Bangalore, India
Bangalore, India

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PubMed | Singapore General Hospital, National University of Singapore and MS Ramaiah Memorial Hospital
Type: | Journal: Bone marrow transplantation | Year: 2016

The refined disease risk index (DRI) is a powerful prognostic model based solely on the disease type and stage for predicting survival outcomes of various hematological malignancies after allogeneic transplant. Here, we analyzed our series of 690 patients transplanted over the past 15 years, and showed that besides overall survival (OS), the refined DRI is also able to segregate event-free survival and relapse mortality in our cohort of largely Southeast Asian patients with a long and complete follow-up. Stratification by refined DRI remains statistically significant even when broken down by specific diseases each with a smaller number of patients, as well as for a small subset of patients younger than 18 years old, providing a robust model for prognostication. Multivariable analysis shows that refined DRI, age, year of transplant and donor type are independent risk factors for OS. We further demonstrated here that prognostication for a given patient with a specific disease can be made more discriminating by integrating independent risk factors such as age and donor type with the refined DRI. The future development of prognostic system incorporating the refined DRI with patient- and transplant-related risk factors will provide a more precise estimate of transplant outcome.Bone Marrow Transplantation advance online publication, 31 October 2016; doi:10.1038/bmt.2016.286.


Gayathri Devi H.J.,MS Ramaiah Medical College | Mohan Rao K.N.,MS Ramaiah Medical College | Prathima K.M.,MS Ramaiah Memorial Hospital | Das J.K.,Cardiothoracic Surgery
Lung India | Year: 2011

Pulmonary alveolar microlithiasis is a rare disease of unknown cause. We report a case in a young boy who presented with history of failure to thrive and chest X-ray finding suggestive of miliary mottling. Open lung biopsy revealed pulmonary alveolar microlithiasis.


Ramkumar S.,MS Ramaiah Hospital | Rakshita C.,MS Ramaiah Hospital | Elizabeth J.,MS Ramaiah Medical College | Mathews J.,MS Ramaiah Memorial Hospital | And 2 more authors.
Online Journal of Health and Allied Sciences | Year: 2011

Background: Medical students today are subject to a variety of stress; academic, social, emotional or stress in the form of affliction of health during their stay at medical school. The physiological response to these depends on various factors including their inherent coping abilities. This study was designed to examine the coping ability of medical and nursing students at the time of admission to medical school. Materials and Methods: 42 medical and 34 nursing students volunteered for the study. They were administered the BAI questionnaire and classified as good and poor adjusters based on their score. Results: The study revealed an unsatisfactory overall coping ability to be prevalent among medical and nursing students. Conclusion: This study showed that there is a need for orientation and counselling of medical and nursing students at the start of college.


PubMed | Nizam's Institute of Medical Sciences, LTM Medical College & LTMG Hospital, Krishna Institute of Medical science, Shubhechha Multispecialty Hospital and 7 more.
Type: Journal Article | Journal: Clinical rheumatology | Year: 2016

The objective of this study was to assess the safety and efficacy of itolizumab with methotrexate in active rheumatoid arthritis (RA) patients who had inadequate response to methotrexate. In this open-label, phase 2 study, 70 patients fulfilling American College of Rheumatology (ACR) criteria and negative for latent tuberculosis were randomized to four arms: 0.2, 0.4, or 0.8mg/kg itolizumab weekly combined with oral methotrexate, and methotrexate alone (2:2:2:1). Patients were treated for 12weeks, followed by 12weeks of methotrexate alone during follow-up. Twelve weeks of itolizumab therapy was well tolerated. Forty-four patients reported adverse events (AEs); except for six severe AEs, all others were mild or moderate. Infusion-related reactions mainly occurred after the first infusion, and none were reported after the 11th infusion. No serum anti-itolizumab antibodies were detected. In the full analysis set, all itolizumab doses showed evidence of efficacy. At 12weeks, 50% of the patients achieved ACR20, and 58.3% moderate or good 28-joint count Disease Activity Score (DAS-28) response; at week 24, these responses were seen in 22 and 31 patients. Significant improvements were seen in Short Form-36 Health Survey and Health Assessment Questionnaire Disability Index scores. Overall, itolizumab in combination with methotrexate was well tolerated and efficacious in RA for 12weeks, with efficacy persisting for the entire 24-week evaluation period. (Clinical Trial Registry of India, http://ctri.nic.in/Clinicaltrials/login.php , CTRI/2008/091/000295).


