Qualification: 
MS, MBBS, DNB
mishajcbabu@aims.amrita.edu

Dr. Misha J. C. Babu currently serves as Associate Professor at the Department of General Surgery, School of Medicine, Kochi.

Publications

Publication Type: Journal Article

Year of Publication Title

2018

Misha J. C. Babu, C Nair, G., R, R., and Jacob, P., “The outcome of papillary Thyroid Cancer Associated with Graves disease; A case control Study”, European Thyroid Journal. Journal of Thyroid Research, 2018.

2018

Riju R. Menon, C Nair, G., Misha J. C. Babu, and Pradeep Jacob, “Factors influencing adverse outcomes in non diabetic necrotizing fascitis- a retrospective study”, Medical Journal Medica Innovatica, vol. 7, no. 1, pp. 16-20, 2018.[Abstract]


Background: Necrotising fasciitis is a rare severe soft tissue infection with a paucity of early symptoms to diagnose the condition. Early diagnosis and institution of treatment may improve outcome.

Aim: To study the factors likely to influence rate of mortality.

Methods: We present a retrospective analysis of a cohort of 42 patients of non-diabetic necrotising fasciitis over 10 years. After clinical examination and workup patient underwent early debridement with empirical antibiotic therapy. The features used for analysis included age, gender, concurrent systemic diseases (diabetes mellitus, coronary artery disease, chronic liver disease, chronic kidney disease and cancer), duration between the onset of symptom and wound debridement and laboratory parameters

Results: Analysis showed that the duration between onset of first symptom and debridement was the key factor deciding the outcome. Mortality is not affected by the microbiological spectrum.

Conclusion: Early adequate source control with debridement gives the best results. Morbidity, mortality and renal risk increase with delay in treatment. Early empirical antibiotic therapy only helps in masking the symptoms.

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2018

Riju R. Menon, Nair, G. C., Misha J. C. Babu, and Pradeep Jacob, “Acute pancreatitis and primary hyperparathyroidism: Effect of parathyroidectomy”, Formosan Journal of Surgery, vol. 51, no. 6, pp. 219-222, 2018.[Abstract]


Background: The association between primary hyperparathyroidism (PHPT) and acute pancreatitis (AP) is well known. However, the causal association is disputed.

Aims: The present cohort study of PHPT patients was done: (1) to assess the prevalence of AP and (2) to assess the effect of successful parathyroidectomy in preventing further recurrence.

Materials and Methods: Case records of patients admitted with AP during the study period were reviewed. Diagnosis of PHPT among this group was based on serum level of corrected calcium and parathyroid hormone. Review of records of patients who were successfully operated for PHPT was done. Records of patients treated with confirmed diagnosis of AP during the study period were reviewed. Variables used for analysis were serum levels of calcium (adjusted to serum albumin), phosphate, intact parathyroid hormone, 25-OH-Vitamin D, alkaline phosphatase, and estimated glomerular filtration rate (eGFR). For continuous/numerical variables with two groups, Mann–Whitney U-test was applied. Multivariate regression analysis was done if the univariate analysis showed significance (P < 0.05).

Results: There were 13 (7.5%) patients with confirmed diagnosis of AP and serum calcium level significantly elevated in this group. There was a linear association of serum calcium with AP. Successful parathyroidectomy prevented further episodes in 11 (84.6%) of patients. There was 2% prevalence of PHPT among 558 patients with AP.

Conclusions: Hypercalcemia in PHPT patients was significantly associated with AP and early parathyroidectomy prevented further recurrence.

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2017

Misha J. C. Babu, C Nair, G., M, B., L, B., P, J., R, M., and AK, R., “Lack of Association of B-type Raf Kinase V600E Mutation with High-risk Tumor Features and Adverse Outcome in Conventional and Follicular Variants of Papillary Thyroid Carcinoma.”, Indian J Endocrinol Metab. , 2017.[Abstract]


INTRODUCTION:

Somatic B-type Raf kinase (BRAF) V600E mutation in exon 15 was frequently found in high frequencies associated with papillary thyroid cancer (PTC). The phenotype of these cancers expressed aggressive clinical and pathological features. The present study aimed to assess the prevalence of BRAF V600E mutation among conventional and follicular variants of PTC and its association with aggressive tumor factors and outcome.

STUDY DESIGN:

Patients who were operated and received further treatment for PTC during 2012 were included in the study. BRAF V600E mutation analysis was done by extracting genomic DNA from tumor tissue.

