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Belhekar MN, Dhorajiwala SS, Krishnamurthy B. Impact of educational interventions on pharmacovigilance and adverse drug reaction reporting by resident doctors and faculty members: A prospective comparative study. Perspect Clin Res 2023; 14:32-38. [PMID: 36909212 PMCID: PMC10003584 DOI: 10.4103/picr.picr_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose/Aim Adverse drug reactions (ADRs) are significantly under-reported worldwide. The aim of this study was to assess the impact of educational interventions (EIs) on knowledge, attitude, and practice (KAP) of hospital resident doctors and faculty members and compare ADR reporting in EI (medical specialties) vs. non-EI (surgical specialties) in these two cadres of doctors. Materials and Methods This study was a prospective comparative study conducted in two groups (EI and non-EI) in resident doctors and faculty members working at a tertiary care hospital. EI group (medical specialties) were provided with EI to increase awareness about ADR reporting, whereas in non-EI group (surgical specialties), no EI was provided and they served as control. Respondents were asked to fill a pretest questionnaire followed by interactive EI in EI group and posttest questionnaire in both groups. The impact of EI among respondents was evaluated by their response to questionnaire and number of ADRs reported after intervention. Results Total (n = 202) respondents were enrolled in the study. The number of resident doctors and faculty members in each group were (n = 101 [50%]). Overall, (n = 100 [49.5%]) were from the medical and (n = 102 [50.5%]) from surgical specialty. Post-EI period, there was statistically significant improvement in KAP domains. Conclusion Our study serves as credible evidence that through EI; statistically significant improvement in KAP of resident doctors and faculty members in both medical and surgical specialties toward ADR reporting and existing pharmacovigilance system can be achieved.
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Affiliation(s)
- Mahesh N. Belhekar
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Shakeeb S. Dhorajiwala
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - B. Krishnamurthy
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Waibel M, Thomas HE, Wentworth JM, Couper JJ, MacIsaac RJ, Cameron FJ, So M, Krishnamurthy B, Doyle MC, Kay TW. Investigating the efficacy of baricitinib in new onset type 1 diabetes mellitus (BANDIT)—study protocol for a phase 2, randomized, placebo controlled trial. Trials 2022; 23:433. [PMID: 35606820 PMCID: PMC9125350 DOI: 10.1186/s13063-022-06356-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Type 1 diabetes (T1D) places an extraordinary burden on individuals and their families, as well as on the healthcare system. Despite recent advances in glucose sensors and insulin pump technology, only a minority of patients meet their glucose targets and face the risk of both acute and long-term complications, some of which are life-threatening.
The JAK-STAT pathway is critical for the immune-mediated pancreatic beta cell destruction in T1D. Our pre-clinical data show that inhibitors of JAK1/JAK2 prevent diabetes and reverse newly diagnosed diabetes in the T1D non-obese diabetic mouse model. The goal of this study is to determine if the JAK1/JAK2 inhibitor baricitinib impairs type 1 diabetes autoimmunity and preserves beta cell function.
Methods
This will be as a multicentre, two-arm, double-blind, placebo-controlled randomized trial in individuals aged 10–30 years with recent-onset T1D. Eighty-three participants will be randomized in a 2:1 ratio within 100 days of diagnosis to receive either baricitinib 4mg/day or placebo for 48 weeks and then monitored for a further 48 weeks after stopping study drug. The primary outcome is the plasma C-peptide 2h area under the curve following ingestion of a mixed meal. Secondary outcomes include HbA1c, insulin dose, continuous glucose profile and adverse events. Mechanistic assessments will characterize general and diabetes-specific immune responses.
Discussion
This study will determine if baricitinib slows the progressive, immune-mediated loss of beta cell function that occurs after clinical presentation of T1D. Preservation of beta cell function would be expected to improve glucose control and prevent diabetes complications, and justify additional trials of baricitinib combined with other therapies and of its use in at-risk populations to prevent T1D.
