S Varma

Biomedical Informatics Centre, Chandigarh, Chandīgarh, India

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Publications (120)171.17 Total impact

  • Clinical Genetics 11/2014; · 4.25 Impact Factor
  • Abhijai Singh, Subhash Varma
    BMJ case reports. 01/2014; 2014.
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    ABSTRACT: Sarcoidosis bone is uncommon, and involvement of the skull is exceptionally rare. We present a 65-year-old obese female who presented with a 2-month history of dryness of mouth, polyuria, fatigue, and anorexia. She had generalized lymphadenopathy, organomegaly, and hypercalcemia, and a skeletal survey revealed extensive osteolytic lesions in the skull and phalanges. Both lymph node biopsy from the cervical lymph node and bone marrow examination revealed non-caseating granulomas, suggesting sarcoidosis. She was started on 1 mg/kg oral corticosteroids; during a follow-up of 6 months, she achieved normocalcemia; however, the punched-out lesions in the skull remained unchanged. This case reiterates several important issues that all lymphadenopathy in emerging nations may not be tubercular, and presence of osteolytic lesions in skull are unusual for sarcoid, at an elderly age, necessitates evaluation for more common etiologies like metastases and myeloma. Finally, patients with osseous sarcoid should be on a close follow-up since due to the rarity of this presentation, no definite consensus on the management of such cases exists in the literature.
    Rheumatology International 04/2013; · 2.21 Impact Factor
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    ABSTRACT: Introduction:Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder with significant morbidity and mortality. The present study was undertaken to identify the causes of in-hospital mortality of patients with SLE.Methods:This was a retrospective study. The hospital records of patients with SLE who died between 1998 and 2007 were reviewed. Demographic details, organ involvement, treatment received and evidence of infection were recorded. Disease activity was calculated using the SLE Disease Activity Index. The cause of death of each patient was determined and this information was classified into either deaths caused primarily due to SLE, deaths caused due to infection or those that were multi-factorial.Results:Seventeen patients with SLE who were diagnosed according to the revised American College of Rheumatology criteria died between 1998 and 2007. Fifteen of these patients were female and two were male. The median age was 25 years. The average duration of hospital stay was 10.29 days. Seven patients (41%) died of active SLE (three from pulmonary hemorrhage, two had renal failure, one had myocarditis and one had severe thrombocytopenia with upper gastrointestinal bleed), three patients (18%) died from infections (one contracted Staphylococcal septicemia, another contracted tuberculous meningitis and the third patient had Pseudomonas septicemia) and in seven patients (41%) the etiology was multi-factorial (these showed both active SLE and evidence of infection). In total 10 patients had evidence of infection, two of these were community-acquired and the rest were hospital-acquired.Conclusion:Active SLE and/or infection are the major causes of death in hospitalised patients with SLE. To reduce patient mortality improvements in supportive care for patients with active SLE and measures to prevent hospital-acquired infections are required.
    Lupus 11/2012; · 2.78 Impact Factor
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    ABSTRACT: Clinico-epidemiological profile of the Human immunodeficiency virus (HIV) epidemic in India is varied and depends on multitude of factors including geographic location. We analyzed the characteristics of HIV-infected patients attending our Immunodeficiency Clinic to determine any changes in their profile over five years. A retrospective observational study. The study sample included all patients with HIV infection from January 1, 2003 to December 31, 2007. Diagnosis of HIV was made according to National AIDS Control Organization guidelines. Of 3 067 HIV-infected patients, 1 887 (61.5%) were male and 1 180 (38.5%) were female patients. Mean age of patients was 35.1 ± 9.0 years. Majority (91.8%) of patients were in the age group of 15 to 49 years. Progressively increasing proportion of female patients was noted from year 2004 onward. Median CD4 count at presentation in year 2003 was 197/μl (Interquartile range [IQR] = 82.5-373) while in year 2007 it was 186.5/μl (IQR = 86.3-336.8). Mean CD4 count of male patients was 203.7 ± 169.4/μl, significantly lower as compared with female patients, which was 284.8 ± 223.3/μl (P value ≤0.05). Every year, substantial proportions of patients presenting to clinic had CD4 count<200/μl indicating advanced disease. Predominant route of transmission was heterosexual in 2 507 (81.7%) patients. Tuberculosis and oropharyngeal candidiasis were the most common opportunistic infections (OIs). Cryptococcal meningitis was the most common central nervous infection. Our patients had comparatively lower median CD4 counts at the time of presentation with various OIs. Patients had advanced stage of HIV infection at the time of presentation throughout five years. Females presented earlier during the course of HIV infection. There is need for early screening and increasing awareness in healthcare providers to make a diagnosis of HIV much sooner.
