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Deepak D, De UK, Sarkar TK, Katoch S, John JK, Sarkar VK. Strategic administration of antioxidant multiminerals and vitamins to transitional buffaloes augments antioxidant and udder defense mechanisms in early lactation. Res Vet Sci 2024; 172:105253. [PMID: 38579632 DOI: 10.1016/j.rvsc.2024.105253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/07/2024]
Abstract
The aim of the study was to examine the effects of repeated administrations of antioxidant multiminerals and vitamins in transition buffaloes on udder defense mechanism, antioxidant activity and occurrence of intramammary infection (IMI) in early lactation period. Forty clinically healthy pregnant buffaloes were enrolled 45 days before expected date of calving and randomly allocated into five different supplementation groups (n = 8): only basal ration (control), vitamin E and selenium (VES), multiminerals (MM), ascorbic acid (AA) and chromium (Cr) picolinate in basal diet. The udder defense mechanism was monitored by measuring phagocytic activity (PA), myeloperoxidase (MPO) and nitric oxide (NO) productions in milk leukocytes, antioxidant activity was evaluated by measuring total antioxidant capacity (TAC) in plasma and occurrence of IMI was assessed by milk cytology, bacterial count in milk and visible clinical signs of udder until day 28 post-calving. The results showed that the VES and MM supplementations exhibited significantly higher PA, MPO and NO productions of milk leukocytes till first week of lactation whereas, elevated mean TAC in plasma was maintained from day -7 to 1 of calving in MM supplementation group as compared to control group. Statistically, no significant difference in occurrences of subclinical or clinical IMI was noted across the groups until four weeks of lactation. Taken together, it is concluded that repeated administrations of VES and MM to transition buffaloes could be an effective strategy to maintain good udder health by augmenting milk leukocyte functions and antioxidant status and preventing incidence of IMI in early lactation.
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Affiliation(s)
- D Deepak
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar 243 122, Uttar Pradesh, India; Department of Veterinary Medicine, College of Veterinary and Animal Sciences, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut 250 110, Uttar Pradesh, India
| | - U K De
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar 243 122, Uttar Pradesh, India.
| | - T K Sarkar
- Department of Veterinary Medicine, College of Veterinary and Animal Sciences, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut 250 110, Uttar Pradesh, India
| | - S Katoch
- Department of Veterinary Microbiology, College of Veterinary and Animal Sciences, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut 250 110, Uttar Pradesh, India
| | - J K John
- Department of Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut 250 110, Uttar Pradesh, India
| | - V K Sarkar
- Division of Medicine, ICAR-Indian Veterinary Research Institute, Izatnagar 243 122, Uttar Pradesh, India
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Rathor S, Shukla M, Deepak D. Isolation of a novel pentasaccharide Ebaliose from immunostimulant fraction of buffalo milk oligosaccharide. Nat Prod Res 2023:1-10. [PMID: 38018765 DOI: 10.1080/14786419.2023.2284869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/12/2023] [Indexed: 11/30/2023]
Abstract
Buffalo milk processed by method of Kobata and Ginsburg for isolation of its oligosaccharide contents showed significant stimulation of anti-body, delayed type hypersensitivity response to sheep red blood cells in BALB/c mice. This oligosaccharide mixture also stimulated non-specific immune response in terms of MMI. In continuation to our previous studies of oligosaccharide contents of buffalo milk another novel pentasaccharide Ebaliose was isolated from immunostimulant oligosaccharide fraction of buffalo milk. Ebaliose was procured in its purest form, by combining the different chromatographic techniques like Gel filtration, Silica Gel column chromatography, and HPLC. The structure of novel oligosaccharide was determined by 1H,13C, HSQC, TOCSY, COSY, HMBC, ESI-MS, chemical transformation, and chemical degradation. The stereoscopic structure of this novel pentasaccharide was established as under.
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Affiliation(s)
- Shraddha Rathor
- Department of Chemistry, University of Lucknow, Lucknow, India
| | - Manisha Shukla
- Department of Chemistry, University of Lucknow, Lucknow, India
| | - Desh Deepak
- Department of Chemistry, University of Lucknow, Lucknow, India
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Das P, Gupta P, Deepak D. Cytological Diagnosis of Pulmonary Hydatid disease by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration of Cyst Fluid. J Bronchology Interv Pulmonol 2023; 30:392-397. [PMID: 37254236 DOI: 10.1097/lbr.0000000000000932] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/25/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Pinakjyoti Das
- Pathology Department, ABVIMS and Dr RML Hospital, New Delhi
| | - Prajwala Gupta
- Pathology Department, ABVIMS and Dr RML Hospital, New Delhi
| | - Desh Deepak
- Respiratory Medicine Department ABVIMS and Dr RML Hospital, New Delhi
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Juneja D, Deepak D, Nasa P. What, why and how to monitor blood glucose in critically ill patients. World J Diabetes 2023; 14:528-538. [PMID: 37273246 PMCID: PMC10236998 DOI: 10.4239/wjd.v14.i5.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/17/2023] [Accepted: 03/07/2023] [Indexed: 05/15/2023] Open
Abstract
Critically ill patients are prone to high glycemic variations irrespective of their diabetes status. This mandates frequent blood glucose (BG) monitoring and regulation of insulin therapy. Even though the most commonly employed capillary BG monitoring is convenient and rapid, it is inaccurate and prone to high bias, overestimating BG levels in critically ill patients. The targets for BG levels have also varied in the past few years ranging from tight glucose control to a more liberal approach. Each of these has its own fallacies, while tight control increases risk of hypoglycemia, liberal BG targets make the patients prone to hyperglycemia. Moreover, the recent evidence suggests that BG indices, such as glycemic variability and time in target range, may also affect patient outcomes. In this review, we highlight the nuances associated with BG monitoring, including the various indices required to be monitored, BG targets and recent advances in BG monitoring in critically ill patients.
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Affiliation(s)
- Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Desh Deepak
- Department of Critical Care, King's College Hospital, Dubai 340901, United Arab Emirates
| | - Prashant Nasa
- Department of Critical Care, NMC Speciality Hospital, Dubai 7832, United Arab Emirates
- Department of Critical Care, College of Medicine and Health Sciences, Al Ain 15551, United Arab Emirates
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Metta V, Chung-Faye G, Ts Benamer H, Mrudula R, Goyal V, Falup-Pecurariu C, Muralidharan N, Deepak D, Abdulraheem M, Borgohain R, Chaudhuri KR. Hiccups, Hypersalivation, Hallucinations in Parkinson's Disease: New Insights, Mechanisms, Pathophysiology, and Management. J Pers Med 2023; 13:jpm13050711. [PMID: 37240881 DOI: 10.3390/jpm13050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Parkinson's disease (PD) is a chronic, progressive neurological disorder and the second most common neurodegenerative condition. We report three common but overlooked symptoms in PD-hiccups, hypersalivation, and hallucinations-in terms of their prevalence, pathophysiology, and up-to-date evidence-based treatment strategies. Whilst all these three symptoms do occur in many other neurological and non-neurological conditions, early recognition and treatment are paramount. Whilst hiccups affect 3% of healthy people, their rate of occurrence is higher (20%) in patients with PD. Hypersalivation (Sialorrhea) is another common neurological manifestation of many neurological and other neurodegenerative conditions such as motor neuron disease (MND), with a median prevalence rate of 56% (range: 32-74%). A 42% prevalence of sialorrhea is also reported in sub-optimally treated patients with PD. Hallucinations, especially visual hallucinations, are commonly reported, with a prevalence of 32-63% in PD, and a 55-78% prevalence is noted in patients with dementia with Lewy bodies (DLB), followed by tactile hallucinations, which are indicated by a sensation of crawling bugs or imaginary creatures across the skin surface. Whilst mainstay and primary management strategies for all these three symptoms are carried out through history taking, it is also essential to identify and treat possible potential triggers such as infection, minimise or avoid causative (such as drug-induced) factors, and especially carry out patient education before considering more definitive treatment strategies, such as botulinum toxin therapies for hypersalivation, to improve the quality of life of patients. This original review paper aims to provide a comprehensive overview of the disease mechanisms, pathophysiology, and management of hiccups, hypersalivation, and hallucinations in Parkinson's disease.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Guy Chung-Faye
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | - Hani Ts Benamer
- Department of Movement Disorders & Parkinson's Centre of Excellence, Mohammed Bin Rashid University, Dubai 263267, United Arab Emirates
| | - Rukmini Mrudula
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Vinay Goyal
- Institute of Movement Disorders, Medanta Hospitals, India
| | | | | | - Desh Deepak
- Kings College Hospital London, Dubai 263267, United Arab Emirates
| | | | - Rupam Borgohain
- CNC Institute of Movement Disorders & Parkinson's Centre of Excellence, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience and Parkinson's Foundation Centre of Excellence, King's College Hospital, King's College London, London WC2R 2LS, UK
- Kings College Hospital London, Dubai 263267, United Arab Emirates
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Sinha N, Singh Chawla MP, Deepak D, Suri A, Jain P, Agarwal A, Bhakhar MK. Post COVID-19 syndrome and new onset diseases: A prospective observational study. Singapore Med J 2023:373774. [PMID: 37077053 DOI: 10.4103/singaporemedj.smj-2022-055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Introduction The National Institute of Health and Care Excellence (NICE) has defined the terms, 'acute coronavirus disease 2019' (COVID-19), 'ongoing symptomatic COVID-19' and 'post-COVID-19 syndrome', with the latter two described as having persistent symptoms after the onset of COVID-19 symptoms for 4-12 weeks and >12 weeks, respectively. Persistent symptoms can either be due to the after-effects of COVID-19 or new-onset diseases after acute COVID-19. All symptoms observed beyond 4 weeks after the onset of COVID-19 need not be present at the time of onset. Previous studies on persistent post-COVID-19 symptoms have not mentioned new-onset diseases after acute COVID-19, and only a select few studies have discussed such new-onset symptoms. Methods Ninety-five patients who attended the post-COVID-19 clinic completed the requisite follow-up till 16 weeks after COVID-19 symptom onset. Data was recorded on a predesigned proforma. Necessary investigations were conducted to rule out any other cause of persistent symptoms. Results Fatigue (62.1%), breathlessness (50.5%) and cough (27.4%) were the most common symptoms present beyond 4 weeks after the onset of COVID-19 symptoms. Forty-nine (51.57%) patients developed post-COVID-19 syndrome - their severity of symptoms (odds ratio [OR] 17.77) and longer duration of hospital stay (OR 1.095) during acute disease were significantly associated with the development of post-COVID-19 syndrome. During follow-up, 25 patients developed new-onset symptoms, such as diabetes mellitus, hypertension and idiopathic tachycardia. Conclusion Patients can have persistent symptoms, new-onset symptoms and new-onset diseases after recovery from acute COVID-19.