Trial registration
ANZCTR ACTRN12620000239965. Registered on 26 February 2020. ClinicalTrials.gov NCT04774224. Registered on 01 March 2021
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Susarla SK, Gupta M, Mantan M, Dhongade R, Bhave S, Das RK, Ray RK, Ramesh Babu T, Ravi MD, Krishnamurthy B, James S, Sandhya G, Satish M, Sahoo DP. Immunogenicity and safety of a liquid Pentavalent (DTwP-Hb-Hib) combination vaccine manufactured by Human Biologicals Institute in 6-8 weeks old healthy infants: A phase III, randomized, single blind, non-inferiority study. Vaccine 2019; 37:5452-5459. [PMID: 31331773 DOI: 10.1016/j.vaccine.2019.06.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/19/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND A liquid Pentavalent (DTwP-Hb-Hib) combination vaccine, developed by Human Biologicals Institute, underwent a Phase III clinical study in India. In this randomized, single blind, non-inferiority study, the immunogenicity and safety of this Investigational vaccine was compared with Pentavac SD® vaccine in 6-8 weeks old healthy infants. METHODS A total of 405 healthy infants aged 6-8 weeks old were randomized in 2:1 ratio to receive three doses of either the Investigational liquid Pentavalent (DTwP-Hb-Hib) combination vaccine or Pentavac SD® vaccine at four to six weeks interval. Immunogenicity was compared by estimation of antibody titers before the first dose and 4-6 weeks after the third dose of vaccination. Safety of each vaccine was assessed and compared by collection of data on solicited and unsolicited adverse events throughout the study period. RESULTS Out of a total of 405 enrolled subjects, 387 subjects completed the study. The seroconversion rates, seroprotection rates and geometric mean titres of the Investigational liquid Pentavalent (DTwP-Hb-Hib) combination vaccine group were found to be comparable and non-inferior to the Pentavac SD® vaccine group at 4-6 weeks after the third dose of vaccination. Pain, erythema and swelling at the site of injection were found to be the most common local adverse events whereas fever, irritability and unusual crying were found to be the most common systemic adverse events in both the vaccine groups. No vaccine related serious adverse event was reported. In this study, both the Investigational vaccine as well as the Comparator vaccine were found to be immunogenic and well tolerated. CONCLUSION After assessment of the results of the study it was concluded that the Investigational liquid Pentavalent (DTwP-Hb-Hib) combination vaccine developed by Human Biologicals Institute was immunogenic and safe when administered to infants aged 6-8 weeks and was non-inferior in immunogenicity and safety to Pentavac SD® vaccine. Clinical Trial Registry of India Identifier: CTRI/2016/01/006541.
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Affiliation(s)
| | - Madhu Gupta
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Mukta Mantan
- Department of Paediatrics, Maulana Azad Medical College, New Delhi, India
| | - Ramchandra Dhongade
- Department of Paediatrics, Sant Dnyaneshwar Medical Education Research Centre, Pune, India
| | - Sheila Bhave
- Paediatric Research, KEM Hospital Research Centre, Pune, India
| | - Rajat Kumar Das
- Department of Paediatrics, KPC Medical College and Hospital, Kolkata, India
| | - Rajib Kumar Ray
- Department of Paediatrics, Hi-Tech Medical College and Hospital, Bhubaneswar, India
| | - T Ramesh Babu
- Department of Paediatrics, Gandhi Medical College and Hospital, Secunderabad, India
| | - M D Ravi
- Department of Paediatrics, JSS Medical College & Hospital, Mysore, India
| | - B Krishnamurthy
- Department of Paediatrics, Mysore Medical College and Research Institute, Mysore, India
| | - Saji James
- Department of Pediatrics, Sri Ramachandra Medical Centre, Chennai, India
| | - G Sandhya
- Human Biologicals Institute, Hyderabad, India
| | - M Satish
- Human Biologicals Institute, Hyderabad, India
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Galligan A, Xu W, Fourlanos S, Nankervis A, Chiang C, Mant AM, Parente P, Rischin D, Krishnamurthy B, Sandhu S, Colman PG. Diabetes associated with immune checkpoint inhibition: presentation and management challenges. Diabet Med 2018; 35:1283-1290. [PMID: 29908076 DOI: 10.1111/dme.13762] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND In recent years, immune checkpoint blockade has become a standard therapy for a wide range of cancers. Adverse events including endocrinopathies result from the induction of autoimmunity. CASE REPORT We report a case series of nine individuals who presented with immunotherapy-induced type 1 diabetes between 2015-2017. DISCUSSION Onset of diabetes occurred within 12 weeks of commencing therapy. Anti- GAD antibodies were present in six people. Retrospective testing of islet antibodies in pre-treatment samples was possible in two people and this revealed anti-GAD seroconversion in the first and high anti-GAD titres pre and post-treatment in the second person. Six people had high risk HLA haplotypes. Clinical and genetic factors are described and compared with previously published cases. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Galligan
