Vasan S.S.,Manipal Hospital
Indian Journal of Urology | Year: 2011
Semen analysis as an integral part of infertility investigations is taken as a surrogate measure for male fecundity in clinical andrology, male fertility, and pregnancy risk assessments. Clearly, laboratory seminology is still very much in its infancy. In as much as the creation of a conventional semen profile will always represent the foundations of male fertility evaluation, the 5th edition of the World Health Organization (WHO) manual is a definitive statement on how such assessments should be carried out and how the quality should be controlled. A major advance in this new edition of the WHO manual, resolving the most salient critique of previous editions, is the development of the first well-defined reference ranges for semen analysis based on the analysis of over 1900 recent fathers. The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. Sperm function testing is used to determine if the sperm have the biologic capacity to perform the tasks necessary to reach and fertilize ova and ultimately result in live births. A variety of tests are available to evaluate different aspects of these functions. To accurately use these functional assays, the clinician must understand what the tests measure, what the indications are for the assays, and how to interpret the results to direct further testing or patient management.
Adhikary R.,Manipal Hospital |
Joshi S.,Manipal Hospital
Indian Journal of Medical Microbiology | Year: 2011
Candidaemia is one of the leading causes of nosocomial bloodstream infections. There is a rise in the incidence of non-albicans candidaemia and emergence of anti-fungal resistance. We performed a retrospective laboratory-based study over a period of 2 years (January 2009 to December 2010) at our quaternary care multi super-specialty hospital in Southern India. There had been 68 Candida isolates detected from the bloodstream of 55 patients during the study period. Overall, 74% of cases were due to non-albicans Candida. C. tropicalis was most commonly isolated (39.7%), followed by C. albicans (26.4%). All Candida isolates remain susceptible to voriconazole, whereas highest degree of resistance was observed for fluconazole.
Elackatt N.J.,Manipal Hospital
Journal of Genetic Counseling | Year: 2013
Although the basic goal and components of genetic counseling appears to be the same across the globe, judged by my experiences there are significant differences in the provision of genetic counseling services in Australasia (Australia and New Zealand) and India. There is poor recognition of the professional status of a genetic counselor in India at present. This may be partly because genetic counseling itself is a relatively new discipline within the medical field in India, although some types of genetic services and research have been conducted since 1960s. In this paper, I aim to provide insight from my personal transnational experiences. © 2013 National Society of Genetic Counselors, Inc.
Sibal M.,Manipal Hospital
Journal of Ultrasound in Medicine | Year: 2012
The follicular ring sign is a novel, easily identifiable sonographic finding of ovarian torsion consisting of hyperechoic rings around the antral follicles. In a retrospective analysis of 15 consecutive patients with torsion undergoing surgery, the follicular ring sign was frequently present, starting early in the disease course. This sign could be valuable for accurate and early diagnosis of torsion in the absence of specific conventional sonographic features. © 2012 by the American Institute of Ultrasound in Medicine.
Sikora S.S.,Manipal Hospital
Indian Journal of Surgery | Year: 2012
Cholecystectomy is one of the common surgical procedure performed across the world and bile duct injury is a dreaded complication. The present review addresses the classification of injuries, preoperative preparation and evaluation of these patients and appropriate timing of surgery. A detailed preoperative evaluation combined with a meticulous wide anastomosis by experienced surgeons is the key in achieving long term success. Vascular injuries and its consequences on repair and outcome is also reviewed. Long term results of surgical repair and quality of life in these patients are excellent © 2011 Association of Surgeons of India.
Vidyadhara S.,Manipal Hospital
Spine | Year: 2014
STUDY DESIGN.: Case report. OBJECTIVE.: To report the first case of 4-level lumbar spondylolysis in the literature. SUMMARY OF BACKGROUND DATA.: Although there are quite a few reported cases of 2-or 3-level spondylolysis, none reported on 4-level spondylolysis. Management guidelines have not been suggested in literature. METHODS.: A 48-year-old female presented with long-standing severe spinal instability, low back pain, and bilateral neurogenic claudication. Management of the patient with 4-level spondylolysis, varied clinical profile of each of the levels with respect to clinical symptoms and treatment based on the usefulness of pars block is described. RESULTS.: Two levels were treated with intervertebral fusions, 1 level with pars repair, and conservative treatment of the last level pars lysis yielded in good clinicoradiological outcome in our patient. CONCLUSION.: Success of management of multiple lyses depends on the choice of appropriate treatment for each level separately. Pars block is a good invasive investigation to detect the symptomatic levels in a complex situation. Copyright © 2014 Lippincott Williams &Wilkins.