RESULTS:

Of the 59 patients included in the study, 51% harbored BRAF V600E mutation, but the mutation status was not associated with aggressive tumor factors and adverse outcome.

CONCLUSION:

BRAF V600E mutation was not significant predictor of aggressive tumor behavior in conventional and follicular variants of PTC.

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2017

Riju R. Menon, Murali, S., C. Nair, G., Misha J. C. Babu, and Pradeep Jacob, “Correlation between the cernea classification of external branch of superior laryngeal nerve in relation to the ultrasound-based volume of thyroid gland”, Indian Journal of Endocrinology and Metabolism, vol. 21, no. 6, pp. 845-847, 2017.[Abstract]


Introductíon:
Goiter is a very common problem dealt with by surgeons. Surgical treatment of thyroid requires removal of a part (hemi) or whole of the gland (total thyroidectomy). The external branch of the superior laryngeal nerve (EBSLN) is an important but less researched structure to be preserved during surgery. Various studies have described the incidence of different types of EBSLN, but have not described regarding the relationship between the change in volume of the gland to the nerve

Materials and Methods:
A prospective analysis of 100 patients who underwent total thyroidectomy in our department was done. All patients underwent preoperative ultrasonography and the volume of the gland was calculated. Intraoperatively, the EBSLN was identified and preserved prior to ligating the superior thyroid vessels. The nerve was classified as per the Cernea classification. The gland was divided into high and low volume, taking 20 ml as the cutoff. The incidence of Type 2 nerve in a low-volume gland was compared with that of a high-volume gland.

Results:
In 100 patients (200 nerves), 191 nerves were identified. The nerve was type 1 in 56/200 (28%), Type 2a in 116/200 (58%), and Type 2b in 19/200 (9%) patients. In large-volume glands, Type 2 nerve was more common (87%).

Conclusion:
Dissection of thyroid gland requires expertise to preserve the EBSLN. Large volume glands pose a more difficult challenge, as the gland is more closer to the nerve.

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2017

Riju R. Menon, R, R., and Misha J. C. Babu, “Study of Accuracy of Clinical Examination in Comparison with MR Fistulogram in Fistula in Ano”, Amrita Journal of Medicine, 2017.

2016

Misha J. C. Babu, Vaidyanathan, S., Prabhu, M., and R, R., “Sapheno-Femoral Junction Anatomy and Haemodynamics in Indian Patients”, Amrita Journal of Medicine, 2016.[Abstract]


Varicose veins, a common disease in surgical practice, has vexed surgeons for ages, due to its various problems. We hereby present a pilot study of 80 consecutive patients who underwent anatomical and haemodynamic evaluation at the time of Tren-delenberg procedure. Aim 1.To study the location of the saphenofemoral junction(SFJ) in relation to the pubic tubercle. 2.To locate variations in the pattern of tributaries around the SFJ 3.To analyse the haemodynamics of the SFJ Materials and methods 80 consecutive patients who underwent Trendelenberg procedure from August 2007 to August 2008 are presented. Radiological and clinical evaluation were done and patients were subjected to Trendelenberg procedure at which time position of the Sapheno-Femoral junction(SFJ) in relation to pubic tubercle was measured, also noting nature and number of tributaries. A demonstration of the severity of reflux was made and all the information was noted and computed. Results We found that in the Indian patient the position of the SFJ was higher and more medial than the Western counterpart. There were fewer tributaries in the Indian patient. The external pudendal artery was seen more commonly in the Indian patient and could act as a landmark for identification of the SFJ. Conclusion SFJ was seen at a much higher point contrary to the popular anatomy. High incision using the pubic tubercle as the reference point gives good exposure for flush ligation and identification of the tributaries at the SFJ thereby preventing inadequate primary surgery. In our study, there are between 4-5 tributaries at the SFJ and these need to be completely identified and disconnected. Deep external pudendal artery is seen as it goes laterally at the lower border of the cribriform facia and forms a good marker of the termination of GSV and presence of the SFJ.

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2016

Misha J. C. Babu, Nair, G., Menon, R., Pradeep Jacob, and Jimmy Mathew, “Renal dysfunction in primary hyperparathyroidism; effect of parathyroidectomy: A retrospective Cohort study”, International Journal of surgery, vol. 36 , no. Part A, 2016.[Abstract]


INTRODUCTION:
Renal dysfunction associated with primary hyperparathyroidism was studied mostly in patients with mildly asymptomatic or asymptomatic parathyroid disorders. Clinical and biochemical profile of asymptomatic and symptomatic disease vary grossly. The present study analyzed renal function in patients with primary hyperparathyroidism and the relation with clinical features, biochemical features and sonologic changes of kidneys in a cohort of primary symptomatic hyperparathyroidism.

