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Satija A, Anand T, Mukherjee A, Velamuri PS, Singh KJ, Das M, Josten K, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Shah PB, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Panda S. Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study. Mycopathologia 2023; 188:745-753. [PMID: 37490256 DOI: 10.1007/s11046-023-00770-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.
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Affiliation(s)
| | - Tanu Anand
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | | | - Kripa Josten
- Indian Council of Medical Research, New Delhi, India
| | | | | | | | - D Himanshu
- King George's Medical University, Lucknow, India
| | - Sejal N Mistry
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Jimy D Patel
- Pandit Deendayal Upadhyay Medical College, Rajkot, India
| | - Prajwal Rao
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Shalesh Rohatgi
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | - Soumitra Ghosh
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Radha Annamalai
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | | | - Mini P Singh
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohammad Shameem
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Nazish Fatima
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | | | | | - Rupa Mehata
- All India Institute of Medical Sciences, Raipur, India
| | | | - Richa Tigga
- All India Institute of Medical Sciences, Raipur, India
| | | | - Vijay Sonkar
- King George's Medical University, Lucknow, India
| | | | - Neeraj Kumar
- King George's Medical University, Lucknow, India
| | - Rajashri Patil
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India
| | | | | | - Preetam Arthur
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - L Somu
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Padma Srikanth
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Pankaj B Shah
- Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Naresh K Panda
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipti Sharma
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Wasil Hasan
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | - Aftab Ahmed
- Jawaharlal Nehru Medical College Aligarh Muslim University, Aligarh, India
| | | | | | | | - Yash Kanani
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | - Chhaya Rajguru
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Lalitkumar R Sankhe
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Shrinivas S Chavan
- Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India.
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Kumar G, Bhalla A, Mukherjee A, Turuk A, Talukdar A, Mukherjee S, Bhardwaj P, Menon GR, Sahu D, Misra P, Sharma LK, Mohindra R, S S, Suri V, Das H, Sarkar D, Ghosh S, Ghosh P, Dutta M, Chakraborty S, Kumar D, Gupta MK, Goel AD, Baruah TD, Kannauje PK, Shukla AK, Khambholja JR, Patel A, Shah N, Bhuniya S, Panigrahi MK, Mohapatra PR, Pathak A, Sharma A, John M, Kaur K, Nongpiur V, Pala S, Shivnitwar SK, Krishna BR, Dulhani N, Gupta B, Gupta J, Bhandari S, Agrawal A, Aggarwal HK, Jain D, Shah AD, Naik P, Panchal M, Anderpa M, Kikon N, Humtsoe CN, Sharma N, Vohra R, Patnaik L, Sahoo JP, Joshi R, Kokane A, Ray Y, Rajvansh K, Purohit HM, Shah NM, Madharia A, Dube S, Shrivastava N, Kataria S, Shameem M, Fatima N, Ghosh S, Hazra A, D H, Salgar VB, Algur S, M L KY, M PK, Panda S, Vishnu Vardhana Rao M, Bhargava B. Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19. BMJ Glob Health 2023; 8:e012245. [PMID: 37816536 PMCID: PMC10565174 DOI: 10.1136/bmjgh-2023-012245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/20/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.
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Affiliation(s)
- Gunjan Kumar
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aparna Mukherjee
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | - Alka Turuk
- Clinical Studies & Trials Unit, Indian Council of Medical Research, New Delhi, India
| | | | | | | | - Geetha R Menon
- National Institute of Medical Statistics, New Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, New Delhi, India
| | | | | | - Ritin Mohindra
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Samita S
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Suri
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Himadri Das
- Medical College and Hospital Kolkata, Kolkata, India
| | | | | | - Priyanka Ghosh
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | - Moumita Dutta
- College of Medicine and Sagore Dutta Hospital, Kolkata, India
| | | | - Deepak Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | | | | | | | | | | | | | | | | | - Sourin Bhuniya
- All India Institute of Medical Sciences, Bhubaneswar, India
| | | | | | | | | | - Mary John
- Christian Medical College and Hospital, Ludhiana, India
| | | | | | | | | | | | | | | | | | | | | | - H K Aggarwal
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Deepak Jain
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Arti D Shah
- SBKS Medical Institute and Research Centre, Vadodara, India
| | - Parshwa Naik
- SBKS Medical Institute and Research Centre, Vadodara, India
| | | | | | - Nyanthung Kikon
- Department of Health and Family Welfare, Government of Nagaland, Kohima, India
| | | | - Nikita Sharma
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Rajaat Vohra
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | | | - Rajnish Joshi
- All India Institute of Medical Sciences, Bhopal, India
| | - Arun Kokane
- All India Institute of Medical Sciences, Bhopal, India
| | - Yogiraj Ray
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | | | | | - Nehal M Shah
- Smt NHL Municipal Medical College, Ahmedabad, India
| | | | | | | | | | | | | | - Saumitra Ghosh
- Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, Institute of Postgraduate Medical Education and Research, Kolkata, India
| | - Himanshu D
- King George Medical University, Lucknow, India
| | | | - Santosh Algur
- Gulbarga Institute of Medical Sciences, Gulbarga, India
| | - Kala Yadhav M L
- Shri Atal Bihari Vajpayee Medical College and Research Institution, Bengaluru, India
| | | | - Samiran Panda
- Indian Council of Medical Research, New Delhi, India
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Chaudhary SC, Gupta P, Sawlani KK, Gupta KK, Singh A, Usman K, Kumar V, Himanshu D, Verma A, Singh AB. Obstructive Sleep Apnea in Hypertension. Cureus 2023; 15:e38229. [PMID: 37252498 PMCID: PMC10225023 DOI: 10.7759/cureus.38229] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction About one-half of patients who have essential hypertension have obstructive sleep apnea (OSA), and about one-half of patients who have obstructive sleep apnea have essential hypertension. OSA can cause even resistant hypertension if left untreated. These two entities often co-exist and are seen as a continuum of the same process. Eighty percent to 90% of OSA cases are undiagnosed mostly because of a lack of awareness. Material and methods This was a cross-sectional study done over a period of one year in a tertiary care hospital. After taking informed consent, 179 hypertensive patients of >18 years were included in the study. All patients were screened for OSA by the STOP-BANG questionnaire. Patients having scores of ≥3 were subjected to overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Patients with a STOP-BANG score ≤2 or score ≥3 with AHI <5, were considered non-OSA. Results More than half (53.1%) of the patients enrolled in the study had OSA. Their age ranged from 18 to 78 years and the mean age was 52.07±11.40 years. The mean age of OSA cases was found to be slightly higher than that of non-OSA. The majority of OSA cases were males (73.7%). There was an increase in the prevalence, as well as the severity of OSA, with an increase in BMI. Most of the cases had snoring and a history of tiredness. Triglyceride (TG) and low-density lipoprotein (LDL) levels of the OSA group were found to be significantly higher and high-density lipoprotein (HDL) levels were significantly lower than that of the non-OSA group. Conclusion More than half of our hypertensive patients had OSA. These two conditions often co-exist and are known as a dangerous pair. Physicians ought to have increased suspicion for early diagnosis and treatment to improve cardiovascular outcomes, reduce road traffic accidents, and improve quality of life.
