4Th Annual Research Day 2013

Abstracts of Annual Research Day 2013

The 4th Annual Research Day 15th November 2013

SCUDDER AUDITORIUM CHRISTIAN MEDICAL COLLEGE VELLORE

Abstracts of Annual Research Day 2013

Schedule for 4th Annual Research Day

Poster Installation 11.00 am

Categories: Basic Sciences Medicine Specialties Surgery Specialties Field Work and Epidemiology Nursing

Poster Session and 01.00 - 03.30 pm Judging:

Lunch 12.30 pm

Oral Presentation 2.55 pm – 6.12 pm

Special Addresses Vice Principal - Prof. Nihal Thomas

Director - Prof. Sunil Chandy

Principal - Prof. Alfred Job Daniel

Special Oration by Chief Guest - Prof. V.I Mathan (Retired Distinguished Scientist)

Prize Distribution and Valediction 6.50 pm

Abstracts of Annual Research Day 2013

ANNUAL RESEARCH DAY – 2013 MEDAL AND ORATION FOR DISTINGUISHED RETIRED FACULTY

Prof. V.I. Mathan graduated MBBS from the then Madras University in 1960 and obtained his MD in General Medicine (1965) and PhD (1973) in Epidemiology from the same University through the Christian Medical College, Vellore. He joined the faculty of the Christian Medical College, Vellore in 1965 in the Department of Medicine and was appointed as Professor of Medicine and Gastroenterology in 1973.

He started the Department of Gastroenterology at Vellore in 1972 and by the time of his retirement it had grown to one of the largest departments in the country.

Prof. Mathan was actively involved in research from his registrar days and has published over 140 papers. He became the Head of The Wellcome Trust Tropical Disease Research Unit at Vellore from 1975. In 1992 this unit was recognized as the Indian Council of Medical Research Centre of Advanced Research on Enteric Diseases. Prof. Mathan’s research work has been recognized by a variety awards and academic distinctions including Honorary Membership and Fellowship of the Royal College of Physicians of London, Honorary Memberships of the British Society of Gastroenterology and The Royal Society of Tropical Medicine and Hygiene. He was elected a Fellow of the Indian National Science Academy in 1991 and awarded the Dr. Ambedkar Medal for lifetime Research Contributions in 1996 by the Indian Council of Medical Research.

In addition to his clinical and research activities, Prof. Mathan has been a distinguished Medical Administrator. He headed the department of Gastroenterology at Vellore from its start in 1972 to 1993. He was Medical Superintendent of the Christian Medical College Hospital from 1988 to 1993 and it’s Director from 1993 to 1997 when he retired on superannuation.

Subsequent to that Prof. Mathan was the Associate Director of the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh for three years and a Senior Consultant to UNAIDS working with the National AIDS Control Organization in Delhi for a year. He occupied the Indian Council of Medical Research Chair of Epidemiology at the National Institute of Epidemiology, Chennai till Sep. 2007. Currently he is Hon. ICMR Consultant, and is the Chair of the Project Advisory Committee on Health Sciences of the Department of Science and Technology, the Scientific Advisory Group of the Division of Epidemiology and Communicable Diseases of the Indian Council of Medical Research and the Technical Committee for the Establishment of Model Rural Health Research Units of the Department of Health Research, Government of India.

For his pioneering research work on Tropical Enteropathy, Tropical Sprue, Epidemiology of Enteric Infections and Acute Diarrhoea, Vitamin B12 Absorption. The role of Luminal Endotoxin in determining the Severity of Diarrhoea and the identification of potential antagonists of Endotoxin and developing a research team which has continued to be productive for nearly two decades after his re tirement. Prof. V I. Mathan is awarded the Annual Research Day distinguished retirted faculty medal and oration for the year 2013.

Abstracts of Annual Research Day 2013

ABSTRACTS FOR ORAL PRESENTATION

Abstracts of Annual Research Day 2013

“DIVING INTO THE UNKNOWN REALM: STRENGTHENING EMERGENCY CARE AT PRIMARY HEALTHCARE LEVEL WITH A HANDY TOOL KIT.” (A proposal to the Indian Government)

Alen Thomas, MBBS 2010, CMC Vellore Dr. Suresh David, Professor, EM Dept, CMC Vellore Dr. Moses Kirubairaj, Assistant Professor, Department of Family Medicine

Aim: Trauma or Emergency situations can strike anytime in this fast moving world and people lose their lives much before they reach the Taluk level hospital. There are numerous published papers that emphasize on the fact that early intervention can significantly bring down Discussion: the mortality rate. Organised positioning will help the health This concept note paper focuses on care professional to be more alert and training, equipping and empowering effective. Handy-kit would be helpful and enthusiastic health professionals at effective for early intervention purposes. primary healthcare level to provide first Essential Emergency drugs are available aid and to expedite rapid transfer to for on-site stabilisation. The provision of hospitals. a Global Positioning Service device would be useful to provide pin-point location of Methodology: the emergency as informed by the call PART 1 Training of EM Commando centre team. It is also useful for identifying potential accident-prone areas PART 2: Putting into practice in their respective areas. However, recruiting people for this purpose may be initially difficult as this is a whole new approach at the primary health care level.

Budget:

BUDGET for entire kit is approximately. Rs 5000/-

Abstracts of Annual Research Day 2013

Results: 7. Retd. Professor, Dept of Clinical Epidemiology, Christian Medical College, The results have not yet been released as Vellore the concept is under study and pilot study would be conducted soon with the help of Background and objectives: the government. Rapid Diagnostic tests (RDTs) are used in Conclusion: most dengue endemic resource limited centres for early and economical I strongly urge that Emergency medicine diagnosis. Hence, we evaluated the should be strengthened at the Primary performance of four commercially care centre and followed effectively with available RDTs during an outbreak season the training of EM commandos and in a tertiary hospital in south India utilization of the recommended handy kit. against a consensus clinical criterion as This would significantly reduce mortality reference standard and establish their and morbidity and together we can build ability to differentiate between acute a better world. primary and secondary infection.

Methods:

“EVALUATION OF THE PERFORMANCE 281 adult patients presenting with OF SERODIAGNOSTIC KITS FOR community acquired acute febrile illness DENGUE INFECTION IN A TERTIARY (< 14 days duration) during the outbreak CARE CENTRE OF SOUTH INDIA. “ season were recruited for the study. The reference standard, to group patients into Rajat Choudhari1, Harshita Nori1, dengue or non dengue, was based on the Shubhanker Mitra2 K.P.P Abhilash2, above clinical criteria with any of the Vishali Jeyaseelan3, Asha Mary constitutional symptoms - myalgia, Abraham4, O.C Abraham5, John A Jude6, headache and rash and supportive Jayaprakash Muliyil7 laboratory findings - thrombocytopenia and leucopoenia with other etiologies like 1. Second year medical student (batch of scrub typhus, leptospirosis, malaria and 2011), MBBS, Christian Medical College, enteric fever proven negative by reliable Vellore tests. The samples were tested using 2. Assistant Professor, Dept of Medicine, Panbio, SD, J. Mitra and Reckon to Christian Medical College, Vellore compare their performance. SPSS version 3. Assistant Professor, Dept of 16.0.1 was used for statistical analysis. Biostatistics, Christian Medical College, Vellore Results: 4. Professor and Head, Dept of Virology, Christian Medical College, Vellore 132 cases were classified as dengue and 5. Professor, Dept of Medicine, Christian 149 as non-dengue. Comparing the IgM Medical College, Vellore results against the reference standard, the 6. Professor, Dept of Microbiology, sensitivities of Panbio, SD, Reckon and Christian Medical College, Vellore J.Mitra were 97.7%, 64.3%, 14% and 36.4% and specificities were 87.8%, 96.6%, 99.3% and 68.7% respectively.

Abstracts of Annual Research Day 2013

plasma levels due to variability in volume NS1 detection sensitivities of the SD, of distribution and clearance among these Reckon, and J.Mitra (Panbio doesn’t patients. Since meropenem is a time detect NS1) were 20.9%, 18.6% and dependant antibiotic, extended infusion 27.1% while specificities were 97.3%, seems be a better alternative to short 96.6% and 92.5%, respectively. infusion in achieving adequate plasma The RDTs could not adequately concentrations. differentiate between acute primary and secondary dengue. Methods: In series combination, Reckon with Panbio and SD gave a specificity of 99.9 % This was an observational study in and 100 % respectively while, in parallel critically ill patients who were prescribed Panbio and SD gave the best sensitivity 1 gm meropenem thrice daily. Dose and (99.2%) duration of infusion were according to treating doctor’s discretion. Meropenem Conclusion: plasma concentrations were assessed using high performance liquid In a dengue endemic resource limited set chromatography and analyzed. The up, IgM assay of Panbio RDT is a reliable, percentage of time (60% and 100% of easily available, economical test whose inter-dose interval), the plasma specificity can be increased by series concentrations were above 4mg/dl (MIC; combination with Reckon or SD. CLSI guidelines) was compared between extended (3 hour) infusion and short (30 minute) infusion. AUC and other pharmacokinetic parameters were also “PHARMACOKINETICS OF MEROPENEM studied. IN CRITICALLY ILL PATIENTS: COMPARISON OF EXTENDED AND Results: SHORT INFUSION REGIMEN” A total of 31 patients (3 hr, n = 15; 30 min, 1 Mathew SK, 1 Mathew BS, 1 Naik GS,1 n = 16) were compared. All 15 patients (3 Gupta RP., 2 Subramani K.,2 Jacob GG, hour) achieved plasma concentration 1 Fleming D.H., 1Department of above 4 mg/dl 60% of inter-dose interval Pharmacology and Clinical compared to only 69% patients in the Pharmacology, 2 Surgical Intensive short infusion group. 87% of patients in Care Unit, division of Critical Care, extended infusion group and 25% of Christian Medical College, Vellore 632 patients in short infusion achieved the 004, Tamil Nadu, India target concentrations for 100% of inter- dose interval time. Mean AUCs in the Background: extended infusion group was significantly higher compared Meropenem is frequently used in to short infusion group (193.34 vs intensive care units for treating serious 118.94; p = 0.006). Clearance of gram negative infections. Inter-individual meropenem was 73.2 (median) (range: variation of pharmacokinetic parameters 18.6 – 210.8) in the extended infusion is high which can result in inadequate group and was significantly higher in

Abstracts of Annual Research Day 2013

short infusion group (median:141.84, magnesium in postthyroidectomy range: 21.39 – 266.85) (p = 0.01112). hypocalcemia. High inter-individual variations in PK parameters were noted. Correlation Aim: between meropenem clearance and creatinine clearance was poor in both Prospectively study the incidence of groups. hypomagnesemia in thyroidectomy patients and its relationship with Conclusions: hypocalcemia. To evaluate the role of other risk factors for postthyroidectomy In critically ill patients achievement of hypocalcemia and their relationship with adequate plasma concentration is crucial. hypomagnesemia. Extended infusion regimen appears to provide adequate exposure of Methods: meropenem in spite of high inter- individual variability in these patients. Fiftypatientsundergoing thyroidectomy CLSI: Clinical and Laboratory Standards between October 2012 and September Institute guidelines 2013 at the department of Endocrine surgery, Christian Medical College, Vellore, Keywords: were prospectivelyanalyzed.

Meropenem, pharmacokinetics, extended Results: infusion, critically ill patients. A female preponderance was observed. The most common procedure performed was total thyroidectomy (72%). Seventy “ROLE OF MAGNESIUM IN POST four percent were malignant. THYROIDECTOMY HYPOCALCEMIA.” Preoperatively sixty percent were vitamin Anish J C1, Pooja Ramakant1, Thomas D deficient, though this did not translate to Paul2, Abraham D T1, M J hypocalcemia post operatively. The Paul1Department of Endocrine preoperative prevalence of surgery1, Department of hypomagnesemia was 24%. There were Endocrinology2 Christian Medical no patients with preoperative College, Vellore hypocalcemia.The incidence of hypocalcemia and hypomagnesemia on Background: the first postoperative day was28% and 70% respectively. Both hypocalcemia and Transient hypocalcemia is the most hypomagnesemia normalizedwithout common complication following intravenous correction for all except three thyroidectomy. A subgroup of these patients. patients have “persistent hypocalcemia” – unresponsive to calcium and vitamin D Persistent hypocalcemia was seen in three supplements. Its cause has not been well patients, all had low parathormone (PTH) studied. There are a few conflicting postoperatively. Among these, twopatients reports in literature on the role of had hypomagnesemia as well. Both these patients received intravenous magnesium

Abstracts of Annual Research Day 2013

correction. PTH increased and calcium margins, neural invasion or unresectable normalized following correction. disease.

Greater volume of fluid used Material and Methods perioperatively resulted in hypocalcemia A forty seven year old lady presented (p = 0.032). Other factors did not seem to with a thyroid swelling for 4 years, have a significant relationship with dyspnoea on exertion for 3 months and postoperative hypocalcemia. noisy breathing for 3 weeks. CT neck showed an asymmetric circumferential Conclusion: thickening of proximal trachea with Hypomagnesemia and hypovitaminosis D luminal narrowing and a multinodular is prevalent in our community.A goiter. She underwent total significant association between post thyroidectomy with tracheal sleeve thyroidectomy hypocalcemia and resection and primary anastomosis. hypomagnesemia was not detected in this Histopathology of the tracheal region was study. A trend of fall in calcium and reported as adenoid cystic carcinoma magnesium following surgery which with the inferior and superior margins normalized without intravenous involved by tumor, however, with correction was observed. Hemodilution negative nodes. She was planned for was the only factor seen to play a radiotherapy for the positive margins. significant role in post thyroidectomy hypocalcemia. It was decided to treat the patient with Intensity Modulated Radiation Therapy (IMRT). The Clinical Target Volume (CTV) was 1.5 cm and the Planning Target ADENOID CYSTIC CARCINOMA OF THE Volume (PTV) of 0.5cm.The surrounding TRACHEA-A DOSIMETRIC STUDY critical structures were contoured as COMPARING DIFFERENT Organs at Risk (OAR) RADIOTHERAPY TECHNIQUES. Various plans like 3D CRT with 6 and 15 MV photons, field in field technique and 3 Aparna M.P., Ebenezer Suman Babu, and 4 fields 3D CRT with 15MV and IMRT Retna Ponmalar, Dr. Paul Ravindran, were created and plan evaluation was Dr. Selvamani B, Dr. Simon Pavamani done. Department of Radiotherapy, Christian Medical College, Vellore, Tamil Nadu. Results

Introduction Various plans - 3D CRT using various beam arrangements and IMRT -were Adenoid cystic carcinoma is a rare created, evaluated and compared. The malignancy, usually originating in the IMRT plan was deemed the best salivary glands of the head and neck dosimetrically. A detailed comparison will region, but, rarely originating in the be presented. trachea. Surgical resection is the Conclusions treatment of choice. Radiotherapy is reserved for microscopically positive

Abstracts of Annual Research Day 2013

Adenoid cystic carcinoma of the trachea is Objective: a rare malignancy and there are no definite guidelines to treat these tumours. To study the association between HLA- IMRT may be the preferred modality of B*1502 and SJS, TEN and DRESS induced radiotherapy for these tumours due their by aromatic amine AEDs. location & proximity to critical structures. Methods:

“ASSOCIATION OF HLA-B*1502 AND In this case-control study, patients who SEVERE CUTANEOUS ADVERSE DRUG developed SJS, TEN or DRESS to one of REACTIONS INDUCED BY AROMATIC the aromatic AEDs (cases) and patients AMINE ANTI-EPILEPTIC DRUGS IN on aromatic AED therapy for at least 3 INDIAN PATIENTS.” months who did not develop SCAR (controls) were recruited. Controls were Girish S Naik, 1T. S. Vijayakumar,2 matched by drug group and origin Mahendran K, 2Sumith K Mathew, (North/South). HLA-B*1502 genotyping 1Denise Helen Fleming, 1Kalpana was performed using a PCR based assay Ernest, 1Maya Thomas,3 Renu George4 and the phenotype-genotype association Department of Pharmacology and assessed. Clinical Pharmacology 1 Results: Molecular Laboratory, Department of Nephrology 2 Genotyping was performed for 84 Department of Neurology 3 patients (30 cases and 54 controls). Department of Dermatology 4 Significant association between SJS/TEN Christian Medical College, Vellore, 632 induced aromatic AED and HLA-B*1502 004, Tamil Nadu, India1-4 was seen (4/9 vs. 4/54; 44% vs. 7.4%; 0.011). CBZ induced SJS/TEN alone compared with CBZ tolerant, origin Background: matched controls also showed significant Aromatic amine anti-epileptic drugs are association (3/4 vs. 0/16; 75% vs. 0%; one of the most common drugs implicated 0.004). None of the patients who in producing severe cutaneous ADR like developed DRESS were positive for the SJS, TEN, SJS/TEN and DIHS/DRESS. allele (0/21 vs. 4/54; 0.569). Mortality is highest with TEN (20-30%) Conclusions: followed by SJS (1-5%).1 Carbamazepine induced SJS has been shown to have the There was no association between strongest association with risk allele HLA- aromatic AED induced DRESS and HLA- B*1502 in South East Asians while other B*1502 among Indian patients. Although aromatic anti-epileptics have also shown association between SJS, TEN due to all association. The study aimed to evaluate aromatic AEDs studied was statistically if HLA-B*1502 genotyping can be of significant, 75% was accounted by CBZ. clinical utility in identifying Indian The association was seen amongst south patients at risk of developing severe Indians in our study similar to an earlier cutaneous ADR to aromatic amine anti- study from India which reported 75% epileptic drugs. prevalence among north Indian CBZ induced SJS/TEN cases. Screening for

Abstracts of Annual Research Day 2013

HLA-B*1502 seems to be prudent before children to prevent renal scarring.(3) initiating Indian patients on CBZ to Although urine culture is the gold prevent SJS/TEN. Studies with larger standard for diagnosing UTI, the results sample size showing association of other may not be available for 2–3 days.(1) aromatic amine AED induced SJS/TEN to Hence, urinalysis is commonly used to HLA-B*1502 among Indians are needed make an early diagnosis of UTI and to before recommending screening prior to start treatment. The sensitivity of pyuria initiating other aromatic AEDs. and positive urine nitrite test as indicators of UTI are low as shown by Abbreviations: several studies.

AED – Anti-Epileptic Drug; CBZ – Neutrophil Gelatinase Associated Carbamazepine; DRESS – Drug Rash with Lipocalin (NGAL), also known as Lipocalin Eosinophilia and Systemic Symptoms; SJS 2, is an iron carrier protein that is – Stevens-Johnson Syndrome; PHT – abundantly expressed in human Phenytoin; SCAR- Severe Cutaneous neutrophils(4). Its transcription is Adverse Reaction; TEN – Toxic Epidermal induced by bacterial Necrolysis lipopolysaccharides.(4). There are some animal studies which had shown that “PROSPECTIVE STUDY TO DETERMINE NGAL is an useful marker to detect THE USEFULNESS OF URINARY UTI.(4) There are no studies done using NEUTROPHIL GELATINASE NGAL for detection of UTI in Indian ASSOCIATED LIPOCALIN (NGAL) AS AN population and in children less than five EARLY AND SENSITIVE MARKER OF years of age. Hence, we proposed to study URINARY TRACT INFECTION (UTI) IN the usefulness of uNGAL as an early, CHILDREN” sensitive predictor of UTI in Indian population and in the age group of less Dr. J. Iswarya, Dr. Indira Agarwal, Dr. than 5 years. Joe Fleming*, Dr. Swasti Chaturvedi, Dr. Rani Diana Sahni**, Department of Aims and objectives: Pediatrics, Clinical Biochemistry* and Microbiology**, Christian Medical Primary objective: College and Hospital, Vellore, India 1. To determine the usefulness of Introduction: urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) as an Urinary tract infections (UTI) are one of early and sensitive marker of the most common infectious diseases urinary tract infection (UTI) in encountered in pediatric practice.(1) In children less than 5 years of age some young children, UTI may lead to renal scarring, leading to poor renal 2. To determine the optimal cut-off growth, recurrent pyelonephritis, level for uNGAL to predict UTI in impaired glomerular function, early this group of children hypertension and end stage renal Secondary objective: disease.(2) Early, aggressive antibiotic treatment has been recommended for symptoms suggestive of UTI in young

Abstracts of Annual Research Day 2013

3. To compare the sensitivity and 7. Transplantation and delayed graft specificity of uNGAL estimation function with urine WBC estimation in 8. Cardiac Surgery (CS) children with culture positivity. 9. Cancers 10. Prior use of antibiotics for treatment Patients and methods: of UTI

This prospective study was conducted in the Department of Pediatrics, Christian Methodology: Medical College, Vellore, India between January 2012 and June 2013. Midstream clean catch urine samples were sent for urine WBC analysis. If urine One hundred children aged between WBC >11/cu.mm alone or if the urine three months and five years, who WBC >5/cu.mm with symptoms presented to either Pediatric Casualty or suggestive of UTI, the child was included Pediatric Out-patient services, and in the study after obtaining informed fulfilled the inclusion criteria and had consent from the parents. Demographic none of the exclusion criteria were details of the patient including name, age, enrolled in the study. The inclusion sex, address and contact phone number criteria and exclusion criteria were as were collected. General examination was follows: done for all patients.

Inclusion Criteria: Supra pubic aspirate (SPA) urine samples for urinary NGAL levels and urine culture All children between the age of three were collected for children aged between months and five years with symptoms three months and three years and suggestive of UTI as listed below and midstream clean void urine samples were urine WBC > 5/cu.mm or urine WBC > obtained for children aged between four 11/cu.mm alone. and five years, before the child was Fever, nausea, vomiting, abdominal pain/ started on antibiotics. A diagnosis of UTI back pain, straining/ poor urinary stream, was made if there is significant foul smelling urine, dysuria, frequency, bacteriuria ( 10,000 cfu /ml of a single urgency of micturition and diarrhoea. pathogen in mid stream clean void urine samples or >≥1000 cfu /ml in mid stream Exclusion Criteria: clean void urine samples, if suggested by our microbiologist as significant or even 1 1. Children with renal anomalies like single bacterium in SPA urine samples) in polycystic kidney disease, the urine culture. multicystic dysplastic kidney 2. Children with lupus nephritis/ Urine NGAL was determined using human glomerulonephritis/ nephritic NGAL/lipocalin-2 immunoturbidimetric syndrome assay, supplied from Bioporto 3. Chronic Kidney Disease (CKD) diagnostics. The urine samples were 4. Renal Replacement Therapy (RRT) stored at -70 degrees Celsius. Before 5. Contrast Induced Nephropathy processing, the sample was thawed for (CIN) one hour and centrifuged at 2000 6. Nephrotoxicity rotations per minute for ten minutes. It 12

Abstracts of Annual Research Day 2013

was then processed using Roche associated urosepsis. Blood culture was molecular P-800 analyser. negative in all cases.

Statistical analysis was done using SPSS Among the 100 patients, 34 were urine 18 software. The sensitivity and culture positive and 66 were culture specificity of uNGAL estimation as a negative. The male: female ratio in the marker of UTI was compared with urine culture positive group was 1.1: 1. WBC estimation in children with culture positivity. Receiver operating curve (ROC) E. coli (82%) was the most common analysis was performed to determine the organism grown in urine culture followed sensitivity and specificity of different cut- by Enterococcus (9%), Klebsiella (6%) off points for uNGAL and urine WBC and Citrobacter (3%). 18 of 25 patients estimation to predict UTI. The most (72%) had Extended-Spectrum Beta- appropriate cut-off point was chosen Lactamase (ESBL) producing strains of E. according to ROC analysis, and the area coli. ESBL producing strains of E. coli are under the curve (AUC) was calculated. more resistant to cephalosporin antibiotics. This makes the infections The positive and negative predictive harder to treat. values and likelihood ratios were also calculated. Receiver Operating Characteristic (ROC) curve analysis was performed for the Results and Discussion: urine NGAL values. According to ROC analysis, the optimal uNGAL value to Majority of children were between 3 and predict urinary tract infection was 12 months of age (51%) followed by 36% 27ng/ml with a sensitivity of 79.4% between 25 and 60 months and 13% and specificity of 68.2%. (Area under between 13 and 24 months. The mean age curve: 0.765). The positive predictive of the children was 22.09 months with a value (PPV) was 56% and negative range of 3-60 months. The female: male predictive value (NPV) was 87%. The ratio was 1.3: 1. positive likelihood ratio (LR+ve) was 2.47 and negative likelihood ratio (LR –ve) was The presenting complaints and symptoms 0.31. were recorded in all 100 children. Fever was the most common symptom and was seen in 85% of patients. Fever was the only presenting symptom in 36% of children. Vomiting was the next most common symptom, seen in 26% of children. Dysuria was seen in 18 children.

The mean urine WBC value was 509.38 (IQR 22- 143.75). The mean urine NGAL value was 221.28 (IQR 2.73-193.58). Blood culture was done in 58 of 100 children, whenever there was suspicion of

Abstracts of Annual Research Day 2013

abnormalities is higher and hence higher ROC analysis showed that the optimal chance of getting UTI. The odds of getting urine WBC value to predict urinary tract a urinary tract infection in children <1 infection was 38/cu.mm with a year was 13 times greater if their urine sensitivity of 70.6% and specificity of NGAL levels are >27ng/ml and in children 53%, which were less than that of > 1 year of age, it was 5 times higher than uNGAL. The positive predictive value the normal population. We found that (PPV) was 44% and negative predictive urine NGAL was statistically significant value (NPV) was 78%. The positive in predicting urinary tract infection in likelihood ratio (LR+ve) was 1.49 and both children <1 year and >1 year of age. negative likelihood ratio (LR –ve) was 0.57. We compared the sensitivity and specificity of urine NGAL and urine WBC With a urine WBC cut-off of 10/cu.mm in predicting UTI in males and females. (routinely followed in clinical practice), ROC analysis showed that the sensitivity the sensitivity and specificity were of urine NGAL in females was 87.5% and 94.1% and 7.6% respectively. The specificity was 52.5%. The sensitivity of positive predictive value (PPV) was 34% NGAL in males was 77.8% and specificity and negative predictive value (NPV) was was 57.7. The area under the curve for 71%. The positive likelihood ratio males was 0.77 and for females was 0.78. (LR+ve) was 1.01 and negative likelihood The sensitivity of urine NGAL was ratio (LR –ve) was 0.86. The specificity higher in females than in males. The was very low, leading to high false mean urine NGAL value to predict UTI positive rates and the unnecessary use of was higher in females (19.25) antibiotics in children with suspected UTI, compared to males (9.25). In females, thus increasing the emerging antibiotic because of the risk of contamination, the resistance. urine NGAL values were higher than males as expected. The correlation of urine NGAL and urine WBC with urine culture in various age Urine NGAL levels were compared groups was looked at in our study. The between the culture positive and culture sensitivity of urine NGAL for predicting negative groups. The mean urine NGAL UTI in children < 1 year of age was values were higher in patients with 84.2% and specificity was 71.9% culture positivity (p value = 0.0001) (p<0.0001). The sensitivity of urine and lower in patients with culture NGAL for predicting UTI in children > 1 negativity (p value = 0.001). This was year was 73.3% and specificity was statistically significant. 64.4% (p<0.014). The area under the curve for urine NGAL <1 year was 0.79 We also compared urine NGAL values and that for >1 year of age was 0.72. between patients who grew E. coli in urine culture with those who grew other The sensitivity and specificity of urine organisms. There was no significant NGAL for predicting UTI was more in difference in the mean urine NGAL values children <1 year of age, thus making it a between E. coli and other organisms. good test to predict UTI in infants, in whom the incidence of urinary tract Conclusion:

Abstracts of Annual Research Day 2013

IMPACT IN REPORTING RECTAL DOSE Urine NGAL proved to be a sensitive IN HDR BRACHYTHERAPY OF CANCER and specific marker to predict simple CERVIX.” uncomplicated UTI in young Indian children, when compared to urine WBC Somnath Dey, Balukrishna S, which is the routine screening test, with V.K.Reddy, Sunitha Susan Varghese, an optimal cut-off level of 27ng/ml. Urine Ebenezer Suman Babu, Rabi Raja WBC cut-off with best sensitivity and Singh, Selvamani B Department of specificity to predict UTI was 38/cu.mm, Radiotherapy, Christian Medical which is higher than the cut-off of College, Vellore, Tamil Nadu 10/cu.mm, which is routinely used. Aim: References: The ICRU through its report no.38 has 1. Yilmaz A, Sevketoglu E, Gedikbasi tried to bring in uniformity in dose A, Karyagar S, Kiyak A, Mulazimoglu M, et reporting in brachytherapy for cancer al. Early prediction of urinary tract cervix. But there is ambiguity and non- infection with urinary neutrophil uniformity in defining and dose reporting gelatinase associated lipocalin. Pediatr of rectal and bladder point in HDR Nephrol. 2009;24(12):2387–92. brachytherapy for carcinoma cervix using orthogonal radiography. This work aims 2. Downing H, Thomas-Jones E, Gal at studying the extent of dose reporting M, Waldron C-A, Sterne J, Hollingworth W, error that exists in Institutions across et al. The diagnosis of urinary tract India. infections in young children (DUTY): protocol for a diagnostic and prospective Materials and methods: observational study to derive and validate a clinical algorithm for the diagnosis of Through personal communication with UTI in children presenting to primary Radiation Oncologists across the teaching care with an acute illness. BMC Infect Dis. centres in India, we listed out three main 2012;12(1):158. methods that are followed for rectal point marking. The response from the 3. Coulthard MG. Is reflux oncologists also revealed that all of them nephropathy preventable, and will the adhered to same method in bladder point NICE childhood UTI guidelines help? Arch marking.10 cases were selected by Dis Child. 2008 Mar 1;93(3):196–9. systematic sampling and the rectal points were marked as R1, R2 and R3 and based 4. Ichino M, Kuroyanagi Y, Kusaka M, on technique 1, 2 and 3 respectively. The Mori T, Ishikawa K, Shiroki R, et al. mean shift between the various points Increased urinary neutrophil gelatinase was measured along with the difference associated lipocalin levels in a rat model in dose at these points. of upper urinary tract infection. J Urol. 2009 May;181(5):2326–31. Results: “ARE WE TALKING ABOUT THE SAME POINT?” POSSIBILITY OF INTER The rectal points marked by the three INSTITUTIONAL VARIATION AND ITS methods were found to have a mean shift

Abstracts of Annual Research Day 2013

in the anterior, posterior, cranial and spinal anaesthesia. This exercise is a lead caudal directions between 5mm and to changing the Institutional practice and 28mm. There were no observed introducing cheaper and convenient differences in the lateral direction. The outpatient procedure. difference in percentage rectal dose reported was as high as 25% and mean of Objectives: 11.2%. The cumulative percentage dose 1. To test the feasibility of fixing a difference at the rectal point as high as sleeve at the cervical os 22.67% .There was no difference noticed 2. To do cost effective analysis of in marking or dose reporting bladder treatment as inpatient basis versus point. predominantly outpatient basis.

Conclusion: Methods:

Although in the era of Image Guided Patients with carcinoma cervix suitable Brachytherapy, CT planning and volume for HDR brachytherapy at the end of based optimization may remove the external beam irradiation were identified. uncertainty, in our country most centres A subject chosen underwent fixation of rely on orthogonal films for HDR the sleeve at the cervical os in theatre brachytherapy. The intent of ICRU 38 in during the first application followed by helping centers to report uniformly is not second and third applications as served here and hence there is a need for outpatient. Three other patients revision for better definition of rectal underwent all three applications under point and strict adherence to the protocol spinal anesthesia were also selected. across the country. Direct medical and direct non-medical costs for each patient were computed. “CHANGING PRACTICE OF INPATIENT HDR BRACHYTHERAPY IN CARCINOMA CERVIX TO AN OUTPATIENT PROCEDURE – A COST MINIMIZATION Results: EXERCISE.” It was possible to suture the sleeve to the Judith Aaron, Balukrishna S, Sunitha S, cervical os and it stayed in place during Selvamani B, Department of the course of treatment (2 weeks). Radiotherapy, Christian Medical College, Vellore, Tamil Nadu The total treatment cost for the study patient (3 applications) amounted to Rs. Background: 29373 while the mean cost per patient who undergoes all three applications Intracavitory Brachytherapy is an under anesthesia is Rs.39243. essential component of radical treatment of cancer cervix. High dose rate Outpatient treatment benefited the brachytherapy is preferred for its patient and society monetarily and in convenience. Though many centers terms of shorter stay in hospital. It was practice an outpatient procedure, at CMC advantageous to the hospital as the we still prefer inpatient application under

Abstracts of Annual Research Day 2013

reduced theatre time and admissions can be best utilized to serve other patients. To study the efficacy of two regimens The effectiveness of treatment was (400 IU/day vs 1000 IU/day) of Vitamin assessed by comparing the dose to point D supplementation in preterm neonates. A, rectal dose and bladder dose. There was no significant under dosage to point Setting: A or over dosage to critical organs. Tertiary care perinatal centre in south Conclusion: India.

An outpatient application and delivery of Methods: HDR brachytherapy was found to be This was a double blind randomized feasible and cost effective as compared to controlled trial conducted recruiting existing practice. inborn preterm babies between 28-34 weeks of age. Baseline levels of serum “A RANDOMIZED DOUBLE BLIND calcium, phosphorus, alkaline CONTROLLED TRIAL COMPARING TWO phosphatase and Vitamin D were sent at REGIMENS OF VITAMIN D 48 hours of age. When babies reached SUPPLEMENTATION IN PRETERM enteral feeds of 100 ml/kg/day, they NEONATES.” were randomised into the trial. All babies Mintoo Tergestina, Sridhar were fed unfortified breast milk and once Santhanam, Anil Kuruvilla, Anna on full feeds, supplemented daily with Simon, Niranjan Thomas, Department calcium, and phosphate. One arm of the of Neonatology, Christian Medical trial received 400 IU of Vitamin D while College, Vellore the other arm received 1000 IU of Vitamin D. At term corrected gestational Background: age serum calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH) Preterm babies are prone to metabolic and 25(OH)D levels were estimated. bone disease and are usually Samples for Serum Calcium and Urine supplemented with calcium, phosphorus spot Calcium Creatinine ratio were taken and vitamin D. While the American at intervals to evaluate for any evidence Academy of Pediatrics recommends 400 of hypervitaminosis D. IU of Vitamin D, the European Society for Paediatric Gastroenterology, Hepatology Results: and Nutrition recommends 800 -1000 IU/day. In a previous study we had Ninety babies were recruited into the trial demonstrated that > 50% of preterms and followed up to term corrected supplemented with 400 IU/day of vitamin gestational age. The mean Vitamin D level D were insufficient at 6 weeks of age. at 48 hours for the 2 groups – 400 v/s Hence the need for randomized 1000 IU was 20.05±9.8 and 24.3±14.8 controlled trials to study higher doses of ng/ml. At term corrected gestational age, vitamin D supplementation in preterm mean Vitamin D level in the group that babies. received 400 IU was 18.59±10 and 1000 IU was 47.63±13.78 ng/ml. None of the Objective:

Abstracts of Annual Research Day 2013

babies were insufficient in the 1000 IU of SSR at the time of admission and group, as against 53.78% in the group subsequent recovery. that received 400 IU. Methods: Conclusion: HRV indices computed in 20 ASIA grade The recommended supplementation of A/B patients at the time of admission preterm babies with 400 IU/day of were correlated with the change in motor vitamin D is insufficient. Preterm babies and sensory scores at the end of the supplemented with 1000 IU/day of rehabilitation programme using vitamin D maintain normal vitamin D Spearman’s correlation coefficient. Chi levels without any side effects. square test was used to study the association between the presence or Key Words: absence of SSR at the time of admission and the change in ASIA grade at the end of Preterm; Vitamin D; Supplementation. the rehabilitation programme.

Results: “STUDY OF THE RELATIONSHIP There was no statistically significant BETWEEN INITIAL AUTONOMIC correlation between the HRV indices and FUNCTIONS AND SUBSEQUENT MOTOR the change in motor and sensory scores. AND SENSORY RECOVERY, IN Neither was there any statistically TRAUMATIC CERVICAL SPINAL CORD significant association between the INJURY PATIENTS.” presence or absence of SSR at the time of admission and the subsequent Latha N. and Elizabeth Tharion, improvement in ASIA grade. Department of Physiology, Christian

Medical College, Vellore.

Aim: To study if assessment of autonomic pathway integrity in traumatic cervical spinal cord injury quadriplegic patients is Conclusion: useful for prognostication. The findings of the present study indicate that HRV indices and SSR are not useful parameters to prognosticate recovery in Objectives: traumatic cervical cord injury quadriplegic patients. To study the (1) correlation between short-term Heart rate Variability (HRV) Authors: indices at the time of admission of quadriplegic patients and the change in Dr. N. Latha, motor and sensory score at the end of the Final year PG, rehabilitation programme and (2) Department of physiology, association between presence or absence Christian Medical College, Bagayam, Vellore – 632 002.

Abstracts of Annual Research Day 2013

Contact No. – 09965614312 in CMC Vellore with history of recurrent E mail - [email protected] miscarriage from 2002 to May 2013.

Dr. Elizabeth Tharion, Results: Professor of Physiology, Department of Physiology, There were totally 479 couples (958 Christian Medical College, individuals) out of whom 69 (7.2%) Bagayam, Vellore – 632 002. individuals were detected to have Contact No. +91416 - 2284268 chromosomal aberrations. 21 (2.1%) E mail – [email protected] individuals had translocations, 34 (3.9%) had numerical abnormalities, 4

(0.4%)with inversions and 6 (0.6%) with “CHROMOSOMAL ABERRATIONS IN other chromosomal abnormalities COUPLES WITH RECURRENT Conclusion: MISCARRIAGES – AN EXPERIENCE OF 479 COUPLES AT A TERTIARY CARE Cytogenetic analysis is an important CENTRE IN INDIA.” investigation in the workup of couples with recurrent miscarriages. Thomas S, Aleyamma T K, Kamath M S, Chandy A, Mangalraj AM, Muthukumar “EFFECTIVENESS OF AN ARTICULATED K, Department of Reproductive KNEE HYPER EXTENSION ORTHOSIS IN Medicine, Christian Medical College GENU RECURVATUM: A CASE REPORT” Hospital, Vellore. Aravind Rahul S.R.M, Student, DPO IInd Background: Year, Rajesh Kumar Mohanty, Lecturer (P&O), Prosthetics & Orthotics Recurrent miscarriage continues to be a Services, Department of PMR, Christian challenging problem for the couple as Medical College, Vellore-632004 well as the clinician and determining the cause can be extremely difficult.In couple Background: with recurrent miscarriages there is an increased risk of one of the partners Genu Recurvatum is a defomity in the carring a structural chromosomal knee joint that tends to push knee aberration. Balanced chromosomal backwards by excessive extension in rearrangements is an important cause for tibio- femoral joints. Commonly used recurrent pregnancy loss. orthoses include heel wedges, ankle foot orthoses (AFO), knee ankle foot orthoses Aim: (KAFO) and knee orthoses (K.O) etc. To evaluate the contribution of However, technically controlling chromosomal abnormalities in causing hyperextension of knee by an orthosis is a recurrent miscarriages. difficult task. Therefore, most of the orthoses commonly prescribed for this Materials and methods: condition have not been successfully given good results with strong evidences. Retrospective study of 479 couples who attended the Reproductive Medicine unit Aim:

Abstracts of Annual Research Day 2013

To check the effectiveness of an articulated knee hyperextension orthosis in genu recurvatum in terms of gait and “MATURITY ONSET DIABETES OF THE energy expenditure. YOUNG (MODY) IN INDIA- NOVEL INSIGHTS DERIVED FROM NEXT GENERATION SEQUENCING.” Case Description & Method: Aaron Chapla, Mahesh DM, Denny V, HS A Subject of 63 years old diagnosed as Asha, V Padmanabhan, Mercy post polio residual paralysis showed Inbakumari, Sarah Mathai*, excessive hyperextension of his left knee Thomas.V.Paul, Nihal Thomas, during long standing and walking. The Department of Endocrinology, tibio-femoral angle during full weight Diabetes and Metabolism, Christian bearing was found to be approximately Medical College, Vellore, India. 40 degrees. An orthotic design was proposed, fabricated and fitted to check CORRESPONDING AUTHOR: the effectiveness of the design which Dr. Nihal Thomas, incorporated design features like MD, MNAMS, DNB (Endo), FRACP articulated, pre-flexed KAFO based on (Endo),FRCP(EDIN),FRCP(Glasg) couple force system. Observational gait Professor & Head, analysis (OGA) by video recording, force Department of Endocrinology, Diabetes plate analysis and Energy expenditure and Metabolism, using physiological cost index (PCI) was Vice Principal (Research), calculated with and without orthosis. Christian Medical College Hospital, Results: Vellore-632004, India. Email: [email protected] The orthosis controlled knee hyperextension by not allowing the knee Background: to go beyond neutral position. Advantages Maturity Onset Diabetes of the Young including sitting cosmesis, assistance to (MODY) has traditionally presented as a weaker quadriceps, M-L stability, monogenic disorder with an autosomal unlocked but stable gait was observed dominant inheritance pattern, during trial. Gait deviations like excessive -Cell dysfunction. An lateral trunk bending, use of ipsilateral overlap of clinical features with the more hand to support and instability was commoncharacterized polygenic by β Type 2 diabetes controlled with the use of orthosis. The mellitus makes differentiation of MODY a gait was more energy efficient and diagnostic challenge. The current genetic natural as revealed from PCI and force diagnostic protocol involves phenotype plate studies. guided sequential screening of only a few Conclusion: of the identified MODY genes. However, limitations in the scalability and The proposed design was found to be prohibitive cost of Sanger sequencing has effective in controlling excessive knee hindered simultaneous genetic screening hyperextension and resulted in stable, of all known comprehensive panel of natural and energy efficient gait. MODY genes.

Abstracts of Annual Research Day 2013

Method: Enhanced recoveries after surgery (ERAS) protocols are increasingly being used in We evaluated 74 patients with young colorectal surgery to improve outcomes onset diabetes of whom, 51 met the and reduce patient discomfort. We clinical criteria of MODY. A panel of 10 analyzed the effect of an enhanced established MODY genes was selected to recovery protocol on outcomes following screen for mutations. A novel multiplex rectal cancer surgery in a tertiary care PCR protocol was developed to enrich the teaching hospital in South India. target genes and further processed on a semiconductor based next-generation Methods: sequencing (NGS). All the identified rare variants were confirmed by Sanger This retrospective study compared two sequencing. cohorts of patients undergoing rectal resection for cancer. An ERAS protocol Results: was introduced in our unit in May 2012.The first cohort of patients (June Using this approach we have identified 2010 to May 2011) underwent standard MODY mutations in thirteen patients of care and the second (June 2012 to May whom nine mutations were novel. These 2013) an ERAS protocol. The ERAS mutations include four patients with protocol consisted of pre operative NEUROD1, two with IPF1, and one each patient education, avoidance of bowel preparation, use of non narcotic CEL and PAX4. Two patients with analgesia, avoidance of post operative NEUROD1with HNF1α, mutation HNF4α, coseggregated GCK, HNF1β, KLF11, with a drains and NG tubes, starting of early post common PDX1 rare variant. operative feeding, early discontinuation of IV fluids, early urinary catheter Conclusion: removal and early discharge. Data was collected from computerised hospital NGS is a rapid and cost-effective method records and a prospectively maintained for performing comprehensive database. parallelized genetic screening of the genes implicated in monogenic disorders Results: like MODY. We have identified a higher frequency of NeuroD1 and PDX1 One hundred and twenty two patients mutations in South Asian Indians, a were included, 51 in the standard arm pattern that differs from populations in and 71 in the ERAS arm. Patient in the the West. ERAS group were found to be younger (47.8 vs. 55.3 years, p=0.008), had more “AN ENHANCED RECOVERY PROTOCOL frequent metastatic disease (0 vs. 8, AFTER RECTAL CANCER SURGERY: p=0.013) and had a higher proportion CHALLENGING SURGICAL DOGMA” underwent laparoscopic surgery (p<0.001). Patients were similar in terms Rohin Mittal, Mark Ranjan Jesudason, of sex distribution, neoadjuvant therapy, Benjamin Perakath, Christian Medical type of surgery and the T and N stage. College, Vellore Median duration of post operative stay Background: was 8 days in the standard care group

Abstracts of Annual Research Day 2013

and 6 days in the ERAS group (p=0.69). In surgery offers hope of reduced morbidity patients without any post operative associated with the surgical trauma. complications, duration of post operative Although, the concept of minimally stay was significantly lower in the ERAS invasive oesophagectomy (MIE) emerged group (4.79 vs. 6.96 days, p=0.006). two decades ago, there is still doubt However, in patients with post operative regarding the superiority of outcomes, complications, there was no difference compared to conventional open surgery. among both groups (12.1 vs. 13.1days, The aim of this study to assess the safety p=0.611). Both groups were similar in and efficacy of MIE and whether it terms of anastomotic leak, pelvic abscess, reduces the morbidity compared with wound infection, post operative ileus, open oesophagectomy, without bleeding and overall complication rates. compromising the oncological principles. There was no difference in readmissions and reoperation rates in both groups. Materials and Methods: The clinical and surgical details of Conclusion: patients who underwent curative surgery An ERAS protocol after rectal resection is for oesophageal cancer, from January safe and helps decrease duration of 2012 to October 2013, at the Upper GI surgical unit, Christian Medical College hospital stay in uncomplicated cases. and Hospital, Vellore was prospectively There is no difference in complication rates, readmission rates and reoperations entered into a computerized database and rates in patients managed under an ERAS used for analysis. The patients were grouped into those who underwent protocol. Further objective studies need conventional open oesophagectomy to be done to quantify improvement of patient comfort in an ERAS programme. (Group A) and those who underwent MIE (Group B). The outcome of the surgery between the two groups was assessed based on intra operative and post “MINIMALLY INVASIVE operative complications, operative time, OESOPHAGECTOMY VERSUS hospital stay and 30 day mortality. The CONVENTIONAL OPEN SURGERY FOR oncological safety was assessed based on OESOPHAGEAL CANCER: A SINGLE the completeness of resection, extent of CENTRE EXPERIENCE.” lymphadenectomy and the overall survival of the patient. Deshpande G, Abraham V. ,George S.V., Yacob M., Chandran B.S., Samarasam I. Results: Department of General Surgery, Upper A total of 37 patients underwent GI surgery unit, Christian Medical oesophagectomy for oesophageal cancer. College and Hospital, Vellore, Tamil Out of these, 18 patients had conventional Nadu, India open surgery (Group A) and 19 patients had MIE (Group B). Radical resection (R0) Background: was achieved in a 78 % of patients from Oesophagectomy is the mainstay of Group A and 84 % patients from Group B. curative treatment for cancer of the The mean operative time taken in Group oesophagus. The use of minimally A was 413 minutes compared to 467 invasive techniques in oesophageal minutes in Group B (p=0.941). The mean

Abstracts of Annual Research Day 2013

lymph node harvest in Group A was 11 nodes compared to 16 nodes in Group B Santanu Samanta, Balukrishna S, (p=0.200). Post operative major surgical Sathish Kumar A, Rabi Raja Singh I, morbidity (Clavien Dindo class 3 or 4) of Selvamani B, Dept of Radiation Group A was 5.5% and that of Group B Oncology, Ida B Scudder Cancer Centre, was 5.2%. Post op ventilation was Christian Medical College, Vellore. required in 11% patients in group A compare to 10% patients in Group B. The Purpose: mean ICU stay in Group A was 5 days compared to 2.6 days in Group B Geometric verification for treatment (p=0.05). The mean duration of hospital position is essential for accurate stay was 19.5 days and 16.3 days in treatment with IMRT. However treatment Group A and Group B respectively delivery uncertainties like set up error (p=0.162). The mean follow up of the two often fail to deliver intended dose. groups was 10.7 months and 12 months Current planning systems give a respectively. There was only one 30 day conformal plan but leave the oncologist to mortality in Group A and none in Group B. compute and analyse the influence of Short term follow up during the study setup errors on the plan. Though targeted period spanning 19 months, revealed an therapy with daily imaging will minimise overall survival of 9.8 months in the study setup errors on treatment delivery, this is group A compared to 12.1 months in not often employed. Here, we propose Group B (p=0.638). DVH band as a good visualization tool to select between competing plans to The MIE was performed in the semiprone minimise influence of random errors on position, which is a novel technique and treatment delivery. has distinct advantages over the classical prone or lateral positions. A short Method: operative video illustrating the operative procedure is also included. Three IGRT plans and their observed couch shift during treatment were Conclusion: analysed retrospectively. From the scatter plot of their shifts the maximum random Our study suggests that minimally shift through the course of therapy was invasive oesophagectomy is a safe found. The shift calculated using procedure, with comparable procedural Euclidean distance formula was used to complications, and possible advantages in generate rival plans for the same planning relation to postoperative recovery, CT and leaf sequence but with isocentric length of ICU and hospital stay. More shift applied to calculated magnitude. The importantly, all this can be achieved with isocentre was shifted to same magnitude no detrimental oncological outcomes. in +x, -x, +y, -y, +z & -z directions respectively and plans generated using the same leaf sequences used for

treatment delivery. The DVH for critical “GENERATION OF DVH-BAND IN organs and targets were overlapped to CONFORMAL RADIOTHERAPY FOR USE create DVH band. AS A PLAN EVALUATION TOOL.”

