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Ghosh K, Trasi S, Nair S, Shetty S, Mohanty D. Prevalence of inherited bleeding disorders in cases of idiopathic menorrhagia: a case of five blind men describing an elephant. J Thromb Haemost 2003; 1:2242-3. [PMID: 14521612 DOI: 10.1046/j.1538-7836.2003.t01-1-00397.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ghosh K, Nabar A, Shetty S, Soren D, Mohanty D. Is there a prethrombotic state in left atrial blood in rheumatic mitral stenosis? Am J Hematol 2003; 74:144. [PMID: 14508805 DOI: 10.1002/ajh.10399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ghosh K, Nair S, Kulkarni B, Shetty S, Mohanty D. Milder bleeding tendency in Glanzmann's thrombasthenia patients inheriting HPA-1b in the homozygous state. J Thromb Haemost 2003; 1:2255-6. [PMID: 14521621 DOI: 10.1046/j.1538-7836.2003.t01-3-00397.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ghosh K, Nair S, Kulkarni B, Khare A, Trasi S, Shetty S, Mohanty D. Inherited haemostatic disorders in idiopathic menorrhagia: do the special interest of a hemostatic laboratory make a difference? Haemophilia 2003; 9:660-1. [PMID: 14511314 DOI: 10.1046/j.1365-2516.2003.00798.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shetty S, Ghosh K, Mohanty D. ELISA for factor VIII antibodies: does it detect antibodies much before the conventional Bethesda assay? Haemophilia 2003; 9:654. [PMID: 14511311 DOI: 10.1046/j.1365-2516.2003.00810.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Babu Rao V, Ghosh K. Combined Down and Klinefelter syndrome. Indian Pediatr 2003; 40:917-9. [PMID: 14530567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Shankarkumar U, Ghosh K, Badakere S, Mohanty D. Novel HLA Class I Alleles Associated with Indian Leprosy Patients. J Biomed Biotechnol 2003; 2003:208-211. [PMID: 12975536 PMCID: PMC400212 DOI: 10.1155/s1110724303210019] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Convincing results on HLA Class II associations have been reported, however data on HLA class I association are limited and inconsistent from studies in Leprosy. We present here the HLA A, B, and C allele distribution by molecular high resolution PCR-SSOP technique in 32 leprosy patients compared with the 67 controls, from the same ethnic background. The significant results from the present study were a significant increase in frequency of HLA A*0206, A*1102, B*4016, B*5110, Cw*0407, and Cw*0703 was observed when compared to controls. A striking decrease in the frequency of HLA A*0101, Cw*04011, and Cw*0602 leprosy patients was observed when compared to the controls. Further haplotype A*1102-B*4006-Cw*1502 was significantly increased among the lepromatous leprosy patients when compared to the controls. It seems that HLA class I alleles play vital roles in disease association/pathogenesis with leprosy among Indians.
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Mehta YS, Ghosh K, Badakere SS, Pathare AV, Mohanty D. Role of antiidiotypic antibodies on the clinical course of idiopathic thrombocytopenic purpura. THE JOURNAL OF LABORATORY AND CLINICAL MEDICINE 2003; 142:113-20. [PMID: 12960958 DOI: 10.1016/s0022-2143(03)00104-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The severity and clinical course of idiopathic thrombocytopenic purpura (ITP) vary from patient to patient. The factors responsible for this variation are not well understood. In this study we attempted to evaluate the role of antiidiotypic antibodies in the immunoregulation of the disease. We investigated 114 cases of chronic ITP in adults. We determined antiidiotypic antibodies against antiplatelet antibodies using (a) idiotype-binding enzyme-linked immunosorbent assay (ELISA), (b) paratope-blocking ELISA, and (c) Western blotting. Results indicated that 80.6%, 11.2%, and 8.3% of the patients, respectively, presented with antiidiotypes against antibodies to GPIIb/IIIa, GPIb/IX, and both GPIIb/IIIa and GPIb/IX. More than 70% of the patients who showed high levels of blocking of antiidiotypic antibodies went into complete remission, compared with less than 5% of patients who showed low levels of such antibodies (P <.01). Disease severity was also found to be inversely related (P < 0.01) to the degree of blocking of antiidiotypic antibodies. The results of this study suggest that antiidiotypic antibodies against antiplatelet antibodies are a potential prognostic marker in chronic ITP.
