65 results on '"S Ramakrishnan"'
Search Results
2. Recurrent Scleritis and Immunoglobulin A Nephropathy - A Case Series and Literature Review of an Unusual Association
- Author
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Padmanabhan Subramanian, MatafShafee Farid, NitinMiyar Nayak, Shakuntala Modi, S. Ramakrishnan, and Dilip Rangarajan
- Subjects
Transplantation ,Nephrology - Published
- 2021
3. Outcome of renal transplantation in IgA nephropathy
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R. Dilip, Kiran Chandra Patro, and S Ramakrishnan
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Transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,medicine.disease ,business ,Outcome (game theory) ,Nephropathy - Published
- 2016
4. Effect of embalming fluid on the histological appearance of organs–a cadaveric study
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A. Jojo, S. Ramakrishnan, T.S. Tintu, V.V. Pillay, and Minnie Pillay
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Embalming chemicals ,business.industry ,Medicine ,Anatomy ,business ,Cadaveric spasm ,Pathology and Forensic Medicine - Published
- 2018
5. Detection of Left Ventricular Remodeling in Acute ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention by Two Dimensional and Three Dimensional Echocardiography
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Rakesh Kumar Ola, S Ramakrishnan, Ashish Kumar Agarwal, Smriti Bhargava, and Chandra Bhan Meena
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0301 basic medicine ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,three-dimensional sphericity index ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,three-dimensional echocardiography ,medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Myocardial infarction ,Ventricular remodeling ,Prospective cohort study ,Ejection fraction ,business.industry ,Left ventricular remodeling ,Percutaneous coronary intervention ,Three dimensional echocardiography ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,Ventricle ,Cardiology ,End-diastolic volume ,Original Article ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) harbingers poor prognosis. Three-dimensional echocardiography (3DE) is more accurate than 2 D echo for the assessment of left ventricle (LV) shape. We assessed LV geometry with 3D ECHO 6 months after STEMI in patients who had primary angioplasty. Materials and Methods: In this prospective study, morphological and functional analysis of LV with 3D ECHO (volumes, LVEF, 3D sphericity index [SI]) was assessed up to 7 days and 6 months in 42 STEMI patients. The LVR was considered for increase >15% of the end diastolic volume of the LV (LVEDV) 6 months after the STEMI, compared to the LVEDV up to 7 days of it. Results: Sixteen (38%) patients had LVR. 3D Echocardiographic measurements up to 7 days after the acute myocardial infarction (AMI) 1-LVEDV in ventricular remodeling group was 99.8 ± 19.1 ml and in no ventricular remodeling group was 87 ± 18.2 mL (P = 0.037); 2-LVEF was 0.48 ± 0.01 and 51 ± 0.02 (P
- Published
- 2018
6. A study to assess the knowledge of medical students regarding organ donation in a selected college of Western Maharashtra
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Apoorva Sindhu, Taramangalam S. Ramakrishnan, Anurag Khera, and Gurpreet Singh
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United Network for Organ Sharing ,medicine.medical_specialty ,education ,lcsh:Medicine ,medical students ,Context (language use) ,0603 philosophy, ethics and religion ,Organ transplantation ,03 medical and health sciences ,0302 clinical medicine ,organ donation ,medicine ,Statistical analysis ,030212 general & internal medicine ,Organ donation ,Medical education ,business.industry ,lcsh:R ,Microsoft excel ,06 humanities and the arts ,General Medicine ,Road traffic accident ,Knowledge ,Optometry ,060301 applied ethics ,business ,Know-how - Abstract
Context: As per United Network for Organ Sharing, there are over 71,000 people on organ transplant waiting list in the United States. The only way to increase organ donations is to educate the health-care professionals and public about the importance of becoming an organ donor. One of the ways to start this is to promote the awareness of the college students, especially those in the medical field, toward organ donation as they are the most suitable persons to carry the message to the community. Aims: This study aims to determine the knowledge of medical students regarding organ donation. Settings and Design: Cross-sectional study conducted in a medical college of Western Maharashtra. Subjects and Methods: A questionnaire adapted to the study requirements from the published research was designed to capture the knowledge toward organ donation. Final year MBBS students who gave verbal consent to the study were included. Statistical Analysis Used: Microsoft Excel and SPSS version 20. Results: 87% of the students had correct knowledge regarding brain death occurring after road traffic accident. Fifty-four percent (54.45%) of students were not aware that an individual suffering from infectious disease cannot donate organs. 61% of the students were not aware that a National network for organ donation exists in their city. 48.5% of students did not know how to register oneself as an organ donor. Conclusions: The results of the study revealed that there exists a knowledge gap among the medical students regarding organ donation and there is an urgent need for addressing this knowledge gap which will help in improving the organ donation rate in our country.
- Published
- 2017
7. Dialysis after renal allograft loss – Our experience
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S Ramakrishnan, R. Dilip, and Kiran Chandra Patro
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Transplantation ,medicine.medical_specialty ,business.industry ,Urology ,medicine ,Renal allograft ,Dialysis (biochemistry) ,business - Published
- 2016
8. Autosomal dominant polycystic kidney disease in children
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Kiran Patro, S Ramakrishnan, and R. Dilip
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0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Pathology ,urogenital system ,business.industry ,lcsh:R ,Autosomal dominant polycystic kidney disease ,lcsh:Medicine ,General Medicine ,Disease ,urologic and male genital diseases ,medicine.disease ,female genital diseases and pregnancy complications ,03 medical and health sciences ,030104 developmental biology ,medicine ,Family history ,Presentation (obstetrics) ,business - Abstract
Autosomal dominant polycystic kidney disease (ADPKD) presenting in adults is well documented, but the presentation in children is uncommon and is unclear why the disease presents early. Cases in children are identified usually while screening those with a strong family history and less commonly when symptomatic. We present here two children with ADPKD.
- Published
- 2016
9. Homocysteine & its metabolite homocysteine-thiolactone & deficiency of copper in patients with age related macular degeneration - A pilot study
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Muthuvel Bharathselvi, Karunakaran Coral, Angayarkanni Narayanansamy, Rajiv Raman, Konerirajapuram Natarajan Sulochana, Radhakrishnan Selvi, Sayantan Biswas, and S Ramakrishnan
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medicine.medical_specialty ,Homocysteine ,Thiobarbituric acid ,Metabolite ,lcsh:Medicine ,Homocysteine-thiolactone ,medicine.disease_cause ,01 natural sciences ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,Thiolactone ,oxidative stress ,Medicine ,glutathione ,0101 mathematics ,Age-related macular degeneration - copper - glutathione - homocysteine - Homocysteine-thiolactone - oxidative stress ,business.industry ,Age-related macular degeneration ,lcsh:R ,homocysteine ,General Medicine ,Glutathione ,Macular degeneration ,medicine.disease ,eye diseases ,010101 applied mathematics ,Endocrinology ,Biochemistry ,chemistry ,copper ,030221 ophthalmology & optometry ,Original Article ,business ,Copper deficiency ,Oxidative stress - Abstract
Background & objectives: Age related macular degeneration (ARMD) is a leading cause of blindness, particularly in persons above 60 yr of age. Homocysteine is implicated in many ocular diseases including ARMD. This study was undertaken to assess the status and relationship between plasma homocysteine, homocysteine - thiolactone, homocysteinylated protein and copper levels in patients with ARMD. Methods: A total of 16 patients with ARMD and 16 age-matched controls were recruited for the study. Plasma glutathione, homocysteine, homocysteine - thiolactone and extent of homocysteine conjugation with proteins, copper and thiobarbituric acid reactive substances were measured. Results: Homocysteine levels were elevated with increase in homocysteine-thiolactone, thiobarbituric acid reactive substances and a decrease of glutathione. The levels of homocysteinylated protein were elevated in ARMD. The elevated homocysteine, homocysteine-thiolactone correlated with the decrease in copper level. Interpretation & conclusions: Elevated homocysteine and its metabolite homocysteine-thiolactone and decreased levels of copper may play an important role in the pathogenesis of ARMD.
