...home of the St. Johns Medical College Community

  • Increase font size
  • Default font size
  • Decrease font size

OSU Cardilogist is Chief Editor Of Heart Journal

E-mail Print PDF
COLUMBUS, Ohio -- Dr. Ragavendra R. Baliga (40354), director of cardiovascular medicine at Ohio State University Hospital East, has been named senior consulting editor for Heart Failure Clinics, a medical journal that provides reviews on cutting-edge topics related to heart failure.

In addition to his role as senior consulting editor, Baliga is also associate editor for the American College of Cardiology’s Cardiosource Review Journal and author of several books including Crash Course: Internal Medicine and Aortic Dissection and Related Syndromes.

He has served as guest editor for the book series “Cardiology Clinics,” which features articles on cardio renal disease and focuses on areas that link kidney and heart disease.

Kristina Day
Medical Center Communications
This e-mail address is being protected from spambots. You need JavaScript enabled to view it




IU, Purdue land prestigious research grant

E-mail Print PDF

Indiana and Purdue universities will create a new medical research program after receiving a $25 million grant from the National Institutes of Health, the universities announced today.

IU and Purdue will launch the Indiana Clinical and Translational Sciences Institute to turn scientific and medical discoveries more quickly into better care for patients and into new commercialized medical products.

The money will be given over five years to the IU School of Medicine in Indianapolis. The medical school will combine those funds with $56 million appropriated by IU and Purdue, the state and Eli Lilly and Co. to fund the research program.

The Clinical and Translational Science Award is one of 38 such grants given by the NIH since 2006. The grants are coveted by medical research centers because they are seen as marking out the nation's top-tier medical schools. Other recipients this year include Harvard, Ohio State and Stanford universities.

"It's not just the money; it's what the award says," said David Johnson, CEO of BioCrossroads Inc., a group that promotes life sciences development in central Indiana. "What it does is to cement the medical school on the map among the schools of the 21st century."

BioCrossroads and the Indiana Economic Development Corp. will be partners in the initiative. So, too, will Clarian Health, Cook Group, Roche Diagnostics and WellPoint Inc.

Dr. Anantha Shekhar (SJMC Batch of 1975), a psychiatrist who is Indiana University's Assistant Vice president for Life Sciences, will direct the institute.

Its deputy directors are Connie Weaver, head of Purdue's foods and nutrition program, and Bennett Bertenthal, dean of the IU College of Arts and Sciences in Bloomington.

Purdue will contribute not only research, but also will use its network of extension offices in Indiana's 92 counties to try to disseminate the institute's findings to health care providers and to solicit their input for research projects.

The funding marks a new strategy for the NIH, which is shrinking the amount of money it gives to basic medical research in order to spend more on efforts to apply research breakthroughs in clinics and companies.

"The consortium (of schools) serves as the bridge in this process that allows researchers to perfect and refine existing treatment through interdisciplinary teams that extend to the clinic and community," NIH Director Dr. Elias A. Zerhouni said in a statement.

The Indiana institute will create a Web-based home called CTSI HUB that will include a database of researchers and their work, research programs, and available experts. The goal is to help all the participants in the statewide initiative to communicate more effectively.

IU President Michael A. McRobbie said the initiative ultimately will make IU and Purdue researchers more competitive for winning other grant money.

"The institute harnesses all of Indiana's major life sciences research centers into a commonly focused enterprise that will give Indiana's research scientists many new advantages in finding ways to do their work more effectively and efficiently," McRobbie said in a statement.'

The NIH announced a total of 14 grants today for a combined $533 million. The size of IU's grant is below the average grant size of $38 million.


An Appeal By Johnite Wenzel Vas To All Alumni

E-mail Print PDF

Hey Johnites,

Hope many of you as possible can make it to the Reunion in Orlando Florida in August later on this year.If you have been reading all of Ragaven's postings you will be aware  of the fact that a lot of ground breaking research has emerged from our Alma Mater. Saint Johns is on the cusp of becoming a premier medical institution in India. We alumni could give the Research Institute a much needed boost by trying to build up a fund which could be used by the institution to reach greater heights.

