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Clinical profile of Thrombocytopenia in Acute Febrile Illnesses; a hospital-based study

Dhunputh P, Acharya R, Umakanth S, Shetty SM, Mohammed AP, Saraswat PP

Kathmandu Univ Med J (KUMJ), 2021 11 26;19(74):248-252.
PMID: 34819445

Background Thrombocytopenia is a common haematological abnormality noted in clinical practice, however, it can be missed in cases where specific investigations are not asked for. Acute Febrile Illness with thrombocytopenia is a diagnostic and therapeutic challenge, as thrombocytopenia has an inverse relation to mortality and morbidity in various febrile illnesses. Vector-borne and zoonotic diseases (like malaria, dengue, scrub typhus, and leptospirosis), infections and sepsis are some of the common causes of fever with thrombocytopenia. Objective To identify the causes of fever with thrombocytopenia, assess the clinical complications associated with febrile thrombocytopenia, and overall study the clinical profile of thrombocytopenia in a tertiary care hospital Method Medical records of all adult patients, admitted to a tertiary level hospital, with fever and thrombocytopenia (platelet count < 1,00,000 /mm3 ) were assessed (from October 2009 to March 2011). Detailed case history, general physical examination findings, routine and specific examinations were recorded according to a pre-decided format. Data were analysed using SPSS 16.0 Result Acute febrile illness with thrombocytopenia was most commonly seen in Dengue patients. Headache and arthralgia were more commonly encountered in scrub typhus. Platelet transfusions were necessitated in a large number of patients, especially in scrub typhus. Malaria patients had the highest mortality rate. Conclusion Acute Febrile Illnesses (AFI) are of varied origins, and proper diagnosis is imperative. The degree of thrombocytopenia in infections has a prognostic value. It can also help in differential diagnosis and clear identification of aetiology of acute febrile illnesses. Timely identification and management of thrombocytopenia in acute febrile illness can positively impact the overall patient outcome.
Fulltext (2E)-2-{[3-Methyl-5-(2-naphth-yloxy)-1-phenyl-1H-pyrazol-4-yl]methyl-idene}hydrazinecarbothio-amide monohydrate

Fun HK, Chia TS, Shetty S, Kalluraya B, Nithinchandra

Acta Crystallogr Sect E Struct Rep Online, 2012 Oct 1;68(Pt 10):o3055-6.
PMID: 23125816 DOI: 10.1107/S1600536812039815

In the title compound, C(22)H(19)N(5)OS·H(2)O, the naphthalene ring system and the benzene ring [dihedral angle = 85.19 (8)°] make dihedral angles of 87.02 (9) and 14.41 (10)°, respectively, with the pyrazole ring. The mean plane through the 2-methyl-enehydrazinecarbothio-amide group [C-N-N-C(=S)-N; maximum deviation = 0.022 (1) Å] is slightly twisted from the pyrazole ring [dihedral angle = 5.60 (11)°]. In the crystal, mol-ecules are linked by N-H⋯S, N-H⋯O, O-H⋯S, O-H⋯N and C-H⋯S hydrogen bonds into sheets parallel to the ab plane. π-π inter-actions are also observed [centroid-to-centroid distances = 3.7778 (12) and 3.7010 (12) Å].
Fulltext Transmission of SARS-CoV-2 Infection by Children: A Study of Contacts of Index Paediatric Cases in India

Gupta N, Saravu K, Varma M, Pm A, Shetty S, Umakanth S

J Trop Pediatr, 2021 01 29;67(1).
PMID: 33280033 DOI: 10.1093/tropej/fmaa081

The susceptibility of children to coronavirus disease-19 (COVID-19) and transmission of COVID-19 from children to others is a relatively unexplored area. The aim of this study was to understand the transmission dynamics of Severe Acute Respiratory Syndrome Coronavirus 2 in children. This was a retrospective observational study where a total of 19 paediatric index cases (including a set of twins) with COVID-19 and 42 primary contacts (adults-36, paediatric-6) from the immediate family members were included. All the index cases and four of the five positive contacts were asymptomatic. Despite adults staying with positive children in the same vehicle, same room in the quarantine centre and the same ward, only four of the parents became positive.
Clinical comments on prognostic and clinicopathological significance of PD-L1 overexpression in oral squamous cell carcinoma (OSCC)

Jayaraj R, Shetty S, Kumaraswamy C, Raghul S, Gothandam KM, Raymond G, et al.

