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Gupta S, Abbot AK, Srinath R, Tewari AK, Gupta A, Gorthi SP, Narayanan CS, Totlani SI, Sirohi YS, Anadure R. Randomized trial to assess safety and clinical efficacy of intensive blood pressure reduction in acute spontaneous intracerebral haemorrhage. Med J Armed Forces India 2018; 74:120-125. [PMID: 29692476 DOI: 10.1016/j.mjafi.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 03/31/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Haematoma expansion due to raised blood pressure in spontaneous intracerebral haemorrhage may determine outcome. The aim of this study was to determine safety and efficacy of lowering blood pressure in acute spontaneous intracerebral haemorrhage. METHODS This open label, multicentric trial randomized patients ≥18 years with spontaneous intracerebral haemorrhage with no secondary cause within 72 h of onset to tight BP control arm where treatment was initiated if mean arterial pressure (MAP) was ≥115 mm of Hg and conventional BP control arm where treatment was initiated if MAP was ≥130 mm of Hg. The MAP was maintained in the respective arm for another 72 h after which both arms had MAP below 115 mm of Hg. Primary outcome was modified Rankin Scale at 90 days. RESULTS 118 patients, 59 in each arm were included. Follow up was available for all. Baseline characteristics were similar. At 90 days there was no significant difference between median mRS between the two arms. Odds Ratio for "poor outcome" (mRS 3-6) in the tight control arm (safety of the intervention) against "good outcome" (mRS 0-2) was not significant (OR 0.70 [95% CI 0.34-1.47] p = 0.35). Efficacy of the intervention in the form of Odds Ratio for "good outcome" in the tight control arm was not significant (OR 1.43 [95% CI 0.68-2.99], p = 0.35). CONCLUSION In patients with spontaneous intracerebral haemorrhage who present within 72 h of the onset of symptoms, MAP can be safely lowered if it crosses 115 mm of Hg but it does not improve clinical outcome.
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Affiliation(s)
- Salil Gupta
- Professor & Head (Neurology), Army Hospital (R&R), New Delhi, India
| | - A K Abbot
- Graded Specialist (Medicine), Military Hospital Partapur, India
| | - R Srinath
- Classified Specialist (Medicine) & Neurologist, Command Hospital (Eastern Command), Kolkata, India
| | - A K Tewari
- Commandant, Base Hospital Delhi Cantt, New Delhi, India
| | - Aditya Gupta
- Senior Adviser (Medicine) & Neurologist, Command Hospital (Western Command), Chandimandir, India
| | - S P Gorthi
- Professor, Department of Neurology, Kasturba Gandhi Medical College, Manipal, India
| | | | - S I Totlani
- Senior Adviser (Medicine) & Neurologist, Command Hospital (Southern Command), Pune 411040, India
| | - Y S Sirohi
- Associate Professor (Internal Medicine), Armed Forces Medical College, Pune 411040, India
| | - Ravi Anadure
- Senior Adviser (Medicine) & Neurologist, Command Hospital Air Force, Bengaluru, India
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D'Souza MM, Gorthi SP, Vadwala K, Trivedi R, Vijayakumar C, Kaur P, Khushu S. Diffusion tensor tractography in cerebral small vessel disease: correlation with cognitive function. Neuroradiol J 2017; 31:83-89. [PMID: 29027841 DOI: 10.1177/1971400916682753] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Patients with cerebral small vessel disease may suffer from varying levels of cognitive deficit and may progress on to vascular dementia. The extent of involvement, as seen on conventional magnetic resonance (MR) measures, correlates poorly with the level of cognitive decline. The purpose of this study was to investigate the utility of diffusion tensor imaging (DTI) as a marker for white matter damage in small vessel disease and to assess its correlation with cognitive function. Methods Thirty consecutive patients with cerebral small vessel disease underwent conventional MR imaging, DTI, and neuropsychological assessment. Results On tractographic analysis, fractional anisotropy was significantly reduced while mean diffusivity significantly increased in several white matter tracts. The alteration in DTI indices correlated well with cognitive function. No significant correlation was identified between T2 lesion load and cognitive performance. Conclusions Tractographic analysis of white matter integrity is a useful measure of disease severity and correlates well with cognitive function. It may have a significant potential in monitoring disease progression and may serve as a surrogate marker for treatment trials.
