CHRISTIAN MEDICAL COLLEGE, VELLORE
VOLUME 1 ISSUE 15 (JULY 2014 - DECEMBER 2014)
Research Digest
Editor’s Message:
Dear Friends,
The Annual Research Digest for the term Jul - Dec 2014 a compilation of the Indexed publications of the institution is provided herewith. Though this is mean to include all publications that were generated by our scientists students and faculty during this time period-there are certainly likely to be lacunae. Do browse through the document and let us know if there are more of your publications which need to be added. We would like to thank Dodd Memorial Library, the staff at the research office and Dr. Sandip for assistant in compiling the current issue.
Dr. Nihal Thomas MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin) FRCP (Glasg) Addl. Vice-Principal (Research)
Research Digest
Contents
Basic Sciences
Clinical Observational
Epidemiology
Miscellaneous
Special request to CMC Faculty
Please use the online submission facility on the Dodd Library Website to submit details of all your indexed and non indexed publications. Please also send pdf or word files of your publications to [email protected] so that we can have copies of all publications.
Nihal Thomas MBBS MD MNAMS DNB (Endo) FRACP (Endo) FRCP (Edin) FRCP (Glasg) ADDL. VICE - PRINCIPAL (RESEARCH)
Research Digest
Research Digest Christian Medical College, Vellore
Anandan, S., Peter, R., Aramugam, R., Babji, S., Arumugam, R., Ismail, N., Veeraraghavan, B. and Kang, Sarvanabhavan, A., Gentsch, J. R. and G. Kang, G. Group A rotavirus gastroenteritis in older Approach to molecular characterization children and adults at a hospital in of partially and completely untyped southern India samples in an Indian rotavirus Vaccine; 2014, 32 Suppl 1 A33-5 surveillance program Vaccine; 2014, 32 Suppl 1 A84-8 Address: Department of Clinical Microbiology, Christian Medical College, Address: Division of Gastrointestinal Vellore, India. Electronic Address: Sciences, Christian Medical College, [email protected] Vellore, India. Electronic Address: Division of Gastrointestinal Sciences, [email protected]. Christian Medical College, Vellore, India. Division of Gastrointestinal Sciences, Department of Clinical Microbiology, Christian Medical College, Vellore, India. Christian Medical College, Vellore, India. Centers for Disease Control and Prevention, 1600 Clifton Road NE, There is limited data on the spectrum Atlanta, GA 30333, USA. and prevalence of rotavirus genotypes in older children and adults in Asia. This Surveillance networks for rotavirus pilot study conducted between document the burden of the disease November 2012 and April 2013 tested using the proportion of children for rotavirus in older children (>12 years hospitalized with gastroenteritis positive of age), and adults with gastroenteritis from southern India. Stool samples from for rotavirus by enzyme immunoassay. patients who were hospitalized or They also describe genotypes of attended out-patient units with diarrhea circulating viruses by polymerase chain were screened for rotavirus using reaction for the VP7 and VP4 genes, Premier Rotaclone((R)). Confirmatory which determine G and P types, testing was by another antigen detection respectively. A proportion of samples sandwich, in-house ELISA, based on cannot be genotyped based on initial capture by a polyclonal serum and VP6 PCR. Genotyping for VP7 and VP4 was testing and laboratories need to assess done using hemi-nested PCRs for G- and further testing strategies based on P-types circulating in India. A total of resources and feasibility. To 365 626 stool samples from older children samples obtained from an Indian and adults were screened and 52 (8.4%) rotavirus strain surveillance program, we were initially positive for rotavirus by applied an approach to determine the G antigen detection. A high proportion of and P types in antigen positive samples samples (27/51) were found to be false positives on confirmatory testing. Of the that failed to type initially with the 23 samples for which genotyping results standard laboratory protocol. Fifty-eight were obtained, G1P[8] was the most samples (19%) were negative for the common genotype. There was one each VP6 gene, indicating that the antigen of G1P[6], G1P[4] and two strains of test was likely to have been false G9P[4] while one sample showed mixed positive. Alternative extraction and genotypes of G2 and G9P[4]. This study priming approaches resulted in the shows that group A rotavirus is found in 3.8% of diarrheal specimens in older identification of G and P types for 264 children and adults with gastroenteritis strains. The identity of one strain was in southern India and that common determined by sequencing the first- genotypes circulate in children and round amplicons. Thirty-five strains were adults. partially typed and seven strains could INTL not be typed at all. The distribution of G PMID: 25091677 PMCID: and P types among strains that had BS initially failed to type, except one strain,
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Research Digest Christian Medical College, Vellore
did not differ from that in strains that 1.25, 95% CI 1.005-1.561) and C allele were typed using the standard of rs 13361189 (OR 1.33, 95% CI 1.07- laboratory protocol. 1.669). Two SNPs--rs11747270 and INTL rs180802994--did not exhibit Hardy- PMID: 25091686 PMCID: Weinberg equilibrium but were BS associated with both Crohn's disease and ulcerative colitis in this population. Baskaran, K., Pugazhendhi, S. and The remaining SNPs did not show Ramakrishna, B. S. significant associations with either Association of IRGM gene mutations with inflammatory bowel disease in the Crohn's disease or ulcerative colitis. Indian population CONCLUSIONS: Association of IRGM PLoS ONE; 2014, 9 (9): e106863 gene SNPs with Crohn's disease is reported for the first time in Indian Address:Wellcome Trust Research patients. We also report, for the first Laboratory, Christian Medical College, time, an association of rs 9637876 in the Vellore, India. IRGM gene with Crohn's disease. Wellcome Trust Research Laboratory, Christian Medical College, Vellore, India; INTL SRM Institutes for Medical Science, PMID:25191865 PMCID:4156415 Vadapalani, Chennai, India. BS
BACKGROUND: Mutations in the IRGM Baskaran, K., Pugazhendhi, S. and gene have been associated with Crohn's Ramakrishna, B. S. disease in several populations but have Protective Association of Tumor Necrosis Factor Superfamily 15 (TNFSF15) not been explored in Indian patients Polymorphic Haplotype with Ulcerative with this disease. This study examined Colitis and Crohn's Disease in an Indian the association of IRGM mutations with Population ulcerative colitis and Crohn's disease in PLoS ONE; 2014, 9 (12): e114665 Indian patients with inflammatory bowel disease. METHODS: The IRGM gene was Address:Wellcome Trust Research amplified in four segments and Sanger- Laboratory, Christian Medical College, Vellore 632 004, India. sequenced in 101 participants (42 Wellcome Trust Research Laboratory, Crohn's disease, 39 ulcerative colitis, Christian Medical College, Vellore 632 and 20 healthy controls). Ten single 004, India; SRM Institutes for Medical nucleotide polymorphisms (SNP) were Science, 1 Jawaharlal Nehru Road, genotyped in 1200 participants (352 Vadapalani, Chennai 600 026, India. Crohn's disease, 400 ulcerative colitis, BACKGROUND: Tumor necrosis factor and 448 healthy controls) using superfamily (TNFSF) proteins are Sequenom MassARRAY iPLEX. Disease involved in the genesis of inflammatory associations were evaluated for each of bowel disease (IBD). We examined the the ten SNPs. RESULTS: Thirty one association of seven single nucleotide mutations were identified in the IRGM polymorphisms (SNP) in the TNFSF15 gene, of which two had not hitherto gene with Crohn's disease (CD) and been reported (150226250- ulcerative colitis (UC) in the Indian ss947429272 & 150227858- population. METHODS: Seven SNPs in ss947429273). Ten SNPs (6 from the the TNFSF15 gene (rs10114470, above and 4 from the literature) were rs3810936, rs6478108, rs4263839, evaluated. Significant associations with rs6478109, rs7848647 and rs7869487) Crohn's disease were noted with the T were genotyped in 309 CD patients, 330 allele of rs1000113 (OR 1.46, 95% CI UC patients and 437 healthy controls 1.12-1.90), T allele of rs9637876 (OR
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Research Digest Christian Medical College, Vellore
using the Sequenom iPLEX MassArray the young (MODY) genetic testing was platform. Disease associations were carried out in 80 subjects of Asian Indian evaluated for allelotypes and for origin with young onset diabetes to genotypes. RESULTS: The minor T identify mutations in a comprehensive alleles and the TT genotypes of panel of ten MODY genes. A novel rs10114470 and rs3810936 were multiplex polymerase chain reaction significantly protectively associated with (PCR)-based target enrichment was both CD and UC. The CC genotype of established, followed by NGS on the Ion rs6478108, AA genotype of rs4263839, Torrent Personal Genome Machine the AA genotype of rs6478109, the TT (PGM). All the mutations and rare genotype of rs7848647 and the CC variants were confirmed by Sanger genotype of rs7869487 were all sequencing. RESULTS: We identified protectively associated with CD but not mutations in 11 (19%) of the 56 with UC. Two haplotype blocks could be clinically diagnosed MODY subjects and discerned, one where SNPs rs10114470 seven of these mutations were novel. and rs3810936 were in tight LD (D' = The identified mutations include 0.8) and the other where rs6478108, p.H241Q, p.E59Q, c.-162G>A 5' UTR in rs4263839, rs6478109, rs7848647 and NEUROD1, p.V169I cosegregating with rs7869487 were in tight LD (D' 0.92- c.493-4G>A and c.493-20C>T, p.E271K 1.00). The second block of haplotypes in HNF4A, p.A501S in HNF1A, p.E440X were not associated with CD or with UC. in GCK, p.V177M in PDX1, p.L92F in The first block of haplotypes was very HNF1B and p.R31L in PAX4 genes. significantly associated with both CD and Interestingly, two patients with UC. CONCLUSIONS: Strong associations NEUROD1 mutation were also positive exist between TNFSF15 gene for the p.E224K mutation in PDX1 gene. polymorphisms and IBD (both CD and These patients with coexisting UC) in the Indian population. NEUROD1-PDX1 mutations showed a INTL marked reduction in glucose-induced PMID: 25501099 PMCID:4264777 insulin secretion. All 24 subjects who BS had not met the clinical criteria of MODY were negative for the mutations. To the Chapla, A., Mruthyunjaya, M. D., Asha, best of our knowledge, this is the first H. S., Varghese, D., Varshney, M., report of PDX1, HNF1B, NEUROD1 and Vasan, S. K., Venkatesan, P., Nair, V., Mathai, S., Paul, T. V. and Thomas, N. PAX4 mutations from India. Maturity onset diabetes of the young in CONCLUSIONS: Multiplex PCR coupled India - a distinctive mutation pattern with NGS provides a rapid, cost-effective identified through targeted next- and accurate method for comprehensive generation sequencing parallelized genetic testing of MODY. Clin Endocrinol (Oxf); 2014, When compared to earlier reports, we
have identified a higher frequency and a Address:Department of Endocrinology, Diabetes and Metabolism, Christian novel digenic mutation pattern involving Medical College, Vellore, India. NEUROD1 and PDX1 genes. INTL OBJECTIVE: To establish and utilize a PMID: 25041077 PMCID: Next-Generation Sequencing (NGS)- BS based strategy to screen for maturity onset diabetes of the young (MODY) Dharmalingam, S. K. and gene mutations in subjects with early- Sahajanandan, R. Intraoperative transesophageal onset diabetes. PATIENTS AND echocardiography assessment of right METHODS: Maturity onset diabetes of
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Research Digest Christian Medical College, Vellore
atrial myxoma resulting in a change of non-responders to JFE were on higher the surgical plan doses of antipsychotic drugs. The main Ann Card Anaesth; 2014, 17 (4): 306-8 side effect was a transient and mild burning sensation in the nose. A cost Address:Department of Anaesthesia, analysis favoured JFE over dopamine Christian Medical College, Vellore, Tamil agonists. CONCLUSION: JFE contains a Nadu, India. prolactin-lowering substance which needs further characterisation. Transesophageal echocardiography INTL (TEE) is an important diagnostic tool. It PMID: 25505191 PMCID: provides structural and functional BS assessment of cardiac structures which can improve the overall outcome of the Giri, S. and Kindo, A. J. patient. We present a case with right Evaluation of antifungal susceptibility atrial myxoma in which TEE helped to testing in Candida isolates by Candifast find the attachment of the mass so that and disk-diffusion method overall surgical plan was changed. Indian J Pathol Microbiol; 2014, 57 (4): INTL 595-7
PMID: 25281631 PMCID: Address:Wellcome Trust Research BS Laboratory, Department of Gastrointestinal Sciences, Christian Finny, P., Stephen, C., Jacob, R., Medical College, Vellore, Tamil Nadu, Tharyan, P. and Seshadri, M. S. India. Jasmine flower extract lowers prolactin Trop Doct; 2014, With the increase in invasive fungal Address:Registrar, Department of infections due to Candida species and Endorinology, Christian Medical College, resistance to antifungal therapy, in vitro Vellore, India [email protected]. antifungal susceptibility testing is Lecturer, Department of Biochemistry, becoming an important part of clinical Christian Medical College, Vellore, India. microbiology laboratories. Along with Lecturer, Department of Psychiatry, broth microdilution and disk diffusion Christian Medical College, Vellore, India. method, various commercial methods Professor, Department of Psychiatry, are being increasingly used for Christian Medical College, Vellore, India. antifungal susceptibility testing, Professor, Department of Endocrinology, especially in the developed world. In our Christian Medical College, Vellore, India. study, we compared the antifungal susceptibility patterns of 39 isolates of BACKGROUND: Antipsychotic drugs Candida to three antifungal drugs frequently cause amenorrhoea and (fluconazole, amphotericin B, galactorrhoea. Jasmine flowers used ketoconazole) by Candifast and disk topically were as effective as oral diffusion method. The following Bromocriptine in suppressing puerperal resistance pattern was found by lactation. This study aims to evaluate Candifast: Fluconazole (30.8%), the efficacy and safety of intranasal ketoconazole (12.8%), amphotericin B jasmine flower extract (JFE) to reduce (0%). The results obtained by disk prolactin levels of patients on stable diffusion method were in complete doses of antipsychotic drugs. METHOD: agreement with Candifast results This is a randomized, double blind, NAT crossover clinical trial. An aqueous- PMID: 25308014 PMCID: ethanol extract of jasmine flowers was BS prepared and used as nasal drops. A
decrease in serum prolactin of >/=25 Gupta, V., Kumar, N., Jana, A. K. and ng/mL was considered a significant Thomas, N. response. RESULTS: Ten out of 35 A modified technique for umbilical women had a significant drop in the arterial catheterization serum prolactin while on the JFE. The Indian Pediatr; 2014, 51 (8): 672
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quantified using maximum standardised Address:Department of Neonatology, uptake value (SUVmax) and correlated CMC, Vellore, Tamil Nadu, India. with Masaoka staging and WHO [email protected]. classification. All patients fasted 4 hr prior to 18F-FDG PET/CT. Images from A modified technique for umbilical artery vertex to mid-thigh were acquired 60min catheterization was assessed in babies in post injection of 3.7 -4.7 MBq/kg (Mega whom conventional method failed or if Becquerel)/kilogram of18F-FDG and SUV the cord was dry. Success rate attained max of each tumour was measured. One with the modified technique was 90% patient underwent DOTATATE scan, (19/21). This modified technique could received 138MBq of 68Gallium (68Ga)- provide an easier and faster method for DOTATATE injection IV and imaging was successful umbilical arterial done after 60 min. RESULTS: Higher catheterization. FDG uptake of SUVmax 7.35 was seen in NAT type B3 thymoma. FDG uptake was PMID: 25129010 PMCID: higher in thymic carcinoma (20.45 in BS primary and 17.46 in the node) or neuroendocrine differentiation (NED) Hephzibah, J., Shanthly, N. and than in patients with thymomas (ranged Oommen, R. 7.35 - 3.02). No significant association Diagnostic Utility of PET CT in Thymic was observed between higher focal FDG Tumours with Emphasis on 68Ga- uptake and advanced-stage disease in DOTATATE PET CT in Thymic thymoma. In NED 68Ga - DOTATATE Neuroendocrine Tumour - Experience at imaging identified more lesions than in a Tertiary Level Hospital in India FDG. CONCLUSION: PET CT is a valuable J Clin Diagn Res; 2014, 8 (9): QC01-3 diagnostic tool in evaluation of thymic tumours, to assess in initial workup, for Address:Associate Professor, treatment response and for Department of Nuclear Medicine, prognostication. 68Ga-DOTATATE Christian Medical College, Christian PET/CT is beneficial in assessing Medical College , Vellore, Ida Scudder neuroendocrine thymic tumours. Focal Road, Vellore, India . FDG uptake cannot predict advanced Professor, Department of Nuclear thymoma but is helpful in distinguishing Medicine, Christian Medical College, thymoma from thymic carcinoma, or the Christian Medical College , Vellore, Ida more aggressive thymoma B3 Scudder Road, Vellore, India . INTL PMID: 25386498 PMCID:4225950 INTRODUCTION: 18 Fluorine-fluoro-2- BS deoxyglucose positron emis-sion tomography/computed tomography Ismail, A. M., Sachithanandham, J., (18F- FDG-PET/CT) is of importance in Eapen, C. E., Kannangai, R. and assessing high-risk thymoma and thymic Abraham, P. carcinomas. Detection of advanced Performance of LigAmp Assay for thymoma versus thymic carcinoma by Sensitive Detection of Drug-Resistant routine cross sectional anatomical Hepatitis B Virus Minor Variants in imaging such as computed tomography Comparison with Standard Nucleotide (CT), magnetic resonance imaging (MRI) Sequencing often poses a diagnostic dilemma. In Mol Diagn Ther; 2014, 18 (6): 655-63 this case series we observed the utility of FDG uptake to predict advanced Address:Departments of Clinical thymoma and distinguish thymoma from Virology, Christian Medical College, thymic cancer. MATERIALS AND Vellore, 632004, Tamil Nadu, India. METHODS: We reviewed 18F- FDG- PET/CT scans of 12 patients (8 males, 4 BACKGROUND AND OBJECTIVES: A virus females); age 24-60yrs with thymic population often exists as a complex epithelial malignancy from January 2011 mixture of genetic populations. Antiviral- to May 2013. FDG activity in lesions was resistant mutants could be circulating as
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minority variants in the mixed virus Janardhanan, J., Trowbridge, P. and population that are not detected by Varghese, G. M. standard sequencing methods. The role Diagnosis of scrub typhus of minor drug-resistant variants and Expert Rev Anti Infect Ther; 2014, 12 clinical outcome is slowly evolving and (12): 1533-40 there is a need to employ sensitive Address:Medicine Unit I and Infectious methods for detection of minority Diseases, Christian Medical College, variants that emerge as dominant Vellore, Tamil Nadu, India. species and subsequently affect the Scrub typhus is an acute febrile illness antiviral efficacy. This study was that, if untreated, can result in intended to develop a technique called considerable morbidity and mortality. the ligation amplification assay (LigAmp) One of the primary reasons for delays in to identify minor drug-resistant variants the treatment of this potentially fatal of hepatitis B virus (HBV). METHODS: A infection is the difficulty in diagnosing LigAmp HBV assay was developed and the condition. Diagnosis is often clinical samples were tested from complicated because of the combination chronic hepatitis B subjects on antiviral of non-specific symptoms that overlap treatment. Nucleotide sequencing of with other infections commonly found in HBV reverse transcriptase (rt) region endemic areas and the poor available was performed and the results were diagnostics. In the majority of the compared with LigAmp assay. The endemic settings, diagnosis still relies on performance of LigAmp assay was the Weil-Felix test, which is neither validated by clonal sequencing. sensitive nor specific. Other methods of Virological response was measured using testing have become available, but at HBV DNA levels and the results were this time, these remain insufficient to correlated with antiviral-resistant provide the rapid point-of-care mutations detected by sequencing and diagnostics that would be necessary to LigAmp assays. RESULTS: A total of 80 significantly change the management of reactions of LigAmp assay were this infection by providers in endemic performed for rtM204V and rtM204I areas. This article reviews the currently (ATT) mutant detection. Samples were available diagnostic tools for scrub obtained from 40 chronic hepatitis B typhus and their utility in the clinical subjects. Among these subjects, setting. rtM204V and rtM204I (ATT) mutations were identified by standard sequencing INTL in 10 (25 %) and 12 (30 %) subjects, respectively. LigAmp detected both PMID: 25359599 PMCID: rtM204V and rtM204I (ATT) mutations in BS 13 (32.5 %) subjects, rtM204I mutation in 12 (30 %) subjects and rtM204V Jeremiah, S. S., Balaji, V., Anandan, S. mutation in 1 (2.5 %) subject, and Sahni, R. D. respectively. LigAmp detected primary A possible alternative to the error prone resistant mutants in 69.4 % of modified Hodge test to correctly identify lamivudine non-responders while the carbapenemase producing Gram- sequencing detected resistant mutations negative bacteria in only 55.6 % subjects (p < 0.001). Indian J Med Microbiol; 2014, 32 (4): CONCLUSIONS: This data shows 414-8 significantly higher sensitivity of LigAmp for detection of minority rtM204V and Address:Department of Microbiology, rtM204I (ATT) mutations over standard Christian Medical College, Vellore, Tamil sequencing. Therefore, LigAmp has Nadu, India. potential clinical utility for appropriate monitoring and tailoring of HBV therapy. CONTEXT: The modified Hodge test INTL (MHT) is widely used as a screening test PMID: 25208639 PMCID: for the detection of carbapenemases in BS Gram-negative bacteria. This test has several pitfalls in terms of validity and
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Research Digest Christian Medical College, Vellore
interpretation. Also the test has a very Chronic stress induces neurochemical low sensitivity in detecting the New changes that include neurotransmitter Delhi metallo-beta-lactamase (NDM). imbalance in the brain. Noise is an Considering the degree of dissemination environmental factor inducing stress. of the NDM and the growing pandemic of Chronic noise stress affects monoamine carbapenem resistance, a more accurate neurotransmitter systems in the central alternative test is needed at the earliest. nervous system. The effect on other AIMS: The study intends to compare the excitatory and inhibitory performance of the MHT with the neurotransmitter systems is not known. commercially available Neo-Sensitabs - The aim was to study the role of chronic Carbapenemases/Metallo-beta- noise stress on the glutamatergic and Lactamase (MBL) Confirmative gamma-aminobutyric acid (GABA)ergic Identification pack to find out whether systems of the brain. Female Wistar rats the latter could be an efficient (155 +/- 5 g) were unintentionally alternative to the former. SETTINGS exposed to noise due to construction AND DESIGN: A total of 105 isolates of (75-95 db, 3-4 hours/day, 5 days a Klebsiella pneumoniae resistant to week for 7-8 weeks) in the vicinity of imipenem and meropenem, collected the animal care facility. Glutamate/GABA prospectively over a period of 2 years levels and their metabolic enzymes were were included in the study. SUBJECTS evaluated in different rat brain regions AND METHODS: The study isolates were (cortex, hippocampus, striatum, and tested with the MHT, the Neo-Sensitabs cerebellum) and compared with age and - Carbapenemases/MBL Confirmative gender matched nonexposed rats. Identification pack and polymerase chain Chronic noise stress decreased reaction (PCR) for detecting the blaNDM- glutamate levels and glutaminase 1 gene. RESULTS: Among the 105 activity 27% and 33% in the cortex, isolates, the MHT identified 100 isolates 15% and 24% in the cerebellum. as carbapenemase producers. In the five Glutamate levels increased 10% in the isolates negative for the MHT, four were hippocampus, 28% in striatum and found to produce MBLs by the Neo- glutaminase activity 15% in striatum. Sensitabs. The Neo-Sensitabs did not Glutamine synthetase activity increased have any false negatives when significantly in all brain regions studied, compared against the PCR. that is, cortex, hippocampus, striatum, CONCLUSIONS: The MHT can give false and cerebellum (P < 0.05). Noise stress- negative results, which lead to failure in increased GABA levels and glutamate detecting the carbapenemase producers. alpha decarboxylase activity 20% and Also considering the other pitfalls of the 45% in the cortex, 13% and 28% in the MHT, the Neo-Sensitabs-- hippocampus respectively. GABA levels Carbapenemases/MBL Confirmative and glutamate alpha decarboxylase Identification pack could be a more activity decreased 15% and 14%, efficient alternative for detection of respectively in the striatum. GABA carbapenemase production in Gram- transaminase activity was significantly negative bacteria reduced in the cortex (55%), NAT hippocampus (17%), and cerebellum (33%). Chronic noise stress differentially PMID: 25297027 PMCID: affected glutamatergic and GABAergic BS neurotransmitter systems in the rat brain, which may alter glutamate and Kazi, A. I. and Oommen, A. GABA neurotransmission. Chronic noise stress-induced alterations INTL of glutamate and gamma-aminobutyric acid and their metabolism in the rat PMID: 25387529 PMCID: brain BS Noise Health; 2014, 16 (73): 343-9 Address:Neurochemistry Laboratory, Kolli, V. K., Natarajan, K., Isaac, B., Department of Neurological Sciences, Selvakumar, D. and Abraham, P. Christian Medical College, Vellore, India.
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Mitochondrial dysfunction and respiratory chain defects in a rodent PMID: 24347301 PMCID: model of methotrexate-induced enteritis BS Hum Exp Toxicol; 2014, 33 (10): 1051- 65 Kompithra, R. Z., Paul, A., Manoharan,
D., Babji, S., Sarkar, R., Mathew, L. G. Address: Department of Biochemistry, Christian Medial College, Bagayam, and Kang, G. Vellore, Tamil Nadu, India. Immunogenicity of a three dose and five Department of Anatomy, Christian dose oral human rotavirus vaccine Medial College, Bagayam, Vellore, Tamil (RIX4414) schedule in south Indian Nadu, India. infants Department of Biochemistry, Christian Vaccine; 2014, 32 Suppl 1 A129-33 Medial College, Bagayam, Vellore, Tamil Nadu, India Address:Department of Paediatrics, [email protected]. Christian Medical College, Vellore, India. Department of Gastrointestinal Sciences, The efficacy of methotrexate (MTX), a Christian Medical College, Vellore, India. widely used chemotherapeutic drug, is Department of Gastrointestinal Sciences, limited by its gastrointestinal toxicity Christian Medical College, Vellore, India. and the mechanism of which is not clear. Electronic Address: The present study investigates the [email protected]. possible role of mitochondrial damage in MTX-induced enteritis. Small intestinal AIM: This study was undertaken to injury was induced in Wistar rats by the compare the immunogenicity of a three administration of 7 mg kg(-1) body wt. dose and five dose schedule of an oral MTX intraperitoneally for 3 consecutive live-attenuated human rotavirus vaccine, days. MTX administration resulted in Rotarix in south Indian infants. severe small intestinal injury and METHOD: Healthy infants (N=90), six to extensive damage to enterocyte seven weeks of age were enrolled to mitochondria. Respiratory control ratio, receive three doses (n=45) or five doses the single most useful and reliable test of Rotarix vaccine (n=45) along with of mitochondrial function, and 3-(4,5- other scheduled vaccines, each dose dimethylthiazol-2-yll)-2,5- separated by a four week interval. Blood diphenyltetrazolium bromide reduction, samples were taken before vaccination a measure of cell viability were and one month post-dose three in the significantly reduced in all the fractions Rotarix three dose group and one month of MTX-treated rat enterocytes. A post-dose five in the Rotarix five dose massive decrease (nearly 70%) in the group; all were tested for anti-rotavirus activities of complexes II and IV was IgA by an antibody sandwich enzyme also observed. The results of the present immunoassay. RESULTS: At baseline, study suggest that MTX-induced damage >50% of infants had >20 units of anti- to enterocyte mitochondria may play a rotavirus IgA. The seroconversion rates critical role in enteritis. MTX-induced after three and five doses were low and alteration in mitochondrial structure may not significantly different in the two cause its dysfunction and decreases the groups. However, among vaccine activities of the electron chain responders, children seropositive at complexes. MTX-induced mitochondrial baseline showed a much greater damage can result in reduced adenosine absolute increase in IgA antibody levels triphosphate synthesis, thereby than children seronegative at baseline. interfering with nutrient absorption and CONCLUSIONS: Rotarix vaccine showed enterocyte renewal. This derangement low immunogenicity in south Indian may contribute to malabsorption of children and increasing the number of nutrients, diarrhea, and weight loss seen doses did not increase the proportion of in patients on MTX chemotherapy. infants seroconverting after vaccination INTL INTL PMID:25091666 PMCID:
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BS build-up for the same gantry angles were found to be 6%, 25%, and 60%, Kumar, A. S., Sharma, S. D. and respectively. The MOSFET response was Ravindran, B. P. found to be independent of dose rate for Characteristics of mobile MOSFET all three energies. The dosimetric dosimetry system for megavoltage characteristics of the MOSFET detector photon beams make it a suitable in vivo dosimeter for J Med Phys; 2014, 39 (3): 142-9 megavoltage photon beams. INTL Address:Department of Radiotherapy, PMID:25190992 PMCID:4154181 Christian Medical College, Vellore, Tamil BS Nadu, India. Radiological Physics and Advisory Mariappan, R., Venkatraghavan, L., Division, Bhabha Atomic Research Vertanian, A., Agnihotri, S., Cynthia, S., Centre, CTCRS Building, Anushaktinagar, Reyhani, S., Tung, T., Khan, O. H. and Mumbai, India. Zadeh, G. Serum lactate as a potential biomarker The characteristics of a mobile metal of malignancy in primary adult brain oxide semiconductor field effect tumours transistor (mobile MOSFET) detector for J Clin Neurosci; 2015, 22 (1): 144-8 standard bias were investigated for megavoltage photon beams. This study Address:Department of Anesthesia, was performed with a brass alloy build- University Health Network, Toronto up cap for three energies namely Co-60, Western Hospital, Toronto, Ontario, 6 and 15 MV photon beams. The Canada. MOSFETs were calibrated and the Division of Neurosurgery, Department of performance characteristics were Surgery, University Health Network, analyzed with respect to dose rate Toronto Western Hospital, 399 Bathurst dependence, energy dependence, field Street, West Wing 4-439, M5T 2S8 size dependence, linearity, build-up Toronto, Ontario, Canada. factor, and angular dependence for all Department of Anesthesia, Christian the three energies. A linear dose- Medical College Hospital, Vellore, India. response curve was noted for Co-60, 6 Division of Neurosurgery, Department of MV, and 15 MV photons. The calibration Surgery, University Health Network, factors were found to be 1.03, 1, and Toronto Western Hospital, 399 Bathurst 0.79 cGy/mV for Co-60, 6 MV, and 15 Street, West Wing 4-439, M5T 2S8 MV photon energies, respectively. The Toronto, Ontario, Canada. Electronic calibration graph has been obtained to Address: [email protected]. the dose up to 600 cGy, and the dose- response curve was found to be linear. Lactate, a by-product of glycolysis, is an The MOSFETs were found to be energy indicator of poor tissue perfusion and is independent both for measurements a useful biomarker with prognostic value performed at depth as well as on the in risk-stratifying patients in several surface diseases. Furthermore, elevated lactate with build-up. However, field size production is observed in tumour dependence was also analyzed for glycolysis, also known as the Warburg variable field sizes and found to be field effect, and is essential in promoting size independent. Angular dependence tumour cell invasion, metastasis, and was analyzed by keeping the MOSFET immune system evasion, promoting dosimeter in parallel and perpendicular resistance to cell death. However, there orientation to the angle of incidence of are no studies of elevated serum lactate the radiation with and without build-up in brain tumour patients as a potential on the surface of the phantom. The biomarker, to our knowledge. The aim of maximum variation for the three this study is to determine possible energies was found to be within +/- 2% correlations between the malignancy of for the gantry angles 90 degrees and tumours and pre- and intraoperative 270 degrees , the deviations without the serum lactate elevation in patients
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undergoing craniotomy for tumour TJLB is a relatively safe procedure that resection. We provide initial evidence may be useful in cases where that a rise in serum lactate can be used conventional TJLB is infeasible. as a non-invasive biomarker that ADVANCES IN KNOWLEDGE: (a) We correlates with brain tumour grade. The describe the technique of trans-caval results from this study and future TJLBs and report our findings in the prospective studies may allow for largest series of published cases. (b) determination of tumour progression Trans-caval TJLB is relatively safe and and response to therapy using serum can be used to increase the success lactate as a biomarker rates of conventional TJLB. INTL INTL PMID:25172017 PMCID: PMID:25248931 PMCID:4207161 BS BS
Mathew, A. J., Crues, J. V., 3rd and Nagappan, A. S., Varghese, J., Danda, D. Pranesh, G. T., Jeyaseelan, V. and Office e-MRI: viewing joints from the Jacob, M. inside Indomethacin inhibits activation of Int J Rheum Dis; 2014, 17 (6): 706-9 endothelial nitric oxide synthase in the rat kidney: Possible role of this effect in Address:Deptartment of Clinical the pathogenesis of indomethacin- Immunology & Rheumatology, Christian induced renal damage Medical College, Vellore, India. Chem Biol Interact; 2014, 221 77-87 INTL Address:Department of Biochemistry, PMID:25346153 PMCID: Christian Medical College, Vellore BS 632002, India. Electronic Address: [email protected]. Moses, V., Keshava, S. N., Mammen, Department of Biochemistry, Christian S., Ahmed, M., Eapen, C. E. and Medical College, Vellore 632002, India. Ramakrishna, B. Electronic Address: Trans-caval trans-jugular liver biopsy--a [email protected]. technical modification of trans-jugular Department of Biochemistry, Christian liver biopsy Medical College, Vellore 632002, India. Br J Radiol; 2014, 87 (1043): 20140327 Electronic Address: [email protected]. Address:1 Department of Radiology, Department of Biostatistics, Christian Christian Medical College, Vellore, Tamil Medical College, Vellore 632002, India. Nadu, India. Electronic Address: [email protected]. OBJECTIVE: To (a) describe the Department of Biochemistry, Christian technical modification of trans-caval Medical College, Vellore 632002, India. TJLB and (b) review our series of nine Electronic Address: cases. METHODS: We performed a [email protected]. retrospective review of all trans-caval TJLBs performed; we assessed The clinical use of non-steroidal anti- indications for the procedure, technical inflammatory drugs (NSAIDs) is often success, complications, adequacy of associated with adverse effects in the specimen and histological positivity. kidney. Indomethacin, an NSAID that RESULTS: The technical success rate of has been shown to induce oxidative the procedure was 9/9 (100%); the stress in the kidney, was used to study minor complication rate was 1/9 (11%), the pathogenesis of renal damage adequate specimen was obtained in all induced by the drug in a rat model. cases and a histological diagnosis was Experimental animals were given achieved in 8/9 (89%) cases. indomethacin (20mg/kg) by oral gavage, CONCLUSION: This preliminary report sacrificed 1, 12 or 24h (h) later and the suggests that trans-caval modification of kidneys studied. Evidence of glomerular
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and tubular damage in the kidney was Thrombotic thrombocytopenic purpura found in response to the drug. Renal (TTP) and systemic lupus erythematosus tissue nitrite levels, a surrogate marker (SLE) very rarely present simultaneously of nitric oxide (NO) synthesis, were and pose a diagnostic and therapeutic significantly decreased at 12 and 24h. dilemma to the physician. Prompt Indomethacin did not affect protein and diagnosis and management with plasma mRNA levels of endothelial nitric oxide exchange and immunosuppression is synthase (eNOS) or inducible NOS life-saving. To describe the effectiveness (iNOS). However, it significantly reduced of cryosupernatant and steroids in the ratio of dimeric (active) to pediatric SLE with TTP. We describe monomeric (inactive) eNOS in the three children aged 12-14 years with kidney, 12 and 24h after drug SLE who were diagnosed with TTP based administration. This was associated with on fever, CNS manifestations, ANA, anti- reductions in heme content, both in dsDNA, anti-sm positivity, renal tissue and in NOS. Heme hypocomplementemia, and oxygenase 1 (HO-1) mRNA (at 1 and microangiopathic anemia with 12h), protein (at 12 and 24h) and thrombocytopenia. All three children activity (at 1, 12 and 24h) were elevated were managed with cryosupernatant and in response to indomethacin. Nuclear steroids without plasmapheresis. All translocation of Nrf2 (at 12h) and p38 children improved with cryosupernatant MAPK signaling (at 12h and 24h), both and steroids. All attained remission of which are known to induce HO-1, also within 10 days. They were doing well at occurred in response to the drug. In last follow up without relapse or flare. summary, our results show that Cryosupernatant and steroids may be an indomethacin reduced levels of activated effective therapy for Thrombotic eNOS in the kidney. This effect is thrombocytopenic purpura with systemic possibly mediated by heme depletion, lupus erythematosus. secondary to HO-1 induction that NAT occurred downstream of Nrf2 and p38 PMID:25332586 PMCID:4192230 MAPK signaling. We postulate that BS reduced renal eNOS activity may result in decreased NO levels, and hence Peter, J. V., Griffith, M. F., Prakash, J. reduced renal perfusion, leading to A., Chrispal, A., Pichamuthu, K. and glomerular and tubular injury with Varghese, G. M. subsequent renal damage. Anti-nuclear antibody expression in INTL severe scrub typhus infection: PMID:25110317 PMCID: preliminary observations BS J Glob Infect Dis; 2014, 6 (4): 195-6
Palaniappan, P., Lionel, A. P., Agarwal, Address:Department of Critical Care, I., Mathai, S., Mathew, L., Agarwal, S., Medical Intensive Care Unit, Christian Keni, P., Khubchandani, R. and Kumar, Medical College, Vellore, India. S. Department of Medicine, University of Cryosupernatant and Colorado School of Medicine, Aurora, Immunosuppression as Effective CO, USA. Alternative Therapies for TTP in Three Department of Microbiology, Christian Pediatric SLE Patients Medical College, Vellore, India. Indian J Hematol Blood Transfus; 2014, Department of Medicine, Christian 30 (Suppl 1): 232-6 Medical College, Vellore, India. INTL Address:Department of Paediatrics, PMID:25538461 PMCID:4265838 Christian Medical College, Vellore, BS 632004 India. Jaslok Hospital & Research Centre, 15 - Phukan, C., Prabhu, S. and Dr. Deshmukh Marg, Pedder Road, Venkatramani, V. Mumbai, 400 026 India. Incidental detection of retroperitoneal lymphangioleiomyomatosis (LAM) - CT
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and MRI findings with relevance to the high antigenic exposure. Their role in the urologist upper female reproductive tract is not Int Braz J Urol; 2014, 40 (4): 574-5 fully understood. This study aims to determine the distribution and Address:Department of Urology, morphology of LC in the normal and Christian Medical College, Vellore, India. post-partum human uterine tubes and INTL uterus by staining with the specific LC PMID:25251963 PMCID: markers, CD1a and zinc iodide-osmium BS (ZIO), and to determine their Prakash, D., Prabhu, S. M. and Irodi, A. association with helper and cytotoxic T Seronegative spondyloarthropathy- cells. MATERIAL AND METHODS: Normal related sacroiliitis: CT, MRI features and and post-partum uterine tube and differentials uterine specimens were stained with Indian J Radiol Imaging; 2014, 24 (3): CD1a and ZIO and their morphology and 271-8 distribution noted. Double immune staining with CD1a-CD4 and CD1a-CD8 Address:Department of Radiology, in post-partum uterine tube were also Christian Medical College, Vellore, Tamil done. RESULTS: It was noted that Nadu, India. CD1a-positive cells were significantly fewer and smaller in diameter than ZIO- Seronegative spondyloarthropathy is a positive cells in the uterine tube and group of chronic inflammatory rheumatic both types of cells were significantly diseases that predominantly affect the more prevalent in post-partum tubes. axial skeleton. Involvement of sacroiliac Perivascular clusters of ZIO-positive cells joint is considered a hallmark for were seen in the post-partum tubes. diagnosis of seronegative Close association of CD1a-positive cells spondyloarthropathy and is usually the with CD4- and CD8-positive T cells was first manifestation of this condition. It is noted in the post-partum uterine tube. essential for the radiologist to know the In the uterus, scanty CD1a-positive cells computed tomography (CT) and were present in the surface and magnetic resonance imaging (MRI) glandular epithelium and endometrial features of spondyloarthropathy-related stroma. ZIO-positive cells were absent. sacroiliitis as imaging plays an important CONCLUSION: This study suggests that role in diagnosis and evaluation of CD1a-positive and ZIO-positive cells response to treatment. We present a may be different subsets of LC that are pictorial essay of CT and MRI imaging needed for presentation of antigen to findings in seronegative immunocompetent cells. Their respective spondyloarthropathy-related sacroiliitis functions are yet to be determined. in various stages and highlight common INTL differentials that need to be considered. PMID:25056459 PMCID: NAT BS PMID:25114391 PMCID:4126143 BS Raghupathy, V., Goel, A., Thangaraj, K. R., Eapen, C. E., Balasubramanian, K. Rabi, S., Jacob, T. M., Lionel, J. and A., Regi, A., Jose, R., Benjamin, S. J. Indrasingh, I. and Ramachandran, A. Different subsets of Langerhans cells in Absence of G1528C mutation in long- human uterine tubes and uterus chain 3-hydroxyacyl-CoA dehydrogenase J Obstet Gynaecol Res; 2014, 40 (7): in four Indian patients with pregnancy- 1833-9 related liver disease Indian J Gastroenterol; 2014, 33 (4): Address:Department of Anatomy, 387-9 Christian Medical College Vellore, Vellore, India. Address:The Wellcome Trust Research Laboratory, Division of Gastrointestinal AIM: Langerhans cells (LC) are antigen- Sciences, Christian Medical College, presenting cells present in tissues with Vellore, 632 004, India.
