1
|
Cormier NR, Park J, Kohli N, Hyman JB. Selecting laser-resistant tracheal tubes for awake flexible scope intubation. Anaesth Rep 2024; 12:e12300. [PMID: 38765553 PMCID: PMC11099760 DOI: 10.1002/anr3.12300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- N. R. Cormier
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
| | - J. Park
- Department of Anesthesia, Critical Care & Pain MedicineHarvard School of MedicineBostonMAUSA
| | - N. Kohli
- Division of Otolaryngology, Department of SurgeryYale School of MedicineNew HavenCTUSA
| | - J. B. Hyman
- Department of AnesthesiologyYale School of MedicineNew HavenCTUSA
| |
Collapse
|
2
|
Loth KA, Ji Z, Kohli N, Fisher JO, Fulkerson JA. Parents of preschoolers use multiple strategies to feed their children: Findings from an observational video pilot study. Appetite 2023; 187:106615. [PMID: 37236362 PMCID: PMC10358371 DOI: 10.1016/j.appet.2023.106615] [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: 11/21/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 05/28/2023]
Abstract
The current study leveraged observational data collection methods to fill gaps in our understanding of parent approach to feeding as well as child responses to various parental approaches. Specifically, the study aimed to: 1) characterize the broad range of food parenting practices used by parents of preschoolers during shared mealtimes at home, including differences by child gender, and 2) describe child responses to specific parent feeding practices. Forty parent-child dyads participated by recording two in-home shared meals. Meals were coded using a behavioral coding scheme that coded the occurrence of 11 distinct food parenting practices (e.g. indirect and direct commands, praise, bribes) and eight child responses (e.g., eat, refuse, cry/whine) to food parenting practices. Results revealed that parents engaged in a broad range of food parenting practices at meals. On average, parents in our sample used 10.51 (SD 7.83; Range 0-30) total food parenting practices per mealtime with a mean use of 3.38 (SD 1.67; Range 0-8) unique food parenting practices per mealtime. Use of indirect and direct commands to eat were most common; direct and indirect commands were used by 97.5% (n = 39) and 87.5% (n = 35) of parents at meals, respectively. No statistically significant differences were observed by child gender. No one specific feeding practice consistently yielded compliance or refusal to eat from the child, instead child responses were often mixed (e.g., compliance followed by refusal and/or refusal followed by compliance). However, use of praise to prompt eating was the practice that most often resulted in child compliance; 80.8% of children complied following parent's use of praise as a prompt to eat. Findings deepen our understanding of the types and frequency of food parenting practices used by parents of preschoolers during meals eaten at home and illuminate child responses to specific food parenting practices.
Collapse
Affiliation(s)
- K A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Minneapolis, MN, 55414, USA.
| | - Z Ji
- Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - N Kohli
- Department of Educational Psychology, University of Minnesota, 56 E River Parkway, Minneapolis, MN, 55455, USA
| | - J O Fisher
- Center for Obesity Research and Education, Department of Social and Behavioral Sciences, College of Public Health, Temple University, 3223 N Broad Street, Philadelphia, PA, 19122, USA
| | - J A Fulkerson
- School of Nursing, University of Minnesota, 308 SE Harvard Street, Minneapolis, MN, 55455, USA
| |
Collapse
|
3
|
Awasthi S, Kohli N, Agarwal M, Pandey CM, Rastogi T, Pandey AK, Roy C, Mishra K, Verma N, Kumar CB, Jain PK, Yadav R, Dhasmana P, Chauhan A, Mohindra N, Shukla RC. Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India. PLoS One 2022; 17:e0276911. [PMID: 36520841 PMCID: PMC9754232 DOI: 10.1371/journal.pone.0276911] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018. The primary objective of this study was to evaluate the effectiveness of PCV13 on chest radiograph (CXR)-confirmed pneumonia, in children hospitalized with WHO-defined severe CAP. METHODS This prospective, multi-site test-negative study was conducted in a hospital-network situated in three districts of Northern India where PCV13 had been introduced. Children aged 2-23 months, hospitalized with severe CAP and with interpretable CXR were included after parental consent. Clinical data was extracted from hospital records. CXRs were interpreted by a panel of three independent blinded trained radiologists. Exposure to PCV13 was defined as ≥2 doses of PCV13 in children aged ≤ 12 months and ≥ 1 dose(s) in children > 12 months of age. Our outcome measures were CXR finding of primary endpoint pneumonia with or without other infiltrates (PEP±OI); vaccine effectiveness (VE) and hospital mortality. RESULTS From 1st June 2017-30th April 2021, among 2711 children included, 678 (25.0%) were exposed to PCV1. CXR positive for PEP±OI on CXR was found in 579 (21.4%), of which 103 (17.8%) were exposed to PCV. Adjusted odds ratio (AOR) for PEP±OI among the exposed group was 0.69 (95% CI, 0.54-0.89, p = 0.004). Adjusted VE was 31.0% (95% CI: 11.0-44.0) for PEP±OI. AOR for hospital mortality with PEP±OI was 2.65 (95% CI: 1.27-5.53, p = 0.01). CONCLUSION In severe CAP, children exposed to PCV13 had significantly reduced odds of having PEP±OI. Since PEP±OI had increased odds of hospital mortality due to CAP, countrywide coverage with PCV13 is an essential priority.
Collapse
Affiliation(s)
- Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radio-diagnosis, King George’s Medical University, Lucknow, India
| | - Monika Agarwal
- Department of Community Medicine, King George’s Medical University, Lucknow, India
| | - Chandra Mani Pandey
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Tuhina Rastogi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Anuj Kumar Pandey
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Chittaranjan Roy
- Department of Community Medicine, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Kripanath Mishra
- Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Neelam Verma
- Department of Pediatrics, Patna Medical College and Hospital, Patna, India
| | | | - Pankaj Kumar Jain
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Rajesh Yadav
- Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Puneet Dhasmana
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Abhishek Chauhan
- Department of Radio-diagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Namita Mohindra
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ram Chandra Shukla
- Department of Radio-diagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
4
|
Johri S, Verma P, Tikku AP, Bains R, Kohli N. Effect of amniotic membrane and platelet-rich fibrin membrane on bone healing post endodontic surgery: An ultrasonographic, randomized controlled study. J Tissue Eng Regen Med 2022; 16:1208-1222. [PMID: 36401577 DOI: 10.1002/term.3362] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 11/21/2022]
Abstract
The use of membrane barriers and bone grafting materials in endodontic surgery promotes healing by regeneration rather than repair by scar tissue. Due to its valuable regenerative and therapeutic properties, the human amniotic membrane can support ideal periapical rehabilitation and promote better healing after surgery. The current trial aimed to evaluate the amniotic membrane's healing potential and compare it with platelet-rich fibrin using color doppler sonography. The current study is a randomized, double-blinded, parallel-group, single-center study. Thirty-four systematically healthy individuals requiring endodontic surgery who fulfilled all inclusion and exclusion criteria were selected and randomly placed in two groups. Surgical curettage of the bony lesion was performed and filled with hydroxyapatite graft. Amniotic membrane (Group 1) and platelet-rich fibrin (Group 2) were placed over the bony crypt, and the flap was sutured back. The lesion's surface area and vascularity were the parameters assessed with ultrasound and color doppler. and observations: The groups found a significant difference in mean vascularity at 1 month and mean vascularity change from baseline to 1 month (p < 0.05). Mean surface area had no statistically significant difference between the groups. However, in terms of the percentage change in surface area, a significant difference was found from baseline to 6 months (p < 0.05). Amniotic membrane was a significantly better promoter of angiogenesis than platelet-rich fibrin in the current trial. The osteogenic potential of both materials was similar. However, the clinical application, availability, and cost-effectiveness of amniotic membrane support it as a promising therapeutic alternative in clinical translation. Further large-scale trials and histologic studies are warranted.
Collapse
Affiliation(s)
- Saumya Johri
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Promila Verma
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Aseem Prakash Tikku
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Rhythm Bains
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
| |
Collapse
|
5
|
Verma AK, Sethi S, Kohli N. Partial anomalous pulmonary venous connection: state-of-the-art review with assessment using a multidetector computed tomography angiography. Pol J Radiol 2022; 87:e549-e556. [PMID: 36420124 PMCID: PMC9673975 DOI: 10.5114/pjr.2022.120513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 02/21/2022] [Indexed: 03/21/2024] Open
Abstract
Pulmonary venous anomalies occur as a result of failure in normal embryological development. These anomalies may present as a spectrum ranging from normal variation to partial anomalous pulmonary venous connection (PAPVC) and total anomalous pulmonary venous connection (TAPVC). Though not rare, PAPVC is an uncommon anomaly in which some of the pulmonary veins abnormally connect and drain into the vascular compartments other than the left atrium (LA); however, the others drain normally into the LA. The clinical presentation and severity of affected patients depend on the morphological heterogeneity of the disease. PAPVC associated with other complex conge-nital cardiac diseases present early and are more severe than isolated PAPVC-associated atrial septal defect only. This radiological review gives a detailed description of PAPVC in terms of morphological variability and associated anomalies along with a discussion of the role of multidetector dual-source computed tomography scan in the diagnostic assessment.
