1
|
Griffin E, Shirley G, Lee XY, Awad SF, Tyagi A, Goadsby PJ. An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity. J Headache Pain 2024; 25:59. [PMID: 38637754 PMCID: PMC11027549 DOI: 10.1186/s10194-024-01749-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Migraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine. METHODS An individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays-informed by the literature-were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule. RESULTS Treatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary. CONCLUSIONS This economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed. TRIAL REGISTRATION N/A.
Collapse
Affiliation(s)
| | | | | | | | - Alok Tyagi
- NHS Greater Glasgow and Clyde, Scotland, UK
| | - Peter J Goadsby
- SLaM Biomedical Research Centre, NIHR King's Clinical Research Facility, and Wolfson SPaRC, King's College London, London, UK
| |
Collapse
|
2
|
Tyagi A, Nigam C, Malhotra RK, Bodh P, Deep S, Singla A. The minimum effective dose (ED 90) of prophylactic oxytocin infusion during cesarean delivery in patients with and without obesity: an up-down sequential allocation dose-response study. Int J Obstet Anesth 2024; 57:103962. [PMID: 38103940 DOI: 10.1016/j.ijoa.2023.103962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Obesity is associated with greater oxytocin requirement during labor induction or augmentation. There are scant data exploring the intra-operative requirement during cesarean delivery in patients with obesity, and none comparing it with those without obesity. We evaluated the minimum effective dose (ED90) of an oxytocin infusion to achieve adequate uterine tone during cesarean delivery in patients with and without obesity. METHODS Patients (body mass index ≥30 kg/m2 represented patients with obesity) undergoing cesarean delivery using subarachnoid block were included. This prospective dual-arm dose-finding study used a 9:1 biased sequential allocation design. Oxytocin infusion was initiated at 13 IU/h at cord clamping in the first patient of each group. Uterine tone was graded as satisfactory or unsatisfactory by the obstetrician four minutes after initiation of the infusion. The dose of oxytocin infusion for subsequent patients was determined according to the response of the previous patient in the group. Oxytocin-associated side effects were evaluated. Dose-response data for the groups was evaluated using log-logistic function and ED90 estimates derived from fitted equations using the delta method. RESULTS The ED90 of oxytocin was significantly higher for patients with obesity (n = 40) compared with those without obesity (n = 40) [25.7 IU/h, 95% CI 18.6 to 32.9) vs. 16.6 IU/h, 95% CI 14.9 to 18.3)]; relative ratio 1.55 [95% CI 1.09 to 2.01] (P = 0.019). CONCLUSIONS Patients with obesity require a higher intra-operative oxytocin infusion dose rate to achieve a satisfactorily contracted uterus after fetal delivery when compared with patients without obesity.
Collapse
Affiliation(s)
- A Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India.
| | - C Nigam
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - R K Malhotra
- Delhi Cancer Registry, Dr BR Ambedkar Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - P Bodh
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - S Deep
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - A Singla
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and GTB Hospital, Delhi, India
| |
Collapse
|
3
|
Javed A, Qadir MO, Lee S, Mitra A, Tyagi A, Sharma A, Lett K, Ch'ng S. Rethinking the urgency priority system in round hole detachments, which should be done first? Macula on or macula off. Eye (Lond) 2024:10.1038/s41433-024-02930-8. [PMID: 38279039 DOI: 10.1038/s41433-024-02930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024] Open
Affiliation(s)
- A Javed
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK.
| | - M O Qadir
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - S Lee
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - A Mitra
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - A Tyagi
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - A Sharma
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - K Lett
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| | - S Ch'ng
- Vitreo-Retinal Department, Birmingham Midlands Eye Unit, Birmingham City Hospital, Birmingham, UK
| |
Collapse
|
4
|
Tyagi A, Tripathi R, Bouarfa S. Learning from past in the aircraft maintenance industry: An empirical evaluation in the safety management framework. Heliyon 2023; 9:e21620. [PMID: 38027765 PMCID: PMC10651513 DOI: 10.1016/j.heliyon.2023.e21620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
The growth of commercial air transport arguably translates into more aging passenger aircraft queuing up for major maintenance, modifications, and/or freighter conversion with the aircraft maintenance industry. In the competitive business environment, this increased maintenance demand possesses the potential to stress the industry and make safety vulnerable. In the aircraft maintenance industry, several aircraft accidents and incidents have resulted from organizational failure to learn from the past. To address this chronic problem, this study aims to (a) establish a learning process model for the aircraft maintenance industry, (b) identify the factors that influence learning, and (c) determine the effect of identified factors on learning from the past. A review of scholarly articles and regulatory publications enabled the development of learning from the past process model and a data collection tool, followed by structural equation modeling to quantify the relationship among influencing factors. The study was conducted in the Indian aircraft maintenance environment and is based on the perspective of the front-line maintenance staff. The study found that safety communication is the decisive stage for learning from the past. Contextualization of the safety information and evaluating the lessons learned during safety communication strongly impact learning from the past, for which existing regulatory provisions are vulnerable. The findings of this study are meant to assist State regulators and management of the aircraft maintenance industry; nevertheless, safety managers and practitioners in other ultra-safe, high-risk sectors may also apply the results in compliance with the respective regulatory guidelines.
Collapse
Affiliation(s)
- Alok Tyagi
- University of Petroleum and Energy Studies (UPES), School of Business, Department of Transportation Management, Dehradun, India
| | - Rajesh Tripathi
- University of Petroleum and Energy Studies (UPES), School of Business, Department of General Management, Dehradun, India
| | | |
Collapse
|
5
|
Mohta M, Kumari S, Malhotra RK, Tyagi A, Agarwal R. Calculation of effective dose of phenylephrine bolus for treatment of post-spinal hypotension in pre-eclamptic patients undergoing caesarean section - a non-randomised controlled trial. Int J Obstet Anesth 2023; 56:103929. [PMID: 37826881 DOI: 10.1016/j.ijoa.2023.103929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/10/2023] [Accepted: 09/03/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Patients with pre-eclampsia require smaller vasopressor doses compared with those with normotension for management of post-spinal hypotension during caesarean section. However, the literature has little evidence as to the phenylephrine dose required for patients with pre-eclampsia. METHODS Fifty patients, with either pre-eclampsia or normotension, and developing post-spinal hypotension during caesarean section under spinal anaesthesia, were studied. Women in both groups did not receive prophylactic vasopressors. The first patient in each group received phenylephrine 50 µg to treat the first episode of hypotension, defined as fall of systolic blood pressure ≥20% from baseline or an absolute value <100 mmHg. If hypotension was corrected within one minute it was considered a 'success'. The doses for the subsequent patients were determined by responses to all previous patients, according to a variation of Narayana's rule for the up-down sequential allocation method. RESULTS The 95% effective dose (ED95) and 50% effective dose (ED50) of phenylephrine was 41.7 µg (95% CI 33.8 to 49.6 µg) and 29.1 µg (95% CI 26.0 to 32.2 µg) respectively in the pre-eclampsia group, and 64.9 µg (95% CI 54.1 to 75.7 µg) and 47.3 µg (95% CI 39.7 to 54.9 µg) respectively in the normotensive group. The proportionate reduction in phenylephrine dose ranged from 33% (95% CI 18 to 44%) to 40% (95% CI 19 to 52%). CONCLUSION Patients with pre-eclampsia may need a 33% to 40% reduction in the first phenylephrine bolus dose, compared with patients with normotension, for the treatment of the first episode of post-spinal hypotension.
