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Article ; Online: Effect of duration of sodium valproate therapy on bone mineral density and vitamin D levels.

Nirmal, Dinesh / Abdul, Samee / Jaiswal, Poornima / Naunihal Singh, S / Avaragollapuravarga Mathada, Amit / Nagaraj, Preeti

Epilepsy & behavior : E&B

2024 Volume 153, Page(s) 109733

Abstract: Objective: This study aimed to evaluate the impact of prolonged sodium valproate use on bone mineral density (BMD) and Vitamin D levels in pediatric epilepsy patients.: Methods: In a cross-sectional study conducted at the Epilepsy Clinic of Niloufer ... ...

Abstract	Objective: This study aimed to evaluate the impact of prolonged sodium valproate use on bone mineral density (BMD) and Vitamin D levels in pediatric epilepsy patients. Methods: In a cross-sectional study conducted at the Epilepsy Clinic of Niloufer Hospital, Hyderabad, India, 50 pediatric patients (aged 4-10 years) were recruited. The cohort comprised 30 epilepsy patients on sodium valproate treatment (cases) and 20 healthy siblings without epilepsy or valproate use (controls). BMD was assessed using dual-energy X-ray absorptiometry to measure height-adjusted total body less head Z-scores (TBLH Z-scores), and serum 25-hydroxyvitamin D levels were measured. Statistical analysis included independent samples t-tests, Mann-Whitney U tests, and Pearson correlation, with a preliminary power analysis ensuring adequate sample size. Results: Cases exhibited significantly lower BMD TBLH Z-scores (Mean = -1.543) compared to controls (Mean = 0.515, p <.001) and reduced Vitamin D levels (Mean = 9.17 for cases vs. 27.80 for controls, p <.001). A negative correlation was observed between the duration of sodium valproate use and both BMD Z-scores (r = -0.626, p <.001) and Vitamin D levels (r = -0.707, p <.001). Conclusions: The findings suggest a significant negative impact of prolonged sodium valproate use on both bone density and Vitamin D levels in pediatric patients. These results underscore the importance of monitoring and managing bone health in children receiving long-term sodium valproate therapy.
MeSH term(s)	Humans ; Child ; Bone Density ; Valproic Acid/adverse effects ; Cross-Sectional Studies ; Absorptiometry, Photon ; Vitamin D ; Epilepsy/drug therapy ; Epilepsy/chemically induced ; Vitamins
Chemical Substances	Valproic Acid (614OI1Z5WI) ; Vitamin D (1406-16-2) ; Vitamins
Language	English
Publishing date	2024-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010587-3
ISSN	1525-5069 ; 1525-5050
ISSN (online)	1525-5069
ISSN	1525-5050
DOI	10.1016/j.yebeh.2024.109733
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Article: Study of pattern & distribution of adverse drug reactions in acute coronary syndrome patients in a tertiary care hospital.

Mahadevappa, Manjappa / Meher, Chinmay / Pushpa, N B / Kulkarni, Prashanth / Poornima, K S / Desai, Nagaraj

The Indian journal of medical research

2022 Volume 156, Issue 1, Page(s) 111–121

Abstract: Background & objectives: With the availability of a wide range of drugs to treat patients with acute coronary syndrome (ACS), adverse drug reactions (ADRs) have become inevitable in clinical practice. Thorough knowledge of such reactions is essential ... ...