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Affiliation(s)
- Maria M D'Souza
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - S P Gorthi
- 2 Department of Neurology, Kasturba Medical College, Manipal Karnataka, India
| | - Kunal Vadwala
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - Richa Trivedi
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - C Vijayakumar
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - Prabhjot Kaur
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - Subash Khushu
- 1 Institute of Nuclear Medicine & Allied Sciences, Delhi, India
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Kumar A, Kumar P, Misra S, Sagar R, Kathuria P, Vibha D, Vivekanandhan S, Garg A, Kaul B, Raghvan S, Gorthi SP, Dabla S, Aggarwal CS, Prasad K. Biomarkers to enhance accuracy and precision of prediction of short-term and long-term outcome after spontaneous intracerebral haemorrhage: a study protocol for a prospective cohort study. BMC Neurol 2015; 15:136. [PMID: 26264492 PMCID: PMC4533964 DOI: 10.1186/s12883-015-0384-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies reported prognostic value of biomarker in intracerebral hemorrhagic (ICH) but they are either preliminary observation or inadequately powered to analyse independent contribution of biomarkers over and above clinical and neuroimaging data. OBJECTIVE To examine whether the biomarker can significantly add to the predictive accuracy of prognosis of ICH. METHOD/DESIGN In a multi-centric prospective cohort study, 1020 patients with ICH within 72 hours of onset are being recruited. After obtaining written informed consent from patients/proxy, venous blood sample (10 ml) is being collected and analysed for C-reactive protein (CRP) level, S100B, Glial fibrillary acidic protein (GFAP), Troponin, change in leukocyte count and Copeptin levels. The patients are telephonically followed using stroke scales (Barthel Index and modified Rankin Scale) at 3, 6, 12 months and 2 years after the recruitment. DISCUSSION This protocol will aim at predicting the short term or long term prognosis with the use of clinical, neuroimaging and biomarkers in order to help clinician to stratify patients for early referral or intervention.
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Affiliation(s)
- A Kumar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - P Kumar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Misra
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - R Sagar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - P Kathuria
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - D Vibha
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Vivekanandhan
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - A Garg
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - B Kaul
- Department of Neurology, Safdarjung, Hospital, New Delhi, India
| | - S Raghvan
- Department of Neurology, Safdarjung, Hospital, New Delhi, India
| | - S P Gorthi
- Department of Neurology, Research and Referral Army Hospital, New Delhi, India
| | - S Dabla
- Pt. B.D. Sharma, PGIMS, Rohtak, India
| | | | - Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
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Cotlarciuc I, Khan MS, Maheshwari A, Yadav S, Khan FY, Al-Hail H, de Silva R, Gorthi SP, Gupta S, Sharma SR, Sylaja PN, Prasad K, Sharma P. Bio-repository of DNA in stroke: a study protocol of three ancestral populations. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012019. [PMID: 24175068 PMCID: PMC3738328 DOI: 10.1258/cvd.2012.012019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of death and disability in the world. Identifying the genes underlying stroke risk may help us to improve our understanding of the mechanisms that cause stroke and also identify novel therapeutic targets. To have sufficient power to disentangle the genetic component of stroke, large-scale highly phenotyped DNA repositories are necessary. The BRAINS (Bio-repository of DNA in stroke) study aims to recruit subjects with all subtypes of stroke as well as controls from UK, India, Sri Lanka and Qatar. BRAINS-UK will include 1500 stroke patients of European ancestry as well as British South Asians. BRAINS-South Asia aims to recruit 3000 stroke subjects and 3000 controls from across India and Sri Lanka. BRAINS-Middle East aims to enrol 1500 stroke patients from Qatar. The controls for BRAINS-Middle East will be recruited from a population-based Qatari Biobank. With the addition of new recruitment centres in India and Qatar, we present an updated version of the BRAINS study protocol. This is the first international DNA biobank for stroke patients and controls from the Middle East. By investigating the influence of genetic factors on stroke risk in European, South Asian and Middle Eastern populations, BRAINS has the potential to improve our understanding of genetic differences between these groups and may lead to new population-specific therapeutic targets.
