1
|
Chetambath R, Kumar P, Nandini V, Chandran S, Chacko A. Catamenial haemothorax-A rare cause of pleural effusion. Lung India 2023; 40:541-544. [PMID: 37961963 PMCID: PMC10723198 DOI: 10.4103/lungindia.lungindia_144_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 11/15/2023] Open
Abstract
Common causes of haemorrhagic pleural effusions include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, collagen vascular diseases, trauma and iatrogenic causes. Clinical history along with pathologic, microbiologic and biochemical evaluation of pleural fluid confirms the diagnosis in most cases. However, if there is recurrent haemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then we should think of uncommon causes. Catamenial haemothorax (CHt) is a rare cause of haemorrhagic pleural effusion, which recurs during each menstrual cycle. This is a manifestation of thoracic endometriosis syndrome (TES) caused by ectopic endometrial tissue in the thoracic cavity in women of child-bearing age. This extremely rare condition is difficult to diagnose, unless direct correlation with the menstrual cycle is established. TES consists of pleural forms such as catamenial pneumothorax, non-catamenial endometriosis-related pneumothorax and haemothorax; and parenchymal forms such as catamenial haemoptysis and lung nodules. Here we report a case of CHt in a 43-year-old female whose diagnosis was established by thoracoscopic pleural biopsy.
Collapse
Affiliation(s)
| | - Praveen Kumar
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - V Nandini
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Shilpa Chandran
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Anju Chacko
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| |
Collapse
|
2
|
Fomina Y, Chacko A, McIntire D, Adhikari E. Evaluating the effect of mandatory prenatal syphilis screening laws on primary and secondary syphilis among women over time. Am J Obstet Gynecol 2020. [DOI: 10.1016/j.ajog.2020.08.155] [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: 10/22/2022]
|
3
|
Sharma M, Chacko A, Rosenthal M, Khan M. 0645 The Association of Hypoglossal Nerve Stimulator Adherence and Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
The gold standard for treatment of Obstructive sleep apnea (OSA) is continuous positive airway pressure (CPAP). However, CPAP adherence is less than 50%. An alternative treatment is the hypoglossal nerve stimulator (HNS) which displaces the tongue anteriorly to treat upper airway obstruction. Difficulties tolerating HNS are related to stimulation discomfort. In this study, we investigated insomnia as a barrier to adherence.
Methods
Patients implanted and activated with HNS at The Ohio State University Wexner Medical Center between 2015 and 2019 were eligible. Patient usage data from the previous six months was obtained and subjects were asked to complete an Insomnia Severity Index (ISI). Participants were divided into adherent (defined as use ≥28 hours/week) and non-adherent (use <28 hours/week).
Results
32 subjects were enrolled, 22 in the adherent group and 10 in the non-adherent group. There was a significant decrease in mean treatment AHI in both groups: 36.25 to 11.14 in the adherent group and 36.30 to 15.69 in the non-adherent group (p<0.0001). The mean ISI score in the adherent group was 6.84 which is consistent with no clinically significant insomnia and 8.67 in the non-adherent group consistent with subthreshold insomnia. However, there was not a statistically significant difference between the two groups (p=0.441). There was a statistically significant higher score for the question “Do you worry about your sleep problems?” in the non-adherent group (1.78, SD1.39 vs 0.74. SD 0.81) (p =0.018).
Conclusion
This study suggests that patients who have difficulty with sleep may have more difficulty with HNS adherence than those who do not. In particular the question stating “Do you worry about your sleep problems” had a statistically higher score in the non-adherent group. Prospective studies are needed to further explore a possible relationship between insomnia and HNS adherence.
Support
N/A
Collapse
Affiliation(s)
- M Sharma
- The Ohio State Unviersity Wexner Medical Center Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH
| | - A Chacko
- The Ohio State Unviersity Wexner Medical Center Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH
| | - M Rosenthal
- The Ohio State Unviersity Wexner Medical Center Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH
| | - M Khan
- The Ohio State Unviersity Wexner Medical Center Division of Pulmonary, Critical Care, and Sleep Medicine, Columbus, OH
| |
Collapse
|
4
|
Chacko A, Bedard ACV, Marks D, Gopalan G, Feirsen N, Uderman J, Chimiklis A, Heber E, Cornwell M, Anderson L, Zwilling A, Ramon M. Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children. Child Neuropsychol 2018; 24:427-450. [PMID: 28277151 PMCID: PMC6224162 DOI: 10.1080/09297049.2017.1282450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent-child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study's limitations, and future directions for research are further discussed.
Collapse
Affiliation(s)
- A Chacko
- a Department of Applied Psychology , New York University , NY , USA
| | - A-C V Bedard
- b Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education , University of Toronto , Canada
| | - D Marks
- c Department of Child and Adolescent Psychiatry , New York University School of Medicine , NY , USA
| | - G Gopalan
- d Department of Social Work , University of Maryland at Baltimore , MD , USA
| | - N Feirsen
- e Department of Psychology , City University of New York , NY , USA
| | - J Uderman
- e Department of Psychology , City University of New York , NY , USA
| | - A Chimiklis
- e Department of Psychology , City University of New York , NY , USA
| | - E Heber
- e Department of Psychology , City University of New York , NY , USA
| | - M Cornwell
- e Department of Psychology , City University of New York , NY , USA
| | - L Anderson
- e Department of Psychology , City University of New York , NY , USA
| | - A Zwilling
- e Department of Psychology , City University of New York , NY , USA
| | - M Ramon
- e Department of Psychology , City University of New York , NY , USA
| |
Collapse
|
5
|
Srivastava K, Chacko A, Tikku T. Evaluation of psychological stress in orthodontic PG students in India. Int J Orthod Rehabil 2017. [DOI: 10.4103/2349-5243.200218] [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: 11/04/2022]
|
6
|
Boddu D, Verghese V, Michael J, Chacko A, Jeyaseelan V. Utility of the QuantiFERON-TB Gold In-tube test (QFT) compared with the Tuberculin Skin Test (TST) in diagnosing tuberculosis in Indian children with malnutrition: A prospective study. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.732] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
7
|
Chacko A, Scholtz L, Vedajallam S, van Wyk C. A rare case of heterotaxy and left ventricular non-compaction in an adult. Cardiovasc J Afr 2015; 27:45-8. [PMID: 26323941 PMCID: PMC4817066 DOI: 10.5830/cvja-2015-063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/29/2014] [Accepted: 08/11/2015] [Indexed: 11/06/2022] Open
Abstract
Heterotaxy syndrome with left ventricular non-compaction is a rare co-existence of abnormalities with unknown cause. It can be isolated with no other associations, or associated with congenital heart diseases, or it can occur with multiple other congenital abnormalities. We describe the third reported case of heterotaxy syndrome with left ventricular non-compaction presenting in an adult.