- Published
- 2016
10. A case of valvular heart disease
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Vijay Bohra, S Ramakrishnan, and Neeraj Parakh
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lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_specialty ,clinical case ,Heart disease ,business.industry ,lcsh:R ,valvular heart disease ,lcsh:Surgery ,lcsh:Medicine ,lcsh:RD1-811 ,rheumatic heart disease ,medicine.disease ,lcsh:RC666-701 ,Bedside case discussion ,Internal medicine ,Palpitations ,medicine ,Cardiology ,Clinical case ,Exertion ,medicine.symptom ,business - Abstract
A 29-year-old female had presented with dyspnea on exertion since she was 10 years old, with sudden worsening for 5 months along with palpitations on exertion for the past 5 months. The examination findings, electrocardiogram, chest X-ray, and echocardiogram are discussed in a stepwise manner to arrive at a diagnosis and plan the management of a patient with rheumatic heart disease with multivalvular lesions. Relevant literature is also reviewed.
- Published
- 2015
11. CMV Disease in renal Transplantation
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Srinivas Nalloor, Dilip Rangarajan, A. Chandrashekar, and S Ramakrishnan
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Transplantation ,Cytomegalovirus infection ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,business ,Gastroenterology - Published
- 2009
12. UTI in Renal Transplantation
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Dilip Rangarajan, Srinivas Nalloor, A. Chandra Shekar, and S Ramakrishnan
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Transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine ,business - Published
- 2009
13. New onset diabetes mellitus after renal transplantation
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Srinivas Nalloor, Dilip Rangarajan, A. Chandra Shekar, and S Ramakrishnan
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Transplantation ,Pediatrics ,medicine.medical_specialty ,New onset diabetes ,business.industry ,Medicine ,business - Published
- 2009
14. Eales′ disease: Oxidant stress and weak antioxidant defence
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Konerirajapuram Natarajan Sulochana, S Ramakrishnan, and Mohanraj Rajesh
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medicine.medical_specialty ,Antioxidant ,Fundus Oculi ,medicine.medical_treatment ,Autoimmunity ,medicine.disease_cause ,Antioxidants ,Superoxide dismutase ,chemistry.chemical_compound ,Retinal Diseases ,Lipid oxidation ,HLA Antigens ,Internal medicine ,medicine ,Humans ,Fluorescein Angiography ,Free-radical theory of aging ,chemistry.chemical_classification ,Arrestin ,biology ,business.industry ,Nitrotyrosine ,Glutathione peroxidase ,Glutathione ,Prognosis ,Retinal Vein ,Oxidative Stress ,Ophthalmology ,Endocrinology ,chemistry ,Immunology ,Disease Progression ,biology.protein ,business ,Oxidative stress - Abstract
Eales' disease (ED) is an idiopathic retinal periphlebitis characterized by capillary non-perfusion and neovascularization. In addition to the existing system, a new staging system has been proposed by Saxena et al. Immunological, molecular biological and biochemical studies have indicated the role of human leucocyte antigen, retinal S antigen autoimmunity, Mycobacterium tuberculosis genome, free radical damage and possibly hyperhomocysteinemia in its etiopathogenesis, which appears multifactorial. Oxidant stress has been shown by increase in the levels of thiobarbituric acid reactive substances (lipid oxidation) in the vitreous, erythrocytes, platelets and monocytes. A decrease in vitamins E and C both in active and healed vasculitis, superoxide dismutase, glutathione and glutathione peroxidase showed a weakened antioxidant defence. Epiretinal membrane from patients of ED who underwent surgery showed, by immunolocalization, presence of carboxy methyl lysine, an advanced glycation end product formed by glycoxidation and is involved in angiogenesis. OH. free radical accumulation in monocytes has been directly shown by electron spin resonance spectrometry. Free radical damage to DNA and of protein was shown by the accumulation of 8 hydroxy 2 deoxyguanosine (in leucocytes) and nitrotyrosine (in monocytes), respectively. Nitrosative stress was shown by increased expression of inducible nitric oxide synthase in monocytes in which levels of iron and copper were increased while those of zinc decreased. A novel 88 kDa protein was found in serum and vitreous in inflammatory condition and had antioxidant function. Platelet fluidity was also affected. Oral, methotrexate in low dosage (12.5 mg/week for 12 weeks) as well as oral vitamin E (400 IU) and C (500 mg) daily for 8 weeks are reported to have beneficial effects.
- Published
- 2007
15. Characterization of Event Related Desynchronization in Chronic Stroke Using Motor Imagery Based Brain Computer Interface for Upper Limb Rehabilitation.
- Author
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Gangadharan SK, Ramakrishnan S, Paek A, Ravindran A, Prasad VA, and Vidal JLC
- Abstract
Objective: Motor imagery-based brain-computer interface (MI-BCI) is a promising novel mode of stroke rehabilitation. The current study aims to investigate the feasibility of MI-BCI in upper limb rehabilitation of chronic stroke survivors and also to study the early event-related desynchronization after MI-BCI intervention., Methods: Changes in the characteristics of sensorimotor rhythm modulations in response to a short brain-computer interface (BCI) intervention for upper limb rehabilitation of stroke-disabled hand and normal hand were examined. The participants were trained to modulate their brain rhythms through motor imagery or execution during calibration, and they played a virtual marble game during the feedback session, where the movement of the marble was controlled by their sensorimotor rhythm., Results: Ipsilesional and contralesional activities were observed in the brain during the upper limb rehabilitation using BCI intervention. All the participants were able to successfully control the position of the virtual marble using their sensorimotor rhythm., Conclusions: The preliminary results support the feasibility of BCI in upper limb rehabilitation and unveil the capability of MI-BCI as a promising medical intervention. This study provides a strong platform for clinicians to build upon new strategies for stroke rehabilitation by integrating MI-BCI with various therapeutic options to induce neural plasticity and recovery., (Copyright © 2024 Copyright: © 2024 Annals of Indian Academy of Neurology.)
