Publications

Year of Publication Publication Type Title

2019

Journal Article

S. Salian, Nampoothiri, S., Shukla, A., and Girisha, K. M., “Further evidence for causation of ischiospinal dysostosis by a pathogenic variant in BMPER and expansion of the phenotype.”, Congenit Anom (Kyoto), vol. 59, no. 1, pp. 26-27, 2019.

2019

Journal Article

C. Pulcini, Binda, F., Lamkang, A. S., Trett, A., Charani, E., Goff, D. A., Harbarth, S., Hinrichsen, S. L., Levy-Hara, G., Mendelson, M., Nathwani, D., Gunturu, R., Singh, S., Srinivasan, A., Thamlikitkul, V., Thursky, K., Vlieghe, E., Wertheim, H., Zeng, M., Gandra, S., and Laxminarayan, R., “Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach.”, Clin Microbiol Infect, vol. 25, no. 1, pp. 20-25, 2019.[Abstract]


<p><b>OBJECTIVES: </b>With increasing global interest in hospital antimicrobial stewardship (AMS) programmes, there is a strong demand for core elements of AMS to be clearly defined on the basis of principles of effectiveness and affordability. To date, efforts to identify such core elements have been limited to Europe, Australia, and North America. The aim of this study was to develop a set of core elements and their related checklist items for AMS programmes that should be present in all hospitals worldwide, regardless of resource availability.</p><p><b>METHODS: </b>A literature review was performed by searching Medline and relevant websites to retrieve a list of core elements and items that could have global relevance. These core elements and items were evaluated by an international group of AMS experts using a structured modified Delphi consensus procedure, using two-phased online in-depth questionnaires.</p><p><b>RESULTS: </b>The literature review identified seven core elements and their related 29 checklist items from 48 references. Fifteen experts from 13 countries in six continents participated in the consensus procedure. Ultimately, all seven core elements were retained, as well as 28 of the initial checklist items plus one that was newly suggested, all with ≥80% agreement; 20 elements and items were rephrased.</p><p><b>CONCLUSIONS: </b>This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.</p>

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2019

Journal Article

Ginil Kumar Pooleri, Bijalwan, P., Kesavan, R., Philip, A., and Keechilat, P., “Robot-assisted supine extraperitoneal retroperitoneal lymph node dissection: a novel approach for template dissection in post-chemotherapy residual mass in non-seminomatous germ cell tumours.”, J Robot Surg, vol. 13, no. 1, pp. 171-173, 2019.[Abstract]


<p>Robot-assisted retroperitoneal lymph node dissection (RA-RPLND) in testicular cancer is conventionally performed through transperitoneal route. We report a case of robot-assisted supine extraperitoneal RPLND (RASE-RPLND), not previously described in the literature, which was performed for post-chemotherapy residual mass in a case of non-seminomatous germ cell tumour (NSGCT). RASE-RPLND apart from providing the benefits of robotic assistance has a significant advantage over transperitoneal approach, as the procedure can be performed in supine position without any bowel handling. Herein, we provide a detailed description of the novel surgical technique employed by us in this case.</p>

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2019

Journal Article

P. Ponnachan, Vinod, V., Pullanhi, U., Varma, P., Singh, S., Biswas, R., and Kumar, A., “Antifungal activity of octenidine dihydrochloride and ultraviolet-C light against multidrug-resistant Candida auris.”, J Hosp Infect, vol. 102, no. 1, pp. 120-124, 2019.[Abstract]


Outbreaks due to multidrug-resistant Candida auris have emerged as a large threat to modern medicine. Since skin colonization and environmental contamination have been identified as a precursor for outbreaks, we evaluated the antifungal activity of ultraviolet-C light using mercury vapour lamp with a peak emission of 254 ± 2 nm and octenidine dihydrochloride against C. auris clinical isolates. Octenidine dihydrochloride was found effective at significantly lower concentrations (0.00005-0.0004%) than those currently used in the clinical setting (0.05-0.1%). Scanning electron microscopy images show destruction of the organism within 6 h of exposure to 0.0005% octenidine dihydrochloride. Ultraviolet-C light could kill all C. auris with 15 min exposure.

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2019

Journal Article

A. Asok, Sreekumar, S., Radhika,, Cc, A., Dr. Umadevi P., and Dr. Pavithran K., “Effectiveness of zolpidem and sleep hygiene counseling in the treatment of insomnia in solid tumor patients.”, J Oncol Pharm Pract, vol. 25, no. 7, pp. 1608-1612, 2019.[Abstract]


Objective: To study the effectiveness of zolpidem and sleep hygiene counseling in managing insomnia in solid tumor patients.
Methods: Cancer patients with a Pittsburgh Sleep Quality Index score ≥ 5 were grouped into two. Both groups received treatment for insomnia in the form of either zolpidem 5 mg for 7 days or sleep hygiene counseling.
Result: At baseline, zolpidem and counseling group had a mean Pittsburgh Sleep Quality Index score of 14.82 ± 2.61 and 11.67 ± 3.32, respectively. The difference in mean Pittsburgh Sleep Quality Index score was found to be 4.03 in patients using zolpidem and 1.5 in counseled patients (p = 0.003). The components of Pittsburgh Sleep Quality Index namely difficulty falling asleep within 30 min (sleep latency), overall sleep quality, trouble staying awake during daytime and trouble staying motivated to get things done showed statistically significant improvement after treatment with zolpidem. Following sleep hygiene counseling, the proportion of patients with sleep latency &gt; 30 min reduced considerably. Waking up to use the bathroom was the most common problem reported by approximately 94% patients in both groups before treatment which remained the most prevalent problem even after treatment. Night or early morning awakenings seemed to decrease significantly in patients taking zolpidem (p = 0.039) while it did not show any improvement with counseling. Counseling seemed to get patients to sleep within 30 min.
Conclusion: Patients on zolpidem showed a reduction in their Pittsburgh Sleep Quality Index scores thereby suggesting it as a treatment for insomnia in solid tumor patients. Sleep hygiene counseling, though not as effective as zolpidem, made a slight difference in the overall sleep.

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2019

Journal Article

N. Subramaniam, Balasubramanian, D., Murthy, S., Rathod, P., Vidhyadharan, S., Thankappan, K., and Iyer, S., “Impact of postoperative radiotherapy on survival and loco-regional control in node-negative oral cavity tumours classified as T3 using the AJCC Cancer Staging Manual eighth edition.”, Int J Oral Maxillofac Surg, vol. 48, no. 2, pp. 152-156, 2019.[Abstract]


According to the eighth edition of the AJCC Cancer Staging Manual (AJCC8), a depth of invasion (DOI) >10mm is classified as pT3, representing a locally advanced tumour requiring postoperative radiotherapy (PORT). When node-negative, however, evidence regarding whether PORT improves loco-regional control or survival is unclear. To clarify this, two cohorts of patients were studied: (1) patients classified as pT3N0 by the seventh edition of the AJCC manual (AJCC7), with DOI >10mm and a tumour diameter >4cm (17 patients who received PORT), and (2) patients classified as pT1N0 and pT2N0 by AJCC7, with DOI >10mm and a tumour diameter <4cm (55 patients who did not receive PORT). Loco-regional control and survival were analysed. PORT was found not to impact overall survival or disease-free survival. It was also found not to impact local, regional, or distant recurrence. Although the two subsets of patients considered here (DOI >10mm with tumour diameter below or above 4cm) were previously distinct, they are both considered pT3 in AJCC8. Data from this study indicate that the routine administration of PORT to patients with a DOI >10mm may not be warranted in the absence of other risk features such as nodal disease or close margins.

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2019

Journal Article

Z. B. Kazi, Desai, A. K., R Troxler, B., Kronn, D., Packman, S., Sabbadini, M., Rizzo, W. B., Scherer, K., Abdul-Rahman, O., Tanpaiboon, P., Nampoothiri, S., Gupta, N., Feigenbaum, A., Niyazov, D. M., Sherry, L., Segel, R., McVie-Wylie, A., Sung, C., Joseph, A. M., Richards, S., and Kishnani, P. S., “An immune tolerance approach using transient low-dose methotrexate in the ERT-naïve setting of patients treated with a therapeutic protein: experience in infantile-onset Pompe disease.”, Genet Med, vol. 21, no. 4, pp. 887-895, 2019.[Abstract]


PURPOSE: To investigate immune tolerance induction with transient low-dose methotrexate (TLD-MTX) initiated with recombinant human acid α-glucosidase (rhGAA), in treatment-naïve cross-reactive immunologic material (CRIM)-positive infantile-onset Pompe disease (IOPD) patients.

METHODS: Newly diagnosed IOPD patients received subcutaneous or oral 0.4 mg/kg TLD-MTX for 3 cycles (3 doses/cycle) with the first 3 rhGAA infusions. Anti-rhGAA IgG titers, classified as high-sustained (HSAT; ≥51,200, ≥2 times after 6 months), sustained intermediate (SIT; ≥12,800 and <51,200 within 12 months), or low (LT; ≤6400 within 12 months), were compared with those of 37 CRIM-positive IOPD historic comparators receiving rhGAA alone.

RESULTS: Fourteen IOPD TLD-MTX recipients at the median age of 3.8 months (range, 0.7-13.5 months) had a median last titer of 150 (range, 0-51,200) at median rhGAA duration ~83 weeks (range, 36-122 weeks). One IOPD patient (7.1%) developed titers in the SIT range and one patient (7.1%) developed titers in the HSAT range. Twelve of the 14 patients (85.7%) that received TLD-MTX remained LT, versus 5/37 HSAT (peak 51,200-409,600), 7/37 SIT (12,800-51,000), and 23/37 LT (200-12,800) among comparators.

CONCLUSION: Results of TLD-MTX coinitiated with rhGAA are encouraging and merit a larger longitudinal study.

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2019

Journal Article

F. E. A. Udink Cate, Sobhy, R., Kalantre, A., Sachdev, S., Subramanian, A., Koneti, N. Rao, Kumar, R. Krishna, Hamza, H., Jayranganath, M., and Sreeram, N., “Off-label use of duct occluder devices to close hemodynamically significant perimembranous ventricular septal defects: A multicenter experience.”, Catheter Cardiovasc Interv, vol. 93, no. 1, pp. 82-88, 2019.[Abstract]


OBJECTIVE: We sought to evaluate the feasibility, technical aspects, and outcome of transcatheter perimembranous ventricular septal defect (pmVSD) closure using duct occluder devices with a single retention disc.

BACKGROUND: Use of duct occluder devices to close pmVSD seems a promising alternative therapy. However, limited data exist on this technique.

METHODS: From 2010 to 2016, 222 patients (female 47.7%) were identified from databases of five participating institutions in whom pmVSD closure was attempted using an Amplatzer Duct Occluder I or Lifetech duct occluder device.

RESULTS: Patients ranged in age from 0.7 to 52 years (median, 7.0 years) and in weight from 4.0 to 70 kg (median, 18.0 kg). The mean size of the VSD was 6.8 ± 2.2 mm. A large defect (> 6 mm) was present in 137 patients (61.7%). Device closure was successful in 218 patients (98.2%). The 10/8 mm device was used in most patients (n = 85, 38.3%), and the vascular approach was from the femoral vein in 169 patients (76.1%). There were 18 early complications in 17/218 patients (7.8%). Three patients (1.4%) developed complete heart block (transient n = 2; requiring permanent pacing n = 1). Median follow-up was 6 months (6 months-6 years). A mild residual shunt was seen in 10 patients at 6 months follow-up.

CONCLUSIONS: The immediate results of transcatheter pmVSD closure using a duct occluder device with a single retention disc are promising. It is an effective technique with a lower rate of complications than for other currently available devices.

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2019

Journal Article

N. M Sundaram, Deepthi, S., Mony, U., Shalumon, K. T., Chen, J. - P., and Dr. Jayakumar Rangasamy, “Chitosan Hydrogel Scaffold Reinforced with Twisted Poly(l lactic acid) Aligned Microfibrous Bundle to Mimic Tendon Extracellular Matrix”, Int J Biol Macromol, vol. 122, pp. 37-44, 2019.[Abstract]


Regeneration of tendon requires construct that provides necessary structural support closely mimicking the native architecture. To recreate this complex architecture a construct made of heat-treated, twisted poly(L lactic acid) (PLLA) microfibers coated with chitosan gel and surrounded by PLLA micro-fibrous layer was developed. The developed construct characterized using SEM showed the macroporous nature of gel coating around four distinct PLLA twisted fibrous bundle and a thin fiber layer surrounding the construct. FTIR analysis confirmed the presence of PLLA and chitosan construct. Mechanical strength increased with increasing number of strips. Protein adsorption was significantly low on the construct with outer covering that could retard cell adhesion to the outer layer. The developed construct showed good cell attachment and proliferation of tenocytes. These results indicate that the construct would find application for tendon tissue engineering

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2019

Journal Article

S. Padmakumar, Dr. Bindhu Paul, Pavithran, K., Vijaykumar, D. Kottarathi, Rajanbabu, A., Sivanarayanan, T. Balakrishn, Kadakia, E., Amiji, M. M., Shantikumar V Nair, and Dr. Deepthy Menon, “Long-term Drug Delivery using Implantable Electrospun Woven Polymeric Nanotextiles”, Nanomedicine: Nanotechnology, Biology, and Medicine, vol. 15, no. 1, pp. 274-284, 2019.[Abstract]


A woven nanotextile implant was developed and optimized for long-term continuous drug delivery for potential oncological applications. Electrospun polydioxanone (PDS) nanoyarns, which are twisted bundles of PDS nanofibres, were loaded with paclitaxel (PTX) and woven into nanotextiles of different packing densities. A mechanistic modeling of in vitro drug release proved that a combination of diffusion and matrix degradation controlled the slow PTX-release from a nanoyarn, emphasizing the role of nanostructure in modulating release kinetics. Woven nanotextiles, through variations in its packing density and thereby architecture, demonstrated tuneable PTX-release. In vivo PTX-release, pharmacokinetics and biodistribution were evaluated in healthy BALB/c mice by suturing the nanotextile to peritoneal wall. The slow and metronomic PTX-release for 60 days from the loosely woven implant was extremely effective in enhancing its residence in peritoneum, in contrast to intraperitoneal injections. Such an implantable matrix offers a novel platform for therapy of solid tumors over prolonged durations

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2019

Journal Article

M. Hebbar, Shukla, A., Nampoothiri, S., Bielas, S., and Girisha, K. M., “Locus and allelic heterogeneity in five families with hereditary spastic paraplegia.”, J Hum Genet, vol. 64, no. 1, pp. 17-21, 2019.[Abstract]


Hereditary spastic paraplegias are a group of genetically heterogeneous neurological disorders characterized by progressive weakness and spasticity of lower limbs. We ascertained five families with eight individuals with hereditary spastic paraplegia. Pathogenic variants were identified by exome sequencing of index cases. The cohort consists of three families with spastic paraplegia type 47 (AP4B1) with a common mutation in two families, a family with spastic paraplegia type 50 (AP4M1), and two male siblings with X-linked spastic paraplegia 2 (PLP1). This work illustrates locus and allelic heterogeneity in five families with hereditary spastic paraplegia.

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2019

Journal Article

P. H. Somashekar, Girisha, K. M., Nampoothiri, S., Gowrishankar, K., Devi, R. R., Gupta, N., Narayanan, D. L., Kaur, A., Bajaj, S., Jagadeesh, S., Lewis, L. E. S., Shailaja, S., and Shukla, A., “Locus and allelic heterogeneity and phenotypic variability in Waardenburg syndrome.”, Clin Genet, vol. 95, no. 3, pp. 398-402, 2019.[Abstract]


Waardenburg syndrome (WS) is a disorder of neural crest cell migration characterized by auditory and pigmentary abnormalities. We investigated a cohort of 14 families (16 subjects) either by targeted sequencing or whole-exome sequencing. Thirteen of these families were clinically diagnosed with WS and one family with isolated non-syndromic hearing loss (NSHL). Intra-familial phenotypic variability and non-penetrance were observed in families diagnosed with WS1, WS2 and WS4 with pathogenic variants in PAX3, MITF and EDNRB, respectively. We observed gonosomal mosaicism for a variant in PAX3 in an asymptomatic father of two affected siblings. For the first time, we report a biallelic pathogenic variant in MITF in a subject with WS2 and a biallelic variant in EDNRB was noted in a subject with WS2. An individual with isolated NSHL carried a pathogenic variant in MITF. Blended phenotype of NSHL and albinism was observed in a subject clinically diagnosed to have WS2. A phenocopy of WS1 was observed in a subject with a reported pathogenic variant in GJB2, known to cause isolated NSHL. These novel and infrequently reported observations exemplify the allelic and genetic heterogeneity and show phenotypic diversity of WS.

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2019

Journal Article

S. Murthy, Low, T. - H. Hubert, Subramaniam, N., Deepak Balasubramanian, Sivakumaran, V., Anand, A., Vijayan, S. Nalumackal, Nambiar, A., Thankappan, K., and Dr. Subramania Iyer K., “Validation of the Eighth Edition AJCC Staging System in Early T1 to T2 Oral Squamous Cell Carcinoma”, J Surg Oncol, vol. 119, no. 4, pp. 449-454, 2019.[Abstract]


BACKGROUND: To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control.

METHODS: Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems.

RESULTS: The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P &lt; 0.001) (AJCC 7) vs 87% and 67% (P &lt; 0.001) (AJCC 8). The 5-year DSS was 78% and 61% for T1 and T2, respectively&nbsp;(P &lt; 0.001) (AJCC 7) vs 89% and 71% (P &lt; 0.001) (AJCC 8). For stages I and II tumours the 5-year OS was 81% and 76%, respectively (P &lt; 0.302) (AJCC 7) vs 87% and 73% (P &lt; 0.017) (AJCC 8). The 5-year DSS was 83% and 82% (P &lt; 0.222) vs 89% and 77% (P &lt; 0.016). With the AJCC eighth edition the 5-year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively.

CONCLUSION: The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.

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2019

Journal Article

R. Nair, Radhakrishnan, K., Chatterjee, A., Gorthi, S. P., and Prabhu, V. A., “Sleep Apnea-Predictor of Functional Outcome in Acute Ischemic Stroke.”, J Stroke Cerebrovasc Dis, vol. 28, no. 3, pp. 807-814, 2019.[Abstract]


BACKGROUND: Sleep apnea is increasingly being recognized as 1 of the important, modifiable risk factors of stroke and cardiovascular diseases. Sleep apnea is thought to impair the functional recovery following stroke. Hence, we evaluated the patients with acute ischemic stroke for prevalence of sleep apnea and compared the functional outcomes of patients with and without sleep apnea, at 3rd month of acute ischemic stroke.

METHOD: This study was conducted in Kasturba Medical College (KMC) hospital, Manipal, India, between May 2015 and August 2016. We included 102 consecutive patients of acute ischemic stroke with hemiplegic upper limb power of Medical Research Council (MRC) 3 or less. Sleep apnea was diagnosed in these patients using the sleep disordered Questionnaire, Berlin Questionnaire, and Epworth sleepiness scale. Functional outcome was measured using Barthel score on day 7 and at 3rd month following the onset of stroke.

RESULT: Out of 102 patients, sleep apnea was present in 31 (30.6%) patients, more in males (67.7%) and elderly. Hypertension was present in 66.6% of patients with sleep apnea. NIHSS score at admission did not differ between the 2 groups. At 3rd month, the Barthel score calculated was better among patient with no apnea, but this was not statistically significant (P = .119). When mean Barthel score at baseline and 3rd month was calculated using repeated measure Analysis of Variance (ANOVA) between the 2 groups, gain in functional independence in no apnea group was statistically significant (P &lt; .001).

CONCLUSION: Sleep-disordered breathing is an independent risk factor for stroke, and sleep apnea is also associated with other known stroke risk factors like hypertension. In acute ischemic stroke, sleep apnea has a negative impact on functional recovery. Sleep apnea is amenable to treatment and should be considered in patients with acute ischemic stroke to improve the chance of recovery, and to reduce the risk of recurrence.

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2019

Journal Article

A. Manthanath, Wakchaure, V. Chandrakan, Ranjeesh, K. Chandran, Das, T., Vanka, K., Nakanishi, T., and Babu, S. Santhosh, “Paintable Room-Temperature Phosphorescent Liquid Formulations of Alkylated Bromonaphthalimide.”, Angew Chem Int Ed Engl, vol. 58, no. 8, pp. 2284-2288, 2019.[Abstract]


Organic phosphors have been widely explored with an understanding that crystalline molecular ordering is a requisite for enhanced intersystem crossing. In this context, we explored the room-temperature phosphorescence features of a solvent-free organic liquid phosphor in air. While alkyl chain substitution varied the physical states of the bromonaphthalimides, the phosphorescence remained unaltered for the solvent-free liquid in air. As the first report, a solvent-free liquid of a long swallow-tailed bromonaphthalimide exhibits room-temperature phosphorescence in air. Doping of the phosphor with carbonyl guests resulted in enhanced phosphorescence, and hence a large-area paintable phosphorescent liquid composite with improved lifetime and quantum yield was developed

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2019

Journal Article

C. Wang, Bangdiwala, S. I., Rangarajan, S., Lear, S. A., AlHabib, K. F., Mohan, V., Teo, K., Poirier, P., Tse, L. Ah, Liu, Z., Rosengren, A., Kumar, R., Lopez-Jaramillo, P., Yusoff, K., Monsef, N., Krishnapillai, V., Ismail, N., Seron, P., Dans, A. L., Kruger, L., Yeates, K., Leach, L., Yusuf, R., Orlandini, A., Wolyniec, M., Bahonar, A., Mohan, I., Khatib, R., Temizhan, A., Li, W., and Yusuf, S., “Association of Estimated Sleep Duration and Naps with Mortality and Cardiovascular Events: a Study of 116 632 People from 21 Countries”, Eur Heart J, vol. 40, no. 20, pp. 1620-1629, 2019.[Abstract]


AIMS: To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events.

METHODS AND RESULTS: We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116&nbsp;632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (&gt;8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6-8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99-1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99-1.12), 1.17 (1.09-1.25), and 1.41 (1.30-1.53) for 8-9 h/day, 9-10 h/day, and &gt;10 h/day, Ptrend &lt; 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h).

CONCLUSION: Estimated total sleep duration of 6-8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with &gt;6 h of nighttime sleep but not in those sleeping ≤6 h/night.

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2019

Journal Article

S. Sharma, Joshi, M., Gupta, D. K., Abraham, M., Mathur, P., Mahajan, J. K., Gangopadhyay, A. N., Rattan, S. K., Vora, R., G Prasad, R., Bhattacharya, N. C., Samuj, R., Rao, K. L. N., and Basu, A. K., “Consensus on the Management of Posterior Urethral Valves from Antenatal Period to Puberty.”, J Indian Assoc Pediatr Surg, vol. 24, no. 1, pp. 4-14, 2019.[Abstract]


The need for successful management of posterior urethral valves always captivates the minds of pediatric surgeons. Its success, however, depends on several factors ranging from prenatal preservation of upper tracts to postoperative pharmacological compliance. Regardless of measures available, some cases do not respond and progress to end stage. The management depends on several issues ranging from age and severity at presentation to long-term follow-up and prevention of secondary renal damage and managing valve bladder syndrome. This article is based on a consensus to the set of questionnaires, prepared by research section of Indian Association of Paediatric Surgeons and discussed by experienced pediatric surgeons based in different institutions in the country. Standard operating procedures for conducting a voiding cystourethrogram and cystoscopy were formulated. Age-wise contrast dosage was calculated for ready reference. Current evidence from literature was also reviewed and included to complete the topic.

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2019

Journal Article

D. S. Raju, Sugunan, A., Dr. Pavithran K., Arun Philip, and Remya Reghu, “Chemoport-related Fungemia Caused by Trichosporon asahii.”, J Pediatr Hematol Oncol, 2019.[Abstract]


Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T. asahii in a 1-year-old child with Wilms Tumor. To the best of our knowledge, this is the first time that fungal sepsis due to T. asahii has been reported in a Wilms tumor patient. The incidence of rare invasive fungal infections is increasing in immunocompromised patients in whom management becomes difficult due to their heterogenous antifungal susceptibility pattern and intrinsic resistance to the standard antifungal agents that are routinely given. The patient was admitted with high spiking fever, and his laboratory investigations suggested neutropenia. T. asahii was isolated from the blood culture, for which he was started on inj. voriconozole. After 14 days of treatment, the fungus was cleared out from the patient's blood.

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2019

Journal Article

S. P. Murthy, Paderno, A., and Deepak Balasubramanian, “Management of the Marginal Mandibular Nerve During and After Neck Dissection”, Curr Opin Otolaryngol Head Neck Surg, vol. 27, no. 2, pp. 104-109, 2019.[Abstract]


PURPOSE OF REVIEW: Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options.

RECENT FINDINGS: A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer.

SUMMARY: When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered.

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2019

Journal Article

P. N. Kantaputra, Smith, L. J., Casal, M. L., Kuptanon, C., Chang, Y. - C., Nampoothiri, S., Paiyarom, A., Veerasakulwong, T., Trachoo, O., Cairns, J. R. Ketudat, Chinadet, W., and Tanpaiboon, P., “Oral manifestations in patients and dogs with mucopolysaccharidosis Type VII.”, Am J Med Genet A, 2019.[Abstract]


Mucopolysaccharidosis Type VII (MPS7, also called β-glucuronidase deficiency or Sly syndrome; MIM 253220) is an extremely rare autosomal recessive lysosomal storage disease, caused by mutations in the GUSB gene. β-glucuronidase (GUSB) is a lysosomal hydrolase involved in the stepwise degradation of glucuronic acid-containing glycosaminoglycans (GAGs). Patients affected with MPS VII are not able to completely degrade glucuronic acid-containing GAGs, including chondroitin 4-sulfate, chondroitin 6-sulfate, dermatan sulfate, and heparan sulfate. The accumulation of these GAGs in lysosomes of various tissues leads to cellular and organ dysfunctions. Characteristic features of MPS VII include short stature, macrocephaly, hirsutism, coarse facies, hearing loss, cloudy cornea, short neck, valvular cardiac defects, hepatosplenomegaly, and dysostosis multiplex. Oral manifestations in patients affected with MPS VII have never been reported. Oral manifestations observed in three patients consist of wide root canal spaces, taurodontism, hyperplastic dental follicles, malposition of unerupted permanent molars, and failure of tooth eruption with malformed roots. The unusual skeletal features of the patients include maxillary hypoplasia, hypoplastic midface, long mandibular length, mandibular prognathism, hypoplastic and aplastic mandibular condyles, absence of the dens of the second cervical vertebra, and erosion of the cortex of the lower border of mandibles. Dogs affected with MPS VII had anterior and posterior open bite, maxillary hypoplasia, premolar crowding, and mandibular prognathism. Unlike patients with MPS VII, the dogs had unremarkable mandibular condyles. This is the first report of oral manifestations in patients affected with MPS VII.

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2019

Journal Article

E. Charani, Smith, I., Skodvin, B., Perozziello, A., Lucet, J. - C., Lescure, F. - X., Birgand, G., Poda, A., Ahmad, R., Singh, S., and Holmes, A. Helen, “Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries-A qualitative study.”, PLoS One, vol. 14, no. 1, p. e0209847, 2019.[Abstract]


BACKGROUND: Most of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.

MATERIALS AND METHODS: Healthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.

RESULTS: 54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, one hospital in India provided the best example of interdisciplinary ASP, championed through organisational leadership.

CONCLUSIONS: ASP initiatives in this study were restricted by professional boundaries and hierarchies, with lack of engagement with the wider healthcare workforce. There needs to be promotion of interdisciplinary team work including pharmacists and nurses, depending on the available healthcare workforce in different countries, in ASP. The surgical pathway remains a hard to reach, but critical target for ASP globally. There is a need to develop contextually driven ASP targeting the surgical pathway in different resource settings.

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2019

Journal Article

B. Srimurugan, Jayashankar, J., Balachandran, R., and Gopalraj, S. S., “Unrecognized double aortic arch in a preterm infant: Diagnostic challenges and perioperative management.”, Ann Card Anaesth, vol. 22, no. 1, pp. 83-85, 2019.[Abstract]


Vascular rings are relatively rare, and are frequently overlooked as a potential cause of neonatal respiratory distress in non specialized centres. This might lead to delay in diagnosis during which the child is subjected to repeated respiratory insults. Procrastination in prompt diagnosis and management can lead to significant comorbidities or even death. We highlight the case report of a preterm infant with an unrecognized double aortic arch who presented with severe respiratory morbidity and the subsequent management.

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2019

Journal Article

P. R. Camfield, Andrade, D., Camfield, C. S., Carrizosa-Moog, J., Appleton, R., Baulac, M., Brown, L., Ben Menachem, E., Cross, H., Desguerre, I., Grant, C., Hosny, H., Jurasek, L., Mula, M., Pfäfflin, M., Rheims, S., Ring, H., Shellhaas, R. A., P., V. K., Wirrell, E., and Nabbout, R., “How can Transition to Adult Care be Best Orchestrated for Adolescents with Epilepsy?”, Epilepsy Behav, vol. 93, pp. 138-147, 2019.[Abstract]


Objective evidence is limited for the value of transition programs for youth with chronic illness moving from pediatric to adult care; however, such programs intuitively "make sense". We describe the strengths and weaknesses of a variety of transition programs from around the world for adolescents with epilepsy. Consequences of poorly organized transition beyond suboptimal seizure control may include an increased risk of sudden unexpected death in epilepsy (SUDEP), poor psychological and social outcome, and inadequate management of comorbidities. The content of transition programs for those with normal intelligence differs from those with intellectual disability, but both groups may benefit from an emphasis on sporting activities. Concerns that may interfere with optimal transition include lack of nursing or social work services, limited numbers of adult neurologists/epileptologists confident in the treatment of complex pediatric epilepsy problems, institutional financial support, and time constraints for pediatric and adult physicians who treat epilepsy and the provision of multidisciplinary care. Successful programs eventually need to rely on a several adult physicians, nurses, and other key healthcare providers and use novel approaches to complex care. More research is needed to document the value and effectiveness of transition programs for youth with epilepsy to persuade institutions and healthcare professionals to support these ventures.

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2019

Journal Article

F. Khan, Rathore, C., Kate, M., Joy, J., Zachariah, G., Vincent, P. C., Varma, R. Prasad, and Radhakrishnan, K., “The Comparative Efficacy of Theta Burst Stimulation or Functional Electrical Stimulation when Combined with Physical Therapy after Stroke: A Randomized Controlled Trial”, Clin Rehabil, vol. 33, no. 4, pp. 693-703, 2019.[Abstract]


OBJECTIVE:: To study the long-term effectiveness of Theta Burst Stimulation (TBS) or Functional Electrical Stimulation (FES) combined with Physical therapy (PT) as compared to PT alone for improving arm functions in patients with acute stroke.

DESIGN:: Single blind randomized controlled trial.

SETTING:: Outpatient clinics and inpatient wards at tertiary care neurology center.

SUBJECTS:: Adult patients with acute middle cerebral artery territory ischemic stroke.

INTERVENTIONS:: 60 patients were randomized into three groups of 20 each: TBS+PT; FES+PT; and PT alone. TBS group received intermittent TBS of ipsilesional hemisphere and continuous TBS of contralesional hemisphere while FES group received FES of paretic limb, both for four weeks. All groups received supervised physical therapy for four weeks followed by home physiotherapy for one year.

OUTCOME MEASURES:: Fugl Meyer Assessment upper limb score (FMA-UL) was primary outcome measure. Patients were evaluated at baseline and subsequently at one, three and six months and one year.

RESULTS:: Compared to PT group, mean FMA-UL scores were higher in TBS and FES groups at all follow-ups ( P &lt; 0.001). From baseline to one year, mean (SD) FMA-UL scores increased from 14.9(2.1) to 55.55(2.46) in TBS group, 15.5(1.99) to 55.85(2.46) in FES group, and 14.3(2.2) to 43.3(4.22) in PT group indicating an increase of 273%, 260%, and 203% respectively. There was no difference between FES and TBS groups.

CONCLUSION:: A four-week intervention with TBS or FES combined with PT produces better long-term arm functions as compared to PT alone in patients with acute stroke.

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2019

Journal Article

A. C. Ratheendran, Subramanian, M., Bhanu, D. K., Prabhu, M. A., Kannan, R., Natarajan, K. U., S Sekhar, S., Thachathodiyil, R., Harikrishnan M. S., and Pai, P. G., “Fragmented QRS on electrocardiography as a predictor of myocardial scar in patients with hypertrophic cardiomyopathy.”, Acta Cardiol, pp. 1-5, 2019.[Abstract]


BACKGROUND: Fragmented QRS (fQRS) and Q waves are ECG findings in patients with myocardial scar. fQRS is more sensitive than pathological Q waves in detecting myocardial fibrosis in patients with coronary artery disease (CAD). Cardiac magnetic resonance (CMR) imaging is used for the diagnosis and for quantifying scar tissue in patients with HCM. Our aim was to correlate ECG parameters like fQRS and Q waves with the presence of late gadolinium enhancement (LGE) assessed by contrast CMR imaging to elucidate ECG markers which might predict scar tissue in HCM.

METHODS: This study is a retrospective analysis which included 39 patients who were diagnosed/suspected to have HCM on echocardiography and referred for contrast CMR imaging at our centre between 2010 and 2016. Presence of fQRS was correlated with scar demonstrated by LGE on CMR.

RESULTS: Twenty four (66.67%) patients had asymmetrical septal hypertrophy, 7 (19.44%) patients had apical involvement while 5 (13.89%) had concentric pattern. Only 4 (11.11%) patients had pathological Q waves in contiguous leads on surface ECG while fQRS in two contiguous leads was present in 23 (63.89%) patients. Presence of fQRS was more in patients with LGE on CMR than those without (84.61 versus 10%, p<.001). When presence of LGE in specific segments (anterior, lateral and inferior) was correlated with corresponding ECG leads, all the three segments showed significant correlation. The overall sensitivity, specificity, PPV and NPV of fQRS for predicting scar tissue were 84.6, 90.0, 95.6 and 69.2%, respectively.

CONCLUSION: fQRS on surface ECG can be used as an indirect marker to predict the presence of fibrosis in HCM.

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2019

Journal Article

S. Nampoothiri, Elcioglu, N. H., Koca, S. S., Dhanya Yesodharan, Kk, C., Krishnan, V., Bhat, M., Radhakrishnan, N., Kappanayil, M., Sheth, J. J., Alves, S., Coutinho, F., Friez, M. J., Pauli, R. M., Unger, S., Superti-Furga, A., Leroy, J. G., and Cathey, S. S., “Does the clinical phenotype of mucolipidosis-IIIγ differ from its αβ counterpart?: supporting facts in a cohort of 18 patients.”, Clin Dysmorphol, vol. 28, no. 1, pp. 7-16, 2019.[Abstract]


Mucolipidosis-IIIγ (ML-IIIγ) is a recessively inherited slowly progressive skeletal dysplasia caused by mutations in GNPTG. We report the genetic and clinical findings in the largest cohort with ML-IIIγ so far: 18 affected individuals from 12 families including 12 patients from India, five from Turkey, and one from the USA. With consanguinity confirmed in eight of 12 families, molecular characterization showed that all affected patients had homozygous pathogenic GNPTG genotypes, underscoring the rarity of the disorder. Unlike ML-IIIαβ, which present with a broader spectrum of severity, the ML-III γ phenotype is milder, with onset in early school age, but nonetheless thus far considered phenotypically not differentiable from ML-IIIαβ. Evaluation of this cohort has yielded phenotypic findings including hypertrophy of the forearms and restricted supination as clues for ML-IIIγ, facilitating an earlier correct choice of genotype screening. Early identification of this disorder may help in offering a timely intervention for the relief of carpal tunnel syndrome, monitoring and surgery for cardiac valve involvement, and evaluation of the need for joint replacement. As this condition may be confused with rheumatoid arthritis, confirmation of diagnosis will prevent inappropriate use of immunosuppressants and disease-modifying agents.

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2019

Journal Article

B. Kavumkal Rajagopalan, Rajesh Jose, Kader, N. Puthukudiy, and Varma, P. Kerala, “Coarctation of aorta aneurysm with aberrant right subclavian artery and single carotid artery: Surgical and perfusion strategies.”, J Thorac Cardiovasc Surg, vol. 157, no. 1, pp. e17-e19, 2019.

2019

Journal Article

V. Sridevi, Reddy, M. Ramasubba, Srinivasan, K., Radhakrishnan, K., Rathore, C., and Nayak, D. S., “Improved Patient-Independent System for Detection of Electrical Onset of Seizures.”, J Clin Neurophysiol, vol. 36, no. 1, pp. 14-24, 2019.[Abstract]


PURPOSE: To design a non-patient-specific system to detect the electrical onset of seizures in patients with temporal lobe epilepsy.

METHODS: We used EEG data from 29 seizures of 18 temporal lobe epilepsy patients who underwent multiday video-scalp EEG monitoring as part of their presurgical evaluations. We segmented each data set into preictal and ictal phases, and identified spectral entropy, spectral energy, and signal energy as useful features for discriminating normal and seizure conditions. The performance of five different classifiers was analyzed using these features to design an automated detection system.

RESULTS: Among the five classifiers, decision tree, k-nearest neighbor, and support vector machine performed with sensitivity (specificity) of 79% (81%), 75% (85%), and 80% (86%), respectively. The other two, linear discriminant algorithm and Naive Bayes classifiers, performed with sensitivity (specificity) of 54% (94%), 47% (96%), respectively.

CONCLUSIONS: The support vector machine-based seizure detection system showed better detection capability in terms of sensitivity and specificity measures as compared to linear discriminant algorithm, Naive Bayes, decision tree, and k-nearest neighbor classifiers.

CONCLUSIONS: Our study shows that a generalized system to detect the electrical onset of seizures in temporal lobe epilepsy using scalp-recorded EEG is possible. If confirmed on a larger data set, our findings may have significant implications for the management of seizures, especially in patients with drug-resistant epilepsy.

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2019

Journal Article

Girish C. M., Dr. Subramania Iyer K., Dr. Krishnakumar T., GS, G., Dr. Manzoor K., and Shantikumar V Nair, “A Novel Surface Enhanced Raman Catheter for Rapid Detection, Classification, and Grading of Oral Cancer”, Advanced Healthcare Materials, vol. 8, no. 13:e1801557, 2019.[Abstract]


Fabrication and testing of a novel nanostructured surface-enhanced Raman catheter device is reported for rapid detection, classification, and grading of normal, premalignant, and malignant tissues with high sensitivity and accuracy. The sensor part of catheter is formed by a surface-enhanced Raman scattering (SERS) substrate made up of leaf-like TiO2 nanostructures decorated with 30 nm sized Ag nanoparticles. The device is tested using a total of 37 patient samples wherein SERS signatures of oral tissues consisting of malignant oral squamous cell carcinoma (OSCC), verrucous carcinoma, premalignant leukoplakia, and disease-free conditions are detected and classified with an accuracy of 97.24% within a short detection-cum-processing time of nearly 25-30 min per patient. Neoplastic grade changes detected using this device correlate strongly with conventional pathological data, enabling correct classification of tumors into three grades with an accuracy of 97.84% in OSCC. Thus, the potential of a SERS catheter device as a point-of-care pathological tool is shown for the rapid and accurate detection, classification, and grading of solid tumors.

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2019

Journal Article

N. Raveendran, Mohandas, A., Riju R. Menon, Menon, A. Somasekhar, Biswas, R., and Dr. Jayakumar Rangasamy, “Ciprofloxacin and Fluconazole Containing Fibrin Nanoparticles Incorporated Chitosan Bandages for the Treatment of Polymicrobial Wound Infections”, ACS Applied Bio Materials, vol. 2, no. 1, pp. 243-254, 2019.[Abstract]


Polymicrobial wound infections often requires high dosage of antibiotics and fungicides. However, prolonged antimicrobial therapies are associated with potential systemic side effects and increased risk for the development of drug resistant microbes. With this focus, we aimed at developing chitosan bandages loaded with anti-microbial (ciprofloxacin and fluconazole) drug loaded nanoparticles for a sustained slow release of drugs. The particle sizes of the prepared ciprofloxacin and flucanazole loaded fibrin nanoparticles were observed to be 132 ± 16 and 175 ± 17 nm respectively. The chitosan bandages with drug containing nanoparticles were flexible with adequate tensile strength and porosity of 80-85%, which would favour excess exudates absorption in an infectious wound. The in vitro toxicity of the bandages studied against human dermal fibroblast (HDF) cell line proved its cytocompatibility. Ciprofloxacin and fluconazole from bandages released upto 14 days in a sustained manner. The antimicrobial drugs loaded bandages showed significant antimicrobial activity towards polymicrobial cultures of C. albicans, E. coli & S. aureus in vitro and ex vivo. In vivo studies were conducted on polymicrobial infected rat wound model. A significant reduction in microbial load was obtained upon application of antimicrobial drug loaded chitosan bandages in vivo.

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2019

Journal Article

A. Kumar Sikary, Anu Sasidharan, Pillay, V. V., and Andrade, C., “Prescription drug suicide in non-abusers: A 6-year forensic survey”, Asian Journal of Psychiatry, vol. 44, pp. 133 - 137, 2019.[Abstract]


Background Prescription drug suicide merits study to guide the development of strategies to reduce suicide risk. We examined prescription drug suicide specifically in non-abusers of prescription drugs; this is a relatively unexplored subject. Methods Six-year data on prescription drug suicide in non-abusers were extracted from the records of the Department of Forensic Medicine at the All India Institute of Medical Sciences, New Delhi. These records contained information obtained from the scene of the suicide, from interviews with relatives of the deceased, and from forensic toxicological analyses at two laboratories. Results There were 27 (8%) cases of prescription drug suicide in non-abusers out of 338 cases of suicidal poisoning. The mean age of this sample was 26 years. The sample was 74% male. Nearly half of the cases (44%) were students. A combination of dextropropoxyphene with dicyclomine, with or without paracetamol, was used by 41% of cases. Overdose was achieved through the ingestion of 10–40 (median, 30) tablets or by the injection of 2–3 (median, 2) vials of medication. In 52% of cases, it appeared that the drugs had been procured over the counter. Conclusions It is reassuring that the absolute number of prescription drug suicides in non-abusers was small; the findings, however, are important because they could serve as a baseline for assessing time trends in future studies. For the present, we suggest that prescription drugs of potential abuse, especially those containing opioids and antispasmodics, should be prescribed and dispensed judiciously, especially to youth.

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2019

Journal Article

A. A, VV, P., B, J., and Anu Sasidharan, “Estimation and Assessment of Carbon Monoxide Levels from Post-mortem Blood Samples in Cases of Death Due to Burns”, J South India Medicolegal Association, vol. 11, 1 vol., 2019.

2019

Journal Article

G. A and Anu Sasidharan, “Impact of problem based learning and lecture based learning with respect to clinical microbiology teaching”, Amrita J Med, vol. 15, 1 vol., pp. 12-14, 2019.

2019

Journal Article

V. V. Pillay, Sasidharan, A., Arathy, S. L., Karimassery Ramaiyer Sundaram, and Greeshma, C. R., “Detection and estimation of arsenic and lead in coconut water - A Kerala study”, Indian Journal of Forensic Medicine and Toxicology, vol. 13, pp. 19-24, 2019.[Abstract]


Coconut is a popular food ingredient in many parts of the world and the water it contains is believed to be the purest form of natural drink available. The water is rich in potassium, sodium, chloride and many vitamins, and hence is considered the beverage of choice. In medical practice, coconut water is recommended as the preferred oral rehydration fluid in cases of severe dehydration due to diarrhoea. Chronic heavy metal poisoning has been shown to occur from plant products. However there is scanty research work relating to coconuts and heavy metal contamination. Among the various metals, lead is said to be the commonest metal involved. Arsenic is only second to lead in the incidence of chronic toxicity. When plants are exposed to heavy metals, mostly through contaminated water (irrigation), or contaminated soil, they accumulate in edible parts such as the fruits. This study was undertaken to detect the presence of two of the commonest heavy metals - arsenic and lead – in coconut water present in coconuts sold in different parts of Ernakulam district of Kerala state, and to quantitatively assess their levels. It was also decided to detect the differences in the levels of the metals between tender and mature coconut water, and also to detect inter-zonal variations within Ernakulam district in the levels of the two heavy metals, in tender and mature coconut water © 2019, Indian Journal of Forensic Medicine and Toxicology. All rights reserved. More »»

2019

Journal Article

Dr. Sheela Nampoothiri, Guillemyn, B., Elcioglu, N., Jagadeesh, S., Dhanya Yesodharan, Suresh, B., Turan, S., Symoens, S., and Malfait, F., “Ptosis as a Unique Hallmark for Autosomal Recessive WNT1-associated Osteogenesis Imperfecta”, Am J Med Genet A, vol. 179, no. 6, pp. 908-914, 2019.[Abstract]


Osteogenesis imperfecta (OI) is a heritable connective tissue disorder, mainly characterized by bone fragility and low bone mass. Defects in the type I procollagen-encoding genes account for the majority of OI, but increasingly more rare autosomal recessive (AR) forms are being identified, which are caused by defects in genes involved in collagen metabolism, bone mineralization, or osteoblast differentiation. Bi-allelic mutations in WNT1 have been associated with a rare form of AR OI, characterized by severe osteoporosis, vertebral compression, scoliosis, fractures, short stature, and variable neurological problems. Heterozygous WNT1 mutations have been linked to autosomal dominant early-onset osteoporosis. In this study, we describe the clinical and molecular findings in 10 new patients with AR WNT1-related OI. Thorough revision of the clinical symptoms of these 10 novel patients and previously published AR WNT1 OI cases highlight ptosis as a unique hallmark in the diagnosis of this OI subtype

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2019

Journal Article

A. K. Cheema, Mehta, K. Y., Santiago, P. T., Fatanmi, O. O., Kaytor, M. D., and Singh, V. K., “Pharmacokinetic and Metabolomic Studies with BIO 300, a Nanosuspension of Genistein, in a Nonhuman Primate Model.”, Int J Mol Sci, vol. 20, no. 5, 2019.[Abstract]


Genistein is a naturally occurring phytoestrogen isoflavone and is the active drug ingredient in BIO 300, a radiation countermeasure under advanced development for acute radiation syndrome (H-ARS) and for the delayed effects of acute radiation exposure (DEARE). Here we have assessed the pharmacokinetics (PK) and safety of BIO 300 in the nonhuman primate (NHP). In addition, we analyzed serum samples from animals receiving a single dose of BIO 300 for global metabolomic changes using ultra-performance liquid chromatography (UPLC) quadrupole time-of-flight mass spectrometry (QTOF-MS). We present a comparison of how either intramuscularly () or orally () administered BIO 300 changed the metabolomic profile. We observed transient alterations in phenylalanine, tyrosine, glycerophosphocholine, and glycerophosphoserine which reverted back to near-normal levels 7 days after drug administration. We found a significant overlap in the metabolite profile changes induced by each route of administration; with the route showing fewer metabolic alterations. Taken together, our results suggest that the administration of BIO 300 results in metabolic shifts that could provide an overall advantage to combat radiation injury. This initial assessment also highlights the utility of metabolomics and lipidomics to determine the underlying physiological mechanisms involved in the radioprotective efficacy of BIO 300

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2019

Journal Article

J. Advani, Verma, R., Chatterjee, O., Pachouri, P. Kumar, Upadhyay, P., Singh, R., Yadav, J., Naaz, F., Ravikumar, R., Buggi, S., Suar, M., Gupta, U. D., Pandey, A., Chauhan, D. S., Tripathy, S. Prasad, Gowda, H., and Prasad, T. S. Keshava, “Whole Genome Sequencing of Clinical Isolates From India Reveals Genetic Heterogeneity and Region-Specific Variations That Might Affect Drug Susceptibility.”, Front Microbiol, vol. 10, p. 309, 2019.[Abstract]


Whole genome sequencing (WGS) of has been constructive in understanding its evolution, genetic diversity and the mechanisms involved in drug resistance. A large number of sequencing efforts from across the globe have revealed genetic diversity among clinical isolates and the genetic determinants for their resistance to anti-tubercular drugs. Considering the high TB burden in India, the availability of WGS studies is limited. Here we present, WGS results of 200 clinical isolates of from North India which are categorized as sensitive to first-line drugs, mono-resistant, multi-drug resistant and pre-extensively drug resistant isolates. WGS revealed that 20% of the isolates were co-infected with and non-tuberculous mycobacteria species. We identified 12,802 novel genetic variations in isolates including 343 novel SNVs in 38 genes which are known to be associated with drug resistance and are not currently used in the diagnostic kits for detection of drug resistant TB. We also identified lineage 3 to be predominant in the northern region of India. Additionally, several novel SNVs, which may potentially confer drug resistance were found to be enriched in the drug resistant i

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2019

Journal Article

S. P. Babu, Menon, R. N., Asranna, A., Dr. Sheela Nampoothiri, Radhakrishnan, A., Cherian, A., and Thomas, S. V., “Novel Genotype-electroclinical Phenotype Correlations in Sporadic Early-onset Childhood Myoclonic-atonic Epilepsy”, Neurol India, vol. 67, no. 1, pp. 264-267, 2019.

2019

Journal Article

S. Radhakrishnan, Unnikrishnan K Menon, and Prof. K. R. Sundaram, “Usefulness of a Modified Questionnaire as a Screening Tool for Swallowing Disorders in Parkinson Disease: A Pilot Study”, Neurol India, vol. 67, no. 1, pp. 118-122, 2019.[Abstract]


<p><b>Aims: </b>To determine the correlation between our questionnaire scores and two standard Parkinson's disease (PD) disability scores [Unified Parkinsons' Disease Rating Scale (UPDRS) and Hoehn and Yahr (H and Y)], and to study the correlation between the various subgroups of our dysphagia screening questionnaire.</p>

<p><b>Settings and Design: </b>This study was conducted at a movement disorder clinic in a tertiary care hospital in Kochi, Kerala. This was a cross-sectional observational study.</p>

<p><b>Materials and Methods: </b>A questionnaire was developed comprising 11 items, keeping in mind the most relevant swallowing issues in PD patients. The questions were subdivided into four groups representing the different stages of swallowing. Reliability and validity studies were conducted for the questionnaire. Corresponding UPDRS and H and Y scores were documented on the same day.</p>

<p><b>Statistical Analysis Used: </b>Mean and standard deviation (SD) values of the scores in each group and the correlation between scores (Pearson correlation coefficient) were done.</p>

<p><b>Results: </b>Responses were obtained from 106 PD patients (67 males, 39 females), with a mean age of 66.9 years (SD, 8.62). Our questionnaire score showed a high coefficient of variation (145%) compared to the UPDRS and H and Y scores. There was also moderate correlation between our questionnaire score and the two standard scores with a significant P value. Finally, the highest mean scores were for questions from group A and the least for questions from group D.</p>

<p><b>Conclusions: </b>The association between worsening motor symptoms and swallowing difficulties has been documented in this study. The oral stage of swallowing remains the most affected in PD, which can be recognized early using our questionnaire.</p>

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2019

Journal Article

J. Mariam Joshua, Meenu Vijayan, and Kumar, G., “A retrospective analysis of patients treated with intravesical BCG for high-risk nonmuscle invasive bladder cancer”, Ther Adv Urol, vol. 11, p. 1756287219833056, 2019.[Abstract]


Background:Adjuvant intravesical immunotherapy with Bacillus Calmette-Guerin (BCG) is considered as the first-line agent in patients with high-risk nonmuscle invasive bladder cancer (NMIBC) after surgery. There are no data in India where there is a high prevalence of tubercle bacillus and inherent immunity against sp. The present study aims to evaluate the outcomes of intravesical BCG in the Indian population.

Methods: A retrospective study of 101 patients who underwent intravesical BCG for high-risk NMIBC between January 2006 and December 2015 was carried out in a single centre. We compared the recurrence-free rate and progression rate of patients who received induction alone and induction with maintenance BCG therapy. The safety profile of intravesical BCG therapy was also assessed in the study.

Results: After a median follow up of 2 years, the disease-free survival (DFS) rates of the induction group and maintenance group were 82% and 88% respectively ( = 0.233). There was no difference in progression-free survival (PFS) rates at 2 years in those who receive maintenance BCG (95%) and those with induction BCG (94.7%; = 0.721). A total of 69.36% of our patients had local adverse events.

Conclusion: </b>Our results suggest that maintenance therapy does not enhance the therapeutic effects of BCG in patients who respond favourably to 6 weeks of induction. Additional prospective studies are warranted in those countries where tuberculosis exposure is prevalent.

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2019

Journal Article

B. Karmegaraj, Prabhu, N., Dr. Mahesh K., and Kumar, R. K., “Percutaneous ultrasound guided thrombin injection for axillary artery pseudoaneurysm following stenting of the arterial duct in two infants: Case report with review of literature.”, Catheter Cardiovasc Interv, 2019.[Abstract]


<p>We report pseudoaneurysm of the axillary artery following stenting of the arterial duct in two infants. They were both successfully managed by ultrasound guided thrombin injection with preservation of native arterial flow. We also review the relevant literature.</p>

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2019

Journal Article

Suhas Udayakumaran, Arjun Krishnadas, and Pramod Subhash, “Why do metopic sutural synostoses angulate? The concept of nasion sutural complex and its implication on the management of hypotelorism-early results and proof of concept.”, Childs Nerv Syst, vol. 35, no. 6, pp. 907-912, 2019.[Abstract]


<b>OBJECT: </b>Angulation at the suture is a hallmark of metopic synostoses amongst all craniosynostoses. No other sutural synostoses demonstrate angulation at synostoses consistently. We look into the possible aetiology and the implication of the understanding in the treatment goals of trigonocephaly. We hypothesise that the nasal bone and nasofrontal suture viz. "nasion sutural complex" are involved in trigonocephaly along with the well-accepted role of metopic suture. We propose that it is the angulation at this junction which leads to trigonocephaly and its secondary features.
<b>MATERIALS AND METHODS: </b>The study included seven infants, who underwent correction for trigonocephaly at our paediatric craniofacial division at Amrita Institute of Medical Sciences and Research Centre, Kochi, India, between the period July 2015 to March 2018. The cohort included were infants with trigonocephaly who had CT head for diagnosis. We analysed the multidimensional CT (MDCT) of these infants and compared to an equal number of age-matched controls. The controls were infants with other forms of sutural synostosis with metopic uninvolved and normal infants where MDCT was done for other reasons. Sutural characteristic at the nasion and metopic suture recorded in comparison with an equal number of age-matched controls. We performed spring cranioplasty for three infants after metopic suturectomy, extending the release beyond the nasion sutural complex, placing springs to distract the suture. The infants who underwent spring cranioplasty were followed up for the aesthetic outcome. Remaining infants of the study underwent standard frontorbital correction for metopic craniosynostoses.

<b>RESULTS: </b>We could demonstrate a fusion of nasofrontal and nasal suture in all cases (n = 7) of trigonocephaly included in the study on MDCT and intraoperatively. We performed spring cranioplasty for three infants (n = 3/7), where we released the internasal suture. At 3&nbsp;months follow-up, along with correction of the angulation, the hypotelorism improved significantly. Other infants in the study (4/7) underwent classical frontorbital advancement.

<b>CONCLUSIONS: </b>Fusion of nasion sutural complex along with metopic sutures may explain the angulation in trigonocephaly. We propose that all minimally invasive techniques for correction of trigonocephaly and associated hypotelorism should consider this fact for an improved outcome

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2019

Journal Article

K. Baubie, Shaughnessy, C., Kostiuk, L., Joseph, M. Varsha, Safdar, N., Dr. Sanjeev K. Singh, Siraj, D., Sethi, A., and Keating, J., “Evaluating antibiotic stewardship in a tertiary care hospital in Kerala, India: a qualitative interview study.”, BMJ Open, vol. 9, no. 5, p. e026193, 2019.[Abstract]


<p><b>OBJECTIVES: </b>To determine what barriers and facilitators to antibiotic stewardship exist within a healthcare facility.</p>

<p><b>SETTING: </b>1300-bed tertiary care private hospital located in the state of Kerala, India.</p>

<p><b>PARTICIPANTS: </b>31 semistructured interviews and 4 focus groups with hospital staff ranging from physicians, nurses, pharmacists and a clinical microbiologist.</p>

<p><b>RESULTS: </b>Key facilitators of antibiotic stewardship (AS) at the hospital included a dedicated committee overseeing appropriate inpatient antibiotic use, a prompt microbiology laboratory, a high level of AS understanding among staff, established guidelines for empiric prescribing and an easily accessible antibiogram. We identified the following barriers: limited access to clinical pharmacists, physician immunity to change regarding stewardship policies, infrequent antibiotic de-escalation, high physician workload, an incomplete electronic medical record (EMR), inadequate AS programme (ASP) physical visibility and high antibiotic use in the community.</p>

<p><b>CONCLUSIONS: </b>Opportunities for improvement at this institution include increasing accessibility to clinical pharmacists, implementing strategies to overcome physician immunity to change and establishing a more accessible and complete EMR. Our findings are likely to be of use to institutions developing ASPs in lower resource settings.</p>

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2019

Journal Article

N. Dhanakodi, J.b Thilak, Varghese, J., Menon, K. Venugopal, Varma, H., and Tripathy, S. Kumar, “Ceramic Bone Graft Substitutes do not reduce donor-site morbidity in ACL reconstruction surgeries: a pilot study.”, SICOT J, vol. 5, p. 14, 2019.[Abstract]


<p><b>INTRODUCTION: </b>Anterior knee pain is a major problem following Bone-patellar-tendon-bone graft (BPTB) use in anterior cruciate ligament (ACL) reconstruction. We hypothesized that filling the donor defect sites with bone-graft substitute would reduce the anterior knee symptoms in ACL reconstruction surgeries.</p>

<p><b>MATERIAL AND METHODS: </b>Patients operated for ACL-deficient knee between March 2012 and August 2013 using BPTB graft were divided into two treatment groups. The patellar and tibial donor-site bony defects were filled-up with Hydroxyapatite-Bioglass (HAP:BG) blocks in the study group (n&nbsp;=&nbsp;15) and no filler was used in the control group (n&nbsp;=&nbsp;16). At 2 years, the clinical improvement was assessed using International Knee Documentation Committee (IKDC) score and donor-site morbidity was assessed by questionnaires and specific tests related to anterior knee pain symptoms.</p>

<p><b>RESULTS: </b>Donor-site tenderness was present in 40% patients in the study group and 37.5% patients in the control group (p&nbsp;=&nbsp;0.59). Pain upon kneeling was present in 33.3% patients in the study group and 37.5% patients in the control group (p&nbsp;=&nbsp;0.55). Walking in kneeling position elicited pain in 40% patients in the study group and 43.8% in the control group (p&nbsp;=&nbsp;0.56). The mean visual analogue score for knee pain was 3.0 in the study group and 3.13 in the control group, with no statistically significant difference (p&nbsp;=&nbsp;0.68). Unlike control group, where a persistent bony depression defect was observed at donor sites, no such defects were observed in the study group.</p>

<p><b>CONCLUSION: </b>Filling the defects of donor sites with HAP:BG blocks do not reduce the anterior knee symptoms in patients with ACL reconstruction using autogenous BPTB graft.</p>

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2019

Journal Article

M. Subramanian, Prabhu, M. A., Rai, M., Harikrishnan M. S., Saritha Sekhar, Praveen G. Pai, and Natarajan, K. U., “A novel prediction model for risk stratification in patients with a type 1 Brugada ECG pattern.”, J Electrocardiol, vol. 55, pp. 65-71, 2019.[Abstract]


<p><b>BACKGROUND: </b>Risk stratification in Brugada syndrome remains a controversial and unresolved clinical problem, especially in asymptomatic patients with a type 1 ECG pattern. The purpose of this study is to derive and validate a prediction model based on clinical and ECG parameters to effectively identify patients with a type 1 ECG pattern who are at high risk of major arrhythmic events (MAE) during follow-up.</p>

<p><b>METHODS: </b>This study analysed data from 103 consecutive patients with Brugada Type 1 ECG pattern and no history of previous cardiac arrest. The prediction model was derived using logistic regression with MAE as the primary outcome, and patient demographic and electrocardiographic parameters as potential predictor variables. The model was externally validated in an independent cohort of 42 patients.</p>

<p><b>RESULTS: </b>The final model (Brugada Risk Stratification [BRS] score) consisted of 4 independent predictors (1 point each) of MAE during follow-up (median 85.3 months): spontaneous type 1 pattern, QRS fragments in inferior leads≥3,S wave upslope duration ratio ≥ 0.8, and T peak - T end ≥ 100 ms. The BRS score (AUC = 0.95,95% CI 0.0.92-0.98) stratifies patients with a type 1 ECG pattern into low (BRS score ≤ 2) and high (BRS score ≥ 3) risk classes, with a class specific risk of MAE of 0-1.1% and 92.3-100% across the derivation and validation cohorts, respectively.</p>

<p><b>CONCLUSIONS: </b>The BRS score is a simple bed-side tool with high predictive accuracy, for risk stratification of patients with a Brugada Type 1 ECG pattern. Prospective validation of the prediction model is necessary before this score can be implemented in clinical practice.</p>

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2019

Journal Article

S. Vidhyadharan, Thankappan, K., Subramaniam, N., Ramu, J., Ajith, A., Deepak Balasubramanian, and Dr. Subramania Iyer K., “Robot-Assisted Surgery Avoids Mandibulotomy in a Case of Adenoid Cystic Carcinoma of Base of the Tongue.”, Craniomaxillofac Trauma Reconstr, vol. 12, no. 2, pp. 163-166, 2019.[Abstract]


Surgical management is increasingly preferred in human papilloma-related oropharyngeal squamous cell carcinoma. Robotic surgery has a different role to play in oropharyngeal salivary origin tumors, where surgery is the primary essential modality. This modality may be used for better access to the oropharynx, avoiding a lip split approach with mandibulotomy. The organ preservation approach such as in oropharyngeal squamous cell carcinoma, with nonsurgical modalities like chemoradiotherapy, is not preferred in such cancers, as in the present case. In this context, robot-assisted surgery helps in reducing the morbidity by avoiding the mandibulotomy

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2019

Journal Article

Rajesh Jose, Shetty, A., Krishna, N., Chathoth, V., Renjitha Bhaskaran, Jayant, A., and Dr. Praveen Varma, “Early and Mid-Term Outcomes of Patients Undergoing Coronary Artery Bypass Grafting in Ischemic Cardiomyopathy.”, J Am Heart Assoc, vol. 8, no. 10, p. e010225, 2019.[Abstract]


Background Many observational studies and trials have shown that coronary artery bypass grafting improves the survival in patients with ischemic cardiomyopathy. However, these results are based on data generated from developed countries. Poor socioeconomic statuses, lack of uniformity in healthcare delivery, differences in risk profile, and affordability to access optimal health care are some factors that make the conclusions from these studies irrelevant to patients from India. Methods and Results One-hundred and sixty-two patients with severe left ventricular dysfunction (ejection fraction ≤35%) who underwent coronary artery bypass grafting from 2009 to 2017 were enrolled for this study. Mean age of the study population was 58.67±9.70&nbsp;years. Operative mortality was 11.62%. Thirty day/in-house composite outcome of stroke and perioperative myocardial infarction were 5.8%. The percentage of survival for 1&nbsp;year was 86.6%, and 5-year survival was 79.9%. Five-year event-free survival was 49.3%. The mean ejection fraction improved from 30.7±4.08% (range 18-35) to 39.9±8.3% (range 24-60). Lack of improvement of left ventricular function was a strong predictor of late mortality (hazard ratio, 21.41; CI 4.33-105.95). Even though there was a trend towards better early outcome in off-pump CABG , the 5-year survival rates were similar in off-pump and on-pump group (73.4% and 78.9%, respectively; P value 0.356). Conclusions We showed that coronary artery bypass grafting in ischemic cardiomyopathy was associated with high early composite outcomes. However, the 5-year survival rates were good. Lack of improvement of left ventricular function was a strong predictor of late mortality.

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2019

Journal Article

A. Ganapathy, Mishra, A., Soni, M. Rani, Kumar, P., Sadagopan, M., Kanthi, A. Vittal, Patric, I. Rosetta Pi, Sobha George, Sridharan, A., Thyagarajan, T. C., Aswathy, S. L., Vidya, H. K., Chinnappa, S. M., Nayanala, S., Prakash, M. B., Raghavendrachar, V. G., Parulekar, M., Gowda, V. K., Dr. Sheela Nampoothiri, Menon, R. N., Pachat, D., Udani, V., Naik, N., Kamate, M., A Devi, R. Rama, Kunju, P. A. Mohammed, Nair, M., Hegde, A. Udwadia, M Kumar, P., Sundaram, S., Tilak, P., Puri, R. D., Shah, K., Sheth, J., Hasan, Q., Sheth, F., Agrawal, P., Katragadda, S., Veeramachaneni, V., Chandru, V., Hariharan, R., and Mannan, A. U., “Multi-gene Testing in Neurological Disorders Showed an Improved Diagnostic Yield: Data from Over 1000 Indian Patients.”, J Neurol, 2019.[Abstract]


<p><b>BACKGROUND: </b>Neurological disorders are clinically heterogeneous group of disorders and are major causes of disability and death. Several of these disorders are caused due to genetic aberration. A precise and confirmatory diagnosis in the patients in a timely manner is essential for appropriate therapeutic and management strategies. Due to the complexity of the clinical presentations across various neurological disorders, arriving at an accurate diagnosis remains a challenge.</p>

<p><b>METHODS: </b>We sequenced 1012 unrelated patients from India with suspected neurological disorders, using TruSight One panel. Genetic variations were identified using the Strand NGS software and interpreted using the StrandOmics platform.</p>

<p><b>RESULTS: </b>We were able to detect mutations in 197 genes in 405 (40%) cases and 178 mutations were novel. The highest diagnostic rate was observed among patients with muscular dystrophy (64%) followed by leukodystrophy and ataxia (43%, each). In our cohort, 26% of the patients who received definitive diagnosis were primarily referred with complex neurological phenotypes with no suggestive diagnosis. In terms of mutations types, 62.8% were truncating and in addition, 13.4% were structural variants, which are also likely to cause loss of function.</p>

<p><b>CONCLUSION: </b>In our study, we observed an improved performance of multi-gene panel testing, with an overall diagnostic yield of 40%. Furthermore, we show that NGS (next-generation sequencing)-based testing is comprehensive and can detect all types of variants including structural variants. It can be considered as a single-platform genetic test for neurological disorders that can provide a swift and definitive diagnosis in a cost-effective manner.</p>

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2019

Journal Article

K. Jagannath Kataki, Gupte, A., Madhavan, R., Beena, K., Dutta, D., Holla, R., and Kalita, M., “Case Report on Stereotactic Body Radiation Therapy for Locally Recurrent Renal Cell Carcinoma after Partial Nephrectomy in a Patient with Single Kidney”, South Asian J Cancer, vol. 8, no. 2, pp. 135-136, 2019.

2019

Journal Article

V. K. Krishnendhu and Leyanna Susan George, “Drivers and Barriers for Measles Rubella Vaccination Campaign: A Qualitative Study”, J Family Med Prim Care, vol. 8, no. 3, pp. 881-885, 2019.[Abstract]


<p><b>Background: </b>The measles-rubella (MR) vaccination campaign was launched in Kerala on 3 October 2017 aiming to eliminate MR by 2020. The drive was carried out in schools, community centers, and medical institutions. The initial phase of the MR campaign met with many controversies that affected its coverage.</p>

<p><b>Objectives: </b>The objectives of the study were to analyze the drivers and barriers for acceptance of MR vaccination in the field area of a primary health center (PHC), which reported a low coverage (62%) during the initial phase of the campaign.</p>

<p><b>Methods: </b>A qualitative study consisting of key informant interviews of parents of vaccinated and unvaccinated children, medical officers of the PHC, Junior Public Health Nurse (JPHN), and Accredited Social Health Activist (ASHA) workers, and the principals of government and private schools where the campaign was conducted was also interviewed.</p>

<p><b>Results: </b>The major barrier to acceptance of MR campaign was the anti-vaccination propaganda in social media. The messages falsely linked fertility issues with the vaccine. The purpose of this campaign was not properly understood by the parents. The campaign was implemented within a short span of time resulting in coordination issues between the stakeholders. However, it was observed that religious affiliations played a major role in reducing coverage. The drivers to acceptance of MR vaccination campaign were the team effort of the healthcare providers who constantly motivated parents to vaccinate their children.</p>

<p><b>Conclusion: </b>Addressing the anti-vaccination propaganda has become the need of the hour. The inclusion of all stakeholders including religious leaders in the planning and implementation of the campaign is essential for its success.</p>

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2019

Journal Article

A. Madhavan, Asokan, A., Anu Vasudevan, Maniyappan, J., and Veena, K., “Comparison of Knowledge, Attitude, and Practices Regarding Needle-stick Injury Among Health Care Providers”, J Family Med Prim Care, vol. 8, no. 3, pp. 840-845, 2019.[Abstract]


Introduction: Needle-stick injury (NSI) is one of the most potential hazards for health care workers. They pose a significant risk of occupational transmission of blood-borne pathogens. The present study was done to determine the incidence of NSI among interns and nurses; their knowledge, attitude, and preventive strategies undertaken by the respondents after NSI.

Materials and Methods: The cross-sectional study was done among interns and nurses in various departments of a tertiary care center in Kerala, India using a self-administered questionnaire.

Results: The incidences of NSI among interns and nurses were 75.6% and 24.4%, respectively. The most common clinical activity leading to NSI among interns was blood withdrawal (42%) followed by recapping (29%). It was found that nurses had enough knowledge and followed better NSI practices and attitude than the interns.

Conclusion: All the parameters analyzed were inadequate among the interns, indicating the need for continual awareness programs particularly during the preclinical years.

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2019

Journal Article

Sunil Rajan, Sudevan, M., Kadapamannil, D., Mohan, A., Jerry Paul, and Kumar, L., “Does Perioperative Use of Noradrenaline Affect Free Flap Outcome Following Reconstructive Microvascular Surgeries? A Retrospective Analysis”, Anesth Essays Res, vol. 13, no. 1, pp. 79-83, 2019.[Abstract]


Background: Over concerns of vasoconstriction leading to free flap failure, it has been a common practice to avoid vasopressors for the maintenance of blood pressure during reconstructive microvascular surgeries.

Aims: The aim of this study was to assess the impact of use of noradrenaline in the perioperative period on outcome of free flaps in patients who underwent reconstructive surgeries as compared to those who did not receive noradrenaline.

Settings and Design: Retrospective analysis was conducted at a tertiary care institute.

Materials and Methods: A total of 120 patients who underwent free flap surgeries were included in the study, of which 102 patients who did not require noradrenaline perioperatively formed the control group (Group C), whereas those who required noradrenaline infusion constituted the study group (Group N). Data regarding flap outcome at discharge, intraoperative hemodynamics and temperature were documented.

Statistical Test Used: Chi-square test, Mann-Whitney test, Independent sample -test, and paired -test were used for statistical analysis.

Results: Out of 120 patients, 15% ( = 18) patients required noradrenaline (Group N). In Group N, 27.78% ( = 5) patients and in Group C, 22.55% ( = 23) were re-explored. Four patients in Group C and none in Group N had a poor flap outcome (3.92% vs. 0%). There was no significant difference in surgical duration and the volume of crystalloids received in both groups. Preoperative hemoglobin levels were lower in Group N; intraoperatively, they were more hypothermic and needed more colloids, blood, and plasma.

Conclusion: Perioperative use of noradrenaline did not adversely affect free flap survival in patients who underwent microvascular reconstructive surgeries. Although re-exploration rate was marginally increased with use of noradrenaline, the final flap outcome was unaffected.

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2019

Journal Article

S. Djearadjane, Sunil Rajan, Jerry Paul, and Kumar, L., “Efficacy of Dexmedetomidine as an Adjunct in Aiding Video laryngoscope-Assisted Assessment of Vocal Cord Movements at Extubation Following Total Thyroidectomy.”, Anesth Essays Res, vol. 13, no. 1, pp. 25-30, 2019.[Abstract]


Background: Assessment of vocal cord movements following total thyroidectomy diagnoses recurrent laryngeal nerve injury. Use of videoscope along with sedatives may blunt hemodynamic responses seen with the conduct of direct laryngoscopy for assessing vocal cord mobility.

Aims: The primary objective of this study was to assess changes in mean arterial pressure (MAP) during vocal cord assessment following total thyroidectomy using video laryngoscope, with and without the use of dexmedetomidine as an adjunct. Secondary objectives included assessment of changes in heart rate (HR), patient reactivity score along with ease of laryngoscopy and vocal cord visibility.

Settings and Design: This randomized, prospective, unblinded study was conducted in 54 patients at a tertiary care center.

Materials and Methods: Group D received dexmedetomidine 0.5 μg/kg, once the thyroid was removed. Group S did not receive dexmedetomidine. Hemodynamic response at extubation, patient reactivity, ease of laryngoscopy, and ease of vocal cord assessment were noted.

Statistical Analysis Used: Chi-square test and Independent -test.

Results: Baseline HR, systolic blood pressure (SBP), and MAP were comparable between the groups. However subsequently, Group D had significantly lower HR and SBP at the time of extubation and at 3 and 6 min later. MAP at extubation and at 3 min later was comparable, but at 6 min, Group D had significantly lower values. In both groups, patient reactivity scores, ease of laryngoscopy, and vocal cord visibility were comparable ( &gt; 0.05).

Conclusion: Dexmedetomidine 0.5 μg/kg when used as an adjunct clinically improved conditions for assessing vocal cord mobility with significant attenuation of associated hemodynamic responses.

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2019

Journal Article

Dr. Sanjeev K. Singh, Menon, V. P., Zubair Umer Mohamed, Dr. Anil Kumar V., Nampoothiri, V., Sudhir, S., Moni, M., Dipu, T. S., Dutt, A., Edathadathil, F., Keerthivasan, G., Kaye, K. S., and Patel, P. K., “Implementation and Impact of an Antimicrobial Stewardship Program at a Tertiary Care Center in South India”, Open Forum Infect Dis, vol. 6, no. 4, p. ofy290, 2019.[Abstract]


Background: Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India.

Methods: An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015-January 2016) and post-implementation phase (February 2016-January 2017).

Results: Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of "inappropriate" antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase.

Conclusions: Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.

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2019

Journal Article

B. Karmegaraj, Rajeshkannan, R., Kappanayil, M., and Balu Vaidyanathan, “Fetal Descending Aortic Tortuosity with Ductal Aneurysm”, Ultrasound Obstet Gynecol, 2019.[Abstract]


Isolated tortuosity of proximal descending aorta is a rare form of congenital disorder. Its association with ductus arteriosus aneurysm (DAA) has not been reported in fetal life . We are reporting the utility of 4-dimensional spatiotemporal image correlation (4D STIC) rendering in diagnosing this rare association in a 23-week fetus. This article is protected by copyright.

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2019

Journal Article

A. R. Asirvatham, Usha Menon, Pavithran, P. V., Vasukutty, J. R., Kumar, H., Bhavani, N., Menon, A., Nair, V., Lakshmanan, V., Varma, A. K., Sukumaran, M. T., and Bal, A., “Role of Procalcitonin as a Predictor of Clinical Outcome in Acute Diabetic Foot Infections: A Prospective Study”, Indian J Endocrinol Metab, vol. 23, no. 1, pp. 122-127, 2019.[Abstract]


Background: Prediction of outcome in diabetic foot infection (DFI) remains difficult due to lack of active signs of infection, and apparently normal white blood cell (WBC) count. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have been studied previously in this regard and were not useful. Hence, we evaluated procalcitonin (PCT) as a prognostic marker in this study.

Objectives: We aimed to study the role of PCT, CRP, and ESR levels in predicting clinical outcome of acute DFI.

Materials and Methods: A total of 250 subjects (197 men, 53 women) with acute DFI were enrolled. WBC count, ESR, CRP, and PCT were done for all subjects at admission after obtaining informed consent. Subjects were managed according to hospital protocol and followed up for 1 month. Clinical outcome was assessed based on mobility and morbidity status of the subject.

Results: Old age, anemia, hyponatremia, hypoalbuminemia, and elevated serum creatinine were risk factors for poor outcome. Presence of cardiac failure, diabetic retinopathy, peripheral vascular disease, previous amputations, and positive bone culture had negative influence on clinical outcome. Elevated WBC count, ESR, CRP, and serum PCT were significantly associated with bad outcome. Elevated PCT (>2 ng/ml) [odds ratio (OR) (95% confidence interval (CI)), 2.03 (1.13-5.19), < 0.001], gangrene [OR (95% CI), 2.2 (1.02-4.73), = 0.04], and sepsis [OR (95% CI), 10.101 (4.34-23.25), < 0.001] were good predictors of clinical outcome in acute DFI.

Conclusion: PCT proved to be a reliable marker of acute DFI and good predictor of clinical outcome than existing markers WBC count, ESR, and CRP. Hence it should be useful for clinicians while managing acute DFI.

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2019

Journal Article

S. Balakrishnan, Rakesh, P. S., Viswanathan, K., Nelson, V., Simon, S., Nair, S. A., Mathew, M. E., and Sunilkumar, M., “Higher Risk of Developing Active TB Among Adult Diabetics Exposed to TB During Childhood: A Study from Kerala, India.”, J Family Med Prim Care, vol. 8, no. 2, pp. 695-700, 2019.[Abstract]


<p><b>Introduction: </b>Factors associated with tuberculosis (TB) in Kerala, the southern Indian state that notifies approximately 33 microbiologically confirmed new cases per 100,000 population every year for the past two decades, are still unclear. We did a community-based case-control study in Kollam district, Kerala, to identify the individual-level risk factors for TB.</p>

<p><b>Methods: </b>Structured questionnaire was applied to 101 microbiologically confirmed new TB cases registered under Revised National Tuberculosis Control Program and 202 age- and gender-matched neighborhood controls without present or past TB. Information was sought on socioeconomic status (SES), smoking, consumption of alcohol, close contact with active TB during childhood or recent past, diabetes mellitus (DM), and other comorbid conditions.</p>

<p><b>Results: </b>Close contact with TB during childhood [odds ratio (OR) 15.88, 95% confidence interval (CI) 3.21-78.55], recent close contact with TB (OR 4.81, 95% CI 2.09-11.07), DM (OR 1.64, 95% CI 1.04-3.06), SES (OR 2.16, 95% CI 1.16-4.03), smoking more than 10 cigarettes/beedis per day (OR 3.32, 95% CI 1.27-8.96), consuming more than 10 standard drinks per week (OR 2.91, 95% CI 1.33-6.37), and the interaction term of having close contact with TB during childhood and DM at present (OR 7.37, 95% CI 1.18-50.29) were found to be associated with TB.</p>

<p><b>Conclusion: </b>Close contact with a case of TB, presence of DM, lower SES, smoking, and alcohol consumption were associated with active TB in Kollam. Having close contact with a case of TB during childhood and development of DM in later life together are significantly associated with active TB in the study population. The findings also direct further studies to confirm and explore mechanisms of interaction of diabetes with childhood exposure to TB.</p>

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2019

Journal Article

A. Gurram, Krishna, N., Anu Vasudevan, Baquero, L. Alberto, Jayant, A., and Dr. Praveen Varma, “Female Gender is not a Risk Factor for Early Mortality after Coronary Artery Bypass Grafting.”, Ann Card Anaesth, vol. 22, no. 2, pp. 187-193, 2019.[Abstract]


<p><b>Background: </b>The female gender is considered as a risk factor for morbidity and mortality after coronary artery bypass grafting (CABG).</p>

<p><b>Aim: </b>In this analysis, we assessed the impact of female gender on early outcome after CABG.</p>

<p><b>Study Design: </b>This is a retrospective analysis of data from our center situated in South India.</p>

<p><b>Statistical Analysis: </b>Patients were categorized according to gender and potential differences in pre-operative and post-operative factors were explored. Significant risk factors were then built in a multivariate model to account for differences in predicting gender influence on surgical outcome.</p>

<p><b>Methods: </b>773 consecutive patients underwent first time CABG between January 2015 and December 2016. 96.77% of cases were performed using off-pump technique. 132 (17.07%) patients were females. These patients formed the study group.</p>

<p><b>Results: </b>The in-house/ 30-day mortality in females was similar to that of males (3.03% vs. 3.12%, p value 0.957). Mediastinitis developed more commonly in females (5.35% vs. 1.30%; p value 0.004) compared to males. There were more re-admissions to hospital for female patients (21.37% in females vs. 10.14% in males, p value &lt;0.001). In multivariate analysis using logistic regression; there was a significant association between age (OR 1.08), chronic obstructive airway disease (OR 4.315), and use of therapeutic antibiotics (OR 6.299), IABP usage (OR 11.18) and renal failure requiring dialysis (OR 28.939) with mortality.</p>

<p><b>Conclusions: </b>Early mortality in females was similar to that of males. Females were associated with higher rate of wound infection and readmission to hospital.</p>

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2019

Journal Article

R. Agarwal, Rajanbabu, A., and Indu Nair, “Undifferentiated Sarcoma of Fallopian Tube Managed with Robotic-Assisted Surgery”, J Obstet Gynaecol India, vol. 69, no. Suppl 1, pp. 63-66, 2019.

2019

Journal Article

G. Goel, Rajanbabu, A., Sandhya, C. J., and Indu Nair, “A Prospective Observational Study Evaluating the Accuracy of MRI in Predicting the Extent of Disease in Endometrial Cancer”, Indian J Surg Oncol, vol. 10, no. 1, pp. 220-224, 2019.[Abstract]


This prospective study looks into the accuracy of magnetic resonance imaging (MRI) in predicting the depth of MI, cervical invasion, lymph node metastasis, and extrauterine spread (EUS) of disease in endometrial cancer. Between June 2014 and December 2015, 58 patients with biopsy-proven endometrial cancer who underwent MRI prior to surgery were included in the study. MRI findings like myometrial invasion, extrauterine spread, lymph nodal metastasis, and cervical invasion were compared against the histopathology report. Sensitivity, specificity, PPV, NPV, and overall accuracy of MRI for myometrial depth assessment were 75.0%, 73.08%, 77.2%, 70.37%, and 74.14 respectively. Sensitivity, specificity, PPV, NPV, and overall accuracy of MRI in assessing lymph node spread were 88.64%, 66.67%, 95.12%, 44.44%, and 86.0% respectively. As for predicting extrauterine spread and cervical invasion, MRI showed poor sensitivity (37.5% and 50% respectively) and a high specificity (92% and 100% respectively). Our study shows that preoperative MRI has high sensitivity and specificity to predict myometrial invasion and lymph node involvement. But, it is not sensitive enough to predict cervical involvement or extrauterine spread.

