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Sawhney JP, Ramakrishnan S, Madan K, Ray S, Jayagopal PB, Prabhakaran D, Nair T, Zachariah G, Jain P, Dalal J, Radhakrishnan S, Chopra A, Kalra S, Mehta A, Pancholia AK, Kabra NK, Kahali D, Ghose T, Yadav S, Kerkar P, Yadav A, Roy D, Das MK, Bang VH, Rath PC, Sinha DP, Banerjee PS, Yadav R, Gupta R. CSI clinical practice guidelines for dyslipidemia management: Executive summary. Indian Heart J 2024; 76 Suppl 1:S6-S19. [PMID: 38052658 PMCID: PMC11019331 DOI: 10.1016/j.ihj.2023.11.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Dyslipidemias are the most important coronary artery disease (CAD) risk factor. Proper management of dyslipidemia is crucial to control the epidemic of premature CAD in India. Cardiological Society of India strived to develop consensus-based guidelines for better lipid management for CAD prevention and treatment. The executive summary provides a bird's eye-view of the 'CSI: Clinical Practice Guidelines for Dyslipidemia Management' published in this issue of the Indian Heart Journal. The summary is focused on the busy clinician and encourages evidence-based management of patients and high-risk individuals. The summary has serialized various aspects of lipid management including epidemiology and categorization of CAD risk. The focus is on management of specific dyslipidemias relevant to India-raised low density lipoprotein (LDL) cholesterol, non-high density lipoprotein cholesterol (non-HDL-C), apolipoproteins, triglycerides and lipoprotein(a). Drug therapies for lipid lowering (statins, non-statin drugs and other pharmaceutical agents) and lifestyle management (dietary interventions, physical activity and yoga) are summarized. Management of dyslipidemias in oft-neglected patient phenotypes-the elderly, young and children, and patients with comorbidities-stroke, peripheral arterial disease, kidney failure, posttransplant, HIV (Human immunodeficiency virus), Covid-19 and familial hypercholesterolemia is also presented. This consensus statement is based on major international guidelines (mainly European) and expert opinion of lipid management leaders from India with focus on the dictum: earlier the better, lower the better, longer the better and together the better. These consensus guidelines cannot replace the individual clinician judgement who remains the sole arbiter in management of the patient.
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Affiliation(s)
| | | | | | - Saumitra Ray
- Advanced Medical Research Institute (Dhakuria), Kolkata, West Bengal, India.
| | | | | | - Tiny Nair
- PRS Hospital, Trivandrum, Kerala, India.
| | | | - Peeyush Jain
- Fortis Escorts Heart Institute, New Delhi, India.
| | | | | | | | | | | | | | | | | | - Tapan Ghose
- Fortis Flt Lt Rajan Dhall Hospital, New Delhi, India.
| | | | | | - Ajay Yadav
- Sir Ganga Ram Hospital, New Delhi, India.
| | - Debabrata Roy
- NH- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India.
| | - Mrinal Kanti Das
- B.M. Birla Heart Research Centre and the Calcutta Medical Research Institute (CMRI), Kolkata, India.
| | - Vijay H Bang
- Lilavati Hospital and Research centre, Mumbai, Maharashtra, India.
| | | | | | | | - Rakesh Yadav
- All India Institute of Medical Sciences, Delhi, India.
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India.
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Sawhney JPS, Madan K. Familial hypercholesterolemia. Indian Heart J 2024; 76 Suppl 1:S108-S112. [PMID: 38599725 PMCID: PMC11019323 DOI: 10.1016/j.ihj.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/02/2023] [Indexed: 04/12/2024] Open
Abstract
Familial hypercholesterolemia is a common genetic disorder of autosomal inheritance associated with elevated LDL-cholesterol. It is estimated to affect 1:250 individuals in general population roughly estimated to be 5 million in India. The prevalence of FH is higher in young CAD patients (<55 years in men; <60 years in women). FH is underdiagnosed and undertreated. Screening during childhood and Cascade screening of family members of known FH patients is of utmost importance in order to prevent the burden of CAD. Early identification of FH patients and early initiation of the lifelong lipid lowering therapy is the most effective strategy for managing FH. FH management includes pharmaceutical agents (statins and non statin drugs) and lifestyle modification. Inspite of maximum dose of statin with or without Ezetimibe, if target levels of LDL-C are not achieved, Bempedoic acid, proprotein convertase subtilisin/kexin type 9 (PCSK9) Inhibitors/Inclisiran can be added.
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Affiliation(s)
- J P S Sawhney
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Kushal Madan
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
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Madan K, Sawhney JPS. Exercise and lipids. Indian Heart J 2024; 76 Suppl 1:S73-S74. [PMID: 38599728 PMCID: PMC11019314 DOI: 10.1016/j.ihj.2023.11.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 11/27/2023] [Indexed: 04/12/2024] Open
Abstract
Evidence from the existing literature suggests that exercise has positive effects for prevention and treatment of cardiovascular diseases by reducing risk factors such as elevated blood lipids. Based on clinical and observational clinical trials, it is well established that increased physical activity and regular exercise has a favourable impact on blood lipids and lipoprotein profiles. Exercise training significantly decreases blood triglycerides concentration and increases high density lipoprotein cholesterol levels. Though the Indian data depicting the effect of exercise on lipids is scarce, exercise directly improves "atherogenic dyslipidaemia" which is frequently present among Indians i.e. HDL-C is increased, TG is reduced and LDL-C particle size is improved. While drug therapy is key to the treatment of dyslipidaemia, lifestyle alterations such as exercise should continue to be actively promoted and encouraged by clinicians. Exercise is a low cost, non pharmacological therapeutic lifestyle change that is of value to lipid metabolism and cardiovascular fitness.
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Affiliation(s)
- Kushal Madan
- Dharma Vira Heart Center Sir Ganga Ram Hospital, New Delhi, 110060, India.
| | - J P S Sawhney
- Dharma Vira Heart Center Sir Ganga Ram Hospital, New Delhi, 110060, India.
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Shah B, Kajal S, Bhalla AS, Madan K, Viswanathan GK, Thakar A, Sikka K, Bairwa M, Verma H. Prolonged Itraconazole Therapy as Sole Treatment for Patients with Allergic Fungal Rhinosinusitis. Laryngoscope 2024; 134:545-551. [PMID: 37377280 DOI: 10.1002/lary.30841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Currently, the mainstay of treatment for allergic fungal rhinosinusitis (AFRS) is surgical debridement along with topical or systemic steroids. However, prolonged systemic steroid therapy comes with side effects and is also sometimes contraindicated. Systemic antifungals have been used earlier as an adjunct to steroids or in refractory cases, but they have not been used as the sole primary treatment. OBJECTIVE To study the effectiveness of sole Itraconazole therapy in patients with AFRS by comparison of clinical, radiological, and biochemical parameters before and after treatment. METHODS Thirty-four patients diagnosed with localized sino-nasal AFRS were recruited and started on the tablet Itraconazole 200 mg orally twice daily for 3 months with q2weekly monitoring of liver function tests. The baseline clinical, radiological, and biochemical parameters were then compared with those after completion of 3 months of Itraconazole therapy. RESULTS There was significant difference between all the parameters-clinical: SNOT-22 score (p < 0.001) and Meltzer endoscopy score (p < 0.001), radiological: Lund-Mackay score (p = 0.004) and 20-point CT score (p = 0.002), and biochemical: serum total IgE (p < 0.001), Aspergillus-specific IgE (p < 0.001), and absolute eosinophil count (p < 0.001). The clearance of the disease was more in anterior sinuses than the posterior ones. CONCLUSION Prolonged Itraconazole can be given as sole therapy in AFRS, especially in patients for whom steroids are contraindicated or in those who are awaiting surgery. It can result in symptomatic and radiological improvement, but surgery still remains the definitive treatment option for AFRS for complete clearance of disease. LEVEL OF EVIDENCE 3 Laryngoscope, 134:545-551, 2024.
