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Dutt TS, Tousheed SZ, Annapandian VM. Accuracy of TB-PCR using endobronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) samples in mediastinal granulomatous lymphadenopathy. Indian J Tuberc 2022; 69:565-570. [PMID: 36460390 DOI: 10.1016/j.ijtb.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 08/12/2021] [Accepted: 09/01/2021] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Mediastinal granulomatous lymphadenopathies, such as tuberculous lymphadenitis, sarcoidosis, are frequently encountered by respiratory physicians, and their diagnosis is based on histological and microbiological tests. Endobronchial ultrasound-guided Trans bronchial needle aspiration (EBUS-TBNA) is widely used to perform mediastinal lymph node sampling. However, very limited data is available on the yield of polymerase chain reaction for Mycobacterium tuberculosis (TB-PCR) using EBUS-TBNA samples in patients with mediastinal granulomatous lymphadenopathy. MATERIALS AND METHODS A retrospective study using a prospectively collected database was performed from January 1, 2018 to December 31, 2018, to evaluate the efficacy of the TB-PCR test using EBUS-TBNA samples in patients with benign mediastinal lymphadenopathy which included both granulomatous lymphadenopathy and reactive lymphadenopathy. The cohort with reactive lymphadenopathy acted as the control group of the study population. The patients with mediastinal lymphadenopathy who were awaiting EBUS-TBNA either for diagnostic evaluation of primary disease or for staging of a known malignancy were included in the study. The patients were then followed up for 1 year post procedure with clinical and radiological evaluation. RESULTS Of the 310 patients with mediastinal lymphadenopathy who underwent EBUS-TBNA, 190 cases had a benign pathology with granulomatous lymphadenopathy in 120 and reactive lymphadenopathy in 70 patients. The sensitivity, specificity, the positive predictive value and the negative predictive value of TB-PCR was at 90%, 97.14%, 98.18%, and 85% respectively. The accuracy of TB-PCR is 92.63%. CONCLUSION TB-PCR using EBUS-TBNA samples is an effective tool for diagnosing mediastinal granulomatous lymphadenopathy. This technique can prevent further invasive interventions like mediastinoscopy in patients whose histological and microbiological tests are non-diagnostic. It should always be performed when tuberculosis is in the differential diagnosis of a patient with mediastinal lymphadenopathy.
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Affiliation(s)
- Tiyas Sen Dutt
- Department of Pulmonology, TATA Medical Hospital, New Town, Kolkata, India.
| | - Syed Zulkharnain Tousheed
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India
| | - Vellaichamy M Annapandian
- Department of Pharmacology, Narayana Hrudayalaya Institute of Medical Sciences, Narayana Hrudayalaya Foundations, Bengaluru, India
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Tousheed SZ, Ranganatha R, Hemanth Kumar M, Manjunath PH, Philip DS, Punitha M, Sagar C, Dutt TS, Murali Mohan BV, Zuhaib M, Annapandian VM. Role of medical thoracoscopy in the diagnosis of pleural effusions. Indian J Tuberc 2022; 69:584-589. [PMID: 36460393 DOI: 10.1016/j.ijtb.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/16/2021] [Accepted: 09/13/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Medical thoracoscopy (semi-rigid and rigid thoracoscopy) have revolutionized the management of undiagnosed pleural effusions. Though semi-rigid thoracoscopy has a good diagnostic yield in malignant and tubercular effusions, its role in the management of a complicated pleural effusions is debatable. Hence, rigid thoracoscopy becomes handy in these cases. The present study looked into the role of medical thoracoscopy in the diagnosis of pleural effusions in different conditions. METHODS This study included all patients who underwent medical thoracoscopy at our center between May-2010 and March-2020. Basic demographics data, type of medical thoracoscopy used, and histopathology details were collected and analyzed. RESULTS A total of 373 patients were subjected to medical thoracoscopy (202 semi-rigid thoracoscopy and 171 rigid thoracoscopy). Out of whom 246 (66%) were males, the mean age was 51.9 ± 13.2 years. Diagnosis was achieved in 370 patients with a yield of 99.2%. The diagnostic yield in semi-rigid thoracoscopy was 99.5% with lung malignancy being the most common diagnosis (41%; n = 81), followed by tuberculosis (31%; n = 61). The diagnostic yield in rigid thoracoscopy was 100% in our study. Along with high diagnostic yield, complete drainage and lung expansion was seen in 93.5% (160 out of 171 patients) without requiring a second procedure. CONCLUSIONS Semi-rigid thoracoscopy and rigid thoracoscopy should complement each other in the diagnosis of pleural effusions. Rigid thoracoscopy should be considered as the procedure of choice in a complicated pleural effusion.
