Biomedical subjects

K P Nair

Publications and source records attributed to K P Nair.

At least 19 recordsLinked to original sources

PubMed2001

Afferent pathways of sympathetic skin response in spinal cord: a clinical and electrophysiological study.

BACKGROUND: Sympathetic skin response (SSR) recording is an established test of sudomotor autonomic functions. However, knowledge of its pathways in spinal cord is putative. OBJECTIVE: This study involved subjects with isolated spinal cord lesions to evaluate the afferent pathways of SSR. METHODS: Clinical examination was done according to standard neurological classification of spinal cord injury. Electrophysiological evaluation included: (1) conventional nerve conduction studies to exclude peripheral nerve lesions, (2) scalp somato-sensory-evoked potentials (SEP) with posterior tibial nerve (PTN) stimulation and (3) SSR recording from palm by stimulating supra orbital nerve (SON) at forehead, and PTN at ankle. Subjects with absent SSR in palm to SON stimulation were excluded. In such patients, the afferent tracts were considered abnormal when SSR was absent in palm on stimulation of PTN. RESULTS: Among 37 subjects (age-28.1+/-12.8 years), the afferent tracts of SSR were affected in 13. Sparing of afferent SSR tracts correlated with preservation of bladder sensations (P<0.01). There was no correlation between SSR and SEP. CONCLUSIONS: Spinal cord lesions frequently involve afferent tracts of SSR. Spinal afferents of SSR are closely related with tracts of bladder sensations and are different from pathways for SEP.

Adolescent↗

PubMed2001

Disabilities in children with Duchenne muscular dystrophy: a profile.

Proper assessment of disabilities is essential for rehabilitation of patients with Duchenne muscular dystrophy. The aim of this study was to identify and quantify the disabilities in children with Duchenne muscular dystrophy and correlate them with impairment. Thirty-one patients with Duchenne muscular dystrophy of age four years and above were studied. The motor functions were evaluated using total motor score, upper and lower extremity function grades and timed function tests. Disability was quantified with Barthel index. The mean scores of motor scales were: total motor score -52 +/- 7.8, total functional grade -4.4 +/- 1.9 and timed function score -12.5 +/- 5.8. Barthel index scores ranged from 45-95 with a mean of 70.8 +/- 12.7. Motor scales correlated with each other and with Barthel index. Thirty children had disabilities in multiple spheres of life, which were significantly influenced by the motor power. Barthel index was useful in identifying and quantifying specific areas of disabilities in these children. Evaluation of disabilities using specific measures may be crucial for planning comprehensive management.

Activities of Daily Living↗

PubMed2001

Neurogenic heterotopic ossification : a diagnostic and therapeutic challenge in neurorehabilitation.

Heterotopic ossification (HO) is an important cause of restriction in range of movements and secondary motor disability following neurotrauma, orthopaedic interventions and burns. It has not received focussed attention in non-traumatic neurological disorders. In a prospective study of 377 patients, on medical problems in neurological rehabilitation setting, 15 subjects (3.97%) had neurogenic heterotopic ossification. Their clinical diagnosis was: transverse myelitis (7), neurotuberculosis (4), traumatic myelopathy (2) and stroke (2). Hip (10), knee (4) and elbow joints (1) were involved. The risk factors included urinary tract infection (15), spasticity (6), pressure sores (13) and deep venous thrombosis (DVT) (6). The initial diagnosis was often other than HO and included DVT (3), haematoma (2) and arthritis (2). ESR and serum alkaline phosphatase levels were elevated in all but one subject. The diagnosis of HO was established using X-rays, CT Scan and three-phase bone scan. Following treatment with non-steroidal anti-inflammatory drugs, the range of motion improved in only four patients. HO resulted in significant loss of therapy time during rehabilitation. High index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Disability Evaluation↗

PubMed1999

Heterotopic ossification in non-traumatic myelopathies.

Heterotopic ossification (HO) is an important complication of spinal cord and brain injuries but is rarely reported among patients with non-traumatic myelopathies. In a prospective study on medical problems seven (6.04%) among the 114 subjects with non-traumatic myelopathies had heterotopic ossification. All of them had involvement of hip joints. The co-morbid conditions were: urinary tract infection, seven; spasticity, three; pressure sores, five; and deep venous thrombosis, one. The initial diagnosis was often other than heterotopic ossification. Erythrocyte sedimentation rate and serum alkaline phosphatase levels were elevated in all subjects. Following rest and non-steroidal anti-inflammatory drugs, the range of motion improved in two patients. Heterotopic ossification can occur in patients with non-traumatic myelopathies and has risk factors and clinical features similar to patients with traumatic spinal cord injury. A high index of suspicion about this complication is necessary for early diagnosis and prompt intervention.

