Dr Sindhura Lakshmi

Associate Professor

Department of Pathology

SUBJECTS CURRENTLY TEACHING

Subject Semester / Year
Pathology
Pathology 3rd,4th and 5th Semester

ACADEMIC QUALIFICATIONS

Degree Specialisation Institute Year of passing
MD Pathology Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai 2010

Experience

Institution / Organisation Designation Role Tenure
KMC, Manipal Associate Professor oct 2020 till date
KMC Manipal Assistant Professor 07/2015 to Sept 2020
Jeevadhara Blood Bank, Mysore Blood Bank Officer 06/2012 to 12/2012
Mysore Diagnostic centre, Mysore Consultant Pathologist 06/2012 to 12/2012
Aditya Diagnostics, Shimoga Consultant Pathologist 08/2010 to 04/2012

Platelet components: towards extension of shelf life by cold storage and cryopreservation. Co investigator

Hemostasis monitoring in sepsis – Analyzing the utility of Thrombin generation assay based on viscoelastic method and cell derived microparticles in the management of patients with sepsis. Co investigator

Circulating Microparticles in Diabetic Kidney Disease: A Novel biomarker of endothelial injury, inflammation & prothrombotic state: A case Control Study. PI

Generating evidence-based strategies for sperm handling and selection for assisted fertilization. Co investigator

Association of cytokine profile and lymphocyte subset with severity of P. vivax malaria in adult patients: A multi-centric cross-sectional study. Co-PI

Performance evaluation of platelet count by unstained whole blood flow cytometry compared to single channel aperture impedance particle counter and International Reference method by flow cytometry

2017-01-01 Sindhura Lakshmi Chetan Manohar

To evaluate the accuracy of the platelet count in unstained whole blood by flow cytometry (method A) versus International Reference Method by flow cytometric analysis over a clinical range, including normal and morphologically abnormal samples with a special focus on platelet counts less than 50.0 x 103/µL

Hematological profile in Chronic Kidney Disease in a tertiary care center in Sothern India

2017-01-01 Sindhura Lakshmi

Knowledge Attitude Practice Survey on Phlebotomy Best Practices among health care workers in a tertiary care hospital

2017-01-01 Sindhura Lakshmi

AREAS OF INTEREST, EXPERTISE AND RESEARCH

Area of Interest

Hematopathology, Flow-cytometry, Molecular Genetics, Immunology, Renal Pathology, Medical Education

Area of Expertise

Flowcytometry

Impact of Temperature and Time Interval Prior to Immature Testicular-Tissue Organotypic Culture on Cellular Niche

2021 Salian S.R Pandya R.K. Laxminarayana S.L.K. Krishnamurthy H. Cheredath A. Tholeti P. Uppangala S. Kalthur G. Majumdar S. Schlatt S.

Cryopreservation of immature-testicular-tissue (ITT) prior to gonadotoxic treatment, while experimental, is the only recommended option for fertility preservation in prepubertal boys. The handling and manipulation of ITT before cryopreservation could influence the functionality of cells during fertility restoration, which this study explored by evaluating cellular niche and quality of mouse ITT subjected to various temperatures and time durations in vitro. ITT from 6-day-old mice were handled at ultraprofound-hypothermic, profound-hypothermic, and mild-warm-ischemic temperatures for varying time periods prior to 14-day organotypic culture. Viability, functionality, synaptonemal complex and chromatin remodeling markers were assessed. Results have shown that cell viability, testosterone level, and in vitro proliferation ability did not change when ITT were held at ultraprofound-hypothermic-temperature up to 24 h, whereas cell viability was significantly reduced (P < 0.01), when held at profound-hypothermic-temperature for 24 h before culture. Further, cell viability and testosterone levels in cultured cells from profound-hypothermic group were comparable to corresponding ultraprofound-hypothermic group but with moderate reduction in postmeiotic cells (P < 0.01). In conclusion, holding ITT at ultraprofound-hypothermic-temperature is most suitable for organotypic culture, whereas short-term exposure at profound-hypothermic-temperature may compromise postmeiotic germ cell yield post in vitro culture. This data, albeit in mouse model, will have immense value in human prepubertal fertility restoration research. © 2020, The Author(s). https://www.scopus.com/inward/record.uri?eid=2-s2.0-85097532278&doi=10.1007%2fs43032-020-00396-z&partnerID=40&md5=b0c70ac8a60653999089d1ec24268040

Acute kidney injury and progressive diabetic kidney disease: An epidemiological perspective

2021 Prabhu R.A Shenoy S.V. Nagaraju S.P. Rangaswamy D. Rao I.R. Bhojaraja M.V. Deepak Nayak M. Laxminarayana S.L.K. Saraf K. Ramaswamy A.

