Browsing by Author "Pandian, JD"

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    Beevor's sign in amyotrophic lateral sclerosis
    (NEUROLOGY INDIA, 1997) Pandian, JD; Mathuranath, PS
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    Brainstem abscess complicating tetralogy of fallot successfully treated with antibiotics alone
    (NEUROLOGY INDIA, 2000)
    Medically treated brainstem abscess in a 11 year old boy with tetralogy of Fallot is reported. There was a complete resolution of the lesion without any neurologic sequelae during parenteral antibiotic therapy with crystalline penicillin, chloramphenicol and metronidazole. The pathogenesis and management of cardiogenic brain abscesses in general and brainstem abscess in particular has been reviewed.
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    Complementary and Alternative Medicine Treatments Among Stroke Patients in India
    (TOPICS IN STROKE REHABILITATION, 2012) Pandian, JD; Toor, G; Arora, R; Kaur, P; Dheeraj, KV; Bhullar, RS; Sylaja, PN
    Background: Complementary and alternative medicine (CAM) is commonly used by persons with stroke throughout the world, particularly in Asia. Objective: The objectives of this study were to determine the frequency of CAM use and the factors that predict the use of CAM in stroke patients. Methods: This study was carried out in the stroke units of Christian Medical College, Ludhiana, and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, from June 2010 to December 2010. Participants were interviewed using a structured questionnaire (>= 6 months post stroke). Outcomes were assessed using a modified Rankin Scale (mRS). Results: Three hundred fourteen stroke patients were interviewed; mean age was 57.4 +/- 12.9 years, and 230(73.2%) patients were men. Of 314 patients, 114 (36.3%) had used the following CAM treatments: ayurvedic massage, 67 (59.3%); intravenous fluids, 22 (19.5%); herbal medicines, 17 (15%); homeopathy, 15 (13.3%); witchcraft, 3 (2.7%); acupuncture, 3 (2.7%); opium intake, 10 (8.8%); and other nonconventional treatments, 10 (8.8%). Patients with severe stroke (P < .0001), limb weakness (P < .0001), dysphagia (P = .02), dyslipidemia (P = .007), hypertension (P = .03), or hemorrhagic stroke (P < .0001) and patients with poor outcome (mRS >2; P < .0001) often used CAM treatments. Conclusion: More than one-third of the patients in this study opted for CAM. Presence of limb weakness, dysphagia, dyslipidemia, hypertension, hemorrhagic stroke, severe stroke, and poor outcome predicted the use of CAM.
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    Complications in acute stroke in India (CAST-1): A multicenter study.
    (J Stroke Cerebrovasc Dis, 2012-12) Pandian, JD; Kaur, A; Jyotsna, R; Sylaja, PN; Vijaya, P; Padma, MV; Venkateswarlu, K; Sukumaran, S; Mathew, R; Kaur, P; Singh, YP; Radhakrishnan, K
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    Complications in acute stroke in India (CAST-1): A multicenter study.
