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How to treat Vitamin D deficiency in sun-drenched India - guidelines
CV Harinarayan
July-September 2018, 7(3):131-140
Vitamin D plays an important role in calcium and mineral metabolism. It is astonishing to find vitamin D deficiency in sun drenched country like India. This could probably due to modernisation of India-mechanization, urbanization, change in life style, dress code and revision of vitamin D adequacy range. India has the unique problem of twin nutrient deficiency- vitamin D and calcium. Low calcium in the diet coupled with vitamin D deficiency has adverse consequences in the skeletal health. Any vitamin D schedule to treat/supplement should be accompanied by adequate calcium in the diet/supplementation. There are many international guide lines for vitamin D supplementation. This review aims at highlighting the vitamin D supplementation schedule suitable in Indian context keeping in mind the cost and compliance. Studies in south India using in vitro ampoule mode with 7-dehyrocholestrol has shown adequate formation of active form of vitamin D from mid-day sun. Time of the day, latitude, and increased skin pigmentation all influence the cutaneous production of vitamin D. Exposing 12%-18% of body surface area to unprotected sunlight for 30-45 mins is equivalent to taking 600-1000 IU of vitamin D which is the dose recommended by experts for fortification of food. Vitamin D synthesized in the skin last twice as long. We as human can get Vitamin D from abundant sunshine. There are various food fortification schedules suggested. The major source of vitamin D for both children and adults is unprotected sun exposure. In the absence of sun exposure adequate amount of vitamin D from dietary sources and supplementation is a must to satisfy body's requirement. In India, adequate amount of vitamin D should be accompanied by dietary/supplemental calcium to achieve desired skeletal benefits.
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The global D-Lemma: The vitamin D deficiency pandemic even in sun-drenched countries
Michael F Holick
July-September 2018, 7(3):101-105
  988 183 1
Pre-analytical phase in clinical chemistry laboratory
Sohini Sengupta Neogi, Mohit Mehndiratta, Stuti Gupta, Dinesh Puri
July-September 2016, 5(3):171-178
The laboratory testing process is divided into the pre-analytical, analytical and post-analytical phases. For obtaining reliable test results, the prevention and detection of errors at all steps is required. While analytical standards have been developed by recognized quality control criteria, there is a scarcity in the development of standards for the pre- analytical phase. This phase is most prone to errors as the steps involved are directly dependent on humans and are out of direct control of the laboratory. Such errors in preanalytical stage often only become apparent in the analytical or post-analytical phase. The development of a pre-analytical quality manual is essential in achieving total quality control. Correct practices and strategies of error prevention can reduce preanalytical errors. This review focuses on prevention of pre-analytical errors that occur while collecting a specimen of blood, urine and cerebrospinal fluid. Most of these can be easily prevented with understanding and education of the personnel involved in and responsible for executing this crucial pre-analytical phase.
[ABSTRACT]   Full text not available  [PDF]
  310 74 -
Intermittent flow centrifugation technique used for large volume leucapheresis in a low-body weight paediatric patient
Yalamanchili Swapna
April-June 2018, 7(2):83-85
Paediatric leucapheresis is a preferred mode of stem cell collection compared to bone marrow harvest. However, the inherent risks of this procedure like difficult venous access, citrate toxicity, large extracorporeal volume and haemodynamic instability are of considerable importance. Leucapheresis can be done by continuous flow centrifugation (CFC) or intermittent flow centrifugation (IFC) technology. Based on the total blood volume that is processed; it is standard or large volume leucapheresis. The use of IFC blood cell separator in paediatric low body weight child to perform large volume leucapheresis is discussed.
