| VML |
V
i r t u a l M e d i c a l L i b r
a r y
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Journal
club is an interactive forum, where medical and health professionals
can discuss online.The main feature of the forum included summary
of an article selected from the recent medical literature and comments
from the Author/Specialist. This would set the ball rolling and
provides readers to comment.The feedback from the readers is appended
to the article summaries.
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| 1).Yoga
for epilepsy
Ramaratnam
S, Sridharan K.
Summary
BACKGROUND:
Stress is considered an important precipitating factor for seizures.Yoga
is believed to induce relaxation and stress reduction. The effect of yogaon
the EEG and the autonomic nervous system have been reported. Yoga would
be anattractive therapeutic option for epilepsy (if proved effective),
in view of itsnonpharmacological nature, minimal side effects and international
acceptance.
OBJECTIVES:
To assess the efficacy of yoga in the treatment of patients withepilepsy.
SEARCH STRATEGY:
We searched the Cochrane Epilepsy Group trialregister, the Cochrane Controlled
Trials Register (The Cochrane Library Issue 4,1998), MEDLINE for articles
published up to the middle of 1998, and alsoregistries of the research
council for complimentary medicine were searched. Inaddition, we searched
the references of all the identified studies. Finally, wecontacted the
members of the Neurological Society of India, severalneurophysiology institutions
and yoga institutes to seek any ongoing studies orstudies published in
nonindexed journals or unpublished studies.
SELECTIONCRITERIA:
Randomized control trials and controlled clinical trials of treatmentof
epilepsy with yoga.
DATA COLLECTION
AND ANALYSIS: The data were extractedindependently
by both reviewers and any discrepancies were resolved bydiscussion. The
main outcomes assessed were percentage of patients renderedseizure free,
number of patients with more than 50% reduction in seizurefrequency or
seizure duration and the overall reduction in seizure frequency.Analyses
were on an intention to treat basis.
MAIN RESULTS:
Only one study metthe selection criteria, and recruited a total of 32
patients, 10 to sahaja yogaand 22 to control treatments. Antiepileptic
drugs were continued in all.Randomization was by roll of a dice. The results
of this study are as follows:(i) Four patients treated with yoga were
seizure free for six months compared tonone in the control groups. The
Odds Ratio (OR) (95% Confidence Interval (CI))for yoga versus sham yoga
group was 14.5 (0.7, 316.7) and for yoga versus notreatment group 17.3
(0.8, 373.5). (ii) Nine patients in the yoga group had morethan 50% reduction
in seizure frequency compared to only one among the controls.The OR (95%
CI) for yoga versus sham yoga group was 81 (4.4, 1504.5) and for theyoga
versus no treatment group was 158.3 (5.8, 4335.9). (iii) There was adecline
in the average number of attacks per month compared to the baselinefrequency
among the patients treated with yoga. The weighted mean difference (95%
CI) between yoga versus sham yoga group was -2.1 (-3.1, -1.0) and for
theyoga versus no treatment group -1.1 (-1.8, -0.4). (iv) More than 50%
reductionin seizure duration was found in seven of the 10 patients treated
with yoga,compared to none among the 22 controls. The OR (95%CI) for yoga
versus sham yogagroup was 45 (2.0, 1006.8) and for yoga versus no treatment
group 53.57 (2.4,1187.3).
REVIEWER'S CONCLUSIONS:
No reliable conclusions can be drawn regardingthe efficacy of yoga as
a treatment for epilepsy. Further studies are necessary to evaluate the
efficacy of yoga in the treatment of epilepsy.
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Your Comment
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2). Vitamin E
supplementation and cardiovascular events in high risk patients
| Authors |
The Heart Outcomes
Prevention Evaluation (HOPE) study investigators. |
| Source |
New England
Journal of Medicine 342:154-60. January 20, 2000. |
| Institutions |
Multi-institutional
and international. |
| Support |
Medical Research
Council of Canada, Natural Source Vitamin E Association, Negma,
Hoechst- Marion Roussel, AstraZeneca, King Pharmaceuticals,
and the Heart and Stroke Foundation of Ontario. |
Background
Experimental and observational
studies have indicated a role for the antioxidant vitamin E in the
prevention of atherosclerosis and cardiovascular events.
However, the few randomized trials conducted so far have not been
unequivocally positive and have suffered from a number of
limitations. This study examined the effect of vitamin E
supplementation on cardiovascular events in high risk patients.
It was conducted as part of the HOPE trial, which also looked at
the benefit of an ACE inhibitor in patients at risk for
cardiovascular events.
|
MethodsPatients
Eligible: Patients
at least 55 years old with a history of: any of the following:
- coronary disease
- stroke
- peripheral vascular disease
- diabetes plus another
cardiovascular risk factor (hypertension, elevated
cholesterol, low HDL, cigarette smoking or microalbuminuria)
Exclusion criteria:
- congestive heart failure or a
documented ejection fraction less than 40%
- patients taking an ACEI or
vitamin E
- MI or stroke within the
previous 4 weeks
- uncontrolled hypertension
- overt nephropathy
Intervention
Patients were randomized to
either 400 IU of vitamin E from natural sources or to placebo (in
addition to being randomized to ramipril or placebo, as the other
part of the HOPE study).
Follow-up
Follow-up visits occurred at one
month, 6 months and every 6 months thereafter, with follow-up
planned for 5 years.
Analysis
The primary outcome was a
composite of cardiovascular death, MI or stroke; each of these
outcomes was also analyzed separately. Secondary outcomes
were all-cause mortality, hospitalization for CHF or unstable
angina, revascularization and the occurrence of diabetic
complications. A number of other cardiovascular
complications were also recorded.
|
ResultsPatients
Of 10,576 patients who enrolled
in the study and participated in the run-in phase for the ACEI
part of the study, 1,035 were excluded because of withdrawal of
consent, noncompliance, electrolyte abnormalities or side-effects.
Of the 9,541 remaining patients, 4,761 were assigned to receive
vitamin E and 4,780 were assigned to placebo.
Baseline characteristics included
(my approximate average of both groups):
- Male sex: 73%; age: 66 years
- BP: 139/79; BMI: 28
- History of coronary disease:
80% (prior MI 53%; CABG 26%; history of angina 56%)
- History of stroke or TIA: 11%
- Peripheral vascular disease:
43%
- Hypertension: 47%; diabetes:
38%; hypercholesterolemia: 66%; current smokers: 14%
- Currently on beta-blockers:
39%; aspirin: 76%; lipid agents: 29%; calcium blockers: 47%
Subsequent chart review of
randomized patients revealed that 54% had had their LV function
determined; it was less than 40% (an exclusion criterion) in about
8% of patients.
Length of
treatment and compliance
Patients were recruited between
December, 1993 and June, 1995. Length of treatment and
follow-up was to be 5 years, but the trial was halted
approximately one year early (April, 1999) because of interim
analyses showing clear efficacy for the ACE inhibitor. The
mean length of follow-up was 4.5 years.
At the end of the study, 89.2% of
patients assigned to vitamin E were taking it, and 3.4% of
patients assigned to placebo were taking vitamin E.