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital
| | - W Xu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre
| | - S Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital
| | - A Nankervis
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital
| | - C Chiang
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital
- Division of Cancer Medicine, Peter MacCallum Cancer Centre
| | - A M Mant
- Cancer Services, Eastern Health, Monash University
| | - P Parente
- Cancer Services, Eastern Health, Monash University
| | - D Rischin
- Division of Cancer Medicine, Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, University of Melbourne
| | | | - S Sandhu
- Division of Cancer Medicine, Peter MacCallum Cancer Centre
- Sir Peter MacCallum Department of Oncology, University of Melbourne
| | - P G Colman
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital
- Division of Cancer Medicine, Peter MacCallum Cancer Centre
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Prakash R, Alawani S, Kumar GM, Rudrappa S, Krishnamurthy B. Predictive ability of venous blood nucleated red blood cells counts in term infants with perinatal asphyxia: A diagnostic study. J Clin Neonatol 2018. [DOI: 10.4103/jcn.jcn_56_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Prakash R, Savitha M, Krishnamurthy B. Neurodevelopmental Outcome at 12 Months of Postnatal Magnesium Sulphate Therapy for Perinatal Asphyxia. J Nepal Paedtr Soc 2017. [DOI: 10.3126/jnps.v36i3.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Postnatal magnesium therapy has been proposed as a novel neuroprotective agent for perinatal asphyxia. A few studies reported short term neurological benefit with magnesium. It is uncertain whether magnesium therapy has any long term effect on neurodevelopment.Material and Methods: We randomly assigned 120 term asphyxiated infants to receive either magnesium sulphate infusion or placebo postnatally in first 48 hours of life. Babies were treated as per the standard treatment protocol for asphyxia. Short term outcome at discharge was previously reported and a follow up evaluation at 12 months was done. The primary outcome was a composite of death or disability, developmental delay and neuromotor tone abnormality at 12 months.Results: Out of 120 infants, 69 infants had moderate-severe hypoxic-ischemic encephalopathy (HIE) during initial NICU stay. Among 69 infants with moderate-severe HIE, 41 infant could be followed up. Out of 41 infants, 22 were in magnesium group and 19 in placebo group. Of 22 infants assigned to magnesium therapy, 3(13.6%) died or survived with neurodevelopmental disability as compared with 5 of 19 infants (26.3%) assigned to placebo (p=0.32). The developmental outcome evaluated found developmental delay in 3 of 22 infants in magnesium group vs 5 of 19 infants in placebo group (p=0.32). Ameil-Tisonneuromotor tone assessment revealed tone abnormality in 3 of 22 infants in study group vs 4 of 19 infants in placebo group (p=0.53).Conclusion: Magnesium therapy for perinatal asphyxia may not result in favourable long term neurodevelopmental outcome, though no significant adverse effect has been documented.J Nepal Paediatr Soc 2016;36(3):256-262
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Singh A, Mitra M, Sampath G, Venugopal P, Rao JV, Krishnamurthy B, Gupta MK, Sri Krishna S, Sudhakar B, Rao NB, Kaushik Y, Gopinathan K, Hegde NR, Gore MM, Krishna Mohan V, Ella KM. A Japanese Encephalitis Vaccine From India Induces Durable and Cross-protective Immunity Against Temporally and Spatially Wide-ranging Global Field Strains. J Infect Dis 2015; 212:715-25. [PMID: 25601942 DOI: 10.1093/infdis/jiv023] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [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: 09/30/2014] [Accepted: 01/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Japanese encephalitis (JE) is a vaccine-preventable acute disease. We report the results of a phase 2/3 trial of JENVAC, a Vero cell-derived vaccine developed using an Indian strain of JE virus (JEV). METHODS JENVAC was administered in 2 doses 28 days apart, and immunogenicity was compared to that from a single dose of SA-14-14-2, the only approved JE vaccine and regimen at the time in India. RESULTS After both the doses, seroconversion and seroprotection were >90% for JENVAC. For SA-14-14-2, seroconversion and seroprotection were 57.69% and 77.56%, respectively, on day 28 and 39.74% and 60.26%, respectively, on day 56. The geometric mean titers at day 28 and day 56 were 145.04 and 460.53, respectively, for JENVAC and 38.56 and 25.29, respectively, for SA-14-14-2. With a single dose of JENVAC, seroprotection titers lasted at least 12 months in >80% of the subjects. Following receipt of 2 doses, 61.17% of subjects retained seroprotection titers at 24 months, and immunogenicity criteria were higher than that for SA-14-14-2 at 12, 18, and 24 months each. Sera from JENVAC subjects neutralized JEV genotypes I, II, III, and IV equally well. Adverse events were not significantly different between the 2 vaccines. CONCLUSIONS JENVAC elicits long-lasting, broadly protective immunity. CLINICAL TRIALS REGISTRATION CTRI/2011/07/001855.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Milind M Gore
