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Winter SF, Walsh D, Catsman-Berrevoets C, Feigin V, Destrebecq F, Dickson SL, Leonardi M, Hoemberg V, Tassorelli C, Ferretti MT, Dé A, Chadha AS, Lynch C, Bakhtadze S, Saylor D, Hwang S, Rostasy K, Kluger BM, Wright C, Zee PC, Dodick DW, Jaarsma J, Owolabi MO, Zaletel J, Albreht T, Dhamija RK, Helme A, Laurson-Doube J, Amos A, Baingana FK, Baker GA, Sofia F, Galvin O, Hawrot T. National plans and awareness campaigns as priorities for achieving global brain health. Lancet Glob Health 2024; 12:e697-e706. [PMID: 38485433 PMCID: PMC10951964 DOI: 10.1016/s2214-109x(23)00598-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 03/19/2024]
Abstract
Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.
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Affiliation(s)
- Sebastian F Winter
- OneNeurology Partnership, Brussels, Belgium; International Bureau for Epilepsy, Washington, DC, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Donna Walsh
- OneNeurology Partnership, Brussels, Belgium; International Bureau for Epilepsy, Washington, DC, USA
| | - Coriene Catsman-Berrevoets
- OneNeurology Partnership, Brussels, Belgium; European Paediatric Neurology Society, Paris, France; Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Valery Feigin
- OneNeurology Partnership, Brussels, Belgium; World Stroke Organization, Geneva, Switzerland; National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Frédéric Destrebecq
- OneNeurology Partnership, Brussels, Belgium; European Brain Council, Brussels, Belgium
| | - Suzanne L Dickson
- OneNeurology Partnership, Brussels, Belgium; European Brain Council, Brussels, Belgium; Department of Physiology/Endocrinology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Matilde Leonardi
- OneNeurology Partnership, Brussels, Belgium; World Federation for Neurorehabilitation, North Shields, UK; Fondazione IRCCS Istituto Neurologico CarloBesta, Milan, Italy
| | - Volker Hoemberg
- OneNeurology Partnership, Brussels, Belgium; World Federation for Neurorehabilitation, North Shields, UK
| | - Cristina Tassorelli
- OneNeurology Partnership, Brussels, Belgium; International Headache Society, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Maria Teresa Ferretti
- OneNeurology Partnership, Brussels, Belgium; Center for Alzheimer Research, Karolinska Institute, Stockholm, Sweden; Women's Brain Project, Bottighofen, Switzerland
| | - Anna Dé
- OneNeurology Partnership, Brussels, Belgium; Women's Brain Project, Bottighofen, Switzerland
| | | | - Chris Lynch
- OneNeurology Partnership, Brussels, Belgium; Alzheimer's Disease International, London, UK
| | - Sophia Bakhtadze
- OneNeurology Partnership, Brussels, Belgium; European Paediatric Neurology Society, Paris, France; Department of Paediatric Neurology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Deanna Saylor
- OneNeurology Partnership, Brussels, Belgium; World Neurology Foundation, New York, NY, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Soonmyung Hwang
- OneNeurology Partnership, Brussels, Belgium; World Neurology Foundation, New York, NY, USA
| | - Kevin Rostasy
- OneNeurology Partnership, Brussels, Belgium; European Paediatric Neurology Society, Paris, France; Department of Paediatric Neurology, Children's Hospital Datteln, University of Witten/Herdecke, Witten, Germany
| | - Benzi M Kluger
- OneNeurology Partnership, Brussels, Belgium; International Neuropalliative Care Society, Roseville, MN, USA; Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Claire Wright
- OneNeurology Partnership, Brussels, Belgium; Meningitis Research Foundation, Bristol, UK; Confederation of Meningitis Organisations, Bristol, UK
| | - Phyllis C Zee
- OneNeurology Partnership, Brussels, Belgium; World Sleep Society, Rochester, MN, USA; Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David W Dodick
- OneNeurology Partnership, Brussels, Belgium; International Headache Society Global Patient Advocacy Coalition, London, UK; Mayo Clinic College of Medicine, Phoenix, AZ, USA; Atria Academy of Science and Medicine, New York, NY, USA; American Migraine Foundation, New York, NY, USA; American Brain Foundation, Minneapolis, MN, USA
| | - Joke Jaarsma
- OneNeurology Partnership, Brussels, Belgium; European Federation of Neurological Associations, Brussels, Belgium
| | - Mayowa O Owolabi
- OneNeurology Partnership, Brussels, Belgium; World Federation for Neurorehabilitation, North Shields, UK; Center for Genomic and Precision Medicine, and Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; African Stroke Organization, Ibadan, Nigeria; Lebanese American University of Beirut, Beirut, Lebanon; Blossom Specialist Medical Center, Ibadan, Nigeria
| | - Jelka Zaletel
- National Institute of Public Health, Ljubljana, Slovenia
| | - Tit Albreht
- National Institute of Public Health, Ljubljana, Slovenia
| | - Rajinder K Dhamija
- OneNeurology Partnership, Brussels, Belgium; World Federation for Neurorehabilitation, North Shields, UK; International Neuropalliative Care Society, Roseville, MN, USA; Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Action Amos
- International Bureau for Epilepsy, Washington, DC, USA; International Bureau for Epilepsy African Region, Blantyre, Malawi
| | - Florence K Baingana
- Regional Advisor, Mental Health and Substance Abuse, World Health Organization African Region, Brazzaville, Congo
| | - Gus A Baker
- OneNeurology Partnership, Brussels, Belgium; International Bureau for Epilepsy, Washington, DC, USA
| | - Francesca Sofia
- OneNeurology Partnership, Brussels, Belgium; International Bureau for Epilepsy, Washington, DC, USA
| | - Orla Galvin
- OneNeurology Partnership, Brussels, Belgium; European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- OneNeurology Partnership, Brussels, Belgium; European Federation of Neurological Associations, Brussels, Belgium
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Gupta HV, Lenka A, Dhamija RK, Fasano A. A video-atlas of levodopa-induced dyskinesia in Parkinson's disease: terminology matters. Neurol Sci 2024; 45:1389-1397. [PMID: 37987930 DOI: 10.1007/s10072-023-07209-6] [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: 08/13/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
Dyskinesia is a common complication of long-term levodopa therapy in patients with Parkinson's disease (PD), which often worsens the quality of life. It is usually dose-dependent and emerges possibly due to pulsatile stimulation of dopamine receptors. Delineating the pattern of dyskinesia is crucial for determining the most effective therapeutic approach, a task that often presents challenges for numerous neurologists. This article comprehensively describes various patterns of dyskinesia in PD patients and features video demonstration of some of the common forms of dyskinesia. We have used a real case scenario as an example to lead the discussion on the phenomenology, distinguishing features, and management of various types of dyskinesia. A comprehensive literature search was conducted in PubMed using "dyskinesia" as a keyword. The prototype case with videos highlights the differentiating features of dyskinesia along with the treatment strategies. A wide range of descriptive rubrics have been used for certain dyskinesia which are described in detail in this article. The newer types of dyskinesia associated with continuous dopaminergic stimulation in patients with advanced PD and their implications have been described. As there are distinct ways of managing various types of dyskinesia, understanding the phenomenology and chronology of dyskinesia is vital for the optimal management of dyskinetic PD patients. We suggest that dyskinesia should be classified broadly into peak-dose dyskinesia (PDD), biphasic dyskinesia (BD), and OFF-period dystonia. The occurrence of low-dose dyskinesia and complex dyskinesia of continuous dopaminergic treatments should be known to specialists and will require additional studies.
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Affiliation(s)
- Harsh V Gupta
- Department of Neurology, Memorial Healthcare System, Hollywood, FL, USA.
| | - Abhishek Lenka
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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Mulchandani R, Lyngdoh T, Gandotra S, Isser HS, Dhamija RK, Kakkar AK. Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future. Front Public Health 2024; 12:1309089. [PMID: 38487184 PMCID: PMC10938915 DOI: 10.3389/fpubh.2024.1309089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Tanica Lyngdoh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sheetal Gandotra
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research (CSIR), New Delhi, India
| | - H. S. Isser
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, University of Delhi, New Delhi, India
| | - Ashish Kumar Kakkar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sharma P, Roy A, Dhamija RK, Bhushan S, Baswal K, Kulandaisamy R, Yadav S, Kumar S, Inampudi KK. A comprehensive proteomic profiling of urinary exosomes and the identification of early non-invasive biomarker in patients with coronary artery disease. J Proteomics 2024; 293:105059. [PMID: 38151158 DOI: 10.1016/j.jprot.2023.105059] [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: 10/05/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 12/29/2023]
Abstract
Urinary small extracellular vesicles or exosomes (uEVs) source could be an emerging trove of biomarkers in coronary artery disease (CAD). It is a chronic inflammatory disease having a long asymptomatic phase of fatty-fibrous development in arteries leading to angina, myocardial infarction, and death. Our study was aimed at identifying differential protein expression profiling of uEVs in CAD. We collected urine samples of CAD patients (n = 41) age 18-65 years and gender matched healthy controls (n = 41). We isolated uEVs using differential ultracentrifugation. Further, uEV samples were characterized by western blotting exosome markers (Flotillin, TSG, CD63, and CD9), nano tracking analysis, and transmission and scanning electron microscopy. A total of 508 proteins were identified by iTRAQ-based mass spectrometry. We observed protein expression levels of AZGP1, SEMG1/2, ORM1, IGL, SERPINA5, HSPG2, prosaposin, gelsolin, and CD59 were upregulated, and UMOD, KNG1, AMBP, prothrombin, and TF were downregulated. Protein-protein interactions, gene ontology and pathway analysis were performed to functionally annotate identified uEVs proteins. A novel uEVs differential protein signature is shown. On validating UMOD protein by ELISA in two clinically different CAD, stable-CAD patients had lower levels than healthy controls whereas recent myocardial infarction patients had lowest. Our findings suggest UMOD importance as early diagnostic biomarker. SIGNIFICANCE: Coronary artery disease is a chronic inflammatory disease caused by gradual deposition of cholesterol and fat along with other proteins to develop plaque inside arteries. This further leads to blockage of artery, heart attack and death. There are no identifiable early biomarkers to diagnose this. For the first time, we have identified the differentially expressed proteins isolated from non-invasive uEV of CAD patients compared to healthy controls by using MS Orbitrap and iTRAQ labelling of peptides. We have identified decreased levels of UMOD protein in CAD. These findings have been confirmed by ELISA. Furthermore, the levels of UMOD were observed as more highly decreased in recent myocardial infarction CAD patients, indicating the importance of this protein as an early diagnostic biomarker. Conclusively, our study represents a non-invasive urinary EVs trove of differentially expressed proteins in CAD. This will form a groundwork for understanding the pathophysiology of CAD and will help in future translational research utilizing uEVs.
