1
|
Correlation of severity & clinical outcomes of COVID-19 with virus variants: A prospective, multicentre hospital network study. Indian J Med Res 2024; 159:91-101. [PMID: 38344919 PMCID: PMC10954099 DOI: 10.4103/ijmr.ijmr_1041_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND OBJECTIVES The clinical course of COVID-19 and its prognosis are influenced by both viral and host factors. The objectives of this study were to develop a nationwide platform to investigate the molecular epidemiology of SARS-CoV-2 (Severe acute respiratory syndrome Corona virus 2) and correlate the severity and clinical outcomes of COVID-19 with virus variants. METHODS A nationwide, longitudinal, prospective cohort study was conducted from September 2021 to December 2022 at 14 hospitals across the country that were linked to a viral sequencing laboratory under the Indian SARS-CoV-2 Genomics Consortium. All participants (18 yr and above) who attended the hospital with a suspicion of SARS-CoV-2 infection and tested positive by the reverse transcription-PCR method were included. The participant population consisted of both hospitalized as well as outpatients. Their clinical course and outcomes were studied prospectively. Nasopharyngeal samples collected were subjected to whole genome sequencing to detect SARS-CoV-2 variants. RESULTS Of the 4972 participants enrolled, 3397 provided samples for viral sequencing and 2723 samples were successfully sequenced. From this, the evolution of virus variants of concern including Omicron subvariants which emerged over time was observed and the same reported here. The mean age of the study participants was 41 yr and overall 49.3 per cent were female. The common symptoms were fever and cough and 32.5 per cent had comorbidities. Infection with the Delta variant evidently increased the risk of severe COVID-19 (adjusted odds ratio: 2.53, 95% confidence interval: 1.52, 4.2), while Omicron was milder independent of vaccination status. The independent risk factors for mortality were age >65 yr, presence of comorbidities and no vaccination. INTERPRETATION CONCLUSIONS The authors believe that this is a first-of-its-kind study in the country that provides real-time data of virus evolution from a pan-India network of hospitals closely linked to the genome sequencing laboratories. The severity of COVID-19 could be correlated with virus variants with Omicron being the milder variant.
Collapse
|
2
|
Comparative Evaluation of Various Lens and Ring Flash Combination for Intraoral Photography. Niger J Clin Pract 2023; 26:1800-1807. [PMID: 38158345 DOI: 10.4103/njcp.njcp_120_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/28/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Extraoral and intraoral dental photographs serve as preoperative records and document the entire treatment. Correctly composed orthodontic photographs are crucial for remote diagnosis and may serve as a bulwark against medicolegal challenges. MATERIALS AND METHODS In this prospective study, intraoral frontal photographs of patients with ideal occlusion were taken using two types of lenses (EF-S 18-55 mm f/3.5-5.6 IS STM lens (Canon, Tokyo, JP), SP 90 mm F/2.8 MACRO VC lens (Model F017 Tamron, NY, USA)) and two different ring flash systems (Meike FC-100 Macro Ring LED Light (Meike, China), Macro Ring flash Lite YN-14EX (Yongnuo digital, China)). The combination of lens and flash used was grouped into four groups. Twenty-eight intraoral photographs of patients were taken. An image quality assessment survey was distributed among two groups - 50 orthodontists and 50 other dental specialists. RESULTS The participants were asked to assess all the intraoral images and subjectively score them on a scale of one to ten, with one being very poor and ten being excellent, considering the sharpness, color, brightness, contrast, and overall quality of the image. The general dentists rated the images taken with a 90-mm macro lens and ring flash as the best quality photographs. Images obtained using an 18-55 mm lens and ring LED received significantly lesser scores and were graded good by dentists. CONCLUSION This combination of lens and flash may prove a valuable investment in the long-term aiding in excellent dental images for diagnosis and treatment monitoring.
Collapse
|
3
|
Postpartum Pulmonary-Renal Syndrome with Thrombotic Microangiopathy in Systemic Lupus Erythematosus. Indian J Nephrol 2023; 33:128-131. [PMID: 37234428 PMCID: PMC10208545 DOI: 10.4103/ijn.ijn_78_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 11/04/2022] Open
Abstract
Postpartum pulmonary syndrome as lupus flares in inactive or mild lupus is uncommon. The diagnosis and management of postpartum lupus flare in second pregnancy presenting with crescentic lupus nephritis (LN), secondary thrombotic microangiopathy (TMA), and severe lupus vasculitis in an undiagnosed systemic lupus erythematosus is extremely challenging. Here, in this case report, we present a young lady who presented with postpartum acute kidney injury (AKI) with systemic complaints about 4 weeks post-term uneventful delivery. Renal biopsy was suggestive of crescentic LN with severe lupus vasculitis. The stormy course was further complicated with diffuse alveolar hemorrhage, portal venous thrombosis, TMA, and anuric AKI requiring renal replacement therapy. She received multiple sessions of plasmapheresis, steroid, intravenous immunoglobulin, inj. cyclophosphamide, and started showing improvement after about 6 weeks of presentation.
Collapse
|
4
|
Specialized pro-resolving lipid mediators regulate inflammatory macrophages: A paradigm shift from antibiotics to immunotherapy for mitigating COVID-19 pandemic. Front Mol Biosci 2023; 10:1104577. [PMID: 36825200 PMCID: PMC9942001 DOI: 10.3389/fmolb.2023.1104577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
The most severe clinical manifestations of the horrifying COVID-19 disease, that claimed millions of lives during the pandemic time, were Acute respiratory distress syndrome (ARDS), Coagulopathies, septic shock leading eventually to death. ARDS was a consequence of Cytokine storm. The viral SARS-COV2infection lead to avalanche of cytokines and eicosanoids causing "cytokine storm" and "eicosanoid storm." Cytokine storm is one of the macrophage-derived inflammatory responses triggered by binding of virus particles to ACE2 receptors of alveolar macrophages, arise mainly due to over production of various pro-inflammatory mediators like cytokines, e.g., interleukin (IL)-1, IL-2, and tumor necrosis factor (TNF)- α, causing pulmonary edema, acute respiratory distress, and multi-organ failure. Cytokine storm was regarded as the predictor of severity of the disease and was deemed one of the causes of the high mortality rates due to the COVID-19. The basis of cytokine storm is imbalanced switching between an inflammation increasing - pro-inflammatory (M1) and an inflammation regulating-anti-inflammatory (M2) forms of alveolar macrophages which further deteriorates if opportunistic secondary bacterial infections prevail in the lungs. Lack of sufficient knowledge regarding the virus and its influence on co-morbidities, clinical treatment of the diseases included exorbitant use of antibiotics to mitigate secondary bacterial infections, which led to the unwarranted development of multidrug resistance (MDR) among the population across the globe. Antimicrobial resistance (AMR) needs to be addressed from various perspectives as it may deprive future generations of the basic health immunity. Specialized pro-resolving mediators (SPMs) are generated from the stereoselective enzymatic conversions of essential fatty acids that serve as immune resolvents in controlling acute inflammatory responses. SPMs facilitate the clearance of injured tissue and cell debris, the removal of pathogens, and augment the concentration of anti-inflammatory lipid mediators. The SPMs, e.g., lipoxins, protectins, and resolvins have been implicated in exerting inhibitory influence on with cytokine storm. Experimental evidence suggests that SPMS lower antibiotic requirement. Therefore, in this review potential roles of SPMs in enhancing macrophage polarization, triggering immunological functions, hastening inflammation resolution, subsiding cytokine storm and decreasing antibiotic requirement that can reduce AMR load are discussed.