Abstracts of Annual Research Day 2013

Results: intracellular iron. Hepcidin, the master regulator of systemic iron homeostasis, The DVH band gave good visual was highly expressed in wild-type interpretation of possible influence of hepatocytes. Insulin treatment (10 or 100 random error on the organ or target for nM for 1, 3 or 6 hrs) did not affect that particular plan. hepcidin expression significantly. In wild- type hepatocytes,insulin (100 nM for 6 Conclusion: hrs)significantly up-regulated the gene The wider the DVH band the greater the expression of transferrin receptor 1 influence of setup errors on that plan. (TfR1) but did not have significant effects Hence this can be studied prospectively on expression of TfR2, divalent metal as a plan evaluation tool for conformal transporter-1 (DMT1), hereditary therapy where less imaging is employed hemochromatosis gene (HFE), at treatment. hemojuvelin (HJV) or matriptase 2 (TMPRSS6).In summary, iron-loaded “INSULIN SIGNALING IS IMPAIRED IN primary hepatocytes isolated from hepc IRON-LOADED PRIMARY MOUSE KO mice showed impaired insulin HEPATOCYTES FROM HEPCIDIN signalling when compared to wild-type KNOCK-OUT MICE.” hepactocytes;pre-treament with DFO tended to reverse this effect.Induction of Joe Varghese1, Andrew McKie2, Molly TfR1 by insulin may explain increased Jacob1., 1 Department of Biochemistry, hepatic iron stores that are associated Christian Medical College, Vellore, with insulin resistance, a condition INDIA., 2 Division of Diabetes and characterized by hyperinsulinemia. Nutritional Sciences, King’s College, Further studies are required to confirm London, UK. this. Mild to moderate increase in body iron “COGNITIVE SYMPTOMS AND stores is associated with insulin DISABILITY” resistance. However, the relationship

betweeninsulin andiron homeostasis is Paul Prabhu K.G., College of Nursing, not clear. To study the effects of Christian Medical College intracellular iron on insulin signalling, we

treated wild-type and iron-loaded Background: primary mouse hepatocytes from

hepcidin knockout (hepc KO) mice with Schizophenia is an enipatic disorder with insulin (10 nM or 100 nM for 10 min). an indisputable clinical heterogoncity. Phosphorylation of Akt (protein kinase B Until or PKB), a marker of insulin signalling, recently,t eahetrts for schizophreniah was significantly reduced in hepc KO avef ocusedm ainly on reducingp ositive hepatocytes. Treatment of these cells with symptoms,o ftenleaving patients \r'ith desferroxamine (DFO), an iron chelator, numerous residual difficulties, including prior to insulin treatment tended to impairment in cagnition, everyday living improve Akt phosphorylation in a dose- skills, and social/ocrlpafional ftnctioning. dependentmanner, indicating improved Owhg to the limited litelature fiom the insulin signalling with reduction in counhy in this area, the researchq uestion

Abstracts of Annual Research Day 2013

of assessi-ocgo gtritive slmptoms in deficits was not studiod. Paucity of patients with schizopb.reoian d its literature in this area especially from relatiooshipw ith furctional disability was India, and findings of this study highlights fomulated. the needf or further researchin this field.

Objective: Key words:

The main objective of the study was to SC2RS- Schizapbmia CognitionR oting assess the cognitive slmptoms in patieDts Scale with WHO-DASI I - World.H ealth Schizophenia, its relationship srith Organization- Disobility assessmenSt futrctioMl disability aod its association cheduleII with selected socio demographic and PANSS- Positive and NegativeS yndiomeS clinical vadables. cale

Methods:

The study had a descdptive cross sectional dosign. 110 subjects who tulfilled the inclusion cdteria cosented for the study, recruiied using coNecutive samplhg tecbnique. SCoRs and WHO-DAS

II atrd WHO-DAS II were used to assess the cognitive symptoms and disability respectively,P ANSS was uscd to assessth e psychopathologyo f patieotsw ith SchizophreDiaI.twas conducted in the in the Departmo of Psychiaty, Cbdstiatr Medical College, Vellore

Results:

It was found that cognitive slmptoms positively cnlrelated with disability

(p=0.00). This relationship was also significant i.! atl the domaitrs of disability (p=0.00). Duratioo of iltoess and medicatiotr adheretrce also showed statistically significaot association with both cognitive symptoms aod disability (p=0.00).

Conclusion:

The subjectsw ere on antipsychotics.T he effect of the drugs causingc lgnitive

Abstracts of Annual Research Day 2013

ABSTRACTS FOR POSTER PRESENTATION

BASIC SCIENCE

Abstracts of Annual Research Day 2013

“LARGE SCALE ISOLATION, and diphyllin in the fluorescent fraction PURIFICATION AND were screened and purified by Thin Layer CHROMATOGRAPHIC ANALYSIS OF BIO Chromatography. ACTIVE COMPOUNDS FROM CLEISTANTHUS COLLINUS.” Results:

Soosai Manickam Amirtham, Sathya The chromatographic analysis of Subramani, Department of Physiology, screened Cleistanthin A, Cleistanthin B Christian Medical College, Vellore-2. and diphyllin were performed by TLC, HPLC, PDA, FTIR and GCMS. The HPLC of Aim: Cleistanthin-A and Cleistanthin-B showed 100% purity. Diphyllin was impure. To isolate active principles of Cleistanthus collinus (C.collinus) by liquid/liquid Conclusion: partition chromatography and enrichment by Thin Layer The screened phytochemicals can be used Chromatography. to study the action of individual active principles and to find a potential antidote, Objectives: in the process.

C.collinus is a known toxic plant, used for “BACTERIOLOGICAL PROFILE AND self-harm in rural South India. The ANTIBIOGRAM FROM A NEONATAL mortality is 28%. The exact mechanism of UNIT IN SOUTH INDIA.” action of this poison is still unknown and there is no promising antidote till date. In Vijay Gupta*, Sridhar S*, Balaji V**, this study we screened major active Niranjan Thomas A W*, Anil Kuruvilla compounds from boiled and room K*, Manish Kumar*, Atanu Kumar temperature extract. Jana*., *Department of Neonatology and **Department of Microbiology, Methods: Christian Medical College, Vellore

C.collinus leaves were shade dried and Background: hexane delipidated. 100grams of leaves were soaked in 3 liters of distilled water Bacteriological profile in a neonatal unit for 24 hrs for room temperature extract. changes with maternal demographics and 100 grams of leaves were immersed in 2.5 local antibiotic policies. There is growing liters of boiling distilled water for 10 concern about emergence of new minutes for boiled extract. The organisms in causing early onset sepsis supernatant of both extracts were -onset sepsis collected and mixed with Chloroform to form two immiscible layers. The bottom in(EOS) the (≤incidence 72 hours) of andinfections late caused by chloroform layer, separated with multidrug(LOS) (≥ 72 resistant hours) organisms.as well as an increase separating funnel sequestered the fluorescent compounds. The top aqueous Objective: layer did not have any fluorescent compounds. The fluorescent portion was To study the bacteriological profile of concentrated and powdered. The active newborn sepsis in a tertiary care unit in principles Cleistanthin A, Cleistanthin B south India.

Abstracts of Annual Research Day 2013

Conclusions: Design: The incidence of neonatal bacterial sepsis Retrospective review of inpatient charts was 8.3 per 1000 livebirths. NFGNB and of newborn babies admitted over a two Klebsiella were the most common year period. organisms as the cause for both EOS and LOS. GBS was a common organism Setting: causing EOS.

Tertiary care perinatal center. Keywords:

Subjects: Neonatal sepsis, antibiogram, South India

All babies admitted in the neonatal unit, “LOW COST NOVEL METHOD OF with blood culture positive sepsis from VISUALLY QUANTIFYING NOISE LEVELS January 2011 to January 2013 were IN THE NICU – THE CMC SOUND included in the study. METER.”

Results: Sudesh Yadav, Kalyani Kareti, Atanu Kumar Jana, Suresh Devasagayam, Among 26,107 inborn babies and 815 Niranjan Thomas., Departments of outborn babies admitted during the study Neonatology and Bioengineering, period, there were 360 organisms Chrisitian Medical College, Vellore, isolated from 271 newborn infants. Of all Tamilnadu. the isolates, 184(51.1%) caused early onset sepsis (EOS) while 176(48.9%) Background: caused late onset sepsis (LOS).The incidence among inborn was 8.3 per 1000 Exposure to high sound levels in the NICU live births and sepsis occurred in 7.6% of have been associated with morbidity like all nursery admissions. NFGNB (mainly hearing impairment and sleep Burkholderia) (47%), Klebsiella(14%) disturbances in preterm babies. The and GBS (12%) were the predominant American Academy of Paediatrics organisms causing E0S, while Klebsiella recommends maximum safe sound levels (38%), NFGNB (mainly in NICU to be 45 dB. A device which can Acinetobacter)(23%) and monitor sound in Neonatal Intensive Care Enterobacter(12%) were the Unit with visual display will be useful. predominant organisms in LOS. Most of the isolates were sensitive to Amikacin, Objective and Design: Cefaperazone sulbactam and Netilmicin. However, resistance to Ciprofloxacin, To build a low cost sound level meter Gentamicin and cefoxitin was seen in with visual display of high sound levels. large number of isolates. All strains of GBS were sensitive to Penicillin. Methods:

A microphone was used as a sensor and sound was converted to electrical signal,

Abstracts of Annual Research Day 2013

preamplified and passed through band The low cost CMC-sound meter was very filters. From the band pass filter the useful in visually displaying high sound signal goes to the LED driver. Reference levels in the NICU and helps make voltage of LED drivers was set and immediate changes to reduce noise in the connected to a LED Bar Graph for display. NICU. (Fig 1) Calibration was done in the Audiometry department where voltage Keywords: from each band pass filter reaching the LED driver was measured and a plot is Sound level meter; Visual display made voltage v/s sound loudness dB. Figure 1 CMC sound meter Validation was done using the Lutron SL- 4013 Sound Level Meter of Spectrum Internationals as the standard and comparison of our instrument and the standard was made by testing it in the NICU during three different timings in the day.

Results:

The mean sound level detected in the NICU by the CMC sound meter was 63.9 ± 4.5 dB and was similar to that obtained at the same time by the Lutron SL-4013 sound level meter (66.1 ± 4.2 dB). The cost of building the CMC sound meter was Rs 1300 as compared to Rs 15,000 for the Lutron SL-4013. All sounds above 45 dB were visible as a LED glow alerting the “HARNESSING GENE EXPRESSION health care worker to be careful. At most PROFILING IN SEARCH OF NEW times, the sound levels in the NICU were CANDIDATE GENES FOR ARA-C more than 45dB. Lower frequencies RESISTANCE IN ACUTE MYELOID contribution was less than high LEUKEMIA.” frequencies. Sounds > 45dB in the NICU were identified due to handover/rounds, Ajay Abraham, Savitha Varatharajan, beeping sound of instruments, phone Sreeja Karathedath, Shaji R ringing, movement of x-ray machine, Velayudhan, Alok Srivastava, Vikram trolley and chair. Movement of chairs and Mathews, Poonkuzhali trolleys contributed maximally in Balasubramanian, Department of increasing noise levels to more than Haematology, Christian Medical 75dB. College, Vellore- India.

Conclusion: Wide inter-individual variation in terms of treatment outcome and toxic side effects of treatment exist among patients

Abstracts of Annual Research Day 2013

with AML receiving chemotherapy with mononuclear cells using tri reagent, cDNA cytarabine (Ara-C) and daunorubicin. We was synthesized and then subjected to have previously evaluated the expression one color 8 X 60K Agilent microarray of the major genes involved in cytarabine analysis. Data was normalized, filtered transport and metabolism on ex-vivo Ara- and analyzed using Gene Spring GX (V C response and compared it with 12.0) software. Normalization was done cytogenetic and molecular markers in using the 75th percentile shift (Percentile AML (Blood (ASH Annual Meeting shift normalization is a global Abstracts) 2011 118: Abstract 3481). Our normalization, where the locations of all candidate gene expression data led us to the spot intensities in an array are propose Ara-C resistance index (Ara-C RI) adjusted). Using unpaired t-Test, 4436 A), genes were identified to be differentially which incorporates candidate Ara-C expressed (Fold change expression values (RImetabolizing = ΔCT (DCK genes X ENT1)/ whose ΔCT CDRNA were provided as log-base 2) between expression are significantly associated Ara-C sensitive samples and Ara-C with ex-vivo Ara-C cytotoxicity. Ara-C RI resistant samples. Differentially regulated values were significantly higher in genes were clustered using hierarchical resistant (IC50 >80 uM) and intermediate clustering based on Pearson coefficient (IC50 6.25-80uM) samples when correlation algorithm to identify compared to sensitive samples (IC50 significant gene expression patterns. <6.25uM) (median 5.459 (1.759- 11.82) Genes were classified based on functional and 5.396 (1.89- 11.62) vs. 3.840 (1.89- category and pathways using GeneSpring 9.8); p <0.0001 (Fig 1a). This was then GX and Genotypic Biointerpreter- validated in the relapsed AML samples, Biological Analysis Software. The which showed a significantly higher RI differentially expressed genes fell into the values (median RI 6.312 (2.01- 19.85)) following biological processes; when compared to sensitive ((3.840 transcription (375 genes), transport (364 (1.895- 9.8)) and resistant samples at genes), metabolism (267 genes; Fig 1d), diagnosis (5.412 (1.759- 11.82)); p immune (155 genes), cell cycle (129 <0.0001 (Fig 1b). genes), apoptosis (123 gene; Fig 1c) and so on. Upregulated gene list in Ara-C Though, the Ara-C RI correlated well with sensitive group included apoptotic ex-vivo cytotoxicity as well as treatment related genes like PMAIP1, NDUFA, BAX, response in vivo (data not shown), this BCL2, TRAF2, transcriptional regulators did not completely explain the variation, including SMAD5, SMAD1, ZNF family suggestive of alternative resistance proteins- ZNF644, ZNF469, ZNF195, mechanisms. We undertook a genome- ZNF22, ZNF3, ZNF713, ZNF777, ZNF234, wide gene expression profiling to address CEBP, PARP, ETV6, E2F3 and so on. possible mechanisms of Ara-C resistance Down-regulated genes in Ara-C sensitive other than the candidate gene approach. group are of special interest as they could Based on ex vivo Ara-C cytotoxicity at be potential candidates for targeting Ara- diagnosis, Ara-C sensitive (IC50 <3uM C non-responsive group. They included AraC) and Ara-C resistant samples (IC50 transcriptional regulators like HDAC4, >80uM) (each 5) were included for KLF4, CREB5, CEBP, RARA, E2F4, MNDA, microarray analysis. Total RNA was MTA3 and PPAR also apoptotic genes extracted from bone marrow like MCL1, PSEN1, ELMO2, PAK1, APAF1,

Abstracts of Annual Research Day 2013

MAPK1, CD40, FAS, CASP1 and CASP8. overcome drug resistance. Interestingly, many of the genes involved in cellular metabolism were found to be down regulated in AraC sensitive group. Major down-regulated metabolic genes include CDA, SLC2A3, SLC2A8, GK, NADK, ACACB, ACSL1, PFKFB4, PFKFB3, PDK4, ME1 and PC. This study has come up with previously unrecognized aspects in Ara-C resistance in AML, and is suggestive of Ara-C sensitive samples having increased expression of anti-Warburg set of genes. “ASSOCIATIONBETWEEN Our data as well as growing evidences APOLIPOPROTEIN E GENOTYPE AND from various malignancies and altered RISK OF NEOPLASMS: A META- cellular metabolism propose the ANALYSIS.” possibility of using metabolic inhibitors alone or in combination with Ara-C to Anand R, Prakash S. S*,

p< 0.0001 p< 0.0001

n=55 n=55 n=30 n=23 N=85 n=55

Fig 1a Fig 1b

Fig 1c Fig 1d Abstracts of Annual Research Day 2013

Veeramanikandan R*., Department of Biochemistry, Christian Medical Results: College, Vellore, Tamilnadu, India. *Equal contribution Overall, the pooled analysis of the data showed no association between ApoE Background: alleles or genotypes with incidence of neoplasms. In the stratified analyses, Apolipoprotein E (ApoE), a protein primarily involved in lipoprotein while, we observed an increased risk of metabolism occurs in 3 isoforms (E2, E3 breast neoplasms in E3/E4 genotype (OR: 1.43; 95%CI: 1.01-2.04; P: 0.046) when and E4). The relation between ApoE compared with E3/E3, the risk of genotype and serum cholesterol levels is known. Cholesterol levels in turn are neoplasms other than breast and associated with increased risk of some colorectal, were decreased (OR: 0.79; 95%CI: 0.63-0.98; P: 0.0337). We also malignancies. In another context, ApoE4 noted a positive association between is a risk factor for Alzheimer's disease and studies report an inverse association E4/E2 genotype and colorectal neoplasms between incidence of malignancies and (OR: 1.42; 95%CI: 1.04-1.94; P: 0.029). Alzheimer's disease. While studies Stratified analyses based on ethnicity did not show any association. evaluating the association between ApoE genotype and incidence of malignancies are available, the results are inconsistent. Conclusion:

Aim: Although subgroup analysis showed associations between specific neoplasms To study the association between ApoE and ApoE genotypes, existing literature genotype and incidence of neoplasms by a does not show a significant association meta-analysis. between the genotype and risk for Methods: neoplasm in general.

A literature search of electronic databases “INDOMETHACIN INHIBITS revealed 49 studies with information on ACTIVATION OF ENDOTHELIAL NITRIC ApoE polymorphisms and neoplasm risk. OXIDE SYNTHASE (ENOS) IN THE RAT After screening and evaluation by a KIDNEY: POSSIBLE ROLE OF THIS structured questionnaire, 21 studies (18 EFFECT IN THE PATHOGENESIS OF case-control/3 prospective; 71858 INDOMETHACIN-INDUCED RENAL cases/12516 controls) were included for DYSFUNCTION.” the present meta-analysis. Pooled odds ratios (OR) with 95% confidence intervals Arumugam Suriyam Nagappan1, Joe (CI) were calculated assuming a random- Varghese1, Gautham Tumkur Pranesh1, effect model for all the genotypes and Visalakshi Jeyaseelan2 and Molly alleles. Subgroup analyses based on Jacob1*., 1Department of Biochemistry, ethnicity and type of neoplasm were also Christian Medical College, Vellore – performed. Appropriate tests to detect 632002, India., 2Department of Bio- heterogeneity, publication bias and statistics, Christian Medical College, sensitivity were done at all stages. Vellore – 632002, India.

Abstracts of Annual Research Day 2013

heme by HO-1 activation that occurred Corresponding author: downstream of Nrf2 and p38 MAPK signaling. Reduced renal eNOS activity Molly Jacob*, Department of may result in decreased NO levels and Biochemistry, Christian Medical College, hence reduced renal perfusion. Vellore, Tamil Nadu, India. Pin: 632 002. E-mail address: [email protected]. Acknowledgements:

Introduction: This study was funded by the Department of Science and Technology (DST), New Clinical use of non-steroidal anti- Delhi, India and by Fluid Research Grants inflammatory drugs (NSAIDs) is often from the Christian Medical College (CMC), associated with adverse effects in the Vellore, Tamil Nadu, India. kidney. Indomethacin, an NSAID that has been shown to induce oxidative stress- induced damage in the kidney, was used “AN ADVANCED BENCH TOP CBCT to study the pathogenesis of such effects SYSTEM FOR SMALL ANIMAL in rats. IMAGING.”

Methods: B Paul Ravindran1, Rajdeep Ojha2 and D Devakumar3, 1Department of Radio Male Wistar rats received oral Therapy (Medical Physics),2 indomethacin (20mg/kg); they were Department of Bioengineering and sacrificed 1, 12 or 24 hours (h) later. 3Department of Nuclear Medicine, CMC Various biochemical parameters in the Vellore, kidneys, affected by oxidative stress, were determined. Aim:

Results & Conclusion: To construct an aSi flat panel based bench-top X-ray cone beam CT scanner Indomethacin significantly reduced the and to investigate its use for small object ratio of dimeric endothelial nitric oxide / animal imaging synthase (eNOS) (active form) to its monomeric (inactive) form, heme staining Introduction: in NOS dimers and tissue nitrite levels at 12 and 24h and renal heme levels at 1 and The viability to generate full 3D 12h. Heme oxygenase 1 (HO-1) activity volumetric data in a single rotation of was significantly elevated at 1 and 12h source and the detector around the object after the drug. Evidence of nuclear (or by rotation of the object with source translocation of Nrf2 (at 12 h) and p38 and the detector stationary) has instilled MAPK signaling (at 12h and 24h), both of interest in development of the cone beam which are known to induce HO-1, were CT (CBCT). During the annual research found to occur in response to day 2012at CMC, Vellore, the feasibility of indomethacin. The results show that developing a prototype bench top CBCT indomethacin reduced levels of activated was presented using an image intensifier eNOS in the kidney possibly by depleting based C-arm X-ray unit. In this work we

Abstracts of Annual Research Day 2013

have developed a bench top CBCT using slices.The bench top CBCT has been amorphous silicon (aSi) based flat panel developed and found to be suitable for detector.We have also implemented small object and could also be used for improved image reconstruction software small animal imaging. developed to run on a Graphic Processing Unit (GPU) using Compute Unified Device Acknowledgment: Architecture (CUDA). This abstract describes the development and the The authors thank Mr Kush and investigation on the image quality of the MsDhivya, M.Tech. Bioengineering CBCT. students of CMC, Vellore for CUDA programming. Materials and Methods: References: A Pleophos D X-ray machine was used as the X-ray source for the CBCT. A 3030D 1. Thomas THM, Devakumar D, aSi flat panel detector supplied by Varian Purnima S, Ravindran BP. The adaptation of size 30cm x 30 cm was used as the of megavoltage cone beam CT for use in imaging detector. The object was placed standard radiotherapy treatment on a turntable supplied by Holmac. The planning. Phys Med Biol. 2009 Apr turntable was rotated using a customized 7;54(7):2067–77. hardware comprising of microcontrollerand a stepper motor “COMBINED EFFECT OF OLFACTORY driver. Software was developed in Visual ENSHEATHING CELLS AND Basic to trigger the microcontroller to FIBROBLAST GROWTH FACTOR ON rotate the turntable and to acquire the SPINAL CORD REGENERATION.” projection images from the flat panel detector at predetermined angular Basir Ahmed1, Durai Morgan2, George interval (0.50, 10,1.50 and 2 degrees) over Tharion2,Indirani.K3#, 1Medical 360 degree.Images of the phantoms to student, Christian Medical College, study the resolution and the contrast of Vellore, TN, India, 2Dept of Physical the CBCT imaging system were Medicine and Rehabilitation, Christian obtained.The image reconstruction was Medical College, Vellore, TN, India, performed with FDK based software 3Dept of Anatomy, Christian Medical developed originally in C(1) and then College, Vellore, TN, India. converted to CUDA for parallel processing with the GPU using NVIDIA graphics card. Spinal cord injury is one of the most debilitating diseases, leaving more than 99% patients with lifelong neurological complications. Trauma management and rehabilitative measures are the mainstay Results and Discussion: of SCI with no established therapeutic treatment. As a result several The GPU based parallel computing experiments are being carried to look for reduced the reconstruction time from 40 a feasible therapy. One of the potential minutes to less than a minute for a full options is the transplantation of Olfactory reconstruction of more than 300 Ensheathing Cells (OECs) into the injured

Abstracts of Annual Research Day 2013

spinal cord to promote neuronal “COMPARISON OF TRANSCUTANEOUS regeneration and axonal growth. This BILIRUBIN MEASUREMENT WITH study aims at evaluating the combined SERUM BILIRUBIN MEASUREMENT IN use of OECs and Fibroblast growth factor SOUTH INDIAN PRETERM AND TERM (FGF) in rat SCI for neuronal regeneration BABIES.” and functional motor recovery .For this, 24 female Albino Wistar Rats were Binu Govind, Preethi C, Kurien Anil randomly distributed into 4 groups:6 for Kuruvilla, Department of Neonatology, control, 6 for OEC, 6 for FGF and 6 for OEC Christian Medical College, Vellore, along with FGF. SCI was inflicted by 10 Tamilnadu. gm drop weight method following T-10 laminectomy. The FGF group was Objective: immediately administered 2ul of FGF solution as was the OEC and FGF group. To evaluate the efficacy of transcutaneous After 9 days, OEC was transplanted in the bilirubinometer in estimating jaundice OEC group and OEC and FGF group. The levels in south Indian neonates. motor recovery was measured over 8 weeks using the BBB (Basso, Beattie and Design: Bresnahan) Scale. At the end of 8 weeks, EMG was done to obtain the Motor Prospective observational cohort study Evoked Potentials. The results show Significant P-Value and 95% Confidence Setting: Interval in all the three groups compared individually with the control group for Tertiary care perinatal center in south both the BBB scores and the EMG-MEP India. results. However, there is no significant difference when either the OEC group is Subjects and interventions: compared to OEC+FGF group or FGF group with OEC+FGF group. The Newborn babies admitted from May significant motor recovery in the three 2011-July 2012 and who had evidence of groups (OEC, FGF and OEC and FGF) clinical jaundice were recruited into the when compared to the control group study. The study patients was classified indicates neuronal regeneration. Thus concluding, there is significant similar wks) babies level of locomotor functional recovery into preterm (<35 wks) and term (≥ 35 indicating neuronal regeneration with the Methods: application of OECs and FGF, when applied either individually or in Within 1 hour of clinical suspicion of combination. jaundice, transcutaneous bilirubin (TcB) measurement from the forehead was obtained using the Drager Jaundice Meter

(JM-103). Serum bilirubin (TSB) levels Article submitted for NNF Gold Medal- were sent simultaneously. NEOCON 2013

Results:

Abstracts of Annual Research Day 2013

During the one year study period, 188 appear jaundiced, serum bilirubin is preterm babies and 381 term babies were determined by obtaining a venous blood evaluated. Correlation between sample and analysed in the laboratory transcutaneous and serum bilirubin in using spectrophotometry. The results are preterm and term babies was good obtained usually only after 2-3 hours and (r=0.77, p<0.01 and 0.7, p <0.01 decisions are made according to age- respectively). Reliability statistics using specific guidelines for starting Cronbachs alpha was 0.857 and 0.821 (p< phototherapy. 0.01) in preterm and term babies Based on this strategy, ~50% of babies respectively. Intraclass Correlation have at least one serum bilirubin Coefficient was 0.75 (CI 0.67-0.80) in determination before discharge and only preterm babies and 0.69 (CI 0.63-0.74) in about 30% of these require phototherapy. term babies. The sensitivity, specificity, A study from India showed that need for positive predicitive value and negative blood sampling was 34% lower in the TcB predicitive value were72.9%, 76.6%, group as compared to those with were 81.2% and of 67% in preterm and 81.4%, visual assessment was used (1). Hence, 70%, 93% and 43.3% in term babies the majority of bilirubin determinations respectively. Bland Altman plot showed do not result in an immediate decision to fair agreement in both term and preterm start phototherapy and thus could have babies. been avoided. Conversely, in some babies, there is a delay in initiating treatment as Conclusion: the process of collecting a venous sample and analysing it in the lab takes time. Transcutaneous bilirubin measurement The newer generation of bilirubinometers correlates well with serum bilirubin namely the Bilichek and the Drager levels in term and preterm south Indian bilirubinometer JM 103 are less babies. TcB can be used as a substitute to influenced by skin pigmentation and serum bilirubin in screening babies with chromogens and have demonstrated good clinical jaundice. correlation with serum bilirubin values (r=0.8-0.91) in several studies (1,2,3,4). Keywords: These instruments are now being used routinely in many centres. Evidence Transcutaneous Bilirubinometry; obtained from their use indicates that this Neonate; Preterm; Term; Jaundice method of screening has the potential to better select babies who need serum Introduction: Neonatal jaundice is the bilirubin determinations (5, 6, and 7). commonest condition necessitating Hence using transcutaneous observation, investigation, readmission bilirubinometry (TcB) will reduce the and treatment in the first week of life. number of invasive serum bilirubin Visual assessment of jaundice is often assays thereby reducing pain, waiting inaccurate, especially when time for patients and workload for health inexperienced personnel are involved in care professionals the assessment. In many centers in India, There have been several studies current practice involves a daily visual comparing the accuracy of TcB readings screening of babies in the nursery and with serum bilirubin in western countries postnatal ward. In those babies who (8, 9, 10, and 11). In India, few studies

Abstracts of Annual Research Day 2013

have been done in term and late preterm neonatal care. When there was clinical babies, all from north India (13, 14). suspicion of jaundice and TSB planned, a However, there is no published data on TcB measurement from the forehead preterm babies (<35 weeks) from India. using the Drager Jaundice Meter (JM-103) Also the effect of darker skin was done within 1 hour and the value was pigmentation of south Indian babies on recorded. The machine was set to take 5 TcB values has not been studied. Hence, readings and display the mean. The TSB though there have been comparative was sent at the same time. studies from the north India, the impact of relatively darker skin of Indian babies Data including the baby’s age in and their effect on TCB needs to be completed hours at the time of studied (11). The aim of the study was to measurement, gender, gestational age in evaluate TCB measurements as completed weeks, weight in grams at performed by Drager JM-103 jaundice birth, length and the occipitofrontal meter, and correlate it with total serum diameter in centimetres, mode of delivery bilirubin levels, measured with standard and hours of life at which jaundice lab methods in south Indian term and developed was noted. We collected data preterm babies. on skin tones of the babies determined by visual assessment by the investigator Methods: aided by Fitzpatrick skin tone scales

Design: Prospective Observational Cohort study

Setting: Study was done in the Neonatology department of Christian Medical College, Vellore, and a tertiary care perinatal center in south India from May 2011 to July 2012.

Population: Newborn babies admitted The Fitzpatrick Skin Tone Scale: either in nursery or the postnatal wards iand who had evidence of clinical jaundice Type I (scores 0-7) White; very fair; were eligible for the study. The study freckles; typical albino skin. group was classified into preterm (<35 Always burns, never tans weeks) weeks) and late preterm and term (≥ 35 Type II (scores 8-16) White; fair. Ethics clearance: The study was started after getting clearance from the Usually burns, tans with difficulty Institutional Review Board and ethics Type III (scores 17-25) Beige; very committee. common.

Method Details: Transcutaneous bilirubin Sometimes mild burn, gradually tans measurements were done on babies who underwent total serum bilirubin (TSB) estimations as a part of their routine

Abstracts of Annual Research Day 2013

Type IV (scores 25-30) Beige with a a cutoff of serum bilirubin of 15 mg% in brown tint; typical Mediterranean term and 10 mg% in preterm babies. The Caucasian skin. data obtained was used to construct Bland Altman plots, comparing the Rarely burns, tans with ease differences between TcB and TSB. Similar plots was also constructed for the Type V (scores over 30) Dark brown. different subgroups to derive limits of Very rarely burns, tans very easily agreements and to compare it with what is reported in the literature Type VI Black.

Never burns, tans very easily Results: Sample size: The required sample size to During the study period, 188 preterm show a sensitivity of 85% for detecting babies and 381 term babies had clinical TSB levels of more than phototherapy suspicion of Jaundice and simultaneous action values with 5% precision and at an serum and transcutaneous bilirubin alpha level of 5% was found to be 200 readings were done. cases. Table1 shows the baseline characteristics Formula: of the preterm and term babies. The mean gestational age in preterm was 31.4±1.9 weeks and the mean birth weight was 1540±357 g. Among the term babies, the mean birth weight was 2840±567 g and where, gestational age 38.3± 1.5 weeks. Ninety five (50.5%) of the preterm were males P = sensitivity of the test and 93 (49.5%) were females. Among the Q = 1-P term babies, 204(53.5%) were male d = precision babies and 177(46.5%) were female Zα/2 is the 5% level of significances babies. 46.5% of the preterm babies were delivered by LSCS compared with 33.2% Statistical Analysis: of term babies.

Statistical analysis was done by the SPSS Fitzpatrick skin tone analysis was done software version 16.. A Regression and the babies were mostly in the dark analysis was done to compare the two skin ranges (Table 2). types of measurement. Correlation between the serum bilirubin and The Correlation between transcutaneous transcutaneous bilirubin was done by and serum bilirubin in preterm showed a Pearson correlation. Reliability statistics correlation coefficient of 0.77 (p <0.01) was done by Cronbachs Alpha and (Fig 1). The term babies also showed Intraclass correlation coefficient. similar findings with Pearson correlation Sensitivity, specificity, positive predictive factor of 0.7 (p <0.01) (Fig 2). value and negative predictive value of transcutaneous bilirubin in comparison with serum bilirubin values were noted at

Abstracts of Annual Research Day 2013

With the help of the Regression analysis, studied (4, 5, 11). Preterm babies had a an equation was derived to predict serum lighter skin tone as compared to term bilirubin from transcutaneous values. babies, probably as pigmentation increases as the fetus matures (5). More In preterm, TSB = 3.487+0.612 x TcB. number of preterms delivered by LSCS because most of the preterm deliveries In Term babies, TSB = 3.618+0.634 x TcB. were secondary to maternal PIH and Reliability statistics using Cronbachs eclampsia. alpha of 0.857 and 0.821 respectively in The TcB values correlated well with preterm and term babies (p<0.001) serum bilirubin levels in our study, both (Table 5 ). Intraclass Correlation Coefficient was 0.75 (CI 0.67-0.80) in in preterm and term babies (r = 0.77 and preterms (p<0.001) and 0.69 (CI O.63- 0.7, p<0.01-Figure 1 and 2). Other studies from the west have shown similar good 0.74) in term babies (p<0.001) (Table 3). correlation among term and near term The diagnostics are shown in Table 4. babies [Bhutani et al (r=0.91) and Rubatelli etal (r = 0.89, 95%CI O.89-0.91)] Sensitivity and Specificity was 72.9% and (5, 6). Ebbessen et al had estimated 76.6% respectively in preterms with correlation of TcB and TSB measurements positive predictive values of 81.2% and in both preterm and term babies and had negative predictive value of 67% to got coefficient of correlation of 0.87 and detect bilirubin levels > 10 mg%. In term 0.88 respectively which was slightly babies, sensitivity was 81.4%, specificity better than our estimates (12). Deorari et 70% with positive and negative al in a study on term and late preterm predictive values of 93% and 43.3% babies showed that TcB values had respectively to detect bilirubin levels > 15 significant correlation with TSB (r= 0.76, mg% (Table 4 ). p<0.001), which is very similar to our study (14). The lower values in the Indian Bland Altman plot was done to look at studies may reflect the effect of skin agreement of the two measurements (TcB pigmentation but the overall correlation and TSB). For preterm babies the mean is still significantly good. difference was 0.8 with limits of agreement from 5.9 to -4.3 (Fig3). In Regression analysis done showed linear term babies the mean difference was 1.27 regression between TcB and TSB values, with limits of agreement from 6.7 to -4.1 which was in line with almost all other (Fig 4). published data (2,3). Based on this we were able to generate a prediction Discussion: equation to predict TSB from TcB. Our study has looked at the correlation of Ebbessen et al(12) had demonstrated TcB with serum bilirubin levels in term slightly but statistically significant higher and preterm babies from south Indian TcB in sick infants than healthy infants babies. The skin tones of the babies were for the same TSB (p<0.01,95%CI mainly dark brown as per Fitzpatrick’s 6.07,17.51); the difference between TcB classification, indicatin that the sample and TSB varied between 65mmol/l and population studied were more pigmented 120mmol/l in comparison with Rubaltelli as compared to the previous populations et al who had got a higher difference (6).

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De Luca et al had calculated the mean The limitations of our study was that the increment rate in TcB for different hours number of preterms <30 weeks were of life based on linear regression analysis small compared to higher gestational and showed that TcB showed increment ages. Hence subset analysis of preterms over the first 72 hours and thereafter was not possible. Also most of our plateaued off (10). Maisels et al also preterm babies did not have values in the showed similar trends in showing similar high range as they were aggressively higher values in the initial days (9). Our treated and so reliability of TcB readings study was not powered to make similar in extreme preterms and higher levels of normograms. Maisels et al also showed bilirubin has to be looked into. decreased gestational age babies having higher values for TcB (9). Conclusion: Regresssion and correlation does not There is good correlation between address reliability and precision. Hence transcutaneous and serum bilirubin levels we did reliability statistics with Cronbach in south Indian term and preterm babies. alpha criterion and Intra class correlation The results attained through the two coefficient, both of which showed methods seem to be reliable and accurate. statistically significant results, suggesting Transcutaneous bilirubin estimation can good reliability of TcB. be used routinely as a reliable screening tool in the management of jaundiced We addressed the issue of precision by babies. using the Bland Altman plot. The mean difference (bias or accuracy) was good References: (0.8 and 1.27 in preterm and term 1. Mishra S, Chawla D, Agarwal R, babies), while the precision was fair (5.9 Deorari AK, Paul VK, Bhutani VK. to -4.3 in preterm and 6.7 to -4.1 in term Transcutaneous bilirubinometry babies). Thus 95% of future reduced the need for blood measurements would like between theses sampling in neonates with visible limits. This was similar to a study done by jaundice. Acta Pediatrica Deorari et al (14) were the mean 2009;98;1916-1919. difference was 0.93 and precision was 4.7 2. Yamanouchi I, Yamauchi Y, to – 2.9. Igarashi I. Transcutaneous Rubatelli et al had published data on bilirubinometry: Preliminary sensitivity (93%) and specificity (73%) studies of noninvasive which was higher than our results with transcutaneous bilirubin meter in similar cut-off (6). Bhutani et al (5) the Okayama National Hospital. constructed normograms from TcB values Pediatrics. 1980; 65:195-202. and identified that the negative predictive 3. Tan KL, Chia HP, Koh BC. value of TcB measurement to identify the Transcutaneous bilrubinometry in infants with hour specific TSB <75th Chinese, Malay and Indian infants. centile is 100%, positive predictive value Acta Paediatr. 1996; 85:986-90. is 32.86%, sensitivity is 100%, specificity 4. Bhutani VK, Gourley GR, Adler S, 88.1% and likelihood ratio 8.43 Kreamer B, Dalin C, Johnson L. Noninvasive measurement of total serum bilirubin in a multiracial

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predischarge newborn population Arch dis Child Fetal and Neonatal to assess the risk of severe ed Nov 2008 Vol 93 No 6; 474. hyperbilirubinemia. Pediatrics. 12. F Ebbesson Rasmussen LM, 2000;106:17-26e. Wimberley PD. A new 5. Bhutani VK, Johnson L, Sivieri EM. transcutaneous Bilirubinometer, Predictive ability of a predischarge Bilichek, used in the neonatal care hour-specific bilirubin for unit and the maternity ward. Act subsequent significant Paediatrica 2002;91:203-211. hyperbilirubinemia in healthy 13. Bhat YR, Rao A. Transcutaneous term and near term newborns. bilirubin in predicting Pediatrics. 1999; 103:6-14. hyperbilirubinemia in term 6. Rubaltelli FF, Gourley GR, Loskamp neonates. Ind J of ped. 2008; N, Modi N, Roth Kleiner, Sender A, 75:119-121. Vert P. Transcutaneous Bilirubin 14. Mishra S, Chawla D, Agarwal R, measurement: A multi centre Deorari AK, Paul VK. evaluation of a new device. Transcutaneous bilirubin levels in Pediatrics 2001; 107:1264-1271. healthy term and late preterm 7. Ong SK, Doraisamy G, Tsou K, Sethi Indian neonates. Ind J Pediatrics SK. Transcutaneous bilirubin 2010; 77:45-50. measurements in Singapore newborns. Abstract Book, 2007 Austalian Association of clinical Biochemists Meeting. Melbourne, Australia. 8. Boo NY, Ishak S. Prediction of severe hyperbilirubinemia using the Bilichek transcutaneous bilirubinometer. J Paed and Child

Health 2007; 43:297-302. 9. Maisels MJ, Kring E. Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of >/= 35 weeks gestation. Pediatrics. 2006;117:1169-1173 10. De Luca D, Romagnoli C, Tiberi E, Zuppa AA, Zecca E. Skin bilirubin nomogram for the first 96h of life in a European normal healthy newborn population obtained with

multiwavelength transcutaneous bilirubinometry. Acta Paed. TABLE – 1 Descriptives 2008;97:146-150 11. Thompson J et al., Transcutaneous Preterm Term Bilirubinometry and ethnicity.

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n=188 n=381

Mean±SD Mean±SD

Gestational Age 31.8±1.9 28.3±1.5

Birth Weight 1548±357 2843±567

Length 40.3±3.5 47.4±2.9

APGAR 5’ 7.9±1.6 8.7±0.9

APGAR 10’ 8.7±0.8 9.5±0.8

LSCS 87 126

Normal 101 255

Male 95 204

Female 93 177

Abstracts of Annual Research Day 2013

Table 2 – Skin Colour grading of study Term 43.3 patients using Fitzpatrick scale 81.4% 70% 93% % category Colour grade N (%)

3 6 (12.5%) Preterm 4 18.1 (70.8%)

5 8 (4.3%)

3 19 (10.8%)

Term 4 188 (67.0%)

5 36 (20.5%)

6 3 (1.7%)

TABLE 3 Reliability Statistics

Preterm Term

Corbach’s 0.857 0.821 Alpha (P<0.01) (P<0.01

Intra Class 0.75 (0.67- 0.69(0.63- Correlation 0.8) 0.74) P<0.01 P<0.01

TABLE – 4 Diagnostic Indices

Sensitivi Specifici PPV NPV ty ty

Preter 81.2 m 72.9% 76.6% 67% %

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Figure 1- Linear Regression- Preterm Figure 3 Bland Altman Plot – Preterm babies babies

Figure 2 Linear Regression – Term Figure 4 Bland Altman Plot- Term Babies babies

Abstracts of Annual Research Day 2013

“LANTHANUM CAUSES 2) To test if the contracture by the above LANTHANUM/CALCIUM EXCHANGE procedure can be relaxed by the addition THROUGH SODIUM CALCIUM of lanthanum. EXCHANGER.” Methods and results: Elizabeth Clarence, Anand Bhaskar and Sathya Subramani, Physiology, Heart isolated from an anaesthetized rat Christian Medical College. was perfused through coronary arteries in Langendorff mode with normal Background: extracellular solution and paced at a rate of 280 per minute. Left ventricular The sodium calcium exchanger (Na+/Ca2+ pressure was recorded with a balloon exchanger) plays a central role in connected to a pressure transducer. regulating contractility in ventricles and automaticity in pace-maker cells. It has a Hearts were initially perfused with stoichiometry of 3Na+: 1Ca2+ and is normal mammalian extracellular solution capable of working in forward (calcium- during the stabilization period. extrusive and sodium-acquisitive) and Subsequent perfusion with sodium-free reverse (sodium extrusive and calcium- Lithium extracellular solution and acquisitive) modes. addition of caffeine (25mM) induced a contracture (due to calcium release from Lanthanum is known to inhibit calcium intracellular stores by caffeine and lack of entry in electrically excitable cells, by its clearance due to absence of sodium in blocking the reverse mode of sodium– the extracellular solution). While the calcium exchanger and voltage gated contracture was maintained in control calcium channels. Action of lanthanum is animals, addition of lanthanum to the by competition for Na+/Ca2+ exchanger, perfusate in tests, caused relaxation. which can execute sodium-lanthanum exchange. This study tests our hypothesis Conclusion: that Na+/Ca2+ exchanger is capable of working in lanthanum-calcium exchange Addition of La3+ to the perfusate relaxed mode too. the contracted heart favouring our hypothesis that it can move through the Aim: NCX by the La3+/Ca2+ mode. This finding is important because it provides another To demonstrate that the Na+/Ca2+ tool for investigating the activity of NCX. exchanger is capable of Lanthanum/calcium exchange in isolated “OXIDATIVE AND NITROSATIVE rat hearts. STRESS IN THE HEART DURING Objectives: DEVELOPMENT OF LIVER CIRRHOSIS.”