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Affiliation(s)
- Shyam C Chaudhary
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Pankaj Gupta
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - K K Sawlani
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Kamlesh K Gupta
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Abhishek Singh
- Department of Cardiology, King George's Medical University, Lucknow, IND
| | - Kauser Usman
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Vivek Kumar
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - D Himanshu
- Department of Internal Medicine, King George's Medical University, Lucknow, IND
| | - Ajay Verma
- Department of Respiratory Medicine, King George's Medical University, Lucknow, IND
| | - Abhishek B Singh
- Department of Otolaryngology - Head and Neck Surgery, King George's Medical University, Lucknow, IND
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Muacevic A, Adler JR, Himanshu D, Bharti V, Sharma D. Acute Liver Failure Prognostic Criteria: It's Time to Revisit. Cureus 2023; 15:e33810. [PMID: 36819396 PMCID: PMC9929612 DOI: 10.7759/cureus.33810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Acute liver failure (ALF) is a devastating disease, and patients are at a higher risk of death without liver transplantation. Indicators are needed to identify the risk of death in ALF, which will help in the timely referral of patients to specialized centers. Clichy criteriaand King's College Hospital (KCH) criteria are the most widely used prognostic criteria. Real-life application of Clichy criteria is limited due to the non-availability of factor V level measurement. KCH criteria have good specificity but low sensitivity to predict outcomes. Therefore, we attempted to use the model for end-stage liver disease (MELD) score and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score in ALF patients as prognostic indicators and need for liver transplantation. METHODS Forty-one patients with ALF were enrolled in the study. On the day of admission, MELD and CLIF-SOFA scores were calculated for each patient. Area under receiver operating characteristics (AUROC) curve, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy (DA) of MELD and CLIF-SOFA score were calculated to predict the outcome of the patients. RESULTS Out of 41 patients, nine patients left against medical advice. The sensitivity, specificity, PPV, NPV, and DA for the MELD score of enrolled patients in the study were 81.5%, 62.5%, 59.5%, 83.3%, 70.1%, and for the CLIF-SOFA score of enrolled patients in the study were 88.9%, 90.0%, 85.7%, 92.3%, 89.6% respectively. Patients who did not survive had higher INR, MELD, CLIF-SOFA scores, and hepatic encephalopathy (HE) grades. Five patients who had a combination of MELD ≥30 and CLIF-SOFA ≥10, expired. CONCLUSION In our study, we used MELD score and CLIF-SOFA as prognostic markers, and we concluded that CLIF-SOFA is a better predictor of mortality than MELD score in terms of sensitivity, specificity, NPV, PPV, and diagnostic accuracy. AUROC for CLIF-SOFA score is higher when compared to the MELD score.
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Gupta PK, Singh S, Mahour P, Gupta B, Agarwal M, Dalal PK, Agarwal V, Nischal A, Tripathi A, Himanshu D, Arya A, Verma S, Mishra D, Gupta V. Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital. Clin Epidemiol Glob Health 2023; 19:101209. [PMID: 36619652 PMCID: PMC9805410 DOI: 10.1016/j.cegh.2022.101209] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/26/2022] [Accepted: 12/26/2022] [Indexed: 01/02/2023] Open
Abstract
Aim The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19. Method Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire. Results Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms. Conclusion Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.
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Affiliation(s)
- Pawan Kumar Gupta
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Shweta Singh
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Pooja Mahour
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Bandna Gupta
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Manu Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Anil Nischal
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - D Himanshu
- Department of Medicine, King George's Medical University, Lucknow, UP, India
| | - Amit Arya
- Department of Psychiatry, King George's Medical University, Lucknow, UP, India
| | - Sudhir Verma
- Department of Medicine, King George's Medical University, Lucknow, UP, India
| | | | - Vishal Gupta
- Department of Psychiatry, County Hospital, Aneurin Bevan University Health Board, Pontypool, Wales, United Kingdom
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Anand T, Mukherjee A, Satija A, Velamuri PS, Singh KJ, Das M, Josten K, Yadav PD, Sahay RR, Keche AY, Nagarkar NM, Gupta P, Himanshu D, Mistry SN, Patel JD, Rao P, Rohatgi S, Ghosh S, Hazra A, Kindo AJ, Annamalai R, Rudramurthy SM, Singh MP, Shameem M, Fatima N, Khambholja JR, Parikh S, Madkaikar M, Pradhan VD, Kataria S, Sharma P, Panda S, Shete AM, Majumdar T, Abraham P, Bhargava A, Mehata R, Arora RD, Tigga R, Banerjee G, Sonkar V, Malhotra HS, Kumar N, Patil R, Raut CG, Bhattacharyya K, Arthur P, Somu L, Srikanth P, Panda NK, Sharma D, Hasan W, Ahmed A, Bathla M, Solanki S, Doshi H, Kanani Y, Patel N, Shah Z, Tembhurne AK, Rajguru C, Sankhe LR, Chavan SS, Yadav RM, Deswal V, Kumar K. A case control investigation of COVID-19 associated mucormycosis in India. BMC Infect Dis 2022; 22:856. [PMID: 36384482 PMCID: PMC9667849 DOI: 10.1186/s12879-022-07844-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07844-y.
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Verma S, Shukla S, Himanshu D, Sawlani KK, Prakash S, Jain A. Unusual clinical presentations of scrub typhus, a neglected tropical disease: A case series from north India. J Vector Borne Dis 2022; 59:380-385. [PMID: 36751770 DOI: 10.4103/0972-9062.355960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Scrub typhus is a neglected tropical disease common in Asia and Africa. It usually presents with non-specific symptoms like fever, rashes, and lymphadenopathy. It has a varying range of clinical picture that often leads to misdiagnosis and initiation of non-specific treatment. This disease is thus associated with high morbidity and mortality. We aim to highlight the uncommon presentations of this common disease to create awareness regarding the unusual presentations of scrub typhus. METHODS This prospective study was performed over a period of two months enrolling eleven adult patients with serological evidence of anti-scrub typhus IgM antibodies. RESULTS All enrolled 11 cases [5 males (45.5%) and 6 females (54.5%)] were positive for anti-ST IgM antibodies and negative for other tested microbial agents. 7/11 (63.6%) patients were admitted with a clinical diagnosis of acute encephalitis syndrome (AES as per standard WHO definition), 3/11 (27.3%) patients presented with jaundice and 1/11 (9.1%) patients presented with rashes. Two out of 7 (28.6%) AES cases had developed peripheral gangrene of extremities. INTERPRETATION & CONCLUSION Scrub typhus is a common tropical disease that can have various unusual clinical presentations like meningoencephalitis, vasculitis, acute kidney injury, jaundice, MODS. It closely mimics other infective etiologies making its diagnosis difficult. A high index of suspicion and clinical awareness is required in clinical practice to identify the different presentations of this disease so that early treatment can be initiated to reduce morbidity and mortality associated with this disease.
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Affiliation(s)
- Shiva Verma
- Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Suruchi Shukla
- Postgraduate Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - K K Sawlani
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Shantanu Prakash
- Postgraduate Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Postgraduate Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Mathur P, Malpiedi P, Walia K, Srikantiah P, Gupta S, Lohiya A, Chakrabarti A, Ray P, Biswal M, Taneja N, Rupali P, Balaji V, Rodrigues C, Lakshmi Nag V, Tak V, Venkatesh V, Mukhopadhyay C, Deotale V, Padmaja K, Wattal C, Bhattacharya S, Karuna T, Behera B, Singh S, Nath R, Ray R, Baveja S, Fomda BA, Sulochana Devi K, Das P, Khandelwal N, Verma P, Bhattacharyya P, Gaind R, Kapoor L, Gupta N, Sharma A, VanderEnde D, Siromany V, Laserson K, Guleria R, Malhotra R, Katoch O, Katyal S, Khurana S, Kumar S, Agrawal R, Dev Soni K, Sagar S, Wig N, Garg P, Kapil A, Lodha R, Sahu M, Misra M, Lamba M, Jain S, Paul H, Sarojini Michael J, Kumar Bhatia P, Singh K, Gupta N, Khera D, Himanshu D, Verma S, Gupta P, Kumar M, Pervez Khan M, Gupta S, Kalwaje Eshwara V, Varma M, Attal R, Sudhaharan S, Goel N, Saigal S, Khadanga S, Gupta A, Thirunarayan M, Sethuraman N, Roy U, Jyoti Raj H, D'Souza D, Chandy M, Mukherjee S, Kumar Roy M, Goel G, Tripathy S, Misra S, Dey A, Misra T, Ranjan Das R, Bashir G, Nazir S, Ranjana Devi K, Chaoba Singh L, Bhargava A, Gaikwad U, Vaghela G, Sukharamwala T, Ch. Phukan A, Lyngdoh C, Saksena R, Sharma R, Velayudhan A. Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study. Lancet Glob Health 2022; 10:e1317-e1325. [PMID: 35961355 DOI: 10.1016/s2214-109x(22)00274-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
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Bhardwaj A, Atam V, Sawlani KK, Himanshu D, Verma R, Verma SP. Thrombocytopenia as a Prognostic Marker in Patients with Acute Encephalitis at a Tertiary Care Centre in Northern India. J Assoc Physicians India 2022; 70:11-12. [PMID: 35443418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Encephalitis is challenging to manage given the diversity of clinical and epidemiologic features. Various predictors of outcome have been studied so far including thrombocytopenia, cerebral edema, hypoglycaemia, development of status epilepticus and need for endotracheal intubation. Thrombocytopenia represents one of the potentially modifiable risk factors for poor prognosis in encephalitis. A better understanding of the epidemiology of this devastating disease and identification of predictors of outcome and management of reversible factors will pave the way for better management of the disease. MATERIAL A total of 98 Hospitalised patients of Acute Encephalitis were enrolled in the study. Diagnoses were confirmed by CSF and Neuroimaging studies. Platelet count <150,000/cumm was considered as thrombocytopenia. Mild, moderate and severe thrombocytopenia was categorized at platelet count 100,000-150,000, 50,000-100,000 and <50,000/ cumm, respectively. Outcome at discharge was assessed using the Modified Ranking Score, categorized into 3 groups - good (0-2), fair (3-4), and poor (5-6). Chi-square, ANOVA and Independent samples 't'-tests were used to compare the data. OBSERVATION Mean age of patients was 34.06±18.76 (range 14-85) years. Majority of patients were males (54.1). Mean GCS at admission was 9.41±1.90. Acute viral encephalitis(unclassified) (n=33; 33.7%), Scrub typhus (n=24; 24.5%) and Japanese encephalitis virus (n=12; 12.2%) were the most common underlying etiologies. A total of 74 (75.5%) patients had thrombocytopenia. Mild, moderate and severe thrombocytopenia was seen in 34 (34.7%), 30 (30.6%) and 10 (10.2%) cases. Thrombocytopenia was significantly higher in Dengue and Scrub as compared to other etiologies. Thrombocytopenia and its severity showed a significant association with lower GCS and higher mRS scores indicating a poor outcome. CONCLUSION Thrombocytopenia is associated with a poor clinical status and adverse outcomes in patients with encephalitis of all causes.