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Affiliation(s)
- Syed Zulkharnain Tousheed
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India.
| | - Ramanjaneya Ranganatha
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - M Hemanth Kumar
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - P H Manjunath
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - Danne S Philip
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - M Punitha
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - Chandrasekar Sagar
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - Tiyas Sen Dutt
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - B V Murali Mohan
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - Muhammed Zuhaib
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Hrudayalaya Limited, Bengaluru, Karnataka, India
| | - Vellaichamy M Annapandian
- Department of Pharmacology, Narayana Institute of Medical Sciences, Narayana Hrudayalaya Foundations, Bengaluru, Karnataka, India
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Tousheed SZ, Dutt TS, Annapandian VM. Evolution of semi-rigid thoracoscopy. Indian J Tuberc 2022; 69:12-19. [PMID: 35074144 DOI: 10.1016/j.ijtb.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/04/2021] [Indexed: 06/14/2023]
Abstract
Pleural effusions despite being so common, there is no much literature available regarding definite diagnosis for pleural effusions. Application of Light's criteria changed the approach to pleural effusion and till date remains a very useful step in the diagnosis of pleural effusions. Pleural fluid biochemistry and adenosine deaminase (ADA) enzyme levels play a significant role in the diagnosis of tubercular effusion. Studies have shown that levels of ADA are more often higher in tubercular effusion than in any other cause for it. But ADA levels can also be elevated in other types of parapneumonic effusions (PPEs), especially complicated PPEs. Hence it is difficult to distinguish a tubercular pleural effusion (TPE) from other PPEs based on pleural fluid ADA levels alone. LDH/ADA ratio as an indicator for ruling out tuberculosis was analyzed in few studies with high sensitivity and specificity. The pleural fluid cytology has a varying sensitivity, with a maximum of only 60% and it may increase with subsequent tapping. Closed pleural biopsy using a Cope or Abrams needle has a sensitivity up to 80% in cases of tuberculous effusion and 40%-73% in cases of Malignancies. Semi-rigid thoracoscopy not only allows for visualization of the pleura but also helps in procuring the biopsies under direct visualization from the abnormal looking areas. In cases of primary pleural malignancies like mesothelioma, pleurodesis can also be done in the same setting after taking the biopsy, hence reducing the number of procedures. Limitation of the semi-rigid thoracoscopy is smaller sample size and more superficial sampling of the pleura. Cryobiopsy and Electrocautery guided pleural biopsy using the IT knife are the modifications in the semi-rigid thoracoscopy to overcome the drawback of smaller sample size. While navigation band image guided pleuroscopy helps in better visualization of the vasculature of pleura during the biopsy. Management of pleural effusions has evolved over a period of time. Starting with a single criterion based on pleural fluid proteins to semi-rigid thoracoscopy. The inexhaustible research in this field suggests the desperate need for a gold standard procedure with cost effectiveness in the management of undiagnosed pleural effusions. Semi-rigid thoracoscopy has revolutionized the management of undiagnosed pleural effusions, but it has its own limitations. Various modifications have been proposed and tried to overcome the limitations to make it a cost-effective procedure.
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Affiliation(s)
- Syed Zulkharnain Tousheed
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India.
