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Hiremath R, Patil S, Kasi Viswanath HM, Kadam DB. Non-communicable disease risk factors among people living with HIV/AIDS (PLHA) – A relook during the covid-19 pandemic. J Family Med Prim Care 2022; 11:498-502. [PMID: 35360797 PMCID: PMC8963592 DOI: 10.4103/jfmpc.jfmpc_892_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The Covid-19 pandemic has resulted in syndemic due to factors like overcrowding, loneliness, poor nutrition, and lack of access to health care services. With the ongoing pandemic, people with NCDs, including PLHA, are at high risk for developing severe and even fatal Covid-19 infections. Our study, which was carried out prior to the pandemic gives us an insight into the NCD risk factors profile of PLHAs so that effective interventions could be initiated to protect them from Covid-19 severity and NCDs. Materials And Methods: A prospective study was carried out among PLHA in western Maharashtra, where PLHA were selected from five ART centers by means of a systematic random sampling method. Data were collected by means of a pretested questionnaire to assess NCD risk factors and anthropometric measurements were done. Data were collected at the baseline during the time of ART initiation and then after one year. Analysis was done by means of SPSS software (version 20.0). Results: The mean age of the study participants was 41.73 years. 59% belonged to rural areas, 21% were illiterate, and 12% belonged to the lower class as per the Modified BG Prasad scale. 33% were laborers by occupation, 66% were married, and 22% were widowed. At baseline, during the start of ART, 26% of the subjects were found to be overweight or obese, 36% had tobacco or smoking habits, and 15% had alcohol consumption habits. Even after one year, despite repeated counseling, about 32% of the subjects were found to be overweight or obese, 28% had tobacco and 8% had alcohol consumption habits, pointing to the need to integrate NCD prevention measures, such as screening routinely as per the national program, even in the PLHAs. 34% had normal BMI, while 35% were underweight, 14% overweight, and 17% obese after one year. 24% of PLHA had abnormal waist circumference at the end of one year. Conclusion: These findings indicate the incorporation of early screening for NCD risk factors among PLHA and effective behavior change communication (BCC) strategies to prevent and manage the same at the earliest before it can aggravate the already compromised immune status in these subjects, particularly during this Covid 19 pandemic. It will also act as a guiding article for family physicians or primary care physicians to help them look at specific basic parameters while screening of NCDs among PLHAs.
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Hiremath R, Viswanath K, Manjunath SR, Kadam DB, Raj R, Nimbannavar S, Kulkarni M. Water, sanitation, and hygiene (WaSH) practices among people living with HIV/AIDS (PLHA) – need to relook, in the era of COVID-19 pandemic. J Family Med Prim Care 2022; 11:3943-3949. [DOI: 10.4103/jfmpc.jfmpc_799_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/04/2022] Open
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Hiremath RN, Patil SS, Yadav AK, Kadam DB. Quality of Life and Nutritional Status of People Living with HIV/AIDS (PLHA’s) in Western Maharashtra-A Prospective Cohort Study. J Clin Diagn Res 2019. [DOI: 10.7860/jcdr/2019/37487.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Harale M, Alurkar A, Basavaraj A, Kadam DB, Chandanwale A. Co-relation of Cerebral Venous Sinus Thrombosis with Vitamin B12 and Homocysteine Levels in a Tertiary Care Centre. J Assoc Physicians India 2019; 67:34-37. [PMID: 30935170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Manasi Harale
- Resident, B.J. Government Medical College, Pune and Sassoon General Hospitals, Pune, Maharashtra
| | - Anand Alurkar
- Associate Professor, B.J. Government Medical College, Pune and Sassoon General Hospitals, Pune, Maharashtra
| | - Anita Basavaraj
- Associate Professor, B.J. Government Medical College, Pune and Sassoon General Hospitals, Pune, Maharashtra
| | - D B Kadam
- Professor and Head of Department, Department of Medicine, B.J. Government Medical College, Pune and Sassoon General Hospitals, Pune, Maharashtra
| | - A Chandanwale
- Dean, B.J. Government Medical, College, Pune and Sassoon General Hospitals, Pune, Maharashtra
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Kadam DB, Salvi S, Chandanwale A. Methanol Poisoning. J Assoc Physicians India 2018; 66:47-50. [PMID: 30347953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mortality associated with methanol has been of great concern time and again. The concurrence of cases from a particular area raises doubts about methanol as the culprit. Knowledge of the patho-physiological changes that occur in the body after methanol consumption is essential for all practicing doctors. This article elucidates the clinical presentation and emergency management of these cases under the framework of basic physiological and biochemical phenomena after methanol exposure. Conversion of methanol to formaldehyde by hepatic enzyme alcohol dehydrogenase triggers the cascade of metabolic events. The manifestations begin as early as 30 minutes and progress to decompensated metabolic acidosis in about 12 hours, if left untreated. Seizures, hypoglycemia and blindness frequently complicate the picture. Acute kidney injury warrants urgent haemodialysis. Fundoscopic examination and arterial blood gas analysis are the key diagnostic elements. The management comprises of intravenous sodium bicarbonate, correction of dyselectrolytemia, ethanol, folic acid and haemodialysis, if necessary. The basic steps in approach must be carried out in the emergency department and followed-up with meticulous monitoring in the intensive care unit for salvage as well as prevention of long term sequelae.