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Affiliation(s)
| | - V Atam
- King George's Medical University, Lucknow
| | | | - D Himanshu
- King George's Medical University, Lucknow
| | - R Verma
- King George's Medical University, Lucknow
| | - S P Verma
- King George's Medical University, Lucknow
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Wamique M, Himanshu D, Ali W. Expression Levels and Genetic Polymorphism of Scavenger Receptor Class B Type 1 as a Biomarker of Type 2 Diabetes Mellitus. Sultan Qaboos Univ Med J 2022; 22:117-122. [PMID: 35299814 PMCID: PMC8904105 DOI: 10.18295/squmj.4.2021.042] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 12/02/2022] Open
Abstract
Objectives This study aimed to determine whether the expression level and genetic polymorphism scavenger receptor class B type 1 (SCARB1) rs5888 may be used as biological markers in type 2 diabetes mellitus (T2DM). Methods This case-control study was conducted at King George’s Medical University, Lucknow, India, from September 2018 to December 2019. Blood samples were collected from each individual with T2DM and each healthy individual. Total proteins were determined using western blot analysis. Additionally, restriction fragment length polymorphism analysis was achieved to detect the incidence of genetic polymorphisms. Results A total of 600 individuals, including 300 individuals with T2DM and 300 healthy individuals, were enrolled in the study. Western blot analysis results revealed that the protein expression of SRB1 was significantly decreased in T2DM of SCARB1 CC variant when compared with controls (P = 0.007). The genotype distribution and the allelic frequencies for the SRB1 polymorphism were significantly different between T2DM and controls (P = 0.03). The CC genotype of the SCARB1 polymorphism showed a potential association with the incidence of T2DM (odds ratio = 1.19, 95% confidence interval = 0.63–2.25; P = 0.577). Conclusion The expression levels and genetic polymorphisms of the SCARB1 CC variant may be potential biomarkers for the occurrence of T2DM.
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Affiliation(s)
- Mohd Wamique
- Department of Pathology, King George’s Medical University, Lucknow, India
| | - D. Himanshu
- Department of Medicine, King George’s Medical University, Lucknow, India
| | - Wahid Ali
- Department of Pathology, King George’s Medical University, Lucknow, India
- Corresponding Author’s e-mail:
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Chandra T, Himanshu D, Maurya P, Agarwal M, Pandey S. Humoral response to SARS-COV-2 in COVID-19-recovered patients and correlation with various factors. Asian J Transfus Sci 2022. [DOI: 10.4103/ajts.ajts_56_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: 11/04/2022] Open
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Abbas SF, Ozair A, Kumar V, Himanshu D. Scrub Typhus Presenting with Hemiparesis: Case Report of a Rare Manifestation. Neurol India 2021; 69:1074-1075. [PMID: 34507454 DOI: 10.4103/0028-3886.325368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Syed F Abbas
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ahmad Ozair
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Solanki A, Singh A, Chauhan A, Agarwal D, Himanshu D, Chandra T. Therapeutic plasma exchange an emerging treatment modality: A 3-year retrospective analysis of patients admitted in a multispecialty hospital of North India. Asian J Transfus Sci 2021; 15:46-51. [PMID: 34349456 PMCID: PMC8294433 DOI: 10.4103/ajts.ajts_125_20] [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] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 03/21/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Therapeutic plasma exchange (TPE) is increasingly used throughout the medical field. We aimed to analyze the various aspects of TPE practices at our hospital in terms of clinical indications, technical feasibility, safety, outcome as well as complications associated with the procedures. MATERIALS AND METHODS The data included demographic profiles, clinical parameters, and technical characteristics of each TPE procedure. All the information was noted in data spread sheet (Microsoft Excel 2013) for further analysis. RESULTS This is a 3-year retrospective study of total 266 TPE procedures carried out on 92 patients with different clinical conditions. Out of them, 55 (59.8%) were male and 37 (40.2%) were female patients. There were six major categories such as (1) neurological, (2) hematological, (3) gastrological, (4) renal, (5) rheumatic, and (6) others. The TPE treatment was highest in neurology group (60.2%), followed by gastrology group (24.4%). Most of the procedures (82.6%) were according to the American society of apheresis 2016 I or II categories (76/92 patients). CONCLUSION TPE is beneficial and used as primary or secondary adjunctive therapy for a wide spectrum of various diseases and syndromes. TPE is considered as safe, cost-effective, and life-saving treatment modality in various diseases.
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Affiliation(s)
- Archana Solanki
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashutosh Singh
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Devisha Agarwal
- Department of ENT, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D. Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Tulika Chandra
- Department of Transfusion Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Solanki A, Singh A, Chauhan A, Chandra T, Himanshu D. Therapeutic plasma exchange: A life-saving modality in Wegener's granulomatosis. Asian J Transfus Sci 2020; 14:203-205. [PMID: 33767553 PMCID: PMC7983145 DOI: 10.4103/ajts.ajts_89_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 12/04/2022] Open
Abstract
We report a case of Wegener's granulomatosis (WG) who very well responded to the combination strategy of therapeutic plasma exchange (TPE) and immunosuppression. The patient was a 38-year-old female, diagnosed with severe form of WG. A total of seven cycles was performed with 1.3 total plasma volumes (TPVs) on every alternate day. Standard induction therapy was also started that comprised of a combination of 500 mg intravenous (i.v.) cyclophosphamide and methylprednisolone 1 g slow i.v. daily for 3 days followed by oral prednisolone 60 mg daily for 4 weeks. After seven cycles of TPE, the patient improved and hence TPE was stopped.
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Affiliation(s)
- Archana Solanki
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - Ashutosh Singh
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - Abhishek Chauhan
- Department of Radiodiagnosis, Dr. RML institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Tulika Chandra
- Department of Transfusion Medicine, KGMU, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of Medicine, KGMU, Lucknow, Uttar Pradesh, India
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Abstract
Type 2 diabetes mellitus (T2DM) is a heterogeneous condition that is related to both defective insulin secretion and peripheral insulin resistance. Beta cells are the major organ for secreting insulin hence, it is important to maintain an adequate beta-cell mass in response to various changes. Insulin resistance is a major cause of T2DM leads to elevated free fatty acid (FFA) levels which increases beta-cell mass and insulin secretion to compensate for insulin insensitivity. Chronic increase of plasma FFA levels results in disturbances in lipid metabolism, which contributes to decreased beta-cell function and lipotoxicity thus promoting T2DM. In the present review, we have discussed the process of beta-cell destruction, the role of genes in contributing to the fast increase in the progression of T2DM in detail. More than 130 variants in various T2DM susceptibility and candidate genes have been discovered to be associated with T2DM. Still, these variants elucidate only a small amount of total heritability of T2DM. Further, there is also an inventory of presently used therapeutic tools and a review of novel therapeutic approaches like incretin-based therapies or sodium-glucose transporter-2 inhibitors. Additionally, providing a concise but comprehensive update, this review will be essential to every clinician involved in the treatment of diabetes mellitus.
