Papers by sangeetha Kandasamy
Archives of Medical Research, 2010
g-Glutamyltransferase (GGT), an enzyme responsible for the extracellular catabolism of antioxidan... more g-Glutamyltransferase (GGT), an enzyme responsible for the extracellular catabolism of antioxidant glutathione, may explicitly participate in atherogenesis. Several populationbased studies have documented strong cross-sectional associations between serum GGT concentrations and certain cardiovascular risk factors, irrespective of alcohol consumption. The mechanism underlying these associations remains largely enigmatic. Considerable association of high-sensitivity C-reactive protein, a major inflammatory marker for cardiovascular risk, with GGT and other cardiovascular risk factors has been described, implying that elevation of serum GGT (conceivably acting as a marker of oxidative stress) is correlated with subclinical microinflammatory response involved in the pathogenesis of atherosclerosis. It is also relevant to assess whether the prognostic impact of a novel risk marker can be influenced by therapeutic intervention, thus decreasing the occurrence of cardiovascular events. Subtle gradations in serum GGT may help predict long-term cardiovascular prognosis, and the supplementary GGT determination to conventional testing has potential implications for screening those at increased cardiovascular risk who may benefit from prophylactic measures and require enhanced therapeutic effort. It has been reported that serum GGT may contribute to the accumulation of GGT activity inside the plaque. Further comprehension is, however, needed about the relationship of GGT activity inside the plaque with inflammatory biomarkers, plasma lipoproteins, and other independent determinants to define the most risky combination and improve the prognostic stratification of patients. Ó 2009 IMSS.
Frontiers in Public Health, Feb 25, 2022
Frontiers in Public Health, Nov 26, 2021
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused phenomenal loss ... more Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused phenomenal loss of lives and overburdened the health system in India. Low morale, fatigue, and inadequate knowledge among the healthcare workers (HCWs) are the perceived threats to pandemic control. We aimed to assess the COVID-19 related level of knowledge, attitude, and practices (KAP) among our HCWs. A cross-sectional, electronically distributed, questionnaire-based study was conducted which identified the demographics of HCWs and the current KAP related to coronavirus disease 2019 (COVID-19). The descriptive statistics were used to present the demographics of the participants and chi-square test was used to assess the differences in KAP among the participants. Of 1,429 total participants, 71.9% belonged to age group 21-40 years. Only 40.2% received any infection control training and 62.7% relied upon single source of information update. However, 82.9% of the participants had adequate knowledge. Being married, urban dwelling, and higher qualification were associated with knowledge adequacy (p < 0.001). Interestingly, the senior HCWs (age 41-50 years) were least likely to have adequate knowledge (74.1%). About 84% had positive attitude toward COVID-19, but 83.8% of the participants feared providing care to the patients with COVID-19. However, 93% of HCWs practiced safety precautions correctly most of the times and training had no influence on practice. In conclusion, more than 80% of HCWs in the study had adequate knowledge, positive attitude, and practiced safely most of the time. However, the pitfalls, such as poor training, knowledge uncertainties, and fear of disease acquisition among the HCWs need to be addressed.
Archives of Medicine and Health Sciences, 2021
Background and Aim: The objective was to study the hematological manifestations of disease caused... more Background and Aim: The objective was to study the hematological manifestations of disease caused by novel coronavirus 2019 (COVID-19) and evaluate the association between absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, total count, and outcome. Materials and Methods: A hospital-based retrospective study was conducted on COVID-19 adult inpatients admitted between March and August 2020. The patients were classified into three groups based on outcome as mild COVID/uneventful recovery (Group 1), severe COVID/recovered (Group 2), and death (Group 3). Their clinical profile and hematological parameters were compared using both univariate and multivariate analyses. Binary and multinomial logistic regression analyses were used to analyze the chances of survival or death with respect to the variable studied. Results: The median age of nonsurvivors was 62.5 years. For unit increase in age, there were 1.03 times higher chances of severe disease (P = 0.013) and 1.04 times chances of death (P = 0.028). For every 1000/μl increase of ANC, the odds of developing severe disease rose by 1.85 (P = 0.270). For every 1000/μl increase in ALC, there were 94.7% lesser chances of death (P = 0.006) and 51.1% lesser chances of severe disease (P = 0.033). The odds of developing severe disease was 1.16 times per unit rise in NLR and the OR for death was 1.27 (P = 0.053). Conclusion: Advanced age, presence of lymphocytopenia, increased neutrophil count, and elevated NLR were associated with severe disease and high mortality due to COVID-19. Lymphocytopenia and age were the strongest predictors of severe disease and death.