1) To induce an increase in cytosolic Ca2+ G. Jayakumar Amirtharaj, K. A. with caffeine and sodium-free lithium Balasubramanian and Anup extracellular solution. Ramachandran, The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian

Abstracts of Annual Research Day 2013

Medical College, Vellore-632004, which in turn could induce nitric oxide INDIA. synthase to elevate nitric oxide levels.

Background:

Liver cirrhosis is an advanced stage of “ASSESSMENT OF DIAGNOSTIC progressive fibrosis due to ongoing liver VALIDITY OF PROCALCITONIN IN injury. The mortality of liver cirrhosis is BURNS SEPSIS PATIENTS- A due to complications such as portal PROSPECTIVE STUDY.” hypertension, bacterial infection and compromised cardiovascular function. Dr. Geley Ete, Dr. Elvino Barreto, Naveen Kumar HR, Dr. Kingsly Paul M, Aim: Department of Plastic Surgery, Christian Medical College Vellore. To examine the role of reactive oxygen Introduction: and nitrogen species in the heart during development of liver cirrhosis. Sepsis is one of the major causes of mortality in burns. Clinically it is very Methods: important to identify systemic infection at an early stage to initiate antibiotic Twice-weekly intraperitoneal therapy and to prevent prolonged administration of thioacetamide morbidity and mortality. This study is produced liver cirrhosis after 3 months undertaken to analyze the procalcitonin was confirmed by histology. Oxidative value in burns patients and also to stress parameters and nitrate levels were determine a cut off value to suspect / measured in heart during cirrhosis diagnose sepsis at its stage. development. Aims and objectives: Results: To establish diagnostic validity A significant increase in oxidative stress (sensitivity and specificity) and best cut parameters were seen in heart during off value of procalcitonin in diagnosis of liver cirrhosis during the time frank sepsis in burns patients. cirrhosis was evident by histology. This Material and Methods: was accompanied by significant increase in nitrate levels and inducible nitric oxide A total of 36 patients with more than20 % synthase protein expression. In addition, TBSA burns were included in thestudy. To phosphorylation of stress kinase p38 know the diagnostic validity, MAPK also increased during cirrhosis procalcitonin levels in patients with and development. without sepsiswere measured. Statistical analysis was done using ROC curve to Conclusion: assess diagnostic performance and Mann- Whitney Utest to know the significance. These results suggest that during liver cirrhosis reactive oxygen species can Results: cause phosphorylation of p38 MAPK

Abstracts of Annual Research Day 2013

Data of 36 patients was analyzed with pain relief and relax distal ureter would mean age of 27.97 years. 44 % were male be an ideal alternative to tamsulosin. and 56 % females. Average TBSA burns were 47.16 %. The diagnostic validity was Objectives: highest at the cut-off value of 5ng/ml To study the effect of log concentrations which gives sensitivity of88.9% of flupirtine on the spontaneous specificityof 83.3% and positive contractility of distal caprine (goat) predictive value of 84.2%. ureter, characterize the dose response Conclusion: curve, determine EC50 (95% CI) and study the mechansim of action. PCT has high diagnostic validity to diagnose sepsis in burns.In burns patients Methods: the cut off value of PCT to diagnose sepsis Isolated specimens of distal caprine is 5ng/ml (sensitivity, specificity 88.9% ureter which exhibited spontaneous and 83.3% respectively). Serial contractions were subjected to log measurement of PCT in burns patients concentrations of flupirtine maleate for a has prognostic importance in period of ten minutes (1-90µM) and the development of sepsis and recovery. effect was reversed with XE991 and 4- Aminopyridine (4-AP), specific Kv7 and “FLUPIRTINE RELAXES DISTAL nonspecific Kv blockers respectively. CAPRINE URETER: AN IN-VITRO Repeated measures ANOVA was used to STUDY” compare log transformed activity scores Girish S Naik, Sumith K Mathew, following exposure to flupirtine and Kalpana Ernest, Manoj G Tyagi, Jacob reversal agents. Nonlinear regression was Peedicayil, Department of done to fit the dose response curve. EC 10, Pharmacology and Clinical 50 and 90 (95% CI) were determined from Pharmacology, Christian Medical the model. College, Vellore, 632 002, Tamil Nadu, Results: India. A total of 63 isolated specimens of distal Background: caprine ureter were studied. Flupirtine Ureteric colic secondary to calculi is a showed a concentration-dependent common problem worldwide. Medical inhibition of spontaneous contractions. Expulsive Therapy (MET) is reserved for The EC50for a contact period of 10 solitary small single distal ureteric minutes (95%CI) was 17.74µM (15.71 to calculus and the standard approved 19.76 µM). XE991 (100µM) and 4-AP treatment is tamsulosin, an alpha blocker. (1mM) reversed the effect of Recently, Kv7 channels have been 30µMflupirtine significantly. demonstrated in the lower urinary tract. Conclusion: Flupirtine maleate, a centrally acting analgesic is an NMDA (N-methyl D- Flupirtine relaxes distal caprine ureter Aspartate) antagonist and Kv7 opener and may be useful in conditions requiring devoid of side effects of opioids and distal ureteric relaxation. Action through NSAIDs. A drug which can produce both opening of voltage-gated potassium

Abstracts of Annual Research Day 2013

channels (Kv) is the likely mechanism, limbs and trunk, and accumulation of fat though involvement of Kv7 channels in the neck and face. Furthermore they could not be confirmed conclusively on are usually associated witha variety of account of higher doses of XE991 used for metabolic disorders including insulin reversal. Action through Kv7.5 is possible resistance, diabetes mellitus, as IC50 for Kv7.5 has been shown to be dyslipidemia, hepatic steatosis and high about 60µM. However, reversal by 100µM blood pressure. XE 991 through Kv2.1 and ERG channels cannot be excluded and studies exploring Objective: further mechanisms are required. To study the clinical and molecular features of a subject with FPLD. “NEXT GENERATION SEQUENCING Subjects and methods: APPROACH FOR MOLECULAR GENETIC DIAGNOSIS OF PARTIAL Utilizing Next Generation Sequencing we LIPODYSTROPHY” carried out mutational analysis of LMNA gene in a woman and her daughter with RUNNING TITLE: FPLD phenotype. Molecular Genetic Diagnosis of Partial Results: Lipodystrophy The subject aged 23 years was diagnosed H.S.Asha, Aaron Chapla, Manika V, to have diabetes mellitus at age 16 years ShrinathShetty and Nihal Thomas, requiring high doses of insulin with Department of Endocrinology, suboptimal glycemic control. She had Diabetes and Metabolism, Christian cushingoid appearance of the face, vulval Medical College, Vellore, India. hypertrophy, acanthosisnigricans, prominent muscular contours with CORRESPONDING AUTHOR: minimal fat in the limbs, Dr. H.S. Asha, phlebomegalyand hepatomegaly Associate Professor consistent with partial lipodystrophy. Her Department of Endocrinology, Diabetes mother was diagnosed to have diabetes and Metabolism, mellitus at age 30 years, with similar Christian Medical College Hospital, features as the daughter. Her sister aged Vellore-632004, India. 17 years also has cushingoid face with prominent muscle contours in the limbs consistent with FPLD. The subject and her Background: mother had elevated C-peptide levels suggestive of insulin resistant diabetes Lipodystrophies are a heterogeneous mellitus. Dual energy X-ray group of diseases characterized by absorptiometry in the subject and her abnormal fat distribution. Familial partial mother showed increased truncal fat with lipodystrophy 2 (FPLD2) is autosomal decreased limb fat confirming fat dominant condition due to mutations in redistribution. the LMNA gene. This subset of patients present with selectiveloss of subcutaneous adipose tissue from the

Abstracts of Annual Research Day 2013

The NGS of LMNA gene showed that of Langerhans cells (LCs) in human lungs mother and daughter were both had been described earlier, their role in heterozygous for a reported c.1444C> T tumour response are still poorly missense mutation which causes the understood. Their presence and number substitution of the Arginine at residue within the tumour tissue is crucial for 482 by a Tryptophan antitumour immune response. (Nabrdaliket.al.,Endokrynol Pol. 2013;64(4):306-11). This identified Aim: mutation was confirmed by Sanger sequencing. To study the morphology and distribution of CD1a positive LCs in benign and The subject was started on Metformin malignant diseases of the human lung by and insulin therapy was optimized immunohistochemistry. resulting in better glycemic control. Methods: Conclusions: After getting informed consent, human Our subject had a clinical form of FPLD2 lung tissue samples were collected from due to a mutation affecting lamin eleven patients who underwent A.Clinical suspicion based on the pulmonary surgery for lung tumours in phenotype followed by appropriate Christian Medical College, Vellore and biochemical and genetic testing led to the were processed for immunohistochemical diagnosis in this family. A clear staining with mouse monoclonal understanding of the disease process is antihuman CD1a antibody. The number of very important to choose the right CD1a positive LCs per square area was treatment modalities, predict the natural counted using CellSens Standard image history of the disease and to determine analyzer software. Statistical analysis was the prognosis. done using SPSS version 17.

Results: “DISTRIBUTION OF CD1A POSITIVE LANGERHANS CELLS IN BENIGN AND CD1a positive LCs were present in MALIGNANT DISEASES OF HUMAN primary and secondary lung malignancy, LUNG USING in the bronchiolar epithelium. In IMMUNOHISTOCHEMISTRY.” addition, they were present in the interstitium in carcinoid tumor and J. Rajkohila, Roy Gnanamuthu, Inbam chondroid hamartoma and in the Indrasingh, J.Suganthy, Department of bronchus associated lymphatic tissue Anatomy, Christian Medical College, in chondroid hamartoma. The alveolar Vellore. compartment did not show any CD1a positive LCs. These cells had typical Background: dendritic morphology except in adenocarcinoma in which they were The dendritic cells are involved in host nondendritic. Pleural condensation immunity and immune surveillance infiltrated with massive number of CD1a against malignancy. Though the presence positive LCs was present in a case of

Abstracts of Annual Research Day 2013

metastatic thymoma. The mean number Alternatively, peripheral blood of CD1a positive LCs was highest in mononuclear cells (PBMNCs), which have pleural metastasis of thymoma and a small fraction of haematopoietic lowest in adenocarcinoma. progenitors, have also been used to obtain cultured erythroid cells (cErCs). Conclusions: Though PBMNCs is an alternative source, the current protocols using these cells do Bronchiolar compartment is better suited not generate sufficient number of cErCs, to mount an immune response than the which is a major hurdle for performing alveolar compartment as CD1a positive transcriptional and epigenetic studies in LCs were predominantly distributed in bronchioles. The number of CD1a positive thalassaemia and sickle cell disease. We LCs in adenocarcinoma correlated establishederythroid cellsa modified from two patients phase withculture β inversely with the tumour grade. protocol using a serum free basal medium Therefore the distribution of CD1a with IL-3, IL-6, Flt3, SCF in phase I and positive LCs in malignancy could be Epo, SCF, IL-3 and iron compounds in regarded as an indicator for tumour phase II and could generate up to 108 cells progression and prognosis in from PBMNCs isolated from 5-10ml blood adenocarcinoma. of pati thalassaemia and those who were “A ROBUST EX-VIVO ERYTHROPOIESIS ents with homozygous β SYSTEM FOR STUDYING TRANSCRIPTIONAL REGULATION OF thalassaemia.compound Real heterozygous time quantitative for PCR β GLOBIN GENES IN THALASSAEMIA.” (qPCR)thalassaemia analysis andshowed HPFH steady orincrease δβ

Janakiram Rayabaram, MSc*, in different stages of erythropoiesis. As Thiyagaraj Mayuranathan, MSc*, Divya wein the obtained expression a large of αnumber and β globinof nucleated genes Jayasree, MSc*, Neeraj Arora, MD*, cells using this protocol, we could Eunice Sindhuvi Edison, Ph.D*, Alok perform chromatin immunoprecipitation Srivastava, MD and Shaji Velayudhan, (ChIP) to study the binding of RNA PhD*, Department of Haematology, Polymerase II (RNAPII), transcription Christian Medical College, Vellore, cofactors, CBP and p300, and histone India. modifications at the regulatory sequences

Ex-vivo differentiation of hematopoietic stem cells and progenitors to erythroid globinof β globin gene cluster. in the High cErCs levels from of RNAPII both cells helped tremendously in our normalwas found individuals at the coding and sequencespatients with of β understanding of transcriptional and splice site mutations suggesting that epigenetic regulation of normal erythroid these mutations do not cause significant differentiation as large number of reduction in the transcription rate. Both nucleated cells can be generated by these CBP and p300 were found to bind at the protocols. However, to study the disease HS3 and HS2 regions of locus control mechanisms in haematological diseases, there are practical difficulties in obtaining cultures though they were not found at mobilized CD34+ cells from the patients. theregion promoter in both normal sequences and β thalassaemiaof actively transcribed genes

in the β globin cluster.50

Abstracts of Annual Research Day 2013

In the patients compound heterozygous - define the molecular mechanisms by and in patients with β thalassaemia could- globinfor β thalassaemia gene expression and HPFH compared3 or (Aγδβ)° to the thalassaemia. The presence of abundant normaldeletion/Inversion, controls and we ChIP found also increased showed γ splicewhich splicevariants site in mutations normal causecontrols β high levels of RNAPII occupancy at the globin gene is regulated globin gene. As it by multiple promoters and other has been shown earlier that alternative regulatorysuggests that elements β and identification of splicingcoding sequences is a transcriptional of γ regulatory these sequences will help in mechanism for cell specific expression of understanding the molecular basis of genes, we performed experiments to human globin gene regulation. identify the alternatively spliced transcripts of - ordinated expression in human erythropoiesis.β RTglobin-PCRs gene and and sequencing their co “THE ROLE OF SODIUM-CALCIUM EXCHANGER IN RHYTHM GENERATION primers that bind at the upstream, IN RAT HEART.” downstreamof β globin cDNAand usingcoding various sequences sets of showed 3 aberrantly spliced transcripts Jesi. W, Anand Bhaskar, Sathya formed by the cryptic splice sites in exon1 Subramani, Department of Physiology, and 4 novel transcripts by the activation Christian Medical College, Vellore. of splice sites at the 5’UTR. Interestingly, 5’ splice site mutations in intron 1 did not Background: activate cryptic splice sites in the coding The pacemaker potential which is sequences and instead, they activated responsible for rhythm generation in specific cryptic splice sites upstream b heart involves four currents namely If globin gene. Q-PCR with chimeric primers (funny currents), currents due to T-type for the exact quantitation of the splice calcium channels, L-type calcium variants showed that the splice site channels, and Sodium calcium Exchanger mutations also cause significant reduction (NCX) in forward mode. (> 90%) in expression of normally spliced transcripts suggesting that nonsense Aim: mediated decay is not the major To study the contribution of NCX in production by these mutations. We found rhythm generation using Ouabain in highmechanism levels forof one the of reduced the aberrantly β globin isolated rat heart model. spliced transcripts with 5’ splice site in Methods: exon 1 (~20%) in normal individuals. All the splice variants showed steady Isolated heart preparation of Wistar rats increase in their expression from early to (n=6) perfused with mammalian ringer in late stages of erythropoiesis. Our study Langendorff mode was used for this shows that ex-vivo erythropoiesis system study. The basal heart rate with is an invaluable tool for studying the mammalian ringer was recorded for the mechanism of globin gene regulation and first 15 minutes , then Ouabain (100 switching. Identification of specific splice and the variants in cErCs of normal individuals μM)was added to the perfusate 51

Abstracts of Annual Research Day 2013

heart rate was recorded for 15 minutes, Measured GFR using DTPA (Gates GFR) followed by 15 minute recording of heart was developed for instant assessment of rate again with normal mammalian ringer GFR. solution. Aims: Results: To study the relationship of creatinine There was a significant reduction in heart and cystatin C based estimated GFRs with rate following perfusion with measured GFR in voluntary kidney Ouabain (p 0.03 with Wilcoxon Signed donors (VKD). Rank test). And there was partial 100reversal μM of heart rate after washout of Ouabain Methods: with normal mammalian ringer. • Consecutive VKDs from Jan 2008 to Dec 2012. Conclusion: The significant reduction in heart rate • Data from: Clinical workstation with Ouabain, while the other three network currents remained active shows the importance of NCX in rhythm generation. • eGFR Equations used

MDRD Study 2006 Recommended by NKF-KDOQI 2002. “TO STUDY THE RELATIONSHIP OF CREATININE AND CYSTATIN C BASED CKD-EPI creatinine 2009 Recommended ESTIMATED GFRs WITH MEASURED by KDIGO 2013. GFR IN VOLUNTARY KIDNEY DONORS.” CKD-EPI cystatin C 2012 Recommended Kakde ST, Alexander S, David VG, Venu by KDIGO 2013. M, Varughese S, Basu G, Mohapatra A, Valson AT,Jacob S, Jacob CK, Tamilarasi CKD-EPI creatinine-cystatin C 2012- V, Department of Nephrology unit 1, Recommended by KDIGO 2013. Christian Medical College, Vellore.

 Statistical Background: methods:

Glomerular filtration rate (GFR) is defined Categorical variables: Chi sq and Fisher as the volume of plasma that can be exact completely cleared of a particular Continuous variables: Independent t test substance by the kidneys in unit time. and ANOVA. Recently developed CKD EPI equations Bias was defined as mean difference based on serum creatinine (2009) and between estimated and measured GFR. 2 cystatitin C ± serum creatinine (2012) Precision was defined by R statistics have been recommended by KDIGO 2013 from linear regression analysis. as alternatives to overcome the Pearson’s correlation was performed limitations of other estimated GFRs between CG, MDRD, CKD-EPI- creatinine, [MDRD, Cockroft- Gault (CG)].

Abstracts of Annual Research Day 2013

CKD EPI cystatin C, CKD EPI creatinine- significant predictors of measured GFR in cystatin C and DTPA (Gates GFR). multivariate analysis. Agreement was assessed by Bland- Altman plots for all estimated GFRs Conclusion: versus measured GFR (DTPA). ROC was constructed for estimated GFRs 1) Among the eGFRs, CKD–EPI with measured GFR (DTPA) as reference creatinine cystatin C (2012) equation had the best correlation 90ml/min/1.73sq.m. with DTPA, lower bias and greatest Software:for detection SPSS v of16.0, GFRLevel of ≤ precision in South Asian voluntary significance – p<0.05 kidney donors.

 Inclusion criteria: 2) CG did not have significant AUC with reference to DTPA in All subjects who underwent renal detecting GFR transplant from Jan 2008 to Dec 90ml/min/1.73m2 or less. 2012 at Dept of Nephrology ,CMC 3) None of the eGFRs had good Vellore. agreement with DTPA Gates GFR.

The underestimation was greatest Results: with MDRD and CG eGFRs.

There were 336 kidney donors with mean age 41.62±11.8 yrs, females 60(65.9%), BMI =24.1±3.8 kg/m2, proteinuria 60.40±27.94 mg/d, sCr=0.9±0.13 mg/dl and cysC=0.8±0.14mg/L. “SLC22A1 (HOCT1) GENETIC VARIANTS INFLUENCE MOLECULAR RESPONSE TO Cocroft Gault GFR (88.1±15.9), MDRD IMATINIB IN PATIENTS WITH Mean(78±14.7) CKD-EPI Creatinine GFR CHRONIC MYELOID LEUKEMIA.” (88.1±15.5ml/min/1.73m2), CKD EPI Bharathi M.R, Preetha Markose, Cystatin c (97±19.9),CKD EPI creatinine Vinodhini K, Sukanya Ganesan, Sreeja cyastatin c(92.5+14.1) was significantly K, Senthamizhselvi A, Aby Abraham, higher than CG and MDRD to detect Auro Viswabandya, Biju George, Alok 2 (reference Srivastava, Vikram Mathews, DTPA). Correlation of CKD EPI Creatinine Poonkuzhali Balasubramanian, GFR≥60mL/min/1.73mcystatin C had best correlation with Department of Haematology, Christian DTPA.Bland Altman analyses for levels of Medical College, Vellore. agreement and precision (95% CI) to DTPA GFR were poor for all estimated Targeted therapy in CML with tyrosine equations: Grubb = -84.7 to 53.3mL/min kinase inhibitor (TKI) imatinib has (95%CI=-9.2 to 5.2), CKD-EPI = -23.5 to resulted in significant improvement in 56mL/min (95%CI=-6.2 to 2.2), MDRD = - outcome. However, resistance and 19 to 63.1mL/min (95%CI=-6.3 to 2.3). intolerance to imatinib have seriously limited the success of this therapy, with Among the baseline variables; donor age, only a proportion of patients achieving BSA and serum creatinine were

Abstracts of Annual Research Day 2013

major molecular response (MMR). It is We identified nine coding important to identify predictors of nonsynonymous variants and one response to imatinib, since early switch to synonymous variant including a novel second generation TKI has been shown to exon2 variant Gly-165-Cys and 5-intronic improve outcome in non-responders. variants in SLC22A1 upon sequencing. Polymorphisms in the imatinib influx and The genotype frequencies of the efflux transporter genes and drug polymorphisms in hOCT1 in CML patients metabolizing enzymes have been shown and healthy volunteers were comparable to influence imatinib therapy. We and are given in Table. Intron5 evaluated the role of polymorphisms in (rs77092743) was in complete linkage imatinib influx transporters hOCT1 disequilibrium with exon6 (rs2282143). (SLC22A1) on molecular response to The 8bp-ins polymorphism in intron7 imatinib therapy in newly diagnosed (rs4646281) was in complete linkage patients with CML. In addition, we disequilibrium with the exon7 coding screened hOCT1 SNPs in normal healthy variant (rs628031) and results in a splice volunteers to compare the genotypic variant due to aberrant truncation. frequencies between CML patients and Intron7 ins polymorphism in the mutant normal controls. state did not produce full length hOCT1 transcript while the heterozygotes From December 2009 till August 2012, showed both truncated and full length 134 newly diagnosed CML patients with transcripts and the wild type did not written informed consent and serial show the truncated transcript upon RT- follow-up were included in the study. PCR. Out of the 134 patients, 56 achieved BCR-ABL transcript levels were MMR, 43 did not achieve MMR; and 19 monitored in CML patients at diagnosis, 3, were intolerant to imatinib; 16 patients 6, 9, 12, 18, 24 and 30 months after start progressed. We then compared the of imatinib. Molecular response to influence of polymorphism in OCT1 with imatinib after a minimum of 12 months molecular response to imatinib. was calculated using the ratio of BCR-ABL Polymorphism in exon7 (rs72552763), to ABL transcript expressed in intron 5 (rs7762846) and intron7 International scale. Patients were (rs9457843) were associated with classified to have MMR (BCR-ABL/ABL molecular response and overall survival. <0.1) or no MMR (BCR-ABL/ABL >0.1) at Further studies are ongoing to compare around 12 months from the start of the imatinib pharmacokinetics in relation imatinib therapy, and resistant (BCR- to the hOCT1 genetic variants. Our study ABL/ABL >10; no cytogenetic response suggests that hOCT1 genetic even after imatinib dose was increased), polymorphisms may contribute towards or intolerant (severe cytopenia or skin inter-individual variations in response to toxicity requiring frequent dose Imatinib treatment in CML patients. reductions). All coding exons of hOCT1 gene were screened using genomic DNA samples by PCR followed by direct sequencing. SNPs were identified using SeqScape software.

Abstracts of Annual Research Day 2013

CORRESPONDING AUTHOR:

Dr. Nihal Thomas, MD, MNAMS, DNB (Endo), FRACP (Endo),FRCP(EDIN),FRCP(Glasg) Professor & Head, Department of Endocrinology, Diabetes and Metabolism, Vice Principal (Research), Christian Medical College Hospital, Vellore-632004, India. Email: [email protected]

Introduction:

Genetic predisposition along with environmental factors plays a significant role in the development of polygenic Type 2 Diabetes Mellitus. Among the diabetogenic genes, the transcription factor 7-like 2 (TCF7L2), a member of the Wnt signalling pathway remains the strongest genetic determinant of type 2 diabetes (T2D) risk in humans. Epidemiological studies suggest an association between gestational diabetes mellitus (GDM) and type 2 diabetes. Our aim was to investigate whether TCF7L2 “DOES TCF7L2 POLYMORPHISMS variants that have previously been INCREASE THE RISK OF GESTATIONAL associated with type 2 diabetes would DIABETES MELLITUS IN SOUTH INDIAN also confer risk for gestational diabetes POPULATION?” mellitus in south India population.

RUNNING TITLE: Methods and Materials: TCF7L2 Polymorphisms in pregnancy In 166 unrelated women (117 women with diabetes with gestational diabetes mellitus, 49 non-diabetic control subjects) DNA Mahesh D M, Aaron Chapla, Johan Paul, extraction was done using Gentra Shwetha N, Flory Christina I, Asha H Puregene Blood Method during the period S,Thomas N., Department of Jan-2012 to April 2013. The Primers were Endocrinology, Diabetes and validated by Sanger sequencing (3130 Metabolism, Christian Medical College, Genetic Analyzer). We genotyped 3 Vellore, India. TCF7L2 polymorphisms (rs7903146, rs12255372 and rs4506565) using

Abstracts of Annual Research Day 2013

TaqMan allelic discrimination assay. Data TCF7L2 Gene Are Strongly Analysis was done with SPSS 17, R Associated with Type 2 Diabetes Mellitus in the Indian Population.” Results and Discussion: 2007;Diabetologia 50 (1) (January): The Common variants of TCF7L2 63–67 • (rs7903146,rs12255372 and rs4506565) Shaat, N, Lernmark, E. L. Groop et al. have been shown to be associated with “A Variant in the Transcription diabetes mellitus in European (Cauchi et Factor 7-like 2 (TCF7L2) Gene Is al. 2007) and Asian population (Chandak Associated with an Increased Risk of et al. 2006, Alami et al. 2012) [ OR=1.3- Gestational Diabetes Mellitus.” 2007; 1.9] . The association of GDM with these Diabetologia 50 (5) (March 7): 972– TCF7L2 variants has varied in different 979 populations, in Mexican Americans • Nobrega, Marcelo A. “TCF7L2 and (OR=2.49 [95% CI 1.17–5.31]; P = 0.018), Glucose Metabolism: Time to Look Arab women (OR=2.370, (95% of CI Beyond the Pancreas.” Diabetes 62 1.010–5.563,p=0.047) and Scandinavian (3) (March1): 2013; 706–708. women(OR=1.49 [95% CI 1.28–1.75], p = 4.9 × “THE INVERSION 16 IN ACUTE population we have found the TCF7L2 MYELOID LEUKEMIA.” polymorphism 10−7 ). rs4506565 In a small southshowed Indian a strong trend towards association Manoj M 1, Nancy A1, Sitaram [O.R=3.75(C.I=0.75-18.53) P=0.08] with U2,Ganapule A1, Abraham A1, increased risk in the occurrence of Viswabandya A1, George B1, Mathews gestational diabetes when compared to V1, Srivastava A1, Srivastava VM.3, other two polymorphisms rs7903146 Departments of 1Haematology, 2 [O.R= 1.77 (C.I=0.503-6.263) P=0.37] and Transfusion Medicine and rs12255372 [O.R=1.40 (C.I=0.24-8.11) Immunohaematology and 3 P=0.70]. Cytogenetics Unit, Christian Medical College, Vellore. Conclusion: Introduction: The TCF7L2 polymorphism rs4506565 showed a strong trend towards Rearrangements of the core binding association when compared to other two factor beta (CBFß) gene on chromosome common polymorphisms in TCF7L2 16, band q22 are associated with a good (rs7903146, rs12255372). This is the first prognosis in acute myeloid leukemia preliminary data of TCF7L2 (AML) 1. The inversion (16)(p13q22) is polymorphisms associated with the typical abnormality in this group and Gestational diabetes in India. However, to results in the formation of a confirm our findings further study needs CBFß/MYH11 fusion gene 2.It accounts to be performed in a large population. for ~ 4% of the AML-associated abnormalities and is usually associated References: with AML M4 with eosinophilia or M2 3. • Chandak, G R, A T Hattersley, C S Trisomy 22 is the most common Yajnik. “Common Variants in the secondary change 4.

Abstracts of Annual Research Day 2013

Materials and methods: especially if the bone marrow shows myelomonocytic leukemia or abnormal G banded karyotypes of all patients with eosinophils or if a solitary trisomy 22 is the inversion 16 seen in the Department present. of Haematology between January 2003 and December 2012 were correlated with References: blood and bone marrow findings. 1.Delaunay, J., et al., Prognosis of Results: inv(16)/t(16;16) acute myeloid leukemia (AML): a survey of 110 cases from the There were 23 patients with the inversion French AML Intergroup. Blood, 2003. 16 among 1842 AMLs seen during this 102(2): p. 462-9. period (1.2 %). The median age was 33 years 2. Liu P, Tarlé SA, Hajra A, Claxton DF, (range 1-58 years). There were 11 males. Marlton P, Freedman M, Siciliano MJ, The median haemoglobin was 8.7g/dl Collins FS. Fusion between transcription (1.6-14.4 g/dl), the median WBC count, factor CBF beta/PEBP2 beta and a myosin 64.9 × 109/L heavy chain in acute myeloid leukemia. (range 1-244.3 × 109/L) and the median Science. 1993 Aug 20;261(5124):1041-4. platelet count, 26×109/L (range 7 -192 × 109/L). The FAB subtypes were AML M4 3. Le Beau MM, Larson RA, Bitter MA, (11 patients), M2 (six), AML not Vardiman JW, Golomb HM, Rowley JD. otherwise specified (four), M1 (two). The Association of an inversion of bone marrow blast percentage ranged chromosome 16 with abnormal marrow from 5-91%. Abnormal eosinophils were eosinophils in acute myelomonocytic seen in nine patients with AML M4 and leukemia. A unique cytogenetic- M2 accounting for four each. clinicopathological association. N Engl J Med. 1983 Sep 15;309(11):630-6. The inversion 16 was solitary in 13 (57%), associated with a single additional 4.Xu, W., et al., Trisomy 22 as the sole abnormality in three (13%) and with two abnormality is an important marker for or more additional abnormalities in seven the diagnosis of acute myeloid leukemia (30%).The common additional with inversion 16. Onkologie, 2008. 31 abnormalities were trisomy 8 (seven (8-9): p. 440-4. patients), trisomy 22 (four) and trisomy 9

(two). “PHYSIOLOGICAL COST INDEX DURING Conclusion: AMBULATION IN SPINAL CORD INJURED PERSONS AT DIFFERENT Our data is similar to the literature except PHASES OF REHABILITATION-A PILOT for trisomy 8 being the most common STUDY.” secondary change. The inversion 16 can Maria Stefy, Physical Medicine and be overlooked unless the morphology of Rehabilitation Centre, Christian the metaphases is good. FISH analysis or Medical College, Vellore. molecular testing is helpful for Background: confirmation of this abnormality,

Abstracts of Annual Research Day 2013

Energy expenditure is an important parameter in the assessment of the Study design: Observational study orthotic gait in persons with locomotor Setting: Rehabilitation Institute CMC, disability. Currently, persons with T9 and Vellore below are trained to be ambulant with Subjects: Persons with T9-L1 paraplegia bilateral Knee ankle foot orthosis and cleared for ambulatory training. elbow crutches. Macgregor combined the heart rate and speed of the locomotion to Procedure: produce a single index called the Physiological Cost Index. The Persons with T9-L1 paraplegia are conventional method of measuring the selected consecutively. Physiological cost Physiological Cost Index (PCI) is done by index using standard bed-side method calculating the oxygen uptake. This computing the pulse rate and speed of method is difficult because of the walking is calculated at midterm phase of unavailability of tools in the clinical setup. their rehabilitation. The participants are This study attempts to observe and followed through their rehabilitation analyze PCI values of the persons with process and prior to their discharge a T9-L1 paraplegia at two different stages final PCI evaluation is done. These two of their rehabilitation process, i.e. during PCI values are computed and analyzed for the mid-term when the person ambulates any correlation. The PCI values are using reciprocal walker and bilateral compared with the established normative KAFO and secondly at the time of data of non injured people to analyze the discharge, when the person walks using difference. bilateral KAFO and elbow crutches. Variables: Objectives: 1. Physiological cost index The objectives of this study are: 2. Single neurological level (T9-L1)

1. To find the PCI of persons with T9-LI Results: paraplegia with walking with reciprocal walker and bilateral KAFO This study shows that there is no at the midterm of the rehab process. difference in the Physiological cost index 2. To find the PCI of the same persons between the orthotic (KAFO) reciprocal walking with bilateral knee ankle foot walking and orthotic (KAFO) walking orthosis and elbow crutch prior to with elbow crutches. There was a their discharge. significant difference in the PCI between 3. To compare the PCI between the two the established normative value for non- phases of rehabilitation in the same injured persons with that of the persons group of participants. with SCI walking with KAFO and elbow 4. To compare the obtained values of the crutches. PCI with the established normative data of PCI in non-injured persons as Acronyms: established in the literature. KAFO – Knee Ankle Foot Orthotics Methodology: PCI – Physiological Cost Index

Abstracts of Annual Research Day 2013

SCI – Spinal cord injury between January 2003 and December 2012 were correlated with blood and Key words: bone marrow findings.

Paraplegia, Spinal cord injury, Results: Physiological Cost Index, reciprocating The translocations were seen in 26/1235 walker, elbow crutch and knee ankle foot (2.1%) patients with ALL. The t(8;14) was orthosis, energy consumption, seen in 19 patients(73%), t(8;22) in six ambulation. (23%) and t(2;8) in one (4 %).

The majority (23, 88.4%) of these “THE T(8;14) AND ITS VARIANTS IN patients were males and adults (21, 80.7 ALL.” %, median age 37 years, range 1-58). The median hemoglobin was 7.9 g/dl (range: Meenu Angi 3 ,Yuvarani S3 ,Sitaram U2, 4.3-12.6); median WBC count, 9.6 x 109/L Nair S2,Ganapule A1, Abraham A1, (range: 2.1-245.8); median platelet count, Viswabandya A1, George B1, Mathews 45x 109/L (range: 1.6- 243), and the V1, Srivastava A1, Srivastava VM.3., median BM blast percentage, 78.5 (range Departments of 1Haematology, 2 36-96%). ALL L3 was seen in 16, L2 in Transfusion Medicine and one, L1 in two and ALL not otherwise Immunohaematology and 3 subtyped in seven. Six patients had extra Cytogenetics Unit, Christian Medical medullary disease with involvement of College, Vellore. nodes (four) or stomach or kidney (one

each). Four had Burkitt lymphoma and Introduction: two, high grade B cell lymphoma. The t(8;14)(q24;q32) and its variants – the t(2;8)(p12;q24) and t(8;22)(q24;q11) The majority (19/ 26, 73.1 %) of patients are associated with B cell neoplasia, had complex karyotypes (two or more notably Burkitt lymphoma /leukemia additional abnormalities). One had ALL- (ALL-L3). These translocations involve L3 and nodal high grade B cell lymphoma the MYC gene on chromosome 8q24 and with both t(8;14 ) and t(14;18) – double- one of the immunoglobulin genes – IgH hit lymphoma. on 14q32, (the most common translocation), the IgK on 2p12 or IgL on Structural abnormalities of chromosome 22q11 leading to the formation of a 1q accounted for 42% of the secondary MYC/Ig fusion gene.1,2 Secondary changes abnormalities followed by deletions 9q, (structural abnormalities of chromosome 11q (11.5% each) and 6q (7.7%), addition 1q and 13q3, trisomies 7 and 12) are seen 13q34 (7.7%), trisomies 7 and 12 and in~ 60% of patients. 3, 4 deletion 17p (3.8% each).

Patients and methods: Conclusion:

G-banded karyotypes of all patients with The frequency of these translocations in ALL and the t (8; 14) and its variants seen our series is slightly lower than what has in the Department of Haematology, been reported (2% vs 3-5%). We also had Christian Medical College, Vellore,

Abstracts of Annual Research Day 2013

a higher number of t (8; 22) – 23% vs entirely clear. The aim of this study was 10%. The association with 1q to test the hypothesis that inflammation abnormalities is similar to the literature affects expression of iron-related proteins while 13q3 abnormalities and trisomies 7 in the duodenum and monocytes in and 12 were seen in fewer patients (7.7 patients with chronic inflammatory and 3.8 vs 15%). disorders, thus contributing to dysregulated iron homeostasis. Duodenal References: mucosal samples and peripheral blood monocytes obtained from patients with 1. Bilhou-Nabera C . chronic inflammatory disorders, viz. t(8;14)(q24;q32); t(2;8)(p12;q24); ulcerative colitis (UC), Crohn’s disease t(8;22)(q24;q11). Atlas Genet Cytogenet (CD) and rheumatoid arthritis (RA), were Oncol Haematol. February 1999 . used for gene and protein expression 2. M R Velangi, M M Reid, N Bown, et studies. Haemoglobin levels were al. J Clin Pathol 2002 55: 591-595. significantly lower and serum C-reactive 3. EG Boerma, R Siebert, PM Kluin protein (CRP) levels significantly higher and M Baudis. Leukemia (2009) 23, 225– in those in the disease groups. Gene 234. expression of several iron-related 4. Johansson B, Mertens F, Mitelman proteins in the duodenum was F. Cytogenetic evolution patterns in non- significantly up-regulated in patients with Hodgkin’s UC and CD. In those with UC, it was found lymphoma. Blood 1995;86:3905 that protein expression of divalent metal transporter (DMT1) and ferroportin, “EXPRESSION OF IRON-RELATED which are involved in absorption of PROTEINS IN THE DUODENUM IS UP- dietary non-heme iron, was also REGULATED IN PATIENTS WITH significantly higher in the duodenal CHRONIC INFLAMMATORY mucosa. Gene expression of the duodenal DISORDERS.” proteins of interest correlated positively with one another and negatively with Abitha Sukumarana, Jithu Jamesa, haemoglobin. Gene expression of iron- Harish PalletiJanardhana, Anita related proteins in monocytes was Amaladasa, Lekshmy studied in patients with UC and found to Madathilazhikathu Suresha, Debashish be unaffected. In a separate group of Dandab, Visalakshi Jeyeseelanc, patients with UC, serum hepcidin levels Balakrishnan Siddharth Ramakrishnad were found to be significantly lower than and Molly Jacoba., Departments of in control subjects. In conclusion, Biochemistrya, Rheumatology and expression of iron-related proteins was Clinical Immunologyb, Biostatisticsc up-regulated in the duodenum of patients andGastrointestinal Sciences, Christian with chronic inflammatory conditions in Medical College, Vellore, Tamil Nadu, this study. The effects appeared to be India. secondary to anemia and the consequent erythropoietic drive. Mechanisms responsible for derangements in iron homeostasis in “RHYTHM GENERATING MECHANISMS chronic inflammatory conditions are not IN ISOLATED RAT HEART.”

Abstracts of Annual Research Day 2013

heart rate in some rats and decrease in Latha N., Swetha Raman, others (n=3 each). With Verapamil and Kamalakannan.V., Anand Bhaskar and NCX Sathya Subramani, Department of and block ICaL), percentage reduction in Physiology, Christian Medical College, heartDiltiazem rate (both was at 70.14 10μM, ± to 5.08% reverse and I Vellore. 46.3±28.4% respectively. With Nifedipine CaL), heart rate Introduction: reduced by 42.86± 5.18% and stopped at (1 μM) (blocker of I In mammalian hearts, automaticity is CaT), the heart rate initiated by the sinoatrial node. Funny reduceda higher only dose by 3.38±10.8%. of 10μM. With Nickel current (If ) initiates the diastolic (40μM) (blocker of I depolarization, which is enhanced by T- Conclusion: type calcium current (ICaT) and sodium Both ICaL and INCX seemed to be calcium exchanger current (I NCX ). L-type mandatory for initiation of pacemaker calcium current (ICaL) is responsible for the action potential that ensues (1). These action potential unlike ICaT that might play currents have been targets for a minor role. Ivabradine did not stop the heart even at the dose used which causes development of anti arrhythmic drugs. maximal blockade of If; therefore If is not Aim: mandatory for rhythm generation.

Reference: To study the contribution of If , I NCX , ICaL and ICaT to rhythm generation in rat heart. 1. Mangoni ME, Nargeot J. Genesis and regulation of the heart automaticity. Methods: Physiol. Rev. 2008 Jul;88(3):919–82.

Heart was isolated from an anaesthetized rat and perfused through the aorta with “CHROMOSOME 14Q FLUORESCENCE physiological salt solution in Langendorff IN-SITU HYBRIDISATION (FISH) mode for 15 minutes to stabilize the heart ANALYSIS IN MENINGIOMAS.” rate. Then it was perfused with test solutions and again reperfused with Noopur Gupta, Geeta Chacko, Ari G. normal solution. Using ECG contact Chacko, V. Rajshekhar, Jayaprakash electrodes, surface electrocardiogram Muliyil, Departments of Pathology, was recorded using a computerized data Community Medicine and Neurological acquisition system (CMC Daq). Sciences, Christian Medical College, Vellore, Tamil Nadu. Results: Background:

(blockers of If ), reduced heart rate by Deletion of 14q has been reported in 27±5Cesium % (5mM)and 45±7 and % Ivabradine respectively. (10μM) With meningiomas and it is implicated in low sodium solution, the heart stopped tumour progression. completely. High calcium solution (5 mM) showed equivocal results with increase in Aim:

Abstracts of Annual Research Day 2013

To correlate histopathological grading of a subgroup stratified by MIB-1 labelling meningiomas segregated into subgroups index, with consistent 14q deletions. 14q based on MIB-1 labelling index with deletion, being a molecular marker of deletion of chromosome 14q. tumour progression may predict the biological behaviour of histologically Methods: benign meningiomas. 46 cases were segregated into five “COMPARISON OF THE RADIOLOGICAL categories based on the MIB-1 labelling TISSUE PROPERTIES OF indices (MIB-1 LI) of <5%, 5-7.5%, 7.5- ANTHROPOMORPHIC PLASTINATED 9.9%, 10% and >10%. PHANTOM WITH ALDERSON RANDO Immunohistochemical staining for MIB-1 PHANTOM.” was performed using a Ventana Benchmark XT Autostainer. Commercial Pauline Shanthi *, I. Rabi Raja Singh **, FISH kit (Abbott Molecular: Vysis Gibikote Sridhar ***, Suganthy Rabi * TelVysion) was used for detecting 14q *Department of Anatomy, ** deletion. The observer reporting 14q Department of Radiotherapy, *** status was blinded to the MIB-1 LI. Department of Radio diagnosis, Subsequently, correlation between 14q Christian Medical College, Vellore. deletion and MIB-1 LI was studied. Background: Results & Conclusion: Plastination is the art of preserving There were 21 WHO grade I, 24 grade II biological tissues with curable polymers. and 1 grade III meningiomas. There was a Phantoms are structures made of one or statistically significant difference between more tissue substitutes that respond to the mean duration of symptoms, average the radiation as similar as human body, maximum dimension and the MIB-1 LI of used extensively in external beam grade I and grade II meningiomas. 33.3% radiotherapy. The Alderson Rando grade I cases showed 14q deletion, when Phantom has been widely used for this compared to 84% of grade II and III purpose. Since plastination yields a stable meningiomas. Amongst the histological specimen which shows repeatability and parameters for diagnosis of atypical reproducibility and are also cost-effective, meningioma, hypercellularity, small cell we propose to make phantoms using the formation, prominent nucleoli and sheet ‘standard S-10 silicone’ plastination like growth were significantly associated technique and study the radiological with 14q deletion. All brain invasive tissue properties of the plastinated meningiomas (n = 6) had 14q deletion. As phantom. MIB-1% increased, the prevalence of deletions was significantly higher. The Aim: mean MIB-1 of the 7 grade I meningiomas that had 14q deletions was 8.86±1.95% To make plastinated phantom from when compared to 4.14±1.35% for those cadaver and to validate it by comparing without 14q deletions. its radiological tissue properties with that of the Alderson Rando phantom. MIB-1 LI correlates with 14q deletion. Meningiomas with grade I histology have Methods:

Abstracts of Annual Research Day 2013

An above-diaphragm specimen from a Poonam Jain1,S Yuvarani1,Usha male cadaver and a below-diaphragm Sitaram 2, Marie-Therese Manipadam4, specimen from a female cadaver were Abhijeet Ganapule3,Aby Abraham3, plastinated using the standard S-10 Auro Viswabandya3,Biju plastination technique. CT imaging was George3,Vikram Mathews3,Alok carried out with PHILIPS CT BRILLIANCE Srivastava3,Vivi M. Srivastava1., 6 slice machine before and after Cytogenetics Unit1, Departments of plastination. These images of pre- Transfusion Medicine and plastinate, post-plastinate and Rando Immunohaematology2, Haematology3 phantom were compared using an Eclipse and Pathology4, Christian Medical 3D Treatment Planning System (VARIAN). College, Vellore, India. The attenuation property of the plastinated head phantom was compared Introduction: to that of the Alderson Rando head phantom by irradiating them with 200 The der(1;7)(q10;p10) is an unbalanced cGy of cobalt-60 by using telecobalt whole-arm translocation which results in machine (Th780C). gain of the long(q) arm of chromosome 1 and loss of chromosome 7q. This Results: translocation is seen in myelodysplastic Plastinated phantoms obtained were dry, syndrome (MDS), acute myeloid leukemia robust and durable. CT imaging of the (AML) and rarely, in myeloproliferative plastinated phantom showed better neoplasms and has been reported to be anatomic detail of the organs than the associated with eosinophilia, trilineage pre-plastinate. However the CT numbers dysplasia and a previous history of 1 were increased in the plastinated chemo- or radio-therapy. It usually phantom. The attenuation of the occurs as a solitary abnormality. plastinated phantom was closer to the Associated abnormalities include trisomy standard water phantom than that of the 8 and, less commonly, trisomies 9 and 21 1-3 Rando phantom. and deletion 20q. Patients and Methods: Conclusion: Though the plastinated phantom had G-banded karyotypes of all patients with increased CT numbers because of the the der(1;7)(q10;p10) seen between silicone, its attenuation property was 2003 - 2013 in the Department of closer to the standard water phantom Hematology, Christian Medical than the Rando phantom. Nevertheless a College,Vellore were analysed and better phantom has to be obtained by correlated with blood and bone marrow light-weight plastination if it has to be findings. used for external beam radiotherapy. Results: ______The der (1; 7) (q10; p10) was seen in nine “THE DER(1;7)(Q10;P10) IN MYELOID patients (median age 52 years, range 26 - NEOPLASIA.” 68; male: female ratio, 3.5:1). The median haemoglobin was 7.9gm/dl (range: 4.8- 13.5), median total leucocyte count, 3.8

Abstracts of Annual Research Day 2013

x109/L (range: 1.3-82.9), median platelet Background: count, 40x109/L (range:3-154), and Cisplatin and concurrent radiotherapy median peripheral blood eosinophil has improved survival over treatment count, 1% (range 0-7%). Five had MDS; with cisplatin or radiotherapy alone. three, AML and one, myelofibrosis.The Cisplatin has radiosensitizing properties der (1; 7) accounted for 0.67% (5/741) of and the best sensitization to the MDS and 0.16% (3/1842) of AML. All nine radiotherapy occurs when the blood drug had dysmegakaryopoiesis, with bi- or tri- concentration is higher. However, the lineage dysplasia in two (22%) each. optimal time sequence between the Reticulin was increased in seven patients. chemotherapy and radiation therapy is unclear Seven patients had additional cytogenetic abnormalities, with complex karyotypes Aim: (three or more abnormalities) in four. These included trisomies 8 (four cases), 9 Determination of total and free plasma and 21 (two each). concentration of cisplatin following long and short durations of intravenous Conclusions: infusion in patients diagnosed with head and neck or cervical malignancy. Our findings are similar to the literature with respect to the male preponderance, Methods: the frequency of the der (1; 7) in AML and its association with trisomy 8. We noted Patients were recruited into one of two differences with respect to the median groups based on their cisplatin infusion age (52 versus 58-68 yrs), the frequency schedule, either the 1 hour or the 3 hour of the der (1; 7) in MDS (0.67% vs 1.5 – infusion regimen. On the day of cisplatin 6%), trilineage dysplasia (22%), infusion, blood specimens were collected additional abnormalities (77% vs 36 – at 0.5, 1, 1.5, 2, 3 and 5hrs from the start 42%) and complex karyotypes (44% vs of infusion in the 1 hr infusion group. For 12%) and the absence of deletion 20q and the 3hr infusion group specimens were eosinophilia. collected at 2, 3, 3.5, 4, 6 and 24hrs from the start of infusion. Total and free “COMPARISON OF TOTAL AND FREE cisplatin were measured using HPLC-UV. PLASMA CONCENTRATION OF CISPLATIN FOLLOWING LONG AND Results: SHORT DURATION INTRAVENOUS INFUSION : A PILOT STUDY.” The highest concentration of total and free cisplatin was achieved at the end of Pradeep Rajkumar L A*, Dr.Binu S the infusion in both regimens. The decline Mathew*, Dr. Saikat Das, Dr.Rajesh in total cisplatin concentration at 30mins I, Dr. Subashini John, Dr.Ratna after the end of infusion in 1h regimen Prabha*, Dr.Denny H Fleming*, (1.5hr specimen) and in 3h regimen *Clinical Pharmacology Unit, (3.5hr specimen) was 41.4% and 39% Department of Radiation Oncology, respectively, compared to the Christian Medical College, Vellore- concentration at the end of the infusion. 632004.