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Affiliation(s)
- D. Himanshu
- Department of Endocrinology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Wahid Ali
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Mohd Wamique
- Department of Pathology, King George’s Medical University, Lucknow, Uttar Pradesh 226003 India
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Chauhan S, Agarwal J, Jain A, Sawlani KK, Gupta P, Goel A, Verma N, Himanshu D. Status of adult immunity to hepatitis A virus in healthcare workers from a tertiary care hospital in north India. Indian J Med Res 2020; 150:508-511. [PMID: 31939396 PMCID: PMC6977358 DOI: 10.4103/ijmr.ijmr_787_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at −20°C. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV.
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Affiliation(s)
- Sanshriti Chauhan
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jyotsna Agarwal
- Department of Microbiology, Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - K K Sawlani
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Goel
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Verma
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Ozair A, Kumar V, Himanshu D, Bhat V. A rare etiology behind isolated lateral rectus palsy: Scrub typhus. J Family Med Prim Care 2020; 9:2538-2540. [PMID: 32754540 PMCID: PMC7380792 DOI: 10.4103/jfmpc.jfmpc_287_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Received: 02/20/2020] [Revised: 03/14/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
Scrub typhus (ST), a zoonotic disease, is currently being recognized as a significant contributor to the changing landscape of infectious diseases in India. As one of the important causes of febrile illness, in many parts of the country, general practitioners need to include it as part of the workup for cases of fever of unknown origin. While very amenable to early treatment with a simple regime of doxycycline, delayed diagnosis can result in a spectrum of complications. We report here one such complication of a case of ST manifesting with isolated lateral rectus palsy, which, to the best of our knowledge, has been reported only thrice in the world previously. Family physicians also need to be aware of the availability in India of affordable serological testing for ST that is useful for rapid and inexpensive diagnosis, leading to timely treatment.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D. Himanshu
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Bhat
- Faculty of Medicine, St. John's Medical College, Bengaluru, Karnataka, India
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Sawlani KK, Kaleem N, Chaudhary SC, Himanshu D, Usman K, Atam V. Ambulatory Blood Pressure Monitoring in Chronic Obstructive Pulmonary Disease Patients. J Assoc Physicians India 2020; 68:36-39. [PMID: 32138481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is now considered as multisystem disorder with high cardiovascular mortality. The study was carried out with an objective to observe the pattern and variation of blood pressure (BP) using ambulatory blood pressure monitoring (ABPM) in COPD patients. METHODS Thirty six cases of COPD diagnosed by spirometry underwent ABPM for blood pressure evaluation. Thirty controls without COPD underwent spirometry and ABPM. Analysis were carried out both during wakefulness and sleep. RESULTS Out of 36 COPD cases 25 were found to be hypertensive on ABPM, while 2 out of 30 controls were found to be hypertensive on ABPM. A significant difference was found between blood pressure levels during the wakefulness, sleep, and 24-hour BP amongst COPD cases and controls. Higher blood pressure levels were observed in COPD patients then in control, except for diastolic levels during wakefulness. The normal nocturnal dip was attenuated in COPD patients whereas physiological dip was present in controls. CONCLUSION COPD patients had higher blood pressure levels than the control group and had abnormal dipping pattern of blood pressure which may lead to high cardiovascular mortality in patients of COPD.
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Affiliation(s)
| | | | | | - D Himanshu
- Associate Professor, Kgmu, Lucknow, Uttar Pradesh
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Natarajan V, Moar P, Kaur US, Venkatesh V, Kumar A, Chaturvedi R, Himanshu D, Tandon R. Helicobacter pylori Reactivates Human Immunodeficiency Virus-1 in Latently Infected Monocytes with Increased Expression of IL-1β and CXCL8. Curr Genomics 2020; 20:556-568. [PMID: 32581644 PMCID: PMC7290055 DOI: 10.2174/1389202921666191226091138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/08/2019] [Accepted: 12/08/2019] [Indexed: 12/13/2022] Open
Abstract
Background Helicobacter pylori are gram-negative bacteria, which colonize the human stomach. More than 50% of the world's population is infected by H. pylori. Based on the high prevalence of H. pylori, it is very likely that HIV and H. pylori infection may coexist. However, the molecular events that occur during HIV-H. pylori co-infection remain unclear. Latent HIV reservoirs are the major obstacle in HIV cure despite effective therapy. Here, we explored the effect of H. pylori stimulation on latently HIV-infected monocytic cell line U1. Methods High throughput RNA-Seq using Illumina platform was performed to analyse the change in transcriptome between unstimulated and H. pylori-stimulated latently HIV-infected U1 cells. Transcriptome analysis identified potential genes and pathways involved in the reversal of HIV latency using bioinformatic tools that were validated by real-time PCR. Results H. pylori stimulation increased the expression of HIV-1 Gag, both at transcription (p<0.001) and protein level. H. pylori stimulation also increased the expression of proinflammatory cytokines IL-1β, CXCL8 and CXCL10 (p<0.0001). Heat-killed H. pylori retained their ability to induce HIV transcription. RNA-Seq analysis revealed 197 significantly upregulated and 101 significantly downregulated genes in H. pylori-stimulated U1 cells. IL-1β and CXCL8 were found to be significantly upregulated using transcriptome analysis, which was consistent with real-time PCR data. Conclusion H. pylori reactivate HIV-1 in latently infected monocytes with the upregulation of IL-1β and CXCL8, which are prominent cytokines involved in the majority of inflammatory pathways. Our results warrant future in vivo studies elucidating the effect of H. pylori in HIV latency and pathogenesis.
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Affiliation(s)
- Vidhya Natarajan
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Preeti Moar
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Urvinder S Kaur
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Vimala Venkatesh
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Abhishek Kumar
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Rupesh Chaturvedi
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - D Himanshu
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
| | - Ravi Tandon
- 1Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 2Department of Microbiology, King Georges Medical University, Lucknow, India; 3Institute of Bioinformatics, International Technology Park, Bangaluru, 560066, India; 4Manipal Academy of Higher Education (MAHE), Manipal576104, Karnataka, India; 5Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; 6Department of Medicine, King Georges Medical University, Lucknow, India
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Kallani M, Mishra A, Himanshu D. Glycemic Gap as a Prognostic Marker for Critically Ill Patients in ICU. J Assoc Physicians India 2020; 68:51. [PMID: 31979572] [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: 06/10/2023]
Affiliation(s)
- M Kallani
- King George Medical College, Lucknow
| | - A Mishra
- King George Medical College, Lucknow
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21
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Majumdar A, Atam V, Himanshu D. Correlation of Stress Hyperglycemia with Clinical Outcome in Acute Stroke Patients in a Tertiary Care Centre of North India. J Assoc Physicians India 2020; 68:60. [PMID: 31979647] [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: 06/10/2023]
Affiliation(s)
| | | | - D Himanshu
- King George's Medical University, Lucknow
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Mishra M, Himanshu D, Sawlani KK. Role of CSF-LDH and Serum LDH Levels to Diff erentiate between Diff erent Types of Meningitis. J Assoc Physicians India 2020; 68:61. [PMID: 31979648] [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: 06/10/2023]
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Shivhare S, Sawlani KK, Atam V, Usman K, Chaudhary SC, Himanshu D. A Study of 24 hours Ambulatory Blood Pressure Among Resident Doctors Working at a Tertiary Care Hospital in Northern India. J Assoc Physicians India 2020; 68:57. [PMID: 31979623] [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: 06/10/2023]
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Kumar G, Atam V, Gupta K, Kumar V, Jain A, Himanshu D. Prognostic Markers in Acute liver failure. J Assoc Physicians India 2020; 68:97. [PMID: 31979907] [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: 06/10/2023]
Affiliation(s)
| | - V Atam
- King George Medical University
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Roy P, Chandra M, Mishra A, Verma V, Sawlani KK, Singh HP, Kumar S, Saxena S, Singh AB, Pandey S, Usman K, Kumar P, Himanshu D. Otological and Visual Implications of Diabetes Mellitus in North Indian Population. Indian J Otolaryngol Head Neck Surg 2019; 71:1639-1651. [PMID: 31750230 PMCID: PMC6841803 DOI: 10.1007/s12070-019-01705-y] [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: 01/17/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
Abstract
The worldwide population of diabetic patients is increasing alarmingly with India claiming number one position. It causes irreversible damage to cochlear hair cells, vestibular apparatus, visual pathway, nephrons, nerves, if not checked in time. A total of 188 patients of diabetes mellitus were included in this prospective study. The patients underwent routine anamnesis, hearing handicap inventory and dizziness handicap inventory assessment along with clinical examination for audiological, vestibular, neurological and ophthalmological (fundoscopy) status. In our study a sensorineural hearing loss, retinopathy, neuropathy, vestibulopathy was seen in diabetic patients.
