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Shanbag P.,Lokmanya Tilak Municipal Medical College and General Hospital | Amarapurkar A.,TN Medical College and BYL Nair Hospital
Indian Journal of Pathology and Microbiology | Year: 2010

An eight-month-old female, delivered to consanguineous parents, presented with acute liver cell failure. Her investigations showed progressive cholestatic jaundice, high liver enzymes and high gamma-glutamyl transferase. Hepatitis and inborn errors of metabolism were excluded. The liver biopsy showed a prominent parenchymal bile stasis without features of bile obstruction or paucity of bile ducts. These findings wee suggestive of Byler disease or progressive familial intra hepatic cholestasis type III (PFIC III) which begins in infancy and usually progresses to cirrhosis and hepatic failure in the first few years of life.


Gupta V.H.,Indian Institute of Technology Bombay | Singh M.,Indian Institute of Technology Bombay | Amarapurkar D.N.,Bombay Hospital and Medical Research Center | Sasi P.,Indian Institute of Technology Bombay | And 5 more authors.
Annals of Hepatology | Year: 2013

Background. The first line anti-tubercular (anti-TB) treatment normally involves isoniazid, rifampicin, pyrazinamide, and ethambutol. Clearance of these drugs depends on the activity of several enzymes such as N-acetyl transferase 2, cytochrome P450 oxidase and glutathione S-transferase (GST). Some of these enzymes are highly polymorphic leading to significant inter-individual variation in their activity thereby increasing the risk of drug induced hepatotoxicity (DIH). Aim. To investigate the possible association of anti-TB DIH with genetic polymorphism of GST genes in Western Indian population. Material and methods. A prospective case-control study was undertaken on patients who received anti-TB treatment. Cases (n = 50) were distinguished from controls (n = 246) based on occurrence of DIH during anti-tubercular treatment. A multiplex polymerase chain reaction was employed to identify homozygous null mutation at GSTM1 and GSTT1 loci. Results. Homozygous null mutation in GSTM1 gene alone or in both GSTM1 and T1 genes was found to be significantly associated with anti-TB DIH at p < 0.02 and p < 0.007, respectively, in our study population. Conclusions. This is the first study to report GSTM1 null and combined GSTM1 and T1 null genotypes to be risk factors of anti-TB DIH in Western Indian population. Screening of patients for these genotypes prior to anti-TB regimen would provide better control of hepatotoxicity.


Valame D.A.,TN Medical College and BYL Nair Hospital | Gore G.B.,TN Medical College and BYL Nair Hospital
Brazilian Journal of Otorhinolaryngology | Year: 2016

Introduction: Cervical vestibular evoked myogenic potentials (cVEMP) can assess the integrity of the inferior vestibular nerve thereby promising to be a useful tool in the audiological test battery to diagnose vestibular schwannoma. Objective: To ascertain the utility of cVEMP in diagnosis of vestibular schwannoma in conjunction with the ABR and to evaluate whether the size of lesion has any effect on the cVEMP measures. Methods: Case-files of 15 known cases of vestibular schwannoma whose pure tone audiometry, auditory brainstem response (ABR), cVEMP and radiological investigation findings were available, were included in the study. Patients were categorised as large or small tumours based on the size. The absolute and inter-peak latencies of ABR, amplitudes of waves V and I, and inter-aural latency difference of wave V of ABR; and latency of P1 and N1 of cVEMP and amplitude of P1-N1 complex were considered in the study. Results: There were eight large and nine small tumours. All the patients with large tumours showed significant severity of hearing loss whereas only three out of nine patients with small tumours showed severe to profound deafness in the affected ear. The rest showed hearing status ranging from normal hearing sensitivity to moderate hearing loss. Most of the patients with large tumours showed complete absence of ABR in the affected ears with no identifiable wave-peaks. ABR in small tumours exhibited delayed III-I and delayed V-I interpeak latency interval (IPL). Four out of five patients with large unilateral tumours revealed contralateral effects of reduced amplitude or absence of cVEMP. On the contrary, six out of eight unilateral small tumours showed a normal cVEMP response in the contralateral ear. Both the patients with NF2 in the present study demonstrated cVEMP abnormalities. Conclusion: ABR and cVEMP, when used in combination, can be of immense use in identification of neuro-otologic conditions such as vestibular schwannoma and bilateral tumours in NF2. In the evaluation of unilateral vestibular schwannoma, abnormal contralateral findings of cVEMP and ABR are strongly indicative of the tumour size >2.5. cm. In unilateral severe to profound loss wherein ABR in poorer ear cannot give information of site-of-lesion, cVEMP can help in the differentiation. © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.


Sharma U.,CSIR - Central Electrochemical Research Institute | Bala M.,CSIR - Central Electrochemical Research Institute | Saini R.,CSIR - Central Electrochemical Research Institute | Verma P.K.,CSIR - Central Electrochemical Research Institute | And 4 more authors.
Indian Journal of Experimental Biology | Year: 2012

Tinospora cordifolia is used in Ayurveda as "Rasayanas" to improve the immune system and the body resistance against infections. Polysaccharides are the main constituents which are considered to be responsible for immune enhancement. In this study, immunomodulatory activity of three polysaccharide enriched fractions was evaluated using the polymorphonuclear leukocyte function test. Sugar composition was determined by GC-MS analysis of the derivatised fractions. The active polysaccharide fractions mainly constitute glucose, fructose and arabinose as monomer units.


Patil P.,TN Medical College and BYL Nair Hospital | Shah V.,TN Medical College and BYL Nair Hospital | Shah B.,TN Medical College and BYL Nair Hospital
Journal of Association of Physicians of India | Year: 2014

The objective of our study was to evaluate and standardise the method of spot (random) urine protein creatinine ratio (UP/C) for estimation of proteinuria. The study contained 241 study participants in a tertiary care hospital inclusive of 208 cases and 33 normal volunteers. The 24 hour urine protein estimation was done on 24 hour urine samples and UP/C ratio was calculated on random urine samples. UP/C ratio and 24 hour urine protein estimation had strong correlation with r = 0.9 and p < 0.05 on Pearson's correlation analysis. Receiver operating characteristic analysis showed random UP/C ratio of 0.1171 reliably predicted 24 hour urine total protein equivalent of >150 mg/24 hrs with sensitivity 100%, specificity 98.1%, positive likelihood ratio 53.5, and negative likelihood ratio 0. UP/C ratio of 3.2 reliably predicted nephrotic range proteinuria at 24 hour urine protein equivalent of >3.5 g/24 hrs with sensitivity 80%, specificity 100%, positive likelihood ratio 154.4, and negative likelihood ratio 0.2. We conclude that spot/random UP/C ratio is a reliable, simple test to be introduced and adopted in routine practice for monitoring of macro proteinuria. © JAPI.

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