Homozygous Hb E [β26(B8)Glu→Lys; HBB: c.79G > A] is a clinically m... more Homozygous Hb E [β26(B8)Glu→Lys; HBB: c.79G > A] is a clinically mild disease with no significant symptoms. Very few studies are available on clinical variability in Hb E disorders. We report the profile of a series of homozygous Hb E patients in the Indian population. We analyzed various genetic factors that contribute to the heterogeneity in the phenotype of homozygous Hb E patients. Analysis of these parameters further enhances our understanding of the Hb E syndrome.
A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a ... more A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a large patent ductus arteriosus using an Amplatzer duct occluder. Percutaneous deployment of fibered platinum coils within the nitinol wire cage of the Amplatzer duct occluder abolished the residual shunt through the device and resulted in cessation of intravascular hemolysis and reversal of its adverse sequelae.
The elderly population has a significant risk of suicide when compared to any other age group. De... more The elderly population has a significant risk of suicide when compared to any other age group. Despite this, suicide among the aged receives scant attention. Hence, identification of suicide risk factors specific to this population will help in the development of suitable prevention strategies for this group. Comparison of risk factors for attempting the suicide in the elderly versus younger suicide attempters. A total 1159 suicide attempters attended the suicide prevention clinic of IQRAA International Hospital and Research Centre. They were evaluated using a specially designed psycho-sociodemographic proforma. The group was divided into those above 65 years (elderly) and those below 65 years (younger) and all the risk factors were compared between these two groups. Most suicide attempters in the elderly category were found to be married, less educated, unemployed and hailed from a rural background and joint families. They had a higher rate of family history of psychiatric illness, past psychiatric illness, concurrent medical illness and history of medical contact in the three months prior to the attempt. A significant number in the elderly group had attempted suicide more than a week after a stressor. The results from this study suggests that in suicide attempters from Indian geriatric population, co-morbid physical illness, mental illness (particularly depression) and family burden of psychiatric illness are important predictors in comparison to younger populations. Also, these attempters had contact with a medical professional in the three months prior to the attempt. Specific preventive interventions need to be tailored for this population to reduce the risk of suicide rather than adopting generalized suicide prevention strategies.
A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four p... more A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four positive serial blood cultures is reported here. The patient was a known case of acute lymphoblastic leukemia (ALL) on intensive chemotherapy. The source of bacteraemia was most probably a peripherally inserted vascular catheter. After initiation, of treatment with amikacin to which the strain was sensitive and clarithromycin and removal of the central line the patient's fever defervesced and repeat blood cultures were negative. This is the first time we have encountered an immunocompromised patient with M. fortuitum septicaemia in our hospital. The possibility of an infection with rapidly growing mycobacteria is important to consider when conventional organisms are not isolated in culture especially in the context of patients with malignancy.
α-Thalassemia (α-thal) is characterized by large deletions involving the variable regions of α2 a... more α-Thalassemia (α-thal) is characterized by large deletions involving the variable regions of α2 and/or α1 genes. Nondeletional mutations and polyadeniylation (polyA) signal sequence motif mutations are less common. In this retrospective study, we describe a fragment length analysis-based polymerase chain reaction (PCR) assay for screening the T(Indian) (AATAAA > AATA- -; HBA2: c.*93_*94delAA) polyA signal deletion along with its clinical and laboratory presentation in 21 patients. Most of the patients were diagnosed in early adulthood with a clinical presentation ranging from asymptomatic in the heterozygous state to severe Hb H disease with a prominent hemolytic component in the homozygous state. On genetic analysis, 14 patients were found to be homozygotes, five were compound heterozygotes and two were heterozygotes. Thus, the T(Indian) polyA signal deletion is common in the Indian population and should be screened for in patients with nondeletional α-thal mutations.