Collapse
|
5
|
“Rendezvous with Osler Weber Rendu” - Closure of Multiple Pulmonary Arteriovenous Malformations with Amplatzer Vascular Plug II in Hereditary Hemorrhagic Telangiectasia. Indian Heart J 2022. [DOI: 10.1016/j.ihj.2022.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
Enhanced heat transfer characteristics of the mini hexagonal tube heat sink using hybrid nanofluids. NANOTECHNOLOGY 2022; 33:475403. [PMID: 35970140 DOI: 10.1088/1361-6528/ac8995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
The thermal performance of different hybrid nanofluids on the mini hexagonal tube heat sink has been investigated experimentally. Al2O3/SiO2-DIW, Al2O3/CuO-DIW, and CuO/SiO2-DIW nanofluids have been used as the working fluids. The aggregate of 0.01 volume fraction of Al2O3, CuO, and SiO2nanoparticles for hybridizing ratios (80:20) has been considered to prepare deionized water-based hybrid nanofluids. The thermal performance of three different hybrid nanofluids inside the mini hexagonal tube heat sink has been assessed. The varying volumetric flow rates of 15-50 lph have been maintained on the hexagonal tube side and 50 lph on the mini passage side. Herein, the proposed hexagonal-shaped heat sink provides a larger heat contact surface to exchange the heat between the hybrid nanofluids and hot DIW. It is divulged that the increase in the volume flow rate of nanofluids promotes the higher Brownian motion, leading to an increase in convective heat transfer. Amongst three hybrid nanofluids, CuO/SiO2-DIW nanofluids have revealed a slight increase in pumping power while increasing the volume flow rate. From the experimental results, it is shown that the heat transfer coefficient, effectiveness, and Nusselt number have been improved by 54.5%, 42%, and 28.4%, respectively, for Al2O3/CuO-DIW nanofluids. Thus, Al2O3/CuO-DIW nanofluid can be deemed to be an efficient working fluid for the miniature heat sinks to accelerate the heat transfer rates.
Collapse
|
7
|
003 A case of SARS-CoV-2 Omicron variant associated acute encephalomyelitis. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With the ongoing pandemic of SARS-CoV-2 many neurological complications in relation to COVID-19 infection as well as immune-mediated and vaccine-associated phenomena have been described. To our knowledge, there has been no publication of a case of SARS-CoV-2 Omicron variant associated acute encephalomyelitis.We present a case of a 73-year-old woman with no relevant background history who is otherwise fit and well and fully vaccinated. She suffered from mild COVID symptoms and had a positive PCR test with presumptive Omicron variant on day 2. Five days into her respiratory illness she developed in quick suc- cession sensory disturbances of hands and feet, bilateral asymmetric flaccid leg weakness, and mild arm weakness. She had absent deep tendon reflexes in the legs and diminished deep tendon reflexes in the right arm. MRI of brain and spine showed signal changes in the brainstem, cervical and low thoracic cord in keeping with acute encephalomyelitis. Her CSF showed an inflammatory picture with raised protein of 1.27g/L and no cells. At the time of abstract submission, the patient received treatment with five days of intravenous steroids followed by ongoing plasma exchange and no comment on treatment response can be made at this stage.
Collapse
|
8
|
168 Asymptomatic dengue illness complicated by Guillain Barre syndrome. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Arboviral infection Dengue can cause a spectrum of disease varying from asymptomatic illness to dengue fever to the severe dengue hemorrhagic fever. Neurological complications are rarely reported in the lit- erature (0.5–6%), mostly from dengue-endemic areas in tropics and subtropical regions. We report a case of a 59-year-old man who returned from a recent work-related travel from India. Three weeks following a mild viral prodrome, he developed bilateral lower motor neuron facial palsy with absent deep tendon reflexes. CSF showed albuminocytologic dissociation and electrophysiological studies showed demyeli- nating neuropathy. Routine GBS screen for common etiological viruses was negative and subsequently additional testing based on recent travel was performed which showed positive Dengue IgM and RNA in serum. The patient was treated with plasma exchange for 5 days and his facial weakness improved to a great extent.This case demonstrates the importance of considering arboviral infections such as Dengue in patients with GBS particularly in people living in or travelling from endemic areas. Additionally, like many other viral illnesses, there may not be clear clinical evidence of Dengue fever and the prodrome may go unnoticed and undiagnosed, hence a high index of suspicion is required.s_hasan_s@yahoo.com
Collapse
|
9
|
162 Cracking the NORSE code. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This 32 year old Irish traveller presented initially with tremor in his left hand. Blood tests and imaging at the time were unremarkable and he was treated with Botox and Gabapentin to some benefit. Three months later this gentleman presented with status epilepticus requiring intubation and ventilation. Despite escalat- ing anti-epileptic agents in addition to anaesthetic agents he remained in non-convulsive status with an EEG focus in the right temporal-occipital region. MRI showed left posterior parietal, right parietal-occipital and bilateral thalamic signal hyper-intensity. Routine investigations including autoimmune antibodies were unremarkable except for a raised CSF protein and CSF lactate. Crucially, the family later disclosed an extensive family history of epilepsy, including the patient’s niece and nephew, who were both POLG-1 mutation A467T homozygotes. Following initial genetic screening we found our patient to be a POLG-1 mutation A467T heterozygote, which interestingly should not be pathological. Further detailed genetic screening later revealed he was also a POLG-1 W748S heterozygote. As a compound heterozygote this can lead to destabilisation of the linker region of the POLG-1 gene and result in disease, typically causing death in infancy. This gentleman unfortunately remained in non-convulsive status epilepticus despite maximum drug and adjuvant treatments and was subsequently palliated.Laura.midgley1@nhs.net
Collapse
|
10
|
Abstract