Collapse
Affiliation(s)
- Amit Kumar Verma
- Department of Radiodiagnosis, King George’s Medical University, India
| | | | - Neera Kohli
- Department of Radiodiagnosis, King George’s Medical University, India
| |
Collapse
|
6
|
Chawla H, Bhosale V, Misra R, Sonkar SK, Kohli N, Jamal N, Vimal SR, Dangi B, Durgapal K, Singh S, Negi MPS, Ghatak A. Lipocalin-2 levels increase in plasma of non-alcoholic fatty liver disease patients with metabolic syndrome. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
7
|
Prabha J, Alam A, Kumar C, Kumar R, Kohli N. Neuroradiologic Features Associated With Severe Restriction of Functional Mobility in Children With Cerebral Palsy in North India. J Child Neurol 2021; 36:711-719. [PMID: 33709827 DOI: 10.1177/0883073821993613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy. OBJECTIVE To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy. METHODS Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ2 test. RESULTS A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category). CONCLUSION Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.
Collapse
Affiliation(s)
- Jayanti Prabha
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Areesha Alam
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India.,Department of Pediatrics, 76140Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Chandrakanta Kumar
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Department of Pediatrics, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radio-diagnosis, 76140King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
8
|
Nigam H, Gambhir S, Pandey S, Garg RK, Verma R, Paliwal VK, Malhotra HS, Sharma PK, Kumar N, Rizvi I, Jain A, Kohli N, Saini VK, Uniyal R. 18FDG-Positron Emission Tomography in patients with Tuberculous Meningitis: A Prospective Evaluation. Am J Trop Med Hyg 2021; 105:1038-1041. [PMID: 34280149 PMCID: PMC8592133 DOI: 10.4269/ajtmh.21-0102] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/07/2022] Open
Abstract
Lower yield of available diagnostic tests for tuberculous meningitis (TBM) frequently causes delay in diagnosis. Recently, 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used in infectious disorders such as pulmonary tuberculosis; however, it is rarely used in TBM. This study was aimed to ascertain the role of FDG PET in the diagnosis and determination of the extent of disease and prognosis in patients with TBM. After excluding unsuitable patients, 25 patients were subjected to whole-body PET-computed tomography (CT) image acquisition along with separate brain protocol with an integrated PET-CT device. FDG PET was found to be abnormal in 92% patients. Extracranial FDG uptake was observed in 80% patients. Most common extracranial site of involvement was lymph nodes (60%), followed by lung (56%), vertebral body (8%), genitourinary organs (8%), and spleen (4%). FDG PET observed extracranial involvement had 80% sensitivity and 20% specificity in detecting definite TBM cases. In conclusion, FDG PET may be a useful test in TBM evaluation.
Collapse
Affiliation(s)
- Harish Nigam
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Vivek Kumar Saini
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
9
|
Awasthi S, Rastogi T, Pandey AK, Roy C, Mishra K, Verma N, Kumar CB, Jain PK, Yadav R, Chauhan A, Mohindra N, Shukla RC, Agarwal M, Pandey CM, Kohli N. Epidemiology of Hypoxic Community-Acquired Pneumonia in Children Under 5 Years of Age: An Observational Study in Northern India. Front Pediatr 2021; 9:790109. [PMID: 35223708 PMCID: PMC8863665 DOI: 10.3389/fped.2021.790109] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the leading cause of under-five mortality in India. An increased risk of mortality has been reported in cases of hypoxic pneumonia. METHODS The primary objective of this study was to assess the proportion of children aged 2-59 months, hospitalized with hypoxic CAP, as well as socio-demographic, clinical, and radiological features associated with it. The secondary objective was to determine the risk of mortality among hospitalized cases of hypoxic CAP. This prospective, observational study was conducted in four districts of Northern India, between January 2015 and April 2021. A hospital-based surveillance network was established. Inclusion criteria were as follows: (a) child between 2 and 59 months, (b) hospitalization with symptoms of WHO-defined CAP, (c) resident of project district, (d) illness of <14 days, and (e) child had neither been hospitalized for this illness nor recruited previously. Children whose chest x-rays (CXRs) were either unavailable/un-interpretable and those that received any dose of pneumococcal conjugate vaccine-13 were excluded. Hypoxic pneumonia was defined as oxygen saturation <90% on pulse oximetry or requiring oxygen supplementation during hospital stay. RESULTS During the study period, 71.9% (7,196/10,006) children of severe pneumonia were eligible for inclusion, of whom 35.9% (2,580/7,196) were having hypoxic pneumonia. Female gender and use of biomass fuel for cooking increased the odds of hypoxic CAP. Clinical factors like wheezing, pallor, tachypnea, low pulse volume, presence of comorbidity, general danger signs, severe malnutrition, and radiological finding of primary end-point pneumonia ± other infiltrates (PEP±OI) also increased the odds of hypoxic CAP in a conditional logistic regression model. Adjusted odds ratio for mortality with hypoxia was 2.36 (95% CI: 1.42-3.92). CONCLUSION Almost one-third of cases hospitalized with severe CAP had hypoxia, which increased chances of mortality. Besides known danger signs, certain newer clinical signs such as pallor and wheezing as well as PEP+OI were associated with hypoxic CAP. Therefore, objective assessment of oxygen saturation must be done by pulse oximetry in all cases of CAP at the time of diagnosis.
Collapse
Affiliation(s)
- Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Tuhina Rastogi
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Anuj Kumar Pandey
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Chittaranjan Roy
- Department of Community Medicine, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Kripanath Mishra
- Department of Pediatrics, Darbhanga Medical College and Hospital, Darbhanga, India
| | - Neelam Verma
- Department of Pediatrics, Patna Medical College and Hospital, Patna, India
| | | | - Pankaj Kumar Jain
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Rajesh Yadav
- Department of Pediatrics, Uttar Pradesh University of Medical Sciences, Etawah, India
| | - Abhishek Chauhan
- Department of Radio-Diagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Namita Mohindra
- Department of Radio-Diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ram Chandra Shukla
- Department of Radio-Diagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Monika Agarwal
- Department of Community Medicine, King George's Medical University, Lucknow, India
| | - Chandra Mani Pandey
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neera Kohli
- Department of Radio-Diagnosis, King George's Medical University, Lucknow, India
| |
Collapse
|
10
|
Pandey CS, Kumar R, Malhotra HS, Kohli N, Kumar C, Verma SK. Movement Disorders in Children: An Observational Study in a Tertiary Care Center in North India. Journal of Pediatric Neurology 2020. [DOI: 10.1055/s-0039-1693030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AbstractMovement disorders (MDs) are disorders of pathological movements that cannot be fully initiated, modulated, or interrupted voluntarily. Spectrum and etiology of MDs are likely to vary with geographical location, but there are few studies on pediatric MDs from India, and severity of the disease is not well documented. Response to treatment of MDs is often unpredictable. Objective of the study was to describe the relative prevalence, types, severity, etiology, and response to treatment of pediatric MDs as seen at a public teaching hospital in northern India. Over a period of 1 year, consecutive children with MDs seen in outpatient department (OPD) or wards were enrolled, after excluding cerebral palsy and musculoskeletal disorders. Detailed history, examination, treatment, and outcome were recorded. Severity was rated according to Battini's scale at initial contact and each follow-up. Neuroimaging and relevant investigations were done for etiology. Serial 2-minute video recordings were obtained. Out of 93 patients enrolled, the most common MDs were dystonia (24.7%), tremors (22.4%), ataxia (19.6%), and chorea (12.9%). Tics, hemiballismus, and myoclonus were also seen and 4% could not be classified. Mixed MDs were seen in 9.7%. Etiologies of MDs were infectious (acute encephalitis syndrome, tuberculous meningitis, subacute sclerosing panencephalitis, and rheumatic chorea) or nutritional (infantile tremor syndrome) in 46%. Genetic neurodegenerations accounted for a significant proportion (15.1%). Improvement occurred in majority (63.4%) of patients. Etiology of MDs was largely specific to this part of the world, related to infectious and nutrition causes. In the absence of complex genetic investigations, many cases were left with unknown etiology.
Collapse
Affiliation(s)
- Chandra Shekhar Pandey
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chandrakanta Kumar
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sanjeev Kumar Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
11
|
Bowman MA, Buysse DJ, Marsland AL, Wright AG, Foust J, Mehra R, Srinivasan S, Kohli N, Carroll L, Jasper A, Hall MH. 0820 Meta-Analysis of the Association of Age and Actigraphy-Assessed Sleep Across the Lifespan. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.816] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep quantity and continuity vary across the lifespan. Actigraphy is reliable, ecologically valid, and is the most widely-used behavioral measure of sleep in research and personal health monitoring. The extent to which age is associated with actigraphy-assessed sleep has not been evaluated across the lifespan. The aim of this meta-analysis was to evaluate the associations between age and actigraphy-assessed sleep in relatively healthy individuals.
