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Biomedical subjects

T Kuruvilla

Publications and source records attributed to T Kuruvilla.

At least 19 recordsLinked to original sources
PubMed2006

Elderly depressed patients: what are their views on treatment options?

The aim of this study was to explore attitudes of elderly patients with depression receiving secondary psychiatric care towards different types of treatment for depression. One hundred patients, recruited from a large teaching hospital in Birmingham, were subjected to structured interviews at which their attitudes towards the effectiveness, likelihood of causing side-effects and acceptability of anti-depressant medication, ECT and psychotherapy were measured on a five-point Likert scale. Psychotherapy was considered both effective and acceptable by our patients although it is not widely available across the UK. Anti-depressants were also considered to be effective and acceptable although likely to cause side-effects. However, our patients did not think highly of ECT, either in its effectiveness or acceptability.

Aged↗
PubMed2004

Thiamine for Wernicke-Korsakoff Syndrome in people at risk from alcohol abuse.

BACKGROUND: Autopsy studies suggest that Wernicke-Korsakoff Syndrome (WKS) is not a rare disorder, particularly in individuals who abuse alcohol. Thiamine has been established as the treatment of choice for over 50 years, but there is uncertainty about appropriate dosage and duration. Current practice guidelines are based on case reports and clinical experience. OBJECTIVES: To determine the quality of evidence for the efficacy of thiamine in preventing and treating the manifestations of WKS as a consequence of alcohol excess, and if so in which form it should be given, at what dose and for how long. SEARCH STRATEGY: Trials were identified from the latest updated search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 3 February 2003 using the terms "(thiamin* or aneurin*) and (Korsakoff* or Wernicke* or alcohol*). The CDCIG Specialized register contains up-to-date records from all major health care databases (Medline, Embase, PsycInfo, Cinahl and others) as well as from many trials databases. SELECTION CRITERIA: All randomized trials in which treatment with thiamine or thiamine-containing products was administered and compared with alternative interventions for people with, or at risk of developing, WKS secondary to alcohol abuse. DATA COLLECTION AND ANALYSIS: All abstracts were independently inspected by two reviewers (ED & PB) and relevant papers were retrieved and assessed for methodological quality using Cochrane Reviewers' Handbook criteria. MAIN RESULTS: Two studies were identified that met the inclusion criteria, but only one contained sufficient data for quantitative analysis. Ambrose (2001) randomized participants (n=107) to one of five doses of intramuscular thiamine and measured outcomes after 2 days of treatment. We compared the lowest dose (5mg/day) with each of the other four doses. There was a significant difference in favour of the 200mg/day compared with the 5 mg/day dose in the number of trials taken to reach criterion on a delayed alternation test (MD -17.90, 95% CI -35.4 to -0.40, p=0.04). No significant differences emerged in comparing the other doses with 5 mg/day. The pattern of results did not present a simple dose-response relationship. The study had methodological shortcomings in design and the presentation of results that limited further analysis. REVIEWER'S CONCLUSIONS: There is insufficient evidence from randomized controlled clinical trials to guide clinicians in the dose, frequency, route or duration of thiamine treatment for prophylaxis against or treatment of WKS due to alcohol abuse.

Humans↗
PubMed2000

Case report. Paraphimosis due to erotic dancing.

Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.

Adolescent↗
PubMed1999

Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon.

BACKGROUND: Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. METHODS: Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. RESULTS: Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. CONCLUSION: Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.

Aged↗
PubMed1998

Simple repair of fractured penis.

Though rare, fracture of the penis is associated with significant morbidity if early surgical repair is not carried out. A simple same-day surgical technique performed under local anaesthesia is presented that requires no pre-operative investigations. Careful clinical examination (rolling sign) is used to accurately identify the fracture site.

Adult↗
PubMed1997

Cerebellar atrophy after acute phenytoin intoxication.

There is some evidence that long-term phenytoin (PHT) use may occasionally give rise to irreversible cerebellar atrophy, but it is unclear whether such changes can occur after acute PHT intoxication. We describe a 38-year-old patient with accidental acute PHT overdose who developed severe cerebellar atrophy. This case provides evidence that acute PHT intoxication can, on rare occasions, result in irreversible cerebellar degeneration.

Acute Disease↗
PubMed1994

An epidemic of dengue haemorrhagic fever & dengue shock syndrome in & around Vellore.

This report describes an epidemic of dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS) in the North Arcot Ambedkar district and the adjoining districts in Tamil Nadu and Andhra Pradesh. Nineteen children who fulfilled the clinical criteria for the diagnosis of DHF/DSS were admitted to the Christian Medical College Hospital, Vellore, during June through November, 1990. The clinical presentation was similar to that described in South-east Asian children and the case fatality rate was 26.3 per cent. Serology was confirmatory or suggestive of recent dengue virus infection in 16 children, uninterpretable in 2 and not consistent with recent dengue virus infection in 1 child. All children over 1 yr of age had very high antibody titres suggesting a secondary response whereas infants had lower titres consistent with primary response. The occurrence of recurrent epidemics in this region in the last few years with associated high case fatality emphasizes the urgent need for public health measures to curtail further epidemics.

Child↗
PubMed1990

Beneficial effect of intravenous nitroglycerin in patients with non-Q myocardial infarction.

In 129 patients with acute myocardial infarction (MI) there was ST segment elevation on admission but no Q wave in the infarcted area: they were randomly divided into 2 groups. In a single blind study 62 patients received intravenous nitroglycerin, while another 67 patients were given placebo. The average time which elapsed since the beginning of symptoms to start of treatment was 157 +/- 82.17 min in nitroglycerin group and 169 +/- 66.9 min in placebo group (NS). The beneficial effect of nitroglycerin on mortality, extension of MI or occurrence of left ventricular failure (LVF) could be seen only if these conditions were combined. No significant difference could be detected if these conditions were analyzed individually. The size of MI assessed by peak of creatine kinase (CK) was similar in both groups. However, if Q and non Q MI were separately analyzed, the peak CK was significantly lower in non Q MI patients receiving nitroglycerin (523 +/- 161 IU/l compared to 1049 +/- 583 IU/l for placebo, p = 0.002) while the same beneficial effect could not be seen in Q MI. Although there was no difference in the final occurrence of Q MI and Q MI in both groups taking nitroglycerin or placebo, we found that non Q MI patients had significantly lower peak CK than Q MI patients (770 +/- 491.9 to 2783 +/- 1720.9, p = 0.001) and this peak CK was observed earlier for non Q MI patients (16.2 +/- 5.41 hours compared to 22.6 +/- 6.86 hours for Q MI patients, p = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