Collapse
Affiliation(s)
- A Chacko
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa.
| | - L Scholtz
- Scholtz & Partners, Diagnostic Radiologists, Pretoria, South Africa
| | | | - C van Wyk
- Cardiologist in Private Practice, Zuid-Afrikaans Hospital, Pretoria, South Africa
| |
Collapse
|
8
|
Lemyre B, Chau V, Ly L, Chacko A, Barrowman N, Whyte H, Miller S. 75: Initiation of Passive Cooling at Referring Center is Most Predictive of Achieving Early Therapeutic Hypothermia in Asphyxiated Newborns. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e60a] [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] Open
|
9
|
Shetty A, Kini AR, Chacko A, Sunil U, Vinod K, Geover L. Mini posterior lumbar interbody fusion with presacral screw stabilization in early lumbosacral instability. Indian J Orthop 2015; 49:278-83. [PMID: 26015626 PMCID: PMC4443408 DOI: 10.4103/0019-5413.156187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical options for the management of early lumbosacral spondylolisthesis and degenerative disc disease with instability vary from open lumbar interbody fusion with transpedicular fixation to a variety of minimal access fusion and fixation procedures. We have used a combination of micro discectomy and axial lumbosacral interbody fusion with presacral screw fixation to treat symptomatic patients with lumbosacral spondylolisthesis or lumbosacral degenerative disc disease, which needed surgical stabilization. This study describes the above technique along with analysis of results. MATERIALS AND METHODS Twelve patients with symptomatic lumbosacral (L5-S1) instability and degenerative lumbosacral disc disease were treated by micro discectomy and interbody fusion using presacral screw stabilization. Patients with history of bowel, bladder dysfunction and local anorectal diseases were excluded from this study. Postoperatively all patients were evaluated neurologically and radiologically for screw position, fusion and stability. Oswestry disability index was used to evaluate results. RESULTS We had nine females and three males with a mean age of 47.33 years (range 26-68 years). Postoperative assessment revealed three patients to have screw placed in anterior 1/4(th) of the 1(st) sacral body, in rest nine the screws were placed in the posterior 3/4(th) of sacral body. At 2 years followup, eight patients (67%) showed evidence of bridging trabeculae at bone graft site and none of the patients showed evidence of instability or implant failure. CONCLUSION Presacral screw fixation along with micro discectomy is an effective procedure to manage early symptomatic lumbosacral spondylolisthesis and degenerative disc disease with instability.
Collapse
Affiliation(s)
- Arjun Shetty
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India,Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India
| | - Abhishek R Kini
- Departments of Neurosurgery and Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore, Karnataka, India,Address for correspondence: Dr. Abhishek R Kini, Departments of Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore - 575 002, Karnataka, India. E-mail:
| | - A Chacko
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Upadhyaya Sunil
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - K Vinod
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Lobo Geover
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| |
Collapse
|
10
|
Bervini D, Messerer M, Jouanneau E, Chacko A, Trouillas J, Levivier M, Daniel R. Nonfunctioning Pituitary Macro Incidentalomas Benefit from Early Surgery before Becoming Symptomatic. J Neurol Surg A Cent Eur Neurosurg 2014. [DOI: 10.1055/s-0034-1383775] [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: 10/25/2022]
|
11
|
Chacko A, Bedard AC, Marks DJ, Feirsen N, Uderman JZ, Chimiklis A, Rajwan E, Cornwell M, Anderson L, Zwilling A, Ramon M. A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. J Child Psychol Psychiatry 2014; 55:247-55. [PMID: 24117656 PMCID: PMC3944087 DOI: 10.1111/jcpp.12146] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cogmed Working Memory Training (CWMT) has received considerable attention as a promising intervention for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. At the same time, methodological weaknesses in previous clinical trials call into question reported efficacy of CWMT. In particular, lack of equivalence in key aspects of CWMT (i.e., contingent reinforcement, time-on-task with computer training, parent-child interactions, supportive coaching) between CWMT and placebo versions of CWMT used in previous trials may account for the beneficial outcomes favoring CWMT. METHODS Eighty-five 7- to 11-year old school-age children with ADHD (66 male; 78%) were randomized to either standard CWMT (CWMT Active) or a well-controlled CWMT placebo condition (CWMT Placebo) and evaluated before and 3 weeks after treatment. Dependent measures included parent and teacher ratings of ADHD symptoms; objective measures of attention, activity level, and impulsivity; and psychometric indices of working memory and academic achievement (Clinical trial title: Combined cognitive remediation and behavioral intervention for the treatment of Attention-Deficit/Hyperactivity Disorder; http://clinicaltrials.gov/ct2/show/NCT01137318). RESULTS CWMT Active participants demonstrated significantly greater improvements in verbal and nonverbal working memory storage, but evidenced no discernible gains in working memory storage plus processing/manipulation. In addition, no treatment group differences were observed for any other outcome measures. CONCLUSIONS When a more rigorous comparison condition is utilized, CWMT demonstrates effects on certain aspects of working memory in children with ADHD; however, CWMT does not appear to foster treatment generalization to other domains of functioning. As such, CWMT should not be considered a viable treatment for children with ADHD.
Collapse
Affiliation(s)
- A Chacko
- Department of Psychology, Queens College, City University of New York, Flushing, NY, USA; Department of Psychology, The Graduate School and University Center, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; New York University Langone Medical Center Child Study Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chacko A, Smal J, Lubbe E, Adroos N. Imaging of disease progression in a case of idiopathic moyamoya. SA J Radiol 2013. [DOI: 10.4102/sajr.v17i3.272] [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: 11/01/2022] Open
Abstract
Moyamoya is a rare cerebrovascular disease characterised by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. We report on the progression of the disease in a 3-year-old boy, confirmed to have idiopathic Moyamoya disease, over 6 ensuing years, using serial magnetic resonance imaging with MR angiography. Comparison is also made with conventional angiography at the last visit. Characteristic imaging appearances of asymmetric narrowing of the internal carotid arteries (especially the supra-clinoid portion) with numerous collateral vessels around the brainstem especially within the ambient and quadrigeminal plate cisterns are demonstrated with progression.
