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Biomedical subjects

D K Subbakrishna

Publications and source records attributed to D K Subbakrishna.

At least 55 records · Page 3Linked to original sources
PubMed1998

A prospective study of bipolar disorder in children and adolescents from India.

Bipolar disorder in adults is known to run an episodic course. However, little information exists on the long-term naturalistic course of bipolar disorder in juvenile populations. The present study was undertaken with the objectives of (i) documenting the rates of recovery and relapse, (ii) identifying the predictors of recovery and relapse and (iii) assessing the rates of comorbid conditions. A total of 30 subjects with onset of bipolar illness (according to DSM-III-R criteria) in childhood and adolescence were assessed systematically at baseline and 4 to 5 years later. All 30 subjects (100%) had recovered from their index episodes and none had exhibited chronicity. Twenty of the 30 subjects (67%) had relapsed, with most relapses occurring within 2 years of recovery from index episodes. No predictors of recovery and relapse could be identified. Conduct disorder was the only comorbid diagnosis in two subjects (7%). The main implication of our study, in view of the high rates of relapse in the crucial developmental phase of a young individual, is that long-term maintenance medication should be considered in juvenile bipolar patients, even if it is a first episode.

Adolescent↗
PubMed1998

EEG seizure in bilateral ECT is different between low and high stimulus doses.

Melancholic depressive patients referred for ECT were randomized to receive either low dose (n = 20) or high dose (n = 20) stimulus applied bifrontotemporally. The two stimulus groups were comparable on the clinical variables. The EEG seizure was recorded on two channels (right and left frontal), digitized, coded and analyzed offline without knowledge of ECT parameters. EEG seizure was of comparable duration in the two stimulus (high dose and low dose) groups. A new composite measure, Strength-Symmetry-Index (SSI), based on strength and symmetry of seizure EEG was computed using fractal geometry. The SSI of the early-seizure was higher in the high dose than in the low dose ECT group. In a stepwise, logistic regression model, this variable contributed to 65% with correct classification of high dose and low dose ECT seizures.

Adult↗
PubMed1998

Heparin in haemorrhagic infarction in cerebral venous sinus thrombosis.

Morbidity and mortality in puerperal cerebral venous thrombosis (CVT) can be reduced by arresting the progression of thrombosis using heparin. However, conventional dose of heparin requires monitoring of coagulation parameters and carries a risk of haemorrhage. The present study involved 56 patients of puerperal CVT with CT evidence of haemorrhagic infarction. Twenty nine of these patients received low dose heparin till 30th post-partum day or symptomatic relief. Their clinical features and severity were similar to 27 patients who did not receive heparin. The mortality and morbidity at discharge was significantly less (P < 0.001) in heparin treated group. There were no haemorrhagic complications. Low dose heparin is safe and effective in cerebral venous thrombosis, even with haemorrhagic infarction.

Adult↗
PubMed1998

Acute post-ECT cardiovascular response: a comparison of threshold right unilateral and bilateral ECT.

The effect of electrode placement on cardiovascular responses was studied. Rate pressure product and diastolic blood pressure before anesthesia and 30 s after electroconvulsive therapy (ECT) seizure were recorded. Recordings were made at the first (threshold ECT) session in 124 bilateral ECT (BLECT) and 95 unilateral ECT (ULECT) consenting patients. Postictal rate pressure product (RPP) was significantly higher after BLECT than ULECT. Mean increase in RPP from pre- to postictal phase was 31% in the former. The corresponding change with ULECT (20%) was significantly smaller. In the stepwise, multiple regression model, pre-ECT RPP, age, and stimulus laterality significantly contributed to postictal RPP. No cardiovascular complications occurred in any of the 219 ECT sessions.

Adult↗
PubMed1998

Formula method for stimulus setting in bilateral electroconvulsive therapy: relevance of age.

Seizure thresholds were determined by titration in consecutive electroconvulsive therapy (ECT) patients at the first (n = 146) and sixth (N = 83) ECT sessions. Equations to predict the threshold at the first and sixth ECT were computed from these data using a stepwise linear regression model. These equations were tested prospectively at the first ECT (n = 48) and sixth ECT (n = 26) sessions. Stimulus dose derived from the corresponding equations yielded adequate seizure (successful) in 82% and 84% of patients, respectively. Predictions based on age alone (disregarding two other significant variables--illness severity and inion-nasion distance) were estimated at these two ECT sessions. This would not appreciably compromise the success rate. The "formula" method using age alone may therefore be used in routine clinical practice.

Adolescent↗
PubMed1997

Temporary amelioration of symptoms with intravenous cyclophosphamide in amyotrophic lateral sclerosis.