Main outcomes
There was no significant
difference in the primary endpoints between patients receiving
vitamin E or placebo.
| |
Vitamin
E |
Placebo |
Relative
risk |
p-value |
| Death
from cardiovascular causes |
7.2% |
6.9% |
1.05 |
NS
(0.54) |
| Death
from non-cardiovascular causes |
4.0% |
4.4% |
|
|
| Death
from any cause |
11.2% |
11.2% |
1.0 |
NS
(0.99) |
| Myocardial
infarction |
11.2% |
11.0% |
1.02 |
NS
(0.74) |
| Stroke |
4.4% |
3.8% |
1.17 |
NS
(0.13) |
| Composite
endpoint: MI, stroke or cardiovascular death |
16.2% |
15.5% |
1.05 |
NS
(0.33) |
These results were not different
in patients receiving or not receiving the ACE inhibitor.
The incidence of the secondary
endpoints also did not differ between patients receiving vitamin E
and placebo.
Subgroup
analyses and adverse effects
These results were not
heterogeneous across various subgroups, including age, sex,
cardiovascular disease, medications, diabetes or smoking status.
There was no difference between
the groups in the incidence of adverse effects or drug
discontinuation (data not given).
|
Author's
discussion
According to the authors, this
study did not demonstrate any significant reduction in the
incidence of cardiovascular events by the administration of 400
units of vitamin E for four to six years.
They describe and comment on the
results of four randomized clinical trials of vitamin E:
- A chinese trial that
randomized patients to a combination of vitamin E, beta
carotene and selenium or placebo. This trial showed a 9
percent decrease in all-cause mortality, but no decrease in
cardiovascular events. The effect of vitamin E could not
be separated out, and the nutritional status of the population
is different from that in the population studied here.
- The ABC trial (Alpha-
Tocopherol, Beta Carotene Cancer Prevention) studied over
29,000 male smokers between the ages of 50 and 70. Fifty mg of
vitamin E daily showed no significant beneficial effect on
cardiovascular events.
- The Cambridge Heart
Antioxidant Study assigned patients with coronary disease to
vitamin E (400 IU or 800 IU) or placebo. There was a
significant decrease in the number of nonfatal MI's, but not
in cardiovascular mortality. The numbers were small, the
effects were seen too quickly to be easily attributable to the
antioxidant properties of vitamin E and there were imbalances
in the study groups.
- An Italian study randomized
11,000 post-MI patients to 300 IU vitamin E or placebo; there
was no statistically significant effect on cardiovascular
events.
The authors note that their
results could be due to inadequate length of follow-up, but
observational studies suggest that effects should be apparent
within 2 years. Furthermore, in a nested substudy of this
trial they are now examining a surrogate marker for
atherosclerosis which would be expected to show earlier results:
the carotid artery intima-media thickness.
Another possible explanation for
the negative results could be a need for vitamin E to be combined
with other antioxidants; other trials looking at this hypothesis
are in progress.
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Comment
This randomized trial of 400 IU of
vitamin E vs. placebo failed to show any decrease in cardiovascular
events after 4.5 years of follow-up. This, despite the fact that
multiple observational trials had suggested a beneficial effect.
One of the areas where observational trials are most likely to be
influenced by bias is when analyzing data that reflect
"healthy" behaviors. Since healthy diets and vitamin
supplementation are strongly associated with other beneficial lifestyle
aspects, it is extremely difficult to avoid the intruduction of bias.
The trial was halted early because of a
significant benefit in the ACE inhibitor portion of the study.
This could have led to an inadequate length of follow-up to detect a
beneficial effect of vitamin E. But, as the authors point out, a
beneficial effect of vitamin E would have been expected before the 4.5
years of follow-up that were available here, so the early termination is
unlikely to have played a major role in the negative result.
This study does not disprove the role
of vitamin E in cancer prevention (still being followed in some of the
patients enrolled in this trial), does not necessarily disprove a
potential role when combined with other antioxidants, and certainly
doesn't negate the potential beneficial role of a diet that is naturally
high in vitamin E. It does, however, call into question the role
of vitamin E supplements alone for the prevention of cardiovascular
events.
July 4, 2000
|
Reader Comments
July 5, 2000
From: Samim Chalabi Çelebi [samim.celebi@fornet.net.tr]
Dear Dr Jacobson,
Thank you for always interesting cases.
It is important to stress that a single cause for vascular disease and
events does not apply or else it would have been sorted out earlier.
First, we need to look at the stress
factor involved in these patients and this might be difficult.
Second, we need to know in younger
generations that are at high risk whether vit e is preventive before
disease starts, like 20 - 30 years of age, as probably prevention is
much more effective than treatment in those patients.
Third, we hope that genetics will give
us insight on who wil benefit and who willl not.
thank you, samim
Factors like stress and genetics,
although important in the pathogenesis of vascular disease, were
presumably evenly distributed between the patients assigned to vitamin
E and placebo, and thus should not invalidate the results presented
here.
Since the study was limited to
just a few years, you are right that we can not be sure that earlier
and longer treatment would not be effective. The authors
partially address this question in the article.
In general, I agree with you that
once there is better understanding of a disease process, it is easier
to target smaller groups who are much more likely to benefit from an
intervention on that process. -- mj
July 5, 2000
From: Enrique S. Corvalan, MD [corvalan@U.Arizona.EDU]
This study deals entirely with
"secondary prevention" of CV events in a fairly sick
population. I would be interested to know same outcomes for a
"primary prevention" point of view. Example: patients without
CV proven disease but with hyperlipidemia, HTN, Diabetes, etc.
Enrique S. Corvalán, MD, ABFP, FAAFP
Assistant Professor Clinical
Family & Community Medicine
It is true that these results
apply to a very specific population, those at highest risk.
However, this is precisely the population in which prevention should
be the easiest to demonstrate. If it can't be shown in this
population, then it's unlikely to be demonstrable in a population at
lower risk.
Unless, of course, you postulate
that these patients are at such high risk that a beneficial
intervention such as vitamin E is powerless to help them, or that
lower-risk patients are somehow susceptible to vitamin E's effects in
a way that high-risk patients aren't. Not impossible, but
unlikely, in my opinion. --mj
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Your Comment
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Literature Alert
This
is a current awareness service built from one or two selected type of literature
viz. highly cited paper, clinical alerts from NLM, reviews on a selected topic,
reviews of the month and trend papers .
FDA Approves Surgically Implanted Stomach Band to Treat
Obesity
Reviewed by
Dr. Dominique S. Walton
On June 5, 2001,
The FDA approved a device made by California firm BioEnterics System, which uses
an adjustable band that is surgically fitted around the stomach to help severely
obese people to lose weight. Here is more information about the newly approved
product:
Name:
Lap-Band Adjustable Gastric Banding System
How It Works: According
to the FDA, the band is placed through a small surgical incision and around the
upper portion of the stomach. Then it is inflated with saline and can be
adjusted for tightness. It makes the stomach pouch smaller, so users eat less
and feel full sooner.
Who Can Use
It: The FDA says this device is intended for use only in people who are
severely obese who have not been able to lose weight through exercise, dieting,
and other programs. These people typically are at least 100 lb over their ideal
body weight.
Basis of
Approval: Nearly 300 patients participated in a clinical trial
involving eight medical centers. In addition to getting the band, they also had
to exercise at least 30 minutes a day and follow a strict diet. As the study
went on for three years, most patients steadily lost weight, losing an average
of 36% of their excess weight. Two percent of the patients gained weight and 5%
remained the same.
