Rout R.,Regional Medical Research Center |
Dhangadamajhi G.,Regional Medical Research Center |
Mohapatra B.N.,SCB Medical College and Hospital |
Kar S.K.,Regional Medical Research Center |
Ranjit M.,Regional Medical Research Center
Infection, Genetics and Evolution | Year: 2011
The complement receptor 1 (CR1/CD35) protein acts as the major rosetting receptor in Plasmodium falciparum infection and several genetic variants of CR1 gene have been shown to be associated with quantitative expression of erythrocyte CR1 (E-CR1) level. However, CR1 level and gene polymorphisms exhibit differences in clinical manifestation of malaria in regions of varying disease endemicity. The result of the present study which analyzed three SNPs (intron 27 HindIIIA>T, exon 22 3650 A>G, and exon 33 5507 C>G) of the CR1 gene in Orissa, a hyperendemic state in eastern-India showed that a significantly increased risk for cerebral malaria (CM) was associated with AA genotype of both intron 27 and exon 22 when compared with mild, severe malaria anemia (SMA) and CM. +. SMA group respectively. Further, the overall haplotype analysis for all the three loci showed predominantly two major haplotypes 'AAC' coding for higher expression of CR1 and 'TGG' haplotype coding for low expression of CR1 level with the former haplotype being significantly associated with CM (P value. <. 0.00619 after Bonferroni correction) compared to mild malaria. The 'TGG' haplotype was proportionately more in SMA cases compared to mild malaria though statistically not significant. These findings suggest that the mild malaria group had an intermediate level of E-CR1 and extremely low or high levels of CR1 can cause severity in malaria. Further large scale studies in different endemic regions are needed to explain the epidemiological differences between E-CR1 expression and clinical manifestation of malaria which may contribute to the understanding of malaria pathogenesis. © 2010 Elsevier B.V.
Das R.R.,All India Institute of Medical Sciences |
Naik S.S.,SCB Medical College and Hospital
Pediatric Allergy and Immunology | Year: 2015
Studies have found a link between neonatal hyperbilirubinemia (NNH) and/or neonatal phototherapy (NPT) and childhood allergic diseases. The present systematic review was conducted to provide updated evidence and to provide direction regarding future research. A systematic search of the published literature was carried out. Observational studies including children up to 12 yr of age were included. Data extraction was carried out using a standardized data extraction form that was designed and pilot tested a priori. The analysis was carried out with the statistical software RevMan (version 5.2) [Protocol is registered at PROSPERO: CRD42014009943]. Of 79 citations retrieved, a total of 7 good quality studies (n = 101,499) were included in the final analysis. There was a significant increase in the odds of asthma and allergic rhinitis (AR) after NNH [asthma, OR 4.26 (95% CI 4.04-4.5); AR, OR 5.37 (95% CI 4.16-6.92)] and after NPT [asthma, OR 3.81 (95% CI 3.53-4.11); AR, OR 3.04(95% CI 2.13-4.32)]. A similar increase in the trend was noted for late onset of asthma after NNH [OR 4.1 (95% CI 2.82-5.94)], and hospitalization due to asthma after NPT [OR 3.56 (95% CI 2.93-4.33)]. The GRADE evidence generated was of 'low quality'. The current evidence finds a significant increase in the odds of childhood allergic diseases after NNH and/or NPT. As observational studies were included, the evidence generated was of 'low quality'. Future studies should try to elucidate the pathophysiologic link between NNH and/or NPT and childhood allergic diseases. © 2015 John Wiley & Sons A/S.