Based on the evidence that autoimmunity may play a role in the pathogenesis of amyotrophic lateral sclerosis (ALS), a variety of immunomodulating agents have been used in the treatment. In an uncontrolled trial we treated 44 patients of ALS with intravenous cyclophosphamide (IVCP) at a total dose of 1.5 g/m2 given over a period of 8 to 10 days. The patients were evaluated using neurological score which included bulbar, motor and daily activity scores before and following treatment. Twenty three patients showed a significant improvement (P=<0.001) in the composite and the individual scores. The improvement persisted only for 2 to 3 months. Amongst them the severely (7) and moderately (16) affected (score less than or more than 150) showed almost a similar response to treatment. A comparison of the improved group of 23 patients with the unimproved group of 21 patients did not reveal any significant factors which influenced the response to IVCP. However, there was a suggestion that patients below the age of 60 years and a duration of illness less than 12 months may respond to the drug. In conclusion, treatment with intravenous cyclophosphamide resulted in mild and temporary improvement in clinical status of the patients with amyotrophic lateral sclerosis. This may be considered as an alternative method of treatment in developing countries where newer drugs are not available and affordable.

Adult↗
PubMed1997

Gender but not stimulus parameters influence prolactin response to electroconvulsive therapy.

The post-ictal prolactin (PRL) response represents one of the most consistent findings of electroconvulsive therapy (ECT), but correlates variably with the gender of the patient, ECT stimulus waveform, dose and electrode placement. Forty patients with endogenous depression (29 drug-naive) received either high-energy (240 mC) or low-energy (60 mC) bilateral brief-pulse ECT once or three times a week. The PRL and growth hormone (GH) levels were estimated using double antibody radioimmunoassay. The average post-ECT PRL levels differed significantly from the pre-ECT levels, with a seven- to nine-fold increase in PRL at each week of treatment. No such difference was observed in the GH levels. All patients showed an increase in PRL levels, whereas 42% failed to show an increase in GH levels. The delta PRL response (difference between post-ECT and pre-ECT serum hormone levels) was not significantly different between the drug-naive and medicated patients nor between the high-energy and low-energy groups at first ECT. Similarly, no difference was observed between the once-weekly and thrice-weekly groups at the third week of ECT. At each week of treatment, the delta PRL was significantly higher in females than in males, unlike the GH response. Electroencephalographic (EEG) seizure duration did not correlate with either delta PRL or delta GH at first ECT and third week ECT. Apart from gender, none of the variables, such as age, baseline severity of illness, presence of psychotic symptoms, drug-naive status, stimulus dose, seizure duration, seizure strength, pattern and symmetry, frequency of ECT and degree of improvement predicted the delta PRL response. Neither stimulus energy nor frequency of ECT had a significant effect on PRL response. Gender differences in PRL response to ECT merit further investigations.

Adult↗
PubMed1996

Neuro-epidemiological pilot survey of an urban population in a developing country. A study in Bangalore, south India.

A feasibility study was conducted in an urban population of 3,040 in Bangalore, South India, to understand the baseline characteristics, evaluate screening questionnaires, identify potential problems and determine the magnitude of the problems. The target population was selected by a random method, from four census enumeration blocks of a specific urban area. A two-phase study design was adopted consisting of screening by trained field investigators in the initial stage and clinical examination by a neurologist in the second stage. The information was collected by an interview method on a house-to-house basis. Evaluation of the screening instruments yielded high sensitivity and specificity rates, and it became clear that there is a need to reduce false-positive results in the screening questionnaire for individuals above 7 years of age. The prevalence of neurological disorders was 32.8 per 1,000 population (with a rate of 7.8/1,000 for epilepsy). It appears feasible to detect a wide range of neurological disorders using the methods described.

Adolescent↗
PubMed1995

Prognosis of extradural haematomas in children.

102 children treated surgically for intracranial extradural haematoma from 1982 to 1991 were evaluated retrospectively and their prognosis was compared with 387 adults treated during the same period. Children had a better prognosis than adults even with a low Glasgow Coma Scale (GSC) score at surgery. Children had a higher incidence of frontal and posterior fossa haematomas. The GCS score and the associated parenchymal injuries had a strong correlation with the outcome both in adult and children, whereas the site of haematoma had no correlation with the final outcome.

Adolescent↗
PubMed1994

Critically ill Guillain Barre' syndrome.

