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Jayant SS, Walia R, Gupta R, Pal R, Chaudhary S, Agrawal K, Rastogi A, Bhattacharya A, Dutta P, Bhadada SK, Bhansali A. Autonomous growth hormone secretion due to McCune Albright syndrome in paediatric age group: an ominous triad. Endocrine 2023:10.1007/s12020-023-03333-7. [PMID: 36877453 DOI: 10.1007/s12020-023-03333-7] [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] [Received: 08/18/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE The current study aimed to report cases of McCune Albright syndrome (MAS) with growth hormone (GH) hyper secretion along with a systematic review of literature to elucidate challenges and intricacies in its diagnosis and management. METHODS It was a single centre study carried out in individuals with MAS and autonomous GH secretion (AGHS). In addition, a systematic search of literature across three databases (PubMed, Scopus and EMBASE) was performed from inception until May 31, 2021 to identify cases of MAS with AGHS in the pediatric age group (<18 years). RESULTS Three cases from authors centre and 42 cases identified from systematic literature review were analysed. Precocious puberty was the most common presenting endocrinopathy seen in 56.8% (25/44) cases, followed by hyperthyroidism (10/45), hypophosphatemia (4/45), and hypercortisolism (2/45). Cranio-facial fibrous dysplasia (CFFD) was seen in all while polyostotic fibrous dysplasia and Café au lait macule was seen in 40/45 (88.9%) and 35/45 (77.8%), respectively. Pituitary adenoma (58.3% microadenoma) was localized in 53.3% (24/45) cases on pituitary imaging. Biochemical and clinical remission of AGHS was achieved in 61.5% (24/45) cases with medical therapy. CONCLUSION Diagnosing AGHS in MAS is challenging because of concomitant presence of CFFD, non-GH endocrinopathies associated height spurt and elevated serum IGF-1. GH-GTT should be performed in presence of elevated growth velocity and serum IGF-1 (>1 X ULN) despite adequate control of non-GH endocrinopathies. Medical management can lead to disease control in substantial number of cases and often entails use of multiple agents.
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Affiliation(s)
| | - Rama Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rahul Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimesh Pal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shakun Chaudhary
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanhaiya Agrawal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Jayant SS, Gupta R, Rastogi A, Agrawal K, Sachdeva N, Ram S, Dutta P, Bhadada SK, Bhansali A. Abdominal obesity and incident cardio-metabolic disorders in Asian-Indians: A 10-years prospective cohort study. Diabetes Metab Syndr 2022; 16:102418. [PMID: 35123378 DOI: 10.1016/j.dsx.2022.102418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS To estimate the strength of association between abdominal obesity and incident cardio-metabolic diseases. METHODS A subset of Chandigarh Urban Diabetes study cohort (n = 543) was followed after a mean of 10.7 years for development of diabetes, prediabetes, dysglycaemia (either prediabetes or diabetes), hypertension and atherosclerotic cardiovascular disease (ASCVD). Diabetes and prediabetes were defined as per American Diabetes Association consulting group criteria, hypertension as blood pressure of ≥140/90 mmHg and ASCVD after review of medical records. Abdominal obesity was defined as waist circumference of ≥80 cm and ≥90 cm in females and males, respectively. RESULTS As compared to non-obese (n = 209), abdominally obese individuals (n = 334) had a higher risk of diabetes [RR:1.82(1.28-2.57)], prediabetes [RR:1.40(1.05-1.85)], dysglycaemia [ RR:1.38(1.07-1.78)], hypertension [RR: 1.84(1.30-2.59)] and ASCVD [RR:2.12(1.02-4.4)]. The optimal cut-off of waist circumference for detecting incident diabetes, hypertension and ASCVD in females was 88 cm, 85 cm and 91 cm, respectively; while in males it was 90 cm, 87 cm and 94 cm, respectively. CONCLUSION In Asian-Indians, abdominal obesity as defined by waist circumference of ≥90 cm and ≥80 cm in males and females, respectively is associated with a twofold higher risk of diabetes, hypertension and ASCVD. In addition, the current-cut-offs of waist circumference to define abdominal obesity need reconsideration to optimally identify individuals at a higher risk of cardio-metabolic diseases. However, a high attrition rate represents a major limitation.
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Affiliation(s)
- Satyam Singh Jayant
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rahul Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Kanhaiya Agrawal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sant Ram
- Department of Biochemistry, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Bhadada S, Agrawal K. Post-thyroidectomy hypoparathyroidism: A rare cause of extensive brain parenchymal calcification. Indian J Med Res 2022; 155:438. [DOI: 10.4103/ijmr.ijmr_1422_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Goswami RK, Agrawal K, Shah MP, Verma P. Bioremediation of heavy metals from wastewater: a current perspective on microalgae-based future. Lett Appl Microbiol 2021; 75:701-717. [PMID: 34562022 DOI: 10.1111/lam.13564] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 07/21/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Heavy metals-containing drinking water and wastewater are posing a severe threat to the environment, and living beings on land, air and water. Different conventional, advanced nanomaterials-based and biological method has been employed for the treatment of heavy metals. Among the biological methods, microalgae are an important group of micro-organisms that have numerous environmental applications and can remediate heavy metals from wastewater. Also, it has numerous advantages over conventional remediation processes. Microalgae cells can uptake the heavy metal via different physiological and biological methods and are utilized as a nutrient source to regulate its metabolic process for the production of biomass. Furthermore, the enhancement in heavy metal removal efficiency can be improved using different strategies such as immobilization of algal cells, development of algal consortia and designing of microalgae-based nanocomposite materials. Also, it can significantly contribute towards environmental sustainability and future. Thus, the review provides a critical overview of heavy metals and their existence along with their negative effects on humans. This review provides insight on recent advanced nanomaterial approaches for the removal of heavy metals, overviews of microalgae-based heavy metal uptake mechanisms and their potential for the amputation of different heavy metals. Furthermore, the special focus is on recent strategies that enhance heavy metal removal efficiency and contribute towards sustainability for the development of a microalgae-based future.
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Affiliation(s)
- R K Goswami
- Bioprocess and Bioenergy Laboratory, Department of Microbiology, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - K Agrawal
- Bioprocess and Bioenergy Laboratory, Department of Microbiology, Central University of Rajasthan, Ajmer, Rajasthan, India
| | - M P Shah
- Industrial Waste Water Research, Division of Applied and Environmental Microbiology, Environment Technology Ltd, Ankleshwar, Gujarat, India
| | - P Verma
- Bioprocess and Bioenergy Laboratory, Department of Microbiology, Central University of Rajasthan, Ajmer, Rajasthan, India
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Agrawal K, Basak P, Dutta P, Walia R, Bhansali A, Sachdeva N. Does Primary BCG Vaccination Prevent Autoimmune Hypothyroid Disease? J Endocr Soc 2021. [PMCID: PMC8090026 DOI: 10.1210/jendso/bvab048.1711] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Autoimmune thyroid disease (AITD) involves autoimmune destruction of thyrocytes marked by the presence of anti-TPO and/or anti-TG antibodies. In autoimmune diseases, an immunomodulatory role of BCG vaccination has been reported with decreased autoantibody production and induction of regulatory T cells (Tregs). We hypothesize that the loss of efficacy of BCG vaccine in adulthood might be associated with the appearance of AITD. To evaluate the protective efficacy of primary BCG vaccination, we assessed the anti-mycobacterial responses, thyroid function, and anti-thyroid autoimmune responses in autoimmune subclinical hypothyroid (SCH) (n=39) and non-autoimmune SCH (n=25) subjects. The anti-mycobacterial responses were determined by the Mantoux test and by BCG induced in-vitro proliferation of peripheral blood mononuclear cells in terms of proliferation index (PI). The immunophenotyping of autoreactive CD8+ T cells recognizing TPO derived epitopes was performed by flow cytometry using APC labelled dextramers by flow cytometry in patients with HLA-A*02 and HLA-A*24 alleles. We observed that the autoimmune SCH group had more subjects with a negative Mantoux reaction (less than 5mm) (61.5% vs 33.3%, p= 0.01). The PI with BCG stimulation was similar in both groups (2.55±0.31 vs 2.51±0.41, p = 0.667). The correlations (r) between Mantoux test and PI in autoimmune SCH and non-autoimmune SCH were, insignificant. The autoimmune SCH group had more subjects with diffused thyroiditis (43% vs 13%, p= 0.02). The SCH subjects with the presence of a BCG scar (n=11) had lower TSH (µIU/ml) (7.94±1.67 vs 6.75±1.56, p= 0.026) levels and lower frequencies of TPO-reactive CD8+ T cells (3.35±0.72% vs 1.77±0.98%, p= 0.061), as compared to subjects with the absence of a BCG scar (n = 53). The SCH subjects with positive Mantoux test (more than 10mm) demonstrated similar titres of anti-TG antibody (IU/ml) [(230 (56.71-508.90) vs 85.5 (15-345.9), p= 0.055] and anti-TPO antibody (IU/ml) [29.9 (5-135) vs 12 (5-83), p= 0.665)] as compared to those with a negative Mantoux test. The TPO-reactive CD8+ T cells and anti-TG antibody titres had a negative correlation in autoimmune SCH (r= -0.695, p=0.038) and non-autoimmune SCH (r= -0.642, p=0.024) subjects. Next, we observed a similar frequency of TPO-reactive CD8+ T cells in non-autoimmune and autoimmune SCH subjects (8.40±3.74% vs 9.02±4.17% p= 0.937). The absence of anti-TPO or anti-TG antibody did not rule out the presence of any underlying autoimmunity. The persistence of the protective effects of either BCG vaccination or exposure to Mycobacterium species might be involved in modulating autoimmune responses towards the thyroid gland. Our study warrants further research on the immunomodulatory role of BCG in adult subjects with a family history of autoimmune diseases including AITD.