    (J Stroke Cerebrovasc Dis, 2012-12) Pandian, JD; Kaur, A; Jyotsna, R; Sylaja, P N; Vijaya, P; Padma, MV; Venkateswarlu, K; Sukumaran, S; Mathew, R; Kaur, P; Singh, YP; Radhakrishnan, K
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    Complications in Acute Stroke in India (CAST-I): A Multicenter Study
    (JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 2012) Pandian, JD; Kaur, A; Jyotsna, R; Sylaja, PN; Vijaya, P; Padma, MV; Venkateswaralu, K; Sukumaran, S; Mathew, R; Kaur, P; Singh, YP; Radhakrishnan, K
    The prognosis and final outcome in patients who sustain stroke are significantly affected by medical complications occurring during the acute phase of stroke. Only limited information is available from India and other developing countries regarding acute complications of stroke. This study examined the frequency of acute stroke and the factors associated with complications of stroke in India. In this prospective multicenter study, running from March 2008 to September 2009, 6 hospitals collected information on complications of first-ever stroke during admission. Complications were defined in accordance with standard criteria. Outcome at 30 days poststroke was assessed using the modified Rankin Scale. Stroke characteristics, length of hospital stay, and stroke severity (based on the National Institutes of Health Stroke Scale) were documented. Hematologic (ie, hemoglobin) and biochemical (ie, total proteins and albumin) parameters also were obtained. A total of 449 patients out of the recruited 476 completed follow-up. The mean age was 58.1 +/- 13.7 years (range, 16-96 years), and the majority were men (n=282; 62.8%). The mean National Institutes of Stroke Scale score was 10.2 +/- 5.3. Overall, 206 patients (45.9%) experienced complications during admission. In the logistic regression analysis, limb weakness (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02-0.67; P=.01), anemia (OR, 0.35; 95% CI, 0.15-0.81; P=.01), length of hospital stay (OR, 0.89; 95% CI, 0.85-0.94; P<.0001), and stroke severity (OR, 0.27; 95% CI, 0.10-0.72; P=.01) were the variables associated with complications. Such complications as urinary tract infection (OR, 0.31; 95% CI, 0.13-0.78; P=.01), chest infection (OR, 1.81; 95% CI, 1.12-2.93; P=.02), bedsores (OR, 3.52; 95% CI, 1.02-12.08; P=.05), other pain (OR, 0.21; 95% CI, 0.09-0.49; P<.0001), and depression (OR, 2.22; 95% CI, 1.30-3.80; P<.01) were associated with poor outcome. Our study shows high rates of complication in acute stroke. Limb weakness, stroke severity, length of hospital stay, and anemia were the factors associated with complications. Other complications, such as urinary tract infection, chest infection, bedsores, other pain, and depression, can lead to poor outcome.
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    Early risk and predictors of cerebrovascular and cardiovascular events in transient ischemic attack and minor ischemic stroke
    (NEUROLOGY INDIA, 2012) Kate, M; Sylaja, PN; Chandrasekharan, K; Balakrishnan, R; Sarma, S; Pandian, JD
    Background: Transient ischemic attack (TIA) and minor ischemic stroke (MIS) are associated with early recurrence and deterioration respectively. The aim of the present study was to assess the risk of new cerebrovascular and cardiovascular events in a prospective, emergently enrolled patient cohort with TIA and MIS and the predictors of risk. Materials and Methods: Patients with TIA and MIS (NIH Stroke Scale [NIHSS] <= 5) presenting within the first 48 h between July 2008-June 2009 were prospectively enrolled. The primary outcome was new-onset stroke, TIA, cardiovascular events and vascular death at 90 days and early deterioration in patients with minor stroke. The 90-day outcome was also assessed (excellent outcome; modified Rankin scale [mRS] <= 2). Results: Eighteen (15.3%) of the 118 patients enrolled developed new cerebrovascular or cardiovascular events during the 90 days of follow-up, nine (50%) of which occurred within seven days. Of the all new events 5.9% (7/118) had new stroke, 4.2% (5/118) patients developed early deterioration, 2.5% (3/118) patients had recurrent TIA and 2.5% (3/118) had cardiovascular events at 90 days. Eight (6.7%) patients had poor outcome at 90 days (mRS>2). The factors predicting new vascular events were presence of coronary artery disease (CAD), and stroke etiology being large artery atherosclerosis (LAA). Conclusion: In patients with TIA and MIS, despite urgent evaluation and aggressive management, the short-term risk of stroke and other vascular events is high. Those with CAD and LAA should be monitored closely for early deterioration.
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    Epidemiology and awareness of epilepsy in Kerala, South India.