Oral Oncol, 2020 Dec;111:104886.
PMID: 32684328 DOI: 10.1016/j.oraloncology.2020.104886
Fulltext Clinical validity of clinicopathological and prognostic significance of circulating tumor cells in head and neck squamous cell carcinoma

Jayaraj R, Shetty S, Kumaraswamy C, Raymond G, Ram M R, Govind SK, et al.

Oral Oncol, 2020 10;109:104727.
PMID: 32327312 DOI: 10.1016/j.oraloncology.2020.104727
Fulltext Clinical approaches to interpreting the findings of systematic review and meta-analysis of the effectiveness of probiotics in the prevention and treatment of Cancer Therapy-Induced Oral Mucositis (CTIOM)

Jayaraj R, Kumaraswamy C, Shetty S, Raymond G, Ram M R, Govind SK, et al.

Oral Oncol, 2020 05;104:104622.
PMID: 32115371 DOI: 10.1016/j.oraloncology.2020.104622
Fulltext Clinical validity and conceptual interpretation of systematic review and meta-analysis on elective neck dissection (END) versus observation for early-stage oral squamous cell carcinoma (OSCC)

Jayaraj R, Shetty S, Kumaraswamy C, Raymond G, Ram M R, Govind SK, et al.

Oral Oncol, 2020 10;109:104764.
PMID: 32402654 DOI: 10.1016/j.oraloncology.2020.104764
Comment on "Supplemental breast cancer-screening ultrasonography in women with dense breasts: a systematic review and meta-analysis"

Jayaraj R, Shaw P, Shetty S, Kumaraswamy C, Gothandam KM, Ravishankar Ram M, et al.

Br J Cancer, 2021 05;124(11):1891-1892.
PMID: 33846522 DOI: 10.1038/s41416-021-01348-3
Fulltext Clinical Investigation of Chemotherapeutic Resistance and miRNA Expressions in Head and Neck Cancers: A Thorough PRISMA Compliant Systematic Review and Comprehensive Meta-Analysis

Jayaraj R, Polpaya K, Kunale M, Kodiveri Muthukaliannan G, Shetty S, Baxi S, et al.

Genes (Basel), 2022 Dec 10;13(12).
PMID: 36553594 DOI: 10.3390/genes13122325

Background: Chemoresistance is a significant barrier to combating head and neck cancer, and decoding this resistance can widen the therapeutic application of such chemotherapeutic drugs. This systematic review and meta-analysis explores the influence of microRNA (miRNA) expressions on chemoresistance in head and neck cancers (HNC). The objective is to evaluate the theragnostic effects of microRNA expressions on chemoresistance in HNC patients and investigate the utility of miRNAs as biomarkers and avenues for new therapeutic targets. Methods: We performed a comprehensive bibliographic search that included the SCOPUS, PubMed, and Science Direct bibliographic databases. These searches conformed to a predefined set of search strategies. Following the PRISMA guidelines, inclusion and exclusion criteria were framed upon completing the literature search. The data items extracted were tabulated and collated in MS Excel. This spreadsheet was used to determine the effect size estimation for the theragnostic effects of miRNA expressions on chemoresistance in HNC, the hazard ratio (HR), and 95% confidence intervals (95% CI). The comprehensive meta-analysis was performed using the random effects model. Heterogeneity among the data collected was assessed using the Q test, Tau2, I2, and Z measures. Publication bias of the included studies was checked using the Egger's bias indicator test, Orwin and classic fail-safe N test, Begg and Mazumdar rank collection test, and Duval and Tweedie's trim and fill methods. Results: After collating the data from 23 studies, dysregulation of 34 miRNAs was observed in 2189 people. These data were gathered from 23 studies. Out of the 34 miRNAs considered, 22 were up-regulated, while 12 were down-regulated. The TaqMan transcription kits were the most used miRNA profiling platform, and miR-200c was seen to have a mixed dysregulation. We measured the overall pooled effect estimate of HR to be 1.516 for the various analyzed miRNA at a 95% confidence interval of 1.303-1.765, with a significant p-value. The null hypothesis test's Z value was 5.377, and the p-value was correspondingly noted to be less than 0.0001. This outcome indicates that the risk of death is determined to be higher in up-regulated groups than in down-regulated groups. Among the 34 miRNAs that were investigated, seven miRNAs were associated with an improved prognosis, especially with the overexpression of these seven miRNAs (miR15b-5p, miR-548b, miR-519d, miR-1278, miR-145, miR-200c, Hsa- miR139-3p). Discussion: The findings reveal that intricate relationships between miRNAs' expression and chemotherapeutic resistance in HNC are more likely to exist and can be potential therapeutic targets. This review suggests the involvement of specific miRNAs as predictors of chemoresistance and sensitivity in HNC. The examination of the current study results illustrates the significance of miRNA expression as a theragnostic biomarker in medical oncology.
Fulltext The application of nanoparticles as advanced drug delivery systems in Attenuating COPD

