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Vishnu VY, Modi M, Garg VK, Mohanty M, Goyal MK, Lal V, Mittal BR, Prabhakar S. Role of inflammatory and hemostatic biomarkers in Alzheimer's and vascular dementia - A pilot study from a tertiary center in Northern India. Asian J Psychiatr 2017; 29:59-62. [PMID: 29061429 DOI: 10.1016/j.ajp.2017.04.015] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/13/2017] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A reliable plasma biomarker in differentiating between Alzheimer's disease (AD) and Vascular dementia (VaD) is the need of the hour, in most memory clinics. Even though there is no disease modifying treatment, it is important to know the type of dementia for both symptomatic treatment and prognostication. METHODS Neuropsychological assessment, MRI brain, FDG-PET brain and CSF biomarkers of AD (Aβ42 and total tau) were used for establishing the diagnosis of Mild Cognitive Impairment (MCI), AD or VaD. RESULTS 68 diagnosed patients of AD/MCI/VaD were included. FDG PET brain, plasma fibrinogen, d dimer, IL6 and CRP were done in all 68 patients while 48 patients underwent CSF biomarker analysis. Sixteen patients had MCI, of which 11 were MCI-AD and 5 were MCI-VaSC. There were 41 patients with AD (Mild AD-9, Mod AD-23, Severe AD-9) and 11 patients with VaD. Alzheimer group (MCI-AD and AD) and Vascular group (MCI VaSC & VaD) consisted of 52 and 16 patients respectively. Alzheimer and Vascular groups did not exhibit significant difference in IL6 and CRP levels. Plasma fibrinogen levels were significantly higher in VaD and vascular group as compared to Alzheimer group. But MCI-VaSC was not significantly different from MCI-AD. Plasma d dimer levels were significantly higher in all vascular subgroups compared to Alzheimer subgroups except between MCI-VaSC and MCI-AD. CONCLUSION Hemostatic biomarkers were higher in Vascular group compared to Alzheimer group whereas there was no difference in inflammatory biomarkers. But the sensitivity and specificity of fibrinogen and d-dimer were not high enough for routine clinical use. Further studies in a larger sample are required to confirm these results.
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Affiliation(s)
- V Y Vishnu
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - M Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - V K Garg
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - M Mohanty
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - M K Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - V Lal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - B R Mittal
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Modi M, Sharma K, Prabhakar S, Goyal MK, Takkar A, Sharma N, Garg A, Faisal S, Khandelwal N, Singh P, Sachdeva J, Shree R, Rishi V, Lal V. Clinical and radiological predictors of outcome in tubercular meningitis: A prospective study of 209 patients. Clin Neurol Neurosurg 2017; 161:29-34. [PMID: 28843114 DOI: 10.1016/j.clineuro.2017.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 04/18/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The predictors of poor outcome in tuberculous meningitis (TBM) remain to be delineated. We determined role of various clinical, radiological and cerebrospinal fluid (CSF) parameters in prediction of outcome in TBM. PATIENTS AND METHODS Current study was a prospective observational study including 209 patients of TBM. All patients underwent detailed evaluation including Gadolinium enhanced Magnetic resonance imaging (GdMRI) of brain as well as tests to detect evidence of tuberculosis elsewhere in body. They also underwent GdMRI at three and nine month follow up. All patients received treatment as per standard guidelines. RESULTS Mean age was 30.4±13.8years. 139 (66.5%) patients had definite TBM while 70 (34.5%) had highly probable TBM. 53 (25.4%) patients died. On univariate analysis, longer duration of illness, altered sensorium, stage III TBM, hydrocephalus and exudates correlated with poor outcome. On multivariate analysis presence of hydrocephalus (p=0.003; OR=3.2; 95% CI=1.5-6.7) and stage III TBM (p<0.0001; OR=8.7; 95% CI=3.7-20.2) correlated with higher risk of mortality. In addition, there was significant positive association between presence of hydrocephalus (p=0.05; OR=2.2; 95% CI=0.97-5.1), stage III TBM (p<0.0001; OR=28; 95% CI=4.9-158) and presence of altered sensorium (p=0.05; OR=22; 95% CI=0.99-4.8) with either death or survival with severe disability. CONCLUSIONS It is possible to prognosticate TBM using a combination of clinical and radiological. The duration of illness (65.9±92days) before diagnosis of TBM continues to be unacceptably long and this stresses on need to educate primary care physicians about TBM. Future studies where intensity and duration of treatment is guided by these cues may help in sorting out some of the most difficult questions in TBM, namely duration of antitubercular therapy as well as dose and duration of steroid therapy etc.
