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Bajpai A. Hypothalamic-Pituitary-Adrenal Axis Suppression with Inhaled Corticosteroids-Time to Close the Debate? Indian J Pediatr 2024; 91:426-427. [PMID: 38233635 DOI: 10.1007/s12098-024-05043-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India.
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Krishna Prasad H, Bajpai A. Pediatric Endocrinology in Office Practice - The Way Forward. Indian J Pediatr 2023; 90:572-573. [PMID: 37140837 DOI: 10.1007/s12098-023-04618-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Hemchand Krishna Prasad
- Department of Pediatric Endocrinology, Mehta Multispeciality Hospitals India Pvt. Ltd, 2, Mc Nichol's Road, Chetpet, Chennai, Tamil Nadu, India.
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Kanpur, Uttar Pradesh, India
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Abstract
Precocious puberty is a common presentation to pediatricians with a significant overlap between physiology and pathology. While most girls with precocious puberty have no identifiable cause, boys are more likely to have a pathological cause. The trend of earlier onset of thelarche with slow pubertal tempo has led to a significant increase in the number of girls presenting with precocious puberty. Advanced growth, bone age, uterine maturation, and elevated LH suggest rapidly progressive puberty. The critical issues in evaluating a child presenting with precocious puberty include its confirmation, exclusion of physiological variants, identification of the cause, and determining the need for treatment. Step-wise evaluation with emphasis on clinical parameters provides cost-effective assessment. Gonadotropin-releasing hormone (GnRH) analogs remain the mainstay of treatment for central precocious puberty but should be restricted to individuals with rapidly progressive puberty and compromised final height. The management of rarer forms of peripheral precocious puberty (McCune Albright syndrome, congenital adrenal hyperplasia, and testotoxicosis) involves using experimental drugs under the guidance of specialists.
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Affiliation(s)
- Sayan Banerjee
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, 208001, India.
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Bajpai A. Body Frame-Based Hypertension Risk Assessment-Has the Time Come? Indian J Pediatr 2023; 90:319-320. [PMID: 36811774 DOI: 10.1007/s12098-023-04502-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India. .,Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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Bajpai A. Atherosclerosis in Pediatric and Adolescent Type 1 Diabetes-A Case for Early Identification? Indian J Pediatr 2023; 90:215-216. [PMID: 36585547 DOI: 10.1007/s12098-022-04430-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India. .,Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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Bajpai A. High Prevalence of Lipid Disorders in Type 1 Diabetes-Time for Treatment? Indian J Pediatr 2023; 90:110-111. [PMID: 36203038 DOI: 10.1007/s12098-022-04373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India.
- Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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Tewari R, Dalal D, Rawat S, Malik A, Ghalaut V, Bajpai A. The altered levels of adiponectin - leptin as predictive biomarkers to estimate the severity of prostate cancer. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1529] [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: 11/16/2022] Open
Abstract
Introduction and Aim: Prostate is one of the commonest sites of malignancy affecting elderly male population & is increasingly becoming a significant public health issue especially in countries having aging population. We hypothesized that altered levels of adiponectin-leptins may be an underlying connection between incidence of prostate cancer (PCa) and aged matched males.
Materials and Methods: This study was designed to comparatively corelate circulating serum levels of adiponectin & leptin in 160 elderly patients with PCa to their serum levels in 160 healthy controls. The age and body mass index in all groups were dissimilar in case and control. Based on the Gleason score of 7, =7 >7, patients were further subdivided into low, intermediate, high grades of PCa, respectively.
Results: No significant statistical variance was identified in terms of age, Body mass index (BMI), Radom blood glucose, HDL, LDL, triglycerides, total cholesterol, creatinine, and BUN levels within the compared groups. In PCa patients’ group, concentration levels of serum adiponectin were significantly lower, and levels of serum leptin was significantly greater compared to healthy controls (P<0.001). Statistical analysis revealed a significant positive inverse association between PSA and adiponectin levels (r=0.285, P<0.001) and significant association between serum levels of PSA and leptin (r=0.285, P<0.001). Significant statistical correlation was also evident between BMI, PSA, TG, and leptin were whole group. However, there was no significant association observed between adiponectin or leptin level and grade of the disease.
Conclusion: Evaluation of data in our study suggests that patients of PCa exhibit low concentration of serum adiponectin levels and high concentration of leptin levels. Further, this association was independent of histological grading of disease of disease/disease progression as well as other biochemical parameters.
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Bajpai A. Waist-to-Height Ratio-The New Body Mass Index? Indian J Pediatr 2022; 89:849-850. [PMID: 35583630 DOI: 10.1007/s12098-022-04257-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India.
- Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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9
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Bajpai A. Vitamin D Deficiency in Indian Adolescents-Time for Targeted Action. Indian J Pediatr 2022; 89:746. [PMID: 35713771 DOI: 10.1007/s12098-022-04307-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh 208001, India. .,Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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10
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Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, Uttar Pradesh, 208001, India. .,Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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11
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Akhtar Z, Sohal M, Kontogiannis C, Leung LWM, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in coronary venous drainage: challenges and solutions in delivering cardiac resynchronisation therapy. Europace 2022. [DOI: 10.1093/europace/euac053.490] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac resynchronisation therapy (CRT) is the cornerstone of heart failure management. Delivery of a left ventricular lead can occur in a small proportion of patients undermining the benefits of this treatment. Abnormal coronary venous anatomy is a contributing factor to this failure. Although epicardial lead placement is available, this patient cohort requiring CRT is subject to higher peri-operative morbidity and mortality than the general population; a transvenous approach is preferable.
Purpose
To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties.
Methods
From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted ‘normal’ anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected.
Results
From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an ‘unroofed’ coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant.
Conclusion
CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required.
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Affiliation(s)
- Z Akhtar
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - C Kontogiannis
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Harding
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Pearse
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - I Beeton
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Leung L, Akhtar Z, Bajpai A, Li A, Sohal M, Norman M, Kaba R, Al-Subaie N, Louis-Auguste J, Hayat J, Zuberi Z, Gallagher M. Oesophageal protection during AF ablation: real world registry data and mechanisms behind the therapeutic effect of tissue cooling. Europace 2022. [DOI: 10.1093/europace/euac053.229] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Oesophageal protection using a dedicated device to provide controlled active thermal protection of the oesophagus during atrial fibrillation ablation has been shown to be effective at reducing endoscopically detected oesophageal lesions. Real world registry data of this device and established evidence on the effect of cooling on localized tissue after thermal injury have been under review.
Purpose
To determine the safety of an oesophageal temperature control device by a review of real-world registry data on its clinical use during catheter ablation procedures and to clarify basic mechanisms of its therapeutic action by a literature review of scientific studies on cooling in the context of thermal injury.
Methods
The United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE), FDA Medical and Radiation Emitting Device Recalls, the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Alerts and SwissMedic records of Field Safety Corrective Actions (FSCA) databases were reviewed for any device-related adverse events. A systematic literature review was conducted to clarify the findings from studies investigating the physiological processes behind the therapeutic effect of cooling after tissue thermal injury.
Results
Of over 20,000 oesophageal temperature control devices clinically used, 7976 were recorded as having been used for the purpose of oesophageal protection during left atrial catheter ablations. No adverse events occurred related to its use during left atrial catheter ablations. No case of clinically significant oesophageal injury was reported in a patient who had been protected by the oesophageal temperature control device. 208 research articles retrieved from PubMed and MEDLINE that met the search criteria were reviewed. The common finding in all the studies was that cooling had an anti-inflammatory and restorative effect via modulation of several immune-mediated pathways, local cellular function and genetic expression.