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2019

Journal Article

A. Laddha, Bijalwan, P., Appu Thomas, and Kumar, Gb, “Small Renal Mass with Level 4 IVC Thrombus”, Indian J Surg Oncol, vol. 10, no. 1, pp. 196-198, 2019.

2019

Journal Article

N. Subramaniam, Deepak Balasubramanian, Reddy, R., Thankappan, K., and Dr. Subramania Iyer K., “Organ Preservation Protocols in T4 Laryngeal Cancer: A Review of the Literature”, Indian J Surg Oncol, vol. 10, no. 1, pp. 149-155, 2019.[Abstract]


Population-based studies indicate that chemoradiation has become the most popular treatment for advanced laryngeal cancers; however, by extrapolating trial results to the general population, several issues have emerged, such as reduced overall survival, non-functional laryngeal preservation, and poor response to treatment. Although included in these trials, T4 laryngeal and hypopharyngeal cancers with cartilage invasion formed a small percentage of these patients and questions over whether they were appropriately staged remain unanswered. Literature on the use of chemoradiation in this set of patients, including the challenges, treatment considerations, and factors predicting response to treatment and outcomes, was reviewed. Current evidence indicates that all patients of T4 laryngeal and hypopharyngeal cancer are not suitable candidates for organ preservation; this modality should be offered only to select patients with good performance status and access to rehabilitative care and regular follow-up in order to achieve good results.

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2019

Journal Article

G. Mohan Sali, Nair, K. R., Bindhu, M. R., Kumar, Gb, Sanjeevan, K. V., and Appu Thomas, “Primary Malignant Melanoma of Urethra-Our Experience with 2 Cases”, Indian J Surg Oncol, vol. 10, no. 1, pp. 137-140, 2019.

2019

Journal Article

A. Shukla, Girisha, K. M., Somashekar, P. H., Dr. Sheela Nampoothiri, McClellan, R., and Vernon, H. J., “Variants in the Transcriptional Corepressor BCORL1 are Associated with an X-linked Disorder of Intellectual Disability, Dysmorphic Features, and Behavioral Abnormalities”, Am J Med Genet A, vol. 179, no. 5, pp. 870-874, 2019.[Abstract]


BCORL1, a transcriptional corepressor, is involved in negative gene regulation through associations with several protein complexes including Class II histone deacetylases (HDACs). Acquired somatic mutations in BCORL1 have been implicated in the pathogenesis of several malignancies, but germline mutations of BCORL1 have not been associated with a specific genetic syndrome. We report five individuals from three pedigrees with phenotypes including intellectual disability, behavioral difficulties, and dysmorphic features who were found via whole exome sequencing to have variants in BCORL1. In silico analysis of these variants strongly suggests pathogenicity. We propose that hemizygous pathogenic variants in BCORL1 underlie a newly identified X-linked epigenetic syndrome.

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2019

Journal Article

K. Singh, Ali, M. K., Devarajan, R., Shivashankar, R., Kondal, D., Ajay, V. S., Usha Menon, Varthakavi, P. K., Viswanathan, V., Dharmalingam, M., Bantwal, G., Sahay, R. Kumar, Masood, M. Qamar, Khadgawat, R., Desai, A., Prabhakaran, D., Narayan, K. M. Venkat, Phillips, V. L., and Tandon, N., “Rationale and Protocol for Estimating the Economic Value of a Multicomponent Quality Improvement Strategy for Diabetes Care in South Asia”, Glob Health Res Policy, vol. 4, p. 7, 2019.[Abstract]


Background: Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia.

Methods/design: This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). Effectiveness measures include multiple risk factor control (achieving HbA1c &lt; 7% and blood pressure &lt; 130/80 mmHg and/or LDL-cholesterol&lt; 100 mg/dl), and patient reported outcomes including quality adjusted life years (QALYs) measured by EQ-5D-3 L, hospitalizations, and diabetes related complications at the trial end. Cost measures include direct medical and non-medical costs relevant to outpatient care (consultation fee, medicines, laboratory tests, supplies, food, and escort/accompanying person costs, transport) and inpatient care (hospitalization, transport, and accompanying person costs) of the intervention compared to usual diabetes care. Patient, healthcare system, and societal perspectives will be applied for costing. Both cost and health effects will be discounted at 3% per year for within trial cost-effectiveness analysis over 2.5 years and decision modelling analysis over a lifetime horizon. Outcomes will be reported as the incremental cost-effectiveness ratios (ICER) to achieve multiple risk factor control, avoid diabetes-related complications, or QALYs gained against varying levels of willingness to pay threshold values. Sensitivity analyses will be performed to assess uncertainties around ICER estimates by varying costs (95% CIs) across public vs. private settings and using conservative estimates of effect size (95% CIs) for multiple risk factor control. Costs will be reported in US$ 2018.

Discussion: We hypothesize that the additional upfront costs of delivering the intervention will be counterbalanced by improvements in clinical outcomes and patient-reported outcomes, thereby rendering this multi-component QI intervention cost-effective in resource constrained South Asian settings.

Trial registration: ClinicalTrials.gov: NCT01212328.

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2019

Journal Article

Teena Mary Joy, Sobha George, Paul, N., Renjini, B. A., Rakesh P. S., and Sreedevi, A., “Assessment of Vaccine Coverage and Associated Factors Among Children in Urban Agglomerations of Kochi, Kerala, India.”, J Family Med Prim Care, vol. 8, no. 1, pp. 91-96, 2019.[Abstract]


Context: Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate.

Aims: This study aims to estimate routine immunization coverage and associated factors among children (12-23 months and 60-84 months) in the urban Kochi Metropolitan Area of Kerala.

Settings and Design: A cross-sectional study was conducted in Kochi Metropolitan area.

Materials and Methods: A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months.

Statistical Analysis: Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage.

Results: Among the children aged 12-23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20-4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06-3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4-5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease.

Conclusion: Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas.

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2019

Journal Article

J. Shaji Mathew, Kumar, K. Y. Santosh, Nair, K., Amma, B. Sivasankar, Krishnakumar, L., Dinesh Balakrishnan, Gopalakrishnan, U., Ramachandran Narayana Menon, Sunny, A., Dhar, P., Vayoth, S. Othiyil, and Surendran, S., “Antegrade Hepatic Artery and Portal Vein Perfusion Versus Portal Vein Perfusion Alone in live Donor Liver Transplantation: A Randomized Trial”, Liver Transpl, 2019.[Abstract]


BACKGROUND: Traditionally, deceased donor liver grafts receive dual perfusion through the portal vein and the hepatic artery(HA) either in-situ or on the back-table. Hepatic artery perfusion is avoided in live donor liver grafts for fear of damage to the intima and consequent risk of hepatic artery thrombosis(HAT). However, biliary vasculature is predominantly derived from the HA. We hypothesized that antegrade perfusion of the HA in addition to the portal vein on the back table could reduce the incidence of post-operative biliary complications.

METHODS: Consecutive adult patients undergoing live donor liver transplants (LDLT) were randomized after donor hepatectomy to receive graft perfusion of HTK (Histidine-tryptophan-ketoglutarate) solution either via both the hepatic artery and portal vein (dual perfusion group,n=62) or only through the portal vein (standard perfusion group,n=62). The primary endpoints were the occurrence of biliary complications (biliary leak/stricture). Secondary endpoints included hepatic artery thrombosis and patient survival.

RESULTS: The incidence of biliary stricture was significantly lower in the dual perfusion group 6.5% vs.19.4%[OR 0.29, 95%CI(0.09-0.95);P=0.04]. There was no significant reduction in the incidence of HAT, bile leak or hospital stay between the two groups. Three year patient and graft survival was significantly higher among patients who received dual perfusion compared to standard perfusion[P=0.004, P=0.003]. On multivariate analysis non perfusion of the hepatic artery and preceding bile leak were found to be risk factors for the development of biliary stricture(P=0.04 &amp; P&lt;0.001).

CONCLUSIONS: Dual perfusion of live donor liver grafts through both hepatic artery and portal vein on the back-table may protect against the development of biliary stricture. This could translate to improved patient survival in the short-term. This article is protected by copyright. All rights reserved.

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2019

Journal Article

K. A. Rauen, Alsaegh, A., Ben-Shachar, S., Berman, Y., Blakeley, J., Cordeiro, I., Elgersma, Y., D Evans, G., Fisher, M. J., Frayling, I. M., George, J., Huson, S. M., Kerr, B., Khire, U., Korf, B., Legius, E., Messiaen, L., van Minkelen, R., Dr. Sheela Nampoothiri, Ngeow, J., Parada, L. F., Phadke, S., Pillai, A., Plotkin, S. R., Puri, R., Raji, A., Ramesh, V., Ratner, N., Shankar, S. P., Sharda, S., Tambe, A., Vikkula, M., Widemann, B. C., Wolkenstein, P., and Upadhyaya, M., “First International Conference on RASopathies and Neurofibromatoses in Asia: Identification and Advances of New Therapeutics”, Am J Med Genet A, vol. 179, no. 6, pp. 1091-1097, 2019.[Abstract]


The neurofibromatoses, which include neurofibromatosis type I (NF1), neurofibromatosis type II (NF2), and schwannomatosis, are a group of syndromes characterized by tumor growth in the nervous system. The RASopathies are a group of syndromes caused by germline mutations in genes that encode components of the RAS/mitogen-activated protein kinase (MAPK) pathway. The RASopathies include NF1, Noonan syndrome, Noonan syndrome with multiple lentigines, Costello syndrome, cardio-facio-cutaneous syndrome, Legius syndrome, capillary malformation arterio-venous malformation syndrome, and SYNGAP1 autism. Due to their common underlying pathogenetic etiology, all these syndromes have significant phenotypic overlap of which one common feature include a predisposition to tumors, which may be benign or malignant. Together as a group, they represent one of the most common multiple congenital anomaly syndromes estimating to affect approximately one in 1000 individuals worldwide. The subcontinent of India represents one of the largest populations in the world, yet remains underserved from an aspect of clinical genetics services. In an effort to bridge this gap, the First International Conference on RASopathies and Neurofibromatoses in Asia: Identification and Advances of New Therapeutics was held in Kochi, Kerala, India. These proceedings chronicle this timely and topical international symposium directed at discussing the best practices and therapies for individuals with neurofibromatoses and RASopathies.

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2019

Journal Article

Natarajan K. U. and Krishna, M. Ram, “Channelopathies - An update 2018”, Indian Pacing Electrophysiol J, vol. 19, no. 2, pp. 68-71, 2019.

2019

Journal Article

Anoop K Koshy, Harshavardhan, R. B., Siyad, I., and Venu, R. P., “Impact of Calcifications on Diagnostic Yield of Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Ductal Adenocarcinoma”, Indian J Gastroenterol, 2019.[Abstract]


INTRODUCTION: Chronic calcific pancreatitis (CCP) is a major risk factor for pancreatic ductal adenocarcinoma (PDAC) and is common in southern India. Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is useful for tissue acquisition in patients with solid pancreatic lesions. Multiple factors may affect the diagnostic yield of&nbsp;FNA samples. The present study was performed to assess the impact of pancreatic calcifications on the diagnostic yield of EUS-FNA in PDAC.

METHODS: All patients with confirmed PDAC from January 2013 to December 2017 were included. CCP was diagnosed based on typical&nbsp;imaging characteristics with or without evidence of pancreatic insufficiency along with surgical histopathology reports showing features of chronic pancreatitis. The diagnostic yield and adequacy of cellularity were&nbsp; assessed by a pathologist who was blinded and were compared between the two groups: group 1: PDAC patients with no evidence of CCP and, group 2: PDAC patients with CCP.

RESULTS: A total of 122 patients were included in the study. The diagnostic yield was lower in patients in group 2 (n&nbsp;= 42, 25 [59.52%]) as compared to those in group 1 (n&nbsp;= 80, 63 [78.75%]) (p-value = 0.01). On multivariate analysis, only the presence of calcifications was found to have an independent association with diagnostic yield (odds ratio 3.83 [95% confidence interval 1.22-11.9]).

CONCLUSIONS: CCP had a significant impact on the diagnostic yield of EUS-FNA for pancreatic adenocarcinoma. Novel techniques and newer technology that may mitigate the negative effect of calcification on diagnostic yield of EUS-FNA in patients with&nbsp;CCP.

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2019

Journal Article

R. Agarwal, Rajanbabu, A., Nitu P. V., Goel, G., Madhusudanan, L., and G, U. U., “A Prospective Study Evaluating the Impact of Implementing the ERAS Protocol on Patients Undergoing Surgery for Advanced Ovarian Cancer”, Int J Gynecol Cancer, vol. 29, no. 3, pp. 605-612, 2019.[Abstract]


OBJECTIVE: Information on the benefits of enhanced recovery after surgery (ERAS) when applied to advanced ovarian cancer() is minimal. The study objectives were to prospectively evaluate whether the implementation of ERAS in AOC patients improves post-operative recovery, and reduces the length of hospital stay (LOHS), without increasing the readmission rate or surgery-related complications; and to investigate ERAS protocol compliance.

METHODS: This was a prospective interventional study carried out at a single university teaching hospital. Patients undergoing laparotomy for advanced ovarian cancer (stages IIb-IV) from March 2017 to February 2018 were managed using an ERAS protocol. The conventional management (CM) period extended from January 2016 to December 2016. The primary outcome was reduction in LOHS. Secondary outcomes were ERAS protocol compliance, incidence of post-operative complications, and readmission rate.

RESULTS: The CM and ERAS groups each comprised 45 patients. Both the groups were comparable in terms of clinicopathological and operative characteristic. Median LOHS of the full cohort, primary debulking cohort, interval debulking cohort, staging surgery cohort (all 6 vs 4 days; p&lt;0.001), and complex cytoreductive surgery cohort (5 vs 4 days; p=0.019) were significantly reduced in the ERAS group. The overall compliance for the ERAS protocol was 90.6%. Occurrence of moderate or severe (17.8% vs 0%; p=0.003) and ≥grade 2 extended Clavein-Dindo complications (22.2% vs 0%; p=0.001); and hospital stay due to occurrence of complications (31.1% vs 2.2%; p&lt;0.001) were also significantly reduced in the ERAS group. There was no difference in the 30-day readmission rates.

CONCLUSION: The results from our investigation suggest that the ERAS program can be successfully implemented in advanced ovarian cancer patients even in low-resource settings provided the program is modified to meet local needs so as not to increase healthcare costs.

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2019

Journal Article

Rakesh P. S., Leyanna Susan George, Teena Mary Joy, Sobha George, Renjini, B. A., and Beena, K. V., “Anemia Among School Children in Ernakulam District, Kerala, India”, Indian J Hematol Blood Transfus, vol. 35, no. 1, pp. 114-118, 2019.[Abstract]


Anaemia has significant negative impact on the health of school children including poor scholastic performance and cognitive impairment. The present study was done with the objective to estimate the prevalence of anemia among school going children in Ernakulam district, Kerala and to determine a few factors associated with anemia. Hemoglobin of 880 students of 6th to 9th standard in 11 randomly selected schools of Ernakulam district was estimated using HemoCue 201 photometer. Prevalence of anaemia was expressed using frequencies and percentages. Univariate analysis for factors associated with anemia was done. Selected variables were entered into a logistic regression model. The prevalence of anemia was estimated to be 44% (95% CI 40.67-47.33). Among them 0.8% had severe anemia, 3.5% had moderate anemia and 39.7% had mild anemia. Among them 21.3% and 52.6% reported not in the habit of consuming green leafy vegetables and citrus fruits respectively, at least three times on a usual week. Anemia among children was associated with female gender (adjusted OR 1.53, 95% CI 1.16-2.04), higher age group (adjusted OR 2.24, 95% CI 1.69-2.91) and regular intake of tea/coffee along with major meals (adjusted OR 1.62, 95% CI 1.20-2.04). Anemia among school going children in Ernakulam remains a public health problem and was more among females, higher age groups (12-15&nbsp;years) and those reported regular intake of tea/coffee along with major meals. The consumption of iron rich foods among the students was poor. Behavior change communication for dietary modification and universal supplementation of iron is warranted.

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2019

Journal Article

E. Berglund, Ljungdahl, M. Andersen, Bogdanović, D., Berglund, D., Wadström, J., Kowalski, J., Brandacher, G., Kamińska, D., Kaufman, C. L., Talbot, S. G., Azari, K., Landin, L., Höhnke, C., Dwyer, K. M., Cavadas, P. C., Thione, A., Clarke, B., Kay, S., Wilks, D., Dr. Subramania Iyer K., Iglesias, M., Özkan, Ö., Özkan, Ö., Krapf, J., Weissenbacher, A., Petruzzo, P., and Schneeberger, S., “Clinical Significance of Alloantibodies in Hand Transplantation - A Multicenter Study”, Transplantation, 2019.[Abstract]


BACKGROUND: Donor-specific antibodies (DSA) have a strong negative correlation with long-term survival in solid organ transplantation. Although the clinical significance of DSA and antibody-mediated rejection (AMR) in upper extremity transplantation (UET) remains to be established, a growing number of single-center reports indicate their presence and potential clinical impact.

METHODS: We present a multicenter study assessing the occurrence and significance of alloantibodies in UET in reference to immunological parameters and functional outcome.

RESULTS: Our study revealed a high prevalence and early development of de novo DSA and non-DSA (43%, the majority detected within the first three post operative years). HLA class II mismatch correlated with antibody development, which in turn significantly correlated with the incidence of acute cellular rejection. Cellular rejections preceded antibody development in almost all cases. A strong correlation between DSA and graft survival or function cannot be statistically established at this early stage but a correlation with a lesser outcome seems to emerge.

CONCLUSIONS: While the phenotype and true clinical effect of AMR remain to be better defined, the high prevalence of DSA and the correlation with acute rejection highlight the need for optimizing immunosuppression, close monitoring and the relevance of an HLA class II match in UET recipients.

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2019

Journal Article

H. Ryung Chang, Cho, S. Yoon, Lee, J. Hoon, Lee, E., Seo, J., Lee, H. Ran, Cavalcanti, D. P., Mäkitie, O., Valta, H., Girisha, K. M., Lee, C., Neethukrishna, K., Bhavani, G. S., Shukla, A., Dr. Sheela Nampoothiri, Phadke, S. R., Park, M. Jung, Ikegawa, S., Wang, Z., Higgs, M. R., Stewart, G. S., Jung, E., Lee, M. - S., Park, J. Hoon, Lee, E. A., Kim, H., Myung, K., Jeon, W., Lee, K., Kim, D., Kim, O. - H., Choi, M., Lee, H. - W., Kim, Y., and Cho, T. - J., “Hypomorphic Mutations in TONSL Cause SPONASTRIME Dysplasia.”, Am J Hum Genet, vol. 104, no. 3, pp. 439-453, 2019.[Abstract]


SPONASTRIME dysplasia is a rare, recessive skeletal dysplasia characterized by short stature, facial dysmorphism, and aberrant radiographic findings of the spine and long bone metaphysis. No causative genetic alterations for SPONASTRIME dysplasia have yet been&nbsp;determined. Using whole-exome sequencing (WES), we identified bi-allelic TONSL mutations in 10 of 13 individuals with SPONASTRIME dysplasia. TONSL is a multi-domain scaffold protein that interacts with DNA replication and repair factors and which plays critical roles in resistance to replication stress and the maintenance of genome integrity. We show here that cellular defects in dermal fibroblasts from affected individuals are complemented by the expression of wild-type TONSL. In addition, in&nbsp;vitro cell-based assays and in silico analyses of TONSL structure support the pathogenicity of those TONSL variants. Intriguingly, a knock-in (KI) Tonsl mouse model leads to embryonic lethality, implying the physiological importance of TONSL. Overall, these findings indicate that genetic variants resulting in reduced function of TONSL cause SPONASTRIME dysplasia and highlight the importance of TONSL in embryonic development and postnatal growth.

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2019

Journal Article

R. Agarwal, Rajanbabu, A., Keechilattu, P., Nair, I. R., K., V. D., and Unnikrishnan, U. G., “A Retrospective Analysis of the Pattern of Care and Survival in Patients with Malignant Ovarian Germ Cell Tumors”, South Asian J Cancer, vol. 8, no. 1, pp. 35-40, 2019.[Abstract]


Objective: The objective of this study is to evaluate the pattern of care and survival outcome in patients with malignant ovarian germ cell tumors (MOGCTs).

Materials and Methods: Between January 2004 and August 2017, 50 patients with MOGCT were identified at Amrita Institute of Medical Sciences and 48 included in analyses. Histologic subtypes were as follows: dysgerminoma 11; immature teratoma 16; yolk sac tumor 3; and mixed germ cell tumor 18. 31 (64.6% patients belonged to Stage I and 17 (35.4%) patients were advanced stage (Stage II-IV).

Results: Median follow-up period was 34 months (range: 1-241 months). The 5- and 10-year disease-free survival (DFS) and overall survival (OS) for the entire cohort were 87.5% and 94.4%, respectively. DFS and OS of incomplete surgery Stage I patients 28.6% and 68.6%, respectively, were significantly lower than completely staged patients 100%. Out of 8 incomplete surgery patients, 5 recurred of which 2 died of disease within 4 and 9 months of recurrence. There was no survival difference with comprehensive surgical staging (CSS) and pediatric surgical staging (PSS) in Stage I MOGCT (DFS and OS 100%). Stage I dysgerminoma kept on active surveillance after PSS had equivalent survival of 100%. There was no survival difference in advanced stage MOGCT treated with primary debulking surgery and neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery (DFS and OS 100%).

Conclusion: Incomplete surgery in Stage I MOGCT was associated with poor survival. There was no survival difference with CSS and PSS. NAC followed by surgery could be a reasonable option for patients of advanced stage MOGCT.

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2019

Journal Article

J. Sheth, Bhavsar, R., Mistri, M., Pancholi, D., Bavdekar, A., Dalal, A., Ranganath, P., Girisha, K. M., Shukla, A., Phadke, S., Puri, R., Panigrahi, I., Kaur, A., Muranjan, M., Goyal, M., Ramadevi, R., Shah, R., Dr. Sheela Nampoothiri, Danda, S., Datar, C., Kapoor, S., Bhatwadekar, S., and Sheth, F., “Gaucher Disease: Single Gene Molecular Characterization of One-hundred Indian Patients Reveals Novel Variants and the Most Prevalent Mutation”, BMC Med Genet, vol. 20, no. 1, p. 31, 2019.[Abstract]


BACKGROUND: Gaucher disease is a rare pan-ethnic, lysosomal storage disorder resulting due to beta-Glucosidase (GBA1) gene defect. This leads to the glucocerebrosidase enzyme deficiency and an increased accumulation of undegraded glycolipid glucocerebroside inside the cells' lysosomes. To date, nearly 460 mutations have been described in the GBA1 gene. With the aim to determine mutations spectrum and molecular pathology of Gaucher disease in India, the present study investigated one hundred unrelated patients (age range: 1 day to 31 years) having splenomegaly, with or without hepatomegaly, cytopenia and bone abnormality in some of the patients.

METHODS: The biochemical investigation for the plasma chitotriosidase enzyme activity and β-Glucosidase enzyme activity confirmed the Gaucher disease. The mutations were identified by screening the patients' whole GBA gene coding region using bidirectional Sanger sequencing.

RESULTS: The biochemical analysis revealed a significant reduction in the β-Glucosidase activity in all patients. Sanger sequencing established 71 patients with homozygous mutation and 22 patients with compound heterozygous mutation in GBA1 gene. Lack of identification of mutations in three patients suggests the possibility of either large deletion/duplication or deep intronic variations in the GBA1 gene. In four cases, where the proband died due to confirmed Gaucher disease, the parents were found to be a carrier. Overall, the study identified 33 mutations in 100 patients that also covers four missense mutations (p.Ser136Leu, p.Leu279Val, p.Gly383Asp, p.Gly399Arg) not previously reported in Gaucher disease patients. The mutation p.Leu483Pro was identified as the most commonly occurring Gaucher disease mutation in the study (62% patients). The second common mutations identified were p.Arg535Cys (7% patients) and RecNcil (7% patients). Another complex mutation Complex C was identified in a compound heterozygous status (3% patients). The homology modeling of the novel mutations suggested the destabilization of the GBA protein structure due to conformational changes.

CONCLUSIONS: The study reports four novel and 29 known mutations identified in the GBA1 gene in one-hundred Gaucher patients. The given study establishes p.Leu483Pro as the most prevalent mutation in the Indian patients with type 1 Gaucher disease that provide new insight into the molecular basis of Gaucher Disease in India.

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2019

Journal Article

R. V. Vora, Kota, R. Krishna Su, Singhal, R. R., and Gopikrishnan Anjaneyan, “Clinical Profile of Androgenic Alopecia and Its Association with Cardiovascular Risk Factors”, Indian J Dermatol, vol. 64, no. 1, pp. 19-22, 2019.[Abstract]


Context: Androgenic alopecia (AGA) is a hereditary androgen-dependent disorder, characterized by gradual conversion of terminal hair into miniaturized hair and defined by various patterns. Common age group affected is between 30 and 50 years. Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors that include diabetes and prediabetes, abdominal obesity, dyslipidemia, and hypertension. The relationship between androgenic alopecia and MetS is still poorly understood.

Aim: The aim was to study the clinical profile of androgenic alopecia and its association with cardiovascular risk factors.

Materials and Methods: This was a hospital-based cross-sectional study done on men in the age group of 25-40 years. Fifty clinically diagnosed cases with early-onset androgenic alopecia of Norwood Grade III or above and fifty controls without androgenic alopecia were included in the study. Data collected included anthropometric measurements, blood pressure, family history of androgenic alopecia, history of alcohol, smoking; fasting blood sugar, and lipid profile were done. MetS was diagnosed as per the new International Diabetes Federation criteria. Chi-square and Student's -test were used for statistical analysis.

Results: MetS was seen in 5 (10%) cases and 1 (2%) control (=0.092). Abdominal obesity, hypertension, and lowered high-density lipoprotein were significantly higher in patients with androgenic alopecia when compared to that of the controls.

Conclusion: A higher prevalence of cardiovascular risk factors was seen in men with early-onset androgenic alopecia. Early screening for MetS and its components may be beneficial in patients with early-onset androgenic alopecia.

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2019

Journal Article

E. Kuriakose, Sumithra N. Unni, Narayanan, S. Kuzhikanda, and Anu Vasudevan, “A Study on Free Light Chain Assay and Serum Immunofixation Electrophoresis for the Diagnosis of Monoclonal Gammopathies.”, Indian J Clin Biochem, vol. 34, no. 1, pp. 76-81, 2019.[Abstract]


Demonstration of monoclonal immunoglobulin molecule in serum forms the mainstay in the diagnosis of monoclonal gammopathies. The major tests that help in this regard are serum protein electrophoresis (SPEP), serum immunofixation electrophoresis (sIFE) and serum free light chain assay (sFLC). Our objectives were to study the accuracy of sFLC and sIFE in the diagnosis of monoclonal gammopathies and also to study the role of combination of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC in the diagnosis of the same. 46 patients who attended the hemato-oncology clinic with signs and symptoms suggestive of monoclonal gammopathy were enrolled in this study. SPEP, sIFE, sFLC and pre-treatment serum beta-2 microglobulin levels were analysed among the study population. Both SPEP and sIFE were performed in the Interlab Genios fully automated machine. Serum beta-2 microglobulin and sFLC were estimated by immunoturbidimetry in Beckman Coulter AU 2700 analyzer. The accuracy of sIFE came to be 80% with respect to sFLC assay. Sensitivity, specificity, positive and negative predictive value of sIFE with respect to sFLC were 81.3, 78.6, 89.7 and 64.7% respectively. It was observed that a combination panel of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC could detect all the cases of myeloma included in this study. Further testing in large samples is required for generalising the findings of this study. The pre-treatment beta-2 microglobulin levels were significantly higher in the group which was positive for myeloma. A combination panel of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC prove to be more useful than individual tests for the detection of myeloma.

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2019

Journal Article

Dr. Sanjeev K. Singh, Charani, E., Wattal, C., Arora, A., Jenkins, A., and Nathwani, D., “The State of Education and Training for Antimicrobial Stewardship Programs in Indian Hospitals-A Qualitative and Quantitative Assessment.”, Antibiotics (Basel), vol. 8, no. 1, 2019.[Abstract]


: To understand the role of infrastructure, manpower, and education and training (E&amp;T) in relation to Antimicrobial Stewardship (AMS) in Indian healthcare organizations. : Mixed method approach using quantitative survey and qualitative interviews was applied. Through key informants, healthcare professionals from 69 hospitals (public &amp; private) were invited to participate in online survey and follow up qualitative interviews. Thematic analysis was applied to identify the key emerging themes from the interviews. The survey data were analyzed using descriptive statistics. : 60 healthcare professionals from 51 hospitals responded to the survey. Eight doctors participated in semi-structured telephone interviews. 69% (27/39) of the respondents received E&amp;T on AMS during undergraduate or postgraduate training. 88% (15/17) had not received any E&amp;T at induction or during employment. In the qualitative interviews three key areas of concern were identified: (1) need for government level endorsement of AMS activities; (2) lack of AMS programs in hospitals; and, (3) lack of postgraduate E&amp;T in AMS for staff. : No structured provision of E&amp;T for AMS currently exists in India. Stakeholder engagement is essential to the sustainable design and implementation of bespoke E&amp;T for hospital AMS in India.

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2019

Journal Article

K. K Kumar and James, C., “Thuvaraka Rasayana Regimen in Psoriasis Vulgaris - A Case Report”, J Ayurveda Integr Med, vol. 10, no. 1, pp. 41-44, 2019.[Abstract]


Psoriasis is one among the wide-spreading, chronic, frequently recurring diseases of the skin. Its world prevalence varies between 0.09% and 11.4% in 2013 which reported in 2006 as in between 0.5% and 4.6%. In Ayurveda, the description of Kushta-roga viz. Vata-Kaphaja kushta finds similarity with psoriasis. The common sites of occurrence of psoriasis are scalp, elbow, knee, earlobes and sole which are also considered as the location of Vata and Kapha. The science of Ayurveda has anecdotal accounts of success in the management of psoriasis in the actual clinical practice even though it lacks the evidence-based medical dermatology research data. It observed that the physicians adopt several treatment protocols for the cure of this disease in clinical practice, which was not rigorously evaluating in research settings. This paper/report is one of on the 'Thuvaraka rasayana' is one such component that could improve treatment outcomes in Psoriasis. A pre and post test case report selected of a 36-year-old lady patient who diagnosed as having stable psoriasis vulgaris for last seven years. She was administered with internal and external therapies along with Shodhana therapies (bio-cleansing procedures) and then followed by intake of Thuvaraka rasayana. The total duration of the treatment was 43 days, and the Study subject assessed before treatment, after treatment and on follow-up for improvement using PASI scoring, and histo-pathological study. All the symptoms observed in the beginning were found considerably reduced, and the severity also found mild. On the follow-up, it concluded that the lesions disappeared completely and the skin set back to its normal texture. Even though psoriasis is an autoimmune disease where recurrence rate found more Shodhana therapy and Thuvaraka rasayana have a definite role

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2019

Journal Article

R. Balu, Kumar, M., Nair, P. G., John, S. R., and Sreekumar, S., “Small Fenestra Stapedotomy Versus Large Fenestra Stapedectomy in Improving Hearing Ability in Patients with Otosclerosis: Our 10 Years Experience”, Indian Journal of Otolaryngology and Head and Neck Surgery, vol. 71, no. 3, pp. 304-308, 2019.[Abstract]


The aim of this study was to review the experience with surgical treatment of otosclerosis over the last 10&nbsp;years at Amrita Institute of Medical Sciences and Research Centre and to compare it with reported outcomes. A total of 125 patients who had reported between January 2008 and June 2018 were selected for the study. The inclusion criteria for the study included the age group 15–60&nbsp;years, conductive hearing loss with intact tympanic membrane and an air–bone–gap (ABG) of more than 30&nbsp;dB. The exclusion criteria included patients below 15&nbsp;years of age and above 60&nbsp;years of age, patients with chronic otitis media and the cases of revision stapes surgery. Audiological evaluation was conducted prior to the surgery and post operative audiological evaluation was also performed after 1&nbsp;month to understand the difference in hearing. In all cases the same surgical technique was used, only the dimension of the foot plate removed varied. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) (version windows base system, SPSS Inc. Chicago IL USA) software. Mean age in years who underwent surgery is 37.8 ± 11.4 and duration of disease in months median 36&nbsp;months (range 1–120&nbsp;months). Of the 125 patients (42% males and 58% females), 73 patients underwent large fenestra stapedotomy, and 52 patients underwent small fenestra stapedotomy. There was significant improvement in the following hearing parameters studied (puretone average of air conduction thresholds-PTA, ABG) in both the groups after surgery. There was no significant difference between the small fenestra and large fenestra groups with respect to improvement in PTA and ABG. On comparison of SDS (pre and post surgery) statistically significant difference was noted only in small fenestra group. However, this difference of SDS was not significant in between group comparison (stapedotomy versus stapedectomy). In summary both techniques are safe and effective treatment for conductive hearing loss in otosclerosis patients. There appears to be no deleterious effects of either procedures on hearing function. Similar results can be obtained in experienced hands using either technique. The absence of serious complications makes it reasonable to perform stapes surgery in both ears in patients with bilateral otosclerosis with conductive hearing loss. © 2019, Association of Otolaryngologists of India.

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2019

Journal Article

G. Hansmann, Koestenberger, M., Alastalo, T. - P., Apitz, C., Austin, E. D., Bonnet, D., Budts, W., D'Alto, M., Gatzoulis, M. A., Hasan, B. S., Kozlik-Feldmann, R., R Krishna Kumar, Lammers, A. E., Latus, H., Michel-Behnke, I., Miera, O., Morrell, N. W., Pieles, G., Quandt, D., Sallmon, H., Schranz, D., Tran-Lundmark, K., Tulloh, R. M. R., Warnecke, G., Wåhlander, H., Weber, S. C., and Zartner, P., “2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT.”, J Heart Lung Transplant, vol. 38, no. 9, pp. 879-901, 2019.[Abstract]


The European Pediatric Pulmonary Vascular Disease Network is a registered, non-profit organization that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of pediatric pulmonary hypertensive vascular disease, including pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, PH associated with congenital heart disease (CHD), persistent PH of the newborn, and related cardiac dysfunction. The executive writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2018) and held face-to-face and web-based meetings. Ten section task forces voted on the updated recommendations, based on the 2016 executive summary. Clinical trials, meta-analyses, guidelines, and other articles that include pediatric data were searched using the term "pulmonary hypertension" and other keywords. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on pediatric data only, or on adult studies that included &gt;10% children or studies that enrolled adults with CHD. New definitions by the World Symposium on Pulmonary Hypertension 2018 were included. We generated 10 tables with graded recommendations (COR/LOE). The topics include diagnosis/monitoring, genetics/biomarkers, cardiac catheterization, echocardiography, cardiac magnetic resonance/chest computed tomography, associated forms of PH, intensive care unit/lung transplantation, and treatment of pediatric PH. For the first time, a set of specific recommendations on the management of PH in middle- and low-income regions was developed. Taken together, these executive, up-to-date guidelines provide a specific, comprehensive, detailed but practical framework for the optimal clinical care of children and young adults with PH.

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2019

Journal Article

H. M. Ali and George, L. Susan, “A qualitative analysis of the impact of Kudumbashree and MGNREGA on the lives of women belonging to a coastal community in Kerala.”, J Family Med Prim Care, vol. 8, no. 9, pp. 2832-2836, 2019.[Abstract]


Background: The rural coastal population of Njarakkal are dependent on fishing for their daily livelihood making them highly economically unstable. Both Kudumbashree and MGNREGA have been implemented in this area for the upliftment of this population especially women. Therefore, the objective of this study was to qualitatively analyze the impact of Kudumbashree and MGNREGA on the lives of women belonging to the rural coastal community of Njarakkal.

Methods: A qualitative study consisting of Focused group discussions and key informant interviews were conducted on women belonging to the fishing community who were active members of both the Kudumbashree and MGNREGA program.

Results: Participation in Kudumbashree and MGNREGA was found to have a positive impact on the lives of these coastal women. They experienced social, economic and political empowerment along with an improvement in their leadership skills and decision making capacity. Their participation in these groups not only led to empowerment in various domains of their lives but also had an impact on their health awareness, needs and utilization of healthcare services.

Conclusion: Both Kudumbashree and MGNREGA were found to very useful platforms for the empowerment of women and thereby aiding in the eradication of poverty. Irrespective of a few lacunae's in these programs, it has resulted in the creation of a cohort of empowered women who can be effectively used as future ambassadors for spreading health awareness in the community.

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2019

Journal Article

Dr. Hisham Ahamed and Subramanian, M., “Letter by Ahamed and Subramanian Regarding Article "Missense Mutations in the FLNC Gene Causing Familial Restrictive Cardiomyopathy".”, Circ Genom Precis Med, vol. 12, no. 7, p. e002587, 2019.

2019

Journal Article

M. Subramanian, Peravali, S., Dr. Hisham Ahamed, and Navin Mathew, “Arrhythmogenic right ventricular cardiomyopathy and sick sinus syndrome : a potential overlap syndrome”, European Heart Journal - Cardiovascular Imaging , vol. 20, Suppliment 2, p. ii53, 2019.[Abstract]


Introduction –

Abnormalities of desmosomes, more specifically mutations in the desmoplakin (DSP) gene, have been shown to cause not only arrhythmogenic right ventricular cardiomyopathy (ARVC) but also sick sinus syndrome (SSS) as well. Although various ARVC overlap syndromes have been described, its association with sinus node dysfunction is not documented. In this report, we describe an autosomal dominant missense mutation in the DSP gene in a proband with sick sinus syndrome and features of ARVC on cardiac MRI.

Clinical case –

A 70 year old man presented with a recurrent episodes of syncope, that were historically suggestive of an arrhythmic etiology. He had a history of systemic hypertension which was under adequate control with ACE inhibitors. His 2D Echocardiogram (ECHO) revealed a structurally normal heart. During his evaluation of syncope, his baseline electrocardiogram (ECG), head up tilt test, brain imaging, and electroencephalography were non-contributory. Cardiac MRI(CMR) examination was performed with 1.5-T MR Imager using a dedicated cardiac phase array coil. It revealed focal out-pouching in the right ventricular free wall that did not satisfy the major ARVD Task Force Criteria. The LV wall morphology and function was normal. No obvious late enhancement was noted. As extended 24 hour and 7 day ECG Holter monitoring also did not reveal any abnormalities, an implantable loop recorder was implanted. This revealed multiple sinus pauses (longest pause of 3.2 seconds) suggestive of sick sinus syndrome. The patient underwent a dual chamber implantable cardioverter defibrillator, and is doing well on follow up. In view of CMR findings suggestive of ARVC ,whole exome sequencing was done and it revealed a missense substitution affecting desmoplakin (DSP) gene on chromosome 6p24.3, previously described as ARVD8.

Family screening –

As shown in Figure 1, the entire family of the proband (I,1) was screened for both features of ARVD and sinus node dysfunction. All children of the proband were asymptomatic at the time of screening. An ECG, 2D ECHO, Exercise testing, CMR , as well as genetic screening was performed. All children were carriers for the same missense mutation (ARVD8) on the DSP gene. In one of the sons (II,1) of the proband, CMR revealed RV dilation and dyskinesia of the anterior right ventricular free wall, suggestive of ARVD. There were no features of sinus node dysfunction in any of the children of the proband.

Conclusion –

Autosomal dominant missense mutations on the desmoplakin (DSP) gene can cause a potential overlap syndrome of ARVC and sick sinus syndrome. Patients with this mutation are may be at higher risk for both cardiac conduction abnormalities and life-threatening ventricular arrhythmias, and hence both CMR and genetic screening are crucial in their risk stratification

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2019

Journal Article

K. D. Salima, Dr Rajesh Gopalakrishna, Renjitha Bhaskaran, and R., R. P., “Physician Preference of Anti-diabetic Medications and Complications in Pancreatic Diabetes - An Experience from A Tertiary Care Teaching Hospital”, Research Journal of Pharmacy and Technology, Raipur, vol. 12, no. 3, 2019.[Abstract]


<p>Aim: There are no guidelines for use of diabetic medications in pancreatic diabetes. Hence we attempted to the<br />benefits of antidiabetic agents in pancreatic diabetes. Materials and methods: a total of 670 chronic pancreatitis<br />patients are selected. Out of that about 126 patients with pancreatic diabetic are selected for the study. The data<br />collected from 2010. Results: In this study mean age was found to be 53.86&plusmn;12.53. The male patients (73.8%)<br />were more predominant in this study than female patients (26.2%). The complications of chronic pancreatitis<br />among 126 patients, 126 (100) patient had diabetes mellitus (DM), 100 (79) patients had pain. Among 126<br />patients 52 (41.3%) patients had taken insulin only, 21 (16.7%) patients had taken insulin+ oral combination, 16<br />(12.7%) patients had taken Biguanides, 13 (10.3%) of patients had taken oral combinations, 13 (10.3%) patients<br />had taken alpha glucosidase inhibitors, 11 (8.7%) patients who are taken sulfonyl ureas. Most of the patients<br />took insulin monotherapy. Conclusion: Insulin was most preferred agent. Metformin was the most commonly<br />preferred oral antidiabetic agent.</p>

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2018

Journal Article

V. Renjith, Pai, A., Radhakrishnan, K., Nayak, B. S., Devi, E. Sanatombi, Ladd, E., and George, A., “Randomized controlled trial on the effectiveness of a multicomponent intervention on migraine: A study protocol.”, J Adv Nurs, vol. 74, no. 3, pp. 734-742, 2018.[Abstract]


<p><b>AIM: </b>To describe a randomized controlled trial protocol that evaluates the effectiveness of a multicomponent intervention in improving the outcomes (quality of life, disability, intensity, frequency and duration) of patients with migraine.</p><p><b>BACKGROUND: </b>Migraine affects various facets of Quality of Life and results in moderate to high levels of disability among migraineurs. Migraine pain can be intense and unremitting that can interfere with the daily routine and reduce the ability to think and function normally. Many people can lower their risk of a migraine by simply avoiding stress, getting enough sleep, eating regularly and by avoiding triggers. Hence, the present study aims at evaluating the effectiveness of a multicomponent intervention in managing migraine headaches. The multicomponent intervention includes behavioural lifestyle modification program and sessions of pranayama (a form of yogic breathing exercise).</p><p><b>DESIGN: </b>The study is a prospective, randomized, controlled, single-blinded trial with parallel arms.</p><p><b>METHODS: </b>The study participants are randomized to intervention and control arms. The participants randomized to the intervention arm would receive the specific multicomponent intervention based on the protocol. The participants in the control arm would receive routine care. They are followed up for 24 weeks and the outcomes are assessed.</p><p><b>DISCUSSION: </b>Various studies report that non-pharmacological therapies and integrative therapies play a major role in the management of migraine headaches. The findings of the study are expected to open up new horizons in health care arena emphasizing the use of non-pharmacological therapy for less focused areas of primary care health problems such as migraine.</p><p><b>TRIAL REGISTRATION: </b>The trial is registered with the Clinical Trials Registry India (CTRI). The CTRI India is one of the primary registries in the WHO registry network (Ctri.nic.in, ). CTRI reference ID: CTRI/2015/10/006282.</p>

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2018

Journal Article

S. Jagadeesan, Anilkumar, V., Panicker, V. Varghese, Anjaneyan, G., and Thomas, J., “ infection complicating traumatic and surgical wounds: A case series.”, Indian J Dermatol Venereol Leprol, vol. 84, no. 1, pp. 45-48, 2018.[Abstract]


<p>Mycobacterium chelonae is a rapidly growing non-tuberculous mycobacterium. The skin and soft tissue infections due to this organism are steadily on the rise and need to be delineated specifically as most of these are not responsive to routine antituberculosis treatment. Here, we report 3 different presentations caused by Mycobacterium chelonae in traumatic and surgical wounds. Mycobacterium chelonae can complicate surgical or traumatic wounds.This infection may also present as injection site abscesses. Diabetics on insulin injections are especially at risk. A high index of suspicion is necessary in long standing culture negative lesions for clinching the diagnosis. PCR can be helpful in confirming the diagnosis.</p>

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2018

Journal Article

M. Raj, Sudhakar, A., Roy, R., Soman, S., Antony, L., Champaneri, B., and Kumar, R. Krishna, “Health-related quality of life in infants and toddlers with congenital heart disease: a cross-sectional survey from South India.”, Arch Dis Child, vol. 103, no. 2, pp. 170-175, 2018.[Abstract]


<p><b>OBJECTIVE: </b>There are limited data on health-related quality of life (HRQOL) for infants and toddlers with congenital heart disease (CHD). We sought to compare generic HRQOL of infants and toddlers between CHD subjects and controls.</p><p><b>DESIGN: </b>Dual-setting, cross-sectional analytical survey.</p><p><b>SETTING: </b>We collected HRQOL data on infants and toddlers through a community survey for controls and through a hospital-based survey for those with CHD.</p><p><b>PATIENTS: </b>A total of 499 subjects with confirmed CHD in the age group of 1-24 months admitted for elective surgery in the study institution were selected by consecutive sampling. In addition, we selected 628 control children in the same age group from an area within the 10 km radius of the study institution.</p><p><b>MAIN OUTCOME MEASURES: </b>The data contain parent proxy report of HRQOL. The Pediatric Quality of Life Inventory (PedsQL 4.0) was used to collect HRQOL data. Questionnaires were self-administered for parents.</p><p><b>RESULTS: </b>The mean total proxy HRQOL scores were significantly higher in control infants compared with infants with CHD (adjusted mean difference 5.0, 99% CI 2.5 to 7.5, p<0.001). Corresponding figure for toddlers was 7.6 (95% CI 5.0 to 10.2, p<0.001). There was no significant difference in total HRQOL scores across CHD functional classes among infants and toddlers (p=0.212 and p=0.502, respectively).</p><p><b>CONCLUSIONS: </b>Infants and toddlers with uncorrected CHD have significant deficiency in proxy HRQOL compared with their controls. The functional class of CHD appears to have no differential impact on overall HRQOL deficiency in this age group.</p>

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2018

Journal Article

J. Shaji Mathew, Manikandan, K., Kumar, K. Y. Santosh, Binoj, S. T., Dinesh Balakrishnan, Gopalakrishnan, U., Menon, R. Narayana, Dhar, P., Sudheer, O. V., Aneesh, S., and Sudhindran, S., “Biliary complications among live donors following live donor liver transplantation.”, Surgeon, vol. 16, no. 4, pp. 214-219, 2018.[Abstract]


<p><b>INTRODUCTION: </b>In live donor liver transplantation (LDLT), bile duct division is a critical step in donor hepatectomy. Biliary complications hence are a feared sequelae even among donors. Long term data on biliary complications in donors from India are sparse.</p><p><b>METHODS: </b>Prospective evaluation of 452 live donors over 10 years was performed to ascertain the incidence & risk factors of clinically significant biliary complications.</p><p><b>RESULTS: </b>Of the 452 donor hepatectomies (M: F = 114:338, median age = 38), 66.2% (299) were extended right lobe grafts, 24.1% (109) modified right lobe and 9.7% (44) were left lobe grafts. Portal vein anatomy was Type-I in 85% (386), Type-II in 7.5% (34) and Type-III in 7.1% (32). Following donor hepatectomy, a single bile duct opening occurred only in 46.5% (210) of the grafts. Of the remaining 53.5% grafts, 2 ductal openings were noted in 217 (48%) and three ductal openings in 25 (5.5%). Incidence of multiple openings in the duct were more commonly noted in Type II (70.6%) and III (75%) portal vein anatomy than in grafts with Type I (50.4%) portal anatomy (P = 0.001) Bile leak was noted in 15 (3.3%) donors which included one broncho-biliary fistula and bilio-pleural fistula. Analysis revealed no association between post-operative biliary complications and type of graft, portal vein anatomy or biliary anatomy. There was a single mortality in this series secondary to biliary sepsis. On long term follow, there were no biliary strictures in any of the patients.</p><p><b>CONCLUSIONS: </b>Biliary complications although rare (3.3%), present significant peri-operative morbidity to the donors.</p>

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2018

Journal Article

F. Kaliyadan, Ashique, K. T., and Jagadeesan, S., “A survey on the pattern of dermoscopy use among dermatologists in India.”, Indian J Dermatol Venereol Leprol, vol. 84, no. 1, p. 120, 2018.[Abstract]


<p><b>INTRODUCTION AND BACKGROUND: </b>Dermoscopy is being increasingly used for improving dermatological diagnosis. Use of dermoscopy in the early recognition of skin malignancies, especially melanoma, is well established. Of late, its use in general clinical dermatology is growing with the recognition of new and specific patterns in conditions such as hair disorders, inflammatory disorders, and infections/infestations. This cross-sectional survey aims to assess the common patterns of dermoscopy use by Indian dermatologists.</p><p><b>METHODS: </b>This was across-sectional survey. An online questionnaire was used to collect data. The questionnaire focused on the frequency of dermoscopy use by Indian dermatologists, reasons for using it or not, and the training they had received on dermoscopy.</p><p><b>RESULTS: </b>Of the total 150 valid responses, eighty two (54.7%) participants reported that they were using dermoscopy routinely in their clinical practice. Lack of familiarity and lack of proper training were the important reasons cited for not using dermoscopy regularly. Among the dermatologists using dermoscopy, consensus on effectiveness was highest for hair disorders.</p><p><b>CONCLUSIONS: </b>Dermoscopy use by dermatologists in India is mainly in the context of inflammatory dermatosis and hair disorders rather than skin tumors. Lack of familiarity with the technique appears to be main factor limiting the use of dermoscopy in India.</p><p><b>LIMITATIONS: </b>Small sample size is the major limitation of this study. It is possible that a large number of dermatologists who do not use dermoscopy might not have responded to the survey, there by affecting the results and their interpretation.</p>

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2018

Journal Article

M. Sarkar and Pillai, A., “Trans-sylvian Approach to Microvascular Decompression for Trigeminal Neuralgia in Syndromic Cranial Base Settling.”, Oper Neurosurg (Hagerstown), vol. 15, no. 2, pp. E9-E12, 2018.[Abstract]


<p><b>BACKGROUND AND IMPORTANCE: </b>The lateral suboccipital approach for microvascular decompression (MVD) of the trigeminal nerve has become a standard-of-care over the past several decades. Syndromic cranial base settling, a rare but known cause for trigeminal neuralgia (TN), poses significant dilemmas in clinical management. In such cases, distorted anatomy may render surgery via the suboccipital approach difficult or even impossible.</p><p><b>CLINICAL PRESENTATION: </b>A 34-yr-old male with osteogenesis imperfecta and severe basilar invagination suffered from TN that was refractory to medication and stereotactic radiosurgery. MVD of the fifth nerve root was performed via a pterional trans-sylvian approach after 3-dimensional trajectory modeling suggested the feasibility of this approach. He experienced complete resolution of TN and remains free of both pain and medications after 18 mo of follow-up.</p><p><b>CONCLUSION: </b>This microsurgical trajectory, previously undescribed for TN, provides good visualization of the trigeminal root entry zone, thereby offering an excellent surgical option for severe TN in the setting of abnormal posterior fossa anatomy.</p>

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2018

Journal Article

F. L. Harms, Nampoothiri, S., Anazi, S., Dhanya Yesodharan, Alawi, M., Kutsche, K., and Alkuraya, F. S., “Elsahy-Waters syndrome is caused by biallelic mutations in CDH11.”, Am J Med Genet A, vol. 176, no. 2, pp. 477-482, 2018.[Abstract]


<p>Elsahy-Waters syndrome (EWS), also known as branchial-skeletal-genital syndrome, is a distinct dysmorphology syndrome characterized by facial asymmetry, broad forehead, marked hypertelorism with proptosis, short and broad nose, midface hypoplasia, intellectual disability, and hypospadias. We have recently published a homozygous potential loss of function variant in CDH11 in a boy with a striking resemblance to EWS. More recently, another homozygous truncating variant in CDH11 was reported in two siblings with suspected EWS. Here, we describe in detail the clinical phenotype of the original CDH11-related patient with EWS as well as a previously unreported EWS-affected girl who was also found to have a novel homozygous truncating variant in CDH11, which confirms that EWS is caused by biallelic CDH11 loss of function mutations. Clinical features in the four CDH11 mutation-positive individuals confirm the established core phenotype of EWS. Additionally, we identify upper eyelid coloboma as a new, though infrequent clinical feature. The pathomechanism underlying EWS remains unclear, although the limited phenotypic data on the Cdh11 mouse suggest that this is a potentially helpful model to explore the craniofacial and brain development in EWS-affected individuals.</p>

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2018

Journal Article

J. M. Hariprakash, Vellarikkal, S. K., Keechilat, P., Verma, A., Jayarajan, R., Dixit, V., Ravi, R., Senthivel, V., Kumar, A., Sehgal, P., Sonakar, A. K., Ambawat, S., Giri, A. K., Philip, A., Sivadas, A., Faruq, M., Bharadwaj, D., Sivasubbu, S., and Scaria, V., “Pharmacogenetic landscape of DPYD variants in south Asian populations by integration of genome-scale data.”, Pharmacogenomics, vol. 19, no. 3, pp. 227-241, 2018.[Abstract]


<p><b>AIM: </b>Adverse drug reactions to 5-Fluorouracil(5-FU) is frequent and largely attributable to genetic variations in the DPYD gene, a rate limiting enzyme that clears 5-FU. The study aims at understanding the pharmacogenetic landscape of DPYD variants in south Asian populations.</p><p><b>MATERIALS & METHODS: </b>Systematic analysis of population scale genome wide datasets of over 3000 south Asians was performed. Independent evaluation was performed in a small cohort of patients.</p><p><b>RESULTS: </b>Our analysis revealed significant differences in the the allelic distribution of variants in different ethnicities.</p><p><b>CONCLUSIONS: </b>This is the first and largest genetic map the DPYD variants associated with adverse drug reaction to 5-FU in south Asian population. Our study highlights ethnic differences in allelic frequencies.</p>

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2018

Journal Article

M. Subramanian, Prabhu, M. A., Saravanan, S., and Thachathodiyl, R., “Bio-width index: a novel biomarker for prognostication of long term outcomes in patients with anaemia and heart failure.”, Acta Cardiol, vol. 73, no. 4, pp. 403-409, 2018.[Abstract]


BACKGROUND: The utility of biomarkers for prognostication of long term outcomes in patients with anaemia and heart failure(HF) is not well defined. The objective of this study was to assess the ability of a novel biomarker, bio-width index (BWI),to improve risk stratification in patients with anaemia and acutely decompensated heart failure(ADHF), in comparison to conventional markers, B-type natriuretic peptide(BNP) and red- cell distribution width(RDW).

METHODS: Data from 1569 consecutive patients with ADHF treated at a multidisciplinary HF unit was analysed in this study. The bio-width index (BWI) was calculated by multiplying BNP to RDW and dividing the product by 10 (BWI = BNP x RDW/10). The primary outcome was one year all-cause mortality.

RESULTS: During follow up (median 422 days), subjects with anaemia had significantly higher one year mortality (49.6 vs. 30.5%, p < .001). Cox regression analysis revealed that, BWI(HR 2.13, 95%CI 2.02-2.24, p = .018) as well as BNP(HR 1.86, 95%CI 1.78-1.94, p = .024), and RDW (HR 1.98, 95%CI 1.91-2.05, p = .033) were all independent predictors of one year mortality after adjusting for conventional risk factors. BWI had a higher discriminative ability compared to BNP(AUC 0.90 vs. 0.75, p < .001) and RDW(AUC 0.90 vs. 0.81, p = .012). The patients with higher BWI ( >1024.9) had a higher one year mortality(85.1 vs. 29.2%, p < .001). In addition, BWI significantly improved the net reclassification compared to both BNP(p = .002) and RDW(p = .018).

CONCLUSIONS: In patients with anaemia and ADHF, bio-width index is superior to the established biomarkers such as BNP and RDW in prognostication of long term mortality.

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2018

Journal Article

J. Mariam Joshua, Kd, S., K, P., and Vijayan, M., “Crizotinib, an Effective Agent in -Rearranged Adenocarcinoma of Lungs: A Case Report.”, Clin Med Insights Case Rep, vol. 11, p. 1179547617749615, 2018.[Abstract]


<p><b>Introduction: </b> rearrangement has recently emerged as a new molecular subtype in non-small-cell lung cancer (NSCLC) and is predominantly found in lung adenocarcinoma compared with other oncogenes such as , or . It has been identified in only 1% to 2% of NSCLC cases.</p><p><b>Case Report: </b>We report a case of 52-year-old man (nonsmoker) with a medical history of allergic rhinitis and bronchial asthma. Histopathologic examination of bronchoscopic-guided biopsy showed adenocarcinoma histology on September 2015. After 2 months, he developed left-sided pneumonia for which he was treated with multiple intravenous antibiotics. In the meantime, fiberoptic bronchoscopy was done which revealed purulent secretion from right upper lobe and narrowed opening of right middle lobe. His cancer symptoms got worsened and bronchial biopsy showed EGFR mutation negative. For further diagnosis, fluorescent in situ hybridization test was done which showed mutation positive. By then, the patient was started with crizotinib 250 mg twice daily for mutation in July 2016. Later, patient appears to benefit from treatment with crizotinib. X-ray report and positron emission tomographic-computed tomographic scan revealed that the patient was overall better with clear chest and well tolerated with the therapy. Crizotinib was approved on March 11, 2016 by Food and Drug Administration for the treatment of patients with ROS1-positive NSCLC.</p><p><b>Conclusions: </b>In this report, crizotinib showed marked antitumor activity in patients with advanced rearrangement, a third molecular subgroup of NSCLC.</p>

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2018

Journal Article

S. Palazhy, Kamath, P., and Vasudevan, D. M., “Dietary Fats and Oxidative Stress: A Cross-Sectional Study Among Coronary Artery Disease Subjects Consuming Coconut Oil/Sunflower Oil.”, Indian J Clin Biochem, vol. 33, no. 1, pp. 69-74, 2018.[Abstract]


<p>Coconut oil has been used by the people of Kerala as a cooking medium for several decades. Due to its alleged hypercholesterolemic activity, general population in recent times is shifting to cooking oils rich in polyunsaturated fats, the most popular being sunflower oil. The effect of long-term consumption of sunflower oil on oxidative stress in humans is not well investigated. We studied oxidative stress among coronary artery disease (CAD) patients who were consuming coconut oil or sunflower oil as a part of their routine diet. Men, aged 35-70 years, with established CAD, who presented to the hospital for routine cardiac evaluations, were enrolled in this observational study. Group 1 and 2 consisted of 73 and 80 subjects consuming coconut oil and sunflower oil respectively for over a period of 2 years. Lipid profile and parameters for oxidative stress were evaluated among them. Conventional lipid parameters did not differ significantly between the two groups. Mean vitamin C concentration was significantly reduced for subjects on sunflower oil compared to those consuming coconut oil ( = 0.044). Malondialdehyde was higher for sunflower oil consumers compared to coconut oil consumers ( < 0.0001). Other parameters such as oxidized LDL, GSH, GPx and SOD were not found to be significantly different between the two groups. The results of the present study show that coconut oil did not induce hypercholesterolemia compared to sunflower oil. On the other hand, sunflower oil group had elevated oxidative stress compared to coconut oil group.</p>

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2018

Journal Article

C. Titus Varghese, Bharathan, V. Kumar, Gopalakrishnan, U., Dinesh Balakrishnan, Menon, R. N., Sudheer, O. Vayoth, Dhar, P., and Sudhindran, S., “Randomized trial on extended versus modified right lobe grafts in living donor liver transplantation.”, Liver Transpl, vol. 24, no. 7, pp. 888-896, 2018.[Abstract]


<p>Despite advances in the practice of living donor liver transplantation (LDLT), the optimum surgical approach with respect to the middle hepatic vein (MHV) in right lobe LDLT remains undefined. We designed a randomized trial to compare the early postoperative outcomes in recipients and donors between extended right lobe grafts (ERGs; transection plane was maintained to the left of MHV and division of MHV performed beyond the segment VIII vein) and modified right lobe grafts (MRGs; transection plane was maintained to the right of MHV; the segment V and VIII drainage was reconstructed using a conduit of recipient portal vein). Eligible patients (n = 86) were prospectively randomized into the ERG arm (n = 43) and the MRG arm (n = 43) at the beginning of donor hepatectomy. The primary endpoint considered in this equivalence trial was patency of the MHV or the reconstructed "neo-MHV" in the recipient. The secondary endpoints included biochemical parameters, postoperative complications, mortality in recipients as well as donors and volume regeneration of remnant liver in donors, measured at 2 months. The patency of the MHV was comparable in the ERG and MRG arms (90.7% versus 81.4%; difference, 9.3%; 95% confidence interval [CI], -5.8 to 24.4; z score, 1.245; P = 0.21). Volume regeneration of the remnant liver in donors was significantly better in the MRG arm (111.3% versus 87.3%; mean difference, 24%; 95% CI, 14.6-33.3; P < 0.001). The remaining secondary endpoints in donors and recipients were similar between the 2 arms. To conclude, MRG with reconstructed neo-MHV has comparable patency to native MHV in ERG and confers equivalent graft outflow in the recipient. Furthermore, it allows better remnant liver regeneration in the donor at 2 months. Liver Transplantation 24 888-896 2018 AASLD.</p>

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2018

Journal Article

A. Kievit, Tessadori, F., Douben, H., Jordens, I., Maurice, M., Hoogeboom, J., Hennekam, R., Nampoothiri, S., Kayserili, H., Castori, M., Whiteford, M., Motter, C., Melver, C., Cunningham, M., Hing, A., Kokitsu-Nakata, N. M., Vendramini-Pittoli, S., Richieri-Costa, A., Baas, A. F., Breugem, C. C., Duran, K., Massink, M., Derksen, P. W. B., van IJcken, W. F. J., van Unen, L., Santos-Simarro, F., Lapunzina, P., Lopes, V. L. Gil-da S., Lustosa-Mendes, E., Krall, M., Slavotinek, A., Martinez-Glez, V., Bakkers, J., van Gassen, K. L. I., de Klein, A., van den Boogaard, M. - J. H., and van Haaften, G., “Variants in members of the cadherin-catenin complex, CDH1 and CTNND1, cause blepharocheilodontic syndrome.”, Eur J Hum Genet, vol. 26, no. 2, pp. 210-219, 2018.[Abstract]


<p>Blepharocheilodontic syndrome (BCDS) consists of lagophthalmia, ectropion of the lower eyelids, distichiasis, euryblepharon, cleft lip/palate and dental anomalies and has autosomal dominant inheritance with variable expression. We identified heterozygous variants in two genes of the cadherin-catenin complex, CDH1, encoding E-cadherin, and CTNND1, encoding p120 catenin delta1 in 15 of 17 BCDS index patients, as was recently described in a different publication. CDH1 plays an essential role in epithelial cell adherence; CTNND1 binds to CDH1 and controls the stability of the complex. Functional experiments in zebrafish and human cells showed that the CDH1 variants impair the cell adhesion function of the cadherin-catenin complex in a dominant-negative manner. Variants in CDH1 have been linked to familial hereditary diffuse gastric cancer and invasive lobular breast cancer; however, no cases of gastric or breast cancer have been reported in our BCDS cases. Functional experiments reported here indicated the BCDS variants comprise a distinct class of CDH1 variants. Altogether, we identified the genetic cause of BCDS enabling DNA diagnostics and counseling, in addition we describe a novel class of dominant negative CDH1 variants.</p>

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2018

Journal Article

R. V. Nair, S, S., Suresh, A., R, A. K., and Nair, S. C., “Sustained release timolol maleate loaded ocusert based on biopolymer composite.”, Int J Biol Macromol, vol. 110, pp. 308-317, 2018.[Abstract]


<p>In the present investigation, the effect of timolol maleate loaded ocuserts was studied as an alternative for conventional anti-glaucoma formulation. Ocuserts were prepared using natural polymer sodium alginate and ethyl cellulose. Physico-chemical properties along with drug entrapment efficiency (94-98%), content uniformity (93.1% ± 0.264-98.00% ± 0.321), in vitro drug release (83.42% ± 0.35 at end of 12 h), ex vivo permeation all showed satisfactory results, which was found to follow zero order kinetics. Ex vivo permeation studies showed better results, revealed that the permeability coefficient was dependent on polymer type. The sterility test accelerated stability studies and in vivo studies such as eye irritancy test, in vivo drug release of the optimized ocusert was determined. The anti-glaucoma activity was measured using Schiotz tonometer at different time interval. Significant reduction in Intra ocular pressure (IOP) within 3 days was observed in case of rabbits treated with ocusert in comparison to the rabbit treated with marketed eye drop formulation. Hence timolol maleate loaded ocuserts proved to be a promising and viable alternative over conventional eye formulation for the sustained and controlled ophthalmic drug delivery, targeting the drug within the ocular globe thus improving patient compliance for the treatment of glaucoma.</p>

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2018

Journal Article

A. Vijay Balegadde, Vijan, V., Thachathodiyl, R., and Kappanayil, M., “A case of asymptomatic large aortopulmonary window in an adult: Role of cardiac CT, CMRI, and 3D printing technology.”, Anatol J Cardiol, vol. 19, no. 1, pp. 72-74, 2018.

2018

Journal Article

K. Viswanathan, Rakesh, P. S., Balakrishnan, S., Shanavas, A., and Dharman, V., “Prevalence of chronic respiratory diseases from a rural area in Kerala, southern India.”, Indian J Tuberc, vol. 65, no. 1, pp. 48-51, 2018.[Abstract]


BACKGROUND: Chronic lung diseases are one of the leading causes of morbidity in developing countries. A community based survey was undertaken with an objective to estimate the prevalence of chronic respiratory diseases and to describe the profile of people with CRDs in the rural area Nilamel health block in Kollam district, Kerala, southern India.

METHODS: A household information sheet and a translated respiratory symptom questionnaire based on International Union against Tuberculosis and Lung Disease (IUATLD) bronchial symptoms questionnaire was administered to 12,556 people above 15 years, selected randomly from Nilamel health block.

RESULTS: Prevalence of self reported asthma was 2.82% (95% CI 2.52-3.12) and that of chronic bronchitis was 6.19% (95% CI 5.76-6.62) while other CRDs which did not fit to either constitute 1.89%. Prevalence of asthma among males was 2.44% (95% CI 2.05-2.85) while that of females was 3.14% (95% CI 2.71-3.57). Chronic bronchitis prevalence was 6.73% and 5.67% among males and females respectively.

CONCLUSION: Although India has devised a programme to combat cancer, diabetes, cardio vascular disease and stroke, none have been devised for chronic respiratory illness till date. Considering high prevalence and its contributions to morbidity and mortality, a comprehensive programme to tackle chronic respiratory diseases is needed.

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2018

Journal Article

S. C. Mellinghoff, Hoenigl, M., Koehler, P., Kumar, A., Lagrou, K., Lass-Flörl, C., Meis, J. F., Menon, V., Rautemaa-Richardson, R., and Cornely, O. A., “EQUAL Candida Score: An ECMM score derived from current guidelines to measure QUAlity of Clinical Candidaemia Management.”, Mycoses, vol. 61, no. 5, pp. 326-330, 2018.[Abstract]


<p>Candida species frequently cause blood stream infections and are reported to be the third to tenth most commonly isolated pathogens. Guidelines and standardised treatment algorithms provided by professional organisations aim to facilitate decision-making regarding diagnosis, management and treatment of candidaemia. In routine clinical practise, however, it may be challenging to comply with these guidelines. The reasons include lack of familiarity or feasibility to adherence, but also their length and complexity. There is no tool to measure guideline adherence currently. To provide such a tool, we reviewed the current guidelines provided by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and by the Infectious Diseases Society of America (IDSA), and selected the strongest recommendations for management quality as the bases for our scoring tool. Factors incorporated were diagnostic (blood cultures, echocardiography, ophthalmoscopy, species identification) and follow-up procedures (repeat blood cultures until negative result) as well as key treatment parameters (echinocandin treatment, step down to fluconazole depending on susceptibility result, CVC removal). The EQUAL Candida Score weighs and aggregates factors recommended for the ideal management of candidaemia and provides a tool for antifungal stewardship as well as for measuring guideline adherence.</p>

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2018

Journal Article

A. Chowdhary, Prakash, A., Sharma, C., Kordalewska, M., Kumar, A., Sarma, S., Tarai, B., Singh, A., Upadhyaya, G., Upadhyay, S., Yadav, P., Singh, P. K., Khillan, V., Sachdeva, N., Perlin, D. S., and Meis, J. F., “A multicentre study of antifungal susceptibility patterns among 350 Candida auris isolates (2009-17) in India: role of the ERG11 and FKS1 genes in azole and echinocandin resistance.”, J Antimicrob Chemother, vol. 73, no. 4, pp. 891-899, 2018.[Abstract]


<p><b>Background: </b>Candida auris has emerged globally as an MDR nosocomial pathogen in ICU patients.</p><p><b>Objectives: </b>We studied the antifungal susceptibility of C. auris isolates (n = 350) from 10 hospitals in India collected over a period of 8 years. To investigate azole resistance, ERG11 gene sequencing and expression profiling was conducted. In addition, echinocandin resistance linked to mutations in the C. auris FKS1 gene was analysed.</p><p><b>Methods: </b>CLSI antifungal susceptibility testing of six azoles, amphotericin B, three echinocandins, terbinafine, 5-flucytosine and nystatin was conducted. Screening for amino acid substitutions in ERG11 and FKS1 was performed.</p><p><b>Results: </b>Overall, 90% of C. auris were fluconazole resistant (MICs 32 to ≥64 mg/L) and 2% and 8% were resistant to echinocandins (≥8 mg/L) and amphotericin B (≥2 mg/L), respectively. ERG11 sequences of C. auris exhibited amino acid substitutions Y132 and K143 in 77% (n = 34/44) of strains that were fluconazole resistant whereas WT genotypes, i.e. without substitutions at these positions, were observed in isolates with low fluconazole MICs (1-2 mg/L) suggesting that these substitutions confer a phenotype of resistance to fluconazole similar to that described for Candida albicans. No significant expression of ERG11 was observed, although expression was inducible in vitro with fluconazole exposure. Echinocandin resistance was linked to a novel mutation S639F in FKS1 hot spot region I.</p><p><b>Conclusions: </b>Overall, 25% and 13% of isolates were MDR and multi-azole resistant, respectively. The most common resistance combination was azoles and 5-flucytosine in 14% followed by azoles and amphotericin B in 7% and azoles and echinocandins in 2% of isolates.</p>

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2018

Journal Article

A. Beyens, Albuisson, J., Boel, A., Al-Essa, M., Al-Manea, W., Bonnet, D., Bostan, O., Boute, O., Busa, T., Canham, N., Cil, E., Coucke, P. J., Cousin, M. A., Dasouki, M., De Backer, J., De Paepe, A., De Schepper, S., de Silva, D., Devriendt, K., De Wandele, I., Deyle, D. R., Dietz, H., Dupuis-Girod, S., Fontenot, E., Fischer-Zirnsak, B., Gezdirici, A., Ghoumid, J., Giuliano, F., Diéz, N. Baena, Haider, M. Z., Hardin, J. S., Jeunemaitre, X., Klee, E. W., Kornak, U., Landecho, M. F., Legrand, A., Loeys, B., Lyonnet, S., Michael, H., Moceri, P., Mohammed, S., Muiño-Mosquera, L., Nampoothiri, S., Pichler, K., Prescott, K., Rajeb, A., Ramos-Arroyo, M., Rossi, M., Salih, M., Seidahmed, M. Z., Schaefer, E., Steichen-Gersdorf, E., Temel, S., Uysal, F., Vanhomwegen, M., Van Laer, L., Van Maldergem, L., Warner, D., Willaert, A., Collins, T. R., Taylor, A., Davis, E. C., Zarate, Y., and Callewaert, B., “Arterial tortuosity syndrome: 40 new families and literature review.”, Genet Med, vol. 20, no. 10, pp. 1236-1245, 2018.[Abstract]


<p><b>PURPOSE: </b>We delineate the clinical spectrum and describe the histology in arterial tortuosity syndrome (ATS), a rare connective tissue disorder characterized by tortuosity of the large and medium-sized arteries, caused by mutations in SLC2A10.</p><p><b>METHODS: </b>We retrospectively characterized 40 novel ATS families (50 patients) and reviewed the 52 previously reported patients. We performed histology and electron microscopy (EM) on skin and vascular biopsies and evaluated TGF-β signaling with immunohistochemistry for pSMAD2 and CTGF.</p><p><b>RESULTS: </b>Stenoses, tortuosity, and aneurysm formation are widespread occurrences. Severe but rare vascular complications include early and aggressive aortic root aneurysms, neonatal intracranial bleeding, ischemic stroke, and gastric perforation. Thus far, no reports unequivocally document vascular dissections or ruptures. Of note, diaphragmatic hernia and infant respiratory distress syndrome (IRDS) are frequently observed. Skin and vascular biopsies show fragmented elastic fibers (EF) and increased collagen deposition. EM of skin EF shows a fragmented elastin core and a peripheral mantle of microfibrils of random directionality. Skin and end-stage diseased vascular tissue do not indicate increased TGF-β signaling.</p><p><b>CONCLUSION: </b>Our findings warrant attention for IRDS and diaphragmatic hernia, close monitoring of the aortic root early in life, and extensive vascular imaging afterwards. EM on skin biopsies shows disease-specific abnormalities.</p>

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2018

Journal Article

V. P. Menon, Prasanna, P., Edathadathil, F., Balachandran, S., Moni, M., Sathyapalan, D., Pai, R. D., and Singh, S., “A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience.”, Qual Manag Health Care, vol. 27, no. 1, pp. 39-49, 2018.[Abstract]


<p><b>QUALITY PROBLEM OR ISSUE: </b>To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization.</p><p><b>INITIAL ASSESSMENT: </b>Frequently observed critical clinical signs and laboratory values of "out-of-ICU" crashes were used to develop Amrita Early Warning Criteria.</p><p><b>CHOICE OF SOLUTION: </b>A physician-led MET was established to respond to code MET, activated by a primary nurse.</p><p><b>IMPLEMENTATION: </b>Rates of "out-of-ICU" cardiopulmonary arrests per 1000 admissions were compared in pre-MET (2013-2014) and post-MET periods (2014-2016) along with disposition following MET and mortality. Descriptive statistics and logistic regression were used for comparative analysis.</p><p><b>EVALUATION: </b>For continued quality improvement, a Likert agreement scale questionnaire collated the nurse's feedback on MET. 386 Code MET were recorded with an activation rate of 18.8 per 1000 inpatients for 2014-2016. Common MET triggers were desaturation (53%), seizure (10%), and syncope (9%). Seventy-one percent of activations were attended within 5 minutes, with 45% reported during nurse's night shift hours. Medical emergency team interventions resulted in 59% being shifted to ICU. In the "post-MET" period, "Cold Blue" dose reduced from 6.9 in 2013-2014 to 2.6 (P = .0002) in 2014-2015 and 3.2 (P = .01) in 2015-2016. Ninety-three percent of the Code Blues with prior MET calls were "delayed MET" and 28% of the Code Blues without prior MET activation were "missed MET." Nurse's feedback revealed that 46% lacked knowledge of correct MET activation process while 31% expressed a fear of reprisal for inappropriate activation.</p><p><b>LESSONS LEARNED: </b>Although MET intervention was successful in significantly reducing "out-of-ICU" Code Blues, focused training of nurses is required for continued quality improvement.</p>

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2018

Journal Article

S. P. Murthy, Thankappan, K., Jayasankaran, S. Chirukanda, Milind, K., Prasad, C., Balasubramanian, D., and Iyer, S., “"Deep Extrinsic Muscle Involvement" Is a Fallacy in the American Joint Committee on Cancer's Seventh Edition of Tumor Staging of Oral Cavity Cancers.”, J Oral Maxillofac Surg, vol. 76, no. 1, pp. 206-212, 2018.[Abstract]


PURPOSE: The seventh edition of tumor staging by the American Joint Committee on Cancer (AJCC) includes extrinsic muscle involvement to define stage T4a tongue carcinomas. The anatomic location of extrinsic muscles predisposes them to early involvement even in superficial tumors. The purpose of this study was to expose a fallacy in this staging system for extrinsic muscle involvement.

MATERIALS AND METHODS: This was a prospective cohort study of 87 patients with oral tongue squamous cell carcinoma. Magnetic resonance imaging (MRI) parameters were 1) the distance of the extrinsic muscles from the surface measured on the normal side in millimeters (range, mean, and standard deviation); 2) maximum transverse, craniocaudal, and anteroposterior tumor dimensions (range, mean, and standard deviation); and 3) tumor involvement of the muscles recorded on the involved side for the number and percentage of each muscle involved. Histopathologic depth of invasion also was recorded.

RESULTS: Sixty-seven patients were men and 20 were women (age range, 18 to 74 yr; mean age, 51 yr). The mean distances of the most superficial part of the muscle to the normal surface at MRI for the genioglossus (anteroventral), hyoglossus, and styloglossus were 3.98, 2.13 and 0.66 mm, respectively. The patterns of extrinsic muscle involvement showed hyoglossus, styloglossus, and genioglossus involvement in 79 (90.8%), 58 (66.76%), and 31 (35.6%), respectively. In patients with a pathologic depth of invasion shallower than 10 mm, involvement of the hyoglossus, styloglossus, and genioglossus was seen in 80, 35, and 15%, respectively.

CONCLUSION: The extrinsic muscles of the tongue are not deep. Even superficial thin tumors can involve these muscles. The eighth edition of tumor staging by the AJCC, which includes tumor thickness in the staging system, is in the process of being implemented. The present study justifies the removal of extrinsic muscle involvement in defining stage T4 of the oral cavity.

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2018

Journal Article

W. O. Tatum, Rubboli, G., Kaplan, P. W., Mirsatari, S. M., Radhakrishnan, K., Gloss, D., Caboclo, L. O., Drislane, F. W., Koutroumanidis, M., Schomer, D. L., D Trenite, K. - N., Cook, M., and Beniczky, S., “Clinical utility of EEG in diagnosing and monitoring epilepsy in adults.”, Clin Neurophysiol, vol. 129, no. 5, pp. 1056-1082, 2018.[Abstract]


Electroencephalography (EEG) remains an essential diagnostic tool for people with epilepsy (PWE). The International Federation of Clinical Neurophysiology produces new guidelines as an educational service for clinicians to address gaps in knowledge in clinical neurophysiology. The current guideline was prepared in response to gaps present in epilepsy-related neurophysiological assessment and is not intended to replace sound clinical judgement in the care of PWE. Furthermore, addressing specific pathophysiological conditions of the brain that produce epilepsy is of primary importance though is beyond the scope of this guideline. Instead, our goal is to summarize the scientific evidence for the utility of EEG when diagnosing and monitoring PWE.

