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Vaideeswar P.,Seth GS Medical College | Shah R.,Seth GS Medical College
Cardiovascular Pathology | Year: 2017

Under the circumstances of cardiovascular adaptations and immunomodulation, an uncommon but disastrous complication of infective endocarditis (IE) can occur in pregnancy. Almost all the cases reported earlier were caused by bacteria. We report a fatal case of zygomycotic valvular and mural endocarditis in a young non-diabetic primigravida with a positive hepatitis B serology. © 2017 Elsevier Inc.


Kela M.,Seth Gs Medical College | Buddhi M.,Seth Gs Medical College
Journal of Anaesthesiology Clinical Pharmacology | Year: 2017

Maternal heart disease complicates 0.2-3% of pregnancies. The optimal management of the pregnant patient with cardiac disease depends on the co-operative efforts of the obstetrician, the cardiologist and the anesthesiologist involved in peripartum care. A comprehensive understanding of physiology of pregnancy and pathophysiology of underlying cardiac disease is of primary importance in provision of obstetric analgesia or anesthesia for these high-risk groups of patients. We report a successful and uncomplicated use of epidural anesthesia for labor and delivery in patient with combined aortic and mitral stenosis.


Dadachanji R.,National Health Research Institute | Shaikh N.,National Health Research Institute | Khavale S.,National Health Research Institute | Patil A.,National Health Research Institute | And 2 more authors.
Fertility and Sterility | Year: 2015

Objective To investigate the association of paraoxonase 1 (PON1) polymorphisms (L55M and Q192R) with polycystic ovary syndrome (PCOS) susceptibility and its related traits in Indian women. Design Case-control study. Setting Academic research institute, infertility, and endocrinology clinics. Patient(s) Controls (n = 326), women with PCOS (n = 482). Intervention(s) None. Main Outcome Measure(s) Genotypic and allelic frequency distribution, genotype-phenotype association, different PON1 activities (lactonase, arylesterase, and paraoxonase). Result(s) The genotypic and allelic frequency distributions of the L55M polymorphism were significantly different between lean controls and lean women with PCOS, and this polymorphism reduced the risk of PCOS development in lean but not in obese Indian women. Furthermore, this polymorphism was significantly associated with decreased 2-hour glucose, apolipoprotein B, free and bioavailable T, and free androgen index concurrent with increased sex hormone-binding globulin (SHBG) and FSH levels only in lean women with PCOS. However, Q192R polymorphism showed comparable genotypic frequency distribution between controls and women with PCOS. PON1 lactonase and arylesterase activities were significantly decreased in women with PCOS compared with controls. PON1 polymorphisms were shown to influence its activities. Conclusion(s) Our study showed that L55M, but not Q192R, polymorphism is significantly associated with reduced PCOS susceptibility only in lean women and also impacts glucose metabolism, lipid parameters, and hyperandrogenemia in them. Our study therefore suggests the possibility of differential genetic pathophysiology of PCOS between lean and obese women. © 2015 American Society for Reproductive Medicine.


Vaideeswar P.,Seth GS Medical College | Deshpande J.R.,BJ Wadia Childrens Hospital
Annals of Pediatric Cardiology | Year: 2013

Takayasu arteritis (TA) is a chronic idiopathic and granulomatous vasculitis, manifesting mainly as a panaortitis. Autoimmune cell-mediated immunity is probably responsible for the disease. The inflammation commences from the adventitia and progresses to the intima and leads to, both in adults and children, segmental stenosis, occlusion, dilatation, and/or aneurysm formation. This review focuses briefly on the etiopathogenesis, and describes the pathological and clinical features in adults and children. Copyright © Annals of Pediatric Cardiology 2013.


Kothari M.,Seth GS Medical College | Mehta L.,Seth GS Medical College
Journal of Postgraduate Medicine | Year: 2012

Medical practice is in crisis - the sophistications are enormous and expensive, and the outcomes leave much to be desired. An epistemologic evaluation that weighs the scope and limitations of any -pathy or any procedure seems to be the need of the day. As an example, described herein is the logic of such an exercise; and a sample of the exercise itself, taking cancer as an example.


Vaideeswar P.,Seth GS Medical College | Pillai R.,Seth GS Medical College
Indian Journal of Pathology and Microbiology | Year: 2013

Most of the pulmonary arterial sarcomas arise from multi-potential mesenchymal intimal cells and are designated as intimal sarcomas. These tumors grow in the direction of blood flow into peripheral arteries producing clinical features mimicking pulmonary thromboembolism. Retrograde extension is rare. We report one such case of intimal sarcoma that had a retrograde extension into the right ventricular outflow tract, and review such a presentation in the last ten years.