Conclusions
There have been no adverse events reported to date in real world clinical use of an oesophageal temperature control device during left atrial catheter ablations, for the purpose of active thermal protection. Literature review data suggests that there are complex biophysical and cellular effects from cooling that leads to its therapeutic effect but further work is required to define the mechanisms of action of thermal protection in this specific context.
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Affiliation(s)
- L Leung
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - R Kaba
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - N Al-Subaie
- Ahmadi hospital, Anaesthetics, Kuwait, Kuwait
| | - J Louis-Auguste
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - J Hayat
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Gallagher
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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Gallagher M, Akhtar Z, Gang Y, Gonna H, Li A, Bajpai A, Zuberi Z, Norman M, Sohal M, Leung LWM. Randomised comparison of achieve and traditional circular mapping catheters in cryoballoon ablation: results at up to a decade. Europace 2022. [DOI: 10.1093/europace/euac053.082] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A single-centre trial randomised patients to the use of the Achieve mapping catheter or a traditional circular mapping catheter during cryoballoon procedures for paroxysmal atrial fibrillation (AF) in 2011-2014. Long-term outcomes from the cohort were determined in 2021.
Purpose
To evaluate the determinants of long-term outcome of ablation for paroxysmal AF.
Methods
Patient and study procedure characteristics and clinical outcomes were determined, including mapping catheter assignment, model of cryoballoon used, AF recurrence, repeat ablations required, findings at repeat ablation long term survival of the patient.
Results
Of 102 patients in the original study, 98 had long-term (4.11+/-2.82 years) follow up data available. 35 patients (35.7%) had AF recurrence, giving a long-term success rate at 64.3% after 1 ablation, increasing to 81.6% after repeat ablation. Of the study cohort n=8 (8.16%) died at a median of 4.9 years after ablation (IQR:1.7-5.7). 25/98 (25.5%) patients had a second ablation and 7 (7.1%) had a third or more ablations. Those who had AF recurrence were older, with a higher prevalence of prior ischaemic heart disease and cardiac device implantation (p=0.02-0.03). After multi-variate analysis, a prior implanted cardiac device was the only significant predictor of recurrence (p=0.03).
Conclusion
Long-term outcomes after a 1st time PAF cryoablation were similar regardless of the type of mapping catheter used, the generation of cryoballoon, and traditional procedure endpoints. AF recurrences were more often detected in older patients with a history of ischaemic heart disease and implanted cardiac devices.
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Affiliation(s)
- M Gallagher
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Y Gang
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - H Gonna
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- Epsom and St Helier University Hospitals NHS Trust, Cardiology, Epsom, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- Royal Surrey County Hospital, Cardiology, Guildford, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- Frimley Park Hospital, Cardiology, Frimley, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - LWM Leung
- St George’s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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Dave C, Agarwal N, Patel R, Shukla R, Bajpai A. Determinants and Predictors of Body Fat in Indian Children and Adolescents. Indian J Pediatr 2022; 89:473-476. [PMID: 34236600 DOI: 10.1007/s12098-021-03815-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study determinants and predictors of body fat in Indian children and adolescents. METHODS In this cross-sectional study, 5175 children and adolescents [3014 boys, age 12.8 (3) y, 5-18 y] participated. Determinants and predictors of body fat were assessed using partial correlation (corrected for age, and gender) and linear regression. RESULTS Fat percentage correlated negatively with the duration of physical activity (r = -0.091, p < 0.01) and sleep (r = -0.044, p = 0.01) and positively with parental body mass index (BMI) (r = 0.202, p < 0.01 for father and r = 0.235, p < 0.01 for mother), and birth weight (r = 0.050, p < 0.01). On linear regression, fat percentage was positively associated with parental BMI and birth weight, and negatively with physical activity and sleep duration. All adiposity markers [BMI standard deviation score (SDS) (r = 0.863, p < 0.01), weight SDS (r = 0.827, p < 0.01) waist to height ratio (r = 0.819, p < 0.01), waist circumference SDS (r = 0.765, p < 0.01) wrist circumference (r = 0.21, p < 0.01), and neck circumference (r = 0.19, p < 0.01)] correlated significantly with fat percentage, showing highest correlation with BMI SDS. CONCLUSION Reduced sleep and physical activity are the key modifiable risk factors for adiposity. BMI SDS is the best clinical surrogate of body fat in Indian children and adolescents. There is a need to explore the impact of lifestyle interventions targeting sleep and physical activity on adiposity.
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Affiliation(s)
- Chetankumar Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, The Mall, Kanpur, Uttar Pradesh, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India
| | - Neha Agarwal
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, The Mall, Kanpur, Uttar Pradesh, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India
| | - Riddhi Patel
- GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India
| | - Rishi Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, The Mall, Kanpur, Uttar Pradesh, 208001, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, The Mall, Kanpur, Uttar Pradesh, 208001, India. .,GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India.
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Bajpai A. Universal Nerve Conduction Screening in Type 1 Diabetes-Are We There Yet? Indian J Pediatr 2022; 89:216-217. [PMID: 35029809 DOI: 10.1007/s12098-021-04075-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India. .,Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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Shukla R, Shukla S, Agarwal N, Bajpai A, Khattri M. Early Cataract and Surgical Recovery in Young Type 1 Diabetics: Experiences from a Single Centre in Northern India. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52927.16451] [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: 11/24/2022]
Abstract
Introduction: Cataract, a non-retinal ophthalmic complication, is the leading cause of visual impairment in adults living with Type 1 Diabetes (T1D). Unfortunately, there is a dearth of data on diabetic cataract in the paediatric population, particularly from developing countries. To the best of our knowledge, the current study is the first and the largest observational study reporting the characteristics, and surgical recovery of early cataract among Indian children and adolescents living with T1D. Aim: To report the patient characteristics and surgical outcome of early cataract in young type 1 diabetics. Materials and Methods: The present study was a retrospective observational study (January 2005-December 2020), conducted at Regency Hospital Pvt. Ltd., Kanpur, Uttar Pradesh, India. Medical records of Children and adolescents (n=150) aged 1-18 years with T1D in the last 15 years, and who developed cataract during follow-up were included in the study and reviewed from January 2021 to March 2021 , for the socio-demographic details, age at which diabetes was diagnosed, presence or absence of ketoacidosis at the time of diagnosis of diabetes, age at which cataract was diagnosed, glycaemic control, morphology and laterality of cataract, history of retinopathy before cataract surgery, presence or absence of concomitant nephropathy, visual acuity at the time of cataract diagnosis, type of surgical intervention done and visual acuity following surgery. Results: Out of 150 T1D patients, a total of ten patients (five boys; 19 eyes) were diagnosed with cataract, before the age of 18 years. The mean age at diagnosis of T1D was 8.6±3.2 years (range, 3-12 years) and cataract was 13.2±4.1 years (range, 6-18 years). Mean HbA1c at the time of cataract diagnosis was 7.99±0.98%. The past history of diabetic ketoacidosis was documented in six patients (60%). Nearly 70% (n=7) patients belonged to the lower socio-economic strata. Cortical cataract (12/19 eyes; 63%) was the most common morphology identified. These patients were operated after a mean duration of 0.5±0.7 years of cataract diagnosis. The corrected visual acuity remained good after a mean follow-up duration of 3.2±2.7 years (range 0-8 years), post cataract extraction. Conclusion: The experiences gained from this study reinforce the need for early cataract screening in the paediatric diabetic population, especially in those, belonging to lower socioeconomic strata, and/or with history of diabetic ketoacidosis. Cortical cataract was the most common form identified. Vision can be preserved with timely surgical intervention.