Research Square (Research Square), Jul 27, 2021
Background. In India, Competency Based Medical Education (CBME) is gaining foothold to transform ... more Background. In India, Competency Based Medical Education (CBME) is gaining foothold to transform the medical student into a doctor ful lling community and societal needs. With that end in view the teaching faculty are getting sensitized and trained by the National Faculty Development Program (FDP). Objectives. To assess the awareness about FDP among teaching faculty in medical colleges. To study the attitude & perceived barriers to implementation of CBME. Methods. This questionnaire based multicentric cross sectional study was conducted among teaching faculties in Indian medical institutes. Electronic media [Google forms] was used to disseminate the questionaire. Attitudinal and perceptional differences were internally compared among the faculties. Results. Among 251 participants 90.2% faculties from private institutes had undergone FDP signi cantly more than those from Government sector (p=0.008). We observed that 92.4% were aware, 80.2 % had undergone Curriculum Implementation Support Program (CISP) and 95.2% did agree that CBME will improve the medical education system. Major challenges perceived were high student to faculty ratio (67.7%), ill developed infrastructure (41.4%) and di culties in assessment (41.1%). The popular solutions suggested were to increase faculty strength (73.7%), improve infrastructure (69.3%), extra remuneration (35.9 %) and increase administrative support (30.7%). There were signi cant difference of opinions between teaching faculty of government and private sector (p=0.017). Conclusion.
Indian Journal of Critical Care Medicine, May 1, 2020
Importance: Rodenticide poisoning is a common occurrence in India. Of the different classes of ro... more Importance: Rodenticide poisoning is a common occurrence in India. Of the different classes of rodenticides available, yellow phosphorus is considered highly toxic. There are scarce epidemiological data regarding the ingestion of yellow phosphorus in the subcontinent. Objectives: This study aimed to identify the clinical profile of rodenticide-poisoned patients and delineate mortality predictors. Design: Prospective observational study.
Journal of evolution of medical and dental sciences, Jan 16, 2014
True Dandy-Walker malformation [DWM]consists of cerebellar vermis hypoplasia, posterior fossa enl... more True Dandy-Walker malformation [DWM]consists of cerebellar vermis hypoplasia, posterior fossa enlargement with elevation of the torcula and an enlarged 4th ventricle extending posteriorly as a retrocerebellar cyst. Other malformations with less severe cerebellar vermis hypoplasia and generally smaller posterior fossa fluid collections were categorized as ''Dandy-Walker variants''. We herein report a case of Dandy Walker Variant who presented in an unusual manner. CASE REPORT: Our patient, a 17 yrs. old adolescent male presented to the hospital with intractable vomit and unsteadiness x 3 days. On detailed elicitation of history, he was apparently asymptomatic till 3 days ago. There was no significant precipitating factor like fever, drug intake or trauma. He is not gainfully employed due to "lack of interest". He had been a poor performer at school and dropped out at 8 th Std. Patient is 3 rd born of consanguineous parents and has 2 elder siblings. Sister is mentally retarded and requires support for ADL; brother has normal mentation and physique. On Clinical Examination, patient was dehydrated, confined to bed, anthropometry was within normal limits. On detailed Neurological Examination, he had an average IQ 80-90, MMSE->18 and speech was staccato. He had evidence of cerebellar dysfunction like truncal ataxia, dysmetria, dyssynergia and nystagmus. Other parts of CNS examination were unremarkable. Laboratory Workup of Patient revealed normal blood counts and basic biochemical analysis. Patient had hyponatremia [Na+ 122MEq/L]. ECG revealed sinus bradycardia. CT scan brain revealed cerebellar vermis atrophy with posterior fossa cyst/ supra tentorial structures normal-features s/o Dandy Walker Variant. MRI Brain was s/o partial vermis aplasia, no displacement, posterior fossa cyst-Dandy Walker Variant. ECHO Cardiography was normal study. Karyotype analysis was carried out which showed normal male karyotype, trisomies ruled out. Since the patient's sister was also a retard we considered an inherited disorder and worked up the sibling sister. However, her laboratory tests, CR and MR imaging, Echocardiography and Karyotype analysis were all normal. Course in the Hospital: Patient was managed conservatively with intravenous fluids, labyrinthine stimulants. His general condition improved, electrolytes reverted to normal and he was able to resume normal activities in 2 days. His sinus bradycardia persisted though for unknown reasons. He got discharged from the hospital on day 7.
