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Biomedical subjects

C Balakrishnan

Publications and source records attributed to C Balakrishnan.

At least 19 recordsLinked to original sources
PubMed2006

Paget's disease of the bone: a report of three cases.

Paget's disease is uncommon in Asians. We present 3 patients with varying manifestations. A 50 years old lady was detected to have raised alkaline phosphatase at a routine health check-up. Isoenzyme studies confirmed its bony origin. Bone scan revealed polyostotic disease. A 65 years old male patient with known Paget's disease of 6 years duration presented with pelvic girdle pain, progressive increase in alkaline phosphatase levels and worsening bone scan. A 45 years old male was admitted with chest pain. Cardiac evaluation was normal. Bone scan picked up a cough fracture in the left 7th rib and an incidental Paget's disease of the skull. All three had elevated markers of bone metabolism in the serum and urine. With monthly intravenous pamidronate there was significant improvement in the bone markers and follow-up bone scans.

Aged↗
PubMed2004

Myelodysplasia and acute myeloid leukaemia in a case of rheumatoid arthritis with secondary amyloidosis treated with chlorambucil.

Immunosuppressive therapy related secondary haematologic malignancy is well reported. A 52 years lady with established rheumatoid arthritis developed reactive amyloidosis. This was initially treated with colchicine and cyclophosphamide and later with chlorambucil. Ten months after stopping chlorambucil she developed pancytopenia and vitamin B12 deficient megaloblastic anaemia. The pancytopenia was refractory to vitamin B12 supplements and a repeat bone marrow confirmed myelodysplasia (FABI RAEB-T). Within three weeks of this diagnosis she evolved into acute myeloid leukaemia and expired due to refractory thrombocytopenia and uncontrolled bleeding. This case stresses the need for long term follow up of RA patients treated with alkylating agents.

Acute Disease↗
PubMed2002

Treatment of AA amyloidosis in rheumatoid arthritis.

Four patients of rheumatoid arthritis (RA) with biopsy confirmed AA amyloidosis were treated with chlorambucil. All had established but uncontrolled RA with a persistently raised ESR. Moderate (> 1 gm, < 3.5 gm/d) to nephrotic range (> 3.5 gm/d) proteinuria and a relatively well preserved renal function was noted in three patients. One patient had deranged renal function and required dialysis. On chlorambucil, there was complete recovery, partial improvement and no improvement in one patient each. The fourth patient required haemodialysis, did not tolerate chlorambucil and succumbed to the illness. Therapy with chlorambucil can benefit some patients of RA with AA amyloidosis. Leucopenia is the most important dose limiting side effect.

Adult↗
PubMed2001

Accidental self-injection with Freund's complete adjuvant.

The case of a research worker who accidentally injected herself with Freund's Complete Adjuvant (FCA) in the right forearm is reported. This resulted in a serious granulomatous inflammation of the hand an forearm. She was treated with corticosteroids and chloroquine with good result. The course of this reaction and the hazards of injection with FCA are emphasised and the relevant literature reviewed.

Accidents, Occupational↗
PubMed2001

Pulmonary nocardial infection and pseudomonas infection of the tongue in a patient with dermatomyositis.

Opportunistic infections in immunocompromised patients are common. We report the case of a 63 year old female patient with dermatomyositis who while on oral steroids developed nocardial infection of the lung and pseudomonas infection of the tongue simultaneously. Nocardial infections are not very commonly seen in patients with dermatomyositis. Pseudomonas infection of the tongue is a rarity. We report this case for its rarity as regards the type and site of infections and review the relevant literature.

Dermatomyositis↗
PubMed2000

Hormone-dependent tumor regression in vivo by an inducible transcriptional repressor directed at the PAX3-FKHR oncogene.

In alveolar rhabdomyosarcomas (ARMSs), a specific chromosomal translocation creates a fusion transcription factor, PAX3-FKHR, that is oncogenic due to transcriptional activation. As a strategy for down-regulation of PAX3-FKHR target genes, we created conditional PAX3 repressors by fusing the PAX3 DNA-binding motifs to the hormone binding domain (HBD) of the estrogen receptor and to the KRAB repression domain. We validated proper expression, specific DNA binding, corepressor interaction, and nuclear localization for the KRAB-PAX3-HBD protein and showed it to be a 4-hydroxytamoxifen-dependent transcriptional repressor of transiently transfected and integrated PAX3 reporters in ARMS cells. We established ARMS cell lines that exhibited stable expression of the conditional PAX3 repressor proteins and used them to down-regulate the malignant growth under low serum or anchorage-independent conditions in a hormone-dependent manner. Terminal deoxynucleotidyl transferase-mediated nick end labeling assays revealed that hormonal activation of the PAX3 repressors induced extensive apoptosis that correlated with down-regulation of BCL-X(L) expression. SCID mice that were engrafted with the KRAB-PAX3-HBD ARMS cell lines and were implanted with 4-hydroxytamoxifen timed-release pellets exhibited suppression of tumor growth and an altered vascularity that was not observed in the control mice. These observations strongly suggest that we have directly repressed the PAX3 target genes that are deregulated by the PAX3-FKHR oncogene in ARMS.

3T3 Cells↗
PubMed1999

Unusual presentation of a ring injury in a psychiatric patient.

1. A ring embedded in the digits may result in erosion of the skin, tendons, and bones. 2. This type of injury may be prevented by removing the ring at the time of the injury. 3. All constricting bands should be carefully monitered and, if necessary, removed from fingers to prevent chronic erosion especially in people with a physical or mental disability.

Adult↗
PubMed1998

Reference centile charts for measures of disease activity, functional impairment, and metrology in ankylosing spondylitis.

OBJECTIVE: To construct reference centile charts for validated measures of disease activity, functional impairment, and metrology (the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Bath Ankylosing Spondylitis Functional Index [BASFI], and Bath Ankylosing Spondylitis Metrology Index [BASMI]) in a population of patients with AS, and to explore the potential application of these charts in patient care and clinical research. METHODS: We collected BASDAI and BASFI data on 2,979 patients with AS from the Royal National Hospital for Rheumatic Diseases (RNHRD) database and BASMI data on 393 patients at RNHRD. Data on age, sex, and duration of AS were also obtained. Centile charts were constructed for the BASDAI, BASFI, and BASMI in both males and females, with duration of AS as the time-dependant variable. Where necessary, BASDAI, BASFI, and BASMI raw scores were transformed to ensure that the indices were normally distributed over the range of disease duration, and allowance was made for change in variability of the indices. RESULTS: Linear models were fitted to the mean and standard deviations of BASDAI, BASFI, and BASMI scores in males and females as a function of disease duration. A standard deviation score plot confirmed goodness of fit of the models, and fitted centiles were derived. Charts showing the 5th, 10th, 25th, 50th, 75th, 90th, and 95th centiles were constructed. The charts confirmed that AS remains active after 40 years' duration (mean BASDAI score 2.22 and 2.99 in males and females, respectively). The charts also demonstrated that females have greater disease activity and more functional impairment than males, despite better metrology. CONCLUSION: The use of centile reference charts for disease activity, functional impairment, and metrology in AS will allow physicians and patients to interpret index scores relative to a reference population and will provide the opportunity to assess change over time and response to therapeutic interventions, to improve definition of disease status, and to enhance patients' involvement in their care.

Aging↗