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Affiliation(s)
- B Shah
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Kajal
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - A S Bhalla
- Department of Radiodiagnosis, AIIMS, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, AIIMS, New Delhi, India
| | - G K Viswanathan
- Department of Haematology and Oncology, AIIMS, New Delhi, India
| | - A Thakar
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - K Sikka
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M Bairwa
- Department of Community Medicine, AIIMS, New Delhi, India
| | - H Verma
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Mishra PP, Madan K, Biswas S, Kini Rao AC. Fibroblastic reticular cell tumor of eyelid: Rare case report and review of literature. INDIAN J PATHOL MICR 2024; 67:166-168. [PMID: 38358212 DOI: 10.4103/ijpm.ijpm_908_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Fibroblastic reticular cell tumours (FRCT) originate from the fibroblastic reticular cells (FBRC) which are histiocytic cells, belonging to the dendritic cell family. These tumours are extremely rare, with only a few cases reported in literature. Histomorphologically, they resemble follicular dendritic cell sarcoma (FDCS); however, they differ immunophenotypically. Extranodal presentations are rare. We report a case of malignant FBRC tumour of the left eyelid, in a 23-year-old woman, who had presented with a recurrent swelling over left lower eyelid. Microscopy revealed an ill circumbscribed tumour composed of oval to spindle cells in storiform pattern, sprinkled with lymphocytes. Immunohistochemistry was performed and diagnosis of FRCT was offered. To the best of our knowledge, this is the first report of malignant FBRC tumour arising in the eyelid region. Here we present this extremely rare case with review of the available literature.
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Affiliation(s)
- Pragnya P Mishra
- Department of Oncopathology, Yenepoya Medical College, Mangalore, Karnataka, India
| | - K Madan
- Department of Oncopathology, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Siddhartha Biswas
- Department of Oncopathology, Yenepoya Medical College, Mangalore, Karnataka, India
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Yadav R, Nagori A, Madan K, Lodha R, Kabra SK. Short-term exposure to air pollution and emergency room visits for acute respiratory symptoms among adults. Int J Tuberc Lung Dis 2023; 27:761-765. [PMID: 37749844 PMCID: PMC10519391 DOI: 10.5588/ijtld.23.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/11/2023] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE: To examine the short-term effect of ambient air pollution on daily acute respiratory emergency room visits among adults.METHODS: A time-series study (June 2017-February 2019) was carried out among adults (≥18 years) visiting a multi-specialty hospital in Delhi. We evaluated the association between the daily levels of particulate matter (PM) <2.5 μm in diameter (PM2.5) and PM <10 μm in diameter (PM10), ozone (O₃), nitrogen dioxide (NO₂), carbon monoxide (CO) and sulphur dioxide and daily count of emergency room (ER) visits for acute respiratory symptoms. Generalised additive model (GAM) was used with the Poisson link function to analyse the associations for 0-1 to 0-7 lag days.RESULTS: A total of 69,400 ER visits were recorded, of which 2,669 were by adults due to acute respiratory symptoms. At 0-7 lag days, an increment of 1 standard deviation in NO₂ and PM2.5 concentration was associated with a percentage increase in acute respiratory ER visits of respectively 53.0% (95% CI 30.84-78.97) and 19.5% (95% CI 4.53-36.65). During 0-7 lag days, a positive trend was observed at higher concentrations of CO (>1.86-3.28 mg/m³), while a negative significant association was observed at low concentrations of CO (<1.171 mg/m³).CONCLUSION: Short-term exposure to ambient NO2 and PM2.5 was associated with acute respiratory emergency visits of adults at lag 0-7 days.
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Affiliation(s)
- R. Yadav
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - A. Nagori
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, New Delhi
- Academy of Scientific and Innovative Research, Ghaziabad
| | - K. Madan
- Department of Pulmonary Critical Care and Sleep Disorders, AIIMS, New Delhi, India
| | - R. Lodha
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi
| | - S. K. Kabra
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi
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Gamit P, Saikia J, Malik P, Kumar S, Jain D, Madan K, Bharati S, Deo S, Kumar S. PP01.23 Outcomes of Stage IIIA Disease in NSCLC, Treated with Surgery - A Single Institution Experience. J Thorac Oncol 2023. [DOI: 10.1016/j.jtho.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sryma PB, Mittal S, Madan NK, Tiwari P, Hadda V, Mohan A, Guleria R, Madan K. Efficacy of Radial Endobronchial Ultrasound (R-EBUS) guided transbronchial cryobiopsy for peripheral pulmonary lesions (PPL...s): A systematic review and meta-analysis. Pulmonology 2023; 29:50-64. [PMID: 33441246 DOI: 10.1016/j.pulmoe.2020.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/16/2020] [Accepted: 12/16/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is frequently described for the diagnosis of diffuse parenchymal lung diseases (DPLD). A few studies have reported transbronchial cryobiopsy for the diagnosis of peripheral pulmonary lesions (PPL...s). We aimed to study the utility and safety of transbronchial cryobiopsy for the diagnosis of PPL...s. METHODS We performed a systematic search of the PubMed and Embase databases to extract the relevant studies. We then performed a meta-analysis to calculate the diagnostic yields of transbronchial cryobiopsy and bronchoscopic forceps biopsy. RESULTS Following a systematic search, we identified nine relevant studies (300 patients undergoing cryobiopsy). All used Radial Endobronchial Ultrasound (R-EBUS) for PPL localization. The pooled diagnostic yield of transbronchial cryobiopsy was 77% (95% CI, 71%...84%) (I^2=38.72%, p=0.11). The diagnostic yield of forceps biopsy was 72% (95% CI, 60%...83%) (I^2=78.56%, p<0.01). The diagnostic yield of cryobiopsy and forceps biopsy was similar (RR 1.05, 95% CI 0.96...1.15), with a 5% risk difference for diagnostic yield (95% CI, ...6% to 15%). There was significant heterogeneity (I^2=57.2%, p=0.017), and no significant publication bias. One severe bleeding and three pneumothoraxes requiring intercostal drain (ICD) placement (major complication rate 4/122, 1.8%) were reported with transbronchial cryobiopsy. CONCLUSIONS R-EBUS guided transbronchial cryobiopsy is a safe and efficacious modality. The diagnostic yields of TBLC and forceps biopsy are similar. More extensive multicentre randomized trials are required for the further evaluation and standardization of transbronchial cryobiopsy for PPL...s.
