Chakrapani Mahabala

Kasturba Medical college, Mangalore,Manipal University · Internal Medicine

Background We evaluated if the course of recovery from sepsis-induced acute kidney injury (AKI) can be predicted using variables collected at admission. Methods A total of 63 patients admitted for sepsis-induced AKI in our Mangalore ICU were evaluated and baseline demographic and clinical/laboratory parameters, including serum creatinine (SCr), bas...

Background Capillary leak is the hallmark of development of severe dengue. A rise in haematocrit has been a major warning sign in WHO guidelines. Postural hypotension, which could reflect the intravascular volume reduction in capillary leak has been noted as warning sign in CDC and Pan American Health Organisation guidelines. We evaluated the diagn...

Background: We evaluated if the course of recovery from sepsis-induced acute kidney injury (AKI) can be predicted using variables collected at admission. Methods: A total of 63 patients admitted for sepsis-induced AKI in our Mangalore ICU were evaluated and baseline demographic and clinical/laboratory parameters, including serum creatinine (SCr),...

Background: Capillary leak is the hallmark of development of severe dengue. A rise in haematocrit has been a major warning sign in WHO guidelines. Postural hypotension, which could reflect the intravascular volume reduction in capillary leak has been noted as warning sign in CDC and Pan American Health Organisation guidelines. We evaluated the diag...

Objectives This study aimed to detect heterogeneous vancomycin-intermediate Staphylococcus aureus (hVISA) among methicillin-resistant S. aureus (MRSA) isolated from healthcare-associated infections and identify staphylococcal cassette chromosome mec (SCCmec) types. Methods This study was conducted from February 2019 to March 2020 and included pati...

Based on the recently added high throughput analysis data on small noncoding RNAs in modulating disease pathophysiology of malaria, we performed an integrative computational analysis for exploring the role of human-host erythrocytic microRNAs (miRNAs) and their influence on parasite survival and host homeostasis. An in silico analysis was performed...

Purpose To study the infections caused by methicillin resistant Staphylococcus aureus (MRSA) with emphasis on heterogeneous vancomycin intermediate S. aureus (hVISA) in diabetic and non-diabetic patients and their comparison. Patients and Methods S. aureus strains isolated from diabetic and non-diabetic patients admitted in four tertiary care hosp...

Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperatur...

Objective Hemophagocytic lymphohistiocytosis is a potentially fatal complication of severe dengue fever. Here we evaluated the serum soluble IL-2R levels as potential biomarker for identifying HLH in patients with dengue fever. Methods In this cross-sectional study conducted in a tertiary care center of a teaching hospital, subjects with dengue an...

Coronary artery disease (CAD) is one of the most common causes of heart ailments; many patients with CAD do not exhibit initial symptoms. An electrocardiogram (ECG) is a diagnostic tool widely used to capture the abnormal activity of the heart and help with diagnoses. Assessing ECG signals may be challenging and time-consuming. Identifying abnormal...

Coronary artery disease is one of the major cardiovascular diseases and is a cardiac condition where plaque formed in arteries leads to death worldwide. The identification of CAD in the traditional approach needs a report of ECG, TMT ECG, Pharmacological test, and echocardiogram. The confirmation of CAD leads to undergoing cardiac catheterization....

Introduction Autoimmune haemolytic anaemia (AIHA) is an autoimmune disorder that can present in primary or secondary forms. The literature looking at impact of baseline FANA positivity on outcomes of AIHA patients is infrequent. Objective To study the impact of baseline FANA positivity in patients with primary AIHA. Method A prospective cohort st...

Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperatur...

Background: Sublingual temperature measurement is a quick and accurate representation of oral temperature and corresponds closely with core temperature. Sub-lingual temperature measurement using non-contact infrared thermometers has not been studied for this purpose and if accurate they would be a reliable and convenient way of recording temperatur...

India faces 0.5 million malaria cases annually, including half of all Plasmodium vivax malaria cases worldwide. This case–control study assessed socioeconomic determinants of urban malaria in coastal Mangaluru, Karnataka, southwestern India. Between June and December 2015, we recruited 859 malaria patients presenting at the governmental Wenlock Hos...

Background and Aim: Mucositis, one of the vulnerabilities of chemotherapy, affects the physiological activities and therapeutic strategies of patients because it can affect the normal cell population. Etoposide is a commonly used chemotherapeutic agent for cancers such as oral, lung, and gastrointestinal. In addition to the abnormal metabolic proce...

Objective: This study examines the effect of core stability exercises on trunk control, core muscle strength, standing weight-bearing symmetry and balance confidence of people with chronic stroke. Design: This was an assessor-blinded randomized controlled trial involving 84 ambulatory patients with middle cerebral artery stroke, randomly assigne...

