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Papers by Arjun Balasubramanian

Journal of clinical and diagnostic research : JCDR, 2014

Torsion of the adnexa is a rare condition which can be potentially lethal for the women. The clin... more Torsion of the adnexa is a rare condition which can be potentially lethal for the women. The clinical presentation can be varied and can be seen in any age group. Understanding the clinical and pathological profile of patients suffering from adenexal torsion can guide the clinicians in diagnosing and managing the condition. To analyze the clinical and pathological profile of adnexal torsion cases in a tertiary care teaching hospital. The study was a retrospective analysis of hospital records. It included all cases of adnexal torsion that underwent laprotomy between January 2007 to December 2012 in a tertiary care teaching hospital. The study was approved by the Institute's human Ethics Committee. A total of 18 patients were included in the study. Majority (66.7%) of participants were in the reproductive age group. Abdominal pain was the most common symptom seen in 77.8% of patients. The other symptoms were abdominal distension, back ache and dysuria. Majority of the women belong...

A STUDY ON PERCEIVED STRESS AND COPING MECHANISMS AMONG STUDENTS OF A MEDICAL SCHOOL IN SOUTH INDIA, Dec 5, 2016

Journal of Family Medicine and Primary Care, 2018

Introduction: Poor adherence is an important barrier to adequate blood pressure control among the... more Introduction: Poor adherence is an important barrier to adequate blood pressure control among the diagnosed hypertensives. The study aimed at assessing the level of adherence to medication and to identify factors associated with it in people with hypertension in a rural population of Kerala. Subjects and Methods: A community-based cross-sectional study was conducted in July 2016 among 189 known hypertensives of a rural population in Kerala. Data was collected by interview method using a semistructured questionnaire. Medication adherence was assessed using 4-item Morisky Medication Adherence Scale. Chi-square was used to test the significance of association, and logistic regression was done to identify independent predictors along with odds ratio (OR). Result: The mean age of study participants was 65.12 ± 11.71 years and the mean duration of disease was 8.69 ± 7.99 years. High adherence was seen in 46% of the patients, while medium and low adherence was seen in 41.3% and 12.7%, respectively. Risk factors of poor adherence identified were poor knowledge of the complications (OR-2.120; 95% confidence interval [CI] 1.110-4.048), availing government pharmacy (OR-2.379; 95% CI 1.131-5.004), and being asymptomatic at the time of diagnosis (OR-2.120; 95% CI 1.110-4.048). Conclusion: Adherence to medication among people with hypertension in the current study is poor. A comprehensive strategy to improve adherence to antihypertensive medications is the need of the hour.

International Journal Of Community Medicine And Public Health, 2021

Background: Hypertension is leading risk factor for cardiovascular diseases and stroke, and leads... more Background: Hypertension is leading risk factor for cardiovascular diseases and stroke, and leads to 12.8% of all deaths in the world. Uncontrolled hypertension doubles the risk of cardiovascular disease among the adults with hypertension. Globally 65% of the treated hypertensive have uncontrolled hypertension and in Kerala about three forth of the treated hypertensive have poor blood pressure control. The burden of uncontrolled hypertension is suggestive of preventable deaths and cardiovascular events.Methods: A cross-sectional study was conducted among 1210 residents of Kochi Corporation of Kerala aged 18 years and above during the period of Sept. 2014 to Sept. 2016. Pre-tested, semi-structured questionnaire was used to collect data on socio-demographic factors such as age, sex, occupation, socio-economic status, education and marital status. Behavioural factors such smoking, alcohol intake, physical activity and dietary factors were collected. Data was analysed by using statistic...

Journal of Evidence Based Medicine and Healthcare, 2018

Wolfram syndrome, named after the physician D J Wolfram is a rare inherited neurodegenerative dis... more Wolfram syndrome, named after the physician D J Wolfram is a rare inherited neurodegenerative disorder. It is characterised by diabetes insipidus, juvenile-onset insulin dependent diabetes mellitus, optic atrophy, and deafness, and hence is also known as DIDMOAD syndrome. 1 Prevalence rates among the general population vary from 1 in 100,000 in North America to 1 in 770,000 in UK. 2,3 The syndrome is caused by a defect in wolframin protein, a 100 kDa transmembrane protein localizing in the Endoplasmic Reticulum encoded by the WFS1 gene located in Chromosome 4p16.1. The protein is involved in the regulation of ER stress and calcium homeostasis and is found in abundance in pancreas, brain, heart and muscle. 2 Two modes of inheritance of Wolfram syndrome have been documented, Autosomal recessive and Mitochondrial. 4 The natural history of Wolfram syndrome begins with Diabetes mellitus at a median age of 6 years and progressive optic atrophy at a median age of 11 years, followed by central diabetes insipidus and sensorineural deafness in the second decade, dilated renal outflow tracts early in the third decade and multiple neurological abnormalities early in the fourth decade of life. Diabetes mellitus and optic atrophy are reported in all cases, but the expression of other features of the syndrome are variable. 5,6 Wolfram syndrome patients rarely present with ketoacidosis as they usually maintain a significant level of C-peptide in the blood. Here we report one such rare case. A 23-year-old male presented to the emergency room with complaints of pain abdomen and altered sensorium. He had no history of fever, headache, vomiting, convulsions or trauma. His past history revealed that he had been on treatment from alternate system of medicine for complaints of polyuria and polydipsia for the past nine years. He has also had progressive loss of vision for 4 years due to which his schooling was discontinued. He denied any history of deafness. Born to parents from a non-consanguineous marriage, he attained his developmental milestones as per age with normal secondary sexual characteristics.

