Madhu Latha - Academia.edu (original) (raw)

Papers by Madhu Latha

Research paper thumbnail of Parsonage-Turner Syndrome Following Covishield (AstraZeneca ChAdOx1 nCoV-19) Vaccination: A Case Report

Research paper thumbnail of Effect of Short Term High Dose Oral Vitamin D Therapy on the Inflammatory Markers in Patients with COVID 19 Disease

Archives of Clinical and Biomedical Research

Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodu... more Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodulator. This study aims to objectively investigate the effect of short term high dose vitamin D therapy in reducing the inflammatory markers of COVID-19. Materials and Methods: Consented COVID-19 patients with hypovitaminosis D were evaluated for inflammatory markers (N/L ratio, CRP, LDH, IL6, Ferritin) along with vitamin D on 0 th day and 9 th / 11 th day as per their respective BMI category. Subjects were allotted to VD and NVD groups. VD group received Pulse D therapy (a short term high dose supplementation of 60,000 IUs of vitamin D for 8 or 10 days depending upon their BMI) in addition to the standard treatment. NVD group received standard treatment alone. Differences in the variables between the two groups were analysed for statistical significance. Results: Eighty seven out of one hundred and thirty subjects have completed the study (VD:44, NVD:43). Vitamin D level has increased from 15 ng/ml to 81 ng/ml in VD group and highly significant (p<0.01) reduction of all the measured inflammatory markers was noted. Reduction of markers in NVD group was insignificant (p>0.05). The difference in the reduction of markers between the groups (NVD vs VD) was highly significant (p<0.01). Conclusions: Therapeutic improvement in vitamin D to 80-100 ng/ml has significantly reduced the inflammatory markers associated with COVID-19 without any side effects. Hence, adjunctive short term high dose vitamin D therapy can be added safely to the existing treatment protocols of COVID-19 for improved outcomes.

Research paper thumbnail of Association of Cord Blood Glucose, Sodium, Potassium, and Calcium Levels With Neonatal Birth Asphyxia: A Hospital-Based Study

Cureus

Neonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to va... more Neonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to various tissues of the body especially the brain. Hypoxia can cause metabolic disturbances, which in turn can lead to imbalances in the levels of glucose, electrolytes, and calcium, which can further worsen the condition. Early detection of these biochemical derangements and immediate correction can prevent the complications and lifelong disabilities of birth asphyxia due to injury to vital organs particularly the brain. The aim is to assess any correlation between the cord blood glucose, electrolytes, and calcium levels and the severity of birth asphyxia. Methods and material In this study, 50 birth asphyxia neonates with birth weight >2.5 kg, and a 5-minute Apgar score ≤ 6 at birth with clinical evidence of asphyxia were compared with healthy neonates with birth weight > 2.5 kg, and a 5minute Apgar score > 7. In all the cases and controls, cord blood glucose was estimated by glucose oxidase and peroxidase (GOD-POD) method, total calcium by Arsenazo method, and sodium and potassium were estimated by ion-selective Electrode (ISE) method using fully automated biochemistry analyzers. Results The mean cord blood concentrations of glucose, sodium, potassium, and calcium were significantly lower among birth asphyxia neonates in comparison with that of controls (p < 0.05). The correlation coefficient (r) for the study variables among cases indicates that there is a low to moderate positive correlation between the 5-minute Apgar score which is a measure of severity of birth asphyxia and cord blood concentrations of glucose, sodium, and calcium. Conclusion In our study, birth asphyxiated neonates were found to have statistically significant low levels of cord blood glucose and electrolytes like sodium and calcium except for potassium. There was a low to moderate positive correlation between cord blood glucose and electrolyte concentrations with the severity of birth asphyxia. Analysis of cord blood for these simple biochemical tests can help pediatricians in the active management of birth asphyxia cases.

