Shashikiran Umakanth

User-driven health care: answering multidimensional information needs in individual patients utilizing post-EBM approaches: an operational model

The hypothesis in the conceptual model was that a user-driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world. It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.

Medical education and the physician workforce of iraq

The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the continuing professional development of physicians.

A questionnaire based survey on awareness of diabetic foot care in Indian population with diabetes: a cross-sectional multicentre study.

OBJECTIVE To find awareness regarding foot care in Indian population with diabetes in various parts of India. MATERIALS AND METHOD A cross-sectional study design was used to perform a multicenter, national level survey from August, 2011 to February, 2012 in various parts of India. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 16. Awareness levels for diabetic foot care were calculated as absolute frequencies and were reported as overall percentages. Spearman test was used to find the correlation for foot problems and diabetic foot care with socioeconomic status. RESULTS A total of 323 peoples were screened (there were 222 men and 101 women in the study with a mean age of 58.2 ± 8.6 years). 8.7% of men reported ulcer during the 1 st year of onset of diabetes, where as 8.3% of women were prone for ulcers in 16-20 years of diabetes, 56.4% of the population in urban area and 46.6% of the population in the rural area had been educated regarding foot care in diabetes. However, only 30.5% of population in urban areas and 9.7% of population in the rural areas knew about the importance of shoe selection in diabetes. Spearmans correlation was significant for foot problems with family income and educational status, P = 0.03 and P = 0.02 respectively. CONCLUSION There is a need to bridge the disparity in awareness regarding diabetic foot management in Indian masses. More aggressive measures are required to implement current preventive foot care strategies in India.

New molecular detection methods of malaria parasites with multiple genes from genomes.

For the effective control of malaria, development of sensitive, accurate and rapid tool to diagnose and manage the disease is essential. In humans subjects, the severe form of malaria is caused by Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) and there is need to identify these parasites in acute, chronic and latent (during and post-infection) stages of the disease. In this study, we report a species specific and sensitive diagnostic method for the detection of Pf and Pv in humans. First, we identified intra and intergenic multiloci short stretch of 152 (PfMLS152) and 110 (PvMLS110) nucleotides which is present up to 44 and 34 times in the genomes of Pf and Pv respectively. We developed the single-step amplification-based method using isolated DNA or from lysed red blood cells for the detection of the two malaria parasites. The limit of detection of real-time polymerase chain reaction based assays were 0.1copyof parasite/μl for PfMLS152 and PvMLS110 target sequences. Next, we have tested 250 clinically suspected cases of malaria to validate the method. Sensitivity and specificity for both targets were 100% compared to the quantitative buffy coat microscopy analysis and real-time PCR (Pf-chloroquine resistance transporter (PfCRT) and Pv-lactate dehydrogenase (PvLDH)) based assays. The sensitivity of microscopy and real-time PCR (PfCRT and PvLDH primers) assays were 80.63%; 95%CI 75.22%-85.31%; p<0.05 and 97.61%; 95%CI 94.50%-99.21%; p<0.05 in detecting malaria infection respectively when compared to PfMLS152 and PvMLS110 targets to identify malaria infection in patients. These improved assays may have potential applications in evaluating malaria in asymptomatic patients, treatment, blood donors and in vaccine studies.

Plasmodium vivax infection causes acute respiratory distress syndrome: a case report

Plasmodium falciparum (Pf) is associated with numerous complications and high mortality, whereas Plasmodium vivax (Pv) infection is generally considered to be benign. However, severe complications, such as acute respiratory distress syndrome (ARDS) in Pv infection, are emerging. This case report highlights the complication of ARDS during the course of Pv infection in a 60-year-old woman. The diagnosis of the patient was made using microscopy, immunochromatography, and polymerase chain reaction assays for Pf and Pv species. The data indicated the presence of mono-Pv infection in the patients blood, and Pf infection was specifically ruled out. The patient was discharged after intensive supportive care and antimalarial treatment. Pv infection is associated with ARDS and other complications such as sepsis and multi-organ dysfunction syndrome; this enhanced severity of Pv infection, if unrecognized, can lead to more deaths in malaria-endemic areas.

Photobiomodulation of surgical wound dehiscence in a diabetic individual by low-level laser therapy following median sternotomy.