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

Introduction: Regular monitoring of blood pressure in chronic hypertensive patients on antihypert... more Introduction: Regular monitoring of blood pressure in chronic hypertensive patients on antihypertensive therapy is essential to assess cardiovascular events and to prevant target organ damage. Aim: The present study was undertaken as an attempt to correlate the relation between random blood pressure monitoring and 24 hour Ambulatory blood pressure monitoring in chronic hypertensive patients on therapy and to assess the efficacy of antihypertensive medication in chronic hypertensive patients. Materials and Methods: The study was undertaken as a prospective cross-sectional study among 100 patients during the period of June 2015 to June 2016 using convenient sampling technique. As per Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High blood Pressure (JNC 7) guidelines, cases of diagnosed hypertension on regular medication and on follow-up in the outpatient department of General Medicine in a tertiary care hospital were included in the study. Blood pressure was recorded using a mercury sphygmomanometer or aneroid or electronic device as per JNC guidelines. After that Ambulatory Blood Pressure Monitoring (ABPM) device was attached on a belt connected to a standard cuff in the upper arm which uses an oscillometry technique to detect systolic, diastolic and Mean Arterial Blood Pressure (MAP). Descriptive statistics was expressed by means and proportions. Paired t-test was used to find statistically significant difference in related sample observations. A p-value <0.05 was considered statistically significant. Results: Majority of the study participants were males and were in the age group of 31-40 years. There was a significant difference between random (clinic) blood pressure and ambulatory blood pressure recordings. It was observed that 36 patients (36%) were dippers, 54 patients (54%) were nondippers, 10 patients (10%) were reverse dippers independent of clinical blood pressure readings. Conclusion: Ambulatory blood pressure monitoring gives a true estimate of 24 hour readings rather than a single clinic blood pressure which can be influenced by so many factors. It also gives an estimate of other variables like morning surge and nocturnal dip.

Journal of Evidence Based Medicine and Healthcare, 2016

BACKGROUND The medical course has been identified as being stressful owing to the demands posed b... more BACKGROUND The medical course has been identified as being stressful owing to the demands posed by the curriculum, frequent examinations, length of the course, heavy workload and financial concerns. People have a characteristic way of coping with stress based on their personality and they choose appropriate strategies to cope with stressors they confront. AIM, SETTING & DESIGN To understand the perceived stress and coping mechanism used by the medical students of a private medical college in south India. Also, to determine the association between different socio-demographic factors and perceived stress levels. MATERIALS AND METHODS A cross-sectional study was carried out in a private medical college situated in Kerala. After obtaining informed consent, medical students belonging to the first, third, fifth and seventh semesters were selected randomly by lottery technique. A self-administered questionnaire proposed by John D and Catharine T MacArthur foundation and "Brief COPE" was used to assess the perceived stress levels and coping mechanisms respectively. STATISTICAL ANALYSIS The data collected was tabulated using MS Excel and analysed using SPSS 20.0. RESULTS AND CONCLUSION It was observed that nearly one third of the medical students were either moderately stressed (14.1%) or suffered from severe stress (15.5%). "Acceptance" was the method that was used a lot by the students. Students were then using active coping, instrumental support, positive reframing and planning as methods in medium amount. Self-distraction, self-blame, religion, use of emotional support, venting and substance use were some of the coping mechanisms that were used a little bit. Some of the coping mechanisms that were least used by students were humour, denial and behavioural disengagement. Therefore, peer counselling through students and faculty may be made accessible to all medical students in order to help them to cope with stress.

Journal of Global Infectious Diseases, 2014

The HAV is transmitted through ingestion of contaminated food and water or through direct contact... more The HAV is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person. [2-5] The virus is shed in the feces of persons with both asymptomatic and symptomatic infection. Under favorable conditions HAV may survive in the environment for months. [2,5] Presentation of disease is determined by the age of exposure, which tends to be asymptomatic or subclinical during childhood and symptomatic usually among adults. It has been reported that 70% of children <6 years of age are asymptomatically infected or develop a mild self-limiting illness. [5,6] Viral hepatitis continues to be a major public health problem in India. Several large outbreaks of hepatitis A in various parts of the country have been recorded in the past decade. [7-10] Most hepatitis A outbreaks were due to fecal-oral route of transmission because of contamination of water with sewage. On March 17, 2013, health workers reported to District Surveillance Unit, an unusual occurrence of 20 cases of Background: There was an outbreak of acute hepatitis in Mylapore village, Kollam district, Kerala, southern India during February to June 2013. An outbreak investigation was initiated with the objective of describing the epidemiological features of the hepatitis outbreak. Materials and Methods: House-to-house visits were undertaken to identify symptomatic cases. The outbreak was described in terms of person, place and time. Hypothesis was generated based on fi ndings from descriptive study, laboratory investigation of water samples, and environmental observations. A case-control study was designed to test the hypothesis. Chi-square test, univariate analysis, and logistic regression to identify the risk factors associated with hepatitis A infection were done. Results: Line list generated consisted of 45 cases. Attack rate was the highest among the age group 15-24 years (4.6%) followed by 5-14 years (3.1%). The geographical distribution of the cases suggested a clustering around the water supply through the pipeline and epidemic curve showed a sharp rise in cases suggestive of a common source outbreak. Water samples collected form pipeline showed evidence of fecal contamination and absence of residual chlorine. In the case-control study, having consumed water from the pipeline (odds ratio: 9.01 [95% confi dence interval: 2.16-37.61]) was associated with the hepatitis A cases. Conclusion: The time frame of disease occurrence, environmental observations, anecdotal evidences, laboratory results and results of the analytical study indicated the possibility of occurrence of hepatitis A outbreak as a result of pipe water contamination supplied from a bore well. The study warrants establishment of an effi cient water quality surveillance system.