For more details
about the weight loss the participants experienced, read a release from the FDA.
Cautions: This
device could offer a less-invasive option to the appropriate patients, because
traditionally, surgical procedures for obesity require a big surgical incision
and cutting, stapling, or rerouting the stomach. But using this band has its own
set of side effects that patients should consider. Nearly 90% of patients
experienced at least some side effects, which included nausea and vomiting,
heartburn, abdominal pain, and band slippage. The band was tested in about 300
patients, and roughly a quarter of them had to have the band removed because of
side effects or because they still were not losing weight.
Consumer
Information on: LAP-Band® Adjustable Gastric Banding (LAGB®) System - P000008
The
following is the list of articles authored by Doctors from Apollo Group of Hospitals.
For your comments or if you find any omissions, please let us know at vml@medvarsity.com
Alphabetical
List of Authors
1: J Assoc Physicians India 2000 Jul;48(7):715-8
- ACE
inhibitors--revisited.
Sathyamurthy
I, Jayanthi K.
Department
of Cardiology, Apollo Hospitals, Chennai 600 006.
Review
Author
Index
2: J
Assoc Physicians India 1998 Mar;46(3):263-7
- Elective
coronary artery stenting--immediate and follow up results.
Rath
PC, Tripathy MP, Panigrahi NK, Agarwal R, Rao PS, Chandra KS, Singh S, Deb
T, Agarwal S, Mannam G, Dixit V.
Apollo
Hospitals, Jubilee Hills, Hyderabad 500 033.
Elective coronary artery stenting was performed in 242 consecutive patients
inour centre for complex lesions (Type B, C), proximal lesions, restenoticlesions,
total occlusion and venous grafts. The procedural success rate was94.21%.
Three patients (1.23%) required emergency coronary artery bypasssurgery. Acute
and sub-acute thrombosis rate was 1.26% and 4.13%, respectively.There was
one in-hospital death (0.41%). 164 patients were followed upclinically for
a mean period of 11 +/- 6 months (range 1 month to 30 months).Angiographic
follow up was done in 68 patients with a restenosis rate of 16.17%.
3: J Indian
Med Assoc 2000 Nov;98(11):715-8
- Percutaneous
transluminal myocardial revascularisation: current status and future perspectives.
Rath
PC, Agarwala MK.
Apollo
Hospital, Hyderabad.
Percutaneous transluminal myocardial revascularisation presently appears to
be apotential palliative treatment for coronary artery disease, neither controlledwith
drugs nor amenable to available coronary revascularisation techniques.Ongoing
trials will provide answer to short and long term efficacy. Recentdevelopments
using angiogenic growth factors appear very promising, and the roleof growth
factors as an adjunct to percutaneous transmyocardialrevascularisation with
laser remains to be seen
4: J Assoc
Physicians India 1996 Feb;44(2):147
- Transradial
de novo coronary artery stenting.
Rath
PC, Rao PS, Tripathy MP.
Dept of
Cardiology, Apollo Hospital, Hyderabad.
5: J Invasive
Cardiol 1997 Apr;9(3):197-199
- Management
of Coronary Artery Dissection and Perforation Following Coronary Angioplasty
by Intra Coronary Stent.
Rath
PC, Tripathy MP.
Senior
Consultant, Director of Cath Lab and Interventional Cardiology, Apollo Hospital,
Jubilee Hills, Hyderabad, 500 033, India.
6: J Invasive
Cardiol 1998 Nov;10(9):558-560
- The
Use of Abciximab in the Treatment of Subacute Stent Thrombosis.
Rath
PC, Panigrahi NK.
Director
Cathlab and Interventional Cardiology, Apollo Hospital, Jubilee Hills,Hyderabad-500
033, (AP), India.
7: J Invasive
Cardiol 1999 Sep;11(9):559-562
- Coil
Embolization of a Giant Atherosclerotic Coronary Artery Aneurysm.
Rath
PC, Panigrahi NK, Agarwala MK, Das NK, Venkatesvaralu R.
Director
Cath Lab and Interventional Cardiology, Apollo Hospitals, Jubilee Hills, 500
033, Hyderabad, AP, India. drpcrath@hotmail.com
The incidence of the coronary artery aneurysm varies from 1.5D5%.Atherosclerosis
is the most common cause of coronary artery aneurysm in adults.A discrete,
giant, saccular atherosclerotic coronary artery aneurysm in anartery without
significant proximal stenosis is rare. We report the first suchcase of a giant
atherosclerotic coronary artery aneurysm successfully treatedwith coil embolization.
8: J Invasive
Cardiol 1999 Feb;11(2):83-86
- Successful
Coil Embolization and Follow-up Result of a Complex Pulmonary Arterio-Venous
Fistula.
Rath
PC, Tripathy MP, Panigrahi NK, Das NK, Venkateswarlu R.
Director Cath Lab and Interventional Cardiology, Apollo Hospitals, Jubilee
Hills, Hyderabad-500 033, A.P., India.
9: Cathet Cardiovasc
Diagn 1998 Jan;43(1):43-7
- Balloon
mitral valvuloplasty with bifoil catheter: immediate and long-term follow-up
results.
Rath
PC, Tripathy MP, Das NK, Rao PS, Deb T, Chandra KS, Agarwal S, Dikshit V,Reddy
BS.
Apollo
Heart Institute, Apollo Hospital, Hyderabad, Andhra Pradesh, India.
This report documents clinical and hemodynamic benefits of balloon mitralvalvuloplasty
(BMV) using a bifoil balloon catheter from a single center in 415consecutive
cases of rheumatic mitral stenosis (MS). The procedure wassuccessful in 396
(95.2%) patients, with an increase in mitral valve area (MVA)from 0.82+/-0.35
cm2 to 2.21+/-0.24 cm2 (P < 0.001). There were 2 (0.48%)in-hospital deaths,
and 6 (1.44%) patients developed acute mitral regurgitation.The procedural
and fluroscopy time was reduced significantly from 52+/-11 and38+/-6 min to
33+/-7 and 19+/-5 min, respectively, after modifications oftechnique in our
last 326 cases. The bifoil balloon catheter technique is safeand effective,
and provides excellent hemodynamic benefits which are sustainedat long-term
follow-up. This technique should be considered as an addition tothe existing
armamentarium of interventional cardiologists performing mitralballoon valvuloplasty.
Author
Index
10:J
Assoc Physicians India 1998 Apr;46(4):341-4
- Left
ventricular mural thrombus following myocardial infarction--a follow up study.
Vidhya
MR, Haranath K, Sathyamurthy I.
Department
of Internal Medicine, Apollo Hospitals Chennai.
Left Ventricular mural thrombus detected by echocardiography in 41 patientsafter
myocardial infarction (MI) were followed up for 4 years. Thirty eightpatients
were males and mean age of study population was 52.4 years.Echocardiography
revealed predominant mural type of thrombi (38 patients) andnone showed mobility.