- Gorakhpur Unit, National Institute of Virology, India
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Gyani GJ, Krishnamurthy B. The National Accreditation Board for Hospital and Health Care Providers accreditation programme in India. World Hosp Health Serv 2014; 50:9-12. [PMID: 24938026] [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
Quality in health care is important as it is directly linked with patient safety. Quality as we know is driven either by regulation or by market demand. Regulation in most developing countries has not been effective, as there is shortage of health care providers and governments have to be flexible. In such circumstances, quality has taken a back seat. Accreditation symbolizes the framework for quality governance of a hospital and is based on optimum standards. Not only is India establishing numerous state of the art hospitals, but they are also experiencing an increase in demand for quality as well as medical tourism. India launched its own accreditation system in 2006, conforming to standards accredited by ISQua. This article shows the journey to accreditation in India and describes the problems encountered by hospitals as well as the benefits it has generated for the industry and patients.
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Sekhar MR, Patil BR, Krishnamurthy B, Rao CB, Gopalkrishna K. Soft tissue reconstruction after hemimandibulectomy in oral malignancies: a retrospective study. J Maxillofac Oral Surg 2013; 11:72-7. [PMID: 23450238 DOI: 10.1007/s12663-011-0272-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/18/2011] [Accepted: 08/02/2011] [Indexed: 10/17/2022] Open
Abstract
AIMS The present study was under taken to evaluate the efficacy of various local and regional soft tissue flaps used for reconstruction after excision of various malignant lesions of the mouth and also to evaluate complications with length of hospital stay after the reconstruction. MATERIALS AND METHODS The study was a record based retrospective analysis of 127 patients who were histologically proven squamous cell carcinoma of the oral cavity for which excision of the lesion along with segmental mandibulectomy and primary reconstruction with local or regional flaps was the treatment modality. RESULTS The male:female mean age is 48.27:48.79. The Z-proportionality test for intra oral reconstruction showed 5% level of significance (P < 0.05) between pectoralis major myocutaneous flap (PMMC) and other flaps. Difference between deltopectoral (DP) and PMMC, PMMC and primary closure at 1% level of significance, i.e. P < 0.01 was found for extra oral defects. The mean stay was found to be 31.31 days. Recurrence rate of 11% was reported. CONCLUSION A total of 127 patients formed the study group. In the absence of bone reconstruction PMMC still continues to be the "work horse" of reconstruction following wide excision and hemimandibulectomy.
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Affiliation(s)
- M Ravi Sekhar
- Department of Oral and Maxillofacial Surgery, Navodaya Dental College and Hospital, Navanagar, Raichur, Karnataka India
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Abstract
Metabolic syndrome (MetS) is defined as a cluster of numerous cardiovascular risk factors, which encompasses obesity, dyslipidaemia, insulin resistance and hypertension. Patients with MetS are more prone to developing cardiovascular events than other patients. To date, several approaches such as physical exercise, dietary control and invasive and non-invasive therapeutic interventions for dyslipidaemia, hypertension and insulin resistance have been used to manage MetS. However, there is a progressive elevation in the incidence of fatal and non-fatal cardiovascular events due to the increased prevalence of obesity and diabetes. Percutaneous coronary intervention has emerged over the last few years as an effective revascularisation strategy for those with coronary artery disease, in parallel with the development of effective anti-platelet medications and newer drug-eluting stents. In recent years, considerable research efforts have been undertaken to elucidate the pathophysiology of re-stenosis and develop strategies to prevent re-stenosis following percutaneous transluminal coronary angioplasty and stent implantation. Although the rate of stent re-stenosis and target-lesion revascularisation has been reduced, there is little information in the literature on the outcome of MetS in the pathophysiology of re-stenosis. In this review article, we summarise the recent development and progress on re-stenosis and the role of drug-eluting stents, particularly in MetS.