    Indian Journal of Community Medicine 07/2012; 37(3):158-64.
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    ABSTRACT: No abstract available.
    Acta Haematologica 05/2012; 128(1):17-9. · 0.89 Impact Factor
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    ABSTRACT: Paroxysmal nocturnal hemoglobinuria (PNH) results due to decrease or absence of glycosylphosphatidylinositol-anchored (GPI) molecules, such as CD55 and CD59, from the surface of the affected cells. PNH-phenotype has been described in various hematological disorders, mainly aplastic anemia and myelodysplastic syndromes; recently it has been reported in patients with lymphoproliferative syndromes and multiple myeloma (MM). We evaluated the presence of CD55 negative and/or CD59 negative red blood cell (RBC) populations in newly diagnosed treatment naive-54 chronic lymphocytic leukemia (CLL) and 29 MM patients by flow cytometry. PNH-phenotype was not reported in any patient; however, RBC populations deficient in CD55 were detected in 16.66% (9/54) CLL and 6.89% (2/29) MM patients. Clinical presentation or the hematological parameters did not show any relationship with the presence of CD55 deficient RBC population. Our study showed absence of PNH-phenotype in patients with CLL and MM; however, isolated CD55 deficient RBC were identified in both CLL and MM. Larger prospective studies by other centers, including simultaneous analysis of granulocytes for the presence of PNH-phenotype, are needed to corroborate these findings and to work out the mechanisms and the significance of the existence of this phenotype in these patients.
    Indian Journal of Pathology and Microbiology 04/2012; 55(2):206-10. · 0.68 Impact Factor
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    ABSTRACT: The t(9;22) (BCR/ABL) and t(4;11) (AF4/MLL) positivity suggests a poor prognosis in B-acute lymphoblastic leukemia (ALL). Many western studies have highlighted the frequency and profile of BCR–ABL-positive B-ALL; however, data from the Indian subcontinent is limited. The aim of the pilot study is to present the complete clinico-hematological, immunophenotyping, and molecular profile of BCR–ABL-positive B-ALL. It is a prospective study involving a total of 15 BCR–ABL-positive B-ALL cases diagnosed by bone marrow examination, immunophenotyping, and multiplex reverse transcriptase polymerase chain reaction assay in our institute. Out of the total 15 cases enrolled in the study, ten (67 %) were adult and five (33 %), pediatric. All cases had splenomegaly, hepatomegaly, high WBC count (>20 × 109/L), and low platelet count (<100 × 109/L) at presentation. Twelve of 15 (80 %) showed aberrant myeloid marker expression, of which 11 showed expression of two myeloid antigens (CD13 and CD117/33). The BCR–ABL transcript type in our study was p210 seen in 8/15 (53.3 %) cases, while p190 in 7/15 (46.6 %) cases. Thirteen of 15 (87 %) cases received imatinib in addition to the ALL induction regimen. Ten of 13 (77 %) of these had complete hematological remission at first check marrow. The disease-free interval, however, ranged from 4–6 months in 6/15 (40 %) cases. Analysis for BCR–ABL transcript is necessary in B-ALL as the cases may benefit from addition of imatinib to the treatment regimen.