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2018

Journal Article

K. Vizhi, Rao, H. B., and Venu, R. P., “Percutaneous endoscopic gastrostomy site infections-Incidence and risk factors.”, Indian J Gastroenterol, vol. 37, no. 2, pp. 103-107, 2018.[Abstract]


<p><b>BACKGROUND: </b>Percutaneous endoscopic gastrostomy (PEG) placement is the modality of choice for long-term enteral nutrition in view of technical ease and cost-effectiveness. Peristomal infection (PI) remains the most common complication following PEG tube placement. The aim of this study was to assess the incidence and risk factors for PI and outline a microbiological profile that can aid in prophylactic and therapeutic strategies.</p><p><b>METHODS: </b>A retrospective study of 781 patients who underwent PEG placement (Cook PEG-Pull-S-20Fr/24Fr) from 2010 to 2015 at our tertiary care center were included. Relevant data were collected from the hospital electronic medical records. The incidence of PI was computed and potential risk factors were assessed using univariate analysis. The microbiological profile was created along with sensitivity patterns after reviewing the culture reports. Statistical analysis was performed using SPSS version 20.0.</p><p><b>RESULTS: </b>PEG tube placement was performed in 781 patients (mean age 55.9 ± 36.1; M:F = 2:75). The major indication was oropharyngeal malignancies. PI was seen in 171 patients (21.9%). Diabetes mellitus, duration of hospital stay more than 7 days, and hypoalbuminemia were found to be significant risk factors for the development of PI (p < 0.05). Patients who had chemotherapy or radiotherapy before PEG placement had a higher incidence of peristomal infections (p 0.00). Pseudomonas and Klebsiella were the most common organisms causing infection.</p><p><b>CONCLUSIONS: </b>PI remains a significant complication of PEG placement. Pseudomonas and Klebsiella are the most common organisms and prophylactic antibiotic protocols should be tailored accordingly. Elective PEG before the institution of chemotherapy/radiotherapy in patients with oropharyngeal malignancies is recommended.</p>

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2018

Journal Article

S. P. Leeladharan, Jayashankar, J. P., Kottayil, B. P., Kappanayil, M., Raman, K., and Balachandran, R., “Pulmonary Hemorrhage Due to Unrecognized Bronchial Collateral After Arterial Switch Operation.”, Ann Thorac Surg, vol. 105, no. 3, pp. e117-e118, 2018.[Abstract]


<p>We report a neonate with transposition of great arteries and intact ventricular septum who had a massive pulmonary hemorrhage soon after an arterial switch operation. An emergency cardiac catheterization revealed a large bronchial collateral artery from the descending aorta feeding the right lung. The hemorrhage was controlled by coil embolization of the collateral, and the patient recovered after prolonged intensive care.</p>

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2018

Journal Article

G. S. Pillai and Radhakrishnan, N., “Ocular Manifestations of Pediatric Systemic Diseases.”, Indian J Pediatr, vol. 85, no. 3, pp. 217-227, 2018.[Abstract]


<p>Ocular manifestations that occur directly or indirectly as result of a pathologic process that involves other parts of the body, in a pediatric population, will be discussed here. While a myriad number of systemic conditions have ocular manifestations, its importance cannot be undermined because it has implications for both diagnosis and treatment. Often, the eye findings can give a clue to the systemic diagnosis and at other times, not managing the eye manifestations can lead to irreversible blindness although the systemic condition was treated well. So, it is important for all clinicians dealing with pediatric population to be aware of ocular manifestations of the common systemic conditions. The authors discuss the ocular manifestations of the following systemic conditions: Genetic and chromosomal anomalies, phakomatoses, metabolic disorders, infectious diseases, craniofacial anomalies, muscular disorders, inflammatory disorders and miscellaneous.</p>

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2018

Journal Article

V. Puthumana Udayakumar, Surendran, S., and Padma, U. Devi, “Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation.”, Indian J Gastroenterol, vol. 37, no. 1, pp. 39-43, 2018.[Abstract]


<p><b>BACKGROUND: </b>Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy.</p><p><b>METHODS: </b>This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute.</p><p><b>RESULTS: </b>Out of 22 recipients [all males, mean age 45.4 years (range 18-64 years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39 months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10 mIU/mL] recipients, eight were prescribed lamivudine (100 mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8 years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300 mg once daily.</p><p><b>CONCLUSIONS: </b>Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong.</p>

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2018

Journal Article

D. Menon, Menon, R. N., Kesavadas, C., Mahadevan, A., Radhakrishnan, A., Kannoth, S., Nair, P. P., Abraham, M., Thomas, B., and Thomas, S. V., “Clinical-radiological-pathological correlation in an unusual case of refractory epilepsy: a two-year journey of whodunit!”, Epileptic Disord, vol. 20, no. 1, pp. 51-59, 2018.[Abstract]


<p>New-onset refractory focal epilepsy poses significant challenges to the clinician in the absence of specific diagnostic biomarkers. Differential diagnoses based on imaging may be expanded by a veritable spectrum of peri-ictal imaging findings that may mask the underlying substrate. We report a 13-year-old girl who presented with refractory focal seizures of left parieto-occipital origin with cytotoxic gyral oedema noted over the same region on imaging. Despite an initial negative autoantibody profile, the patient was treated with immunosuppression, followed by serial relapses requiring immune-modulation. Over the next year, her syndrome persisted as focal left posterior cortex epilepsy that necessitated occipital lobectomy, following a relapsing-remitting radiological profile, consistent with peri-ictal MRI changes. Histopathology was inconclusive for any definitive substrate. After a period of quiescence, she developed focal motor seizures of right hemispheric origin with progressive encephalopathy, at which point a repeat cerebrospinal fluid anti-N-methyl-D-aspartate receptor antibody profile returned positive. The patient was managed with steroids and rituximab with a good clinical outcome. We hypothesise that persistent or relapsing-remitting focal gyral oedema in unexplained refractory focal epilepsy mandates consideration of focal encephalitis secondary to autoimmunity, and late appearance of intrathecal auto-antibody synthesis correlates with evolution into a more diffuse disease.</p>

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2018

Journal Article

S. P. Murthy, Balasubramanian, D., Subramaniam, N., Nair, G., Babu, M. J. C., Rathod, P. V., Thankappan, K., Iyer, S., Vijayan, S. Nalumackal, Prasad, C., and Nair, V., “Prevalence of adverse pathological features in 1 to 4 cm low-risk differentiated thyroid carcinoma.”, Head Neck, vol. 40, no. 6, pp. 1214-1218, 2018.[Abstract]


<p><b>BACKGROUND: </b>The American Thyroid Association (ATA) recommends thyroid lobectomy for 1 to 4 cm tumors without adverse features. We studied the prevalence of adverse pathological features in patients eligible for unilateral lobectomy.</p><p><b>METHODS: </b>We conducted a retrospective study of patients who underwent total thyroidectomy. Patients with differentiated thyroid cancer (DTC) with tumors measuring 1 to 4 cm with no known preoperative adverse features were included in this study. Patients with nodal and distant metastasis, tumors <1 cm to > 4 cm, age < 17 years old, and gross extrathyroidal extension were excluded. Patients with bilateral nodularity on imaging were excluded from the final analysis on adverse features.</p><p><b>RESULTS: </b>There were 59.1% of patients undergoing thyroidectomy with tumors measuring 1 to 4 cm and no preoperatively known adverse features who were eligible for lobectomy under current ATA guidelines who would have needed a completion thyroidectomy after pathological analysis of the index tumor.</p><p><b>CONCLUSION: </b>Two thirds of the patients may require a completion thyroidectomy if unilateral lobectomy is done in tumors measuring 1 to 4 cm based on adverse pathological features.</p>

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2018

Journal Article

M. Mayadevi, Thankappan, K., Limbachiya, S. Vishnubhai, Vidhyadharan, S., Villegas, B., Ouyoung, M., Balasubramanian, D., Menon, J. R., Sinha, U., and Iyer, S., “Interdisciplinary Telemedicine in the Management of Dysphagia in Head and Neck.”, Dysphagia, vol. 33, no. 4, pp. 474-480, 2018.[Abstract]


<p>The study considered the feasibility and impact of interdisciplinary telemedicine discussions in the management of post-treatment dysphagia in patients with head and neck tumors. This is a retrospective analysis of patients with persistent dysphagia after treatment for head and neck pathology, at an institute in India. The cases were discussed in the telemedicine meeting conducted between host institute and a second unit in the United States. A monthly meeting was organized, using an internet-based video conference system. The ongoing swallowing problems and management were presented, and through discussions, a plan for further management was formulated and carried out. The Functional Oral Intake Scale (FOIS) was measured before and after the implementation of the plan. Twenty-six patients were discussed, out of which, 22 were head and neck malignancies. The recommendations concurred with that of the host unit in 18, differed for three and additive in five patients. The pre-treatment mean FOIS was 1.46 with a standard deviation of 0.989 and post-treatment mean improved to 3.92 with a standard deviation of 1.809 (p < 0.0001). The present study supports the success of an interdisciplinary telemedicine meeting to manage difficult cases of dysphagia in head and neck. The outcome in terms of the FOIS score improved significantly after implementing them. In addition to the direct patient benefits, the meeting helped to facilitate interdepartmental collaboration between two units treating similar sets of patients across the globe, in specialized clinical areas like dysphagia management.</p>

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2018

Journal Article

A. Kurupath and Sureka, P., “A Study on Tobacco Use Among School Children.”, Community Ment Health J, vol. 54, no. 8, pp. 1253-1258, 2018.[Abstract]


<p>Tobacco use among school children is becoming a serious problem. The early age of initiation underscores the urgent need to intervene and protect this vulnerable group from falling prey to this addiction. The present study was undertaken to assess (i) the prevalence and pattern of tobacco use among school children in India (ii) relation of tobacco use prevalence and pattern with socio-economic status (SES) of student's family. This is a cross sectional 16 months study done in school going Indian students aged ≥ 6 years with sample size of 1460. The prevalence of tobacco use in children from lower SES families was 9.4% compared to 5.7% in children from middle SES families (p = 0.017). Among children who used tobacco, mean age of onset was younger among children from lower SES (9.97 year vs 11.85 year, p = < 0.01) and they were more likely to use smokeless tobacco only (79.1% vs 61.3%, p = .0.006). However there was no significant difference between two groups in factors which motivated them towards first experience of tobacco. Also there was no significant difference between family histories of two groups in terms of tobacco use. The high prevalence of tobacco consumption, especially smokeless tobacco among children highlights the need for early intervention like regular screening at school level. Also tobacco use cases need to be followed up with intensive treatment.</p>

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2018

Journal Article

G. S. Pillai and Radhakrishnan, N., “Ocular Manifestations of Pediatric Systemic Diseases”, Indian Journal of Pediatrics, vol. 85, pp. 217-227, 2018.[Abstract]


Ocular manifestations that occur directly or indirectly as result of a pathologic process that involves other parts of the body, in a pediatric population, will be discussed here. While a myriad number of systemic conditions have ocular manifestations, its importance cannot be undermined because it has implications for both diagnosis and treatment. Often, the eye findings can give a clue to the systemic diagnosis and at other times, not managing the eye manifestations can lead to irreversible blindness although the systemic condition was treated well. So, it is important for all clinicians dealing with pediatric population to be aware of ocular manifestations of the common systemic conditions. The authors discuss the ocular manifestations of the following systemic conditions: Genetic and chromosomal anomalies, phakomatoses, metabolic disorders, infectious diseases, craniofacial anomalies, muscular disorders, inflammatory disorders and miscellaneous. © 2018, Dr. K C Chaudhuri Foundation.

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2018

Journal Article

V. P. Udayakumar, S. Surendran, and Padma, U. D., “Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation”, Indian Journal of Gastroenterology, pp. 1-5, 2018.[Abstract]


Background: Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy. Methods: This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute. Results: Out of 22 recipients [all males, mean age 45.4 years (range 18–64 years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39 months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10 mIU/mL] recipients, eight were prescribed lamivudine (100 mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8 years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300 mg once daily. Conclusions: Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong. © 2018 Indian Society of Gastroenterology

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2018

Journal Article

R. A. Joy, Vikkath, N., and Ariyannur, P. S., “Metabolism and mechanisms of action of hyaluronan in human biology”, Drug Metabolism and Personalized Therapy, vol. 33, pp. 15-32, 2018.[Abstract]


Hyaluronan is a ubiquitous high-molecular weight polymer of repeated disaccharides of glucuronic acid and N-acetylglucosamine. It is a membrane-bound, viscous material extruded into the extracellular matrix after being synthesized in the cytoplasm by hyaluronan synthases complex and a regulated degradation by a group of enzymes called hyaluronidases. Hyaluronan has varied biological roles on many vital organismal functions, such as cellular and tissue development, migration and repair after injury or inflammation and cancer genesis. Hyaluronan in the tissue microenvironment is regulated by its concentration as well as the chain length of the polysaccharide. Many functions of hyaluronan are mediated by specific receptors at the cellular level, though its general physiochemical properties facilitate and coordinate many organ functions as well as in development. These fundamental characteristics of hyaluronan are reviewed, focusing on human biological context. © 2018 Walter de Gruyter GmbH, Berlin/Boston. More »»

2018

Journal Article

N. Subramaniam, Deepak Balasubramanian, Low, T. - H., Murthy, S., Clark, J. R., Thankappan, K., and Dr. Subramania Iyer K., “Factors Affecting Survival in Surgically Salvaged Locoregional Recurrences of Squamous Cell Carcinoma of the Tongue”, Journal of Oral and Maxillofacial Surgery, 2018.[Abstract]


Purpose: To determine the factors affecting outcomes in surgically salvaged, locoregionally recurrent squamous cell carcinoma of the tongue (SCCT). Materials and Methods: In a retrospective cohort of patients who underwent successful salvage of locoregionally recurrent SCCT, we performed this observational analytical study to determine survival and its determinants. Details extracted from our database were patient characteristics (age, gender, tobacco use), treatment characteristics, and characteristics of recurrent disease (stage and adverse pathologic features [APFs] such as grade, perineural invasion, and lymphovascular invasion). Overall survival (OS) curves were plotted using the Kaplan-Meier method. A Cox proportional hazards model was used to determine the impact of patient, disease, and treatment characteristics on OS. Results: Of 52 patients with locoregional recurrences of surgically treated SCCT, 25 (48.1%) underwent surgical salvage with curative intent. The median overall OS for this cohort was 26 months. Factors predictive of worse OS were previous adjuvant therapy (P = .016) and increasing APFs in recurrent tumor histology (P = .008). Lymphovascular invasion in recurrent tumor histology and patients with a disease-free interval of less than 6 months showed worse survival (P = .008 and P = .058, respectively). Conclusions: Among patients with locoregional recurrence, the number who are eligible for curative-intent surgical salvage is small. Those who received previous adjuvant therapy and those with increasing APFs in recurrent tumors had poor outcomes despite attempts at surgical salvage, particularly patients with early recurrence. © 2018 American Association of Oral and Maxillofacial Surgeons.

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2018

Journal Article

A. James, Vincent, B., Sivadas, A., and Pavithran, K., “A study on the clinical outcome of abiraterone acetate in castration resistant prostate cancer patients”, International Journal of Hematology-Oncology and Stem Cell Research, vol. 12, pp. 4-7, 2018.[Abstract]


Background: Abiraterone acetate was approved by FDA and EMA in April and September 2011, respectively for treatment of patients with casteration resistant prostate cancer and those previously treated with docetaxel. It is a selective inhibitor of androgen biosynthesis which potentially and irreversibly blocks CYP17, a crucial enzyme in oestrogen and testosterone synthesis. Materials and Methods: This retrospective study was conducted to evaluate the safety and efficacy of abiraterone acetate in the treatment of castration resistant prostate cancer patients. Twenty-two male patients diagnosed with CRPC and experienced treatment failure with one or more lines of treatment (hormonal manipulation or chemotherapy) were selected and administered abiraterone acetate (1,000 mg daily) along with prednisone (5 mg twice daily). Results: Out of 22 patients, 32% had a good response in reduction of PSA values, while 22% had progression in disease and 45% had a stable disease. Potassium, Haemoglobin, and serum sreatinine levels were not affected by the drug. Due to severe GI intolerance, the drug had to be stopped for one patient. The results of this study showed that abiraterone acetate significantly lowered the PSA values and prolonged progression-free survival in metastatic castration resistant prostate cancer patients who had progressed after first-line or second-line treatment. The overall average median survival and the median duration of drug exposure for CRPC who received AA was found to be 11.1 months [range 3−18]. Since AA plus prednisolone are available as oral dosage forms, they can be given in outpatient setting. Conclusion: Abiraterone acetate is a drug of choice for CRPC and also for those who had previously received one or two chemotherapy regimens. Since it is a new therapeutic regimen, this study included small sample size, but there are a few studies indicating the therapeutic efficacy of AA among patients with castration-resistant prostate cancer. © 2018, Tehran University of Medical Sciences (TUMS). All rights reserved.

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2018

Journal Article

J. M. Joshua, Salima, K. D., Pavithran, K., and Vijayan, M., “Crizotinib, an effective agent in ROS1-rearranged adenocarcinoma of lungs: A case report”, Clinical Medicine Insights: Case Reports, vol. 11, pp. 1-3, 2018.[Abstract]


Introduction: ROS1 rearrangement has recently emerged as a new molecular subtype in non–small-cell lung cancer (NSCLC) and is predominantly found in lung adenocarcinoma compared with other oncogenes such as EGFR, KRAS, or ALK. It has been identified in only 1% to 2% of NSCLC cases. Case report: We report a case of 52-year-old man (nonsmoker) with a medical history of allergic rhinitis and bronchial asthma. Histopathologic examination of bronchoscopic-guided biopsy showed adenocarcinoma histology on September 2015. After 2 months, he developed left-sided pneumonia for which he was treated with multiple intravenous antibiotics. In the meantime, fiberoptic bronchoscopy was done which revealed purulent secretion from right upper lobe and narrowed opening of right middle lobe. His cancer symptoms got worsened and bronchial biopsy showed EGFR mutation negative. For further diagnosis, fluorescent in situ hybridization test was done which showed ROS1 mutation positive. By then, the patient was started with crizotinib 250 mg twice daily for ROS1 mutation in July 2016. Later, patient appears to benefit from treatment with crizotinib. X-ray report and positron emission tomographic-computed tomographic scan revealed that the patient was overall better with clear chest and well tolerated with the therapy. Crizotinib was approved on March 11, 2016 by Food and Drug Administration for the treatment of patients with ROS1-positive NSCLC. Conclusions: In this report, crizotinib showed marked antitumor activity in patients with advanced ROS1 rearrangement, a third molecular subgroup of NSCLC. © The Author(s) 2018.

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2018

Journal Article

S. Salian, Shukla, A., Shah, H., Bhat, S. N., Bhat, V. R., Nampoothiri, S., Shenoy, R., Phadke, S. R., Hariharan, S. V., and Girisha, K. M., “Seven additional families with spondylocarpotarsal synostosis syndrome with novel biallelic deleterious variants in FLNB.”, Clin Genet, vol. 94, no. 1, pp. 159-164, 2018.[Abstract]


<p>The location and/or type of variants in FLNB result in a spectrum of osteochondrodysplasias ranging from mild forms, like spondylocarpotarsal synostosis syndrome and Larsen syndrome, to severe perinatal lethal forms, such as atelosteogenesis I and III and Boomerang dysplasia. Spondylocarpotarsal synostosis syndrome is characterized by disproportionate short stature, vertebral anomalies and fusion of carpal and tarsal bones. Biallelic loss-of-function variants in FLNB are known to cause spondylocarpotarsal synostosis syndrome and 9 families and 9 pathogenic variants have been reported so far. We report clinical features of 10 additional patients from 7 families with spondylocarpotarsal synostosis syndrome due to 7 novel deleterious variants in FLNB, thus expanding the clinical and molecular repertoire of spondylocarpotarsal synostosis syndrome. Our report validates key clinical (fused thoracic vertebrae and carpal and tarsal coalition) and molecular (truncating variants in FLNB) characteristics of this condition.</p>

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2018

Journal Article

S. P. Murthy, Balasubramanian, D., Anand, A., Limbachiya, S. Vishnubhai, Subramaniam, N., Nair, V., Thankappan, K., and Iyer, S., “Extent of Thyroidectomy in Differentiated Thyroid Cancers-Review of Evidence.”, Indian J Surg Oncol, vol. 9, no. 1, pp. 90-96, 2018.[Abstract]


<p>Differentiated thyroid cancers (DTC) are seen with increasing incidence in clinical practice. These tumours have good prognosis and the extent of surgery can be tailored to the size and pathological characteristics of the lesion. Historically total thyroidectomy was the recommended procedure for tumours >1 cm; however, current recommendations suggest a more conservative approach. This review focuses on the evolution of the extent of surgery in differentiated thyroid cancer.</p>

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2018

Journal Article

A. Rajanbabu and Agarwal, R., “A prospective evaluation of the sentinel node mapping algorithm in endometrial cancer and correlation of its performance against endometrial cancer risk subtypes.”, Eur J Obstet Gynecol Reprod Biol, vol. 224, pp. 77-80, 2018.[Abstract]


<p><b>OBJECTIVE: </b>Sentinel node mapping is emerging as the alternative to lymphadenectomy in endometrial cancer. The objective of our study is to validate of the sentinel node mapping surgical algorithm and also to compare the performance of the algorithm against endometrial cancer risk subtypes DESIGN: This is a prospective interventional study carried out at a Single University teaching hospital. All patients with apparent early stage endometrial cancer who underwent robotic assisted surgical staging were included. Intracervical injection of Indocyanine Green dye and sentinel node identification and biopsy was done for all study patients. The node positive rate when using SLN mapping alone versus SLN mapping algorithm were compared. The node positivity was compared against various risk subtypes of endometrial cancer.</p><p><b>RESULTS: </b>69 patients were included in the study. In 95.7% patients SLN was detected with a bilateral detection rate of 87.9%. 10 patients had nodal positivity, among which 7 were identified by SLN mapping alone. The algorithm captured all 10 patients with positive LNs, yielding a node positivity rate of 14.9%, sensitivity and NPV of 100%. For SLN mapping alone the sensitivity was 77.8%, false negative rate (FNR) 22.2%, and NPV 96.6%. In low- and intermediate-risk subtypes SLN mapping as well as algorithm identified all node positive patients, but in high-risk endometrial cancers the SLN mapping technique alone had a sensitivity of 57.1% and false-negative rate of 42.9% when compared with 100% sensitivity for the SLN mapping algorithm.</p><p><b>CONCLUSIONS: </b>When doing SLN mapping and biopsy during endometrial cancer staging surgery it is essential that the steps mentioned in the SLN mapping algorithm are followed as SLN mapping alone seems to have a limitation in detecting positive nodes especially in high risk subtypes of endometrial cancer. Even with the lack of survival data, based on the performance of SLN mapping surgical algorithm (even if ultrastaging facility is not available), it seems to be a better technique in detecting metastatic nodes, giving prognostic information, and enabling accurate adjuvant treatment.</p>

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2018

Journal Article

A. Anilkumar, Vasudevan, D. M., Kappanayil, M., Sundaram, K. R., R Kumar, K., and Nampoothiri, S., “Platelet parameters in children with chromosome 22q11 deletion and conotruncal heart defects.”, Congenit Heart Dis, vol. 13, no. 3, pp. 483-487, 2018.[Abstract]


<p><b>BACKGROUND AND OBJECTIVES: </b>The 22q11 deletion syndrome is associated with a wide spectrum of phenotypic features, hence clinical diagnosis is difficult. Individuals with this syndrome are found to have a risk of developing transfusion associated graft-versus-host reaction, if they are given nonirradiated blood. Our aim was to elucidate whether chromosome 22q11 deletion in children with syndromic conotruncal heart defects is associated with platelet abnormality.</p><p><b>MATERIALS AND METHODS: </b>The genetic analysis was performed by standard cytogenetic and Fluorescence in situ hybridization technique. The platelet parameters in 39 patients with chromosome 22q11 deletion were compared with 154 cases without deletion.</p><p><b>RESULTS: </b>In deletion versus no deletion group, the mean of mean platelet volume (MPV) was 10.5 ± 2.5 vs 7.6 ± 1.5 fL, platelet count was 225 ± 80.7 and 339 ± 127.3 × 10 /L and frequency of high MPV was 49% vs 7% (P < .0001). The MPV was associated with a sensitivity of 90.9% and a specificity of 79.6% at a cutoff value of 8.32 fL, (area under the ROC curve 91%). A nonsignificant negative correlation was found between MPV and platelet count (r = -0.152; P = .361) in children with deletion.</p><p><b>CONCLUSION: </b>A cutoff value of 8.32 fL for MPV can be an indicator of high risk of chromosome 22q11 deletion in individuals with syndromic conotruncal defects. Individuals with chromosome 22q11 deletion should be given irradiated blood especially during cardiac surgery. Further investigation should clarify the etiology behind variation in frequency of high MPV in different conotruncal lesions.</p>

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2018

Journal Article

B. Vaidyanathan, Vijayaraghavan, A., Karmagaraj, B., and Kottayil, B., “Prenatal Diagnosis of Distal Aortopulmonary Window With Type A Aortic Arch Interruption With 4-Dimensional Spatiotemporal Image Correlation Rendering.”, Circ Cardiovasc Imaging, vol. 11, no. 5, p. e007721, 2018.

2018

Journal Article

M. Mon Oo, Gandhi, H. Ramesh, Chong, K. - T., Goh, J. - Q., Ng, K. - W., Hein, A. - T., and Tan, Y. K., “Automated Needle Targeting with X-ray (ANT-X) - Robot-assisted device for percutaneous nephrolithotomy (PCNL) with its first successful use in human.”, J Endourol, 2018.[Abstract]


INTRODUCTION: To make percutaneous access easier in PCNL, we developed Automated Needle Targeting with X-ray (ANT-X) Method: ANT-X uses an image registration software with a closed loop feedback system to autoalign the puncture needle to the desired calyx using the bullseye technique. We tried percutaneous punctures on a live pig model and compared the results with free-hand technique. We then performed our first PCNL in a human subject with the aid of ANT-X. Our patient was a 48 year-old gentleman with a 1.4cm left lower pole stone.

RESULTS: Initial results for live animal trial showed radiation exposure for robot-assisted arm during puncture was reduced by 26% compared to the free-hand technique (8.2mGy vs 11.2mGy). In the human trial, obtaining percutaneous access was successful at first attempt.

CONCLUSION: ANT-X system can potentially help surgeons feel confident and potentially reduce complications, hence enabling more surgeons to adopt this procedure.

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2018

Journal Article

J. Stephen, Nampoothiri, S., Banerjee, A., Tolman, N. J., Penninger, J. Martin, Elling, U., Agu, C. A., Burke, J. D., Devadathan, K., Kannan, R., Huang, Y., Steinbach, P. J., Martinis, S. A., Gahl, W. A., and Malicdan, M. Christine, “Loss of function mutations in VARS encoding cytoplasmic valyl-tRNA synthetase cause microcephaly, seizures, and progressive cerebral atrophy.”, Hum Genet, vol. 137, no. 4, pp. 293-303, 2018.[Abstract]


<p>Progressive microcephaly and neurodegeneration are genetically heterogenous conditions, largely associated with genes that are essential for the survival of neurons. In this study, we interrogate the genetic etiology of two siblings from a non-consanguineous family with severe early onset of neurological manifestations. Whole exome sequencing identified novel compound heterozygous mutations in VARS that segregated with the proband: a missense (c.3192G>A; p.Met1064Ile) and a splice site mutation (c.1577-2A>G). The VARS gene encodes cytoplasmic valyl-tRNA synthetase (ValRS), an enzyme that is essential during eukaryotic translation. cDNA analysis on patient derived fibroblasts revealed that the splice site acceptor variant allele led to nonsense mediated decay, thus resulting in a null allele. Three-dimensional modeling of ValRS predicts that the missense mutation lies in a highly conserved region and could alter side chain packing, thus affecting tRNA binding or destabilizing the interface between the catalytic and tRNA binding domains. Further quantitation of the expression of VARS showed remarkably reduced levels of mRNA and protein in skin derived fibroblasts. Aminoacylation experiments on patient derived cells showed markedly reduced enzyme activity of ValRS suggesting the mutations to be loss of function. Bi-allelic mutations in cytoplasmic amino acyl tRNA synthetases are well-known for their role in neurodegenerative disorders, yet human disorders associated with VARS mutations have not yet been clinically well characterized. Our study describes the phenotype associated with recessive VARS mutations and further functional delineation of the pathogenicity of novel variants identified, which widens the clinical and genetic spectrum of patients with progressive microcephaly.</p>

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2018

Journal Article

S. S. Palaniswamy, Borde, C. R., and Subramanyam, P., “18F-FDG PET/CT in the evaluation of cancer cervix: Where do we stand today?”, Nucl Med Commun, vol. 39, no. 7, pp. 583-592, 2018.[Abstract]


<p>The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus. The staging procedure is purely clinical (i.e. gynecologic examination under general anesthesia) according to the International Federation of Gynaecology and Obstetrics classification. Earlier, with the nonavailability of sophisticated medical equipment and imaging specialists, oncologists relied heavily on clinical examination. However, anatomical and functional imaging has been proven to be considerably superior in understanding parametrial involvement and nodal/distant metastases in the cancer cervix than clinical examination alone. Data are evolving on the usage of F-FDG PET/CT in initial staging, treatment planning, and monitoring therapy response for gynecological malignancies. Prognostic information derived from the primary lesion such as the maximum standardized uptake value, metabolic tumor volume, and extent of para-aortic nodal metastatic disease plays a critical role in tailoring therapy on the basis of patient tumor-specific factors rather than on International Federation of Gynaecology and Obstetrics stage alone. Thus, F-FDG PET/CT needs to be listed not only under the panel of pretherapy investigations for Ca cervix but also for recurrence and therapy response assessments. It allows a more confident approach to patient management at initial staging, especially in terms of the decision to choose surgical versus palliation measures.</p>

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2018

Journal Article

P. Subramanyam and P Sundaram, S., “Which is Better - A Standalone Ventilation or Perfusion Scan or Combined Imaging to Predict Postoperative FEV in One Seconds in Patients Posted for Lung Surgeries with Borderline Pulmonary Reserve.”, Indian J Nucl Med, vol. 33, no. 2, pp. 105-111, 2018.[Abstract]


<p><b>Introduction: </b>Forced expiratory volume in one second (FEV) is an independent predictor for respiratory morbidity. Reports are varied and controversial substantiating the use of either lung perfusion (Q) or ventilation (V) scintigraphy as a single stage investigation to predict postoperative (ppo) FEV in patients scheduled for lung resection surgeries. It is said that there is no additional benefit by performing both V/Q scan. As per one of the recommendations, no further respiratory function tests are required for a lobectomy if the postbronchodilator FEV is >1.5 l. We wanted to study the ppo FEV in patients with FEV of <1.5 L scheduled for lung surgeries. Being a high-risk population, we wanted to assess (a) whether the ppo changes by this combined V/Q imaging and (b) whether the incidence of respiratory complication in the postoperative setting of this subgroup is different, (c) and study the short- and long-term clinical outcome.</p><p><b>Materials and Methods: </b>Fifty-two high-risk patients (with comorbidities) and borderline preoperative FEV of 1.5 L or less planned for lung resection were enroled in this prospective study. V and Q scans were performed, and tracer uptake percentage was tabulated.</p><p><b>Results: </b>Tracer uptake in each lung was quantitated. Manual method of ROI drawing is preferred in high risk patients with reduced pulmonary reserve over the automatic method. Based on uptake patterns by V/Q scans, 4 different types of patterns were tabulated. Eighty-eight percentage of centrally placed tumors showed the difference in uptake patterns. Chronic obstructive pulmonary disease patients usually showed more modest ventilatory defects (categorised as type 2 or 3). Lung tumours produce erratic uptake patterns (Type 4) which depend heavily on their location and extent. The range of FEV predicted was 0.6-1.38 L/min.</p><p><b>Conclusion: </b>We recommend that combined imaging should be performed in patients with borderline pulmonary reserve to derive the benefit of surgery as it provides a realistic ppo FEV in patients with moderate to severely damaged lung. Centrally placed hilar or bronchial tumors (even those <2 cm in size), produce discrepancies in V/Q distribution pattern. Patient who was thought ineligible for surgery due to low baseline FEV may be actually be operable by this combined imaging if uptake pattern is better in V or Q scan with a good outcome. Accurate estimation of postop FEV in fact helps the surgical team to implement measures to prepare high risk patients to reduce postoperative complications, enable faster weaning from ventilatory support and ensure favourable prognosis.</p>

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2018

Journal Article

M. - L. Vuillaume, Moizard, M. - P., Rossignol, S., Cottereau, E., Vonwill, S., Alessandri, J. - L., Busa, T., Colin, E., Gérard, M., Giuliano, F., Lambert, L., Lefevre, M., Kotecha, U., Nampoothiri, S., Netchine, I., Raynaud, M., Brioude, F., and Toutain, A., “Mutation update for the GPC3 gene involved in Simpson-Golabi-Behmel syndrome and review of the literature.”, Hum Mutat, vol. 39, no. 6, pp. 790-805, 2018.[Abstract]


<p>Simpson-Golabi-Behmel syndrome (SGBS) is an X-linked multiple congenital anomalies and overgrowth syndrome caused by a defect in the glypican-3 gene (GPC3). Until now, GPC3 mutations have been reported in isolated cases or small series and the global genotypic spectrum of these mutations has never been delineated. In this study, we review the 57 previously described GPC3 mutations and significantly expand this mutational spectrum with the description of 29 novel mutations. Compiling our data and those of the literature, we provide an overview of 86 distinct GPC3 mutations identified in 120 unrelated families, ranging from single nucleotide variations to complex genomic rearrangements and dispersed throughout the entire coding region of GPC3. The vast majority of them are deletions or truncating mutations (frameshift, nonsense mutations) predicted to result in a loss-of-function. Missense mutations are rare and the two which were functionally characterized, impaired GPC3 function by preventing GPC3 cleavage and cell surface addressing respectively. This report by describing for the first time the wide mutational spectrum of GPC3 could help clinicians and geneticists in interpreting GPC3 variants identified incidentally by high-throughput sequencing technologies and also reinforces the need for functional validation of non-truncating mutations (missense, in frame mutations, duplications).</p>

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2018

Journal Article

A. Singh, Healey, K. R., Yadav, P., Upadhyaya, G., Sachdeva, N., Sarma, S., Kumar, A., Tarai, B., Perlin, D. S., and Chowdhary, A., “Absence of Azole or Echinocandin Resistance in Candida glabrata Isolates in India despite Background Prevalence of Strains with Defects in the DNA Mismatch Repair Pathway.”, Antimicrob Agents Chemother, vol. 62, no. 6, 2018.[Abstract]


<p> infections are increasing worldwide and exhibit greater rates of antifungal resistance than those with other species. DNA mismatch repair (MMR) gene deletions, such as , in resulting in a mutator phenotype have recently been reported to facilitate rapid acquisition of antifungal resistance. This study determined the antifungal susceptibility profiles of 210 isolates in 10 hospitals in India and investigated the impact of novel polymorphisms on mutation potential. No echinocandin- or azole-resistant strains and no mutations in hot spot regions were detected among the isolates, supporting our susceptibility testing results. CLSI antifungal susceptibility data showed that the MICs of anidulafungin (geometric mean [GM], 0.12 μg/ml) and micafungin (GM, 0.01 μg/ml) were lower and below the susceptibility breakpoint compared to that of caspofungin (CAS) (GM, 1.31 μg/ml). Interestingly, 69% of the strains sequenced contained six nonsynonymous mutations in , i.e., V239L and the novel mutations E459K, R847C, Q386K, T772S, and V239/D946E. Functional analysis of mutations revealed that 49% of the tested strains (40/81) contained a partial loss-of-function mutation. The novel substitution Q386K produced higher frequencies of CAS-resistant colonies upon expression in the mutant. However, expression of two other novel alleles, i.e., E459K or R847C, did not confer selection of resistant colonies, confirming that not all mutations in the MMR pathway affect its function or generate a phenotype of resistance to antifungal drugs. The lack of drug resistance prevented any correlations from being drawn with respect to genotype.</p>

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2018

Journal Article

S. Khan, Kumar, A., Kale, S., Kurkure, N., Nair, iv, G., and Dinesh, K., “Multiple cortical brain abscesses due to Listeria monocytogenes in an immunocompetent patient.”, Trop Doct, vol. 48, no. 2, pp. 160-163, 2018.[Abstract]


<p>Listeria monocytogenes is an intracellular organism which is well recognised for its ability to cause meningeal infections in neonates, immunosuppressed, debilitated and elderly individuals. Other less common central nervous system (CNS) infections caused by Listeria spp. include rhomboencephalitis, cerebritis and abscesses in the brain, brain stem and spinal cord. The neuroradiological appearance of Listeria brain abscesses is similar to other types and may also mimic primary or metastatic brain tumours. We report a case of Listeria brain abscesses in a patient who was being treated for atypical parkinsonism. A good clinical outcome was achieved after appropriate antimicrobial therapy.</p>

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2018

Journal Article

P. Subramanyam and Sundaram, S. P., “Which is Better - A Standalone Ventilation or Perfusion Scan or Combined Imaging to Predict Postoperative FEV1in One Seconds in Patients Posted for Lung Surgeries with Borderline Pulmonary Reserve”, Indian Journal of Nuclear Medicine, vol. 33, pp. 105-111, 2018.[Abstract]


Introduction: Forced expiratory volume in one second (FEV1) is an independent predictor for respiratory morbidity. Reports are varied and controversial substantiating the use of either lung perfusion (Q) or ventilation (V) scintigraphy as a single stage investigation to predict postoperative (ppo) FEV1in patients scheduled for lung resection surgeries. It is said that there is no additional benefit by performing both V/Q scan. As per one of the recommendations, no further respiratory function tests are required for a lobectomy if the postbronchodilator FEV1is >1.5 l. We wanted to study the ppo FEV1in patients with FEV1of <1.5 L scheduled for lung surgeries. Being a high-risk population, we wanted to assess (a) whether the ppo changes by this combined V/Q imaging and (b) whether the incidence of respiratory complication in the postoperative setting of this subgroup is different, (c) and study the short- and long-term clinical outcome. Materials and Methods: Fifty-two high-risk patients (with comorbidities) and borderline preoperative FEV1of 1.5 L or less planned for lung resection were enroled in this prospective study. V and Q scans were performed, and tracer uptake percentage was tabulated. Results: Tracer uptake in each lung was quantitated. Manual method of ROI drawing is preferred in high risk patients with reduced pulmonary reserve over the automatic method. Based on uptake patterns by V/Q scans, 4 different types of patterns were tabulated. Eighty-eight percentage of centrally placed tumors showed the difference in uptake patterns. Chronic obstructive pulmonary disease patients usually showed more modest ventilatory defects (categorised as type 2 or 3). Lung tumours produce erratic uptake patterns (Type 4) which depend heavily on their location and extent. The range of FEV1predicted was 0.6-1.38 L/min Conclusion: We recommend that combined imaging should be performed in patients with borderline pulmonary reserve to derive the benefit of surgery as it provides a realistic ppo FEV1in patients with moderate to severely damaged lung. Centrally placed hilar or bronchial tumors (even those <2 cm in size), produce discrepancies in V/Q distribution pattern. Patient who was thought ineligible for surgery due to low baseline FEV1may be actually be operable by this combined imaging if uptake pattern is better in V or Q scan with a good outcome. Accurate estimation of postop FEV1in fact helps the surgical team to implement measures to prepare high risk patients to reduce postoperative complications, enable faster weaning from ventilatory support and ensure favourable prognosis. © 2018 Indian Journal of Nuclear Medicine | Published by Wolters Kluwer -Medknow.

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2018

Journal Article

S. Khan, Kumar, A., Kale, S., Kurkure, N., Nair, G., and Dinesh, K., “Multiple cortical brain abscesses due to Listeria monocytogenes in an immunocompetent patient”, Tropical Doctor, vol. 48, pp. 160-163, 2018.[Abstract]


Listeria monocytogenes is an intracellular organism which is well recognised for its ability to cause meningeal infections in neonates, immunosuppressed, debilitated and elderly individuals.1 Other less common central nervous system (CNS) infections caused by Listeria spp. include rhomboencephalitis, cerebritis and abscesses in the brain, brain stem and spinal cord. The neuroradiological appearance of Listeria brain abscesses is similar to other types and may also mimic primary or metastatic brain tumours.2,3 We report a case of Listeria brain abscesses in a patient who was being treated for atypical parkinsonism. A good clinical outcome was achieved after appropriate antimicrobial therapy. © 2017, © The Author(s) 2017.

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2018

Journal Article

S. M. Alex, Menon, V. P., Sabarish, B., Umadevi, P., and Dipu, T. S., “Clozapine-induced diabetic ketoacidosis: A case report”, Asian Journal of Pharmaceutical and Clinical Research, vol. 11, pp. 1-2, 2018.[Abstract]


The objective of this study was to report a case of a person with psychiatric illness treated with clozapine presented with diabetic ketoacidosis (DKA). A clinical monitoring was done on a 38-year-old Indian man affected by schizoaffective disorder, bipolar type presented with DKA after 3 months of clozapine therapy (250 mg/day). After treatment of DKA and discontinuation of clozapine, the patient improved symptomatically, his blood sugar levels normalized and insulin requirements also decreased. This report thus highlights that clinicians should be vigilant about the potential risk of new-onset diabetes and DKA in patients taking clozapine and utilize appropriate clinical and laboratory monitoring early in the course of treatment to prevent serious adverse effects. © 2018 The Authors.

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2018

Journal Article

P. Sreelatha and Jose, W. M., “Prolonged remission and good quality of life with maintenance chemotherapy in recurrent ewing’s sarcoma”, Journal of Clinical and Diagnostic Research, vol. 12, pp. XD01-XD03, 2018.[Abstract]


Ewing’s sarcoma is an aggressive tumour of bone commonly affecting individuals in 10-20 years of age group. Older age and metastatic disease has an overall poor outcome. We are reporting a case of a 37-year-old lady with Ewing’s sarcoma who was initially diagnosed with localised disease involving C5-7 vertebral bodies. She received conventional treatment. She relapsed three years later with metastatic disease and was treated with salvage treatment followed by high dose chemotherapy and autologous stem cell transplant. She had a second relapse with lung metastasis after 28 months. She was treated with gemcitabine and docetaxel and she achieved complete remission again. She is on maintenance chemotherapy with cyclophosphamide and etoposide and continues to be in remission on maintenance treatment. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.

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2018

Journal Article

A. A. Mehta and Perathur, A., “Right hilar mass diagnosed by endobronchial ultrasound guided transvascular needle aspiration”, Journal of Clinical and Diagnostic Research, vol. 12, pp. OD16-OD18, 2018.[Abstract]


The Endo Bronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUSTBNA) for diagnosis and staging of benign and malignant thoracic diseases is the standard of care nowadays. The complications associated with it are rare and minor. We report one case of a 47-year-old male, was evaluated by his primary care physician for complaints of cough, chest pain on right side and episodic dyspnea of one month duration. He was a non smoker and chef by occupation. He denied any history of fever, chills, sputum production, wheezing, or haemoptysis. Chest radiograph showed right lower zone mass. Computed tomography (CT) of the chest revealed well defined a 3×4 centimeter tumorous lesion arising from the right middle lobe bronchus. Fiberoptic bronchoscopy was normal. Endobronchial Ultrasound (EBUS) revealed 2.3×3.3 cm hypoechoic lesion at station 12R lying adjacent to a branch of right inferior pulmonary artery. We examined the pulmonary artery segment using color flow Doppler enhancement. It showed no blood flow over the mass. We next deployed the biopsy needle to its full length into the mass, traversing the near and far walls of the pulmonary artery branch in the process. Rapid on site evaluation by a cytopathologist revealed diagnosis of spindle cell neoplasm. In present case, we did EBUSTBNA of a right hilar mass traversing the pulmonary artery. There was no vascular injury in the current procedure and with the small diameter needle and real-time guidance such procedures can be performed safely. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.

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2018

Journal Article

S. Rajan, Joseph, N., Tosh, P., Kadapamannil, D., Paul, J., and Kumar, L., “Effectiveness of transnasal humidified rapid-insufflation ventilatory exchange versus traditional preoxygenation followed by apnoeic oxygenation in delaying desaturation during apnoea: A preliminary study”, Indian Journal of Anaesthesia, vol. 62, pp. 202-207, 2018.[Abstract]


Background and Aims: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during apnoea has shown to delay desaturation. The primary objective was to compare time to desaturate to <90% during apnoea with THRIVE versus traditional preoxygenation followed by apnoeic oxygenation. Methods: This prospective, randomised, single-blinded study was conducted in 10 adult patients presenting for direct laryngoscopy under general anaesthesia without endotracheal intubation. Group P patients were preoxygenated with 100% oxygen, and in Group H, high-flow humidified oxygen was delivered using nasal cannula for 3 min. After induction and neuromuscular blockade, time to desaturate to 90%, while receiving apnoeic oxygenation, was noted. Chi-square test and Mann–Whitney tests were used. Results: Group H had a significantly longer apnoea time as compared to Group P (796.00 ± 43.36 vs. 444.00 ± 52.56 s). All patients in Group H continued to have nearly 100% saturation even at 12 min of apnoea. However, in Group P, 80% of patients desaturated to <90% after 6 min of apnoea. Baseline blood gases, that following preoxygenation and at 3 min of apnoea time were comparable in both groups. At 6 min, Group H had a significantly higher PaO2 (295.20 ± 122.26 vs. 135.00 ± 116.78) and PaCO2 (69.46 ± 7.15 vs. 59.00 ± 4.64). Group H continued to have a PaO2 of >200 mmHg even at 12 min of apnoea with a significant rise in PaCO2 along with fall in pH after 6 min. Conclusion: During apnoeic periods time to desaturate to <90% was significantly prolonged with use of THRIVE. © 2018 Indian Journal of Anaesthesia.

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2018

Journal Article

S. Rajan, Tosh, P., Paul, J., and Kumar, L., “Effect of inhaled budesonide suspension, administered using a metered dose inhaler, on post-operative sore throat, hoarseness of voice and cough”, Indian Journal of Anaesthesia, vol. 62, pp. 66-71, 2018.[Abstract]


Background and Aims: Post-operative sore throat (POST) is often considered an inevitable consequence of tracheal intubation. This study was performed to compare the effect of inhaled budesonide suspension, administered using a metered dose inhaler, on the incidence and severity of POST. Methods: In this prospective randomised study, 46 patients undergoing laparoscopic surgeries lasting <2 h were randomly allotted into two equal groups. Group A received 200 µg budesonide inhalation suspension, using a metered dose inhaler, 10 min before intubation, and repeated 6 h after extubation. No such intervention was performed in Group B. The primary outcome was the incidence and severity of POST. Secondary outocomes included the incidence of post-operative hoarseness and cough. Pearson’s Chi-square test, Fisher’s exact test and Independent sample t-test were used as applicable. Results: Compared to Group B, significantly fewer patients had POST in Group A at 2, 6, 12 and 24 h (P < 0.001). Although more patients in Group B had post-operative hoarseness of voice and cough at all-time points, the difference was statistically significant only at 12 h and 24 h for post-operative hoarseness and at 2 h and 12 h for post-operative cough. Severity as well as the incidence of POST showed downward trends in both groups over time, and by 24 h no patient in Group A had sore throat. Conclusion: Inhaled budesonide suspension is effective in significantly reducing the incidence and severity of POST. © 2018 Indian Journal of Anaesthesia.

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2018

Journal Article

R. Sharon Solomon, Sasi, T., Sudhakar, A., Kumar, R. Krishna, and Vaidyanathan, B., “Early Neurodevelopmental Outcomes After Corrective Cardiac Surgery In Infants.”, Indian Pediatr, vol. 55, 5 vol., no. 5, pp. 400-404, 2018.[Abstract]


<p><b>OBJECTIVE: </b>To assess neurodevelopmental status in Indian infants undergoing corrective surgery for congenital heart disease (CHD) and to analyze factors associated with neurodevelopmental delay.</p><p><b>DESIGN: </b>Cross-sectional study.</p><p><b>SETTING: </b>Tertiary-care pediatric cardiology facility.</p><p><b>PARTICIPANTS: </b>Consecutive infants undergoing corrective surgery for CHD (January 2013 -December 2014). Palliative procedures, and patients with known genetic syndromes were excluded.</p><p><b>MAIN OUTCOME MEASURES: </b>Neurodevelopmental evaluation 3 months, and one year after surgery using Developmental Assessment Scales for Indian Infants (DASII); scores were categorized as delayed if ≤70.</p><p><b>RESULTS: </b>Of the 162 children enrolled, delayed PDI and MDI scores were observed in 33.5% and 19.6% of patients at 3 months, respectively; this reduced to 14.5%on 1-year follow-up. On multivariate analysis, delayed PDI outcome at one year was predicted by early term birth and one-year postoperative head circumference Z-score <-2. Delayed MDI was associated with higher mean perfusion pressure on cardiopulmonary bypass. Cardiac diagnosis and peri-operative factors did not impact neurodevelopmental outcomes.</p><p><b>CONCLUSIONS: </b>Neurodevelopmental status is delayed in 14.5% of infants one year after corrective infant heart surgery.</p>

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2018

Journal Article

N. Vikkath, Ariyannur, P., Krishnakumar N. Menon, Mr, B., and Pillai, A., “Exploring the Role of Defective Fibronectin Matrix Assembly in the VHL-Associated CNS Hemangioblastoma.”, Drug Metab Pers Ther, vol. 33, no. 3, pp. 127-134, 2018.

2018

Journal Article

J. Stephen, Nampoothiri, S., Vinayan, K. P., Dhanya Yesodharan, Remesh, P., Gahl, W. A., and Malicdan, M. Christine, “Cortical atrophy and hypofibrinogenemia due to FGG and TBCD mutations in a single family: a case report.”, BMC Med Genet, vol. 19, no. 1, p. 80, 2018.[Abstract]


<p><b>BACKGROUND: </b>Blended phenotypes or co-occurrence of independent phenotypically distinct conditions are extremely rare and are due to coincidence of multiple pathogenic mutations, especially due to consanguinity. Hereditary fibrinogen deficiencies result from mutations in the genes FGA, FGB, and FGG, encoding the three different polypeptide chains that comprise fibrinogen. Neurodevelopmental abnormalities have not been associated with fibrinogen deficiencies. In this study, we report an unusual patient with a combination of two independently inherited genetic conditions; fibrinogen deficiency and early onset cortical atrophy.</p><p><b>CASE PRESENTATION: </b>The study describes a male child from consanguineous family presented with hypofibrinogenemia, diffuse cortical atrophy, microcephaly, hypertonia and axonal motor neuropathy. Through a combination of homozygosity mapping and exome sequencing, we identified bi-allelic pathogenic mutations in two genes: a homozygous novel truncating mutation in FGG (c.554del; p.Lys185Argfs*14) and a homozygous missense mutation in TBCD (c.1423G > A;p.Ala475Thr). Loss of function mutations in FGG have been associated with fibrinogen deficiency, while the c.1423G > A mutation in TBCD causes a novel syndrome of neurodegeneration and early onset encephalopathy.</p><p><b>CONCLUSIONS: </b>Our study highlights the importance of homozygosity mapping and exome sequencing in molecular prenatal diagnosis, especially when multiple gene mutations are responsible for the phenotype.</p>

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2018

Journal Article

R. George, Menon, V. P., Edathadathil, F., Balachandran, S., Moni, M., Sathyapalan, D., Prasanna, P., S, G., Paul, J., K, C. K., Kumar, L., and Pillai, A., “Myocardial injury after noncardiac surgery-incidence and predictors from a prospective observational cohort study at an Indian tertiary care centre.”, Medicine (Baltimore), vol. 97, no. 19, p. e0402, 2018.[Abstract]


<p>Asymptomatic myocardial injury following noncardiac surgery (MINS) is an independent predictor of 30-day mortality and may go unrecognized based on standard diagnostic definition for myocardial infarction (MI). Given lack of published research on MINS in India, our study aims to determine incidence of MINS in patients undergoing noncardiac surgery at our tertiary care hospital, and evaluate the clinical characteristics including 30-day outcome.The prospective observational study included patients >65 years or >45 years with either hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular accident (CVA), or peripheral arterial disease undergoing noncardiac surgery. MINS was peak troponin level of ≥0.03 ng/dL at 12-hour or 24-hour postoperative. All patients were followed for 30 days postoperatively. Predictors of MINS and mortality were analyzed using multivariate logistic regression. Patients categorized based on peak troponin cut-off values determined by receiver operating characteristic curve were analyzed by Kaplan-Meir test to compare the survival of patients between the groups.Among 1075 patients screened during 34-month period, the incidence of MINS was 17.5% (188/1075). Patients with DM, CAD, or who underwent peripheral nerve block anaesthesia were 1.5 (P < .01), 2 (P < .001), and 12 (P < .001) times, respectively, more likely to develop MINS than others. Patients with heart rates ≥96 bpm before induction of anesthesia were significantly associated with MINS (P = .005) and mortality (P = .02). The 30-day mortality in MINS cohort was 11.7% (22/188, 95% CI 7.5%-17.2%) vs 2.5% (23/887, 95% CI 1.7%-3.9%) in patients without MINS (P < .001). ECG changes (P = .002), peak troponin values >1 ng/mL (P = .01) were significantly associated with mortality. A peak troponin cut-off of >0.152 ng/mL predicted mortality among MINS patients at 72% sensitivity and 58% specificity. Lack of antithrombotic therapy following MINS was independent predictor of mortality (P < .001), with decreased mortality in patients who took post-op ASA (Aspirin) or Clopidogrel. Mortality among MINS patients with post-op ASA intake is 6.7% vs 12.1% among MINS patients without post-op ASA intake. Mortality among MINS patients with post-op Clopidogrel intake is 10.5% vs 11.8% among MINS patients without post-op Clopidogrel intake.A higher (17.5%, 95% CI 15-19%) incidence of MINS was observed in our patient cohort with significant association with 30-day mortality. Serial postoperative monitoring of troponin following noncardiac surgery as standard of care, would identify "at risk" patients translating to improved outcomes.</p>

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2018

Journal Article

M. Abdel-All, Thrift, A. Gay, Riddell, M., Thankappan, K. Raman Than, Mini, G. Krishnakur, Chow, C. K., Maulik, P. Kumar, Mahal, A., Guggilla, R., Kalyanram, K., Kartik, K., Suresh, O., Evans, R. George, Oldenburg, B., Thomas, N., and Joshi, R., “Evaluation of a training program of hypertension for accredited social health activists (ASHA) in rural India.”, BMC Health Serv Res, vol. 18, no. 1, p. 320, 2018.[Abstract]


<p><b>BACKGROUND: </b>Hypertension is a major risk factor for cardiovascular disease, a leading cause of premature death and disability in India. Since access to health services is poor in rural India and Accredited Social Health Activists (ASHAs) are available throughout India for maternal and child health, a potential solution for improving hypertension control is by utilising this available workforce. We aimed to develop and implement a training package for ASHAs to identify and control hypertension in the community, and evaluate the effectiveness of the training program using the Kirkpatrick Evaluation Model.</p><p><b>METHODS: </b>The training program was part of a cluster randomised feasibility trial of a 3-month intervention to improve hypertension outcomes in South India. Training materials incorporated details on managing hypertension, goal setting, facilitating group meetings, and how to measure blood pressure and weight. The 15 ASHAs attended a five-day training workshop that was delivered using interactive instructional strategies. ASHAs then led community-based education support groups for 3 months. Training was evaluated using Kirkpatrick's evaluation model for measuring reactions, learning, behaviour and results using tests on knowledge at baseline, post-training and post-intervention, observation of performance during meetings and post-intervention interviews.</p><p><b>RESULTS: </b>The ASHAs' knowledge of hypertension improved from a mean score of 64% at baseline to 76% post-training and 84% after the 3-month intervention. Research officers, who observed the community meetings, reported that ASHAs delivered the self-management content effectively without additional assistance. The ASHAs reported that the training materials were easy to understand and useful in educating community members.</p><p><b>CONCLUSION: </b>ASHAs can be trained to lead community-based group educational discussions and support individuals for the management of high blood pressure.</p><p><b>TRIAL REGISTRATION: </b>The feasibility trial is registered with the Clinical Trials Registry - India (CTRI) CTRI/2016/02/006678 (25/02/2016).</p>

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2018

Journal Article

S. Vasudevan, Priyankaraj, C. K., Senthilvel, S., and Sureshbabu, J., “Iodine Deficiency Disorder in Rural Population: A Community Based Observational Study on Prevalence in Coastal Area of Tamil Nadu State, South India”, Indian Journal of Public Health Research and Development, vol. 9, pp. 100-105, 2018.[Abstract]


Background and Objectives: Iodine is an essential micronutrient needed for normal human growth and brain development. Methods and Study Design: A community based observational study was done in Anichakuppam, Villupuram district, Tamil Nadu, South India in the year of 2012 with a sample of 2830 individuals from 1233 households. Eight villages were randomly selected and data were collected by house-to-house survey. All age groups were included with an exclusion of &lt;2 years in this present study. Results: In the present study, overall goiter prevalence was 8% of which the visible goiter rate was 2.6%. The prevalence of goiter is more in the lower socio-economic group, higher prevalence was found in females as compared to males’ population. Conclusion: We have concluded that the prevalence of goiter would be reduced by consuming mineral water for drinking purpose and by a program of distribution of iodized salt has been initiated to eliminate goiter problem.

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2018

Journal Article

S. C. Mellinghoff, Hartmann, P., Cornely, F. B., Knauth, L., Köhler, F., Köhler, P., Krause, C., Kronenberg, C., Kranz, S. - L., Menon, V., Müller, H., Naendrup, J. - H., Pützfeld, S., Ronge, A., Rutz, J., Seidel, D., Wisplinghoff, H., and Cornely, O. A., “Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship.”, Eur J Clin Microbiol Infect Dis, vol. 37, no. 8, pp. 1563-1571, 2018.[Abstract]


<p>Candidemia epidemiology varies significantly by region; thus, local data are essential for evidence-based decision-making in prophylaxis and treatment. Current management strategies are derived from large randomized controlled trials mostly executed in large high-volume tertiary care centers. Results may not be entirely transferable to smaller hospitals. This study investigates epidemiology, diagnosis, and treatment standards in six hospitals in the Cologne metropolitan area (number of inhabitants approx. one million). We assessed adherence to the current guideline of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the Infectious Diseases Society of America (IDSA) using the EQUAL Candida Score of the European Confederation of Medical Mycology (ECMM). Data were documented by trained medical students as part of an integrated research and teaching concept at the University of Cologne. Between January 2014 and June 2017, 77 patients had candidemia, corresponding to an incidence of 0.2 cases/1000 admissions. While 55 patients were enrolled, 22 patients were excluded due to incompletely retrievable health records. Fluconazole monotherapy was the preferred first-line treatment in cases with Candida albicans infection (21/29). A central vascular catheter was present in 40 patients and was removed in 17 (43%) during treatment. Overall mortality at 30 days was 44%. Patients reached a mean EQUAL Candida Score of 9.9 (range 8-14), which was well below the maximum score of 22 for perfect guideline adherence. In summary, management of candidemia differed from current European recommendations. It remains unclear to what extent enhanced adherence would improve patient outcome. Larger prospective studies need to answer that question.</p>

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2018

Journal Article

F. L. Harms, Nampoothiri, S., Kortüm, F., Thomas, J., Panicker, V. V., Alawi, M., Altmüller, J., Yesodharan, D., and Kutsche, K., “Coinheritance of biallelic SLURP1 and SLC39A4 mutations cause a severe genodermatosis with skin peeling and hair loss all over the body.”, Br J Dermatol, vol. 179, no. 5, pp. 1192-1194, 2018.

2018

Journal Article

T. Van Damme, Pang, X., Guillemyn, B., Gulberti, S., Syx, D., De Rycke, R., Kaye, O., de Die-Smulders, C. E. M., Pfundt, R., Kariminejad, A., Nampoothiri, S., Pierquin, G., Bulk, S., Larson, A. A., Chatfield, K. C., Simon, M., Legrand, A., Gérard, M., Symoens, S., Fournel-Gigleux, S., and Malfait, F., “Biallelic B3GALT6 mutations cause spondylodysplastic Ehlers-Danlos syndrome.”, Hum Mol Genet, 2018.[Abstract]


Proteoglycans are among the most abundant and structurally complex biomacromolecules and play critical roles in connective tissues. They are composed of a core protein onto which glycosaminoglycan (GAG) side chains are attached via a linker region. Biallelic mutations in B3GALT6, encoding one of the linker region glycosyltransferases, are known to cause either spondyloepimetaphyseal dysplasia (SEMD) or a severe pleiotropic form of Ehlers-Danlos syndromes (EDS). This study provides clinical, molecular and biochemical data on 12 patients with biallelic B3GALT6 mutations. Notably, all patients have features of both EDS and SEMD. In addition, some patients have severe and potential life-threatening complications such as aortic dilatation and aneurysm, cervical spine instability, and respiratory insufficiency. Whole-exome sequencing, next generation panel sequencing, and direct sequencing identified biallelic B3GALT6 mutations in all patients. We show that these mutations reduce the amount of β3GalT6 protein and lead to a complete loss of galactosyltransferase activity. In turn, this leads to deficient GAG synthesis, and ultrastructural abnormalities in collagen fibril organization. In conclusion, this study redefines the phenotype associated with B3GALT6 mutations on the basis of clinical, molecular and biochemical data in 12 patients, and provides an in-depth assessment of β3GalT6 activity and GAG synthesis to better understand this rare condition.

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2018

Journal Article

C. Rathore, Jeyaraj, M. K., Dash, G. K., Wattamwar, P., Baheti, N., Sarma, S. P., and Radhakrishnan, K., “Outcome after seizure recurrence on antiepileptic drug withdrawal following temporal lobectomy.”, Neurology, 2018.[Abstract]


OBJECTIVE: To study the long-term outcome following seizure recurrence on antiepileptic drug (AED) withdrawal after anterior temporal lobectomy for mesial temporal lobe epilepsy.

METHODS: We retrospectively studied the AED profile of patients who had a minimum of 5 years of postoperative follow-up after anterior temporal lobectomy for mesial temporal lobe epilepsy. Only those patients with hippocampal sclerosis or normal MRI were included. AED withdrawal was initiated at 3 months in patients on ≥2 drugs and at 1 year for patients on a single drug.

RESULTS: Three hundred eighty-four patients with median postoperative follow-up of 12 years (range, 7-17 years) were included. Of them, 316 patients (82.3%) were seizure-free during the terminal 1 year. AED withdrawal was attempted in 326 patients (84.9%). At last follow-up, AEDs were discontinued in 207 patients (53.9%). Seizure recurrence occurred in 92 patients (28.2%) on attempted withdrawal. After a median postrecurrence follow-up of 7 years, 79 (86%) of them were seizure-free during the terminal 2 years. AEDs could be stopped in 17 patients (18.5%) and doses were reduced in another 57 patients (62%). Patients with febrile seizures, normal postoperative EEG at 1 year, and duration of epilepsy of <20 years (FND20 score) had 17% risk of seizure recurrence on attempted AED withdrawal. We also formulated a score to predict the chances of AED freedom for the whole cohort.

CONCLUSION: Patients with seizure recurrence on AED withdrawal have good outcome with 86% becoming seizure-free and 18% becoming drug-free after initial recurrence. A FND20 score helps in predicting recurrence on AED withdrawal.

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2018

Journal Article

V. Jayakumar Sunandhakumari, Sadasivan, A., Koshi, E., Krishna, A., Alim, A., and Sebastian, A., “Effect of NonSurgical Periodontal Therapy on Plasma Levels of IL-17 in Chronic Periodontitis Patients with Well Controlled Type-II Diabetes Mellitus-A Clinical Study.”, Dent J (Basel), vol. 6, no. 2, 2018.[Abstract]


For years the pathogenesis of periodontitis was under an immunological Th1/Th2 paradigm. Th1 cells are considered to afford protection against the intracellular pathogens. These cells produce the interferons (IFN) that are involved in macrophage activation, which, in turn, plays an important role in phagocytosis, complement fixation, and opsonization. Th2 cells are thought to have evolved as a form of protection against parasitic helminthes. Th17 subset of CD4Not Necessary+ T cells was identified in the year 2005, which added greater complexity to Th function and are pro inflammatory in nature. Interleukins (ILs) have the ability to alter immunological changes and they also possess the ability to regulate lymphocyte differentiation and haemopoietic stem cells, cell proliferation, and motility, which are classified as pro-inflammatory and anti-inflammatory. There are numerous studies that reported IL-17 levels associated with chronic periodontitis (CP) development. Type II diabetes mellitus (DM) is considered a risk factor for the development of periodontal diseases because the incidence, progression, and severity of periodontal diseases are more common with Type II DM than without DM. This study was aimed at evaluating whether non-surgical periodontal therapy had any effect on plasma concentrations of Interleukin-17 in systemically healthy chronic periodontitis patients and in chronic periodontitis patients with well controlled Type II Diabetes mellitus. Patients were divided into the two groups including the chronic periodontitis group (20 subjects) and the chronic periodontitis with well-controlled Type II Diabetes mellitus group (20 subjects). The Gingival Index and Plaque Index as well as the clinical Attachment Level (CAL) were taken from all the patients of two groups after evaluating fasting blood sugar, post prandial blood sugar, and the Glycated Hemoglobin Level (HbA1c). Then 5 mL blood samples were collected from each patient and plasma was separated and the IL-17 level is evaluated using the ELISA method. Then, as part of phase I periodontal therapy, scaling and root planning was performed. Patients were recalled after one month and clinical and biochemical parameters were reevaluated. Non-surgical periodontal therapy resulted in a reduction of plasma levels of IL-17 in chronic periodontitis patients with and without well controlled Type II Diabetes mellitus.

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2018

Journal Article

P. Sundar, Bijalwan, P., and Ginil Kumar Pooleri, “Castleman's Disease: a Suprarenal Surprise!”, Indian J Surg Oncol, vol. 9, no. 2, pp. 254-255, 2018.[Abstract]


Castleman's disease is a distinct form of lymph node hyperplasia. It commonly presents as a mediastinal mass and rarely as a solitary retroperitoneal mass. We narrate a case of Castleman's disease presenting as a right suprarenal mass emphasising the usefulness of robot-assisted retroperitoneoscopy in surgical management of retroperitoneal masses in close relation to vital structures.

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2018

Journal Article

K. Thankappan and Iyer, S., “Initiating a Robotic Thyroidectomy Program in India.”, Indian J Surg Oncol, vol. 9, no. 2, pp. 241-246, 2018.[Abstract]


Robotic surgery has been successfully used for many surgical indications in head and neck surgery. Robotic thyroidectomy is getting accepted worldwide, but the majority of the literature is from South Korea. The purpose of the paper is to review and give a personal perspective on how a robotic thyroidectomy program was initiated in a tertiary care academic medical institution in India. Advantages of robotic approaches are the three-dimensional visualization, precision, dexterity, and surgeon ergonomics. Cost is an important concern. Training includes basic robotics skill training, cadaveric training, observership, and hands-on training. Sufficient preclinical and clinical training is essential before embarking onto the newer surgical modality. Surgeon credentialing, though institution dependent, has specific guidelines. Case selection is the key, especially in the initial learning curve. The authors prefer the retroauricular approach for robotic thyroidectomy, and our initial experience in the first ten cases of total thyroidectomy was encouraging.

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2018

Journal Article

N. Subramaniam, Balasubramanian, D., Rka, P., Murthy, S., Rathod, P., Vidhyadharan, S., Thankappan, K., and Iyer, S., “ACSNSQIP Risk Calculator in Indian Patients Undergoing Surgery for Head and Neck Cancers: Is It Valid?”, Indian Journal of Surgical Oncology, vol. 9, no. 2, pp. 122-125, 2018.[Abstract]


Pre-operative assessment is vital to determine patient-specific risks and minimize them in order to optimize surgical outcomes. The American College of Surgeons National Surgical Quality Improvement Program (ACSNSQIP) Surgical Risk Calculator is the most comprehensive surgical risk assessment tool available. We performed this study to determine the validity of ACSNSQIP calculator when used to predict surgical complications in a cohort of patients with head and neck cancer treated in an Indian tertiary care center. Retrospective data was collected for 150 patients with head and neck cancer who were operated in the Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, in the year 2016. The predicted outcome data was compared with actual documented outcome data for the variables mentioned. Brier’s score was used to estimate the predictive value of the risk assessment generated. Pearson’s r coefficient was utilized to validate the prediction of length of hospital stay. Brier’s score for the entire calculator was 0.32 (not significant). Additionally, when the score was determined for individual parameters (surgical site infection, pneumonia, etc.), none were significant. Pearson’s r value for length of stay was also not significant (p =.632). The ACSNSQIP risk assessment tool did not accurately reflect surgical outcomes in our cohort of Indian patients. Although it is the most comprehensive tool available at present, modifications that may improve accuracy are allowing for input of multiple procedure codes, risk stratifying for previous radiation or surgery, and better risk assessment for microvascular flap reconstruction. © 2018, Indian Association of Surgical Oncology. More »»

2018

Journal Article

S. George, Joy, T. Mary, Kumar, A., Panicker, K. N., Leyanna Susan George, Raj, M., Leelamoni, K., and Nair, P., “Prevalence of Neglected Tropical Diseases (Leishmaniasis and Lymphatic Filariasis) and Malaria Among a Migrant Labour Settlement in Kerala, India.”, J Immigr Minor Health, 2018.[Abstract]


Neglected tropical diseases (visceral leismaniasis, lymphatic filariasis) and malaria are endemic in northern states of India. Kerala has become a hub of construction activities employing a large number of migrants from these endemic states. Studies on morbidity pattern among migrants in Kerala are lacking. It is essential to look into the burden of these infections among migrant laborers who can act as reservoirs and are a threat to native population. A cross sectional study was done among migrant laborers in Ernakulam district, Kerala. After getting informed consent, a questionnaire was administered to each participant to collect sociodemographic details and 5 ml of blood was collected for detection of antigens using rapid diagnostic tests (RDT). Of the 309 migrants tested, none of them were positive for leishmaniasis, while 3.8% were positive for malaria and 3.6% for filariasis. With 2.5 million migrant laborers in Kerala, the magnitude of the problem in absolute numbers is enormous. Active surveillance and treatment is needed to prevent the reemergence of these diseases in Kerala.

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2018

Journal Article

S. Gandra, Alvarez-Uria, G., Murki, S., Singh, S. K., Kanithi, R., Jinka, D. R., Chikkappa, A. K., Subramanian, S., Sharma, A., Dharmapalan, D., Kandraju, H., Vasudevan, A. Kumar, Tunga, O., Akula, A., Hsia, Y., Sharland, M., and Laxminarayan, R., “Point prevalence surveys of antimicrobial use among eight neonatal intensive care units in India: 2016.”, Int J Infect Dis, vol. 71, pp. 20-24, 2018.[Abstract]


BACKGROUND: Information about antimicrobial use is scarce and poorly understood among neonatal intensive care units (NICUs) in India. In this study, we describe antimicrobial use in eight NICUs using four point prevalence surveys (PPSs).

METHODS: As part of the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children (GARPEC) study, one-day, cross-sectional, hospital-based PPSs were conducted four times between 1 February 2016 and 28 February 2017 in eight NICUs. Using a standardized web-based electronic data entry form, detailed data were collected for babies on antimicrobials.

RESULTS: A total of 403 babies were admitted to NICUs across all survey days, and 208 (51.6%) were prescribed one or more antimicrobials. Among 208 babies, 155 (74.5%) were prescribed antimicrobials for treatment of an active infection. Among 155 babies with an active infection, treatment was empiric in 109 (70.3%). Sepsis (108, 49.1%) was the most common reason for prescribing antimicrobials. Amikacin (17%) followed by meropenem (12%) were the two most commonly prescribed antimicrobials. For community-acquired sepsis, piperacillin-tazobactam (17.5%) was the most commonly prescribed drug. A combination of ampicillin and gentamicin was prescribed in only two babies (5%).

CONCLUSIONS: The recommended first-line antimicrobial agents, ampicillin and gentamicin, were rarely prescribed in Indian NICUs for community acquired neonatal sepsis.

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2018

Journal Article

Suhas Udayakumaran and Rathod, C. T., “Tailored Strategies to Manage Cerebrospinal Fluid Leaks or Pseudomeningocele After Surgery for Tethered Cord Syndrome.”, World Neurosurg, vol. 114, pp. e1049-e1056, 2018.[Abstract]


BACKGROUND: Cerebrospinal fluid (CSF) leaks are a dreaded complication after surgery for tethered cord and are associated with significant patient morbidity. Although many strategies for managing postoperative CSF leaks exist, this problem is still daunting, especially in very young patients. In this study, we compared different management techniques for CSF leaks or significant pseudomeningocele in patients with tethered cord syndrome (TCS).

METHODS: We analyzed a cohort of children who underwent surgery for TCS from January 2011 to March 2016 (n = 260) and postoperatively experienced either a CSF leak or significant pseudomeningocele. A subset of patients presented with CSF leak (n = 25). We analyzed patient age, sex, presentation, leak appearance, management, and outcome. The different techniques of management were compared for efficacy and morbidity.

RESULTS: The diseases associated with leak formation included lipomyelomeningocele (n = 16), myelocystocele (n = 4), and myelomeningocele (n = 5). Three children also had hydrocephalus. Management techniques included cystoperitoneal shunt (CPS) (n = 15), primary resuturing with local rotation flap of muscle (n = 3), external ventricular drain placement (n = 1), ventriculoperitoneal shunt (n = 3), external ventricular drainage (n = 1), and a combination of techniques (rotation flap with external drain; n = 1). Five patients who underwent primary wound revision experienced a leak and required a secondary intervention, but none of the patients who underwent CPS had any complications.

CONCLUSIONS: In carefully selected cases, CPS performed early after CSF leakage is highly successful with low morbidity. The primary closure can be attempted for low-pressure leaks without an associated pseudomeningocele.

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2018

Journal Article

J. Yeshavant Lagoo, D'Souza, M. Charles, Kartha, A., and Kutappa, A. Muthanna, “Role of Ulinastatin, a trypsin inhibitor, in severe acute pancreatitis in critical care setting: A retrospective analysis.”, J Crit Care, vol. 45, pp. 27-32, 2018.[Abstract]


PURPOSE: To evaluate the clinical utility of Ulinastatin, a multifunctional serine protease inhibitor, in the management of severe acute pancreatitis.

MATERIALS AND METHODS: We conducted a retrospective analysis of the archived data of adult patients diagnosed with acute pancreatitis and admitted to surgical intensive care unit with one or more end organ dysfunction. The patients were divided into two groups depending on whether they did or did not receive ulinastatin. Outcome variables namely in-hospital mortality, development of new-onset organ dysfunction, resolution of existing organ dysfunction by Day 5 and length of hospital stay were compared.

RESULTS: Forty-eight patients, 25 who received Ulinastatin (Ulinastatin group) and 23 who did not (Control group) were analyzed. The in-hospital mortality was significantly lower in the Ulinastatin group (16% vs 69.6%; p = 0.0003). Significantly smaller proportion of patients (24% vs 73.9%; p = 0.0005) developed new-onset organ dysfunction in the ulinastatin group by day 5. Resolution of existing organ dysfunctions by day 5 was more frequent in the ulinastatin group. Duration of hospital stay was similar in the two groups.

CONCLUSION: Ulinastatin treatment was associated with improved outcomes in patients with severe acute pancreatitis.

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2018

Journal Article

S. Vidhyadharan, Thankappan, K., Janarthanan, R., Balasubramanian, D., Sharma, M., Mathew, J., Sudheer, O. V., and Iyer, S., “Gastro-omental free flap for reconstruction of tongue defects”, Oral Oncology, vol. 83, pp. 134-139, 2018.[Abstract]


Objectives: The purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects. Materials and Methods: This is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro–omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented. Results: Five patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy. Conclusion: Gastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well. © 2018 Elsevier Ltd

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2018

Journal Article

J. Joseph, Krishnan, A. G., Cherian, A. M., Rajagopalan, B., Jose, R., Varma, P., Maniyal, V., Balakrishnan, S., Shantikumar V Nair, and Dr. Deepthy Menon, “Transforming Nanofibers into Woven Nanotextiles for Vascular Application”, ACS Applied Materials and Interfaces, vol. 10, pp. 19449-19458, 2018.[Abstract]


This study investigates the unique properties, fabrication technique, and vascular applications of woven nanotextiles made from low-strength nanoyarns, which are bundles of thousands of nanofibers. An innovative robotic system was developed to meticulously interweave nanoyarns in longitudinal and transverse directions, resulting in a flexible, but strong woven product. This is the only technique for producing seamless nanotextiles in tubular form from nanofibers. The porosity and the mechanical properties of nanotextiles could be substantially tuned by altering the number of nanoyarns per unit area. Investigations of the physical and biological properties of the woven nanotextile revealed remarkable and fundamental differences from its nonwoven nanofibrous form and conventional textiles. This enhancement in the material property was attributed to the multitude of hierarchically arranged nanofibers in the woven nanotextiles. This patterned woven nanotextile architecture leads to a superhydrophilic behavior in an otherwise hydrophobic material, which in turn contributed to enhanced protein adsorption and consequent cell attachment and spreading. Short-term in vivo testing was performed, which proved that the nanotextile conduit was robust, suturable, kink proof, and nonthrombogenic and could act as an efficient embolizer when deployed into an artery. © 2018 American Chemical Society.

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2018

Journal Article

Nivedhitha Sundaram M., V. Kaliannagounder, K., Selvaprithiviraj, V., Suresh, M., Biswas, R., Vasudevan, A. K., Varma, P. K., and Dr. Jayakumar Rangasamy, “Bioadhesive, Hemostatic, and Antibacterial in Situ Chitin-Fibrin Nanocomposite Gel for Controlling Bleeding and Preventing Infections at Mediastinum”, ACS Sustainable Chemistry and Engineering, vol. 6, pp. 7826-7840, 2018.[Abstract]


Mediastinitis occurs after cardiac surgery and is a major threat to patient's life due to postoperative bleeding and deep sternal wound infection. Major challenge in treating this condition is that it demands a material that should adhere to the applied site and act as both a hemostatic and an antibacterial agent. On the basis of this we have developed an in situ forming tissue adhesive chitin-fibrin (CH-FB) gel with tigecycline loaded gelatin nanoparticles (tGNPs) for controlling bleeding and preventing bacterial infection. Spherical shaped tGNPs (231 ± 20 nm) were prepared and characterized. In situ forming tGNPsCH-FB gel was formed using a dual syringe applicator in which one syringe was loaded with a mixer of fibrinogen solution, chitin gel, and tGNPs; the other syringe was loaded with a mixture of thrombin solution, chitin gel, and tGNPs. Both these mixtures were injected together. In situ gel formed within a minute and exhibited excellent tissue adhesive property. tGNPsCH-FB gel was found to be cyto-compatible against human umbilical vein endothelial cells (HUVECs). Sustained release of tigecycline from tGNPsCH-FB gel was found to occur over 21 days. In vitro antibacterial activity of tGNPsCH-FB gel was tested against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli (E. coli), and their clinical isolates. Furthermore, in vivo hemostatic potential of tGNPsCH-FB gel was evaluated in deep organ injuries created in Sprague-Dawley rats. The developed gel exhibited rapid blood clotting potential by achieving hemostasis within 154 and 84 s under femoral artery (pressured) and liver (oozing) bleeding conditions. Hence, these findings exhibit the potential application of the developed tGNPsCH-FB gel to adhere at surgical site for controlling bleeding and prevent bacterial infection after cardiac surgery. © 2018 American Chemical Society.

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2018

Journal Article

S. George, Joy, T. M., Kumar, A., Panicker, K. N., George, L. S., Raj, M., Leelamoni, K., and Nair, P., “Prevalence of Neglected Tropical Diseases (Leishmaniasis and Lymphatic Filariasis) and Malaria Among a Migrant Labour Settlement in Kerala, India”, Journal of Immigrant and Minority Health, pp. 1-7, 2018.[Abstract]


Neglected tropical diseases (visceral leismaniasis, lymphatic filariasis) and malaria are endemic in northern states of India. Kerala has become a hub of construction activities employing a large number of migrants from these endemic states. Studies on morbidity pattern among migrants in Kerala are lacking. It is essential to look into the burden of these infections among migrant laborers who can act as reservoirs and are a threat to native population. A cross sectional study was done among migrant laborers in Ernakulam district, Kerala. After getting informed consent, a questionnaire was administered to each participant to collect sociodemographic details and 5 ml of blood was collected for detection of antigens using rapid diagnostic tests (RDT). Of the 309 migrants tested, none of them were positive for leishmaniasis, while 3.8% were positive for malaria and 3.6% for filariasis. With 2.5 million migrant laborers in Kerala, the magnitude of the problem in absolute numbers is enormous. Active surveillance and treatment is needed to prevent the reemergence of these diseases in Kerala. © 2018 Springer Science+Business Media, LLC, part of Springer Nature

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2018

Journal Article

P. Kerala Varma and Krishna, N., “Transcatheter aortic valve replacement: Role of anesthesiologists.”, Ann Card Anaesth, vol. 21, no. 3, pp. 285-286, 2018.

2018

Journal Article

V. Jayakumar Sunandhakumari, Vidhyadharan, A. Kumar, Alim, A., Kumar, D., Ravindran, J., Krishna, A., and Prasad, M., “Fabrication and In Vitro Characterization of Bioactive Glass/Nano Hydroxyapatite Reinforced Electrospun Poly(ε-Caprolactone) Composite Membranes for Guided Tissue Regeneration.”, Bioengineering (Basel), vol. 5, no. 3, 2018.[Abstract]


<strong>BACKGROUND: </strong>Current resorbable and non-resorbable membranes act as a physical barrier to avoid connective and epithelial tissue downgrowth into the defect, favoring the regeneration of periodontal tissues. These conventional membranes possess many structural and bio-functional limitations. We hypothesized that the next-generation of guided tissue regeneration (GTR) membranes for periodontal tissue engineering will be a biologically active, spatially designed nanofibrous biomaterial that closely mimics the native extra-cellular matrix (ECM).

<strong>METHODS: </strong>GTR membranes made of poly(ε-Caprolactone) with a molecular weight of 80,000 reinforced with different weight concentrations of nano-Hydroxyapatite/Bioactive glass (2%, 5%, 10%, 15%) is fabricated by the method of electrospinning. After fabrication, in vitro properties are evaluated.

<strong>RESULTS: </strong>The electrospun nanofibrous membranes possessed excellent mechanical properties initially and after one month of degradation in phosphate buffer solution (PBS). Moreover, none of the fabricated membranes were found to be cytotoxic at lower concentrations and higher concentrations. Comparing the overall properties, PCL (poly(e-caprolactone)) + BG (Bioactive glass) 2% exhibited superior cell attachment and percentage of viable cells, increased fiber and pore diameter which satisfies the ideal properties needed for GTR membranes.

<strong>CONCLUSION: </strong>Composite nanofibrous membranes prepared by electrospinning are suitable for use as a GTR membrane and are a useful prototype for further development of a final membrane for clinical use.

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2018

Journal Article

Sandeep Kondisetty, Krishnakumar N. Menon, and Ginil Kumar Pooleri, “Fibronectin protein expression in renal cell carcinoma in correlation with clinical stage of tumour.”, Biomark Res, vol. 6, p. 23, 2018.[Abstract]


<strong>Background: </strong>Carcinogenesis is a multistep process which involves interplay between the tumour cells and the matrix proteins. This occurs by adherence between the tumour cells and proteins in the extracellular matrix. VHL mutation affects through the hypoxia inducible factor (HIF) and causes changes in various tissue proteins like VEGF, PDGF, TGF, Fibronectin and others. As not much literature is available, we aim to quantify the changes of fibronectin protein in renal cell carcinoma (RCC) tissue.

<strong>Methods: </strong>This Prospective unbalanced case control study was conducted over a period of 18&nbsp;months from April 2016 to September 2017. The patients undergoing nephrectomy for the diagnosis of RCC were included in the study after obtaining written informed consent. Patients were excluded from study, if normal renal tissue could not be identified in the resected kidney and if the artery clamp time to retrieval of tissue was more than 30&nbsp;min. Fibronectin protein is estimated in the tumour tissue by gel electrophoresis and western blotting which is compared with that of normal kidney tissue of the same kidney. Results have been expressed as absolute values with standard deviation and relative expression (RE).

<strong>Results: </strong>Of the 21 patients analysed 15 showed an increase in fibronectin expression in the renal tumour tissue while 6 did not. The mean expression of Fibronectin protein has increased 1.5 times in the tumour tissue when compared with the normal tissue. The increase was 1.54 times in early tumours compared to 1.37 times in advanced tumours of RCC.

<strong>Conclusions: </strong>Fibronectin showed a 1.5 times increase in the tumour compared to normal. This increase is more in Stage 1&amp;2 tumours when compared to the Stage 3&amp;4 tumours.

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2018

Journal Article

I. Ramachandr Nair, Mathew, A. John, and Kottarathil, V. Dehannapar, “Detection of micrometastasis in axillary lymph nodes of breast carcinoma patients and its association with clinical outcome.”, Indian J Pathol Microbiol, vol. 61, no. 3, pp. 330-333, 2018.[Abstract]


<strong>Context: </strong>There is heterogeneity in the clinical behavior of breast carcinoma patients with node negativity. Studies have analyzed different factors influencing the outcome in such patients. It is suggested that the presence of nodal micrometastasis can act as a tool in predicting the aggressiveness of these tumors.

