Publications by authors named "Shubhabrata Das"

6 Publications

  • Page 1 of 1

Antithrombotic Management in Ischemic Stroke with Essential Thrombocythemia: Current Evidence and Dilemmas.

Med Princ Pract 2021 Apr 13. Epub 2021 Apr 13.

Thrombotic diseases like ischemic stroke are common complications of essential thrombocythemia (ET) due to abnormal megakaryopoiesis and platelet dysfunction. Ischemic stroke in ET can occur as a result of both cerebral arterial and venous thrombosis. Management of ET is aimed at preventing vascular complications including thrombosis. Acute management of ischemic stroke in ET is the same as that in the general population without myeloproliferative disorder. However, an ET patient with ischemic stroke is at high risk for re-thrombosis and therefore additionally managed with cytoreductive therapy and antithrombotic agents. Given abnormal platelet production in ET, there is suboptimal suppression of platelets with the usual recommended dose of Aspirin for cardiovascular (CV) prevention. Hence, for optimal CV protection in ET, low dose Aspirin is recommended twice daily in an arterial thrombotic disease like atherothrombotic ischemic stroke in presence of the following risk factors: age > 60 years, Janus kinase2V617F gene mutation, presence of CV risk factors. In presence of the same risk factors, concurrent antiplatelet and anticoagulant therapy is suggested for venous thrombosis. However, increased risk of bleeding with dual anti-thrombotic agents poses a significant challenge in their use in cerebral venous thromboembolism or, atrial fibrillation in presence of the above-mentioned risk factors. We discuss these dilemmas about antithrombotic management in ischemic stroke in ET in this cased based review of literature in the light of current evidence.
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http://dx.doi.org/10.1159/000516471DOI Listing
April 2021

Disease Activity in Spondyloarthropathy: Does it affect Vascular Health?

J Assoc Physicians India 2018 Jul;66(7):63-66

Student, Bankura Sammilani Medical College, Bankura, West Bengal.

Background: Chronic inflammation in spondyloarthropathy (SpA) is associated with accelerated atherosclerotic cardiovascular disease (CVD). Flow mediated vasodilatation (FMD) and carotid intima-media thickness (cIMT) detects endothelial dysfunction and subclinical atherosclerosis respectively, responsible for atherosclerotic CVD.

Objective: We aimed to examine the association of disease activity in SpA with surrogate markers of CVD, i.e., FMD and cIMT.

Methods: Fifty patients of Axial SpA (Assessment of SpondyloArthritis Society-ASAS 2009 criteria) (<5 years disease duration) and 50 control subjects, matched for age (33.7±8.8 vs. 33.7±8.4 years) and sex, with no CV risk factors were recruited. Ultrasound assessment of FMD of brachial artery and cIMT of both common carotid arteries were performed. Measurements were compared between patients and controls by Student's t test. Association of disease activity in SpA patients with FMD and cIMT, were evaluated by Pearson/Spearman's correlation.

Results: FMD (4.9±1.4 vs. 8.7±1.6 %) and cIMT (0.52±0.04 vs. 0.44±0.11 mm), were impaired in SpA patients than healthy controls (all p<0.05). However, subjects in both the groups had no difference in age and body mass index with similar, within normal range blood pressure and lipid profile.

Conclusion: We observed that FMD and cIMT were deranged in SpA, and higher disease activity in SpA was associated with impaired FMD and cIMT. However, a larger population with a prospective study-design would further confirm this relationship between SpA disease activity and CVD surrogate markers.
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July 2018

Haemolytic anaemia as first manifestation of Wilson's disease: a report of two cases.

J Assoc Physicians India 2014 Oct;62(10):55-7

Wilson's disease can have different manifestations like jaundice, cirrhosis of liver, extrapyramidal symptoms and dementia. Haemolytic anaemia may occur but it is commonly associated with florid manifestation of liver disease. Sometimes, liver cell necrosis can release huge free copper ions in blood, giving rise to oxidant damage to erythrocytes. Oxidative damage to cell membrane, haemoglobin and erythrocyte metabolism causes haemolytic crisis. In some cases, liver involvement is subclinical, but nonetheless, free copper is released from necrosed hepatocytes and causes oxidative damage to erythrocytes.We had two cases of Wilson's disease with initial presentation as severe haemolytic anaemia and no other clinical feature suggestive of Wilson's disease was present. In unclear cause of haemolytic anaemia, especially in adolescents or young adults, Wilson's disease should be considered. As Wilson disease is rare and its initial presentation with haemolytic anaemia is rarer, high level of suspicion is required to diagnose it.
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October 2014

Generalised hyperpigmentation in vitamin B12 deficiency.

J Assoc Physicians India 2014 Aug;62(8):714-6

In developing countries like India, nutritional deficiencies are prevalent and hyperpigmentation due to protein energy malnutrition, zinc deficiency and pellagra are common. Indian women, especially vegetarian are prone to vitamin B12 deficiency. Vitamin B12 deficiency can present as anaemia, neurological defect, gastrointestinal symptoms or dementia. Hyperpigmentation as the first presentation of Vitamin B12 deficiency is rare. Our patient, a 45 year-old Hindu vegetarian female presented to us with generalized hyperpigmentation. Examination revealed associated anaemia and peripheral neuropathy. Laboratory investigation confirmed vitamin B12 deficiency. Clinical features along with hyperpigmentation improved with vitamin B12 supplementation. We report this case to highlight this rare manifestation of vitamin B12 deficiency. A high index of clinical suspicion is warranted to diagnose the case. Since India is a country with a large number of potential vitamin B12 deficiency cases, the physicians need to be aware of all the varied manifestations of this vitamin deficiency. In case of hyperpigmentation, nutritional aspect must be ruled out as it is reversible. Early replacement therapy may also help to prevent morbidities like dementia and neuropathy.
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August 2014

Hyperventilation of pregnancy presenting with flaccid quadriparesis due to hypokalaemia secondary to respiratory alkalosis.

J Assoc Physicians India 2014 Jun;62(6):536-8

Hyperventilation in pregnancy is a cause of chronic respiratory alkalosis. Alkalosis either metabolic or respiratory may cause intracellular shift of potassium ions that may lead to hypokalaemia. However, the resultant hypokalaemia in respiratory alkalosis is usually mild and does not cause much clinical features. A five-months-pregnant female of the age 25 years presented with sudden onset flaccid weakness of both lower limbs associated with thigh muscle pain followed by weakness of both upper limbs within three days. Subsequent investigation revealed severe hypokalaemia due to acute exacerbation of chronic respiratory alkalosis secondary to hyperventilation of pregnancy, other causes of hypokalaemia being ruled out. Respiratory alkalosis causes tetany and other clinical manifestations. But hypokalaemia and such weakness is rarely found. Thisis probably the first report of this type from India.
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June 2014

Congenital giant right atrium in an elderly woman.

J Assoc Physicians India 2014 Jul;62(7):634-6

Enlargement of right atrium is usually secondary to pulmonary hypertension due to valvular heart diseases or obstructive pulmonary disorders, atrial septal defect, tricuspid atresia or stenosis, pulmonary stenosis, primary pulmonary hypertension, Ebstein's anomaly. Congenital enlargement of right atrium is rare and it commonly presents in children. Our patient presented with congenital giant right atrium at 65 years of age, other cardiac diseases being excluded. Patient developed tricuspid regurgitation, but pulmonary hypertension was absent till the date. Congenital giant right atrium has rarely been reported from India.
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July 2014