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Daswani BR, Chandanwale AS, Kadam DB, Ghongane BB, Ghorpade VS, Manu HC. Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases. J Clin Diagn Res 2017; 11:FC17-FC21. [PMID: 29207729 DOI: 10.7860/jcdr/2017/20132.10670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/01/2017] [Indexed: 11/24/2022]
Abstract
Introduction Considering the cost of Anti-Snake Venom (ASV) and irregularity in its supply, there is often a need to curtail doses of ASV, despite guidelines for management of snake bite. During June 2013 to September 2013, when ASV was in short supply, our institutional committee reviewed the overall hospital statistics of snake bite cases as well as scientific literature and formulated a working modified protocol that used low dose of ASV in snake bite cases. Aim To retrospectively analyse and compare the modified ASV protocol versus conventional ASV protocol with respect to outcome, number of ASV vials required, duration of stay in the hospital/ ICU, and additional supportive interventions needed. Materials and Methods This was a retrospective study conducted at a tertiary care teaching hospital, Maharashtra, India. Hospital records of inpatients admitted for snake bite during June 2013 to September 2013 (since introduction of the modified protocol) as well as during June 2012 to September 2012, (when patients received conventional protocol-historical controls) were retrospectively analysed to assess the number of ASV vials received by the patients during the stay, need for supportive therapy, duration of stay and outcome of the patients. Results There was a significant reduction in average number of ASV vials per patient, required vide the modified protocol compared to their historical controls (10.74±0.95 vs 28.17±2.75 p<0.001). There was no significant difference in outcome, need for dialysis, fresh frozen plasma requirement, need for ICU stay and duration of hospitalization of snake bite patients. Yet, the average cost of management of each patient reduced by approximately 11974.41 INR per treated patient, based on the requirement of ASV. Conclusion The modified ASV protocol used in this study is more cost effective as compared to the conventional protocol, deserves prospective evaluation and may be followed at least during prime time of scarcity of ASV.