<strong>Aims: </strong>The aim of this study is to assess the yield of micrometastasis/isolated tumor cell (ITC) by ultrastaging the morphologically negative axillary nodes and staining them with immunohistochemistry for epithelial membrane antigen. The association of such metastasis with the clinical outcome is determined.

<strong>Settings and Design: </strong>This was a retrospective analytical study. One hundred cases of node-negative breast carcinoma patients who underwent surgery along with axillary lymph node dissection were selected.

<strong>Materials and Methods: </strong>The largest node from the axillary dissection was selected and subjected to ultrastaging and immunohistochemical staining (as sentinel node dissection was not a routine practice at that time), to look for occult metastasis in the form of micrometastasis or ITCs.

<strong>Statistical Analysis: </strong>Occurrence of events in the form of recurrence or death was noted. Association of the parameters was analyzed using Fisher's exact test.

<strong>Results: </strong>Among the 100 cases, 79 patients were followed up for a minimum period of 5 years. Two cases had micromets in one node each. These two patients were among the eight, who developed events subsequently (25%). Hence, a statistically significant association was found between the presence of micromets with events.

<strong>Conclusions: </strong>There is a statistically significant association between the presence of micromets and disease recurrence. Hence, we suggest that ultrastaging of the negative axillary node (now sentinel node, as it is being routinely done) might prove effective in predicting the events/prognosis in clinically and morphologically node-negative breast carcinoma patients.

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2018

Journal Article

S. Maria, Barnwal, G., Kumar, A., Mohan, K., Vinod, V., Varghese, A., and Dr. Raja Biswas, “Species Distribution and Antifungal Susceptibility Among Clinical Isolates of Candida Parapsilosis Complex from India”, Rev Iberoam Micol, pp. 147-150, 2018.[Abstract]


<strong>BACKGROUND: </strong>Candida parapsilosis is recognized as a species complex: Candida parapsilosis sensu stricto, Candida orthopsilosis and Candida metapsilosis are three distinct but closely related species.

<strong>AIMS: </strong>To determine the species and antifungal susceptibility of members of the C. parapsilosis complex, isolated from clinical samples.

<strong>METHODS: </strong>Isolates identified as C. parapsilosis complex by VITEK 2 system were included. Antifungal susceptibility test was done using the VITEK 2 semi-automated system. The distribution of the species in the complex was determined by multiplex PCR.

<strong>RESULTS: </strong>Among the seventy-seven C. parapsilosis complex isolates, C. parapsilosis sensu stricto (57.1%) was the commonest species, followed by C. orthopsilosis (40.2%) and C. metapsilosis (2.5%). All three species were susceptible to amphotericin B, caspofungin and micafungin. Among C. parapsilosis sensu stricto isolates, 16% were resistant to fluconazole while 2.2% showed dose dependent susceptibility. Also, 18.2% of C. parapsilosis sensu stricto isolates showed dose dependent susceptibility to voriconazole.

<strong>CONCLUSIONS: </strong>C. parapsilosis sensu stricto was the most commonly isolated member of the C. parapsilosis complex and it showed high resistance to fluconazole. A high prevalence of C. orthopsilosis (40.2%) was also noted.

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2018

Journal Article

A. Jan Battoo, Haji, A. Gauhar, Sheikh, Z. Ahmad, Thankappan, K., and Mir, W. Abdul, “Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid.”, Int Arch Otorhinolaryngol, vol. 22, no. 3, pp. 256-259, 2018.[Abstract]


There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established.  To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance.  This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation.  Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions &lt; 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age. The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma.  Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (&gt; 5 cm).

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2018

Journal Article

S. E. Sajeevan, M. Chatterjee, V. Paul, G. Baranwal, V. A. Kumar, C. Bose, A. Banerji, Dr. Bipin G. Nair, B. P. Prasanth, and Dr. Raja Biswas, “Impregnation of Catheters with Anacardic Acid from Cashew nut Shell Prevents Staphylococcus aureus Biofilm Development.”, Journal of Applied Microbiology, vol. 125, no. 5, pp. 1286-1295, 2018.[Abstract]


AIM: The effect of anacardic acid impregnation on catheter surfaces for the prevention of Staphylococcus aureus attachments and biofilm formations were evaluated. METHODS AND RESULTS: Silicon catheter tubes were impregnated using different concentrations of anacardic acids (0·002-0·25%). Anacardic acids are antibacterial phenolic lipids from cashew nut (Anacardium occidentale) shell oil. Anacardic acid-impregnated silicon catheters revealed no significant haemolytic activity and were cytocompatible against fibroblast cell line (L929). Sustained release of anacardic acids was observed for 4 days. Anacardic acid-impregnated silicon catheters efficiently inhibited S. aureus colonization and the biofilm formation on its surface. The in vivo antibiofilm activity of anacardic acid-impregnated catheters was tested in an intraperitoneal catheter-associated medaka fish infection model. Significant reduction in S. aureus colonization on anacardic acid-impregnated catheter tubes was observed.

CONCLUSIONS: Our data suggest that anacardic acid-impregnated silicon catheters may help in preventing catheter-related staphylococcal infections. SIGNIFICANCE AND IMPACT OF THE STUDY: This study opens new directions for designing antimicrobial phytochemical-coated surfaces with ideal antibiofilm properties and could be of great interest for biomedical research scientists.

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2018

Journal Article

Serene Xavier, Karimassery Ramaiyer Sundaram, Lalitha Biswas, Dilip Panikar, Bindhu Mangalath Rajamma, Nair, S., Krishnakumar N. Menon, and Dr. Lakshmi Sumitra, “Molecular Analysis of Oncogene Expressions in Different Grades of Gliomas”, Journal of Integrated OMICS, vol. 8, pp. 66-73, 2018.[Abstract]


The aggressiveness of brain tumors is attributed to the expression of multiple oncogenes involved in proliferation, metabolism and therapeutic resistance whose potential correlation with tumor progression has not been well-studied. In this study, we aimed to investigate the relationship of oncotargets involved in pathogenesis with respect to glioma grades. Gliomas (n=40) were analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and sequencing for the detection of epidermal growth factor receptor (EGFR) mutants. Expressions levels of EGFRy EGFR variant III (EGFRvIII), Lek/Yes novel tyrosine kinase (Lyn), Spleen tyrosine kinase (SYK), insulin receptor substrate 1 (IRSl)y phosphatidylinositol 3-kinase (PI3K), Src homology 2 domain-containing inositol 5-phosphatase 1 (SHIP1) and glucose transporter 3 (GLUT3) were studied using real-time PCR and compared against glioma grades via statistical methods. Protein expressions were analyzed using immunohistochemistry and western blotting. EGFRvIII was detected in 53% and exon 4 deletion (de4 EGFR) in 20% of gliomas. Importantly, the expressions levels of candidate oncogenes were significantly upregulated (P&lt;0.05) and positively correlated with the glioma grades. Hence, these oncotargets require high surveillance during tumor progression and further investigations on larger patient cohorts can affirm their role as potential markers in the pathology of glioma, thereby aiding in the development of patient-specific multi-targeted therapy. © 2018, Proteomass Scientific Society. All rights reserved.

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2018

Journal Article

N. Subramaniam, Balasubramanian, D., Reddy, R., Rathod, P., Murthy, S., Vidhyadharan, S., Thankappan, K., and Iyer, S., “Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection”, International Journal of Oral and Maxillofacial Surgery, 2018.[Abstract]


Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated. A total of 586 neck dissection specimens obtained between 2005 and 2014 from patients operated on at the study institution for floor of mouth, tongue, and buccal primaries, were evaluated for direct invasion of the gland and periglandular lymphadenopathy. Of 226 node-positive patients, 21 (9.3%) had direct gland invasion by tumour. Risk factors were tumour diameter &gt;4 cm (P = 0.002) and depth of invasion &gt;10 mm (P = 0.003). Determinants of periglandular lymphadenopathy were depth of invasion &gt;10 mm (P &lt; 0.001), perineural invasion (P = 0.02), lymphovascular invasion (P = 0.014), and moderate/poor differentiation (P &lt; 0.0001). Gland-sparing neck dissection is safe in early tumours (pT1pN0–1), with a good chance of minimizing xerostomia without radiotherapy. Larger tumours without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy may be considered for gland preservation, however the oncological safety is unclear. © 2018 International Association of Oral and Maxillofacial Surgeons.

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2018

Journal Article

G. Naik, Sekhar, S., Prabhu, M., Singh, G., Vijay, A., Subrahmanian, M., and Natarajan, K. U., “Comparison of CHA2DS2-VASc-HS score and gensini score to predict severity of coronary artery disease”, Journal of Clinical and Diagnostic Research, vol. 12, pp. IC01-IC04, 2018.[Abstract]


Introduction: A plethora of risk assessment scores which identify the severity of Coronary Artery Disease (CAD) are available. However, most of them require results of coronary angiography or coronary computed tomography angiography. Aim: In this study, we assessed the accuracy of newly developed CHA2DS2-VASc-HS scoring system which does not require such sophisticated evaluations and compared it with Gensini score. Materials and Methods: The study was a single center, prospective, observational cohort study. The cohort of patients admitted to the Amrita School of Medicine, Kochi, Kerala, India for diagnostic angiography from November 2014 to October 2015 were observed for Gensini score and CHA2DS2-VASc-HS scores. Patients undergoing repeat angiography were excluded. The outcomes were classified into three groups as Normal, Mild CAD and Severe (Obstructive) CAD and the scores were compared. Statistical methods such an ANOVA, Spearman’s rank correlation and Mann-Whitney test were applied. Results: A total of 100 patients were studied whose mean age was 59.4±8.9 years. Among these patients, 19 patients (19%) had normal angiograms, 22 patients (22%) had mild CAD, and 59 (59%) patients had obstructive (severe) CAD. A significant increase in both the scores was observed with increase in severity of CAD. Mean Gensini score in the group with CHA2DS2-VASc-HS score &lt;3 (n=44) was 2.34±4.13 (median-1, range 0-21), while the mean Gensini score in the group with CHA2DS2-VASc-HS score ≥3 (n=58) was 43.66±31.95 (median-33.8, range 0-153). There was a positive correlation between CHA2DS2-VASc-HS score and Gensini Score (correlation coefficient 0.813, p&lt;0.001). Conclusion: This newly developed scoring system is an effective, convenient as well as rapid screening method, which can be used in hospital settings to predict severity of CAD. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.

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2018

Journal Article

N. Baby, Vinayan, K. P., Pavithran, N., and A. Roy, G., “A pragmatic study on efficacy, tolerability and long term acceptance of ketogenic diet therapy in 74 South Indian children with pharmacoresistant epilepsy”, Seizure, vol. 58, pp. 41-46, 2018.[Abstract]


Purpose: Significant challenges exist for Ketogenic Diet (KD) programs in many populations, mainly due to the variations in local dietary preferences. Here we report a single center experience of KD therapy in a cohort of South Indian children with pharmaco-resistant epilepsies. Methods: Children aged 0–18 years, enrolled in the KD program for pharmacoresistant epilepsies of Amrita institute of Medical Sciences, Kochi, Kerala, India (2010 − 2015) were included in this pragmatic study. Diet efficacy was evaluated according to reduction in seizure frequency and in the number of antiepileptic drugs (AED). Duration of retention, reasons for discontinuation and the rate of adverse events were used for assessing KD tolerability. Results: Seventy four children were enrolled in the KD program. Four children could not complete the initiation process. Median age at KD initiation was 4.2years. 53 children had developmental delay. 89% were on 3 or more AEDs. Baseline seizure frequency was &gt;5/day in 52 children. KD was continued for a median duration of 10.43 months. At the last contact, 59.4% reported seizure reduction of more than 50%. More than 90% reduction was noted in 25 children (33.7%). 6(8.1%) of them became completely seizure free. Four children expired during the study period and four children reported major adverse events necessitating KD withdrawal. Main reasons for discontinuation of KD were poor compliance, lack of response to diet and relapse of seizures. Conclusion: KD may be a safe and effective option for children with pharmacoresistant epilepsies even while on a traditional carbohydrate rich South Indian diet. © 2018 British Epilepsy Association.

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2018

Journal Article

R. Agarwal, Rajanbabu, A., and Unnikrishnan, U. G., “A retrospective evaluation of the perioperative drug use and comparison of its cost in robotic vs open surgery for endometrial cancer”, Journal of Robotic Surgery, pp. 1-8, 2018.[Abstract]


To compare the usage and cost of analgesics (opioid and non-opioids), antiemetics, and IV fluids and its associated costs in robotic vs open staging surgery for endometrial cancer (EC). This retrospective study was performed at a single academic institution from January 2014 to June 2017 in the department of Gynecology Oncology at Amrita Institute of Medical Science, Kerala, India. The study included women with biopsy confirmed clinically early stage endometrial cancer or atypical hyperplasia, who underwent robotic-assisted or open staging surgery. Data on surgical time, blood loss, post-anaesthesia care unit (PACU) stay, and length of hospital (LOH) stay; analgesic, antiemetic, and IV fluid use were collected for three distinct periods: intra-operative, PACU, and ward. Direct medicine and material costs associated with the administration of intravenous (IV) fluids, analgesics, and antiemetics were collected. All parameters were compared between two surgical groups. The study included 133 (54 open and 79 robotic-assisted) patients. As compared to open surgery, robotic-assisted surgery was associated with significantly reduced: surgical time (p = 0.007), estimated blood loss (p &lt; 0.001), PACU stay (p &lt; 0.001), LOH stay (p &lt; 0.001); IV fluids (crystalloid and colloid; p &lt; 0.001); opioids (p &lt; 0.001), non-opioids (intravenous acetaminophen, oral acetaminophen, diclofenac; all p &lt; 0.001); incidence of post-operative nausea and vomiting and the requirement of rescue antiemetics (p &lt; 0.001). EC staging using robotic-assisted surgery was associated with significantly lower medicine and material costs attributed to IV fluids, analgesia, and antiemetics (p &lt; 0.001). As compared to open surgery, robotic surgery was associated with the total saving of $107.7 ($19.5 in IV fluids, $49.2 in analgesics, $1.33 in antiemetics, and $37.8 in material). Robotic-assisted surgical staging for endometrial cancer is associated with decreased requirement and expenditure attributable to post-operative pain, post-operative nausea and vomiting, and maintenance and replacement fluid therapy. © 2018 Springer-Verlag London Ltd., part of Springer Nature.

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2018

Journal Article

B. Bhasy, Varghese, L., Krishnan, A., and Viswanath, L., “Perceived risk and abilities for health practices related to prevention of type II diabetes mellitus among postnatal mothers with gestational diabetes mellitus”, Asian Journal of Pharmaceutical and Clinical Research, vol. 11, pp. 354-356, 2018.[Abstract]


Objectives: The study is aimed to assess the perceived risk and abilities for health practices related to prevention of Type II diabetes mellitus (DM) among postnatal mothers with gestational DM (GDM). Methods: This is a descriptive study involving 60 postnatal mothers at Amrita Institute of Medical Sciences, Kochi. Non-probability convenience sampling technique was used for the study, data collected through semi-structured questionnaire, risk perception survey for developing diabetes is used to assess the perceived risks and self-rated abilities for health practice scale is used to assess abilities for health practices. Result: Most of the postnatal mothers 55% with GDM had an average personal control and 53% of postnatal mother with GDM were high optimistic that they will not develop Type II DM. In case of diabetes risk knowledge, more than half of the mothers 54% with GDM had average perception. Based on health practices, majority of the postnatal mothers 63 % with GDM have average abilities for health practices related to prevention of Type II DM. Conclusion: Strategies should be designed to care for the postnatal mothers with GDM such as early detection and postpartum screening are mandatory to detect future DM. © 2018 The Authors.

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2018

Journal Article

K. Ganesh, Nair, R., Seethalekshmy, N., Kurian, G., Mathew, A., Sreedharan, S., and Paul, Z., “A study of clinical presentation and correlative histopathological patterns in renal parenchymal disease”, Indian Journal of Nephrology, vol. 28, pp. 28-34, 2018.[Abstract]


Suspicion and subsequent detection of renal disease is by an assessment of the urinalysis and renal function in the clinical context. Our attempt in this study is to correlate initial presenting features of urinalysis and renal function to the final histopathological diagnosis. A retrospective analysis of 1059 native kidney biopsies performed from January 2002 to June 2015 at Amrita Institute of Medical Sciences was conducted. Correlative patterns between urinalysis, renal function, and final histopathological diagnosis were studied. Five hundred and eleven (48%) patients had nephrotic syndrome. Out of these, 193 (38%) had pure: nephrotic syndrome, 181 (35.8%) had associated microhematuria, 110 (21.7%) had microhematuria and renal failure, and 27 (5.3%) had only associated renal failure. Minimal change disease (MCD) (30%), membranous nephropathy (30%), and IgA nephropathy (29%) were the major diseases in the respective groups. Five hundred and five (47.6%) patients had subnephrotic proteinuria. Out of these, 29 (5.6%) had only subnephrotic proteinuria, 134 (27%) had additional microhematuria, 300 (59%) had subnephrotic proteinuria, microhematuria, and renal failure, and 42 (8%) had subnephrotic proteinuria with renal failure. Lupus Nephritis (45% and 40%) and IgA Nephropathy (32% and 21%) were the major disorders in the subgroups respectively. Forty-two patients (3.7%) were biopsied for isolated renal failure with bland urinary sediment. Cast nephropathy and acute interstitial nephritis were the major diseases. Out of 89 patients with diabetes who were biopsied, 15 (16.8%) had diabetic nephropathy, 45 (50.5%) had no diabetic nephropathy, and 29 (32.5%) had diabetic nephropathy along with a non-diabetic renal disease. Postinfectious glomerulonephritis was the major glomerular disease. IgA nephropathy (22.2%) and membranous nephropathy (15.5%) were the major diseases in patients with diabetes with no diabetic nephropathy. In our population, MCD and membranous nephropathy formed the majority of diseases in biopsied nephrotic syndrome. Added microhematuria did not seem to decrease the incidence of either disease on the whole. We found a significant number of patients with membranous nephropathy with nephrotic syndrome, microhematuria, and additional renal failure. IgA nephropathy formed a majority of cases with nephrotic syndrome, microhematuria, and renal failure. The presence of renal failure regardless of other abnormalities in urinalysis showed a trend toward IgA nephropathy. Membranous nephropathy may have a more varied presentation than was originally thought and IgA nephropathy presenting as nephrotic syndrome may not be uncommon. MCD is the major subgroup of diseases in the pediatric population and presents both as nephrotic syndrome as well as nephrotic syndrome with microhematuria. Thus, urinalysis and renal failure may be a valuable tool in assessing renal disease. © 2018 Medknow Publications. All rights reserved.

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2018

Journal Article

N. Bhavani, Bhadran, K., Nair, V., Menon, U. V., Pavithran, P. V., Menon, A. S., Abraham, N., Pankaj, A., and Kumar, H., “Treatment outcomes in pediatric differentiated thyroid carcinoma.”, Journal of Pediatric Endocrinology and Metabolism, 2018.

2018

Journal Article

P. S. Ariyannur, Vikkath, N., and Pillai, A. B., “Cerebrospinal Fluid Hyaluronan and Neurofibromatosis Type 2.”, Cancer Microenviron, 2018.[Abstract]


Neurofibromatosis type 2 (NF-2) is associated with mainly three types of recurrent benign tumors restricted to the central nervous system: schwannoma, meningioma and ependymoma. The absence of the protein NF2/Merlin causes an uninterrupted cell proliferation cascade originating from an abnormal interaction between an extracellular mucopolysaccharide, hyaluronan (HA), and schwann cell surface CD44 receptor, which has been identified as one of the central causative factors for schwannoma. Most tumors in NF-2 have a predilection to originate from either arachnoid cap cells or schwann cells of the cisternal portion of nerve rootlets that share a continuous exposure to cerebrospinal fluid (CSF). We hypothesize that the CSF HA may play a role in tumorigenesis in NF-2. In a prospective analysis over a period of one year, the levels of medium to low molecular weight HA (LMW HA) was estimated in the CSF of three subjects with central schwannomas and compared against that of age-sex matched controls, using Cetyltrimethylammonium bromide coupled turbidimetric assay and found to be seventeen-fold higher in the schwannoma subjects compared to the controls. HA was observed to be actively secreted by cultured schwannoma cells isolated from tumor tissues commensurate with their proliferation rate. On cell viability index analysis to compare the cell proliferation of astrocytoma cells with LMW HA vs. oligomeric HA (OHA), we found a decrease in cell proliferation of up to 30% with OHA. The study provides initial evidence that CSF HA may have a central role in the tumorigenesis of schwannoma in NF-2.

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2018

Journal Article

G. K. Dash, Rathore, C., Jeyaraj, M. K., Wattamwar, P., Sarma, S. P., and Radhakrishnan, K., “Predictors of seizure outcome following resective surgery for drug-resistant epilepsy associated with focal gliosis.”, J Neurosurg, pp. 1-9, 2018.[Abstract]


OBJECTIVE The authors studied the clinical characteristics and postoperative outcomes of drug-resistant epilepsy associated with focal gliosis. METHODS From their epilepsy surgery database, the authors selected the patients with drug-resistant epilepsy and MRI-defined focal gliosis who underwent focal resective surgery. All patients underwent standard presurgical evaluation. Intracranial electroencephalography (EEG) was performed in patients with discordant presurgical data, ill-defined lesions, and lesions close to eloquent regions. Completeness of resection was defined on the basis of extraoperative and intraoperative electrocorticography studies. Favorable postoperative outcome was defined as Engel class I outcome during the last 2 years of follow-up. RESULTS Sixty-six patients fulfilled inclusion criteria. An initial precipitating injury was present in 38 (57.6%) patients, mainly in the form of perinatal injury (n = 10), trauma (n = 10), and meningoencephalitis (n = 8). Gliosis involved a single lobe in 38 (57.6%) patients and 2 adjacent lobes in 14 (21.2%) patients; the remaining 14 (21.2%) patients had multilobar gliosis. In patients with unilobar or bilobar gliosis, the posterior region of the head was involved in 34 (65%) patients and the frontal lobes in 12 (23%) patients. During a median follow-up of 4 years (range 2-9 years), 41 (62.1%) patients had favorable outcome. On multivariate analysis, the presence of a well-defined aura (p = 0.019), electrocorticographically defined completeness of resection (p = 0.024), and normal postoperative EEG findings at 1 year (p = 0.003) were predictive of favorable postoperative seizure outcome. CONCLUSIONS Focal gliosis is a common etiology for drug-resistant extratemporal epilepsy in developing countries and is most often located in the posterior region of the head. The majority of these patients have perinatal injuries or neurological infections as initial precipitating injuries. Patients with focal gliosis have good postoperative seizure outcomes after well-planned resective surgery.

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2018

Journal Article

K. Gurumurthy, Narasimha, H. Belgode, Wyawahare, M., and Biswal, N., “Leptospirosis: a diagnostic conundrum.”, Trop Doct, p. 49475518788470, 2018.[Abstract]


Leptospirosis is a serious public health concern worldwide. It is highly endemic in the Andaman Islands and its prevalence is increasing in other Indian states. Clinical features are non-specific and diagnosis relies on laboratory confirmation. The gold standard is microscopic agglutination testing, but this is not widely available. Real-time polymerase chain reaction testing of LipL32 antigen provides the earliest detection of pathogenic Leptospira in the body. We found it to be 100% specific, but it should be used in the first 10 days of illness for reliable results.

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2018

Journal Article

G. Singh, Ganguly, K. K., Banerji, M., Addlakha, R., Shah, U., Tripathi, M., Saxena, V., Vohra, H., Wakankar, Y., Sharma, M., and Radhakrishnan, K., “Marriage in people with epilepsy: A compelling theme for psycho-behavioral research.”, Seizure, vol. 62, pp. 127-130, 2018.[Abstract]


People with epilepsy frequently experience problems in marriage including reduced marital prospects, poor marital outcomes and diminished quality of married life. Conversely, marriage might impact epilepsy self-management and quality of life in people with epilepsy. There is little in published literature on marriage and epilepsy, so there is a need for psycho-behavioral research. Here, we focus on arranged marriages which, although now rare in western cultures, are widely prevalent in South Asian communities. Arranged marriages, in which families rather than individuals choose marital partners, are particularly problematic because epilepsy is frequently hidden during marital negotiations as well as later. From the psycho-behavioral perspective, marital prospects, outcomes and satisfaction should be examined in relation to the type of marriage (arranged vs. love) and whether or not epilepsy is hidden. Additionally, culturally-relevant tools to appraise marital quality and epilepsy self-management within marriage should be developed. The main objective should be to develop a multi-sectorial action plan with interventions at several different levels involving different stakeholders to mitigate stigma associated with epilepsy in matrimony.

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2018

Journal Article

N. Subramaniam, Murthy, S., Balasubramanian, D., Low, T. - H. Hubert, Vidhyadharan, S., Clark, J. R., Thankappan, K., and Iyer, S., “Adverse pathologic features in T1/2 oral squamous cell carcinoma classified by the American Joint Committee on Cancer eighth edition and implications for treatment.”, Head Neck, 2018.[Abstract]


BACKGROUND: The American Joint Committee on Cancer (AJCC) eighth edition has incorporated depth of invasion into TNM classification of oral cavity squamous cell carcinoma (SCC) due to the prognostic impact on recurrence and survival. After reclassifying our patients with T1 to T2 oral cavity SCC according to these recommendations, we intended to study the effect of adverse pathological features (perineural invasion [PNI], lymphovascular invasion, and differentiation) on overall survival (OS).

METHODS: We conducted a retrospective analysis of 442 patients with T1 to T2 oral cavity SCC. Univariate and multivariate analysis was performed for impact of adverse pathological features on OS.

RESULTS: For the newly reclassified T1 to T2 oral cavity tumors, on multivariate analysis, the prognostically relevant parameters were PNI (P = .032) and differentiation (P = .009). Increasing adverse pathological features resulted in worse survival (P = .005).

CONCLUSION: Incorporation of PNI and differentiation better reflect prognostic outcome in oral cavity tumors classified as T1 to T2 as per the new AJCC eighth edition. Increasing adverse pathological features resulted in worse survival.

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2018

Journal Article

S. Vidhyadharan, Thankappan, K., Janarthanan, R., Balasubramanian, D., Sharma, M., Mathew, J., Sudheer, O. Vayoth, and Iyer, S., “Gastro-omental free flap for reconstruction of tongue defects.”, Oral Oncol, vol. 83, pp. 134-139, 2018.[Abstract]


OBJECTIVES: The purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects.

MATERIALS AND METHODS: This is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro-omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented.

RESULTS: Five patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy.

CONCLUSION: Gastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well.

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2018

Journal Article

N. Subramaniam, Balasubramanian, D., Rka, P., Rathod, P., Murthy, S., Vidhyadharan, S., Rajan, S., Paul, J., Thankappan, K., and Iyer, S., “Peri-operative outcomes following major surgery for head and neck cancer in the elderly: institutional audit and case-control study.”, J Laryngol Otol, pp. 1-6, 2018.[Abstract]


<p><strong>OBJECTIVE: </strong>Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.</p>

<p><strong>METHODS: </strong>In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50-60 years, and univariate analysis was performed.</p>

<p><strong>RESULTS: </strong>Elderly patients had a reduced performance status (p &lt; 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p &lt; 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).</p>

<p><strong>CONCLUSION: </strong>Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.</p>

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2018

Journal Article

J. Nayar, Nair, S. S., and George, N. Annie, “Is LNG-IUS the One-Stop Answer to AUB?”, J Obstet Gynaecol India, vol. 68, no. 4, pp. 253-257, 2018.[Abstract]


A systematic search of the literature available on the use of Levonorgestrel intra-uterine system (LNG-IUS) in women with abnormal uterine bleeding was done. This included PubMed searches up to February 2017 as well as references available with the authors. LNG-IUS usage in other situations was not included in the study. Each relevant published article was evaluated as to whether it served the purpose of this review. Available data show that LNG-IUS is certainly the one-stop answer to AUB, providing a safe and cost-effective treatment and being a substitute for hysterectomy in most women with AUB.

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2018

Journal Article

S. Harikrishnan, Sanjay, G., Ashishkumar, M., Menon, J., Rajesh, G. Nair, Kumar, R. Krishna, A Koshy, G., Attacheril, T. V., George, R., Punnoose, E., Ashraf, S. M., Arun, S. R., Cholakkal, M., and Jeemon, P., “Pulmonary hypertension registry of Kerala, India (PRO-KERALA) - Clinical characteristics and practice patterns.”, Int J Cardiol, vol. 265, pp. 212-217, 2018.[Abstract]


BACKGROUND: </strong>Epidemiological data on pulmonary hypertension (PH) are scarce from developing countries including India.

METHODS: </strong>We established a multi-center registry of PH, the PRO-KERALA registry, in Kerala, India. Fifty hospitals enrolled consecutive adult (&gt;18 years) patients for one year. Echocardiographic criteria (right ventricular systolic pressure - RVSP &gt; 50 mmHg) or invasively obtained mean pulmonary artery pressure &gt; 25 mmHg was the criteria for entry.

RESULTS: </strong>There were 2003 patients (52% Women, mean age 56 ± 16.1 years) enrolled. The mean RVSP was 68.2 (SD = 17.9) mmHg. Majority of the study participants (59%) belonged to group 2 of the WHO Nice Classification 2013 (PH secondary to left heart disease). One-fifth (21.2%) belonged to group 1, while 13.3%, 3.8% and 2.4% of the study population belonged to groups 3, 4 and 5 respectively. More than a quarter (27%) reported PH due to left heart disease with valvular disease etiology; while 20.7% had coronary artery disease. The other common etiological factors were chronic obstructive pulmonary disease (10.6%), congenital heart disease (14.6%), idiopathic pulmonary hypertension (5.8%), and chronic thromboembolic pulmonary hypertension (3.8%). Only one of two patients with pulmonary artery hypertension was receiving PH specific therapies. The use of combination therapy was negligible and PH-specific therapies were prescribed off-label to a small proportion of patients too.

CONCLUSION: </strong>PRO-KERALA is the first PH registry from South Asia and the second largest globally. Left heart diseases attribute to three fifths of patients with PH. Utilization rates of PH specific drug therapies are remarkably lower than the Western population.

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2018

Journal Article

R. K. Pathinarupothi, Durga, P., and Rangan, E. S., “Data to diagnosis in global health: A 3P approach”, BMC Medical Informatics and Decision Making, vol. 18, 2018.[Abstract]


Background: With connected medical devices fast becoming ubiquitous in healthcare monitoring there is a deluge of data coming from multiple body-attached sensors. Transforming this flood of data into effective and efficient diagnosis is a major challenge. Methods: To address this challenge, we present a 3P approach: personalized patient monitoring, precision diagnostics, and preventive criticality alerts. In a collaborative work with doctors, we present the design, development, and testing of a healthcare data analytics and communication framework that we call RASPRO (Rapid Active Summarization for effective PROgnosis). The heart of RASPRO is Physician Assist Filters (PAF) that transform unwieldy multi-sensor time series data into summarized patient/disease specific trends in steps of progressive precision as demanded by the doctor for patient's personalized condition at hand and help in identifying and subsequently predictively alerting the onset of critical conditions. The output of PAFs is a clinically useful, yet extremely succinct summary of a patient's medical condition, represented as a motif, which could be sent to remote doctors even over SMS, reducing the need for data bandwidths. We evaluate the clinical validity of these techniques using SVM machine learning models measuring both the predictive power and its ability to classify disease condition. We used more than 16,000 min of patient data (N=70) from the openly available MIMIC II database for conducting these experiments. Furthermore, we also report the clinical utility of the system through doctor feedback from a large super-speciality hospital in India. Results: The results show that the RASPRO motifs perform as well as (and in many cases better than) raw time series data. In addition, we also see improvement in diagnostic performance using optimized sensor severity threshold ranges set using the personalization PAF severity quantizer. Conclusion: The RASPRO-PAF system and the associated techniques are found to be useful in many healthcare applications, especially in remote patient monitoring. The personalization, precision, and prevention PAFs presented in the paper successfully shows remarkable performance in satisfying the goals of 3Ps, thereby providing the advantages of three A's: availability, affordability, and accessibility in the global health scenario. © 2018 The Author(s). More »»

2018

Journal Article

Gitanjali Natarajan, Sangeetha PL, and Praveen Arathil, “A Case Report of Psychotic Symptoms in Social Anxiety disorder”, Indian Journal of Psychological Medicine, 2018.

2018

Journal Article

P. Sharma and Agrawal, A., “Letter to the Editor regarding: "A novel approach to improving the interpretation of CT brain in trauma".”, Injury, vol. 49, no. 11, pp. 2093-2094, 2018.

2018

Journal Article

A. Kumar, Biswas, L., Omgy, N., Mohan, K., Vinod, V., Sajeev, A., Nair, P., Singh, S., and Biswas, R., “Colistin resistance due to insertional inactivation of the mgrB in Klebsiella pneumoniae of clinical origin: First report from India.”, Rev Esp Quimioter, vol. 31, no. 5, pp. 406-410, 2018.[Abstract]


OBJECTIVE: Mutations in mgrB, phoP/phoQ, pmrA, pmrB, pmrC, and crrABC regulatory systems have been found responsible for colistin resistance. The aim of our study was to investigate the role of alteration in mgrB gene and plasmid mediate mcr-1 and mcr-2 genes as a source of colistin resistance in 17 non duplicate Klebsiella pneumoniae clinical isolates.

METHODS: All isolates classified as resistant to colistin by VITEK 2 system (BioMerieux, Marcy I' Etoile, France) were included. Susceptibility to colistin was also determined by broth microdilution using breakpoints recommended by EUCAST (>2mg/L resistant; and ≤2mg/L susceptible). PCR amplification of mgrB gene was performed and sequenced using specific primers. Presence of mcr-1 and mcr-2 was also investigated using PCR.

RESULTS: PCR amplification of the mgrB gene of the 17 K.pneumoniae isolates revealed a larger (~1000bp) amplicon in three isolates when compared with the wild type mgrB ampiclon (250 bp). Sequencing of these amplicons showed that mgrB was disrupted by the insertion of ISKpn14, a IS element belonging to the IS1 family. Sequencing, of the 250 bp mgrB gene in the remaining 14 isolates revealed frame shift mutation after the second codon leading to a premature stop codon in only one isolate.

CONCLUSIONS: The study showed that colistin resistance in 20% of the K. pneumoniae isolates was due to loss of function of mgrB. We describe for the first-time from India, insertional inactivation of mgrB by ISKpn14 inserted at different sites, responsible for colistin resistance.

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2018

Journal Article

V. Mehta, Shetiya, S. Hegde, Kakodkar, P., Chandrashekar Janakiram, and Rizwan, S. Abdulkader, “Efficacy of herbal dentifrice on the prevention of plaque and gingivitis as compared to conventional dentifrice: A systematic review and meta-analysis.”, J Indian Soc Periodontol, vol. 22, no. 5, pp. 379-389, 2018.[Abstract]


Objective: The aim of this study was to review literature on the effects of herbal dentifrice compared to conventional dentifrice on plaque and gingival inflammation.

Materials and Methods: MEDLINE, Cochrane Central Register of Controlled Trials, and major journals were explored for studies up to September 30, 2017. A comprehensive search was designed and the articles were independently screened for eligibility by two reviewers. Randomized controlled clinical trials, in which oral prophylaxis was undertaken before the intervention was introduced into the oral cavity using toothbrush were included. Where appropriate, a meta-analysis (MA) was performed and standardized mean differences (SMDs) were calculated.

Results: Ten articles out of 1378 titles were found to meet the eligibility criteria. A MA showed that for plaque intervention the SMD was 2.14; 95% confidence interval (CI): 0.88-3.41, = 0.0009; test for heterogeneity: < 0.00001, = 96% in favor of conventional dentifrice; and for gingival inflammation, the SMD was 1.37; 95% CI: 0.49-2.26, = 0.002; test for heterogeneity: < 0.00001, = 94% which also was in favor of conventional dentifrice. Subgroup analysis for plaque intervention and gingival inflammation in case of long-term (more than 4 weeks and up to 6 months) and short-term effects (minimum of 4 weeks) of herbal dentifrice showed no difference when compared to conventional dentifrice.

Conclusion: Currently, there is no high-quality evidence to support or abnegate the anti-plaque and anti-gingivitis effects of the herbal dentifrice.

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2018

Journal Article

A. Pillai, Ratnathankom, A., Ramachandran, S. N., Suhas Udayakumaran, Pramod Subhash, and Arjun Krishnadas, “Expanding the Spectrum of Robotic Assistance in Cranial Neurosurgery.”, Oper Neurosurg (Hagerstown), 2018.[Abstract]


BACKGROUND: Robotic automation and haptic guidance have multiple applications in neurosurgery.

OBJECTIVE: To define the spectrum of cranial procedures potentially benefiting from robotic assistance in a university hospital neurosurgical practice setting.

METHODS: Procedures utilizing robotic assistance during a 24-mo period were retrospectively analyzed and classified as stereotactic or endoscopic based on the mode utilized in the ROSA system (Zimmer Biomet, Warsaw, Indiana). Machine log file data were retrospectively analyzed to compare registration accuracy using 3 different methods: (1) facial laser scanning, (2) bone fiduciary, or (3) skin fiduciary.

RESULTS: Two hundred seven cranial neurosurgical procedures utilizing robotic assistance were performed in a 24-mo period. One hundred forty-five procedures utilizing the stereotactic mode included 33% stereotactic biopsy, 31% Stereo-EEG electrode insertion, 20% cranial navigation, 7% stereotactic catheter placement, 6% craniofacial stereotactic wire placement, 2% deep brain stimulation lead placement, and 1% stereotactic radiofrequency ablation. Sixty-two procedures utilizing the haptic endoscope guidance mode consisted of 48% transnasal endoscopic, 29% ventriculoscopic, and 23% endoport tubular access. Statistically significant differences in registration accuracies were observed with 0.521 ± 0.135 mm (n = 132) for facial laser scanning, 1.026 ± 0.398 mm for bone fiduciary (n = 22), and 1.750 ± 0.967 mm for skin fiduciary (n = 30; ANOVA, P < .001).

CONCLUSION: The combination of accurate, automated stereotaxy with image and haptic guidance can be applied to a wide range of cranial neurosurgical procedures. The facial laser scanning method offered the best registration accuracy for the ROSA system based on our retrospective analysis.

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2018

Journal Article

A. Beyens, Albuisson, J., Boel, A., Al-Essa, M., Al-Manea, W., Bonnet, D., Bostan, O., Boute, O., Busa, T., Canham, N., Cil, E., Coucke, P. J., Cousin, M. A., Dasouki, M., De Backer, J., De Paepe, A., De Schepper, S., de Silva, D., Devriendt, K., De Wandele, I., Deyle, D. R., Dietz, H., Dupuis-Girod, S., Fontenot, E., Fischer-Zirnsak, B., Gezdirici, A., Ghoumid, J., Giuliano, F., Baena, N., Haider, M. Z., Hardin, J. S., Jeunemaitre, X., Klee, E. W., Kornak, U., Landecho, M. F., Legrand, A., Loeys, B., Lyonnet, S., Michael, H., Moceri, P., Mohammed, S., Muiño-Mosquera, L., Nampoothiri, S., Pichler, K., Prescott, K., Rajeb, A., Ramos-Arroyo, M., Rossi, M., Salih, M., Seidahmed, M. Z., Schaefer, E., Steichen-Gersdorf, E., Temel, S., Uysal, F., Vanhomwegen, M., Van Laer, L., Van Maldergem, L., Warner, D., Willaert, A., Ii, T. R. Collins, Taylor, A., Davis, E. C., Zarate, Y., and Callewaert, B., “Correction: Arterial tortuosity syndrome: 40 new families and literature review.”, Genet Med, 2018.[Abstract]


In the published version of this paper the author Neus Baena's name was incorrectly given as Neus Baena Diez. This has now been corrected in both the HTML and PDF versions of the paper.

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2018

Journal Article

R. Krishnan Pathinarupothi, Durga, P., and Rangan, E. Srihari, “Data to diagnosis in global health: a 3P approach.”, BMC Med Inform Decis Mak, vol. 18, no. 1, p. 78, 2018.[Abstract]


BACKGROUND: With connected medical devices fast becoming ubiquitous in healthcare monitoring there is a deluge of data coming from multiple body-attached sensors. Transforming this flood of data into effective and efficient diagnosis is a major challenge.

METHODS: To address this challenge, we present a 3P approach: personalized patient monitoring, precision diagnostics, and preventive criticality alerts. In a collaborative work with doctors, we present the design, development, and testing of a healthcare data analytics and communication framework that we call RASPRO (Rapid Active Summarization for effective PROgnosis). The heart of RASPRO is Physician Assist Filters (PAF) that transform unwieldy multi-sensor time series data into summarized patient/disease specific trends in steps of progressive precision as demanded by the doctor for patient's personalized condition at hand and help in identifying and subsequently predictively alerting the onset of critical conditions. The output of PAFs is a clinically useful, yet extremely succinct summary of a patient's medical condition, represented as a motif, which could be sent to remote doctors even over SMS, reducing the need for data bandwidths. We evaluate the clinical validity of these techniques using SVM machine learning models measuring both the predictive power and its ability to classify disease condition. We used more than 16,000 min of patient data (N=70) from the openly available MIMIC II database for conducting these experiments. Furthermore, we also report the clinical utility of the system through doctor feedback from a large super-speciality hospital in India.

RESULTS: The results show that the RASPRO motifs perform as well as (and in many cases better than) raw time series data. In addition, we also see improvement in diagnostic performance using optimized sensor severity threshold ranges set using the personalization PAF severity quantizer.

CONCLUSION: The RASPRO-PAF system and the associated techniques are found to be useful in many healthcare applications, especially in remote patient monitoring. The personalization, precision, and prevention PAFs presented in the paper successfully shows remarkable performance in satisfying the goals of 3Ps, thereby providing the advantages of three A's: availability, affordability, and accessibility in the global health scenario.

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2018

Journal Article

S. Auvin, Wirrell, E., Donald, K. A., Berl, M., Hartmann, H., Valente, K. D., Van Bogaert, P., J Cross, H., Osawa, M., Kanemura, H., Aihara, M., Guerreiro, M. M., Samia, P., Vinayan, K. Puthenveet, Smith, M. Lou, Carmant, L., Kerr, M., Hermann, B., Dunn, D., and Wilmshurst, J. M., “Systematic review of the screening, diagnosis, and management of ADHD in children with epilepsy. Consensus paper of the Task Force on Comorbidities of the ILAE Pediatric Commission.”, Epilepsia, 2018.[Abstract]


Attention-deficit/hyperactivity disorder (ADHD) is a common and challenging comorbidity affecting many children with epilepsy. A working group under the International League Against Epilepsy (ILAE) Pediatric Commission identified key questions on the identification and management of ADHD in children with epilepsy. Systematic reviews of the evidence to support approaches to these questions were collated and graded using criteria from the American Academy of Neurology Practice Parameter. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements were followed, with PROSPERO registration (CRD42018094617). No increased risk of ADHD in boys with epilepsy compared to girls with epilepsy was found (Level A). Valproate use in pregnancy is associated with inattentiveness and hyperactivity in offspring (1 class I study), and children with intellectual and developmental disabilities are at increased risk of ADHD (Level A). Impact of early seizure onset on development of ADHD was unclear (Level U), but more evident with poor seizure control (Level B). ADHD screening should be performed from 6 years of age, or at diagnosis, and repeated annually (Level U) and reevaluated after change of antiepileptic drug (AED) (Level U). Diagnosis should involve health practitioners with expert training in ADHD (Level U). Use of the Strength and Difficulties Questionnaire screening tool is supported (Level B). Formal cognitive testing is strongly recommended in children with epilepsy who are struggling at school (Level U). Behavioral problems are more likely with polytherapy than monotherapy (Level C). Valproate can exacerbate attentional issues in children with childhood absence epilepsy (Level A). Methylphenidate is tolerated and effective in children with epilepsy (Level B). Limited evidence supports that atomoxetine is tolerated (Level C). Multidisciplinary involvement in transition and adult ADHD clinics is essential (Level U). In conclusion, although recommendations could be proposed for some of the study questions, this systematic review highlighted the need for more comprehensive and targeted large-population prospective studies.

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2018

Journal Article

S. Kasturi, Balaji, S., Sudhakar, A., Sunil, G. S., Kottayil, B. P., Bayya, P. Reddy, and Kumar, R. Krishna, “Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot.”, Pediatr Cardiol, 2018.[Abstract]


The long-term outcome after repair of tetralogy of Fallot (TOF) is critically dependent pulmonary valve competence that is compromised by trans-annular patch (TAP). We compared a new echocardiographic index [pulmonary annulus index (PAI)] to conventional methods of predicting need for TAP in infants undergoing TOF repair. Consecutive infants undergoing TOF repair were prospectively studied. Pre-operative aortic and pulmonary annuli and main pulmonary artery (MPA) diameters were measured and z scores determined. PAI was a ratio of observed to expected pulmonary annulus (PA) diameter. TAP was based on intra-operative sizing by surgeons blinded to PAI values. Receiver operator curves (ROC) were generated for all PAI, MPA z scores and pulmonary annulus z scores. Of 84 infants (8.6 ± 2.6 months; 7.5 ± 1.3 kg), 36 needed TAP (43%). All the three indices viz. PAI, Pulmonary annulus and MPA z scores performed similarly in predicting need for TAP (ROC curves ~ 80%). Combining cut-offs of MPA z scores (> - 3.83) with either PAI (> 0.73) or PA z score (> - 1.83) predicted avoidance of TAP with ~ 90% accuracy. When both PAI and MPA z scores were below the cut-offs there was an 80% likelihood of TAP. Failure to predict TAP was associated with unicommisural pulmonary valves. PAI was equal to PA z scores in predicting need for TAP during repair of TOF. Combining either with MPA z scores was the most accurate method of prediction. Failure of prediction was mainly due to presence of a unicommissural pulmonary valve.

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2018

Journal Article

G. G. Salve, Jain, S. A., Sharma, B., Nimbalkar, M. S., Katkade, S. S., Kurien, J., Bhadane, N. S., Dalvi, B. V., Kumar, R. Krishna, and Shivaprakash, K., “Intraoperative customized double-patch device with twin sutures for multiple muscular septal defects.”, Interact Cardiovasc Thorac Surg, vol. 27, no. 3, pp. 402-409, 2018.[Abstract]


OBJECTIVES: Closure of multiple muscular ventricular septal defects (VSDs) remains a challenge because of anatomical complexity.

METHODS: We mapped all the VSDs using en face reconstruction of the right ventricular septal surface through echocardiography and then performed an 'Intraoperative Customized Double-Patch Device' technique to surgically close them in 39 patients (male:female = 25:14). The median age of the patients was 6 months (2 months-10 years), and mean weight was 5.98 ± 4.21 kg. A patch of polytetrafluoroethylene was placed on the left ventricular side of the defect and another on the right ventricular side, and they were anchored to each other using 2 polypropylene sutures. Residual shunts were evaluated using intraoperative echocardiography and measurements of right atrial-pulmonary arterial saturation were taken in all patients.

RESULTS: The distribution of muscular VSDs was as follows: anterior muscular 12, posterior muscular 18, mid-muscular 11 and apical 9. The associated lesions included perimembranous VSD (n = 28), tetralogy of Fallot (n = 6), double-outlet right ventricle (n = 2) and supramitral membrane (n = 2). Mean clamp time and bypass time were 93 ± 19 min and 147 ± 26 min, respectively. Mean hospital stay was 11 ± 3.39 days with no in-hospital mortality. Five patients with significant residual shunts needed concomitant PA banding. All patients remained in New York Heart Association Class I. There was either no residual shunt (n = 3) or trivial shunt (n = 2) among the banded patients. All patients remained symptom-free and continued to thrive well at the most recent follow-up (3.48 ± 1.51 years).

CONCLUSIONS: Muscular VSDs can be mapped through en face reconstruction and closed using intraoperative customized double-patch device technique in a variety of situations with satisfactory immediate and short-term results.

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2018

Journal Article

N. Subramaniam, Murthy, S., Balasubramanian, D., Low, T. - H. H., Vidhyadharan, S., Clark, J. R., Thankappan, K., and Iyer, S., “Adverse pathologic features in T1/2 oral squamous cell carcinoma classified by the American Joint Committee on Cancer eighth edition and implications for treatment”, Head and Neck, 2018.[Abstract]


Background: The American Joint Committee on Cancer (AJCC) eighth edition has incorporated depth of invasion into TNM classification of oral cavity squamous cell carcinoma (SCC) due to the prognostic impact on recurrence and survival. After reclassifying our patients with T1 to T2 oral cavity SCC according to these recommendations, we intended to study the effect of adverse pathological features (perineural invasion [PNI], lymphovascular invasion, and differentiation) on overall survival (OS). Methods: We conducted a retrospective analysis of 442 patients with T1 to T2 oral cavity SCC. Univariate and multivariate analysis was performed for impact of adverse pathological features on OS. Results: For the newly reclassified T1 to T2 oral cavity tumors, on multivariate analysis, the prognostically relevant parameters were PNI (P =.032) and differentiation (P =.009). Increasing adverse pathological features resulted in worse survival (P =.005). Conclusion: Incorporation of PNI and differentiation better reflect prognostic outcome in oral cavity tumors classified as T1 to T2 as per the new AJCC eighth edition. Increasing adverse pathological features resulted in worse survival. © 2018 Wiley Periodicals, Inc.

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2018

Journal Article

A. Jan Battoo, Sheikh, Z. Ahmad, Thankappan, K., Mir, A. Wahid, and Haji, A. Gowhar, “Level V Clearance in Neck Dissection for Papillary Thyroid Carcinoma: A Need for Homogeneous Studies.”, Int Arch Otorhinolaryngol, vol. 22, no. 4, pp. 449-454, 2018.[Abstract]


 Papillary thyroid carcinoma has a very high rate of lateral neck node metastases, and there is almost unanimity concerning the fact that some sort of formal neck dissection must be performed to address the clinical neck disease in these cases. Although there is an agreement that levels II to IV need to be cleared in these patients, the clearance of level V is debatable.  We herein have tried to analyze various papers that have documented a structured approach to neck dissection in these patients. Moreover, we have also tried to consider this issue through various aspects, like spinal accessory nerve injury and the impact of neck recurrence on survival.  The PubMed, Medline, Google Scholar, Surveillance, Epidemiology, and End Results (SEER), and Ovid databases were searched for studies written in English that focused on lateral neck dissection (levels II-IV or II-V) for papillary thyroid carcinoma. Case reports with 10 patients or less were excluded.  The current evidence is equivocal whether to clear level V or not, and the studies published on this issue are very heterogeneous. Level II-IV versus level II-V selective neck dissections in node-positive papillary thyroid carcinoma patients is far from categorical, with pros and cons for both approaches. Hence, we feel that there is a need for more robust homogeneous data in order to provide an answer to this question.

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2018

Journal Article

P. Bijalwan, Ginil Kumar Pooleri, Kalavampara, S. V., Bhat, S., Thomas, A., Sundar, P., and Laddha, A., “Pathological outcomes and biochemical recurrence-free survival after radical prostatectomy for high-risk prostate cancer in the Indian population.”, Indian J Urol, vol. 34, no. 4, pp. 260-267, 2018.[Abstract]


Introduction: We analyzed the biochemical recurrence-free survival (BRFS) of patients with high-risk prostate cancer (HRCaP) as per the D'Amico classification undergoing radical prostatectomy (RP) at our center. We aimed to determine whether the number and type of risk factors (cT2c-T3b, prostate-specific antigen >20 ng/ml, Gleason score >7) are associated with biochemical recurrence (BCR) in HRCaP patients undergoing RP in the Indian population.

Methods: Between 2006 and 2017, 192 patients underwent RP (open RP [ORP], laparoscopic RP [LRP], and robotic RP [RRP]) at our center, of which 109 had D'Amico HR disease. Preoperative, postoperative, and pathological outcome data were analyzed for patients with HR disease as per the D'Amico classification. Subgroups were formed to determine whether an increasing number of risk factors (1, 2, or 3) were associated with poorer oncological results and early BCR. The Kaplan-Meier method with log-rank test was used to test the difference in BRFS between the groups. Univariate and multivariate analyses were done to find significant variable against BCR.

Results: According to the D'Amico criteria, 109 patients had HR, 63 patients had intermediate-risk, and 19 patients had low-risk disease. These 109 patients with HR disease were analyzed in our study (50 RRP, 33 ORP, and 26 LRP). A total of 59 (54.1%) patients had one HR factor (1HR), 44 (40%) had two HR factors (2HR), and 6 (5.5%) had three HR factors (3HR). The mean follow-up for our patient population was 21.5 ± 19 months (median 18 months; range, 0-108). Overall, the 2-year and 5-year BRFS was 45% and 35%, respectively (mean BRFS 46 ± 6 months). Two-year BRFS was 63%, 23%, and 22%, respectively, for 1HR, 2HR, and 3HR (logrank, < 0.0001). The prognostic substratification based on the three risk factors was significantly predictive for adverse pathologic features and oncologic outcomes.

Conclusion: Substratification based on the three well-defined criteria leads to a better identification of the more aggressive cancers and prediction of need for additional treatment modalities. Localized HRCaP includes a heterogeneous population of patients with variable oncological outcomes.

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2018

Journal Article

R. Liza Jose and Varma, P. Kerala, “Rationale for change in the criteria for defining severe ischemic mitral regurgitation in 2017 American College of Cardiology/American heart association guidelines.”, Ann Card Anaesth, vol. 21, no. 4, pp. 464-465, 2018.

2018

Journal Article

S. Gangadharan, Sundaram, K. R., Vasudevan, S., Ananthakrishnan, B., Balachandran, R., Cherian, A., Varma, P. Kerala, Gracia, L. Bakero, Murukan, K., Madaiker, A., Rajesh Jose, Seetharaman, R., Gopal, K., Menon, S., Thushara, M., Jose, R. Liza, Deepak, G., Vanga, S. Babu, and Jayant, A., “Predictors of acute kidney injury in patients undergoing adult cardiac surgery.”, Ann Card Anaesth, vol. 21, no. 4, pp. 448-454, 2018.[Abstract]


Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS.

Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication.

Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described.

Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population.

Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

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2018

Journal Article

A. Sreedevi, “Measles-Rubella vaccination campaign: A trust deficit?”, Journal of Postgraduate Medicine, vol. 64, no. 4, pp. 202-203, 2018.

2018

Journal Article

R. L. Jose and Varma, P. K., “Rationale for change in the criteria for defining severe ischemic mitral regurgitation in 2017 American College of Cardiology/American Heart Association guidelines”, Annals of Cardiac Anaesthesia, vol. 21, pp. 464-465, 2018.

2018

Journal Article

A. S. Kumar, Santhakumara, R. P., and Ramachandran, L., “Pomalidomide related pulmonary toxicity: A case report”, Journal of Young Pharmacists, vol. 10, pp. 487-488, 2018.[Abstract]


Pomalidomide, an analogue of thalidomide, developed as a third generation oral immunomodulatory antineoplastic agent used for the management of multiple myeloma refractory to both lenolidomide and bortezomib. It exerts a potential immunomodulatory effect in myeloma cells and T lymphocytes. We report a case of 67 year old male patient undergoing treatment for multiple myeloma presented with fever and cough. He was receiving pomalidomide 4 mg, once daily (OD). After taking pomalidomide he developed fever, cough, breathing difficulty and desaturation. He was tachycardiac and tachypenic, auscultation of chest revealed scattered crepts bilateral, ABG (arterial- blood gas) showed hypoxia and chest X-ray showed hilar opacities. MDCT (Multidetector computed tomography) pulmonology angiogram showed no pulmonary thromboembolism, consolidation involving both the lungs, bilateral minimal left pleural effusion and multiple collapsed thoracic vertebra with lytic lesions in all visualized bones. Most commonly reported hematological complaint was dose dependent bone marrow suppression presented by neutropenia, anemia and thrombocytopenia and most commonly reported non-hematological complaints were fatigue, weakness, constipation and back pain. The drug has been rarely known to cause pulmonary toxicity. We document a case report of pomalidomide related pulmonary toxicity in a patient with Multiple Myeloma and conclude that pulmonary toxicity is a potential adverse reaction of pomalidomide treatment and motivate physicians to remain aware of its clinical presentation. © 2018 EManuscript Technologies. All rights reserved.

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2018

Journal Article

P. S. Ariyannur, Vikkath, N., and Pillai, A. B., “Cerebrospinal Fluid Hyaluronan and Neurofibromatosis Type 2”, Cancer Microenvironment, 2018.[Abstract]


Neurofibromatosis type 2 (NF-2) is associated with mainly three types of recurrent benign tumors restricted to the central nervous system: schwannoma, meningioma and ependymoma. The absence of the protein NF2/Merlin causes an uninterrupted cell proliferation cascade originating from an abnormal interaction between an extracellular mucopolysaccharide, hyaluronan (HA), and schwann cell surface CD44 receptor, which has been identified as one of the central causative factors for schwannoma. Most tumors in NF-2 have a predilection to originate from either arachnoid cap cells or schwann cells of the cisternal portion of nerve rootlets that share a continuous exposure to cerebrospinal fluid (CSF). We hypothesize that the CSF HA may play a role in tumorigenesis in NF-2. In a prospective analysis over a period of one year, the levels of medium to low molecular weight HA (LMW HA) was estimated in the CSF of three subjects with central schwannomas and compared against that of age-sex matched controls, using Cetyltrimethylammonium bromide coupled turbidimetric assay and found to be seventeen-fold higher in the schwannoma subjects compared to the controls. HA was observed to be actively secreted by cultured schwannoma cells isolated from tumor tissues commensurate with their proliferation rate. On cell viability index analysis to compare the cell proliferation of astrocytoma cells with LMW HA vs. oligomeric HA (OHA), we found a decrease in cell proliferation of up to 30% with OHA. The study provides initial evidence that CSF HA may have a central role in the tumorigenesis of schwannoma in NF-2. © 2018, Springer Nature B.V.

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2018

Journal Article

D. Udayan, Khan, S., Pullanhi, U., and Kumar, A., “Fosfomycin as a promising alternative to treat urinary tract infection due to multidrug resistant uropathogens.”, Turk J Urol, vol. 44, no. 6, p. 515, 2018.

2018

Journal Article

N. Subramaniam, Balasubramanian, D., Low, T. - H. Hubert, Murthy, S., Anand, A., Prasad, C., Vijayan, S. N., Thankappan, K., and Iyer, S., “Role of adverse pathological features in surgically treated early oral cavity carcinomas with adequate margins and the development of a scoring system to predict local control.”, Head Neck, vol. 40, no. 11, pp. 2329-2333, 2018.[Abstract]


BACKGROUND: The purpose of this study was to determine the factors affecting local control in patients with T1N0 squamous cell carcinoma (SCC) of the tongue.

METHODS: We conducted a retrospective analysis of 144 patients with pT1N0 SCC of the tongue who underwent wide excision and neck dissection without adjuvant therapy.

RESULTS: The adverse pathological features associated with local control were least margin 5 mm (P = .004), infiltrative margin (P = .403), depth >4 mm (P = .136), lymphovascular invasion (P = .301), and perineural invasion (P = .342). We derived a scoring system of 10 points based on the hazard ratio for local failure; those with scores >5 points had a 5-year local control of <60%.

CONCLUSION: This study suggests patients having a margin of 5 mm need revision, however, if they do not have additional adverse pathological features (score ≤4), local control is 88% at 5 years, and they may be observed. Those who have margins over 5 mm with a total score >5 may still benefit from adjuvant therapy. Those with margins over 5 mm have improved local control (P = .029).

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2018

Journal Article

N. Sandoval, Carreño, M., Novick, W. M., Agarwal, R., Ahmed, I., Balachandran, R., Balestrini, M., Cherian, K. M., Croti, U., Du, X., Gauvreau, K., Giang, D. Thi Cam, Shastri, R., and Jenkins, K. J., “Tetralogy of Fallot Repair in Developing Countries: International Quality Improvement Collaborative.”, Ann Thorac Surg, vol. 106, no. 5, pp. 1446-1451, 2018.[Abstract]


BACKGROUND: Isolated reports from low- and middle-income countries (LMICs) for surgical results in tetralogy of Fallot (TOF) are available. The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) seeks to improve surgical results promoting reductions in infection and mortality in LMICs.

METHODS: All cases of TOF in the IQIC database performed between 2010 and 2014 at 32 centers in 20 LMICs were included. Excluded from the analysis were TOF with any associated lesions. A logistic regression analysis was performed to identify risk factors for in-hospital mortality after surgery for TOF.

RESULTS: A total of 2,164 patients were identified. There were 1,839 initial primary repairs, 200 with initial systemic-to-pulmonary artery shunt, and 125 underwent secondary repair after initial palliation. Overall mortality was 3.6% (78 of 2,164), initial primary repair was 3.3% (60 of 1,839), initial systemic-to-pulmonary artery shunt was 8.0% (16 of 200), and secondary repair was 1.6% (2 of 125; p = 0.003). Major infections occurred in 5.9% (128 of 2,164) of the entire cohort. Risk factors for death after the initial primary repair were oxygen saturation less than 90% and weight/body mass index for age below the fifth percentile (p < 0.001). The initial primary repair occurred after age 1 year in 54% (991 of 1,839). Older age at initial primary repair was not a risk factor for death (p = 0.21).

CONCLUSIONS: TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.

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2018

Journal Article

P. Kerala Varma and Dr. Hisham Ahamed, “Left Atrial Approach to Septal Myectomy: Word of Caution.”, Annals of Thoracic Surgery, vol. 106, no. 5, pp. 1591-1592, 2018.

2018

Journal Article

N. Velusamy, Thirumalaivasan, N., Bobba, K. Naidu, Podder, A., Wu, S. - P., and Bhuniya, S., “FRET-based dual channel fluorescent probe for detecting endogenous/exogenous HO/HS formation through multicolor images.”, J Photochem Photobiol B, vol. 191, pp. 99-106, 2018.[Abstract]


We have developed a FRET-based fluorescent probe (PHS1) as a combination of two different fluorophores (coumarin and naphthalimide); which can detect both exogenous and endogenous HS and HO in live cells through multicolor images. The precise overlap between UV-absorption of naphthalimide and the emission band of coumarin in probe PHS1 allows the acquisition of the self-calibrated information of dual analytes through FRET-based imaging. The UV-Vis absorption (λ 390 nm) and fluorescence emission (λ 460 nm) of probe PHS1 in the presence of HO are increased ∽35- fold and ∽15-fold respectively. It also allows the estimation of the levels of HS through enhancement of emission intensity at 550 nm. The probe PHS1 exhibits high stability against various analytes, including various pH (4-9.5). The cell viability assay data indicate that the probe is not harmful to the cancer cells. The nontoxic nature of the probe PHS1 encourages application for cancer cell labeling. The probe PHS1 can detect the level of endogenous HO, HS, and HO/HS in cancer cells through blue, green and FRET-based green channel imaging. PHS1 is a unique probe, has potential application for diagnosing cancer by providing information on the level of dual analytes (HS, HO) in cancer cells.

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2018

Journal Article

J. Pavithran, Puthiyottil, I. Vadakke, Narayan, M., Vidhyadharan, S., Menon, J. R., and Iyer, S., “Observations from a pediatric dysphagia clinic: Characteristics of children at risk of aspiration pneumonia.”, Laryngoscope, 2018.[Abstract]


OBJECTIVES: The clinical variables that are predictive of aspiration pneumonia are not clear in the pediatric population. This study was conducted in order to identify the demographic, clinical, and radiological risk factors for the development of aspiration pneumonia in children referred to the dysphagia clinic.

METHODS: A retrospective analysis of medical records of 88 children referred to the dysphagia clinic who had undergone videofluroscopic swallow study (VFSS).

RESULTS: Oropharyngeal dysphagia was found in 61.3% (54 of 88). Incidence of aspiration pneumonia was 39.8% (35 of 88).

CONCLUSION: Respiratory symptoms such as cough, choking, excessive secretions, and pharyngeal dysmotility other than aspiration in VFSS were not predictors of pneumonia. Infants and children with laryngotracheal anomalies, demonstrable aspiration in VFSS, and major cardiac illness are at risk of presenting with aspiration pneumonia. Whether gastroesophageal reflux disease (GERD) or esophageal dysmotility are causative of aspiration in the rest of the population needs to be investigated by future prospective studies.

LEVEL OF EVIDENCE: 3b. Laryngoscope, 2018.

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2018

Journal Article

R. Sankaran, Kamath, R., Nambiar, V., and Kumar, A., “A prospective study on the effects of Ayurvedic massage in post-stroke patients.”, J Ayurveda Integr Med, 2018.[Abstract]


We noted some of our stroke patients reported improvements after Ayurvedic massage, while others did not. There is a little indexed literature to support the use of this in rehabilitation. To objectively measured the differences between patients with stroke who received Ayurvedic massage in addition to standard Physiotherapy (PT) versus those who received only standard PT. Design-Prospective case control study, retrospectively analyzed Setting- Tertiary level hospital, Neuro-rehabilitation unit Participants- Fifty-two patients undergoing acute inpatient rehabilitation were prospectively followed post stroke. They were self selected one month from the event for Ayurvedic Massage with regular PT or PT alone. Twenty five received Ayurvedic massage with PT and twenty seven received only PT. All participants completed treatment. Duration- 2014-2017 Intervention- Age, gender, National Institute of Health Stroke Scale result, number of co-morbidities, and whether cases were deemed simple or complex were taken at baseline. All patients received 6 hours of physical therapy averaged over a week. Massage was delivered daily for a total of 10 sessions followed by steam application. Main Outcome Measurements:- Brunnstrom Leg progression, spasticity using the Modified Ashworth Scale (MAS), time to achieve stand with minimal assistance, Functional Independence Measure (FIM) score for walking at discharge, use of antispastic drugs at discharge were followed. Patients were categorized as simple or complicated stroke based on events prior to rehabilitation. Both simple and complicated patients who received Ayurvedic massage had lower MAS and need for antispastic drugs, achieved standing with minimal assistance sooner, and had better locomotion at discharge. All these differences were significant. Conclusion- Utilizing Ayurvedic massage in post stroke patients with flaccidity can promote faster standing with minimal assistance and lead to less need for antispastic drugs at discharge.

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2018

Journal Article

M. Aravind Prabhu, Shekhar, S., Pai, P., and Natarajan, K. Umayammal, “Atrio-Hisian block precludes preexcitation-What is the mechanism?”, J Arrhythm, vol. 34, no. 6, pp. 659-660, 2018.

2018

Journal Article

J. Sheth, Mistri, M., Bhavsar, R., Pancholi, D., Kamate, M., Gupta, N., Kabra, M., Mehta, iv, S., Nampoothiri, S., Thakker, A., Jain, V., Shah, R., and Sheth, F., “Batten disease: biochemical and molecular characterization revealing novel PPT1 and TPP1 gene mutations in Indian patients.”, BMC Neurol, vol. 18, no. 1, p. 203, 2018.[Abstract]


BACKGROUND: Neuronal ceroid lipofuscinoses type I and type II (NCL1 and NCL2) also known as Batten disease are the commonly observed neurodegenerative lysosomal storage disorder caused by mutations in the PPT1 and TPP1 genes respectively. Till date, nearly 76 mutations in PPT1 and approximately 140 mutations, including large deletion/duplications, in TPP1 genes have been reported in the literature. The present study includes 34 unrelated Indian patients (12 females and 22 males) having epilepsy, visual impairment, cerebral atrophy, and cerebellar atrophy.

METHODS: The biochemical investigation involved measuring the palmitoyl protein thioesterase 1 and tripeptidy peptidase l enzyme activity from the leukocytes. Based on the biochemical analysis all patients were screened for variations in either PPT1 gene or TPP1 gene using bidirectional Sanger sequencing. In cases where Sanger sequencing results was uninformative Multiplex Ligation-dependent Probe Amplification technique was employed. The online tools performed the protein homology modeling and orthologous conservation of the novel variants.

RESULTS: Out of 34 patients analyzed, the biochemical assay confirmed 12 patients with NCL1 and 22 patients with NCL2. Molecular analysis of PPT1 gene in NCL1 patients revealed three known mutations (p.Val181Met, p.Asn110Ser, and p.Trp186Ter) and four novel variants (p.Glu178Asnfs*13, p.Pro238Leu, p.Cys45Arg, and p.Val236Gly). In the case of NCL2 patients, the TPP1 gene analysis identified seven known mutations and eight novel variants. Overall these 15 variants comprised seven missense variants (p.Met345Leu, p.Arg339Trp, p.Arg339Gln, p.Arg206Cys, p.Asn286Ser, p.Arg152Ser, p.Tyr459Ser), four frameshift variants (p.Ser62Argfs*19, p.Ser153Profs*19, p.Phe230Serfs*28, p.Ile484Aspfs*7), three nonsense variants (p.Phe516*, p.Arg208*, p.Tyr157*) and one intronic variant (g.2023_2024insT). No large deletion/duplication was identified in three NCL1 patients where Sanger sequencing study was normal.

CONCLUSION: The given study reports 34 patients with Batten disease. In addition, the study contributes four novel variants to the spectrum of PPT1 gene mutations and eight novel variants to the TPP1 gene mutation data. The novel pathogenic variant p.Pro238Leu occurred most commonly in the NCL1 cohort while the occurrence of a known pathogenic mutation p.Arg206Cys dominated in the NCL2 cohort. This study provides an insight into the molecular pathology of NCL1 and NCL2 disease for Indian origin patients.

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2018

Journal Article

A. Howaldt, Nampoothiri, S., Quell, L. - M., Ozden, A., Fischer-Zirnsak, B., Collet, C., de Vernejoul, M. - C., Doneray, H., Kayserili, H., and Kornak, U., “Sclerosing bone dysplasias with hallmarks of dysosteosclerosis in four patients carrying mutations in SLC29A3 and TCIRG1.”, Bone, vol. 120, pp. 495-503, 2018.[Abstract]


The osteopetroses and related sclerosing bone dysplasias can have a broad range of manifestations. Especially in the milder forms, sandwich vertebrae are an easily recognizable and reliable radiological hallmark. We report on four patients from three families presenting with sandwich vertebrae and platyspondyly. The long bone phenotypes were discordant with one patient showing modeling defects and patchy osteosclerosis, while the second displayed only metaphyseal sclerotic bands, and the third and fourth had extreme metaphyseal flaring with uniform osteosclerosis. Two of the four patients had experienced pathological fractures, two had developmental delay, but none showed cranial nerve damage, hepatosplenomegaly, or bone marrow failure. According to these clinical features the diagnoses ranged between intermediate autosomal recessive osteopetrosis and dysosteosclerosis. After exclusion of mutations in CLCN7 we performed gene panel and exome sequencing. Two novel mutations in SLC29A3 were found in the first two patients. In the third family a TCIRG1 C-terminal frameshift mutation in combination with a mutation at position +4 in intron 2 were detected. Our study adds two cases to the small group of individuals with SLC29A3 mutations diagnosed with dysosteosclerosis, and expands the phenotypic variability. The finding that intermediate autosomal recessive osteopetrosis due to TCIRG1 splice site mutations can also present with platyspondyly further increases the molecular heterogeneity of dysosteosclerosis-like sclerosing bone dysplasias.

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2018

Journal Article

J. Stephen, Maddirevula, S., Nampoothiri, S., Burke, J. D., Herzog, M., Shukla, A., Steindl, K., Eskin, A., Patil, S. J., Joset, P., Lee, H., Garrett, L. J., Yokoyama, T., Balanda, N., Bodine, S. P., Tolman, N. J., Zerfas, P. M., Zheng, A., Ramantani, G., Girisha, K. M., Rivas, C., Suresh, P. V., Elkahloun, A., Alsaif, H. S., Wakil, S. M., Mahmoud, L., Ali, R., Prochazkova, M., Kulkarni, A. B., Ben-Omran, T., Colak, D., H Morris, D., Rauch, A., Martinez-Agosto, J. A., Nelson, S. F., Alkuraya, F. S., Gahl, W. A., and Malicdan, M. Christine, “Bi-allelic TMEM94 Truncating Variants Are Associated with Neurodevelopmental Delay, Congenital Heart Defects, and Distinct Facial Dysmorphism.”, Am J Hum Genet, vol. 103, no. 6, pp. 948-967, 2018.[Abstract]


Neurodevelopmental disorders (NDD) are genetically and phenotypically heterogeneous conditions due to defects in genes involved in development and function of the nervous system. Individuals with NDD, in addition to their primary neurodevelopmental phenotype, may also have accompanying syndromic features that can be very helpful diagnostically especially those with recognizable facial appearance. In this study, we describe ten similarly affected individuals from six unrelated families of different ethnic origins having bi-allelic truncating variants in TMEM94, which encodes for an uncharacterized transmembrane nuclear protein that is highly conserved across mammals. The affected individuals manifested with global developmental delay/intellectual disability, and dysmorphic facial features including triangular face, deep set eyes, broad nasal root and tip and anteverted nostrils, thick arched eye brows, hypertrichosis, pointed chin, and hypertelorism. Birthweight in the upper normal range was observed in most, and all but one had congenital heart defects (CHD). Gene expression analysis in available cells from affected individuals showed reduced expression of TMEM94. Global transcriptome profiling using microarray and RNA sequencing revealed several dysregulated genes essential for cell growth, proliferation and survival that are predicted to have an impact on cardiotoxicity hematological system and neurodevelopment. Loss of Tmem94 in mouse model generated by CRISPR/Cas9 was embryonic lethal and led to craniofacial and cardiac abnormalities and abnormal neuronal migration pattern, suggesting that this gene is important in craniofacial, cardiovascular, and nervous system development. Our study suggests the genetic etiology of a recognizable dysmorphic syndrome with NDD and CHD and highlights the role of TMEM94 in early development.

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2018

Journal Article

C. Humphries, Jaganathan, S., Panniyammakal, J., Singh, S., Goenka, S., Dorairaj, P., Gill, P., Greenfield, S., Lilford, R., and Manaseki-Holland, S., “Investigating clinical handover and healthcare communication for outpatients with chronic disease in India: A mixed-methods study.”, PLoS One, vol. 13, no. 12, p. e0207511, 2018.[Abstract]


OBJECTIVES: Research concentrating on continuity of care for chronic, non-communicable disease (NCD) patients in resource-constrained settings is currently limited and focusses on inpatients. Outpatient care requires attention as this is where NCD patients often seek treatment and optimal handover of information is essential. We investigated handover, healthcare communication and barriers to continuity of care for chronic NCD outpatients in India. We also explored potential interventions for improving storage and exchange of healthcare information.

METHODS: A mixed-methods design was used across five healthcare facilities in Kerala and Himachal Pradesh states. Questionnaires from 513 outpatients with cardiovascular disease, chronic respiratory disease, or diabetes covered the form and comprehensiveness of information exchange between healthcare professionals (HCPs) and between HCPs and patients. Semi-structured interviews with outpatients and HCPs explored handover, healthcare communication and intervention ideas. Barriers to continuity of care were identified through triangulation of all data sources.

RESULTS: Almost half (46%) of patients self-referred to hospital outpatient clinics (OPCs). Patient-held healthcare information was often poorly recorded on unstructured sheets of paper; 24% of OPC documents contained the following: diagnosis, medication, long-term care and follow-up information. Just 55% of patients recalled receiving verbal follow-up and medication instructions during OPC appointments. Qualitative themes included patient preference for hospital visits, system factors, inconsistent doctor-patient communication and attitudes towards medical documents. Barriers were hospital time constraints, inconsistent referral practices and absences of OPC medical record-keeping, structured patient-held medical documents and clinical handover training. Patients and HCPs were in favour of the introduction of patient-held booklets for storing and transporting medical documents.

CONCLUSIONS: Deficiencies in communicative practices are compromising the continuity of chronic NCD outpatient care. Targeted systems-based interventions are urgently required to improve information provision and exchange. Our findings indicate that well-designed patient-held booklets are likely to be an acceptable, affordable and effective part of the solution.

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2018

Journal Article

J. Stephen, Nampoothiri, S., Kuppa, S., Dhanya Yesodharan, Radhakrishnan, N., Gahl, W. A., and Malicdan, M. Christine, “Novel truncating mutation in TENM3 in siblings with motor developmental delay, ocular coloboma, oval cornea, without microphthalmia.”, Am J Med Genet A, vol. 176, no. 12, pp. 2930-2933, 2018.

2018

Journal Article

N. Subramaniam, Balasubramanian, D., Reddy, R., Rathod, P., Murthy, S., Vidhyadharan, S., Thankappan, K., and Iyer, S., “Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection.”, Int J Oral Maxillofac Surg, vol. 47, no. 12, pp. 1507-1510, 2018.[Abstract]


Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated. A total of 586 neck dissection specimens obtained between 2005 and 2014 from patients operated on at the study institution for floor of mouth, tongue, and buccal primaries, were evaluated for direct invasion of the gland and periglandular lymphadenopathy. Of 226 node-positive patients, 21 (9.3%) had direct gland invasion by tumour. Risk factors were tumour diameter >4cm (P=0.002) and depth of invasion >10mm (P=0.003). Determinants of periglandular lymphadenopathy were depth of invasion >10mm (P<0.001), perineural invasion (P=0.02), lymphovascular invasion (P=0.014), and moderate/poor differentiation (P<0.0001). Gland-sparing neck dissection is safe in early tumours (pT1pN0-1), with a good chance of minimizing xerostomia without radiotherapy. Larger tumours without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy may be considered for gland preservation, however the oncological safety is unclear.

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2018

Journal Article

Dhanya Yesodharan, Büschenfelde, U. Meyer Zum, Kutsche, K., K Nair, M., and Nampoothiri, S., “Goltz-Gorlin Syndrome: Revisiting the Clinical Spectrum.”, Indian J Pediatr, vol. 85, no. 12, pp. 1067-1072, 2018.[Abstract]


OBJECTIVE: To describe the varying phenotypic spectrum of Focal Dermal Hypoplasia (FDH) and to emphasize the need for identifying the condition in mildly affected females which is crucial for offering a prenatal diagnosis in subsequent pregnancy owing to the risk of having a severely affected baby.

METHODS: The phenotype-genotype correlation of 4 patients with FDH, over a period of 11 y from the genetic clinic in a tertiary care centre from Kerala, India was done.

RESULTS: All four mutation proven patients were females (2 adults and 2 children). One of the adult female subjects were mildly affected, though she had a history of having a severely affected female child who expired on day six. Among the 2 affected children, one of them had an unaffected mother and the other had an affected mother.

CONCLUSIONS: FDH has a wide clinical spectrum from very subtle findings to severe manifestations. The lethality of the condition in males and the disfigurement and multisystem involvement in females highlights the importance of confirmation of diagnosis by molecular analysis so that the family can be offered prenatal diagnosis in subsequent pregnancy.

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2018

Journal Article

T. S. Sree Durga, Pavithran, K., and P. Devi, U., “Ibrutinib in the management of non-hodgkin’s lymphoma: A case report”, Asian Journal of Pharmaceutical and Clinical Research, vol. 11, pp. 1-2, 2018.[Abstract]


Non-Hodgkin’s lymphoma (NHL) is a diverse group of lymphoid neoplasms, the prevalence of which has increased over the past few decades. NHL is diverse in the manner of presentation, response to various treatment and prognosis. The current case report describes a 40-year-old man who was diagnosed with small lymphocytic lymphoma/chronic lymphocytic leukemia in 2006. The patient had disease progression during the course of 10 years from the time of diagnosis for which he received multiple lines of chemotherapy (chlorambucil/prednisolone; rituximab/cyclophosphamide/ fludarabine; bendamustine/rituximab; and ofatumumab). However, in 2016, his disease again showed signs of progression, and hence he was started on ibrutinib 140 mg 3 times daily. After treatment with ibrutinib, there were no clinical nodes and hepatosplenomegaly, and all counts also normalized. Since the commencement of this agent, no disease progression was observed for almost 16 months. However, in July 2017, again disease progression occurred, and the patient was started on with cyclophosphamide, vincristine, and prednisone (COP) regimen. He received one cycle of COP regimen and continued on treatment with ibrutinib, and the treatment was well tolerated. In December 2017, he expired due to the progression of the disease. Ibrutinib, a Bruton’s tyrosine kinase inhibitor, appears to be safe and effective in providing long-term disease control even in refractory cases of NHL. © 2018, Innovare Academics Sciences Pvt. Ltd. All rights reserved.

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2018

Journal Article

A. K. Krishnan, Menon, P., Kumar, K. P. Gireesh, Sreekrishnan, T. P., Garg, M., and Kumar, V. S., “Electrocardiogram-guided technique: An alternative method for confirming central venous catheter tip placement”, Journal of Emergencies, Trauma and Shock, vol. 11, pp. 276-281, 2018.[Abstract]


Background: The current standard followed for assessing central venous catheter (CVC) tip placement location is through radiological confirmation using chest X-ray (CXR). Placement of CVCs under electrocardiogram (ECG) guidance may save cost and time compared to CXR. Objective: The objective of this study is to compare the accurate placement of the CVC tip using anatomical landmark technique with ECG-guided technique. Another objective is to compare CVC placement time and postprocedural complications between the two techniques. Methods and Materials: A total of 144 adult individuals, who were critically ill and required CVC placement in the Emergency Department, were included for the study. Study duration was 6 months. Anatomical landmark and ECG-guided groups were assigned 72 participants each. Analyses were performed using t and Chi square-tests. Results: It was observed that 13 (18%) in the landmark technique were malpositioned as compared to none in the ECG-guided technique (P = 0.000). The landmark group had 22 (30.6%) participants with arrhythmias during the procedure, compared to none in the ECG-guided group (P = 0.000). The landmark group revealed that 30 (41.7%) of the CVC were overinserted and required immediate repositioning, compared to none in the ECG-guided group (P = 0.000). Conclusion: ECG-guided technique was found to be more accurate for CVC tip placement than the anatomical landmark technique. Furthermore, the ECG-guided technique was more time-effective and had less complications than the anatomical landmark technique. Hence, ECG-guided CVC placement is relatively accurate, efficient, and safe and can be considered as an alternative method to conventional radiography for confirmation of CVC tip placement. © 2018 Medknow Publications.All rights reserved.