All of them showed regional wall motion abnormality (RWMA)and Left Ventricular
(LV) aneurysm was found in 28 patients. Embolic events wereobserved in 6 patients
and 1 patient died following embolic stroke. Follow upstudy revealed persistent
left ventricular thrombus in 19 patients and riskfactors detected were severe
LV dysfunction and LV aneurysm. Six patients hadspontaneous resolution and
6 had resolution of the thrombus afteranticoagulants. While anticoagulant
therapy was very effective in preventingembolism after recent MI (within 3
weeks), it was found not useful in chronic LVthrombi. We observed ongoing
embolic risk in chronic LV thrombi with LVaneurysms but a randomized trial
is needed to decide the role of anticoagulantsin such situation.
Clinical trial
11: J Assoc
Physicians India 2000 Feb;48(2):216-20
- Current
status of low molecular weight heparins in clinical practice.
Vidhya
MR, Sathyamurthy I.
Department
of Cardiology, Apollo Hospitals, Chennai.
Author
Index
12: J
Assoc Physicians India 1998 Jun;46(6):533-7
- Plaque
rupture or erosion? The enigma of acute myocardial infarction.
Kaul
S, Misra KP.
Apollo
Hospital, Chennai-600 006, India.
Review
Author
Index
13: Transplant
Proc 2001 Feb-Mar;33(1-2):1997-8
- The
success of laparoscopic donor nephrectomy: is the open approach justified?
Soin
AS, Rajasekar MR, Rajakumari DV, Mishra A, Jasuja S.
Department of Multiorgan Transplantation, Indraprastha Apollo Hospital, NewDelhi,
India
14: Transplant
Proc 2000 Nov;32(7):1585
- Experience
with laparoscopic donor nephrectomy in India: is the open approach
justified any longer?
Soin
AS, Rajasekar MR, Rajakumari V V, Rehmani B, Mishra A, Jasuja S.
Department
of Multiorgan Transplantation, Indraprastha Apollo Hospital, New Delhi, India
Author
Index
15: Indian Pediatr 2001 Mar;38(3):309-10
- Recurrent
abdominal pain - a reappraisal?
Srivastava
RN. Consultant Pediatric Nephrologist, Apollo Indraprastha Hospital, New Delhi
110019, India.
rns2@vsnl.com
16: Indian
J Pediatr 1999 Mar-Apr;66(2):199-205
- Acute
glomerulonephritis.
Srivastava
RN.
Apollo
Indraprastha Hospital, New Delhi.
Acute glomerulonephritis (AGN) manifests with abrupt onset of hematuria, facialedema,
hypertension and impairment of renal function. The commonest form of AGNin
developing countries is that following a beta hemolytic streptococcalinfection
where the glomerular injury is mediated by deposition of immunecomplexes.
In the usual patient with moderately severe poststreptococcal AGN(PSAGN) the
above-mentioned features are present However, gross or microscopichematuria
may be the only abnormality. A similar picture may occasionally beproduced
by a variety of infections (when GN is referred to as post-infectiousand the
mechanism of glomerular damage and the renal histology are similar tothat
in PSAGN), primary renal glomerular disorders (e.g. membranoproliferativeGN,
IgA nephropathy), collagen vascular diseases (systemic lupus erythematosus),systemic
vasculitis (Henoch Schonlein purpura) and hereditary nephritis and somenonglomerular
conditions. PSAGN may also present with one or more of itscomplications such
as profound volume expansion with heart failure andhypertensive encephalopathy.
PSAGN resolves rapidly and has an excellentprognosis. Patients with severe
renal involvement and life threateningcomplications need expert supportive
management. AGN with associated systemicfeatures or very pronounced azotemia,
nonstreptococcal AGN and unresolving GNneed prompt, appropriate evaluation
that often includes a renal biopsy. Ifextensive crescentic changes are found
(crescentic GN), aggressiveimmunosuppression will be necessary.
17: Indian
Pediatr 2000 Feb;37(2):173-8
- Pediatric
tertiary care and subspecialities in the new millennium.
Srivastava
RN.
Apollo
Center for Advanced Pediatrics, Apollo Indraprastha Hospital, New Delhi,India.
rns2@vsnl.com
Author
Index
18: Indian
Pediatr 2001 Mar;38(3):287-91
- India
s First Successful Pediatric Liver Transplant.
Poonacha
P, Sibal A, Soin AS, Rajashekar MR, Rajakumari DV.
Apollo
Center for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi 110
044, India.
Author
Index
19: J
Assoc Physicians India 1997;Suppl 2:60-1
- Acute
respiratory failure.
Kanwar
MS.
Apollo
Hospital, New Delhi.
Author
Index
20: J
Assoc Physicians India 1997;Suppl 2:12-3
- Cardiogenic
shock in acute myocardial infarction.
Shrivastava
MP.
Indraprastha
Apollo Hospital, New Delhi-110 047.
Author
Index
21: J
Assoc Physicians India 1998;Suppl 1:30-40
- Prazosin
GITS vs sustained release nifedipine in patients with hypertension and abnormal
lipid profile: a randomized, controlled, multicenter study. MadrasHypertension
Study Group.
Misra
KP, Joglekar SJ, Mukherjee S, Nanivadekar AS.
Department
of Cardiology, Apollo Hospitals, Madras 600006.
OBJECTIVE: To compare the long-term antihypertensive efficacy, tolerability,
andmetabolic effects of prazosin GITS and a sustained release (SR) preparation
ofnifedipine. DESIGN: Randomized, controlled, multicenter study of 26 weeksduration.
SETTING: Office practices of 24 physicians in Chennai, Tamil Nadu,India. PATIENTS:
Males and females, aged 30 to 70 yrs, with hypertension of JNCV stage 1 or
2 at the end of a 2-week placebo run-in period, and an abnormallipid profile.
Sufficient number of patients recruited so that at least 60complete the entire
study. INTERVENTIONS: Prazosin GITS (Minipress XL, 2.5-5 mgonce daily) or
sustained release nifedipine (Nicardia Retard 10-20 mg twicedaily) for upto
6 weeks, continued upto 24 weeks in those showing a pre-definedresponse (SBP
and/or DBP normalized, or DBP fall of at least 10 mm Hg withactual value of
DBP < 95 mm Hg). Patients allocated to either of the twointerventions by
randomization. OUTCOME MEASURES: Percent patients showingpre-defined BP response
at week 6; percent patients with DBP < 90 mm Hg, SBP <140 mm Hg, and
both; percent patients with DBP fall > or = 10 mm Hg; mean fallin BP among
those receiving treatment for 24 weeks; mean change in blood glucoseand serum
lipids at the end of weeks 8, 16, and 24 of treatment; frequency andintensity
of adverse events judged probably or definitely related to the drug.RESULTS:
54 patients randomized to prazosin GITS group and 52 to nifedipine SRgroup.
Of these, 39 in prazosin GITS group (M 23, F 16; mean age-50. 6 yr, SEM1.66)
and 36 in nifedipine SR group (M 20, F 16; mean age-52.3 yr, SEM 1.71)completed
the study. Percent patients with DBP < 90 mm Hg at 24 weeks: prazosinGITS--100%,
nifedipine SR--100%; SBP < 140 mm Hg: prazosin GITS--94.9%,nifedipine SR--91.7%;
both DBP < 90 mm Hg and SBP < 140 mm Hg: prazosinGITS--92.3%, nifedipine
SR--91.7%; percent patients with DBP fall of 10 mm Hg ormore at 24 weeks:
prazosin GITS--76.9%, nifedipine SR--83.3%. The mean fall inthe systolic and
diastolic blood pressure from the end-of-placebo-phase valuesto all the other
time points was comparable in the 2 groups. Treatment withprazosin GITS did
not produce any statistically or clinically significant changein the metabolic
parameters at the end of 24 weeks, while with nifedipine SRthere was a significant
increase in the serum LDL values at 24 weeks (p =0.009). Adverse events probably
or definitely related to the drug: prazosinGITS--1.9%, nifedipine SR--2.1%.