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Affiliation(s)
- Kanhaiya Agrawal
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
| | - Preetam Basak
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post graduate institute of medical science, Chandigarh, India
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Agrawal K, Arya AK, Sood A, Kumari P, Singh P, Sapara M, Rastogi A, Behera A, Bhadada SK. A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy. Clin Endocrinol (Oxf) 2021; 94:371-376. [PMID: 32789888 DOI: 10.1111/cen.14311] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (PHPT) is a systemic disorder characterized by hypercalcaemia and inappropriately elevated parathyroid hormone (PTH). Renal manifestations are one of the main presenting features both in symptomatic and asymptomatic PHPT patients. OBJECTIVES We aimed to compare demographic, clinical and biochemical parameters of PHPT patients with and without renal manifestations and also analysed the influence of curative parathyroidectomy on renal functions. METHODS We retrospectively analysed the data of PHPT patients from the last 25 years (1995- March 2019) and compared the demographic and clinical presentation and biochemical measurements between patients with and without renal manifestations and evaluated the changes in renal functions after 1 year of curative parathyroidectomy. RESULTS Of the total 544 PHPT patients, 299 (55%) including 91 out of 141 (65%) males had renal manifestations. Among renal manifestations, nephrolithiasis and nephrocalcinosis were found in 41.7% and 27.6% PHPT patients, respectively. PHPT patients with renal manifestations had significantly higher creatinine (109.7 vs 79.6 µmol/L; P < .0001) and lower eGFR level (78.8 vs 93.9 mL/min/1.73 m2 ; P < .0001) compared to patients without renal manifestations. Parathyroidectomy resolved the clinical symptoms with biochemical cure in the patients from both the groups. Patients with renal manifestations showed improvement in creatinine and eGFR levels after 1 year of curative parathyroidectomy; however, patients without renal manifestations showed no change in creatinine and eGFR levels. CONCLUSION Young age and male gender are predictors of renal manifestations in PHPT. Curative parathyroidectomy improves renal functions in PHPT patients with renal manifestations compared to PHPT patients without renal manifestation.
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Affiliation(s)
- Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashutosh Kumar Arya
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Poonam Kumari
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Priyanka Singh
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Mohin Sapara
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Arya AK, Kumari P, Bhadada SK, Agrawal K, Singh P, Mukherjee S, Sood A, Rao SD. Progressive rise in the prevalence of asymptomatic primary hyperparathyroidism in India: Data from PHPT registry. J Bone Miner Metab 2021; 39:253-259. [PMID: 32894354 DOI: 10.1007/s00774-020-01142-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/14/2020] [Accepted: 08/09/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT), a third common endocrine disorder, varies from asymptomatic disease, mostly seen in the West where routine biochemical screening is practiced, to the classical symptomatic disease mostly seen in the Eastern countries. We aimed to compare the demographic, clinical, biochemical measurements in patients with asymptomatic and symptomatic PHPT from the Indian PHPT registry. MATERIAL AND METHODS Data of PHPT patients from the last 25 years (1995-2019) were analyzed for demographic, clinical presentation and biochemical measurements, and compared these characteristics between asymptomatic and symptomatic PHPT patients. RESULTS Of the 554 patients, 54 (10%) patients had asymptomatic PHPT. There was a sharp rise in the proportion of asymptomatic PHPT patients of 3% in the first decade to 13% in the second decade of the century (p = 0.003). Patients with asymptomatic PHPT were significantly older (50 vs. 42 years; p < 0.0001) and had higher mean body mass index (27.8 vs. 23.5 kg/m2; p < 0.0001) compared to the symptomatic PHPT group. In addition, asymptomatic PHPT patients had significantly lower median plasma iPTH (180 vs. 370 pg/mL; p < 0.0001), serum alkaline phosphatase (119 vs. 172 IU/L; p < 0.0001), and parathyroid adenoma weight (1.0 vs. 2.62 g; p = 0.006) compared to the symptomatic PHPT group. CONCLUSION Although symptomatic PHPT is still most prevalent (> 90%) in India with higher indices of the disease and tumor weights, there is a progressive rise in the prevalence of asymptomatic PHPT patients in the last decade. Improvements in calcium and vitamin D nutrition might account for this change as in the Western series.
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Affiliation(s)
- Ashutosh Kumar Arya
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Poonam Kumari
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Priyanka Singh
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Soham Mukherjee
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sudhaker D Rao
- Bone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, USA
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Jayant SS, Gupta R, Agrawal K, Das L, Dutta P, Bhansali A. Triple A (Allgrove) syndrome due to AAAS gene mutation with a rare association of amyotrophy. Hormones (Athens) 2021; 20:197-205. [PMID: 32700293 DOI: 10.1007/s42000-020-00217-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Triple A (Allgrove) syndrome is a rare autosomal recessive disorder characterized by cardinal features of primary adrenal insufficiency (AI) due to adrenocorticotropic hormone (ACTH) resistance, achalasia, and alacrima. It is frequently associated with neurological manifestations such as autonomic dysfunction, cognitive dysfunction, cranial nerve, or motor involvement. Amyotrophy/motor neuron disease is a rare association. CASE PRESENTATION We herein report a 19-year-old boy diagnosed with triple A syndrome (TAS), with the classic triad of ACTH-resistant adrenal insufficiency, achalasia, and alacrima. Additionally, he had distal spinal muscle amyotrophy. Alacrima was the earliest feature evident in early childhood, followed by achalasia at 12 years of age. He was diagnosed with AI at the age of 19 years, with involvement of the mineralocorticoid axis. Further evaluation showed a neurogenic pattern on electromyography, consistent with a diagnosis of motor neuron disease. A nerve conduction study revealed no significant neuropathy. Genetic analysis confirmed a pathogenic homozygous mutation in the AAAS gene c.43C>A, p.Gln15Lys. He improved with glucocorticoid and mineralocorticoid supplements for AI, and nifedipine for achalasia and artificial tears. He is planned for esophagomyotomy. CONCLUSION In any young patient with AI not due to congenital adrenal hyperplasia, Allgrove syndrome should be ruled out. Though mineralocorticoid sparing pattern is classical, it can rarely be involved, as seen in the index case. Various components of the syndrome, as well as amyotrophy and other neurologic features, may present in a metachronous fashion. Hence, a high index of clinical suspicion can aid in early diagnosis and management.
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Affiliation(s)
| | - Rahul Gupta
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | | | - Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
- PGIMER, 108, Nehru Extension Block, Chandigarh, 160012, India.