PubMed | Siddhi Nursing Home, Krishna Institute of Medical science, Fortis Hospital, Vadodara Institute for Reconstructive Orthopedic Care and 10 more.
Type: | Journal: Asian journal of surgery | Year: 2016

In the Re-NOVATE II study, oral dabigatran provided thromboprophylaxis after total hip arthroplasty and improved compliance postdischarge in a global population. This article aims to identify trends (if any) in the Indian population.In this prospective, double-blind, double-dummy study, patients scheduled for primary, unilateral, elective total hip arthroplasty were randomized to 220mg oral dabigatran once daily, starting with a 110mg half-dose, 1-4hours after surgery, or subcutaneous enoxaparin 40mg once daily, starting the evening before surgery. Each group received a placebo of the other study drug. The primary efficacy outcome was the composite of total venous thromboembolism (VTE) and all-cause mortality. Secondary outcome measures were composite of major VTE and VTE-related mortality during the treatment period. The major safety outcome was incidence of bleeding events.Of the 179 Indian patients randomized, 91 received oral dabigatran and 88 received subcutaneous enoxaparin for 28-35days. Total VTE and all-cause mortality occurred in 18.7% of patients in the dabigatran group and 13.7% in the enoxaparin group [odds ratio=1.4 (95% confidence interval 0.6, 3.5)]. Major VTE and VTE-related mortality was numerically lower in the dabigatran group (7.9%) compared with the enoxaparin group (9.9%). Safety outcomes were comparable between both groups.Dabigatran is an effective oral alternative to enoxaparin for thromboprophylaxis as demonstrated by the RE-NOVATE II study global results. Data analyzed in Indian patients indicate comparable effects of dabigatran etexilate for major efficacy and safety outcomes.


Gupta P.K.,Stempeutics Research Pvt Ltd. | Chullikana A.,Stempeutics Research Pvt Ltd. | Parakh R.,Medicity | Desai S.,MS Ramaiah Memorial Hospital | And 6 more authors.
Journal of Translational Medicine | Year: 2013

Background: Peripheral vascular disease of the lower extremities comprises a clinical spectrum that extends from no symptoms to presentation with critical limb ischemia (CLI). Bone marrow derived Mesenchymal Stem Cells (BM- MSCs) may ameliorate the consequences of CLI due to their combinatorial potential for inducing angiogenesis and immunomodulatory environment in situ. The primary objective was to determine the safety of BM- MSCs in patients with CLI.Methods: Prospective, double blind randomized placebo controlled multi-center study was conducted in patients with established CLI as per Rutherford classification in category II-4, III-5, or III-6 with infra-inguinal arterial occlusive disease and were not suitable for or had failed revascularization treatment. The primary end point was incidence of treatment - related adverse events (AE). Exploratory efficacy end points were improvement in rest pain, increase in Ankle Brachial Pressure Index (ABPI), ankle pressure, healing of ulcers, and amputation rates. Twenty patients (BM-MSC: Placebo = 1:1) were administered with allogeneic BM-MSCs at a dose of 2 million cells/kg or placebo (PlasmaLyte A) at the gastrocnemius muscle of the ischemic limb.Results: Improvement was observed in the rest pain scores in both the arms. Significant increase in ABPI and ankle pressure was seen in BM-MSC arm compared to the placebo group. Incidence of AEs in the BM-MSC arm was 13 vs. 45 in the placebo arm where as serious adverse events (SAE) were similar in both the arms (5 in BM-MSC and 4 in the placebo group). SAEs resulted in death, infected gangrene, amputations in these patients. It was observed that the SAEs were related to disease progression and not related to stem cells.Conclusion: BM-MSCs are safe when injected IM at a dose of 2 million cells/kg body weight. Few efficacy parameters such as ABPI and ankle pressure showed positive trend warranting further studies.Trial registration: NIH website (http://www.clinicaltrials.gov/ct2/show/NCT00883870). © 2013 Gupta et al.; licensee BioMed Central Ltd.