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2018

Journal Article

N. Bhavani, Bhadran, K., Nair, V., Menon, U. V., Pavithran, P. V., Menon, A. S., Abraham, N., Pankaj, A., and Kumar, H., “Treatment outcomes in pediatric differentiated thyroid carcinoma”, Journal of Pediatric Endocrinology and Metabolism, vol. 31, pp. 1117-1122, 2018.[Abstract]


Until the American Thyroid Association (ATA) guidelines on management of pediatric differentiated thyroid carcinoma (DTC) became available in 2015, all children with DTC were treated like adults. This study aims to investigate the outcome of pediatric DTC and factors predicting the response to therapy in pediatric DTC managed according to adult guidelines. Clinical records of 41 children less than 18 years of age diagnosed with DTC followed from 2007 in a single center were reviewed. According to the new ATA classification for pediatric DTC, five had low-risk, 28 had intermediate-risk and eight had high-risk disease at presentation. There was no mortality or recurrence in this cohort of pediatric DTC patients and the cure rate was 46% during a mean follow-up of 44 months when they were managed according to adult guidelines. Neither the new ATA risk classification nor any clinicopathological character was identified which could predict the response to therapy. The new ATA guidelines would have avoided 27% of the radioiodine therapies given. This study showed that DTC in children managed according to adult guidelines had a good cure rate. The new ATA guidelines on pediatric DTC might have drastically reduced the number of radioiodine therapies in the affected children. Long term prospective studies are needed to validate the benefits and risks of both these approaches. © 2018 2018 Walter de Gruyter GmbH, Berlin/Boston.

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2018

Journal Article

R. K. Pathinarupothi, Durga, P., and Rangan, E. S., “IoT Based Smart Edge for Global Health: Remote Monitoring with Severity Detection and Alerts Transmission”, IEEE Internet of Things Journal, 2018.[Abstract]


Global health which denotes equitable access to healthcare, particularly in remote-rural-developing regions, is characterized by unique challenges of affordability, accessibility, and availability for which one of the most promising technological interventions that is emerging is the Internet of Things (IoT) based remote health monitoring. We present an IoT based smart edge system for remote health monitoring, in which wearable vital sensors transmit data into two novel software engines, namely Rapid Active Summarization for effective PROgnosis (RASPRO) and Criticality Measure Index (CMI) alerts, both of which we have implemented in the IoT smart edge. RASPRO transforms voluminous sensor data into clinically meaningful summaries called Personalized Health Motifs (PHMs). The CMI alerts engine computes an aggregate criticality score. Our IoT smart edge employs a risk-stratified protocol consisting of rapid guaranteed push of alerts & PHMs directly to the physicians, and best effort pull of detailed data-on-demand (DD-on-D) through the cloud. We have carried out both clinical validation and performance evaluation of our smart edge system. The clinical validation on 183 patients demonstrated that the IoT smart edge is highly effective in remote monitoring, advance warning and detection of cardiac conditions, as quantified by three measures, precision (0.87), recall (0.83), and F1-score (0.85). Furthermore, performance evaluation showed significant reductions in the bandwidth (98%) and energy (90%), thereby making it suitable for emerging narrow-band IoT networks. In the deployment of our system in the cardiology institute of our University hospital, we observed that our IoT smart edge helped to increase the availability of physicians by 59%. Hence, our IoT smart edge system is a significant step towards addressing the requirements for global health. IEEE

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2018

Journal Article

U. C. Ghoshal, Sachdeva, S., Pratap, N., Verma, A., Karyampudi, A., Misra, A., Abraham, P., Bhatia, S. J., Bhat, N., Chandra, A., Chakravartty, K., Chaudhuri, S., Chandrasekar, T. S., Gupta, A., Goenka, M., Goyal, O., Makharia, G., Prasad, V. G. Mohan, Anupama, N. K., Paliwal, M., Ramakrishna, B. S., Reddy, D. N., Ray, G., Shukla, A., Sainani, R., Sadasivan, S., Singh, S. P., Upadhyay, R., and Venkataraman, J., “Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology.”, Indian J Gastroenterol, vol. 37, no. 6, pp. 526-544, 2018.[Abstract]


The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.

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2018

Journal Article

Riju R. Menon, Gopalakrishnan, N., Babu, M., Pradeep Jacob, and G Krishna, P., “The Outcome of Papillary Thyroid Cancer Associated with Graves’ Disease: A Case Control Study”, Journal of Thyroid Research, vol. 2018, p. 5, 2018.[Abstract]


INTRODUCTION:
Thyroidectomy is now a less popular therapeutic option for Graves' disease. The frequency of thyroid nodule and the cancer risk of these nodules accompanying Graves' disease are controversial. The outcome of thyroid cancers coexisting with Graves' disease is debated.

STUDY DESIGN:
Designed as retrospective case control study of papillary thyroid cancers associated with Graves' disease and those with euthyroid background. Pathological characteristics and outcome of papillary thyroid cancers in the two groups were compared.

RESULTS:
The tumour characteristics did not differ significantly in the groups. The patients were followed for a mean period of 77.32 months and found significant incidences of disease progression in patients with papillary thyroid cancer associated with Graves' disease (p = 0.034; OR 2.747, CI 1.078-7.004). Disease progression as new distant metastases mostly in skeletal locations was high in this group compared to euthyroid group (p = 0.027; OR 4.121, CI 1.008-15.600). There was higher incidence of cumulative metastatic diseases in papillary thyroid cancer associated with Graves' disease.

CONCLUSION:
Papillary thyroid cancers associated with Graves' disease show aggressive biological behaviour and favoured site of distant metastases was osseous locations. Early diagnosis by routine screening of Graves' disease patients with ultrasound imaging and aspiration studies is recommended.

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2018

Journal Article

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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2018

Journal Article

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

Journal Article

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

Journal Article

T. P.H.A, N, R., and Anu Sasidharan, “Child Sexual Abuse – The Current Scenario”, Amrita J Med , vol. 14, 1 vol., pp. 3 - 7, 2018.

2018

Journal Article

S. Kumar Gupta, Siddharth, V., Belagere, M. R., Stewardson, A. James, Kant, S., Dr. Sanjeev K. Singh, and Singh, N., “National survey of infection control programmes in South Asian association for Regional Cooperation countries in the era of patient safety.”, Indian J Med Microbiol, vol. 36, no. 4, pp. 577-581, 2018.[Abstract]


<p><b>Background: </b>The implementation of hospital infection prevention and control (IPC) in south Asia is not well described. We aimed to assess IPC programmes in hospitals in this region and explore opportunities for improvement.</p>

<p><b>Methods: </b>Attendees from hospitals in the South Asian Association for Regional Cooperation (SAARC) region who were at one of four National Initiative for Patient Safety workshops organised by All India Institute of Medical Sciences (New Delhi) from 2009 to 2012 were invited to complete a semi-structured questionnaire. The survey addressed six main components of IPC programmes.</p>

<p><b>Results: </b>We received responses from 306 participants from 82 hospitals. Five key opportunities for improvement emerged: (1) lack of healthcare epidemiologists, (2) relative infrequency of antibiotic guidelines (53%) and prescribing audits (33%) (3) lack of awareness of needle stick injury rates (84%) (4) only 47% of hospitals were prepared for surge capacity for patients with infectious diseases, and (5) limited coordination of hospital infection control personnel with other support services (55%-66%).</p>

<p><b>Conclusion: </b>These results outline IPC challenges in the SAARC region and may be useful to guide future quality improvement initiatives.</p>

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2018

Journal Article

A. John Kurien, Rejiv, A., Premarajan, A., Renjini, B. A., and Rakesh, P. S., “Breakfast-eating Habits of School-Going Adolescents in Kochi, Kerala, India.”, Natl Med J India, vol. 31, no. 3, p. 188, 2018.

2018

Journal Article

N. Puthenveettil, Mohan, A., Sunil Rajan, Jerry Paul, and Kumar, L., “Labor Epidural Analgesia: Comparison of Two Different Intermittent Bolus Regimes.”, Anesth Essays Res, vol. 12, no. 4, pp. 832-836, 2018.[Abstract]


Background: Optimal labor analgesia can be provided with epidural by addition of opioid to the local anesthetic.

Aims: The aim of this study is to compare the efficacy of labor epidural bolus regimes 20 mL of 0.1% ropivacaine with 40 μg fentanyl versus 15 mL of 0.1% ropivacaine with 15 μg fentanyl as epidural bolus dose.

Settings and Design: This was prospective double-blinded randomized study.

Materials and Methods: After approval from the Institutional Ethical Committee, 50 consenting parturients in active labor were allotted into two groups by closed envelope technique. Group A received 20 mL of 0.1% ropivacaine with 40 μg fentanyl, whereas Group B received 15 mL of 0.1% ropivacaine with 15 μg fentanyl as an epidural bolus dose. The onset, duration of analgesia, motor block, top-up doses required, consumption of ropivacaine, and fentanyl and fetomaternal outcome were compared.

Statistical Analysis Used: Numerical variables are expressed as a mean and standard deviation and categorical variables are expressed as frequency and percentages. To obtain the association between categorical variables and different doses Fischer's exact test was applied. To compare clinical parameters between different drug doses independent two-sample -test were applied. Mann-Whitney U-test applied for nonparametric data. Results: Effective labor analgesia with no motor blockade was observed in both groups with no failure rate. Duration of analgesia was significantly longer in Group A (166.8 ± 54.64 vs. 100.2 ± 32.39 min &lt; 0.001). The onset of analgesia was faster in Group A (88% vs. 16% within 7 min, &lt; 0.001).

Conclusion: Labor epidural analgesia with larger volume boluses produces faster onset and prolonged duration of analgesia.

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2018

Journal Article

A. Prakash, Anoop K Koshy, B, H. Rao, and Venu, R. P., “Endoscopic Ultrasound-Guided Rendezvous Procedure for a Nondilated, Leaking Pancreatic Duct”, ACG Case Rep J, vol. 5, p. e105, 2018.[Abstract]


Pancreatic duct (PD) leak leading to pancreatic ascites is a serious complication of chronic pancreatitis. Endoscopic management with endoscopic retrograde cholangiopancreatography (ERCP) has been found to be successful; however, if selective cannulation of the PD is unsuccessful, an endoscopic ultrasound-guided rendezvous procedure can help in bridging PD leaks, provided the duct is dilated. We report a successful endoscopic ultrasound-guided rendezvous procedure in a patient with PD leak, pancreatic ascites, and a nondilated duct with failed ERCP who was a poor candidate for surgery. The pancreatic ascites resolved following the procedure.

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2018

Journal Article

D. Devadas, Dr. Minnie Pillay, and Sukumaran, T. Thottiyil, “A Cadaveric Study on Variations in Branching Pattern of External Carotid Artery”, Anat Cell Biol, vol. 51, no. 4, pp. 225-231, 2018.[Abstract]


<p>the head and neck deserve special importance and protection from iatrogenic injury during radiological evaluations and surgical interventions. The present study was carried out over a period of 4 years from 2012-2016 to assess the variant anatomy of external carotid artery. The external carotid artery and its branches were dissected bilaterally in 40 formalin embalmed cadavers. The external carotid artery was traced from its origin to termination and variations in the branching pattern as well as the level of the carotid bifurcation were observed and analysed. A higher carotid bifurcation was observed in 25% cases. The linguofacial trunk was the commonest variation noted in the branching pattern seen in 20% cases. A single case of unilateral thyrolinguofacial trunk was also observed. The external carotid artery gave rise to accessory branches in 7.5% cases namely the superior laryngeal, accessory ascending pharyngeal and masseteric branches. A slender branch to the internal jugular vein was also observed in one case. These findings may provide further insight into the understanding of the vascular anatomy of the carotid triangle to the curious student, the discerning radiologist and the vigilant surgeon to avert complications and help improve overall treatment outcome.

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2018

Journal Article

N. Puthenveettil, Sunil Rajan, Mohan, A., Jerry Paul, and Kumar, L., “Sphenopalatine Ganglion Block for Treatment of Post-dural Puncture Headache in Obstetric Patients: An Observational Study”, Indian J Anaesth, vol. 62, no. 12, pp. 972-977, 2018.[Abstract]


Background and Aims: Post-dural puncture headache (PDPH) is a consequence of spinal and epidural anaesthesia in approximately 1% of obstetric patients. The gold standard for its treatment is epidural blood patch. Sphenopalatine ganglion block (SPGB) has been proposed as a non-invasive intervention with minimal adverse effect. The primary objective of this study was to assess the efficacy of SPGB for treatment of PDPH. Secondary objectives were to assess onset of analgesia, duration of block and adverse effects.

Methods: Twenty parturients diagnosed to have PDPH, resistant to standard treatment modalities such as intravenous fluids, abdominal binder, bed rest and caffeine, were recruited into this prospective observational study. Patients were allocated to either of the two groups. Group A patients received paracetamol 1 g 8 hourly intravenously for a day. If adequate pain relief was not achieved, diclofenac 75 mg 12 hourly was added. Patients in group B received SPGB with 2% lignocaine. Fisher's exact test, Mann-Whitney test and independent sample -test were used for statistical analysis.

Results: About 88.89% patients in group B had adequate pain relief within 5 min of block ( &lt; 0.001). Pain was significantly lower in Group B for up to 8 h, with no adverse effects.

Conclusion: SPGB is an effective initial modality for managing severe headache in patients with PDPH.

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2018

Journal Article

Rakesh P. S., Mainu, T. T. Carmel R., Raj, A., Babu, D., Rajiv, M., K Mohandas, S., Das, A., and Balasubramanian, A., “Investigating a Community Wide Outbreak of Hepatitis A in Kerala, India.”, J Family Med Prim Care, vol. 7, no. 6, pp. 1537-1541, 2018.[Abstract]


Background: There was an outbreak of acute hepatitis in Nellikuzhy panchayat of Kothamangalam taluk, Ernakulam district, Kerala, during November and early December 2016. Objective of this study is to describe the epidemiological features of the outbreak and to identify the probable source.

Materials and Methods: The outbreak was defined in terms of time, place, and person. A hypothesis was generated and tested using a case-control study. Cases were selected by simple random sampling from the line list and controls were age-matched neighborhood individuals without any history of jaundice. Chi-square test, univariate analysis, and multi-variate logistic regression analyses were done to identify the probable risk factors.

Results: Around 223 hepatitis A cases were identified. Attack rate was found to be highest among the age group of 16-30 years at 1.44% and was eight times higher among males. Epidemic curve suggested a point source outbreak possibly from exposure to food or water from a newly opened hotel in the area. The case-control study confirmed the hypothesis with a statistically significant association between cases and history of exposure to food from the hotel [OR 120; 95% CI 14.6-996.2; value &lt; 0.001].

Conclusion: Observations and results of the case-control study revealed that the probable source of the Hepatitis A outbreak at Nellikuzhy panchayat was a hotel. The study findings also add evidences to the changing epidemiological pattern of hepatitis A in Kerala, and warrant the necessity to enforce food safety rules in the State.

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2018

Journal Article

L. Premnazir, Nair, A. S., Suji, S., Das, A. M., Divyamol, S., and Rakesh P. S., “Geriatric Club Attached to a Primary Care Hospital as an Effort to Physically, Socially, and Mentally Engage Elderly: A Case Study from Kerala, India”, J Family Med Prim Care, vol. 7, no. 6, pp. 1476-1481, 2018.[Abstract]


Introduction: Ageing leads to physiological, social and mental changes. The case study shares experiences about the development and evolution of a 'geriatric club' attached to a primary health centre in Kerala, India and the early outcomes noticed among the members of the geriatric club.

Process: This club, established three years before, has become an ongoing self-sustainable organisation helping senior citizens to socialise with their peers. Meeting on a regular day every week at the health centre, with programs varying from discussions on health issues to entertainments like music, dance, festival celebration and film shows, the club has become part of all elderly patients in and around the health centre.

Outcome: Outcome of the club was looked qualitatively and quantitatively through Focus Group Discussions and before and after comparison of Mini Mental Status Examination Scores and Geriatric Depression Scale scores of elderly club members. FGDs concluded that members were benefitted through participation in the club and the club activities helped them to get engaged physically, mentally and socially. Mean GDS scores of the participants decreased from baseline [5.43, SE 0.76] to after six months [5.20, SE 0.74] ( 0.006). Mean MMSE scores showed improvement from baseline [22.26, SE 0.69] to after six months [24.80, SE 0.81] ( 0.001).

Conclusion: Geriatric social clubs attached to primary health care hospitals with suitable contextual adaptations can engage elderly patients physically, mentally and socially. It is hypothesised that such activities can have positive impact on depression and cognitive improvement.

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2018

Journal Article

V. Manohar, S Prasad, B., Raj, S., Sreekrishnan, T. P., and Gireesh Kumar K. P., “The Eminence of Neutrophil-lymphocyte Count Ratio in Predicting Bacteremia for Community-acquired Infections at an Emergency Medicine Department in a Tertiary Care Setting.”, J Emerg Trauma Shock, vol. 11, no. 4, pp. 271-275, 2018.[Abstract]


Introduction: The changes in the white blood cells counts and other blood parameters are well-recognized feature in sepsis. A ratio between neutrophils and lymphocytes can be used as a screening marker in sepsis. Even though new markers such as Procalcitonin and adrenomedullin have been rolled out in the field, implementation of these markers has been hindered by cost, accessibility, and proper validation. We looked for the ability of simple neutrophil-lymphocyte count ratio (NLCR) when compared to the gold standard blood culture method in predicting bacteremia, on patients presented to emergency department (ED) with features of suspected community-acquired infections.

Materials and Methods: A comparative study done on 258 adult patients, admitted with suspected features of community-acquired infections. The study group included all patients who had positive blood culture results on index presentation at ED. Patients with hematological, chronic liver and retroviral diseases, patients receiving chemotherapy, and steroid medications were excluded from the study. The study group was compared with gender- and age-matched control group who were also admitted with a suspicion of the same, but in whom the blood culture results were negative.

Results: There was no statistically significant difference for predicting bacteremia by NLCR (&gt;4.63) and culture positivity methods ( = 1.00). NLCR of &gt; 4.63 predicts bacteremia with an accuracy of 84.9%.

Conclusion: In our setting, NLCR performs equally well with culture positivity, in detecting severe infection at the early phase of disease. The NLCR may, therefore, be used as a suitable screening marker at ED for suspected community-acquired infections.

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2018

Journal Article

Debnarayan Dutta, Menon, A., Abraham, A. George, Madhavan, R., Nair, H., Shalet, P. G., Jishan, J., and Holla, R., “Cholangiocarcinoma Treatment with Synchrony-based Robotic Radiosurgery System: Tracking Options”, J Radiosurg SBRT, vol. 5, no. 4, pp. 335-340, 2018.

2018

Journal Article

P. Arathil, Mathew, K., and Narayanan, D., “Lithium-Induced Thyroiditis in a Patient Having Bipolar Affective Disorder - A Rare Case Report.”, Indian J Psychol Med, vol. 40, no. 6, pp. 577-579, 2018.[Abstract]


A 22-year-old female, previously diagnosed with bipolar affective disorder on lithium therapy, presented to us with manic symptoms. The blood investigations revealed elevated thyroxine and thyroid peroxidase antibodies and reduced thyroid-stimulating hormone with poor tapping function of thyroid on technetium thyroid scintigraphy indicating lithium-induced thyroiditis.

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2018

Journal Article

J. Baishya, Kesav, P., Dr. Sheela Nampoothiri, Sreedharan, S. Erat, and Sylaja, P. N., “Extensive Extrapulvinar Calcification in Fabry Disease.”, Ann Indian Acad Neurol, vol. 21, no. 4, pp. 309-310, 2018.

2018

Journal Article

Deepak Balasubramanian, Subramaniam, N., Rathod, P., Murthy, S., Sharma, M., Jimmy Mathew, Thankappan, K., and Dr. Subramania Iyer K., “Outcomes Following Pharyngeal Reconstruction in Total Laryngectomy - Institutional Experience and Review of Literature”, Indian J Plast Surg, vol. 51, no. 2, pp. 190-195, 2018.[Abstract]


Background: Pharyngeal reconstruction is a challenging aspect of reconstruction after resections for head-and-neck cancer. The goals of reconstruction are to restore the continuity of the pharyngeal passage to enable oral alimentation and rehabilitation of speech wherever possible. This study was performed to determine the outcomes following pharyngeal reconstruction in total laryngectomy (TL) using different reconstructive options and to determine the predictors of pharyngocutaneous fistula (PCF) and swallowing dysfunction.

Materials and Methods: Retrospective analysis of patient data between 2003 and 2010 of patients undergoing TL with partial or total pharyngectomy. Demographic and treatment details were collected and analysed. Univariate analysis was performed to determine predictors of PCF and swallowing dysfunction.

Results: Fifty-seven patients underwent pharyngeal reconstruction following TL, 31 of whom had received prior treatment. Following tumour resection, 31 patients had circumferential defects and 26 patients had partial pharyngeal defects. The flaps used include pectoralis major myocutaneous flap ( = 29), anterolateral thigh flap ( = 8), gastric pull-up ( = 13) and free jejunal flap ( = 7). PCF was seen in 20 patients, of which 15 (75%) were managed conservatively and 5 required another surgery. At last follow-up, 99 patients (68%) were on full oral alimentation. Tracheo-oesophageal puncture and prosthesis insertion was done in 20 patients, of whom 17 (85%) developed satisfactory speech. Partial pharyngeal defects were associated with a higher risk of PCF on univariate analysis ( = 0.006) but were not significant on multivariate analysis. Post-operative swallowing dysfunction was significantly higher with hypopharyngeal involvement by tumour ( = 0.003).

Conclusion: Pharyngeal reconstruction in TL is feasible with good results. Majority of the patients swallow and regain acceptable swallowing function within 3 months.

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2018

Journal Article

S. Sundaram, Nair, M., Dr. Sheela Nampoothiri, and Menon, R. N., “Mitochondrial Acetoacetyl-CoA Thiolase Enzyme Deficiency in a 9-month Old Boy: Atypical Urinary Metabolic Profile with a Novel Homozygous Mutation in ACAT1 Gene”, Neurol India, vol. 66, no. 6, pp. 1802-1804, 2018.

2018

Journal Article

K. Sruthi, Chelakkot, P. G., R. Madhavan, Nair, R. R., and Dinesh, M., “Single-Fraction Radiation: A Promising Adjuvant Therapy to Prevent Keloid Recurrence”, J Cancer Res Ther, vol. 14, no. 6, pp. 1251-1255, 2018.[Abstract]


Introduction: Keloids are characterized by collection of atypical fibroblasts with excessive deposition of extracellular matrix components. Keloids are prone to high recurrence (50%-80%) with unimodality treatment. Radiation is a promising approach among the adjuvant modalities in vogue though consensus is lacking on dose-fractionation schedule.

Aim: The present study aimed to analyze the efficacy of single-fraction high-dose adjuvant radiotherapy to prevent keloid recurrence.

Materials and Methods: Details of patients treated for keloids using external beam radiation therapy from January 2011 to December 2016 were retrieved from electronic medical records and radiation therapy charts and analyzed.

Results: Thirty-seven keloid lesions in thirty patients were analyzed. Keloids received radiation within 24-72 h postsurgery using 6 MeV electron beam. 45.9% of keloids were in the chest wall. Dose ranged between 5 Gy and 12 Gy in 1-3 fractions. Eight Gy was used in 78.4%. The single fraction was preferred in 91.9%. Good cosmesis was achieved in all except three who had wound dehiscence. Median follow-up was 32.67 months. 16.2% had recurrence. Median time to recur was 13.6 months, and median recurrence-free interval 21.23 months. Among those who received 8 Gy single fraction, 73.4% remained recurrence-free at 5 years.

Conclusion: Albeit a retrospective analysis, ours is the only study in literature offering 8 Gy single dose, using electrons, as a postoperative adjuvant treatment to prevent recurrence in keloids. Our recurrence rates were similar to that quoted in published series. This hence can be validated in further studies as it is cosmetically acceptable, safe, painless, and cost-effective with good patient compliance.

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2018

Journal Article

A. Sachu, Madhavan, A., Anu Vasudevan, and Vasudevapanicker, J., “Prevalence of Dengue and Leptospirosis Co-infection in a Tertiary Care Hospital in South India”, Iran J Microbiol, vol. 10, no. 4, pp. 227-232, 2018.[Abstract]


Background and Objectives: Dengue and Leptospirosis were often discussed separately with rash being more common in dengue and jaundice in leptospirosis. But with increasing reports of co-infection, the situation has become worse. The main objective of this study was to look for the presence of both Dengue and Leptospira IgM antibodies in serum samples of patients, presenting with acute febrile illness. Medical records of the co-infected patients were examined to analyse the clinical features and laboratory findings.

Materials and Methods: Serum samples of patients presenting with acute febrile illness were screened for the presence of Dengue IgM antibodies and Leptospira antibodies. Clinical features and laboratory parameters of patients with co-infection were compared with patients having dengue alone. Rainfall data was obtained to look for an association between rainfall and Dengue, leptospirosis and co-infected cases.

Results: Co-infection was seen in 33 (3.4%) samples. There was a statistically significant association between clinical features like rashes, bleeding gums and co-infection. There was a statistically significant association between various laboratory parameters like thrombocytopenia and co-infection. There was positive correlation between rainfall and development of dengue, leptospirosis, and co-infection but it was not statistically significant.

Conclusion: The overall prevalence of co-infection was 3.4%. This study re-emphasizes the fact that dengue and leptospirosis are widely prevalent in south India and clinicians should be aware that co-infection with dengue and leptospirosis is not uncommon.

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2018

Journal Article

C. U. Onyia and Dr. Sajesh K. Menon, “Laminectomy Versus Laminoplasty in the Surgical Management of Long-Segment Intradural Spinal Tumors: Any Difference in Neurological Outcomes?”, Asian J Neurosurg, vol. 13, no. 4, pp. 1128-1133, 2018.[Abstract]


Background: Previous comparative studies have shown that apart from lack of any significant difference in neurologic outcomes between laminoplasty and laminectomy following resection of intradural spinal tumours, spinal column issues such as postoperative deformities, malalignment, and adjacent level disease have also been clearly demonstrated to be quite similar for both techniques. However, there is no study yet that describes any difference in neurologic outcomes for long-segment intradural lesions as a rare subset of these lesions (in terms of number of spinal segments involved) following surgical management between these two techniques.

Materials and Methods: This is a retrospective review of surgical treatment with either laminectomy or laminoplasty done for patients with long-segment intradural tumors at a tertiary health-care institution in India.

Results: Out of over 167 patients surgically treated for intradural tumors during the study period, a total of 60 patients were included in the evaluation. The long-segment tumors were intramedullary in 22 (36.7%) patients and intradural-extramedullary in the remaining 38 (63.3%) patients. No patient in both cohorts had any revisional surgery after initial resection or any serious complications. The incidence of neurologic function remaining unchanged at the end of follow-up was similar between laminoplasty and laminectomy (12.5% vs. 11.1%). There was no significant correlation between the preoperative McCormick score and postoperative McCormick score ( &gt; 0.05 at 95% degree of confidence; Spearman's rho = 0.028), suggesting that functional outcomes were not dependent on the initial neurologic status. Multivariate logistic regression analysis showed that : the two independent variables (Extent of surgery and Choice of procedure) were not significant predictors of the dependent variable (Functional outcome following surgery) (odds ratio = 3.836; = 0.071).

Conclusion: This retrospective evaluation demonstrates laminoplasty not to be more or less likely to have any better functional outcome or need for revision compared to laminectomy in the resection of long-segment intradural lesions. A quality randomized controlled study on a much larger scale will be required to validate this finding.

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2018

Journal Article

P. George Mathen, Sreekrishnan, T. P., Gireesh Kumar K. P., and Mohan, N., “Camphor Poisoning: A Rare Cause of Acute Symptomatic Seizures in Children”, J Emerg Trauma Shock, vol. 11, no. 3, pp. 228-229, 2018.[Abstract]


Camphor is a toxic compound easily available over the counter, which can cause fatal seizures in children when ingested. It is available in several forms and is commonly used in Indian households, especially for religious rituals and for its cough-suppressive and nasal-decongestant effect. The toxic effect remains unknown in most homes. Seizures are usually well controlled with intravenous benzodiazepines, and recurrences of seizures are rarely reported.

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2018

Journal Article

J. Chandramati, Majeed, A., Aswin S. Prabhu, and Ponthenkandath, S., “Paradoxical Vocal Cord Motion in a Pair of Twin Preterm Infants.”, Indian Pediatr, vol. 55, no. 10, pp. 905-906, 2018.[Abstract]


BACKGROUND: Intractable obstructive apneas requiring multiple intubations are rare in newborns.

CASE CHARACTERISTICS: We report a pair of twins born at 29 weeks gestation who had severe obstructive apneas due to Paradoxical Vocal Cord Motion (PVCM).

OUTCOME: The symptoms resolved promptly with ipratropium nebulization. Follow-up at 12 months of age revealed normal development.

MESSAGE: PVCM should be considered in the differential diagnosis of intractable obstructive apneas in very low birth weight preterm infants.

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2018

Journal Article

A. Anand, Deepak Balasubramanian, Subramanian, N., Murthy, S., Limbachiya, S., Iyer, S., Thankappan, K., and Sharma, M., “Secondary Lymphedema After Head and Neck Cancer Therapy: A Review”, Lymphology, vol. 51, no. 3, pp. 109-118, 2018.[Abstract]


Secondary head and neck lymphedema (SHNL) is a chronic condition affecting patients who have undergone treatment for head and neck cancers. It results from the disruption of normal lymphatic flow by surgery and/or radiation. The incidence of secondary head and neck lymphedema varies anywhere between 12 and 54% of all patients treated for head and neck cancer, but it is still commonly under-diagnosed in routine clinical practice. In spite of awareness of this condition, treatment has been difficult as definitive staging, diagnostic, and assessment tools are still under development. This review article is aimed at looking at the evidence, standards of management, and deficiencies in current literature related to SHNL to optimize management of these patients and improve their quality of life.

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2018

Journal Article

B. R. J. Satish, Thadi, M., Thirumalaisamy, S., sunil, A., Basanagoudar, P. L., and Leo, B., “How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty?”, Arch Bone Jt Surg, vol. 6, no. 5, pp. 381-389, 2018.[Abstract]


Background: No scientific evidence exists regarding the amount of bone cement used and discarded in primary cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized for component fixation in primary TKA.

Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack of 40g Palacos bone cement (PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The actual quantity of cement utilized for component fixation was calculated.

Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57 g, the solidified dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had simple syringe lavage before implantation.

Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when a standard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement. Customizing cement pack according to the implant size can potentially avoid this cement wastage. Future research is required to study the utility and economic impact of smaller packs (20 g or 30 g) of bone cement in primary TKA.

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2018

Journal Article

R. Kesavan, Balakrishnan, S., Sunil Rajan, Purushothaman, S. S., Varghese, R., and Kumar, L., “Efficiency and Efficacy of Two Techniques of Preoxygenation during Modified Rapid Sequence Intubation.”, Anesth Essays Res, vol. 12, no. 3, pp. 754-757, 2018.[Abstract]


Background: Apneic mass movement of oxygen by applying continuous positive airway pressure (CPAP) is possible only when the airway is kept patent which helps to reduce the rate of desaturation.

Aims: The aim of this study was to check the efficiency of preoxygenation and apneic oxygenation by assessing the drop in partial pressure of arterial oxygen (PaO) during apnea with and without keeping an oropharyngeal airway to maintain the patency of airway.

Settings and Design: This prospective observational study was conducted at a tertiary care center.

Materials and Methods: Sixty patients undergoing robotic and laparoscopic-assisted surgeries requiring modified rapid sequence intubation were recruited for the study. In Group A, CPAP was not applied during preoxygenation and oropharyngeal airway was not used, but oxygen was administered at 5 L/min during the apnea. In Group B, CPAP of 5 cmHO was maintained during preoxygenation and after induction an oropharyngeal airway was inserted. Patients in both the groups were induced and paralyzed following standardized anesthesia protocol.

Statistical Analysis Used: Chi-square test, independent t-test, and ANCOVA were used as applicable.

Results: Group B showed significantly higher mean PaO levels after preoxygenation (525.3 ± 42.5 vs. 500.8 ± 51) and at 90 s of apnea (494.8 ± 42.6 vs. 368.6 ± 98.4) as compared to Group A. The fall in PaO was significantly lower in Group B. The rise in partial pressure of arterial carbon dioxide was comparable in both groups.

Conclusion: Preoxygenation with CPAP of 5 cmHO followed by apneic oxygenation with CPAP keeping the airway patent with an oropharyngeal airway results in significantly higher PaO after preoxygenation and slower reduction in PaO during apnea.

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2018

Journal Article

P. Kerala Varma, Krishna, N., Dr. Hisham Ahamed, and Madassery, S., “Posterior mitral leaflet plication for hypertrophic obstructive cardiomyopathy.”, Asian Cardiovascular and Thoracic Annals, vol. 26, no. 5, pp. 400-403, 2018.[Abstract]


Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication.

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2017

Journal Article

P. Shanavas Khan, Thilak, J., George, M. J., Nair, A. V., and Madanan, A., “Tubercular infection after arthroscopic rotator cuff repair.”, Knee Surg Sports Traumatol Arthrosc, vol. 25, no. 7, pp. 2205-2207, 2017.[Abstract]


<p>Tubercular septic arthritis after shoulder arthroscopy has not been reported in the English literature to our knowledge. A case of Tubercular septic arthritis of the shoulder following arthroscopic rotator cuff repair is presented. The sinus and the wound healed well, and laboratory parameters returned to normal, which suggests that the infection was well controlled with the treatment follow-up of 1 year. But the functional score was poor due to repeated surgeries; long-standing infection and the arthritic changes developed. Tubercular infection can occur after arthroscopic shoulder surgery especially in healthcare workers in zones endemic for Tuberculosis. Level of evidence V.</p>

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2017

Journal Article

K. Yokote, Chanprasert, S., Lee, L., Eirich, K., Takemoto, M., Watanabe, A., Koizumi, N., Lessel, D., Mori, T., Hisama, F. M., Ladd, P. D., Angle, B., Baris, H., Cefle, K., Palanduz, S., Ozturk, S., Chateau, A., Deguchi, K., Easwar, T. K. M., Federico, A., Fox, A., Grebe, T. A., Hay, B., Nampoothiri, S., Seiter, K., Streeten, E., Piña-Aguilar, R. E., Poke, G., Poot, M., Posmyk, R., Martin, G. M., Kubisch, C., Schindler, D., and Oshima, J., “WRN Mutation Update: Mutation Spectrum, Patient Registries, and Translational Prospects.”, Hum Mutat, vol. 38, no. 1, pp. 7-15, 2017.[Abstract]


<p>Werner syndrome (WS) is a rare autosomal recessive disorder characterized by a constellation of adult onset phenotypes consistent with an acceleration of intrinsic biological aging. It is caused by pathogenic variants in the WRN gene, which encodes a multifunctional nuclear protein with exonuclease and helicase activities. WRN protein is thought to be involved in optimization of various aspects of DNA metabolism, including DNA repair, recombination, replication, and transcription. In this update, we summarize a total of 83 different WRN mutations, including eight previously unpublished mutations identified by the International Registry of Werner Syndrome (Seattle, WA) and the Japanese Werner Consortium (Chiba, Japan), as well as 75 mutations already reported in the literature. The Seattle International Registry recruits patients from all over the world to investigate genetic causes of a wide variety of progeroid syndromes in order to contribute to the knowledge of basic mechanisms of human aging. Given the unusually high prevalence of WS patients and heterozygous carriers in Japan, the major goal of the Japanese Consortium is to develop effective therapies and to establish management guidelines for WS patients in Japan and elsewhere. This review will also discuss potential translational approaches to this disorder, including those currently under investigation.</p>

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2017

Journal Article

V. V. Panicker, Riyaz, N., and Balachandran, P. K., “A clinical study of cutaneous changes in pregnancy.”, J Epidemiol Glob Health, vol. 7, no. 1, pp. 63-70, 2017.[Abstract]


<p><b>BACKGROUND/OBJECTIVE: </b>Pregnant women experience a myriad of physiological and metabolic changes that affect different organ systems in the body. Cutaneous and appendageal alterations that manifest during pregnancy are largely modulated by hormonal, immunologic, and metabolic factors. Detailed reports encompassing physiological changes and specific dermatoses of pregnancy and effects of various dermatoses on pregnant women are scanty in literature. This study was conducted to examine in detail both physiological changes and specific dermatoses. The cutaneous changes are divided into physiological changes, skin diseases aggravated by pregnancy, and specific dermatoses of pregnancy. The objectives were to study the various cutaneous changes of pregnancy and to know the proportion of these cutaneous manifestations in pregnant women.</p><p><b>METHODS: </b>This study included 600 pregnant women attending the Obstetrics and Gynecology Department of a tertiary teaching hospital in Northern Kerala, India. Detailed history elicitation and complete physical and dermatological examination were performed. Skin biopsy was performed in relevant cases.</p><p><b>RESULTS: </b>Cutaneous changes were seen in a majority of patients, of which physiological changes were the most common (99%). The most common cutaneous manifestation was hyperpigmentation (526; 87.6%), followed by striae gravidarum (72.8%). Other changes were vascular, including pedal edema (10%), pregnancy gingivitis (1.8%), and varicose veins (1%). Infections were the common dermatological problem in this study group. The most common infections were vulvovaginal candidiasis (21%), Tinea versicolor (6%), scabies (2.8%), dermatophytosis (1.5%), and sexually transmitted infection (0.5%). Specific dermatoses were seen in 12 cases (2%), with the most common being pruritic urticarial papules and plaques of pregnancy (1.3%).</p><p><b>CONCLUSION: </b>Pregnant women are prone to suffer from a wide range of dermatological problems apart from specific dermatoses of pregnancy. The study emphasizes the need for a detailed and meticulous examination of these patients to detect these various disorders.</p>

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2017

Journal Article

A. Pillai, Mathew, G., Nachimuthu, S., and Kalavampara, S. Vasudevan, “Ventriculo-ureteral shunt insertion using percutaneous nephrostomy: a novel minimally invasive option in a patient with chronic hydrocephalus complicated by multiple distal ventriculoperitoneal shunt failures.”, J Neurosurg, vol. 127, no. 2, pp. 255-259, 2017.[Abstract]


<p>The management of ventriculoperitoneal (VP) shunt failure is a common problem in neurosurgical practice. On occasion, extraperitoneal sites for CSF diversion are required when shunting to the peritoneal cavity has failed after multiple attempts. The authors report a novel minimally invasive procedure allowing cannulation of the ureter for the purpose of ventriculo-ureteral (VU) shunting. Sixteen years prior to presentation, this 46-year-old woman had contracted tuberculous meningitis and had chronic hydrocephalus, with multiple distal shunt failures in recent months. A percutaneous nephrostomy was used to pass the distal catheter based on intraoperative retrograde pyelography. Following successful placement of the VU shunt, the patient's hydrocephalus stabilized and she returned to her regular functional status. The only long-term complication noted within 36 months of follow-up was a transient episode of electrolyte disturbance and dehydration associated with a diarrheal illness that responded to adequate hydration and salt supplementation. By its minimally invasive nature, this approach offers a reasonable extraperitoneal alternative after multiple distal shunt catheter failures have occurred.</p>

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2017

Journal Article

M. A. Prabhu, Shekhar, S., and Natarajan, K. U., “An under-recognized cause for syncope.”, Eur J Intern Med, vol. 42, pp. e3-e4, 2017.

2017

Journal Article

M. Aravind Prabhu, Pai, P. Gopalakris, Vupputuri, A., Shekhar, S., Harikrishnan, M. Santhakuma, and Kumaraswamy, N. Umayammal, “Supra-Hisian Conduction Block as an Unusual Presenting Feature of Takotsubo Cardiomyopathy.”, Pacing Clin Electrophysiol, vol. 40, no. 5, pp. 596-599, 2017.[Abstract]


<p><b>BACKGROUND: </b>Atrioventricular (AV) block is rare in Takotsubo cardiomyopathy (TC).</p><p><b>CASE REPORT: </b>A 66-year-old female presented with fatigue. Her electrocardiogram revealed 3:2 Mobitz Type II AV block, confirmed to be supra-Hisian by electrophysiological study. Echocardiogram and left ventricular angiogram showed moderate left ventricular dysfunction and apical ballooning, whereas coronary angiogram revealed mildly ectatic coronaries. At 2 weeks AV block persisted, needing permanent pacemaker implantation. At 1-month follow-up, she had normal ventricular function and no AV block.</p><p><b>CONCLUSION: </b>Delayed recovery of AV conduction is possible in TC, thus implying to wait for a longer period before implanting a pacemaker.</p>

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2017

Journal Article

A. Sreedevi, Gopalakrishnan, U. Ambika, Ramaiyer, S. Karimasser, and Kamalamma, L., “A Randomized controlled trial of the effect of yoga and peer support on glycaemic outcomes in women with type 2 diabetes mellitus: a feasibility study.”, BMC Complement Altern Med, vol. 17, no. 1, p. 100, 2017.[Abstract]


<p><b>BACKGROUND: </b>Type two diabetes is a complex and demanding chronic disease and its impact in a state (Kerala) which leads India in terms of the number of people with Diabetes is profound. Though the male to female ratio among the people with diabetes is roughly equal, women are uniquely and more severely affected. Management of type two Diabetes requires considerable dexterity on the part of the patient to manage drugs, diet and exercise. Therefore, in a low middle-income country like India it is necessary to look at low cost interventions that can empower the patient and build on available resources to help manage diabetes. Hence, we studied the feasibility and effect of two low cost interventions; yoga and peer support on glycaemic and other outcomes among women with type two diabetes.</p><p><b>METHODS: </b>An open label parallel three armed randomized control trial was conducted among 124 recruited women with Diabetes for three months. Block randomization with a block length of six was carried out with each group having at least 41 women. In the Yoga arm, sessions by an instructor, consisting of a group of postures coordinated with breathing were conducted for an hour, two days a week. In the peer support arm each peer mentor after training visited 13-14 women with diabetes every week followed by a phone call. The meeting was about applying disease management or prevention plans in daily life.</p><p><b>RESULTS: </b>There was a trend in decline of fasting plasma glucose in the peer and yoga group and of glycosylated haemoglobin (HbA1c) in the yoga group only, though not significant. A significant decrease was observed in diastolic blood pressure and hip circumference in the yoga group. The process indicated that most (80%) of the women in the yoga group attended classes regularly and 90% of the women in the peer group reported that peer mentoring was useful.</p><p><b>CONCLUSION: </b>The effect of yoga and peer support on glycaemic outcomes was incremental. Longer term studies are necessary to ascertain the benefits shown by this feasibility study.</p><p><b>TRIAL REGISTRATION: </b>CTRI/2011/12/002227 dated 14/12/2011.</p>

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2017

Journal Article

K. S Priya, Kumar, K., Hiran, K. R., Bindhu, M. R., Nagare, R. P., Vijaykumar, D. K., and Ganesan, T. S., “Expression of a novel endothelial marker, C-type lectin 14A, in epithelial ovarian cancer and its prognostic significance.”, Int J Clin Oncol, vol. 22, no. 1, pp. 107-117, 2017.[Abstract]


<p><b>OBJECTIVE: </b>The purpose of this study was to evaluate microvessel density (MVD) as assessed by C-type lectin 14A (CLEC14A), which is a new marker for endothelial cells, and compare its expression to CD31 and CD105 in epithelial ovarian cancer (EOC).</p><p><b>METHODS: </b>MVD was evaluated in tumors (n = 50) from patients with EOC who underwent primary surgery and in patients with EOC who received preoperative chemotherapy (n = 49) using immunohistochemistry with antibodies to CLEC14A, CD31 and CD105. The median duration of follow-up was 24.5 months (range 1-101 months). The effect of prognostic factors on event-free survival (EFS) and overall survival (OS) was assessed using the Cox regression model.</p><p><b>RESULTS: </b>The amount of residual disease was found to be an independent prognostic factor in multivariate analysis with respect to EFS (P = 0.009) and OS (P < 0.001). The mean MVD of CLEC14A (MVD = 6), in tumors from patients who underwent primary surgery, was significantly lower than that of CD31 (MVD = 25, P < 0.0001) and CD105 (MVD = 11, P = 0.018). However, there was no significant correlation between MVD as detected by these markers and clinical outcome. There was no expression of CLEC14A in tumors from patients who received preoperative chemotherapy and the MVD of CD31 and CD105 was significantly reduced (P = 0.001 and 0.006, respectively) in this set of patients.</p><p><b>CONCLUSION: </b>This study demonstrates MVD as detected by CLEC14A in EOC. Treatment with chemotherapy reduces tumor blood vessels significantly. We suggest that CLEC14A may be a more specific endothelial marker to assess tumor angiogenesis.</p>

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2017

Journal Article

La Kumar, Dominic, Mb, Rajan, Sa, and Dr. Sanjeev K. Singh, “Impact of modified quality control checklist on protocol adherence and outcomes in a post-surgical intensive care unit”, Indian Journal of Anaesthesia, vol. 61, pp. 29-35, 2017.[Abstract]


Background and Aims: Quality improvement (QI) is the sum of all activities that create desired changes in the quality. An effective QI system results in a stepwise increase in quality of care. The efficiency of any health-care unit is judged by its quality indicators. We aimed to evaluate the impact of QI initiatives on outcomes in a surgical Intensive Care Unit (ICU). Methods: This was an observational study carried out using a compliance checklist, developed from the combination of the World Health Organization surgery checklist and Society for Healthcare Epidemiology of America guidelines for the prevention of infections. A total of 170 patients were prospectively evaluated for adherence to the checklist and occurrence of infections. This was compared with a random retrospective analysis of 170 patients who had undergone similar surgeries in the previous 3 months. Results: Introduction and supervised documentation of comprehensive checklist brought out significant improvement in the documentation of quality indicators (98% vs. 32%) in the prospective samples. There was no difference in mortality, health-care-related infection rates or length of ICU stay. Conclusion: The introduction of comprehensive surgical checklist improved documentation of parameters for quality control but did not decrease the rates of infection in comparison to the control sample. © 2017 Indian Journal of Anaesthesia.

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2017

Journal Article

D. Harichandran and Dinesh, K. Radhakrish, “Antimicrobial susceptibility profile, treatment outcome and serotype distribution of clinical isolates of subspecies : a 2-year study from Kerala, South India.”, Infect Drug Resist, vol. 10, pp. 97-101, 2017.[Abstract]


<p><b>BACKGROUND/PURPOSE: </b>Typhoid and paratyphoid fever continue to be important causes of illness and death in parts of Asia, being associated with poor sanitation and consumption of unsafe food and water. Antimicrobial resistance has emerged to traditional first-line drugs, namely, the fluoroquinolones, as well as to third-generation cephalosporins, posing challenges to treatment. Azithromycin has proven to be an effective alternative for treatment of uncomplicated typhoid fever. The purpose of this study was to determine the antimicrobial susceptibility, clinical outcome and serotype distribution pattern of clinical isolates belonging to subspecies .</p><p><b>METHODOLOGY: </b>All clinical isolates of obtained from blood, sterile body fluids, as well as stool and urine samples at Amrita Institute of Medical Sciences and Research Centre, Kerala, India, between August 2011 and July 2013 were included in the study and processed based on standard microbiology protocols.</p><p><b>RESULTS: </b>A total of 118 isolates of were obtained during the study period. Out of these, 79 were of Typhi (66.95%), followed by isolates of Paratyphi A (22; 18.64%) and Typhimurium 12 (10.17%). Five isolates could not be identified further. There was 100% susceptibility to ceftriaxone in all subspecies. Ciprofloxacin susceptibility was 32.91% for Typhi and 40.90% for Paratyphi A as determined by the disk diffusion method. The susceptibility profile of Typhi isolates to different antimicrobials was as follows: chloramphenicol (94.93%), ampicillin (77.21%), cotrimoxazole (75.94%) and azithromycin (78.48%). For Typhi, the minimum inhibitory concentration (MIC) of ciprofloxacin required to inhibit the growth of 50% of organisms was 0.5 μg/mL (intermediate) and MIC required to inhibit the growth of 90% of organisms was 1 μg/mL (resistant). . Typhimurium was 100% susceptible to cotrimoxazole, ampicillin, ceftriaxone, chloramphenicol, ofloxacin and azithromycin. Susceptibility to ciprofloxacin was 66.66%. Patients from whom . Typhimurium was isolated had comorbidities with documented risk. Of the 118 patients, 3 expired. Two had typhoid fever and were in sepsis at admission. One had . Typhimurium and was suffering from multiple myeloma.</p><p><b>CONCLUSION: </b>. Typhi was the predominant isolate. All isolates were susceptible to ceftriaxone. Chloramphenicol susceptibility was >90%. No multidrug-resistant strains were isolated. Susceptibility to ciprofloxacin for . Typhi was 33%. Recovery rate was 97%.</p>

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2017

Journal Article

B. Palafox, Mocumbi, A. Olga, R Kumar, K., Ali, S. K. M., Kennedy, E., Haileamlak, A., Watkins, D., Petricca, K., Wyber, R., Timeon, P., and Mwangi, J., “The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of RHD.”, Glob Heart, vol. 12, no. 1, pp. 47-62, 2017.[Abstract]


<p>Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts.</p>

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2017

Journal Article

M. Subramanian, Prabhu, M. A., Harikrishnan, M. Santhakuma, Shekhar, S. S., Pai, P. G., and Natarajan, K., “The Utility of Exercise Testing in Risk Stratification of Asymptomatic Patients With Type 1 Brugada Pattern.”, J Cardiovasc Electrophysiol, vol. 28, no. 6, pp. 677-683, 2017.[Abstract]


<p><b>INTRODUCTION: </b>Risk stratification of asymptomatic patients with a Brugada type 1 ECG pattern remains an unresolved clinical conundrum. In contrast to provocative pharmacological testing in Brugada syndrome, there is limited data on the role of exercise stress testing as a risk stratification modality. The objective of this study was to evaluate the utility of exercise testing in asymptomatic patients with type 1 Brugada pattern to prognosticate major arrhythmic events (MAE) during follow-up.</p><p><b>METHODS AND RESULTS: </b>Treadmill exercise testing was conducted for 75 asymptomatic patients with type 1 Brugada pattern and for 88 healthy control subjects. The clinical end point of MAE was defined as the occurrence of sudden cardiac death (SCD) or resuscitated ventricular fibrillation (VF). During a follow-up of 77.9 ± 28.9 months, eight MAE occurred (five VF and three SCD). Multivariate Cox regression analysis showed that the following were independent predictors of MAE in asymptomatic patients with a type 1 Brugada pattern: increase in S wave upslope duration ratio >30% at peak exercise (HR 1.35, 95% CI 1.08-10.97, P = 0.023), augmentation of J point elevation in lead aVR >2 mm in late recovery (HR 1.88, 95% 1.21-15.67, P = 0.011), and delayed HR recovery (HR 1.14, 95% CI 1.06-18.22, P = 0.042). A high-risk cohort was identified by the final step-wise regression model with good accuracy (specificity = 98.4%, sensitivity = 62.5%) and discriminative power (AUC = 0.93, 95% CI 0.89-0.96, P = 0.002). Kaplan-Meier analysis revealed increasing MAE in subjects with one, two, or three predictors, respectively (log rank P < 0.001).</p><p><b>CONCLUSIONS: </b>Exercise testing in asymptomatic patients with type 1 Brugada pattern aids in identification of high-risk patients and provides a unique window of opportunity for early intervention.</p>

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2017

Journal Article

L. Guo, Bobhate, P., Kumar, S., Vadlamudi, K., Kaddoura, T., Elgendi, M., Holinski, P., Coe, J. Y., Rutledge, J., and Adatia, I., “Hyperoxia Reduces Oxygen Consumption in Children with Pulmonary Hypertension.”, Pediatr Cardiol, vol. 38, no. 5, pp. 959-964, 2017.[Abstract]


<p>High inspired oxygen concentration (FiO > 0.85) is administered to test pulmonary vascular reactivity in children with pulmonary hypertension (PH). It is difficult to measure oxygen consumption (VO) if the subject is breathing a hyperoxic gas mixture so the assumption is made that baseline VO does not change. We hypothesized that hyperoxia changes VO. We sought to compare the VO measured by a thermodilution catheter in room air and hyperoxia. A retrospective review of the hemodynamic data obtained in children with PH who underwent cardiac catheterization was conducted between 2009 and 2014. Cardiac index (CI) was measured by a thermodilution catheter in room air and hyperoxia. VO was calculated using the equation CI = VO/arterial-venous oxygen content difference. Data were available in 24 subjects (males = 10), with median age 8.3 years (0.8-17.6 years), weight 23.3 kg (7.5-95 kg), and body surface area 0.9 m (0.4-2.0 m). In hyperoxia compared with room air, we measured decreased VO (154 ± 38 to 136 ± 34 ml/min/m, p = 0.007), heart rate (91 [Formula: see text] 20 to 83 [Formula: see text] 21 beats/minute, p=0.005), mean pulmonary artery pressure (41 [Formula: see text] 16 to 35 [Formula: see text] 14 mmHg, p=0.024), CI (3.6 [Formula: see text] 0.8 to 3.3 [Formula: see text] 0.9 L/min/m, p = 0.03), pulmonary vascular resistance (9 [Formula: see text] 6 to 7 [Formula: see text] 3 WU m, p = 0.029), increased mean aortic (61 [Formula: see text] 11 to 67 [Formula: see text] 11 mmHg, p = 0.005), pulmonary artery wedge pressures (11 [Formula: see text] 8 to 13 [Formula: see text] 9 mmHg, p = 0.006), and systemic vascular resistance (12 [Formula: see text] 6 to 20 [Formula: see text] 7 WU m, p=0.001). Hyperoxia decreased VO and CI and caused pulmonary vasodilation and systemic vasoconstriction in children with PH. The assumption that VO remains unchanged in hyperoxia may be incorrect and, if the Fick equation is used, may lead to an overestimation of pulmonary blood flow and underestimation of PVRI.</p>

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2017

Journal Article

S. Vijaykumar Patil and S Y Nanduri, L., “Interaction of chitin/chitosan with salivary and other epithelial cells-An overview.”, Int J Biol Macromol, vol. 104, no. Pt B, pp. 1398-1406, 2017.[Abstract]


<p>Chitin and its deacetylated form, chitosan, have been widely used for tissue engineering of both epithelial and mesenchymal tissues. Epithelial cells characterised by their sheet-like tight cellular arrangement and polarised nature, constitute a major component in various organs and play a variety of roles including protection, secretion and maintenance of tissue homeostasis. Regeneration of damaged epithelial tissues has been studied using biomaterials such as chitin, chitosan, hyaluronan, gelatin and alginate. Chitin and chitosan are known to promote proliferation of various embryonic and adult epithelial cells. However it is not clearly understood how this activity is achieved or what are the mechanisms involved in the chitin/chitosan driven proliferation of epithelial cells. Mechanistic understanding of influence of chitin/chitosan on epithelial cells will guide us to develop more targeted regenerative scaffold/hydrogel systems. Therefore, current review attempts to elicit a mechanistic insight into how chitin and chitosan interact with salivary, mammary, skin, nasal, lung, intestinal and bladder epithelial cells.</p>

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2017

Journal Article

P. S. Panicker, Melge, A. R., Biswas, L., Keechilat, P., and Mohan, C. G., “Epidermal growth factor receptor (EGFR) structure-based bioactive pharmacophore models for identifying next-generation inhibitors against clinically relevant EGFR mutations.”, Chem Biol Drug Des, vol. 90, no. 4, pp. 629-636, 2017.[Abstract]


<p>Present work elucidates identification of next generation inhibitors for clinically relevant mutations of epidermal growth factor receptor (EGFR) using structure-based bioactive pharmacophore modeling followed by virtual screening (VS) techniques. Three-dimensional (3D) pharmacophore models of EGFR and its different mutants were generated. This includes seven 3D pharmacophoric points with three different chemical features (descriptors), that is, one hydrogen bond donor, three hydrogen bond acceptors and three aromatic rings. Pharmacophore models were validated using decoy dataset, Receiver operating characteristic plot, and external dataset compounds. The robust, bioactive 3D e-pharmacophore models were then used for VS of four different small compound databases: FDA approved, investigational, anticancer, and bioactive compounds collections of Selleck Chemicals. CUDC101 a multitargeted kinase inhibitor showed highest binding free energy and 3D pharmacophore fit value than the well known EGFR inhibitors, Gefitinib and Erlotinib. Further, we obtained ML167 as the second best hit on VS from bioactive database showing high binding energy and pharmacophore fit value with respect to EGFR receptor and its mutants. Optimistically, presented drug discovery based on the computational study serves as a foundation in identifying and designing of more potent EGFR next-generation kinase inhibitors and warrants further experimental studies to fight against lung cancer.</p>

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2017

Journal Article

S. T. Joseph, Thankappan, K., and Iyer, S., “Reconstruction of a Combined Maxillectomy and Segmental Mandibulectomy Defect in a Seven-Year-Old with a Single Free Fibula Osteocutaneous Flap.”, Craniomaxillofac Trauma Reconstr, vol. 10, no. 1, pp. 73-76, 2017.[Abstract]


<p>Combined upper alveolectomy and segmental mandibulectomy are complex defects. Reconstruction of these defects is usually suboptimal. We describe the case of a pediatric patient with vessel-depleted neck with recurrent vascular malformation involving the ramus and coronoid process of mandible and a previous history of maxillectomy and a reconstruction with anterolateral thigh flap. The patient underwent wide resection. The defects involving the upper alveolus and mandible were simultaneously reconstructed with a single free fibula flap.</p>

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2017

Journal Article

K. V. Mankulangara, Sreekumar, A., and Vijayakumar, P., “Case report of warfarin induced upper gastrointestinal bleeding”, Journal of Applied Pharmaceutical Science, vol. 7, pp. 233-236, 2017.[Abstract]


Warfarin is an oral vitamin k antagonist prescribed to those patients for the treatment and prevention of venous thromboembolism. The major challenges to be faced during the therapy were a greater risk for both major as well as minor bleeding, which makes the regular monitoring of INR (international normalized ratio) mandatory. Here we report a case study of 80 year old male who presented to casualty with the complaints of vomiting fresh blood in large quantities due to consumption of warfarin three times in a day for past 2 weeks. Patient was on anticoagulation therapy for paroxysmal atrial fibrillation since 2012 and was taking all his medications alone, he was independent in activities of daily living and instrumental activities of daily living. The blood investigation revealed anemia (Hemoglobin:6.1g/dl). He was immediately transfused with packed RBC and fresh frozen plasma to replenish the body reserves. Prothrombin time (PT)/INR was reported undetectable and warfarin was withheld from the past medications and was restarted at INR 1.56. The overdose has led to additional monitoring and prolonged hospital stay. Furthermore this case highlights the need for a better communication by providing counselling regarding all aspects of medications as well as lifestyle modifications and also by giving patient information leaflets. © 2017 Kavya Vinod Mankulangara et al.

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2017

Journal Article

L. Sunny, Lakshmi R., and M. Vijayakumar, “Evaluation of Antimicrobial use in Ventilated Patients in Coronary Care Unit of a Tertiary Care Hospital”, Research Journal of Pharmacy and Technology , vol. 10, no. 1, pp. 05-10 , 2017.[Abstract]


In developing countries, excess and indiscriminate use of antibiotics in community and hospital settings can lead to adverse effects primary to prolongation of therapy, harbour antibiotic resistance bacteria, rise in health expenditures and decrease quality of life. Antimicrobial resistance in the intensive care unit (ICU) has emerged as an important problem in this scenario. Recent studies revealed that antibiotic use is roughly ten times larger in ICU than in general wards. Research studies are required to gain suitable information concerning the use of antimicrobials (AMA) in ventilated patients which helps in improving the prescribing pattern of antimicrobial and also in executing infection control strategies in the therapy modification of such patients. There is barely limited data on antibiotic prescribing pattern in ventilated patients from India hence this study was carried out with an objective to know more about the antibiotic prescribing pattern and to analyze rationality among the prescriptions. This retrospective study was conducted in the Coronary care unit (CCU) of tertiary care hospital in South India from June 2014 to December 2014. The prescribing pattern of antimicrobials in patients aged between 10-90 years was studied. Total 33 AMA preparations were used either single or in combination. In the study, the commonly used AMAs were beta-lactam antibiotics, particularly ceftriaxone, levofloxacin followed by piperacillin + tazobactam (extended –spectrum penicillins + ß-lactamase inhibitor) as single or combination therapy. Combination of AMAs was used in 54.3% of patients. In order to achieve good outcome right use of antibiotic at right time and right dose is required, based on general AMAs prescribing pattern and susceptibility pattern of pathogens, which aid to minimize the irrational employ of antibiotics and extra pressure for resistance.

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2017

Journal Article

A. C. Sen, Morrow, D. F., Balachandran, R., Du, X., Gauvreau, K., Jagannath, B. R., Kumar, R. K., Kupiec, J. K., Melgar, M. L., Chau, N. T., Potter-Bynoe, G., Tamariz-Cruz, O., and Jenkins, K. J., “Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data from the International Quality Improvement Collaborative”, Circulation: Cardiovascular Quality and Outcomes, vol. 10, 2017.[Abstract]


Background - Postoperative infections contribute substantially to morbidity and mortality after congenital heart disease surgery and are often preventable. We sought to identify risk factors for postoperative infection and the impact on outcomes after congenital heart surgery, using data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries. Methods and Results - Pediatric cardiac surgical cases performed between 2010 and 2012 at 27 participating sites in 16 developing countries were included. Key variables were audited during site visits. Demographics, preoperative, procedural, surgical complexity, and outcome data were analyzed. Univariate and multivariable logistic regression were used to identify risk factors for infection, including bacterial sepsis and surgical site infection, and other clinical outcomes. Standardized infection ratios were computed to track progress over time. Of 14 545 cases, 793 (5.5%) had bacterial sepsis and 306 (2.1%) had surgical site infection. In-hospital mortality was significantly higher among cases with infection than among those without infection (16.7% versus 5.3%; P<0.001), as were postoperative ventilation duration (80 versus 14 hours; P<0.001) and intensive care unit stay (216 versus 68 hours; P<0.001). Younger age at surgery, higher surgical complexity, lower oxygen saturation, and major medical illness were independent risk factors for infection. The overall standardized infection ratio was 0.65 (95% confidence interval, 0.58-0.73) in 2011 and 0.59 (95% confidence interval, 0.54-0.64) in 2012, compared with that in 2010. Conclusions - Postoperative infections contribute to mortality and morbidity after congenital heart surgery. Younger, more complex patients are at particular risk. Quality improvement targeted at infection risk may reduce morbidity and mortality in the developing world. © 2017 American Heart Association, Inc. More »»

2017

Journal Article

Anu Sasidharan, John, A., and Prof. K. R. Sundaram, “Comparison of knowledge, attitude and practice FF self-learning among different levels of faculty members”, Journal of South India Medicolegal Association, vol. 9, pp. 18-25, 2017.[Abstract]


The teaching methodologies in medical colleges can be tilted towards teacher centric or learner centric kind of approach. Recently Medical Council of India has been mandating revised faculty training programmes and one of the objectives of such training programmes is to promote a learner-centred approach. Self-Learning is the vital component of a learner-centred approach in medical education. Through self-learning the learners assume responsibility for their learning thereby facilitating adult learning. However till date, there is no published literature on the existing knowledge, attitude and practice of self-learning among faculty members of a medical college. Unless the existing scenario is clear, it is not possible to decide on the emphasis of self-learning in the revised faculty training programmes across the country. Moreover unless the faculty members are trained adequately, it is near to impossible to promote self-learning in the learners. This pilot research work was chosen as a beginning to determine this gap of knowledge of existing scenario amongst the faculty members in medical colleges. 30 junior level and 30 senior level faculty members voluntarily participated in this study that lasted six months. The results have shown that the attitude and practice of self-learning in faculty members, especially juniors were disappointing and it is high time for research works relating to medical education to be taken up involving faculty members in order to understand the pitfalls in the existing system. © 2017 South India Medico-Legal Association. All rights reserved.

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2017

Journal Article

S. Rajan, Surendran, J., Paul, J., and Kumar, L., “Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients”, Indian Journal of Anaesthesia, vol. 61, pp. 230-234, 2017.[Abstract]


{Background and Aims: Obese individuals are predisposed to difficult airway and intubation. They usually yield confusing or misleading auscultatory findings. We aimed to assess the rapidity and efficacy of ultrasonographic (USG) sliding lung sign for confirming endotracheal intubation in normal as well as overweight and obese surgical patients. Methods: This prospective, observational study was performed in forty surgical patients. Twenty patients with body mass index (BMI) <25 were recruited to Group A, whereas twenty patients with BMI ≥25 constituted Group B. Following induction and intubation, appearance of end‑tidal carbon dioxide waveform was used to confirm endotracheal intubation. Presence of breath sounds bilaterally was sought by auscultation, and time taken for auscultatory confirmation was noted. The USG confirmation of air entry to the lung field as indicated by lung sliding was sought, and the time taken was noted. Chi‑square test, independent t‑test and paired t‑test were used as applicable. Results: Auscultatory confirmation was more rapid in Group A as compared to Group B (9.34 ± 2.43 s vs. 14.35 ± 5.53 s More »»

2017

Journal Article

Dr. Anil Kumar V., Sachu, A., Mohan, K., Vinod, V., Dinesh, K. Radhakrish, and Karim, S., “Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium”, Revista Iberoamericana de Micologia, 2017.[Abstract]


Background: Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments. Aims: To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. Methods: Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii, and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation. Results: On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37. °C and 42. °C after 24 and 48. h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24. h while at 48. h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42. °C. Conclusions: We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2. © 2017 Asociación Española de Micología.

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2017

Journal Article

G. Zaidi, Bhatia, V., Sahoo, S. K., Sarangi, A. Narayan, Bharti, N., Zhang, L., Yu, L., Eriksson, D., Bensing, S., Kämpe, O., Bharani, N., Yachha, S. Kumar, Bhansali, A., Sachan, A., Jain, V., Shah, N., Aggarwal, R., Aggarwal, A., Srinivasan, M., Agarwal, S., and Bhatia, E., “Autoimmune polyendocrine syndrome type 1 in an Indian cohort: a longitudinal study.”, Endocr Connect, vol. 6, no. 5, pp. 289-296, 2017.[Abstract]


<p><b>OBJECTIVE: </b>Autoimmune polyendocrine syndrome type 1 (APS1) is a rare autosomal recessive disorder characterized by progressive organ-specific autoimmunity. There is scant information on APS1 in ethnic groups other than European Caucasians. We studied clinical aspects and autoimmune regulator () gene mutations in a cohort of Indian APS1 patients.</p><p><b>DESIGN: </b>Twenty-three patients (19 families) from six referral centres in India, diagnosed between 1996 and 2016, were followed for [median (range)] 4 (0.2-19) years.</p><p><b>METHODS: </b>Clinical features, mortality, organ-specific autoantibodies and gene mutations were studied.</p><p><b>RESULTS: </b>Patients varied widely in their age of presentation [3.5 (0.1-17) years] and number of clinical manifestations [5 (2-11)]. Despite genetic heterogeneity, the frequencies of the major APS1 components (mucocutaneous candidiasis: 96%; hypoparathyroidism: 91%; primary adrenal insufficiency: 55%) were similar to reports in European series. In contrast, primary hypothyroidism (23%) occurred more frequently and at an early age, while kerato-conjunctivitis, urticarial rash and autoimmune hepatitis were uncommon (9% each). Six (26%) patients died at a young age [5.8 (3-23) years] due to septicaemia, hepatic failure and adrenal/hypocalcaemic crisis from non-compliance/unexplained cause. Interferon-α and/or interleukin-22 antibodies were elevated in all 19 patients tested, including an asymptomatic infant. Eleven mutations were detected, the most common being p.C322fsX372 (haplotype frequency 37%). Four mutations were novel, while six others were previously described in European Caucasians.</p><p><b>CONCLUSIONS: </b>Indian APS1 patients exhibited considerable genetic heterogeneity and had highly variable clinical features. While the frequency of major manifestations was similar to that of European Caucasians, other features showed significant differences. A high mortality at a young age was observed.</p>

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2017

Journal Article

M. Thillai, Sethi, P., Menon, R. Narayana, and Kader, N. Puthukudiy, “Cystic artery pseudoaneurysm following acute necrotising pancreatitis.”, BMJ Case Rep, vol. 2017, 2017.[Abstract]


<p>Cystic artery pseudoaneurysm is a rare pathology. Of the 20 cases reported so far, chronic cholecystitis and iatrogenic biliary injury form the majority of causes. Currently, there is no published report of such pseudoaneurysms caused secondary to pancreatitis, hence the management in such a scenario is unclear. We hereby present the first such report of cystic artery pseudoaneurysm occurring as a sequel of acute necrotising pancreatitis. A 33-year-old man who recovered from a recent attack of acute pancreatitis was readmitted for melena and fever. Computed tomography of abdomen revealed blood in the gall bladder with pericholecystic blush and resolving pancreatic necrosis. Percutaneous transarterial embolisation of the cystic artery was done. This stabilised the patient but persistent sepsis and clinical deterioration warranted a surgical exploration and cholecystostomy. Hence, transarterial embolisation followed by surgery in selected cases can be an ideal management protocol.</p>

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2017

Journal Article

R. Sarkar, Podder, I., Gokhale, N., Jagadeesan, S., and Garg, V. K., “Use of vegetable oils in dermatology: an overview.”, Int J Dermatol, vol. 56, no. 11, pp. 1080-1086, 2017.[Abstract]


<p>Vegetable oils have been used for a wide variety of purposes since time immemorial; however, their principle use remains as skin moisturizers, especially in neonates and children. Because of their considerable efficacy and a low side effect profile and bearable cost, these oils are hugely popular as moisturizers among the common people in countries such as India. A wide variety of oils have been used, and newer ones are coming up with each passing day. This article focuses on the different types of vegetable oils and their varied uses in dermatology.</p>

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2017

Journal Article

P. S. Rakesh, Balakrishnan, S., Krishnaveni, V., Narayanan, V., Pillai, S., and Thomas, S. Merin, “Patients' perception towards directly observed treatment - A qualitative study from Kollam district, Kerala, southern India.”, Indian J Tuberc, vol. 64, no. 2, pp. 93-98, 2017.[Abstract]


<p><b>BACKGROUND: </b>The Direct Observation of Treatment (DOT) is an important component of the country's TB Control strategy. Standards of TB care in India and the End TB strategy emphasised the importance of a patient-centered approach to foster adherence. A qualitative study was conducted to explore the perception of people with Tuberculosis in Kerala regarding DOT, mechanisms to make the treatment of TB more patients centered and to identify the preferable mechanisms to ensure adherence.</p><p><b>METHODS: </b>Six focus group discussions were conducted - two among people with TB from rural area, two among people with TB in urban area, one among multipurpose health workers of rural area and one among key field staff of TB control in urban area.</p><p><b>RESULTS: </b>Patients who were on a strict DOT were unhappy about the issues of confidentiality, patient inconvenience and provider centered approach. A flexible, patient centered approach were a family member can act as the DOT provider with guidance from a trained health worker was evolved as the most acceptable and comfortable mode of treatment to majority of the TB patients. They felt that a strict external monitor as a DOT provider was not a necessity in majority of the cases. Only practical way to effectively incorporate ICT in monitoring patient compliance in current scenario was identified as daily phone call reminders. Patients also expressed their concerns in keeping the medicines for entire duration at home.</p><p><b>CONCLUSION: </b>A flexible patient wise individualized system based on patient's behavior, literacy and awareness along with attitude of family members is needed to ensure adherence to anti TB drugs.</p>

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2017

Journal Article

A. Chanchal Sen, Morrow, D. Forbes, Balachandran, R., Du, X., Gauvreau, K., Jagannath, B. R., Kumar, R. Krishna, Kupiec, J. Koch, Melgar, M. L., Chau, N. Tran, Potter-Bynoe, G., Tamariz-Cruz, O., and Jenkins, K. J., “Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality Improvement Collaborative.”, Circ Cardiovasc Qual Outcomes, vol. 10, no. 4, 2017.[Abstract]


<p><b>BACKGROUND: </b>Postoperative infections contribute substantially to morbidity and mortality after congenital heart disease surgery and are often preventable. We sought to identify risk factors for postoperative infection and the impact on outcomes after congenital heart surgery, using data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries.</p><p><b>METHODS AND RESULTS: </b>Pediatric cardiac surgical cases performed between 2010 and 2012 at 27 participating sites in 16 developing countries were included. Key variables were audited during site visits. Demographics, preoperative, procedural, surgical complexity, and outcome data were analyzed. Univariate and multivariable logistic regression were used to identify risk factors for infection, including bacterial sepsis and surgical site infection, and other clinical outcomes. Standardized infection ratios were computed to track progress over time. Of 14 545 cases, 793 (5.5%) had bacterial sepsis and 306 (2.1%) had surgical site infection. In-hospital mortality was significantly higher among cases with infection than among those without infection (16.7% versus 5.3%; <0.001), as were postoperative ventilation duration (80 versus 14 hours; <0.001) and intensive care unit stay (216 versus 68 hours; <0.001). Younger age at surgery, higher surgical complexity, lower oxygen saturation, and major medical illness were independent risk factors for infection. The overall standardized infection ratio was 0.65 (95% confidence interval, 0.58-0.73) in 2011 and 0.59 (95% confidence interval, 0.54-0.64) in 2012, compared with that in 2010.</p><p><b>CONCLUSIONS: </b>Postoperative infections contribute to mortality and morbidity after congenital heart surgery. Younger, more complex patients are at particular risk. Quality improvement targeted at infection risk may reduce morbidity and mortality in the developing world.</p>

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2017

Journal Article

B. Chandran, Bharathan, V. Kumar, Mathew, J. Shaji, Amma, B. Sivasankar, Gopalakrishnan, U., Dinesh Balakrishnan, Ramachandran Narayana Menon, Dhar, P., Vayoth, S. Othiyil, and Surendran, S., “Quality of life of liver donors following donor hepatectomy.”, Indian J Gastroenterol, vol. 36, no. 2, pp. 92-98, 2017.[Abstract]


<p><b>BACKGROUND: </b>Although morbidity following living liver donation is well characterized, there is sparse data regarding health-related quality of life (HRQOL) of donors.</p><p><b>METHODS: </b>HRQOL of 200 consecutive live liver donors from 2011-2014 performed at an Indian center were prospectively collected using the SF-36 version 2, 1 year after surgery. The effect of donor demographics, operative details, post-operative complications (Clavien-Dindo and 50-50 criteria), and recipient mortality on the quality-of-life (QOL) scoring was analyzed.</p><p><b>RESULTS: </b>Among 200 donors (female/male=141:59), 77 (38.5%) had complications (14.5%, 16.5%, 4.5%, and 3.5%, Clavien-Dindo grades I-IV, respectively). The physical composite score (PCS) of donors 1 year after surgery was less than ideal (48.75±9.5) while the mental composite score (MCS) was good (53.37±6.16). Recipient death was the only factor that showed a statistically significant correlation with both PCS (p<0.001) and MCS (p=0.05). Age above 50 years (p<0.001), increasing body mass index (BMI) (p=0.026), and hospital stay more than 14 days ( p= 0.042) negatively affected the physical scores while emergency surgery (p<0.001) resulted in lower mental scores. Gender, postoperative complications, type of graft, or fulfillment of 50-50 criteria did not influence HRQOL. On asking the hypothetical question whether the donors would be willing to donate again, 99% reiterated there will be no change in their decision.</p><p><b>CONCLUSION: </b>Recipient death, donation in emergency setting, age above 50, higher BMI, and prolonged hospital stay are factors that lead to impaired HRQOL following live liver donation. Despite this, 99% donors did not repent the decision to donate.</p>

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2017

Journal Article

A. Kumar, Sachu, A., Mohan, K., Vinod, V., Dinesh, K., and Karim, S., “Simple low cost differentiation of Candida auris from Candida haemulonii complex using CHROMagar Candida medium supplemented with Pal's medium.”, Rev Iberoam Micol, vol. 34, no. 2, pp. 109-111, 2017.[Abstract]


<p><b>BACKGROUND: </b>Candida auris is unique due to its multidrug resistance and misidentification as Candida haemulonii by commercial systems. Its correct identification is important to avoid inappropriate treatments.</p><p><b>AIMS: </b>To develop a cheap method for differentiating C. auris from isolates identified as C. haemulonii by VITEK2.</p><p><b>METHODS: </b>Fifteen C. auris isolates, six isolates each of C. haemulonii and Candida duobushaemulonii, and one isolate of Candida haemulonii var. vulnera were tested using CHROMagar Candida medium supplemented with Pal's agar for better differentiation.</p><p><b>RESULTS: </b>On CHROMagar Candida medium supplemented with Pal's agar all C. auris strains showed confluent growth of white to cream colored smooth colonies at 37°C and 42°C after 24 and 48h incubation and did not produce pseudohyphae. The isolates of the C. haemulonii complex, on the contrary, showed poor growth of smooth, light-pink colonies at 24h while at 48h the growth was semiconfluent with the production of pseudohyphae. C. haemulonii complex failed to grow at 42°C.</p><p><b>CONCLUSIONS: </b>We report a rapid and cheap method using CHROMagar Candida medium supplemented with Pal's agar for differentiating C. auris from isolates identified as C. haemulonii by VITEK2.</p>

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2017

Journal Article

B. Ahrén, Masmiquel, L., Kumar, H., Sargin, M., Karsbøl, J. Derving, Jacobsen, S. Hald, and Chow, F., “Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial.”, Lancet Diabetes Endocrinol, vol. 5, no. 5, pp. 341-354, 2017.[Abstract]


<p><b>BACKGROUND: </b>Semaglutide is a novel glucagon-like peptide-1 (GLP-1) analogue, suitable for once-weekly subcutaneous administration, in development for treatment of type 2 diabetes. We assessed the efficacy and safety of semaglutide versus the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin in patients with type 2 diabetes inadequately controlled on metformin, thiazolidinediones, or both.</p><p><b>METHODS: </b>We did a 56-week, phase 3a, randomised, double-blind, double-dummy, active-controlled, parallel-group, multinational, multicentre trial (SUSTAIN 2) at 128 sites in 18 countries. Eligible patients were aged at least 18 years (or at least 20 years in Japan) and diagnosed with type 2 diabetes, with insufficient glycaemic control (HbA 7·0-10·5% [53·0-91·0 mmol/mol]) despite stable treatment with metformin, thiazolidinediones, or both. We randomly assigned participants (2:2:1:1) using an interactive voice or web response system to 56 weeks of treatment with subcutaneous semaglutide 0·5 mg once weekly plus oral sitagliptin placebo once daily, subcutaneous semaglutide 1·0 mg once weekly plus oral sitagliptin placebo once daily, oral sitagliptin 100 mg once daily plus subcutaneous semaglutide placebo 0·5 mg once weekly, or oral sitagliptin 100 mg once daily plus subcutaneous semaglutide placebo 1·0 mg once weekly. The two oral sitagliptin 100 mg groups (with semaglutide placebo 0·5 mg and 1·0 mg) were pooled for the analyses. The primary endpoint was change in HbA from baseline to week 56, assessed in the modified intention-to-treat population (all randomly assigned participants who received at least one dose of study drug); change in bodyweight from baseline to week 56 was the confirmatory secondary endpoint. Safety endpoints included adverse events and hypoglycaemic episodes. This trial is registered with ClinicalTrials.gov, number NCT01930188.</p><p><b>FINDINGS: </b>Between Dec 2, 2013, and Aug 5, 2015, we randomly assigned 1231 participants; of the 1225 included in the modified intention-to-treat analysis, 409 received semaglutide 0·5 mg, 409 received semaglutide 1·0 mg, and 407 received sitagliptin 100 mg. Mean baseline HbA was 8·1% (SD 0·93); at week 56, HbA was reduced by 1·3% in the semaglutide 0·5 mg group, 1·6% in the semaglutide 1·0 mg group, and 0·5% with sitagliptin (estimated treatment difference vs sitagliptin -0·77% [95% CI -0·92 to -0·62] with semaglutide 0·5 mg and -1·06% [-1·21 to -0·91] with semaglutide 1·0 mg; p<0·0001 for non-inferiority and for superiority, for both semaglutide doses vs sitagliptin). Mean baseline bodyweight was 89·5 kg (SD 20·3); at week 56, bodyweight reduced by 4·3 kg with semaglutide 0·5 mg, 6·1 kg with semaglutide 1·0 mg, and 1·9 kg with sitagliptin (estimated treatment difference vs sitagliptin -2·35 kg [95% CI -3·06 to -1·63] with semaglutide 0·5 mg and -4·20 kg [-4·91 to -3·49] with semaglutide 1·0 mg; p<0·0001 for superiority, for both semaglutide doses vs sitagliptin). The proportion of patients who discontinued treatment because of adverse events was 33 (8%) for semaglutide 0·5 mg, 39 (10%) for semaglutide 1·0 mg, and 12 (3%) for sitagliptin. The most frequently reported adverse events in both semaglutide groups were gastrointestinal in nature: nausea was reported in 73 (18%) who received semaglutide 0·5 mg, 72 (18%) who received semaglutide 1·0 mg, and 30 (7%) who received placebo, and diarrhoea was reported in 54 (13%) who received semaglutide 0·5 mg, 53 (13%) who received semaglutide 1·0 mg, and 29 (7%) who received placebo. Seven (2%) patients in the semaglutide 0·5 mg group, two (<1%) in the semaglutide 1·0 mg group, and five (1%) in the sitagliptin group had blood-glucose confirmed hypoglycaemia. There were six fatal events (two in the semaglutide 0·5 mg group, one in the semaglutide 1·0 mg group, and three in the sitagliptin group); none were considered likely to be related to the trial drugs.</p><p><b>INTERPRETATION: </b>Once-weekly semaglutide was superior to sitagliptin at improving glycaemic control and reducing bodyweight in participants with type 2 diabetes on metformin, thiazolidinediones, or both, and had a similar safety profile to that of other GLP-1 receptor agonists. Semaglutide seems to be an effective add-on treatment option for this patient population.</p><p><b>FUNDING: </b>Novo Nordisk A/S.</p>

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2017

Journal Article

H. B. Rao, Ahamed, H., Panicker, S., Sudhindran, S., and Venu, R. P., “Endoscopic therapy for biliary strictures complicating living donor liver transplantation: Factors predicting better outcome.”, World J Gastrointest Pathophysiol, vol. 8, no. 2, pp. 77-86, 2017.[Abstract]


<p><b>AIM: </b>To identify factors predicting outcome of endoscopic therapy in bile duct strictures (BDS) post living donor liver transplantation (LDLT).</p><p><b>METHODS: </b>Patients referred with BDS post LDLT, were retrospectively studied. Patient demographics, symptoms (Pruritus, Jaundice, cholangitis), intra-op variables (cold ischemia time, blood transfusions, number of ducts used, .), peri-op complications [hepatic artery thrombosis (HAT), bile leak, infections], stricture morphology (length, donor and recipient duct diameters) and relevant laboratory data both pre- and post-endotherapy were studied. Favourable response to endotherapy was defined as symptomatic relief with > 80% reduction in total bilirubin/serum gamma glutamyl transferase. Statistical analysis was performed using SPSS 20.0.</p><p><b>RESULTS: </b>Forty-one patients were included (age: 8-63 years). All had right lobe LDLT with duct-to-duct anastomosis. Twenty patients (48.7%) had favourable response to endotherapy. Patients with single duct anastomosis, aggressive stent therapy (multiple endoscopic retrograde cholagiography, upsizing of stents, dilatation and longer duration of stents) and an initial favourable response to endotherapy were independent predictors of good outcome ( < 0.05). Older donor age, HAT, multiple ductal anastomosis and persistent bile leak (> 4 wk post LT) were found to be significant predictors of poor response on multivariate analysis ( < 0.05).</p><p><b>CONCLUSION: </b>Endoscopic therapy with aggressive stent therapy especially in patients with single duct-to-duct anastomosis was associated with a better outcome. Multiple ductal anastomosis, older donor age, shorter duration of stent therapy, early bile leak and HAT were predictors of poor outcome with endotherapy in these patients.</p>

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2017

Journal Article

M. Kappanayil, Koneti, N. Rao, Kannan, R. R., Kottayil, B. P., and Kumar, K., “Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases: Early experience and proof of concept in a resource-limited environment.”, Ann Pediatr Cardiol, vol. 10, no. 2, pp. 117-125, 2017.[Abstract]


<p><b>INTRODUCTION: </b>Three-dimensional. (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts" Healthcare applications are currently in evolution.</p><p><b>OBJECTIVE: </b>The objective of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from high-resolution medical imaging data (cardiac magnetic resonance imaging/computed tomography [MRI/CT]) on surgical decision-making and preoperative planning in selected cases of complex congenital heart diseases (CHDs).</p><p><b>MATERIALS AND METHODS: </b>Five patients with complex CHD with previously unresolved management decisions were chosen. These included two patients with complex double-outlet right ventricle, two patients with criss-cross atrioventricular connections, and one patient with congenitally corrected transposition of great arteries with pulmonary atresia. Cardiac MRI was done for all patients, cardiac CT for one; specific surgical challenges were identified. Volumetric data were used to generate patient-specific 3D models. All cases were reviewed along with their 3D models, and the impact on surgical decision-making and preoperative planning was assessed.</p><p><b>RESULTS: </b>Accurate life-sized 3D cardiac prototypes were successfully created for all patients. The models enabled radically improved 3D understanding of anatomy, identification of specific technical challenges, and precise surgical planning. Augmentation of existing clinical and imaging data by 3D prototypes allowed successful execution of complex surgeries for all five patients, in accordance with the preoperative planning.</p><p><b>CONCLUSIONS: </b>3D-printed cardiac prototypes can radically assist decision-making, planning, and safe execution of complex congenital heart surgery by improving understanding of 3D anatomy and allowing anticipation of technical challenges.</p>

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2017

Journal Article

R. Krishna Kumar, “A roadmap for the aspiring interventional pediatric cardiologist.”, Ann Pediatr Cardiol, vol. 10, no. 2, pp. 109-113, 2017.