Chacko J.,Manipal Hospital |
Gagan B.,Manipal Hospital |
Kumar U.,Manipal Hospital |
Mundlapudi B.,Manipal Hospital
Minerva Anestesiologica | Year: 2015
Background. Real-time ultrasound guidance may enable precise introducer needle and guidewire insertion during percutaneous dilatational tracheostomy (PDT). However, the safety of PDT done solely under ultrasound guidance has not been compared to additional bronchoscopic confirmation. We aimed to compare the efficacy, incidence of complications and procedural times of real-time ultrasound guided PDTs done with and without bronchoscopic confirmation. Methods. We analysed all bedside PDTs performed over an 18 month period. On transverse view, the introducer needle was inserted under real time guidance into the chosen interspace. The interspace of guidewire entry was confirmed on longitudinal view. In the bronchoscope group, needle and guidewire position within the tracheal lumen were confirmed by bronchoscopy. Results. We performed 177 PDTs under ultrasound guidance during the study period - 95 with and 82 without bronchoscopic confirmation. The introducer needle was inserted at the desired level on the first attempt in 81.4% of instances with no difference between groups (77.9% vs. 85.4%, P=0.6). Introducer needle entry between the first and third tracheal cartilages did not differ between groups (90.5% vs. 92.7%, P=0.6). Procedural times were longer in the bronchoscope group (13.9 min vs. 10.7 min, P<0.0001). There were more episodes of fall in oxygen saturation below 90% in the bronchoscope group (16.8% vs. 3.7%, P=0.006). Minor bleeding occurred in 6.2% of cases and did not differ between groups. Conclusion. Ultrasound guidance for PDT may be equally safe, even without bronchoscopic confirmation; the incidence of hypoxic episodes may be less and the procedure can be performed in less time. © 2015 EDIZIONI MINERVA MEDICA.
Gopurappilly R.,Manipal University India |
Bhat V.,Manipal Hospital |
Bhonde R.,Manipal University India
Journal of Cellular Biochemistry | Year: 2013
Insufficient β-cell mass is a common denominator for both type1 and type 2 diabetes. In vitro generation of β-cells from islet precursor cells, exocrine cells or ductal epithelia provide an alternative source of insulin-producing cells. However the presence of multipotent precursor cells within the pancreas is also deliberated. In this study we isolated mesenchymal stromal cell (MSC)-like cells from adult mouse pancreas by collagenase digestion. We used Knockout DMEM for our isolation procedure and the floating islets and acini were removed after 48 h. This strategy permitted the adhesion of stromal cells with typical mesenchymal morphology. These cells not only expressed MSC-specific markers like Sca-1, CD90.2, CD73, and CD44 but also generated osteocytes, adipocytes, and neurons when induced with specific growth media. Upon exposure to islet differentiation serum-free cocktail a significant upregulation of pancreatic markers like Nkx2.2, Nkx6.1, Pdx1, insulin, and somatostatin was seen. The differentiated islet-like cell aggregates (ICAs) secreted insulin which increased over the days in culture in presence of basal glucose levels. Taken together, our data strongly indicate that there is a tissue-resident precursor population within the pancreas that can be exploited for islet neogenesis in vitro. J. Cell. Biochem. 114: 2240-2247, 2013. © 2013 Wiley Periodicals, Inc. Copyright © 2013 Wiley Periodicals, Inc.
Dubey D.,Manipal Hospital
Indian Journal of Urology | Year: 2011
Introduction : Direct visual internal urethrotomy (DVIU) followed by intermittent self-dilatation (ISD) is the most commonly performed intervention for urethral stricture disease. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of anterior urethral strictures. Materials and Methods : A Pubmed database search was performed with the words "internal urethrotomy" and "internal urethrotomy self-catheterization." All papers dealing with this subject were scrutinized. Cross-references from the retrieved articles were also viewed. Only English language articles were included in the analyses. Studies were analyzed to identify predictors for success for DVIU. Results : Initial studies showed excellent outcomes with DVIU with success rates ranging from 50% to 85%. However, these studies reported only short-term results. Recent studies with longer followup have shown a poor success rate ranging from 6% to 28%. Stricture length and degree of fibrosis (luminal narrowing) were found to be predictors of response. Repeated urethrotomies were associated with poor results. Studies involving intermittent self-catheterization following DVIU have shown no role in short-term ISD with one study reporting beneficial effects if continued for more than a year. A significant number of studies have shown long-term complications with SC and high dropout rates. Conclusions : DVIU is associated with poor long-term cure rates. It remains as a treatment of first choice for bulbar urethral strictures <1cm with minimal spongiofibrosis. There is no role for repeated urethrotomy as outcomes are uniformly poor. ISD, when used for more than a year on a weekly or biweekly basis may delay the onset of stricture recurrence.
Somashekhar S.P.,Manipal Hospital
Best Practice and Research: Clinical Obstetrics and Gynaecology | Year: 2015
Lymph-node-positive gynaecological cancers remain a pharmacotherapeutic challenge, and patients with lymph-node-positive gynaecological cancers have poor survival. The purpose of this review is to determine whether a survival advantage arises from surgical debulking of enlarged positive lymph nodes in different types of gynaecological cancers. Information from studies published on the survival benefits from debulking lymph nodes in gynaecological cancers was investigated. Pertaining to therapeutic lymphadenectomy, survival benefit can be analysed in two ways, direct survival benefit following therapeutic lymphadenectomy of bulky positive metastatic lymph nodes and indirect survival benefit, which results after a sequela of systematic lymphadenectomy, proper, accurate staging of disease and stage migration and tailor-made adjuvant treatment. The direct hypothesis of therapeutic lymphadenectomy and survival benefit has been prospected in cervical cancers and vulval cancers and in post-chemotherapy residual paraarotic nodal mass in germ cell ovarian cancer. The indirect survival benefit of therapeutic paraarotic lymphadenectomy in high-risk endometrial cancers and advanced epithelial ovarian cancers needs to be tested in randomized controlled trials. More randomized controlled trials are required to investigate this research question. Further, indirect benefit due to tailor-made adjuvant treatment, secondary to accurate staging achieved as a sequela of systematic lymphadenectomy, needs to be analysed in future trials. © 2015 Elsevier Ltd.