Among the 153 patients fulfilling NINDS criteria for Guillain Barre' Syndrome (GBS) seen over 5.5 yrs, there were 47 (M:F 38.9) critically ill patients (age range 4 to 60 years). Antecedent event was recorded in 25 patients and the peak deficit was attained over a mean period of 9.5 days. Besides severe motor paralysis other salient features were: bulbar paralysis--42, sensory symptoms or signs--21, dysautonomia 31 and requirement for ventilatory assistance 45. CSF protein was raised in 63% cases. All the 17 patients who underwent electromyography had abnormalities of nerve conduction paramentes. Mean stay on the ventilator was 29.6 days and was not influenced by corticosteroid. Complications were frequent: pulmonary and urinary tract infection, dysautonomia, electrolyte disturbances, haemetmesis, bleeding from tracheostomy site and hepatic and renal failure. Mortality in steroids treated group (13/27) and the conservatively managed group (5/20) did not differ significantly. No discriminant factor emerged between survivors and non-survivors. Age and sex of the patients, presence of antecedent event, onset to peak interval and CSF protein level did not predict the need for ventilatory assistance, although these patients at admission had more frequent weakness of facial, bulbar, trunk, neck and proximal muscles of upper limbs and autonomic disturbances. Course of GBS remains unpredictable at the onset of the disease, warrants close supervision and meticulous supportive care and remains a therapeutic challenge.

Adolescent↗
PubMed1993

Twice versus thrice weekly ECT in melancholia: a double-blind prospective comparison.

Thirty patients with major depressive disorder of melancholic subtype were randomly allocated to receive ECT either twice or thrice a week. Double-blind ratings on the Hamilton Scale for Depression and Clinical Global impression showed no differences in the outcome through 4 weeks of trial as well as at 6-month follow-up. Cumulative seizure duration was higher in the thrice weekly group but not significantly so in spite of having received a significantly greater number of ECTs. The results indicate that ECT given thrice a week conferred no advantage over ECT given twice a week.

Adult↗
PubMed1993

Prognosis of single unprovoked seizure.

201 patients (131 males and 70 females) with mean age of 18 years (range 5-55 years) who presented at median of 6 days after the onset of first unprovoked seizure were studied. They were followed for a mean period of 60 months (range 12-84 months). One hundred and fifty four (76%) patients were treated with anticonvulsant medication (group A) on a non-randomized basis and the remaining 47 patients (24%) were not treated (group B). Both the groups were comparable for age, sex, type of seizure and interval between onset of seizure and consultation. The cumulative risk of recurrence for entire study group was 24% at 1 month, 32% at 6 months, 34% at 12 months, 35% at 24 months and 36% at 36 months. The cumulative risk of recurrence in group A was 23%, 30%, 32%, 33% and 33% as compared to 28%, 36%, 40%, 43% and 45% at 1, 6, 12, 24 and 36 months respectively (p > 0.05). Maximum number of recurrences (67%) occurred within 1 month. No recurrence occurred after 36 months after the onset of first seizure. Age at onset, sex, seizure type, family history of seizure, EEG abnormalities and nature of antiepileptic drugs did not influence the risk of recurrence.

Adolescent↗
PubMed1992

Time dependent therapeutic effects of single electroconvulsive therapy (ECT) in endogenous depression.

The present study was addressed to test the hypothesis of time dependent effects of a single ECT in endogenous depression. In a randomized, prospective and double blind controlled comparison 12 patients received only one true modified ECT followed by five sham ECTs on alternate days. They responded as well as the control group of 12 patients who received six true ECTs on alternate days. The Hamilton Rating Scale for Depression and a global rating scale for depression were used to monitor therapeutic response. The therapeutic effects of ECT were time dependent developing during the second week of the study period.

Adult↗
PubMed1989

Alcoholism--assessment and diagnosis.

Ninety-two patients with alcoholism were interviewed on various aspects of alcohol use. Factor analysis of the data revealed five factors: withdrawal symptoms; help seeking behaviour; pathological drinking; legal difficulties; family problems. The analysis suggested the possibility of heterogenity in this clinical sampling with alcoholism.

Alcohol Drinking↗
PubMedDate not supplied

Calcium and phosphorus levels in serum and CSF in dementia.

Marked differences in CSF levels of both calcium and phosphorus were observed in patients with dementia and aged controls when compared with adult controls. A significant decrease in both Ca and P in CSF was observed in Alzheimer's type dementia (p less than 0.01) and multi-infarct dementia cases (p less than 0.01). The geriatric controls also showed a significant decrease in both Ca and P. A 60% decrease in diffusible Ca in CSF was noted both in patients and geriatric controls when compared to adult controls (p less than 0.001). Diffusible P was also decreased in all three groups (p less than 0.05). A marginal decrease in serum Ca and slight increase in P was observed in both patients and geriatric controls. The significant decrease in CSF Ca and P in both groups of patients compared with aged controls suggests this lowering of Ca and P is not due to solely to the aging process and indicates a role in the pathology of age-related disorders.

Adult↗