Research Square (Research Square), Nov 30, 2021
Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiolo... more Background. Approximately 5% of COVID-19 patients suffer near fatal disease. Clinical and radiologic features may predict severe disease albeit with limited speci city and radiation hazard. Laboratory biomarkers are eyed as simple, speci c and point of care triage tools to optimize management decisions.This study aimed to study the role of in ammatory markers in prognosticating COVID-19 patients. Methodology. A hospital based retrospective study was conducted on COVID-19 adult inpatients classi ed into three groups as mild disease-recovered [Group I], severe disease-recovered [Group II] and dead [Group III]. Categorical outcomes were compared using Chi square test. Univariate binary logistic regression analysis was performed to test the association between the explanatory and outcome variables. Unadjusted OR along with 95% CI was calculated. The utility of lab parameters (Ferritin, LDH, D dimer, N/L ratio and PLT/L ratio) in predicting severity of COVID-19 was assessed by Receiver Operative Curve (ROC) analysis. P value < 0.05 was considered statistically signi cant. Results. The mean age was 49.32 +/-17.1 years. Among study population, 378 were Group I, 66 Group II, and 56 Group III. Median levels of Ferritin among the 3 groups were 62ng/mL, 388.50 ng/mL and 1199.50 ng/mL. Median value of LDH were 95U/L, 720 and 982.50(p <0.001). D-dimer values of 3 groups were 23.20ng/mL, 104.30 ng/mL and 197.10 ng/mL (p <0.001). CRP done qualitatively was positive in 2 (0.53%), 30 (45.45%) and 53 (94.64%) of patients. The odds of patients suffering severe COVID-19 rose with rising values of ferritin, LDH and D-dimer [unadjusted OR 1.007, 1.004 &1.020] Conclusion. One time measurement of serum ferritin, LDH, D-dimer and CRP is promising to predict outcomes for COVID 19 inpatients. Single qualitative CRP was equally good but more cost effective than quantitative CRP. The most speci c combination was NLR, Lymphocyte percentage and D-dimer levels done between 7 th-10 th day of symptoms.
Research Square (Research Square), Oct 7, 2020
Background: In India, SARS-CoV-2 pandemic has caused phenomenal loss of lives and overburdened th... more Background: In India, SARS-CoV-2 pandemic has caused phenomenal loss of lives and overburdened the health system. Low morale, fatigue and inadequate knowledge among health personnel are perceived threats to pandemic control. Knowledge, Attitude and Practice (KAP) studies among HCWs can identify crucial knowledge gaps and gauge psychological impact. We aimed to assess the COVID-19 related current level of knowledge, attitude and practices among our HCWs. Methods: A cross-sectional, electronically distributed, questionnaire-based study was conducted among HCWs. The questionnaire identi ed participants' demographics and the current KAP related to COVID-19. Descriptive statistics were used to present the participants' demographics and Chi-square test to assess differences among the participants' demographics based KAP. α < 0.05 was used for statistical signi cance. The association between the knowledge, attitude and practices was assessed using Pearson correlation coe cient (r). Results: Of 1,429 total participants, 71.9% belonged to age group 21-40 years. Female workers constituted 61.5%. Only 40.2% received any infection control training and 62.7% relied upon single source of information update. However, 82.9% of participants had adequate knowledge. Being married, urban dwelling and higher quali cation were associated with knowledge adequacy (p<0.001). Interestingly, senior HCWs (age 41-50 years) were least likely to have adequate knowledge (74.1%). 84.2% had positive attitude towards COVID. Notably, 83.8% feared providing care to COVID patient. 93% practised safety precautions correctly most of the times and training had no in uence on practise. Positive correlation was recognized between adequate knowledge and positive attitude (r=0.26). Conclusion: More than 80% of HCWs in India had adequate knowledge, positive attitude and practiced safely most of the time. However pitfalls like poor training, knowledge uncertainties and fear of disease acquisition among HCWs need to be addressed. Adverse outcomes can be averted by structured training sessions and psychological support programs for HCWs.
