Sunil Pradhan

Sunil Pradhan (born 25 June 1957) is an Indian neurologist, medical researcher and writer, known for the invention of two electrophysiological techniques. He has also described five medical signs, of which one related to Duchenne muscular dystrophy is known as Pradhan Sign,[1][2] and the others associated with facioscapulohumeral muscular dystrophy (FSHD) and similar neuro diseases.[3] The Government of India awarded him the Padma Shri, the fourth highest civilian award, in 2014 for his contributions to the field of neuroscience.[4]

Sunil Pradhan
Born (1957-06-25) 25 June 1957
Najibabad, Bijnaur, Uttar Pradesh, India
OccupationIndian neurologist
AwardsPadma Shri
Shanti Swarup Bhatnagar Prize
Dr. B. C. Roy Award
Uttar Pradesh Vigyan Ratna
Dr. H. B. Dingley Memorial Award
Shakuntala Amirchand Memorial Award
Rajib Goyal Award
Amrut Modi Unichem Award
Maj Gen. Amir Chand Award
Dr. S. T. Achar Award
Best Poster Paper Award
Best Paper Award
Vocational Excellence Prize
WebsiteOfficial web site

Biography
Dr. Pradhan's extensive clinical research in the area of muscular dystrophy has led to the discovery of five new clinical signs, each indicative of a specific type of the disease. Sanjay Gandhi Post Graduate Institute of Medical Sciences circular.[1]

Pradhan was born in the hill station of Najibabad, Bijnaur District, in the Indian state of Uttar Pradesh, on 25 June 1957.[1][5] He did schooling at many local schools in Jhansi, Aligarh, Banda, Allahabad and Lucknow[1] and, choosing medical profession, he graduated in medicine, MBBS, from the King George's Medical University, Lucknow, in 1979 and did his post graduate studies in Internal Medicine (MD) there, which he completed in 1983. He did further specialization in neurology and secured the degree of DM.[1]

Pradhan started his career at Jaslok Hospital, Mumbai and later, shifted to the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. After a further move to the Nizam's Institute of Medical Sciences, Hyderabad, in 1989, he joined the faculty of the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow,[1][5] and worked there till 2007, in various capacities. The next move was to the Institute of Human Behaviour and Allied Sciences (IHBAS) as the Head of the Department of Neurology and works there now as the Medical Superintendent since 2008.

Pradhan brought about many changes at the IHBAS. He was instrumental in updating and elaborating the signage, displays and boards and constructing patient shelters. The electrophysiology Lab was started where he arranged for the setting up of modern equipment like 32 Channels Polysomnography, Nicolet 32 Channels digital Portable Electroencephalography and Electromyography.

Pradhan lives in Lucknow, along the Rae Bareilly Road, in Uttar Pradesh.[5]

Legacy

The legacy of Pradhan centres primarily around the five medical signs he has discovered, the two electrophysiological techniques he has invented and his research findings on the neuro diseases of Japanese Encephalitis, Hirayama type monomelic amyotrophy and epilepsy.[1]

Medical signs

Pradhan sign or Valley sign: The first of the signs he discovered is related to Duchenne muscular dystrophy (DMD).[6] He discovered that the DMD patients tend to suffer visible enlargement of the infraspinatus and deltoid muscles, which when contracted shows partial wastage. Pradhan clarified that this revealed a valley between the two mounts, visible behind the outstretched shoulders and called it valley sign.[7] The sign was evident in patients with little calf muscle enlargement and visibly positive in DMD cases with 90% sensitivity. The sign was later renamed as Pradhan Sign, on recommendation from the American Academy of Pediatrics.[1][6]

Poly hill sign: Poly Hill Sign,[8] the second of the signs Pradhan discovered related to facioscapulohumeral muscular dystrophy(FSHD).[6] Pradhan noticed that the shoulder abduction of a patient with external rotation resulted in the formation of six bulges on the back of the shoulders and arms and named it poly hill due to the bulges.[1] He has also reported of an extra hill in one of the cases he attended to.[9]

Shank sign: The third sign, Shank Sign,[10] is related to myotonic dystrophy type 1 (DM-1). When patients suffering from the disease abduct their arms to 90 degrees, a tapering of the upper arm musculature is observed when examined from behind, due to wasting of the biceps, triceps and forearm muscles. This gives a visual resemblance of the shanks of an animal. This sign had an occurrence on 78% of the patients examined by Dr. Pradhan.[6][11]

Calf-head sign: miyoshi myopathy patients, when they raise their arms with shoulders abducted and elbows flexed to 90 degrees, returned a visual similar to a calf head trophy, on magnetic resonance imaging.[12] The test returned positive on 10 of the 15 patients examined by Dr. Pradhan.[6][13]

Diamond on quadriceps sign: The sign is related to dysferlinopathy.[6] A clinical study of 31 patients revealed that the patients with the disease developed a diamond shaped bulge on the upper half of the anterolateral aspect of thighs when they stand with knees slightly bent, thereby putting pressure on the quadriceps muscles. The bulge did not appear when the patients were sitting or standing. MRI images confirmed focal bulging out of muscles.[14] The occurrence is observed on 66% of the patients.