Abstract	Background & objectives: With the availability of a wide range of drugs to treat patients with acute coronary syndrome (ACS), adverse drug reactions (ADRs) have become inevitable in clinical practice. Thorough knowledge of such reactions is essential for the treating physician for optimal treatment and better outcomes. There are many scales to define, measure and assess the ADRs, but there is a dearth of data available on such drug reactions among ACS patients. Hence, this study attempted to analyze the pattern, causality, severity, predictability and preventability of ADRs in ACS patients. All the ADRs reported during the study period were analyzed for causality by the World Health Organization-Uppsala Monitoring Centre (WHO-UMC), Naranjo's and Karch and Lasagna scales; severity by modified Hartwig and Siegel scale; predictability by Rawlins and Thompson criterion and preventability by Schumock and Thornton scale. Methods: A single-centre, record-based analysis for the occurrence of ADRs was done among ACS patients admitted to the department of Cardiology between January and October 2017. Demographic data, comorbid conditions, reported ADRs and ADR assessment details were noted from the hospital case records and ADR monitoring centre (AMC) records. The data were analyzed and presented in a descriptive manner using percentages, mean and standard deviation. The Pearson's chi-squared test was used to ascertain the significance of the association between different groups. Results: Out of 324 patients under evaluation, 67 had developed one or more ADRs. There were 30 different types of ADRs reported, headache being the most common. Among the drugs, heparin was the most common factor, causing 27 per cent of ADRs. Definite causality of a suspected drug causing ADRs was seen in 11.9 (n=8), nine (n=6) and 7.5 (n=5) per cent cases as per WHO-UMC, Naranjo (Naranjo algorithm) and Karch and Lasagna scales, respectively. In the severity of ADRs, the most severe reactions according to the modified Hartwig-Siegel scale (level 4a in our study) were seen in 17.5 (n=12) per cent of patients, and the rest were either level 2 or 3 reactions. Nearly 92.5 (n=62) per cent of reactions were predictable according to the Rawlins and Thompson criterion. Application of the modified Schumock-Thornton scale showed that 22.4 per cent of ACS patients had preventable reactions, and the rest were not preventable. Interpretation & conclusions: The study results suggest that ADRs are relatively common among ACS patients. Most of these can be identified and assessed for causality, severity, predictability and preventability using various available scales. Diligent pharmacovigilance for identifying and assessing ADRs may help manage and mitigate morbidity associated with these in high-risk ACS patients.
MeSH term(s)	Humans ; Tertiary Care Centers ; Acute Coronary Syndrome/drug therapy ; Acute Coronary Syndrome/epidemiology ; Pharmacovigilance ; Drug-Related Side Effects and Adverse Reactions/epidemiology ; Hospitalization
Language	English
Publishing date	2022-12-12
Publishing country	India
Document type	Journal Article
ZDB-ID	390883-5
ISSN	0971-5916 ; 0019-5340
ISSN	0971-5916 ; 0019-5340
DOI	10.4103/ijmr.IJMR_1275_20
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Article ; Online: Impact of Anticoagulation Clinic Intervention on Patient Centred Outcomes in a Tertiary Care Hospital

S Sunil Kumar / Oliver Joel Gona / Nagaraj Desai / B Shyam Prasad Shetty / KS Poornima / Ramesh Madhan

Journal of Clinical and Diagnostic Research, Vol 14, Iss 9, Pp OC11-OC

2020 Volume 15

Abstract: Introduction: Vitamin K Antagonists (VKAs) have been in use for more than 50 years. They have remained as mainstay therapy in the prevention of thromboembolic events in atrial fibrillation, mechanical heart valves and venous thromboembolism. Despite many ...

Abstract	Introduction: Vitamin K Antagonists (VKAs) have been in use for more than 50 years. They have remained as mainstay therapy in the prevention of thromboembolic events in atrial fibrillation, mechanical heart valves and venous thromboembolism. Despite many years of clinical experience with VKAs, the quality of anticoagulation achieved in routine clinical practice is suboptimal. Aim: To study the effects of structured Anticoagulation Clinic (ACC) interventions on patient centred outcomes in subjects taking VKAs. Materials and Methods: A retrospective study was conducted among patients taking VKAs enrolled in ACC. A total of 169 patients receiving VKAs for at least six months with 4 INR (International Normalised Ratio) values and completed 12 months of follow-up were analysed. Anticoagulation related quality measures like Time in the Therapeutic Range (TTR), Percentage of International Normalised Ratios in the therapeutic Range (PINRR) and clinical outcomes like stroke, systemic embolic events and bleeding was analysed at the time of enrolment and compared with those during ACC care. Results: Among 352 patients enrolled in ACC, 169 patients were eligible for analysis. The mean age of the study population was 55.62±13.77 years. Atrial fibrillation (59%) was the most common indication for VKA therapy. Hypertension (66.3%) was the most common co-morbidity. Mean TTRs were significantly higher in the ACC care when compared with the pre-ACC care at 12 months follow-up (77.58±8.85% vs 51.01±16.7%, p<0.0001). There was a significant improvement in TTRs as early as three months of ACC intervention (73.18±13.56%). At the time of enrolment, 21.9% of patients had individual TTRs (i-TTR) >70% which increased to 70.4% at 12 months of followup. INR testing was done more frequently in ACC care. Adverse clinical events were higher in pre-ACC care than ACC care (4.7% vs 2.4%, p>0.05). Major bleeding and thromboembolic events were higher in pre-ACC care than ACC care (1.8% vs. 0.6% and 2.4% vs. 0.6% respectively). Conclusion: ...
Keywords	international normalised ratio ; percentage of international normalised ratios in the therapeutic range ; time in the therapeutic range ; vitamin k antagonists ; Medicine ; R
Subject code	610
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	JCDR Research and Publications Private Limited
Document type	Article ; Online
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Article ; Online: A rare primary immunodeficiency.

