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Patel M, Pattajoshi AS, Dhamudia HC, Unnikrishnan A, Paul J, Nuthiapali P. Spectrum of Clinical Presentation and Surgical Outcome in Patients with Chronic Subdural Haemorrhage: A Retrospective Study. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/47067.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Chronic subdural haematomas are one among common neurosurgical emergencies especially affecting elderly male. Usually, presents with subacute Cerebro Vascular Accident (CVA), impaired higher mental function and sometimes with reversible dementia. Rarely, it presents with end stage herniation. Burr Hole Drainage (BHD) is the most popular and worldwide procedure of choice and it successfully address the problem in majority of cases. However, in a small group of patients it needs a wider craniotomy to deal with the subdural membrane which is mainly associated with recurrence of the entity. Aim: To evaluate the comparative incidence of various clinical presentation and analysing the outcome of different treatment modalities in different subgroups of patients with chronic subdural haemorrhage with respect to complication and survivality. Materials and Methods: This retrospective study enrolled data of 100 consecutive patients of subacute (n=30) and chronic subdural haematoma (n=70) who were admitted and undergone neurosurgical management of Veer Surendra Sai Institute of Medical Science and Research (VIMSAR), Burla, Odisha between September 2018 to September 2020. Variables were collected from patient’s records at discharge and analysed with respect to spectrum of clinical presentation and surgical outcome of different treatment modalities and problems associated with it. Results: The mean age group was 57.39 years and headache was the most common clinical presentation in the present study (86%) followed by hemiparasis (74%). BHD was carried out in 94 patients (94%). Primary craniotomy and membrane excision was carried out in 5 patients. Secondary craniotomy was performed in 1 patient after early re-accumulation and clinical deterioration. The outcome was assessed utilising Glasgow outcome scale with total five deaths in the series. Conclusion: Chronic Subdural Haemorrhage (CSDH) a problem of late adulthood (5th to 6th decade) which mostly follows two to three weeks after trauma. It needs proper preoperative assessment and requires timely intervention with skilled nursing care for early recovery. Post-traumatic subacute subdural haematoma in young subject and alcoholics needs special attention during course of their treatment. Bilateral puppilary failure, low Glasgow Coma Scale (GCS) and seizure association are risk factors for poor outcome.
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Affiliation(s)
- G. Sreekumar
- Department of Electronics & Communication, Rajagiri School of Engineering & Technology (RSET), Kochi, India
| | - Leena Mary
- Department of Electronics & Communication, GEC Idukki, Idukki, India
| | - A. Unnikrishnan
- Department of Electronics & Communication, Rajagiri School of Engineering & Technology (RSET), Kochi, India
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Unnikrishnan A, Vo ANQ, Pickford R, Raftery MJ, Nunez AC, Verma A, Hesson LB, Pimanda JE. AZA-MS: a novel multiparameter mass spectrometry method to determine the intracellular dynamics of azacitidine therapy in vivo. Leukemia 2017; 32:900-910. [PMID: 29249821 PMCID: PMC5886051 DOI: 10.1038/leu.2017.340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/19/2017] [Accepted: 11/23/2017] [Indexed: 01/19/2023]
Abstract
The cytidine analogue, 5-azacytidine (AZA; 5-AZA-cR), is the primary treatment for myelodysplastic syndrome and chronic myelomonocytic leukaemia. However, only ~50% of treated patients will respond to AZA and the drivers of AZA resistance in vivo are poorly understood. To better understand the intracellular dynamics of AZA upon therapy and decipher the molecular basis for AZA resistance, we have developed a novel, multiparameter, quantitative mass spectrometry method (AZA-MS). Using AZA-MS, we have accurately quantified the abundance of the ribonucleoside (5-AZA-cR) and deoxyribonucleoside (5-AZA-CdR) forms of AZA in RNA, DNA and the cytoplasm within the same sample using nanogram quantities of input material. We report that although AZA induces DNA demethylation in a dose-dependent manner, it has no corresponding effect on RNA methylation. By applying AZA-MS to primary bone marrow samples from patients undergoing AZA therapy, we have identified that responders accumulate more 5-AZA-CdR in their DNA compared with nonresponders. AZA resistance was not a result of impaired AZA metabolism or intracellular accumulation. Furthermore, AZA-MS has helped to uncover different modes of AZA resistance. Whereas some nonresponders fail to incorporate sufficient 5-AZA-CdR into DNA, others incorporate 5-AZA-CdR and effect DNA demethylation like AZA responders, but show no clinical benefit.