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Affiliation(s)
- S N Goyal
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Viswanath L, Bindhu J, Krishnamurthy B, Suresh KP. Granulocyte-Colony Stimulating Factor (G-CSF) accelerates healing of radiation induced moist desquamation of the skin. Klin Onkol 2012; 25:199-205. [PMID: 22724569] [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: 06/01/2023]
Abstract
DESIGN Clinical evidence from a few experimental and randomized trials have implicated the possible benefit of cytokines in prevention and healing of radiation induced mucositis. This pilot study was undertaken to assess the effectiveness of Granulocyte-Colony Stimulating Factor (G-CSF) on healing of radiation induced moist desquamation of the skin. RATIONALE FOR THE STUDY intervention with exogenous growth factors along with conventional treatment practices may stimulate faster skin healing and help the patient in resuming normalcy at the earliest. MATERIALS AND METHODS Twenty three patients with established grade III moist desquamation of skin at the site of radiation and during the course of their radiotherapy were recruited for this study. Patients were administered a single dose of Granulocyte-Colony Stimulating Factor (G-CSF - Neupogen® (Filgrastim)) 300 µg subcutaneously at the periphery of the wound as a single session. The rate of skin healing was documented as a function of time from D1 (day of Filgastrim instillation) to the number of days required for complete healing/re-epithelization of the open skin wound. RESULTS There was a rapid response and decreased severity of the grade III radiation skin reactions, which extrapolated to an early resumption of radiotherapy treatment. Twenty patients (86%) showed healing of their wounds within 10 days which was notably faster than the expected 2 to 3 weeks anticipated for the severity/grade of the skin reaction. Thirteen patients (56.5%) showed a remarkably rapid response of healing within 5 days. No significant side effects were experienced after the single dose was administered. The mean duration to resolution of moist desquamation was calculated as 6.65 ± 4.73 days. Among the associated parameters, only location of lesion and depth of skin reaction significantly affected the rate of healing. Superficial epidermal erosions showed excellent response with 4.53 ± 2.07 days of re-epithelization & healing (p < 0.001) compared to deep dermal exposure. The results are suggestive of a promising role of G-CSF in the management of Grade III radiation induced skin reaction (moist desquamation).This concept requires structured randomized trials to establish significance of benefit. CONCLUSION G-CSF appears to promote wound healing; this cytokine has the potential to favorably modify the healing process of radiation induced moist desquamation of the skin. This study demonstrates that this dreaded side effect of radiotherapy can by managed in a very simple, convenient and cost effective way, without toxicity & intervention.
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Affiliation(s)
- L Viswanath
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka State, India.
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Lingaiah K, Sosalagere DM, Mysore SR, Krishnamurthy B, Narayanappa D, Nallur RB. Mutations of TFAP2B in congenital heart disease patients in Mysore, South India. Indian J Med Res 2011; 134:621-6. [PMID: 22199100 PMCID: PMC3249959 DOI: 10.4103/0971-5916.90986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND & OBJECTIVES Cardiac malformations in the young constitute a major portion of clinically significant birth defects. Congenital heart disease (CHD) is a common congenital cardiac birth defect, affecting nearly 1 per cent of all live births. Patent ductus arteriosus (PDA) is clinically significant foetal circulation anomaly, second most common form of CHD which constitutes approximately 10 per cent of total CHDs. The study aimed to screen for TFAP2B mutations in CHD patients of Mysore. METHODS With informed consent, 100 clinically diagnosed CHD patients and 50 healthy controls in Mysore, south India, were recruited for the analysis of screening of mutations. MassARRAY analysis of 5 prominent mutations of TFAP2B was performed. RESULTS The analysis did not show any of the five mutations of TFAP2B screened by massARRAY in patients and controls, indicating that these mutations were not involved in the manifestation of CHD in the patients at Mysore, south India. INTERPRETATION & CONCLUSIONS The findings suggest the lack of involvement of known mutations of TFAP2B with syndromic or nonsyndromic CHDs in Mysore patients.