Collapse
Affiliation(s)
- M Mohta
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | - S Kumari
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - R K Malhotra
- Cancer Registry, Dr. BRAIRCH, All India Institute of Medical Sciences, Delhi, India
| | - A Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| | - R Agarwal
- Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
| |
Collapse
|
6
|
Lowe M, Murray L, Tyagi A, Gorrie G, Miller S, Dani K. Efficacy of erenumab and factors predicting response after 3 months in treatment resistant chronic migraine: a clinical service evaluation. J Headache Pain 2022; 23:86. [PMID: 35869443 PMCID: PMC9306036 DOI: 10.1186/s10194-022-01456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Calcitonin gene-related peptide (CGRP) inhibitors have been developed as options for treatment of chronic and episodic migraine. We present our experience of the use of erenumab in a tertiary headache centre. Methods This was a prospective clinical audit of all patients commenced on erenumab following a locally agreed pathway and criteria over a consecutive period. Patients received monthly erenumab 140 mg for 3 months. Data were collected prospectively at baseline and 3 months follow up. Results One hundred three patients were commenced on erenumab during the study period. Patients had tried a median of 7 previous prophylactics, including onabotulinum toxin A in 94%. At 3 months there was a reduction in median total (28 to 20, 29% reduction, p < 0.0001) and severe (15 to 5, 67% reduction, p < 0.0001) headache days. 39.8% of patients achieved at least a 30% reduction in total headache days; 61.8% of patients achieved at least a 50% reduction in severe headache days. Meeting either of these thresholds was considered a positive response, 68% of patients achieved this. Presence of daily headache pattern was negatively associated with response, (56% response vs. 90% without daily headache, p = 0.0003). There was no association between age, gender, presence of medication overuse or number of previously tried prophylactic treatments and response to erenumab. 43% of patients reported at least one adverse effect, most commonly constipation (26%); treatment was discontinued in 3 patients due to adverse effects. Conclusions Erenumab was an effective treatment for chronic migraine in this treatment resistant population over 3 months of follow up. Presence of daily headache predicted poorer response but there was still a significant positive response rate in this group.
Collapse
|
7
|
Agrahri A, Tyagi A, Kumar D, Kusumakar S, Palaniswami M, Yan B. Detection of Epileptic Seizure Using Accelerometer Time Series Data and Hidden Markov Model. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:2426-2429. [PMID: 36086544 DOI: 10.1109/embc48229.2022.9871914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Epilepsy is one of the most prevalent neurological diseases globally, which causes seizures in the patient. As per a survey done worldwide, it is found that approximately 70 million people are living with epilepsy (~1% of the total population of the world). Effective detection of these seizures requires specialized approaches such as video and electroencephalography monitoring, which are expensive and are mainly available at specialized hospitals and institutes. Hence, there is a need to develop simpler and affordable systems that can be made available to health care centers and patients for accurate detection of epileptic seizures. A wireless remote monitoring system based on a wrist-worn accelerometer is an optimum choice for the same. Sophisticated algorithms need to be developed for effectively detecting seizure events from this accelerometer data with minimal false alarms. This paper presents a Hidden Markov Model (HMM) based probabilistic approach applied to the reduced-dimension feature vector representation of time-series accelerometer data to detect epileptic seizures. The results obtained from the HMM were compared with three commonly used machine learning models viz. support vector machine (SVM), logistic regression, and random forest. The proposed approach was able to detect 95.7% of seizures with a low false alarm rate of 14.8% with a run time of just under 24 seconds.
Collapse
|
8
|
Tyagi A, Sharma S, Ali S, Gaikwad K. Crosstalk between H 2 S and NO: an emerging signalling pathway during waterlogging stress in legume crops. Plant Biol (Stuttg) 2022; 24:576-586. [PMID: 34693601 DOI: 10.1111/plb.13319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 06/13/2023]
Abstract
In legumes, waterlogging is a major detrimental factor leading to huge yield losses. Generally, legumes lack tolerance to submergence, and conventional breeding to develop tolerant varieties are limited due to the lack of tolerant germplasm and potential target genes. Moreover, our understanding of the various signalling cascades, their interactions and key pathways induced during waterlogging is limited. Here, we focus on the role of two important plant signalling molecules, viz. hydrogen sulphide (H2 S) and nitric oxide (NO), during waterlogging stress in legumes. Plants and soil microbes produce these signalling molecules both endogenously and exogenously under various stresses, including waterlogging. NO and H2 S are known to regulate key physiological pathways, such as stomatal closure, leaf senescence and regulation of numerous stress signalling pathways, while NO plays a pivotal role in adventitious root formation during waterlogging. The crosstalk between H2 S and NO is synergistic because of the resemblance of their physiological effects and proteomic functions, which mainly operate through cysteine-dependent post-translational modifications via S-nitrosation and persulfidation. Such knowledge has provided novel platforms for researchers to unravel the complexity associated with H2 S-NO signalling and interactions with plant stress hormones. This review provides an overall summary on H2 S and NO, including biosynthesis, biological importance, crosstalk, transporter regulation as well as understanding their role during waterlogging using 'multi-omics' approach. Understanding H2 S and NO signalling will help in deciphering the metabolic interactions and identifying key regulatory genes that could be used for developing waterlogging tolerance in legumes.