Collapse
|
13
|
Chowdhury SD, Chacko A, Ramakrishna BS, Dutta AK, Augustine J, Koshy AK, Simon EG, Joseph AJ. Clinical profile and outcome of chronic pancreatitis in children. Indian Pediatr 2013; 50:1016-9. [PMID: 23798627 DOI: 10.1007/s13312-013-0281-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/03/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the etiology, presentation, complications and management of chronic pancreatitis in children. DESIGN Retrospective chart review. SETTING Gastroenterology department at Christian Medical College and Hospital, Vellore, India between January 2005 and December 2010. PARTICIPANTS 99 Children (>18 yrs) diagnosed with chronic pancreatitis based on clinical and imaging features. MAIN OUTCOME MEASURES Etiology, clinical presentation, complications and management of chronic pancreatitis in children. RESULTS Of 3887 children who attended the Gastroenterology department, 99(2.5%) had chronic pancreatitis, of which 60 (60.6%) were males. In 95(95.9%) patients no definite cause was detected and they were labeled as Idiopathic chronic pancreatitis. All patients had abdominal pain, while 9(9.1%) had diabetes mellitus. Of the 22 children tested for stool fat, 10(45.5%) had steatorrhea. Pancreatic calcification was seen in 69 (69.7%). 68 (71.6%) patients with idiopathic chronic pancreatitis had calcification. Calcific idiopathic chronic pancreatitis was more frequent in males (67.6% vs. 48.1%, P=0.07), and was more commonly associated with diabetes mellitus (13.2% vs. none, P=0.047) and steatorrhea (61.5% vs. 16.7%, P=0.069). Pseudocyst (17.1%) and ascites (9.1%) were the most common complications. All children were treated with pancreatic enzyme supplements for pain relief. 57 patients were followed up. With enzyme supplementation, pain relief was present in 32 (56.1%) patients. Of those who did not improve, 10 underwent endotherapy and 15 underwent surgery. Follow up of 8 patients who underwent endotherapy, showed that 5 (62.5%) had relief. Follow up of 11 patients who underwent surgery showed that only 3 (27%) had pain relief. There was no death. CONCLUSIONS Idiopathic chronic pancreatitis is the predominant form of chronic pancreatitis in children and adolescents. It can present with or without calcification. The calcific variety is an aggressive disease characterized by early morphological and functional damage to the pancreas.
Collapse
Affiliation(s)
- S D Chowdhury
- Department of GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India. Correspondence to: Professor Ashok Chacko, Department of G.I. Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Thomas R, Job A, Chacko A. Successful Dural Repair Following the Endoscopic Extended Transsphenoidal Approach for Suprasellar Meningiomas. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1313988] [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: 10/28/2022]
|
15
|
Affiliation(s)
- S Vedajallam
- Department of Radiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | | | | | | | | |
Collapse
|
16
|
Chowdhury SD, Dutta AK, Pal S, Leena RV, Chacko A. Jejunogastric intussusception causing gastrointestinal bleeding. Endoscopy 2011; 43 Suppl 2 UCTN:E247. [PMID: 21837596 DOI: 10.1055/s-0030-1256601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S D Chowdhury
- Department of GI Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | | |
Collapse
|
17
|
Dutta AK, Balekuduru A, Chacko A. Spectrum of malabsorption in India--tropical sprue is still the leader. J Assoc Physicians India 2011; 59:420-422. [PMID: 22315745] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Two decades ago tropical sprue, Immunoproliferative Small Intestinal Disease (IPSID) and infections were common causes of malabsorption in India. It is possible that implementation of preventive health measures and improved sanitation may have changed the spectrum of disorders causing malabsorption. The aim of this study therefore was to assess the spectrum of malabsorption seen at our center during the past nine years. METHODOLOGY Patients seen at our center with malabsorption from January 2000 to December 2008 were included in this study. The etiological, clinical and investigation details were recorded on uniform structured data forms. The data obtained was retrospectively analyzed. RESULTS Malabsorption was detected in 124 patients during the study period. The mean age of patients was 31.9+16 years and 60.5% were males. Tropical sprue was the commonest etiology (29%) followed by celiac and Crohn's disease (15.3% each). Other important etiologies included parasitic infestations (9.7%) and immune deficiency disorders (5.6%). Intestinal tuberculosis was seen in only 2.4% patients. CONCLUSIONS We are witnessing a change in etiological spectrum of malabsorption . Celiac disease and inflammatory bowel disorders are emerging as important causes and ImmunoProliferative Small Intestinal Disease (IPSID) and intestinal tuberculosis are on the decline. Tropical Sprue however continues to be the commonest cause as in the past.
Collapse
Affiliation(s)
- A K Dutta
- Department of Gastrointestinal Sciences, Christian Medical College & Hospital, Vellore 632 004
| | | | | |
Collapse
|
18
|
Chacko A, Jithesh PV, Grills C, Paul I, Crawford N, Fennell DA. The Rab27A effector MYRIP as a regulator of survival in non-small cell lung cancer cells. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13537] [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: 11/20/2022] Open
|
19
|
Avinash B, Dutta AK, Chacko A. Pediatric inflammatory bowel disease in South India. Indian Pediatr 2009; 46:639-640. [PMID: 19638665] [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: 05/28/2023]
Abstract
Among 34 children diagnosed to have inflammatory bowel disease (IBD) over past 8 years, 23 had Crohns disease and 11 had ulcerative colitis. Pediatric patients accounted for 7% of new cases of IBD seen annually. Median delay in diagnosis was 15 months. Nutritional impairment was significantly more common in Crohns disease.
Collapse
Affiliation(s)
- B Avinash
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | | | | |
Collapse
|
20
|
Jeyamani R, Joseph AJ, Chacko A. Severe and treatment resistant strongyloidiasis--indicator of HTLV-I infection. Trop Gastroenterol 2007; 28:176-177. [PMID: 18416349] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The association between severe and persistent strongyloidiasis with human T cell lymphotropic virus type I (HTLV-1) infection is well documented in reports from HTLV-1 endemic regions like Japan and Jamaica. But there are no reports from non-endemic areas like India. We report a case of severe intestinal strongyloidiasis in a 45-year old Keralite man, living in Sikkim. Despite standard treatment with many courses of albendazole, his stool persistently showed Strongyloides stercoralis larvae. In the absence of other immunosuppressive conditions, human T cell lymphotropic virus type I infection was considered and determined positive. Subsequently, treatment with 2 courses of ivermectin achieved eradication of the infection. On follow-up, 3 years later, his stools again revealed Strongyloides stercoralis larvae.