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Shankarkumar U, Ghosh K, Mohanty D. Novel HLA B*2714 and B*2708 allele associations in seronegative spondarthritis patients and haemophilia patients with chronic synovitis in India. TISSUE ANTIGENS 2003; 62:175-8. [PMID: 12889998 DOI: 10.1034/j.1399-0039.2003.00074.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
HLA B27 association with seronegative spondarthritis (SSA) has been recognized for over a decade and its association with chronic synovitis in Haemophilia patients has been recently reported. We characterized the HLA B27 subtypes in a cohort of 98 B27 positive individuals with SSA (n = 45), haemophilia with chronic synovitis (n = 21) and normal controls (n = 32), using polymerase chain reaction-based sequence specific primers (PCR-SSP) and reverse line strip (RLS) techniques. The results revealed a significant association for a novel allele B*2714 in SSA along with the previously reported B*2705 allele. We also found a significant association between haemophilia patients with chronic synovitis from India and a hitherto unidentified allele, B*2708.
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Liu S, Ghosh K, Muthukumar M. Polyelectrolyte solutions with added salt: A simulation study. J Chem Phys 2003. [DOI: 10.1063/1.1580109] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ghosh AK, Ghosh K. Communication of risks: an analysis beyond numbers. QJM 2003; 96:455. [PMID: 12788968 DOI: 10.1093/qjmed/hcg073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ghosh K, Madkaikar M, Jijina F, Gandhi S, Shetty S, Mohanty D. Open heart surgery with mitral valve replacement--ordeal of an undiagnosed haemophilia patient. CLINICAL AND LABORATORY HAEMATOLOGY 2003; 25:131-3. [PMID: 12641618 DOI: 10.1046/j.1365-2257.2003.00498.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rao VB, Seema K, Lily K, Ghosh K, Mohanty D. Trisomy 22 with unusual phenotype. Indian Pediatr 2003; 40:371-2. [PMID: 12736417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Shankarkumar U, Ghosh K, Badakere SS, Mohanty D. HLA-DRB1*03 and DQB1*0302 associations in a subset of patients severely affected with systemic lupus erythematosus from western India. Ann Rheum Dis 2003; 62:92-3. [PMID: 12480686 PMCID: PMC1754282 DOI: 10.1136/ard.62.1.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ghosh K, Jijina F, Shetty S, Madkaikar M, Mohanty D. First-time development of FVIII inhibitor in haemophilia patients during the postoperative period. Haemophilia 2002; 8:776-80. [PMID: 12410646 DOI: 10.1046/j.1365-2516.2002.00687.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Development of inhibitor to FVIII in haemophilia patients is well-known and is not uncommon. However, their development for the first time during the postoperative period has hardly been reported. In a developing country such as India, where resources are limited, development of such an eventuality may prove disastrous. However, as many of our patients are sparingly treated, therefore, even if they test negative for the inhibitor preoperatively, they may get the requisite FVIII antigenic stimulation during the preoperative and immediate postoperative period, leading to the development of inhibitors during this critical time of wound healing. We describe here six patients who developed such an inhibitor, from a group of 35 patients with haemophilia A who underwent various surgical procedures (19%). We stress that such an eventuality may not remain rare in developing countries as more patients of severe haemophilia undergo surgery and are therefore challenged for the first time in their life with large amounts of FVIII concentrate during their preoperative period.