Journal of evolution of medical and dental sciences, Jun 11, 2015
BACKGROUND: "Epilepsia Partialis Continua" is considered as the status epilepticus equivalent of ... more BACKGROUND: "Epilepsia Partialis Continua" is considered as the status epilepticus equivalent of simple partial motor seizures. First described by Kojewnikoff in 1894, this unique type of prolonged focal seizure continues to perplex neurologists for over a century now. Controversy looms large over the site of origin of this seizure. The unequivocal cortical origin of epilepsia partialis continua is substantiated by clinical, electrophysiologic and neurosurgical evidence. However, distant, or even subcortical sites of origin have been documented earlier. Despite our progressive knowledge about this disorder, to date, neither Antiepileptic drugs (AEDs) nor invasive/surgical treatment approaches have altered the course of this disease. We herein report a case of EPC who is admitted to our hospital. CASE REPORT: On the 31 st of July, Ms A, 20/female, educated upto XII Std, was brought to the hospital for h/o 4 episodes of seizures since morning. On examination, patient was drowsy, obeyed simple commands and largely responsive. She had persistent tachycardia [110-130/mt], her BP-110/80 mmHg. Neurologic examination revealed left hemiparesis and left UMN 7 th nerve palsy. Her brief interictal periods [5-10mts] were punctuated by clonic seizures of left side face, upper and lower limbs [1-2mts]. She was diagnosed as "simple partial status epilepticus". Patient's blood investigations, CT and MRI brain were normal, EEG showed generalized abnormal seizure activity without any specific epileptogenic foci. Her Serum electrolytes and CSF studies including culture and biochemistry were normal. Patient was started and titrated sequentially on anticonvulsant polytherapy [Oral and injectables] with phenytoin, sodium valproate, carbamazepine, benzodiazepines, phenobarbitone, leviteracetam, clonazepam and clobazam. Her seizures remained uncontrolled with ongoing fits-day 93.
Archives of Medicine and Health Sciences
Background and Aim: The objective was to study the hematological manifestations of disease caused... more Background and Aim: The objective was to study the hematological manifestations of disease caused by novel coronavirus 2019 (COVID-19) and evaluate the association between absolute neutrophil count (ANC), absolute lymphocyte count (ALC), neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio, total count, and outcome. Materials and Methods: A hospital-based retrospective study was conducted on COVID-19 adult inpatients admitted between March and August 2020. The patients were classified into three groups based on outcome as mild COVID/uneventful recovery (Group 1), severe COVID/recovered (Group 2), and death (Group 3). Their clinical profile and hematological parameters were compared using both univariate and multivariate analyses. Binary and multinomial logistic regression analyses were used to analyze the chances of survival or death with respect to the variable studied. Results: The median age of nonsurvivors was 62.5 years. For unit increase in age, there were 1.03 times higher chances of severe disease (P = 0.013) and 1.04 times chances of death (P = 0.028). For every 1000/μl increase of ANC, the odds of developing severe disease rose by 1.85 (P = 0.270). For every 1000/μl increase in ALC, there were 94.7% lesser chances of death (P = 0.006) and 51.1% lesser chances of severe disease (P = 0.033). The odds of developing severe disease was 1.16 times per unit rise in NLR and the OR for death was 1.27 (P = 0.053). Conclusion: Advanced age, presence of lymphocytopenia, increased neutrophil count, and elevated NLR were associated with severe disease and high mortality due to COVID-19. Lymphocytopenia and age were the strongest predictors of severe disease and death.