2017

Journal Article

K. G. Gopakumar, Thankamony, P., Nampoothiri, S., Bali, D., Raj, J., Vasudevan, J. A., and Nair, R. K., “Wolman Disease: A Mimic of Infant Leukemia.”, J Pediatr Hematol Oncol, vol. 39, no. 8, pp. e489-e492, 2017.[Abstract]


<p><b>BACKGROUND: </b>Infant leukemia most commonly present with pallor and hepatosplenomegaly. The possibility of other differential diagnosis also has to be kept in mind during evaluation, as identifying the precise etiology for this clinical presentation is crucial for management.</p><p><b>OBSERVATION: </b>An infant, was referred to us with suspected infant leukemia and was subsequently diagnosed to have lysosomal acid lipase deficiency/Wolman disease with a novel 5 bp deletion "c.1180_1184del" in the last exon (exon 10) of the lipase A (LIPA) gene.</p><p><b>CONCLUSIONS: </b>Hepatosplenomegaly and pallor resulting from nutritional deficiency or bone marrow involvement in Wolman disease can mimic infant leukemia.</p>

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2017

Journal Article

B. Champaneri, Kappanayil, M., and Kumar, R. K., “Transcatheter closure of a membranous ventricular septal defect in a 1.8-kg infant using Amplatzer Duct Occluder II additional size device.”, Cardiol Young, vol. 27, no. 7, pp. 1437-1440, 2017.[Abstract]


<p>Catheter closure of membranous ventricular septal defects is generally not considered feasible in small infants. We report the successful closure of a membranous ventricular septal defect in a 1.8-kg infant with bilateral femoral artery occlusion using Amplatzer Duct Occluder II additional size device. The ventricular septal defect was crossed from the right ventricle, and the device was deployed using transthoracic echocardiographic guidance.</p>

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2017

Journal Article

V. K. Nambiar, Sajitha, S., Viswanath, N., Praveen, V. P., and Bindhu, M. R., “Cerebral venous thrombosis due to pheochromocytoma in a patient with Von Hippel Lindau mutation.”, Neurol India, vol. 65, no. 3, pp. 643-645, 2017.

2017

Journal Article

P. Shanavas Khan and Thilak, J., “Causes of Total Knee Revision in Emerging Economies: Is It Different from the Western World?”, J Knee Surg, vol. 30, no. 4, pp. 341-346, 2017.[Abstract]


<p>There is limited information in English literature regarding the cause of revision total knee arthroplasty (TKA) in emerging economies. The purpose of this study is to report a detailed analysis of the TKA failure mechanisms from a referral hospital in India and to determine whether the failure mechanisms of primary TKA are different from that of the western world. A total of 53 revision TKAs performed at our institution over the past 5 years were identified. The revision TKA group was divided into subgroups according to the cause of failure, including infection, aseptic loosening, periprosthetic fracture, instability, extensor mechanism failure, and other causes. All revision TKA patients were subdivided into early (less than 2 years from primary) and late (more than 2 years from primary) failure groups depending upon the time interval between primary TKA and revision procedure. The overall common failure mechanisms were infection (73.58%), aseptic loosening (13.2%), and periprosthetic fracture (5.6%). Infection was the most common failure mechanism for early revision (< 2 years from primary) and aseptic loosening was the most common reason for late revision. Our study shows a pattern similar to the earliest trends of revision TKA in western literature reporting infection as the major cause for revision. The level of evidence for the study is Level 3.</p>

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2017

Journal Article

Suhas Udayakumaran, Onyia, C. U., and Cherkil, S., “An Analysis of Outcome of Endoscopic Fenestration of Cavum Septum Pellucidum Cyst - More Grey than Black and White?”, Pediatr Neurosurg, vol. 52, no. 4, pp. 225-233, 2017.[Abstract]


<p><b>BACKGROUND: </b>Cavum septum pellucidum (CSP) and cavum vergae are actually fluid-filled, generally communicating midline cavities located between the third ventricle and corpus callosum. There have been various reports of their association with many behavioral and psychiatric disorders. Infrequently, they have been associated with an obstructive hydrocephalus-like picture. Although the structure and management of CSP has long been known, it has been an enigma as far as functional significance and management indications are concerned. The authors of this article try to analyze the significance of a persistent cavum and involvement of the same entity in varied presentations ranging from an incidental imaging finding to acute hydrocephalus, and propose a possible implication on the present surgical intervention paradigm.</p><p><b>PURPOSE: </b>To assess the surgical outcome of fenestration of a CSP cyst.</p><p><b>METHODS: </b>Retrospective analysis of 3 patients who underwent endoscopic fenestration for CSP with obstructive hydrocephalus between 2012 and 2014 was done, and data were analyzed for symptomatic clinical improvement in particular behavior.</p><p><b>RESULTS: </b>Pre- and postoperative brain MRI showed a significant decrease in the size of the cyst as well as the ventricles. There were no recurrences during follow-up. All of the patients improved.</p><p><b>CONCLUSIONS: </b>(1) Endoscopic fenestration of symptomatic CSP cysts is a safe treatment option. (2) Neurocognitive assessment is essential in the evaluation and outcome assessment of CSP.</p>

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2017

Journal Article

A. V. Balegadde, Vijan, V., and Rajesh Thachathodiyl, “A case series of young patients with completely reversed severe pulmonary hypertension”, Journal of Clinical and Diagnostic Research, vol. 11, pp. OR04-OR05, 2017.[Abstract]


Pulmonary Arterial Hypertension (PAH) is a progressive symptomatic disorder, which may ultimately lead to death if left untreated. Although majority of PAH cases are idiopathic, pulmonary hypertension resulting due to certain underlying conditions are also observed frequently. In such cases, it becomes essential to identify any potentially treatable or reversible causes for PAH. There have been significant advances in the medical management of PAH and various medicines have been approved by US Food and Drug Administration (FDA) for various stages of PAH. With these therapies, there can be varying degrees of improvement in the pulmonary artery pressures and hemodynamic profile. Therefore, physiologic reversal can and does occur, sometimes to the point of normalization. We hereby present three such cases of severe PAH in patients below 50 years of age due to various aetiologies like left heart disease, isolated unilateral absence of right pulmonary artery with hypoplastic right lung and factor V Leiden mutation associated pulmonary thromboembolism, all of whose pulmonary artery pressures are completely normalised with adequate treatment of the underlying disease and with optimised medications for PAH, ultimately leading to tapering and stoppage of PAH medications. © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.

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2017

Journal Article

K. Surendran, Harilal, O. P., Hrudya, P., Poornachandran, P., and Suchetha, N. K., “Stylometry detection using deep learning”, Advances in Intelligent Systems and Computing, vol. 556, pp. 749-757, 2017.[Abstract]


Author profiling is one of the active researches in the field of data mining. Rather than only concentrated on the syntactic as well as stylometric features, this paper describes about more relevant features which will profile the authors more accurately. Readability metrics, vocabulary richness, and emotional status are the features which are taken into consideration. Age and gender are detected as the metrics for author profiling. Stylometry is defined by using deep learning algorithm. This approach has attained an accuracy of 97.7% for gender and 90.1% for age prediction. © Springer Nature Singapore Pte Ltd. 2017.

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2017

Journal Article

P. S. Rakesh, Lalu, J., and Leelamoni, K., “Prevalence of exposure to secondhand smoke among higher secondary school students in Ernakulam District, Kerala, Southern India”, Journal of Pharmacy and Bioallied Sciences, vol. 9, pp. 44-47, 2017.[Abstract]


Introduction: The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India. Materials and Methods: A structured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke (adjusted OR 4.51 [95% CI 1.66-12.22]). More than half of the study participants (56.3%) reported that they were exposed to cigarette smoke in past 1 week in a public place and 10.2% in closed public places. Nearly one-third of the students reported that they have seen somebody smoking inside school campus in the past 30 days. Conclusion: Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents.

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2017

Journal Article

R. Agarwal, Rajanbabu, A., Nair, I. R., Satish, C., Jose, G., and Unikrishnan, U. G., “Endometrial stromal sarcoma-A retropsective analysis of factors affecting recurrence.”, Eur J Obstet Gynecol Reprod Biol, vol. 216, pp. 92-97, 2017.[Abstract]


<p><b>OBJECTIVE: </b>To assess the factors associated with disease free survival and overall survival in endometrial stromal sarcoma (ESS).</p><p><b>METHODS: </b>This was a single institution retrospective analysis done at Amrita Institute of Medical Sciences. Records from January 2005 to October 2016 were analysed and 42 patients with ESS were identified. Clinicopathological, surgical management, adjuvant treatment and outcome data were collected. Disease free and overall survivals were analysed using Kaplan-Meier method and compared using log rank test.</p><p><b>RESULTS: </b>Out of 38 patients included in analysis 28 (73.7%) had low grade ESS (LGESS) and 10 (26.3%) had high grade ESS (HGESS). The median follow up period was 28 months (range 1-110 months). The 5year disease free survival (DFS) and overall survival (OS) for the entire cohort were 62.9 and 89.1% respectively. High grade ESS was significantly associated with recurrence on univariate analysis (p=0.045). Complete staging surgery in both HGESS and LGESS and adjuvant treatment in HGESS and advanced stage LGESS (cohort 1) were associated with improved 5-year DFS of 90.9% (p<0.001). Completion staging surgery in patients with initial incomplete surgery (cohort 3) was associated with improved 5-year DFS of 100% (p<0.001). Complete Staging surgery but no adjuvant treatment in HGESS and advanced stage LGESS (cohort 2) was associated with significantly poor 2-year DFS of 20% (5-year DFS rate 0%; as all patients recurred within 27 months) (P<0.001). Significantly reduced 5-year DFS rate of 25% (p<0.001) was also seen in cases where initial incomplete surgery was not followed by complete staging and adjuvant treatment (cohort 4). Adjuvant treatment in HGESS was associated with improved 5-year DFS of 66.7% (p=0.043). Resection of recurrent lesions were associated with improved mean survival of 41.2 months.</p><p><b>CONCLUSION: </b>Incomplete surgery and no adjuvant treatment in ESS are associated with poor DFS. Complete staging surgery is associated with improved DFS. Resection of recurrent disease is associated with survival advantage.</p>

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2017

Journal Article

P. Bijalwan, Sanjeevan, K. V., Mathew, A., and T Nair, B., “Outcome and complications of living donor pediatric renal transplantation: Experience from a tertiary care center.”, Indian J Urol, vol. 33, no. 3, pp. 221-225, 2017.[Abstract]


<p><b>INTRODUCTION: </b>We retrospectively reviewed the patient characteristics, outcome, and complications of renal transplantation in pediatric age group performed at our center and compared the results with various centers in India and other developed countries.</p><p><b>MATERIALS AND METHODS: </b>Patients younger than eighteen years of age who underwent renal transplantation from 2003 to 2014 at our institute were reviewed. Demographic data of the transplant recipients and donors, etiology of ESRD, mode of dialysis, surgical details of renal transplantation, immunosuppression, medical and surgical complications, and post-transplant follow-up were assessed. Graft survival was determined at 1, 3 and 5 years post-transplant. All data collected were entered into Microsoft excel program and analyzed using SPSS 20. Kaplan-Meier method was applied to determine the graft survival at 1, 3, and 5 years. The log-rank test was applied to test the statistical significance of the difference in survival between groups.</p><p><b>RESULTS: </b>Thirty-two children underwent transplantation comprising of 18 females and 14 males. The mean age was 14.5 years (range 10-17 years). The primary cause of renal failure was glomerular diseases in 53% (17/32) of patients. Seventeen postsurgical complications were noted in our series. Two grafts were lost over a follow-up of 5 years. The 1, 3, and 5 year graft survival rates were 96.7%, 92.9%, and 85%, respectively. There was no mortality.</p><p><b>CONCLUSION: </b>The etiology of ESRD in our region is different from that of developed countries. The mean age at which children undergo renal transplantation is higher. Graft survival at our center is comparable to that of developed nations. Renal transplantation can be safely performed in children with ESRD.</p>

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2017

Journal Article

D. Menon, Chelakkot, P. G., Sunil, D., and Lakshmaiah, A., “A cross sectional review of patient information available in the World Wide Web on CyberKnife: fallacies and pitfalls.”, Support Care Cancer, vol. 25, no. 12, pp. 3769-3773, 2017.[Abstract]


<p><b>PURPOSE: </b>The purpose of this study is to assess the quality of videos available in YouTube on CyberKnife.</p><p><b>METHODS: </b>The term "CyberKnife" was input into the search window of www.youtube.com on a specific date and the first 50 videos were assessed for technical and content issues. The data was tabulated and analysed.</p><p><b>RESULTS: </b>The search yielded 32,300 videos in 0.33 s. Among the first 50 analysed, most were professional videos, mostly on CyberKnife in general and for brain tumours. Most of the videos did not mention anything about patient selection or lesion size. The other technical details were covered by most although they seemed muffled by the animations. Many patient videos were recordings of one entire treatment, thus giving future patients an insight on what to expect. Almost half the videos projected glorified views about the treatment technique.</p><p><b>CONCLUSIONS: </b>The company videos were reasonably accurate and well presented as were many institutional videos, although there was a tendency to gloss over a few points. The glorification of the treatment technique was a disturbing finding. The profound trust of the patients on the health care system is humbling.</p>

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2017

Journal Article

S. Vijayrajratnam, Pushkaran, A. Choorakott, Balakrishnan, A., Vasudevan, A. Kumar, Dr. Raja Biswas, and Dr. Gopi Mohan C., “Understanding the Molecular Differential Recognition of Muramyl Peptide Ligands by LRR Domains of Human NOD Receptors.”, Biochem J, vol. 474, no. 16, pp. 2691-2711, 2017.[Abstract]


<p>Human nucleotide-binding oligomerization domain proteins, hNOD1 and hNOD2, are host intracellular receptors with C-terminal leucine-rich repeat (LRR) domains, which recognize specific bacterial peptidoglycan (PG) fragments as their ligands. The specificity of this recognition is dependent on the third amino acid of the stem peptide of the PG ligand, which is usually -diaminopimelic acid (DAP) or l-lysine (l-Lys). Since the LRR domains of hNOD receptors had been experimentally shown to confer the PG ligand-sensing specificity, we developed three-dimensional structures of hNOD1-LRR and the hNOD2-LRR to understand the mechanism of differential recognition of muramyl peptide ligands by hNOD receptors. The hNOD1-LRR and hNOD2-LRR receptor models exhibited right-handed curved solenoid shape. The hot-spot residues experimentally proved to be critical for ligand recognition were located in the concavity of the NOD-LRR and formed the recognition site. Our molecular docking analyses and molecular electrostatic potential mapping studies explain the activation of hNOD-LRRs, in response to effective molecular interactions of PG ligands at the recognition site; and conversely, the inability of certain PG ligands to activate hNOD-LRRs, by deviations from the recognition site. Based on molecular docking studies using PG ligands, we propose few residues - G825, D826 and N850 in hNOD1-LRR and L904, G905, W931, L932 and S933 in hNOD2-LRR, evolutionarily conserved across different host species, which may play a major role in ligand recognition. Thus, our integrated experimental and computational approach elucidates the molecular basis underlying the differential recognition of PG ligands by hNOD receptors.</p>

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2017

Journal Article

A. Kallikunne Mohamed, Mehta, A. Anilkumar, and James, P., “Predictors of mortality of severe sepsis among adult patients in the medical Intensive Care Unit.”, Lung India, vol. 34, no. 4, pp. 330-335, 2017.[Abstract]


<p><b>BACKGROUND: </b>Sepsis is an important cause of mortality in the Intensive Care Units (ICUs) worldwide. Information regarding early predictive factors for mortality and morbidity is limited.</p><p><b>AIMS AND OBJECTIVES: </b>The primary objective of the study was to estimate the mortality of severe sepsis among adult patients admitted into the medical ICU. The secondary objective was to identify the predictors associated with mortality.</p><p><b>MATERIALS AND METHODS: </b>Adult patients admitted with severe sepsis in the medical ICU were studied. The primary outcome was the mortality among the study population. Baseline demographic, clinical, and laboratory data were recorded upon inclusion into the study. Risk factors associated with mortality were studied by univariate analysis. The variables having statistical significance were further included in multivariate analysis to identify the independent predictors of mortality.</p><p><b>RESULTS: </b>Out of eighty patients, 54 (67.5%) died. Univariate analysis showed that age >60 years, tachycardia, hypotension, elevated C-reactive protein (CRP) and lactate, thrombocytopenia, need of mechanical ventilation, and high Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment scores were variables associated with high mortality. The independent predictors of mortality identified by multivariate regression analysis were platelet count below 1 lakhs, serum levels of CRP >100, APACHE II score >25 on the day of admission to the ICU with severe sepsis, and the need for invasive mechanical ventilation.</p><p><b>CONCLUSIONS: </b>Low platelet count, elevated serum levels of CRP, APACHE score >25, and the need for invasive mechanical ventilation were found to be independent predictors of mortality of severe sepsis among adult patients with severe sepsis in the medical ICU.</p>

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2017

Journal Article

N. Subramaniam, Balasubramanian, D., Murthy, S., Limbachiya, S., Thankappan, K., and Iyer, S., “Adverse pathologic features in early oral squamous cell carcinoma and the role of postoperative radiotherapy-a review.”, Oral Surg Oral Med Oral Pathol Oral Radiol, vol. 124, no. 1, pp. 24-31, 2017.[Abstract]


<p>The use of postoperative radiotherapy (PORT) in early stage oral cancer with adverse pathologic features (APFs) is controversial. Prognostically relevant APFs reviewed were perineural invasion, lymphovascular invasion, depth of invasion, worst pattern of invasion, and margin status. The current literature remains divided with regard to the benefit of treatment escalation in these patients; although these patients are at high risk for recurrence, the morbidity of PORT needs to be balanced against the likely benefit in disease control. A wide heterogeneity in the literature exists, likely as a result of differences in treatment protocols. We performed a literature review of the role of PORT in early-stage oral cancer with APFs. Based on the current evidence, the decision to administer adjuvant therapy needs to be made on an individual basis; patients with >1 APF are likely to benefit from PORT, and the use of risk-scoring systems may help in decision making.</p>

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2017

Journal Article

S. Singhal, N.K. Prabhu, Sethi, P., and S. Moorthy, “Role of multi detector computed tomography (MDCT) in preoperative staging of pancreatic carcinoma”, Journal of Clinical and Diagnostic Research, vol. 11, pp. TC01-TC05, 2017.[Abstract]


Introduction: Pancreatic carcinoma is one of the leading causes of cancer related death in advanced countries and has shown rising trends in developing countries like India. Increase in the incidence has been linked to risk factors like lifestyle modification associated with increased alcohol consumption and rapid urbanization. Most patients at the time of diagnosis present with an advanced condition. Surgical resection offers the only chance for cure in them and imaging plays a crucial role in the early diagnosis of the condition. Aim: To compare the staging of pancreatic carcinoma by MDCT (Multi Detector Computed Tomography) with surgery in a preoperative setting in a tertiary referral centre in Kerala. Materials and Methods: A cross sectional observational study was performed between November 2014 and October 2016, 25 patients (12 men, 13 women), with a mean age of 54.2 years, were evaluated. MDCT was performed using 16 slice, 64 slice and 256 slice multi detector CT machines. The gold standard for diagnosis was histopathology and operative data. All statistical analysis was done using IBM SPSS version 20.0. Validity parameters like sensitivity, specificity, accuracy and Positive Predictive Value (PPV)/Negative Predictive Value (NPV) were computed for MDCT with respect to surgery. Results: Of the 25 patients who were evaluated for surgery, 15 (60%) cases were classified as resectable tumours, 3 (12%) as borderline resectable and 7 (28%) as unresectable tumours. CT showed a sensitivity of 82.3% with a specificity of 87.5%. However, for assessing vascular invasion, CT showed sensitivity and specificity of 100% and 93.3% respectively. Three (12%) patients in the study who were classified as borderline resectable pancreatic tumours underwent surgery. Conclusion: Contrast-enhanced multiphase pancreatic imaging using MDCT plays a pivotal role in diagnosing and assessing resectability and vascular invasion of pancreatic tumours. It is very useful for determining borderline resectable tumours pre-operatively, which aids for better treatment planning. © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.

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2017

Journal Article

G. P. Chelakkot, Ravind, R., Sruthi, K., Chigurupati, N., Kotne, S., Holla, R., R. Madhavan, and Dinesh, M., “Adjuvant hypofractionated radiation in carcinoma breast - Photon versus Electron: Comparison of treatment outcome”, Journal of Cancer Research and Therapeutics, vol. 13, pp. 262-267, 2017.[Abstract]


Background: Breast cancer tissue is sensitive to hypofractionation. This is an analysis of patients treated with hypofractionated protocols since 2009, at our tertiary cancer center. Methods: Details of breast cancer patients treated with adjuvant hypofractionated external beam radiation therapy (EBRT) from January 2009 to December 2014 were retrieved and analyzed. Results: One thousand seven hundred and eighty patients received adjuvant EBRT during this period. Three hundred and eight were offered hypofractionated schedule. One hundred and eighty-eight had modified radical mastectomy (MRM) and 120 had breast conservation surgery (BCS). Dose was 40 Gy in 15 fractions to chest wall/breast, and tumor bed boost of 10 Gy in 5 fractions, where indicated, using three-dimensional conformal radiotherapy (3DCRT). Electrons were used in 159 and photons in 149. Single en face electron field was used for chest wall in MRM patients, and tangential photon beams for the whole breast. Patients on follow-up were assessed for locoregional recurrence, chest wall, breast or ipsilateral upper limb edema, brachial neuralgia, local skeletal events, pulmonary and cardiac symptoms, and cosmetic results. Two developed chest wall recurrence, one each in electron and photon arms. No skeletal, cardiac, or pulmonary adverse events were recorded. About 13.6% had arm edema, which was staged according to the International Society of Lymphology lymphedema staging, as Stage I-7.8%, Stage II-3.9%, and Stage III-1.9%. Twenty-six treated with electrons had arm edema. Increased incidence of arm edema in MRM patients could be attributed to combined surgical and radiation morbidity. Five-year overall survival was 81.9%. Conclusion: Hypofractionation is an accepted cost-effective standard of care in adjuvant breast radiation. Single en face electron field is well tolerated, and 3DCRT planning ensures homogeneous chest wall coverage, respecting dose constraints to organs at risk. © 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow.

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2017

Journal Article

S. Khan and Kumar, A., “Hepatitis B Vaccination for Healthcare Workers”, Indian Journal of Medical Microbiology, vol. 35, p. 315, 2017.

2017

Journal Article

P. Sethi, Thillai, M., Thankamonyamma, B. S., Mallick, S., Gopalakrishnan, U., Balakrishnan, D., Menon, R. N., S. Surendran, Dhar, P., and S. Vayoth, O., “Living Donor Liver Transplantation Using Small-for-Size Grafts: Does Size Really Matter?”, Journal of Clinical and Experimental Hepatology, 2017.[Abstract]


Background: In living donor liver transplantation (LDLT), graft-to-recipient weight ratio (GRWR). > 0.8% is perceived as the critical graft size. This lower limit of GRWR (0.8%) has been challenged over the last decade owing to the surgical refinements, especially related to inflow and outflow modulation techniques. Our aim was to compare the recipient outcome in small-for-size (GRWR. < 0.8) versus normal-sized grafts (GRWR. > 0.8) and to determine the risk factors for mortality when small-for-size grafts (SFSG) were used. Methods: Data of 200 transplant recipients and their donors were analyzed over a period of two years. Routine practice of harvesting middle hepatic vein (MHV) or reconstructing anterior sectoral veins into neo-MHV was followed during LDLT. Outcomes were compared in terms of mortality, hospital stay, ICU stay, and occurrence of various complications such as functional small-for-size syndrome (F-SFSS), hepatic artery thrombosis (HAT), early allograft dysfunction (EAD), portal vein thrombosis (PVT), and postoperative sepsis. A multivariate analysis was also done to determine the risk factors for mortality in both the groups. Results: Recipient and donor characteristics, intraoperative variables, and demographical data were comparable in both the groups (GRWR. < 0.8 and GRWR. ≥. 0.8). Postoperative 90-day mortality (15.5% vs. 22.85%), mean ICU stay (10 vs. 10.32 days), and mean hospital stay (21.4 vs. 20.76 days) were statistically similar in the groups. There was no difference in postoperative outcomes such as occurrence of SFSS, HAT, PVT, EAD, or sepsis between the groups. Thrombosis of MHV/reconstructed MHV was a risk factor for mortality in grafts with GRWR. <. 0.8 but not in those with GRWR. >. 0.8. Conclusion: Graft survival after LDLT using a small-for-size right lobe graft (GRWR. < 0.8%) is as good as with normal grafts. However, patency of anterior sectoral outflow by MHV or reconstructed MHV is crucial to maintain graft function when SFSG are used. © 2017 INASL.

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2017

Journal Article

C. U. Onyia and Menon, S. K., “The debate on most ideal technique for managing recurrent lumbar disc herniation: a short review.”, Br J Neurosurg, vol. 31, no. 6, pp. 701-708, 2017.[Abstract]


<p><b>BACKGROUND: </b>Though different techniques have been successfully employed in the treatment of recurrent lumbar disc herniation, the one which should be considered most ideal has remained a controversy, particularly since there are currently no generally accepted guidelines for surgical care.</p><p><b>OBJECTIVE: </b>To review previous publications comparing the available operative options, with the aim of determining if any of the available interventions gives better outcomes compared to others.</p><p><b>METHODS: </b>A systematic literature review of previous publications comparing various techniques employed in the surgical treatment of recurrent disc herniation.</p><p><b>RESULTS: </b>All publications investigated in this review clearly demonstrated quite comparable outcomes, with no superiority of one method over the other.</p><p><b>CONCLUSION: </b>In view of the currently available data and evidence, minimally invasive techniques for revision of recurrent disc herniation do not really appear to be superior to the conventional open surgical approaches and vice-versa. We suggest the management strategy for surgical treatment of each case of recurrence to be simply based on the experience of the surgeon, the available facilities and equipment. Fusion should not be undertaken in all recurrences but should only be considered as an option for revision when spinal instability, spinal deformity or associated radiculopathy is present.</p>

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2017

Journal Article

Suhas Udayakumaran, Onyia, C. U., and R Kumar, K., “Forgotten? Not Yet. Cardiogenic Brain Abscess in Children: A Case Series-Based Review.”, World Neurosurg, vol. 107, pp. 124-129, 2017.[Abstract]


<p><b>BACKGROUND: </b>Brain abscess is a significant cause of morbidity in patients with uncorrected or partially palliated congenital cyanotic heart disease (CCHD). Unfortunately, in the developing world, the majority of patients with CCHD remain either uncorrected or only partially palliated. Furthermore, a risk of this feared complication also exists even among those undergoing staged corrective operations in the interval in between operations. There have been no recent articles in the literature on the outcomes of surgical management of cardiogenic brain abscess in children. In this study, we aimed to describe the clinical and demographic profile of patients with cardiogenic cerebral abscess and to highlight the fact that uncorrected or palliated CCHD continue to be at risk for brain abscess.</p><p><b>METHODS: </b>This study was a retrospective analysis of 26 children (age <19 years) being managed for CCHD who were diagnosed with cerebral abscess managed surgically (26 of 39 of cases cerebral abscess in children), at Amrita Institute of Medical Sciences and Research Centre, Kochi, India between December 2000 and January 2014. Data collected retrospectively included demographic information, modes of presentation, diagnosis, location of abscess, details of the underlying heart disease, management of the cerebral abscess, and outcomes of management.</p><p><b>RESULTS: </b>The patient cohort comprised 26 patients (16 males and 10 females), with a mean age of 7.19 years (range, 1.5-19 years). Ten of the 26 patients (38%) required reaspiration after the initial surgery. On follow-up, all the patients had improved symptomatically and demonstrated no signs of cerebral abscess.</p><p><b>CONCLUSIONS: </b>Cardiogenic origin of cerebral abscess is the most common cause of cerebral abscess in children. Unresolved CCHD is a risk factor for the occurrence, persistence, and recurrence of cerebral abscess.</p>

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2017

Journal Article

R. Antony, Krishna, S., James, J., Kunoor, A., and Vijayan, M., “Case report on docetaxel-induced interstitial lung disease”, Asian Journal of Pharmaceutical and Clinical Research, vol. 10, pp. 10-12, 2017.[Abstract]


Docetaxel belongs to taxane family of antineoplastic agents that are indicated for the treatment of locally advanced or metastatic non-small-cell lung cancer. Docetaxel is associated with many adverse effects, and pulmonary reaction has an incidence of 41%. However, interstitial pulmonary disease is found to occur only in &lt;1% of the population as per the post-marketing surveillance reports. Here, we report a case of docetaxel-induced interstitial lung disease (ILD). The patient information and details were collected using the hospital information system. The adverse drug reaction (ADR) of ILD occurred after 5 cycles of chemotherapy with docetaxel at a dose of 60 mg/m2 that is 80 mg IV. The causality of the event in our case was assessed using the Naranjo ADR probability scale which marked a score of 7 (probable). It is necessary that all physicians be aware of the reaction and to closely monitor clinicoradiological and functional status of the patients at regular intervals after administration of docetaxel.

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2017

Journal Article

M. S. M. Iype, Kunoor, A., and N, A. K., “A Treatment Dilemma Concerning Immunosuppressant Use: A Case Report”, Asian Journal of Pharmaceutical and Clinical Research, vol. 10, pp. 4-6, 2017.[Abstract]


Immunosuppressants including corticosteroids (prednisolone &gt;15 mg/day) are responsible for an increased risk of susceptibility to infections (especially pneumonia, tuberculosis [TB] including extra pulmonary TB), an important safety concern when providing immunosuppressive therapy. Anti-TB treatment (ATT) is medicines used to treat tuberculosis, an infectious disease which can affect lungs and other organs. Isoniazid, rifampicin, and pyrazinamide are known to cause ATT induced hepatitis. The prevalence of immunosuppressant induced TB and pyrazinamide induced hepatotoxicity during treatment for active TB ranges to about 0.6%-1% and &lt;1%, respectively. Here, we illustrate a typical case report of a 61-year-old woman who is a known case of interstitial lung disease and developed TB arthritis following therapy with the long-term use of immunosuppressants (prednisolone, azathioprine, leflunomide, and sulfasalazine). ATT regimen was started for TB arthritis which was later modified along with addition of liver protectant due to the development of hepatotoxicity. The causality of both the adverse drug reactions was confirmed to be probable via NARANJO causality assessment scale. This case highlights the incidence of infectious complications like TB which may be expected to be encountered more frequently in the future due to the increasing use of immunosuppressants for the treatment of allergic and inflammatory disorders.

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2017

Journal Article

J. Nayar, Nair, S. S., and George, N. A., “Is LNG-IUS the One-Stop Answer to AUB?”, Journal of Obstetrics and Gynecology of India, pp. 1-5, 2017.[Abstract]


A systematic search of the literature available on the use of Levonorgestrel intra-uterine system (LNG-IUS) in women with abnormal uterine bleeding was done. This included PubMed searches up to February 2017 as well as references available with the authors. LNG-IUS usage in other situations was not included in the study. Each relevant published article was evaluated as to whether it served the purpose of this review. Available data show that LNG-IUS is certainly the one-stop answer to AUB, providing a safe and cost-effective treatment and being a substitute for hysterectomy in most women with AUB. © 2017 Federation of Obstetric & Gynecological Societies of India

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2017

Journal Article

A. Vijay Kanetkar, Dinesh Balakrishnan, Sudhindran, S., Dhar, P., Gopalakrishnan, U., Menon, R., and Sudheer, O. Vayoth, “Is Portal Venous Pressure or Porto-systemic Gradient Really A Harbinger of Poor Outcomes After Living Donor Liver Transplantation?”, J Clin Exp Hepatol, vol. 7, no. 3, pp. 235-246, 2017.[Abstract]


<p><b>BACKGROUND: </b>Portal hyperperfusion as a cause of small for size syndrome (SFSS) after living donor liver transplantation (LDLT) remains controversial. Portal venous pressure (PVP) is often measured indirectly and may be confounded by central venous pressure (CVP).</p><p><b>METHODS: </b>In 42 adult cirrhotics undergoing elective LDLT, PVP was measured by direct canulation of portal vein and porto systemic gradient (PSG) was obtained after subtracting CVP from PVP. None underwent portal inflow modulation. SFSS was looked in 27 patients after excluding 15 with technical complications.</p><p><b>RESULTS: </b>Clinical features of SFSS found in 6 patients, 5 with graft recipient weight ratio (GRWR) > 0.8% and PVP < 20 mm of Hg. One with GRWR < 0.8% could truly be labeled as SFSS. Incidence of SFSS was not higher in patients with elevated PVP > 20 mm of Hg (14.3% vs 0%,  = 0.259) or PSG > 13 mm of Hg (33.3% vs 0%,  = 0.111). Intensive care unit (ICU) stay was longer in patients with elevated PVP (14.55 vs 9.13 days,  = 0.007) and PSG (16.8 vs 9.72 days,  = 0.009). There was no difference in graft functions, post-operative complications and mortality in first month post-LDLT.</p><p><b>CONCLUSION: </b>Elevated PVP or PSG increased morbidity but neither predicted SFSS nor affected survival.</p>

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2017

Journal Article

K. Y. Santosh Kumar, Mathew, J. Shaji, Dinesh Balakrishnan, Bharathan, V. Kumar, Amma, B. Sivasankar, Gopalakrishnan, U., Menon, R. Narayana, Dhar, P., Vayoth, S. Othiyil, and Sudhindran, S., “Intraductal Transanastomotic Stenting in Duct-to-Duct Biliary Reconstruction after Living-Donor Liver Transplantation: A Randomized Trial.”, J Am Coll Surg, vol. 225, no. 6, pp. 747-754, 2017.[Abstract]


BACKGROUND: Biliary complications continue to be the "Achilles heel" of living-donor liver transplantation (LDLT). The use of biliary stents in LDLT to reduce biliary complications is a controversial issue. We performed a randomized trial to study the impact of intraductal biliary stents on postoperative biliary complications after LDLT.

STUDY DESIGN: Of the 94 LDLTs that were performed during a period of 16 months, ABO-incompatible transplants, left lobe grafts, 3 or more bile ducts on the graft, and those requiring bilioenteric drainage were excluded. Eligible patients were randomized to either a study arm (intraductal stent, n = 31) or a control arm (no stent, n = 33) by block randomization. Stratification was done, based on the number of ducts on the graft requiring anastomosis, into single (n = 20) or 2 ducts (n = 44). Ureteric stents of 3F to 5F placed across the biliary anastomosis and exiting into the duodenum for later endoscopic removal at 3 months were used. The primary end point was postoperative bile leak.

RESULTS: Bile leak occurred in 15 of 64 (23.4%), the incidence was higher in the stented group compared with the control group (35.5% vs 12.1%; p = 0.03). Multiplicity of bile ducts and stenting were identified as risk factors for bile leak on multivariate analysis (p = 0.031 and p = 0.032). During a median follow-up of 2 years, biliary stricture developed in 9 patients (14.1%). Postoperative bile leak is a significant risk factor for the development of biliary stricture (p = 0.003).

CONCLUSIONS: Intraductal transanastomotic biliary stenting and multiplicity of graft ducts were identified as independent risk factors for the development of postoperative biliary complications.

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2017

Journal Article

S. Nampoothiri, Hebbar, M., Roy, A. Grace, Kochumon, S. P., Bielas, S., Shukla, A., and Girisha, K. M., “Hyperphosphatasia with Mental Retardation Syndrome Due to a Novel Mutation in .”, J Pediatr Genet, vol. 6, no. 3, pp. 191-193, 2017.[Abstract]


<p>Hyperphosphatasia with mental retardation syndrome is a heterogeneous genetic condition. Two siblings aged 5 years and 3 years were evaluated for global development delay and facial dysmorphism. A novel missense variant, c.851A>G (p.H284R, NM_033419.3), in was identified using whole-exome sequencing. Assays for elevated alkaline phosphatase and exome sequencing can be useful for the diagnosis of hyperphosphatasia with mental retardation syndrome.</p>

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2017

Journal Article

W. M. Jose, Pavithran, K., and Ganesan, T. S., “Short-course lenalidomide plus low-dose dexamethasone in the treatment of newly diagnosed multiple myeloma— A single-centre pragmatic study”, Current Oncology, vol. 24, pp. e361-e367, 2017.[Abstract]


Purpose We assessed response to treatment, toxicity, time to progression, progression-free survival, and overall survival in patients newly diagnosed with multiple myeloma who were ineligible for or unwilling to undergo transplantation and who were treated with a combination of lenalidomide and low-dose dexamethasone for a fixed 6 cycles in a resource-constrained environment. Methods This pragmatic study, conducted in a single tertiary cancer centre in South India, enrolled patients from May 2009 till April 2011. Treatment included lenalidomide 25 mg daily for 21 days, with dexamethasone 40 mg on days 1, 8, 15, and 22 of a 28-day cycle, for 6 cycles. Response was evaluated after the 3rd and 6th cycles of treatment. All patients were followed for 5 years. Results The study enrolled 51 patients. Median age in the group was 61 years (range: 38–76 years). Immunoglobulin G or A myeloma constituted 70.6% of the diagnoses, and light-chain myeloma constituted 29.4%. Stages i, ii, and iii (International Staging System) disease constituted 21.4%, 28.6%, and 50% of the diagnoses respectively. All patients were transplantation-eligible, but 34 (66.7%) refused for economic reasons. After treatment, 19.6% of the patients achieved a stringent complete response; 35.3%, a complete response; 5.9%, a very good partial response; and 29.4%, a partial response, for an overall response rate of 90.2%. Stable disease was seen in 3.9% of patients, and progressive disease, in 5.9%. Grade 3 or greater nonhematologic and hematologic toxicity occurred in 35.2% and 11.7% of patients respectively. Pulmonary embolism occurred in 1 patient. No patient experienced deep-vein thrombosis or peripheral neuropathy. The median follow-up duration was 66 months. All patients experienced disease progression. Median progression-free survival was 16 months. In 10 patients, re-challenge with lenalidomide and dexamethasone achieved a second complete response. At the time of writing, 19 patients had died. The overall survival rate at 5 years was 62.74%. Median overall survival is not yet reached. Conclusions In a resource-constrained setting, lenalidomide with low-dose dexamethasone is an effective treatment with acceptable toxicity in patients newly diagnosed with multiple myeloma and not planned for transplantation. Complete responses were significantly more frequent than reported in the Western literature. Occurrence of clinical deep-vein thrombosis was rare, but hyperglycemia was common. An abbreviated course of treatment is suboptimal in multiple myeloma. Maintenance regimens should be advocated.

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2017

Journal Article

G. Desai, G Kumar, S., Manoj, L., Gokul, G. R., Beena, K. V., Thennarasu, K., and Jaisoorya, T. S., “Prevalence & correlates of chronic perinatal pain - a study from India.”, J Psychosom Obstet Gynaecol, pp. 1-6, 2017.[Abstract]


OBJECTIVES: To study the prevalence of chronic perinatal pain among mothers who had infants between the ages of 13-25 months in the State of Kerala, India and to report its correlates in the socio-demographic, obstetric and psychological domains.

METHODS: A total of 9305 mothers selected by cluster random sampling were assessed cross-sectionally for chronic perinatal pain using a questionnaire by Junior Public Health Nurses (JPHNs). In addition, information regarding socio-demographic profile, obstetric history, infant details and perinatal depression were collected.

RESULTS: Of the 8302 (89.3%) valid responses, 552 (6.6%) mothers reported chronic perinatal pain. Among those with pain, 142 (25.6%) reported pain during pregnancy, 314 (56.7%) during postpartum and 96 (17.7%) during both periods. The commonest sites of pain reported were back 280 (51%) and pelvic region 110 (19%). Mothers with chronic perinatal pain were more likely to be younger, less educated, employed and from an urban background. Chronic perinatal pain was associated with obstetric complications, delivery by instrumental/caesarean section, non-exclusive breast feeding and higher maternal depression scores.

CONCLUSION: Chronic pain is common among mothers in India during the perinatal period and greater attention needs to be given for it to be recognised and treated early.

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2017

Journal Article

P. Makhija, Gopinath, S., Kannoth, S., and Radhakrishnan, K., “A case of post-leptospirosis autoimmune epilepsy presenting with sleep-related hypermotor seizures.”, Epileptic Disord, vol. 19, no. 4, pp. 456-460, 2017.[Abstract]


<p>This video-illustrated case report concerns a 49-year-old woman who presented with sleep-related hypermotor seizures. The antecedent history of leptospirosis, high frequency of new-onset seizures, presence of an unclassified anti-neuronal antibody, and dramatic response to steroids strongly supported post-infectious immune-mediated pathogenesis in our patient. To the best of our knowledge, post-leptospirosis autoimmune epilepsy presenting as sleep-related hypermotor seizures has not hitherto been reported. [Published with video sequence on www.epilepticdisorders.com].</p>

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2017

Journal Article

S. Kuthiroly, Dhanya Yesodharan, Ghosh, A., White, K. E., and Nampoothiri, S., “Osteoglophonic Dysplasia: Phenotypic and Radiological Clues.”, J Pediatr Genet, vol. 6, no. 4, pp. 247-251, 2017.[Abstract]


<p>Osteoglophonic dysplasia (OD) is an extremely rare, skeletal dysplasia with an autosomal dominant mode of inheritance. Rhizomelic dwarfism, craniosynostosis, impacted teeth, hypodontia or anodontia, and multiple nonossifying bone lesions are the salient features of this condition. We report a 14-year-old girl with clinical and radiological features consistent with OD. She presented with disproportionate short stature, craniosynostosis, a prominent supraorbital ridge, delayed teeth eruption, hypodontia, and multiple nonossifying bone lesions in the femur, tibia, and fibula. She had hypophosphatemia, which is a known association in this dysplasia. She also had advanced bone age, which is an unreported feature of this dysplasia. This condition is caused by activating mutations in . A missense mutation was detected in the , NM_001174067 ( _v001):c.1115G > A [p.(Cys372Tyr)] confirming the diagnosis; this is the first mutation-proven case to be reported from India.</p>

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2017

Journal Article

Dhanya Yesodharan, Sudarsanan, B., Jojo, A., Abraham, M., Bhavani, N., Mathews, H., and Nampoothiri, S., “Plexiform Neurofibroma of Clitoris.”, J Pediatr Genet, vol. 6, no. 4, pp. 244-246, 2017.[Abstract]


<p>The most frequent genital presentation of neurofibromatosis in females is clitoromegaly. We report a case of a 5-year-old girl with neurofibromatosis type 1 with clitoral plexiform neurofibromatosis. Clitoroplasty was done, and the histopathology confirmed the diagnosis. Though rare, plexiform neurofibroma of clitoris should always be considered as a differential diagnosis in children with clitoromegaly before embarking on detailed investigations.</p>

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2017

Journal Article

S. Radhakrishnan, George, M., Dhar, M., Reny, N., Prathapan, M., and Anandkumar, A., “A longitudinal study of retinal nerve fibre layer profile in patients with multiple sclerosis and its significance.”, Neurol India, vol. 65, no. 6, pp. 1402-1403, 2017.

2017

Journal Article

L. Kumar, Dinesh Balakrishnan, Varghese, R., and Surendran, S., “Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome.”, BMJ Case Rep, vol. 2017, 2017.[Abstract]


<p>Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO of 37 mm Hg on room air and underwent living donor liver transplant. Although stable intraoperatively, he desaturated on the second postoperative day. Despite a number of interventions, oxygenation remained critically low on 100% inspired oxygen. Extracorporeal membrane oxygenator (ECMO) was established with instant improvement in oxygenation (PaO68 mm Hg), and the patient was eventually salvaged. We suggest that ECMO could be a means of managing refractory post-transplant hypoxaemia in patients with HPS.</p>

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2017

Journal Article

A. Keepanasseril, Keerthana, K., Keepanasseril, A., Maurya, D. K., Kadambari, D., and Sistla, S., “Pregnancy in women with Klippel-Trenaunay syndrome: Report of three pregnancies in a single patient and review of literature.”, Obstet Med, vol. 10, no. 4, pp. 177-182, 2017.[Abstract]


<p>Klippel-Trenaunay syndrome is characterised by vascular abnormality which increases the risk of thromboembolism and haemorrhage. Physiological changes in pregnancy pose an increased risk to these complications. Being an uncommon disorder, there is limited literature about the management of women with pregnancy and Klippel-Trenaunay syndrome. We report in detail two of three pregnancies in a woman with Klippel-Trenaunay syndrome who had repeated episodes of haematochezia leading to anaemia, managed with Argon laser Photo-Coagulation in pregnancy and also reviewed the complications and the management of pregnant women with Klippel-Trenaunay syndrome.</p>

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2017

Journal Article

P. Bijalwan, Bindhu, M. R., and Ginil Kumar Pooleri, “Primary Mucin Secreting Adenocarcinoma Bladder: a Case Series.”, Indian J Surg Oncol, vol. 8, no. 4, pp. 634-636, 2017.[Abstract]


<p>Primary mucinous adenocarcinoma is an extremely rare type of bladder cancer. These tumours may have varied presenting complains with isolated mucusuria in some patients. As it is difficult to differentiate primary from secondary tumours, it is often a diagnostic dilemma. We narrate three cases of primary mucinous adenocarcinoma bladder and try to bring out the clinical and pathological features unique to this tumour along with the diagnostic importance of immunohistochemistry.</p>

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2017

Journal Article

A. Puneet, Balagopal, N., Ginil, K., Georgie, M., Sanjeevan, K. V., and Appu, T., “Correlation of Transabdominal Ultrasonography and Cystoscopy in Follow-up of Patients with Non-muscle Invasive Bladder Cancer.”, Indian J Surg Oncol, vol. 8, no. 4, pp. 548-553, 2017.[Abstract]


<p>Cystoscopy (CS) is considered to be the gold standard in the follow-up of non-muscle invasive bladder cancer. However, CS is invasive, time-consuming, and expensive. On the other hand, modern sensitive transducers have improved the imaging of urinary tract rendering transabdominal ultrasonography (US) more effective in visualizing intraluminal filling defects in the bladder than it was in the past. Twenty-five follow-up patients of low-risk bladder cancer meeting the inclusion and exclusion criteria were included in study. Ultrasonography of the bladder was performed by a single senior radiologist, and subsequently, these patients were subjected to flexible cystoscopy under local anesthesia. Pain score was calculated for each of the cystoscopies done. Findings of transabdominal ultrasound of the bladder were correlated and compared with those of cystoscopy. Subjects with US and/or CS findings suggestive of recurrence underwent transurethral resection of bladder tumor (TURBT) under general anesthesia and confirmation of the bladder carcinoma was achieved by the histopathological examination. Mean patient age was 60.56 years with range of 29 to 77 years. The sensitivity of modern ultrasonographic techniques was found to be 84.61% with specificity of 91.7% taking flexible cystoscopy as the gold standard for detection of recurrence. The accuracy of US was 88% with positive predictive value of 91.7% and negative predictive value of 84.61%. Technological evolution has improved the accuracy of ultrasonography in diagnosis of bladder carcinoma. It represents a valuable surveillance tool in selected sub group of low risk non-muscle invasive bladder cancer patients.</p>

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2017

Journal Article

A. C. Argent, Balachandran, R., Vaidyanathan, B., Khan, A., and R Kumar, K., “Management of undernutrition and failure to thrive in children with congenital heart disease in low- and middle-income countries.”, Cardiol Young, vol. 27, no. S6, pp. S22-S30, 2017.[Abstract]


<p>Poor growth with underweight for age, decreased length/height for age, and underweight-for-height are all relatively common in children with CHD. The underlying causes of this failure to thrive may be multifactorial, including innate growth potential, severity of cardiac disease, increased energy requirements, decreased nutritional intake, malabsorption, and poor utilisation of absorbed nutrition. These factors are particularly common and severe in low- and middle-income countries. Although nutrition should be carefully assessed in all patients, failure of growth is not a contraindication to surgical repair, and patients should receive surgical repair where indicated as soon as possible. Close attention should be paid to nutritional support - primarily enteral feeding, with particular use of breast milk in infancy - in the perioperative period and in the paediatric ICU. This nutritional support requires specific attention and allocation of resources, including appropriately skilled personnel. Thereafter, it is essential to monitor growth and development and to identify causes for failure to catch-up or grow appropriately.</p>

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2017

Journal Article

R. A. Bronicki, Pollak, U., Argent, A. C., R Kumar, K., Balestrini, M., Cogo, P., Borim, B. Cury, De Costa, K., Beca, J., Shimizu, N., and Dominguez, T. E., “Global perspective on training and staffing for paediatric cardiac critical care.”, Cardiol Young, vol. 27, no. S6, pp. S9-S13, 2017.[Abstract]


<p>This manuscript provides a global perspective on physician and nursing education and training in paediatric cardiac critical care, including available resources and delivery of care models with representatives from several regions of the world including Africa, Israel, Asia, Australasia, Europe, South America, and the United States of America.</p>

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2017

Journal Article

A. Sreeja and Vinayan, K. P., “Multidimensional knowledge-based framework is an essential step in the categorization of gene sets in complex disorders.”, J Bioinform Comput Biol, vol. 15, no. 6, p. 1750022, 2017.[Abstract]


<p>In complex disorders, collaborative role of several genes accounts for the multitude of symptoms and the discovery of molecular mechanisms requires proper understanding of pertinent genes. Majority of the recent techniques utilize either single information or consolidate the independent outlook from multiple knowledge sources for assisting the discovery of candidate genes. In any case, given that various sorts of heterogeneous sources are possibly significant for quality gene prioritization, every source bearing data not conveyed by another, we assert that a perfect strategy ought to give approaches to observe among them in a genuine integrative style that catches the degree of each, instead of utilizing a straightforward mix of sources. We propose a flexible approach that empowers multi-source information reconciliation for quality gene prioritization that augments the complementary nature of various learning sources so as to utilize the maximum information of aggregated data. To illustrate the proposed approach, we took Autism Spectrum Disorder (ASD) as a case study and validated the framework on benchmark studies. We observed that the combined ranking based on integrated knowledge reduces the false positive observations and boosts the performance when compared with individual rankings. The clinical phenotype validation for ASD shows that there is a significant linkage between top positioned genes and endophenotypes of ASD. Categorization of genes based on endophenotype associations by this method will be useful for further hypothesis generation leading to clinical and translational analysis. This approach may also be useful in other complex neurological and psychiatric disorders with a strong genetic component.</p>

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2017

Journal Article

R. UK, Anu Sasidharan, Pillay V. V., Ajid, A., and KR, S., “Role and Utility of Clinical Forensic Medicine unit (CFMU) in a Major Hospital - Part I”, J South India Medicolegal Assoc , vol. 9, no. 2, pp. 68 - 73, 2017.

2017

Journal Article

Anu Sasidharan, UK, R., Pillay V. V., Ajid, A., and KR, S., “Role and utility of Clinical Forensic Medicine Unit (CFMU) in a major hospital – Part II”, J South India Medicolegal Assoc , vol. 9, no. 2, pp. 74 - 79, 2017.[Abstract]


This study is subsequent to an earlier study conducted by the investigators to establish the importance of a Clinical Forensic Medicine Unit (CFMU) in a major hospital, which was done by way of comparison of the quality of wound certification. In this study the authors decided to compare the quality of discharge certification or treatment certification that has serious implications when it comes to presentation of a medico-legal case in the court. Handling of medico-legal issues has been always a challenging task in India. The scenario here unlike the West is much less satisfactory with regard to discharge of medico-legal duties. The treating physician may efficiently manage the medical needs of the injured/poisoned, but later when the treatment certificate/records are perused in the court, there is often confusion in relation to medicolegal aspects. The guidance or services of a forensic expert is essential for effective management of such medico-legal problems and the Clinical Forensic Medicine Unit (CFMU) started a year ago under the overall administrative control of the Department of Forensic Medicine & Toxicology in Amrita Institute of Medical Sciences, Cochin, Kerala has been proven to be successful in this regard. In this retrospective study discharge/treatment summaries were compared with discharge/treatment certificates. Until the advent of CFMU the treatment summaries were used as medico-legal documents in the court. The medico-legal aspects documented in 200 certificates, i.e. 100 numbers that were prepared by non-forensic doctors and 100 numbers that were prepared by the CFMU, were compared, scrutinised and analysed. The statistical results showed that the differences in the documentation of discharge details (for medico-legal purpose) were highly significant with a p value of <0.001. © 2017 South India Medico-Legal Association. All rights reserved.

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2017

Journal Article

Pillay V. V., ,, TS, T., and Pillay, M., “Sexual Dimorphism of Complete and Incomplete metopic Suture: a Regional South Indian Study”, . Indian J Forensic Med Toxicol, 2017.

2017

Journal Article

P. T. Francis, “Is Social Distancing the Unvaccinated Justifiable?”, Res Pediatrics Neonatology, vol. 1, no. 3, p. 513, 2017.

2017

Journal Article

Anu Sasidharan and Kumar, D., “An Unfortunate Infant: A Case Report”, The Indian Police Journal, vol. 64, no. 1, 2017.[Abstract]


The importance of a medico-legal case doesn't end by the conclusion of the autopsy examination. Medico-legal cases are unique and there are some important 'take home messages' to be taken from each case into the society for the benefit of the common man. Careful observations and inquisitive thinking can bring forth interesting as well as educative lessons. These lessons should be imbibed in the most effective manner not only by the doctors, police officers and judiciary but also by the society as a whole. We hereby present a case report of an infant who died due to injuries sustained to her head in the most unfortunate manner. We have presented the various medico-legal aspects and extenuating circumstances that are surrounding this case in adjunction with the existing literature. Thereby in this case scenario some light has been thrown upon those 'hard truths' that are commonly overlooked, in order to bring out the grey areas and moot points that can be involved in similar situations.

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2017

Journal Article

V. N. Laghima, Sobha George, and Paul, N., “Study on Lifestyle Risk Factors in School Children and its Relationship to their Mothers”, National Journal of Research in Community Medicine, vol. 6, p. 313, 2017.[Abstract]


Globally Non Communicable Diseases (NCDs) are a rnajor cause of morbidity and mortality. 1'hey occur atier exposure to a set of lifestyle risk factors. Obesity and hypertension among adults has its antecedents during childhood .When governments are assessing ways to generate finances for management of NCDs, it is worthwhile to give due irnportance to preventiveservices.Objectives:Tostudyrelationshipoflifestyleriskfactors(BMI&amp;BP)betweenschool childrenand their rnothers ald to study the factors associated with BMI&amp; BP. Methodology: School based cross sectiorral study done among 225 studelts and their mothers in three settings,rural,tribal and urban. Students and mothers were interviewed using questionnair-e in local language after obtaining consent. Height, Weight and BP measured using standardized instrurrretrts. Data tabulated usi6g MS excel , analyzed using SPSS version 20. Results: There was statistically sigrrificarrt associalion between BMI of rnother and student.Association between BP ol' mother arrd student was not statistically signilicarrt. Association betweep BMI and BP was statistically significant among rnothers and students. Considering BMl, statistically significarrt association was noted for physical activity, use of non-smokirrg tobacco and desire to change weight. Considering BP, desire to change weight, use of non-smoking tobacco and intake of food frotn outside showed statistically signilicant associatiorr. Conclusion:Maintaiuirrg normal BMI is important as it is found to affect next generatiotr. Incleased llMl is associatedwithabnormal Pvalues,whichisaprecursorforlifbstylediseases.Hencecotrtrol ofBMI andBPisessential ttr protect future generations from lifestyle diseases.

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2017

Journal Article

M. Philip, Augustine, P., Thomas, V., Ramesh, G. N., Vinayakumar, K. R., Ramachandran, T. M., Siyad, I., Mukkada, R. J., R Devi, S., Chettupuzha, A. P., Jaison, V. A., Ramesh, M., Mahadevan, P., and Koshy, A., “Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases.”, Indian J Gastroenterol, vol. 36, no. 6, pp. 459-467, 2017.[Abstract]


<p><b>BACKGROUND: </b>Inflammatory bowel disease (IBD) is considered uncommon in Asia. The aim of this study was to document the demographic characteristics and clinical aspects of ulcerative colitis (UC) and Crohn's disease (CD) in Kerala, India.</p><p><b>METHODS: </b>A survey of IBD in Kerala was performed. All gastroenterologists in the region were invited. From May 2013 to October 2015, data were collected in a standardized pro-forma.</p><p><b>RESULTS: </b>Forty-seven doctors in 34 centers contributed data. A total of 2142 patients were analyzed. This is the largest state-wide survey of IBD in India. Ulcerative colitis was diagnosed in 1112 (38 new), Crohn's disease in 980 (53 new), and 50 were unclassified (5 new). The district-wise distribution of IBD cases correlated with the District-wise Gross State Domestic Product (r = 0.69, p < 0.01). Three percent was below the age of 18. Patients with UC had more diarrhea (73% vs. 51%), bleeding PR (79% vs. 34%), and intermittent flares (35% vs. 13%) (all p < 0.01). Patients with CD had more abdominal pain (62% vs. 46%), weight loss (53% vs. 40%), fever (28% vs. 18%), and history of antituberculosis treatment (21% vs. 5%) (all p < 0.01). Compared to adults, children (below 18 years) were more likely to have extensive UC (58% vs. 34%, p < 0.01) and unclassified IBD (15% vs. 2%, p < 0.01).</p><p><b>CONCLUSION: </b>Inflammatory bowel disease is common in Kerala, India. The disease characteristics of patients with IBD are almost similar to those from other parts of the country. Both UC and CD were seen in equal proportion in Kerala.</p>

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2017

Journal Article

K. C. Ratha and Mahapatra, S. K., “Resolving the mahanadi water conflict”, Economic and Political Weekly, vol. 52, pp. 84-88, 2017.[Abstract]


To chalk out the future course of action in view of the disputes regarding the use of Mahanadi river water, a well-rounded strategy that includes both the people and policymakers is needed. The strategy must allow for dialogue by rebuilding trust and should look at arbitration and negotiation as methods of conflict resolution. It is necessary to evolve a strategy that optimises the rational usage of Mahanadi water to benefit people from both Chhattisgarh and Odisha, coupled with the implementation of a multi-stakeholder forum that finds peaceful solutions and minimises areas of contention in a negotiable and consensual manner.

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2017

Journal Article

S. S. Lekshmi, Antony, R., Sidharthan, N., Kammath, G., and Anila, K. N., “Methotrexate induced lung toxicity - A case report”, Research Journal of Pharmacy and Technology, vol. 10, pp. 3458-3460, 2017.[Abstract]


Methotrexate (MTX) belongs to a class of antimetabolites. It may cause serious side effects like lung problems, lung infections. Methotrexate-induced lung disease, as well as acute or chronic interstitial pneumonitis, is a potentially risky sore, which can happen intensely whenever, amid treatment and has been accounted for at low doses. The diagnosis of drug-induced pulmonary toxicity is generally settled in light of clinical discoveries. The present report describes a case of methotrexate-induced lung toxicity. Biopsy that had done reported as relapsed lymphoma. Then he got admitted for high dose methotrexate and rituximab followed by folinic acid rescue. He tolerated 2 chemotherapies well, without any major complications. He developed fever, cough with expectoration and breathlessness. In view of persisting high grade fever, associated with cough and breathing difficulty, pulmonology consultation was sought and CT done. In medication-induced lung toxicity, the radiologic patterns seen are exceeding factor and rely upon the kind of unfavorable response the patient is experiencing. One possibility in the clinical setting is methotrexate induced lung changes. Differential diagnosis (DD) is alveolitis due to infection. In view of suspected methotrexate induced lung toxicity, planned to withhold next dose of Methotrexate. He was started on high dose steroids. The patient symptomatically improved, fever subsided, counts improved. Prompt diagnosis is vital in light of the fact that early medication actuated lung harm will regularly relapse with cessation of treatment. It was found that the severity of the methotrexate induced lung toxicity is a probable adverse drug reaction (ADR) with Naranjo score of 7. © RJPT All right reserved.

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2017

Journal Article

S. Iyer, Sharma, M., Kishore, P., Mathew, J., Vijayaraghavan, S., Ramu, J., Wakure, A., Reddy, R., S. Chetan, M., Varma, V., Chaudhari, A., Dhake, S., Omkumar, A., and Prasad, V., “First two bilateral hand transplantations in India (Part 1): From vision to reality”, Indian Journal of Plastic Surgery, vol. 50, pp. 148-152, 2017.[Abstract]


Introduction: Vascularized composite tissue allotransplantation is a relatively new concept, which was unavailable in the Indian subcontinent till a bilateral hand transplant was carried out successfully in January 2015. Materials and Methods: The setting up of the transplant programme involved obtaining legal clearances, creating public awareness, harnessing the institutional facilities, drawing up protocols, assembling the surgical team, managing immunological issues, rehabilitation and preparing the ancillary services. Results: Both, the first and second bilateral hand transplants were resounding successes with both the recipients getting back to their original daily routines. Conclusions: The organisation of the hand transplant programme was a large task, which necessitated intensive planning, and cooperation from various teams within and outside the institution. Exemplary team-work was the key to the phenomenal success of these path breaking endeavors in the subcontinent. Iyer Subramania 1 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Sharma Mohit 2 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Kishore P 3 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Mathew Jimmy 4 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Vijayaraghavan Sundeep 5 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Ramu Janarthanan 6 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Wakure Abhijeet 7 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Reddy Raghuveer 8 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Mali Chetan S 9 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Varma Visakh 10 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Chaudhari Ashish 11 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Dhake Swapnil 12 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Omkumar Akshay 13 Department of Plastic and Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala Prasad V 14 Department of Transplant co-ordinator, Amrita Institute of Medical Sciences, Kochi, Kerala Petruzzo P, Lanzetta M, Dubernard JM, Landin L, Cavadas P, Margreiter R, et al. The international registry on hand and composite tissue transplantation. Transplantation 2010;90:1590-4. Baumeister S, Kleist C, Döhler B, Bickert B, Germann G, Opelz G, et al. Risks of allogeneic hand transplantation. Microsurgery 2004;24:98-103. Landin L, Bonastre J, Casado-Sanchez C, Diez J, Ninkovic M, Lanzetta M, et al. Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: A systematic review. Transpl Int 2012;25:424-32. Sandeep S, Srija M, Shilpa P, Mathew A, Rajesh R, Kurian G, et al. Kidney transplantation - Experience at Amrita hospital. Amrita J Med 2013;9:24-7. 325 Liver Transplants in Ten Years at Amrita Institute of Medical Sciences (AIMS), Kochi. Amrita Vishwa Vidyapeetham (Amrita University); c2017. Available from: https://www.amrita.edu/news/325-liver-transplants-ten-years-amrita-insti.... [Last accessed on 2017 Mar 11]. Kerala Network for Organ Sharing Mrithasanjeevani. MOHAN Foundation; c2016. Available from: http://www.knos.org.in/default.aspx. [Last accessed on 2017 Mar 11]. Amirlak B, Gonzalez R, Gorantla V, Breidenbach WC 3rd, Tobin GR. Creating a hand transplant program. Clin Plast Surg 2007;34:279-89, x. Cendales LC, Kanitakis J, Schneeberger S, Burns C, Ruiz P, Landin L, et al. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transplant 2008;8:1396-400.

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2017

Journal Article

D. Joseph, Varghese, D. R., Prabhu, R., and Anila, K. N., “Mechanism of resistance to tyrosine kinase inhibitors - A case report and review”, National Journal of Physiology, Pharmacy and Pharmacology, vol. 7, pp. 1444-1446, 2017.[Abstract]


This report aims to assess the viability of various challenging approaches such as tyrosine kinase inhibitors (TKIs) therapy, chemotherapy, and stem cell transplantation in patients with chronic myeloid leukemia (CML), especially for those in an advanced phase. Although standard treatments have been extremely effective in combating CML propagation and negating the disease symptoms along with an increased survival rate, these traditional treatment methods have experienced an increased failure rate due to TKI treatment resistance. A common mechanism that can be attributed to the increase in TKI resistance is the increasing mutations of the BCR-ABL 1 kinase domain. These mutations can be clearly observed in clinical trials. Currently, there are five BCR-ABL 1 kinase inhibitors that are approved for the safe treatment of CML. These are imatinib, dasatinib, nilotinib, bosutinib, and ponatinib. Mutational testing should be carried out on patients in such cases that show little response to traditional TKI therapy.In this report, we evaluate a patient who has been diagnosed with an accelerated phase CML and requires constant monitoring to tailor the treatment program to their requirements. © 2017 Dawnwin Joseph, et al.

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2017

Journal Article

J. Palepu, Shrikhande, S. V., Bhaduri, D., Shah, R. C., Sirohi, B., Chhabra, V., Dhar, P., Sastry, R., and Sikora, S., “Trends in diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in India: A report of multicenter data from a web-based registry.”, Indian J Gastroenterol, vol. 36, no. 6, pp. 445-451, 2017.[Abstract]


<p><b>INTRODUCTION: </b>Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare tumors. We report data of 407 GEP-NET cases from a neuroendocrine tumor (NET) registry in India.</p><p><b>METHODS: </b>The AP-NET registry is an open-label, multicenter, longitudinal observational registry of patients with GEP-NETs in which six tertiary care oncology centers contributed data. Data was prospectively entered in a dedicated computerized database and was reviewed retrospectively. The patients were divided into three cohorts-those diagnosed from 2001 to 2005, from 2006 to 2010, and from 2011 to 2016.</p><p><b>RESULTS: </b>Of the 407 cases registered, 37 were in Cohort I, 136 in Cohort II, and 234 in Cohort III. Majority were symptomatic with only 98 patients (24.0%) asymptomatic. The most common presentation of non-functional tumors was abdominal pain (42.4%), while functional tumors presented most commonly with carcinoid syndrome. Use of DOTA-PET, introduced in 2011, has increased evaluation in 33.3% patients in Cohort III. The most common primary site was pancreas in all three cohorts. Male preponderance (58.3%) was seen. Histopathological grading was obtained in 230 (56.5%) patients-118 (29%) Grade I, 74 (18.2%) Grade II, and 36 (8.8%) Grade III NET.</p><p><b>CONCLUSION: </b>This report highlights changing trends in the diagnosis and reporting of NETs over the last 15 years.</p>

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2017

Journal Article

P. T. James, Kunoor, A., and Rakesh, P. S., “Awareness of Health Care Workers, Patients and Visitors Regarding Air Borne Infection Control - A Descriptive Study from a Tertiary Care Centre in Kerala, Southern India.”, Indian J Tuberc, vol. 65, no. 2, pp. 168-171, 2017.[Abstract]


Airborne infections are major public health concern especially in hospitals and public spaces in a highly populated country like India. Generating awareness about good infection control practices among common man and health care workers are important steps in curtailing transmission of air borne infections. In this study we were trying to assess the awareness of airborne infection control measures among patients, bystanders and healthcare workers in a tertiary care hospital at Kochi, Kerala. Self-administered questionnaire which included 10 questions for health care staff and 12 questions for lay men prepared on the basis of NAIC and NCDC guideline were given to the study participants. 143 health care staff and 332 laymen were participated in the study. In both groups majority of the responses were correct. However, only a small proportion of health care staff correctly answered fast tracking of a patient with TB (14.7%) and minimum air exchanges in air-conditioned settings (15.4%). Among laymen only a few correctly identified ideal place for sputum collection (43.3%) and role of hand washing in preventing flu (36.4%). Overall more intervention needed in improving awareness about good infection control practices among both health care staff and laymen

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2017

Journal Article

A. Ramachandran, Rajanbabu, A., Bagul, K. Gulabrao, Pavithran, K., and Vijaykumar, D. K., “Correlation of Pattern of Spread and Outcomes in Advanced Epithelial Ovarian Cancers.”, Indian J Surg Oncol, vol. 9, no. 2, pp. 126-132, 2017.[Abstract]


The purpose of this study was to correlate the pattern of spread with oncological outcomes in advanced ovarian cancer patients. This is a retrospective analysis of 55 consecutive patients who had advanced epithelial ovarian cancer or primary peritoneal carcinomatosis (stages 3C and 4) with primary surgical intervention as the initial modality of treatment. Based on the spread of disease, they were further classified into class A: disease confined to the pelvis (excluded); class B: disease extending to the lower abdomen and omentum; class C: diffuse small-bowel disease with or without A, B, or D; and class D: disease in the upper abdomen. There were 17 patients (30.9%) in class B, 17 (30.9%) in class C, and 21 (38.2%) in class D. The number of patients with suboptimal cytoreduction was highest in class C (six patients). At the end of follow-up (median 38.6 months), 16 patients had no evidence of disease and 26 patients were alive with disease. The 3-year overall survival rates in classes B, C, and D were 94.1, 52.5, and 93.3%, respectively. The 3-year progression-free survival rates were 55.8, 11.8, and 41.9%, respectively. The rates were lowest for class C. The differences in the overall survival rate ( < 0.001) and progression-free survival rate ( = 0.001) were statistically significant. In advanced ovarian cancer patients, the presence of disease in the small-bowel serosa and mesentery results in poorer outcomes in terms of overall and progression-free survival. The number of patients with suboptimal cytoreduction was also highest in this group.

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2017

Journal Article

D. Deepa Devadas, “A Study of Variations in the Origin of Superior Laryngeal Artery and its Clinical Relevance”, Anatomy and cell biology, vol. 49, pp. 254-258, 2017.

2017

Journal Article

D. L. Kumar, R, P., BK, V., S, R., and SG, N., “Efficacy of Intranasal Dexmedetomidine Versus Oral Midazolam for Paediatric Premedication”, Indian J Anaesth, vol. 61, no. 2, pp. 125–130, 2017.[Abstract]


Premedication is an integral component of paediatric anaesthesia which, when optimal, allows comfortable separation of the child from the parent for induction and conduct of anaesthesia. Midazolam has been accepted as a safe and effective oral premedicant. Dexmedetomidine is a selective alpha-2 agonist with sedative and analgesic effects, which is effective through the transmucosal route. We compared the efficacy and safety of standard premedication with oral midazolam versus intranasal dexmedetomidine as premedication in children undergoing elective lower abdominal surgery.

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2017

Journal Article

D. A. Chanchal Sen, Rajan, S., Balachandran, R., Kumar, L., and Nair, S. G., “Comparison of Perioperative Thoracic epidural Fentanyl with Bupivacaine and Intravenous Fentanyl for Analgesia in Patients Undergoing Coronary Artery Bypass Grafting Surgery ”, Anesth Essays Res, vol. 11, no. 1, pp. 105-109, 2017.

2017

Journal Article

D. S. Rajan, Malayil, G. J., Varghese, R., and Kumar, L., “Comparison of Usefulness of Ketamine and Magnesium Sulphate Nebulisations for Attenuating Post Operative Sore Throat, Hoarseness of Voice and Cough”, 2017.

2017

Journal Article

D. Sunil Rajan, Sreekumar, S., and Kumar, L., “Effect of lactate Versus Acetate Based Intravenous Fluids on Acid Base Balance in Patients Undergoing Free Flap Reconstructive Surgeries”, J Anaesthesiol Clin Pharmacol, vol. 33, no. 4, pp. 514-519, 2017.

2017

Journal Article

D. Sunil Rajan, Surendran, J., Paul, J., and Kumar, L., “Rapidity and Efficacy of Ultrasonographic Sliding Lung Sign and Auscultation in Confirming Endotracheal Intubation in Overweight and Obese Patient ”, Ind J of Anaesth, vol. 61, no. 3, pp. 230–234, 2017.

2017

Journal Article

D. Sunil Rajan, Arora, V., Paul, J., and Kumar, L., “Effectiveness of Transtracheal Lidocaine as an Adjunct to General Anaesthesia in Providing Patient Immobility During Total Parotidectomy: A Comparison with Dex-Medetomidine Infusion ”, J Anaesthesiol Clin Pharmacol., vol. 33, no. 2, pp. 193-196, 2017.

2017

Journal Article

D. S. Rajan, Talukdar, R., Vasu, B. K., Paul, J., and Kumar, L., “Haemodynamic Responses and Safety of Sedation Following Premedication with Dexmedetomidine and Fentanyl During Fiberoptic Assisted Intubation in Patients with Predicted Difficult Airway”, Anesth Essays Res, vol. 12, no. 1, pp. 11-15, 2017.

2017

Journal Article

D. S. Rajan, Tosh, P., Puthenveettil, N., and Kumar, L., “Oral Clonidine Premedication for Attenuation of Haemodynamic Responses Following Ketamine Administration During Total Intravenous Anaesthesia ”, Ind J of Anaesth , 2017.

2017

Journal Article

D. G. Das and Rajgopal, R., “Comparison of 3% Hypertonic Saline and the Different Concentration of Manital for ICP Reduction in Elective Supra Tentoril Surgery”, Amrita Journal, 2017.

2017

Journal Article

D. Aveek Jayant, “Delirium After Cardiac Surgery: A Pilot Study from a Single Tertiary Referral Centre”, Ann Card Anaesth , pp. 76-82, 2017.

2017

Journal Article

D. Amitabh Ch Sen, B, D. R., and Krishnakumar, D. R., “Postoperative Infection in Developing world Congenital Heart surgery programme: Data from the International Quality Improvement Collaborative”, Circulation outcomes, 2017.

2017

Journal Article

D. M. Pillay, “Corona Mortis: An Indian Perspective.”, Italian Journal of Anatomy and Embryology, 2017.

2017

Journal Article

M. S. Farhan, Sudhakaran, R., and Thilak, J., “Solving the Mystery of the Anterolateral Ligament”, Journal of Clinical and diagnostic Research, 2017.

2017

Journal Article

D. S. Iyer, Minnie, P., Krishnakumar, T., and Raghuveer, R., “Soft Embalming of Cadavers for Training Purposes: Optimising for Long Term Use in Tropical Weather”, Indian Journal of Plastic Surgery, 2017.

2017

Journal Article

D. Paul T.Francis, “Utilization of Anganwadi Services in a Rural Population of Kerala”, Indian Pediatrics, vol. 54, pp. 65-66, 2017.[Abstract]


Integrated Child Developmental Services (ICDS) has played an important role in improving the health and education of children of India [1]. The state of Kerala has better health and socio-economic indicators compared to most other parts of the country. However, there are not many studies assessing the utilization of Anganwadi services in Kerala [2-4]. This study was done in a rural area near Kochi. In the first stage of sampling, we selected four wards randomly. In the selected wards, the investigators visited consecutive houses in all directions from the entry point to the ward. We collected data from 352 households regarding utilization of Anganwadi services in the past 1 year. The information was obtained from an adult member present at the time of visit, preferably a lady.

In our sampling frame, 136 families had children below 6 years, 66 families had adolescent girls (11-19), and 193 women were in reproductive age group out of which 26 were lactating or pregnant. All respondents knew about Anganwadi; 79% were aware of supplementary nutrition provided from there. Respondents had average (71.4%) or good (8.5%) knowledge about services provided to children below 3 years, but not to other age groups.

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2017

Journal Article

D. N. Mohan, “Mortality Predictors in Acute Coronary Syndrome Induced Ventricular Arrhythmias”, Amrita Journal, 2017.

2017

Journal Article

D. N. Mohan, “A Study on the Efficacy of Intravenous Labetalol in Hypertensive Urgency”, Int. J of Pharmaceutical Science and Research, 2017.

2017

Journal Article

D. A. Balasubramanian, “Adherence to Treatment Among Hypertensives of Rural Kerala, India”, Journal of Family Medicine and primary care, 2017.

2017

Journal Article

D. Beena kumari, D, V., and Anand R, “Adjuvant Treatment in Carcinoma of Endometrium: Where Do We Stand?”, Ind J of Gynec oncology, 2017.

2017

Journal Article

D. V. DK, “Predicting No-Shows for Breast Cancer Follow-Up Visits: An India Perspective Manuscript Number:  IJGO-D-17-00010”, International J of Medical Informatics, 2017.

2017

Journal Article

G. Goel, Janaki, P. D., Anupama, R., Agarwal, R., and Vijaykumar, D. K., “Predicting Nodal Burden in Clinically N0 Breast Cancer: A Comparison Between Ultrasound-Guided Fine Needle Aspiration Cytology (FNAC) and Sentinel Lymph Node Biopsy (SLNB)”, Indian Journal of Gynecologic Oncology, vol. 15, p. 33, 2017.[Abstract]


Post-Z0011 era there is much debate on omitting axillary clearance in select group of patients. However, there is difference in nodal burden in SLNB and FNAC positive group even though both are clinically N0. This study compares the nodal burden in SLNB and FNAC positive patients of clinically N0 breast cancer

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2017

Journal Article

D. V. DK, “Detection of EGFRvIII among Gynecological Cancers, Breast Cancers and HNSCC: A Study from a Single Indian Academic Institution".Laxmi Vijaychandran et al; The reference number for this manuscript is "IJC_57_17”, Ind J of Cancer, 2017.

2017

Journal Article

M. Sarika K. S, Balakrishnan, D. Vandana, Sundaram, D. K. R., and , “Physiological Impact of Integrated Amrita Meditation Technique in improving glycemic control in type 2 diabetes”, J of Physiological Sciences, 2017.

2017

Journal Article

B. R. J. Satishkumar, Mohan, T., Thirumalaisamy, S., sunil, A., Praveen, B. L., and Leo, B., “How Much Bone Cement is Utilized for Component Fixation in Primary Cemented Total knee Arthroplasty ?"”, J of Arthroplasty, p. -, 2017.[Abstract]


Purpose: No scientific evidence exists regarding the amount of bone cement used and discarded in primary cemented Total knee arthroplasty (TKA). The aim of this study was to identify the exact amount of bone cement utilized for component fixation in primary TKA. Methods: In a prospective study carried out at five centers, 133 primary cemented TKAs were performed. One pack of 40g Palacos bone cement ( PBC 40) was hand mixed and digitally applied during the surgery. After fixation of the TKA components, the remaining bone cement was methodically collected and weighed on a digital weighing scale. The actual quantity of cement utilized for component fixation was calculated. Results: On an average, 22.1 g of bone cement was utilized per joint, which accounted to 39 % of 57g , the solidified dry weight of PBC 40. Among 133 knees, the cement usage was 20 % to 50% in 109 knees, more than 50% in 20 knees and less than 20% in 4 knees. Knees which received larger sized femoral implant required more cement compared to medium and small sizes. Knees which had pulse lavage had more cement utilization compared to knees which had simple syringe lavage before implantation. Conclusion: Large quantity of bone cement was handled than actual requirements in primary TKA when a standard 40g pack was used with the digital application technique, resulting in sizeable discard of bone cement. Customizing cement pack according to the implant size can potentially avoid this cement wastage. Future research is required to study the utility and economic impact of smaller packs ( 20 g or 30 g) of bone cement in primary TKA.