Jessamine V, Mehndiratta S, De Rubis G, Paudel KR, Shetty S, Suares D, et al.

Heliyon, 2024 Feb 15;10(3):e25393.
PMID: 38356590 DOI: 10.1016/j.heliyon.2024.e25393

Chronic Obstructive Pulmonary Disease (COPD) is a dilapidating condition which is characterized by inflammation, an excess in free radical generation and airway obstruction. Currently, the drugs commercially available for the management of COPD pose several limitations such as systemic adverse effects, including bone density loss and an increased risk of developing pneumonia. Moreover, another limitation includes the need for regular and frequent dosing regimens; which can affect the adherence to the therapy. Furthermore, these current treatments provide symptomatic relief; however, they cannot stop the progression of COPD. Comparatively, nanoparticles (NPs) provide great therapeutic potential to treat COPD due to their high specificity, biocompatibility, and higher bioavailability. Furthermore, the NP-based drug delivery systems involve less frequent dosing requirements and in smaller doses which assist in minimizing side effects. In this review, the benefits and limitations of conventional therapies are explored, while providing an in-depth insight on advanced applications of NP-based systems in the treatment of COPD.
Effect of photobiomodulation therapy on inflammatory cytokines in healing dynamics of diabetic wounds: a systematic review of preclinical studies

Karkada G, Maiya GA, Houreld NN, Arany P, Rao Kg M, Adiga S, et al.

Arch Physiol Biochem, 2020 Dec 28.
PMID: 33370535 DOI: 10.1080/13813455.2020.1861025

CONTEXT: Delayed wound healing in diabetes mellitus (DM) is due to the overlapping phases of the healing process. The prolonged inflammation and altered levels of inflammatory cytokines lead to deformed cell proliferation. Photobiomodulation alleviates the expression of inflammatory cytokines and promotes tissue repair, thereby restoring the wound healing process.
OBJECTIVE: To find out the effect of photobiomodulation therapy (PBMT) in the healing dynamics of diabetic wounds with particular emphasis on interleukin-6, interleukin-1β, and tumour necrosis factor-α.
METHODS: Scientific databases searched using keywords of the population: DM, intervention: PBMT, and outcomes: inflammatory cytokines.
RESULTS: We have included five preclinical studies in the present systematic review for qualitative analysis. These studies evaluated the effect of PBMT at different wavelengths, dosage, and time on wound healing in DM.
CONCLUSIONS: The systematic review concludes that PBMT regulates inflammatory cytokines levels, enhances cell proliferation, and migration, thereby improving the wound healing properties.
Fulltext Oral Candidal Load and Oral Health Status in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Case-Cohort Study

Khijmatgar S, Belur G, Venkataram R, Karobari MI, Marya A, Shetty V, et al.