STUDY DESIGN:
Cross-sectional study was done in a cohort of surgically proven patients of primary symptomatic hyperparathyroidism. Urinary tract was evaluated with high definition Ultrasonography and renal function was estimated using Modification of Diet in Renal disease (MDRD) Study equation before and after parathyroidectomy.

RESULT:
Case records 145 patients were studied and there were 44 patients (30.4%) with estimated Glomerular Filtration Rate (eGFR) less than 60&nbsp;mL/min/1.73&nbsp;m2. Associated renal complications, coincident hypertension and high serum level of calcium were strongly associated with renal dysfunction. Renal dysfunction marginally improved after 1 year following surgical cure of hyperparathyroidism in 25% of patients with renal dysfunction. There was no detectable change in renal function during the follow up period.

CONCLUSION:
There was high prevalence of renal dysfunction among symptomatic hyperparathyroidism. Patients with primary hyperparathyroidism should undergo complete sonological assessment of kidneys which may include presence of nephrocalcinosis and cortical echogenicity. Successful parathyroidectomy prevented deterioration of renal function in most of patients and a significant subset with renal dysfunction showed improvement of functional status.

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2016

G. C. Nair, Misha J. C. Babu, Jacob, P., Menon, R., and Jimmy Mathew, “Is Intraoperative Parathyroid Hormone monitoring necessary in symptomatic primary hyperparathyroidism with concordant imaging?”, Indian Journal of Endocrinology and Metabolism, 2016.

2015

G. C. Nair, ,, Pradeep Jacob, Riju R. Menon, and Misha J. C. Babu, “Inflammatory diseases of the non-lactating female breasts (Original Research)”, International Journal of Surgery, vol. 13, pp. 8 - 11, 2015.[Abstract]


Chronic inflammatory diseases of the non-lactating breasts cause considerable difficulty in diagnosis and treatment. There is a spectrum of aetiological factors ranging from infection to autoimmune disorders. The disease causes considerable morbidity and psychological distress in relatively young females. The study aimed to analyse the spectrum of chronic disease and to formulate a treatment protocol. Method: Female patients with histological confirmation of inflammatory disease of the breast in the non-lactational phase were included in the study. The patients were categorized based on histological findings supplemented with immunohistochemical staining with CD3 and CD20 antibodies. Result: Out of 50 patients included in the study, 38 patients (76%) were diagnosed as idiopathic granulomatous mastitis (IGM) and 12 (24%) patients as periductal mastitis (PD). The possible aetiology of IGM was localized autoimmunity as evidenced by the infiltration of CD3 positive T lymphocyte. Systemic prednisolone was given for 6 months and 95.6% patients were disease-free after 24months. Out of 15 patients who did not receive prednisolone, only 2 patients were disease-free after 24 months (p&nbsp;=&nbsp;.003). Conclusion: Idiopathic granulomatous mastitis is an uncommon inflammatory disease of the non-lactating breast. The combination of limited surgical treatment and systemic prednisolone given for 6 months effectively controls the disease as well as prevents recurrence.

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2014

C. G. Nair, Pradeep Jacob, Riju R. Menon, and Misha J. C. Babu, “Graves' disease in a dialysis dependent chronic renal failure patient”, Indian Journal of Nephrology, vol. 24, pp. 397-399, 2014.[Abstract]


Thyroid hormone level may be altered in chronic renal failure patients. Low levels of thyroxine protect the body from excess protein loss by minimizing catabolism. Hyperthyroidism is rarely encountered in end-stage dialysis dependent patients. Less than 10 well-documented cases of Graves' disease (GD) are reported in literature so far. We report a case of GD in a patient on dialysis.

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2013

Misha J. C. Babu, C Nair, G., Riju R. Menon, and Pradeep Jacob, “Lithium-induced parathyroid dysfunction: A new case”, Indian Journal of Endocrinology and Metabolism, vol. 17, no. 5, pp. 930-932, 2013.[Abstract]


Lithium salts are widely used in psychiatric practice and are known to induce thyroid dysfunction. Lithium-induced parathyroid dysfunction is rare. We are reporting a case of hyperparathyroidism in a 28-year-old female patient who was on lithium carbonate for 2 years, when she developed osteopenia and girdle girdle-type muscle weakness. Biochemical parameters showed hyperparathyroidism with shift of calcium creatinine clearance ratio to 0.013, indicating an error in threshold of calcium sensing receptor. The patient eventually required parathyroidectomy and the histology of the gland showed atypical features.