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Affiliation(s)
- B R Daswani
- Associate Professor, Department of Pharmacology, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - A S Chandanwale
- Dean, BJ Government Medical College and Sassoon General Hospitals, Pune Maharashtra, India
| | - D B Kadam
- Professor and Head, Department of Medicine, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - B B Ghongane
- Professor and Head, Department of Pharmacology, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - V S Ghorpade
- Assistant Professor, Department of Pharmacology, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
| | - H C Manu
- Student, Department of Pharmacology, BJ Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
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Karade SK, Kulkarni SS, Ghate MV, Patil AA, Londhe R, Salvi SP, Kadam DB, Joshi RK, Rewari BB, Gangakhedkar RR. Antiretroviral resistance following immunological monitoring in a resource-limited setting of western India: A cross-sectional study. PLoS One 2017; 12:e0181889. [PMID: 28763465 PMCID: PMC5538665 DOI: 10.1371/journal.pone.0181889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The free antiretroviral therapy (ART) program in India still relies on the clinico-immunological monitoring for diagnosis of treatment failure. As the nucleoside reverse transcriptase inhibitor (NRTI) backbone is shared in first- and second-line regimens, accumulation of drug resistant mutations (DRMs) can compromise the efficacy of NRTI. This study was undertaken to describe the pattern of HIV DRMs following immunological monitoring and investigate its impact on the cycling of NRTI between first- and second-line ART. METHODS AND FINDINGS This cross-sectional study was performed at a state-sponsored ART clinic of Pune city in western India between January and June 2016. Consecutive adults receiving first-line ART with immunological failure (IF) were recruited for plasma viral load (PVL) estimation. Randomly selected 80 participants with PVL >1000 copies/mL underwent HIV drug resistance genotyping. Of these, 75 plasma sample were successfully genotyped. The median CD4 count and duration of ART at the time of failure were 98 (IQR: 61.60-153.50) cells/μL and 4.62 (IQR: 3.17-6.15) years, respectively. The prevalence of NRTI, non-NRTI, and major protease inhibitor resistance mutations were 89.30%, 96%, and 1.33%, respectively. Following first-line failure, sequences from 56.67% of individuals indicated low- to high-level resistance to all available NRTI. The proportion of sequences with ≥2 thymidine analogue mutations (TAMs) and ≥3 TAMs were 62.12% and 39.39%, respectively. An average of 1.98 TAMs per sequence were observed following IF as compared to 0.37 TAMs per sequence following targeted PVL monitoring at 12 months of ART from a prior study; this difference was significant (p<0.001). CONCLUSION The option of cycling of NRTI analogues between first- and second-line regimens would no longer be effective if individuals are followed-up by immunological monitoring due to accumulation of mutations. Introduction of routine PVL monitoring is a priority for the long-term sustainability of free ART program in India.
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Affiliation(s)
- Santosh K. Karade
- HIV Drug Resistance Laboratory, National AIDS Research Institute (ICMR), Pune, India
- Department of Microbiology, Armed Forces Medical College, Pune, India
| | - Smita S. Kulkarni
- Department of Virology, National AIDS Research Institute (ICMR), Pune, India
| | - Manisha V. Ghate
- Department of Clinical Sciences, National AIDS Research Institute (ICMR), Pune, India
| | - Ajit A. Patil
- HIV Drug Resistance Laboratory, National AIDS Research Institute (ICMR), Pune, India
| | - Rajkumar Londhe
- Department of Virology, National AIDS Research Institute (ICMR), Pune, India
| | - Sonali P. Salvi
- Department of Medicine, BJ Medical College and Sasoon General Hospital, Pune, India
| | - Dileep B. Kadam
- Department of Medicine, BJ Medical College and Sasoon General Hospital, Pune, India
| | - Rajneesh K. Joshi
- Department of Epidemiology and Biostatistics, National AIDS Research Institute (ICMR), Pune, India
- Department of Community Medicine, Armed Forces Medical college, Pune, India
| | - Bharat B. Rewari
- Department of AIDS Control, National AIDS Control Organization, New Delhi, India
| | - Raman R. Gangakhedkar
- Department of Clinical Sciences, National AIDS Research Institute (ICMR), Pune, India