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Affiliation(s)
- Pratibha Sharma
- Human Behaviour Department, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, New Delhi, India; Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India.
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Human Behaviour Department, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, New Delhi, India
| | - Sudha Bhushan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Baswal
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Saroj Kumar
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India; Department of Health Education and Technology, Luleå University of Technology, Sweden
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Sharma P, Malhotra L, Dhamija RK. Comprehensive amino acid composition analysis of seed storage proteins of cereals and legumes: identification and understanding of intrinsically disordered and allergenic peptides. J Biomol Struct Dyn 2024:1-13. [PMID: 38178552 DOI: 10.1080/07391102.2023.2300126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
The seed storage proteins of cereal and legumes are the primary source of amino acids which are required for sustaining the nitrogen and carbon demands during germination and growth. Humans derive most of their dietary proteins from storage proteins in form of a wide variety of foods, for consumption. The amino acid content of most of these proteins is biased and the need for this biasness is not understood. The high abundance of proline, glutamine, and cysteine in cereals makes the gluten fraction viscoelastic. The cereal proteins have less charge and legume proteins have more charge on them. Their non-polar amino acid distribution has large variations. These characteristics are strongly responsible for the partial and complete unfolding of several domains of the storage proteins. Many of the storage proteins share a highly conserved structural feature within the cupin superfamily spread across all kingdoms of life. The intrinsically disordered viscoelastic proteins help in making dough which is vital for the quality of bread. Unfolded regions harbor more immunogenic sequences and cause food-related allergies and intolerance. We have discussed these properties in terms of comparison of cereal and legume storage protein sequences and allergy. Our study supports the findings that large disordered regions contain allergen-representative peptides. Interestingly, a high number of allergen-representative peptides were cleavable by digestive enzymes. Furthermore, unfolded storage proteins mimic microbial immunogens to induce a memory immune response. Results findings can be used to guide the understanding of immunological characteristics of storage proteins and may assist in treatment decisions for food allergy.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Pratibha Sharma
- Human Behaviour Department, Institute of Human Behaviour and Allied Sciences, New Delhi, India
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshay Malhotra
- Department of Biophysics, All India Institute of Medical Sciences, New Delhi, India
- Department of Biochemistry, Sri Venkateswara College, University of Delhi, New Delhi, India
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Saluja A, Anees S, Abbey P, Ghotekar LH, Dhamija RK. Tubercular Mediastinal Lymphadenopathy Presenting as an Isolated Unilateral Vocal Cord Palsy and the "Sail" Sign. Cureus 2024; 16:e51950. [PMID: 38333460 PMCID: PMC10852528 DOI: 10.7759/cureus.51950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Tuberculosis continues to remain a major public health challenge, especially in low- and middle-income countries. Unilateral vocal cord palsy in adults as the sole manifestation of tubercular mediastinal lymphadenopathy has been rarely reported. A 22-year-old lady presented with a history of hoarseness of voice for the past month. The general physical examination revealed palpable lymph nodes in the left axilla. Axial CT sections at the level of the vocal cords demonstrated dilation of the right laryngeal ventricle and mild anteromedial deviation of the ipsilateral arytenoid cartilage ("sail" sign) suggestive of a right vocal cord palsy. Contrast-enhanced CT chest revealed right paratracheal, right hilar, and subcarinal lymph nodes with areas of central necrosis. She was started on anti-tubercular therapy and her voice completely improved after three months of treatment. The "Sail" sign on axial CT scans is a useful radiological sign for diagnosing unilateral vocal cord palsy. Rarely, compression of the recurrent laryngeal nerve by enlarged mediastinal lymph nodes due to tuberculosis can present with unilateral vocal cord palsy as the sole manifestation in adults.
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Affiliation(s)
- Alvee Saluja
- Neurology, Lady Hardinge Medical College, New Delhi, IND
| | - Shahbaz Anees
- Neurology, Lady Hardinge Medical College, New Delhi, IND
| | - Pooja Abbey
- Radio-diagnosis, Lady Hardinge Medical College, New Delhi, IND
| | - L H Ghotekar
- Internal Medicine, Lady Hardinge Medical College, New Delhi, IND
| | - Rajinder K Dhamija
- Neurology, Institute of Human Behavior and Allied Sciences, New Delhi, IND
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Kumar P, Saluja A, Garg J, Dhamija RK, Anand KS. Peripheral Neuropathy in Parkinson's Disease is Significantly Associated with Elevated Serum Homocysteine Levels. Neurol India 2023; 71:1292-1293. [PMID: 38174487 DOI: 10.4103/0028-3886.391350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Prashant Kumar
- Department of Neurology, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Jyoti Garg
- Department of Neurology, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Metta V, Dhamija RK, Batzu L, Mrudula R, Kumar NSS, S A, Falup-Pecurariu C, Rodriguez-Blazquez C, Goyal V, L K P, Bhattacharya K, Kumar S, Chaudhuri KR, Borgohain R. Safety and tolerability of long-term apomorphine infusion in advanced Parkinson's disease: an Indian multi-center (APO-IND) experience. Sci Rep 2023; 13:18681. [PMID: 37907679 PMCID: PMC10618227 DOI: 10.1038/s41598-023-46003-4] [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: 05/30/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
Advanced Parkinson's Disease (APD) is complicated by the emergence of motor and non-motor fluctuations, which are initially predictable and eventually become unpredictable, in part due to erratic gastric absorption and short half of oral levodopa. Attempts to manage such fluctuations with oral dopaminergic drugs often lead to disabling dyskinesias. Continuous Subcutaneous Apomorphine Infusion (CSAI), despite being approved for the treatment of APD since 1993, was approved in India only in 2019. We studied the safety, tolerability and efficacy of CSAI in Indian patients with APD in a registry design to raise local awareness of this important treatment. We conducted a prospective registry-based observational audit at 10 centers across different states of India. Patients with APD, not responding to or with significant side effects from oral dopaminergic therapy, were assessed at baseline and at month 6 and 12 following CSAI infusion. Fifty-one patients completed the study, CSAI significantly reduced the functional impact of dyskinesia (p < 0.01 at 6 months and p < 0.001 at 12 months). There was a significant improvement in the OFF-state from baseline (p < 0.01 at 6 months and p < 0.001 at 12 months) No discernible side effects were observed apart from mild site reaction (n = 7), nausea (n = 7) skin nodules (n = 2). CSAI demonstrated safety, efficacy, tolerability and improved quality of life in patients with APD, as shown in previous studies. Our study highlighted current existing inequalities in treatment availability, lack of awareness, knowledge gap, affordability and cost remains a concern regarding apomorphine use in Indian PD population.
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Affiliation(s)
- Vinod Metta
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK.
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates.
- Parkinson's Foundation Centre of Excellence, King's College Hospital London, London, SE5 9RS, UK.
| | - Rajinder K Dhamija
- Institute of Human Behavior and Allied Sciences, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Lucia Batzu
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rukmini Mrudula
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Natuva Sai Sampath Kumar
- Institute of Movement Disorders, Narayana Medical College and Postgraduate Research Centre, Nellore, India
| | - Arunan S
- SRM Institute of Medical Sciences and Technology, Chennai, India
| | | | | | - Vinay Goyal
- Institute of Movement Disorders and Parkinson's Centre, Medanta Hospital, New Delhi, India
| | - Prashanth L K
- Center for Parkinson's Disease and Movement Disorders, Manipal Hospital, Bangalore, India
| | | | - Suresh Kumar
- Amrita Institute of Medical Sciences, Kochi, India
| | - Kallol Ray Chaudhuri
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience and Parkinson's Foundation Centre of Excellence, King's College London, King's College Hospital, London, UK
- Parkinson's Foundation Centre of Excellence, King's College Hospital, London, Dubai, United Arab Emirates
| | - Rupam Borgohain
- Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Rajendran D, Bandhu R, Gautam S, K Dhamija R, Mondal S. Auditory Evoked P300 Potential in Patients With Parkinson's Disease. Cureus 2023; 15:e45933. [PMID: 37885554 PMCID: PMC10599456 DOI: 10.7759/cureus.45933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder. Though the cardinal features of PD are motor symptoms, it is also associated with many non-motor symptoms, such as cognitive impairment, autonomic dysfunction, sleep disorders, and depression, which could affect the quality of life. Early identification of PD's non-motor signs can aid in the diagnosis of PD. The current research aimed to assess the neurophysiological changes in PD patients using auditory evoked P300 potential and to determine the possible correlation between P300 wave components and cognitive impairment. MATERIALS AND METHODS This cross-sectional research involved 32 idiopathic PD patients. The neurophysiological changes in PD patients were studied using auditory evoked P300 potential and the obtained data were compared with normative data. The patient's cognitive status was scored using the Montreal Cognitive Assessment (MoCA) questionnaire and they were divided into two groups: the patients with normal cognition and the patients with impaired cognition. RESULTS The participants showed a significant decrease in P300 amplitude (p = 0.000) but no change in P300 latency when compared to normative data using the Wilcoxon rank sum test. Also, there was a positive correlation between the MoCA score and P300 amplitude (p < 0.05), indicating that if cognition is impaired, P300 amplitude would also be reduced. There was a significant difference between PD patients with impaired cognition and patients with normal cognition in the P300 amplitude at Cz (p = 0.001) and Fz (p = 0.003) when the Mann-Whitney U test was used. These findings indicate that it is possible to notice changes in the P300 wave components among PD patients when their cognition is impaired. CONCLUSION Auditory evoked P300 potentials can be used to objectively evaluate cognition in PD patients and by starting supportive therapy, the quality of life for PD patients can be improved.
