Browsing by Author "Seshadri, M S"

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    25 (OH) vitamin D level in Crohn’s disease: association with sun exposure & disease activity.
    (2009-08) Joseph, A J; George, Biju; Pulimood, A B; Seshadri, M S; Chacko, Ashok
    Background & objectives: Western studies show that up to 65 per cent of patients with Crohn’s disease have low serum 25-hydroxy vitamin D concentrations, and 45 per cent of these patients have metabolic bone disease. No data are available from India or from any country with comparable climatic conditions or ethnicity. We carried out this study to measure the serum 25 (OH) vitamin D levels of Crohn’s disease patients and compare with matched controls and to assess the consequences of low 25 (OH) vitamin D levels on bone and mineral metabolism in these patients. Methods: Adult patients with Crohn’s disease were compared with age and sex matched patients diagnosed to have irritable bowel syndrome. Serum 25 (OH) vitamin D, the effect of disease characteristics, sunlight exposure and milk consumption on 25 (OH) vitamin D level, and the consequences of low 25 (OH) vitamin D level on bone and mineral metabolism were assessed. Results: Thirty four patients with Crohn’s disease (M:F, 24:10, age 39.2 ± 12.9 yr) and 34 controls (M:F, 24:10, age 38.9 ± 13.4 yr) were studied. 25 (OH) vitamin D levels were significantly lower in patients with Crohn’s disease as compared to controls (Crohn’s disease vs controls: 16.3 ± 10.8 vs 22.8 ± 11.9 ng/ml; P<0.05). The severity of disease activity as assessed by the Harvey Bradshaw score correlated negatively (Correlation coefficient -0.484, significance P<0.004), and the duration of sunlight exposure correlated positively (Correlation coefficient 0.327, significance P=0.007) with the serum 25 (OH) vitamin D level. Interpretation & conclusions: Serum 25 (OH) vitamin D levels were significantly lower among patients with Crohn’s disease as compared to age and sex matched controls. Further, 25 (OH) vitamin D levels in patients with Crohn’s disease were lower in those with severe disease activity and less sun exposure. Further studies need to be done to correlate low 25 (OH) vitamin D level with bone density and assess the effect of vitamin D supplementation in these patients.
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    99mTc-Sestamibi scan in a patient with an ectopic parathyroid adenoma.
    (2000-11-20) Unnikrishnan, A G; Seshadri, M S; Rajaratnam, S; Krishnaveni,; Nair, A; Shanthly, N
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    Accuracy of filter paper method for measuring glycated hemoglobin.
    (2007-02-19) Anjali,; Geethanjali, F S; Kumar, R Selva; Seshadri, M S
    BACKGROUND AND OBJECTIVES: Glycated hemoglobin (HbA1c) provides an accurate and reliable method to assess the glycemic control in patients with Diabetes. Its measurement is limited by the inconvenience of sample collection that requires venipuncture, sample handling and storage factors. The aim of this study was to assess the feasibility of using a dried capillary blood spot on a filter paper to estimate HbA1c, to check its stability at room temperature and to compare these values with the venous sample HbA1c by Turbidimetric Inhibition Immunoassay (TINA, Tina-quant HbA1c II). METHODS: Venous blood samples of seventy eight patients with Type 1 or type 2 diabetes, were collected in EDTA containing vacutainers. Stability of HbA1c was studied in capillary blood samples blotted on to Whatman number 1 filter paper and stored at room temperature, for the first 20 patients enrolled in the study. After establishing the stability over a ten day period, HbA1c values obtained on the capillary blood spots were compared with those obtained from the venous blood samples of the remaining 58 patients. RESULTS: Glycated hemoglobin is found to be stable in dried capillary blood spots on filter paper till the 10th day, stored at room temperature. It however, shows an inherent variability of +/- 15%, which falls within the permissible variability (18%) of the quality control material. Seventy nine percent of the capillary HbA1c values were found to fall within this range. With linear regression, we derived the relationship between filter paper and venous HbA1c values. The regression equation was as follows: Cap.HbA1c = 0.95 (Ven.HbA1c) + 1.4. The filter paper results were highly correlated with the venous sample values (r = 0.889, p < 0.01). CONCLUSION: Measurement of glycated hemoglobin in dried blood spots on filter paper gives reliable and reproducible results. In our study, the mean capillary sample HbA1c value was 12% higher compared to the venous sample HbA1c values. Therefore a higher normal range may have to be used for interpreting the dried blood spot capillary blood HbA1c values.