CONCLUSION: Both drugs were equally effectiveand well tolerated. While prazosin
GITS was neutral on serum lipids, use ofnifedipine SR was associated with
a significant increase in serum LDLcholesterol at the end of 24 weeks.
Author
Index
22: Seizure
2001 Jan;10(1):3-6
- Yoga
for epilepsy: methodological issues.
Ramaratnam
S.
Consultant
Neurologist, Apollo Hospital, Greams Lane, Madras, 600006, India
This article deals with the methodological issues that might be encountered
indesigning and conducting a randomized controlled study of the efficacy of
yogain the treatment of epilepsy. Methodological issues relating to patientselection,
randomization, blinding, type of intervention, outcome measures andanalysis
are highlighted. Copyright 2001 BEA Trading Ltd.
23: Cochrane
Database Syst Rev 2000;(2):CD001524
- Yoga
for epilepsy.
Ramaratnam
S, Sridharan K.
Department of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road,Madras,
Tamil Nadu, India, 600006. rsridharan@vsnl.com
BACKGROUND: Stress is considered an important precipitating factor for seizures.Yoga
is believed to induce relaxation and stress reduction. The effect of yogaon
the EEG and the autonomic nervous system have been reported. Yoga would be
anattractive therapeutic option for epilepsy (if proved effective), in view
of itsnonpharmacological nature, minimal side effects and international acceptance.OBJECTIVES:
To assess the efficacy of yoga in the treatment of patients withepilepsy.
SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trialregister, the
Cochrane Controlled Trials Register (The Cochrane Library Issue 4,1998), MEDLINE
for articles published up to the middle of 1998, and alsoregistries of the
research council for complimentary medicine were searched. Inaddition, we
searched the references of all the identified studies. Finally, wecontacted
the members of the Neurological Society of India, severalneurophysiology institutions
and yoga institutes to seek any ongoing studies orstudies published in nonindexed
journals or unpublished studies. SELECTIONCRITERIA: Randomized control trials
and controlled clinical trials of treatmentof epilepsy with yoga. DATA COLLECTION
AND ANALYSIS: The data were extractedindependently by both reviewers and any
discrepancies were resolved bydiscussion. The main outcomes assessed were
percentage of patients renderedseizure free, number of patients with more
than 50% reduction in seizurefrequency or seizure duration and the overall
reduction in seizure frequency.Analyses were on an intention to treat basis.
MAIN RESULTS: Only one study metthe selection criteria, and recruited a total
of 32 patients, 10 to sahaja yogaand 22 to control treatments. Antiepileptic
drugs were continued in all.Randomization was by roll of a dice. The results
of this study are as follows:(i) Four patients treated with yoga were seizure
free for six months compared tonone in the control groups. The Odds Ratio
(OR) (95% Confidence Interval (CI))for yoga versus sham yoga group was 14.5
(0.7, 316.7) and for yoga versus notreatment group 17.3 (0.8, 373.5). (ii)
Nine patients in the yoga group had morethan 50% reduction in seizure frequency
compared to only one among the controls.The OR (95% CI) for yoga versus sham
yoga group was 81 (4.4, 1504.5) and for theyoga versus no treatment group
was 158.3 (5.8, 4335.9). (iii) There was adecline in the average number of
attacks per month compared to the baselinefrequency among the patients treated
with yoga. The weighted mean difference (95% CI) between yoga versus sham
yoga group was -2.1 (-3.1, -1.0) and for theyoga versus no treatment group
-1.1 (-1.8, -0.4). (iv) More than 50% reductionin seizure duration was found
in seven of the 10 patients treated with yoga,compared to none among the 22
controls. The OR (95%CI) for yoga versus sham yogagroup was 45 (2.0, 1006.8)
and for yoga versus no treatment group 53.57 (2.4,1187.3). REVIEWER'S CONCLUSIONS:
No reliable conclusions can be drawn regardingthe efficacy of yoga as a treatment
for epilepsy. Further studies are necessary to evaluate the efficacy of yoga
in the treatment of epilepsy.
24: Cochrane
Database Syst Rev 2000;(3):CD001909
- Lamotrigine
add-on for drug-resistant partial epilepsy (Cochrane review).
Ramaratnam
S, Marson AG, Baker GA.
Department
of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road,Madras, Tamil
Nadu, INDIA, 600006. rsridharan@vsnl.com.
BACKGROUND: Epilepsy is a common neurological disorder, affecting almost 0.5
to1% of the population. Nearly 30% of patients with epilepsy are refractory
tocurrently available drugs. Lamotrigine is one of the newer antiepileptic
drugsand is the topic of this review. OBJECTIVES: To examine the effects oflamotrigine
on seizures, side effects, cognition and quality of life, when usedas an add-on
treatment for patients with drug-resistant partial epilepsy. SEARCHSTRATEGY:
We searched the Cochrane Epilepsy Group trials register, the CochraneControlled
Trials Register (Cochrane Library Issue 1, 2000), MEDLINE (January1966 to
December 1999) and reference lists of articles. We also contacted themanufacturers
of lamotrigine (Glaxo-Wellcome). SELECTION CRITERIA: Randomizedplacebo controlled
trials, of patients with drug-resistant partial epilepsy ofany age, in which
an adequate method of concealment of randomization was used.The studies may
be double, single or unblinded. For crossover studies, the firsttreatment
period was treated as a parallel trial. DATA COLLECTION AND ANALYSIS:Two reviewers
independently assessed the trials for inclusion and extracteddata. Primary
analyses were by intention to treat. Outcomes included 50% orgreater reduction
in seizure frequency, treatment withdrawal (any reason), sideeffects, effects
on cognition, and quality of life. MAIN RESULTS: We found threeparallel add-on
studies and eight cross-over studies, which included 1243patients (199 children
and 1044 adults). The overall Peto's Odds Ratio (OR) and95% confidence intervals
(CIs) across all studies for 50% or greater reductionin seizure frequency
was 2.71 (1.87, 3.91) indicating that lamotrigine issignificantly more effective
than placebo in reducing seizure frequency. Theoverall OR (95%CI) for treatment
withdrawal (for any reason) is 1.12 (0.78, 1.61). The 99% CIs for ataxia,
dizziness, nausea, and diplopia do not includeunity, indicating that they
are significantly associated with lamotrigine. The limited data available
preclude any conclusions about effects on cognition andquality of life, though
there may be minor benefits in affect balance(happiness) and mastery. REVIEWER'S
CONCLUSIONS: Lamotrigine add-on therapy iseffective in reducing the seizure
frequency, in patients with drug-resistantpartial epilepsy. Further trials
are needed to assess the long term effects oflamotrigine, and to compare it
with other add-on drugs.