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- 2024
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16. Characterization of Ocular Sonography Findings and their Relationship to Clinical Features from a South Indian Cohort of Idiopathic Intracranial Hypertension.
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Kishore KV, Patwardhan A, Aravinda HR, Mustare V, and Ramakrishnan S
- Abstract
Background: Idiopathic intracranial hypertension (IIH) typically manifests with headache, accompanied by papilledema and visual loss, and has a higher prevalence in females. In recent years, ocular sonography, particularly, measurement of optic nerve sheath diameter (ONSD), is being investigated for diagnosis of IIH., Methods: A total of 35 patients over the age of 18 years, fulfilling the modified Dandy's criteria for diagnosis of IIH were included. Patients underwent assessment with magnetic resonance imaging, lumbar puncture, and ocular sonography to measure ONSD and ocular arterial indices., Results: The mean ONSD values (in centimeters) in the right eye of patients with IIH was 0.57 ± 0.13, while it was 0.48 ± 0.03 in controls. In the left eye, the mean ONSD value (cm) was 0.59 ± 0.13 in patients with IIH and 0.48 ± 0.03 in controls. ONSD was significantly higher in cases compared to controls ( P < 0.001, Welch test). Pulsatility index of the central retinal artery was significantly higher in cases compared to controls ( P < 0.001, Welch test). Resistance index of the ophthalmic artery was statistically significant ( P < 0.005, Welch test). Receiver operating characteristic curve analysis revealed a cutoff value of 5.1 mm on the right side and 5 mm on the left side had a sensitivity and specificity of more than 80% for IIH diagnosis., Conclusion: Our study provides insights into the utility of optic nerve sheath measurements and arterial indices in the diagnosis of IIH in a South Indian cohort. Further research is needed to fully understand the longitudinal relationship of these parameters and treatment outcomes in IIH., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Annals of Indian Academy of Neurology.)
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- 2024
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17. Clinicoradiological Features and Long-term Cognitive and Functional Outcome in Patients with Deep Cerebral Venous Thrombosis.
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Patwardhan A, Gupta M, Philip M, Rangarajan A, Joshi T, Alladi S, Kulkarni GB, and Ramakrishnan S
- Abstract
Background: Deep cerebral venous thrombosis (DCVT) can have long-term functional and cognitive sequelae. Although literature exists on cognitive impairment after arterial stroke, cognitive sequelae after cerebral venous thrombosis (CVT) are much less studied., Methods: Clinical records of 29 patients diagnosed with DCVT were reviewed. The Modified Telephonic Interview for Cognitive Status (TICS-M) was adapted and validated in the regional language (Kannada) and applied to 18 patients with DCVT, at a mean follow-up duration of 5.32 years. Screening for depression was done via telephonic Patient Health Questionnaire-9 (PHQ-9)-Kannada version, and functional status was screened by applying the modified Rankin Scale (mRS)., Results: DCVT had a mortality rate of 10.34% due to acute complications. mRS scores of 0-1 were achieved at follow-up in all patients who survived. Receiver operating characteristic (ROC) analysis revealed a cutoff of ≤44.5 (maximum score of 49) for the diagnosis of cognitive impairment via TICS-M (Kannada version) in DCVT patients. Evidence of cognitive dysfunction was seen in eight patients (42.10%), and three patients (16.66%) had evidence of depression., Conclusions: Survivors of acute DCVT can potentially have long-term cognitive sequelae. Screening for cognitive dysfunction, depression, and functional status can be effectively done using telephonically applied scales that are adapted to the local language. Neuropsychological evaluation and early cognitive rehabilitation can be initiated for patients in whom deficits are identified on cognitive screening., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Annals of Indian Academy of Neurology.)
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- 2024
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18. Cerebral Venous Sinus Thrombosis Associated Subdural Hematoma: A Case Series on Clinical Presentation and Management.
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Chakkera P, Gupta M, Marasakatla S, Ramakrishnan S, and Kulkarni GB
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Diagnosis and treatment of cerebral venous sinus thrombosis (CVT) associated with subdural hematoma (SDH) is challenging with an increased risk of rebleeding on using anticoagulation. There are no guidelines at present due to its rare presentation. In this report we describe three patients who presented with non-traumatic SDH and CVT over the last 3 years. Clinical assessment, investigations including neuroimaging, and management were reviewed both at time of admission and follow-up. These patients presented with varied CVT syndromes -isolated raised intracranial pressure (ICP), focal and diffuse encephalopathy. Neuroimaging helped in diagnosing CVT and SDH. Cases 1 and 3 had SDH alone, while case 2 had SDH along with intraparenchymal hemorrhage. Management of these patients was tailored individually as per mechanism of CVT. Case 1 was clinically stable, however, she had rebleeding after starting anticoagulation, requiring its discontinuation. Cases 2 and 3 underwent immediate neurosurgical intervention in view of deteriorated sensorium. Although CVT manifesting as SDH is rare, clinicians should have a high index of suspicion to accurately diagnose and manage these challenging cases. The decision regarding use of anticoagulation and apt time for neurosurgical intervention needs to be individualized depending on patients condition and response to treatment., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Indian Academy of Neurology.)
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- 2023
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19. Surgical Management of Vision Loss in Cerebral Venous Thrombosis: Case Series from a Tertiary Care Stroke Center.
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Reddy TAV, Seshagiri DV, Reddy HK, Patwardhan AA, Joshi TH, Shukla D, Kulkarni GB, Mustare VK, and Ramakrishnan S
- Abstract
Background and Purpose: Cerebral venous thrombosis (CVT) presenting as vision loss is uncommon. Raised intracranial tension in CVT is proposed as one of the mechanisms (13.2%). There are still unknown underlying mechanisms to explain vision loss in CVT. The safety and outcome of the surgery (optic nerve sheath fenestration [ONSF] or theco-peritoneal shunt [TPS]) to reduce intracranial hypertension and prevent vision loss has not been studied., Methods: A retrospective case record review of CVT patients with impending vision loss who underwent ONSF/TPS from 2007 to 2019 was performed from the stroke registry. All patients had formal neuro-ophthalmological evaluation and documentation of visual acuity, supplemented by visual field assessments by perimetry in a subset of patients. Safety and outcomes were assessed based on vision improvement and adverse effects after the surgery., Results: Among approximately 1400 patients with CVT admitted in the stroke ward over 12 years, surgery for rescuing vision was done in 18. Among these, the males were 6, and the females were 12. The mean age of presentation was 24 (range 18-52 years). All of them had headaches and progressive blurring of vision with papilledema. The number of patients who underwent TPS was 13, ONSF was 1, and both were 4. In the TPS group (26 eyes), vision improved in 15 eyes (57.7%), remained status-quo in 8 eyes (30.7%), and worsened in 3 eyes (11.5%). Four patients underwent both surgeries; three eyes improved, two remained status quo, and three worsened. One patient underwent ONSF, and his vision remained status quo (no perception of light). Three patients (17.6%) of the TPS group had minor complications (low-pressure headache, subdural hygroma), and five (29.4%) had major complications like subdural hemorrhage, abdominal wound infection, and meningitis., Conclusion and Implications: In patients with CVT, adequate vision monitoring is mandatory. Shunt surgeries (especially TPS) may help in stabilizing/improving vision in CVT patients with impending vision loss, despite adequate anti-edema measures (53.8% improved). Early diagnosis and precise decisions in referring for surgery are crucial., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Annals of Indian Academy of Neurology.)