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Affiliation(s)
- Prateek Roy
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | - Manish Chandra
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | - Anupam Mishra
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | | | | | - H. P. Singh
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | - Sunil Kumar
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | | | - A. B. Singh
- Department of ENT Head Neck Surgery, KGMU, Lucknow, India
| | | | | | - Pramod Kumar
- Department of Ophthalmology, KGMU, Lucknow, India
| | - D. Himanshu
- Department of Medicine, KGMU, Lucknow, India
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Singh A, Kumar S, Himanshu D, Sethi R, Pradhan A. Clinico-Epidemiological Study of Pericardial Effusion in Northern India. Indian J Community Health 2019. [DOI: 10.47203/ijch.2019.v31i03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Pericardial effusions may be discovered incidentally or as life-threatening scenario of cardiac tamponade. Hence, etiological identification of pericardial effusion proves crucial in-patient management. Aim: To assess the clinical presentation and etiology of pericardial effusion at a tertiary-care centre in India. Methods: This was a retrospective, observational, single-centre one-year hospital-based study. Data from 70 diagnosed cases of pericardial effusion from our tertiary-care centre in India from August 2016 to July 2017 was retrospectively reviewed. A diagnosis of pericardial effusion was confirmed based on findings from clinical history, examination, specific laboratory investigations, and radiological investigations. Pericardial fluid analysis was also performed. Results: The mean age of the patients was 46.87±14.40 years. Almost equal frequencies of men 36 (51.4%) and women 34 (48.6%) were observed. The most commonly observed signs/symptoms of patients diagnosed with pericardial effusion was raised jugular venous pulse in 39 (55.7%) patients, breathlessness in 36 (51.4%) patients, and tachypnea and tachycardia (heart rate >100 beats per minute) in 33 (47.1%) patients each. An etiology of tubercular effusion was common in 32 (44.4%) patients. On analyzing data according to the underlying etiology, the most frequent sign/symptom was raised jugular venous pulse in 20 (62.5%) patients diagnosed with tubercular effusion, tachypnea in 10 (52.6%) patients diagnosed with hypothyroidism and tachycardia in 12 (63.2%) patients with a diagnosis other than pericardial effusion or hypothyroidism. Conclusions: The high prevalence of tuberculosis in India warrants increased control and awareness of this infection.
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Kaur US, Shet A, Rajnala N, Gopalan BP, Moar P, D H, Singh BP, Chaturvedi R, Tandon R. High Abundance of genus Prevotella in the gut of perinatally HIV-infected children is associated with IP-10 levels despite therapy. Sci Rep 2018; 8:17679. [PMID: 30518941 PMCID: PMC6281660 DOI: 10.1038/s41598-018-35877-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 11/12/2018] [Indexed: 12/11/2022] Open
Abstract
Perinatal HIV infection is characterized by faster HIV disease progression and higher initial rate of HIV replication compared to adults. While antiretroviral therapy (ART) has greatly reduced HIV replication to undetectable levels, there is persistent elevated inflammation associated with HIV disease progression. Alteration of gut microbiota is associated with increased inflammation in chronic adult HIV infection. Here, we aim to study the gut microbiome and its role in inflammation in treated and untreated HIV-infected children. Examination of fecal microbiota revealed that perinatally infected children living with HIV had significantly higher levels of genus Prevotella that persisted despite ART. These children also had higher levels of soluble CD14 (sCD14), a marker of microbial translocation, and IP-10 despite therapy. The Prevotella positively correlated with IP-10 levels in both treated and untreated HIV-infected children, while genus Prevotella and species Prevotella copri was inversely associated with CD4 count. Relative abundance of genus Prevotella and species Prevotella copri showed positive correlation with sCD14 in ART-suppressed perinatally HIV-infected children. Our study suggests that gut microbiota may serve as one of the driving forces behind the persistent inflammation in children despite ART. Reshaping of microbiota using probiotics may be recommended as an adjunctive therapy along with ART.
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Affiliation(s)
- Urvinder S Kaur
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins School of Public Health, Baltimore, USA
| | - Niharika Rajnala
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of health Sciences, Bangalore, India
| | - Bindu Parachalil Gopalan
- Division of Infectious Diseases, St. John's Research Institute, St. John's National Academy of health Sciences, Bangalore, India
| | - Preeti Moar
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Himanshu D
- Department of Medicine, King Georges Medical University, Lucknow, India
| | | | - Rupesh Chaturvedi
- Host Pathogen Interaction Laboratory, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India
| | - Ravi Tandon
- Laboratory of AIDS Research and Immunology, School of Biotechnology, Jawaharlal Nehru University, New Delhi, India.
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Balhara YPS, Kalra S, Bajaj S, Kuppili PP, Himanshu D, Atam V, Usman K, Singh V, Usman K, Singh V, Chaudhary SC, Chakravorty S, Wakhlu A, Fatma J, Tandon S, Maheshwari A, Gupta A, Parvez A, Chakravarty J, Chaudhary RR, Singh AK, Sawlani KK, Mathur M, Soni NK, Gupta OK, Gupta M, Agarwal S. Uttar Pradesh Association of Physicians of India Position Statement: Betel Quid (Paan) and Diabetes. J Assoc Physicians India 2018; 66:11-12. [PMID: 31315339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Betel quid (paan) chewing is common in India, especially in Uttar Pradesh. Betel quid has multifaceted relationship with health, including metabolic and psychosocial health. The current recommendations have been released keeping in view the public health and clinical importance of this addictive behavior. The objective of this document is to offer clinical guidance for screening, diagnosis and management of co-occurring betel quid chewing among persons with Diabetes Mellitus (DM). The document aims to provide education and guidance to clinicians engaged in care and management of persons with DM, and improve access to treatment for co-occurring betel quid chewing among persons with DM. The current recommendation grades are based on published evidence, and categorized as strong, intermediate, weak and no evidence. The strength of these recommendations is based on the level of evidence.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Associate Professor of Psychiatry, National Drug Dependence Treatment Center and Department of Psychiatry, AIIMS, Delhi
| | - Sanjay Kalra
- Consultant, Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana
| | - Sarita Bajaj
- Consultant Endocrinologist, Director-Professor and Head, Dept of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - D Himanshu
- Senior Resident, Department of Psychiatry, JIPMER, Puducherry
| | - Veerendra Atam
- Professor and Head, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Singh
- Professor and Head, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Singh
- Professor and Head, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | | | - S Chakravorty
- Additional Professor, Dept of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Anupam Wakhlu
- Sr. Consultant Physician and Unit Head, Department of Internal Medicine, Diabetology and Critical Care, Metro Multispeciality Hospital, Noida, Uttar Pradesh
| | - Jalees Fatma
- Professor, Department of Rheumatology, KGMU, Lucknow, Uttar Pradesh
| | - Sanjay Tandon
- Professor and Head, Depatment of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh
| | - Anuj Maheshwari
- Diabetologist and Metabolic Physician, Professor and Head in Internal Medicine, BBDCODS, BBD University, Lucknow, Uttar Pradesh
| | - Abha Gupta
- Consultant Physician, Former Associate Prof and Head, Dept. of Medicine, AIODS, Lucknow, Uttar Pradesh
| | - Anjum Parvez
- Professor, Dept. of Medicine, LLRM Medical College, Meerut, Uttar Pradesh
| | - Jaya Chakravarty
- Professor, Dept. of Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh
| | - R R Chaudhary
- Professor, Dept of Medicine, IMS, BHU, Varanasi, Uttar Pradesh
| | - A K Singh
- Senior Consultant Physician & Geriatrician, S.S.P.G Divisional District Hospital, Varanasi, Uttar Pradesh
| | - K K Sawlani
- Associate Professor, Department of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Manoj Mathur
- Senior Consultant Physician and Geriatrician, S.S.P.G. Divisional District Hospital, Varanasi, Uttar Pradesh
| | - N K Soni
- Associate Professor, Dept. of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - Madhukar Gupta
- Sr. Consultant and Clinical Hematologist, Metro Heart and Research Institute, Noida, Uttar Pradesh
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Chaudhary SC, Kumari T, Usman K, Sawlani KK, Himanshu D, Gupta KK, Patel ML, Agarwal A, Verma AK. Study of Pulmonary Function Test Abnormalities in Metabolic Syndrome. J Assoc Physicians India 2018; 66:27-30. [PMID: 31317703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Metabolic Syndrome (MetS) is defined as a constellation of an interconnected physiological, biochemical, clinical, and metabolic factors that directly increases the risk of atherosclerotic cardiovascular disease and T2DM. Although the link between impaired lung function and cardiovascular events and T2DM has been recognized, the association between impaired lung function and MetS has not been comprehensively assessed. MATERIAL AND METHODS A cross sectional prevalence study was done in tertiary care hospital in northern India on 100 patients of the age between 25-65 years who fulfilled the IDF criteria for MetS to evaluate pulmonary function test (Spirometry) abnormalities. RESULTS Maximum number of patients were in 31-40 years of age group (45%) followed by those aged 41-50 year (26%), < 30 years (15%), >50 years (14%). Mean age of patients was 39.59±8.67 year. In this cross-sectional study, patients with Metabolic Syndrome showed significantly lower FVC % predicted (P< 0.001), FEV1 % predicted (P< 0.001) as compared to the group without Metabolic Syndrome. There was a strong linear decrease in FVC and FEV1 % predicted as the number of components of MetS increases. We observed that 28% of the male and 46.6% of female patients showed restrictive ventilatory pattern and 7% of male and 13.4% of female patients showed mixed pattern. CONCLUSION All MetS components were associated with pulmonary function impairment. As the number of MetS components increases, patients had more severe decline in pulmonary functions.