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Affiliation(s)
- P B Sryma
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Mittal
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - N K Madan
- Department of Pathology, VMMC and Safdarjung Hospital, New Delhi, India
| | - P Tiwari
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - V Hadda
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - A Mohan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - R Guleria
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - K Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Madan K, Rudresh HK, Rao A, Sandeep S, Monica N, Gupta A. Clues from the Pandora's Box: Frequency of Acute Abdominal Symptoms in COVID-19 and Its Association with Inflammatory Markers-a Cross-Sectional Study. Indian J Surg 2022; 85:1-6. [PMID: 36033378 PMCID: PMC9395837 DOI: 10.1007/s12262-022-03550-w] [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: 05/13/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is primarily considered to be a respiratory ailment. Hitherto, abdominal symptoms have been reported with variable frequency in acute COVID-19. The purpose of this study was to estimate the frequency of abdominal symptoms at presentation among patients hospitalised with COVID-19 infection, and to determine their association with disease severity. This was a single-centre cross-sectional observational study conducted at a COVID-19 tertiary care hospital (CTRI/2021/10/037195, registered on 08/10/2021). Consecutive patients hospitalised with acute COVID-19 illness during the study period were included in the study. Their demographic information, abdominal symptoms, comorbidities and category of COVID-19 illness were elicited. All patients had serum inflammatory markers tested on the day of hospitalisation. Among the 685 participants, 214 patients had mild-to-moderate category illness whereas the rest 471 had severe COVID-19 illness. Abdominal complaints were present among 132/685 (18.3%) patients with distension of abdomen (8.03%) being the most common symptom, followed by vomiting (6.72%) and abdominal pain (3.94%). At admission to the hospital, abdominal complaints were commoner among patients with severe disease than in those with mild-to-moderate disease (101/471 vs. 31/214; p=0.029). Abdominal symptoms were associated with a higher neutrophil to lymphocyte ratio (p=0.029). The mortality among COVID-19 patients with abdominal symptoms was higher (9.09 vs. 3.25%; p = 0.007). This study demonstrates the spectrum of abdominal symptoms that can be a part of acute COVID-19 at hospitalisation and also highlights their prognostic potential in acute COVID-19 infection.
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Affiliation(s)
- K. Madan
- Department of General Surgery, Ramaiah Medical College, Bangalore, Karnataka India
| | - H. K. Rudresh
- Department of General Surgery, Ramaiah Medical College, Bangalore, Karnataka India
| | - Akshay Rao
- Department of General Medicine, Ramaiah Medical College, Bangalore, Karnataka India
| | - S. Sandeep
- Department of General Surgery, Ramaiah Medical College, Bangalore, Karnataka India
| | - N. Monica
- Department of General Surgery, Ramaiah Medical College, Bangalore, Karnataka India
| | - Anupam Gupta
- Department of General Surgery, Ramaiah Medical College, Bangalore, Karnataka India
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Sawhney J, Vanani J, Madan K, Sharma M, Tyagi K, Kandpal B, Mehta A. Achieving the LDL-C goal in Indian patients of acute coronary syndrome with high intensity statin. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.543] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Kumar TP, Madan K, Arjun AS, Monica N. Assessment of Potential Risk Factors, Characteristics, and Outcome of Pneumothorax and Pneumomediastinum in Patients with COVID-19: A Retrospective Case-control Study. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/57842.17012] [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: 11/12/2022]
Abstract
Introduction: Pneumothorax (PTX) and/or pneumomediastinum (PMD) are rare complications of Coronavirus Disease-2019 (COVID-19) and are linked to high mortality. Incidence rates vary between 0.56-2.01% in the reported literature. With clinical examination being hampered in the current pandemic setting, there is a delay in the diagnosis. There is a need to identify and establish potential predictive factors, that may aid in identifying patients with a high-risk of developing PTX and/or PMD. Aim: To identify potential risk factors and thus, explore their association with PTX and/or PMD among patients with COVID-19. Materials and Methods: A retrospective case-control study was conducted at MS Ramaiah Medical College and Hospital, Bangalore, South India over a six-month period. A total of 130 patients diagnosed with COVID-19 were recruited in a 1:3 ratio as cases and controls respectively. Cases were patients, diagnosed radiologically with PTX and/or PMD, and controls were, matched individuals without PTX and/or PMD. Patient’s clinical and laboratory parameters (complete blood count, renal and liver function tests, serum levels of inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), and D-Dimer were tested for potential association with PTX and/or PMD. Student’s t-test, Chi-square test, multivariate and univariate logistic regression analysis were performed. Results: During the study period, there was a total of 3,251 COVID-19 admissions at the centre with 976 patients requiring Intensive Care Unit (ICU) admission. The overall incidence of PTX and/or PMD during the study period was (31/3251) 0.95%. The previous history of COVID-19, non vaccination with COVID-19 vaccine, cough as a predominant symptom, high values of baseline CRP, total bilirubin, Aspartate Transaminase (AST), and total leukocyte counts had a positive association. In-hospital mortality (54.8% vs 33.30%) and mortality 28 days (35.7% vs 7.6%) following discharge, were higher among those with PTX and/or PMD. Conclusion: Patients with a history of previous infection with COVID-19, non vaccination /incomplete-vaccination with COVID-19 vaccines, and patients with increasing total leukocyte counts and AST levels, high baseline total serum bilirubin were at increased risk of a detrimental clinical course and may indicate, the possibility of development of PTX and/or PMD in COVID-19 disease.
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Kumar A, Tyagi K, Madan K, Mehta A. Prevalence of elevated lipoprotein (a) in atherosclerotic cardiovascular disease and its relation to severity of coronary artery disease. Indian Heart J 2021. [DOI: 10.1016/j.ihj.2021.11.161] [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: 11/28/2022] Open
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Saikia J, Malik P, Kumar S, Jain D, Madan K, Bharati S, Deo S, Kumar S. 7P Predictive and prognostic value of cell-free DNA in plasma and pleural lavage among surgically treated adenocarcinomas of the lung (ADCL). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2003] [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: 11/28/2022] Open
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Sawhney J, Tyagi K, Sharma M, Madan K, Vanani J, Kandpal B, Mehta A. Lipoprotein (a) in young coronary artery disease and its association with severity of coronary artery disease. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.346] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mittal A, Malik PS, Kumar S, Saikia J, Chitikela S, Khurana S, Bharti S, Jain D, Pathy S, Thulkar S, Kumar R, Madan K, Mohan A. Dose-dense Paclitaxel and Carboplatin as Neoadjuvant Chemotherapy for Stage IIB/IIIA Non-small Cell Lung Cancer - A Phase II trial. Clin Oncol (R Coll Radiol) 2021; 33:e553-e560. [PMID: 34340919 DOI: 10.1016/j.clon.2021.07.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 12/25/2022]
Abstract
AIMS The approach to potentially resectable non-small cell lung cancer (NSCLC) remains controversial. There is a benefit of neoadjuvant chemotherapy (NACT), but the ideal regimen is unknown. We evaluated the efficacy and safety of dose-dense NACT in potentially resectable NSCLC in this phase II trial. MATERIALS AND METHODS Paclitaxel at 80 mg/m2 on days 1, 8 and 15 with AUC-6 carboplatin on day 1, 3 weekly for four cycles was evaluated as NACT. Patients with Eastern Cooperative Oncology Group performance status 0-2, stage IIB and IIIA (with only non-bulky N2 nodes) were included. The primary end point was the objective response rate. Secondary end points included toxicity, progression-free survival, recurrence-free survival, complete resection rate and overall survival. The relative dose intensity (RDI) was calculated to define tolerability (CTRI/2016/05/006916). RESULTS In total, 37 patients were enrolled (median age 55 years). Most (78.8%) were smokers. Most patients had adenocarcinoma (57.6%) and stage IIIA disease (81.0%) according to the seventh American Joint Committee on Cancer staging system. Seventy-eight per cent of patients completed four cycles. The objective response rate was 75.6% with a complete response in 10.8%. The mean RDI of paclitaxel was 88.61%, with 68.0% of patients able to maintain an RDI ≥85.0%. In total, 187 toxicity events were recorded (120 grade 1, 64 grade 2 and three grade 3 events). Common toxicities were peripheral neuropathy (20.3%), myalgia (19.8%), nausea (15.7%) and neutropenia (10.2%). There were no treatment-related deaths. Seventeen patients underwent surgery (lobectomy 82.4%). After a median follow-up of 47 months (95% confidence interval 27-50.7 months), the median progression-free survival was 9.6 months (7.4-17.4) and overall survival was 29.2 months (16.0-37.2). CONCLUSION Dose-dense paclitaxel-carboplatin is feasible, safe and efficacious and should be evaluated further in potentially resectable NSCLC.