Research paper thumbnail of Hypovitaminosis D in patients with osteoporotic hip fractures

Journal of Clinical Orthopaedics and Trauma, 2019

Background: Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, ... more Background: Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, increased bone turnover, bone loss and increased fracture risk. Vitamin D is well recognized to be suboptimal in older patients when compared to age-matched controls. There are no published studies on the prevalence of hypovitaminosis D in Indian population with fragility fractures around the hip associated with osteoporosis and comminution at the fracture site. Aim: To investigate the prevalence of hypovitaminosis D in patients admitted with osteoporotic hip fractures and associated fracture site comminution in a South Indian Institute. Material & Methods: A prospective cross sectional study was conducted on 100 patients admitted with osteoporotic hip fracture. Measurement of serum 25-hydroxy vitamin D was done and the same was correlated with the degree of osteoporosis using Singh's index and fracture site comminution. Results: Out of 100 patients studied, 92% had hypovitaminosis D with mean vitamin D level of 16.08 AE 5.95 ng/dl (65% vitamin D deficiency with mean 13.16 AE 4.24 ng/dl and 27% vitamin D insufficiency with mean 23.11 AE 2.62 ng/dl) and 94% had osteoporosis with Singh's index grade 3 or less. Out of the 36 patients with fracture site comminution 34 patients (94%) had hypovitaminosis D and 33 patients (91.6%) had osteoporosis. Statistical significance was established for all the variables. Conclusion: Significant association was found between hypovitaminosis D, osteoporosis and fracture site comminution. High prevalence of hypovitaminosis D in patients presenting with hip fractures and fracture site comminution implicates the necessity for proper evaluation and effective supplementation of vitamin D in elderly patients along with anti-osteoporotic regimens for effective prevention and appropriate management of osteoporotic hip fractures.

Research paper thumbnail of Efficiency of vitamin D supplementation in patients with mechanical low back ache

Journal of Clinical Orthopaedics and Trauma, 2019

Background: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mecha... more Background: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). Aim: This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market. Materials & methods: Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. Results: High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, indoor and outdoor , smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. Conclusion: Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.

Research paper thumbnail of Impact of Pulse D Therapy on The Inflammatory Markers in Patients With COVID-19

Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodu... more Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodulator. This study aims to objectively investigate the impact of Pulse D therapy in reducing the inflammatory markers of COVID-19. Materials/ Methods: Consented COVID-19 patients with hypovitaminosis D were evaluated for inflammatory markers (N/L ratio, CRP, LDH, IL6, Ferritin) along with vitamin D on 0th day and 9th / 11th day as per their respective BMI category. Subjects were randomised into VD and NVD groups. VD group received Pulse D therapy (targeted daily supplementation of 60,000 IUs of vitamin D for 8 or 10 days depending upon their BMI) in addition to the standard treatment. NVD group received standard treatment alone. Differences in the variables between the two groups were analysed for statistical significance. Results: Eighty seven out of one hundred and thirty subjects have completed the study (VD:44, NVD:43). Vitamin D level has increased from 15.65 ± 5.54 ng/ml to 88.96 ± ...

Research paper thumbnail of Pre and Post Dialysis Variations in Serum Lipid Profile among End Stage Renal Disease Patients