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Karade SK, Ghate MV, Chaturbhuj DN, Kadam DB, Shankar S, Gaikwad N, Gurav S, Joshi R, Sane SS, Kulkarni SS, Kurle SN, Paranjape RS, Rewari BB, Gangakhedkar RR. Cross-sectional study of virological failure and multinucleoside reverse transcriptase inhibitor resistance at 12 months of antiretroviral therapy in Western India. Medicine (Baltimore) 2016; 95:e4886. [PMID: 27631260 PMCID: PMC5402603 DOI: 10.1097/md.0000000000004886] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The free antiretroviral therapy (ART) program in India has scaled up to register second largest number of people living with HIV/AIDS across the globe. To assess the effectiveness of current first-line regimen we estimated virological suppression on completion of 1 year of ART. The study describes the correlates of virological failure (VF) and multinucleoside reverse transcriptase inhibitor (NRTI) drug resistance mutations (DRMs).In this cross-sectional study conducted between June and August 2014, consecutive adults from 4 State sponsored ART clinics of western India were recruited for plasma viral load screening at 12 ± 2 months of ART initiation. Individuals with plasma viral load >1000 copies/mL were selected for HIV drug resistance (HIVDR) genotyping. Logistic regression analyses were performed to assess factors associated with VF and multi-NRTI resistance mutations. Criteria adopted for multi-NRTI resistance mutation were either presence of K65R or 3 or more thymidine analog mutations (TAMs) or presence of M184V along with 2 TAMs.Of the 844 study participants, virological suppression at 1 year was achieved in 87.7% of individuals. Factors significantly associated with VF (P < 0.005) were 12 months CD4 count of ≤100 cells/μL (adjusted OR -7.11), low reported adherence (adjusted OR -4.44), and those living without any partner (adjusted OR -1.98). In patients with VF, the prevalence of non-nucleoside reverse transcriptase inhibitor (NNRTI) DRM (78.75%) were higher as compared to NRTI (58.75%). Multi-NRTI DRMs were present in 32.5% of sequences and were significantly associated with CD4 count of ≤100 cells/μL at baseline (adjusted OR -13.00) and TDF-based failing regimen (adjusted OR -20.43). Additionally, low reported adherence was negatively associated with multi-NRTI resistance (adjusted OR -0.11, P = 0.015). K65R mutation was significantly associated with tenofovir (TDF)-based failing regimen (P < 0.001).The study supports early linkage of HIV-infected individuals to the program for ART initiation, adherence improvement, and introduction of viral load monitoring. With recent introduction of TDF-based regimen, the emergence of K65R needs to be monitored closely among HIV-1 subtype C-infected Indian population.
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Affiliation(s)
| | - Manisha V. Ghate
- Department of Clinical Sciences, National AIDS Research Institute
| | | | - Dileep B. Kadam
- Department of Medicine, BJ Medical College and Sasoon General Hospital, Pune
| | | | - Nitin Gaikwad
- Department of Tuberculosis and Chest Diseases, YCM Hospital
| | | | | | | | | | | | | | - Bharat B. Rewari
- Department of AIDS Control, National AIDS Control Organization, New Delhi, India
| | - Raman R. Gangakhedkar
- Department of Clinical Sciences, National AIDS Research Institute
- Correspondence: Raman R. Gangakhedkar, National AIDS Research Institute (ICMR), 73 G Block, MIDC Bhosari, Pune 411026, India (e-mail: )
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Kadam DB, Salvi S, Chandanwale A. Expanded Dengue. J Assoc Physicians India 2016; 64:59-63. [PMID: 27759344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The World Health Organization (WHO) has coined the term expanded dengue to describe cases which do not fall into either dengue shock syndrome or dengue hemorrhagic fever. This has incorporated several atypical findings of dengue. Dengue virus has not been enlisted as a common etiological agent in several conditions like encephalitis, Guillain Barre syndrome. Moreover it is a great mimic of co-existing epidemics like Malaria, Chikungunya and Zika virus disease, which are also mosquito-borne diseases. The atypical manifestations noted in dengue can be mutisystemic and multifacetal. In clinical practice, the occurrence of atypical presentation should prompt us to investigate for dengue. Knowledge of expanded dengue helps to clinch the diagnosis of dengue early, especially during ongoing epidemics, avoiding further battery of investigations. Dengue has proved to be the epidemic with the ability to recur and has a diverse array of presentation as seen in large series from India, Srilanka, Indonesia and Taiwan. WHO has given the case definition of dengue fever in their comprehensive guidelines. Accordingly, a probable case is defined as acute febrile illness with two or more of any findings viz. headache, retro-orbital pain, myalgia, arthralgia, rash, hemorrhagic manifestations, leucopenia and supportive serology. There have been cases of patients admitted with fever, altered mentation with or without neck stiffness and pyramidal tract signs. Some had seizures or status epilepticus as presentation. When they were tested for serology, dengue was positive. After ruling out other causes, dengue remained the only culprit. We have come across varied presentations of dengue fever in clinical practice and the present article throws light on atypical manifestations of dengue.