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2017

Journal Article

R. Madhavan, P.K, B., Nithiya, A., Kani, J., mathi, M., P, B., and Kumar, S., “A Comparative study of radical radiotherapy with weekly paclitaxel versus radical radiotherapy with weekly cisplatin in the management of locally advanced squamous cell carcinomas of head and neck”, International Journal of Research in Medical Sciences, vol. 5, pp. 473–477} doi = {10.18203/2320-6012.ijrms20170135, 2017.[Abstract]


Background: Concurrent chemo radiation is standard of care in locally advanced squamous cell carcinomas of head and neck. Single agent Cisplatin either weekly or three weekly is commonly used concurrently with radiation. The present study aims to evaluate the response rate and toxicity of radical radiotherapy with weekly paclitaxel and cisplatin in head and neck cancers.Methods: This is a prospective double arm study in which sixty patients with histologically proved squamous cell carcinomas registered in our department were accrued into the study with thirty patients in each arm. All patients were treated using Theratron phoenix 780 cobalt unit with a dose of 66 Gy in 33 fractions. The patients were randomized to receive 40 mg/m2 of weekly cisplatin or 40 mg/m2 of weekly Paclitaxel concurrently with radiation. The response to the therapy was assessed six weeks after completion of treatment. The statistical analysis was done using SPSS software.Results: In cisplatin group 18 patients achieved complete response and 12 patients achieved partial response whereas in Paclitaxel group 21 patients achieved complete response and 9 patients achieved partial response. However in paclitaxel arm the incidence of radiation dermatitis, mucositis, dysphagia and laryngitis are slightly higher compared to cisplatin group.Conclusions: The weekly paclitaxel concurrent with radiation is a feasible alternative to weekly cisplatin in locally advanced squamous cell carcinomas of head and neck.

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2017

Journal Article

D. R. Madhavan, “Effect of Bladder Filling in Dosimetry in Intracavitary Brachytherapy Versus Vaginal Vault Brachytherapy”, J of contemporary brachytherapy, 2017.

2017

Journal Article

D. R. Madhavan, “Stereotactic Body Radiation Therapy, Ia An Active Breath Coordinator necessary?”, Lung India, 2017.

2017

Journal Article

D. R. Madhavan, “Pediatric Brain Tumors, An Analysis of Five Years of Data from a Tertiary Cancer Care Centre, India ”, Ind J of Cancer, 2017.[Abstract]


BACKGROUND: Pediatric brain tumors are the most common solid tumors in children and a leading cause of mortality and morbidity in children worldwide. Even though there are enough data about the epidemiology of pediatric brain tumors in western population, there are only a few reports from developing countries like India. AIMS: To study the epidemiological patterns of brain tumors in children, to study the patterns of care, and to assess the treatment response. MATERIALS AND METHODS: A retrospective epidemiological approach is used. The records of children <18 years registered in our department from August 2006 to July 2011 diagnosed as primary brain tumors are selected. Data regarding age, sex, site of the tumor, clinical features, histology, treatment plan, and treatment response are collected. The World Health Organization classification of neoplasms was adopted. RESULTS: Of 250 cases, females (57%) slightly outnumbered males. The present study revealed that astrocytoma (52%) is the most common brain tumor in childhood. Surgery was the main modality of treatment. Chemotherapy was given to 16% of patients. Even though radiation therapy was offered to 74% of patients, only 42% completed radiotherapy. There was subjective clinical improvement in 68% of patient population after treatment. CONCLUSIONS: This is the second study from Tamil Nadu that deals with epidemiology of brain tumors. Multimodality management including surgery, chemotherapy, and radiation therapy remains the cornerstone in the management of pediatric brain tumors.

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2017

Journal Article

A. Gopinathan, Mukhopadhyay, C., and E., V. K., “Characterization of Antimicrobial Resistance Mechanisms of Multidrug Resistant Gram Negative Bacterial Wound Infections and their Clinical Epidemiology from a Tertiary Care Hospital in Karnataka, India”, International Journal of Research in Medical Sciences, vol. 5, pp. 824–828} doi = {10.18203/2320-6012.ijrms20170535, 2017.[Abstract]


Background: Extended spectrum beta lactamases, AmpC and Metallo-betalactamases in GNB isolates are a common occurrence in most Indian hospitals. The presence of these antimicrobial resistance mechanisms contributes to prolonged hospital stay, poor quality of life, increased morbidity and mortality among patients with these infections. The aim of the study was to analyse the antimicrobial resistance mechanisms of multidrug resistant Gram negative bacterial wound infection and their clinical epidemiology.Methods: A prospective study was conducted for one year among 100 patients of Kasturba Medical College, Manipal admitted with MDR GNB wound infections. The antibiogram and phenotypic resistance mechanisms of the bacterial isolate from these infections were identified using phenyl boronic acid and ethyl diacetate. The empirical therapy, specific therapy and clinical outcome of the patients were also analyzed.Results: Out of 100 study patients, 152 MDR GNB isolates were obtained. 73% patients were admitted in the surgical wards. 43% patients had diabetes. Ulcers (27%) and abscess (25%) were the most common diagnosis. Escherichia coli (39%), Klebsiella pneumoniae (24%) and Pseudomonas aeruginosa (19%) were the most common isolates. Maximum number of ESBL was seen among Enteric Gram negative bacilli (36%), MBL was seen among Pseudomonas aeruginosa and Acinetobacter species (55% each), AmpC was seen among enteric GNB (10%) and Acinetobacter species (18%). Cefaperazone sulbactam, amikacin and meropenem were the most common antibiotics given as specific therapy. Clinical response was observed among 93% patients.Conclusions: The determination of the antimicrobial resistance mechanisms of GNB isolates from wound infections plays a major role in establishing an antibiotic policy for the treatment of these infections.

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2017

Journal Article

S. P and C, J., “ Erosive Esophagitis with Transient Respiratory Distress in Newborns: Case Reports”, J Pediatr Res, vol. 4, no. 1, pp. 48-52, 2017.

2017

Journal Article

N. Srinivasan, Chandramathi, J., Prabhu, A., and Ponthenkandath, S., “Vitamin D deficiency and morbidity among preterm infants in a developing country”, International Journal of Contemporary Pediatrics, vol. 4, pp. 499–502} doi = {10.18203/2349-3291.ijcp20170697, 2017.[Abstract]


Background: The association of serum vitamin D levels to clinical outcome in VLBW infants has not been studied. Our objective was to measure the cord blood levels, and the dose response for two doses of vitamin D in preterm infants and correlate the relationship of vitamin D levels to the clinical outcome.Methods: We prospectively obtained cord blood levels in 80 preterm infants under 34 weeks gestation (mean gestation age 29±2 weeks and BW: 1210±350 gms). Infants were supplemented with 400 IU or 800-1000 IU vitamin D daily. Serun vitamin D levels were obtained at 2 - 3 weeks after supplementation and levels were correlated to clinical outcome. Results: The mean cord blood vitamin D level was 12±8.5 ng/ml. Babies who developed sepsis and compared to those who did not develop these morbidities, ROP had vitamin D levels: 13.5±6 (ng/ml) versus 30.5±10 (ng/ml) (p &lt; 0.01) and 15.7±11 (ng/ml) versus 34±18 (ng/ml) (p &lt;0.03) respectively. Supplementation with 400 IU vitamin D resulted in levels of 17±8.6 (ng/ml) and infants given 800-1000 IU vitamin D had levels 46±17(ng/ml) (p &lt;0.001).Conclusions: These data suggest that cord blood vitamin D levels are low in preterm infants and 800-1000 IU vitamin D supplementation is advisable to achieve levels &gt;30 ng/ml. Infants with low levels of vitamin D have higher incidence of sepsis, and ROP.

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2017

Journal Article

A. Majeed, Chandramati, J., Prabhu, A., and Ponthenkandath, S., “PARADOXICAL VOCAL CORD MOTION (PVCM) IN VERY LOW BIRTH WEIGHT PRETERM INFANTS: CASE REPORTS AND A BRIEF REVIEW ”, International Journal of Pediatric Otorhinolaryngology, 2017.

2017

Journal Article

D. Madhumita Kumar, Sreeparvathi, A., Kalyanikuttyamma, L. Kumari, Sreekumar, N., and Veerasigamani, N., “Significance of Blood Eosinophil Count in Patients with Chronic Rhinosinusitis with Nasal Polyposis”, Journal of Clinical Diagnostic Research – JCDR, 2017.

2017

Journal Article

J. PT, .K, A., and .PS, R., “To Assess the Awareness of Airborne Infection Control Among Patients and Healthcare Workers in a Tertiary care Hospital in Cochin”, TB Association of India, 2017.

2017

Journal Article

Sobha George, Paul, N., Francis, P. T., and Leelamoni, K., “Prevalence of Domestic Accidents in a Rural Area of Kerala: A Cross Sectional Study”, International Journal Of Community Medicine And Public Health, vol. 4, pp. 949–953} doi = {10.18203/2394-6040.ijcmph20170949, 2017.[Abstract]


Background: Domestic accidents are important worldwide public health problems which require increased attention. A domestic accident means an accident that takes place at home or its immediate surroundings. Domestic accidents can result in disability and loss of productivity. The aim of the study was to find the prevalence of domestic accidents in a rural area and the various epidemiological factors associated with it. Methods: A community based cross sectional study was done in a rural area of Kerala. The study period was April-May 2016. Face to face interview with a responsible adult informant was done to collect information from 403 households consisting of 1826 individuals using a semi-structured questionnaire after getting consent. Data was tabulated using MS Excel and analysed using SPSS version 20. Qualitative variables expressed as percentages and association found out using Chi square test.Results: The prevalence of domestic accidents in the community was found to be 10.5% (9.14 – 11.95, 95% CI). Majority of the victims were females (66%). Falls were the most prevalent type of domestic accident (33.5%) and it was found to be significantly associated with age, educational status, place of occurrence and activity during accident. First aid kits were available only in 38.2% of houses. Conclusions: Increased awareness, specially among female population is needed to reduce domestic accidents. Take extra care of the extreme ages as they are more vulnerable to falls. It is essential that every house has a first aid kit.

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2017

Journal Article

L. George, S., A., Paul, N., and Leelamoni, K., “Community based interventional study on dengue awareness and vector control in a rural population in Ernakulam, Kerala”, International Journal Of Community Medicine And Public Health, vol. 4, pp. 962–967} doi = {10.18203/2394-6040.ijcmph20170984, 2017.[Abstract]


<p>Background: Dengue fever is an acute infectious disease for which there are currently no specific drugs or effective vaccines available. Therefore its prevention &amp; control solely rest on vector control strategies, for which behavioural change of the community is a requirement. Hence, the aim of our study was to implement a standardised behaviour change communication intervention strategy (BCC) and to measure its impact on the population in terms of awareness, attitude and practice regarding dengue and its vector control. Methods: This study was carried out in a ward in Njarackal Panchayath in Ernakulam district of Kerala. An initial baseline survey was conducted to assess the current awareness, attitude and practices of dengue &amp; its vector control among the residents of the ward. This was followed by the implementation of standardized BCC Intervention strategy. A post intervention survey was carried out two months later to analyze its impact. Results: This BCC strategy resulted in increasing the awareness regarding dengue and its vector control even though it was found not to be statistically significant. However, the strategy was able to bring about a significant change in the attitude and practice of the people with regard to dengue prevention and control strategies. Conclusions: This BCC strategy was successful in this population due to community acceptance, however it requires constant reinforcement for its sustainability.</p>

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2017

Journal Article

A. B, “Live donor liver transplantation for anti-tubular drug induced acute liver failure”, Indian Journal of Gastroenterology, 2017.

2017

Journal Article

R. A. Henry, Rao, G., and , “Determination and Validation of a Lower Cut off Value of Cerebrospinal Fluid - Adenosine Deaminase (CSF-ADA) Activity in Diagnosis of Tuberculous Meningitis.”, 2017.

2017

Journal Article

H. Ahamed, Henry, R., and Pai, R., “Association of mean platelet volume and acute coronary syndrome”, International Journal of Research in Medical Sciences, vol. 5, pp. 1217–1220} doi = {10.18203/2320-6012.ijrms20170968, 2017.[Abstract]


Background: Acute coronary syndrome (ACS) is a set of signs and symptoms due to rupture of a plaque and are a consequence of platelet rich coronary thrombus formation. Larger platelets are haemostatically more active and and hence carry risk for developing coronary thrombosis leading to ACS. Platelet parameters especially mean platelet volume (MPV) could be used as an important and reliable marker in early detection of ACS when the patients come to emergency department with chest pain. The primary objective is to study the association between mean platelet volume and acute coronary syndrome. The secondary objectives are to analyse if there is a statistically significant difference in mean platelet volume between Non-ST elevation (NSTEMI) and ST-elevation Myocardial Infarction (STEMI) and between double vessel disease (DVD) and triple vessel disease (TVD).Methods: A total of 260 patients were included in the study depending on the inclusion and exclusion criteria. After dividing the patients with chest pain into control (Non-cardiac chest pain) and study group (ACS) which contained 130 each, venous blood was drawn and taken to haematology laboratory for analysis of MPV within 2 hrs. The statistical analysis used were mean, median, test of significance in difference (t-test) and chi-square test.Results: Mean platelet volume (MPV) was found to be higher among ACS patients (9.4868±0.85270) as compared to control (7.430±0.72172) and it was significant with a P value &lt;0.05. It was also noticed that MPV was higher among patients with STEMI when compared to NSTEMI, 10.32±0.77932 and 9.22±0.52743 and it was statistically significant (P&lt;0.05). Similarly, MPV between patients with triple and double vessel disease were compared and the mean MPV of 10.04±0.88738 of TVD was greater than the mean MPV of 9.22±0.67438 in DVD and was statistically significant (P&lt;0.05).Conclusions: In this study the MPV was higher in patients with ACS than those in control group. The study also showed that there was significant difference in MPV values between people with STEMI and NSTEMI and between people with DVD and TVD. Hence it might be useful as an additional cost efficient test in conjunction with other markers in the early prediction of ACS in the emergency room. Larger platelets are haemostatically more active and hence carry risk for developing coronary thrombosis leading to ACS. Patients with increased MPV could be easily identified during routine haematological analysis and hence could play an important role in early detection of acute coronary syndrome (ACS).

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2017

Journal Article

D. Sajana Krishna, “Dermatological Problems in Geriatric Population”, Journal of medicine/ Amrita Viswa Vidyapeetham university, vol. 13, 2017.

2017

Journal Article

D. L. Susan George, “Utilization of health servicesand its determinants among elderly population of Raichur District, Karnataka”, National Journal of research in Community Medicine, 2017.[Abstract]


Introduction: Utilization of Health Services is a result of “Health Seeking Behavior” which in fact is an entity of a wider concept known as “Health Behavior”. Data regarding the utilization of health services by the elderly and the factors associated with it from the most rural and backward areas of Raichur district of Karnataka are lacking. Objectives: To assess the utilization of health services and the socio-demographic factors associated with it among the elderly population of the rural villages of Raichur district. Materials and Methods: This community based cross sectional study was carried out in the most rural and backward villages of Raichur District. Data was collected using a pre-designed and pre-tested questionnaire. 230 elderly were interviewed regarding their socio-demographic profile and utilization of health services. Results: It was observed that, 83% of the elderly used health services in the past year of which 78% utilized the allopathic health services. However, 16% of them still utilized the services of quacks. The average monthly expenditure of the elderly on health was Rs100/-. A higher level of education and social class were found to be significant factors favouring the utilization of healthcare services by the elderly. Recommendation: Integration of geriatric care into the primary healthcare system has become the need of the hour in order to make health services more accessible to the elderly

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2017

Journal Article

D. Ram Madhavan, Kunheri, D. B., .Haridas.M.Nair, D., and Holla, M. R., “Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma, Experience from a Tertiary Cancer Care Center in India”, vol. 54, no. 1, 2017.

2017

Journal Article

P. R. I. Y. A. N. K. BIJALWAN, ,, and Appu Thomas, “Comparison of Sterile Water Irrigation Versus Mmc in Non Muscle Invasive Bladder Cancer”, Indian Journal of Urology, 2017.

2017

Journal Article

P. R. I. Y. A. N. K. BIJALWAN, SANJEEVAN, K. V., Anil Mathew, and NAIR, B. A. L. A. G. O. P. A. L., “OUTCOME AND COMPLICATIONS OF LIVING DONOR PEDIATRIC RENAL TRANSPLANTAION : EXPERIENCE FROM A TERTIARY CARE CENTRE IN SOUTH INDIA”, INDIAN JOURNAL OF UROLOGY, 2017.

2017

Journal Article

D. Nandu Mohan, K.P, D. Gireesh Ku, and T.P, S., “A Study on Efficacy of IV Labetalol in Hypertensive Urgency in Emergency room.”, 2017.

2017

Journal Article

D. Nandu Mohan, K.P, D. Gireesh Ku, T.P, S., Mohan, D. Naveen, and Prasad, D. Bharath, “ Mortality predictors in ACS induced Ventricular arrythmias”, Amrita Journal , 2017.

2017

Journal Article

D. Sreekrishn T.P and K.P, D. Gireesh Ku, “ Provenance of Vitamin D Deficiency in Patients coming to Emergency Room”, 2017.

2017

Journal Article

T. Joy, Paul, N., Rakesh P. S., and Leelamoni, K., “High Prevalence of Dietary and Physical Activity Related Risk Factors for Non-communicable Diseases Among Apparently Healthy Urban Women in Kochi, Kerala, South India”, International Journal Of Community Medicine And Public Health, vol. 4, pp. 987–991} doi = {10.18203/2394-6040.ijcmph20171311, 2017.[Abstract]


Background: Non communicable diseases (NCDs) represent the biggest threat to women’s health worldwide. NCD is a leading cause of morbidity and premature mortality among women in Kerala. This study attempts to delineate the risk factors of NCDs among apparently healthy urban women in Kochi, Kerala. Methods: A cross sectional study was conducted among apparently healthy women of age 20-60 years in randomly selected wards of Eloor municipality, Kochi, Kerala. The minimum calculated sample size was 130. Houses were selected by systematic random sampling. A semi structured questionnaire based on the STEPS instrument was administered to eligible subjects. Their anthropometric measurements were also taken using standardised tools. Data were entered into Excel sheet and analysed using SPSS version 15. Results: The mean age of the women surveyed was 38.9 years (SD 10.2). Majority (71%) of the study participants were home makers. Majority (97.2%) consumed less than 5 servings of fruits and vegetables a day. Of them, 79.3% were in the low physical activity category. Around 55% of the women were either overweight or obese. Conclusions: The current study showed a high burden of risk factors for non-communicable diseases among women in urban area in Kerala. Considering the burden of NCD risk factors in the population, there is urgent need to plan and implement gender sensitive community-based interventions at different levels including health promotion, and prevention.

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2017

Journal Article

K. Kumar M. K. and George, L. Susan, “Pulmonary function of automobile repair workers in the informal sector of Raichur urban”, International Journal Of Community Medicine And Public Health, vol. 4, pp. 1510–1514} doi = {10.18203/2394-6040.ijcmph20171571, 2017.[Abstract]


Background: Automobile repair workers of the informal sector are exposed to dusts, toxic fumes and aerosols. Long term occupational exposure may lead to pulmonary function impairment. Hence, the objectives were to study the occurrence of obstructive and restrictive pulmonary impairment among the automobile repair workers by using pulmonary function test and the factors associated with it.Methods: A cross sectional study was carried out in automobile repair workers who work in informal sector in the urban area of Raichur in Karnataka. The pulmonary function tests viz. Forced Expiratory volume in one second, Forced vital capacity, Peak Expiratory Flow Rate per liter and FEV1/FVC ratio in percentage were measured for each worker in sitting posture using a digital spirometer. Data collected were analyzed in SPSS 16.0 software. Chi-square test and t test was used.Results: Out of the 97 automobile repair workers, 42 (43.3%) had normal pulmonary function. Among the abnormal PFT, 20 (20.6%) had obstructive lung function, 25 (25.8%) had restrictive lung function and 10 (10.3%) had mixed obstructive and restrictive lung function. The workers with abnormal PFT consisted of body repair workers (25.0%), mechanical workers (38.1%), spray painters (75.0%), battery repair workers (100.0%) and tyre retreading workers (88.9%).Conclusions: In this study, 56.7% of workers had some form of pulmonary function impairment. Smoking, increase in duration of work hours and years of work showed significant pulmonary impairment. The study highlights the need for creating awareness and encouraging the use of protective gears such as masks, early screening, diagnosis and treatment of respiratory diseases among the garage workers.

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2017

Journal Article

G. BN, G, R., K, V., and V, B., “ Zinc/copper Ratio: a Predictor of Pancreatic Function in Chronic Pancreatitis?”, 2017.[Abstract]


Background:&nbsp;The role of trace elements in the maintenance of normal pancreatic function is unclear.

Aim:&nbsp;To estimate trace elements (zinc and copper) in chronic pancreatitis (CP) patients and study their relationship with exocrine and endocrine insufficiency. Methods: The study involved 101 CP patients and 113 healthy controls. Disease characteristics and imaging features were recorded. Erythrocyte zinc (Zn) and copper (Cu) were estimated by flame atomic absorption spectrophotometry. Fecal pancreatic elastase1 was estimated by polyclonal antibody ELISA method as a marker of pancreatic exocrine function

Results:&nbsp;The mean erythrocyte Zn level and Zn/Cu ratio were significantly lower whereas the copper level was significantly higher in CP patients than controls. The mean Zn level and Zn/Cu ratio was significantly lower in CP patients with diabetes and those with low elastase1 as compared to non-diabetics and those with normal elastase1 respectively. Erythrocyte Cu level was significantly higher in CP patients with diabetes and with low elastase1 than those without diabetes and with normal elastase1 levels respectively. There was a significant positive correlation between elastase1 and Zn/Cu ratio (r = 0.396, p &lt; 0.001). Receiver operating characteristic curve (ROC) analysis was performed to predict the development of exocrine insufficiency and it indicated an area under curve (AUC) of 0.838 ± 0.047 (95% CI: 0.746-0.93). The optimal cutoff value was 9.03 (sensitivity 86.5%, specificity 73.5%). When the same was performed to predict the development of diabetes, the AUC was 0.710 ± 0.05 (95% CI: 0.607-0.812). The optimal cutoff value was 7.2 (sensitivity 69.1%, specificity 69.7%).

Conclusion:&nbsp;Low erythrocyte Zn/Cu ratio was found to be associated with exocrine and endocrine insufficiency in CP patients.

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2017

Journal Article

R. M, ,, R, R., ,, TM, J., and RK, K., “ Health Related Quality of Life (HRQL) in Indian children -A community based cross-sectional survey. ”, 2017.

2017

Journal Article

L. Feinberg, Menon, J., Smith, R., Rajeev, J. G., Kumar, R. Krishan, and Banerjee, A., “Potential for mobile health (mHealth) prevention of cardiovascular diseases in Kerala: A population-based survey”, Indian Heart Journal, vol. 69, pp. 182 - 199, 2017.[Abstract]


Background India's southern state of Kerala stands at the forefront of India's epidemic of cardiovascular disease (CVD), among other non-communicable diseases (NCDs). Mobile phone use in healthcare (mHealth) has shown promise in India, including NCDs. However, suitability and acceptability of m-Health interventions is poorly researched, particularly in rural settings. Objectives (1)To explore mobile phone usage patterns in rural Kerala (Ernakulam).(2)To explore acceptability of mHealth delivery of health promotion and CVD prevention. Methods A questionnaire regarding mobile phone usage and possible use in healthcare was verbally administered in five primary health centres and by home visits in five village councils (“panchayats”) of Ernakulam, Kerala. Adults who spoke Malayalam or English, with access to a mobile phone were recruited by convenience sampling in partnership with accredited social health activists (ASHAs). Quantitative data analysis was conducted using SPSS software. Results 262 participants were recruited. 87% routinely used and 88% owned a mobile phone. 92% were willing to receive mHealth advice, and 94% favoured mobile medication reminders. 70.3% and 73% preferred voice calls over short messaging service (SMS) for delivering health information and medication reminders, respectively. 85.9% would send home recorded information on their blood pressure, weight, medication use and lifestyle to a doctor or ASHA. 75.2% trusted the confidentiality of mHealth data, while 77.1% had no concerns about the privacy of their information. Conclusions The majority of this population approve mHealth interventions. While further investigation of mHealth as a health education tool is warranted, SMS interventions may fail to maximise equity and penetration across all patient groups.

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2017

Journal Article

V. S and RK, K., “Should we close small ventricular septal defects?”, 2017.

2017

Journal Article

R. ps, “Prevalence of Anemia in Kerala- A Review”, Journal of Clinical and Diagnostic Research, vol. 11, no. 5, 2017.[Abstract]


Introduction
Anaemia is the most common nutritional problem affecting children, adolescents and women. A systematic review was undertaken to find out the prevalence of anaemia and to identify the trend in the prevalence of anaemia in Kerala state, Southern India.

Aim
The aim of the review was to identify the prevalence of anaemia in Kerala and to comment on its trend across last 25 years.

Materials and Methods
PubMed and google scholar searches and scanning of reference lists were used to identify studies. All population based studies on anaemia from Kerala, irrespective of its designs, published between Jan 1st 1990 to Dec 31st 2015 were included. Data extraction and quality assessment were carried out using structured proformas. Due to the heterogeneity of reviewed studies, meta-analysis was not done. A narrative approach was used.

Results
A total of 10 studies in addition to two major survey reports- National Family Health Survey (NFHS) and District Level Household Survey (DLHS) were included in the final analysis. Prevalence of anaemia among adolescents from recent study reports was around 30% and prevalence of severe anaemia was less than 1% in all studies. Anaemia among tribal women and children were in the range of 78.3% to 96.5%. A key finding of this review was the paucity of data and inconsistency in haemoglobin estimation methods and population characteristics which made comparisons impossible.

Conclusion
The current prevalence of anaemia in Kerala is unclear. Though, there are many studies and reports regarding prevalence of anaemia in the state, those results could not be combined due to non uniform haemoglobin estimation methods. Standardised prospective study of general population including subgroups will be necessary.

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2017

Journal Article

S. N., R., S., V., N. Pillai, S., M., M., R., D., V., C., J., and A., S., “Low-dose prophylaxis for children with haemophilia in a resource-limited setting in south India—A clinical audit report”, Haemophilia, vol. 23, pp. e382-e384, 2017.

2017

Journal Article

C. Lyssikatos, Pavithran, P. V., Tirosh, A., R.Faucz, F., Vasukutty, J. R., Belyavskaya, E., Ahamed, A., Raygada, M., and Stratakis, C. A., “NEWLY DIAGNOSED CARNEY COMPLEX IN THREE YOUNG ADULTS WITH PRIMARY ADRENAL CUSHING SYNDROME”, 2017.

2017

Journal Article

D. .Aswathy.s, .K.N.Panicker, D., and Paul, N., “Targeting Infant and Young child feeding practices. An interventional behaviour change communicate approach”, 2017.

2017

Journal Article

Teena Mary Joy, MK, S., Paul, N., and K, L., “Prevalence of Tobacco Use in an Urban Slum Population in Kochi, Kerala”, National Journal of Research in Community Medicine, 2017.

2017

Journal Article

R. Reddy, Iyer, S., Pillay, M., and Thankappan, K., “Soft emblaming of cadavers for training purposes:Optimising for long term use in tropical weather”, Indian Journal of Plastic Surgery, 2017.

2017

Journal Article

M. S. Dharmadas, Kumar, D. Harish, Pillay, D. M., .K.R.Sundaram, D., C.J, D. S., .Mangalanandhan, D., Lakshmanan, D. Vivek, .V.P.Praveen, D., and Bal, D. A., “Prevalence of Charcot Arthropathy in Type 2 Diabetes Patients Aged over 50 Years with Severe Peripheral Neuropathy: A Retrospective Study in a Tertiary Care South Indian Hospital”, Indian Journal of Endocrinology and Metabolism, 2017.

2017

Journal Article

K. B, G, A., PS, S., R, A., and KU, P., “ Nasopharyngeal Carcinoma:Experience and Treatment Outcome with Radical Conformal Radiotherapy from a Tertiary”, Indian Journal of Cancer, 2017.

2017

Journal Article

, Kumar, H., KR, S., and Menon, A. S., “GLYCEMIC RESPONSE AND SATIETY TO TRADITIONAL AND HIGH FIBER CEREAL PREPARATIONS OF KERALA CUISINE IN HEALTHY VOLUNTEER ”, Indian Journal of Nutrition, vol. 4, no. 1, 2017.

2017

Journal Article

S. .P, Menon.S, A., K.R, S., Menon.N, L., .M, G., and , “ CORRELATION BETWEEN BODY MASS INDEX (BMI) AND WAIST CIRCUMFERENCE (W.C) WITH URINE ALBUMIN EXCRETION IN NON-DIABETIC OBESE SUBJECTS - A CROSS SECTIONAL STUDY ”, IOSR Journal of Dental and Medical Sciences, 2017.

2017

Journal Article

M. T. Shenoy, Menon, A. S., Nazar, P. K., Moorthy, S., Kumar, H., Nair, V., Pavithran, P. Valiyapara, Bhavani, N., Menon, V. Usha, Abraham, N., and R. Jayakumar, V., “Radiofrequency Ablation Followed by Percutaneous Ethanol Ablation Leading to Long-Term Remission of Hyperparathyroidism”, Journal of the Endocrine Society, vol. 1, pp. 676-680, 2017.

2017

Journal Article

K. Jonnalagadda, Bhavani, N., Pavithran, P., Kumar, H., Menon, U., and R., C., “Spontaneous Bilateral Adrenal Hemorrhage of Pregnancy”, International Journal of Reproduction, Contraception, Obstetrics and Gynecology, vol. 6, pp. 772–775} doi = {10.18203/2320-1770.ijrcog20170423, 2017.[Abstract]


Spontaneous adrenal hemorrhage of pregnancy is an acute hemorrhage into the adrenal gland in pregnancy in the absence of trauma, tumor or decoagulant therapy. This can have catastrophic consequences on the mother and the baby and if the hemorrhage involves both the adrenal glands the risk is aggravated because of the high incidence of resulting adrenal insufficiency. We report a case of spontaneous bilateral adrenal hemorrhage in pregnancy resulting in adrenal crisis. A 26 year old primigravida presented at 32 weeks of gestation initially with right sided infrascapular pain and one month later with similar pain in the left side associated with high blood pressure. Imaging with ultrasound and MRI was suggestive of bilateral adrenal mass probably hemorrhage; 2 days following the second episode of pain she developed drowsiness and hypotension and a diagnosis of primary adrenal insufficiency was confirmed by a low serum cortisol and high ACTH. She stabilized with hydrocortisone therapy and the fetus was closely monitored. At 37 weeks she had a normal vaginal delivery under steroid cover. Repeat MRI abdomen 3 months after delivery showed resolution of the hemorrhage but biochemically she continued to be cortisol insufficient at 1 year of follow up. Prompt diagnosis of adrenal hemorrhage in pregnancy and treatment of adrenal insufficiency along with close fetal monitoring usually results in good perinatal outcome in spontaneous adrenal hemorrhage of pregnancy.

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2017

Journal Article

C. Lyssikatos, Pavithran, P. V., Tirosh, A., Faucz, F. R., Vasukutty, J. R., Belyavskaya, E., Ahamed, A., Raygada, M., and Stratakis, C. A., “NEWLY DIAGNOSED CARNEY COMPLEX IN 3 YOUNG ADULTS WITH PRIMARY ADRENAL CUSHING SYNDROME – A CASE SERIES AND REVIEW OF THE LITERATURE”, AACE Clinical Case Reports, vol. 3, pp. e326-e330, 2017.

2017

Journal Article

B. O. Aliren Lui Masmiquel, Kumar, H., Sargin, M., and Chow, J. Derving Ka, “Efficacy & Safety of Once Weekly Semaglutide Verses Once Daily Sitagliptin as an Add as to Metformin, Thiafolinediones, or both in Patients with Type 2 Diabetes (SUSTAIN 2) : a 56 Week, Double Blind Phase 3 a Randomized Trial”, 2017.

2017

Journal Article

J. R, T, G., JS, G., and al, et, “Efficacy of Stereotactic Conformal Radiotherapy vs Conventional Radiotherapy on Benign and Low-grade Brain tumors: A Randomized Clinical Trial”, JAMA Oncology, vol. 3, pp. 1368-1376, 2017.

2017

Journal Article

A. Sreedevi and Paul, N., “Prevalence and Social Determinants of Type 2 Diabetes in a Coastal Area of Kerala,India”, Journal of Endocrinology and metabolism, vol. 4, no. 3, 2017.

2017

Journal Article

D. Prem Nair, P.S, D. Rakesh ., and .James.P.T, D., “How We Achieved Hundred Percentage TB Notification Experiennces from a Private Territory Care Centre in India”, 2017.

2017

Journal Article

D. Prem Nair, Akhilesh, D., P.S, D. Rakesh ., and .James.P.T, D., “Outcome of Patients Treated with Private Anti TB Regiment”, 2017.

2017

Journal Article

S. Khan, Anil kumar, Kale, S., Kurkure, N., Nair, G., and Dinesh, K., “Multiple Cortical Brain Abscesses Due to Listeria Monocytogenes in an Immunocompetent Patient”, Tropical Doctor, vol. 48, pp. 160-163, 2017.[Abstract]


Listeria monocytogenes is an intracellular organism which is well recognised for its ability to cause meningeal infections in neonates, immunosuppressed, debilitated and elderly individuals.1 Other less common central nervous system (CNS) infections caused by Listeria spp. include rhomboencephalitis, cerebritis and abscesses in the brain, brain stem and spinal cord. The neuroradiological appearance of Listeria brain abscesses is similar to other types and may also mimic primary or metastatic brain tumours.2,3 We report a case of Listeria brain abscesses in a patient who was being treated for atypical parkinsonism. A good clinical outcome was achieved after appropriate antimicrobial therapy.

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2017

Journal Article

L. V.N, Sobha George, and Paul, N., “Study on Risk Factors Associated with Diabetic Retinopathy among the patients with Type II Diabetes Mellitus in South India: Hospital Based Cross Sectional Study ”, National Journal of research in Community Medicine, 2017.

2017

Journal Article

P. S. Rakesh, Balakrishnan, S., Jayasankar, S., and Asokan, R. V., “TB management by private practitioners – Is it bad everywhere?”, Indian Journal of Tuberculosis, vol. 63, pp. 251 - 254, 2017.[Abstract]


ntroduction Poor prescribing practice is alleged to be one of the major factors fuelling the drug-resistant tuberculosis (DR TB) emergence. A study in Mumbai revealed the extent of inappropriate tuberculosis (TB) management practices of private practitioners and discussed that with the context of high DR TB. Kerala is rated among the well performing States in India as far as TB control is concerned with evidences for a lower level of TB transmission and DR TB. The current study was done in Kerala State to assess the prescribing practices of private sector doctors in the treatment of TB. Methods Survey questionnaire to write a standard prescription for treating TB was administered to private practitioners dealing with TB, who attended continuing medical education programme on TB at two major cities in Kerala. Results Responses from a total of 124 questionnaires were studied. None of them prescribed anti-TB regimen for less than 6 months. Only 7 (5.6%) prescribed a regimen without complete four drugs (H, R, Z, E) in the intensive phase. Out of the 81 doctors who prescribed private anti-TB regimen, 67 (82.7%) had of the opinion that not less than 80% of their patients complete the treatment for the prescribed duration. Conclusion The current study reports a reasonable TB management practice among the private sector doctors from a State with a low prevalence of DR TB and compliments the argument that effective treatment of TB following the principles of standards for TB care can prevent the emergence of DR TB.

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2017

Journal Article

K. Viswanathan, Rakesh, P. S., Balakrishnan, S., and Kumar, A. S. Pradeep, “Health Benefits of Practical Approach to Lung Health (PAL) Experienced by Patients with Chronic Respiratory Diseases – Results from PAL Pilot Project in Primary Health Care Setting in Kerala, India”, Indian Journal of Tuberculosis, vol. 65, pp. 237 - 240, 2017.[Abstract]


Government of Kerala state had implemented a pilot project of the World Health Organisation recommended Practical Approach to Lung health (PAL) strategy, with an intention to improve the quality of diagnosis, treatment and management of common chronic respiratory diseases (CRD) in primary health care settings. The current study was done as a part of implementation of PAL pilot project and was intended to assess the benefits of PAL for the individual patients with CRDs accessing services from primary health institutions. Exit interviews were conducted at the baseline and for impact assessment after six months of pilot project by interviewing patients with CRD attending primary health institutions implementing PAL and control institutions. A total of 94 and 100 CRD patients were interviewed at baseline and after six months in the PAL implementing institutions, and 88 and 96 CRD patients were interviewed at the control institutions. Reduction in number of medical consultation, hospital admissions and exacerbations among CRD patients were 5.03, 3.20 and 2.24 times higher in PAL implementing institutions as compared to the control institutions. PAL pilot project in India implemented in an area with a reasonably sound primary health care system has proved that it might be beneficial for the patients with CRD as it reduces frequency of exacerbations, hospital visits and frequency of medical consultations.

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2017

Journal Article

V. nelson, Rakesh, P. S., and simon, S., “Work related health problems of female workers engaged in Cashew processing Industries- a cross-sectional study from Kollam district, Kerala, southern India”, Indian Journal of Community Health , vol. 28, no. 4, 2017.[Abstract]


Background: India accounted for one third of the global export market for cashew kernels. Unhealthy sitting posture, working near furnaces and contact with the cashew nut shell liquid may make the workers in the cashew sector vulnerable to many health issues Aims & Objectives: To identify the health related problems among female workers of cashew processing industries in Kollam district, southern Kerala, Setting and Design: A cross sectional study was conducted in selected cashew units of Kollam, Kerala. Material & Methods: An interviewer administered and structured questionnaire was used to collect health related issues from 301 female cashew processing workers. Statistical analysis: Descriptive statistics using frequencies was done and chi square test was used to detect difference between proportions. Results: Low back pain was the predominant problem (48.8%) followed by hand and wrist pain (46.6%), knee pain (37.8%) and neck pain (32.5%). Among the workers engaged in roasting, 86.6% had experienced a burn (p < 0.001). Workers engaged in roasting (53.3%) and shelling (43.7%) had blackish staining of their palms and fingers. Conclusion: Health related issues pertaining to musculoskeletal system, respiratory system, and skin conditions are highly prevalent among women engaged in cashew processing industry. A comprehensive programme to prevent health related issues may be considered to promote health of women engaged in cashew processing industries

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2017

Journal Article

S. TP, Raj, S., M, N., S, R., Jayakumar, A., Nair, P. G., and KP, G. Kumar, “Efficacy of Low Dose Fentanyl in the Treatment of Severe Pain”, 2017.

2017

Journal Article

A. Balachandran and Hussain, S. Shakeer, “Determination of stature from the length of middle finger – An autopsy Sudy”, 2017.

2017

Journal Article

M. Pillay, Sukumaran, T. T., and Mayilswamy, M., “Anatomical Considerations on Surgical Implications of Corona Mortis: an Indian Study”, Italian Journal of Anatomy and Embryology, vol. 122, 2017.[Abstract]


The blood vessels traversing the superior pubic ramus are usually vascular connections between obturator and external iliac systems of vessels. Dislocated fractures or iatrogenic injury can cause life threatening bleeding and hence these vascular anomalies are referred to as corona mortis meaning ‘crown of death’. Except for a case report, no study on corona mortis has been attempted in India so far and hence the present study was intended at exploring the possible variations, both morphological and topographical, of these vascular connections in Indian population through cadaveric dissection. 24 adult cadavers dissected bilaterally (48 hemipelves) and 19 random hemipelves available in the Department of Anatomy were considered for the study.The vascular connections observed were classified as arterial, venous or both (Types I, II and III). Type III was further classified into subtypes a, b, c, d and e based on various combinations of the first two types. In a total of 67 pelvic halves corona mortis was detected in 56 (83.58%) specimens: arterial 7/56 (12.5%), venous 34/56 (60.7%) and both arterial and venous in 15/56 (26.78%) specimens respectively. 22 hemipelves had an artery on the superior pubic ramus out of which in 7 cases there was only an artery whereas in 15 cases both an artery and a vein were present. Commonest source of obturator artery was inferior epigastric artery 15/22 (68.18%) followed by external iliac artery 4/22 (18.18%). 49 of the 56 corona mortis positive specimens had a vein on the superior pubic ramus. In 34/56 specimens only a vein was present.12/49 (24.48%) veins drained into external iliac vein, 3/49 (6.12%) into inferior epigastric vein. A venous anastamosis was found between obturator vein and external iliac vein in 21/49 (42.85%) cases and between obturator and inferior epigastric vein in 10/49% (20.40%) cases. Corona mortis was observed in a significant percentage of specimens, venous corona mortis being more common than arterial. Every surgeon dealing with hernias or fractures of the region needs to be aware of the possible variations and ligate vessels if corona mortis presents itself or else it becomes difficult to control bleeding if a cut vessel retracts into the pelvis.

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2017

Journal Article

S. Dharmadas, Kumar, D. H., Pillay, D. M., Jojo, D. A., and .Tessy.P.J, D., “Microarchitecture of Foot Bone of Diabetic Patients with Chronic Charcot arthopathy Gives Insight into Pathogenesis”, Conference -ESICON 2017 Indian Journal of Endocrinology and Metabolism, 2017.

2017

Journal Article

P. M, S, R., Tintu, T. S., A, J., and V, P. V., “Effect of Embalming Fluid on the Histological Appearance of Organs-A Cadaveric study”, Conference- 65th National Conference of Anatomical Society of India-2017,Chattisgarh, 2017.

2017

Journal Article

D. .Gopalan.M and Pillai, D. G. S., “Human Iris Patterns-Iridology-Applications”, Conference- 65th National Conference of Anatomical Society of India-2017,Chattisgarh, 2017.

2017

Journal Article

D. Sunil Rajan, “Effectiveness of transtracheal lidocaine as an adjunct to general anesthesia in providing patient immobility during total parotidectomy: A comparison with dexmedetomidine infusion”, Journal of Anaesthesiology Clinical Pharmacology, 2017.

2017

Journal Article

D. Pulak Tosh, “Oral Clonidine Premedication Attenuates Hemodynamic Responses of Ketamine During Total Intravenous Anesthesia.”, Anesthesia: Essays and Researches , 2017.

2017

Journal Article

D. Bindu K. Vasu, “Efficacy of Atomised Local Anaesthetic Versus Transtracheal Topical Anaesthesia for Awake Fibreoptic Intubation”, Indian J Anaesth, vol. 61, 2017.

2017

Journal Article

S. M. Zachariah, C., S., S., A., Kokkayil, P., and Mathews, A. A., “Investigation of Hepatitis A outbreak in Palakkad district”, International Journal Of Community Medicine And Public Health, vol. 4, pp. 4125–4130} doi = {10.18203/2394-6040.ijcmph20174630, 2017.[Abstract]


Background: A study was carried out to investigate an outbreak of viral hepatitis reported by district health authorities from a self-administrative unit, Koppam of Palakkad district in Kerala in the month of November 2016. Methods: An epidemiological investigation was carried out to investigate the outbreak, describe epidemiological features and recommend measures for control. An epidemiological case sheet was prepared, case definition formulated and blood samples were collected to confirm the diagnosis of hepatitis. Environmental samples were collected from wells, soil and tested for hepatitis A virus. Results: 15 blood samples taken from cases of jaundice tested positive for hepatitis A, IgM antibody by ELISA test. More than three fourths 39 (79.6%) of the cases gave a history of having attended the same wedding function prior to the occurrence of symptoms. Attack rate (6.14%) was highest among 15-25 year age group. The water analysis from 3 of the wells in the area showed presence of coliform bacteria. Hepatitis A virus IIIA genotype was isolated from the soil sample of the house of the index case. Consumption of welcome drink was found to be associated significantly with cases than controls (OR 2.77; 95% CI: 1.02-7.52, p&lt;0.05). Conclusions: The hepatitis A (type IIIA) outbreak in Koppam was associated with poor sanitation practices among the people. During a socio-cultural-demographic event like marriage this led to an explosive outbreak. Involving community organizations to generate awareness regarding food sanitation, supported by a system of registration of such events, certification of food handlers can help to prevent future outbreaks

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2017

Journal Article

A. Khot, Thomas, T. K., P, S., and N, R. A., “Analysis of the pattern of ADR's reported to an ADR monitoring Centre in South India: a prospective study”, International Journal  of Basic & Clinical Pharmacology, no. 10, pp. 2477-2481, 2017.

2017

Journal Article

S. T. P and KP, G. Kumar, “PREVELANCE OF VITAMIN D DEFICIENCY IN PATIENTS COMING TO A TERTIARY CARE HOSPITAL IN INDIA”, International Journal of Recent Scientific Research, 2017.

2017

Journal Article

A. A.K, Mohan, N., Prasad, B., C.U, K., and Kumar, G., “ETCO2: A NON INVASIVE GUIDE TO ARTERIAL PaCO2 IN THE EMERGENCY ROOM”, International Journal of Recent Scientific Research, 2017.

2017

Journal Article

E. Kuriakose, Cheppayil, S. Narayanan, Narayanan, S. Kuzhikanda, and Anu Vasudevan, “A Study on Free Light Chain Assay and Serum Immunofixation Electrophoresis for the Diagnosis of Monoclonal Gammopathies”, Indian Journal of Clinical Biochemistry, 2017.[Abstract]


Demonstration of monoclonal immunoglobulin molecule in serum forms the mainstay in the diagnosis of monoclonal gammopathies. The major tests that help in this regard are serum protein electrophoresis (SPEP), serum immunofixation electrophoresis (sIFE) and serum free light chain assay (sFLC). Our objectives were to study the accuracy of sFLC and sIFE in the diagnosis of monoclonal gammopathies and also to study the role of combination of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC in the diagnosis of the same. 46 patients who attended the hemato-oncology clinic with signs and symptoms suggestive of monoclonal gammopathy were enrolled in this study. SPEP, sIFE, sFLC and pre-treatment serum beta-2 microglobulin levels were analysed among the study population. Both SPEP and sIFE were performed in the Interlab Genios fully automated machine. Serum beta-2 microglobulin and sFLC were estimated by immunoturbidimetry in Beckman Coulter AU 2700 analyzer. The accuracy of sIFE came to be 80{%} with respect to sFLC assay. Sensitivity, specificity, positive and negative predictive value of sIFE with respect to sFLC were 81.3, 78.6, 89.7 and 64.7{%} respectively. It was observed that a combination panel of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC could detect all the cases of myeloma included in this study. Further testing in large samples is required for generalising the findings of this study. The pre-treatment beta-2 microglobulin levels were significantly higher in the group which was positive for myeloma. A combination panel of SPEP&nbsp;+&nbsp;sIFE&nbsp;+&nbsp;sFLC prove to be more useful than individual tests for the detection of myeloma.

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2017

Journal Article

A. Nair, Haridas, N., Ahmed, S., and Eapen, M., “Radial Probe Endobronchial Ultrasound for Peripheral Pulmonary Lesions: Initial Experience in an Indian Tertiary Healthcare Centre”, Journal of Cardio-Thoracic Medicine, vol. 5, pp. 213-217, 2017.[Abstract]


Introduction : Diagnosis of peripheral pulmonary nodules is confusing; therefore, an accurate and safe lung biopsy can prevent unnecessary invasive diagnostic procedures. This study soughtto study the diagnostic yield, sensitivity, specificity, and negative and positive predictive values (NPV and PPV) of radial probe endobronchial ultrasound (EBUS)-guided biopsy for peripheral pulmonary lesions. Materials and Methods: Patients referred to the Division of Pulmonary Medicine for evaluation of peripheral pulmonary lesions were subjected to radial probe EBUS-guided transbronchial lung biopsy under conscious sedation after reviewing positron emission tomography scan/computed tomography results. The obtained specimens were considered diagnostic when the cytological, histopathological, or microbiological diagnosis was consistent with the clinical presentations. Results: Totally, 14 procedures were performed on 13 patients with mean lesion size of 30.42 mm. Mean distance between the lesion and pleura was 1.17±0.68 cm, and the diagnostic yield of this technique was 78.57%. Furthermore, the sensitivity, specificity, and NPV were 70% (range: 34.75 to 93.33), 100% (range: 39.76 to 100), and 57.14% (range: 18.41 to 90.10), respectively. This procedure was not associated with any major complications. Conclusion: Radial probe EBUS with satisfactory diagnostic yield and low complication rate is a promising tool for early diagnosis of lung cancer

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2017

Journal Article

Rakesh P S, “A Point Source Outbreak of Acute Gastroenteritis Among School Students in Kerala, India”, Indian J Public Health , vol. 61, pp. 302-4, 2017.

2017

Journal Article

D. Kotchuther Mathew, “ Lithium Induced Thyroiditis in a Subject Having Bipolar Affective Disorder”, 2017.

2017

Journal Article

D. Kotchuther Mathew, “ A Case Report of Phenytoin Toxicity in an Adolescent with Epilepsy Following Self Harm- Is Early Detection of Depression Imperative ?”, 2017.

2017

Journal Article

D. Prabhakaran, Anand, S., Watkins, D., Gaziano, T., Wu, Y., Mbanya, J. Claude, Nugent, R., Ajay, V. S., Afshin, A., Adler, A., Ali, M. K., Bateman, E., Bettger, J., Bonow, R. O., Brouwer, E., Bukhman, G., Bull, F., Burney, P., Capewell, S., Chan, J., Chandrasekar, E. K., Chen, J., Criqui, M. H., Dirks, J., Dugani, S. B., Engelgau, M., Nahas, M. El, Fall, C. H. D., Feigin, V., F Fowkes, G. R., Glassman, A., Goenka, S., Gupta, R., Hasan, B., Hersch, F., Hu, F., Huffman, M. D., Jabbour, S., Jarvis, D., Jeemon, P., Joshi, R., Kamano, J. H., Kengne, A. Pascal, Kudesia, P., R Krishna Kumar, Kumaran, K., Lambert, E. V., Lee, E. S., Li, C., Luo, R., Magee, M., Malik, V. S., J Marin-Neto, A., Marks, G., Mayosi, B., McGuire, H., Micha, R., J Miranda, J., Montoya, P. Aschner, Moran, A. E., Mozaffarian, D., Naicker, S., Naidoo, N. G., Narayan, K. M. Venkat, Nikolic, I., O'Donnell, M., Onen, C., Osmond, C., Patel, A., Perez-Padilla, R., Poulter, N., Pratt, M., Rabkin, M., Rajan, V., Rassi, A., Rassi, A., Rawal, I., Remuzzi, G., Riella, M., Roth, G. A., Roy, A., Rubinstein, A., Sakuma, Y., Sampson, U. K. A., Siegel, K. R., Sliwa, K., Suhrcke, M., Tandon, N., Thomas, B., Vaca, C., Vedanthan, R., Verguet, S., Webb, M., Weber, M. Beth, Whitsel, L., Wong, G., Yan, L. L., Yancy, C. W., Zhang, P., Zhao, D., and Zhu, Y., “Cardiovascular, Respiratory, and Related Disorders: key Messages from Disease Control Priorities, 3rd edition”, The Lancet, vol. 391, pp. 1224 - 1236, 2017.[Abstract]


Summary Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

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2017

Journal Article

L. Dandona, Dandona, R., G Kumar, A., Shukla, D. K., Paul, V. K., Balakrishnan, K., Prabhakaran, D., Tandon, N., Salvi, S., Dash, A. P., Nandakumar, A., Patel, V., Agarwal, S. K., Gupta, P. C., Dhaliwal, R. S., Mathur, P., Laxmaiah, A., Dhillon, P. K., Dey, S., Mathur, M. R., Afshin, A., Fitzmaurice, C., Gakidou, E., Gething, P., Hay, S. I., Kassebaum, N. J., Kyu, H., Lim, S. S., Naghavi, M., Roth, G. A., Stanaway, J. D., Whiteford, H., Chadha, V. K., Khaparde, S. D., Rao, R., Rade, K., Dewan, P., Furtado, M., Dutta, E., Varghese, C. M., Mehrotra, R., Jambulingam, P., Kaur, T., Sharma, M., Singh, S., Arora, R., Rasaily, R., Anjana, R. M., Mohan, V., Agrawal, A., Chopra, A., Mathew, A. J., Bhardwaj, D., Muraleedharan, P., Mutreja, P., Bienhoff, K., Glenn, S., Abdulkader, R. S., Aggarwal, A. N., Aggarwal, R., Albert, S., Ambekar, A., Arora, M., Bachani, D., Bavdekar, A., Beig, G., Bhansali, A., Bhargava, A., Bhatia, E., Camara, B., Christopher, D. J., Das, S. K., Dave, P. V., Dey, S., Ghoshal, A. G., Gopalakrishnan, N., Guleria, R., Gupta, R., Gupta, S. S., Gupta, T., Gupte, M. D., Gururaj, G., Harikrishnan, S., Iyer, V., Jain, S. K., Jeemon, P., Joshua, V., Kant, R., Kar, A., Kataki, A. C., Katoch, K., Khanna, T., Khera, A., Kinra, S., Koul, P. A., Krishnan, A., Kumar, A., Kumar, R. K., Kumar, R., Kurpad, A., Ladusingh, L., Lodha, R., Mahesh, P. A., Malhotra, R., Mathai, M., Mavalankar, D., BV, M. Mohan, Mukhopadhyay, S., Murhekar, M., Murthy, G. V. S., Nair, S., Nair, S. A., Nanda, L., Nongmaithem, R. S., Oommen, A. M., Pandian, J. D., Pandya, S., Parameswaran, S., Pati, S., Prasad, K., Prasad, N., Purwar, M., Rahim, A., Raju, S., Ramji, S., Rangaswamy, T., Rath, G. K., Roy, A., Sabde, Y., Sachdeva, K. S., Sadhu, H., Sagar, R., Sankar, M. J., Sharma, R., Shet, A., Shirude, S., Shukla, R., Shukla, S. R., Singh, G., Singh, N. P., Singh, V., Sinha, A., Sinha, D. N., Srivastava, R. K., Srividya, A., Suri, V., Swaminathan, R., Sylaja, P. N., Tandale, B., Thakur, J. S., Thankappan, K. R., Thomas, N., Tripathy, S., Varghese, M., Varughese, S., Venkatesh, S., Venugopal, K., Vijayakumar, L., Xavier, D., Yajnik, C. S., Zachariah, G., Zodpey, S., Rao, J. V. R. Prasad, Vos, T., K Reddy, S., Murray, C. J. L., and Swaminathan, S., “Nations Within a Nation: Variations in Epidemiological Transition Across the States of India, 1990–2016 in the Global Burden of Disease Study”, The Lancet, vol. 390, pp. 2437 - 2460, 2017.[Abstract]


Summary Background 18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016. Methods Using all available data sources, the India State-Level Disease Burden Initiative estimated burden (metrics were deaths, disability-adjusted life-years [DALYs], prevalence, incidence, and life expectancy) from 333 disease conditions and injuries and 84 risk factors for each state of India from 1990 to 2016 as part of GBD 2016. We divided the states of India into four epidemiological transition level (ETL) groups on the basis of the ratio of DALYs from communicable, maternal, neonatal, and nutritional diseases (CMNNDs) to those from non-communicable diseases (NCDs) and injuries combined in 2016. We assessed variations in the burden of diseases and risk factors between ETL state groups and between states to inform a more specific health-system response in the states and for India as a whole. Findings DALYs due to NCDs and injuries exceeded those due to CMNNDs in 2003 for India, but this transition had a range of 24 years for the four ETL state groups. The age-standardised DALY rate dropped by 36·2% in India from 1990 to 2016. The numbers of DALYs and DALY rates dropped substantially for most CMNNDs between 1990 and 2016 across all ETL groups, but rates of reduction for CMNNDs were slowest in the low ETL state group. By contrast, numbers of DALYs increased substantially for NCDs in all ETL state groups, and increased significantly for injuries in all ETL state groups except the highest. The all-age prevalence of most leading NCDs increased substantially in India from 1990 to 2016, and a modest decrease was recorded in the age-standardised NCD DALY rates. The major risk factors for NCDs, including high systolic blood pressure, high fasting plasma glucose, high total cholesterol, and high body-mass index, increased from 1990 to 2016, with generally higher levels in higher ETL states; ambient air pollution also increased and was highest in the low ETL group. The incidence rate of the leading causes of injuries also increased from 1990 to 2016. The five leading individual causes of DALYs in India in 2016 were ischaemic heart disease, chronic obstructive pulmonary disease, diarrhoeal diseases, lower respiratory infections, and cerebrovascular disease; and the five leading risk factors for DALYs in 2016 were child and maternal malnutrition, air pollution, dietary risks, high systolic blood pressure, and high fasting plasma glucose. Behind these broad trends many variations existed between the ETL state groups and between states within the ETL groups. Of the ten leading causes of disease burden in India in 2016, five causes had at least a five-times difference between the highest and lowest state-specific DALY rates for individual causes. Interpretation Per capita disease burden measured as DALY rate has dropped by about a third in India over the past 26 years. However, the magnitude and causes of disease burden and the risk factors vary greatly between the states. The change to dominance of NCDs and injuries over CMNNDs occurred about a quarter century apart in the four ETL state groups. Nevertheless, the burden of some of the leading CMNNDs continues to be very high, especially in the lowest ETL states. This comprehensive mapping of inequalities in disease burden and its causes across the states of India can be a crucial input for more specific health planning for each state as is envisioned by the Government of India's premier think tank, the National Institution for Transforming India, and the National Health Policy 2017. Funding Bill &amp; Melinda Gates Foundation; Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India; and World Bank

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2017

Journal Article

D. Abdul Maje K and K, D. Pavithran, “Bence Jones Myeloma- An Analysis of 28 Cases ”, IJSR - INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 2017.

2017

Journal Article

A. Bhardwaj, .S, A., Vasudevan, S., Paul, N., and Vidyadha, G., “Prevalence of Anaemic Among Tribal Adolescent Girls Attending a Primary Care Facility ,Wayanad, Kerala”, 2017.

2017

Journal Article

D. Sruthi C. Babu, “Postoperative Ultrasound Guided Continuous Femoral Nerve Blockade for Unilateral Total Knee Arthroplasty: A Comparison of 0.125% Bupivacaine and 0.2% Ropivacaine”, Anesthesia Essays and Researches Anesth Essays Res, vol. 11, 2017.

2017

Journal Article

D. Sunil Rajan, “Effect of Inhaled Budesonide Suspension, Administered Using a Metered Dose Inhaler, on Post Operative Sore Throat, Hoarseness of Voice and Cough”, Indian Journal of Anaesthesia, 2017.

2017

Journal Article

A. R. Nair, Ahmed, S., Kunoor, A., Salam, B., Ponneduthamkuzhi, J. P., and Ajith, A. M., “Reliability of Overnight Desaturation Index (ODI)in Suspected Obstructive Sleep Apnea”, European Respiratory Journal, vol. 50, 2017.[Abstract]


Background: A full polysomnography (PSG) is the gold standard for diagnosis of obstructive sleep apnea(OSA) and provides comprehensive data on the sleep stages, efficiency, apnea, hypopnea events, and overnight oximetry during supervised overnight sleep study.Aims: Overnight desaturation index (ODI) is a surrogate marker for diagnosis of OSA and can be easily recorded using portable standalone overnight oximetry devices which are considerably inexpensive when compared to the full PSG. There is limited data on comparisons between AHI &amp; ODI. There is a need to find out if ODI is a reliable measure when compared to the AHI, to guide its use for first line screening in patients who attend the sleep service.Methods: The study was conducted in a tertiary care university hospital in South India. 250 consecutive patients who underwent 22-channel full PSG were included. All subjects were included after full clinical evaluation in a dedicated sleep clinic. Demographic data including comorbidities, AHI and ODI were compared.Results: Fifty four%(n=135)of subjects were obese with a mean AHI of 35.8 and 46%(n=115) were non obese with an AHI of 26.95 respectively. Underlying asthma was identified in 19.6%(n=49) and they had statistically higher AHI when compared to non asthmatics ( 42.1 vs 29.2, p0.005). There was a linear significant correlation between AHI &amp; ODI (r 0.83, p&lt;0.001) and agreement between the two as determined by single measure intra class coefficient(ICC) 0.81(0.76-0.85, p&lt;0.001)Conclusion: Overnight oximetry based surrogates (ODI) have the potential for use as reliable first line screening tool in OSA

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2017

Journal Article

S. H. Advani, Malhotra, H., Chacko, R. Titus, Basade, M., Keechilat, P., Mahapatra, P. N., Goswami, C., Sahoo, T. P., and Shah, C., “ Advanced Therapeutic Options and Importance of Rebiopsy in Epidermal Growth factor Receptor‑Tyrosine Kinase Inhibitor‑Progressed Nonsmall Cell Lung Carcinoma Patients: An Expert Opinion”, Indian Journal of Cancer, 2017.

2017

Journal Article

N. Haridas, “Yooung Man with Non Resolving Pneumonia”, Egyptian journal of bronchology, 2017.

2017

Journal Article

D. .Rakesh.P.S, “Prevalence of Bronchial Asthma and Factors Associated with it Among Higher Secondary School Children in Ernakulam District, Kerala”, J Family Med Prim Care, vol. 6, no. 2, pp. 311-315, 2017.

2017

Journal Article

D. Leyanna Su George, “Morbidity Pattern and Socio Demographic Determinants Among Elderly Population of Raichur Dist, Karnataka, India”, 2017.

2017

Journal Article

D. R. P.S, “Outcome of Patients with TB Treated with Individualised Regiment from a Territory Care in India”, 2017.

2017

Journal Article

D. Kesavankut Nayar, “ A STUDY ON FIXED DOSE COMBINATIONS ( FDCS) AND RELATED ISSUES AND PROBLEMS IN INDIA”, 2017.

2017

Journal Article

G. K, Sandeep, S., Z, P., A, M., G, K., and R, N., “Profile of Pediatric Kidney Transplantation at a Tertiary Care Centre in Southern India”, J Ped. Nephrology , 2017.

2017

Journal Article

R. Abraham, Sreedharan, S., Paul, Z., Anil Mathew, Kurian, G., and Nair, R. R., “Structural and Functional Changes in the Heart in Patients with Chronic Kidney Disease on Hemodialysis”, Urology Nephrology Andrology International , vol. 2, no. 1, pp. 17-20, 2017.[Abstract]


Osteoarthrosis incidence among subjects above 65 is 60-70%, and arterial hypertension in the same age-related group occurs in 50% of the subjects. But the severity of arterial hypertension is determined not only by the degree of arterial pressure increase. Early diagnostics of disordering the structure and function of target organs, and, first of all, those of the heart is one of the important moments. 50 patients at the age above 50 with the knee and the hip osteoarthrosis have been examined. All of them had associated arterial hypertension of II-III stage. The patients were divided into groups depending on their age. ECG- and EchoCG-examination was performed in all of them. Left vetricular remodeling and hypertrophy progressing with age were observed in 82 % of cases. The higher values of wall thickness, myocardium mass, and myocardium mass index of the left ventricle, as well as the decreased values of ejection fraction and fractional shortening were observed in patients with the heart geometry changed in comparison with the patients with the heart normal geometry. High percentage of revealing the diastolic function disorder of both the left and the right ventricles was observed in all the groups.

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2017

Journal Article

A. K, Sreedharan, S., Nair, S. S., Paul, Z., Anil Mathew, Kurian, G., and Nair, R. R., “Comparison of Adequacy of Hemodialysis in Patients with Dual lumen Tunneled Catheter and Arteriovenous Fistula”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Sreedharan, Anil Mathew, Paul, Z., Kurian, G., and Nair, R. R., “Changes In Left Ventricular Mass And Cardiac Function After Kidney Transplantation”, International Journal of Organ Transplantation Medicine, 2017.

2017

Journal Article

K. Ganesh, Nair, R. R., Seethalekshmy, N. V., Kurian, G., Mathew, A., Sreedharan, S., and Paul, Z., “A Study of Clinical Presentation and Correlative Histopathological Patterns in Renal Parenchymal Disease”, Indian Journal of Nephrology , 2017.[Abstract]


Suspicion and subsequent detection of renal disease is by an assessment of the urinalysis and renal function in the clinical context. Our attempt in this study is to correlate initial presenting features of urinalysis and renal function to the final histopathological diagnosis. A retrospective analysis of 1059 native kidney biopsies performed from January 2002 to June 2015 at Amrita Institute of Medical Sciences was conducted. Correlative patterns between urinalysis, renal function, and final histopathological diagnosis were studied. Five hundred and eleven (48%) patients had nephrotic syndrome. Out of these, 193 (38%) had pure: nephrotic syndrome, 181 (35.8%) had associated microhematuria, 110 (21.7%) had microhematuria and renal failure, and 27 (5.3%) had only associated renal failure. Minimal change disease (MCD) (30%), membranous nephropathy (30%), and IgA nephropathy (29%) were the major diseases in the respective groups. Five hundred and five (47.6%) patients had subnephrotic proteinuria. Out of these, 29 (5.6%) had only subnephrotic proteinuria, 134 (27%) had additional microhematuria, 300 (59%) had subnephrotic proteinuria, microhematuria, and renal failure, and 42 (8%) had subnephrotic proteinuria with renal failure. Lupus Nephritis (45% and 40%) and IgA Nephropathy (32% and 21%) were the major disorders in the subgroups respectively. Forty-two patients (3.7%) were biopsied for isolated renal failure with bland urinary sediment. Cast nephropathy and acute interstitial nephritis were the major diseases. Out of 89 patients with diabetes who were biopsied, 15 (16.8%) had diabetic nephropathy, 45 (50.5%) had no diabetic nephropathy, and 29 (32.5%) had diabetic nephropathy along with a non-diabetic renal disease. Postinfectious glomerulonephritis was the major glomerular disease. IgA nephropathy (22.2%) and membranous nephropathy (15.5%) were the major diseases in patients with diabetes with no diabetic nephropathy. In our population, MCD and membranous nephropathy formed the majority of diseases in biopsied nephrotic syndrome. Added microhematuria did not seem to decrease the incidence of either disease on the whole. We found a significant number of patients with membranous nephropathy with nephrotic syndrome, microhematuria, and additional renal failure. IgA nephropathy formed a majority of cases with nephrotic syndrome, microhematuria, and renal failure. The presence of renal failure regardless of other abnormalities in urinalysis showed a trend toward IgA nephropathy. Membranous nephropathy may have a more varied presentation than was originally thought and IgA nephropathy presenting as nephrotic syndrome may not be uncommon. MCD is the major subgroup of diseases in the pediatric population and presents both as nephrotic syndrome as well as nephrotic syndrome with microhematuria. Thus, urinalysis and renal failure may be a valuable tool in assessing renal disease.

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2017

Journal Article

M. Venkatesan, Sekhar, S., Nair, R., Kurian, G., Anil Mathew, Sreedharan, S., Paul, Z., and Joshy, P., “Role of Urinary NGAL at 4 Hours PostCoronary Angioplasty in Detecting Contrast Induced Acute Kidney Injury. Cardiorenal Medicine”, Cardiorenal Medicine , 2017.

2017

Journal Article

T. Joseph, “Prevalence of Tuberculosis Among Community Acquired Pneumonia Diagnosed Patients ”, Journal of Pulmonary and Respiratory Medicine , 2017.

2017

Journal Article

T. Joseph, Nair, S., and P.T., J., “Clinical-Radiaological , Pathological Profile and Treatment Outcome of Patients with Haemoptysis”, Journal of Pulmonary and Respiratory Medicine , 2017.

2017

Journal Article

S. Krishna, “Prevalence of Dermatological Problems in Indian Geriatric Population ”, Amrita Journal of Medicine, 2017.

2017

Journal Article

R. Raj, “Percentage Comparison and Evaluation of Curve of Spee and Overbite Among Class II division 1 and Class I Malocclusion Group”, Amrita Journal of Medicine. , 2017.

2017

Journal Article

U. K. Menon, “Perceptions of Students Towards a Change of Pattern in the Otorhinolaryngology (ENT) Question Paper”, Amrita Journal of Medicine, 2017.

2017

Journal Article

R. Rajagopal, “Comparison of 3% Hypertonic Saline with 20% Mannitol on Water - Electrolyte Balance and Brain Relaxation During Elective Supratentorial Tumour Surgeries ”, Amrita Journal of Medicine, 2017.

2017

Journal Article

B. Prasad S, “Factors Determining Immediate Mortality In Hospitalised Patients Suffering Cardio pulmonary Arrest – Observations From A Tertiary Care Center”, Amrita Journal of Medicine., 2017.

2017

Journal Article

F. Ali A. A, “Treatment Outcomes of Bicondylar Tibial Plateau Fractures by Hybrid Fixator and with open Reduction and Internal Fixation”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Nair, “Myxoedema Madness”, Amrita Journal of Medicine, 2017.

2017

Journal Article

J. V. Chimmen, “Primary Urachal Mucinous Adenocarcinoma of the Urinary Bladder”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Sasidharan, “Screening Tools for Assessment of Early Changes of Retinal Toxicity in Patients on Hydroxychloroquine Therapy”, Amrita Journal of Medicine, 2017.

2017

Journal Article

V. G, “A Prospective Comparative Study on the Outcome of Treatment with Gabapentin and Oxcarbazepine in Patients with Neuropathic Pain Due to Lumbosacral Radiculopathy”, Amrita Journal of Medicine, 2017.

2017

Journal Article

N. M, “Mortality Predictors In Acute Coronary Syndrome Induced Ventricular Arrhthymias”, Amrita Journal of Medicine, 2017.

2017

Journal Article

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.

2017

Journal Article

R. A. K, “Outcome and Predictors of Outcome in Patients with Pathological Node Negative Status of Breast Carcinoma”, Amrita Journal of Medicine, 2017.

2017

Journal Article

V. Krishna S, “Clinical Spectrum of Lung Cancer and its Association with Smoking Habit”, Amrita Journal of Medicine., 2017.

2017

Journal Article

R. M. V, “A Study of Hand Deformities in Rheumatoid Arthritis”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. M Sankari, “Evaluation of Second Trimester Uterine Artery Doppler in Prognosticating the Outcome of Pregnancy”, Amrita Journal of Medicine, 2017.

2017

Journal Article

K. Nayar, “Urinary Retention Associated With Amisulpride”, Amrita Journal of Medicine, 2017.

2017

Journal Article

K. K. V, “Ergonomics in Dentistry”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Haridasan, “A Prospective Randomized Cohort Study Compairing the Use of Topical Anaesthesia with Intracameral Lignocaine Versus Peribulbar Anaesthesia in Small Incision Cataract Surgery- A Surgeons View Point”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Sharma, “Isolation and Quantitative Standardisation of Adipose Derived Stem Cells (ADSCs) in Stromal Vascular Fraction (SVF) for Improving Fat Graft Viability in Humans”, Amrita Journal of Medicine, 2017.

2017

Journal Article

H. Rao B, “Utility of Acoustic Radiation Force Impulse (ARFI) Imaging of Liver and Spleen in Predicting the Variceal Status in Chronic Liver Disease”, Amrita Journal of Medicine, 2017.

2017

Journal Article

R. Sudevan, “Sex Based Differences in Barriers to Health Care Seeking Behaviour and Treatment After Acute Myocardial Infarction Among Patients Attending a Tertiary Care Hospital”, Amrita Journal of Medicine, 2017.

2017

Journal Article

V. S. P, “Clinical Profile of Interstitial Lung Diseases at a Tertiary Referral Centre in South India”, Amrita Journal of Medicine, 2017.

2017

Journal Article

M. Rajagopal, “Effectiveness of Jacobson’s Progressive Muscle Relaxation (JPMR) on Hypertension among School going Adolescents”, Amrita Journal of Medicine, 2017.

2017

Journal Article

M. Shafiq U, “Procalcitonin Levels in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Admitted to the Hospital”, Amrita Journal of Medicine., 2017.

2017

Journal Article

S. M, “A Study of Psychiatric Comorbidities and Executive Function- Deficits in First Degree Relatives of Alcoholics”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Narayanamoorthy, “Evaluation of Mid-trimester Amniocentesis Markers with Obstetric Outcomes”, Amrita Journal of Medicine., 2017.

2017

Journal Article

A. B, “Establishment of Reference Ranges of Hematological Parameters In a Tertiary Care Center”, Amrita Journal of Medicine, 2017.

2017

Journal Article

C. Anuj Singhal, “To Study The Prevalence of Various Risk Factors for OSA and Their Correlation With Severity of OSA in Indian Urban Population”, Amrita Journal of Medicine, 2017.

2017

Journal Article

A. Rajeev, “The study of incidence of post operative delirium in sensory impaired patients undergoing coronary artery bypass grafting procedure in a tertiary care hospital”, Amrita Journal of Medicine, 2017.

2017

Journal Article

A. A, “Common Errors of Insulin Injection in Patients with Diabetes”, Amrita Journal of Medicine, 2017.

2017

Journal Article

R. Savalgi, “Organic or Steroid-induced Mania with Psychotic Symptoms”, Amrita Journal of Medicine, 2017.

2017

Journal Article

Z. Mohamed, “Unrecognised Transfixion of Colon During Percutaneous Endoscopic Gastrostomy”, Amrita Journal of Medicine, 2017.

2017

Journal Article

J. Chandrasekhar, Varghese, T. Panikasser, Gopi, A., raj, M., Sudevan, R., and Jayakumar, H., “Treatment Effect of Probiotic Bacillus Clausii on Neonatal Jaundice in Late Preterm and Term Newborn Babies: An Experimental Study”, Pediatrics & Therapeutics, 2017.

2017

Journal Article

N. Sidharthan, Joseph, M. Varsha, Georgy, S. Ann, S, P., ,, ,, Sudevan, R., and Vijayakumar, G., “Clinical Profile and Treatment of Primary Myelofibrosis - An Observational study from a tertiary care centre in Kerala, South India”, Amrita Journal of Medicine, 2017.

2017

Journal Article

V. Nambiar, Das, J. S., MaryPhilip, J., RachelVargheese, D., AlexanderFernandez, A., P, U., .S, D. T., Sudevan, R., raj, M., Ajai, A., and Pulickal, G., “Age Influence on Clinical Profile and Outcome of Stroke –A Hospital Based Cohort Study from aComprehensive Stroke Care Centre in Kerala, South India ”, Amrita Journal of Medicine. , 2017.

2017

Journal Article

, Sudevan, R., and , “A Case Report on ALPS, An Experience from a Tertiary Care Centre”, Journal of pharmacy medicine, 2017.

2017

Journal Article

V. Anand Viswanathen, Sudevan, R., and Vijayakumar, G., “Need of Routine Upper GI Endoscopy in Renal Transplant Workup Patients in a Resource Limited Setting- A Cross Sectional Study from Kerala, South India”, Amrita Journal of Medicine, 2017.

2017

Journal Article

S. Ann Georgy, R, L., and Sudevan, R., “The Pattern of Antibiotic use in the Treatment of General Pediatric Conditions: A Descriptive Study from a Tertiary Care Centre, India”, Amrita Journal of Medicine, 2017.

2017

Journal Article

Dr. Lalitha Biswas, CG, N., M, B., Pradeep Jacob, Riju R. Menon, AK, R., and K, N., “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 Journal of Endocrinol Metab, vol. 21, no. 2, pp. 329-333, 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

Journal Article

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

Journal Article

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

Journal Article

M. Subramanian, Dr. Hisham Ahamed, and Mathew, N., “Familial restrictive cardiomyopathy: A novel troponin mutation”, Indian Heart Journal, vol. 69, Suppliment 2, pp. S87 - S88, 2017.[Abstract]


Background: Although sporadic cases of familial restrictive cardiomyopathy (RCM) have been reported, there is limited data on whether a distinct genetic entity exists.

Methods: We recognized a large family in which 5 individuals died suddenly and several surviving relatives had symptoms of heart disease. Our index case was a 49-year-old male who had onset of heart failure symptoms since the age of 40 years. Echocardiography revealed bi-atrial enlargement accompanied by a restrictive filling pattern, and normal systolic function. He had recurrent admissions for heart failure and died within 1 month of initial admission. We applied a candidate gene approach to our index case and family members that were willing for genetic analysis.

Results: We identified a novel heterozygous missense mutation in exon 7 of the TNNI3 gene that results in the amino acid substitution of Tryptophan for Arginine at codon 145. The TNNI3 gene encodes a highly conserved region of the cardiac troponin I (cTnI) gene. Five other members of the family were detected to be carriers of the same mutation, among which two members had a similar restrictive filling pattern and biatrial dilation on echocardiography.

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2017

Journal Article

S. V., Subramaniam, M., Shanmugam, A., Philip, A., Susan, A., Prabhu, R., Unni, M., Sidharthan, N., Jose, W., V., S. N., Dr. Hisham Ahamed, Mathew, N., and Keechilat, P., “1025PIndependent predictors of one year mortality in patients with primary systemic immunoglobulin light chain cardiac amyloidosis”, Annals of Oncology, vol. 28, 2017.[Abstract]


Background: Immunoglobulin light chain amyloidosis (AL amyloidosis) is a monoclonal plasma cell proliferative disorder that is characterized by tissue deposits of misfolded insoluble κ and λ light chain derived amyloid fibrils, leading to organ dysfunction. The prognosis of patients depends on the number and severity of organ involvement, especially cardiac involvement. Nearly half of the patients with amyloidosis die within a year of diagnosis. We analysed factors predicting early mortality (within one year) in patients with systemic immunoglobulin light chain cardiac amyloidosis.Methods: Retrospective analysis of patients between January 2007 and January 2016 from our hospital database. In patients with AL cardiac amyloidosis, cardiac involvement was defined as per American society of echocardiography (ASE) criteria. We evaluated the clinical, ECG and ECHO parameters of early relapse (ER) within one year in these cardiac AL amyloidosis patients. Log rank test was done to identify independent predictors of one year all cause mortality.

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2016

Journal Article

Ma Pillay, Yesodharan, Db, Narayanan, D. Lb, Jojo, Ac, Luiz, Nd, and Nampoothiri, Se, “Sirenomelia: Case reports and current concepts of pathogenesis”, Pediatric and Developmental Pathology, vol. 15, pp. 403-406, 2016.[Abstract]


We present 2 cases of sirenomelia and highlight the recent theories about its pathogenesis. Both cases had a large aberrant abdominal umbilical artery (AAUA) arising from the aorta, suggesting vascular steal as the pathophysiology. However, the bilateral upper limb defects noted in 1 case, the reported 10% association of holoprosencephaly and anencephaly, and the reports of sirenomelia with normal umbilical arteries point to the alternative caudal dysgenesis (CD) theory. This proposes that an insult at the early blastogenic stage interferes with the formation of the notochord, resulting in abnormal development of caudal structures, an AAUA, and occasional neural tube defects. We have also analyzed the implications of the similarities between sirenomelia/CD and the VATER association; the increased risk of CD but not sirenomelia in infants of diabetic mothers; the fact that sirenomelia, holoprosencephaly, and the VATER association are all more common in monozygotic twins; the experimental production of sirenomelia in mice; and the possible genetic implications of the co-occurrence of sirenomelia and CD. © 2012 Society for Pediatric Pathology.

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2016

Journal Article

J. M. Kanthi, Sumathy, S., Sreedhar, S., Rajammal, B., Usha, M. G., and Sheejamol, V. S., “Comparative Study of Cesarean Myomectomy with Abdominal Myomectomy in Terms of Blood Loss in Single Fibroid”, Journal of Obstetrics and Gynecology of India, vol. 66, pp. 287-291, 2016.[Abstract]


Objective: In this study, we evaluate the safety and feasibility of cesarean myomectomy and compare this procedure with abdominal myomectomy in single fibroid, in terms of blood loss and postoperative complications. Methods: Thirty-three patients who underwent cesarean myomectomy from June 2006 to 2012 in Amrita Institute of Medical Sciences, were included in the study. Almost an equal number of patients who underwent abdominal myomectomy (32) in the same period were included. Women are divided into two groups: group 1—cesarean myomectomy, group 2—abdominal myomectomy. Results: Mean age of the women was comparable; mean gestational age in group 1 was 37.97 +/− 1.57 weeks; and 60 % were primiparous. Hemoglobin (Hb) drop postoperatively was compared between the groups, and there was no significant difference. Though there was statistically significant difference among the groups regarding the size of fibroids, the main outcome measure of the study, the Hb drop was comparable between group 1 and 2. There is statistically significant difference in the Hb difference with increasing mean diameter of the fibroids. As the size increases, Hb drop also increases indicating the increasing blood loss. The measures used to reduce blood loss such as vasopressin instillation and stepwise devascularization influence the blood loss, and P value shows borderline significance. There was no difference in Hb drop among the groups according to the type of fibroids. But more subserous fibroids were removed in group 1, whereas more intramural fibroids were removed in group 2. Conclusion: Cesarean myomectomy can be safely done in single fibroids and is comparable to abdominal myomectomy in terms of blood loss. © 2015 Federation of Obstetric & Gynecological Societies of India

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2016

Journal Article

M. Chatterjee, Anju, C. P., Biswas, L., V. Kumar, A., Dr. Gopi Mohan C., and Dr. Raja Biswas, “Antibiotic Resistance in Pseudomonas Aeruginosa and Alternative Therapeutic Options”, International Journal of Medical Microbiology, vol. 306, pp. 48 - 58, 2016.[Abstract]


Pseudomonas aeruginosa is a leading cause of nosocomial infections and is responsible for ∼10% of all hospital-acquired infections worldwide. It continues to pose a therapeutic challenge because of the high rate of morbidity and mortality associated with it and the possibility of development of drug resistance during therapy. Standard antibiotic regimes against P. aeruginosa are increasingly becoming ineffective due to the rise in drug resistance. With the scope for developing new antibiotics being limited, alternative treatment options are gaining more and more attention. A number of recent studies reported complementary and alternative treatment options to combat P. aeruginosa infections. Quorum sensing inhibitors, phages, probiotics, anti-microbial peptides, vaccine antigens and antimicrobial nanoparticles have the potential to act against drug resistant strains. Unfortunately, most studies considering alternative treatment options are still confined in the pre-clinical stages, although some of these findings have tremendous potential to be turned into valuable therapeutics. This review is intended to raise awareness of several novel approaches that can be considered further for combating drug resistant P. aeruginosa infections. © 2015 Elsevier GmbH.