Electrophysiological techniques

Pradhan is credited with two new techniques related to electrophysiology.[1]

The first technique is related to the non-invasive study of intercostal nerves.[15] The technique is reported to have been included in a text book published from the US, calling it as Pradhan Method.[1] The technique advises surface stimulation of the intercostal skin while using specific sites of the rectus abdominis muscle for surface recording. This helps in early detection of the symptoms in patients with Guillain–Barré syndrome. It is also used in the diagnosis of diabetic thoraco abdominal neuropathy.[1]

The second technique involves stimulating the intercostal nerves to study the somatosensory evoked potentials, for localizing the non compressive spinal cord lesions.[16]

Pradhan was successful in elucidating the mechanisms of neurophysiological F‑response generation in healthy and diseased bodies and discovered a phenomenon, F-response multiplicity, a symptom of the lower motor neuron disorder. Pradhan asserted, by way of his findings, loss of early components and scattering of late components are responsible for the different F-response parameters in the lower neuron disorders.[1] He has also demonstrated standardized variables of contraction enhanced H‑reflex called R‑1 response and its utility in nerve root lesions where H-reflex is not electable. This was ratified by many researchers.[1]

Research on Japanese Encephalitis

Pradhan found out that the Japanese‑B encephalitis (JE) sometimes produced selective lesions on the substrata nigra and this observation has assisted in eliciting a clue in explaining the early onset of Parkinson's disease.[17] This was ratified by Japanese scientists with the help of an animal model of the disease using rats.[1] His findings led to a new clinical entity called Parainfectious conus myelitis, thus drawing an explanation for the unexplained urinary symptoms in young patients. He is credited with the discovery of the role of immunoglobins in acute disseminated encephalomyelitis, a finding confirmed by many other researchers.[1]

Research on Epilepsy

Pradhan has done extensive research on epilepsy.[18] His studies revealed that patients are likely to suffer from chronic epileptogenesis with poor seizure outcome if gliosis is present around their lesions. He averred that the patients with neurocysticercosis are prone to developing perilesional gliosis, may develop drug resistance during anti‑epileptic drug (AED) therapy and may suffer seizures if the drug is stopped. He has also explained tickling seizures[19] and micturition induced reflex epilepsy,[20] both reported to be first time findings.[1]

Research on Hirayama type Monomelic Amyotrophy

Pradhan has done research on Hirayama type monomelic amyotrophy,[21] a disease described by Dr. Hirayama in 1959.[22] In 1977, he published a report explaining the features of diagnostic magnetic resonance imaging.[1] The diagnosis of the disease remaining purely clinical, it is reported that his findings are the only objective diagnostic method. Dr. Hirayama, in 2003, published a paper confirming Dr. Pradhan's findings.[1]

Other studies

Pradhan is also credited with other findings such as:

  • If the process is of long duration, patients may develop central pontine myelinolysis, irrespective of whether the correction of hyponatremia is kept slow.[1][23]
  • Explanation of the sheathing of the retinal vessels in Tuberous Sclerosis.[1][24]
  • Description of MRI and other features of acute endosulphan poisoning and its similarities with the MRI features of Huntington's disease and suggested neurotoxic mechanism by blocking mitochondrial energy metabolism.[1][25]
  • Description of a new method for extracting lipid from muscle tissues for NMR studies.[26]
  • Description of micturition induced reflex epilepsy.[20]
  • Classification of acute transverse myelitis.[27]

Awards and recognitions

The Government of India, in 2014, honoured Dr. Sunil Pradhan, by awarding him the civilian honour of Padma Shri.[4] He has received many other awards such as:

Publications

Pradhan has published several research papers in peer reviewed journals, both national and international in circulation.[30] A random selection of his articles features:

  • Levac D, Espy D, Fox E, Pradhan S, Deutsch JE (25 September 2014). ""Kinect-ing" With Clinicians: A Knowledge Translation Resource to Support Decision Making About Video Game Use in Rehabilitation". Physical Therapy. 95 (3): 426–440. doi:10.2522/ptj.20130618. PMC 4348717. PMID 25256741.
  • Snoussi K, Gillen JS, Horska A, Puts NA, Pradhan S, Edden RA, Barker PB (22 September 2014). "Comparison of brain gray and white matter macromolecule resonances at 3 and 7 Tesla". Magnetic Resonance in Medicine. 74 (3): 607–13. doi:10.1002/mrm.25468. PMC 4369478. PMID 25252131.
  • Pradhan S, Kumar A (July 2014). "Lower motor neuron paralysis with extensive cord atrophyin parainfectious acute transverse myelitis". Annals of Indian Academy of Neurology. 17 (3): 347–48. doi:10.4103/0972-2327.138525. PMC 4162027. PMID 25221410.
  • Pradhan SK1, Kamble NM1, Pillai AS1, Gaikwad SS1, Khulape SA1, Reddy MR, Mohan CM, Kataria JM, Dey S. (August 2014). "Recombinant nucleocapsid protein based single serum dilution ELISA for the detection of antibodies to infectious bronchitis virus in poultry". Journal of Virological Methods. 209: 1–6. doi:10.1016/j.jviromet.2014.08.015. PMID 25173423.CS1 maint: multiple names: authors list (link)
  • Sunil Pradhan (2004). "Valley sign in Becker muscular dystrophy and outliers of Duchenne and Becker muscular dystrophy". Neurology India. 52 (2): 203–05. PMID 15269471.

The National Center for Biotechnology Information of the United States National Library of Medicine has published the abstracts of over 750 papers published by Dr. Pradhan.[30] Nanojamians, a blog providing information on technological advancement in neuro sciences, has also listed many of his papers.

Controversy
It was around 12 noon on Monday when the judge came to the OPD and asked to be seen by me. As is the normal procedure, I requested that the case should first go to a resident doctor for preparation of a medical case sheet. But he insisted to be seen by me only. He carried no medical file with him. Also, no doctor had referred him to me. Anyway, I called him in. As I was busy seeing a patient, I could only offer a chair to the lady accompanying the judge. I did not have more chairs to offer to the judge. He, however, left, Dr. Pradhan said about the incident.[2]

On 9 October 2006, Dr. Pradhan received a court summons from the Lucknow bench of the Allahabad High Court, on charges of contempt of court for allegedly ignoring a sitting judge of Allahabad High Court, to present himself before the judge the next day. Dr. Pradhan appeared before the judge at his chamber, along with the Advocate General and the Additional Advocate General of Uttar Pradesh and was asked to tender a written apology, which included an assurance to not to repeat the mistake in future. He duly did so and was released without a sentence. Reports about the incident appeared in the media, and drew comments from the public and the law circles. The comments of the judge, however, was not reported.[2]

Later, acting on the news report, the Governor of Uttar Pradesh, T. V. Rajeswar, ordered an enquiry into the incident. The Principal Secretary to the Governor contacted Sanjay Gandhi Post Graduate Institute of Medical Sciences and asked for a report from the management of the institute. Dr. Pradhan's statement was recorded and a report was submitted to the Governor. The details about the action taken are not known.[31]

gollark: _ponders running that on something_
gollark: Very dull.
gollark: It just goes through a lot of thingies, errors when it hits an undeletable thing, then `ls` doesn't work.
gollark: There's an automated version.
gollark: Works on my Alpine Linux container.