| | - Tiyas Sen Dutt
- Department of Respiratory Medicine, Peterborough City Hospital, NHS, UK
| | - Vellaichamy M Annapandian
- Department of Pharmacology, Narayana Institute of Medical Sciences, Narayana Hrudayalaya Foundations, Bengaluru, India
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Mohapatra A, Valson AT, Annapandian VM, David VG, Alexander S, Jacob S, Kakde S, Kumar S, Devasia A, Vijayakumar TS, Tamilarasi V, Jacob CK, Basu G, John GT, Varughese S. Post-transplant complications, patient, and graft survival in pediatric and adolescent kidney transplant recipients at a tropical tertiary care center across two immunosuppression eras. Pediatr Transplant 2021; 25:e13973. [PMID: 33463876 PMCID: PMC7615901 DOI: 10.1111/petr.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND We report pediatric PAKT patient and graft outcomes at a large tropical tertiary center spanning two transplant eras. METHODS In this retrospective cohort study, all children ≤18 years who underwent kidney transplantation at our center between 1991 and 2016 were included. Data pertaining to their baseline characteristics, post-transplant events, and outcome were retrieved from transplant records and compared between transplant eras (1991-2005 and 2006-2016). RESULTS A total of 139 children (mean age 15.2 ± 2.9 years) underwent PAKT during this period. The incidence of UTIs, CMV disease, BKVN, invasive fungal infections, new-onset diabetes after transplant, leucopenia, and recurrent NKD was higher in the 2006-2016 era (P < .001 for all), while 1-year cumulative BPAR was comparable (P = .100). Five-year graft and patient survival in the two eras were 89.9% and 94.2% (P = .365) and 92.1% and 95.3% (P = .739), respectively. Incidence of CMV disease, BKVN, graft loss, and death was lower in the calcineurin withdrawal group. Non-adherence accounted for 36% of graft loss; infections caused 43.7% of deaths. On multivariate Cox proportional hazards analysis, independent predictors for graft loss were UTIs and blood transfusion naïve status and for death were serious infections and glomerular NKD. CONCLUSIONS PAKT in India has excellent long-term graft outcomes, though patient outcomes remain suboptimal owing to a high burden of infections. Current immunosuppression protocols need to be re-examined to balance infection risk, graft, and patient survival.
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Affiliation(s)
- Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Anna T. Valson
- Department of Nephrology, Christian Medical College, Vellore, India
| | | | | | | | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Shailesh Kakde
- Department of Nephrology, Christian Medical College, Vellore, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College, Vellore, India
| | - Antony Devasia
- Department of Urology, Christian Medical College, Vellore, India
| | | | | | | | - Gopal Basu
- Department of Nephrology, Christian Medical College, Vellore, India
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Murali Mohan BV, Tousheed SZ, Manjunath PH, Ravichandra MR, Ranganatha R, Annapandian VM, Kumar MH, Sagar C. Multidisciplinary team obviates biopsy in most patients with diffuse parenchymal lung diseases-A retrospective study from India. Clin Respir J 2021; 15:761-769. [PMID: 33721404 DOI: 10.1111/crj.13358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/21/2020] [Accepted: 03/11/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The inflammation and fibrosis in diffuse parenchymal lung diseases (DPLDs) in varied proportions give rise to different patterns in radiology and histopathology. The radiological pattern on CT of the thorax most often allows us to make a diagnosis with varying levels of confidence, to optimize management. With a multidisciplinary team bringing the strengths of their individual domains of knowledge, clinical, radiological, histopathological, and in many cases rheumatological, the level of confidence in making this diagnosis increases, often to the stage where the diagnosis is most often right, is concordant with the diagnosis achieved at histopathology and therefore obviates the need for lung biopsy which carries its own costs and risks of complications. Our study emphasizes the role of the multidisciplinary team (MDT) in the management of DPLDs at a tertiary care referral center. MATERIALS AND METHODS Every case of DPLD presenting to our pulmonology department was discussed in an MDT meeting before subjecting them to any diagnostic intervention or therapy. A clinico-radiological diagnosis was made according to the 2002 ATS/ERS guidelines initially. Later an official ATS/ERS/JRS/ALAT statement on idiopathic pulmonary fibrosis and a 2013 ATS/ERS consensus for the classification and diagnosis of idiopathic interstitial pneumonia was used. The concordance in our study was defined as the percentage of histopathological diagnoses that were identical to the clinico-radiological MDT diagnosis prior to the biopsy. RESULTS A total of 434 patients with DPLDs were evaluated. The MDT suggested biopsy for only 38.7% (168/434) patients since the pattern was very clear in 266 (61.3%) cases. As not all patients consented to undergo the biopsy procedure when recommended, histopathology was obtained in 102 patients. The histological diagnosis was concordant with the initial MDT diagnosis in 80.3% (82/102) of samples. On an individual basis, connective tissue disease-interstitial lung disease and sarcoidosis showed the best concordance (87%). In idiopathic non-specific interstitial pneumonitis (NSIP) cases, the histopathological diagnosis concurred in only 53.3% (8/15), out of which 8 were NSIP, 4 were usual interstitial pneumonia, and 3 were reported as inadequate sampling on histopathology. CONCLUSION The MDT plays a crucial role in the diagnosis of DPLDs. Not every pattern requires biopsy confirmation. However, an idiopathic non-specific interstitial pneumonitis diagnosis by the MDT should probably be better confirmed by biopsy.