Collapse
Affiliation(s)
- A Tyagi
- ICAR - National Institute for Plant Biotechnology, New Delhi, India
| | - S Sharma
- ICAR - National Institute for Plant Biotechnology, New Delhi, India
| | - S Ali
- Department of Biotechnology, Yeungnam University, Gyeongsan Gyeongbuk, Republic of Korea
| | - K Gaikwad
- ICAR - National Institute for Plant Biotechnology, New Delhi, India
| |
Collapse
|
9
|
Dani K, Murray L, Benchiheub A, Gorrie G, Selvarajah J, Sharma S, McKenzie M, McCorkell L, Rankin C, Tyagi A. 050 Evaluation of 3 month data for the use of erenumab for chronic migraine in Glasgow. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background andMethodsErenumab, a monoclonal antibody to CGRP, is a new treatment option for preventive treatment of migraine. We audited 3 month outcome data of erenumab for prevention of chronic migraine in Glasgow. Patients are offered erenumab 140mg if they fail 4 migraine prophylactic agents in addition to Botox. Erenumab is continued for a further 9 months if effective at 3 months (≥30% reduction in total headache days or ≥50% reduction in severe headache days, using data from the “best month”). A 3 month extension is occasionally considered if there is a trend for improvement.ResultsData were available for 93 patients (86% female). Previous treatments included: all 4 prespecified prophylactics (76%); flunarizine(63%); GON block(51%); Botox(95%); neuromodulation(25%); dihydroergot- amine infusion (19%). Erenumab was continued in 81% (53% continued for reduction in headache days, 28% for reduced severity/clinical discretion) and discontinued in 19% for dramatic improvement (2%), side effects (2%), and inefficacy (15%). Side effects included constipation(23%), hair loss(3%) injection site reactions, fatigue, cramps, itch (all 2%), itch, blistering, restless legs, rash, nausea, diarrhoea, insomnia, flushes (all 1%).ConclusionA surprisingly high response rate was observed at 3 months. Twelve month data are required to determine if the effect is sustained.krishnadani@icloud.com50
Collapse
|
10
|
Lowe M, Gorrie G, Dani K, Selvarajah J, Tyagi A. 206 Use of non-invasive vagal nerve stimulation in a tertiary headache service. J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionNon-invasive vagal nerve stimulation (nVNS) is a novel treatment modality for primary headache disorders. There is some clinical trial evidence to support its use, both as an abortive and pre- ventative treatment, in cluster headache and migraine. We evaluated the use of this novel treatment in a regional tertiary headache service.MethodsA retrospective analysis of case notes of all patients currently using nVNS in our service was undertaken. Other current and previous headache treatments were recorded. A subjective assessment of response to nVNS was made based on available clinical data.Results21 patients currently using nVNS were identified. Diagnoses were chronic cluster headache (n=12), episodic cluster headache (n=1), migraine (n=4), hemicrania continua (n=3) and SUNCT (n=1). All current users reported some degree of positive response to nVNS, with 14 (67%) assessed as having a large improvement. The most frequently reported improvement parameter was reduction in headache frequency (15, 71%). Those reporting a large improvement used significantly fewer concurrent preventa- tive medications (median 0 vs. 2.5, p=0.033).ConclusionsIn this small group of patients with a variety of headache diagnoses nVNS has been an effective treatment; this appears to be due to efficacy as a preventative treatment.michaelcmlowe@gmail.com
Collapse
|
11
|
Sharma R, Rana A, Sharma V, Mehrotra A, Babu H, Gupta S, Singh R, Tyagi A, Sethi N, Bhatt P, Yadav V, Chopra P, Upadhyay D. Clinical correlation and assessment of olfactory dysfunction with n-butanol in COVID-19 patients: our experience. RHINOL 2022. [DOI: 10.4193/rhinol/21.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Studies showed olfactory disturbances in COVID patients. This has attracted focus of clinicians as an easy clinical screening tool in suspected population. Material and methods: 70 mild and moderate category COVID-19 RT-PCR positive patients, more than 10 years of age were tested on day of admission for olfaction with serial dilution of n-butanol and asked to grade severity of their olfactory dysfunction according to visual analogue score from 1-10. Results: Fatigue 42 (93.33%), sore throat 37 (82.22%), fever 36 (80%) and dyspnea 23 (51.11%) were the most common symptoms in moderate patients. Diabetes, hypertension and allergy were the three prominent risk factors. At time of admission, n-butanol diagnosed 20 patients having olfactory dysfunction compared to 11 by VAS. Patients tend to grade their dysfunction higher on VAS whereas the n-butanol test classified their olfactory dysfunction lower. Viral load and high CRP were not found to be significantly related with olfactory dysfunction. d-Dimer and LDH levels were found statistically associated with higher grading of olfactory dysfunction detected by n-butanol. Conclusion: The majority of cases developed hyposmia before they were admitted to hospital even before they realized that they were having hyposmia as revealed by n-butanol testing. We should go for objective tests of olfaction.
Collapse
|
12
|
Tyagi A, Khan A, Thatte P, Ramakrishnan U. Genome‐wide
SNP
markers from fecal samples reveal anthropogenic impacts on connectivity: case of a small carnivore in the central Indian landscape. Anim Conserv 2022. [DOI: 10.1111/acv.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Tyagi
- National Centre for Biological Sciences Tata Institute of Fundamental Research Bangalore India
- SASTRA Deemed to be University Thanjavur India
| | - A. Khan
- National Centre for Biological Sciences Tata Institute of Fundamental Research Bangalore India
| | - P. Thatte
- National Centre for Biological Sciences Tata Institute of Fundamental Research Bangalore India
- World Wide Fund for Nature‐India New Delhi India
| | - U. Ramakrishnan
- National Centre for Biological Sciences Tata Institute of Fundamental Research Bangalore India
| |
Collapse
|
13
|
Das S, Gupta C, Jain C, Rai G, Alqumber MAA, Singh PK, Sharma R, Tyagi A, Salhotra R, Narang S, Singh NP, Dar SA. Utility of serum Galactomannan in diagnosing COVID-19 patients with suspected IPA: an observational study in resource limited settings. Eur Rev Med Pharmacol Sci 2022; 26:710-714. [PMID: 35113446 DOI: 10.26355/eurrev_202201_27897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To study the utility of Galactomannan (GM) antigen as a screening marker for diagnosing invasive pulmonary aspergillosis (IPA) in coronavirus disease 2019 (COVID-19) patients. PATIENTS AND METHODS The serum samples from patients with severe COVID-19 diseases admitted to the Critical Care Unit were collected on the 5th day of admission for GM screening. The samples were analysed by enzyme linked immune sorbent assay (ELISA) and GM index of more than 1 was considered as positive. All GM positive patients were serially followed until discharge or death. RESULTS The GM was raised in serum of 12 out of 38 patients, indicating an incidence of possible COVID-19 associated IPA (CAPA) in 31.57% of patients. The median age of these CAPA patients was 56.5 years, males were significantly more affected than females. The inflammatory marker serum ferritin was raised in all 12 patients (median value of 713.74 ng/ml), while IL-6 was raised in 9 patients (median value of 54.13 ng/ml). None of these patients received antifungals. Their median length of hospital stay was 20 days (IQR: 12, 34 days). All these patients succumbed to the illness. CONCLUSIONS The serum GM appears to be sensitive diagnostic tool to identify early IPA in COVID-19 patients and pre-emptive antifungal therapy could play a role in salvaging these patients.
Collapse
Affiliation(s)
- S Das
- Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Castro M, Ganti A, Grover H, Kumar A, Mohapatra S, Basu K, Sahu D, Tyagi A, Nair P, Prasad S, Kumari P, Mundkur N, Patel S, Sauban M, Behura L, Kulkarni S, Patil M, Narvekar Y, Ghosh A, Ullal Y, Amara A, Kapoor S, Velcheti V. P12.06 Computational Omics Biology Model (CBM) Identifies PD-L1 Immunotherapy Response Criteria Based on Genomic Signature of NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
15
|
Fathy RA, McMahon DE, Lee C, Chamberlin GC, Rosenbach M, Lipoff JB, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Fassett M, Fox LP, Greenberg HL, Blumenthal K, Freeman EE. Varicella-zoster and herpes simplex virus reactivation post-COVID-19 vaccination: a review of 40 cases in an International Dermatology Registry. J Eur Acad Dermatol Venereol 2021; 36:e6-e9. [PMID: 34487581 PMCID: PMC8656951 DOI: 10.1111/jdv.17646] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023]
Affiliation(s)
- R A Fathy
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - D E McMahon
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - C Lee
- Department of Dermatology, Las Vegas School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - G C Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - M Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - J B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - A Tyagi
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - S R Desai
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Innovative Dermatology, Plano, TX, USA
| | - L E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - B H Thiers
- Department of Dermatology and Dermatologic Surgery, Medical University of SC, Charleston, SC, USA
| | - G J Hruza
- Department of Dermatology, St. Louis University, St. Louis, MO, USA
| | - M Fassett
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - L P Fox
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - K Blumenthal
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - E E Freeman
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
16
|
Abstract
Background Chronic migraine is an under-recognized and under-treated disorder. A greater understanding of the pathophysiology of migraine and transformation to chronic migraine has led to the first targeted treatments for chronic migraine. In this review, we review current approaches to the diagnosis and management of chronic migraine and discuss recent and emerging novel therapies. Objective The aim of this study was to provide an update on the diagnosis and management of chronic migraine. Methods and Material The PubMed database was searched for relevant articles published on or before October 2020. Results and Conclusions Chronic migraine is an under-recognized and under-treated disorder. Prompt diagnosis and appropriate management can lead to a significant improvement in the quality of life with subsequent socioeconomic benefits.