Collapse
Affiliation(s)
- R Jeyamani
- Department of GI Sciences, Christian Medical College, Vellore, Tamil Nadu.
| | | | | |
Collapse
|
21
|
Abstract
Bortezomib (Velcade, PS341) was licensed in 2003 as a first-in-class 20S proteasome inhibitor indicated for treatment of multiple myeloma, and is currently being evaluated clinically in a range of solid tumours. The mechanisms underlying its cancer cell toxicity are complex. A growing body of evidence suggests proteasome inhibition-dependent regulation of the BCL-2 family is a critical requirement. In particular, the stabilization of BH3-only proteins BIK, NOXA and BIM, appear to be essential for effecting BAX- and BAK-dependent cell death. These mechanisms are reviewed and the implications for favourable novel drug interactions are highlighted.
Collapse
Affiliation(s)
- D A Fennell
- Thoracic Oncology Research Group, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Northern Ireland, UK.
| | | | | |
Collapse
|
22
|
McFarlane S, Seaton A, Chacko A, Johnston P, Montironi R, Waugh D. 45 POSTER Focal adhesion kinase is a key signalling intermediate in interleukin-8 promoted chemotaxis and adhesion of prostate cancer cells to bone marrow endothelium. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70051-9] [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: 10/23/2022] Open
|
23
|
Chacko A, Coleman G, Harriott P, Greer B, Gaudino G, Mutti L, Fennell D. 96 Bortezomib accelerates BAX BAK dependent mitochondrial depolarization in malignant pleural mesothelioma cells. Lung Cancer 2006. [DOI: 10.1016/s0169-5002(07)70172-1] [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: 10/23/2022]
|
24
|
Danda D, Kurian G, Chacko A, Chandy G, Patra S, Mathew A, Thomas K. Crohn's disease in rheumatology clinic--an Indian experience. J Postgrad Med 2005; 51:269-72; discussion 272-4. [PMID: 16388168] [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: 05/06/2023] Open
Abstract
BACKGROUND Prevalence of Crohn's disease (CD) among patients with rheumatic illnesses in India is grossly under estimated, especially when it has overtaken that of Ulcerative Colitis in the West. AIM To study the frequency of histologically unequivocal CD amongst clinically suspected patients with enteropathic arthropathy and to ascertain if the arthritics with CD have any independent clinical predictor. SETTINGS AND DESIGNS Retrospective datasheet analysis from a Rheumatology clinic of a large tertiary care centre. MATERIALS AND METHODS Patients of suspected enteropathic arthropathy were studied by ileocolonoscopy and segmental colonic biopsy for histological evidence of Crohn's disease and followed up. STATISTICAL ANALYSIS Logistic regression analysis was done to find out any clinical predictor of histologically proven CD. RESULTS Fourteen of the twenty-nine patients studied had histologically confirmed CD. Those with CD were younger than those without (34.7 yr vs 41.6 yrs, p=0.057). The CD group also had significantly higher number of people with loss of weight (12 vs 1), fever (11 vs 0), perianal fistula (4 vs 0), abdominal pain (8 vs 2), history of dysentery (4 vs 0) and uveitis (6 vs 1) (p=0.00002, 0.00001, 0.026, 0.013, 0.026 & 0.01 respectively). However logistic regression analysis of the most relevant ones among these, namely, loss of weight, fever, and perianal fistula showed loss of weight as only independent predictor of CD in this subset of patients (p=0.03 with odds ratio of 28). CONCLUSION Presence of significant loss of weight in an Indian patient with clinically suspected enteropathic arthropathy is an independent predictor of CD.
Collapse
Affiliation(s)
- Debashish Danda
- Department of Medicine II and Clinical Immunology & Rheumatology Unit, Christian Medical College and Hospital, Vellore, India.
| | | | | | | | | | | | | |
Collapse
|
25
|
Ellis M, Serreli A, Colque-Navarro P, Hedstrom U, Chacko A, Siemkowicz E, Möllby R. Role of staphylococcal enterotoxin A in a fatal case of endocarditis. J Med Microbiol 2003; 52:109-112. [PMID: 12543915 DOI: 10.1099/jmm.0.05003-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A young female with no identifiable risk factors developed rapid, overwhelming Staphylococcus aureus endocarditis. Despite rapid sterilization of the blood and the mitral valve with optimal antimicrobials, she had persistent septic shock. In order to investigate this, the toxin-producing capacity of the infecting strain and the patient's ability to produce antibodies were determined. The strain produced high levels of both alpha-toxin and staphylococcal enterotoxin A (SEA), whilst the patient responded with modestly high levels of antibodies to alpha-toxin and low-normal levels to SEA. The patient was most probably susceptible to the actions of SEA and developed a toxic-shock-syndrome-like disease that further aggravated her valvular dysfunction. This case illustrates that optimal antimicrobial therapy alone is not sufficient treatment in patients with persistent toxic shock and that there is a need to evaluate immunomodulatory strategies in such patients.
Collapse
Affiliation(s)
- M Ellis
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - A Serreli
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - P Colque-Navarro
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - U Hedstrom
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - A Chacko
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - E Siemkowicz
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| | - R Möllby
- Department of Medicine Faculty and Health Sciences, UAE University, PO Box 17666, Al Ain, UAE 2Microbiology and Tumorbiology Center, Karolinska Institute, Sweden 3Department of Infectious Diseases, Huddinge Hospital, Sweden 4,5Departments of Medicine4 and Intensive Care5, Tawam Hospital, UAE
| |
Collapse
|
26
|
Abstract
BACKGROUND Recent reports have established that eye changes occur in patients treated with vigabatrin. AIM To identify the eye changes associated with vigabatrin, based on a prospective study of children treated for seizures. METHODS Twenty nine children on vigabatrin (mainly as add on therapy) were followed up for 6.5 years. Ophthalmic examination was performed before starting treatment and then six monthly in the outpatient clinic. RESULTS Twenty one children fulfilled the inclusion criteria. Most had epileptic syndromes with infantile spasms-namely West syndrome, Lennox-Gastaut syndrome, and partial seizures. Vigabatrin dose was 25-114 mg/kg/day (mean 55.8); duration of therapy was 6-85 months (mean 35.7). Four children (19%) developed eye changes (retinal pigmentation, hypopigmented retinal spots, vascular sheathing, and optic atrophy). Visual evoked potentials were abnormal in 16 children. Electroretinography and electro-oculography, which could have picked up eye changes in early stages, were not performed, as this facility was not available. CONCLUSIONS Vigabatrin causes eye damage. Most children with epileptic syndromes on vigabatrin cannot complain of their eye problems, hence 3-6 monthly ophthalmic follow up is strongly advised, along with regular electroretinography, electro-oculography, and visual evoked potentials if possible.