Abstracts of Annual Research Day 2013

After 1hr in both regimens the free drug indeterminate cytology findings. concentration declined by73.9% (1hr However, the frequency of BRAF Infusion) and 70.8% (3hr infusion). mutations among Indian patients remains However, the total drug, in both regimens unclear. had only declined by 41.9% (1hr Infusion) and 44.0% (3hr infusion). Aim:

Conclusion: The aim of this study was to evaluate the BRAF mutational frequency in fine-needle In conclusion, the ideal time to administer aspirates obtained from thyroid nodules. radiation therapy, based on the maximum concentration of total and free cisplatin, Methods: would be immediately at the end of infusion, in both regimens. A delay of 30 In this study, we enrolled 136 patients minutes causes a significant fall in the from our hospital and BRAF mutation cisplatin concentration. status was examined by direct sequencing on thyroid fine-needle aspirates and “FREQUENCY OF BRAF MUTATION IN correlated with clinico-pathological THYROID FINE-NEEDLE ASPIRATES parameters of the patients. AMONG INDIAN PATIENTS.” Results: Prakash Gangadaran1,2, Rekha Pai1, Marie Therese Manipadam1, Deepak Out of 136 thyroid nodules tested, 12 Abraham2, Pooja Ramakanth2, Simon cases were found to be malignant by Rajaratnam3, Nihal Thomas3, Paul MJ2., routine cytological analysis and 7 cases 1Department of Pathology, had papillary thyroid cancer (58 %). 2Department of Endocrine Surgery, Seventy one percent of patients with PTC 3Department of Endocrinology, were females. Out of 7 PTCs, 4 cases were Christian Medical College, Vellore, positive for BRAF mutation (57 %); the Tamil Nadu, India. incidence of the BRAF mutation did not differ between male and female. Three of Background: the 4 PTC patients with BRAF mutation had a smaller tumor (3cm) when The BRAF V600E mutation is the most compared to those without mutations. common genetic alteration. BRAF mutation activates the mitogen-activated Conclusions: protein kinase (MAPK/ERK) pathway and may confer an aggressive phenotype in The frequency of muations seen at our PTC. Testing for BRAF mutation is centre though higher than that reported clinically useful in providing prognostic from many western countries, is similar prediction and facilitating accurate to that reported from a single other study diagnosis of PTC in thyroid fine-needle from the Indian subcontinent which aspirate (FNA) samples. It has also been showed 53% mutation positivity. proposed as a diagnostic adjunctive tool in evaluation of thyroid nodules with

Abstracts of Annual Research Day 2013

“ABSENCE OF G1528C MUTATION IN MELLITUS USING LONG-CHAIN 3-HYDROXYACYL-COA EUGLYCEMICHYPERINSULINEMIC DEHYDROGENASE IN FOUR INDIAN PANCREATIC CLAMP, DUAL ENERGY X- PATIENTS WITH PREGNANCY- RAY ABSORPTIOMETRY SCAN AND 1- RELATED LIVER DISEASE.” H-NUCLEAR MAGNETIC RESONANCE SPECTROSCOPYTECHNIQUES.” Raghupathy V, AshishGoel, KavithaThangaraj, Eapen C. E, RUNNING TITLE: Balasubramanian K. A; Annie Regi, Ruby Jose, Santosh J Benjamin, Anup Metabolic characteristics and body Ramachandran composition in Asian Indian subjects The human placenta is known to use fatty with Type 1 Diabetes Mellitus acids as a significant source of metabolic Riddhi Das Gupta, Ron Thomas fuel during gestation and expresses Varghese, Veena Nair, Padmanabhan S, Mercy Inbakumari, Flory Christina, oxidation. Fetal disorders of Roshan Livingstone1,H.S. Asha, Sylvia enzymes involved in mitochondrial β Kehlenbrink2,Sudha Koppaka2, especially deficiency of long chain 3- Michelle Carey2, Meredith Hawkins2, hydroxyacylmitochondrial-coenzyme fatty acid-A dehydrogenase β oxidation, Nihal Thomas, Department of (LCHAD) has been correlated with hepatic Endocrinology, Diabetes and disorders such as pre-eclampsia, Acute Metabolism, Christian Medical College, Fatty Liver of Pregnancy (AFLP) and Vellore, India, 1Department of Hemolysis, Elevated Liver enzymes, Low Radiodiagnosis, Christian Medical Platelets (HELLP). The commonest College, Vellore, India, 2Dept. of identified mutation in Western Endocrinology, Albert Einstein College populations is G1528C in exon 15 of the of Medicine , New York, USA. mitochondrial trifunctional protein (MTP) CORRESPONDING AUTHOR: LCHAD activity. Though a few studies haveα subunit, pointed which out the selectively lack of this decreasesmutation Dr. Nihal Thomas, in Chinese and Japanese populations, the MD, MNAMS, DNB (Endo), FRACP status in the Indian population is (Endo),FRCP(EDIN),FRCP(Glasg) unknown. As the genetic composition of Professor & Head, the placenta is same as the fetus, we used Department of Endocrinology, Diabetes the placental DNA to screen for the and Metabolism, G1528C mutation by PCR-RFLP analysis Vice Principal (Research), and report its absence in 3 AFLP and 1 Christian Medical College Hospital, HELLP patient but identify a novel Vellore-632004, India. mutation in one of the AFLP patients. Email: [email protected]

Introduction: Type 1 Diabetes Mellitus has a significant “ASSESSMENT OF METABOLIC contribution to the global diabetes CHARACTERISTICS AND BODY epidemic.However, the physiological COMPOSITION IN ASIAN INDIAN mechanisms regulating insulin sensitivity SUBJECTS WITH TYPE 1 DIABETES

Abstracts of Annual Research Day 2013

and body composition in themremains weight, body surface area, and hip elusive. circumference, while EMCL correlated with waist hip ratio and basal metabolic Materials and methods: rate (p < 0.05).

14 male subjects with Type 1 Diabetes Conclusions: Mellituswere studied. Insulin sensitivity at the hepatic and peripheral tissueswas Subjects with Type 1 Diabetes evaluated using a 6-hour Mellituswere insulin resistant as EuglycemicHyperinsulinemicPancreatic compared to matched non- diabetic Clamp.Body composition assessment subjects and as insulin resistant at the included skin fold thickness , DEXA scan hepatic level as subjects with Type 2 for total body fat %and 1H-NMR Diabetes. The Intramyocellular and Spectroscopy forHepatocellular Lipid ExtramyocellularLipid weremarkers for (HCL) and IntramyocellularLipid (IMCL) subcutaneous and visceral fat and ExtramyocellularLipid (EMCL) at the respectively in these subjects. The lean level of soleus muscle. The results were diabetic group were significantly more compared with 11subjects with Type 2 resistant than the Type 1 Diabetes group Diabetes Mellitus, 5 lean subjects with at both the hepatic and peripheral levels.

BMI-matched non-diabetic subjects. diabetes (BMI ≤ 19 kg/m2) and9age and “ESSENTIALITY OF ARGININE AND Results and analysis: HISTIDINE IN HUMANS – A CRITICAL

APPRAISAL OF AVAILABLE EVIDENCE.” The M-value, an index of whole body

insulin sensitivity, was lowerfor subjects Prakash S. S, Arthi T. S*, Jagadish R*., with Type 1 Diabetes as compared to the Department of Biochemistry, Christian non diabetic group (13.82 vs Medical College, Vellore, India. 22.28µmol/kg/min) .The Rate of

Disappearance of glucose (Rd)an estimate *Contributed equally of peripheral insulin sensitivity,was

higher in Type 1 Diabetes subjects as Background: compared to those with Type 2 Diabetes (8.23 vs 4.60 mg/kg/min). Endogenous Essentiality of amino acids from a Glucose Production (EGP), an index of nutritional point of view is addressed by hepatic insulin sensitivity, was similar in its effect on nitrogen balance and other Type 1 and Type 2 Diabetes subjects biochemical parameters. Based on this, (0.42 vs 0.43 mg/kg/min). In the Type 1 ten amino acids are classified as essential Diabetes group, M value correlated amino acids which need to be supplied in significantly with Weight, BMI and diet. Of these, arginine and histidine are subscapular skinfold thickness (p < 0.05), reported to be semi-essential in some Rd correlated with M value, BMI,Waist cases. circumference, subscapular skinfold thickness and Total body fat % (p < 0.05), Aim: while EGP correlated significantly with HCL. The IMCL correlated with age, To ascertain the essentiality of arginine and histidine based on available evidence.

Abstracts of Annual Research Day 2013

Methods: We would like to thank Dr. Molly Jacob and Dr. Premila Abraham for their We initially collected evidence from all valuable inputs. We would also like to the available latest editions of textbooks appreciate the efforts of some of the of biochemistry in our institutional students of MBBS batch of 2013 who library on whether arginine and histidine searched the literature and submitted are listed as essential or semi-essential. their reports. Besides, we also referred to electronic databases such as PUBMED on the same “STUDY OF THE KINETICS OF topic. CYTOMEGALOVIRUS (CMV) MRNA LEVELS IN PATIENTS WITH CMV Results: REACTIVATION FOLLOWING BONE According to the foreign author MARROW TRANSPLANTATION.” textbooks, histidine was listed as an Sangeeta Susan Thomas, Rayaz Ahmed, essential amino acid. Arginine was listed Santhosh Kumar D, Rajesh Kannangai, as conditionally essential in some and Biju George, Asha Mary Abraham, essential in others. In all the Indian Department of Clinical Virology and author textbooks, both histidine and Department of Hematology, Christian arginine were listed as semi-essential Medical College, Vellore. amino acids. The discrepancy was resolved by our findings from the Background: published literature. It was found that arginine can be synthesized in our body Cytomegalovirus infections form the as an intermediate in the urea cycle, and major viral opportunistic infection in is sufficient for adults. However, arginine bone marrow transplant patients that supplements are found to be useful in manifest in the early post-transplant some clinical conditions. In children, period. CMV mRNA levels were quantified especially in pre-term infants arginine is as a marker of reactivation in the post- an essential nutrient. Histidine cannot be transplant period. synthesized in humans as they lack the enzymes involved in its biosynthesis. A Aim: histidine-deficient diet for longer periods To quantitate the CMV mRNA levels in (about 7 days) has shown to alter blood samples of bone marrow transplant nitrogen balance. Histidine is thus an patients using real time reverse essential amino acid in humans. transcriptase PCR (RT-qPCR) in the post- transplant period. Conclusion: Methods: Both arginine and histidine should be regarded as essential amino acids. One hundred and sixty two bone marrow Arginine becomes conditionally essential transplant patients were enrolled in the in some cases. This study emphasizes the study and 2467 EDTA blood samples need for critically analyzing the existing were collected from them. Peripheral facts to ascertain the right information. blood mononuclear cells were separated from the samples using Ficoll-Hypaque Acknowledgements: and stored in RNA Later solution at -80ºC.

Abstracts of Annual Research Day 2013

Of 162 patients recruited into the study, 35 (21.6%) showed CMV reactivation as Nuclear Hormone Receptors (NHRs) are a determined clinically and by CMV DNA large superfamily of ligand dependent levels. Of the 35, only 25 patients had the transcription factors regulating a plethora complete set of samples collected and of genes involved in metabolism, growth they were tested to obtain serial CMV and differentiation. Recent studies DNA levels in the post transplant period. identified the overwhelming role played Of these 25 patients, samples from 15 by NHR in determining hematopoiesis as patients were preliminarily tested for one well as HSC function and fate, suggesting splice variant of CMV Immediate Early that defective proliferation and (IE) mRNA using RT-qPCR. maturation of progenitors in hematopoietic malignancies could be Results: attributed to altered expression of these transcriptional regulators. NHRs are Of the 15 patients tested preliminarily, attractive but relatively unexplored drug 7(46.6%) tested positive for CMV targets and there is limited data on their mRNA.The samples from patients with expression profile in declining levels of CMV DNA tested hematological malignancies. Our negative for CMV mRNA.The mean CMV preliminary screening of AML cell lines DNA value of patients who were CMV and primary cells revealed differential mRNA positive was higher than those who were CMV mRNA negative. AML cell lines and decreased expression ofexpression these targets of PPARg in resistant and RXRαcell lines among vs. Conclusion: sensitive ones (Fig.1a). We extended this study aiming to identify the expression Testing for CMV IE-mRNA may be used as pattern of all NHRs in myeloid a marker of CMV reactivation. malignancies, compare with ex-vivo chemoresistance and prognostic “EXPRESSION PROFILING OF NUCLEAR markers.Myeloid leukemia cell lines HORMONE RECEPTORS IN MYELOID AML(n=12) carrying AML-ETO, Inv-16, LEUKEMIA REVEALS POTENTIAL.” PML-RAR fusion transcript, NPM1 or FLT3 mutation and CML(n=8), pooled Novel Drug Targets for Combination primary samples harboring only FLT3 Therapy ITD mutation and only NPM1 mutation, CD34+ cells and total cellular RNA Sreeja Karathedath*, Sukanya samples from normal donors were Ganesan*, Wei Zhang, Ajay Abraham, included in the study. Bone marrow Savitha Varatharajan, Bharathi, M.R, samples from AML patients and Shaji R.V, Alok Srivastava, Vikram peripheral blood samples from healthy Mathews, Poonkuzhali volunteers were collected after informed Balasubramanian, Department of consent. PBSC from normal donors (n=7) Haematology, Christian Medical were enriched for CD34+ cells by College, Vellore, India & 2Department magnetic enrichment. RNA extraction of Pediatrics,University of Illinois, followed by purification and cDNA Chicago, USA. synthesis were done as per manufacturer’s recommendation. The

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expression of 42 NHRs and 42 co- several differentiation markers NR1H3, regulators was profiled by qRT PCR using NR1D2, RORA, RORB, RARA and VDR RT2 PCR Profiler array (SABiosciences, were elevated in cells with increased Germany). Expression of each gene was degree of maturation. The receptor normalized to the average of 5 inducing terminal differentiation of - erythrocytes THRA, had lesser expression microglobulin, HGPRT & RPLP0) and (<60 Fold) in erythroleukemic cell lines differentialhousekeeping expression genes (GAPDH, was calculated b−actin, b2 by K562, HEL and LAMA-84 compared to normalizing this with normal total RNA normal (Fig.1c). In Ara-C resistant cell samples to determine fold change. Data lines, expression of NR1I3, AHR, and normalization and differential gene HNF4A were up-regulated while PPARG expression were computed using and RXRA were down-regulated. NPM1 SABiosciences web-based analysis positive cell lines and patient samples had software. Ex vivo cytotoxicity to increased expression of PPARG, cytarabine and daunorubicin was PPARGC1A, NOTCH2, NR1H3 and NR2F2 analyzed using MTT assay and IC50 was than the FLT3 mutated group (Fig.1d) and calculated using Adapt software. Based on similar expression of PPARG and RXRA Ara-C and Dnr IC50, AML samples were was validated in NPM mutated primary categorized as sensitive or resistant (IC50 AML blasts (Fig.1e). Our comprehensive - analysis of NHRs and its co regulatory -ITDand NPM1 molecules provides us with insights on <6.25μMmutations and were >6.25μM screened for Ara usingC; <0.5μM PCR NHR expression on differentiation and followedand >0.5μM by for GeneScan Dnr). FLT3 methods. Upon drug resistance across myeloid leukemia analysis we observed steroid receptors cell lines with various genetic and except PPARG, NR5A1, RXRG, NR1D2, molecular characteristics. This could be glucocorticoid receptors, androgen further explored to identify potential receptors and their co-regulatory novel drug targets to be used as molecules were expressed across all cell combination therapy in myeloid lines. In contrast, expression of certain leukemias to overcome drug resistance. NHRs such as NR2E3, NR1I2, NR1H4, NR0B1, NR0B2, ESRRG, ESRRB, NR1D1 and the co-regulator HDAC7 were less or at undetectable levels, while estrogen receptors and its co-regulatory molecules except PPARGC1B, steroid receptors HNF4A, NR2F1, NR2F2, RARG and NR3C2 were moderately expressed across the cell lines (Fig.1b). Analysis also revealed significantly reduced expression of ESR2, ESRRG, NR2F2, NR2F6 and THRB and increased PPARG in AML compared to CML cell lines. Comparison between CD34+ progenitor population and well differentiated hematopoietic cells demonstrated >6 fold change in NR4A1 expression. Likewise, expression of

Abstracts of Annual Research Day 2013

transporters (ABCG2, ABCB1), decreased expression of influx transporters (hOCT1) and polymorphisms in these transporters and drug metabolizing enzymes have been shown to influence imatinib therapy. The reduced expression and activity of hOCT1 in CML primitive progenitor population is also a marker of long term disease persistence. We evaluated the role of RNA expression and polymorphisms in imatinib influx and efflux transporters in newly diagnosed patients with CML; ratio of influx to efflux transporters: dCt hOCT1/ dCt ABCB1*dCTABCG2, referred to as resistance index (RI), was lower significantly in patients with MMR compared to those who did not achieve MMR. We developed a predictive model with RNA expression pattern and genotype that could identify CML patients

who would achieve MMR on imatinib “CD34+ CML CELLS HAVE LOW HOCT1 therapy (ASH annual Meeting abstracts RNA EXPRESSION AND TRUNCATED 2012-120: Abstract 2785). The RNA BUT DOES NOT DETERMINE expression status of these transporters in RESPONSE TO IMATINIB THERAPY.” CML CD34+ population, a major contributor to disease progression, could Sreeja Karathedath, Sukanya Ganesan, predict the molecular response with Vinodhini K, Senthamizhselvi A, better precision. Bharathi M.R, Aby Abraham, Auro The aims of the present study was to Viswabandya, Biju George, Alok identify differential RNA expression of Srivastava, Vikram Mathews and transporters hOCT1, ABCB1, ABCG2 in Poonkuzhali Balasubramanian, CML CD34+ population vs. total cellular Department of Haematology, CMC, expression and the potential association Vellore. with molecular response to imatinib. Bone marrow samples from imatinib Chronic Myeloid leukemia (CML) is a naïve patients with CML in chronic phase clonal malignancy of the hematopoietic (n=50) was collected after informed system which renders the cells with consent. RNA from the total cells as well constitutive tyrosine kinase activity. The as the cells enriched for CD34 (EasySep, tyrosine kinase inhibitor imatinib has Stem cell technologies, Canada) was tremendously improved the treatment isolated by Trizol extraction followed by outcome in CML patients.Despite this cDNA synthesis. The expression of therapeutic success, resistance and ABCB1, ABCG2 and hOCT1 was identified intolerance to imatinib has hampered the by qRT PCR using Taqman gene clinical outcome. Overexpression of efflux expression assays and the normalization

Abstracts of Annual Research Day 2013

was done against GAPDH. The expression Srivastava, Vikram Mathews, of these genes in CD34+ and total CML Poonkuzhali Balasubramanian, cells was compared. There was a Department of Haematology, Christian significant increased expression of efflux Medical College, Vellore. transporters ABCG2 (p=0.001) and ABCB1 (p=0.007) and decreased Targeted therapy with Imatinib mesylate, expression of hOCT1 (p=<0.001) in has revolutionized the treatment CD34+ fraction compared to the total response and survival in patients with cellular RNA. This reduction in OCT-1 chronic myeloid leukemia (CML). mRNA was also observed in CD34+ cells Imatinib steady-state plasma levels, derived from healthy donors (data not measured following the first month of shown). To determinewhether these treatment with the standard 400-mg/day parameters may be predictive of clinical dose, has been shown to be correlated responsesto IM, RNA expression of these with long-term complete cytogenetic and transporters in the CD34+ cells was molecular responses, as well as long-term compared with molecular response to event free survival (EFS). There is limited imatinib therapy. There was no report from India on the association significant association between RNA between imatinib levels and molecular expression of these transporters and response. We aimed to determine molecular response, though the number correlation of plasma imatinib and its of samples for which the CD34+ cell metabolite desmethyl imatinib levels as fraction was available was very less well as intracellular imatinib levels (after (n=50). We further tested if the decreased ex-vivo incubation of primary CML cells expression of hOCT1 in CD34+ fraction with imatinib) with molecular response in was due to the presence of short CML. transcript of hOCT1 resulting in decreased functional activity and found Imatinib naïve CML patients (n=135) that it is indeed true. We are currently treated with standard dose of imatinib evaluating the gene expression profiles of with serial follow-up post therapy were CD34+ fractions from patients with good included in this study [Chronic phase or poor response to imatinib therapy to (n=117), Accelerated phase (n=12), Blast predict a molecular signature of imatinib crisis (n=6)]. After obtaining informed response in CML. consent, peripheral blood samples were collected from patients 24 hours post first imatinib dose and on Day 29 (steady

state). Imatinib and desmethyl imatinib “ASSOCIATION OF PLASMA AND levels were measured using HPLC with INTRACELLULAR IMATINIB LEVELS UV detection. Molecular response to WITH MOLECULAR RESPONSE IN imatinib was measured by RQ-PCR for PATIENTS WITH CML.” BCR-ABL fusion transcript from

peripheral blood samples collected once Sukanya Ganesan, Preetha Markose, in three months with a minimum follow- Savitha Varatharajan, Ezhilpavai up of 12 months post therapy. The results Mohanan, Vinodhini Kumaraswamy, were expressed in the International Scale Senthamizhselvi Anandan, Auro (Poonkuzhali et al, Acta Haematologica, Viswabandya, Biju George, Alok 2012).

Abstracts of Annual Research Day 2013

The median plasma concentration of Objectives: imatinib and desmethyl imatinib at 24 hours was 593ng/mL (74-2177) and To study the effect of benidipine on the 86ng/mL (12-609) while on Day 29 it was frequency and amplitude of spontaneous 1072ng/mL (106-3694) and 206ng/mL contraction of distal caprine (goat) ureter. (31-613) respectively. Based on To determine the EC50 and dose- therapeutic response after 12 months, response relationship of benidipine on patients were divided into complete distal caprine ureter. molecular response [CMR (n=11)], major molecular response [MMR (n=48)], no Materials and methods: molecular response (n=39); in addition, patients were classified as intolerant The effect of an L- type and T- type (n=26) and those with disease calcium channel blocker benidipine, in progression (n=11). The plasma imatinib inhibiting the spontaneous contractions and Desmethyl imatinib concentration of distal segments of caprine ureter was (24 hours) was significantly higher in studied using a physiograph. The effects patients who achieved CMR/MMR when of different concentrations of benidipine compared to those with who did not. hydrochloride were assessed in 54 (P=0.02) Intracellular imatinib level did specimens. We analyzed the effect of drug not show significant association with on spontaneous contraction of ureters achievement of MMR/CMR. Number of over time using Repeated measures patients who achieved CMR/MMR had ANOVA and plotted a dose response curve significant association with high plasma to determine the EC50 of benidipine imatinib concentration suggesting that hydrochloride in inhibiting spontaneous higher the level of plasma imatinib contractions using DRC package in concentration, better the probability of software R. attaining response. Though the number of patients included is small, this study Results: suggests that monitoring plasma could help predict treatment outcome as well as There was significant inhibition of timely dose increase in imatinib to spontaneous contractions over time when improve clinical response. we used 6 × 10 -8 M, 3 × 10 -7M, 10 -6 M, 3 × 10 -6M, and 10 -5 M concentrations of benidipine. There was no significant inhibition of contractions in the control “BENIDIPINE, AN L-TYPE AND T-TYPE arm. The EC50 of benidipine in inhibiting CALCIUM CHANNEL BLOCKER, the spontaneous contraction of distal INHIBITS SPONTANEOUS caprine ureter over 30 minutes was 47.2 CONTRACTION OF ISOLATED CAPRINE × 10 -6 M with 95% confidence interval of URETER.” 12.12 × 10 -9 M – 82.26 × 10 -6 M.

Sumith K. Mathew, Girish S Naik, Jacob Conclusion: Peedicayil, Department of Pharmacology and Clinical Benidipine inhibits the spontaneous Pharmacology, Christian Medical contractions of ureter significantly at College, Vellore. clinically achievable plasma

Abstracts of Annual Research Day 2013

concentrations. Frequency of contractions Patients diagnosed to have TRS by were less inhibited compared to standard criteria were the subjects of the amplitude of contractions especially at study. Their premorbid functioning, lower test drug concentrations, responses to traumatic events, cognitive suggesting the role of T- type calcium status and extent of disability were channels in modulating the frequency of assessed. DNA was isolated from blood spontaneous ureteric contractions. from these subjects. Polymorphisms in the genes of interest and serum clozapine levels were determined. Associations “EFFECT OF POLYMORPHISMS IN between the genotypes and clinical CYP1A2*1C, CYP1A2*1F AND TAQ1A response, serum levels and adverse ON CLINICAL RESPONSE TO CLOZAPINE effects of clozapine were determined IN PATIENTS WITH TREATMENT- using appropriate statistical tests. RESISTANT SCHIZOPHRENIA (TRS) – A PRELIMINARY REPORT.” Results:

Susan Philip1, Veeramanikandan R2, The 45 patients recruited consisted of 31 Lakshmikirupa S1, Anto P Rajkumar3, C males and 14 females, with a mean age of Chitra1, Anju Kuruvilla1, Alok 32.28 years (±10.44). Scores of the Srivastava4, B Poonkuzhali4, Molly subjects, using the Brief Psychiatric Jacob2 and K S Jacob1, 1Department of Rating Scale (BPRS) for assessment of Psychiatry, Christian Medical College, psychopathology, ranged from 18 to 147 Vellore, India; 2Department of with a mean of 52.44 (±23.35). Subjects Biochemistry, Christian Medical were grouped as responders (BPRS score College, Vellore, India; 3Centre for -responders (BPRS score > Psychiatric Research, Aarhus 35). The Taq1A polymorphism showed University Hospital, Risskov-8240, significant≤ 35) and nonassociation with response to Denmark; 4Department of Hematology, clozapine; the heterozygous genotype Christian Medical College, Vellore, (A/B) occurred more frequently in India. responders than wild type and homozygous genotypes (OR 9.0; CI 1.0 – Background and Aim: 80.0; p 0.045). However, this association was not seen when age and gender were Clinical response to clozapine, used in adjusted for. CYP1A2*1C and CYP1A2*1F treatment-resistant schizophrenia (TRS), polymorphisms did not show significant is often variable. The present study associations with response to clozapine. evaluated whether polymorphisms in None of the polymorphisms influenced genes that metabolize clozapine serum levels of clozapine or occurrence of (CYP1A2*1F and CYP1A2*1C) and adverse effects. regulate dopamine synthesis (Taq1A) affected clinical response to, serum levels Conclusion: and adverse effects of clozapine in such patients. Polymorphisms in Taq1A, but not CYP1A2*1C and CYP1A2*1F, showed a Methodology: tendency to influence clinical response to

Abstracts of Annual Research Day 2013

clozapine. None of them affected serum and respiratory rate were recorded using levels or adverse effects of the drug. This CMC data acquisition system. Regular is an on-going study and further analysis arterial samples were taken to estimate with larger sample sizes will be necessary electrolytes and blood gases. If the pre before definitive conclusions can be intervention blood parameters satisfied drawn. published inclusion criteria, the animals were randomized into test (NFF-Oduvan) “IS THE NON FLUORESCENT FRACTION or control (Drumstick-processed OF CLEISTANTHUS COLLINUS TOXIC?” similarly) groups and received the respective extracts intraperitoneally at a Swetha Raman, Soosai Manickam, dose of 20 mg/100gBW. Sathya Subramani, Department of Physiology, Christian Medical Results & Conclusion: College,Vellore. 20% mortality in test and 0% in controls Cleistanthus Collinus (Oduvanthazhai) is (n=5 each) was recorded. Normal a poisonous shrub and our larger aim is to electrolyte levels without altered pH was delineate the toxic compounds in it. observed (both). Respiration and intra Excluding non-toxic fractions and arterial pressure remained normal (both), focusing on just the toxic fractions is one but associated with a progressive of our approaches in defining the toxicity tachycardia in test (p=0.00). Peculiarly, of the plant. All fluorescent fractions in there was hyperoxia (p=0.00) with the aqueous extract could be sequestered hypercapnia (both). The blood gases did by partitioning it with chloroform. Its not seem to satisfy the limits of the known toxins, Cleistanthin A and B which alveolar gas equation. are fluorescent, are toxic as seen in previous studies. The aim here was to To conclude, NFF fraction seemed to be assess the toxicity of its non fluorescent non-toxic, which has to be substantiated fraction (NFF) of the boiled extract. by testing for a longer period with a larger sample size. For clinical relevance, Objectives: oral gavaging must be the mode of administration rather than (a) To assess if the non-fluorescent intraperitoneal. fraction of C.collinus causes death in within 8 hours after intraperitoneal “VARIEGATED EXPRESSION OF administration. IMPRINTED GENES IN MOUSE INDUCED (b) To monitor arterial blood gases, PLURIPOTENT STEM CELLS.” electrolytes, respiration, ECG, blood pressure, urine pH in test animals and Syed Mohammed Musheer Aalam, compare it with controls. Kannan V Manian, Sumitha P Bharathan, Alok Srivastava, Shaji R Methods: Velayudhan, Centre for Stem Cell Research and Department of Carotid artery of anaesthetized wistar Haematology, Christian Medical rats was cannulated. Blood pressure, ECG College, Vellore, India.

Abstracts of Annual Research Day 2013

the transgenes and had no induction of Most of the generated mouse induced endogenous pluripotency genes except pluripotent stem cells (iPSC) clones show for Oct4. The RFP- Nanog+ clones showed embryonic stem cell (ESC) like features of variegated expression of Rian, Gtl2, Mirg; expression of pluripotency genes and the 2 out of 4 OSKM clones had high levels of ability for in vitro and in vivo Gtl2 and Mirg expression but lacked the differentiation. However, many clones do expression of Rian and the remaining two not support the full term development of clones lacked the expression of all three tetraploid-complemented mice. Recent imprinted genes. Out of the 3 OSK clones, studies have shown that transcripts 2 clones expressed optimal levels of Rian present in the imprinted Dlk1-Dio3 gene and Mirg, but they lacked expression of cluster on chromosome 12qF1 are Gtl2 and the other one expressed only aberrantly silenced in most of the iPSC Rian. In 7 out of 8 RFP+ clones, the clones which causes poor contribution to imprinted genes were silenced and in one chimeras. Decreased expression of these of them only Gtl2 was expressed. We imprinted genes has been attributed could not find any correlation between variously to sub optimal reprogramming expression of Klf4 and Dlk1-Dio3 cluster factor stoichiometry and loss of active genes. We measured the expression levels chromatin marks or hypermethylation of of Hdac1 to 11 and the results showed this locus. Addition of Vitamin C and that Hdac7 is repressed in R1ES cells and downregulation of Dnmt3a/3b have been RFP- iPSCs but is highly expressed in shown to help in maintaining the normal RFP+ iPSCs and mouse embryonic imprinting of the genes in this locus. It fibroblasts (MEFs) and in contrast, Hdac1 has also been proposed that Klf4 and Oct4 was found to be repressed in MEFs and regulate the expression of these activated at comparable levels in R1ESCs imprinted genes and the overexpression and in both RFP- and RFP+ iPSC colonies. of Klf4 and Oct4 causes their normal However, there was no correlation expression. We estimated the expression between the expression levels of Hdac1 or levels of Gtl2, Rian and Mirg in the Dlk1- Hdac7 and the imprinted genes. These Dio3 imprinted cluster in various mouse results suggest that downregulation of iPSC clones in our laboratory to test Hdac7 is important for reprogramming, whether it can be used as an effective and but not sufficient to activate the quick method to assess the pluripotency expression of imprinted genes in iPSC of mouse iPSC clones generated using clones. VPA causes increase in acetylation retroviral transduction of four factors, of imprinted genes, but not by directly Oct4, Sox2, Klf4 and c-Myc (OSKM) or modulating the levels of Hdac1 and three factors, Oct4, Sox2 and Klf4 (OSK). Hdac7. We conclude that there is We included mRFP1 for transduction to heterogeneity in the expression of Dlk1- monitor retroviral transgene silencing, Dio3 cluster genes and they are not which occurs in pluripotent clones. The transcriptionally co-regulated and transgene silenced (RFP-) clones (n=7) different epigenetic mechanisms may had activated expression of endogenous control the individual expression of these pluripotency genes Oct4, Sox2, Klf4 and genes. A thorough understanding of the Nanog to the levels similar to those in factors responsible for the activation of R1ESCs while RFP+ clones (n=8) these genes will help us tailor strategies maintained high expression levels of all

Abstracts of Annual Research Day 2013

to obtain fully pluripotent mouse iPSC thalassaemia and HPFH still remains clones. unclear. We screened 90 individuals from 51 families by gap-PCR for previously reported common deletions and by MLPA and quantitative fluorescent multiplex - “MOLECULAR BASIS OF (ΔΒ)0 PCR (QFM-PCR) for new deletions in the THALASSAEMIA AND HPFH IN INDIAN -globin cluster. After identification of POPULATION AND THE ROLE OF NON- the approximate locations of the deletions CODING TRANSCRIPTS IN INCREASING byβ MLPA and QFM-PCR, we developed FOETAL HAEMOGLOBIN IN ADULTS.” PCR strategies to amplify across the breakpoints and the products were Thiyagaraj Mayuranathan1, Janakiram sequenced to characterize the Rayabaram1, Reena Das,2 Neeraj breakpoints. We identified six different Arora1, Eunice Sindhuvi Edison1, deletions in Indian population. The Mammen Chandy3, Alok Srivastava1, frequencies of the previously reported Shaji R Velayudhan1. common mutations, Asian inversion 1Department of Haematology, deletion and HPFH-3, were 46.66% and Christian Medical College, Vellore, 24.44%, respectively. The rare mutations Tamil Nadu., 2Postgraduate Institute of which were not found earlier in Indian Medical Education and Research, population include 49.3kb deletion Chandigarh., 3Tata Medical Centre, (12.22%) and 32.6kb deletion (10%). We Kolkata. found 2 novel deletions, 49.98kb deletion and 86.7kb deletion, which accounted 5.55% and 1.11%, respectively. The Hereditary persistence of foetal breakpoints of the 49.98kb deletion were haemoglobin (HPFH) and) ( 0- found to be very close to those of HPFH-3 thalassaemia are conditions caused by and this mutation was found in large deletions of - and -globin genes compound het - and they are characterized by high foetal thalassaemia in a 8 year old boy with haemoglobin (HbF) in heterozygotes of thalassaemia intermediaerozygous (Hb=8.8g/dL). with β these mutations. Complete Four heterozygotes in the family had characterization of these deletions is mean MCV = 79.7fL (range: 76-85.6), important for understanding the mean HbF%= 26.9% (range: 23.3-33.0) transcriptional and epigenetic and pancellular distribution of HbF mechanisms involved in increase in HbF suggesting that this mutation causes levels by these mutations. Previous HPFH. The 86.7kb region encompassing studies demonstrated that these large A-, -and - globin genes was found in deletions remove the regulatory heterozygous state in one individual and -globin gene it also had haematological parameters of expression in adults and increase the HPFH (MCV=80.8fL and HbF=32.2%). To interactionsequences whichof long suppress range enhancers γ with develop an experimental model to study - - -globin the molecular mechanisms for elevated genes are deleted. However, the exact HbF in these conditions we established mechanismγ globin promoter for elevated since δ HbFand in β these ex-vivo erythropoiesis system with the conditions and differences in HbF levels peripheral blood mononuclear cells and phenotypes between ) ( 0-

Abstracts of Annual Research Day 2013

obtained from patients with Asian which mimicked the pattern of globin inversion deletion and HPFH-3. gene expression in normal individuals Quantitative real time PCR (qPCR) and patients with globin gene mutations, showed in -globin we could identify the role of noncoding transcripts in the cultured erythroid cells transcripts in increased HbF expression and chromatincreased expressionimmunoprecipitation of γ in the patients with HPFH and () 0- (ChIP) of RNA Polymerase II (RNAPII) thalassaemia. also showed increased transcriptional “AUDIT OF TEXT BOOK INFORMATION -globin gene in the ABOUT PACEMAKER MECHANISMS, erythroid cells obtained from the patients WITH SPECIAL REFERENCE TO IF AND activationwith these mutations. of γ To understand the INCX .” roles of non-coding transcripts at the 5’ and 3’ breakpoints of the deletions in the Abirami. V, Sathya Subramani -globin, we performed qPCR with the cDNA obtained Background: transcriptionalfrom cultured erythroid activation cells of γ using the primers that bind upstream and Current debate on the fundamentals of downstream of these breakpoints. The pacemaker mechanism of heart revolves results showed that the level of BGL3, the around two ionic currents, If and INCX. If noncoding transcript present near the (funny current) is a hyperpolarisation 5’breakpoint, is enhanced by these activated depolarising current that plays deletions. We found activation of a novel a vital role in pacemaker mechanism. non-coding transcript at the 3’ Recent data suggests a significant role for breakpoints and they were absent in the INCX (sodium calcium exchanger current) erythroid cells of normal individuals. ChIP as a pacemaker current. Studies from our also showed significant binding of RNAPII laboratory also show that INCX is at the genomic regions from where these mandatory for pacemaker activity. non-coding transcripts are produced. The In view of this we undertook to review role of non-coding transcripts has not textbook information on pacemaker been reported earlier as a mechanism for mechanisms and hence this poster. -globin transcription in HPFH and ( )0-thalassaemia. It is possible Aim: thatincreased these γdeletions remove the genetic elements that cause transcription To catalogue information on pacemaker -globin gene in normal mechanism of heart from various adults and they also cause activation of Physiology text books used by medical nonrepression-coding transcripts of γ which change the students and faculty in our institution -globin gene Objective: resulting in its active transcription. To conclude,epigenetic using status QFM of- PCRs γ we could To assess specifically whether the text 0 perform a comprehensive study of ( )- books chosen for the audit mention If and thalassaemia and HPFH in Indian INCX in pacemaker mechanisms population and detected rare and novel deletions that cause these conditions. Methods: Using ex-vivo erythropoiesis system

Abstracts of Annual Research Day 2013

12 Physiology textbooks were chosen be improved by reducing the length of the based on popular usage by medical _exor tendon by surgical correction. PG students in our institution. Information Trainee ( MS Bioengineering), Dept of on pacemaker currents (with special Bioengineering, CMC Vellore. E-mail reference to If and INCX currents) was address: [email protected] entered into a table.

Results: “THE EFFECT OF DIFFERENT LOADING DOSES OF PHENOBARBITONE ON 50% of the textbooks listed in the table SERUM PHENOBARBITONE LEVELS IN mention the role of I Only 17% of text f. NEONATES.” books mention about INCX, which is now evolving as an important pacemaker Vinod Pallaparthy, Atanu Kumar Jana, current. Santhanam Sridhar, Manish Kumar, Anil Kuruvilla, Niranjan Thomas, Conclusion: Department of Neonatology, Christian Majority of Physiology textbooks do not Medical College, Vellore. describe the major pacemaker Background: mechanisms in heart. Using the current recommendation for “MOTORIZED TENODESIS HAND phenobarbitone dosing (loading dose at ORTHOSIS FOR CERVICAL LEVEL 20-10-10 mg/kg), we have noted that SPINAL CORD INJURY PATIENTS.” babies are extremely sedated with elevated phenobarbitone levels. We Vinil T.C postulate that in asphyxiated babies, damage to the liver impairs drug Spinal Cord injury leads to partial or metabolism and renal damage affects complete paralysis of di_er-ent motor drug elimination, thus elevating serum functions. When partial paralysis of upper levels. Hypothermia can also affect the limb occurs in patients due cervical level drug levels. 5 spinal cord injury, their activities of daily living is a_ected. Objective:

To remedy this problem a light weight, To determine the serum levels of the low pro_le motorized tenodesis splint has phenobarbitone in babies receiving been designed to restore prehension different loading doses of phenobarbitone ability in these patients. The actu-ating for neonatal seizures and to study the mechanism involving a four bar linkage effect of asphyxia and therapeutic driven by a servo motor. The linkage from hypothermia on drug levels. the motor is attached to the wrist using a Design: cu_. By _exing wrist around 30 degree, internal _exor tendon will be stretched Prospective observational Cohort study and thereby the digits will come closer, creating just the right movement to be Setting: able to grasp objects without consciously Tertiary care perinatal center. moving _ngers. E_ciency of this action can

Abstracts of Annual Research Day 2013

Material and Methods: therapeutic phenobarbitone levels in a majority of babies, especially those Term neonates with seizures of any cause undergoing therapeutic hypothermia. were given phenobarbitone 20mg/kg as a Loading doses beyond 20 mg/kg should loading dose followed by additional doses be used with close monitoring of serum of 10mg/kg upto a maximum of 40mg/kg. levels. Maintenance dose of 5mg/kg in two divided doses was started after 24 hours Key words: of loading dose. Serum phenobarbitone levels were asessed after 4 hours of the Phenobarbitone; Serum levels; Asphyxia; initial loading dose and the subsequent Therapeutic hypothermia. values at 24, 48, and 72 hours from the time when the baby received the maximum loading dose. “PHENOTYPIC AND MOLECULAR CHARACTERIZATION OF VANCOMYCIN Results: RESISTANT ENTEROCOCCI (VRE).”

A total of 28 babies completed the study. Baby Abirami S¹, Suganya D¹, Dr. Balaji Fourteen (50%) received 20 mg/kg, 8 V¹., ¹ Department of Clinical (28.6%) received 30 mg/kg and 6 Microbiology. (21.4%) received 40 mg/kg loading dose. Asphyxia was the cause of seizures in 19 Introduction: (67.9%) of which 7 underwent therapeutic hypothermia. The mean Vancomycin-resistant Enterococci (VRE) phenobarbitone levels were 30.5±11.4, infections are the cause of nosocomial 44±18.4, 47.4±20.8 and 53.8±23.5 outbreak which remains an amendable mcg/ml at 4, 24, 48 and 72 hours of age challenge for treatment. Acquired respectively. The mean phenobarbitone glycopeptide resistance in Enterococcus level at 72 hours was 45.4±31.5 mcg/ml species is due to the acquisition of vanA, when 20 mg/k was used as loading dose vanB, vanD, vanE, and vanG genes This as compared to 51.2±12.4 and 55.6±15.2 study highlights the VRE resistance mcg/ml when loading doses of 30 and 40 profile which was further confirmed by mg/kg were used. 83.3% of babies who multiplex PCR detecting VanA and VanB had received 40 mg/kg loading dose had gene to estimate the prevalence rate and phenobarbitone levels more than the to formulate antimicrobial therapy for therapeutic range at 72 hours compared treatment. to 57.1% of those who received 20 m/kg. The mean phenobarbitone levels at 72 Aim: hours were higher in asphyxiated babies who underwent therapeutic hypothermia To determine the presence of van A and as compared to those with other causes vanB gene which confers glycopeptide (61.2±7.4 vs 44.2±3 mcg/ml). resistance in Enterococcus spp.