Collapse
Affiliation(s)
- Catriona L Gribbin
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Krishna A Dani
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alok Tyagi
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| |
Collapse
|
17
|
Seejore K, Alavi SA, Pearson SM, Robins JMW, Alromhain B, Sheikh A, Nix P, Wilson T, Orme SM, Tyagi A, Phillips N, Murray RD. Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes. BMC Endocr Disord 2021; 21:116. [PMID: 34112169 PMCID: PMC8194144 DOI: 10.1186/s12902-021-00777-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. METHODS Data from patients who underwent endoscopic TSS for a NFPMA (2009-2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. RESULTS Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). CONCLUSION Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.
Collapse
Affiliation(s)
- K Seejore
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S A Alavi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Pearson
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J M W Robins
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Alromhain
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Sheikh
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Nix
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Wilson
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Orme
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Tyagi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Phillips
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R D Murray
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| |
Collapse
|
18
|
Goyal MK, Solanki G, Tyagi A, Singh D. An Adolescent With Wilson's Disease and Empty Sella Syndrome Presenting as Psychotic Disorder. Prim Care Companion CNS Disord 2021; 23. [PMID: 34000121 DOI: 10.4088/pcc.20l02680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Gunjan Solanki
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India.,Corresponding author: Gunjan Solanki, MD, 334, Nirman Nagar AB, Mandir Marg, Ajmer Rd, Jaipur 302019, Rajasthan, India
| | - Alok Tyagi
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - Dharamdeep Singh
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
19
|
Ghoneim A, Pollard C, Tyagi A, Jampana R. Substantia nigra micro-haemorrhage causing ipsilateral unilateral Parkinsonism and abnormal dopamine transporter scan uptake. BJR Case Rep 2021; 7:20200118. [PMID: 33614119 PMCID: PMC7869125 DOI: 10.1259/bjrcr.20200118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/20/2020] [Accepted: 09/26/2020] [Indexed: 11/05/2022] Open
Abstract
Parkinsonism is a commonly seen movement disorder syndrome with neurodegenerative and non-neurodegenerative causes. Presynaptic dopamine transporter (DaT) single-photon emission computed tomography (SPECT) imaging is the most commonly used imaging technique in clinical practice to differentiate degenerative Parkinson's disease (PD) and PD plus syndromes from other causes such as essential tremor and drug-induced parkinsonism. This can help identify the patients who would benefit from medical therapy due to underlying pre-synaptic dopaminergic deficits. We report a case of unilateral parkinsonism caused by ipsilateral substantia nigra micro-haemorrhage resulting in disruption of the nigrostriatal pathway. This is an unusual case of a 55-year-old male patient who presented with unilateral Parkinsonism a decade after significant head trauma where MRI plays a critical and complementary role in diagnosing complete interruption of the nigrostriatal pathway due to cerebral micro-haemorrhage. The case also beautifully demonstrates the anatomy of the nigrostriatal pathway where a small lesion in the substantia nigra caused complete loss of radioligand uptake in the ipsilateral corpus striatum. Physicians should be aware of the importance of structural imaging in atypical movement disorder cases and, in particular, the routine use of susceptibility-weighted sequences (SWI).
Collapse
Affiliation(s)
- Aliaa Ghoneim
- Consultant Neuroradiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Christopher Pollard
- Department of Neuroradiology, Consultant Neuroradiology, Institute of Neurological Sciences, Glasgow, UK
| | - Alok Tyagi
- Department of Neurology, Consultant Neurology, Institute of Neurological Sciences, Glasgow, UK
| | - Ravi Jampana
- Department of Neuroradiology, Consultant Neuroradiology, Institute of Neurological Sciences, Glasgow, UK
| |
Collapse
|
20
|
Kontorinis G, Tyagi A. Potential association between recurrent facial nerve palsy and migraines. J Laryngol Otol 2020; 134:1-4. [PMID: 32940194 DOI: 10.1017/s0022215120001905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to investigate the possible association between recurrent facial nerve palsy and migraines. METHOD This study was a prospective case series with a two-year follow-up at an academic, tertiary referral centre and included patients with at least four episodes of recurrent lower motor neuron facial nerve palsy. All patients underwent standardised diagnostic tests. RESULTS Four patients fulfilled the inclusion criteria. The patients were all female with an average age at presentation of 40.75 years (range, 33-60 years) and an average age at the initial episode of 14 years (range, 12-16 years). The number of episodes varied between six and nine. All patients had at least one episode of facial nerve palsy on the contralateral side. Two patients were diagnosed and treated for migraine with aura remaining asymptomatic following prophylactic medication for migraines. CONCLUSION The results raise the possibility of an association between recurrent facial nerve palsy and migraines. Prospective studies in patients with even fewer episodes of facial nerve palsy could shed more light on this association.
Collapse
Affiliation(s)
- G Kontorinis
- Department of Otolaryngology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| | - A Tyagi
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, Scotland, UK
| |
Collapse
|
21
|
Radhakrishna V, Tyagi A, Narendranath S, Vadodariya K, Yadav R, Singh B, Balaji G, Satya N, Shetty A, Suresha Kumar HN, Kumar ., Vaishali S, Pillai NS, Tadepalli S, Raghavendra V, Sreekumar P, Agarwal A, Valarmathi N. Chandrayaan-2 Large Area Soft X-ray Spectrometer. CURR SCI INDIA 2020. [DOI: 10.18520/cs/v118/i2/219-225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
22
|
Kaushik S, Punia R, Tyagi A. Study of Dosimetric Properties of Flattening Filter Free Photon Beam Passing through Cadmium Free Compensator Alloy. J Biomed Phys Eng 2019; 9:647-652. [PMID: 32039095 PMCID: PMC6943851 DOI: 10.31661/jbpe.v0i0.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/22/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aims to investigate radiation beam geometry of Cyberknife beam and change in dosimetric characteristics of six megavoltage (6MV) flattening filter free (FFF) beam after passing through high density cadmium free compensator alloy. MATERIAL AND METHODS In this experimental study, changes in FFF beam dosimetric characteristics after passing through compensator alloy was measured. Transmitted intensity of FFF beam was measured in air by an ion chamber at a source to detector distance (SDD) of 800mm. Extended SDD measurement also has been performed at a distance of 1270mm to analyze scattering due to compensator. Linear attenuation coefficient (µeff) was measured for cadmium free compensator alloy using simple exponential attenuation model. Percentage depth doses (PDDs) have been measured by a radiation field analyzer with compensator material to observe the beam hardening and change in surface doses and depth doses. RESULTS Linear attenuation coefficient of compensator alloy was measured 0.042 (Standard Deviation ±0.00099) mm-1 and it was found that there is no change with increase in collimator size. Even after increasing distance source from detector, µeff has no change. PDDs were found to increase with thickness of compensator. PDD from a 60mm collimator size increased by 5% and 6% at a depth of 100mm and 200mm, respectively in water. PDD also increased with collimator size less significantly. Surface dose was found to decrease with increase in compensator thickness. CONCLUSION Cyberknife beam has been found to be narrow beam geometry. FFF beam contains lesser scattered photons. Presence of high density compensator filters out the soft x-ray photon causes significant dosimetric changes.