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NAT P types were P[6] accounting for 16 PMID:24105666 PMCID: (46%) samples, P[4] 7 (20%), P[1] 3 BS (8.5%) and P[8] 3 (8.5%). An unusual P type P[15] was seen in one sample in Rajendran, P. and Kang, G. combination with G10. The finding of G2 Molecular epidemiology of rotavirus in infections which are rarely identified in children and animals and animals implies anthroponotic characterization of an unusual G10P[15] transmission since this genotype is strain associated with bovine diarrhea in predominantly associated with infection south India in humans. Vaccine; 2014, 32 Suppl 1 A89-94 INTL PMID:25091687 PMCID: Address:The Wellcome Trust Research BS Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Rose, W., Kitai, I., Kakkar, F., Read, S. Vellore, TN, India. E., Behr, M. A. and Bitnun, A. The Wellcome Trust Research Quantiferon Gold-in-tube assay for TB Laboratory, Division of Gastrointestinal screening in HIV infected children: Sciences, Christian Medical College, influence of quantitative values Vellore, TN, India. Electronic Address: BMC Infect Dis; 2014, 14 516 [email protected]. Address:Department of Pediatrics, Rotaviruses are enteric pathogens Christian Medical College, Vellore causing acute, watery, dehydrating 632004, India. diarrhea in various host species, [email protected]. including birds and mammals. This study BACKGROUND: HIV infected children are collected data on the disease burden and at increased risk of TB disease and strain prevalence of Group A rotavirus in require annual TB screening. Data on animals and humans in Vellore and use of IGRA for TB screening in them are investigated interspecies transmission by limited. We retrospectively evaluated the comparison of circulating genotypes. usefulness of Quantiferon Stool samples from children aged less Gold-in-tube test (QFT), an IGRA in than 5 years, admitted to the hospital screening for LTBI in relatively healthy, between January 2003 and May 2006 for immunologically stable HIV infected diarrhea and diarrheal samples from children. METHODS: HIV infected animals that were collected from a children with no prior history of TB were veterinary clinic and several dairy farms screened for latent TB as part of routine near Vellore between February 2007 and care. They underwent risk of TB May 2008 were processed and subjected assessment, TST and QFT. QFT was to RNA extraction and reverse- repeated twice or three times depending transcription PCR for genotyping of VP7 on the quantitative values. Independent and VP4. Of 394 children with diarrhea, test validation was also performed. 158 (40%) were positive for rotavirus RESULTS: Eighty one children had 109 and the common G types identified were QFT tests. All had adequate mitogen G1 (47, 29.7%), G2 (43, 27.2%), G9 responses. The initial QFT was positive (22, 13.9%), G10 (2, 1.2%), G12 (1, in 15 (18.5%) children; quantitative 0.6%) and mixed infections (27, IGRA responses were 0.35-1.0 IU/mL in 17.8%). The common P types were P[4] 9 (60%), 1.0-10 IU/mL in5 (33.3%) and accounting for 57 (36%) samples, P[8] >10 IU/mL in 1 (6.7%). None that 57 (36%), P[11] 3 (1.8%) and P[6] 2 tested positive had documented TB (1.2%). Of 627 animals, 35 (1 bullock, 2 exposure or TB disease. Baseline goats, 32 cows) were found to be characteristics in the QFT positive and infected with rotavirus (5.5%). The negative groups were similar. Repeat common G types identified in order of testing within 17 weeks demonstrated frequency were G6 (17, 48.5%), G2 (10, reversion to negative in 79% of cases. 28%), G10 (4, 11%), G8 (2, 5.7%) and Repeat blinded independent testing of all mixed infections (2, 5.7%). The common QFT positive results and a random
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selection of initial negative tests BACKGROUND: Despite the wide demonstrated concordance in 96% of spectrum of adenoma behavior in cases. Seven children (QFT > 1.0 IU/mL patients with acromegaly, the ability of or positive TST) were offered INH most pathological markers to predict preventive therapy. In no case has TB clinical and radiological behavior remains disease developed in 2 years of close controversial. The authors sought to follow-up. CONCLUSIONS: QFT is a valid comprehensively examine clinical and method for LTBI screening relatively radiological correlates of growth healthy, immunologically stable HIV hormone (GH)-secreting pituitary infected children. However, reversion to adenomas with regard to several negative on repeat testing and lack of commonly used immunocytochemical correlation with TST results and risk of techniques in patients undergoing TB exposure makes interpretation transsphenoidal surgery for acromegaly. difficult. METHOD: We performed a retrospective INTL review of histopathological findings in PMID:25248406 PMCID:4181619 101 surgically resected GH adenomas. BS Tumors were assessed radiologically for different patterns of extension. Each Rose, W., Veeraraghavan, B., tumor specimen was subject to Pragasam, A. K. and Verghese, V. P. immunocytochemical analysis, including Antimicrobial susceptibility profile of assessments of granulation patterns, isolates from pediatric blood stream MIB-1 labeling indices, prolactin infections cosecretion, p53 expression and mitotic Indian Pediatr; 2014, 51 (9): 752-3 activity. Endocrinological outcome was assessed in 93 patients, with remission Address:Departments of Pediatrics and defined by the 2010 consensus criteria. *Microbiology, Christian Medical College, RESULTS: Most tumors were Vellore, India. macroadenomas and almost half were [email protected]. invasive. When compared to densely granulated tumors, sparsely granulated We describe the pathogens and their adenomas were associated with a antimicrobial profile causing blood younger age at presentation, higher stream infections in children over a 4- preoperative IGF-1 levels, elevated MIB- year period. The commonest pathogens 1 index and pure GH immunostaining, were: non-fermenting Gram negative but did not differ significantly in terms of bacilli other than Pseudomonas, extrasellar invasion or outcome. Salmonella species, Escherichia coli, Increased mitotic activity and p53 Staphylococcus aureus and Klebsiella expression were also associated with species. High rates of drug-resistance higher proliferation indices and a were observed younger age at presentation. Mixed NAT GH/prolactin tumors demonstrated PMID: 25228617 PMCID: significantly higher remission rates, BS independent of variations in extrasellar growth. MIB-1 indices did not correlate Sarkar, S., Chacko, A. G. and Chacko, with the preoperative GH/IGF-1 levels, G. adenoma size or Knosp grade. An analysis of granulation patterns, MIB- CONCLUSION: The pathobiology of 1 proliferation indices and p53 acromegaly is complex, and the expression in 101 patients with clinicoradiological significance of acromegaly subtyping on the basis of the markers Acta Neurochir (Wien); 2014, 156 (12): employed in this study is debatable. 2221-30; discussion 2230 Further investigation of newer molecular markers is warranted. Address:Section of Neurosurgery, INTL Department of Neurological Sciences, PMID:25238988 PMCID: Christian Medical College, Vellore, India. BS
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Turel, M. K. and Rajshekhar, V. Magnetic resonance imaging localization with cod liver oil capsules for the minimally invasive approach to small intradural extramedullary tumors of the thoracolumbar spine J Neurosurg Spine; 2014, 21 (6): 882-5
Address:Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
Object Accurate intraoperative localization of small intradural extramedullary thoracolumbar (T-1 to L- 3 level) spinal cord tumors is vital when minimally invasive techniques, such as hemilaminectomy, are used to excise these lesions. In this study, the authors describe a simple and effective method of preoperative MRI localization of small intradural extramedullary tumors using cod liver oil capsules. Methods Thirty- five patients with intradural tumors underwent preoperative MRI localization the evening prior to surgery. Patients were positioned prone in the MRI gantry, mimicking the intraoperative position. Nine capsules were placed in 3 rows to cover the lesion. This localization was used to guide the level for a minimally invasive approach using a hemilaminectomy to excise these tumors. Results The mean patient age was 51.5 +/- 14.3 years, and the mean body mass index was 24.1 +/- 3.5 kg/m(2). Twenty-two tumors involved the thoracic spine, and 13 involved the upper lumbar spine from L-1 to L-3. The mean tumor size was 2.2 +/- 1.0 cm. Localization was accurate in 34 patients (97.1%). Conclusions Accurate localization with the described method is quick, safe, cost-effective, and noninvasive with no exposure to radiation. It also reduces operating time by eliminating the need for intraoperative fluoroscop INTL Abraham AP, Vidyasagar A, PMID:25325173 PMCID: Lakshmanan J, Nair S, Joseph M(1). BS Phenytoin toxicity in patients with traumatic brain injury. Neurol India. 2014 May-Jun;62(3):285- 9. doi: 10.4103/0028-3886.136929.
Author information:
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Research Digest Christian Medical College, Vellore
(1)Department of Neurological Sciences, CO Christian Medical College, Vellore, India. Abrol, N., Panda, A. and Kekre, N. S. Painful varicoceles: Role of BACKGROUND: We observed that in varicocelectomy patients with traumatic brain injury Indian J Urol; 2014, 30 (4): 369-73 (TBI) who did not improve as expected, serum levels of phenytoin were in the Address:Department of Urology, toxic range and that their sensorium Christian Medical College, Vellore, Tamil improved with modification of the dose. Nadu, India. This led us to study the usage of phenytoin in patients with TBI. AIMS: To The incidence of varicocele in the determine the prevalence of phenytoin general population is up to 15%. It is toxicity in TBI patients and to study the estimated that the prevalence of pain suitability of using ideal body weight with varicoceles is around 2-10%. Till (IBW) to guide phenytoin dosing. the year 2000, only two studies SETTING AND DESIGN: Neurotrauma evaluated efficacy of varicocelectomy in unit of a tertiary care centre in India. painful varicoceles with conflicting Prospective data collection from an results. Over the past decade many already established protocol of drug other studies have addressed this issue level monitoring. MATERIALS AND and reported on the treatment outcome METHODS: The study cohort included and predictors of success. We critically 100 consecutive adult patients with mild appraised studies published from March or moderate TBI who were administered 2000 to May 2013 evaluating surgical phenytoin based on IBW. Trough serum management in painful varicoceles to phenytoin and albumin levels were provide an evidence based review of measured on day 4 after administration effectiveness of varicocelectomy in of the loading dose and actual body relieving pain in patients with weight obtained when it was possible. symptomatic painful varicoceles. The STATISTICAL ANALYSIS: Chi-square was association between varicoceles and pain used for comparing categorical variables, is not clearly established. Conservative student's t-test for continuous variables treatment is warranted as the first line and multivariate regression analysis to of treatment in men with painful clinical obtain independent risk factors. varicoceles. In carefully selected men RESULTS: Clinical toxicity was observed with clinically palpable varicoceles and in 15% of patients and biochemical associated characteristic chronic dull toxicity in 36%, with a significant ache, dragging or throbbing pain who do association between the two (P < 0.01). not respond to conservative therapy, Using multivariate analysis, abdominal varicocelectomy is warranted and is girth ≤75 cm (P = 0.07), neck associated with approximately 80% circumference ≤34 cm (P = 0.025) and success. However, surgical success does IV dose proportion ≥80% (P = 0.003) not always translate into resolution of were independent risk factors for pain and pain might persist even when biochemical toxicity. The plot between no varicoceles are detected actual weight and IBW showed that postoperatively. toxicity occurred when IBW was higher NAT than actual weight. CONCLUSION: The PMID:25378815 PMCID:4220373 prevalence of biochemical phenytoin CO toxicity was high, with independent risk
factors being a higher proportion of IV Albert, S., Jayashankar, V. and Gouse, administration and overestimation of M. weight by IBW. Clinical suspicion of A paradoxical triad: scapulothoracic phenytoin toxicity was a good predictor dissociation with clavicle and humeral of biochemical toxicity. shaft fractures NAT Case Rep Emerg Med; 2014, 2014 PMID: 25033851 [PubMed - indexed 689157 for MEDLINE]
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Address:Department of Orthopaedics, Department of Urology, Christian Christian Medical College, Unit 1, Vellore Medical College, Vellore, Tamil Nadu, 632004, India. India.
Scapulothoracic dissociation involves A 22-year-old male patient presented varying degree of discontinuity of the with iatrogenic vesicourethral fistula upper extremity from its truncal after immediate retrograde endoscopic attachment. An eighteen-year-old male realignment of urethra after a posterior presented to the accident and urethral injury associated with pelvic emergency department following a fracture. motor vehicle accident where he was hit INTL by a four wheeler while riding a two PMID: 25440761 PMCID: wheeler. He had tenderness and CO deformity over the left clavicle and the left humerus. He was unable to perform Bal, H. S., Jehangir, S. and Kurian, J. J. active wrist and finger dorsiflexion. A CT A giant lymphangioma of the body wall subsequently revealed a grade 2 splenic in a child: a heavy companion laceration. The splenic laceration was BMJ Case Rep; 2014, 2014 treated conservatively. As his general condition improved, he was gradually Address: Department of Paediatric weaned off the ventilator and his left Surgery, Christian Medical College, upper limb neurology was reassessed. He had isolated radial nerve palsy with Vellore, Tamil Nadu, India. an otherwise intact brachial plexus. He INTL underwent internal fixation of the PMID:25427931 PMCID: clavicle and the humerus. At 4 months CO after injury the EMG/NCV report showed Banerji, J. S. and George, A. J. signs of renervation of the radial nerve, Total ureterectomy and ileal ureteric and the fracture progressed to an replacement for TCC ureter in a solitary uneventful union. This prior unreported kidney triad of scapulothoracic dissociation with Can Urol Assoc J; 2014, 8 (11-12): ipsilateral clavicular and humeral E938-40 fractures may represent a parody. An apparent increase in the severity of Address:Christian Medical College, skeletal injury was associated with a Vellore, India; ; Virginia Mason Medical paradoxical decrease in the severity of Center, Seattle, Washington. neurovascular injury. We report this Christian Medical College, Vellore, India; case to create awareness among orthopedic surgeons and emergency Traditional treatment of upper tract physicians about the clinical presentation transitional cell carcinoma (TCC) is of such injuries nephroureterectomy with a bladder cuff. INTL This is in keeping with the nature of the PMID:25140262 PMCID:4129962 disease, in that TCC is a panurothelial CO disease. However, there are a few rare occasions when this would mean making Arora, R., John, N. T. and Kumar, S. a subject anephric, as in a TCC in a Vesicourethral fistula after retrograde solitary kidney or bilateral primary endoscopic realignment in synchronous/metachronous disease. We posterior urethral injury present a case of a patient with a Urology; 2015, 85 (1): e1-2 dysplastic, poorly functioning left kidney and with a TCC of the ureter on the right Address:Department of Urology, side. Christian Medical College, Vellore, Tamil INTL Nadu, India. Electronic Address: PMID:25553174 PMCID: [email protected]. CO
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Banerji, J. S., Devasia, A., Kekre, N. S. INTL and Chacko, N. PMID: 25366250 PMCID: Early urinary diversion with ileal conduit CO and vesicovaginostomy in the treatment of radiation cystitis due to carcinoma Bhatt, A. A., Mathews, S. S., Kumari, A. cervix: a study from a tertiary care and Paul, T. V. hospital in South India Tumour-induced osteomalacia ANZ J Surg; 2014, Hong Kong Med J; 2014, 20 (4): 350 e1- 2 Address: Department of Urology, Christian Medical College, Vellore, India. Address: Department of Endocrinology, Diabetes and Metabolism, Christian BACKGROUND: To study the magnitude Medical College, Vellore 632 004, India. of radiation cystitis following radiation Department of ENT, Christian Medical therapy for carcinoma cervix, and College, Vellore 632 004, India. propose an algorithm to decide on early Department of General Pathology, diversion, with or without Christian Medical College, Vellore 632 vesicovaginostomy. METHODS: Women 004, India who developed radiation cystitis INTL following radiotherapy for carcinoma PMID: 25104013 PMCID: cervix from January 1998 to December CO 2011 were included in this retrospective study. Electronic hospital records were analysed to document the presence of Bhatt, A. D., Joel, A. and Chacko, R. radiation cystitis. All women who Lesser known evil of a commonly used developed evidence of radiation-induced devil-bleomycin induced flagellate cystitis, according to the common dermatitis toxicity and Radiation Therapy Oncology Indian Dermatol Online J; 2014, 5 (4): Group criteria, were included in the 517 study. We looked at transfusion requirements, number of hospital Address: Department of Medical admissions, quality of life and cost Oncology, Christian Medical College, involved. Chi-square tests were done Vellore, Tamil Nadu, India. where applicable. SPSS version 16 was NAT used for analysis. RESULTS: Of the 902 PMID: 25396145 PMCID:4228657 patients who received radiation for CO carcinoma cervix in the 13-year period, 62 (6.87%) developed grade 3/4 Banerji, J. S., Devasia, A., Kekre, N. S. cystitis. Twenty-eight of them and Chacko, N. underwent ileal conduit diversion, with Early urinary diversion with ileal conduit 18 undergoing concomitant and vesicovaginostomy in the treatment vesicovaginostomy. When compared of radiation cystitis due to carcinoma with the patients who did not have cervix: a study from a tertiary care diversion, the transfusion requirements, hospital in South India number of hospital admissions and ANZ J Surg; 2014, quality of life had a statistically significant difference. Cost analysis of Address: Department of Urology, early diversion too showed a marginal Christian Medical College, Vellore, India. benefit with early diversion. The limitation of the study was that it was BACKGROUND: To study the magnitude retrospective in nature. CONCLUSION: of radiation cystitis following radiation In radiation cystitis, multiple hospital therapy for carcinoma cervix, and admissions and consequential increase propose an algorithm to decide on early in cost is the norm. In severe disease, diversion, with or without early diversion is a prudent, cost- vesicovaginostomy. METHODS: Women effective approach with good quality of who developed radiation cystitis life and early return to normal activity following radiotherapy for carcinoma
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cervix from January 1998 to December CO 2011 were included in this retrospective study. Electronic hospital records were Bhatt, A. D., Joel, A. and Chacko, R. analysed to document the presence of Lesser known evil of a commonly used radiation cystitis. All women who devil-bleomycin induced flagellate developed evidence of radiation-induced dermatitis cystitis, according to the common Indian Dermatol Online J; 2014, 5 (4): toxicity and Radiation Therapy Oncology 517 Group criteria, were included in the study. We looked at transfusion Address:Department of Medical requirements, number of hospital Oncology, Christian Medical College, admissions, quality of life and cost Vellore, Tamil Nadu, India. involved. Chi-square tests were done NAT where applicable. SPSS version 16 was PMID:25396145 PMCID:4228657 used for analysis. RESULTS: Of the 902 CO patients who received radiation for
carcinoma cervix in the 13-year period, Bhide, R. P., Solomons, C., 62 (6.87%) developed grade 3/4 Devsahayam, S. and Tharion, G. cystitis. Twenty-eight of them Exercise and gait training in persons underwent ileal conduit diversion, with with paraplegia and its effect on muscle 18 undergoing concomitant properties vesicovaginostomy. When compared J Back Musculoskelet Rehabil; 2014, with the patients who did not have
diversion, the transfusion requirements, Address:Clinical Fellow, Division of number of hospital admissions and Physiatry, Department of Medicine, quality of life had a statistically University of Toronto, Toronto, ON, significant difference. Cost analysis of Canada. early diversion too showed a marginal Department of Bioengineering, Christian benefit with early diversion. The Medical College, Vellore, Tamil Nadu, limitation of the study was that it was India. retrospective in nature. CONCLUSION: Department of Physical Medicine and In radiation cystitis, multiple hospital Rehabilitation, Christian Medical College, admissions and consequential increase Vellore, Tamil Nadu, India. in cost is the norm. In severe disease,
early diversion is a prudent, cost- BACKGROUND: Upper extremity effective approach with good quality of strengthening and gait training with life and early return to normal activity orthoses form a major part of inpatient INTL rehabilitation of paraplegic patients in PMID:25366250 PMCID: developing countries. This helps to CO overcome architectural barriers and limited wheelchair accessible Bhatt, A. A., Mathews, S. S., Kumari, A. environment in the community. and Paul, T. V. OBJECTIVES: To evaluate the changes in Tumour-induced osteomalacia physiological properties of the Triceps Hong Kong Med J; 2014, 20 (4): 350 e1- Brachii muscle following exercise 2 training in individuals with paraplegia. The authors also explored the correlation Address:Department of Endocrinology, between muscle property changes and Diabetes and Metabolism, Christian gait parameters using orthoses in Medical College, Vellore 632 004, India. paraplegic persons. METHODS: Twelve Department of ENT, Christian Medical subjects with complete paraplegia and College, Vellore 632 004, India. neurological level of injury (NLI) from T9 Department of General Pathology, to L1, underwent exercise training for a Christian Medical College, Vellore 632 mean 64.1 +/- 4.1 days. Triceps brachii 004, India was chosen as the sample muscle. INTL Variables like arm circumference, time to PMID:25104013 PMCID: fatigue and mean power frequency (MF)
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(surface EMG parameter), were recorded limbs for 1 year. Histopathology of the at the beginning and the end of training, skin showed dense lymphoid infiltrate during a voluntary sub-maximal from dermis to subcutaneous fat. isometric elbow extension. Non- Immunohistochemistry of this lymphoid parametric tests were used to assess infiltrate was CD3, CD8, CD56, CD57, statistical significance between the two Granzyme B, TIA, and Epstein Barr virus recordings. Additionally, gait parameters LMP1. The histopathology and like walking speed and distance (with immunohistochemistry were consistent the help of orthoses) were obtained and with the diagnosis of hydroa compared with the above variables, to vacciniforme-like T-cell lymphoma. The determine impact of upper extremity child responded remarkably to oral strengthening on gait improvements in steroids but relapsed on tapering doses. such patients. RESULTS: Statistically CHOP (Cyclophosphamide, Adriamycin, significant changes were noted in Vincristine, and Prednisolone) bilateral arm circumferences (p=0.003 chemotherapy was initiated in view of bilaterally) and MF drop, expressed as systemic involvement to which he percentage (right p=0.04, left p=0.01), showed some response, however, the indicative of better muscle resilience and disease relapsed again. He then had a adaptation. Significant positive rapidly progressive disease and correlation was observed between `time ultimately succumbed to his illness. This to fatigue' and the orthoses-aided total is the first case of hydroa vacciniforme- walking distance (right rho=0.65, left like T-cell lymphoma being reported rho=0.69). CONCLUSIONS: Exercise from this subcontinent. training induces noticeable changes in INTL the muscles of upper extremities PMID:25072366 PMCID: favoring better muscle adaptation. CO Furthermore, positive correlation between 'time to fatigue' and (orthotic) Chaturvedi, S., Lipszyc, D. H., Licht, aided walking distance highlights the C., Craig, J. C. and Parekh, R. positive impact of strengthening Pharmacological interventions for program on gait parameters in hypertension in children paraplegic patients. These findings are Evid Based Child Health; 2014, 9 (3): important and relevant in developing 498-580 countries with environmental barriers. Upper extremity strengthening should be Address:Department of Paediatrics, included in the rehabilitation of Christian Medical College, Vellore, India. paraplegic patients who are being [email protected]. trained for ambulation with orthoses. INTL BACKGROUND: Hypertension is a major PMID:25547234 PMCID: risk factor for stroke, coronary artery CO disease and kidney damage in adults. There is a paucity of data on the long- Boddu, D., George, R., Nair, S., Bindra, term sequelae of persistent hypertension M. and L, G. Mathew in children, but it is known that children Hydroa Vacciniforme-Like Lymphoma: A with hypertension have evidence of end Case Report From India organ damage and are at risk of J Pediatr Hematol Oncol; 2014, hypertension into adulthood. The prevalence of hypertension in children is Address:Department of *Pediatrics rising, most likely due to a concurrent daggerDermatology double rise in obesity rates. In children with daggerPathology, Christian Medical hypertension, non-pharmacological College, Vellore, India. measures are often recommended as first-line therapy, but a significant We report a 14-year-old Indian boy who proportion of children will eventually presented with a history of weight loss, require pharmacological treatment to fever, facial edema, and a relapsing reduce blood pressure, especially those papulovesicular eruption on the face and with evidence of end organ damage at
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presentation or during follow-up. A enzyme inhibitor with an angiotensin systematic review of the effects of receptor blocker. No randomised trial antihypertensive agents in children has was identified that evaluated the not previously been conducted. effectiveness of antihypertensive OBJECTIVES: To determine the dose- medications on target end organ related effects of different classes of damage. The trials were of variable antihypertensive medications, as quality and most were funded by monotherapy compared to placebo; as pharmaceutical companies. Among the combination therapy compared to angiotensin receptor blockers, placebo or a single medication; or in candesartan (one trial, n = 240), when comparisons of various doses within the compared to placebo, reduced systolic same class, on systolic or diastolic blood blood pressure by 6.50 mmHg (95% pressure (or both) in children with confidence interval (CI) -9.44 to -3.56) hypertension. SEARCH METHODS: We and diastolic blood pressure by 5.50 searched the Cochrane Hypertension mmHg (95% CI -9.62 to -1.38) (low- Group Specialised Register, the quality evidence). High dose telmisartan Cochrane Central Register of Controlled (one trial, n = 76), when compared to Trials (CENTRAL) (2013, Issue 9), Ovid placebo, reduced systolic blood pressure MEDLINE (1946 to October 2013), Ovid by -8.50 (95% CI -13.79 to -3.21) but EMBASE (1974 to October 2013) and not diastolic blood pressure (-4.80, 95% bibliographic citations. SELECTION CI -9.50 to 0.10) (low-quality evidence). CRITERIA: The selection criteria were Beta blocker (metoprolol, one trial, n = deliberately broad due to there being 140), when compared with placebo , few clinical trials in children. We included significantly reduced systolic blood randomised controlled trials (RCTs) of at pressure by 4.20 mmHg (95% CI -8.12 least two weeks duration comparing to -0.28) but not diastolic blood pressure antihypertensive agents either as (-3.20 mmHg 95% CI -7.12 to 0.72) monotherapy or combination therapy (low-quality evidence). Beta with either placebo or another blocker/diuretic combination medication, or comparing different doses (Bisoprolol/hydrochlorothiazide, one of the same medication, in children with trial, n = 94)when compared with hypertension. Hypertension was defined placebo , did not result in a significant as an average (over a minimum of three reduction in systolic blood pressure (-4.0 readings) systolic or diastolic blood mmHg, 95% CI -8.99 to -0.19) but did pressure (or both) on the 95(th) have an effect on diastolic blood percentile or above for age, height and pressure (-4.50 mmHg, 95% CI -8.26 to gender. DATA COLLECTION AND -0.74) (low-quality evidence). Calcium ANALYSIS: Two authors independently channel blocker (extended-release selected relevant studies, extracted data felodipine,one trial, n = 133) was not and assessed risk of bias. We effective in reducing systolic blood summarised data, where possible, using pressure (-0.62 mmHg, 95% CI -2.97 to a random-effects model. Formal 1.73) or diastolic blood pressure (-1.86 assessment of heterogeneity was not mmHg, 95% CI -5.23 to 1.51) when possible because of insufficient data. compared with placebo. Further, there MAIN RESULTS: A total of 21 trials was no consistent dose response evaluated antihypertensive medications observed among any of the drug classes. of various drug classes in 3454 The adverse events associated with the hypertensive children with periods of antihypertensive agents were mostly follow-up ranging from three to 24 minor and included headaches, dizziness weeks. There were five RCTs comparing and upper respiratory infections. an antihypertensive drug directly with AUTHORS' CONCLUSIONS: Overall, placebo, 12 dose-finding trials, two trials there are sparse data informing the use comparing calcium channel blockers with of antihypertensive agents in children, angiotensin receptor blockers, one trial with outcomes reported limited to blood comparing a centrally acting alpha pressure and not end organ damage. blocker with a diuretic and one trial The most data are available for comparing an angiotensin-converting candesartan, for which there is low-
