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Biomedical subjects

D Karnad

Publications and source records attributed to D Karnad.

8 recordsLinked to original sources
PubMed2002

Deferiprone (L1) as an adjuvant therapy for Plasmodium falciparum malaria.

BACKGROUND & OBJECTIVES: Mortality due to Plasmodium falciparum infection remains high in India, hence any modality of treatment which can improve the outcome of this disease is worth exploring. The present study was undertaken to see whether addition of an oral iron chelator, deferiprone (L1) to the conventional treatment regime for P. falciparum infection improves the clinical course and final outcome. METHODS: In this prospective, randomised double blind trial, 45 consecutive patients with P. falciparum infection were randomised into two groups. Patients in Group I (control group, 21 patients) received standard quinine and doxycycline therapy along with supportive therapy and placebo capsules for 10 days. Patients in Group II (24 patients) received the same treatment as Group I but in place of placebo capsule received deferiprone capsules 75 mg/kg/day in 12 hourly divided doses. The parameters evaluated included the time taken in resolution of parasitaemia, fever and coma, differences in final outcome i.e., death or other severe complications, and side effects and deferiprone tolerance. RESULTS: Four patients in Group I and two in Group II died (P > 0.05). The resolution of fever and coma was significantly faster in Group II (P < 0.05) and parasitaemia cleared 24 h earlier in this Group. The drug was well tolerated and had no side effects. INTERPRETATION & CONCLUSION: Deferiprone (L1) seems to be a promising agent as an adjuvant in the treatment for severe P. falciparum malaria infection.

Adolescent↗
PubMed1999

Methanol poisoning: brain computed tomography scan findings in four patients.

Methanol, through its chief metabolite, formate, causes irreversible neurological damage. Methanol intoxication produces classic neuropathological changes and characteristic imaging findings. Computed tomography was performed on four patients who presented with a history of methanol poisoning. Prominent, hypodense lesions in the lentiform nuclei and peripheral white matter, sometimes with haemorrhage, were the characteristic imaging findings in the present patients. It was noted that the severity and extent of necrosis of the lentiform nuclei do not necessarily correlate with the clinical outcome.

Adult↗
PubMed1994

The stapedial reflex in cephalic tetanus.

Three patients are presented with cephalic tetanus following injuries to the face. Two were adults and one a child. All three had bilateral VIIth cranial nerve involvement and one patient also presented with involvement of the IIIrd, IVth and VIth cranial nerves. The patients initially an ipsilateral VIIth cranial nerve weakness which later in the course of the illness developed into hyperactivity of the VIIth cranial nerve. The contralateral VIIth cranial nerve demonstrated a similar pattern. The stapedial reflex was tested serially. The stapedius muscle activity preceded that of the muscles of the face thus serving as an indicator of improvement or impending deterioration. Deflections measuring more than 1 cm, on stapedial reflex threshold testing, were indicative of stapedial reflex spasm. In the stapedial reflex decay test, both ill-sustained (intermittent) and sustained spasms of the stapedius muscle were seen.

Acoustic Impedance Tests↗
PubMed1994

Cerebellar venous infarction in chronic suppurative otitis media. A case report with review of four other cases.

BACKGROUND: Cerebellar venous infarction is a rare condition. Thus far only four cases have been reported in the literature. We recently encountered a patient with chronic suppurative otitis media complicated by cerebellar venous infarction. The features of cerebellar venous infarction in the other four cases are also reviewed. CASE DESCRIPTION: A 20-year-old man presented with clinical features suggestive of chronic suppurative otitis media. Computed tomographic scan of the brain revealed left mastoiditis with cholesteatoma and moderate communicating hydrocephalus. The patient was subjected to left radical mastoidectomy, and an attico-antral cholesteatoma was removed. Subsequently the patient developed clinical features suggestive of cerebellar abscess. A repeat computed tomographic scan revealed normal posterior fossa. Four-vessel angiography revealed left sigmoid and lateral sinus thrombosis and nonopacification of the left-sided cerebellar veins. Magnetic resonance imaging showed a venous infarct in the left cerebellar hemisphere. The patient was treated with cerebral dehydration measures. The patient subsequently improved and had no neurological deficit 3 months after surgery. CONCLUSIONS: Although cerebellar venous infarction is rare, it can occur in chronic suppurative otitis media, pregnancy, antithrombin III deficiency, and diabetic osmolar coma. Sometimes no cause is found. Treatment includes correction of the underlying cause. The presence of a hemorrhagic lesion on computed tomographic scan and deep coma at presentation indicate poor prognosis.