Methods
A systematic search of PubMed, Embase.com, Cochrane CENTRAL, and PsycINFO using “actigraphy” and “sleep” terms provided 7,079 titles/abstracts, which were screened to exclude studies of only individuals with mental health disorders, medical conditions, sleep disorders, or shift workers. We evaluated 1,379 full-text articles for reports on the association between age and actigraphy-assessed sleep duration, efficiency, timing, and/or regularity. Overall, 88 articles met these criteria (182 effect sizes; N=18,443). Four meta-analyses were conducted, examining sleep duration (k=86), sleep efficiency (k=58), bedtime (k=27), and wake-up time (k=11). There were insufficient numbers of studies (less than 5) to evaluate sleep midpoint or sleep regularity. We tested continent of the study, study design, actigraphy device type, and number of nights of data collection as moderators of meta-analytic associations.
Results
With increasing age, sleep duration was shorter (r = -0.13) and sleep efficiency was lower (r = -0.06). Bedtime was later with age for ages 6-21 (r = 0.31) and earlier for ages 22 and up (r = -0.65). Wake-up time was not associated with age for ages 6-21 (r = 0.20) but was earlier with increasing age for ages 22 and up (r = -0.71). The strength of these associations was modified by continent and study design, but not by type of actigraphy device or number of nights of data collection.
Conclusion
Weak associations between age and actigraphy-assessed duration and efficiency suggest that inadequate sleep quantity or poor sleep continuity should not be dismissed as typical consequences of aging. Large associations between age and sleep timing, despite a small literature, highlights a promising area for further study, particularly to determine the age at which sleep timing shifts from delaying to advancing.
Support
MAB was supported by T32 HL07560.
Collapse
Affiliation(s)
- M A Bowman
- University of Pittsburgh, Pittsburgh, PA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
| | | | - A G Wright
- University of Pittsburgh, Pittsburgh, PA
| | - J Foust
- University of Pittsburgh, Pittsburgh, PA
| | - R Mehra
- University of Pittsburgh, Pittsburgh, PA
| | | | - N Kohli
- University of Pittsburgh, Pittsburgh, PA
| | - L Carroll
- University of Pittsburgh, Pittsburgh, PA
| | - A Jasper
- University of Pittsburgh, Pittsburgh, PA
| | - M H Hall
- University of Pittsburgh, Pittsburgh, PA
| |
Collapse
|
12
|
Sahoo H, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, Garg R, Kohli N, Verma R, Sharma PK, Pandey S, Uniyal R. Extra-central nervous system tuberculosis in HIV-uninfected patients of tuberculous meningitis: A prospective evaluation. J Infect Public Health 2020; 13:1101-1106. [PMID: 32439354 DOI: 10.1016/j.jiph.2020.04.011] [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: 01/04/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Disseminated tuberculosis is characterized with involvement of two or more non-contiguous sites. In this work we evaluated patients of tuberculous meningitis for possible extra-central nervous system tuberculosis. METHOD This prospective observational study was performed at a tertiary care institute in Northern India. We included consecutive HIV-uninfected cases of TBM. Patients were evaluated for extra-central nervous system (CNS) tuberculosis. We focussed on peripheral lymph nodes, chest, abdomen, and spinal involvement. All patients were subjected to MRI brain and spine. Patients were also subjected to CT thorax and abdomen. Enlarged lymph nodes, if present, were biopsied. Ascitic and pleural fluid were subjected to biochemical, cellular analysis as well as cartridge-based nucleic acid amplification test (CBNAAT) for detection of Mycobacterium tuberculosis and rifampicin resistance. RESULTS We enrolled 110 patients of TBM. After cerebrospinal fluid examination alone, 14 (12.7%) patients had microbiologically-confirmed TBM. After planned work-up for extra CNS tuberculosis, 5 additional cases were microbiologically confirmed. Similarly, before work-up for extra CNS tuberculosis, 29 (26.4%) patients were categorized as probable TBM. The number of probable cases increased to 72 (65.5%) (P<0.001) with identification of tuberculosis elsewhere. Lung (83.6%) was the most involved site. Abdominal tuberculosis was noted in 29 (26.4%) patients. On imaging spine, 17 (15.5%) patients demonstrated presence of spinal tuberculous. Lymph adenopathy recorded in 2 cases. Lymph node biopsy revealed tuberculous granuloma in both the cases. All 7 patients, who died, had disseminated tuberculosis. CONCLUSION Extra CNS tuberculous involvement is common in TBM. Search for extra CNS tuberculous enables upgrading diagnostic accuracy.
Collapse
Affiliation(s)
- Haramohan Sahoo
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India.
| | - Imran Rizvi
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajiv Garg
- Department of Respiratory Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Rajesh Verma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Praveen Kumar Sharma
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Shweta Pandey
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, 226003, India
| |
Collapse
|
13
|
Awasthi S, Rastogi T, Mishra N, Chauhan A, Mohindra N, Shukla RC, Agarwal M, Pandey CM, Kohli N, Study Group C. Chest radiograph findings in children aged 2-59 months hospitalised with community-acquired pneumonia, prior to the introduction of pneumococcal conjugate vaccine in India: a prospective multisite observational study. BMJ Open 2020; 10:e034066. [PMID: 32385059 PMCID: PMC7228527 DOI: 10.1136/bmjopen-2019-034066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The current study was a hospital-based surveillance of cases hospitalised with WHO-defined community-acquired pneumonia in children aged 2-59 months, to assess the radiological abnormalities in chest X-rays and to identify the demographic and clinical correlates of specific radiological abnormalities, in residents of prespecified districts of Uttar Pradesh and Bihar, India. DESIGN Prospective, active, hospital-based surveillance. SETTING Multisite study conducted in a network of 117 secondary/tertiary care hospitals in four districts of Uttar Pradesh and Bihar, India. PARTICIPANTS Included were children aged 2-59 months, hospitalised with community-acquired pneumonia, residing in the project district, with duration of illness <14 days and who had not been hospitalised elsewhere for this episode nor had been recruited previously. MAIN OUTCOME MEASURE Concordant radiological abnormalities in the chest X-rays. RESULTS From January 2015 to April 2017, 3214 cases were recruited and in 99.40% (3195/3214) chest X-rays were available, among which 88.54% (2829/3195) were interpretable. Relevant radiological abnormalities were found in 34.53% (977/2829, 95% CI 32.78 to 36.28). These were primary end point pneumonia alone or with other infiltrates in 22.44% (635/2829, 95% CI 20.90% to 23.98%) and other infiltrates in 12.09% (342/2829; 95% CI 10.88% to 13.29%). There was a statistically significant interdistrict variation in radiological abnormalities. Statistically significantly higher proportion of abnormal chest X-rays were found in girls, those with weight-for-age z-score ≤-3SD, longer duration of fever, pallor and with exposure to biomass fuel. CONCLUSIONS Among hospitalised cases of community-acquired pneumonia, almost one-third children had abnormal chest radiographs, which were higher in females, malnourished children and those with longer illnesses; and an intra-district variation was observed.
Collapse
Affiliation(s)
- Shally Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Tuhina Rastogi
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Neha Mishra
- Department of Pediatrics, King George's Medical University, Lucknow, India
| | - Abhishek Chauhan
- Department of Radio-diagnosis, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Namita Mohindra
- Department of Radio-diagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ram Chandra Shukla
- Department of Radio-diagnosis, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India
| | - Chandra Mani Pandey
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Neera Kohli
- Department of Radio-diagnosis, King George's Medical University, Lucknow, India
| | | |
Collapse
|
14
|
Pandey S, Malhotra HS, Garg RK, Malhotra KP, Kumar N, Rizvi I, Jain A, Kohli N, Verma R, Sharma P, Uniyal R, Pandey S. Quantitative assessment of lesion load and efficacy of 3 cycles of albendazole in disseminated cysticercosis: a prospective evaluation. BMC Infect Dis 2020; 20:220. [PMID: 32171260 PMCID: PMC7071677 DOI: 10.1186/s12879-020-4891-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of disseminated cysticercosis is unclear and largely considered hazardous. The role of albendazole remains controversial in such patients. METHODS A tertiary care, University hospital-based prospective intervention study was conducted from December 2015 to December 2017. Patients with disseminated cysticercosis, defined as the presence of multiple viable neurocysticerci (≥ 3) in the brain along with involvement of an additional extra site, were included in the study. Patients with cysticercal encephalitis were excluded. A detailed evaluation, including ophthalmoscopy, ocular B scans, ultrasound abdomen, and X-rays were done. Albendazole was administered at a dose of 15 mg/kg/day in 3 cycles of 28 days each. All patients were also given adjuvant corticosteroids and anti-epileptic drugs. Clinical and radiological follow up was carried out at a difference of 3 months between each treatment cycle. For radiological quantification, lesions were counted at 10 pre-specified levels. Statistical analysis was done to estimate the difference in seizure frequency and lesion load. RESULTS Twenty-nine patients (21 with > 20 lesions; 8 with ≤ 20 lesions) were given albendazole as per the protocol. There was a significant reduction in the occurrence of seizures (P < 0.001) and headache (P < 0.001). A significant reduction in lesion load from baseline to third follow-up was seen in the estimations done at different levels (P < 0.001). No patient developed serious side-effect warranting cessation of therapy. CONCLUSION Cyclical use of albendazole appears efficacious in treating disseminated cysticercosis. The method of quantification described may be used in future studies for objective assessment. TRIAL REGISTRATION ISRCTN11630542; 28th September 2019; Retrospectively registered.