In this single case study, we attempt to outline the possible effect of low-level laser therapy (LLLT) on delayed wound healing and pain in chronic dehiscent sternotomy of a diabetic individual. The methods that were employed to evaluate changes pre and post irradiation were wound photography, wound area measurement, pressure ulcer scale of healing (PUSH), and visual analogue scale (VAS) for pain. After irradiation, proliferation of healthy granulation tissue was observed with decrease in scores of PUSH for sternal dehiscence and VAS for bilateral shoulders and sternal dehiscence. We found that LLLT irradiation could be a novel method of treatment for chronic sternal dehiscence following coronary artery bypass grafting, as it augments wound healing with an early closure of the wound deficit. Hence, this might be translated into an early functional rehabilitation and decreased pain perception of an individual following surgical complication.

Pemphigus vulgaris in a pregnant woman and her neonate.

A 23-year-old pregnant woman in her second trimester of pregnancy presented with blisters on the face, abdomen and the leg. Based on the clinical presentation and skin biopsy (histopathology and direct immunofluorescence) the diagnosis of pemphigus vulgaris was established. The child born to this patient also had similar skin lesions. The lesions in the mother and the child improved after treatment. The authors report a rare case of pemphigus vulgaris in a pregnant lady and neonatal pemphigus in her child, both of whom were treated successfully.

Categorical complexities of Plasmodium falciparum malaria in individuals is associated with genetic variations in ADORA2A and GRK5 genes

In the erythrocytes, malaria parasite entry and infection is mediated through complex membrane sorting and signaling processes. We investigated the effects of single-locus and multilocus interactions to test the hypothesis that the members of the GPCR family genes, adenosine A2a receptor (ADORA2A) and G-protein coupled receptor kinase5 (GRK5), may contribute to the pathogenesis of malaria caused by Plasmodium falciparum (Pf) independently or through complex interactions. In a case-control study of adults, individuals affected by Pf malaria (complicated n=168; uncomplicated n=282) and healthy controls (n=450) were tested for their association to four known SNPs in GRK5 (rs2230345, rs2275036, rs4752307 and rs11198918) and two in ADORA2A (rs9624472 and rs5751876) genes with malaria susceptibility, using techniques of polymerase chain reaction-restriction fragment length polymorphisms and direct DNA sequencing. Single-locus analysis showed significant association of 2 SNPs; rs5751876 (OR=3.2(2.0-5.2); p=0.0006) of ADORA2A and rs2230345 (OR=0.3(0.2-0.5); p=0.0006) of GRK5 with malaria. The mean of the serum creatinine levels were significantly higher in patients with variant GG (p=0.006) of rs9624472 in ADORA2A gene compared to AA and AG genotypes in complicated Pf malaria cases, with the G allele also showing increased risk for malaria (OR=1.3(1.1-1.6); p=0.017). Analyses of predicted haplotypes of the two ADORA2A and the four GRK5 SNPs have identified the haplotypes that conferred risk as well as resistance to malaria with statistical significance. Molecular docking analysis of evolutionary rs2230345 SNP indicated a stable activity of GRK5 for the mutant allele compared to the wild type. Further, generalized multifactor dimensionality reduction to test the contribution of individual effects of the six polymorphisms and higher-order interactions to risk of symptoms/clinical complications of malaria suggested a best six-locus model showing statistical significance. The study provides evidence for the role of ADORA2A and GRK5 that might influence the etiology of malaria infection.

A subcutaneous cord over the chest in Mondor’s disease

A middle-aged man presented with pain over the right anterior aspect of chest. He gave history of doing heavy exercise (extreme yoga postures) few days ago. On examination, there was a tender area on right anterolateral part of chest with a vertical cord like swelling just under the skin. On overhead abduction of …

Cerebral malaria in a man with Plasmodium vivax mono-infection: a case report.

Cerebral malaria (CM) is a diffuse encephalopathy associated with coma and seizures commonly caused by Plasmodium falciparum (P. falciparum) in children with severe malaria. We present a case of a 19-year-old man with CM due to Plasmodium vivax (P. vivax) infection. Cerebrospinal fluid (CSF) was negative for Japanese B encephalitis, enterovirus, herpes simplex 1 and 2, varicella and mumps viruses as determined by real-time polymerase chain reaction (PCR). P. falciparum and P. vivax species were analysed by microscopy, immunochromatography and PCR assays and confirmed mono-infection of P. vivax in the patient’s blood, and P. falciparum infection was established to be negative. The patient was discharged after intensive supportive care and antimalarial treatment (intravenous artesunate and oral doxycycline). We conclude that P. vivax infection is associated with CM, a life-threatening complication rarely seen in coastal districts of Karnataka. In endemic areas, the possibility of CM should be considered even with P. vivax infection.