Collapse
Affiliation(s)
- R Koul
- Department of Child Health, Division of Paediatric Neurology, Sultan Qaboos University Hospital, Al Khod, 123, Sultanate of Oman.
| | | | | | | | | |
Collapse
|
27
|
Abstract
Rippling muscle disease (RMD) has previously been reported as a skeletal myopathy that was attributed to a defect in the sarcomere. Here we report a new form of RMD that is more severe, characterized by fatal arrhythmic cardiomyopathy and delayed bone age. Mortality has previously not been associated with RMD. With this report we hope to raise awareness that a subset of patients with this clinical entity are predisposed to severe cardiac disease.
Collapse
Affiliation(s)
- R L Koul
- Department of Pediatric Neurology, Sultan Qaboos University Hospital, Muscat, Oman
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Forty-four children (20 male: 24 female) with West syndrome (infantile spasms, mental retardation/regression and hypsarrhythmia) diagnosed at Sultan Qaboos University Hospital (Pediatric Neurology Division of the Department of Child Health) are reported, with thirty-four (77.3%) children constituting the symptomatic group. All children were followed up for an initial 1 year at this hospital. Thirty-seven cases (84%) still continue their follow-up with us. The age of onset ranged from 1 to 14 months (mean, 6.0 months). Developmental delay before the onset of infantile spasms was noted in 29 (65.9%) children. Brain computed tomography was abnormal in 29 (65.9%). Sodium valproate and vigabatrin were the most often used drugs, though other antiepileptic drugs were also used. Nine (24.5%) children achieved good seizure control, out of which five have normal development. Only one child could be weaned off antiepileptic drugs completely. There was one death in the whole series, related to aspiration pneumonia.
Collapse
Affiliation(s)
- R Koul
- Division of Pediatric Neurology, Department of Child Health, Sultan Qaboos University Hospital, P.B. No. 38, Al Khod 123, Oman.
| | | | | |
Collapse
|
29
|
Abstract
RATIONALE AND OBJECTIVES Soft-copy viewing of digital radiographs allows for image processing to improve visualization of anatomy and lesions, but it can take more time than film-based viewing. Enhanced visualization processing (EVP) was developed to increase the latitude of an image without reducing the vital contrast, potentially reducing the need for the radiologist to manipulate images. This study examined the influence of processing radiographic images with EVP on workflow in a picture archiving and communications system (PACS). MATERIALS AND METHODS Portable computed radiographic chest images were obtained and processed either with EVP or without. A security camera with a videocassette recorder was positioned above the PACS workstation. Four radiologists reviewed the images during their normal work schedule. The current diagnostic image was used to determine if the case contained EVP or non-EVP images. The videotapes of the sessions were reviewed to determine diagnostic viewing times and how zoom and/or window and level manipulation was used. RESULTS Viewing time was significantly longer for the non-EVP than the EVP cases. The difference occurred with all readers. Window and level manipulation was used on 35% of the EVP and 41% of the non-EVP images. Zoom was used on 64% of the EVP and 69% of the non-EVP images. Average time spent using zoom and window and level manipulation was significantly shorter with the EVP than with the non-EVP images. CONCLUSION EVP of chest images displayed on PACS monitors significantly improved workflow as measured by viewing time. EVP decreased use of window and level manipulation and zooming and the amount of time each one was used.
Collapse
Affiliation(s)
- E A Krupinski
- Department of Radiology, University of Arizona, Tucson 85724, USA
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Two siblings with familial encephalopathy, calcification of the basal ganglia, and cerebrospinal fluid lymphocytosis, constituting the triad of Aicardi-Goutieres syndrome, are reported. This syndrome resembles congenital intrauterine infections, which must be meticulously excluded. Aicardi-Goutieres syndrome is extremely rare and is being reported from the Arab world for the first time to our knowledge.
Collapse
MESH Headings
- Atrophy
- Basal Ganglia Diseases/cerebrospinal fluid
- Basal Ganglia Diseases/diagnosis
- Basal Ganglia Diseases/genetics
- Brain Damage, Chronic/cerebrospinal fluid
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/genetics
- Calcinosis/cerebrospinal fluid
- Calcinosis/diagnosis
- Calcinosis/genetics
- Cerebral Cortex/pathology
- Child
- Child, Preschool
- Chromosome Aberrations
- Chromosome Mapping
- Chromosomes, Human, Pair 3
- Consanguinity
- Diagnosis, Differential
- Female
- Follow-Up Studies
- Genes, Recessive/genetics
- Humans
- Infant
- Infant, Newborn
- Lymphocytosis/cerebrospinal fluid
- Lymphocytosis/diagnosis
- Lymphocytosis/genetics
- Male
- Syndrome
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- R Koul
- Department of Child Health, Sultan Qaboos University Hospital, Al Khod, Sultanate of Oman.
| | | | | | | |
Collapse
|
31
|
Chacko A, Koul R, Sankhla DK. Corpus callosum agenesis. Neurosciences (Riyadh) 2001; 6:63-66. [PMID: 24185229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The objectives are to analyse corpus callosum agenesis in children with various neurological problems in a hospital set-up, and to study the neurological and systemic abnormalities associated with this condition. METHODS The children with various neurological problems who underwent computerized tomography brain from January 1993 to December 1997, and were found to have corpus callosum agenesis, formed the subjects of this study. These children were examined for any syndromic association, congenital infections or metabolic defects. RESULTS Out of 2164 children who underwent computerized tomography brain, 22 had corpus callosum agenesis (1%). Most cases were not syndromic and 64% were males. Epileptic disorders were noted in about one third of cases. CONCLUSION Corpus callosum agenesis an important anomaly in children with neurodevelopment handicaps, usually detected by neuroradiology.
Collapse
Affiliation(s)
- A Chacko
- Division of Pediatric Neurology, Department of Child Health, Sultan Qaboos University Hospital, Oman
| | | | | |
Collapse
|
32
|
Chacko A, Koul R, Sankhla DK. Corpus callosum agenesis. Saudi Med J 2001; 22:22-5. [PMID: 11255605] [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: 02/19/2023] Open
Abstract
OBJECTIVE The objectives are to analyse corpus callosum agenesis in children with various neurological problems in a hospital set-up, and to study the neurological and systemic abnormalities associated with this condition. METHODS The children with various neurological problems who underwent computerized tomography brain from January 1993 to December 1997, and were found to have corpus callosum agenesis, formed the subjects of this study. These children were examined for any syndromic association, congenital infections or metabolic defects. RESULTS Out of 2164 children who underwent computerized tomography brain, 22 had corpus callosum agenesis (1%). Most cases were not syndromic and 64% were males. Epileptic disorders were noted in about one third of cases. CONCLUSION Corpus callosum agenesis is an important anomaly in children with neurodevelopment handicaps, usually detected by neuroradiology.
