Dr. TMA Pai Hospital

OBJECTIVES: This study was carried out to establish the age at onset of menopause and the prevalence of menopause and menopausal symptoms in South Indian women. MATERIALS AND METHODS: Three hundred and fifty-two postmenopausal women attending the outpatient clinics of obstetrics and gynaecology department of Dr TMA Pai Hospital, a tertiary care Hospital in South India, were included in the study. The Menopause-Specific Quality of Life (MENQOL) questionnaire was used in the study. Data were presented as percentages for qualitative variable. RESULTS: The mean age at menopause was 48.7 years. Most frequent menopausal symptoms were aching in muscle and joints, feeling tired, poor memory, lower backache and difficulty in sleeping. The vasomotor and sexual domains were less frequently complained when compared to physical and psychological domains. CONCLUSION: The age at onset of menopause in southern Karnataka (India) is 48.7 years which is four years more than the mean menopause age for Indian women. This could be attributed to better socioeconomic and health-care facility in this region.

Multiple mechanisms such as genetic and epigenetic variations within a key gene may play a role in malarial susceptibility and response to anti-malarial drugs in the population. ABCB1 is one of the well-studied membrane transporter genes that code for the P-glycoprotein (an efflux protein) and whose effect on malaria disease predisposition and susceptibility to drugs remains to be understood. We studied the association of single nucleotide variations in human ABCB1 that influences its function in subjects with uncomplicated and complicated malaria caused by Plasmodium falciparum (Pf). Global DNA methylation and ABCB1 DNA promoter methylation levels were performed along with transcriptional response and protein expression in subjects with malaria and healthy controls. The rs2032582 locus was significantly associated with complicated and combined malaria groups when compared to controls (p < 0.05). Significant DNA methylation difference was noticed between case and control (p < 0.05). In addition, global DNA methylation levels of the host DNA were inversely proportional to parasitemia in individuals with Pf infection. Our study also revealed the correlation between ABCB1 DNA promoter methylation with rs1128503 and rs2032582 polymorphisms in malaria and was related to increased expression of ABCB1 protein levels in complicated malaria group (p < 0.05) when compared to uncomplicated malaria and control groups. The study provides evidence for multiple mechanisms that may regulate the role of host ABCB1 function to mediate aetiology of malaria susceptibility, prognosis and drug response. These may have clinical implications and therapeutic application for various malarial conditions.

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.

Abstract Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2), colloquially known as Coronavirus surfaced in late 2019 and is an extremely dangerous disease. RT-PCR (Reverse transcription Polymerase Chain Reaction) tests are extensively used in COVID-19 diagnosis. However, they are prone to a lot of false negatives and erroneous results. Hence, alternate methods are being researched and discovered for the detection of this infectious disease. We diagnose and forecast COVID-19 with the help of routine blood tests and Artificial Intelligence in this paper. The COVID-19 patient dataset was obtained from Israelita Albert Einstein Hospital, Brazil. Logistic regression, random forest, k nearest neighbours and Xgboost were the classifiers used for prediction. Since the dataset was extremely unbalanced, a technique called SMOTE was used to perform oversampling. Random forest obtained optimal results with an accuracy of 92%. The most important parameters according to the study were leukocytes, eosinophils, platelets and monocytes. This preliminary COVID-19 detection can be utilised in conjunction with RT-PCR testing to improve sensitivity, as well as in further pandemic outbreaks.

Invasive aspergillosis is a highly lethal opportunistic infection that poses a significant threat to immunocompromised patients. With studies suggesting that the incidence of this disease is increasing, and mortality rates remain high, early diagnosis and treatment are very important to improve patient survival. We present the case of a 33-year-old immunocompetent woman who presented with a history of cough and severe breathlessness, and was diagnosed to have invasive aspergillosis. This case emphasises the importance of maintaining a high index of suspicion and also of remembering that invasive aspergillosis is no longer only a disease of immunocompromised individuals. In addition, this case tells us that aspergillosis is one of the new emerging infections in intensive care units.