Nagaraj, Poornima / Sivathanu, Shobhana / Sampath, Sowmya / Ramakrishnan, Nithiyanantham

BMJ case reports

2014 Volume 2014

Abstract: A 9-year-old girl presented with failure to thrive, chronic mucopurulent nasal discharge, recurrent skin pustules and recurrent episodes of purulent ear discharge since 2 years of age. She had coarse facial features with extensive eczema, multiple ... ...

Abstract	A 9-year-old girl presented with failure to thrive, chronic mucopurulent nasal discharge, recurrent skin pustules and recurrent episodes of purulent ear discharge since 2 years of age. She had coarse facial features with extensive eczema, multiple pyoderma scars, florid dental caries, retained primary dentition, hypermobile joints and a woody induration of the vulva. Autosomal dominant hyper-IgE syndrome was suspected and confirmed by very high serum IgE levels. Vulval biopsy revealed a premalignant condition. STAT 3 mutation, which is usually responsible for this condition, was not found in our case, indicating an as yet unidentified mutation. The child also had unusual features like the total absence of clinical and radiological features of pneumonia. The premalignant change in the vulva was also unusual since vulval carcinoma has not been reported so far in children with this disorder. This child will require a close follow-up to look for malignant transformation.
MeSH term(s)	Biopsy ; Child ; DNA/genetics ; DNA Mutational Analysis ; Female ; Humans ; Immunologic Deficiency Syndromes/diagnosis ; Immunologic Deficiency Syndromes/genetics ; Mutation ; STAT3 Transcription Factor/genetics ; STAT3 Transcription Factor/metabolism
Chemical Substances	STAT3 Transcription Factor ; STAT3 protein, human ; DNA (9007-49-2)
Language	English
Publishing date	2014-09-24
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2014-205088
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Article: Osseointegrated dental implants in growing children: a literature review.

Mankani, Nivedita / Chowdhary, Ramesh / Patil, Brijesh A / Nagaraj, E / Madalli, Poornima

The Journal of oral implantology

2014 Volume 40, Issue 5, Page(s) 627–631

Abstract: Edentulism is usually associated with the aging patient. However, total or partial tooth loss also affects young individuals, mainly as a result of trauma, decay, anodontia, or congenital and acquired jaw defects involving the alveolar processes. For ... ...