    (EPILEPSIA, 1999) Radhakrshnan, K; Pandian, JD; Santoshkumar, T; Deetha, TD
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    Epilepsia partialis continua - a clinical and electroencephalography study
    (SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 2002)
    Epilepsia partialis continua (EPC) is a rare type of localization-related motor epilepsy. Clinical spectrum, electroencephalography (EEG) characteristics and various prognostic factors in EPC were studied in 20 patients. Patients who fulfilled the criteria for EPC between the years 1985 and 1999 were included in this retrospective and prospective study. The mean age was 18 years (range 5 months-70 years). Eleven patients (55%) had Type 1 EPC and in the remaining nine (45%) patients there were features of Type 2 EPC. Among children Rasmussen's encephalitis and viral encephalitis were the commonest cause for EPC. Encephalitis and vascular aetiology were frequently observed in adults. Tuberculous meningitis and tuberculomas occurred evenly in both the groups. The cause was unknown in two cases. Focal EEG abnormalities commonly consisted of discrete spikes, sharp waves (or) slow wave activity and periodic lateralized epileptiform discharges. The mean duration of follow up was 9.6 months with a range between I month and 4 years. Cognitive decline, motor deficits and pharmacoresistance to drugs were significantly seen among children with Type 2 EPC. Patients with Type I EPC had mild impairment of functional status with good response to treatment. The long-term prognosis depends upon the underlying cause. (C) 2002 Published by Elsevier Science Ltd on behalf of BEA Trading Ltd.
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    FACTORS PREDICTING RETURN TOWORK POST STROKE IN INDIA
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Chahal, A; Pandian, JD; Pannu, A; Arora, D; Sylaja, PN; Kaul, S; Khurana, D; Padma, MV; Thankachan, T; Singhal, AB
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    Fulminant cerebral infarction in a patient with nephrotic syndrome
    (NEUROLOGY INDIA, 2000) Pandian, JD; Sarada, C; Elizabeth, J; Visweswaran, RK
    Fulminant cerebral infarction secondary to arterial thrombosis in adults with nephrotic syndrome is rare. We report a 42 year old male with fulminant right anterior cerebral and middle cerebral artery infarction. Minimal change disease of the kidney was documented by renal biopsy. The possible pathogenesis is discussed and pertinent literature reviewed.
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    Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015
