Sudha Vidyasagar

• Professor at Manipal Academy of Higher Education

Background It was observed that many people in the western coastal belt were found to have a high HDL cholesterol, the cause of which was not known. This study was done to learn about the factors contributing to the high HDL cholesterol in these patients and its effect on ASCVD risk. Methods In this prospective, case control study, 150 patients we...

Background The past few decades have seen a marked increase in the macrovascular complications of Type-2 diabetes mellitus (T2DM) such as coronary heart disease, peripheral arterial disease, and cerebrovascular disease. This has been predominantly attributed to the increased atherosclerosis in these patients. Atherosclerosis usually remains an asym...

Introduction Metabolic syndrome which is a syndrome complex that is associated with insulin resistance. Osteocalcin (OC), a bone derived protein has been found to decrease insulin resistance and stimulate production of insulin from the pancreas. Serum osteocalcin levels correlate with body mass index (BMI) and waist circumference. Thus, serum osteo...

Purpose: The global pandemic of COVID-19 has infected several people worldwide. World Health Organization(WHO) has reported that an alarming number of health care workers (HCWs) have been affected and have also succumbed to this disease. Though health infrastructure can be boosted in a short period, the number of HCWs cannot. Hence understanding th...

Purpose: The global pandemic of COVID-19 has infected several people worldwide. World Health Organization(WHO) has reported that an alarming number of health care workers (HCWs) have been affected and have also succumbed to this disease. Though health infrastructure can be boosted in a short period, the number of HCWs cannot. Hence understanding th...

Sulfonylureas (SU) are one of the most used antidiabetic medications mainly due to their cost-effectiveness and reduced frequency of dosing. They have a therapeutic effect in patients with adequate β cell function. SU were first discovered in 1942 by Janbon who observed that some sulfonamides generated hypoglycemia in experimental animals.

Background There is increasing evidence that cardiovascular disease risk starts rising from the stage of prediabetes. Our aim was to study the relationship of prediabetes with coronary artery disease (CAD) severity and whether the degree of glycaemia impacts the severity of CAD. Methods In this cross-sectional study patients admitted with acute co...

Aims To study the prevalence, clinical characteristics, complications, and treatment pattern of childhood – and adolescent-onset type 2 diabetes among young diabetes patients (<25 years at diagnosis). Methods We conducted an observational retro-prospective study among young diabetics at a tertiary care hospital between January 2012 and December 20...

Background Osteocalcin (OC), also known as bone Gla (gamma-carboxyglutamic acid) protein, is a marker of bone formation. OC has effect on glucose and fat metabolism. Role of OC in type 2 diabetes mellitus (T2DM) is not well studied in Indian population. Our study aimed to see the relationship between OC and parameters of glucose metabolism in type...

Introduction Scrub encephalitis (SE) is one of the known causes of acute encephalitis syndrome (AES). Although central nervous system involvement is known in scrub typhus, its association with AES is less understood and lesser diagnosed. In the absence of a point of care test for scrub typhus, cases of SE can be easily missed. A clinical approach u...

Blood grouping discrepancy in patients with hematological disorders can occur due to red cell sensitization following transfusion, transplantation, and pregnancy or pre-analytical errors. Prompt initiation of root cause analysis is vital to avoid complications of wrong blood transfusion. We present an unusual case of Rh mismatched grouping report o...

Acute flaccid quadriparesis is a common presentation to the emergency department with multiple etiologies such as paralytic snakebite, Guillain–Barre Syndrome, and periodic paralysis. Periodic paralysis is a rare entity where the patient presents with weakness, proximal more than distal. The cause for periodic paralysis may vary from hypokalemia to...

Introduction Steroid-induced diabetes (SID) can be defined as the occurrence of hyperglycemic state in non-diabetic individuals following steroid therapy. The traditional risk factors for type 2 DM, such as age, abdominal obesity, family history, and physical activity, have been incorporated in the Indian diabetes risk score (IDRS). We conducted th...

Background: Cerebral venous and sinus thrombosis (CVT) is one of the common causes of stroke in young people. It is a relatively uncommon neurologic disorder that is potentially reversible with prompt diagnosis and appropriate medical care. The purpose of this study is to identify the clinical and radiological features aiding diagnosis of cortical...