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Basavaraj A, Kadam M, Kadam DB. Primary Maxillary Sinus Plasmablastic Lymphoma in HIV/AIDS. J Assoc Physicians India 2016; 64:71-72. [PMID: 27735156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Classically, the HIV/AIDS-related lymphomas are of the B cell type and involve the central nervous system and the abdominal cavity. Primary maxillary sinus lymphoma is rare. Plasmablastic lymphoma (PBL) is an aggressive form of non-Hodgkinvs lymphoma, and is extremely rare. Here we present a case of plasmablastic lymphoma with primary site being maxillary sinus, a rare location.
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Affiliation(s)
| | | | - D B Kadam
- Professor and Head, Department of Medicine, Sassoon General Hospital, Pune, Maharashtra
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Ghate MV, Kadam DB, Gurav NP, Rewari BB, Gangakhedkar RR. Hypersensitivity Reactions in HIV Infected Individuals after Substitution of Antiretroviral Drug Regimen: Need for Pharmacovigilance in the National Program. J Assoc Physicians India 2015; 63:94-95. [PMID: 27608708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | | | - Nilam P Gurav
- Technical Assistant, National AIDS Research Institute
| | - Bharat B Rewari
- WHO National Consultant, National AIDS Control Organisation, New Delhi
| | - Raman R Gangakhedkar
- Scientist F and Director in Charge, National AIDS Research Institute, Pune, Maharashtra
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Marcelo A, Ganesh J, Mohan J, Kadam DB, Ratta BS, Kulatunga G, John S, Chandra A, Primadi O, Mohamed AAS, Khan MAH, Azad AA, Marcelo P. Governance and management of national telehealth programs in Asia. Stud Health Technol Inform 2015; 209:95-101. [PMID: 25980710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
UNLABELLED Telehealth and telemedicine are increasingly becoming accepted practices in Asia, but challenges remain in deploying these services to the farthest areas of many developing countries. With the increasing popularity of universal health coverage, there is a resurgence in promoting telehealth services. But while telehealth that reaches the remotest part of a nation is the ideal endpoint, such goals are burdened by various constraints ranging from governance to funding to infrastructure and operational efficiency. OBJECTIVES enumerate the public funded national telehealth programs in Asia and determine the state of their governance and management. METHOD Review of literature, review of official program websites and request for information from key informants. CONCLUSIONS While there are national telehealth programs already in operation in Asia, most experience challenges with governance and subsequently, with management and sustainability of operations. It is important to learn from successful programs that have built and maintained their services over time. An IT governance framework may assist countries to achieve success in offering telehealth and telemedicine to their citizens.
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Affiliation(s)
| | - Jai Ganesh
- Sri Sathya Sai Central Trust, Prasanthi Nilayam, Andhra Pradesh, India
| | - Jai Mohan
- International Medical University, Malaysia
| | | | | | | | - Sheila John
- Medical Research Foundation, Sankara Nethralaya, Chennai, India
| | - Andry Chandra
- Directorate Ancillary and Health Facility, Ministry of Health Indonesia
| | - Oscar Primadi
- Center of Data & Information, Ministry of Health Indonesia
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Basavaraj A, Kadam M, Chugh A, Kadam DB. Spinal intramedullary lipoma without dysraphism. J Assoc Physicians India 2014; 62:42. [PMID: 25906520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Basavaraj A, Kulkarni R, Kadam DB. Gastric Antral Vascular Ectasia. J Assoc Physicians India 2014; 62:842-845. [PMID: 26259325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Iron deficiency anaemia secondary to gastrointestinal bleeding is very common in the elderly. Gastric antral vascular ectasia (GAVE) syndrome, also known as watermelon stomach is an uncommon but significant cause of acute or chronic gastrointestinal blood loss in the elderly. It is characterised endoscopically by "watermelon stripes." It is more common in females than males, and manifests mostly as iron deficiency anaemia due to the gradual blood loss. Pathogenesis is unknown though several humoral factors have been proposed. Diagnosis is based on the clinical history and endoscopic appearance and histological changes. We describe elderly patient who presented with haematemesis and iron deficiency anaemia and was diagnosed to have GAVE and was treated successfully with endoscopic band ligation.