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
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Das L, Dutta P, Walia R, Mukherjee S, Suri V, Puri GD, Mahajan V, Malhotra P, Chaudhary S, Gupta R, Jayant SS, Agrawal K, Kumar V, Sachdeva N, Rastogi A, Bhadada SK, Ram S, Bhansali A. Spectrum of Endocrine Dysfunction and Association With Disease Severity in Patients With COVID-19: Insights From a Cross-Sectional, Observational Study. Front Endocrinol (Lausanne) 2021; 12:645787. [PMID: 34276556 PMCID: PMC8283965 DOI: 10.3389/fendo.2021.645787] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/21/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Evidence on new-onset endocrine dysfunction and identifying whether the degree of this dysfunction is associated with the severity of disease in patients with COVID-19 is scarce. PATIENTS AND METHODS Consecutive patients enrolled at PGIMER Chandigarh were stratified on the basis of disease severity as group I (moderate-to-severe disease including oxygen saturation <94% on room air or those with comorbidities) (n= 35) and group II (mild disease, with oxygen saturation >94% and without comorbidities) (n=49). Hypothalamo-pituitary-adrenal, thyroid, gonadal axes, and lactotroph function were evaluated. Inflammatory and cell-injury markers were also analysed. RESULTS Patients in group I had higher prevalence of hypocortisolism (38.5 vs 6.8%, p=0.012), lower ACTH (16.3 vs 32.1pg/ml, p=0.234) and DHEAS (86.29 vs 117.8µg/dl, p= 0.086) as compared to group II. Low T3 syndrome was a universal finding, irrespective of disease severity. Sick euthyroid syndrome (apart from low T3 syndrome) (80.9 vs 73.1%, p= 0.046) and atypical thyroiditis (low T3, high T4, low or normal TSH) (14.3 vs 2.4%, p= 0.046) were more frequent in group I than group II. Male hypogonadism was also more prevalent in group I (75.6% vs 20.6%, p=0.006) than group II, with higher prevalence of both secondary (56.8 vs 15.3%, p=0.006) and primary (18.8 vs 5.3%, p=0.006) hypogonadism. Hyperprolactinemia was observed in 42.4% of patients without significant difference between both groups. CONCLUSION COVID-19 can involve multiple endocrine organs and axes, with a greater prevalence and degree of endocrine dysfunction in those with more severe disease.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Soham Mukherjee
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Varun Mahajan
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | | | - Shakun Chaudhary
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rahul Gupta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satyam Singh Jayant
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kanhaiya Agrawal
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vijay Kumar
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashu Rastogi
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sant Ram
- Department of Biochemistry, PGIMER, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- *Correspondence: Anil Bhansali,
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Pal R, Dutta A, Agrawal K, Jain N, Dutta P, Bhansali A, Behera A, Bhadada SK. Primary Hyperparathyroidism Presenting as Posterior Reversible Encephalopathy Syndrome: A Report of Two Cases. J Clin Res Pediatr Endocrinol 2020; 12:432-438. [PMID: 32129057 PMCID: PMC7711632 DOI: 10.4274/jcrpe.galenos.2020.2019.0181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological entity characterized by subcortical vasogenic edema presenting with acute neurological symptoms. Common precipitating causes include renal failure, pre-eclampsia/eclampsia, post-organ transplant, and cytotoxic drugs. Hypercalcemia is a rare cause of PRES; most cases occur in the setting of severe hypercalcemia secondary to malignancy or iatrogenic vitamin D/calcium overdose. Primary hyperparathyroidism (PHPT), as a cause of PRES, is an oddity. We report two cases of adolescent PHPT presenting with generalized tonic-clonic seizures and altered sensorium. On evaluation, both had hypertension, severe hypercalcemia (serum calcium 14.1 mg/dL and 14.5 mg/dL, respectively) and elevated parathyroid hormone levels. Magnetic resonance imaging (MRI) revealed T2/fluid-attenuated inversion recovery hyperintensities located predominantly in the parieto-occipital regions, suggestive of PRES. Identification and excision of parathyroid adenoma led to the restoration of normocalcemia. Neurological symptoms and MRI changes improved subsequently. An extensive literature search revealed only four cases of PHPTassociated PRES; none of them being in the pediatric/adolescent age group. The predominant clinical manifestations were seizures and altered sensorium. All had severe hypercalcemia; three had hypertension at presentation, while one was normotensive. Parathyroid adenomectomy led to normalization of serum calcium and resolution of neurological symptoms and radiological changes. Thus, severe hypercalcemia, although rare in PHPT, can lead to hypercalcemic crisis precipitating acute hypertension that can result in cerebral endothelial dysfunction with the breakdown of the blood-brain barrier, culminating in PRES. We therefore recommend that serum calcium levels should be checked in all patients with PRES and that PHPT be regarded as a differential diagnosis in those with underlying hypercalcemia.
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Affiliation(s)
- Rimesh Pal
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Aditya Dutta
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Kanhaiya Agrawal
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Nimisha Jain
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Pinaki Dutta
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Anil Bhansali
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India
| | - Arunanshu Behera
- Post Graduate Institute of Medical Training and Research, Clinic of General Surgery, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India,* Address for Correspondence: Post Graduate Institute of Medical Training and Research, Clinic of Endocrinology, Chandigarh, India Phone: +91 9876602448 E-mail:
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Topno RK, Madhukar M, Pandey K, Kumar R, Rabidas VN, Kumar M, Agrawal K, Verma N, Yadav DP, Bimal S, Siddiqui NA, Das P. False Positivity of rK39 Test in Five Chronic Myeloid Leukemia Cases from Bihar, India: A Possible Challenge to Leishmaniasis Diagnosis. Am J Trop Med Hyg 2020; 103:2257-2259. [PMID: 32975180 DOI: 10.4269/ajtmh.20-0301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A rapid and noninvasive rK39 rapid diagnostic test (RDT) is the best and most reliable tool for visceral leishmaniasis (VL) screening in the field. However, splenic and bone marrow aspiration remain two gold standard methods for microscopic identification of Leishmania donovani (LD) bodies and confirmatory diagnosis of VL. Five patients with signs and symptoms of fever, loss of appetite, loss of weight, hepatomegaly, and massive splenomegaly were found to be false positive with the rK39 RDT. These patients were suspected to have chronic myeloid leukemia (CML) because their blood pictures showed a total white blood cell count of > 100,000/mm3 and abnormal cells such as stab, segmented promyelocytes, myelocytes, metamyelocytes, and blast cells. Splenic aspirate and bone marrow were negative for Leishmania donovani bodies. The bone marrow showed myeloid series of cells, that is, myelocytes, metamyelocytes, stab and segmented cells, blast cells, and markedly increased myeloid:erythroid ratio. Later, the CML diagnosis was confirmed in all cases by breakpoint cluster region-tyrosine protein kinase (BCR-ABL) gene positive test results. In this study, the rK39 RDT's false positivity was observed in CML cases. It could have important implications for the differential diagnosis of VL with CML. The rK39 positive test result in CML cases was a serendipitous occurrence; this should be validated further to determine the utility of the rK39 test in the differential diagnosis of VL with CML.
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Affiliation(s)
- Roshan Kamal Topno
- Department of Epidemiology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Major Madhukar
- Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Krishna Pandey
- Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Rishikesh Kumar
- Department of Biostatistics, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Vidya Nand Rabidas
- Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Maneesh Kumar
- Department of Virology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Kanhaiya Agrawal
- Department of Clinical Medicine, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Neena Verma
- Department of Pathology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Devendra Prasad Yadav
- Central Diagnostic Laboratory, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Sanjeeva Bimal
- Department of Immunology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Niyamat Ali Siddiqui
- Department of Biostatistics, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
| | - Pradeep Das
- Department of Molecular Biology, ICMR-Rajendra Memorial Research Institute of Medical Sciences, Patna, India
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Agrawal K, Surya N, Someshwar H. Short term health care costs associated with acute ischemic stroke in Mumbai, India. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Someshwar H, Agrawal K, Surya N. Effect of a brief awareness lecture on knowledge, attitude and perception of epilepsy amongst school children of Mumbai, Maharashtra. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.828] [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]
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Pal R, Agrawal K, Gupta S, Bhansali A, Behera A, Bhadada SK. Worsening of unrecognized tumour-induced osteomalacia with inadvertent use of recombinant human parathyroid hormone. Endokrynol Pol 2019; 71:102-103. [PMID: 31566250 DOI: 10.5603/ep.a2019.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022]
Abstract
Not required for Clinical Vignette.
