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Christopher J.,CARE Hospitals | Raj V.,Narayana Institute of Cardiac science | Nukala S.,CARE Hospitals | Venugopal K.,Pushpagiri Institute of Medical science
Current Cardiovascular Imaging Reports | Year: 2015

Noninvasive cardiac imaging has undergone a recent resurgence in India with the development of new approaches for imaging coronary atherosclerosis. Noncontrast computed tomography (CT) for imaging the extent of coronary artery calcification (CAC) and contrast CT for noninvasive coronary angiography (CTA) are developments with a growing evidence base regarding risk assessment and the diagnosis of obstructive coronary disease. Stress myocardial perfusion SPECT (MPS) is the most commonly used stress imaging technique for patients with suspected or known coronary disease, which is slowly gaining popularity in urban India. In contrast to the nascent evidence noted with coronary CTA, MPS has a robust evidence base, including the support of numerous clinical guidelines. It is likely that assessing the extent of atherosclerosis using CAC or coronary CTA will become an increasing part of mainstream cardiovascular imaging practices. © 2015, Springer Science+Business Media New York.

Vupputuri A.,Amrita University | Sekhar S.,Amrita University | Krishnan S.,Amrita University | Venugopal K.,Pushpagiri Institute of Medical science | Natarajan K.U.,Amrita University
Indian Heart Journal | Year: 2015

Background Heart-type fatty acid-binding protein (H-FABP) is an emerging biomarker, which was found to be sensitive for the early diagnosis of acute myocardial infarction (AMI). We prospectively investigated the usefulness of H-FABP determination for the evaluation of acute chest pain in patients arriving at the emergency department. Methods Fifty-four patients presenting with acute ischemic chest pain were evaluated. H-FABP was estimated at admission using latex-enhanced immunoturbidimetric assay. Serial cardiac troponin I (cTnI), creatinine kinase-MB (CK-MB) determination, ischemia workup with stress testing, and/or coronary angiogram (CAG) were performed according to standard protocols. Results The sensitivity and specificity of H-FABP was 89.7% and 68%, for cTnI it was 62.1% and 100%, and for CK-MB it was 44.8% and 92%, respectively for diagnosis of AMI. The sensitivity of H-FABP was found to be far superior to initial cTnI and CK-MB, for those seen within 6 h (100% vs. 46.1%, 33% respectively). On further evaluation of patients with positive H-FABP and negative cTnI, 71.4% of the patients had significant lesion on CAG, indicating ischemic cause of H-FABP elevation. Six patients with normal cTnI and CK-MB with high H-FABP had ST elevation on subsequent ECGs and were taken for primary angioplasty. Conclusion H-FABP is a highly sensitive biomarker for the early diagnosis of AMI. H-FABP as early marker and cTnI as late marker would be the ideal combination to cover the complete diagnostic window for AMI. Detection of myocardial injury by H-FABP may also be applied in patients with unstable angina. H-FABP can also be used as a marker for early detection of STEMI before the ECG changes become apparent. © 2015 Cardiological Society of India.

Jacob K.,Christian Medical College | Kallivayalil R.,Pushpagiri Institute of Medical science | Mallik A.,Burdwan Medical College | Gupta N.,Government Medical College and Hospital | And 5 more authors.
Indian Journal of Psychiatry | Year: 2013

The development of the Diagnostic and Statistical Manual-5 (DSM-5) has been an exhaustive and elaborate exercise involving the review of DSM-IV categories, identifying new evidence and ideas, field testing, and revising issues in order that it is based on the best available evidence. This report of the Task Force of the Indian Psychiatric Society examines the current draft of the DSM-5 and discusses the implications from an Indian perspective. It highlights the issues related to the use of universal categories applied across diverse cultures. It reiterates the evidence for mental disorders commonly seen in India. It emphasizes the need for caution when clinical categories useful to specialists are employed in the contexts of primary care and in community settings. While the DSM-5 is essentially for the membership of the American Psychiatric Association, its impact will be felt far beyond the boundaries of psychiatry and that of the United States of America. However, its atheoretical approach, despite its pretensions, pushes a purely biomedical agenda to the exclusion of other approaches to mental health and illness. Nevertheless, the DSM-5 should serve a gate-keeping function, which intends to set minimum standards. It is work in progress and will continue to evolve with the generation of new evidence. For the DSM-5 to be relevant and useful across the cultures and countries, it needs to be broad-based and consider social and cultural contexts, issues, and phenomena. The convergence and compatibility with International Classification of Diseases-11 is a worthy goal. While the phenomenal effort of the DSM-5 revision is commendable, psychiatry should continue to strive for a more holistic understanding of mental health, illness, and disease.

Kallivayalil R.A.,Pushpagiri Institute of Medical science
Indian Journal of Psychiatry | Year: 2016

The Burgholzli Hospital Zurich has a very important place in history, as part of of modern era in Psychiatry. Founded in 1870 by the efforts of Griesinger, it was here many eminent path breakers in Psychiatry like Bleuler, Jung, Adolf Meyer and others once worked. From here, Bleuler coined the term 'Schizophrenia'. Now the University Hospital of Zurich, Burgholzli's transformation from a mental hospital to a centre of excellence speaks of a rich legacy. It is a model worth emulating in many parts of the world. © 2016 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow.

Supriya Simon A.,Pushpagiri Institute of Medical science | Dinesh Roy D.,Center for Advanced Genetic Studies | Jayapal V.,Government General Hospital | Vijayakumar T.,Kannur University
Indian Journal of Clinical Biochemistry | Year: 2011

Cardiovascular autonomic neuropathy (CAN) is one of the most clinically significant complications of diabetes mellitus. Even though many ethological factors have been attributed for the pathogenesis of this disease no attempts were made to correlate DNA damage as a causative factor. Hence the present study was undertaken to asses the extent of somatic DNA damages by cytokinesis-block micronuclei assay (CBMN). An attempt is also being made to correlate the habits and/or risk factors and socioeconomic status with CAN. The CBMN frequency of 46 patients suffering from autonomic neuropathy was compared with that of 25 healthy age and sex matched controls. All the subjects were suffering from type 2 diabetes for at least 8 years and have varying degrees of coronary artery diseases. The mean CBMN frequency of the patients was statistically higher than that of the healthy control subjects (P < 0.05). The CBMN frequency was found to be significantly altered in CAN patients who where physical inactivity and smoking. A significant correlation could also be observed between CAN and smoking, diabetes mellitus, hypertension, dyslipidemia, abdominal obesity, and physical activity. © 2010 Association of Clinical Biochemists of India.

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