  362 16 -
Transfusion-related acute lung injury
V Arun Raja, C Rahul, M Krishna Kumar, V Pradeep, KV Sreedhar Babu, J Harikrishna
January-March 2018, 7(1):24-29
Transfusion-related acute lung injury (TRALI), an important non-infectious risk of blood transfusion is a leading cause of morbidity and mortality. Activation of polymorphonuclear (PMN) leucocytes by the mediators released due to the interaction of donor antibodies against the recipient monocytes is thought to trigger TRALI. Major histocompatibility complex Class II antibodies have been implicated in the direct causation of TRALI by direct activation of PMN leucocytes. TRALI has been reported in patients receiving all blood components that contain plasma. Awareness regarding TRALI among clinicians and a high index of suspicion will facilitate early diagnosis of the condition. TRALI is a clinical diagnosis that is suspected when new acute lung injury (ALI) develops within six hours of a transfusion. Diagnostic work-up should focus on ruling out other risk factors for ALI like sepsis, aspiration, among others. TRALI mitigation strategies are helpful to ensure blood safety and facilitate lessening of other transfusion reactions transfusion associated circulatory overload as well. The treatment for TRALI is symptomatic and supportive and is similar to that administered for ALI.
  221 148 -
A prospective study on the common infectious causes of thrombocytopenia (dengue fever, leptospirosis, scrub typhus and malaria) in a tertiary care teaching hospital
G Nibandhana, Usha Kalawat, KK Sharma, Rashmi Patnayak, DT Katyarmal, Abhijit Chaudhury
January-March 2018, 7(1):2-6
Background: The present study was undertaken to know the contribution of four infectious causes of fever namely dengue, chikungunya, scrub typhus and malaria in patients presenting with fever of more than one week duration with thrombocytopenia in a tertiary care teaching hospital, Tirupati, Andhra Pradesh. Methods: In this prospective study, 1014 samples from different patients who presented with fever and of more than one week duration and thrombocytopenia were collected over a period of six months and were processed for the detection of non-structural 1 (NS1) glycoprotein antigen for dengue, immunoglobulin M (IgM) antibodies for leptospirosis and scrub typhus by ELISA and malaria parasite by quantitative buffy coat (QBC). Results: Among 1014 samples obtained from patients with fever with thrombocytopenia, 111 (10.94%) were due to thrombocytopenia due to infectious causes. Ninety (81.08%) were due to single infection and twenty one (18.92%) due to co-infections. Males were more affected. Peak incidence was in 40-49 years of age with scrub typhus as the predominant infection. Grade-3 thrombocytopenia was more common in all the four infections. Conclusions: Our observations suggest that scrub typhus was the predominant cause of fever with thrombocytopenia, along with dengue, leptospira and malaria. Diagnostic evaluation should include search for these causes in patients presenting with fever with thrombocytopenia. This can be helpful as both are easily treatable infections with commonly available oral antibiotics.
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Clinico-epidemiological study of melasma in men
Keerthi Charupalli, TS Rajasekhar, Madhusudan Mukkara
January-March 2018, 7(1):19-23
Background: Melasma is one of the most common and distressing pigmentary disorders presenting to dermatology clinics. There is paucity of data regarding the aetiological factors and clinical presentation of melasma in men. The present study was taken up to fill this lacuna and to understand the unique aspects of melasma in this group. Methods: Study was conducted in the Department of Dermatology at University teaching hospital from January 2015 to July 2016. A total of 72 male patients with melasma were studied. A detailed history including occupation, onset, duration and evolution of melasma, predisposing factors like sun exposure and genetic factors, were taken followed by general physical examination, cutaneous examination and Woods lamp examination and recorded in a proforma. Laboratory investigations like complete haemogram, hormonal profile, liver function tests were done whenever necessary depending on the presenting condition. Results: The mean age of onset was 31.5 years. The duration of melasma varied from 3 months to 6.5 years. The aetiological factors identified were, sun exposure in 42 patients (58.3%) and family history in 29 (40.3%). Laboratory investigations revealed hepatic disorders in 5 patients(6.9%), increased luteinizing hormone (LH) and low testosterone in 2 (2.8%) and hypothyroidism in 4 patients (5.6%). According to clinical patterns, malar pattern was seen in 65.3% of patients, centro-facial in 31.9% and mandibular in 2.8% of patients. The most common skin type found to be type IV. Conclusion: Melasma was evident in men in their fourth decade of life; malar pattern, type IV skin type were most commonly seen.