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quality evidence of a modest lowering decide about the need for lateral effect on blood pressure. We did not find canthotomy to reduce the transiently evidence of a consistent dose response increased intraorbital pressure. relationship for escalating doses of INTL angiotensin receptor blockers, calcium PMID:25148921 PMCID: channel blockers or angiotensin- CO converting enzyme inhibitors. All agents appear safe, at least in the short term. Chowdhury, S. D., Masih, D., Chawla, INTL G., Pal, S., Kurien, R. T. and Augustine, PMID:25236305 PMCID: J. CO Metastasis of renal cell carcinoma to the duodenal papilla Chiramel, G. K., Keshava, S. N., Moses, Indian J Gastroenterol; 2014, 33 (5): V., Mammen, S., David, S. and Sen, S. 493-4 Percutaneous Sclerotherapy of Congenital Slow-Flow Vascular Address:Department of Malformations of the Orbit Gastroenterology, Christian Medical Cardiovasc Intervent Radiol; 2014, College, Vellore, 632 004, India, Address:Department of Radiology, [email protected] Christian Medical College, Vellore, NAT 632004, Tamil Nadu, India, PMID:24122316 PMCID: [email protected]. CO
PURPOSE: This manuscript describes the Christopher, R. H., David, K. V. and clinical features, imaging findings, Pricilla, R. A. treatment details, and short-term Primary hypoparathyroidism presenting outcomes of a series of congenital slow- with new adult onset seizures in family flow vascular malformations. METHODS: practice This was a prospective study of J Family Med Prim Care; 2014, 3 (3): congenital slow-flow vascular 266-8 malformations involving the orbital region treated at a single institution with Address:Department of Family percutaneous sclerotherapy. RESULTS: Medicine, Christian Medical College, Ten patients presented during the study Vellore, Tamil Nadu, India. period, comprising eight venous malformations, one lymphatic Low Cost Effective Care Unit, Christian malformation, and one veno-lymphatic Medical College, Vellore, Tamil Nadu, malformation. Nine patients underwent India. percutaneous sclerotherapy under digital Hypoparathyroidism commonly presents subtraction angiography guidance, of with paresthesias, fatigue, anxiety, which three developed marked rise in muscle cramps and infrequently with intraocular pressure requiring lateral seizures due to hypocalcaemia. Here, we canthotomy. The treatments were present a case of 27-year-old adult performed in the presence of an female presenting with new onset ophthalmologist who measured the convulsions who was subsequently intraorbital pressure during and after the diagnosed to have primary (congenital) procedure. On follow-up, some of the hypoparathyroidism. patients required repeat sessions of INTL sclerotherapy. All patients had PMID:25374867 PMCID:4209685 improvement of symptoms on follow up CO after the procedure. CONCLUSION: Congenital slow-flow vascular malformations of the orbital region are Dangi, A. D., Kumar, R. and Kekre, N. rare lesions that should be treated using S. a multidisciplinary approach. Monitoring Renal arteriovenous malformation with of the intraorbital pressure is required inferior vena caval extension mimicking both during and after the procedure to renal cell carcinoma
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Indian J Urol; 2014, 30 (3): 357-9 site. Surgery remains the treatment of choice as radiotherapy and Address:Department of Urology, chemotherapy have proved to be of Christian Medical College, Vellore, Tamil limited benefit in metastatic disease. Nadu, India. This case reports suggests that Department of Pathology, Christian radiofrequency ablation has the potential Medical College, Vellore, Tamil Nadu, to be a novel and effective treatment India. option in these patients. A young lady presented with complaints INTL of right flank pain and a palpable mass. PMID:25324902 PMCID:4185329 On contrast-enhanced tomography CO (CECT), a renal mass with extension into the inferior vena cava (IVC) - suggestive David VG(1), Yadav B(2), Jeyaseelan of renal cell carcinoma - was diagnosed L(2), Deborah MN(1), Jacob S(1), and she underwent radical nephrectomy Alexander S(1), Varughese S(1), John with en bloc excision of the IVC GT(3). thrombus. Histopathology revealed a Prospective blood pressure benign arteriovenous malformation that measurement in renal transplant had extended into the IVC. recipients. Arteriovenous malformation should Indian J Nephrol. 2014 May;24(3):154- therefore be kept in the list of 60. doi: 10.4103/0971-4065.132006. differentials for a renal mass with IVC extension. NAT Author information: PMID:25097329 PMCID:4120230 (1)Department of Nephrology, Christian CO Medical College/Hospital, Vellore, Tamil Nadu, India. (2)Department of Dasgupta, R., Shetty, S., Keshava, S. Biostatics, Christian Medical N., Gupta, M., Paul, M. J. and Thomas, College/Hospital, Vellore, Tamil Nadu, N. India. (3)Department of Renal Unit, Metastatic parathyroid carcinoma Royal Brisbane and Women's Hospital, treated with radiofrequency ablation: A QLD, Australia. novel therapeutic modality Australas Med J; 2014, 7 (9): 372-5 Blood pressure (BP) control at home is difficult when managed only with office Address:Department of Endocrinology, blood pressure monitoring (OBPM). In Diabetes and Metabolism, Christian this prospective study, the reliability of Medical College, Vellore, India. BP measurements in renal transplant Department of Radiology, Christian patients with OBPM and home blood Medical College, Vellore, India. pressure monitoring (HBPM) was Department of Pathology, Christian compared with ambulatory blood Medical College, Vellore, India. pressure monitoring (ABPM) as the gold Department of Endocrine Surgery, standard. Adult patients who had living- Christian Medical College, Vellore, India. related renal transplantation from March 2007 to February 2008 had BP Parathyroid carcinoma (PCA), accounting measured by two methods; OBPM and for less than one per cent of all ABPM at pretransplantation, 2(nd), endocrine malignancies, is a rare cause 4(th), 6(th), and 9(th) months and all of primary hyperparathyroidism. A the three methods: OBPM, ABPM, and diagnosis of parathyroid carcinoma may HBPM at 6 months after transplantation. be challenging in the presence of A total of 49 patients, age 35 ± 11 localised disease and involves a years, on prednisolone, tacrolimus, and histological diagnosis based on capsular, mycophenolate were evaluated. A total vascular, or perineural invasion or the of 39 were males (79.6%). Systolic BP presence of metastasis. Distant (SBP) and diastolic BP (DBP) measured metastasis remains a rare presentation, by OBPM were higher than HBPM when with the lung being the most common compared with ABPM. When assessed
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using OBPM and awake ABPM, both SBP was 4 years, range being 6 months to and DBP were significantly 23 years. Evaluation revealed overestimated by OBPM with mean opportunistic infections including Giardia difference of 3-12 mm Hg by office SBP lamblia in 31.8 % and Cryptosporidium and 6-8 mm Hg for office DBP. When parvum, Isospora belli, Cytomegalovirus HBPM was compared with mean ABPM at and Aeromonas in 4.5 % each. Serum 6 months both the SBP and DBP were globulins were low in all patients. overestimated by and 7 mm Hg Duodenal biopsy showed paucity of respectively. At 6 months post plasma cells in 45 %, villous atrophy in transplantation, when compared with 35 % and nodular lymphoid hyperplasia ABPM, OBPM was more specific than in 30 % patients. Though uncommon, HBPM in diagnosing hypertension (98% hypogammaglobulinemia is associated specificity, Kappa: 0.88 vs. 89% with GI disease. The possibility of a specificity, Kappa: 0.71). HBPM was primary immunodeficiency should be superior to OBPM in identifying patients considered in patients presenting with GI achieving goal BP (89% specificity, symptoms and low serum globulin. Kappa: 0.71 vs. 50% specificity Kappa: NAT 0.54). In the absence of a gold standard PMID:25352181 PMCID: for comparison the latent class model CO analysis still showed that ABPM was the best tool for diagnosing hypertension Desai, L., Kurien, R. T., Simon, E. G., and monitoring patients reaching Dutta, A. K., Joseph, A. J. and targeted control. OBPM remains an Chowdhury, S. D. important tool for the diagnosis and Hypogammaglobulinemia-associated management of hypertension in renal gastrointestinal disease-A case series transplant recipients. HBPM and ABPM Indian J Gastroenterol; 2014, could be used to achieve BP control. NAT Address:Department of Gastrointestinal PMCID: PMC4127834 PMID: 25120292 Sciences, Christian Medical College, [PubMed] Vellore, 632 004, India. CO Hypogammaglobulinemia, a form of Desai, L., Kurien, R. T., Simon, E. G., primary immunodeficiency, is an Dutta, A. K., Joseph, A. J. and uncommon condition. Gastrointestinal Chowdhury, S. D. (GI) symptoms may be the only Hypogammaglobulinemia-associated presentation. A series of 22 patients who gastrointestinal disease-A case series presented with GI symptoms and were Indian J Gastroenterol; 2014, diagnosed with hypogammaglobulinemia is presented. Chronic diarrhea was the Address:Department of Gastrointestinal presentation in majority (90.9 %) of Sciences, Christian Medical College, patients. Malabsorption was identified in Vellore, 632 004, India. 87.5 % of patients followed by weight loss (59.0 %), abdominal pain (27.2 %), Hypogammaglobulinemia, a form of and oral ulcers (4.5 %). The median primary immunodeficiency, is an duration of symptoms prior to diagnosis uncommon condition. Gastrointestinal was 4 years, range being 6 months to (GI) symptoms may be the only 23 years. Evaluation revealed presentation. A series of 22 patients who opportunistic infections including Giardia presented with GI symptoms and were lamblia in 31.8 % and Cryptosporidium diagnosed with hypogammaglobulinemia parvum, Isospora belli, Cytomegalovirus is presented. Chronic diarrhea was the and Aeromonas in 4.5 % each. Serum presentation in majority (90.9 %) of globulins were low in all patients. patients. Malabsorption was identified in Duodenal biopsy showed paucity of 87.5 % of patients followed by weight plasma cells in 45 %, villous atrophy in loss (59.0 %), abdominal pain (27.2 %), 35 % and nodular lymphoid hyperplasia and oral ulcers (4.5 %). The median in 30 % patients. Though uncommon, duration of symptoms prior to diagnosis hypogammaglobulinemia is associated
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with GI disease. The possibility of a required mechanical ventilation for 4-14 primary immunodeficiency should be days. All patients were treated with considered in patients presenting with GI methylene blue; 4 received more than symptoms and low serum globulin. one dose. Three patients also received NAT intravenous ascorbic acid 500 mg, once PMID:25352181 PMCID: daily, for 3 days. Following treatment, CO there was evidence of haemolysis in all patients; 2 required blood transfusion. D'sa S, R., Victor, P., Jagannati, M., All patients survived. CONCLUSION: Sudarsan, T. I., Carey, R. A. and Peter, Patients with severe toxin-induced J. V. methemoglobinemia present with altered Severe methemoglobinemia due to sensorium and cyanosis and may require ingestion of toxicants ventilatory support and inotropes. Clin Toxicol (Phila); 2014, 52 (8): 897- Though methemoglobin concentrations 900 greater than 70% are considered fatal, aggressive management with methylene Address:Department of Critical Care, blue and supportive therapy can lead to Christian Medical College and Hospital , survival. Vellore , India. INTL PMID:25116418 PMCID: BACKGROUND: Toxin-induced CO methemoglobinemia is seen in poisoning with oxidizing agents. We report the Ganapule, A. P., Gupta, M., Kokil, G. clinical features and outcome of patients and Viswabandya, A. admitted with severe Histiocytic sarcoma with acute methemoglobinemia due to intentional lymphoblastic leukemia a rare ingestion of toxicants. METHODS: In this association: case report and literature observational case series, patients review admitted with toxin-induced Indian J Hematol Blood Transfus; 2014, methemoglobinemia between September 30 (Suppl 1): 305-8 2011 and January 2014 were identified from the institutional poisoning Address:Department of Haematology, database. Clinical profile and outcome of Christian Medical College and Hospital, patients with methemoglobin Ida Scudder Road, Vellore, 632004 concentration greater than or equal to Tamil Nadu India. 49% is reported. RESULTS: Of the 824 Department of Pathology, Christian patients admitted with poisoning, 5 Medical College and Hospital, Ida patients with methemoglobin Scudder Road, Vellore, 632004 Tamil concentration greater than or equal to Nadu India. 49% were included. The implicated compounds were nitrobenzene, Definition and diagnostic criteria for benzoylphenylurea, flubendamide and histiocytic sarcoma (HS) have changed Rishab(TM). One patient refused to over last two decades due to available name the compound. All patients were new immunohistochemical markers, as managed in the intensive care unit. well as better understanding of the Altered sensorium [Glasgow coma scale biology of disease. We report here a (GCS) < 10] was common (80%); 2 case of 4 years old boy diagnosed as patients presented with a GCS greater acute lymphoblastic leukemia (ALL), who than 4. All patients manifested cyanosis, later developed HS of pleura, when he low oxygen saturation and chocolate- was on maintenance phase of ALL brown-colored blood despite protocol. HS constitutes less than 1 % of supplemental oxygen therapy. The the haematolymphoid neoplasm, even median methemoglobin concentration more rare is association of HS with ALL. was 64.7% (range 49.8-91.6%); 2 Thus reporting here a rare association of patients had methemoglobin HS with ALL, will help in knowing the concentration greater than 70%. One actual incidence of HS as well as patient needed inotropes. Four patients association with ALL
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NAT Address: Assistant Professor, PMID:25332605 PMCID:4192204 Department of Haematology, Christian CO Medical College and Hospital , Vellore, Tamil Nadu, India . Ganapule, A. P., Tavaavaava, V. S., Professor, Department of Haematology, Kumar, R. M., T, J. N. and Viswabandya, Christian Medical College and Hospital , A. Vellore, Tamil Nadu, India . Synchronous presentation of chronic Assistant Professor, Department of myeloid leukemia with carcinoma penis: Radiology, Christian Medical College and a rare presentation Hospital , Vellore, Tamil Nadu, India . J Clin Diagn Res; 2014, 8 (9): QD01-2 Assistant Professor, Department of Address:Assistant Professor, Pathology, Christian Medical College and Department of Haematology, Chrisitan Hospital , Vellore, Tamil Nadu, India . Medical College , Vellore, India . Fellow In Haematopathology, Professor, Head Cytogenetics, Department of Pathology, Christian Department of Pathology, Chrisitan Medical College and Hospital , Vellore, Medical College , Vellore, India . Tamil Nadu, India . Associate Professor, Department of Pathology, Chrisitan Medical College , Granulocytic sarcoma occurs most Vellore, India . commonly in acute myelogenous Associate Professor, Department of leukemia. The appearance of Urology, Chrisitan Medical College , granulocytic sarcoma in chronic Vellore, India . myelogenous leukemia signals Professor, Department of Haematology, accelerated phase/ blast transformation. Chrisitan Medical College , Vellore, India This is a rare case of undiagnosed We report here a case of 52-year-old chronic myelogenous leukemia with male presenting with penile ulcer. On granulocytic sarcoma causing cord evaluation, he was diagnosed to have compression, which went into tumour Carcinoma penis with concurrent CML in lysis syndrome requiring dialysis after chronic phase. Clinical examination starting of steroids and radiotherapy. A showed pallor, bilateral inguinal 43-year-old male presented in lymphadenopathy, bilateral pitting pedal oedema and hepatosplenomegaly. He emergency department with acute onset was diagnosed to have chronic myeloid of flaccid paralysis. On clinical leukemia based on peripheral smear examination, there was examination showing raised counts with hepatosplenomegaly and lower motor shift to left and fluorescence in situ neuron paralysis in the lower limbs. The hydridisation (FISH) showing t (9:22). peripheral smear was consistent with The ilio-inguinal block dissection chronic myelogenous leukemia in chronic specimen showed inguinal metastasis of squamous cell carcinoma (SCC). This phase. The MRI spine revealed para- case is being presented here in view of spinal and epidural masses causing cord the rarity in combination of CML with compression and the biopsy from the another malignancy. paraspinal mass was consistent with INTL granulocytic sarcoma. PMID:25386499 PMCID:4225951 INTL CO PMID:25177619 PMCID:4149125 CO Ganapule, A. P., Viswabandya, A.,
Jasper, A., Patel, P. and Kokil, G. Gangadharan, S., Rathinam, B. and Granulocytic sarcoma with compressive Madhuri, V. myelopathy: a rare presentation of Radial nerve safety in Dorgan's lateral chronic myelogenous leukemia cross-pinning of the supracondylar J Clin Diagn Res; 2014, 8 (7): QD03-4 humeral fracture in children: a case
report and cadaveric study
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J Pediatr Orthop B; 2014, 23 (6): 579- biopsies, which helped to exclude GvHD. 83 The skin lesions responded well to treatment with acitretin. Psoriasis should Address:Paediatric Orthopaedics Unit, be considered in the differential Department of Orthopaedics, Christian diagnosis of skin rash following SCT. Medical College, Vellore, Tamil Nadu, INTL India. PMID:25472781 PMCID: CO We encountered an iatrogenic radial nerve injury following Dorgan's lateral Gopalakrishnan, R., Thangadurai, P., cross-pinning in a 5-year-old girl with a Kuruvilla, A. and Jacob, K. S. supracondylar fracture of the humerus. Situational psychogenic anejaculation: a This prompted a cadaveric study to case study Indian J Psychol Med; 2014, 36 (3): define a safe entry point for the proximal 329-31 lateral Kirschner -wire. A child's cadaveric humerus was pinned laterally Address:Department of Psychiatry, in three coronal planes, simulating the Christian Medical College, Vellore, Tamil proximal entry pin. The radial nerve lay Nadu, India. farthest from the wire in the posterolateral plane, 1 and 2 cm Anejaculation is an uncommon clinical entity that may result from a variety of proximal to the lateral epicondyle. We causes, both organic and psychological. report the first incidence of radial nerve Psychogenic anejaculation is influenced injury with lateral cross-pinning and by relationship, behavioral, and suggest that the wire should be placed psychological factors. We present a posterolaterally within 2 cm from the clinical case of situational anejaculation, lateral epicondyle. which was managed with a combination INTL of techniques that addressed these factors including changes in PMID:25238330 PMCID: masturbatory technique, improved CO marital communication and quality, and reduction of anxiety using cognitive George, L., Mathews, V., George, B., behavioral techniques. It is suggested Thomas, M. and Pulimood, S. A. that the standard techniques of sex Generalized pustular psoriasis following therapy be modified and tailored to allogeneic stem cell transplantation manage the specific problems of the Clin Exp Dermatol; 2014, individual patient NAT Address:Department of Dermatology, PMID:25035564 PMCID:4100426 Christian Medical College, Vellore, Tamil CO Nadu, India.
Development of psoriasis following Gouse, M., Jayasankar, V. and allogeneic stem cell transplantation Alexander, M. (SCT) is rare, and has been described An unusual presentation of primary once previously, following SCT from a lymphoma of the ilium sibling donor with psoriasis. This Case Rep Med; 2014, 2014 509837 condition should be differentiated from psoriasiform graft-versus-host disease Address:Department of Orthopaedics, (GvHD) by histopathology. We describe Unit 1, Christian Medical College, a 9-year-old boy who developed Vellore, India. generalized pustular psoriasis 2 months Department of Pathology, Christian after allogeneic SCT from an HLA- Medical College, Vellore, India. identical sibling donor with no history of psoriasis. Diagnosis was confirmed by Primary bone lymphoma involving the clinical features and multiple skin pelvic bone is a rare entity. It does not
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have distinct clinical features or subcontinent. We describe the clinical radiological features that are diagnostic. profile, organ dysfunction, and Biopsy is the gold standard predictors of mortality of severe scrub investigation. We present a case of typhus infection. MATERIALS AND primary pelvic lymphoma with initial METHODS: Retrospective study of histopathological features of chronic patients admitted with scrub typhus osteomyelitis. Upon further clinical infection to a tertiary care university follow-up, repeat biopsy of the lesion affiliated teaching hospital in India revealed features of B-cell Non- during a 21-month period. RESULTS: Hodgkin's lymphoma, thus emphasizing The cohort (n = 116) aged 40.0 +/- the need for a high index of suspicion 15.2 years (mean +/- SD), presented and close clinical follow-up. This case is 8.5 +/- 4.4 days after symptom onset. presented for the diagnostic dilemma Common symptoms included fever and the unique feature of lymphomatous (100%), breathlessness (68.5%), and lesion mimicking chronic osteomyelitis in altered mental status (25.5%). Forty- its early stages. seven (41.6%) patients had an eschar. INTL Admission APACHE-II score was 19.6 PMID:25276142 PMCID:4170923 +/- 8.2. Ninety-one (85.2%) patients CO had dysfunction of 3 or more organ systems. Respiratory (96.6%) and Griffith, M., Peter, J. V., Karthik, G., hematological (86.2%) dysfunction were Ramakrishna, K., Prakash, J. A., Kalki, frequent. Mechanical ventilation was R. C., Varghese, G. M., Chrispal, A., Pichamuthu, K., Iyyadurai, R. and required in 102 (87.9%) patients, of Abraham, O. C. whom 14 (12.1%) were solely managed Profile of organ dysfunction and with non-invasive ventilation. Thirteen predictors of mortality in severe scrub patients (11.2%) required dialysis. typhus infection requiring intensive care Duration of hospital stay was 10.7 +/- admission 9.7 days. Actual hospital mortality Indian J Crit Care Med; 2014, 18 (8): (24.1%) was less than predicted 497-502 APACHE-II mortality (36%; 95% Address:Department of Internal Confidence interval 32-41). APACHE-II Medicine, University of Colorado, score and duration of fever were Colorada, USA. independently associated with mortality Department of Critical Care, Associate on logistic regression analysis. Professor, Medical Intensive Care Unit, CONCLUSIONS: In this cohort of severe Christian Medical College Hospital, scrub typhus infection with multi-organ Vellore, Tamil Nadu, India. Department of Critical Care, Registrar, dysfunction, survival was good despite Medical Intensive Care Unit, Christian high severity of illness scores. APACHE- Medical College Hospital, Vellore, Tamil II score and duration of fever Nadu, India. independently predicted mortality Department of Microbiology, Christian NAT Medical College Hospital, Vellore, Tamil PMID:25136187 PMCID:4134622 Nadu, India. CO Department of Medicine, Christian Medical College Hospital, Vellore, Tamil Nadu, India. Hooda, A., Pati, P. K., John, B., George, P. V. and Michael, J. S. BACKGROUND AND AIMS: Scrub typhus, Disseminated Mycobacterium chelonae infection causing pacemaker lead a zoonotic rickettsial infection, is an endocarditis in an immunocompetent important reason for intensive care unit host (ICU) admission in the Indian BMJ Case Rep; 2014, 2014
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Research Digest Christian Medical College, Vellore
Address:Department of Cardiology, revealed an abdominal sponge Christian Medical College Hospital, surrounded by foreign body granuloma Vellore, Tamil Nadu, India. adherent to surrounding structures. Department of Microbiology, Christian Gossypiboma can mimic a tumor and is Medical College, Vellore, Tamil Nadu, a diagnostic challenge. India. INTL PMID:25123428 PMCID: Pacemaker infection with Mycobacterium CO chelonae has not been reported previously. We Jasper, A. and Keshava, S. N. report the first case of pacemaker lead Aortic coarctation associated with an endocarditis due to M. chelonae, which absent segment of the proximal right was successfully treated with multidrug subclavian artery regimen. M. chelonae is regarded as an J Postgrad Med; 2014, 60 (4): 397-9 environmental bacterium and its pathogenicity has been recognised Address:Department of Radiology, recently. The present case illustrates its Christian Medical College, Vellore, Tamil ability as a primary invader should not Nadu, India. be underestimated, especially in an Coarctation of the aorta is a congenital immunocompetent patient with anomaly of the thoracic aorta with many indwelling devices. Epidemiology and management of this rare cause of known associations. We describe the culture-negative endocarditis is case of a young man referred for discussed. management of subarachnoid INTL hemorrhage, in whom subsequent work- PMID:25535221 PMCID: up revealed the previously undescribed CO combination of severe postductal aortic coarctation and an absent segment of Jacob Philip George, A., Mukha, R. P. the proximal right subclavian artery and Kekre, N. S. NAT Gossypiboma mimicking a retroperitoneal tumor PMID:25370550 PMCID: Urology; 2014, 84 (4): e13-4 CO
Address:Department of Urology Unit 1, Jehangir, S., John, J., Rajkumar, S., Christian Medical College and Hospital Mani, B., Srinivasan, R. and Kang, G. Vellore, Vellore Town, Tamil Nadu, India. Intussusception in southern India: Electronic Address: comparison of retrospective analysis and [email protected]. active surveillance Department of Urology Unit 2, Christian Vaccine; 2014, 32 Suppl 1 A99-103 Medical College and Hospital Vellore, Vellore Town, Tamil Nadu, India. Address:Department of Pediatric "Gossypiboma" denotes a mass of cotton Surgery, Christian Medical College, that is retained in the body after Vellore, India. surgery. An image is presented of a Department of Community Health, retroperitoneal mass in a lady who had a Christian Medical College, Vellore, India. right nephrectomy 8 years earlier for a Division of Gastrointestinal Sciences, nonfunctioning kidney. Clinical Christian Medical College, Vellore, India. examination and plain abdominal Department of Radiology, Christian radiography were not contributory. Medical College, Vellore, India. Contrast-enhanced abdominal computed Division of Gastrointestinal Sciences, tomography revealed a well-defined, Christian Medical College, Vellore, India. heterogeneous, spherical, soft-tissue Electronic Address: mass, 13 x 9 x 9 cm in size, in the [email protected]. retroperitoneum, with a dense enhanced wall, abutting the right psoas and Surveillance for intussusception is a post posterior abdominal wall. Exploration marketing requirement for rotavirus
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Research Digest Christian Medical College, Vellore
vaccines following observation of a small INTL increased risk of intussusception after PMID:25091689 PMCID: rotavirus vaccination in some global CO settings. This study presents the clinical presentation and outcomes of children Jena SS(1), Mathew A, Sanjith A, Ajith who presented with intussusception at a S, Nair BR, Prakash J. large tertiary care facility directly (non- Cerebral venous sinus thrombosis surveillance) as retrospective analysis of presentation in severe scrub typhus a period where rotavirus vaccine was not infection: a rare entity. in routine use, or as part of active Neurol India. 2014 May-Jun;62(3):308- surveillance in a phase III oral rotavirus 10. doi: 10.4103/0028-3886.136991. vaccine trial. Hospital records of children under 2 years of age treated for Author information:(1)Department of intussusception between 1 January 2010 Neurological Sciences, Christian Medical and 31 August 2013 at the Christian College, Vellore, Medical College Hospital, Vellore, India, TamilNadu, India. were reviewed. Sixty-one cases of NAT intussusception in children under two PMID:25033856 [PubMed - indexed for years of age presented at the hospital. An additional 16 cases of ultrasound MEDLINE] diagnosed intussusception were CO identified through the active surveillance of a cohort of 1500 children participating Jha, A., Abhilash, K. P., in a rotavirus phase III trial in the same Bandhyopadhyay, R. and Victor, P. J. period. In the nonsurveillance group, Hypoglycemia - A rare complication of median age at presentation was 214 carbamazepine overdose days (IQR 153-321) with 52 events Indian J Pharmacol; 2014, 46 (6): 651-2 (85.3%) occurring in the first year of life. Cases were seen year-round with no Address:Medical Intensive Care Unit, definitive evidence of seasonality. Christian Medical College, Vellore, Tamil Thirty-one (50.8%) intussusceptions Nadu, India. required surgical reduction, 26 (42.6%) Department of General Medicine, had pneumatic reduction and 2 (3.3%) Christian Medical College, Vellore, Tamil barium enema reduction. Two Nadu, India. intussusceptions (3.3%) resolved spontaneously. There were no deaths, Carbamazepine overdose usually all children were discharged after presents with neurological recovery. Active surveillance identified manifestations such as ataxia, seizures 16 children with a median age at event and altered sensorium or cardiac of 375 days (IQR 248-574). Nine (56%) manifestations that include tachycardia, children had small bowel or transient intussusception that resolved hypotension and ventricular extra- spontaneously. Seven intussusceptions systoles. We report a patient with were reduced radiologically; none carbamazepine overdose who required surgery. In summary, there manifested recurrent hypoglycemia on were significant differences between the third and fourth day following presentation and outcomes in cases of ingestion that resolved with supportive intussusception identified by passive and therapy. active surveillance, likely related to enhanced and early detection of NAT intussusception through active PMID:25538340 PMCID:4264084 monitoring in the trial. The WHO CO recommendation of sentinel hospital based surveillance for post-marketing John RR(1), Lionel AP(1), Sitaram V(2), surveillance after rotavirus vaccine Mathew LG(1). introduction is likely to a better Liver metastasis in an adolescent treated approach than active surveillance. for third ventricle germ cell tumor.