Collapse
Affiliation(s)
- A Chacko
- Division of Pediatric Neurology, Deparment of Child Health, Sultan Qaboos University Hospital, PO Box 35, Postal Code 123, Sultanate of Oman
| | | | | |
Collapse
|
33
|
Koul RL, Chacko A, Al-Lamki Z, Al-Amri AM, Al-Khusaiby S. Munchausen syndrome by proxy. Neurosciences (Riyadh) 2000; 5:177-181. [PMID: 24276809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Five children (3F:2M), in the age group 1 years to 11 years, with Munchausen syndrome by proxy are reported from the Sultanate of Oman. They were seen over a four years period from 1996-1999. In all these children, the mother came up with history of uncontrolled epilepsy. Carbamazepine was the most common antiepileptic drug used. One of these children remained hospitalized elsewhere for nearly 9 months, as a case of uncontrolled status epilepticus. It took 18 months to 6 years (mean 2.8 years) to establish the diagnosis and the mother was the offender in all. The main lead to diagnosis, was the disparity between history and clinical presentation to hospital. The carbamazepine levels were several times above the upper limit of therapeutic range. Munchausen syndrome by proxy very much exists here, but is possibly less recognized and needs immediate attention to formulate policies to identify and manage these children. It is necessary to create awareness even in the medical community, to recognise this problem. There is an urgent need to develop a child protection council at the national or regional level.
Collapse
Affiliation(s)
- R L Koul
- Department of Child Health, College of Medicine, Sultan Qaboos University, Sultanate of Oman
| | | | | | | | | |
Collapse
|
34
|
Javed H, Nair MP, Koul RL, Chacko A, Fazalullah M. Long term intubation and successful weaning in two children with Guillain-Barre syndrome. Saudi Med J 2000; 21:686-8. [PMID: 11500736] [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: 02/21/2023] Open
Abstract
No definite criteria exists in Guillian-Barre syndrome in children regarding prolonged ventilation through an endo-tracheal tube without tracheostomy and successful weaning using a T-piece. Here we report two such cases of Guillian-Barre syndrome requiring prolonged intubation for 56 days and ventilation for 30 days and ultimately successfully weaning them using the T-piece. Both the children eventually made a complete recovery, highlighting the point that in children prolonged intubation and ventilation using the portex tube is equally good, if not, better than tracheostomy with its attendant risks.
Collapse
Affiliation(s)
- H Javed
- Department of Child Health, Sultan Qaboos University Hospital, Al-Khod 123 Muscat, Sultanate of Oman
| | | | | | | | | |
Collapse
|
35
|
Siegel E, Reiner B, Abiri M, Chacko A, Morin R, Ro DW, Spicer K, Strickland N, Young J. The filmless radiology reading room: a survey of established picture archiving and communication system sites. J Digit Imaging 2000; 13:22-3. [PMID: 10847356 PMCID: PMC3453269 DOI: 10.1007/bf03167618] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The purpose of this study was to survey radiologists experienced in soft-copy diagnosis using computer workstations about their current reading room environment, their impressions of the efficacy of their reading room design, and their recommendations based on their experience for improvement of the soft-copy reading environment. Surveys were obtained from radiologists at seven sites representing three major picture archiving and communication system (PACS) vendors throughout the world that have had extensive experience with soft-copy interpretation of radiology studies. The radiologists filled out a detailed survey, which was designed to assess their current reading room environment and to provide them with the opportunity to make suggestions about improvement of the PACS reading rooms. The survey data were entered into a database and results were correlated with multiple parameters, including experience with PACS, types of modalities interpreted on the system, and number of years of experience in radiology. The factors judged to be most important in promoting radiologist productivity were room lighting, monitor number, and monitor brightness. Almost all of the radiologists indicated that their lighting source was from overhead rather than indirect or portable light sources. Approximately half indicated they had the capability of dimming the brightness of the overhead lighting. Most radiologists indicated that they were able to adjust room temperature but that they did not have individual temperature controls at their workstations. The radiologists indicated that the most troublesome sources of noise included background noise, other radiologists, and clinicians much more than noise from computer monitors, technologists, or patients. Most radiologists did not have chairs that could recline or arm rests. Most did have wheels and the capability to swivel, both of which were judged important. The majority of chairs also had lumbar support, which was also seen to be important. Radiologists commonly adjusted room lighting and their reading chair, but rarely adjusted room temperature or monitor brightness. The median number of hours spent at the workstation before taken a "break" was 1.5. Common recommendations to improve the room layout included compartmentalization of the reading room and availability of the hospital/radiology information system at each workstation. The survey data suggest several areas of potential improvement based on radiologists' experience. Optimization of soft-copy reading room design is likely to result in decreased fatigue and increased productivity.
Collapse
Affiliation(s)
- E Siegel
- Department of Diagnostic Radiology and Nuclear Medicine, Veterans Affairs Maryland Healthcare System, Baltimore 21201, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Romlein J, Lyche D, Chacko A, Cawthon M, Vanderburgh D, Stokes R. New facility picture archiving and communication system implementation strategy. J Digit Imaging 2000; 13:3-5. [PMID: 10847351 PMCID: PMC3453254 DOI: 10.1007/bf03167613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Strategies for deployment of picture archiving and communications systems (PACS) in new hospitals often involve the establishment of initial PACS operations. Such a strategy is flawed in the sense that the clinical and radiological users must adapt to PACS operations, while being faced with several other new facility learning curves. This increases the complexity and risk of the radiological services. A strategy of implementing PACS operations in the old facility and performing a zero-downtime transition into the new facility offers several advantages to this method. The successful undertaking of such a project will support not only the physical movement of the existing PACS, but the accomplishment of other re-engineering goals associated with the new hospital. This report will describe the strategy used in two successful transitions of PACS into newly constructed hospitals.
