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PubMed | Medical Intensive Care Unit, Clinical Epidemiology Unit, SRM University, Pondicherry Institute of Medical science PIMS and Christian Medical College
Type: Journal Article | Journal: International journal of technology assessment in health care | Year: 2016

The majority of patients in India access private sector providers for curative medical services. However, there is scanty information on the cost of treatment of critically ill patients in this setting. The study evaluates the cost and extent of financial subsidy required for patients admitted to an intensive care unit (ICU) in India.Data on direct medical, direct nonmedical, and indirect cost were prospectively collected from critically ill patients admitted to a tertiary teaching hospital in India. Willingness-to-pay (WTP) amount was obtained from the next-of-kin following admission and the actual cost paid by the family at discharge was recorded.The main diagnoses (n = 499) were infection (26 percent) and poisoning (21 percent). The mean APACHE-II score was 13.9 (95 percent confidence interval [CI], 13.3-14.5); 86 percent were ventilated. ICU stay was 7.8 days (95 percent CI, 7.3-8.3). Hospital mortality was 27.9 percent. Direct medical cost accounted for 77 percent (US$ 2164) of the total treatment cost (US$ 2818). Indirect cost and direct nonmedical cost contributed to 19 percent (US$ 547.5) and 4 percent (US$ 106.5), respectively. Average total and daily ICU cost were US$ 1,897 and US$ 255, respectively. Although the familys WTP was 53 percent (US$ 1146; 95 percent CI, 1090-1204) of direct medical cost, their final contribution was 67.7 percent (US$ 1465; 95 percent CI, 1327-1604).The cost of an ICU admission in our setting is US$ 2818. Although the familys contribution to expenses exceeded their initial WTP, a substantial subsidy (33 percent) is still required. Alternate financing strategies for the poor and optimization of ICU resources are urgently required.


Sukumar S.,JIPMER | Das U.B.,Pondicherry Institute of Medical science PIMS
Indian Journal of Forensic Medicine and Toxicology | Year: 2015

In the examination of skeletal trauma, meticulous analysis of the skeletal remains is essential. In this paper we discuss a case where an autopsy was conducted on skeletonised remains of a body scattered in a grove. Some tell tale sign of injuries were present on the skull of the skeletonised remains, which indicated blunt and sharp force trauma sustained, but the samples taken at the site of injury sent to the forensic science laboratory for analysis turned out to be inconclusive. The focus of this paper is to highlight the fact that the fracture patterning in combination with fractured edge characteristics can be more useful for the assessment of perimortem skeletal trauma and that skeletal trauma is usually the only available source of information on cause and manner of death of skeletal remains. © 2015, Indian Journal of Forensic Medicine and Toxicology. All rights reserved.


Pal G.K.,JIPMER | Pal P.,JIPMER | Lalitha V.,JIPMER | Amudharaj D.,JIPMER | And 3 more authors.
International Angiology | Year: 2012

Aim. Prehypertension has recently been observed as a potent cardiovascular risk factor. Though prehypertension has a strong familial predisposition, the pathophysiological mechanisms that cause its progression to prehypertension in normotensive sibling of hypertensive parents have not yet been fully elucidated. Therefore, the present study was conducted in normotensive and prehypertensive sibling by spectral analysis of heart rate variability (HRV) to understand the nature of change in sympathovagal balance (SVB) in this condition. Methods. Body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), rate pressure product (RPP) and spectral indices of HRV were assessed in three groups of subjects: Group I (normotensive offspring of normotensive parents, N.=231); Group II (normotensive offspring of hypertensive parents, N.=113); and Group III (prehypertensives offspring of hypertensive parents, N.=52). SVB was analyzed and correlated with BMI, WHR, BHR, BP and RPP in all the groups. Results. Sympathovagal imbalance (SVI) was observed to be present in both normotensive and prehypertensive sibling of hypertensive parents. In normotensive sibling, SVI was mild in the form of proportionate increase in sympathetic and decreased vagal activity. In prehypertensive sibling, SVI was prominent with more of vagal withdrawal. Though LF-HF ratio, the indicator of SVB was correlated with all parameters in groups II and III, the significance was more with diastolic pressure and WHR. Conclusion. It was concluded that vagal inhibition plays a critical role in modulation of SVB for progression into prehypertension in normotensive sibling of hypertensive parents and WHR is a prominent marker of SVI in these subjects.