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Affiliation(s)
- Nitin Sinha
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Mahinder Pal Singh Chawla
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Desh Deepak
- Department of Respiratory Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Amit Suri
- Department of Respiratory Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Piyush Jain
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Ankit Agarwal
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manoj Kumar Bhakhar
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Goel A, Sethi Y, Moinuddin A, Deepak D, Gupta P. Competency-based medical education (CBME) curriculum and its effect on prevalence of anxiety, depression and stress amongst medical undergraduates. J Educ Health Promot 2022; 11:380. [PMID: 36618479 PMCID: PMC9818703 DOI: 10.4103/jehp.jehp_564_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND A growing body of literature now identifies higher levels of anxiety, depression, and stress among medical students as a distinct mental health domain. The competency-based medical education (CBME) curriculum was introduced to revamp the existing curriculum with an aim to garner constructive impact on the mental health of undergraduate medical students. As such, we sought to draw comparisons between the mental health of medical students, studying the old (2018 batch) and the new (2019 batch) medical education systems in India. MATERIALS AND METHODS We designed a survey that contained structured questions pertained to anxiety (HAM-A, GAD-7), depression (HAM-D, BDI), and stress (PSS) amongst medical undergraduate students of 2018 and 2019 batches at the Government Doon Medical College (GDMC), Dehradun, India. RESULTS Contrasting the 2018 and 2019 batches, the introduction of CBME resulted in a significant two-fold decrease in moderate anxiety, as exhibited by both HAM-A (6.0 vs 3.0, P = 0.016) and GAD-7 (3.5 vs 1.0, P = 0.037) scales, although no significant change in mild and severe anxiety, and overall depression (BDI: P = 0.05, HAM-D: P = 0.05) or stress (PSS: P = 0.86) was found. CONCLUSION The CBME system has made a significant impact on the mental health of undergraduate medical students for anxiety, albeit its effect on depression and stress remains equivocal. Future studies are warranted to compare the effect of CBME in other undergraduate and postgraduate courses across the country to help predict the psychological impact of the newfangled CBME education system.
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Affiliation(s)
- Ashish Goel
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Yashendra Sethi
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Arsalan Moinuddin
- Vascular Health Researcher, Department of Sports and Exercise Physiology, School of Sport and Exercise, University of Gloucestershire, UK
| | - Desh Deepak
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Priyanka Gupta
- Department of Physiology, Government Doon Medical College, Dehradun, Uttarakhand, India
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Nomula GR, Sharma B, Deepak D. P499 A cross-sectional observational to assess the role of Bronchoalveolar lavage fluid galactomannan in the diagnosis of invasive pulmonary aspergillosis in non-neutropenic patients. Med Mycol 2022. [PMCID: PMC9509949 DOI: 10.1093/mmy/myac072.p499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objective This study was done to assess the role of Bronchoalveolar lavage fluid (BALF) galactomannan (GM) in the diagnosis of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients and to determine the optimal cut-off value of BALF GM for diagnosing IPA in non-neutropenic hosts. Methods We conducted a cross-sectional observational study on 96 non-neutropenic patients of age > 18 years with suspected pulmonary infections of fungal etiology. A detailed history of predisposing conditions was obtained and routine laboratory investigations with chest computerized (CT) tomography were performed. Fiberoptic bronchoscopy under local anesthesia and sedation was done using a video bronchoscope. Bronchoalveolar lavage was done from the segment or lobe of interest instilling 60-100 ml of saline withdrawn under low pressure and the sample was tested for a battery of investigations; fungal KOH smear; fungal culture; GM by Platelia Aspergillus enzyme immunoassay; and others required for diagnosis. A protected brush specimen and transbronchial lung biopsy were done wherever feasible. The yield from the BALF GM assay was compared with diagnosis based on definitions given by EORTC/MSG excluding host factors. Patients were classified into three groups namely non-IPA, probable IPA, and proven IPA. For statistical analysis, probable and proven IPA were taken as one group i.e., the IPA group. Mann-Whitney test and Chi-Square test along with Fisher's exact test were performed for inter-group comparison between quantitative and qualitative variables respectively. The receiver operator characteristic curve was used to establish a cut-off point of BALF GM and Serum GM for predicting IPA. Sensitivity, specificity, PPV, and NPV were calculated. The McNemar test was used for the comparison of sensitivity and specificity. Inter-rater kappa agreement was used to find the strength of agreement of BALF GM, BALF culture, and BALF DM. Results Out of 96, 1 was diagnosed with proven IPA, 34 were probable IPA cases and 61 were not IPA cases. Chronic kidney disease (CKD) as a risk factor was more common in IPA cases compared to non-IPA cases (25.7% vs. 8.2%, P-value .019). Chest CT showed cavity in a significant number of IPA patients compared to non-IPA cases (60% vs. 29.5%, P-value .003). BALF direct microscopy, culture, and serum GM had sensitivities < 60% but specificities close to 95%. BALF GM showed promising results with a sensitivity of 88.5% and specificity of 85.7% at cutoff value of 0.8. See Figures below. Conclusions Our study highlights the magnitude of IPA in non-neutropenic hosts with unconventional risk factors like CKD, diabetes, and the need for increased vigilance for diagnosis of IPA in such patients. We suggest a lower cut-off value of BALF GM against 1 as in EORTC/MSG criteria and consider CKD as one of the risk factors for IPA.
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Affiliation(s)
| | - Brijesh Sharma
- Department of medicine , ABVIMS & Dr RML Hospital, New Delhi , India
| | - Desh Deepak
- Department of respiratory medicine , ABVIMS & Dr RML Hospital, New Delhi , India
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Kumara HN, Babu S, Rao GB, Mahato S, Bhattacharya M, Rao NVR, Tamiliniyan D, Parengal H, Deepak D, Balakrishnan A, Bilaskar M. Responses of birds and mammals to long-established wind farms in India. Sci Rep 2022; 12:1339. [PMID: 35079039 PMCID: PMC8789773 DOI: 10.1038/s41598-022-05159-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Wind turbines have been recognised as an alternative and clean-energy source with a low environmental impact. The selection of sites for wind-farm often creates serious conservation concerns on biodiversity. Wind turbines have become a serious threat to migratory birds as they collide with the turbine blades in some regions across the globe, while the impact on terrestrial mammals is relatively less explored. In this context, we assessed the responses of birds and mammals to the wind turbines in central Karnataka, India from January 2016 to May 2018 using carcass searches to quantify animal collisions (i.e., birds and bats), fixed radius point count for bird population parameters, and an occupancy framework for assessing the factor that determines the spatial occurrence of terrestrial mammals. The mean annual animal fatality rate per wind turbine was 0.26/year. Species richness, abundance, and unique species of birds were relatively higher in control sites over wind turbine sites. Species and functional compositions of birds in control sites were different from wind turbine sites, explaining the varied patterns of bird assemblages of different feeding guilds. Blackbuck, Chinkara, Golden Jackal, and Jungle Cat were less likely to occupy sites with a high number of wind turbines. The study indicates that certain bird and mammal species avoided wind turbine-dominated sites, affecting their distribution pattern. This is of concern to the management of the forested areas with wind turbines. We raised conservation issues and mitigating measures to overcome the negative effects of wind turbines on animals.