Syndrome of inappropriate antidiuretic hormone release (SIADH) is a condition defined by the unsuppressed release of antidiuretic hormone (ADH) from the pituitary gland or nonpituitary sources or its continued action on vasopressin receptors. Of the many causes of SIADH, an important one includes tumours that secrete ADH. We describe a rare case of...

Background and aims Diabetes mellitus is one of the critical public health challenges in the Indian healthcare scenario. Novel anthropometric indices are promising surrogate markers to detect prediabetes compared to the traditional anthropometric indices that only reflect gross obesity. Thus, the authors aim to analyse the potential of three novel...

Organophosphate and carbamate (OPC) poisoning is a major global health hazard requiring immediate medical intervention. Atropine (ATR) is an essential antidote in organophosphate and carbamate poisoning, with the inclusion of cholinesterase reactivators and other anticholinergics, namely pralidoxime (PAM) and glycopyrrolate (GPR). This study aimed...

Tenofovir disoproxil fumarate (TDF) is an anti-retroviral drug that is known to cause nephrotoxicity including renal tubular acidosis (RTA). With increasing literature on proximal RTA caused by TDF, reports on distal RTA are scarce, with only one case reported so far. We report a case of distal RTA in patient living with human immunodeficiency viru...

Glucocorticoids (GCs) treatment has a profound effect on bone turnover and the mechanism is complex and not elucidated completely. One of the actions on bone explained by many studies is its effect on serum osteocalcin levels. To investigate changes in the osteocalcin levels among patients who are on GCs and to correlate these levels with various d...

Pleural effusion in liver cirrhotics is more commonly transudative. A transudative pleural effusion secondary to ascites in decompensated cirrhosis is also known as hepatic hydrothorax and is usually due to fluid seepage through congenital pores in the diaphragm. The patient, a known case of decompensated chronic liver disease, presented with a mas...

Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity described by Hinchey et al in late 90’s, characterised by variable associations of seizure activity, consciousness impairment ranging from confusion to coma, headaches, visual abnormalities, nausea/vomiting and focal neurological signs. Common causes are accelerate...

Aspergillus species are widespread in the environment with Aspergillus fumigatus being the most common pulmonary pathogen. In a person with normal immunity, Aspergillosis in the lung can mainfest as hypersensitivity reaction. It can also present as an invasive infection in immunocompromised patients. In its severe form, invasive pulmonary aspergill...

Introduction: In India, HIV patients are at a high risk of developing hematological and dermatological adverse drug reactions (ADRs) leading to financial burden. Materials and Methods: A prospective observational study was conducted on hematological and dermatological ADRs in a South Indian teaching hospital from October 2011 to October 2012. The d...

Objectives To compare different anthropometric indices, Body composition analysis and lipid profile markers in terms of their ability to predict prediabetes (PD). Methods We enrolled 83 subjects with PD and 84 normoglycemic subjects who were matched for age and gender. The diagnosis of prediabetes was done according to the American Diabetes Associ...

Proforma for case collection and screening. (DOCX)

Data pertaining to subjects with prediabetes and control population. (XLSX)

To study the clinical and biochemical profiles across the different ranges of impaired fasting glucose (IFG) based on American Diabetes Association (ADA) and World Health Organization (WHO) criteria. A cross-sectional study was conducted on 149 subjects, of which 63 belonged to group 1 (IFG = 100–110 mg/dl) and 86 to group 2 (IFG = 111–125 mg/dl)....

Aim To study the risk factors for bacteremia by carbapenem resistant enterobacteriaceae (CRE). Material & methods This study is prospective observational Case Control study in subjects aged more than 18 years admitted at Kasturba Hospital, Manipal, India from June 2015 to July 2017. Subjects with blood cultures isolating CRE were designated cases...

Neomercazole is one of the most commonly used drugs to treat hyperthyroidism. Common side effects include rash, hair loss and agranulocytosis. Hepatotoxicity is a common side effect of Propylthiouracil, the other major antithyroid drug, but it has been rarely described as a side effect of neomercazole. Here, a patient presents with hepatitis 6 mont...