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Affiliation(s)
- A Mittal
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - S Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - J Saikia
- Department of Surgical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Chitikela
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Khurana
- Department of Medical Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Bharti
- Department of Oncoanaesthesia and Palliative Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Pathy
- Department of Radiation Oncology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Mohan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Saikia J, Malik P, Jain D, Kumar S, Bharati S, Madan K, Gamit P, Deo S, Kumar S. 23P Clinical utility of cell free DNA in pleural lavage and plasma in resectable NSCLC: A pilot study. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)01865-7] [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: 10/21/2022]
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Prabhakaran D, Chandrasekaran AM, Singh K, Mohan B, Chattopadhyay K, Chadha DS, Negi PC, Bhat P, Sadananda KS, Ajay VS, Singh K, Praveen PA, Devarajan R, Kondal D, Soni D, Mallinson P, Manchanda SC, Madan K, Hughes AD, Chathurvedi N, Roberts I, Ebrahim S, Reddy KS, Tandon N, Pocock S, Roy A, Kinra S. Yoga-Based Cardiac Rehabilitation After Acute Myocardial Infarction: A Randomized Trial. J Am Coll Cardiol 2020; 75:1551-1561. [PMID: 32241371 PMCID: PMC7132532 DOI: 10.1016/j.jacc.2020.01.050] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the shortage of cardiac rehabilitation (CR) programs in India and poor uptake worldwide, there is an urgent need to find alternative models of CR that are inexpensive and may offer choice to subgroups with poor uptake (e.g., women and elderly). OBJECTIVES This study sought to evaluate the effects of yoga-based CR (Yoga-CaRe) on major cardiovascular events and self-rated health in a multicenter randomized controlled trial. METHODS The trial was conducted in 24 medical centers across India. This study recruited 3,959 patients with acute myocardial infarction with a median and minimum follow-up of 22 and 6 months. Patients were individually randomized to receive either a Yoga-CaRe program (n = 1,970) or enhanced standard care involving educational advice (n = 1,989). The co-primary outcomes were: 1) first occurrence of major adverse cardiovascular events (MACE) (composite of all-cause mortality, myocardial infarction, stroke, or emergency cardiovascular hospitalization); and 2) self-rated health on the European Quality of Life-5 Dimensions-5 Level visual analogue scale at 12 weeks. RESULTS MACE occurred in 131 (6.7%) patients in the Yoga-CaRe group and 146 (7.4%) patients in the enhanced standard care group (hazard ratio with Yoga-CaRe: 0.90; 95% confidence interval [CI]: 0.71 to 1.15; p = 0.41). Self-rated health was 77 in Yoga-CaRe and 75.7 in the enhanced standard care group (baseline-adjusted mean difference in favor of Yoga-CaRe: 1.5; 95% CI: 0.5 to 2.5; p = 0.002). The Yoga-CaRe group had greater return to pre-infarct activities, but there was no difference in tobacco cessation or medication adherence between the treatment groups (secondary outcomes). CONCLUSIONS Yoga-CaRe improved self-rated health and return to pre-infarct activities after acute myocardial infarction, but the trial lacked statistical power to show a difference in MACE. Yoga-CaRe may be an option when conventional CR is unavailable or unacceptable to individuals. (A study on effectiveness of YOGA based cardiac rehabilitation programme in India and United Kingdom; CTRI/2012/02/002408).
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Affiliation(s)
- Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom; Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | | | - Kalpana Singh
- Centre for Chronic Disease Control, New Delhi, India
| | | | - Kaushik Chattopadhyay
- London School of Hygiene and Tropical Medicine, London, United Kingdom; The University of Nottingham, Nottingham, United Kingdom
| | | | | | - Prabhavathi Bhat
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
| | | | - Vamadevan S Ajay
- Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India
| | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
| | - Pradeep A Praveen
- Centre for Chronic Disease Control, New Delhi, India; All India Institute of Medical Sciences, New Delhi, India
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Divya Soni
- Centre for Chronic Disease Control, New Delhi, India
| | - Poppy Mallinson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Alun D Hughes
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Nishi Chathurvedi
- MRC Unit for Lifelong Health and Ageing at University College London, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Ian Roberts
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ambuj Roy
- All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Sawhney J, Mori V, Sharma M, Madan K, Verma I. Coronary risk factors and arcus cornealis in young patients of coronary artery disease with and without familial hypercholestrolemia. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.666] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, Pandit U, Shetye JV, Diwate A, Damke U, Ravindra S, Patil P, Nagarwala RM, Gaikwad P, Agarwal S, Madan K, Jacob P, Surendran PJ, Swaminathan N. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020; 24:905-913. [PMID: 33281313 PMCID: PMC7689134 DOI: 10.5005/jp-journals-10071-23564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.
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Affiliation(s)
- Mariya P Jiandani
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Bela Agarwal
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Gaurang Baxi
- Department of Physiotherapy, Dr. DY Patil College of Physiotherapy, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sudeep Kale
- Department of Cardiorespiratory Physiotherapy, Terna Physiotherapy College, Navi Mumbai, Maharashtra, India
| | - Titiksha Pol
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Anjali Bhise
- Department of Physiotherapy, Government Physiotherapy College and Spine Institute, Civil Hospital, Ahmedabad, Gujarat, India
| | - Unnati Pandit
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Jaimala V Shetye
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Abhijit Diwate
- Department of Physiotherapy, Dr. Vithalrao Vikhe Patil Foundations College of Physiotherapy, Ahmednagar, Maharashtra, India
| | - Umanjali Damke
- Physiotherapy School and Center, Government Medical College, Nagpur, Maharashtra, India
| | - Savita Ravindra
- COO-Centre for Rehabilitation, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Prajakta Patil
- Department of Cardiorespiratory Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashtra, India
| | - Raziya M Nagarwala
- Cardiovascular and Respiratory Physiotherapy Department, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
| | - Pratibha Gaikwad
- Department of Physiotherapy, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | | | - Kushal Madan
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Praveen J Surendran
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Narasimman Swaminathan
- Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Gilchrist SC, Barac A, Ades PA, Alfano CM, Franklin BA, Jones LW, La Gerche A, Ligibel JA, Lopez G, Madan K, Oeffinger KC, Salamone J, Scott JM, Squires RW, Thomas RJ, Treat-Jacobson DJ, Wright JS. Cardio-Oncology Rehabilitation to Manage Cardiovascular Outcomes in Cancer Patients and Survivors: A Scientific Statement From the American Heart Association. Circulation 2020; 139:e997-e1012. [PMID: 30955352 DOI: 10.1161/cir.0000000000000679] [Citation(s) in RCA: 214] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease is a competing cause of death in patients with cancer with early-stage disease. This elevated cardiovascular disease risk is thought to derive from both the direct effects of cancer therapies and the accumulation of risk factors such as hypertension, weight gain, cigarette smoking, and loss of cardiorespiratory fitness. Effective and viable strategies are needed to mitigate cardiovascular disease risk in this population; a multimodal model such as cardiac rehabilitation may be a potential solution. This statement from the American Heart Association provides an overview of the existing knowledge and rationale for the use of cardiac rehabilitation to provide structured exercise and ancillary services to cancer patients and survivors. This document introduces the concept of cardio-oncology rehabilitation, which includes identification of patients with cancer at high risk for cardiac dysfunction and a description of the cardiac rehabilitation infrastructure needed to address the unique exposures and complications related to cancer care. In this statement, we also discuss the need for future research to fully implement a multimodal model of cardiac rehabilitation for patients with cancer and to determine whether reimbursement of these services is clinically warranted.