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Affiliation(s)
- Dhivya Rajendran
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, IND
| | - Rajiv Bandhu
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, IND
| | - Sujata Gautam
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, IND
| | - Rajinder K Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, IND
| | - Sunita Mondal
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, IND
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Gupta M, Rao C, Yadav AK, Jat M, Dhamija RK, Saikia N. The COVID-19 pandemic death toll in India: can we know better? BMJ Glob Health 2023; 8:e012818. [PMID: 37643805 PMCID: PMC10465911 DOI: 10.1136/bmjgh-2023-012818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- M Gupta
- Alchemist Research and Data Analysis, Chandigarh, India
| | - Chalapati Rao
- Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Munita Jat
- Alchemist Research and Data Analysis, Chandigarh, India
| | - Rajinder K Dhamija
- Institute of Human Behaviour and Allied Sciences, New Delhi, Delhi, India
| | - Nandita Saikia
- International Institute for Population Sciences, Mumbai, Maharashtra, India
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Saluja A, Sinha P, Anees S, Verma J, Ghotekar LH, Dhamija RK. Wing beating tremors in Wilson's disease: An important clinical clue. J Neurosci Rural Pract 2023; 14:547-548. [PMID: 37692815 PMCID: PMC10483189 DOI: 10.25259/jnrp_264_2023] [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] [Received: 05/13/2023] [Accepted: 06/08/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Prerna Sinha
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Shahbaz Anees
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Jyoti Verma
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - L. H. Ghotekar
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Chockalingam M, Srivastava A, C Gandhi DB, Solomon JM, Kamalakannan S, Rajeswaran J, Dhamija RK, Someshwar HP, Surya N. Digitalization of Neurorehabilitation in LMICs: Experiences from the Indian Federation of Neurorehabilitation. Neurol India 2023; 71:783-784. [PMID: 37635520 DOI: 10.4103/0028-3886.383873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Manigandan Chockalingam
- Department of Occupational Therapy, School of Health Sciences, University of Galway, University Road, Galway, Ireland
| | - Abhishek Srivastava
- Centre for Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharastra, India
| | - Dorcas B C Gandhi
- Department of Neurology and College of Physiotherapy, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sureshkumar Kamalakannan
- Department of Social Work, School of Health and Life Sciences, Education and Community Well-Being, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, NIMHANS, Bengaluru, Karnataka, India
| | - Rajinder K Dhamija
- Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, India
| | - Hitav Pankaj Someshwar
- Early Intervention Center, TNMC and BYL Nair Ch. Hospital, Bhaudaji Road, Matunga, Mumbai, Maharastra, India
| | - Nirmal Surya
- Department of Neurology, Bombay Hospital and Medical Research, Mumbai, Maharastra, India
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Sharma P, Dhamija RK, Nag TC, Roy A, Inampudi KK. Different Biofluids, Small Extracellular Vesicles or Exosomes: Structural Analysis in Atherosclerotic Cardiovascular Disease Using Electron Microscopy Techniques. Microsc Microanal 2023; 29:1168-1177. [PMID: 37749667 DOI: 10.1093/micmic/ozad025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/20/2023] [Indexed: 09/27/2023]
Abstract
Small extracellular vesicles (sEVs) or exosomes are secretory vesicles largely involved in cell-cell communications and found to play a role in development as well as diseases including atherosclerosis. They hold a huge potential for translational research by devising better clinical diagnostics, biomarker discovery, drug delivery, and therapeutic strategies. Variations terms of morphology and distribution are crucial to biological function integrity. Moreover, it is dependent on susceptibility to influential factors of the environment like cell stress, inflammation, and secretion by different cells in subsequent biofluids. We have observed the morphological variations in sEVs or exosomes freshly isolated from patients with atherosclerotic cardiovascular disease (AsCVD), in blood plasma, saliva, and urine biofluids compared to healthy controls. High-resolution images were obtained by transmission electron microscopy (TEM) and scanning electron microscopy (SEM) for the characterization of sEVs morphology. Western blotting and immuno-TEM gold labeling confirmed the presence of exosome markers. For the first time, we report size and shape variations, which suggest the existence of different functions of sEVs in the disease state. Morphological variations in sEVs were observed significantly in noninvasive AsCVD saliva and urine samples, important to understand the cell behavior and physiological state. These variations will be useful to investigate their possible role in the disease process.
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Affiliation(s)
- Pratibha Sharma
- Department of Biophysics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
- Human Behaviour Department, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi 110095, India
| | - Rajinder K Dhamija
- Human Behaviour Department, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi 110095, India
| | - Tapas Chandra Nag
- Department of Anatomy, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Krishna Kishore Inampudi
- Department of Biophysics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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14
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Owolabi MO, Leonardi M, Bassetti C, Jaarsma J, Hawrot T, Makanjuola AI, Dhamija RK, Feng W, Straub V, Camaradou J, Dodick DW, Sunna R, Menon B, Wright C, Lynch C, Chadha AS, Ferretti MT, Dé A, Catsman-Berrevoets CE, Gichu M, Tassorelli C, Oliver D, Paulus W, Mohammed RK, Charway-Felli A, Rostasy K, Feigin V, Craven A, Cunningham E, Galvin O, Perry AH, Fink EL, Baneke P, Helme A, Laurson-Doube J, Medina MT, Roa JD, Hogl B, O'Bryan A, Trenkwalder C, Wilmshurst J, Akinyemi RO, Yaria JO, Good DC, Hoemberg V, Boon P, Wiebe S, Cross JH, Haas M, Jabalpurwala I, Mojasevic M, DiLuca M, Barbarino P, Clarke S, Zuberi SM, Olowoyo P, Owolabi A, Oyesiku N, Maly-Sundgren PC, Norrving B, Soekadar SR, van Doorn PA, Lewis R, Solomon T, Servadei F. Global synergistic actions to improve brain health for human development. Nat Rev Neurol 2023; 19:371-383. [PMID: 37208496 PMCID: PMC10197060 DOI: 10.1038/s41582-023-00808-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 05/21/2023]
Abstract
The global burden of neurological disorders is substantial and increasing, especially in low-resource settings. The current increased global interest in brain health and its impact on population wellbeing and economic growth, highlighted in the World Health Organization's new Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders 2022-2031, presents an opportunity to rethink the delivery of neurological services. In this Perspective, we highlight the global burden of neurological disorders and propose pragmatic solutions to enhance neurological health, with an emphasis on building global synergies and fostering a 'neurological revolution' across four key pillars - surveillance, prevention, acute care and rehabilitation - termed the neurological quadrangle. Innovative strategies for achieving this transformation include the recognition and promotion of holistic, spiritual and planetary health. These strategies can be deployed through co-design and co-implementation to create equitable and inclusive access to services for the promotion, protection and recovery of neurological health in all human populations across the life course.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- Neurology Unit, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.
- African Stroke Organization, Ibadan, Nigeria.
- World Federation for Neurorehabilitation, North Shields, UK.
- Lebanese American University of Beirut, Beirut, Lebanon.
- Blossom Specialist Medical Center, Ibadan, Nigeria.
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudio Bassetti
- Neurology Department Inselspital - University of Bern, Bern, Switzerland
- European Academy of Neurology, Vienna, Austria
| | - Joke Jaarsma
- European Federation of Neurological Associations, Brussels, Belgium
| | - Tadeusz Hawrot
- European Federation of Neurological Associations, Brussels, Belgium
| | | | | | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jennifer Camaradou
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- One Neurology Initiative, Brussels, Belgium
| | - David W Dodick
- Department of Neurology, Mayo Clinic, Phoenix, AZ, USA
- Atria Academy of Science and Medicine, New York, NY, USA
- American Brain Foundation, Minneapolis, MN, USA
| | - Rosita Sunna
- Tics and Tourette Across the Globe, Hannover, Germany
- Australian Clinical Psychology Association, Sydney, New South Wales, Australia
| | - Bindu Menon
- Department of Neurology, Apollo Specialty Hospitals, Nellore, India
| | | | - Chris Lynch
- Alzheimer's Disease International, London, UK
| | | | | | - Anna Dé
- Women's Brain Project, Guntershausen, Switzerland
| | - Coriene E Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- European Paediatric Neurology Society, Bolton, UK
| | - Muthoni Gichu
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Global Brain Health Institute, San Francisco, CA, USA
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences of the University of Pavia, Pavia, Italy
- IRCCS C. Mondino Foundation Neurological Institute, Pavia, Italy
- International Headache Society, London, UK
| | - David Oliver
- University of Kent, Canterbury, UK
- International Neuro-Palliative Care Society, Roseville, MN, USA
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians University Munich, Klinikum Großhadern, Munich, Germany
- International Federation of Clinical Neurophysiology, Milwaukee, WI, USA
| | - Ramla K Mohammed
- Amal Neuro Developmental Centres, Gudalur, India
- Al Ameen Educational Trust, Gudalur, India
| | | | - Kevin Rostasy
- European Paediatric Neurology Society, Bolton, UK
- Department of Paediatric Neurology, Children's Hospital Datteln, University Witten/Herdecke, Witten, Germany
| | - Valery Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Orla Galvin
- European Federation of Neurological Associations, Brussels, Belgium
| | | | - Ericka L Fink
- Department of Paediatric Neurology and Critical Care, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Safar Center for Resuscitation Research, University of Pittsburgh Medical Centre Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
| | - Anne Helme
- Multiple Sclerosis International Federation, London, UK
| | | | - Marco T Medina
- National Autonomous University of Honduras, Tegucigalpa, Honduras
- Pan-American Federation of Neurological Societies, Santiago de Chile, Chile
| | - Juan David Roa
- HOMI Fundacion Hospital Paediatrico la Misericordia, Bogota, Colombia
| | - Birgit Hogl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- World Sleep Society, Rochester, MN, USA
| | | | - Claudia Trenkwalder
- Paracelsus-Elena Hospital, Kassel, Department of Neurosurgery, University Medical Centre, Goettingen, Germany
| | - Jo Wilmshurst
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- International Child Neurology Association, London, UK
| | - Rufus O Akinyemi
- African Stroke Organization, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Joseph O Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - David C Good
- World Federation for Neurorehabilitation, North Shields, UK
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Volker Hoemberg
- World Federation for Neurorehabilitation, North Shields, UK
- SRH Neurorehabilitation Hospital Bad Wimpfen, Bad Wimpfen, Germany
| | - Paul Boon
- European Academy of Neurology, Vienna, Austria
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Samuel Wiebe
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
- International League Against Epilepsy, Flower Mound, TX, USA
| | - J Helen Cross
- International League Against Epilepsy, Flower Mound, TX, USA
- Clinical Neurosciences Section, UCL Institute of Child Health, University College London, London, UK
| | - Magali Haas
- Cohen Veterans Bioscience, New York, NY, USA
| | | | | | - Monica DiLuca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- European Brain Council, Brussels, Belgium
| | | | - Stephanie Clarke
- World Federation for Neurorehabilitation, North Shields, UK
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sameer M Zuberi
- European Paediatric Neurology Society, Bolton, UK
- Paediatric Neurosciences Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Olowoyo
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
- Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | | | - Nelson Oyesiku
- Department of Neurosurgery, University of North Carolina at Chapel Hill, North Carolina, NC, USA
- World Federation of Neurosurgical Societies, Prague, Czech Republic
| | - Pia C Maly-Sundgren
- Department of Clinical Sciences/Diagnostic Radiology, Lund University, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences/Neurology, Lund University, Lund, Sweden
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Peripheral Nerve Society, Roseville, MN, USA
| | - Richard Lewis
- Peripheral Nerve Society, Roseville, MN, USA
- Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Tom Solomon
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, North Yorkshire, UK
| | - Franco Servadei
- World Federation of Neurosurgical Societies, Prague, Czech Republic
- Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Milan, Italy
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Baruah U, Sharma P, Thomas PT, Dhamija RK. Neuropalliative Care in India - Barriers, Challenges and Future Directions. Ann Indian Acad Neurol 2023; 26:107-111. [PMID: 37179665 PMCID: PMC10171018 DOI: 10.4103/aian.aian_1021_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
Neuropalliative care is an emerging sub-specialty of neurology and palliative care that aims to relieve suffering from symptoms, reduce distress and improve the quality of life of people with life-limiting neurological conditions and their family caregivers. As advances are being made in the prevention, diagnosis, and treatment of neurological illnesses, there is an increasing need to guide and support patients and their families through complex choices involving immense uncertainty and important life-changing outcomes. The unmet need for palliative care in neurological illnesses is high, especially in a low-resource setting like India. This article discusses the scope of neuropalliative care in India, the barriers and challenges that impede the specialty's development, and the factors that could facilitate the development and scale-up delivery of neuropalliative services. The article also attempts to highlight priority areas for advancing neuropalliative care in India which include context-specific assessment tools, sensitization of the healthcare system, identification of intervention outcomes, the need for developing culturally sensitive models based on home-based or community-based care, evidence-based practices, and development of manpower and training resources.