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

Introduction: Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die f... more Introduction: Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die from Cardiovascular Disease (CVD) rather than End Stage Renal Disease (ESRD). Dyslipidaemia is a major contributor of CVD in these patients. The exact effect of Renal Dialysis (RD) on lipid parameters in ESRD is not clearly elucidated. Aim: To assess the variations in serum lipid profile and study the pattern of lipoproteins by agarose gel electrophoresis before and after RD. Materials and Methods: In this case-control study, 30 ESRD patients (15 male and 15 female) receiving maintenance renal dialysis were taken as cases and 30 age and sex matched healthy individuals were recruited as controls. Lipid profile parameters were estimated in Siemens automated analyser. Lipoprotein electrophoresis was done on Sebia Semi automated analyser. The data were analysed using GraphPad prism. Student's t-test for normally distributed data, Mann-Whitney U test for nonnormally distributed data and ANOVA for comparison of more than two groups was done. A p-value <0.05 was considered statistically significant. Results: In ESRD cases there was a significant increase (p <0.001) in Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C) after RD compared to the values before RD (151.4±38.92 versus 183±57.18 mg/dL; 75.3±24.66 mg/dL versus 84.23±29.74; 31.9±9.74 mg/dL versus 35.57±12.49 mg/dL); respectively. Triglycerides (TG) and Very Low Density Lipoprotein (VLDL) values decreased after RD compared to the values before RD (123.6±50 versus 121.4±49.26; 24.73±10 versus 24.29±9.85); (p>0.05). Fractionation of lipoproteins reveals a significant increase in lipoprotein a {Lp(a)} as compared to controls (21.20±17.46 versus 12.38±10.63, p<0.05). The values of alpha and beta lipoproteins in electrophoresis didn't correlate well with the values obtained from automated enzymatic lipoprotein measurements in ESRD cases after dialysis (r=0.22, p=0.18). Conclusion: There is a remarkable increase in atherosclerotic risk after RD noted due to significant increase in TC, LDL-C and Lp(a) which might increase the risk of CVD in RD subjects.

Research paper thumbnail of Parsonage-Turner Syndrome Following Covishield (AstraZeneca ChAdOx1 nCoV-19) Vaccination: A Case Report

Research paper thumbnail of Effect of Short Term High Dose Oral Vitamin D Therapy on the Inflammatory Markers in Patients with COVID 19 Disease

Archives of Clinical and Biomedical Research

Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodu... more Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodulator. This study aims to objectively investigate the effect of short term high dose vitamin D therapy in reducing the inflammatory markers of COVID-19. Materials and Methods: Consented COVID-19 patients with hypovitaminosis D were evaluated for inflammatory markers (N/L ratio, CRP, LDH, IL6, Ferritin) along with vitamin D on 0 th day and 9 th / 11 th day as per their respective BMI category. Subjects were allotted to VD and NVD groups. VD group received Pulse D therapy (a short term high dose supplementation of 60,000 IUs of vitamin D for 8 or 10 days depending upon their BMI) in addition to the standard treatment. NVD group received standard treatment alone. Differences in the variables between the two groups were analysed for statistical significance. Results: Eighty seven out of one hundred and thirty subjects have completed the study (VD:44, NVD:43). Vitamin D level has increased from 15 ng/ml to 81 ng/ml in VD group and highly significant (p&lt;0.01) reduction of all the measured inflammatory markers was noted. Reduction of markers in NVD group was insignificant (p&gt;0.05). The difference in the reduction of markers between the groups (NVD vs VD) was highly significant (p&lt;0.01). Conclusions: Therapeutic improvement in vitamin D to 80-100 ng/ml has significantly reduced the inflammatory markers associated with COVID-19 without any side effects. Hence, adjunctive short term high dose vitamin D therapy can be added safely to the existing treatment protocols of COVID-19 for improved outcomes.

Research paper thumbnail of Association of Cord Blood Glucose, Sodium, Potassium, and Calcium Levels With Neonatal Birth Asphyxia: A Hospital-Based Study

Cureus

Neonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to va... more Neonatal birth/perinatal asphyxia is a serious condition with the potential to cause damage to various tissues of the body especially the brain. Hypoxia can cause metabolic disturbances, which in turn can lead to imbalances in the levels of glucose, electrolytes, and calcium, which can further worsen the condition. Early detection of these biochemical derangements and immediate correction can prevent the complications and lifelong disabilities of birth asphyxia due to injury to vital organs particularly the brain. The aim is to assess any correlation between the cord blood glucose, electrolytes, and calcium levels and the severity of birth asphyxia. Methods and material In this study, 50 birth asphyxia neonates with birth weight >2.5 kg, and a 5-minute Apgar score ≤ 6 at birth with clinical evidence of asphyxia were compared with healthy neonates with birth weight > 2.5 kg, and a 5minute Apgar score > 7. In all the cases and controls, cord blood glucose was estimated by glucose oxidase and peroxidase (GOD-POD) method, total calcium by Arsenazo method, and sodium and potassium were estimated by ion-selective Electrode (ISE) method using fully automated biochemistry analyzers. Results The mean cord blood concentrations of glucose, sodium, potassium, and calcium were significantly lower among birth asphyxia neonates in comparison with that of controls (p < 0.05). The correlation coefficient (r) for the study variables among cases indicates that there is a low to moderate positive correlation between the 5-minute Apgar score which is a measure of severity of birth asphyxia and cord blood concentrations of glucose, sodium, and calcium. Conclusion In our study, birth asphyxiated neonates were found to have statistically significant low levels of cord blood glucose and electrolytes like sodium and calcium except for potassium. There was a low to moderate positive correlation between cord blood glucose and electrolyte concentrations with the severity of birth asphyxia. Analysis of cord blood for these simple biochemical tests can help pediatricians in the active management of birth asphyxia cases.