Abstract	Edentulism is usually associated with the aging patient. However, total or partial tooth loss also affects young individuals, mainly as a result of trauma, decay, anodontia, or congenital and acquired jaw defects involving the alveolar processes. For elderly patients, the use of oral implants has become an accepted treatment modality for edentulism, and most of today's knowledge regarding implants is based on such practice. There has been hesitation to perform implant therapy for growing children; hence, few children to date have been provided with implant-supported construction. Consequently, little is known about the outcome of the osseointegration procedure in young patients, and until now, only a limited number of case presentations have been reported. This article reviews the current literature to discuss the use of dental implants in growing patients and the influence of maxillary and mandibular skeletal and dental growth on the stability of those implants. The literature review was performed through Science Direct, Wileys Blackwell Synergy, PubMed, Google, Embase, Medknow publications, and Springer for references published from 1963 to 2011. It is recommended to wait for the completion of dental and skeletal growth, except for severe cases of ectodermal dysplasia.
MeSH term(s)	Dental Implantation, Endosseous/methods ; Dental Implants ; Humans ; Mandible/growth & development ; Maxilla/growth & development ; Maxillofacial Development/physiology ; Osseointegration/physiology
Chemical Substances	Dental Implants
Language	English
Publishing date	2014-10
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	448462-9
ISSN	1548-1336 ; 0160-6972
ISSN (online)	1548-1336
ISSN	0160-6972
DOI	10.1563/AAID-JOI-D-11-00186
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Article: To Study the Effectiveness of Oral Azithromycin as Compared to Parenteral Ceftriaxone in the Treatment of Uncomplicated Enteric Fever

Nagaraj, Poornima / Sivathanu, Shobhana / Manickam, Kumar / Kumar, Satheesh / Kumar, Sunder / Sampath, Sowmya

Journal of Pediatric Infectious Diseases

2016 Volume 11, Issue 04, Page(s) 113–117

Abstract: Aim: This study aims to compare the effectiveness of oral azithromycin and intravenous ceftriaxone in the treatment of uncomplicated enteric fever in children aged between 2 and 12 years.: Methods: This prospective randomized open-labeled study was ... ...

Abstract	Aim: This study aims to compare the effectiveness of oral azithromycin and intravenous ceftriaxone in the treatment of uncomplicated enteric fever in children aged between 2 and 12 years. Methods: This prospective randomized open-labeled study was conducted in the Department of Pediatrics in a medical college of South India. A total of 126 children with proven enteric fever were randomized into two treatment groups. One group received oral azithromycin (20 mg/kg/d) and the other group received parenteral ceftriaxone (75 mg/kg/d), both of which were given for a duration of 7 days. The study population was observed for fever defervescence, duration of hospital stay, and relapse. Results: The mean time for fever defervescence was 3.68 ± 2.109 and 4.08 ± 1.903 days in the azithromycin group and the ceftriaxone group, respectively. The mean duration of hospital stay was 7.35 ± 2.604 days in the azithromycin group and 9.44 ± 0.249 days in the ceftriaxone group. In the azithromycin group three children had treatment failure and had to crossover to ceftriaxone group. Among the four treatment failures in the ceftriaxone group, two cases relapsed within 4-week follow-up period. There was no relapse in the azithromycin group. Conclusion: Oral azithromycin is as effective as intravenous ceftriaxone in treating uncomplicated typhoid fever in children with respect to fever defervescence, duration of hospital stay, and relapse.
Keywords	randomized ; enteric fever ; azithromycin ; ceftriaxone
Language	English
Publishing date	2016-12-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2236947-8
ISSN	1305-7693 ; 1305-7707 ; 1871-0336
ISSN (online)	1305-7693
ISSN	1305-7707 ; 1871-0336
DOI	10.1055/s-0036-1593889
Database	Thieme publisher's database

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Article ; Online: Health-related quality of life among osteoarthritis patients attending primary care clinics of Mangalore city

HN Harsha Kumar / K Nagaraj / Kritika Luthra / Parul Gupta / Poornima Sapar / Suvigya Gupta / Anuj Tyagi

International Journal of Medicine and Public Health, Vol 5, Iss 1, Pp 55-

2015 Volume 58

Abstract: Introduction: Osteoarthritis (OA) of the knee is the most common type of arthritis of the elderly among Asians. Reports suggest that it affects the quality of life. Hence, this study was undertaken with the objective to know the impact of OA of the knee ... ...

