Parvaiz koul - Academia.edu (original) (raw)
Papers by Parvaiz koul
Lancet (London, England), Jan 8, 2016
Improving survival and extending the longevity of life for all populations requires timely, robus... more Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...
Lancet (London, England), Oct 8, 2016
In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...
Journal of Postgraduate Medicine
ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/... more ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/100,000 per year for men and 1.2-6/100,000 per year for women. [1] About 11% of spontaneous pneumothorax patients have a positive family history, and the various heritable causes include Marfan syndrome, Ehlers-Danlos syndrome More Details, α1-antitrypsin deficiency, lymphangioleiomyomatosis, Langerhan's cell hisiocytosis, cystic light chain disease, and cystic fibrosis. [2] Birt-Hogg-Dubé syndrome (BHDS) is a genodermatosis that, in addition to the dermatological manifestations, is characterized by predisposition to lung cysts and renal neoplasms. [3],[4] The cutaneous manifestations include fibrofolicullomas, trichodiscomas, and achrodons, [3],[4] whereas the renal neoplasms include renal oncocytoma, chromophobe renal cell carcinoma, oncocytic hybrid tumor, and clear cell renal cell carcinoma. While renal cell carcinoma is the most common and feared neoplasm reported in association with BHDS, non-renal tumors have been reported as well. Even as the primary focus of care in BHDS is the management of renal tumors, pulmonary manifestations are among the most common manifestations. Cystic lung disease is seen in up to 90% of patients with BHDS, whereas spontaneous pneumothorax occurs in about 38%, [5] with a family history of pneumothorax in about 35%. [6] The syndrome typically exhibits clinical heterogeneity and the patients do not always have the three characteristic phenotypes (that of skin, kidney, and lung involvement). Lung disease (both cysts as well as pneumothoraces) may exist without the cutaneous manifestations, [7] and may be the earliest involvement. On radiological imaging, the cysts generally are elliptical or lentiform in shape with basilar and peripheral predominance and have a perivascular and periseptal localization. [6] As against cysts in other pulmonary conditions, cysts in BHDS are located in the middle and lower lobes toward the mediastinum and have an intimate association with interlobular septa and/or visceral pleura. These characteristic computed tomographic (CT) imaging features help clinicians differentiate the cysts from other cystic lung diseases. [8] Histopathologically, these cysts lack subpleural fibroelastic scars and changes of smoking, whereas cysts associated with pneumothorax in other pulmonary conditions show changes of respiratory bronchiolitis and fibroelastic scars. [9] Recently, it has been demonstrated that in BHDS, the cyst wall expands toward visceral pleura and gets incorporated partially into the interlobular septum, parenchyma, and/or bronchovascular bundle. [10] The cysts are lined on the inside by alveolar cells which may at times be attenuated and on occasion interspersed with cuboidal cells resembling type II pneumocytes. [10] The structural architecture of the cysts, however, gets distorted in pneumothorax-associated cysts. [10] BHDS is caused by heterozygous mutations in the folliculin (FLCN) gene that is located on the short arm of chromosome 17 (17p 11.2). Folliculin is a 579-amino acid protein that is expressed in skin, skin appendages, stromal cells, the distal nephron, and pneumocytes. [5] It has 14 exons, and even as its exact molecular functions are unknown, it is believed to be a conserved tumor suppressor gene. [11] More than 100 germline mutations have been reported in the FLCN gene. They are seen in around 88% of cases of BHDS and include splice, deletions, insertions, nonsense, deletion/insertion, and missense mutations. [5] Geographic variation has been noted in these mutations. Whereas a cytosine duplication or deletion in the C8 tract of exon 11 is known to be a hotspot in Western patients, c.1347_1353dupCCACCCT in exon 12 and c.1533_1536delGATG in exon 13 are the hotspots in Asian kindreds. [12],[13] Specific germline mutations or mutation types have not been associated with distinct phenotypic expression in BHDS due to the sheer lack of numbers to record such associations. [5] In this issue of the journal, a Taiwanese kindred with mutation c.1579_1580insA in exon 14 has been presented and the authors conclude that this mutation is associated with predominant lung involvement in BHDS without any renal involvement. Sequence analysis of select exons has shown that 53% of the families with BHDS had deletion or duplication of a C-nucleotide in the polycytosine tract in exon 11, which is a mutational hotspot, [5] with c.1733insC or c.1733delC being the most common BHDS mutation reported to date. [14],[15],[16],[17],[18],[19],[20],[21],[22] In a recent review of about 89 families, the most common 5' BHDS mutation was reported to have occurred at nucleotide 454 (c. 458delG) in exon 4 affecting the initiator codon of FLCN, [22] whereas the most common 3' mutation was reported to have occurred at nucleotide 2034 (c.2034 C>T) in exon 14. [5] The c.1579_1580insA reported by the authors in exon 14 is unique in being the only insertion…
European Journal of Internal Medicine, 2018
Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP),... more Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP. Methods: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors. Results: 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%. Conclusion: In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.