To the Editor We have read the article titled “Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure: Post Hoc Analysis of a Randomized Clinical Trial” by Qureshi et al,¹ published online in JAMA Neurology on September 8, 2020. We would like to congratu...

Background:Post discharge, Home-based exercise program (HEP), prescribed by physiotherapistis an integral part, to plan effective stroke rehabilitation, with the intended goal of maintainingfunctional motor performance and enhancing functional progress.Earlier studies have shown thatmany factors attribute to adherence and barriers for structured gr...

To the Editor This letter is in reference to the Challenge in Clinical Electrocardiography by Choxi et al¹ describing an irregular narrow complex tachycardia. The article described an interesting and unusual case of occurrence of dual atrioventricular nodal nonreentrant tachycardia and the need to differentiate it from atrial fibrillation. We would...

p class="abstract"> Background: The limited epidemiological and outcome data of acute kidney injury (AKI) is available in developing countries. The current single-center study determined the clinical profile of AKI by attempting to identify the presenting symptoms, etiologies, treatment modalities, and disease prognosis in patients admitted in inte...

Fever is a readily measurable physiological response that has been used in medicine for centuries. However, the information provided has been greatly limited by a plain thresholding approach, overlooking the additional information provided by temporal variations and temperature values below such threshold that are also representative of the subject...

We report an unusual case of massive haemoptysis in young patient with mass lesion in left upper lobe. Bronchoscopic biopsy, percutaneous CT guided biopsy & serum marker confirmed the lesion to be granulomatous with polyangiitis (GPA). Rarity of the case was endoluminal bronchial lesion in GPA and radiographic presentation of mass lesion on the Com...

Objective: This study aimed to identify asymptomatic malaria carriers and study the differences in local and migrant population in Mangalore. Materials and Methods: This study was conducted using two‑stage cluster sampling. In the first stage, wards were randomly selected. The sample size for each cluster (wards) was determined using the probabilit...

Accurate diagnosis of undifferentiated fever case at the earliest is a challenging effort, which needs extensive diagnostic tests. Prediction of undifferentiated fever cases at an early stage will help in diagnosing the disease in comparatively lesser time and more effectively. The aim of the present study was to apply Artificial Intelligence (AI)...

Micro-RNAs (miRNAs) play a crucial role in immune regulation, and a common miRNA-146a polymorphism (rs2910164) increased the odds of falciparum malaria in pregnant African women. Here, we examined whether this association holds true in a different population, that is, 449 mainly male and adult malaria patients and 666 community controls in southwes...

Introduction: Cytokines and granulocyte elastase produced in sepsis cleave a disintegrin and metalloprotease with thrombospondin type I motif 13 (ADAMTS13) and deplete its levels. By this mechanism, sepsis results in microangiopathic hemolytic anemia (MAHA) with thrombocytopenia. Hence, the hypothesis is that plasmapheresis may help in sepsis-indu...

Fever is a common symptom of many diseases. Fever temporal patterns can be different depending on the specific pathology. Differentiation of diseases based on multiple mathematical features and visual observations has been recently studied in the scientific literature. However, the classification of diseases using a single mathematical feature has...

Background: Duffy blood group antigens serve as receptors for Plasmodium vivax invasion into erythrocytes, and they are determined by polymorphisms of the Duffy antigen receptor for chemokines (DARC), also known as Fy glycoprotein (FY). Duffy negativity, i.e., absence of the antigens, protects against P. vivax infection and is rare among non-Afric...

India accounts for approximately half of the global Plasmodium vivax cases, but information as to the presence of chloroquine (CQ) resistance is scarce. In an observational study in Mangaluru, south-western India, of 116 vivax malaria patients analyzed, 89.5% (102/114) had cleared parasitemia on days two or three of CQ treatment. Two remaining pati...

Body temperature monitoring in most healthcare institutions is limited to checking the presence or absence of fever. Our present study evaluated the 24h continuous tympanic temperature pattern in patients with fever in order to detect typical patterns seen in tuberculosis (TB). This observational study was conducted on 81 undifferentiated fever pat...

Vitamin D, a steroid hormone is primarily known for its role in calcium and bone mineral homeostasis. Over the years, vitamin D has been implicated in various non-skeletal diseases. The extraskeletal phenomenon can be attributed to the presence of vitamin D receptors (VDRs) in almost all cells and identification of 1-α hydroxylase in extrarenal tis...

Glucose-6-phosphate dehydrogenase (G6PD) deficiency can present a diagnostic dilemma owing to the varying degrees of disease severity and the wide range of precipitating factors. Here, we report a case of a 56-year-old man who presented with signs and symptoms of heart failure and, during the course of treatment, developed intravascular hemolysis....