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Menon RK, Bajpai A. Growth Failure and Obesity-The Twin Epidemic. Indian J Pediatr 2021; 88:1195. [PMID: 34674112 DOI: 10.1007/s12098-021-03970-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ram K Menon
- Division of Endocrinology, Department of Pediatrics, CS Mott Children Hospital University of Michigan, Ann Arbor, MI, 48109, USA
| | - Anurag Bajpai
- Department of Pediatric & Adolescent Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Kanpur, Uttar Pradesh, 208001, India.
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Abstract
Short stature is a common presentation to pediatricians with a significant overlap between physiology and pathology. Thus, while most short children have a physiological cause, growth failure may be the only manifestation of severe underlying disease. Growth failure evaluation aims to avoid unnecessary investigations in children with a physiological cause without missing pathology. Guidelines for the evaluation of short stature allow stepwise evaluation but are limited by their resource-intense nature. An objective application of anthropometric indices and careful clinical evaluation allows rational growth failure workup. The use of height standard deviation score (SDS) for determining the need for evaluation (no evaluation above -2, follow-up between -2 to -3, and immediate workup with height below -3), corrected height SDS to identify familial short stature (above -1.5), height SDS for bone age for constitutional delay of puberty and growth (above -2), and BMI SDS for nutritional pattern growth failure (below -1) helps reduce the burden of investigations. The present review provides a framework for comprehensive growth evaluation across resource levels and settings.
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Affiliation(s)
- Riddhi Patel
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India.,Kanpur & GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India. .,Kanpur & GROW Society, Growth & Obesity Workforce, Kanpur, Uttar Pradesh, India.
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19
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Elbatran A, Akhtar Z, Bajpai A, Leung LWM, Li A, Pearse S, Zuberi Z, Kaba R, Saba M, Norman M, Grimster A, Gallagher MM, Sohal M. Transvenous lead revision for cardiac perforation: a single centre experience. Europace 2021. [DOI: 10.1093/europace/euab116.491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac perforation is an uncommon but life-threatening complication of cardiac implantable electronic device (CIED) implantation. Management strategy commonly relies on diagnostic Computed Tomography (CT) imaging and cardiac surgery. Emerging evidence has indicated a diversion from this approach. Transvenous culprit lead revision has been shown to be safe and efficacious in limited series.
We sought to evaluate the outcomes of transvenous lead revision in patients with cardiac perforation.
Method
Data was collected retrospectively of patients admitted to a single tertiary centre with CIED-related cardiac perforation between December 2013 – October 2019. Transvenous lead revision was performed as standard with cardiac surgery on standby. Patient demographics, use of CT imaging, method of removal and 30-day outcomes were recorded.
Results
Of the 46 recorded CIED-related cardiac perforations, the majority occurred in female patients (63%) and hypertensives (61%), whilst a proportion had cancer (20%) and ischaemic heart disease (30%). The culprit in most cases was a standard pacing lead (92%) of an active fixation (98%) in the right ventricle (80%) positioned at the ventricular apex (65%). The median time to presentation from implant was 14 days [IQR 4-50 days] with chest pain (44%); abnormal pacing indices was highly prevalent (95%) whilst a pericardial effusion was noted in the majority of cases (57%). CT scanning was performed in 19 cases (41%) for various indications but deemed essential in only 4, all of which had non-diagnostic pacing indices and imaging. Chest X-ray (CXR) found clear perforation, lead displacement or pleural effusion in 74% of cases, whilst an echocardiogram found these in 64% of cases. The culprit lead was replaced in the majority of cases (87%) under local anaesthesia (76%) with surgical backup. The median hospital stay was 7 days [IQR 3-10 days] with zero procedural and 30-day mortality.
Conclusion
Transvenous lead revision for CIED-related cardiac perforation is safe and efficacious. CT modality for diagnostic purposes is useful in providing incremental value in a minority of cases; patients with non-diagnostic pacing parameters and non-CT imaging benefit most from this.
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Affiliation(s)
- A Elbatran
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - L WM Leung
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - S Pearse
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - R Kaba
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Saba
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - A Grimster
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland
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Leung L, Bajpai A, Zuberi Z, Li A, Norman M, Kaba RA, Sohal M, Akhtar Z, Evranos B, Gonna H, Harding I, Al Subaie N, Louis-Auguste J, Hayat J, Gallagher MM. A registry review of 2532 catheter ablations for atrial fibrillation using active thermal protection. Europace 2021. [DOI: 10.1093/europace/euab116.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Dr Leung has received research support from Attune Medical (Chicago, IL). Dr Gallagher has received research funding from Attune Medical (Chicago, IL).
Background
Thermal injury to the oesophagus causes a spectrum of adverse effects after ablation for atrial fibrillation (AF); at the most severe end, atrio-oesophageal fistula carries a high mortality rate. Controlled active thermal protection in the oesophagus during ablation is the most promising method of oesophageal protection. Randomized evidence from the IMPACT trial (NCT03819946) showed an 83.4% reduction in endoscopically detected oesophageal lesions compared to standard care when an oesophageal temperature control device was used to control the local temperature. The IMPACT patients who were randomized to the use of the device had no adverse event related to its use. Real world registry data on applications of this device have not previously been available.
Purpose
To determine the safety of an oesophageal temperature control device by review of real-world registry data on its clinical use and any reported device-related adverse events.
Methods
We reviewed the following databases for any reported oesophageal temperature control device-related complications: The United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE), FDA Medical and Radiation Emitting Device Recalls, the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Alerts and SwissMedic records of Field Safety Corrective Actions (FSCA). An internal registry (post-marketing follow up) database maintained by the manufacturer of the device was used to quantify the number used for each indication. Reported events were reviewed and catalogued for description and identification of any events related to its use in the cardiac electrophysiology lab. The IMPACT study patients were reviewed for any device-related events.
Results
Of the 13, 284 oesophageal temperature control devices used, 2532 were recorded as having been used for the purpose of oesophageal protection during catheter ablation for AF. A total of 5 events associated with the device were identified, all from the MAUDE database. Three were from 2017, one from 2018, and one from 2019. All involved its use in critical care or trauma patients and were related to user error or contraindicated patient selection; none resulted in serious harm to the patient. No adverse events occurred related to its use in the cardiac electrophysiology lab. No case of clinically significant oesophageal injury was reported in a patient who had been protected by the oesophageal temperature control device.