The European respiratory journal, Jan 5, 2018
is a challenging bacterium to treat due to its intrinsic antibiotic resistance to the most freque... more is a challenging bacterium to treat due to its intrinsic antibiotic resistance to the most frequently used antibiotics in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with -CAP are limited. We assessed the multinational burden and specific risk factors associated with CAP.We enrolled 3,193 patients in 54 countries with confirmed diagnosis of CAP that underwent microbiological testing at admission. Prevalence was calculated according to the identification of Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant CAP.The prevalence of and antibiotic-resistant CAP was 4.2% and 2.0%, respectively. The rate of CAP in patients with prior infection/colonisation due to and at least one of the three independently associated chronic lung diseases [ tracheostomy, bronchiectasis and/or very severe COPD]) was 67%. In contrast, the rate of CAP was 2% in patients without prior ...
The Lancet. Infectious diseases, 2016
Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant... more Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia. We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analy...
Clinical Infectious Diseases, 2018
Background The correct management of immunocompromised patients with pneumonia is debated. We eva... more Background The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CA...
Journal of Association of Physicians of India, 1995
... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Bar... more ... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Barre Syndrome related weakness in a case of periodic paralysis. Journal of the Association of Physicians of India. 1995 May; 43(5): 373. Language: eng. ...
Journal of Association of Physicians of India, 1993
Widal reaction was studied in 52 patients having malaria parasites in the peripheral blood smear.... more Widal reaction was studied in 52 patients having malaria parasites in the peripheral blood smear. Twenty had Plasmodium vivax, 26 had Plasmodium falciparum and the rest had mixed (both vivax and falciparum) infections. Widal test for both O and H antigens of Salmonella typhi was positive in high titres in 3 falciparum, 3 vivax and 2 cases of mixed infection. Of these 8 cases, one had been treated for typhoid fever 3 months back and again one month back for relapse. Blood culture for Salmonella typhi was negative in all. All were cured after antimalarial therapy. The positive Widal reaction may be false.
Indian Journal of Medical Research, 1997
The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50... more The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50 randomly selected Kashmiri Muslim patients with established rheumatic heart disease and compared with that of 50 controls of similar ethnicity. A significant increase in the frequency of HLA-DR4 (P < 0.005, RR 3.27) and a significant decrease in the frequency of HLA-B5 (P < 0.001, RR 0.19) were found in the patient group. Though HLA-DQ3 showed a significant increase (P < 0.005, RR 2.52) and HLA-DR7 a significant decrease (P < 0.05, RR 0.42) in the patient group, the corrected P value was not significant. The findings suggest that susceptibility to RHD in the studied population is HLA-related, with HLA-DR4 influencing its occurrence and HLA-B5 conferring protection against the same.
Journal of Association of Physicians of India, 1998
Journal of Association of Physicians of India, 2000
To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia ... more To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated dr...
Journal of Association of Physicians of India, 2000
A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash ... more A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.
Journal of Association of Physicians of India, 2000
Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate... more Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattress...
Journal of Association of Physicians of India, 1996
Journal of Association of Physicians of India, 2003
A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion... more A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion of the eyes. Clinically there was evidence of left auricular chondritis, nasal chondritis and conjunctivitis with a history of multiple similar episodes in the past, features suggestive of relapsing polychondritis. The patient improved with oral prednisolone.