Collapse
Affiliation(s)
- S Kaushik
- PhD, DRP, Guru Jambheshwar University of Science and Technology, Hisar, Haryana, India
| | - R Punia
- PhD, Maharishi Dayanand University, Rohtak, Haryana, India
- PhD, Chaudhary Ranbir Singh University, Jind, Haryana, India
| | - A Tyagi
- PhD, DRP, BLK Super Speciality Hospital, New Delhi India
| |
Collapse
|
23
|
Gaur V, Chaudhary S, Tyagi A, Bakhshi S, Sharma P, Kumar S. Differential expression of various miRNAs in pediatric cytogenetically normal acute myeloid leukemia (CN-AML). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
de Coo IF, Marin JC, Silberstein SD, Friedman DI, Gaul C, McClure CK, Tyagi A, Liebler E, Tepper SJ, Ferrari MD, Goadsby PJ. Differential efficacy of non-invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: A meta-analysis. Cephalalgia 2019; 39:967-977. [PMID: 31246132 PMCID: PMC6637721 DOI: 10.1177/0333102419856607] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Two randomized, double-blind, sham-controlled trials (ACT1, ACT2) evaluated non-invasive vagus nerve stimulation (nVNS) as acute treatment for cluster headache. We analyzed pooled ACT1/ACT2 data to increase statistical power and gain insight into the differential efficacy of nVNS in episodic and chronic cluster headache. METHODS Data extracted from ACT1 and ACT2 were pooled using a fixed-effects model. Main outcome measures were the primary endpoints of each study. This was the proportion of participants whose first treated attack improved from moderate (2), severe (3), or very severe (4) pain intensity to mild (1) or nil (0) for ACT1 and the proportion of treated attacks whose pain intensity improved from 2-4 to 0 for ACT2. RESULTS The pooled population included 225 participants (episodic: n = 112; chronic: n = 113) from ACT1 (n = 133) and ACT2 (n = 92) in the nVNS (n = 108) and sham (n = 117) groups. Interaction was shown between treatment group and cluster headache subtype (p < 0.05). nVNS was superior to sham in episodic but not chronic cluster headache (both endpoints p < 0.01). Only four patients discontinued the studies due to adverse events. CONCLUSIONS nVNS is a well-tolerated and effective acute treatment for episodic cluster headache. TRIAL REGISTRATION The studies were registered at clinicaltrials.gov (ACT1: NCT01792817; ACT2: NCT01958125).
Collapse
Affiliation(s)
- Ilse F de Coo
- 1 Leiden University Medical Centre, Leiden, the Netherlands
| | - Juana Ca Marin
- 2 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK
| | | | - Deborah I Friedman
- 4 Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Charly Gaul
- 5 Migraine and Headache Clinic, Königstein, Germany
| | | | - Alok Tyagi
- 7 Neurology Department, The Southern Hospital, Glasgow, UK
| | | | | | | | - Peter J Goadsby
- 2 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, UK
| |
Collapse
|
25
|
Mohta M, Dubey M, Malhotra R, Tyagi A. Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section. Int J Obstet Anesth 2019; 38:25-31. [DOI: 10.1016/j.ijoa.2018.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/11/2018] [Accepted: 12/06/2018] [Indexed: 11/30/2022]
|
26
|
Mukherjee S, Sivakumar G, Goodden J, Tyagi A, Chumas P. FP2-1 Prognostic value of leucocytosis in paediatric traumatic brain injury. J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesWe assessed leucocytosis and evaluated its prognostic value in isolated paediatric traumatic brain injury (TBI).DesignRetrospective analysis.Subjects106 consecutive paediatric patients with isolated TBI admitted between June 2008 and June 2016.MethodsInitial blood leucocyte count (WCC), Glasgow Coma Score (GCS), computed tomographic (CT) findings, duration of hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS) scores were analysed.ResultsMean age was 4.2 years. For patients with GCS 3–8, 9–13 and 14–15, WCC was 20, 15.9 and 10.7 × 109/L respectively. Differences in WCC were significant between the different GCS groups (p<0.01). Length of hospital stay, extent of midline shift on CT and poor 6 month PCPCS rating were each significantly correlated with WCC (p<0.05). Multivariate regression analysis revealed a cut-off WCC of 16.1 × 109/L, above which GCS, CT findings, length of hospital stay and PCPCS were less favourable. Application of the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) adult TBI prediction model to our paediatric cohort, using area under the operating curve (AUROC) and coefficient analyses, demonstrated increased accuracy with incorporation of WCC as a risk factor.ConclusionsHigh initial leucocytosis (>16.1×109/L) is predictive for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating WCC into TBI prediction models may increase the accuracy of prognostication.
Collapse
|
27
|
Vartak A, Tyagi A, Talwar R, Pradeep J, Mukherjee D. Institutional experience of post mastectomy single stage implant based reconstruction with modified dual plane technique in carcinoma breast patients. Breast 2019. [DOI: 10.1016/s0960-9776(19)30386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
28
|
Abstract
Rate-dependent left bundle branch block during general anaesthesia is rare. Its occurrence makes electrocardiographic diagnosis of acute myocardial ischaemia or infarction difficult. It can also be confused with a slow rate ventricular tachycardia. We present a case of rate-dependent left bundle branch block in a patient with no previous history of ischaemic heart disease. Carotid sinus massage resulted in a decrease in heart rate and reversion to normal sinus rhythm.
Collapse
Affiliation(s)
- A Tyagi
- Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Shahadra, Delhi, India
| | | | | | | |
Collapse
|
29
|
Karanam S, Dasari R, Kumar A, Tyagi A, Kumar S, Lakshmi AY. Hemodialysis arteriovenous fistula maturation and role of perioperative vascular mapping. J NTR Univ Health Sci 2019. [DOI: 10.4103/jdrntruhs.jdrntruhs_55_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Affiliation(s)
- Georgios Kontorinis
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alok Tyagi
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - John A Crowther
- Department of Otolaryngology, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
31
|
Tyagi A, Luthra A, Kumar M, Das S. Epidemiology of acute kidney injury and the role of urinary [TIMP-2]·[IGFBP7]: a prospective cohort study in critically ill obstetric patients. Int J Obstet Anesth 2018; 36:77-84. [PMID: 30245258 DOI: 10.1016/j.ijoa.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 06/15/2018] [Accepted: 08/03/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are few data regarding acute kidney injury in critically-ill obstetric patients. A combination of urinary cell cycle arrest markers, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein7 (IGFBP7), is validated for the early prediction of acute kidney injury in non-obstetric patients. METHODS We evaluated the epidemiology of acute kidney injury in critically-ill obstetric patients and the role of the biomarker combination in predicting acute kidney injury and mortality. Acute kidney injury, its severity and risk factors, were assessed using Kidney Disease: Improving Global Outcomes (KDIGO) guidelines during the intensive care unit stay. An ELISA technique measured TIMP-2 and IGFBP7 in urine samples collected at the time of admission there. RESULTS Results for 66 patients showed an overall incidence of acute kidney injury of 40/66 (61%), with 50%, 10% and 40% being in stage 1, 2 and 3 respectively. Patients with acute kidney injury showed significantly greater sepsis and shock; longer stay and higher mortality during intensive care (33% vs 0%) and in hospital (38% vs 0%) compared to those without (P <0.05). The area-under-the receiver operating characteristics curve was <0.5 for urinary [TIMP-2]·[IGFBP7] as a predictor of kidney injury and mortality (P >0.05). CONCLUSIONS Acute kidney injury is common in critically-ill obstetric patients, increasing mortality and duration of hospitalization. It was significantly more common in patients with septic shock. Previously validated results of urinary [TIMP-2]·[IGFBP7] that successfully predict early acute kidney injury or mortality are not applicable to obstetric patients.