Purpose: Diabetic kidney disease (DKD) represents a unique subset of patients with chronic kidney disease (CKD). Acute kidney injury (AKI) is implicated in DKD progression; however, their interplay is not studied well. We studied risk factors for AKI and the effect of AKI on disease progression in a homogeneous group of patients with DKD. Patients and Methods: We conducted a retrospective open cohort study of patients with DKD at a single tertiary care centre between August 2016 – August 2019. Patients with a minimum follow-up of 2 years were included in the study. The incidence, etiology and risk factors for AKI were studied. The primary outcome studied was the effect of AKI on reduction in estimated glomerular filtration rate (eGFR) in DKD. Loss in eGFR by 50% and need for renal replacement therapy or reaching CKD stage V were studied as secondary outcomes. Results: Two hundred and ninety-two DKD patients meeting the study criteria with a follow-up of 29.57 (±4.3) months were included. The incidence of AKI was 31.1%. Sepsis was the most common etiology (61%). Proteinuria was an independent risk factor for AKI after adjusting for covariates (adjusted OR-1.158; 95% CI (1.018–1.316); p=0.025). In patients with AKI, median decline in eGFR was 10.29 mL/min/1.73m2/year (IQR-5.58– 13.84) which was significantly higher compared to patients with no AKI [eGFR 7.25 (IQR 5.06–11.38); p-0.014]. On subgroup analysis, sepsis-induced AKI (versus non-sepsis AKI; p<0.001) and higher AKI stage (stage 2/3 versus stage 1; p=0.019) were associated with a faster decline in eGFR. Conclusion: AKI is common in patients with DKD with sepsis being the most common etiology. AKI in diabetic kidney disease is associated with a faster decline in eGFR. Baseline proteinuria is an independent risk factor for AKI. © 2021 Prabhu et al. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85101742826&doi=10.2147%2fIJNRD.S291319&partnerID=40&md5=4d8dfe743f242abb89424e0adce3f2a1

Impact of World Health Organization (WHO) Revised Criteria-2016 on the Diagnosis of Polycythemia Vera

2020 Nathany S Koulmane Laxminarayana S.L. Tewari S. Belurkar S. Khanna R. Manohar C

The diagnosis of polycythemia vera (PV) requires the integration of clinical and laboratory findings, bone marrow morphologic features, and JAK2 analysis. JAK2V617F (exon 14) mutation is found in 95% of PV cases. In PV, addition of characteristic bone marrow morphology as one of three major diagnostic criteria allowed reduced hemoglobin/hematocrit threshold for diagnosis to 16.5 g/dL/49% in men and 16 g/dL/48% in women. JAK2 mutation is still the third major diagnostic criterion in PV. Low serum erythropoietin level is now considered as minor criterion in PV and is used to detect cases, which are negative for JAK2 mutation. In this retrospective study, cases diagnosed as PV from January 2013 to December 2015 were reclassified using WHO 2016 criteria. Their clinical and laboratory parameters along with treatment and outcome were studied. Out of 26 patients of previously diagnosed PV, either definitively or provisionally, twenty-one were found to comply with the new 2016 revision of the WHO Criteria. Median age was 55.5 years, with a male preponderance. The median values of hemoglobin, hematocrit and platelets were 17.5 gm/dL, 56.7% and 493 × 109/L, respectively. JAK2V617F was mutated in 17 cases. Bone marrow showed hypercellularity, panmyelosis and marked megakaryocyte dyspoiesis in all patients. All patients had normal oxygen saturation, confirming the primary nature of the disease. Our study, first of its kind in India, underscores the importance of the 2016 revision of the WHO document in detecting cases of masked PV. © 2019, Indian Society of Hematology and Blood Transfusion. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074009809&doi=10.1007%2fs12288-019-01202-w&partnerID=40&md5=887a2c0469a29326bbaa4dc75d04fc8f

Transition from morphologic diagnosis to immunophenotypic diagnosis of acute leukemia—experience of establishing a new flow cytometry laboratory

2019 Pavithra P Koulmane Laxminarayana S.L. Manohar C. Belurkar S. Kairanna N.V.

In this era of targeted therapy, traditional reporting of acute leukemia by morphology using French-American-British (FAB) system of classification has limited uses due to lack of standardization and use in risk stratification. Flow cytometry (FCM), cytogenetics, and molecular testing drive the therapeutic decision. However, the lack of high-end testing at all health care strata leaves a general pathologist in a quandary. This study aimed at documenting the leukemia-associated immunophenotype (LAIP) specific for morphologic (FAB) subclasses of acute leukemia (AL). A retrospective case record-based study was carried out including 100 cases of de novo acute leukemia over 1 year to study the association of FCM immunophenotype profile with morphologic FAB classification of acute leukemia. Fourteen cases (14%) were diagnosed as acute leukemia—unclassified by morphology which were accurately classified by FCM into B cell acute lymphoblastic leukemia (ALL) (6), T cell ALL (3), acute myeloid leukemia (AML) (4), and mixed phenotype acute leukemia (MPAL) (1). FCM also differentiated Pre B cell ALL from Burkitt lymphoma, subclassified T cell ALL into thymic categories, diagnosed MPAL, and identified blasts with monocytic differentiation which were not detected by morphology. Although morphologic FAB diagnosis is still widely used to classify acute leukemia, it is imperative that FCM should be used for accurate leukemia diagnosis. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85072050598&doi=10.1007%2fs12308-019-00368-6&partnerID=40&md5=3f41b7103264f2aef9c7ca3c34c8a7b0