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Affiliation(s)
- M Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - K Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - S Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - M K Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - A Takkar
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - N Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - A Garg
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - S Faisal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - N Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - P Singh
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - J Sachdeva
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - R Shree
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - V Rishi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - V Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Sharma S, Goyal MK, Sharma K, Modi M, Sharma M, Khandelwal N, Prabhakar S, Sharma N, R S, Gairolla J, Jain A, Lal V. Cytokines do play a role in pathogenesis of tuberculous meningitis: A prospective study from a tertiary care center in India. J Neurol Sci 2017; 379:131-136. [PMID: 28716226 DOI: 10.1016/j.jns.2017.06.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 05/01/2017] [Accepted: 06/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Though animal studies have suggested a role for proinflammatory cytokines in pathogenesis their exact role in pathogenesis of human meningeal tuberculosis continues to be controversial with different studies yielding contradictory results. AIM AND OBJECTIVES To study the levels of proinflammatory cytokines in serum and cerebrospinal fluid (CSF) of patients with tubercular meningitis (TBM) and to determine whether these correlate with disease severity. PATIENTS AND METHODS Present study included 146 patients with TBM (90- Definite TBM; 56- Probable TBM), diagnosed according to criteria laid by Ahuja et al. which were modified to include CSF nucleic acid based tests. Serum (n=146) and CSF (n=140) levels of various proinflammatory cytokines (IL-1β, IL-2, IL-6, TNF-α and IFNγ) were compared between TBM patients and healthy volunteers (n=99). These levels were correlated with various clinical, radiological and CSF parameters of TBM patients. RESULTS Proinflammatory cytokines include cytokines which promote systemic inflammation. In current study, the serum and CSF levels of various cytokines (IL-2, IL-4, IL-6, IL-1β, IFN-γ and TNF-α) were significantly elevated in TBM patients compared to controls. A significant correlation was found between a) Higher stage of TBM and various cytokines (except for serum IL-6 and CSF IFN-γ); b) High CSF TNF-α, IL-4 and IL-1β with severity of hydrocephalus; c) High CSF IL1β and IFN-γ with presence of exudates on MRI; d) Serum and CSF levels of all cytokines with poor outcome as determined by death or as defined by S and E ADL (Schwab and England activities of daily living) score or by GOS (Glasgow outcome scale) (except for interferon gamma); and e) Serum and CSF IL-4 and IL1β with presence of infarcts on MRI brain. CONCLUSION Proinflammatory cytokines play an important role in the pathogenesis of TBM and contribute significantly towards severity of disease.
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Affiliation(s)
- S Sharma
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - M K Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - K Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - M Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - M Sharma
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - N Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - S Prabhakar
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - N Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shree R
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - J Gairolla
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - A Jain
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - V Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Goyal MK, Khan Z, Makela H, Sahota PK. 0663 COMPARISON OF INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS (ICSD)-3 AND DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS (DSM)-5 GUIDELINES FOR DIAGNOSING NARCOLEPSY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.662] [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: 11/12/2022] Open
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Affiliation(s)
- B Das
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Patil
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M K Goyal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - M Modi
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - V Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - C Ahuja
- Department of Radiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Abstract
We report two cases of fatal chronic meningoencephalitis caused by Balamuthia mandrillaris in immunocompetent men. Diagnosis of amoebic meningoencephalitis was made ante-mortem in one case and postmortem in another by histopathological examination and confirmed by demonstration of B. mandrillaris deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR).
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Affiliation(s)
| | | | | | | | - B D Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Affiliation(s)
- A Gupta
- Department of Neurology, PGIMER, Chandigarh 160012, India
| | - S Chakravarthi
- Department of Neurology, PGIMER, Chandigarh 160012, India
| | - M K Goyal
- Department of Neurology, PGIMER, Chandigarh 160012, India
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Kumari B, Goyal MK, Lal V. Pearls & Oy-sters: Bilateral cavernous sinus syndrome as presenting manifestation of nasopharyngeal carcinoma. Neurology 2014; 82:e51-4. [DOI: 10.1212/wnl.0000000000000103] [Citation(s) in RCA: 2] [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: 11/15/2022] Open
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Abstract
We report the clinicoradiological features of tuberculosis in the clavicle in 4 patients. The patients' ages ranged from 9 months to 29 years. All patients were managed with antitubercular drug therapy for one year and one underwent surgical debridement and curettage as well. Clinicians should be aware of the varied presentation (pain, non-healing ulcer, abscess, multifocal osteoarticular tuberculosis) of this condition. With the worldwide resurgence of tuberculosis, clinicians should maintain a high index of suspicion. The diagnosis of osteoarticular tuberculosis is usually made on clinico-radiological features.