Das R.R.,All India Institute of Medical Sciences |
Sankar J.,All India Institute of Medical Sciences |
Naik S.S.,SCB Medical College and Hospital
Archives of Disease in Childhood | Year: 2015
Objective: We evaluated the role of diosmectite as an add-on treatment to the 'recommended treatment' of acute diarrhoea in children. Methods: We searched all published literature through the major databases: Medline via Ovid, PubMed, CENTRAL, Embase and Google Scholar till May 2014. Randomised clinical trials comparing diosmectite versus placebo were included (PROSPERO registration: CRD42014013783). Main outcome measures: The primary outcome measures were duration of acute diarrhoea (h), and dayto-day cure rates (%). The secondary outcome measures were stool output (volume), stool output (frequency) and adverse events. Results: Of 384 citations retrieved, a total of 13 randomised clinical trials (2164 children, 1-60 months old) were included in the meta-analysis. A dose of 3-6 grams per day of diosmectite was given for a duration from 3 days until recovery. Compared with placebo, diosmectite significantly decreased the duration of acute diarrhoea (mean difference, -23.39; 95% CI -28.77 to -18.01), and increased the cure rate (%) at day 5 (OR, 4.44; 95% CI 1.66 to 11.84), without any increases in the risk of adverse events. Diosmectite was effective in all types of acute childhood diarrhoea except dysentery. Because, most of the trials were open-label, and there was a high possibility of publication bias, the GRADE evidence generated was of 'low quality'. Conclusions: Diosmectite may be a useful additive in the treatment of acute childhood diarrhoea. As the evidence generated was of 'low quality', future research is needed with higher quality designs before any firm recommendations can be made. Trial registration number: PROSPERO registration: CRD42014013783. © 2015, BMJ Publishing Group. All rights reserved.
Panda C.,SCB Medical College and Hospital
Journal of Association of Physicians of India | Year: 2013
Objective: To investigate the efficacy and safety of Telbivudine + Tenofovir combination therapy in chronic hepatitis B patients, over a period of 52 weeks, in real life clinical settings. Methods: HBeAg-positive and HBeAg-negative adult CHB patients, with hepatitis B virus (HBV) DNA > 4 log10 copies/ml and ALT 1.2 times above upper limit of normal (> 30 IU/L) were started on a combination of Telbivudine 600 mg + Tenofovir 300 mg in a real life clinical setting. The reduction in serum HBV DNA levels from baseline was evaluated at Week 24 and 52. The HBV DNA was measured using the PCR test with a lower limit of detection of 100 IU/ml Results: 21 (2 female/19 male) patients, with mean (SD) age of 46.2 (13.2), were prescribed this regimen. 70% of them were HBeAg negative at baseline. Data of 11 out of 21 patients was available at week 52. The mean HBA-DNA reduction from baseline to week 24 (n=15) was 2.6 log10 copies/mL (p =.000) and 4.0 log10 copies/mL (p =.001) at week 52 (n = 11). By the end of study visit at week 52, 10 out of 11 patients had achieved the HBV-DNA levels of < 100 Iu/ml. The mean ALT levels came down by 101.4 IU/L (p =.005) at week 24 (n = 15) and by 104.6 IU/L at week 52 (n = 11). 7 patients achieved ALT normalisation (ALT < 40 IU/L) at week 24, with additional 4 achieving the goals at week 52. Combination therapy was well tolerated, with no safety related concerns. No cases of virological breakthrough or primary treatment failure were observed. Being a real life setting, there were certain limitations: Out of 10 patients whose data was not available at 52 weeks, 5 patients were lost to follow-up; another 2 coming from far off remote areas were unable to report for follow-up every 3 months. 1 patient who was on chemotherapy expired due to progression of the malignancy, another patient with decompensated liver disease expired due to disease progression. Yet another patient was a pregnant lady on therapy who stopped treatment post partum to breast feed the baby. Conclusion: Chronic hepatitis B patients treated with Telbivudine + Tenofovir combination exhibited significant virologic and biochemical responses, over the period of 1 year. However, the mean decline in HBV DNA over 1 year with combination therapy was not higher than that seen with monotherapy. © JAPI.