Journal of education and health promotion, 2022
Journal of Current Research in Scientific Medicine
International Journal of Medical and Health Research, Nov 1, 2019
Envenomation and death resulting from snakebite is a particularly important public health problem... more Envenomation and death resulting from snakebite is a particularly important public health problem in the rural tropics. Knowledge about the early clinical and biochemical manifestations of envenomation is imperative to plan effective management strategy. This study aimed to identify potential markers of envenomation. This is a prospective cohort study, wherein consecutive, hospitalized snakebite victims [envenomed and non-envenomed] were enrolled as Cohorts I and II. The complete clinical profile and biochemical parameters [Blood glucose, urea, serum creatinine, Alanine transaminase, Aspartate transaminase, Creatine Kinase and Lactate Dehydrogenase] were assessed. The findings were computed and analyzed. There were 61 patients in each Cohort. In Cohort I, 61.1% were hemotoxic, 24.2% neurotoxic, 9.8% both and 4.9% local envenomation. The predominant clinical manifestations included edema 72.5%, coagulopathy 70.1%, neuroparalysis 34 % and oliguria 33.1%. Biochemical evaluation reveale...
Journal of Evolution of medical and Dental Sciences, 2013
BACKGROUND: Fever is a burning issue in the tropics and the most common cause of morbidity. Quite... more BACKGROUND: Fever is a burning issue in the tropics and the most common cause of morbidity. Quite frequently this fever goes undiagnosed because of many reasons like the lack of diagnostic facilities, insufficient epidemiological data available on causes of fever, and so on. This research study was aimed to find out the etiology and clinical markers of Acute Undifferentiated Febrile Illness [AUFI] among the rural population of Southern India. METHODOLOGY: This prospective, observational study was conducted at Government Villupuram Medical College and Hospital, a rural tertiary care centre in Tamil Nadu, India. Consecutive hospitalised adult patients [>16 years] with AUFI[5-14 days fever] were enrolled into the study from August 2010 to February 2012 [18 months].Upon enrollment, detailed history was recorded, physical examination done and basic blood tests including biochemical examination, smear study for malaria, blood cultures and serology for the commonly encountered infection...
Indian Journal of Critical Care Medicine, 2020
Importance: Rodenticide poisoning is a common occurrence in India. Of the different classes of ro... more Importance: Rodenticide poisoning is a common occurrence in India. Of the different classes of rodenticides available, yellow phosphorus is considered highly toxic. There are scarce epidemiological data regarding the ingestion of yellow phosphorus in the subcontinent. Objectives: This study aimed to identify the clinical profile of rodenticide-poisoned patients and delineate mortality predictors. Design: Prospective observational study.
Internet Journal of Medical Update - EJOURNAL, 2017
A major cause of mortality in Government Villupuram Medical College & Hospital is due to toxin ex... more A major cause of mortality in Government Villupuram Medical College & Hospital is due to toxin exposure. Oleander poisoning ranks second in the list being superseded only by organophosphate poisoning. Data on the incidence, clinical features and the determinants of mortality are scanty. Standardized treatment or monitoring protocols are lacking. The study aimed to identify key mortality predictors in oleander poisoning, document the clinical spectrum of patients presenting with oleander poisoningand to devise a standard assessment protocol in oleander-poisoned patients. This is a prospective, observational study conducted at Villupuram Medical College. Consecutive hospitalized patients who had consumed oleander seeds, fruits or leaves were included in the study after obtaining informed, written consent. Upon registration, detailed history, clinical examination, baseline investigations and targeted investigations were performed. The data were documented in the standardized case proforma and subsequently computed. Patients were followed up 12 hourly by clinical examination and ECG recordings for a duration of 3 days. The data were analyzed using standard statistical methods. A total of 101 patients (46 male and 55 female) were enrolled into the study. There were 18 deaths, most of them (82.55%) occurring within 24 hours of intake. Among the parameters assessed, females, low BMI (Body Mass Index), consumption of > 3 seeds, delayed presentation (after 120 minutes), altered mental status, clinical shock, presence of heart block and absent p waves in ECG were significantly associated with mortality. Males, high BMI, low dosage of poison (<=3 seeds) and hemodynamic stability on day 1 were associated with favorable outcomes. ST-T segment changes, sinus tachycardia, ventricular premature contractions and administration of orciprenaline had no significant effect on the outcome. Oleander poisoning claims lives in the rural tropics. Institutional assessment and treatment protocols based on the infrastructure and expertise available are the need of the hour. Prompt first aid, critical assessment and timely referral for cardiac pacing can cut down mortality to a large extent.
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Papers by sangeetha Kandasamy