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Affiliation(s)
- A N Aggarwal
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Aggarwal AN, Goyal MK, Rishi Gupta N. Postaxial polydactyly. JNMA J Nepal Med Assoc 2009; 48:153-154. [PMID: 20387358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We present a case of postaxial polydactyly with well formed six digits on left hand and seven digits on right hand. Both conditions are rare and combination of these two conditions even rarer. The patient also had supernumerary sixth right toe and cleft lip. Very few cases of postaxial polydactyly are reported previously.
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Affiliation(s)
- A N Aggarwal
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delshi, India
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Abstract
The aim of this study was to determine the serum cytokine levels in patients with Wilson's disease (WD) and correlate with phenotype, therapeutic status and laboratory data. In this cross-sectional study, the serum levels of cytokines were estimated in 34 patients (M : F, 23 : 11; drug-naive, 11) with WD (mean age: 13.8 +/- 8.6 and 19.6 +/- 9.03 years) and compared with 30 controls. The following serum cytokines were analysed using enzyme-linked immunosorbent assay: (i) tumour necrosis factor (TNF)-alpha, (ii) interferon (IFN)-gamma, (iii) interleukin (IL)-2, (iv) IL-6 and (v) IL-4. Serum TNF-alpha (P < 0.001), IFN-gamma (P = 0.005) and IL-6 (P < 0.001) were detectable in WD compared with controls. However, serum level elevation of IL-4 (P = 0.49) and IL-2 (P = 0.11), although detectable compared with controls, was statistically insignificant. The disease severity and therapeutic status did not affect the cytokines. Presence of anaemia, leucopenia, thrombocytopenia, pancytopenia and hepatic dysfunction did not influence cytokine levels. There was a significant negative correlation between IL-6 and ceruloplasmin (P = 0.04) and anti-inflammatory cytokines (IL-4) and copper level (P = 0.01). Serum cytokines, both proinflammatory and anti-inflammatory subtypes, were elevated significantly in patients with WD. Further studies would establish their role in its pathogenesis.
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Affiliation(s)
- M K Goyal
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Goyal MK, Sinha S, Ravishankar S, Shivshankar JJ. Case report: Reversible restricted diffusion and cytotoxic edema in the perilesional zone following continuous partial seizures. Indian J Radiol Imaging 2008; 18:227-9. [PMID: 19774163 PMCID: PMC2747428 DOI: 10.4103/0971-3026.41833] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- MK Goyal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - S Ravishankar
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - JJ Shivshankar
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Afif H, Sutter RW, Kew OM, Fontaine RE, Pallansch MA, Goyal MK, Cochi SL. Outbreak of poliomyelitis in Gizan, Saudi Arabia: cocirculation of wild type 1 polioviruses from three separate origins. J Infect Dis 1997; 175 Suppl 1:S71-5. [PMID: 9203695 DOI: 10.1093/infdis/175.supplement_1.s71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In 1989, a localized outbreak of 10 cases of poliomyelitis occurred in Saudi Arabia. Wild poliovirus type 1 was isolated from 5 patients. To determine the patterns of poliovirus circulation, partial nucleotide sequences of the poliovirus isolates were compared. These isolates were remarkably diverse. Two isolates were closely related to each other and to viruses isolated during the 1988 epidemic in Oman. Two other isolates were very similar to viruses found in Egypt. The fifth isolate was distantly related to the latter pair. The molecular data suggest that the 10 cases represented three separate outbreaks. The virologic findings underscore the potential for Saudi Arabia, which receives millions of guest workers and their families each year from countries in which polio is endemic, to be exposed to frequent importations of wild polioviruses. To restrict the circulation of imported polioviruses, Saudi Arabia must maintain high population immunity to poliovirus in all geopolitical divisions.
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Affiliation(s)
- H Afif
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia
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Affiliation(s)
- M K Goyal
- Department of Radiology, Children's Hospital of Philadelphia, Pennsylvania 19104
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