Collapse
Affiliation(s)
- J Romlein
- InformaTech-Telemedicine Services, Frederick, MD 21703, USA.
| | | | | | | | | | | |
Collapse
|
37
|
Koul RL, Chacko A, Al-Lamki Z, Al-Amri AM, Al-Khusaiby S. Munchausen syndrome by proxy. Saudi Med J 2000; 21:482-6. [PMID: 11500687] [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: 02/21/2023] Open
Abstract
Five children (3F:2M), in the age group 1 years to 11 years, with Munchausen syndrome by proxy are reported from the Sultanate of Oman. They were seen over a four years period from 1996-1999. In all these children, the mother came up with history of uncontrolled epilepsy. Carbamazepine was the most common antiepileptic drug used. One of these children remained hospitalized elsewhere for nearly 9 months, as a case of uncontrolled status epilepticus. It took 18 months to 6 years (mean 2.8 years) to establish the diagnosis and the mother was the offender in all. The main lead to diagnosis, was the disparity between history and clinical presentation to hospital. The carbamazepine levels were several times above the upper limit of therapeutic range. Munchausen syndrome by proxy very much exists here, but is possibly less recognized and needs immediate attention to formulate policies to identify and manage these children. It is necessary to create awareness even in the medical community, to recognise this problem. There is an urgent need to develop a child protection council at the national or regional level.
Collapse
Affiliation(s)
- R L Koul
- Department of Child Health, College of Medicine, Sultan Qaboos University, Sultanate of Oman
| | | | | | | | | |
Collapse
|
38
|
Koul RL, Chacko A, Leven HO. Dandy-Walker syndrome in association with neurofibromatosis in monozygotic twins. Saudi Med J 2000; 21:390-2. [PMID: 11533827] [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: 02/21/2023] Open
Abstract
Dandy-Walker syndrome in monozygotic twins is reported. The twins reported, presented with delayed development, big head and dysmorphic features. In addition, there were significant cafe-au-lait spots on the trunk and other minor features consistent with the diagnosis of neurofibromatosis. To the best of our knowledge, Dandy-Walker syndrome in combination with neurofibromatosis in monozygotic twins has not been previously reported.
Collapse
Affiliation(s)
- R L Koul
- Department of Pediatric Neurology, Sultan Qaboos University Hospital, PO Box 38, Al-Khoud 123, Sultanate of Oman
| | | | | |
Collapse
|
39
|
Gupta A, Chandy G, Chacko A. Hepatobiliary and pancreatic: recurrent right upper quadrant pain. J Gastroenterol Hepatol 2000; 15:211, 214. [PMID: 10735546 DOI: 10.1046/j.1440-1746.2000.2084a.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- A Gupta
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, India
| | | | | |
Collapse
|
40
|
Govil S, Justus A, Korah I, Cherian R, Chacko A. Efficacy of non-breath-hold magnetic resonance cholangiography at midfield strength. Indian J Med Res 1999; 110:194-9. [PMID: 10701299] [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: 02/15/2023] Open
Abstract
The efficacy of non-breath-hold magnetic resonance (MR) cholangiography at mid-field strength (0.5 Tesla) was evaluated for delineating biliary anatomy and the cause and extent of biliary obstruction. We performed 65 MR cholangiograms on a mid-field 0.5 Tesla MR unit and correlated them with contrast cholangiography and/or surgery. MR cholangiography was found to be both sensitive and specific in the detection of biliary obstruction and in the definition of its cause (sensitivity 98%, specificity 100%, positive predictive value 100%, negative predictive value 85.7%, accuracy 98%). MR cholangiography accurately predicted the level of obstruction in 94 per cent of strictures. Normal caliber intra-hepatic biliary radicles were visualised in only 6 per cent of the MR cholangiograms. In contrast, 94 per cent of dilated intrahepatic biliary radicles were demonstrated. The confluence, and right and left hepatic ducts were visualized in 98 per cent; the gall bladder in 65 per cent; the cystic duct in 45 per cent and the cystic duct insertion in 25 per cent. The extrahepatic bile duct was seen in 82.7 per cent. A normal caliber pancreatic duct was seen in 18 per cent while a dilated pancreatic duct was seen in 86 per cent. The pancreatico-biliary junction was visualised in 7 per cent. Non-breath-hold MR cholangiography at midfield strength is a highly accurate method of evaluating the cause and level of biliary obstruction, comparable to high-field MR cholangiography. The spatial resolution however is inadequate for the detection of variations in biliary or pancreatic ductal anatomy when the ducts are of normal caliber.
Collapse
Affiliation(s)
- S Govil
- Department of Radiology, Christian Medical College & Hospital, Vellore
| | | | | | | | | |
Collapse
|
41
|
Abstract
BACKGROUND Current interest in cytomegalovirus (CMV) is largely due to an increase in the number of cases of acquired immunodeficiency syndrome and organ transplantation in recent years. The proper recognition of CMV-infected cells in gastrointestinal mucosal biopsies is critical for effective treatment of this condition. METHODS A total of 6580 endoscopic mucosal biopsies from 6323 patients in the 8-year period (1989-1996) were examined for CMV inclusion bodies. The endoscopic appearance and particularly the presence of ulcers were also analysed. RESULTS AND CONCLUSIONS The prevalence of cytomegalovirus (CMV) inclusions was 9 per thousand in the gastrointestinal mucosal biopsies from an unselected group of patients. Of the 54 patients with CMV infection, 37 were immunocompromised and 17 apparently immunocompetent. Typical Cowdry inclusions and atypical inclusions were present, the latter more frequently in immunocompromised patients. The maximum prevalence of inclusions was in the oesophageal mucosa in immunocompromised individuals.
Collapse
Affiliation(s)
- S Patra
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore, Tamilnadu, India.
| | | | | | | | | |
Collapse
|
42
|
Kang G, Rajan DP, Patra S, Chacko A, Mathan MM. Use of serology, the urease test & histology in diagnosis of Helicobacter pylori infection in symptomatic & asymptomatic Indians. Indian J Med Res 1999; 110:86-90. [PMID: 10612909] [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: 02/15/2023] Open
Abstract
Age-specific prevalence of IgA and IgG antibodies in 714 subjects without gastrointestinal complaints aged 6 months to 90 yr was measured by an enzyme linked immunoassay using an acid-glycine extract of H. pylori as the antigen. The urease test and histology were used for the diagnosis of H. pylori infection in 83 subjects with a clinical diagnosis of dyspepsia, and these results were compared with measurement of IgG, IgA and IgM antibodies. The age specific prevalence of IgG and IgA antibodies respectively was 57 and 43 per cent for subjects aged 6 months to 4 yr and showed an increase with age to a maximum of 90 per cent for IgG in subjects > 60 yr of age and to 87 per cent for IgA in subjects between 51 and 60 yr. In symptomatic patients, there was a high degree of correlation between severity of H. pylori infection on histopathological examination and IgG (P < 0.02) levels. The use of IgG and IgA estimation could have identified H. pylori infection without endoscopy in 50 of the 83 patients. Serology for IgG and IgA antibodies against H. pylori may play a major role in decreasing the need for endoscopy, but cut-off values must be determined for each assay based on the prevalence of antibodies in the population.