Conclusion: Materials and methods: Using the current recommended loading dose of upto 40 mg/kg may lead to supra

Abstracts of Annual Research Day 2013

A total of 70 VRE isolates were included resistance rates. The Study for Monitoring in this study. Screening for vancomycin Antimicrobial Resistance Trends resistance was done by Kirby Bauer Disc (SMART) surveillance program monitors Diffusion method and thereby confirmed the susceptibility of GNB from IAIs to with E-test. Molecular identification of ertapenem and other comparator agents. VanA and VanB gene were done by PCR. Objectives: Results: To monitor the in vitro susceptibility of Out of 70 VRE isolates, 87% of the isolates GNB to Ertapenem and other were E.faecalis and remaining 13% of the antimicrobial agents. isolates were E.faecium. The isolates were Materials and Methods: A total of 703 0% susceptible to vancomycin and 1% to isolates derived from IAIs were collected teicoplanin. 92% to daptomycin and 93% across India from a period of 2010 – to linezolid .This study shows an overall 2012. All isolates were identified up-to prevalence of VanA gene (100%) and species level and tested by Micro broth none of them had VanB gene (0%). dilution method as per CLSI guidelines

Conclusion: Results:

Emerging VRE complicate the clinical A total of 330, 167, 110, 30, 29, 27 and 10 situations further. Hence implicate the isolates of E.coli, Klebsiella, necessity for routine screening and Pseudomonas, Enterobacter, Proteus, identification of VRE. Molecular methods Citrobacter and Morganella were will provides information on geographical collected during 2010-2012. Ertapenem prevalence of resistant strains. and Imipenem activity towards E.coli, Klebsiella, Pseudomonas, Enterobacter, Proteus, Citrobacter and Morganella spp shows >80 % susceptibility. Whereas the “ANTIBIOTIC SUSCEPTIBILITY other comparator agents MIC for 90% of PROFILES OF GRAM NEGATIVE BACILLI tested strains varied considerably. The (GNB) ISOLATED FROM INTRA remaining data will be included during ABDOMINAL INFECTIONS (IAIS) the presentation. COLLECTED ACROSS INDIA.” Conclusion: Agila Kumari Pragasam1, Yamuna Devi B1 Balaji V1, Shalini Anandan1, The regional rates of Extended Spectrum Department of Clinical Microbiology, Beta Lactamases (ESBL) positive isolates Christian Medical College, Vellore. ranged from 68 %, 56 % in 2010 increasing to 70%, 60% in 2012 for E. coli Introduction: and K. pneumoniae respectively. Of the nine antimicrobial agents tested, only A variety of antimicrobial agents are amikacin, ertapenem and Imipenem recommended for the treatment of IAIs consistently exhibited percent but utility of many of these has become restricted, over time owing to increasing the study. However fluctuations in the susceptibilities of ≥80% for all 3 years of 81

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susceptibility to other antibiotics were Susceptibility was evaluated against a also observed. range of antimicrobial agents using Epsilometrytest andKirby-Bauer disc diffusion method as per the CLSI & EUCAST guidelines and the production of “UNDERSTANDING THE ANTIBIOGRAM -lactamase was tested using a nitrocefin- OF MOST FREQUENT based test. RESPIRATORY PATHOGENS.” β Results: Jones Lionel Kumar D1, GEETHA PRIYA D1, DR. BALAJI V1, DR. SHALINI A total of 89 isolates of S. pneumoniae, 32 ANANDAN1, Department of Clinical isolates of H. influenzae, 19 isolates of Microbiology, Christian Medical S.pyogenes and (11)M.cattarhalis were College & Hospital, Vellore. collected largely from patients with indications of CA-RTI from January - Introduction: October 2013. S. pneumoniae isolates were >90% susceptible to Levofloxacin, The empiric management of community- Penicillin, Amoxicillin/clavulanate and acquired respiratory tract infections has Ofloxacin while 82% were non resistant been complicated by the emergence of to Azithromycin and Co-trimoxazole. high rates of antimicrobial resistance. Similarly >95% S.pyogeneswere Major causative agents likeStreptococcus susceptible to Penicillin and 5% resistant pneumoniae,Haemophilusinfluenzae, to Levofloxacin, 100% resistant to Moraxella catarrhalis and Streptococcus Azithromycin, Co-trimoxazole and pyogenes , have developed multiple Clarithromycin(74%). H. influenzae resistance mechanisms to combat the showed the highest percent susceptibility effects of most commonly used classes of to Cephalosporins(100%), antibiotics, particularly the beta-lactams Levofloxacin(94%). 87.5% of these and macrolides. This study helps to isolates were susceptible to understand the susceptibility profiles of Amoxicillin/clavulanate, Ampicillin and pathogens involved in community- Azithromycin, 84.3% to Ofloxacin, 81% to acquired respiratory tract infections that Ciprofloxacin, while 78% were resistant can help in treatment and also reduce the to Co-trimoxazole and 69% to spread of resistance. Clarithromycin. M. cattarhaliswere all susceptible toAzithromycin and Cefixime Objectives: and completely resistant to cefuroxime. Overall, the percentage of H. influenzae To understand the antibiotic andM. - susceptibility profile of most lactamase was 12.5% and 100%, frequent pathogens respectively.cattarhalis isolates producing β involved in community- acquired respiratory tract infections. Conclusions:

Materials and Methods: In our study all these CA-RTI isolates -lactams and fluroquinolones when compared to shows highest susceptibility to β 82

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-lactams may continue to be Materials and Methods: considered options for non complicated CAmacrolides.-RTI. Β A prospective analysis of all Invasive S.pneumoniae isolates from children less than five years of age, during 2007 – 2013 June was made. S.pneumoniae were “SEROTYPE DISTRIBUTION AND confirmed by traditional methods. ANTIMICROBIAL RESISTANCE IN Isolates were then serogrouped and typed STREPTOCOCCUS PNEUMONIAE by Co-agglutination technique and CAUSING INVASIVE DISEASE IN INDIAN reconfirmed by multiplex PCR. CHILDREN.” Results: 1 1 Ranjith J , Rosemol Varghese , Dr. V. 1 2 Balaji , Dr. V. P. Verghese , Dr. Kurien The prevalent serotypes causing invasive 3, 1 thomas Department of Microbiology, infections in children less than five years Christian Medical College and Hospital, of age are 14, 19F, 5, 6A and 6B. 96.4% of 2 Vellore, India, Department of Child the isolates were non-susceptible to Health Unit, Christian Medical College Cotrimoxazole, and 30% were non- and Hospital, Vellore, India, susceptible to Erythromycin. 5.2% of the 3 Department of General Medicine, isolates were non-susceptible to Christian Medical College and Hospital, Penicillin; only 0.8% was non-susceptible

Vellore, India. to Cefotaxime.

Introduction: Conclusion:

Streptococcus pneumoniae causes Streptococcus pneumoniae causes significant morbidity and mortality significant morbidity and mortality in worldwide; particularly in childrens less Indian children. Understanding the than five years. Antibiotic resistance in epidemiology of pneumococcal infections S.pneumonia is also a growing concern. in relation to serotypes and antibiotic Surveillance on pneumococcal serotypes resistance trends will help to implement and antibiotic resistance is necessary to pneumococcal disease preventive understand the epidemiology of measures. pneumococcal diseases and formulating appropriate treatment options. Here we present data on S.pneumoniaeinfections in Indian children, with response to its “BASELINE MINIMUM INHIBITORY serotype distribution and antimicrobial CONCENTRATION (MIC) OF susceptibility profile. SULBACTAM FOR ACINETOBACTER BAUMANII-CALCOACETICUS COMPLEX Aim: (ABCC) AND SYNERGISM WITH CARBAPENEM.” To determine the serotype distribution and antimicrobial resistance profile for Sangeetha Rajenderan1, Dr. Shakti S.pneumoniae in Indian children Laishram1, Dr. Shalini Anandan1, Dr.

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Balaji. V1, Department of Microbiology, index).Combination of meropenem and Christian Medical College, Vellore. sulbactam may show synergism for ABCC isolates. Introduction: Carbepenem are often the drugs of choice Conclusion: for the treatment of infections due to TKA detected synergism more than the multidrug-resistant ABCC. Due to checkerboard assay. High level of emerging resistance to carbapenems the synergism (77%), bactericidal effect treatment options are now limited only to (73%) and the lack of antagonism seen colistin and tigecycline which is not with combination of meropenem and approved for infections other than skin sulbactam in both CB and TKA are an and soft tissue and abdominal infection. encouraging outcome with possible use of Various drug combinations used for these combination of these drugs for the carbapenem isolates often without treatment of carbapenem resistant laboratory verification of efficacy of the Acinetobacter infection. combination against the isolate. “COMPARISON OF PNEUMOCOCCAL Aim: SEROTYPES IN ITS DISEASE POTENTIAL IN INDIAN ADULTS.” To determine MIC for sulbactam and in vitro synergistic activity of sulbactam in Suganya D¹, Baby Abirami S¹, Dr.Balaji combination with meropenem and V¹, ¹ Department of Clinical colistin against ABCC Microbiology Introduction: Materials and Methods: Streptococcus pneumoniae is a major cause of bacterial infections with Thirty carbapenems resistant ABCC significant morbidity and mortality isolates from respiratory and blood worldwide. WHO estimates sample was included in the study. MICs approximately 1.6 million deaths for sulbactam and meropenem were annually, in young children and elderly. determined by micro broth dilution Serotype based vaccines are effective in method as per CLSI guidelines. Synergism preventing pneumococcal diseases. Since between Sulbactam and meropenem was there is epidemiological variation in detected by the checkerboard (CB) and capsular types, serosurveillance is time-kill assay (TKA) at a sub-inhibitory necessary to determine the impact of concentration of ½ MIC. available vaccines . In our study we compared the seroprevalence of Results: bacteremic and non bacteremic pneumococcal isolates in adults.

to either meropenem or sulbactam. The Aim: checkerboardAll the isolates showingmethod MIC with (≥8µg/mL) the combination of meropenem and To determine the seroprevalence of sulbactam demonstrated40% synergism Streptococcus .pneumoniae causing and 60% indifference (lowest FIC diseases in Indian adults.

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Introduction: Materials and methods: A total of 145 S. pneumoniae invasive Development of antimicrobial resistance (CSF, Blood) and 148 non invasive among Gram-negative pathogens is isolates (sputum) collected during 2011 becoming progressively increasing and to 2013 were included in this study. associate with the dangerous noscomial Phenotypic identification were done by outbreak. E. coli is the most common conventional methods. Serotyping of etiologic gram-negative organism, which isolates were done by co-agglutination is followed in descending order of method and confirmed by molecular frequency by P. aeruginosa, Klebsiella typing (PCR). spp, Enterobacter spp, and A. baumannii. Multiresistant strains are particularly Result: problematic.

Most prevalent serotypes found in Objectives: invasive isolates are 1(16%), 19F(13%), 23F(5%), 5(5%), 4(3%). Pattern of To estimate the species prevalence among seroprevalence observed with non- the pathogens causing urinary tract invasive isolates are 19F (30%), 6B infection and also to determine antibiotic (15%) and 14(13%). Hence this study susceptibility pattern of significant elucidate the most common prevalence of pathogens isolated from urinary tract serotypes (1, 6B, 19F, 14 followed by 23F, infection. 5 and 4) encountered in invasive and noninvasive pneumococcal infection. Materials and methods: Conclusion: Urinary isolates collected during the The prevalence of serotypes varies period (2010-2012) and identified up to between invasive and non-invasive species level by conventional methods isolates. The epidemiology of and its antibiotic susceptibility pattern Streptococcus pneumoniae varies with against 15 different antibiotics were potency of disease which is illustrated in determined by micro-broth dilution our study. Continues surveillance is method (Pre-coated antibiotic panels essential to understand the pneumococcal from Merck), interpretation was carried disease and formulating vaccine out according to CLSI guidelines. strategies. Result:

“EMERGING ANTIBIOTIC RESISTANCE ESBL producing E.coli and Klebsiella spp AMONG GRAM NEGATIVE PATHOGENS showed promising activity to amikacin CAUSING URINARY TRACT INFECTION.” ertapenem, imipenem with 90%, 93%, 97% and 80%, 80%, 97% respectively. Yamuna Devi1, Agila Kumari1, Dr. V. Indeed ciprofloxacin and levofloxacin Balaji1, 1Department of Clinical showed poor activity against ESBL Microbiology, Christian Medical producing E.coli (6% & 9%) and College, Vellore. Klebsiella (13% and 39%). P.aeruginosa exhibits with the susceptibility profile of

Abstracts of Annual Research Day 2013

53%, 47%, 50%, and 50% to amikacin, Samples from 75 HIV-1, 13 HIV-2, 20 HIV ceftazidime, imipenem and negative and an additional 50 HIV-1 Piperacillin/Tazobactam. 100% of treatment experienced individuals were resistance to ertapenem was observed tested. ExaVir is an ELISA format to P.aeruginosa isolates. A.baumannii quantitate the RT activity in plasma showed a peak resistant profile against all (fg/ml) and gives corresponding VL the tested antibiotics (copies/ml) with the help of the software provided. The lower detection limit was Conclusion: 200 copies/ml. For HIV-1, values were compared with VL measured by real-time Routine screening of isolates for ESBL and PCR (Artus Qiagen,Hilden,Germany) and Carbapenemase detection is necessary to discordant samples or the ones with log10 formulate appropriate antibiotic therapy. difference of >0.5 were tested with another assay(Abbott,Illinois,U.S.A). For HIV-2 samples, ExaVir VL was correlated “EVALUATION OF THE CAVIDI EXAVIR with CD4 counts. The ExaVir and Artus VERSION 3.0 REVERSE real time PCR VL values in HIV-1 infected TRANSCRIPTASE(RT) ASSAY FOR THE treatment naïve individuals were MEASUREMENT OF HIV-1 AND HIV-2 compared with CDC staging for HIV. PLASMA VIRAL LOAD. “ Results: Priyadarshini A Padaki, Jaiprasath Sachithanandham, Veena V All the HIV negative samples were Ramalingam, Rita Isaac, O C Abraham, undetectable. Bland Altman analysis Susanne A Pulimood, Rajesh showed a bias of 0.1log between Artus Kannangai, Departments of Clinical and ExaVir (n=66, r=0.63, p<0.001) and Virology, RUHSA, Internal Medicine 0.2 log between Abbott and ExaVir (n=32, and Dermatology, Christian Medical r=0.81,p<0.001) with samples having College, Vellore, Tamil Nadu-632004 . detectable VL. The sensitivity of the assay was 77.6% and 82.5% when compared to Background: Artus and Abbott respectively for samples with VL >200copies/ml. The same for There is a need for simpler less expensive samples with VL >1000copies/ml, was HIV viral load (VL) assays for the 86.8% and 94.1% respectively. There was monitoring of HIV infected individuals. a significant negative correlation (rho= - 0.83, p=0.0039) between ExaVir HIV-2 VL Aim: and CD4 count. There was no significant correlation observed between CDC To evaluate ExaVir version 3.0 assay for clinical staging and ExaVir as well as the estimation of RT activity(equivalent Artus real time PCR VL values. plasma viral load) in HIV infected individuals. Conclusion:

The ExaVir version 3 assay has very good Materials and methods: specificity and has a better sensitivity

compared to its previous versions and

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hence can be used in resource limited isolates have shown a slight rise, from settings for the monitoring of HIV 3%(2010) , to 4% (2011) and 4%(2012). infected individuals including HIV-2. Of 1228 Klebsiella isolates, CRO have peaked , from 25%(2010) to 40% (2011) “ANTIMICROBIAL RESISTANCE IN and fallen to 25% (2012). Of the total 601 BLOOD CULTURE ISOLATES- A enterococci isolates, the VRE have risen TERTIARY CARE EXPERIENCE OVER 3 from 9% (2010) to 17.6%(2011) and YEARS (2010 TO 2012).” then fallen to 11.8%(2012).

Dr. Marilyn Mary Ninan, Dr. Shakti Conclusions: Laishram , Dr. Shalini Anandan, Dr. V. This study provides information on Balaji, Clinical Microbiology, Christian antibiotic resistance profile of blood Medical College , Vellore. isolates. It clearly illustrates howimproved antimicrobial stewardship Introduction: and good hospital control practices can help curb drug resistance. Blood stream infections are an important cause of mortality and morbidity - studying the resistance profile will help “IMPROVED ADENO-ASSOCIATED treatment. VIRUS (AAV) VECTORS FOR HEPATIC GENE THERAPY.” Objectives: Dwaipayan Sen1*, Akshaya To describe the temporal trend of Krishnagopal2*,Rupali A Gadkari3, resistant bacterial isolates (MRSA, ESBL, Govindarajan Sudha3,Vaani Roshini1, CRO and VRE) in blood cultures. Ijaz Mahamadulla2, Narayanaswamy Srinivasan3, Alok Srivastava1,2, Materials and Methods: Giridhara R Jayandharan1,2*., 1Department of Hematology, 2Centre All positive blood cultures during 2010– for Stem Cell Research, Christian 2012 were evaluated retrospectively. Medical College, Vellore, Tamil Nadu, 3Molecular Biophysics unit, Indian Results: Institute of Science, Bengaluru, India.

Amongst the total Staphylococcus * Both authors contributed equally. isolates, a fall in isolates of MRSA over 3 Background: years( 36% to 33%)with an upward Vancomycin MIC creep. Of 2259 E. coli Recombinant adeno-associated virus isolates over 3 years, a fall in the ESBL (AAV) vectors based on serotype -8 have isolates from 77% (2010) , to shown significant promise for hepatic 71%(2011), to 65%(2012). Of 1228 gene therapy of hemophilia B. However, Klebsiella isolates over 3 years, the ESBL the theme of vector dose dependent isolates have fallen from 61%(2010) to immunotoxicity seen with AAV2 vectors 51% (2011) and 53% (2012). Of 2259 , E. earlier has re-emerged with AAV8 vectors coli isolates over the 3 years, the CRO as well. We had previously reported that

Abstracts of Annual Research Day 2013

novel AAV2 vectors bioengineered at C57BL/6 mice. Hepatic gene expression specific (S)/threonine (T) alanine (A)or was analyzed 2 and 5 weeks after gene lysine (K) arginine (R) on its transfer in a small-animal imaging capsidhave enhanced potential for liver system.As seen in Fig. 1 A-C, the S156A directed gene transfer (Gabriel et al, Hum and double mutant (S671A+K137R) Gene Ther Methods, 2013). Similar proof- vectors showed increased luciferase of-concept mutagenesis of homologous expression (2.5-4 fold Vs WT-AAV8) in residues in the AAV8 serotype vectors the liver 2- weeks post gene transfer. improved coagulation factor IX Interestingly, at a longer follow-up (5 expression with concomitant reduction in weeks) a systemic distribution of inflammatory and neutralizing antibody luciferase gene expression was noted for response invivo (Sen et al, Hum Gene K143R, K652R, S149A and T138A vectors. Ther Methods, 2013).In the present This was further corroborated by real studies, we investigated if further time PCR analysis of vector copy numbers modifications of capsid motifs identified in organs like kidney (K143R- 4, K652R- by computational analysis on AAV8 can 8, S149A- 3, T138A- 1.6 Vs WT-AAV8- improve the efficiency of hepatic gene 0.67 vector copies/diploid genome) and therapy. spleen (K143R- 1.4, K652R- 14, S149A- 6, T138A- 2.7 Vs WT-AAV8- 0.3 vector Results: genome copies/diploid genome).

Extensive computational analysis was Conclusions: carried out toscrutinize other potential sites on the AAV8 capsid (PDB 2qa0), Our data suggests that alteration of AAV8 which would generate efficient novel phosphosites based on in silico prediction vectors. The study was done with respect alters the phenotype of this promising to the inclusion of specific gene therapy vector. Further on-going motifs/aminoacidsin phosphodegrons studies with these vectors expressing (phosphorylation sites recognized as human coagulation factor IX in murine degradation initiation signals by models, will demonstrate the feasibility of ubiquitinligases), they being either the use of these novel vectors for phosphosites or ubiquitination sites, or potential gene therapy of hemophilia B. their participation in the protein-protein interactions of the capsid proteins. Figure 1: Inclusion of these positions in the antigenic segments on capsid proteins Hepatic gene expression of various novel and/or in the receptor binding regions AAV8 vectors 2 weeks and 5 weeks post wasalso investigated.Based on data vector administration (A). Quantitation of generated from this analysis we data from A is presented in photons/sec, strategically mutated the following sites, 2 weeks (B) and 5 weeks (C) post vector K143, K652, S149, S156, T138, T654 on administration. AAV8 capsid. To test the efficiency of these novel vectors,we delivered luciferase gene under the control of -actin promoter (5x1010 vgs per mouse, i.v) into 8-12 weeks old male chicken β 88

Abstracts of Annual Research Day 2013

B Retrospective chart review of all A 2 weeks 5 weeks 2 weeks patients diagnosed to have cystic fibrosis 14 * WT-AAV8 12 * was done. Diagnosis of cystic fibrosis was 10 8 made by clinical features and elevated 6 sweat chloride level > 60meq/l. Few

K143R (photons/sec)10^6 4 children who had borderline sweat X 2 0 chloride level (>50meq/l), and suggestive clinical features of CF or one CFTR K652R Total Flux mutation with classical CF features were also included in this study. C S149A Sweat collection and analysis was done by 5 weeks WESCOR macroduct sweat collection 30 * system by pilocarpine iontophoresis. S156A 25 Clinical features were documented using * 20 a structured proforma. Mutation analysis

(photons/sec) 15 for four common mutations were done on T138A 10

X 10^6 10^6 X 5 a subgroup of children by ARMS 0 (Amplication Refractory mutation T654A -5 system) and verified by DNA sequencing. Total Flux -10 K137R +S671A Results:

Total number of children included in the study were sixty of which 36 (60%) were males. 35 (58%) reported symptom onset “CLINICAL PROFILE OF 60 CHILDREN in infancy, but only 20 (33%) were WITH CYSTIC FIBROSIS.” diagnosed before the age of 5 years. In 4 (7%) diagnosis was made only 10yrs after D. Accurate Mercy, Sneha Varkki, reported symptom onset. 1/3rd were Sumita Danda*, Department of given empirical anti tuberculosis Paediatrics and Department of Clinical treatment , based on their symptoms Genetics*, Christian Medical College before the diagnosis of CF. There were 3 and Hospital, Vellore,Tamil Nadu, families with more than one child 632004. affected. However prenatal genetic counseling was offered to none of them. Objectives: Majority 37(62%) of the children in our study were from southern Indian states. To document the clinical profile of Sweat chloride level varied from 50 -120 children with cystic fibrosis (CF) meq/l. 10(17%) children had values attending a tertiary care centre in South above 100meq/l. Genetic mutation India. analysis was done on a subgroup of 41(68%) subjects, 3 (5%) subjects had Methods: F508del mutation –homozygous and 6(10%) had the same mutation in one copy only. We also looked for G551D,

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G542X, 621G2T mutations but none were Study design: Randomized controlled present in this population. trial

Common clinical manifestations at the Objectives: time of presentation: To evaluate the effectiveness of medicine

ball training in sitting balance in persons Recurrent or persistent pneumonia in 51 with thoracic level spinal cord injury. (85%), failure to thrive in 37 (62%), steatorrhoea and malabsorption Setting: symptoms in 15 (25%) and history of meconium ileus in 1 (2%) were the Rehabilitation Institute, PMR Department, symptoms at presentation. History of Christian Medical College, Bagayam, salty taste on kissing was present in Vellore. 3(5%). 34 (57%) had bronchiectsis or severe lung disease at the time of Background: presentation. Nasal polyposis was the Spinal cord injury is a condition where only symptom in 2 children. 18 (30%) of motor, sensory, and autonomic systems these children had pseudomonas species are affected. Unsupported sitting is an isolated from airway secretion cultures. important component in spinal cord

injury patients to carry out most of their Conclusion: activities of daily living. Sitting balance We report here clinical profile of 60 can be improved by task specific training children diagnosed and followed up in and goal based exercises etc. Medicine our institution. Majority of children had ball exercise is a new intervention which advanced lung disease at the time of can be used to improve muscle strength, diagnosis. There are differences in the muscle power, co-ordination, balance, clinical and genetic profile of patients speed etc. In this study we are trying to reported from different parts of India. It is find how effective the medicine ball important to increase awareness about exercise was in high sitting balance in the condition in order to diagnose and person with spinal cord injury level T1 to initiate treatment early and to avoid T12. unnecessary anti tuberculosis treatment. It is also important to give prenatal Methodology: genetic counseling to parents and offer prenatal diagnosis where possible. Persons with thoracic level spinal cord injury (T1 to T12) satisfying the inclusion “EFFECT OF MEDICINE BALL TRAINING criteria are selected and randomly IN IMPROVING SITTING BALANCE IN allocated into control and experimental PERSONS WITH T1 TOT12 SPINAL group by computer generated random CORD INJURY.” allocation method. The primary investigator does the pre and post Annu T, Physical Medicine and intervention assessment and is blinded to Rehabilitation, Christian Medical the grouping and interventions. The co- College, Vellore. primary investigator does the intervention for persons in control and

Abstracts of Annual Research Day 2013

experimental group. The intervention is Spinal cord injury (SCI), Functional for 5 days a week for 2 consecutive balance scale (FBS), Modified functional weeks. The primary outcome measure reach test (MFRT). used in this study is modified functional reach test and secondary outcome Acronyms measure is duration of high sitting with SCI - Spinal cord injury arms at chest level without any support. FBS - Functional balance scale The normality of the collected data was MFRT - Modified functional reach test analysed and statistical tool was used accordingly for pre vs. post in within the group and post vs. post between two “CONTRALATERAL LIMB APPLICATION groups. OF TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) FOR Results: MANAGEMENT OF PHANTOM LIMB PAIN (PLP) IN AMPUTEES – A SINGLE The control group did not show a BLINDED RANDOMIZED CONTROLLED statistically significant difference in the TRIAL.” Modified Functional Reach Test (p value = 0.085). The control group showed Anumeha Srivastava, Physical statistically significant difference in Medicine and Rehabilitation, Christian unsupported sitting duration (p value = Medical College, Vellore. 0.012). Experimental group showed statistically significant difference in both Objectives: MFRT and Unsupported sitting duration (p value = 0.018 and 0.012 respectively). To find out the efficacy of contralateral Comparing the post interventional values limb application of TENS in the for both the groups there was statistically management of PLP. significant difference in the secondary outcome measure ie unsupported sitting Background: duration (p value = 0.026),Whereas the Almost 85% of all amputees experience primary outcome measure did not show PLP that hampers rehabilitative progress statistically significant difference (p value besides causing immense socio- =0.441). psychological distress. Residual limb site application of TENS has been the Conclusion: mainstay treatment. In the recent past, Contralateral limb application of TENS Medicine ball training was found to be an has been proposed to treat PLP. However, effective method to improve the high there are no Randomized control trials to sitting balance and thereby improving the support these findings. functional abilities in persons with spinal cord injury. Methodology:

Key words: A total of 16 amputees (mean age 37.25± 9.103 years) who registered for the Amputee Clinic at Christian Medical

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College, Vellore, were eligible and Sanjeev M Padankatti, Joseph Bedford consented to participate in this study. A Thomas Raj, Arputh Martin Sam baseline assessment was done by a Physical Therapist (PT 1) who was Background: blinded to the treatment given. Patients were then randomly allocated into Group Around 150 individuals have undergone I (Contralateral TENS) and Group II rehab at a residential school for (residual limb TENS). Final assessment individuals with cerebral palsy situated in was done by PT 1 after 4 days of Vellore town. During this period they intervention. Paired t test was used to undergo a holistic rehabilitation process find individual group efficacy. including occupational therapy, Independent samples t test was used to physiotherapy, speech therapy, special compare intergroup efficacy. education and vocational training. Till IRB Approval Minute Number: 8255. date the productive stature and functional status of these individuals who have Results: graduated from this center has not been evaluated. This study attempts to explore There was a significant reduction in PLP, how these individuals are performing in in both Group1 (p value = 0.000) and their respective communities. Group 2 (p value = 0.001). However, no significant difference was found between Aim: both the groups, in the reduction of PLP. (p value = 0.235) To identify the Functional status, community reintegration and the current Conclusion: self-perceived problems of individuals In patients with phantom limb pain, with cerebral palsy after a residential based rehabilitation. application of TENS to both the sites were found to be effective, however there was no difference between the groups. Design:

Implications to Healthcare: Cross sectional explorative study.

Contralateral TENS application can be Participants: started as an early intervention measure for management of PLP even before the Individuals with cerebral palsy residing residual limb site gets healed. within 20 KM radius of Vellore, who have undergone rehabilitation in the residential based rehabilitation center in “FUNCTIONAL STATUS AND Vellore. 10 males and 7 females were COMMUNITY REINTEGRATION IN recruited for this study. INDIVIDUALS WITH CEREBRAL PALSY AFTER RESIDENTIAL BASED Main Outcome Measures: REHABILITATION.” Gross motor functional classification system (GMFCS), Manual ability classification system (MACS), Craig

Abstracts of Annual Research Day 2013

handicap assessment and reporting Introduction: technique (CHART), Canadian Occupational Performance Measure Critical illness polyneuropathy and (COPM). myopathy (CIPNM) is a distal axonal sensorimotor polyneuropathy, in which Results: distal degeneration of both motor and sensory axons occur without The functional status at admission versus inflammation. It can complicate critical discharge was significant (p<0.01), but illness and manifests as muscle weakness the status from discharge till date and failure to wean from the ventilator. remains statuesque. Aim: The mean score for community The aim of our study was to find the integration according to the CHART was incidence of CIPNM in critically ill 76.49 ± 19.66. Physical independence children and to analyse the risk factors (82.24±17.23), cognition (80.29±20.23) associated with it. were the areas with high community integration and occupation (60.47 ± Method: 60.47) was the least. The children who were admitted to PICU, The prioritized self-perceived need as who either had SIRS for more than 5 days assessed by COPM was in the domain of and/or mechanically ventilated for more productivity; in areas of employment and than 5 days and/or who developed MODS house hold management. were included in the study. These patients underwent neurological Conclusion: examination and electrophysiological studies at first and second week after The Functional status after discharge inclusion in the study. from the Residential based rehabilitation center has neither improved nor Results: worsened.Though individuals have been There were 515 patients admitted to PICU well trained in the area of Physical during the study period, of which 30 independence and cognition, employment patients were included in the study. and household management stand as an Among the 30 children, 27 developed area of concern. CIPNM. Most of the affected children were less than 5 years of age with male predominance. 70% of children with CIPNM had PICU stay of more than 10 “PAEDIATRIC CIPNM STUDY – A days. Among the 27 children with SIRS, 25 PROSPECTIVE DESCRIPTIVE AND developed CIPNM and 16 out of 17 OBSERVATIONAL STUDY ON CRITICAL children with MODS developed CIPNM. 17 ILLNESS POLYNEUROPATHY AND children had both SIRS and MODS, out of MYOPATHY IN CHILDREN.” which 16 developed CIPNM. In children Cherryl Tryphena, Maya Thomas, with CIPNM, 24 required ventilation for Mathew Alexander, Ebor Jacob, more than 5 days. 6 out of 30 patients Department: PICU, CMCH, Vellore. underwent dialysis for acute kidney injury and all 6 children developed

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CIPNM. 59% of children had high CPK Methods: levels and 89% had positive CRP. Three patients were recruited between Conclusions: December 2010 and May 2012, two had carcinoma oropharynx and the third had Children less than 5 years were more carcinoma hypopharynx. The treatment prone for developing CIPNM with male planning was done in two phases. Phase I predominance. Risk factors like SIRS, included High risk volume(HRV) and MODS, prolonged PICU stay and sepsis Intermediate risk volume(IRV) and were associated with higher chances of received 60Gy in 50 fractions at 1.2Gy per developing CIPNM. fraction, two fractions per day, 6 – 8 hours apart. The Low risk volume(LRV)

received 55Gy at 1.1Gy per fraction. In Phase II, HRV received 1960cGy in 20 “HYPERFRACTIONATED INTENSITY fractions, to a total of 7960cGy over 7 MODULATED RADIATION THERAPY weeks. (HF-IMRT) IN HEAD AND NECK CANCER - A PILOT STUDY TO ASSESS THE Results: FEASIBILITY.” The three patients were assessed weekly Balukrishna S, Reddy V.K. , Rajeev during radiotherapy for radiation induced Michael , Paul Ravindran, Prasanna toxicities. The overall treatment duration Samuel, Simon Pavamani, Selvamani B, ranged from 50 to 60 days. The maximum Viswanathan P.N.,Dept of Radiation break during treatment was 11 days. Oncology, Ida B Scudder Cancer Centre, Grade II dermatitis was seen during the Christian Medical College, Vellore. last 2 weeks of radiation. Grade II mucositis was seen in two patients and Aim: the patient with carcinoma supraglottis had Grade III mucositis during the last 3 weeks of radiation therapy. One patient To study the feasibility of hyper- was disease free at 9 months and another fractionated radiation therapy in head was disease free at 6 months. The third and neck cancers utilising Intensity patient is due for his follow up visit. Modulation. Swallowing function was assessed Background: subjectively and all three patients required diet modification during Among various fractionation schedules in radiation therapy. The average weight head and neck cancers, survival benefit loss was 3Kg during radiation therapy. was seen only in hyperfractionation according to Meta-analysis by MARCH Conclusion: collaborative group. The present study This pilot study demonstrates the was conducted to investigate the benefits feasibility of combining radiobiological of combining hyperfractionation with benefits of hyperfractionation with tissue Intensity Modulated Radiotherapy. sparing IMRT. With the benefit of normal tissue sparing of IMRT, the acute toxicity is expected to be less.

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have had pessary insertion with structured follow up by the clinician may “INCARCERATED PESSARY: REPORT OF help in the prevention of major A CASE SERIES FROM CMCH OG complications. DEPARTMENT.” “OCULOFACIOCARDIODENTAL Catherine. S*, Aruna N Kekre**, SYNDROME IN SIBLINGS – AN EIGHT Department of Obstetrics and YEAR FOLLOW UP. “ Gynaecology Unit II, Christian Medical College, Vellore ,TN. Deepa John*, Padma Paul*, , Sumita Danda**, Santosh koshy*** Kerstin *MS postgraduate trainee, **Professor & Head Kutsche#, Renu Raju*, *Departments of Pessaries are used in non-surgical Ophthalmology, **Clinical Genetics and management of pelvic organ prolapse in *** Dental Surgery, Christian Medical patients on whom definitive surgery is College, Vellore, India and Institute of deferred due to underlying comorbidities Human Genetics, University Medical or advanced age. They are also used in the Center Hamburg-Eppendorf, Hamburg, management of stress urinary Germany. incontinence and in pregnancy complicated by prolapse or incarcerated Contact Information: and retroverted uterus. Pessaries though Deepa John cost effective and easy to use are not Department of Ophthalmology, without complications. We report Schell Eye Hospital, herewith three patients with Christian Medical College. complications related to use of pessary. Three women with impacted ring pessary Introduction: were seen in our department during the Two sisters, now aged 8 and 6 years, were period 2009 to 2013. All of them had brought by their mother at 40 and 13 history of prolapse ranging from 3 to 23 days of age respectively, as advised by years. All three patients required removal their physician. Examination revealed of the impacted pessary under bilateral cataract and microcornea in both anaesthesia. Two patients required sisters. They underwent bilateral lens definitive corrective surgical procedure in matter aspiration, primary posterior the form of Vaginal hysterectomy with capsulotomy and partial anterior pelvic floor reconstruction for prolapse. vitrectomy, and were given aphakic One 90 years old patient had reinsertion spectacles. Systemic evaluation showed of pessary. ventricular septal defect with pulmonary Pessary insertion can result in serious stenosis and facial dysmorphism in the complications. We emphasize the elder child. Based on this a diagnosis of importance of patient education on self- oculofaciocardiodental (OFCD) syndrome care, regular follow up and the need to was considered and genetic testing seek immediate medical advice in the requested. Molecular analysis of the BCOR presence of warning symptoms. gene revealed a heterozygous nonsense Maintaining a register of patients who mutation (c.3490C>T / p.R1164*) in exon 8 in both sisters confirming the diagnosis

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OFCD syndrome. On follow up, both Dysfunction using Echocardiogram and children developed raised intraocular assessing the prevalence of Hypertension pressure in one eye. The elder sibling was by both clinic BP and 24 hour Ambulatory started on topical antiglaucoma BP monitoring. medications while the younger sibling required Methods: trabeculectomy.Discussion:OFCD syndrome is an X-linked genetic disorder In this prospective cross sectional study, that affects ocular, cardiac, facial and 1-18 year old children with CKD stages III dental systems(1,2). It is seen only in to V were recruited from the Pediatric females as it is embryonically lethal in Nephrology OPD after informed parental males(3). Ocular features such as consent.Cardiovascular risk was assessed congenital cataract, microcornea, by comparing 3 clinic BP readings with secondary glaucoma(1)and typical 24hour Ambulatory BP (ABPM) using coloboma(4) have also been Space Labs Health Care machine. ECHO described.Conclusions:Congenital was done to determine Left Ventricular cataract surgery at an early age along Hypertrophy (LVH) and Left Ventricular with small cornea carries a high risk for dysfunction. raised intraocular pressure. It is essential to have periodic follow up to assess vision, refraction, intraocular pressure Results: and other co-morbidities in children with Forty six children with CKD were studied. OFCD. The Male: Female ratio was 4.1:1. Obstructive uropathy was found to be the commonest cause of CKD (48%). Clinic “A PROSPECTIVE CROSS SECTIONAL Hypertension was present in 10/46 STUDY OF THE CARDIOVASCULAR (21.7%) while ABPM helped to detect RISKS IN CHILDREN WITH CHRONIC masked hypertension in 32/46 (69.5%). KIDNEY DISEASE.” Amongst known hypertensives on treatment, Clinic BP was elevated in 8/34 Dulari Gupta1, Indira Agarwal 1, (23.5%), whereas ABPM was elevated in Swasti Chaturvedi1 and Sunil Chandy 30/34 (88.2%). Thus ABPM was able to 2. 1Pediatric Nephrology, Christian detect an additional 22/30 (73.3%) Medical College, Vellore, Tamil Nadu, children with poor BP control. India and 2Cardiology, Christian Echocardiography detected LVH in 13 Medical College, Vellore, Tamil Nadu, children (28.26 %).Those on dialysis had India. a significantly higher percentage of LVH (p=0.036). Left Ventricular Mass (LVM) Introduction and Aims: and LVM/Ht were found have linear Cardiovascular consequences in children correlation with systolic and diastolic with chronic kidney disease are an blood pressure detected by both ABPM important cause of mortality but are not and Clinic BP (p = <0.001). adequately monitored. We aim to study Conclusions: the cardiovascular risks amongst children with CKD by measuring Left Ventricular

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Hypertension is an important Secondary Outcome: cardiovascular risk factor amongst 1. Timed up and go test children with CKD and may be masked. ABPM is strongly recommended in every Result: child with CKD along with regular ECHO to reduce morbidity and improve Lindop Parkinson’s assessment scale gait [email protected] Cell: mobility mean pre test score was found to 09894145887. be 24.36 which was increased post cycling to 27.71 ( significance level 0.001 ). .Mean POMA pre test score was 19.50 and post test score was found to be 22.43 Objective: To find out immediate effect (significance level 0.001) which clearly of active leg cycling on functional mobility indicates a marked difference following and risk of fall in individuals with the therapy. TUG test score showed Parkinson’s disease significant improvement from 22.64 to 19.36 following therapy (level of Design: significance 0.02). UPDRS motor pre test Quasi experimental one group pre test mean was 4.14 and post test mean was post test study 3.79. (significance level 0.290). Method: Conclusion:

Patients fulfilling the inclusion criteria This study proves that there is significant have been recruited for the study. improvement in functional mobility and a Functional mobility and risk of fall were remarkable reduction in of risk of fall in assessed using UPDRS motor subscale, individuals with Parkinson’s disease, Lindop Parkinson’s assessment tool , following three days of 30 minutes active Timed up and go test(TUG) and Tinnetti leg cycling . UPDRS subscale scores balance gait POMA scale before however did not show significant treatment. Active leg cycling was improvement post cycling. administered for 3 consecutive days. Key Words: After three days of treatment the same assessment was repeated. The values PD-Parkinson’s disease obtained during the pre test and post test was calculated and observed the difference before and after cycling. “POSITIONING FOR COUGH EFFICIENCY Outcome measure(s): IN PERSONS WITH HEMIPARESIS.”

Primary Outcome: Hephzy Philipose, Samuel Vinod 1. UPDRS- Subscale III – 26,27,29 Kumar D, Lenny Vasanthan T, Raji Thomas, Anand Zachariah. 2. Lindop Parkinson’s assessment scale Background:

Person with hemiparesis or hemiplegia 3. Tinnette Balance Gait –POMA followed Cerebro Vasculo Accident (CVA)

Abstracts of Annual Research Day 2013

carry a risk of developing respiratory Conclusion: complications which could range from retention of secretions, atelectasis to Positioning a person in a more upright aspiration pneumonia, this is primarily position helps in improving cough due to their inability in clearing efficiency. PCF is a safe method which can secretions accumulated in the airways. be used in persons with Hemiparesis.

Strength of cough varies with position of a Key Words: person, though this is a physiologically Secretion, Airway clearance, Forced accepted principle there are no studies to expiration, Peak cough flow. elucidate the same. Hence we have attempted to find an efficient position for coughing in persons with hemiparesis which would help health care members “ACUTE MYELOID LEUKEMIA WITH who are involved in bronchial hygiene to THE T(1;22)(P13;Q13)- REPORT OF make evidence based decisions on the use THREE CASES.” of positioning for effective secretion clearance. Meena J 1, Nancy A1, Sitaram U2,Ganapule A1, Abraham A1, Objectives: Viswabandya A1, George B1, Mathews V1, Srivastava A1, Srivastava VM.3., To explore the efficient position for cough Departments of 1Haematology, 2 in persons with hemiparesis following Transfusion Medicine and CVA. Immunohaematology and 3 Methodology: Cytogenetics Unit, Christian Medical College, Vellore. 24 subjects with at least grade 2 voluntary control according to Introduction: Brunnstorm voluntary control scale were The t(1;22) is a rare translocation which recruited from multidisciplinary stroke is typically associated with AML M7 in clinic (PMR OPD) and medicine wards. infants and young children and an After obtaining their written consent they intermediate to poor prognosis 1. This were asked to cough on a peak cough flow translocation is seen in 0-3% of paediatric (PCF) meter three times in each position AML and results in the formation of a (supine, both side lying and supported fusion gene, RBM15/MKL12,3. In the sitting). Best of three measurements were WHO classification (2008) of AML with taken for analysis. recurrent genetic abnormalities, AML Results: with the t(1;22) has been included as a separate subtype 4.Fewer than 50 cases Values obtained were analysed using have been described till date 5.We SPSS version 16.0.Sitting position showed describe the cytogenetic and a higher value in PCF as compared to all morphological features of three children other positions. Incidentally we found with the t(1;22). that people who were used to smoking generated a higher expiratory flow rate Materials and methods: when compared to non smokers.

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Karyotypes of AML with the t(1;22) seen between January 2003 and July 2012 were correlated with peripheral blood References: and bone marrow findings. For each 1. Bernstein J, Dastugue N, Haas patient, at least 20 G-banded metaphases OA, Harbott J, Heerema NA, Huret were analysed from unstimulated JL, Landman-Parker J, LeBeau overnight cultures of bone marrow. MM,Leonard C, Mann G, Pages Results: MP, Perot C, Pirc-Danoewinata H, Roitzheim B, Rubin CM, Slociak There were 1694 AML seen during the M, Viguie F.Leukemia. 2000 period of study of which three (0.18%) Jan;14(1):216-8. showed the t(1;22). The age of the 2. Carroll A, Civin C, Schneider N, Dahl G, patients was 9 months to two years. Two Pappo A, Bowman P, Emami A, Gross were males. The haemoglobin ranged S,Alvarado C, Phillips C, et al. Blood. from 7.5 - 10.3 g/dl, WBC count, 1.3 – 1991 Aug 1;78(3):748-52. 30.9× 109 /L, and platelet count, 5 -129 × 3. Ma Z, Morris SW, Valentine V, Li M, 109 /L. Herbrick JA, Cui X, Bouman D, Li Y, Mehta PK, Nizetic D, Kaneko Y, Chan One of the three children had received GC, Chan LC, Squire J, Scherer SW, treatment elsewhere and his marrow Hitzler JK. Nat Genet. 2001 showed acute leukemia with 40% blasts; Jul;28(3):220-1. further morphological subtyping was not 4. Vardiman JW, Thiele J, Arber possible. DA, Brunning RD, Borowitz MJ, Porwit The other two patients presented at A, Harris NL, Le Beau MM, Hellström- diagnosis. In one, the bone marrow Lindberg E, Tefferi A, Bloomfield CD. morphology morphology was typical of Blood. 2009 Jul 30;114(5):937-51. doi: AML M7. The marrow of the third patient 10.1182/blood-2009-03-209262. showed scattered immature cells Epub 2009 Apr 8. resembling megakaryoblasts with focal 5. Huret JL . t(1;22)(p13;q13). Atlas marked reticulin fibrosis. Genet Cytogenet Oncol Haematol. June 2001 . All three children had hyperdiploid karyotypes (chromosome number 47~56). The additional abnormalities “A NEW ERA IN included gain of the derivative THE MANAGEMENT OF RH chromosome 1 and trisomy 6 in two ISOIMMUNISED PREGNANCY - USE OF patients. MARI’S CURVE.” Jameela Pon Malar A. R, Jiji Elizabeth Conclusion: Mathews, Swathi, Santhosh, Anuja, Department of Obstetrics and AML M7 may be mistaken for a non- Gynecology, Christiab Medical Collrge, haematopoietic tumour due to the Vellore. primitive appearance of the blasts 1. Therefore, it is important to be aware of Introduction: this translocation which is diagnostic of AML M7.

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Red blood cell alloimmunization, also with false positivity of 12% .False known as erythrolastosis fetalis,is the positivity increases after 35weeks. formation of maternal antibodies to fetal RBC antigens.These antibodies can Conclusion: lead to hemolysis and anemia in the We have attempted to place the most fetus.Most recently progress in the field contemporary advancement ,MCA-PSV

of ultrasonography has improved for the diagnosis of fetal anemia into its management of this disease through appropriate historical and clinical less invasive means of anemia context while reviewing the current

diagnosis by using mari’s curve. knowledge of this disease.

Case Report:

Mrs.X, G4P3L2END1, previous 3 LSCS, booked at 10weeks gestation was detected to be allo-immunised in the second trimester ,and was on frequent follow up .Her indirect coombs test,in dilution was 1.128 at 27+4weeks and was serially monitored with MCAPSV on mari’s curve .Cordocentesis was done twice to check fetal hematocrit as MCA PSV was in zone A.She was admitted in ward at 32+2weeks for close monitoring since there was drop in fetal hematocrit.she was given steroids for lung maturity and at 33+2weeks she went into spontaneous labour and undewent Caesarean section .Baby was found to have a bilirubin of 5.1mg% on the second day was treated with double surface phototherapy and baby was well at discharge.