Collapse
Affiliation(s)
- Sudhakar Pandey
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | | | - Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Kiran Preet Malhotra
- Department of Pathology, R.M.L. Institute of Medical Sciences, Lucknow, 226010, India
| | - Neeraj Kumar
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Imran Rizvi
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Amita Jain
- Department of Microbiology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, U.P, Lucknow, 226003, India
| | - Rajesh Verma
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Praveen Sharma
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Ravi Uniyal
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| | - Shweta Pandey
- Department of Neurology, King George's Medical University, U.P, Lucknow, 226003, India
| |
Collapse
|
15
|
Barman B, Parihar A, Kohli N, Agarwal A, Dwivedi DK, Kumari G. Impact of Bedside Combined Cardiopulmonary Ultrasound on Etiological Diagnosis and Treatment of Acute Respiratory Failure in Critically Ill Patients. Indian J Crit Care Med 2020; 24:1062-1070. [PMID: 33384512 PMCID: PMC7751041 DOI: 10.5005/jp-journals-10071-23661] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 12/14/2022] Open
Abstract
Aims and objectives To prospectively evaluate the impact of cardiopulmonary ultrasound (CPUS) on etiological diagnosis and treatment of critically ill acute respiratory failure (ARF) patients. Design This is a prospective observational study conducted in a general intensive care unit (ICU) of a tertiary care center in India. Patients over 18 years old with presence of one of the objective criteria of ARF. Patients either consecutively admitted for ARF to ICU or already admitted to ICU for a different reason but later developed ARF during their hospital stay. Written informed consent in local language was obtained from next of kin. Interventions All included patients underwent bedside CPUS including lung ultrasound (US) and transthoracic echocardiography plus targeted venous US by single investigator, blinded to clinical data. The US diagnosis of ARF etiology was shared with treating intensivist. Initial clinical diagnosis (ICD) and treatment plan (made before US) of each patient were compared with post-US clinical diagnosis and treatment plan. The changes in diagnosis and treatment up to 24 hours post-US were considered as impact of US. Results Mean age of 108 included patients was 45.7 ± 20.4 years (standard deviation). The ICD was correct in 67.5% (73/108) cases, whereas the combined CPUS yielded correct etiological diagnosis in 88% (95/108) cases. Among the 108 included patients, etiological diagnosis of ARF was altered after CPUS in 40 (37%) patients, which included "diagnosis changed" in 18 (17%) and "diagnosis added" in 22 (20%). Treatment plan was changed in 39 (36%) patients after CPUS, which included surgical interventions in 17 (16%), changes in medical therapy in 12 (11%), and changes in ventilation strategy in 4 (3.5%) patients. Conclusion This study demonstrates that use of combined US approach as an initial test in ARF, improves diagnostic accuracy for identification of underlying etiology, and frequently changes clinical diagnosis and/or treatment. How to cite this article Barman B, Parihar A, Kohli N, Agarwal A, Dwivedi DK, Kumari G. Impact of Bedside Combined Cardiopulmonary Ultrasound on Etiological Diagnosis and Treatment of Acute Respiratory Failure in Critically Ill Patients. Indian J Crit Care Med 2020;24(11):1062-1070.
Collapse
Affiliation(s)
- Bapi Barman
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Anit Parihar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Avinash Agarwal
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Durgesh K Dwivedi
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gangotri Kumari
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
16
|
Ajao MO, Cohen SL, Kohli N, Einarsson JI. Feasibility of Outpatient Combined Laparoscopic Apical and Vaginal Prolapse Repair. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Khan R, Kohli N, Douglas A, Chan A, Charania J, Philipp R, Simkus G, Vuurmans T. COMPARING ANGIOGRAPHIC BURDEN OF CORONARY ARTERY DISEASE AND 30-DAY OUTCOMES BETWEEN SOUTH ASIAN AND NON-SOUTH ASIAN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
18
|
Singh B, Pandey NM, Garg RK, Kohli N, Usman K, Agarwal GG, Tiwari SC. Sample attrition rate of a community study: An analysis of Lucknow urban and rural elderly follow-up over a period of 9 years. Indian J Psychiatry 2019; 61:290-294. [PMID: 31142908 PMCID: PMC6532467 DOI: 10.4103/psychiatry.indianjpsychiatry_317_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Longitudinal/follow-up studies of older adults are a tough task as sample attrition rates due to mortality and other factors may be high in this particular group. However, such studies are very much needed to assess the outcome of health status as well as explore preventive, protective, interventional aspects, as well as risk factors. Given this, a follow-up study was planned and carried out. AIM To discuss the rate of sample loss as well as the reasons over 9 years. METHODS An Indian Council of Medical Research (ICMR) supported follow-up study of urban and rural elderly was done during June, 2016-May, 2017; these subjects were studied in 2007-09 through two independent ICMR supported studies. Similar methodology and assessment tools were applied in these studies. During follow-up a semi structured proforma was developed to get the information of study cohort, obtained data was analyzed and presented applying percentage statistics. RESULTS The sample attrition rate was reported to be comparatively high in urban 52.1% (n= 633) cohort than their rural counterparts 36.3% (n= 457). CONCLUSION Over a period of 9 years chances of cohort loss due to mortality is about 32%-35%.
Collapse
Affiliation(s)
- Bhupendra Singh
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nisha Mani Pandey
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - R. K. Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radio-Diagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Kausar Usman
- Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - G. G. Agarwal
- Department of Statistics, Lucknow University, Lucknow, Uttar Pradesh, India
| | - Sarvada Chandra Tiwari
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
19
|
Bansod A, Garg RK, Rizvi I, Malhotra HS, Kumar N, Jain A, Verma R, Kohli N, Sharma PK, Uniyal R, Pandey S. Magnetic resonance venographic findings in patients with tuberculous meningitis: Predictors and outcome. Magn Reson Imaging 2018; 54:8-14. [DOI: 10.1016/j.mri.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/09/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
|
20
|
Soni RM, Tiwari SC, Mahdi AA, Kohli N. Serum Homocysteine and Behavioral and Psychological Symptoms of Dementia: Is There Any Correlation in Alzheimer's Disease? Ann Neurosci 2018; 25:152-159. [PMID: 30814822 DOI: 10.1159/000487068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background There are studies showing the relation between serum B12, folate and Behavioral and Psychological symptoms of Dementia (BPSD) in Alzheimer's disease (AD). Serum levels of these vitamins do not reflect actual disease status and therefore checking the serum Homocysteine level is considered a better test. Homocysteine has been found to be associated with cognitive impairment and various psychiatric disorders. Purpose This study was planned to identify the correlation between serum homocysteine levels and BPSD in AD patients. Methods AD patients (n = 18) and healthy controls (n = 18) were included in the study. Diagnosis of AD was confirmed using International Classification Disease-10. AD patients were assessed using Mini Mental Status Examination (MMSE), Clinical Dementia Rating scale (CDR), Global Deterioration scale (GDS), and Neuropsychiatric inventory (NPI). Healthy controls were assessed on MMSE and Mini International Neuropsychiatric Interview. Serum homocysteine, vitamin B12, and folate levels were measured in all study subjects. Results Patients with AD had statistically significant higher serum levels of homocysteine as compared to the control group, while the levels of vitamin B12 and folate did not differ significantly. There was statistically significant positive correlation of serum homocysteine levels with total NPI score as well as with NPI sub-domains particularly delusion, agitation/aggression, and depression/dysphoria. Serum homocysteine levels did not correlate significantly with MMSE, CDR, and GDS scores. Conclusion Correlation was observed between serum homocysteine levels and behavioral and psychological symptoms of AD. There is a possibility of etiological role, but the underlying pathophysiological mechanisms need to be elucidated. Whether patients will benefit or not with supplements of vitamin B12 and folate requires further research. This was a cross-sectional study and findings should not be generalized. Further prospective longitudinal studies with a large number of patients are needed.