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2013

G. C Nair, Misha J. C. Babu, Riju R. Menon, and Pradeep Jacob, “Hypocalcaemia following total thyroidectomy: An analysis of 806 patients”, Indian Journal of Endocrinology and Metabolism, vol. 17, no. 2, pp. 298-303, 2013.[Abstract]


BACKGROUND:Permanent hypocalcaemia following thyroidectomy causes considerable morbidity. This prospective observational study aims to define the factors likely to predict hypocalcaemia following total thyroidectomy.

MATERIALS AND METHODS:Patients who were subjected to total thyroidectomy during January 2005 to December 2009 were followed up for a minimum period of 1 year. Efficacy of an intraoperative parathyroid hormone assay to predict hypocalcaemia was validated.

RESULTS:Overall incidence of hypocalcaemia was 23.6% (n = 190) and that of permanent hypocalcaemia was 1.61% (n = 13). Onset was delayed up to 3(rd) postoperative day in 13 patients. Hypocalcaemia was significantly associated with thyroidectomy for Grave's Disease (P = 0.001), Hashimoto's thyroiditis (P = 0.003), and with incidental parathyroidectomy (P = 0.006). The intraoperative assay of parathyroid hormone showed low sensitivity (0.5) and satisfactory specificity (0.9) in predicting hypocalcemia.

CONCLUSION:Hypocalcemia could manifest late in the immediate postoperative period and this may explain latent hypocalcemia. High incidence of hypocalcaemia noted in Grave's Disease could be due to the autoimmunity since same feature was noted associated with Hashimoto's thyroiditis and the incidence of hypocalcaemia was not high in the subgroup with toxic nodular goiter. The incidence of hypocalcemia was not affected by age or sex.

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2012

Misha J. C. Babu, C Nair, G., Riju R. Menon, and Pradeep Jacob, “Toxic thyroid carcinoma: A new case.”, Indian Journal of Endocrinology and Metabolism, vol. 16, no. 4, pp. 668–670, 2012.[Abstract]


Sir,
Differentiated thyroid cancer may coexist with hyperthyroidism. Cancer cell mass is less functional and appears as cold nodule in thyroid scintigraphy. Cancer cell mass rarely becomes site of excess hormone production. When thyroid cancer cell mass occupies a scintigraphically hot, functionally autonomous thyroid nodule and if thyrotoxicosis is attributable exclusively to this nodule, as shown by clinical and histologic correlation, a toxic thyroid carcinoma is diagnosed.[1] We are reporting case feature which coincides well with the above mentioned diagnosis.

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2009

Misha J. C. Babu, Riju, R., Jadhav, S., Kanthaswamy, R., Jacob, P., and Gopalakrishnan, C., “Is total thyroidectomy justified in multinodular goitre.”, Journal of the Indian Medical Association , 2009.[Abstract]


Role of total thyroidectomy in treatment of patients with benign diseases of thyroid gland remains controversial. The hypothesis behind the study is that total thyroidectomy can be performed in all benign thyroid diseases with equal rate of immediate and late complications compared with those of subtotal thyroidectomy. The retrospective case control study was done by reviewing the case records of patients with benign thyroid diseases involving both lobes operated during May, 2002 to September, 2004. The minimum follow-up period was 3 years. Of the 189 patients included in the study 94 underwent total thyroidectomy and 95 patients underwent subtotal thyroidectomy. There was no incidence of permanent recurrent laryngeal nerve paralysis in both groups. Temporary unilateral recurrent laryngeal nerve paralysis occurred in 3 patients (3.2%) in total thyroidectomy group and 1 (1.1%) patient in subtotal thyroidectomy group, which was not statistically significant (p = 0.307). Temporary hypocalcaemia was noted in 10 patients of total thyroidectomy group (10.6%) and 3 patients of subtotal thyroidectomy group (3.2%). Permanent hypocalcaemia was noted in 2 patients each in total thyroidectomy group and subtotal thyroidectomy group (p = 0.991). Total thyroidectomy is an acceptable alternative to subtotal thyroidectomy in benign diseases, considering the higher rate of postoperative morbidity in recurrent goitres.

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Publication Type: Book

Year of Publication Title

2015

S. Vaidyanathan, Ramachandran, R., Jacob, P., John, B., and Misha J. C. Babu, Chronic Venous Disorders of the Lower limb. Springer, 2015.