    Journal of Hematopathology. 03/2012; 6(1).
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    ABSTRACT: OBJECTIVE: A preliminary opt-out screening study for HIV was conducted in a tertiary care hospital in India according to Center for Disease Control (CDC) guidelines. A total of 876 cases were screened for HIV during August 2007 to December 2007 using tests approved by the National AIDS Control Organization (NACO). RESULTS: Data indicates that the prevalence of HIV in emergency and pre-surgical setting was 21 per thousand at the tertiary care center. Positivity rate in the pediatric population was 20.9 per thousand while in adults it was 21.4 per thousand. Most patients were totally unsuspected. Nearly 40000 patients seek admission annually to the emergency department alone. Thus nearly 700 to 800 patients may be missed every year if one does not resort to such a practice. Conclusion: Since India has the second largest number of HIV cases in the world, opt-out screening program and testing in an emergency setting, as recommended by CDC, is extremely relevant. Logistics of implementation of this policy need to be worked out at a national level.
    Indian Journal of Pathology and Microbiology 01/2010; 53(2):287-9. · 0.68 Impact Factor
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    ABSTRACT: There is lack of data comparing the improvement in CD4 count following antitubercular (ATT) and antiretroviral therapy (ART) in patients presenting with Human Immunodeficiency Virus/Tuberculosis (HIV/TB) dual infection compared with CD4 matched cohort of TB uninfected HIV patients initiated on ART. We sought to test the hypothesis; TB additionally contributes to reduction in CD4 count in HIV/TB co-infected patients and this would result in greater improvement in count following treatment compared with CD4 matched TB uninfected individuals. In a retrospective cohort study design we studied the change in CD4 cell counts in two groups of patients - those with CD4 cell count >100 cells / mm 3 (Group 1) and <100/mm 3 (Group 2) at presentation. In each group the change in CD4 cell count in dually infected patients following six-month ATT and ART was compared to cohorts of CD4 matched TB uninfected patients initiated on ART. In Group 1 (52 patients) dually infected subjects' CD4 count improved from 150 cells/ mm 3 to 345 cells/mm 3 (P=0.001). In the control TB uninfected patients, the change was from 159 cells/mm 3 to 317 cells/mm 3 (P=0.001). Additional improvement in dually infected patients compared to the control group was not statistically significant (P=0.24). In Group 2 (65 patients) dually infected subjects count improved from 49 cells/mm3 to 249 cells/mm 3 (P=0.001) where as in control TB uninfected patients improvement was from 50 cells/ mm 3 to 205 cells/mm 3 (P=0.001), there being statistically significant additional improvement in dually infected subjects (P=0.01). Greater increment in CD4 counts with ATT and ART in dually infected patients suggests that TB additionally influences the reduction of CD4 counts in HIV patients.
    Indian Journal of Pathology and Microbiology 01/2010; 53(4):745-9. · 0.68 Impact Factor
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    ABSTRACT: A recent meta-analysis has demonstrated an association between hepatitis C virus and non-Hodgkin lymphoma (NHL). There is also evidence on the association between hepatitis B virus (HBV) and NHL. The aim of this study was to evaluate this evidence using a meta-analytic approach. We searched the MEDLINE database from 1962 to 2008 for case-control studies that have reported the association of HBV with NHL. We calculated the odds ratio (OR) and 95% confidence intervals (CI) to assess the prevalence of HBV infection and pooled the results using three different statistical models. Our search yielded 12 studies with 11 studies (3262 NHL patients, 1,523,205 controls) evaluating HBV infection in NHL and one study (3888 HBV-infected individuals, 205,203 controls) that had investigated for NHL in HBV infection. The OR of detecting HBV infection in NHL when compared with the control population was 2.56 (95% CI, 2.24-2.92) by the fixed effects model; 2.61 (95% CI, 2.29-2.98) by the exact method and 2.67 (95% CI, 2.04-3.49) by the random effects model suggesting a high prevalence of HBV carrier state in lymphoma. There was evidence of statistical heterogeneity which disappeared after exclusion of retrospective studies on sensitivity analysis. The results of this study suggest a possible causal relation between HBV infection and NHL which needs to be confirmed by experimental and epidemiological studies. In countries where prevalence of HBV infection is 1% or more, it may be prudent to screen patients with NHL for occult HBV infection.