Hyponatraemia is a well-established and potentially, a life-threatening adverse effect of selective serotonin receptor uptake inhibitors (SSRI). However, its occurrence secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) with escitalopram, has been reported extremely sporadically. The reporting of such rare, but life-threa...

Hyponatraemia is a well-established and potentially, a life-threatening adverse effect of selective serotonin receptor uptake inhibitors (SSRI). However, its occurrence secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) with escitalopram, has been reported extremely sporadically. The reporting of such rare, but life-threa...

Background: Greatest challenges for clinician is to recognize risk factors for clinically significant drug interactions (CSDIs). There is a lack of awareness about CSDIs among healthcare professionals in India. Objective: To recognize all possible risk factors for drug-drug interactions (DDIs) and to identify clinically significant drug interact...

Spinal cord compression (SCC) is an unusual sequale of extra-medullary hematopoiesis (EMH). We report a patient diagnosed with β-thalassemia intermedia at the age of 7 years presenting as a 24-year-old with symptoms suggestive of paraparesis. MR imaging revealed long masses of EMH opposite T5-T11 and L5-S2 vertebrae with cord compression at T6 vert...

Eschar in scrub typhus aids in early diagnosis and institution of appropriate therapy; however, the eschar positivity rates vary greatly in endemic regions. Multiple eschars in scrub typhus are a rare presentation. Our patient presented with fever and multiple eschars and was empirically started on doxycycline. Nested polymerase chain reaction from...

Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatobiliary causes (40% to 60%). Most are polymicrobial with less than 10% being caused by Staphylococcus aureus. Of these, few are caused by methicillin-resistant Staphylococcus aureus (MRSA) and fewer still by a community-acquired strain. Here we present a...

Objective: To study the clinical and biochemical profile of patients who develop steroid-induced diabetes (SID) and its predisposing factors. Methods: Non-diabetic patients aged ≥18 years started on steroids were considered eligible for the study. In every case after detailed examination, fasting plasma glucose (FPG), post-prandial plasma glucose (...

Methods: Non-diabetic patients aged ≥18 years started on steroids were considered eligible for the study. In every case after detailed examination, fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), glycated hemoglobin, fasting insulin were measured prior to starting steroids and was repeated in 1st week (day 3/4) after starting ster...

Patients with diabetes mellitus (DM) are prone to develop heart failure even in the absence of evident hypertension and coronary artery disease. This entity is difficult to detect in early stages by conventional echocardiographic techniques. 32 asymptomatic TMT (tread mill stress test) negative DM patients compared with control subjects were screen...

Anaphylaxis is a life threatening emergency requiring emergency management and prompt detection of the inciting agent to prevent future episodes. Ranitidine most commonly prescribed drug in yester-years for GERD, peptic ulcer disease, gastritis and preoperative prophylaxis for aspiration, is rarely associated with allergy and anaphylaxis. Anaphylax...

Background & aims: Diabetic peripheral neuropathy (DPN) accounts for most common complications of T2DM. Painful DPN is associated with functional limitation & poor quality of life. Therefore, objective of the study is to find the effect of low level laser therapy on painful diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM). Ma...

Of late there have been accounts of therapeutic failure and chloroquine resistance in Plasmodium vivax malaria especially from Southeast Asian regions. The present study was conducted to assess the therapeutic efficacy of chloroquine-primaquine (CQ-PQ) combined regimen in a cohort of uncomplicated P. vivax mono-infection. A tertiary care hospital-b...

Aim: To evaluate the distribution of plantar pressures on the foot in patients with type 2 diabetes without peripheral neuropathy compared them with nondiabetic control subjects. Methods: Plantar pressures were recorded in 20 T2DM subjects without peripheral neuropathy (mean age 47.65 ± 6.65yeras, BMI 23.38 ± 1.67kg/m2 and duration of diabetes 6.75...

Problem considered Type 2 Diabetes Mellitus is a heritable condition. Some studies suggest a strong maternal association while others claim paternal transmission of diabetes to be more significant. The present study was aimed at identifying the role of parental transmission in Type 2 diabetic patients with family history of diabetes. Methods This...