Conclusions
Real world registry data has shown no adverse events reported to date in over 2500 uses of an oesophageal temperature control device in the cardiac electrophysiology lab, for the purpose of active thermal protection. This data supports the randomized trial evidence of its clinical effectiveness. Abstract Figure. Oesophageal active thermal protection
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Affiliation(s)
- L Leung
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Bajpai
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Zuberi
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - A Li
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Norman
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - RA Kaba
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - M Sohal
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - Z Akhtar
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - B Evranos
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - H Gonna
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - I Harding
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - N Al Subaie
- Ahmadi hospital, Anaesthetics , Kuwait, Kuwait
| | - J Louis-Auguste
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - J Hayat
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
| | - MM Gallagher
- St George"s Hospital (London), London, United Kingdom of Great Britain & Northern Ireland
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Shukla R, Gupta M, Agarwal N, Bajpai A. Mindfulness Meditation as Adjunctive Therapy to Improve the Glycemic Care and Quality of Life in Patients with Type 1 Diabetes. Med Sci (Basel) 2021; 9:33. [PMID: 34064218 PMCID: PMC8162570 DOI: 10.3390/medsci9020033] [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] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mindfulness Meditation (MM) is known to improve glycemic control and enhance the quality of life (QoL) in type 2 diabetes (T2D) patients. Unfortunately, the role of meditation in type 1 diabetes (T1D) has not been studied extensively. Therefore, we conducted this study to determine the effect of MM on the glycemic control and QoL in people living with T1D. METHODOLOGY Thirty-two adults living with T1D were equally randomized into intervention (meditation) and control groups. The glycemic control and QoL were assessed at the baseline and after six months of intervention. RESULTS A total of thirty-two adults (15 males, 46.9%; mean age 23.8 ± 6.6 years) with type 1 diabetes (mean diabetes duration 12.7 ± 6.2 years) participated in the study. At the end of six months, a statistically significant improvement was seen in the mean blood glucose level in the control group (222.4 ± 77.8 versus 182.6 ± 52.0; p = 0.007) and the intervention group (215.3 ± 50.1 versus 193.2 ± 31.8; p = 0.008). Additionally, there was a significant reduction in the total diabetes distress score in the intervention group (1.6 ± 0.3 versus 1.3 ± 0.3; p = 0.003), while no change was observed in the control group (1.6 ± 0.7 versus 1.7 ± 0.4; p = 0.762). A statistically significant improvement was noticed in the health and functioning domain in the intervention group (p = 0.023). CONCLUSIONS An improvement in the glycemic control and quality of life of the patients was observed in our study. MM certainly plays an important role in attaining peace of mind and helps patients to channel their energy in a positive direction.
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Affiliation(s)
- Rishi Shukla
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
| | - Manisha Gupta
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
| | - Neha Agarwal
- Society for Prevention And Awareness of Diabetes, Kanpur 208002, Uttar Pradesh, India; (R.S.); (M.G.)
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
| | - Anurag Bajpai
- Regency Center for Diabetes Endocrinology & Research, Department of Endocrinology, Kanpur 208002, Uttar Pradesh, India;
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22
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Patel R, Dave C, Mehta S, Mendpara H, Shukla R, Bajpai A. Metabolic Impact of Subclinical Hypothyroidism in Obese Children and Adolescents. Indian J Pediatr 2021; 88:437-440. [PMID: 32797391 DOI: 10.1007/s12098-020-03463-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Subclinical hypothyroidism is common in children and adolescents with obesity and has been considered to be its effect with no need for treatment. Its metabolic impact has not been evaluated. Therefore the present study was conducted to determine the metabolic impact of obesity related subclinical hypothyroidism. METHODS Retrospective record review of obese children and adolescents between 5 and 18 y of age presenting to pediatric endocrine clinic was done. Four hundred four obese children and adolescents [251 boys, 11.8 (3.2); 5.1-18 y, BMI SDS 2.4 (0.7); 1.4-6.6] were assessed regarding thyroid functions, adiposity (clinical and DXA derived) and metabolic complications. RESULTS Subclinical hypothyroidism was observed in 122 (30.2%) and was associated with higher fat percentage [49.2 (5.8) vs. 47.2 (6.4) p = 0.009], android to gynoid ratio [1.1 (0.1) vs. 1.0 (0.1), p = 0.007] and alanine aminotransferase (ALT) levels [49.3 (31.5) vs. 40.8 (38.1), p = 0.04]. Subjects with subclinical hypothyroidism had 1.9 times greater odds of having non-alcoholic steatohepatitis (47.3% vs. 31.8%, p = 0.005) with no difference in the prevalence of dyslipidemia, dysglycemia or hypertension. Subclinical hypothyroidism was the only determinant of non-alcoholic steatohepatitis on binomial logistic regression (WALD = 11.04, p = 0.001) with no impact of BMI SDS, waist circumference SDS, fat percentage or android to gynoid ratio. Thyroid stimulating hormone (TSH) was the most important determinant of ALT on linear regression (B = 3.027, p < 0.005). CONCLUSIONS Obesity related subclinical hypothyroidism predisposes to increased ALT and non-alcoholic steatohepatitis independent of severity adiposity. The impact of thyroid supplementation in this setting needs to be explored.
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Affiliation(s)
- Riddhi Patel
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, India
| | - Chetankumar Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, India
| | - Sajili Mehta
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, India
| | - Hemangkumar Mendpara
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India.,GROW Society, Growth & Obesity Workforce, Kanpur, India
| | - Rishi Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology & Research, Kanpur, 208001, India. .,GROW Society, Growth & Obesity Workforce, Kanpur, India.
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Bajpai A. HOMA-AD and Metabolic Syndrome-The Homecoming of Adiponectin in Pediatric Obesity. Indian J Pediatr 2021; 88:322-323. [PMID: 33704684 DOI: 10.1007/s12098-021-03712-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Anurag Bajpai
- Department of Pediatric & Adolescent Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Regency City Clinic, Opposite PPN Market, Kanpur, Uttar Pradesh, 208001, India.
- Center for Diabetes, Endocrinology and Cholesterol, Fortis Memorial Research Institute, Gurgaon, Haryana, India.
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Patel R, Dave C, Agarwal N, Mendpara H, Shukla R, Bajpai A. Predictive Value of IAP 2015, IAP 2007 and WHO Growth Charts in Identifying Pathological Short Stature. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2132-7] [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: 10/22/2022]
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25
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Patel R, Dave C, Agarwal N, Mendpara H, Shukla R, Bajpai A. Predictive Value of IAP 2015, IAP 2007 and WHO Growth Charts in Identifying Pathological Short Stature. Indian Pediatr 2021; 58:149-151. [PMID: 33632946] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the diagnostic accuracy of IAP 2015, WHO and IAP 2007 growth charts in identifying pathological short stature in Indian children. METHODOLOGY The predictive value of the growth charts for pathological short stature was assessed in 500 (266 boys) short subjects (age 5-17.9 years) presenting to our pediatric endocrine clinic. RESULTS WHO, IAP 2015, IAP 2007 criteria classified 500, 410 (82%) and 331 (66.2%) subjects short respectively. A total of 218 (43.6%) subjects had a pathological cause. Two out of 90 subjects short by WHO criteria but normal as per IAP 2015 had a pathological cause (2.2%) whereas 38 out of 79 subjects short as per WHO and IAP 2015 criteria but normal by IAP 2007 had pathological short stature. The diagnostic measures of IAP 2015 and IAP 2007 charts in identifying pathological short stature showed a sensitivity 99.1% and 81.7%, negative predictive value 97.8% as against 76.3%, positive predictive value 52.7% and 53.8%, and specificity of 31.2% and 45.7%, respectively. CONCLUSION IAP 2015 growth charts are superior in identifying pathological growth failure compared to WHO and IAP 2007.
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Affiliation(s)
- Riddhi Patel
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur and GROW Society, Growth and Obesity Workforce, Kanpur, India
| | - Chetankumar Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur and GROW Society, Growth and Obesity Workforce, Kanpur, India
| | - Neha Agarwal
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur and GROW Society, Growth and Obesity Workforce, Kanpur, India
| | - Hemangkumar Mendpara
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur and Department of Pediatric Critical Care, Kanpur, India
| | - Rishi Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur and GROW Society, Growth and Obesity Workforce, Kanpur, India. Correspondence to: Dr Anurag Bajpai, Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur 208 001, Uttar Pradesh, India.