    Internal Medicine Journal 10/2009; 40(9):633-41. · 1.82 Impact Factor
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    Indian Journal of Medical Sciences 08/2009; 63(7):311-2.
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    ABSTRACT: Four people admitted to a tertiary care hospital during February 2002 had similar respiratory symptoms; they belonged to one family residing in a village in Himachal Pradesh, India. The clustering of these cases in space and time led to the suspicion that it could be a pneumonic plague outbreak. A standard case definition, and treatment and prophylaxis guidelines were prepared. Active surveillance identified 30 cases. The incubation period ranged from 3 to 7 days. Among the affected people, 53.3% were males, and 90% were >15 years of age. Fever with cough was the most common presenting feature (43.3%). The diagnosis of pneumonic plague was confirmed from blood cultures using conventional biochemical tests, phage susceptibility of the identified organisms, and F1 antigen ELISA and PCR for the pla gene. Five patients died giving a case-fatality ratio of 16.6%. The other cases recovered following treatment. Early identification of cases and prompt institution of control measures, particularly among close family members, relatives and health care contacts is essential for containing outbreaks. To prevent future outbreaks, known endemic foci should be identified and essential information should be gathered on the epizoology of plague.
    Transactions of the Royal Society of Tropical Medicine and Hygiene 02/2009; 103(5):455-60. · 1.82 Impact Factor
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    ABSTRACT: Polycythemia vera (PV) is an uncommon clonal disorder of stem cells. The literature regarding the thrombotic complications of this disorder in the developing countries is scarce. The present study was undertaken retrospectively to look at the association of thrombotic complications of PV with various patient characteristics. All the patients diagnosed to have PV from January 1986 to December 2005 according to Polycythemia Vera Study Group criteria were included. Their clinical characteristics, laboratory parameters, clinical complications such as thrombosis and myelofibrosis, treatment modalities, malignancies and deaths, if any were noted. The various characteristics of patients who had developed thrombosis were compared statistically with those of patients without thrombosis. Out of the 9550 patients seen during this period, 32 patients fulfilled the inclusion criteria. The median age at the time of diagnosis was 56.5 years. Eight patients developed thrombotic complications; out of which four had arterial and four had venous thrombosis. There was no statistically significant difference in the mean hemoglobin, white cell count (WBC), platelet count and RBC mass in patients with thrombosis as compared to patients without thrombosis. These parameters were also not statistically significant when patients with arterial thrombosis were compared with patients with venous thrombosis. PV is an uncommon disorder when compared with other hematological disorders in northern India. There was no relationship between the development of thrombotic complications and hemoglobin, RBC mass or platelet count. Twenty patients received hydroxyurea with a median follow-up of 57 months, none developed acute leukemia.
    Hematology (Amsterdam, Netherlands) 01/2009; 13(6):319-23. · 1.33 Impact Factor
  • Journal of The Neurological Sciences - J NEUROL SCI. 01/2009; 285.
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    ABSTRACT: A second malignant neoplasm has been found to be more frequent than might be expected from the general population rates. Therapy-related myelodysplastic syndrome and acute leukemia are dreaded long-term complications of five cases of hematological malignancies following treatment for successful breast cancer therapy (therapeutic drugs or radiotherapy). We encountered carcinoma from north India over a 7-year period from 1999 to 2005. The patients presented 2-5 years after treatment of breast carcinoma. Three patients underwent surgery and received chemoradiotherapy. One patient received chemotherapy after surgery. One patient underwent only surgery and after 3 years presented with acute myeloid leukemia and bone marrow metastasis of carcinoma of the breast. At the time of presentation, all the patients had either bicytopenia or pancytopenia. A close follow-up with complete blood cell counts of the patients who previously had carcinoma of the breast is suggested for early detection of hematological abnormalities. However, the poor prognosis, limited financial resources and poor health insurance coverage results in few patients and their family members opting for treatment.
