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Koul P.,SheriKashmir Institute of Medical science | Khan U.,Internal and Pulmonary Medicine | Bhat K.,SKIMS | Saha S.,India Influenza Center | And 3 more authors.
PLoS Currents | Year: 2013

Some parts of world, including India observed a recrudescent wave of influenza A/H1N1pdm09 in 2012. We undertook a study to examine the circulating influenza strains, their clinical association and antigenic characteristics to understand the recrudescent wave of A/H1N1pdm09 from November 26, 2012 to Feb 28, 2013 in Kashmir, India. Of the 751 patients (545 outpatient and 206 hospitalized) presenting with acute respiratory infection at a tertiary care hospital in Srinagar; 184 (24.5%) tested positive for influenza. Further type and subtype analysis revealed that 106 (58%) were influenza A (H1N1pdm09 =105, H3N2=1) and 78 (42%) were influenza B. The influenza positive cases had a higher frequency of chills, nasal discharge, sore throat, body aches and headache, compared to influenza negative cases. Of the 206 patients hospitalized for pneumonia/acute respiratory distress syndrome or an exacerbation of an underlying lung disease, 34 (16.5%) tested positive for influenza (22 for H1N1pdm09, 11 for influenza B). All influenza-positive patients received oseltamivir and while most patients responded well to antiviral therapy and supportive care, 6 patients (4 with H1N1pdm09 and 2 with influenza B) patients died of progressive respiratory failure and multi-organ dysfunction. Following a period of minimal circulation, H1N1pdm09 re-emerged in Kashmir in 2012-2013, causing serious illness and fatalities. As such the healthcare administrators and policy planners need to be wary and monitor the situation closely. © 2013, Public Library of Science. All Rights Reserved.


Lorenzo F.R.,University of Utah | Phillips J.D.,University of Utah | Nussenzveig R.,Arup | Lingam B.,University of Utah | And 4 more authors.
Blood Cells, Molecules, and Diseases | Year: 2011

Congenital methemoglobinemia due to NADH-cytochrome b5 reductase 3 (CYB5R3) deficiency is an autosomal recessive disorder that occurs sporadically worldwide, although endemic clusters of this disorder have been identified in certain ethnic groups. It is present as two distinct phenotypes, type I and type II. Type I methemoglobinemia is characterized by CYB5R3 enzyme deficiency restricted to erythrocytes and is associated with benign cyanosis. The less frequent type II methemoglobinemia is associated with generalized CYB5R3 deficiency affecting all cells and is lethal in early infancy. Here we describe the molecular basis of type I methemoglobinemia due to CYB5R3 deficiency in four patients from three distinct ethnic backgrounds, Asian Indian, Mexican and Greek.The CYB5R3 gene of three probands with type I methemoglobinemia and their relatives were sequenced revealing several putative causative mutations; in one subject multiple mutations were present. Two novel mutations, S54R and F157C, were identified and the previously described A179T, V253M mutations were also identified. All these point mutations mapped to the NADH binding domain and or the FAD binding domain. Each has the potential to sterically hinder cofactor binding causing instability of the CYB5R3 protein. Wild-type CYB5R3, as well as two of these novel mutations, S54R and F157C, was amplified, cloned, and purified recombinant peptide obtained. Kinetic and thermodynamic studies of these proteins show that the above mutations lead to decreased thermal stability. © 2011 Elsevier Inc.


Koul P.A.,SheriKashmir Institute of Medical science | Hajni M.R.,SheriKashmir Institute of Medical science | Sheikh M.A.,SheriKashmir Institute of Medical science | Khan U.H.,SheriKashmir Institute of Medical science | And 4 more authors.
Asian Pacific Journal of Cancer Prevention | Year: 2011

Background: The literature about the causal relationship between lung cancer and tobacco smoking mostly concerns cigarettes. Hookah smoking is popular in the Kashmir valley of the Indian subcontinent, and is generally believed to be innocuous because of the passage of the smoke through water before inhalation. Objective: To determine the relationship of hookah smoking to lung cancer in Kashmir. Materials and Methods: In a casecontrol design, 251 cases of lung cancer and 500 age-matched controls were studied. A predefined questionnaire was administered through a personal interview regarding various smoking and dietary patterns and the results compared through statistical analyses. Results: There were 194 (178 current) ever-smokers amongst the cases and 223 (134 current) amongst controls. Smokers had a 4.2 times risk of lung cancer compared to non smokers (OR 4.23, 95% CI 3.0-5.96, p<0.0001). There were 120 hookah smokers amongst the cases and 100 amongst the controls and hookah smokers were nearly six times at risk for lung cancer as compared to nonsmokers (OR 5.83, (95% CI 3.95-8.60, p< 0.0001). Cigarette smokers were commoner amongst cases (46 vs 64 in controls; OR 3.49, 95% CI 2.18-5.60, p=0.000). The severity of smoking was associated with a higher risk of lung cancer (Chi-square 72.09, p 0.000).The practice of changing water of the hookah after each session proved non-existent. Conclusion: Hookah smoking is associated with a significantly higher risk for lung cancer in Kashmiri population, with about 6 fold elevated risk as compared to non-smoking controls.