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Affiliation(s)
- Kusuma Lingaiah
- Department of Studies in Zoology, University of Mysore, Mysore, India
| | | | - Savitha R. Mysore
- Department of Pediatrics, Cheluvamba Hospital, Mysore Medical College & Research Institute, Mysore, India
| | - B. Krishnamurthy
- Department of Pediatrics, Cheluvamba Hospital, Mysore Medical College & Research Institute, Mysore, India
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Dinesh S, Kusuma L, Smitha R, Savitha M, Krishnamurthy B, Narayanappa D, Ramachandra NB. Single-Nucleotide Polymorphisms of NKX2.5 Found in Congenital Heart Disease Patients of Mysore, South India. Genet Test Mol Biomarkers 2010; 14:873-9. [DOI: 10.1089/gtmb.2010.0100] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S.M. Dinesh
- Genomics Laboratory, Department of Studies in Zoology, University of Mysore, Mysore, Karnataka, India
| | - L. Kusuma
- Genomics Laboratory, Department of Studies in Zoology, University of Mysore, Mysore, Karnataka, India
| | - R. Smitha
- Genomics Laboratory, Department of Studies in Zoology, University of Mysore, Mysore, Karnataka, India
| | - M.R. Savitha
- Department of Pediatrics, Cheluvamba Hospital, Mysore Medical College, Mysore, Karnataka, India
| | - B. Krishnamurthy
- Department of Pediatrics, Cheluvamba Hospital, Mysore Medical College, Mysore, Karnataka, India
| | - D. Narayanappa
- Department of Pediatrics, JSS Medical College and Hospital, Mysore, Karnataka, India
| | - Nallur B. Ramachandra
- Genomics Laboratory, Department of Studies in Zoology, University of Mysore, Mysore, Karnataka, India
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Viswanath L, Pallade S, Krishnamurthy B, Naveen T, Preethi BL, Pramod KPR, Reddy O, Padma G. Darier-Roussy Sarcoidosis Mimicking Metastatic Breast Cancer. Case Rep Oncol 2009; 2:251-254. [PMID: 20737045 PMCID: PMC2914390 DOI: 10.1159/000262412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Subcutaneous sarcoidosis (also known as ‘Darier-Roussy sarcoid’) is a cutaneous condition characterized by numerous deep-seated nodules on the trunk and extremities. Coexistence of sarcoidosis and breast cancer are reported in the literature, but there will always be a chance of misdiagnosis. It is very crucial to obtain a tissue diagnosis of suspicious metastatic lesions. We report a case of breast cancer presenting with a subcutaneous sarcoid lesion masquerading as a metastatic lesion. A 50-year-old female patient, who had had cancer of the left breast, was on hormone therapy 2 years after treatment with surgery, radiotherapy and chemotherapy. The patient presented with a sudden onset of a forehead subcutaneous swelling mimicking metastasis which on excision biopsy was proved to be sarcoidosis. In India, sarcoidosis is reported rarely. We have to keep in mind that there is a chance of the metastatic lesions being of sarcoidosis origin or another granulomatous disease. To avoid misdiagnosis, it is better to obtain a tissue diagnosis.
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Affiliation(s)
- Lokesh Viswanath
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bangalore, India
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Abstract
OBJECTIVES To detect prevalence of essential hypertension in early and mid adolescents and to identify various risk factors. METHODS Blood pressure was recorded in 503 apparently normal school students in 10 to 16 yr age group as per standard guidelines. Detailed clinical examination was done in all cases. A detailed questionnaire was sent to parents. RESULTS 6.16% of adolescents had high blood pressure at the end of fourth screening. Both systolic and diastolic hypertensions were documented. Increased body mass index and reduced consumption of vegetables and fruits were found to be statistically significant risk factors for hypertension. CONCLUSION Multiple blood pressure recordings are essential for accurate diagnosis of hypertension. There is a high prevalence of essential hypertension amongst adolescents in Mysore city with modifiable risk factors for hypertension.
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Affiliation(s)
- M R Savitha
- Department of Pediatrics, Government Medical College, Mysore, India.
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Savitha MR, Krishnamurthy B, Ashok DA, Ramachandra NB. Self abortion of attacks in patients with Hot Water Epilepsy. Indian Pediatr 2007; 44:295-8. [PMID: 17468527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A cross sectional hospital based study was undertaken to find out the various clinical aspects and management of Hot Water Epilepsy (HWE) in children. Of the 71 cases analysed, 67.6% had onset of seizures in the first decade of life. Seizures occurred frequently towards the end of head bath (71.8%). In 14.1% cases, seizures were precipitated with cold-water head bath also. Complex partial seizures (60.6%) and generalized atonic seizures (21.1%) were common. Spontaneous non-reflex epilepsy was seen in 47.9% cases. Self-induction and self-abortion of seizures were seen in 16.9% and 12.7% patients respectively. Family history was available in 32.4% of cases. Majority had good response to continuous prophylactic treatment with antiepileptic drugs. We conclude that high incidence of spontaneous seizures and generalized atonic seizures seem to be peculiar to our geographical area. "Self abortion of attacks"may be of immense help in controlling the attacks.