Collapse
Affiliation(s)
- Ravi M Soni
- Department of Geriatric Mnetal Health, King George's Medical University, Lucknow, India
| | - Sarvada C Tiwari
- Department of Geriatric Mnetal Health, King George's Medical University, Lucknow, India
| | - Abbas A Mahdi
- Department of Bichemistry, King George's Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, India
| |
Collapse
|
21
|
Abstract
Menkes disease is a rare neurodegenerative metabolic disease with a reported incidence of 1 per 300 000 live births. It occurs due to mutations in ATP7A gene located on X-chromosome leading to deficiency of several copper-containing enzymes. The patient presents with history of neuroregression with characteristic kinky hair. MRI is the imaging modality of choice. Characteristic imaging findings are: bilateral subdural hygromas, cerebral and cerebellar atrophy, white matter changes and tortuous intracranial vessels on angiography. The rarity of this condition prompted us to report this case of Menkes disease along with the characteristic neuroimaging findings and brief review of literature.
Collapse
Affiliation(s)
- Pulkit Rangarh
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis and Imaging, RML Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
22
|
Manoj K, Garg G, Nagathan D, Verma SK, Kohli N, Kumar S, Pandey SK, Sankhwar SN. Duplex Ultrasound-guided Direct Percutaneous Management of Pseudoaneurysm of Branch of Segmental Renal Artery: Technique and Its Outcome. Urology 2018; 118:234-238. [PMID: 29723587 DOI: 10.1016/j.urology.2018.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/30/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe the role of duplex ultrasound imaging (DUI) in prompt diagnosis of pseudoaneurysm (PSA) of a branch of the segmental renal artery (b-SRA) and to evaluate outcomes of DUI directed percutaneous embolization. MATERIALS AND METHODS Forty-five patients were referred to us for the management of intractable renal hematuria. A total of 20 cases (44.44%) had developed PSA after nephrolithotomy, 12 cases (12.66%) had developed PSA after guided renal biopsies, 6 cases (13.33%) had developed PSA following road side trauma, and 2 cases (4.44%) of the tuberous sclerosis complex had developed PSA. Three cases (6.66%) of arteriovenous and 2 cases (4.44%) of arteriocalyceal fistulae had been excluded from the study. DUI-guided direct percutaneous management (DPM) was done as a 4-step process. First is the identification of PSA sac in the neck and offending b-SRA. Second is the puncture of PSA sac with 18 g puncture needle under DUI. Subsequently, manual injection of temporary embolic agent was done followed by N-butyl cyanoacrylate glue. Thrombosis of the PSA sac was confirmed by absent flow on DUI. RESULTS Forty cases of b-SRA were managed successfully in a single session and followed up by clinical findings, DUI, and computed tomography angiography. There was no need for the second session of DPM, transarterial embolization, or surgery in this cohort. Twelve cases (30%) had developed a mild fever and were managed conservatively. All 40 cases had no evidence of renal hematuria after follow-up of 3 months. CONCLUSION DUI-guided DPM is a safe, feasible, cost-effective, and nephron-sparing promising alternative to TAE or surgery for management of PSA of b-SRA.
Collapse
Affiliation(s)
- Kumar Manoj
- Department of Radiodiagnosis, King Georges Medical University, Uttar Pradesh, India.
| | - Gaurav Garg
- Department of Urology, King Georges Medical University, Uttar Pradesh, India
| | - Deepak Nagathan
- Department of Urology, King Georges Medical University, Uttar Pradesh, India
| | - Sanjeev Kumar Verma
- Department of Pediatrics, King Georges Medical University, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King Georges Medical University, Uttar Pradesh, India
| | - Santosh Kumar
- Department of Pulmonary Medicine, King Georges Medical University, Uttar Pradesh, India
| | - Sant Kumar Pandey
- Department of Nephrology, King Georges Medical University, Uttar Pradesh, India
| | | |
Collapse
|
23
|
Gupta BP, Sharma I, Kohli N, Sharma S, Rathi A, Sharma AK. Preliminary clinical assessment and non- toxicity evaluation of an ayurvedic formulation BGR-34 in NIDDM. J Tradit Complement Med 2018; 8:506-514. [PMID: 30302331 PMCID: PMC6174273 DOI: 10.1016/j.jtcme.2017.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 11/15/2022] Open
Abstract
In view of the overall health impact of NIDDM, inventers understand the necessity of improving glycemic control in adults with type 2 diabetes. BGR-34 provides an effective treatment option for adults with type 2 diabetes who have been inadequately controlled on lifestyle with or without other oral hypoglycemic agents (OHGAs) such as metformin, sulfonylurea, or a glitazones. BGR-34 is an appropriate option to consider for addition to a managed care drug formulary. Treatment with BGR-34 produced clinically relevant and statistically significant reductions in all three key measures of glucose control studied -FPG, PPBG and HbA1c- when compared with placebo. BGR-34, showed the promising result with respect to glycemic parameters in NIDDM patient with a significant reduction in fasting blood sugar by 34.3%, postprandial blood sugar 35.5% & glycosylated haemoglobin by 20.31% as compared to placebo group showing a reduction by 13.2%, 10.9% & 10.87% respectively. The trial has also been registered to CTRI, India. This study has been registered in the clinical trial registry-India.
Collapse
Key Words
- ALP, alkaline phosphatase
- BBN, total bilirubin
- BGR-34
- Berberis aristata
- CPCSEA, committee for the purpose of conduct and supervisions of experiments on rats
- CSIR, council of scientific & industrial research, india
- CTRI, clinical trial registry-India
- DLC, differential leukocyte count
- FPG, fasting plasma glucose
- HDL, high-density lipoproteins
- Hb, haemoglobin
- HbA1c, glycosylated haemoglobin
- Indian system medicine
- NIDDM
- NIDDM, noninsulin-dependent diabetes mellitus
- OECD, organization for economic co-operation and development
- OHGAs, other oral hypoglycemic agents
- OPD, out Patient Department
- PPBG, post-prandial blood glucose
- SGOT, serum glutamate oxaloacetate transaminase
- SGPT, serum glutamate pyruvate transaminase
- TLC, TOTAL leukocyte count
- Type 2 diabetes
Collapse
Affiliation(s)
- B P Gupta
- Aggarwal Dharmarth Hospital, New Delhi, India
| | - I Sharma
- Research and Development, Aimil Pharmaceuticals (India) Ltd, New Delhi, India
| | - N Kohli
- Aimil Healthcare and Research Centre, New Delhi, India
| | - S Sharma
- Research and Development, Aimil Pharmaceuticals (India) Ltd, New Delhi, India
| | - A Rathi
- Research and Development, Aimil Pharmaceuticals (India) Ltd, New Delhi, India
| | - A K Sharma
- Research and Development, Aimil Pharmaceuticals (India) Ltd, New Delhi, India
| |
Collapse
|
24
|
Ross MW, Leshabari S, Rosser BRS, Trent M, Mgopa L, Wadley J, Kohli N, Agardh A. Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: The sexual health education for professionals scale (SHEPS). Appl Nurs Res 2018; 40:152-156. [PMID: 29579491 DOI: 10.1016/j.apnr.2018.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/26/2017] [Revised: 10/04/2017] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Abstract
We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.
Collapse
Affiliation(s)
- M W Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota Medical School, 1300 South 2nd Street, Minneapolis, MN 55454, USA.
| | - S Leshabari
- School of Nursing, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
| | - B R S Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454, USA
| | - M Trent
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, 200 N. Wolfe Street, #2064, Baltimore, MD 21287, USA
| | - L Mgopa
- Department of Psychiatry, School of Medicine, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
| | - J Wadley
- Department of Counseling and Human Services, Lincoln University, 1570 Baltimore Pike, PA 19352, USA
| | - N Kohli
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street, Minneapolis, MN 55454, USA
| | - A Agardh
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
25
|
Rathore R, Parihar A, Dwivedi DK, Dwivedi AK, Kohli N, Garg RK, Chandra A. Predictive Models in Differentiating Vertebral Lesions Using Multiparametric MRI. AJNR Am J Neuroradiol 2017; 38:2391-2398. [PMID: 29025721 DOI: 10.3174/ajnr.a5411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging has high sensitivity but limited specificity in differentiating various vertebral lesions. We aimed to assess the ability of multiparametric MR imaging in differentiating spinal vertebral lesions and to develop statistical models for predicting the probability of malignant vertebral lesions. MATERIALS AND METHODS One hundred twenty-six consecutive patients underwent multiparametric MRI (conventional MR imaging, diffusion-weighted MR imaging, and in-phase/opposed-phase imaging) for vertebral lesions. Vertebral lesions were divided into 3 subgroups: infectious, noninfectious benign, and malignant. The cutoffs for apparent diffusion coefficient (expressed as 10-3 mm2/s) and signal intensity ratio values were calculated, and 3 predictive models were established for differentiating these subgroups. RESULTS Of the lesions of the 126 patients, 62 were infectious, 22 were noninfectious benign, and 42 were malignant. The mean ADC was 1.23 ± 0.16 for infectious, 1.41 ± 0.31 for noninfectious benign, and 1.01 ± 0.22 mm2/s for malignant lesions. The mean signal intensity ratio was 0.80 ± 0.13 for infectious, 0.75 ± 0.19 for noninfectious benign, and 0.98 ± 0.11 for the malignant group. The combination of ADC and signal intensity ratio showed strong discriminatory ability to differentiate lesion type. We found an area under the curve of 0.92 for the predictive model in differentiating infectious from malignant lesions and an area under the curve of 0.91 for the predictive model in differentiating noninfectious benign from malignant lesions. On the basis of the mean ADC and signal intensity ratio, we established automated statistical models that would be helpful in differentiating vertebral lesions. CONCLUSIONS Our study shows that multiparametric MRI differentiates various vertebral lesions, and we established prediction models for the same.