Clinical diagnosis of scrub typhus is often difficult as the symptoms are very similar to other febrile illness such as dengue, leptospirosis, malaria and other viral haemorrhagic fevers. Though better diagnostic tests are available for rickettsial diseases and scrub typhus elsewhere, Weil Felix test is still in common use in India. This is mainly...

For the calculation of parasite index (PI) by microscopy method, an assumed total leucocyte count (TLC) of 8,000/μL is used conventionally. However, due to obvious variation in the population and individual TLCs, use of 8,000/μL may result in either over/underestimation of the PI. This study was aimed at ascertaining the utility of 8,000/μL TLC, as...

Background: Central venous catheters (CVC) are a major risk factor for candidemia. Mixed candidemia with bacteremia due to CVCs has been increasingly reported in recent times. However, the risk factors for this dual infection have not been clearly identified. The aim of this study was to identify the risk factors for CVC associated mixed candidemia...

The most important and unique adverse effect of abacavir (ABC) is fatal hypersensitivity reaction (HSR). The objective of this report is to describe a case of ABC induced HSR that occurred in an Indian HIV patient during treatment. Although this adverse effect is not uncommon, it is perhaps underreported or has never been reported so far in an Indi...

Background: Directly observed treatment short course (DOTS) and self-administered therapy (SAT) are the treatment options available for tuberculosis (TB). Studies conducted worldwide have shown difference in treatment outcome with these two treatment modalities. Aim: The study was undertaken to compare treatment outcome of DOTS and SAT in patien...

Scrub typhus is an acute febrile illness caused by a tick bite infected with the bacteria Orientia tsutsugamushi. The clinical diagnosis is difficult as the symptoms are similar to other febrile illnesses such as dengue, typhoid, leptospirosis and so on. An eschar, if present, will narrow down the provisional diagnosis towards scrub typhus. There a...

Physical activity trends for a lower-middle income country like India suggest a gradual decline in work related physical activity and no concomitant increase in leisure time physical activity. Perceived health benefits of physical activity and intention to increase physical activity have been established as independent correlates of physical activi...

A 65-year-old woman, treated for non-ST segment elevation myocardial infarction and unexplained type 2 respiratory failure, was referred to our hospital in view of difficulty in weaning off the ventilator. She was evaluated in detail for persistent hypercapnia. Ultrasound of the diaphragm showed minimal excursion of diaphragm while she was off the...

Background and Objectives : Increasing HDL-C has been proven to reduce the risk of CHD. Several trials have demonstrated that exercise training can increase HDL-C. The objective of this study was to investigate a dose response relationship between exercise intensity and HDL-C in sedentary Indians who are otherwise healthy. Method : 94 Participants...

Leptospirosis and dengue fever are increasingly seen as causes of tropical febrile illness and often are clinically indistinguishable. This two-year prospective study from a tertiary care centre comprised 200 patients including 68 men (mean 34.8 years) with dengue and 73 (mean 46.19 years) with leptospirosis. Oliguria, icterus, muscle tenderness, a...

Background: Neurocysticercosis (NCC) is a common infection in tropical countries like India. It is one of the important causes of seizures and accounts for one-third cases of epilepsy in the country. It is one of the treatable causes of seizures in adults. This study tries to address the clinical presentation and outcomes of NCC. Methods: We have...

Background: Scrub typhus is a common cause of acute febrile illness in the tropical countries, often presenting with respiratory manifestations including Acute Respiratory Distress Syndrome (ARDS). The study was aimed to analyze the respiratory manifestations in patients with scrub typhus. Methods: A prospective observational study was conducted...

Background: Septic shock is a leading cause of mortality in hospitals. Appropriate timely empirical antibiotics are vital for outcome for septic shock. This study aimed to see the impact of appropriateness of empirical antibiotics in patients who presented with septic shock. Methods: : We have conducted a prospective observational study from Marc...

Background: In India, Human immunodeficiency (HIV) infected patients with highly active antiretroviral therapy (HAART) are at higher risk of developing adverse drug reactions (ADRs). Objectives: The aim of this study was to characterize the pattern of use of HAART, occurrence, incidence, severity and causality of ADRs to HAART in Indian HIV positiv...