  274 46 -
Does clinical posting in psychiatry change attitude towards psychiatry? A prospective study
Animesh Sharma, GK Vankar, PB Behere, KK Mishra
July-September 2018, 7(3):106-113
Background: Worldwide, mental illnesses are on rise. There is an acute shortage of psychiatrists. Young medical graduates find psychiatry specialty a less attractive career option. The present study was conducted to find out attitudinal change of medical graduates to psychiatry specialty after their clinical posting. Methods: The study was carried out in a tertiary medical care centre situated in eastern Maharashtra in a rural setting. The medical graduates undergo rotation which includes clinical posting in psychiatry while they are in second year. One hundred medical students were administered Attitudes Towards Psychiatry-30 (ATP-30) questionnaire at the beginning and the end of two weeks of posting. Results: The response rate was 93% and the mean pre-rotation score on ATP-30 questionnaire was not significantly different as compared with the mean post-rotation score [107 ± 11.7 (SD) vs. 106 ± 12.4 (SD); (p=NS)]. Subgroup analysis revealed a significant decline [56 ± 6.4 vs. 54 ± 6.6 (p< 0.05)] in attitude on 15 positive questions of the questionnaire. Students with urban background [(55.8 ±6.6 vs 58.6 ± 9.3 (p=0.88)] as compared with rural background [58.1 ± 3.2 vs 53.9 ± 6.1 (p=0.03)] had significantly more decline on ATP-30 questionnaire. Conclusions: Overall, there was no change in medical students' attitude following two weeks clinical posting. Based on these findings medical curriculum including duration and frequency of clinical posting in psychiatry during undergraduate training requires change.
  247 68 -
Costs incurred by patients with diabetes mellitus in a tertiary care hospital - a cross sectional study
VV Anupamaa, K Nagaraj
October-December 2017, 6(4):203-207
Background: Diabetes mellitus has emerged as a disease with huge economic burden in developing countries. As sparse data are available from South India regarding the costs incurred by patients with diabetes mellitus the present study was conducted. Methods: In this cross-sectional study, a pre-structured questionnaire had been administered to 80 patients with diabetes mellitus admitted to our tertiary care teaching hospital to assess the direct and indirect costs incurred. Results: The median [inter quartile range (IQR)] total direct costs incurred by the study subjects was found to be 8145 (IQR 4600-12150) during hospitalization at the time of the study. The median (IQR) direct costs incurred during two years prior to the study were found to be 19050 (IQR 12020-55400). The median (IQR) indirect costs incurred due to hospitalization during the study period were 0 (0-2025). Conclusions: The present study provides a real-time measurement of the direct and indirect costs incurred by patients with diabetes mellitus. This information could be useful to health administrators to plan providing care for patients with diabetes mellitus.