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Affiliation(s)
| | - Syed Zulkharnain Tousheed
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India
| | | | | | - Ramanjaneya Ranganatha
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India
| | | | - M Hemanth Kumar
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India
| | - Chandrasekar Sagar
- Department of Pulmonology and Internal Medicine, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru, India
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Kannan S, Shivaprasad KS, Khadilkar K, Rajesh S, Sigamani A, Annapandian VM. Achieving Higher Levels of Efficiency in a Diabetes Outpatient Clinic With Improved Patient Care Quality Through the Use of Digital Clinical Assistant Software Application. J Diabetes Sci Technol 2020; 14:496-498. [PMID: 31701756 PMCID: PMC7196860 DOI: 10.1177/1932296819884338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Subramanian Kannan
- Department of Endocrinology, Diabetes
and Metabolism, Narayana Health City, Bangalore, Karnataka, India
- Subramanian Kannan, MD, AB, Department of
Endocrinology, Diabetes and Metabolism, Mazumdar Shaw Medical Center, Narayana
Health City, 258/A Bommasandra Industrial Area, Hosur Road, Bangalore 560099,
Karnataka, India.
| | | | - Kranti Khadilkar
- Department of Endocrinology, Diabetes
and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Shalini Rajesh
- Department of Endocrinology, Diabetes
and Metabolism, Narayana Health City, Bangalore, Karnataka, India
| | - Alben Sigamani
- Clinical Research Department, Mazumdar
Shaw Medical Center, Narayana Health City, Bangalore, Karnataka, India
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Abstract
Myroides species formerly known as Flavobacterium odoratum, a rare clinical isolate often considered as nonpathogenic. Myroides odoratimimus commonly found in the environment and frequently isolated from the immunocompromised patients. The incidence of urinary tract infection (UTI) caused by Myroides species is a rare phenomenon. We describe a rare case of UTI caused by Myroides odoratimimus in an elderly patient.
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Affiliation(s)
- Ishthiaque Ahamed
- Department of Nephrology, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, Karnataka, India
| | | | - Krithika D Muralidhara
- Department of Nephrology, Mazumdar Shaw Medical Center, Narayana Health, Bengaluru, Karnataka, India
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Mohapatra A, Kakde S, Annapandian VM, Valson AT, Duhli N, Korula A, Matthai SM, Pulimood AB, David VG, Alexander S, Jacob S, Varughese S, Basu G, Tamilarasi V, John GT. Spectrum of biopsy proven renal disease in South Asian children: Two decades at a tropical tertiary care centre. Nephrology (Carlton) 2018; 23:1013-1022. [PMID: 28846194 PMCID: PMC7615900 DOI: 10.1111/nep.13160] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/29/2022]
Abstract
AIM We report findings from a large single centre paediatric renal biopsy cohort in South Asia. METHODS We analyzed all renal biopsies performed on children aged ≤18 years between 1996 and 2015 at our centre. The clinical characteristics and histological diagnosis pertaining to each case, distribution of renal diseases in children with various clinical presentations, and changes in the pattern of kidney disease during the study period were analyzed. RESULTS A total of 1740 paediatric kidney biopsies were performed during the study period. The mean age was 12.8 ± 4.9 years (8 months to 18 years) and the male: female ratio was 1.5:1. The most common indication for renal biopsy was nephrotic syndrome (63.2%) followed by acute nephritic syndrome (13%). Minimal change disease was the most common cause of nephrotic syndrome while endocapillary proliferative glomerulonephritis (65.7% infection related), remained the commonest cause of acute nephritic syndrome. IgA nephropathy was the commonest cause of chronic kidney disease. Contrary to trends in European paediatric cohorts, the frequency of lupus nephritis increased over the two decades of the study, while that of endocapillary proliferative glomerulonephritis did not show any appreciable decline. CONCLUSION This study provides the largest data on biopsy proven renal disease in children from South Asia published till date and highlights important differences in the spectrum and trends of kidney disease compared to data from other regions.