Collapse
Affiliation(s)
- R Rathore
- From the Departments of Radiodiagnosis (R.R., A.P., D.K.D., N.K.)
| | - A Parihar
- From the Departments of Radiodiagnosis (R.R., A.P., D.K.D., N.K.)
| | - D K Dwivedi
- From the Departments of Radiodiagnosis (R.R., A.P., D.K.D., N.K.)
| | - A K Dwivedi
- Division of Biostatistics & Epidemiology (A.K.D.), Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, Texas
| | - N Kohli
- From the Departments of Radiodiagnosis (R.R., A.P., D.K.D., N.K.)
| | | | - A Chandra
- Neurosurgery (A.C.), King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
26
|
Kohli N, Miklos J. Office-Based Comprehensive Bladder Evaluation Using a Novel 4-Way Catheter. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Kohli N, Sun X, Grazul-Bilska A, Vonnahme K, Webb B. Rethinking the Urinary Catheter: Less Trauma Through Better Design – A Sheep Model. J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
28
|
Verma AK, Garg RK, Pradeep Y, Malhotra HS, Rizvi I, Kumar N, Kohli N, Pandey S. Posterior encephalopathy syndrome in women with eclampsia: Predictors and outcome. Pregnancy Hypertens 2017; 10:74-82. [DOI: 10.1016/j.preghy.2017.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/16/2017] [Accepted: 06/07/2017] [Indexed: 12/01/2022]
|
29
|
Flynn PM, John MT, Naik A, Kohli N, VanWormer JJ, Self K. Psychometric properties of the English version of the Oral Health Literacy Adults Questionnaire - OHL-AQ. Community Dent Health 2017; 33:274-280. [PMID: 28537364 DOI: 10.1922/cdh_3868flynn07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/01/2016] [Indexed: 11/11/2022]
Abstract
Objective To test the psychometric properties of the Oral Health Literacy Adult Questionnaire (OHL-AQ) in English. The OHL-AQ was designed to test functional oral health literacy in general populations and was initially validated in Iran. Methods The instrument was administered to 405 adult subjects (mean age 45 (SD 16) years and 67% female) attending the 2014 Minnesota State Fair. The OHL-AQ is composed of 17 items measuring four conceptual dimensions: reading comprehension, numeracy, listening, and decision-making. Participants selected the best answer for written or verbally administered items and entered answers on an electronic tablet. Item responses for each individual were combined into a summary score (range 0-17) with higher scores indicating better oral health literacy. Score dimensionality, reliability, and validity were investigated. Results For dimensionality, both exploratory factor analysis and a parallel analysis yielded evidence for scale unidimensionality. Reliability was sufficient indicated by a Cronbach's alpha ⟩0.74. Validity of scores was supported by "small" and "medium" effect sizes for construct validity. "Small" effect sizes were observed for global oral health self-report, OHIP-5 scores, treatment urgency, and having a regular dentist. "Medium" effect sizes were seen for presence of dentures, number of natural teeth present, and educational level. Conclusions Dimensionality, reliability and validity of the English version of the OHL-AQ in a general adult English-speaking population is supported, providing sufficient psychometric properties in an important target population of the instrument.
Collapse
Affiliation(s)
- P M Flynn
- Department of Primary Dental Care, University of Minnesota School of Dentistry, USA
| | - M T John
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, USA
| | - A Naik
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, USA
| | - N Kohli
- Department of Educational Psychology, College of Human Development, University of Minnesota, USA
| | - J J VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Foundation, Marshfield Clinic, Wisconsin, USA
| | - K Self
- Department of Primary Dental Care, University of Minnesota School of Dentistry, USA
| |
Collapse
|
30
|
Garg RK, Malhotra HS, Kumar V, Jain A, Goel M, Prakash V, Kumar S, Kohli N. Multiple nerve abscesses: An unusual manifestation of lepra reaction in a patient with borderline leprosy. Neurol India 2016; 64:1326-1328. [PMID: 27841214 DOI: 10.4103/0028-3886.193787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Vijay Kumar
- Department of Plastic Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Amita Jain
- Department of Microbiology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Madhumati Goel
- Department of Pathology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sukriti Kumar
- Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
31
|
Singh AK, Malhotra HS, Garg RK, Jain A, Kumar N, Kohli N, Verma R, Sharma PK. Paradoxical reaction in tuberculous meningitis: presentation, predictors and impact on prognosis. BMC Infect Dis 2016; 16:306. [PMID: 27329253 PMCID: PMC4915108 DOI: 10.1186/s12879-016-1625-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [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] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 06/07/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Awareness about paradoxical reactions in tuberculous meningitis is crucial as a paradoxical reaction may lead to certain wrong conclusions (for example, an erroneous diagnosis, and a possibility of treatment failure, mycobacterial drug-resistance, drug toxicity, or presence of a malignancy). The present study was planned to evaluate the incidence and predictive factors of paradoxical reactions in light of clinical, cerebrospinal fluid, and neuroimaging characteristics. METHODS In this prospective cohort study, consecutive patients fulfilling the International Consensus criteria of tuberculous meningitis were included. Patients were subjected to clinical evaluation, cerebrospinal fluid evaluation, and neuroimaging. Patients were treated with anti-tuberculosis drugs along with corticosteroids. Patients were regularly followed up at 3 monthly intervals. At each follow up patients were evaluated clinically and repeat cerebrospinal fluid analysis was performed along with repeat neuroimaging. Disability assessment was done using Barthel index. RESULTS We enrolled 141 patients of tuberculous meningitis. Approximately one-third of patients (44/141; 31.2 %) developed a paradoxical reaction. Twenty-seven patients developed hydrocephalus, 26 developed tuberculomas, 12 developed optochiasmatic arachnoiditis and 4 patients had spinal arachnoiditis. In 41 patients (out of 44) cerebrospinal fluid paradoxically worsened (increase in cells and/or protein); 2 demonstrated a decrease in cells with polymorph predominance while in one it was normal. In 3 patients, paradoxical cerebrospinal fluid changes were not associated with neuroimaging changes. On multivariate analysis, predictors of paradoxical reaction were female gender (p = 0.013), HIV positivity (p = 0.01) and a shorter duration of illness (p = 0.049). Development of paradoxical reactions did not predict the disability status of the patients. CONCLUSIONS Paradoxical reaction occurs in approximately one-third of patients with tuberculous meningitis. Female gender, concomitant HIV infection, and a shorter duration of illness were significant predictors. Paradoxical reactions did not adversely affect the outcome.
Collapse
Affiliation(s)
- Anurag Kumar Singh
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| | - Hardeep Singh Malhotra
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| | - Ravindra Kumar Garg
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| | - Amita Jain
- />Department of Microbiology, King George Medical University, Uttar Pradesh Lucknow, India
| | - Neeraj Kumar
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| | - Neera Kohli
- />Department of Radiodiagnosis, King George Medical University, Uttar Pradesh Lucknow, India
| | - Rajesh Verma
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| | - Praveen Kumar Sharma
- />Department of Neurology, King George Medical University, Uttar Pradesh Lucknow, PIN-226003 India
| |
Collapse
|
32
|
Abstract
Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig disease, is a chronic degenerative neurologic disease and is characterized by the selective involvement of the motor system. Usually, patients present with upper motor neuron (UMN) and lower motor neuron compromise. Degeneration of the UMN in the cerebral cortex is one of the main pathologic changes in ALS. These changes usually affect corticospinal tracts leading to degeneration of the fibers which show characteristic hyperintensities along the tracts leading to the “wine glass sign.” Patients with ALS usually present in the sixth decade of life; presentation in pediatric age in the form of juvenile ALS being rare.