In most of India, sulfadoxine-pyrimethamine (SP) plus artesunate serves as first-line treatment for uncomplicated falciparum malaria. In 112 clinical Plasmodium falciparum isolates from Mangaluru, southwestern India, we sequenced molecular markers associated with resistance to SP, lumefantrine, and artemisinin (pfdhfr, pfdhps, pfmdr1, and K13). The...

Background: Severe and fatal vivax malaria is increasingly reported from India. In Mangaluru, southern India, malaria is focused in urban areas and associated with importation by migrant workers. In Wenlock Hospital, the largest governmental hospital, the clinical, parasitological and biochemical characteristics of malaria patients were assessed....

Dengue fever is an acute febrile illness with a duration of 2–12 days. Our observational study observed the 24-h continuous tympanic temperature pattern of 15 patients with dengue fever and compared this with 26 others with fever due to a non-dengue aetiology. A tri-phasic fever pattern was seen among two-thirds of dengue fever patients, but in onl...

Objective: The study objective was to examine the efficacy of plinth and Swiss ball-based trunk exercise regimes on balance, mobility, physical function, and community reintegration compared with standard physiotherapy in chronic stroke. Subjects and methods: This observer-blinded parallel-group randomized trial was conducted in outpatient strok...

Fever is one of the major clinical symptoms of undifferentiated fever cases. Early diagnosis of undifferentiated fever is a challenging task for the physician. The aim of this study was to classify infectious and noninfectious diseases from 24-hour continuous tympanic temperature recordings of patients with undifferentiated fever using a machine le...

Diagnosis of undifferentiated fever is a major challenging task to the physician which often remains undiagnosed and delays the treatment. The aim of the study was to record and analyze a 24-hour continuous tympanic temperature and evaluate its utility in the diagnosis of undifferentiated fevers. This was an observational study conducted in the Kas...

Introduction: Patients with chronic stroke show atypical coordination of trunk movement and they find difficulty during bed mobility and transfer skills due to weakness of trunk muscles. Routine bedside clinical examination fails to quantify the trunk muscle strength in patients with stroke. Handheld dynamometer is widely administered to quantify...

Vancomycin is used as the antibiotic of choice for severe infection caused by methicillin resistant Staphylococcus aureus. Increased use of vancomycin and the selective pressure has resulted in the emergence of S.aureus with reduced susceptibility to vancomycin and vancomycin resistant S.aureus. This review summarizes the definition, mechanism, cli...

Aim Subclinical hypothyroidism (SCH) with TSH less than (10µIU/ml) is a common finding discovered during routine thyroid function testing. Thyroxine substitution and its benefits to alleviate dyslipidemia and oxidative stress (OS) markers at this stage are a matter of debate.Material and Methods This study aimed to investigate the influence of thyr...

Objective To investigate the existence of vitamin D deficiency (VDD) among type 2 diabetes, non-diabetes subjects and its effect on both glycemic and lipid profiles.MethodsA case control study was conducted on 200 subjects of both gender (100 type 2 diabetes and 100 non-diabetes individuals) aged 40 to 60 years. Fasting serum 25(OH) D levels, Fasti...

Background: Stroke subjects presented with greater postural instability which lead to challenge their balance control in sensory conflict conditions. Studies have shown that deficits of sensorimotor integration and an inability to select the appropriate sensory input are associated with balance measures following stroke.However, limited studies hav...

Introduction: Complications of malaria can develop suddenly and unexpectedly. Although various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Many of the malarial complications are inflammatory in nature, and C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (E...

Background and Purpose Altered pelvic alignment and asymmetrical weight bearing on lower extremities are the most common findings observed in standing and walking after stroke. The purpose of this study was to find the relationship between pelvic alignment and weight-bearing asymmetry (WBA) in community-dwelling chronic stroke survivors. Materials...

Bone marrow aspirate examination is a gold standard to assess bone marrow iron stores. The correlation between serum ferritin and bone marrow iron has not been established in detail, as the cutoff value for iron stores have not been uniformly established. Ours was a cross-sectional study. Perl’s Prussian blue stain was used to stain bone marrow, as...

Objective: There is an increased risk of coronary artery disease (CAD) in both diabetes and non-diabetes. Insulin resistance (IR) has been associated with the development of CAD in this both populations. However, there are not many studies on correlation between IR and severity of CAD in non-diabetes. This study aimed to establish a correlation bet...

Introduction: Detection of accurate body temperature fluctuations in hospitalized patients is crucial for appropriate clinical decision-making. The accuracy and reliability of body temperature assessment may significantly affect the proper treatment. Aim: To compare the conventional and continuous body temperature recordings in hospitalized patient...