A 65 year old lady presented with a one week history of chorea, dysarthria, behaviour change and imbalance. Her condition continued to progress with development of a motor axonal polyneuropathy, affecting mainly the distal upper limbs, and encephalopathy, with a Glasgow Coma Score (GCS) of 6.MRI head revealed non-specific white matter changes in the cerebral hemispheres. EEG showed a slow background and bifrontal triphasic waves. CSF testing revealed a lymphocytic pleocytosis (34/mm3) with elevated protein (0.88g/L). Extensive microbiological, genetic and autoimmune screening was negative other than positive IgLON5 antibodies (titre 1:1000).Treatment with intravenous methylprednisolone appeared to be unhelpful, however, plasma exchange was associated with resolution of the encephalopathy and distal upper limb weakness. Intravenous cyclophosphamide was given followed by oral mycophenolate. The patient remains clinically stable at one year after onset.Anti-IgLON5 disease is typically characterised by central nervous system involvement (sleep disturbance, chorea, gait imbalance and bulbar features) and an uncertain response to treatment. We have presented a case of this rare condition, unusual on account of the peripheral involvement (motor axonal polyneu- ropathy), and apparent improvement with immunosuppression.Laura.midgley1@nhs.net
Collapse
|
11
|
036 A rare subtype of a rare type of stroke – sulcal artery syndrome. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 78 year old man was woken from sleep by a sudden excruciating neck pain. The pain was accompa- nied by left arm and leg weakness and paraesthesia which progressed to maximum intensity over hours. His past medical history was significant for ischaemic heart disease and type 2 diabetes. On examination there was an incomplete Brown-Sequard syndrome localising to the left hemicord. MRI of the cervical spine showed intramedullary T2 hyperintensity and restricted diffusion in the left hemicord at C2-C3 level. CT angiogram of the vertebral arteries excluded dissection.We diagnosed acute spinal cord infarction due to a sulcal artery occlusion, and treated with antiplatelets and secondary stroke prevention. The neurological deficit improved significantly over the following days.Spinal cord strokes are diagnostic challenges and account for only 1.25% of all strokes. Sulcal artery syndrome is a rare cause of spinal cord infarction, involving the territory of the sulcal arteries, which are paired penetrating branches of the anterior spinal artery and perfuse the anterior two-thirds of half the spinal cord. An acute onset with pain is an important clue - otherwise the hemi-distribution and short segment of signal change may be misdiagnosed as an inflammatory lesion.myatwin@nhs.net43
Collapse
|
12
|
098 Guillain Barré syndrome (GBS) – like presentation as a first clinical manifestation of non-Hodgkin’s lymphoma. Journal of Neurology, Neurosurgery and Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A variety of peripheral nerve disorders can be seen in association with lymphomas. We present a case of a 68-year-old female who presented with ten days history of rapid onset ascending paresthesias followed by unsteadiness. Neurological examination was remarkable for truncal ataxia with wide-based gait, large fiber sensory impairment (proprioception/vibration). There was some evidence of autonomic instability given labile blood pressure and tachycardia. MRI head and spine were unremarkable, as was the CSF. She was initially treated as acute ataxic variant of GBS with IVIG; however, there was continued clinical deterioration. Electrophysiology three weeks after symptom onset showed minimally delayed F waves, with normal sensory and motor NCS. Nerve Ultrasound revealed pronounced enlargement of C6 nerve root which was confirmed later with MRI of brachial plexus showing thickening and some enhancement of roots and trunks. Subsequent CT CAP and PET scan showed mediastinal, hilar and supraclavicular lymphadenopathy, though no PET uptake in the region of dorsal root ganglion. Biopsy of the right supra- clavicular node was consistent with an anaplastic large cell lymphoma.Atypical presentations of acute neuropathy can be attributed to GBS; however, they should include evalu- ation of a paraneoplastic process which can have similar acute presentations. This case also demonstrates the importance of nerve ultrasound which can be significantly abnormal in sensory neuronopathy with relatively normal electrophysiological testing.s_hasan_s@yahoo.com
Collapse
|
13
|
Pharmacogenetic variants influence vitamin K anticoagulant dosing in patients with mechanical prosthetic heart valves. Pharmacogenomics 2022; 23:475-485. [PMID: 35608144 DOI: 10.2217/pgs-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Vitamin K antagonists (VKAs) are class I oral anticoagulants that are widely prescribed following surgical heart valve implantation. The objective of this study was to quantify the relative effects of VKORC1, CYP2C9 and CYP4F2 genotypes in predicting VKA dosing. Materials & methods: A total of 506 South Indian patients with mechanical prosthetic heart valves who were prescribed oral VKAs, such as warfarin or acenocoumarol, were genotyped. The discriminatory ability of mutant genotypes to predict dose categories and bleeding events was assessed using regression analysis. Results: The VKORC1 rs9923231, CYP2C9*3 and CYP4F2*3 mutant genotypes significantly influenced VKA-dose requirements and explained 27.47% of the observed dose variation. Conclusion: These results support pharmacogenetic screening for initial VKA dosing among South Indian patients with mechanical prosthetic heart valves.
Collapse
|
14
|
Current Status and Barriers in Pulmonary Hypertension Care Delivery in India: A Qualitative Analysis. Pulm Circ 2022; 12:e12094. [PMID: 35770278 PMCID: PMC9210552 DOI: 10.1002/pul2.12094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Although pulmonary hypertension (PH) is widely prevalent in India, care delivery for this condition has unique challenges in a lower middle‐income country (LMIC). To describe care delivery for patients with PH and associated barriers in India. We interviewed physicians across eight healthcare systems in India about PH clinical care using semi‐structured enquiries to understand care delivery and associated challenges in their specific practice as well as the associated health system. Qualitative analysis was performed using content analysis methodology. Physicians reported that common causes for PH in their practice were rheumatic mitral valve disease, coronary artery disease, and congenital heart disease (CHD). No center had a dedicated PH program. Only one center had a specific protocol for PH management. Diagnostic evaluations were limited, and right heart catheterizations were recommended for patients with CHD. Pulmonary vasodilator therapy was used for severe symptoms or markers of severe disease. Agents used to treat PH were widely variable across physicians and prostacyclins are unavailable in India. Barriers included limited training in PH for physicians, lack of consensus guidelines for PH specific to LMIC, and lack of financial incentives for health care systems to organize dedicated PH programs. Other barriers included poor patient health literacy and socioeconomic barriers that limit ability to test and treat PH. PH care delivery in India is variable with widely differing clinical practices. Dedicated training in PH management and establishing guidelines specific to LMIC like India can form the first step forward.