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Basavaraj A, Shinde A, Kulkarni R, Kadam DB, Chugh A. HIV associated Burkitt's lymphoma. J Assoc Physicians India 2014; 62:723-727. [PMID: 25856946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Burkitt's lymphoma (BL) is a highly aggressive B-cell non-Hodgkin Lymphoma (NHL) associated with chromosomal translocations resulting in upregulation of the proto-oncogene C-MYC, which drives progression through the cell cycle NHL accounts for approximately one third of AIDS-related malignancies and the frequency of BL is 2.4-20% of HIV-associated NHL. The outcome of HIV-associated non-Hodgkin lymphoma (NHL) has improved substantially in the highly active antiretroviral therapy (HAART) era. However, HIV-Burkitt lymphoma (BL), which accounts for up to 20% of HIV-NHL, still has poor outcome with standard chemotherapy. We present here a 26 years old female who presented with congestive cardiac failure and sudden onset paraparesis and was finally diagnosed to have right atrial mass and had extradural lesion extending from L2 to S1 which turned out to be High grade NHL-Burkitt's Lymphoma.
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Borse RT, Kadam DB, Sangle SA, Basavraj A, Prasad HB, Umarji PB, Jamkar AV. Comparison of demographic, clinical, radiological characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of influenza A (H1N1). J Assoc Physicians India 2013; 61:887-893. [PMID: 24968544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. Simple demographic, clinical and radiological variables are described in this article in mechanically ventilated and nonventilated patients. OBJECTIVES To describe and correlate demographic, clinical, radiographic characteristics and comorbidities in mechanically ventilated and nonventilated, adult patients admitted in ICU with confirmed diagnosis of Influenza A(H1N1) infection. MATERIAL AND METHODS Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A (H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine demographic, clinical and radiographic features, comorbidities, mechanical ventilator required or not. RESULTS 35 Patients required mechanical ventilation. 27 required IMV, 4 required NIMV while 4 patients initially were put on NIMV required IMV subsequently. 19 (40.42%) female patients required mechanical ventilator. Mean age of mechanically ventilated patients was 33 years, mean duration of illness was 7.9 days, mean duration of hospital stay was 6.8 days. 07 (20.00%) patients with pregnancy, 05 (14.29%) with DM, 05 (14.29%) with HT, 04/11.43%) with obesity required mechanical ventilator. 97.14% patients with fever, 88.54% with breathlessness, 11.43% with haemoptysis, 31.42% patients with throat pain required mechanical ventilator. However except Tachypnoea (p <0.01) no other symptom was statistically significant for mechanical ventilation 33(36.26%) patients with abnormal X ray,16 (80.00%) patients with right sided, 09(60.00%) patients with left sided and 40(71.43%) patients with bilateral disease required mechanical ventilator, right sided (p < 0.01) and bilateral (p <0.01) disease is statistically significant for requirement of mechanical ventilator. 33(47.14%) patients with lower zone involvement, 44 (67.70%) patients with middle zone and 23 (47.92%) patients with upper zone involvement required mechanical ventilator. Upper zone disease (p < 0.01) and middle zone disease (p < 0.01) is statistically significant for requirement of ventilator. 23 (47.92%) patients with right upper zone, 29 (42.64%) patients with right middle zone, 29 (46.77%) with left middle zone, 32 (42.67%) with right lower zone involvement required mechanical ventilator. RUZ (p < 0.01), RMZ (p < 0.01), LMZ (p < 0.001) and RLZ (p < 0.01) involvement had statistical significance for requirement of mechanical ventilator. 20 (33.89%) patients with patchy consolidation, 08 (36.36%) patients with reticulonodular and 05 (50.00%) patients with nodular pattern required mechanical ventilator however none of the pattern is statistically significant for mechanical ventilator. 08 (72.72%) patients with 6 zone involvement, 05 (50.00%) patients with single zone, 08 (40.00%)patients with 4 zone and 06 (33.33%) patients with 3 zone involvement required mechanical ventilator,however none was statistically significant for mechanical ventilator. All four patients requiring NIMV survived, while 28 died out of 31 on IMV. CONCLUSIONS Mechanical ventilation requirement was more in females, in presence of comorbidities like pregnancy, DM, HT, in presence of tachypnoea, in presence of bilateral disease and in presence of middle zone and right upper zone disease and with multiple zone disease. All patients with heart involvement required mechanical ventilator. If there is radiological finding of right upper zone involvement, then, there is more probability that these patients require mechanical ventilator for case management. Similarly, RMZ, LMZ and RLZ and cardiomegaly if shown in X-ray, the necessity of ventilator management is more.