Collapse
Affiliation(s)
- G Kang
- Wellcome Trust Research Laboratory, Department of Gastrointestinal Sciences Christian Medical College & Hospital, Vellore
| | | | | | | | | |
Collapse
|
43
|
Chacko A, Cook J, Contreras M, Lollar B, Radvany M, Shah R, Cawthon M, Timbloe HL. The philosophy of change and adaptation of radiology to the information age. J Digit Imaging 1999; 12:67-70. [PMID: 10342170 PMCID: PMC3452872 DOI: 10.1007/bf03168759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- A Chacko
- Department of Radiology, Brooke Army Medical Center, Fort Sam, TX 78234-6200, USA
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Agnes K, Tan A, Chacko A, Roghmann M. Use of electronic surveillance for C. Difficile infections. Am J Infect Control 1999. [DOI: 10.1016/s0196-6553(99)80121-7] [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: 10/23/2022]
|
45
|
Venkataraman S, Ramakrishna BS, Mathan M, Chacko A, Chandy G, Kurian G, Mathan VI. Eosinophilic gastroenteritis--an Indian experience. Indian J Gastroenterol 1998; 17:148-9. [PMID: 9795503] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Eosinophilic gastroenteritis is an uncommon disorder with varied presentation. Records of 7 patients (6 men) with eosinophilic gastroenteritis, presenting to a large referral hospital over a 10-year period, were analyzed. The patients were young adults (mean age 32 years) with short duration (median 2 months) of illness. Symptoms included abdominal pain and vomiting (100%), weight loss (57%), diarrhea (43%) and abdominal distension (43%). Peripheral eosinophilia was present in all the patients. The diagnosis was made at duodenal (2 patients) or cecal (1) biopsy or surgical full-thickness jejunal biopsy (4). Three patients had predominantly mucosal disease (Klein type I), whereas two patients each had predominantly muscular (type II) and submucosal (type III) disease. Surgical resection was curative in one patient with type II disease. The other six responded to prednisolone, with complete resolution in one patient.
Collapse
Affiliation(s)
- S Venkataraman
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Sixteen cases of external hydrocephalus (EH) were seen from January 1993 to June 1995. There were 13 (81.3 per cent) male and three female children. Fourteen (87.5 per cent) were under 12 months of age. Three siblings with EH were seen in one family. All but three of the 16 recovered over time without medical or surgical intervention. These three needed cerebral decongestants in the acute phase.
Collapse
Affiliation(s)
- K Roshan
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | | | | | | | | | | |
Collapse
|
47
|
Affiliation(s)
- V Sitaram
- Department of Surgery, Christian Medical College and Hospital, Vellore, India
| | | | | | | | | | | |
Collapse
|
48
|
Chacko RT, Chacko A. Serum & muscle magnesium in Indians with cirrhosis of liver. Indian J Med Res 1997; 106:469-74. [PMID: 9415743] [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: 02/05/2023] Open
Abstract
Magnesium status of Indian patients with cirrhosis of liver (alcoholic and non alcoholic) and the role of low magnesium in neuromuscular and neuropsychiatric manifestations of chronic liver disease were evaluated in 76 male cirrhotics (alcoholic 37, aged 48 +/- 11 yr, non alcoholic 39, aged 47 +/- 12 yr) and 37 male controls (aged 49 +/- 11 yr). Serum magnesium levels were similar in the 3 groups studied. Muscle magnesium in both groups of cirrhotics were significantly lower than in controls (alcoholic cirrhosis 33.77 +/- 16.85; non alcoholic cirrhosis 37.93 +/- 18.86 and controls 70.52 +/- 6.49 mEq/kg fat free dry mass; P < 0.001). Multiple regression analysis comparing muscle magnesium with clinical and biochemical parameters in cirrhosis showed that hepatic encephalopathy was associated significantly and independently with low muscle magnesium (Beta = -0.313; P = 0.01). These results indicate that patients with cirrhosis have significantly lower muscle magnesium than controls and suggests that low muscle magnesium may be a factor associated with or precipitating hepatic encephalopathy.
Collapse
Affiliation(s)
- R T Chacko
- Department of Medicine, Christian Medical College & Hospital, Vellore
| | | |
Collapse
|
49
|
Chacko A, Samal SC, Pulimood A. Tracheo-bronchial remnants: a rare cause of dysphagia. Indian J Gastroenterol 1997; 16:159-60. [PMID: 9357197] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A 14-year-old girl presented with dysphagia since the age of one year. Investigations revealed two strictures at the lower esophagus. Endoscopic mucosal biopsy from the strictures showed pseudostratified columnar epithelium suggesting that tracheobronchial remnants was the cause of the stenosis. Esophageal dilatation failed to relieve her symptoms.
Collapse
Affiliation(s)
- A Chacko
- Department of Gastrointestinal Sciences, Christian Medical College and Hospital, Vellore
| | | | | |
Collapse
|
50
|
Abstract
Nutritional support is an important aspect of the management of burn patients. Nutrition supplementation can be achieved either by 'hospital-made' or 'commercial' diets. Commercial diets are efficacious but expensive and sometimes not easily available. This study was undertaken to compare the efficacy and tolerance of a hospital-made diet with a commercial diet. Twenty patients with burns ranging from 20-50 per cent TBSA were studied to compare the efficacy and tolerance of the 'hospital-made' diet with 'commercial' preparations. Patients were divided into two groups of 10 each and randomised within each group to receive either a hospital-made diet (five patients) or a commercial diet (five patients). Efficacy of diet was assessed by evaluation of nutritional status, graft take, number of surgical procedures and duration of hospital stay. Tolerance was assessed by recording side effects such as nausea, vomiting, abdominal distention and diarrhoea. Both diets were well tolerated by all patients. There was no significant difference in nutritional status, number of surgical procedures, percentage of graft take and duration of hospital stay on either diet, suggesting that hospital-made diets are similar in efficacy and tolerance but cheaper and more easily available. They are a good alternative to 'commercial' diets, especially in poor patients.
Collapse
Affiliation(s)
- P Dhanraj
- Department of Plastic and Reconstructive Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | | | | | | |
Collapse
|