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Kedia S, Virmani S, Bajaj A, Markandey M, Singh N, Madan D, Kaushal K, Sahu P, Vuyyuru SK, Kante B, Kumar P, Thomas DM, Mundhra SK, Singh MK, Verma M, Sharma R, Das P, Dash NR, Monga N, Awasthi A, Makharia G, Ahuja V. Coconut Water Induces Clinical Remission in Mild to Moderate Ulcerative Colitis: Double-blind Placebo-controlled Trial. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00088-0. [PMID: 38278200 DOI: 10.1016/j.cgh.2024.01.013] [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: 08/28/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND & AIMS Coconut water (CW) is anti-inflammatory, can manipulate the gut microbiome, and is a rich source of potassium. Gut microbiome modulation improves outcomes in ulcerative colitis (UC), and potassium possesses in vitro anti-inflammatory property. We evaluated the effect of CW as an adjunct therapy for patients with mild-moderate UC. METHODS This single-center, double-blind, placebo-controlled trial randomized patients with mild to moderate (Simple Clinical Colitis Activity Index [SCCAI] :3-9) endoscopically active UC (Ulcerative Colitis Endoscopic Index of Severity [UCEIS] >1) in 1:1 ratio to CW + standard medical therapy (SMT) vs placebo + SMT. Four hundred mL of CW was administered for 8 weeks. Primary outcome measure was clinical remission (SCCAI ≤2), and secondary outcome measures were clinical response (SCCAI decline ≥3) and adverse events at 8 weeks. Microbiome was analyzed at baseline and 8 weeks. RESULTS Of 121 patients screened, 95 were included for modified intention to treat analysis (CW, n = 49; placebo, n = 46) (mean age, 37.2 ± 1.2 years; males, 54.1%; disease duration, 48 months [interquartile range (IQR), 24-90 months]; pancolitis, 26.1%; SCCAI, 5 [IQR, 4-6]; UCEIS, 4 [IQR, 3-5]). Clinical response (57.1% vs 28.3%; odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-7.9; P = .01), remission (53.1% vs 28.3%; OR, 2.9; 95% CI, 1.2-6.7; P = .02), and proportion of patients with fecal calprotectin (FCP) <150 μg/g (30.6% vs 6.5%; OR, 6.3; 95% CI, 1.7-23.6; P = .003) were significantly higher in CW. The relative abundance of bacterial taxa that had a significant or trend towards negative correlation with SCCAI, UCEIS, or FCP increased at 8 weeks in CW, and this effect was independent of disease activity and dietary fiber. Adverse events were comparable, and no patient developed hyperkalemia. CONCLUSIONS CW was more effective than placebo for induction of clinical remission in patients with mild to moderate UC. The trial was prospectively registered on Clinical Trials Registry of India (No: CTRI/2019/03/01827).
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Affiliation(s)
- Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubi Virmani
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditya Bajaj
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Manasvini Markandey
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Singh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Madan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Kanav Kaushal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Pabitra Sahu
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Kumar Vuyyuru
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Kante
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Peeyush Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - David Mathew Thomas
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Kumar Mundhra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Kumar Singh
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahak Verma
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of GI Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nitika Monga
- Non-communicable Disease Division, Indian Council of Medical Research, New Delhi, India
| | - Amit Awasthi
- Department of Infection and Immunology, Translational Health Science and Technology Institute, Faridabad, Haryana, India
| | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
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Gupta A, Singh N, Madan D, Farooqui M, Singh N, Thomas DM, Kante B, Singh M, Virmani S, Verma M, Bajaj A, Markandey M, Kumar P, Vuyyuru SK, Sahu P, Monga N, Makharia G, Kedia S, Ahuja V. Development and Validation of a Smartphone Application for Telenutrition in Patients with Inflammatory Bowel Disease. Diagnostics (Basel) 2022; 12:diagnostics12102482. [PMID: 36292172 PMCID: PMC9600056 DOI: 10.3390/diagnostics12102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
The use of smartphone-based applications as a telenutrition tool could redefine the nutritional management of IBD. We developed and validated a digital health platform in the form of a smartphone application for the nutritional assessment of IBD patients. Our team of gastroenterologists and dieticians at the All-India Institute of Medical Sciences, New Delhi developed a smartphone application titled IBD NutriCare, which was made available in both Android and iOS interfaces in English and seven other Indian languages. The application includes >650 Indian recipes and provides subjective global assessment and IBD clinical activity scores in a patient-friendly manner. The utility of the smartphone app was validated in comparison with the traditional 24-h dietary recall method. A total of 49 IBD patients were enrolled in the study. The mean difference in energy intake between the two dietary assessment methods was −4.776 kJ (95% LOA, range −417.916−408.365 kJ). A total of 94% of patients found the smartphone application convenient and acceptable in comparison to the recall method for dietary assessment. Bland−Altman plots showed a good level of agreement for nutrients and food groups between the two methods. Telenutrition in the form of a smartphone application helps in real-time tracking of dietary details of IBD patients, thus making appropriate interventions and large-scale data acquisition feasible.