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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Jeyaprakash P, Khor L, Madan K, Sivapathan S, Hill L, Robledo K, Hallani H, Roy P, Ellenberger K, Jepson N, Roy J, Pressley L, Patal S, Thomas L, French J, Burgess S. 887 STEMI in the Time of COVID-19: NSW Data. Heart Lung Circ 2020. [PMCID: PMC8435296 DOI: 10.1016/j.hlc.2020.09.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mittal S, Suri T, Hadda V, Madan K, Mohan A, PB S, Tiwari P, Guleria R. A comparison of a wrist worn portable device (watchpat)™ with in-lab polysomnography for the diagnosis of obstructive sleep apnea. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.726] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jain A, Manchanda S, Madan K, Bhola S, Sawhney J. Effect of yoga in Heart Failure: randomized trial. Indian Heart J 2019. [DOI: 10.1016/j.ihj.2019.11.074] [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: 10/25/2022] Open
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Saikia J, Malik P, Madan K, Jain D, Bharati S, Gowda M, Nandi S, Deo S, Kumar S. EP1.17-13 Operated Stages I-IIIB NSCLC Among Young Indian Cohorts - Clinical Profile and Outcomes. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2423] [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: 11/30/2022]
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Hadda V, Kumar R, Dhungana A, Khan MA, Madan K, Khilnani GC. Inter- and intra-observer variability of ultrasonographic arm muscle thickness measurement by critical care physicians. J Postgrad Med 2019; 63:157-161. [PMID: 28272064 PMCID: PMC5525479 DOI: 10.4103/0022-3859.201412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Purpose: The aim of this study was to assess inter- and intra-observer variability of arm muscle thickness measured by critical care physicians using bedside ultrasonography (USG). Methodology: This prospective study included twenty patients admitted with sepsis. Three measurements of thickness of right arm muscles of each patient using B-mode USG were taken by two critical care fellows, independently. Intra- and inter-observer reliability was tested using intraclass correlation coefficient (ICC). Results: The mean 1st, 2nd, and 3rd measurements of muscle thickness recorded by observer 1 and 2 were 23.620 (±4.171) versus 23.840 (±3.849) mm, 23.235 (±3.620) versus 23.625 (±4.062) mm, and 24.125 (±4.098) versus 23.965 (±3.651) mm, respectively. The average muscle thickness measured by first and second observer was 23.660 (±3.834) mm and 23.810 (±3.674) mm, respectively. ICC for intra-observer variability for observer 1 and 2 was 0.964 (95% confidence interval [CI] 0.924–0.985) and 0.949 (95% CI 0.892–0.978), respectively. ICC for inter-observer variability was 0.995 (95% CI 0.988–0.998). Conclusions: USG is a reliable tool for assessment of arm muscle thickness by critical care physicians.
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Affiliation(s)
- V Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - A Dhungana
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - M A Khan
- Department of Biostatistics, All Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
| | - G C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All Institute of Medical Sciences, New Delhi, India
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Sawhney J, Mori V, Prasad S, Sharma M, Madan K, Manchanda S, Verma I. Prevalence Of Familial Hypercholesterolemia In Young Coronary Artery Disease Patients Admitted To A Referral Hospital In North India. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.648] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chattopadhyay K, Chandrasekaran AM, Praveen PA, Manchanda SC, Madan K, Ajay VS, Singh K, Tillin T, Hughes AD, Chaturvedi N, Ebrahim S, Pocock S, Reddy KS, Tandon N, Prabhakaran D, Kinra S. Development of a Yoga-Based Cardiac Rehabilitation (Yoga-CaRe) Programme for Secondary Prevention of Myocardial Infarction. Evid Based Complement Alternat Med 2019; 2019:7470184. [PMID: 31186666 PMCID: PMC6521480 DOI: 10.1155/2019/7470184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/23/2019] [Accepted: 04/15/2019] [Indexed: 01/19/2023]
Abstract
Cardiac rehabilitation (CR) after myocardial infarction is highly effective. It is unavailable in public hospitals in India due to limited resources. Our objective was to develop a scalable model of CR for India based on yoga, which could also appeal to some groups with low uptake of CR (e.g., ethnic minorities, women, and older people) globally. The intervention was developed using a structured process. A literature review and consultations with yoga experts, CR experts, and postmyocardial infarction patients were conducted to systematically identify and shortlist appropriate yoga exercises and postures, breathing exercises, meditation and relaxation practices, and lifestyle changes, which were incorporated into a conventional CR framework. The draft intervention was further refined based on the feedback from an internal stakeholder group and an external panel of international experts, before being piloted with yoga instructors and patients with myocardial infarction. A four-phase yoga-based CR (Yoga-CaRe) programme was developed for delivery by a single yoga instructor with basic training. The programme consists of a total of 13 instructor-led sessions (2 individual and 11 group) over a 3-month period. Group sessions include guided practice of yoga exercises and postures, breathing exercises, and meditation and relaxation practices, and support for the lifestyle change and coping through a moderated discussion. Patients are encouraged to self-practice daily at home and continue long-term with the help of a booklet and digital video disc (DVD). Family members/carers are encouraged to join throughout. In conclusion, a novel yoga-based CR programme has been developed, which promises to provide a scalable CR solution for India and an alternative choice for CR globally. It is currently being evaluated in a large multicentre randomised controlled trial across India.
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Affiliation(s)
- Kaushik Chattopadhyay
- The University of Nottingham, Nottingham, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Pradeep A. Praveen
- Centre for Chronic Disease Control, New Delhi, India
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Kavita Singh
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | | | - Alun D. Hughes
- University College London, London, UK
- Imperial College London, London, UK
| | - Nishi Chaturvedi
- University College London, London, UK
- Imperial College London, London, UK
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Dorairaj Prabhakaran
- London School of Hygiene and Tropical Medicine, London, UK
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, Gurgaon, India
| | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, UK
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Sawhney JPS, Prasad SR, Sharma M, Madan K, Mohanty A, Passey R, Mehta A, Kandpal B, Makhija A, Jain R, Mantri RR, Vivek BS, Manchanda SC, Verma IC. Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India. Indian Heart J 2019; 71:118-122. [PMID: 31280822 PMCID: PMC6620422 DOI: 10.1016/j.ihj.2018.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/27/2018] [Revised: 11/27/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022] Open
Abstract
Aims The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.
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Affiliation(s)
- J P S Sawhney
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | | | - Manish Sharma
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Kushal Madan
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - A Mohanty
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Rajiv Passey
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Ashwani Mehta
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - B Kandpal
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Aman Makhija
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - Rajneesh Jain
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - R R Mantri
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | | | - S C Manchanda
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - I C Verma
- Institute of Medical Genetics and Genomics, Sir Gangaram Hospital, New Delhi 110060, India.