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Indian J Med Paediatr Oncol. 2014 metaphyseal widening and loss of Apr;35(2):181-3. doi: 10.4103/0971- diaphyseal constriction. All cases 5851.138999. dramatically responded to oral steroid
and no longer needed blood transfusion. Author information: (1)Pediatric Hematology-Oncology, They required steroid at low doses for Pediatrics I, Division of Child Health, long term (up to 5 y). GHDD is easy to Vellore, Tamil Nadu, India. diagnose with long-bone radiography (2)Department of Hepatic Pancreatic and and consistently responds to steroid. It Biliary Surgery, Christian Medical should therefore be considered as a College, Vellore, Tamil Nadu, India. differential diagnosis of unusual anemia
in early childhood, especially in children Systemic dissemination of intracranial from the Middle East or the Indian germ cell tumors (GCTs) occur only in subcontinent. 3% of cases and the common sites are INTL bone, lungs, and lymph nodes. PMID:25374284 PMCID: Metastasis to the liver is rare. As far as CO we could find, only six cases of liver
metastasis of intracranial GCTs have Johnson, S., Sathyaseelan, M., Charles, been reported so far. We report an H., Jeyaseelan, V. and Jacob, K. S. adolescent girl who presented with Predictors of insight in first-episode hepatic relapse 2½ years after schizophrenia: a 5-year cohort study successful completion of treatment of from India intracranial GCT. She was treated with Int J Soc Psychiatry; 2014, 60 (6): 566- 74 chemotherapy and right hepatectomy
and is doing well 30 months after Address:Department of Psychiatric treatment for the metastatic disease. Nursing College of Nursing, Christian NAT Medical College, Vellore, India. PMCID: PMC4152639 PMID: 25197184 Department of Biostatistics, Psychiatry, [PubMed] Christian Medical College, Vellore, India. CO Department of Psychiatry, Christian John, R. R., Boddu, D., Chaudhary, N., Medical College, Vellore, India Yadav, V. K. and Mathew, L. G. [email protected]. Steroid-responsive Anemia in Patients of BACKGROUND AND AIMS: There is a Ghosal Hematodiaphyseal Dysplasia: dearth of data on the predictors of Simple to Diagnose and Easy to Treat insight in schizophrenia. This study J Pediatr Hematol Oncol; 2014, attempted to assess the predictors of insight in a cohort of first-episode Address:Departments of *Child Health schizophrenia followed up over 5 years. daggerRadiology, Christian Medical METHODS: Patients diagnosed to have College, Vellore, Tamil Nadu, India. Diagnostic and statistical manual of mental disorders (4th ed.; DSM-IV) Ghosal hematodiaphyseal dysplasia schizophrenia (n = 131) were assessed prospectively for insight, (GHDD) is a recently recognized cause psychopathology and explanatory of steroid-responsive anemia. We would models of illness over a 5-year period like to report 3 cases of GHDD who using standard instruments. Multiple presented in early childhood with linear regression and generalized moderate to severe anemia, estimating equations (GEE) were splenomegaly, and a hypocellular employed to assess predictors of insight. marrow with increased reticulin. They RESULTS: We could follow up 95 (72.5%) patients, 5 years after were easily diagnosed with long-bone x- recruitment. A total of 65 of these rays showing diaphyseal and patients interviewed at 60 months
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(68.4%) achieved remission. Cross- PURPOSE: Does transfer of supernatant sectional evaluations suggest a embryo culture fluid (stimulation of relationship between insight, psychosis endometrial embryo transfer - SEET) rating and explanatory models of illness prior to vitrified warmed blastocyst with good insight and medical models associated with good outcome. However, transfer result in better clinical baseline and early illness data do not pregnancy and live birth rates than predict insight scores at 5 years. Serial direct vitrified warmed blastocyst longitudinal assessment of insight is transfer? METHODS: This randomized negatively associated with Brief controlled trial compared SEET group Psychiatric Rating Scale (BPRS) scores and direct transfer group (control) in 60 and positively associated with the women undergoing vitrified warmed number of nonmedical explanatory models of illness held by patients. blastocyst transfers. The duration of the CONCLUSION: These findings argue that study was 3 years. The patients were insight and explanatory models of illness undergoing vitrified warmed blastocyst are secondary to psychopathology, transfer at university level infertility course and outcome. They are centre. Sixty women were randomized dependent on the trajectory of the to SEET (n = 30) or control (n = 30). person's illness, are not independent of RESULTS: Data was available for the condition and call for multifaceted understanding of the issues. analysis from all the 30 women in the INTL SEET group and 30 women in the control PMID:24097842 PMCID: group. There were no drop outs in the CO trial. The implantation rate was significantly lower in the SEET group Joseph, G. and Mathew, A. compared to the control group (27 vs. Corkscrew intravascular channels within 44 %, P = 0.018). The clinical chronic common carotid artery pregnancy rates were similar in both the occlusions in takayasu arteritis that disappear after angioplasty groups (47 vs. 53 %) but the live birth JACC Cardiovasc Interv; 2014, 7 (12): rate was also significantly lower in SEET e193-5 group (23 vs. 50 %, P = 0.03). LIMITATIONS: The sample size based on Address:Department of Cardiology, clinical pregnancy rates was small and Christian Medical College, Vellore, India. hence not adequately powered to detect Electronic Address: differences in live birth rates. Lack of [email protected]. Department of Cardiology, Christian blinding leading to possible bias cannot Medical College, Vellore, India. be ruled out. CONCLUSION: There was INTL no evidence of an improvement in PMID:25457054PMCID: clinical pregnancy rate following SEET in CO vitrified warmed blastocyst transfer Kamath, M. S., Mascarenhas, M., B, K., compared to direct transfer. Vasani, N. N., Joshi, A., K, M. and INTL George, K. PMID:25428435 PMCID: Uterine flushing with supernatant CO embryo culture medium in vitrified
warmed blastocyst transfer cycles: a Kang, G. randomized controlled trial Cryptosporidiosis with and without HIV J Assist Reprod Genet; 2014, infection in India
Trop Parasitol; 2014, 4 (2): 76 Address:Reproductive Medicine Unit,
Christian Medical College Hospital, Address:Division of Gastrointestinal Vellore, Tamil Nadu, 632004, India. Sciences, Christian Medical College,
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Vellore, Tamil Nadu, India. E-mail: Environmental enteric dysfunction: [email protected]. pathogenesis, diagnosis, and clinical INTL consequences PMID:25250225 PMCID:4166806 Clin Infect Dis; 2014, 59 Suppl 4 S207- CO 12
Kapoor, N., Shetty, S., Thomas, N. and Address:Boston University, Paul, T. V. Massachusetts. University of Wilson's disease: An endocrine Washington, Seattle. Johns Hopkins revelation University, Baltimore, Maryland.Boston Indian J Endocrinol Metab; 2014, 18 (6): Children's Hospital, Massachusetts. 855-7 University of Virginia, Charlottesville. St Michael's Hospital, Toronto, Canada. Address:Department of Endocrinology, Tufts University. Massachusetts General Diabetes and Metabolism, Christian Hospital, Boston. Washington University, Medical College and Hospital, Vellore, St Louis. Tamil Nadu, India. Aga Khan University, Karachi, Pakistan. University of the Witwatersrand, Wilson's disease is an inherited disorder Johannesburg, South Africa. Federal of copper metabolism. The affected University of Ceara, Fortaleza, Brazil. patients, who otherwise have a near Christian Medical College, Vellore, India. normal life span, may often suffer from Aga Khan University, Karachi, Pakistan some potentially treatable and under Bill & Melinda Gates Foundation, Seattle, recognized endocrine disorders that may Washington. Bill & Melinda Gates hinder their quality of life. We explored Foundation, Seattle, Washington. previously published literature on the various endocrine aspects of this disease Stunting is common in young children in with their probable underlying developing countries, and is associated mechanisms, highlighting the universal with increased morbidity, developmental need of research in this area. delays, and mortality. Its complex NAT pathogenesis likely involves poor intrauterine and postnatal nutrition, PMID:25364683 PMCID:4192994 exposure to microbes, and the metabolic CO consequences of repeated infections.
Acquired enteropathy affecting both gut Kapoor, N., Shetty, S., Thomas, N. and structure and function likely plays a Paul, T. V. significant role in this outcome, Lingual thyroid associated with especially in the first few months of life, hypothyroidism as a cause for short and serve as a precursor to later stature interactions of infection and BMJ Case Rep; 2014, 2014 malnutrition. However, the lack of
validated clinical diagnostic criteria has Address:Department of Endocrinology, limited the ability to study its role, Christian Medical College, Vellore, Tamil identify causative factors, and determine Nadu, India. cost-effective interventions. This review INTL addresses these issues through a PMID:25398918 PMCID: historical approach, and provides CO recommendations to define and validate a working clinical diagnosis and to guide Keusch, G. T., Denno, D. M., Black, R. critical research in this area to E., Duggan, C., Guerrant, R. L., Lavery, effectively proceed. Prevention of early J. V., Nataro, J. P., Rosenberg, I. H., gut functional changes and inflammation Ryan, E. T., Tarr, P. I., Ward, H., may preclude or mitigate the later Bhutta, Z. A., Coovadia, H., Lima, A., adverse vicious cycle of malnutrition and Ramakrishna, B., Zaidi, A. K., Hay infection. Burgess, D. C. and Brewer, T. INTL PMID:25305288 PMCID:
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Research Digest Christian Medical College, Vellore
CO and BMD were measured. RESULTS: The control group had a significantly higher Korula M daily DCI with mean +/- SD of 396 +/- Placebo analgesia: Does it have a role in 91 mg versus 326 +/- 101 mg (P = pain management? 0.007) and more sunlight exposure of Indian Journal of Pain. 2014 September- 234 +/- 81 vs 167 +/- 69 min (P = December; 28(3):125-8 0.05). BMD at the femoral neck was significantly lower in cases (0.783 +/- Address for correspondence: 0.105 g/cm(2)) when compared to Prof. Mary Korula, Department of controls (0.819 +/- 0.114 g/cm(2)). Anesthesia, Christian Medical College Majority of the patients (61%) had low Hospital, femoral neck BMD (P = 0.04). There was Vellore - 632 004, Tamil Nadu, India. E- no significant difference in the mail: [email protected] proportion of subjects with vitamin D deficiency (<20 ng/mL) between cases NON INDEXED (n = 32) and controls (n = 37) (P = CO 0.234). CONCLUSIONS: Vitamin D deficiency was seen in both the groups Koshy, G., Varghese, R. T., Naik, D., in equal proportions, highlighting the Asha, H. S., Thomas, N., Seshadri, M. existence of a high prevalence of this S., Alexander, M., Thomas, M., Aaron, S. problem in India. Low femoral neck BMD and Paul, T. V. found in cases may stress the need for Derangements in bone mineral supplementing calcium and treating parameters and bone mineral density in vitamin D deficiency in this specific south Indian subjects on antiepileptic group. However, the benefit of such medications intervention has to be studied in a larger Ann Indian Acad Neurol; 2014, 17 (3): proportion of epileptic patients. 272-6 NAT PMID:25221394PMCID:4162011 Address:Department of Endocrinology, CO Diabetes and Metabolism, Unit-III, Christian Medical College, Vellore, Tamil Kumar N(1), Gupta V, Thomas N. Nadu, India. Brownie-nose: hyperpigmentation in Department of Neurological Science, neonatal chikungunya. Unit-III, Christian Medical College, Indian Pediatr. 2014 May;51(5):419. Vellore, Tamil Nadu, India. Author information: (1)Department of BACKGROUND: Although there are Neonatology, CMC Vellore, Tamil Nadu, reports describing the association of India. [email protected]. alternations of bone and mineral NAT metabolism in epileptic patients with PMID: 24953593 [PubMed - in process] long-term anticonvulsant therapy, there CO are only limited Indian studies which have looked at this aspect. OBJECTIVES: This study was done to compare the Kurian, J. J., Kishore, R., John, T. J. prevalence of changes in bone mineral and Parmer, H. parameters and bone mineral density A rare case of kaposiform (BMD) in ambulant individuals on long- hemangioendothelioma presenting as term anticonvulsant therapy with age- intussusception in a 4-month-old child and body mass index (BMI)-matched without Kasabach-Merrit syndrome: A healthy controls. MATERIALS AND case report METHODS: There were 55 men (on J Indian Assoc Pediatr Surg; 2014, 19 medications for more than 6 months) (4): 233-5 and age- and BMI-matched 53 controls. Drug history, dietary calcium intake Address:Department of Paediatric (DCI), and duration of sunlight exposure Surgery, Christian Medical College and were recorded. Bone mineral parameters Hospital, Vellore, Tamil Nadu, India.
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We report the identification of Macroepithelial defects (n = 9), stromal Kaposiform hemangioendothelioma of whitening with epithelial defect (n = 3), the cecum presenting as colocolic and stromal scar (n = 3) were intussusception in a 4-month-old boy infrequent. None developed microbial without Kasabach-Merrit syndrome. To keratitis. On multivariate logistic our knowledge this is the first reported regression analysis, eyelid position (odds case in the literature of such a ratio, 2.93; 95% confidence interval, presentation 1.37-6.25), and ventilation duration INTL (odds ratio, 1.11; 95% confidence PMID:25336808 PMCID:4204251 interval, 1.04-1.19) were strongly CO associated with the development of keratopathy after ICU admission. Kuruvilla, S., Peter, J., David, S., Keratopathy resolved in 3.6 +/- 4.5days. Premkumar, P. S., Ramakrishna, K., CONCLUSIONS: Severe exposure Thomas, L., Vedakumar, M. and Peter, J. keratopathy is infrequent in a V. protocolized ICU setting. Eyelid position Incidence and risk factor evaluation of and duration of ventilation are exposure keratopathy in critically ill associated with exposure keratopathy. patients: A cohort study INTL J Crit Care; 2014, PMID:25468364 PMCID: CO Address:Department of Ophthalmology, Schell hospital, Lepcha, A., Amalanathan, S., Christian Medical College, Vellore, India. Augustine, A. M., Tyagi, A. K. and Balraj, Department of Biostatistics, Christian A. Medical College, Vellore, India. Flunarizine in the prophylaxis of Medical Intensive Care Unit, Christian migrainous vertigo: a randomized Medical College, Vellore, India. controlled trial Medical Intensive Care Unit, Christian Eur Arch Otorhinolaryngol; 2014, 271 Medical College, Vellore, India. (11): 2931-6 Electronic Address: [email protected]. Address:Department of ENT, Unit IV, Christian Medical College and Hospital, PURPOSE: Recent emphasis on eye care Vellore, 632004, Tamilnadu, India, in intensive care unit (ICU) patients has [email protected]. translated to eye assessment being part of routine care. In this setting, we Migrainous vertigo is a common cause of determined the incidence, risk factors, dizziness presenting to an and resolution time of exposure otorhinolaryngology/otoneurology clinic. keratopathy. METHODS: In this Although it causes a substantial burden prospective cohort study, 301 patients to the individual and society there are no were examined within 24 hours of ICU randomized controlled trails on admission and subsequently daily by an prophylactic medication for this ophthalmologist till death or discharge. condition. Flunarizine, a calcium channel Eyelid position, conjunctival and corneal blocker has been used effectively in both changes, treatment, and outcome data migraine and vestibular conditions. This were collected. RESULTS: Admission randomized control trial was undertaken diagnoses included febrile illnesses in a tertiary academic referral center to (35.2%) and respiratory failure evaluate the efficacy of flunarizine in (32.6%); 84.1% were ventilated. Forty- patients with migrainous vertigo when nine patients had exposure keratopathy compared to non-specific vestibular (bilateral = 35, unilateral = 14) at treatment of betahistine and vestibular admission; 35 patients developed new exercises. The effect of flunarizine on onset keratopathy (incidence 13.2%) two particularly disabling symptoms of 4.6 +/- 2.6days after ICU admission. In vertigo and headache was studied. A 67 patients, keratopathy was mild total of 48 patients who were diagnosed (punctate epithelial erosions). with definitive migrainous vertigo
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completed the study of 12 weeks CO duration. Patients in arm A received 10- mg flunarizine daily along with Madhuri, V., Dutt, V., Gahukamble, A. betahistine 16 mg and paracetamol 1 D. and Tharyan, P. gm during episodes, and arm B received Interventions for treating femoral shaft only betahistine and paracetamol during fractures in children and adolescents episodes. Symptom scores were noted Evid Based Child Health; 2014, 9 (4): at the start of the study and at the end 753-826 of 12 weeks. Analysis of the frequency of vertiginous episodes showed a Address:Paediatric Orthopaedics Unit, significant difference between arm A and Christian Medical College, Vellore, India.. arm B (p = 0.010) and improvement in [email protected]. severity of vertigo between the two groups (p = 0.046). Headache frequency BACKGROUND: Fractures of the femoral and severity did not improve to a shaft in children are relatively significant degree in arm A as compared uncommon but serious injuries that to arm B. The main side effects were disrupt the lives of children and their weight gain and somnolence and this carers and can result in significant long- was not significantly different between term disability. Treatment involves the two groups. Flunarizine (10 mg) is either surgical fixation, such as effective in patients with migrainous intramedullary nailing or external vertigo who suffer from considerable fixation, or conservative treatment vestibular symptoms. involving prolonged immobilisation, INTL often in hospital. OBJECTIVES: To PMID:24166742 PMCID: assess the effects (benefits and harms) CO of interventions for treating femoral shaft fractures in children and Lionel, A. P., Chinnaswamy, G., John, adolescents. SEARCH METHODS: We R. R. and Mathai, S. searched the Cochrane Bone, Joint and Ifosfamide induced renal rickets Muscle Trauma Group Specialised Indian J Pediatr; 2014, 81 (9): 943-5 Register (accessed 16 August 2013), the Cochrane Central Register of Controlled Address:Department of Pediatrics, Trials (The Cochrane Library 2013 Issue Pediatric Endocrinology & Pediatric 1, 7), MEDLINE (1946 to August Week 1 Christian Medical College Hospital, 2013), EMBASE (1980 to 2012 week 9), Vellore, Tamil Nadu, 632004, India. CINAHL (16 August 2013), clinical trials registries, conference proceedings and Ifosfamide is commonly used as a reference lists; and contacted trial chemotherapeutic agent in children. The authors and experts in the field. authors report a 4-y-old boy who SELECTION CRITERIA: Randomised and developed proximal renal tubulopathy quasi-randomised controlled trials with florid rickets a year after comparing conservative and surgical completion of ifosfamide therapy for interventions for diaphyseal fractures of Ewing's sarcoma. After initiation of the femur in children under 18 years of treatment, there was complete healing age. Our primary outcomes were of rickets and he did not need functional outcome measures, supplements beyond 18 mo. Growth unacceptable malunion, and serious monitoring and musculoskeletal system adverse events. DATA COLLECTION AND examination is important in all children ANALYSIS: Two authors independently who have received ifosfamide therapy. screened and selected trials, assessed Routine monitoring for nephrotoxicity risk of bias and extracted data. We during and after ifosfamide therapy assessed the overall quality of the helps in early identification and evidence for each outcome for each intervention. comparison using the GRADE approach. NAT We pooled data using a fixed-effect model. MAIN RESULTS: We included 10
trials (six randomised and four quasi- PMID:23912821 PMCID:
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randomised) involving a total of 527 followed by a cast, and that surgery children (531 fractures). All trials were reduced the time taken off from school. at some risk of bias, including Comparisons of different methods of performance bias as care provider conservative treatment The three trials blinding was not practical, but to a in this category made three different differing extent. Just one trial was at low comparisons. We are very unsure if risk of selection bias. Reflecting both the unacceptable malunion rates differ risk of bias and the imprecision of between immediate hip spica versus findings, we judged the quality of skeletal traction followed by spica in evidence to be 'low' for most outcomes, children aged 3 to 10 years followed up meaning that we are unsure about the for six to eight weeks (RR 4.0, 95% CI estimates of effect. Most trials failed to 0.5 to 32.9; one trial, 42 children; very report on self-assessed function or when low quality evidence). Malunion rates at children resumed their usual activities. 5 to 10 years may not differ between The trials evaluated 10 different traction followed by functional orthosis comparisons, belonging to three main versus traction followed by spica cast in categories. Surgical versus conservative children aged 5 to 13 years (RR 0.98, treatment Four trials presenting data for 95% CI 0.46 to 2.12; one trial, 43 264 children aged 4 to 12 years made children; low quality evidence). We are this comparison. Low quality evidence very unsure (very low quality evidence) (one trial, 101 children) showed children if either function or serious adverse had very similar function assessed using events (zero events reported) differ the RAND health status score at two between single-leg versus double-leg years after surgery (external fixation) spica casts (one trial, 52 young children compared with conservative treatment aged two to seven years). Low quality (spica cast): mean 69 versus 68. The evidence on the same comparison other three trials did not report on indicates that single-leg casts are less function. There was moderate quality awkward to manage by parents, more evidence (four trials, 264 children, aged comfortable for the child and may 4 to 12 years, followed up 3 to 24 require less time off work by the months) that surgery reduced the risk of caregiver. Comparisons of different malunion (risk ratio (RR) 0.29, 95% methods of surgical treatment The three confidence interval (CI) 0.15 to 0.59, 4 trials in this category made three trials). Assuming an illustrative baseline different comparisons. Very low quality risk of 115 malunions per 1000 in evidence means that we are very unsure children treated conservatively, these if the rates of malunion, serious adverse data equate to 81 fewer (95% CI 47 to events, time to return to school or 97 fewer) malunions per 1000 in parental satisfaction actually differ in surgically-treated children. Conversely, children whose fractures were fixed low quality evidence indicated that there using elastic stable intramedullary were more serious adverse events such nailing or external fixation (one trial, 19 as infections after surgery (RR 2.39, children). The same applies to the rates 95% CI 1.10 to 5.17, 4 trials). Assuming of serious adverse events and time to an illustrative baseline risk of 40 serious resume full weight-bearing in children adverse events per 1000 for treated with dynamic versus static conservative treatment, these data external fixation (one trial, 52 children). equate to 56 more (95% CI 4 to 167 Very low quality evidence (one trial, 47 more) serious adverse events per 1000 children) means that we do not know if children treated surgically. There was malunion, serious adverse events and low quality evidence (one trial, 101 time to resume weight-bearing actually children) of similar satisfaction levels in differ between intramedullary nailing children and parents with surgery versus submuscular plating. However, involving external fixation and plaster there could be more difficulties in plate cast only. However, there was low removal subsequently. AUTHORS' quality evidence (one trial, 46 children) CONCLUSIONS: There is insufficient that more parents were satisfied with evidence to determine if long-term intramedullary nailing than with traction function differs between surgical and
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conservative treatment. Surgery results did not report this outcome. There was in lower rates of malunion in children moderate quality evidence (four trials, aged 4 to 12 years, but may increase 264 children, aged 4 to 12 years, the risk of serious adverse events. followed up for 3 to 24 months) that Elastic stable intramedullary nailing may surgery reduced the risk of malunion reduce recovery time. There is (the leg is deformed) compared with insufficient evidence from comparisons non-surgical treatment. However, low of different methods of conservative quality evidence (four trials) indicated treatment or of different methods of that there were more serious adverse surgical treatment to draw conclusions events such as infections after surgery. on the relative effects of the treatments There was low quality evidence (one compared in the included trials. PLAIN trial, 101 children) of similar satisfaction LANGUAGE SUMMARY: Different levels in children and parents with methods of treating fractures of the surgery involving external fixation and shaft of the thigh bone in children and plaster cast only. However, there was adolescents Although uncommon, low quality evidence (one trial, 46 fractures of the femoral shaft (thigh children) that more parents were bone) in children may require prolonged satisfied with surgery involving an treatment in hospital and sometimes internal nail than with traction followed surgery. This can cause significant by a cast and that surgery reduced the discomfort and can disrupt the lives of time taken off from school. Comparing the children and their familles. This various non-surgical treatments Very review compared different methods of low quality evidence means that we are treating these fractures. Surgical very unsure if the rates of malunion treatment comprises different methods differ or not between children treated of fixing the broken bones, such as with immediate plaster casts versus with internally-placed nails, or pins traction followed by plaster cast (one incorporated into an external frame trial, 42 children), or between children (external fixation). Non-surgical or treated with traction followed by either a conservative treatment usually involves functional orthosis (a brace or cast that different types of plaster casts with or allows some movement) or a cast (one without traction (where a pulling force is trial, 43 children). We are very unsure if applied to the leg). We searched for either function or serious adverse events studies in the medical literature until differ between young children (aged two August 2013. The review includes 10 to seven years) immobilised in single-leg randomised or quasi-randomised versus double-leg casts (one trial, 52 controlled trials that recruited 527 children). However, single-leg casts children. Four trials compared different appear to be easier to manage by surgical versus non-surgical treatments; parents and more comfortable for the three compared different methods of child. Comparing various surgical non-surgical treatment and three treatments Very low quality evidence compared different methods of surgical means that we are very unsure if the treatment. Generally we are unsure rates of malunion, serious adverse about the results of these trials because events, time to return to school or some were at risk of bias, some results parental satisfaction actually differ in were contradictory and usually there children whose fractures were fixed was too little evidence to rule out chance using internal nails or external fixation findings. Most trials failed to report on (one trial, 19 children). (ABSTRACT self-assessed function or when children TRUNCATED) resumed their usual activities. INTL Comparing surgical versus non-surgical PMID:25504970 PMCID: treatment Low quality evidence (one CO trial, 101 children) showed children had similar function at two years after Mahesh, D. M., Nehru, A. G., Seshadri, having surgery, involving external M. S., Thomas, N., Nair, A., Pai, R. and fixation, compared with those treated Rajaratnam, S. with a plaster cast. The other three trials
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RET mutations in a large indian family with medullary thyroid carcinoma BACKGROUND: There is limited data on Indian J Endocrinol Metab; 2014, 18 (4): celiac disease in patients with 516-20 cryptogenic cirrhosis or idiopathic noncirrhotic intrahepatic portal Address:Department of Endocrinology, hypertension (NCIPH). Our objective was Christian Medical College, Vellore, Tamil to evaluate for celiac disease in patients Nadu, India. with portal hypertension in India. Department of Pathology, Christian METHODS: Consecutive patients with Medical College, Vellore, Tamil Nadu, portal hypertension having cryptogenic India. chronic liver disease (cases) and Department of Endocrine Surgery, hepatitis B- or C-related cirrhosis Christian Medical College, Vellore, Tamil (controls) were prospectively enrolled. Nadu, India. We studied tissue transglutaminase (tTG) antibody and duodenal histology in BACKGROUND: Medullary thyroid study patients. RESULT: Sixty-one cases carcinoma (MTC) is a tumor arising from (including 14 NCIPH patients) and 59 the para follicular (C) cells of the thyroid controls were enrolled. Celiac disease gland and can occur either sporadically was noted in six cases (including two or as part of an inherited syndrome. A NCIPH patients) as compared to none in proportion of these cases carry an controls. In a significant proportion of autosomal dominant mutation in the RET the remaining study subjects, duodenal (REarranged during Transfection) proto- biopsy showed villous atrophy, crypt oncogene. Screening for these mutations hyperplasia, and lamina propria in the affected patients and the carriers inflammation, not accompanied by "at risk" which includes the first-degree raised intraepithelial lymphocytes relatives is of utmost importance for (IELs); this was seen more commonly in early detection and prompt treatment cases as compared to controls. An including prophylactic thyroidectomy in unexpectedly high rate of tTG antibody cases that harbor these mutations. positivity was seen in study subjects (66 RESULTS: This report presents details of %) of cases as compared to 29 % in screening and subsequent follow-up of a controls (p-value < 0.001), which could large Indian family, where the index indicate false-positive test result. case was found to carry p. Cys634Ser CONCLUSION: In this study, 10 % of mutation involving exon 11 of the RET patients with unexplained portal gene. These data are of value hypertension (cryptogenic chronic liver considering the paucity of information disease) had associated celiac disease. within the region in context of screening In addition, an unexplained enteropathy large families affected by these was seen in a significant proportion of mutations study patients, more so in patients with NAT cryptogenic chronic liver disease. This PMID:25143909 PMCID:4138908 finding warrants further investigation. CO NAT PMID:25231910 PMCID: Maiwall, R., Goel, A., Pulimood, A. B., CO Babji, S., Sophia, J., Prasad, C., Balasubramanian, K. A., Ramakrishna, Mascarenhas M(1), Kamath MS(1), B., Kurian, S., Fletcher, G. J., Abraham, Muthukumar K(1), Mangalaraj AM(1), P., Kang, G., Ramakrishna, B. S., Elias, Chandy A(1), Aleyamma T(1). E. and Eapen, C. E. Obstetric outcomes of monochorionic Investigation into celiac disease in pregnancies conceived following assisted Indian patients with portal hypertension reproductive technology: A retrospective Indian J Gastroenterol; 2014, study. J Hum Reprod Sci. 2014 Apr;7(2):119- Address:Department of Gastrointestinal 24. doi: 10.4103/0974-1208.138870. Sciences, Christian Medical College, Vellore, 632 004, India.
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Author information: Allogeneic Stem Cell Transplantation for (1)Reproductive Medicine Unit, Christian Thalassemia Major Medical College Hospital, Vellore, Tamil Hematol Oncol Clin North Am; 2014, 28 Nadu, India. (6): 1187-1200
OBJECTIVES: The overwhelming Address:Department of Haematology, numbers of twins following assisted Christian Medical College, Ida Scudder reproductive technology (ART) are Road, Vellore, TN 632004, India. dichorionic twins, but monochorionic Electronic Address: twins account for around 0.9% of post [email protected]. ART pregnancies. The data for post ART- Department of Haematology, Christian monochorionic pregnancy outcomes are Medical College, Ida Scudder Road, scarce due to the rarity of this condition. Vellore, TN 632004, India. Hence, we evaluated the obstetric Department of Haematology and Bone outcomes of monochorionic and Marrow Transplant, Tata Medical Center, dichorionic pregnancies conceived on Rajarhat, Kolkata 700020, India. ART. SETTINGS: University teaching hospital. STUDY DESIGN: A case-control Allogeneic stem cell transplant remains study of monochorionic diamniotic the only curative option for beta- (MCDA) and dichorionic diamniotic thalassemia major. In patients with good (DCDA) pregnancies conceived following risk features it is reasonable to ART treatment. Charts of all women who anticipate a greater than 90% chance of conceived following ART from 2008 to a successful transplant outcome. The 2013 were screened. Among them, the conventional risk stratification system monochorionic twins diagnosed in the has limitations and alternative systems first trimester were included and their are being explored to better identify obstetric outcome was followed-up. For subsets that require innovative comparison, an equal number of approaches. Several novel regimens dichorionic twin pregnancies from age have been evaluated to reduce and body mass index matched mothers treatment-related morbidity and was selected. RESULTS: The baseline mortality. There remain challenges in clinical characteristics were similar improving the clinical outcome of high- between the two groups. MCDA group risk patients. There are limited data on had a higher miscarriage rate (50%) the role of splenectomy before than the DCDA group (10%), with three transplantation or optimal posttransplant seconds trimester miscarriages in the chelation and care of these patients. MCDA group. The live birth rates were INTL lower in the MCDA versus DCDA group PMID:25459187 PMCID: (40% vs. 90%). Among triplet CO pregnancies with a monochorionic component, the live birth rate was only Matthai, T. P., Zachariah, U. G. and 25%. CONCLUSIONS: Monochorionic Matthai, S. M. pregnancies following ART have poorer Recurrent episodic acute kidney injury obstetric outcomes when compared to as presenting manifestation of dichorionic pregnancies. For mitochondrial myopathy monochorionic pregnancies following Indian J Nephrol; 2014, 24 (6): 387-9 ART, intensive antenatal surveillance at a tertiary level obstetric and neonatal Address:Deptartment of Nephrology, center may help optimize the outcome. St. Mary's Dialysis Centre, Karipal NAT Hospital, Kottayam, Kerala, India. PMCID: PMC4150138 PMID: 25191025 Department of Hepatology, Central [PubMed] Electron Microscopy Unit, Christian CO Medical College, Vellore, Tamil Nadu, India. Mathews, V., Srivastava, A. and Department of Pathology, Central Chandy, M. Electron Microscopy Unit, Christian
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Medical College, Vellore, Tamil Nadu, BACKGROUND: There is a paucity of India. published reports on pregnancy outcome following scrub and murine typhus Mitochondrial cytopathies (MC) are a despite these infections being leading rare heterogenous group of disorders causes of undifferentiated fever in Asia. with frequent multisystem involvement This study aimed to relate pregnancy including uncommon renal outcome with treatment of typhus. manifestations. Acute kidney injury METHODOLOGY/PRINCIPAL FINDINGS: (AKI) as the primary manifestation of Data were analyzed from: i) pregnant MC is extremely rare. Here, we report a women with a diagnosis of scrub and/or case of recurrent episodic AKI in an murine typhus from a fever cohort adult male who was subsequently studies; ii) case series of published diagnosed to have mitochondrial studies in PubMed using the search disease. terms "scrub typhus" (ST), "murine NAT typhus" (MT), "Orientia tsutsugamushi", PMID:25484535 PMCID:4244721 "Rickettsia tsutsugamushi", "Rickettsia CO typhi", "rickettsiae", "typhus", or "rickettsiosis"; and "pregnancy", until Mcgready, R., Prakash, J. A., Benjamin, February 2014 and iii) an unpublished S. J., Watthanaworawit, W., Anantatat, case series. Fever clearance time (FCT) T., Tanganuchitcharnchai, A., Ling, C. L., and pregnancy outcome (miscarriage Tan, S. O., Ashley, E. A., Pimanpanarak, and delivery) were compared to M., Blacksell, S. D., Day, N. P., treatment. Poor neonatal outcome was a Singhasivanon, P., White, N. J., Nosten, composite measure for pregnancies F. and Paris, D. H. sustained to 28 weeks or more of Pregnancy outcome in relation to gestation ending in stillbirth, preterm treatment of murine typhus and scrub birth, or delivery of a growth restricted typhus infection: a fever cohort and a or low birth weight newborn. RESULTS: case series analysis There were 26 women in the fever PLoS Negl Trop Dis; 2014, 8 (11): e3327 cohort. MT and ST were clinically indistinguishable apart from two ST Address:Shoklo Malaria Research Unit patients with eschars. FCTs (median (SMRU), Mahidol-Oxford Tropical [range] hours) were 25 [16-42] for Medicine Research Unit, Mae Sot, Tak, azithromycin (n=5), 34 [20-53] for Thailand; Centre for Tropical Medicine, antimalarials (n=5) and 92 [6-260] for Nuffield Department of Medicine, other antibiotics/supportive therapy University of Oxford, Oxford, United (n=16). There were 36.4% (8/22) with a Kingdom. poor neonatal outcome. In 18 years, 97 Immunology Laboratories, Department pregnancies were collated, 82 with of Clinical Microbiology, Christian Medical known outcomes, including two maternal College, Vellore, Tamil Nadu, India. deaths. Proportions of miscarriage Shoklo Malaria Research Unit (SMRU), 17.3% (14/81) and poor neonatal Mahidol-Oxford Tropical Medicine outcomes 41.8% (28/67) were high, Research Unit, Mae Sot, Tak, Thailand. increasing with longer FCTs (p=0.050, Mahidol-Oxford Tropical Medicine linear trend). Use of azithromycin was Research Unit (MORU), Faculty of not significantly associated with Tropical Medicine, Mahidol University, improved neonatal outcomes (p=0.610). Bangkok, Thailand. CONCLUSION: The published ST and MT Centre for Tropical Medicine, Nuffield world literature amounts to less than Department of Medicine, University of 100 pregnancies due to under Oxford, Oxford, United Kingdom; recognition and under diagnosis. Mahidol-Oxford Tropical Medicine Evidence supporting the most commonly Research Unit (MORU), Faculty of used treatment, azithromycin, is weak. Tropical Medicine, Mahidol University, Collaborative, prospective clinical trials Bangkok, Thailand. in pregnant women are urgently required to reduce the burden of adverse maternal and newborn
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outcomes and to determine the safety and efficacy of antimicrobial treatment. Fucosidosis is a rare lysosomal storage INTL disorder due to deficiency of fucosidase enzyme, with around 100 cases reported PMID:25412503 PMCID:4238995 worldwide. Here, we describe the clinical CO and imaging features in two siblings with fucosidosis. An 8-year-old girl presented Mukherjee, S., Salphale, P. and Singh, with global developmental delay, V. followed by regression of acquired Late onset angioma serpiginosum of the milestones from 3 years of age with breast with co-existing cherry angioma bipyramidal, extrapyramidal Indian Dermatol Online J; 2014, 5 (3): involvement, coarse facies, 316-9 telangiectatic lesions, dysostosis multiplex, characteristic magnetic Address:Departments of Dermatology, resonance imaging finding along with Venereology and Leprosy, Christian undetectable levels of the fucosidase Medical College and Hospital, Vellore, activity, which confirmed the diagnosis. Tamil Nadu, India. Younger sibling has mild developmental Department of Pathology, Christian delay with autistic traits with no Medical College and Hospital, Vellore, neuroregression until now. He also has Tamil Nadu, India. undetectable level of fucosidase enzyme activity and is being considered for stem Angioma serpiginosum is a cutaneous cell transplantation. New case reports vascular nevoid disorder that presents would expand the clinical spectrum, as red, nonblanchable and grouped early diagnosis and help formulating macules distributed in a serpiginous appropriate therapy. Early diagnosis is pattern and resembles purpura. It crucial and hence sibling screening can usually begins in childhood and be done, and those in the commonly affects the lower limbs and presymptomatic stage can undergo the buttocks. Late onset of the lesions is hematopoietic stem cell transplantation, unusual. We report a 46-year-old female which is potentially curable. who presented with progressively NAT extending lesions on her breast since PMCID: PMC4166842 PMID: 25250075 preceding four years. She also had a [PubMed] cherry angioma overlying the lesions, an CO observation hitherto not reported so far. Muthusamy, K., Sudhakar, S. V., NAT Yoganathan, S., Thomas, M. M. and PMID:25165654 PMCID:4144222 Alexander, M. CO Hypomyelination, Hypodontia, Hypogonadotropic Hypogonadism (4H) Muthusamy K(1), Thomas MM(1), Syndrome With Vertebral Anomalies: A George RE(2), Alexander M(1), Mani Novel Association S(3), Benjamin RN(1). J Child Neurol; 2014, Siblings with fucosidosis. J Pediatr Neurosci. 2014 May;9(2):156- Address:Section of Neurology, 8. doi: 10.4103/1817-1745.139331. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Author information: Nadu, India. (1)Department of Neurological Sciences, Department of Radiology, Christian Christian Medical College, Vellore, Tamil Medical College, Vellore, Tamil Nadu, Nadu, India. (2)Department of India. Dermatology, Christian Medical College, Section of Neurology, Department of Vellore, Tamil Nadu, India. Neurological Sciences, Christian Medical (3)Department of Radiology, Christian College, Vellore, Tamil Nadu, India Medical College, Vellore, Tamil Nadu, [email protected]. India.