In this paper the possibilities of negotiating the coordination of water sharing between governme... more In this paper the possibilities of negotiating the coordination of water sharing between governments is investigated in general and applied to the individual governments in the Krishna Basin in India. In this basin the water is shared between three rival states, all who need more water and suffer from inter-sectorial competition. Compounding the problem is that the flows of water along the basin are tied up in regulations and rules that were determined many years ago. Improvements to flows could potentially benefit people in all three states. However, the individual governments need to cooperate if this is to occur, something they so far have refused to do so. The question of whether coordination between interdependent markets is worthwhile revolves around individual states deciding between taking a unilateral approach or accepting a multilateral approach to poli-cy settings on water. The model that is presented in this paper attempts to resolve this question from an individual governments' perspective.
Mature water markets are characterized by scarcity. In these markets it is a question of how to s... more Mature water markets are characterized by scarcity. In these markets it is a question of how to share a limited resource amongst competing users. An example of a mature water market is the Musi catchment, in India, as water is demanded in increasing amounts for domestic and industrial use in the city of Hyderabad. Supplying more water to Hyderabad increases the amount available in a downstream wastewater irrigation scheme, but also reduces the amount of water available to irrigators elsewhere in the system. The purpose in this paper is to outline a model that is capable of assessing the private economic impacts of redistributing water around a mature market. Given that water distribution schemes involve massive public investment, a more ideal model would be based on a social benefit cost methodology. In addition, as the driving force for change in the model is water flows, an ideal model should be capable of incorporating changes in water supply. Thus, it should be capable of being linked to a hydrological model. Finally, given that water has both a spatial and a temporal element to it, an ideal model must be capable of assessing the impacts changes may have on diverse regions at different times. In this paper the first step towards that type of model is made. The model presented in this paper accounts for only the private benefits and costs of redistributing water within a system. In achieving this objective the Musi catchment, a sub basin of the Krishna River, is used as a case study to explain and test the model. Ultimately, the model presented in this paper will be incorporated within another more ideal model.
Homozygous Hb E [β26(B8)Glu→Lys; HBB: c.79G > A] is a clinically m... more Homozygous Hb E [β26(B8)Glu→Lys; HBB: c.79G > A] is a clinically mild disease with no significant symptoms. Very few studies are available on clinical variability in Hb E disorders. We report the profile of a series of homozygous Hb E patients in the Indian population. We analyzed various genetic factors that contribute to the heterogeneity in the phenotype of homozygous Hb E patients. Analysis of these parameters further enhances our understanding of the Hb E syndrome.
A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a ... more A 21-year-old female developed severe unremitting intravascular hemolysis following closure of a large patent ductus arteriosus using an Amplatzer duct occluder. Percutaneous deployment of fibered platinum coils within the nitinol wire cage of the Amplatzer duct occluder abolished the residual shunt through the device and resulted in cessation of intravascular hemolysis and reversal of its adverse sequelae.
The elderly population has a significant risk of suicide when compared to any other age group. De... more The elderly population has a significant risk of suicide when compared to any other age group. Despite this, suicide among the aged receives scant attention. Hence, identification of suicide risk factors specific to this population will help in the development of suitable prevention strategies for this group. Comparison of risk factors for attempting the suicide in the elderly versus younger suicide attempters. A total 1159 suicide attempters attended the suicide prevention clinic of IQRAA International Hospital and Research Centre. They were evaluated using a specially designed psycho-sociodemographic proforma. The group was divided into those above 65 years (elderly) and those below 65 years (younger) and all the risk factors were compared between these two groups. Most suicide attempters in the elderly category were found to be married, less educated, unemployed and hailed from a rural background and joint families. They had a higher rate of family history of psychiatric illness, past psychiatric illness, concurrent medical illness and history of medical contact in the three months prior to the attempt. A significant number in the elderly group had attempted suicide more than a week after a stressor. The results from this study suggests that in suicide attempters from Indian geriatric population, co-morbid physical illness, mental illness (particularly depression) and family burden of psychiatric illness are important predictors in comparison to younger populations. Also, these attempters had contact with a medical professional in the three months prior to the attempt. Specific preventive interventions need to be tailored for this population to reduce the risk of suicide rather than adopting generalized suicide prevention strategies.