    Indian Journal of Pathology and Microbiology 01/2009; 52(2):167-70. · 0.68 Impact Factor
  • R. Agarwal, S. Varma
    Eastern J Med. 01/2009; 14(2):57-68.
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    ABSTRACT: Chemical warfare agents (CWA's) are defined as any chemical substance whose toxic properties are utilised to kill, injure or incapacitate an enemy in warfare and associated military operations. Chemical agents have been used in war since times immemorial, but their use reached a peak during World War I. During World War II only the Germans used them in the infamous gas chambers. Since then these have been intermittently used both in war and acts of terrorisms. Many countries have stockpiles of these agents. There has been a legislative effort worldwide to ban the use of CWA's under the chemical weapons convention which came into force in 1997. However the manufacture of these agents cannot be completely prohibited as some of them have potential industrial uses. Moreover despite the remedial measures taken so far and worldwide condemnation, the ease of manufacturing these agents and effectiveness during combat or small scale terrorist operations still make them a powerful weapon to reckon with. These agents are classified according to mechanism of toxicity in humans into blister agents, nerve agents, asphyxiants, choking agents and incapacitating/behavior altering agents. Some of these agents can be as devastating as a nuclear bomb. In addition to immediate injuries caused by chemical agents, some of them are associated with long term morbidities and psychological problems. In this review we will discuss briefly about the historical background, properties, manufacture techniques and industrial uses, mechanism of toxicity, clinical features of exposure and pharmacological management of casualties caused by chemical agents.
    Environmental Toxicology and Pharmacology 09/2008; 26(2):113-22. · 2.01 Impact Factor
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    ABSTRACT: Keeping in view the fact that a single acquired genetic abnormality "Bcr-Abl chimeric gene" accompanied by elevated telomerase activity has been widely recognized to be responsible for the leukemic myelopoiesis observed in chronic myeloid leukemia (CML), the present study was addressed to understand as to how selective and specific knock-down of human telomerase reverse transcriptase (hTERT) gene within mononuclear cells derived from untreated CML subjects could influence the apoptotic, genotypic (such as Bcr-Abl; C-myc; Bcl-2; IL-6; GMCSF; IL-3; and acetylated H(3) and H(4)), and phenotypic (such as CD34 and CD89) characteristics of these cells. Based upon these results, we propose that hTERT gene-based drug design may be useful in the treatment of leukemic myelopoiesis.
    Molecular and Cellular Biochemistry 08/2008; 314(1-2):19-23. · 2.33 Impact Factor
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    ABSTRACT: Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunosuppressed patients. Though acute lymphoblastic leukemia (ALL) is an immunosuppressed state, CMV disease has been reported infrequently. We present a patient of adult B lineage ALL who was on maintenance chemotherapy and developed CMV pneumonia. Patient was managed with intravenous ganciclovir and had successful outcome. However, three weeks later patient had a relapse of ALL and died shortly after high dose chemotherapy.
    The Journal of the Association of Physicians of India 08/2008; 56:541-2.

Publication Stats

629 Citations
171.17 Total Impact Points

Institutions

  • 1998–2013
    • Biomedical Informatics Centre
      Chandigarh, Chandīgarh, India
  • 1988–2012
    • Postgraduate Institute of Medical Education and Research
      • • Department of Internal Medicine
      • • Department of Haematology
      Chandigarh, Chandīgarh, India
  • 2004
    • Government Medical College, Jammu
      Jammu City, Kashmir, India