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Hypomyelination, hypodontia, involving the first lumbar vertebra and hypogonadotropic hypogonadism (4H) the left iliopsoas. Preoperative syndrome is a rare hypomyelination angiography revealed the artery of disorder with around 40 cases reported Adamkiewicz arising from the left first worldwide. Children with lumbar segmental artery. Excision of hypomyelination, hypodontia, pseudotumor was successfully carried hypogonadotropic hypogonadism out with additional spinal stabilization. syndrome present with varying degrees At 2 years followup, there was no of developmental delay with a spastic recurrence and the patient was well ataxic syndrome with delayed eruption stabilized with a satisfactory functional of teeth along with disruption in the status. Surgical excision gives eruption sequence, hypogonadotropic satisfactory outcome in such cases. hypogonadism, and a fluctuating clinical NAT course with intercurrent infections and PMID:25404776 PMCID:4232833 varying periods of stability. The disorder CO is caused by mutations in POL3A and POL3B genes and is collectively termed Naik, D., Jebasingh, K. F., Cherian, A. J. as pol III-related leukodystrophies. Here and Dasgupta, R. we describe 2 children with Ectopic thymic parathyroid adenoma hypomyelination, hypodontia, BMJ Case Rep; 2014, 2014 hypogonadotropic, hypogonadism syndrome and the association of multiple Address:Department of Endocrinology, vertebral fusion anomalies in one of Christian Medical College, Vellore, Tamil them, which has not been previously Nadu, India. described in the literature. We conclude Department of Endocrinology, Diabetes that the spectrum of the disorder is not and Metabolism, Christian Medical limited to brain parenchyma alone and College, Vellore, Tamil Nadu, India. involves all the structures arising from Department of Endocrine Surgery, neural ectoderm, and this needs further Christian Medical College, Vellore, Tamil research Nadu, India. INTL INTL PMID:25213661 PMCID: PMID:25257890 PMCID: CO CO
Nachimuthu, G., Arockiaraj, J., Navamani, K., Natarajan, M. M., Lionel, Krishnan, V. and Sundararaj, G. D. A. P. and Kumar, S. Hemophilic pseudotumor of the first Hepatitis a virus infection-associated lumbar vertebra hemophagocytic lymphohistiocytosis in Indian J Orthop; 2014, 48 (6): 617-20 two children Indian J Hematol Blood Transfus; 2014, Address:Department of Orthopaedics, 30 (Suppl 1): 239-42 Christian Medical College, Vellore, Tamil Nadu, India. Address:Department of Paediatrics, Christian Medical College, Vellore, Hemophilic pseudotumor involving the 632004 India. spine is extremely uncommon and presents a challenging problem. Hemophagocytic lymphohistiocytosis Preoperative planning, angiography, (HLH) is a syndrome characterized by intra and perioperative monitoring with high fever, maculopapular rash, factor VIII cover and postoperative care neurological symptoms, abnormal liver for hemophilic pseudotumor is vital. functions and coagulopathy. Primary Recognition of the artery of Adamkiewicz HLH is due to an underlying genetic in the thoracolumbar junction helps to abnormality. Secondary HLH are due to avoid intraoperative neurological injury. an underlying infection, autoimmune We report the case of a 26-year-old disease or malignancy. Secondary HLH male patient with hemophilia A, who due to viral infections are commonly due presented with a massive pseudotumor to the herpes group commonest of which
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is the Ebstein Barr virus (EBV). We Address:Department of Infectious describe two children with virus Disease Epidemiology. associated hemophagocytic Department of Paediatrics, St Mary's lymphohistiocytosis (VAHLH) secondary Campus, Imperial College London, to hepatitis A infection. United Kingdom MRC Unit, The Gambia, NAT Fajara. PMID:25332588 PMCID:4192162 CO Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India. Noel, J., Krishnadas, R., BACKGROUND: The impaired Gopalakrishnan, R. and Kuruvilla, A. immunogenicity of oral poliovirus Delusional disorder: an unusual vaccine (OPV) in low-income countries presentation has been apparent since the early field Indian J Psychol Med; 2014, 36 (4): trials of this vaccine. Infection with 444-6 enteropathogens at the time of vaccination may contribute to this Address:Department of Psychiatry, phenomenon. However, the relative Christian Medical College, Vellore, Tamil influence of these infections on OPV Nadu, India. performance remains uncertain. METHODS: We conducted a systematic Delusions with a sexual theme are rare, review to examine the impact of but when present are usually seen in concurrent enteric infections on OPV patients with schizophrenia or other response. Using random-effects models, chronic psychotic disorders. We report a we assessed the effects of nonpolio case of delusional disorder, with a single enteroviruses (NPEVs) and diarrhea on belief of a sexual theme. This report the odds of seroconversion and/or focuses on the management issues, vaccine virus shedding. RESULTS: We wherein a combination of identified 25 trials in which OPV pharmacological and nonpharmacological outcomes were compared according to interventions proved helpful the presence or absence of enteric NAT infections, the majority of which (n = 17) reported only on NPEVs. Concurrent PMID:25336783 PMCID:4201803 NPEVs significantly reduced the odds of CO per-dose seroconversion for type 1
poliovirus (odds ratio [OR] 0.44, 95% Palaniappan, P., Lionel, A. P. and confidence interval 0.23-0.84), but not Kumar, S. type 2 (OR 0.53 [0.19-1.46]) or type 3 Successful treatment of calcinosis cutis (OR 0.56 [0.27-1.12]). A similar in juvenile dermatomyositis with reduction, significant for type 1 pamidronate poliovirus (OR 0.50 [0.28-0.89]), was J Clin Rheumatol; 2014, 20 (8): 454-5 observed in the odds of vaccine virus
shedding among NPEV-infected Address:Department of Paediatrics individuals. Concurrent diarrhea Christian Medical College Vellore, India significantly inhibited per-dose [email protected]. seroconversion overall (OR 0.61 [0.38- INTL 0.87]). CONCLUSIONS: Our findings are PMID:25417690 PMCID: consistent with an inhibitory effect of CO concurrent enteric infections on OPV response. Parker, E. P., Kampmann, B., Kang, G. INTL and Grassly, N. C. PMID:24688069 PMCID:4136801 Influence of enteric infections on CO response to oral poliovirus vaccine: a systematic review and meta-analysis Peter, J., Andrew, N. H., Smith, C., J Infect Dis; 2014, 210 (6): 853-64 Figueira, E. and Selva, D. Idiopathic inflammatory orbital myositis presenting with vision loss
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Orbit; 2014, 33 (6): 449-52 CO
Address:Department of Ophthalmology, Pramanick, A., Peedicayil, A. and Shah, Schell Eye Hospital, Christian Medical A. College , Vellore , India . Bilateral tubal pregnancy with intrauterine pregnancy in a natural We present a first case of 58-year-old conception cycle along with liver cell man with vision loss in a biopsy-proven failure: case report and review of idiopathic literature inflammatory orbital tendon sparing J Obstet Gynaecol India; 2014, 64 myositis. Tests for thyroid (Suppl 1): 50-2 autoantibodies were negative at the initial presentation and at 10-month Address:Department of Obstetrics and follow-up period. The diagnosis was Gynaecology, Christian Medical College confirmed on histopathological and Hospital, Vellore, 632004 India. examination and was also supported by Department of Pathology, Christian avid sarcolemmal staining for MHC-1 Medical College and Hospital, Vellore, and MHC-2. India. INTL NAT PMID:25207637 PMCID: PMID:25404809 PMCID:4228004 CO CO
Peter, J., Joseph, G., Mathew, V. and Punnen, A., Loganathan, S. K., Veetiyil, Peter, J. V. G. I., Scott, J. X. and Kumar, S. Visual loss in Takayasu Arteritis - Look Neonate with orbital bleed Beyond the Eye Pediatr Blood Cancer; 2014, J Clin Diagn Res; 2014, 8 (8): MD06-7 Address:Department of Pediatrics, Address:Assistant Professor, Christian Medical College, Vellore, Department of Ophthalmology, Christian 632004,, India. Medical College , Vellore, India . INTL Professor and Head, Department of PMID:25447027 PMCID: Cardiology Unit I, Christian Medical CO College , Vellore, India Professor, Department of Neurology, Christian Medical College , Vellore, India Raghunath, R., Varghese, G. and . Simon, B. Associate Professor, Department of Chronic arthritis of the hip joint: an Medicine, Christian Medical College , unusual complication of an inadequately Vellore, India . treated fistula-in-ano BMJ Case Rep; 2014, 2014 Patients with Takayasu arteritis often Address:Department of Surgery Unit 2 present with reduced vision related & Colorectal Surgery, Christian Medical either to the disease per se or due to College, Vellore, Tamil Nadu, India. complications of therapy. We report a Department of Radiology, Christian patient with Takayasu arteritis who Medical College, Vellore, Tamil Nadu, developed acute onset bilateral visual India. loss 6wks following percutaneous revascularization of occluded aortic arch We report a case of chronic arthritis of branches. No ocular cause for the visual the right hip joint in an otherwise loss was evident. The reason for visual healthy young male athlete as a loss in this patient was an extraocular complication of inadequately treated cause. Ocular and extraocular causes of anal fistula. A young male athlete visual loss in Takayasu arteritis are presented with symptoms of right hip discussed. pain and difficulty in walking and INTL intermittent fever for 2 months. He had a history of perianal abscess drainage. PMID:25300450 PMCID:4190754 On examination he was found to have a
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tender right hip joint with severe Genotyping of the patients was carried restriction of movements. He was also out to detect the presence of the found to have a partially drained right polymorphism of interest. Clozapine- ischiorectal abscess. X-ray and MRI of induced sialorrhea was found to be the hip joint revealed chronic arthritis of the right hip joint, which was associated significantly with the 120-bp communicating with a complex fistula- duplication in DRD4. The association was in-ano. He underwent a diversion found to fit a log-additive model with an sigmoid colostomy and right ischiorectal odds ratio of 2.95 (95% confidence abscess drainage along with appropriate interval 1.51-5.75; P=0.0006). Thus, antibiotics with a plan for definitive hip the presence of the 120-bp duplication joint procedure later. He was lost to in DRD4 appears to confer a risk for follow-up and succumbed to severe perianal sepsis within a few months. sialorrhea in response to clozapine INTL therapy. The underlying pathophysiology PMID:25414226 PMCID: and clinical significance of this CO phenomenon warrant further investigation. Rajagopal, V., Sundaresan, L., INTL Rajkumar, A. P., Chittybabu, C., PMID:25304228 PMCID: Kuruvilla, A., Srivastava, A., CO Balasubramanian, P., Jacob, K. S. and Jacob, M. Rajan, S., Kurien, M., Gupta, A. K., Genetic association between the DRD4 Mathews, S. S., Albert, R. R. and promoter polymorphism and clozapine- Tychicus, D. induced sialorrhea Velopharyngeal incompetence in patients Psychiatr Genet; 2014, 24 (6): 273-6 with cleft palate, flexible video pharyngoscopy and perceptual speech Address:Departments of aBiochemistry assessment: a correlational pilot study bPsychiatry cHematology, Christian J Laryngol Otol; 2014, 128 (11): 986-90 Medical College, Vellore, Tamil Nadu, India dDepartment of Biomedicine, Address:Department of Aarhus University, Aarhus, Denmark. Otorhinolaryngology and Head and Neck Surgery,Christian Medical The use of clozapine, an effective College,Vellore, Tamil Nadu,India. antipsychotic drug used in treatment- Department of Plastic Surgery,Christian resistant schizophrenia, is associated Medical College,Vellore, Tamil with adverse effects. Sialorrhea is one Nadu,India.
such effect, which can be distressing for OBJECTIVES: To assess the role of video many patients. Studies on the endoscopy in evaluating velopharyngeal pharmacogenetics of the adverse effects incompetence and investigate a possible of clozapine are limited. The aim of the relationship between velopharyngeal present study was to determine whether incompetence type and speech defect in clozapine-induced sialorrhea is cleft palate patients. METHODS: A associated with a 120 base-pairs (bp) prospective study of 28 pre- or post- operative cleft palate patients with tandem duplication polymorphism in the speech defects who attended Plastic dopamine receptor subtype D4 (DRD4) Surgery-Cleft Palate and ENT out-patient gene. Ninety-five patients, mean age clinics was performed. The velar defect 35.43+/-9.43 years, with treatment- type was determined using a flexible resistant schizophrenia and on clozapine endoscope and findings were video were included in the study. Development recorded. Speech pathology was assessed using the cleft palate audit of sialorrhea in response to the drug, as protocol for speech. RESULTS: A manifested by drooling of saliva, was significant, clinically relevant relationship documented in 45 (47.4%) patients. was noted between the perceived
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characteristics of hypernasality and Kikuchi's disease from a tertiary care velopharyngeal insufficiency type. center in southern India. MATERIALS Hypernasal speech was a definite clinical AND METHODS: Retrospective analysis indicator of velopharyngeal of all adult patients with incompetence, and the type 1 histopathologically confirmed Kikuchi's velopharyngeal defect was most disease from January 2007 to December common. Type 1 velopharyngeal 2011 in a 2700-bed teaching hospital in coronal-type dysfunction was strongly South India was done. The clinical and associated with hypernasality (p < laboratory characteristics and outcome 0.05). When speech substitution was were analyzed. RESULTS: There were 22 noted, type 2 velopharyngeal (or histopathologically confirmed cases of sagittal) incompetence could be Kikuchi's disease over the 5-year period predicted (p < 0.05). CONCLUSION: In of this study. The mean age of the the management of cleft palate patients, subjects' was 29.7 years (SD 8.11) and it is important that surgical correction of majority were women (Male: female- the defect and achieving velopharyngeal 1:3.4). Apart from enlarged cervical competency for speech are performed lymph nodes, prolonged fever was the simultaneously. Pre-operative most common presenting complaint velopharyngeal endoscopy with speech (77.3%). The major laboratory features assessment will define the anatomical included anemia (54.5%), increased and functional bases for velopharyngeal erythrocyte sedimentation rate (31.8%), correction and assist in planning and elevated alanine aminotransferase tailoring the pharyngeal flap. (27.2%) and elevated lactate dehydrogenase (LDH) (31.8%). INTL CONCLUSION: Even though rare, PMID:25335572 PMCID: Kikuchi's disease should be considered in CO the differential diagnosis of young individuals, especially women, Rakesh, P., Alex, R. G., Varghese, G. presenting with lymphadenopathy and M., Mathew, P., David, T., Manipadam, prolonged fever. Establishing the M. T., Nair, S. and Abraham, O. C. diagnosis histopathologically is essential Kikuchi-fujimoto disease: clinical and to avoid inappropriate investigations and laboratory characteristics and outcome therapy. J Glob Infect Dis; 2014, 6 (4): 147-50 INTL Address:Department of Community PMID:25538452 PMCID:4265829 Health, Christian Medical College, CO Vellore, Tamil Nadu, India. Department of Internal Medicine, Rathinavelu, B., Arockiaraj, J., Christian Medical College, Vellore, Tamil Krishnan, V., Amritanand, R. and Nadu, India. Sundararaj, G. D. Department of Pathology, Christian The Extended Posterior Circumferential Medical College, Vellore, Tamil Nadu, Decompression Technique in the India. Management of Tubercular Spondylitis with and without Paraplegia INTRODUCTION: Kikuchi-Fujimoto Asian Spine J; 2014, 8 (6): 711-9 disease is an uncommon disorder with worldwide distribution, characterized by Address:Department of Orthopaedics, fever and benign enlargement of the Christian Medical College and Hospital, lymph nodes, primarily affecting young Vellore, India. adults. Awareness about this disorder may help prevent misdiagnosis and STUDY DESIGN: Retrospective clinical inappropriate investigations and series. PURPOSE: To study the clinical, treatment. The objective of the study functional and radiological results of was to evaluate the clinical and patients with tuberculous spondylitis laboratory characteristics of with and without paraplegia, treated histopathologically confirmed cases of surgically using the "Extended Posterior
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Circumferential Decompression (EPCD)" PMID:25404800 PMCID:4228002 technique. OVERVIEW OF LITERATURE: CO With the increasing possibility of addressing all three columns by a single Rose, W., Rajendran, G. and Peter, J. approach, posterior and posterolateral Crusted scabies Indian Pediatr; 2014, 51 approaches are gaining acceptance. A (8): 680 single exposure for cases with neurological deficit and kyphotic Address: Department of Pediatrics, deformity requiring circumferential CMC, Vellore, India. decompression, anterior column [email protected] reconstruction and posterior instrumentation is helpful. METHODS: NAT Forty-one patients with PMID:25129017 PMCID: dorsal/dorsolumbar/lumbar tubercular CO spondylitis who were operated using the EPCD approach between 2006 to 2009 Russell, P. S., John, J. K., Lakshmanan, were included. Postoperatively, patients J., Russell, S., Nair, M. K. and Ganesh, were started on nine-month anti- B. tuberculous treatment. They were Pre-intervention Predictors for serially followed up to thirty-six months Acquisition of Adaptive Behavior Among and both clinical measures (including Children with Intellectual Disability pain, neurological status and ambulatory Indian J Pediatr; 2014, 81 Suppl 2 165-8 status) and radiological measures (including kyphotic angle correction, loss Address:Child and Adolescent of correction and healing status) were Psychiatry Unit, Department of used for assessment. RESULTS: Psychiatry, Christian Medical College, Disease-healing with bony fusion Vellore, 632 002, Tamil Nadu, India, (interbody fusion) was seen in 97.5% of [email protected]. cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine OBJECTIVE: To determine the predictive and 207.3% in lumbar spine. factors associated with the adaptive Corresponding loss of correction was 3.6 behavior acquisition among children with degrees in dorsal spine and 1.9 degrees Intellectual Disability (ID) in two in the lumbar spine. Neurological different training packages. METHODS: recovery in Frankel B and C paraplegia Parents of 52 consecutive children was 85.7% and 62.5%, respectively. completed a demographic data form. CONCLUSIONS: The EPCD approach Pre-intervention quantification of ID, permits all the advantages of a single or parental attitude and adaptive behavior dual session anterior and posterior assessments were done using the Binet- surgery, with significant benefits in Kamat Test of Intelligence or Gessells terms of decreased operative time, Developmental Schedule, Parental reduced hospital stay and better Attitude Scale towards Management of kyphotic angle correction. Intellectual Disability and Vineland Social INTL Maturity Scale respectively, by independent raters. Univariate and PMID:25558312 PMCID: multiple logistic regression models were CO used to identify the predictive models for the training outcomes and further Rathore, S., Pramanick, A., Regi, A. validated using re-sampling technique. and Lionel, J. RESULTS: Predictive factors associated Aplastic anemia in pregnancy with the good outcome in the J Obstet Gynaecol India; 2014, 64 multimodal adaptive behavior training (Suppl 1): 26-8 plus interactive group psycho-education group were: younger age of the parent Address:Department of Obstetrics and trained, and more than two siblings. Gynecology Unit III, Christian Medical Among the multimodal adaptive College, Vellore, 632004 India. behavior training plus didactic lectures NAT group, education of parent trained
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predicted better adaptive behavior settings are poorly understood. A nested interventional outcome. There was no case-control study was conducted to association between the place of assess factors associated with childhood residence, socio-economic status, cryptosporidiosis (detected by stool profession of parent, level of disability or the parental attitude. CONCLUSIONS: polymerase chain reaction) in an Different predictive factors are endemic, Indian slum community using associated with potential short-term data from two community-based studies outcome of different adaptive behavior with 580 children followed prospectively training for children with ID. Based on until their second birthday. Factors were these pre-intervention predicators assessed for overall cryptosporidiosis (N children and their parents can be given = 406), and for multiple (N = 208), specific intervention packages. asymptomatic (N = 243), and NAT symptomatic (N = 163) infections, PMID:25338491 PMCID: respectively. Presence of older siblings CO (odds ratio [OR] = 1.88, P = 0.002) and stunting at 6 months of age (OR = 1.74, Sarkar, R., Kattula, D., Francis, M. R., P = 0.019) were important risk factors Ajjampur, S. S., Prabakaran, A. D., for childhood cryptosporidiosis. Always Jayavelu, N., Muliyil, J., Balraj, V., boiling drinking water before Naumova, E. N., Ward, H. D. and Kang, consumption, the use of a toilet by all G. Risk factors for cryptosporidiosis among members of the family, and maternal children in a semi urban slum in age >/= 23 years were protective. southern India: a nested case-control These results provide insights into study acquisition of childhood cryptosporidiosis Am J Trop Med Hyg; 2014, 91 (6): in settings with poor environmental 1128-37 sanitation, contaminated public water
supply systems, and close human- Address:Division of Gastrointestinal Sciences, Christian Medical College, animal contact. Disease control Vellore, India; Community Health strategies will require a multifaceted Department, Christian Medical College, approach. Vellore, India; Department of Civil and INTL Environmental Engineering, Tufts PMID:25331810 PMCID: University School of Engineering, CO Medford, Massachusetts; Division of
Geographic Medicine and Infectious Sarkar, S., Rajaratnam, S., Diseases, Tufts Medical Center, Tufts Backianathan, S., Chacko, G. and University School of Medicine, Boston, Chacko, A. G. Massachusetts. Radiation-induced opticochiasmatic Division of Gastrointestinal Sciences, glioblastoma multiforme following Christian Medical College, Vellore, India; conventional radiotherapy for Cushing's Community Health Department, disease Christian Medical College, Vellore, India; Br J Neurosurg; 2014, 28 (4): 510-2 Department of Civil and Environmental
Engineering, Tufts University School of Address:Department of Neurological Engineering, Medford, Massachusetts; Sciences, Christian Medical College , Division of Geographic Medicine and Vellore, TN , India. Infectious Diseases, Tufts Medical We report the rare occurrence of an Center, Tufts University School of opticochiasmatic glioblastoma Medicine, Boston, Massachusetts multiforme 6 years following [email protected]. conventional radiotherapy for Cushing's
disease. This article highlights the risks The risk factors for acquisition of of collateral damage to the optic cryptosporidial infection in resource-poor
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apparatus when irradiating the sellar groups, surgically induced region. hypopituitarism was less frequent with INTL the former. CONCLUSIONS: We report PMID:24066683 PMCID: our surgical experience with CO predominantly large, invasive GH adenomas using the 2010 criteria for Sarkar, S., Rajaratnam, S., Chacko, G. cure. Patients with smaller, non-invasive and Chacko, A. G. tumors with lower preoperative GH Endocrinological outcomes following levels are most likely to achieve endoscopic and microscopic remission. Outcomes with either the transsphenoidal surgery in 113 patients microscopic or endoscopic approach do with acromegaly not differ significantly, although the rate Clin Neurol Neurosurg; 2014, 126 190-5 of surgically induced hypopituitarism may be higher with the former. Address:Section of Neurosurgery, Transsphenoidal surgery remains the Department of Neurological Sciences, first line of treatment for patients with Christian Medical College, Vellore, India. acromegaly, but invasive adenomas will Department of Endocrinology, Diabetes frequently require adjuvant therapy. and Metabolism, Christian Medical INTL College, Vellore, India. PMID:25278017 PMCID: Section of Neurosurgery, Department of CO Neurological Sciences, Christian Medical College, Vellore, India. Electronic Sen S; Chacko J; Karl S; Mathai J; Address: [email protected]. Thomas R; Dastidar A; Barla Sri Sathya
Ravi Kishore; Joseph Ninan P; George J BACKGROUND: To describe outcomes and complications in patients undergoing Pediatric bladder augmentation in transsphenoidal surgery for acromegaly developing country: Lessions learnt from using the 2010 consensus criteria for an experience of 195 cases biochemical remission. METHODS: Journal of International Medical Sciences Retrospective review of 113 treatment Academy. 2014 apr-jun; 27(2): 79-83 naive patients who underwent transsphenoidal surgery with the Address: Department of Pediatric endoscopic (n=66) and the endonasal microscopic technique (n=47). Cure was Surgery and Rehabilitation Medicine, defined if the age and sex-adjusted IGF- CMC, Vellore. E-mail: 1 level was normal and either the basal [email protected] GH was <1ng/ml or the nadir GH was <0.4ng/ml following oral glucose ABSTRACT: We report our experience suppression at last follow-up. RESULTS: with 195 children who had undergone The mean age at presentation was bladder augmentation in our department 38.1+/-7.1 years and 86% of tumors were macroadenomas. Adenoma sizes during the period 1997-2009. These averaged 21.1+/-9.7mm, but 56% of all included 78 children with neurogenic tumors were >/=2cm in size and 43.4% bladder, 73 children with incontinent were invasive. Remission rates between exstrophy and 27 children with posterior endoscopic and microscopic urethral valves. While incontinence was transsphenoidal surgery did not differ a major clinical symptom in many of significantly overall (28.8% versus 36.2%). On univariate analysis, a these children, 107 children had preoperative GH level <40ng/ml, hydroureteronephrosis and 53 had adenoma size <20mm and non- elevated levels of serum creatinine invasiveness were predictors of preoperatively. Tissue used for remission at follow-up. Although there augmentation includes sigmoid colon in were no statistically significant 118, ileocecal segment in 39, ileu in 21 differences in remission rates between and a dilated ureter in 14. Concomitant the endoscopic and microsurgical
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surgery included bladder neck Department of General Pathology, procedures (Young Dees Leadbetter Christian Medical College and Hospital, plasty, bladder neck closure, fascial Vellore, 632004 India.
slings) in 80 children, a catheterizable Wiskott-Aldrich syndrome (WAS) is an X abdominal stoma in 184, and variety of linked rare primary immunodeficiency anti reflux procedures. Special syndrome with an increased propensity techniques of augmentation such as the for infection, autoimmunity and preperitioneal augmentation and the malignancy. Here we report a male "doughnut" augmentation are also child, who was diagnosed with WAS at 1 described. Results (mean follow up year of age following evaluation for symptomatic thrombocytopenia and period of 5 years, longest 15 years) eczematous skin lesions. He presented were highly satisfactory as regardscure later with lymphadenopathy, which was of incontinence and stabilization of consistent with diffuse large B cell hydroureteronephrosis. Vesicoureteric lymphoma on histopathology. He reflux resolved in 98 of 129 units received 6 cycles of R-CHOP studied. Renal failure, if severe chemotherapy for the same and is preoperatively, continued to progress presently in remission after 6 months. We review the major publications of and was the major cause of late lymphoma in WAS and discuss the mortality. pathological findings, treatment and prognosis of lymphoma in WAS. KEYWORDS: NAT Humans; Child; India; Urologic Surgical PMID:25332606 PMCID:4192205 Procedures; Urinary Bladder/SU CO References: 34 Senapati, J., Devasia, A. J., Sudhakar, S. and Viswabandya, A. Asymptomatic gastrosplenic fistula in a NAT patient with marginal zonal lymphoma Record Identifier: NI248419 transformed to diffuse large B cell CO lymphoma--a case report and review of literature Sen, I. and Agarwal, S. Ann Hematol; 2014, 93 (9): 1599-602 Cutaneous lesions from lymphangioma circumscriptum Address:Department of Clinical ANZ J Surg; 2014, Haematology, Christian Medical College and Hospital, Vellore, 632004, Tamil Address:Department of Vascular Nadu, India, [email protected]. Surgery, Christian Medical College, INTL Vellore, Tamil Nadu, India. PMID:24362455 PMCID: INTL CO PMID:25556623 PMCID: Sengupta, M., Benjamin, S. and CO Prakash, J. A. Senapati, J., Devasia, A. J., David, S., Scrub typhus continues to be a threat in Manipadam, M. T., Nair, S., pregnancy Jayandharan, G. R. and George, B. Int J Gynaecol Obstet; 2014, 127 (2): Diffuse large B cell lymphoma in wiskott- 212 Aldrich syndrome: a case report and review of literature Address:Department of Clinical Indian J Hematol Blood Transfus; 2014, Microbiology, Christian Medical College, 30 (Suppl 1): 309-13 Vellore, India. Department of Obstetrics and Address:Department of Clinical Gynecology, Christian Medical College, Haematology, Christian Medical College Vellore, India. and Hospital, Vellore, 632004 India. Department of Clinical Microbiology, Christian Medical College, Vellore, India.
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Electronic Address: Address:Department of Endocrinology, [email protected]. Diabetes & Metabolism, Christian Medical INTL College & Hospital, Vellore 632004, PMID:25109770 PMCID: India. CO Objective. To study the prevalence of Shetty, S., Hephzibah, J., Borah, B., osteoporosis and vitamin D deficiency in Burad, D., Chandrakumar, V., Paul, M. J. healthy men and to explore the influence and Thomas, N. of various life style factors on bone Paraneoplastic polyarthritis in mineral density (BMD) and also to look association with metastatic at number of subjects warranting neuroendocrince tumour of the adrenal treatment. Methods. Ambulatory south gland Indian men aged above 50 were Australas Med J; 2014, 7 (8): 345-9 recruited by cluster random sampling. The physical activity, risk factors in the Address:Department of Endocrinology, FRAX tool, BMD, vitamin D, and PTH Diabetes & Metabolism, Christian Medical were assessed. The number of people College, Vellore, India. needing treatment was calculated, which Department of Nuclear Medicine, included subjects with osteoporosis and Christian Medical College, Vellore, India. osteopenia with 10-year probability of Department of General Pathology, major osteoporotic fracture >20 percent Christian Medical College, Vellore, India. and hip fracture >3 percent in FRAX Department of Endocrine Surgery, India. Results. A total of 252 men with a Christian Medical College, Vellore, India. mean age of 58 years were studied. The prevalence of osteoporosis and Paraneoplastic polyarthritis is a rare osteopenia at any one site was 20% manifestation described in association (50/252) and 58%, respectively. Vitamin with various solid tumours. We describe D deficiency (<20 ng/dL) was seen in the clinical presentation, diagnostic 53%. On multiple logistic regression, evaluation, differential diagnosis, and BMI (OR 0.3; P value = 0.04) and management of a 28-year-old woman physical activity (OR 0.4; P value < who presented with fever, weight loss, 0.001) had protective effect on BMD. and symmetrical polyarthritis, Twenty-five percent warranted subsequently diagnosed to have a treatment. Conclusions. A significantly metastatic neuroendocrine tumour of the large proportion of south Indian men adrenal gland with paraneoplastic had osteoporosis and vitamin D polyarthritis. Paraneoplastic polyarthritis deficiency. Further interventional studies must be considered in polyarthritis are needed to look at reduction in end unexplained by common aetiologies. The points like fractures in these subjects. unusual presentation of this case, alerts INTL us about the atypical presentation of PMID:25478284 PMCID:4244976 these tumours. To the best of our CO knowledge, this is the first case study of Simon, B., Chandramohan, A., Eapen, a neuroendocrine tumour presenting as A., Nayak, S. and Jeyaraj, V. paraneoplastic polyarthritis. Intravascular mesenchymal INTL chondrosarcoma PMID:25279010 PMCID:4157154 J Vasc Interv Radiol; 2014, 25 (12): CO 1937 Shetty, S., Kapoor, N., Naik, D., Asha, H. S., Prabu, S., Thomas, N., Seshadri, Address:Department of Radiodiagnosis, M. S. and Paul, T. V. Christian Medical College and Hospital, Osteoporosis in healthy South Indian Vellore, Tamil Nadu, India 632004. males and the influence of life style Electronic Address: factors and vitamin d status on bone [email protected]. mineral density Department of Radiodiagnosis, Christian J Osteoporos; 2014, 2014 723238 Medical College and Hospital, Vellore, Tamil Nadu, India 632004.