Lila A.R.,Seth GS Medical College
BMJ case reports | Year: 2013

Paradoxical response to dexamethasone and spontaneous development of hypocortisolism are rare features of Cushing's disease. We report a 13-year-old boy with Cushing's disease owing to a pituitary macroadenoma. On initial evaluation, he had partial suppression of serum cortisol by dexamethasone. He developed transient hypocortisolism after first adenomectomy, but the disease recurred after 1 year. Repeat evaluation showed recurrent hypercortisolism and paradoxical response to dexamethasone. He underwent second surgery and, postoperatively, hypercostisolism persisted even after 2 years of surgery. Repeat evaluations after 8 years of second surgery revealed persistent hypocortisolism despite residual tumour of same size and similar plasma adrenocorticotropic hormone (ACTH) levels. We have also shown that the paradoxical increase in serum cortisol was preceded by a paradoxical increase in ACTH. The paradoxical response persisted despite hypocortisolism. This patient with Cushing's disease had two very rare features: paradoxical response to dexamethasone and spontaneous development of hypocortisolism.


Gupte P.A.,Seth GS Medical College | Vaideeswar P.,Seth GS Medical College | Kandalkar B.M.,Seth GS Medical College
Congenital Heart Disease | Year: 2014

Objective: Nephropathy is a known complication in cyanotic congenital heart disease (CCHD). This study was undertaken for an objective analysis of histopathological changes of cyanotic nephropathy at autopsy. Design: Retrospective case records studied. Setting: Tertiary care teaching hospital affiliated to medical college in Mumbai, India. Patients and Methods: The renal histopathological findings of 50 consecutive autopsies in patients with CCHD were compared with 25 age-matched controls. The Bowman's capsular, glomerular tuft, and hilar arteriolar diameters were measured morphometrically. Statistical analysis was performed using unpaired t-test. A P value equal to or less than .05 was considered significant. Results: Among the 50 autopsied cases of CCHD, there were 35 males and 15 females, with a mean age of 4.64 years. The renal changes observed were glomerulomegaly, glomerulosclerosis, periglomerular fibrosis, hyperplastic arteriolosclerosis, and interstitial fibrosis. The objectively measured parameters were higher in cases as compared with controls in all age groups, and further these were also found to be higher in patients having decreased pulmonary arterial blood flow than those having normal to increased pulmonary arterial blood flow. The difference in Bowman's capsular and glomerular tuft diameters was statistically significant in the neonates and children in the age groups, 1-5 years and above 10 years. The difference in hilar arteriolar diameter was statistically significant for all age groups except neonates. Conclusion: Patients with CCHD show significant changes in the kidneys as assessed morphometrically, leading to renal dysfunction, and the age of the patients plays a role in their development. © 2013 Wiley Periodicals, Inc.


Jamale T.E.,Seth GS Medical College
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2012

Effects of laparoscopic donor nephrectomy (LDN) on graft function, especially early post-transplant, have been controversial. To assess and compare early and late graft function in kidneys procured by open and laparoscopic methods, a retrospective observational study was carried out on 37 recipients-donors who underwent LDN after introduction of this technique in February 2007 at our center, a tertiary care nephrology referral center. Demographic, immunological and intraoperative variables as well as immunosuppressive protocols and number of human leukocyte antigen (HLA) mismatches were noted. Early graft function was assessed by serum creatinine on Days two, five, seven, 14 and 28 and at the time of discharge. Serum creatinine values at three months and at one year post-transplant were considered as the surrogates of late graft function. Data obtained were compared with the data from 33 randomly selected kidney transplants performed after January 2000 by the same surgical team, in whom open donor nephrectomy was used. Pearson's chi square test, Student's t test and Mann-Whitney U test were used for statistical analysis. Early graft function (serum creatinine on Day five 2.15 mg/dL vs 1.49 mg/dL, P = 0.027) was poorer in the LDN group. Late graft function as assessed by serum creatinine at three months (1.45 mg/dL vs 1.31 mg/dL, P = 0.335) and one year (1.56 mg/dL vs 1.34 mg/dL, P = 0.275) was equivalent in the two groups. Episodes of early acute graft dysfunction due to acute tubular necrosis were significantly higher in the LDN group (37.8% vs 12.1%, Z score 2.457, P = 0.014). Warm ischemia time was significantly prolonged in the LDN group (255 s vs 132.5 s, P = 0.002). LDN is associated with slower recovery of graft function and higher incidence of early acute graft dysfunction due to acute tubular necrosis. Late graft function at one year is however comparable.


Vaideeswar P.,Seth GS Medical College
Mycopathologia | Year: 2015

Infective endocarditis is increasingly perceived as a byproduct of aggressive medications and/or invasive medical procedures. Some of the organisms are fungi, and in this situation, Candida species account for nearly half of all fungal IE. We report a single-institute pathological experience of 14 cases of candidial endocarditis among surgically excised cardiac tissues and autopsied cases in a 14-year period. Twelve of the 14 cases were seen as healthcare-associated invasive infections, and only five had been diagnosed antemortem. Candidial endocarditis was predominantly right-sided and valvular. The risk factors included underlying heart diseases, central venous catheterization and prolonged antibiotic therapy. Mortality among the autopsied patients was related to septicemia and/or embolic complications. © 2015, Springer Science+Business Media Dordrecht.

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