assays to ascertain antioxidative and free scavenger properties of natural products. © 2015, Asian Journal of Pharmaceutical and Clinical Research. All rights reserved.


Panigrahi M.,Krishna Institute of Medical science | Das P.K.,Indraprastha Apollo Hospital
Indian Journal of Cancer | Year: 2011

Glioblastoma is a rapidly progressive and extremely fatal form of brain tumor with poor prognosis. It is the most common type of primary brain tumor. Even with the most aggressive conventional treatment that comprises surgery followed by radiotherapy and chemotherapy, most patients die within a year of diagnosis. Developments in molecular and cell biology have led to better understanding of tumor development, leading to novel treatment strategies including biological therapy and immunotherapy to combat the deadly disease. Targeted drug delivery strategies to circumvent the blood-brain barrier have shown efficiency in clinical trials. Gliadel wafer is a new approach to the treatment of glioblastoma, which involves controlled release delivery of carmustine from biodegradable polymer wafers. It has shown promising results and provides a silver lining for glioblastoma patients.


Somayajula S.,Krishna Institute of Medical science | Vooturi S.,Krishna Institute of Medical science | Jayalakshmi S.,Krishna Institute of Medical science
Epilepsy and Behavior | Year: 2015

Objective: The current study evaluated the association between clinical variables and psychiatric disorders (PDs) in patients with juvenile myoclonic epilepsy (JME). Methods: Consecutive patients with JME who had at least two years of regular follow-up from May 2011 to April 2014 formed the study population. The association between clinical and sociodemographic data with psychiatric evaluation on structured clinical interview and quality of life in epilepsy - 31 (QOLIE-31) was evaluated using logistic regression analysis. Results: Out of 165 patients in the current study, 77 (46.6%) patients were diagnosed with PDs; while 50 were categorized to having anxiety disorders, 27 patients had depressive disorders. The mean age of the study population was 25.35. ± 7.6. years with 37.52% women. Patients with PDs had lower overall QOLIE score (55.84. ± 13.07 vs 68.70. ± 11.23, p < 0.001) and lower social function score (80.95. ± 19.22 vs 91.09. ± 14.74, p < 0.001). Being married was the strongest predictor of depressive disorders (β = 8.59; 95% CI, 1.44-51.28; p = 0.018); whereas, lower emotional well-being (β = 0.942; 95% CI, 0.907-0.978; p = 0.002) was the only variable associated with anxiety disorders. Patients with depressive disorders had longer duration of PDs (11.85. ± 8.68. years vs 7.75. ± 6.70. years, p = 0.039), and a majority of them were married (66.7% vs 26.0%, p = 0.001). Patients with depressive disorders scored low on emotional well-being (50.81. ± 14.62 vs 61.02. ± 13.05, p = 0.002), energy levels (52.78. ± 11.71 vs 62.80. ± 10.84, p < 0.001), and social function (70.96. ± 20.69 vs 86.34. ± 16.16, p = 0.001). Depressive disorders were more prevalent among married patients above 35. years of age (5.2% vs 36.8%, p = 0.042). Significance: Nearly half of the patients with JME had coexisting PDs. The psychological profile of anxiety disorders was different from depressive disorders in patients with JME. Depressive disorders were more prevalent among older patients with JME, and marriage was strongly associated with depressive disorders. © 2015 Elsevier Inc..


Vooturi S.,Krishna Institute of Medical science | Jayalakshmi S.,Krishna Institute of Medical science | Sahu S.,Krishna Institute of Medical science | Mohandas S.,Krishna Institute of Medical science
Clinical Neurology and Neurosurgery | Year: 2014

Methods In this open cohort study, data of 126 patients, aged 18 years and above, with convulsive status epilepticus (SE) admitted in NICU was collected. Status epilepticus was defined as seizures lasting for more than five minutes without regaining consciousness. Refractory SE (RSE) was defined as SE refractory to 2 antiepileptic drugs and requiring anesthetic agents for seizure control. Survival and regression analysis were done to analyze the outcome and factors predicting outcome respectively in the study population.Results Out of 126 patients, 81 patients had non -refractory status epilepticus (NRSE); 45 (35.7%) had RSE. Acute symptomatic etiology was noted in 58.6% of entire cohort. Significantly higher percentage of patients with RSE had an etiology of CNS infections than NRSE group (44.4% vs. 23.5%; P = 0.0171). Amongst the CNS infections, viral encephalitis was significantly higher in RSE than NRSE patients (31% vs. 6.2%; P = 0.0004). All the patients with RSE required mechanical ventilation. Overall mortality was 19%. The mortality in RSE was 42% (19 out of 45), significantly higher when compared to NRSE where only 6% (5 out of 81) died. On logistic regression, the only predictor of death was fever with an odds ratio of 8.55 (P = 0.024).Objective To evaluate the etiological profile, clinical characteristics and outcome of patients with refractory generalized convulsive status epilepticus treated in Neurological Intensive Care Unit (NICU).Conclusion CNS infections, especially viral encephalitis and complications of mechanical ventilation were significantly higher in adult RSE patients. Although mortality is higher in adult patients with RSE, etiology does not contribute to mortality; however fever predicts mortality in these patients. Aggressive management of underlying etiology and prevention of systemic complications may improve outcome in adult RSE patients. © 2014 Elsevier B.V.


Wader J.,Krishna Institute of Medical science | Gajbi N.,Krishna Institute of Medical science
Journal of Clinical and Diagnostic Research | Year: 2013

A neoplastic (solid), calcifying ghost cell tumour is a rare subtype of Calcifying Odontogenic Cyst. The most important features of this pathologic entity are histopathological features, which include a proliferating cystic lining which demonstrates characteristic "Ghost" epithelial cells which have a propensity to calcify. We are reporting a case of a 61-year-old male with a painful swelling in the lower right jaw. Radiology showed a bilocular, well circumscribed, radiolucent lesion in the mandible, which measured 2×1 cm, with radiopaque structures within it. Tooth extraction was done, with enucleation of the lesion, which histopathologically revealed features of a solid, calcifying ghost cell tumour, with an intraosseous variant. The case has been presented, with a brief review of literature.

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