Collapse
|
15
|
Prevalence, Awareness, Treatment, and Control of Hypertension in Young Adults (20-39 Years) in Kerala, South India. Front Cardiovasc Med 2022; 9:765442. [PMID: 35509277 PMCID: PMC9058086 DOI: 10.3389/fcvm.2022.765442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to study the prevalence of hypertension and the levels of awareness, treatment and control of hypertension in the young adults in Kerala, India compared to older adults. Methods We identified 1,221 young adults (men 36.7%) in the age group 20-39 years from the 5,150 participants of the Cardiological Society of India Kerala Coronary artery disease (CAD) and its Risk factors Prevalence (CSI Kerala CRP) Study. We determined prevalence and levels of awareness, treatment and control of hypertension among them compared to older adults. Results We found that among the young adults, 11.2% had hypertension and 33.3% had prehypertension. Hypertension was nearly three times more prevalent among men than women (20.5 vs. 7.5% p < 0.001) while in older adults there was no difference between men and women in its prevalence. Male sex (OR 3.36, 95% CI 2.15-5.25 p-value <0.001), urban residence (OR 2.21, 95% CI 1.52-3.22 p-value <0.001), abdominal obesity (OR 1.74, 95% CI 1.06-2.87 p-value 0.028) and hypercholesterolemia (OR 1.64 95% CI 1.12-2.40 p-value 0.011) were significant factors favoring hypertension in the young adults. Awareness and treatment of hypertension were significantly poor among younger adults compared to older adults. In young adults, awareness, treatment and control of hypertension were significantly lower among men compared to women (23.9 vs. 51.7% p-value 0.001, 12.0 vs. 25.9% p-value 0.045, and 18.5 vs. 37.9% p-value 0.012, respectively). Participants who had checked blood pressure at least once during the previous year had significantly better awareness and treatment (58.7 vs. 24.0% and 41.3 vs. 19.2%, respectively). Conclusions We found that one eighth of young subjects had hypertension with three times higher prevalence of hypertension among men compared to women. Awareness, treatment and control of hypertension were less among young adults and worse in young men compared to young women. Identifying hypertension and measures to control it are important and should be specifically targeted to young men.
Collapse
|
16
|
Clinico-epidemiological profile and outcomes of adults with COVID-19: A hospital-based retrospective study in Kerala, India. J Family Med Prim Care 2022; 11:3000-3005. [PMID: 36119227 PMCID: PMC9480700 DOI: 10.4103/jfmpc.jfmpc_2273_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: The clinical and epidemiological presentations of patients with coronavirus disease 2019 (COVID-19) in India is still not well explored. We studied the epidemiological and clinical profile and outcomes of COVID-19 patients admitted to a tertiary care private hospital in Kerala, India. Methods: In this retrospective study, we analyzed data of 476 adult (≥18 years) COVID-19 patients admitted to a tertiary care hospital in Kerala from September 1, 2020 to March 31, 2021. The patients were categorized into mild, moderate, and severe cases and followed till discharge or death. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 23.0 with a significance set at P < 0.05. Results: The median age was 57 years (56% men). Mild, moderate, and severe cases accounted for 17%, 65%, and 18%, respectively. Around 75% had at least one comorbidity, and 51% had multiple comorbidities. The most common comorbidities were diabetes (45%), hypertension (44%), dyslipidemia (15%), and cardiac problems (12%). The elevated D-dimer values among patients in different categories were significantly different, with 74% in severe, 46% in moderate, and 19% in mild category patients. Serum ferritin, C-reactive protein, lactic acid dehydrogenase, and neutrophil to lymphocyte ratio values were significantly higher for severely ill patients. Thirty deaths (67% men) occurred during the study period, with a case fatality rate of 6.3%. Mortality mainly happened in the older age group (80%) and those with multimorbidity (90%). Conclusion: Age and multimorbidity are the major contributing factors for death in hospitalized COVID-19 patients. Generalization of the findings necessitates well-designed large-scale studies.
Collapse
|
17
|
Ascending aortic dissecting aneurysm with rupture into the right atrium associated with COVID-19. J Postgrad Med 2022; 68:117-119. [PMID: 35417997 PMCID: PMC9196298 DOI: 10.4103/jpgm.jpgm_903_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
18
|
Two cases of adult-onset de novo immunoglobulin A vasculitis with nephritis: Post-Covishield (ChAdOx1 nCoV-19; Oxford–Astra Zeneca) vaccination. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_85_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
19
|
Development and validation of a mobile application based on a machine learning model to aid in predicting dosage of vitamin K antagonists among Indian patients post mechanical heart valve replacement. Indian Heart J 2022; 74:469-473. [PMID: 36243102 PMCID: PMC9773288 DOI: 10.1016/j.ihj.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Patients who undergo heart valve replacements with mechanical valves need to take Vitamin K Antagonists (VKA) drugs (Warfarin, Nicoumalone) which has got a very narrow therapeutic range and needs very close monitoring using PT-INR. Accessibility to physicians to titrate drugs doses is a major problem in low-middle income countries (LMIC) like India. Our work was aimed at predicting the maintenance dosage of these drugs, using the de-identified medical data collected from patients attending an INR Clinic in South India. We used artificial intelligence (AI) - machine learning to develop the algorithm. A Support Vector Machine (SVM) regression model was built to predict the maintenance dosage of warfarin, who have stable INR values between 2.0 and 4.0. We developed a simple user friendly android mobile application for patients to use the algorithm to predict the doses. The algorithm generated drug doses in 1100 patients were compared to cardiologist prescribed doses and found to have an excellent correlation.
Collapse
|
20
|
Pulmonary Hypertension Registry of Kerala, India (PRO-KERALA): One-year outcomes. Indian Heart J 2021; 74:34-39. [PMID: 34919965 PMCID: PMC8891004 DOI: 10.1016/j.ihj.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/11/2021] [Accepted: 12/04/2021] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Short term outcomes of patients with pulmonary hypertension are not available from low and middle-income countries including India. METHODS We conducted a prospective study of 2003 patients with pulmonary hypertension, from 50 centres (PROKERALA) in Kerala, who were followed up for one year. Pulmonary hypertension (PH) was mainly diagnosed on the basis of Doppler echocardiography. The primary outcome was a composite end-point of all-cause death and hospital admission for heart failure. All cause hospitalisation events constituted the secondary outcome. RESULTS Mean age of study population was 56 ± 16 years. Group 1 and Group 2 PH categories constituted 21.2% and 59% of the study population, respectively. Nearly two-thirds (65%) of the study participants had functional class II symptoms. 31% of Group 1 PH patients were on specific vasodilator drugs.In total, 83 patients (4.1%) died during the one-year follow-up period. Further, 1235 re-hospitalisation events (61.7%) were reported. In the multivariate model, baseline NYHA class III/IV (OR 1.87, 95% C.I. 1.35-2.56), use of calcium channel blockers (OR 0.18, 95% C.I. 0.04-0.77), vasodilator therapy (OR 0.5, 95% C.I. 0.28-0.87) and antiplatelet agents (OR 1.80, 95% C.I. 1.29-2.51) were associated with primary composite outcome at one-year (p < 0.05). CONCLUSION In the PROKERALA registry, annual mortality rate was 4%. More than half of the patients reported re-hospitalisation events on follow up. Uptake of guideline directed therapies were suboptimal in the study population. Quality improvement programmes to improve guideline directed therapy may improve clinical outcomes of PH patients in India.