References
  1. "CSIR". Central Council of Industrial Research. 30 June 2003. Retrieved 2 October 2014.
  2. "Controversy". Hindustan Times. 10 October 2006. Retrieved 1 October 2014.
  3. Pradhan S (11 November 1994). "New clinical sign in Duchenne muscular dystrophy". Pediatr. Neurol. 11 (4): 298–300. doi:10.1016/0887-8994(94)90005-1. PMID 7702689.
  4. "Padma Awards Announced". Circular. Press Information Bureau, Government of India. 25 January 2014. Archived from the original on 8 February 2014. Retrieved 23 August 2014.
  5. "Vidhwan". Vidhwan. 2014. Retrieved 1 October 2014.
  6. "TOI". TOI. 7 November 2011. Retrieved 1 October 2014.
  7. "Valley sign in duchenne muscular dystrophy: importance in patients with inconspicuous calves". Neurological Society of India. November 2002. Retrieved 3 October 2014.
  8. Pradhan, Sunil (2 April 2002). "Poly Hill Sign". Muscle & Nerve. 25 (5): 754–755. doi:10.1002/mus.10108. PMID 11994973.
  9. Pradhan, Sunil (24 April 2007). "Extra hill". Neurology India. 55 (4): 436–7. doi:10.4103/0028-3886.37109. PMID 18040140.
  10. Pradhan S (January 2007). "Shank sign in myotonic dystrophy type-1 (DM-1)". J Clin Neurosci. 14 (1): 27–32. doi:10.1016/j.jocn.2005.10.009. PMID 17092719.
  11. Pradhan S (January 2007). "Shank sign 2". J Clin Neurosci. 14: 27–32. doi:10.1016/j.jocn.2005.10.009. PMID 17092719.
  12. Pradhan S (October 2006). "Calf-head sign in Miyoshi myopathy". Arch. Neurol. 63 (10): 1414–7. doi:10.1001/archneur.63.10.1414. PMID 17030657.
  13. Pradhan, Sunil (2014). "Calf head sign 2". Archives of Neurology. 63 (10): 1414–7. doi:10.1001/archneur.63.10.1414. PMID 17030657. Retrieved 2 October 2014.
  14. Pradhan S (April 2009). "Diamond on quadriceps" (PDF). Neurol India. 57 (2): 172–5. doi:10.4103/0028-3886.51287. PMID 19439848.
  15. Pradhan S, Taly A (June 1989). "Intercostal nerve conduction study in man". J. Neurol. Neurosurg. Psychiatry. 52 (6): 763–6. doi:10.1136/jnnp.52.6.763. PMC 1032029. PMID 2526200.
  16. Polo A, Curro' Dossi M, Fiaschi A, Zanette GP, Rizzuto N (May 2003). "Peripheral and segmental spinal abnormalities of median and ulnar somatosensory evoked potentials in Hirayama's disease". J. Neurol. Neurosurg. Psychiatry. 74 (5): 627–32. doi:10.1136/jnnp.74.5.627. PMC 1738443. PMID 12700306.
  17. Pradhan S, Pandey N, Shashank S, Gupta RK, Mathur A (November 1999). "Parkinsonism due to predominant involvement of substantia nigra in Japanese encephalitis". Neurology. 53 (8): 1781–6. doi:10.1212/wnl.53.8.1781. PMID 10563628.
  18. Pradhan S, Kathuria MK, Gupta RK (August 2000). "Perilesional gliosis and seizure outcome: a study based on magnetization transfer magnetic resonance imaging in patients with neurocysticercosis". Ann. Neurol. 48 (2): 181–7. doi:10.1002/1531-8249(200008)48:2<181::aid-ana7>3.0.co;2-c. PMID 10939568.
  19. Kalita, J.; Pradhan, S. (1996). "Tickling Seizures". Neurology India. 44 (1): 27–29. PMID 29542652. Retrieved 3 October 2014.
  20. Jayantee, Kalita; Kalita, J.; Pradhan, S. (1993). "Micturition induced reflex epilepsy". Neurology India. 41 (4): 221–223. PMID 29542670. Retrieved 3 October 2014.
  21. Hassan KM, Sahni H, Jha A (April 2012). "Clinical and radiological profile of Hirayama disease: A flexion myelopathy due to tight cervical dural canal amenable to collar therapy". Ann Indian Acad Neurol. 15 (2): 106–12. doi:10.4103/0972-2327.94993. PMC 3345586. PMID 22566723.
  22. "Hirayama" (PDF). scielo.br. 2007. Retrieved 2 October 2014.
  23. Pradhan S, Jha R, Singh MN, Gupta S, Phadke RV, Kher V (November 1995). "Central pontine myelinolysis following 'slow' correction of hyponatremia". Clin Neurol Neurosurg. 97 (4): 340–3. doi:10.1016/0303-8467(95)00060-w. PMID 8599905.
  24. "Focal Sheathing of Retinal Arteries in Tuberous Sclerosis". Pedatr. Neurosurg. 1991. Retrieved 3 October 2014.
  25. Pradhan S, Pandey N, Phadke RV, Kaur A, Sharma K, Gupta RK (April 1997). "Selective involvement of basal ganglia and occipital cortex in a patient with acute endosulfan poisoning". J. Neurol. Sci. 147 (2): 209–13. doi:10.1016/s0022-510x(96)05345-2. PMID 9106131.
  26. "An improved, single step standardized method of lipid extraction from human skeletal muscle tissue". Elsevier Properties SA. 2006. Retrieved 3 October 2014.
  27. Kalita J, Shah S, Kapoor R, Misra UK (August 2002). "Bladder dysfunction in acute transverse myelitis: magnetic resonance imaging and neurophysiological and urodynamic correlations". J. Neurol. Neurosurg. Psychiatry. 73 (2): 154–9. doi:10.1136/jnnp.73.2.154. PMC 1737981. PMID 12122174.
  28. "Tribune". Tribune India. 4 February 2003. Retrieved 2 October 2014.
  29. "List of Fellows - NAMS" (PDF). National Academy of Medical Sciences. 2016. Retrieved 19 March 2016.
  30. "U.S. National Library of Medicine". U.S. National Library of Medicine. 2014. Retrieved 1 October 2014.
  31. "Highbeam Research". Highbeam Research. 11 October 2006. Archived from the original on 23 March 2015. Retrieved 2 October 2014.

31. "Highbeam Research". Highbeam Research. 11 October 2006. Retrieved 2 October 2014. 32. Rajeswar steps in on behalf of Dr. Pradhan. Lucknow edition, The Times of India, 12 October 2006. 33. PGI controversy. The Times of India, 14 October 2006.

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