Collapse
Affiliation(s)
- A Tyagi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
| | - A Luthra
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - M Kumar
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - S Das
- Department of Microbiology, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| |
Collapse
|
32
|
Affiliation(s)
- A. Tyagi
- University College of Medical Sciences and GTB Hospital; Delhi India
| | - M. Ramanujam
- University College of Medical Sciences and GTB Hospital; Delhi India
| |
Collapse
|
33
|
Goadsby PJ, de Coo IF, Silver N, Tyagi A, Ahmed F, Gaul C, Jensen RH, Diener HC, Solbach K, Straube A, Liebler E, Marin JCA, Ferrari MD. Non-invasive vagus nerve stimulation for the acute treatment of episodic and chronic cluster headache: A randomized, double-blind, sham-controlled ACT2 study. Cephalalgia 2018; 38:959-969. [PMID: 29231763 PMCID: PMC5896689 DOI: 10.1177/0333102417744362] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 01/03/2023]
Abstract
Background Clinical observations and results from recent studies support the use of non-invasive vagus nerve stimulation (nVNS) for treating cluster headache (CH) attacks. This study compared nVNS with a sham device for acute treatment in patients with episodic or chronic CH (eCH, cCH). Methods After completing a 1-week run-in period, subjects were randomly assigned (1:1) to receive nVNS or sham therapy during a 2-week double-blind period. The primary efficacy endpoint was the proportion of all treated attacks that achieved pain-free status within 15 minutes after treatment initiation, without rescue treatment. Results The Full Analysis Set comprised 48 nVNS-treated (14 eCH, 34 cCH) and 44 sham-treated (13 eCH, 31 cCH) subjects. For the primary endpoint, nVNS (14%) and sham (12%) treatments were not significantly different for the total cohort. In the eCH subgroup, nVNS (48%) was superior to sham (6%; p < 0.01). No significant differences between nVNS (5%) and sham (13%) were seen in the cCH subgroup. Conclusions Combing both eCH and cCH patients, nVNS was no different to sham. For the treatment of CH attacks, nVNS was superior to sham therapy in eCH but not in cCH. These results confirm and extend previous findings regarding the efficacy, safety, and tolerability of nVNS for the acute treatment of eCH.
Collapse
Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King’s Clinical
Research Facility, King’s College Hospital, London, UK
| | - Ilse F de Coo
- Leiden University Medical Centre,
Leiden, the Netherlands
| | - Nicholas Silver
- The Walton Centre for Neurology and
Neurosurgery, Liverpool, UK
| | - Alok Tyagi
- Queen Elizabeth University Hospital
Glasgow, Glasgow, UK
| | | | - Charly Gaul
- Migraine and Headache Clinic,
Königstein, Germany
| | | | | | | | - Andreas Straube
- Department of Neurology, University
Hospital, LMU Munich, Munich, Germany
| | | | - Juana CA Marin
- NIHR-Wellcome Trust King’s Clinical
Research Facility, King’s College Hospital, London, UK
| | | |
Collapse
|
34
|
Solanki RK, Sharma P, Tyagi A, Singh C. Serum Levels of Neuroactive Steroids in First-episode Antipsychotic-naïve Schizophrenic Patients and Its Correlation with Aggression: A Case-control Study. East Asian Arch Psychiatry 2017; 27:79-84. [PMID: 28652501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The evidence of hypothalamic-pituitary-adrenal axis dysfunction in schizophrenia has been reviewed in the context of the stress-diathesis model. Overactivation of this axis leads to altered blood levels of cortisol and dehydroepiandrosterone sulfate (DHEA-S). These neurosteroids in turn act on the hippocampus and interact with gamma-aminobutyric acid and N-methyl-D-aspartate receptors leading to neurotoxicity and may be involved in the neurobiology of aggression. This study aimed to explore the blood level of these neurosteroids and ascertain its correlation with state aggression and psychopathology in first-episode antipsychotic-naïve schizophrenic patients. METHODS A total of 30 patients with first-episode schizophrenia along with 20 age- and gender-matched healthy controls participated in the study. Both groups were subjected to serum cortisol and DHEA-S measurement after assessment of psychopathology and aggression on a standardised psychometric scale. RESULTS Serum DHEA-S level was significantly higher in the patient group (p = 0.001). No difference was noted between males and females in the patient group (p = 0.93) but female controls had a significantly lower serum DHEA-S level than male controls (p < 0.01). Serum DHEA-S inversely correlated with scores on Modified Overt Aggression Scale (p = 0.01) but not with Positive and Negative Syndrome Scale (p = 0.39) or Clinical Global Impression Scale (p = 0.28). CONCLUSION The first-episode antipsychotic-naïve schizophrenic patients showed a significantly higher blood level of DHEA-S compared with healthy controls. Serum DHEA-S level has an inverse relationship with aggression and may serve as a biological adaptive mechanism to antagonise the neuronal damage caused by cortisol.
Collapse
Affiliation(s)
- R K Solanki
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - P Sharma
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - A Tyagi
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - C Singh
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
35
|
Abstract
We describe a 39-year-old man who developed thunderclap headaches during a hospital admission for accidental superficial burns. His magnetic resonance brain imaging was normal expect for diffuse segmental vasoconstriction. Prior to admission, he was consuming excessive amounts of caffeine which was restarted and slowly tapered and stopped over weeks. Repeat magnetic resonance angiogram showed resolution of segmental vasoconstriction. The implications of prescribed and non-prescribed drugs on cerebral vasculature have been discussed.