Khan U.H.,SheriKashmir Institute of Medical Sciencess | Koul P.A.,SheriKashmir Institute of Medical Sciencess | Koul P.A.,SheriKashmir Institute of Medical science
BMJ Case Reports | Year: 2013

A 20-year-old female patient presented with fever and swelling in the neck accompanied by anorexia and weight loss. The clinical examination revealed a febrile patient with diffuse cervical lymphadenopathy. Routine investigations were negative. A 5TU (tuberculin units) tuberculin skin test (Mantoux test) was positive with an induration of 52×40 mm after 72 h with central blistering, exudation and ulceration. Aspiration cytology from the cervical lymph node revealed the presence of caseating granulomas. The patient responded completely to antitubrecular therapy. Enhanced-tuberculin reactions may occur on occasion in tuberculosis. Copyright © 2013 BMJ Publishing Group. All rights reserved.


Koul P.A.,SheriKashmir Institute of Medical science | Ahmad S.H.,SheriKashmir Institute of Medical science | Ahmad F.,SheriKashmir Institute of Medical science | Jan R.A.,SheriKashmir Institute of Medical science | And 2 more authors.
Oman Medical Journal | Year: 2011

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases. © OMSB, 2011.


Koul P.A.,SheriKashmir Institute of Medical science
BMJ case reports | Year: 2013

A young man presented with erythematous rash that appeared 3 days following upper respiratory symptoms and fever. Diffuse exanthematous rash was seen over whole body, most pronounced over the trunk. A subconjunctival haemorrhage also appeared in the left eye following incessant cough. Reverse transcription-PCR of the nasopharyngeal secretions revealed influenza A (2009 pandemic H1N1). The patient responded to oseltamivir therapy. Influenza should be considered in patients presenting with exanthematous skin rash.


Sofi F.A.,SheriKashmir Institute of Medical science | Koul P.A.,SheriKashmir Institute of Medical science | Mufti S.A.,SheriKashmir Institute of Medical science | Dhobi G.N.,SheriKashmir Institute of Medical science
BMJ Case Reports | Year: 2011

A 20-year-old young female presented with extensive skin rashes with bullae and extensive epidermal necrolysis about 20 days after the addition of lamotrigine (LTG) to her anticonvulsant medication. The patient was managed by stopping LTG and supportive treatment. The seizures were controlled with increase in the doses of carbamazepine. The report emphasises exercising of caution once LTG is added to a regimen containing valproic acid.


Koul P.A.,SheriKashmir Institute of Medical science | Singh A.A.,SheriKashmir Institute of Medical science | Ahanger A.G.,SheriKashmir Institute of Medical science | Wahid A.,SheriKashmir Institute of Medical science | Sofi B.A.,SheriKashmir Institute of Medical science
ANZ Journal of Surgery | Year: 2010

Background: The optimal duration of preoperative anti-helminths for prevention of recurrences in pulmonary hydatidosis is unclear, although 1-3 weeks of therapy is routinely used. Methods: Forty-five patients of pulmonary hydatid disease were randomly assigned into four groups to receive either 0, 2, 4 or 8 weeks of preoperative albendazole (ABZ) and praziquantel (PZQ). Viability of the scolices in the fluid harvested at surgery (methylene blue staining) and ability to produce peritoneal hydatids in mice (intra-peritoneal inoculation) were compared in different groups. Results: The percentage viability of the scolices as a whole was significantly (P < 0.001) lower in the treated cysts (n = 36, mean 43.5 ± 35.69) compared with the untreated cysts (n = 8, mean 94.75 ± 7.21). The viability progressively decreased with increasing durations of chemotherapy (P < 0.001). Mean percentage viability of scolices was 88.72 ± 4.91% in patients treated for 2 weeks (n = 12), 38.09 ± 9.10% after 4 weeks (n = 11) and 8.1 ± 9.23% after 8 weeks (n = 14). Intra-peritoneal mice inoculation was positive in 90% of the cysts that received therapy for 2 weeks or less and none of the patients who received therapy for 8 weeks had a positive inoculation. Conclusions: Preoperative combination therapy with ABZ and PZQ effects a scolicidal response which increases with the increasing duration of the preoperative chemotherapy, and a 4-week course of the combination chemotherapeutic agents seems to be the minimum required duration for ensuring scolicidal activity enough to prevent spillage-induced recurrences following pulmonary hydatidosis. © 2009 Royal Australasian College of Surgeons.


Sofi F.A.,SheriKashmir Institute of Medical science
BMJ case reports | Year: 2011

A 20-year-old young female presented with extensive skin rashes with bullae and extensive epidermal necrolysis about 20 days after the addition of lamotrigine (LTG) to her anticonvulsant medication. The patient was managed by stopping LTG and supportive treatment. The seizures were controlled with increase in the doses of carbamazepine. The report emphasises exercising of caution once LTG is added to a regimen containing valproic acid.


PubMed | SheriKashmir Institute of Medical science
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

A 16-year-old female presented with a 6-month history of a gradually increasing swelling of the left side of her face. A panoramic radiographic view of the mandible showed diffuse radiolucency in the ramus of the mandible with a loss of cortication on the superior and anterior portion of the condyle. The computed tomography (CT) scan revealed destruction of the mandibular bone and a large retromandibular and inferior temporal fossa mass with areas of breakdown. The biopsy was consistent with tubercular osteomyelitis. Antitubercular therapy resulted in a marked reduction of the size of the swelling over a 9-month period.

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