Research paper thumbnail of Hypovitaminosis D in patients with osteoporotic hip fractures

Journal of Clinical Orthopaedics and Trauma, 2019

Background: Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, ... more Background: Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, increased bone turnover, bone loss and increased fracture risk. Vitamin D is well recognized to be suboptimal in older patients when compared to age-matched controls. There are no published studies on the prevalence of hypovitaminosis D in Indian population with fragility fractures around the hip associated with osteoporosis and comminution at the fracture site. Aim: To investigate the prevalence of hypovitaminosis D in patients admitted with osteoporotic hip fractures and associated fracture site comminution in a South Indian Institute. Material & Methods: A prospective cross sectional study was conducted on 100 patients admitted with osteoporotic hip fracture. Measurement of serum 25-hydroxy vitamin D was done and the same was correlated with the degree of osteoporosis using Singh's index and fracture site comminution. Results: Out of 100 patients studied, 92% had hypovitaminosis D with mean vitamin D level of 16.08 AE 5.95 ng/dl (65% vitamin D deficiency with mean 13.16 AE 4.24 ng/dl and 27% vitamin D insufficiency with mean 23.11 AE 2.62 ng/dl) and 94% had osteoporosis with Singh's index grade 3 or less. Out of the 36 patients with fracture site comminution 34 patients (94%) had hypovitaminosis D and 33 patients (91.6%) had osteoporosis. Statistical significance was established for all the variables. Conclusion: Significant association was found between hypovitaminosis D, osteoporosis and fracture site comminution. High prevalence of hypovitaminosis D in patients presenting with hip fractures and fracture site comminution implicates the necessity for proper evaluation and effective supplementation of vitamin D in elderly patients along with anti-osteoporotic regimens for effective prevention and appropriate management of osteoporotic hip fractures.

Research paper thumbnail of Efficiency of vitamin D supplementation in patients with mechanical low back ache

Journal of Clinical Orthopaedics and Trauma, 2019

Background: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mecha... more Background: Preliminary evidence suggests an association of hypovitaminosis D (hypo.D) with mechanical Low back ache (mLBA). Aim: This study was designed to 1. Explore the relationship of hypovitaminosis D with mLBA in the absence of other confounding factors 2. Formulate and validate an appropriate treatment protocol and 3. Explore the differences in outcomes with various oral formulations of vitamin D available in Indian market. Materials & methods: Three randomised groups of patients with mLBA and hypo.D between 18 and 45 years of age without any co morbid conditions were studied for the effectiveness of adjunctive vit.D supplementation of 6,00,000 IUs (60,000 IUs/day for ten consecutive days) in the form of granule or nano syrup or soft gel capsule for the treatment of mLBA. Review evaluation of pain, functional disability and vit.D was done at three weeks and an additional evaluation of vit.D was done at nine months. Evaluation with 3,00,000 IUs of vit.D (60,000 IUs/day for five consecutive days) was done with nano syrup in a different cohort. Results: High prevalence of hypo.D (96%) was noted in patients with mLBA. Significant improvement was noted after supplementation of vit.D. The subjects of nano syrup group have shown significantly better improvement compared to others (P < 0.000). Non obese and chronic patients have shown significantly better results than their peers. Though there was significant difference in vit.D before treatment, the difference of improvement between the genders, deficiency and insufficiency, indoor and outdoor , smokers and non smoker subgroups was not significant. Seasonal variation in vit.D before and after the treatment was significant. Conclusion: Hypovitaminosis D can be a potential causative factor for mLBA in addition to the other known causes. Proper evaluation and adjunctive vit.D supplementation can effectively break the vicious cycle of low back ache with significant improvement in serum vit.D level, effective relief of pain and significant functional improvement without any adverse effects. Improvement in vit.D was not significantly related to its initial status and obese individuals have shown significantly lesser improvement. The results with nano syrup formulation were significantly better compared to others. Formulation based dosage adjustments assume significance in view of these results.