Collapse
Affiliation(s)
- Saurabh Kumar
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pallavi Aga
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Aakansha Gupta
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Neera Kohli
- Department of Radiodiagnosis, King George's Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
33
|
Awasthi S, Singh J, Pandey C, Kohli N, Agarwal M. Hospital Based Surveillance for Radiological Pneumonia in children under 5 years of age in Uttar Pradesh and Bihar: Project protocol and preliminary results. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
34
|
Goyal S, Kohli N, Jain A, Dixit P, Kanta C, Kumar R. Clinical and radiological prognostic indicators in childhood tuberculous meningitis. J Pediatr Neurol 2015. [DOI: 10.3233/jpn-2012-0564] [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]
Affiliation(s)
- Saurabh Goyal
- Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Neera Kohli
- Department of Radiodiagnosis, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Amita Jain
- Department Microbiology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Pratima Dixit
- Department Microbiology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Chandra Kanta
- Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | - Rashmi Kumar
- Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| |
Collapse
|
35
|
Manoj K, Hatimi H, Kumar P, Chandra A, Sankhwar SN, Kumar S, Kohli N. An innovative modification of sandwich embolization technique for simultaneous management of ruptured pseudoaneurysm of branch of splenic artery and hypersplenism syndrome. Indian J Gastroenterol 2015; 34:178-81. [PMID: 25900542 DOI: 10.1007/s12664-015-0546-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/23/2015] [Indexed: 02/04/2023]
Abstract
Pancreatitis induced ruptured pseudoaneurysm (PSA) of the peri-pancreatic and splenic arteries may become a source of life-threatening hemorrhage. Its management is challenging and requires an individualized and multidisciplinary approach. The index case is a 32-year-old chronic alcoholic male presented with multiple episodes of hematemesis and melena. Pathological and imaging findings were consistent with anemia and acute pancreatitis with ruptured PSA of branch of splenic artery, portal cavernoma formation, and splenomegaly. Thrombosis of PSA sac, embolization of offending branch of splenic artery, and splenic infarction were successfully contemplated in a single session by direct percutaneous embolization with gelfoam and glue as embolic agents under guidance of duplex ultrasound imaging. We describe a modified sandwich embolization technique, its long-term success and complications of simultaneous management of ruptured PSA of branch of splenic artery and hypersplenism syndrome in limited resource scenario.
Collapse
Affiliation(s)
- Kumar Manoj
- Department of Radiodiagnosis, King George's Medical University, Shah Mina Road, Chowk, Lucknow, 226 003, India,
| | | | | | | | | | | | | |
Collapse
|
36
|
Mallipeddi PK, Steele AC, Kohli N, Karram MM. Anatomic and Functional Outcome of Vaginal Paravaginal Repair in the Correction of Anterior Vaginal Wall Prolapse. Int Urogynecol J 2014; 12:83-8. [PMID: 11374518 DOI: 10.1007/s001920170070] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over a 2-year period 45 patients with bilateral paravaginal support defects underwent vaginal paravaginal repair. Postoperative evaluations were conducted and anatomic outcome was determined by vaginal examination, with grading of vaginal wall support. Functional outcome was assessed by a standardized quality of life questionnaire, voiding dairy and standing stress test with a full bladder. Thirty-five patients had long-term follow-up with a mean of 1.6 years (range 1-85). The recurrence rates for displacement cystocele, enterocele and rectocele were 3% (1/35), 20% (7/35) and 14% (5/35), respectively. In no patients did vault prolapse develop or recur. Subjective or objective evidence of persistent stress urinary incontinence was found in 57% of patients (12/21). Vaginal paravaginal repair is a safe and effective technique for the surgical correction of anterior vaginal wall prolapse but has limited applicability in the surgical correction of genuine stress incontinence.
Collapse
|
37
|
Rai D, Malhotra HS, Garg RK, Goel MM, Malhotra KP, Kumar V, Singh AK, Jain A, Kohli N, Singh SK. Nerve abscess in primary neuritic leprosy. LEPROSY REV 2013; 84:136-140. [PMID: 24171239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Nerve abscess is an infrequently reported complication of leprosy. We describe a patient with a pure neuritic type of leprosy with multiple nerve abscesses, who presented with tingling and numbness in the medial aspect of his right forearm and hand. Subsequently he developed pain, redness and swelling over the medial side of his right elbow and the flexor aspect of his right wrist. High-resolution ultrasound showed diffuse thickening of the right ulnar nerve with hypoechoic texture housing a cystic lesion with internal debris suggesting an abscess, at the cubital tunnel. Histopathological examination of the pus and tissue obtained from the abscess revealed presence of granulomas with lepra bacilli. The patient responded to surgery and multidrug therapy. In conclusion, the nerve abscess as the first manifestation of leprosy is uncommon and a high index of suspicion is required to make a correct diagnosis.
Collapse
Affiliation(s)
- Dheeraj Rai
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow, India
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, Kohli N, Parihar A. Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis. J Infect 2013; 66:330-7. [PMID: 23291048 DOI: 10.1016/j.jinf.2012.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/24/2012] [Accepted: 12/26/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hydrocephalus is one of the most common complications of tuberculous meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of tuberculous meningitis. MATERIAL AND METHODS In a prospective cohort study, all patients fulfilling the inclusion criteria of tuberculous meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index. RESULTS Of 80 patients with tuberculous meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early tuberculous meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. CONCLUSION Hydrocephalus occurs in approximately two-third of patients with tuberculous meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of tuberculous meningitis may resolve completely.
Collapse
Affiliation(s)
- Tushar Raut
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow 226003, India
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Cohen S, Kohli N, Morse A, Hill-Lydecker C, Sandberg E, Vree F, Jonsdottir G, Einarsson J. Analysis of Joint Surgical Approach to Minimally Invasive Repair of Apical Prolapse. J Minim Invasive Gynecol 2012. [DOI: 10.1016/j.jmig.2012.08.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
40
|
Vidhate M, Garg RK, Yadav R, Kohli N, Naphade P, Anuradha HK. An unusual case of Takayasu's arteritis: Evaluation by CT angiography. Ann Indian Acad Neurol 2012; 14:304-6. [PMID: 22346024 PMCID: PMC3271474 DOI: 10.4103/0972-2327.91960] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 09/06/2010] [Accepted: 10/11/2010] [Indexed: 11/14/2022] Open
Abstract
Takayasu's arteritis is a chronic, idiopathic, medium and large vessel vasculitis involving aorta and its main branches. Frequent neurological manifestations include postural syncope, seizures, and blindness. Stroke, as presenting feature of Takayasu's arteritis, is unusual. CT angiography reveals characteristic involvement of aortic arch and its branches. Involvement of intracranial vasculature is rather unusual. We are describing an unusual patient of Takayasu's arteritis who presented with recurrent disabling syncopal attacks and had extensive involvement of intracranial vasculature. CT angiography revealed severe involvement of aortic arch. There was near complete occlusion at origins of both subclavian arteries, distal flow was maintained by collateral vessels along the chest wall. There was near total occlusion (at origin) of right common carotid with normal flow in distal part. The left common carotid was more severely involved showing greater than 80% narrowing in proximal half of the vessel. CT angiography also revealed involvement of left internal carotid artery, narrowing of left middle cerebral artery and involvement of cortical vessels. Patient was treated with oral corticosteroids. She improved remarkably after two and half months of follow up.
Collapse
Affiliation(s)
- Mukund Vidhate
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India
| | | | | | | | | | | |
Collapse
|
41
|
Dwivedi SK, Chandra S, Vijay SK, Saran RK, Kohli N, Singh R. Multimodality Imaging and Transcatheter Closure of a Giant Right Pulmonary Artery to Left Atrium Communication. J Am Coll Cardiol 2012; 60:e15. [DOI: 10.1016/j.jacc.2012.02.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 10/28/2022]
|
42
|
Singh B, Garg RK, Singh MK, Verma R, Malhotra HS, Jain A, Singh R, Kohli N, Phadke RV, Shukla R, Parihar A. Computed tomography angiography in patients with tuberculous meningitis. J Infect 2012; 64:565-72. [DOI: 10.1016/j.jinf.2012.03.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/24/2012] [Accepted: 03/18/2012] [Indexed: 10/28/2022]
|
43
|
Abstract
Di Sala syndrome or fetal warfarin syndrome/fetal warfarin embryopathy is a rare condition as result of fetal exposure due to maternal ingestion of warfarin during pregnancy. The authors report here a male infant with this condition whose mother was suffering from rheumatic mitral valvular heart disease for which she underwent prosthetic mitral valvular replacement surgery and put on injectable long acting penicillin and oral low-molecular weight anticoagulant drug (warfarin) for life long. The patient presented with facial dysmorphism, pectus excavatum, stippled epiphyses dolichocephaly, brachydactyly, polydactyly short neck and growth retardation. Shortened fourth metacarpal bones were also noted in this case which was not yet reported in literatures, to the best of our knowledge.