Collapse
Affiliation(s)
- Dheeraj Kalladka
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
| | - Aslam Siddiqui
- 2 AS, Consultant Neuroradiologist, Department of Neuroradiology, Queen Elizabeth University Hospital, UK
| | - Alok Tyagi
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
| | - Edward Newman
- 1 DK, Neurology Registrar/Stroke Fellow AT & EN, Consultant Neurologists, Department of Neurology, Queen Elizabeth University Hospital, UK
| |
Collapse
|
36
|
Tyagi A, Singh S, Kumar M, Sethi AK. Intra-abdominal pressure and intra-abdominal hypertension in critically ill obstetric patients: a prospective cohort study. Int J Obstet Anesth 2017; 32:33-40. [PMID: 28619279 DOI: 10.1016/j.ijoa.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/15/2017] [Accepted: 05/04/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Critically ill obstetric patients may have risk factors for intra-abdominal hypertension. This study evaluated the intra-abdominal pressure and its effect on organ function and the epidemiology of intra-abdominal hypertension. METHODS Obstetric patients admitted to an Intensive Care Unit, with an anticipated stay greater than 24hours, were included. Intra-abdominal pressure was measured daily via a Foley catheter, based on intravesical pressure. RESULTS One-hundred-and-one patients were enrolled. The intra-abdominal pressure was 5-7mmHg in 34%; 7-12mmHg in 60%; and ≥12mmHg (intra-abdominal hypertension) in 6%. All six patients with intra-abdominal hypertension were pregnant at the time of admission. The intra-abdominal pressure in four patients normalized to <12mmHg following delivery, but in the remaining two it persisted ≥12mmHg and both these patients died. Correlation between intra-abdominal pressure and organ dysfunction was weak (r=0.211). Statistical comparison between patients with and without intra-abdominal hypertension for risk factors, daily intra-abdominal pressures, and Sequential Organ Failure Assessment score could not be done due to the disproportionately small number of patients with intra-abdominal hypertension as opposed to those without (6 versus 95). Intra-abdominal pressure did not significantly differ between survivors and non-survivors (8.5±1.1 vs 7.9±1.7mmHg, P=0.079). CONCLUSIONS The incidence of intra-abdominal hypertension in critically ill obstetric patients was lower than previously defined for mixed Intensive Care Unit populations, with an association with the pregnant state. Normalization of intra-abdominal pressure after delivery was associated with better survival. There was no correlation between intra-abdominal pressure and organ function or mortality.
Collapse
Affiliation(s)
- A Tyagi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India.
| | - S Singh
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - M Kumar
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| | - A K Sethi
- Department of Anaesthesiology & Critical Care, University College of Medical Sciences & GTB Hospital, Delhi 110095, India
| |
Collapse
|
37
|
Tyagi A, Kaushik S, Punia R, Singh M. SU-F-T-533: Study of Dosimetric Properties of Cadmium Free Alloy Used in Compensator Based IMRT. Med Phys 2016. [DOI: 10.1118/1.4956718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
38
|
Kalladka D, Paul M, Tyagi A. Teaching NeuroImages: Red ear syndrome. Neurology 2016; 86:e177-8. [PMID: 27164455 DOI: 10.1212/wnl.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dheeraj Kalladka
- From the Departments of Neurology (D.K., A.T.) and Pathology (M.P.), Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK.
| | - Maxine Paul
- From the Departments of Neurology (D.K., A.T.) and Pathology (M.P.), Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Alok Tyagi
- From the Departments of Neurology (D.K., A.T.) and Pathology (M.P.), Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| |
Collapse
|
39
|
Srivastava R, Batra A, Tyagi A, Dhawan D, Ramakrishnan L, Bakhshi S. Adiponectin correlates with obesity: A study of 159 childhood acute leukemia survivors from India. Indian J Cancer 2016; 52:195-7. [PMID: 26853401 DOI: 10.4103/0019-509x.175824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia survivors are predisposed to obesity. However, the exact underlying mechanisms are not known. AIMS The study was done to assess the role of biomarkers of obesity in acute leukemia survivors. SETTINGS AND DESIGNS This is a cross-sectional study conducted at All India Institute of Medical Sciences in survivors of acute leukemia who had completed treatment at least 1 year before enrollment in this study. MATERIALS AND METHODS Obesity was studied by determining the body mass index. Potential biomarkers were studied by assessing serum leptin, resistin, and adiponectin by enzyme-linked immunosorbant assay, and the results were compared in obese versus nonobese survivors. STATISTICAL ANALYSIS Descriptive analysis for baseline demographic factors and Student's t-test for comparing the mean levels of biomarkers among the obese and nonobese survivors. RESULTS One hundred and fifty-nine acute leukemia patients were enrolled in this study with a median follow-up of 36.8 months. The median age was 10 (range: 3-18) years, and 123 (77.3%) patients were males. The overall prevalence of overweight/obesity was 26.4%, and this was similar in acute myeloid leukemia and acute lymphoblastic leukemia sub-groups (26.2% vs. 27.3%, P = 0.9). Mean serum leptin and resistin were similar in obese and nonobese leukemia survivors (3.7 vs. 2.85 pg/mL, P = 0.064; 8.01 vs. 9.33 ng/mL, P = 0.36). However, mean serum adiponectin was significantly lower in obese leukemia survivors (7.97 vs. 11.5 μg/mL, P = 0.023). CONCLUSIONS Obese leukemic survivors had lower serum adiponectin levels than nonobese survivors. However, serum resistin and leptin levels were similar in the two groups.
Collapse
Affiliation(s)
| | | | | | | | | | - S Bakhshi
- Department of Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
40
|
Nix P, Tyagi A, Phillips N. Evolution of a UK endoscopic anterior skull base pituitary service - the first one hundred and twenty-three patients: Our Experience. Clin Otolaryngol 2016; 41:289-93. [DOI: 10.1111/coa.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2015] [Indexed: 11/27/2022]
Affiliation(s)
- P. Nix
- Department of Otolaryngology; Leeds Teaching Hospitals; Leeds UK
| | - A. Tyagi
- Department of Neurosurgery; Leeds Teaching Hospitals; Leeds UK
| | - N. Phillips
- Department of Neurosurgery; Leeds Teaching Hospitals; Leeds UK
| |
Collapse
|
41
|
|
42
|
Ansel S, Rae A, Tyagi A. Efficacy of epidural blood patches for spontaneous low-pressure headaches: a case series. J R Coll Physicians Edinb 2016; 46:234-237. [DOI: 10.4997/jrcpe.2016.404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
43
|
Tripathi R, Soni A, Tyagi A, Mehta S, Gupta S. Comparative Study of Neurological Soft Signs in Patients with Schizophrenia or Obsessive-compulsive Disorder, and Healthy Controls. East Asian Arch Psychiatry 2015; 25:64-72. [PMID: 26118745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The primary objective of this study was to examine neurological soft signs in patients with obsessive-compulsive disorder compared with patients with schizophrenia and a control group in the Indian setting. The secondary objective was to find any correlation between age at onset and neurological soft signs scores, as well as that between severity of obsessive-compulsive disorder symptoms (total Yale-Brown Obsessive Compulsive Scale score) and neurological soft signs scores. METHODS This was a cross-sectional hospital-based study of 135 individuals (45 patients with schizophrenia, 45 patients with obsessive-compulsive disorder who were attending the psychiatric outpatient department of Sawai Man Singh Medical College, Jaipur, India, and 45 matched healthy controls) from 20 June 2013 to 22 December 2014. After applying strict inclusion and exclusion criteria, the participants completed the study instruments (Cambridge Neurological Inventory [Part 2] and Yale-Brown Obsessive Compulsive Scale). Their socio-demographic data were also recorded. RESULTS The neurological soft signs total score and domain scores (motor coordination, sensory integration, and disinhibition) were significantly higher in patients with schizophrenia (p < 0.05) than in the obsessive-compulsive disorder group or the control group. The obsessive-compulsive disorder group did not significantly differ from the control group in terms of neurological soft signs scores. No correlation was found between neurological soft signs scores and age at onset as well as that between neurological soft signs scores and total Yale-Brown Obsessive Compulsive Scale score. CONCLUSION Neurological soft signs assessed by the Cambridge Neurological Inventory and Yale-Brown Obsessive Compulsive Scale, which discriminate patients with schizophrenia from controls, appear to be relatively specific to schizophrenia. Further studies are required to explore neurological soft signs in patients with obsessive-compulsive disorder.