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Affiliation(s)
- Rimesh Pal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Setu Gupta
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Topno RK, Kumar R, Pandey K, Verma N, Das VR, Sahoo GC, Siddiqui NA, Sinha AK, Kumar R, Kumar R, Agrawal K, Das P. A co-infection with malaria and visceral leishmaniasis in Eastern state of India. Presse Med 2019; 48:328-331. [PMID: 30853284 DOI: 10.1016/j.lpm.2018.04.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/08/2018] [Accepted: 04/04/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Roshan Kamal Topno
- Rajendra Memorial Research Institute of Medical Science, Department of Epidemiology, Agamkuan, Patna, Bihar 800007, India.
| | - Rishikesh Kumar
- Rajendra Memorial Research Institute of Medical Science, Department of Virology and Nanomedicine, Agamkuan, Patna, Bihar 800007, India
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Science, Department of Clinical Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Neena Verma
- Rajendra Memorial Research Institute of Medical Science, Department of Pathology, Agamkuan, Patna, Bihar 800007, India
| | - Vidyanand Ravi Das
- Rajendra Memorial Research Institute of Medical Science, Department of Clinical Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Ganesh Chandra Sahoo
- Rajendra Memorial Research Institute of Medical Science, Department of Virology and Nanomedicine, Agamkuan, Patna, Bihar 800007, India
| | - Niyamat Ali Siddiqui
- Rajendra Memorial Research Institute of Medical Science, Department of Statics, Agamkuan, Patna, Bihar 800007, India
| | - Ajay Kumar Sinha
- Nalanda Medical College & Hospital, Department of Community Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Rajeev Kumar
- Nalanda Medical College & Hospital, Department of Community Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Rakesh Kumar
- Nalanda Medical College & Hospital, Department of Community Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Kanhaiya Agrawal
- Rajendra Memorial Research Institute of Medical Science, Department of Clinical Medicine, Agamkuan, Patna, Bihar 800007, India
| | - Pradeep Das
- Rajendra Memorial Research Institute of Medical Science, Indian Council of Medical Research, Department of Molecular Biology, Agamkuan, Patna, Bihar 800007, India
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Kumar J, Yadav A, Agrawal K. Vitamin D deficiency: An emerging pandemic. J Family Med Prim Care 2019; 7:1146-1147. [PMID: 30598983 PMCID: PMC6259547 DOI: 10.4103/jfmpc.jfmpc_179_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jogender Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Yadav
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Kanhaiya Agrawal
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Topno R, Kumar R, Pandey K, Dikhit M, Madhukar M, Kumar M, Bimal S, Siddiqui N, Das V, Agrawal K, Verma N, Lal C, Das P. Early diagnostic marker for the conversion of asymptomatic to symptomatic visceral leishmaniasis. J Med Allied Sci 2019. [DOI: 10.5455/jmas.52041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Topno RK, Shankar V, Dikhit MR, Madhukar M, Pandey K, Das VNR, Kumar M, Kumar B, Agrawal K, Siddiqui NA, Sahoo GC, Kumar R, Singh AK, Kumar R, Singh D, Das P. Noninvasive Sweat-Based Diagnosis of Visceral Leishmaniasis and Post Kala-Azar Dermal Leishmaniasis. Am J Trop Med Hyg 2018; 99:1162-1164. [PMID: 30203740 PMCID: PMC6221248 DOI: 10.4269/ajtmh.17-0749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/27/2017] [Accepted: 06/28/2018] [Indexed: 01/16/2023] Open
Abstract
The diagnosis of visceral leishmaniasis (VL) is one of the foremost barriers in the control of this disease, as demonstration of the parasite by splenic/bone marrow aspiration is relatively difficult and requires expertise and laboratory support. The aim of the present study was to find a noninvasive diagnostic approach using the existing recombinant kinesine-39 (rK-39) immunochromatographic nitrocellulose strips test (ICT) with a human sweat specimen for the diagnosis of VL. The investigation was carried out on specimens (blood, sweat, and urine) collected from 58 confirmed VL, 50 confirmed post kala-azar dermal leishmaniasis (PKDL), 36 healthy control, and 35 patients from other diseases. The data obtained from this study reveal that 96.6% clinically confirmed active VL participants were found to be positive when tested against a sweat specimen. Interestingly, the scenario was similar when tested against a blood specimen (96.6% positive by rK-39). Moreover, a test of both sweats and blood specimens from 50 PKDL participants resulted in 100% positivity, whereas no healthy control participants were found to be rK-39 positive. The sensitivity of the rK-39 ICT in sweat specimen was 94.7%, whereas the specificity was 100% in healthy controls from endemic, nonendemic, and other infectious diseases, respectively. No difference was observed in sweat specimen of VL and PKDL cases which signifies its reliability. However, further evaluation of this method on a larger scale could enhance the reliability of the proposed model so that it could be used efficiently in VL management and eradication.
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Affiliation(s)
- Roshan Kamal Topno
- Department of Epidemiology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Vikas Shankar
- Department of Skin and VD, Nalanda Medical College and Hospital, Patna, India
| | - Manas Ranjan Dikhit
- Department of Bioinformatics, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Major Madhukar
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - V. N. R. Das
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Maneesh Kumar
- Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Bipin Kumar
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Kanhaiya Agrawal
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Niyamat Ali Siddiqui
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Ganesh Chandra Sahoo
- Department of Bioinformatics, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Rishikesh Kumar
- Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Ashish Kumar Singh
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
| | - Rajeev Kumar
- Department of Community Medicine, Nalanda Medical College and Hospital, Patna, India
| | - Dharmendra Singh
- Department of Biochemistry, National JALMA institute for Leprosy and other Mycobacterial Disease (ICMR), Agra, India
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Patna, India
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Mittra I, Pal K, Pancholi N, Shaikh A, Rane B, Tidke P, Kirolikar S, Khare NK, Agrawal K, Nagare H, Nair NK. Prevention of chemotherapy toxicity by agents that neutralize or degrade cell-free chromatin. Ann Oncol 2018; 28:2119-2127. [PMID: 28911066 DOI: 10.1093/annonc/mdx318] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Toxicity associated with chemotherapy is a major therapeutic challenge and is caused by chemotherapy-induced DNA damage and inflammation. We have recently reported that cell-free chromatin (cfCh) fragments released from dying cells can readily enter into healthy cells of the body to integrate into their genomes and induce DNA double-strand breaks, apoptosis and inflammation in them. We hypothesized that much of the toxicity of chemotherapy might be due to release of large quantities of cfCh from dying cells that could trigger an exaggerated DNA damage, apoptotic and inflammatory response in healthy cells over and above that caused by the drugs themselves. Methods We tested this hypothesis by administering cfCh neutralizing/degrading agents namely, anti-histone antibody complexed nanoparticles, DNase I and a novel DNA degrading agent-Resveratrol-Cu concurrently with five different chemotherapeutic agents to examine if chemotherapy-induced toxicity could be minimized. Results We observed (i) significant reduction in chemotherapy-induced surge of cfCh in blood; (ii) significant reduction in chemotherapy-induced surge of inflammatory cytokines CRP, IL-6, IFNγ and TNFα in blood; (iii) abolition of chemotherapy-induced tissue DNA damage (γH2AX), apoptosis (active caspase-3) and inflammation (NFκB and IL-6) in multiple organs and peripheral blood mononuclear cells; (iv) prevention of prolonged neutropenia following a single injection of adriamycin and (v) significant reduction in death following a lethal dose of adriamycin. Conclusion Our results suggest that toxicity of chemotherapy is caused to a large extent by cfCh released from dying cells and can be prevented by concurrent treatment with cfCh neutralizing/degrading agents.