25: Cochrane
Database Syst Rev 2000;(3):CD001524
- Yoga
for epilepsy (Cochrane review).
Ramaratnam
S, Sridharan K.
Department
of Neurology, Apollo Hospitals, 21 Greams Lane, Off Greams Road, Madras, Tamil
Nadu, INDIA, 600006. rsridharan@vsnl.com.
BACKGROUND: Stress is considered an important precipitating factor for seizures.Yoga
is believed to induce relaxation and stress reduction. The effect of yogaon
the EEG and the autonomic nervous system have been reported. Yoga would be
anattractive therapeutic option for epilepsy (if proved effective), in view
of itsnonpharmacological nature, minimal side effects and international acceptance.OBJECTIVES:
To assess the efficacy of yoga in the treatment of patients withepilepsy.
SEARCH STRATEGY: We searched the Cochrane Epilepsy Group trialregister, the
Cochrane Controlled Trials Register (The Cochrane Library Issue 4,1998), MEDLINE
for articles published up to the middle of 1998, and alsoregistries of the
research council for complimentary medicine were searched. Inaddition, we
searched the references of all the identified studies. Finally, wecontacted
the members of the Neurological Society of India, severalneurophysiology institutions
and yoga institutes to seek any ongoing studies orstudies published in nonindexed
journals or unpublished studies. SELECTIONCRITERIA: Randomized control trials
and controlled clinical trials of treatmentof epilepsy with yoga. DATA COLLECTION
AND ANALYSIS: The data were extractedindependently by both reviewers and any
discrepancies were resolved bydiscussion. The main outcomes assessed were
percentage of patients renderedseizure free, number of patients with more
than 50% reduction in seizurefrequency or seizure duration and the overall
reduction in seizure frequency.Analyses were on an intention to treat basis.
MAIN RESULTS: Only one study metthe selection criteria, and recruited a total
of 32 patients, 10 to sahaja yogaand 22 to control treatments. Antiepileptic
drugs were continued in all.Randomization was by roll of a dice. The results
of this study are as follows:(i) Four patients treated with yoga were seizure
free for six months compared tonone in the control groups. The Odds Ratio
(OR) (95% Confidence Interval (CI))for yoga versus sham yoga group was 14.5
(0.7, 316.7) and for yoga versus notreatment group 17.3 (0.8, 373.5). (ii)
Nine patients in the yoga group had morethan 50% reduction in seizure frequency
compared to only one among the controls.The OR (95% CI) for yoga versus sham
yoga group was 81 (4.4, 1504.5) and for theyoga versus no treatment group
was 158.3 (5.8, 4335.9). (iii) There was adecline in the average number of
attacks per month compared to the baselinefrequency among the patients treated
with yoga. The weighted mean difference (95% CI) between yoga versus sham
yoga group was -2.1 (-3.1, -1.0) and for theyoga versus no treatment group
-1.1 (-1.8, -0.4). (iv) More than 50% reductionin seizure duration was found
in seven of the 10 patients treated with yoga,compared to none among the 22
controls. The OR (95%CI) for yoga versus sham yogagroup was 45 (2.0, 1006.8)
and for yoga versus no treatment group 53.57 (2.4,1187.3). REVIEWER'S CONCLUSIONS:
No reliable conclusions can be drawn regardingthe efficacy of yoga as a treatment
for epilepsy. Further studies are necessaryto evaluate the efficacy of yoga
in the treatment of epilepsy.
Author
Index
26: Neurol
India 2000 Dec;48(4):396-8
- Primary
fibrosarcoma of brain.
Vatsal
DK, Sharma S, Renjen PN, Kaul S, Jha AN.
Department
of Neurosurgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110044,
India.
This is a case presentation of a young patient with an intracranialspace-occupying
lesion following multiple episodes of generalised tonic clonicseizures for
the last 20 years. Such a long latency period between the onset offits and
the discovery of an intracranial lesion is highly unusual in malignantbrain
tumours. This lesion was excised completely and proved to be a primarylesion
of the brain - fibrosarcoma. These rare tumours of mesenchymal origin inthe
central nervous system are very rare.
Author
Index
27: Indian
J Pediatr 1999;66(1 Suppl):S56-62
- Helicobacter
pylori in children.
Mishra
D, Sibal A.
Department
of Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
Helicobacter pylori (Hp) infection is one of the most frequently encounteredbacterial
infections worldwide. Although strong epidemiological associationexists between
Hp infection and duodenal and gastric ulcers and gastric cancerin adults,
the clinical spectrum of Hp infection in children is yet to beestablished.
The increasing use of endoscopy as a diagnostic modality ingastroduodenal
diseases in children has raised some questions regarding the roleof Hp in
causing symptoms in children and need for eradication therapy. Despitea variety
of protocols, the standard therapy of Hp in children is stillundecided. This
article discusses the epidemiological and clinical spectrum ofHp infection
in children and includes a review of various diagnostic modalitiesand treatment
protocols for this infection.
Review
Author
Index
28: Indian
J Pediatr 1999;66(1 Suppl):S120-3
- Liver
transplantation in the developing world.
Sibal
A, Rajasekar MR, Soin AS.
Department
of Multiorgan Transplantation, Indraprastha Apollo Hospital, NewDelhi.
Liver transplantation is an accepted therapy for acute and chronic liverfailure.
Advances in preoperative and postoperative management and surgicaltechniques
have extended the indications and improved results. Mostinternational centres
report one year actual survival rates of between 58-90%and 5-8 years survival
of 75-80%. These developments, however, have been limitedlargely to the West.
While the need for liver transplantation is well recognisedin the developing
world, liver transplantation has only recently been performedsuccessfully
in India. This article examines the challenges of livertransplantation in
the developing world.
Review
Author
Index
29: Transplant
Proc 2000 Nov;32(7):1581
- Challenges
in laparoscopic donor nephrectomy and technical innovations to makeit cost
effective.
Rajasekar
MR, Rajakumari V V, Rehmani B, Soin AS.
Department
of Multiorgan Transplantation, Indraprastha Apollo Hospital, NewDelhi, India
Author
Index
30: Indian
Heart J 2000 Mar-Apr;52(2):205-6
- Renal
artery in-stent restenosis: treatment with high speed rotational atherectomy.
Rao
BH, Chandra KS.
Apollo
Hospitals, Hyderabad.
31: Indian
Heart J 1996 Mar-Apr;48(2):161-2
- Familial
occurrence of a rare combination of dilated cardiomyopathy with palmoplantar
keratoderma and curly hair.
Rao
BH, Reddy IS, Chandra KS.
Department
of Cardiology, Apollo Hospital, Hyderabad.
Author
Index
32: Indian
Heart J 2000 Mar-Apr;52(2):201-2
- Coronary
arterial fistula from both the coronaries to pulmonary artery in association
with congenital bicuspid aortic stenosis.
Oomman
A, Mao R.
Department
of Cardiology, Apollo Hospitals, Chennai.
Author
Index
33: J
Invasive Cardiol 1996 Nov;8(9):443-446
- Non-Surgical
Repair of Abdominal Aortic Aneurysm.
Chandra
KS, Venkateshwarlu J, Tripathy MP, Rao BH, Gopichand M.