BACKGROUND: C-terminal Agrin Fragment (CAF) has emerged as a potent biomarker for identifying sarcopenia. However, the effect of interventions on CAF concentration and the association of CAF with sarcopenia components are unclear. OBJECTIVE: To review the association between CAF concentration and muscle mass, muscle strength, and physical performance among individuals with primary and secondary sarcopenia and to synthesize the effect of interventions on the change in the level of CAF concentration. METHODS: A systematic literature search was conducted in six electronic databases, and studies were included if they met the selection criteria decided a priori. The data extraction sheet was prepared, validated, and extracted relevant data. RESULTS: A total of 5,158 records were found, of which 16 were included. Among studies conducted on individuals with primary sarcopenia, muscle mass was significantly associated with CAF levels, followed by hand grip strength (HGS) and physical performance, with more consistent findings in males. While in secondary sarcopenics, the strongest association was found for HGS and CAF levels, followed by physical performance and muscle mass. CAF concentration was reduced in trials that used functional, dual task, and power training, whereas resistance training and physical activity raised CAF levels. Hormonal therapy did not affect serum CAF concentration. CONCLUSION(S): The association between CAF and sarcopenic assessment parameters varies in primary and secondary sarcopenics. The findings would help practitioners and researchers choose the best training mode/parameters/exercises to reduce CAF levels and, eventually, manage sarcopenia.

BACKGROUND: Parental views and expectations about family-centred care (FCC) need to be understood for its successful implementation. Knowledge of caregiver's perceptions and needs, within their social and cultural context, forms the basis for effective health care partnerships with families. The purpose of this study was to explore perceptions about FCC among caregivers of children with cerebral palsy (CP) in South India. METHOD: Fourteen caregivers of children with CP (aged 4-12 years) living in rural areas of the coastal region of Karnataka, India, participated in this qualitative study. Face-to-face semi-structured interviews were recorded and transcribed for analysis using the framework and hybrid approaches. Thematic mapping of the categories and themes was done to explore relationships about perceptions of FCC. RESULTS: Caregiver's life emerged inductively as a new theme highlighting caregiver's own physical and mental health, family roles and well-being, integrating the onus of care with household responsibilities, limited participation in personal activities and social isolation. The qualitative findings revealed the ubiquity of respectful and trusting relationships with health professionals while expressing paucity of coordinated comprehensive care, sporadic partnerships and opportunities for shared decision-making; desire for receiving specific information related to child's progress and prognosis; and general information on community resources and the need of empowerment and support groups. CONCLUSION: Our study has practical implications for the implementation of FCC within the South Indian context, by recognizing unique caregiver needs and expectations in sync with cultural perspectives towards childhood disability such as societal stigma, values and traditional beliefs; attitudes towards medical professionals; and life stressors and gender responsibilities.

Weakness in myasthenia gravis (MG) has a characteristic predilection for ocular, bulbar, and proximal muscles; although, in unusual and atypical manifestations like limb girdle MG, predominant distal weakness presenting as wrist drop and finger drop, isolated foot drop, and head drop do exist with a prevalence rate of 4.4% among MG patients.[1] Here, we report a case who presented clinically with isolated triceps muscle weakness, along with mild ocular manifestations at a later date. Knowing the variations existing in the presentation of the disease improves the approach towards establishing the diagnosis, decreases unnecessary investigations which are a financial burden to the patient, and also has therapeutic implications.

Extrinsic and intrinsic pathological stimuli in vascular disorders induce DNA methylation based epigenetic reprogramming in endothelial cells, leads to perturbed gene expression and subsequently results in endothelial dysfunction (ED). ED is also characterized by release of exosomes with altered proteome leading to paracrine interactions in vasculature and subsequently contributing to manifestation, progression and severity of vascular complications. However, epigenetic regulation of exosome proteome is not known. Hence, our present study aimed to understand influence of DNA methylation on exosome proteome composition and their influence on endothelial cell (EC) function. DNMT isoforms (DNMT1, DNMT3A, and DNMT3B) were overexpressed using lentivirus in ECs. Exosomes were isolated from all groups, as well as from ECs and C57BL/6 mice treated with 5-aza-2’-deoxycytidine. 3D spheroid assay was performed to understand the influence of exosomes derived from cells overexpressing DNMTs on EC functions. Further, the exosomes were subjected to TMT labelled proteomics analysis followed by validation.3D spheroid assay showed increase in the pro-angiogenic activity in response to exosomes derived from overexpressing cells which was impeded by inclusion of 5-aza-2’-deoxycytidine. Our results showed that exosome proteome and PTMs are significantly modulated and are associated with dysregulation of vascular homeostasis, metabolism, inflammation and endothelial cell functions. In vitro and in vivo validation showed elevated DNMT1 and TGF-β1 exosome proteins due to DNMT1 and DNMT3A overexpression, not DNMT3B which was mitigated by 5-aza-2’-deoxycytidine indicating epigenetic regulation. Further, exosomes induced ED as evidenced by reduced expression of phospho-eNOSser1177. Our study unveils epigenetically regulated exosome proteins, aiding management of vascular complications.