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Affiliation(s)
- Anjali Mohapatra
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Shailesh Kakde
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Vellaichamy M Annapandian
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
- Academic Research Department, Narayana Hrudayalaya Foundations, Bangalore, India
| | - Anna T Valson
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Neelaveni Duhli
- Department of Pathology, Christian Medical College and Hospital, Vellore, India
| | - Anila Korula
- Department of Pathology, Christian Medical College and Hospital, Vellore, India
| | - Smita Mary Matthai
- Central Electron Microscopy Unit, Christian Medical College and Hospital, Vellore, India
| | - Anna B. Pulimood
- Central Electron Microscopy Unit, Christian Medical College and Hospital, Vellore, India
| | - Vinoi G David
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - Gopal Basu
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
- Department of Nephrology, Central Northern Adelaide Renal and Transplant Service, Adelaide, Australia
| | - Veerasamy Tamilarasi
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
| | - George T John
- Department of Nephrology, Christian Medical College and Hospital, Vellore, India
- Department of Renal Medicine, Royal Brisbane and Women’s Hospital, Queensland, Australia
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Ahamed I, Nellikode S, Annapandian VM. Case Report of Salmonella gallinarum Urinary Tract Infection in a Renal Allograft Recipient. Transplant Proc 2017; 49:1591-1592. [PMID: 28838447 DOI: 10.1016/j.transproceed.2017.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/07/2017] [Indexed: 11/24/2022]
Abstract
Urinary tract infections (UTIs) caused by nontyphoidal Salmonella in a renal allograft recipient are a rare occurrence. Although there is some existing literature on Salmonella typhi bacteriuria and non-typhoidal bacteriuria, none of the cases has been reported in a renal transplant patient. This case report describes a rare instance in which group D Salmonella was isolated from a renal allograft recipient's urine culture and the patient was successfully treated with antibiotics.
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Affiliation(s)
- I Ahamed
- Department of Nephrology, Narayana Health Multispeciality Hospital, Bangalore, India [formerly Department of Nephrology, Universal Hospital, Abu Dhabi, United Arab Emirates].
| | - S Nellikode
- Department of Neurology, Universal Hospital, Abu Dhabi, United Arab Emirates
| | - V M Annapandian
- Department of Pharmacology, JKK Nattraja College of Pharmacy, Namakkal, India
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10
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Annapandian VM, Sundaram RS. In vitro Antidiabetic Activity of Polar and Nonpolar Solvent Extracts from Leucas aspera (Willd.) Link Leaves. Pharmacognosy Res 2017; 9:261-265. [PMID: 28827967 PMCID: PMC5541482 DOI: 10.4103/pr.pr_141_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Diabetes mellitus is a chronic illness, and the management of diabetes is a global problem. Successful treatment is required to prevent complications and organ damages. Herbal medicines are having minimal adverse effects when compared to the available synthetic drugs to treat such chronic diseases and disorders. Objective: The present study was aimed to evaluate the antidiabetic and antioxidant activity of polar and nonpolar solvent extracts of Leucas aspera (Willd.) link leaves under in vitro models. Materials and Methods: The in vitro antidiabetic activity of petroleum ether (nonpolar) and ethanol (polar) extracts were evaluated in C2C12 cell lines by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay (cell viability method) and glucose uptake assay. 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging method used for the evaluation of in vitro antioxidant activity. Results: Both the polar and nonpolar solvent extracts of L. aspera had shown better antioxidant activity compared to standard (IC50 = 18.96 and 19.90 μg/mL, respectively). Petroleum ether extract exhibited better cytotoxic activity in C2C12 cell line compared to ethanol extract (concentration of test drug needed to inhibit cell growth by 50% 110.75 ± 5.5 vs. 415.25 ± 8.0 μg/mL) whereas ethanol extract showed enhanced glucose uptake activity than petroleum ether extract in C2C12 cell line at same concentrations. Conclusion: From our study results, we concluded that L. aspera (Willd.) link leaves had shown better antidiabetic activity and antioxidant activity under in vitro models. Nonpolar solvent extract produced slightly better activity than polar solvent extract. This study warrants further research and experiments on animal models. SUMMARY Petroleum ether extract of Leucas aspera (PELA) exhibited slightly higher 1,1-diphenyl-2-picrylhydrazyl (DPPH) scavenging activity compared to ethanol extract of L. aspera (EELA) PELA exhibited better cytotoxic activity in C2C12 cell line compared to EELA EELA had shown enhanced glucose uptake activity than PELA in C2C12 cell line at same concentrations L. aspera leaf extracts have potential scavenging of DPPH radicals similar to that of ascorbic acid Overall, PELA (nonpolar) produced slightly better antidiabetic activity and antioxidant activity than EELA (polar).