PubMed | Pondicherry University, Pondicherry Institute of Medical science PIMS, Manipal Cure and Care and Pondicherry Medical Mission
Type: Published Erratum | Journal: Emerging microbes & infections | Year: 2015

[This corrects the article DOI: 10.1038/emi.2013.71.].


PubMed | Pondicherry University, Pondicherry Institute of Medical science PIMS, Manipal Cure and Care and Pondicherry Medical Mission
Type: Journal Article | Journal: Emerging microbes & infections | Year: 2015

Although not previously known to cause human infections, Kocuria species have now emerged as human pathogens, mostly in compromised hosts with severe underlying disease. Recently, there has been an increasing incidence of different types of Kocuria infections reported, most likely due to the adoption of better identification methods. Here, we report a case of peritonitis caused by Kocuria rosea in a diabetic nephropathy patient who was on continuous ambulatory peritoneal dialysis. Sepsis and peritonitis caused by K. rosea in our case yielded two identical Kocuria isolates from the peritoneal dialysate fluid within a period of three days. The infection was subsequently resolved by antibiotic treatment and catheter removal. In addition to reporting this case, we herein review the literature concerning the emergence of Kocuria as a significant human pathogen. The majority of cases were device-related, acquired in the hospital or endogenous, and different Kocuria species appear to share a common etiology of peritonitis. The overall disease burden associated with Kocuria appears to be high, and the treatment guidelines for diseases associated with Kocuria have not yet been clearly defined.


Girish C.,Pondicherry Institute Of Medical Science Pims | Pradhan S.C.,Jawaharlal Institute of Postgraduate Medical Education & Research
Fundamental and Clinical Pharmacology | Year: 2012

Plant drugs are known to play a major role in the management of liver diseases. There are many plants and their extracts that have been shown to possess hepatoprotective activities. There are more than 300 preparations in Indian system of medicine for the treatment of jaundice and chronic liver diseases. About 600 commercial herbal formulations with claimed hepatoprotective activity are being sold all over the globe. The active phytochemical fraction that imparts hepatoprotective activity has been identified in many plants. These phytochemicals can be isolated and developed as single-ingredient drugs, with quality and standards of modern medicine. The major problem faced with herbal products is their standardization and their quality assurance. There can be batch-to-batch variations in their efficacies as a result of natural and genetic alterations, seasonal changes, differences in soil and climatic conditions, and nutritional status of the medicinal plant. Pharmacological validation of each hepatoprotective plant should include efficacy evaluation against liver diseases induced by various agents. The most effective drugs for each kind of liver disease have to be selected by separate efficacy evaluations. To treat liver disease of known, unknown, or multiple causes, a combination of different herbs with active fractions (or purified compounds) has to be developed. They may prove to be useful in the treatment of infective, toxic, and degenerative diseases of the liver. © 2011 The Authors Fundamental and Clinical Pharmacology © 2011 Société Française de Pharmacologie et de Thérapeutique.


Ambroise M.M.,Pondicherry Institute of Medical science PIMS | Balasundaram K.,Pondicherry Institute of Medical science PIMS | Phansalkar M.,Pondicherry Institute of Medical science PIMS
Turk Patoloji Dergisi/Turkish Journal of Pathology | Year: 2013

Objective: A micronucleus is a small additional nucleus formed due to chromosomal loss or fragmentation. The aim of this study was to assess the utility of micronucleus count as a screening tool in cervical cancer. Material and Method: A total of 132 cases consisting of 42 pre-neoplastic and neoplastic cases and 90 non-neoplastic cases were studied. Only routine Papanicolaou-stained cervical smears were used. In each smear, the number of micronucleated cells and binucleated cells were counted under oil immersion and expressed as a count per 1,000 cells. The micronucleated and binucleated cell counts in pre-neoplastic, neoplastic and non-neoplastic categories were compared for statistical significance. The counts were also correlated with age, duration of marital life, number of pregnancies and abortions. Results: The micronucleus count and the binucleated cell count were significantly higher in the high -grade squamous intraepithelial lesion (HSIL) and invasive carcinoma categories compared to low -grade squamous intraepithelial lesion (LSIL) and non-neoplastic cases. Receiver operating characteristic (ROC) curve analysis revealed that micronucleus count and binucleated cell count possess a high degree of sensitivity and specificity for identifying HSIL and invasive carcinoma. Conclusion: Our results reveal that micronucleus evaluation in routine Pap smears is a very useful biomarker in cervical cancer screening. The binucleated cell count increases the predictive value of this simple test.