Adolescent↗

PubMed1999

Non-traumatic acute rhabdomyolysis.

A boy developed sudden severe generalized muscle stiffness, bulbar weakness and passed dark coloured urine. Laboratory tests revealed marked elevation of creatinine kinase(CK) levels and myoglobinuria. Histopathology of quadriceps muscle showed features of acute rhabdomyolysis. Patient made complete clinical recovery over a period of three weeks and CK returned to normal level. The possible aetiologies of non-traumatic rhabdomyolysis are discussed and the relevant literature reviewed.

Acute Disease↗

PubMed1998

Sympathetic skin response in myelopathies.

Autonomic dysfunctions cause significant morbidity and mortality among patients with spinal cord disorders. Sympathetic skin response (SSR), a simple, noninvasive electrophysiological technique, may be useful for assessing sympathetic functions in patients with myelopathies. Our aim was to study SSR in patients with myelopathy and correlate it with clinical features, severity of the impairment, somatosensory evoked potentials. and outcome. Thirty patients (15 men, 15 women) 12 to 60 years old with myelopathies of different etiology were studied. Subjects with clinical, electrophysiologic, or radiologic evidence of lesions outside the spinal cord were excluded. Somatosensory evoked potentials (SSEP) were recorded from scalp with median nerve stimulation at the wrist and posterior tibial nerve below the medial malleolus. The SSR was recorded from palm and sole after stimulating the supraorbital nerve at forehead, median nerve at wrist, and posterior tibial nerve below medial malleolus. The SSR was considered abnormal when absent. The sites of the lesions in these patients were cervical (13), thoracic (16), and lumbar (1). The lesion was clinically complete in six patients. Good motor recovery was noted in 16 subjects. SSR was absent from sole in 25 and palm in 10 patients from all three sites of stimulation. In addition, three patients also had absent SSR from palm on posterior tibial nerve (PTN) stimulation. SSEP was absent from median (N19) in three and posterior tibial (N39) in 20 patients. Among 10 patients with absent SSR from palm, only three had a good outcome. Presence of SSR from palm to PTN stimulation correlated with sparing of bladder sensations and good outcome. However, absent SSR from sole did not correlate with clinical features, bladder dysfunction, or outcome. Sympathetic skin response is frequently abnormal in patients with myelopathies. Spinal afferent and efferent tracts for SSR are different and may be affected individually. The afferent pathways are closely related to tracts conveying bladder sensation. Preserved palmar SSR on PTN stimulation may suggest good motor outcome. SSR may be a valuable adjunct in evaluating patients with myelopathies.

Adolescent↗

PubMed1997

CT in simple partial seizures in children: a clinical and computed tomography study.

INTRODUCTION: Therapeutic relevance of computed tomography (CT) in children with simple partial seizures (SPS) is reported to be remarkably low (1-2%). There are not studies, however, from the developing countries where neuroinfections are among important causes of seizures. The present study from India is aimed at evaluating the significance of CT in the management of SPS in children and to determine the difference in clinical features of children with and without focal brain lesions in CT. PATIENTS AND METHODS: CT scans of all patients aged 15 years of younger with SPS, seen over a period of 15 months, were reviewed. The clinical features of the patients with focal lesions in the CT were compared with those of children without focal abnormalities. RESULTS: Focal structural lesions were present in 117 (59.09%) of 198 children. These included: solitary contrast enhancing CT lesion-16.16%, focal calcification-12.12%, cysticerosis-10.10%, focal atrophy-9.59%, tuberculoma-6.56% and infarction-6.06%. Neuroinfections or their sequelae were responsible for seizures in 89 children (44.94%). There were no statistically significant differences in clinical features of patients with and without focal lesions in CT. CONCLUSIONS: CT study in children with SPS in developing countries has significant therapeutic relevance. It is not possible to clinically differentiate children with focal lesions from those without focal lesions in CT.

Adolescent↗

PubMed1990

Paget--Schroetter's syndrome.

Primary thrombosis of the subclavian axillary veins is known as Paget-Schroetter's syndrome. A 35 year old male with classical features of this syndrome is being reported. Antecubital venogram showed bilateral subclavian thrombosis.

Adult↗

PubMed1987