Jyothi B Lingegowda’s research while affiliated with Vinayaka Missions Kirupananda Variyar Engineering College and other places

Background: Metabolic syndrome refers to a cluster of various interrelated cardio-metabolic risk factors that promote the development of atherosclerotic cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Identifying at risk individuals is necessary for early medical management, thereby reducing the economic burden on the patient and the society. The objective of this study was to assess the prevalence of metabolic syndrome in patients presenting to medicine clinics of our institute. Methods: This cross-sectional hospital based study was carried out at department of medicine, DM Wayanad institute of medical sciences, Wayanad, Kerala and included 432 patients attending the general medicine outpatient department. Patients’ demographic details and anthropometric measurements including height, weight, waist and hip measurements were taken. Clinical data including blood pressure, blood sugars and fasting lipid profile was also collected. The NCEP ATP III (National cholesterol education program - adult treatment panel III) criteria for diagnosis of metabolic syndrome were used to make a diagnosis of metabolic syndrome. Results: On applying the modified NCEP ATP III guidelines with the waist circumference specific to Asian population, we found that the prevalence of metabolic syndrome in our study population was 60.9%. The prevalence was more in females than in males and the difference was statistically significant (p = 0.049). Abdominal obesity and decreased HDL was more in females as compared to males and the difference was also found to be statistically significant. 27% of the study population with metabolic syndrome was normal or underweight. Conclusions: The prevalence of metabolic syndrome in the present studied population was high as they represent patients presenting to hospital. This data is more like the tip of an iceberg. Larger population based studies and intervention in the form of aggressive lifestyle modification is the need of the hour to prevent the cardio-metabolic complications of metabolic syndrome.

Introduction: H pylori infection is associated with wide spectrum of neoplastic and non-neoplastic lesions and commonly presents as dyspepsia. Upper gastrointestinal endoscopy not only helps to differentiate between organic and functional dyspepsia, but also helps in the diagnosis of H pylori infection. In this study we aim to assess the prevalence of helicobacter pylori associated gastrointestinal diseases using rapid urease test (RUT) in patients undergoing endoscopy with upper GI symptoms in rural Kerala. Materials and Methods: This observational cross sectional descriptive study was done in the Department of Gastroenterology at DM Wayanad institute of medical sciences, which is a tertiary care setup in rural Kerala. 510 patients, who underwent gastrointestinal endoscopy for various upper GI symptoms were included in the study. After applying exclusion criteria, 479 patients with demographic details, upper GI symptoms list, endoscopic findings and H pylori results formed the crux of the study. Results: Among 479 patients evaluated, males (58%) were predominant.248 (51.7%) of the 479 patients were H pylori positive. Dyspepsia (66.5%) was the commonest symptom amongst the H pylori positive patients. Gastritis was the commonest endoscopic finding followed by esophagitis and duodenal ulcer both in the general study group and in the H pylori positive group. Amongst 8 patients with carcinoma of stomach, 7 patients were positive for H pylori infection and this association was statistically significant. Conclusion: Dyspepsia as a symptom has great social and economic impact and is the commonest symptom presenting to the physician. Being a developing country with limited resources and its ever increasing elderly population and high prevalence of H pylori and dyspeptic symptoms, larger study to frame appropriate guidelines for endoscopy and empirical treatment of dyspepsia is desired.

INTRODUCTION IDF definition of metabolic syndrome uses waist circumference as the main criteria without which metabolic syndrome cannot be diagnosed. The IDF cut-offs for waist circumference is ethnicity specific, but there is a vast heterogeneity amongst South Asians and within the Indian subcontinent itself. MATERIALS AND METHODS This cross-sectional study was conducted on 100 consecutive cases of diabetes in a medical college catering to predominantly rural population who attended the Medicine Department OPD. Demographic data and anthropometric data with relevant biochemical values were collected with patient’s permission and the study was conducted. The IDF criterion of cut-off for waist circumference was solely used to identify the correlation between waist circumference and development of diabetes. RESULTS Study comprised of 55 males and 45 females with diabetes. 40% amongst males with diabetes had a waist circumference below the cut-off for metabolic syndrome. Amongst females, 8% did not fit into the IDF criteria of waist circumference for metabolic syndrome. CONCLUSION Many countries have proposed different cut-off values for waist circumference for diagnosis of metabolic syndrome. India being a heterogenous population requires region and population specific study to identify exact cut-off point. The authors believe 90 cm as waist circumference in males is too high and many metabolic syndrome cases are likely to be missed using this criteria.