Perhaps we could get fifty Johnites taking turns to pledge an amount of 2000$ for five years (tax deducitible) which could result in 100,000 $ being collected every year for five years. By way of context one Alumni already has pledged $100,000. The college subsidised our fees hugely. My fees were Rs.500 per year that is 12$ per year in 1967. The return on this small amount is incalculable. Now is your chance to do a little pay back and help move this intitiative forward.

So friends please consider suporting this cause and hope to see you all at the Reunion. Just in case you cannot make it please consider making a cheque out to help our Alma Mater in reaching new heights.

Thank you

Wenzel Vas
Alumnus 1967


Abstract At ASCO Meeting 2008-- Presenter-Dr Leo Mascarenhas

E-mail Print PDF

Randomized phase II window study of two schedules of irinotecan (CPT-11) and vincristine (VCR) in rhabdomyosarcoma (RMS) at first relapse/disease progression.


Pediatric Solid Tumors


Pediatric Cancer


2008 ASCO Annual Meeting

Abstract No:



J Clin Oncol 26: 2008 (May 20 suppl; abstr 10013)


L. Mascarenhas, E. R. Lyden, P. P. Breitfeld, S. S. Donaldson, C. N. Paidas, D. M. Parham, W. H. Meyer, D. S. Hawkins, Soft Tissue Sarcoma Commitee of the Children's Oncology Group


Background: Patients with RMS have a poor prognosis at first relapse/disease progression. CPT-11 has significant and schedule-dependent preclinical activity in RMS, and prolonged exposure results in increased efficacy.

 Methods: Patients with biopsy proven RMS, < 21 years of age at original diagnosis and unfavorable prognosis at first relapse/progression were eligible. Entry criteria were: life expectancy > 2 months, performance status < 2, adequate organ function and written informed consent. Patients were randomized to one of two schedules of CPT-11/VCR: Regimen 1A: CPT-11, 20 mg/m2 intravenously (IV) daily x 5d x 2w on weeks 1 and 4, VCR 1.5 mg/m2 IV on day 1 of weeks 1, 2, 4 and 5; Regimen 1B: CPT-11, 50 mg/m2 IV daily x 5d

on weeks 1 and 4, VCR identical to IA. Disease response at week 6 was assessed using RECIST. Secondary endpoints included toxicity, progression free survival (PFS) and survival (OS). The study was powered to detect a 25% improvement in response to IA when compared to IB (?=0.1, 1-?=0.9, 1-sided test). Those with responsive/stable disease continued to receive 44 weeks of standard multi-agent chemotherapy (doxorubicin, cyclophosphamide, etoposide, ifosfamide) in combination with their assigned CPT- 11/VCR regimen. Results: 92 patients were randomized (IA-45, IB-47)

 Response in 86 evaluable patients was: 1A - 4 CR, 6 PR, 11 SD, 19 PD (overall response 25%) 1B - 0 CR, 17 PR, 14 SD, 15 PD (overall response 37%) (p=0.23). The 1-year PFS on IA was 32% (95% CI: 18%, 47%) and for IB was 36% (95% CI: 22%, 50%). The 1-year OS for IA was 47% (95% CI: 30%, 62%) and 1B was 56% (95% CI: 40%, 69%). There were no unexpected toxicities or significant differences in toxicity between the two regimens.

Conclusions: There was no difference in the response rates between the two CPT-11/VCR regimens. The shorter, more convenient CPT-11/VCR regimen is now being investigated in frontline Children's Oncology Group RMS clinical trials. 

