Raviraja Acharya

Jog falls: a pervasive healthcare platform for diabetes management

This paper presents Jog Falls, an end to end system to manage diabetes that blends activity and energy expenditure monitoring, diet-logging, and analysis of health data for patients and physicians. It describes the architectural details, sensing modalities, user interface and the physicians backend portal. We show that the body wearable sensors accurately estimate the energy expenditure across a varied set of active and sedentary states through the fusion of heart rate and accelerometer data. The GUI ensures continuous engagement with the patient by showing the activity goals, current and past activity states and dietary records along with its nutritional values. The system also provides a comprehensive and unbiased view of the patients activity and food intake trends to the physician, hence increasing his/her effectiveness in coaching the patient. We conducted a user study using Jog Falls at Manipal University, a leading medical school in India. The study involved 15 participants, who used the system for 63 days. The results indicate a strong positive correlation between weight reduction and hours of use of the system.

Segmentation and classification of tuberculosis bacilli from ZN-stained sputum smear images

Quality of tuberculosis (TB) diagnosis by manual observation varies depending on the quality of the smear and skill of the pathologist. To overcome this problem, a method for diagnosis of TB from ZN-stained sputum smear images is presented in this paper. Hue color component based approach is proposed to segment the bacilli by adaptive choice of the hue range. The bacilli are declared to be valid or invalid depending on the presence of beaded structure inside them. The beaded structure is segmented by thresholding the saturation component of the bacilli pixels. Clumps of bacilli and other artifacts are removed by thresholding the area, thread length and thread width parameters of the bacilli. Results presented for several images taken from different patients show that the scheme detects the presence of TB accurately.

Role of hemodialysis in baclofen overdose with normal renal function

The treatment of baclofen overdose is primarily supportive. There have been case reports of hemodialysis being used in patients with chronic kidney disease with baclofen overdose. A case report of hemodialysis in a baclofen-overdose patient with normal renal function is presented. Review of literature has also been provided.

Comprehensive DNA copy number profile and BAC library construction of an Indian individual

Bacterial artificial chromosomes (BACs) are used in genomic variation studies due to their capacity to carry a large insert, their high clonal stability, low rate of chimerism and ease of manipulation. In the present study, an attempt was made to create the first genomic BAC library of an anonymous Indian male (IMBL4) consisting of 100,224 clones covering the human genome more than three times. Restriction mapping of 255 BAC clones by pulse field gel electrophoresis confirmed an average insert size of 120 kb. The library was screened by PCR using SHANK3 (SH3 and multiple ankyrin repeat domains 3) and OLFM3 (olfactomedin 3) specific primers. A selection of clones was analyzed by fluorescent in situ hybridization (FISH) and sequencing. Fine mapping of copy number variable regions by array based comparative genomic hybridization identified 467 CNVRs in the IMBL4 genome. The IMBL4 BAC library represents the first cataloged Indian genome resource for applications in basic and clinical research.

Looking beyond the obvious: cefepime‑induced nonconvulsive status epilepticus

Cephalosporins are a commonly used class of antibiotics in various types of infections. Cefepime, a fourth-generation cephalosporin, has been reported to cause neurotoxicity, which can present itself as varied manifestations. Nonconvulsive status epilepticus (NCSE) is a rare manifestation of this neurotoxicity. This condition often proves difficult to diagnose because it is chiefly an electroencephalogram-based diagnosis. The authors report a case of cefepime-induced NCSE in a 57-year-old female patient with compromised renal status.

An unusual cause for hyponatremia with seizures

A 50-year-old Asian Indian female with known hypertension presented with persistent vomiting but no other symptoms of meningism. Clinical examination and basic laboratory parameters were entirely normal except for significant hyponatremia. Further investigation was suggestive of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Subsequently, despite steady correction of hyponatremia, the patient developed generalised seizures. Cerebrospinal fluid (CSF) analysis performed was inconclusive. Screening for a chronic meningitis underlying SIADH, yielded positive blood and CSF titres for venereal disease research laboratory (VDRL), which were confirmed by Treponema pallidum haemagglutination (TPHA). The patient was treated for neurosyphilis and made a complete recovery. Hyponatremia resolved and she had no further episodes of seizures. She was tested for HIV infection which was negative. On follow-up, she remained TPHA positive but VDRL titres became negative.