    (LANCET) Wang, HD; Naghavi, M; Allen, C; Barber, RM; Bhutta, ZA; Carter, A; Casey, DC; Charlson, FJ; Chen, AZ; Coates, MM; Coggeshall, M; Dandona, L; Dicker, DJ; Erskine, HE; Ferrari, AJ; Fitzmaurice, C; Foreman, K; Forouzanfar, MH; Fraser, MS; Pullman, N; Gething, PW; Goldberg, EM; Graetz, N; Haagsma, JA; Hay, SI; Huynh, C; Johnson, C; Kassebaum, NJ; Kinfu, Y; Kulikoff, XR; Kutz, M; Kyu, HH; Larson, HJ; Leung, J; Liang, XF; Lim, SS; Lind, M; Lozano, R; Marquez, N; Mensah, GA; Mikesell, J; Mokdad, AH; Mooney, MD; Nguyen, G; Nsoesie, E; Pigott, DM; Pinho, C; Roth, GA; Salomon, JA; Sandar, L; Silpakit, N; Sligar, A; Sorensen, RJD; Stanaway, J; Steiner, C; Teeple, S; Thomas, BA; Troeger, C; VanderZanden, A; Vollset, SE; Wanga, V; Whiteford, HA; Wolock, T; Zoeckler, L; Abate, KH; Abbafati, C; Abbas, KM; Abd-Allah, F; Abera, SF; Abreu, DMX; Abu-Raddad, LJ; Abyu, GY; Achoki, T; Adelekan, AL; Ademi, Z; Adou, AK; Adsuar, JC; Afanvi, KA; Afshin, A; Agardh, EE; Agarwal, A; Agrawal, A; Kiadaliri, AA; Ajala, ON; Akanda, AS; Akinyemi, RO; Akinyemiju, TF; Akseer, N; Al Lami, FH; Alabed, S; Al-Aly, Z; Alam, K; Alam, NKM; Alasfoor, D; Aldhahri, SF; Aldridge, RW; Alegretti, MA; Aleman, AV; Alemu, ZA; Alexander, LT; Alhabib, S; Ali, R; Alkerwi, A; Alla, F; Allebeck, P; Al-Raddadi, R; Alsharif, U; Altirkawi, KA; Martin, EA; Alvis-Guzman, N; Amare, AT; Amegah, AK; Ameh, EA; Amini, H; Ammar, W; Amrock, SM; Andersen, HH; Anderson, B; Anderson, GM; Antonio, CAT; Aregay, AF; Arnlov, J; Arsenijevic, VSA; Al Artaman; Asayesh, H; Asghar, RJ; Atique, S; Avokpaho, EFGA; Awasthi, A; Azzopardi, P; Bacha, U; Badawi, A; Bahit, MC; Balakrishnan, K; Banerjee, A; Barac, A; Barker-Collo, SL; Barnighausen, T; Barregard, L; Barrero, LH; Basu, A; Basu, S; Bayou, YT; Bazargan-Hejazi, S; Beardsley, J; Bedi, N; Beghi, E; Belay, HA; Bell, B; Bell, ML; Bello, AK; Bennett, DA; Bensenor, IM; Berhane, A; Bernabe, E; Betsu, BD; Beyene, AS; Bhala, N; Bhalla, A; Biadgilign, S; Bikbov, B; Bin Abdulhak, AA; Biroscak, BJ; Biryukov, S; Bjertness, E; Blore, JD; Blosser, CD; Bohensky, MA; Borschmann, R; Bose, D; Bourne, RRA; Brainin, M; Brayne, CEG; Brazinova, A; Breitborde, NJK; Brenner, H; Brewer, JD; Brown, A; Brown, J; Brugha, TS; Buckle, GC; Butt, ZA; Calabria, B; Campos-Novato, IR; Campuzano, JC; Carapetis, JR; Cardenas, R; Carpenter, D; Carrero, JJ; Castaneda-Oquela, CA; Rivas, JC; Catala-Lopez, F; Cavalleri, F; Cercy, K; Cerda, J; Chen, WQ; Chew, A; Chiang, PPC; Chibalabala, M; Chibueze, CE; Chimed-Ochir, O; Chisumpa, VH; Choi, JYJ; Chowdhury, R; Christensen, H; Christopher, DJ; Ciobanu, LG; Cirillo, M; Cohen, AJ; Colistro, V; Colomar, M; Colquhoun, SM; Cooper, C; Cooper, LT; Cortinovis, M; Cowie, BC; Crump, JA; Damsere-Derry, J; Danawi, H; Dandona, R; Daoud, F; Darby, SC; Dargan, PI; das Neves, J; Davey, G; Davis, AC; Davitoiu, DV; de Castro, EF; de Jager, P; De Leo, D; Degenhardt, L; Dellavalle, RP; Deribe, K; Deribew, A; Dharmaratne, SD; Dhillon, PK; Diaz-Torne, C; Ding, EL; dos Santos, KPB; Dossou, E; Driscoll, TR; Duan, LL; Dubey, M; Bartholow, B; Ellenbogen, RG; Lycke, C; Elyazar, I; Endries, AY; Ermakov, SP; Eshrati, B; Esteghamati, A; Estep, K; Faghmous, IDA; Fahimi, S; Jose, E; Farid, TA; Farinha, CSES; Faro, A; Farvid, MS; Farzadfar, F; Feigin, VL; Fereshtehnejad, SM; Fernandes, JG; Fernandes, JC; Fischer, F; Fitchett, JRA; Flaxman, A; Foigt, N; Fowkes, FGR; Franca, EB; Franklin, RC; Friedman, J; Frostad, J; Hirst, T; Futran, ND; Gall, SL; Gambashidze, K; Gamkrelidze, A; Ganguly, P; Gankpe, FG; Gebre, T; Gebrehiwot, TT; Gebremedhin, AT; Gebru, AA; Geleijnse, JM; Gessner, BD; Ghoshal, AG; Gibney, KB; Gillum, RF; Gilmour, S; Giref, AZ; Giroud, M; Gishu, MD; Giussani, G; Glaser, E; Godwin, WW; Gomez-Dantes, H; Gona, P; Goodridge, A; Gopalani, SV; Gosselin, RA; Gotay, CC; Goto, A; Gouda, HN; Greaves, F; Gugnani, HC; Gupta, R; Gupta, R; Gupta, V; Gutierrez, RA; Hafezi-Nejad, N; Haile, D; Hailu, AD; Hailu, GB; Halasa, YA; Hamadeh, RR; Hamidi, S; Hancock, J; Handal, AJ; Hankey, GJ; Hao, YT; Harb, HL; Harikrishnan, S; Haro, JM; Havmoeller, R; Heckbert, SR; Heredia-Pi, IB; Heydarpour, P; Hilderink, HBM; Hoek, HW; Hogg, RS; Horino, M; Horita, N; Hosgood, HD; Hotez, PJ; Hoy, DG; Hsairi, M; Htet, AS; Htike, MMT; Hu, GQ; Huang, C; Huang, H; Huiart, L; Husseini, A; Huybrechts, I; Huynh, G; Iburg, KM; Innos, K; Inoue, M; Iyer, VJ; Jacobs, TA; Jacobsen, KH; Jahanmehr, N; Jakovljevic, MB; James, P; Javanbakht, M; Jayaraman, SP; Jayatilleke, AU; Jeemon, P; Jensen, PN; Jha, V; Jiang, G; Jiang, Y; Jibat, T; Jimenez-Corona, A; Jonas, JB; Joshi, TK; Kabir, Z; Karnak, R; Kan, HD; Kant, S; Karch, A; Karema, CK; Karimkhani, C; Karletsos, D; Karthikeyan, G; Kasaeian, A; Katibeh, M; Kaul, A; Kawakami, N; Kayibanda, JF; Keiyoro, PN; Kemmer, L; Kemp, AH; Kengne, AP; Keren, A; Kereselidze, M; Kesavachandran, CN; Khader, YS; Khalil, IA; Khan, AR; Khan, EA; Khang, YH; Khera, S; Khoja, TAM; Kieling, C; Kim, D; Kim, YJ; Kissela, BM; Kissoon, N; Knibbs, LD; Knudsen, AK; Kokubo, Y; Kolte, D; Kopec, JA; Kosen, S; Koul, PA; Koyanagi, A; Krog, NH; Defo, BK; Bicer, BK; Kudom, AA; Kuipers, EJ; Kulkarni, VS; Kumar, GA; Kwan, GF; Lal, A; Lal, DK; Lalloo, R; Lam, H; Lam, JO; Langan, SM; Lansingh, VC; Larsson, A; Laryea, DO; Latif, AA; Lawrynowicz, AEB; Leigh, J; Levi, M; Li, Y; Lindsay, MP; Lipshultz, SE; Liu, PY; Liu, S; Liu, Y; Lo, LT; Logroscino, G; Lotufo, PA; Lucas, RM; Lunevicius, R; Lyons, RA; Ma, S; Machado, VMP; Mackay, MT; MacLachlan, JH; El Razek, HMA; El Razek, MMA; Majdan, M; Majeed, A; Malekzadeh, R; Manamo, WAA; Mandisarisa, J; Mangalam, S; Mapoma, CC; Marcenes, W; Margolis, DJ; Martin, GR; Martinez-Raga, J; Marzan, MB; Masiye, F; -Jones, AJM; Massano, J; Matzopoulos, R; Mayosi, BM; McGarvey, ST; McGrath, JJ; Mckee, M; McMahon, BJ; Meaney, PA; Mehari, A; Mehndiratta, MM; Mena-Rodriguez, F; Mekonnen, AB; Melaku, YA; Memiah, P; Memish, ZA; Mendoza, W; Meretoja, A; Meretoja, TJ; Mhimbira, FA; Micha, R; Miller, TR; Mirarefin, M; Misganaw, A; Mock, CN; Mohammad, KA; Mohammadi, A; Mohammed, S; Mohan, V; Mola, GLD; Monasta, L; Hernandez, JCM; Montero, P; Montico, M; Montine, TJ; Moradi-Lakeh, M; Morawska, L; Morgan, K; Mori, R; Mozaffarian, D; Mueller, U; Murthy, GVS; Murthy, S; Musa, KI; Nachega, JB; Nagel, G; Naidoo, KS; Naik, N; Naldi, L; Nangia, V; Nash, D; Nejjari, C; Neupane, S; Newton, CR; Newton, JN; Ng, M; Ngalesoni, FN; Ngirabega, JD; Le