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Affiliation(s)
- I Mittra
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - K Pal
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - N Pancholi
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - A Shaikh
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - B Rane
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - P Tidke
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - S Kirolikar
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - N K Khare
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - K Agrawal
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - H Nagare
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
| | - N K Nair
- Translational Research Laboratory, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Sector 22, Utsav Chowk - CISF Road, Kharghar, Navi Mumbai, Raigad, Maharashtra 410210, India
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Vasan SK, Roy A, Samuel VT, Antonisamy B, Bhargava SK, Alex AG, Singh B, Osmond C, Geethanjali FS, Karpe F, Sachdev H, Agrawal K, Ramakrishnan L, Tandon N, Thomas N, Premkumar PS, Asaithambi P, Princy SFX, Sinha S, Paul TV, Prabhakaran D, Fall CHD. IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians. BMJ Open 2018; 8:e019675. [PMID: 29643156 PMCID: PMC5898335 DOI: 10.1136/bmjopen-2017-019675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians. METHODS AND ANALYSIS We propose to study approximately 3000 men and women aged 43-50 years from two birth cohorts established in 1969-1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes. ETHICS AND DISSEMINATION The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN13432279; Pre-results.
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Affiliation(s)
- Senthil K Vasan
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ambuj Roy
- Centre for Chronic Disease Control, New Delhi, India
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Viji Thomson Samuel
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Belavendra Antonisamy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Anoop George Alex
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bhaskar Singh
- Department of Paediatrics, Sunder Lal Jain Hospital, New Delhi, India
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Finney S Geethanjali
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Fredrik Karpe
- Oxford Center for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Harshpal Sachdev
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Kanhaiya Agrawal
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Lakshmy Ramakrishnan
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India
| | - Nihal Thomas
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prasanna S Premkumar
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prrathepa Asaithambi
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sneha F X Princy
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sikha Sinha
- Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Thomas Vizhalil Paul
- Departments of Cardiology, Biostatistics, Endocrinology and Clinical Biochemistry, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India
- Public Health Foundation of India, New Delhi, India
| | - Caroline H D Fall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Abstract
BACKGROUND Protease activity of Per a 10 favours Th2 responses by differential regulation of IL-12p70 and IL-23 cytokine subunits. This study aimed to elucidate the underlying mechanism of differential regulation of IL-12p70 and IL-23. METHODS PAR-2 activation was blocked in murine model by administering SAM11 before each sensitization. CD11c+ p-STAT3+ cells were measured in lungs by flow cytometry. BMDCs were pretreated with SAM11 or isotype control or stattic and stimulated with Per a 10. p-STAT3 levels were measured using Western blot. Transcript levels of IL-12p35, IL-12/23p40 and IL-23p19 were measured using RT-PCR. Cytokine levels were analysed using ELISA. RESULTS Protease activity of Per a 10 increased p-STAT3 levels in mouse lungs, which was reduced upon PAR-2 blockage. Percentage of p-STAT3+ CD11c+ cells was higher in Per a 10-administered mice and was reduced upon PAR-2 blockage. IL-12p35 and IL-12p70 levels were higher, and IL-23p19 and IL-23 levels were lower in both SAM11-treated mice and BMDCs indicating a role of PAR-2-mediated signalling. IL-4, TSLP, IL-17A, EPO activity, total cell count and specific IgE and IgG1 levels were lower in SAM11-administered mice. Inhibiting STAT3 activation via stattic also leads to lower levels of IL-23p19 and IL-23 and higher levels of IL-12p35. CONCLUSIONS Per a 10 leads to PAR-2 activation on BMDCs resulting in downstream activation of STAT3 to regulate the balance between IL-12/IL-23 subunits causing a cytokine milieu rich in IL-23 to favour Th2 polarization.
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Affiliation(s)
- K. Agrawal
- Allergy and Immunology section; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Academy of Scientific and Innovative Research (AcSIR); CSIR-IGIB Campus; New Delhi India
| | - N. Arora
- Allergy and Immunology section; CSIR-Institute of Genomics and Integrative Biology; New Delhi India
- Academy of Scientific and Innovative Research (AcSIR); CSIR-IGIB Campus; New Delhi India
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Agrawal K, Gainder S, Dhaliwal LK, Suri V. Ovulation Induction Using Clomiphene Citrate Using Stair - Step Regimen versus Traditional Regimen in Polycystic Ovary Syndrome Women - A Randomized Control Trial. J Hum Reprod Sci 2018; 10:261-264. [PMID: 29430152 PMCID: PMC5799929 DOI: 10.4103/jhrs.jhrs_15_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To determine the efficacy of the stair-step protocol (SSP) using clomiphene citrate (CC) in patients with polycystic ovary syndrome (PCOS) and compare it with traditional regimen. Design: This was randomized control trial. Setting: Infertility Clinic. Patient(s): Sixty infertile PCOS women. Intervention(s): Patients were randomized into the study (SSP – 30 patients) and control group (traditional protocol – 30 patients). In the SSP, patients were treated with CC 50 mg/day for 5 days and in nonresponsive patients, the dosage was increased to 100 mg/day for 5 days in the same cycle. Maximum dose of 150 mg was given until the dominant follicle was generated. In control group, the dose increment in nonovulatory cases was done in subsequent cycle. Ultrasonography follow-up was done to detect ovulation. Main Outcome Measure(s): Ovulation rate and duration of treatment. Results: Ovulation (66.7% vs. 50% respectively) and pregnancy rates (26.7% vs. 15.7%) were similar between the stair step and the control group. The duration of treatment was significantly shorter in stair step compared to traditional protocol (17.23 vs. 53 days). CC 100 mg was the most effective dose for ovulation in either group. There were no significant differences in the systemic side effect. Conclusions: By using SSP, effective treatment is provided in significantly shorter time period without any detrimental effect on the ovulation and pregnancy rates.
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Affiliation(s)
- K Agrawal
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | - Shalini Gainder
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
| | | | - Vanita Suri
- Department of Obstetrics and Gynecology, PGIMER, Chandigarh, India
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Chen PM, Nguyen DT, Ho JP, Pirastehfar M, Narula R, Rapp K, Agrawal K, Huisa B, Modir R, Meyer D, Hemmen T, Kidwell C, Meyer BC. Factors Influencing Acute Stroke Thrombolytic Treatments in Hispanics In the San Diego Region. Austin J Cerebrovasc Dis Stroke 2018; 5:1074. [PMID: 30148213 PMCID: PMC6103626] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Since the introduction of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, rt-PA rate and number of stroke centers have increased. Despite this, studies have shown racial and ethnic disparities in stroke care especially in Black and Hispanic populations. What factors are related to the administration of rt-PA within the Hispanic population has to date been unclear. METHODS We performed a retrospective review of IRB approved, prospectively collected data from the UC San Diego Stroke Registry from 7/2004-7/2016. Patients were included based on the primary diagnosis of Transient Ischemic Attack or Ischemic Stroke. Hispanic vs non-Hispanic patients were compared to assess for overall rt-PA treatment rates and process of care intervals. For the Hispanic cohort itself, demographics and NIHSS scores were assessed to determine why some Hispanics received rt-PA while others were not. RESULTS Overall, 1489 patients (300 Hispanic vs. 1189 non-Hispanic) were included. Comparing Hispanics to non-Hispanics, there was no difference in rt-PA rate (35.3% vs. 33.1%; p=0.49). In rt-PA treated patients, "onset to arrival" interval was higher in Hispanics (1.03 vs. 0.88 hours; p=0.04), while the "arrival to treatment" interval was not different (1.13 vs. 1.02 hours; p=0.07). When looking at Hispanic patients only, there was no difference in baseline characteristics except for initial NIHSS in treated vs. non-treated patients (13.27 vs. 7.24; p<.001). CONCLUSION Our analyses sought to determine the factors important to administration of rt-PA to Hispanic patients. These findings highlight the need for strategies to improve recognition and presentation pathways for Hispanics.