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Agarwal N, Shukla R, Yagnik D, Gupta M, Ganguli B, Shukla S, Bajpai A. Diabetes Educational intervention in Society to Improve (DESI) quality of life. J Diabetol 2021. [DOI: 10.4103/jod.jod_78_20] [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: 11/04/2022] Open
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Leung L, Bajpai A, Zuberi Z, Li A, Norman M, Kaba R, Akhtar Z, Evranos B, Gonna H, Harding I, Sohal M, Al-Subaie N, Louis-Auguste J, Hayat J, Gallagher M. Patient outcomes after AF ablation using Ablation Index technology with oesophageal protection: insight from the IMPACT study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0619] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Atrio-oesophageal fistula formation accounts for the majority of AF ablation-related morbidity and mortality. Thermal injury to the oesophagus can be significantly reduced by application of oesophageal cooling for protection during AF ablation. The effect of this method of oesophageal protection in patients receiving radiofrequency (RF) ablation guided by Ablation Index technology is currently unknown.
Objective
To investigate the ability of a temperature control device to protect the oesophagus from ablation-related thermal injury in patients receiving AF ablation guided by Ablation Index technology.
Methods
The IMPACT study is a single-centre, prospective, double-blind randomized controlled trial, which investigated the ability of a controlled method of oesophageal cooling to protect the oesophagus from ablation-related thermal injury. The EnsoETM device was used to deliver oesophageal cooling. This method was compared in a 1:1 randomization to a control group of standard practice utilizing a single-sensor temperature probe. In the study group, the device was used to keep the luminal temperature at 4°C during RF ablation. All participants received AF ablation using Ablation Index technology at posterior and anterior settings (30W at 350–400 and 40W at 450–500, respectively). Endoscopic examination was performed within 7 days post-ablation and oesophageal injury was graded. The patient and the endoscopist were blinded to the randomization. Structured clinical follow up occurred after 3 months post-ablation; both patient and follow up clinician were blinded.
Results
We recruited 188 patients, of whom 120 underwent endoscopic evaluation. Thermal injury to the mucosa was significantly more common in the control group than in those receiving oesophageal protection (12/60 versus 2/60; P=0.008). There was no difference between groups in RF time, lesion duration, force, power and combined ablation index (P value range= 0.2–0.9). Procedure and fluoroscopy duration were similar (P=0.97, P=0.91 respectively). The majority of those who passed through the 1st follow up evaluation (n=136) did not have gastrointestinal or chest pain symptoms post ablation and there was no difference between the randomized groups. Only 4.4% overall had severe symptoms and they were poorly correlated against those who sustained mucosal lesions. AF recurrence was similar in both groups (8% vs 8.8%). There were 2 cases of vascular trauma needing intervention in the control group and 1 case of conservatively managed pericardial effusion in the protected group only. Clinical and endoscopy findings did not report any EnsoETM device-related trauma.
Conclusion
Thermal protection of the oesophagus significantly reduces ablation-related thermal injury compared to standard care when ablation is performed using radiofrequency with Ablation Index technology. This method of oesophageal protection is safe and does not compromise the efficacy of the ablation procedure.
Endoscopy findings and patient symptoms.
Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): 1. Public hospital: St. George's NHS Foundation Trust; 2. Private company: Attune Medical (Chicago, IL)
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Affiliation(s)
- L Leung
- St. George's Hospital, London, United Kingdom
| | - A Bajpai
- St. George's Hospital, London, United Kingdom
| | - Z Zuberi
- St. George's Hospital, London, United Kingdom
| | - A Li
- St. George's Hospital, London, United Kingdom
| | - M Norman
- St. George's Hospital, London, United Kingdom
| | - R Kaba
- St. George's Hospital, London, United Kingdom
| | - Z Akhtar
- St. George's Hospital, London, United Kingdom
| | - B Evranos
- St. George's Hospital, London, United Kingdom
| | - H Gonna
- St. George's Hospital, London, United Kingdom
| | - I Harding
- St. George's Hospital, London, United Kingdom
| | - M Sohal
- St. George's Hospital, London, United Kingdom
| | - N Al-Subaie
- St. George's Hospital, London, United Kingdom
| | | | - J Hayat
- St. George's Hospital, London, United Kingdom
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Agarwal N, Harikar M, Shukla R, Bajpai A. COVID-19 pandemic: a double trouble for Indian adolescents and young adults living with type 1 diabetes. Int J Diabetes Dev Ctries 2020; 40:346-352. [PMID: 32963456 PMCID: PMC7498738 DOI: 10.1007/s13410-020-00869-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background Strict isolation measures and interrupted health care services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as type 1 diabetes (T1D). Methods A cross-sectional, observational study was done to assess determinants of stress and its impact on glycemic control in adolescents and young adults (aged 12–24 years) living with T1D in India. An online, semi-structured survey including Perceived Stress Scale (PSS-10) was distributed and results were analyzed. Results A total of 89 participants (46 males, mean age 19.61 ± 3.8 years) with T1D completed the survey. Age (r = 0.325, p = 0.005) and HBA1C level within the preceding 3 months (r = 0.274, p = 0.036) correlated positively with PSS-10 scores. There was a statistically significant difference in PSS-10 score based on gender (t(70) = − 2.147; p = 0.035), education (F (4,67) = 4.34, p = 0.003), and occupation (F(3,68) = 4.50, p = .006). On multiple linear regression, gender, occupation, and HbA1C were the significant determinants of PSS-10 (F(3,55) = 12.01, p < 0.001, R2 = 0.363). One-way ANOVA showed a significant impact of mean PSS-10 score on the glycemic control (F(2,69) = 3.813, p = 0.027). Conclusion An increased prevalence of stress was seen among Indian adolescents and young adults living with T1D. Female gender, salaried individuals, and pre-existing poorly controlled diabetes contributed to an increased risk of stress. Increased stress resulted in worsened glycemic control.
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Affiliation(s)
- Neha Agarwal
- GROW Society, Growth and Obesity Workforce, Kanpur, India
| | | | - Rishi Shukla
- GROW Society, Growth and Obesity Workforce, Kanpur, India.,Department of Endocrinology, Regency Healthcare, Kanpur, India
| | - Anurag Bajpai
- GROW Society, Growth and Obesity Workforce, Kanpur, India.,Department of Endocrinology, Regency Healthcare, Kanpur, India
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Agarwal N, Dave C, Patel R, Shukla R, Bajpai A. Celiac Disease in Indian Children and Adolescents with Type 1 Diabetes. Indian Pediatr 2020; 57:750-752. [PMID: 32844764] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To estimate the time trend and prevalence of celiac disease in 208 children with type 1 diabetes by retrospective case review. Tissue transglutaminase (TTG IgA) levels were done within the first six months of diagnosis and annually on follow-up. Celiac disease was diagnosed in 35 (16.8%; 3 before diagnosis, 18 at initial screening and 14 on follow-up). 14 subjects with negative TTG serology at presentation, developed celiac disease after 3.9 (2.9) years (range 1.4 - 12.6 years, 85.7% within 5 years). Celiac disease is common in Indian children and adolescents with type I diabetes, developing in most within five years of diagnosis.
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Affiliation(s)
- N Agarwal
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur; and GROW Society, Growth and Obesity Workforce; Uttar Pradesh, India
| | - C Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur; and GROW Society, Growth and Obesity Workforce; Uttar Pradesh, India
| | - R Patel
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur; and GROW Society, Growth and Obesity Workforce; Uttar Pradesh, India
| | - R Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India
| | - A Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur; and GROW Society, Growth and Obesity Workforce; Uttar Pradesh, India.