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Affiliation(s)
- Honnavalli N Kumara
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.
| | - S Babu
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.
| | - G Babu Rao
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,Manipal Academy of Higher Education, Madhav Nagar, Manipal, Karnataka, 576104, India
| | - Santanu Mahato
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,Biopsychology Laboratory, Institution of Excellence, University of Mysore, Mysuru, Karnataka, 570006, India
| | - Malyasri Bhattacharya
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,Wildlife Institute of India, Chandrabani, Dehradun, Uttarakhand, 248001, India
| | - Nitin Venkatesh Ranga Rao
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India
| | - D Tamiliniyan
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India
| | - Harif Parengal
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,Bharathiar University, Coimbatore, Tamil Nadu, India
| | - D Deepak
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India
| | - Athira Balakrishnan
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,National Institute of Advanced Studies, Indian Institute of Science Campus, Bangalore, Karnataka, 560012, India
| | - Mahesh Bilaskar
- Sálim Ali Centre for Ornithology and Natural History, Anaikatty, Coimbatore, Tamil Nadu, 641108, India.,Department of Environmental Sciences, Savitribai Phule Pune University, Ganeshkhind Road, Pune, 411007, Maharashtra, India
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Singh R, Krishnamurthy P, Deepak D, Sharma B, Prasad A. Small airway disease and its predictors in patients with rheumatoid arthritis. Respir Investig 2022; 60:379-384. [PMID: 34992007 DOI: 10.1016/j.resinv.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/20/2021] [Accepted: 12/04/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a connective tissue disease, characterized by symmetric peripheral polyarthritis. Extra-articular disease occurs in approximately 50% of the patients with lung being a common site. The presence of functional or morphological abnormalities in small airways has recently been noted in patients with RA but its exact prevalence and clinical significance is still a subject of debate. This study was aimed to determine the prevalence of small airway disease (SAD) in patients with RA and the factors influencing it. METHODS Fifty consecutive patients with RA were included in this cross-sectional observational study. All patients were subjected to pulmonary function tests (PFT) including Spirometry and Forced Oscillation technique (FOT). Those with features of SAD on PFT were subjected to High-Resolution Computed Tomography (HRCT) of the chest. RESULTS Spirometry was suggestive of SAD in 17 patients, with 34% prevalence and FOT was abnormal in 9 patients, with 18% prevalence in the study population. Of 17 patients with SAD on spirometry, 8 (47.05%) patients showed mosaic attenuation, a sign of SAD on the HRCT chest. On univariate analysis, age, Disease Activity Score (DAS-28), joint erosions on X-ray, RF and anti-CCP were found to be associated with SAD. CONCLUSION SAD was present in one-third of the patients with RA, even in those with short duration of disease, low to moderate disease activity and no respiratory symptoms. It is thus inferred that the complete workup of RA patients should include pulmonary function assessment.
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Affiliation(s)
- Rajnish Singh
- Department of Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India
| | - Premapassan Krishnamurthy
- Department of Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India.
| | - Desh Deepak
- Department of Respiratory Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India
| | - Brijesh Sharma
- Department of Medicine, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India
| | - Akhilandeswari Prasad
- Department of Radiology, ABVIMS and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India
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Kumar V, Rahar S, Misra S, Kannappan A, Deepak D, Panesar S. Study of clinical profile, laboratory parameters and outcomes of COVID-19 Patients in a Tertiary Care Centre in North India. J NTR Univ Health Sci 2022. [DOI: 10.4103/jdrntruhs.jdrntruhs_116_21] [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: 01/08/2023] Open
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Srinivasan G, Chaturvedi D, Verma D, Pal H, Khatoon H, Yadav D, Sahil AP, Gautam D, Deepak D. Prevalence of depression and anxiety among drug resistant tuberculosis: A study in North India. Indian J Tuberc 2021; 68:457-463. [PMID: 34752313 DOI: 10.1016/j.ijtb.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/06/2021] [Accepted: 04/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Drug Resistant Tuberculosis (DR-TB) is an emergent issue in the recent decades. Multidrug resistant (MDR-TB) and Extensive drug resistant (XDR-TB) tuberculosis are the common type of DR-TB. Psychological issues like depression and anxiety are common among the chronic illnesses like tuberculosis. This study aimed at estimating the prevalence of depression and anxiety among these patients. METHODS Our study is conducted in a tertiary care teaching hospital in North India. This study aimed at identifying the prevalence of depression and anxiety among the drug resistant tuberculosis patients attending DOTS clinic. The depression and anxiety were screened using PHQ-9 and HAM-A inventories. Binomial and multinomial regression analysis were done to identifying the predictors of depression and anxiety. RESULTS The prevalence rate of depression in MDR-TB and XDR-TB is 68% and 78% respectively. The prevalence of anxiety is 54% in MDR-TB and 66% in XDR-TB respectively in our study. Duration of illness and literacy were the significant predictors of depression and anxiety. CONCLUSION Patients with DR-TB faces huge psychological burden and this study highlighted the toll of depression and anxiety among them. Adequate screening, identification and treatment for these disorders among DR-TB patients at their earlier treatment stage helps in improving the adherence to treatment and functionality.
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Affiliation(s)
- G Srinivasan
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Deepanshi Chaturvedi
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Divyanshu Verma
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Hemlata Pal
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Heena Khatoon
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Deepika Yadav
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Abhishek Pratap Sahil
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Deepanshi Gautam
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Desh Deepak
- KGMU College of Nursing, King George's Medical University, Lucknow, Uttar Pradesh, 226003, India
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Abstract
The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed en bloc with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.
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Affiliation(s)
- Divyansh Bajaj
- Department of Medicine, Quinnipiac University Frank H. Netter MD School of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Ashutosh Sachdeva
- Division of Pulmonary and Critical Care, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Desh Deepak
- Department of Respiratory Medicine, Dr. RML Hospital & Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Bharati P, Deepak D, Kaushal M, Gupta P. Diagnostic utility of rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden. Cytopathology 2021; 32:428-435. [PMID: 33848034 DOI: 10.1111/cyt.12975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/28/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on-site evaluation (ROSE) in EBUS-TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden. OBJECTIVE This study was undertaken to evaluate the utility of ROSE in EBUS-TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies. METHODS This was a prospective study including 47 patients who underwent EBUS-TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10-month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis. RESULTS Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non-specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients. CONCLUSION ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples.
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Affiliation(s)
- Purnima Bharati
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Desh Deepak
- Department of Respiratory Medicine, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Manju Kaushal
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
| | - Prajwala Gupta
- Department of Pathology, Dr. Ram Manohar Lohia Hospital & ABVIMS, New Delhi, India
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15
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Ramesh P, Kaur G, Deepak D, Kumar P. Disseminated pulmonary mucormycosis with concomitant tuberculosis infection in a diabetic patient. Int J Mycobacteriol 2021; 9:95-97. [PMID: 32474496 DOI: 10.4103/ijmy.ijmy_186_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with diabetes are often susceptible to various opportunistic infections such as tuberculosis and mucormycosis. However, the occurrence of both these infections simultaneously is rare. We present one such case of pulmonary tuberculosis with disseminated pulmonary mucormycosis in a patient with diabetes, which was successfully managed.
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Affiliation(s)
- Priyamvadha Ramesh
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
| | - Gurmeet Kaur
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
| | - Desh Deepak
- Department of Pulmonary Medicine, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
| | - Prabhat Kumar
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. RML Hospital, New Delhi, India
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Sardana K, Mathachan SR, Deepak D, Khurana A, Sinha S. Cutaneous side effects of hydroxychloroquine in health care workers in a COVID referral hospital – implications for clinical practice. J DERMATOL TREAT 2020; 33:1104-1106. [DOI: 10.1080/09546634.2020.1781041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Kabir Sardana
- Department of Dermatology and STDs, Dr RML Hospital and PGIMER, New Delhi, India
| | - Sinu Rose Mathachan
- Department of Dermatology and STDs, Dr RML Hospital and ABVIMS, New Delhi, India
| | - Desh Deepak
- Department of Pulmonary Medicine, Dr RML Hospital and ABVIMS, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology and STDs, Dr RML Hospital and PGIMER, New Delhi, India
| | - Surabhi Sinha
- Department of Dermatology and STDs, Dr RML Hospital and PGIMER, New Delhi, India
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Affiliation(s)
- D. Deepak
- TKM College of Engineering, Kollam, India
| | - Bibin Mathew
- National Institute of Technology Calicut, Kozhikode, India
| | | | - Harish Garg
- School of Mathematics, Thapar Institute of Engineering and Technology, Patiala, India
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18
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Srivastava R, Narain D, Deepak D, Khare A. Isolation of a C-21 Norpregnane Precursor from Hoya Parasitica. Nat Prod Commun 2019. [DOI: 10.1177/1934578x0700201107] [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: 11/17/2022] Open
Abstract
A novel norpregnane, foligenin (1), was isolated, along with the pregnane calogenin, from Hoya parasitica. The structure of 1 was elucidated as 3β-hydroxy-21-norpregna-5-ene by spectroscopic methods.