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Affiliation(s)
- P M Chen
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - D T Nguyen
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - J P Ho
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - M Pirastehfar
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - R Narula
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - K Rapp
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - K Agrawal
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - B Huisa
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - R Modir
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - D Meyer
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - T Hemmen
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
| | - C Kidwell
- Department of Neurology, University of Arizona, USA
| | - B C Meyer
- Department of Neurosciences, Stroke Center, University of California, San Diego, USA
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Agrawal K, Cherian KE, Hephzibah J, Thomas N. An uncommon cause of warm foot. BMJ Case Rep 2017; 2017:bcr-2017-219465. [DOI: 10.1136/bcr-2017-219465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ho JP, Nguyen DT, Pirastefahr M, Narula R, Hailey L, Mortin M, Rapp K, Agrawal K, Huisa-Garate B, Modir R, Meyer DM, Hemmen TM, Meyer BC. Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions. Austin J Cerebrovasc Dis Stroke 2017; 4:1068. [PMID: 29367951 PMCID: PMC5777582] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Identification of large vessel occlusions (LVO) is important with recent guidelines supporting endovascular therapy in selected acute ischemic stroke patients. Many stroke centers perform CT angiography (CTA) in patients with suspected LVO, however this requires additional time and contrast administration. Non-enhanced CT maximum intensity projection (NECT-MIPs) may offer a rapid alternative to CTA. METHODS We retrospectively reviewed acute stroke patients with LVO in the UCSD Stroke Registry, presenting between 6/2014-7/2016. NECT-MIPs were evaluated for presence of LVO. Gold standard comparison was to CTA. Results were stratified by level of training (Faculty, Fellow and Acute Care Practitioners [ACPs]). Inter-rater agreement was assessed using Fleiss' Kappa Coefficient. RESULTS We reviewed 24 patients using NECT-MIPs for the detection of LVO. Faculty had a sensitivity and specificity of 95% & 92% for ICA/M1, 42% & 100% for M2, and 67% & 96% for basilar occlusions. Fellows and ACPs had a sensitivity and specificity of 61% & 94% for ICA/M1, 19% & 83% for M2, and 75% & 95% for basilar occlusions. Inter-rater agreement among Faculty readers was k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions. CONCLUSIONS NECT-MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement is fair and higher amongst more experienced reviewers. These results suggest that NECT-MIPs may be helpful to streamline the identification of LVO and reduce door to needle and door to intervention times.
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Affiliation(s)
- JP Ho
- Department of Neurosciences, University of California San Diego, USA
| | - DT Nguyen
- Department of Neurosciences, University of California San Diego, USA
| | - M Pirastefahr
- Department of Neurosciences, University of California San Diego, USA
| | - R Narula
- Department of Neurosciences, University of California San Diego, USA
| | - L Hailey
- Department of Neurosciences, University of California San Diego, USA
| | - M Mortin
- Department of Neurosciences, University of California San Diego, USA
| | - K Rapp
- Department of Neurosciences, University of California San Diego, USA
| | - K Agrawal
- Department of Neurosciences, University of California San Diego, USA
| | - B Huisa-Garate
- Department of Neurosciences, University of California San Diego, USA
| | - R Modir
- Department of Neurosciences, University of California San Diego, USA
| | - DM Meyer
- Department of Neurosciences, University of California San Diego, USA
| | - TM Hemmen
- Department of Neurosciences, University of California San Diego, USA
| | - BC Meyer
- Department of Neurosciences, University of California San Diego, USA
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Kumar R, Das VNR, Topno RK, Pal B, Imam A, Agrawal K, Singh A, Murti K, Lal CS, Verma N, Das P, Pandey K. Para-kala-azar dermal Leishmaniasis cases in Indian subcontinent - A case series. Pathog Glob Health 2016; 110:326-329. [PMID: 27871210 DOI: 10.1080/20477724.2016.1258163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rakesh Kumar
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Vidya Nand Rabi Das
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Roshan Kamal Topno
- b Department of Epidemiology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Biplab Pal
- c Department of Pharmacy Practice , National Institute of Pharmaceutical Education and Research , Hajipur , India
| | - Adnan Imam
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Kanhaiya Agrawal
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Anima Singh
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Krishna Murti
- c Department of Pharmacy Practice , National Institute of Pharmaceutical Education and Research , Hajipur , India
| | - Chandra Shekhar Lal
- d Department of Clinical Biochemistry , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Neena Verma
- e Department of Pathology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Pradeep Das
- f Department of Molecular Biology , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
| | - Krishna Pandey
- a Department of Clinical Medicine , Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research) , Patna , India
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Choi HR, Agrawal K, Bedair H. The diagnostic thresholds for synovial fluid analysis in late periprosthetic infection of the hip depend on the duration of symptoms. Bone Joint J 2016; 98-B:1355-1359. [DOI: 10.1302/0301-620x.98b10.37615] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 11/23/2015] [Accepted: 06/01/2016] [Indexed: 11/05/2022]
Abstract
Aims We hypothesised that the synovial white blood cell (WBC) count in patients with a late periprosthetic joint infection (PJI) of the hip would depend on the duration of a patient’s symptoms, and that the optimal diagnostic threshold would also depend on this period of time. Patients and Methods The synovial WBC count and percentage of polymorphonuclear cells (%PMN), and the serum CRP and ESR levels obtained > six weeks after primary THA were compared between 50 infected and 88 non-infected THAs, and in patients with symptoms for more than or less than two weeks. Diagnostic thresholds for the synovial WBC count were calculated using area under the curve calculation. Results The synovial WBC count was significantly higher in patients with symptoms for ≤ two weeks compared with those with symptoms for > two weeks (p = 0.03). The optimal threshold for diagnosing PJI for the synovial WBC count was 5750 cells/µL (sensitivity 94; specificity 100; PPV 100%; NPV 89%; AUC 99%) and 1556 cells/µL (sensitivity 91; specificity 94; PPV 87% and NPV 97%; AUC 95%), respectively. The thresholds for the cut-offs based on duration of symptoms improved the diagnostic performance of this test. Conclusion This study shows that the diagnostic thresholds for synovial fluid analysis in late periprosthetic infection following THA may depend on duration of symptoms. Cite this article: Bone Joint J 2016;98-B:1355–9.
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Affiliation(s)
- H-R. Choi
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - K. Agrawal
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - H. Bedair
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Agrawal K, Agarwal Y, Chopra RK, Batra A, Chandra R, Thukral BB. Evaluation of MR Spectroscopy and Diffusion-Weighted MRI in Postmenopausal Bone Strength. Cureus 2015; 7:e327. [PMID: 26543685 PMCID: PMC4627835 DOI: 10.7759/cureus.327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM To prospectively investigate the role of MR spectroscopy (MRS) and diffusion-weighted magnetic resonance imaging (DWI) in assessing vertebral marrow changes in postmenopausal women. MATERIALS AND METHODS Fifty postmenopausal women, who underwent dual-energy x-ray absorptiometry of the spine, were divided into three bone density groups (normal, osteopenia, and osteoporosis) based on T-score. Both MRS and DWI of the L3 vertebral body were performed to calculate the marrow fat content and apparent diffusion coefficient (ADC). The results were compared between three groups and correlated with BMD. RESULTS Vertebral marrow fat content was significantly increased in the osteoporotic group when compared with that of the osteopenic group and the normal bone density group. ADC values in the osteoporotic, osteopenic, and normal bone density groups were 338, 408 and 464, respectively, with statistically significant differences (P < 0.001). A statistically significant positive correlation between T-scores and ADC existed (r=0.694, p value <0.001). The vertebral marrow fat content was negatively correlated to the bone density (r=-0.455, p< 0.001) and to marrow ADC (r= -0.302, p < 0.05). CONCLUSION The postmenopausal women with osteoporosis exhibited a corresponding increase in vertebral marrow fat content as the bone density decreased. Marrow fat content and ADC were related to the bone density. MRS and DWI are helpful in evaluating the bone marrow changes in postmenopausal women.