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Affiliation(s)
- Ioana Cotlarciuc
- Imperial College Cerebrovascular Research Unit (ICCRU) , Imperial College London , London , UK
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Affiliation(s)
- Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Affiliation(s)
- S P Gorthi
- Associate Professor, Armed Forces Medical College, Pune -411040
| | - A K Nagpal
- Professor and Head (Department of Internal Medicine), Armed Forces Medical College, Pune -411040
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Shankar S, Chatterji RS, Chaudary NR, Sharma LR, Gorthi SP, Shanmuganandan K. Partner Counselling and Referral Services (PCRS) for HIV in Armed Forces - Visiting a Blind Spot. Med J Armed Forces India 2011; 62:367-9. [PMID: 27688544 DOI: 10.1016/s0377-1237(06)80111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2005] [Accepted: 04/25/2005] [Indexed: 11/16/2022] Open
Abstract
The Indian armed forces have over 5000 cases of human immunodeficiency virus (HIV) infection since 1990. The spouses of the affected soldiers are at a constant risk of contracting infection if not informed of their husband's HIV status. The onus of counselling the spouse has been delegated to the commanding officer (CO) of the soldier as per policy. The spouses usually reside at their hometown away from the soldier's unit and bridging this "geographical discordance" and offering effective counselling becomes a tricky issue for the commanding officer (CO). This article examines the effectiveness of this strategy as practised in Indian armed forces.
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Affiliation(s)
- S Shankar
- Classified Specialist (Medicine) and Clinical Immunologist, Command Hospital (AF), Bangalore
| | - R S Chatterji
- Classified Specialist (Medicine and Chest diseases), Command Hospital (SC), Pune
| | - N Ray Chaudary
- Consultant (Medicine and Nephrology), Command Hospital (SC), Pune
| | - L R Sharma
- Senior Advisor (Medicine), Base Hospital, Delhi Cantt
| | - S P Gorthi
- Classified Specialist (Medicine and Neurology), Command Hospital (SC), Pune
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Abstract
BACKGROUND Folstein's Mini Mental Status Examination (MMSE) often fails to identify executive dysfunction even if quite severe. Detailed neuropsychological tests and extensive bedside tests are available to evaluate executive function, but most of them are time consuming. This study was done to determine the value of a Clock Drawing Test (CDT) as a simple tool to identify cognitive dysfunction in various neurological disorders and to assess its utility as an adjunct to MMSE in identifying executive dysfunction in a a busy out patient department (OPD). METHODS A total of 81 patients suffering from neurological disorders and 81 controls were studied. All subjects received the MMSE and the CDT. The CDT is divided into an unprompted task that is sensitive to executive control (CDT 1) and a copying task which is not (CDT 2). RESULT All the three tests (CDT 1, CDT 2 and MMSE) could recognize cognitive and executive function deficits, when compared with age and sex matched controls (p < 0. 001). CDT scores correlated strongly with the level of executive function deficits. CDT+MMSE detected 95% cases as abnormal as compared to 47% detected by MMSE alone. CONCLUSION CDT along with MMSE can detect executive control deficits and cognitive deficits. The CDT 1 tests executive control performance, while CDT 2 tests posterior cortical deficits.
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Affiliation(s)
- C Mittal
- Clinical Research Department, Fortis Escorts Hospital, JLN Marg, Jaipur
| | - SP Gorthi
- Associate Professor, Dept of Internal Medicine, AFMC, Pune-40
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Swamy MN, Johri S, Gorthi SP, Dubey AK, Sharma JR, Ramdas GV, Yadav KK. Pathological Laughter, Multiple Sclerosis, Behavioural Abnormality. Med J Armed Forces India 2006; 62:383-4. [PMID: 27688550 DOI: 10.1016/s0377-1237(06)80117-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2005] [Accepted: 04/24/2006] [Indexed: 11/18/2022] Open
Affiliation(s)
- M N Swamy
- Classified Specialist (Neurosurgery), Command Hospital (SC), Pune
| | - S Johri
- Senior Advisor (Medicine), Command Hospital (NC), C/o 56 APO
| | - S P Gorthi
- Classified Specialist (Neurosurgery), Command Hospital (SC), Pune
| | - A K Dubey
- Consultant (Medicine), Army Hospital (R&R), Delhi Cantt
| | - J R Sharma
- Senior Advisor (Surgery and Neurosurgery), Command Hospital (WC), Chandigargh
| | - G V Ramdas
- Classified Specialist (Surgery), Command Hospital (SC), Pune
| | - K K Yadav
- Graded Specialist (Surgery & Neurosurgery), Command Hospital, Bangalore