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Affiliation(s)
- Rinky Srivastava
- Department of Chemistry, Lucknow University, Lucknow, India 226007
| | - Deepali Narain
- Department of Chemistry, Lucknow University, Lucknow, India 226007
| | - Desh Deepak
- Department of Chemistry, Lucknow University, Lucknow, India 226007
| | - Anakshi Khare
- Department of Chemistry, Lucknow University, Lucknow, India 226007
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19
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Affiliation(s)
- Desh Deepak
- Department of Respiratory Medicine, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Manjari Kishore
- Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
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20
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Abstract
Summary Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi that colonize the airways. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Although Aspergillus has progressively gained recognition as a causative agent in past few decades, other fungi, that have been reported to cause ABPM, are not yet widely evaluated. We studied hundred and two patients with asthma for occurrence of ABPM. Patients were tested for cutaneous hypersensitivity and serum precipitin to 12 common fungal antigens. The positive cases were further evaluated for ABPM using standard criteria. Out of 102 asthma patients screened, 18 patients had either skin prick test (SPT) and/or serum precipitin positive. While 14 patients were SPT positive for one or more fungal antigen, two patients were serum precipitin positive for one or more fungi. Two patients had both serum precipitin positive as well as SPT positive. Six (5.8%) patients were diagnosed as ABPM as they fulfilled the criteria. Three of these were because of Aspergillus sp. Two were because of fungi other than Aspergillus namely Schizophyllum and Curvularia. One patient had ABPM because of both Aspergillus and Curvularia. In our study absolute eosinophil count (AEC), total IgE, serum precipitin and SPT had sensitivity of 100%, 100% 50% and 83.3% respectively for diagnosing ABPM. The specificity of these tests was 44.79%, 64.58% 98.96% and 88.54% respectively. Specfic IgE was positive in 50% of patients with either serum precipitin or SPT positivity. SPT or serum precipitin followed by specific IgE had sensitivity of 100% and specificity of 96.88% for diagnosing ABPM. SPT alone followed by Specific IgE had a sensitivity of 83.33% and specificity of 96.88% for diagnosing ABPM. We found that fungi other than Aspergillus such as schizophyllum, and curvularia, can be implicated in ABPM. Multiple fungal agents may be responsible for ABPM in an individual. There is a subset of patients of BA who have fungal sensitization but do not fulfil the criteria for ABPM. SPT was the single most sensitive and specific test, AEC >350 and total IgE more than 417IU were most sensitive tests and SPT followed by specific IgE was most effective strategy for diagnosing ABPM.
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Affiliation(s)
- D Deepak
- Chest Physician PGIMER and Dr.Ram Manohar Lohia Hospital New Delhi
| | - M Singh Rajput
- Department of Medicine, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi
| | - B Sharma
- Department of Medicine, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi
| | - A Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi
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21
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Kishore M, Kaushal M, Deepak D, Kumari M. Cytopathological examination of bronchoalveolar lavage fluid in diagnosis of pulmonary alveolar proteinosis. J Lab Physicians 2018; 10:109-112. [PMID: 29403217 PMCID: PMC5784280 DOI: 10.4103/jlp.jlp_109_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the deposition of extracellular lipoproteinaceous material within the air spaces. Although the diagnosis is mainly based on histopathological findings, sometimes, the diagnostic yield of transbronchial and even open lung biopsy can be unsatisfactory. The advantage with bronchoalveolar lavage (BAL) cytology is that apart from being safer for the patient, it can sample a much wider area and help in giving an early diagnosis and treatment to the patient. Herein, we present a case of PAP diagnosed on BAL fluid cytology in an elderly female.
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Affiliation(s)
- Manjari Kishore
- Department of Pathology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manju Kaushal
- Department of Pathology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Desh Deepak
- Department of Respiratory Medicine, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Manju Kumari
- Department of Pathology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
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23
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Gupta A, Juneja D, Singh O, Garg SK, Arora V, Deepak D. Clinical Profile, Intensive Care Unit Course, and Outcome of Patients Admitted in Intensive Care Unit with Chikungunya. Indian J Crit Care Med 2018; 22:5-9. [PMID: 29422725 PMCID: PMC5793025 DOI: 10.4103/ijccm.ijccm_336_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective Chikungunya is generally a mild disease, rarely requiring Intensive Care Unit (ICU) admission. However, certain populations may develop organ dysfunction necessitating ICU admission. The purpose of the study was to assess the clinical profile and course of chikungunya patients admitted to the ICU, and to ascertain factors linked with poor outcome. Methods All patients with chikungunya admitted to ICU were included in the study. Admission Acute Physiology and Chronic Health Evaluation (APACHE) II score and sequential organ failure assessment (SOFA) score were calculated. Primary outcome measured was 28-day mortality and secondary outcomes measured were length of hospital and ICU stay and the need for vasopressor support, renal replacement therapy (RRT), and mechanical ventilation (MV). Logistic regression analysis was performed to identify factors predicting mortality. Results The most common complaints were fever (96.67%) and altered sensorium (56.67%). Mean admission APACHE II and SOFA scores were 17.28 ± 7.9 and 7.15 ± 4.2, respectively. Fifty-one patients had underlying comorbidities. Vasopressors were required by 46.76%; RRT by 26.67%, and MV by 58.33%, respectively. The 28-day mortality was 36.67%. High APACHE II score (odds ratio: 1.535; 95% confidence interval: 1.053-2.237; P = 0.026) and need for dialysis (odds ratio: 833.221; 95% confidence interval: 1.853-374,664.825; P = 0.031) could independently predict mortality. Conclusions Patients with chikungunya fever may require ICU admission for organ failure. They are generally elderly patients with underlying comorbidities. Despite aggressive resuscitation and organ support, these patients are at high risk of death. Admission APACHE II score and need for dialysis may predict patients at higher risk of death.
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Affiliation(s)
- Anish Gupta
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Suneel Kumar Garg
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Varun Arora
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
| | - Desh Deepak
- Institute of Critical Care Medicine, Max Super Speciality Hospital, New Delhi, India
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Deepak D, Prasad A, Atwal SS, Agarwal K. Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled. J Clin Diagn Res 2017; 11:TE01-TE05. [PMID: 28511478 DOI: 10.7860/jcdr/2017/19920.9478] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 12/11/2016] [Indexed: 11/24/2022]
Abstract
The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.
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Affiliation(s)
- Desh Deepak
- Chief Medical Officer, Department of Medicine, Respiratory Division, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Akhila Prasad
- Associate Professor, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Swapndeep Singh Atwal
- Ex-Senior Resident, Department of Radiodiagnosis, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kshitij Agarwal
- Consultant, QRG Health City, Faridabad SR, Respiratory Medicine, VP Chest Institute, New Delhi, India
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25
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Kishore M, Gupta P, Preeti, Deepak D. Pulmonary Hamartoma Mimicking Malignancy: A Cytopathological Diagnosis. J Clin Diagn Res 2016; 10:ED06-ED07. [PMID: 28050379 DOI: 10.7860/jcdr/2016/22597.8844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
Pulmonary Hamartomas (PH) are benign tumour-like lesions of lung with an uncommon occurrence and pose a diagnostic challenge on chest radiograph. Fine Needle Aspiration Cytology (FNAC) can lead to a definitive diagnosis as well as distinguishes these from malignant lung mass. Most of the patients are asymptomatic and incidentally detected on routine chest radiographs. We report a case of pulmonary hamartoma where the patient was symptomatic and a possibility of malignant neoplasm was considered until the FNAC concluded the diagnosis.