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Department of General Surgery, admission. The ventilatory parameters Christian Medical College and Hospital, and chest radiographs were recorded Vellore, Tamil Nadu, India 632004. every 24 h. The P/F ratio, PEEP and Department of Pathology, Christian Lung Injury Score were calculated each Medical College and Hospital, Vellore, Tamil Nadu, India 632004. day until the day of discharge from the INTL Intensive Care Unit or for the first 7 PMID:25457141 PMCID: days of admission, whichever was CO shorter. RESULTS: The incidence of Simon, B., Oommen, S. P., Shah, K., ARDS among those who were Mani, S. E. and Gibikote, S. mechanically ventilated was 11.4%. Cockayne syndrome: characteristic Sepsis was the most common (34.6%) neuroimaging features etiology. Among those with risk factors, Acta Neurol Belg; 2014, the incidence of ARDS was 30% and that
Address:Department of Radiology, of ALI was 32.7%. The mortality in Christian Medical College, Vellore, those with ARDS was 41.8%. Those who 632004, India, develop ARDS had higher APACHE II [email protected]. scores, lower pH and higher PaCO2 at admission compared with those who INTL developed ALI or no lung injury. PMID:25381627 PMCID: CONCLUSION: The incidence and CO mortality of ARDS was similar to other
Singh, G., Gladdy, G., Chandy, T. T. studies. Identifying those with risk and Sen, N. factors for ARDS or mortality will enable Incidence and outcome of acute lung appropriate interventional measures. injury and acute respiratory distress NAT syndrome in the surgical intensive care PMID:25316976 PMCID:4195196 unit CO Indian J Crit Care Med; 2014, 18 (10): Tiewsoh I; Singh V; Jajoo UN 659-65 Megaloblastic anemia with peripheral Address:Department of Anaesthesia, neuropathy, a misleading initial Christian Medical College and Hospital, presentation in POEMS syndrome: A Vellore, Tamil Nadu, India. case report Division of Critical Care, Christian Journal of Mahatma Gandhi Institute of Medical College and Hospital, Vellore, Medical Sciences. 2014 mar; 19(1): 55- Tamil Nadu, India. 58
INTRODUCTION: To determine the ADDRESS: Dr. Iadarilang Tiewsoh, incidence and mortality of acute lung Room no 216, LIQ, CMC Vellore - 632 injury (ALI) and acute respiratory 004, Tamil Nadu, India. E-mail: distress syndrome (ARDS) in a cohort of [email protected] patients with risk factors admitted to the Surgical Intensive Care Unit (SICU). ABSTRACT: POEMS (peripheral MATERIALS AND METHODS: A neuropathy, organomegaly, prospective observational inception endocrinopathy, M protein, skin cohort study with no intervention was changes) syndrome is a rare conducted over 12 months. All patients multisystem paraneoplastic disorder that with at least one known risk factor for occurs in the setting of a plasma cell ALI/ARDS admitted to the SICU were dyscrasia. A 57-year-old male with initial included in the study. The APACHE II presentation of peripheral neuropathy of severity of disease classification system lower limbs and a peripheral blood scoring was performed within 1 h of picture of megaloblastic anemia,
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presented with progressive lower motor neuron weakness over few months; Address:Department of Neurological followed by additional features of skin Sciences, Christian Medical College, Vellore, Tamil Nadu, India. hyperpigmentation, generalized
lymphadenopathy, erectile dysfunction, OBJECT Prospective studies of quality of weight loss, and an attack of life (QOL) are infrequently performed in cerebrovascular accident (stroke infarct) patients undergoing surgery for which recovered. On further evaluation vestibular schwannoma (VS). The with time, there were presence of authors designed this to study to hepatosplenomegaly, Castleman's investigate health-related QOL (HR-QOL) in patients with large and giant VSs disease of the lymph node on biopsy, before and after surgery. METHODS serum electrophoresis suggestive of Between January 2009 and December monoclonal gammopathy with light band 2012, HR-QOL was measured lambda chain, and endocrinopathy prospectively before and after surgery, (hypothyroidism and hypogonadism). using the 36-Item Short Form Health His bone marrow was suggestive of Survey (SF-36), in 100 patients who plasmacytosis. This case report underwent surgery for unilateral large or giant VS (tumor size >/= 3 cm). The describes a patient who presented with Glasgow Benefit Inventory (GBI) was initial picture of peripheral neuropathy also used to evaluate the effect of with megaloblastic anemia, but when surgery. RESULTS A total of 100 patients followed-up there were diverse clinical were included in the study (65 men and manifestations fulfilling the diagnostic 35 women). Their mean age (+/- SD) clinical criteria of POEMS Syndrome. was 44.2 +/- 11.5 years. The preoperative QOL was decreased in all KEYWORDS: Humans; Male SF-36 domains. A 1-year follow-up OTHER KEYWORDS: Castleman's evaluation was conducted for all patients Disease; Poems; Polyneuropathy; (mean 13.5 +/- 5.3 months after Vascular Endothelial Growth Factor surgery). The results showed an References: 7 improvement in HR-QOL compared with NAT preoperative status in all cases, with Record Identifier: NI248667 NON 63%-85% of patients showing a minimum clinically important difference INDEXED (MCID) in various domains. A second CO follow-up evaluation was performed in Tilak, M., Paul, A., Samuel, C. S., 51 cases (mean time after surgery, 29.0 David, J. A., Viswabandya, A. and +/- 8.3 months) and showed sustained Srivastava, A. improvement in SF-36 scores. In some Cryotherapy for acute haemarthrosis in domains there was further improvement haemophilia - attempts to understand beyond the first follow-up. On the GBI, the 'ice age' practice 87% of patients reported improvement, Haemophilia; 2015, 21 (1): e103-5 1% felt no change, and 12% of patients reported deterioration. CONCLUSIONS Address:Department of Physical Patients harboring large or giant VSs Medicine and Rehabilitation, Christian score lower on all the QOL domains Medical College, Vellore, India. compared with the normative INTL population. More than 60% showed a PMID:25471230 PMCID: clinically significant improvement in HR- CO QOL 1 year after surgery, a result that Turel, M. K., Thakar, S. and was sustained at subsequent follow-up. Rajshekhar, V. INTL Quality of life following surgery for large PMID:25479119 PMCID: and giant vestibular schwannomas: a CO prospective study Upadhyay, R., Kant, S., Prakash, V. J Neurosurg; 2014, 1-9 and Saheer, S.
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Sinobronchial allergic aspergillosis with Department of Pulmonary Medicine, allergic bronchopulmonary aspergillosis: CMC, Vellore, Tamil Nadu, India. a less common co-existence BMJ Case Rep; 2014, 2014 Tubercular infection of the nasal cavity is an infrequently encountered condition. Address:Department of Pulmonary More so, after the discovery of relevant Medicine, King George's Medical antibiotics, nasal sinus tuberculosis is University, Lucknow, Uttar Pradesh, not commonly seen. Few cases have India. reported tuberculosis of the paranasal Department of Pulmonary Medicine, sinuses, nasopharynx and larynx. With CMC, Vellore, Tamil Nadu, India. the increasing incidence of HIV, these rare forms of infection have started re- Allergic bronchopulmonary aspergillosis emerging. We present a case of a middle (ABPA) is an immunological pulmonary aged man presenting with nasal cavity disorder that is characterised by a lesion along with pulmonary hyper-responsiveness of the airways to tuberculosis, which came to light only Aspergillus fumigatus. Although several after the diagnosis of maxillary sinus other fungi may also present with similar tuberculosis. clinical conditions, Aspergillus remains INTL the most common fungal pathogen PMID:25085948 PMCID: causing airway infections. Co-existence CO of ABPA with allergic Aspergillus sinusitis V, K., Raiyani, P. D. and Vyas, S. S. (AAS) is an uncommon presentation. Tracheobronchial amyloidosis-a series of The concept of one airway/one disease two cases justifies the co-existence of ABPA with J Clin Diagn Res; 2014, 8 (9): FD09-10 AAS, but it does not always hold true. We report a case of a 35-year-old Address:Assistant Professor, woman who presented with symptoms Department of General Pathology, suggestive of bronchial asthma. On Christian Medical College , Vellore, India further investigation, the radiological . pattern showed fleeting shadows and CT Assistant Professor, Department of scan showed central cystic Pulmonary Medicine, Christian Medical bronchiectatic changes characteristic of College , Vellore, India . ABPA. The nasal secretions were investigated for the presence of Amyloidosis is a rare disorder Aspergillus and were found to be characterised by accumulation of positive. Hence a diagnosis of ABPA with insoluble fibrillar proteins in extracellular AAS was established. The patient was space. Respiratory amyloidosis presents treated with oral steroids and antifungal as two tracheobronchial forms (local and drugs diffuse) and two parenchymal forms INTL (nodular and diffuse), of which diffuse PMID:25371437 PMCID: tracheobronchial amyloidosis is the least CO common. We herein present two cases Upadhyay, R., Prakash, V., Singh, A. B. of tracheobronchial amyloidosis. and Saheer, S. INTL Maxillary sinusitis with pulmonary PMID:25386446 PMCID:4225898 tuberculosis CO BMJ Case Rep; 2014, 2014 bcr-2014- Valson AT(1), David VG(1), Balaji V(2), 203952 John GT(3). Multifocal bacterial osteomyelitis in a Address:Department of Pulmonary renal allograft recipient following Medicine, King George's Medical urosepsis. University, Lucknow, Uttar Pradesh, Indian J Nephrol. 2014 May;24(3):189- India. 92. doi: 10.4103/0971-4065.132022. Department of ENT, King George's Medical University, Lucknow, Uttar Pradesh, India. Author information:
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(1)Department of Nephrology, Christian Electronic Address: Medical College Hospital, Vellore, Tamil [email protected]. Nadu, India. (2)Department of Department of Urology, Christian Microbiology, Christian Medical College Medical College, Vellore, India. Hospital, Vellore, Tamil Nadu, India. (3)Department of Renal Medicine, Royal OBJECTIVE: To study the presentation, Brisbane and Women's Hospital, management, and outcome of patients Herston, Queensland, Australia. with exstrophy-epispadias complex, who present in adulthood (aged >18 years). Non-tubercular bacterial osteomyelitis is MATERIALS AND METHODS: A a rare infection. We report on a renal retrospective review of the electronic allograft recipient with osteomyelitis medical records of patients with complicating urosepsis, manifesting as a exstrophy-epispadias complex managed multifocal infection poorly responsive to from January 2001 to December 2010 appropriate antibiotics and surgical was undertaken. Patients aged >18 intervention and culminating in graft years at presentation, with detailed loss. medical records were selected. They NAT were classified into 2 groups: group A PMCID: PMC4127842 PMID: 25120300 (previously untreated) and group B [PubMed] (residual defects or complications after CO childhood surgery). RESULTS: Thirty- Venkatramani, V. and Banerji, J. S. nine patients with exstrophy-epispadias Spontaneous perinephric hemorrhage complex presented to our institution (Wunderlich syndrome) secondary to over this 10-year period. Of these 26 polyarteritis nodosa: Computed were adults (aged >18 years; range, 18- tomography and angiographic findings 48 years). Detailed medical records Indian J Urol; 2014, 30 (4): 452-3 could be obtained for 21 of them and they were included. Group A consisted of Address:Department of Urology, 4 patients-2 male and 2 female. All Christian Medical College, Vellore, Tamil underwent cystectomy; 2 had an ileal Nadu, India. conduit and 2 had ureterosigmoidostomy (Mainz II). All had improved quality of We report the case of a young man who life and a stable renal function at follow- presented with spontaneous left up. Group B consisted of 17 patients. perinephric hematoma and per-rectal Mean number of surgeries attempted bleeding. Evaluation revealed renal and previously was 4.4 (range, 2-13). superior mesenteric arterial aneurysms Presentation was varied but primarily secondary to polyarteritis nodosa (PAN). involved incontinence of urine (n = 12). Computed tomography and angiographic Four patients were lost to follow-up, 2 findings are presented. The aetiology of were managed conservatively, and 11 spontaneous perinephric hemorrhage underwent a surgical procedure. All along with relevant features of PAN are patients returned to normal activity with discussed. an improvement in the quality of life NAT postoperatively. CONCLUSION: Exstrophy-epispadias complex is difficult PMID:25378832 PMCID:4220390 to manage in resource-poor settings CO associated with illiteracy and poverty. Venkatramani, V., Chandrasingh, J., However, successful rehabilitation and Devasia, A. and Kekre, N. S. an improved quality of life are possible Exstrophy-epispadias Complex even in cases presenting in adults. Presenting in Adulthood: A Single-center INTL Review of Presentation, Management, PMID:25443942 PMCID: and Outcomes CO Urology; 2014, 84 (5): 1243-7
Address:Department of Urology, Williams, A. and Singh, G. Christian Medical College, Vellore, India.
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Tongue bite injury after use of probably best maintained by transcranial electric stimulation motor- complementary regular supplementation evoked potential monitoring in a primary prevention strategy rather J Anaesthesiol Clin Pharmacol; 2014, 30 than secondary prevention triggered by (3): 439-40 acute diarrhea. The assessment of zinc status is challenging and complex Address:Department of Anesthesiology, without simple, validated measures to Christian Medical College, Vellore, Tamil facilitate field testing of novel Nadu, India. interventions. Zinc bioavailability may be INTL a crucial factor in the success of primary prevention strategies, and a range of PMID:25190968 PMCID:4152700 options, all still inadequately explored, CO might be valuable in improving zinc Young, G. P., Mortimer, E. K., nutrition. Some therapeutic actions of Gopalsamy, G. L., Alpers, D. H., Binder, zinc on diarrhea seem attributable to H. J., Manary, M. J., Ramakrishna, B. S., pharmacologic effects, whereas others Brown, I. L. and Brewer, T. G. are related to the reversal of deficiency Zinc deficiency in children with (ie, nutritional). The distinction between environmental enteropathy-development these 2 mechanisms cannot be clarified of new strategies: report from an expert given the insensitivity of serum zinc to workshop identify subclinical deficiency states. Am J Clin Nutr; 2014, 100 (4): 1198- Why zinc seems to be less effective than 207 expected at all ages, and ineffective for secondary prevention of diarrhea in Address:From the School of Medicine, children <12 mo of age, remains Flinders University of South Australia, unclear. It was concluded that a Adelaide, Australia (GPY, EKM, GLG, and reframing of the current ILB); Washington University School of recommendation is warranted with Medicine, St Louis, MO (DHA and MJM); consideration of how to better optimize Yale University School of Medicine, New and deliver zinc and whether to provide Haven, CT (HJB); the Department of a complementary public health primary Medical Gastroenterology, Christian prevention zinc strategy. This requires Medical College Vellore, Vellore, India careful consideration of the zinc product (BSR); and Enteric and Diarrheal to be used as well as strategies for its Diseases, the Bill & Melinda Gates delivery. Foundation, Seattle, WA (TGB). INTL Zinc deficiency is a major cause of PMID:25240082 PMCID:4163797 childhood morbidity and mortality. The CO WHO/UNICEF strategy for zinc supplementation as adjunctive therapy for diarrhea is poorly implemented. A conference of experts in zinc nutrition and gastrointestinal disorders was convened to consider approaches that might complement the current recommendation and what research was needed to develop these approaches. Several key points were identified. The design of novel zinc interventions would be facilitated by a better understanding of how disturbed gut function, such as environmental (or tropical) enteropathy, affects zinc absorption, losses, and homeostasis. Because only 10% of zinc stores are able to be rapidly turned over, and appear to be rapidly depleted by acute intestinal illness, they are
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Babji, S., Arumugam, R., Sarvanabhavan, A., Moses, P. D., Simon, A., Aggarwal, I., Mathew, A., Sr, Anita and Kang, G. Multi-center surveillance of rotavirus diarrhea in hospitalized children <5 years of age in India, 2009-2012 Vaccine; 2014, 32 Suppl 1 A10-2
Address:Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India. Department of Child Health, Christian Medical College, Vellore, India. Department of Pediatrics, St. Stephen's Hospital, Delhi, India. Child Jesus Hospital, Trichy, India. Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India. Electronic Address: [email protected].
Diarrheal disease due to Group A rotaviruses continues to be an important cause of morbidity in the developing world and India contributes significantly to the disease burden. Surveillance carried out between July 2009 and June 2012 at two medical centers in south India and one center in north India estimated 39% of all diarrheal
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admissions to be due to rotavirus. The 11.37 million episodes of rotavirus most prevalent genotype isolated was gastroenteritis occur each year in India, G1P[8](33%) followed by G2P[4](17%). requiring 3.27 million outpatient visits G9P[4] has also emerged as a significant and 872,000 inpatient admissions when cause of rotavirus diarrhea. No seasonal health access is unconstrained, resulting variation was noticed from the centers in in a need for Rs. 10.37 billion each year south India, whereas we observed in direct costs. An estimated 78,000 increased rotavirus diarrhea in the rotavirus-associated deaths occur center in north India during March and annually of which 59,000 occur in the April. first 2 years of life. Introduction of a INTL rotavirus vaccine of similar efficacy to PMID:25091661 PMCID: the Rotavac in the national immunization EPH program would result in 686,277 fewer John, J., Sarkar, R., Muliyil, J., outpatient visits, 291,756 fewer Bhandari, N., Bhan, M. K. and Kang, G. hospitalizations and 26,985 fewer deaths Rotavirus gastroenteritis in India, 2011- each year in India, assuming no indirect 2013: revised estimates of disease effects for the vaccine burden and potential impact of vaccines INTL Vaccine; 2014, 32 Suppl 1 A5-9 PMID:25091681 PMCID: EPH Address:Christian Medical College, Vellore, India. John, T. J. Society for Applied Studies, New Delhi, Hepatitis B immunization in public health India. mode in India Ministry of Science and Technology, New Indian Pediatr; 2014, 51 (11): 869-70 Delhi, India. Christian Medical College, Vellore, India. Address:Formerly Professor and Head, Electronic Address: Departments of Clinical Microbiology and [email protected]. Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India. While improvements in oral rehydration [email protected]. use and access to healthcare have NAT contributed to impressive gains in child PMID:25432213 PMCID: survival, diarrheal diseases remain the EPH second most important cause of child mortality in India. Pathogen specific John, T. J. disease rates, while key to deciding on Encephalopathy clusters conflated with the utility of specific public health encephalitis outbreaks interventions such as vaccines, are Indian Pediatr; 2014, 51 (11): 937 extremely difficult to obtain in developing country settings with less Address:Retired Professor and Head, than optimal health access, diagnostic Department of Clinical Virology, CMC, services and information systems. This Vellore, TN, India. study combined disease burden within [email protected]. five cohorts of infants followed up for NAT diarrheal morbidity with data from the PMID:25432236 PMCID: nationally representative Indian EPH Rotavirus Surveillance Network and Kattula, D., Sarkar, R., applies rates of rotavirus related events Sivarathinaswamy, P., Velusamy, V., to UNICEF birth and mortality estimates Venugopal, S., Naumova, E. N., Muliyil, for India. These estimates, while limited J., Ward, H. and Kang, G. by the lack of data from nationally The first 1000 days of life: prenatal and representative population based studies, postnatal risk factors for morbidity and use methods consistent with those growth in a birth cohort in southern employed by the World Health India Organization Child Health Epidemiology BMJ Open; 2014, 4 (7): e005404 Reference Group. We estimate that
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Address:Department of Gastrointestinal prenatal factors and gastrointestinal and Sciences, Christian Medical College, respiratory illness. Policymakers need Vellore, Tamil Nadu, India. disease prevalence and pathways to Department of Gastrointestinal Sciences, target high-risk groups with appropriate Christian Medical College, Vellore, Tamil interventions in the community. Nadu, India Department of Civil and INTL Environmental Engineering, Tufts PMID:25056979 PMCID:4120427 University School of Engineering, EPH Medford, Massachusetts, USA. Madsen, C., Mogensen, P., Thomas, N., Department of Gastrointestinal Sciences, Christensen, D. L., Bygbjerg, I. C., Christian Medical College, Vellore, Tamil Mohan, V., Inbakumari, M., Nadig, S. V., Nadu, India Division of Geographic Alex, R., Geetanjali, F. S., Westgate, K., Medicine and Infectious Diseases, Tufts Brage, S., Vaag, A. and Grunnet, L. G. Medical Center, Boston, Massachusetts, Effects of an outdoor bicycle-based USA. intervention in healthy rural Indian men with normal and low birth weight OBJECTIVE: To estimate the burden and J Dev Orig Health Dis; 2014, 1-11 assess prenatal and postnatal determinants of illnesses experienced by Address:1Department of Diabetes and children residing in a semiurban slum, Metabolism,Copenhagen University during the first 1000 days of life. Hospital DESIGN: Community-based birth cohort (Rigshospitalet),Copenhagen,Denmark. SETTING: Southern India 2Department of Endocrinology,Diabetes PARTICIPANTS: Four hundred and and Metabolism,Christian Medical ninety-seven children of 561 pregnant College,Vellore,India. women recruited and followed for 2 3Department of International years with surveillance and Health,Immunology and anthropometry. MAIN OUTCOME Microbiology,University of MEASURE: Incidence rates of illness; Copenhagen,Copenhagen,Denmark. rates of clinic visits and hospitalisations; 4Department of Community factors associated with low birth weight, Health,Christian Medical various illnesses and growth. RESULTS: College,Vellore,India. Data on 10 377.7 child-months of 5Department of Clinical follow-up estimated an average rate of Biochemistry,Christian Medical 14.8 illnesses/child-year. College,Vellore,India. Gastrointestinal and respiratory illnesses 6MRC Epidemiology Unit,University of were 20.6% and 47.8% of the total Cambridge,Cambridge,United Kingdom. disease burden, respectively. The hospitalisation rate reduced from 46/100 Physical inactivity and low birth weight child-years during infancy to 19/100 (LBW) may lead to an increased risk for child-years in the second year. Anaemia developing type 2 diabetes. The extent during pregnancy (OR=2.3, 95% to which LBW individuals may benefit CI=1.08 to 5.18), less than four from physical exercise training when antenatal visits (OR=6.8, 95% CI=2.1 to compared with those with normal birth 22.5) and preterm birth (OR=3.3, 95% weight (NBW) controls is uncertain. We CI=1.1 to 9.7) were independent assessed the impact of an outdoor prenatal risk factors for low birth weight. exercise intervention on body Female gender (HR=0.88, 95% CI=0.79 composition, insulin secretion and action to 0.99) and 6 months of exclusive in young men born with LBW and NBW breast feeding (HR=0.76, 95% CI=0.66 in rural India. A total of 61 LBW and 56 to 0.88) offered protection against all NBW healthy young men were recruited morbidity. Average monthly height and into the study. The individuals were weight gain were lower in female child instructed to perform outdoor bicycle and children exclusively breast fed for 6 exercise training for 45 min every day. months. CONCLUSIONS: The high Fasting blood samples, intravenous morbidity in Indian slum children in the glucose tolerance tests and first 1000 days of life was mainly due to bioimpedance body composition
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assessment were carried out. Physical findings support the need for activity was measured using combined consideration of timely immunization or accelerometry and heart rate monitoring an accelerated immunization schedule during the first and the last week of the with a birth dose to protect this intervention. Following the exercise vulnerable age. intervention, the LBW group displayed INTL an increase in physical fitness [55.0 ml PMID:25091679 PMCID: (O2)/kg min (52.0-58.0)-57.5 ml EPH (O2)/kg min (54.4-60.5)] level and total Mohan, V. R., Jayaraman, T., Babu, P., fat-free mass [10.9% (8.0-13.4)-11.4% Dorny, P., Vercruysse, J. and (8.0-14.6)], as well as a corresponding Rajshekhar, V. decline in the ratio of total fat mass/fat- Prevalence and risk factors for Taenia free mass. In contrast, an increase in solium taeniasis in Kaniyambadi block, total fat percentage as well as total fat Tamil Nadu, South India mass was observed in the NBW group. Indian J Public Health; 2014, 58 (3): After intervention, fasting plasma insulin 202-3 levels, homoeostasis model assessments (HOMA) of insulin resistance (HOMA-IR) Address:Professor, Department of and insulin secretion (HOMA-IS), Community Health, Christian Medical improved to the same extent in both the College, Vellore, Tamil Nadu, India. groups. In summary, young men born with LBW in rural India benefit NAT metabolically from exercise training to PMID:25116828 PMCID: an extent comparable with NBW EPH controls. INTL Mohan, V. R., Sharma, S., Ramanujam, K., Babji, S., Koshy, B., Bondu, J. D., PMID:25514893 PMCID: John, S. M. and Kang, G. EPH Effects of elevated blood lead levels in Mathew, A., Rao, P. S., preschool children in urban Vellore Sowmyanarayanan, T. V. and Kang, G. Indian Pediatr; 2014, 51 (8): 621-5 Severity of rotavirus gastroenteritis in an Indian population: report from a 3 Address:Departments of Community year surveillance study Health, # Surgery, $ Gastrointestinal Vaccine; 2014, 32 Suppl 1 A45-8 Sciences, ^Developmental Pediatrics, ** Clinical Biochemistry and *Low Cost Address:Department of Pediatrics, St. Effective Care Unit, Christian Medical Stephens' Hospital, Delhi, India. College, Vellore. Tamil Nadu. Electronic Address: Correspondence to: Dr Venkata Raghava [email protected]. Mohan, Department of Community Leprosy Mission Trust, New Delhi, India. Health, Christian Medical College, Vellore Division of Gastrointestinal Sciences, 632 002, Tamil Nadu, India. Christian Medical College, Vellore, India. [email protected].
This study investigated the severity of OBJECTIVE: To study the burden and rotavirus gastroenteritis (RVGE) in associated risk factors for elevated blood hospitalized children less than 60 lead levels among pre-school children months of age and compared severity in (15-24 months) in urban Vellore, and to the first five months of life to severity in study its effects on child cognition and children 6 to 23 months of age. Results anemia. DESIGN: An investigative study from a 3 year surveillance study show through Mal-ED cohort. SETTING: Eight an early peak of rotavirus disease, with adjacent urban slums in Vellore, Tamil 117 (31%) RVGE hospitalizations in Nadu. PARTICIPANTS: 251 babies children <6 months old. Higher recruited through Mal-ED Network. incidence of severe dehydration, OUTCOME MEASURES: Blood lead levels acidemia and acidosis at admission and using Graphite Furnace Atomic prolonged hospitalization >7 days were Absorption Spectrophotometry method seen in infants 0-5 months of age. The at 15 and 24 mo; hemoglobin estimation
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by azidemethemoglobin method; surveillance and diarrheal stool were cognitive levels using Bayley Scales of collected from 452 children enrolled at Infant Development III. RESULTS: birth, of whom 373 completed three Around 45% of children at 15 months years of follow up. Samples were and 46.4% at 24 months had elevated screened for rotavirus by an ELISA and blood lead levels (>10 microg/dL). genotyped by reverse transcription Among children who had elevated blood polymerase chain reaction for VP7 and lead levels at 15 months, 69.2% (45/65) VP4 genes. Rotavirus incidence rates continued to have elevated levels at 24 were calculated using Poisson regression months. After adjusting for potential equations. Risk factors associated with confounders, children from houses symptomatic and asymptomatic having a piped drinking water supply rotavirus infections were compared and houses with mud or clay floors were using multiple logistic regression. at significantly higher risk of having RESULTS: A total of 1149 episodes of elevated blood lead levels at 15 months. rotavirus infections occurred in 94.4% Thirty one percent (21/67) of the children in the cohort. Incidence of children with elevated blood lead levels rotavirus infection was 1.04 (0.97-1.1) had poor cognitive scores. Children with per child-year with 0.75 asymptomatic elevated blood lead levels at 15 months and 0.29 symptomatic infections per had higher risk (Adjusted OR 1.80; 95% child-year. About 18% of the children CI 0.80 - 3.99) of having poorer were infected in the first month, mainly cognitive scores at 24 months. More with the G10P[11] strain. Rotavirus than half of the children (57%) were infections were more prevalent during anemic at 15 months of age, and October-March, but seasonality was not elevated blood lead levels were not as marked in rotavirus disease. significantly associated with anemia. Rotavirus was associated with 15.1% of CONCLUSIONS: Elevated blood lead mild diarrhea, 38.9% of levels are common among preschool moderate/severe diarrhea and 66.7% of children living in urban slums of Vellore. very severe diarrhea. Four common G Poorer conditions of the living types - G1 (26.8%), G2 (16%), G10 environment are associated with (11.2%) and G9 (9.6%) were seen, with elevated lead levels. high rates of mixed infections and NAT untypable samples. Male gender, PMID:25128994 PMCID: presence of siblings and low maternal EPH education were associated with rotavirus disease. CONCLUSION: This study Paul, A., Gladstone, B. P., demonstrates that rotavirus is the most Mukhopadhya, I. and Kang, G. common cause of gastroenteritis in the Rotavirus infections in a community community, and indicates that since based cohort in Vellore, India rotavirus caused the greatest proportion Vaccine; 2014, 32 Suppl 1 A49-54 of moderate and severe disease, targeted interventions such as vaccines Address:Department of Gastrointestinal are needed for rotavirus, in addition to Sciences, Christian Medical College, health education, sanitation and Vellore, India. appropriate treatment to decrease Department of Gastrointestinal Sciences, diarrheal disease in communities. Christian Medical College, Vellore, India. INTL Electronic Address: PMID:25091680 PMCID: [email protected]. EPH Premkumar, P. S., Parashar, U. D., INTRODUCTION: The burden of infection Gastanaduy, P. A., Mccracken, J. P., De in communities determines the spread of Oliveira, L. H., Payne, D. C., Patel, M. rotavirus infection and disease in M., Tate, J. E. and Lopman, B. A. susceptible populations. This study Reduced Rotavirus Vaccine Effectiveness reports rotavirus infection and disease in Among Children Born During the a community based birth cohort in Rotavirus Season: A Pooled Analysis of 5 Vellore. METHODS: Bimonthly Case-Control Studies From the Americas
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Clin Infect Dis; 2014, Sciences, Christian Medical College, Address:National Center for Vellore, Tamil Nadu 632004, India. Immunization and Respiratory Diseases, National Center for Immunization and Centers for Disease Control and Respiratory Diseases, Centers for Prevention, Atlanta, Georgia The Disease Control and Prevention, 1600 Wellcome Trust Research Laboratory, Clifton Road, MS-G04, Atlanta, GA Division of Gastrointestinal Sciences, 30333, USA. Christian Medical College, Vellore, Tamil Nadu, India. Serum antibodies play an important role National Center for Immunization and in natural protection from rotavirus Respiratory Diseases, Centers for infection and disease, but conflicting Disease Control and Prevention, Atlanta, estimates of association have emerged Georgia. from epidemiological studies in different Center for Health Studies, Universidad geographical settings. In this study, we del Valle de Guatemala, Guatemala City. aim to assess the relationship between Pan American Health Organization, pre-existing serum immunoglobulin Washington, District of Columbia. (Ig)G and IgA titers with protection against rotavirus infection and disease in Using data from rotavirus vaccine a birth cohort of Indian children. effectiveness (VE) studies, we assessed Children were recruited at birth and whether rotavirus season modifies followed up for 36 months. Stool rotavirus VE in infants. In the first year samples were collected every 2 weeks of life, adjusted VE was 72% for children and during episodes of diarrhea and born during rotavirus season and 84% serum samples were obtained at least for children born in other months (P = every 6 months. The incidence rate of .01). Seasonal factors may interfere with rotavirus infection and diarrhea was 0.9 vaccine performance. (95% CI: 0.88, 0.99) and 0.2 (95% CI: 0.19, 0.25) episodes per child year, INTL respectively. The risk of rotavirus PMID:25452592 PMCID: infection and diarrhea decreased with EPH age, while antibody titers (IgG and IgA) Premkumar, P., Lopman, B., Ramani, increased with age. After adjusting for S., Paul, A., Gladstone, B., Muliyil, J., age and number of previous infections, Mukhopadhya, I., Parashar, U. and higher levels of IgG and IgA were Kang, G. independently associated with reduced Association of serum antibodies with risk of rotavirus infection. However, we protection against rotavirus infection and did not find a clear association of IgG or disease in South Indian children IgA with rotavirus diarrhea risk or a Vaccine; 2014, 32 Suppl 1 A55-61 threshold level of protection. The study supports a correlation of serum Address:National Center for antibodies in reducing the risk of Immunization and Respiratory Diseases, rotavirus infections, however the Centers for Disease Control and potential of serum antibody titer as a Prevention, 1600 Clifton Road, MS-G04, correlate of protection is not clear for Atlanta, GA 30333, USA; The Wellcome children in lower income settings. Trust Research Laboratory, Division of INTL Gastrointestinal Sciences, Christian PMID:25091682 PMCID: Medical College, Vellore, Tamil Nadu EPH 632004, India. Rahman, S. M., Angeline, R. P., David, National Center for Immunization and K. V. and Christopher, P. Respiratory Diseases, Centers for Role of Family Medicine Education in Disease Control and Prevention, 1600 India's Step Toward Universal Health Clifton Road, MS-G04, Atlanta, GA Coverage 30333, USA. Electronic Address: J Family Med Prim Care; 2014, 3 (3): [email protected]. 180-2 The Wellcome Trust Research Laboratory, Division of Gastrointestinal
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Address:Department of Family pneumococcal vaccine has already been Medicine, Christian Medical College, introduced in the country, there is very Vellore, Tamil Nadu, India. little epidemiological data regarding S. Department of Community Medicine, pneumoniae colonization and antibiotic Christian Medical College, Vellore, Tamil susceptibility in Indian infants. Nadu, India. METHODS: We studied serogroup/serotype (SGT) distribution India's commitment to universal health and antibiotic susceptibility pattern of S. coverage has grown stronger with the pneumoniae in unvaccinated Indian submission of High Level Expert Group infants by performing monthly report by the Planning Commission in nasopharyngeal swabbing of a birth 2012. With this report comes the cohort for 2 years. RESULTS: commitment to increase the primary Colonization began soon after birth and health-care workforce to meet the was complete in the first year of life in population needs. However, the focus the majority of those colonized. Carriage should not be just to increase the rates increased during winter (p<0.01) number of health workers, but to and in those with upper respiratory produce better health workers. Doctors, infection (URI) (p<0.01). The most nurses and community health workers frequently (76.1%) isolated SGT were trained in primary and secondary health- 19, 6, 15, 23, 9, 35 and 10. Vaccine SGT care facilities can make a significant accounted for 60.5% of all colonizers. contribution in responding to the needs Antibiotic resistance was maximum for of the local community. The role of cotrimoxazole (94.3%) and least for family medicine education is worth erythromycin (11.2%) with no penicillin exploring in this context to equip the resistance. Ten of the commonest SGT primary care health workers with the which cause invasive disease among competencies of providing person- Indian infants comprised 46.9% of the centered, comprehensive and continuous colonizers. Serogroups 1, 5, 45 and 12 care. which cause invasive disease in under- INTL fives were not seen in this birth cohort in the first year. CONCLUSIONS: S. PMID:25374848 PMCID:4209666 pneumoniae colonization in Indian EPH infants commences soon after birth and Rupa, V., Isaac, R., Jalagandeeswaran, chiefly occurs in the first year of life. The R., Manoharan, A. and Rebekah, G. 13 valent vaccine may protect against a Epidemiology of nasopharyngeal little less than half the commonly seen colonization by S. pneumoniae in Indian invasive SGT of S infants in the first 2 years of life INTL Int J Pediatr Otorhinolaryngol; 2014, 78 PMID:25112164 PMCID: (10): 1701-6 EPH
Sarkar, R., Tate, J. E., Ajjampur, S. S., Address:Department of ENT, Christian Kattula, D., John, J., Ward, H. D. and Medical College, Vellore, India. Kang, G. Electronic Address: Burden of diarrhea, hospitalization and [email protected]. mortality due to cryptosporidial Department of RUHSA, Christian Medical infections in Indian children College, Vellore, India. PLoS Negl Trop Dis; 2014, 8 (7): e3042 Department of Medicine (Infectious
Diseases Unit), Christian Medical Address:Christian Medical College, College, Vellore, India. Vellore, Tamil Nadu, India. Department of Biostatistics, Christian Centers for Disease Control and Medical College, Vellore, India. Prevention, Atlanta, Georgia, United
States of America. BACKGROUND: Streptococcus Christian Medical College, Vellore, Tamil pneumoniae is a leading cause of Nadu, India; Tufts Medical Center, invasive disease in developing countries Boston, Massachusetts, United States of like India. Although the 13 valent America.