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Borse RT, Kadam DB, Sangle SA, Basavraj A, Prasad HB, Umarji PB, Khadase GJ, Rao SP, Mave V, Ghorpade SV, Bharadwaj R, Jamkar AV. Clinicoradiologic correlation in adult patients diagnosed with novel influenza A (H1N1). J Assoc Physicians India 2013; 61:600-607. [PMID: 24772694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Influenza A(H1N1) infection affected Indian population in 2009. Patients needed ICU admission and monitoring. OBJECTIVES To describe and correlate clinical and radiographic features of Influenza A(H1N1) infection in patients hospitalised in Intensive care unit. MATERIAL AND METHODS Retrospective study of records of 100 RT-PCR confirmed patients with Influenza A(H1N1) infection from August 2009 to March 2010 was done. Each patient underwent an evaluation to determine clinical and radiographic features. RESULTS Mean age of the patients was 33.43 years (+/- 12.152) with maximum patients between 18-40 years, with 53% males and 43% females. Cough (96%), Fever (95%), breathlessness (83%), throat pain (34%), crepitations (69%), Tachypnoea (59%)were the prominent symptoms and signs. 61% (n = 63) had comorbid condition like pregnancy (n = 13,20.63%), Diabetes Mellitus (DM) (n = 12,19.05%), HT (n = 11,17.60%), Obesity (n = 10, 15.87%) and Rheumatic Valvular Heart Disease (RVHD) (n = 6,09.52%). Chest X ray was abnormal in 91% patients and normal in 09% pts. Bilateral findings were seen in 61.53% cases. Most common zones affected were lower zones (77.46%), then middle zones (71.42%), followed by upper zones (42.7%). Most common patterns were consolidation (64.83%), reticulonodular (24.17%) and nodular (10.98%). 27.47% had two, 21.97% had four, 19.78% had three,12.08% had six, 7.69% had five and 10.98% had single zone involvement. Fever, cough and tachypnoea were present in all 100% pts with nodular pattern while crepitations were observed in 79.66% cases of consolidation. Patchy consolidation was seen in comorbidities like pregnancy (n = 10) and obesity (n = 06), while reticulonodular pattern was observed in hypertensive patients (n = 06). Maximum number of deaths were between 21 and 30 years of age (60.71%). Total number of deaths were 28 with 60.71% (n = 17) deaths between 21 and 30 years of age. Deaths were more in presence of comorbidities like Pregnancy (n = 5, 17.85%), Hypertension (n = 4,14.28%), Diabetes (n = 3 10.21%) and RVHD (n = 3,10.71%), in presence of RLZ involvement (92.85%), RMZ (89.28%), LMZ (85.21%) and RUZ involvement (71.42%), with consolidation pattern (57.14%) followed by reticulonodular pattern (21.42%) and in presence of six zone involvement (36.37%) followed by four zone (35%) and then by three(33%) and two (32%) zone involvement. Mean duration of hospital stay was 9.1 days. 23% patients stayed for less than 5 days, 41% stayed between 9 and 14 days while only 7% required to stay for more than 15 days. 37% pts showed normal Xray at the time of discharge or death. 38% patients showed persistence of radiological lesion at discharge or death. CONCLUSIONS Young to middle age patients were commonly affected. Common comorbidities were Pregnancy, Diabetes, Hypertension, and Obesity and patients had fever, cough, breathlessness, tachypnoea, crepitations as common clinical features. Radiologically it was multizonal, bilateral disease with predominant lower zone involvement and common patterns were consolidation followed by reticulonodular and nodular. Patchy consolidation was more common in pregnancy and obesity while reticulonodular pattern was more in hypertensive patients. Fever, cough and tachypnoea were present in all 100% pts with nodular pattern. Crepitations were common in pts with consolidation. Clinical recovery preceded radiological recovery. Young to middle aged individuals died more. Deaths were more in presence of comorbidities like Pregnancy, HT, DM and RVHD, also with RLZ, RMZ, LMZ involvement and with consolidation pattern and with six zone involvement.