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Affiliation(s)
- Shyam Chand Chaudhary
- Professor, Department of Medicine,K.G.M.U., Lucknow, Uttar Pradesh; * Corresponding Author
| | - Tulika Kumari
- Junior Resident, Department of Medicine, Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor,Department of Respiratory Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - Kamal Kumar Sawlani
- Associate Professor, Department of Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - D Himanshu
- Professor, Department of Critical Care Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - Kamlesh Kumar Gupta
- Associate Professor, Department of Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - Munna Lal Patel
- Associate Professor, Department of Medicine,K.G.M.U., Lucknow, Uttar Pradesh
| | - Avinash Agarwal
- Professor, Department of Critical Care Medicine, K.G.M.U., Lucknow, Uttar Pradesh
| | - Ajay Kumar Verma
- Assistant Professor, Department of Respiratory Medicine, K.G.M.U., Lucknow, Uttar Pradesh
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Balhara YPS, Kalra S, Bajaj S, Kuppili PP, Himanshu D, Atam V, Usman K, Singh V, Chaudhary SC, Chakravorty S, Wakhlu A, Fatma J, Tandon S, Maheshwari A, Gupta A, Parvez A, Chakravarty J, Chaudhary RR, Singh AK, Sawlani KK, Mathur M, Soni NK, Gupta OK, Rai M, Agarwal S. Uttar Pradesh Association of Physicians of India Position Statement: Tobacco Use and Metabolic Syndrome. J Assoc Physicians India 2017; 65:66-72. [PMID: 29327524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Tobacco use is one of the main preventable causes of mortality and morbidity worldwide. The global disease burden due to tobacco use is huge with projected mortality of eight million lives per year by 2030. Metabolic syndrome (MS) is defined as a constellation of cardiovascular and endocrine risk factors such as insulin resistance, obesity, raised blood pressure, and abnormal lipid profile. The relationship between tobacco use and MS has been well established. Also, the causal association between tobacco use and development of individual components of MS is well established. The Uttar Pradesh Association of Physicians of India (UP API) has drafted this position statement on managing tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). This position statement presents evidence-based recommendations as described below. Scope and purpose The objective of this position statement is to offer clinical recommendations for screening, diagnosis and management of tobacco use among persons with or at risk of developing Metabolic Syndrome (MS). The purpose of this document is to aid in identification and treatment of maladaptive patterns of tobacco use i.e. tobacco use disorder (tobacco dependence, harmful use, abuse) in person with or at risk of developing MS. Intended Audience The position statement is targeted at the clinicians engaged in care and management of person with or at risk of developing Metabolic Syndrome (MS). This might also be of relevance to the policy makers considering the public health burden of both MS and tobacco use disorders.
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Affiliation(s)
- Yatan Pal Singh Balhara
- Associate Professor of Psychiatry, National Drug Dependence Treatment Center and Department of Psychiatry, AIIMS, Delhi
| | - Sanjay Kalra
- Consultant, Department of Endocrinology, Bharti Hospital & BRIDE, Karnal, Haryana
| | - Sarita Bajaj
- Consultant Endocrinologist, Director-Professor and Head, Dept of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | | | - D Himanshu
- Associate Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Veerendra Atam
- Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Kauser Usman
- Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | | | | | - S Chakravorty
- Sr. Consultant Physician & Unit Head, Department of Internal Medicine, Diabetology & Critical Care, Metro Multispeciality Hospital, Noida, Uttar Pradesh
| | - Anupam Wakhlu
- Professor, Department of Rheumatology, KGMU, Lucknow, Uttar Pradesh
| | - Jalees Fatma
- Professor and Head, Depatment of Medicine, Era's Lucknow Medical College, Lucknow, Uttar Pradesh
| | - Sanjay Tandon
- Consultant Physician, Former Associate Prof and Head, Dept. of Medicine, AIODS, Lucknow, Uttar Pradesh
| | - Anuj Maheshwari
- Diabetologist & Metabolic Physician, Professor & Head in Internal Medicine, BBDCODS, BBD University, Lucknow, Uttar Pradesh
| | - Abha Gupta
- Professor, Dept. of Medicine, LLRM Medical College, Meerut, Uttar Pradesh
| | - Anjum Parvez
- Professor, Dept. of Medicine, JN Medical College, AMU, Aligarh, Uttar Pradesh
| | | | - R R Chaudhary
- Professor and Head, Dept of Medicine, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh
| | - A K Singh
- Senior Consultant Physician & Geriatrician, S.S.P.G. Divisional District Hospital, Varanasi, Uttar Pradesh
| | - K K Sawlani
- Associate Professor, Dept. of Medicine, KGMU, Lucknow, Uttar Pradesh
| | - Manoj Mathur
- Associate Professor, Dept. of Medicine, MLN Medical College, Allahabad, Uttar Pradesh
| | - N K Soni
- Consultant Physician, Ghaziabad, Uttar Pradesh
| | - Om Kumari Gupta
- Sr. Consultant and Clinical Hematologist, Metro Heart and Research Institute, Noida, Uttar Pradesh
| | - Madhukar Rai
- Professor, Dept of Medicine, IMS, BHU, Varanasi, Uttar Pradesh
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Singh J, Dinkar A, Atam V, Himanshu D, Gupta KK, Usman K, Misra R. Awareness and Outcome of Changing Trends in Clinical Profile of Dengue Fever: A Retrospective Analysis of Dengue Epidemic from January to December 2014 at a Tertiary Care Hospital. J Assoc Physicians India 2017; 65:42-46. [PMID: 28598047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Dengue fever is caused by mosquito-borne arboviral infection that has become a public health concern globally. Recently, an alarming rise of dengue has also been seen in India. Hence the study was undertaken to know profile of clinical manifestations and laboratory findings during the evolution of dengue fever. METHODS In this study, retrospective data analysis was done in 216 seropositive dengue patients admitted between January to December 2014 in department of medicine at a north Indian care hospital. The tests analyzed were blood counts, serum electrolytes, liver function tests, kidney function tests, chest x-ray and other relevant investigations. RESULTS Males were commonly affected and the most exposed age group was found to be18-35 years. The seropositive case rate for dengue was 56% for NS1 antigen and 36% for IgM. There was rural dominancy of cases with a peak in September. Fever was the most common clinical feature followed by headache, myalgia, backache, nausea and abdominal pain. Petechia was most common haemorrhagic manifestation. Common laboratory findings included 89.35% decreased Platelet counts (<100 000/cmm), 67.59% increased hematocrit (>45%) and 58.33% deranged liver function test. There was no reported mortality in dengue. CONCLUSIONS From prompt and proper treatment could prevent deaths in moderate and severe dengue. Atypical presentations of dengue should be kept in mind so as not to miss the cases. Increased community awareness and vector control measures need to be strengthened during peri-monsoon period to reduce burden of dengue cases.