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Affiliation(s)
- M R Savitha
- Department of Pediatrics, Government Medical College, Mysore, India.
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Abstract
Myotonia congenita is a rare disease of skeletal muscle characterized by painless myotonia, generalized muscular hypertrophy and a non-progressive course. We report a 10-year-old girl with myotonia, "Herculean appearance" and electromyographic confirmation of myotonic discharges. There was a dramatic response to carbamazepine. The aim of this report is to make the readers aware of this entity which can be easily controlled with medication and also prevented by genetic counseling.
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Affiliation(s)
- M R Savitha
- Department of Pediatrics, Government Medical College, Mysore, India.
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Ramachandra NB, Smitha R, Karat SC, Narayanappa D, Krishnamurthy B, Prasanth SN. Prevalence of congenital heart diseases in Mysore. Indian J Hum Genet 2006. [DOI: 10.4103/0971-6866.25296] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Krishnamurthy B, Jagdish S, Pai D, Babu P. Transection of common bile duct following blunt injury to abdomen. Indian J Gastroenterol 1997; 16:109-10. [PMID: 9248186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Isolated complete transection of the common bile duct due to blunt abdominal trauma is rare. We report such a case following an assault.
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Affiliation(s)
- B Krishnamurthy
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Researoh, Pondicherry
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Krishnamurthy B, McMurray TJ, McClean E. The peri-operative use of the oesophageal Doppler monitor in patients undergoing coronary artery revascularisation. A comparison with the continuous cardiac output monitor. Anaesthesia 1997; 52:624-9. [PMID: 9244018 DOI: 10.1111/j.1365-2044.1997.147-az0151.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was carried out to evaluate the ease of use and reliability of cardiac output estimations performed by an oesophageal Doppler monitor and to compare its use with that of a continuous cardiac output pulmonary flotation catheter. Measurements were made during and after surgery in 16 patients scheduled to undergo coronary revascularisation. Both devices suffered significant intra-operative problems which led us to question their suitability as operating theatre monitors. After surgery the continuous cardiac output monitor provided stable results while the oesophageal Doppler monitor required the continuous presence of an experienced anaesthetist to ensure comparable cardiac output estimations.
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Affiliation(s)
- B Krishnamurthy
- Department of Clinical Anaesthesia, Royal Group of Hospitals, Northern Ireland, UK
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Esser MT, Dinglasan RD, Krishnamurthy B, Gullo CA, Graham MB, Braciale VL. IL-2 induces Fas ligand/Fas (CD95L/CD95) cytotoxicity in CD8+ and CD4+ T lymphocyte clones. J Immunol 1997; 158:5612-8. [PMID: 9190908] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
IL-2 is a T cell growth factor that has pleiotropic functions in T cell differentiation, induction of lymphokine-activated killer cells, and regulation of immune responses. In studying TCR triggering of perforin or Fas ligand (FasL)/Fas (CD95 ligand/CD95) cytotoxicity in our influenza-specific T cell clones, we found that IL-2 can also induce FasL/Fas cytotoxicity. IL-2 induces FasL/Fas cytotoxicity in our CD8+ and CD4+ Th1 clones, but not in our CD4+ Th2 clones. IL-2 induction of cytolytic activity occurs when the CD8+ T cells are refractory to IL-2-induced proliferation. This killing is Ag independent, MHC unrestricted, and blocked by Fas.Fc fusion protein. IL-2 induces FasL/Fas cytotoxicity in a dose-dependent manner, but does not induce high levels of FasL expression as detected by flow cytometry. TCR triggered FasL/Fas cytotoxicity is detectable in CD8+ and Th1 clones by 3 h and peaks at 6 h; high levels of killing are maintained for at least 24 h. Similarly, IL-2 induces FasL/Fas killing in CD8+ and Th1 clones within 3 h of stimulation and maintains high levels for at least 24 h. TCR-triggered FasL/Fas killing is inhibited by emetine and cyclosporin A, whereas IL-2-induced FasL/Fas killing is inhibited by emetine, but not by cyclosporin A. These results demonstrate a second mechanism to induce FasL/Fas cytotoxicity in CD8+ and Th1 clones and may explain IL-2 induction of Ag-independent MHC-unrestricted lymphokine-activated killer cell activity.