Biswal S.,Scb Medical College And Hospital
Journal of Pharmacology and Pharmacotherapeutics | Year: 2012
We present a case of complete heart block (CHB) in a 58-year-old female patient with acute myeloid leukemia (AML) with no past history of cardiac disease, who received caspofungin in the treatment of disseminated fungal infection. To our knowledge, this is the first case of CHB associated with caspofungins. Subsequent to induction chemotherapy the patient developed invasive pulmonary aspergillosis with sudden tachypnea, dyspnoea, fever, bilateral pulmonary infiltrates and acute respiratory insufficiency consequent to neutropenia with ANC<500. During the first dose of antifungal therapy with caspofungins, she developed complete atrioventricular block and cardiac arrest. Complete heart block is an unusual adverse effect of caspofungins which has not been reported previously. Caspofungins release histamine in peripheral blood cells, so possible histamine-mediated symptoms ranging from severe fatal anaphylaxis can occur. These data suggest that infusion-related reactions associated with caspofungin may be mediated by histamine release secondary to caspofungin therapy.
Sahoo M.R.,SCB Medical College and Hospital |
Gowda M.S.,SCB Medical College and Hospital |
Kaladagi R.M.,SCB Medical College and Hospital
American Journal of Case Reports | Year: 2013
Objective: Challenging differential diagnosis. Background: Malignant melanoma is usually readily diagnosed by the presence of melanin granules. Although amelanotic melanoma contains a few melanin granules, it is often difficult to differentiate from non-epithelial malignant tumors. Immunohistochemical staining may be needed to diagnose the condition. Case Report: This report describes a case of amelanotic melanoma of the rectum, which was originally suspected to be an adenocarcinoma, but was subsequently correctly diagnosed by immunohistochemical staining with HMB-45 antibody and by the presence of S-100 protein. A pinkish-red ulceroproliferative growth was located about 7 cm from the anal verge. The patient was treated by laparoscopic low anterior resection. Conclusions: Very few cases of amelanotic melanoma of rectum have been reported in the literature and there is only limited clinical experience with this disease. It appears to be a highly lethal tumor and may need much more aggressive treatment than that used for carcinoma of the rectum. © Am J Case Rep, 2013.
Prevalence of inflammatory markers (high-sensitivity C-reactive protein, nuclear factor-κB, and adiponectin) in Indian patients with type 2 diabetes mellitus with and without macrovascular complications
Misra D.P.,Scb Medical College And Hospital |
Das S.,Scb Medical College And Hospital |
Sahu P.K.,Scb Medical College And Hospital
Metabolic Syndrome and Related Disorders | Year: 2012
Background: Atherosclerosis is more prevalent in subjects with diabetes mellitus. Recent evidence suggests that diabetic atherosclerosis is not simply a disease of hyperlipidemia, but is also an inflammatory disorder. Our aim was to study the prevalence of inflammatory markers such as high-sensitivity C-reactive protein (hsCRP), adiponectin, and nuclear factor-κB (NF-κB) expression, in peripheral blood mononuclear cells in Indian patients with type 2 diabetes mellitus (T2DM) with and without macrovascular disease (MVD). Methods: A total of 29 consecutive cases of T2DM with proven MVD (group A), 28 matched cases without MVD (group B), and 14 healthy controls (group C) were evaluated for the clinical parameters fasting blood glucose (FBG), 2-h postprandial blood glucose (PPBG), glycosylated hemoglobin (HbA1c), lipid profile, and the above-mentioned inflammatory markers. Results: Diabetic subjects with T2DM had higher hsCRP and NF-κB expression and lower values of adiponectin compared to healthy controls. Group A had significantly higher serum hsCRP than group B (P=0.0001) despite comparable values of BMI, FBG, 2-h PPBG, HbA1c, and lipid parameters. Group A had significantly higher serum hsCRP and NF-κB expression and significantly lower levels of adiponectin than group C (P=0.0001, 0.007, and 0.02, respectively). In Group A, serum adiponectin negatively correlated with NF-κB expression. In Group B, adiponectin values correlated negatively with both FBG and 2-h PPBG. Conclusions: Indian subjects with T2DM with or without MVD had higher hsCRP and lower adiponectin values as compared to healthy controls, whereas hsCRP was significantly higher in those with MVD, suggesting that our patients with T2DM were in a proinflammatory state. © 2012 Mary Ann Liebert, Inc.