Biomed Res Int, 2021;2021:5548746.
PMID: 34545329 DOI: 10.1155/2021/5548746

Objective: The objective of this study was to determine the candidal load of the patients with Chronic Obstructive Pulmonary Disease (COPD) and evaluate the oral health status of subjects with COPD. Material and Methods. N = 112 COPD subjects and N = 100 control subjects were included in the study. The selection of COPD cases was confirmed based on the set criteria from the American College of Physicians. The oral health status was assessed as per WHO criteria to determine the score of decayed, missing, and filled teeth (DMFT), significant caries index (SiC), community periodontal index and treatment needs (CPITN), and oral hygiene index-simplified (OHI-S). Gram staining was performed to identify Candida using the whole saliva. Quantitative evaluation of the candidal load was carried out using Sabouraud Dextrose Agar (SDA). Chrome agar was used to differentiate between the commensal carriages. A statistical analysis paired t-test and 95% confidence interval (CI) for proportions was carried out using STATA software.
Results: Candidal growth was found in 21.42% (n = 24) of COPD cases and 1.1% (n = 11) of control cases (p < 0.05) (95% CI 0.45, 0.59). The DMFT score was 8.26 in COPD subjects and 4.6 in controls, the SiC score was 16.42 in COPD subjects and 10.25 in controls, and the CPITN score for both COPD and control cases was score 2.
Conclusion: In conclusion, there was a higher candidal load among subjects suffering from COPD. Theophylline medication can be a risk factor for increased candidal load in COPD patients.
Effectiveness of Photobiomodulation Therapy on Neuropathic Pain, Nerve Conduction and Plantar Pressure Distribution in Diabetic Peripheral Neuropathy - A Systematic Review

Korada HY, Arora E, Maiya GA, Rao S, Hande M, Shetty S, et al.

Curr Diabetes Rev, 2023;19(9):e290422204244.
PMID: 37622461 DOI: 10.2174/1573399818666220429085256

BACKGROUND: Diabetic peripheral neuropathy is a severe complication of type 2 diabetes mellitus. The most common symptoms are neuropathic pain and altered sensorium due to damage to small nerve fibers. Altered plantar pressure distribution is also a major risk factor in diabetic peripheral neuropathy, leading to diabetic foot ulcers.
OBJECTIVE: The objective of this systematic review was to analyze the various studies involving photobiomodulation therapy on neuropathic pain and plantar pressure distribution in diabetic peripheral neuropathy.
METHODS: We conducted a systematic review (PubMed, Web of Science, CINAHL, and Cochrane) to summarise the evidence on photobiomodulation therapy for Diabetic Peripheral Neuropathy with type 2 diabetes mellitus. Randomized and non-randomized studies were included in the review.
RESULTS: This systematic review included eight studies in which photobiomodulation therapy showed improvement in neuropathic pain and nerve conduction velocity. It also reduces plantar pressure distribution, which is a high risk for developing foot ulcers.
CONCLUSION: We conclude that photobiomodulation therapy is an effective, non-invasive, and costefficient means to improve neuropathic pain and altered plantar pressure distribution in diabetic peripheral neuropathy.
Fulltext Lower motor neuron facial palsy in a postnatal mother with COVID-19

Kumar V, Narayanan P, Shetty S, Mohammed AP

BMJ Case Rep, 2021 Mar 01;14(3).
PMID: 33649026 DOI: 10.1136/bcr-2020-240267

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.
Unusual contribution of the first jejunal vein in the formation of the portal vein

Nayak SB, Shetty SD, Packirisamy V, Vasudeva SK

Morphologie, 2021 May 05.
PMID: 33965324 DOI: 10.1016/j.morpho.2021.04.003

Jejunum is drained into superior mesenteric vein through a series of jejunal veins. The way in which the first jejunal vein terminates is of great importance in upper abdominal surgery and radiological procedures. Knowledge of its variations is particularly important in surgical procedures like orthotropic hepatic transplantation, hepatic vein reconstruction, pancreatic surgery and surgical procedures of duodenojejunal junction. We saw a first jejunal vein opening directly into the portal vein. Further, the inferior mesenteric vein drained into the first jejunal vein. This case could be useful to gastroenterologists, general surgeons and radiologists.
Complete enclosure of gall bladder inside the lesser omentum - a rare anomaly

Nayak SB, Shetty SD, Vasudeva SK

Morphologie, 2021 Jun 16.
PMID: 34147369 DOI: 10.1016/j.morpho.2021.06.001

Gall bladder is known for many congenital anomalies such as duplication, intrahepatic position, floating position etc. Most of its anomalies can be detected in ultrasound examination and radiography. We report an extremely rare congenital anomaly of gall bladder as observed in a male cadaver during dissection classes. The gall bladder was totally enclosed in the right free margin of the lesser omentum, in front of the usual contents of the right free margin of lesser omentum. The size, shape and blood supply of the gall bladder were normal. Though this anomaly might not cause any functional disturbances, it might result in complications during laparoscopic cholecystectomy.
Oncocytic Salivary Gland Tumours: Cytological Features and Diagnostic Pitfalls