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    Aetiology and treatment response in patients with spontaneous diabetes insipidus.
    (2000-10-24) Rajaratnam, S; Shailajah, K; Seshadri, M S
    BACKGROUND: Spontaneous diabetes insipidus (DI) is an uncommon disorder. This study analysed aetiology and response to treatment in patients with spontaneous DI admitted to the endocrinology service of a teaching hospital. METHODS: Twenty patients were seen over a eight year period (1991-1998). The diagnosis of DI was confirmed in each case by the standard water deprivation test. Appropriate diagnostic procedures were carried out to determine aetiology. RESULTS: Sixteen patients had complete DI and four patients had partial DI. Eighteen had central DI and two nephrogenic DI. The etiology in sixteen of the eighteen patients with central DI included: histiocytosis--three, eosinophilic granuloma--two, neurosarcoidosis--three, viper-bite--one, head injury--two, germinoma--one, post RT--one, tuberculous meningitis--one, acute-sphenoid sinusitis--one and hypothalamic tumour--one. Eleven patients (61%) responded to tab. carbamazepine, while nine (45%) required intra-nasal DDAVP. One of the two patients with nephrogenic DI responded to thiazide diuretic. CONCLUSION: We identified the aetiology in 88% of our patients with central DI. Histiocytosis and sarcoidosis accounted for 40%. Most patients (61%) responded to treatment with oral carbamazepine, others required intra-nasal DDAVP.
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    Behcet's disease: a case report.
    (1995-04-01) Thomas, R V; Christopher, D J; Nair, S; Seshadri, M S; Cherian, A M
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    Benign intracranial hypertension.
    (1987-08-01) Dayal, A K; Alan, G; Kurien, T; Seshadri, M S; Cherian, A M
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    Conn's syndrome: a simple diagnostic approach.
    (1999-09-29) Mathew, S; Perakath, B; Nair, A; Rajaratnam, S; Seshadri, M S
    BACKGROUND: Primary aldosteronism is usually diagnosed after a battery of biochemical tests and adrenal imaging. If an adrenal tumour (Conn's syndrome) is identified, patients need surgery. However, bilateral adrenal hyperplasia is treated medically. Till 1994, we diagnosed Conn's syndrome using simple biochemical tests and a CT scan of the adrenal glands. Aldosterone and plasma renin activity assay became available in our institution in 1994 and were used subsequently in the work up of patients suspected to have Conn's syndrome. We analysed our data to determine whether simple tests such as serum and urinary potassium values combined with CT imaging of the adrenal glands are adequate to arrive at a diagnosis in these patients. METHODS: All consecutive patients (n = 17) diagnosed to have Conn's syndrome, managed by the Departments of Endocrinology and Surgical Endocrinology of this institution during a nine-year period from 1990 to 1998, were studied retrospectively. RESULTS: Until 1994, Conn's syndrome was diagnosed after documenting hypertension, hypokalaemia, inappropriate kaliuresis, metabolic alkalosis and CT scanning to localize the tumour. Serum aldosterone and plasma renin activity (PRA) were used in addition since 1994. All patients underwent adrenalectomy after adequate preoperative preparation. There was no operative mortality. Postoperatively, normokalaemia was established in all patients. Persistent postoperative hypertension was present in 43.8% of patients. CONCLUSIONS: In our experience, Conn's syndrome could be diagnosed accurately with simple investigations and CT imaging of the adrenal glands. Extensive biochemical testing, including aldosterone and PRA assay, is helpful when the diagnosis is uncertain. While hypokalaemia is curable after surgery, residual hypertension persists in about 45% of patients.
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    Detection & elimination of preanalytical errors in the determination of zinc in biological samples.
    (1993-08-01) Swaminathan, S; Seshadri, M S; Srikrishna, G; Mathew, P; Kanagasabapathy, A S
    Exogenous contamination poses a major problem to accurate determination of trace metals in biological samples. Analysis of these elements in biological material entails adoption of special precautionary measures. In this study we have assessed the various procedural steps of sampling and analysis of zinc in order to identify and minimize extraneous contamination in the laboratory. In addition we have established reference limits (2 SD) for zinc in human plasma, erythrocytes and hair.