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Breta M, Arava S, Madan K, Singh A, Jain D, Guleria R. Endobronchial metastasis from extrathoracic malignancies : A clinicopathological study of 11 cases. Lung India 2019. [DOI: 10.4103/0970-2113.257715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Madan K, Mittal S, Hadda V, Mohan A. Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker. Lung India 2019. [DOI: 10.4103/0970-2113.257708] [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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Parati G, Agabiti-Rosei E, Bakris GL, Bilo G, Branzi G, Cecchi F, Chrostowska M, De la Sierra A, Domenech M, Dorobantu M, Faria T, Huo Y, Jelaković B, Kahan T, Konradi A, Laurent S, Li N, Madan K, Mancia G, McManus RJ, Modesti PA, Ochoa JE, Octavio JA, Omboni S, Palatini P, Park JB, Pellegrini D, Perl S, Podoleanu C, Pucci G, Redon J, Renna N, Rhee MY, Rodilla Sala E, Sanchez R, Schmieder R, Soranna D, Stergiou G, Stojanovic M, Tsioufis K, Valsecchi MG, Veglio F, Waisman GD, Wang JG, Wijnmaalen P, Zambon A, Zanchetti A, Zhang Y. MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol. BMJ Open 2018; 8:e021038. [PMID: 30573476 PMCID: PMC6303603 DOI: 10.1136/bmjopen-2017-021038] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM. METHODS AND ANALYSIS MASTER is a 4-year prospective, randomised, open-label, blinded-endpoint investigation. A total of 1240 treated hypertensive patients from about 40 secondary care clinical centres worldwide will be included -upon confirming presence of MUCH (repeated on treatment OBP <140/90 mm Hg, and at least one of the following: daytime ABP ≥135/85 mm Hg; night-time ABP ≥120/70 mm Hg; 24 hour ABP ≥130/80 mm Hg), and will be randomised to a management strategy based on OBPM (group 1) or on ABPM (group 2). Patients in group 1 will have OBP measured at 0, 3, 6, 12, 18, 24, 30, 36, 42 and 48 months and taken as a guide for treatment; ABPM will be performed at randomisation and at 12, 24, 36 and 48 months but will not be used to take treatment decisions. Patients randomised to group 2 will have ABPM performed at randomisation and all scheduled visits as a guide to antihypertensive treatment. The effects of MUCH management strategy based on ABPM or on OBPM on CV and renal intermediate outcomes (changing left ventricular mass and microalbuminuria, coprimary outcomes) at 1 year and on CV events at 4 years and on changes in BP-related variables will be assessed. ETHICS AND DISSEMINATION MASTER study protocol has received approval by the ethical review board of Istituto Auxologico Italiano. The procedures set out in this protocol are in accordance with principles of Declaration of Helsinki and Good Clinical Practice guidelines. Results will be published in accordance with the CONSORT statement in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER NCT02804074; Pre-results.
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Affiliation(s)
- Gianfranco Parati
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Centro Interuniversitario di Fisiologia Clinica e Ipertensione, University of Milan, Milan, Italy
| | - Enrico Agabiti-Rosei
- Department of Medicine, Azienda Spedali Civili di Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - George L Bakris
- Department of Medicine, University of Chicago, Chicago, USA
- ASH Comprehensive Hypertension Center, Section of Endocrinology, Diabetes and metabolism, Chicago, USA
| | - Grzegorz Bilo
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Giovanna Branzi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Franco Cecchi
- Department of Cardiology, Università di Firenze, Florence, Italy
| | - Marzena Chrostowska
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland
| | - Alejandro De la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | - Monica Domenech
- Department of Cardiovascular, Nutrition and Aging, Hospital Clinic of Barcelona, University of Barcelona, Insitut d’investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Dorobantu
- Department of Cardiology, Emergency Clinical Hospital of Bucharest, Bucharest, Romania
| | - Thays Faria
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bojan Jelaković
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University of Zagreb School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden
- Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Alexandra Konradi
- Hypertension Department, Almazov Federeal North-Werst Medical Research Centre, St.Petersburg, Russian Federation
| | - Stéphane Laurent
- Departments of Pharmacology, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Inserm UMR 970 and University Paris Descartes, Paris, France
| | - Nanfang Li
- The Center of Hypertension of the Peoples Hospital, Urumqi, China
| | - Kushal Madan
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Giuseppe Mancia
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Pietro Amedeo Modesti
- Department of Medicina Sperimentale e Clinica, University of Florence, Florence, Italy
| | - Juan Eugenio Ochoa
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - José Andrés Octavio
- Fundacion Venezolana de Hipertensión Arterial, Instituto de investigaciones de Enfermedades Cardiovasculares de LUZ, Maracaibo, Venezuela, Bolivarian Republic of
| | - Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Italy
| | - Paolo Palatini
- Dipartimento di Medicina DIMED, University of Padova, Padua, Italy
| | | | - Dario Pellegrini
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Sabine Perl
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Cristian Podoleanu
- Department of Cardiology, County Clinical Hospital, University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
| | - Giacomo Pucci
- Department of Medicine, University of Perugia, Perugia, Italy
- Hypertension Clinic, Unit of Internal Medicine, “S.Maria” Hospital, Terni, Italy
| | - Josep Redon
- University of Valencia and INCLIVA Research Institute, Valencia, Spain
- Hypertension Clinic, Hospital Clinico de Valencia, Valencia, Spain
| | - Nicolas Renna
- Department of Cardiology, Hospital Español de Mendoza, Mendoza, Argentina
| | - Moo Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang-si/Gyeonggi-do, Korea (the Republic of)
| | - Enrique Rodilla Sala
- Department of Hypertension, Hospital de Sagunto and University CEU Cardenal Herrera, Ciencias de la Salud, Valencia, Spain
| | - Ramiro Sanchez
- Metabolic Unit, Hypertension section, Favaloro Foundation, Buenos Aires, Argentina
| | - Roland Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Statistics and Quantitative methods, University of Milan-Bicocca, Milan, Italy
| | - George Stergiou
- School of Medicine, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Athens, Greece
- Third Department of Medicine, Sotiria Hospital, Athens, Greece
| | - Milos Stojanovic
- Excellence Centre for Hypertension, Department of Endocrinology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, Center of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Milan, Italy
| | - Franco Veglio
- Department of Medical Sciences, Internal Medicine and Hypertension Division, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Gabriel Dario Waisman
- Department of Internal Medicine, Hypertension Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ji Guang Wang
- School of Medicince, The Shanghai Institute of Hypertension, Ruijin Hospital; Shanghai Jiaotong University, Shanghai, China
- Department of Hypertension, Centre For Epidemiological Studies And Clinical Trials, Shanghai Key Laboratory Of Hypertension, Shanghai, China
| | - Paulina Wijnmaalen
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Antonella Zambon
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Statistics and Quantitative methods, University of Milan-Bicocca, Milan, Italy
| | - Alberto Zanchetti
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Yuqing Zhang
- Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical Colleges, Beijing, China
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Dadlani A, Madan K, Sawhney JPS. Ambulatory blood pressure monitoring in clinical practice. Indian Heart J 2018; 71:91-97. [PMID: 31000190 PMCID: PMC6477132 DOI: 10.1016/j.ihj.2018.11.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/03/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
Being one of the most widely prevalent diseases throughout the world, hypertension has emerged as one of the leading causes of global premature morbidity and mortality. Hence, blood pressure (BP) measurements are essential for physicians in the diagnosis and management of hypertension. Current American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend initiating antihypertensive medications on the basis of office BP readings. However, office BP readings provide a snapshot evaluation of the patient's BP, which might not reflect patient's true BP, with the possibility of being falsely elevated or falsely low. Recently, there is ample evidence to show that ambulatory blood pressure monitoring (ABPM) is a better predictor of major cardiovascular events than BP measurements at clinic settings. ABPM helps in reducing the number of possible false readings, along with the added benefit of understanding the dynamic variability of BP. This article will focus on the significance of ambulatory BP, its advantages and limitations compared with the standard office BP measurement and a brief outlook on its use and interpretation to diagnose and treat hypertension.
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Affiliation(s)
- Apaar Dadlani
- Division of Nephrology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA.
| | - Kushal Madan
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
| | - J P S Sawhney
- Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi 110060, India.