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Affiliation(s)
- Manjari Kishore
- Senior Resident, Department of Pathology, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital , New Delhi, India
| | - Prajwala Gupta
- Associate Professor, Department of Pathology, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital , New Delhi, India
| | - Preeti
- Junior Resident, Department of Pathology, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital , New Delhi, India
| | - Desh Deepak
- Chief Medical Officer, Department of Respiratory Medicine, Postgraduate Institute of Medical Education and Research, Dr. RML Hospital , New Delhi, India
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Singh M, Kumar A, Srivastava G, Deepak D, Singh M. Isolation, structure elucidation and DFT study on two novel oligosaccharides from yak milk. J Mol Struct 2016. [DOI: 10.1016/j.molstruc.2016.03.065] [Citation(s) in RCA: 4] [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: 12/24/2022]
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Kumar A, Sinha AN, Deepak D, Pandey NK, Nandani. Single Incision Laparoscopic Assisted Appendectomy: Experience of 82 Cases. J Clin Diagn Res 2016; 10:PC01-3. [PMID: 27437295 DOI: 10.7860/jcdr/2016/8146.7775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/25/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Single Incision Laparoscopic Surgery (SILS) is one of the most recent developments which have been made in the field of minimal assesses surgery. It has potential advantages of less postoperative pain and better cosmesis, but at the same time, this procedure is time consuming and it increases the cost of surgery. AIM In this study, we evaluated the feasibility, safety and potential advantages of single incision laparoscopic assisted appendectomy. MATERIALS AND METHODS Single incision laparoscopic assisted appendectomy was done in 82 patients who were diagnosed with acute or chronic appendicitis. A single 10mm incision made over right lower quadrant was used for placing two 5mm trocars and appendisectomy was done as in open surgery, after delivering out the appendix from the incision. RESULTS Mean operative time was 32.56 ± 15.5 minutes. Mean post-operative pain scores as per visual analogue scalewere 6.5, 4.2 and 1.2 on 12 hours day 1 and day 2 after surgery respectively. Mean length of hospital stay was 1.4 ± 1.2 days. CONCLUSION Single incision laparoscopic appendectomy is safe and feasible.
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Affiliation(s)
- Abhay Kumar
- Assistant Professor, Department of Surgery, Veer Chandra Singh Garwali Government Medical science and Research Institute , Sringar, Uttarakhand, India
| | - Anant Narayan Sinha
- Assistant Professor, Department of Physiology, Veer Chandra Singh Garwali Government Medical Science and Research Institute , Sringar, Uttarakhand, India
| | - Desh Deepak
- Professor and Head, Department of Physiology, Veer Chandra Singh Gadhwali Government Medical College and Research Institute , Sringar, Uttarakhand, India
| | - N K Pandey
- Professor and Head, Department of Anatomy, KMC , Katihar, Bihar, India
| | - Nandani
- Post Graduate Student, Department of Biochemistry, KMC , Katihar, Bihar, India
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Garg SK, Singh O, Deepak D, Singh A, Yadav R, Vashist K. Extracorporeal treatment with high-volume continuous venovenous hemodiafiltration and charcoal-based sorbent hemoperfusion for severe metformin-associated lactic acidosis. Indian J Crit Care Med 2016; 20:295-8. [PMID: 27275079 PMCID: PMC4876652 DOI: 10.4103/0972-5229.182205] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We present a case of a 49-year-old female with an alleged history of ingestion of approximately 100 tablets of metformin (850 mg each). Investigations revealed severe lactic acidosis with lactate levels of 13.5 mmol/L and pH of 7.17. This indicates severe toxicity and is associated with a high mortality. Charcoal-based sorbent hemoperfusion was done as a desperate effort, as patient continued to deteriorate despite supportive care and high-volume continuous venovenous hemodiafiltration. The patient survived despite metformin-associated lactic acidosis related to severe metformin toxicity.
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Affiliation(s)
- Suneel Kumar Garg
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Desh Deepak
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Akhilesh Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Rohit Yadav
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Kirti Vashist
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
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Prasad A, Agarwal K, Deepak D, Atwal SS. Pulmonary Aspergillosis: What CT can Offer Before it is too Late! J Clin Diagn Res 2016; 10:TE01-5. [PMID: 27190919 DOI: 10.7860/jcdr/2016/17141.7684] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/22/2016] [Indexed: 01/15/2023]
Abstract
Aspergillus is a large genus of saprophytic fungi which are present everywhere in the environment. However, in persons with underlying weakened immune response this innocent bystander can cause fatal illness if timely diagnosis and management is not done. Chest infection is the most common infection caused by Aspergillus in human beings. Radiological investigations particularly Computed Tomography (CT) provides the easiest, rapid and decision making information where tissue diagnosis and culture may be difficult and time-consuming. This article explores the crucial role of CT and offers a bird's eye view of all the radiological patterns encountered in pulmonary aspergillosis viewed in the context of the immune derangement associated with it.
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Affiliation(s)
- Akhila Prasad
- Associate Professor, Department of Radiodiagnosis, PGIMER & Dr Ram Manohar Lohia Hospital , New Delhi, India
| | - Kshitij Agarwal
- Senior Resident, Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi , Delhi, India
| | - Desh Deepak
- Chief Medical Officer, Respiratory Division, Department of Medicine, Postgraduate Institute of Medical Education and Research and Dr. Ram Manohar Lohia Hospital , New-Delhi, India
| | - Swapndeep Singh Atwal
- Ex-Senior Resident, Department of Radiodiagnosis, PGIMER & Dr Ram Manohar Lohia Hospital , New Delhi, India
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Abstract
A 22-year-old lactating mother presented with symptoms of uneasiness, palpitation, tachycardia and exophthalmos. She had an abdominal lump suggestive of 26 weeks uterine size but her urine pregnancy test was negative. Her thyroid profile was suggestive of hyperthyroidism. Gynaecological and ultrasonographic findings revealed a hydatidiform mole. She had a low β-human chorionic gonadotropin level that surprisingly increased after suction and evacuation. The paradoxical findings that appeared as erroneous laboratory results could be explained by the 'high-dose hook effect' after a review of literature. One week after the evacuation, the patient's thyroid profile and symptoms resolved completely without any treatment for hyperthyroidism.
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Affiliation(s)
- Rita Jindal
- Department of Gynaecology and Obstetrics, Hindu Rao Hospital, New Delhi, India
| | - Desh Deepak
- Department of Pulmonary Medicine, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Gopal Chandra Ghosh
- Department of Internal Medicine, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mamta Gupta
- Department of Gynaecology and Obstetrics, Hindu Rao Hospital, New Delhi, India
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Sinha AN, Deepak D, Gusain VS. Assessment of the effects of pranayama/alternate nostril breathing on the parasympathetic nervous system in young adults. J Clin Diagn Res 2013; 7:821-3. [PMID: 23814719 DOI: 10.7860/jcdr/2013/4750.2948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 02/14/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Pranayama, the art of breath control, is considered to be the heart of yogic exercises. The present study was performed with the aim of evaluating the effect of Pranayama/Alternate Nostril Breathing (A.N.B.) on the parasympathetic nervous system in healthy young adult males. METHODS A comparative account of the expiratioin: inspiration ratio (E:I ratio) and the orthostatic tolerance test (30:15 ratio) at the basal level, at the start of the study and after the practice of A.N.B for 5 minutes and following a training period of 6 weeks. RESULT AND CONCLUSION This study showed that the parasympathetic tone was enhanced appreciably in the participants. The observations of this study suggest that the yogic exercise of A.N.B. influences the parasympathetic nervous system significantly.
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Affiliation(s)
- Anant Narayan Sinha
- Associate Professor, Department of Physiology, VCSG Govt Medical Sciences and Research Institute , Srinagar, Uttarakhand, India
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Reena P, Dayananda S, Pai R, Jamema SV, Gupta T, Deepak D, Rajeev S. Performance characterization of siemens primus linear accelerator under small monitor unit and small segments for the implementation of step-and-shoot intensity-modulated radiotherapy. J Med Phys 2011; 31:269-74. [PMID: 21206643 PMCID: PMC3004102 DOI: 10.4103/0971-6203.29197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 09/02/2006] [Indexed: 11/24/2022] Open
Abstract
Implementation of step-and-shoot intensity-modulated radiotherapy (IMRT) needs careful understanding of the accelerator start-up characteristic to ensure accurate and precise delivery of radiation dose to patient. The dosimetric characteristic of a Siemens Primus linear accelerator (LA) which delivers 6 and 18 MV x-rays at the dose rate of 300 and 500 monitor unit (MU) per minutes (min) respectively was studied under the condition of small MU ranging from 1 to 100. Dose monitor linearity was studied at different dose calibration parameter (D1_C0) by measuring ionization at 10 cm depth in a solid water phantom using a 0.6 cc ionization chamber. Monitor unit stability was studied from different intensity modulated (IM) groups comprising various combinations of MU per field and number of fields. Stability of beam flatness and symmetry was investigated under normal and IMRT mode for 20×20 cm2 field under small MU using a 2D Profiler kept isocentrically at 5 cm depth. Inter segment response was investigated form 1 to 10 MU by measuring the dose per MU from various IM groups, each consisting of four segments with inter-segment separation of 2 cm. In the range 1-4 MU, the dose linearity error was more than 5% (max −32% at 1 MU) for 6 MV x-rays at factory calibrated D1_C0 value of 6000. The dose linearity error was reduced to −10.95% at 1 MU, within −3% for 2 and 3 MU and ±1% for MU ≥4 when the D1_C0 was subsequently tuned at 4500. For 18 MV x-rays, the dose linearity error at factory calibrated D1_C0 value of 4400 was within ±1% for MU ≥3 with maximum of −13.5 observed at 1 MU. For both the beam energies and MU/field ≥4, the stability of monitor unit tested for different IM groups was within ±1% of the dose from the normal treatment field. This variation increases to −2.6% for 6 MV and −2.7% for 18 MV x-rays for 2 MU/field. No significant variation was observed in the stability of beam profile measured from normal and IMRT mode. The beam flatness was within 3% for 6 MV x-rays and more than 3% (Max 3.5%) for 18 MV x-rays at lesser irradiation time ≤3 MU. The beam stability improves with the increase in irradiation time. Both the beam energies show very good symmetry (≤2%) at all irradiation time. For all the three segment sizes studied, the nonlinearity was observed at smaller MU/segment in both the energies. When the MU/segment is ≥4, all segment size shows fairly linear relation with dose/MU. The smaller segment size shows larger nonlinearity at smaller MU/segment and become more linear at larger MU/segment. Based on our study, we conclude that the Primus LA from Siemens installed at our hospital is ideally suited for step-and-shoot IMRT preferably for radiation ON time ≥4MU per segment.