Collapse
|
21
|
Shock Wave Behaviour of Polymeric Materials for Detonation Waveshapers. DEFENCE SCI J 2021. [DOI: 10.14429/dsj.71.16943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper discusses the experimental determination of explosive shock attenuation parameters of four different polymers viz., Teflon, Phenol formaldehyde, Polyethylene foam and Polypropylene foam. These polymers are candidate materials for waveshapers in shaped charge warheads. Cylindrical specimens of the polymer materials were subjected to explosive shock loading by the detonation of RDX:Wax (95:5). Shock arrival time was measured using piezo-wafers positioned at known spatial intervals in the specimens. Initial shock velocity, stabilised shock velocity and attenuation constant were determined. These parameters are essential for the design of waveshapers. Foams have better shock attenuating properties compared to solids due to their cellular structure. Polypropylene foam has the highest shock attenuating characteristic among the four materials studied.
Collapse
|
22
|
A Numerical Study of Penetration in Concrete Targets by Eroding Projectiles of Different Materials. DEFENCE SCI J 2021. [DOI: 10.14429/dsj.71.16942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Numerical simulations have been performed to examine the effect of three different eroding rod materials on the penetration in concrete targets. Same kinetic energy is delivered to concrete target using cylindrical rods of Aluminium, Iron, and Copper of identical size. Impact velocities have been varied to keep the kinetic energy the same. Penetration characteristics like centerline interface velocity, penetrator deceleration, plastic strain in the target, and energy partitioning during penetration have been studied for the three different penetrator materials. In all three cases, penetration proceeds nearly hydrodynamically. It is seen that even though the steady-state penetration ceases before reaching the hydrodynamic limit, the secondary penetration takes the total penetration beyond the hydrodynamic value. Plastic strain in the target material is a measure of damage beyond the crater produced by penetration. The lateral extent of plastic strain in target is more for Aluminium penetrator compared to the other two. Energy partitioning during penetration provides details of the rate at which energy is entering into the target. Kinetic energy delivered to the target during impact is partitioned into internal energy and kinetic energy of the target. Finally, the influence of target thickness on the extent of plastic strain has been studied. The result shows that Aluminium penetrators inflict maximum damage to targets of finite thickness.
Collapse
|
23
|
Development of portable, non-destructive freshness indicative sensor for Indian Mackerel (Rastrelliger kanagurta) stored under ice. J FOOD ENG 2020. [DOI: 10.1016/j.jfoodeng.2020.110132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
24
|
Immediate and long term outcomes of balloon mitral valvotomy in juvenile mitral stenosis in comparision with adult mitral stenosis. Indian Heart J 2020. [DOI: 10.1016/j.ihj.2020.11.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
25
|
Cardiological society of India position statement on COVID-19 and heart failure. Indian Heart J 2020; 72:75-81. [PMID: 32405088 PMCID: PMC7219407 DOI: 10.1016/j.ihj.2020.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
|
26
|
Abstract
Aim: The role of mirSNPs in the 3'UTR of VKORC1, CYP2C9 and CYP4F2 genes that could influence warfarin dose variability via a discrete miRNA-mediated mechanism remains unexplained. Methods: Genotypic data in the 1000 Genomes dataset were analyzed for pair-wise linkage disequilibrium and allelic enrichment. Results: MirSNP rs7294 in the 3'UTR of VKORC1 gene displayed varying strengths of linkage disequilibrium with rs9923231 and rs9934438 across populations, albeit consistently associated with higher warfarin dose requirements based on genome-wide association studies, meta-analysis and population-based association studies. In silico analysis predicted altered hybrid stability for the hsa-miR-133a-3p conserved binding site, providing evidence for miRNA-mediated gene regulation. Conclusion: The results support the inclusion of rs7294 as a functional variable for population-specific dosing algorithms to improve dosing accuracy.
Collapse
|
27
|
Congenital extrahepatic portosystemic shunt with progressive myelopathy and encephalopathy. Pract Neurol 2019; 19:368-371. [PMID: 31048365 DOI: 10.1136/practneurol-2018-002111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/03/2019] [Accepted: 03/10/2019] [Indexed: 11/04/2022]
Abstract
Portosystemic encephalopathy commonly occurs in patients with portal hypertension caused by end-stage liver disease or portal vein thrombosis. Congenital extrahepatic portosystemic shunt (CEPS) is an underdiagnosed and treatable condition that can cause encephalopathy and various neuropsychiatric symptoms. We report an unusual case of type 2 CEPS in a 29-year-old woman who presented with progressive myelopathy and fluctuating encephalopathy on a background of congenital cardiac disease. Investigations showed hyperammonaemia, and despite no evidence of portal hypertension on ultrasound imaging, CT scan of abdomen showed a shunt between the mesenteric and left internal iliac veins. Patients with unexplained fluctuating or progressive neuropsychiatric symptoms should have their serum ammonia checked. A raised serum ammonia concentration without known portal hypertension should prompt further investigations for extrahepatic shunts.
Collapse
|
28
|
Infective endocarditis due to Streptococci and Enterococci: A 3-year retrospective study. INDIAN J PATHOL MICR 2019; 61:545-548. [PMID: 30303145 DOI: 10.4103/ijpm.ijpm_205_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Infective endocarditis (IE) is an infection of the heart valves with an aggregation of bacteria in a fibrin plaque called vegetation. Aims and Objectives This is a retrospective study of all infective endocarditis cases due to alpha haemolytic streptococci and enterococci. Methods All cases of infective endocarditis cases due to alpha haemolytic streptococci and enterococci in a period of three years from 1st January 2010 to 31st December 2012 were included. Isolation of the same organism from more than one set of blood cultures was taken as a confirmed case of infective endocarditis. Clinical and serological parameters were recorded using a proforma. Results Native valve endocarditis was more common with only five prosthetic valves being involved. Out of 89 clinically suspected cases of IE in the three years from Jan 2010 to Dec 2012, for which blood was sent for culture, 63(70.78%) samples were positive by culture. Of these, 42/63(66.66%) were due to alpha-lytic Streptococci, enterococci and rare gram positive cocci. The rare ones included Enterococcus gallinarum, abiotropha defective, Vagococcus fluvialis and Nutritionally Variant Streptococci(NVS). High level Aminoglycoside resistance(HLAR) was also encountered. The varied and important features of these isolates are discussed. Complications and treatment are described. Conclusion From a clinical microbiology point of view, the major challenge faced by the microbiologist in diagnosis of IE is proper aseptic collection of sample before starting antibiotics with a need for multiple samples to detect and also to prove the causative organism. Sensitivity reporting can be a difficult task in the context of NVS, HLAR and gram positives that are slow growing. Congestive failure and embolisation occurs even when the antibiotic treatment is successful.When patients go in for complications, it is very rarely due to wrong antibiotics.