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Nambirajan A, Longchar M, Mallick S, Kakkar A, Madan K, Mathur S, Jain D. P1.05-11 Role of EBUS-TBNA in Evaluation of Mediastinal Lymphadenopathy and Masses in Patients with Known or Suspected Extra-Pulmonary Malignancies. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.763] [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: 10/28/2022]
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Jain D, Jangra K, Malik PS, Arulselvi S, Madan K, Mathur S, Sharma MC. Anaplastic lymphoma kinase immunohistochemistry in lung adenocarcinomas: Evaluation of performance of standard manual method using D5F3 antibody. Indian J Cancer 2018; 54:209-213. [PMID: 29199692 DOI: 10.4103/0019-509x.219588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Immunohistochemistry (IHC) with anaplastic lymphoma kinase (ALK) antibodies is considered as an economical screening method in lung adenocarcinomas. Automated Ventana D5F3-IHC is approved by US Food and Drug Administration for targeted therapy; however, the automated IHC apparatus are not widely used in most laboratories. We evaluated the performance of ALK IHC using the manual semiquantitative method to assess the concordance with Ventana ALK IHC assay. MATERIALS AND METHODS We tested 156 cases of primary lung adenocarcinomas for ALK protein expression by D5F3-IHC. The intensity of cytoplasmic staining was classified as 0 or 1+/2+/3+ (weak/medium/strong). Binary score of positive and negative was used for Ventana assay. A comparison analysis and clinicopathological features were recorded. RESULTS ALK IHC was positive in 25 (16.02%) cases, of which 18 were men and mostly nonsmokers. The mean age for all patients was 55 years, and for ALK IHC-positive cases was 48 years. Nine of 25 (36%) ALK IHC-positive cases showed signet ring cell and mucinous morphology. On comparison, all, but one, cases positive by manual method showed positive results by automated assay. IHC negative cases by manual method were negative by Ventana assay. CONCLUSION Manual IHC is equally effective in the detection of ALK-rearranged cases as automated methods. It can be easily integrated as a screening method into routine practice thus reducing the cost of automated systems. However, equivocal cases should be tested by approved methods.
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Affiliation(s)
- D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K Jangra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - P S Malik
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - S Arulselvi
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine and Sleep Disorder, All India Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Nakra T, Jain D, Madan K, Mallick S, Mathur SR, Iyer VK, Ramteke P. Endobronchial ultrasound guided transbronchial needle aspirate from subcarinal lymph node: Mesothelial lesion, a diagnostic dilemma. Cytopathology 2018; 29:486-488. [PMID: 29797365 DOI: 10.1111/cyt.12547] [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] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- T Nakra
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - S Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - P Ramteke
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Vashistha V, Choudhari C, Garg A, Gupta A, Parthasarathy G, Mohan C, Madan K, Hadda V, Khilnani G, Mohan A. 41P Gender based variations in presentation and management of lung cancer at a south Asian tertiary referral centre. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30321-6] [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: 10/17/2022]
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Kumar N, Deo S, Shukla N, Boriwal S, Kumar V, Ramanathan P, Jain D, Madan K, Kumar S. 225P Surgical experience of advanced bronchopulmonary carcinoids: An analysis from a tertiary care hospital of North India. J Thorac Oncol 2018. [DOI: 10.1016/s1556-0864(18)30497-0] [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: 11/28/2022]
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Mohan A, Poulose R, Ansari A, Madan K, Hadda V, Khilnani GC, Guleria R. Novel use of bioelectric impedence technique to detect alterations in body composition in advanced small cell lung cancer. Indian J Cancer 2018; 54:478-480. [PMID: 29469082 DOI: 10.4103/ijc.ijc_497_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Malnutrition is frequent in lung cancer and is measured using various tools, including the novel bioelectric impedance technique for measuring body composition. However, the validation of this technique for assessing body composition in advanced small cell lung cancer (SCLC) is untested. METHODS Forty-one treatment naïve patients (all males) and an equal number of age- and sex-matched controls were evaluated by anthropometric measurements of skinfold thicknesses and body composition parameters such as body fat%, fat mass, fat-free mass (FFM), and total body water (TBW). RESULTS The mean (SD) age of the patient group was 55.7 (7.5) years, median pack-years was 20 (range, 0-80), and mean (SD) duration of symptoms was 152.6 (153.7) days. Median Karnofsky Performance Scale was 70 (range, 50-90). Majority of our patients (68.3%) were Stage IV followed by Stage III (31.7%). The percentage of patients with low, normal, and high body mass index (BMI) was 31.7%, 61%, and 7.3%, respectively. All components of body composition, i.e., body fat%, FFM, and TBW were significantly lower in patients compared to controls. However, the body composition in patients and controls with normal BMI was similar. The phenomenon of sarcopenia as a cause of cancer cachexia may explain these findings, whereas the combination of loss of body fat and lean body mass may lead to weight loss and reduced BMI. CONCLUSION Our results indicate that body composition is markedly altered in Indian patients with advanced SCLC. The impact of these parameters on clinically relevant outcomes needs further evaluation.
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Affiliation(s)
- A Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - R Poulose
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - A Ansari
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - V Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - G C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Nambirajan A, Kaur H, Jangra K, Kaur K, Madan K, Mathur SR, Iyer VK, Jain D. Adenocarcinoma predominant pattern subtyping and nuclear grading in cytology: Is there a role in prognostication of advanced pulmonary adenocarcinomas? Cytopathology 2018; 29:163-171. [DOI: 10.1111/cyt.12519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 12/30/2022]
Affiliation(s)
- A. Nambirajan
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - H. Kaur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Jangra
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Kaur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - K. Madan
- Department of Pulmonary Medicine; All India Institute of Medical Sciences; New Delhi India
| | - S. R. Mathur
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - V. K. Iyer
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
| | - D. Jain
- Department of Pathology; All India Institute of Medical Sciences; New Delhi India
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Shah SR, Chowdhury A, Mehta R, Kapoor D, Duseja A, Koshy A, Shukla A, Sood A, Madan K, Sud R, Nijhawan S, Pawan R, Prasad M, Kersey K, Jiang D, Svarovskaia E, Doehle B, Kanwar B, Subramanian M, Acharya SK, Sarin S. Sofosbuvir plus ribavirin in treatment-naïve patients with chronic hepatitis C virus genotype 1 or 3 infection in India. J Viral Hepat 2017; 24:371-379. [PMID: 27933698 DOI: 10.1111/jvh.12654] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
Until 2014, pegylated interferon plus ribavirin was the recommended standard of care for the treatment of chronic hepatitis C virus (HCV) infection in India. This open-label phase 3b study, conducted across 14 sites in India between 31 March 2014 and 30 November 2015, evaluated the efficacy and safety of sofosbuvir plus ribavirin therapy among treatment-naïve patients with chronic genotype 1 or 3 HCV infection. A total of 117 patients with genotype 1 or 3 HCV infection were randomized 1:1 to receive sofosbuvir 400 mg and weight-based ribavirin (1000 or 1200 mg) daily for 16 or 24 weeks. Among those with genotype 1 infection, the primary efficacy endpoint of sustained virologic response at 12 weeks post-treatment (SVR12) was reported in 90% (95% confidence intervals [CI], 73-98) and 96% (95% CI, 82-100) of patients following 16 and 24 weeks of treatment, respectively. For patients with genotype 3 infection, SVR12 rates were 100% (95% CI, 88-100) and 93% (95% CI, 78-99) after 16 and 24 weeks of therapy, respectively. Adverse events, most of which were mild or moderate in severity, occurred in 69% and 57% of patients receiving 16 and 24 weeks of treatment, respectively. The most common treatment-emergent adverse events were asthenia, headache and cough. Only one patient in the 24-week group discontinued treatment with sofosbuvir during this study. Overall, sofosbuvir plus ribavirin therapy achieved SVR12 rates ≥90% and was well tolerated among treatment-naïve patients with chronic genotype 1 or 3 HCV infection in India.