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Affiliation(s)
- P Reena
- Department of Radiation Oncology, ACTREC, TMC, Kharghar, New Mumbai, India
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Banerjee N, Javed A, Deepak D, Pawar M, Chattopadhyay TK. Hyperbaric oxygen therapy: an adjuvant treatment modality for chemo-radiation induced hemorrhagic gastritis. Trop Gastroenterol 2011; 32:248-250. [PMID: 22332352] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Neerja Banerjee
- Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Samra T, Yadav A, Banerjee N, Pawar M, Deepak D. Flucytosine for treatment of Candida albicans in H1N1-positive patient. Indian J Pharmacol 2011; 42:318-9. [PMID: 21206626 PMCID: PMC2959217 DOI: 10.4103/0253-7613.70398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 06/16/2010] [Accepted: 07/06/2010] [Indexed: 11/15/2022] Open
Abstract
A 17-year-old H1N1-positive patient was successfully extubated after 25 days of ventilatory support for treatment of viral pneumonia which was complicated by empyema thoracis due to Candida albicans. Hematogenous spread was suspected as simultaneous culture of ascitic fluid identified Candida species sensitive to flucytosine but resistant to amphotericin B and azole group of antifungals. Monotherapy with flucytosine led to clinical and radiological improvement.
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Affiliation(s)
- Tanvir Samra
- Department of Anaesthesia and Intensive Care, Dr Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, Connaught Place, New Delhi - 110 001, India
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Deepak D, Daousi C, Javadpour M, Clark D, Perry Y, Pinkney J, Macfarlane IA. The influence of growth hormone replacement on peripheral inflammatory and cardiovascular risk markers in adults with severe growth hormone deficiency. Growth Horm IGF Res 2010; 20:220-225. [PMID: 20185347 DOI: 10.1016/j.ghir.2010.02.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [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] [Received: 10/14/2009] [Revised: 01/27/2010] [Accepted: 02/01/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adult GHD syndrome is associated with clustering of adverse cardiovascular (CV) risk factors such as abnormal body composition, dyslipidemia, insulin resistance and abnormal haemostatic factors. There is a wealth of evidence linking CV events with elevated levels of inflammatory markers (hs-CRP and IL-6) in the general population; however data on their abnormalities in GHD and specially the effects of GH replacement (GHR) on these inflammatory markers are limited. OBJECTIVE To study the effects of GHR on inflammatory markers, glucose homeostasis and body composition in a cohort of adults with recently diagnosed severe GHD due to hypothalamic pituitary disease. DESIGN Fifteen hypopituitary adults (11 males, mean age 48.5 years) with recently diagnosed, severe GHD were recruited. Patients received GHR (in addition to other pituitary hormone replacements) titrated to clinical response and to normalize age and gender adjusted IGF-1 levels. Weight, waist hip ratio (WHR), body composition, fasting plasma glucose and insulin, insulin resistance index (HOMA-IR), fasting serum lipid levels, hs-CRP, IL-6 and TNF-alpha were measured at baseline and following a minimum 6 months of stable maintenance GHR. RESULTS GHR resulted in a physiological increase in IGF-1 SDS [median -0.6 to +0.39, P<0.0001], improved quality of life (mean pre-treatment AGHDA score 16 vs. post-treatment score 7, P<0.0001) and reduction in WHR (0.94 vs. 0.92, P=0.01). There were no significant changes in body weight and composition. Levels of hs-CRP (log transformed, mean (SD)) were significantly reduced following GHR (pre 1.21 (0.9) vs. post 0.27 (0.9), P<0.0001) but TNF-alpha and IL-6 levels remained unchanged. Fasting glucose (mmol/L) [4.6 (0.1) vs. 5.1 (0.1), P=0.003], fasting insulin (muU/mL) [9.4 (8.1) vs. 12.1 (9.2), P=0.03] and HOMA-IR [1.2 (1.0) vs. 1.5 (1.1) P=0.02] (all pre-GHR vs. post-GHR and mean (SD)) significantly increased following GHR indicating increased insulin resistance. Significant improvements were noted in fasting LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) levels following GHR [3.4 (0.9) vs. 2.9 (0.7), P=0.03 and 1.2 (0.2) vs. 1.3 (0.2), P=0.02, respectively] (all pre-GHR vs. post-GHR and mean (SD)). Levels of total cholesterol and triglycerides did not change following GHR. CONCLUSIONS Physiological GHR for at least 6 months in hypopituitary adults with recently diagnosed severe GHD resulted in favourable changes in hs-CRP, WHR, fasting LDL-C and HDL-C levels all of which are recognised CV risk markers. However, there remains a high prevalence of obesity in this population and given the worsening of insulin sensitivity in the short term with GHR, monitoring and aggressive treatment of established CV risk factors is essential to reduce premature atherosclerotic CVD in this patient population.
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Affiliation(s)
- D Deepak
- Diabetes and Endocrinology Research Group, Clinical Sciences Centre, Aintree University Hospitals NHS Foundation Trust, Liverpool L9 7AL, UK.
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Abstract
BACKGROUND Adults with growth hormone deficiency (AGHD) have an adverse body composition with an increased prevalence of obesity. It is not known whether growth hormone replacement (GHR) results in alterations in energy intake (EI) and/or energy expenditure (EE). The aim of the study was to investigate the effects of GHR on EI and EE. MATERIALS AND METHODS Nineteen hypopituitary adults (14 males, 5 females, mean age 46.2 years) with severe GHD (peak GH response to glucagon <or= 9 mU L(-1)) were studied. All patients self-injected recombinant human GH starting with 0.3 mg s.c. daily. The following were measured before and following 6 months of stable maintenance of GHR: food intake during a test meal, appetite ratings, resting EE (indirect calorimetry) and voluntary physical activity (accelerometry). RESULTS GHR nearly doubled voluntary physical activity (mean activity units 3319 vs. 1881, P = 0.007) and improved quality of life score (mean score 9.1 vs. 16.5, P < 0.0001). Subjects reported higher fasting hunger ratings (mean 64.8 vs. 49.6, P = 0.02) but ad libitum energy intake remained unchanged. Eating behavioural traits were favourably altered with lower disinhibition (mean 6.0 vs. 7.2, P = 0.02) and lower susceptibility to hunger ratings (4.6 vs. 6.8, P = 0.001) after GHR. Additionally, GHR did not result in significant changes in resting EE, body weight and body mass index. CONCLUSIONS GHR in AGHD significantly improves voluntary physical activity and quality of life. Following GHR, subjects experience greater 'state' (physiological) hunger, reductions in eating disinhibition and hunger susceptibility, but no effects on calorie intake or macronutrient choice were detected.
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Affiliation(s)
- D Deepak
- Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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Arif E, Vibhuti A, Deepak D, Singh B, Siddiqui MS, Pasha MAQ. COX2 and p53 risk-alleles coexist in COPD. Clin Chim Acta 2008; 397:48-50. [PMID: 18692035 DOI: 10.1016/j.cca.2008.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 07/07/2008] [Accepted: 07/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette smoke stimulates airway epithelial cells to release pro-inflammatory cytokines which influence various inflammation-related genes, including COX2, whereas p53 expression is known to alter in such a condition. Since both the genes share several common physiological functions including inflammation and oxidative stress, we investigated within gene and gene-gene interactions towards susceptibility to the disease. METHOD In a prospective gene-association study we conducted PCR-RFLP for genotyping the COX2 -765G/C and 8473T/C and p53 72Pro/Arg polymorphisms in 229 COPD patients and 147 healthy controls. RESULTS The -765GC+CC genotypes of COX2 and Pro/Pro+Pro/Arg genotypes of p53 were prevalent in patients with significant odds ratio, 2.05 and 2.30, respectively (p=0.001; p=0.009, respectively), as a consequence, the -765C and 72Pro alleles were prevalent (p<or=0.001). Individually, the 8473T/C polymorphism did not associate with the disease (p=NS), however, it did in the haplotype -765C:8473C, which was significantly higher in patients (p<0.0001). Based on its prevalence, the three alleles were identified as risk-alleles in patients. The combinations of the genotypes containing 3, 4 and 5 risk alleles of the 3 polymorphisms were significantly over-represented in patients, whereas, the genotypes combinations containing 0, 1 and 2 risk alleles were significantly higher in controls (p=0.0004). The pairwise gene-gene interactions validated prevalence of risk-alleles associated pairing of genotypes such as the Pro/Pro+ Pro/Arg with -765GC+-765CC in patients (p=0.01). CONCLUSION The prevalence of COX2 and p53 risk-alleles contributes towards susceptibility to the disease.