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Graney PL, Ben-Shaul S, Landau S, Bajpai A, Singh B, Eager J, Cohen A, Levenberg S, Spiller KL. Macrophages of diverse phenotypes drive vascularization of engineered tissues. Sci Adv 2020; 6:eaay6391. [PMID: 32494664 PMCID: PMC7195167 DOI: 10.1126/sciadv.aay6391] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/10/2020] [Indexed: 05/05/2023]
Abstract
Macrophages are key contributors to vascularization, but the mechanisms behind their actions are not understood. Here, we show that diverse macrophage phenotypes have distinct effects on endothelial cell behavior, with resulting effects on vascularization of engineered tissues. In Transwell coculture, proinflammatory M1 macrophages caused endothelial cells to up-regulate genes associated with sprouting angiogenesis, whereas prohealing (M2a), proremodeling (M2c), and anti-inflammatory (M2f) macrophages promoted up-regulation of genes associated with pericyte cell differentiation. In 3D tissue-engineered human blood vessel networks in vitro, short-term exposure (1 day) to M1 macrophages increased vessel formation, while long-term exposure (3 days) caused regression. When human tissue-engineered blood vessel networks were implanted into athymic mice, macrophages expressing markers of both M1 and M2 phenotypes wrapped around and bridged adjacent vessels and formed vessel-like structures themselves. Last, depletion of host macrophages inhibited remodeling of engineered vessels, infiltration of host vessels, and anastomosis with host vessels.
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Affiliation(s)
- P. L. Graney
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - S. Ben-Shaul
- Department of Biomedical Engineering, Technion–Israel Institute of Technology, Haifa, Israel
| | - S. Landau
- Department of Biomedical Engineering, Technion–Israel Institute of Technology, Haifa, Israel
| | - A. Bajpai
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - B. Singh
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - J. Eager
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - A. Cohen
- Department of Electrical and Computer Engineering, Drexel University, Philadelphia, PA, USA
| | - S. Levenberg
- Department of Biomedical Engineering, Technion–Israel Institute of Technology, Haifa, Israel
- Corresponding author. (S.L.); (K.L.S.)
| | - K. L. Spiller
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
- Corresponding author. (S.L.); (K.L.S.)
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Agarwal N, Dave C, Patel R, Shukla R, Kapoor R, Bajpai A. Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian Pediatr 2020; 57:310-313. [PMID: 32038036] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the time course and predictors of cerebral edema in diabetic ketoacidosis (DKA). METHODS Review of hospital records of 107 episodes of DKA between January 2013 to March 2019. RESULTS Cerebral edema was identified in 26 (24.3%; 22 at presentation and 4 during treatment). Cerebral edema at presentation was associated with lower (<10 mmHg) arterial carbon dioxide (OR 3.6, 95% CI 1.0,12.7; P=0.04), prior fluid treatment (OR 4.7, 95% CI 1.8,12.7; P=0.001) and new onset diabetes (OR 3.5, 95% CI 1.1,11.1; P=0.03). Prior fluid was the only significant predictor on multivariate analysis (P=0.013). Cerebral edema resulted in a longer ICU stay [4.1 (2.3) vs 1.8 (0.9) d; P<0.001]. CONCLUSIONS Cerebral edema at admission is common in Indian children with DKA and should be suspected with severe metabolic acidosis and inappropriate prior fluid treatment.
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Affiliation(s)
- N Agarwal
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India, and Growth and Obesity Workforce (GROW)
| | - C Dave
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India, and Growth and Obesity Workforce (GROW)
| | - R Patel
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India, and Growth and Obesity Workforce (GROW)
| | - R Shukla
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India
| | - R Kapoor
- Department of Pediatric Critical Care, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India, and Growth and Obesity Workforce (GROW)
| | - A Bajpai
- Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur, Uttar Pradesh, India, and Growth and Obesity Workforce (GROW). Correspondence to: Dr Anurag Bajpai, Department of Pediatric Endocrinology, Regency Center for Diabetes Endocrinology and Research, Kanpur 208 001, Uttar Pradesh, India.
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Bangalore Krishna K, Fuqua JS, Rogol AD, Klein KO, Popovic J, Houk CP, Charmandari E, Lee PA, Freire AV, Ropelato MG, Yazid Jalaludin M, Mbogo J, Kanaka-Gantenbein C, Luo X, Eugster EA, Klein KO, Vogiatzi MG, Reifschneider K, Bamba V, Garcia Rudaz C, Kaplowitz P, Backeljauw P, Allen DB, Palmert MR, Harrington J, Guerra-Junior G, Stanley T, Torres Tamayo M, Miranda Lora AL, Bajpai A, Silverman LA, Miller BS, Dayal A, Horikawa R, Oberfield S, Rogol AD, Tajima T, Popovic J, Witchel SF, Rosenthal SM, Finlayson C, Hannema SE, Castilla-Peon MF, Mericq V, Medina Bravo PG. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res Paediatr 2020; 91:357-372. [PMID: 31319416 DOI: 10.1159/000501336] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [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: 02/25/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022] Open
Abstract
This update, written by authors designated by multiple pediatric endocrinology societies (see List of Participating Societies) from around the globe, concisely addresses topics related to changes in GnRHa usage in children and adolescents over the last decade. Topics related to the use of GnRHa in precocious puberty include diagnostic criteria, globally available formulations, considerations of benefit of treatment, monitoring of therapy, adverse events, and long-term outcome data. Additional sections review use in transgender individuals and other pediatric endocrine related conditions. Although there have been many significant changes in GnRHa usage, there is a definite paucity of evidence-based publications to support them. Therefore, this paper is explicitly not intended to evaluate what is recommended in terms of the best use of GnRHa, based on evidence and expert opinion, but rather to describe how these drugs are used, irrespective of any qualitative evaluation. Thus, this paper should be considered a narrative review on GnRHa utilization in precocious puberty and other clinical situations. These changes are reviewed not only to point out deficiencies in the literature but also to stimulate future studies and publications in this area.
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Affiliation(s)
- Kanthi Bangalore Krishna
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA,
| | - John S Fuqua
- Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Alan D Rogol
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
| | - Karen O Klein
- University of California, San Diego and Rady Children's Hospital, San Diego, California, USA
| | - Jadranka Popovic
- Division of Pediatric Endocrinology, Pediatric Alliance, Pittsburgh, Pennsylvania, USA
| | - Christopher P Houk
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Evangelia Charmandari
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Peter A Lee
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Agarwal N, Dave C, Patel R, Shukla R, Kapoor R, Bajpai A. Factors Associated With Cerebral Edema at Admission in Indian Children with Diabetic Ketoacidosis. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1781-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bajpai A. Early Onset Non-Syndromic Obesity- Is Next Generation Sequencing the Next in Agenda? Indian J Pediatr 2020; 87:93. [PMID: 31925712 DOI: 10.1007/s12098-019-03175-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Anurag Bajpai
- Pediatric & Adolescent Endocrinology, Regency Center for Diabetes, Endocrinology & Research, Kanpur, Uttar Pradesh, India.