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Affiliation(s)
- Arti Gupta
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Namrata Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Divya Madan
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mariyam Farooqui
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Neha Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - David Mathew Thomas
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bhaskar Kante
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mukesh Singh
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shubi Virmani
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Mehak Verma
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Aditya Bajaj
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manasvini Markandey
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Peeyush Kumar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Sudheer Kumar Vuyyuru
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pabitra Sahu
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nitika Monga
- Indian Council of Medical Research, New Delhi 110029, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Saurabh Kedia
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence: (S.K.); (V.A.)
| | - Vineet Ahuja
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence: (S.K.); (V.A.)
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Malhotra S, Mani K, Lodha R, Bakhshi S, Mathur VP, Gupta P, Kedia S, Sankar MJ, Kumar P, Kumar A, H V, Ahuja V, Sinha S, Guleria R, Dua A, Ahmad S, Upadhyay AD, Sati HC, Mani K, Lokade AK, Devi KP, Johnson RM, Gowthaman K, Kumari M, Singh R, Kalra D, Swetambri, Vasudha, Sharma S, Singh A, Sharma V, Kanswal S, Sharma R, Giri T, Rajput S, Mehra G, Sharma A, Madan D, Singh M, Gupta A, Sharma S, Sachdeva S, Kumar M, Sachin, Singh AK, Gohar N, Kumar R, Kanojia N, Singhania J, Dubey R, Shukla S, G A, Sarkar S, Gupta I, Rai S, Tummala S, Reddy T, Vadodaria V, Sharma A, Gupta A, Vats M, Deori TJ, Jaiswal A, Pandit S. COVID-19 infection, and reinfection, and vaccine effectiveness against symptomatic infection among health care workers in the setting of omicron variant transmission in New Delhi, India. Lancet Reg Health Southeast Asia 2022; 3:100023. [PMID: 35769163 PMCID: PMC9167830 DOI: 10.1016/j.lansea.2022.100023] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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] [Indexed: 12/15/2022]
Abstract
Background Surge of SARS CoV-2 infections ascribed to omicron variant began in December 2021 in New Delhi. We determined the infection and reinfection density in a cohort of health care workers (HCWs) along with vaccine effectiveness (VE) against symptomatic infection within omicron transmission period (considered from December 01, 2021 to February 25, 2022. Methods This is an observational study from the All India Institute of Medical Sciences, New Delhi. Data were collected telephonically. Person-time at risk was counted from November 30, 2021 till date of infection/ reinfection, or date of interview. Comparison of clinical features and severity was done with previous pandemic periods. VE was estimated using test-negative case-control design [matched pairs (for age and sex)]. Vaccination status was compared and adjusted odds ratios (OR) were computed by conditional logistic regression. VE was estimated as (1-adjusted OR)X100-. Findings 11474 HCWs participated in this study. The mean age was 36⋅2 (±10⋅7) years. Complete vaccination with two doses were reported by 9522 (83%) HCWs [8394 (88%) Covaxin and 1072 Covishield (11%)]. The incidence density of all infections and reinfection during the omicron transmission period was 34⋅8 [95% Confidence Interval (CI): 33⋅5-36⋅2] and 45⋅6 [95% CI: 42⋅9-48⋅5] per 10000 person days respectively. The infection was milder as compared to previous periods. VE was 52⋅5% (95% CI: 3⋅9-76⋅5, p = 0⋅036) for those who were tested within 14-60 days of receiving second dose and beyond this period (61-180 days), modest effect was observed. Interpretation Almost one-fifth of HCWs were infected with SARS CoV-2 during omicron transmission period, with predominant mild spectrum of COVID-19 disease. Waning effects of vaccine protection were noted with increase in time intervals since vaccination. Funding None.