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Affiliation(s)
- Ehtesham Arif
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Delhi, India
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Sharma P, Kar HK, Singh B, Deepak D, Bhardwaj M. Systemic sarcoidosis in a case of lepromatous leprosy: a case report. Indian J Lepr 2008; 80:275-278. [PMID: 19432358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The clinical features of cutaneous sarcoidosis and leprosy are some times difficult to differentiate and there have been many reports where pulmonary sarcoidosis was treated as pulmonary tuberculosis or a case of sarcoidosis was treated with anti-leprosy multidrug therapy, before a correct diagnosis was made. So far there has been only one published case report of leprosy and sarcoidosis co-infection, where tuberculoid leprosy developed in a case of sarcoidosis, known for over a decade. We are reporting a case of dual affliction, where sarcoidosis was discovered (on routine screening) in a case of lepromatous leprosy, after administration of 2 years of multidrug therapy. The role of mycobacterial antigens (among a vast array of different animate or inanimate particles) in causation of sarcoidosis, is still speculative, as reviewed from literature.
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Affiliation(s)
- P Sharma
- Department of Dermatology, STDs and Leprosy, Dr Ram Manohar Lohia Hospital and PGIMER, Baba Kharak Singh Marg, New Delhi-110001, India
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Arif E, Ahsan A, Vibhuti A, Rajput C, Deepak D, Athar M, Singh B, Pasha MAQ. Endothelial nitric oxide synthase gene variants contribute to oxidative stress in COPD. Biochem Biophys Res Commun 2007; 361:182-8. [PMID: 17658478 DOI: 10.1016/j.bbrc.2007.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 07/05/2007] [Indexed: 10/23/2022]
Abstract
Nitric oxide (NO) plays critical role in endothelial dysfunction and oxidative stress in COPD, pointing to the significance of endothelial nitric oxide synthase gene (eNOS) variants. We investigated the association of -786T/C, -922A/G, 4B/4A, and 894G/T polymorphisms of eNOS with the disease and its impact on nitrite and malonaldehyde levels in 190 COPD patients and 134 healthy controls, all smokers. The -786C, -922G and 4A alleles were significantly over-represented in patients (p=0.02, p=0.02, and p=0.03, respectively). The haplotypes, -786C:4A, 4A:894G, -786C:894G, and -786C:4A:894G were significantly over-represented in patients (p<0.0001, p =0.02, p=0.02, and p <0.0001, respectively), whereas, haplotypes, -786T:4B, 4B:894G, -786T:894G, and -786T:4B:894G were significantly under-represented in the patients (p<0.0001). The patients had significantly increased levels of nitrite (p=0.003) and malonaldehyde (p<0.0001). Combination of genotypes containing -786C and 4A alleles were greater in patients (p 0.05), and these combinations associated with decreased FEV1 value and nitrite level (p=0.03 and p=0.04, respectively) and with increased malonaldehyde levels (p=0.02). The eNOS -786C, -922G, and 4A alleles, these alleles associated haplotypes and genotype combinations were over-represented in patients. The variants and their combinations of four polymorphisms of eNOS contribute to disturbed pulmonary function and oxidative stress in COPD.
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Affiliation(s)
- Ehtesham Arif
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Delhi 110 007, India
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Huda MSB, Durham BH, Wong SP, Deepak D, Kerrigan D, McCulloch P, Ranganath L, Pinkney J, Wilding JPH. Plasma obestatin levels are lower in obese and post-gastrectomy subjects, but do not change in response to a meal. Int J Obes (Lond) 2007; 32:129-35. [PMID: 17667911 DOI: 10.1038/sj.ijo.0803694] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [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: 11/09/2022]
Abstract
OBJECTIVE To investigate a potential role for obestatin in humans by examining response to a fixed energy meal. CONTEXT A new anorectic peptide hormone, obestatin has recently been isolated from rat stomach. The significance of this peptide in humans is unknown. STUDY DESIGN Case-control study. SETTING Hospital-based study. PATIENTS Nine healthy controls, nine morbidly obese subjects and eight post-gastrectomy subjects. INTERVENTION Subjects attended after an overnight fast and were given a fixed energy meal (1550 kJ). MAIN OUTCOME MEASURE The response of obestatin to a meal in the different groups. RESULTS Fasting obestatin was significantly lower in obese subjects as compared to lean subjects (27.8+/-4 vs 17.2+/-2 pg/ml, P=0.03). Obestatin was also decreased in gastrectomy subjects but this did not reach statistical significance (27.8+/-4 vs 21.9+/-3 pg/ml, P=0.3). Obestatin did not change significantly from baseline in response to the meal. Lean and obese subjects had a similar obestatin/ghrelin ratio (0.04+/-0.003 vs 0.05+/-0.009, P=0.32), but this was higher in the gastrectomy group (0.04+/-0.003 vs 0.1+/-0.01, P<0.001). CONCLUSIONS Obestatin does not vary significantly with a fixed energy meal, but is significantly lower in morbidly obese subjects as compared to lean subjects supporting a possible role for obestatin in long-term body weight regulation. Obestatin tended to be lower in gastrectomy subjects and their obestatin/ghrelin ratio differed from healthy controls. Hence, the expression of obestatin is altered following gastrectomy, suggesting other sites outside the stomach may also secrete obestatin.
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Affiliation(s)
- M S B Huda
- Diabetes and Endocrinology Research Group, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK
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Arif E, Vibhuti A, Alam P, Deepak D, Singh B, Athar M, Pasha MAQ. Association of CYP2E1 and NAT2 gene polymorphisms with chronic obstructive pulmonary disease. Clin Chim Acta 2007; 382:37-42. [PMID: 17442289 DOI: 10.1016/j.cca.2007.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Detoxification genes are potential candidates in the susceptibility of patients with chronic obstructive pulmonary disease. Polymorphisms in these genes alter the metabolism of xenobiotics such as present in cigarette smoke. METHODS We conducted a case-control study to investigate total 9 polymorphisms of CYP2E1, CYP2D6 and NAT2 genes by PCR-RFLP. RESULTS The -1053C/T and -1293G/C promoter polymorphisms of CYP2E1 were found to be in complete linkage disequilibrium (LD) (D'=1.00, r(2)=1.0, p<0.0001), whereas -1293G/C and 7632T/A polymorphisms of the same gene were also in significant LD (D'=0.5183, r(2)=1.0, p=0.01) in patients. The patients over-represented the -1293GC+CC genotypes of -1293G/C polymorphism of CYP2E1 (p=0.03) and NAT2*4/7, NAT2()5/6, NAT2*5/7, NAT2*6/6 and NAT2*6/7 genotypes of NAT2 (p=0.01, p=0.039, p=0.01, p=0.032, p=0.006, respectively), resulting in to higher frequency of -1293C (OR=7.02, 95% CI=1.63-30.15, p=0.002), NAT2*6 (OR=1.90, 95% CI=1.27-2.83, p=0.001) and NAT2*7 (OR=2.91, 95% CI=1.65-5.12, p=0.0001) alleles. The 7632T/A and 9893C/G polymorphisms of CYP2E1 and 1934G/A polymorphism of CYP2D6 did not associate with the disease (p>0.05). The haplotypes -1293G:9893C and -1293G:7632T:9893C were under-represented (p<0.001), whereas haplotypes -1293C:7632T, -1293C:9893C, -1293C:9893G and -1293C:7632T:9893C of the 4 CYP2E1 polymorphisms were over-represented in patients (p<0.05). CONCLUSION The CYP2E1 and NAT2 variants associated with COPD.
