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Thivyah Prabha A.G.,Narayana Medical College and Hospital | Sekar D.,Bangalore University
Gene Reports | Year: 2017

Breast cancer is more common among urban females. It has been estimated that in India there will be 155,000 new cases of breast cancer and 76,000 deaths due to breast cancer in 2015. Many factors play a key role in the progression of breast cancer but there is no evidence that proves or cures its progressions. Therefore, it is very important to take necessary early steps to screen, diagnose and treat the breast cancer as early as possible to save millions of lives. The present review high lights the significance of so many factors responsible for the progression of this disease, which includes pathological causes, roles of various molecular and biochemical markers, genetic mutations, role of micro RNA, gene expression analysis, cancer stem cells, apoptotic markers, prognosis, treatment and also emerging treatment modalities along with the existing ones like vaccines. © 2017


Bathala L.,Narayana Medical College and Hospital | Sharma V.K.,National University Hospital Singapore
Annals of Indian Academy of Neurology | Year: 2013

Although the clinical features in some patients with cerebrovascular ischemia may be ill defined, majority of the patients present with focal neurological deficits caused by an arterial occlusion, and the clinical presentations are usually referable to the involved arterial territory. Therefore, vascular imaging constitutes an important component of the diagnostic workup. Cervical duplex ultrasonography of carotid and vertebral arteries is employed to evaluate the extracranial vasculature while transcranial Doppler provides important information about intracranial hemodynamic changes in cerebrovascular ischemia. These two components of cerebrovascular ultrasonography are fast and reproducible, and can be performed at the bedside. They provide real-time information about the status of cervico-cranial arterial patency and various hemodynamic alterations, including collateral flow. The information obtained from cerebrovascular ultrasonography is useful for diagnostic as well as prognostic purposes. Furthermore, it can be used to monitor cerebral blood flow for extended periods and aid in decision making for various interventions. The hemodynamic information obtained from cerebrovascular ultrasonography helps in determining the underlying mechanisms of brain ischemia, and is complementary to the clinical examination and other imaging modalities. We describe the technique of performing cervical duplex sonography, diagnostic criteria for arterial stenosis, characterizing plaque morphology, measuring intima-media thickness and various pitfalls while performing the test. © 2013 Annals of Indian Academy of Neurology.


Gundala R.,Narayana Dental College and Hospital | Chava V.K.,Narayana Dental College and Hospital | Ramalingam K.,Narayana Medical College and Hospital
Journal of Periodontology | Year: 2014

Background: Serum leptin concentrations are reported to be elevated in patients with periodontal diseases and may have a modulating role in cardiovascular diseases. Serum leptin concentrations have not been assessed in periodontitis associated with acute myocardial infarction (AMI) to date. The purpose of this study was to assess the concentration of serum leptin in periodontitis associated with AMI. Methods: A cross-sectional clinical study was conducted comprising a sample size of 120 participants divided into four groups (n = 30 each) based on their clinical signs: 1) control; 2) AMI; 3) generalized chronic periodontitis (GCP); and 4) GCP + AMI. Body mass index (BMI) was calculated and recorded for all the subjects based on BMI chart of the World Health Organization. After thorough clinical and oral examination, plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment loss (AL) were recorded. In addition, 2mL venous blood was collected by venipuncture from all participants to determine serum leptin concentration using the enzyme-linked immunosorbent assay method. Results: A strong correlation of serum leptin concentration to BMI was observed in AMI, GCP, and GCP + AMI groups. Serum leptin levels were significantly elevated in AMI, GCP, and GCP + AMI groups compared to the control group. Significant associations between serum leptin concentration and PI, GI, PD, and AL were also seen in the GCP group. PI, GI, PD, and AL were statistically significantly elevated in GCP + AMI and AMI groups. Conclusion: Elevated serum leptin concentration was associated with increased BMI, GCP, and AMI and may serve as a risk marker for these conditions.


Burg E.W.-Van.,St Elisabeth Hospital | Bathala L.,Narayana Medical College and Hospital | Visser L.H.,St Elisabeth Hospital
Muscle and Nerve | Year: 2014

Introduction: Ultrasound (US) measurement of the median nerve cross-sectional area (CSA) at the wrist is a useful diagnostic test for carpal tunnel syndrome (CTS). We compared median nerve normal values between samples of Indian and Dutch populations. Methods: The median nerve was examined by US at the wrist in 100 healthy volunteers in India and 137 volunteers in The Netherlands using the same protocol. Results: Median nerve CSA at the wrist (7.0±1.1 mm2) in the Indian cohort was lower in comparison to the Dutch cohort (8.3±1.9 mm2; P<0.05). This difference was still present after controlling for age, height, and weight (P=0.001). Conclusions: CSA normal values for the median nerve were different between the examined population samples even after correcting for age, height, and weight. This enforces the idea that laboratories around the world should obtain their own normative data. © 2013 Wiley Periodicals, Inc..


Krishna C.V.,Narayana Medical College and Hospital
Dermatology online journal | Year: 2013

Hobnail hemangioma is a rare, benign vascular growth that typically presents in the third and fourth decades of life. It classically presents as a targetoid lesion with a violaceous central papule surrounded by a peripheral ecchymotic rim. Common sites of involvement include extremities and trunk. We present this case of hobnail hemangioma in a 10-year- old boy because of its rarity.