Background: Right ventricular infarction (RVI) is frequently associated with inferior wall myocardial infarction (MI). Methods: This study was designed to identify the burden of RVI in patients presenting with inferior wall MI (n=50) by right precordial electrocardiogram (ECG) and comparing it with echocardiography (ECHO). Results: Their mean age w...

There are no studies performed in India on the safety of highly active antiretroviral therapy (HAART) combinations which focus on the base-line CD4+ T-cell count. Further, no data on risk factors for Adverse drug reactions (ADRs) to HAART and there is a lack of data on CD4+ T-cell count recovery after HAART. The aim of this study was to assess risk...

Background: Metabolic syndrome is known to predispose to atherosclerosis. C-reactive protein, a marker of systemic inflammation is significantly associated with the atherosclerotic process. Methods: We prospectively studied the relationship between high-sensitivity C-reactive protein (hs-CRP) with various components of metabolic syndrome in 91 pati...

Background: In India, there is a lack of awareness and inadequate knowledge about use of HighlyActiveAntiretroviral Therapy (HAART) due to social stigma leading to intentional non-adherence among Human Immunodeficiency Virus (HIV) infected patients thus, Educational Intervention (EI) must be sought. Need for the study: There is a need for an EI pro...

Background / Purpose: Candida species are the most common cause of fungal infections worldwide. They can cause a great variety of infections ranging from simple, mucocutaneous lesions to severe, invasive infections that can involve virtually any organ. Blood stream infections caused by Candida are increasingly common, and often are associated wit...

Cardiovascular diseases are gaining a dubious distinction of becoming the leading cause of death. Thus, the search for new risk markers and risk factors of cardiovascular disease continue, in an attempt to predict the risk of cardiovascular events with greater precision. Of all the risk markers available, high sensitivity C-reactive Protein (hsCRP)...

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 Soc...

Data from UKPDS study suggests that the onset of ß cell dysfunction in diabetes occurs well before the development of hyperglycemia. To study the concept of secondary OHA failure in type 2 diabetes patients of more than 10years duration in a tertiary care hospital. A retrospective analysis of all the cases of type 2 diabetes mellitus of more than 1...

In patients infected with human immunodeficiency virus (HIV), zidovudine has been known to cause a severe anemia that resolves promptly when the drug is stopped. The study was aimed to assess the incidence, the pattern of occurrence of zidovudine induced anemia, causality, severity, predictability, preventability and to identify risk factors for zi...

This study had two objectives: 1) to determine the clinical and microbiological profiles of patients developing intravascular catheter-related local (localized catheter colonization and exit site) and systemic infections and their predisposing factors; 2) to study the antibiotic sensitivity patterns of the organisms isolated. This case-control stud...

Objective: To assess the incidence, severity pattern, causality, predictability and preventability of adverse drug reactions (ADRs) and to identify risk factors for adverse drug reactions in highly active antiretroviral therapy. Methods: Enrolled patients were intensively monitored for ADRs to highly active antiretroviral therapy. Predictability...

[RETRACTED]Objective: To assess the incidence, severity pattern, causality, predictability and preventability of adverse drug reactions (ADRs) and to identify risk factors for adverse drug reactions in highly active antiretroviral therapy. Methods: Enrolled patients were intensively monitored for ADRs to highly active antiretroviral therapy. Predic...

Objective: To assess the incidence, pattern and potential drug-drug interactions (DDIs) and to identify risk factors for DDIs in highly active antiretroviral therapy. Material & Methods: Patients were intensively monitored between August 2009 to March 2010 for DDIs to highly active antiretroviral therapy. The prescription of each enrolled patient w...

Objective: To assess awareness of pharmacovigilance among the healthcare professionals and to evaluate the impact of an educational intervention for improving awareness of pharmacovigilance among physician, pharmacist and nurses in an Indian tertiary care teaching hospital. Material &Methods: A suitable self-administered Knowledge, attitude, practi...

The prevalence of Type 2 diabetes mellitus (DM) has grown rapidly, but little is known about the drivers of inpatient spending in low- and middle-income countries. This study aims to compare the clinical presentation and expenditure on hospital admission for inpatients with a primary diagnosis of Type 2 DM in India, China, Thailand and Malaysia. We...