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Affiliation(s)
- Upasana Baruah
- Department of Psychiatric Social Work, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Prerna Sharma
- Clinical Psychology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Kapoor S, Saluja A, Margekar SL, Agarwal M, Mondal S, Dhamija RK. Neurogenic Supine Hypertension and Cardiovascular Autonomic Dysfunction in Patients with Parkinson's Disease. Ann Indian Acad Neurol 2023; 26:33-38. [PMID: 37034036 PMCID: PMC10081556 DOI: 10.4103/aian.aian_476_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/22/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022] Open
Abstract
Background Natural history and disease progression in patients with Idiopathic Parkinson's Disease (PD) is quite heterogeneous. Autonomic dysfunction occurs commonly among Idiopathic PD patients. Heart rate variability and ambulatory blood pressure monitoring are used to assess cardiac autonomic dysfunction. The prevalence and magnitude of supine hypertension in Indian PD patients has not been studied to date. The present study aimed to record cardiovascular autonomic functions and supine hypertension in PD patients and to correlate them with the age of onset, duration and severity of the disease, and non-motor symptom burden. Material and Methods The cross-sectional study involved 60 PD patients. Webster rating scale was used to determine the disease severity. Non-motor symptom burden was assessed using the Non-Motor Symptom Scale (NMSS). Ambulatory blood pressure monitoring and heart rate variability parameters determined cardiac autonomic function. Supine hypertension was defined as Systolic Blood Pressure (SBP) ≥150 mmHg and/or DBP ≥90 mmHg. Less than 10% decrease or even increase in blood pressure during the night were classified as non-dippers. Pearson coefficient was used appropriately to establish correlation. P ≤ 0.05 was considered significant. Results Age of onset was 61.2 ± 8.7 years and duration of disease was 1.7 ± 1.1 years. Mean Webster and non-motor symptom scores were 12.7 ± 4.4 and 15.5 ± 8.0, respectively. About 50 patients (83%) were non-dipper, while 32 (53%) had supine hypertension. Low Frequency oscillations (LF) (r = 0.28), High Frequency oscillations (HF) (r = 0.29), Standard Deviation NN intervals (SDNN) (0.26), and Root Mean Squared Successive Differences of NN intervals (RMSSD) (r = 0.28) correlated significantly with non-motor symptoms scale. LF (r = -0.39), HF (r = -0.43), SDNN (-0.40), RMSSD (r = -0.41), NN50 (r = -0.38), PNN50 (r = -0.42), mean SBP (r = 0.26), and mean DBP (r = 0.33) correlated significantly with disease duration. PNN50 (r = -0.255), mean SBP (r = -0.29), and mean DBP (r = -0.27) correlated significantly with age at onset. Conclusion Awareness regarding neurogenic supine hypertension is needed as it occurs commonly among Indian PD patients. Heart rate variability (HRV) parameters and ambulatory blood pressure are of significant help in the detection of early cardiovascular autonomic dysfunction and correlate significantly with disease duration and non-motor symptom burden among PD patients.
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Affiliation(s)
- Sunil Kapoor
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Shubha Laxmi Margekar
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Mayank Agarwal
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sunita Mondal
- Department of Physiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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17
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Saluja A, Parihar J, Dhamija RK. Reader Response: Impact of the COVID-19 Pandemic on Epilepsy Center Practice in the United States. Neurology 2022; 99:866-867. [PMID: 36344276 DOI: 10.1212/wnl.0000000000201460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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18
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Sireesha Y, Shree R, Nagappa M, Patil A, Singla M, Padma Srivastava MV, Dhamija RK, Balaram N, Pathak A, Ramachandran D, Kumar S, Puri I, Sharma S, Panda S, Desai S, Samal P, Choudhary A, Vijaya P, Ferreira T, Nair SS, Sinha HP, Bhoi SK, Sebastian J, Sharma S, Basheer A, Bhartiya M, Mathukumalli N, Jabeen SA, Lal V, Modi M, Sharma PP, Kaul S, Singh G, Agarwal A, Garg D, Jose J, Dev P, Iype T, Gopalakrishnan M, Upadhyay A, Bhatia R, Pandit AK, Singh RK, Salunkhe M, Yogeesh P, Reyaz A, Nadda N, Jha M, Kumar B, Kushwaha PK, Chovatiya H, Madduluri B, Ramesh P, Goel A, Yadav R, Vishnu VY. Impact of COVID-19 on Guillain-Barre Syndrome in India: A Multicenter Ambispective Cohort Study. Ann Indian Acad Neurol 2022; 25:1116-1121. [PMID: 36911481 PMCID: PMC9996522 DOI: 10.4103/aian.aian_523_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 03/14/2023] Open
Abstract
Introduction/Aims Studies conducted during the coronavirus disease 2019 (COVID-19) pandemic have reported varied data regarding the incidence of Guillain-Barre syndrome (GBS). The present study investigated demographic and clinical features, management, and outcomes of patients with GBS during a specified period of the COVID-19 pandemic, and compared these features to those of GBS in the previous year. Methods A multicenter, ambispective cohort study including 26 centers across India was conducted. Data from a pre-COVID-19 period (March 1 to August 31, 2019) were collected retrospectively and collected ambispectively for a specified COVID-19 period (March 1 to August 31, 2020). The study was registered with the Clinical Trial Registry India (CTRI/2020/11/029143). Results Data from 555 patients were included for analysis: pre-COVID-19 (n = 334) and COVID-19 (n = 221). Males were more commonly affected during both periods (male:female, 2:1). Gastroenteritis was the most frequent antecedent event in 2019 (17.4%), whereas fever was the most common event in 2020 (10.7%). Paraparesis (21.3% versus [vs.] 9.3%, P = 0.001) and sensory involvement (51.1% vs. 41.3%; P = 0.023) were more common during COVID-19 in 2020, whereas back pain (26.3% vs. 18.4%; P = 0.032) and bowel symptoms (20.7% vs. 13.7%; P = 0.024) were more frequent in the pre-COVID period. There was no difference in clinical outcomes between the two groups in terms of GBS disability score at discharge and 3 months after discharge. Independent predictors of disability in the pre-COVID period included areflexia/hyporeflexia, the requirementfor intubation, and time to bulbar weakness; in the COVID-19 period, independent predictors included time from onset to admission, intubation, and intubation requirement. The mortality rate was 2.3% during the entire study period (13/555 cases). Discussion Results of this study revealed an overall reduction in the frequency of GBS during the pandemic. The lockdown likely reduced the risk for antecedent infections due to social distancing and improved hygiene, which may have resulted in the reduction of the frequency of GBS.