Pal G.K.,Post Graduate Institute of Medical Education and Research | Pal P.,Post Graduate Institute of Medical Education and Research | Nanda N.,Pondicherry Institute of Medical science PIMS | Amudharaj D.,Post Graduate Institute of Medical Education and Research | Adithan C.,Post Graduate Institute of Medical Education and Research
Future Cardiology | Year: 2013

Hypertension (HTN) and prehypertension (pre-HTN) have been identified as independent risk factors for adverse cardiovascular events. Recently, increased psychosocial stress and work stress have contributed to the increased prevalence of HTN and pre-HTN, in addition to the contribution of obesity, diabetes, poor food habits and physical inactivity. Irrespective of the etiology, sympathetic overactivity has been recognized as the main pathophysiologic mechanism in the genesis of HTN and pre-HTN. Sympathovagal imbalance owing to sympathetic overactivity and vagal withdrawal is reported to be the basis of many clinical disorders. However, the role played by vagal withdrawal has been under-reported. In this review, we have analyzed the pathophysiologic involvement of sympathovagal imbalance in the development of HTN and pre-HTN, and the link of sympathovagal imbalance to cardiovascular dysfunctions. We have emphasized that adaptation to a healthier lifestyle will help improve sympathovagal homeostasis and prevent the occurrence of HTN and pre-HTN. © 2013 Future Medicine Ltd.


Arul P.,Pondicherry Institute of Medical science PIMS | Varghese R.G.,Pondicherry Institute of Medical science PIMS | Ramdas A.,Pondicherry Institute of Medical science PIMS
Journal of Clinical and Diagnostic Research | Year: 2013

A pseudotumour is a rare presentation of bronchopulmonary tuberculosis which occurs in immunocompetent patients, which can simulate malignancy, both clinically and radiologically, and may cause delay in its diagnosis and treatment. The incidence of bronchopulmonary pseudotumours was found to vary from 2-4%, as was seen in various studies. A mycobacterial pseudotumour of the pleura is a rare entity. We are reporting a case of a pleura based tubercular pseudotumour in a 59 years old patient who presented with a four month history of the nonspecific symptoms of cough and chest pain. The radiological investigations showed that a pleural based mass lesion was occupying the right lower hemithorax. The initial biopsy was suggestive of a hyalinizing variant of an inflammatory pseudotumour. The follow-up surgical resected mass was consistent with the features of a tubercular granuloma. The clinical presentation and the histopathological findings have been presented, with a brief review of the literature. Due to its varied and unusual presentation, bronchopulmonary tuberculosis should always be kept in mind when a patient with a similar clinical and a radiological picture is being evaluated.


Pal G.K.,Post Graduate Institute of Medical Education and Research | Pal P.,Post Graduate Institute of Medical Education and Research | Nanda N.,Pondicherry Institute of Medical science PIMS | Lalitha V.,Post Graduate Institute of Medical Education and Research | And 2 more authors.
International Journal of Hypertension | Year: 2011

Objective. Though prehypertension has strong familial predisposition, difference in pathophysiological mechanisms in its genesis in offspring of both parents and single parent hypertensive have not been elucidated. Methods. Body mass index (BMI), waist-hip ratio (WHR), basal heart rate (BHR), blood pressure (BP), HR and BP response to standing, deep breathing difference, BP response to handgrip and spectral indices of heart rate variability (HRV) were analyzed in normotensive offspring of two parents hypertensive (Group I), normotensive offspring of one parent hypertensive (Group II), prehypertensive offspring of two parents hypertensive (Group III) and prehypertensive offspring of one parent hypertensive (Group IV). Results. Sympathovagal imbalance (SVI) in prehypertensive offspring was observed due to increased sympathetic and decreased vagal activity. In group III, SVI was more prominent with greater contribution by vagal withdrawal. LF-HF ratio, the marker of SVI was correlated more with diastolic pressure, 30: 15 ratio and E: I ratio in prehypertensives and the degree of correlation was more in group III prehypertensives. Conclusion. Vagal withdrawal plays a critical role in development of SVI in prehypertensive offspring of hypertensive parents. The intensity of SVI was more in offspring of two parents hypertensive compared to single parent hypertensive. © 2011 G. K. Pal et al.

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