Consultant
Cardiologist, Apollo Hospitals, Jubilee Hills, Hyderabad, 500 033,India.
The conventional treatment of abdominal aortic aneurysm is surgical replacementwith
a synthetic graft. Attempts have been made to treat these aneurysms usingstent
mounted grafts with reasonable success, thus obviating the need forsurgery.
However, certain problems like thromboembolism and the large profileare yet
to be overcome. We report a case of a 75-year-old man where an attemptto repair
a symptomatic abdominal aortic aneurysm was made using an endovascularuncovered
OwallO stent combined with endosaccular coil implantation.
Author
Index
34: J
Assoc Physicians India 1999 Oct;47(10):998-1002
- The
enigma of the endothelium.
Mathavan
A, Shankar KJ, Misra KP.
Dept. of
Cardiology, Apollo Hospitals, Chennai.
The endothelium was earlier regarded as a relatively inert layer performingrather
simple physiological functions. However extensive research has recentlyrevealed
that the endothelial layer performs a vast array of functions such asmaintenance
of vascular tone, control over coagulation and fibrinolysis besidesa lot of
chemical interactions. More recently, endothelial dysfunction has beenimplicated
as important in the pathogenesis of atherosclerosis, coronary arterydisease,
myocardial ischemia and post-intervention restenosis. The demonstrationthat
endothelial dysfunction may be reversible by employing various strategiesraises
the possibility of retarding the progress or even preventing the processof
atherosclerosis thereby reducing the risk of acute cardiovascular events.
Review
Author
Index
35: Trop
Gastroenterol 1999 Oct-Dec;20(4):191-2
- A
case of large oesophageal mucocele after surgical isolation.
Shanmugam
RP, Natarajan AS, Hussain MK, Vivekanandan S.
Surgical
Gastroenterology Unit, Apollo Hospital, Chennai. dr-rps@hotmail.com
Author
Index
36: Indian
Heart J 1999 Sep-Oct;51(5):545-7
- Submitral
pseudoaneurysm and anticardiolipin antibodies.
Bharat
V, Rath PC.
Tata Main
Hospital, Jamshedpur and Apollo Hospital, Hyderabad
Author
Index
37: Indian
J Med Res 1999 Oct;110:123-5
- Prevalence
of hepatitis C virus antibody in healthy blood donors.
Makroo
RN, Raina V, Kaushik V.
Department
of Transfusion Medicine, Indraprastha Apollo Hospitals, New Delhi.
The present study was conducted to find the prevalence of HCV antibody in
blooddonors with an aim to provide safe blood for transfusion. A total of
44,086blood samples from healthy blood donors was screened for HCV antibody
by thirdgeneration ELISA assay and a prevalence of 0.53 per cent was found
in our study.We suggest that routine screening of all donor blood should be
done
38: Indian
J Pathol Microbiol 1996 Apr;39(2):139-4
- Trends
of HIV infection in the blood donors of Delhi.
Makroo
RN, Salil P, Vashist RP, Shivlal.
Department
of Transfusion Medicine, Apollo Hospital, New Delhi.
Screening of HIV Infection was made mandatory for every unit of blood collectedfor
transfusion in Delhi, India since 1989. Ten Zonal Blood Testing Centres havebeen
identified which test all the blood collected for HIV by 29 blood blanksfor
the city. Reports from these testing centres have been analysed yearwise tofind
out the magnitude and trends of HIV infection in different groups of blooddonors.
Although initially there was no difference in HIV Sero-reactivity indifferent
blood donors categories (between 1 & 2 per 1000 blood donors samplestested)
but subsequently there is significant increase (5.24/1000 in 1992 &7.48/1000
in 1993) in the HIV sero-reactivity in replacement donor categorypossibly
because professional donors donate blood in the guise of beingreplacement
donors. The fact which comes out clearly is that HIV infection ispresent in
all sections of the population in Delhi and mandatory HIV Screeningof all
blood collected for transfusion is justified.
Author
Index
39: >J
Indian Med Assoc 1999 Jul;97(7):278-81
- Techniques
and follow-up results of coronary artery by-pass grafting with special reference
to Indian subset of patients.
Girinath
MR, Raghuram AR.
Department
of Cardiovascular Surgery, Apollo Hospitals, Chennai.
Coronary artery by-pass surgery is fast becoming the most commonly performedmajor
operation even in our country. Coronary heart disease in Indian patientshas
a lot of peculiarity which distinguishes it from the western population.Indian
patients are younger in age, more often diabetic and hyperlipidaemic.Smoking
and obesity are not as common as in the west. The coronary arteries aresmaller
in diameter and are affected diffusely with the atherosclerotic process.These
factors make the operation technically more difficult. The techniques havebeen
perfected to a very high level and are being performed in India withresults
comparable to the western world. The average operative mortality forcoronary
artery by-pass grafting (CABG) is around 2%.
Review
Author
Index
40: J
Indian Med Assoc 1999 Jul;97(7):271-5
- Angioplasty
versus coronary artery by-pass surgery: a reappraisal.
Chakraborty
R.
Apollo
Hospitals, Hyderabad.
Revascularisation is the main principle of treatment of obstructive coronaryartery
disease. This technique is available either by catheter intervention likeangioplasty
or by-pass surgery. The superiority of one over the other is stillundetermined.
In symptomatic single vessel disease angioplasty may be a betteroption than
by-pass surgery. In two-vessel coronary artery disease angioplastymay also
be preferred especially with good left ventricular function. Inpatients with
double-vessel disease particularly involving proximal leftanterior descending
artery in association with diabetes mellitus surgery hasbetter long term results.
In multivessel disease by-pass surgery is a preferredoption although initial
results of angioplasty in this group may be verysatisfactory. The incidence
of further intervention either by surgery or repeatangioplasty is high in
patients undergoing angioplasty in multivessel disease.Left main stem disease
should be dealt with by-pass surgery. With continuedadvancement in the revascularisation
technology of coronary artery disease bothin catheter intervention and surgical
fronts there is no room for unequivocal oruniversal strategy plan in the management
of coronary artery disease. Both thetechniques are complimentary to each other.
Cost consideration is a majorconsideration in India. Choice should be made
after proper evaluation ofcoronary anatomy, underlying clinical condition,
local experience, social andespecially economic circumstances.
Review
Author
Index
41: Indian
Heart J 1999 Jul-Aug;51(4):429-31
- Complete
thrombolysis for acute embolic stroke during coronary angiography.
Kumar
KP, Rao JS, Deb PS, Rao PS.
Department
of Cardiology, Apollo Hospitals, Hyderabad.
Author
Index
42: Indian
J Chest Dis Allied Sci 1999 Jul-Sep;41(3):145-51
- Pulmonary
sarcoidosis in a south Indian hospital: clinical and lung function profile.
Singh
RB, Babu KS.
Department of Respiratory Medicine, Apollo Hospital, Chennai.rajbsingh@hotmail.com
Twenty-two histopathologically proven cases of sarcoidosis were analyzed todetermine
the clinical presentation, lung function and the response totreatment. Laboratory
data, chest x-ray and pulmonary function tests (PFT) wereanalyzed. Sarcoidosis
was found to be more common in females in this study.Cough, breathlessness
and weight loss were the predominant symptoms. Serumangiotensin converting
enzyme (SACE) was elevated in 50% patients. Comparison ofchest radiographs
and PFT at the time of diagnosis revealed that stage I diseasewas associated
with normal pulmonary function, 50% patients with stage IIdisease had mildly
impaired PFT and 75% patient with stage III disease hadseverely impaired PFT.