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Affiliation(s)
- Yareeda Sireesha
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ritu Shree
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Nagappa
- National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Anuja Patil
- Krishna Institute of Medical Sciences Hospital, Secunderabad, Telangana, India
| | | | | | - RK Dhamija
- Lady Hardinge Medical College, New Delhi, India
| | | | - Abhishek Pathak
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | | | - Sujit Kumar
- Apollo Hospitals, Sheshadripuram, Bangalore, India
| | - Inder Puri
- PBM Hospital, Sardar Patel Medical College, Bikaner, India
| | - Sudhir Sharma
- Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
| | - Samhita Panda
- All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Soaham Desai
- Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | | | | | - Pamidimukkala Vijaya
- Lalitha Super Specialities Hospital Private Limited, Guntur, Andhra Pradesh, India
| | | | - S. S. Nair
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - H. P. Sinha
- NH MMI Narayana Superspeciality Hospital, Raipur, Chattisgarh, India
| | - S. K. Bhoi
- All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | | | - Sanjay Sharma
- Ramakrishna Care Medical Sciences Private Limited, Raipur, India
| | - Aneesh Basheer
- Pondicherry Institute of Medical Sciences, Pondicherry, India
| | | | | | | | - Vivek Lal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - P Praveen Sharma
- National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Subash Kaul
- Krishna Institute of Medical Sciences Hospital, Secunderabad, Telangana, India
| | | | - Ayush Agarwal
- All India Institute of Medical Sciences, New Delhi, India
| | | | - James Jose
- Government Medical College Kozhikode, Kerala, India
| | - Priya Dev
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Thomas Iype
- Government Medical College, Thiruvananthapuram, Kerala, India
| | | | | | - Rohit Bhatia
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - P.M. Yogeesh
- All India Institute of Medical Sciences, New Delhi, India
| | - Alisha Reyaz
- All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Nadda
- Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh, India
| | - Menkha Jha
- All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bismay Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - PK Kushwaha
- NH MMI Narayana Superspeciality Hospital, Raipur, Chattisgarh, India
| | - Harshadkumar Chovatiya
- Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
| | | | - P Ramesh
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Abeer Goel
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Yadav
- Shree Krishna Hospital and Pramukhswami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
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Saluja A, Verma J, Anees S, Nangia A, Dhamija RK. Morvan's syndrome: An unusual presentation of a solid pseudopapillary pancreatic tumor. J Neurosci Rural Pract 2022; 13:768-770. [PMID: 36743755 PMCID: PMC9894319 DOI: 10.25259/jnrp-2022-3-49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/16/2022] [Indexed: 11/19/2022] Open
Abstract
Morvan's syndrome is a rare anti-contactin-associated protein-like 2 (CASPR2) antibody-mediated autoimmune disorder. The clinical features of this syndrome include muscular twitching, insomnia, dysautonomia, peripheral nerve hyperexcitability, and fluctuating delirium. An underlying tumor is commonly found among Morvan's syndrome cases, with thymoma being the most frequent association. We describe an unusual case of a 39-year-old female with excruciating bilateral leg pain, insomnia, hyperhidrosis, peripheral nerve hyperexcitability, serum anti-CASPR2 antibody positivity, and a solid pseudopapillary tumor of the pancreas on histopathology. Furthermore, the patient's symptoms improved after receiving intravenous immunoglobulin (0.4 g/kg per day for 5 days). To the best of our knowledge, this is the first case of Morvan syndrome associated with a solid pseudopapillary pancreatic tumor to be reported in the literature to date. Our case adds to the spectrum of malignancies that are associated with Morvan's syndrome. The recognition of this rare syndrome and its various associations are important for the neurologist, as it is a potentially treatable condition.
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Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Jyoti Verma
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Shahbaz Anees
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Anita Nangia
- Department of Pathology, Lady Hardinge Medical College, New Delhi, India
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20
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Dhamija RK, Saluja A. Seizures Associated with Cerebrovascular Disease: Experience from an Indian Tertiary Care Center. Neurol India 2022; 70:2279-2280. [PMID: 36352676 DOI: 10.4103/0028-3886.359168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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21
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Kumari S, Singh R, Chandra S, Mehndiratta M, Debnath E, Dhamija RK. Association of Paraoxonase-2 (C1053G) Gene Polymorphism with the Expression of Paraoxonase-2 Gene in Patients of Ischemic Stroke - A Pilot Study in Indian Population. Neurol India 2022; 70:1575-1579. [PMID: 36076661 DOI: 10.4103/0028-3886.355082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Objective Oxidative stress plays an important role in atherosclerosis and ischemic stroke. Due to antioxidant properties of Paraoxonase-2, we studied the implication of Paraoxonase-2 gene polymorphism (C1053G) on expression of Paraoxonase-2 gene at mRNA level in ischemic stroke patients. Material and Methods 40 patients of ischemic stroke and 40 age and sex-matched controls were included. Paraoxonase-2 genotypes were evaluated by Polymerase Chain Reaction and Restriction Fragment Length Polymorphism and expression of Paraoxonase-2 gene at mRNA level was determined by quantitative real time Polymerase Chain Reaction analysed as delta-CT (△CT). Result and Discussion The observed allele frequencies in patients for C and G allele were 0.61 and 0.39 respectively, and were 0.72 and 0.28 in control group. No significant association was found in C allele of C1053G polymorphism and ischemic stroke. The average △ CT value is significantly (p = 0.0001) higher in patients group (7.68 ± 2.0) as compared to controls (5.70 ± 1.8). We found a significant difference in the average delta-CT value (p = 0.0001), wherein down-regulated paraoxonase-2 gene expression (approximately 0.25 fold) was observed in case of patients as compared to controls. Down-regulated expression of paraoxonase-2 gene was observed in patients with GG genotype as compared to CG and CC genotypes in patients with ischemic stroke (p = 0.0001). Conclusion Down-regulated Paraoxonase-2 gene expression, as evidenced by low mRNA levels in GG genotype may be one of the contributory factors in the progression of ischemic stroke.
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Affiliation(s)
- Seema Kumari
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Sudhir Chandra
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Mohit Mehndiratta
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Ekta Debnath
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
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22
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Sarwal R, Dhamija RK, Jain K, Basavaraddi IV. Efficacy of Pranayama in Preventing COVID-19 in Exposed Healthcare Professionals: A Quasi-Randomized Clinical Trial. J Ayurveda Integr Med 2022; 14:100586. [PMID: 35541985 PMCID: PMC9072812 DOI: 10.1016/j.jaim.2022.100586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/23/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background The global outbreak of COVID-19 has created a challenging situation, especially for the frontline Health Care Professionals (HCPs), who are routinely exposed and thus are at a higher risk of infection. Pranayama, a component of Yoga, is known to improve immune function and reduce infection. However, no clinical trial on the efficacy of Pranayama in preventing COVID-19 has yet been conducted. Aim & Objective This quasi-randomized clinical trial assessed the efficacy of Pranayama in preventing COVID-19 infection in HCPs routinely exposed to COVID-19. Methodology The study was conducted at 5 different COVID-19 hospitals, India in year 2020. The inclusion criteria were being an HCP exposed to COVID-19 patients and being negative on antibody tests. 280 HCPs were recruited sequential and assigned to intervention and control groups. Of these, 250 HCPs completed the study. The intervention was twice daily practice, for 28 days, of specially designed Pranayama modules under the online supervision of Yoga instructors. The HCPs in the control group were advised to continue their normal daily routine, but no pranayama sessions. Participants who developed symptoms suggestive of COVID-19 were subjected to Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) or Point of Care Rapid Antigen Test (RAT) for confirmation of the diagnosis. All the participants were tested for antibodies to COVID-19 on 28th day of the intervention to detect any asymptomatic infection. Results The intervention (123) and control (127) groups had comparable demographics and baseline characteristics. At end of 28 days of intervention, nine participants in the control group and one in the intervention group developed COVID-19 (P-value: 0.01, Odds Ratio: 0.107, 95% CI: 0.86; Risk Ratio: 0.11, 95% CI: 0.89). Conclusion The intervention of twice daily practice of the Pranayama module for 28 days in HCPs might have made a noteworthy contribution and may have helped in preventing COVID-19 infection. CTRI Number CTRI/2020/07/026667.
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23
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Khandare P, Saluja A, Solanki RS, Singh R, Vani K, Garg D, Dhamija RK. Serum S100B and NSE Levels Correlate With Infarct Size and Bladder-Bowel Involvement Among Acute Ischemic Stroke Patients. J Neurosci Rural Pract 2022; 13:218-225. [PMID: 35694066 PMCID: PMC9187393 DOI: 10.1055/s-0042-1743214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives Stroke is a major global health concern. Due to limited availability of neuroimaging particularly in rural and regional areas in India as well as its limitation, the interest in use of biochemical markers for stroke diagnosis, severity, and prognosis is increasing. Only a handful of studies on stroke biomarkers have been conducted in India. Hence, this study was conducted to investigate the correlation of serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) levels with stroke severity according to infarct size in acute ischemic stroke patients.
Material and Methods Sixty stroke patients were recruited for the study and were evaluated. Noncontrast computed tomography (CT) scan of the brain was performed for all patients within 48 hours of onset of symptoms. Infarct volume was measured by evaluating dimensions in three planes on CT head. Serum NSE and S100B levels were measured by commercially available immunoassay kits. Continuous data was represented as mean ± standard deviation. Categorical data was expressed in terms of percentages and proportions. Pearson's correlation coefficient was applied to assess correlation between NSE and S100B and infarct size. Infarct size was classified arbitrarily into three groups according to infarct volume (low, moderate, and large) and analysis of variance was applied for comparing mean S100B and NSE levels in the three groups. To assess the independent predictors of infarct size among stroke cases, multivariate logistic regression analysis was used. Association between serum S100B or NSE levels and clinical features was done by the Mann–Whitney U test.
Results Correlation between serum S100B protein levels and NSE with larger infarct volume was highly significant (r(S100B) = 0.611, p (S100B) < 0.0001; r(NSE) = 0.258, p(NSE) = 0.047). Using multivariate regression analysis, bladder and bowel involvement, prior stroke history, and dyslipidemia among stroke patients correlated with a larger infarct size. Mann–Whitney U test showed both NSE and S100B levels were significantly associated with bladder bowel involvement among stroke cases.
Conclusion There was a positive correlation between serum S100B and NSE levels with infarct size. In addition, bladder-bowel involvement among stroke patients was associated with increased S100B levels. Therefore, levels of protein S100B and NSE may serve as indicator of infarct size and may be predictors of severe clinical presentations of acute ischemic stroke.
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Affiliation(s)
- Pravin Khandare
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ravi S. Solanki
- Department of Radiodiagnosis, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Kavita Vani
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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24
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Saluja A, Dhamija RK. Prioritizing Neuro-rehabilitation Services in Low-and Middle-income countries: Needs, Challenges and Possible Solutions. Ann Indian Acad Neurol 2022; 25:579-582. [PMID: 36211136 PMCID: PMC9540924 DOI: 10.4103/aian.aian_499_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K. Dhamija
- Director, IHBAS, New Delhi, India,Address for correspondence: Prof. Rajinder K. Dhamija, Director IHBAS New Delhi - 110 095, India. E-mail:
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25
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Dhamija RK, Aggarwal A, Saluja A, Parihar J, Garg D. Emerging Trends in Stroke Epidemiology in Indian Women Over the Last Decade. Neurol India 2022; 70:315-318. [PMID: 35263903 DOI: 10.4103/0028-3886.338672] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Temporal trends in clinico-epidemiological parameters of stroke among Indian women have not been studied. We aimed to study the changes in these parameters over the last decade. MATERIAL AND METHODS 417 strokes (ischemic/hemorrhagic) were prospectively recruited in two timelines. In total, 267 strokes were recruited in 2005 while 150 strokes were recruited in 2016-17. Patients underwent stepwise evaluation via a structured proforma. Demographic factors, stroke subtypes, and risk factors were analyzed. RESULTS Female strokes had a higher mean age in 2017 compared to 2005 (60.90 ± 16.9 vs. 53.21 ± 16.75 years, P = 0.002). Hemorrhagic strokes among females increased over the last decade. Female strokes with dyslipidemia were significantly lower in 2017 compared to 2005 (P = 0.002). Proportion of hypertensive and diabetic strokes were not significantly different between these two periods. CONCLUSIONS Over the past decade, the mean age of stroke onset has increased while the prevalence of dyslipidemia has reduced significantly among Indian female stroke patients.