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Affiliation(s)
- A Unnikrishnan
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - A N Q Vo
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - R Pickford
- Bioanalytical Mass Spectrometry Facility, UNSW Sydney, Sydney, New South Wales, Australia
| | - M J Raftery
- Bioanalytical Mass Spectrometry Facility, UNSW Sydney, Sydney, New South Wales, Australia
| | - A C Nunez
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - A Verma
- Climate Change Cluster, University of Technology Sydney, Sydney, New South Wales, Australia
| | - L B Hesson
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - J E Pimanda
- Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.,Department of Pathology, School of Medical Sciences, UNSW Sydney, Sydney, New South Wales, Australia.,Haematology Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
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Panikar V, Sosale A, Agarwal S, Unnikrishnan A, Kalra S, Bhattacharya A, Chawla M, Anjana RM, Bhatt A, Jaggi S, Sosale B, Hasnani D, Vadgama J. RSSDI clinical practice recommendations for management of In-hospital hyperglycaemia—2016. Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0528-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Muthu P, Unnikrishnan A, Jose WM, Keechilat P. A case of biphasic pulmonary blastoma showing good response to preoperative chemotherapy. Indian J Cancer 2016; 51:510-1. [PMID: 26842180 DOI: 10.4103/0019-509x.175297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Muthu
- Department of Medical Oncology, Cancer Institute, Amrita Institute of Medical Sciences, Ponekkara, Edappally, Kochi, Kerala, India
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Tursky ML, Beck D, Thoms JAI, Huang Y, Kumari A, Unnikrishnan A, Knezevic K, Evans K, Richards LA, Lee E, Morris J, Goldberg L, Izraeli S, Wong JWH, Olivier J, Lock RB, MacKenzie KL, Pimanda JE. Overexpression of ERG in cord blood progenitors promotes expansion and recapitulates molecular signatures of high ERG leukemias. Leukemia 2014; 29:819-27. [PMID: 25306899 DOI: 10.1038/leu.2014.299] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/04/2014] [Accepted: 10/03/2014] [Indexed: 02/07/2023]
Abstract
High expression of the ETS family transcription factor ERG is associated with poor clinical outcome in acute myeloid leukemia (AML) and acute T-cell lymphoblastic leukemia (T-ALL). In murine models, high ERG expression induces both T-ALL and AML. However, no study to date has defined the effect of high ERG expression on primary human hematopoietic cells. In the present study, human CD34+ cells were transduced with retroviral vectors to elevate ERG gene expression to levels detected in high ERG AML. RNA sequencing was performed on purified populations of transduced cells to define the effects of high ERG on gene expression in human CD34+ cells. Integration of the genome-wide expression data with other data sets revealed that high ERG drives an expression signature that shares features of normal hematopoietic stem cells, high ERG AMLs, early T-cell precursor-ALLs and leukemic stem cell signatures associated with poor clinical outcome. Functional assays linked this gene expression profile to enhanced progenitor cell expansion. These results support a model whereby a stem cell gene expression network driven by high ERG in human cells enhances the expansion of the progenitor pool, providing opportunity for the acquisition and propagation of mutations and the development of leukemia.
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Affiliation(s)
- M L Tursky
- 1] Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia [2] Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - D Beck
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - J A I Thoms
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - Y Huang
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - A Kumari
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - A Unnikrishnan
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - K Knezevic
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - K Evans
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - L A Richards
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - E Lee
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - J Morris
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | - L Goldberg
- 1] Cancer Research Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel [2] Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv, Israel
| | - S Izraeli
- 1] Cancer Research Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel [2] Department of Human Molecular Genetics and Biochemistry, Tel Aviv University, Tel Aviv, Israel
| | - J W H Wong
- Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - J Olivier
- School of Mathematics and Statistics, UNSW, Sydney, Australia
| | - R B Lock
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - K L MacKenzie
- Children's Cancer Institute Australia, Lowy Cancer Research Centre, UNSW, Sydney, Australia
| | - J E Pimanda
- 1] Adult Cancer Program, Prince of Wales Clinical School, Lowy Cancer Research Centre, UNSW, Sydney, Australia [2] Department of Haematology, Prince of Wales Hospital, Sydney, Australia
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Kumar N, Bhattacharya C, Unnikrishnan A. Passive Source Localization Using Compressively Sensed Towed Array. DEFENCE SCI J 2013. [DOI: 10.14429/dsj.63.5765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Athappan G, Chengat V, Unnikrishnan A, Chandraprakasam S, Kumar S, Ganesh N. Aortic dissection presenting as posterior circulation stroke. Singapore Med J 2009; 50:e35-e38. [PMID: 19224068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Aortic dissection is a rare and life-threatening event. While pain is the most common symptom of aortic dissection, it may be absent in ten percent of patients and present with a myriad of symptoms suggestive of a diverse range of other conditions. A high index of clinical suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. We report a 25-year-old woman with aortic dissection presenting as a posterior circulation stroke. This combination is very rare.
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Affiliation(s)
- G Athappan
- Department of Medicine, Madurai Medical College, Tamil Nadu, India.
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Miny G, Morris A, Jayendran M, Unnikrishnan A. PC Based Display for Sonar Applications: A Design Experience. DEFENCE SCI J 1994. [DOI: 10.14429/dsj.44.4162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Unnikrishnan A, Chhabra RP. An experimental study of motion of cylinders in newtonian fluids: Wall effects and drag coefficient. CAN J CHEM ENG 1991. [DOI: 10.1002/cjce.5450690315] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nagwekar JB, Unnikrishnan A. Michaelis-Menten kinetics of renal tubular secretion of D-(-)-p-methyl mandelic acid and D-(-)-p-ethyl mandelic acid in rats. J Pharm Sci 1971; 60:375-80. [PMID: 5572113 DOI: 10.1002/jps.2600600307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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