Collapse
Affiliation(s)
- Manoj Kumar
- Department of Radiodiagnosis and Imaging, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttarpradesh, India.
| | | | | | | | | |
Collapse
|
44
|
Aga P, Raj G, Kapoor A, Kohli N, Singh R. Coronary-cameral fistula from the sinoatrial nodal branch of the right coronary artery draining into the right atrium: demonstration by multidetector CT. Pediatr Radiol 2011; 41:1583-6. [PMID: 21617954 DOI: 10.1007/s00247-011-2144-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/15/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Pallavi Aga
- Radiodiagnosis, CSMMU, Lucknow 226014, India.
| | | | | | | | | |
Collapse
|
45
|
Parashari UC, Khanduri S, Bhadury S, Kohli N, Parihar A, Singh R, Srivastava RN, Upadhyay D. Diagnostic and prognostic role of MRI in spinal trauma, its comparison and correlation with clinical profile and neurological outcome, according to ASIA impairment scale. J Craniovertebr Junction Spine 2011; 2:17-26. [PMID: 22013371 PMCID: PMC3190425 DOI: 10.4103/0974-8237.85309] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Aims and objectives: To evaluate the role of magnetic resonance imaging (MRI) as a non-invasive diagnostic tool in patients with acute and chronic spinal trauma and to compare and correlate the MRI findings with those of patients’ clinical profile and neurological outcome according to ASIA impairment scale to assess prognostic and clinical value of MRI. Materials and Methods: Sixty two patients of spinal trauma formed the study group in a prospective fashion. The patients undergoing MR imaging and magnetic resonance images were analyzed and correlated with findings on neurological examination according to American Spinal Injury Association (ASIA) impairment scale (AIS) at the time of MRI examination and subsequently at sub-acute interval to assess neurological outcome. Statistical Analysis: Sample profile was described in terms of 95% confidence limit and proportion. To describe strength of association between extent of spinal cord injury and outcome, odd's ratio, bivariate and multi variant analysis, was used. Pearson's chi square (χ) 2 statistics was applied to test the association between two categorical variables. Data were analyzed using statistical software package, STATA 9.2 and the difference was considered to be significant if ‘P’ value was <0.05. Observation and Results: The cord edema without hemorrhage was the most common MR finding (41.5%). The others were sizable focus of hemorrhage within the cord (33%), epidural hematoma (5.0%), and normal cord (26%). Majority of MR findings correlated well with clinical profile of the patient according to ASIA impairment scale. This study demonstrated that patients with presence of sizable focus of haemorrhage had larger cord edema and more severe grade of initial ASIA impairment scale( AIS) with poor recovery at follow up (P=0.032).Improvement in upper extremity was more than lower extremity. Severe cord compression was also associated with poor neurological outcome; however it was not statistically significant (P=0.149). Conclusions: With this study the authors concluded that various MRI findings in acute spinal cord injury correlated well with the initial clinical findings and on follow-up according to ASIA impairment scale. MRI is useful for initial diagnosis of acute spinal cord injury and its prognostication for predicting neurological recovery.
Collapse
Affiliation(s)
- Umesh C Parashari
- Department of Radio Diagnosis, Era's Lucknow Medical College, Lucknow, India
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Jauhari P, Boggula R, Bhave A, Bhargava R, Singh C, Kohli N, Yadav R, Kumar R. Aetiology of intellectual disability in paediatric outpatients in Northern India. Dev Med Child Neurol 2011; 53:167-72. [PMID: 21087235 DOI: 10.1111/j.1469-8749.2010.03823.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To study the aetiology of intellectual disability in patients presenting to hospital and the diagnostic yield of a standardized examination. METHOD Over a 1-year period, the first three children presenting to the paediatric outpatients department (OPD) on 2 selected weekdays with developmental delay, suspected intellectual disability, or school failure were enrolled for study if they satisfied standard definitions of global developmental delay (GDD), or intellectual disability as tested by scales for Indian children: Developmental Assessment for Indian Infants, Binet Karnat Test, and the Vineland Social Maturity Scale (Malin's Adaptation). Detailed history, and physical and neurological examinations were recorded. An algorithmic approach to investigations was followed. Also, neuroimaging, thyroid function, electroencephalograph, karyotyping, and studies for fragile-X syndrome were conducted. Aetiological diagnosis was considered established only if clinical features were supported by investigations. Clinical features associated with a successful aetiological diagnosis were computed. RESULTS A total of 122 children were enrolled in a cross-sectional analytic study (mean age 43.5 mo [SD 40.66]; 84 males, 38 females). Of these, a definite aetiology could be assigned in 66 children (54.1%); 17 prenatal, 38 perinatal/neonatal, and 11 postneonatal. Factors associated with reaching a definite diagnosis included younger age at presentation, presence of seizures, microcephaly, adverse neonatal events, and abnormal motor signs. Clinical history and examination gave important clues to the aetiology in 89 (72.9%) patients. Neuroimaging was abnormal in 91 out of 114 children, with aetiological findings in 48 children. INTERPRETATION Perinatal/neonatal causes predominate as the cause of GDD or intellectual disability in India. The study highlights that a large majority of cases seen here were preventable.
Collapse
Affiliation(s)
- Prashant Jauhari
- Department of Paediatrics, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India
| | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Aga P, Parashari UC, Parihar A, Singh R, Kohli N, Yadav R. Macrodystrophia lipomatosa – MR imaging of a rare congenital anomaly: review of 3 cases. SA J Radiol 2010. [DOI: 10.4102/sajr.v14i4.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Macrodystrophia lipomatosa (MDL) results from progressive overgrowth of all the mesenchymal elements, with a disproportionate increase in fibro-adipose tissue. This rare congenital abnormality occurs most frequently in the distribution of the median nerve in the upper, and medial plantar nerve in the lower, extremity.
Excess of unencapsulated fibro-adipose tissue on magnetic resonance imaging (MRI) is virtually diagnostic and can differentiate this entity from other diseases with similar presentations. Involvement of the ulnar aspect of the hand, though rare, has been described; however, the lateral aspect of the foot as seen in our second case has not been reported, to the best of our knowledge.
Collapse
|
49
|
Aga P, Parashari UC, Parihar A, Singh R, Kohli N. MRI in isolated dextrogastria with eventration of the right hemidiaphragm with associated mesentero-axial volvulus. Pediatr Radiol 2010; 40:1576-8. [PMID: 20379708 DOI: 10.1007/s00247-010-1637-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/24/2010] [Accepted: 01/30/2010] [Indexed: 10/19/2022]
Abstract
Isolated dextrogastria is the rarest of all visceral transpositions and usually coexists with eventration of the right hemidiaphragm. We herein report a unique case of isolated dextrogastria with eventration of the right hemidiaphragm along with mesentero-axial volvulus. Such a case has not been reported in young children. As the barium study was suboptimal, MRI helped by exquisitely depicting the anomaly without radiation risk to the child.
Collapse
Affiliation(s)
- Pallavi Aga
- Department of Radiodiagnosis, Chatrapati Shahuji Maharaj Medical University (CSMMU), Lucknow, India.
| | | | | | | | | |
Collapse
|
50
|
Chaurasia RN, Garg RK, Agarwall A, Kohli N, Verma R, Singh MK, Shukla R. Three day albendazole therapy in patients with a solitary cysticercus granuloma: a randomized double blind placebo controlled study. Southeast Asian J Trop Med Public Health 2010; 41:517-525. [PMID: 20578537] [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: 05/29/2023]
Abstract
A solitary cysticercus granuloma is a benign form of neurocysticercosis. Several reports have suggested albendazole is effective in early resolution of these lesions. A short duration (7 days) albendazole therapy has been found to be effective in treatment. In this study, we evaluated a "three day course" of albendazole in a prospective randomized double- blind trial. Sixty-seven consecutive patients who presented with new-onset seizures and a solitary cysticercus granuloma were randomly allocated to receive either albendazole (15 mg/kg/day for 3 days) or placebo. All patients were treated with antiepileptic drugs. Patients were followed up for 6 months. A repeat CT of the brain was obtained at the end of 6 months of follow-up. The end points were complete resolution of the lesion on CT scan and total seizure control at 6 months follow-up. In the albendazole group complete resolution of lesions was noted in 28 of 33 patients (84.8%), while in the control group only 14 of 34 patients (41.2%) had complete resolution of the lesion (p = 0.001). Partial resolution of lesion was seen in 2 patients (6%) in the albendazole group and 4 patients (11.8%) in the control group (p = 0.06). The lesion remained unchanged in 9 cases (26.5%) in the control group only. The lesion became calcified in 7 (20.6%) and 3 (9.1%) patients in the control and albendazole groups, respectively (p = 0.187). Seizure recurrence occurred in 3 patients (9.1%) in the albendazole and 1 patient (2.9%) in the control group (p = 0.239). The three days course of albendazole was effective in resolving lesions, but there was no significant difference in seizure recurrence rates between the two treatment groups.
Collapse
Affiliation(s)
- Rameshwar Nath Chaurasia
- Department of Neurology, Chhatrapati Shahuji Maharaj Medical University, Uttar Pradesh, Lucknow, India
| | | | | | | | | | | | | |
Collapse
|