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Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Abhishek Aggarwal
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Goyal A, Saluja A, Saraswathy KN, Bansal P, Dhamija RK. Role of ACE Polymorphism in Acute Ischemic Stroke. Neurol India 2021; 69:1217-1221. [PMID: 34747787 DOI: 10.4103/0028-3886.329586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Stroke is one of the leading causes of death and disability in India. Angiotensin-converting enzyme (ACE) is involved in the development of hypertension, atherosclerosis, cardio, and cerebrovascular disease and is a plausible genetic candidate for stroke. The role of ACE polymorphism is still uncertain and requires further investigation. Objective The aim of this study was to study the role of ACE insertion/deletion polymorphism in acute ischemic stroke (AIS). Materials and Methods One hundred thirty AIS cases and 130 age and sex matched healthy controls were recruited. Ten milliliters venous blood was drawn and 6 mL of blood was used for routine hematological, biochemical tests. Remaining 4 mL of EDTA blood was used for DNA extraction, PCR amplification, and restriction digestion. Three genotypes (II, ID, and DD) were visualized on 3% agarose gel. Association between genotypes among stroke case was done by Chi-square test with P value <0.05 taken as significant. Results DD genotype was significantly associated with the risk of stroke with P value of 0.0001. Both the dominant and recessive models showed that the DD genotype was independently associated with an increased risk of ischemic stroke (OR = 20.732; 95% CI: 2.7241-157.7864; P value = 0.003 for the recessive model and OR = 2.848; 95% CI: 1.5127-5.3649; P value = 0.001 for dominant model). Conclusions Our study showed a strong association between ACE polymorphism and the risk of AIS. This study paves the way for further studies to confirm the role of ACE polymorphism as genetic risk factors for AIS.
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Affiliation(s)
- Ankit Goyal
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, Delhi, India
| | | | - Priya Bansal
- Department of Medicine, Lady Hardinge Medical College and Associated Hospitals, Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, Delhi, India
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27
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Garg D, Majumdar R, Chauhan S, Preenja R, Parihar J, Saluja A, Dhamija RK. Teleneurorehabilitation Among Person with Parkinson's Disease in India: The Initial Experience and Barriers to Implementation. Ann Indian Acad Neurol 2021; 24:536-541. [PMID: 34728947 PMCID: PMC8513956 DOI: 10.4103/aian.aian_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 02/01/2023] Open
Abstract
Objective We aimed to assess the feasibility of teleneurorehabilitation (TNR) among persons with Parkinson's disease (PD), considering difficulties imposed by the COVID-19 pandemic in access to healthcare, particularly in low-resource settings. The feasibility of TNR in India has not been formally assessed so far. Methods We conducted a single-center, prospective cohort study at a tertiary center in India. Persons with PD with Hoehn & Yahr (H&Y) stages 1-2.5, who were not enrolled into any formal exercise program, were offered TNR as per a predesigned program for 12 weeks. Baseline and post-intervention assessment included Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), part II and III, Parkinson's Disease Questionnaire (PDQ)-8 and Non-Motor Symptoms Scale (NMSS). We assessed adherence to TNR and problems expressed by patients/caregivers by means of open-ended surveys addressing barriers to rehabilitation. Results We recruited 22 for TNR. Median age (interquartile range [IQR]) was 66.0 (44.0-71.0) years; 66.7% were H&Y stage 2.0. One patient died of COVID-19-related complications. Of the remaining 21, 14 (66.7%) had adherence of ≥75%; 16/21 (76.2%) patients had problems with attending TNR sessions as the family shared a single phone. Slow Internet speed was an issue among 13/21 (61.9%) of the patients. Other issues included lack of rapport, migration to distant hometowns and motor-hand impairment. Conclusion Multiple challenges were faced in implementing a telerehabilitation program among persons with PD, exacerbated by the COVID-19 pandemic. These barriers were present at various levels: recruitment, adherence issues and maintenance. Future TNR programs must address these concerns.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Majumdar
- Department of Physical Medicine and Rehabilitation, Lady Hardinge Medical College, New Delhi, India
| | - Sonal Chauhan
- Department of Physical Medicine and Rehabilitation, Lady Hardinge Medical College, New Delhi, India
| | - Ravi Preenja
- Department of Physical Medicine and Rehabilitation, Lady Hardinge Medical College, New Delhi, India
| | - Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Dhamija RK, Saluja A. Challenges in estimating the burden of neurological disorders across Indian states. Lancet Glob Health 2021; 9:e1503. [DOI: 10.1016/s2214-109x(21)00413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
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29
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Dhamija RK, Saluja A, Miyasaki J. Advancing neuropalliative care. Lancet Neurol 2021; 20:885-886. [PMID: 34687624 DOI: 10.1016/s1474-4422(21)00333-1] [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] [Received: 08/05/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Alvee Saluja
- Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Janis Miyasaki
- University of Alberta Hospital, Edmonton, AB T6G 2G3, Canada.
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Agrawal AK, Anand KS, Juneja A, Kumar P, Saluja A, Dhamija RK. Predictors of Pain Severity and its Impact on Quality of Life in Patients with Parkinson's Disease. Neurol India 2021; 69:979-983. [PMID: 34507425 DOI: 10.4103/0028-3886.325323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Pain is a common and distressing symptom of Parkinson's disease (PD). The relation of pain, its predictors, and its impact on quality of life (QoL) in PD has not been studied in Indian PD patients. Objective To assess the predictors of pain and investigate its impact on QoL among Indian PD patients. Methodology We conducted a cross-sectional study on 100 PD patients. The cases were diagnosed according to the UK brain bank criteria. Unified PD Rating Scale (UPDRS) parts III, V, and VI were employed to assess the severity of the disease. King's Parkinson Disease Pain Scale (KPPS) and PD questionnaire-8 (PDQ-8) were used to evaluate pain and QoL, respectively. Results Prevalence of different pain types in patients with PD was 70%, mainly including musculoskeletal (53%), fluctuation-related (35%), and nocturnal pain (27%). Subjects with pain developed PD symptoms at a younger age and had a longer duration of the disease. A positive correlation was found between KPPS scores and UPDRS parts III and V, while a negative correlation was observed with UPDRS part VI. Pain in PD subjects had a significant impact on the QoL. Conclusions Most of the PD patients suffered some form of pain with significant correlations with motor disability and poor QoL. Predictors of pain severity among PD patients included a longer disease duration, younger age of disease onset, and a higher levodopa equivalent daily dose (LEDD).
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Affiliation(s)
- Arun Kumar Agrawal
- Department of Neurology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Kuljeet Singh Anand
- Department of Neurology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Abhishek Juneja
- Department of Neurology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Pawan Kumar
- Department of Neurology, ABVIMS and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Margekar SL, Devi MS, Bansal P, Srivastava A, Aggarwal R, Saluja A, Dhamija RK. Chronic Inflammatory Demyelinating Polyneuropathy with Diabetes, Crohn's disease and multiple co-infections: A Clinical Quandry. J Assoc Physicians India 2021; 69:11-12. [PMID: 34585904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Priya Bansal
- Department of Neurology, Lady Hardinge Medical College, New Delhi
| | | | - Ramesh Aggarwal
- Department of Medicine, Lady Hardinge Medical College, New Delhi
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi
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32
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Garg D, Kallur SN, Kumar B, Dhamija RK. Haptoglobin gene polymorphism and ischemic stroke: A case control study. Ann Indian Acad Neurol 2021; 24:447-448. [PMID: 34447022 PMCID: PMC8370169 DOI: 10.4103/aian.aian_336_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | | | - Barun Kumar
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Saluja A, Saraswathy KN, Thakur S, Margekar S, Goyal A, Dhamija RK. Endothelial Nitric Oxide Synthase (Glu298Asp) Polymorphism is Associated Significantly with Ischemic Stroke Presenting with Seizures and Altered Sensorium. Neurol India 2021; 69:686-691. [PMID: 34169869 DOI: 10.4103/0028-3886.319217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Endothelial nitric oxide synthase (eNOS) is an enzymatic marker whose genetic polymorphism might predispose to acute ischemic stroke (AIS) via vascular endothelial dysfunction. It has a potential role in atherosclerosis, making it a plausible risk factor for stroke. Prior studies have failed to prove a conclusive relationship between eNOS polymorphism and AIS. Objective The aim of this study is to find an association between the presence of eNOS polymorphism (Glu298Asp) and the risk of developing AIS. Materials and Methods We recruited 307 subjects including 153 AIS cases and 154 healthy controls. The eNOS (Glu298Asp) polymorphism was identified in EDTA blood by PCR amplification of the target region followed by restriction enzyme digestion, and genotyping on Agarose gel. GG, GT and TT genotypes were obtained. Statistical analysis was done using SPSS software version 20. Results A significant association was found between the presence of TT genotype and the risk of AIS (Odd's ratio (OR): 2.43, P-value = 0.038). There was no significant association between the TT genotype and the traditional stroke risk factors. However, the TT genotype was significantly associated with the presence of altered consciousness (OR: 5.27, 95% CI: 1.59-17.04, P-value = 0.003) and with the occurrence of seizures at presentation (OR: 7.98, 95% CI: 1.99-32.09, P-value = 0.007). Conclusions There is a significant association between the presence of eNOSpolymorphism (Glu298Asp) and the risk of AIS, and the TT genotype may predispose to a more severe initial presentation of ischemic stroke.