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Affiliation(s)
- Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Prakash Mathur
- Division of Pedodontics and Preventive Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pooja Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mari Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Parmeshwar Kumar
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas H
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Subrata Sinha
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | | | - Aman Dua
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shafi Ahmad
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Datt Upadhyay
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Hem Chandra Sati
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kiruba Mani
- Dr. Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Kumar Lokade
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - K Pavithra Devi
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Riya Marie Johnson
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Keerthana Gowthaman
- Centre For Dental Education And Research, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Kumari
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ritika Singh
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Devanshi Kalra
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Swetambri
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vasudha
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shubhangi Sharma
- Department of Medical Oncology, Dr. B.R.A Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Singh
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Sunita Kanswal
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Tanika Giri
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Simple Rajput
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Geeta Mehra
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Sharma
- Centralized Core Research Facility, All India Institute of Medical Sciences, New Delhi, India
| | - Divya Madan
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Singh
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Anvita Gupta
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Shilpi Sharma
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Surbhi Sachdeva
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Mayank Kumar
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin
- Department of Gastroenterology & Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Kumar Singh
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Gohar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramu Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Kanojia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Singhania
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Dubey
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Shukla
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Abishek G
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Swarnabha Sarkar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ishan Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - Sabin Rai
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Thrisha Reddy
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Ajay Sharma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Vats
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Trideep Jyoti Deori
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sabitri Pandit
- Medical Device Monitoring Center, Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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Smith DR, Richterich P, Rubenfield M, Rice PW, Butler C, Lee HM, Kirst S, Gundersen K, Abendschan K, Xu Q, Chung M, Deloughery C, Aldredge T, Maher J, Lundstrom R, Tulig C, Falls K, Imrich J, Torrey D, Engelstein M, Breton G, Madan D, Nietupski R, Seitz B, Connelly S, McDougall S, Safer H, Gibson R, Doucette-Stamm L, Eiglmeier K, Bergh S, Cole ST, Robison K, Richterich L, Johnson J, Church GM, Mao JI. Multiplex sequencing of 1.5 Mb of the Mycobacterium leprae genome. Genome Res 1997; 7:802-19. [PMID: 9267804 DOI: 10.1101/gr.7.8.802] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The nucleotide sequence of 1.5 Mb of genomic DNA from Mycobacterium leprae was determined using computer-assisted multiplex sequencing technology. This brings the 2.8-Mb M. leprae genome sequence to approximately 66% completion. The sequences, derived from 43 recombinant cosmids, contain 1046 putative protein-coding genes, 44 repetitive regions, 3 tRNAs, and 15 tRNAs. The gene density of one per 1.4 kb is slightly lower than that of Mycoplasma (1.2 kb). Of the protein coding genes, 44% have significant matches to genes with well-defined functions. Comparison of 1157 M. leprae and 1564 Mycobacterium tuberculosis proteins shows a complex mosaic of homologous genomic blocks with up to 22 adjacent proteins in conserved map order. Matches to known enzymatic, antigenic, membrane, cell wall, cell division, multidrug resistance, and virulence proteins suggest therapeutic and vaccine targets. Unusual features of the M. leprae genome include large polyketide synthase (pks) operons, inteins, and highly fragmented pseudogenes.
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Affiliation(s)
- D R Smith
- Genome Therapeutics Corporation, Collaborative Research Division, Waltham, Massachusetts 02154, USA
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