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Bajpai A, Wetzel B, Friedrich K. High strength epoxy system modified with soft block copolymer and stiff core-shell rubber nanoparticles: Morphology, mechanical properties, and fracture mechanisms. EXPRESS POLYM LETT 2020. [DOI: 10.3144/expresspolymlett.2020.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abraham G, Ghazanfar MA, Bajpai A. An unusual cause of shortness of breath and palpitations. BMJ 2018; 363:k3883. [PMID: 30337276 DOI: 10.1136/bmj.k3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- G Abraham
- Cardiology, Epsom General Hospital, Epsom, UK
| | | | - A Bajpai
- Cardiology, Epsom General Hospital, Epsom, UK
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Goyal M, Bansal M, Bajpai A, Siddique A, Srivastava RK. Impact of Educational Intervention on the Awareness of Disposal of Leftover/Expired Medicines among Health care Professionals. J Pharmacol Pharmacother 2018. [DOI: 10.4103/jpp.jpp_44_18] [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: 11/04/2022] Open
Affiliation(s)
| | - Monika Bansal
- Physiology, N.C. Medical College and Hospital, Panipat, Haryana, India
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Leung L, Gonzalez-Matos C, Bajpai A, Saba M. P1037Post-ablation mahaim accessory pathway automaticity: a rare cause of recurrent symptoms. Europace 2017. [DOI: 10.1093/ehjci/eux151.217] [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: 11/14/2022] Open
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Rao YK, Midha T, Singh S, Bajpai A, Tilak A. Increment in vitamin D level and bone mineral accrual in children with vitamin D deficiency. Korean J Pediatr 2016; 59:292-7. [PMID: 27588029 PMCID: PMC5007424 DOI: 10.3345/kjp.2016.59.7.292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/27/2022]
Abstract
Purpose To compare different regimens of vitamin D with respect to its serum increment levels and bone mineral accrual in vitamin D-deficient children. Methods Children identified as being vitamin D deficient (serum levels<20 ng/mL) were divided into 3 treatment groups by stratified block randomization (group 1, 4,000 IU/day of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; group 2, 30,000 IU/wk of vitamin D3 plus 50 mg/kg/day calcium for 12 weeks; and group 3, 300,000 IU of vitamin D3 once intramuscularly plus 50 mg/kg/day calcium). After regimen completion, each child received a maintenance dose of 400 IU/day vitamin D3 plus 50 mg/kg/day calcium. Their serum vitamin D level was measured after 3 and 12 months. Total body less head bone mineral concentration (BMC) and total body less head bone mineral density (BMD) were measured after 12 months. Results The mean increment in serum vitamin D levels from baseline to 3 months was significantly higher in group 3 than in groups 1 and 2, but the levels from 3 to 12 months were almost similar among all 3 groups. There were no significant differences among the 3 groups with respect to percentage increase of BMD and BMC. Conclusion The injectable form of vitamin D was more efficacious than the oral forms in increasing the serum level to the normal range. All 3 regimens were equally effective in increasing the BMC and BMD. The 400 IU/day maintenance dose was sufficient to keep the serum level within the normal range.
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Affiliation(s)
- Yashwant Kumar Rao
- Department of Pediatrics, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Tanu Midha
- Department of Community Medicine, Government Medical College, Kannauj, India
| | - Satyajeet Singh
- Department of Pediatrics, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
| | - Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Hospital, Kanpur, India
| | - Amita Tilak
- Department of Pharmacology, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, India
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Bansal A, Kumar S, Bajpai A, Tiwari VN, Nayak M, Venkatesan S, Narayanan R. Remote health monitoring system for detecting cardiac disorders. IET Syst Biol 2016; 9:309-14. [PMID: 26577166 DOI: 10.1049/iet-syb.2015.0012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Remote health monitoring system with clinical decision support system as a key component could potentially quicken the response of medical specialists to critical health emergencies experienced by their patients. A monitoring system, specifically designed for cardiac care with electrocardiogram (ECG) signal analysis as the core diagnostic technique, could play a vital role in early detection of a wide range of cardiac ailments, from a simple arrhythmia to life threatening conditions such as myocardial infarction. The system that the authors have developed consists of three major components, namely, (a) mobile gateway, deployed on patient's mobile device, that receives 12-lead ECG signals from any ECG sensor, (b) remote server component that hosts algorithms for accurate annotation and analysis of the ECG signal and (c) point of care device of the doctor to receive a diagnostic report from the server based on the analysis of ECG signals. In the present study, their focus has been toward developing a system capable of detecting critical cardiac events well in advance using an advanced remote monitoring system. A system of this kind is expected to have applications ranging from tracking wellness/fitness to detection of symptoms leading to fatal cardiac events.
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Affiliation(s)
- Ayush Bansal
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India.
| | - Sunil Kumar
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
| | - Anurag Bajpai
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
| | - Vijay N Tiwari
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
| | - Mithun Nayak
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
| | - Shankar Venkatesan
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
| | - Rangavittal Narayanan
- Advanced Technology Lab, Samsung R&D Institute India-Bangalore PVT.LTD, Bangalore, India
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Bajpai A, Jilla V, Tiwari VN, Venkatesan SM, Narayanan R. Quantifiable fitness tracking using wearable devices. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:1633-7. [PMID: 26736588 DOI: 10.1109/embc.2015.7318688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Monitoring health and fitness is emerging as an important benefit that smartphone users could expect from their mobile devices today. Rule of thumb calorie tracking and recommendation based on selective activity monitoring is widely available today, as both on-device and server based solutions. What is surprisingly not available to the users is a simple application geared towards quantitative fitness tracking. Such an application potentially can be a direct indicator of one's cardio-vascular performance and associated long term health risks. Since wearable devices with various inbuilt sensors like accelerometer, gyroscope, SPO2 and heart rate are increasingly becoming available, it is vital that the enormous data coming from these sensors be used to perform analytics to uncover hidden health and fitness associated facts. A continuous estimation of fitness level employing these wearable devices can potentially help users in setting personalized short and long-term exercise goals leading to positive impact on one's overall health. The present work describes a step in this direction. This work involves an unobtrusive method to track an individual's physical activity seamlessly, estimate calorie consumption during a day by mapping the activity to the calories spent and assess fitness level using heart rate data from wearable sensors. We employ a heart rate based parameter called Endurance to quantitatively estimate cardio-respiratory fitness of a person. This opens up avenues for personalization and adaptiveness by dynamically using individual's personal fitness data towards building robust modeling based on analytical principles.