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Manisha M, Ghosh K, Shetty S, Nair S, Khare A, Kulkarni B, Pathare AV, Baindur S, Mohanty D. Spectrum of inherited bleeding disorders from Western India. HAEMATOLOGIA 2002; 32:39-47. [PMID: 12243554 DOI: 10.1163/156855902760262754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The study was undertaken to assess the magnitude and diversity of different bleeding disorders in Western India. MATERIALS AND METHODS 768 cases referred to our Institute for evaluation of an underlying bleeding diathesis were investigated appropriately to detect the cause of the abnormal hemostatic function. RESULTS 630 patients were diagnosed to have hereditary bleeding diathesis. Amongst these, 598 patients had a coagulation disorder while only 32 patients had a platelet function abnormality. Amongst the coagulation disorders, hemophilia A (70.5%) was the most common disorder followed by hemophilia B (14%) and VWD (10.8%). Glanzman's thrombasthenia (84.3%) was the most common platelet function disorder followed by Bernard-Soulier syndrome (12.5%). Some rare disorders have also been diagnosed. CONCLUSION In spite of their apparent rarity, India has a substantial number of cases of inherited bleeding disorders. A large number of these patients is referred to many tertiary care institutions. It is therefore desirable that district hospitals must develop their laboratories to detect most of these disorders so that the patients need not travel long distances to get an appropriate diagnosis and proper management. All 1st degree female relatives of severe and moderate hemophilia must get factor assays done because some of them may be vulnerable to post-procedural or post-traumatic bleeding.
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Pradhan V, Badakere SS, Shankarkumar U, Iyer YS, Ghosh K, Karnad D. Anti-neutrophil cytoplasmic antibodies (ANCA) in malaria. INDIAN JOURNAL OF MALARIOLOGY 2002; 39:51-9. [PMID: 14686112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Various autoantibodies like anti-nuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), anti-histone antibodies (AHA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-myeloperoxidase (anti-MPO), anti-proteinase3 (anti-PR3) and anti-lactoferrin (anti-LF) antibodies were studied in 173 acute hospitalised patients suffering from malaria of which 160 patients had P. falciparum and remaining 13 had P. vivax infection. Standard methods like indirect immunofluorescence (IIF) microscopy along with Confocal microscopy and ELISA were used for identifying and quantifying the autoantibodies and IIF patterns on PMN and HL-60 cells were studied for ANCA classification. Also HEp-2 cells were used for ANA detection, while estimation of anti-dsDNA, AHA, anti-MPO, anti-PR3 and anti-LF were tested using ELISA. Sera from malaria patients showed prominent immunofluorescence staining patterns where 23.8% cases had ANA in P. falciparum group as compared to 15.4% in P. vivax group and ANCA was found to be present in 20% in P. falciparum and 15.4% in P. vivax group. An interesting observation was that, of the total ANCA positives, 59% had p-ANCA, 5.9% had c-ANCA and 44.1% of the cases showed the 'atypical' or X-ANCA pattern. When p-ANCA positivity was compared with c-ANCA positivity among these patients, a good statistical correlation was noted with OR = 16, chi 2 = 16.43, EF = 0.46 and p-value = 5.037E 0.5. ELISA showed 31.2% anti-MPO and 6.2% anti-PR3 in P. falciparum cases while the two ANCA positive cases in P. vivax had anti-MPO. Anti-LF was found to be present in 40.6% cases. Neither the P. falciparum nor P. vivax contained autoantibodies with specificities similar to the characteristic lupus autoantibodies such as double stranded DNA (dsDNA). ANCA positivity develops in some types of malarial infection also with the presence of various autoantibodies which is important from a clinical point of view and should be carefully evaluated in those geographic areas where malaria is endemic. It also alerts us to the fact, whether in cases of repeated malarial infections in susceptible individuals, vasculitic disorders, which through ANCA pathways develop, could lead to renal and other complications.
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Shankarkumar U, Devaraj JP, Ghosh K, Karnad D, Anand K, Mohanty D. HLA associations in P. falciparum malaria patients from Mumbai, western India. INDIAN JOURNAL OF MALARIOLOGY 2002; 39:76-82. [PMID: 14686115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In the present study, HLA associations among the cohort of 171 severe P. falciparum malaria patients were compared with that of 101 normal sex, age and ethnically matched control samples. All these individuals lived in Mumbai in an area of low and seasonal P. falciparum transmission. HLA A, B, DRB1 and DQB1 antigens were serologically (A and B) and molecularly (DRB and DQB) determined using isolated lymphocytes and genomic DNA following the microlymphocytotoxicity assay and PCR-SSP techniques. Significant differences were observed between patients with malaria and controls in the following groups of alleles: A3, B27, B49, DRB1*04, and DRB1*0809 were increased, while A19, A34, B18, B37, and DQB1*0203 were decreased. HLA B49 and DRB1*0809 were found to be positively associated with the complicated severe malaria patients (OR = 13.88; p < 0.0001). HLA A19, B5 and B13 were protective in patients with high parasite index (> 2%). These observations revealed the importance of ethnic background, which has to be taken into consideration while developing an ideal malaria vaccine. Further, when compared to HLA associations of other world populations the present study indicates the relative importance of different HLA alleles that may vary in different populations.