Collapse
Affiliation(s)
- R Tripathi
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, India
| | - A Soni
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, India
| | - A Tyagi
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, India
| | - S Mehta
- Navjeevan Hospital, Hisar, Haryana, India
| | - S Gupta
- Department of Psychiatry, Sawai Man Singh Medical College, Jaipur, India
| |
Collapse
|
44
|
Amoaku W, Cackett P, Tyagi A, Mahmood U, Nosek J, Mennie G, Rumney N. Redesigning services for the management of vitreomacular traction and macular hole. Eye (Lond) 2015; 28 Suppl 1:S1-10. [PMID: 25008433 PMCID: PMC4097190 DOI: 10.1038/eye.2014.125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey—from initial referral to treatment—taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.
Collapse
Affiliation(s)
- W Amoaku
- Faculty of Medicine and Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - P Cackett
- Princess Alexandra Eye Pavilion, Edinburgh, UK
| | - A Tyagi
- Birmingham and Midlands Eye Centre and Sandwell General Hospital, Birmingham, UK
| | - U Mahmood
- University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - J Nosek
- Wolverhampton Eye Infirmary, Wolverhampton, UK
| | - G Mennie
- Gloucestershire Clinical Commissioning Group, Brockworth, UK
| | | |
Collapse
|
45
|
Mehta S, Tyagi A, Swami MK, Gupta S, Kumar M, Tripathi R. Onset of acute and transient psychotic disorder in India: a study of socio-demographics and factors affecting its outcomes. East Asian Arch Psychiatry 2014; 24:75-80. [PMID: 24986202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Acute and transient psychotic disorder has been accepted as a distinct diagnostic entity in the ICD-10. However, there are few studies delineating its demographics and factors affecting its outcome. This study aimed to examine the socio-demographic profile of patients with acute and transient psychotic disorder and the variables associated with the onset of illness and their effect on illness outcome in an Indian setting. METHODS This was a retrospective study in which case notes of patients admitted from 1 January to 31 December 2012 and diagnosed with acute and transient psychotic disorder (according to the ICD-10 diagnostic criteria) were analysed. Socio-demographic variables and variables associated with the onset of illness were noted. Duration of hospital stay was used as a proxy measure for clinical outcome. RESULTS A total of 185 patient records were analysed. Overall, 49% of the patients were males and 51% were females. Most of the cases (60%) were aged between 20 and 39 years. The majority was married, unemployed, educated up to middle school, living in a nuclear family, and had a rural background. Age (p = 0.05) and marital status (p = 0.03) significantly affected the outcome. Overall, 46% of the patients had stress as a precipitating factor, 27% reported substance use, and 23% had a family history of psychiatric illness prior to the onset of their illness. The onset of illness was from May to October in 54% of the patients, with the duration of untreated illness ranging from 7 to 15 days in 38% of the patients. The clinical outcome was significantly affected by duration of untreated illness (p = 0.05). CONCLUSIONS Acute and transient psychotic disorders show slight female preponderance and occur in early adulthood. There is no precipitating stress in most cases and shorter duration of untreated illness predicts favourable clinical outcome.
Collapse
Affiliation(s)
- S Mehta
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - A Tyagi
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - M K Swami
- Department of Psychiatry, BPS Government Medical College for Women, Sonepat, Haryana, India
| | - S Gupta
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - M Kumar
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| | - R Tripathi
- Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
46
|
Mehta S, Tyagi A, Tripathi R, Kumar M. Study of inter-relationship of depression, seizure frequency and quality of life of people with epilepsy in India. Ment Illn 2014. [DOI: 10.1108/mi.2014.5169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Epilepsy is a chronic neurological disorder that can have profound physical, social and psychological consequences. We aimed to assess the clinical predictors of quality of life of people with epilepsy. We recruited 31 patients suffering from epilepsy in this cross-sectional study. Their clinical profile was recorded. Quality Of Life in Epilepsy (QOLIE-31) was used to assess quality of life of our patients. Depression was screened by Neurological Disorders Depression Inventory in Epilepsy (NDDI-E). Among all the clinical variables, only seizure frequency significantly correlated with seizure worry (P=0.002), emotional well-being (P=0.026) and social functions (P=0.013) subscales of QOLIE-31. NDDIE score showed a significant negative correlation with all the subscales of QOLIE-31 except medication effects (P=0.993). A significant positive correlation was also noted between seizure frequency and NDDI-E score (r=0.417, P=0.020). Seizure frequency and depression are the most important predictors of quality of life in epilepsy patients. The management of patients with epilepsy should not only be aimed at just preventing seizures but the treating clinicians should also be cognizant about depression which itself can significantly affect the quality of life of patients.
Collapse
|
47
|
Mehta S, Tyagi A, Tripathi R, Kumar M. Study of Inter-relationship of Depression, Seizure Frequency and Quality of Life of People with Epilepsy in India. Ment Illn 2014; 6:5169. [PMID: 25478138 PMCID: PMC4253398 DOI: 10.4081/mi.2014.5169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/25/2014] [Indexed: 12/02/2022] Open
Abstract
Epilepsy is a chronic neurological disorder that can have profound physical, social and psychological consequences. We aimed to assess the clinical predictors of quality of life of people with epilepsy. We recruited 31 patients suffering from epilepsy in this cross-sectional study. Their clinical profile was recorded. Quality Of Life in Epilepsy (QOLIE-31) was used to assess quality of life of our patients. Depression was screened by Neurological Disorders Depression Inventory in Epilepsy (NDDI-E). Among all the clinical variables, only seizure frequency significantly correlated with seizure worry (P=0.002), emotional well-being (P=0.026) and social functions (P=0.013) subscales of QOLIE-31. NDDIE score showed a significant negative correlation with all the subscales of QOLIE-31 except medication effects (P=0.993). A significant positive correlation was also noted between seizure frequency and NDDI-E score (r=0.417, P=0.020). Seizure frequency and depression are the most important predictors of quality of life in epilepsy patients. The management of patients with epilepsy should not only be aimed at just preventing seizures but the treating clinicians should also be cognizant about depression which itself can significantly affect the quality of life of patients.
Collapse
Affiliation(s)
- Shubham Mehta
- Department of Psychiatry, SMS Medical College , Jaipur, Rajasthan, India
| | - Alok Tyagi
- Department of Psychiatry, SMS Medical College , Jaipur, Rajasthan, India
| | - Richa Tripathi
- Department of Psychiatry, SMS Medical College , Jaipur, Rajasthan, India
| | - Mahesh Kumar
- Department of Psychiatry, SMS Medical College , Jaipur, Rajasthan, India
| |
Collapse
|
48
|
Sclafani R, Agarwal R, Tyagi A, Siriwardana S, Takahata T, Frederick B, Raben D. Chemoprevention by Resveratrol in Head-and-Neck Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2013.11.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
49
|
Lip SZL, Miller SL, Tyagi A. AUDIT OF HEADACHE REFERRALS FROM PRIMARY CARE TO A REGIONAL HEADACHE SERVICE. J Neurol Neurosurg Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306573.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
50
|
|