Currently, in India, air pollution is widespread in urban areas where vehicles are major contributors. The aim of this study was to investigate the level of exposure in traffic police officers exposed to vehicle exhaust for less than 8 h/day. The specific objective of the study was to determine the levels of carboxyhaemoglobin (COHb) in these offic...

Background The pelvis is not stable after stroke, and poor trunk recovery might be the foremost contributor to altered pelvic alignment in sitting, standing and during walking. Aim To analyze the relationship between pelvic alignment in standing and trunk control after stroke, and also test how these correlations are related to Brunnstrom's lower...

Aims: To develop a risk score, for identifying severe and complex CAD in patients with type 2 diabetes mellitus. Methods: In this cross sectional study, 179 patients with type 2 diabetes mellitus undergoing coronary angiogram for the evaluation of suspected coronary artery disease (CAD) were recruited at a tertiary-care hospital. Patients were d...

Objectives: To compare agar dilution method and Etest in the determination of minimum inhibitory concentration (MIC) of vancomycin to healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA). Methods: A total of 98 non-duplicate strains of HA-MRSA isolated from different clinical specimens were tested for their antibiotic suscept...

Objectives: Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen worldwide and its multidrug resistance is a major concern. This study aimed to determine the clinical characteristics and antibiotic susceptibility profile of healthcare-associated MRSA with emphasis on resistance to macrolide-lincosamide-stre...

Objective: The present cross-sectional study was conducted to determine minimum inhibitory concentration (MIC) of daptomycin and vancomycin to clinical isolates of healthcare-associated-methicillin-resistant Staphylococcus aureus (HA-MRSA). Methods: Centers for Disease Control and Prevention Criteria were used to define HR infections due to MRSA. A...

Introduction: The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enha...

Introduction: The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enha...

Background: Laboratory tools such as force platform, posturography, and Gaitrite provide precise and accurate information, but are limited in availability due to their high cost and required skilled work force. This necessitates the need for relatively inexpensive, simple and clinically accessible tools to measure the limits of stability and spatia...

Aim: The aim of our study was to compare the angiographic changes in 53 nondiabetic patients, 54 type 2 diabetic patients of less than 5 years of duration, 41 patients with 5-10 years of diabetes, and 27 with more than 10 years of diabetic duration. Methods: In this cross-sectional study, 175 patients, who underwent coronary angiogram for the ev...

Background: Diabetes increases the oxidative stress over the myocardium that leads to arteriogenesis. Coronary collaterals (CC) serve as an alternative source of blood supply to the compromised myocardium. Though a few insights about the development and associations of CC in coronary artery disease (CAD) are known, conclusive data regarding their p...

The erythrocyte sedimentation rate, ESR is one of the most frequently used laboratory investigations. The usefulness of the erythrocyte sedimentation rate is becoming limited as a result of low sensitivity and specificity and emergence of new methods of evaluating disease. The aim of the current study was to assess the clinical relevance of a simpl...

Body temperature is a continuous physiological variable. In normal healthy adults, oral temperature is estimated to vary between 36.1°C and 37.2°C. Fever is a complex host response to many external and internal agents and is a potential contributor to many clinical conditions. Despite being one of the foremost vital signs, temperature and its analy...

Type 2 diabetes mellitus is an important risk factor in the development of coronary artery disease (CAD) and is often associated with severe disease. However, this risk is not uniform, some patients remain free of CAD even after many years of treatment for diabetes. The present study was aimed to identify the factors that are associated with a favo...

Community-acquired methicillin resistant Staphylococcus aureus (MRSA) usually causes skin and soft tissue infections. However, community-acquired methicillin resistant S.aureus has been identified as a causative agent of many invasive infections like necrotizing fasciitis, pneumonia and bacteremia. Risk factors such as immunodeficiency and skin and...

Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, if not recognized and treated in time. A high index of suspicion can help identify the condition early. This condition can occur in the primary or secondary form. Secondary HLH or hemophagocytic syndrome (HPS) secondary to infections is an important clinic...

Aim: To investigate relationship between serum TSH and lipid parameters in subjects with different levels of TSH. Methodology: 348 subjects were screened of which 194 were selected. Lipid parameters, TSH, T 3 , T 4 and glycemic status were determined. Association between TSH and serum lipids were studied by categorizing subjects into three groups b...

Background: Laboratory tools such as force platform, posturography, and Gaitrite provide precise and accurate information, but are limited in availability due to their high cost and required skilled work force. This necessitates the need for relatively inexpensive, simple and clinically accessible tools to measure the limits of stability and spatia...