Collapse
|
29
|
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare neurological condition infrequently associated with dysphagia on initial presentation. We describe the case of a 54-year-old woman who presented multiple times to healthcare professionals with severe vomiting, followed by sudden profound dysphagia. Her diagnosis was elusive, initially attributed to achalasia cardia and subsequently to stroke. A dorsal medullary lesion was revealed on MRI of the brain, which involved and extended beyond the area postrema. The patient required percutaneous gastrostomy, and repeated aspiration pneumonia complicated her clinical course. After aquaporin-4 antibodies returned positive, a diagnosis of NMOSD was made and she improved with immunosuppression. We discuss the process of lesion localisation and aetiology determination, as well as the difficulties that this case presented. Our hope is that this report will facilitate earlier diagnosis in similar cases in the future.
Collapse
|
30
|
Value of VKORC1 (-1639G>A) rs9923231 genotyping in predicting warfarin dose: A replication study in South Indian population. Indian Heart J 2018; 70 Suppl 3:S110-S115. [PMID: 30595241 PMCID: PMC6310074 DOI: 10.1016/j.ihj.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Warfarin is the most commonly prescribed oral anticoagulant, although having a narrow therapeutic index and wide interindividual variability. The aim of this study was to replicate the utility of VKORC1 (-1639G>A) rs9923231 genotyping in predicting the mean daily dose and to evaluate its ability to categorize warfarin-treated patients to high-, intermediate-, or low-dose categories in the South Indian population. MATERIALS AND METHODS A cohort of 222 warfarin-treated patients was genotyped using restriction fragment length polymorphism method. The influence of the rs9923231 polymorphism on the variations in the mean daily dose was compared using one-way analysis of variance and linear regression analysis. Discriminatory ability of the rs9923231 polymorphism to group the patients into ordered dose categories was assessed by estimating the proportional odds ratios using the ordered logit regression analysis. RESULTS The frequency of AA genotype and A allele in the study sample was found to be 1.8% and 9.23%, respectively, which was similar to reports from other South Indian populations. The mean daily dose required to achieve the optimum international normalized ratio was significantly lower in AA homozygous genotype carriers (3.99 ± 1.67 mg/day) and GA heterozygous (4.26 ± 1.57 mg/day) compared to the GG genotype carriers (5.51 ± 2.13 mg/day), p = 0.003. The A allele carriers (GA+AA genotypes) had a 3.23 higher odds of being grouped as a low-dose requiring category compared to non-carriers (95% CI 1.49-6.98, p = 0.003). CONCLUSIONS These preliminary results strongly support the use of VKORC1 (-1639G>A) rs9923231 polymorphism for genetically guided initial warfarin dosing in South Indian patients with heart valve replacements.
Collapse
|
31
|
Corrigendum to "Cardiological Society of India position statement on management of heart failure in India" [Indian Heart J 70 (S1) (2018) S1-S72]. Indian Heart J 2018; 70:952-953. [PMID: 30580876 PMCID: PMC6306345 DOI: 10.1016/j.ihj.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
32
|
Pulmonary hypertension registry of Kerala, India (PRO-KERALA) — Clinical characteristics and practice patterns. Int J Cardiol 2018; 265:212-217. [DOI: 10.1016/j.ijcard.2018.02.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/20/2017] [Accepted: 02/09/2018] [Indexed: 12/28/2022]
|
33
|
Adverse effects on macrophage lipid transport and survival by high density lipoprotein from patients with coronary heart disease. J Biochem Mol Toxicol 2018; 32:e22192. [PMID: 29992715 DOI: 10.1002/jbt.22192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 11/06/2022]
Abstract
High density lipoprotein (HDL)-macrophage interactions have the potential to modulate macrophage function in a beneficial way to prevent the development of lipid-loaded foam cell formation in atherosclerosis. Although HDL is atheroprotective, it can become dysfunctional in chronic inflammatory conditions and increase cardiovascular risk. Here, we examined the effect of dysfunctional-HDL from patients with coronary artery disease, on macrophage function in comparison to functional-HDL from controls. Exposure of macrophages to dysfunctional-HDL for 24 h resulted significant increase in cellular oxidative stress, cholesterol, and cytotoxicity. It also stimulated mitochondrial membrane depolarization, DNA damage, apoptosis, and cleavage of poly (ADP-ribose) polymerase, which are characteristics of proapoptotic pathways. In contrast, functional-HDL treatment maintained cholesterol homeostasis, essential membrane potential, DNA integrity, and cell survival. These results demonstrate that HDL from coronary artery disease (CAD) patient promotes proatherogenic effects that in turn trigger macrophage apoptosis, an important feature in atherogenesis and thereby providing new insight in our understanding of the atherogenic mechanisms.
Collapse
|
34
|
|
35
|
Kerala acute heart failure registry-Rationale, design and methods. Indian Heart J 2018; 70 Suppl 1:S118-S120. [PMID: 30122241 PMCID: PMC6097170 DOI: 10.1016/j.ihj.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/09/2018] [Indexed: 11/30/2022] Open
Abstract
Heart failure (HF) is recognized as a major public health problem in both the low and high- income countries. However, data are scarce on the burden, prevailing practice patterns and long-term health outcomes of HF patients in India. The Kerala heart failure registry (KHFR) is a multi-centric, prospective, and hospital based registry in Kerala, India. Consecutive patients admitted with the diagnosis of acute heart failure satisfying the European Society of Cardiology (ESC) criteria will be enrolled in the registry. Data on demographic, clinical, laboratory, imaging, other diagnostics and therapeutic approaches employed and the usage of guideline based medical therapy will be collected as part of the registry. Additionally, all registered patients will be followed-up regularly at 1-month, and thereafter at every 3-months. Both mortality and hospital admission data will be collected during the follow-up visits. We will be recruiting 7500 HF patients in the KHFR. Once completed, KFHR is going to be the largest HF registry in India. We will validate a HF mortality risk score developed based on a previously conducted Trivandrum Heart Failure Registry in the KHFR patients.