Abbreviations Used: DM: Diabetes mellitus, EELA: Ethanol extract of Leucas aspera, L. aspera: Leucas aspera, PELA: Petroleum ether extract of Leucas aspera.
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Affiliation(s)
- V M Annapandian
- Department of Pharmacology, JKK Nattraja College of Pharmacy, Namakkal, Tamil Nadu, India
| | - R Shanmuga Sundaram
- Department of Pharmacology, JKK Nattraja College of Pharmacy, Namakkal, Tamil Nadu, India
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Abstract
Renal transplant patients prescribed mycophenolate mofetil (MMF) may require treatment for tuberculosis with a regimen including the tuberculocidal drug rifampicin. MMF is an ester prodrug which is rapidly hydrolysed to the active compound, mycophenolic acid (MPA). Therapeutic drug monitoring of mycophenolate involves the measurement of MPA area under the curve (MPA-AUC0-12). Rifampicin is known to increase the metabolism and decrease enterohepatic recirculation of mycophenolic acid, (MPA). When MPA is monitored after the discontinuation of rifampicin, an important factor is the time required for the MPA area under the curve to return to the pre-rifampicin value. At present this is not known. This report describes one such renal allograft patient, on long term MMF and prescribed rifampicin by a local physician. As expected there was a clinically significant decrease in MPA-AUC0-12 Three weeks after rifampicin was discontinued the MPA-AUC0-12 was still only 65% of the pre-rifampicin value and only 55% of the steady state MPA-AUC0-12 measured six months later.
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Affiliation(s)
- V M Annapandian
- Department of Nephrology, Christian Medical College, Vellore, India
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12
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Annapandian VM, Mathew BS, Naseema SU, Fleming DH, Varughese S, Tamilarasi V, Jacob CK, John GT. Individualization of Mycophenolate dosing based on AUC Monitoring is ideal for renal allograft recipients. Indian Journal of Transplantation 2009. [DOI: 10.1016/s2212-0017(11)60100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Annapandian VM, Basu G, Neelakantan N, Fleming DH, Mathew BS, Varughese S, John GT. Mycophenolate Versus Azathioprine as Primary Immunosuppression In Renal Transplantation – A Case Control Study. Indian Journal of Transplantation 2008. [DOI: 10.1016/s2212-0017(12)60055-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mathew BS, Fleming DH, Jeyaseelan V, Chandy SJ, Annapandian VM, Subbanna PK, John GT. A limited sampling strategy for tacrolimus in renal transplant patients. Br J Clin Pharmacol 2008; 66:467-72. [PMID: 18662286 DOI: 10.1111/j.1365-2125.2008.03251.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
AIMS To develop and validate limited sampling strategy (LSS) equations to estimate area under the curve (AUC(0-12)) in renal transplant patients. METHODS Twenty-nine renal transplant patients (3-6 months post transplant) who were at steady state with respect to tacrolimus kinetics were included in this study. The blood samples starting with the predose (trough) and collected at fixed time points for 12 h were analysed by microparticle enzyme immunoassay. Linear regression analysis estimated the correlations of tacrolimus concentrations at different sampling time points with the total measured AUC(0-12). By applying multiple stepwise linear regression analysis, LSS equations with acceptable correlation coefficients (R(2)), bias and precision were identified. The predictive performance of these models was validated by the jackknife technique. RESULTS Three models were identified, all with R(2) > or = 0.907. Two point models included one with trough (C(0)) and 1.5 h postdose (C(1.5)), another with trough and 4 h postdose. Increasing the number of sampling time points to more than two increased R(2) marginally (0.951 to 0.990). After jackknife validation, the two sampling time point (trough and 1.5 h postdose) model accurately predicted AUC(0-12). Regression coefficient R(2) = 0.951, intraclass correlation = 0.976, bias [95% confidence interval (CI)] 0.53% (-2.63, 3.69) and precision (95% CI) 6.35% (4.36, 8.35). CONCLUSION The two-point LSS equation [AUC(0-12) = 19.16 + (6.75.C(0)) + (3.33.C1.5)] can be used as a predictable and accurate measure of AUC(0-12) in stable renal transplant patients prescribed prednisolone and mycophenolate.
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Affiliation(s)
- Binu S Mathew
- Clinical Pharmacology Unit, Department of Biostatistics and Clinical Pharmacology, Christian Medical College, Vellore, India
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