Prabhakar P, Rao N, Kairanna NV, Shetty S, Singh VK

Indian J Otolaryngol Head Neck Surg, 2022 Dec;74(Suppl 3):6112-6118.
PMID: 36742835 DOI: 10.1007/s12070-021-02764-w

Oncocytes are epithelial cells having abundant eosinophilic cytoplasm. The presence of oncocytes in salivary glands pose a diagnostic challenge since they can be present in lesions ranging from non-neoplastic, benign to malignant. FNAC is a simple procedure which can aid in the pre-operative diagnosis of these lesions. This study is an eight year retrospective study in which salivary gland aspiration cytology cases having oncocytic cells and with available corresponding histopathology were included. These slides were reviewed for features like cellularity, presence of oncocytic cells, glandular elements, squamoid cells, nuclear atypia, mitosis, lymphoid tissue, necrosis. Twenty cases were included in the study. The mean age of presentation was 60 years showing male preponderance with parotid gland being the most common site of involvement. Concordant diagnosis on cytology and histopathology was seen in 16 cases and discordance was seen in 4 cases. All the discordant cases were reported as benign on cytology but on histopathology they were labelled as acinic cell carcinoma, squamous cell carcinoma, mucoepidermoid carcinoma and an intraparotid lymph node respectively. Review of discordant cases showed subtle findings like ill-formed acini, cytoplasmic vacuolation, goblet cells and dysplastic foci raising suspicion of a different diagnosis. The potential areas of pitfall and cause of discrepancy have been discussed in this study. It is crucial to be aware of the spectrum of lesions in which oncocytes are seen, to enable an accurate diagnosis on cytology. Careful evaluation of smears for subtle clues can minimize errors.
Fulltext Conceptual interpretation and clinical applicability of a systematic review and meta-analysis about prognostic value of apolipoproteins in COVID-19 patients

Rajagopal M, Senthilnathan R, Shetty S, Devi A, Ravishankar Ram M, Samiappan S, et al.

Travel Med Infect Dis, 2022;46:102248.
PMID: 34990864 DOI: 10.1016/j.tmaid.2021.102248
Concurrent Variations of Celiac and Superior Mesenteric Arteries

Satheesha Nayak B, Shetty SD, Sirasanagandla SR, Kumar N, Swamy Ravindra S, Abhinitha P

Kathmandu Univ Med J (KUMJ), 2019 11 16;16(64):345-347.
PMID: 31729351

Celiac trunk is the first ventral branch of the abdominal aorta. It usually terminates by giving three branches; the common hepatic artery, the left gastric artery and the splenic artery. We report a rare variation of the branching pattern of the celiac trunk. The Celiac trunk divided into two branches; left gastric artery and splenicogastroduodenal trunk. The splenico-gastroduodenal trunk divided into splenic and gastroduodenal arteries. The superior mesenteric artery and hepatic artery took origin from a common hepato-mesenteric trunk. The hepatic artery had a winding course around the portal vein and hepatic duct. The knowledge of these variations is important while doing radiological investigations and liver transplant and pancreatic surgeries.
Nutritional status of refugee children entering DeKalb County, Georgia

Shah AY, Suchdev PS, Mitchell T, Shetty S, Warner C, Oladele A, et al.

J Immigr Minor Health, 2014 Oct;16(5):959-67.
PMID: 23828627 DOI: 10.1007/s10903-013-9867-8

This study determines the nutritional status among refugee children entering one of the largest resettlement counties in the United States and identifies differences between incoming populations. Medical records of all newly arriving pediatric refugees (0-18 years) entering DeKalb County, Georgia between October 2010 and July 2011 were reviewed. Refugee children were grouped as African, Bhutanese, or Burmese (resettling from either Thailand or Malaysia) for comparative analysis. Approximately one in five refugees were anemic or malnourished, while a quarter had stool parasites, and nearly half had dental caries. African refugees had the highest anemia but the lowest underweight prevalence (p < 0.05). Compared to Burmese resettling from Malaysia, Burmese children from Thailand had a higher prevalence of anemia, underweight, and stool parasites (p < 0.05). Clinicians should use CDC medical screening guidelines for newly arriving pediatric refugees, as well as ensure proper nutritional support and follow-up care.

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