Abstract	Introduction: Osteoarthritis (OA) of the knee is the most common type of arthritis of the elderly among Asians. Reports suggest that it affects the quality of life. Hence, this study was undertaken with the objective to know the impact of OA of the knee on 8 domains of health related quality of life (HRQoL) which include: (1) Physical functioning (PF), (2) role limitation due to physical health (RP). (3) Emotional well-being/mental health (MH), (4) role limitation due to emotional problems (RE), (5) energy/vitality, (6) social well-being (short form [SF]), (7) body pain, (8) general health. Materials and Methods: This cross-sectional study was conducted in primary care rural clinics situated on peripheral areas of Mangalore city. Total sample size was calculated to be 77. Patients who met the criteria of modified American Rheumatologic Association Classification for OA of knee were administered a SF-36 questionnaire to measure the HRQoL in the local language version. Mean scores (with its standard deviation) across each domain was calculated. Results: Of 80 patients, 38 were males. OA affected HRQoL. Four out 8 factors had more impact on HRQoL (they are PF, RP, MH, RE). Duration of OA is an important determinant on HRQoL. Patients with newer onset of OA (<4 years) had less physical impact on (Domain, Mean) (PF, 54.36; RP, 13.5) and more emotional/mental impact (MH, 28.23; RE, 59.13). With increasing duration (>4 years) of OA (Domain, Mean), the emotional impact (MH, 44.67; RE, 45.67) reduced but the physical impact (PF, 47.83; RP, 19.75) persisted/got worse. Conclusion: Osteoarthritis had impact on HRQoL. Duration of OA determines the kind of impact. With the onset of OA emotional/mental support would be needed in addition to the medical treatment. As the disease progresses, they tend to cope with emotional/mental problems even as the physical problems persist/increase.
Keywords	Geriatrics ; health related quality of life ; osteoarthritis ; primary care ; Medicine (General) ; R5-920 ; Medicine ; R
Subject code	796
Language	English
Publishing date	2015-01-01T00:00:00Z
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Conference proceedings ; Online: VALUATION OF EXTERNALITIES IN WATER, FORESTS AND ENVIRONMENT FOR SUSTAINABLE DEVELOPMENT

2008

Abstract: Paper presented at EAAE 2008 Congress ... Conceptual development in the theory of externalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are social costs, ... ...

Abstract	Paper presented at EAAE 2008 Congress Conceptual development in the theory of externalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are social costs, accountability is crucial in increasing environmental awareness and for collective action through education and extension more so in developing countries. Here a modest attempt has been made to estimate externalities in water, forests and environment with field data from peninsular India to reflect on the economic perception of externalities by farmers and users of environment for the consideration of policy makers to devise institutions for payment towards environmental services. The methodology largely used here in estimation / valuation of externalities is by considering ‘with – without’ situations (including ‘before – after’ in some cases) akin to ‘project valuation’. Studies cover empirical estimation of externalities inter alia due to over extraction of groundwater , sand mining, watershed development, conservation of forests, sacred groves, cultivation of organic coffee, use of medicinal plants as alternate medicines and the annual values presented are in 2008 prices. The negative externality due to sand mining 24 € per acre, that due to distillery effluent pollution is 34 € per acre. The positive externality due to watershed program is around 51 € per acre, and that due to rehabilitation of irrigation tanks is 26 € per acre. The positive externality due to cultivation of shade coffee is 9 € per acre and that due to forest conservation 27 € per acre. The positive externality due to sacred grove conservation was 12 € per family. The impact of forest conservation on Non timber forest products was 88 € / per tribal household. The positive externality due to use of medicinal plants as alternate medicine is equal to 35 € per patient suffering from osteo-arthritis and 19 € per patient suffering from peptic-ulcer. While these estimates are not sacro sanct as the methodologies for valuation of externalities are subject to further review and improvement, they however serve as initial indicators of spillovers. And they signal possibilities for consideration of policy makers for devising alternate institutions for potential payment towards environmental services.
Keywords	Consumer/Household Economics ; Demand and Price Analysis ; Environmental Economics and Policy ; Research and Development/Tech Change/Emerging Technologies ; Research Methods/ Statistical Methods ; Externalities ; Environmental services ; Sustainable development
Subject code	333
Language	English
Publishing date	2008-08-25
Publishing country	us
Document type	Conference proceedings ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Conference proceedings ; Online: Valuation of Externalities in Water, Forests and Environment for Sustainable Development

2008

Abstract: Conceptual development in the theory of externalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are social costs, accountability is crucial in increasing ... ...