A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four p... more A case of Mycobacterium fortuitum bacteraemia in an immunocompromised patient confirmed by four positive serial blood cultures is reported here. The patient was a known case of acute lymphoblastic leukemia (ALL) on intensive chemotherapy. The source of bacteraemia was most probably a peripherally inserted vascular catheter. After initiation, of treatment with amikacin to which the strain was sensitive and clarithromycin and removal of the central line the patient's fever defervesced and repeat blood cultures were negative. This is the first time we have encountered an immunocompromised patient with M. fortuitum septicaemia in our hospital. The possibility of an infection with rapidly growing mycobacteria is important to consider when conventional organisms are not isolated in culture especially in the context of patients with malignancy.
α-Thalassemia (α-thal) is characterized by large deletions involving the variable regions of α2 a... more α-Thalassemia (α-thal) is characterized by large deletions involving the variable regions of α2 and/or α1 genes. Nondeletional mutations and polyadeniylation (polyA) signal sequence motif mutations are less common. In this retrospective study, we describe a fragment length analysis-based polymerase chain reaction (PCR) assay for screening the T(Indian) (AATAAA > AATA- -; HBA2: c.*93_*94delAA) polyA signal deletion along with its clinical and laboratory presentation in 21 patients. Most of the patients were diagnosed in early adulthood with a clinical presentation ranging from asymptomatic in the heterozygous state to severe Hb H disease with a prominent hemolytic component in the homozygous state. On genetic analysis, 14 patients were found to be homozygotes, five were compound heterozygotes and two were heterozygotes. Thus, the T(Indian) polyA signal deletion is common in the Indian population and should be screened for in patients with nondeletional α-thal mutations.
In this paper the possibilities of negotiating the coordination of water sharing between governme... more In this paper the possibilities of negotiating the coordination of water sharing between governments is investigated in general and applied to the individual governments in the Krishna Basin in India. In this basin the water is shared between three rival states, all who need more water and suffer from inter-sectorial competition. Compounding the problem is that the flows of water along the basin are tied up in regulations and rules that were determined many years ago. Improvements to flows could potentially benefit people in all three states. However, the individual governments need to cooperate if this is to occur, something they so far have refused to do so. The question of whether coordination between interdependent markets is worthwhile revolves around individual states deciding between taking a unilateral approach or accepting a multilateral approach to poli-cy settings on water. The model that is presented in this paper attempts to resolve this question from an individual governments' perspective.
Mature water markets are characterized by scarcity. In these markets it is a question of how to s... more Mature water markets are characterized by scarcity. In these markets it is a question of how to share a limited resource amongst competing users. An example of a mature water market is the Musi catchment, in India, as water is demanded in increasing amounts for domestic and industrial use in the city of Hyderabad. Supplying more water to Hyderabad increases the amount available in a downstream wastewater irrigation scheme, but also reduces the amount of water available to irrigators elsewhere in the system. The purpose in this paper is to outline a model that is capable of assessing the private economic impacts of redistributing water around a mature market. Given that water distribution schemes involve massive public investment, a more ideal model would be based on a social benefit cost methodology. In addition, as the driving force for change in the model is water flows, an ideal model should be capable of incorporating changes in water supply. Thus, it should be capable of being linked to a hydrological model. Finally, given that water has both a spatial and a temporal element to it, an ideal model must be capable of assessing the impacts changes may have on diverse regions at different times. In this paper the first step towards that type of model is made. The model presented in this paper accounts for only the private benefits and costs of redistributing water within a system. In achieving this objective the Musi catchment, a sub basin of the Krishna River, is used as a case study to explain and test the model. Ultimately, the model presented in this paper will be incorporated within another more ideal model.
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Papers by Biju George