[ABSTRACT]   Full text not available  [PDF]
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Study of oxidant and anti-oxidant status in patients with chronic kidney disease
A V. S S. N. Sridhar, P V. L N. Srinivasa Rao, Vishnubhotla Sivakumar, P Satish, P Shalini, MM Suchitra, Vinapamula S Kiranmayi
July-September 2018, 7(3):124-130
Background: Chronic kidney disease (CKD) is associated with oxidative stress (OS), which occurs even in early stages of CKD and was shown to further contribute to progression of renal dysfunction and increased cardiovascular risk in CKD patients. Majority of studies have evaluated OS in CKD patients using limited biomarkers. Present study aimed at comprehensive evaluation of oxidant and antioxidant status in CKD patients. Methods: 120 patients diagnosed with CKD who were classified into three groups of 40 each [group-1 (CKD stage1 and 2), group-2 (CKD stage3 and 4) and group-3 (CKD stage 5] based on eGFR and 30 healthy controls were recruited. Malondialdehyde (MDA), protein carbonyls (PC), ferric reducing ability of plasma (FRAP), protein thiols, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase were measured in all subjects. FRAP was corrected for uric acid (FRAP_UA) and MDA/FRAP_UA ratio was calculated. Score for oxidative stress (SOS) was calculated using the oxidant antioxidant parameters studied. Results: MDA, PC, MDA/FRAP_UA, FRAP and SOS were higher whereas protein thiols, SOD, GPx and catalase were lower in CKD patients than controls. Further, MDA, PC and FRAP and SOS increased progressively and protein thiols, SOD and catalase decreased progressively with increasing renal dysfunction. MDA, PC, FRAP and SOS showed positive correlation with creatinine and negative correlation with eGFR, whereas protein thiols, SOD, and catalase showed positive association with eGFR and negative correlation with creatinine. Conclusions: CKD patients are prone for oxidant injury which increases progressively with worsening renal dysfunction and is associated with degree of renal impairment. Score for oxidative stress helps in comprehensive assessment of oxidative stress in CKD patients.
  218 49 -
The Journal of Clinical and Scientific Research: The leap forwards!
TS Ravi Kumar, P. V L. N Srinivasa Rao
January-March 2018, 7(1):1-1
  215 51 -
Three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy in carcinoma cervix
Revathi Badiginchala, Swapna Jilla, BV Subramanian, Prana Bandhu Das, Archana Prathipati, G Sanjeeva Kumar
July-September 2018, 7(3):114-118
Background: Cervical cancer is the most common gynecological cancer among Indian women. 3D-CRT treatment is associated with more acute and late toxicities, because of close proximity of bladder and rectum to the cervix. The newer technique like IMRT is associated with less toxicities. Our study is to compare 3D-CRT and IMRT in terms of dosimetric parameters, toxicities and clinical outcomes. Methods: From February 2015 to July 2016 total 40 newly diagnosed locally advanced cervical carcinoma patients were treated with concurrent chemo radiotherapy with weekly cisplatin. Those patients were randomized to arm A - 3D-CRT and arm B - IMRT. Results: The dosimetric parameters of the bladder, rectum, bowel bag, and pelvic bone marrow were significantly decreased in the IMRT arm as compared to 3DCRT arm except for V30, V50 of bowel bag and V50 of pelvic bone marrow. The acute and late toxicities were similar among both arms. All the patients were assessed for treatment response at 6 weeks after completion of the treatment. All achieved complete clinical response. Out of 40 patients only one had brain metastasis after a median follow up of 18 months. Conclusions: Though IMRT showed dosimetric reduction compared to 3D-CRT but it did not showed any clinical benefit. At present scenario in developing countries like India where the cancer centers are over loaded with the carcinoma cervix cases can be treated with the 3D-CRT technique without compromising clinical outcomes.