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EPH BACKGROUND: Cryptosporidium spp. is a common, but under-reported cause of childhood diarrhea throughout the world, especially in developing countries. A comprehensive estimate of the burden of cryptosporidiosis in resource-poor settings is not available. METHODOLOGY/PRINCIPAL FINDINGS: We used published and unpublished studies to estimate the burden of diarrhea, hospitalization and mortality due to cryptosporidial infections in Indian children. Our estimates suggest that annually, one in every 6-11 children <2 years of age will have an episode of cryptosporidial diarrhea, 1 in every 169- 633 children will be hospitalized and 1 in every 2890-7247 children will die due to cryptosporidiosis. Since there are approximately 42 million children <2 years of age in India, it is estimated that Cryptosporidium results in 3.9-7.1 million diarrheal episodes, 66.4-249.0 thousand hospitalizations, and 5.8-14.6 Abraham, A., Devasia, A. J., thousand deaths each year. Varatharajan, S., Karathedath, S., CONCLUSIONS/SIGNIFICANCE: The Balasubramanian, P. and Mathews, V. findings of this study suggest a high Effect of cytosine arabinoside burden of cryptosporidiosis among metabolizing enzyme expression on drug children <2 years of age in India and toxicity in acute myeloid leukemia makes a compelling case for further Ann Hematol; 2014, research on transmission and prevention modalities of Cryptosporidium spp. in Address:Department of Haematology, India and other developing countries. Christian Medical College, Vellore, INTL 632004, India. PMID:25058664 PMCID:4109911 INTL EPH PMID:25391240 PMCID: MISC Tate, J. E., Arora, R., Bhan, M. K., Yewale, V., Parashar, U. D. and Kang, G. Balamurugan, R., Rotavirus disease and vaccines in India: Chandragunasekaran, A. S., Chellappan, a tremendous public health opportunity G., Rajaram, K., Ramamoorthi, G. and Vaccine; 2014, 32 Suppl 1 vii-xii Ramakrishna, B. S. Probiotic potential of lactic acid bacteria Address:Centers for Disease Control present in home made curd in southern and Prevention, Atlanta, GA, USA. India Indian Council of Medical Research, New Indian J Med Res; 2014, 140 (3): 345- Delhi, India. 55 Ministry of Science and Technology, Government of India, India. Address:The Wellcome Trust Research Indian Academy of Pediatrics, Mumbai, Laboratory, Department of Maharashtra, India. Gastrointestinal Sciences, Christian Christian Medical College, Vellore, Tamil Medical College, Vellore, India. Nadu, India. Electronic Address: [email protected]. BACKGROUND & OBJECTIVES: The INTL human gut microbiota play a significant PMID:25091690 PMCID: role in nutritional processes. The concept
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of probiotics has led to widespread Benjamin, T. E., Crasta, J. E., Suresh, consumption of food preparations A. P., Alwinesh, M. J., Kanniappan, G., containing probiotic microbes such as Padankatti, S. M., Nair, M. K. and curd and yogurt. Curd prepared at home Russell, P. S. is consumed every day in most homes in Sensory profile caregiver questionnaire: southern India. In this study the home- a measure for sensory impairment made curd was evaluated for lactic acid among children with developmental bacteria (LAB) with probiotic potential. disabilities in India METHODS: Fifteen LAB (12 lactobacilli, 1 Indian J Pediatr; 2014, 81 Suppl 2 183-6 l0 actococcus , 2 Leuconostoc) and one yeast isolated from home-made curd Address:Department of Occupational were evaluated for resistance to acid, Therapy, Christian Medical College, pepsin, pancreatin and bile salts; Vellore, Tamil Nadu, India. antimicrobial resistance; intrinsic antimicrobial activity; adherence to OBJECTIVE: There is no validated Caco-2 epithelial cells; ability to block measure for assessing sensory pathogen adherence to Caco-2 cells; processing among children with ability to inhibit interleukin (IL)-8 Developmental Disorders (DD) in India, secretion from HT-29 epithelial cells in and therefore, the authors validated the response to Vibrio cholerae; and ability Sensory Profile Caregiver Questionnaire to induce anti-inflammatory cytokine (SPCQ). METHODS: Parents of 119 expression in THP-1 monocyte cells. children with DD or typical development RESULTS: Lactobacillus abundance in completed the SPCQ. The diagnosis of fermenting curd peaked sharply at 12 h. DD was confirmed by psychologists Nine of the strains survived exposure to using standardized measures. Two acid (pH 3.0) for at least one hour, and experienced occupational therapists all strains survived in the presence of independently diagnosed sensory pancreatin or bile salts for 3 h. None processing dysfunction by consensus as showed haemolytic activity. All were reference standard diagnosis. The resistant to most antimicrobials tested, convergent and divergent validity were but were sensitive to imipenem. Most assessed by another rater. The data was strains inhibited the growth of analyzed for diagnostic accuracy, Salmonella Typhimurium while five reliability and validity appropriately. inhibited growth of V. cholerae O139. RESULTS: A total SPCQ score of
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MISC satisfaction were calculated. RESULTS: While 63.4% of interns reported high Bhaskar, A. levels of satisfaction, 45.2% of the Playing games during a lecture hour: interns experienced high levels of stress, experience with an online blood grouping 17.6% coped with work stress by using game alcohol and nicotine, and 37% coped Adv Physiol Educ; 2014, 38 (3): 277-8 through unhealthy eating habits. CONCLUSION: More people found Address:Department of Physiology, internship satisfying than stressful. Christian Medical College, Vellore, However, a high proportion found it Tamilnadu, India stressful, and many reported unhealthy [email protected]. coping mechanisms. INTL NAT PMID:25179620 PMCID:4154262 PMID:25035558 PMCID:4100420 MISC MISC
Chandramouleeswaran, S., Edwin, N. Chandramouleeswaran, S., Edwin, N. C. and Braganza, D. C., Victor, P. J. and Tharyan, P. Job stress, satisfaction, and coping The emergency physician's assessment strategies among medical interns in a of suicide risk in intentional self- South Indian tertiary hospital poisoning using the modified SAD Indian J Psychol Med; 2014, 36 (3): PERSONS scale versus standard 308-11 psychiatric evaluation in a general hospital in South India: A cross-sectional Address:Department of Psychiatry, study Christian Medical College, Vellore, Tamil Trop Doct; 2015, 45 (1): 21-6 Nadu, India. Department of General Medicine, Address:Assistant Professor, Christian Medical College, Vellore, Tamil Department of Psychiatry, Christian Nadu, India. Medical College, Vellore, Tamil Nadu, India [email protected]. BACKGROUND: It has previously been Assistant Professor, Department of Acute demonstrated that there is a significant Care Medicine, Christian Medical College, drop in all domains of quality of life Vellore, Tamil Nadu, India. among interns during internship. AIMS: Professor, Department of Critical Care A modified version of the health Medicine, Christian Medical College, consultant's job stress and satisfaction Vellore, Tamil Nadu, India. questionnaire (HCJSSQ) was used to Professor, Department of Psychiatry, assess and quantify aspects of internship Prof BV Moses Centre for Evidence- that were perceived as stressful and Informed Health Care and Health Policy, satisfying. Methods used to cope with Christian Medical College, Vellore, Tamil work place stress were explored. Nadu, India. SETTINGS AND DESIGN: A prospective cohort study was undertaken among 93 INTRODUCTION: The reliable medical interns doing a rotating identification, by emergency physicians, internship at the Christian Medical of those with intentional self-poisoning College and Hospital, a tertiary-care at risk of repeating attempts is crucial, hospital in southern India. MATERIALS particularly in countries with a shortfall AND METHODS: After completion of 6 of mental health professionals. months of internship, the modified METHODS: This cross-sectional study of version of the HCJSSQ was administered intentional self-poisoning in India to all participants. STATISTICAL compared an emergency physician's ANALYSIS: The data were entered into assessment for the need for psychiatric Statistical Package for the Social referral, using the modified SAD Sciences (SPSS) Version 9 by double PERSONS Scale (MSPS) as an interview data entry technique. Percentages of guide, with a standard psychiatric interns reporting high levels of stress, interview. RESULTS: In 67 consecutive
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adults with intentional self-poisoning, Environmental Microbial Food Safety MSPS cut-off scores of 5 or more best Laboratory, USDA, Beltsville, MD, USA. approximated psychiatric assessments Department of Public Health and for the need for psychiatric referral Community Medicine, Tufts University, (positive likelihood ratio 2.9, 95% Boston, MA, USA. confidence interval [CI] 0.8-10.2; Division of Infectious Diseases and negative likelihood ratio 0.5, 95% CI International Health, University of 0.3-0.8). CONCLUSIONS: MSPS-guided Virginia, Charlottesville, VA, USA. emergency physicians' assessments Department of Biology and Department after self-poisoning showed modest of Chemistry, Brandeis University, concordance with psychiatric Waltham, MA, USA. assessments of suicide-risk. Division of Infectious Diseases, Concordance with psychiatric University of Vermont, Burlington, VT, assessments may improve if risk factors USA. prevalent in different settings are Division of Infectious Disease and identified and incorporated in the MSPS. Tropical Pediatrics, Department of Pediatrics, Center for Vaccine INTL Development, University of Maryland PMID:25358507PMCID: School of Medicine, Baltimore, MD, USA. MISC Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India. Checkley, W., White, A. C., Jr., Department of Pediatrics, Emory Jaganath, D., Arrowood, M. J., University, Atlanta, GA, USA; Atlanta VA Chalmers, R. M., Chen, X., Fayer, R., Medical Center, Decatur, GA, USA. Griffiths, J. K., Guerrant, R. L., Fogarty International Center, National Hedstrom, L., Huston, C. D., Kotloff, K. Institutes of Health, Bethesda, MD, USA. L., Kang, G., Mead, J. R., Miller, M., Department of Biology, University of Petri, W. A., Jr., Priest, J. W., Roos, D. Pennsylvania, Philadelphia, PA, USA. S., Striepen, B., Thompson, R. C., Ward, Center for Tropical and Emerging Global H. D., Van Voorhis, W. A., Xiao, L., Zhu, Diseases, University of Georgia, Athens, G. and Houpt, E. R. GA, USA. A review of the global burden, novel School of Veterinary and Life Sciences, diagnostics, therapeutics, and vaccine Murdoch University, Perth, WA, targets for cryptosporidium Australia. Lancet Infect Dis; 2015, 15 (1): 85-94 Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center Address:Program in Global Disease Boston, MA, USA. Epidemiology and Control, Department Allergy and Infectious Diseases Division, of International Health, Johns Hopkins Departments of Medicine, Global Health, University, Baltimore, MD, USA; Fogarty and Microbiology, University of International Center, National Institutes Washington, Seattle, WA, USA. of Health, Bethesda, MD, USA. Electronic Department of Veterinary Pathobiology, Address: [email protected]. Texas A&M University, College Station, Division of Infectious Diseases, TX, USA. University of Texas Medical Branch, Galveston, TX, USA. Cryptosporidium spp are well recognised Program in Global Disease Epidemiology as causes of diarrhoeal disease during and Control, Department of International waterborne epidemics and in Health, Johns Hopkins University, immunocompromised hosts. Studies Baltimore, MD, USA. have also drawn attention to an Centers for Disease Control and underestimated global burden and Prevention, Atlanta, GA, USA. suggest major gaps in optimum National Cryptosporidium Reference diagnosis, treatment, and immunisation. Unit, Public Health Wales, Swansea, UK. Cryptosporidiosis is increasingly Department of Medical Microbiology and identified as an important cause of Immunology, Creighton University, morbidity and mortality worldwide. Omaha, NE, USA. Studies in low-resource settings and
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high-income countries have confirmed India, were provided training on the the importance of cryptosporidium as a administration of drugs for acute cause of diarrhoea and childhood symptoms. A plastic box with partitions malnutrition. Diagnostic tests for for drugs specific to symptom was cryptosporidium infection are provided. On follow-up visits, the usage suboptimum, necessitating specialised of the kit, drugs used, and routes of tests that are often insensitive. Antigen- administration were noted. A structured detection and PCR improve sensitivity, questionnaire with a 4-point scale was and multiplexed antigen detection and used to assess primary caregiver views molecular assays are underused. and satisfaction. RESULTS: Of primary Therapy has some effect in healthy hosts caregivers, 96.7% used a kit. The and no proven efficacy in patients with common medications used were AIDS. Use of cryptosporidium genomes morphine, metoclopramide, has helped to identify promising dexamethasone, and benzodiazepines. therapeutic targets, and drugs are in Seventy-three percent of primary development, but methods to assess the caregivers administered subcutaneous efficacy in vitro and in animals are not injections at home. Hospital visits for well standardised. Partial immunity after acute symptoms reduced by 80%; 90% exposure suggests the potential for were satisfied with the training received; successful vaccines, and several are in 73% stated it was not a burden to treat development; however, surrogates of the patient at home. CONCLUSION: The protection are not well defined. training program and acute symptom Improved methods for propagation and management kit were favorably received genetic manipulation of the organism and appropriately used by caregivers of would be significant advances. diverse backgrounds. Rural backgrounds INTL and illiteracy were not barriers to PMID:25278220 PMCID: acceptance. IMPLICATION FOR MISC PRACTICE: Healthcare professionals should train caregivers during hospital Chellappan, S., Ezhilarasu, P., visits, empowering them to manage Gnanadurai, A., George, R. and acute symptoms and provide simple Christopher, S. nursing care. This is doubly important in Can symptom relief be provided in the countries where resources are limited home to palliative care cancer patients and palliative care facilities scarce. by the primary caregivers? An Indian INTL study PMID:24172754 PMCID: Cancer Nurs; 2014, 37 (5): E40-7 MISC Crasta, J. E., Benjamin, T. E., Suresh, Address:Author Affiliation: Christian A. P., Alwinesh, M. T., Kanniappan, G., Medical College, Vellore, Tamil Nadu, Padankatti, S. M., Russell, P. S. and India. Nair, M. K. Feeding problems among children with BACKGROUND: A large proportion of autism in a clinical population in India cancer deaths occur in the developing Indian J Pediatr; 2014, 81 Suppl 2 169- world, with limited resources for 72 palliative care. Many patients dying at home experience difficult symptoms. Address:Department of Occupational OBJECTIVE: The objective of this study Therapy, Christian Medical College, was to assess the feasibility of a Vellore, Tamil Nadu, India. structured training program on symptom management along with an acute OBJECTIVES: To compare the symptom management kit for primary prevalence and profile of feeding caregivers of cancer patients receiving problems (FP) and their relationship with home care. METHODS: Descriptive sensory processing in children with design was used. Thirty primary autism and intellectual disability (ID). caregivers of cancer patients attending METHODS: Children between ages 3 to the palliative care clinic in Vellore, South 10 y with autism (N = 41) and ID (N =
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56) were recruited and assessed with Hospital, Vellore 632004, Tamil Nadu, Brief Autism Mealtime Behavior India. Inventory, Sensory Profile Questionnaire, Childhood Autism Rating AIMS: Coronary artery disease is the Scale and Binet-Kamat Scale of leading cause of mortality and morbidity Intelligence or Gesell's Developmental in our country, of which ST elevation Schedule. Assessments were done by myocardial infarction (STEMI) accounts independent raters. Bivariate and for the major part of health spending. multivariate analyses were used We sought to study the effect of appropriately. RESULTS: The prevalence induction of government health of FP were 61 and 46.4 % among insurance scheme on the trends of children with autism and ID respectively. reperfusion in patients of acute STEMI. Feeding problems were severe among METHODS AND RESULTS: 1133 patients children with autism (P 0.001), presenting with acute STEMI enrolled. especially in young children with autism 1079 (95.1%) received some form of (P 0.05), and gender was not related to reperfusion therapy. Primary PCI was FP. Disruptive meal-time behaviors (P used in 60.6% of patients as the primary 0.001) and food over-selectivity (P 0.02) reperfusion modality, a six fold increase were significantly more among children as compared to previous years. with autism in the bivariate and Government health insurance accounted multivariate analysis. Feeding problems for the one third of all. 34.5% patients and various dimensions of sensory underwent pharmacological reperfusion, processing were significantly associated most commonly with streptokinase. after controlling the confounders. 4.9% patients of STEMI did not receive CONCLUSIONS: These findings any form of reperfusion therapy in underscore the need for mandatory contrast to 14% during previous years. assessment of FP in children with CONCLUSION: Introduction of developmental disabilities, and if government health insurance along with present, they need to be addressed with increased awareness has resulted in multimodal-multidisciplinary dramatic changes in the management of interventions. STEMI patients. NAT NAT PMID:25413215 PMCID: PMID:25443602 PMCID:4223206 MISC MISC
George, P. V., Hooda, A., Pati, P. K., Gupta, R., James, P., Thangakunam, B. Varghese, L. and Lahiri, A. and Christopher, D. J. Effect of a Government Scheme on Medical thoracoscopic removal of a Reperfusion Trends in a tertiary care metal needle from the pleural space centre in South India BMJ Case Rep; 2014, 2014 Indian Heart J; 2014, 66 (5): 503-5 Address:Department of Pulmonary Address:Professor, Department of Medicine, Christian Medical College, Cardiology, Christian Medical College Vellore, Tamil Nadu, India. Hospital, Vellore 632004, Tamil Nadu, Pulmonary Department, Christian India. Medical College, Vellore, Tamil Nadu, Assistant Professor, Department of India. Cardiology, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, Medical thoracoscopy is an excellent India. Electronic Address: diagnostic and therapeutic tool for [email protected]. management of pleural diseases. There Assistant Professor, Department of have been case reports of removal of Cardiology, Christian Medical College foreign bodies from pleural spaces with Hospital, Vellore 632004, Tamil Nadu, video-assisted thoracoscopic surgery India. under general anaesthesia by thoracic Senior Registrar, Department of surgeons. We present a case of Cardiology, Christian Medical College successful removal of an 8 cm long
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metal needle from the pleural space with Address:Christian Medical College, single port medical semirigid Vellore 632002, India. Electronic thoracoscopy under local anaesthesia by Address: [email protected] a chest physician. Removal of a foreign body from the pleural space is one more While the traditional view within indication for medical thoracoscopy, psychiatry is that insight is independent however, an experienced chest physician of psychopathology and predicts the and proper case selection are very course and outcome of psychosis, recent important for safety and a successful data from India argues that insight is outcome of this procedure. secondary to interaction between INTL progression of illness on one hand and PMID:25301430 PMCID: local culture and social environment on MISC the other. The findings suggest that "insight" is an explanatory model (EM) Halder, A. and Jose, R. and may reflect attempts at coping with Residual adherent placenta with bladder the devastating effects of mental injury: can we use methotrexate? disorders. Most societies are pluralistic J Obstet Gynaecol India; 2014, 64 (4): and offer multiple, divergent and 293-4 contradictory explanations for illnesses. These belief systems interact with the Address:Department of Obstetrics & trajectory of the person's illness to Gynecology, Christian Medical College, produce a unique personal OG4 Office, 7th Floor, ISSCC Building, understanding, often based on a set of Ida Scudder Road, Vellore, 632004 complex and contradictory EMs. Like all India. EMs, insight provides meaning to explain NAT and overcome challenges including disabling symptoms, persistent deficits, PMID:25136179 PMCID:4126940 impaired social relations and difficult
livelihood issues. The persistence of MISC distress, impairment, disability and
handicap, despite regular and optimal Iadarling T treatment, call for explanations, which POEMS Syndrome: Response to queries go beyond the simplistic concept of Journal of Mahatma Gandhi Institute of disease. People tend to choose EMs, Medical Sciences. 2014 sep; 19(2): 170- which are non-stigmatizing and which 71 seem to help explain and rationalize their individual concerns. The frequent presence of multiple and often ADDRESS: Dr. T. Iadarling CMC, contradictory EMs, held simultaneously, Vellore, Tamil Nadu, India. E-mail: suggest that they are pragmatic [email protected] responses at coping. The results advocate a non-judgmental approach KEYWORDS: and broad based assessment of EMs of POEMS Syndrome; Humans illness and their comparison with References: 3 culturally appropriate beliefs, attributions and actions. The biomedical NAT model of illness should be presented Record Identifier: NI248656 without dismissing patient beliefs or NON INDEXED belittling local cultural explanations for MISC illness. Clinical practice demands a negotiation of shared model of care and Jacob, K. S. treatment plan between patient and Insight in psychosis: An independent physician perspectives. The diversity of predictor of outcome or an explanatory patients, problems, beliefs and cultures model of illness? mandates the need to educate, match, Asian J Psychiatr; 2014, 11 65-71 negotiate and integrate psychiatric and psychological frameworks and
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interventions. It calls for multifaceted Medical College, Vellore, Tamil Nadu, and nuanced understanding of "insight" India. and explanatory models of illness. Department of Endocrinology, Christian INTL Medical College, Vellore, Tamil Nadu, PMID:25453700 PMCID: India. MISC Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, Jayaprakash, S., Jeevanandam, J. and India. Subramani, K. Department of Endocrine Surgery, Ab initio molecular orbital and density Christian Medical College, Vellore, Tamil functional studies on the ring-opening Nadu, India. reaction of oxetene INTL J Mol Model; 2014, 20 (11): 2494 PMID:25535229 PMCID: MISC Address:Department of Chemistry, Islamiah College, Vaniyambadi, Vellore John, S. M., Thomas, R. J., Kaki, S., District, Tamil Nadu, India, Sharma, S. L., Ramanujam, K., [email protected]. Raghava, M. V., Koshy, B., Bose, A., Rose, A., Rose, W., Ramachandran, A., Electrocyclic ring opening (ERO) reaction Joseph, A. J., Babji, S. and Kang, G. of 2H-Oxete (oxetene) has been carried Establishment of the MAL-ED birth out computationally in the gas phase cohort study site in Vellore, Southern and ring opening barrier has been India computed. When comparing the ERO Clin Infect Dis; 2014, 59 Suppl 4 S295-9 reaction of oxetene with the parent hydrocarbon (cyclobutene), the ring Address:Low Cost Effective Care Unit. opening of cyclobutene is found to Department of Gastrointestinal Sciences. exhibit pericyclic behavior while oxetene Department of Community Health. shows mild pseudopericyclic nature. Department of Developmental Pediatrics. Computation of the nucleus-independent Department of Child Health, Christian chemical shift (NICS) of oxetene adds Medical College, Vellore, India. evidence for pseudopericyclic behavior of oxetene. By locking of lone pair of The Indian Etiology, Risk Factors and electrons by hydrogen bonding, it is Interactions of Enteric Infections and seen that the pseudopericyclic nature of Malnutrition and the Consequences for the ring opening of oxetene is converted Child Health and Development (MAL-ED) into a pericyclic one. CASSCF(5,6)/6- site is in Vellore, Tamil Nadu, in south 311+G** computation was carried out India and is coordinated by the Christian to understand the extent of involvement Medical College, Vellore, which has of lone pair of electrons during the many years of experience in establishing course of the reaction. CR-CCSD(T)/6- and following cohorts. India is a diverse 311+G** computation was performed to country, and no single area can be assess the energies of the reactant, representative with regard to many transition state and the product more health and socioeconomic indicators. The accurately site in Vellore is an urban semiorganized INTL settlement or slum. In the study site, PMID:25367041 PMCID: the average family size is 5.7, adults MISC who are gainfully employed are mostly unskilled laborers, and 51% of the Jebasingh, F. K., Naik, D., population uses the field as their toilet Chandramohan, A. and Paul, M. J. facility. Previous studies from Vellore Posterior gastric diverticulum mimicking slums have reported stunting in well adrenal adenoma on imaging over a third of children, comparable to BMJ Case Rep; 2014, 2014 national estimates. The infant mortality Address:Department of Endocrinology, rate is 38 per 1000 live births, with Diabetes and Metabolism, Christian deaths due mainly to perinatal and infectious causes. Rigorous staff
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training, monitoring, supervision and symptoms abated, and at 1-year follow- refinement of tools have been essential up, there was no endoleak, and the to maintaining the quality of the aneurysm sac had shrunken markedly. significantly large quantity of data Conclusion : Antegrade transseptal collected. Establishing a field clinic ascending aortic access facilitates within the site has minimized transcatheter embolization of type Ia inconvenience to participants and endoleak in the proximal aortic arch. researchers and enabled better rapport INTL with the community and better follow- PMID:25453882 PMCID: up. These factors contribute to the MISC wealth of information that will be generated from the MAL-ED multisite Korah, S., Philip, S., Jasper, S., cohort, which will improve our Antonio-Santos, A. and Braganza, A. understanding of enteric infections and Strabismus surgery before versus after its interactions with malnutrition and completion of amblyopia therapy in development of young children. children INTL Cochrane Database Syst Rev; 2014, 10 CD009272 PMID:25305300 PMCID: MISC Address:Department of Ophthalmology, Christian Medical College, Vellore, Tamil Joseph, G., Chacko, S. T., Stephen, E. Nadu, India, 632001. and Joseph, E. Transseptal ascending aortic access BACKGROUND: Normal visual facilitates transcatheter embolization of development occurs when the brain is proximal type I endoleak associated with able to integrate the visual input from bird-beak configuration of an endograft each of the two eyes to form a single in the proximal aortic arch three-dimensional image. The process of J Endovasc Ther; 2014, 21 (6): 805-11 development of complete three- dimensional vision begins at birth and is Address:1 Department of Cardiology, almost complete by 24 months of age. Christian Medical College, Vellore, India. The development of this binocular vision Purpose : To report the initial use of is hindered by any abnormality that antegrade transseptal ascending aortic prevents the brain from receiving a access to perform transcatheter clear, similar image from each eye, due embolization of a proximal type I to decreased vision (e.g. amblyopia), or endoleak associated with bird-beak due to misalignment of the two eyes configuration of an endograft in the (strabismus or squint) in infancy and proximal aortic arch. Case Report : A early childhood. Currently, practice 61-year-old man underwent patterns for management of a child with endovascular repair of a large, both strabismus and amblyopia are not symptomatic aortic arch aneurysm standardized. OBJECTIVES: To study the located distal to the left common carotid functional and anatomic (ocular artery using a fenestrated endograft. alignment) outcomes of strabismus Completion angiography showed bird- surgery before completion of amblyopia beak configuration of the proximal therapy as compared with surgery after endograft and a large type Ia endoleak. completion of amblyopia therapy in In a separate procedure, the endoleak children under seven years of age. was embolized with cyanoacrylate glue SEARCH METHODS: We searched via an antegrade ascending aortic access CENTRAL (which contains the Cochrane obtained through a transseptal sheath Eyes and Vision Group Trials Register) stabilized by an indwelling arteriovenous (2014, Issue 6), Ovid MEDLINE, Ovid wire loop. This approach provided MEDLINE In-Process and Other Non- straight-line access into the endoleak Indexed Citations, Ovid MEDLINE Daily, with requisite catheter support, and Ovid OLDMEDLINE (January 1946 to July complete thrombosis of the aneurysm 2014), EMBASE (January 1980 to July sac was achieved. The patient's 2014), Latin American and Caribbean
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Health Sciences Literature Database (LILACS) (January 1982 to July 2014), Kurien, R. T., Chowdhury, S. D., the metaRegister of Controlled Trials Unnikrishnan, L. S., Simon, E. G., Dutta, (mRCT) (www.controlled-trials.com), A. K., Mahanta, K., Alex, T. and Joseph, ClinicalTrials.gov (www.clinicaltrials.gov) A. J. and the World Health Organization Endoscopic treatment of a duodenal (WHO) International Clinical Trials duplication cyst Registry Platform (ICTRP) Endoscopy; 2014, 46 Suppl 1 UCTN (www.who.int/ictrp/search/en). We did E583-4 not use any date or language restrictions in the electronic searches for trials. We Address:Department of Gastrointestinal last searched the electronic databases Sciences, Christian Medical College, on 24 July 2014. A manual search for Vellore, India. articles from a review of the references Department of Radiodiagnosis, Christian of the selected publications and Medical College, Vellore, India. conference abstracts was completed to Department of Pathology, Christian identify any additional relevant studies. Medical College, Vellore, India. SELECTION CRITERIA: We searched for INTL randomized controlled trials (RCTs) that PMID:25502250 PMCID: provided data on strabismus surgery in MISC children less than seven years of age, performed after initiation of, but before Lionel, K. R., Singh, G., Mathew, R. R., completion of amblyopia therapy, as Moorthy, R. K. and Rajshekhar, V. compared with strabismus surgery after Hypoventilation: an aid to the completion of amblyopia therapy. DATA neurosurgeon COLLECTION AND ANALYSIS: Two Neurol India; 2014, 62 (4): 441-3 authors independently assessed studies identified from the electronic and Address:Department of Anaesthesia, manual searches. MAIN RESULTS: There Christian Medical College, Vellore, Tamil were no RCTs that fit our inclusion Nadu, India. criteria and so no analysis was possible. NAT AUTHORS' CONCLUSIONS: As there are PMID:25237957 PMCID: no RCTs currently available and the best MISC existing evidence is only from non- randomized studies, there is a need for prospective RCTs to investigate Madhuri, V. and Gahukamble, A. strabismus surgery in the presence of Cochrane in context: Interventions for strabismic amblyopia. The optimal treating femoral shaft fractures in timing of when to perform strabismus children and adolescents surgery in children with amblyopia is Evid Based Child Health; 2014, 9 (4): unknown. 827-8
INTL Address:Paediatric Orthopaedics Unit, PMID:25315969 PMCID: Christian Medical College, Vellore, India. [email protected]. MISC
Cochrane Review: Interventions for Kumar, S. treating femoral shaft fractures in A time of change children and adolescents Madhuri V, Dutt Indian J Urol; 2014, 30 (4): 365 V, Gahukamble AD, Tharyan P. Address:Associate Editor, Indian Interventions for treating femoral shaft Journal of Urology, Professor in Urology, fractures in children and adolescents. Christian Medical College, Vellore, Cochrane Database of Systematic Tamilnadu, India E-mail: Reviews 2014, Issue 7. Art. No.: [email protected]. CD009076. DOI: NAT 10.1002/14651858.CD009076.pub2. PMID:25378812 PMCID:4220370 This companion piece to the review, MISC "Interventions for treating femoral shaft
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fractures in children and adolescents," unacceptable malunion, and serious contains the following pieces: The adverse events. DATA COLLECTION AND abstract of the review A commentary ANALYSIS: Two authors independently from one or more of the review authors, screened and selected trials, assessed explaining why the review team felt the risk of bias and extracted data. We review was an important one to produce assessed the overall quality of the Some other recently published evidence for each outcome for each references on this topic. comparison using the GRADE approach. INTL We pooled data using a fixed-effect PMID:25504971 PMCID: model. MAIN RESULTS: We included 10 MISC trials (six randomised and four quasi- randomised) involving a total of 527 Madhuri, V., Dutt, V., Gahukamble, A. children (531 fractures). All trials were D. and Tharyan, P. at some risk of bias, including Interventions for treating femoral shaft performance bias as care provider fractures in children and adolescents blinding was not practical, but to a Cochrane Database Syst Rev; 2014, 7 differing extent. Just one trial was at low CD009076 risk of selection bias. Reflecting both the risk of bias and the imprecision of Address:Paediatric Orthopaedics Unit, findings, we judged the quality of Christian Medical College, Ida Scudder evidence to be 'low' for most outcomes, Road, Vellore, Tamilnadu, India, meaning that we are unsure about the 632004. estimates of effect. Most trials failed to report on self-assessed function or when BACKGROUND: Fractures of the femoral children resumed their usual activities. shaft in children are relatively The trials evaluated 10 different uncommon but serious injuries that comparisons, belonging to three main disrupt the lives of children and their categories. Surgical versus conservative carers and can result in significant long- treatment Four trials presenting data for term disability. Treatment involves 264 children aged 4 to 12 years made either surgical fixation, such as this comparison. Low quality evidence intramedullary nailing or external (one trial, 101 children) showed children fixation, or conservative treatment had very similar function assessed using involving prolonged immobilisation, the RAND health status score at two often in hospital. OBJECTIVES: To years after surgery (external fixation) assess the effects (benefits and harms) compared with conservative treatment of interventions for treating femoral (spica cast): mean 69 versus 68. The shaft fractures in children and other three trials did not report on adolescents. SEARCH METHODS: We function. There was moderate quality searched the Cochrane Bone, Joint and evidence (four trials, 264 children, aged Muscle Trauma Group Specialised 4 to 12 years, followed up 3 to 24 Register (accessed 16 August 2013), the months) that surgery reduced the risk of Cochrane Central Register of Controlled malunion (risk ratio (RR) 0.29, 95% Trials (The Cochrane Library 2013 Issue confidence interval (CI) 0.15 to 0.59, 4 7), MEDLINE (1946 to August Week 1 trials). Assuming an illustrative baseline 2013), EMBASE (1980 to 2012 week 9), risk of 115 malunions per 1000 in CINAHL (16 August 2013), clinical trials children treated conservatively, these registries, conference proceedings and data equate to 81 fewer (95% CI 47 to reference lists; and contacted trial 97 fewer) malunions per 1000 in authors and experts in the field. surgically-treated children. Conversely, SELECTION CRITERIA: Randomised and low quality evidence indicated that there quasi-randomised controlled trials were more serious adverse events such comparing conservative and surgical as infections after surgery (RR 2.39, interventions for diaphyseal fractures of 95% CI 1.10 to 5.17, 4 trials). Assuming the femur in children under 18 years of an illustrative baseline risk of 40 serious age. Our primary outcomes were adverse events per 1000 for functional outcome measures, conservative treatment, these data
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equate to 56 more (95% CI 4 to 167 Very low quality evidence (one trial, 47 more) serious adverse events per 1000 children) means that we do not know if children treated surgically. There was malunion, serious adverse events and low quality evidence (one trial, 101 time to resume weight-bearing actually children) of similar satisfaction levels in differ between intramedullary nailing children and parents with surgery versus submuscular plating. However, involving external fixation and plaster there could be more difficulties in plate cast only. However, there was low removal subsequently. AUTHORS' quality evidence (one trial, 46 children) CONCLUSIONS: There is insufficient that more parents were satisfied with evidence to determine if long-term intramedullary nailing than with traction function differs between surgical and followed by a cast, and that surgery conservative treatment. Surgery results reduced the time taken off from school. in lower rates of malunion in children Comparisons of different methods of aged 4 to 12 years, but may increase conservative treatmentThe three trials in the risk of serious adverse events. this category made three different Elastic stable intramedullary nailing may comparisons. We are very unsure if reduce recovery time.There is unacceptable malunion rates differ insufficient evidence from comparisons between immediate hip spica versus of different methods of conservative skeletal traction followed by spica in treatment or of different methods of children aged 3 to 10 years followed up surgical treatment to draw conclusions for six to eight weeks (RR 4.0, 95% CI on the relative effects of the treatments 0.5 to 32.9; one trial, 42 children; very compared in the included trials. low quality evidence). Malunion rates at INTL 5 to 10 years may not differ between PMID:25072888 PMCID: traction followed by functional orthosis MISC versus traction followed by spica cast in children aged 5 to 13 years (RR 0.98, Mandal, S., Pile, K., Chacko, R. T. and 95% CI 0.46 to 2.12; one trial, 43 Danda, D. children; low quality evidence). We are Malignancy and autoimmunity: causally very unsure (very low quality evidence) or casually related? if either function or serious adverse Int J Rheum Dis; 2014, 17 (6): 601-5 events (zero events reported) differ between single-leg versus double-leg Address:Department of Clinical spica casts (one trial, 52 young children Immunology and Rheumatology, aged two to seven years). Low quality Christian Medical College and Hospital, evidence on the same comparison Vellore, India indicates that single-leg casts are less INTL awkward to manage by parents, more PMID:25346148 PMCID: comfortable for the child and may MISC require less time off work by the caregiver. Comparisons of different methods of surgical treatmentThe three Mariappan, R., Harshit, C. R. and trials in this category made three Prasanna, R. G. different comparisons. Very low quality Novel Method of Identifying evidence means that we are very unsure Intraoperative Cuff Leak and its if the rates of malunion, serious adverse Treatment While Monitoring Cuff events, time to return to school or Pressure parental satisfaction actually differ in J Neurosurg Anesthesiol; 2014, children whose fractures were fixed Address:Christian Medical College, using elastic stable intramedullary Vellore Tamil Nadu, India. nailing or external fixation (one trial, 19 INTL children). The same applies to the rates PMID:25514495PMCID: of serious adverse events and time to MISC resume full weight-bearing in children treated with dynamic versus static Mathews, V. external fixation (one trial, 52 children).