Adult↗
PubMedDate not supplied

Anti-neutrophil cytoplasmic antibodies (ANCA) in malaria.

Various autoantibodies like anti-nuclear antibodies (ANA), anti-double stranded DNA (anti-dsDNA), anti-histone antibodies (AHA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-myeloperoxidase (anti-MPO), anti-proteinase3 (anti-PR3) and anti-lactoferrin (anti-LF) antibodies were studied in 173 acute hospitalised patients suffering from malaria of which 160 patients had P. falciparum and remaining 13 had P. vivax infection. Standard methods like indirect immunofluorescence (IIF) microscopy along with Confocal microscopy and ELISA were used for identifying and quantifying the autoantibodies and IIF patterns on PMN and HL-60 cells were studied for ANCA classification. Also HEp-2 cells were used for ANA detection, while estimation of anti-dsDNA, AHA, anti-MPO, anti-PR3 and anti-LF were tested using ELISA. Sera from malaria patients showed prominent immunofluorescence staining patterns where 23.8% cases had ANA in P. falciparum group as compared to 15.4% in P. vivax group and ANCA was found to be present in 20% in P. falciparum and 15.4% in P. vivax group. An interesting observation was that, of the total ANCA positives, 59% had p-ANCA, 5.9% had c-ANCA and 44.1% of the cases showed the 'atypical' or X-ANCA pattern. When p-ANCA positivity was compared with c-ANCA positivity among these patients, a good statistical correlation was noted with OR = 16, chi 2 = 16.43, EF = 0.46 and p-value = 5.037E 0.5. ELISA showed 31.2% anti-MPO and 6.2% anti-PR3 in P. falciparum cases while the two ANCA positive cases in P. vivax had anti-MPO. Anti-LF was found to be present in 40.6% cases. Neither the P. falciparum nor P. vivax contained autoantibodies with specificities similar to the characteristic lupus autoantibodies such as double stranded DNA (dsDNA). ANCA positivity develops in some types of malarial infection also with the presence of various autoantibodies which is important from a clinical point of view and should be carefully evaluated in those geographic areas where malaria is endemic. It also alerts us to the fact, whether in cases of repeated malarial infections in susceptible individuals, vasculitic disorders, which through ANCA pathways develop, could lead to renal and other complications.

Adolescent↗
PubMedDate not supplied

HLA associations in P. falciparum malaria patients from Mumbai, western India.

In the present study, HLA associations among the cohort of 171 severe P. falciparum malaria patients were compared with that of 101 normal sex, age and ethnically matched control samples. All these individuals lived in Mumbai in an area of low and seasonal P. falciparum transmission. HLA A, B, DRB1 and DQB1 antigens were serologically (A and B) and molecularly (DRB and DQB) determined using isolated lymphocytes and genomic DNA following the microlymphocytotoxicity assay and PCR-SSP techniques. Significant differences were observed between patients with malaria and controls in the following groups of alleles: A3, B27, B49, DRB1*04, and DRB1*0809 were increased, while A19, A34, B18, B37, and DQB1*0203 were decreased. HLA B49 and DRB1*0809 were found to be positively associated with the complicated severe malaria patients (OR = 13.88; p < 0.0001). HLA A19, B5 and B13 were protective in patients with high parasite index (> 2%). These observations revealed the importance of ethnic background, which has to be taken into consideration while developing an ideal malaria vaccine. Further, when compared to HLA associations of other world populations the present study indicates the relative importance of different HLA alleles that may vary in different populations.

Adolescent↗