Discussion:

Amniocentesis for detecting fetal anemia become obsolete since the first large trial of doppler sonography of the middlec erebral artery was published by MARI ET AL in 2000.Ultrasound examination of the MCA in fetus has become the standard of care for fetal anemia screening. MCA PSV greater than 1.5MOM have 100%sensitivity

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MEDICAL SPECIALITY

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“ANTIBIOTIC SUSCEPTIBILITY prevalent in children between 4 to 10 PATTERN OF ORGANISMS years of age. Recently the increase in the ASSOCIATED WITH rates of antibiotic resistance amongst the TONSILLOPHARYNGITIS IN major microbial agents involved, has PAEDIATRIC PATIENTS IN A compromised the selection of empirical TERTIARY CARE CENTRE.” treatment for some of these infections. This study identifies the micro-organisms associated with acute tonsillopharyngitis 1 1 Kent RK , Abhinav A , Margaret SFX and their antimicrobial susceptibility 2 2 3 , Winston AB , Debasis DA , Shalini pattern in paediatric patients. 4 A Settings & Design: 1.Undergraduate Students, IInd year, Christian Medical College, A retrospective study conducted in a Vellore, tertiary care centre in India. 2.Department of Pharmacology, Christian Medical College, Vellore, Subjects & Methods: 3.Department of Paediatrics, Christian Medical College, Vellore, A total of 389 patients below 15 years of 4. Department of Microbiology, age, who presented with acute Christian Medical College, Vellore tonsillopharyngitis during February - June 2013 were included in the study. Background: Their microbiology reports and demography details were analyzed. Acute respiratory tract infections are the most common illnesses in childhood, of Results: which tonsillopharyngitis is the most

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Among the 389 samples, 141 (36.3%) grew normal flora and 7 (1.8%) did not Conclusion: grow any micro-organisms. Among the rest 241 samples, 186 (77.2%) grew a The commonest organisms isolated were single organism while 55 (22.8%) grew -haemolytic more than one organism. Streptococci. Most of these organisms wereHaemophilus susceptible species to the andpenicillin β group of The most common organisms isolated drugs. The resistance of Streptococcus were Haemophilus parainfluenzae 142 pneumoniae to Penicillin was also noted. -haemolytic Streptococci (Groups A, C & G) 57 (18.8%), Haemophilus(36.2%), β influenzae 30 (9.9%), “PSEUDOACHONDROPLASIA: Streptococcus pneumoniae 26 (8.6%), REHABILITATION CHALLENGES AND Staphylococcus aureus 12 (4.0%), PREVENTION OF MISDIAGNOSIS.” Moraxella catarrhalis 12 (4.0%) and MRSA 11 (3.6%). Lahunlang Sohliya, Rohit Bhide, Shiela Mary Verghese, Raji Thomas, -haemolytic Streptococci (Groups A, C & Department of PMR, Christian Medical G) were susceptible to Penicillin (100%) College, Vellore. andβ Erythromycin (56.1%). Pseudoachondroplasia has been mistaken Haemophilus influenzae were susceptible for classical Achondroplasia, which is the to Amoxicillin/clavulanic acid (100.0%), most common type of short limbed Azithromycin (100.0%), Ceftriaxone dwarfism. The two, although genetically (100.0%) and Levofloxacin (96.7%) while different phenotypes, can be mistaken for they were highly resistant to each other, if the differentiation between Sulfamethoxazole (76.7% resistant). their presenting features is not clear. Accuracy of diagnosis is important for Other Haemophilus species (H. genetic counselling and patient parainfluenzae, H. hemolyticus, H. management. parahemolyticus) were susceptible to In this report, we describe the case of a 37 Amoxicillin/clavulanic acid (97.3%), year old lady diagnosed earlier to have Azithromycin (95.9%), Ceftriaxone achondroplasia. She presented to us with (93.2%) and Levofloxacin (89.0%) while multiple somatic complaints and inability they were highly resistant to to meet the daily challenges of her Sulfamethoxazole (78.8% resistant). disorder. She had undergone multiple surgeries and procedures prior to Streptococcus pneumoniae were presenting to us. While admitted under susceptible to Levofloxacin (100%), us, she was diagnosed to have Penicillin (92.3%) while being resistant pseudoachondroplasia. to Erythromycin (53.8%). The report touches upon how Moraxella catarrhalis were susceptible to pseudoachondroplasia can often be Levofloxacin, Netilmicin, Amikacin, misdiagnosed as achondroplasia, and the Ceftazidime, Tobramycin and Piperacillin clinical and roentgenological features (100%).

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which differentiate the two are neck. There was diffuse cutaneous elaborated so that such instances can be atrophy of the trunk and extremities and prevented. The physical challenges of mottled pigmentation over the posterior dwarfism and the medical complications trunk and extremities. Haemorrhagic of pseudoachondroplasia are thereafter bullae were noted over the palms and discussed. The report also describes the erosions with haemorrhagic crusting role of rehabilitation to overcome these noted over the extremities especially over challenges by physical and occupational the joints. Mild palmoplantar therapy and the use of orthoses to keratoderma was present. Oral mucosa, improve ambulation and activities of daily scalp and nails were normal. living. Discussion: “KINDLER’S SYNDROME WITH A NOVEL MUTATION OF THE FERMT1 GENE : A With the above, a possibility of Kindler’s CASE REPORT.” syndrome was suspected. Genetic analysis revealed a novel homozygous Lydia Mathew 1, Renu George 1, mutation c.907G>T, p.E303* in exon 7 of Christina Has 2 Department of the FERMT1 gene confirming the Dermatology, Venereology and diagnosis of Kindler syndrome. Leprosy, Christian Medical College1 and the Department of Dermatology, Conclusion: University of Freiburg, Freiburg, Germany 2 In inherited blistering disorders, a history of photosensitivity and careful cutaneous Introduction: examination for poikilodermatous changes is essential to suspect Kindler’s Kindler’s syndrome is an autosomal syndrome. The report of the novel recessive inherited blistering disorder mutation detected in our patient adds to characterised by skin fragility caused by the evolving database of this rare mutation in focal adhesion protein inherited blistering disorder. kindlin-1 expressed in keratinocytes especially basal keratinocytes . Kindlin-1 “EFFECTIVENESS OF A PARENT is encoded by the FERMT1(KIND1) gene ADMINISTERED PRE-FEEDING on chromosome 20p12.3 STIMULATION PROTOCOL ON PRE- TERM INFANTS.” Case report: Magdalene Grace, Sanjeev Padankatti, A 5 year old girl born by normal vaginal Hima J.B, Grace Samuel, Anil Kuruvilla, delivery to parents of non- Department of Neonatology, consanguineous marriage presented with Department of Physical Medicine And history of recurrent blisters over the Rehabilitation, Christian Medical trunk and extremities since 5 days of College and Hospital, Vellore. birth. There was a history of Background: photosensitivity. On examination poikilodermatous skin was noted over the Preterm babies often have oral-motor difficulties due to which they are started

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on naso-gastric tube feeds. Oral-motor as efficient as the therapist in providing stimulation is required in order to enable oral-motor stimulation. However, further optimum suck-swallow-breathe co- research using a larger study population ordination which is an important pre- is needed to generalize the findings. requisite to oral feeds. Complete oral feeds are an important criterion for discharge from the nursery. This study “FOOD BELIEFS AND PRACTICES aims at comparing the effectiveness of DURING PREGNANCY WITH SPECIAL stimulation given by the therapist to REFERENCE TO THERMAL intervention given by the mother on ATTRIBUTES.” outcomes such as length of hospitalization, weight gain, head Mahendri. N.V., Department of circumference, time required for Dietetics, Christian Medical College, transition from gavage to oral feeds and Vellore-632 004. neonatal breastfeeding behaviors. *Ms. Mahendri .N.V Methods: HOD, Department of Dietetics 21 Infants who fulfilled the inclusion Christian Medical College, Vellore- 632 criteria were included in the study. They 004 were randomly divided into 2 groups Email ID: [email protected] (Group A =10, group B=11). Stimulation was begun once they were on stable Background: feeds. Group A received stimulation from the therapist only and Group B received Maternal diet is an important stimulation from the mother. Neonatal determinant of outcomes of pregnancy breastfeeding behaviour observations and is strongly influenced by food choice. were carried out twice a week once the Every society has its own traditional child started to breastfeed, till discharge. beliefs and practices regarding food Head circumference was measured twice choice during pregnancy. In India, a week. Other details were obtained from thermal attributes of food play a major records. role in food selection during pregnancy.

Aim: Results: In all the parameters assessed there was To assess food beliefs and practices with no significant difference between the special reference to thermal attributes therapist’s and the mothers’ intervention. during pregnancy. The modified behaviour state of quiet alert (p value=0.02) was found to be Methods: better in the group in which the therapist intervened (Group A=0.005, Group A cross-sectional survey was conducted B=0.003). in an urban antenatal clinic of a tertiary care center in Tamilnadu .100 pregnant Conclusion: women visited the clinic were From this study it can be concluded that interviewed after obtaining their consent. mothers who are taught the protocol are A pre-tested questionnaire was used to

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elicit the information. Statistical analysis Dr. H. S. Asha, was done using proportions (%). Associate Professor, Department of Endocrinology, Diabetes Results: and Metabolism, Christian Medical College Hospital, 55-90% of the subjects believed thatragi, Vellore-632004, India. whole grams, milk, curd, green leafy vegetables, beans, roots, apple, banana, Introduction: guava, orange, pomegranate and non- vegetarian foods (except chicken), were H syndrome is a rare autosomal recessive healthy foods and included. 40-90% genodermatosis caused by mutation in believed that papaya, pineapple, jamun, the SLC29A3 gene which encodes for horse gram, chicken and beef were hot, hENT3. Utilizing Next Generation harmful foods and can lead to abortion Sequencing approach this report presents and avoided. 10-55% believed ragi, a SLC29A3 mutation ina 19 year old girl banana, guava, orange, beans ,cabbage, withH syndrome. pumpkin as cold foods and avoided. Case report: However, majority of them still included ragi, guava and orange as they considered Our subject, born to parents of non- them to be healthy foods. All respondents consanguineous marriage presented were literate except one. Majority of the withprogressively increasing subjects’ food choice was found to be hyperpigmented lesions and influenced by mother and mother-in-law. generalisedhypertrichosis from 6 years of age.She developed diabetes at the age of 6 Conclusion: years, hypothyroidism and hearing loss at 9 years of age. She had primary Changing traditional food belief and amenorrhoea.She was short statured and practices is difficult; however cutaneous features included symmetrical personalized nutrition education would largehyperpigmented , indurated plaques help in improving dietary practices of with terminal hair over the lower limbs pregnant women. with characteristic sparing the buttocks and knees, hyperpigmented patches over the lower abdominal wall,hirsuitism with “THE H SYNDROME: A CASE REPORT” FerrimanGallwey score of 12/36, ichthyosis of the feet with non-pitting Mahesh D M, Lydia Mathew1, Aaron pedal edema. Other features noted Chapla, H S Asha, Renu George1, werecamptodactyly, arthrogryposis at the Thomas Paul, Nihal Thomas, ankles, breasts –tanner stage 1. She had Department of Endocrinology, non-auto-immune insulin deficient Diabetes and Metabolism, Christian diabetes mellitus. She had anelevated ESR Medical College, Vellore, India, and CRP, audiogram showed bilateral 1Department of Dermatology, sensorineural hearing loss andbicuspid Christian Medical College, Vellore, aortic valveon echocardiogram suggestive India. of H syndrome.Next Generation Sequencing of SLC29A3 gene revealed a CORRESPONDING AUTHOR:

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previously reported homozygous administration affects clinical pregnancy mutation c.400C>T, p.R134C. These rate in fresh embryo transfer cycles. results were further confirmed by Sanger sequencing. Materials and methods: Retrospective cohort study of all IVF Conclusion: cycles at the Reproductive Medicine unit The diagnosis of H syndrome was based in CMC Vellore from January 2011 to on confirmedhomozygous SLC29A3 December 2012. mutationwith spectrum of multisystemic manifestationswhich include Results: hyperpigmentation, hypertrichosis, hyperglycemia, height abnormality (short There were 285 fresh embryo transfer stature), antagonist cycles of which 136 cycles hypogonadotropichypogonadism, (47.1%) had a clinical pregnancy. 17 sensorineural hearing loss and cycles had a progesterone level > 1.5 involvement of the heart. ng/ml, out of which 3 (17.6% ) had a clinical pregnancy. 272 cycles had a progesterone level 1, out of GONADOTROPIN (HCG) which 5 (20.8% ) had a clinical ADMINISTRATION AFFECT CLINICAL pregnancy. 265 cycles had a PREGNANCY RATE IN FRESH EMBRYO progesterone/estradiol ratio

Background: The clinical pregnancy rates are significantly lower in the fresh embryo Elevated serum progesterone levels on transfer cycles in which the progesterone the day of hCG administration has been levels on the day of hCG trigger are > 1.5 suggested to cause premature ng/ml, or the progesterone/estradiol endometrial advancement and hence ratio is >1. decline in pregnancy rates. However, the evidence is still weak especially with regard to antagonist cycles, “EFFECT OF THERAPEUTIC DOSES OF Aim: CIPROFLOXACIN ON QTC INTERVALS IN NEONATES.” To determine whether serum progesterone level on the day of hCG

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Nelby George Mathew, Devi A, Atanu antibiotic, 24-48 hours and 72 hours Kumar Jana, Niranjan Thomas, after the first dose of ciprofloxacin. To Department of Neonatology and account for the variation in heart rate the Cardiology, Christian Medical College, corrected QTc interval was calculated Vellore. using 3 formula’s- Bazetts’, Fredriks and linear regression (QTc interval was Background: calculated as in five beats using lead II and these five values were then Ciprofloxacin is used commonly as a averaged). second line antibiotic in neonatal infections. Ciprofloxacin is known to Outcome measures: cause QT prolongation in adults but the A QTc interval higher than the arbitrary effect in neonates has not been studied. value of 0.450 msec was regarded as Over the last 3 years, 2 babies admitted in significant and the mean difference in QTc our unit died soon after an intravenous was also evaluated. dose of ciprofloxacin. There are also a few case reports that have reported Results: sudden death after ciprofloxacin use in neonates and children. The mean QTc increased from 401.4±23.9 mses at baseline to 405.6±23.38 at 24

hours and 406.3±27.3 at 72 hours. This Objective: was not statistically significant. However,

though there were no babies with QTc > To evaluate the effect of therapeutic 450 msec before ciprofloxacin doses of ciprofloxacin on QTc intervals in administration, 2 babies developed QTc > neonates. 450 msec after ciprofloxacin

administration. Of the three methods Setting: used to measure QTc, the QTc was longest

in the linear regression method and the Tertiary care neonatal unit in south India shortest in the Fredriks method. from April 2013 to September 2013.

Conclusion: Methods: The study was an observational cohort Ciprofloxacin in neonates caused study in which babies in the neonatology prolongation in mean QTc, though this unit who were started on ciprofloxacin, was not statistically significant. However, were included. Those with complex heart two babies developed QTc > 450 msec disease, hypothyroidism, electrolyte after ciprofloxacin administration abnormalities, on drugs known too affect suggesting the possibility of a potential to the QT interval and those with baseline cause cardiac arrthymias and sudden QTc > 450 msec were excluded, According death. to the unit protocol ciprofloxacin was given at a dose of 20 mg/kg/day in two divided doses. Twelve lead ECG was Keywords: obtained as base line before starting the

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Ciprofloxacin; QTc interval, Arrthymias. bilateral hip replacement. MRI spine revealed multilevel disc bulge, with spinal canal narrowing and C3-4 intervertebral disc prolapse. “SPONDYLOEPIPHYSEAL DYSPLASIA TARDA WITH PROGRESSIVE Conclusion: ARTHROPATHY MIMICKING JUVENILE RHEUMATOID ARTHRITIS.” Genetic disorders like SEDT-PA may have a rheumatological involvement, and they Nicholas Vijay Rao G are a close mimic of juvenile rheumatoid arthritis. The classic difference being Background: presence of non erosive arthritis and lack Spondyloepiphyseal dysplasia tarda with of response to Disease modifying anti progressive arthropathy (SEDT-PA) is a rheumatic drugs (DMARDs).It’s important rare autosomal recessive hereditary to consider this entity in the differential skeletal disease. WISP3 gene is essential diagnosis of progressive arthropathy. for maintaining cartilage integrity mainly THORACIC SCOLIOSIS by regulating the expression of collagen II. Mutations of WISP3 gene can compromise this function and lead to cartilage loss leading to SEDT-PA. It is characterised by generalised platyspondyly and epiphyseal involvement, with enlargement of both ends of the short tubular bones of the hands. Clinical features include onset in childhood, a disproportionately short stature and premature osteoarthritis.

In the present case report, we describe a female patient diagnosed with SEDT-PA at the age of 39 years who presented with pain and progressive deforming arthritis of the hip joint and the small joints of the hand since the age of 6 years. She had a short stature with exaggerated thoracic kyphosis and lumbar lordosis. The range of motion was restricted in the spine, hip PLATYSPONDYLY and the wrist joints. Phalangeal epiphyses and metaphyses were enlarged with multiple joint narrowing and osteoarthritic changes. Radiologic examination also revealed generalized platyspondyly and irregularity of the vertebral endplates and bony ankylosis of the hip joints for which she underwent

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HAND XRAY – EPIPHYSEAL ENLARGEMENT WITH JOINT SPACE NARROWING

Left hip ankylosed with arthritis and reduced joint space right hip

Fused atlanto-occipital joints bilaterally

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site infections. Mortality, catheter loss, transfer to hemodialysis and “COMPLICATIONS AND OUTCOMES OF transplantation were studied as CHRONIC PERITONEAL DIALYSIS IN A outcomes. TERTIARY CARE CENTER - AN OBSERVATIONAL COHORT STUDY.” Results:

Ninoo G, Alexander S, David VG, Jacob 178 patients with a mean age of 49.8 ± S, Mohapatra A, Valson A, Basu G, 14.7 years were followed up for a median Varughese S, Jacob CK, Tamilarasi V., period of 14.5 months (IQR 0-47). The Department of Nephrology, Christian male-female ratio is 1.8:1. The underlying Medical College, Vellore. renal disease was diabetic nephropathy in 52.3% patients. PD catheter was inserted Key Words: using blind, percutaneous technique in 152 (85.4%) patients. Catheter insertion- CAPD, complications, PD-related related complications occurred in 26.9% infections, peritonitis in open-surgical group and 15.1% in Introduction and aim: percutaneous group (p, 0.091). The occurrence of peri-catheter leak and poor The success of peritoneal dialysis and outflow occurred significantly less in the patient outcomes are influenced by percutaneous group compared to the various infective and non-infective open, surgical group (3.3% Vs 11.5% p, complications occurring during chronic 0.031 and 3.3% Vs 11.5% p, 0.009 peritoneal dialysis (CPD). Only limited respectively). Overall among 178 data is available on the immediate patients, the peritonitis rate is 1/27 complications of the blind, percutaneous patient-months or 0.44 episode/year-at- technique of CAPD catheter insertion, risk. Exit-site infection occurred in 2.8% done by nephrologists. Infective and tunnel infection in 3.9%. Among complications remain an important cause culture-positive cases (67%), majority of morbidity and mortality on CPD. were gram-negative (52.9%). Gram- Therefore, we sought to determine the positive, mycobacterial and fungal occurrence of complications related to the infections accounted for 17.6%, 8.8% and percutaneous and open surgical 20.5% respectively. The incidence of technique of Tenckhoff catheter insertion, culture negative peritonitis is 33%. PD-related infective complications and Mortality occurred in 37.1% patients. In patient outcomes in CPD in our center. multivariate logistic regression analysis, age>55 years (p=0.002), female sex Materials and methods: (p=0.008), diabetes (0.028) and concomitant HIV (p=0.006) or HCV We conducted an observational study of infection (0.037) were significant patients initiated on PD from January predictors of mortality. 2009 to March 2012. The double-cuffed Tenckhoff PD catheter was inserted using Conclusion: blind, percutaneous or open surgical technique. Data was collected from The blind, percutaneous technique of PD- patient records. Standard definitions catheter insertion is safe. Peritonitis were used for peritonitis, tunnel and exit- incidence in our center is 0.44 episode /

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patient-year-at-risk. Most infections (23%) were found to have incidental lung occurred due to gram-negative nodules in planning CT scans. Fourteen organisms. Age >55 years, female sex, patients had solitary nodules and 16 had diabetes mellitus and concomitant multiple nodules. 21 had nodule less than HIV/HCV infection significantly predicted 5mm and 9 had more than 5mm. Median mortality. follow up period was 13 months (range 2–37 months). During follow up, 5 ______patients(3%) progressed to lung “CLINICAL SIGNIFICANCE OF metastases at 9 months median follow up. INDETERMINATE PULMONARY 4/5 patients had multiple nodules and NODULE IN RT PLANNING CT SCANS OF locally advanced breast carcinoma at BREAST CANCER PATIENTS.” presentation. Conclusion: Paul Gopu, V K Reddy, Balukrishna S, Selvamani B, Dept of Radiation Incidental lung nodules are common Oncology, Ida B Scudder Cancer Centre, finding on routine imaging. Multiple Christian Medical College, Vellore. nodules, size >5mm, initial advanced Background: stage are high risk for progression to lung metastases and should be closely Incidental finding of lung nodules on followed up. Majority of incidental lung Planning CT scans in breast cancer nodules are benign and unnecessary patients is common. It causes clinical evaluation should be avoided as it delays dilemma regarding the plan of further treatment of the primary. management. It is important to study the course of these lung nodules to make proper clinical judgment in future. “URINARY TRACT INFECTIONS IN Patients and Methods: KIDNEY TRANSPLANT RECIPIENTS – A STUDY OF RISK FACTORS, COURSE AND From January 2010 to May 2013, RT CONSEQUENCES.” planning CT scans done for breast cancer patients were reviewed retrospectively to Riyaz Ahmed Asad, Gopal Basu, Golla identify indeterminate pulmonary Sudhakar, Anjali Mohapatra, Anna T nodules. Patients with pulmonary nodules Valson, Shibu Jacob, Suceena were grouped according to number, size, Alexander, Vinoi George David, associated benign diseases, stage and Santosh Varughese, Balaji were followed up. Increase in the size of Veeraraghavan1, Chakko Korula Jacob, the nodules were further evaluated with Veerasamy Tamilarasi, Department of either biopsy or PET CT scan. The lung Nephrology, Christian Medical College, nodules which had progressed were Vellore., 1 Department of correlated with patient’s characteristics. Microbiology, Christian Medical College, Vellore. Results: Introduction and Aim: Out of 134 patients treated with conformal radiation therapy, 30 patients

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Urinary tract Infection (UTI) is a common significantly associated with female cause of morbidity and post transplant recipients, higher recipient age, H/o pre graft dysfunction and contributes to graft transplant UTIs, urological NKD, post loss. We aimed to study the incidence, transplant CMV disease, NODAT and clinical profile and outcome of UTIs in systemic mycosis. Acute graft Renal allograft recipients (RARs) in a pyelonephritis (AGPN) is associated with tertiary care hospital. increased graft loss and urosepsis with poor survival. Methodology and materials: Conclusion: We performed an observational study of consecutive renal allograft recipients who UTIs are common in RARs and underwent kidney transplantation significantly associated with NKD due to between January 2005 and December urologic causes, prior UTIs, NODAT, CMV 2011. Renal allograft recipients disease and systemic mycosis. Majority of underwent routine urine culture the symptomatic UTI in RARs are due to evaluation before transplantation, 7-10 ESBL pathogens. AGPN is significantly days after transplantation, monthly associated with graft loss and poor thereafter, and ad-hoc when symptomatic patient survival. of UTI. Data was collected from transplant records and electronic medical records. Standard statistical tests were applied for analysis considering a p <0.05 as “THE DIAGNOSIS OF OSTEOPOROSIS significant. AMONG SOUTH INDIAN MALE AND FEMALE SUBJECTS WITH LOW IMPACT Results: HIP FRACTURE AND COMPARISON BETWEEN INDIAN COUNCIL OF 531 RARs (mean age =35.9±12.3 yr; M:F = MEDICAL RESEARCH (ICMR) AND 3.4:1) underwent renal transplant at our CAUCASIAN BONE MINERAL DENSITY centre during the study period, from DATABASES.” 91.1% living donors (mean age=41.4±11.2 yr; M:F=1:1.7) and 8.9% RUNNING TITLE deceased donors. Urological native kidney Comparison between Indian Council of disease (NKD) was observed in 6.2% Medical Research (ICMR) and recipients. Pre Transplant UTI was Caucasian Bone Mineral Density observed in 15.4% recipients, and was Databases significantly associated with urological NKD (69.7% vs. 11.8%; p<0.001) Sahana Shetty, Kapoor N, Asha HS, Naik Incidence of asymptomatic bacteruria in D, Visalakshi P1, Cherian VM2, RARs was 18.8%, whereas, symptomatic Oommen AT2, Daniel AJ2, Thomas N, UTIs were seen in 28.2%. The most Paul TV, Department of Endocrinology, common pathogens causing symptomatic Diabetes and Metabolism, UTI were E.coli (66.0%), Klebsiella 1Department of Biostatistics., (14.7%), Enterococcus (12.0%), and 2Department of Orthopedics., Pseudomonas (6.1%). ESBL organisms Christian Medical College, Vellore, more commonly result in symptomatic India. UTIs and urosepsis. Symptomatic UTI was

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CORRESPONDING AUTHOR: three of 314(23.5%) defined as Dr Thomas V Paul, MD, DNB(Endo), osteoporosis according to HD were PhD(Endo) classified as osteopenia according to Professor, ICMRD. The ROC derived BMD cut-off of Department of Endocrinology, Diabetes 0.681gm/cm2 had a 82% sensitivity and a and Metabolism, 71% specificity to detect a fracture which Christian Medical College Hospital, corresponded with a T-score of -2.1 using Vellore-632004, India. a HD and -2.0 with ICMRD using hospital database as controls. When healthy Aims & objectives: postmenopausal women from community were taken as controls, BMD of This study was undertaken to look at the 0.681gm/cm2 had 82% sensitivity and agreement between the Hologic 71% specificity in predicting fracture risk Database(HD) based on NHANES Bone which corresponded to a T-score of -2.1 Mineral Density(BMD)data in Caucasians using a HD and -2.0 with ICMRD. and the ICMR database(ICMRD) published in 2010 in defining normal and Conclusions: subnormal BMD in subjects with or without hip fracture and to arrive at a The threshold of hip BMD T-score for BMD cut off which has a high sensitivity treating osteoporosis may have to be of predicting fracture. redefined if the ICMR reference database is used. This study also highlights the Materials & methods: importance of assessing risk factors other than BMD affecting bone health for A cross sectional study of 3098 subjects making therapeutic decisions. Follow up (men-341, women-2757) (mean studies with a larger sample size are age+SD=60.1+7.6yrs), which included needed to further validate our findings. 314 subjects with low impact hip fracture, 2321 from the hospital database and healthy postmenopausal women (n=461) from community who underwent (DXA) scanning between 2007-2012. “SWEET’S SYNDROME ASSOCIATED Recalculated T-scores from ICMRD were WITH CROHN’S DISEASE – A CASE used for the diagnosis of osteoporosis and REPORT.” compared with HD. The threshold of hip BMD which best predicts the fracture risk Sheena Evelyn Ebenezer, Thambu was assessed using ROC curve. David, Ravali Hickson, Department of Medicine II, Christian Medical College, Results: Vellore.

Almost a perfect agreement existed Background: between two databases for the diagnosis Sweet’s syndrome, also known as acute of osteoporosis at the hip (Kappa- febrile neutrophilic dermatosis, has been 0.82,P<0.0001)in overall subjects and associated with malignancy, autoimmune substantial in subjects with hip disease and collagen vascular disease. The fracture(Kappa-0.65,P<0.0001). Seventy

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association of Crohn's disease and an extra- articular manifestation of Sweet's syndrome is rare. We report a Crohn’s disease. case of Sweet's syndrome in a patient with Crohn's disease. Case presentation: “ONCOGENIC OSTEOMALACIA: FIVE YEARS EXPERIENCE IN A TERTIARY A 50 year old lady presented with CARE CENTRE.” inflammatory arthritis of the knee and ankle joints for 10 years associated with Shetty S, Asha HS, Naik D, Rajaratnam bilateral gluteal pain. She also had a S, Thomas N, Paul TV, Department of history of chronic small volume loose Endocrinology, Diabetes and stools with blood and mucus for 4 years Metabolism, Christian Medical College, and episodic painful erythematous Vellore, India. nodules in both palms and back for 2 years each episode lasting for one month. The current episode of erythematous skin CORRESPONDING AUTHOR: nodules was associated with high grade Dr Thomas V Paul, feverfor1 week. On examination she had Professor, tender violaceous papules and plaques in Department of Endocrinology, Diabetes bilateral hands and back and Schobers and Metabolism, test was positive (3 cms). Skin biopsy Christian Medical College Hospital, from the lesion in the palm was Vellore-632004, India. suggestive of neutrophilic dermatosis and colonoscopy revealed multiple ulcers in Background: ileocaecal region and entire colon, with Oncogenic osteomalacia (OO) is a skipped areas of normal mucosa. Biopsy paraneoplastic syndrome seen in tumours from the colonic ulcers revealed chronic of mesenchymalorigin. They secrete activeileitis, pancolitis, proctitis with 'phosphatonins,' like fibroblast growth crypt disarray. Diagnosis of Crohn’s factor-23 (FGF-23) that inhibit therenal disease with Sweet’s syndrome was tubular reabsorption of phosphates. They made. She was started on Mesalazine for are characterized by hypophosphatemia the Crohn’s disease. She showed good andosteomalacia. The patients make response to treatment. remarkable recovery once tumours are localized and excised. Discussion: Aim: Differentials for a patient with fever , and violaceous tender nodules with To study retrospectively the clinical, leucocytosis can be infection, vasculitis biochemical profile and follow up of the and neutrophilic dermatosis . In a subjects whopresented with the features patient fulfilling criteria, for Sweet’s of OO to our department. syndrome detailed work up for underlying malignancy, connective tissue Methods: disorder and inflammatory bowel disease has to be done. Sweet’s syndrome can be

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Clinical, biochemical and radiological data 1. J Assoc Physicians India. 1994 of all the patients diagnosed to Sep;42(9):692-4.Osteomalacia-- havehypophosphatemicosteomalacia fifty five patientsseen in a teaching (HO) from 2008-2012 were collected institution over a 4 year using the computerizeddatabase. The period.Mathew JT, Seshadri patients with proven OO were analyzed. MS,Thomas K, Krishnaswami H, Cherian AM. Results: 2. JJ Jacob, P Finny, MeeraThomas,N Thomas, M John; Oncogenic Among the 43 patients who presented Osteomalacia:JAPI March 2007; with features of HO, 10 were diagnosed to VOL. 55:231-233 have OO.The most common presenting 3. Hendry DS, Wissman R. Case 165: symptoms were bone pains and proximal Oncogenic Osteomalacia. muscle weakness. The median duration of Radiology. 2011 Jan1;258(1):320– symptoms before initial presentation was 2. 5.5 years. The mostcommon site of 4. William H Chong. Tumor-induced tumour was nasal cavity. The median age osteomalacia. Endocrine-Related of presentation was 42.5 years. The Cancer 2011June;18(3):R53–R77. average serum corrected calcium, phosphorus, Tubular maximum Phosphate Reabsorptionper Glomerular “EFFECT OF IVABRADINE ON HEART- Filtration Rate (TmP/GFR), Alkaline RATE AND HEMODYNAMICS IN Phosphatase, 25 hydroxyl vitamin D CRITICALLY ILL PATIENTS.” were9.05 mg%, 1.7 mg%, 1.1, 327 U/L and 36.5 ng/ml respectively. FGF23 was Mitra S, Thomas K, Chacko B, Peter JV. available for only 5patients with a median CMC Hospital, Vellore. of 303 RU/ml (Reference interval 21.6- Purpose: 91.0 RU/ml). The tumourwas localized in 5 patients at initial presentation and the We evaluated if ivabradine, a specific rest on follow up. All patients funny channel blocker, reduces heart-rate underwentsurgical excision, of which 8 without adverse hemodynamic effects in are in complete remission, rest are on critically ill patients. medical treatment. Materials and methods: Conclusion: In this double-blinded randomized

crossover trial, 53 patients admitted in Screening for OO should be done in the ICU with persistent sinus tachycardia patients with HO. The head and neck (heart rate region is the mostcommon area of tumor randomized to receive either ivabradine occurrence. A high index of clinical or placebo. Patients≥120 beats/min)randomized were to suspicion, selective imaging and followup ivabradine received 2 doses of 7.5-mg by is needed to recognize this condition. oral/nasoenteric route 12-hours apart. Surgery is the treatment of choice. Placebo consisted of pantoprazole 40-mg.

After 24-hours, subjects crossed over to References: the second treatment if heart rate was

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NEMAKI STUDY observation period of 48-hours, heart- rate≥80 and beats/min. hemodynamic During parameters the entirewere “URINARY NGAL AS AN EARLY MARKER recorded. The primary endpoint was OF ACUTE KIDNEY INJURY IN heart rate reduction and changes in blood CHILDREN WITH SHOCK IN pressure. Secondary endpoints included PAEDIATRIC ICU.” vasopressor score and lactate levels. Steve Thomas, Manivachagan, Joe CTRI Reference number: REFCTRI- Fleming, Indira Agarwal, J. Ebor Jacob, 2010 002969, 08-11-2010 Paediatric ICU, Clinical Biochemistry, Christian Medical College, Vellore. Results: Background: At the end of the first treatment period, a significant reduction in heart-rate was Acute kidney injury (AKI) is a frequent observed with both ivabradine and serious problem ,associated with high (130.9±8.0 to 103.0±17.9, P<0.001) and mortality and morbidity in the critically ill placebo (129.7±10.9 to 118.7±14.0, children.The current diagnostic tools at P=0.003). However, a greater reduction in an early stage of AKI are limited,leading heart rate was observed with ivabradine to delay in diagnosis and initiation of when compared with placebo (mean renal protective measures in early difference -15.7, 95%CI -25.3 to -5.2, stages.Several biomarkers such P<0.001). Using repeated measures asCystatin C, KIM-1, NGAL, Cytokines (IL- ANOVA, there was an overall significant 6, IL-8,IL-18), L-FABP, NHE3have been difference between ivabradine and studied. Among these NGAL has been placebo at different time points emerging as a promising biomarker. (P<0.001). There was no significant Hence, this study was designed. difference between the groups with Aim: respect to blood pressure (P>0.10), need for vasoactive agents (P=0.53) or lactate To analyze urinary NGAL as an early levels (P=0.28). A significant reduction in marker of AKI in children presenting heart rate without adverse withshock .To correlate titres of urinary hemodynamics was observed with NGAL with hospital stay, need for renal ivabradine in the second period of the replacement and mortality. crossover and on pooled analysis of both treatment periods. Method: Conclusions: Prospective

Ivabradine at the dose of 7.5-mg twice Period: daily produces a substantial reduction in 10 months heart rate without any adverse hemodynamic effects in critically ill Results: patients. 81 patients were included in the study.31% (25 out of 81) developed AKI.UrinaryNGAL with the cutoff of >120

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, was found to a have a sensitivity of 80% muscle function in COPD. The duration of and specificity of 71.4%.The AUC-ROC exercise training in pulmonary curve was 0.8175, proves that urinary rehabilitation is 8 to 12 weeks and the NGAL is a early marker of acute kidney long term rehabilitation needs extensive injury.AKI was associated with high personal efforts from the patient. mortality of 84% when compared to Therefore, there exists a need of a shorter children with shockbut no cost effective exercise program that AKI(14.29%).Independently urinary benefit the patient to improve their NGAL was a predictor of exercise capacity and the functional mortality.(P=0.0014).Duration of PICU status. stay was significantly increased with children with AKI(P=0.0382).We also Aim: found urinary NGAL values were To evaluate the effectiveness of a short significantly high in children with septic term exercise training program in shock(irrespective of AKI) and improving the exercise capacity and comparatively low in dengue shock,this symptom relief in moderate to severe was statistically significant. COPD patients. Conclusion: Methods: Urinary NGAL is a good early marker of Twenty five patients with moderate to AKI in critically ill children presenting severe COPD patients were given exercise with shock with normal creatinine training for one week which included levels.Urinary NGAL rises early (<24 static cycling, treadmill walking for 30 hours) in children with AKI and correlates minutes and peripheral muscle well with mortality,need for renal strengthening exercises. VO2 max using replacement therapy and duration of Breath by breath analysis PICU stay. (Cardiopulmonary exercise testing), the perceived level of breathlessness was measured using Borg scale and 6 minute “EFFECTIVENESS OF A SHORT-TERM walk test were done before and after one EXERCISE TRAINING TO IMPROVE week of exercise training to assess EXERCISE PERFORMANCE IN physiologic response to exercise. This MODERATE TO SEVERE COPD study was approved by the Institutional PATIENTS.” Review Board.

Subashini. K, Neethu John, Study design: Balamugesh.T, ChristopherDJ, Prospective, observational study Department of Pulmonary Medicine, CMC, Vellore. Data Analysis:

Introduction: Statistical analysis were done using paired t test and using SPSS for windows Exercise conditioning is a corner stone of version 11 pulmonary rehabilitation program and is the best available means of improving Results:

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A statistically significant increase was Results: seen in in Vo2 max from pre and post with a mean difference of 159.28(95% CI A total of 155 kidney transplant 88.95-241.59) (p<0.0001). There was a recipients (mean age =35.6±12.3 years; significant reduction in Borg pre and post M:F = 3.4:1) received renal allografts from measures with a mean difference of 0.72 92.3% living donors (mean age= 42±11.2 (0.22-1.24) (p=0.018) There was no years; M:F=1:2) and 7.7% deceased significant increase from pre and post six donors. 83.9% of patients received minute walk distance with a mean Basiliximab (2 dose) induction and 12.9% reduction of 18.92 (95%CI: – 7.37- 45.21) received ATG (immunologically high risk (p =0.150) or deceased donor transplants). The most common immunosuppressive regimen Conclusion: was prednisolone + Tacrolimus + Mycophenolate (in 94.8%). All patients These findings suggest that short term were offered ValG prophylaxis; however, pulmonary rehabilitation benefits only 87.7% were on ValG prophylaxis. patients with COPD with moderate to ValG was used at 450 mg/day for a period severe airflow obstruction, as reflected in of 3 months and adjusted according to improvement in Vo2 max and reduction tendency to develop leucopenia. in Borg score. The incidence of CMV disease among the study cohort was 6.5 % (5.9% vs. 10.5% among those taking vs not taking ValG “PROFILE OF CYTOMEGALOVIRUS prophylaxis). The mean time of diagnosis INFECTION IN KIDNEY TRANSPLANT of CMV disease was 5.1 ±2.5 months after RECIPIENTS IN THE VALGANCICLOVIR transplantation. 80% of the CMV disease PROPHYLAXIS ERA. “ in the study was diagnosed by viremia Sudhakar G, Basu G, Valson AT, with symptoms. Only 20% of the patients Mohapatra A, David VG, Alexander S, with CMV disease had tissue invasion. Jacob S, Varughese S, Jacob CK, 20% of the CMV disease occurred in Tamilarasi V., Department of patients not taking ValG prophylaxis. The Nephrology, Christian Medical College, mean time of diagnosis of CMV disease Vellore. among patients not on ValG prophylaxis Aim: was significantly earlier (during the first three months of transplantation) To study the incidence and clinical profile compared to those on ValG prophylaxis of CMV infection among renal allograft (2.8 ± 0.0 vs. 5.6 ±2.6 months; p= 0.018). recipients in the era of Valganciclovir A higher percentage of patients not on (ValG) prophylaxis ValG prophylaxis had tissue invasive CMV disease. 20% of patients had recurrence / Methodology: CMV not responding to treatment with ValG. Retrospective Observational study of consecutive renal transplant recipients CMV disease was significantly associated from June 2009 to December 2011 with both death (20.0% vs. 1.4%; p=

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0.021 ) and graft loss (20.0% vs. 2.1%; To study the prevalence and clinical and p=0.035) laboratory predictors of asymptomatic bacteriuria in older women with Type 2 Conclusions: diabetes. ValG prophylaxis reduces the incidence of Methods: CMV disease, delays its onset and appears to reduce tissue invasive CMV disease. A total of 107 diabetic women , 50 years CMV disease is significantly associated and above ,who attended the Geriatric with death and graft loss among kidney Medicine and Endocrinology outpatient transplant recipient. clinic in a tertiary teaching care hospital in south India between October 2007 to August 2008 were included in the study .We evaluated risk factors by interviewing “ASYMPTOMATIC BACTERIURIA IN and screening for the presence of OLDER DIABETIC WOMEN.” asymptomatic bacteriuria in these Sushil Thomas Alexander*, K.Prasad women. Mathews**, Nitin Kekre***, *Assistant Results: Professor of Medicine-UNIT III,**Professor of Medicine & The prevalence of asymptomatic Geriatrics-UNIT III,***Professor of bacteriuria was 16.7% in Type 2 diabetic Urology UNIT-I, CMC Hospital Vellore women.The most common organism India. cultured was Escherichia coli. Risk factors for asymptomatic bacteriuria in Type 2 Background: diabetic women included presence of macrovascular complications , the use of insulin and the presence of lower peak Diabetic patients are more prone for urinary flow rates. No significant serious complications of most infections association was associated with age, BMI, especially urinary tract infections. duration of diabetes, HbA1c, Symptomatic urinary tract infections can dyslipidemia, nephropathy, neuropathy be preceeded by asymptomatic and microvascular diabetic complications. bacteriuria (ASB) which is more prevalent in older diabetics. Whether symptomatic Conclusion: urinary tract infections are preceded by asymptomatic bacteriuria (ASB) has Asymptomatic bacteriuria is a commonly remained a matter of debate.This study prevalent condition in older women with was done with a view of looking at Type 2 diabetes mellitus .The most potentially modifiable risk factors common causative bacteria was including cystopathy and bladder outlet Escherichia coli. The increased obstruction to reduce the overall risk association of Diabetic subjects with a posed by this condition. lower peak urinary and asymptomatic Objectives: bacteriuria needs further clarification in future studies.

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ORGANIC PERSONALITY CHANGE: DIAGNOSTIC DILEMMAS.” “DIFFUSE PRIMARY LEPTOMENINGEAL GLIOMATOSIS- AN UNUSUAL MIMIC OF Background: TUBERCULAR MENINGITIS.” 20-30% of patients coming to tertiary care epilepsy clinics for refractory seizures have both epilepsy and Swaratika Majumdar, Soumya psychogenic non-epileptic seizures Sathyendra (PNES)[1].

Primary diffuse leptomeningeal PNES in patients with epilepsy is gliomatosis is a rare, progressive hypothesized to be modulated by neoplasm involving the CNS arising from traumatic life experiences, nests of glial tissue within the neuropsychological impairments, subarachnoid space. It presents with symptom modeling, specific headache, neck stiffness, papilledema and environmental triggers and inadequate multiple cranial nerve paralysis. The coping during crisis. [2] clinical manifestations being similar to chronic meningitis, it is often mistaken for Case report-Mr. K, a 21 years old single tubercular meningitis. However it differs male with a childhood history of treated from tubercular meningitis in having a seizures, suffered from recurrence of both short, aggressive course and universally complex partial and Generalized tonic fatal outcome with limited treatment clonic seizures following an episode of options. We describe a case of primary Varicella Encephalopathy. He showed a diffuse leptomeningeal gliomatosis with distinct change from premorbid rapid, progressive neurological personality, memory deficits and seizures deterioration and eventual death. remained refractory to treatment.Detailed psychiatric evaluation revealed a third constellation of symptoms along with continuing complex Author’s Name- Dr. Swetha Madhuri. partial seizures without loss of Chikkala consciousness with intact awareness of surrounding occuring in presence of Co- author - Dr. Saumil Dholakia family members and temporally Address - Department of Psychiatry, correlated with situational stressors Christian Medical College (CMC), suggestive of PNES. Bagayam, Vellore-632002, Tamil Nadu, Adequate augmentation of antiepileptic India drugs with psychopharmacological and Phone number- 9500519969, non-pharmacological strategies in a psychiatric setting along with close liason Email – [email protected] with neurology helped achieve adequate symptom control and return to functional “PSYCHOGENIC NON-EPILEPTIC recovery. SEIZURES IN A PATIENT SUFFERING FROM REFRACTORY EPILEPSY AND Discussion:

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This case report highlights the need to of General Surgery & Head and Neck revisit dichotomous concepts of disease Oncology Christian Medical College, vs illness, functional origin vs organic Vellore., # Department of Radiotherapy origin of illness and categorical vs Christian Medical College , Vellore. dimensional methods of assessment of patient’s problems.[3]. Introduction:

Conclusion: Interdigitating dendritic cell sarcoma are rare tumors which affect the lymphatic Detailed psychological evaluation for system as well the extranodal site. patients with refractory epilepsy and Diagnosis depends on adequate treatment of underlying morphological,histological ,electron psychiatric morbidity seems necessary microscopy and most importantly on for adequate control of symptoms. immunohistolchemistry. Here we report a rare case of interdigitating dendritic cell References: sarcoma (IDCS). [1]. Turner K, Piazzini A, Chiesa V, Barbieri V, Vignoli A, Gardella E, Tisi G, Scarone S, Canevini MP, Gambini O. Case presentation: Patients with epilepsy and patients with psychogenic non-epileptic seizures:video- A young 40male presented with multiple EEG, clinical and neuropsychological swellings of the right side of the neck and evaluation. Seizure. 2011 Nov;20(9):706- axilla for six months, without any 10. doi: 10.1016/j.seizure.2011.07.001. constitutional symptoms. Epub 2011 Jul26. On examination he had multiple large [2]. N.M.G. Bodde, J.L. Brooks, G.A. Baker, discrete well defined nodes involving the P.A.J.M. Boon, J.G.M. Hendriksen, O.G. right cervical and right axillary region, the Mulder, A.P. Aldenkamp. Psychogenic biopsy of the node suggested Kimura's non-epileptic seizures-Definition, disease. The axillary and the cervical etiology, treatment and prognostic issues: nodes were surgically resected and a critical review. Seizure, 2009 biopsy came as inter digitating dendritic Oct;18(8):543-553. cell sarcoma. Evaluation by PET scan and bone marrow examination was normal. [3]. Cecil G Helman. Disease versus illness Patient was planned for adjuvant in general practice.Journal of Royal radiotherapy along withchemotherapy College of General Practioners. .Patient is on chemotherapy currently. 1981;31:548-552. Conclusion:

IDCS of lymph node is a very rare entity of “INTERDIGITATING DENDRETIC CELL not many cases reported all over the SARCOMA OF CERVICAL AND AXILLARY world. Immunohistochemistery plays a LYMPH NODE: A CASE REPORT.” major role in molecular characterization. In a non metastatic disease surgical Tirkey A.J;* Rajnikanth J;*Thomas excision constitutes the main treatment C.T;*Das S.# ;Gaikwad P.;*., *Departemt

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modality followed by adjuvant nodes is considered essential. Various radiotherapy and chemotherapy. factors affect the adequacy of lymph node harvest in rectal resections. We studied Dr. Amit Jiwan Tirkey, Associate the lymph node harvest after neoadjuvant Professor of General Surgery, Christian therapy and rectal resection for cancer, Medical College Vellore and Dept of with regard to adequacy, lymph node General Surgery &Head and Neck positivity and factors affecting lymph Oncology, Christian Medical College & node yield. Hospital, Vellore 632 004, Tamil Nadu, India. Methods:

Contact Details All patients undergoing rectal resection Postal Address for cancer, between June 2012 and May Dept of General Surgery Unit I 2013, in a colorectal unit in a tertiary care 2nd floor,Paul Brand Building hospital in South India were included in Christian Medical College & Hospital the study. Data was collected from Vellore 632 004, computerized hospital records and a Tamil Nadu, India prospectively maintained database. Office Telephone Office +91 (416) 2282082 Results: Fax +91 (416) 2232035 Sixty-nine patients underwent rectal / 2232103 / 2232054 resection for cancer. Forty six (66.7%) E Mail [email protected] were males. Mean age was 47.9 (20-74) years. Sixty eight of the 69 patients Personal received neoadjuvant therapy. Sixty one Telephone Residence0416 3077102 (88.4%) patients received neoadjuvant Mobile No. 09443800353 long course chemoradiotherapy (LCCRT), E Mail [email protected] 1 (1.4%) short course radiotherapy (SCCRT) alone, 3 (4.3%) chemotherapy followed by SCRT and 3 (4.3%) chemotherapy followed by LCCRT. “LYMPH NODE HARVEST IN RECTAL Twenty-six (37.7%) patients underwent RESECTION FOR CANCER.” abdominoperineal excision and Amrit Pipara, Rohin Mittal, Mark 43(62.3%) sphincter sparing surgery. Ranjan Jesudason, Benjamin Perakath, Forty (58%) patients underwent Department of surgery unit-2 - laparoscopic resection and 29 (42%) Colorectal Surgery, Christian Medical open resection. Circumferential resection College, Vellore. margin (CRM) was less than 2mm in 23 (33.3%) patients. Background: Node negative disease was present in Lymph node harvest in rectal cancer 50(72.5%), while positive disease was surgery is important for staging, found in only 19 (27.5%) patients. The prognostication and to decide on the need average lymph node harvest was 8.78(0- for adjuvant chemotherapy. For accurate 20). Twenty two (31.9%) patients had lymph node staging, a minimum of 12 more than 12 lymph nodes harvested.