Collapse
|
36
|
Prevalence of metabolic syndrome and its risk factors in Kerala, South India: Analysis of a community based cross-sectional study. PLoS One 2018; 13:e0192372. [PMID: 29584725 PMCID: PMC5870937 DOI: 10.1371/journal.pone.0192372] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coronary Artery Disease (CAD) is a leading cause of death and disability in Kerala, India. Metabolic syndrome (MS) is a constellation of established risk factors for CAD. We aimed to estimate the prevalence of MS and evaluate the association between MS and CAD using a community-based sample population. METHODS A cross-sectional community based survey was conducted in urban and rural areas of Kerala in 2011. We included 5063 individuals for analysis. Age standardized prevalence of MS, associated diagnoses (hypertension, diabetes and hypercholesterolemia) and other potential risk factors were assessed for men and women in both urban and rural locations. Univariate and multivariate logistic regression models were developed to identify participant characteristics that are associated with MS. RESULTS After standardization for age and adjustment for sex and urban-rural distribution, the prevalence of metabolic syndrome in Kerala was 24%, 29% and 33% for the NCEP ATP III, IDF and AHA/NHLBI Harmonization definitions, respectively. The mean (SD) age of the participants was 51 (14) years, and 60% were women. Women had a higher prevalence of MS than men (28% versus 20% for ATP III, p<0.001). Similarly, participants living in urban areas had higher prevalence of MS than their rural counterparts (26% versus 22%, p<0.001). Elevated body mass index, older age, and female sex were associated with MS in an adjusted multivariate model. The propensity for definite CAD was 1.7 times higher in individuals with MS defined based on ATP III criteria compared to those without MS (Adjusted OR = 1.69; 95% CI: 1.3-2.2, p<0.001). CONCLUSIONS One of four to one of three adult individuals in Kerala have MS based on different criteria. Higher propensity for CAD in individuals with MS in Kerala calls for urgent steps to prevent and control the burden of metabolic conditions.
Collapse
|
37
|
Abstract
Glial fibrillary acidic protein antibody-positive meningoencephalomyelitis is a newly described, possibly under-recognised, severe inflammatory condition of the nervous system. The clinical presentation is variable but most commonly is a combination of meningitis, encephalitis and myelitis; other manifestations may include seizures, psychiatric symptoms and tremor. There is a significant association with malignancies, often occult, and with other autoimmune conditions. Although the disease responds well to corticosteroids acutely, it typically relapses when these are tapered, and so patients need long-term immunosuppression. We report a young man presenting with subacute meningoencephalitis and subsequent myelitis, and discuss the typical presentation and management of this severe but treatable condition.
Collapse
|
38
|
Abstract
Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient's quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.
Collapse
|
39
|
PO160 Atypical transverse myelitis in a patient with newly diagnosed hepatitis c: a case report and review of the literature. Journal of Neurology, Neurosurgery and Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
40
|
PO121 Continuous facial myokymia as the presenting symptom of multiple sclerosis. Journal of Neurology, Neurosurgery and Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
41
|
Lack of association of mirSNP rs11174811 in AVPR1A gene with arterial blood pressure and hypertension in South Indian population. Clin Exp Hypertens 2017; 40:534-538. [PMID: 29182374 DOI: 10.1080/10641963.2017.1403624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Epigenetic regulation of arterial blood pressure mediated through mirSNPs in renin-angiotensin aldosterone system (RAAS) genes is a less explored hypothesis. Recently, the mirSNP rs11174811 in the 3'UTR of the AVPR1A gene was associated with higher arterial blood pressure in a large study population from the Study of Myocardial Infarctions Leiden (SMILE). The aim of the present study was to replicate the association of mirSNP rs11174811 with blood pressure outcomes and hypertension in a south Indian population. Four hundred and fifteen hypertensive cases and 416 normotensive controls were genotyped using a 5' nuclease allelic discrimination assay. Logistic regression was used to test the association of mirSNP rs11174811 with the hypertension phenotype. Censored normal regression was used to test the association of the polymorphism with continuous blood pressure outcomes such as systolic and diastolic blood pressure. The mirSNP rs11174811 did not show any significant association with hypertension. The adjusted odds ratio was 1.02, with 95% CI of 0.72 to 1.45 (p = 0.909). The mean systolic and diastolic blood pressure values were not significantly different across the three genotypic groups, between hypertensives and normotensives, or when stratified by gender. Despite having a similar minor allele frequency (MAF) of 14.5% compared with the SMILE cohort, our results did not support an association of the mirSNP rs11174811 with the hypertension phenotype or with continuous blood pressure outcomes in the south Indian population.
Collapse
|
42
|
<b>Floristic diversity of the Indian Cardamom Research Institute campus, Myladumpara, Western Ghats, India</b>. JOURNAL OF THREATENED TAXA 2017. [DOI: 10.11609/jott.2611.9.10.10804-10822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A study on the flora of Indian Cardamom Research Institute campus, Myladumpara was carried out during 2012–2015 and a total of 515 taxa were collected during this study. The indigenous or naturalized flora is represented by 392 taxa in 303 genera under 94 families. Dicotyledonous plants dominate with 335 species in 251 genera under 80 families. Monocotyledons are represented by 57 species in 52 genera under 14 families. Among the families, Fabaceae dominates with 29 species followed by Asteraceae (27 spp.) and Euphorbiaceae (22 spp.) and 40 families are represented by single species each. During the study 68 species that are considered as endemic to the Western Ghats could be collected.
Collapse
|
43
|
Cranial neuropathy in chronic inflammatory demyelinating polyradiculoneuropathy: A consideration with variable response to treatment. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
44
|
P730Characteristics of patients with pulmonary hypertension from a developing country setting; data from the PROKERALA registry in Kerala, India. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
45
|
P3544Late clinical outcomes of post balloon mitral valvotomy patients who were categorized based on the absolute post procedural mitral valve area and percentage gain in valve area. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
A PROgramme of Lifestyle Intervention in Families for Cardiovascular risk reduction (PROLIFIC Study): design and rationale of a family based randomized controlled trial in individuals with family history of premature coronary heart disease. BMC Public Health 2017; 17:10. [PMID: 28056897 PMCID: PMC5217619 DOI: 10.1186/s12889-016-3928-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recognizing patterns of coronary heart disease (CHD) risk in families helps to identify and target individuals who may have the most to gain from preventive interventions. The overall goal of the study is to test the effectiveness and sustainability of an integrated care model for managing cardiovascular risk in high risk families. The proposed care model targets the structural and environmental conditions that predispose high risk families to development of CHD through the following interventions: 1) screening for cardiovascular risk factors, 2) providing lifestyle interventions 3) providing a framework for linkage to appropriate primary health care facility, and 4) active follow-up of intervention adherence. METHODS Initially, a formative qualitative research component will gather information on understanding of diseases, barriers to care, specific components of the intervention package and feedback on the intervention. Then a cluster randomized controlled trial involving 740 families comprising 1480 participants will be conducted to determine whether the package of interventions (integrated care model) is effective in reducing or preventing the progression of CHD risk factors and risk factor clustering in families. The sustainability and scalability of this intervention will be assessed through economic (cost-effectiveness analyses) and qualitative evaluation (process outcomes) to estimate value and acceptability. Scalability is informed by cost-effectiveness and acceptability of the integrated cardiovascular risk reduction approach. DISCUSSION Knowledge generated from this trial has the potential to significantly affect new programmatic policy and clinical guidelines that will lead to improvements in cardiovascular health in India. TRIAL REGISTRATION NUMBER NCT02771873, registered in May 2016 ( https://clinicaltrials.gov/ct2/show/results/NCT02771873 ).