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- 2023
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20. Interesting rare case of polyarteritis nodosa related to hepatitis B virus and plasma exchange role? - A case report and review of the literature.
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Tripathi PP, Sharma RR, Kopp CR, Basnet A, Ramakrishnan S, Lamba DS, Hans R, and Sharma A
- Abstract
Immune-mediated diseases wherein immune complex-mediated injury is predominant; plasma exchange remains a therapeutic option for vasculitis. Hepatitis B virus-associated polyarteritis nodosa (HBV-PAN) wherein immunosuppressants can be contraindicated, plasma exchanges have a proven role when combined with antiviral therapy. Plasma exchange by hastening the clearance of immune complexes is beneficial in acute organ dysfunction. A 25-year-old male presented with complaints of generalized weakness, tingling numbness and weakness of extremities, joint pain, weight loss, and rashes over arms and legs for 2 months. Hepatitis B workup showed high viral loads of HBV (34 million IU/ml) and hepatitis e antigen positivity (1129.06 U/ml). Cardiac workup showed elevated cardiac enzymes and decreased ejection fraction (40%-45%). The finding of contrast-enhanced computed tomography (CECT) chest and abdomen with CT angiogram abdomen was steady with medium vessel vasculitis. A diagnosis of vasculitis with probable etiology of HBV-related PAN with mononeuritis multiplex and myocarditis was made. He was treated with steroids, tablet tenofovir, and 12 sessions of plasma exchanges. On average, 2078 ml of plasma was exchanged during each session with 4% albumin as a replacement fluid using central femoral line dialysis catheter as vascular access on automated cell separator Optia ®Spectra (Terumo BCT, Lakewood, Co). He was discharged with the resolution of symptoms, including myocarditis and increase in power strength and still in follow-up. The present index case indicates that antiviral combined with plasma exchange after short-term corticosteroids is an effective therapy for HBV-PAN. TPE can be used as adjuvant therapy along with antiviral therapy in a rare disease like HBV-related PAN., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Asian Journal of Transfusion Science.)
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- 2023
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21. Imaging Acute Myocarditis with 68Ga-DOTANOC PET/CT.
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Jaleel J, Patel CD, Chandra KB, Ramakrishnan S, and Seth S
- Abstract
Somatostatin receptor (SSTR) imaging is a useful method in the diagnosis of acute myocarditis. We present a case of a 54-year-old male with a clinical diagnosis of acute myocarditis in whom, 68Ga-DOTANOC positron emission tomography/computed tomography PET/CT showed diffuse left ventricular myocardial uptake. SSTR imaging can act as a surrogate marker of active inflammation. SSTR imaging is useful in deciding site of biopsy, assessing response to therapy and for prognostication., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Nuclear Medicine.)
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- 2023
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22. Muscle MRI-Based Atrophy Pattern Recognition: Notable Findings in a Case of Pathologically Proven Lipid Storage Myopathy.
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Patwardhan A, Mukherjee J, Mhatre R, Lanka V, Asranna A, Tiwari R, Sriram N, Kulanthaivelu K, Mahadevan A, and Ramakrishnan S
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Competing Interests: There are no conflicts of interest.
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- 2022
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23. Coexistence of NMDAR and CASPR2 Antibodies with HLA-B5 Positivity: A Puzzling Trilogy with Atypical Neuroimaging.
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Jha S, Asranna A, Kulanthaivelu K, Sanjaysingh B, Ramakrishnan S, Mahadevan A, and Kenchaiah R
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Competing Interests: There are no conflicts of interest.
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- 2022
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24. Vanishing Brain Lesions in a Patient with Vision Loss and Ataxia: A Case of CNS Lymphoma with Corticosteroid Related Regression.
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Elavarasi A, Rao S, Ramakrishnan S, and Bhatt D
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Competing Interests: There are no conflicts of interest.
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- 2022
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25. Recurrent Scleritis and Immunoglobulin A Nephropathy - A Case Series and Literature Review of an Unusual Association.
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Farid MS, Nayak NM, Modi S, Ramakrishnan S, Rangarajan D, and Subramanian P
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- Hematuria, Humans, Immunoglobulin A, Kidney pathology, Proteinuria diagnosis, Proteinuria etiology, Glomerulonephritis, IGA complications, Glomerulonephritis, IGA diagnosis, Glomerulonephritis, IGA drug therapy, Scleritis diagnosis, Scleritis drug therapy, Scleritis etiology
- Abstract
Immunoglobulin A (IgA) nephropathy is usually restricted to the kidneys in most cases, but associations with other immune and inflammatory diseases exist. Scleritis, however, is an unusual association. We present an observational case series of two patients who initially presented with recurrent episodes of scleritis. A thorough evaluation for recurrent scleritis did not reveal any secondary cause per se. They were further evaluated extensively for incidental proteinuria and microscopic hematuria. Renal function was normal. Renal biopsy was performed which revealed IgA nephropathy in both the patients. They were given oral prednisolone and telmisartan for six months and followed for nine and six months, respectively, after steroids were discontinued. Proteinuria remitted, renal function remained normal, and there were no further episodes of scleritis in these patients.
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- 2021
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26. Cerebral venous thrombosis presenting as vision loss & multiple cranial palsy - A rarity.
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Reddy Taallapalli AV and Ramakrishnan S
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- Blindness diagnosis, Blindness etiology, Humans, Paralysis, Vision Disorders diagnosis, Vision Disorders etiology, Skull, Venous Thrombosis diagnosis, Venous Thrombosis diagnostic imaging
- Abstract
Competing Interests: None
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- 2020
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27. Neuromyelitis optica with fluorosis: An association or coincidence.
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Arshad F and Ramakrishnan S
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- Brain, Humans, Fluoride Poisoning, Neuromyelitis Optica complications
- Abstract
Competing Interests: None
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- 2020
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28. A Screening Tool to Detect Stroke Aphasia: Adaptation of Frenchay Aphasia Screening Test (FAST) to the Indian Context.