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Open surgery was associated with a higher lymph node harvest (p=0.013). Age, gender, sphincter sparing or sacrificing surgery, pathological T and N stage and number of positive lymph nodes did not affect lymph node yield. Conclusion:

In patients receiving adequate neoadjuvant therapy, the rate of lymph node positivity is low, with only about a quarter of patients having positive lymph nodes. Only about a third of such patients have an adequate lymph node harvest after rectal resection for cancer.

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SURGICAL SPECIALITY

“MISSED RADIAL HEAD DISLOCATION Case outline: ASSOCIATED WITH BOTH BONE FOREARM FRACTURES.” Our patient is a 32 years old male, who Arun Immanuel Muthiah, Jerry sustained closed left Bado type IV Nesaraj, Thilak Jepegnanam, monteggia fracture who was treated with Department of Orthopaedics Unit III, ORIF of radius and ulna elsewhere and Christian Medical College Vellore the radial head dislocation was missed Hospital, Tamil Nadu, India. during the initial surgery. He presented to us with painful restriction of forearm * MS Ortho PG registrar rotations, after 2 years. We did ulnar ** Assistant Professor, Ortho Unit III corrective osteotomy and radial head *** Professor, Ortho Unit III. reduction. He regained full pronation and supination in the forearm and his ulnar Introduction: osteotomy healed uneventfully.

A Monteggia lesion is a dislocation of the radial head associated with a fracture in Conclusion: the proximal third of the ulna. We present a case report of missed monteggia Eventhough Monteggia fractures are rare, fracture and the outcome following the radial head dislocation is frequently reduction of the radial head. missed and can lead to severe morbidity if not properly addressed. So careful

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attention should be given to all proximal differentiated neuroendocrine carcinoma forearm fractures to rule out radial head and multiple cervical and axillary nodal dislocation. metastases with extranodal extension. He received 5 cycles of adjuvant

chemotherapy with carboplatin and “POORLY DIFFERENTIATED etoposide. The 6th cycle was deferred as NEUROENDOCRINE CARCINOMA OF he developed generalized weakness and THE ORAL CAVITY – A CASE REPORT.” bony pains. His investigations revealed hypercalcemia which was thought to be Thomas CT, Tirkey AJ, Rajinikanth. J, paraneoplastic or due to skeletal Gaikwad.P, Department of General metastases. He also had a metastatic node Surgery – Unit 1 in the left supraclavicular region. At this point, the patient expressed his desire to Introduction: forgo any further evaluation and return Neuroendocrine carcinoma is a rare home. tumor of epithelial and neural Conclusion: differentiation. Primary neuroendocrine carcinomas of the head and neck region Neuroendocrine carcinomas of the oral have been reported, largely, in the larynx cavity are aggressive tumors and with a few reports of these in the oral treatment needs to be individualized. The cavity. role of debulking surgery in metastatic disease (like our case) needs to be Case history: considered. A 63 year old gentleman, who was a smoker, presented with a 3 month history of oral ulcer, difficulty in swallowing and “VISUAL OUTCOME OF OPEN GLOBE multiple swellings over the left side of the INJURIES IN CHILDREN AT A TERTIARY neck. On examination, there was a 2.5x2 CARE CENTRE – A 4 ½ YEAR STUDY.” cm ulcer over the left retromolar trigone. There were multiple left cervical lymph Shimna C P, Mary Esther John B, Deepa nodes palpable at levels Ib to V, the John, Padma Paul, Pushpa Jacob, Renu largest measuring 4x3 cm and multiple, Raju, Department of Opthalmology, enlarged left axillary nodes upto 2 cm in Christian Medical College, Vellore. diameter. Biopsy of the ulcer was suggestive of neuroendocrine carcinoma. Aim: Immunohistochemistry revealed tumour To study the demography and the factors cells positive for pancytoK (paranuclear dot-like), synaptophysin and CD56. Whole affecting visual outcome of open globe injuries in children. body PET scan revealed disease limited to the neck and axilla. He underwent a left Methods: composite resection, axillary clearance and reconstruction with a pectoralis Observational study including major myocutaneous flap. He had an retrospective chart analysis for 4 years uneventful postoperative period. The and prospective analysis for 6 months of postoperative biopsy revealed a poorly children with open globe injury.

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Results: sparse data in patients with hepatolithiasis. Our study included 156 children, of which 72.4% were boys and 27.6% were Aims: girls.The mean age among boys was 9.04 years and among girls was 7.66 To study the predictors of liver years.Final visual outcome in the injured dysfunction in patients with eye was better than or equal to 6/12 in hepatolithiasis, who underwent surgical 44.5%, 6/18 to 6/36 in 17.5%, 6/60 to treatment at Christian Medical College, 3/60 in 7.7% and <3/60 in 30.3%.Our Vellore from 2004 to 2012. study has shown statistically significant Methods: association between corneal tear involving visual axis, presence of relative From 2004 to 2012, 106 patients were afferent pupillary defect (RAPD)at evaluated for hepatolithiasis, of which 83 presentation and presence of intraocular had surgical treatment. These patients foreign body (IOFB) with poor visual were divided into two groups based on outcome.Conclusion: This is the first cross sectional imaging and intra- study showing association between RAPD operative findings: those with liver and presence of IOFB as factors affecting dysfunction and those without. All final visual acuity in children presenting patients underwent standard surgical with open globe injuries. management.

Results:

“PRE-OPERATIVE PREDICTORS OF There were 34 (40.96%) male and 49 LIVER DYSFUNCTION IN PATIENTS (59.04%) female patients. The WITH HEPATOLITHIASIS: A commonest cause of hepatolithiasis was RETROSPECTIVE ANALYSIS OF 83 choledochal cyst (36.14%). Twenty seven PATIENTS.” patients had liver dysfunction (32.53%) whereas fifty six patients did not Dhiraj John Sonbare, Ravish Sanghi, (67.47%). Fredrick L Vyas, Philip Joseph, Venkatramni Sitaram, Department of On univariate analysis, male sex (P = HPB Surgery, Christian Medical 0.031), high globulin level (P = 0.032), College, Vellore. lower albumin globulin ratio (P = 0.040) and increased INR (P = 0.005) predicted Background: liver dysfunction at 5% significant levels and lower albumin level (P = 0.097) and Hepatolithiasis is common in Asia-Pacific presence of a biliary stricture, extra region with prevalence as high as 30- hepatic or intrahepatic, (P = 0.083), 50%. Its prevalence in Indian predicted dysfunction at 10% significance subcontinent is unknown. The treatment level. of hepatolithiasis is difficult and marked by treatment failure, recurrences and Multivariate logistic regression analysis liver dysfunction. Although the predictors was performed on factors which were and outcome of liver complications in significant on univariate analysis. On malignant disease is known, there is multivariate analysis, the male sex (P

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value 0.008) and higher absolute globulin A retrospective analysis of the case levels (P value 0.035) were predictors of records of all patients with squamous cell liver dysfunction in patients with carcinoma of the oesophagus, treated hepatolithiasis. with NACRT followed by surgery, was performed. Response to the NACRT was Conclusion: evaluated by the percentage of complete pathological response (pCR or ypT0N0) Male sex and high absolute globulin levels predict liver dysfunction in patients with and the overall survival (OS). The Kaplan hepatolithiasis. This can be used for Meier survival probability was estimated. Logistic regression analysis was used to scoring liver dysfunction in these patients evaluate the clinico-pathological variables in pre-operative setting. affecting the survival of these patients.

Results:

“NEOADJUVANT From January 1995 to June 2013, 119 CHEMORADIOTHERAPY FOLLOWED BY patients with squamous cell carcinoma of OESOPHAGECTOMY FOR SQUAMOUS the oesophagus were treated with NACRT CELL CARCINOMA OF OESOPHAGUS : A (cisplatin and 5- fluorouracil with 45 Gy SINGLE CENTRE EXPERIENCE.” of concurrent radiotherapy), at the Deshpande G*., Samarasam I*., Mittal Christian Medical College and Hospital, R.*, Abraham V.* ,George S.V*., Vellore, India. Around 83% of these Chandran B.S*, Subhashini. J.# Mathew patients successfully completed the G*, *Department of General Surgery, NACRT protocol. The patients with mid Upper GI surgery unit, # Department of third tumors underwent transthoracic Radiation Oncology, Christian Medical resection and patients with lower third College and Hospital, Vellore, Tamil tumors underwent either a transthoracic Nadu, India . or transhiatal resection. Radical resection and pCR was achieved in a significant Background: number of patients. Post operative mortality was within the acceptable Neoadjuvant chemoradiotherapy levels. The overall survival of the study (NACRT) followed by surgery for group was 39 months. operable squamous cell carcinoma (SCC) of the oesophagus has shown survival Conclusion: benefit, frequently at the expense of increased morbidity and operative This study reinstates the fact that in mortality. This study evaluates the patients with squamous cell carcinoma of effectiveness of a standard NACRT the oesophagus, neoadjuvant protocol, with regards to tolerance, chemoradiotherapy followed by surgery complete pathological response (pCR) is well tolerated and can be performed rate, completeness of resection (R0) and with acceptable morbidity and mortality. long term survival. In addition, NACRT helps in achieving R0 resection and high pCR rates. Thus, Materials and methods: NACRT improves the overall survival among potentially curable SCC of the oesophagus, as seen in this study.

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for treatment of patients on oral anticoagulation. “EVALUATION OF A POINT OF CARE DEVICE FOR INR TESTING IN A VASCULAR SURGERY OUTPATIENT CLINIC.” “RIGHT COLON CANCER – 10 YEAR EXPERIENCE FROM A TERTIARY CARE Indirani Sen, Vascular Surgery, CENTRE IN INDIA” Christian Medical College, Vellore. Joshua Franklyn, Rohin Mittal, Introduction: Benjamin Perakath, Department of General surgery unit 2, Christian Patients presenting with venous and Medical College, Vellore. occasionally arterial thrombosis need oral anticoagulation and monitoring of INR. Background: We studied the analytical performance of a coagulation monitoring system INRatio There is sparse Indian data on the [point of care] for the determination of demographics and outcomes of surgically INR compared with an established treated right sided colon cancer. We laboratory method and its use in reviewed our 10 year experience with shortening patient treatment time in a right sided colon cancer. tertiary care vascular surgery centre. The 5 year survival of colon cancer in Methods: India is perceived to be lower compared to the west and the rest of Asia. This was a prospective case control study which was carried out in the Department Methods: of Vascular surgery from Feb 2012 to Feb Data on patients operated for right sided 2013. Patients who were on oral colon cancer between January 2004 and anticoagulation alone were included in December 2012 in a colorectal surgery the study; lupus anticoagulant positive or unit were studied. The patients were those on concurrent injectable followed up telephonically and using preparations were excluded. The study hospital records. was granted IRB approval. Results: Results: Two hundred and thirty one patients The point of care device meant for home underwent surgery for right colon cancer. use can be used in the OPD setting with The mean age at presentation was 48 significant shortening of patient years and 53.6% were 50 years or treatment time. The sensitivity of the test younger. is 92.7% for INR’s in the therapeutic range. On staging, 2(1%) were T1, 24(10.3%) were T2, 150(66%) were T3 and Conclusions: 51(22.5%) were T4. Node positive A point of care machine availability in the disease was present in 118(51%) patients Vascular Surgery ODP is an useful adjunct and metastatic disease in 31(13%). Tumour was in the caecum in 49(21.2%),

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ascending colon in 105(45.5%) and extremity lymphatics that may reduce the hepatic flexure in 44(19%) patients and incidence of lymphedema after axillary 33(14.2%) in transverse colon. Two lymph node dissection (ALND). hundred and twenty one (95%) patients Lymphedema is a long term, devastating were anastomosed. The anastomotic leak complication of axillary dissection and its rate was 8.1%(18). incidence has ranged from 6% to 77% in various studies. The concept of ARM is to Follow up was available for 197(85.6%) map the lymphatic drainage of the arm to patients. Mean follow up was 34 months. avoid injuring it during axillary 5 year disease free survival and overall dissection. However concerns have been survival was 79% and 80%. 5 year stage raised that nodes with metastatic tumour wise survival was 100 % for stage 1, 90% may be left behind in the axilla. The for stage 2, 77% for stage 3 and 16% for technique uses indocyanine green (ICG) stage 4. 5 year disease free survival was dye and an in-house near infrared (NIR) 100% for stage 1, 89% for stage 2, 53% fluorescent imaging system to visualize for stage 3 and 0 for stage 4. the lymphatic pathways and nodes. This Stage of disease, presence of study will determine the feasibility and lymphovascular invasion and perineural oncologic safety of ARM. invasion,<12 lymph nodes harvested and Methods: anastomotic leak were predictors of poor outcome. The institutional review board (IRB) approved study from March 2013 to Conclusions: August 2014, involves 100 patients with Right colon cancer presents at a younger breast cancer, undergoing ALND. In ARM, 2.5ml – 5ml indocyanine green (ICG) dye age and at a more advanced stage in India. is injected into the upper inner aspect, When colon cancer is treated with along the medial inter-muscular groove of curative intent, good long term survival the ipsilateral arm. Fluorescence images can be achieved in the Indian setting. will be obtained using a charge couple device (CCD) camera with a cut filter as a “AXILLARY REVERSE MAPPING IN detector and light emitting diodes (LED) BREAST CANCER USING INDOCYANINE at 760 nm as the light source. The ARM GREEN DYE AND AN IN-HOUSE NEAR- node is then dissected by fluorescence INFRARED FLUORESCENCE IMAGING navigation and sent for histopathological SYSTEM.” examination to detect metastasis. Jyothsna M, Syrpailyne Wankhar, Pooja Summary: Ramakant, Deepak Abraham, M J Paul, Department of Endocrine Surgery and If ARM, can be confirmed to be both Bioengineering, Christian Medical effective in preventing lymphedema and College, Vellore – 632 004. to be safe, this technique could become one of the most important technological Background: advancements since sentinel lymph node biopsy. Fluorescence imaging is used for Axillary reverse mapping (ARM) is a the visualisation of cells and tissues both novel technique to preserve upper in vitro and in vivo. ICG has been used in

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ophthalmic angiography and for A 58 year old gentleman presented with a determining cardiac output and hepatic swelling over the right side of his face for function and tumor delineation on the 45 years with a 6 months history of rapid basis of its dark green colour. NIR-ICG has increase in its size and right sided facial also appeared most promising in the weakness. He had a 10 x 10 cm irregular, detection of sentinel lymph node and firm, nontender swelling seen on the right evaluation of lymphedema and parotid area of the face with restricted assessment of micro vascular circulation mobility, lifting up the right ear lobe. The of free flaps in reconstructive surgery. overlying skin was stretched, hyper NIR-ICG fluorescence imaging may enable pigmented and ulcerated. He had new discoveries associated with significant right cervical lymphatic function as it allows non- lymphadenopathy and a right lower invasive imaging of lymphatic motor neuron facial palsy.Trucut biopsy architecture due to its exquisite and imaging studies confirmed a parotid sensitivity enabling high spatial and malignancy and he underwent a right temporal resolution and real-time image radical parotidectomy with a modified guidance during surgery. radical neck dissection. Intraoperatively a large mass involving the parotid gland Keywords: infiltrating the surrounding structures with multiple ipsilateral neck nodes was Axillary reverse mapping, Breast cancer, Indocyanine green, Fluorescence imaging, seen. The vagus nerve was infiltrated by and Navigation surgery. the tumor. Histopathology revealed a high grade mucoepidermoid carcinoma and the vagus nerve showed features of perineural invasion by the tumor. “PERINEURAL INVASION OF VAGUS NERVE IN MUCOEPIDERMOID Mucoepidermoid carcinoma is the CARCINOMA OF PAROTID: A RARE commonest type of malignant neoplasm PRESENTATION.” arising from the parotid gland. This tumor is not encapsulated and is characterized Lurstep Wanshnong, Amit J Tirkey, by squamous cells, mucus-secreting cells, Pranay Gaikwad, Department of and intermediate cells. They can be Division of Surgery Unit 1 – Head and classified as low grade (well localized) Neck Oncosurgery, Christian Medical and high grade (nonlocalised). Peri neural College, Vellore. involvement is ascribed to myoepithelial cells and is believed to be due to over Perineural spread and infiltration is expression of cell adhesion molecules e.g. known to occur in salivary gland N-CAM. Trigeminal and facial nerve are malignancies. Commonly seen in adenoid the commonest nerve to be involved with cystic carcinomas, it is also known to a tendency to extend to skull base. occur in mucoepidermoid carcinomas. Although this is not associated with a Perineural invasion is not very common poor prognosis it is usually seen in high in mucoepidermoid carcinomas and grade malignancies and is an indication involvement of vagus nerve is rarely for adjuvant treatment. reported.

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and modified Japanese Orthopedic Association (JOA) scores. “REDUCTION IN RANGE OF CERVICAL MOTION ON SERIAL LONG TERM Results FOLLOW-UP IN PATIENTS The majority (23 patients) had a single or UNDERGOING OBLIQUE CORPECTOMY 2-level corpectomy. The average duration FOR CERVICAL SPONDYLOTIC of follow-up was 45 months. The Nurick’s MYELOPATHY.” grade and the JOA scores showed Mazda K. Turel, Sauradeep Sarkar, statistically significant improvements Krishna Prabhu, Roy T. Daniel, 1KS after surgery (p<0.001). 17% of patients Jacob, Ari G. Chacko, Section of with preoperative lordotic spines had a Neurosurgery, Department of loss of lordosis at last follow-up but with Neurological Sciences and no clinical worsening. 77% of the whole 1Department of Psychiatry, Christian spine ROM and 62% of segmental ROM Medical College, Vellore 632 004, was preserved at last follow-up. The Tamil Nadu, India. whole spine and segmental ROM decreased by 11.2 and 10.9 degrees Background greater range of segmental movement Long-term effects of the oblique cervical preoperativelyrespectively (p≤0.001). had a statistically Patients greater with a corpectomy (OCC) performed for cervical range of movement at follow up. Analysis spondylotic myelopathy (CSM) and its of serial radiographs indicated that the outcome on movement of the cervical range of movement of the whole spine spine have not been studied. and range of movement at the segmental spine levels significantly reduced during Aims the follow up period. Nathan’s grade To determine whether motion showed increase in osteophytosis in more preservation following OCC for CSM than two-thirds of the patients (p=<0.01). persists with serial follow-up. The whole spine range of movement at follow up significantly correlated with Methods Nathan’s grade.

We included 28 patients with Conclusions preoperative and at least two serial follow-up neutral and dynamic cervical Although the OCC preserves segmental spine radiographs who underwent OCC and whole spine ROM, serial for CSM. Patients with an ossified measurements show a progressive posterior longitudinal ligament (OPLL) decrease in ROM albeit without clinical were excluded. Changes in sagittal worsening. The reduction in this ROM is curvature, segmental and whole spine probably related to degenerative range of motion (ROM) were measured. ossification of spinal ligaments. Nathan’s system graded anterior osteophyte formation. Neurological function was measured by Nurick’s grade

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“BENIGN BREAST DISEASES - WIDE duration of 2 years. About 61.5% of CLINICAL SPECTRUM AND patients presented with unilateral MANAGEMENT OPTIONS.” complaints and 37.1% with bilateral involvement. 73 % of women had breast Mithun Raam, Pooja Ramakant, fed and 5 % were lactating at the time of Abraham DT, Paul MJ, Department of presentation. Family history of BBD was Endocrine Surgery, Christian Medical documented in about 3.5% and that of College, Vellore. breast cancer in 2.1%. On examination Aim: 47.6 % had breast lumps, 29.4 % had nodularity and 25.9% had tenderness. To evaluate the various clinical The most common modality of presentations in women with Benign management done elsewhere prior to Breast Diseases (BBD) and assess presentation to our OPD was surgical response to various management options. (14.7%) followed by Evening Primrose oil (EPO) (8.4%) and Danazol (4.2%). Background: Medical management was prescribed in Benign breast diseases(BBD)is the most CMCH for 54.5% of women, Surgical common problem for which a woman management in 10.5% and 23.1% women presents to the breast clinic, affecting were kept on observation. EPO was the upto 70% women, atleast once in their commonest drug used (39.9%) followed lifetime. They constitute a heterogeneous by Ormeloxifene in 11.9% , Vitamin E in group with a wide range of clinical 11.2% and Tamoxifen in 1.4%. 38.5 % of presentations. Due to their varied patients on medical management came etiopathogenesis, multiple treatment for review out of which 56.6% showed modalities are available and show improvement (30% with EPO,45% with variations in terms of efficacy from Ormeloxifene and 40% with vitamin E). person to person.

Methodology: Conclusion: Benign breast disease forms a sizeable A Retrospective chart analysis was done part of the patient load at the Endocrine from 1st January 2012 to 29th Feb 2012 Surgery OPD in CMCH. Patients present on all patients presenting with complaints with a variety of clinical features. of Benign Breast Diseases to the Numerous treatment options are Endocrine surgery OPD. available and majority of patients can be managed medically. Efficacy with Results: Ormeloxifene was found to be higher than A total of 143 women were included in others and needs further objective the study with a mean age of 34±10.8 assessment with a prospective RCT. years. Majority of women were premenopausal (86%) and multiparous (65.7%). The most common presenting “MONITORING CAPILLARY GLUCOSE complaint was mastalgia (60.8%) LEVELS OF FLAPS BY GLUCOMETER : A followed by lump (55.9%) and nipple SIMPLE AND OBJECTIVE METHOD OF discharge (12.6%) with the mean FLAP MONITORING.”

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Mukesh Sharma, Elvino Barreto, Flap blood glucose monitoring is an Kingsly Paul M, Department of Plastic Objective, Easy to do, In-expensive, Surgery, CMC Vellore. sensitive and specific test which can be done by any medical professional Introduction: (Nurses/ Interns/ Paramedics) without need of any specialised setup. From the Flap surgery is one of the most commonly current study we concluded that flap performed surgeries in the field of reconstructive surgery. Early detection of capillary glucose levels less then 63mg/dl flap failure and rapid re-exploration are is suggestive of ischemia of flap (sensitivity and specificity 92% and 92%, important for flap salvage and hence a respectively). This test allows early reliable monitoring method is required. This study is to evaluate flap blood detection of vascular compromise which glucose measurement (BGM) as a reliable helps in early intervention for flap salvage. method for flap monitoring. Objectives:

To assess the efficacy of flap capillary “ENDOSCOPIC ULTRASONOGRAPHY--A glucose level and its best cut-off value in SENSITIVE TOOL IN THE the post-operative monitoring of pedicled PREOPERATIVE LOCALIZATION OF and free flaps. INSULINOMA.”

Material and Methods: NitinKapoor, Joseph AJ, Simon EG, Chacko A, Thomas EM, Eapen A, 45 different flaps were monitored. Post- Abraham DT, Jacob PM, Paul T, operative examination was done every Rajaratnam S, Thomas N, Dept. of hour for the first 6 hours, and every 6th Endocrinology, Diabetes and hour thereafter till 5 days. Flap capillary Metabolism, CMC, Vellore. glucose levels were measured by using accu check glucometer. Glucose levels of Objective: flap with necrosis and without necrosis A number of imaging modalities have were compared. Statistical analysis was been used in the preoperative localization done by ROC curve to determine the best of insulinomas. Computed tomography cutoff value for the flap blood glucose (CT) is the most commonly employed monitoring. modality. Endoscopic ultrasound (EUS) Result: allows the transducer to be placed in close proximity to the pancreas, thereby Out of 45 different flaps 1 flap had yielding higher quality images, which complete failure and 11 flaps had partial facilitates accurate localization, minimally necrosis. To detect flap ischemia a cut-off invasive surgery, and a lower occurrence value of 63 mg/dL was determined for of residual tumors, all of which contribute the flap BGM, at which the sensitivity and to a better clinical outcome. specificity were 92% and 92%. Methods: Conclusion:

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We analyzed the hospital records of all Aim: adult patients (age >18 years) diagnosed with insulinomabetween October 2004 To compare malignancy profiles in GD, and September 2010. The diagnosis was TA/TMNG AND HT with hyperthyroidism. based on the clinical practice guidelines of the American Endocrine Society. We Methods: compared the sensitivities of EUS and multidetector computed tomography Data of patients with toxic goiters (MDCT) in lesion. managed during January, 2004- Decemer,2012 were reviewed Results: retrospectively. Data analyzed using Independent Sample T test (SPSS v.17). Eighteen patients were seen over a period of 6 years, and all underwent EUS. MDCT Results: scans were carried out in 17 patients. EUS had greater sensitivity (89%) in localizing Out of total 157 patients with insulinomas compared to CT (69%). In thyrotoxicosis, 150 underwent surgery (7 this series, the lesions that were missed defaulted) and this surgical group on CT but picked up on EUS were smaller included 40 patients with GD, 83 with (<12 mm, P<.001). Lesions that were near TA/ TMNG and 27 with HT with mesenteric vessels and those located in thyrotoxicosis. Mean age was in 41.8(+ the head of the pancreas were more likely 1.8,21-64), 51.4(+1.3,25-72) and to be missed on CT. 41.6(+2.2,23-65) years in the 3 groups respectively. Female gender Conclusions: preponderance was noticed in all 3 groups. Thyroid antibody positivity rates EUS has a greater sensitivity in were 43%, 33% and 100% respectively. identifying and localizing insulinomas. As Ophthalmopathy was present in 63%, availability increases, EUS should be part 14% and 19% respectively. Histology was of a preoperative insulinoma workup. benign in 34 with GD, 72 with TA/TMNG and 24 with HT. Malignancy rates were higher in TMNG ( 11/58 malignant) as compared to TA(1/10 “COMPARING MALIGNANCY PROFILE malignant).Diffusely nodular(n=15) toxic IN PATIENTS WITH THYROTOXICOSIS goiters were all benign. In malignant GD, DUE TO GRAVES’ DISEASE (GD), TOXIC 2/6 had multiple nodules. In all the 3 ADENOMAS (TA)/MULTINODULAR groups, most common malignancy was GOITERS (TMNG) AND HASHIMOTO’S papillary thyroid carcinoma followed by THYROIDITIS (HT) - A RETROSPECTIVE papillary microcarcinoma. ANALYSIS.” Introduction: Character Gra Toxic Hashi istics ves’ nodules(toxic moto’s The literature gives conflicting views on dise adenoma/mul thyroid the incidence and patterns of malignancy ase tinodular itis in patients with thyrotoxicosis. goiters)

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(n=83) “LASER LITHOTRIPSY - A NOVEL APPROACH TO IMPACTED STONES IN (n= (n=27) THE TERMINAL END OF COMMON BILE 40) DUCT (CBD). “ Malignanc 6( 11( 13.3) 3 Prerit Thomas, Surgery, Christian y rates 15) (11.1) Meical College, Vellore. (n,%) 8 5 3 Introduction: (Papillary Stones in the CBD are commonly dealt thyroid 2 cancer with endoscopically. However when the 1 0 1 ampulla cannot be visualized/accessed by Papillary 0 0 an endoscope, it will require a surgical microcarc exploration via the CBD to successfully inoma extract these stones.. In spite of this, inability to completely extract all stones Follicular occurs, especially those impacted at the thyroid terminal end of the CBD. This would cancer) require additional procedures such as a Mean 1.8 2.95 (0.3-13) 1.1 duodenotomy and sphincteroplasty to tumor (1- (0.2-2) remove these stones. size 5) (cm)(rang Case report: e in cm) A 55 year old female presented with Nodal 0 1 1 upper abdominal pain and transient fever metastase and jaundice. She was diagnosed to have s 0 1 lung, 1 0 cholelithiasis and choledocholithiasis and skeletal underwent ERCP at another centre but Distant the papilla was edematous and could not metastase be cannulated. She presented to this s institution where the diagnosis was confirmed by MRCP. A second ERCP was Ophthalm 5 2 0 attempted but failed because the papilla opathy could not be accessed.

Conclusion: The patient developed cholangitis with Compared to literature, malignancy rates E.coli sepsis while undergoing evaluation overall are higher in our patients with and was treated with appropriate thyrotoxicosis. Toxic multinodular goiters antibiotics. She underwent open present in older age group, have higher cholecystectomy and common bile duct malignancy rates and more aggressive exploration. At exploration of the CBD compared to Graves’ disease and stones were found to be impacted at the Hashimoto’s thyroiditis. terminal end of CBD and could not be extracted mechanically.

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This was confirmed with a flexible numbers in which more than 12 nodes choledochoscope inserted through the were harvested. choledochotomy. Through the choledochoscope a Holmium-YAG laser Methods: was introduced and complete lithopexy of the CBD stones was done. A cross sectional study was done where 51 patients who underwent curative Inference: resection for operable colonic carcinoma in the past year were included. Patients Laser lithopexy adds a new paradigm in undergoing palliative resection or the management of impacted terminal patients who had undergone neoadjuvant bile duct stones. It avoids opening the therapy were excluded. The sample was a duodenum as route for extraction of universal sample and information was impacted stones and preserves the collected from patients’ medical records. sphincter of Oddi function. Results: Forty patients (78.4%) were male and 11 (21.6%) were female. The average age “IS LAPAROSCOPIC COLONIC was 49.67 years (SD = 13.26). Twenty five RESECTION AN ONCOLOGICALLY SAFE patients (49%) had open and twenty six OPTION?” (51%) had laparoscopic resection. The tumour was located in the caecum and Rajat Raghunath, Rohin Mittal, Mark right colon in 32 (62.7%), in the Ranjan Jesudason and Benjamin transverse colon in 4 (7.8%), and in the Perakath, Department of Surgery, CMC sigmoid colon and rectosigmoid in 15 Vellore. (29.4%). The average number of lymph Background: nodes resected in open colonic resections was 16.36 (SD=7.01) and in laparoscopic Laparoscopic colonic resections are being colonic resections was 17.35 (SD= 8.153). performed as standard of care for colon The difference between these 2 means cancers in most centers today. was not significant (p = 0.646). Laparoscopic resection has been shown to be superior to open surgery in terms of Adequate lymph node resection (more postoperative pain, duration of stay, post than 12 lymph nodes) was done in 72.2% op morbidity and return of bowel of the open colonic resections and 92.9% function. There is conflicting evidence as of the laparoscopic colonic resections. to the superiority of one method over the The difference between the 2 proportions other as far as oncological parameters are was also not significant (chi square 2.2, p concerned, thus leaving this issue =0.138). unanswered. Comparison of lymph node yield may be one way of assessing Conclusions: oncological adequacy of laparoscopic Laparoscopic and open resections in our resection. We therefore examined if hands remove an adequate and lymph node resection was adequate by comparable number of nodes. Thus comparing the number of nodes retrieved laparoscopy is not oncologically inferior in each group and also comparing the to open surgery.

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free at last follow up. The sites of metastases seen were lung, bone, inguinal “OSTEOSARCOMA OF EXTREMITIES : nodes and right ventricle. THE OUTCOMES OF NEOADJUVANT CHEMOTHERAPY AND SURGERY.” Conclusion:

Renitha Miriam Cherian, Selvamani.B, The combination of advances in surgical V.T.K Titus*, Department of Radiation techniques, improved imaging modalities Oncology, Department of to accurately document tumor extent and Orthopaedics* Christian Medical the effect of neoadjuvant chemotherapy College, Vellore. has made limb salvage surgery as the standard of care in the management of Objectives: osteosarcoma. Comprehensive multidisciplinary approach has To describe an institutional experience of transformed it from a disease with a osteosarcoma of extremities and to modest long term survival in which at determine whether neoadjuvant least 2/3 of the patients will be cured. chemotherapy would allow limb salvage Successful management of osteosarcoma surgery yet maintain local disease control. with limb salvage surgery is a challenging problem in the developing world. Methods: Between April 2011 to April 2013, 39 “THE EVOLUTION OF T2-WEIGHTED patients were seen in Department of INTRAMEDULLARY SIGNAL CHANGES Radiation Oncology with osteosarcoma. FOLLOWING THE OBLIQUE CERVICAL They were retrospectively analysed with CORPECTOMY FOR CERVICAL respect to age, gender, site of tumor, SPONDYLOTIC MYELOPATHY.” stage, histology, surgery, post surgical histopathology response and condition on Sauradeep Sarkar, Department of last follow up. Neurological Sciences, Christian Medical College, Vellore. Results: Object: There were 29 males and 10 females with age ranging from 16 yrs to 60 yrs. The T2-weighted intramedullary increased most common site was around the knee signal intensity (ISI) on MR imaging in joint and uncommon sites were pelvis, L3, patients with cervical spondylotic scalp and gingiva. The commonest myelopathy (CSM) appears to represent a histology was high grade osteosarcoma. wide spectrum of pathological changes Twelve patients were excluded from the that determine reversibility of cord study as they had no treatment or had damage. Although sharp T2-weighted ISI metastatic disease. Out of the other 27 on preoperative imaging may correlate patients, 5 had amputation, 18 underwent with poorer surgical outcomes, there is limb salvage surgery and 4 had wide local limited data on how these changes excision. The follow up ranged from 3 to progress following surgery. In this study, 27 months. Fifteen patients were disease we characterized pre- and postoperative ISI changes in patients undergoing

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surgery for CSM and studied their regression in ISI size compared to postoperative evolution in an attempt to patients imaged earlier. On logistic quantify their clinical significance. regression analysis, preoperative Nurick Grade and duration of follow-up were the only significant predictors of postoperative improvement in functional Methods: status (OR 4.136, p value 0.003 and OR 6.402, p value 0.03 respectively). The preoperative and postoperative MR images of 56 patients who underwent the Conclusions: oblique cervical corpectomy (OCC) for CSM were reviewed and the ISI classified There are a distinct group of patients with into 4 subtypes based on their margins multisegmental Type 3 intramedullary and intensity: Type 0 (none), Type 1 changes, who show remarkable (“fuzzy”), Type 2 (“sharp”) and Type 3 radiological regression after surgery, but (“mixed”). The locations of the ISI were demonstrate a residual sharp focal ISI at further classified as focal if they were follow-up. A regression of the ISI by >50% single discrete lesions, multifocal if there predicts better functional outcomes. were multiple lesions with intervening Patients with a good preoperative normal cord and multisegmental when functional status remain the most likely to they were continuous over >1 segment. show improvement, and the improvement The maximum craniocaudal length of the continues to occur even at remote follow- ISI was measured on each mid-sagittal up. The clinical relevance of the quality of MR image. The Nurick grade and JOA the T2-weighted ISI changes in patients score were used to assess clinical status. with CSM remains uncertain; however The mean duration of follow-up was 28 postoperative regression of the ISI change months. is possibly a more important correlate of patient outcome than the quality of the ISI Results: change alone.

T2-weighted ISI changes were noted preoperatively in 54 patients (96%). Most preoperative ISI changes were Type 1 “ONCOLOGICAL OUTCOMES AND (41%) or Type 3 (34%), with a significant FEASIBILITY OF STRAP MUSCLE FLAP trend towards Type 2 (71%) changes at IN HEAD AND NECK follow-up. Multisegmental and Type 3 RECONSTRUCTION.” lesions tended to regress significantly $ $ after surgery (p value 0.000), reducing to Jayanth S T , Rajinikanth J , Gaikwad $ $ Type 2 changes at follow-up. Clinical P , Department of General Surgery outcomes did not correlate with ISI including Head and Neck Surgery, subtype, however, there was a Christian Medical College, Vellore. statistically significant trend towards Corresponding author improvement in postoperative Nurick ([email protected] ) Grade in patients with a >50% regression in ISI size. In addition, patients with >18 Background: months follow-up showed significant

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It is well accepted that vascularised free local and regional recurrence and one flaps is the optimal choice of with lung metastases. There were five reconstruction for oral cavity defects. deaths (Three due to local and regional Often, due to time and financial recurrence, one due to lung metastases constraints in developing countries, there and one due to a myocardial infarction). is a need for cost-effective and simpler The cost of strap muscle flap (Rupees local flaps. Local flaps have not gained 60,000) when compared to radial artery popularity in head and neck forearm free flap (Rupees 2.5 lakhs) is reconstruction, due to concerns about significantly lower. All flaps were oncological safety. Infrahyoid musculo- performed by the corresponding author. cutaneous flap (strap muscle flap) appears to be a suitable alternative. It is Conclusion: easy, quick to harvest and oncologically safe. The strap muscle flap is a reliable and convenient flap suitable for repairing Methods: small and medium-sized defect that arise This is a retrospective chart review of after resection of tongue and FOM lesions. nineteen patients who underwent strap It serves as an alternative to microvascular free flaps in select cases. It muscle flap as reconstruction for does not compromise neck dissection and glossectomy and floor of mouth defects from November 2011 to May 2013. A it is easy to harvest and is cost effective. It critical analysis of the short term is oncologically safe but long term results are yet to be established. This flap should outcomes and oncological safety of the be ideally reserved for node negative flap was done. disease as nodes in level II and III may Results: complicate the harvesting of the flap.

There were nine females and ten males in Key words: this study group. The mean age was 47 years (Range: 27 – 67 years). The Infrahyoid myocutaneous flap, reconstruction strap muscle flap was Alternative to free flap reconstruction, done after wide local excision of tongue oral cavity defects, oncological safety, cost (16) and floor of mouth (3) lesions. effective.

There were three patients with total and Introduction: one with partial flap necrosis. There were 3 patients with flap infection and one Reconstruction following resection of oral each with a seroma and flap haematoma. cavity cancers is a challenge. Optimal Of the four patients who had flap failure reconstruction should restore both form (either partial or total) one patient had and function and should not compromise clinically positive nodes in level II. There on the oncological safety. It is important were seven patients with close margins to tailor the reconstruction based on the and one with positive margin. site of the primary lesion, the size of the On follow up (Range: 2 to 18 defect, nodal status, the associated co- months) there were three patients with morbidities and others. Currently vacsularised free flaps are the preferred

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method of such reconstruction. There has was done. There were nine females and been data to suggest that it provides good ten males in this study group. The mean functional and oncological outcomes. The age was 47 years (Range: 27 – 67 years ). flap that is commonly used is the free The commonest histological type was radial forearm flap. It is very versatile and squamous cell carcinoma. The reliable and offers good form and reconstruction with infrahyoid function. Radial forearm free flap offers musculocutaneous flap was done after thin pliable skin to suit most of the lining wide local excision of tongue(16) and defects in the oral cavity including tongue floor of mouth(3) lesions. and the Floor of the mouth defects. Often, not all patients are suitable for free flap Results: reconstruction and there is time and financial constraints in developing The number of nodes harvested were countries and hence there is a need for between 15 – 20. The mean size of the cost-effective simpler local flaps. The flap defect was 5 x 4 cm and the mean harvest that is used as a workhorse is the time of the flap was one hour. Four of the pectoralis major myocutaneous flap. flaps were horizontally oriented and fifteen were vertically oriented. Local flaps are not very popular due to concerns of oncological safety and the There were three total necrosis and one short rotation arch. Infrahyoid partial flap necrosis. There were 3 myocutaneous flaps were described first patients with flap infection and one each by Wang and Shen in 1980. It is based on with a seroma and flap haematoma. Two the superior thyoid artery. It has been Patients underwent flap revision and used in reconstruction of defects in the three patients underwent debridement of oral cavity and pharynx following the necrosed flap. Of the four patients resection of oropharyngeal cancers. The who had flap failure (either partial or complication rate reported in the total) two had positive nodes and two had literature is extremely variable, ranging negative nodes on histopathology. In this from 3% to 47%. The main problems are subgroup of flap necrosis, margin related to the reliability of the skin paddle positivity did not seem to have an impact for insufficient venous drainage. on the failure of the flap (two patients had close and two had clear margins). There Materials and Methods: were seven close margins and one positive margin. This is a retrospective chart review of nineteen patients who underwent strap On follow up (Range: 2 to 18 months) muscle flap as reconstruction for there were three patients with local and glossectomy and floor of mouth defects regional recurrence and one with lung from November 2011 to May 2013. A metastases. One patient with a regional critical analysis of the oncological safety recurrence underwent a revisional of the flap with review of close margins in surgery with total glossectomy, the resected area and local & regional tracheostomy, feeding gastrostomy and a recurrence, the number of nodes pectoralis major myocutaneous flap. harvested during neck dissection, success However he succumbed to a loco-regional rate of the flaps and the size of the defects recurrence within a month. There were

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five deaths (Three due to local and radiation dose escalation on urinary regional recurrence, one due to lung toxicity in Indian men undergoing metastases and one due to a myocardial treatment for prostate cancer with WP- infarction). The cost of strap muscle flap IMRT utilizing CBCT image guidance. (Rupees 60,000) when compared to radial artery forearm free flap (Rupees Material and methods: 2.5 lakhs) is significantly lower. All flaps were performed by the corresponding Between 2010 and 2013, patients with author. localized high risk prostate cancer were treated with ADT and WP-IMRT. WP- Conclusion: IMRT (4680cGy) was followed by an IMRT boost (2520 to 2880cGy) to the The infrahyoid myocutaneous flap is a prostate, based on tolerance of organs at reliable and convenient flap suitable for risk. Image guidance was done by Daily repairing small and medium-sized defect CBCT. Urinary symptoms of patients were that arise after resection of tongue and assessed using International Prostate FOM lesions. It serves as an alternative to Symptom Score (IPSS) prior to starting microvascular free flaps in select cases. It radiation and during each follow-up. The does not compromise neck dissection and initial scores were analyzed and it is oncologically safe and easy to harvest, compared with the scores on follow up. in less than an hour. This flap should be ideally reserved for node negative disease Results: as nodes in level II and III may complicate the harvesting of the flap. Twelve patients with localized high risk prostate cancer were treated with WP- IMRT with CBCT image guidance. The “URINARY TOXICITY IN HIGH RISK median prescription radiation dose was PROSTATE CANCER PATIENTS 7380cGy. The planned radiation dose to TREATED WITH WHOLE PELVIS the urinary bladder was within the INTENSITY MODULATED accepted tolerance limits. The median RADIOTHERAPY (WP-IMRT) WITH follow-up after completion of radiation CONE BEAM CT (CBCT) FOR IMAGE was 9.5 months with a range of 3 to 23 GUIDANCE.” months. IPSS scores improved in 5 patients at the time of first follow-up and in 9 by second follow-up. Only one patient Simon Pavamani had a 10 point increase in IPSS at his first follow-up, but the score improved to Background: below his baseline by second follow-up. In India, the incidence of prostate cancer There was no significant worsening of is low & patients are usually diagnosed in urinary symptoms by the second follow- advanced stages of disease. Patients with up. No patient suffered urinary localized high risk prostate cancer incontinence or obstruction. undergo androgen deprivation therapy(ADT) and whole pelvic radiation. Conclusion: This study aimed to assess the impact of

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IMRT delivered with image guidance is a underestimation being 2-4% in relatively new treatment modality in comparison with the graph method. India. Patients undergoing WP-IMRT experience urinary toxicity. However, this Conclusions: resolves within a year and the majority of patients do not experience any significant The photographic standardised wound long term urinary toxicity. measurement is a simple, accurate, noninvasive and cost effective technique.

“A NOVEL AND ACCURATE TECHNIQUE “INCIDENCE AND RISK FACTORS OF OF PHOTOGRAPHIC WOUND POST MASTECTOMY LYMPHEDEMA.” MEASUREMENT.” Dr Soumya Gupta, Dr. Ashish Kumar Ashish Kumar Gupta, Shashank Lamba, Gupta, Dr. M J Paul, Department of Aashish Shashidharan, Soumya Gupta, Plastic and Reconstructive Surgery, Rahul Shetty, Department of Plastic Christian Medical College, Vellore. and Reconstructive Surgery, Christian Medical College, Vellore. Background: Background: The incidence of lymphedema varies from 10-60% depending on the method of Wound measurement helps in estimation. Many risk factors have been quantitative assessment of healing or attributed to susceptibility of patients for progression of wound. This renders the developing lymphedema. Obesity, treatment efficacy predictable. hypertension, axillary dissection, wound Aim: infection, chemotherapy and radiotherapy are most commonly related. To introduce a simple and accurate In breast cancer patients, lymphedema technique of wound measurement. has been described as an often overlooked and undertreated condition. Method: Early diagnosis, referral and intervention have been shown to reduce the risk of The graph method was taken as the chronic lymphedema and to improve control measurement. The extent of outcomes. deviation in wound measurements with our method was compared with the Aim: standard technique. The statistical analysis used was ANOVA. To study the incidence and factors influencing post mastectomy Results: lymphedema. The ruler method overestimated the Method: wound size by nearly 50%.Our technique remained consistent and accurate with 103 adult women were included in the the percentage of over or study. Baseline preoperative measurements were taken and then they

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were followed up for one year with To do a dosimetric comparison between periodic measurement. The probable risk IMRS and SRS to assess feasibility and factors were accounted and measured. safety of IMRS.