Mantri S.,Scb Medical College And Hospital |
Mohapatra P.C.,Scb Medical College And Hospital
Indian Journal of Clinical Biochemistry | Year: 2014
We tried here to optimize the proliferation of both Hematopoietic and Mesenchymal stem cells of Umbilical Cord blood in minimal cytokine growth condition. Failing to get good results of expansion of non-adherent Hematopoietic Total Nucleated Cells and adherent Fibroblastic Mesenchymal Stem Cells derived from 10-12 ml of collected Cord blood, we designed the further experimental study by increasing the volume of Cord blood sample up to 65-70 ml. We harvested the non-adherent as well as adherent fraction separately derived from the primary culture of Umbilical Cord blood stem cells under the influence of growth promoting Cytokines or Growth Factors. The proliferation study was conducted by taking different combinations of two hematopoietic growth stimulatory Cytokines like stem cell factor (SCF) and Fms like tyrosine kinase-3Ligand (Flt3L) at concentrations (10 ng/ml, 100 ng/ml) while we preferred Mesenchymal specific growth factor i.e. basic Fibroblast growth factor (FGF-β) at its 10 ng/ml concentration for adherent cells to get optimal results. The Hematopoietic and Fibroblast Colony forming abilities of the expanded stem cells were performed through Colony Forming Unit assay. Culture Medium containing cytokine combination like SCF 100 ng/ml with Flt3L 10 ng/ml was found to be optimal for the proliferation of hematopoietic stem cells. But the number of hematopoietic colonies like Erythroid colonies generated were less in case of media supplemented with SCF & Flt3L while more number of Myeloid colonies were observed in Growth factor supplemented media in comparison to the control one. The FGF-β supplemented media successfully enhanced the proliferation of Mesenchymal Stem Cells and exhibited its efficient Fibroblast colony forming ability. Our experimental study supports the minimal utilization of cytokines for haematopoietic and mesenchymal stem cell proliferation which may help in future safe Cord blood stem cell infusion. © 2013 Association of Clinical Biochemists of India.
Biswal S.,SCB Medical College and Hospital |
Sahoo S.S.,SCB Medical College and Hospital
International Journal of Dermatology | Year: 2014
Background: Though any drug can be a potential cause of such hypersensitivity reactions, paracetamol, an over-the-counter drug used extensively as an analgesic and antipyretic agent, is considered to be relatively safe, with hepatotoxicity as a major adverse effect only in large doses. Materials and methods: We report an instance of a severe case of SJS-TEN overlap syndrome in a 12-year-old girl, induced by three over-the-counter doses of 500 mg of paracetamol taken at 8-hour intervals for fever. Results and discussion: Stevens-Johnson Syndrome and its severe variant toxic epidermal necrolysis (TEN) are idiosyncratic, delayed hypersensitivity inflammatory adverse drug reactions that are associated with increased morbidity and mortality. However, treatment with antibiotics and intravenous corticosteroids along with supportive therapy improved the course of the disorder. Conclusion: This case report addresses the fact that severe hypersensitivity reactions can occur with paracetamol, which can be potentially dangerous and life threatening. It is hence important for the clinicians to be alert to such severe hypersensitivity reactions even with drugs which are considered to be potentially safe such as paracetamol. © 2013 The International Society of Dermatology.
Biswal S.,SCB Medical College and Hospital |
Godnaik C.,SCB Medical College and Hospital
ecancermedicalscience | Year: 2013
We hypothesise that treating patients with acute leukaemia in general wards, with proper hygienic and sanitary practices, would result in the minimum utilisation of resources as compared with the corresponding patients receiving ICU support. For this study, the acute leukaemia patients on induction chemotherapy were kept in general wards and observed for the incidence of neutropenia, resultant neutropenic febriles, the causative organism, and the effect of empirical antimicrobial treatment protocol on the outcome of such infections. Prophylactic anti-fungal therapy and cotrimoxazole therapy improved the outcome of infections. The therapy of neutropenic fever and infections must be adapted according to the risk factors and should include early empiric antifungal therapy. It was observed that the treatment of such patients in general wards could be managed effectively, with the added advantage of optimum utilisation of resources and in a patient-friendly environment, at a reasonable cost to the patients. © the authors; licensee ecancermedicalscience.