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Paplikar A, Iyer GK, Varghese F, Alladi S, Pauranik A, Mekala S, Kaul S, Sharma M, Dhaliwal RS, Saroja AO, Dharamkar S, Dutt A, Divyaraj G, Ghosh A, Kandukuri R, Mathew R, Menon R, Narayanan J, Nehra A, Padma MV, Ramakrishnan S, Ravi SK, Shah U, Tripathi M, Sylaja PN, and Varma RP
- Abstract
Background: Aphasia is a common consequence of stroke. To optimize recovery, it becomes critical as there are early identification and treatment of language deficits. The rising burden of stroke aphasia and lack of screening tools in the Indian context necessitates the need for a screening tool., Objective: We aimed to adapt and validate the Frenchay Aphasia Screening Test (FAST) to the Indian context in two widely spoken Indian languages, Telugu and Kannada, for the literate and illiterate population., Methods: A systematic process of adaptation and culturally appropriate modifications of the original FAST were done in 116 healthy controls and 115 patients. The validity of the adapted test was established., Results: The optimum cut-off values for detecting aphasia in our sample ranged from 25 to 25.5 (literate) and 13.5 to 15.5 (illiterate) with high sensitivity and specificity. There was also a significant correlation between aphasia scores for adapted FAST and the Western Aphasia Battery (WAB), establishing good convergent validity., Discussion: Results of the adaptation and validation of two Indian versions of FAST, suggest that it is an easy-to-use screening measure for detecting stroke-related language disabilities. The psychometric properties of the Indian version of FAST met the standardised requirements for adaptation and validation., Conclusions: The Indian version of FAST was found to be a reliable and valid bedside screening tool for aphasia in stroke patients. We aim that this study will facilitate the use of the test across other Indian languages and a large clinical population in the future., Competing Interests: There are no conflicts of interest., (Copyright: © 2006 - 2020 Annals of Indian Academy of Neurology.)
- Published
- 2020
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29. Concomitant diaphragmatic hernia repair with coronary artery bypass grafting surgery.
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Mohan G, Kalyanaraman S, Ramakrishnan S, and Theodore S
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- Coronary Angiography, Coronary Artery Disease complications, Electrocardiography, Hernia, Diaphragmatic complications, Humans, Male, Middle Aged, One-Lung Ventilation, Tomography, X-Ray Computed, Cardiac Surgical Procedures methods, Coronary Artery Bypass methods, Coronary Artery Disease surgery, Hernia, Diaphragmatic surgery, Herniorrhaphy methods
- Abstract
Congenital Bochdalek diaphragmatic hernia (DH) is often diagnosed incidentally in adulthood. It is recommended that all cases of DH be repaired immediately at diagnosis since acute presentation after the complications have already developed has higher morbidity and mortality. A 47-year-old male presented with Grade III angina and dyspnea. A routine chest radiograph revealed bowel shadows in the right thorax, and subsequent computerized tomography (CT) scan confirmed the same. Coronary angiogram revealed coronary artery disease which needed surgery. Off-pump coronary artery bypass grafting followed by DH repair under one-lung ventilation., Competing Interests: There are no conflicts of interest
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- 2018
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30. Bleeding in the lung complicates a routine intracardiac repair: What went wrong!!!
- Author
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Makhija N, Magoon R, Choudhury M, and Ramakrishnan S
- Subjects
- Cardiopulmonary Bypass, Child, Female, Humans, Tetralogy of Fallot complications, Hemorrhage therapy, Lung Diseases therapy, Tetralogy of Fallot surgery
- Abstract
Cyanotic congenital heart disease presents an increased tendency to bleed in view of subtle coagulation defects. Airway bleeding can be particularly difficult to manage while maintaining an adequate ventilation. An isolated lung bleed with the exclusion of possible traumatic, medical and surgical causes of bleeding, should alert the attending anesthesiologist to the possibility of the collateral-related bleeding. Preoperative coil embolization remains an important initial management step in a case of tetralogy of Fallot (TOF) with major aortopulmonary collaterals. Nevertheless, the coiling of the collaterals in certain specific case scenarios is not feasible, rendering the management of a lung bleed, all the more challenging. We, hereby discuss a case of a 7-year-old girl with a massive endotracheal bleed at the time of weaning from cardiopulmonary bypass after corrective surgery for TOF. The subsequent approach and management are discussed. The optimal management of tetralogy with collaterals mandates an effective communication among the cardiologist, radiologist, anesthesiologist, and the surgeon.
- Published
- 2018
- Full Text
- View/download PDF
31. Treatment-related Fluctuations in Guillain Barre Syndrome and the Conundrum of Additional Cycles of Plasmapheresis.
- Author
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Ramakrishnan S, Mustare V, Philip M, Thennarasu K, and Periyavan S
- Abstract
Introduction: In Guillain Barre syndrome (GBS), worsening of weakness or disability after initial period of recovery or stabilization is described as treatment-related fluctuations (TRF)., Aim: This study aims to describe the clinical characteristics and outcome of six patients with GBS and TRF., Patients and Methods: Six patients with GBS fulfilling NINCDS criteria, evaluated at a tertiary care university hospital during 2008-2017, were diagnosed to have TRF. They form the basis of this report., Results: All patients were men and their mean age was 40 years. At presentation, mean duration of illness was 15 days; the illness had plateaued in three and progressive in other three patients. Two of the four patients had variant GBS. Initially, five patients were treated with large volume plasmapheresis (LVPP) and one patient with methyl prednisolone. At 17-28 days after disease onset, three patients developed new neurologic deficits (bilateral facial paresis in two; paralytic ileus in one). Other three patients with worsening of limb weakness (medical research council sum score of >5) and disability (Hughes disability grade by ≥1) fulfilled Kleyweg's criteria for TRF. All the six patients were treated with the completion of five cycles or additional cycles of LVPP., Conclusion: Awareness about TRF is essential for correct diagnosis and management of patients with GBS., Competing Interests: There are no conflicts of interest.
- Published
- 2017
- Full Text
- View/download PDF
32. Authors' Response.
- Author
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Bharathselvi M, Biswas S, Raman R, Selvi R, Coral K, Narayanansamy A, Ramakrishnan S, and Sulochana KN
- Published
- 2017
- Full Text
- View/download PDF
33. Circulating Monoclonal IgG1-kappa Antibodies Causing Anti-glomerular Basement Membrane Nephritis.
- Author
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Vankalakunti M, Nada R, Kumar A, Patro K, Ramakrishnan S, and Rangarajan D
- Abstract
Anti-glomerular basement membrane (GBM) antibody disease is a rare but well-characterized cause of glomerulonephritis. Patients present with rapidly progressive renal failure with hemoptysis. Early diagnosis is crucial in salvaging the renal damage and life-threatening pulmonary hemorrhage. Plasmapheresis and immunosuppression is the mode of therapy. Anti-GBM antibodies are polyclonal in nature. However, rare monoclonal antibodies can cause similar destruction of glomerular capillary walls. We describe distinct combination of circulating monoclonal and anti-GBM nephritis., Competing Interests: There are no conflicts of interest.