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2016

Journal Article

Chitra P. and Jeenu, K. M., “Perspectives of Strange Environmental Stressors among Hospitalized Children at AIMS, Kochi”, Indian Journal of Public Health Research & Development, vol. 7, pp. 266–270, 2016.[Abstract]


Introduction: Common fears of childhood which includes fear of separation, loss of control and bodily injury, mutilation or harm. Hospitalization does affect the child’s control over decisions related to his/her own body. Method: The qualitative approach, exploratory research design was chosen. The tools used were Dichotomous Questions, NAVAS (Noise Assessment Visual Analogue Scale), Photographs images, Rank Order and Forced Choice Questions. The study was conducted among 100 Hospitalized Children (HC) used non probability purposive sampling technique to select the children. Results: The children 49 of them had previous exposure and 51 of them were new experience of hospitalization. Researchers were asked the opinions about existing ventilation, all (100)of them preferred open ventilation in day time but nearly half of them (52) liked closed ventilation in night. Perspectives of Strange Environmental Stressors (SES)was assessed by the use of selected photographs images - to choose in color of the unit, bedding, uniform and light set up. Most of them have chosen blue color is their favorite. Procedure room and indoor play room they have selected fantasyimagery. Hospitalequipments, supplies and utensils they have chosen fashionable, picturized items. A question was asked regarding what causes fear and stress during their hospitalization, majority of them reported such a manner, afraid of strange of any equipment’s, threatened pain in invasive procedures, scared in white uniform nurses talk and touch. Conclusion: The study findings revealed that, children’s perspectives is different, and too depth to visualize in each and everything. Especially where they spend time even if it is hospital, they are expecting fantasy environment they didn’t think as adult about the importance of hospital, treatment, health..

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2016

Journal Article

S. Rajan, Paul, J., and Kumar, L., “Spontaneous Repositioning of a Malpositioned Peripherally Inserted Central Catheter”, Indian Journal of Anaesthesia, vol. 60, pp. 148-149, 2016.

2016

Journal Article

Dr. Asha J. Mathew, Dr. Geetha S.G., and Sukumaran, T. T., “A study of the supratrochlear foramen of the humerus: Anatomical and clinical perspective”, Journal of Clinical and Diagnostic Research, vol. 10, pp. AC05-AC08, 2016.[Abstract]


Introduction: The Supratrochlear Foramen (STF) is a variably shaped perforation present in the bony septum that separates the olecranon and coronoid fossae at the distal end of the humerus, between the two epicondyles. Its incidence varies widely from 0.3% to 58% in different races. Aim: This study aims to describe its prevalence and morphometry in relation to its shape and size and distance from the epicondyles. Materials and Methods: A prospective study of 244 unpaired humerii, 130 of the left side and 114 of the right side of unknown age and sex were examined for the presence of STF and prevalence stated. The STF was classified according to shape and their metric assessment was carried out, along with measures of its distance from the epicodyles and trochlear margin. Results: Of the 244 humeri studied 60 showed presence of the foramen, 45 were opaque and 139 showed translucent septum. The sidewise prevalence of opacity, translucent septum and foraminae were tabulated. The commonest shape noted was oval. Other shapes such as round, triangular, rectangular, sieve and reniform were visualised. In the oval STF, transverse and vertical diameters were measured. The transverse and vertical diameters on the left were 4.9 and 3.27 mm and on the right it was 5.12 and 3.48mm respectively. The distance from the medial epicondyle, lateral epicondyle and trochlea to the STF margins was measured and the mean values were calculated separately for right and left sides. The mean diameter of the round foramen was 3.23 and 4.89mm for left and right sides respectively. In the triangular type the maximum vertical and transverse diameters were recorded. There was only one sample of the rectangular type. Its length was 4.1mm and the breadth was 2.27mm and it belonged to the right side. The reniform type totalled 7 of which 6 were of the left side. The average vertical length at the hilum was 4.52 mm and the transverse measurement was 7.44 mm. The foraminae of the right side were found to be larger, regardless of shape. Conclusion: Its existence is important to the orthopaedician in the preoperative planning of nailing fractures of the distal humerus and to the radiologist for differentiating it from an osteolytic or cystic lesion. © 2016, Journal of Clinical and Diagnostic Research. All rights reserved.

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2016

Journal Article

K. L, S, S., R, K., and N, M. R., “Simultaneous Pancreas–kidney Transplant for Type I Diabetes with Renal Failure: Anaesthetic Considerations”, Indian J Anaesth, vol. 60, no. 2, pp. 131 - 4, 2016.[Abstract]


Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation.

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2016

Journal Article

Dr. Chandrashekar Janakiram, Venkitachalam, R., and Joseph, J., “Profile of Institutional Ethics Committees in Dental Teaching Institutions in Kerala, India”, Accountability in Research, vol. 23, pp. 219-229, 2016.[Abstract]


<p>Objectives: To assess the existence, structure, and functioning of Institutional Ethics Committees (IECs) in dental teaching institutions in Kerala. Methodology: A cross-sectional questionnaire-based survey was conducted by personally approaching Heads of Institutions/Ethics Committee (EC) in-charge of all dental colleges (23) in Kerala. The validated questionnaire consisted of two parts. The first part pertained to details of institutions, and the second part assessed the structure and functioning of the IEC. The data obtained was tabulated and analyzed using descriptive statistics. Results: Of the participating 17 colleges, 13 colleges had a functioning IEC. Only four of these IECs were accredited to a central agency. Only one among the 12 colleges completely adhered to recommended structure. Regarding the functioning of IECs, 69% of the IECs had neither a separate application form for ethical review of proposals nor a proforma for its evaluation. On average, more than ten proposals were reviewed in a single EC meeting in 54% of the colleges. Nearly 40% of the IECs had no representation of a lay person. Conclusion: The absence of IEC in four colleges and non-accreditation to a central agency was a matter of concern. Enforced accreditation is the need of the hour to ensure ethical protection to human participants. © 2016 Taylor &amp; Francis.</p>

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2016

Journal Article

Dr. Subramania Iyer K., Thankappan, K., and Balasubramanian, D., “Early detection of oral cancers: Current status and future prospects”, Current Opinion in Otolaryngology and Head and Neck Surgery, vol. 24, pp. 110-114, 2016.[Abstract]


Purpose of review: This article reviews the current literature and summarizes the latest developments in screening and early detection of oral cancers and looks at the future possibilities. Recent findings: Oral cancer is the best model for screening and prevention. The screening for oral cancer can be population based, opportunistic, or targeted. A long-term 15-year follow-up data of a randomized controlled study from a developing country setting indicated a sustained reduction in oral cancer mortality in high-risk individuals. Visual oral examination remains the mainstay in the screening. Several adjunctive techniques have been described to aid in the clinical examination of these lesions. A Cochrane review revealed that there is no evidence to recommend these adjuncts in clinically visible lesions. Salivary biomarkers seem to be promising as a tool for screening in the future. A Targeted Evidence Update for the US Preventive Services Task Force found no evidence on screening either in the general or selected high-risk population for oral cancer in the United States or on benefit of any adjunctive device affecting the performance of the screening examination. Summary: Current evidence shows that community based screening has a value in reducing the oral cancer mortality in high-risk group of population. But this evidence may not be universally applicable. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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2016

Journal Article

S. Rajan, Paul, J., and Kumar, L., “Carbon dioxide embolism during endoscopic thyroidectomy”, Indian Journal of Anaesthesia, vol. 60, pp. 65-66, 2016.

2016

Journal Article

D. Joseph and Kumar, S., “Identifying clues to molecular etiology of multiple sclerosis in South Indian patients”, Multiple Sclerosis and Related Disorders, vol. 5, pp. 7-11, 2016.[Abstract]


Background: Environmental risk factors have a dominant role in the pathogenesis of multiple sclerosis (MS). Unhealthy lifestyle can predispose people to autoimmune diseases. MS was a rare disease in Kerala, but now, we notice frequent cases of MS at the city neurology clinic. Changing lifestyle and associated changes in the level of proinflammatory biomolecules like: leptin, soluble leptin receptor (SLR) and free fatty acids (FA) could be contributing to rise in MS incidence. Objective: To identify variations in the levels of bio-molecules: leptin, SLR and FA, between MS patients and matched healthy control. Method: Leptin and SLR levels in the blood serum, were estimated using ELISA, while total FA levels, were estimated using an enzyme based calorimetric assay. Result: Mean serum FA levels in MS patients (31.39±4.83 nmole/100 μl) were 2.7 fold higher than controls (11.54±2.66 nmoles/100 μl) at more than 99% CI. The differences in mean leptin and SLR levels were not statistically significant. Conclusion: MS patients had high level of total FA in their blood. High FA in blood may have a role in MS pathogenesis. More in-depth study is required to understand the precise mechanism by which FA rise in MS blood sample can contribute to pathogenesis. © 2015 Elsevier B.V. All rights reserved.

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2016

Journal Article

G. Madhu S, Emmanuel James, and Ramakrishna Venugopal, “Appropriateness of antibiotic usage for gastrointestinal disorders in a tertiary care hospital”, European Journal of Hospital Pharmacy, 2016.[Abstract]


Objective To assess antibiotic usage in gastrointestinal disorders with respect to appropriateness, pattern of resistance, and incidence of adverse drug reactions (ADRs).Methodology Antibiotic prescribing in the gastroenterology department of a tertiary care hospital was evaluated using the Gyssens criteria and also by assessing drug related problems (DRPs) using the Pharmaceutical Care Network Europe V.6.2. A total of 173 patients were studied prospectively by a team of clinical pharmacists. Antibiotic susceptibility was prospectively studied; in addition, retrospective data on culture and sensitivity reports of commonly isolated organisms from 1 October 2012 to 30 September 2014 were collected to determine the resistance pattern in previous years. ADRs were evaluated using the Naranjo scale.Results Antibiotic therapy was appropriate in 60% of patients and inappropriate in the remaining patients due to incorrect decision, choice, and use. A total of 184 DRPs and 30 ADRs of antibiotics were identified. In the study patients, the most commonly isolated organism was Escherichia coli (27.3%) followed by Klebsiella pneumoniae (16.7%). Both E coli and K pneumoniae exhibited 100% resistance towards cefotaxime. There was an increase in the resistance of E coli and K pneumoniae against various antibiotics tested in 2013–2014 as compared to the previous year. An empirical antibiotic policy was developed which was endorsed by the gastroenterology department.Conclusions Although antibiotic therapy was appropriate in the majority of patients, irrational use occurred due to incorrect choice, improper dosage, and improper duration of therapy. E coli and K pneumoniae isolates showed an increase in resistance towards various antibiotics tested.

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2016

Journal Article

M. Vijayakumar, Vasudevan, D. M., Sundaram, K. R., Krishnan, S., Vaidyanathan, K., Nandakumar, S., Chandrasekhar, iv, R., and Mathew, N., “A randomized study of coconut oil versus sunflower oil on cardiovascular risk factors in patients with stable coronary heart disease”, Indian Heart Journal, 2016.[Abstract]


Coronary artery disease (CAD) and its pathological atherosclerotic process are closely related to lipids. Lipids levels are in turn influenced by dietary oils and fats. Saturated fatty acids increase the risk for atherosclerosis by increasing the cholesterol level. This study was conducted to investigate the impact of cooking oil media (coconut oil and sunflower oil) on lipid profile, antioxidant mechanism, and endothelial function in patients with established CAD. More »»

2016

Journal Article

A. Pillai, “Gamma Knife Surgery for Metastatic Brain Tumors from Gynecologic Cancer: Time for What Saves Time, Grants Time, and Is Tested By Time?”, World Neurosurg, vol. 91, pp. 597-9, 2016.

2016

Journal Article

V. Vijan, Vupputuri, A., and Nair, iv, R. Chandrasek, “An Unusual Case of Biatrial Myxoma in a Young Female”, Case Reports in Cardiology, vol. 2016, 2016.[Abstract]


Myxoma, a rare type of intracardiac tumor, forms a very small percentage of the cardiac cases. Reports of biatrial myxoma are rarer, with cases of single tumor reaching both atria being more common. Here, we present an unusual case of two independently growing atrial myxoma in a 29-year-old female. We emphasize that early recognition of symptoms, confirmation of diagnosis by transesophageal echocardiography, and prompt surgical excision remain vital in the management of such patients. The patient in the present case was managed successfully with no evidences of recurrence at the last follow-up.

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2016

Journal Article

M. Pillay, Ramakrishnan, S., and Mayilswamy, M., “Two Cases of Rectus Sternalis Muscle”, Journal of Clinical and Diagnostic Research, vol. 10, pp. AD01-AD03, 2016.[Abstract]


The sternalis muscle, an uncommon anatomical variant of the chest wall musculature, though perhaps well known to anatomists, is quite unfamiliar to clinicians and radiologists despite attempts to highlight its clinical importance in recent years. During routine dissection for undergraduate medical teaching, in the department of anatomy, we came across two cases of sternalis muscle. The first was a unique case of unilateral right sternalis with contralateral insertion on the left sternocleidomastoid, and the second case where bilateral presence of the muscle was noted with ipsilateral insertion. The former was supplied by medial pectoral nerve and the latter by lower intercostal nerves. Usually present between the pectoral and superficial fasciae, wide ranging prevalence and morphology have been attributed to this muscular variant. Opinions differ on its development and nerve supply. Its presence can be misdiagnosed as a wide range of benign and malignant anterior chest wall lesions and tumours, but it is also of great use as a pedicle flap or flap microvascular anastomosis in reconstructive surgeries of anterior chest wall, head and neck and breast. In this paper, two cases of sternalis muscle which presented very differently from each other are discussed. © 2015, Journal of Clinical and Diagnostic Research. All rights Reserved.

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2016

Journal Article

L. Kumar, Ramamurthi, P., Rajan, S., and S. Surendran, “Post–Operative Myocardial Infarction Complicating Donor Hepatectomy: Implications for Donor Safety”, Indian Journal of Anaesthesia, vol. 60, pp. 433-435, 2016.

2016

Journal Article

Sweatha V. Nair, Baranwal, G., Chatterjee, M., Sachu, A., Dr. Anil Kumar V., Chinchu Bose, Dr. Asoke Banerji, and Dr. Raja Biswas, “Antimicrobial Activity of Plumbagin, a Naturally Occurring Naphthoquinone from Plumbago Rosea, against Staphylococcus Aureus and Candida Albicans”, International Journal of Medical Microbiology, vol. 306, pp. 237-248, 2016.[Abstract]


Candida albicans and Staphylococcus aureus are opportunistic pathogens. Despite causing a number of independent infections, both pathogens can co-infect to cause urinary tract infections, skin infections, biofilm associated infections, sepsis and pneumonia. Infections of these two pathogens especially their biofilm associated infections are often difficult to treat using currently available anti-bacterial and anti-fungal agents. In order to identify a common anti-microbial agent which could confer a broad range of protection against their infections, we screened several phytochemicals and identified plumbagin (5-hydroxy-2-methyl-1,4-naphthoquinone), a phytochemical from Plumbago species as a potent antimicrobial agent against S. aureus and C. albicans, with a minimum inhibitory concentration of 5 μg/ml. Antimicrobial activity of plumbagin was validated using an ex-vivo porcine skin model. For better understanding of the antimicrobial activity of plumbagin, a Drosophila melanogaster infection model was used, where D. melanogaster was infected using S. aureus and C. albicans, or with both organisms. The fly's survival rate was dramatically increased when infected flies were treated using plumbagin. Further, plumbagin was effective in preventing and dispersing catheter associated biofilms formed by these pathogens. The overall results of this work provides evidence that plumbagin, possesses an excellent antimicrobial activity which should be explored further for the treatment of S. aureus and C. albicans infections.

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2016

Journal Article

Ja Toledo, George, Lb, Martinez, Ec, Lazaro, Ad, Han, W. We, Coelho, G. Ef, Ranzinger, SgRunge, and Horstick, Oh, “Relevance of Non-communicable Comorbidities for the Development of the Severe Forms of Dengue: A Systematic Literature Review”, PLoS Neglected Tropical Diseases, vol. 10, 2016.[Abstract]


Patients with dengue fever and comorbidities seem to be at higher risk of developing complications and/or severe dengue compared to healthier individuals. This study systematically reviews the evidence related to comorbidities and dengue. A systematic literature review was performed in five databases (EMBASE, PUBMED, Global Health, SciELO, Cochrane) and grey literature for full-text articles since its inceptions until October 10, 2015. A total of 230 articles were retrieved. Sixteen studies were analysed after applying all inclusion and exclusion criteria. Seven case control studies and nine retrospective cohort studies showed that comorbidities may contribute to severe dengue, especially 1) cardiovascular disease, 2) stroke, 3) diabetes, 4) respiratory disease and 5) renal disease, as well as old age. However, due to heterogeneity in studies, the real estimate effect of comorbidities as modifiers of dengue severity could not be established. Further research in regions with high prevalence of dengue infection would contribute to a better understanding of the relevance of comorbidities in severe dengue, especially with a standardised protocol, for outcomes, specific comorbidities, study design—best using prospective designs—and sample sizes.

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2016

Journal Article

Suhas Udayakumaran and Onyia, C. U., “Customizable rigid head fixation for infants: technical note.”, Childs Nerv Syst, vol. 32, no. 1, pp. 159-61, 2016.[Abstract]


<p><b>INTRODUCTION: </b>The need and advantages of rigid fixation of the head in cranial surgeries are well documented (Berryhill et al., Otolaryngol Head Neck Surg 121:269-273, 1999). Head fixation for neurosurgical procedures in infants and in early years has been a challenge and is fraught with risk. Despite the fact that pediatric pins are designed, rigid head fixation involving direct application of pins to the head of infants and slightly older children is still generally not safe (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). Yet, there are some surgeries in which some form of rigid fixation is required (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). We describe a simple technique to achieve rigid fixation of the head in infants for neurosurgical procedures.</p><p><b>TECHNICAL NOTE: </b>This involves applying a head band made of Plaster of Paris (POP) around the head and then applying the fixation pins of the fixation frame directly on to the POP.</p><p><b>CONCLUSION: </b>We have used this technique of head fixation successfully for infants with no complications.</p>

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2016

Journal Article

A. Christabel, Anantanarayanan, P., Subash, P., Soh, C. L., Ramanathan, M., Muthusekhar, M. R., and Narayanan, V., “Comparison of pterygomaxillary dysjunction with tuberosity separation in isolated Le Fort I osteotomies: a prospective, multi-centre, triple-blind, randomized controlled trial.”, Int J Oral Maxillofac Surg, vol. 45, no. 2, pp. 180-5, 2016.[Abstract]


<p>The aim of this trial was to compare two techniques of maxillary dysjunction, with 10mg/kg tranexamic acid as an adjuvant, in isolated non-segmented Le Fort I procedures. Two hundred patients were randomized to one of four groups: group A, pterygomaxillary dysjunction+saline; group B, tuberosity separation+saline; group C, pterygomaxillary dysjunction+tranexamic acid; and group D, tuberosity separation+tranexamic acid. Primary outcome measures were intraoperative blood loss and operating time, while the secondary outcome measures were surgical field assessment, need for blood transfusion, and duration of hospitalization. The data were analyzed using one-way analysis of variance (SPSS v. 17.0), and the level of significance was set at P<0.05. Results revealed that group D (tuberosity separation+tranexamic acid) had the least blood loss (mean 172 ml) and shortest operating times (mean 49 min), with the best surgical field. This group also exhibited the lowest drop in postoperative haemoglobin concentration (Hbgm/dl) and packed cell volume (PCV). Five patients, all in group A, required a blood transfusion and had an extra 24h of hospitalization. This trial revealed that the tuberosity separation technique with the use of tranexamic acid was the best protocol in producing the least blood loss, minimizing the operating time, and providing the best surgical field.</p>

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2016

Journal Article

M. John Kuzhimattam and Krishnakumar, R., “Naked facet sign in a case of traumatic injury to the thoracic vertebra.”, Spine J, vol. 16, no. 2, pp. e37-8, 2016.

2016

Journal Article

A. Prakash, Sharma, C., Singh, A., P Singh, K., Kumar, A., Hagen, F., Govender, N. P., Colombo, A. L., Meis, J. F., and Chowdhary, A., “Evidence of genotypic diversity among Candida auris isolates by multilocus sequence typing, matrix-assisted laser desorption ionization time-of-flight mass spectrometry and amplified fragment length polymorphism.”, Clin Microbiol Infect, vol. 22, no. 3, pp. 277.e1-9, 2016.[Abstract]


<p>Candida auris is a multidrug-resistant nosocomial bloodstream pathogen that has been reported from Asian countries and South Africa. Herein, we studied the population structure and genetic relatedness among 104 global C. auris isolates from India, South Africa and Brazil using multilocus sequence typing (MLST), amplified fragment length polymorphism (AFLP) fingerprinting and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). RPB1, RPB2 and internal transcribed spacer (ITS) and D1/D2 regions of the ribosomal DNA were sequenced for MLST. Further, genetic variation and proteomic assessment was carried out using AFLP and MALDI-TOF MS, respectively. Both MLST and AFLP typing clearly demarcated two major clusters comprising Indian and Brazilian isolates. However, the South African isolates were randomly distributed, suggesting different genotypes. MALDI-TOF MS spectral profiling also revealed evidence of geographical clustering but did not correlate fully with the genotyping methods. Notably, overall the population structure of C. auris showed evidence of geographical clustering by all the three techniques analysed. Antifungal susceptibility testing by the CLSI microbroth dilution method revealed that fluconazole had limited activity against 87% of isolates (MIC90, 64 mg/L). Also, MIC90 of AMB was 4 mg/L. Candida auris is emerging as an important yeast pathogen globally and requires reproducible laboratory methods for identification and typing. Evaluation of MALDI-TOF MS as a typing method for this yeast is warranted.</p>

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2016

Journal Article

R. Sankaran, Shah, R., Menon, S., and Pillai, A., “Congenital subaxial cervical subluxation presenting as a bilateral Erb's palsy: surgical management, rehabilitation, and outcome.”, Childs Nerv Syst, vol. 32, no. 5, pp. 849-55, 2016.[Abstract]


<p><b>INTRODUCTION: </b>Subaxial spine injuries during infancy are uncommon.</p><p><b>CASE REPORT: </b>We present the case of an infant referred to our brachial plexus clinic with proximal weakness of both arms noted immediately following a complicated breech delivery. Nerve conduction studies were consistent with bilateral proximal upper plexus injury; however, radiological evaluation revealed a C4-C5 subluxation and MRI features of bilateral C5 root avulsions. He was immobilized in a cervical-body orthosis and underwent open reduction and posterior C4-C5-C6 fixation at 10 weeks age using luque rods, sublaminar wires, and rib graft. The spine was immobilized in a custom molded cervicothoracic brace for a total of 3 months, and a home exercise program prescribed. Follow-up radiographic evaluation showed good posterior bony fusion by 2 months but persistent bilateral proximal upper limb weakness with reduced compound motor action potential (CMAP) amplitudes of the axillary and musculocutaneous nerves. Bilateral supraclavicular exploration and C5 root neurotization using the ipsilateral C7 nerve roots were performed at 7 months of age. Voluntary biceps activity followed by voluntary external rotation with gravity eliminated was noted within the next 2-3 months. He progressed to develop near normal motor control of bilateral upper limbs within 1 year.</p><p><b>CONCLUSIONS: </b>We wish to report this rare entity and our favorable outcome using a strategy of early spinal stabilization and neurotization repair to restore function following proximal nerve root injury.</p>

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2016

Journal Article

V. M Priya, Sabitha, M., and Dr. Jayakumar Rangasamy, “Colloidal Chitin Nanogels: A Plethora of Applications Under One Shell”, Carbohydr Polym, vol. 136, pp. 609-17, 2016.[Abstract]


<p>Chitin nanogels (CNGs) are a relatively new class of natural polymeric nanomaterials which have a large potential in the field of drug delivery and nanotherapeutics. These nanogels being very biocompatible are non-toxic when internalized by cells. In this review various properties, preparation techniques and applications of CNGs have been described. CNGs because of their nano-size possess certain unique properties which enable them to be used in a number of biomedical applications. CNGs are prepared by simple regeneration technique without using any cross-linkers. Various polymers, drugs and fluorescent dyes can be blended or incorporated or labelled with the chitin hydrogel network. Drugs and molecules encapsulated within CNGs can be used for targeted delivery, in vivo monitoring or even for therapeutic purposes. Here various applications of CNGs in the field of drug delivery, imaging, sensing and therapeutics have been discussed. </p>

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2016

Journal Article

R. Gupta, Gupta, N., Nampoothiri, S., Mandal, K., Kishore, Y., Sharma, P., Kabra, M., and Phadke, S. R., “Smith-Magenis Syndrome: Face Speaks.”, Indian J Pediatr, vol. 83, no. 6, pp. 589-93, 2016.[Abstract]


<p>Smith-Magenis syndrome is a well delineated microdeletion syndrome with characteristic facial and behavioral phenotype. With the availability of the multi-targeted molecular cytogenetic techniques like Multiplex Ligation Probe Amplification and cytogenetic microarray, the cases are diagnosed even without clinical suspicion. Here, the authors present clinical features of nine Indian cases of Smith-Magenis syndrome. Characteristic facial phenotype including tented upper lip, broad forehead, midface hypoplasia, short philtrum and upslant of palpebral fissure is obvious in the photographs. The behavioral variations were seen in some of the cases but were not the presenting features. The characteristic facial phenotype can be an important clinical guide to the diagnosis. </p>

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2016

Journal Article

S. Balan, “Approach to Joint Pain in Children.”, Indian J Pediatr, vol. 83, no. 2, pp. 135-9, 2016.[Abstract]


<p>It is not uncommon in pediatric clinical practice to encounter children with musculoskeletal symptoms. A number of disparate conditions can present with joint complaints in children. In this article, the author describes the clinical approach to a child presenting with joint complaints. A detailed clinical history, including the family history, along with a complete physical examination can provide vital clues to the underlying condition in most cases. A structured screening examination of the musculoskeletal system that has been recently developed (i.e., pGALS) is also discussed. It is also pointed out that the pattern of joint involvement gives us one of the most important clues to the etiology of arthritis. The pediatrician has to be aware of the conditions that can have arthritis as one of the manifestations so as to investigate and treat the child accordingly. </p>

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2016

Journal Article

J. Urquhart, Roberts, R., de Silva, D., Shalev, S., Chervinsky, E., Nampoothiri, S., Sznajer, Y., Revencu, N., Gunasekera, R., Suri, M., Ellingford, J., Williams, S., Bhaskar, S., and Clayton-Smith, J., “Exploring the genetic basis of 3MC syndrome: Findings in 12 further families.”, Am J Med Genet A, vol. 170A, no. 5, pp. 1216-24, 2016.[Abstract]


<p>The 3MC syndromes are a group of rare autosomal recessive disorders where the main clinical features are cleft lip and palate, hypertelorism, highly arched eyebrows, caudal appendage, postnatal growth deficiency, and genitourinary tract anomalies. Ophthalmological abnormalities, most notably anterior chamber defects may also be seen. We describe the clinical and molecular findings in 13 individuals with suspected 3MC syndrome from 12 previously unreported families. The exclusion of the MASP1 and COLEC11 Loci in two individuals from different consanguineous families and the absence of mutations in four further individuals sequenced for both genes raises the possibility that that there is further genetic heterogeneity of 3MC syndrome.</p>

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2016

Journal Article

P. Sethi, Dinesh Balakrishnan, Surendran, S., and Mohamed, Z. Umer, “Fulminant zygomycosis of graft liver following liver transplantation.”, BMJ Case Rep, vol. 2016, 2016.[Abstract]


<p>A 44-year-old man with hepatitis B virus (HBV)-related cirrhosis underwent living donor liver transplantation at our institute. Induction of immunosuppression was achieved with basiliximab, due to deranged renal function, and maintained with prednisolone, tacrolimus and mycophenolate mofetil. The intraoperative and immediate postoperative periods were fairly uneventful. A duplex scan, taken during the third week post-transplantation due to sudden rise in liver enzymes, revealed multifocal hypoechoic lesions in the graft liver with normal Doppler parameters. Multidetecor computed tomography (MDCT) showed multiple hypodense vessel-sparing lesions in the graft liver. Cultures from the aspirate grew filamentous fungi identified as Basidiobolus ranarum species. Despite multiple broad spectrum antifungal infusions including liposomal amphotericin, itraconazole, caspofungin and posaconazole, serial sonography showed the hepatic lesions increasing in size, and involving segments V, VI and VII. The patient developed severe liver dysfunction ultimately progressing to sepsis, multiorgan dysfunction and death. </p>

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2016

Journal Article

D. Khadakban, Kudpaje, A., Thankappan, K., Jayaprasad, K., Gorasia, T., Vidhyadharan, S., Mathew, J., Sharma, M., and Iyer, S., “Reconstructive Indications of Anterolateral Thigh Free Flaps in Head and Neck Reconstruction.”, Craniomaxillofac Trauma Reconstr, vol. 9, no. 1, pp. 40-5, 2016.[Abstract]


<p>Anterolateral thigh (ALT) free flap is a common flap with multitude of indications. The purpose of this article is to review the reconstructive indications of the flap in head and neck defects. This is a retrospective study of 194 consecutive ALT flaps. Data including patient characteristics (age, sex, comorbidities), disease characteristics (histology, T stage), and flap characteristics (size of the flap, type of closure of ALT donor site) were collected. The outcome in terms of flap success rate, surgical, and donor site morbidity were studied. A total of 194 flaps were performed in 193 patients over a period of 10 years. Mean age of the patients was 55 years (range 16-80 years). Out of the 193 patients, 91 (47.1%) patients had oromandibular defects, 52 (26.9%) had tongue defects, 15 (7.7%) had pharyngeal defects, 17 (8.8%) had skull base defects, 4 (2%) had scalp defects, and 14 (7.2%) had contour defects of the neck. The overall flap success rate was 95.8% (8 total flap loss out of 194). Hypertrophic scar was the commonest donor site problem seen in 20 (10.3%) patients. This study shows the versatility of free ALT flap in head and neck reconstruction. It is a reliable and safe. Donor site morbidity is minimal. </p>

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2016

Journal Article

N. Bhavani, Asirvatham, A. Reena, Kallur, K., Menon, A. S., Pavithran, P. V., Nair, V., Vasukutty, J. R., Usha Menon, and Kumar, H., “Utility of Gallium-68 DOTANOC PET/CT in the localization of Tumour-induced osteomalacia.”, Clin Endocrinol (Oxf), vol. 84, no. 1, pp. 134-40, 2016.[Abstract]


<p><b>BACKGROUND: </b>Tumour-induced osteomalacia (TIO) is a rare disorder characterized by hypophosphataemic osteomalacia caused by small mesenchymal tumours secreting fibroblast growth factor 23 (FGF 23). The most difficult part in the management of these patients is the localization of tumours causing TIO.</p><p><b>OBJECTIVE: </b>We describe the utility of Gallium (Ga)-68 DOTANOC PET/CT in the localization of tumours causing TIO.</p><p><b>PATIENTS AND METHODS: </b>The study was conducted in a single tertiary referral university teaching hospital in India. Ten patients with TIO who underwent Ga-68 DOTANOC PET/CT from the time period 2009 to 2014 were included in this study. Their detailed clinical history, biochemical parameters, imaging modalities, surgical interventions, histopathology and outcomes were reviewed.</p><p><b>RESULTS: </b>Ga-68 DOTANOC PET/CT could correctly localize the tumours in TIO in 9 of the 10 cases in which it was performed. Complete resection of the tumour led to full clinical recovery in six of the ten patients; two patients who had partial resection and one patient who underwent radiofrequency ablation showed partial remission. One patient in whom Ga-68 DOTANOC PET/CT was positive in vertebral body with a low standardized uptake value (SUV) did not show up the tumour on surgery.</p><p><b>CONCLUSIONS: </b>We conclude that Ga-68 DOTANOC PET/CT can be used as the first imaging modality in patients diagnosed with TIO. The extremely good outcome following the resection of these small otherwise undiagnosed tumours far outweighs its cost even in resource limited settings.</p>

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2016

Journal Article

G. Divya, Rajitha Panonnummal, Swati P. Gupta, Dr. Jayakumar Rangasamy, and Sabitha, M., “Acitretin and Aloe-Emodin Loaded Chitin Nanogel for the Treatment of Psoriasis”, European Journal of Pharmaceutics and Biopharmaceutics, vol. 107, pp. 97-109, 2016.[Abstract]


The present study focuses on the development of an effective topical nanogel formulation of two anti-psoriatic drugs; Acitretin (Act) and Aloe-emodin (AE) using natural polymer chitin. Simple regeneration chemistry was used to prepare Chitin Nanogel Systems (CNGs). The developed control chitin (CNGs) nanogels, acitretin loaded chitin nanogels (ActCNGs) and aloe-emodin loaded chitin nanogels (AECNGs) were characterized by DLS, SEM, FTIR, XRD and TG-DTA. The systems were found to be spherical in shape with a size range of 98&nbsp;±&nbsp;10, 138&nbsp;±&nbsp;8 and 238&nbsp;±&nbsp;6&nbsp;nm having zeta potential values of +28&nbsp;±&nbsp;3, +27&nbsp;±&nbsp;3 and +25&nbsp;±&nbsp;6&nbsp;mV for CNGs, ActCNGs and AECNGs respectively. The in vitro haemolysis assay revealed that all the nanogel systems are blood compatible. The systems exhibited higher swelling and release at acidic pH. The ex vivo skin permeation studies using porcine skin confirmed the higher deposition of the systems at epidermal and dermal layers, which was confirmed further by fluorescent imaging. The in vivo anti-psoriatic activity study using Perry's mouse tail model and skin safety studies confirmed the potential benefit of the system for topical delivery of acitretin and aloe-emodin in psoriasis. © 2016 Elsevier B.V.

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2016

Journal Article

S. Nampoothiri, Fernández-Rebollo, E., Dhanya Yesodharan, Gardella, T. J., Rush, E. T., Langman, C. B., and Jüppner, H., “Jansen Metaphyseal Chondrodysplasia due to Heterozygous H223R-PTH1R Mutations With or Without Overt Hypercalcemia.”, J Clin Endocrinol Metab, vol. 101, no. 11, pp. 4283-4289, 2016.[Abstract]


<p><b>CONTEXT: </b>Jansen's metaphyseal chondrodysplasia (JMC) is a rare skeletal dysplasia characterized by abnormal endochondral bone formation and typically severe hypercalcemia despite normal/low levels of PTH. Five different heterozygous activating PTH/PTHrP receptor (PTH1R) mutations that change one of three different amino acid residues are known to cause JMC.</p><p><b>OBJECTIVES: </b>Establishing the diagnosis of JMC during infancy or early childhood can be challenging, especially in the absence of family history and/or overt hypercalcemia. We therefore sought to provide radiographic findings supporting this diagnosis early in life.</p><p><b>PATIENTS AND METHODS: </b>Three patients, a mother and her two sons, had radiographic evidence for JMC. However, obvious hypercalcemia and suppressed PTH levels were encountered only in both affected children. Sanger sequencing and endonuclease (SphI) digestion of PCR-amplified genomic DNA were performed to search for the H223R-PTH1R mutation.</p><p><b>RESULTS: </b>The heterozygous H223R mutation was identified in all three affected individuals. Surprisingly, however, the now 38-year-old mother was never overtly hypercalcemic and was therefore not diagnosed until her sons were found to be affected by JMC at the ages of 28 months and 40 days, respectively. The presented radiographic findings at different ages will help diagnose other infants/toddlers suspected of having JMC.</p><p><b>CONCLUSION: </b>The H223R mutation is typically associated with profound hypercalcemia despite low/normal PTH levels. However, the findings presented herein show that overt hypercalcemia is not always encountered in JMC, even if caused by this relatively frequent mutation, which is similar to observations with other PTH1R mutations that show less constitutive activity.</p>

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2016

Journal Article

S. Korula, Balakrishnan, S., Sundar, S., Paul, V., and Balagopal, A., “Acute kidney injury-incidence, prognostic factors, and outcome of patients in an Intensive Care Unit in a tertiary center: A prospective observational study.”, Indian J Crit Care Med, vol. 20, no. 6, pp. 332-6, 2016.[Abstract]


<p><b>BACKGROUND AND AIMS: </b>The information regarding the incidence of acute kidney injury (AKI) in medical Intensive Care Units (ICUs) in South India is limited. The aim of the study was to find the incidence, prognostic factors, and outcome of patients with AKI. We also assessed whether only urine output criteria of risk, injury, failure, loss, end (RIFLE) classification can be used to look at the outcome of AKI.</p><p><b>PATIENTS AND METHODS: </b>This was a prospective, cross-sectional study of 6 months duration in a 28 bedded medical ICU of a tertiary center. AKI was defined as an absolute creatinine value of>1.6 mg/dl or a 25% increase from baseline creatinine values.</p><p><b>RESULTS: </b>The incidence of AKI was 16.1%, and mortality was 7.8% in our study population. Among patients with AKI 87 (75.7%) patients had sepsis. 71.3% patients had metabolic acidosis on admission, and 47.8% patients were in shock. 57.4% of patient's required mechanical ventilation (MV). 39.1% of AKI patients required renal replacement therapy (RRT). Requirement of RRT was significantly affected by increasing age, Acute Physiology and Chronic Health Evaluation II and sequential organ failure assessment scores on admission, serum creatinine, and use of vasopressors. 49.5% of patients with AKI died within 28 days. Increasing age, MV, hemodialysis (HD), hypertension, chronic kidney disease, and requirement of noradrenaline support were associated with increasing 28 days mortality. The maximum RIFLE score with urine output criteria showed association to the requirement of HD in univariate analysis but did not show relation to mortality.</p><p><b>CONCLUSION: </b>The incidence of AKI was 16.1% in critically ill patients. In patients with AKI, 39.1% patients required HD and 28 days mortality was 49.5%. The study also showed good univariate association of urine output criteria of RIFLE classification to the requirement of HD in AKI patients.</p>

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2016

Journal Article

R. Prabhu, Renjitha Bhaskaran, Shenoy, V., G, R., and Sidharthan, N., “Clinical characteristics and treatment outcomes of primary autoimmune hemolytic anemia: a single center study from South India.”, Blood Res, vol. 51, no. 2, pp. 88-94, 2016.[Abstract]


<p><b>BACKGROUND: </b>Autoimmune hemolytic anemia (AIHA) is a less recognized, potentially fatal condition. There is a scarcity of data on clinicoserological characteristics and response to therapy concerning this disease from South India.</p><p><b>METHODS: </b>Data for 33 patients with primary AIHA recorded from July 2009 to June 2015 were retrospectively analyzed for clinical presentation, response to frontline therapy, durability of response, time to next treatment (TTNT), and response to second-line agents.</p><p><b>RESULTS: </b>The median follow-up period was 50 months. Among 33 patients, 48% of the cases were warm autoimmune hemolytic anemia (WAIHA), 46% were cold agglutinin disease (CAD), and 6% were atypical. Three-fourth of patients had severe anemia (<8 g/dL hemoglobin [Hb]) at onset; younger patients (age <40 yr) had more severe anemia. All of the patients who required treatment received oral prednisolone at 1.5 mg/kg/d as a frontline therapy, and the response rate was 90% (62% complete response [CR] and 28% partial response [PR]). The overall response to corticosteroids in WAIHA and CAD was 87% and 92%, respectively. The median corticosteroid duration was 14 months, and 50% of the patients required second-line agents. Fourteen patients received azathioprine as a second-line agent, and 11 of these patients responded well, with half of them not requiring a third agent. Four patients developed severe infections (pneumonia, sepsis, and soft tissue abscess) and two had life-threatening venous thrombosis. One case of death was recorded.</p><p><b>CONCLUSION: </b>AIHA is a heterogeneous disease that requires care by physicians experienced in treating these patients.</p>

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2016

Journal Article

G. C Nair, Babu, M. J. C., Pradeep Jacob, Riju R. Menon, and Mathew, J., “Is intraoperative parathyroid hormone monitoring necessary in symptomatic primary hyperparathyroidism with concordant imaging?”, Indian Journal of endocrinology and Metabolism, vol. 20, no. 4, pp. 512-516, 2016.[Abstract]


INTRODUCTION:
Symptomatic primary hyperparathyroidism (PHPT) is still seen frequently in referral centers all over India. These patients require parathyroidectomy and this study aimed to assess the roll of intraoperative parathyroid hormone (PTH) assay when concordant results of two localization studies were available.

STUDY DESIGN:
We analyzed the case records of patients who underwent parathyroidectomy for PHPT from January 2005 to June 2015.

RESULTS:
Of 143 patients included in the study, technetium 99m methoxyisobutylisonitrate dual phase scintigraphy showed true positive images in 93.7% and high definition ultrasonography in 84.6% of patients. Concordance in localization studies was observed in 121 (84.6%) patients, successful parathyroidectomy was done in 117 (96.7%) patients with concordant localization studies. Intraoperative PTH monitoring showed 97.84% sensitivity and 75% specificity and predicted failure in 2 patients with concordant imaging. However, re-exploration was not successful in these patients.

CONCLUSION:
When concordant result is available between parathyroid scintigraphy and anatomical imaging surgical cure rate is high in trained hands. Re-exploration is unlikely to be successful since these patients require higher imaging.

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2016

Journal Article

S. Boby Thomas, Balasubramaniam, D., Hiran, K. R., Dinesh, M., and Pavithran, K., “Esthesioneuroblastoma with intracranial extension: A non-surgical approach.”, Asian J Neurosurg, vol. 11, no. 3, p. 313, 2016.[Abstract]


<p>Esthesioneuroblastoma is a rare tumor arising from the olfactory mucosa of upper respiratory tract. The primary modality of treatment has been surgery with craniofacial resection followed by post-operative radiotherapy. There are only a few reported cases of non-surgical approaches. We report a case of esthesioneuroblastoma with intracranial extension treated with Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide, Etoposide protocol followed by radiation with 5 years of follow-up. This is the first reported case using this chemotherapy schedule. </p>

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2016

Journal Article

S. B. Patil, Roy, A. Grace, and Vinayan, K. Puthenveet, “Clinical profile and treatment outcome of febrile infection-related epilepsy syndrome in South Indian children.”, Ann Indian Acad Neurol, vol. 19, no. 2, pp. 188-94, 2016.[Abstract]


<p><b>PURPOSE: </b>To describe the clinical features and outcome of febrile infection-related epilepsy syndrome (FIRES), a catastrophic epileptic encephalopathy, in a cohort of South Indian children.</p><p><b>MATERIALS AND METHODS: </b>We performed a retrospective chart review of a cohort of children with previously normal development who presented with status epilepticus or encephalopathy with recurrent seizures following a nonspecific febrile illness during the period between January 2007 and January 2012. They were divided into two groups super refractory status epilepticus (SRSE) and refractory status epilepticus (RSE) depending on the duration and severity of the seizures.</p><p><b>KEY FINDINGS: </b>Fifteen children who met the inclusion criteria were included for the final analysis. The age of the children at presentation ranged 3-15 years (median 6.3 years). All the children presented with prolonged or recurrent seizures occurring 1-12 days (median 4 days) after the onset of fever. Eight children had SRSE while seven children had refractory seizures with encephalopathy. Cerebrospinal fluid (CSF) analysis was done in all the children in the acute phase, and the cell count ranged 0-12 cells/μL (median 2 cells/μL) with normal sugar and protein levels. Initial neuroimaging done in all children (MRI in 10 and CT in 5), and it was normal in 13 children. Treatment modalities included multiple antiepileptic drugs (AEDs) (4-9 drugs) (median 5 drugs). Midazolam (MDZ) infusion was administered in seven patients. Eight patients required barbiturate coma to suppress the seizure activity. The duration of the barbiturate coma ranged 2-90 days (median 3 days). Steroids were used in 14 children and intravenous immunoglobulin (2 g/kg) in 7 children. Three children died in the acute phase. All children were maintained on multiple AEDs till the last follow-up, the number of AEDs ranged 1-6 (median 5 AEDs). The patients with super refractory status in the acute phase were found to be more severely disabled at the follow-up; the median score of these patients on the Glasgow Outcome Scale (GOS) was 2 compared to 5 in the RSE group.</p><p><b>SIGNIFICANCE: </b>This study reports one of the largest single center cohorts from India, with an adverse long-term developmental and seizure outcome. The duration and severity of seizures in the acute period correlated directly with the short-term and long-term clinical outcomes. There is an urgent need for developing new effective therapeutic strategies to treat this acute catastrophic epileptic syndrome.</p>

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2016

Journal Article

M. Kumar, Thilak, J., Zahoor, A., and Jyothi, A., “Septic arthritis due to tubercular and Aspergillus co-infection.”, Indian J Orthop, vol. 50, no. 3, pp. 327-30, 2016.[Abstract]


<p>Aspergillus septic arthritis is a rare and serious medical and surgical problem. It occurs mainly in immunocompromised patients. Aspergillus fumigatus is the most common causative organism followed by Aspergillus flavus. The most common site affected is knee followed by shoulder, ankle, wrist, hip and sacroiliac joint. Debridement and voriconazole are primary treatment of articular aspergilosis. To the best of our knowledge, there are no reported cases of co-infection of tuberculosis (TB) and Aspergillus infecting joints. We report a case of co-infection of TB and A. flavus of hip and knee of a 60-year-old male, with type 2 diabetes mellitus. He was treated with debridement, intravenous voriconazole, and antitubercular drugs. </p>

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2016

Journal Article

L. Kumar, Rajan, S., and Baalachandran, R., “Outcomes associated with stroke volume variation versus central venous pressure guided fluid replacements during major abdominal surgery.”, J Anaesthesiol Clin Pharmacol, vol. 32, no. 2, pp. 182-6, 2016.[Abstract]


<p><b>BACKGROUND AND AIMS: </b>There is limited data on the impact of perioperative fluid therapy guided by dynamic preload variables like stroke volume variation (SVV) on outcomes after abdominal surgery. We studied the effect of SVV guided versus central venous pressure (CVP) guided perioperative fluid administration on outcomes after major abdominal surgery.</p><p><b>MATERIAL AND METHODS: </b>Sixty patients undergoing major abdominal surgeries were randomized into two equal groups in this prospective single blind randomized study. In the standard care group, the CVP was maintained at 10-12 mmHg while in the intervention group a SVV of 10% was achieved by the administration of fluids. The primary end-points were the length of Intensive Care Unit (ICU) and hospital stay. The secondary end points were intraoperative lactate, intravenous fluid use, requirement for inotropes, postoperative ventilation and return of bowel function.</p><p><b>RESULTS: </b>The ICU stay was significantly shorter in the intervention group as compared to the control group (2.9 ± 1.15 vs. 5.4 ± 2.71 days). The length of hospital stay was also shorter in the intervention group, (9.9 ± 2.68 vs. 11.96 ± 5.15 days) though not statistically significant. The use of intraoperative fluids was significantly lower in the intervention group than the control group (7721.5 ± 4138.9 vs. 9216.33 ± 2821.38 ml). Other secondary outcomes were comparable between the two groups.</p><p><b>CONCLUSION: </b>Implementation of fluid replacement guided by a dynamic preload variable (SVV) versus conventional static variables (CVP) is associated with lesser postoperative ICU stay and reduced fluid requirements in major abdominal surgery.</p>

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2016

Journal Article

L. Kumar, “Brain death and care of the organ donor.”, J Anaesthesiol Clin Pharmacol, vol. 32, no. 2, pp. 146-52, 2016.[Abstract]


<p>Brain death has specific implications for organ donation with the potential for saving several lives. Awareness on maintenance of the brain dead has increased over the last decade with the progress in the field of transplant. The diagnosis of brain death is clinical and can be confirmed by apnea testing. Ancillary tests can be considered when the apnea test cannot be completed or is inconclusive. Reflexes of spinal origin may be present and should not be confused against the diagnosis of brain death. Adequate care for the donor targeting hemodynamic indices and lung protective ventilator strategies can improve graft quality for donation. Hormone supplementation using thyroxine, antidiuretic hormone, corticosteroid and insulin has shown to improve outcomes following transplant. India still ranks low compared to the rest of the world in deceased donation. The formation of organ sharing networks supported by state governments has shown a substantial increase in the numbers of deceased donors primarily by creating awareness and ensuring protocols in caring for the donor. This review describes the steps in the establishment of brain death and the management of the organ donor. Material for the review was collected through a Medline search, and the search terms included were brain death and organ donation. </p>

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2016

Journal Article

M. Sathiyasekaran, Biradar, V., Ramaswamy, G., Srinivas, S., Ashish, B., Sumathi, B., Nirmala, D., and Geetha, M., “Pancreatitis in Children.”, Indian J Pediatr, vol. 83, no. 12-13, pp. 1459-1472, 2016.[Abstract]


<p>Pancreatic disease in children has a wide clinical spectrum and may present as Acute pancreatitis (AP), Acute recurrent pancreatitis (ARP), Chronic pancreatitis (CP) and Pancreatic disease without pancreatitis. This article highlights the etiopathogenesis and management of pancreatitis in children along with clinical data from five tertiary care hospitals in south India [Chennai (3), Cochin and Pune].</p>

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2016

Journal Article

M. Abraham Kuriakose, Ramdas, K., Dey, B., Iyer, S., Rajan, G., Elango, K. K., Suresh, A., Ravindran, D., Kumar, R. R., R, P., Ramachandran, S., Kumar, N. Asok, Thomas, G., Somanathan, T., Ravindran, H. K., Ranganathan, K., Katakam, S. Babu, Parashuram, S., Jayaprakash, V., and M Pillai, R., “A Randomized Double-Blind Placebo-Controlled Phase IIB Trial of Curcumin in Oral Leukoplakia.”, Cancer Prev Res (Phila), vol. 9, no. 8, pp. 683-91, 2016.[Abstract]


<p>Oral leukoplakia is a potentially malignant lesion of the oral cavity, for which no effective treatment is available. We investigated the effectiveness of curcumin, a potent inhibitor of NF-κB/COX-2, molecules perturbed in oral carcinogenesis, to treat leukoplakia. Subjects with oral leukoplakia (n = 223) were randomized (1:1 ratio) to receive orally, either 3.6 g/day of curcumin (n = 111) or placebo (n = 112), for 6 months. The primary endpoint was clinical response obtained by bi-dimensional measurement of leukoplakia size at recruitment and 6 months. Histologic response, combined clinical and histologic response, durability and effect of long-term therapy for an additional six months in partial responders, safety and compliance were the secondary endpoints. Clinical response was observed in 75 (67.5%) subjects [95% confidence interval (CI), 58.4-75.6] in the curcumin and 62 (55.3%; 95% CI, 46.1-64.2) in placebo arm (P = 0.03). This response was durable, with 16 of the 18 (88.9%; 95% CI, 67.2-96.9) subjects with complete response in curcumin and 7 of 8 subjects (87.5%) in placebo arm, demonstrating no relapse after 6 months follow-up. Difference in histologic response between curcumin and placebo was not significant (HR, 0.88, 95% CI, 0.45-1.71; P = 0.71). Combined clinical and histologic response assessment indicated a significantly better response with curcumin (HR, 0.50; 95% CI, 0.27-0.92; P = 0.02). Continued therapy, in subjects with partial response at 6 months, did not yield additional benefit. The treatment did not raise any safety concerns. Treatment of oral leukoplakia with curcumin (3.6 g for six months), thus was well tolerated and demonstrated significant and durable clinical response for 6 months. Cancer Prev Res; 9(8); 683-91. ©2016 AACR. </p>

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2016

Journal Article

P. D. Shenoy, Bavaliya, M., Sashidharan, S., Nalianda, K., and Sreenath, S., “Cyclophosphamide versus mycophenolate mofetil in scleroderma interstitial lung disease (SSc-ILD) as induction therapy: a single-centre, retrospective analysis.”, Arthritis Res Ther, vol. 18, no. 1, p. 123, 2016.[Abstract]


<p><b>BACKGROUND: </b>Scleroderma is a systemic autoimmune disease characterized mainly by skin manifestations and involvement of various visceral organs, especially the lungs. Lung involvement is the leading cause of mortality in patients with scleroderma. There are data to suggest that cyclophosphamide (CYC) and mycophenolate mofetil (MMF) are effective in the management of scleroderma interstitial lung disease (SSc-ILD) but no head to head comparative data are available to date.</p><p><b>METHODS: </b>For the last 3 years, patients with SSc-ILD have been treated at our centre by protocol-based administration of intravenous CYC and MMF. Results of lung function tests (spirometry) were recorded at baseline, 3 months and 6 months in every patient. The clinical records of patients with systemic sclerosis and significant ILD, who were not previously exposed to any immunosuppressant and were treated with MMF OR CYC, were reviewed. The efficacy of treatment was assessed by the change in forced vital capacity on spirometry.</p><p><b>RESULTS: </b>Of the total 57 patients included in the analysis, 34 were treated with MMF and 23 were treated with CYC. Mean duration of illness was 4.19 ± 2.82 years in the MMF and 6.04 ± 5.96 years in the CYC group. After 6 months of therapy, FVC increased by 10.84 ± 13.81 % in the CYC group and by 6.07 ± 11.92 % in the MMF group. This improvement from baseline was statistically significant in both groups (P < 0.01). The improvement was comparable with no statistically significant differences between groups (P = 0.373). There were no major adverse events reported in either arm.</p><p><b>CONCLUSION: </b>Both MMF and CYC were equally effective in stabilizing lung function in patients with scleroderma and ILD.</p>

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2016

Journal Article

A. Kumar, Prakash, A., Singh, A., Kumar, H., Hagen, F., Meis, J. F., and Chowdhary, A., “Candida haemulonii species complex: an emerging species in India and its genetic diversity assessed with multilocus sequence and amplified fragment-length polymorphism analyses.”, Emerg Microbes Infect, vol. 5, p. e49, 2016.

2016

Journal Article

A. Kalantre, Sunil, G. S., and Kumar, R. Krishna, “Pulmonary venous hypertension may allow delayed palliation of single ventricle physiology with pulmonary hypertension.”, Ann Pediatr Cardiol, vol. 9, no. 2, pp. 147-52, 2016.[Abstract]


<p>Pulmonary vascular disease develops early in untreated single ventricle patients with increased pulmonary flow. Pulmonary artery (PA) banding is done at a young age in these patients in order to protect the lung vasculature and maintain low pulmonary artery pressures (PAP) and pulmonary vascular resistance (PVR). This also enables future completion of the single ventricle palliation. Pulmonary venous hypertension (PVH) secondary to left sided obstruction if present in addition in this setting contributes to the pulmonary arterial hypertension (PAH) but involves an element of reversibility of the PAH if the obstruction is relieved. We present two cases of single ventricle both of who re-presented late with PAH and PVH (secondary to mitral valve obstruction) and underwent delayed PA banding at 9.5 and 4.5 years of age respectively. Both patients however had different outcomes. The patient undergoing PA banding at 9.5 years successfully underwent a cavo-pulmonary shunt at the age of 12 years. The patient with PA banding at 4.5 years however, has residual PAH that presently precludes a cavo-pulmonary shunt. </p>

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2016

Journal Article

A. Chauhan and Sharma, M. Mathur, “Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery.”, Med J Armed Forces India, vol. 72, no. 1, pp. 12-8, 2016.[Abstract]


<p><b>BACKGROUND: </b>The aim of this study was to determine whether oncoplastic breast surgery (OBS) ensures better tumour resection than conventional breast conservation surgery (BCS).</p><p><b>METHODS: </b>A prospective comparative study, conducted over a 3-year period, enrolled patients with early breast cancer who underwent OBS. The total volume of glandular resection, tumour volume resection and width of the margins obtained were noted. The incidence of complications, requirement of revision surgery and locoregional recurrence during follow-up period were also noted. The data were compared with matched controls who had undergone convention BCS in the past.</p><p><b>RESULTS: </b>Thirty-three patients underwent oncoplastic surgery and the data was compared with 46 patients of conventional breast conservation. The mean volume of specimen was higher in the oncoplastic group (173.5 cm(3) vs 101.4 cm(3), p = 0.03) though the tumour volume excised was similar (43.2 cm(3) vs 36.4 cm(3), p = 0.14). The mean margin widths were larger in the oncoplastic group (14 mm vs 6 mm, p = 0.01). There were more instances of close and positive margins seen in conventional BCS groups. The incidence of complication rate was similar. Median follow-up 18 months for oncoplasty group showed no cases of locoregional recurrence while in median follow-up of 38 months for conventional BCS group, six cases of locoregional relapse were noted.</p><p><b>CONCLUSIONS: </b>Oncoplastic surgery results in excision of larger volume of breast tissue and correspondingly obtain wider surgical margins as compared to conventional BCS. Longer follow-up is required to determine if wider resection translates into better locoregional control.</p>

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2016

Journal Article

S. L. Staveski, Parveen, V. P., Madathil, S. B., Kools, S., and Franck, L. S., “Parent education discharge instruction program for care of children at home after cardiac surgery in Southern India.”, Cardiol Young, vol. 26, no. 6, pp. 1213-20, 2016.[Abstract]


<p><b>UNLABELLED: </b>Introduction In many developing countries, children with CHD are now receiving surgical repair or palliation for their complex medical condition. Consequently, parents require more in-depth discharge education programmes to enable them to recognise complications and manage their children's care after hospital discharge. This investigation evaluated the effectiveness of a structured nurse-led parent discharge teaching programme on nurse, parent, and child outcomes in India. Materials and methods A quasi-experimental investigation compared nurse and parent home care knowledge before and at two time points after the parent education discharge instruction program's implementation. Child surgical-site infections and hospital costs were compared for 6 months before and after the discharge programme's implementation.</p><p><b>RESULTS: </b>Both nurses (n=63) and parents (n=68) participated in this study. Records of 195 children who had undergone cardiac surgery were reviewed. Nurses had a high-level baseline home care knowledge that increased immediately after the discharge programme's implementation (T1=24.4±2.89; T2=27.4±1.55; p0.05) after the programme's implementation.</p><p><b>CONCLUSION: </b>Nurse, parent, and child outcomes were improved after implementation of the structured nurse-led parent discharge programme for parents in India. Structured nurse-led parent discharge programmes may help prepare parents to provide better home care for their children after cardiac surgery. Further investigation of causality and influencing factors is warranted.</p>

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2016

Journal Article

Y. Singh Sudan, Vinayan, K. P., Roy, A. Grace, Wagh, A., Kannoth, S., and Patil, S., “Clinical Characteristics and Follow-up of South Indian Children with Autoimmune Encephalopathy.”, Indian J Pediatr, vol. 83, no. 12-13, pp. 1367-1373, 2016.[Abstract]


<p><b>OBJECTIVE: </b>To describe the clinical characteristics of a cohort of south Indian children with probable autoimmune encephalopathy from a tertiary care academic hospital and to compare this data with the existing literature.</p><p><b>METHODS: </b>Patients with encephalopathy plus one or more of neuropsychiatric symptoms, seizures, movement disorder or cognitive dysfunction were identified. Common infectious causes were excluded. Clinical characteristics, investigations, management and outcome were analyzed.</p><p><b>RESULTS: </b>Thirteen patients were included in the study; 12 were females (92.3 %) and mean age was 9.6 y. Most common presentation was behavior change (13 patients) followed by seizures (11 patients). Three patients showed lymphocytic pleocytosis in CSF and one patient had oligoclonal bands. Initial MRI was normal in all patients except in one. Most common EEG abnormality was mild background slowing. Only one child had ovarian tumor. S.NMDA receptor antibody was positive in 10 patients (83 %), and all of them received immunotherapy. Six out of 13 children were followed up for more than 1 y (mean - 21 mo). Recurrence was noted in 4 out of 6 patients (66 %). On last follow-up, good recovery was seen in 2 children (33 %), moderate disability in 3 (50 %) and severe disability in 1 (16 %).</p><p><b>CONCLUSIONS: </b>The clinical characteristics and outcome of one of the largest single center cohort of Indian children with autoimmune encephalopathy is reported. Autoimmune encephalopathy should be considered as a differential diagnosis in the acute and subacute encephalopathies of childhood and treating pediatrician should be aware of this entity.</p>

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2016

Journal Article

R. Chandrasekharan, Pullara, S. K., Thomas, T., Kader, N. Puthukudiy, and Moorthy, S., “Congenital intrahepatic portosystemic shunts: Imaging findings and endovascular management.”, Indian J Radiol Imaging, vol. 26, no. 1, pp. 92-4, 2016.[Abstract]


<p>We present two cases of congenital intrahepatic portosystemic shunts in which the right portal vein directly communicated with the inferior venacava (IVC) in one patient and with the hepatic vein in the other. Multiple hepatic nodules consistent with focal nodular hyperplasia (FNH) were seen in the first patient. The second patient presented with recurrent history of hepatic encephalopathy. Percutaneous transhepatic embolization was performed using coils and Amplatz device following which she completely recovered. </p>

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2016

Journal Article

L. Devi Padmanabhan and Nampoothiri, S., “Prenatal detection of congenital high airway obstruction syndrome with encephalocele.”, Indian J Radiol Imaging, vol. 26, no. 1, pp. 70-2, 2016.[Abstract]


<p>Congenital high airway obstruction syndrome (CHAOS) causes secondary morphological changes which can be detected on ultrasound. Here we report a case of congenital high airway obstruction with an occipital encephalocele detected at 23 weeks of gestation. </p>

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2016

Journal Article

L. Devi Padmanabhan, Hamza, Z. V., Thampi, M. Venugopala, and Nampoothiri, S., “Prenatal diagnosis of amniotic band syndrome.”, Indian J Radiol Imaging, vol. 26, no. 1, pp. 63-6, 2016.[Abstract]


<p>Amniotic band can cause a broad spectrum of anomalies ranging from simple band constrictions to major craniofacial and visceral defects. It can cause significant neonatal morbidity. Accurate diagnosis will help in the management of the present pregnancy and in counseling with regard to future pregnancies. Here we report three cases of amniotic band syndrome detected in the prenatal period. </p>

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2016

Journal Article

S. Khan and Kumar, A., “Microbial identification systems: Making us tilt at windmills?”, Indian J Med Microbiol, vol. 34, no. 2, pp. 260-1, 2016.

2016

Journal Article

S. Mohan, Nampoothiri, S., Dhanya Yesodharan, Venkatesan, V., Koshy, T., Paul, S. F. D., and Perumal, V., “Reciprocal Microduplication of the Williams-Beuren Syndrome Chromosome Region in a 9-Year-Old Omani Boy.”, Lab Med, vol. 47, no. 2, pp. 171-5, 2016.[Abstract]


<p><b>BACKGROUND: </b>Microdeletions of the 7q11.23 Williams-Beuren syndrome chromosome region (WBSCR) are reported with a frequency of 1 in 10,000, whereas microduplications of the region, although expected to occur at the same frequency, are not widely reported.</p><p><b>METHOD: </b>We evaluated a 9-year old Omani boy for idiopathic intellectual disability using genetic methods, including multiplex ligation-dependent probe amplification (MLPA), for detection of microdeletions (P064-B3).</p><p><b>RESULTS: </b>MLPA analysis revealed that the boy has a rare microduplication of the WBSCR. Prominent clinical features include global developmental delay with pronounced speech delay, dysmorphic facies, and autistic features.</p><p><b>CONCLUSION: </b>Microduplications, in general, are reported at a lesser frequency, perhaps owing to their milder phenotype. Complete genetic assessment in children with idiopathic intellectual disability would help in identifying rare conditions such as duplication of the WBSCR.</p>

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2016

Journal Article

G. Anjaneyan, Jagadeesan, S., and Thomas, J., “Cytodiagnostic copper pennies in chromoblastomycosis.”, Indian Dermatol Online J, vol. 7, no. 2, pp. 145-6, 2016.

2016

Journal Article

K. George, Abdulkader, J. Kulapurath, Sugumar, M., and Rajagopal, G. Kalarikkal, “Prevalence of MRSA Nasal Carriage in Patients Admitted to a Tertiary Care Hospital in Southern India.”, J Clin Diagn Res, vol. 10, no. 2, pp. DC11-3, 2016.[Abstract]


<p><b>INTRODUCTION: </b>Infections with MRSA, both community and hospital acquired, are well established and the source of infection is often a carrier. There are very few studies showing the magnitude of MRSA nasal colonization among healthy persons from the community. This study was conducted to detect the prevalence of MRSA nasal carriage in patients who did not have any known risk factors associated with HA- MRSA colonization, admitted to a tertiary care centre in Kerala.</p><p><b>MATERIALS AND METHODS: </b>Nasal swabs were collected from patients within 24 hours of admission. Specimen were inoculated on chromogenic agar (HiCrome MeReSa agar-HiMedia) for MRSA screening. Isolates were then subjected to antibiotic sensitivity tests, SCCmec typing and PVL gene detection.</p><p><b>RESULTS: </b>Out of 683 patients, 16 carried MRSA in their nares (2.3%). Of the 16 strains 13 (81.25 %) strain were SCCmec type III and one belonged to SCCmec type IV (6.25 %). Two strains failed to amplify SCCmec genes. Three strains carried genes for PVL toxin (18.75%).</p><p><b>CONCLUSION: </b>With a better understanding of the complex epidemiology of MRSA it is increasingly apparent that demarcations between the HA and CA phenotypes are not as clear cut as previously thought. In this study of nasal carriage of MRSA in the community we have demonstrated prevalence consistent with published data. Most isolates however were shown to belong to the type conventionally assigned to HA-MRSA.</p>

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2016

Journal Article

N. Singhal, Praveen, V. P., Bhavani, N., Menon, A. S., Usha Menon, Abraham, N., Kumar, H., JayKumar, R. V., Nair, V., Sundaram, S., and Sundaram, P., “Technetium uptake predicts remission and relapse in Grave's disease patients on antithyroid drugs for at least 1 year in South Indian subjects.”, Indian J Endocrinol Metab, vol. 20, no. 2, pp. 157-61, 2016.[Abstract]


<p><b>CONTEXT: </b>Most of the information on remission related factors in Grave's disease are derived from Western literature. It is likely that there may be additional prognostic factors and differences in the postdrug treatment course of Grave's disease in India.</p><p><b>AIM: </b>To study factors which predict remission/relapse in Grave's disease patients from South India. Also to establish if technetium (Tc) uptake has a role in predicting remission.</p><p><b>SUBJECTS AND METHODS: </b>Records of 174 patients with clinical, biochemical, and scintigraphic criteria consistent with Grave's disease, seen in our Institution between January 2006 and 2014 were analyzed. Patient factors, drug-related factors, Tc-99m uptake and other clinical factors were compared between the remission and nonremission groups.</p><p><b>STATISTICAL ANALYSIS USED: </b>Mann-Whitney U-test and Chi-square tests were used when appropriate to compare the groups.</p><p><b>RESULTS: </b>Fifty-seven (32.7%) patients attained remission after at least 1 year of thionamide therapy. Of these, 11 (19.2%) patients relapsed within 1 year. Age, gender, goiter, and presence of extrathyroidal manifestations were not associated with remission. Higher values of Tc uptake were positively associated with remission (P- 0.02). Time to achievement of normal thyroid function and composite dose: Time scores were significantly associated with remission (P - 0.05 and P - 0.01, respectively). Patients with lower FT4 at presentation had a higher chance of remission (P - 0.01). The relapse rates were lower than previously reported in the literature. A higher Tc uptake was found to be significantly associated with relapse also (P - 0.009).</p><p><b>CONCLUSION: </b>The prognostic factors associated with remission in Graves's disease in this South Indian study are not the same as that reported in Western literature. Tc scintigraphy may have an additional role in identifying people who are likely to undergo remission and thus predict the outcome of Grave's disease.</p>

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2016

Journal Article

A. Putoux, Alqahtani, A., Pinson, L., Paulussen, A. D. C., Michel, J., Besson, A., Mazoyer, S., Borg, I., Nampoothiri, S., Vasiljevic, A., Uwineza, A., Boggio, D., Champion, F., de Die-Smulders, C. E., Gardeitchik, T., van Putten, W. K., Perez, M. J., Musizzano, Y., Razavi, F., Drunat, S., Verloes, A., Hennekam, R., Guibaud, L., Alix, E., Sanlaville, D., Lesca, G., and Edery, P., “Refining the phenotypical and mutational spectrum of Taybi-Linder syndrome.”, Clin Genet, vol. 90, no. 6, pp. 550-555, 2016.[Abstract]


<p>Taybi-Linder syndrome (TALS, OMIM 210710) is a rare autosomal recessive disorder belonging to the group of microcephalic osteodysplastic primordial dwarfisms (MOPD). This syndrome is characterized by short stature, skeletal anomalies, severe microcephaly with brain malformations and facial dysmorphism, and is caused by mutations in RNU4ATAC. RNU4ATAC is transcribed into a non-coding small nuclear RNA which is a critical component of the minor spliceosome. We report here four foetuses and four unrelated patients with RNU4ATAC mutations. We provide antenatal descriptions of this rare syndrome including unusual features found in two twin foetuses with compound heterozygosity for two rare mutations who presented with mild intrauterine growth retardation and atypical dysmorphic facial features. We also carried out a literature review of the patients described up to now with RNU4ATAC mutations, affected either with TALS or Roifman syndrome, a recently described allelic disorder.</p>

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2016

Journal Article

M. Pandey, Vidhyadharan, S., Puthalath, U., Veeraraghavan, R., Sukumaran, S. V., Prasad, C., Iyer, S., and Thankappan, K., “Macroscopic technique for the evaluation of oral tongue tumour thickness: a reliable intraoperative method.”, Int J Oral Maxillofac Surg, vol. 45, no. 8, pp. 933-7, 2016.[Abstract]


<p>There is no reliable method to assess tumour thickness preoperatively or intraoperatively in cases of oral tongue squamous cell carcinoma (SCC). The purpose of this study was to evaluate the efficacy of a macroscopic technique to measure tumour thickness. This was a prospective study of 51 consecutive patients with T1/T2 primary SCC of the oral tongue. All patients underwent primary resection with ipsilateral neck dissection. Thickness measurements were obtained using Vernier calipers on the fresh specimen. The technique was correlated with the microscopic evaluation statistically using (1) Pearson's correlation coefficient, (2) intra-class correlation, and (3) Bland-Altman plot with 95% confidence intervals. On comparing the macroscopic technique to the microscopic evaluation, Pearson's correlation (r) was 0.915 (P<0.001). The inter-rater reliability using the intra-class correlation coefficient was 0.955. The Bland-Altman plot to test the agreement between the techniques showed the average difference between macroscopic thickness and microscopic thickness (bias) to be -0.421, with 95% limits of agreement of -3.166 and 2.82. There was a significant correlation and agreement between the macroscopic and microscopic measures of tumour thickness. The macroscopic technique could be used as a reliable tool to measure tumour thickness intraoperatively, prior to neck dissection. </p>

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2016

Journal Article

S. Viswanathan, Singhi, A. K., and Kumar, R. Krishna, “Pediatric cardiac sciences 2015: A summary of significant publications.”, Ann Pediatr Cardiol, vol. 9, no. 1, pp. 96-107, 2016.

2016

Journal Article

R. Aghoram, Srijithesh, P. R., and Kannoth, S., “Adult-onset Satoyoshi syndrome and response to plasmapheresis.”, Ann Indian Acad Neurol, vol. 19, no. 1, pp. 131-3, 2016.[Abstract]


<p>Satoyoshi syndrome is a rare disease characterized by alopecia, recurrent muscle spasms, diarrhea, and skeletal abnormalities Adult-onset disease is reported only in five patients. Most of the reports have not characterized the nature of muscle spasm in the disease. In this paper, we report the first case of adult-onset Satoyoshi syndrome from India and the clinical and electrophysiological response to plasmapheresis. </p>

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2016

Journal Article

A. V Kumar, “Comments on "Impact of bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit".”, J Crit Care, vol. 33, p. 274, 2016.

2016

Journal Article

F. Moreau, Yang, R., Nambiar, V., Demchuk, A. M., and Dunn, J. F., “Near-infrared measurements of brain oxygenation in stroke.”, Neurophotonics, vol. 3, no. 3, p. 031403, 2016.[Abstract]


<p>We investigated the feasibility of using frequency-domain near-infrared spectroscopy (fdNIRS) to study brain oxygenation in the first few hours of stroke onset. The OxiplexTS(®) fdNIRS system was used in this study. Using a standard probing protocol based on surface landmarks, we measured brain tHb and [Formula: see text] in healthy volunteers, cadavers, and acute stroke patients within 9 h of stroke onset and 3 days later. We obtained measurements from 11 controls, 5 cadavers, and 5 acute stroke patients. [Formula: see text] values were significantly lower in cadavers compared to the controls and stroke patients. Each stroke patient had at least one area with reduced [Formula: see text] on the stroke side compared to the contralateral side. The evolution of tHb and [Formula: see text] at 3 days differed depending on whether a large infarct occurred. This study shows the proof of principle that quantified measurements of brain oxygenation using NIRS could be used in the hectic environment of acute stroke management. It also highlights the current technical limitations and future challenges in the development of this unique bedside monitoring tool for stroke. </p>

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2016

Journal Article

R. Yadav, Jaswal, A., Chennapragada, S., Kamath, P., Hiremath, S. M. S., Kahali, D., Anand, S., Sood, N. K., Mishra, A., Makkar, J. S., and Kaul, U., “Effectiveness of Ventricular Intrinsic Preference (VIP™) and Ventricular AutoCapture (VAC) algorithms in pacemaker patients: Results of the validate study.”, J Arrhythm, vol. 32, no. 1, pp. 29-35, 2016.[Abstract]


<p><b>BACKGROUND: </b>Several past clinical studies have demonstrated that frequent and unnecessary right ventricular pacing in patients with sick sinus syndrome and compromised atrio-ventricular conduction (AVC) produces long-term adverse effects. The safety and efficacy of two pacemaker algorithms, Ventricular Intrinsic Preference™ (VIP) and Ventricular AutoCapture (VAC), were evaluated in a multi-center study in pacemaker patients.</p><p><b>METHODS: </b>We evaluated 80 patients across 10 centers in India. Patients were enrolled within 15 days of dual chamber pacemaker (DDDR) implantation, and within 45 days thereafter were classified to either a compromised AVC (cAVC) arm or an intact AVC (iAVC) arm based on intrinsic paced/sensed (AV/PV) delays. In each arm, patients were then randomized (1:1) into the following groups: VIP OFF and VAC OFF (Control group; CG), or VIP ON and VAC ON (Treatment Group; TG). Subsequently, the AV/PV delays in the CG groups were mandatorily programmed at 180/150 ms, and to up to 350 ms in the TG groups. The percentage of right ventricular pacing (%RVp) evaluated at 12-month post-implantation follow-ups were compared between the two groups in each arm. Additionally, in-clinic time required for collecting device data was compared between patients programmed with the automated AutoCapture algorithm activated (VAC ON) vs. the manually programmed method (VAC OFF).</p><p><b>RESULTS: </b>Patients randomized to the TG with the VIP algorithm activated exhibited a significantly lower %RVp at 12 months than those in the CG in both the cAVC arm (39±41% vs. 97±3%; p=0.0004) and the iAVC arm (15±25% vs. 68±39%; p=0.0067). In-clinic time required to collect device data was less in patients with the VAC algorithm activated. No device-related adverse events were reported during the year-long study period.</p><p><b>CONCLUSIONS: </b>In our study cohort, the use of the VIP algorithm significantly reduced the %RVp, while the VAC algorithm reduced in-clinic time needed to collect device data.</p>

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2016

Journal Article

L. Bonafé, Kariminejad, A., Li, J., Royer-Bertrand, B., Garcia, V., Mahdavi, S., Bozorgmehr, B., Lachman, R. L., Mittaz-Crettol, L., Campos-Xavier, B., Nampoothiri, S., Unger, S., Rivolta, C., Levade, T., and Superti-Furga, A., “Brief Report: Peripheral Osteolysis in Adults Linked to ASAH1 (Acid Ceramidase) Mutations: A New Presentation of Farber's Disease.”, Arthritis Rheumatol, vol. 68, no. 9, pp. 2323-7, 2016.[Abstract]


<p><b>OBJECTIVE: </b>To establish a diagnosis and provide counseling and treatment for 3 adult patients from one family presenting with peripheral osteolysis.</p><p><b>METHODS: </b>Following clinical and radiographic assessment, exome sequencing, targeted gene resequencing, and determination of enzyme activity in cultured fibroblasts were performed.</p><p><b>RESULTS: </b>The proband (age 40 years) had a history of episodic fever and pain in childhood that subsided around puberty. He and 2 of his older sisters (ages 58 and 60 years, respectively) showed adult-onset progressive shortening of fingers and toes with redundancy of the overlying skin. Radiographs showed severe osteolysis of the distal radius and ulna, carpal bones, metacarpal bones, and phalanges. Sequencing of the known genes for recessively inherited osteolysis, MMP2 and MMP14, failed to show pathogenic mutations. Exome sequencing revealed compound heterozygosity for mutations c.505T>C (p.Trp169Arg) and c.760A>G (p.Arg254Gly) in ASAH1, the gene coding for acid ceramidase. Sanger sequencing confirmed correct segregation in the family, and enzyme activity in fibroblast cultures from the patients was reduced to ∼8% of that in controls, confirming a diagnosis of Farber's disease.</p><p><b>CONCLUSION: </b>Our findings indicate that hypomorphic mutations in ASAH1 may result in an osteoarticular phenotype with a juvenile phase resembling rheumatoid arthritis that evolves to osteolysis as the final stage in the absence of neurologic signs. This observation delineates a novel type of recessively inherited peripheral osteolysis and illustrates the long-term skeletal manifestations of acid ceramidase deficiency (Farber's disease) in what appear to be the oldest affected individuals known so far.</p>

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2016

Journal Article

S. Kannoth, Anandakkuttan, A., Mathai, A., Sasikumar, A. Nirmala, and Nambiar, V., “Autoimmune atypical parkinsonism - A group of treatable parkinsonism.”, J Neurol Sci, vol. 362, pp. 40-6, 2016.[Abstract]


<p><b>BACKGROUND: </b>Immunological causes of atypical parkinsonism/Parkinson plus syndromes are rare.</p><p><b>OBJECTIVE: </b>To study the clinical and laboratory features and treatment outcome of autoimmune atypical parkinsonism.</p><p><b>METHODS: </b>Retrospective case series. Patients with atypical parkinsonism and positive antibodies were identified retrospectively. Those who received immunotherapy (intravenous methyl prednisolone 1g daily for five days followed by mycophenylate mofetil 2g daily or azathioprine 2-3mg/kg/day) and consented for publication of non-anonymized videos were included.</p><p><b>RESULTS: </b>There were ten cases (nine males, age range 49-75years, disease duration 2months to 13years, follow-up 1-7months) of atypical parkinsonism [probable multiple system atrophy (MSA)-2, possible progressive supranuclear palsy (PSP)-1, probable PSP-3]. Eight had new uncharacterized neuronal antibodies, leucine rich glioma associated protein 1 (LGI1) antibody in one, and the other had another uncharacterized neuronal antibody along with LGI1 antibody. Four had abnormal CSF. There was a prompt, dramatic improvement in terms of Unified Parkinson Disease Rating Scale motor scale and or modified Rankin Scale as well as improvement in eye movement, postural instability, cerebellar, autonomic and non-motor symptoms. Two had reappearance of symptoms on discontinuing steroids and improvement on restarting. One died of infection despite good recovery of encephalopathy and parkinsonism.</p><p><b>CONCLUSION: </b>Autoimmune atypical parkinsonism is characterized by atypical parkinsonism with neuronal specific antibodies, sometimes associated with abnormal CSF and significant response to immunotherapy.</p>

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2016

Journal Article

S. J. Gandhi, Satish, C., Sundaram, P. Shanmuga, Subramanyam, P., and Vijaykumar, D. K., “Feasibility study of axillary reverse mapping lymphoscintigraphy in carcinoma breast: A concept toward preventing lymphedema.”, Indian J Nucl Med, vol. 31, no. 1, pp. 9-13, 2016.[Abstract]


<p><b>OBJECTIVE: </b>In the surgery of breast cancer, axillary reverse mapping (ARM) is the identification and preservation of arm draining lymph node (ARM node) during an axillary dissection. The assumption is that the ARM node is different from node draining breast and is unlikely to be involved even in the patients with axillary nodal metastases. If we can identify and preserve ARM node using lymphoscintigraphy; morbidity of lymphedema, as seen with axillary dissection, may be avoided.</p><p><b>MATERIALS AND METHODS: </b>Pathologically proven 50 breast cancer patients undergoing initial surgery (cTx-4, cN0-2, and Mx-0) were included in this study. Less than 37 MBq, 0.5 ml in equally divided doses of filtered 99mTc sulfur colloid was injected intradermally into the second and third web spaces. ARM nodes in the axilla were identified with the help of Gamma Probe intraoperatively; however, their location was noted with the reference to specific anatomical landmarks and sent for histopathological examination after excision.</p><p><b>RESULTS: </b>The ARM node was successfully identified in 47/50 cases (sensitivity - 94%). In 40 out of 47 cases (85%), the location of the ARM node was found to lateral to the subscapular pedicle, above the second intercostobrachial nerve and just below the axillary vein. Of the 47 patients in whom ARM node/s were identified, metastasis was noted in 5 of them (10%). Four out of these 5 patients had the pN3 disease.</p><p><b>CONCLUSION: </b>ARM node exists, and it is feasible to identify ARM node using radio isotope technique with an excellent sensitivity. ARM node seems to have a fairly constant location in more than 80% cases. It is involved with metastasis (10% cases) only when there are multiple lymph nodal metastases in the axilla.</p>

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2016

Journal Article

P. Georgeena, Rajanbabu, A., Vijaykumar, D. K., Pavithran, K., Sundaram, K. R., Deepak, K. S., and Sanal, M. R., “Surgical treatment pattern and outcomes in epithelial ovarian cancer patients from a cancer institute in Kerala, India.”, Ecancermedicalscience, vol. 10, p. 619, 2016.[Abstract]


<p><b>OBJECTIVE: </b>To evaluate the treatment and survival pattern of patients with advanced epithelial ovarian cancer.</p><p><b>METHODS AND RESULTS: </b>Retrospective study of all advanced epithelial ovarian cancer patients treated in the department of gynaecologic oncology from an academic centre, in a four year period from 1 January 2008-31 December 2011.</p><p><b>SELECTION CRITERIA: </b>All patients with advanced epithelial ovarian cancer (stage III and IV) who underwent surgery from 2008-2011and had a follow-up of at least three months after completion of treatment were included. The decision on whether primary surgery or neoadjuvant chemotherapy (NACT) in advanced ovarian cancer was based on age, performance status, clinical and imaging findings.</p><p><b>RESULTS: </b>A total of 178 cases of epithelial ovarian cancer were operated on during this four year period. Among them 28 patients were recurrent cases, 22 had early stages of ovarian cancer, and the rest 128 had st