Journal of postgraduate medicine, 2013
ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/... more ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/100,000 per year for men and 1.2-6/100,000 per year for women. [1] About 11% of spontaneous pneumothorax patients have a positive family history, and the various heritable causes include Marfan syndrome, Ehlers-Danlos syndrome More Details, α1-antitrypsin deficiency, lymphangioleiomyomatosis, Langerhan's cell hisiocytosis, cystic light chain disease, and cystic fibrosis. [2] Birt-Hogg-Dubé syndrome (BHDS) is a genodermatosis that, in addition to the dermatological manifestations, is characterized by predisposition to lung cysts and renal neoplasms. [3],[4] The cutaneous manifestations include fibrofolicullomas, trichodiscomas, and achrodons, [3],[4] whereas the renal neoplasms include renal oncocytoma, chromophobe renal cell carcinoma, oncocytic hybrid tumor, and clear cell renal cell carcinoma. While renal cell carcinoma is the most common and feared neoplasm reported in association with BHDS, non-renal tumors have been reported as well. Even as the primary focus of care in BHDS is the management of renal tumors, pulmonary manifestations are among the most common manifestations. Cystic lung disease is seen in up to 90% of patients with BHDS, whereas spontaneous pneumothorax occurs in about 38%, [5] with a family history of pneumothorax in about 35%. [6] The syndrome typically exhibits clinical heterogeneity and the patients do not always have the three characteristic phenotypes (that of skin, kidney, and lung involvement). Lung disease (both cysts as well as pneumothoraces) may exist without the cutaneous manifestations, [7] and may be the earliest involvement. On radiological imaging, the cysts generally are elliptical or lentiform in shape with basilar and peripheral predominance and have a perivascular and periseptal localization. [6] As against cysts in other pulmonary conditions, cysts in BHDS are located in the middle and lower lobes toward the mediastinum and have an intimate association with interlobular septa and/or visceral pleura. These characteristic computed tomographic (CT) imaging features help clinicians differentiate the cysts from other cystic lung diseases. [8] Histopathologically, these cysts lack subpleural fibroelastic scars and changes of smoking, whereas cysts associated with pneumothorax in other pulmonary conditions show changes of respiratory bronchiolitis and fibroelastic scars. [9] Recently, it has been demonstrated that in BHDS, the cyst wall expands toward visceral pleura and gets incorporated partially into the interlobular septum, parenchyma, and/or bronchovascular bundle. [10] The cysts are lined on the inside by alveolar cells which may at times be attenuated and on occasion interspersed with cuboidal cells resembling type II pneumocytes. [10] The structural architecture of the cysts, however, gets distorted in pneumothorax-associated cysts. [10] BHDS is caused by heterozygous mutations in the folliculin (FLCN) gene that is located on the short arm of chromosome 17 (17p 11.2). Folliculin is a 579-amino acid protein that is expressed in skin, skin appendages, stromal cells, the distal nephron, and pneumocytes. [5] It has 14 exons, and even as its exact molecular functions are unknown, it is believed to be a conserved tumor suppressor gene. [11] More than 100 germline mutations have been reported in the FLCN gene. They are seen in around 88% of cases of BHDS and include splice, deletions, insertions, nonsense, deletion/insertion, and missense mutations. [5] Geographic variation has been noted in these mutations. Whereas a cytosine duplication or deletion in the C8 tract of exon 11 is known to be a hotspot in Western patients, c.1347_1353dupCCACCCT in exon 12 and c.1533_1536delGATG in exon 13 are the hotspots in Asian kindreds. [12],[13] Specific germline mutations or mutation types have not been associated with distinct phenotypic expression in BHDS due to the sheer lack of numbers to record such associations. [5] In this issue of the journal, a Taiwanese kindred with mutation c.1579_1580insA in exon 14 has been presented and the authors conclude that this mutation is associated with predominant lung involvement in BHDS without any renal involvement. Sequence analysis of select exons has shown that 53% of the families with BHDS had deletion or duplication of a C-nucleotide in the polycytosine tract in exon 11, which is a mutational hotspot, [5] with c.1733insC or c.1733delC being the most common BHDS mutation reported to date. [14],[15],[16],[17],[18],[19],[20],[21],[22] In a recent review of about 89 families, the most common 5' BHDS mutation was reported to have occurred at nucleotide 454 (c. 458delG) in exon 4 affecting the initiator codon of FLCN, [22] whereas the most common 3' mutation was reported to have occurred at nucleotide 2034 (c.2034 C>T) in exon 14. [5] The c.1579_1580insA reported by the authors in exon 14 is unique in being the only insertion…
The Journal of the Association of Physicians of India, 1998
The Journal of the Association of Physicians of India, 1995
... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Bar... more ... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Barre Syndrome related weakness in a case of periodic paralysis. Journal of the Association of Physicians of India. 1995 May; 43(5): 373. Language: eng. ...