- Published
- 2017
- Full Text
- View/download PDF
34. Studying diastology with speckle tracking echocardiography: The essentials.
- Author
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Choudhury A, Magoon R, Malik V, Kapoor PM, and Ramakrishnan S
- Subjects
- Heart physiopathology, Heart Diseases pathology, Heart Diseases physiopathology, Humans, Myocardium pathology, Cardiology methods, Diastole, Echocardiography methods, Heart Diseases diagnostic imaging
- Abstract
Diastolic dysfunction is common in cardiac disease and an important finding independent of systolic function as it contributes to the signs and symptoms of heart failure. Tissue Doppler mitral early diastolic velocity (Ea) combined with peak transmitral early diastolic velocity (E) to obtain E/Ea ratio provides an estimate of the left ventricular (LV) filling pressure. However, E/Ea has a significant gray zone and less reliable in patients with preserved ejection fraction (>50%). Two-dimensional echocardiographic speckle tracking measure myocardial strain and strain rate (Sr) avoiding the Doppler-associated angulation errors and tethering artifacts. Global myocardial peak diastolic strain (Ds) and diastolic Sr (DSr) at the time of E and isovolumic relaxation combined with E (E/Ds and E/10 DSr) have been recently proposed as novel indices to determine LV filling pressure. The present article elucidates the methodology of studying diastology with strain echocardiography along with the advantages and limitations of the novel technique in light of the available literature.
- Published
- 2017
- Full Text
- View/download PDF
35. Autosomal dominant polycystic kidney disease in children.
- Author
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Patro KC, Dilip R, and Ramakrishnan S
- Subjects
- Child, Humans, Polycystic Kidney, Autosomal Dominant
- Abstract
Autosomal dominant polycystic kidney disease (ADPKD) presenting in adults is well documented, but the presentation in children is uncommon and is unclear why the disease presents early. Cases in children are identified usually while screening those with a strong family history and less commonly when symptomatic. We present here two children with ADPKD.
- Published
- 2016
- Full Text
- View/download PDF
36. Homocysteine & its metabolite homocysteine-thiolactone & deficiency of copper in patients with age related macular degeneration - A pilot study.
- Author
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Bharathselvi M, Biswas S, Raman R, Selvi R, Coral K, Narayanansamy A, Ramakrishnan S, and Sulochana KN
- Subjects
- Aged, Copper deficiency, Female, Glutathione blood, Humans, Macular Degeneration pathology, Male, Middle Aged, Oxidative Stress, Thiobarbituric Acid Reactive Substances metabolism, Copper blood, Homocysteine analogs & derivatives, Homocysteine blood, Macular Degeneration blood
- Abstract
Background & Objectives: Age related macular degeneration (ARMD) is a leading cause of blindness, particularly in persons above 60 yr of age. Homocysteine is implicated in many ocular diseases including ARMD. This study was undertaken to assess the status and relationship between plasma homocysteine, homocysteine - thiolactone, homocysteinylated protein and copper levels in patients with ARMD., Methods: A total of 16 patients with ARMD and 16 age-matched controls were recruited for the study. Plasma glutathione, homocysteine, homocysteine - thiolactone and extent of homocysteine conjugation with proteins, copper and thiobarbituric acid reactive substances were measured., Results: Homocysteine levels were elevated with increase in homocysteine-thiolactone, thiobarbituric acid reactive substances and a decrease of glutathione. The levels of homocysteinylated protein were elevated in ARMD. The elevated homocysteine, homocysteine-thiolactone correlated with the decrease in copper level., Interpretation & Conclusions: Elevated homocysteine and its metabolite homocysteine-thiolactone and decreased levels of copper may play an important role in the pathogenesis of ARMD., Competing Interests: None.
- Published
- 2016
- Full Text
- View/download PDF
37. Vocal cord palsy in a case of chronic progressive external ophthalmoplegia.
- Author
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Ramakrishnan S, Yadav R, Adwani S, Mustare V, Kulkarni GB, Narayanappa G, Periyasamy G, and Kumarasamy T
- Published
- 2015
- Full Text
- View/download PDF
38. Comparison of tapentadol with tramadol for analgesia after cardiac surgery.
- Author
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Iyer SK, Mohan G, Ramakrishnan S, and Theodore S
- Subjects
- Adult, Female, Humans, Male, Tapentadol, Analgesics, Opioid therapeutic use, Cardiac Surgical Procedures, Pain, Postoperative drug therapy, Phenols therapeutic use, Tramadol therapeutic use
- Abstract
Background: Tapentadol is a relatively new analgesic. We decided to compare it with tramadol for their various effects after cardiac surgery., Setting: A study in a tertiary care hospital., Materials and Methods: Sixty adults undergoing cardiac surgery were divided into 2 groups of 30 each by computerized random allotment (Group X = tapentadol 50 mg oral and Group Y = tramadol 100 mg oral). Informed Consent and Institutional Ethics Committee approval were obtained. The patients were given either drug X or drug Y after extubation in this single blinded study, wherein the data collectors and analyzers were blinded to the study. All patients received oral paracetamol qds and either drug X or drug Y tds. The pain score was noted on a Visual Analog Scale before each drug dose, 3 h later and on coughing. Heart rate, respiratory rate, and blood pressure were recorded before the drug dose and 3 h later. Postoperative nausea or vomiting (PONV), temperature, and modified Glasgow Coma Scale readings were recorded. The above readings were obtained for 6 doses (up to 48 h after extubation)., Statistics: t-test, Pearson Chi-square test, Fisher exact test, and Mantel-Haenszel test were used for statistics., Results: Tapentadol group patients had significantly better analgesia 3 h after the drug and "on coughing" than tramadol group. The difference in their effects on blood creatinine levels, temperature, hemodynamics, oxygen saturation, and respiratory rate were not clinically significant. Tapentadol produced lesser drowsiness and lesser vomiting than tramadol., Conclusions: Tapentadol, due to its norepinephrine reuptake inhibition properties, in addition to mu agonist, is a better analgesic than tramadol and has lesser PONV.
- Published
- 2015
- Full Text
- View/download PDF
39. Survival analysis of patients on maintenance hemodialysis.
- Author
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Chandrashekar A, Ramakrishnan S, and Rangarajan D
- Abstract
Despite the continuous improvement of dialysis technology and pharmacological treatment, mortality rates for dialysis patients are still high. A 2-year prospective study was conducted at a tertiary care hospital to determine the factors influencing survival among patients on maintenance hemodialysis. 96 patients with end-stage renal disease surviving more than 3 months on hemodialysis (8-12 h/week) were studied. Follow-up was censored at the time of death or at the end of 2-year study period, whichever occurred first. Of the 96 patients studied (mean age 49.74 ± 14.55 years, 75% male and 44.7% diabetics), 19 died with an estimated mortality rate of 19.8%. On an age-adjusted multivariate analysis, female gender and hypokalemia independently predicted mortality. In Cox analyses, patient survival was associated with delivered dialysis dose (single pool Kt/V, hazard ratio [HR] =0.01, P = 0.016), frequency of hemodialysis (HR = 3.81, P = 0.05) and serum albumin (HR = 0.24, P = 0.005). There was no significant difference between diabetes and non-diabetes in relation to death (Relative Risk = 1.109; 95% CI = 0.49-2.48, P = 0.803). This study revealed that mortality among hemodialysis patients remained high, mostly due to sepsis and ischemic heart disease. Patient survival was better with higher dialysis dose, increased frequency of dialysis and adequate serum albumin level. Efforts at minimizing infectious complications, preventing cardiovascular events and improving nutrition should increase survival among hemodialysis patients.