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Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | | | - Sunil Thakur
- Department of Medicine, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Shubhalaxmi Margekar
- Department of Medicine, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Ankit Goyal
- Department of Medicine, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
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Dhamija RK, Garg D. The Great Indian Apomorphine Story: Challenges and Its Usage in Parkinson's Disease in the Indian Context. Neurol India 2021; 69:137-139. [PMID: 33642285 DOI: 10.4103/0028-3886.310088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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35
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Saluja A, Dhamija RK, Solanki RS. Teaching NeuroImages: Fluorosis: A Forgotten Cause of Compressive Myelopathy. Neurology 2021; 97:e1973-e1974. [PMID: 34145001 DOI: 10.1212/wnl.0000000000012389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India;
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ravi S Solanki
- Department of Radiodiagnosis, Lady Hardinge Medical College, New Delhi, India
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36
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Garg D, Gupta A, Dhamija RK. Old Bottle, New Wine: Diplopia Sans Proptosis as the Sole Presentation of Thyroid Orbitopathy. Cureus 2021; 13:e15850. [PMID: 34322340 PMCID: PMC8299316 DOI: 10.7759/cureus.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
Thyroid orbitopathy holds a dominant place in the list of causes for external ophthalmoplegia and is commonly accompanied by eye surface signs such as congestion, lacrimation, and proptosis. An elderly male presented to us with painless diplopia in the absence of proptosis, conjunctival congestion, tearing or irritative symptoms. He had bilateral complete external ophthalmoplegia. He was evaluated to have hypothyroidism with elevated anti-thyroid peroxidase antibodies. MRI revealed bulky extraocular muscles in a pattern of sparing of tendinous insertions, highly suggestive of thyroid orbitopathy. He was managed with IV steroid pulse and thyroxine supplementation with minimal improvement. Through this case report, we highlight an unusual presentation of thyroid eye disease in the form of isolated diplopia, in the absence of other usual eye signs. We also emphasize the characteristic typical neuroimaging signs, such as the 'Coca Cola bottle' sign, which strongly augments the diagnosis in an atypical setting.
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Affiliation(s)
- Divyani Garg
- Neurology, Lady Hardinge Medical College, Delhi, IND
| | - Ankit Gupta
- Neurology, Lady Hardinge Medical College, New Delhi, IND
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37
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Gaur K, Puri V, Agarwal K, Suman S, Dhamija RK. Chronic Liver Disease Presenting as Immune Hemolytic Anemia: The Challenges of Diagnosis in the Critically Ill in a Resource-Limited Health Care Setting. Cureus 2021; 13:e14880. [PMID: 34104606 PMCID: PMC8179951 DOI: 10.7759/cureus.14880] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Immune hemolytic anemia is very rarely associated with chronic liver disease. Diagnosis is often complicated in critically ill patients, where an etiological diagnosis can be elusive, especially in routine health care settings. A 48-year-old man presented with jaundice for three months. Ultrasonography showed features of chronic liver disease. Fibroscan showed increased parenchymal stiffness suggesting cirrhosis. Investigations revealed immune hemolytic anemia and thrombocytopenia. A percutaneous liver biopsy was not performed due to worsening thrombocytopenia. Isolated protein C deficiency and portal vein thrombosis were noted in subsequent testing. The patient eventually succumbed to illness. Coagulopathy such as protein C and D-dimer elevation discovered in subsequent rounds of testing may be misleading in rapidly deteriorating patients, emphasizing the need for timely coagulation workup and imaging. Despite comprehensive testing, lack of liver biopsy, as seen herein, may hamper clinical management. Training residents in the skill of transjugular liver biopsy is necessary to manage critical patients at secondary health care facilities.
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Affiliation(s)
- Kavita Gaur
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Vandana Puri
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Kiran Agarwal
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
| | - Santosh Suman
- Department of Pathology, Lady Hardinge Medical College, Delhi, IND
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38
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Garg D, Dhamija RK. Opsoclonus-Myoclonus Syndrome as a Heralding Feature of Scrub Typhus: An Illustrative Case with a Video Vignette. J Mov Disord 2021; 15:80-82. [PMID: 33915676 PMCID: PMC8820885 DOI: 10.14802/jmd.20148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/02/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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39
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Saluja A, Parihar J, Garg D, Dhamija RK. The Impact of COVID-19 Pandemic on Disease Severity and Quality of Life in Parkinson's Disease. Ann Indian Acad Neurol 2021; 24:217-226. [PMID: 34220066 PMCID: PMC8232490 DOI: 10.4103/aian.aian_1240_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/29/2020] [Accepted: 01/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background: The challenges being faced during the lockdown period may worsen motor or non-motor symptoms in Parkinson's disease (PD). Objective: This study was undertaken to investigate the impact of lockdown on the disease activity, caregiver perceptions and the quality of life of patients with PD. Materials and Methods: This cross-sectional study was conducted from June till September 2020. Sixty-four patients with PD and caregivers were interviewed telephonically after obtaining consent. The responses were recorded by means of a structured questionnaire. Non-motor symptoms scale (NMSS) and the Parkinson Disease Questinnaire-8 (PDQ-8) were applied. PDQ-8 severity index (PDQ-8 SI) scores were expressed as percentage of the raw PDQ-8 score of the total score. Data were analsyed by using SPSS version 20.0. Results: Of 64 patients, 39 (60.9%) were men and 25 (39.1%) were women. The overall median age of the patients was 65 (55.25–69.75) years. The median duration was 48 (30–84) months. Twenty-six (40.6%) patients reported symptomatic worsening during the lockdown period. Slowness in activities of daily living and walking worsened in 15 (57.7%) and 14 (53.8%) patients, respectively, while tremors increased in 12 (46.2%) patients. Mood and sleep disturbances were the most common non-motor symptoms to worsen. Increase in non-motor symptoms and the NMSS total score were independent predictors of PDQ-8 scores. Increase in non-motor symptoms during the lockdown was an independent predictor of the highest quartile of PDQ-8 SI scores. Conclusions: Motor and non-motor symptoms have worsened in patients with PD during the lockdown. The increase in non-motor symptoms was independently associated with poorer quality of life among patients with PD during the lockdown.
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Affiliation(s)
- Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospital, New Delhi, India
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40
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Dhamija RK, Gupta A, Saluja A, Gurtoo A, Srivasata A, Bhattacharjee J, Parihar J. Ischemic Stroke Patients have Significantly Higher Serum Levels of Acute Phase Proteins. J Assoc Physicians India 2021; 69:11-12. [PMID: 34470198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Rajinder K Dhamija
- Director, Professor and Head of Neurology Department, Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Abhishek Gupta
- Resident,Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Alvee Saluja
- Asstt. Professor of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Anil Gurtoo
- Director, Professor and HOD Medicine,Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Anshuman Srivasata
- Asstt. Professor of Medicine, Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Jayashree Bhattacharjee
- Ex. Director, Professor of Biochemistry, Lady Hardinge Medical College and Associated Hospitals, New Delhi
| | - Jasmine Parihar
- Asstt. Professor of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi
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41
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Dhamija RK, Srivastava A, Chauhan S, Shah U, Nagda T, Palande D, Chitnis S, Dantala PS, Solomon JM, Krishnan SM, Someshwar H, Surya N. Consensus Statement on Neurorehabilitation during COVID-19 Times: Expert Group on Behalf of the Indian Federation of Neurorehabilitation (IFNR). Ann Indian Acad Neurol 2021; 24:138-141. [PMID: 34220054 PMCID: PMC8232470 DOI: 10.4103/aian.aian_997_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 11/04/2022] Open
Abstract
The COVID19 pandemic in India is causing significant morbidity and disruptions of healthcare delivery. The rapidly escalating contagion is straining our public health system, which is already under pressure due to a shortage of infrastructure and inadequate workforce. Neuro rehabilitation services that are still in its infancy in our country have been significantly interrupted in the last six months. An expert group from Indian Federation of Neurorehabilitation (IFNR) have formulated the guidelines and consensus recommendations for Neurologists, Physiatrists, and Therapists managing neurological disabilities during COVID 19. The aim of this consensus paper is to sensitize the clinicians and therapists about maintaining the continuum of care and rehabilitation needs of Covid patients as well as non Covid patients with neurological disorders during the ongoing COVID 19 pandemic.
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Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Abhishek Srivastava
- Centre for Physical Medicine and Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Sonal Chauhan
- Department of Physical Medicine and Rehabiltation, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Urvashi Shah
- Center for Neuropsychology Studies, Department of Neurology, KEM Hospital, Mumbai, Maharashtra, India
| | - Taral Nagda
- Department of Pediatric Orthopaedics, NH SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Deepak Palande
- Department of Neurosurgery, Sir J J Hospital and Grant Government Medical College, Mumbai, Maharashtra, India
| | - Sonal Chitnis
- School of Audiology Speech and Language Pathology, Bharati Vidyapeeth (DU) Medical College, Pune, Maharashtra, India
| | - P S Dantala
- Department of Orthotics, Dhyan Health Care, Mumbai, Maharashtra, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, India
| | - S Murali Krishnan
- Faculty of Occupational Therapy, Meenakshi Academy of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Hitav Someshwar
- Department of Neurophysiotherapy, KJ Somaiya College of Physiotherapy, Mumbai, Maharashtra, India
| | - Nirmal Surya
- Indian Federation of Neurorehabilitation, Surya Neuro Centre, Mumbai, Maharashtra, India
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Abstract
Objective
The aim of the study is to visually rate major forms of dementia using global cortical atrophy (GCA), medial temporal lobe atrophy (MTA), and Fazeka’s scales and Koedam’s score using magnetic resonance imaging (MRI). The purpose is to correlate the visual rating scales (VRS) with severity of dementia.
Materials and Methods
Thirty patients fulfilling DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria for Alzheimer’s dementia (AD), vascular dementia (VaD), and frontotemporal dementia (FTD) underwent MRI brain. Cortical atrophy, medial temporal, and parietal lobe atrophy were assessed using GCA and MTA scales and Koedam’s score, respectively. White matter hyperintensities were assessed using Fazeka’s scale. Correlation between VRS and mini-mental state exam (MMSE) scores was done using Pearson correlation coefficient.