Lancet (London, England), Jan 8, 2016
Improving survival and extending the longevity of life for all populations requires timely, robus... more Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...
Lancet (London, England), Oct 8, 2016
In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...
Journal of Postgraduate Medicine
ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/... more ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/100,000 per year for men and 1.2-6/100,000 per year for women. [1] About 11% of spontaneous pneumothorax patients have a positive family history, and the various heritable causes include Marfan syndrome, Ehlers-Danlos syndrome More Details, α1-antitrypsin deficiency, lymphangioleiomyomatosis, Langerhan's cell hisiocytosis, cystic light chain disease, and cystic fibrosis. [2] Birt-Hogg-Dubé syndrome (BHDS) is a genodermatosis that, in addition to the dermatological manifestations, is characterized by predisposition to lung cysts and renal neoplasms. [3],[4] The cutaneous manifestations include fibrofolicullomas, trichodiscomas, and achrodons, [3],[4] whereas the renal neoplasms include renal oncocytoma, chromophobe renal cell carcinoma, oncocytic hybrid tumor, and clear cell renal cell carcinoma. While renal cell carcinoma is the most common and feared neoplasm reported in association with BHDS, non-renal tumors have been reported as well. Even as the primary focus of care in BHDS is the management of renal tumors, pulmonary manifestations are among the most common manifestations. Cystic lung disease is seen in up to 90% of patients with BHDS, whereas spontaneous pneumothorax occurs in about 38%, [5] with a family history of pneumothorax in about 35%. [6] The syndrome typically exhibits clinical heterogeneity and the patients do not always have the three characteristic phenotypes (that of skin, kidney, and lung involvement). Lung disease (both cysts as well as pneumothoraces) may exist without the cutaneous manifestations, [7] and may be the earliest involvement. On radiological imaging, the cysts generally are elliptical or lentiform in shape with basilar and peripheral predominance and have a perivascular and periseptal localization. [6] As against cysts in other pulmonary conditions, cysts in BHDS are located in the middle and lower lobes toward the mediastinum and have an intimate association with interlobular septa and/or visceral pleura. These characteristic computed tomographic (CT) imaging features help clinicians differentiate the cysts from other cystic lung diseases. [8] Histopathologically, these cysts lack subpleural fibroelastic scars and changes of smoking, whereas cysts associated with pneumothorax in other pulmonary conditions show changes of respiratory bronchiolitis and fibroelastic scars. [9] Recently, it has been demonstrated that in BHDS, the cyst wall expands toward visceral pleura and gets incorporated partially into the interlobular septum, parenchyma, and/or bronchovascular bundle. [10] The cysts are lined on the inside by alveolar cells which may at times be attenuated and on occasion interspersed with cuboidal cells resembling type II pneumocytes. [10] The structural architecture of the cysts, however, gets distorted in pneumothorax-associated cysts. [10] BHDS is caused by heterozygous mutations in the folliculin (FLCN) gene that is located on the short arm of chromosome 17 (17p 11.2). Folliculin is a 579-amino acid protein that is expressed in skin, skin appendages, stromal cells, the distal nephron, and pneumocytes. [5] It has 14 exons, and even as its exact molecular functions are unknown, it is believed to be a conserved tumor suppressor gene. [11] More than 100 germline mutations have been reported in the FLCN gene. They are seen in around 88% of cases of BHDS and include splice, deletions, insertions, nonsense, deletion/insertion, and missense mutations. [5] Geographic variation has been noted in these mutations. Whereas a cytosine duplication or deletion in the C8 tract of exon 11 is known to be a hotspot in Western patients, c.1347_1353dupCCACCCT in exon 12 and c.1533_1536delGATG in exon 13 are the hotspots in Asian kindreds. [12],[13] Specific germline mutations or mutation types have not been associated with distinct phenotypic expression in BHDS due to the sheer lack of numbers to record such associations. [5] In this issue of the journal, a Taiwanese kindred with mutation c.1579_1580insA in exon 14 has been presented and the