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Abstract
We have characterized HLA B27 alleles in a sample population of Maharastra, Western Indians (n = 51), with the aim to investigate the different subtypes present among this population. The study was carried out using polymerase chain reaction with sequence-specific primers (PCR-SSP) and reverse line strip (RLS) techniques. Significant new findings have arisen from this study: B*2704, B*2705, B*2707, B*2708 and B*2714 alleles were found to be present, and two novel B27 alleles, B*2708 and B*2714, were found in this Indian population. In addition, B*2714 was observed in a patient with ankylosing spondylitis. This association has not been previously reported in ethnic groups from India.
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Shankarkumar U, Ghosh K, Mohanty D. The human leucocyte antigen (HLA) system. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2002; 50:916-26. [PMID: 12126348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Shankarkumar U, Devraj JP, Ghosh K, Mohanty D. Seronegative spondarthritis and human leucocyte antigen association. Br J Biomed Sci 2002; 59:38-41. [PMID: 12000185 DOI: 10.1080/09674845.2002.11783633] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The human leucocyte antigen (HLA) B27 has been associated with seronegative spondarthritis universally, but the associations varies (19-94%) in different Indian population groups. It is possible that this variation is due to patient selection bias. Here, we use strict clinical, radiological and serological criteria to select 79 patients with seronegative spondarthritis (SSA) and compare them with 110 healthy, normal individuals from the same ethnic background. The standard National Institute of Health (NIH) microlymphocytotoxicity assay is used to evaluate HLA B27 status in both groups. Significant association between HLA B27 and AS disease was found (odds ratio [OR]: 72.22; P<0.0001; confidence interval [CI]=1.5-3.8) when compared to the control group. Furthermore, HLA B5 was decreased when compared to the control group (OR: 0.39; P<0.01). Those in the 20-40 age group were more vulnerable, with a male preponderance (7:1) over females. These findings confirm the strong association of the HLA B27 allele with various types of spondarthritis and suggest that allele detection would help in the diagnosis of AS where clinical presentation is unclear and in identifying family members at risk.
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Ghosh K, Gosavi S, Pathare A, Madkaikar M, Rao VB, Mohanty D. Low cost autologous peripheral blood stem cell transplantation performed in a municipal hospital for a patient with plasma cell leukaemia. CLINICAL AND LABORATORY HAEMATOLOGY 2002; 24:187-90. [PMID: 12067286 DOI: 10.1046/j.1365-2257.2002.00376.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Autologous peripheral blood stem cell transplantation (PBSCT) is a costly procedure. In India, the cost varies from US$20000 to 25000 and most patients cannot afford it. Using several cost-cutting measures, we were able to treat a patient with plasma cell leukaemia by autologous PBSCT. A 42-year-old-male presented with plasma cell leukaemia. He was treated with VAD therapy, followed by high-dose cyclophosphamide and granulocyte colony-stimulating factor (G-CSF) for mobilization of peripheral blood stem cells. The patient was conditioned with high dose melphalan, followed by autologous PBSCT. The procedure was performed in a municipal hospital in which there was no prior experience with stem cell transplantation. Costs were reduced by: (i) using oral medication whenever possible; (ii) having a relative of the patient prepare his food under medical guidance; (iii) starting G-CSF on day 7 rather than on day 1; (iv) short-term storage of the PBSC in an ordinary refrigerator at 4 degrees C without cryopreservation; (v) infusing a large number of CD34+ cells, which shortened the time to engraftment; (vi) delegating many of the functions of a marrow transplant nurse to a resident physician. The cost of transplantation was thereby reduced to about US$ 6000, with successful engraftment by day +13. The patient remained in remission for 7 months, after which he relapsed and was treated with chemotherapy and electron beam radiation to the skin.
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