Uveitis Following Snake Venom Therapy

E-mail Print PDF

Journal of Venomous Animals and Toxins including Tropical Disease


Uveitis following anti-snake venom therapy

Nayak S. G.I; Satish R.I; Nityanandam S.II; Thomas R. K.II

IDepartment of Nephrology, St. John's Medical College Hospital, Bangalore, Karnataka State, India
IIDepartment of Ophthalmology, St. John's Medical College Hospital, Bangalore, Karnataka State, India


Snakebite is a common medical emergency in the tropics, causing multisystemic involvement. Ophthalmic manifestations after snakebite have included ptosis and ophthalmoplegia. Uveitis as an immunological complication following therapy with anti-snake venom (ASV) serum has been rarely reported in literature. We reported two patients who developed uveitis and acute renal failure following snakebite treatment with ASV serum. Both patients recovered uneventfully with appropriate therapy.

Key words: snakebite, uveitis, anti-snake venom, ptosis, ophthalmoplegia.


Ocular manifestations resulting from snake envenomation are myriad and vary with the nature of the toxin. Elapidae (cobras and kraits) venoms are mainly neurotoxic and may cause neuro-ophthalmologic manifestations. These include diplopia, poor visual acuity, ophthalmoplegia and ptosis. Viperidae venoms are hematotoxic and may lead to subconjunctival hemorrhage, hyphema, retinal and vitreous hemorrhages.

Uveitis associated with snakebites is rare, and only one case has been reported in literature (1). We reported two patients presenting viper envenomation who developed bilateral uveitis after receiving anti-snakevenom (ASV) therapy.



A 20-year-old man sought treatment for oliguria and epistaxis following viper envenomation two days prior to admission at St. John's Medical College Hospital, Bangalore, Karnataka State, India. The patient had received anti-snake venom sera at a primary treatment center.

Systemically, the patient was conscious, alert and stable. Hematological evaluation revealed a marked reduction in platelet count (5,000/mm3) and low hemoglobin levels (7.5mg/dl). Prothrombin time (patient, 20.4s; control, 17s) and activated prothrombin time (APTT: patient, 43s; control, 34s) were prolonged. Renal function tests were abnormal: blood urea (BU), 303mg/dl; serum creatinine, 12.2mg/dl. Urine analysis was normal. He was treated with hemodialysis with multiple transfusions and anti-snake venom sera. The patient sought an ophthalmology consult 15 days after the snakebite due to rapidly, progressive, painless loss of vision in both eyes. Ocular examination revealed visual acuity of 6/18; <N36 both eyes, which deteriorated to 4/60 over the next 24 hours. There was bilateral subconjunctival hemorrhage. Pupils were sluggishly reactive to light. Slit lamp examination showed 2+ cells and flare, as well as 3+ retrolental cells. Fundus view was hazy due to vitritis, hyperemic optic disc and tortuous retinal blood vessels. B-scan ultrasound showed a few vitreous echoes, and the rest of the posterior segment was normal. Intravenous methyl prednisolone (IV MP) was administered at the dose of 1g/day for 3 days. Thereafter, the patient received oral prednisolone at the dose of 40mg/day, which was tapered over 4 weeks. At the beginning of IV MP injections, renal functions were grossly abnormal although the hematological parameters were normal.

Visual acuity improved to 6/9; N6 both eyes, with marked reduction of vitritis on day 3 of IV MP treatment. There was significant improvement in renal functions and serum creatinine increased from 11.5mg/dl to 4.4mg/dl over the next 7 days. After 2 months of follow up, visual acuity was 6/6, N6 presented normal color vision and no evidence of active uveitis. Renal functions at follow up were: BU, 45mg/dl, serum creatinine, 1.5mg/dl.



A 60-year-old man was admitted to St. John's Medical College Hospital with a history of snakebite by Russel's viper on the dorsum of his left foot 10 days before. He had received anti-snake venom serum at a local governmental center before being referred to our center due to worsening renal functions.

His hematological and coagulation profiles were normal. Renal functions were abnormal; blood urea concentration was 210mg% and serum creatinine concentration was 7.5mg%. He showed normal serum electrolytes and blood gas analysis. The patient was non-oliguric at presentation and could be managed conservatively for renal failure. One day after admission, he complained of redness and watering in both eyes. Ocular examination showed ciliary congestion and lid edema. Extraocular movements were normal. Vision was diminished to 6/18 in both eyes. Slit lamp examination showed 2+ cells and flare. Pupillary reactions were sluggish in both eyes. The intraocular pressure, measured by indentation tonometry, was normal in both eyes. Fundus examination was normal. The patient was treated with IV MP followed by a short course of oral steroids, 60mg/day, for 2 weeks.