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Chang LW, Kadam DB, Sangle S, Narayanan S, Borse RT, McKenzie-White J, Bowen CW, Sisson SD, Bollinger RC. Evaluation of a multimodal, distance learning HIV management course for clinical care providers in India. ACTA ACUST UNITED AC 2012; 11:277-82. [PMID: 22802357 DOI: 10.1177/1545109712451330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distance learning is an important tool for training HIV health workers. However, there is limited evidence on design and evaluation of distance learning HIV curricula and tools. We therefore designed, implemented, and evaluated a distance learning course on HIV management for clinical care providers in India. After course completion, participant scores rose significantly from a pretest (78.4% mean correct) compared with the posttest (87.5%, P < .001). After course completion, participants were more likely to be confident in starting an initial antiretroviral (ARV) regimen, understanding ARV toxicities, encouraging patient adherence, diagnosing immune reconstitution syndrome, and monitoring patients on ARV medications (P ≤ .05). All participants (100%) strongly agreed/agreed that they would recommend this course to others, and most of them (96%) strongly agreed/agreed that they would take a course in this format again. A pragmatic approach to HIV curriculum development and evaluation resulted in reliable learning outcomes, as well as learner satisfaction and improvement in knowledge.
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Affiliation(s)
- Larry William Chang
- 1Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Prasad HB, Puranik SC, Kadam DB, Sangle SA, Borse RT, Basavraj A, Umarji PB, Mave V, Ghorpade SV, Bharadwaj R, Jamkar AV, Mishra AC. Retrospective analysis of necropsy findings in patients of H1N1 and their correlation to clinical features. J Assoc Physicians India 2011; 59:498-500. [PMID: 21887906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
India reported its first case of H1N1 in July 2009 in Pune and since then, the number of reported cases and deaths exploded in India. Since very little data is available about histopathological findings in patients of H1N1 fatal cases in India, a retrospective chart analysis of necropsy findings of 15 cases of 2009 H1N1 fatal cases was performed. Common clinical features were fever, cough, and breathlessness followed by sore throat and rhinorrhea. Common lung findings were mononuclear cell infiltration, thick alveolar septae, intraalveolar hemorrhage. The other findings were congested pulmonary blood vessels, pulmonary edema, cytomegaly, fibrin accumulation and formation of eosinophilic membrane. These findings are suggestive of diffuse alveolar damage (DAD) and DAD with hemorrhage. All patients who underwent necropsy had radiographic findings suggestive of unilobar or multilobar pneumonia. This clinical finding can be correlated pathologically in these patients as all of them had either polymorphonuclear or mononuclear infiltrate. Furthermore, necrotizing pneumonitis pattern seen on these patients is the likely cause of mortality in these patients. Although clinical ARDS pattern was noted in all these patients, it was well correlated in lung pathology in all these cases.
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Affiliation(s)
- H B Prasad
- B.J. Medical College Clinical Research Site, Pune
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Sangle SA, Vadgaonkar G, Kadam DB, Chadha M. Influenza A (H3N2) associated acute necrotising encephalopathy. J Assoc Physicians India 2011; 59:52-54. [PMID: 21751668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of 16 year old female admitted with complaints of influenza like symptoms followed by convulsions and sudden impairment of consciousness. Magnetic resonance imaging abnormalities were found in bilateral thalami including cerebellum. Diagnosis of influenza associated acute necrotizing encephalopathy was made on the basis of clinical features, neuroimaging findings and isolation of influenza A(H3N2) virus from throat swab. This is probably first case of Influenza associated acute necrotizing encephalopathy reported in India in 2009.
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Affiliation(s)
- S A Sangle
- Dept. of Medicine, B.J. Medical College, Pune
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