Results
70% of patients had Grade 2 GCA. More patients with AD had higher MTA scores as compared with others with 57% of AD patients showing abnormal for age MTA scores. Fazeka’s scale was abnormal for age in 58.33% of VaD and 57% AD patients. Majority (75%) showing severe parietal atrophy (Grade 3 Koedam’s score) were AD patients. Disproportionate frontal lobe atrophy was seen in all four (100%) FTD patients. Significant negative correlation was seen between MMSE and GCA scores of all patients (
p
-value = 0.003) as well as between MTA and MMSE scores in AD patients (
p
-value = 0.00095).
Conclusion
Visual rating of MTA is a reliable method for detecting AD and correlates strongly with memory scores. Atrophy of specific regions is seen more commonly in some conditions, for instance, where MTA and parietal atrophy are specific for AD while asymmetric frontal lobe and temporal pole atrophy favor FTD.
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Affiliation(s)
- Surabhi Kaushik
- Department of Radiology, Dr. Ram Manohar Lohia Hospital, Delhi, India
| | - Kavita Vani
- Department of Radiology, Dr. Ram Manohar Lohia Hospital, Delhi, India
| | - Shishir Chumber
- Department of Neurology, Dr. Ram Manohar Lohia Hospital, Delhi, India
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Gaur K, Khedar RS, Mangal K, Sharma AK, Dhamija RK, Gupta R. Macrolevel association of COVID-19 with non-communicable disease risk factors in India. Diabetes Metab Syndr 2021; 15:343-350. [PMID: 33503583 PMCID: PMC7817457 DOI: 10.1016/j.dsx.2021.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Greater COVID-19 related mortality has been reported among persons with various non-communicable diseases (NCDs). We performed an ecological study to determine the association of state-level cases and deaths with NCD risk factors and healthcare and social indices. METHODS We obtained cumulative national and state-level data on COVID-19 cases and deaths from publicly available database www.covid19india.org from February to end November 2020. To identify association with major NCD risk factors, NCDs, healthcare related and social variables we obtained data from public sources. Association was determined using univariate and multivariate statistics. RESULTS More than 9.5 million COVID-19 cases and 135,000 deaths have been reported in India towards end of November 2020. There is significant positive correlation (Pearson r) of state-level COVID-19 cases and deaths per million, respectively, with NCD risk factors- obesity (0.64, 0.52), hypertension (0.28, 0.16), diabetes (0.66, 0.46), NCD epidemiological transition index (0.58, 0.54) and ischemic heart disease mortality (0.22, 0.33). Correlation is also observed with indices of healthcare access and quality (0.71, 0.61), urbanization (0.75, 0.73) and human (0.61, 0.56) and sociodemographic (0.70, 0.69) development. Multivariate adjusted analyses shows strong correlation of COVID-19 burden and deaths with NCD risk factors (r2 = 0.51, 0.43), NCDs (r2 = 0.32, 0.16) and healthcare (r2 = 0.52, 0.38). CONCLUSIONS COVID-19 disease burden and mortality in India is ecologically associated with greater state-level burden of NCDs and risk factors, especially obesity and diabetes.
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Affiliation(s)
- Kiran Gaur
- Department of Statistics, Mathematics and Computer Science, Govt SKN Agriculture College, SKN Agriculture University, Jobner, Jaipur, India
| | - Raghubir S Khedar
- Department of Medicine and Critical Care, Eternal Hospital, Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Kishore Mangal
- Department of Medicine and Critical Care, Eternal Hospital, Eternal Heart Care Centre & Research Institute, Jaipur, India
| | - Arvind K Sharma
- Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajeev Gupta
- Department of Medicine and Critical Care, Eternal Hospital, Eternal Heart Care Centre & Research Institute, Jaipur, India; Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India.
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Garg D, Dhamija RK. Teleneurorehabilitation for Parkinson's Disease: A Panacea for the Times to Come? Ann Indian Acad Neurol 2020; 23:592-597. [PMID: 33623256 PMCID: PMC7887501 DOI: 10.4103/aian.aian_566_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
Telemedicine is witnessing a rebirth due to the COVID-19 pandemic and the continuing need for limited-contact or contactless care in medicine. Telerehabilitation, an offshoot of telemedicine, is a valuable yet underexplored tool in the therapeutic armamentarium of patients with neurological conditions, particularly Parkinson's disease (PD). Although there is evidence in literature reporting the use of telerehabilitation and virtual reality-based services in providing rehabilitation to improve speech, swallowing, gait, and postural instability among persons with PD, the evidence is limited due to small patient numbers. Teleneurorehabilitation (TNR) is an underutilized strategy that may be as effective and perhaps more feasible and affordable among Indian PD patients and also allows sustained rehabilitation. In this article, we encapsulate the evidence on the utility and efficacy of TNR among persons with PD and call upon the neurology community to recognize and utilize the valuable asset that TNR may be for PD patients.
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Garg D, Srivastava AK, Dhamija RK. Beyond Fever, Cough and Dyspnea: The Neurology of COVID-19. J Assoc Physicians India 2020; 68:62-66. [PMID: 32798347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The pandemic due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) has rapidly engulfed the entire world, and continues to evolve at an aggressive pace. Although the characteristic concern in patients with COVID-19 is acute respiratory distress, there is meteoric accrual of data on neurological involvement. Neurological manifestations in COVID-19 have staggering diversity, ranging from mild olfactory and gustatory perception abnormalities to necrotising encephalopathy and stroke. Understanding of pathophysiological mechanisms underlying neurological invasion and disease is still nascent, and dictated largely by evidence from previous coronavirus infections which are known to have neuroinvasive potential. It has also been postulated that SARS CoV2 may affect the medullary respiratory centres in the brain stem thereby playing a possible role in causing neurogenic acute respiratory failure. Preliminary data suggest a role of immune hyperinflammation and hyperthrombosis mediating neurological features. Apart from acute neurological manifestations, immune dysregulation may contribute to para and post-infectious complications and potentially, neurodegenerative conditions. These concepts are paramount in developing therapeutic paradigms to mitigate the impact of the pandemic. In this review, we summarise putative pathophysiological underpinnings of neurological manifestations of COVID-19 and guidance for their management.
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Affiliation(s)
- Divyani Garg
- Assistant Professor, Department of Neurology, Lady Hardinge Medical College, New Delhi
| | - Achal K Srivastava
- Professor, Department of Neurology, All India Institute of Medical Sciences, New Delhi
| | - Rajinder K Dhamija
- Director, Professor and Head of Department, Department of Neurology, Lady Hardinge Medical College, New Delhi
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Saroha D, Garg D, Singh AK, Dhamija RK. Irreversible neuropathy in extremely-drug resistant tuberculosis: An unfortunate clinical conundrum. Indian J Tuberc 2020; 67:389-392. [PMID: 32825876 DOI: 10.1016/j.ijtb.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
Drug-resistant tuberculosis is an increasing healthcare challenge. Drug regimen building demands the use of different therapeutic groups, many of which harbor neurotoxicity as a side-effect, whether central or peripheral. Peripheral neuropathy is a major concern as it tends to be severe and usually irreversible. Anti-tubercular drugs that may contribute to peripheral neuropathy include INH, ethambutol, linezolid, cycloserine and para-amino salicylic acid. This potential adverse effect must be balanced against the intrinsically grave prognosis that drug resistant tuberculosis harbors. We present such a clinically challenging case of a 25 years-old female with extremely drug resistant tuberculosis whose treatment necessitated the use of several neurotoxic anti-tubercular drugs, leading to severe sensory peripheral neuropathy who did not improve despite the withdrawal of culprit drugs. She developed positive and negative sensory symptoms in both lower limbs. Nerve conduction studies were suggestive of sensory neuropathy affecting both lower limbs. Alternate causes of peripheral neuropathy including HIV, vasculitis, B12 deficiency and diabetes were ruled out. Despite drug withdrawal, the patient did not improve significantly. This case emphasizes the irreversibility of anti-tubercular therapy-induced peripheral neuropathy, demanding more rigorous clinical screening for the same while managing such patients.
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Affiliation(s)
- Deepika Saroha
- Department of Neurology, Lady Hardinge Medical College and SK Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and SK Hospital, New Delhi, India.
| | - Ashok Kumar Singh
- Department of Pulmonary Medicine, Lady Hardinge Medical College and SK Hospital, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and SK Hospital, New Delhi, India
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47
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Dhamija RK, Garg D. World Brain Day 2020 - Challenges and Opportunities in India. Ann Indian Acad Neurol 2020; 24:1-2. [PMID: 33911368 PMCID: PMC8061519 DOI: 10.4103/aian.aian_660_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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48
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Garg D, Gupta A, Dhamija RK. Ipsilesional Torsional Nystagmus in Midbrain Infarction: A Rare Entity of Localizing Value. Ann Indian Acad Neurol 2020; 23:378-379. [PMID: 32606542 PMCID: PMC7313563 DOI: 10.4103/aian.aian_646_19] [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] [Received: 12/05/2019] [Revised: 12/12/2019] [Accepted: 12/15/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ankit Gupta
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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49
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Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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Parihar J, Tripathi M, Dhamija RK. Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic. J Epilepsy Res 2020; 10:3-7. [PMID: 32983949 PMCID: PMC7494888 DOI: 10.14581/jer.20002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
The end of the year 2019 was marked by novel coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) outbreak in China that rapidly spread to the rest of the world. While the involvement of the lower respiratory system causing pneumonia is identified as the primary target of the virus, extra-pulmonary manifestations, especially of the central nervous system, are also being increasingly reported. Previous research on Middle East respiratory syndrome coronavirus and SARS-CoV have shown neurological involvement in human coronavirus infections. While several cases of seizures have been reported in patients with coronavirus disease 2019 (COVID-19) patients, there is no specific data to suggest an association of COVID-19 with epilepsy. Epilepsy patients on immunosuppressive medications may have a higher risk of contracting the viral infection. There can be an indirect relation of COVID-19 to epilepsy as the viral infection is associated with fever in most COVID-19 cases, which can lower seizure threshold. Additionally, inadequate sleep and stress due to ongoing pandemic of coronavirus can be another trigger for seizure precipitation in epilepsy patients. Drug compliance, availability of antiepileptic drugs, and drug interactions with COVID-19 experimental drugs are major concerns in epilepsy patients. Adopting telemedicine services and the use of epilepsy helplines may be important in assisting epilepsy patients and ensuring that treatment continues uninterrupted.
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Affiliation(s)
- Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
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