The uveitis responded well to treatment. His renal functions also recovered spontaneously and did not require dialysis. He was discharged presenting 2.1mg% serum creatinine. One month later, his visual acuity was 6/6 and serum creatinine concentration was 1.2mg/dl.



Systemic manifestations of snakebite depend on the various polypeptide toxins present in the venom. Neurotoxic manifestations can appear as early as 3 minutes after the bite but may be delayed for up to 19 hours (5). Ocular manifestations resulting from snakebite have been uncommonly reported in literature. Subconjunctival hemorrhage, hyphema, retinal and vitreous hemorrhages are well-known complications of viper envenomation. Other rare complications described included ptosis, ophthalmoplegia, central retinal artery occlusion, optic neuritis, optic atrophy, cortical blindness, and angle closure glaucoma (1, 4, 6-8). Ptosis and ophthalmoplegia may be the only manifestations following elapid bites. Cobra venom can lead to blindness due to retinal cells damage causing bilateral optic neuritis (2, 6).

Uveitis following snakebite has been reported earlier (3). It could be part of serum sickness like a response to horse ASV serum (3).

Both our patients developed severe uveitis 10-15 days following snakebite. The late onset of uveitis excludes the direct effects of the snake toxins on its pathogenesis. Vitritis was probably an immune response to ASV sera. The response to systemic steroids also favors an immune response as the pathogenetic mechanism for this uveitis.

In conclusion, uveitis due to snakebites, although rare, can be very severe leading to vision threatening situations. Physicians and ophthalmologists should always consider the possibility of severe uveitis so that timely and appropriate treatment can be instituted. Immune reactions to equine serum are rare but can lead to increased morbidity, which, if recognized early, will respond to therapy.



1 ARI AB. Patient with purely extra-ocular manifestations from pit viper snakebite. Mil. Med., 2001, 166, 667-69.        [  ]

2 BERGER RR., BROOK S. Cobrabite: Ophthalmic manifestations. Herafuah, 1993, 125, 265-6 (in Hebrew).        [  ]

3 BUTTES GP., AYAN N., CAMI G. Uveitis after snakebite. Arch. Pediatr., 1996, 3, 832-3.        [  ]

4 DHALIWAL U. Cortical blindness: an unusual sequela of snakebite. Indian J. Ophthalmol., 1999, 47, 191-2.        [  ]

5 MITRAKUL C., DHAMKRONG-AT A., FUTRAKAL P., THISYAKORN C., VONGSRISART K., VARAVITHYA C., PHANCHAROEN S. Clinical features of neurotoxic snakebite and response to antivenom in 47 children. Am. J. Trop. Med. Hyg., 1984, 33, 1258-66.        [  ]

6 SANGHAVI NG., AMIN SK., NAIK RS. Bilateral optic neuritis following snakebite. J. Assoc. Physicians India, 1982, 30, 117-8.        [  ]

7 SCHWERSENSKI J., BEATTY DW. Unusual features in a case of snakebite, presumably due to a Cape Cobra (Naja nigricollis). S. Afr. Med. J., 1982, 61, 597-8.        [  ]

8 SRINIVASAN R., KALIAPERUMAL S., DUTTA TK. Bilateral angle closure glaucoma following snakebite. J. Assoc. Physicians India, 2005, 53, 46-8.        [  ]

Correspondence to:
Shobhana G. Nayak
Department of Nephrology
St. John's Medical College Hospital
Sarjapur Road, Bangalore, 560034
Karnataka State, India
Phone: 91 80 2206 5301
Fax: 91 80 2563 3844
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Received: December 13, 2006
Accepted: January 19, 2007
Abstract published online: January 23, 2007
Full paper published online: February 28, 2007
Conflicts of interest: There is no conflict.


Page 83 of 87