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Menon B.,Narayana Medical College and Superspeciality Hospital | Kinnera N.,Narayana Medical College
Annals of Indian Academy of Neurology | Year: 2013

Background: Migraine is a common neurological disorder with significant impact on quality of life. The aim of this study was to investigate the prevalence and characteristics of migraine headaches in medical students, to measure its impact on their life, and to assess their knowledge about the ailment. Information about lifestyle variables was also collected. Materials and Methods: All medical students who confirmed of having headache for more than 1 year formed the study group. Students filled a detailed questionnaire focusing on demographics, pain characteristics, accompanying factors, triggers, and family history of migraine. Lifestyle variables were enquired and migraine associated disability was assessed by MIDAS (Migraine Disability Assessment). The diagnosis of migraine was made according to the International Headache Society criteria. Results are expressed in n = numbers and percentage. Results: Sixty-eight percent of medical students had headache. The prevalence of migraine in the whole cohort was 28%; however, of the headache group, migraine constituted 42%. There was a female preponderance. One-fourth of the students had weekly or daily attacks with 31% students reporting increase in their headache intensity and frequency. Forty-four percent of students had severe headaches. Dizziness, allodynia, and neck stiffness were reported as accompanying symptoms. Trigger factors were identified in 99% students, predominant of which were poor sleep hygiene, environmental changes, head movements, and mental stress. Only 4% of students did regular exercise. Twenty-seven percent of students reported self-medication use of analgesics. One-fourth of the students had migraine-associated disability but only 6% realized that they had migraine. Conclusion: Our study found a high prevalence of headache with migraine in medical students. The students' awareness of the disease was very low with one-fourth of the students resorting to self-medication. Our study identified previously less-recognized triggers like head movement and accompanying symptoms like neck stiffness. Migraine-attributed burden was high in medical students.


Krishna Reddy S.V.,Narayana Medical College
International Neurourology Journal | Year: 2013

Various self-inflicted foreign bodies have been removed from the lower urinary tract and external male genitalia. In many cases foreign bodies were inserted or applied for autoerotic reasons which are frequently associated with mental health disorders. Here the author reports an unusual case of self insertion of a 6-cm long metal needle at penoscrotal junction of the erect penis for sexual pleasure. The stitching needle was inserted by a 20-year old male who was too ashamed to admit the motive at first. The caudal end of the needle was palpable at the root of the penis as it was below the urogenital diaphragm. The needle was successfully removed under fluoroscopic guidance with minor surgical exploration and with no complications. © 2013 Korean Continence Society.


Harihar C.,Narayana Medical College | Dasari P.,Narayana Medical College | Srinivas J.S.,Narayana Medical College
Indian Journal of Psychiatry | Year: 2013

It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression.


Krishna Reddy S.V.,Narayana Medical College | Shaik A.B.,Sri Venkateswara University
International Braz J Urol | Year: 2016

Purpose: To compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi. Materials and Methods: The medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared. Results: There was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p < 0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p < 0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2. Conclusion: Our study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.


Sarojini A.,Narayana Medical College | Sai Ravi Shanker A.,Narayana Medical College | Anitha M.,Narayana Medical College
Journal of Obstetrics and Gynecology of India | Year: 2013

Aim/Objective: Peripartum cardiomyopathy (PPCM) is a disorder of unknown etiology in which symptoms of heart failure occur between the last month of pregnancy and 5 months post-partum. These findings prompted us to carry out a more detailed study aimed at correlating plasma levels of C-reactive protein TNF-α and IL-6 as prognostic value for major clinical in-hospital events and 6-month follow-up in patients with PPCM. Materials and Methods: After ethical clearance, in the present prospective case-control study, a total of 86 subjects were enrolled [patients (n = 46) and controls (n = 40)]. After checking for the inclusion and exclusion criteria, informed consent was obtained and patients were enrolled. The details of history of pre-eclampsia and mode of delivery were obtained from the patients. The history of onset of symptoms and signs was recorded at the first presentation and at 6 months. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. All patients received treatment with diuretics and the ACE inhibitor (ramipril), Carvedilol if not contraindicated, and inotropic support inj-Dobutamine. Inflammatory markers (C-reactive protein, TNF-α, and IL-6) were measured at baseline and at 6 months. Data were analyzed using the SAS version 9.1 statistical program. Results: The characteristics of the study population at first presentation to the cardiac clinic are similar (compared with controls): 0.91 % of the study patients were diagnosed as PPCM patients for the first time and 49 % patients presented within one month after delivery. C-reactive protein (22 vs 08 mg/dl, p < 0.05), TNF-α (9.6 vs 3.2 pg/dl, p < 001), and IL-6 (73.19 ± 34.4 vs 31.52 ± 8.83 pg/dl, p < 0.005) were significantly abnormal, and these patients showed significantly higher LV dimensions, LV EDD (61.6 ± 7.1 vs 46 ± 9 mm p < 0.004) LV ESD (53.1 ± 7 vs 32 ± 8, p < 0.005), and significantly lower echocardiographic left ventricular ejection fraction (LVEF) (25.9 ± 8.2 vs 55 ± 12 p < 0.001) and correlate well with NYHA FC and death. LVEF improved from 25.9 ± 8.2 to 42.9 + 13.6 % at 6 months (p < 0.0001). Patients who completed 6 months of standard care showed a significant reduction of heart rate, LV dimensions, and NYHA FC (p < 0.001). However, normalization of LVEF (>50 %) was only observed in 11 (35 %) patients. Seven patients died within 6 months of diagnoses and eight patients were lost to follow-up. Conclusions: Plasma markers of inflammation were significantly elevated in PPCM patients and correlated with increased LV dimensions and lower EF at presentation. Baseline CRP, IL-6, TNF-α, and higher NYHA FC were the only predictors of mortality. These results contribute to inflammation which may contribute to the pathogenesis of PPCM and its complications and predictors of mortality. © 2013 Federation of Obstetric & Gynecological Societies of India.