  215 46 -
Stroke in patients with and without diabetes mellitus
Avin Subhash, Chinta Raj Kumar, Neelam Kumari Singh, Suresh Krishnamurthy, MV Nagabushana, YJ Visweswara Reddy
January-March 2018, 7(1):7-11
Background: Diabetes mellitus (DM) is a well-recognized risk factor for stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. This study was carried out with the aim to identify and compare distinctive patterns between diabetic and non-diabetic stroke cases. Methods: It is a hospital based cross-sectional study, carried out at PESIMSR Hospital, Kuppam, Andhra Pradesh, in which 80 consecutive patients with stroke (40 patients with and 40 without DM) were studied. Clinical features, risk factors, stroke patterns and outcome were studied. Results: The mean age (years) in stroke patients 57.5 ± 12.7 and 61.3 ± 12.9 (p=NS) stroke in patients with and without DM respectively. Males outnumbered females in both the groups (p=NS). Stroke patients with DM known to have hypertension were 75% and that of non-DM group was 42.5%. Diabetic stroke patients with history of coronary artery disease formed 32.5% and that of non-diabetic group was 27.5%. The mean high density lipoprotein (HDL) cholesterol (mg/dL) was lower in the diabetic group (38.8 ± 12.6) compared to that in the non-diabetic group (50.1 ± 6.9). The mean triglycerides (TG) (mg/dL) was significantly higher in the diabetic (216.9 ± 67.6) than in the non- diabetic group (150.05 ± 60.58). Both diabetic and non-diabetic patients had greater incidence of ischemic stroke (about 75%) than hemorrhagic stroke. In the present study, 37.5% of stroke patients with diabetes had a poor outcome compared to 22.5% of stroke patients without diabetes. Conclusions: DM is an independent risk factor for stroke. Stroke in patients with DM differs from that of stroke in persons without DM with respect to age, gender, stroke severity, prevalence of risk factors and outcome. Hypertension, HDL level and TG were significantly associated with DM. Diabetics stroke patients were having significantly higher levels of mean TG level, lower mean HDL level.
  210 49 -
Medical Council of India's amended qualifications for Indian medical teachers: Well intended, yet half-hearted
Sunita V S Bandewar, Amita Aggarwal, Rajeev Kumar, Rakesh Aggarwal, Peush Sahni, Sanjay A Pai
October-December 2018, 7(4):155-158
  182 55 -
Vitamin D deficiency in India: Fortify or let the sun shine in?
PM Srinivasa, CV Harinarayan
July-September 2015, 4(3):220-226
Vitamin D plays a pivotal role in calcium and mineral metabolism. It is astonishing to find vitamin D deficiency in India despite plentiful sunlight. This could probably because of urbanization, life style and dress code changes, and revision of vitamin D adequacy range. Recent studies in south India using in vitro ampoule model with 7- dehydrocholesterol have shown adequate formation of active form of vitamin D in mid-day sun. In India 70% of populations reside in rural areas. Only 35% of Indian populations have access to regulated milk supply. We as humans can get vitamin D from abundant sunshine, by exposing 18% of body surface area (without sunscreen) to mid-day sun for 30-45 min to cause 1 minimal erythemal dose (MED) which is equivalent to taking about 600 to 1000 IU of vitamin D. This is about the recommended daily dose by expert group on human nutrient requirements and the dose used in studies with fortified milk supplementation studies. Vitamin D synthesized in the skin lasts two-times longer in the body. In populations where there is limited exposure to sunlight, like dress-code limiting sun-exposure, usage of sunscreen with (SPF) greater than 8 etc., vitamin D supplementation may also be required. Since there is widespread calcium deficiency in Indian population, calcium supplementation should be an integral part of vitamin D supplementation therapy.
[ABSTRACT]   Full text not available  [PDF] [CITATIONS]
  201 34 5
Pseudopseudohypoparathyroidism: an unusual case
Srinivasa P Munigoti
July-September 2018, 7(3):141-144
We report unusual case of a 22-year-old male patient who presented with phenotypic features of Albright's hereditary osteodystrophy, but had associated multiple hormonal deficiencies suggestive of pseudo-pseudohypararthyroidism.