Research paper thumbnail of Impact of Pulse D Therapy on The Inflammatory Markers in Patients With COVID-19

Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodu... more Introduction: COVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodulator. This study aims to objectively investigate the impact of Pulse D therapy in reducing the inflammatory markers of COVID-19. Materials/ Methods: Consented COVID-19 patients with hypovitaminosis D were evaluated for inflammatory markers (N/L ratio, CRP, LDH, IL6, Ferritin) along with vitamin D on 0th day and 9th / 11th day as per their respective BMI category. Subjects were randomised into VD and NVD groups. VD group received Pulse D therapy (targeted daily supplementation of 60,000 IUs of vitamin D for 8 or 10 days depending upon their BMI) in addition to the standard treatment. NVD group received standard treatment alone. Differences in the variables between the two groups were analysed for statistical significance. Results: Eighty seven out of one hundred and thirty subjects have completed the study (VD:44, NVD:43). Vitamin D level has increased from 15.65 ± 5.54 ng/ml to 88.96 ± ...

Research paper thumbnail of Pre and Post Dialysis Variations in Serum Lipid Profile among End Stage Renal Disease Patients

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018

Introduction: Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die f... more Introduction: Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die from Cardiovascular Disease (CVD) rather than End Stage Renal Disease (ESRD). Dyslipidaemia is a major contributor of CVD in these patients. The exact effect of Renal Dialysis (RD) on lipid parameters in ESRD is not clearly elucidated. Aim: To assess the variations in serum lipid profile and study the pattern of lipoproteins by agarose gel electrophoresis before and after RD. Materials and Methods: In this case-control study, 30 ESRD patients (15 male and 15 female) receiving maintenance renal dialysis were taken as cases and 30 age and sex matched healthy individuals were recruited as controls. Lipid profile parameters were estimated in Siemens automated analyser. Lipoprotein electrophoresis was done on Sebia Semi automated analyser. The data were analysed using GraphPad prism. Student's t-test for normally distributed data, Mann-Whitney U test for nonnormally distributed data and ANOVA for comparison of more than two groups was done. A p-value <0.05 was considered statistically significant. Results: In ESRD cases there was a significant increase (p <0.001) in Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C) after RD compared to the values before RD (151.4±38.92 versus 183±57.18 mg/dL; 75.3±24.66 mg/dL versus 84.23±29.74; 31.9±9.74 mg/dL versus 35.57±12.49 mg/dL); respectively. Triglycerides (TG) and Very Low Density Lipoprotein (VLDL) values decreased after RD compared to the values before RD (123.6±50 versus 121.4±49.26; 24.73±10 versus 24.29±9.85); (p>0.05). Fractionation of lipoproteins reveals a significant increase in lipoprotein a {Lp(a)} as compared to controls (21.20±17.46 versus 12.38±10.63, p<0.05). The values of alpha and beta lipoproteins in electrophoresis didn't correlate well with the values obtained from automated enzymatic lipoprotein measurements in ESRD cases after dialysis (r=0.22, p=0.18). Conclusion: There is a remarkable increase in atherosclerotic risk after RD noted due to significant increase in TC, LDL-C and Lp(a) which might increase the risk of CVD in RD subjects.