Collapse
|
47
|
Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS- COFFRS study. Indian Heart J 2016; 69:499-504. [PMID: 28822518 PMCID: PMC5560872 DOI: 10.1016/j.ihj.2016.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 11/23/2016] [Accepted: 12/12/2016] [Indexed: 11/29/2022] Open
Abstract
Background We undertook this study to validate the impact of FFR-guided coronary interventions among Indian patients, which is not readily available as of date. Our patients differ from their western counterparts, both in terms of risk profile (younger, more metabolic syndrome, lipid rich diet) as well as their coronary size. Methods We retrospectively evaluated 282 patients with intermediate stenosis in their coronary arteries, who underwent FFR to assess the functional severity of the lesion. There were 3 groups: Group 1–FFR > 0.8 and kept on medical follow-up; Group 2–FFR ≤ 0.8 and underwent revascularisation; and Group 3–FFR ≤ 0.8 and refused to undergo revascularization. 281(99.6%) patients had regular follow-up in our clinic. Results Median age-57 years (range = 28–78). Males = 230, 90 patients were in Group 1, 175 in group 2 (PCI in 144 & CABG in 31) and 17 in group 3. Median follow-up of patients was 17.9 months (2 to 56 months). Three patients(3.4%) in Group 1 had MACE (1 STEMI, 2 UA); 4 patients (2.3%) in Group 2 had Non-STE-ACS; 7 patients (41%) in Group 3 had MACE (3 deaths with acute LVF, 2 NSTEMI, 2 STEMI) Conclusion In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73). Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03). FFR based revascularization decision appears to be a safe strategy in Indian patients.
Collapse
|
48
|
High-density lipoprotein from subjects with coronary artery disease promotes macrophage foam cell formation: role of scavenger receptor CD36 and ERK/MAPK signaling. Mol Cell Biochem 2016; 427:23-34. [PMID: 27995417 DOI: 10.1007/s11010-016-2895-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022]
Abstract
Although high-density lipoprotein is atheroprotective, it can become dysfunctional in chronic inflammatory conditions and increase cardiovascular risk. We previously demonstrated that HDL from subjects with documented coronary artery disease is dysfunctional and is pro-oxidant/proinflammatory in macrophages. Here we examined the influence of dysfunctional/proinflammatory HDL (piHDL) on lipid accumulation in human macrophages, in comparison to functional HDL (nHDL). Exposure of macrophages to piHDL, in contrast to nHDL, resulted in oxidative stress and marked uptake of lipids from piHDL, leading to the formation of foam cell phenotype as noted by oil red O staining with concomitant increase in total cellular cholesterol content. Using western blotting, we identified that piHDL profoundly upregulated the expression of scavenger receptor CD36 and suppressed the expression of ABCG1 and SRB1 in macrophages, thereby facilitating cholesterol influx capacity of macrophages. We then identified that CD36 did not act alone, indeed it was activated in macrophages along with ERK/MAPK, in response to piHDL, which in turn led to lipid accumulation as well as proinflammatory response via activation of NFkB and subsequent release of proinflammatory markers-TNF-ά and MMP-9. These effects were confirmed using pharmacological inhibitors for either CD36 or ERK/MAPK. Furthermore, piHDL treatment moderately activated PPAR-γ and Nrf2, the known regulators of CD36 in macrophages, suggesting that the two forms of HDL differentially regulate CD36 expression. Taken together, the results demonstrate that a novel CD36-ERK/MAPK-dependent mechanism is involved in macrophage lipid accumulation by piHDL, there by revealing the importance of functional deficiency in HDL and its potential link to atherogenesis.
Collapse
|
49
|
PERIPHERAL NEUROPATHY ASSOCIATED WITH WHIPPLE'S DISEASE. J Neurol Psychiatry 2016. [DOI: 10.1136/jnnp-2016-315106.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
Evaluating genomic DNA extraction methods from human whole blood using endpoint and real-time PCR assays. Mol Biol Rep 2016; 44:97-108. [PMID: 27686559 DOI: 10.1007/s11033-016-4085-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 09/22/2016] [Indexed: 11/29/2022]
Abstract
The extraction of genomic DNA is the crucial first step in large-scale epidemiological studies. Though there are many popular DNA isolation methods from human whole blood, only a few reports have compared their efficiencies using both end-point and real-time PCR assays. Genomic DNA was extracted from coronary artery disease patients using solution-based conventional protocols such as the phenol-chloroform/proteinase-K method and a non-phenolic non-enzymatic Rapid-Method, which were evaluated and compared vis-a-vis a commercially available silica column-based Blood DNA isolation kit. The appropriate method for efficiently extracting relatively pure DNA was assessed based on the total DNA yield, concentration, purity ratios (A260/A280 and A260/A230), spectral profile and agarose gel electrophoresis analysis. The quality of the isolated DNA was further analysed for PCR inhibition using a murine specific ATP1A3 qPCR assay and mtDNA/Y-chromosome ratio determination assay. The suitability of the extracted DNA for downstream applications such as end-point SNP genotyping, was tested using PCR-RFLP analysis of the AGTR1-1166A>C variant, a mirSNP having pharmacogenetic relevance in cardiovascular diseases. Compared to the traditional phenol-chloroform/proteinase-K method, our results indicated the Rapid-Method to be a more suitable protocol for genomic DNA extraction from human whole blood in terms of DNA quantity, quality, safety, processing time and cost. The Rapid-Method, which is based on a simple salting-out procedure, is not only safe and cost-effective, but also has the added advantage of being scaled up to process variable sample volumes, thus enabling it to be applied in large-scale epidemiological studies.
Collapse
|