  214 20 -
Effect of sevoflurane with morphine or fentanyl on haemodynamic response to laryngoscopy and tracheal intubation: a prospective, randomised, double-blind study
S. R A. N Bhushanam Padala, Muralidhar Anakapalli, Hanumantha Rao Mangu, Madhusudan Mukkara, Aloka Samantaray
April-June 2018, 7(2):58-63
Background: Multimodal therapy can be used for obtundation of the haemodynamic response to laryngoscopy and tracheal intubation. The current study was undertaken to compare the haemodynamic response to laryngoscopy and tracheal intubation after administration of 0.2 mg/kg morphine or 2 μg/kg fentanyl with 2% end tidal sevoflurane during induction of anaesthesia. Methods: Sixty patients were randomised into two equal groups to receive either 2% end tidal sevoflurane + fentanyl 2 μg/kg (Group SF) or 2% end tidal sevoflurane + morphine 0.2 mg/kg (Group SM). General anaesthesia technique was standardised for both the groups. Haemodynamic parameters heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were recorded for 15 min. Results: The maximum increase in HR compared to baseline was statistically significant in Group SM (16.5%, P = 0.0002) which occurred at one min after tracheal intubation. The maximum increases in SBP, DBP and MAP compared to baseline occurred at one min after tracheal intubation in both the groups, Group SF (7.04%, 6.5% and 7.9% respectively) and Group SM (6.2%, 8.2% and 8.1% respectively) which was not statistically significant. The attenuation of haemodynamic response between the two groups was not statistically significant (for HR P = 0.1428, for SBP P = 0.8558, for DBP P = 0.1958 and for MAP P = 0.5303). Conclusions: With 2% end tidal sevoflurane during induction of anaesthesia, both 0.2 mg/kg morphine and 2 μg/kg fentanyl were equally effective in attenuating haemodynamic response to laryngoscopy and tracheal intubation. However morphine appeared to be less effective in attenuating the chronotropic response resulting in a greater increase in heart rate from baseline.
  187 43 -
Critical flicker frequency: A useful tool in diagnosis of minimal hepatic encephalopathy
Sukanya Bhrugumalla, Padmavathi R Choudeswari, Nayana Joshi, Ajit Kumar
April-June 2018, 7(2):53-57
Background: Minimal hepatic encephalopathy (MHE) is viewed as mild neuro-cognitive abnormalities in cirrhotics without overt encephalopathy. Diagnostic strategies for MHE include portosystemic encephalopathy (PSE) syndrome test, critical flicker frequency test (CFF), computerised tests like Inhibitory control test, Scan test etc. We compared critical flicker frequency test with standard PSE syndrome test. Methods: Fifty patients with cirrhotics of liver without overt encephalopathy were studied. PSE syndrome test was done with the standard charts. PSE score was calculated from the normal distribution tables. CFF was tested with manual CFF tool. Results: Their mean age (years) was 46 ± 12.8; there were 45 males. Of these 22, 21 and 7 patients belonged to Child's A, B and C categories. PSE score detected MHE in 40%, of which 35% were in Child's A and 65% in Child's B/C. CFF was normal (>39HZ) in 36% patients and abnormal (<39HZ) in 64% patients. Mean ammonia levels were significantly higher in abnormal CFF (70.87 ± 14.38) as compared normal CFF (32.21 ± 7.9) group (P < 0.001). The sensitivity of CFF for detecting MHE was 85%, specificity 52%, positive predictive value 56% and negative predictive value 85%. Thus, CFF appears to be a good test for excluding MHE. Conclusions: CFF test is highly sensitive (85%) with high negative predictive value (85%). It is a useful test to rule out MHE. The test is simple, quick and in-expensive and can be performed in the outpatient settings.
  179 29 -
Anthropometric correlates of dyslipidaemia in various stages of chronic obstructive pulmonary disease
G. Leela Jaya Madhuri, M Sriharibabu, Somanath Das, Y Himabindu, D Kiranmai, RK Chaitanya Reddy
July-September 2018, 7(3):119-123
Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major non-communicable diseases associated with increased morbidity and mortality. Even though COPD is a systemic disorder with the predominant involvement of lungs, several co-morbidities have been recognised in COPD. Both cachexia and obesity are common in COPD. This study explored the correlations between anthropometry and lipid parameters in different stages of COPD. Methods: This cross-sectional study conducted in a tertiary care teaching hospital included 120 subjects who satisfied the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD. After thorough clinical examination according to a predesigned study questionnaire all subjects underwent spirometric assessment for determination of the stage of COPD. Anthropometric measures like BMI, waist circumference, hip circumference and lipid parameters were measured in all study subjects. Pearson's correlation coefficients were calculated to see the correlation between anthropometry and lipid profile. Results: Dyslipidaemia was seen in all stages of COPD even though the pattern of dyslipidaemia varied from stage to stage. Significant positive correlations were observed between anthropometry and lipid parameters in stages III and IV COPD. Conclusions: The observations made in this study reveal that anthropometry correlates with dyslipidaemia in late stages of COPD.