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Affiliation(s)
- Ehtesham Arif
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Delhi, India
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Vibhuti A, Arif E, Deepak D, Singh B, Qadar Pasha MA. Correlation of oxidative status with BMI and lung function in COPD. Clin Biochem 2007; 40:958-63. [PMID: 17631288 DOI: 10.1016/j.clinbiochem.2007.04.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2006] [Revised: 03/09/2007] [Accepted: 04/30/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The imbalance in oxidative status together with nutrition depletion and low body weight play a vital role in the pathogenesis and severity of chronic obstructive pulmonary disease (COPD). The study was undertaken to ascertain if a relationship existed between oxidative status and BMI in COPD. In addition, association of oxidative status and BMI with lung function of the disease was also examined. MATERIALS AND METHODS In 202 COPD patients and 136 healthy controls plasma lipid peroxidation (LPO), reduced glutathione (GSH), glutathione peroxidase (GPx), catalase (CAT) activities, BMI and FEV(1)% predicted were looked for interactions. RESULTS The patients had increased LPO (p=0.006) and decreased antioxidants (GSH, p=0.005; GPx, p=0.035 and CAT, p=0.008, respectively). Of note are the correlations of oxidative stress markers with BMI and FEV(1)% predicted in the patients. LPO inversely and GSH, GPx, and CAT positively correlated with both BMI (p=0.007, p<0.001, p=0.045 and p=0.009, respectively), and FEV(1)% of predicted (LPO, p=0.001; GSH, p<0.001; GPx, p=0.043 and CAT, p<0.001) in the patients. Further, a positive correlation existed between BMI and FEV(1)% predicted (p=0.016) in COPD. CONCLUSION The intimate relationship of oxidative status with BMI and lung function, and the direct correlation between BMI and FEV(1) may potentiate severity of the disease.
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Affiliation(s)
- Arpana Vibhuti
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, Delhi, India
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Vibhuti A, Arif E, Deepak D, Singh B, Qadar Pasha MA. Genetic polymorphisms of GSTP1 and mEPHX correlate with oxidative stress markers and lung function in COPD. Biochem Biophys Res Commun 2007; 359:136-42. [PMID: 17532303 DOI: 10.1016/j.bbrc.2007.05.076] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 05/14/2007] [Indexed: 11/19/2022]
Abstract
The genetic susceptibility to COPD might depend on variations in detoxification enzymes that activate and detoxify cigarette smoke products, which otherwise generate oxidative stress causing pathogenesis. In a case-control study of 202 COPD patients and 136 normals, we examined the association of polymorphisms I105V, A114V of GSTP1 and Y113H, H139R of mEPHX individually or in combination with disease and their contribution to oxidative stress markers such as MDA, GSH, GPx and airflow obstruction. Patients were over-represented by the alleles 105V, 114V of GSTP1 and 113H, 139H of mEPHX (chi(2)=10.63, p=0.001, chi(2)=13.92, p<0.001, chi(2)=13.02, p<0.001 and chi(2)=4.48, p=0.034, respectively) and the haplotypes of same alleles i.e. 105V-114V and 113H-139H (chi(2)=14.58, p<0.001 and chi(2)=23.14, p<0.001). Moreover, there was marked over-representation of combination of genotypes, I105I+A114A of GSTP1 (53% vs. 36%) in controls; whereas, the combinations with 105V/114V alleles (64% vs. 47%) of GSTP1 (OR=1.99; 95% CI=1.28-3.09; p=0.002) and the homozygotes H113H+H139H (27% vs.10%) of mEPHX (OR=3.26; 95% CI=1.73-6.15; p=0.0001) in patients. Patients had significantly elevated MDA level (p<0.001) and decreased GSH level (p<0.001) and GPx activity (p=0.035), respectively. Of note, the genotypes, I105V/V105V, A114V/V114V of GSTP1 and Y113H/H113H of mEPHX associated with increased MDA level (p=0.04, p=0.03 and p=0.003), decreased GSH level (p=0.019, p=0.007 and p=0.0006) and lower FEV1 (p=0.23, p=0.037 and p=0.029), respectively, in patients; so was the correlation of these biomarkers and lung function with the combinations of the genotypes. In conclusion, 105V/114V alleles of GSTP1 and 113H/139H alleles of mEPHX and the combination of genotypes with same alleles associated with imbalanced oxidative stress and lung function in patients, signifying the importance in the disease.
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Affiliation(s)
- Arpana Vibhuti
- Functional Genomics Unit, Institute of Genomics and Integrative Biology, New Delhi, India
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Deepak D, Furlong NJ, Wilding JPH, MacFarlane IA. Cardiovascular disease, hypertension, dyslipidaemia and obesity in patients with hypothalamic-pituitary disease. Postgrad Med J 2007; 83:277-80. [PMID: 17403957 PMCID: PMC2600037 DOI: 10.1136/pgmj.2006.052241] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Accepted: 10/10/2006] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Adults with hypothalamic-pituitary disease have increased morbidity and mortality from cardiovascular disease (CVD). Therefore, the prevalence of CVD and adequacy of treatment of cardiovascular risk factors (according to current treatment guidelines) was studied in a large group of patients with hypothalamic-pituitary disease. STUDY DESIGN In 2005, 152 consecutive adult patients with hypothalamic-pituitary disease attending our neuro-endocrine centre were clinically examined and blood pressure (BP), lipid profile, type 2 diabetes mellitus, body composition and smoking status were assessed. RESULTS Of the 152 patients, 36.8% had treated hypertension and 28.2% had treated dyslipidaemia. Many of these patients had inadequate BP control (BP >140/85 mm Hg, 44.6%) and undesirable lipid levels (total cholesterol >4.0 mmol/l, 69%). Also, many of the untreated patients had BP and lipid levels which should have been considered for treatment (26 patients (27%) and 83 patients (76%), respectively). Smoking was admitted in 18% of patients. Central adiposity was present in 86% and obesity (body mass index > or =30) was present in 50%. CONCLUSIONS Cardiovascular risk factors are highly prevalent and often inadequately treated in adult patients with hypothalamic-pituitary disease. Aggressive treatment of these factors is essential to reduce mortality and morbidity from CVD in these patients.
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Affiliation(s)
- D Deepak
- University Department of Diabetes and Endocrinology, Clinical Sciences Centre, University Hospital Aintree, Liverpool, UK.
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Abstract
Two pregnanes namely desacylkondurangogenin C (1) and deniagenin (3, new) and two new pregnane glycosides designated as denin (5) and marsin (12) have been isolated from chloroform soluble extract of dried stem of Marsdenia roylei. Chemical and spectroscopic evidences are consistent with the structures of deniagenin, denin and marsin as 3beta, 11alpha, l2beta, 14beta, 17beta, 20-hexahydroxy pregn-5-ene; desacylkondurangogenin C-3-O-alpha-D-glucopyranosyl-(1-->4)-O-alpha-L-fucopyranoside and ketocalogenin-3-O-alpha-L-fucopyranoside, respectively.
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Affiliation(s)
- Vijay S Gupta
- Department of Chemistry, Lucknow University, -226 007, Lucknow, India
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Deepak D, Panjabi C, Gudwani S, Chaudhary N, Shah A. Nasal septal perforation in a patient with allergic bronchopulmonary aspergillosis and rhinitis on long term corticosteroids. Asian Pac J Allergy Immunol 2001; 19:287-90. [PMID: 12009079] [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: 02/25/2023]
Abstract
A 22-year-old male, referred to us as a case of multi-drug resistant tuberculosis was diagnosed as allergic bronchopulmonary aspergillosis (ABPA) after serological and computed tomography confirmation. He was initiated on oral as well as inhaled corticosteroids along with nasal corticosteroid spray for his nasal complaints. One year subsequently, he developed a nasal septal perforation. Biopsy taken from the site did not reveal any granulomatous or atrophic changes and cultures of the biopsy did not yield any organism. The septal defect, repaired surgically by Hazeltine's method healed completely within 6 weeks. There have been anecdotal reports of septal perforation in patients with rhinitis on intranasal corticosteroids but hitherto not in patients with ABPA. A periodic examination of the nasal septum should be undertaken in patients with ABPA and rhinitis on long term inhaled oral and intranasal corticosteroids along with oral corticosteroids.
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Affiliation(s)
- D Deepak
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, India
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Abstract
Two novel pregnane glycosides, denicunine (1) and heminine (4), have been isolated from the dried stem of Hemidesmus indicus R.Br. (family: Asclepiadaceae). Chemical transformations and spectroscopic evidence viz: 1H and 13C NMR spectroscopy and FABMS are consistent with the structures calogenin 3-O-3-O-methyl-beta-D-fucopyranosyl-(1-->4)-O-beta-D-oleandropyranosi de and calogenin 3-O-beta-D-cymaropyranosyl-(1-->4)-O-beta-D-digitoxopyranoside+ ++, respectively.
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Affiliation(s)
- P Sigler
- Department of Chemistry, Lucknow University, India
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Deepak D, Agarwal AK, Shah A. The "half-moon sign" in saccular aortic aneurysm. Indian J Chest Dis Allied Sci 1999; 41:219-23. [PMID: 10661010] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- D Deepak
- Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi
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