Multiparametric Flow Cytometry in Mixed Phenotype Acute Leukemia

2019 Koulmane Laxminarayana S.L. Madireddy N. Manohar C. Udupa K.

Mixed phenotype acute leukaemia (MPAL) is a diverse group of leukemia of ambiguous lineage diagnosed when blasts in peripheral blood and/or bone marrow have antigens of more than one lineage or a mosaic of blasts belonging to more than one lineage. Retrospective analysis of 218 consecutive cases of acute leukaemia diagnosed by multiparametric flow cytometry (FCM) was done. MPAL cases were identified in accordance with European Group for the Immunological Classification of Leukaemias Criteria and World Health Organization 2008/2016 guidelines for lineage assignment. Nine out of 218 (4.1%) cases were classified as MPAL. Eight out of nine patients (88.8%) were male and 4/9 (44.4%) were < 20 years of age. There were three cases of B/T and T/myeloid MPAL each. Two cases were B/myeloid MPAL and one case was chronic myeloid leukaemia (CML) in B/myeloid blast crisis. B/myeloid MPAL and CML in B/myeloid blast crisis cases were Philadelphia chromosome positive. The latter case had a complex karyotype as well. Seven cases were treated with acute lymphoblastic leukaemia treatment regimen; two of them achieved complete remission (CR). The patient with CML in B/myeloid blast crisis was treated with imatinib based regimen, attained CR, underwent allogenic bone marrow stem cell transplantation, but developed graft versus host disease. Five patients died due to complications of febrile neutropenia early in the course of treatment (62.5%). The last patient (B/T MPAL) refused therapy and was lost to follow-up. Early accurate diagnosis of MPAL requires FCM. It may be misdiagnosed if a limited panel of antibodies is used. © 2019, Indian Society of Hematology and Blood Transfusion. https://www.scopus.com/inward/record.uri?eid=2-s2.0-85061657991&doi=10.1007%2fs12288-019-01101-0&partnerID=40&md5=fc33d89dd4b3389fd7cfa1a715d1974b

Role of corticosteroid therapy in IgA nephropathy - where do we stand?

2016-01-04 Nagaraju SP Mareddy AS Prabhu AR Rangaswamy Madken. M Rao.S Mateti. U.V Koulmane Laxminarayana SL

Kidney International Reports (2016) 1, Volume 1, Issue 4, Supplement, Page S1–S22

Hemophagocytic lymphohistiocytosis: An unusual presentation of tuberculosis in hemodialysis patients

2015-01-07 Koulmane Laxminarayana SL Nagaraju SP Prabhu Attur R Manohar C Parthasarathy R Chari B

Hemodial Int. 2015 Jul;19(3):E16-9

Modified - ‘modified ponticelli regimen’ - for idiopathic membranous nephropathy

Shankar Prasad Nagaraju SP Parthasarathy R Prabhu RA Kosuru S Rangaswamy D Mareddy AS Madken M Kaza S Rao SP Koulmane Laxminarayana SL

Nephrol. Dial. Transplant. (2015)30 (suppl 3): iii426.

Hypokalemic periodic paralysis - A rare presentation of distal renal tubular acidosis in Sjogren’s syndrome

Nagaraju SP Kumar N Kosuru S Prabhu RA Rangaswamy D Parthasarathy R Mareddy AS Madken M Kaza S Koulmane Laxminarayana SL

Nephrology Dialysis Transplantation, 30 (Supl-3). iii66-iii69

Glomerulonephritis with crescents in adults− clinico− pathological characteristics and determinants of outcome

Nagaraju SP Srinivas Kosuru S Rajeevalochana Parthasarathy R Manohar Bairy M Ravindra Prabhu R Vasudeva Guddattu V Koulmane Laxminarayana SL

Nephrol. Dial. Transplant. (2014)29 (suppl 3): 186-200

Pleomorphic lipoma with furuncular myiasis (maggots) of the scalp- A rare case report

Chari B Rao L Singh BM Sindhura Lakshmi KL

International journal of scientific study

Heterotopic pregnancy- Incidental microscopic finding at puerperal tubal ligation

2011-01-04 Jashnani KD Sindhura Lakshmi KL Metkar Gouri S

Bombay Hospital Journal. Vol 53:2. April 2011