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Affiliation(s)
- S R Shah
- Global Hospitals, Mumbai, Maharashtra, India
| | - A Chowdhury
- Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - R Mehta
- Nirmal Hospital Pvt Ltd, Surat, Gujarat, India
| | - D Kapoor
- Global Hospitals, Hyderabad, Andhra Pradesh, India
| | - A Duseja
- Postgraduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - A Koshy
- Lakeshore Hospital, Kochi, Kerala, India
| | - A Shukla
- Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - A Sood
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - K Madan
- Artemis Hospitals, Gurgaon, Haryana, India
| | - R Sud
- Medanta - The Medicity, Gurgaon, Haryana, India
| | - S Nijhawan
- Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - R Pawan
- Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - M Prasad
- VGM Hospital, Coimbatore, Tamil Nadu, India
| | - K Kersey
- Gilead Sciences, Inc., Foster City, CA, USA
| | - D Jiang
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - B Doehle
- Gilead Sciences, Inc., Foster City, CA, USA
| | - B Kanwar
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | - S K Acharya
- All India Institute of Medical Science, New Delhi, Delhi, India
| | - S Sarin
- Institute of Liver and Biliary Sciences, New Delhi, Delhi, India
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Bamania A, Sahni D, Mohan A, Malik P, Madan K, Hadda V, Khilnani G, Guleria R. P227 Comparison of clinical profile of patients with ALK-positive and EGFR-positive non- small cell lung adenocarcinoma in an indian population. Chest 2017. [DOI: 10.1016/j.chest.2017.04.133] [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: 11/25/2022] Open
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Salib M, Madan K, Chandrala P, Coulshed D. Safety of Early Emergency Discharge in High-Sensitivity-Troponin-I (HsTnI) Negative Chest Pain Patients. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.121] [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: 11/16/2022]
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Vohra J, Madan K, Sharma M, Sawhney J. Abstract 452: Effect of Exercise Training on Sleep Quality and Quality of Life in Post Myocardial Infarction Patients. Circ Res 2016. [DOI: 10.1161/res.119.suppl_1.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives:
To study the effect of four weeks of aerobic exercise training, on sleep quality and quality of life parameters like anxiety, depression and physical functioning in Post Myocardial Infarction (MI) patients.
Methods:
ST elevated MI patients (n=21, <65years age) were voluntarily divided into 2 groups, control group (n=11) and exercising group (n=10). The patients in experimental group followed an exercise program of 3 sessions per week for 4 weeks. The subjective quality of life, anxiety and depression levels were assessed by the SF 36 questionnaire and Hospital Anxiety & Depression Scale (HAD scale) and the sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality and short sleep duration was defined as PSQI > 5 and total sleep time <6hrs. respectively. After 4 weeks of the program the questionnaires were repeated for all 21 patients. Wilcoxon rank order test and Student T test were used. P<0.05 was considered statistically significant
Results:
Intergroup analysis showed statically significant reduction in anxiety score (9vs0.5) and depression score (3vs0) in exercise group as compared to control group respectively. As compared to control group, exercise group also showed statistically significant improvement in the quality of life parameter score [physical functioning (750vs1000), role functioning physical (0vs400) & emotional (0vs300), energy level (215vs400), emotional well-being (400vs500), social functioning (120vs200), general health (230vs462.5) & health changes (50vs100)]. Intra group analysis also showed significant changes only in exercise group. After 4 weeks of exercise training, PSQI score improved in the experimental group from 9.5±4.11 to 1.13±0.35 (p=0.00029) indicating better sleep quality and duration. While it remained comparable to the baseline values in the control group i.e. from 9.9±4.70 to 10.33±3.87 (p value= 0.514).
Conclusion:
Four weeks of exercise program improves the quality & duration of sleep and quality of life in MI patients after 2 weeks of index event.
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Mohan A, Poulose R, Kulshreshtha I, Chautani AM, Madan K, Hadda V, Guleria R. High prevalence of malnutrition and deranged relationship between energy demands and food intake in advanced non-small cell lung cancer. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27099023 DOI: 10.1111/ecc.12503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/15/2016] [Indexed: 12/01/2022]
Abstract
The relation between dietary intake and metabolic profile in non-small cell lung cancer (NSCLC) was evaluated. Patients with NSCLC were recruited and their caloric requirement and resting energy expenditure (REE) were calculated using the Harris-Benedict equation and Katch-McArdle formula respectively. Hypermetabolic state was defined as REE more than 10% above the basal metabolic rate (BMR). Body composition parameters were calculated by bioelectric impedance method. The 24-h dietary intake method and Malnutrition Universal Screening Tool assessed nutritional intake. One hundred and forty-eight subjects were included (87% males). Of these, 46.6% subjects were hypermetabolic and 31% cachexic, with lower calorie and protein intakes than recommended, although per cent of total energy derived from protein, fat and carbohydrates were similar. Hypermetabolic patients had lower BMI, though the per cent deficit in energy and protein consumption was similar. Cachexia was associated with lower BMR but not with deficit in energy or protein consumption. No correlation was seen between dietary intake and body composition parameters. The calorie and protein intake of NSCLC patients is lower than recommended. The discordance between elevated REE and dietary intake implies that the relationship between increased energy demands and food intake may be altered.
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Affiliation(s)
- A Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
| | - R Poulose
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
| | - I Kulshreshtha
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
| | - A M Chautani
- Department of Dietitics and Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
| | - V Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi
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Madan K, Hadda V, Khilnani GC, Guleria R. Expectorating the diagnosis: ruptured hydatid cyst. Assoc Med J 2015. [DOI: 10.1136/bmj.h654] [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]
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48
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Vijaya Bharathi B, Jaya Prakash G, Krishna KM, Ravi Krishna CH, Sivanarayana T, Madan K, Rama Raju GA, Annapurna A. Protective effect of alpha glucosyl hesperidin (G-hesperidin) on chronic vanadium induced testicular toxicity and sperm nuclear DNA damage in male Sprague Dawley rats. Andrologia 2014; 47:568-78. [DOI: 10.1111/and.12304] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2014] [Indexed: 01/30/2023] Open
Affiliation(s)
- B. Vijaya Bharathi
- Pharmacology Division; University College of Pharmaceutical Sciences; Andhra University; Visakhapatnam India
| | - G. Jaya Prakash
- Embryology Research Group; Krishna IVF Clinic; Visakhapatnam India
| | - K. M. Krishna
- Embryology Research Group; Krishna IVF Clinic; Visakhapatnam India
| | | | | | - K. Madan
- Vijaya Medical Center; Visakhapatnam India
| | - G. A. Rama Raju
- Embryology Research Group; Krishna IVF Clinic; Visakhapatnam India
| | - A. Annapurna
- Pharmacology Division; University College of Pharmaceutical Sciences; Andhra University; Visakhapatnam India
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Purkait S, Jain D, Madan K, Mathur S, Iyer VK. Combined small cell carcinoma of the lung: a case diagnosed on bronchoscopic wash cytology and bronchial biopsy. Cytopathology 2014; 26:197-9. [PMID: 24734994 DOI: 10.1111/cyt.12145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Purkait
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - K Madan
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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50
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Hadda V, Madan K, Mohan A, Ayub II. Furosemide Nebulization in Patients With COPD Exacerbation. Respir Care 2014; 59:e41. [DOI: 10.4187/respcare.03034] [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: 11/05/2022]
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