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Generic imatinib: the real-deal or just a thereby optimising the use of available deal? personnel and resources. Leuk Lymphoma; 2014, 55 (12): 2678- INTL 80 PMID:25425088 PMCID: MISC Address:Department of Clinical Hematology, Christian Medical College , Naik, G. S., Kodagali, R., Mathew, B. S., Vellore, Tamil Nadu Thomas, M., Prabha, R., Mathew, V. and India Fleming, D. H. INTL Therapeutic Drug Monitoring of PMID:24798742 PMCID: Levetiracetam and Lamotrigine: Is there MISC a Need? Ther Drug Monit; 2014, Mohan, V. R., Sarkar, R., Abraham, V. Address:1Department of Pharmacology J., Balraj, V. and Naumova, E. N. and Clinical Pharmacology, Christian Differential patterns, trends and Medical College, Vellore, 632 004, Tamil hotspots of road traffic injuries on Nadu, India 2Department of Neurological different road networks in Vellore Sciences, Christian Medical College, district, southern India Vellore, 632 004, Tamil Nadu, India. Trop Med Int Health; 2014, Address:Christian Medical College, BACKGROUND:: This study was a Vellore, India. retrospective assessment of the therapeutic drug monitoring (TDM) data OBJECTIVE: To describe spatial and collected for levetiracetam and temporal profiles of Road Traffic Injuries lamotrigine from a clinical setting. The (RTIs) on different road networks in proportion of patients in relation to the Vellore district of southern India. therapeutic ranges for serum METHODS: Using the information in the concentrations of lamotrigine and police maintained First Information levetiracetam were estimated and the Reports (FIRs), daily time series of RTI influence of age and anticonvulsant co- counts were created and temporal medications on their clearances were characteristics were analysed with studied. METHODS:: Information on respect to the vehicle, road types and levetiracetam (2011-2013) and time of the day for the period January lamotrigine (2008-2013) dose, trough 2005 to May 2007. Daily incidence and concentration, age, sex, body weight trend of RTIs were estimated using a and anticonvulsant co-medications Poisson regression analysis. RESULTS: prescribed was obtained from the TDM Of the reported 3262 RTIs, 52% had register and archived medical records. occurred on the National Highway (NH). Patients were categorized into 4 groups The overall RTI rate on the NH was based on anticonvulsant co-medications 8.8/100 000 vehicles per day with and further divided into 3 sub-groups significantly higher pedestrian based on age (a: < 9 years; b: 9-17 involvement. The mean numbers of RTIs years; c: >/=18 years).In each sub- were significantly higher on weekends. group, the proportion of patients who Thirteen percentage of all RTIs were achieved trough concentrations in the associated with fatalities. Hotspots are therapeutic range for levetiracetam and major town junctions, and RTI rates lamotrigine was computed. Apparent differ over different stretches of the NH. clearance (CL/F) was compared across CONCLUSION: In India, FIRs form a sub-groups by one way ANOVA and valuable source of RTI information. factors which significantly predicted CL/F Information on different vehicle profile, were identified by stepwise multiple RTI patterns, and their spatial and linear regression. RESULTS:: Overall, temporal trends can be used by 348 (330 patients) and 706 (493 administrators to devise effective patients) samples for levetiracetam and strategies for RTI prevention by lamotrigine were included in the concentrating on the high-risk areas, analysis. 56.9 % and 72.4% were within, 43.1% and 23.9% below, 0%
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and 3.7% above the therapeutic range Pati, P. K., Verghese, M. J. and George, for levetiracetam and lamotrigine P. V. respectively. A significant difference in Isolation of left subclavian artery with CL/F was noted across subgroups for reversal of neurological and levetiracetam (p < 0.001) and hemodynamic abnormalities after lamotrigine (p < 0.001). Age < 9 years, percutaneous closure age >/= 18 years and inducer co- Indian Heart J; 2014, 66 (4): 477-80 medications significantly predicted CL/F for levetiracetam. For lamotrigine, Address:Professor, Department of inhibitor co-medications, age < 9 years, Cardiology, Christian Medical College inducer co-medications and age 9 -17 and Hospital, Vellore, Tamil Nadu years significantly predicted CL/F. 632004, India. Electronic Address: CONCLUSION:: These findings [email protected]. emphasize the need to monitor relatively Assistant Professor, Department of newer anticonvulsants, lamotrigine and Cardiology, Christian Medical College levetiracetam especially among children and Hospital, Vellore, Tamil Nadu and when other anticonvulsant co- 632004, India. medications are prescribed or Professor and Head, Department of discontinued in the treatment regimen. Cardiology, Christian Medical College INTL and Hospital, Vellore, Tamil Nadu PMID:25478905 PMCID: 632004, India. MISC Isolation of left subclavian artery is a Nayak, R., Shetty, S., Kapoor, N., rare congenital anomaly. In this Chacko, A. G. and Paul, T. V. abnormality, the left subclavian artery Visual vignette arises from the homo-lateral pulmonary Endocr Pract; 2014, 20 (11): 1237 artery rather than from aorta. This condition is often diagnosed by Address:Department of Neurosurgery, angiography and treated by surgery. The Unit-I, Christian Medical College and authors present a case, which had Hospital, Vellore, India. vertebro-basilar insufficiency, subclavian Department of Endocrinology, Diabetes, steal phenomenon and pulmonary and Metabolism, Christian Medical plethora. All these clinical signs College and Hospital, Vellore, India. disappeared by a simple percutaneous INTL intervention. INTL PMID:25100394 PMCID: MISC PMID:25173211 PMCID:4150035 MISC
Panda, A. Commenatry on Gautam G. Is it truly Paul, S. A., Karthik, A. K., Chacko, R. outrageous to consider radical and Karunya, W. prostatectomy for men with metastatic Audit on titanium reconstruction of prostate cancer? Indian J Urol mandibular defects for jaw lesions 2014;30:366-7 J Pharm Bioallied Sci; 2014, 6 (Suppl 1): Indian J Urol; 2014, 30 (4): 368 S39-43
Address:Associate Editor, Indian Address:Department of Dental and Oral Journal of Urology, Associate Professor Surgery, Unit I, Christian Medical of Urology, Christian Medical College, College and Hospital, Vellore, Tamil Vellore - 632 004, Tamil Nadu, India. E- Nadu, India. mail: [email protected]. Department of Oral and Maxillofacial NAT Surgery, JKK Nattrajah Dental College and Hospital, Komarapalayam, Tamil PMID:25378814 PMCID:4220372 Nadu, India. MISC
AIMS: The aim of the study is to audit the titanium reconstruction of jaw
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defects in benign conditions in Christian poisoning were retrieved for detailed Medical College and Hospital, Vellore. evaluation. In addition to the traditional METHODS AND MATERIAL: A approach of symptoms and signs of OP retrospective study of titanium poisoning as peripheral (muscarinic, reconstruction of mandibular defects due nicotinic) and central nervous system to jaw lesions at Christian Medical receptor stimulation, symptoms were College and Hospital, Vellore, India, alternatively approached using a time- between May 2008 and May 2011. based classification. In this, symptom RESULTS: Mouth opening, facial onset was categorized as acute (within symmetry, occlusion, chewing ability, 24-h), delayed (24-h to 2-week) or late plate exposure and patient satisfaction (beyond 2-week). Although most were used as outcome measures. symptoms occur with minutes or hours CONCLUSIONS: The three-dimensional following acute exposure, delayed onset titanium plate is a reasonable material symptoms occurring after a period of for immediate mandible reconstruction minimal or mild symptoms, may impact after surgical resection of benign jaw treatment and timing of the discharge pathologies. following acute exposure. Symptoms INTL and signs were also viewed as an organ PMID:25210382 PMCID:4157278 specific as cardiovascular, respiratory or MISC neurological manifestations. An organ specific approach enables focused Peter, J. V., Sudarsan, T. I. and Moran, management of individual organ J. L. dysfunction that may vary with different Clinical features of organophosphate OP compounds. CONCLUSIONS: poisoning: A review of different Different approaches to the symptoms classification systems and approaches and signs in OP poisoning may better Indian J Crit Care Med; 2014, 18 (11): our understanding of the underlying 735-45 mechanism that in turn may assist with the management of acutely poisoned Address:Department of Medical patients. Intensive Care, Christian Medical College NAT and Hospital, Vellore, Tamil Nadu, India. PMID:25425841 PMCID:4238091 Department of Intensive Care Medicine, MISC The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia. Raji, J. B., Velavan, J., Anbarasi, S. and Grant, L. PURPOSE: The typical toxidrome in Can credit systems help in family organophosphate (OP) poisoning medicine training in developing comprises of the Salivation, Lacrimation, countries? An innovative concept Urination, Defecation, Gastric cramps, J Family Med Prim Care; 2014, 3 (3): Emesis (SLUDGE) symptoms. However, 183-7 several other manifestations are described. We review the spectrum of Address:Department of Distance symptoms and signs in OP poisoning as Education, Christian Medical College, well as the different approaches to Vellore, Tamil Nadu, India. clinical features in these patients. Department of General Practice, Global MATERIALS AND METHODS: Articles Health Academy, University of were obtained by electronic search of Edinburgh, Edinburgh, Scotland, UK. PubMed((R)) between 1966 and April 2014 using the search terms There is irrefutable evidence that health organophosphorus compounds or systems perform best when supported phosphoric acid esters AND poison or by a Family Physician network. Training poisoning AND manifestations. a critical mass of highly skilled Family RESULTS: Of the 5026 articles on OP Physicians can help developing countries poisoning, 2584 articles pertained to to reach their Millennium Development human poisoning; 452 articles focusing Goals and deliver comprehensive on clinical manifestations in human OP patient-centered health care to their
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population. The challenge in developing countries across the world with and countries is the need to rapidly train without support from the GAVI Alliance. these Family Physicians in large India has the highest disease burden of numbers, while also ensuring the quality rotavirus based on morbidity and of the learning, and assuring the quality mortality estimates and several of training. The experience of Christian indigenous vaccine manufacturers are Medical College (CMC), Vellore, India developing rotavirus vaccines. One and other global examples confirm the candidate has undergone phase III fact that training large numbers is testing and others have completed possible through well-designed blended evaluation in phase II. Global data on learning programs. The question then licensed vaccine performance in terms of arises as to how these programs can be impact on disease, strain diversity, standardized. Globally, the concept of safety and cost-effectiveness has been the "credit system" has become the reviewed to provide a framework for watch-word for many training programs decision making in India. seeking standardization. This article INTL explores the possibility of introducing PMID:25091672 PMCID: incremental academic certifications using MISC credit systems as a method to standardize these blended learning Samuel, R., Ramanathan, K., Mathews, programs, gives a glimpse at the J. E. and Seshadri, M. S. innovation that CMC, Vellore is piloting Back to the future: examining type 2 in this regard partnering with the diabetic vasculature using the University of Edinburgh and analyses the gestational diabetic placenta possible benefits and pitfalls of such an Diab Vasc Dis Res; 2014, 11 (5): 363-5 approach. INTL Address:Centre for Stem Cell Research, PMID:25374849PMCID:4209667 Christian Medical College, Vellore, India MISC [email protected]. Department of Biostatistics, Christian Rao, T. S., Arora, R., Khera, A., Tate, J. Medical College, Vellore, India. E., Parashar, U. and Kang, G. Unit V, Department of Obstetrics & Insights from global data for use of Gynaecology, Christian Medical College rotavirus vaccines in India and Hospital, Vellore, India. Vaccine; 2014, 32 Suppl 1 A171-8 Thirumalai Mission Hospital, Ranipet, India. Address:Department of Biotechnology, Ministry of Science and Technology, Understanding the association between Government of India, CGO Complex, the intrauterine hyperglycemic milieu New Delhi, India. and the development of adult diabetic Division of Epidemiology and vasculopathy is of particular relevance in Communicable Diseases, Indian Council India, where diabetes and vascular for Medical Research, Ansari Nagar, New disease are prevalent. The gestational Delhi, India. diabetes mellitus placenta is a valuable Child Health and Immunization, Ministry tool to examine blood vessels that have of Health and Family Welfare, Nirman been exposed to hyperglycemic cues. Bhawan, New Delhi, India. We report an interesting observation in a cohort of gestational diabetes mellitus Viral Gastroenteritis Division, Centers for foetal placental vasculature from South Disease Control and Prevention, Atlanta, India. Transmission electron microscopy GA, USA. demonstrated pericyte detachment and Division of Gastrointestinal Sciences, pericyte ghost cells reminiscent of adult Christian Medical College, Vellore type 2 diabetic retinopathy, in 632004, Tamil Nadu, India. Electronic gestational diabetes mellitus foetal Address: [email protected]. placental blood vessels that were not Rotavirus vaccines are being introduced observed in non-gestational diabetes in several low- and middle-income mellitus placentas (p
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Endothelial cell irregularity was observed received 1 hour of MT in addition to the in 76% gestational diabetes mellitus conventional stroke rehabilitation. MAIN foetal blood vessels as compared with OUTCOME MEASURES: The Upper 10.4% non-gestational diabetes mellitus Extremity Fugl-Meyer Assessment for placental vasculature (p
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Siromani, U., Thasian, T., Selvaraj, K. Appropriate bivariate and multivariate G., Daniel, D., Mammen, J. J., Nair, S. statistical test were used. RESULTS: The C. and Isaac, R. total burden and level of burden was Determinants which influence to donate similar among PCG of children with ASD blood voluntarily at a northeast district + ID and ID (P = 0.8). However, of the state of Tamil Nadu, South India financial burden (P = 0.03) and burden Indian J Community Med; 2014, 39 (4): due to the effects on the physical health 250 of other family members (P = 0.03) was more among the ID group. The burden Address:Department of Transfusion due to the effects on family interaction Medicine and Immunohaematology, was more (P = 0.009) in the ASD + ID Christian Medical College, Vellore, group. The socio-economic status (OR = Tamilnadu, India E-mail: 3.60; P = 0.03) and the kinship of the [email protected]. primary care-giver (OR = 0.37; P = Rural Unit for Health and Social Affairs 0.008) were significantly associated with (RUHSA), Christian Medical College, high level of burden. In addition, the Vellore, Tamilnadu, India. diagnosis, and gender of the child Professor, Department of Bio-Statistics, contributed to the prediction model for Christian Medical College, Vellore, high level of burden. CONCLUSIONS: Tamilnadu, India. The interventions for children with ASD NAT + ID and ID should have modules to PMID:25364151 PMCID:4215508 address burden among PCG. Disability MISC specific burden alleviating strategies should be used among PCG who are at Suresh, A. P., Benjamin, T. E., Crasta, risk of having high burden. J. E., Alwinesh, M. T., Kanniappan, G., Padankatti, S. M., Nair, M. K. and NAT Russell, P. S. PMID:25387661 PMCID: Comparison of Burden Among Primary MISC Care-givers of Children with Autism and Intellectual Disability Against Children Thangadurai, P. and Jacob, K. S. with Intellectual Disability Only in a Medicalizing distress, ignoring public Hospital Population in India health strategies Indian J Pediatr; 2014, 81 Suppl 2 179- Indian J Psychol Med; 2014, 36 (4): 82 351-4
Address:Department of Occupational Address:Department of Psychiatry, Therapy, Christian Medical College, Christian Medical College, Vellore, Tamil Vellore, Tamil Nadu, India. Nadu, India E-mail: [email protected]. OBJECTIVE: To compare the burden NAT among the primary caregivers (PCG) of PMCID:4201784 PMID:25336764 children with autism and intellectual disability (ASD + ID) against intellectual MISC disability (ID) only, and identify the
factors that predict high caregiver Thomas HM(1), Balukrishna S, burden. METHODS: Children with either Devakumar D, Muthuswamy P, Samuel ASD + ID (N = 41) or ID (N = 56) and EJ. their PCG were recruited and assessed Can positron emission tomography be using the Family Burden Interview more than a diagnostic tool? A survey on Schedule, Binet Kamat Scale of clinical practice among radiation Intelligence or Gesell's Developmental oncologists in India. Schedule and Vineland Social Maturity Indian J Cancer. 2014 Apr- Scale, Childhood Autism Rating Scale, Jun;51(2):145-9. doi: 10.4103/0019- Sensory Profile and Brief Autism 509X.138247. Mealtime Behavior Inventory after
collecting the socio-demographic details. Author information:
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(1)Photonics, Nuclear and Medical ICD-10 and Alternative Diagnostic Physics Division, School of Advanced Criteria for Childhood Autism Among Sciences, (3)Survey Research Centre, Children with Intellectual Disability Indian J Pediatr; 2014, 81 Suppl 2 173-8 VIT University, Departments of (2)
Radiotherapy, and (4) Nuclear Medicine, Address: Child and Adolescent Christian Medical College, Vellore, Tamil Psychiatry Unit, Department of Nadu, India Correspondence to: Ms. Psychiatry, Vellore, 632 002, Tamil Hannah Mary Thomas T, E-mail: Nadu, India. [email protected] OBJECTIVES: The diagnosis of Childhood AIM: The purpose of the survey was to Autism (CA) among children with understand the role of positron emission Intellectual Disability (ID) based on tomography (PET) in clinical clinical criteria validated for populations radiotherapy practice among the with average intelligence compromises radiation oncologists' in India. SETTINGS it's diagnostic accuracy in this special AND DESIGN: An online questionnaire population. This study documents the was developed to survey the oncologists diagnostic accuracy of ICD-10 and on their use of PET, viewing protocols, alternative criteria for CA in ID contouring techniques practiced, the population. METHODS: Consensus barriers on the use of PET and the need clinical diagnosis of autism made by a for training in use of PET in multi-disciplinary team as the reference radiotherapy. The questionnaire was data were extracted from the case notes sent to about 500 oncologists and 76 and psychological tests details by two completed responses were received. trainee psychologists, and ICD-10 based RESULTS: The survey shows that clinical diagnosis, demographics, ID, CA radiation oncologists use PET largely to related data documented independently assess treatment response and staging of the psychiatrist. The appropriate but limitedly use it for radiotherapy statistical analyses were completed. treatment planning. Only manual RESULTS: Repetitive behaviors formed contouring and fixed threshold based the most common symptom cluster. The delineation techniques (e.g. 40% high internal consistency (kappa = 0.75) maximum standard uptake value [SUV among the three groups of ICD-10 max ] or SUV 2.5) are used. Cost is the symptoms indicate their usefulness in major barrier in the wider use of PET, the diagnosis of CA among children with followed by limited availability of FDG ID, but significantly more children with radionuclide tracer. Limited or no ID failed to meet the ICD-10 criteria for training was available for the use of PET. CA. The fourth alternative criteria had CONCLUSIONS: Our survey revealed the the highest concordance with the vast difference between literature reference standard (100 %) and the first suggestions and actual clinical practice alternative criteria had the highest on the use of PET in radiotherapy. agreement with the reference standard Additional training and standardization (kappa = 0.88) in identifying CA among of protocols for use of PET in ID. The diagnostic accuracy of all the radiotherapy is essential for fully alternative criteria was significantly utilizing the capability of PET. better than that of ICD-10 with the first NAT alternative criteria having the best diagnostic accuracy (Sn = 98 %; Sp = PMID: 25104197 [PubMed - in process] 100 %; PPV = 1; NPV =0.83) closest to
the reference standard. CONCLUSIONS: MISC The symptom clusters in ICD-10 for CA should be retained, however Thomas, N., Singh, A., Sankaran, S., reorganising the diagnostic criteria is Russell, P. S., Tsheringla, S., required for diagnosing CA accurately Viswanathan, S. A. and Nair, M. K. among children with ID. The first alternative criteria can significantly improve the case identifying ability and
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diagnostic accuracy altering there by the significant relationship between epidemiological data on Childhood ADOS(M1) and study quality as well as Autism among children with Intellectual sample size. There were subgroup Disability. differences in the DOR. CONCLUSIONS: NAT The authors conclude that ADOS(M1) PMID:25297645 PMCID: with the original diagnostic algorithm lacks overall diagnostic accuracy and MISC pooled specificity to confirm the diagnosis of Autism Spectrum Disorders.
ADOS(M1) with the revised diagnostic Tsheringla, S., Minju, K. A., Russell, S., algorithm should be used instead for the Mammen, P., Russell, P. S. and Nair, M. diagnosis of this group of disorders. K. NAT A Meta-analysis of the Diagnostic Accuracy of Autism Diagnostic PMID:25377926 PMCID: Observation Schedule Module-1 for MISC Autism Spectrum Disorders Indian J Pediatr; 2014, 81 Suppl 2 187- Tsheringla, S., Minju, K. A., Russell, S., 92 Mammen, P., Russell, P. S. and Nair, M. Address:Child and Adolescent K. Psychiatry Unit, Department of Erratum to: A Meta-analysis of the Psychiatry, Christian Medical College, Diagnostic Accuracy of Autism Vellore, 632 002, Tamil Nadu, India. Diagnostic Observation Schedule Module-1 for Autism Spectrum Disorders OBJECTIVE: Autism Diagnostic Indian J Pediatr; 2014, 81 Suppl 2 193-5 Observation Schedule (ADOS) is considered gold standard for the Address:Child and Adolescent diagnosis of Autism Spectrum Disorders Psychiatry Unit, Department of (ASD). The authors evaluated the Psychiatry, Christian Medical College, cumulative diagnostic accuracy of ADOS- Vellore, 632 002, Tamil Nadu, India. Module 1 (ADOS(M1)) using the original NAT diagnostic algorithm with meta-analysis PMID:25514887 PMCID: and meta-regression. METHODS: The MISC authors, electronically and manually searched for studies from 1999 to 2013 Tsheringla, S., Simon, A., Russell, P. that evaluated the accuracy of S., Shankar, S., Russell, S., Mammen, P. ADOS(M1) using the original diagnostic and Nair, M. K. algorithm in detecting ASD. Primary ADD-H-Comprehensive Teacher's Rating results of Sensitivity (Sn), Specificity Scale (ACTeRS): A Measure for Attention (Sp) and Diagnostic Odds Ratio (DOR) Deficit Hyperactivity Disorder Among for ADOS(M1) were summarized using Children with Intellectual Disability in random-effects model. Summary India Receiver Operating characteristic Curves Indian J Pediatr; 2014, 81 Suppl 2 161-4 and its Area Under the Curve (SROC- AUC) were used to summarize overall Address:Child and Adolescent diagnostic accuracy of ADOS(M1). The Psychiatry Unit, Department of modifying effects of quality of study and Psychiatry, Christian Medical College, sample size, on the diagnostic odds Vellore, 632 002, Tamil Nadu, India. ratio, were investigated using meta- regression. RESULTS: A total of 7 cross- OBJECTIVE: There is no validated sectional studies provided data on 4,057 measure for assessing Attention Deficit children. The pooled Sn, Sp, DOR and Hyperactivity Disorder (ADHD) in India, SROC-AUC for the overall diagnostic and therefore, the authors validated the accuracy of ADOS(M1) were: 0.91 (95 % ADD-H Comprehensive Teacher's Rating CI = 0.88 to 0.93), 0.27 (95 % CI = Scale (ACTeRS). METHODS: 0.24 to 0.30), 5.40 (95 % CI = 1.51 to Teachers/parents/clinicians of 110 19.23) and 0.52 respectively. Meta- children with ADHD completed the regression analysis showed a non- ACTeRS. The diagnosis of ADHD was
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confirmed by an independent multi- BACKGROUND: There is paucity of data disciplinary team using ICD-10 diagnosis regarding the morbidity and mortality of for diagnostic accuracy and criterion rigid bronchoscopy in children for foreign validity. The convergent and divergent body (FB) retrieval from India. The aim validity were assessed by another rater. was to audit data regarding anaesthetic The data was analyzed for diagnostic management of rigid bronchoscopy in accuracy, reliability and validity children and associated morbidity and appropriately. RESULTS: An ACTeRS mortality. MATERIALS AND METHODS: score of >/=61 [Sensitivity (Sn) =85.51 Hospital records of all patients below 18 %; Specificity (Sp) = 90.24 %; Area years of age undergoing rigid under the curve (AUC) = 0.94] is bronchoscopy for suspected FB appropriate for the diagnosis of ADHD. aspiration (FBA) between January 1, The test-re-test reliability [Intra-class 2002 and December 31, 2011 were correlation coefficient (ICC) = 0.87], audited to assess their demographic internal consistency (Cronbach's alpha = profile, anaesthetic management, 0.80; range of 0.89-0.93), section-total complications, and postoperative correlation, face and content validity for outcomes. The children were divided into the ACTeRS were good. Convergent early and late diagnosis groups validity of attention deficit, hyperactivity depending on whether they presented to and oppositional subscales of ACTeRS the hospital within 24 hours of FBA, or with the corresponding subscales of later. RESULTS: One hundred and forty Swanson, Nolan & Pelham Rating Scale- children, predominantly male (75%), Revised (SNAP-IV) was moderate (r = with an average age of 1-year and 8 0.60, P = 0.005; r = 0.49, P = 0.02; r = months, presented to our hospital for 0.58, P = 0.008 respectively), and rigid bronchoscopy during the study negative correlation with the Childhood period. Majority of children presented in Autism Rating Scale (r = -0.36; P =0.1) the late diagnosis group (59.29% vs. for divergent validity was found. The 40.71%). The penetration syndrome was criterion validity analysis showed a high observed in 22% of patients. Majority of concordance rate of 82.52 % between patients aspirated an organic FB ACTeRS and International Classification (organic: Inorganic FB = 3:1), with of Diseases, Edition10 (ICD-10) peanuts being the most common diagnosis of ADHD. A 4-factor structure (49.28%). A significantly higher number was replicated. CONCLUSIONS: The of children presented with cough (P = ACTeRS has adequate psychometric 0.0001) and history of choking (P = properties for use in the Indian 0.0022) in the early diagnosis group and population for identifying ADHD. crepitations (P = 0.0011) in the late diagnosis group. Major complications NAT included cardiac arrest (2.1%), PMID:25265891 PMCID: pneumothorax (0.7%), and laryngeal oedema (9.3%). The average duration of MISC hospitalization in our series was 3.08 +/- 0.7 days. CONCLUSIONS: Foreign Williams, A., George, C., Atul, P. S., body aspiration causes considerable Sam, S. and Shukla, S. morbidity, especially when diagnosis is An audit of morbidity and mortality delayed. associated with foreign body aspiration INTL in children from a tertiary level hospital PMID:25323175 PMCID: in Northern India MISC Afr J Paediatr Surg; 2014, 11 (4): 287- 92
Address: Department of Anaesthesiology, Christian Medical College, Vellore, India.
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