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Affiliation(s)
- Kanhaiya Agrawal
- The Department of Diagnostic Radiology and Imaging, Safdarjung Hospital
| | - Yatish Agarwal
- The Department of Diagnostic Radiology and Imaging, Safdarjung Hospital
| | | | - Achla Batra
- The Department of Obstetrics & Gynaecology, Safdarjung Hospital
| | - Ranjan Chandra
- The Department of Diagnostic Radiology and Imaging, Safdarjung Hospital
| | - Brij B Thukral
- The Department of Diagnostic Radiology and Imaging, Safdarjung Hospital
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Gupta M, Mittal MK, Agrawal K, Agarwal AK, Thukral BB. Gorlin-Goltz Syndrome - A Rare Cause of Recurrent Jaw Pain in a Young Child. Cureus 2015. [DOI: 10.7759/cureus.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Agrawal K, Weaver J, Ngu R, Krishnamurthy Mohan H. Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT. Clin Radiol 2015; 70:536-43. [PMID: 25687827 DOI: 10.1016/j.crad.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
Incidental uptake of 2-[(18)F]-fluoro-2-deoxy-d-glucose ((18)F-FDG) in the thyroid gland is not uncommonly encountered in day-to-day practice of oncological (18)F-FDG positron-emission tomography/computed tomography (PET/CT). These are often felt to be "nuisance lesions" by referring clinicians and radiologists alike. However, recognition of the importance of different patterns of FDG uptake in the thyroid gland and knowledge of the possible underlying aetiologies are crucial in ensuring that patients are managed appropriately in the clinical context of their primary diagnosis, as the underlying pathological condition may be clinically important in a significant minority of such cases. This review describes the various patterns of (18)F-FDG uptake within the thyroid and discusses the clinical significance and possible impact on patient management. Incidental low-grade homogeneous diffuse increased thyroid (18)F-FDG uptake is usually seen in the patients with chronic thyroiditis, Grave's disease, and hypothyroidism. Thyroid function tests and antibody profiling are advised in these patients. Incidental focal (18)F-FDG thyroid uptake should raise the possibility of underlying malignancy. Ultrasound with or without fine-needle aspiration cytology is usually recommended for the evaluation of these lesions. Heterogeneous uptake with prominent focal uptake in the thyroid should be further evaluated to exclude malignancy.
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Affiliation(s)
- K Agrawal
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - J Weaver
- School of medicine, King's College London, London, UK
| | - R Ngu
- Department of Dental Maxillofacial Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Krishnamurthy Mohan
- Dept of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Clinical PET Centre, St Thomas' Hospital, London, UK
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Manohar K, Mittal BR, Agrawal K, Kashyap R, Bhattacharya A, Mandal AK. Response assessment to Sunitinib by F-18 Fluorodeoxyglucose PET/CT in a case of venous tumor thrombosis from renal cell carcinoma. Indian J Cancer 2014; 51:390. [PMID: 25494158 DOI: 10.4103/0019-509x.146770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - B R Mittal
- Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Paliwal G, Agrawal K, Srivastava R, Sharma S. Domestic liquefied petroleum gas: Are we using a kitchen bomb? Burns 2014; 40:1219-24. [DOI: 10.1016/j.burns.2013.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/29/2013] [Accepted: 12/22/2013] [Indexed: 11/29/2022]
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Yadav S, Khadka R, Agrawal K, Lamsal M, Shrestha R, Paudel B. P168: Cardiovascular autonomic function in hypothyroid patients. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50308-2] [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]
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Thapa M, Neopane AK, Singh UK, Aryal N, Agrawal K, Shrestha B. Nutritional status of children in two districts of the mountain region of Nepal. J Nepal Health Res Counc 2013; 11:235-239. [PMID: 24908522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Nutritional status is a prime indicator of health. Generally, three anthropometric indicators are often used to assess nutritional status during childhood and adolescence: underweight (weight-for-age), stunting (height- for-age) and thinness (BMI-for-age). Malnutrition in children is a major public health problem in many developing countries. This study was conducted to assess nutritional status among children attending health camps in two mountainous districts in Nepal. METHODS Five hundred and seventy five children below 15 years of age attending the medical camp in Humla and Mugu districts in October 2011 were assessed for nutritional status. For children less than five years, weight for age, weight for height and height for age as per WHO classification, and for children between five to 15 years age specific values of height, weight and Body Mass Index (BMI) were calculated. RESULTS In Humla district, 28.2% children were undernourished, 8.8% wasted and 22.4% stunted in less than five years. In the same age group, 31.7% children were undernourished, 9.4% wasted and 29.4% stunted in Mugu district. In the age group five to 15 years, thinness was seen in 22.4% and 29.4% children in Humla and Mugu respectively. CONCLUSIONS Malnutrition (underweight, stunting, wasting and thinness) still constitutes a major health problem among Nepalese children, particularly in mountainous regions.
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Affiliation(s)
- M Thapa
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - A K Neopane
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - U K Singh
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - N Aryal
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - K Agrawal
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - B Shrestha
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
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Abstract
This paper reviews the various aspects of tissue regeneration during the process of tissue expansion. “Creep” and mechanical and biological “stretch” are responsible for expansion. During expansion, the epidermis thickens, the dermis thins out, vascularity improves, significant angiogenesis occurs, hair telogen phase becomes shorter and the peripheral nerves, vessels and muscle fibres lengthen. Expansion is associated with molecular changes in the tissue. Almost all these biological changes are reversible after the removal of the expander.This study is also aimed at reviewing the difficulty in deciding the volume and dimension of the expander for a defect. Basic mathematical formulae and the computer programmes for calculating the dimension of tissue expanders, although available in the literature, are not popular. A user-friendly computer programme based on the easily available Microsoft Excel spread sheet has been introduced. When we feed the area of defect and base dimension of the donor area or tissue expander, this programme calculates the volume and height of the expander. The shape of the expander is decided clinically based on the availability of the donor area and the designing of the future tissue movement. Today, tissue expansion is better understood biologically and mechanically. Clinical judgement remains indispensable in choosing the size and shape of the tissue expander.
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Affiliation(s)
- K Agrawal
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjang Hospital, New Delhi, India
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Tandon R, Agrawal K, Narayan RP, Tiwari VK, Prakash V, Kumar S, Sharma S. Firecracker injuries during Diwali festival: The epidemiology and impact of legislation in Delhi. Indian J Plast Surg 2012; 45:97-101. [PMID: 22754162 PMCID: PMC3385409 DOI: 10.4103/0970-0358.96595] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
SETTING AND DESIGN A hospital-based retrospective study of firecracker-related injuries was carried out at a government sponsored hospital in Delhi. MATERIALS AND METHODS 1373 patients attended the emergency burn care out-patients clinic during 2002-2010 pre-Diwali, Diwali and post-Diwali days. Every year, a disaster management protocol is revoked during these 3 days under the direct supervision of the Ministry of Health and Family Welfare, Government of India. RESULTS There was an increase in the number of patients of firecracker-related injuries in Delhi national capital region from the year 2002 to 2010, based on the hospital statistics. During the study period, the hospital received approximately one patient with firecracker-related injury per 100,000 population of the city. 73.02% of the victims were 5-30 years old. Majority (90.87%) of them sustained <5% total body surface area burn. CONCLUSIONS In spite of legislations and court orders, the number of patients is on the rise. The implementation agencies have to analyse the situation to find a way to control this preventable manmade accident. Websites, emails, SMS, social sites, etc. should be used for public education, apart from conventional methods of public awareness.
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Affiliation(s)
- R Tandon
- Department of Burns, Plastic and Maxillofacial Surgery, VM Medical College and Safdarjung Hospital, New Delhi, India
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Kundra P, Yuvaraj K, Agrawal K, Krishnappa S, Kumar LT. Surgical outcome in children undergoing hypospadias repair under caudal epidural vs penile block. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000600030] [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: 11/22/2022] Open
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Agrawal N, Agrawal K, Mhaske S. An uncommon presentation of an inflammatory gingival enlargement--responding to non-surgical periodontal therapy. Int J Dent Hyg 2011; 9:303-7. [PMID: 21356030 DOI: 10.1111/j.1601-5037.2010.00497.x] [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: 11/27/2022]
Abstract
BACKGROUND The various clinical manifestations of inflammatory gingival enlargement reported are more or less similar regardless of the underlying aetiological factors. Unusual presentation and unknown aetiology pose a diagnostic challenge for a periodontist. METHODS A 34-year-old Indian woman presented with the complaint of gum swelling that was sessile, lobulated, soft in consistency and bluish red in colour with ulcerated surface in some region, which was covered by the necrotic slough. This type of enlargement was unusual and some underlying systemic pathology was suspected. But a written consultation from her physician confirmed her systemic health, which was based on clinical, radiological and haematological investigations. Histopathological examination confirmed the diagnosis of inflammatory gingival enlargement. Patient was treated with oral hygiene instructions, scaling and root planning. RESULT Within a month of conventional periodontal therapy, gum enlargement reduced markedly and patient was put on oral hygiene maintenance programme. CONCLUSION Periodontal therapy is diagnosis-driven and, to the extent possible, should address all the possible factors that impact development and progression of diseases that may affect periodontal tissue. In plaque-induced periodontal diseases, non-surgical periodontal therapy is still a gold standard among all the therapies available.