Nguyen, Q; Nisar, MI; Pete, PMN; Nomura, M; Norheim, OF; Norman, PE; Norrving, B; Nyakarahuka, L; Ogbo, FA; Ohkubo, T; Ojelabi, FA; Olivares, PR; Olusanya, BO; Olusanya, JO; Opio, JN; Oren, E; Ortiz, A; Osman, M; Ota, E; Ozdemir, R; Pa, M; Pandian, JD; Pant, PR; Papachristou, C; Park, EK; Park, JH; Parry, CD; Parsaeian, M; Caicedo, AJP; Patten, SB; Patton, GC; Paul, VK; Pearce, N; Pedro, JM; Stokic, LP; Pereira, DM; Perico, N; Pesudovs, K; Petzold, M; Phillips, MR; Piel, FB; Pillay, JD; Plass, D; Platts-Mills, JA; Polinder, S; Pope, CA; Popova, S; Poulton, RG; Pourmalek, F; Prabhakaran, D; Qorbani, M; Quame-Amaglo, J; Quistberg, DA; Rafay, A; Rahimi, K; Rahimi-Movaghar, V; Rahman, M; Rahman, MHU; Rahman, SU; Rai, RK; Rajavi, Z; Rajsic, S; Raju, M; Rakovac, I; Rana, SM; Ranabhat, CL; Rangaswamy, T; Rao, P; Rao, SR; Refaat, AH; Rehm, J; Reitsma, MB; Remuzzi, G; Resnikofff, S; Ribeiro, AL; Ricci, S; Blancas, MJR; Roberts, B; Roca, A; Rojas-Rueda, D; Ronfani, L; Roshandel, G; Rothenbacher, D; Roy, A; Roy, NK; Ruhago, GM; Sagar, R; Saha, S; Sahathevan, R; Saleh, MM; Sanabria, JR; Sanchez-Nino, MD; Sanchez-Riera, L; Santos, IS; Sarmiento-Suarez, R; Sartorius, B; Satpathy, M; Savic, M; Sawhney, M; Schaub, MP; Schmidt, MI; Schneider, IJC; Schottker, B; Schutte, AE; Schwebel, DC; Seedat, S; Sepanlou, SG; Servan-Mori, EE; Shackelford, KA; Shaddick, G; Shaheen, A; Shahraz, S; Shaikh, MA; Shakh-Nazarova, M; Sharma, R; She, J; Sheikhbahaei, S; Shen, JB; Shen, ZY; Shepard, DS; Sheth, KN; Shetty, BP; Shi, PL; Shibuya, K; Shin, MJ; Shiri, R; Shiue, I; Shrime, MG; Sigfusdottir, ID; Silberberg, DH; Silva, DAS; Silveira, DGA; Silverberg, JI; Simard, EP; Singh, A; Singh, GM; Singh, JA; Singh, OP; Singh, PK; Singh, V; Soneji, S; Soreide, K; Soriano, JB; Sposato, LA; Sreeramareddy, CT; Stathopoulou, V; Stein, DJ; Stein, MB; Stranges, S; Stroumpoulis, K; Sunguya, BF; Sur, P; Swaminathan, S; Sykes, BL; Szoeke, CEI; Tabares-Seisdedos, R; Tabb, KM; Takahashi, K; Takala, JS; Talongwa, RT; Tandon, N; Tavakkoli, M; Taye, B; Taylor, HR; Ao, BJT; Tedla, BA; Tefera, WM; Ten Have, M; Terkawi, AS; Tesfay, FH; Tessema, GA; Thomson, AJ; Thorne-Lyman, AL; Thrift, AG; Thurston, GD; Tillmann, T; Tirschwell, DL; Tonelli, M; Topor-Madry, R; Topouzis, F; Nx, JAT; Traebert, J; Tran, BX; Truelsen, T; Trujillo, U; Tura, AK; Tuzcu, EM; Uchendu, US; Ukwaja, KN; Undurraga, EA; Uthman, OA; Van Dingenen, R; Van Donkelaar, A; Vasankari, T; Vasconcelos, AMN; Venketasubramanian, N; Vidavalur, R; Vijayakumar, L; Villalpando, S; Violante, FS; Vlassov, VV; Wagner, JA; Wagner, GR; Wallin, MT; Wang, LH; Watkins, DA; Weichenthal, S; Weiderpass, E; Weintraub, RG; Werdecker, A; Westerman, R; White, RA; Wijeratne, T; Wilkinson, JD; Williams, HC; Wiysonge, CS; Woldeyohannes, SM; Wolfe, CDA; Won, SH; Wong, JQ; Woolf, AD; Xavier, D; Xiao, QY; Xu, GL; Yakob, B; Yalew, AZ; Yan, LL; Yano, YC; Yaseri, M; Ye, P; Yebyo, HG; Yip, P; Yirsaw, BD; Yonemoto, N; Yonga, G; Younis, MZ; Yu, SC; Zaidi, Z; Zaki, MES; Zannad, F; Zavala, DE; Zeeb, H; Zeleke, BM; Zhang, H; Zodpey, S; Zonies, D; Zuhlke, LJ; Vos, T; Lopez, AD; Murray, CJL
    Background 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. Methods 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, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.