authors conclude that this mutation is associated with predominant lung involvement in BHDS without any renal involvement. Sequence analysis of select exons has shown that 53% of the families with BHDS had deletion or duplication of a C-nucleotide in the polycytosine tract in exon 11, which is a mutational hotspot, [5] with c.1733insC or c.1733delC being the most common BHDS mutation reported to date. [14],[15],[16],[17],[18],[19],[20],[21],[22] In a recent review of about 89 families, the most common 5' BHDS mutation was reported to have occurred at nucleotide 454 (c. 458delG) in exon 4 affecting the initiator codon of FLCN, [22] whereas the most common 3' mutation was reported to have occurred at nucleotide 2034 (c.2034 C>T) in exon 14. [5] The c.1579_1580insA reported by the authors in exon 14 is unique in being the only insertion…
European Journal of Internal Medicine, 2018
Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP),... more Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP. Methods: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors. Results: 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%. Conclusion: In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor.
The European respiratory journal, Jan 5, 2018
is a challenging bacterium to treat due to its intrinsic antibiotic resistance to the most freque... more is a challenging bacterium to treat due to its intrinsic antibiotic resistance to the most frequently used antibiotics in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with -CAP are limited. We assessed the multinational burden and specific risk factors associated with CAP.We enrolled 3,193 patients in 54 countries with confirmed diagnosis of CAP that underwent microbiological testing at admission. Prevalence was calculated according to the identification of Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant CAP.The prevalence of and antibiotic-resistant CAP was 4.2% and 2.0%, respectively. The rate of CAP in patients with prior infection/colonisation due to and at least one of the three independently associated chronic lung diseases [ tracheostomy, bronchiectasis and/or very severe COPD]) was 67%. In contrast, the rate of CAP was 2% in patients without prior ...
The Lancet. Infectious diseases, 2016
Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant... more Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are available on the worldwide prevalence and risk factors for MRSA pneumonia. We aimed to determine the point prevalence of MRSA pneumonia and identify specific MRSA risk factors in community-dwelling patients hospitalised with pneumonia. We did an international, multicentre study of community-dwelling, adult patients admitted to hospital with pneumonia who had microbiological tests taken within 24 h of presentation. We recruited investigators from 222 hospitals in 54 countries to gather point-prevalence data for all patients admitted with these characteristics during 4 days randomly selected during the months of March, April, May, and June in 2015. We assessed prevalence of MRSA pneumonia and associated risk factors through logistic regression analy...
Clinical Infectious Diseases, 2018
Background The correct management of immunocompromised patients with pneumonia is debated. We eva... more Background The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CA...
Journal of Association of Physicians of India, 1995
... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Bar... more ... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Barre Syndrome related weakness in a case of periodic paralysis. Journal of the Association of Physicians of India. 1995 May; 43(5): 373. Language: eng. ...
Journal of Association of Physicians of India, 1993
Widal reaction was studied in 52 patients having malaria parasites in the peripheral blood smear.... more Widal reaction was studied in 52 patients having malaria parasites in the peripheral blood smear. Twenty had Plasmodium vivax, 26 had Plasmodium falciparum and the rest had mixed (both vivax and falciparum) infections. Widal test for both O and H antigens of Salmonella typhi was positive in high titres in 3 falciparum, 3 vivax and 2 cases of mixed infection. Of these 8 cases, one had been treated for typhoid fever 3 months back and again one month back for relapse. Blood culture for Salmonella typhi was negative in all. All were cured after antimalarial therapy. The positive Widal reaction may be false.