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Affiliation(s)
| | - Anju Dinkar
- Assistant Professor, Department of Microbiology, Institute of Medical Science, BHU, Varanasi, Uttar Pradesh
| | | | | | | | | | - Ravi Misra
- Professor and Head, Department of Medicine, King George Medical University, Lucknow, Uttar Pradesh
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Himanshu D, Sawlani KK, Deep Chandh Raja S, Verma SP, Jain N, Chaudhary SC. Role of Aggressive Management on Outcome in Patients of Acute Aluminium Phosphide Poisoning. Toxicol Int 2017. [DOI: 10.22506/ti/2017/v24/i1/149030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Agrawal KK, Rao J, Anwar M, Singh K, Himanshu D. Flapless vs flapped implant insertion in patients with controlled type 2 diabetes subjected to delayed loading: 1-year follow-up results from a randomised controlled trial. Eur J Oral Implantol 2017; 10:403-413. [PMID: 29234747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To compare the outcome of dental implants placed following full-thickness flap surgery with flapless surgery in controlled type 2 diabetic patients. MATERIALS AND METHODS A total of 92 controlled type 2 diabetic patients, who needed missing mandibular first molars to be replaced by implants, were selected for a single-centre, parallel group, double-blinded randomised controlled trial. Patients were randomly allocated into two groups: flap (46 patients) vs flapless (46 patients) implant placement. Implants were loaded with metal-ceramic crowns, 4 months after placement in both groups. OUTCOME MEASURES Implant and crown success, complications, post-operative pain and swelling, plaque index, sulcular bleeding index, pocket depth and HbA1c level. Follow up examinations were made after 24 h, and on the third and seventh days for soft tissue healing, pain and swelling evaluation; then at 6 months and 12 months (after loading) for dental plaque, sulcular bleeding, pocket depth, and HbA1c level evaluation. RESULTS After 16 months of implant placement, no dropouts occurred. Five implants failed, two in the flap group and three in the flapless group (4.34% vs 6.52%, McNemar test P = 1, difference = 0.4457, 95% CI of difference = 4.554 to 47.234). Seven prosthesis failures occurred, three in the flap group and four in the flapless group (McNemar test P = 1; difference = 0.4239; 95% CI of difference = 29.95 to 3.86). Two patients in each group were affected by complications. There were statistically insignificant differences in the incidence of complications between the groups (McNemar test P = 1; difference = 0.457; 95% CI of difference = 90.75 to 5.33). After 24 h, the flapped group patients showed significantly greater pain compared with the flapless group (24 h: P = 0.017, difference = 0.37 and 95% CI = 0.673 to -0.067). After the third and seventh postoperative days, the mean pain level in both groups decreased linearly after the treatments (third day: P = 0.183, difference = 0.19 and 95% CI = -0.472 to 0.092; seventh day: P = 0.225, difference = 0.09 and 95% CI = -0.237 to 0.056). The frequency of post-operative swelling "some + a lot" at the third day was significantly higher in the full thickness flap group compared with the flapless group (P = 0.002, difference = 0.1835 and 95% CI = -0.0409 to 0.4079). Most of the cases in either of the study groups demonstrated no swelling (P =1.00, difference = 0.00 and 95% CI = -0.3034 to 0.3034) on the seventh post-operative day. The mean plaque index (6 months: 1.00 ± 0.47 vs 0.83 ± 0.79, P = 0.230, difference = 0.17 and 95% CI = -0.450 to 0.110 and 12 months: 1.30 ± 0.67 vs 1.04 ± 0.86, P = 0.123, difference = 0.26 and 95% CI = 0.593 to 0.073), mean sulcular bleeding index (6 months: 1.40 ± 0.52 vs 1.04 ± 0.83, P = 0.018, difference = 0.36 and 95% CI = 0.658 to 0.062 and 12 months: 1.90 ± 0.48 vs 1.17 ± 0.57, P = < 0.001, difference = -0.73 and 95% CI = -0.958 to -0.503) and pocket depth (6 months: 1.30 ± 0.26 vs 1.17 ± 0.25, P = 0.021, difference = -0.13 and 95% CI = - 0.240 to- 0.012 and 12 months: 1.95 ± 0.28 vs 1.56 ± 0.17, P = < 0.001, difference = -0.39 and 95% CI = -0.490 to -0.290) in both groups increased after the treatment and the increase was evident higher in full thickness flap group than flapless group. CONCLUSIONS On the basis of these results, it was concluded that flapless surgical technique could be considered for dental implant placement in type 2 diabetic patients to reduce post-operative pain and swelling.
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Yadav R, Agrawal KK, Rao J, Anwar M, Alvi HA, Singh K, Himanshu D. Crestal Bone Loss under Delayed Loading of Full Thickness Versus Flapless Surgically Placed Dental Implants in Controlled Type 2 Diabetic Patients: A Parallel Group Randomized Clinical Trial. J Prosthodont 2016; 27:611-617. [PMID: 27731955 DOI: 10.1111/jopr.12549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare crestal bone loss around dental implants using a delayed loading protocol. Bone loss was compared in patients following conventional full thickness flap and flapless surgery in controlled type 2 diabetic patients. MATERIALS AND METHODS Eighty-eight type 2 diabetic patients satisfying predetermined inclusion and exclusion criteria were selected for this single center, parallel group study after obtaining institutional review board approval and informed consent. These patients were randomly divided into two groups. Group I consisted of patients undergoing full thickness flap surgery for implant placement, and group II consisted of patients undergoing flapless surgery for implant placement. The mean age, duration of diabetes, glycosylated hemoglobin levels, and male-to-female ratio in both groups were matched and compared statistically. Dental implants were placed followed by delayed loading (4 months) in both groups. Crestal bone loss was assessed with intraoral periapical radiographs with the help of computer software (DBSWIN viewer). Actual implant length acted as the radiographic index, and implant-abutment junctions were used as a reference point for all measurements. Mesial and distal bone levels at baseline, 6, and 12 months post implant placement of the two groups were determined. Mesial and distal crestal bone loss from baseline to 6 and 12 months were calculated and compared with Tukey test using SPSS v15.0 statistical analysis software. RESULTS Tukey test revealed similar (not statistically different) mean mesial crestal bone loss between the two groups after 6 months (0.47 ± 0.08 mm vs. 0.36 ± 0.13 mm, p = 0.576) and after 12 months (1.56 ± 0.25 mm vs. 1.50 ± 0.22 mm, p = 0.891). The mean distal bone loss resulting between the two groups was not statistically different at 6 months (0.44 ± 0.08 mm vs. 0.35 ± 0.12 mm, p = 0.687) and at 12 months (1.57 ± 0.23 mm vs. 1.61 ± 0.22 mm, p = 0.947). CONCLUSIONS The results of this clinical randomized control trial indicated that in controlled type 2 diabetic patients, levels of crestal bone loss around dental implants placed following conventional full thickness flap surgery was comparable to crestal bone loss around dental implants placed with the flapless surgical technique. More clinical studies are required regarding controlled type 2 diabetics with larger sample sizes, for long time periods to obtain more predictable results.
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Affiliation(s)
- Rohit Yadav
- Department of Prosthodontics, King George's Medical University, Lucknow, India
| | | | - Jitendra Rao
- Department of Prosthodontics, King George's Medical University, Lucknow, India
| | - Mohd Anwar
- Department of Prosthodontics, King George's Medical University, Lucknow, India
| | - Habib Ahmed Alvi
- Department of Prosthodontics, King George's Medical University, Lucknow, India
| | - Kalpana Singh
- Department of Biochemistry, King George's Medical University, Lucknow, India
| | - D Himanshu
- Department of Medicine, King George's Medical University, Lucknow, India
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Chaudhary SC, Nanda S, Tripathi A, Sawlani KK, Gupta KK, Himanshu D, Verma AK. Prevalence of psychiatric comorbidities in chronic obstructive pulmonary disease patients. Lung India 2016; 33:174-8. [PMID: 27051106 PMCID: PMC4797437 DOI: 10.4103/0970-2113.177441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD) patients, but there is a paucity of data from India. AIMS AND OBJECTIVES Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. MATERIALS AND METHODS This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University). A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. RESULTS The frequency of psychiatric comorbidities was significantly higher (P < 0.05) in COPD patients (28.4%) as compared to controls (2.7%). As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. CONCLUSION The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any.