AcceptedJune 3, 2015.J-STAGE AdvancePublication July10, 2015.DOI: 10.7883/yoken.JJID.2014.474*Corresponding author: Mailing address: Enteric DiseasesDivision–Incharge, Central Research Lab, Kasturba Medi-cal College, Manipal University, Manipal-576104, Kar-nataka, India. Tel: 91 820 2922651, Fax: 91 820 2571927,E-mail: mamatha_98＠yahoo.comJpn. J. Infect. Dis., 68, 530–531, 2015

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) results in impaired water excretion and consequent water intoxication and hyponatremia. In patients with cancer, SIADH is most commonly driven by ectopic ADH production, a paraneoplastic syndrome frequently seen in small cell lung cancer. A 63 year old male presented with loss of appetite, vomiting and hiccups. No abnormalities were detected on physical examination. Upper gastrointestinal endoscopy showed a proliferative growth in the stomach and histopathology report confirmed gastric adenocarcinoma. His laboratory investigations revealed low serum sodium and further work up for SIADH confirmed the diagnosis. The patient was treated with hypertonic saline and he improved symptomatically. He was subsequently treated with two cycles of capecitabine and oxaliplatin. The patient was asymptomatic and maintained a serum sodium in the range of 120 to 130 mEq/L, with a serum sodium of 127 mEq/L on follow up.

COVID-19 was an unprecedented pandemic of our lifetime. Uncertainties were part of daily life and were the only certainty. Bracing for this pandemic at the level of a hospital was challenging. From infection control to patient management, from training healthcare workers to taking care of them, from public education to fighting fake news and misinformation, the pandemic presented with unique challenges and opportunities. This paper briefly discusses some of the important areas of focus and the experience of a dedicated COVID-19 hospital and the district during the pandemic.

Background: This study, conducted from August 2014 to August 2015, investigated hyponatremia in 228 in-hospital patients, aiming to discern its clinical and biochemical features and compare the efficacy of vaptans against standard treatments. The null hypothesis assumed no significant disparity in outcomes, while the alternate hypothesis posited otherwise. Methods: Using an open-label, non-blinded, observational, prospective comparative design, we assessed 228 hyponatremia patients. We scrutinized their clinical and biochemical profiles and made comparisons between moderate and profound hyponatremia cases, along with different treatment approaches. Results: Our findings revealed that patients aged 61-80, primarily females, dominated the cohort. Moderate hyponatremia occurred in 56.6% of cases, with severe hyponatremia in 43.4%. Common symptoms included drowsiness, nausea, and vomiting. Euvolemic hyponatremia was predominantly due to SIADH, while heart failure led to most hypervolemic cases. Various treatments were employed, with fluid restriction and normal saline being common. Tolvaptan and 1.6% hypertonic saline significantly increased serum sodium levels at 24 and 48 hours. Hospital stay duration didn’t significantly differ, and no osmotic demyelination cases emerged. Mortality stood at 10.5%, notably higher in profound hyponatremia cases. Conclusions: This study provides insights into hyponatremia’s clinical and biochemical aspects and compares vaptans to standard treatments. Tolvaptan and hypertonic saline displayed promise in raising serum sodium levels. Nevertheless, further research is warranted to validate these findings and explore additional factors impacting hyponatremia treatment outcomes.