Indian Journal of Medical Research, 1997
The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50... more The distribution of HLA class-I (A, B and C), and class II (DR and DQ) antigens was studied in 50 randomly selected Kashmiri Muslim patients with established rheumatic heart disease and compared with that of 50 controls of similar ethnicity. A significant increase in the frequency of HLA-DR4 (P < 0.005, RR 3.27) and a significant decrease in the frequency of HLA-B5 (P < 0.001, RR 0.19) were found in the patient group. Though HLA-DQ3 showed a significant increase (P < 0.005, RR 2.52) and HLA-DR7 a significant decrease (P < 0.05, RR 0.42) in the patient group, the corrected P value was not significant. The findings suggest that susceptibility to RHD in the studied population is HLA-related, with HLA-DR4 influencing its occurrence and HLA-B5 conferring protection against the same.
Journal of Association of Physicians of India, 1998
Journal of Association of Physicians of India, 2000
To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia ... more To evaluate the efficacy of mepacrine (quinacrine) in patients with niclosamide resistant Taenia saginata infection. Eighty six cases with niclosamide resistant Taenia saginata (unresponsive to 2-8 courses of niclosamide) were treated with quinacrine (1 g) administered orally or via a nasogastric tube, and followed at 2, 4, 8 and 12 weeks for recurrence of passage of proglottids and presence of Taenia eggs in the stool examinations. Pre and post-therapy egg counts were obtained and egg viability was tested by staining with methylene blue. Eighty-one (94.2%) patients responded promptly with passage of the worm within 4-72 hours. The egg counts showed a drastic fall in 79 cases and a fall in viability from a median of 100% to 0% was observed. Only one patient demonstrated a relapse at 4 weeks. Gastrointestinal side effects occurred in 9 cases but were controlled easily by symptomatic therapy. We conclude that quinacrine is a safe, inexpensive, effective and generally well tolerated dr...
Journal of Association of Physicians of India, 2000
A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash ... more A 55 years post menopausal lady presented with puffiness of face, and a pruritic urticarial rash over face and upper trunk of one week duration with accompanying dysphagia. Clinical examination revealed an urticarial rash over face and upper trunk, two small ulcers over floor of mouth and evidence of bilateral VIII, IX and Xth cranial nerve palsies. Hypocomplementemia, negative immune profile and evidence of vasculitis on skin biopsy suggested a diagnosis of hypocomplementemic urticarial vasculitis. The patient responded to a course of steroids.
Journal of Association of Physicians of India, 2000
Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate... more Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattress...
Journal of Association of Physicians of India, 1996
Journal of Association of Physicians of India, 2003
A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion... more A 65 years patient presented with left ear swelling, swelling of the nasal bridge with congestion of the eyes. Clinically there was evidence of left auricular chondritis, nasal chondritis and conjunctivitis with a history of multiple similar episodes in the past, features suggestive of relapsing polychondritis. The patient improved with oral prednisolone.