Ranganath V.,Newcastle University Medicine Malaysia | Gayathri T.,Narayana Medical College
International Journal of Morphology | Year: 2013

During the routine dissection, a rare anomaly was observed in left lower limb of a female cadaver. The external iliac artery continued as femoral artery, branched on lateral side as the lateral circumflex femoral artery and on medial side as profunda femoris artery. On tracing the lateral circumflex femoral artery, the ascending branch towards the spinous anastomosis was very thin and coursed behind the rectus femoris muscle. The transverse and descending branches were not observed, however, the artery coursed along the vastus lateralis towards the knee. The femoral artery had its normal course and continued as popliteal artery. The profunda femoris artery originated from the medial side of the external iliac artery, initially superficial to the femoral vein, coursed downwards and posteriorly, relating posteromedial to femoral artery. The medial circumflex femoral artery originated as thin branch, which further divided into two divisions. The profunda femoris gave origin of 3 perforators and continued as 4th perforator. The unusual branching pattern was observed to be novel and not reported in the literature.


Reddy V.P.,Narayana Medical College
UroToday International Journal | Year: 2012

Wilms tumor is rare in adulthood. The prognosis is poor when compared with children. Adults more frequently present with advanced disease stages, and chemotherapy has a moderate effect. The various protocols of chemotherapy and indications for surgery and radiotherapy are not yet precisely defined, mainly due to the rarity of the disease. Here we report a case of adult Wilms tumor with spinal metastases who remains disease free for 3 years after undergoing multimodality treatment. © 2012 Digital Science Press, Inc.


Sai Ravi Shanker A.,Narayana Medical College | Phanikrishna B.,Narayana Medical College | Bhaktha Vatsala Reddy C.,Narayana Medical College
Indian Heart Journal | Year: 2013

Background/aims: To investigate the prevalence of erectile dysfunction (ED) in patients with coronary artery disease (CAD), its relationship between the severity of ED and the extent of coronary vessel involvement and to register the mean time interval between them. Methods: 240 patients with CAD divided into three age-matched groups: Group 1 (n = 60), ACS with one-vessel disease (1VD); group 2 (n = 60), ACS with 2,3VD; group 3 (n = 60), CSA. Control group (C, n = 60) was composed of patients with suspected CAD who were found to have entirely normal coronary arteries by angiography. ED as any value <26 according to the Gensini's scores and according to the International Index of Erectile Function (IIEF). Results: ED prevalence was 76%. ED prevalence was lower in G1 vs. G3 (22 vs.65%). G2 ED rate [55%, P < 0.0001] IIEF = 24 (17-29) & Gensini's scores-21 (12.5-32) were significantly different from G1 and similar to G3, ED in ACS differs according to the extent of CAD. G3 patients who had ED symptoms prior to CAD symptoms and time interval between ED and CAD symptom onset in CCS according to number of vessels. Onset of sexual dysfunction occurred before CAD onset with a mean time interval of 24 m [12-36]. Conclusion: Early diagnosis of ED, cardiovascular assessment and aggressive treatment of cardiovascular risk factors might have contributed to prevent the acute events of this patient. Patients should be systematically screened for ED as a part of periodic examination programs. This would lead to early detection of modifiable vascular risk factors, or already existing vascular disease and to prevent ED and vascular disease progression through pharmacological and life style modifications. Copyright © 2013, Cardiological Society of India. All rights reserved.


Anushree C.N.,Narayana Medical College | Shanti V.,Narayana Medical College
Journal of Clinical and Diagnostic Research | Year: 2015

A teratoma is a tumour with tissue or organ components resembling normal derivatives of more than one germ layer. We present a case of mediastinal mature teratoma as they have a low incidence rate. A 45-year-old female presented with right sided chest pain and paroxysmal attacks of dry cough and fever. A diagnosis of pulmonary hydatid cyst was made on computed tomography (CT) examination. Microscopic study revealed a tumour composed of elements from all the three germ layers. A diagnosis of mature mediastinal teratoma was made which is the second common site for germ cell tumours. © 2015, Journal of Clinical and Diagnostic Research. All right reserved.


Visser L.H.,St Elisabeth hospital | Jain S.,CODEWEL Nireekshana ACET | Lokesh B.,Narayana Medical College | Suneetha S.,CODEWEL Nireekshana ACET | Subbanna J.,Blue Peter Public Health and Research Center
Muscle and Nerve | Year: 2012

Introduction: From histopathological studies of peripheral nerves in leprosy, it is known that the epineurium can be thickened. We measured the epineurial thickness of the ulnar nerve by high resolution sonography (HRUS). Methods: The epineurium of the ulnar nerve was measured above the elbow on transverse scan in 25 healthy controls and 26 leprosy patients. Results: The mean epineurial thickness was 0.77 mm (95% confidence interval [CI] 0.66-0.88) in symptomatic ulnar nerves (n = 20), 0.58 mm (CI 0.51-0.65) in asymptomatic nerves (n = 30), and 0.49 mm (CI 0.44-0.54) in healthy controls (n = 25) (P = 0.0001). This thickening was related to the cross-sectional area of the ulnar nerve, but not with increased blood flow. Conclusions: The epineurium of the ulnar nerve can be measured with the use of HRUS, and it is often strikingly thickened in leprosy patients, especially in those with ulnar involvement. © 2012 Wiley Periodicals, Inc.

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