  181 26 -
Stray dog menace fuelling rabies in India: what can be done?
RV Suresh Kumar, A Jagadeesh Babu
April-June 2018, 7(2):51-52
  163 38 -
Ectopic parathyroid adenoma: single-centre experience from India
CV Harinarayan, Honey Ashok, Adil Sadiq, GR Prashant, Divya Badanidiyur, Neha Gupta, Indira Rajani, NK Sunil Kumar, Shabnam Roohi, G Nandita
April-June 2018, 7(2):69-74
Background: The commonest cause of primary hyperparathyroidism (PHPT) is hyperfunctional parathyroid adenoma (PA) (94%), parathyroid hyperplasia (<6%) and rarely parathyroid carcinoma (<1%). Excision of PA is a definitive cure with a success rate of 95%. Less than 15% have one or more hyperfunctioning glands in an ectopic location. Methods: Between 2014 to 2017, seven of the 13 patients with PHPT, who had failed surgical and noninvasive localisation, were included in the study. Hybrid localisation technique positron emission tomography-Computed tomography (PET-CT) with tracer 11C-choline was used. Location of parathyroid adenoma was classified using Perrier classification, which uses, letters A-G to describe the exact location of the adenoma. A 50% drop in PTH levels as compared with pre-incision values was confirmed as a cure. Results: The biochemical and hormonal profile of the 7 (54%) patients with ectopic PA are (mean±SD) serum calcium (mg/dL), 25OH-D (ng/dL) and PTH (pg/mL) 11.36 ± 0.82; 22.82 ± 8.57; 205 ± 105 respectively. Three of the seven had renal stones. In all, seven patients of PA were localised using PET-CT using tracer 11C-choline. The profile of PA were two type-G (intrathyroidal), one type-C (posterior mediastinum), two type-F (superior mediastinum), one of type D (mid region of posterior surface of thyroid parenchyma at the junction of recurrent laryngeal nerve and the middle thyroid vein) and one type B. Conclusion: Ectopic PA is rare. In a biochemically and hormonally confirmed PHPT and in failed imaging localisation techniques/failed neck exploration one should look for ectopic PA. Newer hybrid techniques combined with newer tracer agents (PET-CT) will help in localization of PA. To the best of our knowledge this is the first report of series of ectopic PA from a single center from India.
  165 34 -
A prospective randomised study on comparison of weekly versus 3 weekly cisplatin chemotherapy as an adjunct to radiotherapy in treatment of carcinoma of the uterine cervix
VL Anusha Konakalla, Pranabandhu Das, Jilla Swapna, Amitabh Jena, K Radhika, B Sreenivasa Rao, Jayasree Kuna, KV Jagannathrao Naidu, BV Subramanian
January-March 2018, 7(1):12-18
Background: The present study attempted to compare concurrent weekly and three weekly cisplatin with radiotherapy in locally advanced cervical cancer. Methods: This prospective randomised study was conducted in 40 patients with locally advanced cervical cancer randomised into 2 arms. Arm A patients received external beam Radiotherapy (EBRT) to pelvis with concurrent weekly cisplatin at dose of 40 mg/m2 and arm B patients received EBRT to pelvis with concurrent cisplatin at dose of 75 mg/m2 three weekly followed by brachytherapy. Acute haematological, gastrointestinal (GI) and genitourinary toxicities and response rates were assessed. Results: All the patient and disease characters were comparable in both arms. There was no significant difference in both arms in terms of upper GI toxicity (75% Vs 80%; P = 0.208), haematological (25% Vs 10%; P = 0.195) and nephrotoxicity (10% Vs 25%; P = 0.212). Compliance to chemoradiation was better in three weekly cisplatin arm but not statistically significant. After a median follow up of 12 months, tumor response rates in both arms were almost similar (85% Vs 90%; P = 0.128). Conclusions: Our observations suggest that either concurrent weekly or three weekly cisplatin chemoradiation is equally effective in treatment of cervical cancer. However randomised trials with larger sample sizes and longer duration of follow up are required.