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    Iatrogenic meningitis after lumbar puncture - a preventable health hazard
    (JOURNAL OF HOSPITAL INFECTION, 2004) Pandian, JD; Sarada, C; Radhakrishnan, VV; Kishore, A
    Iatrogenic meningitis (IM) is a rare complication of diagnostic and therapeutic lumbar puncture (LP). This study includes cases of IM managed in the Departments of Neurology, of two referral hospitals, in India between January 1984 and April 2002. The diagnosis of IM was made when symptoms of meningitis occurred 24 h to 21 days after LP. All the procedures were performed in the peripheral hospitals before they were referred to the two centres. There were 17 (63%) women and 10 (37%) men. The age range was 19-50 years with a mean age of 31. The precipitating event was spinal anaesthesia for pelvic and intra-abdominal surgeries (Caesarean section 11 cases, hysterectomy three cases, herniorraphy two cases, appendicectomy two cases, anal fissurectomy one case, varicocelectomy one case and hydrocelectomy one case) laminectomy in two and diagnostic myelogram in four patients. The cerebrospinal fluid (CSF) culture was positive in six (22%) patients. The organisms were Pseudomonas aeruginosa in one case, Staphylococcus aureus in three cases, Acinetobacter spp. in one case and Mycobacterium tuberculosis in one case. In five individuals, mycotic aneurysms with subarachnoid haemorrhage due to invasive aspergillosis was documented at autopsy. The mean follow-up was 10.6 months (range 1-18). Seventeen (63%) patients received conventional antibiotics alone, while 10 patients received antibiotics and anti-tuberculous drugs when the meningitis became chronic. The mortality was 36%. The poor prognostic factors were women who underwent Caesarean section (P < 0.04), presence of hemiplegia (P < 0.04) and altered mental status (P < 0.0004). This study shows high morbidity and mortality of IM after LP. Simple aseptic precautions undertaken before the procedure can prevent IM. The urgent need for increasing the awareness among medical personnel in peripheral hospitals of developing countries cannot be over emphasized. (C) 2003 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
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    ILLICIT DRUG USE AND STROKE IN INDIA: DATA FROM INDO-US STROKE REGISTRY
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Arora, D; Pandian, JD; Pannu, A; Sylaja, PN; Kaul, S; Khurana, D; Padma, MV; Thankachan, T; Singhal, AB
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    INFLUENCE OF RELIGION ON STROKE RISK FACTORS AND OUTCOME IN INDIA: DATA FROM INDO US STROKE REGISTRY
    (INTERNATIONAL JOURNAL OF STROKE, 2016) Arora, D; Pandian, JD; Pannu, A; Sylaja, PN; Kaul, S; Khurana, D; Padma, MV; Thankachan, T; Singhal, AB
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    Intravenous and Intra-arterial Thrombolysis In India: The Indo-US Stroke Project
    (CEREBROVASCULAR DISEASES, 2014) Pandian, JD; Sylaja, PN; Kaul, S; Khurana, D; Padma, MV; Thankachan, T; Arora, D; Titus, P; Singhal, A
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    Maternal and fetal outcome in women with epilepsy associated with neurocysticercosis
    (EPILEPTIC DISORDERS, 2007) Pandian, JD; Venkateswaralu, K; Thomas, SV; Sarma, PS