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Affiliation(s)
- N Agrawal
- Department of Periodontics, People's Dental Academy, Bhopal, India.
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Subramanian B, Agrawal K, Panda K. Congenital fusion of the jaws: a management protocol. Int J Oral Maxillofac Surg 2010; 39:925-9. [DOI: 10.1016/j.ijom.2010.03.027] [Citation(s) in RCA: 19] [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: 07/09/2009] [Revised: 03/03/2010] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
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Abstract
BACKGROUND The pathogenesis of gastro-oesophageal reflux disease includes increased acid reflux, reduced salivation and impaired peristalsis. This may depend upon the height of acid wave and magnitude of oesophageal mucosal exposure. Interestingly, the effect of site of acid infusion upon salivary secretion and heartburn has not been examined in any detail. AIM To examine whether acid infusion in the upper oesophagus may cause increased salivation and heartburn as compared with acid infusion in the lower oesophagus. METHODS Twelve healthy male subjects (mean age 30) received infusions of HCl, citric acid and acetic acid at 10 and 20 cm above the lower oesophageal sphincter (LES) for fixed time periods. Parotid saliva collected periodically and heartburn severity scored using standardized scale. Standard statistical methods (paired t-tests, analysis of variance) were used to determine the significance of results. RESULTS Acid infusion in the upper oesophagus increased parotid flow rate as compared with that in the lower oesophagus (P < 0.05). Likewise, there was a significantly increased heartburn score at 20 cm as well as 10 cm above LES (P < 0.05) as compared with that in the stomach. CONCLUSION These data suggest a significant increase in salivation and heartburn in response to acid infusion in the upper vs. lower part of the oesophagus.
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Affiliation(s)
- S K Dutta
- Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
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Chouhan V, Agrawal K, Vinothkumar TK, Mathesul A. Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia. ACTA ACUST UNITED AC 2010; 92:1028-31. [DOI: 10.1302/0301-620x.92b7.24526] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser’s zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.
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Affiliation(s)
| | - K. Agrawal
- King Edward VII Memorial Hospital, Parel, Mumbai-12, Maharastra, 400012, India
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Kundra P, Supraja N, Agrawal K, Ravishankar M. Flexible laryngeal mask airway for cleft palate surgery in children: a randomized clinical trial on efficacy and safety. Cleft Palate Craniofac J 2008; 46:368-73. [PMID: 19642771 DOI: 10.1597/08-009.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of a flexible laryngeal mask airway in children undergoing palatoplasty. DESIGN Prospective, randomized, single-center study. SETTING Jawaharlal Institute of Postgraduate Medical Education and Research. PATIENTS Sixty-six children (American Society of Anesthesiologists physical status 1 and 2) scheduled to undergo palatoplasty were assigned randomly to an endotracheal intubation group (RAE group, n = 33) and a flexible laryngeal mask airway group (FLMA group, n = 33). MAIN OUTCOME MEASURES Peak airway pressure, inspired and expired tidal volume, end-tidal carbon dioxide, lung compliance, and airway resistance were continuously measured after placement of the assigned airway. The percentage leak around the airway was quantified as the leak fraction. Parametric data between groups were analyzed using an unpaired Student's t test and within groups using a one-way analysis of variance. Nonparametric variables were analyzed using the Fisher exact test. RESULTS In two children, the flexible laryngeal mask airway was displaced from its original position; whereas, one endotrachial tube advanced endobronchially. The leak fraction was significantly higher in the RAE group when compared with that in FLMA group (13.34% +/- 13.74% versus 5.96% +/- 3.78%, p < .05) until the throat pack was applied. Peak airway pressure and resistance were significantly higher in the RAE group compared with the FLMA group at all time intervals, p < .05. During emergence, frequency of coughing, desaturation, and laryngospasm were increased in the RAE group. CONCLUSION A flexible laryngeal airway mask is suitable for maintaining the airway and helps in smooth emergence in children undergoing palatoplasty.
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Affiliation(s)
- Pankaj Kundra
- Department of Anesthesiolog, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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Abstract
AbstractWe present a case report of a single lesion of cysticercosis cellulosae, a parasitic infection caused by the larval stage of Taenia solium (pork tapeworm), presenting as a soft tissue swelling of the lower lip. We stress the importance of knowledge about oral manifestations of parasitic infections.
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Affiliation(s)
- B Subramanian
- Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry-605006, India.
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Gupta AK, Jain A, Jain A, Agrawal K, Saraswat V, Revathi S, Soni LK, Kaskhedikar SG. QSAR Analysis of Indazole Estrogens as Selective β-Estrogen Receptor Ligands: Rationalization of Physicochemical Properties. Med Chem 2007; 3:347-53. [PMID: 17627571 DOI: 10.2174/157340607781024384] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Quantification of structure activity relationships was performed on a series of indazole estrogen analogs, for their relative beta estrogenic receptor agonist activity, in order to understand the essential structural requirements for selectivity of indazole estrogen analogs for beta-estrogenic receptor over alpha-estrogenic receptor. The de novo and Hansch approach suggested that the 3(rd) position of indazole nucleus (R(1)) is decisive for the selectivity of molecules towards beta-estrogenic receptor over alpha-estrogenic receptor. The study also depicted that the substitution of polar group at R(1) position might prove helpful in the beta-estrogenic receptor selectivity (ER(beta/alpha )).
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Affiliation(s)
- A K Gupta
- Department of Pharmaceutical Chemistry, B.R.Nahata College of Pharmacy, Mandsaur, India
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Abstract
OBJECTIVE To assess the prevalence and type of obesity in affluent schoolgirls aged 16 and 17 yr. METHODS A cross-sectional study was conducted in 2002, in 4 randomly selected public schools of Delhi. All girls from randomly chosen classes were included. Weight, height and waist and hip circumferences were measured for all 414 schoolgirls and their socio-demographic profile was recorded. Body mass index [BMI] and waist hip ratio [WHR] were calculated for all the girls. BMI > 30 (i.e.--95th percentile) denotes obesity and BMI > 25 (i.e.--85th percentile) denotes overweight as according to International Obesity Task Force (IOTF) criteria. WC > 80 cm or WHR > 0.85 denote central obesity. RESULTS Prevalence of obesity and overweight amongst the study subjects was 5.3% and 15.2% respectively (IOTF). Out of the 22 obese girls central obesity was present in 21 girls (95.4%) [WC > 80 cm] and 12 girls (54.5%) [WHR > 0.85]. CONCLUSION There is significant prevalence of obesity in affluent schoolgirls in Delhi and more than half of them have central obesity.
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Affiliation(s)
- M Mehta
- Department of Community Medicine, University College of Medical Sciences & Guru Teg Bahadur Hospital, New Delhi, India.
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Magu S, Ratan KN, Agrawal K. Images: CT whirl sign - midgut volvulus. Indian J Radiol Imaging 2006. [DOI: 10.4103/0971-3026.29055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Magu
- Department of Radiodiagnosis and Pediatric Surgery, Pt. B.D. Sharma PGIMS, Rohtak - 124001 Haryana, India
| | - K N Ratan
- Department of Radiodiagnosis and Pediatric Surgery, Pt. B.D. Sharma PGIMS, Rohtak - 124001 Haryana, India
| | - K Agrawal
- Department of Radiodiagnosis and Pediatric Surgery, Pt. B.D. Sharma PGIMS, Rohtak - 124001 Haryana, India
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Agrawal K. An Easy and Summative Approach to Integrated Management of Childhood Illness (IMCI). Med J Shree Birendra Hosp 2005. [DOI: 10.3126/mjsbh.v7i0.21097] [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: 11/18/2022] Open
Abstract
An Easy and Summative Approach to Integrated Management of Childhood Illness (IMCI)
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Dwivedi S, Mehta M, Bhasin S, Agrawal K. M.502 Central obesity, pre-hypertension and parental history of cardiovascular allied disorders in affluent schoolgirls in Delhi. ATHEROSCLEROSIS SUPP 2004. [DOI: 10.1016/s1567-5688(04)90500-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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