  161 30 -
Relationship of clinical deterioration in leprosy patients while on multidrug therapy with their glucose-6-phosphate dehydrogenase levels
Abhishek Sharma, D Ramachandra Reddy, Prathap Reddy, Bhumesh Tyagi, Shivanu Mathon, Suryash Jain
April-June 2018, 7(2):64-68
Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is known to cause haemolysis in patients with Hansen's disease receiving dapsone containing multidrug-therapy (MDT). However, sparse recent data are available on this topic from India. Methods: All patients aged over 10 years with Hansen's disease receiving MDT who presented with clinical deterioration to our tertiary care teaching hospital in Moradabad, Uttar Pradesh, India, were included in the study. G6PD levels were estimated in all of them. Once G6PD deficiency was confirmed dapsone was stopped and rescue therapy was initiated. Results: Between March 2015 and June 2016, 50 patients (mean age 34 ± 13.3 years) were included. G6PD deficiency was found in 14.3% patients. Peripheral blood smear showed Heinz bodies and bite cells in all of them. Mean pretreatment G6PD levels were 19.5 (range 17.5 – 25) units/g haemoglobin, mean serum bilirubin was 3.3 (range 1.6-9.2) mg/dL. Nineteen patients had lepra reactions (type 1 = 5 type 2 = 14). Ten patients required packed red blood cell transfusion. Conclusions: Our observations suggest that checking for G6PD levels before initiating dapsone containing MDT can be helpful in reducing the occurrence of haemolytic complications.
  154 27 -
Fever of unknown origin (FUO): Evolution of case definition, changing aetiological spectrum
D Prabath Kumar, D Arun Kumar, K Rajeshwari, D Neeharika, G Sindhu, B Sreevidya
January-March 2016, 5(1):33-39
Prolonged fever is a common problem faced by clinicians in everyday practise. Since the first description of the entity “fever of unexplained origin” by Petersdorf and Beeson in 1961, the case definition of this entity was further refined with modifications over the last 55 years. Durack and Street proposed noteworthy changes in the definition of “fever of unknown origin (FUO)”. First, they divided FUO into four groups, namely, classic, nosocomial, human immunodeficiency virus (HIV) related and neutropenic FUO. They also proposed a change in the time frame from “one week hospital study” to “three outpatient visits or three days of in-hospital investigations”. The more recent definition modified the temperature recording of above 38.3 °C (101 °F) on “several occasions” to “at least two occasions” and has listed the minimum essential laboratory testing required for diagnosis. The last five decades have also witnessed a change in the aetiological spectrum of FUO. Infectious diseases like tuberculosis are still common causes of FUO in India; an increase in non-infectious causes of FUO are increasingly being documented in studies form the west. Inspite of great advances in imaging and laboratory diagnostic methods a significant number of patients with FUO remained undiagnosed. Studies from other parts of the world have shown 9%-78% cases of FUO to remain undiagnosed while studies from India have shown this figure to be 0%-27.4%. Generating reliable epidemiological data regarding the aetiological spectrum of FUO will facilitate development of optimal work-up strategy to establish the aetiological diagnosis and facilitate the specific tests.
[ABSTRACT]   Full text not available  [PDF]
  157 21 -
Mycobacterium tuberculosis: A perpetual health care challenge
S Ramakumar
October-December 2017, 6(4):201-202
Full text not available  [PDF]
  116 60 -