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Castellano G, Cafiero C, Divella C, Sallustio F, Gigante M, Gesualdo L, Kirsch AH, Smaczny N, Riegelbauer V, Sedej S, Hofmeister A, Stojakovic T, Brodmann M, Pilger E, Rosenkranz A, Eller K, Eller P, Meier P, Lucisano S, Arena A, Donato V, Fazio MR, Santoro D, Buemi M, Wornle M, Ribeiro A, Koppel S, Pircher J, Czermak T, Merkle M, Rupanagudi K, Kulkarni OP, Lichtnekert J, Darisipudi MN, Mulay SR, Schott B, Hartmann G, Anders HJ, Pletinck A, Glorieux G, Schepers E, Van Landschoot M, Eloot S, Van Biesen W, Vanholder R, Castoldi A, Oliveira V, Amano M, Aguiar C, Caricilli A, Vieira P, Burgos M, Hiyane M, Festuccia W, Camara N, Djudjaj S, Rong S, Lue H, Bajpai A, Klinkhammer B, Moeller M, Floege J, Bernhagen J, Ostendorf T, Boor P, Wornle M, Ribeiro A, Koppel S, Merkle M, Ito S, Aoki R, Hamada K, Edamatsu T, Itoh Y, Osaka M, Yoshida M, Oliva E, Maritati F, Palmisano A, Alberici F, Buzio C, Vaglio A, Grabulosa C, Cruz E, Carvalho J, Manfredi S, Canziani M, Cuppari L, Quinto B, Batista M, Cendoroglo M, Dalboni M, Wornle M, Ribeiro A, Merkle M, Niemir Z, Swierzko A, Polcyn-Adamczak M, Cedzynski M, Sokolowska A, Szala A, Baudoux T, Hougardy JM, Pozdzik A, Antoine MH, Husson C, De Prez E, Nortier J, Ni HF, Chen JF, Zhang MH, Pan MM, Liu BC, Machcinska M, Bocian K, Korczak-Kowalska G, Tami Amano M, Castoldi A, Andrade-Oliveira V, da Silva M, Miyagi MYS, Olsen Camara N, Xu L, Jin Y, Zhong F, Liu J, Dai Q, Wang W, Chen N, Grosjean F, Tribioli C, Esposito V, Catucci D, Azar G, Torreggiani M, Merlini G, Esposito C, Fell LH, Zawada AM, Rogacev KS, Seiler S, Fliser D, Heine GH, Neprintseva N, Tchebotareva N, Bobkova I, Kozlovskaya L, Virzi GM, Brocca A, de Cal M, Bolin C, Vescovo G, Ronco C, Fuchs A, Eidenschink K, Steege A, Fellner C, Bollheimer C, Gronwald W, Schroeder J, Banas B, Banas MC, Zawada AM, Luthe A, Seiler SS, Rogacev K, Fliser D, Heine GH, Trimboli D, Graziani G, Haroche J, Lupica R, Fazio MR, Lucisano S, Donato V, Cernaro V, Montalto G, Pettinato G, Buemi M, Cho E, Lee JW, Kim MG, Jo SK, Cho WY, kim HK. Immune and inflammatory mechanisms. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft142] [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
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Abstract
Precocious puberty poses significant diagnostic and therapeutic challenge to the physician. Recent advances in the understanding of pathophysiology of precocious puberty have resulted in improved management. Timely intervention is mandatory to achieve successful outcome. The identification of critical role of KISS-1-kisspeptin-GPR54 system has gone a long way to provide an insight into pubertal physiology. It is likely that the system would become an important diagnostic and therapeutic target in children with precocious puberty. Epidemiological studies point toward earlier thelarche. This is, however, associated with slower progression as the age of menarche is static. These changes have led to suggestions of lowering the age cutoffs for precocious puberty in girls. New developments in assessment of precocious puberty including gonadotropin releasing hormone (GnRH) agonist test have made characterization of precocious puberty easier. Longstanding GnRH analogs have become the mainstay of treatment of gonadotropin-dependent precocious puberty, while aromatase inhibitors and inhibitors of sex hormone action are increasingly being used in gonadotropin-independent precocious puberty.
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Affiliation(s)
- Anurag Bajpai
- Department of Pediatric Endocrinology, Regency Hospital Limited, Kanpur, Uttar Pradesh, India
| | - P. S. N Menon
- Department of Pediatrics, Jaber Al-Ahmed Armed Forces Hospital, Kuwait
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Abstract
BACKGROUND McCune Albright syndrome (MAS), a disorder caused by somatic activating mutations in the GNAS gene, usually presents with cutaneous, skeletal, and endocrine manifestations. While focal lesions involving multiple tissues have been identified in MAS, almost nothing is known about gastrointestinal lesions in this disease. METHODS Two MAS patients with perioral freckling, resembling Peutz-Jeghers syndrome (PJS), and two MAS patients without similar pigmentation underwent gastrointestinal endoscopy to establish if they had coexisting hamartomatous polyposis. Three of 4 subjects had documented GNAS mutations in peripheral blood. Genetic testing for STK11 and PRKAR1A genes was performed to exclude presence of coexistent PJS and Carney complex. Genetic testing of biopsy material was also performed. RESULTS Hamartomatous gastrointestinal polyps with histological features similar to those in PJS were observed in all 4 subjects, only in the stomach and/or upper duodenum. Activating GNAS mutations were found in the polyps or adjacent mucosa in 3 of 4 subjects. One patient each had mutation only in the blood or tissue, while 2 patients had both. No subject harboured any detectable PRKARIA or STK11 mutation as determined by direct DNA sequencing and copy number variation analysis. CONCLUSIONS These findings confirm that gastrointestinal polyps are a common manifestation of MAS, indicate an overlap between MAS and PJS, and point towards a putative interaction between the GNAS and STK11 genes in the pathogenesis of these two disorders. The findings suggest a need for routine gastrointestinal endoscopy in patients with MAS, to establish the true incidence of polyps in these patients.
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Affiliation(s)
- Margaret Zacharin
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria 3052, Australia.
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Bajpai A, Simm PJ, McPherson SJ, Russo VC, Azar WJ, Wark JD, Risbridger GP, Werther GA. Peripubertal aromatase inhibition in male rats has adverse long-term effects on bone strength and growth and induces prostatic hyperplasia. J Endocrinol 2010; 207:27-34. [PMID: 20675302 DOI: 10.1677/joe-10-0006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aromatase inhibitors have been increasingly used in boys with growth retardation to prolong the duration of growth and increase final height. Multiple important roles of oestrogen in males point to potential adverse effects of this strategy. Although the deleterious effects of aromatase deficiency in early childhood and adulthood are well documented, there is limited information about the potential long-term adverse effects of peripubertal aromatase inhibition. To address this issue, we evaluated short-term and long-term effects of peripubertal aromatase inhibition in an animal model. Peripubertal male Wistar rats were treated with aromatase inhibitor letrozole or placebo and followed until adulthood. Letrozole treatment caused sustained reduction in bone strength and alteration in skeletal geometry, lowering of IGF1 levels, inhibition of growth resulting in significantly lower weight and length of treated animals and development of focal prostatic hyperplasia. Our observation of adverse long-term effects after peripubertal male rats were exposed to aromatase inhibitors highlights the need for further characterisation of long-term adverse effects of aromatase inhibitors in peripubertal boys before further widespread use is accepted. Furthermore, this suggests the need to develop more selective oestrogen inhibition strategies in order to inhibit oestrogen action on the growth plate, while beneficial effects in other tissues are preserved.
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Affiliation(s)
- Anurag Bajpai
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia
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Bajpai A, Klingeler R, Wizent N, Nigam AK, Cheong SW, Büchner B. Unusual field dependence of remanent magnetization in granular CrO2: the possible relevance of piezomagnetism. J Phys Condens Matter 2010; 22:096005. [PMID: 21389432 DOI: 10.1088/0953-8984/22/9/096005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We present low field thermoremanent magnetization (TRM) measurements in granular CrO(2) and composites of ferromagnetic (FM) CrO(2) and antiferromagnetic (AFM) Cr(2)O(3). TRM in these samples is seen to display two distinct timescales. A quasi-static part of remanence, appearing only in the low field regime, exhibits a peculiar field dependence. TRM is seen to first rise and then fall with increasing cooling fields, eventually vanishing above a critical field. Similar features in TRM have previously been observed in some antiferromagnets that exhibit the phenomenon of piezomagnetism. Scaling analysis of the TRM data suggest that presumably piezomoments generated in the AFM component drive the FM magnetization dynamics in these granular systems in the low field regime.
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Affiliation(s)
- A Bajpai
- Leibniz-Institute for Solid State and Materials Research, IFW Dresden, D-01171 Dresden, Germany
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Affiliation(s)
- Atul Malhotra
- Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
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