Background: Assigning a score to cytology/FNA of thyroid lesions can provide important information regarding their neoplastic or non-neoplastic nature. The present study was undertaken to score thyroid lesions on aspirates based on various characteristics and correlating with standard cytological classification. Histopathology was done and the two cytological classification systems (Cytological scoring and Standard method) were compared. Methods: 196 cases of thyroid lesions with preoperative cytologic diagnosis were assigned cytological score/classified. Histopathology diagnosis was compared and statistical analysis was performed; correlation between cytologic score and histopathology was established using Spearman correlation coefficient. Regression analysis was done to assess the significance of each cytological score. Results: Multivariate analysis of cytologic features revealed that the amount of colloid, nuclear features and background pattern are the most influential features. There was high degree of correlation between the scoring methods on cytology with histopathology compared to standard cyto classification with histopathology. There was a significant association (p<0.001) between the scores assigned to cytologic and histopathologic specimens. Interpretation and Conclusion: Cytological scoring method can be used to assess the lesions of the thyroid as a significant relationship exists between both the classification systems and histopathology.

Introduction: Cervical cancer is a malignant neoplasm arising from the uterine cervix. One of the most common symptoms of cervical cancer is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer has progressed to an advanced stage. Treatment usually consists of surgery in early stages, and chemotherapy and /or radiotherapy in more advanced stages of the disease. Materials and Methods: This retrospective study of histomorphological patterns of cervical lesions was done over a period of 5 years (2008 to 2013). Totally 795 cervical biopsies were received, amongst which 618 biopsies were chronic cervicitis, 95 showed varying degrees of dysplasia's and 82 cases were malignancies. These cases were further correlated with clinical presentations. Results: The commonest age group in the malignant cases (18 years to 80 years) were 4 th and 5 th decade with history of bleeding per vagina being the commonest clinical presentation. Squamous cell carcinoma was the commonest variant. Conclusion: Histopathological patterns of malignancies needs to be sub-typed further along with special stains, immunohistochemistry and molecular studies, as the treatment modalities and prognosis largely varies with each type of lesion.

Introduction: Red Cell Exchange (RCE) is removal of a patient’s red blood cells while replacing with donor red blood cells either manually or using automated systems. RCE is beneficial in patients with Sickle Cell Disease (SCD) either during sickling crisis or prior to major surgical procedures to bring down the sickling percentage as high sickling percentage during prolonged anaesthesia may lead to vaso-occlusive crisis. It is also employed in patients infested with malaria and babesiosis where parasitic index remain high despite medical management. RCE is also tried as an adjuvant therapy in certain poisons like nitrobenzene and carbon monoxide when first line management fails. Aim: To study the effectiveness, clinical outcome, challenges and complications of RCE in various clinical scenario and to understand how this procedure can be effectively utilized in the management of patients in Indian scenario. Materials and Methods: This retro prospective study was conducted in tertiary care center in southern India which analyzed 21 RCE procedures performed on patients with different clinical conditions. Of the 21 RCE performed, 18 procedures were performed on patients with case of sickle cell disease, Two procedures were performed on patients infested with severe falciparum malaria and one procedure was performed on a patient with nitrobenzene poisoning. All procedures were performed using Spectra Optia® Apheresis System - Terumo BCT. Results: All the 18 patients who underwent the RCE for sickle cell anaemia were admitted for hemi-arthroplasty for avascular necrosis of the head of femur. The average initial HbS levels were between 73-85% and post RCE it was brought down to 22-29% and was achieved in a single sitting in all the cases. Among the two patients infested with severe falciparum malaria, RCE helped in reducing the infestation rate. In case of nitrobenzene poisoning, RCE helped in improvement of oxygen saturation and patient showed significant improvement. Conclusion: RCE is a safe and clinically effective therapeutic modality with very minimal to nil side effects. RCE is possibly underutilized therapy in developing world like India due to various reasons like inadequate awareness/ technical expertise, lack of equipments and facilities to identify the clinical conditions per se etc.