- Published
- 2014
- Full Text
- View/download PDF
40. Prevalence of systemic co-morbidities in patients with various grades of diabetic retinopathy.
- Author
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Venkatesh P, Tibrewal S, Bhowmik D, Tripathi M, Ramakrishnan S, Vashist N, Vohra R, and Garg S
- Subjects
- Comorbidity, Creatinine blood, Diabetic Nephropathies classification, Diabetic Retinopathy classification, Humans, India epidemiology, Neural Conduction physiology, Odds Ratio, Serum Albumin metabolism, Statistics, Nonparametric, Diabetic Nephropathies epidemiology, Diabetic Neuropathies epidemiology, Diabetic Retinopathy epidemiology, Vascular Diseases epidemiology
- Abstract
Background & Objectives: Though diabetes affects multiple organs, most studies highlight the occurence of only one complication in isolation. We conducted a hospital-based study to estimate the co-existence of significant systemic co-morbid conditions in patients with varying grades of diabetic retinopathy., Methods: A total of 170 consecutive patients with diabetic retinopathy were prospectively recruited for the study between June 2009 to June 2010 at a tertiary care eye centre in north India. Retinopathy was graded by fundus biomicroscopy and fundus photography and classified into three categories (mild-moderate nonproliferative retinopathy, proliferative retinopathy requiring only laser and proliferative retinopathy requiring surgery). Nephropathy was classified by calculating the six variable estimated glomerular filtration rate (eGFR) for all patients. Nerve conduction studies and clinical assessment were used to determine presence of neuropathy. Co-existence of macrovascular disease and peripheral vascular disease was also ascertained., Results: The percentages of patients with overt nephropathy in the three groups were 19.2, 38.0 and 41.2, respectively. Significant linear trends were observed for serum creatinine (P=0.004), albumin (P=0.017) and eGFR (P=0.030). A higher per cent had abnormal nerve conduction on electrophysiology than that diagnosed clinically (65.4 vs. 44.2, 76.0 vs. 40.0 and 64.8 vs. 48.6, respectively). The odds ratio (95% CI) for co-existence of nephropathy, neuropathy, CVA (cerebrovascular accidents) and PVD (peripheral vascular disease) was 2.9, 0.9, 4.8 and 3.5, respectively. Independent of retinopathy severity, patients with clinically significant macular oedema (CSME) had a higher percentage of nephropathy ( p0 < 0.005)., Interpretation & Conclusions: The co-existence of overt nephropathy, nerve conduction based neuropathy and macrovascular co-morbidity in patients with early grades of diabetic retinopathy was significant. Screening for overt nephropathy by eGFR should be considered in all patients with clinically significant macular oedema.
- Published
- 2014
41. A study of impact of cost-effective nutritional supplement in patients on maintenance hemodialysis.
- Author
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Rangarajan D, Ramakrishnan S, Patro KC, Vakrani G, and Badrinath S
- Abstract
Nutritional status in patients on hemodialysis is always of concern as malnutrition predisposes to excess morbidity and mortality. Most of the nutritional supplements available in the market are expensive. We explored the possibility of improving nutrition of the patients on maintenance hemodialysis by supplementation of calories and proteins that can be given in the form of a palatable and economical gruel in this prospectively designed, open labeled study. Patients who were on maintenance hemodialysis (twice a week) for a period of at least 6 months were divided into two groups. The study group was given the gruel supplement and the control group was not given the gruel supplement. Nutritional status was assessed in the study group and controls at 0 and 3 months by the following parameters: percentage body fat, mid arm muscle circumference and serum albumin. Analysis of results revealed that there was a significant decline in the protein intake at the end of the 3(rd) month in the control group (P = 0.01). Other parameters did not show significant change at the end of the study period in both groups. The nutritional supplement can be assumed to have helped at least in the maintenance of protein intake over this short period and could possibly in the long run contribute to improvement of nutritional parameters.
- Published
- 2014
- Full Text
- View/download PDF
42. Pneumocephalus in mixed aerobic and anaerobic (Bacteroides fragilis) meningitis.
- Author
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Ramakrishnan S, Krishnan P, Chandra PS, VeenaKumari HB, and Nagarathna S
- Subjects
- Bacteroides Infections microbiology, Brain pathology, Coinfection complications, Coinfection diagnosis, Coinfection microbiology, Humans, Magnetic Resonance Imaging, Male, Meningitis, Bacterial microbiology, Middle Aged, Pneumocephalus pathology, Radiography, Thoracic, Tuberculosis, Pulmonary diagnosis, Tuberculosis, Pulmonary pathology, Bacteroides Infections complications, Bacteroides Infections diagnosis, Bacteroides fragilis isolation & purification, Meningitis, Bacterial complications, Meningitis, Bacterial diagnosis, Pneumocephalus diagnosis
- Published
- 2014
- Full Text
- View/download PDF
43. Classical Supravalvar Aortic Stenosis and Peripheral Pulmonary Stenosis.
- Author
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Kahr PC, Gupta SK, Kothari SS, and Ramakrishnan S
- Abstract
Supravalvar aortic stenosis as well as peripheral pulmonary stenosis are rare forms of congenital heart disease, which occur, however, relatively frequently in association. Here we report and discuss the classical findings of SVAS and PPS upon clinical examination and imaging in a six-year-old girl that presented with repeated respiratory tract infections and failure to thrive.
- Published
- 2014
44. Native valve Escherichia coli endocarditis following urosepsis.
- Author
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Rangarajan D, Ramakrishnan S, Patro KC, Devaraj S, Krishnamurthy V, Kothari Y, and Satyaki N
- Abstract
Gram-negative organisms are a rare cause of infective endocarditis. Escherichia coli, the most common cause of urinary tract infection and gram-negative septicemia involves endocardium rarely. In this case report, we describe infection of native mitral valve by E. coli following septicemia of urinary tract origin in a diabetic male; subsequently, he required prosthetic tissue valve replacement indicated by persistent sepsis and congestive cardiac failure.
- Published
- 2013
- Full Text
- View/download PDF
45. Lipid storage myopathy with clinical markers of Marfan syndrome: A rare association.
- Author
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Ramakrishnan S, Narayanappa G, and Christopher R
- Abstract
Disorders of lipid metabolism can cause variable clinical presentations, often involving skeletal muscle, alone or together with other tissues. A 19-year-old boy presented with a 2-year history of muscle pain, cramps, exercise intolerance and progressive weakness of proximal lower limbs. Examination revealed skeletal markers of Marfan syndrome in the form of increased arm span compared with height, Kyphoscoliois, moderate pectus excavatum, high arched palate and wrist sign. He also had mild neck flexor weakness and proximal lower limb weakness with areflexia. Pathologic findings revealed lipid-laden fine vacuoles in the muscle fibers. Possibility of carnitine deficiency myopathy was considered and the patient was started on carnitine and Co Q. The patient made remarkable clinical improvement over the next 2 months. This case is reported for rarity of the association of clinical markers of Marfan syndrome and lipid storage myopathy and sparse literature on lipid storage myopathy in the Indian context.