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Affiliation(s)
- Shyam Chand Chaudhary
- Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Satyan Nanda
- Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamal Kumar Sawlani
- Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kamlesh Kumar Gupta
- Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - D Himanshu
- Department of General Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajay Kumar Verma
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Khare V, Gupta P, Himanshu D, Kumar D. Emergence of co-trimoxazole resistant Nocardia brasiliensis causing fatal pneumonia. BMJ Case Rep 2013; 2013:bcr-2013-009069. [PMID: 23598938 DOI: 10.1136/bcr-2013-009069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 85-year-old man was admitted to the medical intensive care unit with a 10-day history of severe breathlessness, fever and cough. The patient was known to have chronic obstructive pulmonary disease and had been receiving corticosteroids in the preceding 18 months. He had been treated for tuberculosis 2.5 years previously. On examination he was febrile, tachycardic with a respiratory rate of 46/min. Auscultation revealed bilateral crepitation's and wheeze. Chest radiograph revealed patchy infiltrates on right lung. The patient developed respiratory depression and was mechanically ventilated. His sputum and endotracheal aspirates revealed Nocardia brasiliensis on culture which was found to be co-trimoxazole resistant. Once this became known imipenem was substituted for co-trimoxazole but unfortunately condition of the patient did not improve and he died following a cardiac arrest.
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Affiliation(s)
- Vineeta Khare
- Department of Microbiology, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Jain N, Tripathi A, Vaish A, Verma S, Himanshu D, Gutch M. Can Metabolic Factors be used Prognostically for Short-Term Mortality in HIV-Infected Patients? Ann Med Health Sci Res 2013; 2:124-8. [PMID: 23440104 PMCID: PMC3573505 DOI: 10.4103/2141-9248.105658] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Metabolic abnormalities are common throughout the course of human immunodeficiency virus (HIV) infection and may occur either due to HIV infection or as a result of side effects of antiretroviral therapy. It has been established that dyslipidemia and dysglycemia associated with HIV disease reduce the long-term survival of the patients, but their role for predicting prognosis of short-term mortality in HIV patients is unknown. AIM To study dyslipidemia and dysglycemia as a prognostic indicator for short-term mortality (<3 months) in HIV patients. SUBJECTS AND METHODS An observational, prospective study was conducted at a tertiary care center over a period of 6 months. Consecutive HIV-positive patients hospitalized (both, HIV status known prior to hospitalization and the diagnosis made for the first time at admission) in medical wards from March to May 2010 were studied. All patients had their random blood sugars, fasting blood sugars (if possible), fasting lipid profile, and cluster of differentiation 4 (CD4) counts tested at the time of enrollment. The patients were followed for a period of 3 months, at the end of which they were categorized as survivors and non-survivors, and the demographic, clinical, and investigational parameters were compared between the above groups. Data was analyzed by applying Mann-Whitney U test, two sample t-test, Fisher-Exact test, and stepwise logistic regression analysis of significance, using the computer-based program, Stata, version 11.1. RESULTS A total of 82 patients were enrolled for the study of which 64 (78.05%) were males and 18 (21.95%) were females, with a mean (SD) age of 34.00 (7.0) years. The mean CD4 count was 206.23 (129.5) cells/mm(3). The overall mortality within 3 months was 20.7% (17/82). Mycobacterium tuberculosis as opportunistic infection was found in 42 patients, out of which 13 expired (P=0.02). Patients with low high-density lipoprotein (HDL) and hypertriglyceridemia (adjusted OR = 22.92, P value = 0.03, adjusted OR = 3.4, P value = 0.02, respectively) had high likelihood of mortality within 3 months. CONCLUSIONS Low HDL and hypertriglyceridemia also appear to be promising short-term mortality markers in HIV patients apart from established factors like low CD4 counts, co-morbid conditions, and opportunistic infections like M. tuberculosis infection. This study warrants further studies with a larger sample size to establish HDL and triglyceride as markers of disease progression and short-term mortality in HIV-infection.
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Affiliation(s)
- N Jain
- Department of Internal Medicine, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
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Abstract
Imatinib mesylate is a tyrosine kinase inhibitor used widely as the first-line treatment for chronic myeloid leukaemia (CML). The side-effect profile of this drug includes fluid retention, muscle cramps, diarrhoea, myelosuppression and skin rashes. Of these, rashes of the type maculo-papular eruptions and oedema developed most commonly. The cutaneous adverse reactions other than maculo-papular eruptions are rare with imatinib. Severe and life-threatening cutaneous reactions can occur in 5% cases. Here, the author reports a case of newly diagnosed CML that developed Steven-Johnsons syndrome due to imatinib therapy. Patient responded and discharged successfully on withdrawal of the culminating drug.
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Affiliation(s)
- Praveen Jha
- Department of Internal Medicine, KGMU., Gwalior, Madhya Pradesh, India
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Abstract
Takayasu's arteritis (TA) is a chronic inflammatory disease of medium and large vessels, mainly involving the aorta and its major branches. TA may have diverse clinical presentation including claudication, stroke, asymmetric pulse or blood pressure. However, the association of TA with digital gangrene is a rare entity. Here, we report a case of a 40-year-old woman who presented with digital gangrene of the right hand, which on workup was diagnosed as a case of TA.
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Affiliation(s)
- Sudhir Verma
- Department of Internal Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Chaudhary SC, Gupta A, Himanshu D, Verma SP, Khanna R, Gupta DK. Abdominal angina: an unusual presentation of Takayasu's arteritis. BMJ Case Rep 2011; 2011:bcr.02.2011.3900. [PMID: 22696728 DOI: 10.1136/bcr.02.2011.3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Takayasu's arteritis (TA) is an idiopathic large vessel vasculitis of young adults that affects the aorta and its major branches. The authors hereby present a case of TA that presented with abdominal aorta thrombosis. She was put on low-molecular weight heparin, antiplatelets, corticosteroids, cyclophosphamide along with haematinics and was referred to Department of Cardiothoracic and Vascular Surgery for further management.
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Affiliation(s)
- S C Chaudhary
- Department of Medicine, CSM Medical University, Lucknow, India.
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Verma SP, Himanshu D, Tripathi AK, Vaish AK, Jain N. An atypical case of dengue haemorrhagic fever presenting as quadriparesis due to compressive myelopathy. BMJ Case Rep 2011; 2011:bcr1020103421. [PMID: 22700077 PMCID: PMC3070340 DOI: 10.1136/bcr.10.2010.3421] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dengue haemorrhagic fever is a serious presentation of dengue viral infection. Case reports of cerebral haemorrhage due to dengue are rare. The authors report a rare case of dengue haemorrhagic fever presenting with fever and acute onset progressive quadriparesis of the upper motor neuron type. Rare cases of quadriparesis in dengue fever have been reported in the literature due to myositis, Guillain-Barre syndrome, myelitis and hypokalaemia. This case on investigations was found to have extramedullary compression due to haematoma in the cervical region as the cause of quadriparesis.
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Affiliation(s)
- S P Verma
- Department of Medicine, CSM Medical University, Lucknow, Uttar Pradesh, India.
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Tripathi AK, Verma SP, Himanshu D. Acute psychosis: a presentation of cyanocobalamin deficiency megaloblastic anemia. Indian J Hematol Blood Transfus 2010; 26:99-100. [PMID: 21886392 PMCID: PMC3002096 DOI: 10.1007/s12288-010-0032-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 08/10/2010] [Indexed: 10/18/2022] Open
Abstract
Cyanocobalamin deficiency is not rare in India. Patients present with megaloblastic anemia, pancytopenia and sometimes neuropsychiatric manifestations. Subacute combined degeneration of the cord, peripheral neuropathy, dementia, psychotic depression and paranoid schizophrenia are well reported. We are reporting a case of cyanocobalamine deficiency anemia who presented with acute psychosis which readily reversed on cyanocobalamin replacement.
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Affiliation(s)
- A. K. Tripathi
- Department of Medicine, CSM Medical University, Lucknow, India
| | - S. P. Verma
- Department of Medicine, CSM Medical University, Lucknow, India
| | - D. Himanshu
- Department of Medicine, CSM Medical University, Lucknow, India
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