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Gorthi SP, Kapoor L, Chaudhry R, Sharma N, Perez-Perez GI, Panigrahi P, Behari M. Guillain-Barré syndrome: association with Campylobacter jejuni and Mycoplasma pneumoniae infections in India. Natl Med J India 2006; 19:137-9. [PMID: 16836263] [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: 05/10/2023]
Abstract
BACKGROUND Guillain-Barré syndrome is the most common cause of acute neuromuscular paralysis and is considered a post-infectious disease. METHODS Twenty patients with Guillain-Barré syndrome admitted to the Neurosciences Centre at the All India Institute of Medical Sciences from November 1997 to August 1998 were investigated for evidence of antecedent infections. This case-control study included 2 controls for each patient, one a household control and the other an age- and sex-matched hospital control suffering from a neurological illness other than Guillain-Barré syndrome. Evidence of recent Campylobacter jejuni infection was investigated by culture and serology, and for Mycoplasma pneumoniae by serology. RESULTS There was evidence of recent C. jejuni infection in 35% of the patients compared with 25% of household controls and none of the hospital controls. M. pneumoniae infection was seen in 50% of patients compared with 25% of household controls and 15% of hospital controls. About one-third of the patients (30%) had evidence of both infections. The association of both infections in patients was found to be statistically significant as compared to hospital controls. CONCLUSION C. jejuni and M. pneumoniae may be important antecedent illnesses in patients with Guillain-Barré syndrome in India.
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Affiliation(s)
- S P Gorthi
- Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi
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Gorthi SP, Shankar S, Johri S, Mishra A, Chaudhary NR. HIV infection with myasthenia gravis. J Assoc Physicians India 2005; 53:995-6. [PMID: 16515244] [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: 05/06/2023]
Abstract
A soldier presented in Jan 2002 with features of proximal myopathy and diplopia. Clinically he had features of myasthenia gravis, which was confirmed by significantly positive neostigmine test, decremental response on electrophysiological study and raised acetylcholine receptor antibody titres. He also tested positive for HIV during evaluation of a cervical lymph node detected incidentally. He responded well to neostigmine and has remained asymptomatic on follow up.
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Affiliation(s)
- S P Gorthi
- Department of Neurology, Base Hospital Delhi Cantt, New Delhi
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Affiliation(s)
- Sharat Johri
- Associate Professor, Department of Medicine, Armed Forces Medical College, Pune
| | - S P Gorthi
- Associate Professor and Classified Specialist (Medicine and Neurology), Command Hospital (SC), Pune
| | - A C Anand
- Professor and Head, Department of Medicine, Armed Forces Medical College, Pune
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Abstract
PURPOSE To evaluate and delineate the characteristics of cerebral toxoplasmosis lesions using a combination of magnetic resonance (MR) spectroscopy, diffusion, and perfusion studies. MATERIAL AND METHODS A total of 8 patients with 23 lesions were evaluated on a 1.5-T MR system. Diffusion-weighted imaging (DWI) was performed with three 'b' values of 50, 500, and 1000 s/mm2, and the apparent diffusion coefficient maps were calculated. The diffusion-weighted appearances and the T2-weighted MR appearances of the lesions were compared. MR spectroscopy was performed using the point-resolved single-voxel technique with two TE values of 135 ms and 270 ms. Perfusion studies were carried out using the dynamic contrast-enhanced technique, and the relative cerebral blood volume maps were qualitatively and quantitatively analyzed. RESULTS DWI revealed the majority of the lesions as having increased diffusion within their necrotic centers, with the ADC ranging from 0.5 to 3.01 (mean +/- SD: 1.49 +/- 0.7). All the lesions revealed a predominant lipid peak on MR spectroscopy and were extremely hypovascular on perfusion MR studies. CONCLUSION MR diffusion, spectroscopy, and perfusion studies help in characterizing toxoplasmosis lesions and, in most cases, can be used in combination to help establish the diagnosis of toxoplasmosis.
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Affiliation(s)
- A Batra
- NMR Research Center, Division of Radiological Imaging and Bio-informatics, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.
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Satyanarayana S, Gorthi SP, Bhardwaj JR, Nath N, Sharma S. Disseminated cysticercosis. J Assoc Physicians India 2002; 50:1180-2. [PMID: 12516706] [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: 02/28/2023]
Affiliation(s)
- S Satyanarayana
- Department of Pathology, Armed Forces Medical College, Pune 411 040
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