- Published
- 2012
- Full Text
- View/download PDF
46. Molecular & phenotypic characterization of Staphylococcus epidermidis in implant related infections.
- Author
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Prasad S, Nayak N, Satpathy G, Nag HL, Venkatesh P, Ramakrishnan S, Ghose S, and Nag TC
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Phenotype, Staphylococcus epidermidis genetics, Virulence, Prostheses and Implants microbiology, Staphylococcus epidermidis isolation & purification
- Abstract
Background & Objectives: The discrimination between the Staphylococcus epidermidis colonizing the deep seated indwelling devices and those which are mere commensals has always been a challenge for the clinical microbiologist. This study was aimed to characterize the S. epidermidis isolates obtained from device related infection for their phenotypic and molecular markers of virulence and to see whether these markers can be used to differentiate the pathogenic S. epidermidis from the commensals., Methods: Fifty five S. epidermidis isolates from various device related infections such as endophthalmitis following intra-ocular lens (IOL) implantation, intravascular (IV) catheter related sepsis and orthopaedic implant infections, were studied for slime production, biotyping, antibiotic sensitivity; and mec A and ica positivity by the recommended procedures., Results: Twenty three (41.8%) isolates were multi-drug resistant, 26 (65.2%) were slime producers, 30 (54.5%) were adherent, 23 (41.8%) possessed the intercellular adhesin (ica) gene, and 28 (50.9%) harboured the mec A gene. Biotypes I and III were the commonest, most members of which were multi- drug resistant. Twenty two (73.3%) of the 30 adherent bacteria were slime producers as opposed to only 4 (16%) of the 25 non-adherent bacteria (P<0.001). A vast majority i.e. 21 (91.3%) of the 23 ica positive organisms were adherent to artificial surfaces in contrast to only 9 (28.1%) of the 32 non-ica positive organisms (P<0.001). Twenty (86.9%) of the 23 ica positive bacteria were slime producers, as opposed to only 6 (18.7%) of the 32 ica negative bacteria (P<0.001). Of the 23 multi-drug resistant isolates, 19 (82.6%) carried the mec A gene., Interpretation & Conclusions: The present findings showed that ica AB and mec A were the two important virulence markers of S. epidermidis in implant infections and slime was responsible for the sessile mode of attachment on the devices.
- Published
- 2012
47. Situs inversus with levocardia and congenitally corrected transposition of great vessels with rheumatic tricuspid valve stenosis and regurgitation.
- Author
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Kukreti BB, Ramakrishnan S, and Bhargava B
- Abstract
Congenitally corrected transposition of great arteries is a rare congenital anomaly. This case report describes a 30-year-old patient of congenitally corrected transposition of the great arteries with rheumatic involvement of systemic (tricuspid) atrio-ventricular valve.
- Published
- 2011
- Full Text
- View/download PDF
48. Total antioxidant capacity in Eales' disease, uveitis & cataract.
- Author
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Selvi R, Angayarkanni N, Biswas J, and Ramakrishnan S
- Subjects
- Adult, Ascorbic Acid blood, Ascorbic Acid metabolism, Cataract blood, Female, Glutathione blood, Glutathione metabolism, Humans, Male, Middle Aged, Neovascularization, Pathologic blood, Retinal Vasculitis blood, Spectrophotometry, Superoxide Dismutase blood, Superoxide Dismutase metabolism, Thiobarbituric Acid Reactive Substances metabolism, Uveitis blood, Vitamin E blood, Vitamin E metabolism, Cataract metabolism, Neovascularization, Pathologic metabolism, Oxidative Stress, Retinal Vasculitis metabolism, Uveitis metabolism
- Abstract
Background & Objectives: The human system possesses antioxidants that act harmoniously to neutralize the harmful oxidants. This study was aimed to evaluate the serum total antioxidant capacity (TAC) as a single parameter in Eales' disease (ED) and in an acute inflammatory condition such as uveitis and in cataract which is chronic, compared to healthy controls., Methods: The TAC assay was done spectrophotometrically in the serum of Eales' disease cases (n=20) as well as in other ocular pathologies involving oxidative stress namely, uveitis and cataract (n=20 each). The oxidative stress measured in terms of TBARS, was correlated with the TAC. Individual antioxidants namely vitamin C, E and glutathione were also estimated and correlated with TAC., Results: TAC was found to be significantly lower in Eales' disease with active vasculitis (0.28 ± 0.09 mM, P<0.001), Eales' disease with healed vasculitis (0.67 ± 0.09 mM), uveitis (0.46 ± 0.09 mM, P<0.001) and cataract (0.53 ± 0.1 mM, P=0.001) compared to the healthy controls, with a TAC level of 0.77 ± 0.09 mM. The TAC was found to correlate positively with vitamin E levels (P=0.05), GSH (P=0.02) but not with vitamin C, as seen in ED cases. In ED cases supplemented with vitamin E and C, there was a significant increase in the TAC level (P=0.02)., Interpretation & Conclusions: The TAC measurement provided a comprehensive assay for establishing a link between the antioxidant capacity and the risk of disease as well as monitoring antioxidant therapy. This method is a good substitute for assay of individual antioxidants as it clearly gives the status of the oxidative stress in the disease process.
- Published
- 2011
49. Persistence of goitre in the post-iodization phase: micronutrient deficiency or thyroid autoimmunity?
- Author
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Das S, Bhansali A, Dutta P, Aggarwal A, Bansal MP, Garg D, Ravikiran M, Walia R, Upreti V, Ramakrishnan S, Sachdeva N, and Bhadada SK
- Subjects
- Adolescent, Case-Control Studies, Child, Female, Humans, India epidemiology, Iodine administration & dosage, Male, Nutritional Status, Thyroid Hormones metabolism, Autoimmunity immunology, Goiter, Endemic diet therapy, Goiter, Endemic epidemiology, Iodine metabolism, Micronutrients deficiency, Sodium Chloride, Dietary administration & dosage, Thyroid Gland immunology
- Abstract
Background & Objectives: Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India., Methods: Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of T3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium., Results: Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, P = 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 μg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism (subclinical and clinical) and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 μg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P < 0.01). More number of goitrous children (39, 20.6%) were depleted of tissue iron stores (serum ferritin <12 μg/l) as compared to controls (11, 6.4%; P < 0.001). Serum ferritin level negatively correlated with the presence of goitre (r = -0.22, P = 0.008) and had an OR of 2.8 (CI 1.20-6.37, P = 0.017)., Interpretation & Conclusions: There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation.
- Published
- 2011
50. Post transplant thrombotic microangiopathy causing acute renal failure.
- Author
-
Qutube S, Arun KG, Jayaram N, Ramakrishnan S, and Dilip R
- Abstract
Acute Renal Failure (ARF) in the immediate post transplant period is most commonly due to acute tubular necrosis, acute cellular rejection and calcineurin inhibitor toxicity apart from usual prerenal and post renal causes. In this report, we discuss an interesting and unusual cause of ARF due to thrombotic micro angiopathy in the immediate post transplant setting.
- Published
- 2009
- Full Text
- View/download PDF
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