Results: Materials and methods: This pilot study was carried out using The incidence of lymphedema in our radiotherapy planning software, on the institute is 25%. No significant risk radiological images of patients with factors could be pointed out. intracranial lesions, who had earlier received SRS treatment with BRW frame Conclusions : in our institution. Twenty such image sets Recognition of early onset of lymphedema were randomly selected from the rehabilitates these patients better. We database using random number sampling. must aim to lower the incidence rate in an These image sets were re-contoured to esteemed institute like ours. include additional Organs at Risk (OARs) including normal brain. The doses delivered by the previous SRS plans was recalculated and new IMRS plan was “A PILOT DOSIMETRIC STUDY TO created for each data set using Brainlab™ COMPARE MICRO-MULTILEAF treatment planning system. The various COLLIMATOR BASED STEREOTACTIC dosimetric parameters concerning Target RADIOSURGERY AND INTENSITY and OARs were calculated and compared MODULATED RADIOSURGERY FOR between SRS and IMRS. INTRACRANIAL TARGETS.” Results: A. Thoke, S. Varghese, S. Backianathan, P. Ravindran, A. Chacko, R. Vedantam, IMRS was able to deliver the desired dose P.N. Viswanathan, Departments of to the target while keeping doses to OARs Radiation Oncology, Radiation Physics within the tolerance range. It was able to and Neurosurgery, Christian Medical achieve higher peripheral isodose College, Vellore. coverage than SRS in majority of plans. The IMRS plans showed increased dose Background: inhomogenity and integral dose to the Stereotactic radiosurgery (SRS) is an normal brain. Conformity index was important modality for treatment of consistently better in SRS than IMRS. It intracranial lesions. Linear accelerator was observed that for targets situated based SRS has been in use since 1980s. very close to OARs, IMRS cannot spare Intensity Modulated Stereotactic OARs better than SRS. The difference was Radiosurgery (IMRS) technique is a not statistically significant because of recent advancement. A dosimetric lower numbers studied in this pilot study. comparison of safety and accuracy Conclusions: between SRS and IMRS is required before actual practical application. IMRS is a feasible and safe modality of radiation delivery to intracranial lesions. Aim:

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significant difference between this subgroup and EBV negative gastric “FREQUENCY OF EPSTEIN - BARR adenocarcinomas with respect to age and VIRUS INFECTION AS DETECTED BY sex predilection, lymph nodal status and EBNA1 MRNA IN HISTOLOGICALLY site of presentation. Short term follow-up PROVEN GASTRIC ADENOCARCINOMA of this subgroup of patients seems to IN PATIENTS PRESENTING TO A indicate a good overall prognosis after TERTIARY CARE CENTER IN SOUTH appropriate treatment. However, a larger INDIA.” prospective study with long term follow up is needed to further establish the role Manbha L. Rymbai, Veena Vadhini of EBV in gastric adenocarcinoma in this Ramalingam, Jerobin J, Asha Mary study population. Abraham, Inian Samarasan, George Mathew, Rajesh Kannangai, Departments of General Surgery and Clinical Virology, Christian Medical “PREVALENCE OF RISK FACTORS FOR College, Vellore-632004. CORONARY HEART DISEASE IN RURAL AREAS- A REPEAT CROSS SECTIONAL EBV associated gastric carcinoma is a SURVEY.” relatively uncommon entity detected in approximately 10% of gastric adenocarcinoma. The purpose of this Anu Mary Oommen, Kuryan George, study was to estimate the prevalence of Vinod Joseph Abraham, Jacob Jose, EBV associated gastric carcinoma and Departments of Community Health and also to assess the nature of presentation, Cardiology, CMC Vellore. any significant difference between this subgroup and EBV negative gastric Background: adenocarcinomas with respect to age and While it is known that non communicable sex predilection, lymph nodal status, site diseases and their risk factors are of presentation. We prospectively increasing in urban areas there are fewer analysed 100 cases of gastric studies documenting such increases in adenocarcinoma which underwent either rural areas. a partial or total gastrectomy from March 2010 to August 2011. The tumour and Methods: the corresponding normal gastric tissue from the same patient were analyzed for A repeat cross sectional survey was done the presence of mRNA for EBNA1 protein in nine villages of Kaniyambadi block that of EBV by real time PCR. EBV was had been surveyed for risk factors for detected in 6% cases of gastric cardiovascular diseases in 1991-94. All adenocarcinoma. All the positive patients consenting adults aged 30 to 64 years were males. In majority of cases involved were interviewed by field workers for the proximal stomach and there was socio-demographic and behavioural risk variable lymph nodal involvement. Our factors using the WHO STEPS study reiterate the fact that there is an questionnaire andfurther screened for association between EBV infection and medical problems at a clinic. gastric adenocarcinoma. There was no

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Results:

Of all the eligible respondents 3799 “KNOWLEDGE ATTITUDE AND (83%) were interviewed with 82% of PRACTICE AMONG MOTHERS these (1323 males and 1772 females) REGARDING POST PARTUM CARE IN providing all results.There was an A RURAL SETUP OF TAMIL NADU.” increase in prevalence of diabetes (fasting First authors: medication) from 2.9% in 1991-94 to Dr Himadri Sinha, Intern, Christian 10.4%plasma in glucose2010-12and ≥ 126hy mg% or on medical college, Vellore 140/90 mm Hg or on medication) from Dr Kiruba Vidhyantha, Intern, 5.6% to 15.3%.The meanpertension total cholesterol (BP ≥ Christian medical college, Vellore and triglyceride values for both sexes

showed an increase from the previous Second author: Dr Chella Sindhu KN, PG registrar, kg/m2increased from 8.5% among males Rural unit for health and social affairs, tosurvey. 26.4% The and proportionfrom 11% among with BMIfemales ≥ 25to Christian medical college, Vellore 34.5%. Third author: The proportion of males who were current smokers decreased from 46% in Dr Sherin Susan Paul, Tutor, Rural unit 1991-94 to 25% in 2010-12 while the for health and social affairs, Christian proportion of male ever consumers of medical college, Vellore alcohol increased from 53.2% to Corresponding author: five servings of fruits/vegetables daily was61.5%.The currently proportion 0.4% while who 43.3% consumed were ≥ Dr Rita Isaac, HOD, Rural unit for classified as having low physical activity. health and social affairs, Christian medical college, Vellore Conclusions: Background: The rates of hypertension, diabetes and obesity have tripled since 1991. A large The rural population and urban proportion of rural persons are physically Population constitute 68.84% and inactive and do not consumeadequate 31.16% respectively to the total fruits and vegetables. Although smoking population of India. Infant mortality rate is decreasing,one in four men smoke in India is very high (47/1000 live births) while alcohol consumption is on the rise. with a greater proportion of the mortality These findings highlight the need for emerging from rural areas. Numerous increased primary prevention efforts to mis-beliefs and food fads centre on the prevent non-communicable diseases in mothers of rural India regarding rural areas. postpartum care, which as a result influence the infant and neonatal Funding: mortality rates considerably. The aim of this study was to understand the The Indian Council of Medical Research. knowledge, attitude and practice among

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mothers about post partum care in a rural was considered as an auspicious day. population of South India. 23.8% mothers clipped their nails on certain specified days. 23.8% mothers did Method: not wash their hands before handling the Study setting: K.V. Kuppam block, Tamil baby. 85.7% only wiped the baby’s buttocks with cloth and did not wash with Nadu water after defecation for the first 3 Study design: months following delivery. The overall prevalence of inadequate knowledge  Qualitative – Focus group regarding postpartum care was 65.1% discussion (95% C.I= +-12). The study found a  Quantitative- Cross sectional study significant difference in knowledge between primiparous and multiparous mothers with primiparous mothers Mothers with children less than six having a higher score (p value=0.021, months were included in the study. A odds ratio 3.491 (95%CI 1.181-10.320). sample size of 65 was calculated based on Higher maternal education was a pilot survey conducted. A two-staged associated with higher scores (p value = cluster sampling was performed. Three 0.004, odds ratio 6.404 (95% CI 1.683- villages were chosen as clusters in the 24.374). Multivariate analysis elicited a first stage and a simple random sampling significant difference between was performed within each of the three primiparous and multiparous mothers, clusters. 63 women fulfilling the inclusion and between higher maternal education criteria were interviewed. and lower education. Results: Key conclusions: 60.3% of the total women interviewed • Prevalence of inadequacy of said they had been advised about spacing knowledge about postpartum of births. 98.4% felt personal hygiene was care= 65.1% (corresponded with important following delivery. 88.9% the pilot survey of 70%). mothers said the baby should be • There was a significant difference breastfed within half to one hour of birth. in the knowledge between A small proportion believed in giving the primiparous and multiparous baby honey, vasambu and donkey’s milk mothers, with primiparous as the first feed. 88.9% mothers said mothers having a higher score. specific food items should be avoided • Higher level of maternal education following delivery. 34.9% avoided water was associated with an increased following delivery as they thought it will awareness regarding postpartum cause the baby to develop cold. 23 women care said they had to follow sleep restriction • Type of family & socioeconomic immediately following water status did not show a significant consumption. Only 7.9% mothers had a difference with respect to post- bath immediately following delivery. A partum care. majority (79.4%) of them washed their Implications for practice: hair on the ninth day of delivery which

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Understanding cultural beliefs and 6/12 were referred for a detailed traditional practices regarding postpartu examination at the hospital. m care of mothers and their babies is important to eliminate harmful practices Results: followed in a vast majority of rural population, with no scientific basis and Of the 4739 children on the rolls in the 6th thereby contributing to the health and the – 9th grades of 22 government schools wellbeing of the children in the early within the Kaniyambadi block all the stages of growth. 87.3% of the children present on the predetermined day of examination underwent screening. Absenteeism was significantly more among boys (p<0.0001). Of the children screened, “PREVALENCE OF REFRACTIVE prevalence of children unable to see the ERRORS AMONG HIGH SCHOOL 6/12 optotype in either eye (uncorrected) CHILDREN IN SOUTH INDIA, A CROSS was 2.30 % (95% Confidence Interval SECTIONAL STUDY.” 1.834 to 2.766). 40 (40.82 %) of these were boys and 58 (59.18%) were girls. Deepika John, Sarada David, Padma The prevalence of refractive error was Paul, Evon Selina Kujur, Smitha Jasper, 2.19%, (95%CI 1.73 – 2.65). Forty Muliyil JP, Ophthalmology percent of those were myopic and the remaining sixty percent were astigmatic. Aim: Amblyopia was the commonest co- To determine the prevalence of morbidity. uncorrected refractive error among high school children in a rural block in South The NNS to detect one child with low India and find the Number Needed to vision or blindness from uncorrected Screen (NNS) to find one child with low refractive error using the National vision or blindness from uncorrected Program for Control of Blindness refractive error in this age group. definitions was only 147 school children studying in grades 6th to 9th. Methods:

A school based cross-sectional study was Conclusions: carried out on pre-determined days in all The prevalence of uncorrected refractive those government schools of error in Kaniyambadi block is similar to Kaniyambadi block which had students in some other studies in children within the the 6th – 9th grades. All children belonging same age group in different studies to these grades willing to participate were around the world and within the country. included. Visual acuity screening was The low number needed to screen makes done using a single line 6/12 optotype E screening a worthwhile proposition for chart at 6 meters. Children were school screening programs in developing categorized into “seeing” or “not seeing” countries such as ours. based on their ability to identify the 6/12 optotype. Those with vision worse than

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FIELD WORK AND EPIDEMIOLOGY

“KNOWLEDGE, PERCEPTION AND that injuries are “accidents” or “acts of AWARENESS ON PREVENTABILITY OF fate”. Changing people’s perceptions and UNINTENTIONAL CHILDHOOD beliefs about the nature of childhood INJURIES AMONG PRIMARY injuries play a vital role in injury CAREGIVERS OF CHILDREN AGED prevention. BETWEEN 0-14 YEARS IN RURAL SOUTHERN INDIA.” Objective:

Nikhil Muduli, MBBS Student, Christian To assess the knowledge, perception and Medical College, Vellore awareness among primary caregivers of children Context: aged between 0-14 years in rural Southern India regarding types of injury Globally, about 2270 children die and its preventability. everyday due to unintentional injury and more than 1000 Setting: children’s lives everyday could be saved by implementing proven interventions . A cross-sectional study was done in 6 Experts estimate that up to 90% of villages of Vellore district in Tamil Nadu. childhood injuries are considered both predictable and preventable 2. However, Design: many among the general public believe

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302 primary caregivers, chosen by cluster Padma Paul, Smitha Jasper, Thomas sampling were interviewed with a semi- Kuriakose, Renu Raju, Kuryan George, structured questionnaire during which Jacob John, Prem Doss, Muliyil JP. demographic profile was collected and ten pictures of high risk situations were shown and a response elicited to Purpose: determine perception on injury, To determine visual function (VF) and knowledge on type of injury, perception quality of life (QOL) among patients on prevention and awareness on having undergone cataract surgery in one prevention methods. or both eyes and measure association between quality of life and visual Results & Conclusions: outcomes in them.

84.5 % (255/302) caregivers had a good Methods: perception of injuries that could have From the population based cross occurred in those situations, 81.7 % sectional study of ten villages selected by (247/302) had adequate knowledge of cluster sampling comprising 5530 the type of injury that could occur in each individuals 50 years and older, 749 situation, 73.5 %(222/302) believed that individuals who had undergone cataract the injuries were preventable, 60.9 % surgery in one or both eyes were (184/302) of the caregivers were aware administered queries regarding cataract of the correct prevention methods that surgery, underwent visual acuity could be used in those situations. Pre- assessment using Log MAR E chart and metric education, illiteracy, low socio- ophthalmic examination after obtaining economic score were significantly informed consent. Outcomes were associated with poor perception on considered ‘good’ if the visual acuity of injury, inadequate knowledge on type of the operated eye was 6/18 or better, ‘fair’ injury, poor perception on prevention and if worse than 6/18 but better than or inadequate awareness on prevention equal to 6/60 and ‘poor’ if worse than methods. This study recommends health 6/60. A previously validated Visual education to primary caregivers of Function (VFQ) and Quality of Life (QOL) children about childhood injuries in order Questionnaire was administered to all to improve their perception and patients with BCVA 6/18 or less in the knowledge about injuries and eventually operated eye and first 10 patients of those bring down morbidity and mortality due with BCVA better than 6/18 in the to the same. operated eye in each village by a trained health worker.

“VISUAL FUNCTION AND QUALITY OF Results: LIFE AFTER CATARACT SURGERY IN KANIYAMBADI BLOCK, A CROSS There was complete information for QOL SECTIONAL STUDY.” in 513 patients and for VFQ in 531 patients. For the VFQ over a third of the respondents reported ‘quite a lot of problem’ (score 3) in recognizing people

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across the street, adjusting to darkness after being in a bright light and seeing with bright lights shining in eyes. The Venkata Raghava Mohan, Srujan social domain had the lowest mean score Sharma, Karthikeyan, Ramanujam, of the QOL domains and remained the SudhirBabji, Sushil Mathew John and domain with respondents requiring most Gagandeep Kang. help (25%) due to vision.

Background: One way ANOVA analysis for the difference in mean for both VFQ and QOL Lead poisoning accounts for about 0.6% scores revealed p value <0.001 which was of the global burden of disease with statistically significant implying that there developing countries having the highest was a significant difference between the burden. Children are more vulnerable to mean scores of VFQ and QOL in the three the toxic effects of lead, with even low different groups of outcomes. levels of exposure potentially causing serious andsometimesirreversible Conclusions: neurological damage.Lead exposure The post operative VF and QOL of during childhood contributes to 600,000 individuals studied seems to be very good incident cases of intellectual disabilities on the whole. The social domain of the among children.Starting with conception, quality of life seems to be most affected in children are at a greater risk of exposure individuals with visual impairment after and increased susceptibility to the toxic cataract surgery. effects of lead. They may be exposed to lead throughout pregnancy and they consume more food and water and breathe more air per unit of body weight. “ELEVATED BLOOD LEAD LEVELS, RISK Their exploratory behaviors, increased FACTORS AND ASSOCIATION WITH hand to mouth contact and tendencies to ANAEMIA AND COGNITION AMONG spend longer periods of time in a single PRESCHOOL CHILDREN IN URBAN

VELLORE.”

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S. no. Variable Dataset Form name 1 Lead levels BLL, 15 and 24 months Blood Lead Assay Results form 2 GIS data Census data Internal data from the site 3 Child characteristics CAF, recruitment Child Assessment Form 4 Maternal MAF, 2 months Maternal Assessment Form 5 Maternal depression SRQ20, 6 months Self reporting questionnaire 20 6 Household FSE, 6 months Follow up Socio-economic status form 7 Breast feeding data SAF, 0 to 24 months Surveillance Assessment Form 8 Child haemoglobin levels BCH, 15 months Blood collection and haemoglobin form 9 Child cognition scores BSD, 24 months Bayley scales of infant and toddler development environment, places them at higher risk levels by Graphite furnace atomic of exposure. Absorption of ingested lead absorption spectrophotometry method is high in children (50% as compared to (GFAAS). A value of 10 µg/dL was used as 10% in adults) with nutritional the cut off level to identify elevated BLLs. deficiencies and pica further enhancing The mean at 15 and 24 months were the absorption rate. calculated and compared using paired samples T-test to identify significant The Centers for Disease Control (CDC) has differences. Risk factor analyses were defined an elevated blood lead level (BLL) performed to test the association between as >10 µg/dL for children under 6 years established risk factors for elevated BLLs of age. The burden of lead poisoning, among children. The effect of elevated sources and patterns of exposure to lead BLLs on the anaemia levels and cognition vary greatly within and between nations. scores were tested using non-parametric tests for association. Objectives: Variables and data sets used for the This study aims to study the proportion of analyses: children with elevated BLLs at 15 and 24 months among the MalED cohort in Vellore, India. We also assessed risk Results: factors for having elevated BLLs at 15 months and studied the effects of elevated A total 150 and 70 blood samples were BLLs on cognition and anaemia. tested for lead levels at 15 and 24 months respectively. The mean (SD) BLLs were Methods: 10.4 (5.4) and 11.1 µg/dL (6.5) at 15 and 24 months respectively, with 44.7% Blood samples were collected from the (67/150) and 44.3% (31/70) children enrolled children at 15and 24 months as with BLLs of 10 µg/dL or more at 15 and per the study protocol and tested for lead 24 months. Proportions of children with

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BLL >15 µg/dL at 15 and 24 months were except for the type of flooring. Unlike 17.1% and 16% .The mean difference of other studies, we found maternal 2.7 µg/dL in the BLLs between 15 and 24 education levels to be negatively months was statistically significant. associated with the 15 month blood lead levels among children. We did not find Independent risk factor analysis showed any significant correlation between BLL elevated BLLs to be higher among boys at 15 months and haemoglobin levels at 7 (47.1%) than girls (42.5%). Under and 15 months. In this study, cognitive educated mothers had a protective effect scores at 24 months were inversely on the BLLs. Belonging to a lower correlated with the 15 month BLLs and socioeconomic group, using piped water elevated BLLs were significantly supply for drinking and having mud or associated with poorer cognitive scores at clay as flooring in the house were 24 months. associated with higher risk of having elevated BLLs. Multivariate logistic The high proportion of children with regression model identified maternal elevated BLLs in this study, may have under education was significantly been exposed to lead from a variety of associated with low BLLs at 15 months of sources. Lead from paints, toys and water age. piping are now considered to be 50.7% (76/150) of the children had important sources of exposure in the anaemia at 15 months of age, with more developing countries. Over 80% of the than half of them with mild anaemia enamel based paints in India have lead (46/76) as estimated by a haemoglobin concentrations above 1000 ppm. value between 10 and 10.9g/dl. Children with low BLLs had higher proportions of More research focussing on the built anaemia across all categories. environment and behavioural characteristics of the children and parents Cognitive scores at 24 months were is needed to understand the exposure correlated with the BLL at 15 months pathways and to establish causality. with a Spearman's rho of 0.091, this was not statistically significant (p=0.33). Children with elevated BLLs had 2.6 times “BLOOD DONATION AWARENESS IN higher odds of having poor cognitive A COMMUNITY SETUP IN SOUTH scores (OR 2.57; 95% CI 1.04 – 6.47) INDIA – A KNOWLEDGE, ATTITUDE, which was statistically significant (Chi- PRACTICE STUDY.” square value = 4.189, p<0.05). (VBAS study – The Vellore Blood donation awareness study)

Discussion and Conclusion: Akhil Kurup, Chella Sindhu KN, Arun The proportion of children with elevated Bhatt, Avanish Jha, Shalini, Anu BLLs (44%) in our study was higher than Oommen. the proportions reported from other parts of India (12 to 38%). We did not Background: detect statistical significance for the established independent risk factors

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Although there is a growing demand for make them weak. Most respondents blood and its products in health care in (76 %) would allow their family members India, only 4% of the eligible population to donate in future but not at present. donates blood. While 52% of available Higher educational status was blood is generated from voluntary donors significantly associated with blood only75% of donors donate at least once a donation (OR=3.758, CI=1.54-9.156). Also year. This study was designed to assess there was significant difference between the knowledge of the people in the occupation and willingness to donate community regarding the blood donation blood (OR=5.333, CI=1.429-19.90). No process, attitude towards voluntary blood significant association was found between donation and to assess the willingness for gender and the willingness to donate voluntary blood donation. blood.

Methodology: Conclusions:

A cross sectional study was carried out in The practice of blood donation was five randomly selected villages in uncommon although almost half of the Kaniyambadi block using a pilot-tested respondents expressed willingness to do interviewer administered questionnaire. so. Widespread false beliefs regarding the Systematic random sampling was used to blood donation process in the community identify one eligible individual per may be the reason why most of the household. eligible population have notdonated blood so far and need to be corrected Results: through health education programs.

The number of persons surveyed was 104 “ARE MANY PATIENTS TELLING of the required sample size of 120. While UNTRUTHS TO OBTAIN CONCESSIONS? 90% were aware that blood can be A SOCIAL WORK REPORT FROM donated on a voluntary basis, the main PALLIATIVE CARE.” sources of their awareness being the Ramu Kandasamy, Sharon Uniki television or on a visit to hospital only Lyngdoh, David Mathew, Jenifer Jeba, 15% had donated blood in the past. Reena George However 44% said they were willing to donate blood and most of the willing Background: persons (83%) said they would donate for anyone in need with serving the Fear of the cost of medical care can lead society being the most common to false information about the motivation. Those who were not willing socioeconomic status on presentation to to donate sighted weakness and lack of hospital. We aimed to assess the extent blood in their body as the reason. Many and severity of this problem in the respondents (74%) thought that blood population seen in palliative care. could be bought with money when needed, 33% thought that women Methodology: and 38 % felt that manual labourers should not donate blood while The palliative care social worker obtains a 22% believed that blood donation would detailed family tree and social history for

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patients attending the clinic. The same social worker then does a home visit to ascertain palliative care needs in the domiciliary setting. The discrepancies between the history reported and the actual situation was analyzed in a random sample of 506 cases seen between 2004 and 2011.

Results:

Families were classified as poor / lower middle class / middle class and / upper middle class + rich. In 78 % of cases there was no change in the socioeconomic class between the clinic history and the home visit, in 8.4% there was a major change and in 14 % there was a change by one category (e.g. poor to low middle class).

Salaried people were significantly less likely to give false information than business people, landowners, and agricultural labourers. Overall, minor or major discrepancies in information were seen in 49% of patients. Most commonly this was regarding the type of job and the number of rooms in the house. Patients were more likely to lie about the number of sons than the number of daughters.

Conclusions: In the majority of cases, falsification of social history was because of genuine financial struggles among the poor and low middle class. It is hoped that the availability of government health schemes will reduce this problem. Social work assessment and support can help improve access to health care for deprived groups.

156

EFFECT OF CHEWING GUM THERAPY ON Results: SELECTED POST OPERATIVE OUTCOMES IN Experimental group had mean time of 84.11 hours PATIENTS UNDERGOING ABDOMINAL to pass stool, the control group took mean time of SURGERY 80.79 hours (p value >0.05). Experimental group had good oral hygiene than the control group ABSTRACT (p<0.001). Thirst experienced by the participants Background: Abdominal surgery and its in the experimental group significantly less than complications are inevitable. Bowel distension is one the control group (p<0.05). of the major complication after abdominal surgery leading to post operative ileus. Postoperative ileus is a common problem among these patients. Patients Conclusion: experience nausea, vomiting, delay in taking oral It was found that there is no significant effect of feeds and feel dry and thirsty. Chewing gum therapy chewing gum therapy on ileus, possibly due to the is an inexpensive therapy having benefits in heterogeneity of the subjects with regard to the decreasing ileus in post operative abdominal surgery type of abdominal surgery. The study showed patients. Gum chewing also improves oral hygiene improved oral hygiene and reduction in feeling of and reduces thirst. thirst.

Objectives of the study: To assess the effectiveness of chewing gum KNOWLEDGE OF NURSING PERSONNEL AND therapy in selected postoperative outcomes such THE ADEQUACY OF CARE PROVIDED TO THE as post operative ileus, oral hygiene, feeling of NEWBORN ON MECHANICAL VENTILATOR thirst and early discharge of patients undergoing abdominal surgery. Secondly, to identify the *Mories sankar M.sc (N) association between selected demographic and **Ebenezer Ellen Benjamin (M.sc (N) clinical variables on the post operative outcomes. ***Christy Simpson (M. sc (N)

Methodology: ABSTRACT A quasi experimental research design was Birth of a Newborn is a special moment of joy with conducted in surgical wards of CMC, Vellore, Tamil immense expectation. However the first minute Nadu. The sample size was 45, chosen by block after birth is full of anxious moments and rapid randomization sampling method and divided into physiological adjustments. Most newborn go control group (24) and experimental group (21). through the transition successfully as a matter of The investigator used a demographic and Clinical routine process. However, 10% of them may need variable proforma, a bowel motility chart to assess varying. A high- tech care is needed when they are the effectiveness of chewing gum therapy in regard critically ill. A descriptive study was conducted to to the occurance of bowel movement, thirst assess the adequacy of care received by newborn distress scale to measure the intensity of thirst and babies on ventilator admitted in LIII nursery, oral hygiene index to assess the oral hygiene from Christian Medical College, Vellore. The data was both control and experimental group. The collected from 22 subjects and 112 observations participants in control group were given regular in LIII Neonatal unit of CMC, Vellore. The data was post operative care and the experimental group collected and analyzed for knowledge and care was given one sugarless chewing gum three times given to the newborn. In this study descriptive a day along with regular post operative care till statistics and chi-square were used to analyze the the participants were discharged. data using statistical package for social sciences

157 (SPSS) P value of < 0.05 was considered significant Methods and P value of <0.001 was considered highly Qualitative study design was adopted with the use significance. To assess the knowledge of the of focus group discussions to assess the students’ nursing personnel worked in LIII nursery regarding perception about their clinical experience. The ventilator care, questionnaires were given to the participants were the group of volunteers nurses. A total of 22 nursing personnel’s consisting of 7 to 10 students from each class of knowledge on ventilator care was assessed which undergraduate nursing students of both Degree showed that (9) 40.9 % had adequate knowledge and Diploma programmes excluding the first year. and (13) 59.1% had moderately adequate The focus group interviews were conducted at knowledge. The over all care in terms of adequate midyear month and last month ofthe academic care 17.9%, moderately adequate care was year. The period of each interview was about 1 to provided 78.6%, and inadequate care was 3.6%. 2 hours. Debriefing notes were made by the The care provided by nurses to mechanically observer after each focus group discussion. The ventilated newborn in the Neonatal Intensive Care discussions were tape recorded and later Unit was moderately adequate. The nurses transcribed. performed very well in those parameters which assessed basic nursing knowledge and techniques. Data Analysis The nurses performed less well in the The content of the tape and the notes of the parameters specifically related to ventilation and observer were compared and checked to include critical care. Hence training of nurses in Neonatal the nonverbal cues of the participants. The Intensive Care Unit should be more focused in researcher analyzed the data looking for the these aspects of care. significant statements and codes and categorized them into different themes. NURSING STUDENTS’ PERCEPTION OF CLINICAL EXPERIENCE Results The following six themes emerged from the data: Mrs. Sophia Lawrence, Professor Dr. Jayarani Clinical anxiety, clinical supervision, clinical Premkumar, Professor Mrs. Ilavarasi Jesudoss, teaching, clinical requirement, professional role Professor Mrs. Amala Rajan, Professor and clinical environment which were considered important factors in clinical experience Abstract: Background Conclusion The clinical experience is perceived to be one of The result of the study showed that the nursing the anxiety producing components of the nursing students were not completely satisfied with their programme by the students. Nursing students’ clinical experience. They experienced anxiety and perception of their clinical experience provides stress and brought out suggestions to improve information to the nurse educators for designing their clinical learning. more effective strategies to improve the clinical learning of the nursing students.

Objective The main objective of this study was to assess the nursing students’ perception about their clinical experience in College of Nursing, Christian Medical College, Vellore. 158 EFFECT OF STRUCTURED TEACHING Result PROGRAMME REGARDING PHYSICAL AND During pre test only 18.8% of nursing personnel CHEMICAL RESTRAINTS ON THE KNOWLEDGE, had adequate knowledge regarding restraints ATTITUDE AND PRACTICE OF NURSING while, 77.6% had adequate knowledge during the PERSONNEL post test. Only 35.3% of nursing personnel had favourable attitude during pre test while 68.2% *Ms. Tinu S. Kurien, M.Sc.(N) had favourable attitude during the post test Also **Dr. (Mrs). Jayarani Premkumar, M.Sc.(N). Ph.D there was a statistically significant (p<0.05) ***Mrs. Sheela Durai, M.Sc.(N). improvement in the practice of nursing personnel ****Dr. Nagamani Sen M.B.B.S., M.D. regarding the use of physical and chemical restraints after the teaching programme. Background Restraints are commonly used in the critical care Conclusion units to control aggressive behaviour among Teaching programme on restraints can improve patients. Nurses in critical care units consider the knowledge,attitude and practice of nurses in restraint related care to be of less priority the use of physical and chemical restraints. compared to all their other responsibilities in the care of critically ill patients. PEDIATRIC BUM OUTCOMES- A REVIEW

Objective Dr. Vinitha Ravindran, Professor, College of A study to assess the effect of a structured teaching Nursing, Dr. Gwen Rempel, Associate Professor, programme regarding the use of physical and University of Alberta, Dr. Linda Ogilvie, Professor, chemical restraints on the knowledge, attitude University of Alberta and practice of nursing personnel in critical care units of Christian Medical College, Vellore. Abstract Background Method Consequences of bums in children have been A pre-experimental study design was undertaken. widely discussed in the literature. Future Eighty five nurses who met inclusion criteria were directions for research, practice, and policy related selected to assess knowledge and attitude. Fifty to pediatric bum rehabilitation, however, are nurses were observed for practice related to the unclear. use of physical and chemical restraints. Purposive sampling technique was used. Pre test was done Aim during the first 2 weeks during which the practice The aim of this literature review was to examine of nursing personnel in the use of restraints was and synthesise data on pediatric bum outcomes observed using an observation checklist. in terms of functional status, comparing data from Following this, a self administered questionnaire HICs and LMICs where possible, so as to identify to assess the knowledge and a Likert’s scale to gaps in the literature that could be addressed assess the attitude regarding restraints was through further research. administered simultaneously to all the subjects. Structured teaching programme was conducted at Method the end of the pre test. This was followed by post A systematized review of pediatric bum literature test. was done.

159 Results Methods Pediatric bum mortality remains high in many low A descriptive study was done. Consecutive and middle-income countries (LMIC) and there is sampling t,chnique was used to recruit 130 a dearth of information on long-term bum caregivers of patients with schizophrenia and outcomes in children and their families. Although BPAD. Burden Assessment Scale and Jalowiec family environment has been identified as a factor Coping Scale were used to assess the burden and for positive outcomes in children, interventions to coping. support families and children have rarely been tested or implemented. Little is known about Results subjective experiences of a bum child’s recovery Findings revealed that the caregivers of both the or parents’ caregiving. condition experience high level of burden in the areas of patient care, finance, physical and Conclusion emotional burden, family relation and occupation, Studies addressing long term pediatric bum Also there was a significant relationship between outcomes in LMICs and contextually relevant the gender of the family member (p=0.003), family and child support interventions are needed relationship with the patient (p=0.011) and the to help establish creative and flexible follow-up high burden. There was significant relationship services for the pediatric bum population. between coping strategies and number of people living with the patient (p=0.021), educational level Key words - of the primary care giver (p=0.011). High burden Bums, Child, Outcomes assessment, Review is related to taking responsibilities of the primary care giver (p=0.010); and using avoidant coping FAMILY BURDEN AND COPING STRATEGIES strategies (p=0.027). AMONG PATIENTS WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDERS Implications This study high lights the need for family *Jeeva.Sebastian, Junior Lecturer, College interventional programs in follow up clinics to OfNursing, Christian Medical College, Vellore. address the specific concern, related to burden **Sheeba Susan Chandy, Professor, College Of and coping strategies of the family members. Nursing, CMC, Vellore. *** Dr.Suja Kurian, Professor, Department of Keywords: psychiatry, CMC, Vellore. Caregivers; Schizopehrenia; Bipolar Affective ****Mrs.Grace Rebecca., Depar.tment of disorder, Burden and copmg strategies. Biostatistics, CMC, Vellore.

ABSTRACT Abstract Context: The concept of patient autonomy and Background good death is gaining importance globally, yet Caregivers of people with Schizophrenia and there is a dearth of national studies to examine Bipolar Affective Disorder suffer from having a the end-of-life care perspectives of patients with considerable burden as a result of their care giving advanced carcinoma and of health professionals role. They develop different kinds of coping caring for them. Advance directive is a conflicting strategies to deal with this burden. This study aims issue in Indian health care setting because of the to assess the burden and coping strategies less availability of medical insurance coverage employed by care givers of patients having compared to the western world and hence most schizophrenia and BPAD. 160 of the decisions are taken by the family members • There was poor agreement between patients and most of the time putients’ wishes are and health care providers regarding various neglected. aspects of end of life care(Kappa co-efficient <0). Patients considered various aspects to be Objectives: important compared to the health care This study was aimed to explore the end-of- professionals life care perspectives of patients with advanced carcinoma and of health care professionals in the Conclusion: The findings of this study have several Department of Radiation Oncology, Christian ethical, legal, moral and social implications in the Medical College, Vellore. field of medicine, nursing and social sciences The resulrs suggest an urgent call for formulating end- Methodology : of-life. care policy and advance directives while A descriptive approach was undertaken to assess caring for patients with terminal illness. Nurses the end-of lije care perspectives. A total with of and physicians should be proactive in offering key 140 patients were selected using enumerative supportive services to ensure patient autonomy sampling technique and 40 health care and facilitate good death professionals selected by quota sampling technique. Data was collected through structured Key words: End-of-life, End-of-life care, End-of life interview from the patients and by self perspectives, Patients, Advanced Carcinoma, administered questionnaire from the health care Health Care Professionals. professionals. EFFECTIVENESS OF INSTRUCTIONAL VIDEO Results: ON PRE-OPERATIVE ANXIETY OF PATIENTS • Majority of the patients’ perceived that POSTED FOR ORTHOPEDIC SURGERY symptom management (93.6%;) and financial arrangement (90.7%) as extremely important Deborah paripoorani. P element of end-of-life care. Conclusion could Mrs. Valliammal Babu, Professor, Medical not be drawn about artificial prolongation of Surgical Nursing, Ms. Poongodi, Professor, life; people varied widely in their opinion. Professor, Medical Surgical Nursing, Dr. Vino.M • There was a significant association between Cherian, Professor, Department of Orthopaedics, the subscale of artificial prolongation of life Mrs. Visalakshi, Professor, Department of with uge (p=0.03) and religion (p= 0.02 ) Biostatistics Patients who belonged to the category of 25- 35 preferred arificial prolongation of life the ABSTRACT most (83%). Patients who were non-Hindus Introduction: gave more importance to artificial The anxiety placed on patients in the pre- prolongation of life ( 74.5%) as compared to operative period may be Underestimated, and Hindus· (53.6%). this burden lessens patients’ ability to • There was no significant association between comprehend and contribute to the postsurgical clinical variables and various dimensions of plan. Nurses are in a key position to provide pre- end-of-life care operative teaching and respond to patient’s • Health care professionals considered questions and concerns. Advancements in symptom management to be of extreme technology have provided nurses the opportunity importance (72.5%). to improve and intensify pre-operative

161 educational strategies. A structured surgical Findings: orientation video provides and effective and The study revealed that there is a significant efficient method of distributing important per reduction of anxiety level in the experimental operative care information and may enhance group after the intervention in the form of video patients’ ability to recall the key aspects of their reduction. About 86% of the participants control pre-operative instruction. group and 88.6% of the participants in the control group had average anxiety. Majority of the Aim : participants experienced average level of anxiety This study was done to assess the effectiveness of before surgery. The control group which had only video instruction about per-operative care on pre- the regular teaching and did not have the operative anxiety of patients posted for orthopedic intervention showed an increase in the level of surgery in selected orthopedic wards of Christian anxiety level on the day of surgery (after Medical College and Hospital, Vellore. intervention) than the anxiety level on the evening before surgery. On the day of surgery (after intervention) the experimental group experienced Methods : lower level of anxiety than that of the control Pre-test, post-test quasi experimental design was group. employed. An instructional video was developed and validated. Multi-stage sampling was used. 35 participants in the experimental group and 35 Conclusion : Most patients who are undergoing participants in the control group were selected. orthopedic surgery are experiencing average level The anxiety was measured in both the groups of anxiety. A certain proportion does undergo high before and after the intervention (instructional levels of anxiety which seems to increase as the video) using STAI scale which is a self administered hours of surgery get closer. Patients undergoing questionnaire. higher levels of anxiety must be identified and helped out. This video teaching can be Data Analysis : implemented in the regular schedule of preparing Data were analyzed using descriptive and orthopedic patients for surgery which can help inferential statistics. Data was collected from 70 them prepare psychologically and handle their subjects with reference to their level of anxiety in anxiety levels. regard to the surgery proposed. 35 were in the intervention group and 35 in the control group. Socio-demographic and clinical variables were analyzed with appropriate descriptive statistic. Values are expressed as mans + standard error of means. Difference between the surgical orientation video (intervention group) and the regular teaching groups (control group) on the level of anxiety were analyzed by t-test. Differential anxiety level effects on nursing instruction with video-tape viewing and regular teaching groups were compared before and after instruction using Paired test. Results were analysed with SPSS for Windows (version 17.0).

162 QUALITY OF LIFE AND ITS RELATIONSHIP TO Objective: SEVERITY OF SYMPTOMS AM’ONG PATIENTS This study was aimed to assess the quality of life WITH END STAGE RENAL DISEASE and its relationship to severity of symptoms UNDERGOING HAEMODIALYSIS among patients with end stage renal disease by undergoing haemodialysis in dialysis unit of Ms.Vidya.J Christian Medical College, Vellore. Methodology: A descriptive correlational study design was used RESEARCH GUIDE and a total of 124 patients were selected using DR. (MRS). JAYARANI PREMKUMAR, total enumeration sampling technique. Data was M.Sc. (N), Ph.D., collected using the Quality of Life Index Dialysis Professor and Head Version III (QLI-D) and Dialysis symptom Index Department of Medical Nursing (DSI) by self administered questionnaire from the College of Nursing, subjects. Christian Medical College, Vellore. Results: CO -GUIDE The findings showed that most of the subjects had MRS. ILAVARASI JESUDOSS, a good quality of life (70.2%) and experienced less B.Sc. (N)., R.N., R.M., M.Sc. (N), Professor severe symptoms(97.6%).There was significant Medical Surgical Nursing correlation between domains of quality of life and College of Nursing, domains of severity of symptoms (p<.Ol). There Christian Medical College, Vellore. was also a significant negative correlation between quality of life and severity of symptoms MEDICAL GUIDE (p<.Ol). There was a significant association DR. ANJALI MOHAPATRA, M.D., D.M., between socio demographic variables like sex, Associate Professor, Department of Nephrology marital status, occupation, monthly family income (II), (p<.Ol) and clinical variables like duration on Christian Medical College, Vellore. dialysis (p=.003), haemoglobin levels (p=.014) with quality of life. There was also a significant STATISTICAL GUIDE association between socio demographic variables MR. PRASSANA SAMUEL, like sex (p=.002) and occupation (p=.002) with Biostatician, Dept of Biostatistics, severity of symptoms. Christian Medical College, Vellore. Conclusion: ABSTRACT The findings suggest that there is a need to Background: educate patients, significant family member and The concept of quality of life for persons with end dialysis professionals on quality of life, severity of stage renal disease is a growing concern among symptoms and factors associated with them. dialysis professionals for two reasons. First, There is a need to use symptom and its ensuring the highest acceptable quality of life management checklist on a periodic basis to constitutes ethical care and second, quality of life evaluate patient’s response to the treatment. measures may assist health care providers to tract Key words: illness progression including identification of end Quality of life, Severity of symptoms, End stage of life. renal disease, Dialysis professionals.

163 ADEQUACY OF NUTRITIONAL SUPPORT AND an observation check list. THE FACTORS ASSOCIATED WITH ITS INADEQUACY IN CRITICALLY ILL PATIENTS Results: The energy received was significantly lesser than Hepsi Raju, *Punitha Ezhilarasu,** Rebecca the estimated requirement (P < .001). Subjects Sumathy Bai**, JV Peter#, Prasanna Samuel##’ with adequate nutritional support was 1.1% on Mahendri”. Day 1 and 15.9% on Day 7. The foremost factor *-Junior lecturer; college of Nursing, CMC, Vellore attributed to inadequacy, both on Day I and 7 **-Professor, College of Nursing was fluid restriction and difficulty with glycemic #-Associate Professor, Physician, Medical ICU, control. The prescribed calories also amounted to CMC, Vellore. much lower than estimated requirements. There ##-Lecturer, Department of Biostatistics, CMC, was a significant difference in the energy Vellore prescribed and received with 37.5% of the subjects Head of the Department of Dietetics, CMC, receiving less than 90% of the prescribed qtlories. Vellore. Gastrointestinal factors were associated with the Prescribed-Delivered gap (P < .001), along with Abstract dilution of feeds (P = .007) and the place of Back ground: admission. Inadequate nutritional support is found to be associated with poor outcomes like increased Conclusion: infectious morbidity and mortality and yet is often This study underlines the importance of a overlooked with underfeeding common in conscientious approach of nurses and physicians critically ill patients. towards meeting the nutritional needs of the critically ill. Further studies can be done to Objectives: identify the perceived barriers among critical The objectives of this study were care health team and evaluate the impact of i. To determine the difference in the estimated nutritional inadequacy. energy requirements and the energy received. ii. To assess the adequacy of nutritional support and the factors associated with the inadequacy iii. To identify the prescribed-delivered gap and KNOWLEDGE, AITITUDE AND PRACTICE ON the factors associated with it. TEMPORARY METHODS OF CONTRACEPTION AMONG WOMEN WHO HAD LOWER Methods: SEGMENT CESAREAN SECTION. A Prospective descriptive study was conducted in the Medical, Surgical and Neuro ICUs and HDUs S. Jebah Terina, Mrs. Rosaline Jayakaran, Dr. of CMC, Vellore with 176 consecutive critically ill Jasmine Helen, Ms. Devika patients with more than 24hr stay in the ICU. The adequacy of nutritional support was Background: assessed with the energy requirement which was knowledge influences practice. A lot of studies estimated using the Harris-Benedict Equation. have been done on the use of contraception, but It was also compared against the calories the use of temporary methods of contraception prescribed and delivered for seven days. Factors after cesarean section has not yet been studied. that could be associated with the inadequacy and the prescribed-delivered gap were assessed by

164 Objective: COGNITIVE SYMPTOMS AND DISABILITY IN The purpose of the study is to assess the SCHIZOPHRENIA knowledge, attitude and practice of mothers regarding temporary methods of contraception Paul Prabhu after lower segment cesarean section, to Manoranjitham Sathiyaseelan determine the association between knowledge, Rajesh Gopalakrishnan attitude and practice, and to develop an Tunny Sebastian instructional module regarding spacing. Devika

Methods: ABSTRACT A self administered questionnaire developed by Background: the investigator was used to extract data. Data was Schizophrenia is an enigmatic disorder with an synthesized using SPSS versionll. indisputable clinical heterogeneity. Until recently, treatments for schizophrenia have focused mainly Result: on reducing positive symptoms, often leaving Data was analyzed from 100 subjects who had patients with numerous residual difficulties, undergone primary cesarean section. Odds ratio including impairment in cognition, everyday living (95%CI) was used to find the association between skills, and social/occupational functioning. Owing knowledge and attitude with practice. 34.4% of to the limited literature from the country in this the study group was using a temporary method area, the research question of assessing cognitive of contraception for spacing. The group with symptoms in patients with schizophrenia and its adequate knowledge had 3 times more chance of relationship with functional disability was practicing contraception as compared to those formulated. with inadequate knowledge. The study group with favorable attitude had 2.7 times more chance of Objective: practicing as compared to the group with The main objective of the study was to assess the unfavorable attitude with a statistically significant cognitive symptoms in patients with P value of <0.05. schizophrenia, its relationship with functional disability and its association with selected socio demographic and clinical variables. Conclusion: The study findings indicated that knowledge Methods: influences practice, so nurses should be prepared The study had a descriptive cross sectional design. to impart knowledge to women of child bearing 110 consecutive subjects who fulfilled the age on methods of contraception, so that they inclusion criteria consented for the study. SCoRs have a positive behavioral change. The and WHO-DAS II and WHO-DAS II were used to instructional module developed can be given to assess the cognitive symptoms and disability postnatal mothers in the hospital and community respectively, PANSS was used to assess the to inform them about the various methods of psychopathology of patients with Schizophrenia. contraception for spacing. Study was conducted in the Department of Psychiatry, Christian Medical College, Vellore Key words: Temporary methods of contraception, Lower Results: Segment Cesarean Section. It was found that cognitive symptoms positively correlated with disability (p=0.00). This

165 relationship was also significant in all the domains of disability (p=0.00). Duration of illness and medication adherence also showed statistically significant association with both cognitive symptoms and disability (p=0.00).

Conclusion: The subjects were on antipsychotics. The effect of the drugs causing cognitive deficits was not studied. Paucity of literature in this area especially from India, and findings of this study highlights the need for further research in this field.

Key words: SCoRS – Schizophrenia Cognition Rating Scale WHO-DAS II – World Health Organization – Disability assessment Schedule II PANSS – Positive and Negative Syndrome Scale

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