    Aim. We wanted to characterize the clinical profile and outcome of pregnancy in women with epilepsy due to neurocysticercosis (NCC) enrolled in the Indian Registry of Epilepsy and Pregnancy (IREP).Methods. We identified all women with NCC in the IREP between January 2000 and September 2005. Age- and parity-matched patients without NCC were identified from the respective centers of IREP for comparison. Statistical analysis was performed using SPSS version 11. Results. There were 30 women with NCC (mean age 24.3 +/- 4 years) among 1071 registrations in the]REP. All the patients had NCC prior to the pregnancy. Fourteen (47%) NCC patients had calcified lesions and 16 (53%) had ring lesions in a CT scan of the brain. Compared to women without NCC, the NCC group had later age-at-onset of seizures (20.7 +/- 4.4 years, p = 0.008) and epilepsy (21.1 +/- 5.2 years, p = 0.01). They were more likely to have partial seizures (70% versus 301%, p = 0.002), an EEG without epileptiform abnormalities (50% versus 100%, p = 0.01), and better control of seizures before (47% versus 3%, p = 0.001) and during pregnancy (33% versus 10%, p = 0.02). Maternal and neonatal complications did not differ between the groups. Conclusions. NCC is an uncommon cause of epilepsy in pregnant women enrolled in IREP. To be noted, as a limitation of our study, that the IREP is a hospital-based registry, which may not reflect global epilepsy characteristics of the community. The maternal and fetal outcome for NCC patients was not different from those women without NCC.
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    Myasthenia gravis, motor neuron syndrome and thymoma
    (NEUROLOGY INDIA, 1998) Pandian, JD; Mathuranath, PS; Suresh, PA; Radhakrishnan, K
    An adult male with thymomatous myasthenia gravis (MG) and a motor neuron syndrome simulating amyotrophic lateral sclerosis is reported. After thymectomy and corticosteroid therapy, the MG remitted. During 4 years of follow-up, the lower motor neuron signs in the upper limbs and upper motor neuron signs in the lower limbs remained unchanged. Literature concerning paraneoplastic neurological syndromes associated with thymoma has been reviewed.
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    Premorbid nutrition and short term outcome of stroke: a multicentre study from India
    (JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2011) Pandian, JD; Jyotsna, R; Singh, R; Sylaja, PN; Vijaya, P; Padma, MV; Venkateswaralu, K; Sukumaran, S; Radhakrishnan, K; Sarma, PS; Mathew, R; Singh, Y
    Background Little is known about the impact of premorbid undernutrition on stroke outcome in developing countries. Aim To study the impact of premorbid undernutrition status, measured by the Subjective Global Assessment (SGA) tool, on short term stroke outcome. Methods First ever stroke patients admitted to six major hospitals in North and South India participated in this study from 1 March 2008 to 30 September 2009. The SGA tool was administered within 48 h of stroke onset, and 6 months premorbid nutritional status was rated as well nourished (A rating) and undernourished (B and C ratings) using this tool. Stroke outcome was assessed after 30 days using the modified Rankin scale (mRs), and a mRs score >3 was defined as a poor outcome. Statistical analyses were performed using SPSS Statistics V.17.0. Results Of 477 patients enrolled, 448 patients were included in the analyses. Mean age was 58.1 +/- 13.7 years (range 16-96) and 281 (62.7%) patients were men. At admission, premorbid undernutrition was found in 121 (27.2%) patients. Older age (OR 4.99, CI 1.26 to 19.64, p=0.021), hypertension (OR 1.99, CI 1.04 to 3.79, p=0.037) and patients from Andhra Pradesh State (OR 1.87, CI 1.05 to 3.32, p=0.032) were predictors of undernutrition in multiple logistic regression analysis. Premorbid undernutrition (OR 1.99, CI 1.20 to 3.31, p=0.007) and length of hospital stay (OR 3.41, CI 1.91 to 6.06, p<0.0001) were the independent predictors of poor outcome in the multiple logistic regression model. Conclusions High rates of premorbid undernutrition in stroke patients were found. Age, hypertension and patients from Andhra Pradesh State were predictors of premorbid undernutrition. Premorbid undernutrition was associated with poor stroke outcome. The results provide opportunities for primary prevention and improving stroke outcome.