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Affiliation(s)
- M T Esser
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
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Esser MT, Dinglasan RD, Krishnamurthy B, Gullo CA, Graham MB, Braciale VL. IL-2 induces Fas ligand/Fas (CD95L/CD95) cytotoxicity in CD8+ and CD4+ T lymphocyte clones. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.158.12.5612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
IL-2 is a T cell growth factor that has pleiotropic functions in T cell differentiation, induction of lymphokine-activated killer cells, and regulation of immune responses. In studying TCR triggering of perforin or Fas ligand (FasL)/Fas (CD95 ligand/CD95) cytotoxicity in our influenza-specific T cell clones, we found that IL-2 can also induce FasL/Fas cytotoxicity. IL-2 induces FasL/Fas cytotoxicity in our CD8+ and CD4+ Th1 clones, but not in our CD4+ Th2 clones. IL-2 induction of cytolytic activity occurs when the CD8+ T cells are refractory to IL-2-induced proliferation. This killing is Ag independent, MHC unrestricted, and blocked by Fas.Fc fusion protein. IL-2 induces FasL/Fas cytotoxicity in a dose-dependent manner, but does not induce high levels of FasL expression as detected by flow cytometry. TCR triggered FasL/Fas cytotoxicity is detectable in CD8+ and Th1 clones by 3 h and peaks at 6 h; high levels of killing are maintained for at least 24 h. Similarly, IL-2 induces FasL/Fas killing in CD8+ and Th1 clones within 3 h of stimulation and maintains high levels for at least 24 h. TCR-triggered FasL/Fas killing is inhibited by emetine and cyclosporin A, whereas IL-2-induced FasL/Fas killing is inhibited by emetine, but not by cyclosporin A. These results demonstrate a second mechanism to induce FasL/Fas cytotoxicity in CD8+ and Th1 clones and may explain IL-2 induction of Ag-independent MHC-unrestricted lymphokine-activated killer cell activity.
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Affiliation(s)
- M T Esser
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
| | - R D Dinglasan
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
| | - B Krishnamurthy
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
| | - C A Gullo
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
| | - M B Graham
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
| | - V L Braciale
- Department of Microbiology and the Beirne B. Carter Center for Immunology Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA
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Abstract
A diverse array of signals are generated in a cytotoxic T lymphocyte (CTL) after the T cell receptor (TCR) engages the class I major histocompatibility complex (MHC) peptide complex. These signals result in a multitude of CTL effector functions, including cellular cytotoxicity, cell surface receptor expression, and cytokine secretion. We have examined signaling through the TCR in a wild type CD8+, MHC-restricted, antigen-specific CTL clone, 14-7, and its interleukin 2-dependent variant clone 14-7FD. We report here that 14-7FD is unable to kill via the perforin mechanism of killing, yet is able to kill via the Fas ligand/Fas mechanism and secrete interferon-gamma in an antigen-specific manner. 14-7FD has cytolytic granules that contain perforin and serine esterases, which are secreted after phorbol ester and Ca2+ ionophore treatment. Lastly, to investigate which TCR signaling requirements were operational in 14-7FD, we examined TCR-triggered intracellular Ca2+ mobilization in the two clones. After TCR engagement, 14-7FD failed to mobilize intracellular Ca2+, which may be the cause for its inability to trigger the perforin/granule exocytosis mechanism of killing. These results indicate that the signal transduction events that trigger perforin killing and the signaling requirements to induce FasL expression are distinct. We hypothesize that these two distinct TCR signal transduction requirements allow for separate activation of these two mechanisms of killing relating to their role in eradication of infected cells or regulation of immune responses.
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Affiliation(s)
- M T Esser
- Department of Microbiology, University of Virginia, Health Sciences Center, Charlottesville 22908, USA
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Dutta TK, Samal SC, Krishnamurthy B. Pigmentation following cyclophosphamide therapy. J Assoc Physicians India 1991; 39:230-1. [PMID: 1842208] [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: 12/29/2022]
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