Mahesh E.,MS Ramaiah Hospitals | Ramesh D.,MS Ramaiah Hospitals | Indumathi V.A.,MS Ramaiah Memorial Hospital | Mohd. Wasim Khan,MS Ramaiah Hospitals | And 2 more authors.
Journal, Indian Academy of Clinical Medicine | Year: 2010

Background: Knowledge of the risk factors associated with community-acquired extended-spectrum-beta-lactamase-positive urinary tract infection is essential in determining the empiric antibiotic therapy of high-risk cases. Epidemiological studies of the same are limited. Aim: To analyse the risk factors of community-acquired extended-spectrum-beta-lactamase-positive urinary tract infection in prior non-hospitalised patients. Methodology: A prospective study was done including patients with established diagnosis of urinary tract infection confirmed by positive urine culture reports. Age over 60 years, male gender, diabetes mellitus, foley's catheterisation, and genitourinary instrumentation were analysed for their predictability for community-acquired extended-spectrum-beta-lactamase-positive urinary tract infection. Results: Except male gender, none of the established risk factors were found to have a significant association with communityacquired extended-spectrum-beta-lactamase-positive urinary tract infection. Conclusion: The trends in the epidemiology of community-acquired extended-spectrum-beta-lactamase-positive urinary tract infection are not similar to hospital-acquired extended-spectrum-beta-lactamase-positive urinary tract infection. Further evaluation is required for better understanding of the rationale of the present results and to establish the epidemiology of community acquired ESBL-positive urinary tract infection.


Gayathri Devi H.J.,MS Ramaiah Medical College | Mohan Rao K.N.,MS Ramaiah Medical College | Prathima K.M.,MS Ramaiah Memorial Hospital | Moideen R.,MS Ramaiah Medical College
Respiratory Medicine Case Reports | Year: 2013

Pulmonary mucormycosis is a relatively uncommon infection. It can present in various forms. Very few cases of pulmonary mucormycosis presenting as vocal cord paralysis have been described in the literature. We report a case of pulmonary mucormycosis presenting as vocal cord paralysis in an uncontrolled diabetic patient. © 2013 Elsevier Ltd.


PubMed | MS Ramaiah Medical College and MS Ramaiah Memorial Hospital
Type: | Journal: Respiratory medicine case reports | Year: 2015

Pulmonary mucormycosis is a relatively uncommon infection. It can present in various forms. Very few cases of pulmonary mucormycosis presenting as vocal cord paralysis have been described in the literature. We report a case of pulmonary mucormycosis presenting as vocal cord paralysis in an uncontrolled diabetic patient.


Ramarajapalli M.L.,MS Ramaiah Memorial Hospital | Rao N.A.R.,MS Ramaiah Memorial Hospital | Murudaraju P.,MS Ramaiah Memorial Hospital | Kilara N.G.,MS Ramaiah Memorial Hospital
Journal of Gynecologic Surgery | Year: 2012

Background: Pure nongestational ovarian choriocarcinoma (NGOC) is very rare tumor and has a poor prognosis. NGOC usually spreads to the lungs, liver, and brain. Metastases to the spleen and adrenal glands are rare, but simultaneous metastases to the spleen and adrenal glands have not been reported so far in the English literature. A case of NGOC with metastases to the splenic parenchyma and right adrenal gland is reported. Case: A 25-year-old woman presented with abdominal pain and was found to have a right ovarian mass and metastatic deposit in the right adrenal gland and spleen. She underwent optimal cytoreduction including excision of a right ovarian tumor, a partial splenectomy by radiofrequency ablation, and a right adrenalectomy. In view of her youth, her uterus and left adnexa were spared. Following these procedures, the patient received chemotherapy. Results: This patient is now in complete remission. Her β-human chorionic gonadotrophin levels post-treatment have reached normal levels. Conclusions: Aggressive surgery combined with chemotherapy may improve the prognosis of individuals with ovarian choriocarcinoma. Fertility-sparing surgery in such young individuals is possible, and may be psychologically beneficial. © 2012 Mary Ann Liebert, Inc.

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