Excessive production of neutrophil extracellular traps (NETs) contributes to immunothrombosis activation in ischemic stroke pathogenesis. The metabolic and mechanistic regulators of NET formation in relation to platelet activation during ischemic stroke remain poorly understood. In the present study, using multiple animal and clinical models of stroke, we examined the role of homocysteine and its biochemical modifications on NET formation and concomitant neuronal damage, platelet aggregation, motor and gait functions. Phosphoproteomics analysis of neutrophils in response to homocysteine revealed an enrichment of kinases and phosphoproteins associated with thrombosis. Homocysteinylated albumin induced significant NET formation via Erk1/2, Akt, ATM, and PAD4-dependent pathways, independent of reactive oxygen species. Hyperhomocysteinemic mice fed a methionine-rich diet exhibited elevated NETs components (neutrophil elastase, citrullinated histones, cell-free DNA (cfDNA)), platelet activation, neuronal damage, and impaired motor, balance, and learning functions. UCCAO-induced ischemia exacerbated neuronal damage, motor dysfunction, and platelet activation in hyperhomocysteinemic mice, which were reversed by disrupting NETs with N-acetyl cysteine and DNase. In stroke patients, homocysteine, neutrophil elastase, and cfDNA levels were significantly elevated, independent of comorbidities (e.g., hypertension, type 2 diabetes), etiology (TOAST classification), or stroke severity. Additionally, stroke patients generated autoantibodies against homocysteinylated albumin, which positively correlated with neutrophil elastase levels. This study identifies homocysteine and its modifications as key metabolic regulators of NETosis in stroke, linking NETs formation to platelet activation and neuronal damage. These findings highlight potential therapeutic targets for mitigating stroke pathogenesis through the modulation of NETs.

Tuberculosis and malaria are two common diseases afflicting the population of the Indian subcontinent. Both are associated with fatal neurological complications. Clinically, it may be difficult to differentiate between the two, except for that the focal neurological complications are more common with central nervous system (CNS) tuberculosis than with cerebral malaria. We report the case of a 48-year-old woman who presented with a history of fever and altered sensorium of short duration. She was initially treated for falciparum malaria on the basis of positive peripheral smear and normal CT scan of the brain, but later on diagnosed to have CNS tuberculosis on the basis of persistence of symptoms, development of focal neurological symptoms and MRI of the brain showing multiple tuberculomas. She improved significantly with a course of antitubercular treatment (ATT) and systemic corticosteroids.

To compare transvaginal digital examination with transabdominal ultrasound in determining the fetal head position in active stage of labour. It is prospective observational study conducted at Department of Obstetrics and Gynecology, Dr. TMA Pai Hospital, Udupi from December 2014 till November 2016. All the women with singleton pregnancy with vertex presentation coming at term in active phase of labour were included. Abdominal examination is done initially to assess fetal head position by palpating fetal spine and cephalic prominence, followed by transvaginal digital examination after rupture of membranes fetal head position is determined after a uterine contraction, based on sagittal suture and posterior fontanelle. Then transabdominal ultrasound examination (also not during contraction) done using M Turbo Ultrasound System Fusifilm Sonosite to determine fetal head position. Ultrasonographic depiction of fetal head position was performed utilising midline intracranial structures (cavum septi pellucid, falx cerebri, thalami and cerebellar hemispheres), and anterior or posterior cranial structures (orbits, nasal bridge and cervical spine). fetal head position was classified as LOA, LOT, LOP, ROA, ROT, ROP. Person doing transvaginal digital examination was blinded from one doing transabdominal ultrasound. The most frequently noted position was LOA (41%). In 78% (162/206) of fetal head positions determined by vaginal examination at <7 cms and 81% (63/77) at > 7 cms was consistent with those obtained by suprapubic transabdominal ultrasound (P = 0.02). Cohen's Kappa test of concordance indicated a good and excellent concordance of 0.70 (at <7 cms) and 0.86 (at > 7 cms). The rate of agreement between the two assessment methods for consultants versus residents was 80% versus 74% which was statistically significant (P = 0.01). The accuracy of transvaginal digital examination with transabdominal ultrasound was 78%, it was better by consultants than residents and also after 7 cms cervical dilatation. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.