Bathala L.,Narayana Medical College and Hospital | Kumar P.,Narayana Medical College and Hospital | Kumar K.,Narayana Medical College and Hospital | Shaik A.B.,Narayana medical college and hospital | Visser L.H.,St Elisabeth Hospital
Muscle and Nerve | Year: 2014

Introduction: The objective of this study is to obtain normative cross-sectional area (CSA) values for median nerve by ultrasound at predetermined sites and correlate them with electrophysiological variables in healthy Asian subjects. Methods: The median nerve was examined ultrasonographically in 100 healthy volunteers, mean age 39 years (range, 18-75 years). CSA of the median nerve was measured at wrist, mid-forearm, mid-arm, and axilla. All subjects underwent simultaneous standardized nerve conduction studies. Results: The mean median nerve CSAs±SD at the distal wrist crease was 7.2±1 mm2; mid-forearm 4.8±0.9 mm2; mid-arm 6.1±1 mm2; axilla 5.9±0.9 mm2. The CSA at the wrist was the largest compared with other levels (P<0.001), and it increased with advancing age (P<0.002). Conclusions: These normative data show that median nerve CSA is not uniform along its length. There are differences between gender, and values increase with advancing age. © 2013 Wiley Periodicals, Inc.


Bathala L.,Narayana medical college and Hospital | Kumar P.,Narayana medical college and Hospital | Kumar K.,Narayana medical college and Hospital | Visser L.H.,St Elisabeth Hospital
Muscle and Nerve | Year: 2013

Introduction: Normative cross-sectional areas (CSAs) have been obtained for the Western population. We obtained CSAs of normal ulnar nerves at predetermined sites and correlate them with electrophysiological variables in Asian subjects. Methods: One hundred healthy volunteers, mean age 39 ± 14 years (range, 18-75 years), were recruited for the study after obtaining informed consent. The ulnar nerve was examined ultrasonographically from wrist to axilla, and CSA was measured at predetermined sites. All subjects underwent a simultaneous standardized nerve conduction study. Results: Men had larger CSAs, and CSAs increased with advancing age. There was a statistically significant correlation between CSA at the wrist and distal ulnar motor latency (P = 0.005). Conclusions: Ulnar CSA correlated with age, gender, and distal motor latency. No correlations were observed with height, weight, or body mass index. © 2012 Wiley Periodicals, Inc.


Subrahmanyam B.V.,Narayana Medical College and Hospital
Journal of Neurosciences in Rural Practice | Year: 2013

In a landmark judgment, the supreme court of India laid down guidelines in cases of alleged negligence against medical practitioners in India. It clearly stated that there is a need for protecting doctors from frivolous or unjust prosecution.


Bathala L.,Narayana Medical College and Hospital
Journal of Neurosciences in Rural Practice | Year: 2012

Southeastern part of United States has been called the Stroke Belt due to a much higher incidence of stroke compared to the rest of the country. In this article, I summarize my 2 weeks of observations as a clinical preceptor at the Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL. 57 patients were admitted during these 2 weeks, 61% had ischemic strokes, and 23% received intravenous recombinant tissue plasminogen activator (IV rt-PA). Endovascular neuro-interventionalists were performing diagnostic catheter angiography in 14% and emergent revascularization procedures in 7% of consecutive patients. Also, the stroke team enrolled 6 patients into National institute of health (NIH) funded clinical trials (3 Argatroban tPA stroke study (ARTSS), 2 Safety study of external counter pulsation as a treatment for acute ischemic stroke (CUFFS), 1 stenting and aggressive medical management for preventing recurrent stroke in intracranial stenosis (SAMMPRIS). In my opinion, these observations provided me with useful knowledge how to develop a cutting edge, proactive stroke treatment system. In particular, availability 24 × 7 and consistent application of a curative, "finding reasons to treat approach" coupled with state-of the-art technologies and skilled operators could make a huge difference.


Bathala L.,Narayana Medical College and Hospital | Mehndiratta M.,GB Pant Hospital | Sharma V.,National University Hospital Singapore
Annals of Indian Academy of Neurology | Year: 2013

Transcranial Doppler (TCD) can be aptly called as the doctor's stethoscope of the brain. Since its introduction in 1982, by Rune Aaslid, TCD has evolved as a diagnostic, monitoring, and therapeutic tool. During evaluation of patients with acute ischemic stroke, TCD combined with cervical duplex ultrasonography provides physiological information on the cerebral hemodynamics, which is often complementary to structural imaging. Currently, TCD is the only diagnostic tool that can provide real time information about cerebral hemodynamics and can detect embolization to the cerebral vessels. TCD is a noninvasive, cost-effective, and bedside tool for obtaining information regarding the collateral flow across various branches of the circle of Willis in patients with cerebrovascular disorders. Advanced applications of TCD help in the detection of right-to-left shunts, vasomotor reactivity, diagnosis, and monitoring of vasospasm in subarachnoid hemorrhage and as a supplementary test for confirmation of brain death. This article describes the basic ultrasound physics pertaining to TCD insonation methods, for detecting the flow in intracranial vessels in addition to the normal and abnormal spectral flow patterns.

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