The indication for oral steroid treatment was respiratorysymptoms in 58.8%
of cases. Of the 13 patients who were available for follow up10 (76.9%) had
subjective improvement in symptoms. Majority of patients showedregression
on chest radiograph but one patient progressed to stage IV disease. Pulmonary
function data of the patients who were followed up showed improvementbut this
was not significant statistically. Oral corticosteroids improvedsymptoms but
changes in pulmonary function seemed to be independent of steroidtherapy.
Further study of a larger number of patients over a longer period wouldbe
necessary.
Author
Index
43: Perit
Dial Int 1999 May-Jun;19(3):277-80
- Comparison
of clinical parameters in different peritoneal transporters in an Indian population.
Baraskar
VJ, Prakash KC.
Apollo
Hospitals, Chennai, India.
Author
Index
44: Indian
J Gastroenterol 1999 Jul-Sep;18(3):122
- Pseudoaneurysm
in gall bladder fossa following laparoscopic cholecystectomy.
Halbe
S, Ahmed NI, Sundar K, Sathyakumar C.
Department
of Radiology, Apollo Hospitals, Chennai. ahel@vsni.com
A 32-year-old lady presented with severe hematemesis and melena afterlaparoscopic
cholecystectomy. Initial ultrasonography and spiral CT suggested avascular
lesion in the gall bladder fossa. Selective hepatic angiographyconfirmed the
presence of a pseudoaneurysm close to the surgical clip andfilling through
the right hepatic artery. This was treated with coilembolization, resulting
in cessation of hematemesis and amelioration ofsymptoms.
Author
Index
45: Perit
Dial Int 1999;19 Suppl 2:S283-
- Tuberculous
peritonitis.
Prakash
KC.
Apollo
Hospitals, Chennai, India.
Although the general incidence of peritonitis has declined considerably withimprovement
in connectology, tuberculous peritonitis is still a major problem inpatients
who are from endemic regions and who belong to high-risk groups. Theproblem
stems mainly from less sensitive diagnostic tools. Confirmation oftuberculous
peritonitis is based on mycobacterial culture of the peritonealfluid, which
takes a few weeks. For patients in whom tuberculous peritonitiscannot be confirmed,
therapeutic trial has been recommended. Treatment oftuberculous peritonitis
consists in removing the peritoneal catheter andinitiating antituberculosis
medications, though the dosage and duration ofantituberculosis medication
are not yet well defined. Early initiation ofantituberculosis medication has
been shown to preserve good ultrafiltration andsolute clearance by the peritoneal
membrane.
Author
Index
46: Current
Science Vol 82, No 6, 25th March 2002, page 664 - 670.
- Epidemiology
of Epilepsy
Sridharan R.
47: Epilepsia
1999 May;40(5):631-6
- Prevalence
and pattern of epilepsy in India.
Sridharan
R, Murthy BN.
Apollo
Hospitals, Institute for Research in Medical Statistics, Indian Councilof
Medical Research, Chennai, Madras.
PURPOSE: To estimate the prevalence of epilepsy in India by meta-analysis
ofpreviously published and unpublished studies and to determine patterns ofepilepsy
by using community-based studies. METHODS: We attempted to identify asmany
previously published and unpublished studies as possible on the prevalenceof
epilepsy in India. The studies were assessed with regard to methods anddefinitions.
The prevalence rates for rural and urban populations and for menand women
were calculated with a 95% confidence interval (CI). The studies thatprovided
details on age structure, age-specific rates, and patterns of epilepsywere
chosen for meta-analysis. Both crude values and age-standardized prevalencerates
were calculated after accounting for heterogeneity. RESULTS: Twentystudies
were found involving a sample population of 598,910, among whom 3,207had epilepsy.
This resulted in a crude prevalence of 5.35/1,000. After acorrection for heterogeneity
due to interstudy variation, the overall prevalenceper 1,000 (and its 95%
CI) was 5.33 (4.25-6.41); with urban areas at 5.11(3.49-6.73); rural areas,
5.47 (4.04-6.9); men, 5.88 (3.89-7.87); and women 5.51(3.49-7.53). After correction
for the variability in estimates of heterogeneity,age-standardized rates (from
five studies) revealed that the prevalence ratesper 1,000 (and the 95% CI),
were as follows: overall, 5.59 (4.15-7.03); men,6.05 (3.79-8.31); women, 5.18
(3.04-7.32); urban, 6.34 (3.43-9.25); rural, 4.94(3.12-6.76). Urban men and
women had a higher prevalence of epilepsy comparedwith rural ones, however
the difference was not statistically significant.Age-specific prevalence rates
were higher in the younger age group, with theonset of epilepsy reported mostly
in the first three decades of the samplepopulation's lives. The treatment
gap (i.e., the percentage of those withepilepsy who were receiving no or inadequate
treatment) was more than 70% in therural areas. CONCLUSIONS: Based on the
total projected population of India inthe year 2001, the estimated number
of people with epilepsy would be 5.5million. Based on a single study on the
incidence of epilepsy, the number of newcases of epilepsy each year would
be close to half a million. Because ruralpopulation constitutes 74% of the
Indian population, the number of people withepilepsy in rural areas will be
approximately 4.1 million, three fourths of whomwill not be getting any specific
treatment as per the present standard.
Meta-analysis
47: Neuroepidemiology
1992;11(1):24-30
- Risk
factors for ischemic stroke: a case control analysis.
Sridharan
R.
Department
of Neurology, Apollo Hospitals, Madras, India.
Case control analysis of 204 patients with acute ischemic stroke revealed
thematched pair odds ratio (and 95% confidence limits) for hypertension, ECGabnormality,
heart disease of any type, diabetes, smoking and alcohol intake tobe 3.95
(2.5, 6.2), 2.1 (1.4, 3.1), 2.1 (1.4, 3.2), 1.7 (1.1, 2.6), 1.8 (1.1,2.8)
and 1.5 (0.86, 2.6), respectively. Except alcohol intake, the other factorswere
statistically significant. Hemoglobin, packed cell volume (hematocrit),serum
cholesterol, triglycerides and low-density lipoprotein cholesterol levelswere
not found to be significant. High-density lipoprotein (HDL) cholesterol anduric
acid were significantly lower and the ratio of total cholesterol to HDLcholesterol
(TC/HDL) was higher among stroke patients. The risk was considerablyhigher
when there was any combination of hypertension, heart disease and HDLcholesterol
level lower than 45 mg/dl. Logistic regression revealedhypertension, heart
disease of any type, lower HDL cholesterol and uric acid andhigher ratio of
TC/HDL to be significant factors.
48. Neurology
India 36, 183, 1988.
- Nocardial
Brain abscess.
Sridharan
R, Ganapathy K, Thara F and Mani M K.
49. Neurology
India 36, 238, 1988.
- Evolution
of Brain abscess.
Sridharan R and Reginald J.
50. Neurology
India 36, 252, 1988.
- Diseminated
tuberclosis with multiple intracranial tuberculomata.