Abstract	Conceptual development in the theory of externalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are social costs, accountability is crucial in increasing environmental awareness and for collective action through education and extension more so in developing countries. Here a modest attempt has been made to estimate externalities in water, forests and environment with field data from peninsular India to reflect on the economic perception of externalities by farmers and users of environment for the consideration of policy makers to devise institutions for payment towards environmental services. The methodology largely used here in estimation / valuation of externalities is by considering ‘with – without’ situations (including ‘before – after’ in some cases) akin to ‘project valuation’. Studies cover empirical estimation of externalities inter alia due to over extraction of groundwater , sand mining, watershed development, conservation of forests, sacred groves, cultivation of organic coffee, use of medicinal plants as alternate medicines and the annual values presented are in 2008 prices. The negative externality due to sand mining 24 € per acre, that due to distillery effluent pollution is 34 € per acre. The positive externality due to watershed program is around 51 € per acre, and that due to rehabilitation of irrigation tanks is 26 € per acre. The positive externality due to cultivation of shade coffee is 9 € per acre and that due to forest conservation 27 € per acre. The positive externality due to sacred grove conservation was 12 € per family. The impact of forest conservation on Non timber forest products was 88 € / per tribal household. The positive externality due to use of medicinal plants as alternate medicine is equal to 35 € per patient suffering from osteo-arthritis and 19 € per patient suffering from peptic-ulcer. While these estimates are not sacro sanct as the methodologies for valuation of externalities are subject to further review and improvement, they however serve as initial indicators of spillovers. And they signal possibilities for consideration of policy makers for devising alternate institutions for potential payment towards environmental services.
Keywords	Externalities ; Environmental services ; Sustainable development ; Resource /Energy Economics and Policy
Subject code	333
Language	English
Publishing country	us
Document type	Conference proceedings ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: VALUATION OF EXTERNALITIES IN WATER, FORESTS AND ENVIRONMENT FOR SUSTAINABLE DEVELOPMENT

Abstract: Conceptual development in the theory ofexternalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are socialcosts, accountability is crucial in increasing ... ...

Abstract	Conceptual development in the theory ofexternalities have opened up several policy options for their internalization including payment towards environmental services. Hence as externalities are socialcosts, accountability is crucial in increasing environmental awareness and for collective action through education and extension more so in developingcountries. Here a modest attempt has been made to estimate externalities in water, forests and environment with field data from peninsular India to reflect on theeconomic perception of externalities by farmers and users of environment for the consideration of policy makers to devise institutions for payment towardsenvironmental services. The methodology largely used here in estimation /valuation of externalities is by considering ‘with – without’ situations (including ‘before – after’ in somecases) akin to ‘project valuation’. Studies cover empirical estimation of externalities inter alia due to over extraction of groundwater , sand mining, watersheddevelopment, conservation of forests, sacred groves, cultivation of organic coffee, use of medicinal plants asalternate medicines and the annual values presented are in 2008 prices.The negative externality due to sand mining 24 € per acre, that due to distillery effluent pollution is 34 € peracre. The positive externality due to watershed program is around 51 € per acre, and that due to rehabilitation ofirrigation tanks is 26 € per acre. The positive externality due to cultivation of shade coffee is 9 € per acre and that due to forest conservation 27 € per acre.The positive externality due to sacred groveconservation was 12 € per family. The impact of forest conservation on Non timber forest products was 88 € / per tribal household. The positive externality due to use of medicinal plants as alternate medicine is equal to 35 € per patient suffering from osteo-arthritis and 19 € perpatient suffering from peptic-ulcer.While these estimates are not sacro sanct as the methodologies for valuation of externalities are subject to further review and improvement, they however serveas initial indicators of spillovers. And they signal possibilities for consideration of policy makers for devising alternate institutions for potential paymenttowards environmental services.
Language	English
Document type	Article
Database	AGRIS - International Information System for the Agricultural Sciences and Technology

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