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    Hemorrhagic necrosis of pituitary adenomas.
    (2002-12-11) Chacko, A G; Chacko, G; Seshadri, M S; Chandy, M J
    A clinicopathological study of 41 cases of pituitary apoplexy in a series of 324 surgically treated pituitary adenomas is presented. In 23 patients, the predominant operative finding was hemorrhage with or without necrosis. However, there were 15 (37.7%) cases where pale, necrotic tissue with no evidence of hemorrhage was found at surgery. Pale, necrotic material was particularly found when there was a long interval between the acute clinical event and surgery. It is concluded that the pale, necrotic debris represents one stage in the resorption process of blood after hemorrhagic necrosis of pituitary adenomas. This entity needs to be kept in mind especially since the material closely resemble the pultaceous material seen in craniopharyngiomas and epidermoid cysts.
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    Hepatitis B surface antigen (HBsAg) positive polyarteritis nodosa. A report of two cases and review of literature.
    (1979-07-01) Seshadri, M S; Varkey, K; John, L; Beatrice, B; Koshy, T S
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    Hepatoma in hemochromatosis.
    (1982-05-01) Seshadri, M S; Dayal, A K; Bhaktaviziam, A
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    Herpes simplex virus antibody in south Indian patients with carcinoma cervix.
    (1984-01-01) Seshadri, L; Seth, P; Walter, A; Seshadri, M S; John, T J
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    The 'hook effect' on serum prolactin estimation in a patient with macroprolactinoma.
    (2001-03-17) Unnikrishnan, A G; Rajaratnam, S; Seshadri, M S; Kanagasapabathy, A S; Stephen, D C
    Large quantities of antigen in an immunoassay system impair antigen-antibody binding, resulting in low antigen determination. This is called the 'high dose hook effect'. We report this phenomenon in a patient with a large macroprolactinoma. In this patient, the correct estimate of serum prolactin (PRL) was obtained only after appropriate dilution of serum. We suggest that in order to avoid the high dose hook effect, the serum PRL be estimated in appropriate dilution in all patients with large pituitary tumours. This is particularly important when the clinical suspicion of high PRL is strong, as in women with amenorrhoea-galactorrhoea and men with long standing hypogonadism.
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    Hyperprolactinemia in women--a series of 71 cases.
    (1993-11-01) Seshadri, M S; Sud, A; Chandy, M J; Thomas, J; Kanagasbapathy, A S; Cherian, A M
    Seventy one cases of hyperproloactinemia (HPRL) in women were seen over five years. Of these, twenty five had pituitary tumors, thirty three had functional HPRL, five had drug induced HPRL and four had hypothyroidism. Surgery was undertaken in fifteen women, rest were treated with bromocriptine. There were thirteen pregnancies in patients with tumor after treatment. Seven of thirty three patients with functional HPRL conceived. No patient had tumor expansion or recurrence during pregnancy. Bromocriptine was required for most patients.
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    Hypokalemic periodic paralysis: an unusual cause.
    (1996-03-01) Thomas, N; Ramakrishna, B; Seshadri, M S
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    Infantile nephropathic cystinosis presenting as incomplete Fanconi syndrome and refractory rickets.
    (1989-05-01) Rajadurai, V S; Shanbag, P; Seshadri, M S; Khanduri, U; Alexander, T A; Jadhav, M A
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    Infective endocarditis caused by Erysipelothrix rhusiopathiae in a patient with systemic lupus erythematosus.
    (1996-03-01) Thomas, N; Jesudason, M; Mukundan, U; John, T J; Seshadri, M S; Cherian, A M
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    Juvenile Sandhoff disease.
    (2001-01-15) Unnikrishnan, A G; Danda, S; Seshadri, M S
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    Kawasaki syndrome.
    (1989-04-01) Seshadri, M S; Cherian, A M; Dayal, A K; Thomas, K
    Kawasaki and associates first described a mucocutaneous lymph node syndrome from Japan. Since then this febrile illness has been reported from several countries. The patient described in this report had all the clinical manifestations of this entity excepting coronary aneurysms.
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    Limited Wegener's granulomatosis.
    (1987-08-01) Dayal, A K; Joyce, P; Alan, G; Kurien, T; Seshadri, M S; Cherian, A M