Interesting association of neurofibroma with diffuse cystic lung disease (NF-DLD)

A man aged 46 years presented with gradually progressive weakness of bilateral lower limbs and reduced sensation below the level of nipple for the past 2 months. There was no history of upper limb weakness and his bowel and bladder movements were normal. On enquiry, he also has a 2-year history of dry cough, wheeze and exertional dyspnoea. He is a non-smoker with no other significant medical history. On examination, power of bilateral lower limbs was 0/5, and knee and ankle reflexes were brisk with extensor plantar response. The patient had decreased sensation below the level of D5 vertebra. He had bilateral occasional rhonchi on chest auscultation. MRI of the spinal cord revealed benign intraspinal extradural dumb-bell-shaped lesion, measuring 3.8×2.0×3.0 cm, isointense on T2WI, hyperintense on T1WI, STIR noted at the D6–7 level causing significant spinal cord compression suggestive of neurogenic tumour …

Performance of the 2010 American College of Rheumatology/European League against Rheumatism (ACR/EULAR) criteria for classification of rheumatoid arthritis in an Indian population: An observational study in a single centre

Background & objectives: The 1987 American College of Rheumatology (ACR) criteria were criticised for classifying patients only in the late stage. The 2010 ACR/European League against Rheumatism (ACR/EULAR) classification criteria for rheumatoid arthritis (RA) were thus formulated to recognize the early stage of disease with high sensitivity. This pilot study was designed to estimate and compare the sensitivities of the 1987 ACR and 2010 ACR/EULAR classification criteria for RA. Methods: In a tertiary care hospital, the medical records of 97 patients diagnosed with RA were reviewed. Case study forms were filled with relevant clinical data and investigation results after reviewing each medical record. The radiographs of hands were also reviewed. To each case, both the 1987 ACR and the 2010 ACR/EULAR criteria were applied and the results of the classification were noted. Results: The sensitivity of the 2010 ACR/EULAR criteria was found to be 79.38 per cent [95% confidence interval (CI) = 71.33-87.43%] and the sensitivity of the 1987 ACR criteria was found to be 63.92 per cent (95% CI = 54.36-73.48%). The difference in the sensitivities was significant (P< 0.01). There was a significant rise in sensitivity of the 2010 ACR/EULAR criteria when patients having anti-cyclic citrullinated peptide (CCP) titres were analysed. Interpretation & conclusions: The 2010 ACR/EULAR criteria were found to be more sensitive than the 1987 ACR criteria possibly owing to features of the criteria. Anti-CCP titres were found to increase the sensitivity of the 2010 ACR/EULAR criteria.

Tubercular Ascites Simulating Ovarian Hyperstimulation Syndrome following In Vitro Fertilization and Embryo Transfer Pregnancy

Ovarian hyperstimulation syndrome (OHSS) is a known complication of using ovulation induction drugs in assisted reproductive techniques. Its incidence and severity vary. Tuberculosis is a very common disease in the developing world, and ascites is one of its sequelae. The newer aids in diagnosing tuberculosis include measuring levels of Adenosine DeAminase (ADA) in the third-space fluids or serum. This case report is from a tertiary care center, reflecting how tubercular ascites simulated OHSS, and the right diagnosis was made and managed. This is being presented due to its rarity.

Delayed presentation of scorpion sting with cardiogenic shock.

A young farmer presented with cardiogenic shock 5 days after a scorpion sting. He was managed with norepinephrine, atropine and supportive measures and made a complete recovery. The role of atropine in treating scorpion sting has to be defined better.