Journal of postgraduate medicine, 2013
ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/... more ABSTRACT Primary spontaneous pneumothorax is a global problem with a reported incidence of 18-28/100,000 per year for men and 1.2-6/100,000 per year for women. [1] About 11% of spontaneous pneumothorax patients have a positive family history, and the various heritable causes include Marfan syndrome, Ehlers-Danlos syndrome More Details, α1-antitrypsin deficiency, lymphangioleiomyomatosis, Langerhan's cell hisiocytosis, cystic light chain disease, and cystic fibrosis. [2] Birt-Hogg-Dubé syndrome (BHDS) is a genodermatosis that, in addition to the dermatological manifestations, is characterized by predisposition to lung cysts and renal neoplasms. [3],[4] The cutaneous manifestations include fibrofolicullomas, trichodiscomas, and achrodons, [3],[4] whereas the renal neoplasms include renal oncocytoma, chromophobe renal cell carcinoma, oncocytic hybrid tumor, and clear cell renal cell carcinoma. While renal cell carcinoma is the most common and feared neoplasm reported in association with BHDS, non-renal tumors have been reported as well. Even as the primary focus of care in BHDS is the management of renal tumors, pulmonary manifestations are among the most common manifestations. Cystic lung disease is seen in up to 90% of patients with BHDS, whereas spontaneous pneumothorax occurs in about 38%, [5] with a family history of pneumothorax in about 35%. [6] The syndrome typically exhibits clinical heterogeneity and the patients do not always have the three characteristic phenotypes (that of skin, kidney, and lung involvement). Lung disease (both cysts as well as pneumothoraces) may exist without the cutaneous manifestations, [7] and may be the earliest involvement. On radiological imaging, the cysts generally are elliptical or lentiform in shape with basilar and peripheral predominance and have a perivascular and periseptal localization. [6] As against cysts in other pulmonary conditions, cysts in BHDS are located in the middle and lower lobes toward the mediastinum and have an intimate association with interlobular septa and/or visceral pleura. These characteristic computed tomographic (CT) imaging features help clinicians differentiate the cysts from other cystic lung diseases. [8] Histopathologically, these cysts lack subpleural fibroelastic scars and changes of smoking, whereas cysts associated with pneumothorax in other pulmonary conditions show changes of respiratory bronchiolitis and fibroelastic scars. [9] Recently, it has been demonstrated that in BHDS, the cyst wall expands toward visceral pleura and gets incorporated partially into the interlobular septum, parenchyma, and/or bronchovascular bundle. [10] The cysts are lined on the inside by alveolar cells which may at times be attenuated and on occasion interspersed with cuboidal cells resembling type II pneumocytes. [10] The structural architecture of the cysts, however, gets distorted in pneumothorax-associated cysts. [10] BHDS is caused by heterozygous mutations in the folliculin (FLCN) gene that is located on the short arm of chromosome 17 (17p 11.2). Folliculin is a 579-amino acid protein that is expressed in skin, skin appendages, stromal cells, the distal nephron, and pneumocytes. [5] It has 14 exons, and even as its exact molecular functions are unknown, it is believed to be a conserved tumor suppressor gene. [11] More than 100 germline mutations have been reported in the FLCN gene. They are seen in around 88% of cases of BHDS and include splice, deletions, insertions, nonsense, deletion/insertion, and missense mutations. [5] Geographic variation has been noted in these mutations. Whereas a cytosine duplication or deletion in the C8 tract of exon 11 is known to be a hotspot in Western patients, c.1347_1353dupCCACCCT in exon 12 and c.1533_1536delGATG in exon 13 are the hotspots in Asian kindreds. [12],[13] Specific germline mutations or mutation types have not been associated with distinct phenotypic expression in BHDS due to the sheer lack of numbers to record such associations. [5] In this issue of the journal, a Taiwanese kindred with mutation c.1579_1580insA in exon 14 has been presented and the authors conclude that this mutation is associated with predominant lung involvement in BHDS without any renal involvement. Sequence analysis of select exons has shown that 53% of the families with BHDS had deletion or duplication of a C-nucleotide in the polycytosine tract in exon 11, which is a mutational hotspot, [5] with c.1733insC or c.1733delC being the most common BHDS mutation reported to date. [14],[15],[16],[17],[18],[19],[20],[21],[22] In a recent review of about 89 families, the most common 5' BHDS mutation was reported to have occurred at nucleotide 454 (c. 458delG) in exon 4 affecting the initiator codon of FLCN, [22] whereas the most common 3' mutation was reported to have occurred at nucleotide 2034 (c.2034 C>T) in exon 14. [5] The c.1579_1580insA reported by the authors in exon 14 is unique in being the only insertion…
The Journal of the Association of Physicians of India, 1998
The Journal of the Association of Physicians of India, 1995
... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Bar... more ... Issue Date: 1-May-1995. Citation: Koul PA, Iqbal J, Wahid A, Bhat MS, Tanveer M. Guillain Barre Syndrome related weakness in a case of periodic paralysis. Journal of the Association of Physicians of India. 1995 May; 43(5): 373. Language: eng. ...